RESUMO
BACKGROUND AND PURPOSE OF THE STUDY: The utility measure is a method to quantify health-related quality of life according to the preference values that patients attach to their health status. This study aimed to estimate the utility measure of patients with controlled and uncontrolled severe asthma (SA) in Spain, separately. Additionally, other characteristics (sociodemographic, clinical, and healthcare resource use [HCRU]) were also assessed for both SA populations. METHODS: This cross-sectional study included 159 patients with SA in Spain. Data were collected from medical records and directly from the patients during the study visit. Asthma Control Questionnaire (ACQ)-5 was used to classify patients with controlled and uncontrolled SA. RESULTS: Most of the patients were female (72.0% uncontrolled SA and 63.6% controlled SA). The mean (SD) EuroQol-5D (EQ-5D-5L) score was 0.88 (0.14) and 0.70 (0.25) in controlled and uncontrolled SA, respectively. The mean (SD) Asthma Quality-of-Life-5D (AQL-5D) score was 0.93 (0.09) and 0.85 (0.09) in controlled and uncontrolled SA, respectively. Emergency visits (19.2 vs. 2.7%) and hospitalizations (7.7% vs. no hospitalization) were more common among uncontrolled SA than controlled SA. Mean (SD) number of visits to primary care and pneumologists in uncontrolled SA vs. controlled SA was 4.1 (2.8) vs. 2.5 (3.0) and 3.7 (3.5) vs. 2.8 (2.2), respectively. CONCLUSION: The study provides data on utility measures among patients with SA in Spain for the first time. Patients with uncontrolled SA had lower HRQoL and higher HCRU than patients with controlled SA. Therefore, the implementation of measures that improve HRQoL among patients with uncontrolled SA is highly recommended.
Despite the existence in Spain of validated asthma questionnaires, the impact of severe asthma on quality of life, depending on whether it is controlled or not, had never been assessed.This study, which included 159 patients, was conducted to fill the gap above by obtaining two utility measures for quality of life, a generic one using the EQ-5D questionnaire (which can be used for comparison with other chronic conditions) and an asthma-specific one using the AQL-5D questionnaire.Patients with uncontrolled SA had a lower utility measure than patients with controlled disease and, therefore, a lower quality of life. In addition, patients with uncontrolled SA also had higher use of healthcare resources.These results highlight that the implementation of measures that improve the quality of life among patients with uncontrolled SA is highly recommended.
Assuntos
Asma , Qualidade de Vida , Humanos , Feminino , Masculino , Estudos Transversais , Espanha , Inquéritos e Questionários , Asma/terapia , Nível de SaúdeRESUMO
Calcifediol and glucocorticoids have been repositioned for the treatment of COVID-19 and may reduce severity, the need for intensive care unit admission and death. OBJECTIVE: to identify class or profiles of patients hospitalized and treated with COVID-19 pneumonia using latent class clustering methods to assess the clinical and prognostic relevance of the resulting patients' profiles. Poor prognosis was defined as death or need for ICU admission, good prognosis, the opposite. With special interest in differential responses to calcifediol. SETTING: Reina Sofia University Hospital, Córdoba Spain. Patients Retrospective observational cohort study of patients admitted for COVID-19. CLINICALTRIALS: gov public database (NCT05819918). INCLUSION CRITERIA: (i) Age ≥ 18 and ≤ 90 years, (ii) Pneumonia characterized by the presence of infiltrates on chest X-ray or CT scan, (iii) SARS-CoV-2 infection, confirmed, and (iv) CURB Scale 65 >1. DESIGN: Latent class analysis, for obtaining homogeneous clusters, without specifying a priori the belonging group, and selecting the optimal number of clusters by minimizing information criteria. Evaluating the differences between groups for each variable by means of chi-square, Fisher's exact test and Kruskal-Wallis test. RESULTS: 707 patients hospitalized from 10 March 2020 until 4 March 2022 were included. For the treatment variable, differences were found between class 3 (60% treated with calcifediol only) and classes 1 (less than 1% calcifediol only vs. 82% treated with both), 2 (less than 1% calcifediol only vs. 82% treated with both) and 4 (1% calcifediol only vs. 84% treated with both). Class 3, (60% with calcifediol), had a significantly better prognosis compared to patients treated with glucocorticoids alone (OR: 15.2, 95% CI: [3.73 - 142], p<0.001) or no treatment (OR: 7.38, 95% CI: [2.63 - 30.2], p<0.001). CONCLUSIONS: our real-life study shows that calcifediol treatment significantly reduces the need for ICU admission and improved prognosis in patients hospitalized for COVID-19 pneumonia, especially in the profile of patients receiving it without glucocorticoids.
RESUMO
Medical treatment of coronavirus 19 disease (COVID-19) is a therapeutic challenge. The available data strongly suggest that calcifediol treatment may reduce the severity of COVID-19, and corticosteroids are the treatment of choice worldwide for severe COVID-19. Both have a very similar action profile, and their combined use in patients may modify the contribution of each administered compound. OBJECTIVE: To evaluate how treatment with calcifediol and/or corticosteroids in medical practice modified the need for ICU admission, death, or poor prognosis of patients hospitalized with COVID-19 during the first outbreaks. DESIGN, PATIENTS AND SETTING: A retrospective observational cohort study of patients admitted for COVID-19 to the Pneumology Unit of the Hospital Universitario Reina Sofía (Córdoba, Spain). INTERVENTIONS: Patients were treated with calcifediol or/and corticosteroids with the best available therapy and standard care, according to clinical practice guidelines. MEASUREMENTS: Admission to the intensive care unit (ICU) or death during hospitalization and poor prognosis. RESULTS: Seven hundred and twenty-eight patients were included. According to the treatment received, they were included in four groups: calcifediol (n = 68), glucocorticoids (n = 112), both (n = 510), or neither (n = 38). Of the 578 patients treated with calcifediol, 88 were admitted to the ICU (15%), while of the 150 not treated with calcifediol, 39 required ICU admission (26%) (p < 0.01). Among the patients taking calcifediol without glucocorticoids, only 4 of 68 (5.8%) required ICU admission, compared to 84 of 510 (16.5%) treated with both (p = 0.022). Of the 595 patients who had a good prognosis, 568 (82.01%) had received treatment with calcifediol versus the 133 patients with a poor prognosis, of whom 90 (67.66%) had received calcifediol (p < 0.001). This difference was not found for corticosteroids. INTERPRETATION: The treatment of choice for hospitalized patients with moderate or mild COVID-19 could be calcifediol, not administering corticosteroids, until the natural history of the disease reaches a stage of hyperinflammation.
Assuntos
Corticosteroides , Tratamento Farmacológico da COVID-19 , COVID-19 , SARS-CoV-2 , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , COVID-19/mortalidade , Corticosteroides/uso terapêutico , Espanha/epidemiologia , Unidades de Terapia Intensiva , Hospitalização , Prognóstico , Idoso de 80 Anos ou mais , Glucocorticoides/uso terapêuticoRESUMO
OBJECTIVE: The vitamin D endocrine system may have a variety of actions on cells and tissues involved in COVID-19 progression especially by decreasing the Acute Respiratory Distress Syndrome. Calcifediol can rapidly increase serum 25OHD concentration. We therefore evaluated the effect of calcifediol treatment, on Intensive Care Unit Admission and Mortality rate among Spanish patients hospitalized for COVID-19. DESIGN: Parallel pilot randomized open label, double-masked clinical trial. SETTING: University hospital setting (Reina Sofia University Hospital, Córdoba Spain.) PARTICIPANTS: 76 consecutive patients hospitalized with COVID-19 infection, clinical picture of acute respiratory infection, confirmed by a radiographic pattern of viral pneumonia and by a positive SARS-CoV-2 PCR with CURB65 severity scale (recommending hospital admission in case of total score > 1). PROCEDURES: All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 h on the first day, and 200 mg every 12 h for the following 5 days), azithromycin (500 mg orally for 5 days. Eligible patients were allocated at a 2 calcifediol:1 no calcifediol ratio through electronic randomization on the day of admission to take oral calcifediol (0.532 mg), or not. Patients in the calcifediol treatment group continued with oral calcifediol (0.266 mg) on day 3 and 7, and then weekly until discharge or ICU admission. Outcomes of effectiveness included rate of ICU admission and deaths. RESULTS: Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50 %) p value X2 Fischer test p < 0.001. Univariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment versus without Calcifediol treatment: 0.02 (95 %CI 0.002-0.17). Multivariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment vs Without Calcifediol treatment ICU (adjusting by Hypertension and T2DM): 0.03 (95 %CI: 0.003-0.25). Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged. CONCLUSION: Our pilot study demonstrated that administration of a high dose of Calcifediol or 25-hydroxyvitamin D, a main metabolite of vitamin D endocrine system, significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven COVID-19. Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.
Assuntos
Betacoronavirus/isolamento & purificação , Conservadores da Densidade Óssea/uso terapêutico , Calcifediol/uso terapêutico , Infecções por Coronavirus/mortalidade , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pneumonia Viral/mortalidade , COVID-19 , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Projetos Piloto , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Prognóstico , SARS-CoV-2RESUMO
BACKGROUND: Omalizumab is a fully humanized monoclonal antibody indicated as add-on therapy to improve asthma control in patients with severe persistent allergic asthma. AIMS: The aim of this study was to evaluate social, healthcare expenditure and clinical outcomes changes after incorporating omalizumab into standard treatment in the control of severe asthma. METHODS: In this multicentre retrospective study, a total of 220 patients were included from 15 respiratory medicine departments in the regions of Andalusia and Extremadura (Spain). Effectiveness was calculated as a 3-point increase in the Asthma Control Test (ACT) and a reduction in the annual number of exacerbations. The economic evaluation included both direct and indirect costs. Incremental cost-effectiveness ratio (ICER) was calculated. Results from the year before and the year after incorporation of omalizumab were compared. RESULTS: After adding omalizumab, improvement of lung function, asthma and rhinitis according to patient perception, as well as the number of exacerbations and asthma control measured by the ACT score were observed. Globally, both healthcare resources and pharmacological costs decreased after omalizumab treatment, excluding omalizumab cost. When only direct costs were considered, the ICER was 1712 (95% CI 1487-1995) per avoided exacerbation and 3859 (95% CI 3327-4418) for every 3-point increase in the ACT score. When both direct and indirect costs were considered, the ICER was 1607 (95% CI 1385-1885) for every avoided exacerbation and 3555 (95% CI 3012-4125) for every 3-point increase. CONCLUSIONS: Omalizumab was shown to be an effective add-on therapy for patients with persistent severe asthma and allowed reducing key drivers of asthma-related costs.
RESUMO
INTRODUCCIÓN: En los pacientes, asegurar una correcta técnica inhalatoria es el principal objetivo para un tratamiento efectivo. Es primordial que el personal sanitario posea los conocimientos necesarios para enseñarles. Sin embargo, los pocos estudios existentes demuestran que los sanitarios presentan conocimientos insuficientes. OBJETIVO: Evidenciar qué conocimientos acerca del uso de inhaladores presurizados de dosis medida (pMDI) frente a polvo seco presentan los médicos residentes de Medicina Familiar y Comunitaria y comprobar si una actividad formativa incrementa ese grado de conocimientos previo. MÉTODOS: Estudio cuasi-experimental antes/después. Los participantes fueron residentes de Medicina Familiar y Comunitaria de la Unidad Docente de Medicina Familiar y Comunitaria de Córdoba durante noviembre y diciembre de 2015. En un primer momento, se pasó un cuestionario y se les realizó una prueba práctica. Seguidamente, se les dio una sesión formativa. Posteriormente, cumplimentaron el mismo cuestionario. RESULTADOS: Participaron 59 residentes. La nota media en el cuestionario preactividad formativa fue 8,31 ± 2,05 (IC 95%: 7,77-8,85) y en el post fue 9,67 ± 1,19 (IC 95%: 9,24-10,09). Existían diferencias estadísticamente significativas (p = 0,001) entre los resultados obtenidos antes y después de la sesión formativa. El 5,4% obtuvo un resultado óptimo al usar inhaladores pMDI, frente al 48,6% con Spiromax. No se hallaron diferencias estadísticamente significativas al estratificar por rotación por Neumología o por año de residencia. CONCLUSIÓN: Una actividad formativa en residentes de Medicina de Familia y Comunitaria tiene un efecto positivo en el conocimiento sobre inhaladores. El año de residencia y el rotatorio por Neumología no son influyentes
INTRODUCTION: Ensuring patients use a correct inhalation technique is the main objective for effective treatment. It is of essential importance that health workers have the skills to teach these patients. However, the few existing studies show that the health workers have insufficient knowledge. OBJECTIVE: To determine the knowledge of the resident physicians of Family and Community Medicine about the use of pressurised metered-dose inhalers (pMDI) against dry powder inhalers and to verify if a training activity increases this previous level of knowledge. METHODS: Quasi-experimental before/after study. Participants were residents of Family and Community Medicine of the Teaching Unit of Family and Community Medicine of Cordoba during november and december 2015. At first, a questionnaire was completed, and then they were given a practical test. This was followed by a training session, and then completing the same questionnaire. RESULTS: A total of 59 residents participated. The mean pre-questionnaire score was 8.31 ± 2.05 (95% CI: 7.77-8.85) and in the post 9.67 ± 1.19 (95% CI: 9.24-10.09). There were statistically significant differences (P = .001) between the results obtained before and after the training session. An optimal outcome was obtained in 5.4% when using pMDI inhalers, compared to 48.6% with Spiromax. No statistically significant differences were found when stratified by rotation into Chest Diseases Units or year of Residence. CONCLUSION: A training activity by residents of Family and Community Medicine has a positive effect on knowledge about inhalers. The year of residence and rotation into Chest Diseases Units have no influence on this knowledge
Assuntos
Humanos , Internato e Residência/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Nebulizadores e Vaporizadores/estatística & dados numéricos , Administração por Inalação , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Asma/epidemiologia , Asma/prevenção & controle , Estado Asmático/epidemiologia , Estado Asmático/prevenção & controle , Sociedades Médicas/normas , Sociedades Médicas/tendências , Sociedades Médicas , Asma/imunologia , Estado Asmático/imunologia , Sociedades Médicas/história , Sociedades Médicas/organização & administraçãoRESUMO
No disponible
Assuntos
Humanos , Corticosteroides/classificação , Corticosteroides/uso terapêutico , Terapia Respiratória/métodos , Administração por Inalação , Fluticasona/uso terapêuticoAssuntos
Asma/complicações , Hiper-Reatividade Brônquica/etiologia , Técnicas de Diagnóstico do Sistema Respiratório , Asma/fisiopatologia , Asma Induzida por Exercício/complicações , Asma Induzida por Exercício/fisiopatologia , Atletas , Hiper-Reatividade Brônquica/diagnóstico , Hiper-Reatividade Brônquica/fisiopatologia , Testes de Provocação Brônquica/métodos , Testes de Provocação Brônquica/normas , Broncoconstritores/administração & dosagem , Contraindicações , Técnicas de Diagnóstico do Sistema Respiratório/normas , Relação Dose-Resposta a Droga , Teste de Esforço/efeitos adversos , Teste de Esforço/normas , Humanos , Hiperventilação/fisiopatologia , Nebulizadores e Vaporizadores , Solução Salina Hipertônica , Espirometria/métodosRESUMO
No disponible
Assuntos
Feminino , Humanos , Masculino , Asma/epidemiologia , Asma/prevenção & controle , Rinite Alérgica Sazonal/epidemiologia , Rinite Alérgica Sazonal/prevenção & controle , Dermatite Atópica/epidemiologia , Dermatite Atópica/prevenção & controle , Hipersensibilidade Imediata/epidemiologia , Urticária/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade/epidemiologia , Asma/tratamento farmacológico , Asma/economia , Dermatite de Contato/epidemiologia , Imunoterapia/métodos , Imunoterapia/normas , Imunoterapia , Aspergilose/epidemiologia , Farmacoeconomia/organização & administração , Farmacoeconomia/normasRESUMO
No disponible