Quality indicators in the rational management of severe asthma: A Spanish multidisciplinary consensus.

AIM: Severe asthma is a complex, heterogeneous condition that can be difficult to control despite currently available treatments. Multidisciplinary severe asthma units (SAU) improve control in these patients and are cost-effective in our setting; however, their implementation and development can represent an organizational challenge. The aim of this study was to validate a set of quality care indicators in severe asthma for SAU in Spain. METHODS: The Carabela initiative, sponsored by SEPAR, SEAIC, SECA and SEDISA and implemented by leading specialists, analyzed the care processes followed in 6 pilot centers in Spain to describe the ideal care pathway for severe asthma. This analysis, together with clinical guidelines and SEPAR and SEAIC accreditation criteria for asthma units, were used to draw up a set of 11 quality of care indicators, which were validated by a panel of 60 experts (pulmonologists, allergologists, and health-policy decision-makers) using a modified Delphi method. RESULTS: All 11 indicators achieved a high level of consensus after just one Delphi round. CONCLUSIONS: Experts in severe asthma agree on a series of minimum requirements for the future optimization, standardization, and excellence of current SAUs in Spain. This proposal is well grounded on evidence and professional experience, but the validity of these consensus indicators must be evaluated in clinical practice.

Transition of Adolescents With Severe Asthma From Pediatric to Adult Care in Spain: The STAR Consensus.

OBJECTIVES: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. METHODS: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. RESULTS: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. CONCLUSION: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

Transition of Adolescents With Severe Asthma From Pediatric to Adult Care in Spain: The STAR Consensus

Objective: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. Methods: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. Results: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. Conclusions: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient (AU)

Objetivo: Evaluar el grado de consenso con un panel multidisciplinar de expertos sobre la transición del adolescente con asma grave de los servicios de pediatría a atención de adultos. Métodos: Se elaboró un cuestionario de 61 ítems basado en recomendaciones de transición para otras patologías crónicas, abarcando la planificación de la transición, preparación, transferencia efectiva y seguimiento. Se evaluó el nivel de consenso entre 98 expertos (49 pediatras, 24 alergólogos y 25 neumólogos) mediante un proceso Delphi de dos rondas. El consenso se estableció con un acuerdo ≥70%. Resultados: Cuarenta y dos ítems (70%) alcanzaron consenso. Los panelistas no alcanzaron consenso en el rango de edad para iniciar la transición. El principal objetivo a conseguir durante la transición según los expertos fue que el adolescente gane autonomía en el manejodel asma grave y tratamientos prescritos. Asimismo, alcanzaron acuerdo en la importancia de desarrollar un plan individualizado, promover la autonomía del paciente e identificar los factores clave en el entorno familiar. Los especialistas de adultos deben tener experiencia en asma grave y tratamientos biológicos, así como en el manejo de pacientes adolescentes. Los equipos sanitarios de pediatría y de adultos deben compartir la información clínica, consensuar los criterios para mantener la terapia biológica y realizar una visita conjunta con el paciente antes de la transferencia. Los especialistas de adultos deben realizar un seguimiento estrecho del paciente tras la transferencia para asegurar una correcta técnica inhalatoria, el cumplimiento del tratamiento y la asistencia a las citas sanitarias. Conclusiones: Este documento de consenso proporciona la primera hoja de ruta en España para que los equipos especialistas de pediatría y adultos garanticen aspectos clave del proceso de transición en pacientes adolescentes con asma grave. La aplicación de estas (AU)

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.

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

El asma es una de las enfermedades crónicas más prevalentes en España. Los tratamientos disponibles permitirían tener controlados a la mayoría de los pacientes; aunque, en la práctica diaria, no se alcanza en muchos casos debido, fundamentalmente, al infradiagnóstico, pérdida de seguimiento y escasa adhesión terapéutica. Para mejorar esta situación es fundamental la coordinación de todos los profesionales que intervienen en la atención del paciente asmático. La Sociedad Española de Alergología e Inmunología Clínica (SEAIC), la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), la Sociedad Española de Médicos Generales y de Familia (SEMG) y la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) han consensuado un documento donde se establecen criterios de derivación y pautas de actuación en el diagnóstico, control y seguimiento del paciente asmático que faciliten la continuidad asistencial y una mejor atención en cada ámbito

[The epidemiology of COPD and asthma exacerbations in a general hospital]. / Características epidemiológicas de las exacerbaciones por EPOC y asma en un hospital general.

This retrospective study identified the clinical and epidemiological characteristics of patients coming to the emergency room of our hospital with exacerbated asthma or chronic obstructive pulmonary disease (COPD) in 1993 and 1994. We followed a previously established protocol to review the case histories of patients from both years. The 1,592 exacerbations we identified in 1,209 asthmatics accounted for 0.9% of all emergency visits, with a mean of 2.2 1.6 (0-9) visits daily. The 2,106 exacerbations of COPD in 1,208 patients accounted for 1.2% of all emergencies, with a mean 2.9 (1-12) visits per day. The mean age was 51.2 (14-93) years for asthmatics and 70.3 (29-96) years for COPD patients. Of asthmatics, 69.8% were women and 30.1% were men, whereas 91.4% of COPD patients were men. The readmission rate was 3.4% for asthmatics and 4.8% for COPD patients. The hospitalization rate was 26.7% for asthmatics and 49.4% for COPD exacerbation patients. The hospital saw 22.6% of asthma exacerbations between midnight and 8 a.m. and 41.6% of COPD exacerbations during the same time frame. For both diseases, more emergencies occurred in winter. Correlation between asthma and COPD and declared influenza cases in the community were r = 0.63 (p < 0.001) for asthma and r = 0.83 (p < 0.0001) for COPD. Our findings underline the considerable emergency care burden generated by exacerbations of obstructive airway diseases and suggest that community acquired respiratory infections are usually the underlying cause.

Características epidemiológicas de las exacerbaciones por EPOC y asma en un hospital general / The epidemiology of COPD and asthma exacerbations in a general hospital

Realizamos un estudio retrospectivo para conocer las características clínicas y epidemiológicas de los pacientes que acudieron al servicio de urgencias del hospital con exacerbaciones de asma y enfermedad pulmonar obstructiva crónica (EPOC) durante los años 1993 y 1994. El análisis se realizó mediante revisión de las historias clínicas de los pacientes atendidos durante estos 2 años de acuerdo con un protocolo de estudio previamente establecido. Identificamos 1.592 exacerbaciones en 1.209 pacientes asmáticos, lo que representa el 0,9 por ciento del total de urgencias atendidas, y una media ñ desviación estándar de 2,2 ñ 1,6 (límites, 0-9) de exacerbaciones diarias. Las agudizaciones de EPOC fueron 2.106 en 1.208 pacientes, lo que significa el 1,2 por ciento del total de urgencias, y una media diaria de 2,9 (límites, 0-12) casos. La edad media de los pacientes con asma fue de 51,2 (límites, 14-93) años, y la de los que padecían EPOC, de 70,3 (límites, 29-96). Con respecto al sexo, entre los asmáticos el 69,8 por ciento eran mujeres y el 30,1 por ciento, varones, mientras que entre los pacientes con EPOC el 91,4 por ciento eran varones. La tasa de reingresos por asma fue del 3,4 por ciento y para la EPOC, del 4,8 por ciento. Precisaron internamiento hospitalario el 26,7 por ciento de los asmáticos y el 49,4 por ciento de las agudizaciones de EPOC. El 22,6 por ciento de los pacientes con asma y el 41,6 por ciento de los que padecían EPOC acudieron al hospital entre las 0:00 y las 8:00 h. Tanto en el caso del asma como en el de la EPOC, en los meses invernales se registró una mayor afluencia. La correlación observada entre el número de exacerbaciones de asma y EPOC y los casos declarados de gripe en la comunidad para asma fue: r = 0,63 (p < 0,0001) y para EPOC, r = 0,83 (p < 0,0001).Nuestros datos destacan la importante carga asistencial que representan las exacerbaciones por enfermedad obstructiva de la vía aérea como motivo de atención hospitalaria urgente y sugieren que las infecciones respiratorias comunitarias podrían ser la causa subyacente (AU)

Applicability of the Asthma Opinion Survey in the Spanish population: distribution and relationship with sociodemographic and clinical variables.

We evaluated a Spanish version of the Asthma Opinion Survey (AOS) in a sample of 90 adult Spanish asthma patients. The Spanish AOS showed acceptable internal consistency, and a factorial structure similar to that reported by others, i.e., vulnerability, perceived quality of care, and recognition and control, although we additional ly obtained a fourth factor, attitudes toward patient knowledge. Vulnerability was significantly higher among older patients, and among patients with lower educational level, lower income, and more severe asthma. Perceived quality of care, and recognition and control were positively correlated with frequency of attacks, and recognition and control was significantly higher in older patients. The factor attitudes toward patient knowledge was significantly higher in younger patients and in patients with relatively high income. These results support the cross-cultural validity of this questionnaire.

[Pseudotumoral allergic bronchopulmonary aspergillosis]. / Aspergilosis broncopulmonar alérgica seudotumoral.

Allergic bronchopulmonary aspergillosis (ABPA) develops as the result of a hypersensitivity reaction to fungi of the genus Aspergillus. Clinical and radiological presentation can be atypical, requiring a high degree of suspicion on the part of the physician who treats such patients. We report the cases of two patients with APBA in whom the form of presentation--with few asthma symptoms, images showing lobar atelectasia and hilar adenopathy--led to an initial suspicion of lung cancer.

Aspergilosis broncopulmonar alérgica seudotumoral / Pseudotumoral allergic bronchopulmonary aspergillosis

La aspergilosis broncopulmonar alérgica (ABPA) se produce por una reacción de hipersensibilidad a hongos, del género Aspergillus. En ocasiones la forma de presentación, tanto clínica como radiológica, es atípica, exigiendo un alto grado de sospecha por parte del clínico que atiende a estos enfermos. Presentamos dos pacientes con ABPA en los que la forma de presentación con asma poco expresivo clínicamente, las imágenes radiológicas de atelectasia lobar y las adenopatías hiliares sugerían, como primera posibilidad, el diagnóstico de una neoplasia pulmonar. (AU)