CLAUDIA VALENZUELA – SEX WITH GYNECOLOGIST / SEXO CON EL GINECÓLOGO
In Spain, it is estimated that there are between 7,500 and 10,000 diagnosed patients of idiopathic pulmonary fibrosis that may also present different symptoms. Its progression is variable and unpredictable and with time the function lung deteriorates to talk about the latest developments. In this pathology, we have a claudio valenzuela as a counterpart of the disease unit diffuse interstitial lungs from the hospital’s pulmonology department university, the princess of madrid doctor hello, very good, good delighted to be with you. How is that operation of the unit of lung diseases diffuse intensities, good? The truth that we have good luck, because the units as such are being created, because I know now understands the diagnosis of interstitial diseases.
As a multidisciplinary diagnosis, where the leader of this group is the pulmonologist and therefore that is why we are lucky in the princess hospital to have our leader, who is the professor Ancochea? Who is the head of this team? And we also have with the presence of radiologists and pathologists, it would be the basic unit, multidisciplinary and in the hospital. We have this unit that consists of 22 pulmonologists of the square included two radiologists and a pathologist, and also we are incorporating other specialists who seem fundamental to us in the management of these patients, as is the nurse a nurse case manager, especially of patients who, with The advent of new treatments need a very close control and an almost monthly follow-up, with many analytics and reviews and, above all, healthy life advice, and that is the nurse, has a fundamental role in all this, and also with a psychologist who allows us to attend to The entire human aspect, and if, in any case, it is generated some kind of depression in these patients who have very illnesses severe and who need that psychological support. Fortunately, it is a necessity that there seems to be awareness that has created relatively recently this awareness.
The truth is that in the The world of the disease is special, and especially in pulmonary fibrosis, it has progressed well in the last decade and progress has been made. This multidisciplinary diagnosis, because they are very complex diseases, then already everyone is aware of the important role of radiology and, of course, the pulmonologist in it makes the differential diagnosis with other pathologies that can be similar, and that is why there is more and more to do That type of diagnosis and teamwork that is essential, precisely the diagnosis of fibrosis by practical way, especially in early stages of pathology. It is a challenge. It is not a challenge because we are arriving late. A lot is being worked on with the primary care physicians, with the different societies within the Spanish society of pulmonology and thoracic surgery, the societies of family, medicine and family medicine.
Doctors, because really since one consults a doctor for attention primary school until it reaches a specialized center, there are studies that show that there is a delay of almost two years, because this disease has symptoms that are very little is very specific. Really are symptoms such as fatigue is say, shortness of breath, which is called dyspnea. We also have a chronic cough and there is much more prevalent diseases that present the same symptoms as copd like asthma, then really a GP who is faced with many patients, have to think about this disease and have to have the basic elements such as spirometry. There is an x-ray of chest to be able to make a suspected diagnosis and send you quickly to the specialist and sometimes the same. Patients are not given count or importance.
200, because they are generally of an average age of 65 years and people who feel that they are thus unused to physical activity or that he’s getting older, he’s getting used to being a sport and soon it costs you much more and also minimizes the symptoms. Then, between that and the non-specificity of the symptoms for this pathology, since there is a delay in the diagnosis that is being worked on, so that it is thought more in fibrosis and a delay that influences in imagining the prognosis of the pathology if it influences independently. In the prognosis, the truth that ideopathic pure fibrosis is a very severe disease with a serious prognosis compared to even many types of cancer, a median survival between 3 and 5 years. But fortunately now we have treatments that in lenses in the disease progression, while preserving by slowing the loss of lung function, which is measured through the forced, vital capacity. Then of It is true that the sooner we make the diagnosis the sooner we can treat our patients and avoid the loss of lung function.
That has been seen that is related to mortality. In some way, the panorama of the idiopathic, pulmonary fibrosis has changed and is changing is not expected to continue changing the truth that it was a very bleak panorama, especially when we had to be in front of these patients and in recent years, since they have been Approved new antifibrotic drugs that is changing. Fortunately, we will probably have survival data in the short term to see if that change is being. What we see in practice daily clinic is not real, it becomes tangible and it is a hope for the patients and a joy for us to have these options therapies for them, and it is also changing because there is an approach, also multidisciplinary, with a global therapeutic Approach not only pharmacological treatments, but also, for example, the respiratory rehabilitation that improves the quality of life of these patients. All that is non-pharmacological treatment have a follow-up narrow to know when we have to give a patient oxygen.
The psychological treatment to support the patient and his family – that is all that is improving the quality of life and making the patient feel more accompanied throughout his illness, and I believe that this will change the panorama of mine. What is the therapeutic arsenal that can be used today in the clinical practice regarding the therapeutic end? There have been many advances because before, above all, because progress has been made in the knowledge of the the disease has advanced in the knowledge of the pathogenesis before believed that it was a disease that began with inflammation and that led to fibrosis of the lung has Now already been seen that there is a purely theory fibrotic where there is damage to the epithelial cells that trigger all the process leading to fibrosis, then acid advance in discovering these drugs that act in the different pathways of the fibrosis process, and these are the antifibrotic Drugs, that is why there is talk of the antifibrotic era in 2014. Two major clinical trials that led to the fd approval of the two antipsychotic drugs that we have available. Pirfenidone inning give you and virgin, and donate already had been approved in 2008 in Japan and in 2011 by the European medicine and between dani, then, and it was approved by the efe of the european agency of drugs at the end of October 2015, and the same As we already have, These drugs are available here in Spain, and that is a joy.
It has cost a lot cost a lot, and I think we can do it now, because we are already making use of them already first for compassionate use. That is called when we did not have them commercialized and now that we have it commercialized. It is already disseminated widely when there is an accurate diagnosis, then well, we have that is the advancement in treatments before we had nothing to offer, such as therapeutic options and now at least treatments that, although they do not cure the disease in lenses in the progression Of this disease – and we also know that, by acting on lung function in the forced, vital capacity that is directly related to the mortality, we already have mortality data with pirfenidone, which is a drug that reduces mortality from all causes and related causes. With the pp and almost 50 %, then we see that we already have enough efficiency tested of these drugs and I commented on it before, but there is a a little more on that importance of having an interdisciplinary team for the approach to a pathology. For all that, I mentioned another type of also of therapies beyond the mind pharmacological bills.
If the The truth is that the multidisciplinary team costs because of course, there has to be pulmonologists radiologists and for all dedicated purely and exclusively to the inter practice, so it costs a bit to train them. But that is the trend and it is doing and also incorporating other figures that are fundamental in the treatment of these patients and also for diseases that are rare that are not very prevalent and therefore the more experience you have in them, because it is better. There is a more accurate diagnosis and the more appropriate treatments, because often the diagnosis of fibrosis, idiopathic pulmonary disease is reviewed in these units and many other causes that sometimes, if many cases have not been seen, then there is no so much experience. Then I think that, for an accurate diagnosis, it is important not only multidisciplinarity but also experience that each unit or each center has in this sense and there they are necessary centers of units of reference. It is necessary to promote the.
I believe that much work is being done on that through the Spanish society of pulmonology and thoracic surgery, especially to try to accredit units reference in quotation marks, because in the reference units they are at the level national and in rare diseases such as pulmonary hypertension. Here in Madrid, there is a unit in front of the October 12 hospital, but that is at the level of the ministry of health. So a first stage, let’s say, would be that through the company those units can be accredited that must meet quality and care requirements. Such as having with a multidisciplinary team, have a certain number of patients a year that they see new cases of fibrosis or have a series of techniques that ensure that an acceptable volume of patients with experience in these pathologies. Not two in that, because it is working specifically and surely when the units begin to be accredited, it will be the next step to be named in reference units at the national level, not to facilitate, above all, that all patients can reach to these units.
Recently, in those affected by pulmonary fibrosis idiopathic and sent a letter to the patient within the European Parliament, asking for a little information asking for access to therapies and even also to operative care to support also for patients and their families. From the point of view of the specialist in daily clinical practice – and there is a lack of little visibility – let’s say for these patients: the truth that they are working very well. The association of patients with pulmonary fibrosis afp and the truth that we work in direct contact with them. We are lucky to have a very fluent communication, especially since all this was started by a teacher in car with them, and it is an association that moves a lot that tries to give visibility to the disease, especially because when the treatments, especially pirfenidone, Spain, has been The country that has the most delayed in having it and they have worked hard so that this treatment is accessible to all patients. Here in spain, when approved by the agency, the drug began to be marketed in different countries of The European Union, and Spain was the one that took the longest from 2011 to almost three years.
We have been waiting to have the drug and, of course, the patients they were very anxious, and rightly they froze and did their best to give visibility to the disease, so that especially the disposition of the treatments. The availability of the treatments is equitable and can have access to all patients alike, and I believe that the strength is in this joint work, because patients are very helpful to give visibility to the disease to be at European level. Also trying to alleviate that difference. Also representing the different patients in each country to alleviate these differences that may exist in different countries and in that sense also that they are now working on reference units in each country. Then there are also projects at the European level that allow us to identify and They intend to identify reference units so that it is known in each country than different hospitals or different units can provide coverage for this type of illness in this type of patient.
Well, that is a job that is somewhat difficult because at the national level it is difficult at the European level, because the project is still bigger, but well me. I think we have to start little by little how this has been built and what little results are obtained and it goes away enlarging the family in all this environment and now that it is also available of treatments. I imagine that patient records will be a useful tool. Being used is expected to use more logs of patients, has always taken it to the Spanish Society of Pneumology and thoracic surgery, and especially rare disease registry. Some with support from the Carlos Third Institute and now in terms of Puma fibrosis in a registry of the Spanish Society of Pulmonology and Thoracic Surgery, which is active.
There are more than 140 or I think, a little more than 150 patients with fibrosis lungs included, and that is very good because it allows us to see the situation current of our patients, not only the situation of the disease and we diagnose soon. If not, we diagnose soon in what situation functional therapy we find are being administered, as is, is tolerating that medication. So I think it is very important, but that It depends on the Spanish society. There is a person in charge and I think they are doing very well. Thank you very much for having been in essalud tv.
Thank you very much.
