Challenges for asthma units in response to COVID-19: a qualitative group dynamics analysis.

OBJECTIVE: To develop a set of recommendations for the management of severe asthma during COVID-19 pandemic. METHODS: Eleven pneumologists and allergologists who were staff members of officially accredited asthma units in Catalonia (Spain) participated in a cross-section study based on three 2-hour virtual workshops (first: brainstorming, second: identification of impacts and challenges summarized in 10 topics, third: establishment of final recommendations by consensus). RESULTS: Impacts and challenges identified were improvement of referral protocols between different levels of care; assessment of the minimum number of function tests to be performed and promote the performance of spirometry in primary care; implementation of videoconferencing, mobile apps, telephone calls, or integral virtual platforms for the follow-up of patients, and definition of the model of care (face-to-face, telematics, mixed) according to the patient's individual needs; self-administration of biologics for domiciliary treatment; and empowerment of the role of nursing and hospital pharmacy in particular for follow-up and self-administration of biologics. The main recommendations included coordination between primary care and specialized care consultation, optimization of lung function testing, implementation of telemedicine, and the role of nursing and hospital pharmacy. CONCLUSION: The specific proposals in response to the effect of COVID-19 pandemic focused on four areas of interest (coordination between primary care and specialized care, optimization of lung function testing, implementation of telemedicine, and empowerment of the role of nursing and hospital pharmacy) may be generalized to other health care settings, and help to introduce new ways of caring asthma patients in the COVID-19 context.

Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data.

BACKGROUND: A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection. OBJECTIVE: We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. METHODS: This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020. RESULTS: The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike. CONCLUSIONS: Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition.

[The future of inhaled antibiotic therapy. New products]. / El futuro de la antibioterapia inhalada. Nuevos productos.

Inhaled antibiotics have been used for more than 30 years to treat bronchial colonization or infection, especially in patients with cystic fibrosis and chronic bronchial infection with Pseudomonas. However, major progress in this field has only been made in the last 10 years: the beneficial effects in this indication have been confirmed by scientific evidence, the number of clinical trials has considerably increased, inhaled antibiotic formulations have appeared, administration systems have improved and their use has been broadened to include other infections. The speed of research indicates that major advances will be made in the indications and arsenal of inhaled antibiotics, as well as in the effectiveness of administration systems in the next 10 years. A desirable aim in the immediate future would be to demonstrate the efficacy of inhaled antibiotics in the treatment of any chronic bronchial infection, irrespective of the causative microorganism or the underlying disease and even in the absence of bronchiectasis. The antibiotic effect is related to the concentration achieved in the site of infection. Antibiotic administration through the inhaled route is subject to many variables: the dose administered, the dose that reaches the site of infection, the type of nebulizer used and the patient's characteristics. Many features of the pharmacokinetics of this route remain unknown and, because of its complexity, it should be prescribed and monitored by specialist physicians to avoid underdosing, which could lead to bacterial resistance.

El futuro de la antibioterapia inhalada. Nuevos productos / The future of inhaled antibiotic therapy. New products

Los antibióticos inhalados están siendo utilizados desde hace más de 30 años para tratar la colonización o lainfección bronquial, especialmente en pacientes con fibrosis quística e infección bronquial crónica porPseudomonas. No ha sido hasta los últimos 10 años cuando más se ha avanzado en este campo: se han confirmadolos efectos beneficiosos en esta indicación con la evidencia científica, los ensayos clínicos se han incrementadode forma considerable, han aparecido formulaciones de antibióticos para vía inhalada, han mejoradolos sistemas de administración y se ha extendido su uso en otras infecciones. La velocidad de la investigaciónnos hace suponer que en los próximos 10 años habrá importantes avances en las indicaciones, en el arsenal deantibióticos disponibles por esta vía y en la eficacia de los sistemas de administración.El futuro inmediato de la investigación en este campo sería deseable que fuese dirigido a demostrar la eficaciade los antibióticos inhalados en el tratamiento de cualquier infección bronquial crónica, sea cual sea el microorganismocausante y la patología de base, incluso sin la presencia todavía de bronquiectasias. El efecto delantibiótico está en relación con la concentración que se alcanza en la zona de la infección. La administraciónde antibióticos por vía inhalada está sujeta a muchas variables: dosis administrada, dosis que llega a la zonade la infección, tipo de nebulizador usado y las características del paciente. Todavía desconocemos muchosaspectos de su farmacocinética, y su complejidad hace aconsejable que sea indicada y controlada por facultativosespecializados para evitar infradosificaciones que induzcan resistencias bacterianas(AU)

Inhaled antibiotics have been used for more than 30 years to treat bronchial colonization or infection,especially in patients with cystic fibrosis and chronic bronchial infection with Pseudomonas. However, majorprogress in this field has only been made in the last 10 years: the beneficial effects in this indication havebeen confirmed by scientific evidence, the number of clinical trials has considerably increased, inhaledantibiotic formulations have appeared, administration systems have improved and their use has beenbroadened to include other infections. The speed of research indicates that major advances will be made inthe indications and arsenal of inhaled antibiotics, as well as in the effectiveness of administration systems inthe next 10 years. A desirable aim in the immediate future would be to demonstrate the efficacy of inhaledantibiotics in the treatment of any chronic bronchial infection, irrespective of the causative microorganism orthe underlying disease and even in the absence of bronchiectasis. The antibiotic effect is related to theconcentration achieved in the site of infection. Antibiotic administration through the inhaled route is subjectto many variables: the dose administered, the dose that reaches the site of infection, the type of nebulizerused and the patient’s characteristics. Many features of the pharmacokinetics of this route remain unknownand, because of its complexity, it should be prescribed and monitored by specialist physicians to avoidunderdosing, which could lead to bacterial resistance(AU)

[Pleural effusion and pulmonary hypertension in a patient with Parkinson disease treated with cabergoline]. / Derrame pleural e hipertensión pulmonar en un paciente con enfermedad de Parkinson en tratamiento con cabergolina.

Cabergoline is a synthetic dopamine agonist used to treat Parkinson disease. The drug occasionally induces pleuropulmonary adverse effects, which manifest as pleural thickening or effusion, interstitial pneumonitis, pulmonary infiltrates, or fibrosis. We report a rare case of pleural effusion and severe pulmonary hypertension in a 79-year-old man with Parkinson disease who had been treated with cabergoline for 1 year. The symptoms disappeared 10 months after the drug was discontinued.

Derrame pleural e hipertensión pulmonar en un paciente con enfermedad de Parkinson en tratamiento con cabergolina / Pleural effusion and pulmonary hypertension in a patient with Parkinson disease treated with cabergoline

La cabergolina es un fármaco sintético dopaminérgico, que se utiliza en el tratamiento de la enfermedad de Parkinson y que rara vez produce efectos adversos pleuropulmonares, los cuales se manifiestan como engrosamiento o derrame pleurales, neumonitis intersticial, infiltrados pulmonares o fibrosis. Presentamos un caso excepcional en un varón de 79 años con enfermedad de Parkinson, tratado con cabergolina durante un año, que presentó un derrame pleural y grave hipertensión pulmonar, que desaparecieron a los 10 meses de la retirada de este fármaco(AU)

Cabergoline is a synthetic dopamine agonist used to treat Parkinson disease. The drug occasionally induces pleuropulmonary adverse effects, which manifest as pleural thickening or effusion, interstitial pneumonitis, pulmonary infiltrates, or fibrosis. We report a rare case of pleural effusion and severe pulmonary hypertension in a 79-year-old man with Parkinson disease who had been treated with cabergoline for 1 year. The symptoms disappeared 10 months after the drug was discontinued(AU)

[Influence of the method used to obtain pleural fluid on the determination of the Acid-base balance]. / Importancia de la forma de obtención del líquido en la determinación del equilibrio ácido-base pleural.

OBJECTIVE: To analyze the methods used in our hospital for obtaining pleural fluid to determine the acid-base balance and to evaluate the clinical repercussions of each method. METHODS: Initially we studied the methods used by physicians in our hospital to collect pleural fluid for determination of the acid-base balance. In a second phase, we performed a prospective, descriptive, comparative study with the participation of 71 patients with pleural effusions in order to compare the acid-base balance according to the technique used to obtain the fluid. RESULTS: Pleural fluid was obtained using 3 methods: a) direct extraction using a heparinized syringe (group 1); b) extraction using a 20 mL syringe with subsequent aspiration from this syringe into a heparinized syringe (group 2); and c) filling a heparinized syringe from the 20 mL syringe (group 3). The only significant differences between group 1 and groups 2 and 3 were an increase in the pleural PO2 and oxygen saturation. The difference in the mean pH between groups 1 and 2 was 0.009 (95% confidence interval: -0.39 to 0.02; P=.5) and between groups 1 and 3 was 0.007 (95% confidence interval: -0.38 to 0.023; P=.6). The correlations between findings for PO2, pH, and PCO2 obtained in the different groups were statistically significant, with values superior to .95 in the last 2 variables. CONCLUSIONS: Physicians who perform thoracentesis in our hospital use different methods for obtaining fluid to determine the pleural acid-base balance. The 3 methods analyzed show no significant differences with regard to pH or PCO2. Pleural fluid may be obtained by a single puncture with a large-volume syringe, subsequently transferring the fluid to a heparinized syringe without this significantly affecting the pH or PCO2, thus reducing the number of manipulations and the risk of complications.

Importancia de la forma de obtención del líquido en la determinación del equilibrio ácido-base pleural / Influence of the method used to obtain pleural fluid on the determination of the acid-base balance

OBJETIVO: Analizar las formas de obtención del líquido para determinar el equilibrio ácido-base pleural en nuestro medio y su influencia o relevancia clínica. MÉTODOS: En una primera fase se describieron las formas en que los médicos de nuestro hospital obtenían el líquido para determinar el equilibrio ácido-base pleural. En una segunda fase se realizó un estudio prospectivo, descriptivo y comparativo de 71 pacientes con derrame para comparar el equilibrio ácido-base pleural según las formas de obtención. RESULTADOS: El líquido pleural se obtenía de 3 formas distintas: a) extracción directa con jeringa heparinizada (grupo I); b) extracción con jeringa de 20 ml, aspirando de esta jeringa con la jeringa heparinizada (grupo II), o c) llenando la jeringa heparinizada con la jeringa de 20 ml (grupo III). Se observó un aumento significativo sólo en los valores de la presión parcial (PO2) y saturación de oxígeno entre el grupo I y los grupos II o III. La diferencia de las medias del pH entre los grupos I y II fue de 0,009 (intervalo de confianza del 95%, -0,039 a 0,02; p = 0,5), y entre los grupos I y III, de 0,007 (intervalo de confianza del 95%, -0,038 a 0,023; p = 0,6). Las correlaciones entre los distintos grupos de la PO2, pH y presión parcial de anhídrido carbónico (PCO2) fueron estadísticamente significativas y con valores superiores a 0,95 en las 2 últimas. CONCLUSIONES: Los médicos que realizan las toracocentesis en nuestro hospital procesan de formas distintas el líquido para determinar el equilibrio ácido-base pleural. Las 3 formas analizadas no mostraron diferencias significativas en cuanto al pH y la PCO2. La obtención del líquido puede realizarse con una única punción con jeringas de mayor capacidad, para posteriormente llenar la jeringa heparinizada, sin que se modifiquen de forma significativa los valores del pH y la PCO2, y con una disminución del número de manipulaciones y el riesgo de complicaciones

OBJECTIVE: To analyze the methods used in our hospital for obtaining pleural fluid to determine the acid-base balance and to evaluate the clinical repercussions of each method. METHODS: Initially we studied the methods used by physicians in our hospital to collect pleural fluid for determination of the acid-base balance. In a second phase, we performed a prospective, descriptive, comparative study with the participation of 71 patients with pleural effusions in order to compare the acid-base balance according to the technique used to obtain the fluid. RESULTS: Pleural fluid was obtained using 3 methods: a) direct extraction using a heparinized syringe (group 1); b) extraction using a 20 mL syringe with subsequent aspiration from this syringe into a heparinized syringe (group 2); and c) filling a heparinized syringe from the 20 mL syringe (group 3). The only significant differences between group 1 and groups 2 and 3 were an increase in the pleural PO2 and oxygen saturation. The difference in the mean pH between groups 1 and 2 was 0.009 (95% confidence interval: -0.39 to 0.02; P=.5) and between groups 1 and 3 was 0.007 (95% confidence interval: -0.38 to 0.023; P=.6). The correlations between findings for PO2, pH, and PCO2 obtained in the different groups were statistically significant, with values superior to .95 in the last 2 variables. CONCLUSIONS: Physicians who perform thoracentesis in our hospital use different methods for obtaining fluid to determine the pleural acid-base balance. The 3 methods analyzed show no significant differences with regard to pH or PCO2. Pleural fluid may be obtained by a single puncture with a large-volume syringe, subsequently transferring the fluid to a heparinized syringe without this significantly affecting the pH or PCO2, thus reducing the number of manipulations and the risk of complications