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)

No es COVID todo lo que reluce / All that glitters is not covid

Se describe el caso de una paciente de 50 años que fue ingresada durante la pandemia de SARS-CoV-2 (COVID-19) por neumonía bilateral, atribuida a la infección por dicho virus. Sin embargo, tras realizar pruebas complementarias, se diagnostica una pieza dentaria localizada en fosa nasal como foco infeccioso del proceso. Se concluye con la necesidad de efectuar una correcta anamnesis para valorar otras posibles causas de neumonía durante la pandemia por SARS-CoV-2 (AU)

We describe the case of a 50-year-old patient who was admitted during the SARS-Cov-2 (COVID-19) pandemic for bilateral pneumonia, attributed to infection by this virus. However, after complementary tests, a tooth located in the nostril is diagnosed as an infectious focus of the process. It concludes with the need to carry out a correct anamnesis to assess other possible causes of pneumonia during the SARS-CoV-2 pandemic (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)

Presente y futuro de las nuevas tecnologías en el asma / Present and future of the new technologies in asthma

Los nuevos avances tecnológicos están suponiendo una constante revolución a nivel científico y de relaciones sociales, lo que incluye la relación entre profesionales, la forma de obtención de información y la forma de interacción entre profesionales sanitarios y pacientes. Los profesionales sanitarios estamos obligados a adaptarnos a los cambios tecnológicos de forma crítica para conseguir una utilización racional de los mismos, y en beneficio de los pacientes. En esta revisión analizamos el presente y el futuro de la utilización y aplicación de las nuevas tecnologías en el asma. Analizaremos el uso y los estudios disponibles en telemedicina y aplicaciones móviles diseñadas para pacientes asmáticos, así como la utilización cada vez mayor de dispositivos electrónicos y weareables. Por otro lado, analizaremos la utilidad de las redes sociales dentro de los cuidados de la salud en el asma, su utilización como medio de interacción con los pacientes, y por profesionales sanitarios como método de compartir información y experiencia

The new technological advances are assuming a constant revolution in science and social relations, which includes the relationship between professionals, the way of obtaining information and the form of interaction between health professionals and patients. Health professionals are obligated to adapt to technological changes critically, to achieve a rational use of them, and to use them for the benefit of patients. In this review we analyze the present and future utility and application of new technologies in asthma. In this review we analyze the available studies of telemedicine and mobile applications designed for asthmatic patients, as well as the increasing use of electronic and wearable devices. On the other hand, we analyze the usefulness of social networks within health care in asthma, its use as a method of interaction with patients, and its use by health professionals as a method of sharing scientific information and medical experience

Successful treatment of allergic bronchopulmonary aspergillosis with benralizumab in a patient who did not respond to omalizumab

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Variación del gasto sanitario por la participación de pacientes en ensayos clínicos. Estudio piloto en asma bronquial / Variation of health care cost by the participation of patients in clinical trials. Pilot study in bronchial asthma

En Europa occidental la incidencia de asma se ha duplicado en los últimos 10 años, generando una gran carga económica para los sistemas de salud. El objetivo de este estudio fue cuantificar el ahorro para el sistema sanitario derivado de la participación de un paciente asmático en un ensayo clínico (EC) en un hospital de nivel terciario. El análisis se realizó con un diseño descriptivo y retrospectivo. Como variable principal se tomó el coste total para el sistema de salud durante los periodos de participación en el EC y durante el periodo control y como variables secundarias el coste por pruebas complementarias, el coste por consultas y el coste por fármacos antiasmáticos. En promedio, la participación de un paciente asmático en un EC supuso un ahorro total (fármacos, consultas y pruebas complementarias) para el sistema sanitario de 21,18 € por semana. Si se contabiliza como ahorro sólo la medicación que reciben los pacientes durante el período de tratamiento del ensayo, el ahorro asciende a 9,71 € por paciente y semana. El ahorro bruto y neto no pudieron explicarse adecuadamente a partir de los factores considerados: costes control, gravedad, tipo de ensayo, edad y sexo. Para el ahorro bruto, sólo el nivel de gravedad del paciente reveló una cierta influencia. Concluimos que la participación de un paciente en un EC de asma en un hospital terciario genera un beneficio económico para el sistema sanitario que se hace más patente a medida que aumenta la gravedad del proceso (AU)

In Western Europe, the incidence of asthma has doubled in the last 10 years, generating a greater economic burden for the health care systems. The purpose of this study was to quantify the savings for the health care system derived from the participation of an asthmatic patient in a clinical trial (CT) in a tertiary level hospital. The analysis was conducted with a descriptive and retrospective design. As principal variable, the total cost was obtained for the health care system during the periods of participation in the CT and during the control period as the secondary variables were cost per complementary tests, cost per consultation and cost per anti-asthma drugs. On an average, participation of an asthma patient in a CT meant a total savings (drugs, consultations, and complementary tests) for the health care system of 21,18 € per week. When analyzing the medication by itself that the patients receive during the trial treatment period, the savings reaches 9,71 € per patient and week. The gross and net savings could not be adequately explained from the factors considered: control costs, severity, type of trial, age and gender. We conclude that the participation of a patient in an Asthma CT in a tertiary hospital generates a financial benefit for the health care system that becomes clearer as the severity of the condition increases (AU)

La hipertensión arterial pulmonar (HAP): definición, clasificación y generalidades / Pulmonary arterial hypertension (PAH): definition, classification and generalities

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Tiotropio: un nuevo broncodilatador anticolinérgico para la EPOC

El uso del nuevo anticolinérgico tiotropio (Spiriva,Ba679 BR) puede suponer un avance en la terapia broncodilatadora de la enfermedad pulmonar obstructiva crónica (EPOC), lo que viene determinado por su especificidad de acción sobre los diferentes subtipos de receptores muscarínicos. Ello le confiere un efecto prolongado, y se puede utilizar una vez al día, lo que facilitará la adhesión y cumplimentación del plan terapéutico por parte del paciente. El tiotropio presenta una mayor potencia de acción que su predecesor, el bromuro de ipratropio (AU)