Documento de consenso sobre asma y tabaquismo del Foro Autonómico de Asma de la SEPAR / Consensus document on asthma and smoking of the Regional Asthma Forum of SEPAR

La prevalencia de tabaquismo activo en adultos con asma es similar ala de la población general. El tabaquismo se asocia con un peor control clínico de la enfermedad, una disminución acelerada de la función pulmonar y una respuesta irregular a la terapia con glucocorticoides. El consumo de tabaco impacta negativamente en la calidad devida de los pacientes asmáticos y provoca un incremento en el númerode visitas y de hospitalizaciones por exacerbaciones. Además, el tabaquismo aumenta el riesgo de cáncer de pulmón, comorbilidades cardiovasculares y muerte en pacientes asmáticos. A pesar de todo ello,las guías actuales del manejo del asma no incluyen recomendacionesespecíficas para el manejo de los pacientes asmáticos fumadores. Poreste motivo, se procedió a una revisión narrativa de la literatura paraun consenso mediante metodología de grupo nominal desarrolladaa lo largo del año 2019 para extraer recomendaciones prácticas quepermitieran mejorar el diagnóstico y el tratamiento del asma en fumadores, así como el tratamiento del tabaquismo en asmáticos. Lasconclusiones y recomendaciones fueron validadas en el congreso nacional de la SEPAR del mismo año. Entre las más relevantes, se incidió en la necesidad de abordar el tabaquismo en las personas conasma mediante consejo sanitario, tratamiento farmacológico y terapiaconductual, al ser un factor que impacta negativamente en la sintomatología, el pronóstico y la respuesta al tratamiento del asma. En elfumador con sospecha de asma, se debe evaluar la presencia de enfisema y el diagnóstico diferencial de otras enfermedades y considerarel impacto del tabaquismo en el resultado de las pruebas diagnósticas.También se concluye que el hábito tabáquico reduce la respuesta altratamiento con corticoides inhalados, por lo que se recomienda terapia combinada con broncodilatadores. (AU)

The prevalence of active smoking in adults with asthma is similar inthe total population. Smoking is associated with worse clinical control of the disease, a rapid reduction of lung function and a variableresponse to corticoids. Tobacco consumption negatively affects thequality of life of asthmatic patients as well as increasing the numberof medical visits and hospital admissions due to exacerbations. Moreover, smoking entails a higher risk of developing lung cancer, cardiovascular comorbidities and death in asthmatic patients. Nevertheless,current asthma guidelines do not include specific recommendationson the management of smoking asthmatic patients and the treatmentof the smoking habit in this subpopulation. For this reason, a narrativereview of the literature was carried out for consensus using a nominalgroup methodology developed throughout 2019 to extract practicalrecommendations that would allow the diagnosis and treatment ofasthma in smokers, as well as the treatment of smoking in asthmatics,to be improved. The conclusions and recommendations were validated at the SEPAR national congress of the same year. Among the mostrelevant, the need to address smoking in people with asthma throughhealth advice, pharmacological treatment and behavioral therapy wasemphasized, as this is a factor that negatively impacts the symptoms,prognosis and response to asthma treatment. In smokers with suspected asthma, the presence of emphysema and the differential diagnosisof other diseases should be evaluated and the impact of smoking onthe result of diagnostic tests should be considered. It is also concluded that smoking reduces the response to treatment with inhaled corticosteroids, which is why combined therapy with bronchodilators isrecommended (AU)

One not to miss: Tuberculous tracheal stenosis.

We describe a patient who developed severe tracheal stenosis while on treatment for pulmonary tuberculosis. Bronchoscopic-guided balloon dilatation succeeded in managing this disorder. Diagnosis of tracheobronchial tuberculosis requires a high index of suspicion because symptoms are usually attributed to co-existing pulmonary disease and airway lesions are not detectable on chest x-ray. Interventional bronchoscopy is employed to restore airway patency once significant stenosis develops. Should bronchoscopic measures fail, surgical options can be considered.

Mucus hypersecretion in asthma is associated with rhinosinusitis, polyps and exacerbations.

BACKGROUND: Bronchial hypersecretion is a poorly studied symptom in asthma. The aim of the study was to determine the specific characteristics of asthmatics with bronchial hypersecretion. METHODS: A total of 142 asthmatics (21.8% men; mean age 49.8 years) were prospectively followed for one year. Mucus hypersecretion was clinically classified into two severity categories: daily sputum production and frequent expectoration but not every day. Clinical and pulmonary function variables associated with mucus hypersecretion were assessed by multiple logistic regression analysis. RESULTS: Daily cough was recorded in 28.9% of patients and sputum production daily or most of the days in 52.1%. Patients with mucus hypersecretion had more dyspnoea, poorer asthma control and quality of life, had suffered from more exacerbations and showed anosmia associated with chronic rhinosinusitis and nasal polyposis more frequently. Factors associated to mucus hypersecretion were anosmia, one exacerbation or more in the previous year and FEV1/FVC <70% (AUC 0.75, 95% CI 0.66-0.85) for the first definition of hypersecretion, and anosmia, poor asthma control and age (AUC 0.75, 95% CI 0.67-0.83) for the second definition. CONCLUSIONS: Mucus hypersecretion is frequent in patients with asthma, and is associated with chronic upper airways disease, airway obstruction, poor asthma control and more exacerbations.

Estimating the economic consequences of an increased medication adherence due to a potential improvement in the inhaler technique with Spiromax® compared with Turbuhaler® in patients with moderate-to-severe chronic obstructive pulmonary disease in Spain.

OBJECTIVE: The objective of this study was to estimate the economic impact of the introduction of DuoResp® Spiromax®, budesonide/formoterol fixed-dose combination (FDC), focusing on an increase in medication adherence due to an enhancement of the inhalation technique for the treatment of COPD patients in Spain and 5 regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia. METHODS: A 4-year budget impact model was developed for the time period of 2015-2018. This study aimed at evaluating the budget impact associated with the introduction of DuoResp Spiromax in comparison with Symbicort® Turbuhaler® and Rilast® Turbuhaler. National and regional data on COPD prevalence were obtained from the literature. Input data on health care resource utilization were obtained by clinical consultation. Resource included primary care visits, specialist visits, hospitalization, and emergency room visits as well as the length of hospital stay. Based on both pharmacological and health care resource costs, overall annual treatment cost per patient was estimated in EUR 2015. RESULTS: It was calculated that 130,777 adults were treated with budesonide/formoterol FDC delivered by a dry powder inhaler, Turbuhaler, in Spain in 2015. However, the target population decreases over the next 4 years. This pattern was observed in 4 regions, but for Andalusia, the treated population increased slightly. The overall budget savings in Spain with the market share of DuoResp Spiromax were estimated to be €6.01 million for the time period of 2015-2018. Region-specific data resulted in savings of €902,133 in Andalusia, €740,520 in Catalonia, €464,281 in Galicia, €748,996 in Madrid, and €495,812 in Valencia for the time period of 2015-2018. CONCLUSION: The introduction of budesonide/formoterol FDC delivered by Spiromax for COPD treatment is likely to contribute in a reduction of health care costs for Spain and in 5 Spanish regions. This model forecasts that Spain and these 5 Spanish regions were likely to have savings, which might be due to fewer days of hospitalization, avoided emergency room, and primary care visits.

A budget impact analysis of Spiromax(®) compared with Turbuhaler(®) for the treatment of moderate to severe asthma: a potential improvement in the inhalation technique to strengthen medication adherence could represent savings for the Spanish Healthcare System and five Spanish regions.

OBJECTIVE: To assess the economic impact of the introduction of DuoResp(®) Spiromax(®) by focusing on a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthmatics in Spain and five Spanish regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia. METHODS: A 4-year budget impact model was developed for the period 2015-2018 from the Spanish Healthcare System perspective. Budesonide-formoterol fixed-dose combination delivered by Turbuhaler(®) was considered to be the most appropriate comparator for assessing the budget impact with the introduction of DuoResp(®) Spiromax(®). National and regional data on asthma prevalence were obtained from the literature. Input parameters on health care resources were obtained by consulting experts from different Spanish hospitals. Resources used included medical visits, emergency room visits, and hospitalizations. The average numbers of primary care and specialist visits per year were also gathered. Based on health care resource use per patient, the total treatment cost per patient was estimated. RESULTS: The population with moderate to severe asthma treated with budesonide-formoterol fixed-dose combinations delivered by Turbuhaler(®) in 2015 was estimated to be 166,985 in Spain. Region-specific prevalence data resulted in 25,081, 12,392, 16,097, 17,829, and 15,148 patients in Andalusia, Catalonia, Galicia, Madrid, and Valencia, respectively. Based on the forecast uptake of DuoResp(®) Spiromax(®), the total budget savings in Spain were expected to be €1.509 million over the next 4 years. Region-specific rates imply that the total savings were expected to be €229,706 in Andalusia, €90,145 in Catalonia, €188,327 in Galicia, €122,669 in Madrid, and €165,796 in Valencia over 2015-2018. CONCLUSION: The introduction of DuoResp(®) Spiromax(®), which represents a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthma, could represent savings for the Spanish National Health Society and five Spanish regions.