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Browsing by Author "Ferreira, JA"

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  • Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study
    Publication . Jácome, C; Almeida, R; Pereira, AM; Amaral, R; Mendes, S; Alves-Correia, M; Vidal, C; López Freire, S; Méndez Brea, P; Araújo, L; Couto, M; Antolín-Amérigo, D; de la Hoz Caballer, B; Barra Castro, A; Gonzalez-De-Olano, D; Todo Bom, A; Azevedo, J; Leiria Pinto, P; Pinto, N; Castro Neves, A; Palhinha, Ana; Todo Bom, F; Costa, A; Chaves Loureiro, C; Maia Santos, L; Arrobas, A; Valério, M; Cardoso, J; Emiliano, M; Gerardo, R; Cidrais Rodrigues, JC; Oliveira, G; Carvalho, J; Mendes, A; Lozoya, C; Santos, N; Menezes, F; Gomes, R; Câmara, R; Rodrigues Alves, R; Moreira, AS; Bordalo, D; Alves, C; Ferreira, JA; Lopes, C; Silva, D; Vasconcelos, MJ; Teixeira, MF; Ferreira-Magalhães, M; Taborda-Barata, L; Cálix, MJ; Alves, A; Almeida Fonseca, J
    Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.
    2021-05-25Journal article Open access Show more
  • Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies
    Publication . Jácome, C; Almeida, R; Pereira, AM; Amaral, R; Vieira-Marques, P; Mendes, S; Alves-Correia, M; Ferreira, JA; Lopes, I; Gomes, J; Araújo, L; Couto, M; Chaves Loureiro, C; Maia Santos, L; Arrobas, A; Valério, M; Todo Bom, A; Azevedo, J; Teixeira, MF; Ferreira-Magalhães, M; Leiria Pinto, P; Pinto, N; Castro Neves, A; Morête, A; Todo Bom, F; Costa, A; Silva, D; Vasconcelos, MJ; Falcão, H; Marques, ML; Mendes, A; Cardoso, J; Cidrais Rodrigues, JC; Oliveira, G; Carvalho, J; Lozoya, C; Santos, N; Menezes, F; Gomes, R; Câmara, R; Rodrigues Alves, R; Moreira, AS; Abreu, C; Silva, R; Bordalo, D; Alves, C; Lopes, C; Taborda-Barata, L; Fernandes, RM; Ferreira, R; Chaves-Loureiro, C; Cálix, MJ; Alves, A; Almeida Fonseca, J
    Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen. Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
    2021Journal article Open access Show more
  • Omalizumab for Severe Asthma: Beyond Allergic Asthma
    Publication . Loureiro, CC; Amaral, L; Ferreira, JA; Lima, R; Pardal, C; Fernandes, I; Semedo, L; Arrobas, A
    Different subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient's response to therapy and pharmacoeconomical analysis are questions that remain to be answered.
    2018Journal article Open access Show more
  • Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two Cohorts
    Publication . Jácome, C; Pereira, AM; Almeida, R; Ferreira-Magalhaes, M; Couto, M; Araujo, L; Pereira, M; Alves Correia, M; Chaves Loureiro, C; Catarata, MJ; Maia Santos, L; Pereira, J; Ramos, B; Lopes, C; Mendes, A; Cidrais Rodrigues, JC; Oliveira, G; Aguiar, AP; Afonso, I; Carvalho, J; Arrobas, A; Coutinho Costa, J; Dias, J; Todo Bom, A; Azevedo, J; Ribeiro, C; Alves, M; Leiria Pinto, P; Neuparth, N; Palhinha, A; Gaspar Marques, J; Pinto, N; Martins, P; Todo Bom, F; Alvarenga Santos, M; Gomes Costa, A; Silva Neto, A; Santalha, M; Lozoya, C; Santos, N; Silva, D; Vasconcelos, MJ; Taborda-Barata, L; Carvalhal, C; Teixeira, MF; Rodrigues Alves, R; Moreira, AS; Sofia Pinto, C; Morais Silva, P; Alves, C; Câmara, R; Coelho, D; Bordalo, D; Fernandes, R; Ferreira, R; Menezes, F; Gomes, R; Calix, MJ; Marques, A; Cardoso, J; Emiliano, M; Gerardo, R; Nunes, C; Câmara, R; Ferreira, JA; Carvalho, A; Freitas, P; Correia, R; Fonseca, J
    OBJECTIVE: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. DESIGN: Baseline data from two prospective multicentre observational studies. SETTING: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. PARTICIPANTS: 395 patients (≥13 years old) with persistent asthma. MEASURES: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. RESULTS: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). CONCLUSION: Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.
    2019-11-07Journal article Open access Show more
  • Sialyl Tn-Expressing Bladder Cancer Cells Induce a Tolerogenic Phenotype in Innate and Adaptive Immune Cells
    Publication . Carrascal, M; Severino, P; Cabral, MG; Silva, M; Ferreira, JA; Calais da Silva, F; Quinto, H; Pen, C; Ligeiro, D; Lara Santos, L; Dall'Olio, F; Videira, P
    Despite the wide acceptance that glycans are centrally implicated in immunity, exactly how they contribute to the tilt immune response remains poorly defined. In this study, we sought to evaluate the impact of the malignant phenotype-associated glycan, sialyl-Tn (STn) in the function of the key orchestrators of the immune response, the dendritic cells (DCs). In high grade bladder cancer tissue, the STn antigen is significantly overexpressed and correlated with the increased expression of ST6GALNAC1 sialyltransferase. Bladder cancer tissue presenting elevated expression of ST6GALNAC1 showed a correlation with increased expression of CD1a, a marker for bladder immature DCs and showed concomitant low levels of Th1-inducing cytokines IL-12 and TNF-α. In vitro, human DCs co-incubated with STn+ bladder cancer cells, had an immature phenotype (MHC-IIlow, CD80low and CD86low) and were unresponsive to further maturation stimuli. When contacting with STn+ cancer cells, DCs expressed significantly less IL-12 and TNF-α. Consistent with a tolerogenic DC profile, T cells that were primed by DCs pulsed with antigens derived from STn+ cancer cells were not activated and showed a FoxP3high IFN-γlow phenotype. Blockade of STn antigens and of STn+ glycoprotein, CD44 and MUC1, in STn+ cancer cells was able to lower the induction of tolerance and DCs become more mature. Overall, our data suggest that STn-expressing cancer cells impair DC maturation and endow DCs with a tolerogenic function, limiting their capacity to trigger protective anti-tumour T cell responses. STn antigens and, in particular, STn+ glycoproteins are potential targets for circumventing tumour-induced tolerogenic mechanisms.
    2014Journal article Open access Show more
  • Validation of App and Phone Versions of the Control of Allergic Rhinitis and Asthma Test (CARAT)
    Publication . Jácome, C; Pereira, AM; Almeida, R; Amaral, R; Correia, MA; Mendes, S; Vieira-Marques, P; Ferreira, JA; Lopes, I; Gomes, J; Vidal, C; López Freire, S; Méndez Brea, P; Arrobas, A; Valério, M; Chaves Loureiro, C; Santos, LM; Couto, M; Araujo, L; Todo Bom, A; Azevedo, JP; Cardoso, J; Emiliano, M; Gerardo, R; Lozoya, C; Pinto, PL; Castro Neves, A; Pinto, N; Palhinha, A; Teixeira, F; Ferreira-Magalhães, M; Alves, C; Coelho, D; Santos, N; Menezes, F; Gomes, R; Cidrais Rodrigues, JC; Oliveira, G; Carvalho, J; Rodrigues Alves, R; Moreira, AS; Costa, A; Abreu, C; Silva, R; Morête, A; Falcão, H; Marques, ML; Câmara, R; Cálix, MJ; Bordalo, D; Silva, D; Vasconcelos, MJ; Fernandes, RM; Ferreira, R; Freitas, P; Lopes, F; Almeida Fonseca, J
    2021-06Journal article Open access Show more