The Response to Biologics is Better in Patients with Severe Asthma Than in Patients with Asthma-COPD Overlap Syndrome.

Although biologics have demonstrated to be effective in T2-high asthma patients, there is little experience with these drugs in asthma-COPD overlap (ACO). The aim of this study was to compare the effectiveness of biologics in these two conditions. We included 318 patients (24 ACO and 297 asthma) treated with monoclonal antibodies and followed for at least 12 months. Omalizumab was the most frequently employed biologic agent both in patients with ACO and asthma. Asthma control test (ACT) scores after at least 12 months of biologic therapy were not significantly different between groups. The percentage of patients with ≥1 exacerbation and ≥1 corticosteroid burst was significantly higher in ACO patients (70.8 vs 27.3 and 83.3% vs 37.5%, respectively), whereas the percentage of "controlled" patients (with no exacerbations, no need for corticosteroids and ACT ≥ 20) was significantly lower (16.7% vs 39.7%). In conclusion, this report suggests that patients with ACO treated with biologics reach worse outcomes than asthma patients.

Asthma Control in Patients with Severe Eosinophilic Asthma Treated with Reslizumab: Spanish Real-Life Data.

BACKGROUND: Reslizumab is an anti-interleukin 5 monoclonal antibody that has demonstrated to reduce the risk of severe exacerbations and to improve symptoms, lung function, and quality of life in randomized controlled trials that included patients with severe eosinophilic uncontrolled asthma (SEUA) and a history of severe exacerbations. OBJECTIVE: The aim of the present study was to evaluate the effectiveness of add-on reslizumab in a cohort of patients with SEUA under real-life conditions. METHODS: This was a multi-centre, retrospective, real-life study that included subjects with SEUA treated with reslizumab in 44 asthma units throughout Spain. Eligible patients were those who had received at least one dose of reslizumab as part of normal clinical practice. The primary endpoint was complete asthma control at 52 weeks, defined as absence of severe exacerbations, ACT ≥20 and no maintenance oral corticosteroids (OCS). Demographic, clinical, and functional data were collected at baseline (T0), after four to six months (T1); after 12 months (T2) and beyond 12 months of therapy (T3). RESULTS: Treatment with reslizumab achieved complete asthma control in 40% of the 208 included SEUA patients and led to a significant reduction in exacerbations (from 3.0; IQR: 2.0-4.0 at V0 to 0.0; IQR: 0.0-0.0 at V2), maintenance OCS use (from 54.8% (95% CI: 48.0-61.6 at T0 to 18.5% (95% CI: 12.5-24.5 at T2) and a meaningful improvement in symptoms in the entire treated population: ACT increased from 12.8 ± 4.5 at V0 to 20.0 ± 5.1 at V2 (p < 0.001). Most of the improvement achieved at 12 months was obtained at 4-6 months. The retention (continuation) rate of reslizumab was 75% through 2 years (95CI%: 1.9-2.1). Overall, reslizumab showed an adequate safety profile. CONCLUSION: Reslizumab is an effective therapy for SEUA with adequate safety profile in real-life conditions.

Alteración funcional pulmonar en el seguimiento precoz de pacientes con neumonía por COVID-19 / Pulmonary Function in Early Follow-up of patients with COVID-19 Pneumonia

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Efficacy and Safety of Reslizumab in Patients with Severe Asthma with Inadequate Response to Omalizumab: A Multicenter, Open-Label Pilot Study.

BACKGROUND: Patients with severe allergic and eosinophilic asthma could qualify for different biologic therapies. OBJECTIVE: To evaluate the efficacy and safety of weight-based intravenous reslizumab dosing in patients who have previously failed therapy with omalizumab. METHODS: We carried out a 24-week prospective, multicenter, open-label, single-group, self-controlled study in patients with severe eosinophilic asthma who had previously failed to respond to omalizumab. The main objective was to determine whether treatment with reslizumab significantly improved asthma symptoms assessed by the Asthma Control Test (ACT) at week 24. Secondary objectives were to evaluate symptoms at weeks 4 and 12, change in FEV1 at week 24, and the incidence of severe exacerbations over the study period. RESULTS: Twenty-nine patients (62.1% women, median age, 50.8 years) were included in the study. The median ACT score significantly increased from 13.0 (interquartile range, 8.0-18.0) at baseline to 21.0 (interquartile range, 14.0-24.0) at 24 weeks (P = .002). Only 2 of 29 patients developed at least 1 severe exacerbation during follow-up and none of them required hospitalization. Overall, 15 of 25 patients (60%) were considered as being controlled (ACT score of ≥20 and no exacerbations) at week 24. The percentage of patients who were receiving daily systemic corticosteroids significantly decreased from 72.4% to 52.0% (P = .019). Adverse events were mostly moderate and within the range of previously reported side effects with reslizumab. CONCLUSION: Reslizumab is an effective and safe option for patients with severe eosinophilic asthma and a history of omalizumab failure.

Mucus hypersecretion in asthma is associated with rhinosinusitis, polyps and exacerbations.

BACKGROUND: Bronchial hypersecretion is a poorly studied symptom in asthma. The aim of the study was to determine the specific characteristics of asthmatics with bronchial hypersecretion. METHODS: A total of 142 asthmatics (21.8% men; mean age 49.8 years) were prospectively followed for one year. Mucus hypersecretion was clinically classified into two severity categories: daily sputum production and frequent expectoration but not every day. Clinical and pulmonary function variables associated with mucus hypersecretion were assessed by multiple logistic regression analysis. RESULTS: Daily cough was recorded in 28.9% of patients and sputum production daily or most of the days in 52.1%. Patients with mucus hypersecretion had more dyspnoea, poorer asthma control and quality of life, had suffered from more exacerbations and showed anosmia associated with chronic rhinosinusitis and nasal polyposis more frequently. Factors associated to mucus hypersecretion were anosmia, one exacerbation or more in the previous year and FEV1/FVC <70% (AUC 0.75, 95% CI 0.66-0.85) for the first definition of hypersecretion, and anosmia, poor asthma control and age (AUC 0.75, 95% CI 0.67-0.83) for the second definition. CONCLUSIONS: Mucus hypersecretion is frequent in patients with asthma, and is associated with chronic upper airways disease, airway obstruction, poor asthma control and more exacerbations.

Impacto del asma en la vida sexual de los pacientes. Un estudio de casos y controles / Impact of Asthma on the Sexual Functioning of Patients. A Case-Control Study

Introducción: Las limitaciones de la vida sexual de los pacientes con enfermedades crónicas desempeñan un importante papel en su calidad de vida. La información disponible sobre el impacto de la enfermedad asmática en la vida sexual de las personas es muy limitada. Material y métodos: Estudio transversal, observacional y multicéntrico. Se reclutaron pacientes asmáticos y sujetos sanos, a los que se les efectuó una entrevista en la que se recogieron datos demográficos y clínicos y en donde además cumplimentaron los siguientes cuestionarios: la escala Goldberg Anxiety-Depression Scale (GADS) para la valoración de la existencia de comorbilidad psiquiátrica, y en varones el Índice Internacional de la Función Eréctil (IIEF) y en mujeres el Índice de la Función Sexual Femenina (FSFI). Resultados: Se incluyeron un total de 276 casos, de los que 172 eran asmáticos (63 hombres y 109 mujeres) con una media de edad de 42 (± 14) años y 104 controles (53 hombres y 51 mujeres) con una media de edad de 39 (± 12) años. El asma presentaba una evolución de 15 años y su gravedad se distribuía: 6,4% intermitente, 17,9% persistente leve, 47,4% moderada y 28,2% grave. La enfermedad se consideró controlada en un 57,7%, parcialmente controlada en un 28,2% y no controlada en un 14,1%. Las mujeres asmáticas presentaron una mayor limitación de la vida sexual que las mujeres del grupo control, con una puntuación total del FSFI de 22,1 (± 9) frente a 26,5 (± 6,8), respectivamente (p < 0,005). Y los varones asmáticos, una significativa mayor disfunción eréctil, con una puntuación total del IIFE de 59,5 (± 12,5) frente a 64,3 (± 8,2), respectivamente (p < 0,05). Se observó además una relación entre la existencia de problemas sexuales y un peor control del asma. Conclusiones: La enfermedad asmática condiciona una peor calidad de vida sexual en las personas afectadas. Estos resultados deberían promover, en la práctica clínica habitual, el interés de los profesionales sanitarios por determinar y paliar las posibles limitaciones sexuales de sus pacientes con asma (AU)

Introduction: Sexual limitations play an important role in the quality of life of patients with chronic diseases. Very limited information is available on the impact of asthma on the sexual functioning of these individuals. Materials and methods: Cross-sectional, observational, multicenter study. Asthma patients and healthy individuals were recruited. All subjects participated in an interview in which demographic and clinical data were recorded, and completed the Goldberg Anxiety-Depression Scale (GADS) to evaluate the presence of concomitant psychiatric disease. Men also completed the International Index of Erectile Function (IIEF), and women, the Female Sexual Function Index (FSFI). Results: A total of 276 cases were included, comprising 172 asthma patients (63 men and 109 women) with a mean age of 42 (± 14) years, and 104 controls (52 men and 51women) with a mean age of 39 (± 12) years. Time since onset of asthma was 15 years and severity distribution was: 6.4% intermittent, 17.9% mild persistent, 47.4% moderate, and 28.2% severe. Disease was considered controlled in 57.7%, partially controlled in 28.2%, and uncontrolled in 14.1%. Women with asthma had greater sexual limitations than women in the control group, with a total FSFI score of 22.1 (± 9) compared to 26.5 (± 6.8), respectively (P < .005). Men with asthma had significantly more severe erectile dysfunction with a total IIEF score of 59.5 (± 12.5) compared to 64.3 (± 8.2) in male controls (P < .05). An association was also observed between sexual problems and poorer asthma control. Conclusions: Asthma is associated with a poorer sexual quality of life among patients. These results should arouse the interest of healthcare professionals in detecting and alleviating possible sexual limitations among their asthma patients in routine clinical practice (AU)

Cistitis enfisematosa y agudización infecciosa de la EPOC. Un hallazgo altamente infrecuente / Emphysematous Cystitis and Infectious Exacerbation of COPD. A Highly Unusual Finding

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Impact of Asthma on the Sexual Functioning of Patients. A Case-Control Study. / Impacto del asma en la vida sexual de los pacientes. Un estudio de casos y controles.

INTRODUCTION: Sexual limitations play an important role in the quality of life of patients with chronic diseases. Very limited information is available on the impact of asthma on the sexual functioning of these individuals. MATERIALS AND METHODS: Cross-sectional, observational, multicenter study. Asthma patients and healthy individuals were recruited. All subjects participated in an interview in which demographic and clinical data were recorded, and completed the Goldberg Anxiety-Depression Scale (GADS) to evaluate the presence of concomitant psychiatric disease. Men also completed the International Index of Erectile Function (IIEF), and women, the Female Sexual Function Index (FSFI). RESULTS: A total of 276cases were included, comprising 172asthma patients (63 men and 109 women) with a mean age of 42 (±14) years, and 104 controls (52men and 51women) with a mean age of 39 (±12) years. Time since onset of asthma was 15 years and severity distribution was: 6.4% intermittent, 17.9% mild persistent, 47.4% moderate, and 28.2% severe. Disease was considered controlled in 57.7%, partially controlled in 28.2%, and uncontrolled in 14.1%. Women with asthma had greater sexual limitations than women in the control group, with a total FSFI score of 22.1 (±9) compared to 26.5 (±6.8), respectively (P<.005). Men with asthma had significantly more severe erectile dysfunction with a total IIEF score of 59.5 (±12.5) compared to 64.3 (±8.2) in male controls (P<.05). An association was also observed between sexual problems and poorer asthma control. CONCLUSIONS: Asthma is associated with a poorer sexual quality of life among patients. These results should arouse the interest of healthcare professionals in detecting and alleviating possible sexual limitations among their asthma patients in routine clinical practice.

Telemedicine spirometry training and quality assurance program in primary care centers of a public health system.

BACKGROUND: Forced spirometry is essential for diagnosing respiratory diseases and is widely used across levels of care. However, several studies have shown that spirometry quality in primary care is not ideal, with risks of misdiagnosis. Our objective was to assess the feasibility and performance of a telemedicine-based training and quality assurance program for forced spirometry in primary care. MATERIALS AND METHODS: The two phases included (1) a 9-month pilot study involving 15 centers, in which spirometry tests were assessed by the Basque Office for Health Technology Assessment, and (2) the introduction of the program to all centers in the Public Basque Health Service. Technicians first received 4 h of training, and, subsequently, they sent all tests to the reference laboratory using the program. Quality assessment was performed in accordance with clinical guidelines (A and B, good; C-F, poor). RESULTS: In the first phase, 1,894 spirometry tests were assessed, showing an improvement in quality: acceptable quality tests increased from 57% at the beginning to 78% after 6 months and 83% after 9 months (p<0.001). In the second phase, 7,200 spirometry tests were assessed after the inclusion of 36 additional centers, maintaining the positive trend (61%, 87%, and 84% at the same time points; p<0.001). CONCLUSIONS: (1) The quality of spirometry tests improved in all centers. (2) The program provides a tool for transferring data that allows monitoring of its quality and training of technicians who perform the tests. (3) This approach is useful for improving spirometry quality in the routine practice of a public health system.

Nuevos retos en la neumonía comunitaria / New challenges in community-acquired pneumonia

La neumonía comunitaria es una importante causa de morbimortalidad en la especie humana. La valoraciónde la gravedad de la neumonía es una herramienta fundamental para la asistencia de estos pacientes alpermitir estratificarlos según el riesgo de muerte y poder proporcionar la intensidad de tratamiento másadecuada. Las escalas más utilizadas son el escala de PSI/Fine y CURB-65, fácilmente calculables en la prácticaclínica y ampliamente validadas. Por otra parte, la adición de biomarcadores a dichas escalas ha demostradoaumentar su precisión la predicción de complicaciones y mortalidad.El diagnóstico etiológico de la neumonía sigue constituyendo un reto para el clínico. Recientemente, y conla experiencia adquirida en la pandemia de gripe A H1/N1 en 2009, se han implementado el diagnósticovirológico de la neumonía por técnicas rápidas de reacción en cadena de la polimerasa así como la adquisiciónde experiencia con el tratamiento antiviral y las complicaciones, sobre todo la sobreinfección bacterianacomo principal evento desfavorable en las neumonías virales.Del mismo modo que el uso de la antibioterapia para el tratamiento de las infecciones cambió radicalmenteel pronóstico y el tratamiento de éstas, progresivamente aparecen referencias en la bibliografía del efectoinmunomodulador de fármacos que no han estado inicialmente diseñados para el tratamiento de la neumonía,abriendo un horizonte esperanzador por el potencial papel modificador de la evolución en estospacientes(AU)

Community-acquired pneumonia is a major cause of morbidity and mortality. Severity assessment is afundamental tool in the management of pneumonia that allows patients to be stratified according to risk ofdeath and the most appropriate treatment intensity to be provided. The most widely used scales are thePSI/Fine and CURB-65 scales, which have been widely validated and are easy to calculate in clinical practice.Biomarkers can additionally be used to increase accuracy in predicting complications and mortality.Etiologic diagnosis of pneumonia continues to pose a challenge to clinicians. With the experience acquiredin the 2009 AH1/N1 influenza pandemic, virological diagnosis of pneumonia by rapid polymerase chainreaction techniques has recently begun to be used. Experience has also been gained in antiviral treatmentand complications, especially bacterial superinfection as the main unfavorable event in viral pneumonias.Just as the use of antibiotics to treat infections radically changed their prognosis and treatment, reports inthe literature have progressively began to appear of the immunomodulatory effect of drugs that were notinitially designed for the treatment of pneumonia, leading to hope for the potential modification ofoutcome in these patients(AU)