Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

Continuous positive airway pressure () in asthma patients with concomitant obstructive sleep apnea syndrome () seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of in 99 adult asthma patients (mean age 57 years) with (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire () and the Mini Asthma Quality of Life Questionnaire (Mini), respectively. Data were analyzed by intention-to-treat basis. The mean ± score of the decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

Continuous positive airway pressure () in asthma patients with concomitant obstructive sleep apnea syndrome () seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of in 99 adult asthma patients (mean age 57 years) with (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire () and the Mini Asthma Quality of Life Questionnaire (Mini), respectively. Data were analyzed by intention-to-treat basis. The mean ± score of the decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome

Asma de riesgo vital. Caracterización e identificación de los fenotipos implicados

Aunque en la mayoría de los casos el asma es una enfermedad leve, que con un tratamiento adecuado permite llevar una vida prácticamente normal, existen otras formas mucho más graves de la enfermedad. En determinadas circunstancias, los pacientes pueden incluso fallecer a consecuencia del asma, o bien sufrir exacerbaciones que comprometen seriamente su vida. Los estudios previos que han analizado a estos pacientes muestran que la etiología y patogenia de este tipo de asma, denominada Asma de Riesgo Vital (ARV), no son homogéneas. Se podría establecer como hipótesis, por tanto, que el ARV es un "cajón de sastre" formado por diferentes subtipos clínico-patológicos de pacientes. Con el propósito de comprobar dicha hipótesis, se diseñó un estudio multicéntrico prospectivo, de ámbito nacional, en el que participaron 33 hospitales de toda España. Durante 2 años se reunió información sobre 236 episodios de ARV, definidos como aquellas crisis agudas de asma que cursaron con al menos una de las siguientes circunstancias: a) fallecimiento del paciente; b) hipercapnia superior a 50 mm Hg y/o acidosis respiratoria con pH inferior a 7,30, c) paro respiratorio y d) ventilación mecánica. El análisis de las características demográficas, clínicas, funcionales, inmunológicas y psicológicas de los pacientes permitió establecer distintos perfiles clínicos del ARV: 1) Los episodios de asma de riesgo vital desarrollados de forma súbita (en menos de 2 horas) son frecuentes: un 20% de los casos se presentaron de esta forma. Estos pacientes, además, presentaron características diferenciales respecto a los asmáticos con episodios de ARV lentos: los desencadenantes de la exacerbación, su intensidad y su evolución clínica fueron distintos.2) La alexitimia, un rasgo de personalidad caracterizado por la dificultad en percibir y expresar sensaciones físicas y emociones, es más frecuente en los pacientes con ARV que en el resto de los asmáticos. Su presencia, por otra parte, se asoció con episodios recurrentes de exacerbaciones muy graves de asma.3) La sensibilización al hongo Alternaria alternata puede estar involucrada en el desarrollo de algunos episodios de ARV. Los pacientes que los padecen muestran un fenotipo particular: son más jóvenes y mejoran más rápidamente, aunque pueden fallecer o presentar graves complicaciones neurológicas con mayor frecuencia.4) La menstruación puede actuar como un factor contribuyente para el desarrollo de crisis de ARV en pacientes con asma inestable.Although in most cases asthma is a mild disease, and patients can lead a normal life with an appropriate treatment, there are other very severe forms of the disease. In certain circumstances, patients can even die as a result of asthma, or suffer such intense exacerbations that can seriously compromise his life. Previous studies have analyzed this kind of asthma, called life-threatening asthma (LTA). Their results show that the etiology and the pathogenesis of LTA are not homogenous. We would be able to establish, therefore, that the life-threatening asthma is a "mixed bag" with different clinical and pathological subtypes of patients. In order to verify this hypothesis, a prospective, multicentric, nation-wide study was designed. For two years, we collected 236 episodes of LTA from 33 hospitals in Spain. LTA was defined as acute asthma crisis with at least one of the following consequences: to) death of the patient; b) hipercapnia higher than 50 mm Hg and/or respiratory acidosis with pH lower than 7,30, c) respiratory arrest and d) need for mechanical ventilation. The analysis of the demographic, clinical, functional, immunological and psychological characteristics of the patients allowed to establish different phenotypes of the LTA: 1) Episodes of rapid-onset fatal and near-fatal asthma (in less than 2 hours) are frequent: 20% of cases were presented in this way. These episodes, also, had differences with slow-onset asthma attacks: the triggers of exacerbation, their intensity and the outcome were different.2) Alexithymia, a psychological trait characterised by a difficulty in recognising and describing body sensations and emotions, is more frequent in patients with LTA that in the rest of asthmatics. Its presence, on the other hand, was associated with recurrent episodes of very severe asthma exacerbations.3) The sensitization to the fungus Alternaria alternata can be related with some LTA episodes. Patients that suffer them show a particular clinical profile: they are younger and improve quicker, although they can die or present serious neurological sequels more frequently.4) Menstruation may have a role as a contributing factor in the development of LTA crisis in patients with unstable asthma

Asma de riesgo vital : caracterización e identificación de los fenotipos implicados /

Descripció del recurs: 12 novembre 2010Aunque en la mayoría de los casos el asma es una enfermedad leve, que con un tratamiento adecuado permite llevar una vida prácticamente normal, existen otras formas mucho más graves de la enfermedad. En determinadas circunstancias, los pacientes pueden incluso fallecer a consecuencia del asma, o bien sufrir exacerbaciones que comprometen seriamente su vida. Los estudios previos que han analizado a estos pacientes muestran que la etiología y patogenia de este tipo de asma, denominada Asma de Riesgo Vital (ARV), no son homogéneas. Se podría establecer como hipótesis, por tanto, que el ARV es un "cajón de sastre" formado por diferentes subtipos clínico-patológicos de pacientes. Con el propósito de comprobar dicha hipótesis, se diseñó un estudio multicéntrico prospectivo, de ámbito nacional, en el que participaron 33 hospitales de toda España. Durante 2 años se reunió información sobre 236 episodios de ARV, definidos como aquellas crisis agudas de asma que cursaron con al menos una de las siguientes circunstancias: a) fallecimiento del paciente; b) hipercapnia superior a 50 mm Hg y/o acidosis respiratoria con pH inferior a 7,30, c) paro respiratorio y d) ventilación mecánica. El análisis de las características demográficas, clínicas, funcionales, inmunológicas y psicológicas de los pacientes permitió establecer distintos perfiles clínicos del ARV: 1) Los episodios de asma de riesgo vital desarrollados de forma súbita (en menos de 2 horas) son frecuentes: un 20% de los casos se presentaron de esta forma. Estos pacientes, además, presentaron características diferenciales respecto a los asmáticos con episodios de ARV lentos: los desencadenantes de la exacerbación, su intensidad y su evolución clínica fueron distintos. 2) La alexitimia, un rasgo de personalidad caracterizado por la dificultad en percibir y expresar sensaciones físicas y emociones, es más frecuente en los pacientes con ARV que en el resto de los asmáticos. Su presencia, por otra parte, se asoció con episodios recurrentes de exacerbaciones muy graves de asma. 3) La sensibilización al hongo Alternaria alternata puede estar involucrada en el desarrollo de algunos episodios de ARV. Los pacientes que los padecen muestran un fenotipo particular: son más jóvenes y mejoran más rápidamente, aunque pueden fallecer o presentar graves complicaciones neurológicas con mayor frecuencia. 4) La menstruación puede actuar como un factor contribuyente para el desarrollo de crisis de ARV en pacientes con asma inestable.Although in most cases asthma is a mild disease, and patients can lead a normal life with an appropriate treatment, there are other very severe forms of the disease. In certain circumstances, patients can even die as a result of asthma, or suffer such intense exacerbations that can seriously compromise his life. Previous studies have analyzed this kind of asthma, called life-threatening asthma (LTA). Their results show that the etiology and the pathogenesis of LTA are not homogenous. We would be able to establish, therefore, that the life-threatening asthma is a "mixed bag" with different clinical and pathological subtypes of patients. In order to verify this hypothesis, a prospective, multicentric, nation-wide study was designed. For two years, we collected 236 episodes of LTA from 33 hospitals in Spain. LTA was defined as acute asthma crisis with at least one of the following consequences: to) death of the patient; b) hipercapnia higher than 50 mm Hg and/or respiratory acidosis with pH lower than 7,30, c) respiratory arrest and d) need for mechanical ventilation. The analysis of the demographic, clinical, functional, immunological and psychological characteristics of the patients allowed to establish different phenotypes of the LTA: 1) Episodes of rapid-onset fatal and near-fatal asthma (in less than 2 hours) are frequent: 20% of cases were presented in this way. These episodes, also, had differences with slow-onset asthma attacks: the triggers of exacerbation, their intensity and the outcome were different. 2) Alexithymia, a psychological trait characterised by a difficulty in recognising and describing body sensations and emotions, is more frequent in patients with LTA that in the rest of asthmatics. Its presence, on the other hand, was associated with recurrent episodes of very severe asthma exacerbations. 3) The sensitization to the fungus Alternaria alternata can be related with some LTA episodes. Patients that suffer them show a particular clinical profile: they are younger and improve quicker, although they can die or present serious neurological sequels more frequently. 4) Menstruation may have a role as a contributing factor in the development of LTA crisis in patients with unstable asthma

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

Continuous positive airway pressure () in asthma patients with concomitant obstructive sleep apnea syndrome () seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of in 99 adult asthma patients (mean age 57 years) with (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire () and the Mini Asthma Quality of Life Questionnaire (Mini), respectively. Data were analyzed by intention-to-treat basis. The mean ± score of the decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome

Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six&nbsp;months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p &lt; 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p &lt; 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p &lt; 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p &lt; 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six&nbsp;months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p &lt; 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six&nbsp;months mortality but not on neurological outcome