Efficacy of mepolizumab in usual clinical practice and characteristics of responders.

BACKGROUND: Severe eosinophilic asthma is a high-burden disease. Mepolizumab has been effective in several randomized clinical trials. However, such success might not be applicable to patients treated in usual clinical practice. The objectives of this article are to evaluate the efficacy of mepolizumab in severe uncontrolled eosinophilic asthma under usual clinical practice, and to determine characteristics associated with the response to this treatment. METHODS: We have conducted a retrospective, multicentre study, including all adult patients with severe uncontrolled eosinophilic asthma in Galicia, Spain, on whom mepolizumab treatment was started before June 2020, at least 6 months before the time of inclusion, and had received at least one dose of the drug. Patient characteristics, clinical data, respiratory function and comorbidities were collected at baseline and at the 6-month-follow-up. Responders and super-responders were defined according to clinical response and requirement of systemic corticosteroids. RESULTS: 122 patients (mean age 58 years old) were included. In the follow-up treatment 6 months later, 75.4% of the patients were well-controlled, displaying a significant reduction in blood eosinophil counts (p < 0.001), hospital admissions and disease exacerbations (p < 0.001), and had their systemic glucocorticosteroid dose significantly reduced (p < 0.001). The inhaled corticosteroid dose was also lowered (p < 0.01) after 6 months of treatment. Around two-thirds had a clinically significant increase in FEV1, 95% of the patients were considered responders and 43% super-responders. CONCLUSION: In routine clinical practice, mepolizumab is effective in patients with severe eosinophilic asthma and it has a good safety profile.

Health Outcomes: Towards the Accreditation of Respiratory Medicine Departments. / Resultados de salud: hacia la acreditación de los servicios de neumología.

National health systems must ensure compliance with conditions such as equity, efficiency, quality, and transparency. Since it is the right of society to know the health outcomes of its healthcare system, our aim was to develop a proposal for the accreditation of respiratory medicine departments in terms of care, teaching, and research, measuring health outcomes using quality of care indicators. The management tools proposed in this article should be implemented to improve outcomes and help us achieve our objectives. Promoting accreditation can serve as a stimulus to improve clinical management and enable professionals to take on greater leadership roles and take action to improve outcomes in patient care.

Health outcomes: Towards the accreditation of respiratory medicine departments.

National health systems must ensure compliance with conditions such as equity, efficiency, quality, and transparency. Since it is the right of society to know the health outcomes of its healthcare system, our aim was to develop a proposal for the accreditation of respiratory medicine departments in terms of care, teaching, and research, measuring health outcomes using quality of care indicators. The management tools proposed in this article should be implemented to improve outcomes and help us achieve our objectives. Promoting accreditation can serve as a stimulus to improve clinical management and enable professionals to take on greater leadership roles and take action to improve outcomes in patient care.

Obesity Does Not Increase the Risk of Asthma Readmissions.

The relationship between obesity and asthma exacerbations is still under debate. The aim of our work is to analyse the relationship between obesity and hospital re-admissions in asthmatics. A review was retrospectively performed on all hospital admissions of adult patients due to asthma exacerbation occurring in our hospital for 11 years. All those cases with asthma as the first diagnosis in the discharge report were included, or those with asthma as the second diagnosis provided when the first diagnosis was respiratory infection or respiratory failure. Only the first hospital admission of each patient was included in this study. The Odds Ratios of a higher incidence of early/late readmissions due to asthma exacerbation were calculated using a binary logistic regression, using the body mass index (BMI) as independent variable, adjusted for all the variables included in the study. The study included 809 patients with a mean age of 55.6 years, and 65.2% were female. The majority (71.4%) were obese or overweight. No significant relationship was observed in the univariate or multivariate analyses between overweight or obesity and the early or late hospital readmissions due to asthma. Therefore, obesity does not seem to be a determining factor in the risk of asthma exacerbations.

P. TYR1381X: Are We Facing a New Mutation of CFTR in a Patient With Severe Cystic Fibrosis? / P. TYR1381X: ¿Nos enfrentamos a una nueva mutación de CFTR en un paciente con fibrosis quística grave?

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Evolución tras la retirada de la oxigenoterapia domiciliaria. Perfil del paciente en el que hay que reintroducirla / Progress After the Withdrawal of Home Oxygen Therapy. The Profile of Patients Requiring Reintroduction

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Estudio ATAUD: la necesidad de mejorar la adherencia / The ATAUD Study: The Need to Improve Adherence

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Necesidad de titular el oxígeno portátil mediante pruebas de marcha de 6 minutos / Need for Portable Oxygen Titration During 6-Minute Walk Tests

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¿Es útil un hospital de día de enfermedades respiratorias en pacientes graves? / Is a Respiratory Day Hospital Useful in Patients with Severe Disease?

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The association between paracetamol and asthma is still under debate.

OBJECTIVE: To analyse the relationship between paracetamol and asthma. DATA SOURCES: An English literature search using electronic search engines (PubMed and EMBASE) was conducted. STUDY SELECTIONS: Articles published in peer-review journals, from 1990 to December 2015 were included. To perform the search for the most suitable and representative articles, keywords were selected ("asthma," "paracetamol" and "acetaminophen"). The evidence level was rated according to the criteria of the Oxford Centre For Evidence-Based Medicine. RESULTS: The exposure to paracetamol during pregnancy was analysed in several cohort studies, showing an association between the prenatal exposure to paracetamol with suffering from asthma or presence of wheezing in childhood, especially for persistent wheezing. Nevertheless, a recent study concluded that the relationship between asthma and paracetamol is explained, at least in part, by confounding factors. Several works have also associated the exposure to paracetamol in the first years of life or in adults with the development of childhood asthma. Several pathophysiological mechanisms are known that could explain this relationship, such as the glutathione pathway, the decrease in the release of Th1 cytokines that are normally produced during febrile episodes, which would then lead to a predominance of Th2 cytokines, the cytotoxic effect of paracetamol for pneumocytes, a modulator effect on the activity of myeloperoxidase, as well as the possible antigenic effect of paracetamol, mediated by IgE. CONCLUSIONS: There are many arguments that suggest a relationship between the use of paracetamol with the appearance of asthmatic symptoms, however the evidence is inconclusive.

Carcinoma estenosante esofágico diagnosticado por ecobroncoscopia / Stenosing esophageal carcinoma diagnosed by endobronchial ultrasound

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Aportación del bloque celular en el diagnóstico de adenopatías y masas mediastínicas o hiliares realizado por ecobroncoscopia / The Contribution of Cell Blocks in the Diagnosis of Mediastinal Masses and Hilar Adenopathy Samples From Echobronchoscopy

Introducción: La punción transbronquial guiada por ecoendoscopia permite obtener bloques celulares a partir del material de punción. Nuestro objetivo fue analizar su contribución al diagnóstico citológico convencional. Metodología: Revisión retrospectiva de las punciones por ecobroncoscopia realizadas de forma consecutiva durante 2 años con diagnóstico específico. Se analizó la capacidad de generar bloques celulares, su contribución al diagnóstico y a la realización de técnicas de inmunohistoquímica. Resultados: Se revisaron 129 muestras de lesiones correspondientes a 110 pacientes. En el 91% el diagnóstico fue de malignidad. Las lesiones puncionadas más frecuentemente fueron las adenopatías 4R (28%) y subcarinal (21%). El 72% de las muestras se procesaron como bloque celular, siendo su capacidad para realizar técnicas de inmunohistoquímica significativamente mayor a la de las muestras citológicas (52,6% vs. 14%, p < 0,0001). En 4 casos el bloque permitió un diagnóstico morfológico exclusivo (3 sarcoidosis y una metástasis de adenocarcinoma prostático) y en 3 carcinomas definir el subtipo y origen. El diagnóstico exclusivo mediante bloque celular fue significativamente más frecuente en la patología benigna que en la maligna (25% vs. 0,9%, p = 0,002). Conclusiones: La obtención de bloque celular a partir de muestras de punción por ecobroncoscopia fue del 72%. Sus principales aportaciones fueron la mejora del diagnóstico de lesiones benignas y la capacidad para realizar técnicas de inmunohistoquímica cuya contribución es esencial para la tipificación de neoplasias

Background: Cell block material from puncture can be obtained with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in many cases. The aim of this study was to analyze the value of additional information from cell blocks obtained with EBUS-TBNA samples from mediastinal and hilar lymph nodes and masses. Methods: Review of pathology reports with a specific diagnosis obtained from EBUS-TBNA samples of mediastinal or hilar lesions, prospectively obtained over a two-year period. The generation of cell blocks from cytology needle samples, the contribution to morphological diagnosis, and the possible use of samples for immunohistochemistry were analyzed. Results: One hundred and twenty-nine samples corresponding to 110 patients were reviewed. The diagnosis was lung cancer in 81% of cases, extrapulmonary carcinoma in 10%, sarcoidosis in 4%, lymphoma in 2.7%, and tuberculosis in 0.9%. Cell blocks could be obtained in 72% of cases. Immunohistochemistry studies on the cell blocks were significantly easier to perform than on conventional smears (52.6% vs 14%, P < 0.0001). In 4 cases, the cell block provided an exclusive morphological diagnosis (3 sarcoidosis and one metastasis from prostatic carcinoma) and in 3 carcinomas, subtype and origin could be identified. Exclusive diagnoses from the cell block were significantly more frequent in benign disease than in malignant disease (25% vs 0.9%, P = 0.002). Conclusions: Cell blocks were obtained from 72% of EBUS-TBNA diagnostic procedures. The main contributions of cell blocks to pathology examinations were the possibility of carrying out immunohistochemical staining for the better classification of neoplasms, especially extrapulmonary metastatic tumors, and the improved diagnosis of benign lesions

The contribution of cell blocks in the diagnosis of mediastinal masses and hilar adenopathy samples from echobronchoscopy.

BACKGROUND: Cell block material from puncture can be obtained with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in many cases. The aim of this study was to analyse the value of additional information from cell blocks obtained with EBUS-TBNA samples from mediastinal and hilar lymph nodes and masses. METHODS: Review of pathology reports with a specific diagnosis obtained from EBUS-TBNA samples of mediastinal or hilar lesions, prospectively obtained over a two-year period. The generation of cell blocks from cytology needle samples, the contribution to morphological diagnosis, and the possible use of samples for immunohistochemistry were analysed. RESULTS: One hundred and twenty-nine samples corresponding to 110 patients were reviewed. The diagnosis was lung cancer in 81% of cases, extrapulmonary carcinoma in 10%, sarcoidosis in 4%, lymphoma in 2.7%, and tuberculosis in 0.9%. Cell blocks could be obtained in 72% of cases. Immunohistochemistry studies on the cell blocks were significantly easier to perform than on conventional smears (52.6% vs. 14%, P<.0001). In 4cases, the cell block provided an exclusive morphological diagnosis (3sarcoidosis and one metastasis from prostatic carcinoma) and in 3carcinomas, subtype and origin could be identified. Exclusive diagnoses from the cell block were significantly more frequent in benign disease than in malignant disease (25% vs 0.9%, P=.002). CONCLUSIONS: Cell blocks were obtained from 72% of EBUS-TBNA diagnostic procedures. The main contributions of cell blocks to pathology examinations were the possibility of carrying out immunohistochemical staining for the better classification of neoplasms, especially extrapulmonary metastatic tumours, and the improved diagnosis of benign lesions.

Mesotelioma pleural secundario a radioterapia: una asociación infrecuente / Pleural Mesothelioma Secondary to Radiotherapy: A Rare Association

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