Effect of Altitude on Respiratory Functional Status in COVID-19 Survivors: Results from a Latin American Cohort-FIRCOV.

Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort-FIRCOV. High Alt Med Biol 24:37-48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation.

Severe asthma: adding new evidence - Latin American Thoracic Society.

This document constitutes a summary of the clinical practice guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select six clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established. 1) We do not recommend the use of an inhaled corticosteroid (ICS) plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-interleukin (IL)-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL-1 for mepolizumab and above 400 cells·µL-1 for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL-1). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.

Preguntas y respuestas relacionadas con tabaquismo en pacientes con EPID. Aplicación de metodología con formato PICO / Questions and Answers on Smoking in Patients With Diffuse ILD. Use of PICO Methodology

INTRODUCCIÓN: Los grupos de Tabaquismo y de Enfermedades Pulmonares Intersticiales Difusas (EPID) de ALAT y SEPAR han colaborado para la realización de este documento. MATERIAL Y MÉTODOS: En el mismo se da respuesta, siguiendo metodología PICO, a diferentes interrogantes sobre la relación entre el consumo de tabaco y las EPID. RESULTADOS Y CONCLUSIONES: Sus principales recomendaciones son: a) evidencia moderada y recomendación fuerte para considerar el tabaquismo como un factor de riesgo para el desarrollo y/o modificador de la progresión de EPID; b) evidencia moderada para identificar que existe un incremento de la mortalidad en la EPID independientemente de su patrón histológico. Evidencia baja para adjudicarlo al tabaquismo y recomendación fuerte para identificar a los pacientes con EPID precozmente. Se hacen necesarios nuevos estudios que evalúen el efecto de la cesación tabáquica en los pacientes con EPID; c) evidencia baja y recomendación débil para definir el impacto del tabaquismo de segunda mano en la EPID; d) evidencia baja para demostrar que la cesación tabáquica mejora los resultados de los pacientes diagnosticados de EPID y recomendación fuerte para aconsejar la cesación tabáquica en casos de EPID en fumadores, y e) evidencia baja que demuestre la utilidad clínica o epidemiológica de la búsqueda activa de los casos de EPID en los programas de cesación tabáquica y recomendación fuerte para justificar la realización de espirometría durante esta búsqueda independientemente del estatus actual de tabaquismo pero con la dosis acumulada previamente, aun en casos asintomáticos

INTRODUCTION: The Smoking and the Diffuse Interstitial Lung Diseases (ILD) groups of ALAT and SEPAR collaborated in the preparation of this document. MATERIALS AND METHODS: This document uses PICO methodology to answer various questions on the relationship between tobacco use and diffuse ILD. RESULTS AND CONCLUSIONS: The main recommendations are: a) moderate level of evidence and strong recommendation to consider smoking as a risk factor for the development and/or modification of the progression of diffuse ILD; b) moderate level of evidence to identify an increase in mortality in diffuse ILD, irrespective of histologic pattern. Low evidence for ascribing it to smoking and strong recommendation for the early identification of patients with diffuse ILD. Further studies are needed to evaluate the effect of smoking cessation in patients with diffuse ILD; c) low level of evidence and weak recommendation for defining the impact of passive smoking in diffuse ILD; d) low level of evidence to demonstrate that smoking cessation improves the outcomes of patients diagnosed with diffuse ILD and strong recommendation to advise smoking cessation in smokers with diffuse ILD, and e) low level of evidence to support the clinical or epidemiological usefulness of active case finding for diffuse ILD in smoking cessation programs, and strong recommendation justifying the performance of spirometry in active case finding, based not on current smoking status, but on previous accumulated consumption, even in asymptomatic cases

Questions and Answers on Smoking in Patients With Diffuse ILD. Use of PICO Methodology. / Preguntas y respuestas relacionadas con tabaquismo en pacientes con EPID. Aplicación de metodología con formato PICO.

INTRODUCTION: The Smoking and the Diffuse Interstitial Lung Diseases (ILD) groups of ALAT and SEPAR collaborated in the preparation of this document. MATERIALS AND METHODS: This document uses PICO methodology to answer various questions on the relationship between tobacco use and diffuse ILD. RESULTS AND CONCLUSIONS: The main recommendations are: a) moderate level of evidence and strong recommendation to consider smoking as a risk factor for the development and/or modification of the progression of diffuse ILD; b) moderate level of evidence to identify an increase in mortality in diffuse ILD, irrespective of histologic pattern. Low evidence for ascribing it to smoking and strong recommendation for the early identification of patients with diffuse ILD. Further studies are needed to evaluate the effect of smoking cessation in patients with diffuse ILD; c) low level of evidence and weak recommendation for defining the impact of passive smoking in diffuse ILD; d) low level of evidence to demonstrate that smoking cessation improves the outcomes of patients diagnosed with diffuse ILD and strong recommendation to advise smoking cessation in smokers with diffuse ILD, and e) low level of evidence to support the clinical or epidemiological usefulness of active case finding for diffuse ILD in smoking cessation programs, and strong recommendation justifying the performance of spirometry in active case finding, based not on current smoking status, but on previous accumulated consumption, even in asymptomatic cases.

Preguntas y respuestas relacionadas con tabaquismo en pacientes con EPOC. Aplicación de metodología con formato PICO / Using PICO Methodology to Answer Questions About Smoking in COPD Patients

Los grupos de control y tratamiento del tabaquismo de ALAT y SEPAR han colaborado para la realización de este documento en el que se da respuesta, siguiendo metodología PICO, a diferentes interrogantes relacionados con la asistencia sanitaria para ayudar a dejar de fumar a los pacientes con EPOC. Sus principales recomendaciones son: a)evidencia moderada y recomendación fuerte para realizar espirometría en pacientes con diagnóstico o en fumadores con alto riesgo de padecer EPOC, como instrumento de motivación, en particular evidenciando la edad pulmonar, y con fines diagnósticos y de búsqueda activa de casos; b)evidencia alta y recomendación fuerte para utilizar asesoramiento conductual intenso y específico y tratamiento farmacológico para ayudar a dejar de fumar a fumadores con EPOC; c)evidencia alta y recomendación fuerte para iniciar intervenciones para ayudar a dejar de fumar a fumadores con EPOC mientras se encuentran hospitalizados mejorando al mantener la intervención tras el alta, y d)evidencia alta y recomendación fuerte para la financiación del tratamiento del tabaquismo en fumadores con EPOC por su impacto sobre la salud y la economía de la salud (AU)

The ALAT and SEPAR Treatment and Control of Smoking Groups have collaborated in the preparation of this document which attempts to answer, by way of PICO methodology, different questions on health interventions for helping COPD patients to stop smoking. The main recommendations are: (I) moderate-quality evidence and strong recommendation for performing spirometry in COPD patients and in smokers with a high risk of developing the disease, as a motivational tool (particularly for showing evidence of lung age), a diagnostic tool, and for active case-finding; (II) high-quality evidence and strong recommendation for using intensive dedicated behavioral counselling and drug treatment for helping COPD patients to stop smoking; (III)high-quality evidence and strong recommendation for initiating interventions for helping COPD patients to stop smoking during hospitalization with improvement when the intervention is prolonged after discharge, and (IV) high-quality evidence and strong recommendation for funding treatment of smoking in COPD patients, in view of the impact on health and health economics (AU)

Using PICO Methodology to Answer Questions About Smoking in COPD Patients. / Preguntas y respuestas relacionadas con tabaquismo en pacientes con EPOC. Aplicación de metodología con formato PICO.

The ALAT and SEPAR Treatment and Control of Smoking Groups have collaborated in the preparation of this document which attempts to answer, by way of PICO methodology, different questions on health interventions for helping COPD patients to stop smoking. The main recommendations are: (i)moderate-quality evidence and strong recommendation for performing spirometry in COPD patients and in smokers with a high risk of developing the disease, as a motivational tool (particularly for showing evidence of lung age), a diagnostic tool, and for active case-finding; (ii)high-quality evidence and strong recommendation for using intensive dedicated behavioral counselling and drug treatment for helping COPD patients to stop smoking; (iii)high-quality evidence and strong recommendation for initiating interventions for helping COPD patients to stop smoking during hospitalization with improvement when the intervention is prolonged after discharge, and (iv)high-quality evidence and strong recommendation for funding treatment of smoking in COPD patients, in view of the impact on health and health economics.

Recomendaciones de asma aguda: De lo global a lo local / Acute asthma recommendations. From the global to the local

Mundialmente, el asma sigue siendo un problema relevante para la salud pública. Afortunadamente, hoy en día las muertes por asma son menos frecuentes, sin embargo, el 80% está relacionada con el nivel socioeconómico bajo o medio. Adicionalmente, sigue existiendo un inaceptable nivel de morbilidad e impacto económico para la salud. Por el estudio EAGLE (Estudio del Asma Grave en Latinoamérica y España) conocemos de importantes carencias asistenciales que se han mantenido en el tiempo, como por ejemplo el escaso uso de medición objetiva para la gravedad de la exacerbación y, en consecuencia, el establecimiento de un tratamiento ajustado a ella. Las exacerbaciones y visitas a la emergencia son uno de los factores que más impacto tiene en Latinoamérica

Quality assessment of asthma clinical practice guidelines: a systematic appraisal.

BACKGROUND: The quality and potential impact of available clinical guidelines for asthma management have not been systematically evaluated. We, therefore, evaluated the quality of clinical practice guidelines (CPGs) for asthma. METHODS: We performed a systematic search of scientific literature published between 2000 and 2010 to identify and select CPGs related to asthma management. We searched guideline databases, guideline developers' websites, and the MEDLINE database of the US National Library of Medicine. Four independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument. We calculated the overall agreement among reviewers with the intraclass correlation coefficient (ICC). RESULTS: Eighteen CPGs published between the years 2000 and 2010 were selected from a total of 1,005 references. The overall agreement among reviewers was moderate (ICC: 0.78; 95% CI, 0.62-0.90). The mean scores for each AGREE domain were: scope and purpose, 44.1% (range: 10.0%-79.0%); stakeholder involvement, 33.8% (range: 4.0%-66.0%); rigor of development, 32.4% (range: 8.0%-64.0%); clarity and presentation, 52.1% (range: 17.0%-85.0%); applicability, 21.1% (range: 3%-55%); and editorial independence, 25% (range: 0%-58%). None of the appraised guidelines had a score > 60% (recommended). One-half of the appraised guidelines were recommended with modifications (nine of 18) or not recommended (nine of 18) for use in clinical practice. We observed improvement over time in overall quality of the guidelines (P = .01; guidelines published in the period 2001-2006 vs 2007-2009). CONCLUSIONS: The quality of guidelines for asthma care is low, although it has improved over time. Greater efforts are needed to provide high-quality guidelines that can be used as reliable tools for clinical decision-making in this field.