Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients.

OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Protocolo de manejo de pacientes con enfermedad pulmonar obstructiva crónica tras agudización en urgencias / Protocol for the management of patients with chronic obstructive pulmonary disease after exacerbation in the emergency department

En la enfermedad pulmonar obstructiva crónica el síndrome de agudización (SAE) es un episodio de inestabilidad clínica por agravamiento de la limitación espiratoria al flujo aéreo o del proceso inflamatorio subyacente. La gravedad del SAE depende de la estratificación del riesgo basal y la intensidad del episodio agudo. La Atención Primaria es el epicentro del circuito asistencial del SAE, pero puede extenderse al Servicio de Urgencias Extrahospitalarias y al propio hospital dependiendo de la situación clínica, del nivel de gravedad, de la disponibilidad de pruebas complementarias y de los recursos terapéuticos necesarios para cada paciente. El registro de los datos clínicos, antecedentes, factores desencadenantes, tratamiento y evolución de los episodios previos de SAE en la historia clínica electrónica son un aspecto esencial para ajustar el tratamiento actual y prevenir la aparición de futuros episodios (AU)

In chronic obstructive pulmonary disease, an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an episode of clinical instability due to the worsening of expiratory airflow limitation or of the underlying inflammatory process. The severity of AECOPD depends on baseline risk stratification and the intensity of the acute episode. Primary Care is the epicenter of the AECOPD care circuit, but it can be extended to the out-of-hospital emergency department and the hospital itself depending on the clinical situation, the level of severity, the availability of complementary tests, and the therapeutic resources required for each patient. Recording clinical data, history, triggering factors, treatment, and evolution of previous episodes of AECOPD in the electronic medical record is an essential aspect to adjust current treatment and prevent the occurrence of future episodes (AU)

[Protocol for the management of patients with chronic obstructive pulmonary disease after exacerbation in the emergency department]. / Protocolo de manejo de pacientes con enfermedad pulmonar obstructiva crónica tras agudización en urgencias.

In chronic obstructive pulmonary disease, an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an episode of clinical instability due to the worsening of expiratory airflow limitation or of the underlying inflammatory process. The severity of AECOPD depends on baseline risk stratification and the intensity of the acute episode. Primary Care is the epicenter of the AECOPD care circuit, but it can be extended to the out-of-hospital emergency department and the hospital itself depending on the clinical situation, the level of severity, the availability of complementary tests, and the therapeutic resources required for each patient. Recording clinical data, history, triggering factors, treatment, and evolution of previous episodes of AECOPD in the electronic medical record is an essential aspect to adjust current treatment and prevent the occurrence of future episodes.

¿Desechan correctamente los pacientes sus dispositivos de inhalación? Proyecto AIRE / Do patients deliver inhalers correctly? The AIRE project

Objetivos: Conocer las actitudes y conocimientos de los usuarios respecto a cómo y dónde se desechan los inhaladores tras finalizar su uso, y describir su opinión sobre el uso de inhaladores recargables. Métodos: Estudio transversal, multicéntrico y de opinión, diseñado para conocer el comportamiento y actitudes respecto al circuito de desecho de los inhaladores y a la utilización de inhaladores recargables. La información se obtuvo mediante la aplicación de un cuestionario ad hoc de conocimientos y actitudes, conteniendo datos de uso y reciclado de inhaladores. Resultados: Se incluyeron 303 sujetos (57,5 ± 19,9 años; tiempo de empleo de inhaladores 9,6±9,8 años; asma/EPOC: 46,2/25,7%). El inhalador más empleado fue el aerosol presurizado en suspensión (30,5%). La mayoría otorgaban una elevada importancia al reciclado de inhaladores (7,75±2,76, sobre 10), y a disponer cada seis meses del mismo inhalador recargable mensualmente (7,77±2,79, sobre 10). El 33% refería haber sido informado alguna vez sobre dónde depositar el inhalador. En cuanto al reciclado, el 42,9% lo hacía en el punto SIGRE de la farmacia. Respecto al destino final de los inhaladores, el 43,6% creía que los dispositivos entregados se reciclaban o destruían y un 35,3% desconocía qué ocurre con los inhaladores después de depositarlos en el punto SIGRE. Conclusiones: A pesar de que los usuarios consideran importante el reciclado de inhaladores y disponer de inhaladores recargables, un porcentaje significativo no los deposita en el punto SIGRE, no han sido informados sobre el lugar correcto de depósito, y desconocen qué ocurre con los inhaladores desechados. Son necesarias campañas de información (AU)

Objectives: To assess users’ attitudes and knowledge of users about how and where inhalers are removed after finalizing their use, and to describe their opinion about utilizing re-usable inhalers. Methods: Cross-sectional, multi-center, and opinion survey, conducted to assess behavior and attitudes regarding the disposal of inhalers recycling and the use of re-usable inhalers, through the application of an ad hoc questionnaire about the knowledge and attitudes, with data about the use and recycling of inhalers. Results: A total of 303 subjects (57.5±19.9 years; time of inhalers’ use 9.6±9.8 years; asthma/COPD: 46.2%/25.7%) were included. Pressurized metered-dose inhalers were the most commonly used inhalers (30.5%). Most users considered the recycling of inhalers to be very important (7.75±2.76, out of 10), and rated highly the availability of having a monthly rechargeable inhaler every 6 months (7.77±2.79, out of 10). Only 33% of users had been informed by their healthcare professionals about the place of delivering the inhaler. With respect to recycling, 42.9% of all users recycled in the SIGRE point of the pharmacy. Regarding the final destination of inhalers, 43.6% thought that the removed inhalers were recycled or destroyed, but 35.3% did not know what would happen to the inhalers after placing in the SIGRE point. Conclusions: Despite users considered the importance of inhalers recycling and the availability of re-usable inhalers, a significant proportion does not recycle in the SIGRE point, has not been informed about the appropriate place of delivering the inhaler and ignores what happens to inhalers. Information campaigns are warranted (AU)

[Do patients deliver inhalers correctly? The AIRE project]. / ¿Desechan correctamente los pacientes sus dispositivos de inhalación? Proyecto AIRE.

OBJECTIVES: To assess users' attitudes and knowledge of users about how and where inhalers are removed after finalizing their use, and to describe their opinion about utilizing re-usable inhalers. METHODS: Cross-sectional, multi-center, and opinion survey, conducted to assess behavior and attitudes regarding the disposal of inhalers recycling and the use of re-usable inhalers, through the application of an ad hoc questionnaire about the knowledge and attitudes, with data about the use and recycling of inhalers. RESULTS: A total of 303 subjects (57.5±19.9 years; time of inhalers' use 9.6±9.8 years; asthma/COPD: 46.2%/25.7%) were included. Pressurized metered-dose inhalers were the most commonly used inhalers (30.5%). Most users considered the recycling of inhalers to be very important (7.75±2.76, out of 10), and rated highly the availability of having a monthly rechargeable inhaler every 6 months (7.77±2.79, out of 10). Only 33% of users had been informed by their healthcare professionals about the place of delivering the inhaler. With respect to recycling, 42.9% of all users recycled in the SIGRE point of the pharmacy. Regarding the final destination of inhalers, 43.6% thought that the removed inhalers were recycled or destroyed, but 35.3% did not know what would happen to the inhalers after placing in the SIGRE point. CONCLUSIONS: Despite users considered the importance of inhalers recycling and the availability of re-usable inhalers, a significant proportion does not recycle in the SIGRE point, has not been informed about the appropriate place of delivering the inhaler and ignores what happens to inhalers. Information campaigns are warranted.

Mortalidad por asma en España, 1990-2015 / Mortality due to asthma in Spain, 1990-2015

INTRODUCCIÓN: El asma es un importante problema de salud pública que afecta a más de 300 millones de personas en el mundo. La importancia de una enfermedad se puede medir por su prevalencia, la carga asistencial, la morbimortalidad. OBJETIVOS: Conocer la carga asistencial o la morbimortalidad por asma en España en el periodo 1990-2015. MATERIAL Y MÉTODOS: Se han obtenido del Instituto Nacional de Estadística el número de defunciones atribuidas al asma por sexo y grupos quinquenales junto con la población a 1 de julio entre los años 1990-2015. A partir de los datos se calcula la tasa de mortalidad bruta por 100.000 habitantes globales, por sexo y grupos etarios. RESULTADOS: En 2015 fallecieron en España con diagnóstico de asma como causa principal 1.134 personas (195 varones y 939 mujeres), con tasas del 0,82/100.000 habitantes frente a 2,58, respectivamente. Las tasas de mortalidad por asma en España se mantienen estables en los últimos 25 años y son ligeramente superiores a las de los países de nuestro entorno. Mientras que la mortalidad por asma ha disminuido en varones más de un 67%, se han incrementado en un 32% en las mujeres. Los fallecimientos se concentran en mayores de 65 y sobre todo 80 años en los que el valor de los certificados de defunción es más limitado. La mortalidad en los grupos de 5-35 años está entre las más bajas de Europa

INTRODUCTION: Asthma is a major public health problem affecting more than 300 million people worldwide. The importance of a disease can be measured by its prevalence, burden of care, and its morbidity and mortality. OBJECTIVE: To determine the mortality rates for asthma in Spain in the period 1990-2015. MATERIAL AND METHODS: The number of deaths attributed to asthma by gender and five-year age groups, together with the population as of July 1 between the years 1990-2015 were obtained from the National Institute of Statistics. Based on these data, the gross mortality rate per 100,000 global inhabitants was calculated, by gender and age groups. RESULTS: In 2015, 1,134 people (195 men and 939 women) died in Spain with a diagnosis of asthma as the main cause, with rates of 0.82 / 100,000 inhabitants compared to 2.58, respectively. The asthma mortality rates in Spain have remained stable for the last 25 years, and are slightly higher than those in the surrounding countries. While asthma mortality has declined by over 67% in males, it has increased by 32% in females. The deaths are concentrated in those over 65 years, and particularly over 80 years, where the value of death certificates is more limited. Mortality in the 5-35 years age groups is among the lowest in Europe

[Mortality due to asthma in Spain, 1990-2015]. / Mortalidad por asma en España, 1990-2015.

INTRODUCTION: Asthma is a major public health problem affecting more than 300 million people worldwide. The importance of a disease can be measured by its prevalence, burden of care, and its morbidity and mortality. OBJECTIVE: To determine the mortality rates for asthma in Spain in the period 1990-2015. MATERIAL AND METHODS: The number of deaths attributed to asthma by gender and five-year age groups, together with the population as of July 1 between the years 1990-2015 were obtained from the National Institute of Statistics. Based on these data, the gross mortality rate per 100,000 global inhabitants was calculated, by gender and age groups. RESULTS: In 2015, 1,134 people (195 men and 939 women) died in Spain with a diagnosis of asthma as the main cause, with rates of 0.82 / 100,000 inhabitants compared to 2.58, respectively. The asthma mortality rates in Spain have remained stable for the last 25 years, and are slightly higher than those in the surrounding countries. While asthma mortality has declined by over 67% in males, it has increased by 32% in females. The deaths are concentrated in those over 65 years, and particularly over 80 years, where the value of death certificates is more limited. Mortality in the 5-35 years age groups is among the lowest in Europe.

Actualización de la terapia inhalada en la enfermedad pulmonar obstructiva crónica / Inhaled in chronic obstructive pulmonary disease therapy update

El conocimiento de la enfermedad pulmonar obstructiva crónica ha evolucionado de manera importante en los últimos años y hoy en día tenemos un concepto más global de la enfermedad. Así mismo, el desarrollo farmacológico actual permite disponer de un amplio abanico de opciones terapéuticas. La vía inhalada es de elección al permitir administrar fármacos que actúan directamente sobre el árbol bronquial. En los últimos meses se han desarrollado nuevas moléculas y dispositivos que aumentan nuestras opciones a la hora de tratar, pero también nuestras dudas al elegir unos u otros; por ello, consideramos relevante realizar una actualización de las medicaciones inhaladas más utilizadas en la enfermedad pulmonar obstructiva crónica. En este artículo pretendemos revisar los distintos tipos de inhaladores de los que disponemos actualmente y evaluar las ventajas e inconvenientes de cada uno de ellos, así como saber cuándo y cómo debemos elegirlos (AU)

Knowledge of chronic obstructive pulmonary disease has increased significantly in recent years, and today we have a more comprehensive concept of the disease. Additionally, drug development allows having a wide range of therapeutic options. The inhaled route is the choice, as it allows drugs to act directly on the bronchial tree. In the past few months, new molecules and devices have been developed that increases our options when treating, but also our doubts when choosing one or the other, so an update of inhaled medications for chronic obstructive pulmonary disease is necessary. he different types of inhalers currently available are reviewed in this article, as well as the advantages and disadvantages of each of them, in order to determine how to choose the right device (AU)

[Fixed-dose combination fluticasone propionate/formoterol for the treatment of asthma: a review of its pharmacology, efficacy and tolerability]. / Combinación a dosis fija de fluticasona propionato/formoterol fumarato para el tratamiento del asma: una revisión de la farmacología, eficacia y tolerabilidad.

The fixed-dose combination fluticasone propionate/formoterol (FPF) is a novel combination of a widely known and used inhaled glucocorticoid (IGC) and a long-acting ß2-adrenergic agonist (LABA), available for the first time in a single device. This fixed-dose combination of FPF has a demonstrated efficacy and safety profile in clinical trials compared with its individual components and other fixed-dose combinations of IGC/LABA and is indicated for the treatment of persistent asthma in adults and adolescents. FPF is available in a wide range of doses that can adequately cover the therapeutic steps recommended by treatment guidelines, constituting a fixed-dose combination of GCI/LABA that is effective, rapid, well tolerated and with a reasonable acquisition cost. Various assessment agencies of the Spanish Autonomous Communities consider this combination to be an appropriate alternative therapy for asthma in the primary care setting.

Calidad de vida del paciente asmático con beclometasona/formoterol. Análisis de coste-utilidad / Quality of life of patients with asthma on beclomethasone/formoterol. Cost-utility analysis

Objetivo. Realizar un estudio de coste-utilidad en pacientes asmáticos en tratamiento con beclometasona/formoterol en combinación fija en Atención Primaria de Salud. Material y métodos. Se seleccionó de forma no probabilística un grupo de pacientes asmáticos con severidad persistente moderada/grave (GEMA 2009), en tratamiento con beclometasona/formoterol a dosis fijas, mayores de 18 años, que habían otorgado su consentimiento informado. El período de observación del estudio fue de 6 meses. Las variables estudiadas fueron: edad, sexo, duración de la enfermedad, recursos sanitarios empleados, análisis de la calidad de vida relacionada con la salud mediante EQ-5D y SF-36, y el cuestionario específico Asthma Quality of Life Questionnaire. Para las variables cualitativas se analizó la frecuencia y la proporción. Para las cuantitativas, la media, la DE y el IC 95%. En la estadística inferencial se utilizaron los test de Chi-cuadrado, t de Student y ANOVA. Las comparaciones se realizaron con una significación estadística de 0,05. Resultados. Sesenta y cuatro pacientes completaron el estudio; el 59,4% eran mujeres. La edad media fue de 49 años y la duración media de la enfermedad fue de 93 meses. Para el control del asma el 53% de los pacientes tenían una pauta prescrita de uno/12 h. Todas las escalas de calidad de vida relacionada con la salud se modificaron respecto del inicio del estudio y las diferencias fueron estadísticamente significativas. Nuestros pacientes lograron mejores puntuaciones en calidad de vida relacionada con la salud que la cohorte española de asma. El coste-utilidad incremental de beclometasona/formoterol frente a la opción habitual de tratamiento fue de 6.256 €/AVAC (AU)

Aim. To perform a cost-utility analysis on asthmatic patients on beclomethasone/formoterol fixed combination in Primary Health Care. Material and methods Non-probability sampling was used to select a group of asthmatic patients with moderate/severe persistent severity (GEMA 2009), treated with beclomethasone/formoterol fixed combination, over 18 years, had given their informed consent. The study observation period was 6 months. The variables studied were: age, sex, duration of disease, health resources used, analysis of health related quality of life by EQ-5D and SF-36, and the specific Asthma Quality of Life Questionnaire. For the qualitative variables, the frequency and percentages were calculated, and for the quantitative variables, the mean, SD and 95% CI. Chi-square, Student t-test and ANOVA were used for statistical inference. Comparisons were made with a statistical significance of 0.05. Results. Of the 64 patients that completed the study, 59.4% were female. The mean age was 49 years, and mean disease duration was 93 months. For asthma control, 53% of patients had a prescription pattern of one/12 h. All health related quality of life scales were modified with respect to the baseline and the differences were statistically significant. Our patients had a better health related quality of life than Spanish asthma cohort. The incremental cost utility beclomethasone/formoterol versus usual treatment option was € 6,256/QALY (AU)

Combinación a dosis fija de fluticasona propionato/formoterol fumarato para el tratamiento del asma: una revisión de la farmacología, eficacia y tolerabilidad / Fixed-dose combination fluticasone propionate/formoterol for the treatment of asthma: a review of its pharmacology, efficacy and tolerability

La combinación a dosis fija de fluticasona propionato/formoterol es una nueva combinación de un glucocorticoide inhalado y un agonista β2-adrenérgico de acción larga ampliamente conocidos y utilizados, disponibles por primera vez en un mismo dispositivo. Esta combinación a dosis fija de fluticasona propionato/formoterol ha demostrado su perfil de eficacia y seguridad en distintos ensayos clínicos frente a sus componentes individuales y otras combinaciones a dosis fijas de glucocorticoide inhalado/agonista β2-adrenérgico de acción larga, y está indicada para el tratamiento del asma persistente en adultos y adolescentes. Fluticasona propionato/formoterol está disponible en un amplio rango de dosis, que permite cubrir adecuadamente los escalones terapéuticos recomendados por las guías terapéuticas, y constituye una combinación a dosis fija de glucocorticoide inhalado/agonista β2-adrenérgico de acción larga eficaz, rápida, bien tolerada y con un coste de adquisición razonable. Esta combinación ha sido posicionada por los distintos organismos evaluadores de las comunidades autónomas como alternativa terapéutica adecuada para el asma en el ámbito de la atención primaria (AU)

The fixed-dose combination fluticasone propionate/formoterol (FPF) is a novel combination of a widely known and used inhaled glucocorticoid (IGC) and a long-acting β2-adrenergic agonist (LABA), available for the first time in a single device. This fixed-dose combination of FPF has a demonstrated efficacy and safety profile in clinical trials compared with its individual components and other fixed-dose combinations of IGC/LABA and is indicated for the treatment of persistent asthma in adults and adolescents. FPF is available in a wide range of doses that can adequately cover the therapeutic steps recommended by treatment guidelines, constituting a fixed-dose combination of GCI/LABA that is effective, rapid, well tolerated and with a reasonable acquisition cost. Various assessment agencies of the Spanish Autonomous Communities consider this combination to be an appropriate alternative therapy for asthma in the primary care setting (AU)

[Quality of life of patients with asthma on beclomethasone/formoterol. Cost-utility analysis]. / Calidad de vida del paciente asmático con beclometasona/formoterol. Análisis de coste-utilidad.

AIM: To perform a cost-utility analysis on asthmatic patients on beclomethasone/formoterol fixed combination in Primary Health Care. Material and methods Non-probability sampling was used to select a group of asthmatic patients with moderate/severe persistent severity (GEMA 2009), treated with beclomethasone/formoterol fixed combination, over 18 years, had given their informed consent. The study observation period was 6 months. The variables studied were: age, sex, duration of disease, health resources used, analysis of health related quality of life by EQ-5D and SF-36, and the specific Asthma Quality of Life Questionnaire. For the qualitative variables, the frequency and percentages were calculated, and for the quantitative variables, the mean, SD and 95% CI. Chi-square, Student t-test and ANOVA were used for statistical inference. Comparisons were made with a statistical significance of 0.05. RESULTS: Of the 64 patients that completed the study, 59.4% were female. The mean age was 49 years, and mean disease duration was 93 months. For asthma control, 53% of patients had a prescription pattern of one/12h. All health related quality of life scales were modified with respect to the baseline and the differences were statistically significant. Our patients had a better health related quality of life than Spanish asthma cohort. The incremental cost utility beclomethasone/formoterol versus usual treatment option was € 6,256/QALY.

[Inhaled in chronic obstructive pulmonary disease therapy update]. / Actualización de la terapia inhalada en la enfermedad pulmonar obstructiva crónica.

Knowledge of chronic obstructive pulmonary disease has increased significantly in recent years, and today we have a more comprehensive concept of the disease. Additionally, drug development allows having a wide range of therapeutic options. The inhaled route is the choice, as it allows drugs to act directly on the bronchial tree. In the past few months, new molecules and devices have been developed that increases our options when treating, but also our doubts when choosing one or the other, so an update of inhaled medications for chronic obstructive pulmonary disease is necessary. The different types of inhalers currently available are reviewed in this article, as well as the advantages and disadvantages of each of them, in order to determine how to choose the right device.