ABSTRACT
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) and asthma are treatable but greatly underdiagnosed disorders. Telemedicine made it possible to continue diagnosis, follow-up visits and treatment modifications during the COVID-19 pandemic. The present study describes the management of patients with COPD and asthma, and their treatments during the pandemic from the pulmonologist's perspective. METHODS: NEUMOBIAL was an ecological study with aggregated data. A total of 279 Spanish pulmonologists answered a 60-question survey about their last 10 patients, focused on the characterisation and changes in visits and treatments during the pandemic. RESULTS: Most pulmonologists (72.0%) considered that the pandemic negatively altered the diagnosis and follow-up of patients with asthma or COPD. Diagnostic tests were reduced during the pandemic, mainly because they were not recommended by pulmonologists (68.1% and 72.7% in the case of COPD and asthma tests, respectively). Moreover, 17.3% of the COPD and 19.1% of the asthma visits were remote visits. According to pulmonologists, low adherence to treatment was mainly due to a lack of patient knowledge about their disease (75.3% and 81.7% in COPD and asthma, respectively). Other factors that also influenced adherence were inadequate use of the inhaler (59.5% for COPD and 57.7% for asthma) and a lack of knowledge about the device (57.3% for COPD and 57.7% for asthma). Pulmonologists chose Zonda® for COPD because of the ease of use of the device (73.1%) and the ability to check whether the entire dose was inhaled (69.5%). For asthma, Spiromax® was chosen because of the ease of use of the device (85.7%) and the possibility of using a single device for maintenance and reliever treatment (82.4%). CONCLUSION: According to pulmonologists, during the pandemic, treatments for COPD and asthma were mainly chosen on the basis of their ease of use; treatment adherence was good; and the number of remote visits increased.
Subject(s)
Asthma , COVID-19 , Pulmonary Disease, Chronic Obstructive , Administration, Inhalation , Asthma/drug therapy , Humans , Pandemics , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/drug therapy , PulmonologistsABSTRACT
Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.
La anafilaxia es una reacción alérgica grave de instauración rápida y potencialmente mortal. Sus manifestaciones clínicas son muy variadas, pudiendo afectar la piel, el sistema cardiovascular, el aparato respiratorio y el digestivo, entre otros. El tratamiento de elección, mediante la inyección intramuscular de adrenalina, debe ser precoz. Por lo anterior, es vital estar preparados para reconocerla adecuadamente. El objetivo de la presente guía de actuación clínica es mejorar el conocimiento de los profesionales sanitarios sobre anafilaxia y, consecuentemente, optimizar el tratamiento y manejo a largo plazo de esta entidad. La guía está adaptada a las peculiaridades de América Latina, especialmente en los aspectos relativos al tratamiento. Se destaca la necesidad de introducir los autoinyectores de adrenalina en los países que no dispongan de ellos.
Subject(s)
Anaphylaxis , Practice Guidelines as Topic , Adrenergic Agonists/administration & dosage , Adrenergic Agonists/therapeutic use , Adult , Algorithms , Anaphylaxis/diagnosis , Anaphylaxis/epidemiology , Anaphylaxis/etiology , Anaphylaxis/therapy , Cardiopulmonary Resuscitation , Child , Combined Modality Therapy , Disease Management , Drug Administration Routes , Epinephrine/administration & dosage , Epinephrine/therapeutic use , Glucagon/administration & dosage , Glucagon/therapeutic use , Humans , Immunologic Tests , Patient Education as Topic , Self Administration , Vasoconstrictor Agents/administration & dosage , Vasoconstrictor Agents/therapeutic useABSTRACT
Esta nueva versión de GALAXIA está dirigida a todos los profesionales sanitarios, en todos los niveles de asistencia, para proporcionar recomendaciones en el manejo de la anafilaxia. La anafilaxia es la reacción alérgica más grave que puede ocurrir, e incluso puede llegar a poner en peligro la vida del paciente. Todos los profesionales sanitarios deberían ser capaces de reconocerla y actuar de forma rápida y adecuada. Se incluyen recomendaciones para pacientes adultos y pediátricos, se comentan situaciones especiales, y se consideran situaciones en el ambiente sanitario y fuera de el.
