ABSTRACT
BACKGROUND: The ORBE II study aimed to describe the characteristics and clinical outcomes of adult patients with severe eosinophilic asthma (SEA) treated with benralizumab in a real-world setting in Spain. METHODS: ORBE II (NCT04648839) was an observational, retrospective cohort study in adult SEA patients who had been prescribed benralizumab. Demographic and clinical data of 204 SEA patients were collected 12 months prior to benralizumab initiation (baseline) and at follow-up. Exacerbation rate, asthma symptoms, maintenance oral corticosteroid (OCS) use and lung function were evaluated, among other variables. RESULTS: A total of 204 SEA patients were evaluated. Mean (standard deviation, SD) age of the study population was 56.4 (12.4) years, 62.3% were women and mean (SD) duration of asthma was 15.1 (12.7) years. Median (Q1-Q3) follow-up duration was 19.5 (14.2-24.2) months. At baseline, 72.6% of the overall population (OP) presented blood eosinophil counts ≥ 300 cells/µL; 36.8% had comorbid chronic rhinosinusitis with nasal polyps (CRSwNP); 84.8% reported at least one severe exacerbation, and 29.1% were OCS-dependent. At 1 year of follow-up, patients receiving benralizumab treatment had a 85.6% mean reduction in exacerbations from baseline, and 81.4% of patients achieved zero exacerbations. We also found a clinically relevant mean (SD) increase in pre-bronchodilator (BD) FEV1 of 331 (413) mL, with 66.7% of patients achieving a pre-BD FEV1 increase ≥ 100 mL, and 46.3% of patients achieving a pre-BD FEV1 ≥ 80% of predicted. Regarding symptom control, 73.8% of the OP obtained an ACT score ≥ 20 points. After 1 year of follow-up, mean reduction in the daily OCS dose was 70.5%, and complete OCS withdrawal was achieved by 52.8% of the OCS-dependent patients. Almost half (43.7%) of the OP on benralizumab met all four criteria for clinical remission. Patients with concomitant CRSwNP obtained similar or enhanced outcomes. CONCLUSIONS: These data support the real-world benefits of benralizumab in SEA patients, and particularly in those with concomitant CRSwNP. TRIAL REGISTRATION: NCT04648839.
Subject(s)
Anti-Asthmatic Agents , Asthma , Pulmonary Eosinophilia , Sinusitis , Adult , Humans , Female , Middle Aged , Male , Anti-Asthmatic Agents/adverse effects , Retrospective Studies , Disease Progression , Asthma/diagnosis , Asthma/drug therapy , Asthma/epidemiology , Pulmonary Eosinophilia/diagnosis , Pulmonary Eosinophilia/drug therapy , Pulmonary Eosinophilia/epidemiology , Chronic Disease , Adrenal Cortex Hormones/therapeutic use , Sinusitis/complicationsABSTRACT
No disponible
Subject(s)
Humans , Mycobacterium abscessus , Neutrophils , In Vitro Techniques , Nontuberculous Mycobacteria , BronchiectasisABSTRACT
Bronchiectasis is considered a consequence of the neutrophilic inflammatory response to infection. Mycobacterial infections, mainly from the Mycobacterium avium complex and M. abscessus, have been inextricably linked to bronchiectasis development. The most important pathogen that infect patients with bronchiectasis is Pseudomonas aeruginosa, associated with an increased risk of death. Patients with bronchiectasis are often co-infected with P. aeruginosa and M. avium complex, and it was studied whether they interacted in immune cell cultures. Peripheral blood mononuclear cells from healthy volunteers were infected overnight with clinical isolates of mycobacteria, 18 h later co-infected with P. aeruginosa and Pseudomonas multiplication was quantified. Inoculated P. aeruginosa multiply faster when cells were previously infected in vitro with M. avium complex or M. tuberculosis, but not with M. kansasii or M. gordonae, mycobacteria not regularly isolated from patients with bronchiectasis. The interaction between mycobacteria and P. aeruginosa also takes place in the absence of cells, but to a lower degree. Growth of Staphylococcus aureus, less frequently co-isolated with mycobacteria, was not affected by previous infection with mycobacteria. Surprisingly, multiplication of P. aeruginosa in neutrophil cultures did not vary in the presence of mycobacteria. Nevertheless, co-infection of mycobacteria and P. aeruginosa induced the production of IL-1ß, a mediator of neutrophilic inflammation. P. aeruginosa stimulation by mycobacteria provides evidence for explaining their common clinical association. Strategies to control mycobacteria may be useful to impair P. aeruginosa colonization.
Subject(s)
Bronchiectasis , Mycobacterium Infections , Mycobacterium avium-intracellulare Infection , Mycobacterium tuberculosis , Humans , Leukocytes, Mononuclear , Mycobacterium avium Complex , Nontuberculous Mycobacteria , Pseudomonas aeruginosaABSTRACT
OBJETIVO: El objetivo de este estudio ha sido conocer las características de los pacientes EPOC por fenotipos y según la GOLD 2011-ABCD y el grado de concordancia de los tratamientos farmacológicos. DISEÑO: Estudio transversal de observación y descriptivo. Emplazamiento Pacientes EPOC entre 40 y 85años pertenecientes al Área de León que figuran en la base de datos MEDORA de Atención Primaria. PARTICIPANTES: De los 5.522 pacientes recogidos en la base de datos de MEDORA con los criterios de selección descritos, se calculó un tamaño muestral de 734 sujetos, de los cuales se estudiaron finalmente 577 enfermos. Mediciones principales: Se diseñó un cuestionario estructurado para recoger la información sociodemográfica, clínica, tratamientos y calidad de vida. Se incluía realización de espirometría y prueba broncodilatadora. RESULTADOS: De los 734 enfermos muestreados se ha conseguido estudiar al 78,6% (577). En 166 pacientes (28,7%), el diagnóstico había sido realizado exclusivamente por la clínica, sin constancia de espirometría en el MEDORA. En 123 (21,3%) el índice FEV1/FVC fue superior a 0,7, por lo que se descartó el diagnóstico de EPOC. Con respecto a los tratamientos prescritos según fenotipos, observamos que en el fenotipo no agudizador existe una sobreprescripción de corticoides inhalados. Lo mismo sucede en los grupos A y B. CONCLUSIONES: A pesar de las guías clínicas, el manejo de los pacientes con EPOC en la vida real sigue siendo mejorable, tanto en el aspecto diagnóstico como de medidas terapéuticas
OBJECTIVE: The purpose of this study was to evaluate different characteristics of COPD patients according to phenotypes and GOLD guidelines.according to GesEPOC phenotypes and GOLD 2011 ABCD guidelines and pharmacological treatment agreement. DESIGN: Cross-sectional survey. LOCATION: COPD patients aged 40-85 from León were randomly selected from Primary Care database, MEDORA. PARTICIPANTS: 5222 eligible COPD patients were collected from MEDORA database. We calculated a sample size of 734 patients and finally studied 577 of them. MAIN MEASUREMENTS: Patients clinical, functional and health related quality of life information were collected. Spirometry and postbroncodilator test were performed. RESULTS: A total of 577 patients were included in this study. 28.7% of them did not have a spirometry recorded in their files. 123 patients had a normal or non-obstructive spirometry pattern, so they were excluded from a COPD diagnostic. With regard to treatments, there was an overprescribing of inhaled steroids in patients from GOLD A and B groups, and also in patients with the called exacerbator phenotype (GesEPOC). CONCLUSION: Although there have been several published guidelines, management of COPD patients in real life should be improved
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiratory Function Tests/statistics & numerical data , Symptom Flare Up , Cross-Sectional Studies , Primary Health Care/statistics & numerical data , Phenotype , Quality of LifeABSTRACT
OBJECTIVE: The purpose of this study was to evaluate different characteristics of COPD patients according to phenotypes and GOLD guidelines.according to GesEPOC phenotypes and GOLD 2011 ABCD guidelines and pharmacological treatment agreement. DESIGN: Cross-sectional survey. LOCATION: COPD patients aged 40-85 from León were randomly selected from Primary Care database, MEDORA. PARTICIPANTS: 5222 eligible COPD patients were collected from MEDORA database. We calculated a sample size of 734 patients and finally studied 577 of them. MAIN MEASUREMENTS: Patients clinical, functional and health related quality of life information were collected. Spirometry and postbroncodilator test were performed. RESULTS: A total of 577 patients were included in this study. 28.7% of them did not have a spirometry recorded in their files. 123 patients had a normal or non-obstructive spirometry pattern, so they were excluded from a COPD diagnostic. With regard to treatments, there was an overprescribing of inhaled steroids in patients from GOLD A and B groups, and also in patients with the called exacerbator phenotype (GesEPOC). CONCLUSION: Although there have been several published guidelines, management of COPD patients in real life should be improved.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapyABSTRACT
La silicosis es una de las enfermedades respiratorias de origen ocupacional más frecuentes en nuestro entorno. Está ocasionada por inhalación de sílice cristalina que desencadena una respuesta fibrótica en el parénquima pulmonar. Se presenta como una enfermedad intersticial difusa y su expresión clínica es variable, existiendo desde formas asintomáticas hasta la insuficiencia respiratoria crónica. El diagnóstico está basado en la historia clínica y los hallazgos radiológicos; no tiene un tratamiento efectivo, y cuando se diagnostica precisa que el paciente sea apartado de toda fuente de exposición laboral. Esta normativa repasa aspectos clínicos, radiológicos y funcionales, sugiriendo también estrategias de diagnóstico y seguimiento para la clasificación de los pacientes, y recomendaciones para las implicaciones laborales de esta enfermedad
Silicosis is one of the occupational respiratory diseases most commonly encountered in our setting. It is caused by inhalation of crystalline silica that triggers a fibrotic response in the lung parenchyma. It presents as diffuse interstitial disease and clinical expression ranges from asymptomatic forms to chronic respiratory failure. Diagnosis is based on clinical history and radiological findings. There is no effective treatment, and once diagnosed, the patient must avoid all sources of occupational exposure. In these guidelines, the clinical, radiological and functional aspects of silicosis are reviewed, and strategies for diagnosis, monitoring and classification of patients are proposed, along with recommendations regarding the occupational implications of this disease
Subject(s)
Humans , Silicosis/epidemiology , Pneumoconiosis/epidemiology , Occupational Diseases/epidemiology , Occupational Exposure/statistics & numerical data , Risk Factors , Mass Chest X-Ray , Respiratory Function TestsABSTRACT
Silicosis is one of the occupational respiratory diseases most commonly encountered in our setting. It is caused by inhalation of crystalline silica that triggers a fibrotic response in the lung parenchyma. It presents as diffuse interstitial disease and clinical expression ranges from asymptomatic forms to chronic respiratory failure. Diagnosis is based on clinical history and radiological findings. There is no effective treatment, and once diagnosed, the patient must avoid all sources of occupational exposure. In these guidelines, the clinical, radiological and functional aspects of silicosis are reviewed, and strategies for diagnosis, monitoring and classification of patients are proposed, along with recommendations regarding the occupational implications of this disease.
Subject(s)
Practice Guidelines as Topic , Silicosis/diagnosis , Diagnostic Techniques, Respiratory System , Disability Evaluation , Humans , Physician's Role , Pulmonary Medicine , Risk Factors , Severity of Illness Index , Silicosis/epidemiology , Silicosis/etiology , Silicosis/prevention & control , Silicosis/therapy , Social Change , Spain/epidemiologyABSTRACT
El ser humano pasa una parte considerable de su tiempo respirando el aire de espacios cerrados en los que, por medio de muy diversas fuentes, pueden generarse contaminantes que deterioren su calidad y constituyan un importante factor de riesgo para la salud de la población en general. En esta revisión se desarrollan los contaminantes presentes en el aire de espacios interiores, describiendo las fuentes que los generan, los mecanismos fisiopatológicos y las enfermedades que pueden producir en el aparato respiratorio(AU)
Humans spend a considerable amount of their time breathing air inside enclosed spaces in which, due to various sources, there may be contaminants that deteriorate the air quality. This is an important risk factor for the health of the general population. This review evaluates the contaminants that are present in the air of indoor air spaces, describing the sources that generate them as well as the physiopathological mechanisms and the diseases that they may cause in the respiratory system(AU)
Subject(s)
Humans , Air Pollution, Indoor/adverse effects , Respiratory Tract Diseases/epidemiology , Environmental Illness , Risk Factors , Respiratory Tract Diseases/physiopathologyABSTRACT
Humans spend a considerable amount of their time breathing air inside enclosed spaces in which, due to various sources, there may be contaminants that deteriorate the air quality. This is an important risk factor for the health of the general population. This review evaluates the contaminants that are present in the air of indoor air spaces, describing the sources that generate them as well as the physiopathological mechanisms and the diseases that they may cause in the respiratory system.