Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo, en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren.

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Data-driven questionnaire-based cluster analysis of asthma in Swedish adults.

The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.

Lung clearance index and steroid response in pediatric severe asthma.

INTRODUCTION: Lung clearance index (LCI) is a measure of airway disease that has been shown to be abnormal in asthma. We hypothesized that LCI would be higher (worse) in children with severe therapy-resistant asthma (STRA) compared with difficult asthma (DA) and healthy controls and that LCI would fall in response to parenteral steroids in STRA. METHODS: Sixty-four children with asthma who were prescribed high-dose asthma therapy (GINA steps 4 or 5) performed LCI and spirometry. Forty-three had STRA and 21 DA. Thirty-nine of forty-three STRA patients attended for a clinically indicated bronchoscopy during which an intramuscular injection of triamcinolone was given. LCI, spirometry, and fractional exhaled nitric oxide (FeNO) were performed on the day of the bronchoscopy and repeated 4 weeks later. RESULTS: LCI was more abnormal in STRA (median: 7.40, range: 5.58-12.34) than in DA (6.55, 5.77-7.75), P = .0006, and healthy controls (6.53, 5.57-7.35), P = .005. In contrast to the first second forced expired volume (FEV1 ), LCI improved following systemic steroids; of 20 STRA patients with an abnormal LCI at baseline, 13 improved following triamcinolone. LCI and FeNO responses were concordant. CONCLUSIONS: There is a subgroup of children with STRA in whom LCI is elevated who improve following parenteral steroids. LCI may be a valuable additional domain in assessing steroid response in pediatric asthma.

[Risk factors for uncontrolled asthma in adults]. / Factores de riesgo para mal control de asma en adultos.

BACKGROUND: Many studies in children had identified risk factors associated with partly or uncontrolled asthma. In adults, factors related to asthma control were not well defined. OBJECTIVE: To find the factors related to partly or uncontrolled asthma in adults. METHODS: Asthmatic adults who had severity at least in the mild persistent level, were recruited. The asthma control levels were classified as controlled, partly controlled and uncontrolled according to the Global Initiative for Asthma guideline. Risk factors were compared between the patients with controlled and partly controlled/ uncontrolled asthma groups. RESULTS: Two hundred (75.5 % females) were included. The mean age was 38.4 ± 11.93 years old. There were 100 patients (50 %) in the controlled and 100 patients (50 %) in partly controlled and uncontrolled asthma group. For asthma severity, 35 patients (88.2 %) were in mild persistent, 14 patients (10 %) in moderate persistent and 97 patients (1.8 %) in severe persistent groups. The absence of stress yielded an OR = 0.41 (95 % CI = 0.23-0.75), p = 0.03. While active smoking, OR = 4.23 (95 % CI = 1.35-13.2), p = 0.007. Patients who have no contact with stuffed animals or rugs have OR = 0.4 (IC 95 % = 0.2-0.79). It was important the result of the patients that if they correctly use their inhalers OR = 0.36 (IC 95 % = 0.13-0.97), p = 0.031. CONCLUSIONS: Current and active smoking and atopic dermatitis are risk factors. As a protective factor to the normal levels of eosinophils in blood, correct use of inhalers, FEV1 > 80 %, the absence of stress and the absence of contact with carpets and stuffed animals.

Antecedentes: Estudios en niños han identificado factores asociados con la falta de control del asma. En adultos no están bien definidos. Objetivo: Identificar los factores relacionados con la falta de control del asma en adultos. Métodos: Se incluyeron adultos con asma clasificados como controlados, parcialmente controlados y no controlados según los criterios de la Global Initiative for Asthma. Resultados: Se incluyeron 200 pacientes (75.5 % mujeres), edad promedio de 38.4 ± 11.93 años. Cien pacientes con asma controlada y 100 con asma no controlada y parcialmente controlada; 35 (88.2 %) con persistencia leve, 14 (10 %) con persistencia moderada y 97 (1.8 %) con persistencia grave; en estrés se encontró RM = 0.41 (IC 95 % = 0.23-0.75), p = 0.03; en tabaquismo actual y activo, RM = 4.23 (IC 95 % = 1.35-13.2), p = 0.007; y en uso correcto de inhaladores, RM = 0.36 (IC 95 % = 0.13-0.97), p = 0.031. Los pacientes no tuvieron contacto con peluches ni alfombras. Conclusiones: Se observó asociación con tabaquismo actual activo y dermatitis atópica. Como factores de protección se identificó niveles normales de eosinófilos en sangre, uso correcto de inhaladores, VEF1 > 80 %, ausencia de estrés y de contacto con alfombras y peluches.

The Cytokines of Asthma.

Asthma is a chronic inflammatory airway disease associated with type 2 cytokines interleukin-4 (IL-4), IL-5, and IL-13, which promote airway eosinophilia, mucus overproduction, bronchial hyperresponsiveness (BHR), and immunogloubulin E (IgE) synthesis. However, only half of asthma patients exhibit signs of an exacerbated Type 2 response. "Type 2-low" asthma has different immune features: airway neutrophilia, obesity-related systemic inflammation, or in some cases, few signs of immune activation. Here, we review the cytokine networks driving asthma, placing these in cellular context and incorporating insights from cytokine-targeting therapies in the clinic. We discuss established and emerging paradigms in the context of the growing appreciation of disease heterogeneity and argue that the development of new and improved therapeutics will require understanding the diverse mechanisms underlying the spectrum of asthma pathologies.

netDx: interpretable patient classification using integrated patient similarity networks.

Patient classification has widespread biomedical and clinical applications, including diagnosis, prognosis, and treatment response prediction. A clinically useful prediction algorithm should be accurate, generalizable, be able to integrate diverse data types, and handle sparse data. A clinical predictor based on genomic data needs to be interpretable to drive hypothesis-driven research into new treatments. We describe netDx, a novel supervised patient classification framework based on patient similarity networks, which meets these criteria. In a cancer survival benchmark dataset integrating up to six data types in four cancer types, netDx significantly outperforms most other machine-learning approaches across most cancer types. Compared to traditional machine-learning-based patient classifiers, netDx results are more interpretable, visualizing the decision boundary in the context of patient similarity space. When patient similarity is defined by pathway-level gene expression, netDx identifies biological pathways important for outcome prediction, as demonstrated in breast cancer and asthma. netDx can serve as a patient classifier and as a tool for discovery of biological features characteristic of disease. We provide a free software implementation of netDx with automation workflows.

A Nasal Brush-based Classifier of Asthma Identified by Machine Learning Analysis of Nasal RNA Sequence Data.

Asthma is a common, under-diagnosed disease affecting all ages. We sought to identify a nasal brush-based classifier of mild/moderate asthma. 190 subjects with mild/moderate asthma and controls underwent nasal brushing and RNA sequencing of nasal samples. A machine learning-based pipeline identified an asthma classifier consisting of 90 genes interpreted via an L2-regularized logistic regression classification model. This classifier performed with strong predictive value and sensitivity across eight test sets, including (1) a test set of independent asthmatic and control subjects profiled by RNA sequencing (positive and negative predictive values of 1.00 and 0.96, respectively; AUC of 0.994), (2) two independent case-control cohorts of asthma profiled by microarray, and (3) five cohorts with other respiratory conditions (allergic rhinitis, upper respiratory infection, cystic fibrosis, smoking), where the classifier had a low to zero misclassification rate. Following validation in large, prospective cohorts, this classifier could be developed into a nasal biomarker of asthma.

Crisis asmática / Asthmatic crisis

El Asma es una de las enfermedades crónicas más frecuentes como causa de morbilidad y mortalidad a nivel mundial. Existe evidencia que la prevalencia durante los últimos 20 años ha ido en aumento, especialmente en niños. La misma varía desde el 1% hasta más del 30% en las diferentes poblaciones, inclusive, según los últimos estudios esta prevalencia va en aumento en la gran mayoría de los países, especialmente en niños jóvenes (AU). Se presenta la fisiopatogenia del asma, diagnóstico, anamnesis, examen físico y complementarios, clasificación, esquema de tratamiento, niveles de control del asma, tratamiento farmacológico, un cuadro de la estimación de gravedad de la crisis de asma, y un algoritmo de tratamiento de la crisis según su gravedad

Using medication utilization information to develop an asthma severity classification model.

BACKGROUND: Claims data are currently widely used as source data in asthma studies. However, the insufficient information in claims data related to level of asthma severity may negatively impact study findings. The present study develops and validates an asthma severity classification model that uses medication utilization in Taiwan National Health Insurance claims data. METHODS: The National Health Insurance Research Database was used for the years 2006-2012 and included a total of 7221 patients newly diagnosed with asthma in 2007 for model development and in 2008 for model validation. The medication utilization of patients during the first year after the index date was used to classify level of severity, and the acute exacerbation of asthma during the second through fourth years after the index date was used as the outcome variable. Three models were developed, with subjects classified into four, three, and two groups, respectively. The area under the receiver operating characteristic curve (AUC) and the Kaplan-Meier survival curve were used to compare the performances of the classification models. RESULTS: In development data, the distribution of subjects and acute exacerbation rate among the stage 1 to stage 4 were: 62.71%, 5.54%, 22.79%, and 8.96%, and 8.17%, 9.55%, 11.97%, and 14.91%, respectively. The results also showed the higher severity groups to be more prone to being prescribed oral corticosteroids for asthma control, while lower severity groups were more likely to be prescribed short-acting medication and inhaled corticosteroid treatment. Furthermore, the results of survival analysis showed two-group classification was recommended and yield moderate performance (AUC = 0.671). In validation data, the distribution of subjects, acute exacerbation rates, and medication uses among stages were similar to those in development data, and the results of survival analysis were also the same. CONCLUSIONS: Understanding asthma severity is critical to conducting effective, scholarly research on asthma, which currently uses claims data as a primary data source. The model developed in the present study not only overcomes a gap in the current literature but also provides an opportunity to improve the validity and quality of claims-data-based asthma studies.

Asthma-COPD overlap is not a homogeneous disorder: further supporting data.

Asthma-COPD ovelap (ACO) is an umbrella term that encompasses patients with COPD and eosinophilic inflammation (e-COPD) and smoking asthmatics with non-fully reversible airflow obstruction (SA). We compared the clinical characteristics and the inflammatory profile of e-COPD and SA. Patients classified as e-COPD were older and more often male and showed significantly impaired pulmonary function (likely explained by a heavier smoking habit). On the contrary, SA had more atopic features, more reversibility of airflow obstruction and higher IgE levels. The concentrations of IL-5, IL-13, IL-8, IL-6, TNF-α, IL17 in serum were similar between the 2 groups. However, Th2-related biomarkers (periostin, FeNO and blood eosinophils) shower higher median values in e-COPD patients. Our findings reinforce the notion that ACO is a heterogeneous disorder and, as a consequence, it might be unacceptable to offer the same treatment for two related but different conditions.

Heterogeneity of obesity-asthma association disentangled by latent class analysis, the SAPALDIA cohort.

Although evidence for the heterogeneity of asthma accumulated, consensus for definitions of asthma phenotypes is still lacking. Obesity may have heterogeneous effects on various asthma phenotypes. We aimed to distinguish asthma phenotypes by latent class analysis and to investigate their associations with different obesity parameters in adults using a population-based Swiss cohort (SAPALDIA). We applied latent class analysis to 959 self-reported asthmatics using information on disease activity, atopy, and age of onset. Associations with obesity were examined by multinomial logistic regression, after adjustments for age, sex, smoking status, educational level, and study centre. Body mass index, percent body fat, waist hip ratio, waist height ratio, and waist circumference were used as obesity measure. Four asthma classes were identified, including persistent multiple symptom-presenting asthma (n = 122), symptom-presenting asthma (n = 290), symptom-free atopic asthma (n = 294), and symptom-free non-atopic asthma (n = 253). Obesity was positively associated with symptom-presenting asthma classes but not with symptom-free ones. Percent body fat showed the strongest association with the persistent multiple symptom-presenting asthma. We observed heterogeneity of associations with obesity across asthma classes, indicating different asthma aetiologies.

Phenotypes of asthma in low-income children and adolescents: cluster analysis / Fenótipos de asma em crianças e adolescentes de baixa renda: análise de agrupamentos

ABSTRACT Objective: Studies characterizing asthma phenotypes have predominantly included adults or have involved children and adolescents in developed countries. Therefore, their applicability in other populations, such as those of developing countries, remains indeterminate. Our objective was to determine how low-income children and adolescents with asthma in Brazil are distributed across a cluster analysis. Methods: We included 306 children and adolescents (6-18 years of age) with a clinical diagnosis of asthma and under medical treatment for at least one year of follow-up. At enrollment, all the patients were clinically stable. For the cluster analysis, we selected 20 variables commonly measured in clinical practice and considered important in defining asthma phenotypes. Variables with high multicollinearity were excluded. A cluster analysis was applied using a twostep agglomerative test and log-likelihood distance measure. Results: Three clusters were defined for our population. Cluster 1 (n = 94) included subjects with normal pulmonary function, mild eosinophil inflammation, few exacerbations, later age at asthma onset, and mild atopy. Cluster 2 (n = 87) included those with normal pulmonary function, a moderate number of exacerbations, early age at asthma onset, more severe eosinophil inflammation, and moderate atopy. Cluster 3 (n = 108) included those with poor pulmonary function, frequent exacerbations, severe eosinophil inflammation, and severe atopy. Conclusions: Asthma was characterized by the presence of atopy, number of exacerbations, and lung function in low-income children and adolescents in Brazil. The many similarities with previous cluster analyses of phenotypes indicate that this approach shows good generalizability.

RESUMO Objetivo: Estudos que caracterizam fenótipos de asma predominantemente incluem adultos ou foram realizados em crianças e adolescentes de países desenvolvidos; portanto, sua aplicabilidade em outras populações, tais como as de países em desenvolvimento, permanece indeterminada. Nosso objetivo foi determinar como crianças e adolescentes asmáticas de baixa renda no Brasil são distribuídos através de uma análise de clusters. Métodos: Foram incluídos 306 crianças e adolescentes (6-18 anos de idade) com diagnóstico clínico de asma e sob tratamento médico por pelo menos um ano de acompanhamento. No momento da inclusão, todos os pacientes estavam clinicamente estáveis. Vinte variáveis comumente determinadas na prática clínica e consideradas importantes na definição dos fenótipos de asma foram selecionadas para a análise de clusters. As variáveis com alta multicolinearidade foram excluídas. Uma análise de clusters foi realizada utilizando-se um teste aglomerativo em duas etapas e log-likelihood distance measure. Resultados: Três clusters foram definidos para nossa população. O cluster 1 (n = 94) incluiu indivíduos com função pulmonar normal, inflamação eosinofílica leve, poucas exacerbações, início mais tardio da asma e atopia leve. O cluster 2 (n = 87) incluiu pacientes com função pulmonar normal, número moderado de exacerbações, início precoce da asma, inflamação eosinofílica mais grave e atopia moderada. O cluster 3 (n = 108) incluiu pacientes com função pulmonar ruim, exacerbações frequentes, inflamação eosinofílica e atopia graves. Conclusões: A asma foi caracterizada por presença de atopia, número de exacerbações e função pulmonar em crianças e adolescentes de baixa renda no Brasil. As muitas semelhanças entre esta e outras análises de clusters de fenótipos indicam que essa abordagem apresenta boa generalização.

U-BIOPRED clinical adult asthma clusters linked to a subset of sputum omics.

BACKGROUND: Asthma is a heterogeneous disease in which there is a differential response to asthma treatments. This heterogeneity needs to be evaluated so that a personalized management approach can be provided. OBJECTIVES: We stratified patients with moderate-to-severe asthma based on clinicophysiologic parameters and performed an omics analysis of sputum. METHODS: Partition-around-medoids clustering was applied to a training set of 266 asthmatic participants from the European Unbiased Biomarkers for the Prediction of Respiratory Diseases Outcomes (U-BIOPRED) adult cohort using 8 prespecified clinic-physiologic variables. This was repeated in a separate validation set of 152 asthmatic patients. The clusters were compared based on sputum proteomics and transcriptomics data. RESULTS: Four reproducible and stable clusters of asthmatic patients were identified. The training set cluster T1 consists of patients with well-controlled moderate-to-severe asthma, whereas cluster T2 is a group of patients with late-onset severe asthma with a history of smoking and chronic airflow obstruction. Cluster T3 is similar to cluster T2 in terms of chronic airflow obstruction but is composed of nonsmokers. Cluster T4 is predominantly composed of obese female patients with uncontrolled severe asthma with increased exacerbations but with normal lung function. The validation set exhibited similar clusters, demonstrating reproducibility of the classification. There were significant differences in sputum proteomics and transcriptomics between the clusters. The severe asthma clusters (T2, T3, and T4) had higher sputum eosinophilia than cluster T1, with no differences in sputum neutrophil counts and exhaled nitric oxide and serum IgE levels. CONCLUSION: Clustering based on clinicophysiologic parameters yielded 4 stable and reproducible clusters that associate with different pathobiological pathways.

[Morphological changes in the respiratory organs in chronic obstructive pulmonary disease].

The basis for airway remoldeling in patients with chronic obstructive pulmonary disease (COPD) is tissue changes contributing to thickening of the walls of the airway and its obstruction. As the disease becomes severer, there are increases in mucosal metaplasia, submucosal hypertrophy, peribronchial fibrosis, and airway smooth muscle mass. Drug therapy for COPD does not virtually lead to regression of airway obstruction, except when eosinophilia is present.

Asma grave / Severe asthma

Los objetivos fueron describir la frecuencia de asma grave (AG), definida según criterios de la Organización Mundial de la Salud y analizar diferencias en las características clínicas del grupo con AG frente a pacientes con asma no grave (ANG); secundariamente, investigar el nivel de control alcanzado en ellos con un tratamiento regular. Entre el 01-01-2005 y el 31-12-2014 se analizaron las historias clínicas de 471 pacientes con asma bronquial atendidos en la Ciudad de Buenos Aires. La frecuencia de AG entre ellos fue del 40.1% (189/471), más elevada en pacientes del sector público de la salud (47.7%, 108/226 vs. 33%, 81/245, p = 0.001). Los pacientes con AG tenían más edad que aquellos con ANG (51.3 ± 17.4 vs. 42.6 ± 17.1 años, p = 0.000), un tiempo de evolución más largo (mediana de 30 vs. 20 años, p = 0.000), menores niveles de escolaridad (secundaria o superior: 41.7% vs. 58.1%, p = 0.000), menor frecuencia de rinitis (47% vs. 60.6%, p = 0.004), niveles más graves de obstrucción (VEF% 50.2 ± 13.7 vs. 77.7 ± 12.4, p = 0.000), mayores antecedentes de asma casi fatal (11.1% vs. 2.8%, p = 0.000), valores más altos de IgE sérica (mediana 410 vs. 279 UI/l, p = 0.01), mayores requerimiento de esteroides (68.7% vs. 50.7%, p = 0.000) e internaciones (37.5% vs. 15.9%, p = 0.000). Un 30.6% de pacientes con AG (58/189) completaron un seguimiento de 12 meses, alcanzando el nivel de asma controlada 13 (22.5%) de ellos. El porcentaje de AG hallada resulta considerable. Se recomienda la realización de estudios multicéntricos que investiguen los niveles de control que podrían alcanzar los pacientes con AG con acceso garantizado a un tratamiento adecuado.

The objectives of this work were to investigate the frequency of severe asthma (SA) according to WHO definition and to compare SA patients’ characteristics with those of non-severe asthma (NSA); secondly, to investigate the level of control reached throughout a period of regular treatment. Between 1-1-2005 and 12-31-2014, 471 medical records from patients with bronchial asthma assisted in Buenos Aires City were analyzed. SA frequency was 40.1% (189/471), being significantly higher among patients from the public health system (47.7%, 108/226 vs. 33%, 81/245, p = 0.001). SA patients were older than NSA ones (51.3 ± 17.4 vs. 42.6 ± 17.1 years, p = 0.000), presented longer time since onset of the disease (median 30 vs. 20 years, p = 0.000), lower educational levels (secondary level or higher 41.7% vs. 58.1%, p = 0.000), lower frequency of rhinitis (47% vs. 60.6%, p = 0.004), more severe levels of airway obstruction (FEV% 50.2 ± 13.7 vs. 77.7 ± 12.4, p = 0.000), more frequent antecedents of Near Fatal Asthma (11.1% vs. 2.8%, p = 0.000), higher levels of serum IgE (median of 410 vs. 279 UI/l, p = 0.01) and higher demand of systemic steroids requirements and hospitalizations (68.7% vs. 50.7%, p = 0.000 and 37.5% vs. 15.9%, p = 0.000, respectively). A 30.6% of SA patients (58/189) reached a follow-up period of 12 months, 13 (22.5%) of whom reached the controlled asthma level. The frequency of SA found seems to be considerable. Multicenter studies to investigate the levels of control reached by SA patients with access to proper treatment are recommended.

Understanding asthma-chronic obstructive pulmonary disease overlap syndrome.

Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a loosely-defined clinical entity referring to patients who exhibit characteristics of both asthma and chronic obstructive pulmonary disease (COPD). Clinical definitions and classifications for ACOS vary widely, which impacts our understanding of prevalence, diagnosis and treatment of the condition. This literature review was therefore conducted to characterize the prevalence of ACOS and the effect of different disease definitions on these estimates, as this has not previously been explored. From an analysis of English language literature published from 2000 to 2014, the estimated prevalence of ACOS ranges from 12.1% to 55.2% among patients with COPD and 13.3%-61.0% among patients with asthma alone. This variability is linked to differences in COPD and asthma diagnostic criteria, disease ascertainment methods (spirometry-based versus clinical or symptom-based diagnoses and claims data), and population characteristics including age, gender and smoking. Understanding the reasons for differences in prevalence estimates of ACOS across the literature may help guide decision making on the most appropriate criteria for defining ACOS and aid investigators in designing future ACOS clinical studies aimed at effective treatment.