[Impact of administering the Asthma Control Test questionnaire on rating asthma control in primary health care]. / Impacto de la administración del cuestionario Asthma Control Test en atención primaria sobre la puntuación de control del asma.

OBJECTIVE: To compare the score indicative of asthma control obtained using the Asthma Control Test (ACT(®)) questionnaire administered by primary health care physicians, habitual users of the questionnaire, and those were not. DESIGN: A multicentre, prospective, epidemiological study. SETTING: Primary health care centres in Spain. PARTICIPANTS: Two study populations were defined: «ACT(®) users¼ and «non-ACT(®) users¼, according to the use of the ACT(®) questionnaire by their respective primary health care physicians. MAIN MEASUREMENTS: The patients completed the ACT(®) questionnaire during a baseline visit, and in another follow-up visit at 8 weeks. The primary outcome was the percentage of patients with an ACT(®) score ≥ 20. The change in the ACT(®) score was analysed if there was a change in treatment. RESULTS: There was a higher percentage of patients with well-controlled asthma in the ACT(®) users group after 8 weeks (68.5% vs. 55.6%; P=.01). A significant increase in the ACT(®) score was observed in the follow-up visit compared to the baseline visit, when there was a change in treatment in both groups (2.5 and 3.8 points, ACT(®) users and non-ACT(®)-users, respectively, P=.001 and P<.0001). CONCLUSIONS: The administering of the ACT(®) questionnaire improved the score indicative of asthma control in both populations of the study, with a higher score being obtained in those patients attended by physicians with previous experience in the use of ACT(®). The administering of the ACT(®) questionnaire could contribute to improving the long-term outcome of the patient, and favouring the appropriateness of the treatment.

Potential impact of mepolizumab in stepping down anti-osteporotic treatment in corticosteroid-dependent asthma.

Oral corticosteroids (OCS) are commonly used for the acute management of severe asthma exacerbations or as maintenance therapy; however, chronic use is associated with significant toxicities, e.g., osteoporosis. In the REal worlD Effectiveness and Safety (REDES) study of mepolizumab in a multicentric Spanish cohort of asthma patients, mepolizumab effectively reduced clinically severe asthma exacerbations and decreased OCS dependence. This post-hoc analysis further evaluates mepolizumab's de-escalation effect on OCS dose. Patients enrolled in REDES who had OCS consumption data available for 12 months pre- and post-mepolizumab treatment were included in this analysis. Primary outcomes were to determine the change in the proportion of patients eligible for anti-osteoporotic treatment due to the changes in OCS consumption before and after 1 year of mepolizumab treatment. All analyses are descriptive. Approximately one-third (98/318; 30.8%) of patients in REDES were on maintenance OCS at the time of mepolizumab treatment initiation. In REDES, mean cumulative OCS exposure decreased by 54.3% after 1 year of treatment. The proportion of patients on high-dose OCS (≥7.5 mg/day) fell from 57.1% at baseline to 28.9% after 12 months of mepolizumab treatment. Thus, 53.6% of OCS-dependent asthma patients treated with mepolizumab would cease to be candidates for anti-osteoporotic treatment according to guidelines thresholds.

Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study.

BACKGROUND: Population distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe the prevalence of reduced DLCO in a population-based sample of current and former smoker subjects without airflow limitation and to describe its morphological, functional and clinical implications. METHODS: A sample of 405 subjects aged 40 years or older with postbronchodilator forced expiratory volume in 1 s/forced vital capacity (FVC) >0.70 was obtained from a random population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, exhaled carbon monoxide (CO) measurement, spirometry, DLCO determination, 6 min walk test, routine blood analysis and low-dose CT scan with evaluation of lung density and airway wall thickness. RESULTS: In never, former and current smokers, prevalence of reduced DLCO was 6.7%, 14.4% and 26.7%, respectively. Current and former smokers with reduced DLCO without airflow limitation were younger than the subjects with normal DLCO, and they had greater levels of dyspnoea and exhaled CO, greater pulmonary artery diameter and lower spirometric parameters, 6 min walk distance, daily physical activity and plasma albumin levels (all p<0.05), with no significant differences in other chronic respiratory symptoms or CT findings. FVC and exhaled CO were identified as independent risk factors for low DLCO. CONCLUSION: Reduced DLCO is a frequent disorder among smokers without airflow limitation, associated with decreased exercise capacity and with CT findings suggesting that it may be a marker of smoking-induced early vascular damage. TRIAL REGISTRATION NUMBER: NCT03028207.

Dissociation between physical capacity and daily physical activity in COPD patients. A population-based approach.

BADKGROUND: Physical capacity (PC) and daily physical activity (PA) are two crucial factors in the clinical course of COPD, although they do not always maintain a close relationship. The objectives were to evaluate the frequency of PC-PA dissociation in patients with COPD and subjects without airflow limitation (AL) and to identify its risk factors. METHODS: A sample of 319 COPD patients and 399 subjects without AL was consecutively obtained from a population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, lung function testing, blood analysis and low-dose computed tomography (CT) scan with evaluation of lung density and airway wall thickness. A distance walked in 6 min > 70% predicted was considered an indicator of normal PC, while a Yale Physical Activity Survey summary index score <51 was used to identify with sedentary lifestyle. RESULTS: 166 COPD patients (52.0%) reported a sedentary lifestyle with evidence of preserved PC, while this phenomenon was present in 188 (47.1%) subjects without AL. In the COPD group, symptoms of chronic bronchitis, depression and elevated hematocrit and blood eosinophil count were identified as independent risk factors for PC-PA dissociation. In turn, in the subjects without AL, the risk factors for PC-PA dissociation were low fat-free mass, obesity and anxiety, as well as reduced levels of HDL-cholesterol and the absence of osteoporosis. CONCLUSIONS: Almost half of COPD patients and subjects without airflow limitation with preserved PC maintain a sedentary lifestyle, with different risk factors for sedentarism between both groups.

Impacto de la administración del cuestionario Asthma Control Test en atención primaria sobre la puntuación de control del asma / Impact of administering the Asthma Control Test questionnaire on rating asthma control in primary health care

Objetivo: Comparar la puntuación indicativa del control del asma obtenida mediante el cuestionario Asthma Control Test (ACT®) administrado por médicos de atención primaria usuarios habituales del cuestionario y otros que no lo eran. Diseño: Estudio epidemiológico, multicéntrico, prospectivo. Emplazamiento: Centros de atención primaria en España. Participantes: Se definieron 2 poblaciones de estudio: «usuarios ACT®» y «no usuarios ACT®», según el uso del cuestionario ACT® de sus respectivos médicos de atención primaria. Mediciones principales: Los pacientes completaron el cuestionario ACT® en una visita basal y en otra de seguimiento a las 8 semanas. La variable de valoración principal fue el porcentaje de pacientes con una puntuación ACT® ≥ 20. Se analizó además la evolución de la puntuación ACT® según si hubo cambio de tratamiento. Resultados: Hubo un mayor porcentaje de pacientes con asma bien controlada en el grupo de usuarios ACT® tras 8 semanas (68,5 vs. 55,6%; p = 0,01). Se observó un aumento significativo en la puntuación ACT®, en la visita de seguimiento respecto a la visita basal, cuando hubo cambio de tratamiento, en ambos grupos (2,5 y 3,8 puntos, usuarios ACT® y no usuarios ACT®, respectivamente, p = 0,001 y p < 0,0001). Conclusiones: La administración del cuestionario ACT® mejoró la puntuación indicativa de control del asma en ambas poblaciones del estudio, obteniendo una mayor puntuación aquellos pacientes atendidos por médicos con experiencia previa en el uso del ACT®. La administración del ACT® podría contribuir a mejorar la evolución longitudinal del paciente favoreciendo la adecuación del tratamiento (AU)

Objective: To compare the score indicative of asthma control obtained using the Asthma Control Test (ACT®) questionnaire administered by primary health care physicians, habitual users of the questionnaire, and those were not. Design: A multicentre, prospective, epidemiological study. Setting: Primary health care centres in Spain. Participants: Two study populations were defined: «ACT® users» and «non-ACT® users», according to the use of the ACT® questionnaire by their respective primary health care physicians. Main measurements: The patients completed the ACT® questionnaire during a baseline visit, and in another follow-up visit at 8 weeks. The primary outcome was the percentage of patients with an ACT® score ≥20. The change in the ACT® score was analysed if there was a change in treatment. Results: There was a higher percentage of patients with well-controlled asthma in the ACT® users group after 8 weeks (68.5% vs. 55.6%; P=.01). A significant increase in the ACT® score was observed in the follow-up visit compared to the baseline visit, when there was a change in treatment in both groups (2.5 and 3.8 points, ACT® users and non-ACT®-users, respectively, P=0.001 and P<0.0001). Conclusions: The administering of the ACT® questionnaire improved the score indicative of asthma control in both populations of the study, with a higher score being obtained in those patients attended by physicians with previous experience in the use of ACT®. The administering of the ACT® questionnaire could contribute to improving the long-term outcome of the patient, and favouring the appropriateness of the treatment (AU)