Impact of Air Pollution on Asthma: A Scoping Review.

Asthma is the most common chronic respiratory disease and a major public health problem. Although the causal relationship between air pollution and asthma remains controversial, a large number of studies have provided increasingly consistent evidence of the involvement of air pollutants in asthma onset and exacerbations. We conducted a keyword search-based literature review using PubMed, Scopus and Web of Science databases for studies with titles or abstracts containing predefined terms. This narrative review discusses the current evidence on the pathological effects of pollution throughout life and the mechanisms involved in the onset, development, and exacerbation of asthma, and presents current measures and interventions for pollution damage control. Further global efforts are still needed to improve air quality.

El asma es la enfermedad respiratoria crónica más común, y un importante problema de salud pública. Aunque la relación causal entre la contaminación del aire y el asma sigue siendo controvertida, una gran cantidad de estudios han proporcionado evidencia cada vez más consistente de la participación de los contaminantes del aire en el inicio y las exacerbaciones del asma. Realizamos una revisión de la literatura basada en búsqueda de palabras clave utilizando las bases de datos PubMed, Scopus y Web of Science para estudios con títulos o resúmenes que contienen términos predefinidos. Esta revisión narrativa analiza la evidencia actual sobre los efectos patológicos de la contaminación a lo largo de la vida y los mecanismos involucrados en el inicio, desarrollo y exacerbación del asma, y presenta las medidas e intervenciones actuales para el control de daños por contaminación. Todavía se necesitan más esfuerzos globales para mejorar la calidad del aire.

[Use of systemic glucocorticoids for the treatment of severe asthma: Spanish Multidisciplinary Consensus]. / Uso de glucocorticoides sistémicos para el tratamiento del asma grave: Consenso multidisciplinar español.

Background and aim: Since their effectiveness was initially demonstrated, oral corticosteroids (OCS) have been routinely used to treat asthma. We now know that their usage is linked to the development of side effects such osteoporosis and adrenal insufficiency. This is an observational study based on Delphi methodology. The questionnaire was divided into 4 sections: OCS generalities, maintenance treatment, short-term treatment, and adverse events. Materials and methods: Two rounds of a 68-item questionnaire were completed by a panel of 48 allergists and pneumologists. Results: Definitions were agreed upon, as was the proper use of OCS in the treatment of severe asthma. The experts agreed that the use of OCS should be minimized as much as possible and that in the event of maintenance treatments, a slow and progressive tapering strategy should be used. They also emphasized the importance of standardizing the technique for measuring the amount of SCG delivered in both cases. Conclusions: This consensus document attempts to bring together scientifically supported suggestions from specialists in the management of asthma to reduce the use of OCS in Spain.

Cost-effectiveness analysis of anti-IL-5 therapies of severe eosinophilic asthma in Spain.

AIM: To analyse the cost-effectiveness of MEP with standard of care (SoC) versus other anti-IL-5 therapies approved for the treatment of severe eosinophilic asthma (SEA) patients, within the Spanish National Health System (NHS) perspective. METHODS: A Markov model with a 4-week cycle length was used to compare MEP with BEN and RES as therapies added to SoC in the management of SEA, in terms of cost per QALY gained and incremental cost-effectiveness ratio (ICER). Costs (€2019) were obtained from public sources, while utilities and transition probabilities were retrieved from literature, e.g. network meta-analysis. Continuation criteria for biological treatment and reduction of oral corticosteroids (OCS) was set at 50% minimum reduction of exacerbation rate. Adverse events related to chronic OCS use included diabetes, osteoporosis, cataracts, acute myocardial infarct, and peptic ulcer. The analysis was performed over a 5-year time horizon from the National Healthcare System (NHCS) perspective, with a yearly discount rate of 3% applied to both costs and QALYs. Probabilistic sensitivity analysis and univariate deterministic sensitivity analysis were performed to address uncertainty around the cost-effectiveness results. RESULTS: On top of SoC, the model indicates that MEP is dominant (lower cost, higher benefit) compared to BEN and RES: For BEN and RES, respectively, treatment with MEP had a point estimate of 0.076 and 0.075 additional QALYs, and savings of €3,173.47 and €7,772.95 per patient. The findings were robust to variation as estimated using sensitivity analysis. CONCLUSIONS: MEP is a cost-effective treatment in comparison with BEN and RES added to SoC for patients with SEA in the Spanish setting.

Common errors in inhalation therapy: Impact and solutions.

OBJECTIVE: Inhalation therapy is one of the key pillars in the treatment of chronic obstructive diseases, such as asthma and COPD (Chronic obstructive pulmonary disease); however, wide number of errors occur with high frequency in the inhalation manoeuvres among these patient. This review discuss the main errors made with inhalation devices, factors associated with poor IT (inhalation technique), their consequences and possible solutions. DATA SOURCES: To do this, we performed a search of any publications available in PubMed between the years 2000 and 2019, using the key words: asthma, COPD, obstructive lung disease, inhalers, misuse and errors. STUDY SELECTIONS: After a review of the titles and abstracts by the working group, the articles chosen were considered the most relevant in providing evidence of the problems and establishing solutions in the inhalation treatment of asthma and COPD. RESULTS: There are several publications that associated the errors in the inhalation technique with a poor prognosis both of asthma and COPD. Most authors generally agree in that a poor IT is associated with poor control of the symptoms. CONCLUSIONS: It is essential to review the IT in all our patients with asthma and COPD due to the high socio-economic impact that it involves; an effort must be made to homogenise the evaluation of IT, so that it helps to transmit a clear message to the patients, as well as to the health professionals on what is and what is not a correct manoeuvre.

Normativa del asma ocupacional / Guidelines for Occupational Asthma

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[Reactive Airways Dysfunction Syndrome. A study of 18 cases]. / Síndrome de disfunción reactiva de las vías respiratorias. Estudio de 18 casos.

BACKGROUND AND OBJECTIVE: We intended to perform a descriptive-evolutive study of a series of patients diagnosed with Reactive Airways Dysfunction Syndrome. PATIENTS AND METHOD: Retrospective study of 18 patients diagnosed with Reactive Airways Dysfunction Syndrome. Clinical data, functional respiratory study, and allergic and laboratory tests were collected. The clinical, functional and occupational evolution one year after diagnosis was evaluated. RESULTS: Twelve men and 4 women aged 27 to 66 years were evaluated. More frequent activities were metallurgy and cleaning, and the related agents were derived from chlorine and sulphur. Time from the beginning of exposure to development of symptoms was 1 hour in 10 (55%) patients and less than 24 hours in all cases. All patients reported to have dyspnea (100%), 12 (67%) wheezing, 8 (44%) nose and throat symptoms, 8 (44%) general symptoms such as headache and vomits, and 4 (22%) ocular manifestations. Although all patients received medical assistance after exposure, a correct diagnosis was made some months or years later (average time 3.6 years). At that time there was an airway obstruction in 6 of 18 (33%) patients. With regard to the clinical evolution, there was an improvement in 8 of 18 (44%) patients, while the rest remained stable. In the functional follow up, 8 of 17 (47%) showed no changes, 6 of 17 (35%) improved and 3 of 17 (18%) worsened. Among the patients who inhaled in the workplace, 7 of 14 (50%) continued working in the same job, 5 of 14 (36%) were off sick and 2 of 14 (14%) changed their role in the same company. CONCLUSIONS: Reactive Airways Dysfunction Syndrome is not frequently suspected and thus its diagnosis and treatment can be delayed for months or years.

Síndrome de disfunción reactiva de las vías respiratorias. Estudio de 18 casos / Reactive airways dysfunction syndrome. A study of 18 cases

Fundamento y objetivo: Estudio descriptivo y evolutivo de una serie de pacientes diagnosticados de síndrome de disfunción reactiva de las vías respiratorias. Pacientes y método: Estudio retrospectivo de 18 pacientes diagnosticados de síndrome de disfunción reactiva de las vías respiratorias. Se recogieron los datos de la historia clínica, el estudio funcional respiratorio, las pruebas de alergia y las analíticas. Se valoró la evolución clínica, funcional y laboral al año del diagnóstico. Resultados: El estudio incluía 12 varones y 6 mujeres con una edad comprendida entre los 27 y los 66 años. Las actividades implicadas con mayor frecuencia fueron la metalurgia y la limpieza. Los agentes que en más ocasiones estuvieron involucrados fueron sustancias o agentes químicos derivados del cloro y del azufre. El tiempo medio desde la exposición a la aparición de los síntomas fue, en todos, antes de 1 h en 10 pacientes (55%) y antes de las 24 h. Todos los pacientes relataron que habían presentado disnea, 12 (67%) refirieron sibilancias, 8 (44%) síntomas del área otorrinolaringológica, 8 (44%) síntomas sistémicos como, por ejemplo, cefalea y vómitos, y 4 (22%) síntomas oculares. Aunque todos los pacientes habían recibido asistencia médica tras la inhalación, el diagnóstico correcto se retrasó durante meses o años (tiempo medio: 3,6 años). En aquel momento 6 de 18 pacientes (33%) mostraron obstrucción bronquial en las pruebas de función respiratoria. En la evolución clínica presentaron mejoría 8 de 18 pacientes (44%), mientras que el resto quedó sin cambios. En el control funcional 8 de 17 (47%) quedaron estacionados, 6 de 17 (35%) mejoraron y 3 de 17 (18%) empeoraron. De los 14 pacientes en que la inhalación se produjo en el lugar de trabajo, 7 (50%) continuaban trabajando en la misma ocupación, 5 (36%) estaban de baja y 2 (14%) habían cambiado de lugar dentro de la misma empresa. Conclusiones: El síndrome de disfunción reactiva de las vías aéreas a menudo no se sospecha, lo que puede producir un retraso de meses o años en el diagnóstico y en el tratamiento adecuado. Incluso entonces, éste debería considerarse, ya que en más de una tercera parte de nuestros pacientes se demostró una mejoría clínica y funcional

Background and objective: We intended to perform a descriptive-evolutive study of a series of patients diagnosed with Reactive Airways Dysfunction Syndrome. Patients and method: Retrospective study of 18 patients diagnosed with Reactive Airways Dysfunction Syndrome. Clinical data, functional respiratory study, and allergic and laboratory tests were collected. The clinical, functional and occupational evolution one year after diagnosis was evaluated. Results: Twelve men and 4 women aged 27 to 66 years were evaluated. More frequent activities were metallurgy and cleaning, and the related agents were derived from chlorine and sulphur. Time from the beginning of exposure to development of symptoms was 1 hour in 10 (55%) patients and less than 24 hours in all cases. All patients reported to have dyspnea (100%), 12 (67%) wheezing, 8 (44%) nose and throat symptoms, 8 (44%) general symptoms such as headache and vomits, and 4 (22%) ocular manifestations. Although all patients received medical assistance after exposure, a correct diagnosis was made some months or years later (average time 3.6 years). At that time there was an airway obstruction in 6 of 18 (33%) patients. With regard to the clinical evolution, there was an improvement in 8 of 18 (44%) patients, while the rest remained stable. In the functional follow up, 8 of 17 (47%) showed no changes, 6 of 17 (35%) improved and 3 of 17 (18%) worsened. Among the patients who inhaled in the workplace, 7 of 14 (50%) continued working in the same job, 5 of 14 (36%) were off sick and 2 of 14 (14%) changed their role in the same company. Conclusions: Reactive Airways Dysfunction Syndrome is not frequently suspected and thus its diagnosis and treatment can be delayed for months or years