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Residential greenness and lung function in a prospective cohort of European adults : The ECRHS study

Resumen Desde la publicacion, hace ya 9 anos, de la ultima normativa de la Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) sobre asma de control dificil (ACD), se han producido avances en los conocimientos de la enfermedad asmatica, que hacen necesario realizar una puesta al dia de los datos disponibles e incorporarlos tras su analisis en el nivel de evidencia y recomendacion mas adecuado. Recientemente han aparecido documentos de consenso y guias de practica clinica (GPC) que abordan este problema. En esta normativa se hara mencion explicita a lo que la previa guia de ACD definia como «verdadera asma de control dificil»; es decir, al asma que tras haber verificado su diagnostico, realizado un abordaje sistematizado para descartar factores ajenos a la propia enfermedad que conducen a un mal control de la misma («falsa asma de control dificil»), y realizar una estrategia de tratamiento adecuado (escalones 5 y 6 de la Guia espanola para el manejo del asma [GEMA]), no se consigue alcanzar el control: «asma grave no controlada» (AGNC). En esta linea la normativa propone una revision de la definicion, un intento de clasificacion de las diferentes manifestaciones de este tipo de asma, una propuesta del abordaje diagnostico por pasos y un tratamiento dirigido segun fenotipo, conjuntamente con un apartado especifico sobre este arquetipo de asma en la infancia, con el objetivo de que pueda servir de ayuda a los profesionales sanitarios y repercutir en el cuidado de estos pacientes.

Airway responsiveness is linked to COPD but prospective studies are lacking. As part of the ALEC Study (EU Horizon 2020 Grant #633212) we evaluated the association between airway responsiveness and COPD incidence using the multicentre population-based ECRHS data. Subjects aged 27-56 years with pre-bronchodilator FEV 1 /FVC >0.70 were identified in 1999–2002 and followed up to 2010–13 to detect incident cases of COPD (post-bronchodilator FEV 1 /FVC 20 2 , FEV 1 and history of active/passive smoking using Poisson regression with centre as a clustering unit. Incident cases of COPD were 170 out of 3049 participants from 23 centres. Both AHR (Incidence Rate Ratio, IRR=2.20, 95%CI: 1.55–3.12) and slope were associated with a greater risk of COPD. Among people without AHR, subjects having intermediate (1 st –2 nd tertile) and high (>2 nd tertile) airway responsiveness had 2-fold (IRR=1.95, 95%CI: 1.17–3.24) and 3-fold (IRR=3.25, 95%CI: 1.82–5.80) risks of COPD respectively, compared to the least responsive (slope st tertile). Results were consistent when defining COPD as FEV 1 /FVC Airway responsiveness measured in young adulthood is prospectively associated with the risk of developing COPD, even among subjects who are classified as non-hyperresponsive according to the PD 20 .

Introduction: Action plans and education can improve asthma control and decrease exacerbations. These plans are effective but they have little efficiency because of their poor implementation. When action plans are used by telemedicine programs associated to education, there is an evidence of decline of hospital admissions while there are variable results about control of symptoms and quality of life questionnaires. The aim of this study was to assess the impact of telemedicine in healthcare demand by the patients with poorly controlled severe persistent asthma. Methods: We have 20 asthmatic patients in telemetry from July 2011 to nowadays, in whose healthcare demand was evaluated from the previous year of the inclusion until the following year post-inclusion in the programme. Equipment: Peak-flow meter and the tablet through which the patients send the data every day. Inclusion criteria: Diagnosis of asthma > 2 years, controlled by a Pulmonologist and one of the indications about the number of hospital admissions, visits to emergency rooms or visits to General Practice clinics, according to the GEMA 2009 and ERS/ATS Task Force criteria. Results: The results are showed in Table 1. Conclusion: In spite of the limitations in this study, we have been able to verify an important decline in healthcare demand with the probable saving of economic resources for health. We think that Telemedicine will be the future in the management of chronic diseases.

BACKGROUND: Cross-sectional studies have reported a lower prevalence of sensitization in older adults, but few longitudinal studies have examined whether this is an aging or a year-of-birth cohort effect. OBJECTIVE: We sought to assess changes in sensitization and total IgE levels in a cohort of European adults as they aged over a 20-year period. METHODS: Levels of serum specific IgE to common aeroallergens (house dust mite, cat, and grass) and total IgE levels were measured in 3206 adults from 25 centers in the European Community Respiratory Health Survey on 3 occasions over 20 years. Changes in sensitization and total IgE levels were analyzed by using regression analysis corrected for potential differences in laboratory equipment and by using inverse sampling probability weights to account for nonresponse. RESULTS: Over the 20-year follow-up, the prevalence of sensitization to at least 1 of the 3 allergens decreased from 29.4% to 24.8% (-4.6%; 95% CI, -7.0% to -2.1%). The prevalence of sensitization to house dust mite (-4.3%; 95% CI, -6.0% to -2.6%) and cat (-2.1%; 95% CI, -3.6% to -0.7%) decreased more than sensitization to grass (-0.6%; 95% CI, -2.5% to 1.3%). Age-specific prevalence of sensitization to house dust mite and cat did not differ between year-of-birth cohorts, but sensitization to grass was most prevalent in the most recent ones. Overall, total IgE levels decreased significantly (geometric mean ratio, 0.63; 95% CI, 0.58-0.68) at all ages in all year-of-birth cohorts. CONCLUSION: Aging was associated with lower levels of sensitization, especially to house dust mite and cat, after the age of 20 years. Amaral receives research funding from the Medical Research Council. M. J. Abramson receives research support from E.H.Walters & M.Abramson, Pfizer, and Boehringer Ingelheim and receives consulting fees from AstraZeneca and travel support from Boehringer Ingelheim and Sanofi. P. Demoly receives consulting fees from ALK-Abell o, Circassia, Stallergenes, Allergopharma, Chiesi, Thermo Fisher Scientific, Medam Menarini, AstraZeneca, Pierre Fabra Mediacament, and DBV. R. Jogi receives research support from the Estonian Research Council and receives consulting and lecture fees from Boehringer, Novartis, and GlaxoSmithKline and travel support from GlaxoSmithKline and Boehringer. C. Neukirch receives consulting fees and travel support from ALKAbell o and Stallergenes. D. Nowak receives speaker fees from Mundipharma. I. Pin receives lecture fees from Novartis and MSD and travel support from GlaxoSmithKline, TEVA, and Novartis. R. van Ree receives consulting fees from HAL Allergy BV and speaker fees from Thermo Fisher Scientific. J.-P. Zock receives research support from FIS, Health Institute Carlos III, and the Spanish Ministry of Health. P. G. J. Burney serves on the Novartis Advisory Board. D. L. Jarvis receives research support from the Medical Research Council

Resumen El interes por la investigacion en asma de los neumologos espanoles va en linea ascendente. En el ultimo ano han aparecido en archivos de bronconeumologia 22 articulos sobre asma, 6 mas que en el ano anterior, y se presentaron 56 comunicaciones al Congreso Nacional de la SEPAR, publicadas en el numero especial de la revista, lo que representa un 60% mas que en el congreso del ano anterior. Se realiza una revision critica de todos estos articulos. Los originales aportan nuevos conocimientos epidemiologicos, clinicos y de investigacion basica. Merece mencion especial la publicacion de 2 guias de practica clinica, la Guia Espanola para el Manejo del Asma 2009 (GEMA) y la Guia ALERTA-2 para el manejo de la exacerbacion asmatica; las 2 suponen no solo una actualizacion de su contenido, sino tambien un cambio en la metodologia en su elaboracion que mejora su calidad cientifica.

Since the publication, 9 years ago, of the latest SEPAR (Spanish Society of Pulmonology and Thoracic Surgery) Guidelines on Difficult-to-Control Asthma (DCA), much progress has been made in the understanding of asthmatic disease. These new data need to be reviewed, analyzed and incorporated into the guidelines according to their level of evidence and recommendation. Recently, consensus documents and clinical practice guidelines (CPG) addressing this issue have been published. In these guidelines, specific mention will be made of what the previous DCA guidelines defined as "true difficult-to-control asthma". This is asthma that remains uncontrolled after diagnosis and a systematic evaluation to rule out factors unrelated to the disease itself that lead to poor control ("false difficult-to-control asthma"), and despite an appropriate treatment strategy (Spanish Guidelines for the Management of Asthma [GEMA] steps 5 and 6): severe uncontrolled asthma. In this respect, the guidelines propose a revised definition, an attempt to classify the various manifestations of this type of asthma, a proposal for a stepwise diagnostic procedure, and phenotype-targeted treatment. A specific section has also been included on DCA in childhood, aimed at assisting healthcare professionals to improve the care of these patients.

Interest in asthma research among Spanish pneumologists is increasing. In the last year, 22 articles on asthma have been published in Archivos de Bronconeumología, six more than in the previous year. Furthermore, 56 communications were presented at the National Congress of the Spanish Society of Pneumology and Thoracic Surgery and were published in a supplement of the journal, representing 60% more than in the previous year's congress. A critical review of all these articles is provided. The original articles contribute further knowledge on epidemiological and clinical aspects of the disease and basic research. A notable contribution is the publication of two clinical practice guidelines, the Spanish Guideline for the Management of Asthma 2009 and the ALERTA-2 Guideline for the Management of Asthma Exacerbations. These two guidelines represent not only an update but also a change in the methodology used in their drafting, thus improving their scientific quality.