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Juliá Benito JC, Moreno-Galarraga L, Bragado Alcaraz E, Asensi Monzó MT, Ortega Casanueva C, Moral L, Rodríguez Fernández-Oliva CR, Sanz Ortega J, Valdesoiro Navarrete L. Inhaled medications and inhalation chambers for childhood asthma. Spanish network of working groups on asthma in pediatrics (REGAP). An Pediatr (Barc) 2024; 100:123-131. [PMID: 38326156 DOI: 10.1016/j.anpede.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.
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Affiliation(s)
- Juan Carlos Juliá Benito
- Centro de Salud República Argentina, Valencia, Spain; Unidad de Alergia y Neumología Pediátrica, Hospital IMED, Valencia, Spain.
| | - Laura Moreno-Galarraga
- Neumología Infantil, Servicio de Pediatría, Hospital Universitario de Navarra, Pamplona, Spain
| | - Esther Bragado Alcaraz
- Unidad de Neumología y Alergia Pediátrica, Hospital Universitario Santa Lucia, Cartagena, Spain
| | | | | | - Luis Moral
- Unidad de Alergología y Neumología Pediátrica, Hospital General Universitario, Alicante, Spain
| | | | | | - Laura Valdesoiro Navarrete
- Unidad de Alergia, Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. Open Respir Arch 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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3
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Moral L, Asensi Monzó M, Juliá Benito JC, Ortega Casanueva C, Paniagua Calzón NM, Pérez García MI, Rodríguez Fernández-Oliva CR, Sanz Ortega J, Valdesoiro Navarrete L, Valverde-Molina J. Pediatric asthma: The REGAP consensus. An Pediatr (Barc) 2021; 95:125.e1-125.e11. [PMID: 34353777 DOI: 10.1016/j.anpede.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 10/20/2022] Open
Abstract
Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.
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Affiliation(s)
- Luis Moral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | | | | | | | | | | | | | - José Sanz Ortega
- Unidad de Alergia y Neumología Infantil, Hospital La Salud, Valencia, Spain
| | - Laura Valdesoiro Navarrete
- Unidad de Alergia, Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - José Valverde-Molina
- Servicio de Pediatría, Hospital Universitario Santa Lucía, Cartagena, Murcia, Spain
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4
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Moral L, Asensi Monzó M, Juliá Benito JC, Ortega Casanueva C, Paniagua Calzón NM, Pérez García MI, Rodríguez Fernández-Oliva CR, Sanz Ortega J, Valdesoiro Navarrete L, Valverde-Molina J. [Pediatric asthma: The REGAP consensus]. An Pediatr (Barc) 2021. [PMID: 33775581 DOI: 10.1016/j.anpedi.2021.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Asthma is one of the main chronic diseases in childhood, due to its high prevalence and its social and health costs. This document is a summary of a consensus guideline approved by 6 Spanish pediatric societies related to asthma and endorsed by the Spanish Pediatric Association. Asthma is easily identifiable by clinical criteria in most patients. Spirometry and other tests are helpful for diagnosis, especially in atypical cases. Asthma exacerbation is a frequent manifestation of the disease and must be identified and treated promptly. When asthma symptoms are frequent and the quality of life is affected, maintenance treatment must be instituted to achieve control of the disease. Low-dose inhaled corticosteroids are effective and safe for long-term use. Education of the patient with asthma is essential for good control. The main reason for poor asthma control is non-compliance with treatment, either due to its erratic and insufficient administration, or due to poor application technique of inhaled drugs. If control is not obtained despite adequate treatment, the diagnosis must be reconsidered, as well as the factors or comorbidities that make control difficult. Other drugs can be added to avoid high doses of inhaled corticosteroids, notably montelukast or long-acting β2 adrenergic agonists. Severe or difficult-to-control asthma, which does not respond to the usual treatments, should be managed in specialized units.
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Affiliation(s)
- Luis Moral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
| | | | | | | | | | | | | | - José Sanz Ortega
- Unidad de Alergia y Neumología Infantil, Hospital La Salud, Valencia, España
| | - Laura Valdesoiro Navarrete
- Unidad de Alergia, Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - José Valverde-Molina
- Servicio de Pediatría, Hospital Universitario Santa Lucía, Cartagena, Murcia, España
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Plaza V, Gómez-Outes A, Quirce Gancedo S, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, García G, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Pérez Encinas M, Plaza Zamora J, Praena Crespo M, Sánchez Pina C, Sanz Ortega J. Discrepancies Between GEMA and GINA in the Classification of Inhaled Corticosteroids. Arch Bronconeumol 2020; 56:472-473. [PMID: 35373761 DOI: 10.1016/j.arbr.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Vicente Plaza
- Comité Ejecutivo de GEMA, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Servicio de Neumología, Hospital Santa Creu i Sant, Barcelona, Spain.
| | - Antonio Gómez-Outes
- Comité Ejecutivo de GEMA, Sociedad Española de Farmacología Clínica (SEFC), Servicio de Área Terapéutica Clínica: Cardiovascular y Respiratorio, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Santiago Quirce Gancedo
- Comité Ejecutivo de GEMA, Sociedad Española de Alergología e Inmunología Clínica (SEAIC), Servicio de Alergia, Hospital Universitario La Paz, Madrid, Spain
| | - Isam Alobid
- Comité Ejecutivo de GEMA, Sociedad Española de Otorrinolaringología (SEORL), Consultoría Otorrinolaringológica, Hospital Clínic, Barcelona, Spain
| | - Cesáreo Álvarez Rodríguez
- Comité Ejecutivo de GEMA, Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Servicio de Urgencias, Hospital de Verín, Orense, Spain
| | - Marina Blanco Aparicio
- Comité Ejecutivo de GEMA, Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña, La Coruña, Spain
| | - Gabriel García
- Comité Ejecutivo de GEMA, Asociación Latinoamericana de Tórax (ALAT), Servicio de Neumonología, Hospital Rossi, La Plata, Argentina
| | - Fernando Gómez Ruiz
- Comité Ejecutivo de GEMA, Sociedad Española de Médicos Generales y de Familia (SEMG), Medicina de Familia, Centro de Salud de Bargas, Bargas (Toledo), Spain
| | - Antonio Hidalgo Requena
- Comité Ejecutivo de GEMA, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Medicina de Familia, Centro de Salud Lucena I, Lucena (Córdoba), Spain
| | - Javier Korta Murua
- Comité Ejecutivo de GEMA, Sociedad Española de Neumología Pediátrica (SENP), Sección de Neumología Infantil, Servicio de Pediatría, Hospital Universitario Donostia, San Sebastián, Spain
| | - Jesús Molina París
- Comité Ejecutivo de GEMA, Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC), Centro de Salud Francia, Fuenlabrada (Madrid), Spain
| | - Francisco J Pellegrini Belinchón
- Comité Ejecutivo de GEMA, Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), Atención Primaria, Centro de Salud Pizarrales, Salamanca, Spain
| | - Montserrat Pérez Encinas
- Comité Ejecutivo de GEMA, Sociedad Española de Farmacia Hospitalaria (SEFH), Servicio de Farmacia, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), Spain
| | - Javier Plaza Zamora
- Comité Ejecutivo de GEMA, Sociedad Española de Farmacia Comunitaria (SEFAC), Farmacia Comunitaria, Farmacia Dres. Zamora Navarro, Mazarrón (Murcia), Spain
| | - Manuel Praena Crespo
- Comité Ejecutivo de GEMA, Asociación Española de Pediatría de Atención Primaria (AEPAP), Universidad de Sevilla, Sevilla, Spain
| | - Concha Sánchez Pina
- Comité Ejecutivo de GEMA, Asociación Española de Pediatría de Atención Primaria (AEPAP), Atención Primaria, Madrid, Spain
| | - José Sanz Ortega
- Comité Ejecutivo de GEMA, Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica (SEICAP), Unidad de Alergia y Neumología Infantil, Hospital Universitario Casa de Salud, Valencia, Spain
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6
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Plaza Moral V, Gómez-Outes A, Quirce Gancedo S, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, García G, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Pérez Encinas M, Plaza Zamora J, Praena Crespo M, Sánchez Pina C, Sanz Ortega J. Discrepancies Between GEMA and GINA in the Classification of Inhaled Corticosteroids. Arch Bronconeumol 2020. [PMID: 32107117 DOI: 10.1016/j.arbres.2019.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vicente Plaza Moral
- Comité Ejecutivo de GEMA, Sociedad Española de Neumología y Cirugía Torácica (SEPAR); Servicio de Neumología, Hospital Santa Creu i Sant, Barcelona, España.
| | - Antonio Gómez-Outes
- Comité Ejecutivo de GEMA, Sociedad Española de Farmacología Clínica (SEFC); Servicio de Área Terapéutica Clínica: Cardiovascular y Respiratorio, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Santiago Quirce Gancedo
- Comité Ejecutivo de GEMA, Sociedad Española de Alergología e Inmunología Clínica (SEAIC); Servicio de Alergia, Hospital Universitario La Paz, Madrid, España
| | - Isam Alobid
- Comité Ejecutivo de GEMA, Sociedad Española de Otorrinolaringología (SEORL), Consultoría Otorrinolaringológica, Hospital Clínic, Barcelona, España
| | - Cesáreo Álvarez Rodríguez
- Comité Ejecutivo de GEMA, Sociedad Española de Medicina de Urgencias y Emergencias (SEMES); Servicio de Urgencias, Hospital de Verín, Orense, España
| | - Marina Blanco Aparicio
- Comité Ejecutivo de GEMA, Sociedad Española de Neumología y Cirugía Torácica (SEPAR); Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Gabriel García
- Comité Ejecutivo de GEMA, Asociación Latinoamericana de Tórax (ALAT); Servicio de Neumonología, Hospital Rossi, La Plata, Argentina
| | - Fernando Gómez Ruiz
- Comité Ejecutivo de GEMA, Sociedad Española de Médicos Generales y de Familia (SEMG); Medicina de familia, Centro de salud de Bargas, Bargas (Toledo), España
| | - Antonio Hidalgo Requena
- Comité Ejecutivo de GEMA, Sociedad Española de Médicos de Atención Primaria (SEMERGEN); Medicina de familia, Centro de Salud Lucena I, Lucena (Córdoba), España
| | - Javier Korta Murua
- Comité Ejecutivo de GEMA, Sociedad Española de Neumología Pediátrica (SENP); Sección de Neumología Infantil, Servicio de Pediatría, Hospital Universitario Donostia, San Sebastián, España
| | - Jesús Molina París
- Comité Ejecutivo de GEMA, Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC); Centro de Salud Francia, Fuenlabrada (Madrid), España
| | - Francisco J Pellegrini Belinchón
- Comité Ejecutivo de GEMA, Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP); Atención Primaria, Centro de Salud Pizarrales, Salamanca, España
| | - Montserrat Pérez Encinas
- Comité Ejecutivo de GEMA, Sociedad Española de Farmacia Hospitalaria (SEFH); Servicio de Farmacia, Hospital Universitario Fundación Alcorcón, Alcorcón (Madrid), España
| | - Javier Plaza Zamora
- Comité Ejecutivo de GEMA, Sociedad Española de Farmacia Comunitaria (SEFAC); Farmacia comunitaria, Farmacia Dres. Zamora Navarro, Mazarrón (Murcia), España
| | - Manuel Praena Crespo
- Comité Ejecutivo de GEMA, Asociación Española de Pediatría de Atención Primaria (AEPAP); Universidad de Sevilla, Sevilla, España
| | - Concha Sánchez Pina
- Comité Ejecutivo de GEMA; Asociación Española de Pediatría de Atención Primaria (AEPAP); Atención Primaria, Madrid, España
| | - José Sanz Ortega
- Comité Ejecutivo de GEMA, Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica (SEICAP); Unidad de Alergia y Neumología Infantil, Hospital Universitario Casa de Salud, Valencia, España
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Plaza Moral V, Alonso Mostaza S, Alvarez Rodríguez C, Gomez-Outes A, Gómez Ruiz F, López Vina A, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Quintano Jiménez JA, Quirce Gancedo S, Sanz Ortega J, Soler Vilarrasa R, Villa Asensi JR. SPANISH GUIDELINE ON THE MANAGEMENT OF ASTHMA. J Investig Allergol Clin Immunol 2016; 26 Suppl 1:1-92. [PMID: 27220197 DOI: 10.18176/jiaci.0065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vicente Plaza Moral
- Coordinator of the GEMA Executive Committee. Pneumology. Hospital de la Santa Creu i Sant Pau. Barcelona
| | - Soledad Alonso Mostaza
- Vice-president and Treasurer of the National Federation of Respiratory Disease Association (FENAER). Madrid
| | | | - Antonio Gomez-Outes
- Coordinator, on behalf of the SEFC. Clinical Pharmacology. Spanish Agency of Medicines and Medical Devices (AEMPS). Madrid
| | - Fernando Gómez Ruiz
- Coordinator, on behalf of the SEMG. Familiy Medicine. Centro de Salud de Bargas. Toledo
| | - Antolín López Vina
- Coordinator, on behalf of the SEPAR.Pneumology. Hospital Universitario Puerta de Hierro Majadahonda. Madrid
| | - Jesús Molina París
- Coordinator, on behalf of the semFYC and GRAP. Family Medicine, semFYC. EAP Francia I. Fuenlabrada. Madrid
| | | | - Javier Plaza Zamora
- Coordinator, on behalf of the SEFAC. Community Pharmacy. Farmacia Drs. Zamora Navarro. Mazarrón. Murcia
| | | | | | - José Sanz Ortega
- Coordinator, on behalf of the SEICAP. Pediatric Allergology. Hospital Católico Universitario Casa de Salud. Valencia
| | - Ramona Soler Vilarrasa
- Coordinator, on behalf of the SEORL. Otorhinolaryngology. Hospital de Son Espases. Palma de Mallorca
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Plaza Moral V, Álvarez Rodríguez C, Gómez-Outes A, Gómez Ruiz F, López Viña A, Pellegrini Belinchón FJ, Plaza Zamora J, Quintano Jiménez JA, Quirce Gancedo S, Sanz Ortega J, Soler Vilarrasa R, Villa Asensi JR. Obsolete anti-pneumococcal vaccination recommendations in the spanish guidelines for the management of asthma (GEMA 4.0): The authors reply. Arch Bronconeumol 2016; 52:449. [PMID: 27139593 DOI: 10.1016/j.arbres.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - José Sanz Ortega
- Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica (SEICAP)
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Abstract
Three cases of duodenal carcinoid tumour are described and the histology of this type of tumour is discussed. Two of the patients have been followed up for 8 years. No further complications related to the tumours have been observed.
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