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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Fe de errores de «Incorporando nuevas evidencias sobre medicamentos inhalados en la EPOC. Asociación Latinoamericana de Tórax (ALAT) 2019» [Arch Bronconeumol. 2020;56(2):106]

Archivos de Bronconeumología (2020)

María Montes de María Victorina López Varela Agustín Acuñaa Eduardo Schiavi Alejandro Casas

10.1016/j.arbres.2020.07.002

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Citations (0)

Consensus on mild asthma management: results of a modified Delphi study

Journal of Asthma (2022)

Christian Domingo Gabriel García Bilun Gemicioğlu Giap Vu Van Désirée Larenas‐Linnemann

In order to understand the role of regular controller inhaled corticosteroids (ICS) versus as-needed ICS-formoterol in managing mild asthma, we performed a modified Delphi procedure.Opinions from 16 respiratory experts to three surveys and during a virtual scientific workshop helped to develop final consensus statements (pre-defined as 70% agreement).Thirteen participants completed all rounds (response rate 81%). At the end of the procedure, there was final consensus on: regular daily ICS being the recommended treatment approach in mild persistent asthma, with better symptom control and robust long-term clinical data compared with as-needed ICS-formoterol (85%); to avoid noncompliance, frequently seen in mild asthma patients, regular ICS dosing should be accompanied by ongoing education on treatment adherence (100%); treatment aims should be targeting asthma control (92%) and reduction of exacerbation risk (85%). No consensus was reached on whether GINA or national guidelines most influence prescribing decisions.It is important to encourage patients to be adherent and to target both asthma control and exacerbation risk reduction. There is robust clinical evidence to support proactive regular dosing with ICS controller therapy plus as-needed short-acting beta-agonists for the management of patients with mild asthma.

Delphi Method

Asthma management

10.1080/02770903.2022.2034850

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Citations (9)

[Translated article] Spanish Asthma Management Guidelines (GEMA) v.5.1. Highlights and Controversies

Archivos de Bronconeumología (2022)

Vicente Plaza Isam Alobid Cesáreo Álvarez Marina Blanco Jorge Ferreira

Asthma management

10.1016/j.arbres.2021.05.032

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Ley 29/2014 de 28 de Noviembre de Régimen del Personal de la Guardia Civil, Art. 77: Clasificación de los Destinos

Leyes Españolas (2014)

Gabriel García

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Asthma control conundrum in clinical practice – Data from a two-stage Delphi survey and literature review

Data in Brief (2023)

Giorgio Walter Canonica Antonio Spanevello Luis Pérez de Llano Christian Domingo John Blakey

Definitions and measures of asthma control used in clinical trials and practice often vary, as highlighted in the manuscript, "Is asthma control more than just an absence of symptoms? An expert consensus statement". Furthermore, the authors discussed differences between patients and healthcare professionals (HCPs) in terms of understanding and managing asthma. Given these disparities, there is a need for consensus regarding what constitutes well-controlled asthma and, especially, how best it can be measured and recorded. In the current work, we describe our data and provide more detail on the methodology from a two-stage Delphi survey and a structured literature review, which were designed to reach a consensus definition of asthma control and alleviate misalignments between patients and HCPs. Survey data were collected using a two-stage Delphi technique; a method used to collate expert opinions over a series of sequential questionnaires to reach a consensus. The collated Delphi survey data were compared with results from a comprehensive, structured literature review of 216 publications, to assess if there was a correlation between existing guidance and measures of asthma control used in clinical trials and standard clinical practice. In order to collate and interpret findings from the Delphi survey, responses from 82 panelists (73 HCPs and 9 authors) were qualitatively analyzed, quantitatively categorized, and presented as percentages or counts in Excel databases, which are detailed in the current work. Searches conducted using PubMed and Cochrane identified 664 manuscripts, and Embase was used to identify 89 congress abstracts. After applying a stringent screening method using predefined key words, the structured literature review consisted of 185 peer-reviewed manuscripts and 31 congress abstracts, and assessed existing guidance and measures of asthma control used in clinical trials. In this publication, we provide further insight into the predefined keywords, search strings, and strategy applied to identify manuscripts and congress abstracts for inclusion/exclusion, and detail methods for data extraction. Together, the data from the Delphi survey and structured literature review aimed to provide greater insights into challenges and approaches in achieving asthma control in clinical practice, with the potential for results to be used to guide a universally accepted definition and measure of asthma control that can be used and understood by patients, HCPs, and researchers. Qualitative and quantitative methodology and analysis from the Delphi survey and literature review search strategy can potentially be used to identify disparities and explore expert opinion and relevant literature in other therapeutic areas to guide a consensus where disparities exist.

Delphi Method

Delphi

10.1016/j.dib.2023.109422

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Incorporando nuevas evidencias sobre medicamentos inhalados en la EPOC. Asociación Latinoamericana de Tórax (ALAT) 2019

Archivos de Bronconeumología (2019)

María Montes de María Victorina López Varela Agustín Acuña Eduardo Schiavi Alejandro Casas

10.1016/j.arbres.2019.09.023

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New Versus Old: The Impact of Changing Patterns of Inhaled Corticosteroid Prescribing and Dosing Regimens in Asthma Management

Advances in Therapy (2022)

Dave Singh Gabriel García Kittipong Maneechotesuwan Peter T. Daley‐Yates Elvis M. Irusen

Inhaled corticosteroid (ICS)-containing therapies are the mainstay of pharmacological management of asthma. They can be administered alone or in combination with a long-acting bronchodilator, depending on asthma severity, and may also be supplemented with short-acting bronchodilators for as-needed rescue medication. Adherence to asthma therapies is generally poor and characterized by underuse of ICS therapies and over-reliance on short-acting bronchodilators, which leads to poor clinical outcomes. This article reviews efficacy versus systemic activity profiles for various dosing regimens of budesonide (BUD) and fluticasone propionate (FP). We performed a structured literature review of BUD and FP regular daily dosing, and BUD/formoterol (FOR) as-needed dosing, to explore the relationship between various dosing patterns of ICS regimens and the risk–benefit profile in terms of the extent of bronchoprotection and cortisol suppression. In addition, we explored how adherence could potentially affect the risk–benefit profile, in patients with mild, moderate, and moderate-to-severe asthma. With a specific focus on BUD or FP-containing treatments, we found that regular daily ICS and ICS/long-acting β2-agonist (LABA) dosing had a greater degree of bronchoprotection than as-needed BUD/FOR dosing or BUD/FOR maintenance and reliever therapy (MART) dosing, and still maintained low systemic activity. We also found that the benefits of regular daily ICS dosing regimens were diminished when adherence was low (50%); the shorter duration of bronchoprotection observed was similar to that seen with typical as-needed BUD/FOR usage. These findings have implications for aiding clinicians with selecting the most suitable treatment option for asthma management, and subsequent implications for the advice clinicians give their patients. Inhaled corticosteroid (ICS)-containing therapies can be administered in a variety of ways depending on a patient's asthma severity. Patients with mild asthma tend to experience symptom relief with as-needed or regular daily use of an ICS alone, whereas patients with more severe asthma may require regular daily use of an ICS plus a long-acting β2-agonist (LABA) to experience sufficient asthma control. However, failure to correctly adhere to ICS-containing therapies or an over-reliance on short-acting bronchodilators for symptom relief hinders optimal asthma management, thus negatively affecting overall patient health and wellbeing. Understanding how different dosing regimens affect the degree of bronchoprotection (efficacy) and cortisol suppression (systemic activity) of ICS treatments would benefit physicians by helping them to prescribe the most appropriate treatment for their patient's asthma. We performed a structured literature review of two ICS molecules—budesonide (BUD) (alone and combined with formoterol [FOR]) and fluticasone propionate (FP)—to explore the relationship between various ICS dosing regimens, and then used these findings to construct models for ICS risk–benefit profiles. Our models factored in different ICS dosing regimens—as-needed, regular daily dosing, and maintenance and reliever therapy (MART)—and various degrees of treatment adherence. We found that regular daily ICS and ICS/LABA dosing provided better bronchoprotection than as-needed BUD/FOR dosing or BUD/FOR MART dosing, but this benefit was diminished with low adherence. Regular daily dosing maintained low cortisol suppression, which indicated a fairly low risk of negative side effects. Our findings have subsequent implications for optimizing treatment in patients with asthma.

Fluticasone propionate

Fluticasone

Salmeterol

10.1007/s12325-022-02092-7

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Citations (25)

Systematic literature review of traits and outcomes reported in randomised controlled trials of asthma with regular dosing of inhaled corticosteroids with short-acting β2-agonist reliever, as-needed ICS/formoterol, or ICS/formoterol maintenance and reliever therapy

Respiratory Medicine (2023)

Nicolás Roche Arzu Yorgancıoğlu Álvaro A. Cruz Gabriel García Kim Lavoie

Asthma treatments based solely on diagnostic label do not benefit patients equally. To identify patient traits that may be associated with improved treatment response to regular inhaled corticosteroid (ICSs) dosing with short-acting β

Salmeterol

10.1016/j.rmed.2023.107478

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Citations (1)

Gregory Vlastos. El argumento del tercer hombre en el Parménides

Estudios de filosofía (2000)

Gabriel García

D ifícilmente 1 un texto de Platón ha sido tan discutido en los últimos cuarenta años ' como los dos pasajes del Parménides cuyo fin es probar que la teoría de los formas implica un regreso al infinito, lo que en la

10.18800/estudiosdefilosofia.200001.005

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Novedades y otros aspectos destacados de la Guía Española para el Manejo del Asma (GEMA), versión 5.0

Archivos de Bronconeumología (2020)

Vicente Plaza Marina Blanco Gabriel García Javier Korta Jesús Molina

10.1016/j.arbres.2020.10.003

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Citations (19)