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Asthma is a complex condition resulting from the interaction of genes and environment. Obesity is a risk factor to develop asthma and contributes to poor response to asthma therapy and severity. The aim of the study was to evaluate the effect of obesity on the expression levels of genes previously associated with severe asthma. Three groups of subjects were studied: non-obese asthmatics (NOA), obese asthma patients (OA), and non-asthmatic obese subjects (O). Previously reported overexpressed (IL-10, MSR1, PHLDA1, SERPINB2, and CD86) and underexpressed genes (CHI3L1, CPA3, IL-8, and PI3) in severe asthma were analyzed by RT-qPCR in peripheral blood mononuclear cells (PBMCs). In the overexpressed genes, obesity significantly decreased the expression of MSR1 and PHLDA1 and had no effects on CD86, IL-10, and SERPINB2. In underexpressed genes, obesity did not affect PI3, CHI3L1, and IL-8 and significantly reduced CPA3 expression. The results of this study show that obesity should be included among the known factors that can contribute toward modifying the expression of genes associated with asthma and, in particular, severe asthma.

Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a relapsing disease with frequent glucocorticoid dependence. Mepolizumab has been demonstrated to reduce flares and spare glucocorticoids (GC). However, EGPA is a heterogeneous condition and the effects of mepolizumab on specific disease manifestations has not been completely delimitated. Objectives To analyse the impact of mepolizumab on manifestations derived from small-vessel vasculitis, ENT (ear, nose and throat) symptoms, asthma, eosinophilic tissue infiltration and anti-neutrophil cytoplasmic antibody (ANCA) status in a single-centre cohort of EGPA patients. Methods Medical charts of EGPA patients treated with mepolizumab were retrospectively reviewed by the authors to describe demographics, clinical characteristics, steroid dose at the initiation of mepolizumab and during follow-up, flares, disease activity, damage accrual and laboratory results. Results and conclusions Among 56 patients with EGPA regularly controlled at our department, 11 patients were treated with mepolizumab because of corticodependence and unsatisfactory disease control. The mean time of treatment was 38 months (range: 3-66 months). Patients with persistent symptoms improved their asthma control, but 3 of them persisted with recurrent ENT symptoms in spite of treatment with mepolizumab. None of the patients developed vasculitic manifestations (cutaneous, neurological, gastrointestinal, renal) during treatment. All patients achieved a Birmingham Vasculitis Activity Score (BVAS) of 0 points at 12 months or earlier. In general, patients reduced the number of flares, which tended to be milder, and all related to asthma or ENT manifestations. The improvement in disease activity allowed notable glucocorticoid tapering.

Purpose Chronic cough (cough that persists for ≥ 8 weeks) can cause a range of physical symptoms and psychosocial effects that significantly impair patients’ quality of life. Refractory chronic cough (RCC) and unexplained chronic cough (UCC) are challenging to diagnose and manage, with substantial economic implications for healthcare systems. Methods This retrospective multicenter non-interventional study aimed to characterize the profile and health resource consumption of patients with RCC or UCC who attended outpatient clinics at Spanish hospitals. Data were collected from medical records of patients with RCC or UCC for up to 3 years before study inclusion. Results The patient cohort (n = 196) was representative of the chronic cough population (77.6% female, mean age 58.5 years). Two-thirds of patients (n = 126) had RCC. The most frequently visited doctors were pulmonologists (93.4% of patients) and primary care physicians (78.6%), with a mean of 5 visits per patient over three years’ observation. The most common diagnostic tests were chest x-ray (83.7%) and spirometry with bronchodilation (77.0%). The most commonly prescribed treatments were proton pump inhibitors (79.6%) and respiratory medications (87.8%). Antibiotics were prescribed empirically to 56 (28.6%) patients. Differences between RCC or UCC groups related mainly to approaches used to manage cough-associated conditions (gastroesophageal reflux disease, asthma) in patients with RCC. Conclusion RCC and UCC are responsible for high health resource utilization in Spanish hospitals. Specific treatments targeting the pathological processes driving chronic cough may provide opportunities to reduce the associated burden for patients and healthcare systems.

Obesity and asthma are associated with systemic inflammation maintained by mediators released by adipose tissue and lung. This study investigated the inflammatory serum mediator profile in obese subjects (O) (n = 35), non-obese asthma (NOA) patients (n = 14), obese asthmatics (OA) (n = 21) and healthy controls (HC) (n = 33). The effect of weight loss after bariatric surgery (BS) was examined in 10 OA and 31 O subjects. We analyzed serum markers including leptin, adiponectin, TGF-β1, TNFR2, MCP-1, ezrin, YKL-40, ST2, IL-5, IL-9, and IL-18. Compared with HC subjects, the O group showed increased levels of leptin, TGF-β1, TNFR2, MCP-1, ezrin, YKL-40, and ST2; the OA group presented increased levels of MCP-1, ezrin, YKL-40, and IL-18, and the NOA group had increased levels of ezrin, YKL-40, IL-5, and IL-18. The higher adiponectin/leptin ratio in NOA with respect to OA subjects was the only significant difference between the two groups. IL-9 was the only cytokine with significantly higher levels in OA with respect to O subjects. TNFR2, ezrin, MCP-1, and IL-18 concentrations significantly decreased in O subjects after BS. O, OA, and NOA showed distinct patterns of systemic inflammation. Leptin and adiponectin are regulated in asthma by obesity-dependent and -independent mechanisms. Combination of asthma and obesity does not result in significant additive effects on circulating cytokine levels.

OBJECTIVE: To develop a set of recommendations for the management of severe asthma during COVID-19 pandemic. METHODS: Eleven pneumologists and allergologists who were staff members of officially accredited asthma units in Catalonia (Spain) participated in a cross-section study based on three 2-hour virtual workshops (first: brainstorming, second: identification of impacts and challenges summarized in 10 topics, third: establishment of final recommendations by consensus). RESULTS: Impacts and challenges identified were improvement of referral protocols between different levels of care; assessment of the minimum number of function tests to be performed and promote the performance of spirometry in primary care; implementation of videoconferencing, mobile apps, telephone calls, or integral virtual platforms for the follow-up of patients, and definition of the model of care (face-to-face, telematics, mixed) according to the patient's individual needs; self-administration of biologics for domiciliary treatment; and empowerment of the role of nursing and hospital pharmacy in particular for follow-up and self-administration of biologics. The main recommendations included coordination between primary care and specialized care consultation, optimization of lung function testing, implementation of telemedicine, and the role of nursing and hospital pharmacy. CONCLUSION: The specific proposals in response to the effect of COVID-19 pandemic focused on four areas of interest (coordination between primary care and specialized care, optimization of lung function testing, implementation of telemedicine, and empowerment of the role of nursing and hospital pharmacy) may be generalized to other health care settings, and help to introduce new ways of caring asthma patients in the COVID-19 context.

Background. Chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by partial (hyposmia) or total (anosmia) loss of smell, is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), worsens disease severity and quality of life. The objective of this study was to determine whether, in real-life conditions, biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare smell improvement in N-ERD and non-N-ERD subgroups. Methods. A multicenter, non-interventional, retrospective, observational study was performed, including 206 patients with severe asthma undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab) with CRSwNP. Results. Improved olfaction was found after treatment with all monoclonal antibodies: omalizumab (35.8%), mepolizumab (35.4%), reslizumab (35.7%), and benralizumab (39.1%), with no differences between groups. Patients with atopy, greater use of short course systemic corticosteroids, and larger polyp size were more likely to experience improvement in smell. The proportion of patients experiencing smell improvement was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups. Conclusions. This is the first study to compare real-life improvement in sense of smell among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in sense of smell (with non-significant differences between biologic drugs). No differences were found in smell improvement between the N-ERD and non-N-ERD group.

Background: Selective IgE deficiency (SIgED) has been previously evaluated in selected patients from allergy units. This study investigates the effects of SIgED on the entire population in a hospital setting and sought to delineate in detail the clinical aspects of SIgED. Methods: A retrospective study of the data obtained from electronic medical records of 52 adult patients (56% female) with a mean age of 43 years and IgE levels of &lt, 2.0 kU/L with normal immunoglobulin (Ig) IgG, IgA, and IgM levels, seen at our hospital, without selection bias, from 2010 to 2019. Results: Recurrent upper respiratory infections were recorded in 18 (34.6%) patients, pneumonia was recorded in 16 (30.7%) patients, bronchiectasis was recorded in 16 (30.7%) patients, and asthma was recorded in 10 (19.2%) patients. Eighteen patients (34.6%) suffered autoimmune clinical manifestations either isolated (19%) or combining two or more diseases (15%), Hashimoto’s thyroiditis being the most frequent (19%), which was followed by arthritis (10%) and thrombocytopenia and/or neutropenia (5.7%). Other less frequent associations were Graves’ disease, primary sclerosing cholangitis, Sjögren’s syndrome, and autoimmune hepatitis. Eczematous dermatitis (15.3%), chronic spontaneous urticaria (17.3%), and symptoms of enteropathy (21%) were also highly prevalent. Thirty percent of patients developed malignancies, with non-Hodgkin lymphomas (13.4%) being the most prevalent. Conclusions: The clinical manifestations of SIgED encompass a variety of infectious, non-infectious complications, and malignancy. Since it cannot be ruled out that some type of selection bias occurred in the routine assessment of IgE serum Ievels, prospective studies are required to better characterize SIgED and to determine whether it should be added to the list of antibody deficiencies.

There is growing evidence that events occurring early in life, both before and after birth, are significantly associated with the risk of asthma, chronic obstructive pulmonary disease, and diminished lung function later in life. In fact, from conception to death, a series of continuous, dynamic gene-environment interactions determine 2 fundamental biological processes, namely, lung development and lung aging. Over 130 birth cohorts have been initiated in the last 30 years. Data from these cohorts have improved our understanding of the inception, progression, and persistency of asthma. In this review, we summarize the main data for the early life events proven to determine later development and persistence of asthma, such as maternal atopy and smoking, preterm birth/bronchopulmonary dysplasia, infections, nutrition, obesity, smoking, and other environmental exposures in childhood and adolescence. While some of these factors are obviously impossible to prevent or eliminate, others have been proven to have a protective role, and current research is aimed optimizing them. Available prophylactic measures are also reviewed. In the case of environmental pollution, large scale political interventions successfully managed to decrease contamination levels, leading to improved lung function and lower asthma prevalence in the respective geographical areas. Future research should focus on better understanding these complex interactions in order to develop and enhance effective preventive therapeutic measures.

Case Reports

[No abstract available]

Obesity increases the risk of developing asthma in children and adults. Obesity is associated with different effects on lung function in children and adults. In adults, obesity has been associated with reduced lung function resulting from a relatively small effect on forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), with the FEV1/FVC ratio remaining unchanged or mildly increased (restrictive pattern). In contrast, in children, obesity is associated with normal or higher FEV1 and FVC but a lower FEV1/FVC ratio (obstructive pattern). This anomaly has recently been associated with a phenomenon known as dysanapsis which results from a disproportionate growth between lung parenchyma size and airway calibre. The mechanisms that promote disproportionate lung parenchyma growth compared with airways in obese children remain to be elucidated. Obesity and dysanapsis in asthma patients might contribute to asthma morbidity by increasing airway obstruction, airway hyper-reactivity and airway inflammation. Obesity and dysanapsis in asthma patients are associated with increased medication use, more emergency department visits, hospitalizations and systemic corticosteroid burst than patients with normal weight. Dysanapsis may explain the reduced response to asthma medications in obese children. Weight loss results in a significant improvement in lung function, airway reactivity and asthma control. Whether these improvements are associated with the changes in the dysanaptic alteration is as yet unclear.

The general aim of this study is to create a cohort of asthma patients with varying grades of severity in order to gain greater insight into the mechanisms underlying the genesis and course of this disease. The specific objectives focus on various studies, including imaging, lung function, inflammation, and bronchial hyperresponsiveness, to determine the relevant events that characterize the asthma population, the long-term parameters that can determine changes in the severity of patients, and the treatments that influence disease progression. The study will also seek to identify the causes of exacerbations and how this affects the course of the disease. Patients will be contacted via the outpatient clinics of the 8 participating institutions under the auspices of the Spanish Respiratory Diseases Networking System (CIBER). In the inclusion visit, a standardized clinical history will be obtained, a clinical examination, including blood pressure, body mass index, complete respiratory function tests, and FENO will be performed, and the Asthma Control Test (ACT), Morisky-Green test, Asthma Quality of Life Questionnaire (Mini AQLQ), the Sino-Nasal Outcome Test 22 (SNOT-22), and the Hospital Anxiety and Depression scale (HADS) will be administered. A specific electronic database has been designed for data collection. Exhaled breath condensate, urine and blood samples will also be collected. Non-specific bronchial hyperresponsiveness testing with methacholine will be performed and an induced sputum sample will be collected at the beginning of the study and every 24 months. A skin prick test for airborne allergens and a chest CT will be performed at the beginning of the study and repeated every 5 years.

Background: The diagnosis of hypersensitivity pneumonitis (HP) onset after fungal antigens inhalation at home can be challenging. Although an early identification of the inhaled antigen and its complete avoidance are recommended, current strategies for identifying the causal antigen are controversial. Objective: To determine the usefulness of this diagnostic strategy in detecting potentially causative fungal agents in the patient’s home environment. Methods: We selected 8 patients with a multidisciplinary diagnosis of HP in our Interstitial Lung Disease Program at a tertiary referral center. All patients had their serum tested against the standard HP screening antigen panel with a positive antibody response, but without an identified antigen based on patient interviews. A standardized environmental sampling took place at each patient’s home. Results: Up to 64 air and swabs samples (median=40; Interquartile range=17) were collected from each patient’s environment. High numbers of colony-forming units (CFU) (more than 100 CFU/plate or more than 100 CFU/ml) of different species of fungi were identificated in each patient’s home. The most prevalent species were Penicillium spp and Cladosporium herbarum. All the individuals had a positive response on the standard antigens panel to more than 1 antigen from the environmental sample. After identifying the possible causative factor, an exhaustive cleaning and remediation of the affected areas were made. Conclusion: An indoor environmental study may be crucial to avoid the continuation of unrecognized exposure to the causative fungal antigen. This might contribute to the correct diagnosis and appropriate management of patients with HP.

Asthma and obesity are two epidemics affecting the developed world. The relationship between obesity and both asthma and severe asthma appears to be weight-dependent, causal, partly genetic, and probably bidirectional. There are two distinct phenotypes: 1. Allergic asthma in children with obesity, which worsens a pre-existing asthma, and 2. An often non allergic, late-onset asthma developing as a consequence of obesity. In obesity, infiltration of adipose tissue by macrophages M1, together with an increased expression of multiple mediators that amplify and propagate inflammation, is considered as the culprit of obesity-related inflammation. Adipose tissue is an important source of adipokines, such as pro-inflammatory leptin, produced in excess in obesity, and adiponectin with anti-inflammatory effects with reduced synthesis. The inflammatory process also involves the synthesis of pro-inflammatory cytokines such as IL-1β, IL-6, TNFα, and TGFβ, which also contribute to asthma pathogenesis. In contrast, asthma pro-inflammatory cytokines such as IL-4, IL-5, IL-13, and IL-33 contribute to maintain the lean state. The resulting regulatory effects of the immunomodulatory pathways underlying both diseases have been hypothesized to be one of the mechanisms by which obesity increases asthma risk and severity. Reduction of weight by diet, exercise, or bariatric surgery reduces inflammatory activity and improves asthma and lung function.

Background Some patients with COPD report frequent acute exacerbations (AECOPD) of the disease (FE), whereas others suffer them infrequently (IE). Because the current diagnosis of exacerbation relies on patient9s perception of increased symptoms (mostly dyspnoea), we hypothesised that dyspnoea perception might be different in COPD patients with FE (≥2 exacerbations or 1 hospitalisation due to AECOPD in the previous year) or IE (≤1 exacerbation in the previous year), AECOPD being defined by the institution antibiotics and/or steroids treatment, or hospital admission. Objective To test the hypothesis that dyspnoea perception is increased in FE and/or decreased in IE with COPD. Methods We compared the perception of dyspnoea (Borg scale), mouth occlusion pressure 0.1 s after the onset of inspiration (P 0.1 ) and ventilatory response to hypercapnia (ΔV E /ΔP ET CO 2 ) in 34 clinically stable COPD patients with FE (n=14) or IE (n=20), with similar age, gender, body mass index and degree of airflow limitation. As a reference, we studied a group of age-matched healthy volunteers (n=10) with normal spirometry. Results At rest, P 0.1 was higher in FE than IE and controls (p Conclusions Dyspnoea perception during CO 2 rebreathing is enhanced in FE and blunted in IE. These differences may contribute to the differential rate of reported exacerbations in FE and IE. Trial registration number NCT02113839.

Our goal was to assess the accuracy of measuring cardiac output (CO) by the FloTrac/Vigileo (CO(V)) device in comparison with thermodilution technique through pulmonary artery catheterization (PAC(TD)) in morbidly obese patients.Cardiac output in 8 morbidly obese patients was assessed twice at upright and lying position breathing ambient air. At least 4 consecutive CO measurements with 10 mL of ice-cold saline injections were performed each time. Simultaneous CO measurements were recorded with both single-bolus thermodilution and CO(V).One hundred thirty-two CO data pairs were collected. The overall mean single-bolus thermodilution 6.2 ± 1.1 L/min was lower than the overall mean CO(V) 7.8 ± 1.6 L/min (P.001). Lin concordance coefficient indicated that overall agreement between PAC(TD) and CO(V) was poor, 0.29. Lin concordance coefficient in sitting position was 0.29, 95% confidence interval (0.17-0.40) and in lying position was 0.30, 95% confidence interval (0.15-0.44). The Bland-Altman plot analysis showed systematically higher values from CO(V) in comparison with PAC(TD). These differences increased in presence of high CO measurements. In 3 of 8 patients, the percentage error was lower than 20%, whereas in the other 5, it was higher than 20%. Of these 5, in 2 cases, the percentage error was greater than 50%.Data obtained using CO(V) vs PAC(TD) measurements showed poor correlation. The results were not interchangeable.

BACKGROUND:Obesity is a global and growing public health problem. Bariatric surgery (BS) is indicated in patients with morbid obesity. To our knowledge, the effects of morbid obesity and BS on ventilation/perfusion ( V.a/ Q.) ratio distributions using the multiple inert gas elimination technique have never before been explored. METHODS:We compared respiratory and inert gas ( V.a/ Q.ratio distributions) pulmonary gas exchange, breathing both ambient air and 100% oxygen, in 19 morbidly obese women (BMI, 45 kg/m2), both before and 1 year after BS, and in eight normal-weight, never smoker, age-matched, healthy women. RESULTS:Before BS, morbidly obese individuals had reduced arterial Po2(76 ± 2 mm Hg) and an increased alveolar-arterial Po2difference (27 ± 2 mm Hg) caused by small amounts of shunt (4.3% ± 1.1% of cardiac output), along with abnormally broadly unimodal blood flow dispersion (0.83 ± 0.06). During 100% oxygen breathing, shunt increased twofold in parallel with a reduction of blood flow to low V.a/ Q.units, suggesting the development of reabsorption atelectasis without reversion of hypoxic pulmonary vasoconstriction. After BS, body weight was reduced significantly (BMI, 31 kg/m2), and pulmonary gas exchange abnormalities were decreased. CONCLUSIONS:Morbid obesity is associated with mild to moderate shunt and V.a/ Q.imbalance. These abnormalities are reduced after BS.

Background The relationship between airway hyperresponsiveness (AHR) and obesity, a low-grade systemic inflammatory condition, remains largely unknown. It is established that AHR to indirect stimuli is associated with active airway inflammation. The objectives were to investigate the rate of AHR to mannitol in obese subjects and its changes 1 year after bariatric surgery (BS). Methods We enrolled 58 candidates to BS severely obese (33 nonsmokers and 25 smokers) without history of asthma and 20 healthy, nonobese participants and related AHR to functional findings and serum and exhaled biomarkers. Results Before surgery, AHR was observed in 16 (28 %) obese with the provocation doses of mannitol to induce a 15 % fall in FEV1 (PD15) of (geometric mean [95 % CI]) 83 (24–145) mg. Compared to control participants, obese participants had lower spirometric values and higher serum and exhaled biomarkers (p

The general aim of this study is to create a cohort of asthma patients with varying grades of severity in order to gain greater insight into the mechanisms underlying the genesis and course of this disease. The specific objectives focus on various studies, including imaging, lung function, inflammation, and bronchial hyperresponsiveness, to determine the relevant events that characterize the asthma population, the long-term parameters that can determine changes in the severity of patients, and the treatments that influence disease progression. The study will also seek to identify the causes of exacerbations and how this affects the course of the disease. Patients will be contacted via the outpatient clinics of the 8 participating institutions under the auspices of the Spanish Respiratory Diseases Networking System (CIBER). In the inclusion visit, a standardized clinical history will be obtained, a clinical examination, including blood pressure, body mass index, complete respiratory function tests, and FENO will be performed, and the Asthma Control Test (ACT), Morisky-Green test, Asthma Quality of Life Questionnaire (Mini AQLQ), the Sino-Nasal Outcome Test 22 (SNOT-22), and the Hospital Anxiety and Depression scale (HADS) will be administered. A specific electronic database has been designed for data collection. Exhaled breath condensate, urine and blood samples will also be collected. Non-specific bronchial hyperresponsiveness testing with methacholine will be performed and an induced sputum sample will be collected at the beginning of the study and every 24 months. A skin prick test for airborne allergens and a chest CT will be performed at the beginning of the study and repeated every 5 years.

Introduction: The general objective of the study is to create a cohort of patients with asthma, in order to broaden our understanding of this pathology. Specific objectives: 1) To establish a common methodology for recruiting a cohort of asthmatic patients; 2) To describe the baseline characteristics of the study population. Method: Patients were collected from the outpatient units of seven participating institutions. A standardized medical history, clinical examination and lung function study were performed and the Mini AQLQ, ACT, and Snott-22 questionnaires were administered. For the collection of the data a specific electronic database was designed. Results: To date, 166 patients have been recruited. Asthma was intermittent/mild in 26 patients, moderate in 71 and severe in 69. Patients with severe asthma consumed more systemic corticosteroids, LABA, LAMA, montelukast and omalizumab (p Conclusions: The common methodology developed seems to be useful for patient recruitment. Patients with severe asthma present higher levels of bronchiectasis. PC20 values were lower in patients with intermittent/mild and moderate asthma. Funded: Fis PI15/01900, CIBER, FEDER, SANOFI

Rationale: Along with reduced gas lung volumes, pulmonary gas exchange in severe obesity could be altered by inflammation and direct effects of perivascular adipose tissue (PVAT) in the pulmonary vasculature. Since both effects could be reflected by elevatedlung tissue volume( Vtiss ), we asked whether Vtiss was reduced by bariatric surgery (BS). Methods: Using densitometry on HRCT scans, we estimated Vtiss in 12 severe obese women before and one year after BS. These findings were compared to those of 8 lean healthy women, age-matched. Vtiss was defined as the total volume of the lung not occupied by air or large bronchi and vessels. For comparisons between subjects, Vtiss was standardized by the subject9s body height. Serum inflammatory markers were also measured. Results: Pre-operatively, as compared with controls, Vtiss , body mass index (BMI) and serum biomarkers (serum C-reactive protein, fibrinogen and leptin) were all increased and were significantly diminished after BS. Vtiss was systematically reduced (by 9%) without affecting other CT lung volumes. No relationship was observed between BS-induced changes in Vtiss and those in pulmonary vessel area. Conclusions: Vtiss is increased in obese compared to lean individuals and decreased systematically by BS. These effects do not appear to be related to changes in the area of blood vessels. Instead, they could be consistent with a potential elevation of extra-vascular lung water, due to low-grade inflammation and/or hypertrophic PVAT in pulmonary small vessels and/or capillary.

Introduction: Omalizumab (OMA) is a monoclonal antibody that binds to immunoglobulin (Ig) E prescribed for severe asthma. Treatment time is unknown, however an hypothesis postulates that 6 years could stabilize the disease. Methods: we described clinical behavior and changes in total (ImmunoCAP, ThermoFisher) and free IgE (Biotez Recovery ELISA) in 22 asthmatics patients at 6 months after 6 years of OMA treatment. Results: 54% (n, 12) remained with well controlled asthma 6 months after stopping OMA treatment (Group A, Success) and 46% (n, 10) worsened (Group B, Relapsed). In all of the patients, total IgE at the beginning of the treatment was (median) 119.5 (interquartile range [74.5-295]) kU/L and significantly increased after 6 years of OMA treatment (373.5 [203.5-795] kU/L) (p Conclusion: Approximately 50% of patients maintained a good clinical asthma control at 6 months after 6 years of OMA treatment. Total and free IgE at the beginning and at the end of treatment of group A (Success) were significantly lower than those of group B (Relapsed). This finding suggests that when the inhibitory effect of OMA on IgE is stronger and persists after discontinuation of treatment, clinical stability remains. Supported by SEPAR “RESPIRA”No 142/2012.

Bariatric surgery (BS) in severely obese subjects causes a significant reduction of body weight with lung function improvement. We have shown that abnormalities in pulmonary gas exchange in morbidly obese subjects are substantially improved with BS. These abnormalities were thought to be related to reduced lung volumes as well as to abnormal endothelial function induced by low-grade chronic inflammation linked to perivascular adipose tissue (PVAT). In this study, we used computed tomography (CT) to assess whether BS also caused measurable structural changes in the lung tissue volume (Vtiss) and cross-sectional vessel analysis, hypothesizing that these measures could be related to the previously reported lung functional changes. This is a post hoc analysis of a previous reported prospective study. Pulmonary vessels and lung volumes, including Vtiss, were quantified in thoracic CT scans. We compared findings in 12 obese women before and after BS and in 8 healthy lean women. Vtiss was significantly elevated in obese subjects before BS compared to control subjects and systematically reduced after BS (by 8 %); other CT lung volumes or vascular areas were not affected in a consistent manner. No relationship was observed between BS-induced individual changes in Vtiss and pulmonary vessel area. Vtiss is elevated in morbidly obese subjects, compared to lean individuals of similar body height, and is systematically reduced by BS. These effects do not appear related to vascular changes but may be caused by elevated extravascular lung water, due to low-grade inflammation, and/or hypertrophic PVAT in severe obesity.

Background: Breathlessness perception varies significantly among patients with chronic obstructive pulmonary disease (COPD). Some of them are prone to frequent exacerbations. Aims and objectives: We hypothesized that COPD patients with higher dyspnea perception report more exacerbations than those with unfrequent exacerbations, independently of their severity of airflow limitation. Accordingly, our aim was to compare the perception of dyspnea in clinically stable COPD patients with a history of frequent (≥1/hospitalization/year) or unfrequent (≤1/year/without hospitalization) exacerbations. Methods: We measured the resting mouth occlusion pressure (P 01 ), the ventilatory response (ΔVE/ΔPetCO2), and the dyspnea perception using the Borg scale during a hyperoxic CO 2 -rebreathing test. Results: We evaluated 34 COPD patients (29 males, 65±9 years), 14 (41%) with frequent exacerbations and 20 (59%) without them, and 10 healthy controls (8 males, 63±6 years). Table shows the main results. Conclusions: Results support our working hypothesis and show that frequent exacerbators have a different symptom perception than unfrequent ones, which could be related to the increased central output.

Rationale and objectives: The impact of severe obesity on transfer factor of the lung for carbon monoxide (TL CO ) remains uncertain. We hypothesized that, in addition to the potential intrinsic effects of obesity on lung function, morbidly obese subjects may require specific TL CO reference values. To this end, TL CO was measured in obese subjects before and after bariatric surgery (BS) and adjustment of the data to reported TL CO reference values was assessed. Methods: We explored 220 morbidly obese subjects (BMI ≥40 kg/m 2 ) before BS and 129 of them were studied one year after BS. The Lin9s concordance coefficient (LCC) (1) was used to assess adjustment between TL CO measurements and the corresponding predicted values derived from different sets of reference equations. Results: TL CO measurements significantly increased after BS (p 2 ) which markedly increased LCC (0.74, from 0.67-0.79). Conclusions: The results indicate that obesity has a significant negative impact on TL CO. Moreover, current reference equations are not adequate for lung function assessment of these subjects. The new TL CO reference equations herein developed may contribute to enhance evaluation of morbidly obese subjects. References: 1) Lin LI. A note on the concordance correlation coefficient. Biometrics 2000; 56:324-325.

We hypothesized that in morbid obesity, pulmonary gas exchange abnormalities will worsen when supine and that bariatric surgery (BS) will mitigate this effect.Gas exchange was investigated in 19 morbidly obese and 8 non-obese, age-matched control females, spontaneously breathing ambient air, both upright and supine, before and one year after BS.In control non-obese individuals, no postural changes in arterial blood gases (ABGs) were observed. While obese subjects had more altered PaO2, SaO2 and AaPO2 values than controls (P0.05 each) when upright, the values unexpectedly remained unchanged when supine. This was also the case in the subset of 6 normoxemic obese but the remaining 13 hypoxemic individuals actually improved ABGs when supine: PaO2 (by +2.7±1.3 mmHg, P=0.06), SaO2 (by +1.5±0.6%), pH (by +0.01±0.01) and AaPO2 (by -3.4±1.4 mmHg); and cardiac output increased (by +0.4±0.2 L·min-1) (P0.05 each). After BS, PaO2 (from 75.5±2.4 to 89.4±2.4 mmHg), AaPO2 (from 27.0±2.0 to 15.4±2.1 mmHg) (P0.05 each), and pulmonary gas exchange were improved compared to before BS when upright, but ABGs worsened when supine (PaO2, by -4.6±1.7 mmHg; AaPO2, by +4.2±1.6 mmHg) (P0.05 each).Before BS, ABGs are not altered in normoxemic obese subjects moving from upright to supine, even improving in those with hypoxemia when supine. After successful BS, pulmonary gas exchange improved when upright in all subjects but ABGs deteriorated when supine. However, the important clinical observation is the lack of gas exchange deterioration when supine, which may have implications for critical care and anesthesia settings.

Segun la actualizacion de 2014 de Global Initiative for Obstructive Lung Disease (GOLD), el tratamiento farmacologico de la enfermedad pulmonar obstructiva cronica (EPOC) estable se utiliza para reducir sintomas, mejorar la salud general del paciente y fomentar la tolerancia al ejercicio, a la vez que se reduce la frecuencia y la gravedad de las exacerbaciones1. En este contexto, los broncodilatadores de accion prolongada son fundamentales para tratar los sintomas de la EPOC. La curva dosis-respuesta y la seguridad a largo plazo de los corticoesteroides inhalados (CI) para la EPOC no se conocen y sus efectos en la inflamacion pulmonar y sistemica siguen siendo controvertidos. En este sentido, el National Institute of Clinical Excellence (NICE) afirma que ninguno de los CI disponibles en estos momentos esta autorizado para emplearse de forma aislada en el tratamiento de la EPOC2. GOLD subraya que el tratamiento habitual con CI mejora los sintomas, la funcion pulmonar y la calidad de vida y reduce la frecuencia de las exacerbaciones en pacientes con EPOC estable con un FEV1 del valor de referencia < 60% (evidencia A)1. La American Thoracic Society (ATS), la European Respiratory Society (ERS)3, el NICE y la Guia Espanola de la EPOC [GesEPOC] de la Sociedad de Neumologia y Cirugia Toracica (SEPAR) han formulado recomendaciones similares4. Un CI combinado con un beta2-agonista de accion prolongada (LABA por sus siglas en ingles) es mas eficaz que sus componentes individuales a la hora de mejorar la funcion pulmonar y la calidad de vida y reducir las exacerbaciones en pacientes con EPOC moderada (evidencia B) o grave o muy grave (evidencia A). En la actualizacion de 2014 de GOLD1 se subraya que anadir una combinacion de LABA + CI a un anticolinergico o antimuscarinico de accion prolongada (LAMA por sus siglas en ingles) mejora la funcion pulmonar y la calidad de vida

Hospital Clinic, Barcelona, Spain, Hospital Clinic, Barcelona, Spain, Department of Pulmonary Medicine. Hospital Clinic de Barcelona 1 2 3 (ICT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), University of Barcelona., Barcelona, Spain, Hospital Clinic, Barcelona, Barcelona, Spain, Hospital Clinic i Provincial of Barcelona, 4 5