Archivos de bronconeumología
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Arch. Bronconeumol. · Apr 2011
ReviewRelationship between gastro-oesophageal reflux and airway diseases: the airway reflux paradigm.
Our understanding of the relationship between gastro-oesophageal reflux and respiratory disease has recently undergone important changes. The previous paradigm of airway reflux as synonymous with the classic gastro-oesophageal reflux disease (GORD) causing heartburn has been overturned. Numerous epidemiological studies have shown a highly significant association of the acid, liquid, and gaseous reflux of GORD with conditions such as laryngeal diseases, chronic rhinosinusitis, treatment resistant asthma, COPD and even idiopathic pulmonary fibrosis. ⋯ The evidence for such a relationship relies on the clinical history pointing to symptom associations with known precipitants of reflux. The tools for the diagnosis of extra-oesophageal reflux, in contrast to the oesophageal reflux of GORD, lack sensitivity and reproducibility. Unfortunately, methodology for detecting such reflux is only just becoming available and much additional work is required to properly delineate its role.
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Arch. Bronconeumol. · Apr 2011
Multicenter StudyReliability and validity of a short version of the STAI anxiety measurement scale in respiratory patients.
There is comorbidity between respiratory disease and anxiety. In order to measure the anxiety of hospitalized patients it is necessary to use reliable and valid, and preferably short questionnaires. ⋯ The short version of the state subscale of the STAI has showed good metric properties in hospitalized respiratory patients.
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Arch. Bronconeumol. · Apr 2011
Review[Physiology and physiopathology of the distal airways in asthma].
The small airways are those with an internal diameter of less than 2 mm. The contribution of these airways to total airflow resistance is small in healthy individuals but can represent 50-90 % of total airflow resistance in asthmatics. Suspicion of small airways disease has been based on reduction of midexpiratory and instantaneous flows, although wide variability in their values and the absence of a sufficiently validated cut-off point has limited their clinical application. ⋯ The characteristic pattern of peripheral obstruction includes a decrease in frequency-dependent resistance, reduced reactivity and an increase in resonance frequency. Single-or multiple-breath nitrogen washout can also provide specific information on the small airways, although the apparatus required is less frequently available. Analysis through bicompartmental models of exhaled nitric oxide allows alveolar nitric oxide concentrations to be determined, which seems to provide information on inflammatory activity in the small airways.
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Arch. Bronconeumol. · Apr 2011
Review[Imaging techniques in the examination of the distal airways: asthma and COPD].
Imaging techniques are highly useful diagnostic tools to study small airway diseases. Despite their differences, from a clinical pathological perspective, these diseases show similar radiological manifestations. High-resolution computed tomography (CT) is the technique of choice to study diffuse diseases and those of the small airways; the slices obtained in expiratory high-resolution CT scan should form part of the study protocol of small airway diseases. ⋯ In asthmatic patients, multi-detector CT (MDTC) allows clinical symptoms, thickening of the airway wall and the degree of airflow obstruction to be directly correlated. MDTC is also useful for quantitative evaluation of the degree of air trapping in patients with emphysema. Magnetic resonance imaging after inhalation of distinct gases, such as (3)He and xenon-129 and dual-energy CT are also useful imaging techniques in the direct or indirect evaluation of the degree of airflow obstruction (air trapping).