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São João da Madeira, Portugal

Alfarrobaa S.,Servico de Pneumologia | Videiraa W.,Servico de Pneumologia | Galvao-Lucasa C.,Servico de Pneumologia | Carvalhob F.,Servico de Imunoalergologia | Barbaraa C.,Servico de Pneumologia
Revista Portuguesa de Pneumologia | Year: 2014

Background: It is widely recognized that asthma control is not always possible in patients with very severe asthma despite available treatment. The aim of this study was to evaluate the efficacy of Omalizumab on asthma control as an add-on therapy in patients from the «Severe Asthma Outpatient Clinic» of Pulido Valente Hospital in Lisbon, Portugal. Methods: A retrospective study was conducted to assess asthma control by the ACT score and by GINA classification, frequency and severity of exacerbations, medication use and pulmonary function in patients treated with Omalizumab. Clinical information was collected from medical records from the start of treatment and at 6, 12 and 24 month follow-up. Results: 26 patients started treatment with Omalizumab, all (100%) were classified by GINA with uncontrolled asthma prior to treatment. Mean ACT score was 11.5. All patients had treatment with fixed-dose ICS and LABA and 34.6% also had an anti-cholinergic inhaler. 42.3% of patients were also treated with oral glucocorticosteroids for control. Patients reported an average of 1.8 moderate and 3.1 severe exacerbations/year. Statistical differences were found at 6 month follow-up in most end-points: GINA score improved: 60.9% of patients with partially controlled asthma and only 39.1% with uncontrolled asthma (Wilcoxon 0.00); ACT score improved to 19.52 (Wilcoxon 0.00); mean FEV1 improved to 76.7% (Wilcoxon 0.025); the proportion of patients requiring oral glucocorticosteroid therapy reduced to 17.4% (Wilcoxon 0.014); and the number of moderate and severe exacerbations also decreased to 1.04 and 1.83 respectively (Wilcoxon 0.007; Wilcoxon 0.002 respectively). Conclusions: The current analysis shows evidence that omalizumab is successful in improving asthma control as an add-on therapy GINA step 5 treatment. © 2013 Sociedade Portuguesa de Pneumologia. Source

Agache I.,Transylvania University | Bilo M.,Allergy Unit | Braunstahl G.-J.,Pulmonology | Delgado L.,University of Porto | And 9 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2015

The allergen challenge test has been the mainstay of diagnosis of allergic diseases for a long time since it offers a direct proof of the clinical relevance of a particular allergen for the allergic disease symptoms and severity. Standardisation and availability for daily practice (including safety issues) are still to be refined but most of the challenge tests have safely crossed the border from research tools to diagnostic tests available for daily practice for a well trained clinical staff. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Source

Rubio M.,Montpellier University | Bousquet P.-J.,Montpellier University | Bousquet P.-J.,University of Nimes | Gomes E.,Servico de Imunoalergologia | And 2 more authors.
Clinical and Experimental Allergy | Year: 2012

Background: Proven IgE or T-cell mediated drug hypersensitivity reactions (DHRs) seem less common in children compared with adults. However, this has never been proved by data. Objective: To determine and compare proven DHR prevalence in children and adults. Methods: Using the DAHD (Drug Allergy and Hypersensitivity Database) cohort, children with proven DHRs were compared with adults. The international EAACI-ENDA recommendations were followed. Patients were divided into four groups: index reaction and test during childhood (C/C), index reaction at childhood and test at adulthood (C/A), index reactions at childhood and adulthood and test at adulthood (CA/A), index reaction and test at adulthood (A/A). Results: A total of 3275 patients (67.9% female), comprising a total of 4370 patient-episodes, were evaluated (74.5% belonged to the A/A group). Prevalence of positive tests was 15.2% (95%CI, 14.1-16.2) for all tested classes, 10.6% (8.3-13.0) for C/C, 10.6% (7.5-13.6) for C/A, 22.1% (12.8-31.3) for CA/A and 16.5% (15.2-17.8) for A/A. The prevalence was lower in group C/C compared with groups A/A (P < 0.0001) and CA/A (P = 0.003). It was also lower in group C/A compared with the two latter groups (respectively P = 0.003 and P = 0.005). Significant differences were found for maculopapular exanthemas only, and not for urticaria/angiœdema and anaphylaxis. The difference was mainly observed with β-lactams and not for NSAIDs. Conclusion and Clinical Relevance: Suspicions of DHRs are less likely to be confirmed in children. © 2011 Blackwell Publishing Ltd. Source

Vieira T.,Servico de Imunoalergologia | Belchior I.,Servico de Pneumologia | Almeida J.,Servico de Pneumologia | Hespanhol V.,Servico de Pneumologia | And 3 more authors.
Revista Portuguesa de Pneumologia | Year: 2011

Aims: To determine patterns of ambulatory oxygen (AO) use among patients with chronic obstructive pulmonary disease (COPD) and interstitial lung diseases, and analyze the effects of this therapy on daily activities and quality of life (QoL). Patients and methods: We included 37 consecutive adult patients on AO by liquid O 2 for more than three months prescribed by hospital pulmonologists. The acute response to O 2 was evaluated through the standardized 6-minutes walk test (6MWT) and the Borg dyspnea scale during the O 2 pre-intervention trial. Time spent away from home, compliance, side effects and QoL (SF-36 v1 questionnaire) were evaluated by a telephone interview during the follow-up period. Time spent away from home and QoL comparisons after and before the intervention were assessed retrospectively. Results: COPD was the most frequent diagnosis (54%), and 29 (78%) patients were already on long-term oxygen therapy. In relation to the acute response to O 2 evaluated through the 6MWT, there were significant improvements in the distance walked (p < 0.001), in resting SatO 2 (p < 0.001), in minimal SatO 2 (p < 0.001), and in percentage of desaturation (p = 0.002), independently of the diagnosis. No differences were observed in Borg dyspnea scale. AO was used for a mean of 4.1 h/day. Patients spent fewer hours per day away from home after AO treatment (3.5 h vs. 5.0 h, p < 0.025). Six patients (16%) were not compliant to the prescription, and 54% mentioned side effects. We verified low scores in almost all of the sub-domains of SF-36 QoL questionnaire, with a significant improvement noted only in emotional role (p = 0.032). Improvement in health global state was described by 49% of patients. © 2011 Published by Elsevier España. Source

Martins M.,Servico de Imunoalergologia | Pereira N.,Servico de Pediatria | Reis R.,Servico de Imunoalergologia | Tomaz E.,Servico de Imunoalergologia
Revista Portuguesa de Imunoalergologia | Year: 2015

Background: Acute bronchiolitis is a frequent pathology in the first months of life. Most of the children with bronchiolitis are treated in outpatient care, but some develop severe respiratory symptoms requiring hospitalization. Risk factors for severity as well as for wheezing recurrence remain poorly understood. The objective of this study was to analyze the relevance of some intrinsic variables of the patient, environmental variables and the severity of the first episode of bronchiolitis requiring hospitalization with the recurrence of wheezing in the following 12 months. Methods: We made a review of clinical files belonging to 79 children under six months of age hospitalized by their first episode of bronchiolitis. The intrinsic variables analyzed were gender, age, race, weight at birth, prematurity and parental atopy. The environmental variables evaluated were breastfeeding, parental smoking, number of siblings and indoor pets. Evaluated as indicators of severity of bronchiolitis were the following hospital data: days of hospitalization, lowest peripheral oxygen saturation, therapeutics, viral etiology, complications and prophylactic treatment initiated and referral to specialist appointments. Data about the twelve months follow‑up were collected from clinical files and complemented by interviews with the parents. The role of studied variables on wheezing recurrence was evaluated using the Multiple Regression Analysis. Results: Forty three per cent of children (n=34) repeated 1 to 3 episodes of wheezing and 9% of children (n=7) had recurrent wheezing (> 3 episodes of acute bronchiolitis). Children with atopic parents had higher number of recurrences (63%) than children with non‑atopic parents (33%). Conclusions: From variables studied only parental atopy showed significant association with wheezing recurrence (p<0,01). © 2015, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Source

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