Publications by authors named "Maria Victorina Lopez-Varela"

Objective: To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points.

Methods: In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores.

Results: Among the 734 patients with COPD, 61% were male, age 69.

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Reduced physical activity (PA) is an independent risk factor for lung function decline, hospitalization and mortality in chronic obstructive pulmonary disease (COPD) and affects a large proportion of patients from Europe and the United States. However, little is known of the level of PA of COPD patients in Latin America. The aim of this study was to provide information of the level of PA and its determinants in COPD patients in Latin America.

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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.

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Article Synopsis
  • A seven-item questionnaire was created to help detect COPD in primary care settings across four Latin American countries, focusing on factors like smoking and respiratory symptoms.
  • The study aimed to externally validate this questionnaire on two populations: one from a primary care facility and another from a general population.
  • Results showed varying prevalence rates of COPD in both groups and identified effective cut-points for the questionnaire, indicating that it can help in early detection and intervention for COPD in different clinical settings.
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Background: Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region.

Methods: This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries.

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Background: To analyse the relationship between symptoms at different times during the 24-hour day and outcomes in COPD.

Methods: Observational cross-sectional study in a patients from 7 Latin American countries. The frequency of symptoms in the morning, at night and during the day was explored by means of standardised and validated questionnaires, and the relationship between symptoms and exacerbations and quality of life were investigated.

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Background: This study assessed the adherence profiles to inhaled therapies and the agreement between two patient self-report adherence methods in stable COPD lpatients from seven Latin American countries.

Methods: This observational, cross-sectional, multinational, multicenter study involved 795 COPD patients (post-bronchodilator forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] <0.70).

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Background: The evidence indicates that risk factors other than smoking are important in the development of COPD. It has been postulated that less traditional risk factors (eg, exposure to coal and/or biomass smoke) may interact with smoking to further increase COPD risk. This analysis evaluated the effect of exposure to biomass and smoking on COPD risk in a primary care setting in Latin America.

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Article Synopsis
  • Lung function decline is a key factor in the development of Chronic Obstructive Pulmonary Disease (COPD), based on data from two surveys of 2026 adults in Latin America.
  • The study found that mean annual post BronchoDilator (postBD) FEV1 decline was similar in individuals with and without COPD, influenced by factors like baseline lung function and smoking habits.
  • Overall, the decline in lung function was linked to higher initial lung capacity, older age, and respiratory issues, being particularly pronounced in smokers and elderly patients.
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  • Asthma-COPD overlap syndrome (ACOS) prevalence varies based on population and definitions, with a study in Latin America indicating a 5.3% prevalence in the general population and higher rates among those with COPD.
  • In the obstructive population, ACOS prevalence climbed to 17.9% and 9.9%, while in those with COPD, rates reached 26.5% and 11.3% depending on definitions used.
  • Patients with ACOS defined by specific criteria showed poorer lung function and experienced significantly more exacerbations compared to COPD patients alone, suggesting a need for tailored clinical approaches.
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Background: COPD, asthma, and asthma-COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting.

Objectives: To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma-COPD overlap.

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  • The study compares two classification systems (GOLD and ALAT) for assessing the stages of COPD in a primary-care population.
  • Findings reveal that while the GOLD system categorizes most patients into the milder stages (groups A and B), ALAT identifies a higher proportion of patients as moderate to severe.
  • The research suggests that future evaluations of ALAT's classification should focus on how well it predicts hospitalization and mortality outcomes for COPD patients.
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  • The PUMA study, conducted in Argentina, Colombia, Venezuela, and Uruguay, aimed to identify the prevalence of chronic obstructive pulmonary disease (COPD) among high-risk individuals visiting primary care, regardless of symptoms.
  • A total of 1,743 subjects took part, revealing a COPD prevalence of 20.1% when using a specific diagnostic criteria, demonstrating significant variations across the countries studied.
  • The study concluded that a simple seven-item scoring system effectively predicts COPD risk and can help prioritize individuals for further spirometry testing in primary care settings.
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  • Bronchodilators (BDs) are essential for COPD treatment, yet their underuse is prevalent in real-life scenarios, as highlighted by the PUMA study across several Latin American countries.
  • The study surveyed and conducted spirometry on patients aged 40 or older at risk for COPD, revealing that only about 25% of those diagnosed with COPD used BDs, with short-acting BDs being the most common.
  • Having health insurance with medication coverage significantly increased the likelihood of BD use among patients with COPD.
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Background: Acknowledgement of COPD underdiagnosis and misdiagnosis in primary care can contribute to improved disease diagnosis. PUMA is an international primary care study in Argentina, Colombia, Venezuela and Uruguay.

Objectives: To assess COPD underdiagnosis and misdiagnosis in primary care and identify factors associated with COPD underdiagnosis in this setting.

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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.

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Article Synopsis
  • The study aimed to find out if COPD and reduced lung function can predict mortality rates in different cohorts from Montevideo, Santiago, and Sao Paulo over 5-9 years.
  • Key findings indicated that COPD significantly increased the risk of overall mortality and specifically cardiovascular death, particularly in patients with more severe stages (GOLD 2-4) of the disease.
  • The results suggest that low FEV1 is a critical indicator for both overall and respiratory mortality, while FVC showed no significant association with overall mortality levels.
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Background: The PLATINO baseline study, conducted from 2003-2005 in five Latin American cities (São Paulo, Mexico City, Montevideo, Santiago, Caracas), showed a high prevalence of chronic obstructive pulmonary disease (COPD).

Methods/design: A follow-up study was conducted in three out of the five centers (Montevideo, Santiago, and São Paulo) after a period of 5, 6 and 9years, respectively, aimed at verifying the stability of the COPD diagnosis over time, the evolution of the disease in terms of survival, morbidity and respiratory function, and the analyses of inflammatory and genetic biomarkers in the blood. Some questions were added to the original questionnaire and death certificates were obtained from the national official registries.

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Background: Several COPD phenotypes have been described; the COPD-asthma overlap is one of the most recognized. The aim of this study was to evaluate the prevalence of three subgroups (asthma, COPD, and COPD-asthma overlap) in the Latin American Project for the Investigation of Obstructive Lung Disease (PLATINO) study population, to describe their main characteristics, and to determine the association of the COPD-asthma overlap group with exacerbations, hospitalizations, limitations due to physical health, and perception of general health status (GHS).

Methods: The PLATINO study is a multicenter population-based survey carried out in five Latin American cities.

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Article Synopsis
  • The study compares the reliability of two spirometry test ratios, FEV1/FEV6 and FEV1/FVC, for detecting airway obstruction.
  • Over a period of 5-9 years, the prevalence of COPD was reassessed in three Latin American cities, showing significant fluctuations when using the FEV1/FVC ratio compared to smaller changes with the FEV1/FEV6 ratio.
  • The findings suggest that the FEV1/FEV6 index is more stable and reliable for diagnosing COPD since it accounts for variations in forced vital capacity caused by exhalation duration.
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Introduction: Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD), and have a significant impact on health status and prognosis. The PLATINO study provides data on self-reported comorbidities and perceived health status in COPD subjects.

Methods: PLATINO is a population-based study on COPD prevalence in five Latin American cities.

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Objectives: We aimed to describe the distribution of self-reported sleep duration in adults over the age of 40 years and to analyze the associated risk factors, comorbid conditions, and quality of life (QoL).

Methods: Our study was constructed as a cross-sectional population-based study and is part of the PLATINO (Spanish acronym for the Latin American Project for Research in Pulmonary Obstruction) study. It includes data from Mexico City (Mexico), Montevideo (Uruguay), Santiago (Chile), and Caracas (Venezuela).

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