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[Objectives] Chronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised clinical decision support systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care., [Design and eligibility criteria] Systematic review, including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series and controlled before-and-after studies, assessing the effect of CDSS (vs usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischaemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis and osteoporosis) managed in primary care., [Data sources] Medline, Embase, CENTRAL, Scopus, Health Management Information Consortium and trial register clinicaltrials.gov were searched from inception to 24 June 2020., [Data extraction and synthesis] Screening, data extraction and quality assessment were performed by two reviewers independently. The Cochrane risk of bias tool was used for quality appraisal., [Results] From 5430 articles, 8 studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components and outcome measurements and focused on diabetes, asthma, hyperlipidaemia and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies., [Conclusions] There is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics and implementation processes., [PROSPERO registration number] CRD42020218184.

Pseudomonas aeruginosa ( P. aeruginosa ) is a ubiquitous and opportunistic microorganism and is considered one of the most significant pathogens that produce chronic colonization and infection of the lower respiratory tract, especially in people with chronic inflammatory airway diseases such as asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), and bronchiectasis. From a microbiological viewpoint, the presence and persistence of P. aeruginosa over time are characterized by adaptation within the host that precludes any rapid, devastating injury to the host. Moreover, this microorganism usually develops antibiotic resistance, which is accelerated in chronic infections especially in those situations where the frequent use of antimicrobials facilitates the selection of "hypermutator P. aeruginosa strain". This phenomenon has been observed in people with bronchiectasis, CF, and the "exacerbator" COPD phenotype. From a clinical point of view, a chronic bronchial infection of P. aeruginosa has been related to more severity and poor prognosis in people with CF, bronchiectasis, and probably in COPD, but little is known on the effect of this microorganism infection in people with asthma. The relationship between the impact and treatment of P. aeruginosa infection in people with airway diseases emerges as an important future challenge and it is the most important objective of this review.

This article contains information related to the research article entitled "Biomarkers associated with disease severity in allergic and nonallergic asthma" (S. Baos, D. Calzada, L. Cremades, J. Sastre, J. Quiralte, F. Florido, C. Lahoz, B. Cárdaba, In press). Specifically, the clinical criteria stablished for selecting the study population (n=104 subjects) are described. Moreover, this article describes the criteria for selecting the 94 genes to be analyzed in PBMCs (peripheral blood mononuclear cells), it is provided a description of these genes and a Table with the genes most differentially expressed by clinical phenotypes and, finally it is detailed the experimental methodology followed for studying the protein expression of MSR1 (macrophage scavenger receptor 1), one of the genes evaluated in the research. This work was supported in part by research grants PI13/01730 co-supported by FEDER, CIBERES (ISCIII, 0013) and Biobank (PT13/0010/0012) from the Fund for Health Research (Spanish Ministry of Economy and Competitiveness). S. Baos was supported by CIBERES (ISCIII, 0013) and Conchita Rábago Foundation. D. Calzada by Conchita Rábago Foundation, Madrid, Spain. L. Cremades was supported by a contract from MINECO (PEJ-2014-A-31609, Sistema de Garantía Juvenil), cofinanced by European Social Fund (ESF) and Youth Employment Initiative (YEI). Yes

Allergic rhinitis is associated with elevated serum IgE levels. IgE response is mediated by the high-affinity IgE receptor (FcεRI), which is polymorphic. Studies analyzing the association between allergic rhinitis and FcεRI variants have been conducted with controversial results. The objective of this study is to analyze, in 1,041 individuals, the putative clinical association of allergic rhinitis with common polymorphisms in FcεRI subunits genes. These SNPs included FECR1A rs2494262, rs2427837 and rs2251746; FECR1B rs1441586, rs569108 and rs512555; FCER1G rs11587213, rs2070901 and rs11421. Statistically significant differences were observed for the FCER1B rs569108 and rs512555 polymorphisms frequencies when comparing patients with allergic rhinitis without asthma and controls. The OR (95% CI) value for the 237Gly allele (rs569108) is equal to 0.26 (0.08–0.86, P = 0.017) and for the G allele (rs512555) it is equal to 0.27 (0.08–0.88, P = 0.020). These two SNPs are linked (D’ = 1.0, LOD = 56.05). Also observed was a statistically significant trend towards lower IgE values among allergic rhinitis patients with variant alleles for both SNPs. In conclusion, in patients with allergic rhinitis without asthma, the FCER1B rs569108 and rs512555 polymorphisms are associated with increased risk of developing allergic rhinitis and with lower IgE levels.

Journal Article; Research Support, Non-U.S. Gov't; OBJECTIVE We aimed to analyze health-related quality of life (HRQOL) in adults with newly diagnosed respiratory allergy according to the sensitization profile for relevant aeroallergens in their usual area of residence. METHODS We performed a cross-sectional, epidemiological, observational, descriptive, multicenter study in allergy clinics in Spain. The sample comprised adults diagnosed with rhinitis, asthma, or both caused by significant allergens in their residential area (olive and/or grass pollen or house dust mite). Allergic rhinitis was classified according to the Allergic Rhinitis and its Impact on Asthma guidelines; asthma was classified according to the Guía Españiola para el Manejo del Asma (Spanish Guideline on the Management of Asthma). HRQOL was studied according to the ESPRINT-15 questionnaire and Mini Asthma Quality of Life Questionnaire. Control of asthma was measured using the Asthma Control Questionnaire 5. RESULTS We studied 1437 patients. Rhinitis was the most common respiratory disease. The HRQOL of rhinitis patients was lower in those sensitized to olive pollen only and in those with combined sensitization to olive and grass pollens. HRQOL associated with rhinitis was worse in patients diagnosed with both rhinitis and asthma than in patients diagnosed with rhinitis only. Asthma patients sensitized to olive pollen or olive and grass pollens had worse HRQOL. CONCLUSIONS In our study population, the HRQOL of patients with respiratory allergies varied with the allergen responsible for symptoms. In patients with rhinitis, the presence of asthma significantly worsened rhinitis-associated HRQOL. Yes Objetivo: Valorar si la afectación en la calidad de vida relacionada con la salud (CVRS) de los pacientes adultos diagnosticados por primera vez de enfermedad respiratoria alérgica se ve influida por el alérgeno causante. Método: Se realizó un estudio epidemiológico, multicéntrico, transversal, observacional y descriptivo en consultas de Alergología de España.Se incluyeron pacientes adultos diagnosticados de rinitis y/o asma alérgica causados por los alérgenos signifi cativos de su lugar de residencia (polen de olivo y/o gramíneas o ácaros del polvo doméstico). La rinitis alérgica se clasificó según los criterios de la guía ARIA y el asma según la guía GEMA. La CVRS se estudió según los cuestionarios ESPRINT-15 y miniAQLQ. El control del asma se midió utilizando el cuestionario ACQ5. Resultados: Se evaluaron un total de 1.437 pacientes. La rinitis fue la enfermedad respiratoria alérgica más común. La CVRS fue menor en pacientes monosensibilizados al polen de olivo y en los que presentaban polisensibilización a polen de olivo y gramíneas. La CVRS asociada a la rinitis fue menor en pacientes con diagnóstico de rinitis y asma, comparados con los pacientes diagnosticados solo de rinitis. Conclusiones: Los pacientes asmáticos sensibilizados al polen de olivo o a polen de gramíneas y olivo presentaban peor calidad de vida. Los pacientes alérgicos a los pólenes presentan peor calidad de vida que los pacientes alérgicos a los ácaros. La presencia de asma en pacientes con rinitis empeora la CVRS asociada a la rinitis.

Journal Article; Review; Severe asthma is a heterogeneous disease that affects only 5%-10% of asthmatic patients, although it accounts for a significant percentage of the consumption of health care resources. Severe asthma is characterized by the need for treatment with high doses of inhaled corticosteroids and includes several clinical and pathophysiological phenotypes. To a large extent, this heterogeneity restricts characterization of the disease and, in most cases, hinders the selection of appropriate treatment. In recent years, therefore, emphasis has been placed on improving our understanding of the various phenotypes of severe asthma and the identification of biomarkers for each of these phenotypes. Likewise, the concept of the endotype has been gaining acceptance with regard to the various subtypes of the disease, which are classified according to their unique functional or pathophysiological mechanism. This review discusses the most relevant aspects of the clinical and inflammatory phenotypes of severe asthma, including severe childhood asthma and the various endotypes of severe asthma. The main therapeutic options available for patients with uncontrolled severe asthma will also be reviewed. Yes El asma grave es una enfermedad heterogénea que constituye entre un 5-10% de los sujetos asmáticos, pero representan un porcentaje significativo del consumo de los recursos sanitarios. El asma grave se caracteriza por precisar tratamiento con altas dosis de corticosteroides, e incluye diversos fenotipos tanto clínicos como fisiopatológicos. Esta heterogeneidad dificulta en gran medida la caracterización de la enfermedad, y en la mayoría de los casos también la elección del tratamiento adecuado. Por esta razón, en los últimos años se ha hecho hincapié en la mejora en el conocimiento de los distintos fenotipos del asma grave, y en la identificación de biomarcadores para cada uno de ellos. Así mismo, también ha tomado fuerza el concepto de endotipo en referencia a los distintos subtipos de la enfermedad divididos en base a su mecanismo funcional o fisiopatológico único. En esta revisión serán discutidos los aspectos más relevantes de los fenotipos clínicos e inflamatorios del asma grave, incluyendo el asma grave infantil y los diferentes endotipos del asma grave serán discutidos en este capítulo. Así mismo, se revisan las principales opciones terapéuticas disponibles en este grupo de pacientes serán revisadas.

Boletín semanal para profesionales sanitarios de la Secretaría General de Salud Pública y Participación Social de la Consejería de Salud Yes Con la llegada de la primavera vuelven las alergias, sobre todo, al polen del olivo. En Andalucía se desarrollan diversas estrategias para afrontar los problemas causados por esta intensa polinización, como el Programa Aire destinado mejorar la atención a pacientes asmáticos graves durante el periodo primaveral. El Programa Aire, desarrollado por la Consejería de Salud a través de la Empresa Pública de Emergencias Sanitarias (EPES) y el Plan Andaluz de Urgencias y Emergencias, recoge una serie de datos mínimos aportados de forma previa y voluntaria por pacientes asmáticos graves o con episodios de shock anafiláctico. En caso de sufrir una crisis de ahogo, la persona afectada o sus familiares deben contactar con el 061 o con el teléfono de Urgencias Sanitarias (902 505 061), e indicar que posee la Tarjeta Aire, que identifica la pertenencia al programa.

Journal Article; Research Support, Non-U.S. Gov't; BACKGROUND Neutrophil defensins, originally identified as broad-spectrum antimicrobial peptides, have been implicated in the regulation of inflammatory and immunological processes. OBJECTIVES To investigate whether the in vitro challenge of neutrophils from patients with bronchial asthma with allergens stimulated the release of alpha-defensins and whether levels released were dependent on lung infections. METHOD The neutrophils were cultivated with different agonists and the concentration of alpha-defensin in cell-free supernatant was measured with enzyme-linked immunosorbent assay (ELISA). RESULTS Neutrophils from allergic patients released alpha-defensins via an allergen-dependent mechanism. Our results indicate that the in vitro activation of neutrophils is highly allergen-specific. In this context, allergens other than those which produced clinical symptoms did not elicit alpha-defensin release, and allergens had no effect on neutrophils from healthy donors. However, neutrophils from both allergic patients and healthy controls were able to release alpha-defensins upon treatment with PMA. In the allergen-stimulated neutrophils, cells from asthmatic patients stimulated with a sensitizing allergen showed a significantly higher production of alpha-defensin under respiratory tract infection than cells from the same patients without such an infection. CONCLUSION Neutrophils from allergic patients release alpha-defensins via an allergen-dependent mechanism. Yes

Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Validation Studies; BACKGROUND Pollen is one of the main causes of allergic sensitization. It is not easy to make an etiological diagnosis of pollen-allergic patients because of the wide variety of sensitizing pollens, association with food allergy, and increasing incidence of polysensitization, which may result from the presence of allergens that are common to different species, as is the case of panallergens. OBJECTIVE To compare the results of skin prick tests (SPT) using whole pollen extract with specific immunoglobulin (Ig) E determination for several allergens (purified panallergens included) in the diagnosis of polysensitized pollen-allergic patients. METHODS The study sample comprised 179 pollen-sensitized patients who underwent SPT with pollen extract and allergen-specific IgE determination against different allergens. RESULTS The level of concordance between the traditional diagnostic test (SPT) and IgE determination was low, especially in patients sensitized to the panallergens profilin and polcalcin. In the case of SPT, the results demonstrated that patients who are sensitized to either of these panallergens present a significantly higher number of positive results than patients who are not. However, IgE determination revealed that while patients sensitized to polcalcins are sensitized to allergens from a higher number of pollens than the rest of the sample, this is not the case in patients sensitized to profilins. On the other hand, sensitization to profilin or lipid transfer proteins was clearly associated with food allergy. CONCLUSIONS Sensitization to panallergens could be a confounding factor in the diagnosis of polysensitized pollen-allergic patients as well as a marker for food allergy. However, more studies are required to further investigate the role of these molecules. Yes RESUMEN:Introducción: el polen es una de las principales causas de sensibilización alérgica. No es fácil a veces hacer un diagnóstico etiológico de los pacientes polínicos debido a la gran variedad de pólenes alergénicos, asociaciones con alergias a alimentos, y al incremento de la polisensibilización. Éste último factor parece deberse fundamentalmente a la existencia de alérgenos comunes en diferentes especies, como es el caso de los panalérgenos. Objetivos: comparar los resultados de los test cutáneos intraepidérmicos usando extractos completos de pólenes con la determinación de IgE específica a diferentes alérgenos (incluido panalérgenos purifi cados) en el diagnóstico de pacientes alérgicos polisensibilizados a pólenes. Métodos: se incluyeron 179 pacientes sensibilizados a pólenes. Se les realizó test cutáneos con extractos de pólenes y se determinó la IgE específi ca frente a diferentes alérgenos. Resultados: el nivel de concordancia entre el test diagnóstico tradicional y el diagnóstico molecular fue bajo, especialmente en pacientes sensibilizados a profilina y polcalcina. En el caso de las pruebas cutáneas, los resultados demostraron que los pacientes que estaban sensibilizados a alguno de esos panalérgenos presentaban un número signifi cativamente mayor de resultados positivos que los pacientes no sensibilizados a panalérgenos. Sin embargo, en la determinación de IgE específi ca a alérgenos, se observó que mientras los pacientes sensibilizados a polcalcina estaban sensibilizados a alérgenos de un mayor número de pólenes que el resto de la muestra, esto no ocurría con los sensibilizados a profilinas. Por otro lado, la sensibilización a profi lina o LTP se asoció claramente con alergia alimentaria. Conclusiones: la sensibilización a panalérgenos podría ser un factor de confusión en el diagnóstico de los pacientes polínicos polisensibilizados, así como un marcador de alergia a alimentos. En cualquier caso, se requieren más estudios para investigar más a fondo el papel de estas moléculas