ABSTRACT
BACKGROUND AND OBJECTIVES: Background: The proposal and the initiative for the Prevalence of Severe Asthma in Hospital Units in Spain (PAGE) study came about because of the widespread implementation of electronic medical records and the limited data available on the prevalence of severe asthma in hospitals in our setting. Objectives: The primary objective was to determine the prevalence of severe asthma in the outpatient clinics of allergy and pulmonology departments in Spain. The secondary objectives were to describe the most prevalent characteristics and phenotypes of severe asthma, to evaluate the selection criteria for receiving approved biological treatments for this disease, and to estimate consumption of resources. Furthermore, digital technology and new data collection sources made it possible to reuse information stored in electronic medical records (Big Data). The study was performed using one such tool, Savana. METHODS: The PAGE study was a multicenter, nonexperimental, observational, cross-sectional study in the first phase and a prospective study in the second phase. The study was controlled and population-based, with 2-stage selection of patients by random sampling. The research was carried out in 40 hospitals selected using convenience sampling in order to ensure geographical representativeness in Spain. RESULTS: This manuscript describes the study design and protocol. CONCLUSIONS: Our study design was sufficiently robust to avoid bias and to establish the prevalence of patients with severe asthma in Spanish hospitals. It was also the first to incorporate new tools that can help in routine clinical practice and research, such as big data analysis software, and to evaluate the reliability and efficiency of these tools.
Subject(s)
Anti-Asthmatic Agents/therapeutic use , Asthma/epidemiology , Clinical Protocols/standards , Adult , Aged , Aged, 80 and over , Ambulatory Care Facilities , Asthma/drug therapy , Big Data , Cohort Studies , Cross-Sectional Studies , Disease Progression , Female , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Severity of Illness Index , Spain/epidemiology , Young AdultABSTRACT
Background: The proposal and the initiative for the Prevalence of Severe Asthma in Hospital Units in Spain (PAGE) study came about because of the widespread implementation of electronic medical records and the limited data available on the prevalence of severe asthma in hospitals in our setting. Objectives: The primary objective was to determine the prevalence of severe asthma in the outpatient clinics of allergy and pulmonology departments in Spain. The secondary objectives were to describe the most prevalent characteristics and phenotypes of severe asthma, to evaluate the selection criteria for receiving approved biological treatments for this disease, and to estimate consumption of resources. Furthermore, digital technology and new data collection sources made it possible to reuse information stored in electronic medical records (Big Data). The study was performed using one such tool, Savana. Methods: The PAGE study was a multicenter, nonexperimental, observational, cross-sectional study in the first phase and a prospective study in the second phase. The study was controlled and population-based, with 2-stage selection of patients by random sampling. The research was carried out in 40 hospitals selected using convenience sampling in order to ensure geographical representativeness in Spain. Results: This manuscript describes the study design and protocol. Conclusions: Our study design was sufficiently robust to avoid bias and to establish the prevalence of patients with severe asthma in Spanish hospitals. It was also the first to incorporate new tools that can help in routine clinical practice and research, such as big data analysis software, and to evaluate the reliability and efficiency of these tools (AU)
Subject(s)
Humans , Asthma/drug therapy , Asthma/epidemiology , Clinical Protocols/standards , Anti-Asthmatic Agents/therapeutic use , Big Data , Severity of Illness Index , Disease Progression , Cross-Sectional Studies , Spain/epidemiology , PrevalenceABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Immunoglobulin E/analysis , Immunoglobulin E/therapeutic use , Hypersensitivity, Immediate/therapy , Immunomodulation/immunology , Immunomodulation/physiology , Immunomodulation , Asthma/epidemiology , Asthma/immunology , Antibodies, Monoclonal/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adult , Eosinophilic Esophagitis/complications , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/immunology , Bronchitis/complications , Bronchitis/diagnosis , Bronchitis/immunology , Omeprazole/therapeutic use , Deglutition Disorders/complications , Eosinophils , Eosinophils/immunology , Hypersensitivity, Immediate/complications , Immunoglobulin E/analysis , Immunoglobulin E , Esophagoscopy/methodsABSTRACT
BACKGROUND: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. MATERIAL AND METHODS: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. RESULTS: The PEF improved on weekends and sick leave. The challenge test provoked a late asthmatic response and the non-specific bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount.
Subject(s)
Acrylates/adverse effects , Art , Asthma/chemically induced , Occupational Diseases/chemically induced , Paint/adverse effects , Acrylates/analysis , Asthma/diagnosis , Asthma/diagnostic imaging , Bronchial Provocation Tests , Cough/etiology , Eosinophil Cationic Protein/analysis , Eosinophilia/chemically induced , Humans , Male , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/diagnostic imaging , Occupational Diseases/immunology , Peak Expiratory Flow Rate , Pneumonia/chemically induced , Radiography , Skin Tests , Sputum/chemistry , Sputum/cytologyABSTRACT
Background: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. Material and methods: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. Results: The PEF improved on weekends and sick leave. The challenge test provoked a late astmatic response and the non-specifc bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount
Antecedentes: Los acrilatos se usan en una amplia variedad de productos, como solventes, adhesivos, pinturas, tinta de imprenta, lentes de contacto blandas y uñas de porcelana, mientras que los metacrilatos los usan dentistas y ortopedas. Hay varios tipos de compuestos acrílicos: acrilatos, cianoacrilatos (como adhesivos de tejidos y pegamentos de uso doméstico), así como de metacrilatos usados en prótesis dentales y rellenos ortopédicos. Los mecanismos de sensibilización se desconocen, pero se piensa que la reacción alérgica no está mediada por IgE, ya que la reacción asmática se produce tardíamente. Hay publicados varios casos de asma inducida por acrilato, especialmente en dentistas y personas que usan colas o pinturas que contienen esas sustancias. Material y métodos: Se presenta el caso de un varón de 52 años de edad que había trabajado en artes gráficas en los últimos 7 años. En los dos últimos años había presentado tos persistente con sensación de ahogo, disnea que aumentaba con el ejercicio moderado y obstrucción nasal, a pesar del tratamiento continuado. Los síntomas aparecieron primero tras un episodio agudo de dificultad respiratoria asociada con pérdida de peso, infiltrados pulmonares y eosinofilia. El flujo espiratorio punta (PEF) se midió durante el trabajo y los días de baja laboral. Se llevó a cabo prueba de provocación con acrilatos en cámara bronquial. Resultados: El PEF mejoró en los fines de semana y los días de baja laboral. El test de provocación dio lugar a una crisis de asma tardía. Después de la prueba, aumentó la hiperreactividad bronquial no específica. Al mismo tiempo, en las muestras de esputo se constató un aumento del contenido en eosinófilos
Subject(s)
Male , Middle Aged , Humans , Acrylates/adverse effects , Art , Asthma/chemically induced , Paint/adverse effects , Pneumonia/chemically induced , Occupational Diseases/chemically induced , Acrylates/analysis , Acrylates , Asthma/diagnosis , Asthma , Cough/etiology , Eosinophilia/chemically induced , Bronchial Provocation Tests , Peak Expiratory Flow Rate , Occupational Diseases/immunologyABSTRACT
El estudio de la causa de una tos crónica puede resultar una tarea complicada y en ocasiones infructuosa. Las causas que más frecuentemente se relacionan con la tos crónica son el asma bronquial, el reflujo gastroesofágico, el goteo nasal posterior y el tratamiento con fármacos inhibidores de la enzima conversora de la angiotensina (IECAs). Sin embargo, existen otras posibles causas de tos crónica. Recientemente se ha descrito una nueva entidad clínica, denominada bronquitis eosinofílica sin asma, que se manifiesta clínicamente con tos seca o poco productiva, persistente o crónica, que cursa sin disnea ni sibilancias, y que mejora notablemente con corticosteroides inhalados. Lo característico de esta entidad es que los pacientes que la padecen presentan eosinofilia en el esputo, pero tienen unas pruebas de función respiratoria normales, al contrario de lo que ocurre en el asma bronquial. Es decir, estos enfermos presentan tos crónica con eosinofilia en el esputo mayor del 3 per cent, similar a la que presentan los enfermos con asma, pero no muestran obstrucción variable al flujo aéreo, no tienen variabilidad de los registros del pico de flujo expiratorio (PEF) diarios ni presentan hiperreactividad bronquial frente a agentes farmacológicos como metacolina o histamina. La bronquitis eosinofílica sin asma debe tenerse en cuenta en el diagnóstico diferencial de la tos crónica. (AU)
Subject(s)
Humans , Bronchitis/complications , Eosinophilia/complications , Cough/etiology , Bronchitis/diagnosis , Bronchitis/drug therapy , Eosinophilia/diagnosis , Eosinophilia/drug therapy , Asthma/complications , Chronic DiseaseABSTRACT
In the last 10 years in the Ramón y Cajal Hospital, in Madrid, we have treated 78 patients who had presented anaphylactic reactions after hymenoptera stings, by means of a rush immunotherapy protocol. Fifty patients received wasp venom and 30 received honeybee venom (2 patients were treated with both venom types). Venom immunotherapy is given to out-patients, at the hospital, in the morning. The interval between injections administered on the same day is 30 minutes and the patient stays for 2 hours under observation after the last daily dose. The schedule we use is as follows: Day 1 (0.05-1-5-10 micrograms of venom), Day 2 (20-40 micrograms), Day 3 (40-60 micrograms), Day 5 (100 micrograms). Afterwards, they receive 100 micrograms after 2 weeks and, finally, monthly. In order to achieve a better tolerance, patients are protected with antihistamines on the days they are administered the immunotherapy (mequitazine 5 mg every 12 hours) and also, doses equal or over 40 micrograms are given fractionally, injecting half dose in each arm. The percentage of systemic reactions (mild or moderate) is 13.3% for patients treated with honeybee venom and 2% for patients treated with wasp venom. These percentages are lower than those obtained with conventional protocols in which it takes several weeks to reach the maintenance dose. The speed and convenience of this protocol and also its appropriate safety have led us to use it as a routine treatment for patients who require venom immunotherapy after suffering anaphylactic reactions due to hymenoptera stings.
