Open Respiratory Archives最新文献

Introduction: Chronic obstructive pulmonary disease (COPD) is a serious global health problem that is ranked third among the leading causes of death worldwide. However, underdiagnosis remains common, especially in Spain. The CARABELA-COPD initiative aims to address these issues by optimizing processes across the diverse healthcare settings in Spain.

Material and methods: CARABELA-COPD employs lean methodology and fosters partnership between scientific societies, industry, clinicians, and managers to improve COPD care. The methodology consists of 4 phases: Phase 1 involved experts analyzing COPD care models and unmet needs; Phase 2, validation and priorization of improvement areas in 7 pilot hospitals, selecting healthcare quality indicators (QIs) in a national meeting; Phase 3, cocreation and refinement of results from a regional perspective; and Phase 4 is ongoing, disseminating the results and implementing them locally.

Results: Initial phases of the initiative have defined a generic patient journey for COPD management from a multidisciplinary approach, identified 7 improvement areas for optimal COPD care, developed 4 care models tailored to different settings, and established QIs that have been validated in national and regional meetings.

Discussion: CARABELA-COPD is a novel practical approach to COPD management in Spain that acts as catalyst for a system transformation to boost overall system efficiency and enhance patient outcomes. It provides a clear framework for improvement, emphasizing interdisciplinary collaboration and communication. The ongoing implementation phase will require flexibility and constant evaluation to further enhance COPD care, ultimately improving patient quality of life and healthcare effectiveness.

Introduction: Lung cancer remains one of the leading causes of cancer death worldwide. This study examines lung cancer mortality trends in Andalusia, Spain, from 2003 to 2022, focusing on gender differences and the influence of age, period and cohort effects.

Material and methods: This longitudinal ecological study analyzed lung cancer mortality data in Andalusia from 2003 to 2022, using age-period-cohort (A-P-C) and joinpoint regression models. Mortality rates were calculated by sex, age group, and standardized to the 2013 European Standard Population.

Results: Between 2003 and 2022, Andalusia recorded 68,480 lung cancer deaths, with a significant gender disparity. Male mortality decreased (-1.9%), while female mortality increased (3.5%). Joinpoint analysis revealed a notable rise in female mortality rates after 2015. Age-specific analyses showed decreasing rates for men across all age groups, with a sharper decline for younger men. Women experienced increasing rates, particularly among those aged 35-64. The A-P-C model identified significant cohort effects, with decreasing rate ratios for men and increasing ones for women, reflecting historical smoking patterns.

Conclusions: Lung cancer mortality in Andalusia has exhibited a stark gender divide, reflecting the region's historical smoking patterns. While declining rates among men and younger women indicate the efficacy of tobacco control measures, the persistent rise in female mortality underscores the enduring effects of past smoking habits. These findings emphasize the imperative for ongoing public health initiatives and gender-specific interventions to mitigate the burden of lung cancer in Andalusia.

Respiratory diseases and cardiovascular diseases (CVDs) have high prevalence and share common risk factors. In some respiratory diseases such as sleep apnoea and COPD, the evidence of their negative impact on the prognosis of CVDs seems clear. However, in other diseases it is less evident whether there is any direct relationship. With this in mind, our objective was to provide information that may be helpful to better understand the relationship between respiratory pathology and CVDs. There are different reasons for this relationship, such as shared risk factors, common pathophysiological mechanisms, side effects of treatment and the direct effect in the heart and great vessels of respiratory diseases. Indeed, aging and smoking are risk factors for CVDs and also for respiratory diseases such as obstructive sleep apnea (OSA), COPD and interstitial lung diseases (ILD). Furthermore, there are common pathophysiological mechanisms that affect both respiratory diseases and CVDs, such as accelerated atherosclerosis, microvascular dysfunction, endothelial dysfunction, inflammation, hypoxemia and oxidative stress. Besides that, it is well known that lung cancer, sarcoidosis and amyloidosis may directly affect the heart and great vessels. Finally, side effects of drugs for respiratory diseases and the discontinuation of treatments that are necessary for CVDs, such as β-blockers and aspirin, may have a deleterious impact on the cardiovascular system. In conclusion, the coexistence of respiratory diseases and CVDs is very common. It makes modifying diagnostic and therapeutic management necessary and is also a relevant prognostic factor.