Gabriel García

Centro de Investigaciones Cardiovasculares

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Vicente Plaza

Universitat Autònoma de Barcelona

Bhumika Aggarwal

Singapore General Hospital

Santiago Quirce

Hospital La Paz Institute for Health Research

Isam Alobid

Universitat de Barcelona

Marina Blanco

Instituto de Investigaciones Biomédicas en Retrovirus y Sida

Christian Domingo

Corporació Sanitària Parc Taulí

Anurita Majumdar

Singapore General Hospital

Antonio Gómez‐Outes

Agencia Española de Medicamentos y Productos Sanitarios

Miguel Bergna

Isabela State University

Javier Plaza Zamora

Spanish Society of Family and Community Medicine

Cooperative Institutions

University of Chile

Sociedad Española de Neumología y Cirugía Torácica

GlaxoSmithKline (United Kingdom)

AVM Faculdade Integrada

Hospital Italiano La Plata

Hospital Universitario de Fuenlabrada

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Inserm

GlaxoSmithKline (India)

Royal Brompton Hospital

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A Simulation Study of the Effect of Clinical Characteristics and Treatment Choice on Reliever Medication Use, Symptom Control and Exacerbation Risk in Moderate–Severe Asthma

Advances in Therapy (2024)

Gabriel García Sven C. van Dijkman Ian Pavord Dave Singh Sean Oosterholt

The relationship between immediate symptom control, reliever medication use and exacerbation risk on treatment response and factors that modify it have not been assessed in an integrated manner. Here we apply simulation scenarios to evaluate the effect of individual baseline characteristics on treatment response in patients with moderate–severe asthma on regular maintenance dosing monotherapy with fluticasone propionate (FP) or combination therapy with fluticasone propionate/salmeterol (FP/SAL) or budesonide/formoterol (BUD/FOR). Reduction in reliever medication use (puffs/24 h), change in symptom control scores (ACQ-5), and annualised exacerbation rate over 12 months were simulated in a cohort of patients with different baseline characteristics (e.g. time since diagnosis, asthma control questionnaire (ACQ-5) symptom score, smoking status, body mass index (BMI) and sex) using drug–disease models derived from large phase III/IV clinical studies. Simulation scenarios show that being a smoker, having higher baseline ACQ-5 and BMI, and long asthma history is associated with increased reliever medication use (p < 0.01). This increase correlates with a higher exacerbation risk and higher ACQ-5 scores over the course of treatment, irrespective of the underlying maintenance therapy. Switching non-responders to ICS monotherapy to combination therapy after 3 months resulted in immediate reduction in reliever medication use (i.e. 1.3 vs. 1.0 puffs/24 h for FP/SAL and BUD/FOR, respectively). In addition, switching patients with ACQ-5 > 1.5 at baseline to FP/SAL resulted in 34% less exacerbations than those receiving regular dosing BUD/FOR (p < 0.01). We have identified baseline characteristics of patients with moderate to severe asthma that are associated with greater reliever medication use, poor symptom control and higher exacerbation risk. Moreover, the effects of different inhaled corticosteroid (ICS)/long-acting beta agonist (LABA) combinations vary significantly when considering long-term treatment performance. These factors should be considered in clinical practice as a basis for personalised management of patients with moderate–severe asthma symptoms. In this study we looked at how different factors affect the response to asthma treatment in people with moderate to severe asthma who are taking regular medication. Specifically, we wanted to quantify how much asthma duration, differences in the degree of symptom control and lung function, as well as smoking habit, body weight, and sex influence how well someone responds to regular maintenance therapy. Using computer simulations based on models obtained from data in a large patient population with moderate–severe asthma, we explored scenarios that reflect real-life management of patients undergoing treatment with inhaled corticosteroids alone or in combination with long-acting beta agonists over a 12-month period. We looked at how much reliever inhaler they use, how well they rate their asthma control, and how often they have asthma attacks. By considering these results together, we evaluated how well the treatments work on ongoing symptoms and/or reduce the risk of future asthma attacks. Our simulations showed that smokers, people with higher asthma symptom scores, who are obese, and have a longer history of asthma tend to use their reliever inhalers more often. This was linked to a higher risk of having asthma attacks and worse symptom control. Switching those patients who do not respond well to their initial treatment with corticosteroid to combination therapy reduced how much reliever inhaler they need. Also, the effects of fluticasone propionate/salmeterol combination therapy were greater than budesonide/formoterol. In conclusion, our study found that certain patient characteristics can predict how well someone responds to asthma treatment.

Asthma Exacerbations

10.1007/s12325-024-02914-w

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Cien años de soledad: edición conmemorativa

Gabriel García

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Guía de práctica clínica de la enfermedad pulmonar obstructiva crónica (EPOC) ALAT-2014: Preguntas y respuestas

Archivos de Bronconeumología (2015)

María Montes de María Victorina López Varela Agustín Acuña Eduardo Schiavi María Alejandra Rey

Lama

Clinical Practice

10.1016/j.arbres.2014.11.017

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Citations (44)

Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Latin America: An Expert Perspective on Knowledge Gaps

Pulmonary Therapy (2024)

Ricardo de Amorim Corrêa Francisco Arancibia Renato de Ávila Kfouri Alberto Chebabo Gabriel García

Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.

10.1007/s41030-024-00253-3

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Citations (5)

Spanish Asthma Management Guidelines (GEMA) VERSION 5.1. Highlights and Controversies.

Vicente Plaza Isam Alobid Cesáreo Álvarez Marina Blanco Jorge Ferreira

Asthma management

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Exploring Clinical Remission in Moderate Asthma – Perspectives from Asia, the Middle East, and South America

Pulmonary Therapy (2024)

Kittipong Maneechotesuwan Bhumika Aggarwal Gabriel García Amir Soltani Hugo Neffen

Clinical remission is a relatively new concept in asthma but recent research initiatives suggest it could be an ambitious and achievable therapeutic target for patients with asthma.

10.1007/s41030-024-00262-2

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Citations (1)

Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios)

Archivos de Bronconeumología (2005)

Luis Borderías M. Zabaleta Murguionda José Miranda C. Pellicer Císcar Jesús Hernández Hernández

10.1157/13075999

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Citations (37)

RDL 8/2014 de Aprobación de Medidas para el Crecimiento la Competitividad y la Eficiencia, Disposición Adicional Vigesimocuarta: Funciones de los Juzgados y Tribunales en Materia de Registro Civil

Leyes Españolas (2015)

Gabriel García