ABSTRACT
Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703-0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217-0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623-0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822-0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829-0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity.
ABSTRACT
RESUMEN Introducción: el asma es una enfermedad infamatoria crónica de la vía aérea, requiere un adecuado tratamiento y control. El Test de Adhesión a los Inhaladores (TAI) identifica al paciente con pobre adherencia al tratamiento, establece el nivel de adhesión y tipo de incumplimiento terapéutico por su técnica y conocimiento sobre el inhalador. Objetivos: evaluar el grado de adhesión al tratamiento del asma en nuestra población e identificar el tipo de incumplimiento que se presenta con mayor prevalencia. Materiales y métodos: se realizó un estudio observacional, prospectivo, transversal y multicéntrico en Argentina, donde se realizó el cuestionario TAI a pacientes entre 18 a 80 años con diagnóstico de asma en tratamiento con inhaladores durante febrero 2017 a mayo 2018. Resultados: se evaluaron 134 pacientes con una edad promedio de 45 años, 59% de sexo femenino y 41% de sexo masculino, en el que el 56% fue del ámbito privado y 44% del público. El 81.5% (101) fueron incumplidores, de tipo errático el 89.1% (110), deliberado el 87% (107) e inconsciente el 18.5% (22). Solo el 18.5% (23) presento buena adhesión. Conclusión: en este estudio se detectó una alta tasa de incumplimiento (81.5%) a los tratamientos inhalados en los pacientes con asma, siendo el errático y deliberado los de mayor frecuencia.
SUMMARY Introduction: asthma is a chronic infammatory disease of the airway, it requires adequate treatment and control. The Test of Adhesion to Inhalers (TAI) identifies the patient with poor adherence to treatment, establishes the level of adherence and type of therapeutic non-compliance due to their technique and knowledge about the inhaler. Objectives: to evaluate the degree of adherence to asthma treatment in our population and to identify the type of non-compliance with the highest prevalence. Materials and methods: An observational, prospective, cross-sectional and multicenter study was carried out in Argentina, where the TAI questionnaire was performed on patients between 18 and 80 years of age with a diagnosis of asthma being treated with inhalers during February 2017 to May 2018. Results: 134 patients with an average age of 45 years, 59% female and 41% male, were evaluated, in which 56% were from the private sphere and 44% from the public. 81.5% (101) were non-compliant, 89.1% (110) erratic, 87% (107) deliberate and 18.5%(22) unconscious. Only 18.5% (23) presented good adhesion. Conclusion: in this study, a high non-compliance rate (81.5%) was detected for inhaled treatments in patients with asthma, the most frequent being erratic and deliberate