La versión española del "Airways Questionaire 20" (AQ20) : adaptación cultural y utilidad para predecir exacerbaciones en asma y EPOC

[Resumen]Objetivos: Elaborar una versión del AQ20 en lengua española (AQ20S), analizar sus propiedades psicométricas y la capacidad para predecir agudizaciones en asma y EPOC en comparación con otros cuestionarios específicos. Método: Se utilizó el método de traducción-retrotraducción para la elaboración de la versión española del AQ20. Se estudiaron 208 pacientes (108 asma y 100 EPOC) recogiendo variables sociodemográficas, clínicas, funcionales y psicológicas en la visita basal. Todos los pacientes cumplimentaron el AQ20S y el St. George´s Respiratory Questionnaire (SGRQ). Los pacientes con EPOC también completaron el Chronic Respiratory Disease Questionnaire (CRQ) y el Clinical COPD Questionnaire (CCQ) y los asmáticos el Asthma Quality of Life Questionnaire (AQLQ). Los pacientes estables clínicamente cumplimentaron el AQ20S a los 14 días. A los 3 meses se realizó la misma valoración que en la visita basal. Se registraron todas las exacerbaciones que requirieron visitas a urgencias u hospitalización durante 2 años de seguimiento. Resultados: El AQ20S obtuvo una elevada equivalencia conceptual con el cuestionario original, alta consistencia interna (α= 0,84 en el grupo total, α= 0,87 en asma y α= 0,81 en EPOC), buena fiabilidad test-retest (CCI= 0,89 en el grupo total; CCI= 0,91 en asma y CCI= 0,87 en EPOC) y alta correlación con el SGRQ tanto en asma como EPOC (rs> 0,75; p< 0,001) así como con el AQLQ (rs= -0,72; p< 0,001) en asma y con el CRQ (rs= -0,59; p< 0,001) en EPOC. Los cambios en las puntuaciones del AQ20S correlacionaron con los cambios de los restantes cuestionarios. El primer año de seguimiento el AQ20S fue predictor de visitas a urgencias (OR: 1,19; p= 0,004; AUC 0,723) y hospitalizaciones (OR: 1,21; p= 0,04; AUC 0,759) para asma y el CCQ fue predictor independiente de visitas a urgencias en EPOC (OR: 1,06; p= 0,036; AUC 0,651). Conclusiones: Se obtuvo una versión en lengua española del AQ20 conceptualmente equivalente al cuestionario original en inglés, con propiedades psicométricas de fiabilidad y validez similares al original y a instrumentos más complejos como SGRQ, CRQ o AQLQ. El AQ20S predice visitas a urgencias y hospitalizaciones en asma y el CCQ predice visitas a urgencias en EPOC en el primer año de seguimiento. Teniendo en cuenta su simplicidad el AQ20S puede ser una alternativa a instrumentos tradicionales más complejos.[Resumo]Obxectivos: Elaborar unha versión do AQ20 en lingua española (AQ20S), analizar as súas propiedades psicométricas e a capacidade para predicir agudizacións en asma e EPOC en comparación con outros cuestionarios específicos. Método: Utilizouse o método de traducción-retrotraducción para a elaboración da versión española do AQ20. Estudáronse 208 doentes (108 asma e 100 EPOC) recollendo variables sociodemográficas, clínicas, funcionais e psicolóxicas na visita basal. Todos os doentes completaron o AQ20S e o St. George's Respiratory Questionnaire (SGRQ). Os doentes con EPOC tamén completaron o Chronic Respiratory Disease Questiormaire (CRQ) e o Clinical COPD Questionnaire (CCQ) e os asmáticos o Asthma Quality of Life Questionnaire (AQLQ). Os doentes estables cubriron o AQ20S aos 14 días. Aos 3 meses realizouse a mesma valoración que na visita basal. Rexistráronse todas as exacerbacións que requiriron visita a urxencias ou hospitalización durante 2 anos de seguimento. Resultados: O AQ20S obtuvo unha alta equivalencia conceptual co cuestionario orixinal, unha alta consistencia interna (a= 0,84 no grupo total, a= 0,87 en asma e a= 0,81 en EPOC) e boa fiabilidade test-reteste (CCI= 0,89 no grupo total, CCI= 0,91 en asma, CCI= 0,87 en EPOC) e aka correlación co SGRQ en ambos asma e EPOC (rs> 0,75, p< 0,001), co AQLQ (r r -0,72, p< 0,001) en asma e co CRQ (rs = -0,59, p< 0,001) en EPOC. Os cambios nas puntuacións do AQ20S tamén se relacionaron cos cambios nos restantes cuestionarios. O primeiro ano de seguimento o AQ20S foi preditor das visitas a urxencias (OR: 1,19, p= 0,004, AUC 0,723) e hospitalizacións (OR: 1,21, p= 0,04, AUC 0,759) para asma e o CCQ foi un preditor i·ndependente de visitas a urxencias en pacientes con EPOC (OR: 1,06, p::: 0,036, AUC 0,651). Conclusións: Obtúvose unha versión en lingua española do AQ20 conceptualmente equivalente ao cuestionario orixina1 en inglés, cunhas propiedades psicométricas de fiabilidade e validez semellantes as do orixinat e as dos instrumentos mais complexos coma SGRQ, CRQ ou AQLQ. O AQ20S foi preditor de visitas a urxencias e hospitalizacións en asma eo CCQ precüxo visitas a urxencias en EPOC no primeiro ano de seguimento. Tendo en canta a súa simplicidade o AQ20S pode ser unha alternativa a instrumentos tradicionais máis complexos.[Abstract]Objectives: To create a version of the AQ20 for use in Spain (AQ20S), to analyze their psychometric properties and to determine the ability to predict exacerbations in asthma and COPD in comparison with other specific HR.QoL questionnaires. Method: Translation-backtranslation method was used to create a Spanish version ofthe AQ20. Two hundred and eight patients (108 asthrna and 100 COPD) were studied collecting sociodemographic, clinical, functional and psychological variables at baseline. All patients completed the AQ20S and the St. George's Respiratory Questionnaire (SGRQ). COPD patients also completed the Chronic Respiratory Disease Questionnaire (CRQ) and the Clinical COPD Questionnaire (CCQ), while asthmatic patients completed the Asthma Quality of Life Questionnaire (AQLQ). Clinically stable patients were asked to fill in again the AQ20S after 14 days. The same assessment as on baseline visit was repeated after 3 months. We registered all exacerbations that required emergency visits or hospitalizations during a 2 year follow-up. Results: The AQ20S obtained a high conceptual equivalence to the original English items, a high interna! consistency (a= 0,84 in total group, a= 0,87 in asthma anda= 0,81 in COPD), a good test-retest reliability (CCI= 0,89 in total group; CCI= 0,91 in asthma and CCI= 0,87 in COPO) and showed a high correlation with the SGRQ in both asthma and COPD (rs> 0,75; p< 0,001), as well as with the AQLQ (rs= -0,72; p< 0,001) in asthma and with the CRQ (rs= -0,59; p< 0,001) in COPD. Changes in AQ20S scores correlated quite well with changes in other HR.QoL questionnaires. In the first year of follow-up, the AQ20S scores predicted both emergency department visits (OR: 1,19; p= 0,004; AUC 0,723) and hospitalizations (OR: 1,21; p= 0,04; AUC 0,759) for asthma patients, and the CCQ emerged as independent predictor of emergency department visits in COPD patients (OR: 1,06; p= 0,036; AUC 0,651). Conclusions: The adaptation process produced a Spanish questionnaire that is conceptually equivalent to the English original with psychometric properties of reliability and validity similar to the original and to the more complex instruments such as SGRQ, CRQ or AQLQ. The AQ20S predicts emergency department visits and hospitalizations in asthma and the CCQ predicts emergency department visits in COPD in the first year of follow-up. Considering its simplicity, the AQ20S may be an altemative to more complex traditional questionnaires

Comparative analysis of three quality of life questionnaires for patients with chronic obstructive pulmonary disease during a rehabilitation program

Póster presentado en el World Confederation for Physical Therapy Congress, Singapore, 2015 May 1-4

Exacerbation impact of a pulmonary rehabilitation program on chronic obstructive pulmonary disease subjects

Abstrac

Effects of a muscular training program on chronic obstructive pulmonary disease patients with moderate or severe exacerbation antecedents

[Abstract] Background: Muscular training is the corner stone of pulmonary rehabilitation programs. Aim: To evaluate the effects of a muscular training program - carried out on chronic obstructive pulmonary disease (COPD) subjects with antecedents of moderate or severe exacerbation - on exercise tolerance, Health Related Quality of Life (HRQoL) and illness prognosis. Design: A quasi-experimental study. Setting: University Hospital. Population: Twenty-five subjects with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) degrees II, III and IV); with moderate or severe exacerbations and functional deterioration due to respiratory disability; with commitment and capacity to participate in the program. Subjects were selected by consecutive sampling. Methods: Subjects underwent 20 muscular training sessions consisting of 30 minutes of inspiratory muscle training, 15 minutes of warm-up protocol of upper limb exercises, 30 minutes of muscle training in ergometric cycle, 5 minutes of stretching protocol of lower limbs plus illness awareness. The main outcome measures were six minute walking test (6MWT), specific HRQoL questionnaires (St. Georges Respiratory Questionnaire (SGRQ), Chronic Respiratory Disease Questionnaire (CRDQ) and Airways Questionnaire 20 (AQ20)) and the BODE Index. Results: All subjects improved significantly (P<0.001) their HRQoL in the SGRQ, the CRDQ and the AQ20, and this was demonstrated in each one of the evaluated dimensions. A positive response in relation to exercise tolerance and illness prognosis was observed. Following the program subjects walked an average of 56 meters more (P<0.001) and the BODE index was a mean of 1.5 less regarding the initial value (P<0.001). Conclusions: A 20-session muscular training program contributes to an improvement in HRQoL, exercise tolerance and illness prognosis in COPD subjects with moderate or severe exacerbations. Clinical rehabilitation impact: The intervention program could be easily implemented since it needs a minimum of human and technological resources

Eradication of pseudomonas aeruginosa with inhaled colistin in adults with non-cystic fibrosis bronchiectasis

[Abstract] The persistent isolation of Pseudomonas aeruginosa in the airways of non-cystic fibrosis bronchiectasis (NCFB) patients is associated with a worsening of the symptoms, increase of exacerbations, poor quality of life and functional impairment. The objective of this study was the analysis of the eradication rate of P. aeruginosa in the sputum of patients with NCFB treated with inhaled colistin and the effects of the treatment in the exacerbations. This was a prospective, cohort, study of 67 NCFB patients treated with inhaled colistin at the Hospital of A Corun˜a (Spain).We recorded dyspnoea, exacerbations, lung function and sputum cultures of P. aeruginosa in the patients. The mean age of the patients was 67.25+14.6 years (59.7% male). The percentages of eradication of P. aeruginosa in sputum at 3, 6, 9 and 12 months were 61.2%, 50.7%, 43.3% and 40.3%, respectively.We observed a significant decrease in exacerbations after 1 year of colistin treatment (1.98+3.62) versus the previous year (3.40 + 4.21, p < 0.001). We conclude that treatment with inhaled colistin in patients with NCFB and P. aeruginosa in sputum can achieve high rates of eradication even in patients with several previous positive cultures, as well as a significant decrease of exacerbations and hospital admissions

The ATLAS ASMA Study : Assessing the Impact of Asthma on Patients' Life - The Spanish Patients' Perspective

ATLAS ASMA described the psychosocial impact of asthma on patients' daily life from patients' perspectives (in terms of impaired personal and intimate relationships, sleep quality, leisure time, daily activities, and others) in Spain. Secondary objective includes description of time since diagnosis, expectations, and satisfaction of patients about disease, treatment and medical assistance received, adherence to treatment, perceived control of asthma, and health-related quality of life. This was a cross-sectional, observational study, based on a self-administered online survey for adult patients (≥18 years) with asthma. Patients with asthma diagnosis of any type and severity who voluntarily participated in the survey through a web link were included consecutively. In the present manuscript, only adult patients' data are included. A total of 132 adults with asthma were included. Moderate/severe asthma constituted 59.1% of the patients (females 71.2%). Overall, most relevant areas affected due to asthma were leisure activities (67.0%) and the quality/quantity of sleep (52.3%). Moderate/severe patients perceived some degree of impairment in work, school, or at home due asthma more frequently vs mild patients (55.2% vs 10.9%). Poorly controlled asthma (ACT≤19) was reported in 41 (70.7%) and 10 (21.7%) moderate/severe and mild patients (p<0.000), respectively. Mild patients obtained higher mean (SD) Mini-AQLQ score than moderate/severe asthma patients (5.6 [1.0] vs 4.3 [1.1], p<0.000), likewise higher significant results for every individual dimension. Most patients cited little limitation to intense efforts (20.5%). Half of the patients mentioned needing more information about asthma. Topics those patients like to have more information were difficulties that may can have and legal topics (78.6%), asthma evolution (78.6%), secondary effects or issues related to the treatment (61.9%) and legal topics (61.9%). The study reported important insights on psychosocial impact of asthma on patients' daily life from patients' perspectives along with health determinants in asthma-related health outcomes, sociodemographic and psychosocial factors

Potential Impact of Mepolizumab in Stepping Down Anti-Osteporotic Treatment in Corticosteroid-Dependent Asthma

Oral corticosteroids (OCS) are commonly used for the acute management of severe asthma exacerbations or as maintenance therapy; however, chronic use is associated with significant toxicities, e.g., osteoporosis. In the REal worlD Effectiveness and Safety (REDES) study of mepolizumab in a multicentric Spanish cohort of asthma patients, mepolizumab effectively reduced clinically severe asthma exacerbations and decreased OCS dependence. This post-hoc analysis further evaluates mepolizumab's de-escalation effect on OCS dose. Patients enrolled in REDES who had OCS consumption data available for 12 months pre- and post-mepolizumab treatment were included in this analysis. Primary outcomes were to determine the change in the proportion of patients eligible for anti-osteoporotic treatment due to the changes in OCS consumption before and after 1 year of mepolizumab treatment. All analyses are descriptive. Approximately one-third (98/318; 30.8%) of patients in REDES were on maintenance OCS at the time of mepolizumab treatment initiation. In REDES, mean cumulative OCS exposure decreased by 54.3% after 1 year of treatment. The proportion of patients on high-dose OCS (≥7.5 mg/day) fell from 57.1% at baseline to 28.9% after 12 months of mepolizumab treatment. Thus, 53.6% of OCS-dependent asthma patients treated with mepolizumab would cease to be candidates for anti-osteoporotic treatment according to guidelines thresholds

A Study of the Prevalence of Asthma in the General Population in Spain

Asma; Epidemiología; PrevalenciaAsthma; Epidemilogy; PrevalenceAsma; Epidemiologia; PrevalençaIntroducción El asma es una enfermedad con elevada prevalencia, que afecta a todos los grupos de edad y genera elevados costes sociosanitarios. Estudios realizados en diversas poblaciones muestran gran variabilidad en su prevalencia, incluso en poblaciones cercanas geográficamente, con datos que sugieren una influencia relevante de factores socioeconómicos. Actualmente en población adulta de España no disponemos de datos poblacionales fiables sobre la prevalencia de esta enfermedad. Los objetivos de este estudio son estimar la prevalencia de asma en población española de 18-79 años, describir la variabilidad entre comunidades autónomas, estimar la prevalencia de infra y sobrediagnóstico, prevalencia de asma no controlada, de asma córticodependiente, conocer el consumo de recursos sanitarios, identificar los fenotipos más frecuentes y establecer un punto de partida para evaluar la tendencia temporal con estudios posteriores. Material y métodos Se realizará un estudio transversal, bietápico, incluyendo pacientes de 50 áreas sanitarias. El estudio se desarrollará en tres fases: 1) cribado y confirmación en historia clínica, en la cual se identificarán los pacientes con diagnóstico previo correctamente establecido de asma; 2) diagnóstico de asma, evaluando a los pacientes en los cuales no está claro el diagnóstico de asma con los datos disponibles en la historia clínica; 3) caracterización del asma, analizando las características de estos pacientes e identificando los fenotipos más frecuentes. Discusión Parece necesario y factible realizar un estudio epidemiológico del asma en España que permita identificar la prevalencia de asma, optimizar la planificación sanitaria, caracterizar los fenotipos más frecuentes de la enfermedad y evaluar los diagnósticos erróneos.Introduction Asthma is a disease with high prevalence, which affects all age groups and generates high health and social care costs. Studies carried out in a number of populations show great variability in its prevalence, even in geographically close populations, with data suggesting a relevant influence of socio-economic factors. At present, we do not have reliable data on the prevalence of this disease in the adult population of Spain. The objectives of this study are to estimate the prevalence of asthma in the Spanish population for those aged 18-79, to describe the variability between autonomous communities, to estimate the prevalence of under and overdiagnosis, to analyse the prevalence of uncontrolled asthma and steroid-dependent asthma, to evaluate the health care cost, to identify the most frequent phenotypes and to establish a starting point to evaluate the temporal trend with subsequent studies. Methods A cross-sectional, two-stage study will be carried out, including patients from 50 catchment areas. The study will be carried out in 3 phases: 1) screening and confirmation in the clinical history, in which patients with a previously correctly established diagnosis of asthma will be identified; 2) diagnosis of asthma to evaluate patients without a confirmed or excluded diagnosis; 3) characterization of asthma, where the characteristics of the asthmatic patients will be analysed, identifying the most frequent phenotypes. Discussion It seems necessary and feasible to carry out an epidemiological study of asthma in Spain to identify the prevalence of asthma, to optimize healthcare planning, to characterize the most frequent phenotypes of the disease, and to evaluate inaccurate diagnoses.Este trabajo ha sido financiado por el Foro Autonómico de Asma-SEPAR

SEPAR Recommendations for COVID-19 Vaccination in Patients With Respiratory Diseases

[ES] La Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de recomendaciones sobre la vacuna para la COVID-19 en las enfermedades respiratorias, con el objetivo de ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación de estos pacientes. Las recomendaciones han sido elaboradas por un grupo de expertos en la materia, tras la revisión de la literatura recopilada hasta el 7 de marzo del 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha. Podemos concluir que las vacunas para la COVID-19 no solo son seguras y eficaces, sino que, en aquellos pacientes vulnerables con enfermedades respiratorias crónicas, son prioritarias. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas.[EN] The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients. The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date. We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage