Mesa 1.2 borja garcía cosío

Mesa 1. EPOC epidemiología y diagnóstico

Dr. Borja García-

Cosío PiquerasHospital Universitario Son Espases.

Mallorca

Mesa 1. EPOC epidemiología y diagnóstico

[ATS] Alpha 1 - Antitrypsin

Deficiency And

Abdominal Aortic

Aneurysms: Does This

Association Really Exist?

Pini L, Bonardelli S,

Ferrarotti I, et al.

Mesa 1. EPOC epidemiología y diagnóstico

Hipothesis

• A1AT is one of the major protease

inhibitors present in human plasma

• An underlying structural defect of

the extracellular matrix (ECM) is

always present and the loss of

elastic fibers is an early step in AAA

formation.

Therefore, AATD seems to be a reasonable risk factor for AAA because it is related to

protease/anti-protease imbalance and enhanced degradation of ECM of the vessel wall.

Mesa 1. EPOC epidemiología y diagnóstico

Objectives

• To investigate the distribution of AATD genotypes in

138 consecutive patients hospitalized for non-

traumatic rupture of AAA.

• The second purpose was to observe the distribution

of the main non genetic risk factors for AAA

between patients: with and without AATD.

Mesa 1. EPOC epidemiología y diagnóstico

Results

AAA patients with and without AATD we found no differences in terms of age, gender,

hypertension, diabetes and smoke habits, but hyperlipidemia was significantly less frequent in the

group of patients with AATD (46.4 vs 12.5 % respectively, P<0.05).

Out of 138 patients, 20 were found with A1ATD: 16 MS, 1 SS, 3MZ and 2 with new rare

normal variants of AAT

% o

f pat

ient

s

P<0.01

NS

Mesa 1. EPOC epidemiología y diagnóstico

Discussion

• CONCLUSION: In AAA patients the frequency of S allele was

higher than in the general Italian population. Our preliminary

results support the hypothesis that AATD might represent a

risk factor for AAA.

• Previous reports:

J Surg Research 1990

Mesa 1. EPOC epidemiología y diagnóstico

[ATS] Risk Factors For

COPD Exacerbations In

Inhaled Medication Users:

COPDGene Study

Biannual Longitudinal

Follow-UpBusch R, Bowler RP, Han MK;

COPDgene Investigators

Mesa 1. EPOC epidemiología y diagnóstico

Background and objectives

• Despite inhaled medications that decrease

exacerbation risk, some COPD patients continue

to have frequent exacerbations.

• Aim: to determine prospective risk factors for

acute exacerbations of COPD (AECOPD)

among subjects in the COPDGene study taking

inhaled respiratory medications.

Mesa 1. EPOC epidemiología y diagnóstico

Methods

• Retrospective data from the COPDGene study and prospective data from the telephone- and web-based biannual Longitudinal Follow-Up program (LFU).

• Medication use groups (TIO/LABA/ICS, TIO, LABA/ICS, and SAB) were defined by subject self-report.

• Exacerbators and nonexacerbators were identified by the frequency of AECOPD (exacerbators had one or more AECOPD per year, non-exacerbators had zero AECOPD per year).

• Associations between AECOPD occurrence and demographics, spirometry, chest CT data, and comorbidities were tested.

Mesa 1. EPOC epidemiología y diagnóstico

Results

GERD

Female gender

Higher total SGRQ scores

Mesa 1. EPOC epidemiología y diagnóstico

Results

• Subjects taking either LABA/ICS or TIO had similar characteristics such as FEV1, 6-minute walk distance, percent emphysema by CT scan, and pack-years of smoking.

• Comparing subjects taking tiotropium vs. long-acting beta-agonist/inhaled corticosteroid, tiotropium subjects showed a trend towards statistically significantly lower rates of exacerbations (OR = 0.69 [95 % CI 0.45, 1.06], p= 0.09), especially in subjects without a doctor's diagnosis of asthma (OR =0.56 [95 % CI 0.31, 1.00], p=0.05).

Mesa 1. EPOC epidemiología y diagnóstico

Discussion

• Conclusion: Characteristic risk factor profiles for exacerbators may

help identify subjects at risk for AECOPD

Mesa 1. EPOC epidemiología y diagnóstico

[ERS] Distribution of

COPD phenotypes

according to the Spanish

COPD guidelines

in clinical practiceMiravitlles M, Calle M, Rodríguez

JL, Murio C, On Behalf of the

FENEPOC Study Group

Mesa 1. EPOC epidemiología y diagnóstico

Background and aims

Aims. To determine the frequency of COPD phenotypes in Spanish clinical practice

and the availability of diagnostic tools.

Mesa 1. EPOC epidemiología y diagnóstico

Methods

• Epidemiological, cross-sectional and multicentre study.

• Patients >40 years with COPD, (FEV₁/FVC<0.7 post-bronchodilator

[post-BC], and >10 pack-years) were included.

• The availability of diagnostic tools to classify COPD phenotypes was

assessed by an ad-hoc questionnaire.

Mesa 1. EPOC epidemiología y diagnóstico

Results• 647 patients [294 Primary Care and 353 Pulmonology]

• Investigators reported that>80 % of DT were available, with exception of computed tomography (26.9 %) and carbon monoxide transfer test (13.5 %) in PC, and sputum eosinophilia (40.4 % PC and 49.4 % P).

ACOS (42, 6.5 %) ECB (188, 29.1 %) EE (110, 17.0 %) NE (307, 47.5 %)

Age(years), mean(SD) 64.2(9.0) 69.5(8.6) 70.0(9.1) 67.2(9.3)

Sex(male), n( %) 21(50.0) 157(83.5) 90(81.8) 255(83.1)

Pack-years, mean(SD) 39.4(17.7) 42.8(21.2) 48.5(25.5) 42.9(23.6)

FEV₁ post-BD( %), mean(SD) 61.5(28.1) 54.8(21.0) 47.9(16.4) 53.0(16.2)

m-MRC scale, mean(SD) 1.8(0.8) 2.1(0.8) 2.2(1.0) 1.5(0.8)

N exacerbations, mean(SD) 3.2(2.5) 3.6(1.7) 3.7(1.9) 0.7(0.7)

Mesa 1. EPOC epidemiología y diagnóstico

Discussion• Conclusion: In clinical practice, most COPD patients were

predominantly NE. In general, investigators have the required tools

for diagnosing COPD phenotypes.

Mesa 1. EPOC epidemiología y diagnóstico

Muchas gracias

por su atención