Telemedicina y asma grave en nuestro entorno: reflexiones sobre la experiencia de los profesionales y propuestas para hacerla realidad

Resumen: Este documento pretende examinar la experiencia reciente de la telemedicina (TM) en el paciente con asma grave (AG). Un comité de profesionales sanitarios que participan en el manejo del asma (neumología, alergología, enfermería respiratoria y farmacia hospitalaria) intercambiaron impresiones sobre la experiencia práctica de la TM para el manejo del AG y los medios habitualmente disponibles y se complementó con una búsqueda bibliográfica con tal de conocer el estado actual de la TM en AG. Las principales barreras detectadas han sido la falta de formación tecnológica, la falta de registro de la TM en la historia clínica, la sobrecarga asistencial o los problemas de conexión a nivel de administración. Se aportan posibles soluciones como la selección del paciente, el registro de la TM en la historia clínica, su inclusión en los objetivos asistenciales o el aumento de financiación para sistemas. Además, se aportan las principales apps y web apps para el uso por parte de los pacientes y los equipos portátiles para realización de pruebas funcionales a distancia. Como conclusión, es necesario que la teleconsulta posea la misma consideración que la visita presencial con una programación en la agenda de citaciones y una estructura tanto de la entrevista médica como de las pruebas a realizar en la consulta. Se debe promover la implantación de un sistema de videollamada, de herramientas que permitan el seguimiento tanto de la adhesión terapéutica como de la técnica inhalatoria y de la función pulmonar del paciente. Abstract: This paper aims to examine the recent experience in telemedicine (TM) management of patients with severe asthma (SA). A committee of health professionals involved in asthma management (pulmonology, allergology, respiratory nursing, and hospital pharmacy) held discussion meetings on the practical experience of TM for the management of SA and the means available complemented with a bibliographic search to know the current status of TM in SA. The main barriers detected for the implementation of TM in SA have been the lack of technological training, the lack of registration of TM in the clinical history, the care overload, or the connectivity problems at the administration level. The practical solutions are provided such as the selection of the patient suitable for TM, the registration of TM in the medical record, its inclusion in the care objectives or the increase of funding for systems. Moreover, the main App and Webapp for use by patients are provided, and the portable equipment for remote functional respiratory tests. In conclusion, it is necessary that the teleconsultation has the same entity as the face-to-face visit with a schedule in the appointment's agenda and a structure of both the medical interview and the tests to be performed in each consultation. Additionally, should be promoted the implementation of a video call system, tools that allow the monitoring of both therapeutic adherence and inhalation technique, as well as the patient's lung function

COVID-19 Course in Allergic Asthma Patients: A Spanish Cohort Analysis.

The acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has had a high impact on patients with chronic diseases. In the literature, there are different perspectives on asthma as comorbidity or risk factor on COVID-19 severity. The aim of this retrospective study across 13 allergy departments in Spain was to determine the severity of COVID-19 in asthmatic adults followed in allergy departments and its relationship with atopy, clinical and demographic characteristics, phenotypes and laboratory data. In addition, lung function test and asthma control test (ACT) before and after COVID-19 were analyzed. Data was obtained from electronic medical records from March 2020 to April 2021. Two hundred one asthmatic patients were diagnosed with COVID-19 infection by validated detection test. About 30% of the patients were admitted for bilateral pneumonia. Advanced age, elevated D-dimer, lower numbers of lymphocytes and eosinophils, heart diseases and hypertension were associated with severe COVID-19. Allergic and mixed allergic/eosinophilic phenotype and their biomarkers (total IgE, aeroallergens sensitizations, allergic rhinitis, and blood eosinophilia) were related to fewer hospital admissions. Poor control and lower forced expiratory volume in the first second (FEV1) were related to worse prognosis of COVID-19. Asthmatic patients with allergic and eosinophilic phenotype have a better evolution of COVID-19 and lower risk of admissions. Older patients, cardiovascular comorbidities, AERD and eosinopenia are related to severity COVID-19

Frequency of clonal mast cell diseases among patients presenting with anaphylaxis: A prospective study in 178 patients from 5 tertiary centers in Spain

This work was supported by grants from the Fundación Sociedad Española Alergología e Inmunología Clínica (SEAIC) 2014