[Rate and characteristics of asthma exacerbations: the ASMAB I study]. / Tasa y características de las agudizaciones asmáticas (ASMAB I).

OBJECTIVE: The aim of this study was to determine the incidence and clinical characteristics of asthma exacerbations seen by emergency services in Barcelona, Spain (the ASMAB-I study). PATIENTS AND METHODS: The emergency services considered in the study served a population of 1 203 598 inhabitants aged over 14 years. Episodes treated in hospital emergency departments and by emergency services called to patients' homes over a period of 129 days were included in the study. RESULTS: In total, 831 episodes of exacerbation were identified; 523 were seen in 3 university hospitals, 113 in secondary hospitals, and 195 by emergency services at the patient's home. Twenty of the patients seen at home were subsequently taken to hospital. The mean frequency was 6.4 episodes per day, corresponding to a daily incidence of 0.53 exacerbations per 100 000 inhabitants (95% confidence interval, 0.46-0.56 exacerbations/100 000 inhabitants) and 8.2 per 100 000 asthmatic patients (95% confidence interval, 6.89-8.41 exacerbations/100 000 asthmatic patients). Of the 276 episodes treated between Monday and Thursday in university hospitals, 66 patients (24%) reported acute onset and 14 (5%) sudden onset. Only 85 patients (31%) regularly used inhaled corticosteroids and only 33 (12%) added oral corticosteroids in the 12 hours prior to consulting emergency services. In 16% of cases the episode was classified as severe and in 3% near fatal. Eighty-two patients (30%) were ultimately admitted to hospital: 12% of mild exacerbations, 39% of moderate exacerbations, 62% of severe episodes, and 100% of near-fatal episodes. The Charlson comorbidity index was higher in patients admitted to hospital (P< .001). In the 28 patients readmitted to hospital (10%), antibiotics (P< .001) and ipratropium bromide (P< .0001) had been prescribed less often at the time of discharge after the first hospital admission. CONCLUSIONS: The rate of asthma exacerbation established in this study may be a useful indicator of the degree of control of the disease and may serve as a reference to confirm future short-term or lasting increases in asthma exacerbation. Rapid onset (acute or sudden) is common and many patients are not receiving appropriate treatment prior to hospital admission. Severe exacerbation is common in our practice setting. Hospital admission is related to severity and comorbidity. Patients who are readmitted to hospital had less often received antibiotic treatment and ipratropium bromide when discharged previously.

[Monitoring of asthma outpatients after adapting treatment to meet international guidelines]. / La población de asmáticos ambulatorios y su control tras adaptar el tratamiento a las recomendaciones internacionales (ASMACAP I).

OBJECTIVE: Poor control of asthma treated in outpatient settings has been demonstrated. The aim of this study was to perform a short intervention, readily replicable in everyday practice, to try to improve control of the disease. PATIENTS AND METHODS: Two primary health care clinics made appointments with asthma patients to administer a questionnaire and adapt their treatment to the guidelines of the Global Initiative for Asthma. Patients also received an explanation of the disease lasting not more than 5 minutes. The protocol was repeated at a second visit 4 months later. Health care parameters were compared with those from the previous visit. RESULTS: The characteristics of the 180 patients were as follows: 70% were women, 17% were smokers, 8% were illiterate, 46% had only primary education, 45% were in contact with cleaning products, and 63% had extrinsic asthma. The asthma severity was as follows: mild in 73%, moderate in 23%, and severe in 4%. Twenty-two percent had received previous explanations of the disease, 50% had a written treatment plan, 14% had a plan for exacerbations, and 54% were taking inhaled corticosteroids. The second appointment was kept by 110 (61%) of the patients, who showed differences with respect to the previous visit 4 months earlier in the percentage taking inhaled corticosteroids (78%, P< .001), the number of visits to the physician (P< .01), visits to the physician due to exacerbations (P< .001), emergency visits to the outpatient clinic (P< .002), and disease severity (P< .02). CONCLUSIONS: This minimal clinical intervention reduced the need for visits to health care centers and improved the control of asthma symptoms.

Incidence and Triggers of Asthma Exacerbations Attended in the Emergency Department as a Level of Care Indicator (ASMAB III, 2005 and ASMAB IV, 2011).

INTRODUCTION: The identification of asthma exacerbations (AE) seen in emergency departments and in the home is proposed as a parameter of asthma control and for monitoring environmental triggers. PATIENTS AND METHODS: All AEs seen in 2005 and 2011 in the reference hospital of the region and in the patients' homes by the Emergency Medical Services were identified. RESULTS: The incidence of AE was 1.93/10(6)inhabitants/day during 2005, and 2/10(6)inhabitants/day in 2011. The most common triggers were slow onset common cold of more than 24h duration in 104/219 (47%) AEs in 2005 and 107/220 (49%) in 2011; prior bronchial symptoms with cough, expectoration and fever were recorded in 41/219 (19%) in 2005 and in 57/220 (26%) AEs in 2011. In total, 49% (2005) and 74% (2011) of the AEs had onset more than 24h before admission. CONCLUSIONS: No significant differences were observed in the rate of attendance in the emergency department due to AE between 2005 and 2011. The most common triggers were common cold and bronchial symptoms with expectoration and fever. AE had begun more than 24h previously in at least half of cases. These findings appear to suggest that there may be a scope for improvement in the outpatient care of the asthmatic patient.

Two short interventions to reduce health care requirements in asthma patients. A multicentre controlled study (ASTHMACAP II).

BACKGROUND AND OBJECTIVE: Asthma control is suboptimal. The objective of this study was to reduce health care requirements and work absenteeism. MATERIAL AND METHODS: Multicenter randomized controlled study investigating asthma control, educational parameters, health service use, and absenteeism. After adjusting treatment according to GINA recommendations, control group patients (CG) followed their physician's recommendations, while intervention group (IG) patients additionally underwent a 5-minute educational intervention. This protocol was repeated at 3 months, and a final assessment was carried out at 6 months. RESULTS: 479 patients (mean age 40 (SD 17) years) were recruited from primary care, and 334 completed the study. Comparatively, IG patients showed an improvement at the 3- and 6-month evaluations in the six educational parameters (P<0.001) and required fewer urgent visits to the GP for exacerbations [RR=0.49 (95% CI 0.26-0.90); P<0.04], and before the third evaluation, also in urgent GP visits [RR=0.25 (95% CI 0.12-0.52); P<0.001]. Before this third evaluation, IG had fewer scheduled visits to the GP [RR=0.48 (95% CI 0.28-0.82); P<0.003], and fewer visits to the primary care [RR=0.40 (95% CI 0.18-0.87); P<0.05], and to hospital emergency rooms [RR=0.13 (95% CI 0.04-0.42); P<0.001]. In addition, before the third evaluation, IG patients were less often absent from work [RR=0.22 (95% CI 0.05-0.98); P<0.03] or unable to work at home [RR=0.31 (95% CI 0.12-0.82); P<0.02]. CONCLUSIONS: Two short educational interventions improved asthma education and decreased the use of health resources and work absenteeism.

Incidencia y desencadenantes de las agudizaciones asmáticas atendidas en Urgencias como muestra del nivel asistencial (ASMAB III, 2005 y ASMAB IV, 2011) / Incidence and Triggers of Asthma Exacerbations Attended in the Emergency Department as a Level of Care Indicator (ASMAB III, 2005 and ASMAB IV, 2011)

Introducción: Se propone la identificación de las agudizaciones asmáticas (AA) atendidas en el Servicio de Urgencias y en el domicilio como parámetro de control y vigilancia de la actuación de desencadenantes ambientales. Pacientes y métodos Se identificaron todas las AA atendidas durante los años 2005 y 2011 en el hospital de referencia de la zona y en el domicilio de los pacientes por el Servicio de Emergencias Médicas. Resultados: La incidencia fue de 1,93AA/106habitantes/día en el año 2005 y de 2AA/106habitantes/día en el 2011. Los desencadenantes más frecuentes fueron: un catarro nasal de instauración lenta de más de 24h en 104/219 (47%) de las AA en 2005 y en 107/220 (49%) en 2011; un cuadro bronquial previo con tos, expectoración y fiebre se registró en 41/219 (19%) en el año 2005 y en 57/220 (26%) de las AA en 2011. En conjunto, el 49% (2005) y el 74% (2011) de las AA se habían iniciado más de 24h antes de su admisión. Conclusiones: No se han observado cambios significativos de la tasa de frecuentación en los servicios de urgencias por AA entre los años 2005 y 2011. Los desencadenantes más frecuentes fueron el catarro nasal y un cuadro bronquial con expectoración y fiebre. La instauración de la AA fue de más de 24h en al menos la mitad de las AA. Estos hallazgos parecen indicar que existe un margen de mejora en la asistencia ambulatoria del paciente asmático

Introduction: The identification of asthma exacerbations (AE) seen in emergency departments and in the home is proposed as a parameter of asthma control and for monitoring environmental triggers. Patients and methods: All AEs seen in 2005 and 2011 in the reference hospital of the region and in the patients’ homes by the Emergency Medical Services were identified. Results: The incidence of AE was 1.93/106inhabitants/day during 2005, and 2/106inhabitants/day in 2011. The most common triggers were slow onset common cold of more than 24h duration in 104/219 (47%) AEs in 2005 and 107/220 (49%) in 2011; prior bronchial symptoms with cough, expectoration and fever were recorded in 41/219 (19%) in 2005 and in 57/220 (26%) AEs in 2011. In total, 49% (2005) and 74% (2011) of the AEs had onset more than 24h before admission. Conclusions: No significant differences were observed in the rate of attendance in the emergency department due to AE between 2005 and 2011. The most common triggers were common cold and bronchial symptoms with expectoration and fever. AE had begun more than 24h previously in at least half of cases. These findings appear to suggest that there may be a scope for improvement in the outpatient care of the asthmatic patient

[Incidence and characteristics of asthma exacerbations in Barcelona (ASMAB II)]. / Incidencia y características de las agudizaciones asmáticas en Barcelona (ASMAB II).

INTRODUCTION: A study has been made on the incidence and clinical characteristics of asthma exacerbations (AE) seen in hospital emergency departments (HED) and domiciliary services (DS) in Barcelona. PATIENTS AND METHODS: AEs were identified over a 56 day period during the months of October and November 2003 and the patients seen in university hospitals were interviewed. RESULTS: A total of 262 AE were identified, 188 in hospital emergency departments and 82 in domiciliary, which was a mean of 4.6 AE/day, giving an incidence of 0.37 AA/10(5) inhabitants. This incidence was no different from that obtained in the same months in 2002 (P>0.05). The mean age (+/-standard deviation) of the 143 cases of AE seen in university hospitals was 41+/-17 years; 87/143 (60%) were women and 57/138 (41%), smokers. In 36/61 (59%) the AE started in the home; in 88/132 (61%) it began 24 hours before arriving at the hospital centre. In 78/123 cases (63%) slow onset of nasal catarrh was noted before the AE and a viral infection was suspected. Inhaled corticoids were given to 45/112 patients (40%), and only one added oral corticoids 12 hours before admission. The AE were mild in 38/75 cases (51%), moderate in 28/75 (37%), severe in 8/75 (11%) and almost fatal in one patient (1.3%). Around 10% (13/137) of patients (10%) were re-admitted. CONCLUSIONS: The daily incidence of AE is 0.37/10(5) inhabitants. More than half of the exacerbations started after nasal catarrh and 11% of the AE were severe.

Epidemic asthma in Barcelona: an evaluation of new strategies for the control of soybean dust emission.

BACKGROUND: Asthma attacks and mortality due to inhalation of soybean antigens in Barcelona have been well documented. Strict protective measures in the unloading process were established in 1998 to avoid the release of soybean dust into the atmosphere. The present study was undertaken to assess the effectiveness of these latest environmental measures, and, if effective, to recommend their implementation in the many harbours where soybean is unloaded. METHODS: Levels of soybean aeroallergen were analysed daily during a period of 5 years and 2 months in a total of 1,854 samples, 125 from the pre-intervention period and 1,729 from the postintervention period. Additionally, the number of asthma admissions to the emergency rooms of the city's three largest hospitals was recorded. Asthma patients attended at home by the public home emergency service and judicial autopsies registering asthma deaths were also investigated. RESULTS: The mean concentration of soybean aeroallergen was 159 U/m(3) in the pre-intervention period and 39 U/m(3) in the postintervention period (p < 0.0001). Significant differences in postintervention aeroallergen concentrations were found between days of soybean unloading (42 U/m(3)) and days of no unloading (33 U/m(3)), with p < 0.0001. No significant relationship was found between concentrations of environmental soybean aeroallergens and the number of emergency room admissions for asthma. CONCLUSIONS: Implementation of stricter protective measures in silos for the soybean unloading process has reduced the concentration of soybean dust in the atmosphere and evidences the effectiveness of the measures adopted.

Incidencia y características de las agudizaciones asmáticas en Barcelona (ASMAB II) / Incidence and Characteristics of Asthma Exacerbations in Barcelona (ASMAB II)

IntroducciónSe ha estudiado la tasa de agudizaciones asmáticas (AA) atendidas en los servicios de urgencias hospitalarios (SUH) y domiciliarios (SEM), así como sus características clínicas.Pacientes y métodosDurante los meses de octubre y noviembre de 2003 se identificaron durante 56 días las AA y se entrevistó a los pacientes atendidos en los hospitales universitarios.ResultadosSe identificaron 262 AA, 188 en los servicios de urgencias hospitalarios y 82 en los domiciliarios, es decir, una media de 4,6 AA/día, lo que significa una tasa de 0,37 AA/105 habitantes, incidencia no diferente de la obtenida en los mismos meses de 2002 (p>0,05). La edad media (±desviación estándar) de los 143 casos de AA atendidas en los hospitales universitarios era de 41±17 años; 87/143 (60%) eran mujeres y 57/138 (41%), fumadores. En 36/61 (59%) la AA se inició en el domicilio; en 88/132 (61%) comenzó 24h antes de la llegada al centro hospitalario. En 78/123 casos (63%) se registró catarro nasal de instauración lenta antes de la AA y se sospechó una infección vírica. Recibían corticoides inhalados 45/112 pacientes (40%), y únicamente uno añadió corticoides orales en las 12h previas al ingreso. La AA era leve en 38/75 casos (51%), moderada en 28/75 (37%), grave en 8/75 (11%) y casi fatal en un paciente (1,3%). Fueron readmitidos 13/137 pacientes (10%).ConclusionesLa incidencia diaria de AA es de 0,37/105 habitantes. Más de la mitad de las agudizaciones se habían iniciado tras un catarro nasal. Un 11% de las AA eran graves(AU)

IntroductionA study has been made on the incidence and clinical characteristics of asthma exacerbations (AE) seen in hospital emergency departments (HED) and domiciliary services (DS) in Barcelona.Patients and methodsAEs were identified over a 56 day period during the months of October and November 2003 and the patients seen in university hospitals were interviewed.ResultsA total of 262 AE were identified, 188 in hospital emergency departments and 82 in domiciliary, which was a mean of 4.6 AE/day, giving an incidence of 0.37 AA/105 inhabitants. This incidence was no different from that obtained in the same months in 2002 (P>0.05). The mean age (±standard deviation) of the143 cases of AE seen in university hospitals was 41±17 years; 87/143 (60%) were women and 57/138 (41%), smokers. In 36/61 (59%) the AE started in the home; in 88/132 (61%) it began 24 hours before arriving at the hospital centre. In 78/123 cases (63%) slow onset of nasal catarrh was noted before the AE and a viral infection was suspected. Inhaled corticoids were given to 45/112 patients (40%), and only one added oral corticoids 12 hours before admission. The AE were mild in 38/75 cases (51%), moderate in 28/75 (37%), severe in 8/75 (11%) and almost fatal in one patient (1.3%). Around 10% (13/137) of patients (10%) were re-admitted.ConclusionsThe daily incidence of AE is 0.37/105 inhabitants. More than half of the exacerbations started after nasal catarrh and 11% of the AE were severe(AU)

Tasa y características de las agudizaciones asmáticas (ASMAB I) / Rate and Characteristics of Asthma Exacerbations: The ASMAB I Study

OBJETIVO: El presente estudio examina la incidencia y las características clínicas de los episodios de agudización asmática (AA) atendidos en los servicios de urgencias (SU) de la ciudad de Barcelona (estudio ASMAB-I). PACIENTES Y MÉTODOS: Se estudiaron los episodios de AA atendidos en los SU hospitalarios y en el SU domiciliario (061) durante 129 días, correspondientes a una población mayor de 14 años de 1.203.598 habitantes. RESULTADOS: Se identificaron 831 episodios de AA, de los que 523 fueron atendidos en 3 hospitales universitarios, 113 en 2 hospitales de segundo nivel y otros 195 (de los que 20 se remitieron a hospitales) en los SU domiciliarios. La frecuentación media fue de 6,4 episodios/día, con una incidencia de AA de 0,53/105 habitantes/día (intervalo de confianza del 95%, 0,46-0,56) y de 8,2/105 pacientes asmáticos (intervalo de confianza del 95%, 6,89-8,41). De los 276 episodios atendidos de lunes a jueves en los servicios de los hospitales universitarios, 66 pacientes (24%) reconocieron un inicio agudo y 14 (5%) un inicio súbito. Únicamente 85 pacientes (31%) tomaban de modo regular corticoides inhalados y sólo 33 (12%) añadieron corticoides orales en las 12 h previas a su llegada a urgencias. Un 16% de los episodios se calificaron de graves y un 3% de casi fatales. Un total de 82 pacientes (30%) fueron finalmente hospitalizados; ingresaron el 12% de las AA leves, el 39% de las AA moderadas, el 62% de las AA graves y el 100% de las casi fatales. El índice de comorbilidad de Charlson fue mayor en los pacientes hospitalizados (p < 0,001). En los 28 readmitidos (10%), al darles el alta previa se les habían prescrito menos antibióticos (p < 0,001) y bromuro de ipratropio (p < 0,0001). CONCLUSIONES: La tasa de AA establecida puede ser un indicador útil del grado de control del asma y servir para confirmar futuros aumentos de AA permanentes o puntuales. El inicio rápido (agudo o súbito) es frecuente. Muchos pacientes no reciben un tratamiento adecuado antes de la hospitalización. La agudización grave es frecuente en nuestro medio. El ingreso está relacionado con la gravedad y la comorbilidad. Los readmitidos han recibido al alta menos antibióticos y bromuro de ipratropio

OBJECTIVE: The aim of this study was to determine the incidence and clinical characteristics of asthma exacerbations seen by emergency services in Barcelona, Spain (the ASMAB-I study). PATIENTS AND METHODS: The emergency services considered in the study served a population of 1 203 598 inhabitants aged over 14 years. Episodes treated in hospital emergency departments and by emergency services called to patients¿ homes over a period of 129 days were included in the study. RESULTS: In total, 831 episodes of exacerbation were identified; 523 were seen in 3 university hospitals, 113 in secondary hospitals, and 195 by emergency services at the patient¿s home. Twenty of the patients seen at home were subsequently taken to hospital. The mean frequency was 6.4 episodes per day, corresponding to a daily incidence of 0.53 exacerbations per 100 000 inhabitants (95% confidence interval, 0.46-0.56 exacerbations/100 000 inhabitants) and 8.2 per 100 000 asthmatic patients (95% confidence interval, 6.89-8.41 exacerbations/100 000 asthmatic patients). Of the 276 episodes treated between Monday and Thursday in university hospitals, 66 patients (24%) reported acute onset and 14 (5%) sudden onset. Only 85 patients (31%) regularly used inhaled corticosteroids and only 33 (12%) added oral corticosteroids in the 12 hours prior to consulting emergency services. In 16% of cases the episode was classified as severe and in 3% near fatal. Eighty-two patients (30%) were ultimately admitted to hospital: 12% of mild exacerbations, 39% of moderate exacerbations, 62% of severe episodes, and 100% of near-fatal episodes. The Charlson comorbidity index was higher in patients admitted to hospital (P<.001). In the 28 patients readmitted to hospital (10%), antibiotics (P<.001) and ipratropium bromide (P<.0001) had been prescribed less often at the time of discharge after the first hospital admission. CONCLUSIONS: The rate of asthma exacerbation established in this study may be a useful indicator of the degree of control of the disease and may serve as a reference to confirm future short-term or lasting increases in asthma exacerbation. Rapid onset (acute or sudden) is common and many patients are not receiving appropriate treatment prior to hospital admission. Severe exacerbation is common in our practice setting. Hospital admission is related to severity and comorbidity. Patients who are readmitted to hospital had less often received antibiotic treatment and ipratropium bromide when discharged previously

La población de asmáticos ambulatorios y su control tras adaptar el tratamiento a las recomendaciones internacionales (ASMACAP I) / Monitoring of asthma outpatients after adapting treatment to meet international guidelines

Objetivo: Los pacientes asmáticos en régimen ambulatorio muestran un deficiente control de su enfermedad. El objetivo de este estudio ha sido realizar una intervención corta, y factible de repetir en la práctica, con el fin de intentar mejorar dicho control. Pacientes y métodos: Se citó a los pacientes asmáticos de 2 centros de asistencia primaria para encuestarles, adaptar el tratamiento según las recomendaciones de la GINA (Global Initiative for Asthma) y explicarles en 5 min en qué consistía la enfermedad. A los 4 meses se realizó una segunda visita repitiendo el protocolo. Se compararon los parámetros asistenciales de los 4 meses anteriores a cada visita. Resultados: De las características clínicas de los 180 pacientes destaca que un 70% eran mujeres, un 17% fumaba, un 8% eran analfabetos, un 46% únicamente tenía estudios primarios, un 45% estaba en contacto con productos de limpieza y en un 63% el asma era extrínseca. Por lo que se refiere a la gravedad del asma, en un 73% ésta era leve, en un 23%, moderada y en un 4%, grave. Un 22% había recibido explicaciones sobre su enfermedad, un 50% tenía el tratamiento por escrito, un 14% tenía un plan para las exacerbaciones y el 54% recibía corticoides inhalados. Los 110 (61%) que acudieron a la segunda visita mostraron diferencias, en los 4 meses previos a cada visita, en el tratamiento con corticoides inhalados (78%, p < 0,001) en el número de visitas a su médico (p < 0,01), en las visitas por agudización a su médico (p < 0,001) y a urgencias en su ambulatorio (p < 0,002), y también en el estadio de la enfermedad (p < 0,02). Conclusiones: Esta actuación clínica mínima ha reducido la frecuentación a los centros asistenciales y ha mejorado el grado de control clínico de los pacientes

Objective: Poor control of asthma treated in outpatient settings has been demonstrated. The aim of this study was to perform a short intervention, readily replicable in everyday practice, to try to improve control of the disease. Patients and methods: Two primary health care clinics made appointments with asthma patients to administer a questionnaire and adapt their treatment to the guidelines of the Global Initiative for Asthma. Patients also received an explanation of the disease lasting not more than 5 minutes. The protocol was repeated at a second visit 4 months later. Health care parameters were compared with those from the previous visit. Results: The characteristics of the 180 patients were as follows: 70% were women, 17% were smokers, 8% were illiterate, 46% had only primary education, 45% were in contact with cleaning products, and 63% had extrinsic asthma. The asthma severity was as follows: mild in 73%, moderate in 23%, and severe in 4%. Twenty-two percent had received previous explanations of the disease, 50% had a written treatment plan, 14% had a plan for exacerbations, and 54% were taking inhaled corticosteroids. The second appointment was kept by 110 (61%) of the patients, who showed differences with respect to the previous visit 4 months earlier in the percentage taking inhaled corticosteroids (78%, P<.001), the number of visits to the physician (P<.01), visits to the physician due to exacerbations (P<.001), emergency visits to the outpatient clinic (P<.002), and disease severity (P<.02). Conclusions: This minimal clinical intervention reduced the need for visits to health care centers and improved the control of asthma symtoms