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Scioscia G, Santacroce R, Tondo P, Hoxhallari A, Soccio P, Giuffreda E, D'Ambrosio MF, Leccese A, Paladini L, Natale MP, Moriondo G, Foschino Barbaro MP, Margaglione M, Lacedonia D. A Report on a Targeted Screening Population for Alpha-1-Antitrypsin Deficiency (AATD) in Central-Southern Italy. Arch Bronconeumol 2024; 60:595-597. [PMID: 38876920 DOI: 10.1016/j.arbres.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Respiratory Care Unit, University-Hospital Policlinico of Foggia, Foggia, Italy
| | - Rosa Santacroce
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Medical Genetics Unit, University-Hospital Policlinico of Foggia, 71122 Foggia, Italy
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Anela Hoxhallari
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Respiratory Care Unit, University-Hospital Policlinico of Foggia, Foggia, Italy
| | - Piera Soccio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Ernesto Giuffreda
- Department of Specialistic Medicine, Respiratory Care Unit, University-Hospital Policlinico of Foggia, Foggia, Italy
| | - Maria Francesca D'Ambrosio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Medical Genetics Unit, University-Hospital Policlinico of Foggia, 71122 Foggia, Italy
| | - Angelica Leccese
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Medical Genetics Unit, University-Hospital Policlinico of Foggia, 71122 Foggia, Italy
| | - Luigi Paladini
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Respiratory Care Unit, University-Hospital Policlinico of Foggia, Foggia, Italy
| | - Matteo Pio Natale
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Respiratory Care Unit, University-Hospital Policlinico of Foggia, Foggia, Italy
| | - Giorgia Moriondo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Respiratory Care Unit, University-Hospital Policlinico of Foggia, Foggia, Italy
| | - Maurizio Margaglione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Medical Genetics Unit, University-Hospital Policlinico of Foggia, 71122 Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Department of Specialistic Medicine, Respiratory Care Unit, University-Hospital Policlinico of Foggia, Foggia, Italy
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Girón R, Golpe R, Martínez-García MÁ. [Bronchiectasis not due to cystic fibrosis]. Med Clin (Barc) 2024; 163:81-90. [PMID: 38637217 DOI: 10.1016/j.medcli.2024.01.023] [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: 10/28/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 04/20/2024]
Abstract
Bronchiectasis is a clinical-radiological condition composed of irreversible bronchial dilation due to inflammation and infection of the airways, which causes respiratory symptoms, usually productive cough and infectious exacerbations. Bronchiectasis can have multiple causes, both pulmonary and extrapulmonary, and its clinical presentation is very heterogenous. Its prevalence is unknown, although up to 35-50% of severe COPD and 25% of severe asthma present them, so their underdiagnosis is evident. Chronic bacterial bronchial infection is common, and Pseudomonas aeruginosa is the pathogen that has been found to imply a worse prognosis. Treatment of bronchiectasis has three fundamental characteristics: it must be multidisciplinary (involvement of several specialties), pyramidal (from primary care to the most specialized units) and multidimensional (management of all aspects that make up the disease).
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Affiliation(s)
- Rosa Girón
- Servicio de Neumología, Hospital Universitario La Princesa, Madrid, España
| | - Rafael Golpe
- Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España
| | - Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBER de Enfermedades Respiratorias. ISCIII, Madrid, España.
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3
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Martins M, Keir HR, Chalmers JD. Endotypes in bronchiectasis: moving towards precision medicine. A narrative review. Pulmonology 2023; 29:505-517. [PMID: 37030997 DOI: 10.1016/j.pulmoe.2023.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/09/2023] Open
Abstract
Bronchiectasis is a highly complex entity that can be very challenging to investigate and manage. Patients are diverse in their aetiology, symptoms, risk of complications and outcomes. "Endotypes"- subtypes of disease with distinct biological mechanisms, has been proposed as a means of better managing bronchiectasis. This review discusses the emerging field of endotyping in bronchiectasis. We searched PubMed and Google Scholar for randomized controlled trials (RCT), observational studies, systematic reviews and meta-analysis published from inception until October 2022, using the terms: "bronchiectasis", "endotypes", "biomarkers", "microbiome" and "inflammation". Exclusion criteria included commentaries and non-English language articles as well as case reports. Duplicate articles between databases were initially identified and appropriately excluded. Studies identified suggest that it is possible to classify bronchiectasis patients into multiple endotypes deriving from their co-morbidities or underlying causes to complex infective or inflammatory endotypes. Specific biomarkers closely related to a particular endotype might be used to determine response to treatment and prognosis. The most clearly defined examples of endotypes in bronchiectasis are the underlying causes such as immunodeficiency or allergic bronchopulmonary aspergillosis where the underlying causes are clearly related to a specific treatment. The heterogeneity of bronchiectasis extends, however, far beyond aetiology and it is now possible to identify subtypes of disease based on inflammatory mechanisms such airway neutrophil extracellular traps and eosinophilia. In future biomarkers of host response and infection, including the microbiome may be useful to guide treatments and to increase the success of randomized trials. Advances in the understanding the inflammatory pathways, microbiome, and genetics in bronchiectasis are key to move towards a personalized medicine in bronchiectasis.
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Affiliation(s)
- M Martins
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - H R Keir
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, United Kinkdom
| | - J D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, United Kinkdom
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Gómez-Olivas JD, Oscullo G, Martínez-García MÁ. Etiology of Bronchiectasis in the World: Data from the Published National and International Registries. J Clin Med 2023; 12:5782. [PMID: 37762723 PMCID: PMC10532132 DOI: 10.3390/jcm12185782] [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: 07/21/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Bronchiectasis is the third leading chronic inflammatory disease of the airway caused by dozens of pulmonary and extra-pulmonary diseases. Infection by pathogenic microorganisms is very common. We aimed to analyze, for the first time in the literature, the etiology of bronchiectasis throughout the world via data published in national and international registries. A bibliographic search was carried out in PubMed and Web of Science. Seven studies were included, with a total of 27,258 patients from 33 countries of four continents. The most frequent cause of bronchiectasis was post-infectious: 30.5% (range: 19.1-40.4%), followed by idiopathic: 28.7% (18.5-38.1%). Post-tuberculous bronchiectasis accounted for 14.1% (1.8-35.5%), while etiologies associated with COPD and asthma comprised 7% (3.4-10.9%) and 5.2% (2.5-7.8%). In conclusion, there was a high degree of heterogeneity in the relative percentages of the main causes of bronchiectasis in the world, although post-infectious and idiophatic bronchiectasis continue to be the most frequent causes.
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Affiliation(s)
- Jose Daniel Gómez-Olivas
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 2026, 46026 Valencia, Spain; (J.D.G.-O.); (G.O.)
| | - Grace Oscullo
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 2026, 46026 Valencia, Spain; (J.D.G.-O.); (G.O.)
| | - Miguel Ángel Martínez-García
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 2026, 46026 Valencia, Spain; (J.D.G.-O.); (G.O.)
- CIBERES de Enfermedades Respiratorias, ISCIII, 28029 Madrid, Spain
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Khan J, Moran B, McCarthy C, Butler MW, Franciosi AN. Management of comorbidities in difficult and severe asthma. Breathe (Sheff) 2023; 19:230133. [PMID: 38020342 PMCID: PMC10644109 DOI: 10.1183/20734735.0133-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians' assessment of asthma treatment efficacy.
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Affiliation(s)
- Jehangir Khan
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Barry Moran
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Cormac McCarthy
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Marcus W. Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
| | - Alessandro N. Franciosi
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
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Yang T, Yu J, Ahmed T, Nguyen K, Nie F, Zan R, Li Z, Han P, Shen H, Zhang X, Takayama S, Song Y. Synthetic neutrophil extracellular traps dissect bactericidal contribution of NETs under regulation of α-1-antitrypsin. SCIENCE ADVANCES 2023; 9:eadf2445. [PMID: 37115934 PMCID: PMC10146876 DOI: 10.1126/sciadv.adf2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/30/2023] [Indexed: 05/03/2023]
Abstract
Deciphering the complex interplay of neutrophil extracellular traps (NETs) with the surrounding environment is a challenge with notable clinical implications. To bridge the gap in knowledge, we report our findings on the antibacterial activity against Pseudomonas aeruginosa of synthetic NET-mimetic materials composed of nanofibrillated DNA-protein complexes. Our synthetic system makes component-by-component bottom-up analysis of NET protein effects possible. When the antimicrobial enzyme neutrophil elastase (NE) is incorporated into the bactericidal DNA-histone complexes, the resulting synthetic NET-like structure exhibits an unexpected reduction in antimicrobial activity. This critical immune function is rescued upon treatment with alpha-1-antitrypsin (AAT), a physiological tissue-protective protease inhibitor. This suggests a direct causal link between AAT inhibition of NE and preservation of histone-mediated antimicrobial activity. These results help better understand the complex and, at times, contradictory observations of in vivo antimicrobial effects of NETs and AAT by excluding neutrophil, cytokine, and chemoattractant contributions.
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Affiliation(s)
- Ting Yang
- School of Material Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, GA 30332, USA
| | - Jinlong Yu
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Tasdiq Ahmed
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, GA 30332, USA
| | - Katherine Nguyen
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, GA 30332, USA
| | - Fang Nie
- Renji Hospital affiliated to Shanghai Jiao Tong University, Shanghai 200127, China
| | - Rui Zan
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China
| | - Zhiwei Li
- Renji Hospital affiliated to Shanghai Jiao Tong University, Shanghai 200127, China
| | - Pei Han
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Hao Shen
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Xiaonong Zhang
- School of Material Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
- Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai 200032, China
| | - Shuichi Takayama
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, GA 30332, USA
| | - Yang Song
- School of Material Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
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Lee SJ, Kim J, Lee KH, Lee JA, Kim CH, Lee SH, Park BJ, Kim JH, Ahn JY, Jeong SJ, Ku NS, Yeom JS, Choi JY. Risk factors of pneumothorax and pneumomediastinum in COVID-19: a matched case-control study. BMC Infect Dis 2023; 23:137. [PMID: 36882735 PMCID: PMC9990560 DOI: 10.1186/s12879-023-08104-3] [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: 10/15/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND During the novel coronavirus disease-2019 pandemic, a considerable number of pneumothorax (PNX)/pneumomediastinum (PNM) associated with COVID-19 have been reported, and the incidence is higher in critically ill patients. Despite using a protective ventilation strategy, PNX/PNM still occurs in patients on invasive mechanical ventilation (IMV). This matched case-control study aims to identify the risk factors and clinical characteristics of PNX/PNM in COVID-19. METHODS This retrospective study enrolled adult patients with COVID-19, admitted to a critical care unit from March 1, 2020, to January 31, 2022. COVID-19 patients with PNX/PNM were compared, in a 1-2 ratio, to COVID-19 patients without PNX/PNM, matched for age, gender, and worst National Institute of Allergy and Infectious Diseases ordinal scale. Conditional logistic regression analysis was performed to assess the risk factors for PNX/PNM in COVID-19. RESULTS 427 patients with COVID-19 were admitted during the period, and 24 patients were diagnosed with PNX/PNM. Body mass index (BMI) was significantly lower in the case group (22.8 kg/m2 and 24.7 kg/m2; P = 0.048). BMI was statistically significant risk factor for PNX/PNM in univariate conditional logistic regression analysis [odds ratio (OR), 0.85; confidence interval (CI), 0.72-0.996; P = 0.044]. For patients on IMV support, univariate conditional logistic regression analysis showed the statistical significance of the duration from symptom onset to intubation (OR, 1.14; CI, 1.006-1.293; P = 0.041). CONCLUSIONS Higher BMI tended to show a protective effect against PNX/PNM due to COVID-19 and delayed application of IMV might be a contributive factor for this complication.
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Affiliation(s)
- Se Ju Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Jinnam Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Hyun Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ah Lee
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Hyup Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Kim
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Ahn
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Su Ku
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon-Sup Yeom
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Calle Rubio M, López-Campos JL, Miravitlles M, Michel de la Rosa FJ, Hernández Pérez JM, Montero Martínez C, Montoro Ronsano JB, Casas Maldonado F, Rodríguez Hermosa JL, Tabernero Huguet EM, Martínez Sesmero JM, Martínez Rivera C, Callejas González FJ, Torres Durán M. COVID-19's impact on care practice for alpha-1-antitrypsin deficiency patients. BMC Health Serv Res 2023; 23:98. [PMID: 36717880 PMCID: PMC9885054 DOI: 10.1186/s12913-023-09094-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patients with alpha-1 antitrypsin deficiency (AATD), commonly categorized as a rare disease, have been affected by the changes in healthcare management brought about by COVID-19. This study's aim was to identify the changes that have taken place in AATD patient care as a result of the COVID-19 pandemic in Spain and to propose experts' recommendations aimed at ensuring humanized and quality care for people with AATD in the post-pandemic situation. METHODS A qualitative descriptive case study with a holistic single-case design was conducted, using focus groups with experts in AATD clinical management, including 15 health professionals with ties to the Spanish health system (12 pneumologists and 2 hospital pharmacists from 11 different hospitals in Spain) and 1 patient representative. RESULTS COVID-19 has had a major impact on numerous aspects of AATD clinical patient management in Spain, including diagnostic, treatment, and follow-up phases. The experts concluded that there is a need to strengthen coordination between Primary Care and Hospital Care and improve the coordination processes across all the organizations and actors involved in the healthcare system. Regarding telemedicine and telecare, experts have concluded that it is necessary to promote this methodology and to develop protocols and training programs. Experts have recommended developing personalized and precision medicine, and patient participation in decision-making, promoting self-care and patient autonomy to optimize their healthcare and improve their quality of life. The possibility of monitoring and treating AATD patients from home has also been proposed by experts. Another result of the study was the recommendation of the need to ensure that plasma donations are made on a regular basis by a sufficient number of healthy individuals. CONCLUSION The study advances knowledge by highlighting the challenges faced by health professionals and changes in AATD patient management in the context of the COVID-19 pandemic. It also proposes experts' recommendations aimed at ensuring humanized and quality care for people with AATD in the post-pandemic situation. This work could serve as a reference study for physicians on their daily clinical practice with AATD patients and may also provide guidance on the changes to be put in place for the post-pandemic situation.
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Affiliation(s)
- Myriam Calle Rubio
- grid.414780.ePulmonology Department, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), San Carlos Clinical Hospital, Madrid, Spain ,grid.4795.f0000 0001 2157 7667Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - José Luis López-Campos
- grid.411109.c0000 0000 9542 1158Medical-Surgical Unit for Respiratory Diseases, Biomedicine Institute of Sevilla (IBiS), Virgen del Rocío University Hospital, Seville, Spain
| | - Marc Miravitlles
- grid.411083.f0000 0001 0675 8654Pulmonology Department, Research Institute of Vall d’Hebron (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Network of Centers for Biomedical Research On Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain
| | | | - José María Hernández Pérez
- grid.413448.e0000 0000 9314 1427Network of Centers for Biomedical Research On Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain ,Pulmonology Department, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Carmen Montero Martínez
- grid.411066.40000 0004 1771 0279Pulmonology Department, A Coruña University Hospital, A Coruña, Spain
| | - José Bruno Montoro Ronsano
- grid.411083.f0000 0001 0675 8654Department of Pharmacy, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Francisco Casas Maldonado
- grid.411380.f0000 0000 8771 3783Pulmonology Department, San Cecilio Clinical University Hospital, Granada, Spain ,grid.4489.10000000121678994School of Health Science, University of Granada, Granada, Spain
| | - Juan Luis Rodríguez Hermosa
- grid.414780.ePulmonology Department, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), San Carlos Clinical Hospital, Madrid, Spain ,grid.4795.f0000 0001 2157 7667Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Carlos Martínez Rivera
- grid.413448.e0000 0000 9314 1427Network of Centers for Biomedical Research On Respiratory Diseases (CIBERES), Carlos III Health Institute, Madrid, Spain ,grid.411438.b0000 0004 1767 6330Pulmonology Department, Research Institute of Germans Trias I Pujol (IGTiP), Germans Trias I Pujol University Hospital, Barcelona, Spain
| | | | - María Torres Durán
- Pulmonology Department, Health Research Institute of Galicia Sur (IISGS), Álvaro Cunqueiro Hospital, Estrada Clara Campoamor, 342. 36312 Vigo, Spain
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