RESUMEN
We assessed the effectiveness of an asthma educational programme based on a repeated short intervention (AEP-RSI) to improve asthma control (symptom control and future risk) and quality of life. A total of 230 adults with mild-to-moderate persistent uncontrolled asthma participated in a 1-year cluster randomised controlled multicentre study. The AEP-RSI was given in four face-to-face sessions at 3-month intervals, and included administration of a written personalised action plan and training on inhaler technique. Centres were randomised to the AEP-RSI (intervention) group or usual clinical practice group. Specialised centres using a standard educational programme were the gold standard group. A significant improvement in the Asthma Control Test score was observed in all three groups (p<0.001), but improvements were higher in the intervention and gold standard groups than in the usual clinical practice group (p=0.042), which also showed fewer exacerbations (mean±sd; 1.20±2.02 and 0.56±1.5 versus 2.04±2.72, respectively) and greater increases in the Mini Asthma Quality of Life Questionnaire scores (0.95±1.04 and 0.89±0.84 versus 0.52±0.97, respectively). The AEP-RSI was effective in improving asthma symptom control, future risk and quality of life.
Asunto(s)
Asma/terapia , Educación del Paciente como Asunto/métodos , Calidad de Vida , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autocuidado , Índice de Severidad de la Enfermedad , España , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The efficacy of omalizumab in severe asthma has been widely demonstrated. The main objective of this study was to evaluate the efficacy and tolerability of omalizumab in a real-life setting in Spain, particularly in those patients with immunoglobulin E (IgE) levels out of range. METHODS: Totally 266 uncontrolled severe asthma patients receiving high-dose inhaled corticosteroids (ICSs) plus long-acting ß2-agonist (LABA) were recruited. Main efficacy outcomes were asthma exacerbation rate (AER), asthma control test (ACT), and global evaluation of treatment effectiveness (GETE). RESULTS: AER was reduced from 3.6 (3.6) in previous year to 0.67 (1.2) at 4 months (p < .05) and to 1.04 (1.8) at 2 years (p < .05). ACT increased significantly from 14.3 (4.7) at baseline to 18.4 (4.4) at 4 months (p < .05) and to 20.3 (4.0) (p < .05) at 2 years. After 4 months, 74.6% of patients had reached a good or excellent rate on the GETE scale (p < .05). This rate continued increasing up to 81.6% at 2 years. These efficacy results were similar for patients with "off-label" IgE > 700 IU/ml. At follow-up, maintenance treatment with oral steroids was discontinued in a considerable number of patients: from 89 to 19 (p < .05). Omalizumab was discontinued because of lack of efficacy only in 28/266 (10.5%) patients. Overall, 30 patients (11.4%) reported adverse events. Severe adverse events were not observed. CONCLUSION: This real-life study confirms that omalizumab is very efficacious and very well tolerated in patients with uncontrolled severe asthma. Results did not vary in the subgroup of patients with IgE levels >700 IU/ml.
Asunto(s)
Antiasmáticos/uso terapéutico , Anticuerpos Antiidiotipos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Asma/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Agonistas Adrenérgicos beta/uso terapéutico , Adulto , Antiasmáticos/efectos adversos , Anticuerpos Antiidiotipos/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Asma/sangre , Femenino , Humanos , Inmunoglobulina E/sangre , Masculino , Persona de Mediana Edad , Omalizumab , Vigilancia de Productos Comercializados , Índice de Severidad de la Enfermedad , Fumar/epidemiología , España/epidemiologíaRESUMEN
BACKGROUND: The prevalence of chronic diseases in the elderly (> 65 years), including asthma, is growing, yet information available on asthma in this population is scarce.Our objective is to determine the differential clinical and functional characteristics of the population > 65 years old with asthma included in the Integrated Research Programs of Asthma Databank of the Spanish Society of Pneumology and Thoracic Surgery (www.bancodatosasma.com). METHODS: Retrospective comparative descriptive study of demographic, clinical and functional variables for 1713 patients with asthma categorized into 3 age groups as follows: adults aged < 65 years (A), younger elderly aged 65-74 years (B) and older elderly aged ≥75 years (C). RESULTS: Predominant features of elderly patients with asthma (N = 471) were the female sex, fewer smokers, greater obesity, poorer lung function, and lower values of nitric oxide in exhaled air (p < 0.01). The most frequently associated comorbidity was gastroesophageal reflux. The highest doses of inhaled corticosteroids were by group A (60.8%). For the sample overall, 23.2% (N = 398) were being treated with omalizumab and 8.2% (N = 140) were corticosteroid-dependent (10.6% in group B). The highest percentage of patients receiving antileukotriene agents was in group B (42.9%). CONCLUSIONS: Asthma in adults aged> 65 is more severe and associated with greater comorbidity, which would indicate the need for a more integrated and multidimensional approach to asthma treatment for these patients.
RESUMEN
OBJECTIVE: Certain sporting activities may trigger asthma exacerbations of varying intensity in children. Such exacerbations may lead to limitations in and rejection of such activities. During school hours, teachers are in a good position to observe these phenomena. The aim of the present study was to evaluate the shuttle run, a test of physical fitness used in school physical education programs, as a way of detecting asthma. PATIENTS AND METHODS: We carried out a cross-sectional observational study of school children between the ages of 6 and 12 years using the asthma symptom questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), a shuttle run test, and a free running test at maximum effort in order to study bronchial hyperresponsiveness. The principal measure of bronchial hyperresponsiveness used in both physical fitness tests was peak expiratory flow rate as measured with a peak flow meter. In comparing the results of the shuttle run test with those of the free running test and the ISAAC questionnaire we used the chi(2) test to measure association and the Cohen kappa coefficient to measure agreement. RESULTS: We distributed the ISAAC questionnaire (n=919) to 460 (50.1%) boys and 459 (49.9%) girls between the ages of 6 and 12 years. All the tests were completed by 826 children. The level of agreement between the shuttle run test and free running test was positive but low for decreases in peak expiratory flow rate compared to baseline of 15% (chi(2)=5.6; P< .05; kappa=0.093; SE, 0.042) and of 20% (chi(2)=4.5; P< .05; kappa=0.08; SE, 0.046). For 10% decreases association was not significant and agreement was low (kappa=0.05; SE, 0.04). There was no agreement between the ISAAC questionnaire and the shuttle run test (kappa=0.095; SE, 0.63). CONCLUSIONS: The shuttle run test using peak expiratory flow rate as the principal measure of bronchial hyperresponsiveness is not valid for the detection of asthma in schoolchildren.
Asunto(s)
Asma/diagnóstico , Asma/epidemiología , Prueba de Esfuerzo , Educación y Entrenamiento Físico , Niño , Estudios Transversales , Tolerancia al Ejercicio , Femenino , Humanos , Masculino , Valor Predictivo de las Pruebas , Instituciones Académicas , Encuestas y CuestionariosRESUMEN
OBJECTIVE: A number of studies have shown that both mortality and hospital admissions due to severe asthma have decreased in recent years in many parts of the world. However, the situation is Spain has not yet been analyzed. The aim of this study was to determine the incidence of very severe, near-fatal asthma in recent years in various Spanish hospitals. PATIENTS AND METHODS: A retrospective review of hospital records from 6 hospitals in 5 Spanish autonomous communities was conducted for the period 1997 to 2004 to determine the annual number of patients who required orotracheal intubation and mechanical ventilation due to an asthma attack. RESULTS: Of the 130 patients included in the study, 81 (62%) were women and 61 (47%) were aged between 51 and 75 years. The number of cases observed for the periods 2001-2002 and 2003-2004 (32 and 18, respectively) was significantly lower than that observed for the 1997-1998 and 1999-2000 periods (40 in both cases; P=.019). A significant increase in the incidence was observed in autumn and winter (n=81 [62%]; P=.018). Seventeen patients (13%) died and 8 (6%) developed serious sequelae. CONCLUSIONS: Although our sample of 6 hospitals is not widely representative of the entire population of hospitals in Spain, our findings strongly suggest a decrease in the incidence of near-fatal asthma in Spain in recent years.
Asunto(s)
Asma/epidemiología , Adolescente , Adulto , Anciano , Asma/terapia , Urgencias Médicas , Femenino , Humanos , Incidencia , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Respiración Artificial , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , España/epidemiologíaRESUMEN
BACKGROUND: Few studies have analysed the relationship between anxiety and alexithymia with functional dyspnea (FD) and its impact on quality of life and asthma control. The aim of this study was to assess the prevalence of DD in asthma, its impact on quality of life and asthma control and its relationship with anxiety and alexithymia. PATIENTS AND METHODS: We performed a cross-sectional study of 264 asthmatic patients and 111 controls. Both groups completed the following questionnaires: quality of life (AQLQ), alexithymia (TAS-20), anxiety (STAI) and FD (Nijmegen). In asthmatics were evaluated: asthma severity, dyspnoea, exacerbation and control of the disease (ACT test). RESULTS: 38% of asthmatics and 5.5% of non-asthmatics had FD. Asthmatics had more anxiety and were more alexithymic. Asthmatics with FD had significantly more anxiety, more alexithymia, poor control of asthma, more exacerbations and poorer quality of life, that asthma without DD. Asthmatics with an ACT<19, a score >3 in the emotion subscale of the AQLQ, who were being treated for anxiety and scored >19 on the alexithymia subscale that assesses difficulty in identifying emotions, showed ORs for FD of 2.6 (1.1-5.9), 6.8 (2.9-15.8), 4.4 (1.9-9.8) and 3.3 (1.5-7), respectively. A predictive model of FD was constructed. CONCLUSIONS: We demonstrated the close relationship between anxiety, alexithymia and DD in asthmatics, as well as the significant impact of FD on the control and quality of life of this asthmatics.
Asunto(s)
Asma/psicología , Disnea/psicología , Adulto , Asma/complicaciones , Estudios Transversales , Disnea/epidemiología , Disnea/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y CuestionariosRESUMEN
UNLABELLED: The association between onset of asthma exacerbation and the inflammatory response has not been sufficiently studied. OBJECTIVE: To determine the differential mechanisms of the rapid onset (RO) asthma exacerbation. METHODS: We designed a prospective, multicentre study that included 34 patients who suffered from asthma exacerbation. They were distributed into three groups of asthmatics, depending of the time of onset: from 0 to 24h, from 25 to 144h and more than 145h. We collected clinical data, sputum, blood and urine samples when first seen at the clinic and the next 24h later, and differential cell counts and biomarkers were determined RESULTS: The asthmatics who suffered a RO exacerbation showed a higher elastase concentration, (1.028±1.140; 310±364; 401±390ng/ml) (P<0.05) and albumin (46.2±4.3; 42±3.4; 39.9±4.8g/l) (P<0.05) in the blood sample. Neutrophils, eosinophils (blood or sputum), eosinophil cationic protein (ECP) (blood), interleukin 8 (IL(8)) (blood) and leukotriene E4 (LTE(4)) (urine) were high in the three groups (P>0.05). We demonstrated an association between the onset of exacerbation and the severity of obstruction (FEV(1)) (r=-0.360; P=0.037), eosinophils in sputum (r=-0.399; P=0.029), albumin (r=-0.442; P=0.013), and IL(8) in sputum (r=0.357; P=0.038). CONCLUSIONS: The results suggest a rapid inflammatory response, both neutrophilic and eosinophilic, in the asthmatic exacerbation. However, the swelling in the bronchi may play an important role in the initial inflammatory response in the exacerbations depending of time of onset.