CARTA AL DIRECTOR

 

About the article "Acute exacerbation of Chronic Obstructive Pulmonary Disease in Dr. León Cuervo Rubio hospital"

 

A propósito del artículo "Exacerbación aguda de la enfermedad pulmonar obstructiva crónica en el hospital Dr. León Cuervo Rubio"

 

 

Angel Ernesto Ramos-Cordero11, Sergio Luis Blanco Betancourt1

1Medical Science University of Pinar del Rio. Medical Science Faculty "Dr. Ernesto Che Guevara de la Serna". Pinar del Ro. Cuba angel94@infomed.sld.cu

 

 

Received: September 21, 2018
Accepted: October 21, 2018
Published: January 1, 2019


Dear Director

We have read with great interest the article "Acute Exacerbation of Chronic Obstructive Pulmonary Disease at Dr. León Cuervo Rubio Hospital”(1). We believe that the work contributes to a better understanding and an approach to the morbidity and the mortality rates caused by chronic obstructive pulmonary disease (COPD) in the Cuban archipelago and specifically in Pinar del Ro province.

We congratulate the authors for starting in the clinical-epidemiological study of this disease from an early age in their profession as physicians, taking into account the elements of union and rupture with respect to their typical presentation, as well as the use of conceptual criteria based on the European and North American Societies for pulmonary diseases, who are authorities on this subject matter.

The variables used allow us to know of the main trends regarding risk factors, comorbidities, clinical behavior and treatment of COPD in the territory, gaining quality and scope when choosing Len Cuervo Rubio Hospital as a setting for the research, due to the experience of their professionals in the care of this health condition.

From our point of view, we believe that it would be worthwhile to comment on some results that we find interesting, such is the case of the distribution per ages in the sample, which deflects our thinking away from the fact that COPD is a disease of the long-term smokers(2), since it is increasingly observed in patients under 65 years old, representing the 15.7 % in the present study.

COPD is a process that is not completely reversible, due to it would be pertinent to generalize the main causes that led to its exacerbation, given that it is a significant element in establishing the conduct to be followed.

Regarding the use of antimicrobials, they will be taken into account whenever the infection is suspected, with findings such as the presence of leukocytosis and radiographic alterations, and in the clinical order, the presence of two of the following signs: increased dyspnea, increased volume of purulence sputum, sputum expectoration and fever(2,3), the analysis of the use of low antibiotic treatment (only in 101 patients), since at least 66.1 % (186 patients) of the sample presented increasing expectoration and dyspnea, and where 50.6 % (142 patients) presented at least worsening in dyspnea and sputum changes, regardless of having or not fever before or during hospital admission.

In short, the work of the authors is very interesting in order to guide us on the clinical and epidemiological behavior to be followed, as well as to take therapeutic actions regarding COPD management among the internists and general physicians who are dedicated or will be practicing in a short time the comprehensive care of respiratory diseases.

We are in the presence of an excellent study, transcendent in the effort to find another approach concerning the management of this health condition; which is so frequent in our environment. Our better understanding will allow guiding the future lines of research on this topic and other related ones.

 

BIBLIOGRAPHIC REFERENCES

1. Pando Hernández EY, Miló Valdés CA, Díaz Fuentes MF, Herrera Suarez A, Díaz Alfonso H. Exacerbación aguda de la enfermedad pulmonar obstructiva crónica en el hospital Dr. León Cuervo Rubio. Revista Universidad Médica Pinareña [Internet]. 2018 [citado 20, septiembre 2018]; 14(2): 139-147. Disponible en: http://galeno.pri.sld.cu/index.php/galeno/article/view/492

2. Noya Chaveco ME, Moya Lorenzo NL. Insuficiencia Respiratoria. Temas de Medicina Interna Tomo I, 5t edición. La Habana: Editorial Ciencias Médicas; 2017. p. 167-173

3. Farreras Valentí P, Rozman C. Medicina Interna 17ma ed. España: Elsevier; 2012 Vol. I p. 660- 668

 

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