Browsing by Author "Taborda-Barata, L"
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- ARIA-EAACI Care Pathways for Allergen Immunotherapy in Respiratory AllergyPublication . Bousquet, J; Pfaar, O; Agache, I; Bedbrook, A; Akdis, CA; Canonica, GW; Chivato, T; Al-Ahmad, M; Abdul Latiff, AH; Ansotegui, IJ; Bachert, C; Baharuddin, A; Bergmann, KC; Bindslev-Jensen, C; Bjermer, L; Bonini, M; Bosnic-Anticevich, S; Bosse, I; Brough, HA; Brussino, L; Calderon, MA; Caraballo, L; Cardona, V; Carreiro-Martins, P; Casale, T; Cecchi, L; Cepeda Sarabia, AM; Chkhartishvili, E; Chu, DK; Cirule, I; Cruz, AA; Czarlewski, W; Del Giacco, S; Demoly, P; Devillier, P; Dokic, D; Durham, SL; Ebisawa, M; El-Gamal, Y; Emuzyte, R; Gamkrelidze, A; Fauquert, JL; Fiocchi, A; Fokkens, WJ; Fonseca, JA; Fontaine, JF; Gawlik, R; Gelincik, A; Gemicioglu, B; Gereda, JE; Gerth van Wijk, R; Gomez, RM; Gotua, M; Grisle, I; Guzmán, MA; Haahtela, T; Halken, S; Heffler, E; Hoffmann-Sommergruber, K; Hossny, E; Hrubiško, M; Irani, C; Ivancevich, JC; Ispayeva, Z; Julge, K; Kaidashev, I; Kalayci, O; Khaitov, M; Klimek, L; Knol, E; Kowalski, ML; Kraxner, H; Kull, I; Kuna, P; Kvedariene, V; Kritikos, V; Lauerma, A; Lau, S; Laune, D; Levin, M; Larenas-Linnemann, DE; Lodrup Carlsen, KC; Lombardi, C; Lourenço, OM; Mahboub, B; Malling, HJ; Manning, P; Marshall, GD; Melén, E; Meltzer, EO; Miculinic, N; Milenkovic, B; Moin, M; Montefort, S; Morais-Almeida, M; Mortz, CG; Mösges, R; Mullol, J; Namazova Baranova, L; Neffen, H; Nekam, K; Niedoszytko, M; Odemyr, M; O'Hehir, RE; Ollert, M; O'Mahony, L; Ohta, K; Okamoto, Y; Okubo, K; Pajno, GB; Palomares, O; Palkonen, S; Panzner, P; G Papadopoulos, N; Park, H; Passalacqua, G; Patella, V; Pawankar, R; Pham-Thi, N; Plavec, D; Popov, TA; Recto, M; Regateiro, FS; Riggioni, C; Roberts, G; Rodriguez-Gonzales, M; Rosario, N; Rottem, M; Rouadi, PW; Ryan, D; Samolinski, B; Sanchez-Borges, M; Serpa, FS; Sastre, J; Scadding, G; Shamji, M; Schmid-Grendelmeier, P; Schünemann, H; Sheikh, A; Scichilone, N; Sisul, JC; Sofiev, M; Solé, D; Sooronbaev, T; Soto-Martinez, M; Soto-Quiros, M; Sova, M; Schwarze, J; Skypala, I; Suppli-Ulrik, C; Taborda-Barata, L; Todo-Bom, A; Torres, MJ; Valentin-Rostan, M; Tomazic, PV; Valero, A; Toppila-Salmi, S; Tsiligianni, I; Untersmayr, E; Urrutia-Pereira, M; Valiulis, A; Valovirta, E; Vandenplas, O; Ventura, MT; Vichyanond, P; Wagenmann, M; Wallace, D; Walusiak-Skorupa, J; Wang, DY; Waserman, S; Wong, GW; Yorgancioglu, A; Yusuf, OM; Zernotti, M; Zhang, L; Zidarn, M; Zuberbier, T; Jutel, M
- Different in Vivo Reactivity Profile in Health Care Workers and Patients with Spina Bifida to Internal and External Latex Glove Surface-Derived Allergen ExtractsPublication . Peixinho, CM; Tavares-Ratado, P; Gabriel, MF; Romeira, AM; Lozoya-Ibanez, C; Taborda-Barata, L; Tomaz, CTBACKGROUND: Allergy to natural rubber latex is a well-recognized health problem, especially among health care workers and patients with spina bifida. Despite latex sensitization being acquired in health institutions in both health care workers and patients with spina bifida, differences in allergen sensitization profiles have been described between these two risk groups. OBJECTIVE: To investigate the in vivo reactivity of health care workers and patients with spina bifida to extracts of internal and external surfaces of latex gloves and also to specific extracts enriched in major allergens for these risk groups. METHODS: Gloves from different manufacturers were used for protein extraction, and salt precipitation and hydrophobic interaction chromatography (HIC) were applied to obtain the enriched latex extracts. The major latex allergens were quantified by an enzyme immunoassay. The extracts obtained were tested in 14 volunteers using skin prick tests (SPT). RESULTS: Latex glove extracts enriched in the hydrophobic allergens that are most often seen in patients with spina bifida were obtained by selective precipitation, whereas HIC produced extracts enriched in the hydrophilic allergens commonly found in health care workers. The health care workers had positive SPTs to glove extracts from internal surfaces and to the hydrophilic allergen-enriched extracts. By contrast, patients with spina bifida had larger skin reactions both to external glove extracts and to the extracts enriched with the hydrophobic major allergens for this risk group. Despite the protein concentration of these extracts being less than half the concentration of the commercial extract, the weal-and-flare reactions were of similar magnitude. CONCLUSION: Using novel latex extracts, our study showed a different in vivo reactivity pattern in health care workers and in patients with spina bifida to extracts of the internal and external surfaces of gloves, which suggests that sensitization may occur by different routes of exposure, and that this influences the allergen reactivity profiles of these risk groups
- Digital Health Europe (DHE) Twinning on Severe Asthma—Kick-off Meeting ReportPublication . Bousquet, J; Bedbrook, A; Czarlewski, W; De Carlo, G; Fonseca, JA; González Ballester, MA; Illario, M; Koskinen, S; Laatikainen, T; Onorato, GL; Palkonen, S; Patella, V; Pham-Thi, N; Puggioni, F; Ventura, MT; Joos, G; Kuna, P; Louis, R; Makris, M; Zalud, P; Zuberbier, T; Bachert, C; Brussino, L; Carreiro-Martins, P; Carrion y Ribas, C; Chalubinski, M; Costa, EM; de Vries, G; Gemicioglu, B; Gennimata, D; Micheli, Y; Niedoszytko, M; Regateiro, FS; Romantowski, J; Taborda-Barata, L; Toppila-Salmi, S; Tsiligianni, I; Viart, F; Laune, D
- Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods StudyPublication . 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, JBackground: 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.
- Molecular Profile of Sensitization to Dermatophagoides Pteronyssinus Dust Mite in PortugalPublication . Limão, R; Spínola Santos, A; Araújo, L; Cosme, J; Inácio, F; Tomaz, E; Ferrão, A; Santos, N; Sokolova, A; Môrete, A; Falcão, H; Cunha, L; Ferreira, A; Bras, A; Ribeiro, F; Lozoya, C; Leiria-Pinto, P; Prates, S; Plácido, J; Coimbra, A; Taborda-Barata, L; Pereira Santos, MC; Pereira Barbosa, M; Pineda, FBackground and objectives: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas. Methods: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South. Results: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496). Conclusion: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size.
- Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility StudiesPublication . 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, JBackground: 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.
- Patient-Physician Discordance in Assessment of Adherence to Inhaled Controller Medication: a Cross-Sectional Analysis of Two CohortsPublication . 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, JOBJECTIVE: 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.