RESUMO
OBJECTIVE: To collect perspectives and explore consensus for expert recommendations related to asthma control and the use of telemedicine among professionals who manage patients with asthma. DESIGN: A Delphi-like questionnaire was designed to analyse the level of agreement about several recommendations formulated by an expert scientific committee about asthma control and the use of telemedicine with this purpose. A dedicated scientific committee validated the questionnaire, which included questions about the participants' profile and the use of technological tools at a personal level or in clinical practice. The experts expressed their agreement with a Likert-scale of 9 values: 1-3 was considered no agreement, 4-6 neutral, and 7-9 agreement. A rate ≥70% with the same answer was considered consensus. SITE: The questionnaire was programmed and distributed as an internet-based survey. PARTICIPANTS: A pre-selected sample of 75 experts with experience in telemedicine (pulmonology, allergology, family medicine, nursing and community pharmacy) responded to a Delphi-like questionnaire composed by six questions and 52 items. INTERVENTIONS: Consultation was performed in two consecutive waves: the first wave was carried out from 12th of July to 8th of September of 2021; the second wave, from 25th of October to 12th of November of 2021. MAIN MEASUREMENTS: Three questions about asthma control (actions for achieving or maintaining control of asthma at every visit, current problems that affect asthma control, and potential solutions to offset such problems), and three questions about the impact of telemedicine in asthma control (potential benefits of telemedicine, and potential reticence about telemedicine among both patients and healthcare professionals) were included. RESULTS: From the 52 items inquired, 35 were agreed by consensus. The actions for achieving or maintaining control of asthma, the problems that affect asthma control, and their potential solutions were agreed by consensus. The potential benefits of telemedicine were validated by consensus. None of the potential reservations of patients about telemedicine were validated, while five out of 14 potential reservations of healthcare professionals were agreed by consensus. CONCLUSIONS: The COMETA consensus provides a current picture of the main problems for achieving asthma control, the benefits and the reservations about the use of telemedicine in the Spanish setting, and offers solutions. A wide interest in implementing telemedicine has been observed, although current limitations need to be overcome.
Assuntos
Asma , Humanos , Técnica Delphi , Consenso , Asma/prevenção & controle , Asma/epidemiologia , Pandemias , Prova PericialAssuntos
Antiasmáticos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Síndrome de Churg-Strauss/tratamento farmacológico , Eosinófilos/imunologia , Eosinófilos/efeitos dos fármacos , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Interleucina-5/imunologiaRESUMO
BACKGROUND: There is limited information on the causes of death in asthma patients.To determine the causes of death in hospitalized asthmatic patients and to compare with those observed in COPD patients and non-respiratory individuals, with a particular interest in associations with previous cardiovascular disease. METHODS: Retrospective case-control study which analyzed the deaths of all hospitalized patients admitted for any reason during January, April, July and October of 2008 in 13 Spanish centers. Medical records of deceased patients were reviewed, and demographic and clinical data were collected. RESULTS: A total of 2,826 deaths (mean age 75 years, 56% men) were included in the analysis, of which 82 (2.9%) were of patients with asthma and 283 (10%) with COPD.The most common causes of death in asthma patients were cardiovascular diseases (29.3%), malignancies (20.7%) and infections (14.6%); in COPD patients they were malignancies (26.5%), acute respiratory failure (25.8%) and cardiovascular diseases (21.6%). Asthma, compared to COPD patients, died significantly less frequently from acute respiratory failure and lung cancer. A multivariate logistic regression analysis failed to associate asthma with cardiovascular deaths. CONCLUSIONS: Cardiovascular disease is the most frequent cause of death among hospitalized asthma patients. The specific causes of death differ between asthma and COPD patients.
Assuntos
Asma/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Estudos de Casos e Controles , Causas de Morte , Feminino , Mortalidade Hospitalar , Humanos , Infecções/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Estudos Retrospectivos , Espanha/epidemiologiaRESUMO
Despite the therapeutic advances currently available, asthma control is poor. Such control is based on assessing the patient, adjusting treatment, and reviewing the response to treatment. In normal situations, asthma is monitored and controlled by sequential face-to-face visits. However, due to biosecurity and distancing measures to avoid disease transmission during a pandemic, such monitoring and control is limited. This is how tele-assistance, which is available from extensive published evidence in asthma, has emerged. Even so, it should not be understood as a substitute for face-to-face consultations, but as a complementary alternative to them, in which patients can be monitored when a face-to-face consultation is not necessary or cannot be carried out. Through the COMETA project (COntrol como Meta en la Era de la Telemedicina en el Asma, Control as a Goal in the Age of Telemedicine in Asthma), a group of experts addressed in depth the asthmatic pathology, analyzing in detail the existing problems in order to achieve control and propose solutions to situations such as those we are currently experiencing with the COVID-19 pandemic.
Assuntos
Asma , Humanos , Asma/diagnóstico , Sistema Respiratório , Muco , Inquéritos e QuestionáriosRESUMO
Objective: To collect perspectives and explore consensus for expert recommendations related to asthma control and the use of telemedicine among professionals who manage patients with asthma. Design: A Delphi-like questionnaire was designed to analyse the level of agreement about several recommendations formulated by an expert scientific committee about asthma control and the use of telemedicine with this purpose. A dedicated scientific committee validated the questionnaire, which included questions about the participants profile and the use of technological tools at a personal level or in clinical practice. The experts expressed their agreement with a Likert-scale of 9 values: 13 was considered no agreement, 46 neutral, and 79 agreement. A rate ≥70% with the same answer was considered consensus. Site: The questionnaire was programmed and distributed as an internet-based survey.Participants: A pre-selected sample of 75 experts with experience in telemedicine (pulmonology, allergology, family medicine, nursing and community pharmacy) responded to a Delphi-like questionnaire composed by six questions and 52 items. Interventions: Consultation was performed in two consecutive waves: the first wave was carried out from 12th of July to 8th of September of 2021; the second wave, from 25th of October to 12th of November of 2021. Main measurements: Three questions about asthma control (actions for achieving or maintaining control of asthma at every visit, current problems that affect asthma control, and potential solutions to offset such problems), and three questions about the impact of telemedicine in asthma control (potential benefits of telemedicine, and potential reticence about telemedicine among both patients and healthcare professionals) were included. Results: From the 52 items inquired, 35 were agreed by consensus.(AU)
Objetivos: Recoger las perspectivas y explorar el consenso de los expertos en las recomendaciones para un mejor control del asma y el uso de la telemedicina entre los profesionales que tratan pacientes con asma. Diseño: Se diseñó un cuestionario con la metodología Delphi para analizar el nivel de acuerdo en varias recomendaciones formuladas por un comité científico experto sobre el asma y el uso de la telemedicina. Un comité experto validó el cuestionario, que incluyó preguntas sobre el perfil de los participantes y el uso de las herramientas tecnológicas a nivel personal y en la práctica clínica. Los expertos expresaron su acuerdo con una escala de Likert de 9 valores: 1-3 se consideró sin acuerdo, 4-6 neutral y 7-9 de acuerdo. Se consideró consenso cuando ≥70% de los participantes respondieron la misma respuesta. Ubicación: La consulta se realizó online. Participantes: Una muestra preseleccionada de 75 expertos con experiencia en telemedicina (neumología, alergología, medicina familiar, enfermería y farmacia comunitaria) respondió a un cuestionario formado por 6 preguntas y 52 ítems. Intervenciones: La consulta se realizó en dos olas consecutivas: la primera ola tuvo lugar desde el 12 de julio al 8 de septiembre de 2021. Y la segunda ola, del 25 de octubre al 12 de noviembre de 2021. Medidas principales: En el cuestionario se incluyeron tres preguntas sobre el control del asma (acciones para lograr y/o mantener el control del asma, problemas actuales que afectan a este control y las posibles soluciones), y tres preguntas sobre el impacto de la telemedicina en el control del asma (potenciales beneficios de la telemedicina y la posible reticencia a telemedicina entre los pacientes y los profesionales sanitarios). Resultados: De los 52 ítems consultados, en 35 de ellos se alcanzó el consenso. Se acordaron por consenso las acciones para lograr o mantener el control del asma, los problemas que afectan al control del asma y sus posibles soluciones.(AU)
Assuntos
Humanos , Masculino , Feminino , Telemedicina , Asma , Pacientes , Prova Pericial , Consenso , Atenção Primária à Saúde , Inquéritos e QuestionáriosAssuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Enfisema Mediastínico/etiologia , Pneumonia Viral/complicações , Idoso , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Evolução Fatal , Feminino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Radiografia Torácica , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pandemias , Enfisema Mediastínico/virologia , Enfisema Mediastínico/diagnóstico por imagemRESUMO
Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as "true difficult-to-control asthma". This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control ("false difficult-to-control asthma"), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients.
Assuntos
Asma/tratamento farmacológico , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Adulto , Antiasmáticos/classificação , Antiasmáticos/uso terapêutico , Asma/classificação , Asma/diagnóstico , Asma/etiologia , Broncodilatadores/uso terapêutico , Criança , Diagnóstico Diferencial , Resistência a Medicamentos , Substituição de Medicamentos , Quimioterapia Combinada , Exposição Ambiental , Humanos , Hipersensibilidade Imediata/complicações , Hipersensibilidade Imediata/genética , Índice de Gravidade de Doença , Disfunção da Prega Vocal/epidemiologiaRESUMO
No disponible
Assuntos
Humanos , Adulto , Asma/economia , Terapia Biológica/economia , Análise Custo-Benefício/métodos , Antiasmáticos/economia , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Análise Custo-Benefício/normas , EspanhaAssuntos
Bronquiolite Obliterante/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas , Complicações Pós-Operatórias/tratamento farmacológico , Pirazóis/uso terapêutico , Adulto , Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Masculino , Nitrilas , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Pirimidinas , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Bronquiolite Obliterante/etiologia , Linfoma Difuso de Grandes Células B/cirurgia , Doença Enxerto-Hospedeiro/tratamento farmacológico , Corticosteroides/uso terapêutico , Doença Enxerto-Hospedeiro/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: To analyze the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations. PATIENTS AND METHODS: Retrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT. RESULTS: We performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9% of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7%) that were diagnostic in 124 (64.6%). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1%). Staging mediastinoscopy was avoided in 67.6% of patients. The prevalence of mediastinal lymph node involvement was 74.4%, sensitivity of TBNA was 86.2% and negative predictive value was 63.6%. Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57 per patient. CONCLUSIONS: TBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients.
Assuntos
Biópsia por Agulha/métodos , Broncoscopia/métodos , Carcinoma Broncogênico/secundário , Redução de Custos/estatística & dados numéricos , Neoplasias Pulmonares/patologia , Metástase Linfática/diagnóstico , Idoso , Biópsia por Agulha/economia , Broncoscopia/economia , Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma Broncogênico/economia , Carcinoma Broncogênico/patologia , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Hospitais Universitários/economia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/economia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Masculino , Mediastinoscopia/economia , Mediastino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/economia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Sensibilidade e Especificidade , Espanha , Tomografia Computadorizada por Raios XAssuntos
Transformação Celular Neoplásica/patologia , Leucemia Linfocítica Crônica de Células B/diagnóstico por imagem , Leucemia Linfocítica Crônica de Células B/patologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Idoso , Evolução Fatal , Feminino , Fluordesoxiglucose F18 , Humanos , Compostos Radiofarmacêuticos , SíndromeRESUMO
Desde la publicación, hace ya 9 años, de la última normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) sobre asma de control difícil(ACD), se han producido avances en los conocimientos de la enfermedad asmática, que hacen necesario realizar una puesta al día de los datos disponibles e incorporarlos tras su análisis en el nivel de evidencia y recomendación más adecuado. Recientemente han aparecido documentos de consenso y guías de práctica clínica (GPC) que abordan este problema. En esta normativa se hará mención explícita a lo que la previa guía de ACD definía como «verdadera asma de control difícil»; es decir, al asma que tras haber verificado su diagnóstico, realizado un abordaje sistematizado para descartar factores ajenos a la propia enfermedad que conducen a un mal control de la misma («falsa asma de control difícil»), y realizar una estrategia de tratamiento adecuado (escalones 5 y 6 de la Guía española para el manejo del asma [GEMA]), no se consigue alcanzar el control: «asma grave no controlada» (AGNC). En esta línea la normativa propone una revisión de la definición, un intento de clasificación de las diferentes manifestaciones de este tipo de asma, una propuesta del abordaje diagnóstico por pasos y un tratamiento dirigido según fenotipo, conjuntamente con un apartado específico sobre este arquetipo de asma en la infancia, con el objetivo de que pueda servir de ayuda a los profesionales sanitarios y repercutir en el cuidado de estos pacientes
Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as «true difficult-to-control asthma». This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control («false difficult-to-control asthma»), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients