Understanding Severe Asthma Through Small and Big Data in Spanish Hospitals: The PAGE Study.

BACKGROUND: Data on the prevalence of severe asthma (SA) are limited. Electronic health records (EHRs) offer a unique research opportunity to test machine learning (ML) tools in epidemiological studies. Our aim was to estimate the prevalence of SA among asthma patients seen in hospital asthma units, using both ML-based and traditional research methodologies. Our secondary objective was to describe patients with nonsevere asthma (NSA) and SA over a follow-up of 12 months. METHODS: PAGE is a multicenter, controlled, observational study conducted in 36 Spanish hospitals and split into 2 phases: a cross-sectional phase for estimation of the prevalence of SA and a prospective phase (3 visits in 12 months) for the follow-up and characterization of SA and NSA patients. A substudy with ML was performed in 6 hospitals. Our ML tool uses EHRead technology, which extracts clinical concepts from EHRs and standardizes them to SNOMED CT. RESULTS: The prevalence of SA among asthma patients in Spanish hospitals was 20.1%, compared with 9.7% using the ML tool. The proportion of SA phenotypes and the features of patients followed up were consistent with previous studies. The clinical predictions of patients' clinical course were unreliable, and ML found only 2 predictive models with discriminatory power to predict outcomes. CONCLUSION: This study is the first to estimate the prevalence of SA in hospitalized asthma patients and to predict patient outcomes using both standard and ML-based research techniques. Our findings offer relevant insights for further epidemiological and clinical research in SA.

Understanding Severe Asthma Through Small and Big Data in Spanish Hospitals: The PAGE Study

Background: Data on the prevalence of severe asthma (SA) are limited. Electronic health records (EHRs) offer a unique research opportunity to test machine learning (ML) tools in epidemiological studies. Our aim was to estimate the prevalence of SA among asthma patients seen in hospital asthma units, using both ML-based and traditional research methodologies. Our secondary objective was to describe patients with nonsevere asthma (NSA) and SA over a follow-up of 12 months. Methods: PAGE is a multicenter, controlled, observational study conducted in 36 Spanish hospitals and split into 2 phases: a cross-sectional phase for estimation of the prevalence of SA and a prospective phase (3 visits in 12 months) for the follow-up and characterization of SA and NSA patients. A substudy with ML was performed in 6 hospitals. Our ML tool uses EHRead technology, which extracts clinical concepts from EHRs and standardizes them to SNOMED CT. Results: The prevalence of SA among asthma patients in Spanish hospitals was 20.1%, compared with 9.7% using the ML tool. The proportion of SA phenotypes and the features of patients followed up were consistent with previous studies. The clinical predictions of patients’ clinical course were unreliable, and ML found only 2 predictive models with discriminatory power to predict outcomes. Conclusion: This study is the first to estimate the prevalence of SA in hospitalized asthma patients and to predict patient outcomes using both standard and ML-based research techniques. Our findings offer relevant insights for further epidemiological and clinical research in SA (AU)

Antecedentes: Los datos sobre la prevalencia del asma grave (SA) son limitados. La implantación de las historias clínicas electrónicas (EHR) ofrece una oportunidad única de investigación con tecnologías de aprendizaje máquina (ML) en los estudios epidemiológicos. El objetivo fue estimar la prevalencia del SA entre los pacientes atendidos en las unidades de asma hospitalarias, utilizando el ML como la metodología de investigación tradicional. Los objetivos secundarios fueron describir los pacientes con asma no grave (NSA) y con SA durante un período de seguimiento de 12 meses. Métodos: El estudio PAGE es un estudio multicéntrico, controlado y observacional realizado en 36 hospitales españoles y dividido en dos fases: una primera fase transversal para la estimación de la prevalencia de AS, y una segunda fase prospectiva (3 visitas en 12 meses) para el seguimiento y caracterización de los pacientes con SA y NSA. Se incluyó un subestudio con ML en 6 hospitales. Resultados: Se obtuvo una prevalencia de SA del 20,1% entre los pacientes asmáticos, frente al 9,7% de la herramienta ML. La proporción de fenotipos de SA y las características de los pacientes en seguimiento fueron consistentes con estudios anteriores. Las predicciones clínicas de la evolución de los pacientes fueron poco fiables, mientras que el ML sólo encontró dos modelos predictivos con potencial discriminatorio para predecir resultados. Conclusión: Este estudio es el primero en estimar la prevalencia del SA, en una población hospitalaria de pacientes con asma, y en predecir los resultados de los pacientes utilizando técnicas estándar y de ML (AU)

Estudio comparativo de efectividad entre la Hipnosis y la intervención Cognitivo-Conductual para la Deshabituación Tabáquica / Comparative study of effectiveness between Hypnosis and Cognitive-Behavioral intervention for Smoking Cessation

Introducción: El consumo de tabaco es la primera causa de muerte evitable. A muchos fumadores les gustaría dejar el hábito. Aun así, a pesar de la eficacia demostrada de las intervenciones, muchos no están dispuestos a realizar un intento debido a las altas tasas de recaída y al miedo a los efectos secundarios de los tratamientos empleados, inclinándose a probar métodos alternativos.Objetivo: Conocer si la intervención avanzada individual (multicomponente cognitiva-conductual) es más efectiva que la intervención con hipnoterapia en pacientes fumadores, como tratamiento para dejar de fumar.Metodología: Estudio cuasiexperimental. Se incluyeron pacientes fumadores con antecedentes de patología respiratoria. Fueron asignados, según su preferencia, a un grupo de intervención avanzada individual en tabaquismo (grupo A) - al que se realizó una terapia multicomponente para dejar de fumar- o a un grupo de hipnoterapia (grupo B) en el que se realizó hipnosis para dejar de fumar.Todos los pacientes recibieron el tratamiento farmacológico y las pautas de actuación habituales que se utilizan en las consultas externas para tratar la enfermedad.Resultados: Se encontraron diferencias significativas en la cesación del consumo de tabaco a los 6 meses, encontrándose valores inferiores tanto en el abandono como en la disminución del consumo en los pacientes a los que se les realizó hipnoterapia versus terapia multicomponente (p 0,023 y p 0,031 respectivamente). Conclusiones: La intervención para el abandono del tabaco que incorpora la hipnosis no ha demostrado ser tan eficaz como la terapia multicomponente en la población estudiada. (AU)

Introduction: Tobacco use is the number one preventable cause of death. Many smokers would like to kick the habit. Still, despite the proven efficacy of the interventions, many are reluctant to try due to high relapse rates and fear of side effects of the treatments used, and are inclined to try alternative approaches.Objetive: To know if the individual advanced intervention (cognitive-behavioural multicomponent) is more effective than the intervention with hypnotherapy in smokers, as a treatment to quit smoking.Methodology: Quasi-experimental study. Smokers with a history of respiratory pathology were included. They were assigned, according to their preference, to an advanced individual smoking cessation intervention group (group A) - which underwent multicomponent therapy to quit smoking - or to a hypnotherapy group (group B) in which hypnosis was performed to quit smoking. of smoking.All patients received the pharmacological treatment and the usual action guidelines that are used in outpatient clinics to treat the disease.Results: Significant differences were found in the cessation of tobacco consumption at 6 months, with lower values both in quitting and in the reduction of consumption in patients who underwent hypnotherapy versus multicomponent therapy (p 0.023 and p 0.031, respectively).Conclusions: Smoking cessation intervention incorporating hypnosis has not been shown to be as effective as multicomponent therapy in the population studied. (AU)

PAGE Study: Summary of a Study Protocol to Estimate the Prevalence of Severe Asthma in Spain Using Big Data Methods.

BACKGROUND AND OBJECTIVES: Background: The proposal and the initiative for the Prevalence of Severe Asthma in Hospital Units in Spain (PAGE) study came about because of the widespread implementation of electronic medical records and the limited data available on the prevalence of severe asthma in hospitals in our setting. Objectives: The primary objective was to determine the prevalence of severe asthma in the outpatient clinics of allergy and pulmonology departments in Spain. The secondary objectives were to describe the most prevalent characteristics and phenotypes of severe asthma, to evaluate the selection criteria for receiving approved biological treatments for this disease, and to estimate consumption of resources. Furthermore, digital technology and new data collection sources made it possible to reuse information stored in electronic medical records (Big Data). The study was performed using one such tool, Savana. METHODS: The PAGE study was a multicenter, nonexperimental, observational, cross-sectional study in the first phase and a prospective study in the second phase. The study was controlled and population-based, with 2-stage selection of patients by random sampling. The research was carried out in 40 hospitals selected using convenience sampling in order to ensure geographical representativeness in Spain. RESULTS: This manuscript describes the study design and protocol. CONCLUSIONS: Our study design was sufficiently robust to avoid bias and to establish the prevalence of patients with severe asthma in Spanish hospitals. It was also the first to incorporate new tools that can help in routine clinical practice and research, such as big data analysis software, and to evaluate the reliability and efficiency of these tools.

PAGE Study: Summary of a Study Protocol to Estimate the Prevalence of Severe Asthma in Spain Using Big Data Methods

Background: The proposal and the initiative for the Prevalence of Severe Asthma in Hospital Units in Spain (PAGE) study came about because of the widespread implementation of electronic medical records and the limited data available on the prevalence of severe asthma in hospitals in our setting. Objectives: The primary objective was to determine the prevalence of severe asthma in the outpatient clinics of allergy and pulmonology departments in Spain. The secondary objectives were to describe the most prevalent characteristics and phenotypes of severe asthma, to evaluate the selection criteria for receiving approved biological treatments for this disease, and to estimate consumption of resources. Furthermore, digital technology and new data collection sources made it possible to reuse information stored in electronic medical records (Big Data). The study was performed using one such tool, Savana. Methods: The PAGE study was a multicenter, nonexperimental, observational, cross-sectional study in the first phase and a prospective study in the second phase. The study was controlled and population-based, with 2-stage selection of patients by random sampling. The research was carried out in 40 hospitals selected using convenience sampling in order to ensure geographical representativeness in Spain. Results: This manuscript describes the study design and protocol. Conclusions: Our study design was sufficiently robust to avoid bias and to establish the prevalence of patients with severe asthma in Spanish hospitals. It was also the first to incorporate new tools that can help in routine clinical practice and research, such as big data analysis software, and to evaluate the reliability and efficiency of these tools (AU)

[The management of asthma as a chronic inflammatory disease and global health problem: A position paper from the scientific societies]. / El manejo del asma como enfermedad inflamatoria crónica y problema sanitario global: documento de posicionamiento de las sociedades científicas.

Asthma is the most prevalent respiratory disease worldwide and it can affect people of all ages and is potentially fatal. Today, maintenance treatments are available that are effective in most patients, yet a significant proportion have poorly controlled disease, despite the resources on offer. This document, endorsed by members of the Spanish medical societies involved in the treatment of asthma, is intended to draw the attention of society and professionals to this problem in Spain. It focuses on the clinical, diagnostic and therapeutic aspects of asthma, and proposes some actions for improvement as regards patients and healthcare professionals which, in view of the current results arising from inadequate asthma control, might be beneficial to improve outcomes for both patients and public health.

Referral Criteria for Asthma: Consensus Document.

Asthma is one of the most prevalent chronic diseases in Spain. Current treatments ensure that the disease is controlled in most cases. However, disease is often uncontrolled in daily clinical practice, mainly owing to underdiagnosis, loss to follow-up, and poor adherence to therapy. In order to improve this situation, we must coordinate all those health professionals who intervene in patient care. Therefore, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG), and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) have drawn up a consensus document in which they establish criteria for referral and guidelines for the diagnosis, control, and follow-up of patients with asthma. The document aims to facilitate continuing and improved care in this area.

Tasa de hospitalización y características de los pacientes ingresados por asma durante el 2009 en un hospital universitario de tercer nivel / Hospitalization rate and characteristics of patients admitted with asthma during 2009 in a tertiary-care University Hospital

Introducción: La tasa de ingresos por asma es criterio para medir la calidad de la asistencia sanitaria, dado que la mayoría de las agudizaciones pueden tratarse de forma ambulatoria. El objetivo del estudio es valorar el número y las características (..) (AU)

Introduction: The rate of hospital admissions for asthma is a criterion for measuring the quality of health care, since the majority of exacerbations can be treated on an outpatient basis. The aim of the study (..) (AU)

Factores relacionados con el seguimiento de los pacientes en programa de deshabituación tabáquica / Follow-up related factors in patients in the anti-smoking program

Objetivo. El objetivo del presente estudio fue evaluar las características de los pacientes que completan un programa de 12 meses de deshabituación tabáquica, en comparación con los que no lo completan, a fin de determinar el perfil de paciente respondedor. Métodos. Estudio observacional, prospectivo, de corte transversal en el que fueron incluidos todos los sujetos que asistieron a nuestra clínica en busca de información sobre los programas de deshabituación entre 2000 y 2005. A todos los pacientes se les realizó una evaluación individual con recogida de los antecedentes personales, incluyendo cuadros médicos y psicológicos, así como diversos aspectos relativos al consumo de tabaco. La relación entre las distintas variables recogidas y la finalización del programa fue analizada en un estudio mutlivariante. Resultados. Durante el período de estudio, fueron atendidos 1.681 sujetos en nuestra unidad de deshabituación. Las variables que resultaron estar relacionadas con la finalización del programa de deshabituación fueron la presencia de insuficiencia cardíaca (OR: 3,50;IC95%: 1,24-9,87), la puntuación del test de Fagerström (OR: 0,93;IC95%: 0,87-0,99), la cantidad de nicotina en el cigarrillo (OR0,19; IC95% 0,05-0,66), el tratamiento con bupropion (OR: 2,59;IC95%: 1,70-3,94), la presencia de trastornos del ánimo (OR: 0,59;IC95% 0,38-0,91) y el número de sesiones de psicoterapia (OR 2,18;IC95% 1,99-2,39).Conclusiones. El presente estudio encuentra una relación entre las variables descritas y la finalización del seguimiento de un programa de deshabituación a los 12 meses. Esta información podría ser de ayuda para identificar a los pacientes que se beneficiarían de una estrategia de seguimiento que mejore la cumplimentación del programa. (AU)

Objective. The objective of this study was to evaluate the characteristics of the patients who complete a 12 month quit smoking program,in comparison with those who do not complete it to determine there sponding patient profile. Methods. This observational, prospective study included all those subjects attending our clinic in search of information about anti-smoking programs between 2000 and 2005. All patients were evaluated individually, including personal background as well as medical and psychological information. Likewise, various aspects relating to the consumption of tobacco were also included. The relationship between the different variables collected and the finalization of the program were analyzed in a multi-variant study. Results. During the study, 1.681 subjects attended our anti-smoking unit. The variables that turned out to be related to the finalization of the anti-smoking program were the presence of cardiac insufficiency(OR: 3.50; IC95%: 1.24-9.87), the scoring on the Fagerström test(OR: 0.93; IC95%: 0.87-0.99), the quantity of nicotine in the cigarette(OR 0.19; IC95% 0.05-0.66), the treatment with bupropion (OR: 2.59; IC95%: 1.70-3.94), the presence of depression (OR:0.59; IC95% 0.38-0.91) and the number of psychotherapy sessions(OR 2.18; IC95% 1.99-2.39).Conclusions. This study found a relationship between the described variables and the finalization of the follow up of anti-smoking program after 12 months. This information could help identify those patients who would benefit from a follow-up strategy that improves their compliance with the program (AU)

Variability in the prevalence of premenstrual asthma.

Our aim is to analyse the differences in the prevalence of premenstrual asthma (PMA) according to a set of criteria, the relationship between them and the influence of asthma severity. The answer "Yes" to "Does your asthma get worse before menstruation?" was considered subjective PMA. A daily respiratory symptoms register of fertile asthmatic females was taken during two consecutive menstrual cycles. For the semi-objective diagnosis, an exacerbation of > or =20% was required in the symptoms register. Objective diagnosis was a premenstrual worsening of > or =20% of peak flow. We selected 103 patients. Subjective premenstrual deterioration was perceived in 43.7%. The semi-objective deterioration of symptoms in the first cycle occurred in 44.7%, and in 22.3% in both cycles. A total of 54.3% of females with semi-objective criteria in the first cycle perceived a subjective deterioration of symptoms, versus 35.1% of those without semi-objective criteria (p = 0.05). PMA was present at all levels of asthma severity, with no clear link to the degree of severity. The detection of PMA prevalence, the subjective perception of this deterioration and its presence at all levels of asthma severity lead us to urge research into possible premenstrual deterioration in all fertile asthmatic females.

Utilidad e indicaciones de Omaluzumab en el asma bronquia / No disponible

No disponible

Tratamiento del tabaquismo: hacia el establecimiento de indicaciones / Treatment of smoking habit: towards the establishment of indications

No disponible

Unidades especializadas de tratamiento del tabaquismo y neumólogos / No disponible

No disponible

[Distribution of pulmonologists and chest surgeons in Spain]. / Distribución de neumólogos y cirujanos torácicos en España.

OBJECTIVE: To study the real situation of respiratory medicine specialists and chest surgeons in the Spanish health service. SUBJECTS AND METHOD: Using the database of the secretary of the Spanish Society of Respiratory Medicine and Chest Surgery (SEPAR) for 1999, we gathered data on 326 Spanish hospitals. We were thus able to ascertain the level of staffing of respiratory medicine and chest surgery departments. The results were expressed as simple percentages showing distribution by age, duties and geographic area. The number of specialists per 100,000 inhabitants in each community was also calculated based on population data provided by the National Statistics Institute for 1997. RESULTS: We studied 1,786 physicians or surgeons (1,245 pneumologists, 185 surgeons and 356 from other specialties). The mean age was 41 9 years for pneumologists, 44 10 years for surgeons and 51 8 years for the others. We observed unequal distribution by geographic area, with a high of 6.66 pneumologists and 0.9 surgeons per 100,000 inhabitants in Asturias and Madrid, respectively and a low of 1.4 pneumologists per 100,000 inhabitants in Murcia and 0 surgeons in Extremadura. CONCLUSIONS: Specialist coverage by pneumologists and chest surgeons is inadequate in many provinces and communities in Spain. The professional market is not saturated, indicating that future specialists can look forward to market demand.

[Risk factors for bronchial asthma in patients with rhinitis]. / Factores de riesgo asociados con asma bronquial en pacientes con rinitis.

OBJECTIVES: To identify risk factors for bronchial asthma in a large sample of patients with rhinitis. PATIENTS AND METHODS: One thousand seven hundred sixty patients with rhinitis treated at the respiratory medicine out-patient service of Hospital Universitario Virgen de Rocío in Seville (Spain) in 1997 and 1998 were studied. Six hundred forty-one (36.4%) had isolated rhinitis and 1,119 (63.6%) had rhinitis and bronchial asthma. The following variables were analyzed for both groups: 1) age, 2) sex, 3) clinical diagnosis, 4) age of onset of symptoms, 5) a family history of asthma and/or atopy, 6) housing conditions, 7) smoking, 8) a history of skin allergy, 9) recurrent episodes of respiratory infection with wheezing during early childhood, 10) a diagnosis of nasosinus polyposis, 11) atopy and sensitivity (pollens and/or household allergens), 12) peripheral blood eosinophil count. RESULTS: The variables that best differentiated the group with rhinitis from the group with both rhinitis and asthma were age, family history of asthma and/or atopy, exposure to household humidity or damp, a history of skin allergy, recurrent episodes of respiratory infection with wheezing in early childhood, atopy, sensitivity to household allergens and peripheral blood eosinophil count. The probability of correctly classifying patients in the appropriate group using this model was 69.7%. Among atopic patients, the best predictive variables were the same, with the exception of household humidity/damp. The probability of correct classification using this model was 69.7%. CONCLUSIONS: Patients with rhinitis have risk factors for bronchial asthma. As many such patients as possible should be identified so that long-term follow-up can take place and strategies to prevent bronchial asthma can be implemented.