Actividad física y acelerómetros en el tratamiento de la HAP: una aproximación práctica a la "vida real" / Physical activity and accelerometers in the treatment of pulmonary hypertension: a practical approach to the "real life"

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Tadalafilo: nuevos aspectos de la inhibición de la fosfodiesterasa tipo 5 en el tratamiento de la hipertensión pulmonar / Tadalafil: Novel aspects of phosphodiesterase-5 inhibition in the treatment of pulmonary hypertension

Desde 2009, el tadalafilo, un potente y selectivo inhibidor de la fosfodiesterasa tipo 5 (PDE5), puede representar una nueva alternativa terapéutica eficaz y segura para pacientes con hipertensión pulmonar (HP) en clases funcionales II y III de la Organización Mundial de la Salud (OMS) —como detallan las «Guías de práctica clínica para el diagnóstico y tratamiento de la HP» de la Sociedad Europea de Cardiología (ESC) y de la European Respiratory Society (ERS)—, en términos de beneficios en ejercicio, en retraso del deterioro clínico y en calidad de vida. Por otra parte, dado su mayor vida media, que permite su dosificación única diaria oral de 40 mg, podría mejorar el cumplimiento terapéutico —facilitando una mayor adhesión al tratamiento— de los pacientes con HP (AU)

Tadalafil, which was commercialized in 2009, is a potent and selective phosphodiesterase type 5 (PDE5) inhibitor, and may be a safe and effective therapeutic alternative for patients with class II and III pulmonary hypertension (PH) in the World Health Organization’s classification – as stated in the Clinical Practice Guidelines for the Diagnosis and Treatment of PH of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) – providing benefits in exercise tolerance, delaying clinical deterioration and improving quality of life. Given the greater half-life of this drug, allowing a single oral dose of 40 mg per day, tadalafil could improve therapeutic compliance – thus facilitating treatment adherence – among patients with PH (AU)

[Tadalafil: novel aspects of phosphodiesterase-5 inhibition in the treatment of pulmonary hypertension]. / Tadalafilo: nuevos aspectos de la inhibición de la fosfodiesterasa tipo 5 en el tratamiento de la hipertensión pulmonar.

Tadalafil, which was commercialized in 2009, is a potent and selective phosphodiesterase type 5 (PDE5) inhibitor, and may be a safe and effective therapeutic alternative for patients with class II and III pulmonary hypertension (PH) in the World Health Organization's classification--as stated in the Clinical Practice Guidelines for the Diagnosis and Treatment of PH of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)--providing benefits in exercise tolerance, delaying clinical deterioration and improving quality of life. Given the greater half-life of this drug, allowing a single oral dose of 40 mg per day, tadalafil could improve therapeutic compliance--thus facilitating treatment adherence--among patients with PH.

Control del asma y de la calidad de vida en pacientes asmáticos alérgicos graves con tratamiento anti-IgE (omalizumab) / Analysis of asthma control and quality of life in severe allergic asthmatics under treatment with anti-IgE, omalizumab

Fundamento y objetivos: Analizar la eficacia del omalizumab en la evolución del asma alérgica grave mediante los cuestionarios de control del asma (ACQ) y de calidad de vida en asma (AQLQ), así como el FEV1 y la apreciación global del médico. Pacientes y método: Se estudió a 14 pacientes con una evolución promedio del asma de 20,7 años con un test cutáneo positivo o un anticuerpo IgE específico a un aeroalérgeno habitual, todos ellos tratados con altas dosis de corticoides inhalados, y 8 tratados además con corticoides orales. Se suministraron 150–600mg de omalizumab por paciente, con periodicidad quincenal o mensual. Se evaluó a cada paciente asmático mensualmente y, al cabo de 4 meses, se precisó si era respondedor o no para decidir la continuidad del omalizumab. Resultados: La apreciación global del médico fue positiva en 11 de 14 pacientes. Se apreció un marcado beneficio a los 2 meses en el ACQ y el AQLQ (p<0,05) y a los 3 y los 4 meses sólo en el AQLQ y el AQLQ-síntomas, respectivamente (p<0,05). El FEV1 mejoró un promedio del 9,4% en 14 pacientes a los 4 meses (p=0,24). Los corticoides orales se redujeron en 4 de 8 pacientes y en otro paciente se suspendió definitivamente. En 2 de 14 pacientes se produjeron reacciones adversas que obligaron a suspender el tratamiento a pesar de apreciarse mejoría en los AQLQ y ACQ. Conclusiones: En nuestra experiencia, el omalizumab resulta eficaz en la mejora de la calidad de vida en más de 3 de cada 4 pacientes afectados de asma grave alérgica según la apreciación global del médico, y se observan, además, mejorías significativas en los ACQ, AQLQ y AQLQ-síntomas a los 2, a los 3 y a los 4 meses de seguimiento, sin apreciarse cambios significativos del FEV1, probablemente por cambios crónicos irreversibles (AU)

Background and objectives:To evaluate anti-IgE (ie, omalizumab) efficacy on severe allergic asthma in order to achieve the efficacy of this treatment on severe allergic asthma progress by means of asthma control questionnaire (ACQ), asthma quality of life questionnaire (AQLQ) as well as pulmonary function (FEV1) and physician overall assessment. Patients and methods: Fourteen patients were studied who suffered from severe allergic asthma for several years; average 20.7yr. A positive skin prick test or specific IgE antibodies to a common aeroallergen were observed in all patients who were under treatment with high doses of inhaled corticosteroids (eight of them also with oral corticosteroids). Omalizumab 150–600mg were administrated once or twice monthly and each patient was monthly evaluated until sixteen weeks, deciding at this time which patient was or not responder in order to follow up or not omalizumab treatment. Results: Physician overall assessment improved in 11 out of every 14 patients. A marked improvement was observed at two months in ACQ and AQLQ (p<0.05) and at 3 and 4 moths only in AQLQ and AQLQ-symptoms respectively (p<0.05). The FEV1 improved by 9.4% average (p=0.24). Oral corticosteroids were reduced in 4 of 8 patients and in another one there was a definitive suspension. Two patients suffered adverse reactions which suspension of treatment despite the fact that they presented improvement in questionnaires of quality of life and control of asthma. Conclusions: Omalizumab showed a marked global efficacy in more than 3 out of 4 patients suffering severe allergic asthma as revealed by physician overall assessment. Moreover significant improvements were observed in ACQ; AQLQ; AQLQ-symptoms at 2, 3 and 4 months of treatment, without significant changes in FEV1 probably due to chronic irreversible changes in airways (AU)

[Analysis of asthma control and quality of life in severe allergic asthmatics under treatment with anti-IgE, omalizumab]. / Control del asma y de la calidad de vida en pacientes asmáticos alérgicos graves con tratamiento anti-IgE (omalizumab).

BACKGROUND AND OBJECTIVES: To evaluate anti-IgE (ie, omalizumab) efficacy on severe allergic asthma in order to achieve the efficacy of this treatment on severe allergic asthma progress by means of asthma control questionnaire (ACQ), asthma quality of life questionnaire (AQLQ) as well as pulmonary function (FEV1) and physician overall assessment. PATIENTS AND METHODS: Fourteen patients were studied who suffered from severe allergic asthma for several years; average 20.7yr. A positive skin prick test or specific IgE antibodies to a common aeroallergen were observed in all patients who were under treatment with high doses of inhaled corticosteroids (eight of them also with oral corticosteroids). Omalizumab 150-600 mg were administrated once or twice monthly and each patient was monthly evaluated until sixteen weeks, deciding at this time which patient was or not responder in order to follow up or not omalizumab treatment. RESULTS: Physician overall assessment improved in 11 out of every 14 patients. A marked improvement was observed at two months in ACQ and AQLQ (p<0.05) and at 3 and 4 moths only in AQLQ and AQLQ-symptoms respectively (p<0.05). The FEV1 improved by 9.4% average (p=0.24). Oral corticosteroids were reduced in 4 of 8 patients and in another one there was a definitive suspension. Two patients suffered adverse reactions which suspension of treatment despite the fact that they presented improvement in questionnaires of quality of life and control of asthma. CONCLUSIONS: Omalizumab showed a marked global efficacy in more than 3 out of 4 patients suffering severe allergic asthma as revealed by physician overall assessment. Moreover significant improvements were observed in ACQ; AQLQ; AQLQ-symptoms at 2, 3 and 4 months of treatment, without significant changes in FEV1 probably due to chronic irreversible changes in airways.