Documento de consenso de expertos para el control del asma en personas mayores / Expert consensus recommendations for the management of asthma in older adults

El asma constituye un problema de salud pública presente en pacientes de cualquier edad, aunque continúa existiendo cierta tendencia a asumir de forma errónea que dicha entidad resulta casi siempre exclusiva de la infancia y de gente joven. Los estudios epidemiológicos señalan que, a partir de la sexta década de la vida, la prevalencia de esta enfermedad en países como España alcanza el 6-10%, con mayor predominio entre las mujeres de 64 a 75 años. Asimismo, dos tercios de las muertes debidas al asma acontecen en esta etapa de la vida, llegando a ocasionar un número de ingresos sustancial, estancias hospitalarias más prolongadas y, desde el punto de vista del financiador, unos costes económicos directos notables. En la actualidad el asma en las personas mayores (65 años o más) constituye un tema de enorme preocupación, cuya realidad se encuentra infravalorada e infratratada, por lo que resulta del todo necesario establecer unas recomendaciones adecuadas para el diagnóstico y tratamiento de la enfermedad en esta población de edad. Con este objetivo nació este consenso que recoge la evidencia disponible más actualizada. Las recomendaciones/conclusiones que se proponen son el resultado de un consenso de tipo nominal desarrollado a lo largo del año 2019 y que han sido validadas por los panelistas en sucesivas rondas de votación. (AU)

Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting. (AU)

Role of Leptin as a Link between Asthma and Obesity: A Systematic Review and Meta-Analysis.

Asthma and obesity are considered as highly prevalent diseases with a great impact on public health. Obesity has been demonstrated to be an aggravating factor in the pathogenesis of asthma. Adipose tissue secretes proinflammatory cytokines and mediators, including leptin, which may promote the development and severity of asthma in obese patients. This study is a systematic review and a meta-analysis based on the relationship between leptin and asthma during obesity. MEDLINE, Cochrane, EMBASE and CINAHL databases were used. Data heterogeneity was analyzed using Cochran's Q and treatment effect with the DerSimonian and Laird method. Random effect analyses were carried out to test data sensitivity. Asymmetry was estimated using Begg's and Egger's tests. All studies showed significant differences in leptin levels. The effect of the measures (p < 0.001), data sensitivity (p < 0.05) and data asymmetry were statistically significant, as well as tBegg's test (p = 0.010) and Egge's test (p < 0.001). Despite the existing limiting factors, the results of this study support the relevant role of leptin in the pathophysiology of asthma in obese subjects. Nevertheless, further studies are needed to obtain better insight in the relationship between leptin and asthma in obesity.

Expert consensus recommendations for the management of asthma in older adults. / Documento de consenso de expertos para el control del asma en personas mayores.

Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting.

Buenas prácticas de trabajo en equipos multidisciplinares para la atención al paciente con asma grave no controlada (Proyecto TEAM) / Best practices for interdisciplinary care of uncontrolled severe asthma patients (TEAM project)

El asma es una de las enfermedades crónicas respiratorias de mayor prevalencia e impacto sanitario y socioeconómico, especialmente en el caso de pacientes que no alcanzan un adecuado control de la enferme-dad. Por ello, mejorar el manejo clínico de los pacientes con asma grave no controlada debe ser una prioridad sanitaria. En un contexto de redefinición general de los modelos de atención orientados al abordaje de la cronicidad y la personalización se ha desarrollado un proyecto para definir las bases del modelo de atención multidisciplinar del paciente con asma grave no controlada. El trabajo realizado refuerza la percepción de la necesidad de optimizar la coordinación entre niveles asistenciales, fomentar la colaboración y el abordaje multidisciplinar, y promover un modelo integral asistencial que permita adaptar la atención a los pacientes con asma grave no controlada de manera más personalizada. El trabajo ha permitido la identificación y priorización de buenas prácticas, por parte de equipos de trabajo multidisciplinares constituidos por médicos especialistas en alergología, neumología y farmacéuticos especialistas en farmacia hospitalaria, en base a su potencial impacto en la mejora de la calidad asistencial, resultados en salud del paciente con asma grave no controlada y la factibilidad de su implementación. Las conclusiones de este proyecto pretenden servir de ayuda a otros equipos de trabajo multidisciplinar con interés en mejo-rar la asistencia a esta patología

As one of the most prevalent chronic respiratory diseases, asthma imposes a heavy health and socioeconomic burden on society, particularly in the case of patients who fail to appropriately control the disease. For this reason, improving the clinical management of patients with severe uncontrolled asthma should be a priority for any healthcare system. At a time when healthcare models for chronic disease management and personalized medicine are undergoing a major overhaul, the project presented in this study seeks to lay the foundations for an interdisciplinary care model for patients with severe uncontrolled asthma. The work carried out reinforces the general perception that it is paramount to optimize coordination between different levels of care, encourage collaboration and an interdisciplinary approach, and promote an integrated care model that makes it possible to adapt the care of patients with severe uncontrolled asthma in a more personalized manner. Under this project, a series of interdisciplinary working groups were created, made up of specialist hospital pharmacists, pneumologists and allergists, to identify and prioritize a number of best practices, and classify them in terms of their potential impact on the improvement of the quality of care and the health outcomes of patients with severe uncontrolled asthma, and their feasibility. The authors' ambition is that the conclusions drawn from this study should help other interdisciplinary teams improve the care provided to patients suffering from severe uncontrolled asthma

Best practices for interdisciplinary care of uncontrolled severe asthma patients (TEAM project).

As one of the most prevalent chronic respiratory diseases, asthma imposes a heavy health and socioeconomic burden on society,  particularly in the case of patients who fail to appropriately control the  disease. For this reason, improving the clinical management of patients  with severe uncontrolled asthma should be a priority for any healthcare  system.At a time when healthcare models for chronic disease management and  personalized medicine are undergoing a major overhaul, the project presented in this study seeks to lay the foundations for an  interdisciplinary care model for patients with severe uncontrolled asthma. The work carried out reinforces the general perception that it is  paramount to optimize coordination between different levels of care,  encourage collaboration and an interdisciplinary approach, and promote  an integrated care model that makes it possible to adapt the care of  patients with severe uncontrolled asthma in a more personalized manner. Under this project, a series of interdisciplinary working groups were  created, made up of specialist hospital pharmacists, pneumologists and  allergists, to identify and prioritize a number of best practices, and  classify them in terms of their potential impact on the improvement of  the quality of care and the health outcomes of patients with severe  uncontrolled asthma, and their feasibility. The authors' ambition is that  the conclusions drawn from this study should help other interdisciplinary  teams improve the care provided to patients suffering from severe  uncontrolled asthma.

El asma es una de las enfermedades crónicas respiratorias de mayor prevalencia e impacto sanitario y socioeconómico, especialmente  en el caso de pacientes que no alcanzan un adecuado control de la  enfermedad.Por ello, mejorar el manejo clínico de los pacientes con asma grave no  controlada debe ser una prioridad sanitaria. En un contexto de  redefinición general de los modelos de atención orientados al abordaje de la cronicidad y la personalización se ha desarrollado un proyecto para  definir las bases del modelo de atención multidisciplinar del paciente con  asma grave no controlada. El trabajo realizado refuerza la percepción de  la necesidad de optimizar la coordinación entre niveles asistenciales,  fomentar la colaboración y el abordaje multidisciplinar, y promover un  modelo integral asistencial que permita adaptar la atención a los  pacientes con asma grave no controlada de manera más personalizada.  El trabajo ha permitido la identificación y priorización de buenas  prácticas, por parte de equipos de trabajo multidisciplinares constituidos  por médicos especialistas en alergología, neumología y farmacéuticos  especialistas en farmacia hospitalaria, en base a su potencial impacto en  la mejora de la calidad asistencial, resultados en salud del paciente con  asma grave no controlada y la factibilidad de su implementación. Las  conclusiones de este proyecto pretenden servir de ayuda a otros equipos  de trabajo multidisciplinar con interés en mejorar la asistencia a esta  patología.

Functional Endoscopic Sinus Surgery for Nasal Polyposis in Asthma PATIENTS: Impact on Bronchial Inflammation / Cirugía endoscópica nasosinusal para la poliposis nasal en pacientes con asma: impacto en la inflamación bronquial

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Effect of 0.5 mg versus 1 mg varenicline for smoking cessation: a randomized controlled trial.

AIMS: Varenicline is used in smoking cessation. The aims of the trial were to test for differences between standard 1- and 0.5-mg doses (both twice daily during 8 weeks) in (1) abstinence, (2) adherence and (3) side effects. DESIGN: Open-label randomized parallel-group controlled trial with 1-year follow-up. All those randomized were included in the final sample using an intention-to-treat (ITT) approach. SETTING: Stop-Smoking Clinic of the Virgen Macarena University Hospital in Seville, Spain. PARTICIPANTS: The study comprised smokers (n = 484), 59.5% of whom were men with a mean age of 50.67 years and a smoking history of 37.5 pack-years. INTERVENTION AND COMPARATOR: Participants were randomized to 1 mg (n = 245) versus 0.5 mg (n = 239) and received behavioural support, which consisted of a baseline visit and six follow-ups during 1 year. MEASUREMENTS: The primary outcome was continuous self-reported abstinence during 1 year, with biochemical verification. The secondary outcomes were adherence and side effects. Also measured were baseline demographics, medical history and smoking characteristics. FINDINGS: Abstinence rates at 1 year were 46.5% with 1 mg versus 46.4% with 0.5 mg [odds ratio (OR) = 0.997; 95% confidence interval (CI) = 0.7-1.43; P = 1.0]; Bayes factor in favour of H0 = 238.507, Bayes factor against H0 = 0.004. Treatment adherence was similar in both regimens (OR = 1.16; 95% CI = 0.8-1.7; P = 0.44). Side effects were reported in 19.3% of cases with 1 mg versus 12.1% with 0.5 mg, although with no significant differences between regimens (OR = 1.73; 95% CI = 0.94-3.18; P = 0.093). CONCLUSIONS: There appears to be no difference in smoking cessation effectiveness between 1 mg and 0.5 mg varenicline, both administered twice daily for 8 weeks, with similar rates of abstinence (46.5% versus 46.4%), adherence and side effects.