Improvement in Olfaction in Patients With CRSwNP and Severe Asthma Taking Anti-IgE and Anti-IL-5 Biologics: A Real-Life Study.

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis with nasal polyps (CRSwNP), which is characterized by partial loss of smell (hyposmia) or total loss of smell (anosmia), is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD). CRSwNP worsens disease severity and quality of life. The objective of this real-world study was to determine whether biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare the improvement in in olfaction in N-ERD and non-N-ERD subgroups. METHODS: We performed a multicenter, noninterventional, retrospective, observational study of 206 patients with severe asthma and CRSwNP undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab). RESULTS: Olfaction improved after treatment with all 4 monoclonal antibodies (omalizumab [35.8%], mepolizumab [35.4%], reslizumab [35.7%], and benralizumab [39.1%]), with no differences between the groups. Olfaction was more likely to improve in patients with atopy, more frequent use of short-course systemic corticosteroids, and larger polyp size. The proportion of patients whose olfaction improved was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups. CONCLUSIONS: This is the first real-world study to compare improvement in olfaction among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in olfaction (with nonsignificant differences between biologic drugs). No differences were found for improved olfaction between the N-ERD and non-N-ERD groups.

Recomendaciones sobre el diagnóstico y manejo de la enfermedad pleural y pulmonar por asbesto / Recommendations for the diagnosis and management of asbestos-related pleural and pulmonary disease

Asbesto, también conocido en España como amianto, es el término utilizado para nombrar a un conjunto de silicatos minerales que suelen romperse en fibras. Su uso ha comportado la aparición de numerosas enfermedades, especialmente pleuropulmonares, todas ellas caracterizadas por su prolongada latencia. El asbesto es, además, un carcinógeno del grupo IA reconocido por la OMS desde 1987. En España está prohibido desde 2002. La publicación en 2013 de la 3.ª edición del protocolo de vigilancia sanitaria específica del amianto junto con la aparición de nuevas técnicas diagnósticas han motivado al grupo EROM de SEPAR a promover la elaboración de esta normativa que revisa aspectos clínicos, radiológicos y funcionales de las diferentes enfermedades relacionadas. También establece recomendaciones para el diagnóstico y seguimiento de los pacientes expuestos. Dichas recomendaciones han sido establecidas mediante sistema GRADE.(AU)

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.(AU)

Inducción de esputo en niños: desarrollo técnico / Sputum induction in children: technical development

Objetivos: Comparar el rendimiento (total de muestras obtenidas) de nebulizadores ultrasónicos de flujo bajo y alto en la inducción de esputo en niños asmáticos, y valorar los efectos adversos asociados. Pacientes y métodos: Se nebulizó suero salino hipertónico a concentraciones crecientes (3%, 4%, 5%) utilizando nebulizadores ultrasónicos de bajo flujo (Omron NE-U07(R); flujo 1ml/min) y de alto flujo (Omron NE-U12(R); flujo 3 ml/min, y DeVilbiss Ultraneb 3000(R); flujo 2,5ml/min). Resultados: Se realizaron 49 inducciones en 49 pacientes entre 7 y 15 años de edad (en 15 niños se utilizó un nebulizador de bajo flujo y en 34 niños un nebulizador de alto flujo (Omron NEU12(R): 6 casos, DeVilbiss Ultraneb 3000(R): 28 casos). Se obtuvieron 37 muestras. Treinta y seis presentaban<20% de células escamosas y 26 tenían una viabilidad ≥60%. El rendimiento de la prueba fue mayor con los nebulizadores de alto flujo (85,3% de muestras), frente al 53% (p=0,04). El 69% de las muestras obtenidas con los nebulizadores de alto flujo fueron válidas, frente al 62,5% con el de bajo flujo (p=0,7). Con los nebulizadores de alto flujo disminuyó la incidencia de tos (17,6%, p=0,08) y de picor de ojos (0%, p=0,02), respecto al nebulizador de bajo flujo (47% y 20% respectivamente), aunque aumentó el sabor desagradable (82,3%, p<0,001) y la sialorrea (14,7%, p=0,3). Conclusiones: Con los nebulizadores ultrasónicos de alto flujo se consigue un mayor rendimiento de la técnica sin que se observe un aumento de efectos adversos significativos (AU)

Objective: To compare low and high flow nebulizers performance (total of samples) and its side effects on sputum induction in asthmatic children. Patients and methods: Sputum induction was performed by inhalation of a hypertonic saline solution at increasing concentrations (3%, 4% and 5%) using low flow (OMRON NE-U07(R); flow rate 1ml/min), or high flow (OMRON NE-U12(R); flow rate 3ml/min, and DeVilbiss Ultraneb 3000(R); flow rate 2.5ml/min) ultrasonic nebulizers. Results: We performed 49 inductions in 49 patients from 7 to 15 years old (in 15 children we used a low flow nebulizer (Omron NE-U07(R)) and in 34 children a high flow nebulizer (OMRON NEU12(R), 6 patients, and DeVilbiss Ultraneb 3000(R), 28 patients). We obtained 37 samples of which 36 had less than 20% of squamous cells, and 26 had a viability ≥60%. The test performance was higher with high-flow nebulizers, obtaining 85.3% of samples compared to 53% (p=0.04). A total of 69% of samples obtained with the high flow nebulizer were valid, compared to 62.5% (p=0.7) with the low flow nebulizers. With high flow rate nebulizers the incidence of cough (17.6%, p=0.08) and itchy eyes (0%, p=0.02) decreased with the low flow nebulizer (47% and 20% respectively), but bad taste (82.3%, p <0.001) and salivation (14.7%, p=0.3) increased. Conclusions: With high flow rate ultrasonic nebulizers we obtain a higher performance of the technique without an increase in significant side effects (AU)

[Sputum induction in children: Technical development]. / Inducción de esputo en niños: desarrollo técnico.

OBJECTIVE: To compare low and high flow nebulizers performance (total of samples) and its side effects on sputum induction in asthmatic children. PATIENTS AND METHODS: Sputum induction was performed by inhalation of a hypertonic saline solution at increasing concentrations (3%, 4% and 5%) using low flow (OMRON NE-U07; flow rate 1ml/min), or high flow (OMRON NE-U12; flow rate 3ml/min, and DeVilbiss Ultraneb 3000; flow rate 2.5ml/min) ultrasonic nebulizers. RESULTS: We performed 49 inductions in 49 patients from 7 to 15 years old (in 15 children we used a low flow nebulizer (Omron NE-U07) and in 34 children a high flow nebulizer (OMRON NEU12, 6 patients, and DeVilbiss Ultraneb 3000, 28 patients). We obtained 37 samples of which 36 had less than 20% of squamous cells, and 26 had a viability > or =60%. The test performance was higher with high-flow nebulizers, obtaining 85.3% of samples compared to 53% (p=0.04). A total of 69% of samples obtained with the high flow nebulizer were valid, compared to 62.5% (p=0.7) with the low flow nebulizers. With high flow rate nebulizers the incidence of cough (17.6%, p=0.08) and itchy eyes (0%, p=0.02) decreased with the low flow nebulizer (47% and 20% respectively), but bad taste (82.3%, p <0.001) and salivation (14.7%, p=0.3) increased. CONCLUSIONS: With high flow rate ultrasonic nebulizers we obtain a higher performance of the technique without an increase in significant side effects.

[Immunogenicity of the 23-valent pneumococcal vaccine in children with chronic renal disease]. / Inmunogenicidad de la vacuna antineumocócica de 23 polisacáridos en niños con enfermedad renal crónica.

OBJECTIVE: To study the immunogenicity of the 23-valent pneumoccal vaccine in children with chronic renal disease and in those with nephrotic syndrome, and to compare it with the response in healthy children. METHODS: The vaccine was administered to 150 children aged 2-18 years: 113 with renal diseases (26 with nephrotic syndrome, 23 with severe grades of vesicoureteral reflux, 16 with chronic renal insufficiency, 6 renal transplant recipients, 6 requiring dialysis and 36 with other renal diseases) (group 1) and 37 healthy (group 2). Specific IgG antibodies concentrations were measured by ELISA before and 30 days after vaccination. The results obtained in both groups were compared. We compared too the response observed between the subgroup of children with renal diseases in which pneumococcal vaccine is indicated (nephrotic syndrome, chronic renal insufficiency, renal transplant and those requiring dialysis (group 3) and healthy children. RESULTS: 87.3% of children showed a 2-fold increase in antibody concentrations after vaccination. No significant differences were observed between the three groups. We considered that the vaccine was immunogenic in 78.4% of healthy children, in 77.9% of group 1 children and in 72.5% of those in the group 3 (p = 0,533). A lower response was observed in children with a kidney transplant and in those requiring dialysis. CONCLUSIONS: These results suggest that 23-valent pneumococcal vaccine is immunogenic in children with chronic renal diseases or nephrotic syndrome and may protect these patients from invasive pneumococcal disease. The importance of improved vaccine coverage is emphasized.

Inmunogenicidad de la vacuna antineumocócica de 23 polisacáridos en niños con enfermedad renal crónica / Immunogenicity of the 23-valent pneumococcal vaccine in children with chronic renal disease

Objetivos: Estudiar la inmunogenicidad de la vacuna antineumocócica de 23 polisacáridos en niños con diversos tipos de enfermedad renal crónica y en los afectados de síndrome nefrótico, y compararla con la obtenida en niños sanos. Métodos: Se han incluido en el estudio 150 niños mayores de 2 años: 113 con enfermedad renal (26 con síndrome nefrótico, 23 con reflujo vesicoureteral grado III-IV, 16 con insuficiencia renal crónica, 6 con trasplante renal, 6 en hemodiálisis y 36 con otras enfermedades renales) (grupo 1) y 37 sanos (grupo 2), a los que se administró una dosis de vacuna. Se ha determinado la concentración de IgG total específica frente a neumococo antes de la vacunación y a los 30 días de la misma por el método ELISA. Se comparan los resultados obtenidos entre los dos grupos de niños, así como la respuesta observada entre el subgrupo de niños con enfermedades renales en las que la vacuna está indicada (síndrome nefrótico, insuficiencia renal crónica, trasplante renal y terapia con hemodiálisis) (grupo 3) y los niños sanos. Resultados El 87,3 por ciento de los niños duplicaron las concentraciones de anticuerpos al mes de la vacunación, no observándose diferencias significativas entre los tres grupos. Se consideró que la vacuna fue inmunógena en el 78,4 por ciento de los niños sanos, en el 77,9 por ciento de los del grupo 1 y en el 72,5 por ciento de los del grupo 3 (p = 0,533). Los niños con trasplante renal y los sometidos a hemodiálisis presentaron una respuesta menor. Conclusiones La vacuna antineumocócica de 23 polisacáridos es inmunógena en niños mayores de 2 años con insuficiencia renal crónica, síndrome nefrótico, sometidos a trasplante renal o a hemodiálisis. Hay que destacar la importancia de aumentar la cobertura vacunal en este grupo de enfermos de alto riesgo de enfermedad neumocócica invasiva (AU)