Even though respiratory viruses are one of the most common triggers for asthma exacerbations, not all of these viruses affect patients equally. There is no strong evidence supporting that patients ...with asthma have a higher risk of becoming seriously ill from coronavirus disease 2019 (CO-VID-19), although recent reports from the USA and the UK suggest that asthma is much more common in children and adults with mild to severe COVID-19 than has previously been reported in Asia and in Europe. As in previous severe acute respiratory syndrome (SARS) outbreaks, patients with asthma, especially children, appear to be less susceptible to the coronavirus with a low rate of asthma exacerbations. A different expression of viral receptors and T2 inflammation can be responsible for different outcomes. Future studies focused on asthma and on other allergic disorders are needed to provide a greater understanding of the impact of underlying asthma and allergic inflammation on COVID-19 susceptibility and disease severity. However, for the moment, it is crucial that asthmatic patients maintain their controller medication, from inhaled corticosteroids to biologics, without making any dose adjustments on their own or stopping the medication. New data are emerging daily, rapidly updating our understanding of this novel coronavirus.
We carefully read the recently published research letter “Is asthma protective of COVID‐19?” by Carli et al.1 with great interest. Important topics for asthma patients during the coronavirus disease ...2019 (COVID‐19) pandemic were discussed, including that until recently there was limited evidence that patients with chronic respiratory disorders are at lower risk of being infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) or becoming severely ill.
Asthma is a fairly common health problem for pregnant women and a potentially serious medical condition that may complicate pregnancy. Most complications are related to lack of disease control, which ...can adversely affect both maternal quality of life and perinatal outcomes. In this article, we review recent literature concerning asthma in pregnancy, describing the course of the disease and associated complications. Furthermore, we review and discuss asthma monitoring and management during pregnancy, labor and post-partum. The course of asthma symptoms during pregnancy is unpredictable but exacerbations are more common during the second trimester. The causes are multifactorial and asthma phenotype may have a role. It has been proposed that combined use of CARAT (Control of Allergic Rhinitis and Asthma Test) and lung function tests can be used to monitor and adjust therapy during pregnancy in patients with asthma. As a complement, an approach that considers airway inflammation assessment using fractional exhaled nitric oxide (FeNO), a noninvasive marker of inflammation, may improve asthma control during pregnancy. It is important to consider a few but relevant differences in asthma management and treatment regarding pregnancy and the peri-partum period to safely achieve optimal management of asthma during all these phases for both mother and offsprings.
Asthma affects nearly 6 million US children. Throughout childhood, children undergo a series of biological, developmental, and psychosocial changes. Thus, factors influencing a child's asthma ...management differ across 3 essential stages-early childhood (0-5 years), school-aged years (5-12 years), and adolescence (12-18 years)-and require varied intervention by parents, school personnel, clinicians, and the children themselves. Because asthma care in children is characterized by fluctuations in severity and coordination among many stakeholders, optimal asthma control is difficult to achieve in this young population. Challenges in childhood asthma management are reflected in the low rates of children's adherence to medication regimes. Although pharmacological and biological factors addressing age in physicians' treatment choices are well outlined, age-specific approaches to patient-provider communication and asthma-related interventions are also important in improving quality of life for patients with pediatric asthma.
COPD is a major cause of morbidity and mortality worldwide and carries a huge and growing economic and social burden. Telemedicine might allow the care of patients with limited access to health ...services and improve their self-management. During the COVID-19 pandemic, patient's safety represents one of the main reasons why we might use these tools to manage our patients. The authors conducted a literature search in MEDLINE database. The retrieval form of the Medical Subject Headings (Mesh) was ((Telemedicine OR Tele-rehabilitation OR Telemonitoring OR mHealth OR Ehealth OR Telehealth) AND COPD). We only included systematic reviews, reviews, meta-analysis, clinical trials and randomized-control trials, in the English language, with the selected search items in title or abstract, and published from January 1st 2015 to 31st May 2020 (n = 56). There was a positive tendency toward benefits in tele-rehabilitation, health-education and self-management, early detection of COPD exacerbations, psychosocial support and smoking cessation, but the heterogeneity of clinical trials and reviews limits the extent to which this value can be understood. Telemonitoring interventions and cost-effectiveness had contradictory results. The literature on teleconsultation was scarce during this period. The non-inferiority tendency of telemedicine programmes comparing to conventional COPD management seems an opportunity to deliver quality healthcare to COPD patients, with a guarantee of patient's safety, especially during the COVID-19 outbreak.
The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.
The PeARL multinational cohort included ...1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.
During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV
and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.
Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.
Data about the occurrence of airborne pollen enables the creation of pollen calendars with an approximation of flowering periods for the most common allergenic plant species in a specific area. The ...aim of this work is to provide pollen calendar for each of the seven monitoring regions of Portugal based on 15 years of airborne sampling, in order to chart the seasonal behaviour of the main allergenic pollen types.
Airborne pollen monitoring (2002–2017) was carried out by the Portuguese Aerobiology Network (RPA), using Hirst-type volumetric spore traps, following well-established guidelines.
A total of 14 airborne pollen types were recorded at RPA monitoring stations, of which 64.2% belong to trees, 28.5% to herbs and 7.1% to weeds. The airborne pollen spectrum is dominated by important allergenic pollen types such as Poaceae, Quercus spp., Urticaceae and Cupressaceae. The average pollen index was 42.557 in mainland Portugal and 3.818 in the Islands. There was an increased trend in the airborne pollen levels over the years, namely in Coimbra, Évora and Porto, compared to the remaining regions.
This report provides accessible information about the main allergenic airborne pollen types occurring in the course of the year. The pollen calendars charted for each Portuguese region showed that the occurrence of most allergenic taxa was centred from March to July. Pollen peak concentrations were detected earlier in the Centre and Lisbon and Tagus Valley regions, and later in the remaining regions.
Dyspnea is reported in a minority of patients affected by coronavirus disease 2019 (COVID-19). Even patients with pneumonia can present hypoxemia without any respiratory distress, a phenomenon known ...as “silent” or “happy hypoxemia”. During the current pandemic there were only a few studies conducted on this subject and these were quite heterogeneous. Therefore, the prevalence of “silent hypoxemia” varied substantially. While studies did not show a clear tendency of “silent hypoxemia” to poorer outcomes compared to hypoxemia presenting with dyspnea, several showed that patients with “silent hypoxemia” are not protected from poor outcomes either. There is a need for a uniform definition of “silent hypoxemia”, in order to better guide clinicians and investigators. More studies are needed to shed light on the mechanisms of “silent hypoxemia”, as well as its presentation and influence in the disease's progression and outcomes, so as to better assist physicians in the care of COVID-19 patients.
Perioperative use of cefazolin has been associated with severe allergic reactions, and patients are usually labelled as allergic to penicillin afterwards. The aim of our study was to describe a group ...of patients with immediate reactions to cefazolin, with proven selective hypersensitivity reactions.
Systematic review of all patients followed at our drug centre with cefazolin-related reactions, between January 2012 and December 2016. All patients were investigated according to the European Network for Drug Allergy (ENDA) recommendations through skin testing (major and minor penicillin determinants, penicillin, amoxicillin, cefazolin, cefuroxime and ceftriaxone) and oral challenges tests.
We included 7 patients (median age 40 years) with perioperative anaphylactic reactions immediately after cefazolin injection, 4 with hypotension and 1 with Kounis syndrome (KS) type I. The presence of a selective IgE-mediated hypersensitivity through positive skin tests to cefazoline has been proven in all patients. Two patients experienced systemic reactions during skin testing. All patients were successfully challenged with amoxicillin, and they tolerated cefuroxime.
Cefazolin can be responsible for immediate severe allergic reactions in perioperative setting, including KS. Allergological workup is essential for an accurate diagnosis and to explore cross-reactivity between cefazolin and other beta-lactams. Our experience confirmed that patients with IgE-mediated hypersensitivity reactions to cefazolin can tolerate other beta-lactams. This selective pattern of clinical reactivity may be explained by its particular chemical structure, whose R1 side-chain is different from other beta-lactams.
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