Archivos De Bronconeumologia最新文献

Objective: Forced expiratory volume in one second (FEV₁) remains the standard parameter for assessing airflow limitation, although the most appropriate expression of its decline for prognostic evaluation remains unclear. This study aims to assess the prognostic significance of different annual FEV₁ decline indices for medium- and long-term mortality in COPD.

Methods: One thousand two hundred forty-seven patients with clinically diagnosed COPD were included, each undergoing at least three annual spirometric evaluations. Six FEV₁ indices were analysed: absolute value, percentage of predicted, z-score, FEV₁ normalized by height squared (FEV₁·Ht^-2) and cubed (FEV₁·Ht^-3), and FEV₁Q. Longitudinal changes were estimated using random-coefficient models. The primary outcome was all-cause mortality over a 15-year follow-up.

Results: A total of 12,863 person-years were analysed. During the follow-up, 577 patients (46.3%) died. All FEV₁ indices were significantly associated with mortality risk. However, in multivariate analysis, only the annual decline in FEV₁z-score remained an independent predictor (adjusted hazard ratio 0.104, 95% confidence interval 0.080-0.135, p<0.001). ROC analyses demonstrated that FEV₁z-score decline provided superior predictive accuracy compared to other indices. A z-score annual decline ≥-0.1969/year was associated with a 4.6-fold increased mortality risk. Additionally, the baseline value of FEV₁·Ht^-3 showed greater prognostic value than the other baseline FEV₁ indices.

Conclusion: The annual decline in FEV₁z-score is the most robust FEV₁ expression predictor of long-term mortality in COPD. These findings suggest that incorporating longitudinal z-score assessments into clinical practice may improve risk stratification and patient management.

Bronchiectasis is a chronic, heterogeneous respiratory disease. Its pathogenesis involves airway inflammation, chronic infection, impaired mucociliary clearance, and progressive lung damage. Despite recent approval of Brensocatib, current management relies mostly on off-label therapies, highlighting the need for evidence-based strategies. Given the heterogeneity of bronchiectasis, precision medicine approaches that integrate patient phenotypes, endotypes, and disease severity are crucial. Mapping the current landscape of randomized clinical trials (RCTs) highlights the efforts to improve patient outcomes and translate mechanistic insights into clinical practice. This review underscores the shift toward individualized, mechanism-based therapy in bronchiectasis management providing a comprehensive overview of current and emerging therapeutic approaches in bronchiectasis, focusing on ongoing and recent RCTs.

Spirometry is the main diagnostic procedure for most respiratory diseases. This document sets out the principal recommendations for performing and interpreting the test in adult and pediatric populations, in accordance with current evidence-based guidelines and standards. It is important to be familiar with the indications and contraindications of the test, as well as the technical requirements of the equipment and the facilities where it is performed. The personnel responsible for conducting the test must have appropriate training in order to obtain maneuvers of sufficient quality for subsequent interpretation. The quality grade of each test must be determined before interpretation. Spirometric tests should be interpreted using updated reference values appropriate for each patient group, and in addition to assessing whether the measured values are within normal limits, spirometry can provide information suggestive of specific patterns indicative of airway disease, parenchymal lung disease, or even disorders of the chest wall. Performing spirometry after administration of a bronchodilator is also often required for the diagnosis of certain respiratory diseases, and standardization of this procedure is essential in order to interpret the changes in spirometric values after bronchodilation.