Systemic Corticosteroids in Patients with Bronchial Asthma: A Real-Life Study.

OBJECTIVES: The objective of the present study was to determine the use of systemic corti-costeroids (SCs) in patients with bronchial asthma using big data analysis. METHODS: We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was per-formed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. RESULTS: During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients at some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, ob-esity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%) and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. CONCLUSION: In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care.

Systemic Corticosteroids in Patients With Bronchial Asthma: A Real-Life Study

Objective: The objective of the present study was to determine the use of systemic corticosteroids (SCs) in patients with bronchial asthma using big data analysis. Methods: We performed an observational, retrospective, noninterventional study based on secondary data captured from free text in the electronic health records. This study was performed based on data from the regional health service of Castille-La Mancha (SESCAM), Spain. We performed the analysis using big data and artificial intelligence via Savana® Manager version 3.0. Results: During the study period, 103 667 patients were diagnosed with and treated for asthma at different care levels. The search was restricted to patients aged 10 to 90 years (mean age, 43.5 [95%CI, 43.4-43.7] years). Of these, 59.8% were women. SCs were taken for treatment of asthma by 58 745 patients t some point during the study period. These patients were older, with a higher prevalence of hypertension, dyslipidemia, diabetes, obesity, depression, and hiatus hernia. SCs are used frequently in the general population with asthma (31.4% in 2015 and 39.6% in 2019). SCs were prescribed mainly in primary care (59%), allergy (13%), and pulmonology (20%). The frequency of prescription of SCs had a direct impact on the main associated adverse effects. Conclusion: In clinical practice, SCs are frequently prescribed to patients with asthma, especially in primary care. Use of SCs is associated with a greater number of adverse events. It is necessary to implement measures to reduce prescription of SCs to patients with asthma, especially in primary care (AU)

Objetivo: El objetivo del presente estudio fue determinar el uso de corticoides sistémicos (CS) en pacientes con asma bronquial mediante el análisis de big data. Métodos: Se realizó un estudio observacional, retrospectivo y no intervencionista basado en datos secundarios capturados a partir de texto libre en las historias clínicas electrónicas. Este estudio se realizó a partir de los datos del Servicio Regional de Salud de Castilla-La Mancha (SESCAM), España. Se realizó el análisis mediante big data e inteligencia artificial a través de Savana® Manager versión 3.0. Resultados: Durante el periodo de estudio, 103 667 pacientes fueron diagnosticados y tratados de asma en los diferentes niveles asistenciales. La búsqueda se restringió a pacientes de entre 10 y 90 años (edad media, 43,5 [IC 95%, 43,4-43,7] años). De ellos, el 59,8% eran mujeres. 58 745 pacientes tomaron SC para el tratamiento del asma en algún momento del periodo de estudio. Estos pacientes eran de mayor edad, con una mayor prevalencia de hipertensión, dislipidemia, diabetes, obesidad, depresión y hernia de hiato. Los SC se utilizan con frecuencia en la población general con asma (31,4% en 2015 y 39,6% en 2019). Los SC se prescribieron principalmente en Atención Primaria (59%), Alergia (13%) y Neumología (20%). La frecuencia de prescripción de SCs tuvo un impacto directo en los principales efectos adversos asociados. Conclusiones: En la práctica clínica, los CS se prescriben con frecuencia a los pacientes con asma, especialmente en Atención Primaria. El uso de los CS se asocia a un mayor número de efectos adversos. Es necesario implementar medidas para reducir la prescripción de CS a los pacientes con asma, especialmente en Atención Primaria (AU)

El pH medido en el condensado de aire exhalado se correlaciona con cambios en los marcadores inflamatorios en los pacientes con EPOC / Ph measured in exhaled air condensate correlates with changes in inflammatory markers in COPD patients

Introducción: La inflamación juega un papel fundamental en el desarrollo y progresión de la enfermedad pulmonar obstructiva crónica (EPOC). El carácter invasivo de las técnicas clásicas de estudio, biopsia, cepillado y lavado broncoalveolar dificulta su aplicación. Sin embargo, la medición del pH en el condensado de aire exhalado (CAE) podría ser una forma fácil para determinar el grado de inflamación y cambios en el estrés oxidativo en los pacientes con EPOC.Objetivos: La finalidad de nuestro estudio es determinar si la medición del pH del CAE en pacientes con EPOC estable puede proporcionar información sobre la presencia de un proceso inflamatorio tanto en plasma como en el condensado de los pacientes diagnosticados de EPOC en fase estable.Sujetos y Métodos: Se seleccionó un grupo formado por fumadores sin EPOC (n = 15) y otro grupo de pacientes diagnosticados de EPOC en situación estable (n = 39). Los pacientes fueron diagnosticados y clasificados de EPOC de acuerdo con la guía Global Initiative for Obstructive Lung Disease (GOLD). Se realizó un examen físico, pruebas de función respiratorias, análisis de sangre [IL-8, LTB4, 8-ISO) y recogida del condensado de aire exhalado (se midió el pH, IL-8, LTB4, 8-ISO).Resultados: El pH se correlaciona significativamente con la IL-8 en suero (r: - 0,43; p: 0,001), el 8-ISO en condensado (r: 0,63; p: 0,000), volumen residual (r: - 0,29; p: 0,035) y el índice paquete año (r: - 0,46 p: 0,000). No encontramos en la muestra analizada que el pH en el condensado se correlacione con el resto de marcadores inflamatorios en sangre y estrésoxidativo tanto en suero como en el condensado de aire exhalado. Tampoco se correlaciona con el FEV1, FVC,TLC y DLCO%, escala de disnea (MRC) ni con la edad.Conclusiones: En la muestra analizada encontramos que aquellas personas con niveles más elevados de IL-8 en plasma y mayor consumo de tabaco presentan una mayor acidez en el condensado de aire exhalado. Sin embargo, encontramos una gran dispersión de los resultados y problemas de reproducibilidad de los mismos. Es por ello que han de realizarse más estudios para confirmar nuestros hallazgos

Introduction: Inflammation plays an essential role in the development and progression of chronic obstructionpulmonary disease (COPD). The invasive character of the classical techniques of the study, biopsy, brush and bronchoalveolar lavage, makes it difficult to apply. However, measurement of pH in the exhaled air condensate (EAC) could be an easy way to measure the inflammation grade and changes in oxidative stress in patients with COPD. Objectives: Our study aims to determine if the measurement of pH of EAC in COPD patients can provide information on the presence of an inflammatory condition both in plasma and in the condensate of patients diagnosed of COPD in stable phase.Subjects and Methods: A group made up of smokers without COPD (n = 15) and another group of patients diagnosed ofCOPD in stable condition (n = 39) were selected. The patients were diagnosed and classified of COPD in agreement with the Global Initiative for Obstructive Lung Disease (GOLD) criteria. A physical examination, respiratory function tests, blood analysis [IL-8, LTB4, 8-ISO) were obtained and collected from condensed exhaled air (pH, IL-8, LTB4, 8-ISO were measured).Results: The pH was significantly correlated with serum IL-8 (r: - 0.43; p: 0.001), 8-ISO in condensed (r: 0.63; p: 0.000), residual volume (r: - 0.29; p: 0.035) and the pack year index (r: -0.46 p: 0.000). In the sample analyzed, we did not find that the pH in the condensate was correlated with the remaining inflammatory markers in blood and oxidative stress both in serumand exhaled air condensate pH. It was not correlated with the FEV1, FVC, TLC and DLCO%, dyspnea scale (MRC) nor age.Conclusions: In our sample, we found that those persons with higher levels of IL-8 in plasma and greater tobaccoconsumption had greater acidity in the exhaled air condensate. However, we found much range of the results and reproducibility problems. Thus, more studies need to be made to confirm our findings (AU)