Redefining the Role of Bronchoscopy in the Workup of Severe Uncontrolled Asthma in the Era of Biologics: A Prospective Study.

BACKGROUND: Severe uncontrolled asthma (SUA) is frequently treated with biologic therapy if a T2 phenotype is found. Bronchoscopy is not routinely recommended in these patients unless a specific indication to rule out comorbidities is present. RESEARCH QUESTION: Is routine bronchoscopy safe and useful in phenotyping and endotyping patients with SUA before the indication of a biologic therapy? STUDY DESIGN AND METHODS: Prospective study of consecutive patients with SUA who were referred to a specialized asthma clinic to assess the indication of a biologic therapy. Patients were clinically phenotyped as T2-allergic, T2-eosinophilic, and non-T2. All patients underwent bronchoscopy, and systematic data collection of endoscopic findings, microbiology of bronchial aspirate, and presence of eosinophils in bronchial biopsy were recorded and compared between asthma phenotypes. Cluster analysis was performed accordingly. RESULTS: One hundred patients were recruited and classified as T2-allergic (28%), T2-eosinophilic (64%), and non-T2 (8%). On bronchoscopy, signs of gastroesophageal reflux disease were detected in 21%, vocal cord dysfunction in 5%, and tracheal abnormalities in 3%. Bronchial aspirate culture isolated bacteria in 27% of patients and fungi in 14%. Three clusters were identified: nonspecific, upper airway, and infection, the latter being less frequently associated with submucosal eosinophilia. Eosinophils were detected in 91% of bronchial biopsies. Despite a correlation to blood eosinophils, five patients with T2-phenotypes showed no eosinophils in bronchial biopsy, and three patients with non-T2 showed eosinophils in bronchial biopsy. Only one patient had moderate bleeding. INTERPRETATION: Routine bronchoscopy in SUA eligible for biologic therapy is a safe procedure that can help to better phenotype and personalize asthma management.

Aplicaciones de las nuevas tecnologías en la deshabituación tabáquica: telemedicina y gamificación / Applications of the new smoking cessation technologies: telemedicine and gamification

La telemedicina y la gamificación son dos estrategias basadas en las tecnologías de la información y comuni-cación que se pueden utilizar en una amplia variedad de patologías, entre las que se incluye el tabaquis-mo. Los programas basados en la telemedicina han demostrado ser similares a la asistencia convencional consiguiendo la deshabituación tabáquica a corto y largo plazo, si bien los estudios han ratificado que la telemedicina no es válida para todos los pacientes y de-bemos investigar más sobre los factores que se asocian a una mejor adherencia del paciente al programa. Por otro lado, en el momento actual solo se ha publicado un estudio sobre la gamificación en la deshabituación tabáquica, aunque sus aplicaciones potenciales podrían favorecer la adquisición de hábitos de vida saludable y aumentar la predisposición de los fumadores para realizar un intento de deshabituación

Telemedicine and gamification are two strategies based on the use of information and communication techno-logies. Both of them could be used in a large variety of pathologies, including smoking cessation. Teleme-dicine programs have shown similar results compared with usual care in terms of smoking cessation at the short and large time. While the studies have ratified that telemedicine is not valid with all patients and should be investigated about factors related to bet-ter patients' adherence to the program. On the other hand, actually, only one article about gamification has been published although their possibilities for impro-ving healthy lifestyle or the patient predisposition to make an attempt to smoking cessation should be in consideration in future studies

Exposición al aire contaminado por humo del tabaco en niños de una consulta de Neumología pediátrica / Exposition to contaminated air due to tobacco smoke in children of an office of pediatric pneumology

Objetivo: El objetivo principal es analizar el porcentaje de niños que acuden a la consulta de Neumología pediátrica que están expuestos al aire contaminado por humo del tabaco (ACHT). Pacientes y método: Se seleccionó una muestra de 201 niños entre 0 y 14 años que acudían a una consulta de Neumología pediátrica. El progenitor que acudía a la consulta respondía un cuestionario y el resto de la información se obtuvo de la historia clínica del niño. Se realizó una intervención breve sobre todos los progenitores. Resultados: El 39% de los niños estaban expuestos al ACHT. Un 19,4% de las madres reconocieron haber fumado en presencia de su hijo y un 18,4% de los padres. Pidieron cita para la consulta de tabaco el 20% de las madres y el 23,9% de los padres fumadores. Tanto en el grupo de niños expuestos como no expuestos la patología más frecuente fue el asma o hiperreactividad bronquial. Conclusiones: El 39% de los niños estaban expuestos al ACHT. Pocos padres muestran su deseo de dejar de fumar. La prohibición de fumar en domicilio no siempre es cumplida. No encontramos diferencias en cuanto a enfermedades entre el grupo de expuestos y no expuestos al ACHT. Desde la consulta de pediatría se puede informar y motivar a todos los padres fumadores para el abandono del tabaco

Objetive: To analyze the percentage of children who are exposed to smoke tobacco pollution in respiratory pediatric practice.Patients and methods. 201 children between 0 and 14 years were selected from respiratory pediatric practice. The information was obtained from a questionnaire answered by the parents who go to the clinic and from the medical history of the child. A brief intervention was carried out with all parents. Results: 39% of children were exposed to tobacco smoke pollution. 19.4% of mothers and 18.4% of fathers recognized smoking next to their children. 20% smoker mothers and 23.9% smoker fathers booked a date for quit smoking. The most frequent respiratory disease among children, both exposed and no tobacco pollution exposed, was asthma and bronchial hyperreactivity. Conclusions: 39% of children were exposed to tobacco smoke pollution. Only few parents want to quit smoking. A ban on smoking in the home is not obey in all cases. There were no differences found between diseases in both groups of exposed and no tobacco exposed. The pediatric practice is an opportunity to inform and motivate smoke cessation in parents

Aspiración de cuerpo extraño / Foreign body in the right lower lobe bronchus

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