[Cost and management of asthma exacerbations in Spanish hospitals (COAX study in hospital services)]. / Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios).

OBJECTIVE: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. PATIENTS AND METHODS: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). RESULTS: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting beta2 agonists. The mean cost was 1555.70 Euros (95% confidence interval [CI], 1237.60 Euros-1907.00 Euros), of which 93.8% (1460.60 Euros; 95% CI, 1152.50 Euros-1779.40 Euros) was due to direct costs, and 6.2% (95.10 Euros; 95% CI, 35.50 Euros-177.00 Euros) to indirect costs. Cost rose with increasing severity of the exacerbation--292.60 Euros for a mild exacerbation, 1230.50 Euros for a moderate exacerbation, and 3543.10 Euros for a severe exacerbation. CONCLUSIONS: The mean cost was 1555.70 Euros. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting beta2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.

Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios) / Cost and management of asthma exacerbations in spanish hospitals (COAX study in hospital services)

Objetivo: La prevalencia y el gasto sanitario originado por el asma están aumentando progresivamente en los países desarrollados. El 70% del coste total está producido por exacerbaciones. El objetivo principal del estudio fue conocer el coste hospitalario de una crisis asmática en nuestro medio. Como objetivo secundario se quiso conocer cuál era el tratamiento de mantenimiento para el control del asma que utilizaban los pacientes antes de la agudización asmática y su tratamiento. El estudio formaba parte de uno más amplio (COAX II) realizado en 8 países europeos que pretendía los mismos objetivos en cada país. Pacientes y métodos: Estudio observacional prospectivo en el que se incluyó a 126 pacientes con crisis asmática tratados de forma habitual en 6 hospitales españoles durante un período de 3 meses (del 1 de enero al 31 de marzo de 2000). Resultados: Siguiendo los criterios de la Global Initiative for Asthma, el 33,3% de las crisis fueron leves, el 38,9% moderadas, el 26,2% graves y el 1,6% con riesgo de parada respiratoria inminente. La utilización de corticoides era generalizada en los pacientes con asma moderada y grave, pero sólo el 68% de los pacientes con asma grave seguían tratamiento con agonistas β2 de larga duración. El coste medio fue de 1.555,7 € (intervalo de confianza [IC] del 95%, 1.237,6-1.907), el 93,8% (1.460,6 €; IC del 95%, 1.152,5-1.779,4) debido a costes directos y el 6,2% (95,1 €; IC del 95%, 35,5-177) a costes indirectos. El coste se incrementaba a medida que la crisis era más grave: 292,6 € para una crisis leve, 1.230,5 € para la crisis moderada y 3.543,1 € para la crisis grave. Conclusiones: El coste medio fue de 1.555,7 €. Los costes de las crisis moderadas y graves eran 4 y 12 veces mayores que los de la leve, respectivamente. Se observó una infrautilización de los β2 de larga duración con respecto a las recomendaciones de las guías en el tratamiento del asma persistente moderada y grave que originaba crisis de asma

Objective: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. Patients and Methods: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). Results: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting β2 agonists. The mean cost was €1555.70 (95% confidence interval [CI], €1237.60-€1907.00), of which 93.8% (€1460.60; 95% CI, €1152.50-€1779.40) was due to direct costs, and 6.2% (€95.10; 95% CI, €35.50-€177.00) to indirect costs. Cost rose with increasing severity of the exacerbation­ €292.60 for a mild exacerbation, €1230.50 for a moderate exacerbation, and €3543.10 for a severe exacerbation. Conclusions: The mean cost was s1555.70. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting β2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations

Asociación de fármacos en el tratamiento del asma. ¿Son realmente útiles? / Combined drug therapy for asthma. Is it really useful?

No disponible

[Strongyloides stercoralis infection in patients with bronchial obstructive pathology]. / Infección por Strongyloides stercoralis en pacientes con patología bronquial obstructiva.

Strongyloides stercoralis infection was hardly seen in Spain until a few years ago but has recently been shown to be fairly common in some geographic areas. In the respiratory tract this germ can cause acute bronchospasms that make diagnosis difficult, particularly in patients with underlying bronchial disease. To determine if curing S. stercoralis infection is accompanied by clinical and functional improvement in patients with bronchial obstruction, we studied the evolution of 22 infected patients: 11 with no bronchopulmonary disease and 11 with chronic airway obstruction or asthma. The following variables were assessed in both groups at the moment of diagnosis of infection and four months after cure: levels of eosinophils and total serum IgE, respiratory symptoms, steroid doses and spirometric parameters. After four months we observed a significant decrease in eosinophil (16 versus 5%) and IgE (1,600 versus 770 IU/ml) levels in both groups. The number of bronchospasms and daily steroid doses required decreased in the group with bronchial disease. No significant differences were seen in spirometric parameters, however. The improvement in respiratory symptoms, blood parameters and need for medication leads us to believe that airway inflammation decreases after the infection has been eradicated, in spite of the lack of improvement in bronchial obstruction.

[Large-cell lung carcinoma producing chorionic gonadotropin hormone: the difficulty in its differential diagnosis from choriocarcinoma]. / Carcinoma pulmonar de células grandes productor de hormona gonadotrofina coriónica: dificultad en el diagnóstico diferencial con un coriocarcinoma.

We describe a patient with giant cell carcinoma with ectopic production of chorionic gonadotrophin hormone (CGH). This entity is compared with choriocarcinoma, given that the immunologic, histologic and chemical similarities between the two neoplasms can make their anatomic and pathologic differential diagnosis difficult. Clinical examination, response to treatment and CGH blood levels are the criteria for differentiation.

[Contribution of the bronchodilator test in the study of bronchial reversibility]. / Aportación del test broncodilatador al estudio de la reversibilidad bronquial.

This study sought to determine the optimum dose of salbutamol and the most useful method for calculating bronchodilator response. Changes in FEV1 after inhalation of 3 doses of salbutamol 200 micrograms were measured in 150 adults (64 healthy individuals, 18 with rhinitis, 53 with asthma and 15 with bronchitis). Bronchodilator response was calculated by 4 different methods: absolute value, percent change form baseline FEV1, from theoretical value and from weighted value. Significant differences in response were observed among the various methods of assessment. Patients with asthma and bronchitis showed the greatest response to salbutamol and their results were used to analyze the usefulness of the reversibility indices. The index that discriminated best was percent of theoretical reference value, although the sensitivity of this index was low and specificity varied from 0.73 to 1 depending on the cut-off point used. This index of reversibility along with absolute value proved to be the least dependent on baseline FEV1. We conclude that bronchodilator response is best assessed by calculating changes in FEV1 in relation to a theoretical reference value. This bronchomotor test, however, does not adequately assess patients with asthma and bronchitis.