[Impact of preventive treatment with long-acting beta(2)-adrenergic agonists and inhaled corticosteroids on the morbidity and mortality of severe asthma exacerbations in 1543 patients]

Incidence and Triggers of Asthma Exacerbations Attended in the Emergency Department as a Level of Care Indicator (ASMAB III, 2005 and ASMAB IV, 2011)

INTRODUCTION

The identification of asthma exacerbations (AE) seen in emergency departments and in the home is proposed as a parameter of asthma control and for monitoring environmental triggers.

PATIENTS AND METHODS

All AEs seen in 2005 and 2011 in the reference hospital of the region and in the patients' homes by the Emergency Medical Services were identified.

RESULTS

The incidence of AE was 1.93/10(6)inhabitants/day during 2005, and 2/10(6)inhabitants/day in 2011. The most common triggers were slow onset common cold of more than 24h duration in 104/219 (47%) AEs in 2005 and 107/220 (49%) in 2011; prior bronchial symptoms with cough, expectoration and fever were recorded in 41/219 (19%) in 2005 and in 57/220 (26%) AEs in 2011. In total, 49% (2005) and 74% (2011) of the AEs had onset more than 24h before admission.

CONCLUSIONS

No significant differences were observed in the rate of attendance in the emergency department due to AE between 2005 and 2011. The most common triggers were common cold and bronchial symptoms with expectoration and fever. AE had begun more than 24h previously in at least half of cases. These findings appear to suggest that there may be a scope for improvement in the outpatient care of the asthmatic patient.

Involvement of Spanish pulmonology centers in patient care, postgraduate education and research in asthma: the results of the ATENEA survey

Although asthma is one of the most prevalent chronic respiratory diseases, the participation of Spanish pulmonology units in the management of asthma may have room for improvement.

OBJECTIVE

To determine the degree of involvement of the Spanish pulmonology services in the patient care, education and research related with asthma disease and especially in difficult-to-control asthma.

METHODS

A survey made up of 75 questions was sent to the heads of several pulmonology departments. The survey asked questions pertaining to respiratory disease care in general, and in asthma in particular, as well as the educational activities and research in asthma during the previous five years.

RESULTS

Out of the 107 surveys sent, 69 (645%) centers filled them out and returned them. Forty-seven (681%) met the criteria for an important level of health-care activity in asthma. However, only 29 (42%) had a monographic consultation for difficult-to-control asthma and 37 (536%) used an education program. As for postgraduate education, only 31 (449%) provided their resident physicians with specific asthma training. And in the research field, 12 (174%) reported having projects funded by SEPAR and 25 (362%) had published studies in journals with an impact factor.

CONCLUSIONS

Although the majority of the pulmonology centers interviewed report a notable activity in asthma patient care, their involvement in the specialized approach for difficult-to-control asthma is insufficient. Likewise, participation in educational activities and research related with the disease is inconsistent and limited to few centers.

Changes in clinical, pulmonary function, quality of life and costs in a cohort of asthmatic patients followed for 10 years

Few studies have comprehensively assessed the evolution asthma disease in recent years.

OBJECTIVES

To determine changes in morbidity, lung function and quality of life and to establish the impact in terms of cost in a cohort of patients with asthma.

METHODS

Prospective, descriptive and realistic study that included 220 asthma patients evaluated 10 years after their inclusion (1994-2004). For all the patients, data for symptoms, lung function, quality of life and financial cost were collected.

RESULTS

There was a decrease in the frequency of health service visits, including: emergency room visits for asthma exacerbations, 0.3 (0.9) versus 0.6 (1) visits per patient per year (P=.003); a reduction in the severity of the disease, with a greater proportion of patients with mild asthma, 121 (54.8%) versus 94 (42.7%) (P=.001); a decrease (improvement in quality of life) in the total SGRQ, 30.1 (16.5) versus 37 (19.6) (P<.001); and reduced total costs, 1,464€ (3,415.8) compared to 2,267€ (4.174) per patient/year (P<.001), mainly due to indirect costs, 617.50€ (2855.9) compared to 1,320.10€ (3,685.3) per patient/year (P=.001). When assessing the changes observed according to asthma severity, no differences were observed between groups.

CONCLUSIONS

The evolution of the morbidity and quality of life of asthma patients between 1994 and 2004 are clearly favorable. This improvement provided a significant reduction in the total costs of disease treatment.

[Asthma in the Archivos de Bronconeumología: a review of publications in the year 2009]

A total of 16 articles (Table 1), were published in the Archivos de Bronconeumología in the past year (December 2008 to November 2009), 9 of which were Originals, which was 17.6% of the originals published in that period. Fortunately, the tendency of a decreasing interest in asthma by pneumologists does not seem to have materialised as was feared a few years ago, on the contrary it seems that research is increasing. All articles that appeared in the journal during the period mentioned are reviewed.