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Fernández-Sánchez MC, Ruiz-López FJ, Ros-Lucas JA, Andújar-Espinosa R, Del Coso J, García-Pastor T. Persons With Chronic Obstructive Pulmonary Disease and High Levels of Activation Improved Their Physical Activity Skills After an Educational Session. Chronic Obstr Pulm Dis 2024. [PMID: 38527191 DOI: 10.15326/jcopdf.2023.0456] [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] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background Daily physical activity is part of the self-management of COPD patients, didactic information sessions may be insufficient for provision of these skills. Prior activation can determine sensitivity to these sessions. We evaluated whether the activation in patients with chronic obstructive pulmonary disease (COPD), as measured by the Patient Activation Measure (PAM)-13 questionnaire, determined their responses to an educational group session on physical activity (PA), which were measured with actigraphy by the amount of steps/day. Methods We conducted an uncontrolled clinical trial in outpatient clinic with 75 patients with non-exacerbating COPD (FEV1 30-80%) who were selected consecutively. Patients were provided with an actigraph that they used for 15 days and completed the PAM-13 questionnaire. On the eighth day, they attended a group educational session where they were given PA information. We compared the changes in activity after the session by pooled MAP levels and the correlation between the change in the number of steps/day and the PAM-13 questionnaire. Results 26 patients had activation levels of 1-2, while 49 patients had levels of 3-4. After the session, patients in levels 1-2 decreased their number of steps (-596±42), while those in levels 3-4 increased them (680±253, p<0.01). The level of activation was positively correlated with change in the number of steps/day (p<0.05). Conclusion COPD patients with greater activation showed greater improvements in daily PA after a group educational session.
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Affiliation(s)
| | | | - José A Ros-Lucas
- Pneumonology Service, Arrixaca University Hospital, Murcia, Spain
| | | | - Juan Del Coso
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, Spain
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Bravo-Gutiérrez FJ, Miralles-López JC, Valverde-Molina J, Alemany Francés ML, Andújar-Espinosa R, Castilla-Martínez M, Avilés-Inglés MJ, Mora-González A, Pajarón-Fernández MJ, Cabrejos-Perotti S, Meseguer-Arce J, Flores Martín I, Pérez-Fernández V. Effectiveness of Mepolizumab in Patients with Severe Eosinophilic Asthma with/without Nasal Polyposis: A Real-Life Study. Int Arch Allergy Immunol 2023; 185:253-259. [PMID: 38035559 DOI: 10.1159/000534902] [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: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Asthma is one of the most common chronic diseases and affects around 334 million people worldwide. The estimated prevalence of severe asthma is 3-10% of the asthmatic population. Mepolizumab has demonstrated efficacy in reducing exacerbations, oral corticosteroid use, and improving quality of life, asthma control, and lung function in patients with severe eosinophilic asthma (SEA). Our study aimed to check the response to mepolizumab in a series of severe asthma patients regarding exacerbations, oral corticosteroid use, asthma control, quality of life, and lung function and to compare the response between patients with and without nasal polyps. METHOD This is a retrospective, multicenter study of RE-ASGRAMUR (Register of Severe Asthma of the Region of Murcia) performed in eight hospitals of the Region of Murcia (Spain) under routine clinical practice conditions. We included patients diagnosed with SEA who completed at least 1 year of treatment with mepolizumab. We analyzed clinical characteristics, drug tolerance, and effectiveness: exacerbations, ACT, miniAQLQ, forced expiratory volume in 1 s (FEV1), and use of oral corticosteroids. We also compared the results between patients with and without nasal polyps. RESULTS The median of exacerbations before treatment was 3 and decreased to 0 after treatment (mean decrease of 77.4%). The median diary oral prednisone intake was 15 mg before treatment and 5 mg after treatment (mean 56% reduction). We have obtained a significant improvement in other variables: ED visits and hospitalizations, asthma control (ACT), quality of life (miniAQLQ), and lung function (FEV1). Thirty-four out of 70 patients (48.57%) fulfilled the criteria of super-responder, and 17 out of 70 (24.29%) had a complete response. More patients in the group with nasal polyps fulfilled the criteria of super-responder and complete response to mepolizumab. CONCLUSIONS Mepolizumab is a safe and effective treatment for SEA patients, improving exacerbations, oral corticosteroid intake, asthma control, quality of life, and lung function. In patients with associated nasal polyposis, there is a statistically significant higher proportion of super-responders and complete responders.
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Affiliation(s)
| | | | - José Valverde-Molina
- Paediatrics Department, University General Hospital Santa Lucia, Cartagena (Murcia), Spain
| | | | | | | | | | - Ana Mora-González
- Allergy Department, University General Hospital Morales Meseguer, Murcia, Spain
| | | | | | - José Meseguer-Arce
- Allergy Department, University Clinic Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Isabel Flores Martín
- Allergy Department, University General Hospital Santa Lucia, Cartagena (Murcia), Spain
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Padilla-Galo A, Moya Carmona I, Ausín P, Carazo Fernández L, García-Moguel I, Velasco-Garrido JL, Andújar-Espinosa R, Casas-Maldonado F, Martínez-Moragón E, Martínez Rivera C, Vera Solsona E, Sánchez-Toril López F, Trisán Alonso A, Blanco Aparicio M, Valverde-Monge M, Valencia Azcona B, Palop Cervera M, Nuevo J, Sánchez Tena J, Resler G, Luzón E, Levy Naon A. Achieving clinical outcomes with benralizumab in severe eosinophilic asthma patients in a real-world setting: orbe II study. Respir Res 2023; 24:235. [PMID: 37770889 PMCID: PMC10540395 DOI: 10.1186/s12931-023-02539-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/10/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The ORBE II study aimed to describe the characteristics and clinical outcomes of adult patients with severe eosinophilic asthma (SEA) treated with benralizumab in a real-world setting in Spain. METHODS ORBE II (NCT04648839) was an observational, retrospective cohort study in adult SEA patients who had been prescribed benralizumab. Demographic and clinical data of 204 SEA patients were collected 12 months prior to benralizumab initiation (baseline) and at follow-up. Exacerbation rate, asthma symptoms, maintenance oral corticosteroid (OCS) use and lung function were evaluated, among other variables. RESULTS A total of 204 SEA patients were evaluated. Mean (standard deviation, SD) age of the study population was 56.4 (12.4) years, 62.3% were women and mean (SD) duration of asthma was 15.1 (12.7) years. Median (Q1-Q3) follow-up duration was 19.5 (14.2-24.2) months. At baseline, 72.6% of the overall population (OP) presented blood eosinophil counts ≥ 300 cells/µL; 36.8% had comorbid chronic rhinosinusitis with nasal polyps (CRSwNP); 84.8% reported at least one severe exacerbation, and 29.1% were OCS-dependent. At 1 year of follow-up, patients receiving benralizumab treatment had a 85.6% mean reduction in exacerbations from baseline, and 81.4% of patients achieved zero exacerbations. We also found a clinically relevant mean (SD) increase in pre-bronchodilator (BD) FEV1 of 331 (413) mL, with 66.7% of patients achieving a pre-BD FEV1 increase ≥ 100 mL, and 46.3% of patients achieving a pre-BD FEV1 ≥ 80% of predicted. Regarding symptom control, 73.8% of the OP obtained an ACT score ≥ 20 points. After 1 year of follow-up, mean reduction in the daily OCS dose was 70.5%, and complete OCS withdrawal was achieved by 52.8% of the OCS-dependent patients. Almost half (43.7%) of the OP on benralizumab met all four criteria for clinical remission. Patients with concomitant CRSwNP obtained similar or enhanced outcomes. CONCLUSIONS These data support the real-world benefits of benralizumab in SEA patients, and particularly in those with concomitant CRSwNP. TRIAL REGISTRATION NCT04648839.
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Affiliation(s)
| | | | - Pilar Ausín
- H. del Mar, Universidad Pompeu Fabra University (UPF), Barcelona, Spain
| | | | - Ismael García-Moguel
- H. U. 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Javier Nuevo
- Medical Department, AstraZeneca Farmacéutica S.A, Madrid, Spain
| | | | - Gustavo Resler
- Medical Department, AstraZeneca Farmacéutica S.A, Madrid, Spain
| | - Elisa Luzón
- Medical Department, AstraZeneca Farmacéutica S.A, Madrid, Spain
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Casado E, Costa E, Mezquita-Raya P, Andújar-Espinosa R, Neyro JL. Calcifediol in the management of vitamin D deficiency-related skeletal and extraskeletal diseases: overview and clinical cases. Drugs Context 2023; 12:2023-5-4. [PMID: 37711731 PMCID: PMC10499368 DOI: 10.7573/dic.2023-5-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023] Open
Abstract
As well as being essential for musculoskeletal health, vitamin D is involved in numerous other physiological processes. Poor vitamin D status is linked to a wide range of diseases, including cardiovascular disease, autoimmune conditions, pulmonary disorders and upper respiratory tract infections. While optimal target concentrations of serum 25-hydroxyvitamin D (25(OH)D) for health maintenance or therapeutic purposes are still the subject of debate, there is reasonable agreement that serum 25(OH)D levels <50 nmol/L (20 ng/mL) constitute vitamin D deficiency and that severe deficiency states (serum 25(OH)D levels <25-30 nmol/L ≈ 10-12 ng/mL) should be avoided. Main strategies to maintain or improve vitamin D status are food supplementation and therapeutic use of medicinal forms of vitamin D. In this review, we examine evidence that implicates vitamin D deficiency in diverse conditions in the clinical settings of endocrinology, rheumatology, pneumology and reproductive health. Cholecalciferol (vitamin D3) is the most frequently used vitamin D supplement worldwide, though calcifediol (25-hydroxyvitamin D3) has recently become more widely available. Calcifediol is one step closer than cholecalciferol in the metabolic pathway to biologically active vitamin D. Pharmacokinetic differences between these vitamin D metabolites confer putative advantages for calcifediol in certain clinical situations. The clinical use of calcifediol is explored more closely through case studies, which illustrate its adjunctive role in the treatment of several vitamin D deficiency-related skeletal and extraskeletal diseases.
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Affiliation(s)
- Enrique Casado
- Rheumatology Department, University Hospital Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Ester Costa
- Rheumatology Department, University Hospital Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Pedro Mezquita-Raya
- Endocrinology and Nutrition Unit, University Hospital of Torrecárdenas, Almería, Spain
| | - Rubén Andújar-Espinosa
- Department of Pulmonology, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain
- Department of Medicine, University of Murcia, Murcia, Spain
| | - José Luis Neyro
- International Master on Climacteric and Menopause, Madrid University (UDIMA), Madrid, Spain
- Gynecology and Obstetrics Department, University Hospital Cruces, Bilbao, Spain
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Castilla-Martínez M, Andújar-Espinosa R, Flores-Martín I, Reyes Cotes MH, Cabrejos-Perotti S, Miralles-López JC, Carbonell-Martínez A, Bravo-Gutierrez FJ, Valverde-Molina J, Pérez-Fernández V. Early effectivity of dupilumab in patients with t2 severe asthma: a prospective real-life study. J Investig Allergol Clin Immunol 2022; 33:126-128. [PMID: 36420744 DOI: 10.18176/jiaci.0872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- M Castilla-Martínez
- Pulmonology Department, University General Hospital Los Arcos, San Javier, Murcia, Spain
| | - R Andújar-Espinosa
- Pulmonology Department, University Clinic Hospital Virgen de la Arrixaca, Murcia, Spain
- Medicine Department, University of Murcia, Murcia, Spain
| | - I Flores-Martín
- Allergy Department, University General Hospital Santa Lucía, Cartagena, Murcia, Spain
| | - M H Reyes Cotes
- Pulmonology Department, Northwest County Hospital, Caravaca, Murcia, Spain
| | - S Cabrejos-Perotti
- Allergy Department, General Hospital Rafael Méndez, Lorca, Murcia, Spain
| | - J C Miralles-López
- Allergy Department, University General Hospital Reina Sofía, Murcia, Spain
| | | | - F J Bravo-Gutierrez
- Pulmonology Department, University General Hospital Santa Lucía, Cartagena, Murcia, Spain
| | - J Valverde-Molina
- Pediatrics Department, University General Hospital Santa Lucía, Cartagena, Murcia, Spain
| | - V Pérez-Fernández
- Department of Public Health Sciences, University of Murcia School of Medicine, Murcia, Spain
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6
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Miralles-López JC, Andújar-Espinosa R, Bravo-Gutiérrez FJ, Castilla-Martínez M, Flores-Martín I, Alemany-Francés ML, Pajarón-Fernández MJ, Mora-González A, Cabrejos-Perotti S, El-Molaka Z, Meseguer-Arce J, Avilés-Inglés MJ, Valverde-Molina J, Pérez-Fernández V, RE-ASGRAMUR GROUP. Analysis of response of severe eosinophilic asthmatic patients to benralizumab. Allergol Immunopathol (Madr) 2022; 50:163-168. [DOI: 10.15586/aei.v50i6.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/11/2022] [Indexed: 03/28/2023]
Abstract
Introduction: Clinical trials and real-life studies have been published showing effectiveness of benralizumab in severe eosinophilic asthmatic patients. The aim of the present study is to describe super-responders to benralizumab in a series of 79 patients who completed at least 1 year of treatment, and to compare super-responders with non super-responders.
Methods: This is a multicenter study of the Register of Severe Asthma of the Region of Murcia (RE-ASGRAMUR) Group performed in eight hospitals under the conditions of routine clinical practice. Patients with zero exacerbations and no oral corticosteroid therapy for asthma were considered super-responders. We analyzed clinical, functional, and inflammatory parameters of selected patients.Results: In all, 50 of the 79 patients (63%) met the super-responder criteria. In addition, 36% of the patients (26/71) were considered as complete responders to treatment (superresponder + Asthma Control Test [ACT] ≥ 20 + forced expiratory volume in 1 s [FEV1] ≥ 80%). The super-responders were significantly older in age (P = 0.0029), had higher eosinophils count (P = 0.0423), higher proportion of nasal polyps (P = 0.036), and they had less severe disease at baseline. After 1 year of treatment, the super-responders had higher levels of ACT questionnaire (23 vs 19, P = 0.0007) and better percentage of FEV1 (83 vs 75, P = 0.0359).
Conclusion: Almost two of the three patients treated with benralizumab were super-responders after 1 year of treatment and 36% had a complete response. Super-responders were associated with older age, higher eosinophils count, had nasal polyposis as comorbidity, and had less severe disease at baseline. This data illustrated the good real-life response of patients with severe eosinophilic asthma to the treatment with benralizumab.
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Entrenas-Castillo M, Salinero-González L, Entrenas-Costa LM, Andújar-Espinosa R. Calcifediol for Use in Treatment of Respiratory Disease. Nutrients 2022; 14:2447. [PMID: 35745177 PMCID: PMC9231174 DOI: 10.3390/nu14122447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 02/01/2023] Open
Abstract
Calcifediol is the prohormone of the vitamin D endocrine system (VDES). It requires hydroxylation to move to 1,25(OH)2D3 or calcitriol, the active form that exerts its functions by activating the vitamin D receptor (VDR) that is expressed in many organs, including the lungs. Due to its rapid oral absorption and because it does not require first hepatic hydroxylation, it is a good option to replace the prevalent deficiency of vitamin D (25 hydroxyvitamin D; 25OHD), to which patients with respiratory pathologies are no strangers. Correcting 25OHD deficiency can decrease the risk of upper respiratory infections and thus improve asthma and COPD control. The same happens with other respiratory pathologies and, in particular, COVID-19. Calcifediol may be a good option for raising 25OHD serum levels quickly because the profile of inflammatory cytokines exhibited by patients with inflammatory respiratory diseases, such as asthma, COPD or COVID-19, can increase the degradation of the active metabolites of the VDES. The aim of this narrative revision is to report the current evidence on the role of calcifediol in main respiratory diseases. In conclusion, good 25OHD status may have beneficial effects on the clinical course of respiratory diseases, including COVID-19. This hypothesis should be confirmed in large, randomized trials. Otherwise, a rapid correction of 25(OH)D deficiency can be useful for patients with respiratory disease.
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Affiliation(s)
- Marta Entrenas-Castillo
- Pneumology Department, Hospital QuironSalud, 14004 Cordoba, Spain
- School of Medicine, University of Córdoba, 14071 Cordoba, Spain
| | | | - Luis M Entrenas-Costa
- Pneumology Department, Hospital QuironSalud, 14004 Cordoba, Spain
- School of Medicine, University of Córdoba, 14071 Cordoba, Spain
- Pneumology Department, Hospital Universitario Reina Sofía, 14004 Cordoba, Spain
| | - Rubén Andújar-Espinosa
- Pneumology Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
- Medicine Department, University of Murcia, 30120 Murcia, Spain
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Miralles López JC, Andújar-Espinosa R, Bravo-Gutiérrez FJ, Castilla-Martínez M, Flores-Martín I, Alemany-Francés ML, Pajarón-Fernández MJ, Mora González A, Valverde-Molina J, Valverde-Molina V. Effectiveness of benralizumab in severe eosinophilic asthma under routine clinical practice. J Investig Allergol Clin Immunol 2022; 32:220-223. [DOI: 10.18176/jiaci.0793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Andújar-Espinosa R, Salinero-González L. Vitamin D supplementation: A treatment with possible benefits in asthma. Arch Bronconeumol 2021; 57:567-568. [PMID: 35702912 DOI: 10.1016/j.arbr.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/04/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Rubén Andújar-Espinosa
- Servicio de Neumología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, Spain.
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Andújar-Espinosa R, Aparicio-Vicente M, Ruiz-López FJ, Salinero-González L. Influence of vitamin D supplementation on the quality of life of asthma patients: Findings from ACVID randomised clinical trial. Respir Med 2021; 185:106484. [PMID: 34089969 DOI: 10.1016/j.rmed.2021.106484] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
Published data on vitamin D and the quality of life of asthma patients are scarce and disparate. The ACVID clinical trial, published in 2020, showed the efficacy of calcifediol in improving asthma control in asthma patients with vitamin D deficiency. Data on vitamin D and quality of life measured by the Mini-AQLQ questionnaire were analysed: supplemented patients showed improved quality of life compared with a placebo group, and the initial mini-AQLQ scores were improved for both groups.
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Affiliation(s)
- R Andújar-Espinosa
- Hospital Universitario Virgen de la Arrixaca, Pulmonology Department, Murcia, Spain; Medicine Department, University of Murcia, Murcia, Spain.
| | - M Aparicio-Vicente
- Hospital Universitario Virgen de la Arrixaca, Pulmonology Department, Murcia, Spain
| | - F J Ruiz-López
- Hospital Universitario Virgen de la Arrixaca, Pulmonology Department, Murcia, Spain; Medicine Department, University of Murcia, Murcia, Spain
| | - L Salinero-González
- Hospital General Universitario Reina Sofía, Endocrinology and Nutrition Department, Murcia, Spain
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11
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Andújar-Espinosa R, Salinero-González L. Vitamin D Supplementation: A Treatment With Possible Benefits in Asthma. Arch Bronconeumol 2021; 57:S0300-2896(21)00027-2. [PMID: 33653580 DOI: 10.1016/j.arbres.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Rubén Andújar-Espinosa
- Servicio de Neumología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Medicina, Facultad de Medicina, Universidad de Murcia, Murcia, España.
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12
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Andújar-Espinosa R, Ros-Lucas JA, Ruiz-López FJ. Protective hood prototype for bronchoscopy during Covid-19. Medicina Clínica (English Edition) 2021; 156:46. [PMID: 33521311 PMCID: PMC7837124 DOI: 10.1016/j.medcle.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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13
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Andújar-Espinosa R, Salinero-González L, Illán-Gómez F, Castilla-Martínez M, Hu-Yang C, Ruiz-López FJ. Effect of vitamin D supplementation on asthma control in patients with vitamin D deficiency: the ACVID randomised clinical trial. Thorax 2020; 76:126-133. [PMID: 33154023 DOI: 10.1136/thoraxjnl-2019-213936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The relationship between asthma and vitamin D deficiency has been known for some time. However, interventional studies conducted in this regard have shown conflicting results. OBJECTIVE To evaluate the efficacy of vitamin D supplementation in asthmatic patients in improving the degree of control of asthma. METHODS Randomised, triple-blind, placebo-controlled, parallel-group study in adult asthmatic patients with serum 25-hydroxyvitamin-D3 <30 ng/mL. The intervention group received oral supplementation with 16 000 IU of calcifediol per week, and the control group had placebo added to their usual asthma treatment. The study period was 6 months. The primary endpoint was the degree of asthma control as determined by the asthma control test (ACT). Secondary endpoints included quality of life measured using the mini Asthma Quality of Life Questionnaire, the number of asthma attacks, oral corticosteroid cycles, the dose of inhaled corticosteroids, number of emergency visits, unscheduled consultations with the primary care physician and hospitalisations for asthma. RESULTS One hundred and twelve patients were randomised (mean age 55 years, with 87 (78%) being women). Of the 112 patients, 106 (95%) completed the trial. Half the patients (56) were assigned to the intervention group and the other half to the control group. A statistically significant clinical improvement was observed in the intervention group (+3.09) compared with the control group (-0.57) (difference 3.66 (95% CI 0.89 to 5.43); p<0.001) as measured using ACT scores. Among the secondary endpoints, a significant improvement in the quality of life was found in the intervention group (5.34), compared with the control group (4.64) (difference 0.7 (95% CI 0.15 to 1.25); p=0.01). CONCLUSION Among adults with asthma and vitamin D deficiency, supplementation with weekly oral calcifediol compared with placebo improved asthma control over 6 months. Further research is needed to assess long-term efficacy and safety. TRIAL REGISTRATION NUMBER NCT02805907.
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Affiliation(s)
- Rubén Andújar-Espinosa
- Pulmonology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | - Fátima Illán-Gómez
- Endocrinology and Nutrition, Hospital Morales Meseguer, Murcia, Murcia, Spain
| | - Manuel Castilla-Martínez
- Pulmonology, Hospital General Universitario Los Arcos del Mar Menor, Pozo Aledo-San Javier, Murcia, Spain
| | - Chunshao Hu-Yang
- Pulmonology, Hospital General Universitario Los Arcos del Mar Menor, Pozo Aledo-San Javier, Murcia, Spain
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Andújar-Espinosa R, Ros-Lucas JA, Ruiz-López FJ. [Protective hood prototype for bronchoscopy during Covid-19]. Med Clin (Barc) 2020; 156:46. [PMID: 33268133 PMCID: PMC7518230 DOI: 10.1016/j.medcli.2020.07.041] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022]
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Andújar-Espinosa R, Ros-Lucas J, Ruiz-López F. Pneumonia associated with intrabronchial foreign body. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sánchez-Nieto JM, Andújar-Espinosa R, Bernabeu-Mora R, Hu C, Gálvez-Martínez B, Carrillo-Alcaraz A, Álvarez-Miranda CF, Meca-Birlanga O, Abad-Corpa E. Efficacy of a self-management plan in exacerbations for patients with advanced COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1939-47. [PMID: 27574418 PMCID: PMC4994798 DOI: 10.2147/copd.s104728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/27/2022] Open
Abstract
Background Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD. Methods Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality. Results After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0.191). Conclusion The implementation of a self-management program for patients with advanced COPD reduced exacerbations that required hospital care.
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Affiliation(s)
| | | | | | - Chunshao Hu
- Division of Pneumology, Hospital Morales Meseguer
| | | | | | | | | | - Eva Abad-Corpa
- Department of Professional Development Unit, Murcia, Spain
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