Adult Severe Asthma Registries: A Global and Growing Inventory.

Aim: The International Severe Asthma Registry (ISAR; http://isaregistries.org/) uses standardised variables to enable multi-country and adequately powered research in severe asthma. This study aims to look at the data countries within ISAR and non-ISAR countries reported collecting that enable global research that support individual country interests. Methods: Registries were identified by online searches and approaching severe asthma experts. Participating registries provided data collection specifications or confirmed variables collected. Core variables (results from ISAR's Delphi study), steroid-related comorbidity variables, biologic safety variables (serious infection, anaphylaxis, and cancer), COVID-19 variables and additional variables (not belonging to the aforementioned categories) that registries reported collecting were summarised. Results: Of the 37 registries identified, 26 were ISAR affiliates and 11 non-ISAR affiliates. Twenty-five ISAR-registries and 4 non-ISAR registries reported collecting >90% of the 65 core variables. Twenty-three registries reported collecting all optional steroid-related comorbidity variables. Twenty-nine registries reported collecting all optional safety variables. Ten registries reported collecting COVID-19 variables. Twenty-four registries reported collecting additional variables including data from asthma questionnaires (10 Asthma Control Questionnaire, 20 Asthma Control Test, 11 Asthma Quality of Life Questionnaire, and 4 EuroQol 5-dimension 5-level Questionnaire). Eight registries are linked to databases such as electronic medical records and national claims or disease databases. Conclusion: Standardised data collection has enabled individual severe asthma registries to collect unified data and increase statistical power for severe asthma research irrespective of ISAR affiliations.

Association of the CFTR gene with asthma and airway mucus hypersecretion.

INTRODUCTION: Asthma with airway mucus hypersecretion is an inadequately characterized variant of asthma. While several studies have reported that hypersecreting patients may carry genetic variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, many of those studies have been questioned for their numerous limitations and contradictory results. OBJECTIVES: (1) To determine the presence of genetic variants of the CFTR gene in patients with asthma with and without airway mucus hypersecretion. (2) To identify the clinical, inflammatory and functional characteristics of the asthma phenotype with airway mucus hypersecretion. METHOD: Comparative multicentre cross-sectional descriptive study that included 100 patients with asthma (39 hypersecretors and 61 non-hypersecretors). Asthmatic hypersecretion was defined as the presence of cough productive of sputum on most days for at least 3 months in 2 successive years. The patients were tested for fractional exhaled nitric oxide, spirometry, induced sputum cell count, total immunoglobulin E (IgE), peripheral blood eosinophil count, C-reactive protein, blood fibrinogen and blood albumin and underwent a skin prick test. Asthma control and quality of life were assessed by the Asthma Control Test and Mini Asthma Quality of Life questionnaires, respectively. Blood DNA samples were collected from the patients and next-generation sequencing using a MiSeq sequencer and the Illumina platform was used for the CFTR gene analysis. RESULTS: Genetic differences were observed in the c.1680-870T>A polymorphism of the CFTR gene, significantly more evident in hypersecretors than in non-hypersecretors: 78.94% vs. 59.32% in the majority allele and 21.05% vs. 40.67% in the minority allele (p = 0.036). Clinically, asthma hypersecretors compared to non-hypersecretors were older (57.4 years vs. 49.4 years; p = 0.004); had greater asthma severity (58.9% vs. 23.7%; p = 0.005); experienced greater airway obstruction (FEV1/FVC% 64.3 vs. 69.5; p = 0.041); had poorer asthma control (60% vs. 29%; p = 0.021); had lower IgE levels (126.4 IU/mL vs. 407.6 IU/mL; p = 0.003); and were less likely to have a positive prick test (37.5% vs. 68.85%; p = 0.011). CONCLUSION: The results suggest that patients with asthma and with mucus hypersecretion (1) may have a different phenotype and disease mechanism produced by an intronic polymorphism in the CFTR gene (NM_000492.3:c.1680-870T>A), and (2) may have a poorer clinical outcome characterized by severe disease and poorer asthma control with a non-allergic inflammatory phenotype.

Telemedicina, una oportunidad para la espirometría / Telemedicine, an Opportunity for Spirometry

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Accreditation of specialized asthma units for adults in Spain: an applicable experience for the management of difficult-to-control asthma.

This paper, developed by consensus of staff physicians of accredited asthma units for the management of severe asthma, presents information on the process and requirements for already-existing asthma units to achieve official accreditation by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Three levels of specialized asthma care have been established based on available resources, which include specialized units for highly complex asthma, specialized asthma units, and basic asthma units. Regardless of the level of accreditation obtained, the distinction of "excellence" could be granted when more requirements in the areas of provision of care, technical and human resources, training in asthma, and teaching and research activities were met at each level. The Spanish experience in the process of accreditation of specialized asthma units, particularly for the care of patients with difficult-to-control asthma, may be applicable to other health care settings.

Farmaeconomía en asma / Pharmaeconomics in asthma

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Evaluación económica e impacto presupuestario de un procedimiento de telemedicina para el control de calidad de las espirometrías en atención primaria / Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting

OBJETIVO: Evaluar el impacto económico de un sistema de telemedicina en un sistema público de salud para la mejora de la calidad de las espirometrías (espirometrías forzadas [EF]) en atención primaria. MATERIAL Y MÉTODOS: Se ha evaluado el impacto económico de 9.039 EF realizadas en 51 centros de salud (2010-2013) mediante teleespirometría (TE) comparándose con el sistema habitual. RESULTADOS: El sistema de TE encarece el coste unitario de la EF (47,8 € vs. 39,7 €) (2013), pero logra una mejora en la calidad de las mismas (un 84% con buena calidad, frente a un 61% mediante el procedimiento habitual). El coste total de la TE ha sido de 431.974 € (358.306 € por sistema habitual), lo que supone un impacto económico de 73.668 € (2013). El aumento de gasto para EF de buena calidad realizadas con TE fue de 34.030 € (2010) y de 144.295 € (2013), mientras que para las pruebas con mala calidad fue de -15.525€ (2010) y de -70.627€ (2013). CONCLUSIÓN: Del análisis coste-efectividad se concluye que la TE es un 23% más costosa y un 46% más efectiva. Asimismo, el gasto sanitario es menor a medida que el número de EF realizadas mediante TE aumenta. La no realización de EF de mala calidad, no válidas, supone un ahorro que compensa el aumento del gasto por la realización mediante TE, siendo un sistema coste-efectivo

OBJECTIVE: To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. Materials and methods: The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. RESULTS: TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). CONCLUSION: The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method

Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting.

OBJECTIVE: To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. MATERIALS AND METHODS: The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. RESULTS: TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). CONCLUSION: The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method.

Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.

BACKGROUND: The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway. OBJECTIVES: The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow. METHODS: The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team. RESULTS: A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms. CONCLUSIONS: Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

Vibration response imaging versus perfusion scan in lung cancer surgery evaluation.

OBJECTIVE: Ventilation/perfusion scan is a standard procedure in high-risk surgical patients to predict pulmonary function after surgery. Vibration response imaging is a technique that could be used in these patients. The objective of our study was to compare this imaging technique with the usual scanning technique for predicting postoperative forced expiratory volume. METHODS: We assessed 48 patients with lung cancer who were candidates for lung resection. Forced spirometry, vibration response imaging, and ventilation/perfusion scan were performed in patients before surgery, and spirometry was performed after intervention. RESULTS: We included 48 patients (43 men; mean age, 64 years) undergoing lung cancer surgery (32 lobectomies/16 pneumonectomies). On comparison of both techniques, for pneumonectomy, we found a concordance of 0.84 (95% confidence interval, 0.76-0.92) and Bland-Altman limits of agreement of -0.33 to +0.45, with an average difference of 0.064. By comparing postoperative spirometry with vibration response imaging, we found a concordance of 0.66 (95% confidence interval, 0.38-0.93) and Bland-Altman limits of agreement of -0.60 to +0.33, with an average difference of -0.13. CONCLUSIONS: The 2 techniques presented good concordance values. Vibration response imaging shows non-negligible confidence intervals. Vibration response imaging may be useful in preoperative algorithms in patients before lung cancer surgery.

Fe de errores de «Infección pulmonar abscesificada como forma de presentación de un absceso pulmonar» / Erratum in «Lung abscess as an onset form of bronchopulmonary abscess»

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Infección pulmonar abscesificada como forma de presentación de un absceso pulmonar / Abscessified lung infection as an onset form of pulmonary abscess

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Evaluation of the utility of vibration response imaging device and Operation Planning Software in the assessment of patients before lung resection surgery.

BACKGROUND AND OBJECTIVES: A variety of methods have been used to evaluate patients with lung cancer to define a patient cohort at high risk for postoperative mortality and respiratory complications associated with lung resection surgery. Our aim was to evaluate the utility of vibration response imaging (VRI(XP)) Operation Planning Software (O-Plan) in assessing suitability for surgical resection and for the prediction of postoperative forced expiratory volume in 1s (ppoFEV(1)). METHODS: A total of 58 subjects with lung cancer underwent evaluation prior to lung resection surgery and postoperative lung function after surgery. RESULTS: Preoperative pulmonary function tests and quantitative breath sound measurements by VRI were performed in all patients to estimate postoperative lung function. In addition, 20 patients underwent perfusion scan prior to surgery. VRI(XP) O-Plan predictions (12 pneumonectomies and 46 lobectomies) showed good correlation and concordance (Lin's coefficient) with postoperative FEV(1) (l) (r=0.865, Lin's coefficient 0.858) and FEV(1) (%) (r=0.877, Lin's coefficient 0.861) 4-6 weeks after surgery. Predicted and postoperative measured FEV(1) showed no significant differences (p>0.05). Average lung function predicted postoperative values were similar for perfusion and VRI(XP) O-Plan calculations with a correlation of 0.74 and concordance of 0.700. CONCLUSIONS: VRI(XP) O-Plan has shown high accuracy in predicting postoperative FEV(1) after lung resection surgery. Given its simplicity of operation and the non-invasive nature of VRI(XP) and O-Plan, it could be a good alternative to perfusion scan in pre-surgery assessment.