Asociación entre la utilización de broncodilatadores de corta duración y el riesgo de hospitalización por asma en condiciones de práctica clínica habitual en una cohorte poblacional / Association between the use of short-acting bronchodilators and the risk of hospitalization for asthma in a real-life clinical practice population cohort

OBJETIVO: Determinar la cantidad de envases de broncodilatadores de corta duración (SABA) dispensados en farmacia en un año que se asocia con mayor riesgo de hospitalización por asma en el mismo periodo en pacientes con asma activa. Diseño descriptivo transversal multicéntrico. EMPLAZAMIENTO: Atención primaria, cohorte MAJORICA. Incluye datos codificados durante la práctica asistencial, sociodemográficos, clínicos y del sistema de prescripción electrónica de 68.578 pacientes con EPOC y asma de Baleares. PARTICIPANTES: Se incluyeron 7.648 pacientes mayores de 18 años con asma activa, que retiraron envases de SABA durante el periodo 2014-2015. Se excluyeron pacientes con EPOC. Mediciones principales: Hospitalización por asma, utilización de fármacos respiratorios, tabaquismo, comorbilidades, edad y sexo. RESULTADOS: Edad promedio 47 años, 38% mujeres, 23,2% fumadores activos. Setenta y siete pacientes (1%) ingresaron por exacerbación de asma en el periodo de estudio. Los pacientes que recibieron más de 8 envases de SABA por año aumentaron el riesgo de hospitalización (OR 2,81; IC95% 1,27-6,24). El escalón terapéutico de gravedad, la cantidad de corticoides inhalados, así como la insuficiencia cardíaca y la apnea del sueño se asociaron también significativamente con la hospitalización. CONCLUSIONES: Un mayor escalón terapéutico de gravedad, la presencia de algunas comorbilidades, el consumo de mayor cantidad de corticoides inhalados y de un mayor número de envases de SABA identifica a asmáticos con mayor riesgo de hospitalización. Existe una asociación significativa entre el riesgo de hospitalización y la retirada de un mayor número de envases de SABA de la farmacia. El número de envases/año que mejor define un mayor riesgo de hospitalización es ≥ 8 y se podría utilizar para identificar asmáticos de riesgo

OBJECTIVE: To determine the number of short-acting beta-agonists (SABA) canisters dispensed in a pharmacy during one year that is associated with higher asthma hospitalization risk in the same period in patients with active asthma. Multi-centre cross-sectional descriptive design. LOCATION: Primary care, MAJORICA cohort including sociodemographic, clinical and electronic prescription system data coded during clinical practice from 68,578 patients with COPD and asthma in the Balearic Islands. PARTICIPANTS: A total of 7,648 patients older than 18 years with active asthma, who got any SABA canister from the pharmacy during the 2014-2015 period were included. COPD patients were excluded. Main measurements: Asthma hospitalization, respiratory medication, tobacco, comorbidities, age and gender. RESULTS: Mean age 47 years, 38% women, 23.2% active smokers. Seventy-seven patients (1%) were admitted for asthma exacerbation in the study period. Patients who received more than 8 SABA containers per year increased the risk of hospitalization (OR 2.81; 95% CI 1.27-6.24). Severity by therapeutic step and amount of inhaled corticosteroids, as well as heart failure and sleep apnea were also significantly associated with hospitalization. CONCLUSIONS: There is a significant association between the risk of hospitalization and the higher number of SABA canisters dispensed from the pharmacy. The number of canisters/year that best defines a higher risk of hospitalization is ≥ 8 and could be used to identify asthma at risk

Discrimination between live and dead cells in bacterial communities from environmental water samples analyzed by 454 pyrosequencing

The preferential detection of cells with intact membranes by sample treatment with propidium monoazide (PMA) in combination with PCR amplification is gaining in popularity. This study evaluates the effect of PMA on 454 pyrosequencing profiles of environmental water samples from a canal in Amsterdam and seawater (with sediment) left untreated or exposed to elevated temperatures (50, 60, or 85 ºC) for 10 min. Community analysis was based on the extraction of genomic DNA followed by PCR amplification of 16S rRNA genes using universal bacterial primers. Whereas the highest temperature in combination with PMA treatment completely suppressed PCR amplification, PCR products from the other samples were subjected to massively parallel tag sequencing. PMA treatment did not substantially affect the sequence profiles of non-heated samples, but heat exposure resulted in a clear difference in the relative proportions of certain groups. This difference was significantly more pronounced in heated seawater than in heated canal water. The effect of the chosen experimental conditions on the membrane integrity of cells was supported by BacLight LIVE/DEAD staining in combination with flow cytometry, which confirmed an increase in the uptake of propidium iodide in samples exposed to high temperatures (AU)

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