Revista Medica Clinica Las Condes最新文献

Currently, obstructive sleep apnea (OSA) is defined as having an apnea-hypopnea index (AHI) of 5 events per hour. The AHI is based on the frequency of respiratory events over time and is used to predict disease severity and guide therapeutic interventions. However, the AHI fails to capture the substantial heterogeneity present in OSA, including patterns of hypoxemia, sympathetic response, and gender differences. In recent years, multiple metrics derived from pulse oximeter signals, heart rate, electroencephalogram, and ventilation signals have been described. This article will focus on those metrics that have been validated through external studies and possess greater clinical relevance.

The current standard for smoking cessation is combined psychological and pharmacological treatment. Administering a drug to stop smoking in isolation (8-10% abstinence per year) is not the same as using it together with support and behavioral intervention (more than 30% abstinence). The fundamental reason drugs are used in the process of quitting smoking is because it has been proven that their use not only mitigates withdrawal symptoms but also increases long term quit rates (6-12 months). Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are all more effective than placebo. In very dependent smokers, a combination of drugs is recommended, with those associations containing varenicline being more effective. In special populations (chronic respiratory diseases, cardiovascular diseases or psychiatric pathology), varenicline alone or combined with NRT is recommended as the first option. Finally, it is important to highlight that the fact that a previous unsuccessful attempt to stop smoking with a certain drug is not a contraindication for its subsequent use since success depends on many factors, such as; correct usage of the drug, motivational stage, presence of environmental obstacles and a firm decision to quit smoking, among others.

The objective of this work is to offer an updated review of pulmonary tuberculosis; covering epidemiological aspects, pathogenesis, clinical presentation, diagnosis and current therapy.

Active tuberculosis is addressed in its different clinical forms. Likewise, the concept of latent and subclinical tuberculosis is analyzed. An update of diagnostic methods and therapy of active tuberculosis, both sensitive and resistant to antibiotics, is made.

Interstitial lung diseases (ILDs) are a heterogeneous group of disorders that affect the lung interstitium, characterized by inflammation and/or fibrosis. Historically, they were based on histopathological characteristics of lung biopsies, but with the advancement of high-resolution computed tomography (HRCT), the approach has shifted, allowing for the identification of disease patterns that suggest different etiologies. The classification of ILDs has evolved, and they are currently classified according to etiology, histopathological and/or radiological patterns, and evolutionary course. Idiopathic interstitial pneumonias (IIPs) are a group of ILDs of unknown origin, with idiopathic pulmonary fibrosis (IPF) being the most common within the IIPs. The concept of progressive fibrosing interstitial lung disease (PF-ILD) has been developed, describing a phenotype of ILD with progression despite treatment. Diagnosis is based on a detailed clinical history, physical examination, pulmonary function tests, autoimmune serology, and imaging techniques such as HRCT. Treatment varies according to etiology and may include immunomodulatory or anti-inflammatory therapy, disease-modifying therapy with antifibrotic agents and, in advanced cases, lung transplantation. Medical care should be holistic, including pulmonary rehabilitation, infection prevention, and oxygen therapy. This article aims to provide a clinical update on interstitial lung diseases and comment on advances in diagnostic and therapeutic strategies.

Obstructive sleep apnea (OSA) is a common disease that causes daytime symptoms, decreased quality of life, increased risk of cardio and cerebrovascular morbidity and mortality, neurocognitive impairments, and higher traffic accident rates. Continuous positive airway pressure therapy (CPAP) is highly effective and has been the treatment of choice for patients with severe disease and those with moderate disease accompanied by daytime symptoms and/or cardiovascular comorbidity. However, CPAP has limitations in terms of acceptance and treatment adherence. There are various treatment options available, such as weight loss, the use of oral devices, positional devices, surgery and emerging therapies like myofunctional therapy. These personalized treatments have shown promising results, particularly in patients with mild to moderate OSA or those seeking an effective alternative to standard treatment. It is increasingly recognized that OSA is a disorder with diverse risk factors, clinical presentations, pathophysiology, and comorbidities. A better understanding of patient heterogeneity will allow for more personalized treatment approaches and ensure the effectiveness of interventions through advanced and precision medicine. This review provides an overview of current approaches to non-surgical treatment of mild to moderate OSA in patients without an indication for CPAP treatment or who reject that option. Additionally, it proposes a therapeutic algorithm to guide the management of these patients.

Respiratory illnesses are an important cause of morbidity and mortality. Lung cancer is the leading cause of cancer and the leading cause of cancer mortality. Worldwide, chronic obstructive pulmonary disease (COPD) is the third leading cause of death, after cardiovascular and neoplastic diseases. Fibrosing interstitial lung disease has maintained a progressive increase in incidence, with high mortality. This is how respiratory palliative care has acquired relevance in this area of medicine, improving not only quality of life, but also, as is the case with lung cancer, survival. The aim of this article is to demonstrate the need for respiratory palliative care in cancer and non-cancer lung disease, allowing for an earlier and more timely referral for our patients.

This article explores the role of high-resolution computed tomography (HRCT) in the diagnosis of diffuse interstitial lung diseases (ILD), discussing key tomographic findings, parenchymal changes, and the importance of identifying various radiological patterns, with a special focus on the usual interstitial pneumonia (UIP) pattern. Given the complexity and diversity of manifestations of diffuse ILD, the collaborative evaluation of a multidisciplinary team, in which the radiologist plays a fundamental role in the diagnostic chain using HRCT, is essential. This exam enables the detection of parenchymal alterations in DILD, such as ground-glass opacities, consolidation, reticular patterns, traction bronchiectasis/bronchiectasis, and honeycombing. The interpretation and association of these findings, along with their distribution, facilitate the establishment of specific radiological patterns that, in addition to indicating possible etiologies, guide the most appropriate therapeutic options. The adoption of specific imaging protocols and the use of standardized language are essential to increase diagnostic accuracy. Moreover, the incorporation of technological innovations, such as advanced photon counting technology and automated analysis through artificial intelligence, promise to significantly improve the identification and quantification of interstitial alterations, shaping the future of thoracic radiology.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous pathology that impacts more than 380 million people globally, being the third leading cause of death worldwide. Since its recognition in the 1960s, the understanding and management of COPD have significantly evolved, thanks to advances in knowledge about its etiopathogenesis and treatment. The guidelines from the Global Initiative for COPD (GOLD COPD) represent an effort to standardize diagnosis and treatment, with its review in 2023 updating the disease's definition. Proper management of COPD includes accurate diagnosis, pharmacological and non-pharmacological therapies, and prevention strategies focused especially on smoking cessation, the main cause of the disease.

Diagnosis is based on the history of exposure to noxious particles or gases, with spirometry as a key exam to confirm not completely reversible bronchial obstruction. The treatment strategy has improved with the development of new drugs and administration devices, focusing on reducing symptoms and the risk of exacerbations. Pharmacological therapy is adapted according to the GOLD classification of the patient, with options ranging from bronchodilator therapies to combinations of multiple drugs for more severe cases. The importance of detecting and treating comorbidities is critical, given their high prevalence in patients with COPD and their impact on mortality.

Non-pharmacological strategies include smoking cessation, long-term oxygen therapy, physical activity, and pulmonary rehabilitation, as well as ensuring adequate immunization. The management of exacerbations must be appropriate and early, as they are associated with an increase in morbidity and mortality.

This review seeks to provide an evidence based integral approach to the management of COPD.

Cough is one of the most common reasons for outpatient medical consultation. Most of the time it is self-limiting so doctors tend not to give it much importance. However, cough can be caused by serious pathologies such as cancer, fibrosis and pulmonary tuberculosis. Furthermore, when the cough is intense or prolonged it can cause significant alterations in the quality of life of patients. In this article we will review the main guidelines for diagnosis and treatment of cough, how to suspect serious etiologies, when to define a treatment according to clinical information and when to request tests. Finally, we will discuss two clinical cases in order to illustrate some concepts.