Asunto(s)
Síndrome de Superposición de la Enfermedad Pulmonar Obstructiva Crónica-Asmática , Humanos , Femenino , Prevalencia , Masculino , Persona de Mediana Edad , Síndrome de Superposición de la Enfermedad Pulmonar Obstructiva Crónica-Asmática/diagnóstico , Síndrome de Superposición de la Enfermedad Pulmonar Obstructiva Crónica-Asmática/epidemiología , Anciano , Pulmón/fisiopatología , Asma/epidemiología , Asma/diagnóstico , Estudios de Cohortes , Adulto , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/diagnósticoRESUMEN
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.
Asunto(s)
COVID-19 , Salud Laboral , Seguridad del Paciente , Hipersensibilidad Respiratoria/fisiopatología , Sistema Respiratorio/fisiopatología , SARS-CoV-2 , COVID-19/diagnóstico , COVID-19/transmisión , Personal de Salud , Humanos , Tamizaje Masivo , Pruebas de Función Respiratoria , VentilaciónRESUMEN
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
Asunto(s)
Humanos , Pruebas de Función Respiratoria/métodos , Infecciones por Coronavirus/epidemiología , Asma/diagnóstico , Biomarcadores , Rinitis Alérgica/diagnóstico , Síndrome Respiratorio Agudo Grave/transmisión , Pruebas de Función Respiratoria/instrumentación , Síndrome Respiratorio Agudo Grave/prevención & control , Infecciones por Coronavirus/prevención & control , Síndrome Respiratorio Agudo Grave/epidemiologíaAsunto(s)
Pruebas Respiratorias/instrumentación , Óxido Nítrico/metabolismo , Adolescente , Adulto , Anciano , Asma/diagnóstico , Asma/metabolismo , Eosinofilia/diagnóstico , Eosinofilia/metabolismo , Espiración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Asthma is one of the most prevalent chronic diseases in Spain. Current treatments ensure that the disease is controlled in most cases. However, disease is often uncontrolled in daily clinical practice, mainly owing to underdiagnosis, loss to follow-up, and poor adherence to therapy. In order to improve this situation, we must coordinate all those health professionals who intervene in patient care. Therefore, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG), and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) have drawn up a consensus document in which they establish criteria for referral and guidelines for the diagnosis, control, and follow-up of patients with asthma. The document aims to facilitate continuing and improved care in this area.
Asunto(s)
Asma , Derivación y Consulta , Asma/diagnóstico , Asma/terapia , Consenso , Humanos , Atención Primaria de SaludAsunto(s)
Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Asma/etiología , Eosinófilos/inmunología , Antiasmáticos/farmacología , Asma/diagnóstico , Terapia Biológica/métodos , Biomarcadores , Eosinófilos/metabolismo , Eosinófilos/patología , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Asma/etiología , Susceptibilidad a Enfermedades , Obesidad/complicaciones , Animales , Antiasmáticos/farmacología , Antiasmáticos/uso terapéutico , Asma/diagnóstico , Asma/tratamiento farmacológico , Asma/epidemiología , Comorbilidad , Humanos , Obesidad/tratamiento farmacológico , Obesidad/epidemiología , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoAsunto(s)
Corticoesteroides/uso terapéutico , Asma/tratamiento farmacológico , Biomarcadores/sangre , Proteína Catiónica del Eosinófilo/sangre , Eosinófilos/efectos de los fármacos , Óxido Nítrico/metabolismo , Esputo/efectos de los fármacos , Asma/sangre , Asma/metabolismo , Biomarcadores/metabolismo , Proteína Catiónica del Eosinófilo/metabolismo , Espiración/efectos de los fármacos , Humanos , Recuento de Leucocitos/métodos , Esputo/metabolismoRESUMEN
BACKGROUND: After a diagnosis of anaphylaxis, patients receive action management plans to prevent and treat new episodes, including attending the emergency department for follow-up or further treatment. In a previous study, we observed that more than half of the children with anaphylaxis were incorrectly prioritized in our Pediatric Emergency Unit (PEU), thus delaying their treatment. In conjunction with our PEU staff, we designed a basic educational intervention (BEI) to try to solve this problem. We analyzed the effect of the intervention on triage of children subsequently diagnosed with anaphylaxis. METHODS: Our BEI consisted of a training lecture given to the PEU triage nurses and the design of a reference card highlighting symptoms and risk factors of anaphylaxis. We included 138 children with a medical diagnosis of anaphylaxis and assessed modifications in their triage priority level and waiting times (WT) before seeing a physician after our intervention. According to the BEI implementation date, 69 children were diagnosed before the intervention (G1) and 69 after (G2). Clinical data were compared to assess the severity of the episodes. RESULTS: There were no differences between the groups. WT decreased (from 8 to 1 minute; P=.03), and the number of correctly identified patients increased after the BEI (36.2% [G1] and 72.2% [G2]; P=.0001). CONCLUSIONS: Our BEI was effective, improving the identification and prioritization of children with anaphylaxis and reducing their WT. We need to pay attention to the functioning of our patients' reference emergency department and establish interdisciplinary measures that enable optimal management of anaphylaxis.
Asunto(s)
Anafilaxia/terapia , Educación/métodos , Personal de Enfermería/educación , Servicio de Urgencia en Hospital/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención al Paciente/métodos , Centros de Atención Terciaria/normas , Triaje/normasAsunto(s)
Asma , Encuestas y Cuestionarios , Humanos , Índice de Severidad de la Enfermedad , EspañaRESUMEN
BACKGROUND: The eosinophilic asthma phenotype (sputum eosinophils 3%) indicates a good response to corticosteroids and T(H)2 immunomodulators. Exhaled nitric oxide (FeNO) is rapidly measured by portable devices, and although it is not a selective marker of eosinophilic inflammation, several studies have demonstrated a strong correlation with it. We investigated which FeNO value was the best fit with 3% sputum eosinophils in asthma patients. METHODS: We included 129 consecutive, nonsmoking asthmatics who underwent skin tests, FeNO quantification (NIOX MINO), spirometry, and induced sputum analysis and completed the Asthma Control Test questionnaire. Receiver operating characteristic curves were constructed, and logistic regression analysis was performed. RESULTS: Symptoms were detected more frequently in the eosinophilic asthma group, as were higher airway obstruction and sensitivity to hypertonic saline. The FeNO cutoff point of 21 ppb was the best fit with 3% sputum eosinophilia. This value behaved better among corticosteroid-naïve patients (sensitivity, 97%; specificity, 58%; positive predictive value, 86%; negative predictive value, 88%) than among those receiving corticosteroids (sensitivity, 81%; specificity, 25%; positive predictive value, 74%; negative predictive value, 33%). CONCLUSION: FeNO ≥ 21 ppb is associated with airway eosinophilia. In corticosteroid-naïve patients, FeNO < 21 ppb enables us to rule out airway eosinophilia.
Asunto(s)
Asma/diagnóstico , Pruebas Respiratorias , Eosinófilos/inmunología , Espiración , Mediadores de Inflamación/metabolismo , Óxido Nítrico/metabolismo , Eosinofilia Pulmonar/diagnóstico , Esputo/inmunología , Adolescente , Adulto , Asma/inmunología , Asma/metabolismo , Asma/fisiopatología , Biomarcadores/metabolismo , Niño , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Fenotipo , Valor Predictivo de las Pruebas , Eosinofilia Pulmonar/inmunología , Eosinofilia Pulmonar/metabolismo , Eosinofilia Pulmonar/fisiopatología , Curva ROC , Pruebas Cutáneas , Espirometría , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Eosinophilic asthma phenotype predicts good response to corticosteroids and associates to asthmatic exacerbations. Sputum induction by hypertonic saline (HS) inhalation is technically demanding. Bronchial hyperresponsiveness (BHR) to osmotic agents indirectly mirrors active airway inflammation. We compared the safety and ability of HS and mannitol to induce sputum and measure BHR. We evaluated the stability of inflammatory phenotypes. We studied 35 non-smoking asthmatics randomized to undergo HS and mannitol challenges on 2 days 1 week apart. Sputum was sampled for cell analysis and phenotyped as eosinophilic (≥3% eosinophils) and non-eosinophilic (<3%) asthma. Nineteen subjects had BHR to mannitol and nine of them also had BHR to HS. Drops in forced expiratory volume in 1 s were higher from HS challenge than from mannitol challenge. Adequate sputum samples were obtained from 80% subjects (68% mannitol and 71% HS). Eosinophils and macrophages from both challenges correlated. Neutrophils were higher in sputum from HS. Ninety percent samples were equally phenotyped with HS and mannitol. Fractional exhaled nitric oxide, sputum eosinophils and BHR correlated in both challenges. HS and mannitol showed similar capacity to produce valuable sputum samples. BHR to both osmotic stimuli partially resembled airway eosinophilic inflammation but mannitol was more sensitive than HS to assess BHR. Eosinophilic phenotype remained stable in most patients with both stimuli.
Asunto(s)
Asma/fisiopatología , Hiperreactividad Bronquial/diagnóstico , Diuréticos Osmóticos/farmacología , Manitol/farmacología , Solución Salina Hipertónica/farmacología , Esputo/citología , Esputo/efectos de los fármacos , Adolescente , Adulto , Asma/complicaciones , Asma/inmunología , Pruebas Respiratorias , Hiperreactividad Bronquial/complicaciones , Diuréticos Osmóticos/efectos adversos , Eosinófilos , Femenino , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Macrófagos , Masculino , Manitol/efectos adversos , Persona de Mediana Edad , Neutrófilos , Óxido Nítrico/análisis , Solución Salina Hipertónica/efectos adversos , Esputo/metabolismo , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Preschool children can perform quality, reproducible spirometric maneuvers, provided appropriate equipment is used and specially trained nursing staff training are available. However, use of spirometry for the diagnosis and follow-up of preschool children with respiratory diseases remains limited in clinical practice, because consensus on test quality and acceptability criteria and reference data are lacking. We initiated the present study with the aim of developing reference equations, since tables of normal values for this age group are not available in our area. PATIENTS AND METHODS: The study population comprised healthy preschool children in our community. Normal values for exhaled nitric oxide in this age range were assessed. Regression equations were constructed using univariate and multivariate models. RESULTS: A total of 114 healthy preschool children aged 3 to 6 years were enrolled. According to the criteria of the American Thoracic Society/European Respiratory Society, 60 children were able to perform acceptable and reproducible spirometric maneuvers. The best correlations were observed for the untransformed linear regression model that included height. The correlation coefficients for forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV0.5 were 0.89, 0.88, and 0.86, respectively. The regression equations for the calculation of reference values were as follows: FVC = -2.6 + 0.036 x height, cm FEV1 = -2.04 + 0.029 x height, cm FEV0.5 = -1.53 + 0.022 x height, cm. We obtained fraction of inhaled nitric oxygen (FeNO) values for 56 children. The mean (SD) value was 11 (4.9) ppb. CONCLUSIONS: Most preschool children in our area were able to perform quality spirometry maneuvers. We obtained regression equations that allowed us to calculate the reference ranges in our population and the distribution of normal FeNO values.
Asunto(s)
Pruebas Respiratorias , Óxido Nítrico/análisis , Enfermedades Respiratorias/diagnóstico , Espirometría , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Valores de Referencia , Análisis de RegresiónRESUMEN
BACKGROUND: Carrying out quality spirometric maneuvers in preschool children in both the diagnosis and follow-up of respiratory diseases continues to be very scarce. This is due to several reasons, including a lack of consensus on quality criteria and the acceptability of the test. The purpose of this study is therefore to obtain reference norms from a population of healthy preschool children from the Autonomous Community of Navarre (Spain). METHOD: A total of 114 healthy preschool children aged between 3 and 7 years of age, without prior experience in carrying out lung function tests, were included. RESULTS: A total of 76 were able to realize at least two acceptable spirometric maneuvers, and 60 of them maneuvers that were acceptable and reproducible, according to ATS/ERS criteria. This represents a global success percentage of 59%. The most common failing was premature and brusque termination of the spirometric maneuver, followed by an inadequate peak in breathing. CONCLUSIONS: Over half of the preschool children were able to realize quality spirometric maneuvers. Our data make it possible to recommend the proposed quality criteria as being suitable for routine use, and to encourage the use of spirometry in regular clinical practice within the setting of specialized care.