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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Simões Cunha M, Amaral R, Pereira AM, Almeida R, Alves-Correia M, Loureiro CC, Lopes C, Carvalho J, Ribeiro C, Vidal C, Antolín-Amérigo D, Pinto D, Ferreira-Magalhães M, Vasconcelos MJ, Lozoya C, Santos N, Cardia F, Taborda-Barata L, Ferreira R, Morais Silva P, Ferreira TM, Câmara R, Silva E, Bordalo D, Guimarães C, Calix MJ, da Silva S, Marques ML, Morete A, Nunes C, Vieira C, Páscoa R, Alves A, Marques JV, Reis B, Monteiro L, Monteiro R, Cepa M, Valentim B, Coelho DS, Fernandes S, Meireles P, Aguiar MA, Mourão AR, Fonseca JA, Jácome C. Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies. BMJ Open 2023; 13:e068725. [PMID: 37147092 PMCID: PMC10163458 DOI: 10.1136/bmjopen-2022-068725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms. METHODS This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built. RESULTS According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression. CONCLUSION At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.
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Affiliation(s)
- Mafalda Simões Cunha
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rita Amaral
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
- Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Magna Alves-Correia
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Basic and Clinic Immunology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Immuno-allergology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carmen Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostella, Spain
| | - Dario Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Diana Pinto
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carlos Lozoya
- Allergy, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Francisca Cardia
- Unidade de Saúde Familiar Terras de Azurara, Agrupamento de Centros de Saúde Dão Lafões, Mangualde, Portugal
| | - Luís Taborda-Barata
- CICS-UBI Centro de Investigação em Ciências da Saúde - Health Sciences Research Centre & UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilha, Portugal
- Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | | | - Tania Monteiro Ferreira
- Unidade de Saúde Familiar Progresso e Saúde, Agrupamento de Centros de Saúde Baixo Mondego, Tocha, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Eurico Silva
- Unidade de Saúde Familiar João Semana, Agrupamento de Centros de Saúde de Baixo Vouga, Ovar, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Cristina Guimarães
- Unidade de Cuidados de Saúde Personalizados Norte (Arnaldo Sampaio), Agrupamento de Centros de Saúde Pinhal Litoral, Monte Redondo, Portugal
| | - Maria José Calix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sofia da Silva
- Unidade de Saúde Familiar Cuidarte, Unidade Local de Saúde do Alto Minho, Portuzelo, Portugal
| | - Maria Luís Marques
- Serviço de Imunoalergologia, Hospital da Senhora da Oliveira, Guimarães, Guimaraes, Portugal
| | - Ana Morete
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Serviço de Imunoalergologia, Hospital Infante D Pedro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Carlos Nunes
- Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Cláudia Vieira
- Unidade de Saúde Familiar Corgo, Agrupamento de Centros de Saúde Douro I - Marão e Douro Norte, Vila Real, Portugal
| | - Rosália Páscoa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Adelaide Alves
- Serviço de Pneumologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Varanda Marques
- Unidade de Saúde Familiar Viseu-Cidade, Agrupamento de Centros de Saúde do Dão Lafões, Viseu, Portugal
| | - Bruno Reis
- Unidade de Cuidados Saúde Personalizados Sicó, Agrupamento de Centros de Saúde Pinhal Litoral, Leiria, Portugal
| | - Luís Monteiro
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- USF Esgueira +, ACES Baixo Vouga, Esgueira, Portugal
| | - Rosário Monteiro
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Margarida Cepa
- Unidade de Saúde Familiar Marquês, ACES Pinhal Litoral, Pombal, Portugal
| | - Bruno Valentim
- Unidade de Saúde Familiar Condeixa, ACES Baixo Mondego, Condeixa-a-Nova, Portugal
| | - Daniela Sousa Coelho
- Unidade de Cuidados de Saúde Personalizados de Amarante, ACES Tâmega I - Baixo Tâmega, Amarante, Portugal
| | - Sara Fernandes
- Unidade de Saúde Familiar Bracara Augusta, ACES Cávado I, Braga, Portugal
| | - Patrícia Meireles
- Unidade de Saúde Familiar Almedina, ACES Douro II - Douro Sul, Lamego, Portugal
| | - Margarida Abreu Aguiar
- Unidade de Saúde Familiar Valongo, ACES Grande Porto III - Maia / Valongo, Valongo, Portugal
| | - Ana Rita Mourão
- Unidade de Saúde Familiar Canelas, ACES Grande Porto VIII - Espinho / Gaia, Vila Nova de Gaia, Portugal
| | - Joao A Fonseca
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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Dominguez-Ortega J, Plaza V, Nieto A, Delgado Romero J, Ancochea J, Mejia N, Pastor M, Blanco-Aparicio M. The ATLAS ASMA Study: Assessing the Impact of Asthma on Patients' Life - The Spanish Patients' Perspective. J Asthma Allergy 2023; 16:461-471. [PMID: 37163179 PMCID: PMC10164385 DOI: 10.2147/jaa.s404525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/05/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose ATLAS ASMA described the psychosocial impact of asthma on patients' daily life from patients' perspectives (in terms of impaired personal and intimate relationships, sleep quality, leisure time, daily activities, and others) in Spain. Secondary objective includes description of time since diagnosis, expectations, and satisfaction of patients about disease, treatment and medical assistance received, adherence to treatment, perceived control of asthma, and health-related quality of life. Patients and Methods This was a cross-sectional, observational study, based on a self-administered online survey for adult patients (≥18 years) with asthma. Patients with asthma diagnosis of any type and severity who voluntarily participated in the survey through a web link were included consecutively. In the present manuscript, only adult patients' data are included. Results A total of 132 adults with asthma were included. Moderate/severe asthma constituted 59.1% of the patients (females 71.2%). Overall, most relevant areas affected due to asthma were leisure activities (67.0%) and the quality/quantity of sleep (52.3%). Moderate/severe patients perceived some degree of impairment in work, school, or at home due asthma more frequently vs mild patients (55.2% vs 10.9%). Poorly controlled asthma (ACT≤19) was reported in 41 (70.7%) and 10 (21.7%) moderate/severe and mild patients (p<0.000), respectively. Mild patients obtained higher mean (SD) Mini-AQLQ score than moderate/severe asthma patients (5.6 [1.0] vs 4.3 [1.1], p<0.000), likewise higher significant results for every individual dimension. Most patients cited little limitation to intense efforts (20.5%). Half of the patients mentioned needing more information about asthma. Topics those patients like to have more information were difficulties that may can have and legal topics (78.6%), asthma evolution (78.6%), secondary effects or issues related to the treatment (61.9%) and legal topics (61.9%). Conclusion The study reported important insights on psychosocial impact of asthma on patients' daily life from patients' perspectives along with health determinants in asthma-related health outcomes, sociodemographic and psychosocial factors.
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Affiliation(s)
- Javier Dominguez-Ortega
- Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain
- Correspondence: Javier Dominguez-Ortega, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain, Tel +34 616 719 390, Email
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain
| | - Antonio Nieto
- Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain
| | | | - Julio Ancochea
- Pneumology Department, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain
- Pneumology Department, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Natalia Mejia
- Medical Department, Novartis Farmacéutica, Barcelona, Spain
| | - Mariano Pastor
- Fundación Española de Asociaciones de Pacientes Alérgicos y con Enfermedades Respiratorias (FENAER), Madrid, Spain
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Plaza V, Alobid I, Alvarez C, Blanco M, Ferreira J, García G, Gómez-Outes A, Gómez F, Hidalgo A, Korta J, Molina J, Pellegrini FJ, Pérez M, Plaza J, Praena M, Quirce S, Sanz J. [Translated article] Spanish Asthma Management Guidelines (GEMA) v.5.1. Highlights and Controversies. Arch Bronconeumol 2022; 58:T150-T158. [PMID: 35971814 DOI: 10.1016/j.arbres.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.
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Affiliation(s)
- Vicente Plaza
- Comité Ejecutivo GEMA, Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Isam Alobid
- Sociedad Española de Otorrinolaringología (SEORL), Hospital Clinic, Universidad de Barcelona, Barcelona, Spain
| | - Cesáreo Alvarez
- Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Hospital de Verín, Orense, Spain
| | - Marina Blanco
- Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Jorge Ferreira
- Sociedad Portuguesa de Pneumologia (SPP), Hospital de São Sebastião • CHEDV, Santa Maria da Feira, Portugal
| | - Gabriel García
- Asociación Latinoamericana del Tórax (ALAT), Hospital Rossi La Plata, Buenos Aires, Argentina
| | - Antonio Gómez-Outes
- Sociedad Española de Farmacología Clínica (SEFC), Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Fernando Gómez
- Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud de Bargas, Toledo, Spain
| | - Antonio Hidalgo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Lucena I. Lucena, Córdoba, Spain
| | - Javier Korta
- Sociedad Española de Neumología Pediátrica (SENP), Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - Jesús Molina
- Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y Sociedad de Respiratorio de Atención Primaria (GRAP), Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, Spain
| | - Francisco Javier Pellegrini
- Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud de Pizarrales, Salamanca, Spain
| | - Montserrat Pérez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Javier Plaza
- Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC), Farmacia Dres. Zamora Navarro, Mazarrón, Murcia, Spain
| | - Manuel Praena
- Asociación Española de Pediatría de Atención Primaria (AEPap), Centro de Salud La Candelaria, Sevilla, Spain
| | - Santiago Quirce
- Sociedad Española de Alergia e Inmunología Clínica (SEAIC), Hospital Universitario La Paz, Madrid, Spain
| | - José Sanz
- Sociedad Española de Inmunología Clínica•Alergología y Asma Pediátrica (SEICAP), Hospital Católico Universitario Casa de Salud, Valencia, Spain
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Casas-Maldonado F, Álvarez-Gutiérrez FJ, Blanco-Aparicio M, Domingo-Ribas C, Cisneros-Serrano C, Soto-Campos G, Román-Bernal B, González-Barcala FJ. Monoclonal antibody treatment for severe uncontrolled asthma in Spain: analytical map. J Asthma 2021; 59:1997-2007. [PMID: 34503370 DOI: 10.1080/02770903.2021.1978483] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Monoclonal antibodies (mABs) have become available to treat more efficiently patients with severe uncontrolled asthma (SUA). However, the use of mABs is lower than expected given the prevalence of SUA, with significant disparities in the use of these treatments. OBJECTIVE To evaluate the proportion of patients with SUA treated with mABs in Spain, and to analyze some of the factors that could determine these prescription patterns. METHODS An analysis was performed on the data provided from the Hospitals National Health System (NHS) 2018 catalogue where Chest Diseases Department and a Hospital Pharmacy were available. Random sampling was performed to determine the sample size, stratifying proportionally by geographic area and hospital level. Characteristics of the participating sites, as well as the prescribing of mABs were collected, which included geographic area, hospital levels, prescribing medical specialities, types of clinics, and mABs prescribed. RESULTS Data from 90 hospitals were analyzed (Response rate 64.3%). Level 4 hospitals, the Canary Islands geographical area, and the presence of a high complexity Asthma Healthcare Unit (ACU) were associated with a higher probability that the SUA was treated with mABs. CONCLUSION The map of the prescribing of mABs for SUA in Spain shows a significant variation by geographic area, hospital level, type of clinic, and the accreditation level of the ACUs. At the current time, there appears to be significant under-prescribing of these treatments.
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Affiliation(s)
| | | | | | - Christian Domingo-Ribas
- Servei de Pneumologia, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.,Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España
| | - Carolina Cisneros-Serrano
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España.,Fundación de Investigación Biomédica La Princesa, Madrid, España
| | - Gregorio Soto-Campos
- Servicio de Neumología y Alergia, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - Berta Román-Bernal
- Neumología, Hospital Dr. José Molina Orosa, Arrecife, Las Palmas, España
| | - Francisco-Javier González-Barcala
- Servicio de Neumología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.,Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, España.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias - CIBERES, Madrid, España.,Grupo Translational Research in Airway Diseases-FIDIS, Santiago de Compostela, A Coruña, España
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Plaza V, Alobid I, Alvarez C, Blanco M, Ferreira J, García G, Gómez-Outes A, Gómez F, Hidalgo A, Korta J, Molina J, Pellegrini FJ, Pérez M, Plaza J, Praena M, Quirce S, Sanz J. Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. Highlights and Controversies. Arch Bronconeumol 2021; 58:150-158. [PMID: 34167859 DOI: 10.1016/j.arbres.2021.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
In this fifth phase of development, the contents of the Spanish Asthma Management Guidelines (GEMA), which include versions 5.0 and 5.1, have undergone a thorough review. The aim here is to set the main changes in context. These could be summarized as follows: DIAGNOSIS: new FENO cut-off and severity classification based on treatment needed to maintain control; INTERMITTENT ASTHMA: a more restrictive concept and treatment extended to include a glucocorticoid/adrenergic combination as needed; MILD ASTHMA: glucocorticoid/adrenergic therapy as needed as an alternative in case of low therapeutic adherence to conventional fixed-dose steroids; SEVERE ASTHMA: readjustment of phenotypes, incorporation of triple therapy in a single inhaler, and criteria for selection of a biologic in severe uncontrolled asthma; OTHERS: specific scoring in childhood asthma, incorporation of certain organizational aspects (care circuits, asthma units, telemedicine), new sections on COVID-19 and nasal polyposis.
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Affiliation(s)
- Vicente Plaza
- Comité Ejecutivo GEMA, Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Isam Alobid
- Sociedad Española de Otorrinolaringología (SEORL), Hospital Clinic, Universidad de Barcelona, Barcelona, España
| | - Cesáreo Alvarez
- Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Hospital de Verín, Orense, España
| | - Marina Blanco
- Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Jorge Ferreira
- Sociedad Portuguesa de Pneumologia (SPP), Hospital de São Sebastião - CHEDV, Santa Maria da Feira, Portugal
| | - Gabriel García
- Asociación Latinoamericana del Tórax (ALAT), Hospital Rossi La Plata, Buenos Aires, Argentina
| | - Antonio Gómez-Outes
- Sociedad Española de Farmacología Clínica (SEFC), Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Fernando Gómez
- Sociedad Española de Médicos Generales y de Familia (SEMG), Centro de Salud de Bargas, Toledo, España
| | - Antonio Hidalgo
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud Lucena I. Lucena, Córdoba, España
| | - Javier Korta
- Sociedad Española de Neumología Pediátrica (SENP), Hospital Universitario Donostia, Donostia-San Sebastián, España
| | - Jesús Molina
- Sociedad Española de Medicina Familiar y Comunitaria (semFYC) y Sociedad de Respiratorio de Atención Primaria (GRAP), Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | - Francisco Javier Pellegrini
- Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Centro de Salud de Pizarrales, Salamanca, España
| | - Montserrat Pérez
- Sociedad Española de Farmacia Hospitalaria (SEFH), Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Javier Plaza
- Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC), Farmacia Dres. Zamora Navarro, Mazarrón, Murcia, España
| | - Manuel Praena
- Asociación Española de Pediatría de Atención Primaria (AEPap), Centro de Salud La Candelaria, Sevilla, España
| | - Santiago Quirce
- Sociedad Española de Alergia e Inmunología Clínica (SEAIC), Hospital Universitario La Paz, Madrid, España
| | - José Sanz
- Sociedad Española de Inmunología Clínica-Alergología y Asma Pediátrica (SEICAP), Hospital Católico Universitario Casa de Salud, Valencia, España
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7
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Rivera CM, Crespo-Lessmann A, Arismendi E, Muñoz-Esquerre M, Aguilar X, Ausín P, Bobolea I, Dalmau Duch G, Pifarre Teixido R, Sabater Talaverano G, Sogo Sabardía A, Gall XM. Challenges for asthma units in response to COVID-19: a qualitative group dynamics analysis. J Asthma 2021; 59:1195-1202. [PMID: 33882776 DOI: 10.1080/02770903.2021.1917605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To develop a set of recommendations for the management of severe asthma during COVID-19 pandemic. METHODS Eleven pneumologists and allergologists who were staff members of officially accredited asthma units in Catalonia (Spain) participated in a cross-section study based on three 2-hour virtual workshops (first: brainstorming, second: identification of impacts and challenges summarized in 10 topics, third: establishment of final recommendations by consensus). RESULTS Impacts and challenges identified were improvement of referral protocols between different levels of care; assessment of the minimum number of function tests to be performed and promote the performance of spirometry in primary care; implementation of videoconferencing, mobile apps, telephone calls, or integral virtual platforms for the follow-up of patients, and definition of the model of care (face-to-face, telematics, mixed) according to the patient's individual needs; self-administration of biologics for domiciliary treatment; and empowerment of the role of nursing and hospital pharmacy in particular for follow-up and self-administration of biologics. The main recommendations included coordination between primary care and specialized care consultation, optimization of lung function testing, implementation of telemedicine, and the role of nursing and hospital pharmacy. CONCLUSION The specific proposals in response to the effect of COVID-19 pandemic focused on four areas of interest (coordination between primary care and specialized care, optimization of lung function testing, implementation of telemedicine, and empowerment of the role of nursing and hospital pharmacy) may be generalized to other health care settings, and help to introduce new ways of caring asthma patients in the COVID-19 context.
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Affiliation(s)
- Carlos Martínez Rivera
- Department of Respiratory Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Astrid Crespo-Lessmann
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona Respiratory Network (BRN), Barcelona, Spain
| | - Ebymar Arismendi
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Service of Pneumology, Hospital Clínic Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariana Muñoz-Esquerre
- Department of Respiratory Medicine, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Aguilar
- Service of Pneumology, Hospital Universitari Joan XXIII, Unidad Docente Joan XIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Pilar Ausín
- Service of Pneumology, Hospital del Mar-Parc de Salut Mar, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Irina Bobolea
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Section of Allergology, Service of Pneumology and Respiratory Allergy, Hospital Clínic Barcelona, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gaspar Dalmau Duch
- Service of Allergology, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Ricardo Pifarre Teixido
- Service of Pneumology, Hospital Universitari Arnau de Vilanova, Department of Medicine, Universitat de Lleida (UdL), Lleida, Spain
| | | | - Ana Sogo Sabardía
- Service of Pneumology, Consorci Corporacio Sanitaria Parc Tauli De Sabadell, Sabadell, Barcelona, Spain
| | - Xavier Muñoz Gall
- Centro de Investigación Biomédica en Red (CIBER) Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Service of Pneumology, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Cell Biology, Physiology, and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
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8
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Alonso F, Auñón P, Cavero T, Salgueira M, Praga M, Quiroga B, de Francisco ÁLM, Macía M. Monographic consultation of onconephrology. Rationale and implementation. Nefrologia 2021; 41:154-164. [PMID: 36165376 DOI: 10.1016/j.nefroe.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 08/06/2020] [Indexed: 06/16/2023] Open
Abstract
The increase in demand for medical care for renal complications associated with neoplastic diseases is a reality in most nephrology departments. In response to this overall situation, the creation of healthcare models such as monographic consultations and develop training programs in Onconephrology could improve the care of these patients. Through an exploratory and descriptive study, we identified current situation of kidney involvement in cancer patients. The objective of the present study is to establish the criteria for specific assistance in the field of Onconephrology. For this, we have reviewed key aspects and analyzed the current situation in our country, through a survey addressed to all nephrologists through the Spanish Society of Nephrology., together with the experience of two Spanish centers. From this information, we have established some requirements and recommendations for the start-up of these consultations.
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Affiliation(s)
| | - Pilar Auñón
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Teresa Cavero
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Manuel Praga
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Ángel L M de Francisco
- Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Manuel Macía
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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9
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Almonacid C, Melero C, López Viña A, Cisneros C, Pérez de Llano L, Plaza V, García-Rivero JL, Romero Falcón A, Ramos J, Bazús González T, Andrés Prado M, Muriel A. Effectiveness of Text Message Reminders on Adherence to Inhaled Therapy in Patients With Asthma: Prospective Multicenter Randomized Clinical Trial. JMIR Form Res 2021; 5:e12218. [PMID: 33560235 PMCID: PMC7902182 DOI: 10.2196/12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 07/20/2019] [Accepted: 10/28/2020] [Indexed: 01/15/2023] Open
Abstract
Background Poor adherence to inhaled medication in asthma patients is of great concern. It is one of the main reasons for inadequate asthma control. Objective The goal of the research was to determine if motivational messages using short message service (SMS, or text) improved adherence to inhaled medication in patients with asthma. Methods A prospective multicenter randomized parallel-group clinical trial was conducted in 10 asthma clinics in Spain. Adherence was assessed with electronic monitors (Smartinhaler, Adherium Ltd) connected to inhalers. Patients in the SMS group received psychologist-developed motivational messages every 3 days for 6 months. Results There were 53 patients in the SMS group and 88 patients in the control group. After 6 months, mean electronic adherence was 70% (SD 17%) in the intervention group and 69% (SD 17%) in the control group (P=.82). Significant differences between the study groups in morning and evening adherence to inhaled therapy, asthma control, exhaled nitric oxide levels, or improvement of lung functions were not observed. Conclusions Motivational messages were not useful to improve adherence to inhaled asthma medication compared with usual care.
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Affiliation(s)
- Carlos Almonacid
- Department of Respiratory Medicine, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcala de Henares, Madrid, Spain
| | - Carlos Melero
- Department of Respiratory Medicine, Hospital Universitario 12 de Octubre, Institute for Health Research (i+12), Complutense University of Madrid, Madrid, Spain
| | - Antolín López Viña
- Department of Respiratory Medicine, Hospital Universitario Puerta de Hierro, Autonoma University of Madrid, Majadahonda, Spain
| | - Carolina Cisneros
- Department of Respiratory Medicine, Hospital Universitario La Princesa, Autónoma University of Madrid, Madrid, Spain
| | - Luis Pérez de Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, University of Lugo, Lugo, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Autònoma University of Barcelona, Barcelona, Spain
| | | | - Auxiliadora Romero Falcón
- Department of Respiratory Medicine, Hospital Universitario Reina Sofia, University of Cordoba, Córdoba, Spain
| | - Jacinto Ramos
- Department of Respiratory Medicine, Hospital Universitario de Salamanca, University of Salamanca, Salamanca, Spain
| | - Teresa Bazús González
- Department of Respiratory Medicine, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - María Andrés Prado
- Department of Health Information Management, Fundación Jimenez Diaz, Madrid, Spain
| | - Alfonso Muriel
- Unit of Clinical Biostatistics, Instituto Ramón y Cajal de Investigación Sanitaria, Consorcio Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, University of Alcala de Henares, Madrid, Spain
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10
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Plaza V, Blanco M, García G, Korta J, Molina J, Quirce S. Highlights of the Spanish Asthma Guidelines (GEMA), version 5.0. Arch Bronconeumol 2020; 57:11-12. [PMID: 33213964 PMCID: PMC7577883 DOI: 10.1016/j.arbres.2020.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Vicente Plaza
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Coordinador del Comité Ejecutivo GEMA.
| | - Marina Blanco
- Servicio de Neumología, Complejo Hospitalario Universitario A Coruña, A Coruña, España; Coordinadora representante de SEPAR
| | - Gabriel García
- Servicio de Neumonología, Hospital Rossi La Plata, Buenos Aires, Argentina; Coordinador representante de ALAT
| | - Javier Korta
- Servicio de Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España; Coordinador representante de la SENP
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, España; Coordinador representante de semFYC y GRAP
| | - Santiago Quirce
- Servicio de Alergología, Hospital Universitario La Paz, Madrid, España; Coordinador representante de SEAIC
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