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González-Díaz SN, Ansotegui IJ, Macouzet-Sánchez C, Acuña-Ortega N, de la Cruz-de la Cruz C. Doxofylline as a steroid-sparing treatment in Mexican children with asthma. J Asthma 2024; 61:574-583. [PMID: 38153316 DOI: 10.1080/02770903.2023.2294909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The aim of this pilot study was to assess the efficacy of doxofylline as an ICS-sparing agent in the treatment of Mexican children with asthma. METHODS 10-week, open-label, crossover, pilot study, we examined the steroid-sparing effect of doxofylline in Mexican children with asthma. Patients aged 6-16 years treated with inhaled corticosteroids (ICS) for at least 8 wk before enrollment were divided randomly into two groups at the baseline visit. Group A (n = 31) received doxofylline (18 mg/kg/day) plus standard-dose budesonide (D + SDB) for the first 4-week period followed by doxofylline plus reduced-dose budesonide (D + RDB) for the second 4-week period. Group B (n = 30) received D + RDB followed by D + SDB. Clinical outcomes assessed included lung function (forced expiratory volume; in 1 s, FEV1), fractional exhaled nitric oxide (FeNO), asthma control, number of exacerbations and use of rescue medication (salbutamol). RESULTS It was shown that combined use of doxofylline and ICS may allow children with asthma to reduce their daily dose of ICS while maintaining lung function and improving asthma control (p = 0.008). There were few asthma exacerbations and only one patient required treatment with systemic corticosteroids. Rescue medication use decreased significantly in patients receiving D + SDB during the first 4-week period. CONCLUSIONS Our results suggest that doxofylline may be a steroid-sparing treatment in asthma, but longer-term, controlled studies are needed to confirm these observations.
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Affiliation(s)
- Sandra Nora González-Díaz
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Autonomous University of Nuevo León, Monterrey, Mexico
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Erandio-Bilbao, Spain
| | - Carlos Macouzet-Sánchez
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Autonomous University of Nuevo León, Monterrey, Mexico
| | - Natalhie Acuña-Ortega
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Autonomous University of Nuevo León, Monterrey, Mexico
| | - Carlos de la Cruz-de la Cruz
- Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Autonomous University of Nuevo León, Monterrey, Mexico
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Pulido-Guillen NA, Morales-Romero J, Bedolla-Barajas M, Bedolla-Pulido TI, Jiménez-Carrillo CE, Arellano-Arteaga KJ, Robles-Figueroa M. Association Between Allergic Rhinitis and Asthma in Adults With Loss of Interest in Sex. Cureus 2023; 15:e36823. [PMID: 37123746 PMCID: PMC10139761 DOI: 10.7759/cureus.36823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The alterations of sexual desire in allergy respiratory diseases have seldom been analyzed. This paper aims to evaluate the association of allergic rhinitis and asthma among adults with the loss of interest in sex. METHODS Through a cross-sectional study, we compared three groups of subjects: one with patients with allergic rhinitis, another with allergic asthma, and a control group. The loss of interest in sex was assessed with the Beck Depression Inventory-II, which includes a scale that evaluates this characteristic. RESULTS The prevalence of loss of interest in sex in patients with allergic asthma, allergic rhinitis, and controls was 48.8%, 39.5%, and 20.2%, respectively. In multivariate models, a positive association between a loss of interest in sex and allergic asthma (OR =2.4, p =0.005) and allergic rhinitis (OR =2.1, p =0.03) was found independently. In both models, other associated factors included being female (p <0.001) and living as a couple (p <0.001). In contrast, no significant association was found with age (≥40 years), smoking, alcohol consumption, physical activity, or excess weight. CONCLUSION Loss of interest in sex is highly prevalent and is notoriously associated with allergic respiratory diseases; similarly, it is associated with living as a couple and being female.
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Affiliation(s)
| | - Jaime Morales-Romero
- Epidemiology and Public Health, Institute of Public Health, Veracruzana University, Xalapa, MEX
| | - Martín Bedolla-Barajas
- Allergy and Clinical Immunology, Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", Guadalajara, MEX
| | | | - Claudia E Jiménez-Carrillo
- Allergy and Immunology, Regional Hospital ¨Dr. Valentín Gómez Farías" Institute of Social Security for Government Workers, Zapopan, MEX
| | | | - Martin Robles-Figueroa
- Internal Medicine, Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", Guadalajara, MEX
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Arteaga-Badillo DA, Portillo-Reyes J, Vargas-Mendoza N, Morales-González JA, Izquierdo-Vega JA, Sánchez-Gutiérrez M, Álvarez-González I, Morales-González Á, Madrigal-Bujaidar E, Madrigal-Santillán E. Asthma: New Integrative Treatment Strategies for the Next Decades. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E438. [PMID: 32872366 PMCID: PMC7558718 DOI: 10.3390/medicina56090438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
Asthma is a chronic disease whose main anatomical-functional alterations are grouped into obstruction, nonspecific bronchial hyperreactivity, inflammation and airway remodeling. Currently, the Global Initiative of Asthma 2020 (GINA 2020) suggests classifying it into intermittent cases, slightly persistent, moderately persistent and severely persistent, thus determining the correct guidelines for its therapy. In general, the drugs used for its management are divided into two groups, those with a potential bronchodilator and the controlling agents of inflammation. However, asthmatic treatments continue to evolve, and notable advances have been made possible in biological therapy with monoclonal antibodies and in the relationship between this disease and oxidative stress. This opens a new path to dietary and herbal strategies and the use of antioxidants as a possible therapy that supports conventional pharmacological treatments and reduces their doses and/or adverse effects. This review compiles information from different published research on risk factors, pathophysiology, classification, diagnosis and the main treatments; likewise, it synthesizes the current evidence of herbal medicine for its control. Studies on integrative medicine (IM) therapies for asthmatic control are critically reviewed. An integrative approach to the prevention and management of asthma warrants consideration in clinical practice. The intention is to encourage health professionals and scientists to expand the horizons of basic and clinical research (preclinical, clinical and integrative medicine) on asthma control.
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Affiliation(s)
- Diego A. Arteaga-Badillo
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico; (D.A.A.-B.); (J.P.-R.); (J.A.I.-V.); (M.S.-G.)
| | - Jacqueline Portillo-Reyes
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico; (D.A.A.-B.); (J.P.-R.); (J.A.I.-V.); (M.S.-G.)
| | - Nancy Vargas-Mendoza
- Escuela Superior de Medicina, Instituto Politécnico Nacional, “Unidad Casco de Santo Tomas”, Ciudad de México 11340, Mexico; (N.V.-M.); (J.A.M.-G.)
| | - José A. Morales-González
- Escuela Superior de Medicina, Instituto Politécnico Nacional, “Unidad Casco de Santo Tomas”, Ciudad de México 11340, Mexico; (N.V.-M.); (J.A.M.-G.)
| | - Jeannett A. Izquierdo-Vega
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico; (D.A.A.-B.); (J.P.-R.); (J.A.I.-V.); (M.S.-G.)
| | - Manuel Sánchez-Gutiérrez
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Ex-Hacienda de la Concepción, Tilcuautla, Pachuca de Soto 42080, Mexico; (D.A.A.-B.); (J.P.-R.); (J.A.I.-V.); (M.S.-G.)
| | - Isela Álvarez-González
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, “Unidad Profesional A. López Mateos”, Ciudad de México 07738, Mexico; (I.Á.-G.); (E.M.-B.)
| | - Ángel Morales-González
- Escuela Superior de Cómputo, Instituto Politécnico Nacional, “Unidad Profesional A. López Mateos”, Ciudad de México 07738, Mexico;
| | - Eduardo Madrigal-Bujaidar
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, “Unidad Profesional A. López Mateos”, Ciudad de México 07738, Mexico; (I.Á.-G.); (E.M.-B.)
| | - Eduardo Madrigal-Santillán
- Escuela Superior de Medicina, Instituto Politécnico Nacional, “Unidad Casco de Santo Tomas”, Ciudad de México 11340, Mexico; (N.V.-M.); (J.A.M.-G.)
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Martínez-González CL, Camargo-Fajardo MCC, Segura-Medina P, Quezada-Bolaños P. Therapeutic Patient Education with Learning Objects Improves Asthma Control in Mexican Children. J Med Syst 2020; 44:79. [PMID: 32128625 DOI: 10.1007/s10916-020-1539-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
One of the most common chronic diseases that causes missed school days and workdays is pediatric asthma, producing education, health and economic delays in low and middle-income countries. A patient-centered remarkable therapeutic strategy in the prevention and treatment of chronic diseases is the Therapeutic Patient Education (TPE) which denotes an outstanding difference in the outcomes, from the awareness, to the personal treatment adaption to prevent crises. In this paper, an intervention of TPE with learning objects (LOs) of a pediatric asthma course, designed to train the uncontrolled patient and the caregiver as a team on the specific knowledge to self-control the disease, was carried out at a health facility in Mexico. The Asthma Control Test (ACT) was used and the learning performance was evaluated with formative quizzes. A randomized controlled trial was designed, with pairs of children patients and caregivers during 60 days; the control group was trained with the usual approach, receiving general information about the disease. ACT measures showed statistical significance for the TPE group after the use of the LOs, achieving a controlled state, while the control group did not show difference. Also, the intervention group obtained a higher score in learning performance assessment. The users learned how to avoid risks, the personal triggers of the patient, how to correctly use the different treatments and accessories, consequently, they learned how to self-manage the disease. Our study also confirmed that control of asthma is not only a matter of knowledge, but financial issues to afford the treatment.
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Affiliation(s)
- C L Martínez-González
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, 07738, México, Mexico.
| | - M C C Camargo-Fajardo
- Programa de Posgrado en Ingeniería de Sistemas, SEPI ESIME-Z, Instituto Politécnico Nacional, Av. IPN S/N, 07738, México, Mexico
| | - P Segura-Medina
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias, 14080, México, Mexico.,Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, 14380, México, Mexico
| | - P Quezada-Bolaños
- CECyT2 "Miguel Bernard", Instituto Politécnico Nacional, Lomas de Sotelo, 11200, México, Mexico
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Désirée LL, Margarita FV, Mónica RG, María Del Carmen CS, Jorge Agustín LP, José Antonio OM, Blanca DRN, Erika Del Carmen LE, Jade RL, Juan Carlos VG, Jorge SP. An online survey detected knowledge gaps and cost-saving opportunities in asthma maintenance treatment among allergists, pulmonologists, ENTs and primary care. World Allergy Organ J 2019; 12:100084. [PMID: 31768217 PMCID: PMC6872758 DOI: 10.1016/j.waojou.2019.100084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 10/04/2019] [Accepted: 10/16/2019] [Indexed: 12/03/2022] Open
Abstract
Background In April 2017 the Mexican Asthma Guidelines (GUIMA) were published. Before the launch, physicians’ knowledge was explored related to key issues of the guideline. Methods A SurveyMonkey® survey was sent out to board-certified physicians of 5 medical specialties treating asthma. Replies were analyzed per specialty against the GUIMA evidence-based recommendations. We present the treatment part here. Results A total of 364 allergists (ALLERG), 161 pulmonologists (PULM), 34 ENTs, 239 pediatricians (PED) and 62 general practitioners (GPs) replied to the survey and 247-83-14-135-37 respectively finished it. Spirometry is not routinely indicated when asthma is very probable by ALLERG 54%, PULM 47%, ENT 39%, PED 65%, GP 64%. A fictitious case proposed to the physicians with intermittent asthma was erroneously treated with ICS by ALLERG 9%, PULM 11%, ENT 28%, PED 10%, GP 11%. The mild persistent case received mistakenly ICS-LABA by ALLERG 25%, PULM 26%, ENT 33%, PED 27%, GP 23%. The first-line option for moderate persistent asthma was ICS(median dose) instead of ICS(low)+LABA for ALLERG 29%, PULM 25%, ENT 17%, PED 27%, GP 23% and in severe asthma maintenance treatment PULM20%, ALLERG-ENT-PED-GP 22-34% failed to indicate LABA. Concerning the guidelines’ recommendation to use one inhaler for maintenance & rescue in moderate-to-severe asthma, PULM45%, ALLERG-ENT-PED-GP 56-80% (p < 0.00001), erroneously indicated ICS-salmeterol could be used, instead of ICS-formoterol. Oral β2 or theophylline are no longer recommended, but PULM 37% and ALLERG-ENT-PED-GP 42-62% (p < 0.01) still indicate their use. In severe asthma 61-73% of physicians consider adding LTRA to the treatment; only PULM38%, OTHERS12-25% consider adding tiotropium (p < 0.001) and 3-17% consider adding omalizumab, both guideline recommended add-ons. As for asthma in pregnancy, most surveyed are not aware budesonide is the 1st line option ICS. Finally, 81-97% of the group-members recognized allergen immunotherapy, as a viable add-on, in line with GINA/GEMA/GUIMA recommendations. Conclusions An online survey could detect knowledge-gaps related to asthma treatment. Interestingly, surveyed physicians tended to over-treat the milder asthma cases, thus clearly leaving room for cost-savings. Caution should be taken in the promotion of the SMART (single-maintenance-and-reliever-treatment) approach, which can only be done with ICS-formoterol. Many physicians opt for other combinations not apt for this approach. Among all surveyed specialties there is ample room for improvement in mild and severe asthma management.
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Key Words
- Allerg, allergist
- Allergist
- Asthma treatment
- ENT, ear-nose-throat specialist
- Education
- GP, general practitioner
- GUIMA, Guía Mexicana del Asma (Mexican asthma guideline)
- ICS, inhaled corticosteroids
- Inhaled corticosteroid
- LABA, long acting beta-agonist
- LTRA, leukotriene receptor antagonists
- Long-acting beta agonist
- OCS, oral corticosteroids
- Omalizumab
- Ped, pediatrician
- Pediatrician
- Pulm, pulmonologist
- Pulmonologist
- Rx, treatment
- SABA, short acting beta-agonist
- Spirometry
- Theophylline
- Tiotropium bromide
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Affiliation(s)
| | | | | | | | - Luna-Pech Jorge Agustín
- Department of Philosophical, Methodological and Instrumental Disciplines, University Center of Science in Health, University of Guadalajara, Mexicocity, Mexico
| | | | | | | | | | | | - Salas-Pérez Jorge
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Mexicocity, Mexico
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