RESUMEN
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.
RESUMEN
Introducción: Las guías clínicas de asma recomiendan la adopción de conductas de evitación alergénica. Para poder adoptarlas, los pacientes deben conocer las alergias que tienen. Sin embargo, este grado de conocimiento no ha sido hasta ahora evaluado. Los objetivos principales del estudio fueron determinar, en pacientes con asma alérgica: a) el grado de conocimiento de sus propias sensibilizaciones alérgicas; b) el porcentaje que conocen todas sus alergias y que, además, siguen normas de evitación alergénica (NEA) frente a todas ellas, y c) el eventual impacto de dicho grado de conocimiento sobre el nivel de control del asma. Pacientes y métodos: Estudio descriptivo, prospectivo y multicéntrico, con inclusión de 147 pacientes reclutados en 9 consultas externas de neumología. Tras verificar el diagnóstico previo de asma alérgica, se cumplimentó un cuestionario registrando los niveles de control y gravedad del asma, los resultados de los estudios de alergia previos, y la descripción y el número de sensibilizaciones alérgicas conocidas por el paciente y de NEA seguidas. Resultados: Tan solo 72 (49%) pacientes conocían todas sus sensibilizaciones alérgicas y únicamente 48 (33%) seguían, además, NEA frente a todos los alérgenos a los que eran alérgicos. No se demostró que existiera ninguna relación entre el grado de conocimiento de las propias sensibilizaciones alérgicas y el nivel de control del asma (p = 0,544). Conclusiones: El conocimiento global acerca de la naturaleza alérgica de su enfermedad, entre los pacientes asmáticos visitados en los servicios de neumología españoles, es insuficiente. Además, un adecuado conocimiento de las propias alergias no parece repercutir, por sí solo, en un mejor control del asma. Todo ello parece cuestionar la eficacia de las estrategias educativas actuales en este campo y, en consecuencia, estas deberían revisarse (AU)
Background: Asthma guidelines recommend the adoption of allergen avoidance measures (AAM). To do so, patients need to know their own allergies. However, this degree of knowledge has not yet been assessed. The aims of this study were to determine, in allergic asthma patients: (I) the degree of knowledge of their own allergic sensitizations; (II) the percentage of those who knew all their allergies and, in addition, adopted AAM against all of them, and (III) the possible impact of this degree of knowledge on the level of asthma control. Patients and methods: Descriptive, prospective and multicentre study, including 147 patients from 9 Respiratory Medicine outpatient clinics. After confirming the previous allergic asthma diagnosis, a questionnaire was completed. It included asthma control and severity levels, results of previous allergy tests, and the description and number of allergic sensitizations known by the patients and AAM followed. Results: Only 72 (49%) patients knew all their allergic sensitizations and only 48 (33%) were also following AAM against all the allergens to which they were allergic. No relationship was established between the degree of knowledge of their own allergies and the level of asthma control (P=0.544). Conclusions: Overall knowledge about the allergic nature of their disease among asthmatic patients attending Spanish Respiratory Medicine Departments is inadequate. Furthermore, a higher degree of knowledge of their allergies does not seem to lead, by itself, to better asthma control. Both findings seem to question the effectiveness of current educational strategies in this field and consequently, and they should be revised (AU)
Asunto(s)
Humanos , Masculino , Femenino , Alérgenos , Alérgenos/uso terapéutico , Desensibilización Inmunológica/instrumentación , Asma/epidemiología , Asma/inmunología , Asma/prevención & control , Pruebas Cutáneas/instrumentación , Pruebas Cutáneas/métodos , Pruebas Cutáneas , Contaminación Ambiental/prevención & control , Contaminación Ambiental/estadística & datos numéricos , Educación en Salud/métodos , Desensibilización Inmunológica/métodos , Desensibilización Inmunológica , Educación en Salud/tendencias , Educación en Salud , Pruebas Cutáneas/tendenciasRESUMEN
BACKGROUND: Asthma guidelines recommend the adoption of allergen avoidance measures (AAM). To do so, patients need to know their own allergies. However, this degree of knowledge has not yet been assessed. The aims of this study were to determine, in allergic asthma patients: i)the degree of knowledge of their own allergic sensitizations; ii)the percentage of those who knew all their allergies and, in addition, adopted AAM against all of them, and iii)the possible impact of this degree of knowledge on the level of asthma control. PATIENTS AND METHODS: Descriptive, prospective and multicentre study, including 147patients from 9 Respiratory Medicine outpatient clinics. After confirming the previous allergic asthma diagnosis, a questionnaire was completed. It included asthma control and severity levels, results of previous allergy tests, and the description and number of allergic sensitizations known by the patients and AAM followed. RESULTS: Only 72 (49%) patients knew all their allergic sensitizations and only 48 (33%) were also following AAM against all the allergens to which they were allergic. No relationship was established between the degree of knowledge of their own allergies and the level of asthma control (P=.544). CONCLUSIONS: Overall knowledge about the allergic nature of their disease among asthmatic patients attending Spanish Respiratory Medicine Departments is inadequate. Furthermore, a higher degree of knowledge of their allergies does not seem to lead, by itself, to better asthma control. Both findings seem to question the effectiveness of current educational strategies in this field and consequently, they should be revised.
Asunto(s)
Alérgenos/efectos adversos , Asma/psicología , Conocimientos, Actitudes y Práctica en Salud , Hipersensibilidad/psicología , Pacientes Ambulatorios/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antialérgicos/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Asma/etiología , Asma/prevención & control , Escolaridad , Femenino , Humanos , Hipersensibilidad/complicaciones , Masculino , Persona de Mediana Edad , Servicio Ambulatorio en Hospital , Educación del Paciente como Asunto , Conocimiento de la Medicación por el Paciente , Estudios Prospectivos , Neumología , España , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To determine the prevalence of chronic colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis, describe antibiotic sensitivity of the strains, and compare the patients' clinical characteristics with those of patients infected with methicillin-sensitive S. aureus (MSSA). PATIENTS AND METHODS: Patients with chronic S. aureus colonization were selected from a total of 50 patients with cystic fibrosis. Sputum samples were cultured according to standard microbiological procedures. Patients were considered to have chronic bronchial colonization if the same microorganism was isolated in 3 consecutive sputum samples, separated by an interval of at least 1 month. The following variables were compared between patients with MSSA (17) and MRSA (8): sex, body mass index, presence of pancreatic insufficiency, bacterial colonization, pulmonary function, Brasfield radiological score, Shwachman clinical score, and number of respiratory exacerbations in the previous year. RESULTS: The prevalence of infection by MRSA was 16%. All the MRSA strains were sensitive to vancomycin, teicoplanin, and linezolid. Patients with MRSA were older and had a larger number of respiratory exacerbations than patients with MSSA. CONCLUSIONS: There is a high percentage of colonization by MRSA in adult cystic fibrosis patients. Although the pathogenic role of this microorganism remains unclear, patients with MRSA had more frequent exacerbations and poorer lung function. Thus, infection control is important and patients should be adequately monitored.
Asunto(s)
Bronquios/microbiología , Bronquitis/microbiología , Fibrosis Quística/complicaciones , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/microbiología , Adulto , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bronquitis/epidemiología , Bronquitis/etiología , Bronquitis/inmunología , Estudios Transversales , Susceptibilidad a Enfermedades , Farmacorresistencia Bacteriana Múltiple , Insuficiencia Pancreática Exocrina/epidemiología , Insuficiencia Pancreática Exocrina/etiología , Femenino , Humanos , Masculino , Resistencia a la Meticilina , Persona de Mediana Edad , Prevalencia , Infecciones por Pseudomonas/epidemiología , Estudios Retrospectivos , España/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiología , Adulto JovenRESUMEN
Objetivo: valorar la prevalencia de colonización crónica por Staphylococcus aureus resistente a meticilina (SARM) en pacientes con fibrosis quística, describir la sensibilidad antibiótica de las cepas, así como comparar las características clínicas con los pacientes con S. aureus sensible a meticilina (SASM). Pacientes y métodos: de un total de 50 pacientes con FQ se seleccionó a los colonizados crónicamente por S. aureus. Las muestras de esputo se cultivaron según los procedimientos microbiológicos habituales, se consideró colonización bronquial crónica el aislamiento de un mismo microorganismo en más de 3 muestras respiratorias consecutivas con un intervalo mínimo de 1 mes entre ellas. Se compararon las siguientes variables entre los pacientes con SASM (n=17) y aquellos con SARM (n=8): sexo, índice de masa corporal, insuficiencia pancreática, colonización bacteriana, función pulmonar, puntuaciones radiológicas de Brasfield y clínica de Shwachman y número de exacerbaciones respiratorias en el año previo. Resultados: la prevalencia de infección por SARM fue del 16%. El 100% de las cepas SARM fueron sensibles a vancomicina, teicoplanina y linezolid. Los enfermos con SARM tenían más edad, peor estado clínico y mayor número de exacerbaciones respiratorias que los pacientes con SASM. Conclusiones: hay un alto porcentaje de colonización por SARM en los pacientes adultos con fibrosis quística. Aunque el papel patogénico de esta bacteria está aún por determinar, parece que los pacientes con SARM tienen un peor estado clínico y presentan muchas exacerbaciones, por lo que la instauración de medidas de control y vigilancia es importante (AU)
Objective: To determine the prevalence of chronic colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients with cystic fibrosis, describe antibiotic sensitivity of the strains, and compare the patients¿ clinical characteristics with those of patients infected with methicillin-sensitive S. aureus (MSSA). Patients and methods: Patients with chronic S. aureus colonization were selected from a total of 50 patients with cystic fibrosis. Sputum samples were cultured according to standard microbiological procedures. Patients were considered to have chronic bronchial colonization if the same microorganism was isolated in 3 consecutive sputum samples, separated by an interval of at least 1 month. The following variables were compared between patients with MSSA (17) and MRSA (8): sex, body mass index, presence of pancreatic insufficiency, bacterial colonization, pulmonary function, Brasfield radiological score, Shwachman clinical score, and number of respiratory exacerbations in the previous year. Results: The prevalence of infection by MRSA was 16%. All the MRSA strains were sensitive to vancomycin, teicoplanin, and linezolid. Patients with MRSA were older and had a larger number of respiratory exacerbations than patients with MSSA. Conclusions: There is a high percentage of colonization by MRSA in adult cystic fibrosis patients. Although the pathogenic role of this microorganism remains unclear, patients with MRSA had more frequent exacerbations and poorer lung function. Thus, infection control is important and patients should be adequately monitored (AU)