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1.
Arch. bronconeumol. (Ed. impr.) ; 52(4): 211-216, abr. 2016. tab, graf
Article in Spanish | IBECS | ID: ibc-150701

ABSTRACT

Objetivos: Evaluar los resultados clínicos y los costes de 2 estrategias de administración de omalizumab. Método: Se compararon, de forma retrospectiva, 2 cohortes de pacientes con asma grave no controlada: una, procedente del hospital A, en la que el tratamiento se administró en un centro de salud, y otra, procedente del Hospital B, con administración hospitalaria convencional. Resultados: Se estudió a 130 pacientes, 86 en A y 44 en B, 30 hombres (24%) y 100 mujeres (76%), edad 50 ± 15 años, FEV1% 67 ± 22%, índice de masa corporal (IMC) 28 ± 6 kg/m2, IgE 639 ± 747 UI/mL, seguimiento de 24 ± 11 meses (12-45), Asthma Control Test (ACT) 12 ± 4 y Asthma Control Questionnaire (ACQ) 3 ± 2, sin diferencias significativas basales entre ambas cohortes en ingresos hospitalarios ni visitas a urgencias en el año previo, ni en número de pacientes con esteroides orales. Al comparar la situación basal y tras los 12 meses de tratamiento, se observaron diferencias significativas en ACT (p < 0,001), ACQ (p < 0,001) y mejoría en el FEV1% (p < 0,001), reducción en número de ingresos (p < 0,001), días de hospitalización (p < 0,001), visitas a urgencias (p < 0,001), ciclos y dosis de esteroides p < 0,001) respecto al año previo, tanto individualmente como en conjunto. Los costes de hospitalización, visitas a urgencias, visitas no programadas a Primaria y al neumólogo se redujeron significativamente en ambos hospitales, pero los costes de administración y desplazamiento fueron un 35% inferiores con la pauta ambulatoria en A. Conclusión: La administración ambulatoria de omalizumab en los centros de salud consigue los mismos resultados clínicos que una pauta de administración hospitalaria, con menores costes


Objectives: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. Method: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. Results: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28±6kg/m2, 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3±2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P < 0.001), ACQ (P<0.001), improvement in FEV1% (P < 0.001), reduction in total admissions (P < 0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P < 0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Asthma/epidemiology , Asthma/mortality , Asthma/pathology , Pharmacy Administration/instrumentation , Pharmacy Administration/methods , Cost-Benefit Analysis/methods , Cost-Benefit Analysis , Respiratory System Agents/analysis , Respiratory System Agents/administration & dosage , Respiratory System Agents/therapeutic use , Benchmarking/methods , Benchmarking , Retrospective Studies , Cohort Studies , Observational Study , Spain
2.
Arch Bronconeumol ; 52(4): 211-6, 2016 Apr.
Article in English, Spanish | MEDLINE | ID: mdl-26651624

ABSTRACT

OBJECTIVES: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. METHOD: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. RESULTS: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28 ± 6 kg/m(2), 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3 ± 2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<0.001), ACQ (P<0.001), improvement in FEV1% (P<0.001), reduction in total admissions (P<0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P<0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. CONCLUSION: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.


Subject(s)
Ambulatory Care/economics , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Costs and Cost Analysis , Hospitalization/economics , Omalizumab/economics , Omalizumab/therapeutic use , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective Studies , Severity of Illness Index
3.
Arch. bronconeumol. (Ed. impr.) ; 49(5): 207-209, mayo 2013. ilus
Article in Spanish | IBECS | ID: ibc-111887

ABSTRACT

La amiloidosis es una enfermedad sistémica producida por el depósito anómalo de material amiloide; tiene la peculiaridad de detectarse con la tinción rojo Congo y es de difícil diagnóstico. La afectación del árbol traqueobronquial es muy poco frecuente y constituye un reto para el neumólogo debido al amplio diagnóstico diferencial de esta enfermedad. Se presentan 2 casos en los que se ha objetivado la afectación traqueobronquial: en uno de ellos como enfermedad primaria y en otro como afectación secundaria. El uso de técnicas broncoscópicas es primordial para el diagnóstico de la afectación traqueobronquial. En ausencia de un tratamiento médico eficaz, el manejo local de esta enfermedad con técnicas endoscópicas de repermeabilización bronquial consigue una mejoría clínica y amplía las opciones terapéuticas y pronósticas en esta enfermedad (AU)


Amyloidosis is a systemic disease caused by abnormal deposition of amyloid material that is detected with Congo red staining and is difficult to diagnose. Involvement of the tracheobronchial tree is rare and is a challenge for pulmonologists because of the wide differential diagnosis of this disease. We present two cases where tracheobronchial affectation has been observed: in one of them as a primary disease, and in another as secondary affectation. The use of bronchoscopic techniques is essential for the diagnosis of tracheobronchial involvement. In the absence of an effective drug therapy, local management of this disease with endoscopic techniques for bronchial repermeabilization is able to provide clinical improvement and expand the treatment options and prognosis in this disease (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Amyloidosis/diagnosis , Bronchoscopy/methods , Bronchoscopy/standards , Bronchoscopy , Endoscopy/methods , Endoscopy , Prednisone/therapeutic use , Melphalan/therapeutic use , Amyloidosis/physiopathology , Amyloidosis , Bronchoscopy/instrumentation , Bronchoscopy/trends , Radiography, Thoracic/methods , Radiography, Thoracic
4.
Arch Bronconeumol ; 49(5): 207-9, 2013 May.
Article in English, Spanish | MEDLINE | ID: mdl-23347550

ABSTRACT

Amyloidosis is a systemic disease caused by abnormal deposition of amyloid material that is detected with Congo red staining and is difficult to diagnose. Involvement of the tracheobronchial tree is rare and is a challenge for pulmonologists because of the wide differential diagnosis of this disease. We present two cases where tracheobronchial affectation has been observed: in one of them as a primary disease, and in another as secondary affectation. The use of bronchoscopic techniques is essential for the diagnosis of tracheobronchial involvement. In the absence of an effective drug therapy, local management of this disease with endoscopic techniques for bronchial repermeabilization is able to provide clinical improvement and expand the treatment options and prognosis in this disease.


Subject(s)
Amyloidosis/surgery , Bronchial Diseases/surgery , Bronchoscopy/methods , Tracheal Diseases/surgery , Airway Obstruction/etiology , Airway Obstruction/surgery , Amyloidosis/complications , Amyloidosis/diagnosis , Amyloidosis/drug therapy , Amyloidosis/pathology , Biopsy , Birefringence , Bone Marrow/pathology , Bronchial Diseases/diagnosis , Bronchial Diseases/drug therapy , Bronchial Diseases/pathology , Bronchial Neoplasms/diagnosis , Coloring Agents , Combined Modality Therapy , Congo Red , Diagnosis, Differential , Female , Hemoptysis/etiology , Humans , Laser Therapy , Lung/pathology , Lung Neoplasms/diagnosis , Male , Melphalan/therapeutic use , Middle Aged , Prednisone/therapeutic use , Tracheal Diseases/diagnosis , Tracheal Diseases/drug therapy , Tracheal Diseases/pathology
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