Quality indicators in the rational management of severe asthma: A Spanish multidisciplinary consensus.

AIM: Severe asthma is a complex, heterogeneous condition that can be difficult to control despite currently available treatments. Multidisciplinary severe asthma units (SAU) improve control in these patients and are cost-effective in our setting; however, their implementation and development can represent an organizational challenge. The aim of this study was to validate a set of quality care indicators in severe asthma for SAU in Spain. METHODS: The Carabela initiative, sponsored by SEPAR, SEAIC, SECA and SEDISA and implemented by leading specialists, analyzed the care processes followed in 6 pilot centers in Spain to describe the ideal care pathway for severe asthma. This analysis, together with clinical guidelines and SEPAR and SEAIC accreditation criteria for asthma units, were used to draw up a set of 11 quality of care indicators, which were validated by a panel of 60 experts (pulmonologists, allergologists, and health-policy decision-makers) using a modified Delphi method. RESULTS: All 11 indicators achieved a high level of consensus after just one Delphi round. CONCLUSIONS: Experts in severe asthma agree on a series of minimum requirements for the future optimization, standardization, and excellence of current SAUs in Spain. This proposal is well grounded on evidence and professional experience, but the validity of these consensus indicators must be evaluated in clinical practice.

Factores predictores de mortalidad en pacientes con enfermedad pulmonar obstructiva crónica y exacerbaciones frecuentes / Precipitating factors of mortality in chronic obstructive pulmonary disease patients with frequent exacerbations

Objetivo. Identificar las características de pacientes con una agudización de la enfermedad pulmonar obstructiva crónica (AEPOC) capaces de predecir en un plazo corto de tiempo la mortalidad por EPOC. Material y método. Estudio retrospectivo caso-control de pacientes ingresados por AEPOC para la identificación de factores predictores de mortalidad. El grupo control estaba formado por pacientes vivos a los 6 meses. Las variables recogidas incluían antecedentes, comorbilidad, estado de salud y nutricional, disnea basal, dependencia, agudizaciones, exploración física, función pulmonar, radiología, electrocardiograma, microbiología y tratamiento. Las diferencias entre grupos se compararon con los test de la χ2 y de la T-Student. La capacidad predictiva se analizó con regresión logística, estableciendo como variable dependiente la mortalidad. Resultados. Se incluyeron 125 pacientes (44 éxitus/81 vivos) (10 mujeres/115 varones) de 74±10 años. Ambos grupos eran similares en edad, sexo y gravedad de la enfermedad. De todas las variables, encontramos diferencias significativas en la disnea basal (p<0,01), los niveles de proteína C reactiva (p<0,007), la hemoglobina (p<0,037) y las plaquetas (p<0,041), en la actividad física (p<0,036), el uso de musculatura accesoria (p<0,007), el aislamiento microbiológico positivo (p<0,013) y el tratamiento con anticolinérgicos (p<0,029) y con digoxina (p<0,039). Ninguna de estas variables, sin embargo, era capaz de predecir la mortalidad en el análisis de regresión logística. Conclusiones. Con los datos que se manejan para el seguimiento habitual de los pacientes con EPOC no parece posible identificar predictores de mortalidad a corto plazo (6 meses) en un ingreso hospitalario, diferentes a la propia gravedad de la agudización. Únicamente algún parámetro que expresaría mayor inflamación crónica y la menor tolerancia al ejercicio parecen ser diferentes en el grupo de pacientes fallecidos en la AECOP(AU)

Objective. To identify the main characteristics in patients with COPD exacerbation, capables to predict the short-term COPD mortality. Matherials and methods. This is a case-control retrospective study of admitted patients with COPD to identify risk factors of mortality. The control group was constituted by alive patients after 6 months. The variables studied were clinical antecedents, comorbility, health and nutritional status, basal dyspnea, dependency, exacerbations, physical examination, pulmonary function, radiology, ECG, microbiology and treatment. Both groups were compared with the Chi-square and the T tests. The predictive capacity was analyzed with logistic regression for which the dependent variable was mortality. Results. 125 patients were enrolled (44 exitus and 81 alive) (10 females and 115 males) with mean age of 74+10 years. No significant differences were found between groups in age, sex and disease severity. On the other hand, we found statistically significant differences in basal dyspnea (p<0,01), RCP levels (p<0,007), Hb (p<0,037) and platelets (p<0,041), physic activity (p<0,036), accessory muscles use (p<0,007), positive microbiological culture (p<0,013) and treatment with anticholinergic agents (p<0,029) and digoxin (p<0,039). However, none of these variables was able to predict mortality in the logistic regression analysis. Conclusions. The usual data managed in the follow-up of COPD patients are not useful to identify short-term mortality predictors (6 months) during a hospital admittance. Only some variables that would represent a higher chronic inflammation and a lower exercise tolerance showed a statistical tendence in the dead patients group in a exacerbation of COPD(AU)