Follow-up with Telemedicine in Early Discharge for COPD Exacerbations: Randomized Clinical Trial (TELEMEDCOPD-Trial).

The results reported by different studies on telemonitoring in patients with chronic obstructive pulmonary disease (COPD) have been contradictory, without showing clear benefits to date. The objective of this study was to ascertain whether an early discharge and home hospitalization telehealth program for patients with COPD exacerbation is as effective as and more efficient than a traditional early discharge and home hospitalization program. A prospective experimental non-inferiority study, randomized into two groups (telemedicine/control) was conducted. The telemedicine group underwent monitoring and was required to transmit data on vital constants and ECGs twice per day, with a subsequent telephone call and 2 home visits by healthcare staff (intermediate and at discharge). The control group received daily visits. The main variable was time until first exacerbation. The secondary variables were: number of exacerbations; use of healthcare resources; satisfaction; quality of life; anxiety-depression; and therapeutic adherence, measured at one and 6 months of hospital discharge. A total of 116 patients were randomized (58 to each group) without significant differences in baseline characteristics or time until first exacerbation, i.e. median 48 days (pp. 25-75:23-120) in the control group, and 47 days (pp. 25-75:19-102) in the intervention group; p = 0.52). A significant decrease in the number of visits was observed in the intervention versus the control group, 3.8 ± 1 vs 5.1 ± 2(p = 0.001), without significant differences in the number of exacerbations. In conclusion follow-up via a telemedicine program in early discharge after hospitalization is as effective as conventional home follow up, being the cost of either strategy not significantly different.

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea.

BACKGROUND: Continuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. METHODS: Prospective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention-to-treat basis. RESULTS: The mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. CONCLUSIONS: Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome.

Medusa's Wrath: Bleeding Giant Scalp Arteriovenous Malformation in an Adult: A Case Report.

BACKGROUND: Scalp arteriovenous malformation (AVM) is a rare congenital disease that may present with massive bleeding. To date, surgical excision remains the definitive management. However, the procedure could lead to intraoperative bleeding due to the tumor's high blood flow and complex vascularity. CASE REPORT: A 49-year old Filipino male presented with a bleeding giant scalp AVM. Computed tomographic scan and duplex studies showed multiple feeding vessels with turbulent flow arising primarily from the right superficial temporal, right posterior auricular, and occipital vessels. Prior to surgery, the patient underwent transfusion due to preoperative hemoglobin of 6 g/dL. Proximal control of the right external carotid artery was performed through a supine position and left in place to reduce the majority of blood flow to the AVM. The patient was turned to a prone position for surgical planning to achieve maximal skin-sparing dissection prior to excision. First, ligation of bilateral superficial temporal and posterior auricular arteries was performed. Next, excision above the periosteum with segmental ligation of feeding vessels around the AVM was carried out. Reconstruction of the defect was done via scalp advancement flap and split-thickness skin grafting. Intraoperative blood loss was 1.6 L. On the sixth postoperative day, the patient was discharged with 100% graft take. CONCLUSION: Management of scalp AV malformation is challenging, and despite measures to decrease intraoperative bleeding, blood loss is still high. While preoperative embolization has been reported to decrease the risk of bleeding, this procedure is not currently available in our setting. Our case highlights the complexity of giant scalp AV malformation management in a limited-resource setting. Even in the absence of endovascular intervention, outright surgical excision of AVM can be performed, albeit with higher levels of blood loss.

Effect of Cerebrolysin in severe traumatic brain injury: A multi-center, retrospective cohort study.

BACKGROUND: Severe traumatic brain injury (TBI) patients with nonoperative lesions are known to have a poorer prognosis. Recent and ongoing clinical studies have been exploring the utility of Cerebrolysin in improving patient outcomes among TBI patients; however, few studies are available on the effect of Cerebrolysin among nonoperative severe TBI patients. OBJECTIVES: To determine the effects of Cerebrolysin as add-on therapy to the standard medical decompression protocol for nonoperative severe TBI patients. METHODS: The study employed a retrospective cohort design and included 87 severe TBI patients on admission. In addition to the current medical decompression protocol, 42 patients received 30 ml/day Cerebrolysin for 14 days, followed by a subsequent 10 ml/day dosage for another 14 days. The control group included 45 patients who received the standard decompression protocol only. Stata MP version 16 was used for data analysis. RESULTS: Compared to the control group, a significantly higher proportion of patients who received Cerebrolysin treatment achieved a favourable outcome at Day 21 post-TBI (50% vs. 87%; p < 0.00001) and GOS ≥ 4 (18% vs. 39%; p = 0.043). The mean length of hospital stay was approximately seven days shorter in the Cerebrolysin group (25.61 days vs. 31.92 days; p < 0.00001), and a significantly lower proportion of Cerebrolysin patients had a LOS ≥ 30 days (Cerebrolysin: 13%; Control: 51%; p < 0.0001). No significant group differences were seen in the 28-day mortality rate. CONCLUSION: Cerebrolysin is beneficial for severe TBI patients with nonoperative lesions as evidenced by stronger improvement in GCS/GOS and shorter length of hospital stay than standard treatment alone.

Increased body mass index does not lead to a worsening of asthma control in a large adult asthmatic population in Spain.

BACKGROUND: Data on the association between obesity and asthma control are conflicting. We performed an analysis to elucidate the association between body mass index (BMI) and asthma control in a large sample of asthmatics. MATERIALS AND METHODS: Data were obtained from a previous study in which the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT) were validated for a Spanish population. The study sample comprised 607 adult (> or = 18 years) asthmatic patients (61% female), of whom 235 (39%) had mild-persistent asthma, 246 (41%) had moderate-persistent asthma, and 126 (21%) had severe-persistent asthma. RESULTS: The analysis showed a significant but very low correlation between BMI and ACQ-forced expiratory volume in the first second of expiration (FEV1) (r=0.1, P=.007) and ACQ-peak expiratory flow (PEF) (r=0.1, P=.010), but not ACQ-without lung function (wLF) (r=0.06, P=.116) or ACT. No significant association was found between BMI and asthma control as defined by physicians or according to ACT or ACQ (ACQ-FEV1, ACQ-PEF and ACQ-wLF) scores. We found no significant associations between ACT, ACQs (ACQ-FEV1, ACQ-PEF and ACQ-wLF), and BMI when BMI was classified as low (BMI, <18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity (BMI, > or = 30 kg/m2), or morbid obesity (BMI, >34.9 kg/m2). However, the percentage of patients with poor control was slightly greater in patients with low BMI and obesity. CONCLUSIONS: Using specific and validated tools, and in the context of clinical practice, this study did not find a relevant association between BMI and asthma control.

Relationships, love and sexuality: what the Filipino teens think and feel.

BACKGROUND: In order to achieve a change among teens' sexual behavior, an important step is to improve our knowledge about their opinions concerning relationships, love and sexuality. METHODS: A questionnaire including topics on relationships, love and sexuality was distributed to a target population of 4,000 Filipino students from third year high school to third year college. Participants were obtained through multi-stage sampling of clusters of universities and schools. This paper concentrates on teens aged 13 to 18. RESULTS: Students reported that they obtained information about love and sexuality mainly from friends. However, they valued parents' opinion more than friends'. They revealed few conversations with their parents on these topics. A majority of them would like to have more information, mainly about emotion-related topics. Almost half of respondents were not aware that condoms are not 100% effective in preventing STIs or pregnancies. More girls, compared to boys, were sensitive and opposed to several types of sexism. After adjusting for sex, age and institution, the belief of 100% condom effectiveness and the approval of pornography and sexism were associated with being sexually experienced. CONCLUSION: There is room for further encouraging parents to talk more with their children about sexuality, specially aspects related to feelings and emotions in order to help them make better sexual choices. Indeed, teens wish to better communicate with their parents on these issues. Condoms are regarded as safer than what they really are by almost half of the participants of this study, and such incorrect knowledge seems to be associated with sexual initiation.

Study of matrix metalloproteinases and their tissue inhibitors in ductal in situ carcinomas of the breast.

AIMS: To analyse the expression of metalloproteinases (MMPs) and their inhibitors (TIMPs) in ductal carcinoma in situ of the breast (DCIS). METHODS AND RESULTS: An immunohistochemical study was performed in 56 patients with pure DCIS, in 39 with DCIS adjacent to invasive carcinoma (IDC) and 63 patients with T1 IDC, using tissue microarrays and specific antibodies against MMPs and TIMPs. Immunohistochemical results were categorized using a specific software program. The data were analysed by unsupervised hierarchical cluster analysis by each cellular type. IDC showed a higher expression rate of MMP-7 and TIMP-1 than pure DCIS, as well as a higher expression rate of MMP-9 and TIMP-3 than the DCIS component of mixed cases, whereas pure DCIS showed a higher rate of expression of MMP-9 and -11 and TIMP-3 than in the DCIS component of mixed cases. Pure DCIS with a periductal inflammatory infiltrate showed significantly higher MMP-2, -14 and TIMP-1. Dendograms identified two cluster groups with distinct MMP/TIMP expression profiles in neoplastic cells and fibroblastic or mononuclear inflammatory cells surrounding the neoplastic ducts of pure DCIS. CONCLUSIONS: The results indicate the distinct variability in MMP/TIMP expression by DCIS, which may be of potential biological and clinical interest in breast cancer.

Evaluation of a Clinical Pharmacist Intervention on Clinical and Drug-Related Problems Among Coronary Heart Disease Inpatients: A pre-experimental prospective study at a general hospital in Indonesia.

OBJECTIVES: This study aimed to evaluate the role of a clinical pharmacist intervention in decreasing subsequent clinical and drug-related problems (DRPs) among coronary heart disease (CHD) inpatients with at least one previous DRP. METHODS: This pre-experimental study with a pre-post design was carried out from January to April 2017 among inpatients with at least one previous DRP at a general hospital in Tangerang District, Banten, Indonesia. Clinical and DRPs were documented prospectively by a clinical pharmacist, with DRPs classified using Version 6.2 of the DRP classification scheme of the Pharmaceutical Care Network Europe Foundation. The intervention consisted of a discussion of identified DRPs with physicians, patients, pharmaceutical logistics clerks, nurses and nutritionists. Following this, any subsequent clinical and DRPs were re-identified and further interventions were conducted as necessary. RESULTS: A total of 75 inpatients were included in the study. Pre-intervention, there were 443 DRPs and 202 clinical problems. The most frequent DRPs were adverse drug reactions (52.6%), followed by drug effects (41.8%). Most DRPs were of moderate severity and would have resulted in moderate consequences had the pharmacist not intervened. The interventions resulted in a significant reduction in the number of DRPs, type of DRPs and number of clinical problems (P <0.05 each). Patients with complications were 26.047 times more likely to have no reduction or an increased number of clinical problems compared to patients without complications (P <0.05). CONCLUSION: Clinical pharmacist interventions were found to reduce subsequent DRPs and clinical problems among CHD patients with at least one previous DRP.

Validation of the Spanish version of the Asthma Control Test (ACT).

OBJECTIVE: Validation of the Spanish version of the Asthma Control Test (ACT). METHODS: A total of 607 asthmatic patients were assessed. The psychometric properties of ACT were evaluated. The ACT capacity to predict the physician's assessment of asthma control was assessed using the area under the receiving operating characteristics (ROC) curve (AUC), sensitivity, specificity, and positive-negative predictive values. RESULTS: ACT's Cronbach alpha was 0.84. The intraclass correlation coefficient was 0.85. The AUC was 0.86, with a sensitivity of 71% and a specificity of 85% for a score of < or =19. CONCLUSIONS: The Spanish version of ACT is shown to be a reliable and valid tool for evaluating and discriminating asthma control.

[Identification of gaps in the clinical patient care of asthma in Spain. Results of the OPTIMA-GEMA survey]. / Identificación de las carencias asistenciales en la atención clínica del asma en España. Resultados de la encuesta OPTIMA-GEMA.

BACKGROUND: Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement. METHODS: The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II). RESULTS: In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups. CONCLUSIONS: The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma.

Abordaje mutidisciplinar en las unidades de asma grave / Multidisciplinary approach in the severe asthma units

El asma es una enfermedad crónica muy prevalente que genera un consumo importante de recursos sanitarios. El mal manejo de estos enfermos conlleva a un inadecuado control de la enfermedad, a un mayor coste sanitario y a un aumento de la morbimortalidad. La creación de unidades multidisciplinares es muy recomendable, principalmente en las formas más graves y ha demostrado una mejoría asistencial (efectividad), reduciendo notablemente los costes económicos de la enfermedad (eficiencia). Dichas unidades precisan un coordinador (neumólogo) que sea conocedor de todos los aspectos del asma y que organice todo el cuidado, incluyendo al resto de las especialidades implicadas (alergólogos, otorrinolaringólogos, gastroenterólogos, endocrinos, psicólogos y psiquiatras)

Asthma is a very prevalent chronic disease that generates a significant consumption of health resources. The mismanagement of these patients leads to poor control of the disease, a higher health cost and an increase in morbidity and mortality. The creation of multidisciplinary units is highly recommended, mainly in the most severe forms. It requires a coordinator (pneumologist) who is knowledgeable about all aspects of asthma and who organizes all the care, including the rest of the specialties involved (allergists, otolaryngologists, gastroenterologists, endocrines, psychologists and psychiatrists). The creation of these units has shown a welfare improvement (effectiveness), significantly reducing the economic costs of the disease (efficiency)

Influence of peak expiratory flow monitoring on an asthma self-management education programme.

We assessed whether peak expiratory flow monitoring added to a self-management education programme reduced morbidity and improved pulmonary function and adherence to treatment in 100 asthma patients (aged 17-65 years) with adequate treatment and regular 1-year follow-up. Patients randomized to the experimental group used peak expiratory flow readings as the basis for their therapeutic plan coupled with educational intervention, whereas patients in the control group received the same educational intervention and used symptoms only to guide self-management. Morbidity parameters, functional status and adherence to medical regimens improved in both groups, although the percentage of patients with satisfactory adherence was significantly better in the group with peak expiratory flow monitoring (83%) than in controls (52%) (P = 0.05). The multivariate analysis showed that severity of asthma (odds ratio 9.28, 95% confidence interval 1.87-45.96, P = 0.006 for moderate asthma) and type of self-management education programme (odds ratio: 6.19; 95% confidence interval: 2.04-18.81; P = 0.001 for the use of peak expiratory flow readings) were the only independent predictors of adherence to treatment. However, a statistically significant association between adherence and use of peak expiratory flow monitoring was only found in patients with moderate asthma (P = 0.0009). We conclude that peak expiratory flow monitorization in optimal conditions (adequate medical regimen, individualized self-management education and regular follow-up) showed a beneficial effect on adherence to prescribed regimens only in patients with moderate asthma.

[Factors related with the morbidity of asthma]. / Estudio de factores relacionados con la morbilidad del asma.

To determine the clinical situation, prescribed treatment and compliance in patients with asthma, and to identify the parameters that most influence control of the disease. We studied 335 asthma patients assigned to health centers. All were interviewed and respiratory gases were measured. Disease symptoms were recorded, along with treatment prescribed and inhalation method used. Compliance and inhaler use were assessed on a scale. Treatment appropriateness was evaluated against criteria of international consensus. Multiple regression analysis was used to identify the variables that most influenced control of asthma. Variables considered were age, sex, smoking, treatment appropriateness, inhaler technique, compliance with prescribed treatment and time since diagnosis. Disease was mild in 96 patients (28.7%), moderate in 111 (33.1%) and severe in 128 (38.2%). Treatment was appropriate in 118 (35.2%). Seventy-two (21.5%) used more drugs or higher doses than recommended. Prescribed treatment was inappropriate in 145 (43.3%). The inhalation technique was appropriate in 87 (27.5%) and inappropriate in 229 (72.5%). Ninety-four patients (28.1%) complied well with treatment and 241 (71.9%) were poor compliers. The variables that were significantly related to control of asthma were appropriate treatment and compliance. There is a high rate of morbidity due to asthma in the population studied. The percentage of inappropriate treatment is high, and compliance is low, these factors being the ones that most influence control of the disease.

20 años en asma / 20 years in asthma

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Predictors of mortality among end-stage renal disease patients with COVID-19 admitted in a Philippine Tertiary Government Hospital: A retrospective cohort study

Background and Objective@#Several studies have examined the predictors of mortality among COVID-19-infected patients; however, to date, few published studies focused on end-stage renal disease patients. The present study,therefore, aims to determine the predictors of in-hospital mortality among end-stage renal disease patients with COVID-19 admitted to a Philippine tertiary hospital. @*Methods@#The researcher utilized a retrospective cohort design. A total of 449 adult end-stage renal disease patients on renal replacement therapy diagnosed with moderate-to-severe COVID-19 and were admitted at the National Kidney and Transplant Institute from June 2020 to 2021 were included. Logistic regression analysis was used to determine the factors associated with in-hospital mortality. @*Results@#In-hospital mortality among end-stage renal disease patients with COVID-19 was 31.18% (95% CI: 26.92- 35.69%). Older age (OR=1.03), male sex (OR=0.56), diabetes mellitus (OR=1.80), coronary artery disease (OR=1.71), encephalopathy (OR=7.58), and intubation (OR=30.78) were associated with in-hospital mortality. @*Conclusion@#Patients with ESRD and COVID-19 showed a high in-hospital mortality rate. Older age, diabetes mellitus, coronary artery disease, encephalopathy, and intubation increased the odds of mortality. Meanwhile, males had lower odds of mortality than females.

Exit-site infection of peritoneal catheter is reduced by the use of polyhexanide. results of a prospective randomized trial.

BACKGROUND: One of the most common and severe complications affecting peritoneal dialysis (PD) patients is exit-site infection of the peritoneal catheter; it is therefore of vital importance to prevent it. This complication has a negative impact on the success of the technique. In spite of this, there are no clear guidelines concerning how to take care of the exit site. The objective of this study was to assess the efficacy of polyhexanide in preventing exit-site infection over a 12-month period. METHODS: We designed a single-center, prospective, open-labeled, randomized controlled clinical trial with parallel groups. Requirements for participation in the study included implantation of the peritoneal catheter at least six weeks before entering the study and no infectious complications requiring either hospital admission or antibiotic treatment for at least three months before entering into the study. Patients were randomized to be daily cured as follows: Group A: traditional care with saline serum and povidone-iodine; and Group B: polyhexanide solution. Exit sites were evaluated at baseline and every four to six weeks or if any event occurred, according to the Twardowski criteria. RESULTS: Of the 60 included patients, 46 completed the 12-month follow-up period. Six underwent transplantation, five died and three were transferred to hemodialysis (HD). The treatment was well tolerated, with no side effects nor abandonments due to such effects. Throughout the study period, six patients (20%) undergoing traditional care and only two (6,7%) receiving polyhexanide developed an exit-site infection (p = 0.032). There were a total number of 12 infections; nine occurred in patients following the traditional approach and only three in patients treated with polyhexanide (p = 0.037). The germs responsible for the infections were: S. aureus (six cases), Corynebacterium jeikeium (two cases) and P. aeruginosa (one case) in the saline serum and povidone-iodine group and P. aeruginosa (three cases) in the polyhexanide group. The mean rate of exit-site infection was 1 episode/36.6 patient-months for the traditional care group and 1 episode/102.7 patient-months for the polyhexanide group (p = 0.017). Patients following the traditional treatment required fewer days to get infected than those using polyhexanide (p = 0.033; log rank: 4.2). CONCLUSIONS: These results show that using polyhexanide is efficient for the prevention of exit-site infections. Patients treated with this product suffer from fewer infections and need more time to become infected. Polyhexanide application is painless, no allergies have been described and it is well tolerated by patients. We therefore propose that it may be used routinely from now on for the care of healthy exit site.

Quality indicators of asthma care derived from the Spanish Guidelines for Asthma Management (GEMA 4.0): a multidisciplinary team report

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Identificación de las carencias asistenciales en la atención clínica del asma en España. Resultados de la encuesta OPTIMA-GEMA / Identification of gaps in the clinical patient care of asthma in Spain. Results of the OPTIMA-GEMA survey

Fundamento: En línea con el lanzamiento de la guía GEMA2009, el objetivo del estudio fue identificar y evaluar las carencias en la implementación de las recomendaciones de la misma y proponer iniciativas de mejora. Material y métodos: Estudio descriptivo-comparativo, transversal, cualitativo. Inicialmente se identificaron los aspectos mejorables refrendándolos con la GEMA2009 (Fase I), para posteriormente priorizar su necesidad de abordaje puntuando los aspectos mejorables utilizando una escala Likert de 9 puntos (Fase II). Resultados: Participaron 134 médicos en la Fase I, y de estos, 107 en la Fase II. El estudio recogió y evaluó las opiniones de un grupo multidisciplinar de expertos en asma (neumólogos, alergólogos, pediatras y médicos de atención primaria). El 81% de las limitaciones identificadas en la atención a adultos y el 49,2% en los niños se consideraron de prioridad alta. Las más importantes fueron: en adultos, mejorar el tratamiento de las embarazadas; en niños, el empleo de los b2-adrenérgicos a dosis elevadas en la exacerbación de asma. Otras carencias relevantes fueron: la escasa utilización de la espirometría, de cuestionarios de síntomas y de planes de acción por escrito para los pacientes, la falta de implicación del personal de enfermería y no ajustar el tratamiento según el grado de control en revisiones. Conclusiones: Las áreas de mejora prioritaria son las relacionadas con el tratamiento. Los futuros programas de implementación de las guías deberían priorizar el uso de los cuestionarios de síntomas, la implicación de enfermería y la atención de la asmática embarazada (AU)

Background: Based on the GEMA 2009 guidelines (Spanish Asthma Management Guidelines), this project identified and assessed the main deficiencies in the implementation of the guidelines and proposed initiatives for improvement. Methods: The study gathered and evaluated the opinions of a multidisciplinary group of asthma experts (allergists, pulmonologists, pediatricians, and primary care physicians). The first step identified health care aspects of GEMA 2009 that could be improved (Phase I). Subsequently, the issues were prioritized, using a 9-point Likert scale (Phase II). Results: In Phase I, 134 physicians participated, and 107 of them took part in Phase II. High priority was assigned to 81% and 49.2% of the limitations identified in health care for adults and children respectively. The most important deficiency in adult care was improving treatment for pregnant women; in pediatric care, it was the use of high doses of beta-2 adrenergic antagonists in asthma deterioration. Other relevant needs were the limited use of spirometry, symptom questionnaires, and written action plans for the patients, as well as the lack of involvement of nursing staff in asthma care and the need to adjust treatment according to levels of control in follow-ups. Conclusions: The priority areas for improvement were those related to asthma treatment. Future programs for implementation of asthma guidelines should prioritize the use of symptom questionnaires, nursing staff involvement, and attention to pregnant women with asthma (AU)