This document provides a summary of topics in pulmonology including smoking, chronic cough, COPD, asthma, bronchiectasis, pneumonia, tuberculosis, lung cancer, pulmonary fibrosis, and sleep apnea. It discusses the health effects of smoking and reviews several recent research studies on the links between smoking and mortality from various diseases. It also examines the impact of smoking on gender differences in life expectancy and the relationship between smoking and survival after a breast cancer diagnosis.

1. 1
NEUMOLOGIA
:UPDATE
2016
(COSECHA
DEL
15-­‐16)
Josep
Morera
BARCELONA
3
Junio
2016

2. 2
CONTENIDO
-­‐ Tabaquismo
-­‐ Tos
crónica
-­‐ EPOC
-­‐ Asma
Bronquial
-­‐ Bronquiectasias
-­‐ Neumonía
-­‐ Tuberculosis
-­‐ Cáncer
de
Pulmón
-­‐ Fibrosis
Pulmonar
-­‐ SLEEP
–APNEA
-­‐
Conclusiones

3. 3
Tabaquismo
The
art
of
medicine
The
cigarePe
catastrophe
conQnues
The
lancet
Vol
385
March14,2015
Robert
N
Proctor

4. 4
Tabaquismo
To
the
Editor:
In
their
nice
editorial
in
the
March
issue
of
the
Journal,
Kiley
and
colleagues
(1)
list
the
strategic
prioriRes
and
procedures
of
the
NaRonal
Heart,
Lung,
and
Blood
InsRtute
(NHLBI)
to
streamline
human
health
research
up
to
2025.
From
a
historical
perspecRve,
we
all
recognize
the
significant
achievements
of
the
U.S.
NaRonal
InsRtutes
of
Health
and
the
NHLBI,
with
decades
of
success,
that
have
facilitated
breakthroughs
in
promoRng
health
and
fighRng
disease
by
funding
key
research
both
internally
and
extramurally,
including
internaRonally.
However,
we
were
surprised
that
the
(magical)
keyword
“tobacco”
was
not
menQoned
at
all
within
this
short
document,
so
anyone
might
wonder,
what
if
.
.
.
the
NHLBI
considers
tobacco?
Likely,
beyond
your
pages,
some
readers
in
the
sister,
simultaneous
publicaRons
in
the
American
Journal
of
Public
Health,
Blood,
CirculaRon,
or
the
Journal
of
the
American
College
of
Cardiology
might
consider
that
tobacco
affects
paRents
in
most
(all?)
respiratory
and
nonrespiratory
condiRons.
We
must
keep
reminding
ourselves
that
tobacco
is
the
first
and
foremost
causal,
avoidable
risk
factor
for
human
disease.
Perhaps
it
has
been
neglected
too
oaen
in
the
past
in
many
medical
venues
(2,
3).
Therefore,
the
NHLBI
should
welcome
iniRaRves
on
key
tobacco-­‐related
translaRonal
issues
as
well
as
on
the
efficacy
and
the
effecRveness
of
any
smoking
reducRon
and/or
avoidance
intervenRons,
in
addiRon
to
iniRaRves
on
any
other
risk
factors
to
help
define
smoking
issues
at
the
populaRon
and
individual
levels.
Well
past
the
so-­‐called
cigarede
century
(4),
tobacco
is
sRll
causally
linked
to
an
increasing
number
of
diseases
(5).
Although
there
have
been
some
recent
successes
in
the
West,
there
are
more
smokers
nowadays
than
ever
before
in
human
history,
causing
far
too
many
premature
deaths
and
disabiliRes
(6).
We
strongly
believe
that
research
drives
all
health
advocacy
and
that
the
final
soluRon
to
the
tobacco
problem
will
be
through
legislaRon
(7).
Rephrasing
the
introductory
paragraphs
of
the
editorial,
“Imagine
a
world
with
no
tobacco,
and
later,
perhaps
only
one
generaRon
aaer,
a
no-­‐tobacco-­‐related-­‐disease
world.”
Wouldn’t
it
be
nice?
We
can
set
this
objecRve
within
our
lifeRme,
and
certainly
we
will
parRcipate
in
this
process
(8).
Volume
191,
Issue
1(June
15,
2015)
Soriano
and
Morera
What
if
.
.
.
the
NaQonal
Heart,
Lung,
and
Blood
InsQtute
Considers
Tobacco?
Joan
B.
Soriano
M.D.
and
Josep
Morera
M.D.

5. 5
Tabaquismo

6. 6
Tabaquismo
Smoking
and
Mortality
—
Beyond
Established
Causes
Brian
D.
Carter,
ChrisRan
C.
Abnet,
Diane
Feskanich,
Neal
D.
Freedman.,
Patricia
Hartge,
Sc.D.,
Cora
E.
Lewis,
M.D.,
Judith
K.
Ockene,
Ross
L.
PrenRce.,
Frank
E.
Speizer,,
Michael
J.
Thun,
and
Eric
J.
Jacobs.
N
Engl
J
Med
2015;
372:
February
12,
In
conclusion,
this
comprehensive
examinaRon
of
cause-­‐specific
mortality
in
a
large
contemporary
populaRon
idenRfied
associaRons
between
smoking
and
increased
mortality
from
several
diseases
that
are
not
currently
established
as
caused
by
smoking.
Although
these
associaRons
should
be
invesRgated
further,
our
results
suggest
that
the
number
of
persons
in
the
United
States
who
die
each
year
as
a
result
of
smoking
cigaredes
may
be
substanRally
greater
than
currently
esRmated.

7. 7
Tabaquismo
The
impact
of
smoking
on
gender
differences
in
life
expectancy:
more
heterogeneous
than
ofen
stated
Marc
Luy
and
ChrisRan
Wegner-­‐Siegmundt
Eur
J
Public
Health.
2015
Aug
Smoking
and
survival
afer
breast
cancer
diagnosis
in
Japanese
women:
A
prospecQve
cohort
study
Yoichiro
Kakugawa,
Masaaki
Kawai,
Yoshikazu
Nishino
Kayoko
Fukamachi,
Takanori
Ishida,
Noriaki
Ohuchi,
and
Yuko
Minami
Cancer
Sci.
2015
Aug;
106(8):
1066–1074.

8. 8
Tos
crónica
Pregabalin
and
Speech
Pathology
CombinaQon
Therapy
for
Refractory
Chronic
Cough:
A
Randomized
Controlled
Trial.
VerRgan
AE1,
Kapela
SL2,
Ryan
NM3,
Birring
SS4,
McElduff
P5,
Gibson
PG6.
Chest.
2016
Mar

9. 9
EPOC
Lung-­‐FuncQon
Trajectories
Leading
to
Chronic
ObstrucQve
Pulmonary
Disease.
Lange
P1,
Celli
B,
Agusr
A,
Boje
Jensen
G,
Divo
M,
Faner
R,
Guerra
S,
Marod
JL,
MarRnez
FD,
MarRnez-­‐Camblor
P,
Meek
P,
Owen
CA,
Petersen
H,
Pinto-­‐Plata
V,
Schnohr
P,
Sood
A,
Soriano
JB,
Tesfaigzi
Y,
Vestbo
J.
N
Engl
J
Med.
2015
Jul

10. 10
EPOC
FluQcasone
furoate
and
vilanterol
and
survival
in
chronic
obstrucQve
pulmonary
disease
with
heightened
cardiovascular
risk
(SUMMIT):
a
double-­‐blind
randomised
controlled
trial
Jorgen
Vestbo,
Julie
A
Anderson,
Robert
D
Brook,Peter
M
A
Calverley,
B.Celli,
Courtney
Crim,
Fernando
MarRnez,
Julie
Yates,
David
E
Newby,
on
behalf
of
the
SUMMIT
InvesRgators.
The
lancet.
April
2016

11. 11
EPOC

12. 12
EPOC
Indacaterol-­‐Glycopyrronium
versus
Salmeterol-­‐FluQcasone
for
COPD.
Wedzicha
JA1,
Banerji
D1,
Chapman
KR1,
Vestbo
J1,
Roche
N1,
Ayers
RT1,
Thach
C1,
Fogel
R1,
Patalano
F1,
Vogelmeier
CF1;
FLAME
InvesRgators.
N
Engl
J
Med.
2016
May
15

13. 13
EPOC
A
SystemaQc
Review
With
Meta-­‐Analysis
of
Dual
BronchodilaQon
With
LAMA/LABA
for
the
Treatment
of
Stable
COPD.
Calzeda
L,
Rogliani
P,
Matera
MG,
Cazzola
M.
Chest.
2016
May
CONCLUSIONS:
The
gradient
of
effecRveness
emerging
from
this
meta-­‐analysis
is
merely
a
weak
indicator
of
possible
differences
between
the
various
LAMA/LABA
FDCs.
Only
direct
comparisons
will
document
if
a
specific
LAMA/LABA
FDC
is
beder
than
the
other.
In
the
meanwhile,
we
believe
it
is
only
proper
to
consider
that
dual
bronchodilaRon
is
beder
than
a
LAMA
or
a
LABA
alone,
regardless
of
the
drugs
used.

14. 14
EPOC
The
Asthma–COPD
Overlap
Syndrome
Postma
DS,
Rabe
KF.
N
Engl
J
Med
2015;373:1241-­‐1249.

15. 15
EPOC

16. 16
Asma
bronquial
Risk
factors
for
asthma:
is
prevenQon
possible?
Beasley
R,
Semprini
A,
Mitchell
EA.
Lancet.
2015
Sep

17. 17
Asma
bronquial
A
systemaQc
review
of
socioeconomic
posiQon
in
relaQon
to
asthma
and
allergic
diseases.Uphoff,
Cabieses,
Pinart,
Valdés,
Antó,
Wright.
Eur
Respir
J.
2015
Aug.
Seung
of
research
conducted
on
asthma/allergies
and
socioeconomic
posiRon.
ISAAC:
InternaRonal
Study
of
Asthma
and
Allergies
in
Childhood.
Evidence
from
this
systemaQc
review
suggests
that
asthma
is
associated
with
lower
SEP,
whereas
the
prevalence
of
allergies
is
associated
with
higher
SEP.

18. 18
Asma
bronquial

19. 19
Asma
bronquial
Reduced
AnQviral
Interferon
ProducQon
in
Poorly
Controlled
Asthma
Is
Associated
With
Neutrophilic
InflammaQon
and
High-­‐Dose
Inhaled
CorQcosteroids.
Simpson
JL,
Carroll
M,
Yang
IA,
Reynolds
PN,
Hodge
S,
James
AL,
Gibson
PG,
Upham
JW.
Chest.
2016
Mar;
CONCLUSIONS:
AnRviral
type
I
IFN
producRon
is
impaired
in
those
with
neutrophilic
airway
inflammaRon
and
in
those
prescribed
high
doses
of
inhaled
corRcosteroids.
Our
study
is
an
important
step
toward
idenRfying
those
with
poorly
controlled
asthma
who
might
respond
best
to
inhaled
IFN
therapy
during
exacerbaRons.

20. 20
Asma
bronquial
PaPerns
of
Growth
and
Decline
in
Lung
FuncQon
in
Persistent
Childhood
Asthma.
McGeachie
MJ,
Yates
KP,
Zhou
X,
Guo
F,
Sternberg
AL,
Van
Nada
ML,
Wise
RA,
Szefler
SJ,
Sharma
S,
Kho
AT,
Cho
MH,
Croteau-­‐Chonka
DC,
Castaldi
PJ,
Jain
G,
Sanyal
A,
Zhan
Y,
Lajoie
BR,
Dekker
J,
Stamatoyannopoulos
J,
Covar
RA,
Zeiger
RS,
Adkinson
NF,
Williams
PV,
Kelly
HW,
Grasemann
H,
Vonk
JM,
Koppelman
GH,
Postma
DS,
Raby
BA,
Houston
I,
Lu
Q,
Fuhlbrigge
AL,
TanRsira
KG,
Silverman
EK,
Tonascia
J,
Weiss
ST,
Strunk
RC;
CAMP
Research
Group.
N
Engl
J
Med.
2016
May
12

21. 21
Bronquiectasias

22. 22
Bronquiectasias
Expert
Opin.
Emerging
Drugs
(2015)
20(2)

23. 23
Neumonía
Community-­‐acquired
pneumonia.
Prina
E,
Ranzani
OT,
Torres
A
Lancet.
2015
Sep
12;
Community-­‐Acquired
Pneumonia
Requiring
HospitalizaQon
among
U.S.
Adults.
Jain
S1,
Self
WH,
Wunderink
RG,
Fakhran
S,
Balk
R,
Bramley
AM,
Reed
C,
Grijalva
CG,
Anderson
EJ,
Courtney
DM,
Chappell
JD,
Qi
C,
Hart
EM,
Carroll
F,
Trabue
C,
Donnelly
HK,
Williams
DJ,
Zhu
Y,
Arnold
SR,
Ampofo
K,
Waterer
GW,
Levine
M,
Lindstrom
S,
Winchell
JM,
Katz
JM,
Erdman
D,
Schneider
E,
Hicks
LA,
McCullers
JA,
Pavia
AT,
Edwards
KM,
Finelli
L;
CDC
EPIC
Study
Team.
N
Engl
J
Med.
2015
Jul
30;373(5):415-­‐27.

24. 24
Tuberculosis
Treatment
of
Tuberculosis.
Horsburgh
CR
Jr,
Barry
CE,
Lange
C.
N
Engl
J
Med.
2015
Nov
26;373(22):2149-­‐60.
Tuberculosis.
Dheda
K,
Barry
CE,
Maartens
G.
Lancet.
2016
Mar
19;387(10024):1211-­‐26.

25. Adenocarcinoma
• Mixed subtype
• Acinar
• Papillary
• Bronchioloalveolar
• Solid
• Lepidic
• Acinar
• Papillary
• Micropapillary
• Solid
• Invasive
• Colloid
• Fetal
• Enteric
• Minimally invasive - MIA
– Non-mucinous
– Mucinous
• Preinvasive lesions
– Atypical adenomatous hyperplasia
– Adenocarcinoma in situ
• Non mucinous
• Mucinous
2004 2015
International Agency for Research on
Cancer
4th Edition
Cáncer
de
pulmón

26. Stage groups and subgroups according to TNM
Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191S–e210S

27. Lung carcinoma stages (I and II)
Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191S–e210S
Cáncer
de
pulmón

28. Lung carcinoma stages (III)
Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191S–e210S
Cáncer
de
pulmón

29. Lung carcinoma stages (IV)
Detterbeck et al. CHEST 2013; 143(5)(Suppl):e191S–e210S
Cáncer
de
pulmón

30. IASLC lymph node map
Detterbeck et al. CHEST 2013;
Cáncer
de
pulmón

31. J Pathol 2014; 232: 121–133
Immuno-regulatory antibodies for the treatment of cancer.
Honeychurch et al. Expert Opin Biol Ther. 2015 Jun;15(6):787-801.
PD-­‐1-­‐pathway
blockers
Cáncer
de
pulmón

32. Cáncer
de
pulmón
A
Bronchial
Genomic
Classifier
for
the
DiagnosQc
EvaluaQon
of
Lung
Cancer.
Silvestri
GA,
Vachani
A,
Whitney
D,
Elashoff
M,
Porta
Smith
K,
Ferguson
JS,
Parsons
E,
Mitra
N,
Brody
J,
Lenburg
ME,
Spira
A;
AEGIS
Study
Team.
N
Engl
J
Med.
2015
Jul
16;373(3):
Conclusions:
The
gene-­‐expression
classifier
improved
the
diagnosRc
performance
of
bronchoscopy
for
the
detecRon
of
lung
cancer.
In
intermediate-­‐risk
paRents
with
a
nondiagnosRc
bronchoscopic
examinaRon,
a
negaRve
classifier
score
provides
support
for
a
more
conservaRve
diagnosRc
approach.

33. Herth FJF, et al. Thorax 2015;70:326–332.
Cáncer
de
pulmón

34. 34
Cáncer
de
pulmón
Pembrolizumab
versus
docetaxel
for
previously
treated,
PD-­‐L1-­‐posiQve,
advanced
non-­‐small-­‐cell
lung
cancer
(KEYNOTE-­‐010):
a
randomised
controlled
trial.
Herbst
R,
Baas
P,
Kim
DW,
Felip
E,
Pérez-­‐Gracia
JL,
Han
JY,
Molina
J,
Kim
JH,
Arvis
CD,
Ahn
MJ,
Majem
M,
Fidler
MJ,
de
Castro
G
Jr,
Garrido
M,
Lubiniecki
GM
Shentu
Y,
Im
E,
Dolled-­‐Filhart
M,
Garon
EB
Lancet.
2016
Apr

35. Nanotechnology in respiratory
medicine
Omlor et al. Respiratory Research (2015)
Cáncer
de
pulmón

36. Fibrosis
pulmonar
CT
staging
and
monitoring
of
fibroQc
intersQQal
lung
diseases
in
clinical
pracQce
and
treatment
trials:
a
posiQon
paper
from
the
Fleischner
Society.
Hansell
DM,
Goldin
JG,
King
TE
Jr,
Lynch
DA,
Richeldi
L,
Wells
AU.
Lancet
Respir
Med.
2015
Jun;3(6):483-­‐96.

37. Fibrosis
pulmonar
CT
Imaging
Phenotypes
of
Pulmonary
Fibrosis
in
the
MUC5B
Promoter
Site
Polymorphism.
Chung
JH,
Peljto
AL,
Chawla
A,
Talbert
JL,
McKean
DF,
Rho
BH,
Fingerlin
TE,
Schwarz
MI,
Schwartz
DA,
Lynch
DA.
Chest.
2016
May;149(5):1215-­‐22.
ClassificaQon
of
usual
intersQQal
pneumonia
in
paQents
with
intersQQal
lung
disease:
assessment
of
a
machine
learning
approach
using
high-­‐dimensional
transcripQonal
data.
Kim
SY,
Diggans
J,
Pankratz
D,
Huang
J,
Pagan
M,
Sindy
N,
Tom
E,
Anderson
J,
Choi
Y,
Lynch
DA,
Steele
MP,
Flaherty
KR,
Brown
KK,
Farah
H,
Bukstein
MJ,
Pardo
A,
Selman
M,
Wolters
PJ,
Nathan
SD,
Colby
TV,
Myers
JL,
Katzenstein
AL,
Raghu
G,
Kennedy
GC.
Lancet
Respir
Med.
2015
Jun;3(6):473-­‐82.

38. Fibrosis
pulmonar
Drug
Treatment
of
Idiopathic
Pulmonary
Fibrosis:
SystemaQc
Review
and
Network
Meta-­‐Analysis.
Canestaro
WJ,
Forrester
SH,
Raghu
G,
Ho
L,
Devine
BE
Chest.
2016
Mar;149(3):756-­‐66.
CONCLUSIONS:
Although
two
treatments
have
been
approved
for
IPF
on
the
basis
of
reduced
decline
in
pulmonary
funcRon,
neither
one
has
a
clear
advantage
on
mortality
outcomes.

39. Sleep
-­‐Apnea
AdapQve
Servo-­‐VenQlaQon
for
Central
Sleep
Apnea
in
Systolic
Heart
Failure.
Cowie
MR,
Woehrle
H,
Wegscheider
K,
Angermann
C,
d'Ortho
MP,
Erdmann
E,
Levy
P,
Simonds
AK,
Somers
VK,
Zannad
F,
Teschler
H.
N
Engl
J
Med.
2015
Sep
17;373(12):1095-­‐105.

40. CONCLUSIONES
1.-­‐
Los
neumólogos
debemos
de
ser
implacables
contra
el
tabaco.
2.-­‐
La
prevalencia
de
la
mayoría
de
las
enfermedades
respiratorias
Qende
a
incrementarse.
3.-­‐
De
entre
todos
los
retos,
el
diagnosQco
precoz
y
el
tratamiento
del
cáncer
de
pulmón
es
probablemente
el
mas
importante.

41. 41
MUCHAS
GRACIAS
!!