[Asthma]. / Asma.

Asthma is a chronic inflammatory disease that affects about 5% of the world's population and generates high health and social costs. Proper management of the disease requires a correct diagnosis, based on objective measures of functional impairment, as well as symptom control and assessment of the future risk of exacerbations.It has been estimated that 18% of asthma patients in Western Europe have severe asthma and approximately 50% of them have poor control. The severity of asthma is established based on the minimum maintenance treatment needs to achieve control. Asthma clinical practice guidelines recommend classifying severe patients into allergic asthma (T2); eosinophilic asthma (T2) and non-T2 asthma in order to establish the most appropriate treatment.In recent decades, new biological therapies have been developed that can be applied according to the phenotype and endotype of asthma, allowing for selective and personalized treatment. These phenotypes and endotypes can change over time and therefore, the identification of biomarkers capable of predicting the severity, the course of the disease and the response to a given treatment seems essential. A large number of biomarkers have been studied in asthma, but so far only a few can be readily used in routine clinical practice. The application of omics technologies (epigenomics, genomics, transcriptomics, proteomics, metabolomics, lipidomics, etc.) for this purpose is still in the research phase.

Mucus hypersecretion in asthma is associated with rhinosinusitis, polyps and exacerbations.

BACKGROUND: Bronchial hypersecretion is a poorly studied symptom in asthma. The aim of the study was to determine the specific characteristics of asthmatics with bronchial hypersecretion. METHODS: A total of 142 asthmatics (21.8% men; mean age 49.8 years) were prospectively followed for one year. Mucus hypersecretion was clinically classified into two severity categories: daily sputum production and frequent expectoration but not every day. Clinical and pulmonary function variables associated with mucus hypersecretion were assessed by multiple logistic regression analysis. RESULTS: Daily cough was recorded in 28.9% of patients and sputum production daily or most of the days in 52.1%. Patients with mucus hypersecretion had more dyspnoea, poorer asthma control and quality of life, had suffered from more exacerbations and showed anosmia associated with chronic rhinosinusitis and nasal polyposis more frequently. Factors associated to mucus hypersecretion were anosmia, one exacerbation or more in the previous year and FEV1/FVC <70% (AUC 0.75, 95% CI 0.66-0.85) for the first definition of hypersecretion, and anosmia, poor asthma control and age (AUC 0.75, 95% CI 0.67-0.83) for the second definition. CONCLUSIONS: Mucus hypersecretion is frequent in patients with asthma, and is associated with chronic upper airways disease, airway obstruction, poor asthma control and more exacerbations.

Impact of Asthma on the Sexual Functioning of Patients. A Case-Control Study. / Impacto del asma en la vida sexual de los pacientes. Un estudio de casos y controles.

INTRODUCTION: Sexual limitations play an important role in the quality of life of patients with chronic diseases. Very limited information is available on the impact of asthma on the sexual functioning of these individuals. MATERIALS AND METHODS: Cross-sectional, observational, multicenter study. Asthma patients and healthy individuals were recruited. All subjects participated in an interview in which demographic and clinical data were recorded, and completed the Goldberg Anxiety-Depression Scale (GADS) to evaluate the presence of concomitant psychiatric disease. Men also completed the International Index of Erectile Function (IIEF), and women, the Female Sexual Function Index (FSFI). RESULTS: A total of 276cases were included, comprising 172asthma patients (63 men and 109 women) with a mean age of 42 (±14) years, and 104 controls (52men and 51women) with a mean age of 39 (±12) years. Time since onset of asthma was 15 years and severity distribution was: 6.4% intermittent, 17.9% mild persistent, 47.4% moderate, and 28.2% severe. Disease was considered controlled in 57.7%, partially controlled in 28.2%, and uncontrolled in 14.1%. Women with asthma had greater sexual limitations than women in the control group, with a total FSFI score of 22.1 (±9) compared to 26.5 (±6.8), respectively (P<.005). Men with asthma had significantly more severe erectile dysfunction with a total IIEF score of 59.5 (±12.5) compared to 64.3 (±8.2) in male controls (P<.05). An association was also observed between sexual problems and poorer asthma control. CONCLUSIONS: Asthma is associated with a poorer sexual quality of life among patients. These results should arouse the interest of healthcare professionals in detecting and alleviating possible sexual limitations among their asthma patients in routine clinical practice.

Impacto del asma en la vida sexual de los pacientes. Un estudio de casos y controles / Impact of Asthma on the Sexual Functioning of Patients. A Case-Control Study

Introducción: Las limitaciones de la vida sexual de los pacientes con enfermedades crónicas desempeñan un importante papel en su calidad de vida. La información disponible sobre el impacto de la enfermedad asmática en la vida sexual de las personas es muy limitada. Material y métodos: Estudio transversal, observacional y multicéntrico. Se reclutaron pacientes asmáticos y sujetos sanos, a los que se les efectuó una entrevista en la que se recogieron datos demográficos y clínicos y en donde además cumplimentaron los siguientes cuestionarios: la escala Goldberg Anxiety-Depression Scale (GADS) para la valoración de la existencia de comorbilidad psiquiátrica, y en varones el Índice Internacional de la Función Eréctil (IIEF) y en mujeres el Índice de la Función Sexual Femenina (FSFI). Resultados: Se incluyeron un total de 276 casos, de los que 172 eran asmáticos (63 hombres y 109 mujeres) con una media de edad de 42 (± 14) años y 104 controles (53 hombres y 51 mujeres) con una media de edad de 39 (± 12) años. El asma presentaba una evolución de 15 años y su gravedad se distribuía: 6,4% intermitente, 17,9% persistente leve, 47,4% moderada y 28,2% grave. La enfermedad se consideró controlada en un 57,7%, parcialmente controlada en un 28,2% y no controlada en un 14,1%. Las mujeres asmáticas presentaron una mayor limitación de la vida sexual que las mujeres del grupo control, con una puntuación total del FSFI de 22,1 (± 9) frente a 26,5 (± 6,8), respectivamente (p < 0,005). Y los varones asmáticos, una significativa mayor disfunción eréctil, con una puntuación total del IIFE de 59,5 (± 12,5) frente a 64,3 (± 8,2), respectivamente (p < 0,05). Se observó además una relación entre la existencia de problemas sexuales y un peor control del asma. Conclusiones: La enfermedad asmática condiciona una peor calidad de vida sexual en las personas afectadas. Estos resultados deberían promover, en la práctica clínica habitual, el interés de los profesionales sanitarios por determinar y paliar las posibles limitaciones sexuales de sus pacientes con asma (AU)

Introduction: Sexual limitations play an important role in the quality of life of patients with chronic diseases. Very limited information is available on the impact of asthma on the sexual functioning of these individuals. Materials and methods: Cross-sectional, observational, multicenter study. Asthma patients and healthy individuals were recruited. All subjects participated in an interview in which demographic and clinical data were recorded, and completed the Goldberg Anxiety-Depression Scale (GADS) to evaluate the presence of concomitant psychiatric disease. Men also completed the International Index of Erectile Function (IIEF), and women, the Female Sexual Function Index (FSFI). Results: A total of 276 cases were included, comprising 172 asthma patients (63 men and 109 women) with a mean age of 42 (± 14) years, and 104 controls (52 men and 51women) with a mean age of 39 (± 12) years. Time since onset of asthma was 15 years and severity distribution was: 6.4% intermittent, 17.9% mild persistent, 47.4% moderate, and 28.2% severe. Disease was considered controlled in 57.7%, partially controlled in 28.2%, and uncontrolled in 14.1%. Women with asthma had greater sexual limitations than women in the control group, with a total FSFI score of 22.1 (± 9) compared to 26.5 (± 6.8), respectively (P < .005). Men with asthma had significantly more severe erectile dysfunction with a total IIEF score of 59.5 (± 12.5) compared to 64.3 (± 8.2) in male controls (P < .05). An association was also observed between sexual problems and poorer asthma control. Conclusions: Asthma is associated with a poorer sexual quality of life among patients. These results should arouse the interest of healthcare professionals in detecting and alleviating possible sexual limitations among their asthma patients in routine clinical practice (AU)

[Pharmacological treatment of COPD. Where are we now?]. / Tratamiento farmacológico de la EPOC. ¿Dónde nos encontramos?

Current clinical guidelines recommend a step-wise approach to the pharmacological treatment of chronic obstructive pulmonary disease (COPD), with drugs being added according to the severity of airflow obstruction, symptoms, and the number of acute exacerbations in patients with severe disease. However, greater knowledge of the physiopathogenesis of this disease has led to COPD being considered a heterogeneous process in which therapeutic decisions should not be based exclusively on the results of spirometry. Treatment is increasingly individualized according to the patient's characteristics. The present article reviews the scientific evidence on the aims of treatment in COPD and the benefits achieved by the various pharmacological options available.

Tratamiento farmacológico de la EPOC. ¿Dónde nos encontramos? / Pharmacological treatment of COPD. Where are we now?

En la actualidad, las guías clínicas recomiendan la terapia escalonada y progresiva para el tratamiento de laenfermedad pulmonar obstructiva crónica (EPOC), que consiste en ir añadiendo fármacos en función de lagravedad de la obstrucción al flujo aéreo, de los síntomas y del número de agudizaciones en los pacientesgraves. Sin embargo, a medida que avanza el conocimiento de la fisiopatogenia de esta enfermedad, se consideraque la EPOC es un proceso heterogéneo en el cual la decisión terapéutica no debe basarse exclusivamenteen un valor espirométrico. Nos inclinamos cada vez más a establecer un tratamiento personalizado, enfunción de las características del paciente. En el presente artículo se repasan las evidencias científicas existentessobre los objetivos en el tratamiento de la EPOC y los beneficios alcanzados por las diferentes intervencionesfarmacológicas disponibles(AU)

Current clinical guidelines recommend a step-wise approach to the pharmacological treatment of chronicobstructive pulmonary disease (COPD), with drugs being added according to the severity of airflowobstruction, symptoms, and the number of acute exacerbations in patients with severe disease. However,greater knowledge of the physiopathogenesis of this disease has led to COPD being considered a heterogeneousprocess in which therapeutic decisions should not be based exclusively on the results of spirometry. Treatmentis increasingly individualized according to the patient’s characteristics. The present article reviews thescientific evidence on the aims of treatment in COPD and the benefits achieved by the various pharmacologicaloptions available(AU)