[Adult asthma in Mexico City: a population-based study]

[Prevalence of asthma in patients hospitalized for pneumonia associated to SARS-CoV-2 infection]

BACKGROUND

The association between asthma and COVID-19 remains controversial. Objective. To establish the prevalence of asthma in a sample of patients with COVID-19-associated pneumonia; furthermore, to describe the clinical characteristics of patients with asthma compared to patients without asthma.

METHODS

Clinical data corresponding to 120 patients hospitalized for pneumonia associated with SARS-CoV-2 infection were analyzed. Patients with and without asthma were compared based on COVID-19 severity.

RESULTS

The prevalence of asthma in patients with COVID-19 pneumonia was 3.5% (95% CI: 2.0% to 5.1%). When comparing the severity of COVID-19 among asthma patients with non-asthma patients, it did not differ based on symptoms, comorbidity, duration of symptoms, need for assisted mechanical ventilation, biomarkers of inflammation, and the occurrence of death. Patients with asthma and COVID-19 showed a high T2 phenotype, poor respiratory function, and no regular treatment for asthma control.

CONCLUSIONS

No significant differences in the frequency of assisted mechanical ventilation or death were observed between patients hospitalized for COVID-19-associated pneumonia with and without a history of asthma.

Dupilumab efficacy and safety in Latin American patients with uncontrolled, moderate-to-severe asthma: phase 3 LIBERTY ASTHMA QUEST study

Objective: While advances in asthma care have been made in Latin America, there is still a large unmet need in patients with uncontrolled asthma. This post hoc analysis of the QUEST study assessed safety and efficacy of dupilumab in the subgroup of patients enrolled in Latin American countries with a type 2 inflammatory asthma phenotype (blood eosinophils ≥150cells/µL or FeNO ≥25ppb).Methods: LIBERTY ASTHMA QUEST (NCT02414854) was a phase 3, multinational, randomized, double-blind, placebo-controlled study in patients with uncontrolled, moderate-to-severe asthma. Eligible patients ≥12 years of age were randomized in a 2:2:1:1 ratio to receive 52 weeks of add-on subcutaneous dupilumab 200 or 300mg every 2 weeks or matched-volume placebos. Pre-specified co-primary efficacy endpoints were the annualized rate of severe exacerbations during the treatment period and the change from baseline in pre-bronchodilator FEV₁ at treatment week 12. Asthma control, changes in asthma biomarker levels, and dupilumab safety were also evaluated.Results: 530 (27.9% of the overall QUEST population; dupilumab: 353, placebo: 177) Latin-American patients were recruited; 420 (79.2%) had a type 2 inflammatory asthma phenotype. Dupilumab vs placebo reduced the annualized rate of severe exacerbations by 52.7% (P < 0.001) and increased pre-bronchodilator FEV₁ at week 12 by 0.15L (P < 0.001), in the type 2 population. Safety was consistent with the known dupilumab safety profile.Conclusions: Consistent with the results in the overall population, dupilumab reduced the risk of severe asthma exacerbations and improved lung function in Latin American patients with uncontrolled, moderate-to-severe asthma and a type 2 phenotype.

Economic burden of severe asthma treatment: A real-life study

Background

Individuals with severe asthma represent 5%–10% of the general asthmatic population. Despite the use of biologic drugs during clinical management, inadequate control of the disease has translated into high economic impact. In Mexico, however, these costs have not yet been assessed.

Methods

A retrospective cohort study was carried out in 2018 and 2019 at Regional Hospital Lic. Adolfo López Mateos, ISSSTE. The assessment of direct costs included pharmacological treatment, clinical tests, days of hospitalization, admissions to the emergency room, and scheduled consultations. The evaluation involved 2 groups of patients—with controlled severe asthma (CSA) and uncontrolled severe asthma (UCSA)—according to presence of exacerbations.

Results

60 patients (18–75 years old, 51 women) were included in the study. In 2018, 23 of them (38.3%) were categorized as belonging to the UCSA group; in 2019, 22 patients (36.7%) were in this condition (exacerbations: median = 1.5, maximum = 6). Of the 60 patients, 12 (20%) presented between 2 and 9 exacerbations in the study's two-year period (median = 3) after between 4 and 10 years (median = 7.8) of complementary anti-immunoglobulin E (IgE) therapy with omalizumab. The cost for all patients in the 2018–2019 period was 993,289.60 USD. The mean cost per patient was higher for those with UCSA (16,392 USD) than for those with CSA (16,246 USD, p = 0.02). We found a positive association between cost and exacerbations, with an increase of 350 USD per exacerbation (p˂0.0001). Our results indicate that 62% of patients respond to complementary anti-IgE treatment, while 38%—and especially 20%—do not respond optimally to this treatment.

Conclusions

Poor asthma control in this latter group of 38% of patients leads to lower quality of life and higher costs associated with pharmacological treatment.

Asthma is not a Risk Factor for Severity of SARS-CoV-2 Infection in the Mexican Population

Objective. This study aims to assess the association between asthma and severity of COVID-19 in the Mexican population.Methods. The data from a national database of confirmed patients diagnosed with COVID-19, who attended from February to June 2020, were analyzed in a retrospective cohort study. Patients with and without asthma were compared concerning hospitalization, pneumonia, endotracheal intubation, and death related to COVID-19. Other covariates (age, sex, indigenous group, and comorbidity) were included in various logistic regression models.Results. Asthma was associated with a lower risk of hospitalization (OR =0.71, 95% CI 0.66 to 0.76), lower risk of pneumonia (OR =0.75, 95% CI 0.69 to 0.81), and lower risk of endotracheal intubation (OR =0.79, 95% CI 0.63 to 0.98). In addition, asthma decreased the risk of death from COVID-19 (OR =0.73, 95% CI 0.65 to 0.82). In a subgroup analysis, the same association was observed in patients who required hospitalization (OR =0.79, 95% CI 0.69 to 0.90), while in non-hospitalized patients, associations were inconsistent according to the covariates introduced in the models. There was no association between asthma and death in patients admitted to the intensive care unit (ICU), however, asthma significantly reduced the risk of death in the hospitalized patients who did not require ICU.Conclusion. Our results suggest that patients with asthma are less likely to require hospitalization, develop pneumonia, need tracheal intubation or die from COVID-19 as compared to patients without asthma.

Asthma Mortality and Hospitalizations in Mexico from 2010 to 2018: Retrospective Epidemiologic Profile

Acute respiratory infections have been established as the principal cause of disease in the Mexican population from 2000 to 2018; however, even when these diseases may aggravate asthma, there is a lack of epidemiologic evidence on the health outcomes when both conditions coexist. Learning about the asthma hospitalizations trends will help us identify monthly variation of hospitalizations, vulnerable groups, needed services, and improvements in therapeutics and prevention. This study aims to analyze the variation in asthma hospitalizations and mortality during the 2010–2018 period in Mexico. Data were obtained from the General Board of Health Information (DGIS) Open Access datasets, which were analyzed taking hospital discharges and hospital deaths recorded from 2010 to 2018 from all public hospitals nationwide. The binomial logistic regression analyses were performed to determine the association between patient ages, hospitalization month, and mortality. The death rate from asthma in Mexico decreased between 2010 and 2018. Still, the hospital mortality rate shows recent improvement; however, prognosis of hospitalized patients depends on their age, accurate diagnosis, length of hospital stay and occurrence of nosocomial infection.

Anxiety and depression in adult patients with asthma: the role of asthma control, obesity and allergic sensitization

OBJECTIVE

To determine the frequency of anxiety and depression in adult patients with asthma and to identify factors associated with them.

METHODS

This cross-sectional study included 164 consecutively recruited patients with asthma aged ≥ 18 years. Participants were clinically assessed and the mental state was analyzed through of the Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI-II); the Asthma Control Test (ACT) was measured, and allergic sensitization and respiratory function were also evaluated. Binary logistic regression models to identify the factors related to anxiety or depression were carried out. Complementary, 95% confidence intervals (CI) were estimated.

RESULTS

Anxiety was present in 54.3% of patients (95% CI: 46.6%-61.7%) while depression was found in 50.6% (95% CI: 43.0%-58.2%). Depression increased the odds of anxiety in patients with asthma (OR: 26.00, p < 0.0001), whereas an ACT score ≥ 20 points and allergic asthma were associated with a lower odds than the reference group (OR: 0.29; p = 0.007 and OR: 0.29; p = 0.024, respectively). Depression was associated with anxiety and obesity (OR: 25.33, p < 0.0001 and OR: 3.66; p = 0.014, respectively).

CONCLUSIONS

Overall, more than half of all asthmatic patients suffer from anxiety and depression. Well-controlled asthma and allergic sensitization decreased the likelihood of anxiety, while depression was associated with both obesity and anxiety.

Propiedades psicométricas del Cuestionario Revisado de Percepción de Enfermedad (IPQ-R) en adultos mexicanos con asma

El objetivo del presente trabajo fue evaluar las propiedades psicométricas de la versión en español del Illness Perception Questionnaire-Revised (IPQ-R) en pacientes mexicanos con asma. Se obtuvo una muestra por conveniencia de 315 adultos quienes respondieron una batería de evaluación. Los resultados muestran que el IPQ-R cuenta con una escala de identidad con 16 síntomas, escala de causas con 21 opciones y un grupo de subescalas en las que se agrupan cuatro factores y tres indicadores con αlfas que van de 0.591 a 0.874, con un KMO= 0.809 y una varianza total explicada del 51.611%, Se incluyen evidencias de validez convergente y divergente con variables de adherencia, creencias sobre medicamentos y control del asma. Se concluye que el IPQ-R es un instrumento confiable y valido para la evaluación de creencias sobre la enfermedad en adultos mexicanos con asma.

Relación entre representación de enfermedad, representación del tratamiento y adherencia en adultos con asma: Una revisión

La adherencia al medicamento de control es el pilar fundamental para el control del asma; sin embargo, se ha identificado que una representación negativa de la enfermedad y el tratamiento impactan de modo negativo en esta. Se hizo una revisión narrativa para identificar los estudios empíricos acerca de representación de enfermedad, representación del tratamiento y adherencia a medicamentos de control en adultos con asma, desde el modelo de sentido común y representación de la enfermedad (MSCRE). Se identificaron 17 estudios divididos en transversales y longitudinales (12), experimentales (3) y de intervención (2), reportando que las principales dimensiones del MSCRE asociadas con la adherencia son la necesidad del tratamiento, preocupación, control de la enfermedad y del tratamiento, temporalidad crónica y consecuencias. Se concluye que el MSCRE es un modelo psicológico que tiene aplicaciones en la investigación y atención clínica para explicar y promover conductas de adherencia a medicamentos de control en adultos con asma.

Revista Digital Internacional de Psicología y Ciencia Social | Volumen 6 | Número 1 | Enero-Junio 2020 | Investigación y acción para el cambio social

El nombre del presente número es “La investigación para la acción y el cambio social”, decidimos titularlo de esa manera porque consideramos de fundamental interés destacar la importancia que ha adquirido el trabajo científico desarrollado por los profesionales de distintas disciplinas para favorecer a la población que atienden respectivamente, pues en los trabajos presentados se muestra una excelente articulación entre la teoría y la práctica, poniendo en evidencia que se parte de una concepción social y científica, holística, pluralista e igualitaria.

Prevalence and Features of Asthma in Young Adults in Urban Areas of Argentina

OBJECTIVE

To investigate the burden of asthma in a young adult population in urban areas of Argentina.

DESIGN

A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications.

RESULTS

In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2-19.9) and family history (OR 3.6, 95% CI 2.3-5.5).

CONCLUSION

Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries.

Information and communication technology use in asthmatic patients: a cross-sectional study in Latin America

Rapid diffusion, low cost and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, communication and interventions in asthma. There is little information in Latin America about usage frequency of ICTs in asthmatic patients.

The analysis undertaken consisted of an observational, cross-sectional study that aimed to identify the frequency and type of ICTs most often used by asthmatics. The Spanish version of the Michigan questionnaire was employed in five Latin American countries. Age and educational level was categorised. Logistic regression was performed among these groups concerning the frequency of ICT usage and the level of interest shown in seeking and receiving information about asthma.

In total, 673 asthma patients were surveyed. The mean age was 43.44 years. Over two-thirds of the participants were female (68.4%). The most used ICT was the short message service (SMS) (69.9%). SMS and E-mail are useful tools for communicating (i.e. receiving and seeking information) with all asthma patients, irrespective of their age. WhatsApp (61.5%) and Facebook (32.0%) were rated as being the most interesting channels of communication for receiving information. Regression analysis showed that younger asthmatics and asthmatics with higher educational levels were most likely to use almost all forms of ICTs.

ICTs are generally an attractive platform for managing care, communication and interventions to improve asthma care. SMS and E-mail were found to be the preferred ICT forms among users. However, social media forms such as WhatsApp and Facebook may also be appropriate for certain types of patient.

ICT and social media use among asthmatics from Latin Americahttp://ow.ly/TxVj30cKylJ

Asthma: epidemiology of disease control in Latin America - short review

Asthma is reported as one of the most common chronic diseases in childhood, impairing the quality of life of patients and their families and incurring high costs to the healthcare system and society. Despite the development of new drugs and the availability of international treatment guidelines, asthma is still poorly controlled, especially in Latin America. Original and review articles on asthma control or epidemiology with high levels of evidence have been selected for analysis among those published in PubMed referenced journals during the last 20 years, using the following keywords: "asthma control" combined with "Latin America", " epidemiology", "prevalence", "burden", "mortality", "treatment and unmet needs", "children", "adolescents", and "infants". There was a high prevalence and severity of asthma during the period analyzed, especially in children and adolescents. Wheezing in infants was a significant reason for seeking medical care in Latin American health centers. Moreover, the frequent use of quick-relief bronchodilators and oral corticosteroids by these patients indicates the lack of a policy for providing better care for asthmatic patients, as well as poor asthma control. Among adults, studies document poor treatment and control of the disease, as revealed by low adherence to routine anti-inflammatory medications and high rates of emergency care visits and hospitalization. In conclusion, although rare, studies on asthma control in Latin America repeatedly show that patients are inadequately controlled and frequently overestimate their degree of asthma control according to the criteria used by international asthma treatment guidelines. Additional education for doctors and patients is essential for adequate control of this illness, and therefore also for reduction of the individual and social burden of asthma.

Medical Expenditure for Chronic Diseases in Mexico: The Case of Selected Diagnoses Treated by the Largest Care Providers

BACKGROUND

Chronic diseases (CD) are a public health emergency in Mexico. Despite concern regarding the financial burden of CDs in the country, economic studies have focused only on diabetes, hypertension, and cancer. Furthermore, these estimated financial burdens were based on hypothetical epidemiology models or ideal healthcare scenarios. The present study estimates the annual expenditure per patient and the financial burden for the nine most prevalent CDs, excluding cancer, for each of the two largest public health providers in the country: the Ministry of Health (MoH) and the Mexican Institute of Social Security (IMSS).

METHODS

Using the Mexican National Health and Nutrition Survey 2012 (ENSANUT) as the main source of data, health services consumption related to CDs was obtained from patient reports. Unit costs for each provided health service (e.g. consultation, drugs, hospitalization) were obtained from official reports. Prevalence data was obtained from the published literature. Annual expenditure due to health services consumption was calculated by multiplying the quantity of services consumed by the unit cost of each health service.

RESULTS

The most expensive CD in both health institutions was chronic kidney disease (CKD), with an annual unit cost for MoH per patient of US$ 8,966 while for IMSS the expenditure was US$ 9,091. Four CDs (CKD, arterial hypertension, type 2 diabetes, and chronic ischemic heart disease) accounted for 88% of the total CDs financial burden (US$ 1.42 billion) in MoH and 85% (US$ 3.96 billion) in IMSS. The financial burden of the nine CDs analyzed represents 8% and 25% of the total annual MoH and IMSS health expenditure, respectively.

CONCLUSIONS/SIGNIFICANCE

The financial burden from the nine most prevalent CDs, excluding cancer, is already high in Mexico. This finding by itself argues for the need to improve health promotion and disease detection, diagnosis, and treatment to ensure CD primary and secondary prevention. If the status quo remains, the financial burden could be higher.

Asthma in Latin America

Consistent with the diversity of Latin America, there is profound variability in asthma burden among and within countries in this region. Regional variation in asthma prevalence is likely multifactorial and due to genetics, perinatal exposures, diet, obesity, tobacco use, indoor and outdoor pollutants, psychosocial stress and microbial or parasitic infections. Similarly, non-uniform progress in asthma management leads to regional variability in disease morbidity. Future studies of distinct asthma phenotypes should follow-up well-characterised Latin American subgroups and examine risk factors that are unique or common in Latin America (eg, stress and violence, parasitic infections and use of biomass fuels for cooking). Because most Latin American countries share the same barriers to asthma management, concerted and multifaceted public health and research efforts are needed, including approaches to curtail tobacco use, campaigns to improve asthma treatment, broadening access to care and clinical trials of non-pharmacological interventions (eg, replacing biomass fuels with gas or electric stoves).