TEST DE ADHESIÓN A INHALADORES EN PACIENTES CON ASMA DE NUESTRA POBLACION EN ARGENTINA

RESUMEN Introducción: el asma es una enfermedad infamatoria crónica de la vía aérea, requiere un adecuado tratamiento y control. El Test de Adhesión a los Inhaladores (TAI) identifica al paciente con pobre adherencia al tratamiento, establece el nivel de adhesión y tipo de incumplimiento terapéutico por su técnica y conocimiento sobre el inhalador. Objetivos: evaluar el grado de adhesión al tratamiento del asma en nuestra población e identificar el tipo de incumplimiento que se presenta con mayor prevalencia. Materiales y métodos: se realizó un estudio observacional, prospectivo, transversal y multicéntrico en Argentina, donde se realizó el cuestionario TAI a pacientes entre 18 a 80 años con diagnóstico de asma en tratamiento con inhaladores durante febrero 2017 a mayo 2018. Resultados: se evaluaron 134 pacientes con una edad promedio de 45 años, 59% de sexo femenino y 41% de sexo masculino, en el que el 56% fue del ámbito privado y 44% del público. El 81.5% (101) fueron incumplidores, de tipo errático el 89.1% (110), deliberado el 87% (107) e inconsciente el 18.5% (22). Solo el 18.5% (23) presento buena adhesión. Conclusión: en este estudio se detectó una alta tasa de incumplimiento (81.5%) a los tratamientos inhalados en los pacientes con asma, siendo el errático y deliberado los de mayor frecuencia.

SUMMARY Introduction: asthma is a chronic infammatory disease of the airway, it requires adequate treatment and control. The Test of Adhesion to Inhalers (TAI) identifies the patient with poor adherence to treatment, establishes the level of adherence and type of therapeutic non-compliance due to their technique and knowledge about the inhaler. Objectives: to evaluate the degree of adherence to asthma treatment in our population and to identify the type of non-compliance with the highest prevalence. Materials and methods: An observational, prospective, cross-sectional and multicenter study was carried out in Argentina, where the TAI questionnaire was performed on patients between 18 and 80 years of age with a diagnosis of asthma being treated with inhalers during February 2017 to May 2018. Results: 134 patients with an average age of 45 years, 59% female and 41% male, were evaluated, in which 56% were from the private sphere and 44% from the public. 81.5% (101) were non-compliant, 89.1% (110) erratic, 87% (107) deliberate and 18.5%(22) unconscious. Only 18.5% (23) presented good adhesion. Conclusion: in this study, a high non-compliance rate (81.5%) was detected for inhaled treatments in patients with asthma, the most frequent being erratic and deliberate

International survey on skin patch test procedures, attitudes and interpretation.

BACKGROUND: Skin patch test is the gold standard method in diagnosing contact allergy. Although used for more than 100 years, the patch test procedure is performed with variability around the world. A number of factors can influence the test results, namely the quality of reagents used, the timing of the application, the patch test series (allergens/haptens) that have been used for testing, the appropriate interpretation of the skin reactions or the evaluation of the patient's benefit. METHODS: We performed an Internet -based survey with 38 questions covering the educational background of respondents, patch test methods and interpretation. The questionnaire was distributed among all representatives of national member societies of the World Allergy Organization (WAO), and the WAO Junior Members Group. RESULTS: One hundred sixty-nine completed surveys were received from 47 countries. The majority of participants had more than 5 years of clinical practice (61 %) and routinely carried out patch tests (70 %). Both allergists and dermatologists were responsible for carrying out the patch tests. We could observe the use of many different guidelines regardless the geographical distribution. The use of home-made preparations was indicated by 47 % of participants and 73 % of the respondents performed 2 or 3 readings. Most of the responders indicated having patients with adverse reactions, including erythroderma (12 %); however, only 30 % of members completed a consent form before conducting the patch test. DISCUSSION: The heterogeneity of patch test practices may be influenced by the level of awareness of clinical guidelines, different training backgrounds, accessibility to various types of devices, the patch test series (allergens/haptens) used for testing, type of clinical practice (public or private practice, clinical or research-based institution), infrastructure availability, financial/commercial implications and regulations among others. CONCLUSION: There is a lack of a worldwide homogeneity of patch test procedures, and this raises concerns about the need for standardization and harmonization of this important diagnostic procedure.

Mecanismos inmunomoduladores de la vitamina D / Immunomodulatory mechanisms of vitamin D

En cuanto a los mecanismos inmunológicos de la vitamina D, po- demos decir que posee efectos sobre la Inmunidad Innata, sobre la Inmunidad. Adaptativa y que su déficit se asocia con mayor riesgo de exacerbación de la enfermedad pulmonar obstructiva crónica. Se relaciona con la severidad del asma, con rinosinusitis crónica e infecciones respiratorias. La suplementación no demuestra ningún efecto beneficioso in vivo, todavía, ya que numerosos estudios solo demuestran resultados in vitro.

The immunological mechanisms of vitamin D, are: effects on the Innate and adaptive immunity and that its deficit is associated with increased risk of exacerbation in chronic obstructive pulmonary disease. It´s realtes with the severity of asthma, chronic rhinosinusitis and respiratory infections. Supplementation does not show any beneficial effect in vivo, still, because numerous stud ies demonstrate only in vitro results.

Mecanismos inmunomoduladores de la vitamina D / Immunomodulatory mechanisms of vitamin D

En cuanto a los mecanismos inmunológicos de la vitamina D, po- demos decir que posee efectos sobre la Inmunidad Innata, sobre la Inmunidad. Adaptativa y que su déficit se asocia con mayor riesgo de exacerbación de la enfermedad pulmonar obstructiva crónica. Se relaciona con la severidad del asma, con rinosinusitis crónica e infecciones respiratorias. La suplementación no demuestra ningún efecto beneficioso in vivo, todavía, ya que numerosos estudios solo demuestran resultados in vitro. (AU)

The immunological mechanisms of vitamin D, are: effects on the Innate and adaptive immunity and that its deficit is associated with increased risk of exacerbation in chronic obstructive pulmonary disease. It´s realtes with the severity of asthma, chronic rhinosinusitis and respiratory infections. Supplementation does not show any beneficial effect in vivo, still, because numerous stud ies demonstrate only in vitro results. (AU)

Sensibilidad a cucaracha y factores de riesgos en riníticos y asmáticos / Cockroach sensibility, socioeconomics factors and enviromental risks in rhinitic and asthmatic

El objetivo de la siguiente investigación es determinar si existe asociación entre sensibilidad a cucaracha y factores de riesgos socioeconómicos y ambientales en riníticos y asmáticos de la ciudad de Córdoba. La sensibilidad a cucaracha persiste desde el año 1960 con un porcentaje alrededor del 45%. No se pudo encontrar ninguna asociación entre sensibilidad a cucaracha y factores de riesgo en riníticos y asmáticos. Puede que el presente estudio no haya tenido un número suficiente de pacientes, como para encontrar la asociación que se planteó en la hipótesis.

The objective to determine if exists association among cockroach sensibility and factor of socioeconomic and environmental risks in rhinitic and asthmatic of the city of Córdoba. The sensibility to cockroach persists from the year 1990 with a percentage around 45%. No association among sensibility to cockroarch and risks factors in rhinitic and asthmatic, was found. May be the present study has not had an enough number of patients, like to find the association that we thought about in the hypothesis.