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Browsing by Author "Costa, E"

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  • ARIA 2019: An Integrated Care Pathway for Allergic Rhinitis in Portugal
    Publication . Fonseca, J; Taveira-Gomes, T; Pereira, AM; Branco-Ferreira, M; Carreiro-Martins, P; Alves-Correia, M; Correia de Sousa, J; Costa, E; Lourenço, O; Morais-Almeida, M; Morête, A; Regateiro, F; Todo Bom, A; Bachert, C; Pfaar, O; Wallace, D; Bedbrook, A; Czarlewski, W; Bousquet, J
    The Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative started more than 20 years ago and has developed and disseminated evidence-based guidelines and projects in the field of allergic rhinitis. This initiative is currently focused on providing patient-centred guidelines that contribute to an integrated care pathway between the various levels of care and take advantage of digital solutions, and the introduction of integrated care pathways in clinical practice has been recommended. In this article we describe the adaptation for Portugal of the ARIA Integrated Care Pathways document. After a brief review of the epidemiology and impact of allergic rhinitis in Portugal and the activities carried out in Portugal within the ARIA initiative, we describe the broad knowledge base used for the development of recommendations for the pharmacological treatment of allergic rhinitis, and these recommendations are based on the GRADE methodology, real world evidence acquired by mobile technology (mHealth) and resulting from allergenic exposure chamber studies. What follows is a summary of integrated care pathways for allergen immunotherapy produced in 2019. Allergen immunotherapy is considered an example of precision medicine where the use of mHealth technologies will improve stratification for patient selection and response monitoring. These recommendations were considered as best practices of integrated patient-centred care supported by digital systems from Directorate General for Health and Food Safety of the European Union (DG Santé) and represent the ARIA Phase 4 Change Management strategy.
    2021-02-01Journal article Open access Show more
  • ARIA Digital Anamorphosis: Digital Transformation of Health and Care in Airway Diseases from Research to Practice
    Publication . Bousquet, J; Anto, JM; Bachert, C; Haahtela, T; Zuberbier, T; Czarlewski, W; Bedbrook, A; Bosnic-Anticevich, S; Walter Canonica, G; Cardona, V; Costa, E; Costa, DJ; Courbis, AL; Custovic, A; Cvetkosvki, B; D'Amato, G; da Silva, J; Dantas, C; Dokic, D; Dauvilliers, Y; De Feo, G; Cruz, AA; De Vries, G; Devillier, P; Di Capua, S; Dray, G; Dubakiene, R; Durham, SR; Dykewicz, M; Ebisawa, M; Gaga, M; El-Gamal, Y; Erhola, M; Heffler, E; Emuzyte, R; Farrell, J; Fauquert, JL; Fiocchi, A; Fink-Wagner, A; Fontaine, JF; Fuentes Perez, JM; Gemicioğlu, B; Gamkrelidze, A; Fokkens, WJ; Garcia-Aymerich, J; Gevaert, P; Gomez, RM; González Diaz, S; Gotua, M; Guldemond, NA; Guzmán, MA; Hajjam, J; Huerta Villalobos, YR; Humbert, M; Fonseca, JA; Iaccarino, G; Ierodiakonou, D; Iinuma, T; Jassem, E; Joos, G; Jung, K; Kaidashev, I; Kalayci, O; Kardas, P; Keil, T; Illario, M; Khaitov, M; Khaltaev, N; Kleine-Tebbe, J; Kouznetsov, R; Kull, I; La Grutta, S; Leonardini, L; Ljungberg, H; Lieberman, P; Lipworth, B; Ivancevich, JC; Lodrup Carlsen, K; Lopes-Pereira, C; Loureiro, C; Louis, R; Mair, A; Mahboub, B; Makris, M; Malva, J; Manning, P; Marshall, G; Jutel, M; Masjedi, M; Carreiro-Martins, P; Makela, M; Mathieu-Dupas, E; Maurer, M; De Manuel Keenoy, E; Melo-Gomes, E; Meltzer, E; Menditto, E; Mercier, J; Klimek, L; Micheli, Y; Miculinic, N; Mihaltan, F; Milenkovic, B; Mitsias, D; Moda, G; Mogica-Martinez, MD; Mohammad, Y; Montefort, S; Monti, R; Kuna, P; Morais-Almeida, M; Mösges, R; Münter, L; Muraro, A; Murray, R; Naclerio, R; Napoli, L; Namazova-Baranova, L; Neffen, H; Nekam, K; Kvedariene, V; Neou, A; Nordlund, B; Novellino, E; Nyembue, D; O'Hehir, R; Ohta, K; Okubo, K; Onorato, G; Orlando, V; Ouedraogo, S; Le, L; Palamarchuk, J; Pali-Schöll, I; Panzner, P; Park, H; Passalacqua, G; Pépin, JL; Paulino, E; Pawankar, R; Phillips, J; Picard, R; Larenas-Linnemann, DE; Pinnock, H; Plavec, D; Popov, T; Portejoie, F; Price, D; Prokopakis, E; Psarros, F; Pugin, B; Puggioni, F; Quinones-Delgado, P; Laune, D; Raciborski, F; Rajabian-Söderlund, R; Regateiro, F; Reitsma, S; Rivero-Yeverino, D; Roberts, G; Roche, N; Rodriguez-Zagal, E; Rolland, C; Roller-Wirnsberger, R; Lourenço, OM; Rosario, N; Romano, A; Rottem, M; Ryan, D; Salimäki, J; Sanchez-Borges, M; Sastre, J; Scadding, G; Scheire, S; Schmid-Grendelmeier, P; Melén, Erik; Schünemann, H; Sarquis Serpa, F; Shamji, M; Sisul, JC; Sofiev, M; Solé, D; Somekh, D; Sooronbaev, T; Sova, M; Spertini, F; Mullol, J; Spranger, O; Stellato, C; Stelmach, R; Thibaudon, M; To, T; Toumi, M; Usmani, O; Valero, A; Valenta, R; Valentin-Rostan, M; Niedoszytko, M; Pereira, M; van der Kleij, R; Van Eerd, M; Vandenplas, O; Vasankari, T; Vaz Carneiro, A; Vezzani, G; Viart, F; Viegi, G; Wallace, D; Odemyr, M; Wagenmann, M; Wang, Y; Waserman, S; Wickman, M; Williams, D; Wong, G; Wroczynski, P; Yiallouros, P; Yusuf, O; Zar, HJ; Okamoto, Y; Zeng, S; Zernotti, ME; Zhang, L; Shan Zhong, N; Papadopoulos, NG; Patella, V; Pfaar, O; Pham-Thi, N; Rolland, C; Samolinski, B; Sheikh, A; Sofiev, M; Suppli Ulrik, C; Todo-Bom, A; Tomazic, PV; Toppila-Salmi, S; Tsiligianni, I; Valiulis, A; Valovirta, E; Ventura, MT; Walker, S; Williams, S; Yorgancioglu, A; Agache, I; Akdis, CA; Almeida, R; Ansotegui, IJ; Annesi-Maesano, I; Arnavielhe, S; Basagaña, X; D Bateman, E; Bédard, A; Bedolla-Barajas, M; Becker, S; Bennoor, KS; Benveniste, S; Bergmann, KC; Bewick, M; Bialek, S; E Billo, N; Bindslev-Jensen, C; Bjermer, L; Blain, H; Bonini, M; Bonniaud, P; Bosse, I; Bouchard, J; Boulet, LP; Bourret, R; Boussery, K; Braido, F; Briedis, V; Briggs, A; Brightling, CE; Brozek, J; Brusselle, G; Brussino, L; Buhl, R; Buonaiuto, R; Calderon, MA; Camargos, P; Camuzat, T; Caraballo, L; Carriazo, AM; Carr, W; Cartier, C; Casale, T; Cecchi, L; Cepeda Sarabia, AM; H Chavannes, N; Chkhartishvili, E; Chu, DK; Cingi, C; Correia de Sousa, J
    Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
    2021Journal article Open access Show more
  • Confronting Ceftolozane-Tazobactam Susceptibility in Multidrug-Resistant Enterobacterales Isolates and Whole-Genome Sequencing Results (STEP Study)
    Publication . Hernández-García, M; García-Fernández, S; García-Castillo, M; Melo-Cristino, J; Pinto, M; Gonçalves, E; Alves, V; Costa, E; Ramalheira, E; Sancho, L; Diogo, J; Ferreira, R; Silva, T; Chaves, C; Pássaro, L; Paixão, L; Romano, J; Cantón, J; STEP Study Group
    Ceftolozane-tazobactam (C/T) is frequently used for infections caused by multidrug-resistant (MDR)-Enterobacterales isolates. Whole-genome sequencing (WGS, Illumina-Hiseq 4000/NovaSeq 6000, OGC, UK) was used to study the population structure, the resistome and the virulome of C/T-susceptible and -resistant MDR Escherichia spp. (n=30) and Klebsiella spp. (n=78) isolates, recovered from lower respiratory, intra-abdominal and urinary tract infections of ICU patients from 11 Portuguese Hospitals (STEP study, 2017-2018). Minimum inhibitory concentrations (MICs) were determined (ISO-broth microdilution, breakpoints EUCAST-2020). In Escherichia spp., a weak concordance between the phenotypic and the WGS method (P=0.051) was observed in the carbapenemase detection (3/30) [blaVIM-2 (2/3), blaKPC-3 (1/3)]; VIM-2-Escherichia coli isolates were C/T-susceptible and only the KPC-3-Escherichia marmotae producer showed C/T-resistance. Overall, CTX-M-15-E. coli-ST131-O25:H4-H30-Rx (11/30) was the most frequent subclone, followed by CTX-M-27-E. coli-ST131-O25:H4-H30 (4/4). Moreover, a wide resistome and virulome were detected in all E. coli isolates. Among Klebsiella spp. isolates [K. pneumoniae (67/78), K. aerogenes (7/78), K. oxytoca (2/78), K. variicola (2/78)], concordance (P<0.001) was observed between the phenotypic and the genomic carbapenemase detection (21/78) [blaKPC-3 (14/21), blaOXA-48 (3/21), blaOXA-181 (3/21)]. A high correlation between C/T-resistance and carbapenemase detection was established (P<0.05). Overall, a high clonal diversity was observed, mainly in KPC-3-producing K. pneumoniae isolates. An extensive resistome was detected in Klebsiella spp. isolates, whereas virulence determinants were mostly identified in carbapenemase producers (P<0.001). WGS is a powerful tool for typing characterization and microbiological study of MDR-Enterobacterales pathogens. Furthermore, carbapenemase genes are associated with C/T-resistance in Klebsiella spp., but other mechanisms might also be involved.
    2021Journal article Open access Show more
  • Digitally‐Enabled, Patient‐Centred Care in Rhinitis and Asthma Multimorbidity: The ARIA‐MASK‐air ® Approach
    Publication . Bousquet, J; Anto, JM; Sousa‐Pinto, B; Czarlewski, W; Bedbrook, A; Haahtela, T; Klimek, L; Pfaar, O; Kuna, P; Kupczyk, M; Regateiro, FS; Samolinski, B; Valiulis, A; Yorgancioglu, A; Arnavielhe, S; Basagaña, X; Bergmann, KC; Bosnic‐Anticevich, S; Brussino, L; Canonica, GW; Cardona, V; Cecchi, L; Chaves‐Loureiro, C; Costa, E; Cruz, AA; Gemicioglu, B; Fokkens, W; Ivancevich, JC; Kraxner, H; Kvedariene, V; Larenas‐Linnemann, DE; Laune, D; Louis, R; Makris, M; Maurer, M; Melén, E; Micheli, Y; Morais‐Almeida, M; Mullol, J; Niedoszytko, M; Okamoto, Y; Papadopoulos, NG; Patella, V; Pham‐Thi, N; Rouadi, PW; Sastre, J; Scichilone, N; Sheikh, A; Sofiev, M; Taborda‐Barata, L; Toppila‐Salmi, S; Tsiligianni, I; Valovirta, E; Ventura, MT; Vieira, RJ; Zidarn, M; Amaral, R; Ansotegui, IJ; Bédard, A; Benveniste, S; Bewick, M; Bindslev‐Jensen, C; Blain, H; Bonini, M; Bourret, R; Braido, F; Carreiro‐Martins, P; Charpin, D; Cherrez‐Ojeda, I; Chivato, T; Chu, DK; Cingi, C; Del Giacco, S; de Blay, F; Devillier, P; De Vries, G; Doulaptsi, M; Doyen, V; Dray, G; Fontaine, JF; Gomez, RM; Hagemann, J; Heffler, E; Hofmann, M; Jassem, E; Jutel, M; Keil, T; Kritikos, V; Kull, I; Kulus, M; Lourenço, O; Mathieu‐Dupas, E; Menditto, E; Mösges, R; Murray, R; Nadif, R; Neffen, H; Nicola, S; O’Hehir, R; Olze, H; Palamarchuk, Y; Pépin, JL; Pétré, B; Picard, R; Pitsios, C; Puggioni, F; Quirce, S; Raciborski, F; Reitsma, S; Roche, N; Rodriguez‐Gonzalez, M; Romantowski, J; Sá‐Sousa, A; Serpa, FS; Savouré, M; Shamji, MH; Sova, M; Sperl, A; Stellato, C; Todo‐Bom, A; Tomazic, PV; Vandenplas, O; Van Eerd, M; Vasankari, T; Viart, F; Waserman, S; Fonseca, JA; Zuberbier, T
    MASK-air® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.
    2023Journal article Open access Show more
  • Rhinitis Associated with Asthma is Distinct from Rhinitis Alone: The ARIA‐MeDALL Hypothesis
    Publication . Bousquet, J; Melén, E; Haahtela, T; Koppelman, GH; Togias, A; Valenta, R; Akdis, CA; Czarlewski, W; Rothenberg, M; Valiulis, A; Wickman, M; Akdis, M; Aguilar, D; Bedbrook, A; Bindslev‐Jensen, C; Bosnic‐Anticevich, S; Boulet, LP; Brightling, CE; Brussino, L; Burte, E; Bustamante, M; Canonica, GW; Cecchi, L; Celedon, JC; Chaves Loureiro, C; Costa, E; Cruz, AA; Erhola, M; Gemicioglu, B; Fokkens, WJ; Garcia‐Aymerich, J; Guerra, S; Heinrich, J; Ivancevich, JC; Keil, T; Klimek, L; Kuna, P; Kupczyk, M; Kvedariene, V; Larenas‐Linnemann, DE; Lemonnier, N; Lodrup Carlsen, KC; Louis, R; Makela, M; Makris, M; Maurer, M; Momas, I; Morais‐Almeida, M; Mullol, J.; Naclerio, RN; Nadeau, K; Nadif, R; Niedoszytko, M; Okamoto, Y; Ollert, M; Papadopoulos, NG; Passalacqua, G; Patella, V; Pawankar, R; Pham‐Thi, N; Pfaar, O; Regateiro, FS; Ring, J; Rouadi, PW; Samolinski, B; Sastre, J; Savouré, M; Scichilone, N; Shamji, MH; Sheikh, A; Siroux, V; Sousa‐Pinto, B; Standl, M; Sunyer, J; Taborda‐Barata, L; Toppila‐Salmi, S; Torres, MJ; Tsiligianni, I; Valovirta, E; Vandenplas, O; Ventura, MT; Weiss, S; Yorgancioglu, A; Zhang, L; Abdul Latiff, AH; Aberer, W; Agache, I; Al‐Ahmad, M; Alobid, I; Ansotegui, IJ; Arshad, SH; Asayag, E; Barbara, C; Baharudin, A; Battur, L; Bennoor, KS; Berghea, EC; Bergmann, KC; Bernstein, D; Bewick, M; Blain, H; Bonini, M; Braido, F; Buhl, R; Bumbacea, RS; Bush, A; Calderon, M; Calvo‐Gil, M; Camargos, P; Caraballo, L; Cardona, V; Carr, W; Carreiro‐Martins, P; Casale, T; Cepeda Sarabia, AM; Chandrasekharan, R; Charpin, D; Chen, YZ; Cherrez‐Ojeda, I; Chivato, T; Chkhartishvili, E; Christoff, G; Chu, DK; Cingi, C; Correia de Sousa, J; Corrigan, C; Custovic, A; D’Amato, G; Del Giacco, S; De Blay, F; Devillier, P; Didier, A; do Ceu Teixeira, M; Dokic, D; Douagui, H; Doulaptsi, M; Durham, S; Dykewicz, M; Eiwegger, T; El‐Sayed, ZA; Emuzyte, R; Fiocchi, A; Fyhrquist, N; Gomez, RM; Gotua, M; Guzman, MA; Hagemann, J; Hamamah, S; Halken, S; Halpin, DMG; Hofmann, M; Hossny, E; Hrubiško, M; Irani, C; Ispayeva, Z; Jares, E; Jartti, T; Jassem, E; Julge, K; Just, J; Jutel, M; Kaidashev, I; Kalayci, O; Kalyoncu, AF; Kardas, P; Kirenga, B; Kraxner, H; Kull, I; Kulus, M; La Grutta, S; Lau, S; Le Tuyet Thi, L; Levin, M; Lipworth, B; Lourenço, O; Mahboub, B; Martinez‐Infante, E; Matricardi, P; Miculinic, N; Migueres, N; Mihaltan, F; Mohammad, Y; Moniuszko, M; Montefort, S; Neffen, H; Nekam, K; Nunes, E; Nyembue Tshipukane, D; O’Hehir, R; Ogulur, I; Ohta, K; Okubo, K; Ouedraogo, S; Olze, H; Pali‐Schöll, I; Palomares, O; Palosuo, K; Panaitescu, C; Panzner, P; Park, HS; Pitsios, C; Plavec, D; Popov, TA; Puggioni, F; Quirce, S; Recto, M; Repka‐Ramirez, MS; Robalo Cordeiro, C; Roche, N; Rodriguez‐Gonzalez, M; Romantowski, J; Rosario Filho, N; Rottem, M; Sagara, H; Serpa, FS; Sayah, Z; Scheire, S; Schmid‐Grendelmeier, P; Sisul, JC; Sole, D; Soto‐Martinez, M; Sova, M; Sperl, A; Spranger, O; Stelmach, R; Suppli Ulrik, C; Thomas, M; To, T; Todo‐Bom, A; Tomazic, PV; Urrutia‐Pereira, M; Valentin‐Rostan, M; Van Ganse, E; van Hage, M; Vasankari, T; Vichyanond, P; Viegi, G; Wallace, D; Wang, DY; Williams, S; Worm, M; Yiallouros, P; Yusuf, O; Zaitoun, F; Zernotti, M; Zidarn, M; Zuberbier, J; Fonseca, JA; Zuberbier, T; Anto, JM
    Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.
    2023Journal article Open access Show more