The progression of amyotrophic lateral sclerosis (ALS): respiratory function
Evolución de la esclerosis lateral amiotrófica a través de la función pulmonar
Read
10366
Timeswas read the article
1736
Total PDF
8630
Total HTML
Share statistics
array:19 [ "pii" => "13046511" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-07-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:327-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5468 "formatos" => array:3 [ "EPUB" => 106 "HTML" => 4773 "PDF" => 589 ] ] "itemSiguiente" => array:15 [ "pii" => "13046510" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-07-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:327" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2452 "formatos" => array:3 [ "EPUB" => 108 "HTML" => 1770 "PDF" => 574 ] ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Alveolar proteinosis or the importance of identifying concurrent infections" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "327" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Proteinosis alveolar o la importancia de identificar infecciones sobreañadidas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S Mayoralas, L Gómez, S Díaz" "autores" => array:3 [ 0 => array:2 [ "Iniciales" => "S" "apellidos" => "Mayoralas" ] 1 => array:2 [ "Iniciales" => "L" "apellidos" => "Gómez" ] 2 => array:2 [ "Iniciales" => "S" "apellidos" => "Díaz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13046510?idApp=UINPBA00003Z" "url" => "/15792129/0000003900000007/v0_201307090915/13046510/v0_201307090915/en/main.assets" ] "itemAnterior" => array:15 [ "pii" => "13046509" "issn" => "15792129" "estado" => "S300" "fechaPublicacion" => "2003-07-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2003;39:324-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3622 "formatos" => array:3 [ "EPUB" => 135 "HTML" => 2566 "PDF" => 921 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Occupational asthma in food packers" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "324" "paginaFinal" => "326" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asma ocupacional en envasadores de alimentos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "X Muñoz, M J Cruz, M Albanell, F Morell" "autores" => array:4 [ 0 => array:2 [ "Iniciales" => "X" "apellidos" => "Muñoz" ] 1 => array:2 [ "Iniciales" => "M J" "apellidos" => "Cruz" ] 2 => array:2 [ "Iniciales" => "M" "apellidos" => "Albanell" ] 3 => array:2 [ "Iniciales" => "F" "apellidos" => "Morell" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13046509?idApp=UINPBA00003Z" "url" => "/15792129/0000003900000007/v0_201307090915/13046509/v0_201307090915/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "The progression of amyotrophic lateral sclerosis (ALS): respiratory function" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "327" "paginaFinal" => "328" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "S Mayoralas, M A Gómez, S Díaz" "autores" => array:3 [ 0 => array:3 [ "Iniciales" => "S" "apellidos" => "Mayoralas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "M A" "apellidos" => "Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "S" "apellidos" => "Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Neumología. Hospital Universitario La Paz. Madrid. Spain." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución de la esclerosis lateral amiotrófica a través de la función pulmonar" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold"> To the Editor:</span> We would like to offer a few comments on the article by Salord et al<span class="elsevierStyleSup">1</span>, which we feel to be of great interest. The authors report the evolution of respiratory function in a 26-year-old patient with amyotrophic lateral sclerosis (ALS) from the time that he is diagnosed until his death from respiratory failure. For a period of just over five years they monitor the gradual reduction of spirometric parameters, maximal respiratory pressures and maximum voluntary ventilation. They also highlight the appearance of a pattern of instability in the upper respiratory tract 18 months into the illness. At the end of the article the authors suggest that these values should be included among the variables regularly used to follow the progression of this illness. However, we were surprised by the absence of any reference to certain aspects that we consider to be fundamental in monitoring the progress of these patients.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> 1</span>. There is a surprising lack of data related to pulmonary gas exchange, which we think are very important in monitoring the progress of patients with ALS. We are referring in particular to arterial blood gas values and nocturnal pulse oximetry readings. According to the scientific evidence at our disposal, it is advisable to initiate the use of noninvasive ventilatory support systems when PaCO<span class="elsevierStyleInf">2</span> is greater than 45 mmHg, when the nocturnal pulse oximeter shows oxygen saturation levels of less than 88% over 5 consecutive minutes, when forced vital capacity (FVC) is less than 50%, or when the maximal inspiratory muscle pressure is less than 60 cm H<span class="elsevierStyleInf">2</span>O<span class="elsevierStyleSup">2</span>. The lack of information on these aspects prevents us from knowing how long the patient suffered from respiratory insufficiency before he died and whether he received any kind of ventilatory support.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> 2</span>. According to the available data on the progression of respiratory function in the patient, vital capacity was 43% and maximal inspiratory pressure 44 cm H<span class="elsevierStyleInf">2</span>O in September 1993, nearly three years before death. According to the criteria mentioned above, he should then have received noninvasive mechanical ventilation (NIV)<span class="elsevierStyleSup">3</span>. The authors should have made some mention of this stating whether or not they started mechanical ventilation and if so what effect it had on the patient's evolution. They should also have mentioned whether they considered providing a tracheostomy at any point.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> 3</span>. The pathophysiology of respiratory failure in patients suffering from neuromuscular diseases is a complex subject. It may include changes in the mechanical properties of the respiratory system, the appearance of signs of muscle fatigue, changes in respiratory control, changes in nocturnal pulmonary gas exchange causing decreased sensitivity of both central and peripheral chemical receptors, and upper respiratory tract dysfunction<span class="elsevierStyleSup">4</span>. Nocturnal respiratory support has proved to be effective in correcting daytime respiratory failure in these patients, probably because it has a greater or lesser effect on the diverse mechanisms involved. This is why it is important to evaluate all aspects of a patient's pulmonary function and not just the spirometric parameters. In the absence of other data indicating the need to initiate NIV, it may make sense to use spirometric parameters to detect a reduction of FVC to 50% in time, but it makes no sense after this point.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"> 4.</span> As the authors say, ALS can progress at different rates. As well as the slowly progressive forms of the illness, we sometimes see forms that start with acute respiratory failure. For these patients diagnosis takes place when the patient has already undergone a tracheostomy and is in an intensive care unit<span class="elsevierStyleSup">5,6</span>. On other occasions bulbar symptoms predominate. In many cases it is impossible to carry out spirometric measurements and the only techniques available for evaluating the patient's respiratory capacity are pulse oximetry and arterial blood gasometry. We find it difficult to understand the need for recording the spirometric measurements of a patient every 3-4 months until the time of death.</p><p class="elsevierStylePara">To sum up, we think that the assessment of ALS patients should be a comprehensive process in which spirometric parameters and maximal muscle pressures assessed at regular intervals do not necessarily play the most important part. Perhaps we should give priority to assessing the right moment for starting mechanical ventilation, to improving the mechanisms for effective coughing, to providing patients and families with reliable and complete information on the progression of the illness and its consequences, and to obtaining informed consent if the time comes to decide whether to create a tracheostomy or simply to accept a dignified death.</p>" "pdfFichero" => "260v39n07a13046511pdf001.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Evolución de la esclerosis lateral amiotrófica a través de la función pulmonar." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Salord N" 1 => "Miralda RM" 2 => "Casan P." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2002" "volumen" => "38" "paginaInicial" => "452" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12237018" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal 0hypoventilation. A consensus conference report." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Consensus Conference." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1999" "volumen" => "116" "paginaInicial" => "521" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10453883" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "¿Ventilación mecánica no invasiva o no invasora?" "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Díaz Lobato S" 1 => "Gómez Mendieta MA" 2 => "Mayoralas Alises S." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2001" "volumen" => "37" "paginaInicial" => "52" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11181234" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Fisiopatología de la insuficiencia respiratoria de origen neuromuscular." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Díaz Lobato S" 1 => "Ruiz Cobos MA" 2 => "García Río F" 3 => "Villamor J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2001" "volumen" => "32" "paginaInicial" => "91" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11293110" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Aplicaciones de la ventilación mecánica no invasiva en pacientes que reciben ventilación endotraqueal." "idioma" => "es" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Díaz Lobato S" 1 => "Gómez Mendieta MA" 2 => "Mayoralas Alises S." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2002" "volumen" => "38" "paginaInicial" => "281" "paginaFinal" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12113744" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Long-term mechanical ventilation in amyotrophic lateral sclerosis." "idioma" => "en" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Escarrabill J" 1 => "Estopa R" 2 => "Farrero E" 3 => "Monasterio C" 4 => "Manresa F." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "1998" "volumen" => "92" "paginaInicial" => "438" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9692102" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000003900000007/v0_201307090915/13046511/v0_201307090915/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000003900000007/v0_201307090915/13046511/v0_201307090915/en/260v39n07a13046511pdf001.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13046511?idApp=UINPBA00003Z" ]
Article information
ISSN: 15792129Original language: English
The statistics are updated each day
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 47 | 14 | 61 |
| 2024 September | 43 | 10 | 53 |
| 2024 August | 63 | 36 | 99 |
| 2024 July | 45 | 25 | 70 |
| 2024 June | 55 | 25 | 80 |
| 2024 May | 59 | 31 | 90 |
| 2024 April | 35 | 27 | 62 |
| 2024 March | 53 | 24 | 77 |
| 2024 February | 41 | 35 | 76 |
| 2023 April | 0 | 1 | 1 |
| 2023 March | 9 | 0 | 9 |
| 2023 February | 84 | 37 | 121 |
| 2023 January | 55 | 25 | 80 |
| 2022 December | 69 | 28 | 97 |
| 2022 November | 66 | 21 | 87 |
| 2022 October | 76 | 30 | 106 |
| 2022 September | 87 | 20 | 107 |
| 2022 August | 79 | 32 | 111 |
| 2022 July | 79 | 45 | 124 |
| 2022 June | 62 | 26 | 88 |
| 2022 May | 95 | 36 | 131 |
| 2022 April | 114 | 24 | 138 |
| 2022 March | 115 | 35 | 150 |
| 2022 February | 100 | 20 | 120 |
| 2022 January | 102 | 30 | 132 |
| 2021 December | 98 | 39 | 137 |
| 2021 November | 77 | 35 | 112 |
| 2021 October | 101 | 41 | 142 |
| 2021 September | 90 | 42 | 132 |
| 2021 August | 89 | 28 | 117 |
| 2021 July | 127 | 22 | 149 |
| 2021 June | 141 | 26 | 167 |
| 2021 May | 124 | 22 | 146 |
| 2021 April | 224 | 100 | 324 |
| 2021 March | 120 | 11 | 131 |
| 2021 February | 75 | 15 | 90 |
| 2021 January | 118 | 15 | 133 |
| 2020 December | 94 | 7 | 101 |
| 2020 November | 78 | 11 | 89 |
| 2020 October | 68 | 8 | 76 |
| 2020 September | 90 | 4 | 94 |
| 2020 August | 81 | 8 | 89 |
| 2020 July | 82 | 17 | 99 |
| 2020 June | 67 | 6 | 73 |
| 2020 May | 92 | 23 | 115 |
| 2020 April | 78 | 13 | 91 |
| 2020 March | 78 | 7 | 85 |
| 2020 February | 82 | 19 | 101 |
| 2020 January | 78 | 11 | 89 |
| 2019 December | 109 | 15 | 124 |
| 2019 November | 117 | 16 | 133 |
| 2019 October | 775 | 14 | 789 |
| 2019 September | 50 | 8 | 58 |
| 2019 August | 39 | 18 | 57 |
| 2019 July | 40 | 14 | 54 |
| 2019 June | 37 | 10 | 47 |
| 2019 May | 48 | 15 | 63 |
| 2019 April | 85 | 14 | 99 |
| 2019 March | 56 | 9 | 65 |
| 2019 February | 46 | 18 | 64 |
| 2019 January | 52 | 18 | 70 |
| 2018 December | 51 | 17 | 68 |
| 2018 November | 40 | 12 | 52 |
| 2018 October | 56 | 13 | 69 |
| 2018 September | 39 | 6 | 45 |
| 2018 May | 26 | 2 | 28 |
| 2018 April | 51 | 4 | 55 |
| 2018 March | 42 | 3 | 45 |
| 2018 February | 51 | 4 | 55 |
| 2018 January | 54 | 8 | 62 |
| 2017 December | 53 | 4 | 57 |
| 2017 November | 62 | 2 | 64 |
| 2017 October | 45 | 7 | 52 |
| 2017 September | 50 | 6 | 56 |
| 2017 August | 69 | 3 | 72 |
| 2017 July | 51 | 1 | 52 |
| 2017 June | 61 | 6 | 67 |
| 2017 May | 75 | 4 | 79 |
| 2017 April | 84 | 3 | 87 |
| 2017 March | 60 | 16 | 76 |
| 2017 February | 128 | 5 | 133 |
| 2017 January | 59 | 5 | 64 |
| 2016 December | 60 | 5 | 65 |
| 2016 November | 101 | 10 | 111 |
| 2016 October | 109 | 8 | 117 |
| 2016 September | 156 | 7 | 163 |
| 2016 August | 80 | 5 | 85 |
| 2016 July | 51 | 7 | 58 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 4 | 0 | 4 |
| 2015 October | 41 | 8 | 49 |
| 2015 September | 51 | 5 | 56 |
| 2015 August | 34 | 11 | 45 |
| 2015 July | 42 | 9 | 51 |
| 2015 June | 86 | 4 | 90 |
| 2015 May | 69 | 4 | 73 |
| 2015 April | 42 | 9 | 51 |
| 2015 March | 31 | 7 | 38 |
| 2015 February | 40 | 4 | 44 |
| 2015 January | 34 | 2 | 36 |
| 2014 December | 32 | 6 | 38 |
| 2014 November | 47 | 3 | 50 |
| 2014 October | 55 | 13 | 68 |
| 2014 September | 48 | 4 | 52 |
| 2014 August | 59 | 8 | 67 |
| 2014 July | 57 | 8 | 65 |
| 2014 June | 51 | 3 | 54 |
| 2014 May | 56 | 10 | 66 |
| 2014 April | 59 | 11 | 70 |
| 2014 March | 67 | 5 | 72 |
| 2014 February | 57 | 10 | 67 |
| 2014 January | 45 | 7 | 52 |
| 2013 December | 39 | 8 | 47 |
| 2013 November | 28 | 9 | 37 |
| 2013 October | 32 | 6 | 38 |
| 2013 September | 40 | 11 | 51 |
| 2013 August | 27 | 8 | 35 |
| 2013 July | 38 | 17 | 55 |
| 2013 June | 38 | 6 | 44 |
| 2013 May | 33 | 4 | 37 |
| 2013 April | 29 | 2 | 31 |
| 2013 March | 10 | 4 | 14 |
Show all
