Publications by authors named "Carlos Torres-Duque"

36 Publications

Chronic Obstructive Pulmonary Disease Patients Have Increased Levels of Plasma Inflammatory Mediators Reported Upregulated in Severe COVID-19.

Front Immunol 2021 15;12:678661. Epub 2021 Jul 15.

Institute for Immunological Research, University of Cartagena, Cartagena, Colombia.

Background: Chronic obstructive pulmonary disease (COPD) is associated with increased risk of severe COVID-19, but the mechanisms are unclear. Besides, patients with severe COVID-19 have been reported to have increased levels of several immune mediators.

Methods: Ninety-two proteins were quantified in 315 plasma samples from 118 asthmatics, 99 COPD patients and 98 healthy controls (age 40-90 years), who were recruited in Colombia before the COVID-19 pandemic. Protein levels were compared between each disease group and healthy controls. Significant proteins were compared to the gene signatures of SARS-CoV-2 infection reported in the "COVID-19 Drug and Gene Set Library" and with experimentally tested protein biomarkers of severe COVID-19.

Results: Forty-one plasma proteins showed differences between patients and controls. Asthmatic patients have increased levels in IL-6 while COPD patients have a broader systemic inflammatory dysregulation driven by HGF, OPG, and several chemokines (CXCL9, CXCL10, CXCL11, CX3CL1, CXCL1, MCP-3, MCP-4, CCL3, CCL4 and CCL11). These proteins are involved in chemokine signaling pathways related with response to viral infections and some, were found up-regulated upon SARS-CoV-2 experimental infection of Calu-3 cells as reported in the COVID-19 Related Gene Sets database. An increase of HPG, CXCL9, CXCL10, IL-6, MCP-3, TNF and EN-RAGE has also been experimentally detected in patients with severe COVID-19.

Conclusions: COPD patients have altered levels of plasma proteins that have been reported increased in patients with severe COVID-19. Our study suggests that COPD patients have a systemic dysregulation in chemokine networks (including HGF and CXCL9) that could make them more susceptible to severe COVID-19. Also, that IL-6 levels are increased in some asthmatic patients (especially in females) and this may influence their response to COVID-19. The findings in this study depict a novel panel of inflammatory plasma proteins in COPD patients that may potentially associate with increased susceptibility to severe COVID-19 and might be useful as a biomarker signature after future experimental validation.
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http://dx.doi.org/10.3389/fimmu.2021.678661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320593PMC
August 2021

Cost-utility analysis of an integrated care program for children with asthma in a medium-income country.

Pediatr Pulmonol 2020 11 12;55(11):3110-3118. Epub 2020 Aug 12.

Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.

Objective: To evaluate the cost-utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for children with asthma compared with standard of care.

Methods: A decision-analytic model was used to compare an integrated care program compared to the standard of care in children with asthma in Bogota, Colombia. Baseline characteristics of the patients were established according to the distribution of patients in the PAI database. Other inputs were obtained from published meta-analysis, local registries, medical bills, general mortality data, and expert opinion. Costs were presented in 2017 Colombian pesos. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 5% per year. Incremental cost-utility ratios were presented for PAI compared with standard of care. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty.

Results: The model predicted that patients that are part of the PAI would accrue more QALYs than patients on standard of care. The incremental results suggest that the PAI is a cost-effective treatment (incremental cost-utility ratio of Colombian pesos $33 753 817/QALY) compared with standard of care. Sensitivity analyses suggest that results are most sensitive to cost of care (with and without PAI) and costs of severe exacerbation. However, the PAI is cost-effective irrespective of variation in any of the input parameters.

Conclusion: Our model predicted that an integrated intervention for the management of asthma in pediatric patients improves QALYs, reduces number of disease related exacerbations compared to standard therapy and is cost-effective for the long-term control of the disease in Colombia.
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http://dx.doi.org/10.1002/ppul.24996DOI Listing
November 2020

Arterial blood gases and ventilation at rest by age and sex in an adult Andean population resident at high altitude.

Eur J Appl Physiol 2020 Dec 16;120(12):2729-2736. Epub 2020 Sep 16.

Fundación Neumologica Colombiana, CR 13B 161-85, Bogota, Colombia.

Purpose: Arterial blood gases (ABG) are influenced by the altitude above sea level, age and sex. Most studies have been conducted at sea level and in small populations ascending to or residents at very high altitudes. Our objective was to evaluate the ventilation and ABG by age and sex in an Andean population resident at high altitude (2640 m).

Methods: Analytical cross-sectional study was done in healthy volunteers. ABG and minute ventilation (VE) were measured. T test and ANOVA for differences by sex and age, and Pearson test for correlations between age, VE and ABG were performed.

Results: We included 374 adults, 55% women from 18 to 83 years and hemoglobin of 15.7 ± 1.6 g/dl. There was a significant decrease in PaO and SaO and an increase in P(A - a)O with age (p < 0.001). Unlike men, with age women had a significant increase in PaCO and a higher decrease in PaO. The correlations between age, the decrease in PaO and the increase in PaCO were greater in women than in men. The VE adjusted to body surface area decreased with age, but this correlation was significantly higher in women.

Conclusions: In this study, with a considerable number of healthy adults living at high altitude (2640 m), we established the physiological impact of altitude, aging and gender in ABG. The PaO and PaCO were significantly lower and the hemoglobin values slightly higher than described at sea level. In addition to PaO decline with age, there was an age-related increase in PaCO in women, associated with a greater reduction of VE.
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http://dx.doi.org/10.1007/s00421-020-04498-zDOI Listing
December 2020

Case series: an essential study design to build knowledge and pose hypotheses for rare and new diseases.

J Bras Pneumol 2020 Sep 7;46(4):e20200389. Epub 2020 Sep 7.

. Methods in Epidemiologic, Clinical, and Operations Research-MECOR-program, American Thoracic Society/Asociación Latinoamericana del Tórax, Montevideo, Uruguay.

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http://dx.doi.org/10.36416/1806-3756/e20200389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567633PMC
September 2020

Highlights of an Expert Advisory Board on Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD) in Latin America.

Int J Chron Obstruct Pulmon Dis 2020 6;15:1919-1929. Epub 2020 Aug 6.

GSK, Panama City, Panama.

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and usually progressive lung disease that affects millions of people worldwide and is the sixth leading cause of death in the Americas. Viral and bacterial respiratory tract infections and air pollution may cause acute exacerbations of COPD (AE-COPD) ranging from mild, moderate to severe. The greatest proportion of the overall COPD burden on the health system is due to disease exacerbations. There is limited evidence regarding the etiology and burden of AE-COPD in Latin America (LATAM).

Methods: To respond to this gap in evidence, an Advisory Board with regional pneumologists and infectious disease experts was convened in September 2018 in Panama City, Panama, to: 1) review the burden of AE-COPD in LATAM; 2) evaluate the etiology of AE-COPD in LATAM; and 3) assess and compare the local/regional guidelines to confirm the etiology, characterize, and manage AE-COPD.

Results: The results of the meeting showed that there is a high prevalence of AE-COPD in LATAM countries, limited evidence on etiology data, and discrepancies in the case definitions and symptomology (ie, severity) classifications used in LATAM.

Conclusion: The Advisory Board discussions further resulted in recommendations for future research on the impact on the epidemiology and burden of disease, on establishing standardized AE-COPD case definition guidelines, and on studying the etiology of both moderate and severe AE-COPD cases.
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http://dx.doi.org/10.2147/COPD.S261258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418149PMC
June 2021

The Latin American Thoracic Association (ALAT): 30 Years of History.

Arch Bronconeumol (Engl Ed) 2020 Jul 31;56(7):413-415. Epub 2020 Mar 31.

Universitat de Barcelona, Institut d'Investigació Biomédica August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, España.

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http://dx.doi.org/10.1016/j.arbres.2020.02.005DOI Listing
July 2020

Frequency of emergency department visits and hospitalizations due to chronic obstructive pulmonary disease exacerbations in patients included in two models of care

Biomedica 2019 12 1;39(4):748-758. Epub 2019 Dec 1.

Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, D.C., Colombia.

Introduction: Exacerbations of chronic obstructive pulmonary disease (COPD) have a huge impact on lung function, quality of life and mortality of patients. Emergency Department visits and hospitalizations due to exacerbations cause a significant economic burden on the health system.

Objective: To describe the differences in the number of emergency visits and hospitalizations due to exacerbations of COPD among patients included in two models of care of the same institution.

Materials And Methods: A historical cohort study in which COPD patients who are users of two models of care were included: COPD integrated care program (CICP) and general consultation of pulmonology (GCP). The first model, unlike the second one, offers additional educational activities, 24/7 telephone service, and priority consultations. The number of emergency visits and hospitalizations due to COPD exacerbations in patients who had completed at least one year of follow-up was evaluated. The multivariable Poisson regression model was used for calculating the incidence rate (IR) and the incidence rate ratio (IRR) with an adjustment for confounding factors.

Results: We included 316 COPD patients (166 from the CICP and 150 from the GCP). During the year of follow-up, the CICP patients had 50% fewer emergency visits and hospitalizations than patients from the GCP (IRR=0.50, 95%CI: 0.29-0.87, p=0.014).

Conclusions: COPD patients in the CICP had fewer emergency visits and hospitalizations due to exacerbations. Prospective clinical studies are required to confirm the results and to evaluate the factors that contribute to the differences.
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http://dx.doi.org/10.7705/biomedica.4815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363357PMC
December 2019

Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019.

Arch Bronconeumol (Engl Ed) 2020 Feb 22;56(2):106-113. Epub 2019 Nov 22.

Universidad de la República, Hospital Maciel, Montevideo, Uruguay.

This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting β-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/μl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD.
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http://dx.doi.org/10.1016/j.arbres.2019.09.023DOI Listing
February 2020

Letter from Colombia.

Respirology 2019 11 25;24(11):1115-1116. Epub 2019 Jul 25.

Director, Research Department - CINEUMO, Fundación Neumológica Colombiana, Bogotá, Colombia.

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http://dx.doi.org/10.1111/resp.13658DOI Listing
November 2019

SMALLa AIRWAY DISEASE IN COPD ASSOCIATED TO BIOMASS EXPOSURE.

Rev Invest Clin 2019 ;71(1):70-78

Department of Respiratory Medicine, Fundación Médica Sur, Mexico City, Mexico.

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous entity that may result from different causative agents and risk factors and may follow diverse clinical courses, including COPD secondary to biomass smoke exposure. At present, this phenotype is becoming more important for two reasons: first, because at least almost half of the world's population is exposed to biomass smoke, and second, because the possibility of it being diagnosed is increasing. Biomass smoke exposure COPD affects primarily women and is related with insults to the airways occurred during early life. Although constituents of biomass smoke and tobacco smoke are similar, the physiopathological changes they induce differ depending not only on the chemical composition (related with the type of fuel used) but also on the particle size and the inhalation pattern. Evidence has shown that biomass smoke exposure affects the airway, predominantly the small airways causing anthracofibrosis and peribronchiolar fibrosis changes that will clinically translate into chronic bronchitis symptoms, with a high impact on the quality of life. In this review, we focus especially on the main epidemiological and clinical differences between COPD secondary to biomass exposure and COPD caused by tobacco exposure.
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http://dx.doi.org/10.24875/RIC.18002652DOI Listing
June 2019

High prevalence of house dust mite sensitization in children with severe asthma living at high altitude in a tropical country.

Pediatr Pulmonol 2018 10 25;53(10):1356-1361. Epub 2018 Jun 25.

Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.

Background: Some studies, mainly in Europe, have shown a low level of sensitization to house dust mite (HDM) allergens at high altitude (HA). Differently, some others in tropical countries have shown a higher level. The aim of this study was to evaluate allergens sensitization, including HDM, in children with severe asthma (SA), residents at HA in a tropical middle-income developing country.

Methods: Observational, analytical, cross-sectional study in children aged 6-15 years old with SA at HA (2640 m). Skin prick tests (SPT), serum IgE, exhaled fraction of nitric oxide (FE ), spirometry, and asthma questionnaire (ACT) were performed. Associations were explored by Pearson or Spearman coefficients.

Results: We included 61 children. Most patients were male (61.3%), median age: 10 years (Interquartile range [IQR]: 8-12), median BMI: 17 kg/m (IQR: 16-20); Median of positive SPT: 2 (IQR: 2-3). At least one SPT was positive in 88.7% of patients and 87.9% were positive for at least one HDM. Serum IgE: 348 UI/mL (IQR: 154-760) and FE : 22 ppb (IQR: 9-41). Prebronchodilator values were (% predicted): FVC: 109.7% (±15.5%), FEV : 98.4% (±16.3); FEV /FVC: 82% (±8%). SPT were inversely correlated with the FEV /FVC (Rho: -0.34; 95% CI: -0.55 a -0.09; P = 0.008).

Conclusions: These children with SA living at HA in a tropical middle-income developing country have a high prevalence of HDM sensitization. One explanation for this might be that tropical conditions, such as temperature and humidity, could modify the effect of the altitude on asthma.
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http://dx.doi.org/10.1002/ppul.24079DOI Listing
October 2018

Chronic bronchitis: High prevalence in never smokers and underdiagnosis- A population-based study in Colombia.

Chron Respir Dis 2019 Jan-Dec;16:1479972318769771. Epub 2018 Apr 18.

1 Research Department, Fundacion Neumologica Colombiana, Bogota, Colombia.

The objective of the article was to establish the prevalence, underdiagnosis, and risk factors of chronic bronchitis (CB) in a general population in five Colombian cities. Cross-sectional study using a probabilistic sampling technique in five Colombian cities was adopted. The CB definition was "cough and expectoration for three or more months per year for at least two consecutive years." Underdiagnosis was considered in subjects with clinical definition without previous medical diagnosis. Univariate χ or Student's t-test and logistic regression analysis were used. The study included 5539 subjects. The prevalence was 5.5%, the underdiagnosis 50.3%, and 33.7% of the cases were in nonsmokers (53.6% in women vs. 16.9% in men, p < 0.001). The adjusted risk factors were living in Bogota, current smoking, male, age ≥ 64 years, low education, indoor wood smoke exposure, and occupational exposure to vapors, gases, dust, and fumes. CB is a common disease among adults in Colombia. The underdiagnosis was high and there were a large proportion of cases in nonsmokers, particularly in women. Our findings support the association of CB with indoor wood smoke and occupational exposures.
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http://dx.doi.org/10.1177/1479972318769771DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6302977PMC
April 2020

Diagnosis and treatment of latent tuberculosis in patients with multiple sclerosis, expert consensus. On behalf of the Colombian Association of Neurology, Committee of Multiple Sclerosis.

Mult Scler J Exp Transl Clin 2018 Jan-Mar;4(1):2055217317752202. Epub 2018 Jan 17.

SIIES Research and Education in Health, Bogotá, Colombia.

Background: Multiple sclerosis is an inflammatory and neurodegenerative demyelinating disease. Current treatment of multiple sclerosis focuses on the use of immunomodulatory, immunosuppressant, and selective immunosuppressant agents. Some of these medications may result in high risk of opportunistic infections including tuberculosis.

Objective: The purpose of this study was to obtain consensus from a panel of neurologists, pulmonologists, infectious disease specialists, and epidemiology experts regarding the diagnosis, treatment, and monitoring of latent tuberculosis in patients with multiple sclerosis.

Methods: A panel of experts in multiple sclerosis and tuberculosis was established. The methodological process was performed in three phases: definition of questions, answer using Delphi methodology, and the discussion of questions not agreed.

Results: Tuberculosis screening is suggested when multiple sclerosis drugs are prescribed. The recommended tests for latent tuberculosis are tuberculin and interferon gamma release test. When an anti-tuberculosis treatment is indicated, monitoring should be performed to determine liver enzyme values with consideration of age as well as comorbid conditions such as a history of alcoholism, age, obesity, concomitant hepatotoxic drugs, and history of liver disease.

Conclusion: Latent tuberculosis should be considered in patients with multiple sclerosis who are going to be treated with immunomodulatory and immunosuppressant medications. Transaminase level monitoring is required on a periodic basis depending on clinical and laboratory characteristics. In addition to the liver impairment, other side effects should be considered when Isoniazid is prescribed.
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http://dx.doi.org/10.1177/2055217317752202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774739PMC
January 2018

Roadmap for Tuberculosis Elimination in Latin America and the Caribbean.

Arch Bronconeumol (Engl Ed) 2018 Jan 6;54(1):7-9. Epub 2017 Oct 6.

World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Maugeri Care and Research Institute, Tradate, Italia.

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http://dx.doi.org/10.1016/j.arbres.2017.07.004DOI Listing
January 2018

Altitude and COPD prevalence: analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study.

Respir Res 2017 08 23;18(1):162. Epub 2017 Aug 23.

Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstrasse 9, A4021, Linz, Austria.

Background: COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors.

Methods: A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as >1500 m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD.

Results: Among 30,874 participants aged 56.1 ± 11.3 years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500 m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p < 0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude.

Conclusion: Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD.
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http://dx.doi.org/10.1186/s12931-017-0643-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569455PMC
August 2017

Poverty cannot be inhaled and it is not a genetic condition. How can it be associated with chronic airflow obstruction?

Eur Respir J 2017 06 1;49(6). Epub 2017 Jun 1.

Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia

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http://dx.doi.org/10.1183/13993003.00823-2017DOI Listing
June 2017

Estimation of personal exposure to asbestos of brake repair workers.

J Expo Sci Environ Epidemiol 2017 07 14;27(4):417-426. Epub 2016 Dec 14.

Department of Civil and Environmental Engineering, Universidad de Los Andes, Bogotá, Colombia.

Exposure assessments are key tools to conduct epidemiological studies. Since 2010, 28 riveters from 18 brake repair shops with different characteristics and workloads were sampled for asbestos exposure in Bogotá, Colombia. Short-term personal samples collected during manipulation activities of brake products, and personal samples collected during non-manipulation activities were used to calculate 103 8-h TWA PCM-equivalent personal asbestos concentrations. The aims of this study are to identify exposure determinant variables associated with the 8-h TWA personal asbestos concentrations among brake mechanics, and propose different models to estimate potential asbestos exposure of brake mechanics in an 8-h work-shift. Longitudinal-based multivariate linear regression models were used to determine the association between personal asbestos concentrations in a work-shift with different variables related to work tasks and workload of the mechanics, and some characteristics of the shops. Monte Carlo simulations were used to estimate the 8-h TWA PCM-Eq personal asbestos concentration in work-shifts that had manipulations of brake products or cleaning activities of the manipulation area, using the results of the sampling campaigns. The simulations proposed could be applied for both current and retrospective studies to determine personal asbestos exposures of brake mechanics, without the need of sampling campaigns or historical data of air asbestos concentrations.
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http://dx.doi.org/10.1038/jes.2016.76DOI Listing
July 2017

Is there a rationale for pulmonary rehabilitation following successful chemotherapy for tuberculosis?

J Bras Pneumol 2016 Sep-Oct;42(5):374-385

. WHO Collaborating Centre for TB and Lung Diseases, Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS - Tradate, Italia.

The role of tuberculosis as a public health care priority and the availability of diagnostic tools to evaluate functional status (spirometry, plethysmography, and DLCO determination), arterial blood gases, capacity to perform exercise, lesions (chest X-ray and CT), and quality of life justify the effort to consider what needs to be done when patients have completed their treatment. To our knowledge, no review has ever evaluated this topic in a comprehensive manner. Our objective was to review the available evidence on this topic and draw conclusions regarding the future role of the "post-tuberculosis treatment" phase, which will potentially affect several million cases every year. We carried out a non-systematic literature review based on a PubMed search using specific keywords (various combinations of the terms "tuberculosis", "rehabilitation", "multidrug-resistant tuberculosis", "pulmonary disease", "obstructive lung disease", and "lung volume measurements"). The reference lists of the most important studies were retrieved in order to improve the sensitivity of the search. Manuscripts written in English, Spanish, and Russian were selected. The main areas of interest were tuberculosis sequelae following tuberculosis diagnosis and treatment; "destroyed lung"; functional evaluation of sequelae; pulmonary rehabilitation interventions (physiotherapy, long-term oxygen therapy, and ventilation); and multidrug-resistant tuberculosis.The evidence found suggests that tuberculosis is definitively responsible for functional sequelae, primarily causing an obstructive pattern on spirometry (but also restrictive and mixed patterns), and that there is a rationale for pulmonary rehabilitation. We also provide a list of variables that should be discussed in future studies on pulmonary rehabilitation in patients with post-tuberculosis sequelae. RESUMO O papel da tuberculose como uma prioridade de saúde pública e a disponibilidade de ferramentas diagnósticas para avaliar o estado funcional (espirometria, pletismografia e DLCO), a gasometria arterial, a capacidade de realizar exercícios, as lesões (radiografia de tórax e TC) e a qualidade de vida justificam o esforço de se considerar o que deve ser feito quando os pacientes completam seu tratamento. Até onde sabemos, nenhuma revisão avaliou esse tópico de forma abrangente. Nosso objetivo foi revisar as evidências disponíveis e obter algumas conclusões sobre o futuro papel da fase de "tratamento pós-tuberculose", que irá potencialmente impactar milhões de casos todos os anos. Realizou-se uma revisão não sistemática da literatura tendo como base uma pesquisa no PubMed usando palavras-chave específicas (várias combinações dos termos "tuberculose", "reabilitação", "tuberculose multirresistente", "doença pulmonar", "doença pulmonar obstrutiva", e "medidas de volume pulmonar"). As listas de referências dos artigos principais foram recuperadas para melhorar a sensibilidade da busca. Foram selecionados manuscritos escritos em inglês, espanhol e russo. As principais áreas de interesse foram sequelas de tuberculose após diagnóstico e tratamento; "pulmão destruído"; avaliação funcional das sequelas; intervenções de reabilitação pulmonar (fisioterapia, oxigenoterapia de longo prazo e ventilação); e tuberculose multirresistente. As evidências encontradas sugerem que a tuberculose é definitivamente responsável por sequelas funcionais, principalmente causando um padrão obstrutivo na espirometria (mas também padrões restritivos e mistos) e que há razão para a reabilitação pulmonar. Fornecemos também uma lista de variáveis a serem discutidas em futuros estudos sobre reabilitação pulmonar em pacientes com sequelas pós-tuberculose.
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http://dx.doi.org/10.1590/S1806-37562016000000226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094875PMC
July 2017

Roadmap for tuberculosis elimination in Latin American and Caribbean countries: a strategic alliance.

Eur Respir J 2016 11;48(5):1282-1287

World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy

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http://dx.doi.org/10.1183/13993003.01549-2016DOI Listing
November 2016

Factors Associated With Non-compliance of Asbestos Occupational Standards in Brake Repair Workers.

Ann Occup Hyg 2016 Oct 27;60(8):1020-35. Epub 2016 May 27.

1.Department of Civil and Environmental Engineering, Universidad de Los Andes, Carrera 1 Este #19A-40 ML328, Bogotá 111711, Colombia;

Asbestos and non-asbestos containing brake products are currently used in low- and middle-income countries like Colombia. Because brake products are distributed detached from their supports, they require manipulation before installation, which release fibers and expose workers. Previous studies of our research group have documented exposures in excess of the widely accepted 0.1 f/cm(3) exposure guideline. The aim of this study is to identify factors associated with non-compliance of the 8-h time weighted average (TWA) 0.1 f/cm(3) asbestos occupational limit among brake mechanics (i.e. riveters). Eighteen brake repair shops (BRS) located in Bogotá (Colombia) were sampled during 3 to 6 consecutive days for the entire work-shift. Personal and short-term personal samples were collected following NIOSH methods 7400 and 7402. Longitudinal based logistic regression models were used to determine the association between the odds of exceeding the 8-h TWA 0.1 f/cm(3) asbestos occupational limit and variables such as type of tasks performed by workers, workload (number of products manipulated daily), years of experience as riveters, and shop characteristics. These models can be used to estimate the odds of being currently or historically overexposed when sampling data do not exist. Since the information required to run the models can vary for both retrospective and current asbestos occupational exposure studies, three models were constructed with different information requirements. The first model evaluated the association between the odds of non-compliance with variables related to the workload, the second model evaluated the association between the odds of non-compliance with variables related to the manipulation tasks, and the third model evaluated the association between the odds of non-compliance with variables related with both the type of tasks performed by workers and the workload. Variables associated with the odds of non-compliance included conducting at least one manipulation activity with beveling and grinding of asbestos and non-asbestos containing brake products during the work shift, the location of the worker in the shop during non-manipulation activities, cleaning activities of the manipulation area, the years of experience working as riveters, and the number of asbestos and non-asbestos containing brake products manipulated daily. These models could be useful for current and retrospective occupational studies, in determining the odds of non-compliance of the asbestos occupational limit among brake mechanics.
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http://dx.doi.org/10.1093/annhyg/mew028DOI Listing
October 2016

Is Chronic Obstructive Pulmonary Disease Caused by Wood Smoke a Different Phenotype or a Different Entity?

Arch Bronconeumol 2016 Aug 17;52(8):425-31. Epub 2016 May 17.

Fundación Neumológica Colombiana, Universidad de La Sabana, Bogotá, Colombia.

Around 40% of the world's population continue using solid fuel, including wood, for cooking or heating their homes. Chronic exposure to wood smoke is a risk factor for developing chronic obstructive pulmonary disease (COPD). In some regions of the world, this can be a more important cause of COPD than exposure to tobacco smoke from cigarettes. Significant differences between COPD associated with wood smoke (W-COPD) and that caused by smoking (S-COPD) have led some authors to suggest that W-COPD should be considered a new COPD phenotype. We present a review of the differences between W-COPD and S-COPD. On the premise that wood smoke and tobacco smoke are not the same and the physiopathological mechanisms they induce may differ, we have analyzed whether W-COPD can be considered as another COPD phenotype or a distinct nosological entity.
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http://dx.doi.org/10.1016/j.arbres.2016.04.004DOI Listing
August 2016

Virus and Mycoplasma pneumoniae prevalence in a selected pediatric population with acute asthma exacerbation.

J Asthma 2016 22;53(3):253-60. Epub 2016 Jan 22.

b Molecular Diagnostics and Bioinformatics Laboratory, Biological Sciences Department , Faculty of Science, Universidad de los Andes , Bogotá , Colombia.

Objective: To determine the prevalence of viral and atypical bacteria Mycoplasma pneumoniae infection in children experiencing asthma exacerbation and compare positive and negative subjects with regard to exacerbation severity, need for hospitalization, and treatment.

Methods: One hundred sixty-nine asthmatic children aged 2-15 years old who were admitted to emergency rooms in Bogota, Colombia for acute asthma exacerbation were interviewed. Nasopharyngeal aspirates were taken for DNA and RNA extraction. M. pneumoniae and virus were detected by PCR using specific primers.

Results: The prevalence of M. pneumoniae and viral infection in the study population was 12.4% and 83.7%, respectively. All subjects positive for M. pneumoniae were also positive for viral infection. Rhinovirus was the most frequently detected viral agent. No significant differences in severity of asthma exacerbations or in need for hospitalization between the virus or M. pneumoniae positive and negative groups were observed. A significantly lower percentage of M. pneumoniae positive subjects had used inhaled steroids over the six months prior to asthma exacerbation compared to M. pneumoniae negative subjects (38.1% vs. 68.2%), suggesting that inhaled corticosteroids may have a protective effect against M. pneumoniae infections.

Conclusions: The M. pneumoniae and virus prevalence found in this study were similar to those described in the literature. The 100% co-infection rate observed suggests that viral infection can predispose patients to M. pneumoniae infection, and that this interaction may trigger asthmatic exacerbation. Further studies should be done to confirm the protective effect of inhaled corticosteroids on M. pneumoniae infection in patients with asthma exacerbations.
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http://dx.doi.org/10.3109/02770903.2015.1075548DOI Listing
August 2016

Prevalence, risk factors and underdiagnosis of asthma and wheezing in adults 40 years and older: A population-based study.

J Asthma 2015 Oct 21;52(8):823-30. Epub 2015 May 21.

a Research Department, Fundacion Neumologica Colombiana , Bogota , Colombia .

Objective: There are differences in the prevalence and risk factors of asthma around the world. The epidemiological situation of adults 40 years and older is not well established. Our aim was to determine the prevalence, underdiagnosis and risk factors of asthma and wheezing in adults in Colombia.

Methods: A cross-sectional, population-based study including 5539 subjects from 40 to 93 years selected by a probabilistic sampling technique in five cities was conducted.

Measurements: respiratory symptoms and risk factors questionnaire and spirometry.

Definitions: (a) Wheezing: Affirmative answer to the question "have you ever had two or more attacks of "wheezes" causing you to feel short of breath?" (b) Asthma: Wheezing definition and FEV1/FVC post-bronchodilator ≥ 70%. (c) Underdiagnosis: Asthma definition without a physician-diagnosis. Logistic regression was used for exploring risk factors.

Results: Prevalence of asthma was 9.0% (95% CI: 8.3-9.8) and wheezing 11.9% (95% CI: 11.0-12.8). Asthma underdiagnosis was 69.9% and increased to 79.0% in subjects 64 years or older. The risk factors related to asthma and/or wheezing were: living in Bogota or Medellin, female gender, first degree relative with asthma, respiratory disease before 16 years of age, obesity, no education, indoor wood smoke exposure and occupational exposure to dust particles, gases or fumes.

Conclusion: We described the epidemiologic situation of asthma in adults 40 years and older in Colombia. In addition to some recognized risk factors, our data supports the association of indoor wood smoke and occupational exposures with asthma and wheezing. Underdiagnosis of asthma in adults was high, particularly in older subjects.
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http://dx.doi.org/10.3109/02770903.2015.1010733DOI Listing
October 2015

Determinants of underdiagnosis of COPD in national and international surveys.

Chest 2015 Oct;148(4):971-985

Oregon Health & Science University, Portland, OR.

Background: COPD ranks within the top three causes of mortality in the global burden of disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations.

Methods: We analyzed representative samples of adults aged ≥ 40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Postbronchodilator FEV1/FVC < lower limit of normal (LLN) was used to define chronic airflow limitation consistent with COPD. Undiagnosed COPD was considered when participants had postbronchodilator FEV1/FVC < LLN but were not given a diagnosis of COPD.

Results: Among 30,874 participants with a mean age of 56 years, 55.8% were women, and 22.9% were current smokers. Population prevalence of (spirometrically defined) COPD ranged from 3.6% in Barranquilla, Colombia, to 19.0% in Cape Town, South Africa. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, whereas 9.7% had a postbronchodilator FEV1/FVC < LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed, with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, Kentucky (50.0%). In multivariate analysis, a greater probability of underdiagnosis of COPD was associated with male sex, younger age, never and current smoking, lower education, no previous spirometry, and less severe airflow limitation.

Conclusions: Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Because effective management strategies are available for COPD, spirometry can help in the diagnosis of COPD at a stage when treatment will lead to better outcomes and improved quality of life.
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http://dx.doi.org/10.1378/chest.14-2535DOI Listing
October 2015

Overnight Polysomnographic Characteristics and Oxygen Saturation of Healthy Infants, 1 to 18 Months of Age, Born and Residing At High Altitude (2,640 Meters).

Chest 2015 Jul;148(1):120-127

Servicio de Sueño y Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia; Universidad La Sabana, Bogotá, Colombia.

Background: Approximately 8% of the world population resides above 1,600 m, with about 10 million people living above 2,500 m in Colombia. However, reference values for polysomnography (PSG) and oxygen saturation (Spo2) of children < 2 years old residing at high altitude are currently unavailable.

Methods: Healthy infants aged 1 to 18 months born and residing at high altitude (Bogotá: 2,640 m) underwent overnight PSG. Four age groups were defined: group 1, < 45 days; group 2, 3 to 4 months; group 3, 6 to 7 months; and group 4, 10 to 18 months. Of 122 children enrolled, 50 had three consecutive PSG tests and were analyzed as a longitudinal subcohort.

Results: A total of 281 PSG tests were performed in 122 infants (56% girls): group 1, 106 PSG tests; group 2, 89 PSG tests; group 3, 61 PSG tests; and group 4, 25 PSG tests. Active sleep diminished and quiet sleep increased with maturation. Apnea-hypopnea indexes (total, central, and obstructive) were highest in group 1 (21.4, 12.4, and 6.8/h total sleep time, respectively) and diminished with age (P < .001). Mean Spo2 during waking and sleep increased with age (P < .001). Nadir Spo2 values during respiratory events were lower in younger infants. Longitudinal assessments of 50 infants confirmed the temporal trends described for the cross-sectional dataset.

Conclusions: Healthy infants (≤ 18 months old) born and residing at high altitude show preserved sleep architecture but higher apnea-hypopnea indexes and more prominent desaturation with respiratory events than do those living at low altitude. The current study findings can be used as reference values for infants at high altitude.
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http://dx.doi.org/10.1378/chest.14-3207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493868PMC
July 2015

Towards tuberculosis elimination: an action framework for low-incidence countries.

Eur Respir J 2015 Apr;45(4):928-52

University of Brescia, Brescia, Italy.

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards "pre-elimination" (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions.
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http://dx.doi.org/10.1183/09031936.00214014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391660PMC
April 2015

ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers.

Arch Bronconeumol 2015 Aug 14;51(8):403-16. Epub 2015 Jan 14.

Hospital Universitario de Caracas, Universidad Central de Venezuela, y Centro Médico Docente La Trinidad, Caracas, Venezuela.

ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting.
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http://dx.doi.org/10.1016/j.arbres.2014.11.017DOI Listing
August 2015

Wood smoke COPD: a new description of a COPD phenotype?

Eur Respir J 2014 Jul;44(1):261-2

Research Dept, Fundación Neumologica Colombiana, Bogota, Colombia.

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http://dx.doi.org/10.1183/09031936.00222913DOI Listing
July 2014

Sleep apnea and oxygen saturation in adults at 2640 m above sea level.

Sleep Sci 2014 Jun 16;7(2):103-6. Epub 2014 Sep 16.

Sleep Laboratory, Fundación Neumológica Colombiana (FNC), Colombia.

Purpose: To describe the SpO2 in wakefulness, sleep and during the apnea-hypopnea in adults living in Bogotá, located at 2640 m above sea level.

Methods: Descriptive observational study in adults referred for polysomnogram (PSG). A normal Apnea hypopnea index (AHI) was defined as ≤5 and obstructive sleep apnea (OSA) was classified as mild (AHI 5-15), moderate (AHI 15-30), and severe (AHI >30). T-test or ANOVA test for SpO2 differences between groups was used.

Results: 1799 patients, 33% women. 222 (12.8%) did not have OSA (normal IAH), 268 (14.9%) mild OSA, 315 (17.5%) moderate ,and 993 (55.2%) severe. In all cases a low SpO2 (SpO2<90%) was found. The SpO2 was lower when the AHI was higher, in wakefulness, in non-REM and in REM (p<0.001). For all grades of severity, SpO2 decreased significantly from wakefulness to non-REM sleep and to REM sleep (p<0.001). Patients with severe OSA had higher desaturation during wakefulness (85.2±6.6%), non-REM sleep (83.1±7.7%), REM sleep (78.8±10.2), and during events (75.1±9.1%).

Conclusions: Patients with OSA at 2640 m have nocturnal desaturation lower than 88%, which decreases with higher severity of OSA. The clinical impact of sleep disorders at this point may be greater than at sea level and should be studied.
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http://dx.doi.org/10.1016/j.slsci.2014.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521663PMC
June 2014
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