Anxiety disorders, characterized by excessive fear and anxiety, are increasingly recognized as significant comorbidities in chronic diseases such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the prevalence of anxiety in COPD patients referred from primary care centers to pulmonology services and to identify predictive factors for anxiety. This was a multicentric, observational, and prospective study in which 293 COPD patients were recruited, and they underwent comprehensive respiratory and smoking histories, spirometry, and anxiety assessments using the Hospital Anxiety and Depression Scale (HADS). The results showed a diagnosis of suspected anxiety in 85 patients (29.0%): 17 possible and 68 with a strong suspicion. The study found significant associations between anxiety and factors such as gender (women had a risk that was 3.5 times higher than men), weight, and body mass index (BMI). Disease severity, smoking status, and clinical manifestations did not significantly influence anxiety prevalence. These findings underscore the need for systematic psychological evaluations in COPD management and support the use of simple diagnostic tools like the HADS to facilitate referrals to mental health services. Addressing anxiety in COPD patients could potentially improve their quality of life and disease outcomes. This study highlights the importance of a multidisciplinary approach involving family medicine, pulmonology, and psychiatry to optimize COPD patient care and suggests that future research should focus on the impact of anxiety treatment on COPD progression. These insights call for integrating psychological assessments into routine clinical practice for comprehensive COPD management. The registration number is 10.14201/gredos.148549.

Apomorphine is a potent dopaminergic agonist widely used in the management of motor fluctuations in advanced Parkinson's disease. Although generally well tolerated, rare pulmonary adverse drug reactions (ADRs) may occur. We report a case of probable apomorphine-induced pneumonitis associated with subcutaneous administration. A 62-year-old Caucasian male with multiple comorbidities presented to the emergency department with headache, non-productive cough, central chest pain, fever, and dyspnea over the past 48 hours (3 weeks after initiation of subcutaneous apomorphin). Chest X-ray revealed bilateral hilar infiltrates and basal consolidation. CT scan showed organizing pneumonia (OP)-like pattern. Extensive microbiological evaluation of bronchoalveolar lavage and bronchial aspirate samples, including bacterial, fungal, mycobacterial, viral, and atypical pathogen testing, was negative. Lack of response to broad-spectrum antibiotics raised the suspicion of drug-induced pneumonitis due to subcutaneous apomorphine. Antibiotics were discontinued, and corticosteroid therapy (methylprednisolone 40 mg/day) was initiated with gradual tapering resulted in rapid clinical improvement and complete radiological resolution within one month. The temporal relationship between apomorphine initiation and symptom onset, compatible clinical and radiological findings, extensive microbiological exclusion of infectious causes, and favorable response after drug withdrawal and corticosteroid therapy supported the diagnosis of probable apomorphine-induced pneumonitis.

Anxiety disorders, characterized by excessive fear and anxiety, are increasingly recognized as significant comorbidities in chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD). This study aimed to evaluate the prevalence of anxiety in COPD patients referred from primary care centers to pulmonology services and identify predictive factors for anxiety. Conducted as a multicentric, observational, and prospective study, 293 COPD patients were recruited, undergoing comprehensive respiratory and smoking histories, spirometry, and anxiety assessments using the Hospital Anxiety and Depression Scale (HADS). These results show: a diagnosis of suspected anxiety in in 85 patients (29.0%): 17 possible and 68 with a strong suspicion. The study found significant associations between anxiety and factors such as gender (women showed a risk 3.5 times higher than men), weight, and body mass index (BMI). Disease severity, smoking status, and clinical manifestations did not significantly influence anxiety prevalence. The findings underscore the need for systematic psychological evaluations in COPD management, advocating for the use of simple diagnostic tools like the HADS to facilitate referrals to mental health services. Addressing anxiety in COPD patients could potentially improve their quality of life and disease outcomes. The study highlights the importance of a multidisciplinary approach involving family medicine, pulmonology, and psychiatry to optimize COPD patient care and suggests future research should focus on the impact of anxiety treatment on COPD progression. These insights call for integrating psychological assessments into routine clinical practice for comprehensive COPD management.

Introduction: Nicotine dependence assessment is essential in smoking cessation programs. The Fagerström Test for Nicotine Dependence (FTND) is widely used, but its subjective nature limits accuracy. Biomarkers such as cotinine, exhaled carbon monoxide (CO), and carboxyhemoglobin (COHb) provide objective measures of tobacco exposure and dependence. Methods: A prospective observational study was conducted at the Smoking Cessation Unit of Salamanca University Hospital from 2009 to 2022. A total of 3820 smokers were included. Demographic data, smoking history, and dependence level were recorded. Biomarkers, including serum cotinine, exhaled CO and COHb, were measured. The correlation between biomarkers and FTND scores was analyzed. Results: Cotinine levels showed the strongest correlation with FTND scores (r = 0.302, p < 0.001), followed by COHb (r = 0.234, p < 0.001) and exhaled CO (r = 0.219, p < 0.001). Conclusion: Biomarkers offer a reliable alternative to subjective nicotine dependence assessments. Cotinine proved to be the most accurate marker. Integrating biomarkers into clinical practice could improve cessation outcomes by enabling personalized treatment strategies.