The Influence of BMI in Asthma: Which Traits Are due to Obesity and Which to the Asthma and Obesity Phenotype?

Background: The characteristics of the asthma and obesity phenotype have been described in cluster studies but have not been subsequently confirmed. Specific characteristics of this phenotype have not been differentiated from those inherent to the patient’s body mass index (BMI). Objectives: This study aims to assess the effect of BMI on asthma in order to identify which traits could define the asthma and obesity phenotype and which are inherent to the patient's BMI. Methods: A real-life retrospective observational study was conducted based on data from 2514 patients with suspected asthma collected at the first visit to the allergy clinic between November 2014 and November 2017. All patients had to perform an appropriate spirometry maneuver. All BMI, sex, and age groups were represented. Results: The influence of BMI on asthma differed according to age group and sex. All spirometry results and FeNO were influenced by BMI. The only notable asthma characteristics were later onset of asthma with higher BMI values. No other differences were found between the BMI groups. Conclusions: The effect of BMI on asthma is age-dependent; therefore, it should be corrected for age. The most important variations are in FeNO and spirometry results. The specific characteristics of the asthma and obesity phenotype are a greater perception of symptoms with fewer alterations in respiratory function tests and a lower prevalence of atopy, rhinitis, and allergy, including allergic asthma. Other characteristics of this phenotype, such as a higher female prevalence or late-onset or noneosinophilic asthma, are nonspecific for this phenotype

Antecedentes : las características del fenotipo del asma y la obesidad se han descrito en estudios grupales, pero no se han confirmado posteriormente. Las características específicas de este fenotipo no se han diferenciado de las inherentes al índice de masa corporal (IMC) del paciente. Objetivos : Este estudio tiene como objetivo evaluar el efecto del IMC sobre el asma para identificar qué rasgos podrían definir el fenotipo del asma y la obesidad y cuáles son inherentes al IMC del paciente. Métodos : Se realizó un estudio observacional retrospectivo de la vida real basado en datos de 2514 pacientes con sospecha de asma recopilados en la primera visita a la clínica de alergia entre noviembre de 2014 y noviembre de 2017. Todos los pacientes tuvieron que realizar una maniobra de espirometría adecuada. Estuvieron representados todos los grupos de IMC, sexo y edad. Resultados : La influencia del IMC sobre el asma difirió según grupo de edad y sexo. Todos los resultados de la espirometría y el FeNO estuvieron influenciados por el IMC. Las únicas características notables del asma fueron la aparición tardía del asma con valores de IMC más altos. No se encontraron otras diferencias entre los grupos de IMC. Conclusiones : El efecto del IMC sobre el asma depende de la edad; por lo tanto, debe corregirse según la edad. Las variaciones más importantes se encuentran en los resultados de FeNO y espirometría. Las características específicas del fenotipo de asma y obesidad son una mayor percepción de los síntomas con menos alteraciones en las pruebas de función respiratoria y una menor prevalencia de atopia, rinitis y alergia, incluido el asma alérgica. Otras características de este fenotipo, como una mayor prevalencia femenina o asma de aparición tardía o no eosinofílica, no son específicas de este fenotipo (AU)

Diseño y validación de un cuestionario para la detección de Abusos Sexuales Infantiles en personas adultas con adicción / Design and validation of a questionnaire for the detection of child sexual abuse in adults with addiction

Introducción y objetivos: el objetivo principal de este trabajo ha sido diseñar y validar un cuestionario específico que evaluara el Abuso Sexual Infantil (ASI) en personas adultas con problemas de adicción. Materiales y método: se diseñó un cuestionario de 120 ítems que medía diferentes secuelas psicopatológicas que están presentes en personas que han sufrido ASI. Se realizó su validación con un grupo de expertos y un estudio piloto en el que participaron 151 personas (68 mujeres y 83 hombres), residentes en España. Para el análisis de datos se usaron diferentes métodos estadísticos. Resultados: los resultados mostraron que el cuestionario se podía reducir a 21 ítems logrando alcanzar unas adecuadas garantías psicométricas, tanto a nivel de validez como de fiabilidad (a = ,872). Conclusiones: El presente instrumento permite la detección de sintomatología relacionada con el ASI, permitiendo al clínico hacer una exploración más amplia en esta área para descartar ASI u otros trastornos y poder mejorar la planificación del tratamiento.(AU)

Introduction and objectives: the main objective of this work has been to design and validate a specific questionnaire to assess Child Sexual Abuse (CSA) in adults with addiction problems. Materials and method: a 120-item questionnaire was designed to measure different psychopathological sequelae that are present in people who have suffered CSA. Validation was carried out with a group of experts and a pilot study in which 151 people (68 women and 83 men) residing in Spain participated. Different statistical methods were used for data analysis. Results: the results showed that the questionnaire could be reduced to 21 items, achieving adequate psychometric guarantees, both in terms of validity and reliability (a = ,872). Conclusions: The present instrument allows the detection of symptoms related to ASI, allowing the clinician to carry out a broader exploration in this area to rule out ASI or other disorders and to improve treatment planning.(AU)

The influence of BMI in asthma. Which traits are due to obesity and which to asthma and obesity phenotype?

BACKGROUND AND OBJECTIVES: Characteristics of the asthma and obesity phenotype have been described by cluster studies, but they have not been subsequently confirmed. Specific characteristics of this phenotype have not been differentiated from those inherent to the patient's body mass index (BMI). This study aims to assess the effect of BMI on asthma. This will allow to identify which traits could define the asthma and obesity phenotype, and which are inherent to the patient´s BMI. METHODS: A real-life retrospective observational study was conducted with a 2,514 patients database. Data was collected on the first visit to the Allergy clinic of all patients who underwent a correct spirometry maneuver due to suspected asthma between November 2014 and November 2017. All BMI, sex and age groups were represented. RESULTS: BMI influence over asthma differed in different age groups and genders. All spirometric results and FeNO were influenced by BMI. Concerning asthma characteristics only a later asthma onset with higher BMI values was observed. No other differences were found between different BMI groups. CONCLUSIONS: The effect of BMI on asthma is age dependent, so it should be corrected for age. The most important variations are on FeNO and spirometric results. The specific characteristics of the asthma and obesity phenotype are a greater perception of symptoms with fewer alterations in respiratory function tests and a lower prevalence of atopy, rhinitis and allergy, including allergic asthma. Other characteristics of this phenotype, such as a higher women prevalence or being late-onset or non-eosinophilic asthma, are non-specific for this phenotype.

The Relation of CFTR-Genotype and Associated Comorbidities to Development of Pulmonary Atelectasis in Cystic Fibrosis Patients

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Functional Examination of the Upper and Lower Airways in Asthma and Respiratory Allergic Diseases: Considerations in the Post-SARS-CoV-2 Era.

Airway examination procedures can potentially transmit infectious diseases to patients and to the health care professionals who perform them via various mechanisms. The COVID-19 pandemic has halted most of the activity of the clinics and laboratories involved in assessment of lung and nasal function, and clear recommendations in this regard have been made. Today, we still do not know for sure what its consequences will be in the short or long term, since important gaps remain in our knowledge of aspects as fundamental as virus transmission mechanisms, pathophysiology, immune response, and diagnosis. In this review, we study the examination techniques used to assess patients with respiratory allergy, asthma, and associated diseases during this period and highlight their possible advantages and disadvantages. Therefore, we focus on exploring the entire upper and lower airways, from the perspective of the safety of both health professionals and patients and their specific characteristics. We also analyze the intrinsic value of these interventions in terms of diagnosis and patient management. The changing situation of COVID-19 may mean that some of the assertions presented in this review will have to be modified in the future. While we seek to ensure a consistently broad approach, some differences in operational details may apply owing to local regulations.

[Validation of the Spanish version of the Golombok Rust Inventory of Sexual Satisfaction]. / Validación de la versión española del Golombok Rust Inventory of Sexual Satisfaction.

INTRODUCTION: Self-reports are one of the most used techniques in the evaluation of human sexuality. For this reason, valid and reliable evaluation instruments are necessary for high quality studies. OBJECTIVE: The main purpose of this study was to translate and validate the Golombok Rust Inventory of Sexual Satisfaction for use in Spanish. METHOD: A sample of 1,265 subjects (1,007 men, 258 women) completed the Golombok Rust Inventory of Sexual Satisfaction questionnaire. Two independent translators performed the translation and a group of experts unified the versions. RESULTS: The items showed adequate correlation, both in the men's version (0.306-0.440), and in the women's version (0.355-0.652). Reliability is high in both versions (men: 0.864; women: 0.924). Factor analysis adjusts to the theoretical dimensions proposed by the authors of the questionnaire, explaining 57.75% of the variance in men, and 66.67% in women. CONCLUSIONS: The Spanish version of the Golombok Rust Inventory of Sexual Satisfaction has the necessary psychometric properties to be used both in the clinic and in research.

Functional Examination of the Upper and Lower Airways in Asthma and Respiratory Allergic Diseases: Considerations in the Post-SARS-CoV-2 Era

Airway examination procedures can potentially transmit infectious diseases to patients and to the health care professionals who perform them via various mechanisms. The COVID-19 pandemic has halted most of the activity of the clinics and laboratories involved in assessment of lung and nasal function, and clear recommendations in this regard have been made. Today, we still do not know for sure what its consequences will be in the short or long term, since important gaps remain in our knowledge of aspects as fundamental as virus transmission mechanisms, pathophysiology, immune response, and diagnosis. In this review, we study the examination techniques used to assess patients with respiratory allergy, asthma, and associated diseases during this period and highlight their possible advantages and disadvantages. Therefore, we focus on exploring the entire upper and lower airways, from the perspective of the safety of both health professionals and patients and their specific characteristics. We also analyze the intrinsic value of these interventions in terms of diagnosis and patient management.The changing situation of COVID-19 may mean that some of the assertions presented in this review will have to be modified in the future. While we seek to ensure a consistently broad approach, some differences in operational details may apply owing to local regulations

Las técnicas de examen de las vías respiratorias son procedimientos que pueden transmitir enfermedades infecciosas, por diversos mecanismos, tanto a los pacientes, como a los profesionales de la salud que las realizan. La situación de pandemia debido a la enfermedad COVID-19 prácticamente ha detenido la mayor parte de la actividad de los laboratorios de función pulmonar y nasal, con recomendaciones, específicas, de múltiples sociedades y guías nacionales e internacionales. Continuamos viviendo las distintas olas de la pandemia y todavía no sabemos con certeza, cuáles serán sus consecuencias a corto o largo plazo, pues existen lagunas importantes en el conocimiento de aspectos tan fundamentales como los mecanismos de transmisión del virus, su fisiopatología y respuesta immune, o su diagnóstico.En esta revisión examinaremos las diferentes técnicas de examen disponibles en la evaluación de pacientes que sufren enfermedades alérgicas como la rinitis o el asma y enfermedades asociadas a ellas, destacando sus posibles ventajas y desventajas, en esta era que estamos viviendo tras la aparición del SARS CoV-2. Por esta razón, queríamos centrarnos en explorar todas las vías aéreas superiores e inferiores. Lo haremos desde la perspectiva de la seguridad tanto de los profesionales de la salud como de los pacientes y sus características específicas. Paralelamente abordaremos el análisis del valor intrínseco que proporcionan estas intervenciones desde el punto de vista tanto del diagnóstico como del tratamiento de estos pacientes. La situación cambiante de esta enfermedad puede causar en el futuro, modificaciones de las afirmaciones presentadas en esta revisión. Si bien esta guía busca garantizar un enfoque amplio y consistente, puede ser necesario aplicar algunas diferencias en los detalles operativos, debido a las distintas regulaciones o situaciones locales

El abuso sexual infantil y la relación con el desarrollo de comportamientos adictivos. Una revisión sistemática / Child sexual abuse and the relationship with the development of addictive behaviors. A systematic review

Resumen: El Abuso Sexual Infantil (ASI) está relacionado con el desarrollo de comportamientos adictivos en la edad adulta. El presente estudio tuvo el objetivo de realizar una revisión sistemática sobre la relación que existe entre el ASI y el desarrollo de comportamientos adictivos con o sin sustancias. Se analizaron 36 artículos desde 2014 a 2018, que cumplieron los criterios de inclusión para formar parte de esta revisión. Este trabajo ha permitido visibilizar la escasa información existente acerca de la relación entre ASI y comportamientos adictivos. Se concluye que se necesita más investigación sistematizada que analice la relación existente entre el haber sido víctima de ASI y tener una adicción en la vida adulta, que se utilicen instrumentos específicos y validados para evaluar la posible presencia o ausencia de ASI en adultos y ser más específicos a la hora de considerar las variables que influyen en esta relación.

Abstract: Child Sexual Abuse (ASI) is related to the development of addictive behaviors in adulthood. The present study had the objective of carrying out a systematic review on the relationship that exists between ASI and the development of addictive behaviors. 36 articles were found from 2014 to 2018, which met the inclusion criteria to be part of this review. This work has made it possible to visualize the scarce existing information about the relationship between ASI and addictive behaviors. It is concluded that studies are needed that use specific and validated instruments to assess the possible presence or absence of ASI in adults and to be more specific in the variables that influence this relationship.

Creating and Validating the DESEA Questionnaire for Men and Women.

In clinical practice, it is essential to be able to identify hypoactive sexual desire disorder (HSDD), with its different severity levels and assess the influence the subject's relationship has on the issue. In order to do this, questionnaires are needed that comprise appropriate psychometric properties. We analyzed the psychometric properties and factorial structure of the Sexual Desire and Aversion (DESEA) questionnaire that evaluates sexual desire and interpersonal stress (relationship problems) in male and female couples. A pilot study was conducted with a group of 1583 people. Finally, it included 20,424 Spanish speakers who answered the questionnaire via an online link. The requirements for factor analysis were verified followed by the exploratory and confirmatory factor analysis. The Cronbach's alpha coefficient calculated the reliability of the test scores at 0.834 in the pilot group and 0.889 in the final group. A 3-factor factorial design explains the 62.08% variance. The KMO (Kaiser-Meyer-Olkin) test (p = 0.904), Bartlett's test of sphericity (126,115.3; p = 0.000010) and the matrix determinant (0.0020770) verified the appropriateness of the factor analysis. The results show that the DESEA questionnaire is a reliable and valid instrument for evaluating desire and interpersonal stress, both in women and men, in clinical and research contexts.

20 años en fisiología respiratoria / 20 years in respiratory physiology

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Correction to: Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective.

Following publication of the original article [1], we have been notified of the below corrections to the 5th paragraph in the Discussion section.

Obesity and Asthma: Key Clinical Questions.

Obesity is a common comorbidity of asthma that is associated not only with development of the disease, but also with poorer disease control and greater severity. Recent prospective evidence supports the idea that body weight gain precedes the development of asthma, although the debate is far from over. The objective of this document is to conduct a systematic review of 3 clinical questions related to asthma and obesity: (a) Obesity and asthma: the chicken or the egg? Clinical insights from epidemiological and phenotyping studies. (b) Is obesity a confounding factor in the diagnosis and management of asthma, especially in severe or difficult-to-control asthma? (c) How do obese asthma patients respond to pharmacological treatments and to biological drugs? Do we have effective specific interventions? Revised epidemiological, pathological, and mechanistic evidence combined with data from interventional clinical trials prevent us from clearly stating that obesity causes asthma. However, the complexity and heterogeneity of both illnesses make several clinical scenarios possible. Furthermore, asthma represents an additional clinical challenge in the obese patient. Physicians need to be aware of the confounding effects created by the more marked perception of symptoms, alterations in lung function, and the various comorbidities that obese persons present. Exhaustive phenotyping of the obese asthma patient should enable us to develop a rational therapeutic plan, including both the pharmacological approach and specific antiobesity therapies such as combining diet and exercise and, in extreme cases, bariatric surgery.

Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse.

BACKGROUND: Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP. METHODS: Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed. RESULTS: The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%. CONCLUSIONS: Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.

Obesity and asthma: key clinical questions

Obesity is a common comorbidity of asthma that is associated not only with development of the disease, but also with poorer disease control and greater severity. Recent prospective evidence supports the idea that body weight gain precedes the development of asthma, although the debate is far from over. The objective of this document is to conduct a systematic review of 3 clinical questions related to asthma and obesity: (a) Obesity and asthma: the chicken or the egg? Clinical insights from epidemiological and phenotyping studies. (b) Is obesity a confounding factor in the diagnosis and management of asthma, especially in severe or difficult-to-control asthma? (c) How do obese asthma patients respond to pharmacological treatments and to biological drugs? Do we have effective specific interventions?Revised epidemiological, pathological, and mechanistic evidence combined with data from interventional clinical trials prevent us from clearly stating that obesity causes asthma. However, the complexity and heterogeneity of both illnesses make several clinical scenarios possible. Furthermore, asthma represents an additional clinical challenge in the obese patient. Physicians need to be aware of the confounding effects created by the more marked perception of symptoms, alterations in lung function, and the various comorbidities that obese persons present. Exhaustive phenotyping of the obese asthma patient should enable us to develop a rational therapeutic plan, including both the pharmacological approach and specific antiobesity therapies such as combining diet and exercise and, in extreme cases, bariatric surgery

La obesidad es una comorbilidad común al asma y se ha asociado no solo con el desarrollo del asma, sino también con un peor control de la misma y con el asma grave. La evidencia prospectiva reciente respalda la idea de que el aumento del peso corporal precede al desarrollo del asma, pero el debate no está ni mucho menos cerrado. El objetivo de este documento es efectuar una revisión sistemática sobre los aspectos clínicos claves del asma y la obesidad: (a) La obesidad y asma: ¿el huevo o la gallina? Aspectos clínicos aprendidos de los estudios epidemiológicos y de fenotipos en el asmático obeso. (b) ¿Es la obesidad un factor de confusión en el diagnóstico y manejo del asma y especialmente en el asma grave o de difícil control? (c) ¿Cuál es la respuesta del asmático obeso al tratamiento farmacológico, y a los fármacos biológicos? ¿Disponemos de intervenciones específicas eficaces?Nuestra revisión de la evidencia epidemiológica, fisiopatológica y mecanística combinada con los datos obtenidos de los ensayos de intervención no permite afirmar claramente que la obesidad sea un agente causal del asma, por lo que debe ser considerada en muchos casos una comorbilidad. No obstante, la complejidad y heterogeneidad de estas dos patologías hacen muy posible diversos escenarios clínicos. Por otra parte, el diagnóstico de asma en un paciente obeso supone un reto clínico adicional, en el que se debe tener presente el efecto de confusión originado por la mayor percepción sintomática, las alteraciones de la función pulmonar y las distintas comorbilidades que presenta el sujeto obeso. Un minucioso fenotipado del paciente asmático obeso, es el que nos debe conducir a un plan terapéutico racional, que contemple el ajuste farmacológico y la puesta en marcha de medidas específicas contra la obesidad con un plan combinado de dieta y ejercicio y en los casos indicados, la cirugía bariátrica

Efectos del consumo de drogas y de la ansiedad en la eyaculación precoz en una muestra de drogodependientes españoles / Effects of drug use and anxiety on premature ejaculation in a sample of Spanish drug addicts

Introducción: La eyaculación precoz puede deberse a múltiples factores y uno de ellos puede ser el consumo de drogas. Objetivos: El objetivo principal de este estudio es conocer cómo afecta el consumo de drogas a la respuesta eyaculatoria, teniendo en cuenta las diferentes sustancias de consumo, el nivel de ansiedad y el tiempo de abstinencia. Método: Se utilizaron 2 muestras, una correspondiente a hombres que han tenido un historial de consumo de sustancias adictivas (n=925) y otra de hombres no consumidores (n=82). Ambas muestras fueron seleccionadas de 28 centros de tratamiento. Se utilizaron los cuestionarios Golombok Rust Inventory of Sexual Satisfaction (GRISS) y el Cuestionario de Ansiedad Estado Rasgo (STAI). Resultados: Los resultados muestran que los hombres con historia de consumo obtienen porcentajes mayores en eyaculación precoz frente a los no consumidores (44,3>15,9%) y puntuaciones medias también mayores en ansiedad (estado=19,83>11,89; rasgo=25,66>12,39), siendo dichas diferencias estadísticamente significativas (p=0,000). Los resultados confirman que el período de abstinencia no mejora la respuesta eyaculatoria y tener pareja no funciona como factor de protección en la eyaculación precoz. Conclusiones: Los hombres con historia de consumo de drogas tienen más probabilidad de padecer eyaculación precoz y más ansiedad, que no mejora en el período de abstinencia, lo que incita a pensar que los consumidores de drogas tienen rasgos de personalidad que predisponen la eyaculación precoz y/o que los daños neurológicos ocasionados por la drogas contribuyen a disminuir la latencia intravaginal eyaculatoria, cuestiones que deben ser estudiadas en próximas investigaciones

Introduction: Premature ejaculation may be due to many factors and one of them may be drug use. Aims: The main objective of this study is to show how drug abuse affects the ejaculatory response, keeping in mind the different substances consumed, the level of anxiety and the period of withdrawal. Method: Two samples were used, one for men who were addicted to drugs (N=925) and one of non-consumers (N=82). Both samples were selected from 28 treatment centers. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire and the State Anxiety Trait Questionnaire (STAI) were used. Results: The results show that men with a history of consumption obtain higher percentages in premature ejaculation compared to non-users (44.3%> 15.9%) and also higher mean scores in anxiety (State Anxiety=19.83>11, 89; Trait Anxiety=25.66>12.39). These differences were statistically significant (P=.000). The results confirm that the withdrawal period does not improve ejaculatory response and having a partner does not work as a protective factor in premature ejaculation. Conclusions: Men with a history of drug use are more likely to suffer from premature ejaculation and higher levels of anxiety, which does not improve during the period of withdrawal, leading to the belief that drug users have personality traits that facilitate premature ejaculation and/or that the neurological damages caused by the drugs contribute to a decrease in the intravaginal ejaculatory latency, issues that should be studied in future investigations

Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective.

BACKGROUND: A head-to-head study demonstrated the superiority of once-daily umeclidinium bromide/vilanterol (UMEC/VI) 62.5/25 mcg on trough forced expiratory volume in 1 s (FEV1) versus once-daily tiotropium/olodaterol (TIO/OLO) 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated the cost effectiveness of UMEC/VI versus TIO/OLO from a Spanish National Healthcare System perspective, using data from this study and Spanish literature. METHODS: This analysis was conducted from the perspective of the Spanish National Healthcare System with a 3-year horizon as base case. A disease progression model using a linked risk equation approach was used to estimate disease progression and associated healthcare costs, and quality-adjusted life years (QALYs). The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was used to develop the statistical risk equations for clinical endpoints, and costs were calculated using a health state approach (by dyspnea severity). Utilities for QALY calculation were estimated using patient baseline characteristics within a regression fit to Spanish observational data. Treatment effect, expressed as change from baseline in FEV1 was obtained from the head-to-head study and used in the model (UMEC/VI minus TIO/OLO difference: + 52 mL [95% confidence interval: 28, 77]). Baseline patient characteristics were sourced from Spanish literature or the head-to-head study if unavailable. A scenario analysis using only the intent-to-treat (ITT) population from the head-to-head study, and sensitivity analyses (including probabilistic sensitivity analyses), were conducted. Direct healthcare costs (2017 Euro) were obtained from Spanish sources and costs and benefits were discounted at 3% per annum. RESULTS: UMEC/VI was associated with small improvements in QALYs (+ 0.029) over a 3-year time horizon, compared with TIO/OLO, alongside cost savings of €393/patient. The ITT scenario analysis and sensitivity analyses had similar results. All probabilistic simulations resulted in UMEC/VI being less costly and more effective than TIO/OLO. CONCLUSION: UMEC/VI dominated TIO/OLO (more effective and less expensive). These results may aid payers and decision-makers in Spain when making judgements on which long-acting muscarinic antagonist/long-acting ß2-agonist (LAMA/LABA) treatments can be considered cost effective in Spain.