Ocular Tuberculosis – A Portuguese Portrait of This Rare and Challenging Problem / Tuberculosis ocular: un retrato portugués de este problema raro y desafiante

Objectives: Although threatening there is not enough awareness for ocular tuberculosis, hence we intend to study and characterize the ocular tuberculosis observed on a Portuguese specialized pulmonology diagnostic center. Materials and Methodologies: Retrospective study of individuals diagnosed with ocular tuberculosis and followed up from 1st January2016 until 31th December 2018. Results: We studied 38 patients with presumed ocular tuberculosis, with mean age 53,315,7 years old, whose 55,3% were females. Only one patient had known immunosuppression, seven patients had history of previous tuberculosis and only two patients reported a known risk contact. None had extraocular disease. All patients had at least one positive immunologic test, either tuberculin skin test (63,2%) or Interferon Gamma Release Assay test (86,8%). Most patients presented bilateral ocular tuberculosis (44,7%). The standard four-drug regimen was the treatment of choice and corticosteroids were administered to 55,3% patients with no differences in treatment outcomes. The mean length of treatment was 8,6 months and among the patients who completed treatment, 72,4% presented clinical improvement or remission of the ocular manifestations. Conclusions: Ocular tuberculosis, despite a rare condition, carries a huge burden in health care centers. Delay in starting proper treatment can result in permanent blindness and impairment of life’s quality. This condition is probably underdiagnosed and, to our knowledge, there are no recent studies characterizing the latest trend of ocular tuberculosis in Portugal. (AU)

Objetivos: Aunque amenazante, no hay suficiente conciencia sobre la tuberculosis ocular, por lo que pretendemos estudiar y caracterizar los casos de tuberculosis ocular observados en un centro portugués de diagnóstico especializado en neumología. Materiales y Metodologías: Estudio retrospectivo de individuos con tuberculosis ocular seguidos desde 1 de enero de 2016 hasta 31 de diciembre de 2018. Resultados: Se estudiaron 38 pacientes, con una edad media de 53,3±15,7 años, de los cuales el 55,3% eran mujeres. Solo un paciente tenía inmunosupresión iatrogénica, siete pacientes tenían antecedentes de tuberculosis previa y dos pacientes reportaron un contacto de riesgo conocido. Ninguno tenía enfermedad extraocular. Todos los pacientes tenían al menos una prueba inmunológica positiva, ya sea prueba cutánea de tuberculina (63,2%) o prueba de interferón gamma (86,8%). La mayoría de los pacientes presentaron patología bilateral (44,7%). El régimen de cuatro fármacos fue el tratamiento de elección y se administraron corticoides al 55,3% de los pacientes sin diferencias en los resultados. La duración del tratamiento fue de 8,6 meses y entre los que completaron tratamiento, 72,4% presentó mejoría clínica o remisión. Conclusión: La tuberculosis ocular, aunque una condición rara, sobrecarga los centros de salud. El retraso en el inicio del tratamiento puede provocar ceguera y deterioro de la calidad de vida. Esta condición probablemente está subdiagnosticada y, hasta donde sabemos, no hay estudios que caractericen su evolución en Portugal. (AU)

The reality of LAMAs for adult asthmatic patients.

INTRODUCTION: The use of tiotropium is approved for the treatment of asthma. There are several studies completed or currently ongoing with the long-acting muscarinic antagonists (LAMAs) umeclidinium and glycopyrronium as an add-on asthma treatment. Adding a second bronchodilator with a different mechanism of action for the treatment of uncontrolled asthma may be a suitable therapeutic approach, although several issues still under discussion. AREAS COVERED: The reality of LAMA plus long-acting beta-agonists (LABA) treatment for adult asthma. A systematic search was conducted on March 2020, and included 6 electronic databases: EMBASE, MEDLINE, Scopus, The Cochrane Library, Web of Science and Google Scholar. EXPERT OPINION: A growing body of evidence generated from several randomized clinical trials is supporting the use of LAMA in adulthood asthma always in association with inhaled corticosteroid (ICS). Currently, only tiotropium has been approved and included in the guidelines. Other LAMAs are under evaluation in clinical trials. Several clinical trials are supporting the use of a triple therapy (ICS/LABA/LAMA) in uncontrolled asthmatic patients under ICS/LABA.