Àlex Roger

Neumonitis por hipersensibilidad en los yeseros de la construcción (espartosis): estudio de 20 casos

FUNDAMENTO Y OBJETIVO: La espartosis es un tipo de neumonitis por hipersensibilidad que afecta, con cierta frecuencia, a los trabajadores de la construccion que manejan fibras de esparto como material de soporte de las placas de yeso. Aun se discute cual es el agente concreto que causa la enfermedad. Los objetivos del estudio fueron: a) demostrar el posible papel etiologico de los hongos que colonizan las fibras de esparto y el del propio esparto en la etiologia de esta enfermedad, y b) describir las caracteristicas clinicas de esta enfermedad en una serie amplia de pacientes. PACIENTES Y METODO: Se estudio a 20 pacientes diagnosticados de neumonitis por hipersensibili- dad causada por la exposicion a esparto. Se realizaron cultivos micologicos de las muestras de esparto proporcionadas por cada paciente. Para determinar los anticuerpos IgG especificos y para realizar pruebas cutaneas especificas y pruebas especificas de provocacion bronquial, se utilizaron extractos antigenicos de los hongos obtenidos en el cultivo y/o el propio esparto no contaminado. RESULTADOS: Los hongos aislados con mayor frecuencia en las muestras de esparto causal fueron Aspergillus sp. (60%) y Mucor sp. (47%). La determinacion de los anticuerpos IgG especificos y las pruebas especificas de provocacion bronquial demostraron antigenicidad no solo para As- pergillus sp., sino tambien para el esparto no contaminado por hongos y para otros hongos como Penicillium sp. o Mucor sp. Estos resultados fueron utiles para establecer una nueva aproximacion diagnostica a esta enfermedad. CONCLUSIONES: Aspergillus fumigatus es conocido como un agente causal de la neumonitis por hipersensibilidad producida por exposicion a esparto. Sin embargo, otras fuentes antigenicas, como Penicillium frequentans y otros hongos, asi como las propias fibras de esparto, parecen tener un papel en la genesis de esta enfermedad. Palabras clave: Neumonitis por hipersensibilidad. Espartosis. Esparto.

Ventilatory Insufficiency due to Asbestos-Related Diffuse Pleural Fibrosis Successfully Treated with Noninvasive Home Mechanical Ventilation

A 54-year-old man with diffuse pleural fibrosis due to previous asbestos exposure developed hypercapnic respiratory failure. Noninvasive mechanical ventilation (NIMV) was started at the hospital and maintained at the patient’s home, achieving reversal of the respiratory failure. During a 2-year follow-up, NIMV has been well tolerated by the patient and no relapse in ventilatory failure has occurred. Home NIMV can be considered as an alternative to pleural decortication in asbestos-related diffuse pleural fibrosis with ventilatory insufficiency.

Monitoring of Asthma Outpatients After Adapting Treatment to Meet International Guidelines

OBJECTIVE Poor control of asthma treated in outpatient settings has been demonstrated. The aim of this study was to perform a short intervention, readily replicable in everyday practice, to try to improve control of the disease. PATIENTS AND METHODS Two primary health care clinics made appointments with asthma patients to administer a questionnaire and adapt their treatment to the guidelines of the Global Initiative for Asthma. Patients also received an explanation of the disease lasting not more than 5 minutes. The protocol was repeated at a second visit 4 months later. Health care parameters were compared with those from the previous visit. RESULTS The characteristics of the 180 patients were as follows: 70% were women, 17% were smokers, 8% were illiterate, 46% had only primary education, 45% were in contact with cleaning products, and 63% had extrinsic asthma. The asthma severity was as follows: mild in 73%, moderate in 23%, and severe in 4%. Twenty-two percent had received previous explanations of the disease, 50% had a written treatment plan, 14% had a plan for exacerbations, and 54% were taking inhaled corticosteroids. The second appointment was kept by 110 (61%) of the patients, who showed differences with respect to the previous visit 4 months earlier in the percentage taking inhaled corticosteroids (78%, P< .001), the number of visits to the physician (P< .01), visits to the physician due to exacerbations (P< .001), emergency visits to the outpatient clinic (P< .002), and disease severity (P< .02). CONCLUSIONS This minimal clinical intervention reduced the need for visits to health care centers and improved the control of asthma symptoms.

Grado de conocimiento de las propias sensibilizaciones alérgicas en pacientes asmáticos y su repercusión en el nivel de control del asma

BACKGROUND Asthma guidelines recommend the adoption of allergen avoidance measures (AAM). To do so, patients need to know their own allergies. However, this degree of knowledge has not yet been assessed. The aims of this study were to determine, in allergic asthma patients: i)the degree of knowledge of their own allergic sensitizations; ii)the percentage of those who knew all their allergies and, in addition, adopted AAM against all of them, and iii)the possible impact of this degree of knowledge on the level of asthma control. PATIENTS AND METHODS Descriptive, prospective and multicentre study, including 147patients from 9 Respiratory Medicine outpatient clinics. After confirming the previous allergic asthma diagnosis, a questionnaire was completed. It included asthma control and severity levels, results of previous allergy tests, and the description and number of allergic sensitizations known by the patients and AAM followed. RESULTS Only 72 (49%) patients knew all their allergic sensitizations and only 48 (33%) were also following AAM against all the allergens to which they were allergic. No relationship was established between the degree of knowledge of their own allergies and the level of asthma control (P=.544). CONCLUSIONS Overall knowledge about the allergic nature of their disease among asthmatic patients attending Spanish Respiratory Medicine Departments is inadequate. Furthermore, a higher degree of knowledge of their allergies does not seem to lead, by itself, to better asthma control. Both findings seem to question the effectiveness of current educational strategies in this field and consequently, they should be revised.