Molecular T2 asthma phenotypes are stable but heterogeneous: the usefulness of periostin for endotyping.

Background: The stability of molecular T2/non-T2 phenotypes remains uncertain. The objectives of this study were to assess the stability of these phenotypes and the correlation between serum periostin and asthma T2 phenotypes and endotypes. Methods: Demographics, clinical data, and blood samples were collected. Patients diagnosed with moderate-to-severe asthma were classified into T2 or non-T2 according to previously defined thresholds of blood eosinophilia and serum total IgE levels. Asthma endotype was also determined. After at least 1 year of follow-up, the stability of T2 phenotypes and endotypes was assessed. Results: A total of 53 patients (72% women), mean age 47 years (range 16-77), were included. In the initial and second evaluations, the T2 phenotype was found in 41.5% and 43.4% of patients and the non-T2 phenotype was found in 58.4% and 56.7%, respectively. The mean [standard deviation (SD), range] serum periostin level was 52.7 (26.2, 22.6-129.7) ng/mL in patients with T2 phenotype, and 39.3 (25.6, 7.7-104.) ng/mL in non-T2 patients (P = 0.063). Periostin levels correlated to endotypes (P = 0.001): 45.7 (27.9) ng/mL in allergic asthma (n = 16 patients), 64.7 (24.9) in aspirin-exacerbated respiratory disease (n = 14), 59.0 (27.6) ng/mL in late-onset eosinophilic asthma (n = 4), and 28.3 (13.3) ng/mL in non-eosinophilic asthma (n = 18). Conclusions: T2 and non-T2 asthma phenotypes assessed by accessible methods in daily practice are stable over time yet widely heterogeneous. Serum periostin does not discriminate between T2 and non-T2 phenotypes. Nevertheless, its correlation to asthma endotypes may contribute to guide therapies targeting T2 cytokines in a more personalized approach.

Uncontrolled severe T2 asthma: Which biological to choose? A biomarker-based approach.

In recent years, advances in knowledge of molecular mechanisms involved in asthma have changed uncontrolled severe asthma (USA) treatment, with the appearance of biological treatment. USA is a heterogeneous entity with different endotypes and phenotypes. Nowadays, the biological drugs approved with asthma indication are omalizumab, mepolizumab, reslizumab, benralizumab and dupilumab. Tezepelumab is approved by the Food and Drug Administration (FDA) in the United States and, recently, by the European Medicines Agency (EMA). All these biological drugs have shown their efficacy in clinical trials, especially in reducing exacerbations, improving asthma control, quality of life, pulmonary function, and withdrawing systemic corticosteroids or at least reducing their daily dose, with some differences between them. Except for mepolizumab and reslizumab, biological drugs have different targets and thus different therapeutic indications should be expected; however, in some patients, more than one drug could be indicated, making the election more difficult. Because there are no direct comparisons between biological drugs, some biomarkers are used to choose between them, but they are not unbeatable. In this article, an algorithm to choose the first biological drug in a specific patient is proposed based on different study results and patient' characteristics.

Corrigendum: Uncontrolled severe T2 asthma: Which biological to choose? A biomarker-based approach.

[This corrects the article DOI: 10.3389/falgy.2022.1007593.].

Economic impact of severe asthma in Spain: multicentre observational longitudinal study.

Objective: Estimate the economic impact of severe asthma from the Spanish social perspective through the estimation of the associated annual direct and indirect costs. Methods: Observational, longitudinal, retrospective study carried out in 20 Spanish secondary settings (Pulmonology and Allergy Services) among patients aged ≥18, diagnosed with severe asthma according to European Respiratory Society/American Thoracic Society consensus and who have not experienced an exacerbation in the previous 2 months. Asthma-related healthcare resource utilization as well as asthma-related days off work were collected over a retrospective 12-month period from medical records review (inclusion period: June to November 2016). Total costs were calculated by multiplying the natural resource units used within 1 year by the corresponding unit cost. Costs were expressed in Euros for 2018. Results: A total of 303 patients were included, mean age was 54 years old and 67% were women. There were 5.7 physician visits per patient (3.3 in secondary care). The most common pharmacologic treatment was fixed dose combination of inhaled corticosteroids/long-acting ß2-adrenergic agonists (96.7%), followed by leukotriene receptor antagonists (57.1%). 134 patients (44.2%) had at least one severe asthma exacerbation (mean: 1.9 exacerbation/patient), of whom 22 patients required hospitalization, with a mean hospital stay of 10.9 days/patient. Mean sick leave due to severe asthma was 9.1 days per patient per year. Mean annual direct cost (confidence interval 95%) was €7472/patient (€6578-8612). The cost per exacerbation was €1410/patient. When indirect costs were added (€1082/patient [€564-1987]), the total annual mean cost rose to €8554/patient (€7411-10199). Conclusions: Taking the social perspective, the economic impact of severe asthma in Spain was estimated to be €8554/patient/year.

Guía práctica de radiología de tórax para Atención Primaria

Monografía que tiene como objetivo facilitar la labor clínica cotidiana al enfrentarse a la patología neumológica en la consulta de Atención Primaria, mediante el repaso o el aprendizaje de las bases que rigen la lectura de la radiografía de tórax, poniendo énfasis en los signos radiológicos, que ayudan a la identificación de estructuras o en la orientación diagnóstica de las respectivas entidades patológicas. Incluye figuras ilustrativas e imágenes de casos reales demostrativos y casos clínicos.

Guidelines for severe uncontrolled asthma.

Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as "true difficult-to-control asthma". This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control ("false difficult-to-control asthma"), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients.

Factors related with the higher percentage of hospitalizations due to asthma amongst women: the FRIAM study.

INTRODUCTION: The reason why there is a higher hospitalization rate due to asthma exacerbations amongst women is unclear. The objective of this study is to explore the possible causes that may explain this fact. METHODS: A multi-center, prospective study including asthma patients hospitalized in the pulmonary medicine departments during a two-year period. By means of a questionnaire, the following data were collected: demographic characteristics and treatment compliance, anxiety-depression, hyperventilation and asthma control, both prior to and during the hospitalization. RESULTS: 183 patients were included, 115 (62.84%) of whom were women. The women were older (52.4 ± 18.3/43.4 ± 18.7; P=.02), were more frequently prescribed inhaled corticosteroids (63.2%/47.1%; P=.03) and had a higher rate of hyperventilation syndrome (57.3/35.9; P=.02) and a longer mean hospital stay (7.3 ± 3.4/5.9 ± 3.6; P=.02). The percentage of smokers among the women was lower (21.2%/38.8%; p=0.01) and the FEV(1) was lower at admittance (58.2% ± 15.9/67.5% ± 17.4; P=.03). In the 40 to 60-year-old age range, an association was demonstrated between being female and the 'previous hospitalizations' variable (OR, 16.1; 95% CI, 1.6-156.7); sex and obesity were also independently associated (OR, 4.8; 95% CI, 1.06-22). CONCLUSIONS: In this cohort, the rate of hospitalization for asthma was higher in women than in men. Being a woman between the ages of 40 and 60 is associated with previous hospitalizations and is a risk factor for asthma-related hospitalization. This situation could partially be explained by the hormonal changes during menopause, where polyposis and obesity are independent risk factors.

[Advances in asthma: review of publications in Archivos de Bronconeumología in the last year]. / Novedades en asma: revisión de las publicaciones del último año en Archivos de Bronconeumología.

Interest in asthma research among Spanish pneumologists is increasing. In the last year, 22 articles on asthma have been published in Archivos de Bronconeumología, six more than in the previous year. Furthermore, 56 communications were presented at the National Congress of the Spanish Society of Pneumology and Thoracic Surgery and were published in a supplement of the journal, representing 60% more than in the previous year's congress. A critical review of all these articles is provided. The original articles contribute further knowledge on epidemiological and clinical aspects of the disease and basic research. A notable contribution is the publication of two clinical practice guidelines, the Spanish Guideline for the Management of Asthma 2009 and the ALERTA-2 Guideline for the Management of Asthma Exacerbations. These two guidelines represent not only an update but also a change in the methodology used in their drafting, thus improving their scientific quality.

[Clinical audit of patients admitted to hospital in Spain due to exacerbation of COPD (AUDIPOC study): method and organisation]. / Auditoria clínica de los pacientes hospitalizados por exacerbación de EPOC en España (estudio AUDIPOC): método y organización del trabajo.

BACKGROUND: There is little information regarding the clinical management of hospital inpatients diagnosed with exacerbation of Chronic Obstructive Pulmonary Disease (COPD). AUDIPOC is a clinical audit dealing with the clinical management of COPD in Spain. OBJECTIVES: To examine the adequacy and validity of the instruments used to measure the variables proposed by AUDIPOC Spain (Preliminary Study) and to verify the viability of AUDIPOC in a complex environment with hospitals of different sizes, resources, and organizational layout (Pilot Study). MATERIALS AND METHODS: The Preliminary Study took place in 4 hospitals and studied 213 cases. The Pilot Study took place in 30 hospitals of 6 Autonomous Communities (i.e. Regions) and studied 1203 cases. RESULTS: The results of both studies contributed to the improvement of the design, methods and organization of the AUDIPOC work. Some of the improvements include better training of those responsible at a hospital level, a new classification of hospitals, the incorporation of new variables and the creation of a Bureau for the Coordination and Management of the Project. CONCLUSIONS: The AUDIPOC study is viable. It aims to recruit 10000 patients across 142 hospitals from all the Regions of Spain.

[Asthma in the Archivos de Bronconeumología: a review of publications in the year 2009]. / El asma en Archivos de Bronconeumología: revisión de las publicaciones de 2009.

A total of 16 articles (Table 1), were published in the Archivos de Bronconeumología in the past year (December 2008 to November 2009), 9 of which were Originals, which was 17.6% of the originals published in that period. Fortunately, the tendency of a decreasing interest in asthma by pneumologists does not seem to have materialised as was feared a few years ago, on the contrary it seems that research is increasing. All articles that appeared in the journal during the period mentioned are reviewed.