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.

Síntomas respiratorios y reflejo tusígeno en poblaciones expuestas a distinto grado de contaminación ambiental / Respiratory symptoms and cough reflex in populations exposed to different degrees of pollution

Background: Santiago is a city with a high degree of environmental pollution caused by particulate matter and ozone, producing adverse effects in the respiratory system. Aim: to compare respiratory symptoms and cough reflex in adults from Santiago and from a rural area with low levels of environmental pollution. Subjects and methods: one hundred twenty six non smoker adults from Santiago and 116 from a rural area with low levels of pollution answered a respiratory symptoms questionnaire. Of these 101 subjects from Santiago and 116 from the rural area inbaled doubling concentrations of capsaicin from 0.5 to 500 µM or until five coughs were elicited. The lowest concentration eliciting 2 or more coughs (CD2) or 5 or more coughs (CD5) was recorded. Levels of environmental particulate matter were also recorded in both locations. Results: Levels of particulate matter were 102 ñ 41 an 64 ñ 24 µg/m3 in Santiago and the rural area respectively. People from Santiago had higher rates throat clearing, cough and pblegm. CD2 geometric mean and confidence limits in Santiago and the rural area were observed between both locations. Multivariate analysis disclosed the variable location (city) as the only independent predictor of respiratory symptoms. Conclusions: the increased CD2 found in Santiago suggests that the higher rates of respiratory symptoms related to air pollution can be associated to a decreased sensitivity of the cough reflex

Bloqueo aurículo ventricular completo en el hipertiroidismo / Complete heart block and hyperthyroidism

Se presenta el caso de una paciente portadora de una Enfermedad de Basedow que desarrolló bloqueo aurículo ventricular (AV) completo sintomático, requiriendo de la instalación de sonda marcapaso transitoria. En ella existía sólo el antecedente de infección de faringe previo. La conducción AV fue normal una vez eutiroídea. Se señala lo comunicado en la literatura en relación a la génesis del trastorno. Se destaca la importancia de evitar fármacos que puedieran aumentar el deterioro de conducción en aquellos pacientes hipertiroídeos con PR largo y prescindir de terapia definitiva ya que invariablemente se normaliza la conducción AV al lograr eutiroidismo