[Asthma 2020 Nursing Consensus Document]. / Documento de consenso de enfermería en asma 2020.

Asthma is a chronic respiratory disease which presents with a risk of exacerbations. Good patient management and continuous monitoring are crucial for good disease control, and pharmacological and non-pharmacological interventions are essential for proper treatment. Nurses specialised in asthma can contribute to the correct management of asthmatic patients. They play a key role in diagnostic tests, administration of medication, and patient follow-up and education. This consensus arose from the need to address an aspect of asthma management that does not appear in the specific recommendations of current guidelines. This document highlights and updates the role of specialized nurses in the care and management of asthma patients, offering conclusions and practical recommendations with the aim of improving their contribution to the treatment of this disease. Proposed recommendations appear as the result of a nominal consensus which was developed during 2019, and validated at the beginning of 2020.

Clinical management, expectations, and satisfaction of patients with moderate to severe allergic rhinoconjunctivitis treated with SQ-standardized grass-allergen tablet under routine clinical practice conditions in Spain.

BACKGROUND: Sublingual immunotherapy has been proven as a well-tolerated and effective treatment for allergic rhinitis. Within this type of treatment, GRAZAX® is the most documented product in terms of safety and efficacy. The objective of this study was to identify the patients' expectations and level of treatment satisfaction, as well as the clinical management of patients with moderate/severe allergic rhinoconjunctivitis treated with GRAZAX®. METHODS: This was a non-interventional, observational, multi-centre, open-label study involving a total of 131 adult patients aged 18-66 years with confirmed diagnosis of grass-allergy and initiated treatment with GRAZAX® between June 2010 and April 2011. RESULTS: In the pollen season after starting treatment, 56.6% of patients stated that their symptoms were much less/less intense, 86% needed less symptomatic medication for control of their symptoms, and 74.4% manifested to have improved (quite/a lot) as regards their allergic disease since treatment was initiated as compared with previous grass pollen season. The patient satisfaction with GRAZAX® was measured using a visual analogue scale (VAS) between 0 (minimum satisfaction) and 100 (maximum satisfaction) comprising five different items: effectiveness, tolerability, cost, convenience and overall satisfaction. The results obtained for each item were [mean (SD)]: 74.7 (18.1), 70.3 (36.1), 39.3 (25.8), 86.2 (12.6), 78.4 (15.8) respectively. The patient's level of satisfaction is highly influenced, especially in terms of assessment of effectiveness, tolerability and convenience, by the information provided by the specialist. CONCLUSIONS: In summary, it can be concluded that improved communication leads to increased patient knowledge, greater patient compliance, and increased patient satisfaction.

Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation.

Exacerbations of COPD represent an important medical and health care problem. Certain susceptible patients suffer recurrent exacerbations and as a consequence have a poorer prognosis. The effects of bronchial infection, either acute or chronic, and of the inflammation characteristic of the disease itself raise the question of the possible role of antibiotics and anti-inflammatory agents in modulating the course of the disease. However, clinical guidelines base their recommendations on clinical trials that usually exclude more severe patients and patients with more comorbidities, and thus often fail to reflect the reality of clinicians attending more severe patients. In order to discuss aspects of clinical practice of relevance to pulmonologists in the treatment and prevention of recurrent exacerbations in patients with severe COPD, a panel discussion was organized involving expert pulmonologists who devote most of their professional activity to day hospital care. This article summarizes the scientific evidence currently available and the debate generated in relation to the following aspects: bacterial and viral infections, chronic bronchial infection and its treatment with cyclic oral or inhaled antibiotics, inflammatory mechanisms and their treatment, and the role of computerized tomography as a diagnostic tool in patients with severe COPD and frequent exacerbations.

Coste económico del paciente asmático en España (estudio AsmaCost) / Economic Cost of Treating the Patient With Asthma in Spain: The Asma Cost Study

IntroducciónSe ha realizado un estudio del consumo de recursos y de los costes derivados, tanto sanitarios como no sanitarios, en el paciente asmático en España.Pacientes y métodosSe trata de un estudio prospectivo y observacional de cohortes, en pacientes asmáticos adultos, diagnosticados según los criterios de GINA/GEMA y seguidos durante 12 meses. Se recogieron datos sobre recursos sanitarios (consumo de medicamentos, consultas médicas, visitas a urgencias, ingresos hospitalarios y pruebas) y no sanitarios (desplazamientos de los pacientes y pérdidas de jornadas laborales).ResultadosParticiparon 627 pacientes de toda España, con asma intermitente (21,2%), leve (24,6%), moderada (27,6%) y grave (26,6%). Desde la perspectiva de la sociedad (incluyendo los recursos no sanitarios), el coste anual de un paciente con asma asciende a 1.726€ (intervalo de confianza [IC] del 95%, 1.314–2.154). El 11,2% del gasto corresponde a recursos no sanitarios. Para el Sistema Nacional de Salud el gasto por paciente es de 1.533€ (IC del 95%, 1.133–1.946). El coste es superior en los pacientes mayores de 65 años (2.079€) y en aquéllos con asma de mayor gravedad (959; 1.598; 1.553, y 2.635€ para asma intermitente, leve, moderada y grave, respectivamente). De acuerdo con estos resultados, se estima que el coste anual del asma en España es de 1.480 millones de euros (IC del 95%, 382–2.565 millones) y de 3.022 millones de euros (IC del 95%, 2.472–3.535 millones) considerando el diagnóstico por hiperreactividad bronquial y sólo sintomático, respectivamente.ConclusionesEl coste anual medio del paciente asmático adulto en España asciende a 1.726 y a 1.533€ desde la perspectiva de la sociedad y del Sistema Nacional de Salud, respectivamente(AU)

ObjectiveThis analysis of the cost of asthma in Spain includes both direct health care costs and indirect costs arising from illness.Patients and MethodsProspective, 12-month observational cohort study of adult patients with asthma diagnosed according to the guidelines of the Global Initiative for Asthma (GINA) and the adapted Spanish criteria (GEMA). We recorded information on health care resources utilized (medications, medical visits, emergency care, hospital admissions, and tests) and indirect costs (patient travel or transfer costs and workdays lost).ResultsA total of 627 patients throughout Spain were studied. Of these, 21.2% had intermittent asthma, 24.6% mild asthma, 27.6% moderate asthma, and 26.6% severe asthma. The total societal cost of asthma (including indirect costs) was €1726 (95% confidence interval [CI], €1314–€2154) per patient annually. Indirect costs accounted for 11.2% of the total. The cost to the National Health Service was €1533 (95% CI, €1133–€1946) per patient annually. The cost of asthma was higher for patients older than 65 years (€2079) and for those with more severe disease (€959 for intermittent asthma; €1598, mild asthma; €1553, moderate asthma; and €2635 severe asthma). Based on these findings, the total annual cost of asthma in Spain is estimated to be €1480 million (95% CI, €382–€2565 million) for patients with demonstrated bronchial hyperreactivity and €3022 million (95% CI, €2472–€3535 million) for patients diagnosed based on symptoms alone.ConclusionsThe average annual cost of asthma in adults in Spain comes to €1726 per patient, considering both direct and indirect costs. The average annual cost per patient to the National Health Service is €1533(AU)

[Economic cost of treating the patient with asthma in Spain: the AsmaCost study]. / Coste económico del paciente asmático en España (estudio AsmaCost).

OBJECTIVE: This analysis of the cost of asthma in Spain includes both direct health care costs and indirect costs arising from illness. PATIENTS AND METHODS: Prospective, 12-month observational cohort study of adult patients with asthma diagnosed according to the guidelines of the Global Initiative for Asthma (GINA) and the adapted Spanish criteria (GEMA). We recorded information on health care resources utilized (medications, medical visits, emergency care, hospital admissions, and tests) and indirect costs (patient travel or transfer costs and workdays lost). RESULTS: A total of 627 patients throughout Spain were studied. Of these, 21.2% had intermittent asthma, 24.6% mild asthma, 27.6% moderate asthma, and 26.6% severe asthma. The total societal cost of asthma (including indirect costs) was euro1726 (95% confidence interval [CI], euro1314-euro2154) per patient annually. Indirect costs accounted for 11.2% of the total. The cost to the National Health Service was euro1533 (95% CI, euro1133-euro1946) per patient annually. The cost of asthma was higher for patients older than 65 years (euro2079) and for those with more severe disease (euro959 for intermittent asthma; euro1598, mild asthma; euro1553, moderate asthma; and euro2635 severe asthma). Based on these findings, the total annual cost of asthma in Spain is estimated to be euro1480 million (95% CI, euro382-euro2565 million) for patients with demonstrated bronchial hyperreactivity and euro3022 million (95% CI, euro2472-euro3535 million) for patients diagnosed based on symptoms alone. CONCLUSIONS: The average annual cost of asthma in adults in Spain comes to euro1726 per patient, considering both direct and indirect costs. The average annual cost per patient to the National Health Service is euro1533.

Differences in asthma clinical outcomes according to initial severity.

UNLABELLED: Information on asthma morbidity outcomes in relation to the initial degree of severity is scarce. OBJECTIVE: To determine the differences in asthma morbidity, quality of life (QOL), and lung function outcomes according to the initial severity of the illness. METHOD: A cohort of 235 (102 mild, 69 moderate, and 64 severe) asthma patients was followed up for 3 years. The following parameters were collected for all patients: asthma morbidity, clinical data, spirometry, and St. George's Respiratory Questionnaire (SGRQ). RESULTS: A significant reduction in asthma morbidity and an improvement in pulmonary function and QOL were observed in the total group 3 years later. However, when the sample was stratified according to the initial severity, differences were observed between means in the third year compared with the first year in the following: number of primary care visits (patient/year) due to asthma: mild -1 (95% CI: -1.42 to -0.56); moderate -0.9 (-.92 to 0.18); and severe 1 (-0.23 to 2.27) (p = 0.020); FEV, (%): mild 8.5 (-5.3 to 11.6), moderate -0.3 (-3.2 to 2.6), and severe -1.5 (-5 to 2) (p < 0.001); and total score of the SGRQ: mild -9.8 (-12.2 to -7.3), moderate -9.1 (-12.9 to -5.2), and severe -7.9 (-11.9 to -3.9) (p < 0.001). CONCLUSIONS: We conclude that asthma prognosis varies according to the initial severity. Clinical, QOL, and pulmonary function outcomes in the mild asthma group are better than in the moderate and severe groups.

Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease.

To assess whether generic and specific health-related quality of life (HRQL) are independently associated with total and specific mortality in patients with chronic obstructive pulmonary disease (COPD), we followed until 1999 a cohort of 321 male patients with COPD, recruited in 1993-1994 at outpatient respiratory clinics. Baseline characteristics recorded under stable clinical conditions included forced spirometry, arterial blood gas tensions, dyspnea scales, 11 comorbid conditions, St. George's Respiratory Questionnaire (SGRQ), and SF-36 Health Survey. Vital status was assessed through reinterviews, the Mortality Register, and clinical records. Subjects who died (106) were older (69.8 versus 62.5 years) (p < 0.001), had lower body mass index (BMI) (25.4 versus 27.1) (p < 0.01), were more impaired in the clinical characteristics studied (%FEV(1), 34.0 versus 51.0) (p < 0.001), and had long-term oxygen therapy more frequently (31% versus 7%) (p < 0.001). Survival was shorter when worse HRQL was reported. SGRQ total and SF-36 physical summary scores were independently associated with total and respiratory mortality in Cox models, including age, FEV(1), and BMI. The total mortality-standardized hazard ratios for both HRQL measures were 1.3, whereas those for FEV(1) were 1.6. HRQL measures provide independent and relevant information on the health status of male patients with COPD. Their use should be considered for a more thorough evaluation and staging of patients with COPD.

Patient perception and acceptability of multidose dry powder inhalers: a randomized crossover comparison of Diskus/Accuhaler with Turbuhaler.

This study was designed to provide information on correct use and preference to features and device handling of two multidose dry powder inhalers, the Diskus/Accuhaler and the Turbuhaler. A total of 169 powder-naive patients (mean age 40 years) with asthma or chronic obstructive pulmonary disease (COPD) were enrolled in a randomized crossover comparison of both inhalers. An effective use of either inhaler was assessed before (leaflet only) and after inhaler education. Ease of use especially during an attack and the presence of a dose counter were regarded as the most important features for an ideal inhaler. The percentage of correct handling maneuvers and the percentage of patients achieving 100% of correct maneuvers increased significantly (p < 0.001) after inhaler education in both devices, but percentage of correct use after the intervention was significantly higher for the Diskus/Accuhaler (92.6%) than for the Turbuhaler (89.8%; p = 0.036). Overall 60% of patients thought the Diskus/Accuhaler was preferable to the Turbuhaler (p < 0.001). The main reasons given were presence of a dose counter, perceived ease of use including ease of learning to use, design, and attached cover. Among those who preferred the Turbuhaler device, the main reason cited was small size, discreetness, and ease of holding. In the multivariate analysis, inhaler education (p = 0.005) and education level (p = 0.009) were significantly associated with the percentage of correct maneuvers. Age, sex, or tested inhaler showed no effect on appropriateness of the inhalation technique.