Teresa Genover

Tasa y características de las agudizaciones asmáticas (ASMAB I)

Objetivo El presente estudio examina la incidencia y las caracteristicas clinicas de los episodios de agudizacion asmatica (AA) atendidos en los servicios de urgencias (SU) de la ciudad de Barcelona (estudio ASMAB-I). Pacientes y metodos Se estudiaron los episodios de AA atendidos en los SU hospitalarios y en el SU domiciliario (061) durante 129 dias, correspondientes a una poblacion mayor de 14 anos de 1.203.598 habitantes. Resultados Se identificaron 831 episodios de AA, de los que 523 fueron atendidos en 3 hospitales universitarios, 113 en 2 hospitales de segundo nivel y otros 195 (de los que 20 se remitieron a hospitales) en los SU domiciliarios. La frecuentacion media fue de 6,4 episodios/dia, con una incidencia de AA de 0,53/105 habitantes/dia (intervalo de confianza del 95%, 0,46-0,56) y de 8,2/105 pacientes asmaticos (intervalo de confianza del 95%, 6,89-8,41). De los 276 episodios atendidos de lunes a jueves en los servicios de los hospitales universitarios, 66 pacientes (24%) reconocieron un inicio agudo y 14 (5%) un inicio subito. Unicamente 85 pacientes (31%) tomaban de modo regular corticoides inhalados y solo 33 (12%) anadieron corticoi-des orales en las 12 h previas a su llegada a urgencias. Un 16% de los episodios se calificaron de graves y un 3% de casi fatales. Un total de 82 pacientes (30%) fueron finalmente hospitalizados; ingresaron el 12% de las AA leves, el 39% de las AA moderadas, el 62% de las A A graves y el 100% de las casi fatales. El indice de comorbilidad de Charlson fue mayor en los pacientes hospitalizados (p Conclusiones La tasa de A A establecida puede ser un indicador util del grado de control del asma y servir para confirmar futuros aumentos de AA permanentes o puntuales. El inicio rapido (agudo o subito) es frecuente. Muchos pacientes no reciben un tratamiento adecuado antes de la hospitalizacion. La agudizacion grave es frecuente en nuestro medio. El ingreso esta relacionado con la gravedad y la comorbilidad. Los readmitidos han recibido al alta menos antibioticos y bromuro de ipratropio.

Epidemic Asthma in Barcelona: An Evaluation of New Strategies for the Control of Soybean Dust Emission

Background: Asthma attacks and mortality due to inhalation of soybean antigens in Barcelona have been well documented. Strict protective measures in the unloading process were established in 1998 to avoid the release of soybean dust into the atmosphere. The present study was undertaken to assess the effectiveness of these latest environmental measures, and, if effective, to recommend their implementation in the many harbours where soybean is unloaded. Methods: Levels of soybean aeroallergen were analysed daily during a period of 5 years and 2 months in a total of 1,854 samples, 125 from the pre-intervention period and 1,729 from the postintervention period. Additionally, the number of asthma admissions to the emergency rooms of the city’s three largest hospitals was recorded. Asthma patients attended at home by the public home emergency service and judicial autopsies registering asthma deaths were also investigated. Results: The mean concentration of soybean aeroallergen was 159 U/m3 in the pre-intervention period and 39 U/m3 in the postintervention period (p < 0.0001). Significant differences in postintervention aeroallergen concentrations were found between days of soybean unloading (42 U/m3) and days of no unloading (33 U/m3), with p < 0.0001. No significant relationship was found between concentrations of environmental soybean aeroallergens and the number of emergency room admissions for asthma. Conclusions: Implementation of stricter protective measures in silos for the soybean unloading process has reduced the concentration of soybean dust in the atmosphere and evidences the effectiveness of the measures adopted.

Incidencia y características de las agudizaciones asmáticas en Barcelona (ASMAB II)

INTRODUCTION A study has been made on the incidence and clinical characteristics of asthma exacerbations (AE) seen in hospital emergency departments (HED) and domiciliary services (DS) in Barcelona. PATIENTS AND METHODS AEs were identified over a 56 day period during the months of October and November 2003 and the patients seen in university hospitals were interviewed. RESULTS A total of 262 AE were identified, 188 in hospital emergency departments and 82 in domiciliary, which was a mean of 4.6 AE/day, giving an incidence of 0.37 AA/10(5) inhabitants. This incidence was no different from that obtained in the same months in 2002 (P>0.05). The mean age (+/-standard deviation) of the 143 cases of AE seen in university hospitals was 41+/-17 years; 87/143 (60%) were women and 57/138 (41%), smokers. In 36/61 (59%) the AE started in the home; in 88/132 (61%) it began 24 hours before arriving at the hospital centre. In 78/123 cases (63%) slow onset of nasal catarrh was noted before the AE and a viral infection was suspected. Inhaled corticoids were given to 45/112 patients (40%), and only one added oral corticoids 12 hours before admission. The AE were mild in 38/75 cases (51%), moderate in 28/75 (37%), severe in 8/75 (11%) and almost fatal in one patient (1.3%). Around 10% (13/137) of patients (10%) were re-admitted. CONCLUSIONS The daily incidence of AE is 0.37/10(5) inhabitants. More than half of the exacerbations started after nasal catarrh and 11% of the AE were severe.

Two short interventions to reduce health care requirements in asthma patients. A multicentre controlled study (ASTHMACAP II)

BACKGROUND AND OBJECTIVE Asthma control is suboptimal. The objective of this study was to reduce health care requirements and work absenteeism. MATERIAL AND METHODS Multicenter randomized controlled study investigating asthma control, educational parameters, health service use, and absenteeism. After adjusting treatment according to GINA recommendations, control group patients (CG) followed their physicians recommendations, while intervention group (IG) patients additionally underwent a 5-minute educational intervention. This protocol was repeated at 3 months, and a final assessment was carried out at 6 months. RESULTS 479 patients (mean age 40 (SD 17) years) were recruited from primary care, and 334 completed the study. Comparatively, IG patients showed an improvement at the 3- and 6-month evaluations in the six educational parameters (P<0.001) and required fewer urgent visits to the GP for exacerbations [RR=0.49 (95% CI 0.26-0.90); P<0.04], and before the third evaluation, also in urgent GP visits [RR=0.25 (95% CI 0.12-0.52); P<0.001]. Before this third evaluation, IG had fewer scheduled visits to the GP [RR=0.48 (95% CI 0.28-0.82); P<0.003], and fewer visits to the primary care [RR=0.40 (95% CI 0.18-0.87); P<0.05], and to hospital emergency rooms [RR=0.13 (95% CI 0.04-0.42); P<0.001]. In addition, before the third evaluation, IG patients were less often absent from work [RR=0.22 (95% CI 0.05-0.98); P<0.03] or unable to work at home [RR=0.31 (95% CI 0.12-0.82); P<0.02]. CONCLUSIONS Two short educational interventions improved asthma education and decreased the use of health resources and work absenteeism.

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.

Incidence and Characteristics of Asthma Exacerbations in Barcelona (ASMAB II)

Abstract Introduction A study has been carried out on the incidence and clinical characteristics of asthma exacerbations (AE) seen in hospital accident and emergency departments (HAE 87/143 (60%) were women and 57/138 (41%) smokers. In 36/61 (59%) the AE started in the home; in 88/132 (61%) it began 24 hours before arriving at the hospital centre. In 78/123 cases (63%) slow onset of nasal cold was noted before the AE and a viral infection was suspected. Inhaled corticosteroids were administered to 45/112 patients (40%), and only one was also given oral corticosteroids 12 hours before admission. The AEs were mild in 38/75 cases (51%), moderate in 28/75 (37%), severe in 8/75 (11%) and almost fatal in one patient (1.3%). Around 10% (13/137) of patients (10%) were readmitted. Conclusions The daily incidence of AE is 0.37/10 5 inhabitants. More than half of the exacerbations started after nasal cold and 11% of the AEs were severe.