Exacerbations Among Patients With Asthma Are Largely Dependent on the Presence of Multimorbidity.

BACKGROUND AND OBJECTIVE: Comorbidities can influence asthma control and promote asthma exacerbations (AEs). However, the impact of multimorbidity in AEs, assessed based on long-term follow-up of patients with asthma of different degrees of severity, has received little attention in real-life conditions. To describe the epidemiological and clinical characteristics and predictors of AEs in patients who had presented at least 1 AE in the previous year in the MEchanism of Genesis and Evolution of Asthma (MEGA) cohort. METHODS: The work-up included a detailed clinical examination, pulmonary function testing, fractional exhaled nitric oxide (FeNO), blood counts, induced sputum, skin prick-tests, asthma questionnaires, and assessment of multimorbidity. The number of moderate-severe AEs in the preceding year was registered for each patient. RESULTS: The study population comprised 486 patients with asthma (23.7% mild, 35% moderate, 41.3% severe). Disease remained uncontrolled in 41.9%, and 47.3% presented ≥1 moderate-severe AE, with a mean (SD) annual exacerbation rate of 0.47 (0.91) vs 2.11 (2.82) in mild and severe asthma, respectively. Comorbidity was detected in 56.4% (66.6% among those with severe asthma). Bronchiectasis, chronic rhinosinusitis with nasal polyps, atopy, psychiatric illnesses, hyperlipidemia, and hypertension were significantly associated with AEs. No associations were found for FeNO, blood eosinophils, or total serum IgE. Sputum eosinophilia and a high-T2 inflammatory pattern were significantly associated with AEs. Multivariable regression analysis showed a significant association with asthma severity, uncontrolled disease, and low prebronchodilator FEV1/FVC. CONCLUSION: Our study revealed a high frequency of AE in the MEGA cohort. This was strongly associated with multimorbidity, asthma severity, poor asthma control, airflow obstruction, higher sputum eosinophils, and a very high-T2 inflammatory pattern.

Improvement in Olfaction in Patients With CRSwNP and Severe Asthma Taking Anti-IgE and Anti-IL-5 Biologics: A Real-Life Study.

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP), which is characterized by partial loss of smell (hyposmia) or total loss of smell (anosmia), is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD). CRSwNP worsens disease severity and quality of life. The objective of this real-world study was to determine whether biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare the improvement in in olfaction in N-ERD and non-N-ERD subgroups. METHODS: We performed a multicenter, noninterventional, retrospective, observational study of 206 patients with severe asthma and CRSwNP undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab). RESULTS: Olfaction improved after treatment with all 4 monoclonal antibodies (omalizumab [35.8%], mepolizumab [35.4%], reslizumab [35.7%], and benralizumab [39.1%]), with no differences between the groups. Olfaction was more likely to improve in patients with atopy, more frequent use of short-course systemic corticosteroids, and larger polyp size. The proportion of patients whose olfaction improved was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups. CONCLUSIONS: This is the first real-world study to compare improvement in olfaction among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in olfaction (with nonsignificant differences between biologic drugs). No differences were found for improved olfaction between the N-ERD and non-N-ERD groups.

Asthma, comorbidities, and aggravating circumstances: the GEMA-FORUM II task force

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Anaemia in chronic obstructive pulmonary disease. Does it really matter?

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic diseases, with an increasing rate in morbidity and mortality. In recent years, there has been a greater awareness about the clinical importance of systemic effects and other chronic conditions associated with COPD, as these significantly impact on the course of disease. The most studied extrapulmonary manifestations in COPD include the presence of concomitant cardiovascular disease, skeletal muscle wasting, osteoporosis and lung cancer. Anaemia is a recognised independent marker of mortality in several chronic diseases. Recent studies have shown that anaemia in patients with COPD may be more frequent than expected, with a prevalence ranging from 5% to 33%. Some evidence suggests that systemic inflammation may play an important pathogenic role, but anaemia in COPD is probably multifactorial and may be caused by others factors, such as concealed chronic renal failure, decreased androgenic levels, iron depletion, angiotensin-converting enzyme inhibitor treatment and exacerbations. Low levels of haemoglobin and haematocrit in COPD patients have been associated with poor clinical and functional outcomes as well as with mortality and increased healthcare costs. Despite the potential clinical benefit of successfully treating anaemia in these patients, evidence supporting the importance of its correction on the prognosis of COPD is uncertain.

Masa cavitada como forma de presentación de un linfoma pulmonar primario / Primary pulmonary lymphoma presenting as a pulmonary mass with cavitation

El linfoma pulmonar primario es una entidad poco frecuente, que en la mayoría de las ocasiones es de estirpe celular tipo B, predominantemente de bajo grado y de tejido linfoide asociado a la mucosa (MALT/BALT). Los linfomas pulmonares primarios de alto grado suelen presentarse en pacientes inmunodeprimidos. Habitualmente se presentan con síntomas respiratorios y generales. La radiografía de tórax puede mostrar una masa pulmonar o atelectasia y derrame pleural. El pronóstico es peor que en los linfomas pulmonares de bajo grado, con un tiempo de supervivencia de 8-10 años y una mayor probabilidad de progresión local o recidiva a distancia. Presentamos el caso de un paciente de 76 años no inmunodeprimido con una masa pulmonar cavitada secundaria a un linfoma pulmonar primario tipo B de células grandes. Después de la cuarta sesión de quimioterapia se objetivó una reducción de la masa pulmonar y en la cavidad residual se desarrolló un aspergiloma. Revisando la bibliografía se ha comprobado lo anecdótico del caso presentado, pues es extremadamente poco frecuente que un linfoma pulmonar primario se presente en forma de masa cavitada única y con poca repercusión clínica en cuanto a sintomatología general (AU)

[Primary pulmonary lymphoma presenting as a pulmonary mass with cavitation]. / Masa cavitada como forma de presentación de un linfoma pulmonar primario.

Primary pulmonary lymphoma is a rare entity usually formed of B-type cells, usually low-grade and composed of mucosal- or bronchial-associated lymphoid tissue. High-grade primary pulmonary lymphomas usually occur in immunodeficient patients who mostly present with respiratory and nonspecific symptoms. A chest x-ray may show a pulmonary mass or atelectasis and pleural effusion. In such cases, the prognosis is worse than for low-grade pulmonary lymphomas; survival is 8 to 10 years and there is a higher probability of local progression or metastasis. We report the case of an immunocompetent 76-year-old patient who had a pulmonary mass with cavitation secondary to a large B-cell primary pulmonary lymphoma. After the fourth session of chemotherapy the pulmonary mass was reduced in size and an aspergilloma was seen to have developed in the residual cavity. A review of the literature revealed this case to be anecdotal as it is extremely infrequent for a primary pulmonary lymphoma to present in the form of a single mass with cavitation and with few symptoms.