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- Asthma is more frequently associated with non-allergic than allergic rhinitis in Portuguese patientsPublication . Lourenço, Olga; Fonseca, AM; Barata, Luis TabordaBackground: Rhinitis prevalence is increasing worldwide and is frequently associated with asthma, for which it is a risk factor. The aims of the study were to characterise the adult population with rhinitis attending the Cova da Beira Hospital Allergy Clinic, and to assess the relationship between rhinitis and asthma. Methods: In total, 686 patients were characterised by clinical history and anterior rhinoscopy, and classified according to international guidelines. Atopy was determined by skin prick testing to aeroallergens and quantification of specific IgE. Results: Seventy two percent of patients had allergic rhinitis (AR), and 28% had non-allergic rhinitis (NAR). NAR was more frequently associated with older age, perennial symptoms and female gender. NAR patients more frequently had bronchial asthma. In addition, more NAR than AR patients also had drug allergy, pharyngitis, sinusitis and urticaria. AR patients with nasal polyps more frequently had asthma. Grass pollen and mites were the major sensitisers for AR patients. Sensitisation profiles were not significantly different between urban- and ruralbased AR patients. Conclusions: Asthma was more frequently associated with non-allergic than with allergic rhinitis. The two types of rhinitis did not differ in clinical severity. Although sensitisation profiles were not different between the urban and rural patients, allergic rhinitis prevalence was higher in urban patients.
- EPOS2020: development strategy and goals for the latest European Position Paper on RhinosinusitisPublication . Fokkens, W; Desrosiers, M; Harvey, R; Hopkins, C; Mullol, J; Philpott, C; Alobid, I; Lima, W T Anselmo; Bachert, Claus; Baroody, F; Bernal-Sprekelsen, M; von Buchwald, C; Cervin, A; Cohen, Noam; Constantinidis, J.; De Gabory, L.; Douglas, R; Gevaert, P; Hafner, A; Hellings, Peter; Joos, G; Kalogjera, L; Kern, R; Knill, A; Kocks, J; Landis, Basile; Limpens, J.; Lebeer, S.; Lourenço, Olga; Matricardi, P M; Meco, C; O Mahony, L.; Reitsma, S; Ryan, D; Schlosser, R; Senior, B; Smith, T; Teeling, T.; Tomazic, Peter Valentin; Toppila-Salmi, S; Wang, D Y; Wang, D; Zhang, L; Lund, VBackground: The European Position Papers on Rhinosinusitis from 2005, 2007 and 2012 have had a measurable impact on the way this common condition with high impact on quality of life is managed around the world. EPOS2020 will be the latest iteration of the guideline, addressing new stakeholders and target users, presenting a summary of the latest literature and evolving treatment modalities, and formulating clear recommendations based on all available evidence. Methodology: Based on the AGREE II framework, this article demonstrates how the EPOS2020 steering group will address six key areas to ensure consistency in quality and presentation of information in the latest rhinosinusitis clinical practice guideline: scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; recommendations and applicability; editorial independence. Results: By analysing the guidance from AGREE II, we formulated a detailed development strategy for EPOS2020. We identify new stakeholders and target users and ratify the importance of patient involvement in the latest EPOS guideline. New and expanded areas of research to be addressed are highlighted. We confirm our intention to use mixed methodologies, combining evidencebased medicine with real life studies; when no evidence can be found, use Delphi rounds to achieve clear, inclusive recommendations. We also introduce new concepts for dissemination of the guideline, using Internet and social media to improve accessibility. Conclusion: This article is an introduction to the EPOS2020 project, and presents the key goals, core stakeholders, planned methodology and dissemination strategies for the latest version of this influential guideline.
- Haemodialysis in Diabetic Patients Modulates Inflammatory Cytokine Profile and T Cell Activation StatusPublication . Almeida, Ana Catarina Silva; Lourenço, Olga; Fonseca, A. M.Diabetic nephropathy (DN) is a common complication in patients with diabetes, and most of them need renal replacement therapy such as haemodialysis (HD). These patients have a high tendency to develop infections and exhibit anomalies in the immune system. The objective of this study was to assess the expression of activation-related markers on T cells, as well as to quantify inflammatory cytokines, before and after a single HD session in DN patients. The study involved DN patients under HD treatment who signed an informed consent form. Blood samples before and after one HD session were collected, to analyse the expression of CD25, CD69 and CD71 in T cells. We also quantified IL-12p70, IL-8, IL-10, IL-1β, TNF-α and IL-6 in serum samples using the cytometric bead array technique. After the HD session, there was an increase in the CD4/CD8 ratio due to significant alterations in both subsets. The relative percentage of CD25+ cells and CD8+ CD25+ increased significantly after the HD session, while the relative percentage of CD69 T cells decreased. There was a significant decrease in the CD25 mean fluorescence intensity values for CD4+ T, as well as in the case of CD71 in T cells after the HD session. Regarding cytokine synthesis, we found a significant increase in IL-10 and IL-6 and a decrease in IL-8 after HD session. This study showed that a HD session in DN patients affects the T cell activation status in the two major subpopulations and differentially modulates the production of inflammatory cytokines.
- Managing Allergic Rhinitis in the Pharmacy: An ARIA Guide for Implementation in PracticePublication . Lourenço, Olga; Bosnic-Anticevich, Sinthia; Costa, Elísio; Fonseca, Joao A; Menditto, Enrica; Cvetkovski, Biljana; Kritikos, Vicky; Tan, Rachel; Bedbrook, Anna; Scheire, Sophie; Bachert, Claus; Białek, Sławomir; Briedis, Vitalis; Boussery, Koen; Canonica, G Walter; Haahtela, Tari; Kuna, Piotr; Novellino, Ettore; Samolinski, Boleslaw; Schünemann, Holger J; Wallace, Dana; Bousquet, JeanThe paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines.
- Demographic, laboratory and clinical characterisation of adult portuguese asthmatic patientsPublication . Lourenço, Olga; Fonseca, A. M.; Barata, Luis TabordaAsthma is a heterogeneous chronic inflammatory condition characterised by reversible airway obstruction and hyperresponsiveness associated with underlying bronchial inflammation and structural changes. It represents an increasing health problem and is a huge burden on the patients, their families and society. The aim of the study was to characterise the adult asthmatic population attending a Hospital Allergy Clinic between the years of 2003 and 2006.
- Evaluation of allergic rhinitis and asthma control in a Portuguese community pharmacy settingPublication . Lourenço, Olga; Calado, Sofia; Sá-Sousa, Ana; Fonseca, JoãoBACKGROUND: Allergic rhinitis and asthma (ARA) are frequent respiratory diseases that often coexist, causing a high social and economic impact. It is important to maintain ARA disease control to reduce the disease burden. OBJECTIVE: To assess control in patients with 1 or both pathologies through the application of validated questionnaires at community pharmacies. METHODS: A cross-sectional study was conducted in the pharmacies of the Portuguese county of Covilhã (located in the central region of Portugal with about 53,000 inhabitants). Subjects aged between 18 and 70 years who presented a prescription for an asthma and/or allergic rhinitis medication were invited to participate in the study by responding to a questionnaire that included the Control of Allergic Rhinitis and Asthma Test (CARAT). The CARAT is a validated tool to simultaneously assess the control of ARA with scores that range from 0 to 30 points, 0 meaning the worst and 30 meaning the best possible control of disease. RESULTS: Of the 224 participants, 58% were female and the median age was 48.5 years. The median CARAT score was 19 (mean = 17.8 ± 5136.4), and 87% of participants had a score < 25, indicating noncontrolled disease. Female participants, the elderly, and those with less school education responded with scores that demonstrated significantly less disease control. CONCLUSIONS: Using a simple self-assessment questionnaire, such as the CARAT, pharmacists can help identify patients with uncontrolled ARA disease, which is an important first step to change patients’ knowledge about their disease, with an ultimate goal of improving ARA outcomes.
- Prevalence and risk factors for food allergy in older people: protocol for a systematic reviewPublication . Dias, Inês Laia; Lozoya-Ibáñez, Carlos; Skypala, Isabel; Gama, Jorge; Nurmatov, Ulugbek; Lourenço, Olga; Barata, Luis TabordaStudies suggest that the prevalence of food allergy may be increasing worldwide. Results regarding the prevalence and features of adverse food reactions older people have, however, scarcely been analysed in the literature. Thus, the objective of the present systematic review will be to describe the prevalence of food allergy in older individuals, its risk factors, clinical features, as well as the most frequently and commonly involved foods.
- Inhaler training and asthma knowledge are associated with a higher proportion of patients with correct inhaler technique in young but not in elderly asthmatic patientsPublication . Ferreira, Eduardo Freitas; Pascoal, Adriana dos Santos; Silva, Patrícia; Lourenço, Olga; Valente, Maria La Salete; Valente, Maria de Jesus; Loureiro, Marli; Gama, Jorge; Fonseca, Joao A; Taborda Barata, LuisObjective: Incorrect inhaler usage is frequent, particularly in elderly asthmatic patients. This study aimed at comparing inhaler technique errors and their determinants, as well inhaler technique self-perception versus real performance, between elderly and non-elderly asthmatics. Methods: Cross-sectional assessment of 92 elderly and 100 non-elderly asthmatics followed at specialty clinics. A standardized questionnaire was applied and inhaler technique demonstration was requested. Errors were assessed using checklists based on manufacturers’ instructions and inhaler technique was graded as correct, acceptable or incorrect. Chi-Square Test and Fischer’s Exact Test were used for comparative analysis of nominal variables. A p value equal to or less than 0.05 was considered statistically significant. Results: Inhaler technique was correct in a minority of elderly and young patients, without significant differences between study groups. Only 11.1% of the elderly who classified their inhaler as easy and 12.7% who stated their technique was correct had no errors. Previous regular inhaler training was associated with better actual performance in young but not in elderly patients. Conclusion: Our study showed that in spite of regular follow up at specialized outpatient clinics, inhaler devices are associated with a high frequency of errors in elderly and non-elderly asthmatics. In addition, most patients tend to overestimate their technique as correct. Finally, previous, frequent training was associated with a significantly higher percentage of patients showing correct or acceptable technique but only in non-elderly asthmatics, which suggests that elderly asthmatics may need specifically tailored inhaler education programs.
- Patient‐centered digital biomarkers for allergic respiratory diseases and asthma: The ARIA‐EAACI approach – ARIA‐EAACI Task Force ReportPublication . Bousquet, Jean; Shamji, Mohamed; Anto, Josep M.; Schünemann, Holger; Canonica, Giorgio Walter; Jutel, Marek; Del Giacco, Stafano; Zuberbier, Torsten; Pfaar, Oliver; Fonseca, Joao A; Pinto, Bernardo Sousa; Pétré, Benoit; Pham‐Thi, Nhân; Puggioni, Francesca; Quirce, Santiago; Roche, Nicolas; Rouadi, Philip; Sousa, Ana Sá; Sagara, Hironori; Sastre, Joaquin; Scichilone, Nicola; Sheikh, Aziz; Sova, Milan; Ulrik, Charlotte Suppli; Taborda Barata, Luis; Todo-Bom, Ana; Torres, María Jose; Tsiligianni, Ioanna; Usmani, Omar; Valovirta, Erkka; Vasankari, Tuula; Vieira, Rafael José; Wallace, Dana; Waserman, Susan; Zidarn, Mihaela; Yorgancıoglu, Arzu; Zhang, Luo; Chivato, Tomás; Ollert, Markus; Klimek, Ludger; Czarlewski, Wienczyslawa; Bedbrook, Anna; Amaral, Rita; Ansotegui Zubeldia, Ignacio Javier; Bosnic-Anticevich, Sinthia; Braido, Fulvio; Loureiro, Cláudia Chaves; Gemicioglu, Bilun; Haahtela, Tari; Kulus, Marek; Kuna, Piotr; Kupczyk, Maciej; Matricardi, Paolo Maria; Regateiro, Frederico S.; Samoliński, Bolesław; Sofiev, Mikhail; Toppila-Salmi, Sanna; Valiulis, Arunas; Ventura, Maria Teresa; Bárbara, Cristina; Bergmann, Karl-Christian; Bewick, Michael; Blain, Hubert; Bonini, Matteo; Boulet, Louis-Philippe; Bourret, Rodolphe; Brusselle, Guy; Brussino, Luisa; Buhl, Roland; Cardona, Victoria; Casale, Thomas; Cecchi, Lorenzo; Charpin, Denis; Cherrez Ojeda, Ivan; Chu, Derek K; Cing, Cemal; Costa, Elísio; Cruz, Álvaro A.; Devillier, Philippe; Dramburg, Stephanie; Fokkens, Wytske; Gotua, Maia; Heffler, Enrico; Ispayeva, Zhanat; Ivancevich, Juan Carlos; Joos, Guy; Kaidashev, Igor; Kraxner, Helga; Kvedarienė, Violeta; Larenas Linnemann, Désirée; Laune, Daniel; Lourenço, Olga; Louis, Renaud; Mäkelä, Mika J.; Makris, Michael; Maurer, Marcus; Melén, Erik; Micheli, Yann; Almeida, Mário Morais; Mullol, Joaquim; Niedoszytko, Marek; O'Hehir, Robyn; Okamoto, Yoshitaka; Olze, Heidi; Papadopoulos, Nikolaos G.; Papi, Alberto; Patella, VincenzoBiomarkers for the diagnosis, treatment and follow-up of patients with rhinitis and/ or asthma are urgently needed. Although some biologic biomarkers exist in specialist care for asthma, they cannot be largely used in primary care. There are no validated biomarkers in rhinitis or allergen immunotherapy (AIT) that can be used in clinical practice. The digital transformation of health and health care (including mHealth) places the patient at the center of the health system and is likely to optimize the practice of allergy. Allergic Rhinitis and its Impact on Asthma (ARIA) and EAACI (European Academy of Allergy and Clinical Immunology) developed a Task Force aimed at proposing patient-reported outcome measures (PROMs) as digital biomarkers that can be easily used for different purposes in rhinitis and asthma. It first defined control digital biomarkers that should make a bridge between clinical practice, randomized controlled trials, observational real-life studies and allergen challenges. Using the MASK-air app as a model, a daily electronic combined symptom-medication score for allergic diseases (CSMS) or for asthma (e-DASTHMA), combined with a monthly control questionnaire, was embedded in a strategy similar to the diabetes approach for disease control. To mimic real-life, it secondly proposed quality-of- life digital biomarkers including daily EQ-5D visual analogue scales and the bi-weekly RhinAsthma Patient Perspective (RAAP). The potential implications for the management of allergic respiratory diseases were proposed.
- SGLT2i and GLP1RA effects in patients followed in a hospital diabetology consultationPublication . Lopes, António Cabral; Lourenço, Olga; Morgado, Manuel Augusto Nunes Vicente PassosAbstract Background: We aimed to investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) in patients with type 2 diabetes mellitus (T2DM) in clinical practice. Research design and methods: A total of 340 patients were included. Data on age, gender, antidiabetic medications, and bioanalytical parameters were collected at baseline and one year later. Were analyzed estimated glomerular filtration rate (eGFR), blood sodium and potassium levels, blood pressure, weight, cardiovascular risk, and glycated hemoglobin (HbA1c). Results: Patients treated with SGLT2i exhibited a significant improvement in eGFR at the endpoint compared to baseline (p = 0.006). Both treatment groups experienced reductions in systolic blood pressure at the endpoint; especially patients treated with SGLT2i (p = 0.0002). GLP1RA treatment resulted in a statistically significant weight reduction from baseline to endpoint (p < 0.0001), with a higher percentage of patients achieving ≥ 5% weight loss compared to the non-GLP1RA group (33.6% vs. 19.8%). Both SGLT2i and GLP1RA treatments significantly reduced cardiovascular risk scores (p = 0.004 and p = 0.002, respectively). Additionally, both treatments were associated with a significant reduction in HbA1c levels at the endpoint (p = 0.010 and p = 0.002, respectively). Conclusions: Our findings suggest that SGLT2i and GLP1RA offer beneficial effects in patients with T2DM.