RESUMEN
Asthma is a chronic respiratory disease with a high health, social and economic impact, particularly in the case of Severe Uncontrolled Asthma (SUA). For this reason, new strategies are especially necessary to improve its approach, with a personalized approach to each patient and from a multidisciplinary perspective, in addition to integrating the new telemedicine and telepharmacy practices promoted as a result of the COVID-19 pandemic. In this context, the TEAM 2.0 project ("Work in Multidisciplinary Asthma Teams") has been developed, following the TEAM project carried out in 2019, with the aim of updating and prioritizing good multidisciplinary work practices in SUA in a post pandemic context and analyze the progress made. A coordinating group, made up of eight multidisciplinary teams of hospital pharmacists, pulmonologists, and allergists, carried out an updated bibliographic review, sharing of good multidisciplinary practices, and analysis of advances. Through five regional meetings with other experts with experience in SUA, the good practices identified were shared and subjected to debate, evaluation and prioritization. In total, 23 good multidisciplinary work practices in SUA, grouped into five work areas: 1) Organization of work in multidisciplinary teams, 2) Patient education, self-management and adherence, 3) Health results, data monitoring and persistence, 4) Telepharmacy and experiences implemented during the COVID-19 pandemic and 5) Training and research, were evaluated and prioritized by 57 professionals from the field of Hospital Pharmacy, Pulmonology, Allergology and Nursing. This work has made it possible to update the roadmap of priority actions to continue advancing in optimal models of care for patients with AGNC in a post-COVID-19 context.
Asunto(s)
Asma , COVID-19 , Humanos , Pandemias , Farmacéuticos , Asma/terapia , Grupo de Atención al PacienteRESUMEN
Asthma is a chronic respiratory disease with a high health, social and economic impact, particularly in the case of Severe Uncontrolled Asthma (SUA). For this reason, new strategies are especially necessary to improve its approach, with a personalized approach to each patient and from a multidisciplinary perspective, in addition to integrating the new telemedicine and telepharmacy practices promoted as a result of the COVID-19 pandemic. In this context, the TEAM 2.0 project ("Work in Multidisciplinary Asthma Teams") has been developed, following the TEAM project carried out in 2019, with the aim of updating and prioritizing good multidisciplinary work practices in SUA in a post pandemic context and analyze the progress made. A coordinating group, made up of eight multidisciplinary teams of hospital pharmacists, pulmonologists, and allergists, carried out an updated bibliographic review, sharing of good multidisciplinary practices, and analysis of advances. Through five regional meetings with other experts with experience in SUA, the good practices identified were shared and subjected to debate, evaluation and prioritization. In total, 23 good multidisciplinary work practices in SUA, grouped into five work areas: 1) Organization of work in multidisciplinary teams, 2) Patient education, self-management and adherence, 3) Health results, data monitoring and persistence, 4) Telepharmacy and experiences implemented during the COVID-19 pandemic and 5) Training and research, were evaluated and prioritized by 57 professionals from the field of Hospital Pharmacy, Pulmonology, Allergology and Nursing. This work has made it possible to update the roadmap of priority actions to continue advancing in optimal models of care for patients with AGNC in a post-COVID-19 context.
Asunto(s)
Asma , COVID-19 , Humanos , Pandemias , Farmacéuticos , Asma/terapia , Grupo de Atención al PacienteRESUMEN
Purpose: ATLAS ASMA described the psychosocial impact of asthma on patients' daily life from patients' perspectives (in terms of impaired personal and intimate relationships, sleep quality, leisure time, daily activities, and others) in Spain. Secondary objective includes description of time since diagnosis, expectations, and satisfaction of patients about disease, treatment and medical assistance received, adherence to treatment, perceived control of asthma, and health-related quality of life. Patients and Methods: This was a cross-sectional, observational study, based on a self-administered online survey for adult patients (≥18 years) with asthma. Patients with asthma diagnosis of any type and severity who voluntarily participated in the survey through a web link were included consecutively. In the present manuscript, only adult patients' data are included. Results: A total of 132 adults with asthma were included. Moderate/severe asthma constituted 59.1% of the patients (females 71.2%). Overall, most relevant areas affected due to asthma were leisure activities (67.0%) and the quality/quantity of sleep (52.3%). Moderate/severe patients perceived some degree of impairment in work, school, or at home due asthma more frequently vs mild patients (55.2% vs 10.9%). Poorly controlled asthma (ACT≤19) was reported in 41 (70.7%) and 10 (21.7%) moderate/severe and mild patients (p<0.000), respectively. Mild patients obtained higher mean (SD) Mini-AQLQ score than moderate/severe asthma patients (5.6 [1.0] vs 4.3 [1.1], p<0.000), likewise higher significant results for every individual dimension. Most patients cited little limitation to intense efforts (20.5%). Half of the patients mentioned needing more information about asthma. Topics those patients like to have more information were difficulties that may can have and legal topics (78.6%), asthma evolution (78.6%), secondary effects or issues related to the treatment (61.9%) and legal topics (61.9%). Conclusion: The study reported important insights on psychosocial impact of asthma on patients' daily life from patients' perspectives along with health determinants in asthma-related health outcomes, sociodemographic and psychosocial factors.
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Background and aim: Since their effectiveness was initially demonstrated, oral corticosteroids (OCS) have been routinely used to treat asthma. We now know that their usage is linked to the development of side effects such osteoporosis and adrenal insufficiency. This is an observational study based on Delphi methodology. The questionnaire was divided into 4 sections: OCS generalities, maintenance treatment, short-term treatment, and adverse events. Materials and methods: Two rounds of a 68-item questionnaire were completed by a panel of 48 allergists and pneumologists. Results: Definitions were agreed upon, as was the proper use of OCS in the treatment of severe asthma. The experts agreed that the use of OCS should be minimized as much as possible and that in the event of maintenance treatments, a slow and progressive tapering strategy should be used. They also emphasized the importance of standardizing the technique for measuring the amount of SCG delivered in both cases. Conclusions: This consensus document attempts to bring together scientifically supported suggestions from specialists in the management of asthma to reduce the use of OCS in Spain.
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Purpose: Benralizumab is a monoclonal antibody that targets the α subunit of the IL-5 receptor. Clinical trials have demonstrated the efficacy of this agent with respect to lung function and symptom control in patients with refractory eosinophilic asthma. However, few studies have evaluated the efficacy of benralizumab after switching previous treatment with other monoclonal antibodies. Patients and Methods: We performed a multicenter retrospective study under conditions of daily clinical practice. The study population comprised consecutively included patients with severe refractory eosinophilic asthma whose initial treatment with omalizumab or mepolizumab was switched to benralizumab. Patients were evaluated at 4 and 12 months after starting treatment with benralizumab. We analyzed asthma control, number of severe exacerbations, corticosteroid cycles, visits to the emergency department, and hospital admissions, as well as lung function. Similarly, we evaluated the response to treatment according to previously established criteria. Results: We evaluated 40 patients who switched from omalizumab (n=16) or mepolizumab (n=24) to benralizumab. The reasons for switching were lack of response in 30 cases, adverse effects in 9, and patient request in 1. Switching was followed by a significant decrease in the number of exacerbations, visits to the emergency department, and corticosteroid cycles, as well as improved ACT both at 4 and 12 months. However, no significant improvement in lung function was observed. Asthma control (including complete response and control) was achieved in 55% of patients (n=22) at 12 months. Specifically, a complete response was achieved in 30% of patients at 12 months (66.7% switching from omalizumab and 33.3% from mepolizumab). Conclusion: Patients diagnosed with severe refractory eosinophilic asthma who experience a partial response with omalizumab or mepolizumab could benefit from switching to benralizumab. This approach can reduce the number of exacerbations, visits to the emergency department, and corticosteroid cycles and improve control of asthma.
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PURPOSE: The acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a high impact on patients with chronic diseases. In the literature, there are different perspectives on asthma as comorbidity or risk factor on COVID-19 severity. PATIENTS AND METHODS: The aim of this retrospective study across 13 allergy departments in Spain was to determine the severity of COVID-19 in asthmatic adults followed in allergy departments and its relationship with atopy, clinical and demographic characteristics, phenotypes and laboratory data. In addition, lung function test and asthma control test (ACT) before and after COVID-19 were analyzed. Data was obtained from electronic medical records from March 2020 to April 2021. RESULTS: Two hundred one asthmatic patients were diagnosed with COVID-19 infection by validated detection test. About 30% of the patients were admitted for bilateral pneumonia. Advanced age, elevated D-dimer, lower numbers of lymphocytes and eosinophils, heart diseases and hypertension were associated with severe COVID-19. Allergic and mixed allergic/eosinophilic phenotype and their biomarkers (total IgE, aeroallergens sensitizations, allergic rhinitis, and blood eosinophilia) were related to fewer hospital admissions. Poor control and lower forced expiratory volume in the first second (FEV1) were related to worse prognosis of COVID-19. CONCLUSION: Asthmatic patients with allergic and eosinophilic phenotype have a better evolution of COVID-19 and lower risk of admissions. Older patients, cardiovascular comorbidities, AERD and eosinopenia are related to severity COVID-19.
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OBJECTIVE: To study patient preference for and satisfaction with the Easyhaler® device and to assess ease of training and use of the inhaler in patients previously treated with a variety of dry powder inhalers (DPIs). METHODS: We designed a non-interventional, cross-sectional, single-visit observational study of adult patients with persistent asthma referred to specialized care who had previously been treated with DPI inhalers for at least 3 months. Once clinical baseline data had been checked, patients filled in questionnaires on asthma control (GINA 2019), Feeling of Satisfaction with the Inhaler (FSI-10), and adherence (TAI and Morisky-Green questionnaires). Thereafter, all patients were trained in the use of Easyhaler. We assessed ease of use and satisfaction (FSI-10) with Easyhaler, as well as inhaler device preferences. RESULTS: We recruited 502 patients (mean age, 50.2 ± 16.2 y; 63.1% female), of whom 485 were evaluable. In response to the main objective of the study, we compared the values of the self-completed adapted FSI-10, to measure satisfaction with the inhaler. A significantly higher score in each item of the questionnaire was recorded for Easyhaler. Overall, 38% of patients showed exclusive preference for Easyhaler (compared with 15% for the previous device) or were evenly matched in 46% of cases. CONCLUSION: In the present study, Easyhaler achieved better patient ratings in terms of preference and satisfaction than previously used DPI devices. In order to improve asthma adherence strategies, patient preferences and device choice should be taken into account.
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Asthma is one of the most prevalent chronic diseases in Spain. In 2019, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) drafted a document laying down the criteria for referral and action guidelines in the diagnosis, control and monitoring of the asthmatic patient to facilitate ongoing care and improved attention in every setting. The new circumstances derived from the Covid-19 pandemic have demanded that some of the recommendations of the previous edition be updated and adapted to the new healthcare situation.
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El asma es una enfermedad respiratoria crónica con un alto impacto sanitario, social y económico, en particular, en el caso del asma grave no controlada (AGNC). Por ello, son especialmente necesarias nuevas estrategias para mejorar su abordaje, con un enfoque personalizado a cada paciente y desde una perspectiva multidisciplinar, además de integrar las nuevas prácticas de telemedicina y telefarmacia impulsadas a raíz de la pandemia de COVID-19. En este contexto se ha desarrollado el proyecto TEAM 2.0 («Trabajo en Equipos de Asma Multidisciplinares»), continuación del proyecto TEAM llevado a cabo en 2019, con el objetivo de actualizar y priorizar buenas prácticas de trabajo multidisciplinar en AGNC en un contexto post pandemia y analizar los avances conseguidos. Un grupo coordinador, constituido por 8 equipos multidisciplinares de farmacéuticos hospitalarios, neumólogos y alergólogos, llevó a cabo una revisión bibliográfica actualizada, puesta en común de buenas prácticas multidisciplinares y análisis de avances. A través de 5 reuniones regionales con otros expertos con experiencia en AGNC, se compartieron las buenas prácticas identificadas y fueron sometidas a debate, evaluación y priorización. En total, 23 buenas prácticas de trabajo multidisciplinar en AGNC, agrupadas en 5 ámbitos de trabajo: 1) organización del trabajo en equipos multidisciplinares, 2) educación al paciente, autoadministración y adherencia, 3) resultados en salud, seguimiento de datos y persistencia, 4) telefarmacia y experiencias implantadas durante la pandemia de COVID-19 y 5) formación e investigación, fueron evaluadas y priorizadas por 57 profesionales del ámbito de la farmacia hospitalaria, la neumología, la alergología y la enfermería. Este trabajo ha permitido actualizar la hoja de ruta de acciones prioritarias, para seguir avanzando en modelos óptimos de atención al paciente con AGNC en un contexto post-COVID-19. (AU)
Asthma is a chronic respiratory disease with a high health, social and economic impact, particularly in the case of Severe Uncontrolled Asthma (SUA). For this reason, new strategies are especially necessary to improve its approach, with a personalized approach to each patient and from a multidisciplinary perspective, in addition to integrating the new telemedicine and telepharmacy practices promoted as a result of the COVID-19 pandemic. In this context, the TEAM 2.0 project (Work in Multidisciplinary Asthma Teams) has been developed, following the TEAM project carried out in 2019, with the aim of updating and prioritizing good multidisciplinary work practices in SUA in a post pandemic context and analyze the progress made. A coordinating group, made up of eight multidisciplinary teams of hospital pharmacists, pulmonologists, and allergists, carried out an updated bibliographic review, sharing of good multidisciplinary practices, and analysis of advances. Through five regional meetings with other experts with experience in SUA, the good practices identified were shared and subjected to debate, evaluation and prioritization. In total, 23 good multidisciplinary work practices in SUA, grouped into five work areas: 1) Organization of work in multidisciplinary teams, 2) Patient education, self-management and adherence, 3) Health results, data monitoring and persistence, 4) Telepharmacy and experiences implemented during the COVID-19 pandemic and 5) Training and research, were evaluated and prioritized by 57 professionals from the field of Hospital Pharmacy, Pulmonology, Allergology and Nursing. This work has made it possible to update the roadmap of priority actions to continue advancing in optimal models of care for patients with AGNC in a post-COVID-19 context. (AU)
Asunto(s)
Humanos , Asma , Equipos y Suministros , Farmacia , Hospitales , Telemedicina , Servicio de Farmacia en HospitalRESUMEN
EN: The purpose of this consensus statement is to provide a tool to assist in the management of asthma in Spanish emergency departments and to improve care of patients with asthma. A multidisciplinary team of 3 emergency medicine specialists, 3 respiratory medicine specialists, and 3 allergy specialists made a list of clinical questions and chose 4 clinical practice guidelines on asthma management to prioritize when answering the questions. The team members first worked individually and then discussed their findings in a meeting to reach consensus about the content of the present statement. The recommendations and clinical algorithms in the statement contribute to detecting the asthmatic patient on arrival at the emergency department, establishing the diagnosis, following unified treatment criteria, and referring the patient to a respiratory medicine specialist, an allergy specialist, or a primary care physician, as appropriate. The definitions used in this statement provide a common language for asthma in the interest of helping to unify care practices in emergency departments. The diagnostic criteria, treatment guidelines, and criteria for discharging and admitting patients provided should be useful for managing asthma in Spanish emergency departments.
El presente documento de consenso se ha desarrollado con el objetivo de facilitar una herramienta para el manejo del paciente asmático en los servicios de urgencias españoles y mejorar la calidad asistencial. Un equipo multidisciplinar formado por tres especialistas en medicina de urgencias, tres especialistas en neumología y tres especialistas en alergología elaboró un listado de preguntas clínicas y utilizó cuatro guías de práctica clínica sobre el manejo del asma para responderlas. Después de un periodo de trabajo individual, se discutieron y consensuaron en una reunión los contenidos del presente documento. Las recomendaciones y los algoritmos incluidos en él van dirigidos a detectar al paciente asmático a su llegada al servicio de urgencias, establecer un diagnóstico correcto, unificar los criterios terapéuticos y realizar posteriormente una correcta derivación al neumólogo, alergólogo o al médico de atención primaria, según proceda. Las definiciones que se ofrecen en el presente documento proporcionan un lenguaje común que puede ayudar a unificar la actividad asistencial en los servicios de urgencias. Los criterios diagnósticos, las pautas de tratamiento y los criterios de alta y hospitalización recogidos en esta guía pueden ser de utilidad para el manejo del paciente asmático en los servicios de urgencias españoles.
Asunto(s)
Asma/terapia , Servicio de Urgencia en Hospital/normas , Asma/diagnóstico , Progresión de la Enfermedad , Humanos , Índice de Severidad de la Enfermedad , EspañaRESUMEN
El presente documento de consenso se ha desarrollado con el objetivo de facilitar una herramienta para el manejo del paciente asmático en los servicios de urgencias españoles y mejorar la calidad asistencial. Un equipo multidisciplinar formado por tres especialistas en medicina de urgencias, tres especialistas en neumología y tres especialistas en alergología elaboró un listado de preguntas clínicas y utilizó cuatro guías de práctica clínica sobre el manejo del asma para responderlas. Después de un periodo de trabajo individual, se discutieron y consensuaron en una reunión los contenidos del presente documento. Las recomendaciones y los algoritmos incluidos en él van dirigidos a detectar al paciente asmático a su llegada al servicio de urgencias, establecer un diagnóstico correcto, unificar los criterios terapéuticos y realizar posteriormente una correcta derivación al neumólogo, alergólogo o al médico de atención primaria, según proceda. Las definiciones que se ofrecen en el presente documento proporcionan un lenguaje común que puede ayudar a unificar la actividad asistencial en los servicios de urgencias. Los criterios diagnósticos, las pautas de tratamiento y los criterios de alta y hospitalización recogidos en esta guía pueden ser de utilidad para el manejo del paciente asmático en los servicios de urgencias españoles
The purpose of this consensus statement is to provide a tool to assist in the management of asthma in Spanish emergency departments and to improve care of patients with asthma. A multidisciplinary team of 3 emergency medicine specialists, 3 respiratory medicine specialists, and 3 allergy specialists made a list of clinical questions and chose 4 clinical practice guidelines on asthma management to prioritize when answering the questions. The team members first worked individually and then discussed their findings in a meeting to reach consensus about the content of the present statement. The recommendations and clinical algorithms in the statement contribute to detecting the asthmatic patient on arrival at the emergency department, establishing the diagnosis, following unified treatment criteria, and referring the patient to a respiratory medicine specialist, an allergy specialist, or a primary care physician, as appropriate. The definitions used in this statement provide a common language for asthma in the interest of helping to unify care practices in emergency departments. The diagnostic criteria, treatment guidelines, and criteria for discharging and admitting patients provided should be useful for managing asthma in Spanish emergency departments
Asunto(s)
Humanos , Asma/terapia , Servicio de Urgencia en Hospital/normas , Asma/diagnóstico , Progresión de la Enfermedad , Índice de Severidad de la Enfermedad , AlgoritmosRESUMEN
No disponible
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Humanos , Masculino , Femenino , Asma/epidemiología , Asma/prevención & control , Estado Asmático/epidemiología , Estado Asmático/prevención & control , Sociedades Médicas/normas , Sociedades Médicas/tendencias , Sociedades Médicas , Asma/inmunología , Estado Asmático/inmunología , Sociedades Médicas/historia , Sociedades Médicas/organización & administraciónRESUMEN
No disponible