Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain

OBJECTIVE

Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases.

METHOD

Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction.

RESULTS

In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF.

CONCLUSIONS

Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.

Impact of the COVID-19 pandemic on diagnosis of respiratory diseases in the Northern Metropolitan Area in Barcelona (Spain)

OBJECTIVE

The COVID-19 pandemic has had a great effect on the management of chronic diseases, by limiting the access to primary care and to diagnostic procedures, causing a decline in the incidence of most diseases. Our aim was to analyze the impact of the pandemic on primary care new diagnoses of respiratory diseases.

METHODS

Observational retrospective study performed to describe the effect of COVID-19 pandemic on the incidence of respiratory diseases according to primary care codification. Incidence rate ratio between pre-pandemic and pandemic period was calculated.

RESULTS

We found a decrease in the incidence of respiratory conditions (IRR 0.65) during the pandemic period. When we compared the different groups of diseases according to ICD-10, we found a significant decrease in the number of new cases during the pandemic period, except in the case of pulmonary tuberculosis, abscesses or necrosis of the lungs and other respiratory complications (J95). Instead, we found increases in flu and pneumonia (IRR 2.17) and respiratory interstitial diseases (IRR 1.41).

CONCLUSION

There has been a decrease in new diagnosis of most respiratory diseases during the COVID-19 pandemic.

Respiratory diseases in Mexico: analysis from the Global Burden of Disease study 2021

BACKGROUND

Respiratory diseases (RD) are often analyzed separately rather than collectively, possibly leading to an underestimation of their total burden.

OBJECTIVE

To analyze the burden of RD in Mexico for population aged 20 or older from 1990 to 2021.

MATERIAL AND METHODS

We present the burden of RD in Mexico based on estimates of the Global Burden of Disease study for mortality and disability-adjusted life years (DALYs), comprising counts, rates per 100,000, as well as age-standardized rates. RDs were categorized into three key groups: chronic respiratory diseases (CRD), respiratory infections (RI), and respiratory cancers.

RESULTS

In 2021, among those aged 20+, RDs were responsible for 336,728 deaths, which accounts for 30.5% of total deaths -a nearly threefold increase since 2019, primarily due to the COVID-19 pandemic. CRDs contributed with 3.4% of total deaths; RIs, with 25.9%; and respiratory cancers, with 1.2%. CRDs showed a continuous rise in deaths, crude mortality, and DALY rates across genders, with no signs of leveling. RD burden varied widely across Mexican states. Age-standardized CRD mortality rates have generally declined since 1990, except for interstitial lung diseases, which have consistently increased.

CONCLUSION

The significant burden of mortality and disability due to RDs in Mexico underscores the n|ecessity for enhanced prevention, research, and for addressing risk factors such as smoking and pollution. Ongoing healthcare training can help reduce RD burden.

Prevalence of chronic obstructive pulmonary disease in patients diagnosed with HIV without prior antiretroviral treatment

Introduction

Chronic obstructive pulmonary disease (COPD) is the most prevalent respiratory problem in the world. Patients with human immunodeficiency virus (HIV) infection have a higher prevalence of smoking and recurrent lung infections and are at higher risk of COPD.

Objective

To determine the prevalence of COPD in HIV-diagnosed patients referred to an infectious diseases hospital.

Method

Individuals with HIV infection without previous or ongoing antiretroviral treatment, with chronic respiratory symptoms, with or without a history of exposure for the development of COPD were included. Pre- and post-bronchodilation spirometry, high-resolution computed tomography, viral load determination and CD4 count were carried out. Spirometry measurements were compared with Wilcoxon's test.

Results

Sixty-six HIV-diagnosed patients, with a mean age of 31.5 years were included; 64 were males and two females. The prevalence of COPD was 7.6 %. The group with obstruction had a lower CD4 count (27.3 versus 225.9) and higher viral load (165,000 versus 57,722), in comparison with the group without obstruction. A positive correlation was observed between lower viral load and higher forced expiratory volume in 1 second/forced vital capacity ratio.

Conclusion

HIV-positive patients with a lower CD4 count and a higher viral load show a decrease in spirometry values.

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND

Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event.

OBJECTIVES

To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities.

METHODS

We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features.

RESULTS

We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50<PM<150) or high (≥150) PM10 levels.

CONCLUSIONS

We found evidence that SDDs carry a risk of emergency hospital admission from respiratory diseases in the Canary Islands.

Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project

INTRODUCTION

The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma.

OBJECTIVE

To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing).

MATERIAL AND METHODS

A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development (SENDO) project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according to the NOVA classification, and the daily consumption was estimated along with the percentage of Kilocalories from the UP. The exposure was grouped into "high" and "low" from the median consumption. Odds Ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings.

RESULTS

In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76 g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR: 1.87, 95% CI: 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI: 1.10-4.05) the prevalence of bronchitis/recurrent wheezing.

CONCLUSIONS

The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.

[Consumption of ultra-processed products and wheezing respiratory diseases in children: The SENDO project]

INTRODUCTION

The consumption of ultra-processed products (UP) is associated with many diseases in the adult, such as arterial hypertension, diabetes, or asthma.

OBJECTIVE

To determine whether the consumption of UP in children is associated with wheezing respiratory diseases (asthma or bronchitis/recurrent wheezing).

MATERIAL AND METHODS

A cross-sectional study was conducted within the Follow-up of the Child for Optimal Development ?SENDO? project (an open, multidisciplinary and multiple outcome study of Spanish children). The consumption of UP was calculated using semi-quantitative questionnaires on the frequency of food consumption. The foods were grouped according the NOVA classification, and the daily consumption was estimated along with the percentage of kilocalories from the UP. The exposure was grouped into "high" and "low" from the median consumption. Odds ratios and 95% confidence intervals were calculated for wheezing respiratory diseases associated with the high consumption UP, using low consumption as a reference. Crude and multi-adjusted estimators were calculated, and mixed regression models were used to take into account the correlation between siblings.

RESULTS

In the 513 children studied (51.8% males, mean age 5.2 years), the mean consumption of UP was 446.76g/day, representing 39.9% of the total calories ingested. A high consumption of UP was associated with an increase of 87% in the prevalence of wheezing respiratory diseases (OR 1.87; 95% CI 1.01-3.45). It was found that a higher consumption of UP multiplied by 2.12 (95% CI 1.10-4.05) the prevalence of bronchitis/recurrent wheezing.

CONCLUSIONS

The results of this study show a direct relationship between UP consumption and the prevalence of wheezing diseases in children.

Do Saharan Dust Days Carry a Risk of Hospitalization From Respiratory Diseases for Citizens of the Canary Islands (Spain)?

BACKGROUND

Saharan dust meets the Canary Islands at the beginning of its westward path across the North Atlantic, exceeding the European daily levels for PM10; for this reason, their two provincial capital cities, constitute optimal sites where to evaluate the health effects of this natural event.

OBJECTIVES

To assess the short-term association between Saharan Dust Days (SDDs) and respiratory morbidity in the two capital cities.

METHODS

We carried out a time-series analysis with daily emergency hospital admissions due to all respiratory system diseases, chronic obstructive pulmonary disease (COPD) and asthma between 2001 and 2005, assessing the independent effect of SDDs, defined according to the application of the methodology accepted by the European Environmental Office. We also examined accumulated effect, and some other specific SDDs' features.

RESULTS

We found a short-term association between SDDs and the increase in admission risk for the three outcomes during concurrent SDDs, compared to non-SDDs, that spread from 0 to 5th day: 22.6% (95% confidence interval [CI], 10.4, 36.0) for all respiratory diseases and 29.9% (95%CI: 6.6, 58.4) for COPD in Santa Cruz de Tenerife, and 33.4% (95%CI: -2.1,82.0) for asthma in Las Palmas de Gran Canaria. We obtained a robust association when Saharan dust transported at low altitude, when SDDs belonged to long episodes (≥5days), from the fifth SDD onwards and those SDDs with medium (50

CONCLUSIONS

We found evidence that SDDs carry a risk of emergency hospital admission from respiratory diseases in the Canary Islands.

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Key Words

• African air intrusions
• Calima sahariana
• Enfermedades respiratorias
• Generalized additive model
• Hospital admissions
• Ingresos hospitalarios
• Intrusiones de aire africano
• Modelos aditivos generalizados
• Particulate matter
• Partículas en suspensión
• Respiratory diseases
• Saharan dust
• Series temporales
• Time-series

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Affiliation(s)

Elena López-Villarrubia Dirección General de Salud Pública. Gobierno de Canarias, Alfonso XIII, 4, 35003 Las Palmas de Gran Canaria, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain.
Olga Costa Estirado Dirección General de Salud Pública. Gobierno de Canarias, Alfonso XIII, 4, 35003 Las Palmas de Gran Canaria, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain
Carmen Íñiguez Hernández Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain
Ferran Ballester Díez Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, 28029 Madrid, Spain; FISABIO-UJI-Universitat de València, Epidemiology and Environmental Health Joint Research Unit, Avenida de Catalunya 21, 46020 Valencia, Spain; Department of Nursing, University of Valencia, C/ Jaume Roig, 46010 Valencia, Spain

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Text mining and medicine: usefulness in respiratory diseases

It is increasingly common to have medical information in electronic format. This includes scientific articles as well as clinical management reviews, and even records from health institutions with patient data. However, traditional instruments, both individual and institutional, are of little use for selecting the most appropriate information in each case, either in the clinical or research field. So-called text or data «mining» enables this huge amount of information to be managed, extracting it from various sources using processing systems (filtration and curation), integrating it and permitting the generation of new knowledge. This review aims to provide an overview of text and data mining, and of the potential usefulness of this bioinformatic technique in the exercise of care in respiratory medicine and in research in the same field.

Spirometry. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)

Spirometry is the main pulmonary function test and is essential for the evaluation and monitoring of respiratory diseases. Its utility transcends the field of Respiratory Medicine, is becoming increasingly important in primary care and applications have even been described outside the field of respiratory diseases. This document is therefore intended to serve as support for all health professionals who use spirometry, providing recommendations based on the best scientific evidence available. An update of the indications and contraindications of the test is proposed. The document sets out recommendations on the requirements necessary for conventional spirometers and portable office equipment, as well as on spirometer hygiene and quality control measures. Spirometric parameters that must be considered, performance of manoeuvres, criteria for acceptability and repeatability of measurements and their quality control are defined. A proposal is also established for presentation of the results and an evaluation and interpretation is proposed according to information generated in recent years. Finally, lines of adaptation and integration of spirometry in the field of new technologies are considered.