Biomedical subjects

Vicente Plaza

Publications and source records attributed to Vicente Plaza.

8 recordsLinked to original sources

PubMed2006

[Swelling of the bronchial mucose and quickness of onset in acute asthma].

BACKGROUND AND OBJECTIVE: The plasma protein leakage produced in the bronchial mucose of patients with acute asthma might be associated to the quickness of the onset exacerbation. The aim of this study was to study this association. PATIENTS AND METHOD: 22 patients with acute asthma were recruited, and the magnitude of plasma protein leakage was measured by the concentrations of albumin and alpha2-macroglobulin in sputum. RESULTS: Days of onset in acute asthma correlated negatively with albumin sputum concentration (r = -0.563; p = 0.006), alpha2-macroglobulin sputum concentration (r = -0.603; p = 0.003), and related relative coefficients of albumin sputum/serum (r = -0.538; p = 0.01) and alpha2-macroglobulin sputum/serum (r = -0.514; p = 0.014). When the sample was divided by the following daily cutoff: < or = 4, patients suffering from a shorter onset of acute asthma showed a higher concentration of alpha2-macroglobulin in sputum: mean (standard deviation) of 14.4 (18) versus 5.3 (5.4) (p = 0.028). CONCLUSIONS: Plasma protein leakage seems to play an important role in the inflammatory pathogenesis of asthma exacerbation. The quicker onset of asthma the more plasma protein extravasation to the bronchial lumen.

Adult↗

PubMed2006

Control of ventilation, breathlessness perception and alexithymia in near-fatal asthma.

Several studies have demonstrated impaired control of ventilation in some patients with near-fatal asthma (NFA). The objective of our study was to determine a possible relationship between alexithymia (a cognitive processing disorder), control of ventilation, and breathlessness perception in patients who had an NFA attack. We analyzed data from 100 subjects: 50 with NFA, 25 asthmatics without NFA, and 25 non-asthmatic controls. Ventilatory responses to hypoxia and hypercapnia were measured by the rebreathing technique in terms of slope of ventilation and mouth occlusion pressure (P0.1). Breathlessness perception was assessed with the Borg scale and alexithymia with the Toronto Alexithymia Scale (TAS). No statistical differences were observed between groups in breathlessness perception and ventilatory responses. The mean (SD) TAS score of 63.6 (14.9) in the NFA group was significantly higher than the score of 56.4 (12.1) in the non-asthmatic group (p = 0.007). More subjects with alexithymia were identified in the NFA group (24%) than in the non-NFA group (12%) or the non-asthmatic control group (12%). Although the presence of alexithymia did not correlate with poor ventilatory responses or breathlessness perception, it was associated with a larger number of previous hospitalisations: 6.2 (8.1) in the NFA group and 2.8 (4.8) in the non-NFA group (p = 0.036). In conclusion, the prevalence of alexithymia is higher among NFA patients than among asthmatics who have not experienced NFA attacks. Neither altered breathlessness perception nor ventilatory response to hypoxia seems to play a role in NFA, although alexithymia may favor poor clinical control.

Adult↗

PubMed2006

[Is the incidence of near-fatal asthma decreasing in Spain?].

OBJECTIVE: A number of studies have shown that both mortality and hospital admissions due to severe asthma have decreased in recent years in many parts of the world. However, the situation is Spain has not yet been analyzed. The aim of this study was to determine the incidence of very severe, near-fatal asthma in recent years in various Spanish hospitals. PATIENTS AND METHODS: A retrospective review of hospital records from 6 hospitals in 5 Spanish autonomous communities was conducted for the period 1997 to 2004 to determine the annual number of patients who required orotracheal intubation and mechanical ventilation due to an asthma attack. RESULTS: Of the 130 patients included in the study, 81 (62%) were women and 61 (47%) were aged between 51 and 75 years. The number of cases observed for the periods 2001-2002 and 2003-2004 (32 and 18, respectively) was significantly lower than that observed for the 1997-1998 and 1999-2000 periods (40 in both cases; P=.019). A significant increase in the incidence was observed in autumn and winter (n=81 [62%]; P=.018). Seventeen patients (13%) died and 8 (6%) developed serious sequelae. CONCLUSIONS: Although our sample of 6 hospitals is not widely representative of the entire population of hospitals in Spain, our findings strongly suggest a decrease in the incidence of near-fatal asthma in Spain in recent years.

Adolescent↗

PubMed2005

[Cost-effectiveness of an intervention based on the Global INitiative for Asthma (GINA) recommendations using a computerized clinical decision support system: a physicians randomized trial].

BACKGROUND AND OBJECTIVE: To assess the cost-effectiveness of an intervention based on the Global INitiative for Asthma (GINA) recommendations as compared to usual care. SUBJECTS AND METHOD: Pragmatic, cluster-randomised trial. Ten pneumologists and 10 general practitioners were randomised to an intervention or control group, recruiting 98 and 100 asthma patients, respectively. The intervention consisted of an education program and a clinical decision support system (CDSS) providing recommendations based on the GINA. The control group was characterized by usual care. Effectiveness was assessed by the health related quality of life as measured by the St. George's Respiratory Questionnaire (SGRQ). Costs were computed from the resource consumption recorded during a 12 months follow-up period, and the cost-effectiveness of the intervention was investigated in an incremental analysis. RESULTS: The intervention effect on the SGRQ total score was estimated as a 6.8 point reduction (95% confidence interval, 2.5-11.1; p = 0.0021), and a significant improvement in the SGRQ subscores and in the symptoms-free periods were also observed. From the social perspective, the mean total costs showed savings of -1,022 Euros (95% confidence interval, -2,165 to 122; p = 0.0795) in intervention group as compared to usual care. The incremental analysis confirmed that the intervention was cost-effective. CONCLUSIONS: The implementation of an asthma management program based in GINA recommendations improved the patient's health related quality of life and was cost-effective as compared to usual care.

Asthma↗

PubMed2005

Differences in asthma clinical outcomes according to initial severity.

UNLABELLED: Information on asthma morbidity outcomes in relation to the initial degree of severity is scarce. OBJECTIVE: To determine the differences in asthma morbidity, quality of life (QOL), and lung function outcomes according to the initial severity of the illness. METHOD: A cohort of 235 (102 mild, 69 moderate, and 64 severe) asthma patients was followed up for 3 years. The following parameters were collected for all patients: asthma morbidity, clinical data, spirometry, and St. George's Respiratory Questionnaire (SGRQ). RESULTS: A significant reduction in asthma morbidity and an improvement in pulmonary function and QOL were observed in the total group 3 years later. However, when the sample was stratified according to the initial severity, differences were observed between means in the third year compared with the first year in the following: number of primary care visits (patient/year) due to asthma: mild -1 (95% CI: -1.42 to -0.56); moderate -0.9 (-.92 to 0.18); and severe 1 (-0.23 to 2.27) (p = 0.020); FEV, (%): mild 8.5 (-5.3 to 11.6), moderate -0.3 (-3.2 to 2.6), and severe -1.5 (-5 to 2) (p < 0.001); and total score of the SGRQ: mild -9.8 (-12.2 to -7.3), moderate -9.1 (-12.9 to -5.2), and severe -7.9 (-11.9 to -3.9) (p < 0.001). CONCLUSIONS: We conclude that asthma prognosis varies according to the initial severity. Clinical, QOL, and pulmonary function outcomes in the mild asthma group are better than in the moderate and severe groups.

Adult↗

PubMed2004

Near-fatal asthma related to menstruation.

BACKGROUND: Menstruation has been suggested as a possible trigger of near-fatal asthma (NFA), but the evidence supporting this association remains weak. OBJECTIVE: We sought to assess the role of menstruation as a contributing factor in the development of NFA episodes in women of reproductive age. METHODS: Forty-four female patients of reproductive age with near-fatal attacks were enrolled in a multicenter study. Data on patient and clinical characteristics were collected. We also performed spirometric and allergy studies when the patients were in stable condition. RESULTS: Significantly more NFA episodes were observed on the first day of menstruation (11 [25%] patients) than on the remaining days (33 [75%] patients, P =.022), and patients who presented for care on the first day of menstruation used more inhaled salbutamol as rescue medication (9 [9.5] vs 1.8 [3.7] microg/d during the 7 days before the asthma exacerbation, P =.003). CONCLUSION: Menstruation might act as a contributing factor in the development of NFA episodes in patients with unstable asthma. Specific recommendations should be included in educational programs, and the self-management plans of asthmatic women of reproductive age should include the systematic recording of their asthma symptoms and pulmonary function in the perimenstrual phase.

Administration, Inhalation↗

PubMed2003

[Clinical characteristics of the fatal and near-fatal asthma in Alternaria alternata sensitized patients].

BACKGROUND AND OBJECTIVE: Some studies have pointed to Alternaria alternata as a trigger of fatal and near-fatal asthma (NFA) crises. The objective of this study was to determine the clinical characteristics of fatal and NFA crisis in patients sensitized to Alternaria. PATIENTS AND METHOD: One hundred ninety four patients with fatal or NFA attacks were enrolled in a multicenter (33 Spanish hospitals), prospective study. We gathered the characteristics and clinical course of the crises. We performed the following tests: spirometry, prick-test to common allergens, and specific IgE to Alternaria when patients were in stable condition. The sensitization test to Alternaria was performed when the prick-test and/or specific IgE levels were positive. RESULTS: Twenty (10%) patients were sensitized to Alternaria. When compared to non-sensitized patients, Alternaria sensitized patients were significantly younger, 35 (15) vs 50 (21) years old (p<0.001); their hospital admission length was shorter, 6.5 (5.5) against 9 (7) days (p=0.039); they had a higher number of deaths or severe neurological sequelae, 15 vs 3% (p=0.026); they had a higher sensitization frequency to the remaining allergens, 68 against 22% (p=0.003); and they exhibited a fewer bronchodilation response upon inhaled salbutamol, 6 vs 10% (p=0.013). CONCLUSIONS: The clinical characteristics of Alternaria sensitised, fatal-and NFA-patients, seem to identify a particular phenotype. Specific avoidance strategies could be useful to prevent fatal and NFA attacks.

Adolescent↗

PubMed2002

Patient perception and acceptability of multidose dry powder inhalers: a randomized crossover comparison of Diskus/Accuhaler with Turbuhaler.

This study was designed to provide information on correct use and preference to features and device handling of two multidose dry powder inhalers, the Diskus/Accuhaler and the Turbuhaler. A total of 169 powder-naive patients (mean age 40 years) with asthma or chronic obstructive pulmonary disease (COPD) were enrolled in a randomized crossover comparison of both inhalers. An effective use of either inhaler was assessed before (leaflet only) and after inhaler education. Ease of use especially during an attack and the presence of a dose counter were regarded as the most important features for an ideal inhaler. The percentage of correct handling maneuvers and the percentage of patients achieving 100% of correct maneuvers increased significantly (p < 0.001) after inhaler education in both devices, but percentage of correct use after the intervention was significantly higher for the Diskus/Accuhaler (92.6%) than for the Turbuhaler (89.8%; p = 0.036). Overall 60% of patients thought the Diskus/Accuhaler was preferable to the Turbuhaler (p < 0.001). The main reasons given were presence of a dose counter, perceived ease of use including ease of learning to use, design, and attached cover. Among those who preferred the Turbuhaler device, the main reason cited was small size, discreetness, and ease of holding. In the multivariate analysis, inhaler education (p = 0.005) and education level (p = 0.009) were significantly associated with the percentage of correct maneuvers. Age, sex, or tested inhaler showed no effect on appropriateness of the inhalation technique.

Administration, Inhalation↗