A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease.

According to the current clinical practice guidelines for chronic obstructive pulmonary disease (COPD), the addition of inhaled corticosteroids (ICS) to long-acting ß2 agonist therapy is recommended in patients with moderate-to-severe disease and an increased risk of exacerbations. However, ICS are largely overprescribed in clinical practice, and most patients are unlikely to benefit from long-term ICS therapy.Evidence from recent randomized-controlled trials supports the hypothesis that ICS can be safely and effectively discontinued in patients with stable COPD and in whom ICS therapy may not be indicated, without detrimental effects on lung function, health status, or risk of exacerbations. This article summarizes the evidence supporting the discontinuation of ICS therapy, and proposes an algorithm for the implementation of ICS withdrawal in patients with COPD in clinical practice.Given the increased risk of potentially serious adverse effects and complications with ICS therapy (including pneumonia), the use of ICS should be limited to the minority of patients in whom the treatment effects outweigh the risks.

Management and referral of patients with severe and poorly controlled asthma in primary care.

BACKGROUND: Over 50% of treated patients with asthma in Europe are not well controlled. Their management in primary health care (PHC) differs from that in specialized care, and there is no real coordination between the two. OBJECTIVES: To identify barriers and solutions to improving the management of patients with severe and poorly controlled asthma and the communication between specialists and PHC, and to reach a consensus on the criteria for referral patients. METHODS: An observational study using a modified Delphi technique. About 79 physicians from PHC, pneumology and allergy fields from different Spanish regions were invited to participate via an online questionnaire. Consensus was reached on an item when more than two-thirds of the panel members scored within the 3-point category (1-3 or 7-9) containing the median and the interquartile range of answers had to be ≤4 points. RESULTS: Response rate: 52%. After the second round, consensus items were 40 (62.5%): of which 37 in agreement and 3 in disagreement. Around 92.68% of respondents agreed that it would be useful to incorporate questionnaires for asthma control into PHC computer-based searches. About 100% of participants agreed that clear consensus criteria between PHC and specialists must be determined to decide when a patient with asthma is referred from PHC to specialist or vice versa. Ten of the proposed criteria reached consensus agreement. CONCLUSION: The failure to use guidelines and specific questionnaires for asthma control in PHC is one reason why there is underdiagnosis and poor control of asthma. Some strategies to improve the asthma care management emerged from the survey results.

Vacunación en neumococo. Actuación en la farmacia comunitaria / Pneumococcal vaccination. Community pharmacy procedure

En la elaboración del documento han participado SEFAC, semFYC, SEMERGEN y SEPAR. El objetivo principal era definir los perfiles de paciente susceptibles prioritariamente de la vacunación frente al neumococo considerando los grupos de riesgo, las patologías concomitantes, las posibles consecuencias de una infección neumocócica y la elaboración, a su vez, de un algoritmo de vacunación en el adulto. Se han definido igualmente las indicaciones de la vacuna así como la propuesta de entrevista por parte de la farmacia comunitaria. El documento, avalado por las principales sociedades científicas médico-farmacéuticas, será de gran utilidad para el farmacéutico comunitario de cara a abordar a pacientes con mayor factor de riesgo de contraer enfermedad neumocócica. Será también una manera muy gráfica para conseguir detectar, asesorar y, llegado el caso, derivar al facultativo médico a todo este tipo de paciente (AU)

SEFAC, semFYC, SEMERGEN and SEPAR were involved in the production of the document. The primary objective was to define the patient profiles most susceptible to be vaccinated against pneumococcus, considering the risk groups, the associated pathologies and the possible consequences of a pneumococcal infection and in turn, to develop a vaccination program in adults. The vaccine indications were also defined, as well as the proposed consultation by the community pharmacy. The document, backed by the main medico-pharmaceutical science companies, will be very useful to community pharmacies with regards to handling patients with a greater degree of risk of contracting pneumococcal disease. This will also be a very explicit way of detecting, assessing and, as necessary, diverting medical staff to this type of patients (AU)

La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere. Respuesta de los autores / Obsolete anti-pneumococcal vaccination recommendations in the spanish guidelines for the management of asthma (GEMA 4.0): the authors reply

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[External assessment of the GEMA2009 recommendations by a multidisciplinary expert panel on asthma]. / Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma.

OBJECTIVES: To assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma. MATERIALS AND METHODS: The study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee. RESULTS: Seventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts. CONCLUSIONS: The external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5%). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research.

Valoración externa de las recomendaciones de la GEMA2009 por un panel multiprofesional de expertos en asma / External Assessment of the GEMA2009 Recommendations by a Multidisciplinary Expert Panel on Asthma

ObjetivosValorar el grado de acuerdo de un panel de expertos en asma de diferentes especialidades con las recomendaciones que propone la Guía Española para el Manejo del Asma (GEMA) 2009.Material y métodosEl estudio se efectuó en 4 fases: 1) constitución del comité científico formado por los 9 coordinadores de GEMA2009, para la selección de las recomendaciones de la Guía que conforman el cuestionario Delphi del estudio (56 ítems); 2) selección de un panel estatal multicéntrico con 74 expertos en asma de todas las especialidades implicadas en la Guía (neumólogos, alergólogos, médicos de familia, otorrinolaringólogos, y especialistas de pediatría); 3) encuesta Delphi en 2 rondas (con valoración personal de cada ítem mediante escala Likert de 5 puntos), por correo electrónico, con informe a panelistas de resultados intermedios; y 4) análisis y discusión de resultados por el comité científico del proyecto.ResultadosSe apreció un consenso de criterio en 49 de las 56 cuestiones analizadas ya en la primera ronda. Tras la interacción del panel, se lograron consensuar 53 ítems de la encuesta, en el sentido favorable al acuerdo del panel con las recomendaciones GEMA. En una de las cuestiones no consensuadas, sobre indicación de inmunoterapia en asma alérgica, se apreció una significativa disparidad de opinión entre especialidades. En otra, sobre las medidas de control ambiental en alergia a ácaros, se apreció una manifiesta oposición del panel (55%), y en la última, sobre la necesidad de cambiar de trabajo en pacientes con síndrome reactivo de disfunción de la vía aérea, se observó una ausencia significativa de criterio establecido en buena parte de los encuestados (40% expresan «ni de acuerdo, ni en desacuerdo»)(AU)

ConclusionesLa valoración externa por expertos en asma de diferentes especialidades constata un elevado nivel de acuerdo profesional con las recomendaciones formuladas en GEMA2009 (93%). Probablemente el desacuerdo evidenciado en 3 de las recomendaciones reflejan la escasez de evidencias, o su gran variabilidad, para establecer recomendaciones consistentes. Estas cuestiones podrían representar áreas susceptibles de un mayor esfuerzo investigador futuro(AU)

ObjectivesTo assess the level of agreement on the GEMA 2009 clinical recommendations by a Spanish expert panel on asthma.Materials and methodsThe study was divided into four stages: 1) establishment of a 9 member scientific committee (GEMA authors) for selection of GEMA recommendations to use in the survey; 2) formation of a panel of 74 professionals with expertise in this field (pulmonologists, allergists, family doctors, ear, nose and throat and paediatric specialists); 3) Delphi survey in two rounds, sent by mail, with intermediate processing of opinions and a report to the panel members; and 4) analysis and discussion of results for the Scientific Committee.ResultsSeventy four participants completed the two rounds of survey. During the first round, a consensus was reached in 49 out of 56 questions analysed. Following discussion by the panel, the consensus was increased to a total of 53 items in the survey. With respect to the remaining questions, Insufficient consensus was obtained on the rest of the questions, due to differing views between sub-specialists, or lack of criteria by most of the experts.ConclusionsThe external analysis by asthma experts from different specialities showed a high level of professional agreement with the GEMA 2009 recommendations in Spain (96.5%). The disagreement shown in three recommendations reflect the lack of a high level evidence. These issues represent areas of interest for future research(AU)

Tratamiento antimicrobiano de la agudización de la EPOC: Documento de Consenso 2007 / Antimicrobial treatment of exacerbation in Chronic Obstructive Pulmonary Disease: 2007 Consensus Statement

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Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano / Antimicrobial therapy of chronic obstructive pulmonary disease in the elderly

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Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano / No disponible

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