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Curto E, Crespo-Lessmann A, González-Gutiérrez MV, Bardagí S, Cañete C, Pellicer C, Bazús T, Vennera MDC, Martínez C, Plaza V. Is asthma in the elderly different? Functional and clinical characteristics of asthma in individuals aged 65 years and older. Asthma Res Pract 2019; 5:2. [PMID: 30937177 PMCID: PMC6425653 DOI: 10.1186/s40733-019-0049-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/08/2019] [Indexed: 01/04/2023] Open
Abstract
Background The prevalence of chronic diseases in the elderly (> 65 years), including asthma, is growing, yet information available on asthma in this population is scarce. Our objective is to determine the differential clinical and functional characteristics of the population > 65 years old with asthma included in the Integrated Research Programs of Asthma Databank of the Spanish Society of Pneumology and Thoracic Surgery (www.bancodatosasma.com). Methods Retrospective comparative descriptive study of demographic, clinical and functional variables for 1713 patients with asthma categorized into 3 age groups as follows: adults aged < 65 years (A), younger elderly aged 65–74 years (B) and older elderly aged ≥75 years (C). Results Predominant features of elderly patients with asthma (N = 471) were the female sex, fewer smokers, greater obesity, poorer lung function, and lower values of nitric oxide in exhaled air (p < 0.01). The most frequently associated comorbidity was gastroesophageal reflux. The highest doses of inhaled corticosteroids were by group A (60.8%). For the sample overall, 23.2% (N = 398) were being treated with omalizumab and 8.2% (N = 140) were corticosteroid-dependent (10.6% in group B). The highest percentage of patients receiving antileukotriene agents was in group B (42.9%). Conclusions Asthma in adults aged> 65 is more severe and associated with greater comorbidity, which would indicate the need for a more integrated and multidimensional approach to asthma treatment for these patients.
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Affiliation(s)
- Elena Curto
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Carrer Mas Casanovas 90, 08041 Barcelona, Spain
| | - Astrid Crespo-Lessmann
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Carrer Mas Casanovas 90, 08041 Barcelona, Spain
| | | | - Santiago Bardagí
- 2Servicio de Neumología, Consorci Sanitari del Maresme, Carrer de Cirera 230, 08304 Mataró, Barcelona, Spain
| | - Concepción Cañete
- Servicio de Neumología, Hospital General de l'Hospitalet, Av. Josep Molins 29, 08906 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Concha Pellicer
- Servicio de Neumología, Hospital Comarcal Francesc De Borja, Avinguda de la Medicina 6, 46702 Gandia, València, Spain
| | - Teresa Bazús
- 5Servicio de Neumología, Hospital Universitario Central de Asturias, Av. Roma s/n, 3301 Oviedo, Spain
| | - María Del Carmen Vennera
- 6Servició de Neumología, Hospital Clinic de Barcelona, Carrer de Villarroel 170, 08036 Barcelona, Spain
| | - Carlos Martínez
- 7Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain
| | - Vicente Plaza
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Carrer Mas Casanovas 90, 08041 Barcelona, Spain
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Pérez de Llano L, García-Rivero JL, Urrutia I, Martínez-Moragón E, Ramos J, Cebollero P, Carballada F, Blanco-Aparicio M, Vennera MDC, Merino M, Torralba-García Y, Plaza V. A Simple Score for Future Risk Prediction in Patients with Controlled Asthma Who Undergo a Guidelines-Based Step-Down Strategy. J Allergy Clin Immunol Pract 2018; 7:1214-1221.e3. [PMID: 30368006 DOI: 10.1016/j.jaip.2018.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The minimum controlling dose of treatment must be established in patients with asthma, but the outcome of step-down is unpredictable. OBJECTIVE To identify factors associated with risk of control loss when stepping down asthma treatment and to develop a score to predict this risk. METHODS A prospective, multicenter study including adults with well-controlled asthma was performed. Treatment was stepped up or stepped down over a 12-month period to maintain asthma control. We determined associations between clinical and functional variables and step-down failure. Finally, we derived a score to predict loss of control in 1 cohort and validated it in an independent cohort. RESULTS The derivation cohort consisted of 228 patients; 218 completed at least 1 step-down episode and a total of 495 step-down episodes were evaluated. A medical-record documented postbronchodilator spirometry result of <70% forced expiratory volume in 1 second (FEV1)/forced vital capacity (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.26-3.43), current FEV1 < 80% (OR = 1.80; 95% CI: 1.03-3.14), ≥1 severe exacerbation in the previous 12 months (OR = 2.43; 95% CI: 1.48-4.01), and Asthma Control Test score < 25 (OR = 2.30; 95% CI: 1.35-3.92) were independently associated with failure. The score showed an area under the curve of 0.690 (95% CI: 0.633-0.747; P < .05) in the derivation cohort and 0.76 (95% CI: 0.643-0.882; P < .001) in a validation cohort of 114 patients. A score <4.5 implies a low risk of failure (<20%), whereas a score >8 implies a high risk (>40%). CONCLUSION This score can facilitate the prediction of step-down failure before medication taper in patients with well-controlled asthma.
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Affiliation(s)
| | | | - Isabel Urrutia
- Pneumology Service, Hospital de Galdakao, Bizkaia, Spain
| | | | - Jacinto Ramos
- Pneumology Service, Complejo Asistencial de Salamanca, Salamanca, València, Spain
| | - Pilar Cebollero
- Pneumology Service, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Marina Blanco-Aparicio
- Pneumology Service, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - María Del Carmen Vennera
- Servei de Pneumologia i Allèrgia Respiratòria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - María Merino
- Health Outcomes Research Department, Weber, Economía y Salud, Madrid, Spain
| | - Yolanda Torralba-García
- Servei de Pneumologia i Allèrgia Respiratòria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Vicente Plaza
- 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, Spain
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Vennera MDC, Valero A, Uría E, Forné C, Picado C. Cost-Effectiveness Analysis of Omalizumab for the Treatment of Severe Persistent Asthma in Real Clinical Practice in Spain. Clin Drug Investig 2016; 36:567-78. [PMID: 27142072 DOI: 10.1007/s40261-016-0402-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Omalizumab is a humanized monoclonal antibody that targets circulating immunoglobulin E molecules to treat severe uncontrolled asthma. The aim of this study was to determine the cost effectiveness of omalizumab compared with standard treatment for the control of severe persistent asthma according to data from patients treated in a specialized asthma unit. METHODS This was an observational, retrospective, single-center study in the setting of the Pulmonology and Respiratory Allergy Service, Thorax Institute, Hospital Clínic de Barcelona, Barcelona, Spain. Data were collected by review of medical records of 86 uncontrolled severe persistent asthma patients treated with omalizumab from January 2005 to April 2014. Effectiveness was assessed by the reduction in asthma exacerbations and 3-point increases in the Asthma Control Test (ACT) score. The economic evaluation was performed from the societal perspective, including direct health costs (resource use and drug treatments) and indirect costs (disease impact on labor productivity) in 2016 Euros. The time horizon was 12 months before and after the initiation of treatment with omalizumab. Results were expressed using the incremental cost-effectiveness ratio (ICER). RESULTS Taking into account only direct costs, the ICERs were €1487.46 (95 % confidence interval [CI] 1241.21-1778.34) per exacerbation avoided and €5425.13 (95 % CI 4539.30-6551.03) per 3-point increase in the ACT. When indirect costs were included, the ICERs were €1130.93 (95 % CI 909.08-1392.86) per exacerbation avoided, and €4124.79 (95 % CI 3281.69-5186.73) per 3-point increase in the ACT. CONCLUSIONS The results of this study confirm the effectiveness of the addition of omalizumab to standard therapy in patients with uncontrolled severe persistent asthma.
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Affiliation(s)
- María Del Carmen Vennera
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Antonio Valero
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Estefany Uría
- Department of Health Economics and Outcome Research, Oblikue Consulting S.L., Barcelona, Spain
| | - Carles Forné
- Department of Health Economics and Outcome Research, Oblikue Consulting S.L., Barcelona, Spain
| | - César Picado
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Abstract
Intrinsic asthma has been considered as a specific disease entity for a long time, although many controversies have emerged in relation to this concept. Of note, not finding specific allergen sensitization in an asthmatic patient neither excludes an allergic component nor the essential role that immunoglobulin E may play in asthma. The diagnostic approach should be similar in any patient suspected to have asthma. The atopic status is one among many other questions. Omalizumab, the only monoclonal anti-immunoglobulin E antibody commercialized for asthma, should be tried in patients with uncontrolled severe asthma independent of their atopic status.
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Affiliation(s)
- María Del Carmen Vennera
- Department of Pneumology and Respiratory Allergy, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain ; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain ; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - César Picado
- Department of Pneumology and Respiratory Allergy, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain ; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain ; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Spain
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de Llano LP, Vennera MDC, Álvarez FJ, Medina JF, Borderías L, Pellicer C, González H, Gullón JA, Martínez-Moragón E, Sabadell C, Zamarro S, Picado C. Effects of omalizumab in non-atopic asthma: results from a Spanish multicenter registry. J Asthma 2013; 50:296-301. [PMID: 23350994 DOI: 10.3109/02770903.2012.757780] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aim. To evaluate the effectiveness of omalizumab in non-atopic asthma. Methods. Using data from a multicenter registry of severe asthma, we evaluated and compared the clinical outcome of 29 omalizumab-treated severe non-atopic asthmatics with 266 omalizumab-treated severe allergic asthmatics. Effectiveness was assessed by considering severe exacerbations, pulmonary function, the Global Evaluation of Treatment Effectiveness (GETE) scale, and Asthma Control Test (ACT). Results. Omalizumab demonstrated significant improvement in the clinical status of non-atopic asthmatics as measured by GETE, which rose from 1.6 ± 1.1 to 2.8 ± 0.9 [corrected] at 4 months (p = .0215) to 2.9 ± 0.9 at 1 year (p = .0093) and to 3.4 ± 0.6 at 2 years (p = .0078), and by the ACT, which increased from 13.3 ± 5.5 [corrected] to 17.5 ± 5.4 at 4 months (p = .0236) to 17.9 ± 4.8 at 1 year (p = .0136) and to 20.6 ± 3.9 at 2 years (p = .0024). Forced expiratory volume in 1 second (FEV1) improved from 61.0 ± 19.4% to 65.1 ± 17.2 at 4 months to 64.1 ± 24.7 at 1 year and to 67.3 ± 23.0% [corrected] at 2 years, but without significant differences between initial and follow-up measurements (p = .52, .91, and .45, respectively) and exacerbations decreased from 3.1 ± 3.5 to 1.9 ± 2.8 at 1 year (p = .1709) to 1.8 ± 4.4 at 2 years (p = .2344). The results were not significantly different from those obtained in atopic asthmatics. Conclusion. Anti-IgE therapy can be effective in non-atopic severe asthma.
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Affiliation(s)
- Luis Pérez de Llano
- Department of Pneumology, Hospital Xeral-Calde, Rua Doutor Ochoa, Lugo, Spain
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Vennera MDC, Pérez De Llano L, Bardagí S, Ausin P, Sanjuas C, González H, Gullón JA, Martínez-Moragón E, Carretero JA, Vera E, Medina JF, Alvarez FJ, Entrenas LM, Padilla A, Irigaray R, Picado C. Omalizumab therapy in severe asthma: experience from the Spanish registry--some new approaches. J Asthma 2012; 49:416-22. [PMID: 22443408 DOI: 10.3109/02770903.2012.668255] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The efficacy of omalizumab in severe asthma has been widely demonstrated. The main objective of this study was to evaluate the efficacy and tolerability of omalizumab in a real-life setting in Spain, particularly in those patients with immunoglobulin E (IgE) levels out of range. METHODS Totally 266 uncontrolled severe asthma patients receiving high-dose inhaled corticosteroids (ICSs) plus long-acting β2-agonist (LABA) were recruited. Main efficacy outcomes were asthma exacerbation rate (AER), asthma control test (ACT), and global evaluation of treatment effectiveness (GETE). RESULTS AER was reduced from 3.6 (3.6) in previous year to 0.67 (1.2) at 4 months (p < .05) and to 1.04 (1.8) at 2 years (p < .05). ACT increased significantly from 14.3 (4.7) at baseline to 18.4 (4.4) at 4 months (p < .05) and to 20.3 (4.0) (p < .05) at 2 years. After 4 months, 74.6% of patients had reached a good or excellent rate on the GETE scale (p < .05). This rate continued increasing up to 81.6% at 2 years. These efficacy results were similar for patients with "off-label" IgE > 700 IU/ml. At follow-up, maintenance treatment with oral steroids was discontinued in a considerable number of patients: from 89 to 19 (p < .05). Omalizumab was discontinued because of lack of efficacy only in 28/266 (10.5%) patients. Overall, 30 patients (11.4%) reported adverse events. Severe adverse events were not observed. CONCLUSION This real-life study confirms that omalizumab is very efficacious and very well tolerated in patients with uncontrolled severe asthma. Results did not vary in the subgroup of patients with IgE levels >700 IU/ml.
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Affiliation(s)
- María Del Carmen Vennera
- Department of Pneumology and Respiratory Allergy, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. ,
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