José Luis Izquierdo

Bio: José Luis Izquierdo is an academic researcher from University of Alcalá. The author has contributed to research in topics: COPD & Medicine. The author has an hindex of 22, co-authored 50 publications receiving 2851 citations. Previous affiliations of José Luis Izquierdo include University of Alabama at Birmingham.

Risk factors of readmission to hospital for a COPD exacerbation: a prospective study

Abstract: Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are a leading cause of admission to hospital among men in many countries, although the factors causing exacerbations are largely unknown. The association between readmission for a COPD exacerbation and a wide range of modifiable potential risk factors, after adjusting for sociodemographic and clinical factors, has been assessed. Methods: Three hundred and forty patients with COPD recruited during an admission for an exacerbation in four tertiary hospitals in the Barcelona area of Spain were followed for a mean period of 1.1 years. Information on potential risk factors, including clinical and functional status, medical care and prescriptions, medication adherence, lifestyle, health status, and social support, was collected at the recruitment admission. A Cox’s proportional hazards model was used to obtain independent relative risks of readmission for COPD. Results: During the follow up period 63% of patients were readmitted at least once, and 29% died. The final multivariate model showed the following risk (or protective) factors: ⩾3 admissions for COPD in the year before recruitment (hazard ratio (HR)=1.66, 95% CI 1.16 to 2.39), forced expiratory volume in 1 second (FEV 1 ) percentage predicted (0.97, 95% CI 0.96 to 0.99), oxygen tension (0.88, 95% CI 0.79 to 0.98), higher levels of usual physical activity (0.54, 95% CI 0.34 to 0.86), and taking anticholinergic drugs (1.81, 95% 1.11 to 2.94). Exposure to passive smoking was also related to an increased risk of readmission with COPD after adjustment for clinical factors (1.63, 95% CI 1.04 to 2.57) but did not remain in the final model. Conclusions: This is the first study to show a strong association between usual physical activity and reduced risk of readmission to hospital with COPD, which is potentially relevant for rehabilitation and other therapeutic strategies.

Consensus Document on the Overlap Phenotype COPD–Asthma in COPD

Abstract: Introduction Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. Methods A nation-wide consensus of experts in COPD in two stages: (1) during an initial meeting, the topics to be dealt with were established and a first draft of statement was elaborated with a structured “brainstorming” method; (2) consensus was reached with two rounds of e-mails, using a Likert-type scale. Results Consensus was reached about the existence of a differential clinical phenotype known as “Overlap Phenotype COPD–Asthma”, whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV 1 ≥15% and ≥400 ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV 1 ≥12% and ≥200 ml) on two or more occasions. The early use of individually adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. Conclusions It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.

Guía clínica para el diagnóstico y el tratamiento de la enfermedad pulmonar obstructiva crónica

Abstract: La enfermedad pulmonar obstructiva crónica (EPOC) es la de mayor prevalencia e impacto socioeconómico de todas las enfermedades respiratorias. Consciente de esta importancia, la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado recomendaciones específicas para su diagnóstico y tratamiento, la primera de ellas en 19921 y la segunda en 19962. Desde la publicación de esta última normativa ha habido un renovado interés en el estudio de la EPOC y se han producido novedades importantes en su tratamiento. Asimismo, en estos últimos años se han publicado guías clínicas por parte de sociedades científicas internacionales (European Respiratory Society, American Thoracic Society3,4) y se ha puesto en marcha la Global Obstructive Lung Disease Initiative, auspiciada por la Organización Mundial de la Salud y los Institutos Nacionales de Salud de Estados Unidos, cuyo objetivo es armonizar la atención clínica de estos pacientes en los distintos países. Por estos motivos, la SEPAR ha considerado de interés actualizar las recomendaciones para el diagnóstico y el tratamiento de la EPOC. La presente actualización va dirigida a los profesionales de la salud que tratan a pacientes con EPOC, y tiene por objetivo servir de instrumento práctico para proporcionar a los pacientes una atención actualizada y adecuada, basada en las mejores evidencias científicas disponibles.

Guía clínica SEPAR-ALAT de diagnóstico y tratamiento de la EPOC

Abstract: Puntos clave: – La enfermedad pulmonar obstructiva cronica (EPOC) se caracteriza por la presencia de obstruccion cronica y poco reversible al flujo aereo, que se asocia a una reaccion inflamatoria anomala, principalmente frente al humo del tabaco – La obstruccion al flujo aereo se define por la espirometria cuando el cociente volumen espiratorio forzado en el primer segundo/capacidad vital forzada (FEV1/FVC) tras broncodilatacion es menor de 0,7 (o por debajo del limite inferior de la normalidad en personas mayores de 60 anos) – La EPOC se asocia a inflamacion cronica con remodelacion que afecta a las vias aereas, parenquima y arterias pulmonares – La gravedad de la EPOC se clasifica por el valor del FEV1 posbroncodilatador, estando tambien relacionada con la existencia de sintomas, atrapamiento aereo, insuficiencia respiratoria, afectacion sistemica y comorbilidad asociada – La prevalencia de la EPOC en la poblacion adulta es del 9% en Espana y oscila entre el 8 y el 20% en Latinoamerica La EPOC representa la cuarta causa de muerte en Espana y en el mundo

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

Abstract: 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.

An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

Abstract: Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST

Characteristics of Physical Activities in Daily Life in Chronic Obstructive Pulmonary Disease

Abstract: Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest.However,detailedcomparisonwithhealthysubjectsisnotavailable.Furthermore,itisunknownwhethertimespentactivelyduring daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 7 years; FEV1 43 18% predicted) and 25 healthy elderly individuals (age 66 5 years). Patients showed lower walking time (44 26 vs. 81 26 minutes/day), standing time (191 99 vs. 295 109 minutes/day), and movement intensity during walking (1.8 0.3 vs. 2.4 0.5 m/second 2 ;p 0.0001 for all), as well as higher sitting time (374 139 vs. 306 108 minutes/day; p 0.04) and lying time (87 97 vs. 29 33 minutes/day; p 0.004). Walking time was highly correlated with the 6-minute walking test (r 0.76, p 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 r 0.64, p 0.05). Patients with chronic obstructive pulmonary disease are

Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study

Abstract: Background: Information about the influence of regular physical activity on the course of chronic obstructive pulmonary disease (COPD) is scarce. A study was undertaken to examine the association between regular physical activity and both hospital admissions for COPD and all-cause and specific mortality in COPD subjects. Methods: From a population-based sample recruited in Copenhagen in 1981–3 and 1991–4, 2386 individuals with COPD (according to lung function tests) were identified and followed until 2000. Self-reported regular physical activity at baseline was classified into four categories (very low, low, moderate, and high). Dates and causes of hospital admissions and mortality were obtained from Danish registers. Adjusted associations between physical activity and hospital admissions for COPD and mortality were obtained using negative binomial and Cox regression models, respectively. Results: After adjustment for relevant confounders, subjects reporting low, moderate or high physical activity had a lower risk of hospital admission for COPD during the follow up period than those who reported very low physical activity (incidence rate ratio 0.72, 95% confidence interval (CI) 0.53 to 0.97). Low, moderate and high levels of regular physical activity were associated with an adjusted lower risk of all-cause mortality (hazard ratio (HR) 0.76, 95% CI 0.65 to 0.90) and respiratory mortality (HR 0.70, 95% CI 0.48 to 1.02). No effect modification was found for sex, age group, COPD severity, or a background of ischaemic heart disease. Conclusions: Subjects with COPD who perform some level of regular physical activity have a lower risk of both COPD admissions and mortality. The recommendation that COPD patients be encouraged to maintain or increase their levels of regular physical activity should be considered in future COPD guidelines, since it is likely to result in a relevant public health benefit.