Efecto del índice de masa corporal sobre las variables clínicas, funcionales e inflamatorias del asma

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 15-12-2020El asma y la obesidad son dos patologías íntimamente relacionadas. En 472 las guías actuales de asma se considera a la obesidad tanto como comorbilidad 473 como causante etiológico de ella, describiéndose el fenotipo asma y obesidad. 474 Pese a ello, la relación entre el asma y el IMC no está correctamente 475 descrita. El desconocimiento de los detalles de esta interacción imposibilita un 476 correcto entendimiento de la verdadera dimensión de esta relación. 477 Se ha realizado un estudio observacional retrospectivo en vida real para 478 poder analizar y describir esta interacción. Se han incluido todos los pacientes 479 con una maniobra espirométrica válida, por sospecha de asma, entre noviembre 480 de 2014 y noviembre de 2017. Se registró la primera consulta de 2514 pacientes, 481 entre los que había 1458 asmáticos. 482 Con el análisis de los datos obtenidos se puede afirmar que el IMC 483 modifica de forma directa múltiples variables del asma. Se ha comprobado como 484 el aumento de IMC aumenta la prevalencia de disanapsis, especialmente entre 485 los obesos. También se ha constatado que los grupos de IMC establecidos 486 describen adecuadamente las tendencias de las variables en ambos sexos, por 487 lo que no requieren ser rediseñados o adaptados según edad o sexo. 488 Los parámetros más intensamente modificados por el IMC son los 489 espirométricos. Estos cambios no son homogéneos, sino que suceden de forma 490 diferente en los diversos estratos etarios. El Z-score no tiene en cuenta el peso, 491 no pudiendo valorar, por tanto, cambios en el IMC. Consecuentemente, se 492 plantea la necesidad de rediseñar este parámetro y los resultados espirométricos 493 para tener en cuenta el IMC en relación con la edad del paciente. 494 El inicio tardío del asma se relaciona con un IMC elevado, no siendo 495 específico del fenotipo de asma y obesidad. En el caso del predominio en 496 mujeres y la descripción como asma no eosinofílica son comunes entre todos los 497 grupos de IMC, no siendo características de este fenotipo ni de un elevado IMC. 498 Por el contrario, el fenotipo de asma y obesidad describe una mayor 499 presencia de síntomas con menores alteraciones espirométricas y una menor 500 prevalencia de atopia, rinitis y enfermedades alérgicas, como el asma alérgico. 501 Estas características no se han encontrado entre los obesos de la población 502 general, pudiendo ser específicas de este fenotipo concret

The Role of Mobile Health Technologies in Allergy Care:an EAACI Position Paper

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed

The Influence of Peripheral Blood Eosinophil Counts in Asthma Comorbidities in Adults: A Real Life Study

Asthma and eosinophilia are two closely related pathologies whose interaction is key in the era of precision medicine. However, this relationship is rarely taken into account without the influence of therapeutic prescriptions. In this study involving 1296 subjects, the relationship between eosinophilia and asthma was analyzed without taking into account other biases. We observed that rhinitis only appears in non-asthmatic patients with elevated blood eosinophil levels, while atopy was elevated in parallel to eosinophilia regardless of whether the patients were asthmatic or not. In terms of lung function, a decrease was observed for higher blood eosinophil levels, which is especially relevant in the FEV1/FVC ratio. FENO is elevated in relation to higher eosinophilia, but total IgE is only elevated in patients with high peripheral blood eosinophil levels and asthma. Finally, the only feature of asthma that is altered by increased peripheral eosinophilia is persistent asthma, with all other features remaining unchanged

Global disparities in availability of epinephrine auto-injectors

Background: Anaphylaxis is the most severe clinical presentation of acute systemic allergic reactions and can cause death. Given the prevalence of anaphylaxis within healthcare systems, it is a high priority public health issue. However, management of anaphylaxis – both acute and preventative – varies by region. Methods: The World Allergy Organization (WAO) Anaphylaxis Committee and the WAO Junior Members Steering Group undertook a global online survey to evaluate local practice in the diagnosis and management of anaphylaxis across regions. Results: Responses were received from WAO members in 66 countries. While intramuscular epinephrine (adrenaline) is first-line treatment for anaphylaxis, some countries continue to recommend alternative routes in contrast to guidelines. Epinephrine auto-injector (EAI) devices, prescribed to individuals at ongoing risk of anaphylaxis in the community setting, are only available in 60% of countries surveyed, mainly in high-income countries. Many countries in South America, Africa/Middle-East and Asian-Pacific regions do not have EAI available, or depend on individual importation. In countries where EAIs are commercially available, national policies regarding the availability of EAIs in public settings are limited to few countries (16%). There is no consensus regarding the time patients should be observed following emergency treatment of anaphylaxis. Conclusion: This survey provides a global snapshot view of the current management of anaphylaxis, and highlights key unmet needs including the global availability of epinephrine for self-injection as a key component of anaphylaxis management

The role of mobile health technologies in allergy care: An EAACI position paper

Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the “Be He@lthy, Be Mobile” WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the “General Data Protection Regulation” and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed