IgE, blood eosinophils and FeNO are not enough for choosing a monoclonal therapy among the approved options in patients with type 2 severe asthma.

Type-2 inflammation is the most frequent endophenotype of asthma. Different biomarkers have been proposed to identify this inflammation because highly effective therapies have improved type-2 severe asthma control. We investigated the frequency of some biomarkers of type-2 inflammation (total IgE, sIgE, blood eosinophil, and FeNO) in the framework of severe asthma and assessed its ability to help us to choose the best biological therapy for each patient. Different scenarios (sensitivity analysis) were evaluated according to the biomarkers proposed for each biological therapy in 72 patients with type-2 severe asthma. Between 54.1% and 68% of patients could receive at least 2 different biological therapies and 34.7%-40.2% could receive any of the 3 types of therapies (anti-IgE, anti-eosinophil, anti-IL4). Biomarkers help to identify type-2 severe asthma but total IgE, sIgE, blood eosinophil, and FeNO are not enough to select 1 specific therapy. With the increasing arrival of new biological therapies, it is necessary to identify new biomarkers that allow us to improve our selection criteria for the best therapy for each patient or to construct a prediction rule.

Patrones de detección del deterioro cognitivo leve en enfermería / Patterns of detection of mild cognitive impairment in nursing

El deterioro cognitivo leve supone una pérdida cognitiva adquirida que sitúa a los pacientes afectados, fundamentalmente ancianos, en un estadio intermedio entre el estado cognitivo normal y la demencia. Supone además una situación de alto riesgo de progresión hacia demencia, siendo susceptible de detección precoz para una intervención más eficaz. Los profesionales de enfermería, sobre todo en un nivel primario de atención en la comunidad, juegan un papel importante en la detección, seguimiento e intervención sobre el deterioro cognitivo leve. Se debe comenzar con una buena anamnesis, en el paciente y sus cuidadores, donde se valoran los cambios que se han producido en la vida diaria, familiar y social del paciente a través de patrones funcionales. La posterior valoración de las funciones cognitivas puede apoyarse sobre diferentes test breves de detección como el Mini Mental State Examinatión u otros similares. Es necesario prestar especial atención a la presencia de síntomas afectivos o depresivos, déficits sensoriales, polifarmacia, factores de riesgo cardiovascular descompensados o un rápido deterioro funcional, dada su especial influencia sobre el cuadro de deterioro cognitivo leve. Finalmente, existen diferentes intervenciones no farmacológicas recomendables desde el profesional de enfermería, eficaces sobre el deterioro cognitivo leve, basadas en el control de factores de riesgo cardiovascular, ejercicio físico e intervenciones cognitivas y psicosociales (AU)

Mild cognitive impairment (MCI) is characterized by an acquired cognitive loss that places individuals, mainly older adults, in an intermediate stage between normal cognitive functioning and dementia. This impairment has a high risk of progression to dementia and is suitable for screening, which allows more effective early intervention. Nursing professionals, especially community-based primary care nurses, play an important role in the detection and follow-up of MCI and in interventions for this condition. The first step should be to take a thorough history from both the patient and his or her carers, which should assess the changes occurring in the patient’s daily, family and social life through functional patterns. In subsequent assessment of cognitive function, brief screening tests can be used such as the Mini Mental State Examination (MMSE) or other similar tests. Special attention should be paid to the presence of affective or depressive symptoms, sensory deficits, polypharmacy, decompensated cardiovascular risk factors, and rapid functional deterioration, given their particular influence on MCI. Finally, various nurse-led, nonpharmacological interventions that are effective in MCI can be recommended, based on cardiovascular risk factor control, physical exercise, and cognitive and psychosocial interventions (AU)

[Patterns of detection of mild cognitive impairment in nursing]. / Patrones de detección del deterioro cognitivo leve en enfermería.

Mild cognitive impairment (MCI) is characterized by an acquired cognitive loss that places individuals, mainly older adults, in an intermediate stage between normal cognitive functioning and dementia. This impairment has a high risk of progression to dementia and is suitable for screening, which allows more effective early intervention. Nursing professionals, especially community-based primary care nurses, play an important role in the detection and follow-up of MCI and in interventions for this condition. The first step should be to take a thorough history from both the patient and his or her carers, which should assess the changes occurring in the patient's daily, family and social life through functional patterns. In subsequent assessment of cognitive function, brief screening tests can be used such as the Mini Mental State Examination (MMSE) or other similar tests. Special attention should be paid to the presence of affective or depressive symptoms, sensory deficits, polypharmacy, decompensated cardiovascular risk factors, and rapid functional deterioration, given their particular influence on MCI. Finally, various nurse-led, non-pharmacological interventions that are effective in MCI can be recommended, based on cardiovascular risk factor control, physical exercise, and cognitive and psychosocial interventions.