Cardiovascular Events in Patients with Severe Asthma-A Retrospective Study of Two Cohorts: Asthma Type T2 Treated with Biologics and Non-Type T2.

Background: The prevalence of cardiovascular events (CVEs) in patients with asthma varies amongst studies, with little evidence as to their prevalence in patients treated with monoclonal antibodies (mAbs). In this retrospective, observational study, we aimed to evaluate the prevalence of CVEs in patients with T2 and non-T2 asthma and to identify risk factors associated with CVEs. Methods: A total of 206 patients with severe asthma were included. Demographic variables, respiratory comorbidities and cardiovascular risk factors were collected, along with respiratory function, laboratory parameters and respiratory pharmacotherapy, including treatment with mAbs. Results: A total of 10.7% of the patients had any CVE from the date of asthma diagnosis, with a higher risk in those patients with chronic obstructive pulmonary disease (odds ratio [OR] = 5.36, 95% CI 1.76-16.31; p = 0.003), arterial hypertension (OR = 2.71, 95% CI 1.13-6.55; p = 0.026) and dyslipidaemia (OR = 9.34, 95% CI 3.57-24.44; p < 0.001). No association between mAb treatment and a CVE or between time of mAb treatment and the event was found. No significant differences were observed between the T2 and non-T2 cohort. After a multivariate analysis, dyslipidaemia was identified as an independent risk factor (OR = 13.33, 95% CI 4.49-39.58; p < 0.001), whereas regular use of inhaled corticosteroids was associated with a reduced risk of a CVE (OR = 0.103, 95% CI 0.021-0.499; p = 0.005). Further research is needed to fully understand the relationship between severe asthma and CVEs. Conclusions: This study suggests that patients with severe asthma experience a higher percentage of CVEs compared with the general population.

Anti-IL-5 and anti-IL-5R biologics for severe asthma. Are there any differences in their effects?

OBJECTIVE: The aim of this retrospective multicentre study is to describe the clinical characteristics of patients diagnosed with severe eosinophilic asthma receiving anti-IL-5/anti-IL-5Rα therapies and to compare their effectiveness. METHODS: We collected and analysed results separately for anti-IL-5 and anti-IL-5Rα therapies from January 2016 until December 2021 in multidisciplinary severe asthma units. We collected demographic and clinical data, treatment with previous anti-IgE and/or anti-IL-5 agents, and comorbidities. We compared the number of exacerbations and admissions to the hospital, daily oral corticosteroid intake, pulmonary function tests, and Asthma Control Test scores before and after 12 months of therapy. 261 patients were included: 176 patients in the anti-IL-5 group and 85 in the anti-IL-5Rα group. RESULTS: Both groups led to statistically significant reductions in asthma exacerbations, hospital admissions, and visits to the Emergency Room. Although both groups showed a significant reduction in blood eosinophiliccount, we found a difference, although not significant, in the magnitude of reduction as benralizumab was able to decrease eosinophil counts to zero. Patients in the anti-IL-5 group achieved higher ACT scores after treatment, although this improvement was seen in both treatment groups. CONCLUSION: The anti-IL-5 and anti-IL-5Rα biologics have shown similar effectiveness despite having different mechanisms of action. The anti-IL-5 group appeared to be better than benralizumab at improving ACT scores and FEV1/FVC and at reducing the number of inhalers. Although these differences were not statistically significant, it is not clear whether they may have clinical relevance and they might highlight the need for further head-to-head studies comparing these treatments.

El neumomediastino como complicación de la neumonía por SARS-CoV-2 / Pneumomediastinum as a complication of SARS-CoV-2 pneumonia

La incidencia de neumomediastino en los pacientes hospitalizados con diagnóstico de neumonía por coronavirus 2 delsíndrome respiratorio agudo grave (SARS-CoV-2) no es para nada desdeñable, muy superior en comparación con la pobla-ción general. La fisiopatología del neumomediastino en la neumonía por SARS-CoV-2 viene explicada por el aumento delgradiente de presión alveolo-intersticio (accesos de tos seca, trabajo respiratorio, barotrauma por soporte ventilatorio) sobreunos pulmones especialmente «frágiles» debido al daño alveolo-intersticial difuso de origen infeccioso-inflamatorio, todo locual aumenta significativamente el riesgo de rotura de la pared alveolar. Cuanta mayor gravedad revista la neumonía porSARS-CoV-2, más probable será la aparición de neumomediastino. El desarrollo de neumomediastino en pacientes conneumonía por SARS-CoV-2 se asocia a unas frecuencias mayores de exitus letalis, ingreso en unidad de cuidados intensi-vos (UCI) y traqueostomía y a unos tiempos mayores de estancia hospitalaria y en UCI. En la mayoría de los casos, elneumomediastino producido en el seno de la neumonía por SARS-CoV-2 es un proceso benigno y autolimitado que seresuelve con tratamiento conservador.(AU)

The incidence of pneumomediastinum in hospitalised patients diagnosed with SARS-CoV-2 pneumonia is by no means ne-gligible, much higher compared to the general population. The pathophysiology of pneumomediastinum in severe acute res-piratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is explained by the increase in alveolar-interstitial pressure gradient(dry coughing spells, respiratory work, barotrauma from ventilatory support) in the context of particularly “fragile” lungs due todiffuse alveolar-interstitial damage from infectious-inflammatory origin, all of which significantly increases the risk of alveolarwall rupture. The more severe the SARS-CoV-2 pneumonia, the more likely it is that pneumomediastinum will occur. The deve-lopment of pneumomediastinum in patients with SARS-CoV-2 pneumonia is associated with higher frequencies of death,intensive care unit (ICU) admission and tracheostomy and longer hospital and ICU lengths of stay. In most cases, pneumo-mediastinum in SARS-CoV-2 pneumonia is a benign and self-limiting process that resolves with conservative treatment.(AU)

Successful Long-Term Treatment Combining Omalizumab and Anti-IL-5 Biologics in Allergic Bronchopulmonary Aspergillosis

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Adherencia a los inhaladores en pacientes con asmagrave tratados con biológicos anti interleucina 5 / Adherence to inhalers in patients with severe asthma treated with anti-interleukin-5 biologics

Objetivo: Dado que la mala adherencia a la medicación en el asma gravees difícil de evaluar en la práctica diaria, se recomienda utilizar al menos dosmétodos simultáneamente. El objetivo es determinar la prevalencia de la faltade adherencia a los inhaladores mediante el cuestionario Test de Adherenciaa los Inhaladores y la ratio de posesión de la medicación obtenida a partirde los datos de dispensación de la farmacia en pacientes con asma gravetratados con biológicos anti interleucina 5 y evaluar su concordancia.Método: Estudio observacional retrospectivo transversal de 53 pacientescon asma grave reclutados en la unidad de asma grave de un hospital terciario de Madrid de junio a diciembre de 2020. Se registraron datos demográficos, comorbilidades y el tratamiento concomitante para el asma. La faltade adherencia se definió como una ratio de posesión de la medicación< 80% y/o un valor en los resultados del cuestionario Test de Adherencia alos Inhaladores < 50. La concordancia se evaluó con el coeficiente kappade Cohen.Resultados: La mediana de edad fue de 61 años (rango intercuartílico51,8-67,0), y 33 (61%) eran mujeres. Según la ratio de posesión de lamedicación, la falta de adherencia al inhalador primario fue del 58,5%.Sin embargo, al utilizar el cuestionario Test de Adherencia a los Inhaladores, ésta fue del 22,6%. Combinando ambos métodos, se consideróque el 17% de los pacientes presentaban no adherencia a los inhaladores. Asimismo, al identificar la no adherencia por cualquiera de estos métodos, se alcanzó una prevalencia del 64,2%. El cuestionario Test deAdherencia a los Inhaladores y la ratio de posesión de la medicacióncoincidieron en el 53,1% y discreparon en el 46,9% de los pacientes(k = 0,137; intervalo de confianza del 95% –0,057 a 0,331; p = 0,318).Conclusiones: Se observó una alta prevalencia de no adherencia a losinhaladores en los pacientes con asma grave tratados con biológicos antiinterleucina 5. (AU)

Objective: Given poor medication adherence in severe asthma is difficult to evaluate in daily practice, using at least two methods concurrently isrecommended. We aimed to determine the prevalence of nonadherenceto inhalers using the Test of Adherence to Inhalers questionnaire and themedication possession ratio obtained from the pharmacy refill data inpatients with severe asthma treated with anti-interleukin-5 biologics and toevaluate their concordance.Method: This was a cross-sectional retrospective observational study of53 patients with severe asthma recruited from the severe asthma unit of atertiary hospital in Madrid from June to December 2020. We registereddemographic data, comorbidities and concomitant therapy for asthma.Nonadherence was defined as pharmacy refill data < 80% and/or Testof Adherence to Inhalers questionnaire results < 50. Concordance wasassessed by determining the Cohen’s kappa statistic.Results: The median age was 61 years (interquartile range 51.8-67.0),and 33 (61%) were women. According to the pharmacy refill data lackof adherence to the primary inhaler was 58.5%. However, when usingthe Test of Adherence to Inhalers questionnaire, it was 22.6%. Combiningboth methods, 17% of patients were considered to have nonadherenceto inhalers. Likewise, when identifying nonadherence by either of thesemethods, it reached a prevalence of 64.2%. The pharmacy refill data andTest of Adherence to Inhalers questionnaire agreed in 53.1% and disagreed in 46.9% of patients (k = 0.137; 95% confidence interval −0.057to 0.331; p = 0.318). (AU)