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Nijra L Lugogo,1 Enrico Heffler,2,3 Vicente Plaza,4 Ole Hilberg,5 Changming Xia,6 Scott Nash,6 Nami Pandit,7 Juby A Jacob-Nara,7 Harry J Sacks,6 Paul J Rowe,7 Yamo Deniz,6 Megan Hardin,8 Xavier Soler6 1University of Michigan Medical School, Ann Arbor, MI, USA; 2IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; 3Humanitas University, Pieve Emanuele, Milan, Italy; 4Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 5Lillebaelt Hospital, Vejle, Denmark; 6Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA; 7Sanofi, Bridgewater, NJ, USA; 8Sanofi, Cambridge, MA, USACorrespondence: Nijra L Lugogo, University of Michigan Medical School, 300 North Ingalls St, Suite 2C40, Ann Arbor, MI, 48109, USA, Email nlugogo@med.umich.edu

Javier Dominguez-Ortega,1 Vicente Plaza,2 Antonio Nieto,3 Julio Delgado Romero,4 Julio Ancochea,5– 7 Natalia Mejia,8 Mariano Pastor,9 Marina Blanco-Aparicio10 1Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain; 2Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; 3Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain; 4Allergology Clinical Management Unit, Hospital Virgen Macarena, Sevilla, Spain; 5Pneumology Department, Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain; 6Pneumology Department, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; 7Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; 8Medical Department, Novartis Farmacéutica, Barcelona, Spain; 9Fundación Española de Asociaciones de Pacientes Alérgicos y con Enfermedades Respiratorias (FENAER), Madrid, Spain; 10Pneumology Department, A Coruña University Hospital, A Coruña, SpainCorrespondence: Javier Dominguez-Ortega, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain, Tel +34 616 719 390, Email javier.dominguez@salud.madrid.orgPurpose: ATLAS ASMA described the psychosocial impact of asthma on patients’ daily life from patients’ perspectives (in terms of impaired personal and intimate relationships, sleep quality, leisure time, daily activities, and others) in Spain. Secondary objective includes description of time since diagnosis, expectations, and satisfaction of patients about disease, treatment and medical assistance received, adherence to treatment, perceived control of asthma, and health-related quality of life.Patients and Methods: This was a cross-sectional, observational study, based on a self-administered online survey for adult patients (≥ 18 years) with asthma. Patients with asthma diagnosis of any type and severity who voluntarily participated in the survey through a web link were included consecutively. In the present manuscript, only adult patients’ data are included.Results: A total of 132 adults with asthma were included. Moderate/severe asthma constituted 59.1% of the patients (females 71.2%). Overall, most relevant areas affected due to asthma were leisure activities (67.0%) and the quality/quantity of sleep (52.3%). Moderate/severe patients perceived some degree of impairment in work, school, or at home due asthma more frequently vs mild patients (55.2% vs 10.9%). Poorly controlled asthma (ACT≤ 19) was reported in 41 (70.7%) and 10 (21.7%) moderate/severe and mild patients (p< 0.000), respectively. Mild patients obtained higher mean (SD) Mini-AQLQ score than moderate/severe asthma patients (5.6 [1.0] vs 4.3 [1.1], p< 0.000), likewise higher significant results for every individual dimension. Most patients cited little limitation to intense efforts (20.5%). Half of the patients mentioned needing more information about asthma. Topics those patients like to have more information were difficulties that may can have and legal topics (78.6%), asthma evolution (78.6%), secondary effects or issues related to the treatment (61.9%) and legal topics (61.9%).Conclusion: The study reported important insights on psychosocial impact of asthma on patients’ daily life from patients’ perspectives along with health determinants in asthma-related health outcomes, sociodemographic and psychosocial factors.Keywords: patient survey, psychosocial impact, health-related quality of life, healthcare resources utilization, Asthma Control Test, Mini-AQLQ

Astrid Crespo-Lessmann,1– 3,&ast; Elena Curto,1– 3,&ast; Eder Freddy Mateus Medina,1– 3 Esther Palones,1– 3 Alicia Belda Soler,1– 3 Soraya Sánchez Maza,1– 3 Lorena Soto-Retes,1– 3 Vicente Plaza1– 3 1Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 2Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain; 3Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain&ast;These authors contributed equally to this workCorrespondence: Astrid Crespo-Lessmann, Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Carrer Mas Casanovas 90, Barcelona, 08041, Spain, Tel +34-935565972, Fax +34 935565601, Email acrespo@santpau.catPurpose: The objectives of this study were, for patients attending a specialist asthma clinic at a tertiary care hospital, to determine, from sputum induction (SI), proportions of bronchial inflammatory phenotypes, demographic, clinical and functional characteristics of each phenotype, and the most accessible non-invasive inflammatory marker that best discriminates between phenotypes.Patients and Methods: Included were 96 patients with asthma, attending a specialist asthma clinic at a tertiary care hospital, who underwent testing as follows: SI, spirometry, fractional exhaled nitric oxide (FeNO), blood eosinophilia, total immunoglobulin E (IgE), and a skin prick test.Results: SI phenotypes were 46.9% eosinophilic, 33.3% paucigranulocytic, 15.6% neutrophilic, and 4.2% mixed. No significantly different clinical or functional characteristics were observed between the phenotypes. A positive correlation was observed between SI eosinophilia and both emergency visits in the last 12 months (p = 0.041; r = 0.214) and FeNO values (p = 0.000; r = 0.368). Blood eosinophilia correlated with SI eosinophilia (p = 0.001; r = 0.362) and was the best predictor of bronchial eosinophilia, followed by FeNO, and total blood IgE (area under the receiver operating characteristic curve (AUC-ROC) 72%, 65%, and 53%, respectively), although precision was only fair.Conclusion: In consultations for severe asthma, the most frequent phenotype was eosinophilic. Peripheral blood eosinophilia is a reliable marker for discriminating between different bronchial inflammatory phenotypes, is useful in enabling doctors to select a suitable biologic treatment and so prevent asthma exacerbation, and is a better predictor of bronchial eosinophilia than FeNO and IgE values.Keywords: asthma, sputum induction, phenotype, eosinophilia

Luis Pérez de Llano,1 Marc Miravitlles,2 Rafael Golpe,1 Francisco Javier Alvarez-Gutiérrez,3 Carolina Cisneros,4 Carlos Almonacid,5 Eva Martinez-Moragon,6 Francisco-Javier Gonzalez-Barcala,7 David Ramos-Barbón,8 Vicente Plaza,8 Jose Luis Lopez-Campos,3 Juan Pablo de-Torres,9 Ciro Casanova,10 Juan Luis Garcia Rivero,11 Juan Rodriguez Hermosa,12 Myriam Calle Rubio,12 Juan Jose Soler-Cataluña,13 Borja G Cosio14 1Pneumology Service, University Hospital Lucus Augusti, Lugo, EOXI Cervo, Lugo, Monforte, Spain; 2Pneumology Service, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain; 3Pneumology Service, Hospital Universitario Virgen del Rocio, Seville, Spain; 4Pneumology Service, La Princesa University Hospital, Madrid, Research Institute La Princesa IIP, Madrid, Spain; 5Pneumology Service, Ramón y Cajal Hospital (Ramon y Cajal Health Research Institute, IRYCIS), Madrid, Spain; 6Pneumology Service, Hospital Universitario Dr Peset, Valencia, Spain; 7Faculty of Medicine at the University of Santiago de Compostela, Pneumology Service of the University Clinical Hospital of Santiago de Compostela, CIBERES, Santiago de Compostela, Spain; 8Pneumology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 9Division of Respirology and Sleep Medicine, Queen’s University, Canada, ON, Canada; 10Pneumology Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain; 11Pneumology Service, Hospital de Laredo, Laredo, Spain; 12Pneumology Service and Faculty of Medicine, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain; 13Pneumology Service, Hospital Arnau de Vilanova, Valencia, Spain; 14Pneumology Service, Son Espases University Hospital, IdISBa, CIBERES, Clínica Quirón-Rotger, Palma, SpainCorrespondence: Borja G CosioPneumology Service, Hospital Universitario Son Espases, IdISBa, CIBERES, Clínica Quirón-Rotger, Ctra. de Valldemossa 79, Palma de Mallorca 07010, SpainTel +34 871 206714 Ext 76714Fax +34 871 909724Email borja.cosio@ssib.esAbstract: Chronic airflow obstruction affects a wide range of airway diseases, the most frequent of which are asthma, COPD, and bronchiectasis; they are clearly identifiable in their extremes, but quite frequently overlap in some of their pathophysiological and clinical characteristics. This has generated the description of new mixed or overlapping disease phenotypes with no clear biological grounds. In this special article, a group of experts provides their perspective and proposes approaching the treatment of chronic airway disease (CAD) through the identification of a series of therapeutic goals (TG) linked to treatable traits (TT) – understood as clinical, physiological, or biological characteristics that are quantifiable using biomarkers. This therapeutic approach needs validating in a clinical trial with the strategy of identification of TG and treatment according to TT for each patient independently of their prior diagnosis.Keywords: airflow obstruction, biomarker, personalised medicine, COPD asthma overlap

Central Chile experienced a very extended and devastating fire season during 2016–17. After 3 years, here we present the results of an analysis of behavior of the wildfires occurred in that season. We used a modeling approach to estimate the physical parameters of fire behavior: speed of linear spread, front-line intensity and flame length; as well as qualified fire severity, and the potential danger of recurrent fires. We selected eight study areas in four regions of Central Chile, under sclerophyllous forest and shrublands with variable composition. To run the model, we gathered data on vegetation structure and composition, and physical information. The values of the physical parameters were in a comparable range in the eight studied areas, with two of these areas showing maximum values. This could result from differences in vegetation. We detected rapid regrowth post-fire, despite the high levels of fire intensity and damage, ascribed to a high availability of very dry fine biomass. Given the predictions of increased drought, we should expect recurrence of wildfires. Based on our results, we anticipate fires of high severity and damage, with emphasis in areas with very high increase of dry biomass. We suggest restoration programs, with frequent monitoring of passive restoration practices, resorting to more active physical support in areas more severely affected.

Luis Pérez de Llano,1,* Borja G Cosío,2,3,* Amanda Iglesias,3 Natividad de las Cuevas,4 Juan Jose Soler-Cataluña,3,5 Jose Luis Izquierdo,6 Jose Luis López-Campos,3,7 Carmen Calero,7 Vicente Plaza,3,8–10 Marc Miravitlles,3,11 Alfons Torrego,8–10 Eva Martinez-Moragon,12 Joan B Soriano,13 Antolin Lopez Viña,14 Irina Bobolea15 On behalf of the CHACOS Study Group 1Department of Respiratory Medicine, Hospital Lucus Augusti, Lugo, Spain; 2Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain; 3CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; 4Department of Allergy, Hospital 12 de Octubre, Madrid, Spain; 5Department of Respiratory Medicine, Hospital Arnau de Vilanova, Valencia, Spain; 6Department of Respiratory Medicine, Hospital Universitario de Guadalajara, Guadalajara, Spain; 7Department of Respiratory Medicine, Hospital Virgen del Rocío, Sevilla, Spain; 8Department of Respiratory Medicine, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain; 9Institut d’Investigació Biomédica Sant Pau, IIB Sant Pau, Barcelona, Spain; 10Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; 11Department of Respiratory Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain; 12Department of Respiratory Medicine, Hospital Dr Peset, Valencia, Spain; 13Instituto de Investigación Hospital de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain; 14Department of Respiratory Medicine, Hospital Puerta de Hierro, Madrid, Spain; 15Servei de Pneumologia i Alergia, Hospital Clinic, Barcelona, Spain *These authors contributed equally to this work Introduction: The asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) is a clinical condition that combines features of those two diseases, and that is difficult to define due to the lack of understanding of the underlying mechanisms. Determining systemic mediators may help clarify the nature of inflammation in patients with ACO. Objectives: We aimed at investigating the role and interaction of common markers of systemic inflammation (IL-6, IL-8, and tumor necrosis factor-α), Th2-related markers (periostin, IL-5, and IL-13), and IL-17 in asthma, COPD, and ACO. Methods: This is a cross-sectional study of patients aged ≥40 years with a post-bronchodilator forced expiratory volume in the first second/forced vital capacity 10 pack-years in a patient with a previous diagnosis of asthma or by the presence of eosinophilia in a patient with a previous diagnosis of COPD. Clinical, functional, and inflammatory parameters were compared between categories using discriminant and network analysis. Results: In total, 109 ACO, 89 COPD, and 94 asthma patients were included. Serum levels (median [interquartile range]) of IL-5 were higher in asthma patients than in COPD patients (2.09 [0.61–3.57] vs 1.11 [0.12–2.42] pg/mL, respectively; p=0.03), and IL-8 levels (median [interquartile range]) were higher in COPD patients than in asthma patients (9.45 [6.61–13.12] vs 7.03 [4.69–10.44] pg/mL, respectively; p

Astrid Crespo-Lessmann,1 Eder Mateus,1,2 Montserrat Torrejón,1 Alicia Belda,1 Jordi Giner,1 Silvia Vidal,2 Oriol Sibila,1 Vicente Plaza,1 1Service of Pneumology, Hospital de la Santa Ceu i Sant Pau, Institute of Sant Pau Biomedical Research (IBB Sant Pau), Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 2Department of Immunology, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain Abstract: Asthma with bronchial hypersecretion is a type of asthma that is poorly studied. Its pathogenesis is not well understood, but is probably related to innate impaired immunity, particularly with toll-like receptors (TLRs) and secretory mucins (MUC). Objectives: 1) Define the clinical and inflammatory phenotype of asthma with bronchial hypersecretion of mucus. 2) Compare the type of mucin present in induced sputum (IS) of patients with and without bronchial hypersecretion. 3) Determine the expression of TLRs in IS and blood of asthmatics with and without bronchial hypersecretion. Materials and methods: Cross-sectional study which included 43 non-smoking asthmatic patients without bronchiectasis, 19 with bronchiectasis, and 24 without bronchial hypersecretion. All patients underwent the following: IS, spirometry, fractional exhaled nitric oxide, prick test, total immunoglobulin E (IgE), and blood albumin. Analysis of mucins was determined by ELISA and expression of TLR2 and TLR4 by flow cytometry. The level of asthma control was determined by the Asthma Control Test (ACT) questionnaire and quality of life was assessed by the reduced version of the Asthma Quality of Life Questionnaire (mini-AQLQ). Results: Asthmatics with bronchial hypersecretion were significantly older (62.6 years vs 48.5 years; p=0.02); had greater severity (persistent severe asthma 94.7% vs 29.2%; p=0.000); a higher proportion of nasal polyposis (36.8% vs 8.3%; p=0.022); less control of asthma (73.7% vs 8.3%; p=0,000); a higher proportion of asthma with negative prick test (68.4% vs 16.6%; p=0.001), and lower levels of IgE (113.4 IU/mL vs 448 IU/mL; p=0.007), compared with asthmatics without bronchial hypersecretion. Significant differences were observed neither in the expression of  TLRs 2 and 4 in inflammatory cells of IS or peripheral blood, nor in the expression of mucins between both groups. Conclusion: Asthma patients with bronchial hypersecretion have more severe and uncontrolled disease, with poor quality of life as well as a non-allergic inflammatory phenotype. Within the mechanisms involving these differences, it does not appear that mucins and TLRs play an important role. Keywords: asthma, mucins, inflammation, induced sputum, toll-like receptor

Miguel Román-Rodríguez,1 Lara Ibarrola-Ruiz,2 Fernando Mora,3 Vicente Plaza,4 Joaquín Sastre,5 Alfonso Torrego,4 José María Vega6 Guadalupe Sánchez-Herrero2 1Centro de Salud Son Pisà, IB-Salut, Balearic Health Service, Unidad de investigación en enfermedades crónicas respiratorias en atención primaria, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma de Mallorca, 2GSK, 3Department of Psychiatry, Hospital Infanta Leonor, Madrid, 4Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, 5Department of Allergology, Fundación Jimenez Díaz y Universidad Autónoma de Madrid, CIBER de Enfermedades Respiratorias, Ministerio de Economía y Competitividad, Madrid, 6Unidad de Gestión Clínica de Alergología, Hospital Regional Universitario de Málaga, Málaga, Spain Objective: The aim of this study was to evaluate the attitudes and perceptions of health care professionals (HCPs) who have been trained in motivational interviewing (MI) to improve adherence. Another objective of this study was to compare groups of HCPs with different levels of training in adherence (trained vs untrained; previous training in adherence education [AdhE] vs specific training in MI). Methods: For this study, a national questionnaire-based survey was conducted among HCPs treating asthma. A total of 360 HCPs were surveyed (allergists: n=110; pulmonologists: n=120; general practitioners: n=130). Of them, 180 physicians had received a training intervention (training in AdhE: n=90; training in MI to promote adherence: n=90). Results: Of the total surveyed HCPs, 92.8% reported adherence is highly important in asthma control. More professionals trained in MI compared to those trained in AdhE considered that “simplifying treatment as far as possible” (85.6% vs 68.9%, P=0.0077), “involving the patient in treatment plans” (85.6% vs 71.1%, P=0.0187), “giving the patient self-care patterns” (52.2% vs 36.7%, P=0.0357) and “performing MI” (42.2% vs 15.6%, P

Marc Miravitlles,1,2 Bernardino Alcázar,3 Francisco Javier Alvarez,4 Teresa Bazús,5 Myriam Calle,6 Ciro Casanova,7 Carolina Cisneros,8 Juan P de-Torres,9 Luis M Entrenas,10 Cristóbal Esteban,11 Patricia García-Sidro,12 Borja G Cosio,13 Arturo Huerta,14 Milagros Iriberri,15 José Luis Izquierdo,16 Antolín López-Viña,17 José Luis López-Campos,2,4 Eva Martínez-Moragón,18 Luis Pérez de Llano,19 Miguel Perpiñá,20 José Antonio Ros,21 José Serrano,22 Juan José Soler-Cataluña,23 Alfons Torrego,24 Isabel Urrutia,11 Vicente Plaza24 1Pneumology Department, Hospital Universitari Vall d’Hebron, Barcelona, 2CIBER de Enfermedades Respiratorias (CIBERES), Madrid, 3Respiratory Department, Hospital de Alta Resolucion de Loja, Granada, 4Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Biomedicine Institute of Seville (IBiS), Seville, 5Department of Pneumology, Hospital Universitario Central de Asturias, Oviedo, 6Department of Pneumology, Hospital Clínico San Carlos, Madrid, 7Department of Pneumology, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, 8Department of Pneumology, Hospital Universitario de La Princesa/Instituto de Investigación Sanitaria (IIS-IP), Madrid, 9Pulmonary Department, Clínica Universidad de Navarra, Pamplona, 10Department of Pneumology, Hospital Universitario Reina Sofia, Córdoba, 11Department of Pneumology, Hospital Galdakao-Usansolo, Galdakao, 12Department of Pneumology, Hospital Universitario de La Plana, Vila-real, 13Department of Pneumology, Hospital Universitario Son Espases IdISPa, Palma de Mallorca, 14Sección Urgencias Medicina – Neumología, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, 15Department of Pneumology, Hospital Universitario de Cruces, Bilbao, 16Department of Pneumology, Hospital Universitario de Guadalajara, Guadalajara, 17Department of Pneumology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, 18Department of Pneumology, Hospital Universitario Dr Peset, Valencia, 19Department of Pneumology, Hospital Universitario Lucus Augusti, Lugo, 20Department of Pneumology, Hospital Universitario y Politécnico La Fe, Valencia, 21Department of Pneumology, Hospital Clínico Universitario Virgen de la Arrinxaca, Murcia, 22Department of Pneumology, Hospital Comarcal de Inca, Inca, 23Pneumology Department, Hospital Arnau de Vilanova-Lliria, Valencia, 24Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain Background: Some patients with COPD may share characteristics of asthma; this is the so-called asthma–COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. Materials and methods: We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. Results: A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity

En este artículo se describe el tratamiento de una niña con estrés postraumático producto de una violación. Este tratamiento integra desensibilización sistemática, relajación, control del pensamiento, y psicoeducación. Se pretendió reducir los síntomas intrusivos, evitativos y de aumento de la activación fisiológica propios de este trastorno. Para medir los efectos de la intervención se registraron los niveles de ansiedad de la niña mediante la escala de unidades subjetivas de ansiedad (SUDS; Wolpe, 1958). Los resultadosindican una disminución gradual de la sintomatología hasta llegar a niveles mínimos en nueve semanas. Estos resultados se mantienen en el seguimiento realizado semanas, meses y dos años después de terminado el tratamiento. Finalmente se discuten las implicancias teóricas y clínicas de estos resultados.