Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

https://www.who.int/respiratory/copd/GOLD_WR_06.pdf

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

Representatives from many countries serve as a network for the dissemination and implementation of programs for diagnosis, management, and prevention of COPD. The GOLD Board of Directors is grateful to the many GOLD National Leaders who participated in discussions of concepts that appear in GOLD reports.

Global initiative for chronic obstructive lung disease.

This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by both an accelerated decline in lung function and periods of acute deterioration in symptoms termed exacerbations. The aim of this study was to investigate whether these are related. METHODS: Over 4 years, peak expiratory flow (PEF) and symptoms were measured at home daily by 109 patients with COPD (81 men; median (IQR) age 68.1 (63-74) years; arterial oxygen tension (PaO(2)) 9.00 (8.3-9.5) kPa, forced expiratory volume in 1 second (FEV(1)) 1.00 (0.7-1.3) l, forced vital capacity (FVC) 2.51 (1.9-3.0) l); of these, 32 (29 men) recorded daily FEV(1). Exacerbations were identified from symptoms and the effect of frequent or infrequent exacerbations (> or < 2.92 per year) on lung function decline was examined using cross sectional, random effects models. RESULTS: The 109 patients experienced 757 exacerbations. Patients with frequent exacerbations had a significantly faster decline in FEV(1) and peak expiratory flow (PEF) of -40.1 ml/year (n=16) and -2.9 l/min/year (n=46) than infrequent exacerbators in whom FEV(1) changed by -32.1 ml/year (n=16) and PEF by -0.7 l/min/year (n=63). Frequent exacerbators also had a greater decline in FEV(1) if allowance was made for smoking status. Patients with frequent exacerbations were more often admitted to hospital with longer length of stay. Frequent exacerbations were a consistent feature within a patient, with their number positively correlated (between years 1 and 2, 2 and 3, 3 and 4). CONCLUSIONS: These results suggest that the frequency of exacerbations contributes to long term decline in lung function of patients with moderate to severe COPD.

https://thorax.bmj.com/content/thoraxjnl/57/10/847.full.pdf

Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease

137 El número de pacientes atendidos en los servicios de urgencias hospitalarios no tiende a disminuir, a pesar del aumento en calidad y cantidad del conjunto de los recursos asistenciales disponibles. En muchos hospitales se constata un incremento progresivo en el número de consultas urgentes. A pesar de la polémica en el análisis de estos datos en el Reino Unido1, en Escocia se ha detectado un incremento medio de los ingresos urgentes del 3,9% anual2. En nuestro hospital, entre 1990 y 1999, los ingresos urgentes han aumentado un 3,3%. La descripción de las urgencias escocesas no se aleja sustancialmente de la de la mayoría de los hospitales de Barcelona y del área metropolitana: a) las consultas y los ingresos presentan picos invernales, pero con un impacto muy variable según los hospitales; b) aumentan los reingresos de un mismo paciente; c) el envejecimiento de la población incide en las consultas urgentes (se atienden más pacientes ancianos con pluripatología), y d) muchos pacientes acuden a urgencias por propia iniciativa, sin consultar previamente al médico de cabecera3. El impacto social de esta situación es enorme, ya que con demasiada frecuencia la única posibilidad que tiene el hospital para ARTÍCULOS ESPECIALES

Los colapsos en los servicios de urgencias hospitalarios durante el invierno

Resumen Introduccion Las terapias respiratorias a domicilio suponen un gran impacto en la vida del paciente y de sus familiares. El objetivo de este estudio reside en conocer las opiniones, percepciones y actitudes de los pacientes y sus cuidadores sobre la oxigenoterapia domiciliaria. Metodo Estudio cualitativo-fenomenologico de una muestra de 57 personas: 18 familiares y 39 pacientes que reciben oxigenoterapia domiciliaria en nucleos urbanos relevantes. Se realizaron 5 grupos focales entre marzo y julio de 2014 en centros hospitalarios de Barcelona, Madrid y Alicante. El material de analisis consto de las grabaciones en audio de las entrevistas en los grupos focales, la trascripcion de las mismas y las notas de campo registradas. El analisis de los datos se realizo a partir del metodo de las comparaciones constantes. Resultados Los datos se analizaron en 2 niveles. En un primer nivel de analisis se obtuvieron 21 categorias que, posteriormente, en un segundo nivel de analisis, se integraron en 6 metacategorias: atencion facilitada por los profesionales sanitarios, impacto psicologico, atencion facilitada por las casas comerciales, impacto en la vida cotidiana, inconvenientes y satisfaccion. Conclusiones La oxigenoterapia domiciliaria tiene un gran impacto psicologico y en la vida diaria tanto de los pacientes como de sus familiares. Por otro lado, seria conveniente mejorar la coordinacion entre los diferentes niveles asistenciales y las empresas suministradoras de oxigenoterapia para facilitar informacion coherente y estrategias utiles para los pacientes y familiares.

Joan Escarrabill

Papers

Los colapsos en los servicios de urgencias hospitalarios durante el invierno

Aproximación a la experiencia del paciente y sus cuidadores en la oxigenoterapia domiciliaria

El futuro de la ventilación mecánica domiciliaria: redes o contenedores

Experiences and real life management of insulin pump therapy in adults with type 1 diabetes.

A qualitative study of patient and carer experiences with home respiratory therapies: Long-term oxygen therapy and home mechanical ventilation.