Background: Epidemiologic studies have reported that the geographical distribution of the prevalence of allelic variants of serine protein inhibitor-A1 (SERPINA1) and severe cases of COVID-19 were similar. Methods: A multicenter, cross-sectional, observational study to evaluate the frequency of alpha-1 antitrypsin deficiency (AATD) in patients with COVID-19 and whether it was associated with having suffered severe COVID-19. Results: 2022 patients who had laboratory-confirmed SARS-CoV-2 infection. Mutations associated with AATD were more frequent in severe COVID versus non-severe (23% vs. 18.8%, p = 0.022). The frequency of Pi*Z was 37.8/1000 in severe COVID versus 17.5/1000 in non-severe, p = 0.001. Having an A1AT level below 116 was more frequent in severe COVID versus non-severe (29.5% vs. 23.1, p = 0.003). Factors associated with a higher likelihood of severe COVID-19 were being male, older, smoking, age-associated comorbidities, and having an A1AT level below 116 mg/dL [OR 1.398, p = 0.003], and a variant of the SERPINA1 gene that could affect A1AT protein [OR 1.294, p = 0.022]. Conclusions: These observations suggest that patients with AATD should be considered at a higher risk of developing severe COVID-19. Further studies are needed on the role of A1AT in the prognosis of SARS-CoV-2 infection and its possible therapeutic role.

Background: Vitamin D deficiency has been associated with an accelerated deterioration in lung function and increased exacerbations in chronic obstructive pulmonary disease (COPD). 25(OH) vitamin D levels have been indicated as a potentially useful marker for adverse results related to COPD. Methods: VITADEPOC is a cross-sectional clinical study recruiting consecutive patients with high-risk COPD. The objective of our study was to investigate vitamin D determination frequency in patients with high-risk COPD in clinical practice at outpatient clinics in Spain and to describe the factors associated with vitamin D testing. We also aimed to determine the frequency of vitamin D deficiency in these patients. Results: Only 51 (44%) patients underwent vitamin D determination and 33 (28.4%) had received vitamin D supplements in clinical practice. The patients who underwent testing for vitamin D in clinical practice were more often women (58.8% vs. 26.2%, p < 0.001) with comorbidities such as osteoporosis (19.6% vs. 6.2%, p < 0.001) or chronic renal failure (7.8% vs. 0%, p < 0.001) and with exacerbator phenotype (55% vs. 32.3%, p = 0.015). A total of 63 (54.3%) patients had serum vitamin D levels <20 ng/mL at the inclusion visit. Of these, 29 (46%) had serum vitamin D levels <12 ng/mL (severe deficiency). Having a history of inhaled corticosteroids (OR 3.210, p < 0.016), being treated with a cycle of systemic corticosteroids (OR 2.149, p < 0.002), and having a lower physical activity level (OR 3.840, p < 0.004) showed a statistically significant positive association with vitamin D deficiency. Conclusion: The testing of vitamin D levels in patients with high-risk COPD treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, a severe deficiency is detected in one in four patients. Efforts to optimize case detection in COPD are needed.

Background: Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder associated with an increased risk of developing chronic obstructive pulmonary disease (COPD) with variable phenotypic expression among different genotypes. While the PiZZ genotype is well characterized, the clinical and structural progression of PiSZ individuals remains less defined. This study evaluates genotype-specific disease trajectories and the impact of augmentation therapy over a two-year follow-up. Methods: A prospective observational cohort study was conducted, including 74 AATD patients (41 PiSZ, 33 PiZZ), stratified by augmentation therapy status. Disease progression was assessed through lung function decline (forced expiratory volume in one second [FEV1], diffusing capacity for carbon monoxide [DLCO], carbon monoxide transfer coefficient [KCO]) and densitometric changes (15th percentile lung density [PD-15], percentage of lung voxels below −950 Hounsfield units [HU-950]). Mixed-effects models and multivariable regression analyses were performed to evaluate genotype-specific progression patterns and treatment effects. Results: Results: PiZZ individuals exhibited significantly greater annual decline in lung function and densitometric parameters compared to PiSZ individuals, with more pronounced loss in basal lung regions and with greater decline in advanced stages, in contrast to the PiSZ genotype, which showed greater progression in earlier stages. Augmentation therapy was associated with a significant reduction in PD-15 decline in both genotypes, with the greatest benefit observed in PiZZ patients and in those diagnosed within five years of disease onset. Smoking and frequent exacerbations were identified as independent risk factors for accelerated disease progression. Conclusions: PiZZ individuals experience a more aggressive disease trajectory than PiSZ individuals in the absence of treatment. Augmentation therapy effectively mitigates disease progression in both genotypes, with greater efficacy when initiated early. Smoking and frequent exacerbations were identified as independent risk factors for accelerated disease progression. These findings underscore the importance of genotype-specific monitoring and personalized therapeutic strategies in AATD to optimize clinical outcomes.

Introduction: The worldwide pandemic, coronavirus disease 2019 (COVID-19) is a novel infection with serious clinical manifestations, including death. Our aim is to describe the first non-ICU Spanish deceased series with COVID-19, comparing specifically between unexpected and expected deaths. Methods: In this single-centre study, all deceased inpatients with laboratory-confirmed COVID-19 who had died from March 4 to April 16, 2020 were consecutively included. Demographic, clinical, treatment, and laboratory data, were analyzed and compared between groups. Factors associated with unexpected death were identified by multivariable logistic regression methods. Results: In total, 324 deceased patients were included. Median age was 82 years (IQR 76–87); 55.9% males. The most common cardiovascular risk factors were hypertension (78.4%), hyperlipidemia (57.7%), and diabetes (34.3%). Other common comorbidities were chronic kidney disease (40.1%), chronic pulmonary disease (30.3%), active cancer (13%), and immunosuppression (13%). The Confusion, BUN, Respiratory Rate, Systolic BP and age ≥65 (CURB-65) score at admission was >2 in 40.7% of patients. During hospitalization, 77.8% of patients received antivirals, 43.3% systemic corticosteroids, and 22.2% full anticoagulation. The rate of bacterial co-infection was 5.5%, and 105 (32.4%) patients had an increased level of troponin I. The median time from initiation of therapy to death was 5 days (IQR 3.0–8.0). In 45 patients (13.9%), the death was exclusively attributed to COVID-19, and in 254 patients (78.4%), both COVID-19 and the clinical status before admission contributed to death. Progressive respiratory failure was the most frequent cause of death (92.0%). Twenty-five patients (7.7%) had an unexpected death. Factors independently associated with unexpected death were male sex, chronic kidney disease, insulin-treated diabetes, and functional independence. Conclusions: This case series provides in-depth characterization of hospitalized non-ICU COVID-19 patients who died in Madrid. Male sex, insulin-treated diabetes, chronic kidney disease, and independency for activities of daily living are predictors of unexpected death.

Introduction: The gold standard test for diagnosing Obstructive sleep apnea (OSA) is polysomnography (PSG); though due to high demand, portable equipment, such as respiratory polygraphy, have been developed. KαLinix® is an intelligent, portable, non-invasive medical device (Upper Airway Stimulation - UAS) that detects episodes of apnea and hypoapnea and provides a diagnosis by measuring an apnea-hyponea index (AHI). Material and Methods: Observational clinical study of diagnostic intervention with a medical device (KαLinix® in 20 patients with suspected OSA (intermediate and high risk by StopBang questionnaire). The objective was to compare the detection and classification of the severity of OSA between the device under study (KαLinix®) and the classical method of PSG carried out simultaneously, on the same night and at home. Results: 20 patients were evaluated (85% male, with a mean age of 56.05 years, an average BMI of 28.6 Kg / m2). Both devices classified practically the same as the 20 patients, except in a case in which PSG considered it moderate, with an IAH of 29.1, and KαLinix® considered it serious with an IAH of 33.8. The correlation coefficient between both methods was 0.97, with a strong linear relationship between the measurement of IAH in both devices and statistically very significant (p-value <0.0001). The agreement between both devices using a regression model was 1.07 (0.93, 1.21). Conclusions: The KαLinix® team has demonstrated a very good correlation and concordance with the gold standard method for the diagnosis of OSA(PSG).

Introduction: Physical activity (AF) is the best predictor of survival in patients with COPD. We aimed to assess the impact on the level of PA, symptoms and health-related quality of life (HRQOL) following a program of physical training and orientation in community self-administered structured physical activity (ACTIVEPOC Program). Material and Methods: Prospective intervention study conducted in patients with COPD. An educational and training program was offered during 8 sessions of 45 minutes that were taught during a month and that included general and specific aerobic training techniques of the peripheral musculature, to be carried out at home and self-administered. Results: A total of 133 patients were evaluated (mean age 67 ± 7 years, 66.9% were women, average BMI of 27.19 kg / m2, 10% active smokers, with a predicted median FEV1 54% (18- 109), and dyspnea grade2 in 77.51%, 56% were treated with double bronchodilation and 22.6% triple therapy). At the beginning, they presented a CAT of 13 ± 6.5; EUROQOL 5D of 0.88 ± 0.12, HADS of 5.03 ± 3.71 in the anxiety subscale. 47.2% were sedentary according to the YALE questionnaire, with a C-PPAC score of 33.87 ± 7.76 and an average number of steps / day of 4102.41 ± (1786). At 3 months, they reached clinically relevant changes in degree of dyspnea (≥1 degree MRC) 59.8%, in CAT (≥2 points) 59.6%, in EUROQOL 5D, in 43.03% and in HAD, 42% of patients. In physical activity, at 3 months only 24.4% were sedentary by Yale questionnaire, and the C-PPAC was 38.5 ± 5.79. 81% of patients improved more than 1100 steps a day. Conclusions: The ACTIVEPOC program has proven effective in improving the level of PA, symptoms and health-related quality of life (HRQOL) in patients with COPD.