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Background The survival of women with cystic fibrosis (CF) is lower than that of men by approximately 5 years. While various factors have been put forward to account for this discrepancy, no specific reasons have been established. Our hypothesis was that anatomical-structural involvement is more pronounced in women with CF than in men and that this is reflected in thoracic HRCT findings. Material and methods We performed a prospective multicentre study, in which adult patients were consecutively included over 18 months. Chest HRCT was performed, and findings were scored by 2 thoracic radiologists using the modified Bhalla system. We also studied respiratory function, applied the CFQR 14+ questionnaire, and collected clinical variables. Results Of the 360 patients followed up in the participating units, 160 were eventually included. Mean age was 28 years, and 47.5% were women. The mean ± SD global score on the modified Bhalla score was 13.7 ± 3.8 in women and 15.2 ± 3.8 in men (p = 0.024). The highest scores were observed for sacculations, bronchial generations, and air trapping in women. Women had lower BMI, %FEV1, %FVC, and %DLCO. Similarly, the results for the respiratory domain in CFQR 14+ were worse in women, who also had more annual exacerbations. Conclusions This is the first study to provide evidence of the implication of sex differences in HRCT findings in patients with CF. Women with CF present a more severe form of the disease that results in more frequent exacerbations, poorer functional and nutritional outcomes, deterioration of quality of life, and greater structural damage.

Resumen: El asma, la enfermedad pulmonar obstructiva crónica y las bronquiectasias son las tres patologías inflamatorias crónicas más frecuentes de la vía aérea, que además pueden coexistir en un mismo paciente. La prevalencia de bronquiectasias en pacientes con enfermedad pulmonar obstructiva crónica es elevada, sobre todo en aquellos más graves. Actualmente contamos con evidencias suficientes para afirmar que los pacientes con enfermedad pulmonar obstructiva crónica y bronquiectasias presentan un fenotipo clínico especial, caracterizado por mayor sintomatología, mayor número de exacerbaciones, mayor porcentaje de infección bronquial crónica, peor función pulmonar, peor pronóstico y mayor mortalidad. Todo ello tiene importantes implicaciones en el manejo de los pacientes y hace necesario el diseño de estrategias terapéuticas específicas. Quedan aún muchas cuestiones a las cuales responder, como son los mecanismos fisiopatológicos implicados en la posible causalidad.En cambio, sobre la relación entre asma y bronquiectasias encontramos mucha menor evidencia científica. La prevalencia de bronquiectasias en pacientes con asma es elevada, principalmente en los pacientes con asma grave no controlada y se relaciona con peores parámetros de salud, niveles más bajos de fracción exhalada de óxido nítrico y mayor porcentaje de infección bronquial crónica. Son necesarios estudios que aporten luz sobre los mecanismos fisiopatológicos implicados y sobre el impacto de la presencia de bronquiectasias en el pronóstico, así como para diseñar estrategias terapéuticas específicas para estos pacientes. Abstract: Asthma, chronic obstructive pulmonary disease, and bronchiectasis are the three most frequent chronic inflammatory diseases of the airway and can coexist in the same patient. Bronchiectasis is highly prevalent in patients with chronic obstructive pulmonary disease, especially in the most severe cases. Sufficient evidence is currently available to claim that patients with chronic obstructive pulmonary disease and bronchiectasis have a particular clinical phenotype, characterized by more severe symptoms, more exacerbations, more chronic bronchial infections, worse lung function, worse prognosis, and higher mortality. This has important implications for patient management and requires specific therapeutic strategies to be developed. There are still many questions to answer, such as the pathophysiological mechanisms involved in possible causality.Far less scientific evidence is available on the association between asthma and bronchiectasis. Bronchiectasis is highly prevalent in patients with asthma, particularly in uncontrolled severe asthma. It is associated with worse health parameters, lower levels of exhaled fraction of nitric oxide, and higher rates of chronic bronchial infection. Studies are needed to clarify the pathophysiological mechanisms involved and the impact of bronchiectasis on prognosis. Specific therapeutic strategies must be designed for these patients.

Introduction Sexual limitations play an important role in the quality of life of patients with chronic diseases. Very limited information is available on the impact of asthma on the sexual functioning of these individuals. Materials and methods Cross-sectional, observational, multicenter study. Asthma patients and healthy individuals were recruited. All subjects participated in an interview in which demographic and clinical data were recorded, and completed the Goldberg Anxiety-Depression Scale (GADS) to evaluate the presence of concomitant psychiatric disease. Men also completed the International Index of Erectile Function (IIEF), and women, the Female Sexual Function Index (FSFI). Results A total of 276 cases were included, comprising 172 asthma patients (63 men and 109 women) with a mean age of 42 (±14) years, and 104 controls (52 men and 51 women) with a mean age of 39 (±12) years. Time since onset of asthma was 15 years and severity distribution was: 6.4% intermittent, 17.9% mild persistent, 47.4% moderate, and 28.2% severe. Disease was considered controlled in 57.7%, partially controlled in 28.2%, and uncontrolled in 14.1%. Women with asthma had greater sexual limitations than women in the control group, with a total FSFI score of 22.1 (±9) compared to 26.5 (±6.8), respectively (P Conclusions Asthma is associated with a poorer sexual quality of life among patients. These results should arouse the interest of healthcare professionals in detecting and alleviating possible sexual limitations among their asthma patients in routine clinical practice.

Resumen Introduccion Las limitaciones de la vida sexual de los pacientes con enfermedades cronicas desempenan un importante papel en su calidad de vida. La informacion disponible sobre el impacto de la enfermedad asmatica en la vida sexual de las personas es muy limitada. Material y metodos Estudio transversal, observacional y multicentrico. Se reclutaron pacientes asmaticos y sujetos sanos, a los que se les efectuo una entrevista en la que se recogieron datos demograficos y clinicos y en donde ademas cumplimentaron los siguientes cuestionarios: la escala Goldberg Anxiety -Depression Scale (GADS) para la valoracion de la existencia de comorbilidad psiquiatrica, y en varones el Indice Internacional de la Funcion Erectil (IIEF) y en mujeres el Indice de la Funcion Sexual Femenina (FSFI). Resultados Se incluyeron un total de 276 casos, de los que 172 eran asmaticos (63 hombres y 109 mujeres) con una media de edad de 42 (± 14) anos y 104 controles (53 hombres y 51 mujeres) con una media de edad de 39 (± 12) anos. El asma presentaba una evolucion de 15 anos y su gravedad se distribuia: 6,4% intermitente, 17,9% persistente leve, 47,4% moderada y 28,2% grave. La enfermedad se considero controlada en un 57,7%, parcialmente controlada en un 28,2% y no controlada en un 14,1%. Las mujeres asmaticas presentaron una mayor limitacion de la vida sexual que las mujeres del grupo control, con una puntuacion total del FSFI de 22,1 (± 9) frente a 26,5 (± 6,8), respectivamente (p Conclusiones La enfermedad asmatica condiciona una peor calidad de vida sexual en las personas afectadas. Estos resultados deberian promover, en la practica clinica habitual, el interes de los profesionales sanitarios por determinar y paliar las posibles limitaciones sexuales de sus pacientes con asma.

Objetivo La desnutricion es frecuente en pacientes con fibrosis quistica (FQ) e implica un desequilibrio entre la ingesta y los requerimientos. Nuestro objetivo ha sido calcular el gasto energetico en reposo (GER) mediante calorimetria indirecta en adultos con FQ, compararlo con las formulas estimativas habitualmente empleadas y valorar la influencia de parametros clinicos sobre el GER. Pacientes y metodos Estudiamos a 21 pacientes con FQ que se encontraban estables clinicamente. Se efectuaron medidas de parametros antropometricos, dinamometria de mano, impedanciometria bioelectrica y del GER medido por calorimetria indirecta (CI) . Estudiamos la concordancia entre los valores del GER medidos y estimados por las formulas de la Organizacion Mundial de la Salud (OMS) y de Harris- Benedict (HB) mediante el coeficiente de correlacion intraclase y el metodo de Bland-Altman. Resultados Las ecuaciones infraestimaron el GER en mas del 90% de los casos. La concordancia entre la CI y la estimada por las formulas fue escasa (para OMS, 0,47, y para HB, 0,41). Mediante el metodo de Bland-Altman observamos un sesgo variable entre la CI y las formulas, independiente de los valores del GER. La diferencia entre la CI respecto de la estimada por la formula de la OMS fue significativamente mayor en homocigoticos ΔF508 y en los pacientes con insuficiencia pancreatica exocrina frente al resto. Conclusiones En adultos con FQ, las formulas de la OMS y de HB infraestiman el GER. Hay una baja concordancia entre los valores del GER medidos y estimados. La infraestimacion fue mayor en pacientes con insuficiencia pancreatica exocrina y en homocigoticos ΔF508.

OBJECTIVE Undernutrition, which implies an imbalance between energy intake and energy requirements, is common in patients with cystic fibrosis. The aim of this study was to compare resting energy expenditure determined by indirect calorimetry with that obtained with commonly used predictive equations in adults with cystic fibrosis and to assess the influence of clinical variables on the values obtained. PATIENTS AND METHODS We studied 21 patients with clinically stable cystic fibrosis, obtaining data on anthropometric variables, hand grip dynamometry, electrical bioimpedance, and resting energy expenditure by indirect calorimetry. We used the intraclass correlation coefficient (ICC) and the Bland–Altman method to assess agreement between the values obtained for resting energy expenditure measured by indirect calorimetry and those obtained with the World Health Organization (WHO) and Harris–Benedict prediction equations. RESULTS The prediction equations underestimated resting energy expenditure in more than 90% of cases. The agreement between the value obtained by indirect calorimetry and that calculated with the prediction equations was poor (ICC for comparisons with the WHO and Harris–Benedict equations, −; 0.47 and 0.41, respectively). Bland–Altman analysis revealed a variable bias between the results of indirect calorimetry and those obtained with prediction equations, irrespective of the resting energy expenditure. The difference between the values measured by indirect calorimetry and those obtained with the WHO equation was significantly larger in patients homozygous for the ΔF508 mutation and in those with exocrine pancreatic insufficiency. CONCLUSIONS The WHO and Harris–Benedict prediction equations underestimate resting energy expenditure in adults with cystic fibrosis. There is poor agreement between the values for resting energy expenditure determined by indirect calorimetry and those estimated with prediction equations. Underestimation was greater in patients with exocrine pancreatic insufficiency and patients who were homozygous for Δ F508.