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Alami-Yadri A, Ghanname I, Cherkani-Hassani A, Zagmout A, Benitez-Rexach AM, Bousouf A, Rahhali K. The analysis of Asthma Control using Markov Models: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco). J Asthma 2024:1-15. [PMID: 38814856 DOI: 10.1080/02770903.2024.2360943] [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: 01/09/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
This study aimed to analyze the probabilities of transitioning between controlled, uncontrolled, and partially controlled states of asthma patients and investigate the influence of age, smoking, dust allergy, and obesity on these probabilities. Four hundred twenty-four asthma patients from three hospitals in Morocco were included in the study, spanning 42 months.A discrete-time homogeneous Markov model with three states and a single aperiodic recurrent class was used to model the asthma evolution, assuming the regularity of consultations. Results showed that controlled patients were more likely to remain in that state, with approximately 79 out of 100 patients expected to stay in optimal control in the long term.A discrete non-homogeneous time Markov Model with the stationarity criterion was used to examine the factors affecting patient states and transitions. Patients seen during the spring and summer seasons were more likely to move into a controlled state compared with those seen in the fall and winter seasons. Patients with dust allergies and obesity significantly impacted asthma exacerbation, with overweight patients more likely to transition into a controlled state.The study estimated the transition intensities matrix under certain conditions, assuming the regularity of patients. In the long term, the probability of an asthmatic patient being in a controlled state was approximately 0.8.Overall, this study provided insights into the probabilities and factors influencing asthma progression in Morocco. Dust allergy and obesity were identified as significant contributors to asthma exacerbation, emphasizing the need for effective management strategies.
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Affiliation(s)
- Amina Alami-Yadri
- Mathematics, Statistics, and Applications Laboratory, Faculty of Sciences, Mohammed V University, Rabat - Morocco
| | - Imane Ghanname
- Research team of Pharmacoepidemiology & Pharmacoeconomic - Faculty of Medicine and Pharmacy, Mohammed V University, Rabat - Morocco
| | - Abha Cherkani-Hassani
- Laboratory of Analytical Chemistry and Bromatology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Adil Zagmout
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca - Morocco
| | - Aida M Benitez-Rexach
- Independent Scholar-Practitioner and Educational Consultant in Health and Educational Psychology
| | - Abdellah Bousouf
- Mathematics, Statistics, and Applications Laboratory, Faculty of Sciences, Mohammed V University, Rabat - Morocco
| | - Khalid Rahhali
- Mathematics, Statistics, and Applications Laboratory, Faculty of Sciences, Mohammed V University, Rabat - Morocco
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2
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Morales E, Alcantara-Lopez MV, Cabezas-Herrera J, de Diego T, Hernandez-Caselles T, Jimenez-Guerrero P, Larque E, Lopez-Soler C, Martinez-Gracia C, Martinez-Torres A, Martin-Orozco E, Mendiola J, Nieto-Díaz A, Noguera JA, Perez-Fernandez V, Prieto-Sánchez MT, Salvador-Garcia C, Sanchez-Solis M, Santaella-Pascual M, Sola-Martinez RA, Torres-Cantero A, Yagüe-Guirao G, Zornoza-Moreno M, Garcia-Marcos L. The Nutrition in Early Life and Asthma (NELA) birth cohort study: Rationale, design, and methods. Paediatr Perinat Epidemiol 2022; 36:310-324. [PMID: 34841558 DOI: 10.1111/ppe.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary prevention strategies for asthma are lacking. Its inception probably starts in utero and/or during the early postnatal period as the developmental origins of health and disease (DOHaD) paradigm suggests. OBJECTIVES The main objective of Nutrition in Early Life and Asthma (NELA) cohort study is to unravel whether the following factors contribute causally to the developmental origins of asthma: (1) maternal obesity/adiposity and foetal growth; (2) maternal and child nutrition; (3) outdoor air pollution; (4) endocrine disruptors; and (5) maternal psychological stress. Maternal and offspring biological samples are used to assess changes in offspring microbiome, immune system, epigenome and volatilome as potential mechanisms influencing disease susceptibility. POPULATION Randomly selected pregnant women from three health areas of Murcia, a south-eastern Mediterranean region of Spain, who fulfilled the inclusion criteria were invited to participate at the time of the follow-up visit for routine foetal anatomy scan at 19-22 weeks of gestation, at the Maternal-Fetal Medicine Unit of the "Virgen de la Arrixaca" University Clinical Hospital over a 36-month period, from March 2015 to April 2018. DESIGN Prospective, population-based, maternal-child, birth cohort study. METHODS Questionnaires on exposures and outcome variables were administered to mothers at 20-24 gestation week; 32-36 gestation week; and delivery. Children were surveyed at birth, 3 and 18 months of age and currently at 5 years. Furthermore, physical examinations were performed; and different measurements and biological samples were obtained at these time points. PRELIMINARY RESULTS Among the 1350 women invited to participate, 738 (54%) were finally enrolled in the study and 720 of their children were eligible at birth. The adherence was high with 612 children (83%) attending the 3 months' visit and 532 children (72%) attending the 18 months' visit. CONCLUSION The NELA cohort will add original and unique knowledge to the developmental origins of asthma.
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Affiliation(s)
- Eva Morales
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain
| | - Maria V Alcantara-Lopez
- Paediatric Psychology Unit, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Juan Cabezas-Herrera
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Molecular Therapy and Biomarkers Research Group, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Teresa de Diego
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Trinidad Hernandez-Caselles
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Pedro Jimenez-Guerrero
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Regional Atmospheric Modelling Group, Department of Physics, University of Murcia, Murcia, Spain
| | - Elvira Larque
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Physiology, University of Murcia, Murcia, Spain.,Maternal and Children Health Network (SAMID III), Murcia, Spain
| | - Concepción Lopez-Soler
- Paediatric Psychology Unit, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain.,Paediatric and Adolescent Clinical Psychology University Research Group (GUIIA-PC), University of Murcia, Murcia, Spain
| | - Carmen Martinez-Gracia
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Food Science and Technology, University of Murcia, Murcia, Spain
| | - Antonela Martinez-Torres
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Paediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Elena Martin-Orozco
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Jaime Mendiola
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain
| | - Anibal Nieto-Díaz
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Materno-Fetal Medicine Unit, Obstetrics and Gynaecology Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Jose A Noguera
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Molecular Therapy and Biomarkers Research Group, Clinical Analysis Service, University Clinical Hospital, Murcia, Spain
| | - Virginia Perez-Fernandez
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain
| | - M Teresa Prieto-Sánchez
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Materno-Fetal Medicine Unit, Obstetrics and Gynaecology Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Carme Salvador-Garcia
- Microbiology Service, General University Hospital Consortium, University of Valencia, Valencia, Spain
| | - Manuel Sanchez-Solis
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Paediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Marina Santaella-Pascual
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Food Science and Technology, University of Murcia, Murcia, Spain
| | - Rosa A Sola-Martinez
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Biochemistry, Molecular Biology, University of Murcia, Murcia, Spain
| | - Alberto Torres-Cantero
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Department of Public Health Sciences, University of Murcia, Murcia, Spain.,Preventive Medicine Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Genoveva Yagüe-Guirao
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Microbiology Service, "Virgen de la Arrixaca" University Clinical Hospital, University of Murcia, Murcia, Spain.,Department of Genetics and Microbiology, University of Murcia, Murcia, Spain
| | - Matilde Zornoza-Moreno
- Department of Physiology, University of Murcia, Murcia, Spain.,"Vistalegre-La Flota" Health Center, Health System of Murcia (SMS), Murcia, Spain
| | - Luis Garcia-Marcos
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain.,Paediatric Respiratory and Allergy Units, "Virgen de la Arrixaca" Children's University Clinical Hospital, University of Murcia, Murcia, Spain.,Network of Asthma and Adverse and Allergic Reactions (ARADyAL), Murcia, Spain
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3
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Izquierdo JL, Almonacid C, González Y, Del Rio-Bermudez C, Ancochea J, Cárdenas R, Lumbreras S, Soriano JB. The impact of COVID-19 on patients with asthma. Eur Respir J 2021; 57:13993003.03142-2020. [PMID: 33154029 PMCID: PMC7651839 DOI: 10.1183/13993003.03142-2020] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
Background An association between the severity of coronavirus disease 2019 (COVID-19) and the presence of certain chronic conditions has been suggested. However, unlike influenza and other viruses, the disease burden of COVID-19 in patients with asthma has been less evident. Objective To understand the impact of COVID-19 in patients with asthma. Methods Using big-data analytics and artificial intelligence through the SAVANA Manager clinical platform, we analysed clinical data from patients with asthma from January 1 to May 10, 2020. Results Out of 71 182 patients with asthma, 1006 (1.41%) suffered from COVID-19. Compared to asthmatic individuals without COVID-19, patients with asthma and COVID-19 were significantly older (55 versus 42 years), predominantly female (66% versus 59%), smoked more frequently and had higher prevalence of hypertension, dyslipidaemias, diabetes and obesity. Allergy-related factors such as rhinitis and eczema were less common in asthmatic patients with COVID-19 (p<0.001). In addition, higher prevalence of these comorbidities was observed in patients with COVID-19 who required hospital admission. The use of inhaled corticosteroids (ICS) was lower in patients who required hospitalisation due to COVID-19, as compared to non-hospitalised patients (48.3% versus 61.5%; OR 0.58, 95% CI 0.44–0.77). Although patients treated with biologics (n=865; 1.21%) showed increased severity and more comorbidities at the ear, nose and throat level, COVID-19-related hospitalisations in these patients were relatively low (0.23%). Conclusion Patients with asthma and COVID-19 were older and at increased risk due to comorbidity-related factors. ICS and biologics are generally safe and may be associated with a protective effect against severe COVID-19 infection. The increased risk of hospitalisation due to COVID-19 in patients with asthma is largely associated with age and related comorbidities. ICS and biologics may be associated with a protective effect against the most severe manifestations of COVID-19. https://bit.ly/37yhr5b
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Affiliation(s)
- José Luis Izquierdo
- Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain.,Dept of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
| | - Carlos Almonacid
- Dept of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain.,Respiratory Medicine, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | - Julio Ancochea
- Respiratory Medicine, Hospital Universitario de La Princesa, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigatión en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Sara Lumbreras
- Savana Medica, Madrid, Spain.,Universidad Pontificia Comillas, Madrid, Spain
| | - Joan B Soriano
- Respiratory Medicine, Hospital Universitario de La Princesa, Madrid, Spain .,Universidad Autónoma de Madrid, Madrid, Spain.,Centro de Investigatión en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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4
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García-Pachón E, Zamora-Molina L, Soler-Sempere MJ, Baeza-Martínez C, Grau-Delgado J, Padilla-Navas I, Gutiérrez F. Asthma and COPD in Hospitalized COVID-19 Patients. Arch Bronconeumol 2020; 56:604-606. [PMID: 32586704 PMCID: PMC7261473 DOI: 10.1016/j.arbres.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Eduardo García-Pachón
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España.
| | - Lucía Zamora-Molina
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - María J Soler-Sempere
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Carlos Baeza-Martínez
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Justo Grau-Delgado
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Isabel Padilla-Navas
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - Félix Gutiérrez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España; Servicio de Medicina Interna, Hospital General Universitario de Elche, Elche, Alicante, España
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5
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Hurtado I, García-Sempere A, Peiró S, Bengoetxea A, Prieto JL, Sanfélix-Gimeno G. Real-World Patterns of Pharmacotherapeutic Management of Asthma Patients With Exacerbations in the Spanish National Health System. Front Pharmacol 2020; 11:1323. [PMID: 32973532 PMCID: PMC7472631 DOI: 10.3389/fphar.2020.01323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background Little is known about the real1world characteristics of asthma patients with exacerbations or their pharmacotherapeutic management. We described the sociodemographic and clinical characteristics, and the patterns of short and long-term management of asthma attacks, in a population-wide cohort of exacerbators in the region of Valencia, Spain. Methods We selected asthma patients with at least one exacerbation in 2015 and 2016, we classified them according to their patterns of exacerbations in the 4 years previous to the index exacerbation and their therapeutic step at baseline based on medication received in the previous year. We described the short and long-term pharmacological management of the index exacerbation. Results 18,714 patients experienced at least one exacerbation. The majority had no previous exacerbation (46.5%), or exacerbated in only one of the years (26.8%). 2.9% had attacks every single year, 25.7% of whom only received rescue medication at baseline. 29.5% of patients without previous exacerbation received maintenance therapy at baseline. Shortly following the index exacerbation, 2,461 patients (13.1%) did not receive any asthma prescription. Among those treated, 70.3% were prescribed a maintenance therapy, 62.4% received a rescue medication, and 30.5% received an oral corticoid. Throughout the year following the index exacerbation, most patients remained in their baseline therapeutic step. Conclusions Most patients that exacerbate present very mild to mild forms of the disease or low levels of treatment and most exacerbations are managed in primary care. These insights may help to refine strategies for improving asthma control in the population.
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Affiliation(s)
- Isabel Hurtado
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Anibal García-Sempere
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Salvador Peiró
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Asier Bengoetxea
- Emergency Room Department, La Ribera University Hospital, Valencia, Spain
| | | | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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6
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García-Pachón E, Zamora-Molina L, Soler-Sempere MJ, Baeza-Martínez C, Grau-Delgado J, Padilla-Navas I, Gutiérrez F. Asthma and COPD in hospitalized COVID-19 patients. Arch Bronconeumol 2020. [PMID: 34025003 PMCID: PMC7386266 DOI: 10.1016/j.arbr.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Eduardo García-Pachón
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain.,Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Lucía Zamora-Molina
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María J Soler-Sempere
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Carlos Baeza-Martínez
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Justo Grau-Delgado
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Isabel Padilla-Navas
- Sección de Neumología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Félix Gutiérrez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain.,Servicio de Medicina Interna, Hospital General Universitario de Elche, Elche, Alicante, Spain
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Puente-Maestu L, Llanos Flores M, Benedetti P, Frías Benzant I, Oliva Ramos A, García de Pedro J, Sanz Sanz P, García-López J. Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain. Biomed Hub 2018; 3:1-9. [PMID: 31988961 PMCID: PMC6945925 DOI: 10.1159/000492075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/11/2018] [Indexed: 12/14/2022] Open
Abstract
Background Bronchial thermoplasty (BT) is a minimally invasive procedure consisting of application of thermal energy into the airways to produce ablation of the hypertrophic smooth muscle. It was approved for use in moderate-severe asthma in Spain in 2010. Objectives The aims of the present study are to analyze the effectiveness and the safety of BT in clinical practice in our center. Methods Participants had a confirmed diagnosis of severe asthma and poor control without therapeutic alternative. Effectiveness was measured by comparing exacerbations, admissions rates, asthma control, and medication 1 year prior and 1 year after BT was completed. All complications appearing during the procedure and in the first year were recorded. Results Patients had a mean age of 51 (SD 8) years and were predominantly female (17/23). The average number of activations per patient was 147 (16). The number of severe exacerbations was reduced by 75% (p < 0.001). A 38% reduction in admissions per year was also observed (p = 0.03). The Asthma Control Test improved by 7.1 (3.7) points (p = 0.018). Before BT, the dose of inhaled corticosteroids was 1,621 (1,015) µg of budesonide-equivalent and the dose of oral corticosteroids was 15 (13) mg of prednisone-equivalent. There was a reduction in 430 (731) µg of budesonide-equivalent (p = 0.02) and 4 (11) mg of prednisone (p = 0.094). No changes in lung function were observed. Complications were related mostly to exacerbation of asthma in the days following the procedure. Conclusions BT is effective and safe for severe uncontrolled bronchial asthma in real clinical practice.
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Affiliation(s)
- Luis Puente-Maestu
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Milagros Llanos Flores
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Paola Benedetti
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Ingrid Frías Benzant
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain
| | - Alicia Oliva Ramos
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Julia García de Pedro
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
| | - Pilar Sanz Sanz
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain
| | - Javier García-López
- Hospital General Universitario "Gregorio Marañón," Servicio de Neumología, Madrid, Spain.,Facultad de Medicina de la Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria "Gregorio Marañón", Madrid, Spain
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8
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Ghanname I, Chaker A, Cherkani Hassani A, Herrak L, Arnaul Ebongue S, Laine M, Rahhali K, Zoglat A, Benitez Rexach AM, Ahid S, Cherrah Y. Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco). BMC Pulm Med 2018; 18:61. [PMID: 29699541 PMCID: PMC5921326 DOI: 10.1186/s12890-018-0624-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of the study is to describe the profile of patients with asthma and to identify the signifiant risks and the protective factors associated with asthma control. METHODS A prospective epidemiological study was conducted in three hospitals of Rabat-Morocco and included 396 patients with asthma. Differences in characteristics across the levels of asthma control were compared by the one-way analysis of variance for continuous variables, and chi-square test was used for categorical variables. The risk and protective factors associated with the asthma control levels were determined by Proportional Odds Model (POM) for bivariate and multivariate ordinal logistic regression, also expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI). RESULTS From 7440 patients screened by 28 physicians, 396 were included in study. 53% of the particiants sufferd controlled, 18% had partly controlled and 29% had uncontrolled asthma symptoms. A multivariate ordinal logistic regression analysis showed that having respiratory infections (AOR = 5.71), suffering from concomitant diseases (AOR = 3.36) and being allergic to animals (AOR = 2.76) were positively associated with poor control of asthma. However, adherence to treatement (AOR = 0.07), possession of health insurance (AOR = 0.41) and having more than 2 children (AOR = 0.47) were associated with good asthma control. CONCLUSION The study established a clinical-epidemiological profile of asthmatic patients in Rabat region in Morocco. By ordinal logistic regression we found that 6 factors - respiratory infections, concomitant diseases, animals allergy, adherence to treatment, health insurance and having more than two children - were associated with asthma control.
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Affiliation(s)
- Imane Ghanname
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco. .,Faculty of Health Sciences, International University of Casablanca, Bouskoura, Morocco.
| | - Ahmed Chaker
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Abha Cherkani Hassani
- Unit of training and research in Nutrition and Food Sciences, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Laila Herrak
- Department of Pneumology, Ibn Sina Hospital, Rabat, Morocco
| | | | - Mustapha Laine
- Department of Pneumology, Moulay Youssef Hospital, Rabat, Morocco
| | - Khalid Rahhali
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Abdelhak Zoglat
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Aida Maria Benitez Rexach
- Department of Languages, International University of Casablanca, Bouskoura, Morocco.,Doctoral Student in Psychology, Walden University, Minneapolis, USA
| | - Samir Ahid
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yahia Cherrah
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Rava M, Czachorowski MJ, Silverman D, Márquez M, Kishore S, Tardón A, Serra C, García-Closas M, Garcia-Closas R, Carrato A, Rothman N, Real FX, Kogevinas M, Malats N. Asthma status is associated with decreased risk of aggressive urothelial bladder cancer. Int J Cancer 2018; 142:470-476. [PMID: 28940228 PMCID: PMC6982397 DOI: 10.1002/ijc.31066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/23/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022]
Abstract
Previous studies suggested an association between atopic conditions and specific cancers. The results on the association with urothelial bladder cancer (UBC) are scarce and inconsistent. To evaluate the association between asthma and risk of UBC, we considered 936 cases and 1,022 controls from the Spanish Bladder Cancer/EPICURO Study (86% males, mean age 65.4 years), a multicenter and hospital-based case-control study conducted during 1998-2001. Participants were asked whether they had asthma and detailed information about occupational exposures, smoking habits, dietary factors, medical conditions and history of medication was collected through face-to-face questionnaires performed by trained interviewers. Since asthma and UBC might share risk factors, association between patients' characteristics and asthma was studied in UBC controls. Association between UBC and asthma was assessed using logistic regression unadjusted and adjusted for potential confounders. The complex interrelationships, direct and mediating effect of asthma on UBC, were appraised using counterfactual mediation models. Asthma was associated with a reduced risk of UBC (odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.37, 0.79) after adjusting for a wide range of confounders. No mediating effect was identified. The reduced risk associated with asthma was restricted to patients with high-risk non-muscle invasive (OR = 0.25, 95%CI 0.10, 0.62) and muscle invasive UBC (OR = 0.32, 95%CI 0.15, 0.69). Our results support that asthma is associated with a decreased risk of UBC, especially among aggressive tumors. Further work on the relationship between asthma and other atopic conditions and cancer risk should shed light on the relationship between immune response mechanisms and bladder carcinogenesis.
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Affiliation(s)
- Marta Rava
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, and CIBERONC, Spain
| | - Maciej J Czachorowski
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, and CIBERONC, Spain
| | - Debra Silverman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Mirari Márquez
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, and CIBERONC, Spain
| | - Sirish Kishore
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, and CIBERONC, Spain
| | - Adonina Tardón
- Department of Preventive Medicine, Universidad de Oviedo, and CIBERESP, Spain
| | - Consol Serra
- Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, IMIM-Hospital del Mar Medical Research Institut, Barcelona, and CIBERESP, Spain
| | - Montse García-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland, USA
| | | | - Alfredo Carrato
- Servicio de Oncología, Hospital Universitario Ramon y Cajal, Madrid, Servicio de Oncología, Hospital Universitario de Elche, and CIBERONC, Spain
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Francisco X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre (CNIO), Madrid, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, and CIBERONC, Spain
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Parc de Salut Mar, Barcelona, and CIBERESP, Madrid, Spain
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, and CIBERONC, Spain
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Cisneros C, Díaz-Campos RM, Marina N, Melero C, Padilla A, Pascual S, Pinedo C, Trisán A. Accreditation of specialized asthma units for adults in Spain: an applicable experience for the management of difficult-to-control asthma. J Asthma Allergy 2017; 10:163-169. [PMID: 28533690 PMCID: PMC5431694 DOI: 10.2147/jaa.s131506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This paper, developed by consensus of staff physicians of accredited asthma units for the management of severe asthma, presents information on the process and requirements for already-existing asthma units to achieve official accreditation by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Three levels of specialized asthma care have been established based on available resources, which include specialized units for highly complex asthma, specialized asthma units, and basic asthma units. Regardless of the level of accreditation obtained, the distinction of “excellence” could be granted when more requirements in the areas of provision of care, technical and human resources, training in asthma, and teaching and research activities were met at each level. The Spanish experience in the process of accreditation of specialized asthma units, particularly for the care of patients with difficult-to-control asthma, may be applicable to other health care settings.
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Affiliation(s)
| | | | - Núria Marina
- Asthma Unit, Laboratorio de Exploración Funcional, Department of Pneumology, Hospital Universitario Cruces, BioCruces, Barakaldo, Bizkaia
| | - Carlos Melero
- Service of Pneumology, Hospital Universitario 12 de Octubre, Madrid
| | | | | | - Celia Pinedo
- Service of Pneumology, Hospital Clínico San Carlos
| | - Andrea Trisán
- Service of Pneumology, Hospital Universitario Puerta de Hierro, Madrid, Spain
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Darbà J, Ramírez G, García-Rivero JL, Mayoralas-Alises S, Pascual JF, Roger A, Vargas D, Bijedic A. A budget impact analysis of Spiromax(®) compared with Turbuhaler(®) for the treatment of moderate to severe asthma: a potential improvement in the inhalation technique to strengthen medication adherence could represent savings for the Spanish Healthcare System and five Spanish regions. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:435-44. [PMID: 27660476 PMCID: PMC5019164 DOI: 10.2147/ceor.s111453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the economic impact of the introduction of DuoResp(®) Spiromax(®) by focusing on a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthmatics in Spain and five Spanish regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia. METHODS A 4-year budget impact model was developed for the period 2015-2018 from the Spanish Healthcare System perspective. Budesonide-formoterol fixed-dose combination delivered by Turbuhaler(®) was considered to be the most appropriate comparator for assessing the budget impact with the introduction of DuoResp(®) Spiromax(®). National and regional data on asthma prevalence were obtained from the literature. Input parameters on health care resources were obtained by consulting experts from different Spanish hospitals. Resources used included medical visits, emergency room visits, and hospitalizations. The average numbers of primary care and specialist visits per year were also gathered. Based on health care resource use per patient, the total treatment cost per patient was estimated. RESULTS The population with moderate to severe asthma treated with budesonide-formoterol fixed-dose combinations delivered by Turbuhaler(®) in 2015 was estimated to be 166,985 in Spain. Region-specific prevalence data resulted in 25,081, 12,392, 16,097, 17,829, and 15,148 patients in Andalusia, Catalonia, Galicia, Madrid, and Valencia, respectively. Based on the forecast uptake of DuoResp(®) Spiromax(®), the total budget savings in Spain were expected to be €1.509 million over the next 4 years. Region-specific rates imply that the total savings were expected to be €229,706 in Andalusia, €90,145 in Catalonia, €188,327 in Galicia, €122,669 in Madrid, and €165,796 in Valencia over 2015-2018. CONCLUSION The introduction of DuoResp(®) Spiromax(®), which represents a potential improvement in the inhalation technique to strengthen medication adherence for the treatment of moderate to severe asthma, could represent savings for the Spanish National Health Society and five Spanish regions.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona
| | | | | | | | | | - Albert Roger
- Hospital Universitario Germans Trias i Pujol, Barcelona
| | | | - Adi Bijedic
- Market Access and HEOR Department, TEVA Pharmaceutical, Madrid, Spain
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12
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Montero M, Iraurgi I, Matellanes B, Montero JM. [Use of the reliable change index to evaluate the effectiveness of clinical interventions: Application of an asthma training program]. Aten Primaria 2015; 47:644-52. [PMID: 25700987 PMCID: PMC6983811 DOI: 10.1016/j.aprim.2014.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare two methods for the evaluation of outcomes to assess effectiveness of a therapeutic intervention of a professional education program on asthma control. DESIGN A naturalistic, intervention study in which asthmatic patients were attended by clinicians (IG group) who Had taken part in a special education program and a control group (CG) that received medical assistance from clinicians still waiting to be trained. LOCATION Five urban Primary Care Health Centres of the same region. PARTICIPANTS From an initial sample of 100 patients, 76 formed the final sample for analysis. The study included 37 males and 39 females, aged between 18 and 65 years (M=41.2 years). The two study groups were found to be homogeneous except for the sex variable. INTERVENTION Training program for clinical treatment adherence. MAIN MEASUREMENTS Peak flow as spirometric index, and structured interview. STATISTICAL ANALYSIS The results were initially analysed using classical techniques based on robust ANOVA models, and then by calculating the Reliable Change Index (RCI). RESULTS ANOVA models, conducted separately for each sex, showed no significant differences, due to sample size. RCI methodology showed significant differences in the percentage of patients improved in both groups, as well as clinically relevant changes being observed individually. CONCLUSIONS The RCI method is presented as an attractive alternative as regards the classical methods of analysis that can help in the clinical decision.
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Affiliation(s)
- Mikel Montero
- DeustoPsych, I+D+i en Psicología y Salud, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, Vizcaya, España.
| | - Ioseba Iraurgi
- DeustoPsych, I+D+i en Psicología y Salud, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, Vizcaya, España
| | - Begoña Matellanes
- DeustoPsych, I+D+i en Psicología y Salud, Facultad de Psicología y Educación, Universidad de Deusto, Bilbao, Vizcaya, España
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13
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Rabell-Santacana V, Panadès-Valls R, Vila-Rigat R, Hernandez-Huet E, Sivecas-Maristany J, Blanché-Prat X, Prieto G, Muñoz L, Torán P. Prevalence of Work-Related Asthma in Primary Health Care: Study Rationale and Design. Open Respir Med J 2015; 9:127-39. [PMID: 26865884 PMCID: PMC4740970 DOI: 10.2174/1874306401509010127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/22/2022] Open
Abstract
Background : Occupational Asthma (OA) is the most frequent origin of occupational respiratory diseases in industrialized countries and accounts for between 5% and 25% of asthmatic patients. The correct and early diagnosis of OA is of great preventive and socio-economic importance. However, few studies exist on OA’s prevalence in Catalonia and in Spain and those affected are mainly treated by the public health services and not by the occupational health services, which are private. Objective : To determine the prevalence of OA in patients diagnosed with asthma in the Primary Healthcare system and to evaluate the socio-economic impact of OA in the Primary Healthcare system. Methods/Design : We will carry out an observational, transversal and multi-center study in the Primary Healthcare Service in the Barcelona region (Catalonia, Spain), with 385 asthmatic workers aged between 16 and 64 who are currently working or have been working in the past. We will confirm the asthma diagnosis in each patient, and those meeting the inclusion criteria will be asked to answer a questionnaire that aims to link asthma to the patient’s past employment history. The resulting diagnosis will be of either occupational asthma, work-aggravated asthma or common asthma. We will also collect socio-demographic information about the patients, about their smoking status, their exposure outside of the workplace, their work situation at the onset of the symptoms, their employment history, their symptoms of asthma, their present and past medical asthma treatment, and, in order to estimate the economic impact in the Primary Healthcare system, where they have been attended to and treated. Prevalence will link OA or work-aggravated asthma to the total of patients participating in the study with a asthma diagnosis. Discussion : The results will show the prevalence of OA and work-aggravated asthma, and shall provide valuable information to set out and apply the necessary personal and technical measures, either in the public or in the occupational health services. No studies evaluating the costs generated by the OA in the Primary Healthcare system have been carried out.
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Affiliation(s)
- Ventura Rabell-Santacana
- Primary Healthcare Centre Vallès Oriental, Catalan Health Institute, Carrer del Museu, 19, 08401 Granollers, Spain
| | - Rafael Panadès-Valls
- Health and Safety Occupational Centre, Department of Business and Occupation, Plaça Eusebi Güell 4-5, 08034 Barcelona, Spain
| | - Rosa Vila-Rigat
- Primary Healthcare Centre La Garriga, Catalan Health Institute, Carrer Torrent de la Sínia 7, 08530 La Garriga, Spain
| | - Enric Hernandez-Huet
- Primary Healthcare Centre Les Franqueses del Vallès, Catalan Health Institute, Carrer de Girona 290, 08520 Les Franqueses del Vallès, Spain
| | - Joan Sivecas-Maristany
- Primary Healthcare Centre Can Borràs, Catalan Health Institute Carrer, Balmes 51, 08440 Cardedeu, Spain
| | - Xavier Blanché-Prat
- Primary Healthcare Centre Llinars del Vallès, Catalan Health Institute Carrer, Frederic Marès, s/n. 08450 Llinars del Vallès
| | - Gemma Prieto
- Primary Care Management of Health of Ávila, Castilla y León (SACYL), Avenida de Portugal 47, 05001 Ávila, Spain
| | - Laura Muñoz
- Primary Healthcare Research Support Unit Metropolitana Nord.IDIAP Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
| | - Pere Torán
- Primary Healthcare Research Support Unit Metropolitana Nord.IDIAP Jordi Gol, Carrer Major 49-53, 08921 Santa Coloma de Gramenet, Spain
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14
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Doz M, Chouaid C, Com-Ruelle L, Calvo E, Brosa M, Robert J, Decuypère L, Pribil C, Huerta A, Detournay B. The association between asthma control, health care costs, and quality of life in France and Spain. BMC Pulm Med 2013; 13:15. [PMID: 23517484 PMCID: PMC3610114 DOI: 10.1186/1471-2466-13-15] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 02/19/2013] [Indexed: 11/23/2022] Open
Abstract
Background Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain. Methods An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®. Results 2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively. For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain). Conclusions In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.
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Affiliation(s)
- Marianne Doz
- Cemka-Eval, 43 Boulevard du Maréchal Joffre, Bourg-la-Reine, F-92340, France
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15
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Ghanname I, Ahid S, Berrada G, Belaiche A, Hassar M, Cherrah Y. Trends in the use of antiasthmatic medications in Morocco (1999-2010). SPRINGERPLUS 2013; 2:82. [PMID: 23519830 PMCID: PMC3601251 DOI: 10.1186/2193-1801-2-82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/19/2013] [Indexed: 11/10/2022]
Abstract
Background Asthma is a big public health problem in Morocco. The drug therapy existing in Morocco is currently insufficient because of the low purchasing power and the low health insurance coverage available to the average citizen in Morocco. In this study we evaluated the consumption of antiasthmatics in Morocco during the period 1999–2010, the classes of used drugs and the generics’ market share. Methods We used sales data from the Moroccan subsidiaries of the IMS Health “Intercontinental Marketing Service”. The consumption volume was converted to Defined Daily Doses (DDDs). Results During 1999–2010, antiasthmatics’s consumption increased from 3.91 to 14.47 DDD per 1000 inhabitants per day. In 2010, the association Beta-2-mimetic-Glucocorticosteroids were the most consumed (8.53 DDD/1000 Inhabitants/day) followed by the short-acting inhaled Beta-2-mimetic (4 DDD/1000 Inhabitants/day) and inhaled Glucocorticosteroids alone accounted for 1.13 DDD/1000 Inhabitants/day. The largest consumption share in volume was held by the short-acting inhaled Beta-2-mimetic (42%) followed by the combination Beta-2-mimetic-Glucocorticosteroids (38%). Between 1999 and 2010, the market for generic antiasthmatics increased from 1.84 to 2.18 DDD/1000 Inhabitants/day. The ratio of the monthly average cost of treatment to the minimum wage in Morocco decreased from 10.8% in 1999 to 7.11% in 2010. Conclusion Antiasthmatics’ consumption in Morocco has undergone significant changes between 1999 and 2010. However, the availability of these drugs expressed as the Average Monthly Expenditure/Guaranteed Minimum Wage ratio improved. Despite this, the use of antiasmathics in Morocco remains low.
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Affiliation(s)
- Imane Ghanname
- Department of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Research team of Pharmacoepidemiology & Pharmacoeconomics, Rabat, Morocco
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16
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Fiori NS, Gonçalves H, Dumith SC, Cesar MADC, Menezes AMB, Macedo SEC. Ten-year trends in prevalence of asthma in adults in southern Brazil: comparison of two population-based studies. CAD SAUDE PUBLICA 2012; 28:135-44. [PMID: 22267073 DOI: 10.1590/s0102-311x2012000100014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 06/27/2011] [Indexed: 11/22/2022] Open
Abstract
There are discrepancies in the literature regarding time trends in the occurrence of asthma in adults. This study compared asthma prevalence in two cross-sectional studies with a ten-year interval in Pelotas, Rio Grande do Sul State, Brazil. The first, in 2000, included 1,968 individuals, and the second, in 2010, 2,466 adults (20-69 years). Prevalence of wheezing and shortness of breath in the prior 12 months remained the same after ten years (6% and 6.1%, respectively). In both studies, asthma was more frequent among females and people with low family income. Physician-diagnosed asthma increased by 35.6%, and lifetime incidence of asthma, by 32.2%. There was no percentage change in current asthma symptoms or current asthma. Local socioeconomic improvement between the two studies was consistent with the increase in medical diagnosis, but did not reflect better management of asthma symptoms, underlining the need for investment regarding other determinants of the disease.
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Affiliation(s)
- Nadia Spada Fiori
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil.
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17
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Gonzalez-Barcala FJ, Aboal J, Valdes L, Carreira JM, Alvarez-Dobaño JM, Puga A, Garcia-Sanz MT, Takkouche B. Trends in adult asthma hospitalization: gender-age effect. Multidiscip Respir Med 2011; 6:82-6. [PMID: 22958944 PMCID: PMC3497863 DOI: 10.1186/2049-6958-6-2-82] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/06/2010] [Indexed: 11/17/2022] Open
Abstract
Background Hospital admissions due to asthma are a reliable source of information on the morbidity of the disease which, after the increase observed in the last quarter of the last century, shows a declining trend in the last few years. The aim of this study was to look at hospital admission trends due to asthma in our community and analyze some of its associated factors. Methods Retrospective analysis of all hospital admissions involving adults aged 15 years and older with asthma as the primary or secondary diagnosis (if the first diagnosis was respiratory failure or respiratory infection) in Public Health Service hospitals in the Galician region of Spain between the years 1995-2009 (total 24,766 admissions). Results The majority of patients admitted were female (71%), over 60 years of age (64%), and admission occurred predominantly in the winter months. The hospitalization rate due to asthma tripled over the period studied, this being mainly accounted for by women aged over 60 years. Mean hospital stay was 9.2 days, longer in older patients or those admitted over the weekend. Conclusions A significant increase in hospital admissions due to asthma over the last few years has been observed in our community, mainly involving older women. The mean stay seems long, increasing with patients' age and admission over the weekend.
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18
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Anandan C, Nurmatov U, van Schayck OCP, Sheikh A. Is the prevalence of asthma declining? Systematic review of epidemiological studies. Allergy 2010; 65:152-67. [PMID: 19912154 DOI: 10.1111/j.1398-9995.2009.02244.x] [Citation(s) in RCA: 351] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Asthma prevalence has increased very considerably in recent decades such that it is now one of the commonest chronic disorders in the world. Recent evidence from epidemiological studies, however, suggests that the prevalence of asthma may now be declining in many parts of the world, which, if true is important for health service planning and also because this offers the possibility of generating and testing new aetiological hypotheses. Our objective was to determine whether the prevalence of asthma is declining worldwide. We undertook a systematic search of EMBASE, Medline, Web of Science and Google Scholar, for high quality reports of cohort studies, repeat cross-sectional studies and analyses of routine healthcare datasets to examine international trends in asthma prevalence in children and adults for the period 1990-2008. There were 48 full reports of studies that satisfied our inclusion criteria. The large volume of data identified clearly indicate that there are, at present, no overall signs of a declining trend in asthma prevalence; on the contrary, asthma prevalence is in many parts of the world still increasing. The reductions in emergency healthcare utilization being reported in some economically developed countries most probably reflect improvements in quality of care. There remain major gaps in the literature on asthma trends in relation to Africa and parts of Asia. There is no overall global downward trend in the prevalence of asthma. Healthcare planners will for the foreseeable future, therefore, need to continue with high levels of anticipated expenditure in relation to provision of asthma care.
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Affiliation(s)
- C Anandan
- Centre for Population Health Sciences, University of Edinburgh, UK
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Vergnenègre A, Godard P, Atsou K, Chouaïd C. [Inhaled corticosteroids in asthma: a medico-economic analysis of clinical trials]. Rev Mal Respir 2008; 25:375-89. [PMID: 18536625 DOI: 10.1016/s0761-8425(08)71581-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asthma is a chronic disease with a heavy economic burden in terms of public health on account of its clinical impact and consequences on quality of life and costs. Its management is based on pharmacological measures with inhaled corticosteroids playing a large role. The objective of this study was to undertake an analysis of the published literature of medico-economic trials of the use of inhaled corticosteroids. METHODS A review of the literature from 1990 to 2007 was undertaken with separate analyses of studies of inhaled steroids alone and those looking at combined preparations. RESULTS The costs of asthma vary greatly depending on the clinical management. Analysis of the published clinical trials showed that the addition of inhaled steroids increased the total cost. When efficacy is taken into account the economic results are acceptable for developed societies. The use of inhaled steroids as maintenance therapy, or maintenance and symptomatic therapy, was always cost effective. CONCLUSION These results are based on data from clinical trials. They need to be confirmed by large scale observational studies using validated criteria of effectiveness.
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Affiliation(s)
- A Vergnenègre
- Hôpital du Cluzeau, 23 avenue D. Larrey, Limoges cedex, France.
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