Early response to Tezepelumab in type-2 severe asthma patients non-responders to other biological treatments: a real-life study.

BACKGROUND: Biologic therapies play a crucial role in the treatment of severe asthma. Tezepelumab, a human monoclonal antibody (mAb), inhibits thymic stromal lymphopoietin, a pivotal factor in the pathophysiology of asthma. Although randomized clinical trials have demonstrated the efficacy of Tezepelumab, evidence gaps remain in real-world scenarios. OBJECTIVE: We sought investigate Tezepelumab's response in a clinical setting, focusing on patients who previously failed to other asthma mAbs. METHODS: Real-life study with severe uncontrolled asthma patients despite mAb treatment, requiring a switch to Tezepelumab. Follow-up was done four to six months after initiation of Tezepelumab. The primary endpoint was to evaluate the response in patients with poor response or intolerance to other mAbs. RESULTS: Nine patients were followed up during 7 months. Patients were predominantly middle-aged females with eosinophilic or eosinophilic-allergic phenotypes. Patients had a median failure rate of 2 mAbs (IQR 2-3), with an uncontrolled asthma (median of 2 severe exacerbations the previous year, airflow obstruction and 78% corticosteroid dependence). Tezepelumab demonstrated after 4 to 6 months of treatment reduce corticosteroid dependence (complete withdrawal in 2/7 patients), no exacerbations in 6/9, symptoms control improvement (Asthma Control Test score improved in 5/9) and modulate lung function (improving in 3/9 patients). These findings align with clinical trial results, suggesting Tezepelumab's potential in real-world settings. CONCLUSION: In real-world scenarios, despite the study's limitations, our results underscore Tezepelumab's promise as a therapeutic option for uncontrolled severe asthma, and may be useful for non-responders to other mAbs. Further studies are needed to corroborate these findings.

Adenopatías mediastínicas en síndromes paraneoplásicos / Mediastinal lymphadenopathies in paraneoplastic syndromes

Los síndromes paraneoplásicos son la forma de manifestación de ciertos tumores. La ecografía endobronquial (EBUS) es útil en el estudio de las adenopatías mediastínicas. El objetivo es describir las características de los pacientes con sospecha de síndromes paraneoplásicos y adenopatías mediastínicas. Se realizó un estudio observacional retrospectivo en el que se incluyeron pacientes de la unidad de endoscopia respiratoria de nuestro centro a quienes se realizó EBUS para valorar adenopatías mediastínicas como parte del estudio de cuadros sospechosos de síndrome paraneoplásico entre 2008 y 2021. Se incluyeron 10 pacientes. Los síndromes paraneoplásicos neurológicos fueron los más frecuentes (70%), con síntomas y anticuerpos onconeuronales altamente relacionados con procesos tumorales. La EBUS tuvo una sensibilidad del 83%. La estirpe tumoral más frecuente fue el carcinoma de células pequeñas (40%). Solo uno de los casos con hallazgo de hiperplasia linfoide en la EBUS fue diagnosticado posteriormente de carcinoma mucosecretor. En pacientes con sospecha de síndrome paraneoplásico y adenopatías significativas en las pruebas de imagen se debe valorar su punción mediante EBUS. En nuestra serie, esta técnica tiene una elevada sensibilidad y permite el diagnóstico de procesos tumorales que en muchas ocasiones son la forma manifestación de ciertos tumores (AU)

Paraneoplastic syndromes are the manifestation of certain tumors. Endobronchial ultrasound (EBUS) is useful in the study of mediastinal lymphadenopathies. The objective is to evaluate the effectiveness of the study of mediastinal lymphadenopathies in patients with suspected paraneoplastic syndrome. We conducted a retrospective observational study, including patients from the Respiratory Endoscopy Unit of the Hospital 12 de Octubre who underwent EBUS for the study of mediastinal lymphadenopathies as part of the study of suspected SP between 2008 and 2021. Ten patients were included. Neurological paraneoplastic syndromes were the most frequent (70%), with symptoms and onconeuronal antibodies highly related to tumor processes. EBUS had a sensitivity of 83%. The most frequent tumor type was small cell carcinoma (40%). Only one of the cases with a finding of lymphoid hyperplasia on EBUS was subsequently diagnosed as a mucosecretory carcinoma. Patients with suspected paraneoplastic syndromes and significant lymphadenopathy on imaging tests should be evaluated for EBUS puncture. In our series, this technique has a high sensitivity and allows the diagnosis of tumor processes that often have no other expression (AU)

The addition of a humidifier device to a circuit and its impact on home ventilator performance: a bench study.

INTRODUCTION AND OBJECTIVES: Humidification and non-invasive ventilation are frequently used together, despite the lack of precise recommendations regarding this practice. We aimed to analyse the impact of active external and built-in humidifiers on the performance of home ventilators, focusing on their pressurization efficacy and their behaviour under different inspiratory efforts. METHODS: We designed a bench study of a lung simulator programmed to emulate mechanical conditions similar to those experienced by real respiratory patients and to simulate three different levels of inspiratory effort: five different commonly used home NIV devices and active humidifiers attached to the latter (internal or "built-in") or to the circuit (external). To test ventilator pressurization under different humidification and effort settings, pressure-time products in the first 300ms and 500ms of the respiratory cycle were calculated in the 45 situations simulated. Inferential statistical analysis was performed. RESULTS: A significant reduction of PTP 300 and PTP 500 was observed with the external humidifier in three of the devices. The same pattern was noted for another device with an internal humidifier, and only one device showed no significant changes. This impact on pressurization was commonly higher under high inspiratory effort. CONCLUSIONS: These results indicate the need to monitor pressure changes in the use of external humidification devices in some home NIV ventilators.