Severity and outcomes of community acquired pneumonia in asthmatic patients.

BACKGROUND: Limited information is available about clinical outcomes and microbiology of community-acquired pneumonia in asthma. METHODS: We prospectively studied 4079 CAP patients over a 12-years period and found 139 (3.4%) asthmatic patients. RESULTS: Asthmatics showed younger age (57 ± 19 vs. 66 ± 19 years), less males (32% vs. 68%) and less active smokers (15% vs. 25%). Moreover, they had used more frequently inhaled corticosteroids (ICs, 53% vs. 17%, p < 0.001) and antibiotics (32% vs. 24%, p = 0.041). In comparison with non asthma-CAP, asthmatics showed at admission more pleuritic pain and dyspnoea but less severe pneumonia (PSI, CURB-65, PaO(2)/FIO(2) ratio; p < 0.05). No differences were observed in CAP microbiology, being Streptococcus pneumoniae the most frequent isolate. Clinical outcomes in asthmatic patients were similar to the general population (mortality, mechanical ventilation, etc.) but with a shorter median length of stay (6 [3; 9] vs. 7 [4; 10] days, p = 0.023). The chronic use of ICs did not influence clinical presentation and outcomes among asthmatic patients. CONCLUSIONS: Asthmatics were younger and showed similar clinical presentation. Consistently with PSI, asthmatics showed similar outcomes than the general population. The microbial aetiology of CAP in asthma did not differ from the general population and antibiotic therapy should follow current guidelines.

Psychological profile of patients with bronchial asthma and functional dyspnea: a comparison with a non-asthmatic population and impact on the disease.

BACKGROUND: Few studies have analysed the relationship between anxiety and alexithymia with functional dyspnea (FD) and its impact on quality of life and asthma control. The aim of this study was to assess the prevalence of DD in asthma, its impact on quality of life and asthma control and its relationship with anxiety and alexithymia. PATIENTS AND METHODS: We performed a cross-sectional study of 264 asthmatic patients and 111 controls. Both groups completed the following questionnaires: quality of life (AQLQ), alexithymia (TAS-20), anxiety (STAI) and FD (Nijmegen). In asthmatics were evaluated: asthma severity, dyspnoea, exacerbation and control of the disease (ACT test). RESULTS: 38% of asthmatics and 5.5% of non-asthmatics had FD. Asthmatics had more anxiety and were more alexithymic. Asthmatics with FD had significantly more anxiety, more alexithymia, poor control of asthma, more exacerbations and poorer quality of life, that asthma without DD. Asthmatics with an ACT<19, a score >3 in the emotion subscale of the AQLQ, who were being treated for anxiety and scored >19 on the alexithymia subscale that assesses difficulty in identifying emotions, showed ORs for FD of 2.6 (1.1-5.9), 6.8 (2.9-15.8), 4.4 (1.9-9.8) and 3.3 (1.5-7), respectively. A predictive model of FD was constructed. CONCLUSIONS: We demonstrated the close relationship between anxiety, alexithymia and DD in asthmatics, as well as the significant impact of FD on the control and quality of life of this asthmatics.

Perfil psicológico de los pacientes con asma bronquial y disnea funcional: comparación con población no asmática e impacto sobre la enfermedad / Psychological Profile of Patients with Bronchial Asthma and Functional Dyspnea: A Comparison with a Non-Asthmatic Population and Impact on the Disease

IntroducciónPocos estudios analizan la relación de la ansiedad o la alexitimia con la disnea funcional (DF) y su impacto en calidad de vida y control del asma. El objetivo de este estudio fue evaluar la prevalencia de la DF en el asma, su repercusión sobre la calidad de vida y el control del asma y su relación con la ansiedad y la alexitimia.Pacientes y métodosSe realizó un estudio transversal de 264 pacientes asmáticos y 111 controles. Ambos grupos cumplimentaron los siguientes cuestionarios: calidad de vida (AQLQ), alexitimia (TAS-20), ansiedad (STAI) y DF (Nijmegen). En asmáticos se evalúo: gravedad del asma, grado de disnea, exacerbaciones y control de la enfermedad (test ACT).ResultadosUn 38% de asmáticos y un 5,5% de no asmáticos tenían DF. Los asmáticos tenían más ansiedad y eran más alexitímicos. Los asmáticos con DF tenían de manera significativa más ansiedad, más alexitimia, peor control del asma, más exacerbaciones y peor calidad de vida que asmáticos sin DF. Los asmáticos con ACT<19, una puntuación > 3 en la subescala de emoción del AQLQ, que estaban siendo tratados para ansiedad y que puntuaban > 19 en la subescala de alexitimia que evalúa dificultad para identificar emociones mostraban OR para DF de 2,6 (1,1-5,9), 6,8 (2,9-15,8), 4,4 (1,9-9,8) y 3,3 (1,5-7), respectivamente. Se construyó modelo predictivo de DF en asmáticos.ConclusionesSe demuestra la relación estrecha entre ansiedad, alexitimia y DF en asmáticos, así como importantes repercusiones que tiene la DF sobre el control y calidad de vida del asmático(AU)

BackgroundFew studies have analysed the relationship between anxiety and alexithymia with functional dyspnea (FD) and its impact on quality of life and asthma control. The aim of this study was to assess the prevalence of DD in asthma, its impact on quality of life and asthma control and its relationship with anxiety and alexithymia.Patients and methodsWe performed a cross-sectional study of 264 asthmatic patients and 111 controls. Both groups completed the following questionnaires: quality of life (AQLQ), alexithymia (TAS-20), anxiety (STAI) and FD (Nijmegen). In asthmatics were evaluated: asthma severity, dyspnoea, exacerbation and control of the disease (ACT test).Results38% of asthmatics and 5.5% of non-asthmatics had FD. Asthmatics had more anxiety and were more alexithymic. Asthmatics with FD had significantly more anxiety, more alexithymia, poor control of asthma, more exacerbations and poorer quality of life, that asthma without DD. Asthmatics with an ACT<19, a score >3 in the emotion subscale of the AQLQ, who were being treated for anxiety and scored >19 on the alexithymia subscale that assesses difficulty in identifying emotions, showed ORs for FD of 2.6 (1.1-5.9), 6.8 (2.9-15.8), 4.4 (1.9-9.8) and 3.3 (1.5-7), respectively. A predictive model of FD was constructed.ConclusionsWe demonstrated the close relationship between anxiety, alexithymia and DD in asthmatics, as well as the significant impact of FD on the control and quality of life of this asthmatics(AU)