Once‐daily LABA/ICS combined inhalers versus inhaled long‐acting beta2‐agonists for people with chronic obstructive pulmonary disease (COPD)

Q1Q11-12This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness and safety of once-daily LABA/ICS in a combined inhaler versus once/twice-daily LABA for the treatment of COPD

Stops during the six-minute walk test and their correlation with new measurements of the test in patients with obstructive pulmonary disease

Marco teórico: se ha reportado que la presencia de paradas involuntarias durante la prueba de caminata de 6 minutos se asocia con un incremento en la mortalidad en los pacientes con enfermedad pulmonar obstructiva crónica. Sin embargo, la relación de las paradas con otras determinaciones de la prueba de caminata de 6 minutos como velocidad, trabajo, el producto distancia-saturación y la desaturación inducida por el ejercicio, aún no se ha establecido. Objetivos: determinar la correlación de las paradas involuntarias con variables clínicas recolectadas de forma rutinaria en la PC6M, así como con las nuevas determinaciones derivadas de la prueba, en pacientes con enfermedad pulmonar obstructiva crónica. Materiales y métodos: se realizó un estudio observacional, analítico, retrospectivo, en el que se revisaron los reportes de pruebas de caminata de 6 minutos de 129 sujetos con enfermedad pulmonar obstructiva crónica. Las determinaciones derivadas de la prueba fueron comparadas entre los pacientes que presentaron paradas y quienes no; se realizaron correlaciones entre ellas y se identificaron los predictores de paradas por medio de análisis de regresión logística. Resultados: 30 pacientes tuvieron paradas involuntarias durante la prueba; en este grupo se observó al final que los puntajes de disnea y fatiga, así como la frecuencia cardiaca, la frecuencia respiratoria y la tensión arterial sistólica final fueron significativamente mayores que en el grupo que no tuvo paradas, mientras que la saturación arterial de oxigeno fue significativamente menor (p<0,001); las nuevas variables derivadas: distancia, velocidad, trabajo y el producto distancia-saturación fueron menores (p<0,001) en los sujetos que pararon, encontrando una buena correlación con ellas. En el análisis de regresión, las variables que permanecieron significativas para la presencia de paradas fueron: saturación final, distancia recorrida, velocidad, trabajo, DDR y producto distancia-saturación. Conclusiones: en los pacientes con enfermedad pulmonar obstructiva crónica estable que realizan una prueba de caminata de 6 minutos, la presencia de paradas se asocia con menor distancia caminada, trabajo, DSP y saturación al final de la prueba. El cálculo de estas nuevas variables, así como el registro de paradas durante la PC6M podría refinar la capacidad pronóstica de la prueba en pacientes con enfermedad pulmonar obstructiva crónica.Artículo Original170-179Theoretical frame: it has been reported that involuntary stops during the six-minute walk test are associated with increased mortality in patients with chronic obstructive pulmonary disease. However, the relationship between the stops and other determinations of the six-minute walk test, such as speed, work, the distance-saturation product, and exercise-induced desaturation, has not yet been established. Objectives: to determine the correlation between involuntary stops and clinical variables gathered routinely in the six-minute walk test, as well as the new determinations derived from the test, in patients with chronic obstructive pulmonary disease. Materials and methods: an observational, analytic, retrospective study was carried out, in which the reports of six-minute walk tests from 129 subjects with chronic obstructive pulmonary disease were reviewed. The determinations derived from the test were compared between the patients who had stops and those who hadn’t; correlations between them were made, and predictors of stops were identified by logistic regression anaylysis. Results: 30 patients had involuntary stops during the test; in this group, it was observed in the end that scores of dyspnea and fatigue, as well as heart rate, respiratory rate, and final systolic arterial blood pressure were significantly higher than those found in the group that did not have stops, while arterial blood oxygen saturation was significantly lower (p<0,001); the new variables derived: distance, speed, work, and the distance-saturation produc were lower (p<0,001) in the subjects who stopped; a good correlation with them was found. On regression analysis, the variables that remained significant for the presence of stops were: final saturation, distance walked, speed, work, DDR, and distance-saturation product. Conclusions: in patients with stable chronic obstructive pulmonary disease who undergo the six-minute walk test, stops are asso- ciated with less distance walked, work, DSP, and saturation at the end of the test. Calculation of these new variables, together with registration of stops during the six-minute walk test, might refine the prognostic capability of the test in patients with chronic obstructive pulmonary disease

Association between T2-related co-morbidities and effectiveness of biologics in severe asthma

Acknowledgments The authors thank Mr. Joash Tan (BSc, Hons), of the Observational and Pragmatic Research Institute (OPRI), and Ms Andrea Lim (BSc, Hons) of the Observational Pragmatic Research Institute (OPRI) for their editorial and formatting assistance that supported the development of this publication. Funding statement: This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. AstraZeneca UK LimitedPeer reviewe

Exhaled nitric oxide (FeNO): Bridging a knowledge gap in asthma diagnosis and treatment

Abstract: « Fractional exhaled nitric oxide (FeNO) testing has emerged as a valuable tool in assessing people with asthma, offering an objec-tive measure of ongoing type 2 cytokine, chemokine and alarmin signalling in the airways.As a non-invasive and easily accessible biomarker, incorporating FeNO testing into asthma management may improve diagnostic accuracy by complementing clinical symp-toms and spirometry measures. [...]

Búsqueda de caso y diagnóstico temprano en sujetos con sospecha de la EPOC

La enfermedad pulmonar obstructiva crónica es una patología comúnmente sub-diagnosticada. A la fecha no existe ninguna revisión sistemática publicada que evalué la búsqueda de caso (sujetos mayores de 40 años con factores de riesgo sin síntomas) y el diagnóstico temprano (factor de riesgo y síntomas) de la enfermedad. \ud \ud Métodos: \ud Se condujo una revisión sistemática en tres bases de datos (Pubmed, CINAHL, EMBASE) para identificar estudios observacionales que reportaran la prevalencia de la EPOC en diferentes poblaciones expuestas a factores de riesgo (búsqueda de caso) o con factores de riesgo y síntomas (diagnóstico temprano), posteriormente con dichos estudios se calculó una prevalencia ponderada para cada grupo y esta se comparó con la prevalencia reportada en la población general en estudios locales. Así mismo se identificaron estudios para determinar la precisión de estrategias de búsqueda de caso (cuestionarios y el pico flujo espiratorio portátil PiKo 6®) usando la espirometría como patrón de oro para el diagnóstico de la EPOC. Dos autores seleccionaron de forma independiente los estudios que cumplían con los criterios de inclusión y exclusión y se evaluó la calidad metodológica por medio de la estrategia GRADE. \ud El número necesario a tamizar (1/ prevalencia) para diagnosticar un caso de EPOC con espirometría fue calculado para los dos grupos de interés y comparado con el valor conocido de la prevalencia nacional. \ud A los cuestionarios y estudios de Piko 6® se les evaluó las características operativas (VPP, VPN) y se calcularon las probabilidades pos test negativas y positivas teniendo en cuenta la prevalencia ponderada. \ud \ud \ud \ud Resultados \ud Para la estrategia de búsqueda de caso, once estudios cumplieron los criterios de inclusión y la prevalencia ponderada en este grupo fue de 22% con un número necesario a tamizar (NNS) con espirometría de 5, comparado con un NNS de 11 obtenido de la prevalencia de la EPOC en Colombia 8.9% ( IC 95% 8.2-9.7). \ud Posterior a la evaluación critica de varios cuestionarios y estudios de piko 6®, seleccionamos el cuestionario desarrollado por Mullernová y cols y el estudio de Frith y cols respectivamente. El cuestionario validado mostro una probabilidad postest positiva del 56% y postest negativa del 3% con un NNS de 2; para piko 6® los valores correspondientes fueron de 44%, 7% y 2 respectivamente. \ud Para el diagnóstico temprano la prevalencia ponderada fue del 33.9% con un NNS de 3. \ud \ud Conclusiones\ud El número necesario a tamizar para la estrategia de búsqueda de caso con cuestionarios y piko 6® es substancialmente menor que el número necesario a tamizar en la población general. El uso de cuestionarios o de piko 6® disminuye a 2 el NNS en el grupo de búsqueda de caso y a 3 para el grupo de diagnóstico temprano.Rationale: Chronic obstructive pulmonary disease (COPD) is commonly underdiagnosed. To date, there is no a systematic evaluation of case finding in subjects with risk factors without symptoms (subjects >40 years with risk factor, no symptoms) and early diagnose those with symptoms (risk factors and symptoms) of the disease. \ud \ud Methods: We performed a systematic review (PubMed, CINAHL, EMBASE) to identify observational studies that reported prevalence of COPD in case finding and early diagnose and calculated a weighted prevalence for each one of the groups. We also searched for studies that determined the accuracy of questionnaires and hand-held expiratory flow meter PiKo-6®, using spirometry as a gold standard (post-bronchodilator FEV1/FVC <70%) for the diagnosis of COPD. Two of the authors independently selected studies that met the inclusion criteria and assessed methodological quality using the GRADE approach.\ud The Number Needed to Screen (NNS: 1/prevalence) to diagnose a case of COPD with spirometry was calculated for these two groups and compared with the value obtained from the national prevalence. Questionnaires and PiKo-6® were for case finding and the positive and negative posttest probability were calculated based on the weighted prevalence.\ud \ud Results: For case finding, eleven studies met the inclusion criteria and the weighted prevalence in this group was 22%, with a NNS with spirometry of 5, compared with a NNS of 11 obtained from the prevalence of COPD of 8,9% (95% IC 8.2-9.7% ) in Colombia. After the critical evaluation of several questionnaires and studies of PiKo-6®, we selected the instrument developed by Müllernováet al. and the study of Frith et al., respectively. The validated questionnaire had a positive posttest probability of 56% and negative posttest probability of 3%, with NNS of 2. For PiKo-6®, the corresponding values were 44%, 7% and 2, respectively. For early diagnosis, the weighted prevalence from 3 studies was 33.9%, with a NNS with spirometry of 3. \ud \ud Conclusion: For case finding of COPD, the NNS with spirometry is substantially lower than the NNS in the general population. The use of a questionnaire or the performance of PiKo-6® for decreases the NNS to 2 in the case finding group. Making early diagnosis in subjects with risk factor and symptoms is also an appropriate strategy with NNS of 3 for spirometry

Smokers with normal spirometry : impact of computed tomography–detected emphysema, functional mechanisms of dyspnea, and clinical significance of symptoms

Q1Q11085-108

Type 2 inflammation in asthma and other airway diseases

Q2Q2Chronic inflammatory airway diseases, including asthma, chronic rhinosinusitis, eosinophilic COPD and allergic rhinitis are a global health concern. Despite the coexistence of these diseases and their common pathophysiology, they are often managed independently, resulting in poor asthma control, continued symptoms and poor quality of life. Understanding disease pathophysiology is important for best treatment practice, reduced disease burden and improved patient outcomes. The pathophysiology of type 2 inflammation is driven by both the innate immune system triggered by pollutants, viral or fungal infections involving type 2 innate lymphoid cells (ILC2) and the adaptive immune system, triggered by contact with an allergen involving type 2 T-helper (Th2) cells. Both ILC2 and Th2 cells produce the type-2 cytokines (interleukin (IL)-4, IL-5 and IL-13), each with several roles in the inflammation cascade. IL-4 and IL-13 cause B-cell class switching and IgE production, release of proinflammatory mediators, barrier disruption and tissue remodelling. In addition, IL-13 causes goblet-cell hyperplasia and mucus production. All three interleukins are involved in trafficking eosinophils to tissues, producing clinical symptoms characteristic of chronic inflammatory airway diseases. Asthma is a heterogenous disease; therefore, identification of biomarkers and early targeted treatment is critical for patients inadequately managed by inhaled corticosteroids and long-acting β-agonists alone. The Global Initiative for Asthma guidelines recommend add-on biological (anti IgE, IL-5/5R, IL-4R) treatments for those not responding to standard of care. Targeted therapies, including omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab and tezepelumab, were developed on current understanding of the pathophysiology of type 2 inflammation. These therapies offer hope for improved management of type 2 inflammatory airway diseases.https://orcid.org/0000-0001-8405-4513https://scholar.google.es/citations?user=1UDmoyQAAAAJ&hl=esRevista Internacional - IndexadaS