Abstract Objectives: Report the prevalence and severity of the most common allergic diseases in children living in Monterrey, México Methods: Cross-sectional multi-center survey on the most common allergic diseases, completed by parents of 6-7-year-old children and by 13-14- year-old adolescents in the Monterrey metropolitan area, between January 2018 and December 2019. Results: A total of 3,044 questionnaires were eligible for the analysis. Among children between 6-7 years old, 30.2% (n = 143/473) presented wheezing at any time in their life; with a higher prevalence in the male population. In the adolescent group, 26.4% reported having experienced wheezing at some point in their life, with aslight predominance in the female group (54.9%). Conclusions: Knowing the prevalence of allergic diseases in our population gives us tools to generate strategies that allow us to provide the best quality healthcare to our patients.

Resumen Objetivo: Reportar la prevalencia y gravedad de las enfermedades alérgicas más comunes en niños residentes en Monterrey, México. Métodos: Encuesta multicéntrica transversal, acerca de las enfermedades alérgicas más comunes, completada por padres de niños de 6 aa 7 años y por adolescentes de 13 a 14 años del área metropolitana de Monterrey, entre enero de 2018 y diciembre de 2019. Resultados: Un total de 3044 cuestionarios fueron elegibles para el análisis. Entre los niños de 6-7 años, 30.2% (n = 143/473) manifestaron sibilancias en algún momento de su vida; con mayor prevalencia en la población masculina. En el grupo de adolescentes el 26.4% refirió haber tenido sibilancias alguna vez en su vida, con un ligero predominio en el grupo femenino (54.9%). Conclusiones: Conocer la prevalencia de las enfermedades alérgicas en la población brinda herramientas para generar estrategias para la mejor calidad asistencial en los pacientes.

Abstract Severe asthma is an entity with a complex diagnosis, requiring an adequate differential diagnosis and identification of endotypes for a correct approach and therapeutic process. In the present review, we show a synthesis of the current literature on the diagnosis, pathophysiology, and management of severe asthma, having critically analyzed the evidence in search engines such as Medline, Scopus, and Embase.

Resumen El asma grave es una enfermedad compleja, que requiere un enfoque y diagnóstico diferencial ordenado e identificación de endotipos para el correcto abordaje y tratamiento. El tratamiento farmacológico cuenta cada vez con más moléculas a disposición del personal médico para el control efectivo de los síntomas. Esta revisión muestra una síntesis de la bibliografía actual acerca del diagnóstico, fisiopatología y tratamiento del asma grave, mediante la lectura crítica previa de la evidencia científica en buscadores como Medline, Scopus y Embase.

Abstract: Respiratory diseases are one of the main causes of morbidity and mortality in children under 5 years of age. The acute respiratory disease (ERA in Spanish) room strategy implemented in Colombia is an important tool to reduce hospitalization and mortality rates in this population. Objective: To describe the health outcomes of the implementation of the ERA room strategy in two health institutions in Bogota. Patients and Method: Multicenter descriptive study including 1785 patients admitted to the ERA rooms of two institutions in Bogota, between December 2019 and 2022. Data on sex, age, admission diagnosis, length of stay in ERA room, education provided, and post discharge follow-up were collected. The main outcomes were evaluated through hospitalization requirement, ICU requirement, and post discharge improvement. Results: 1785 patients were included during the study period. 57% were male; median age was 26.6 months (IQR: 11.8 to 40.6); length of stay in ERA room was 2.62 hours (IQR: 1.73 to 4.88); 91.65% of family members and/or caregivers received educational measures. Conclusions: This study describes the results of the implementation of the ERA room strategy; the low proportion of patients requiring hospitalization is evident. Additionally, the education provided to parents and caregivers on home management is relevant, as well as the post discharge follow-up of this cohort of patients with acute respiratory disease.

Resumen: Las enfermedades respiratorias son una de las principales causas de morbilidad y mortalidad en los niños menores de 5 años. La estrategia de una sala de enfermedad respiratoria aguda (ERA) implementada en Colombia, es una importante herramienta para contribuir a la disminución de los índices de hospitalización y mortalidad en esta población. Objetivo: Describir los resultados en salud de la implementación de la estrategia de sala ERA en dos instituciones de salud en la ciudad de Bogotá. Pacientes y Método: Estudio descriptivo multicéntrico que incluyó 1.785 pacientes ingresados a las salas ERA de dos instituciones de la ciudad de Bogotá, atendidos entre diciembre de 2019 y de 2022. Se recolectaron datos como sexo, edad, diagnóstico de ingreso, tiempo de estancia en sala ERA, educación brindada y seguimiento post egreso. Los principales resultados se evaluaron a través del requerimiento de hospitalización, requerimiento de UCI y la mejoría post egreso. Resultados: Se incluyeron 1785 pacientes durante el periodo de estudio. El 57% corresponde al sexo masculino; la mediana de edad fue de 26,6 meses (RIC: 11,8 a 40,6); el tiempo de estancia en sala ERA fue de 2,62 horas (RIC: 1,73 a 4,88); el 91,65% de los familiares y/o cuidadores recibieron acciones educativas. Conclusiones: Este estudio describe los resultados de la implementación de la estrategia sala ERA, se evidencia la baja proporción de pacientes que requirieron hospitalización. Adicionalmente, es relevante la educación brindada a los padres y cuidadores del manejo en casa; así como, el seguimiento post egreso realizado en esta cohorte de pacientes con ERA.

ABSTRACT Digital health can effectively engage patients in the self-management of their asthma. Still, it will only reach its full potential when apps are aligned with patients’ needs and are integrated into clinical practice. We aim to test a framework for the involvement of patients/carers in all phases of developing and implementing an app for asthma. This protocol was co-designed with six asthma patients/carers and includes 5 tasks. Regular interactions among patients, developers and healthcare professionals will be a priority for user requirements definition (task 1) and iterative development and testing until the app’s initial version (tasks 2-3). Patients/carers and healthcare professionals will be fully engaged in the real-life feasibility study (task 4) and management and dissemination activities (task 5). The eligibility criteria to participate in tasks 2-4 are 1) diagnosis of asthma or carer of a person with asthma; 2) ≥18 years; 3) ability to use apps and access a mobile device with Internet. We anticipate applying questionnaires such as the User Experience Questionnaire and the System Usability Scale in all app testing tasks. We expect to have a final version of the asthma app that meets patients’/carers’ needs and experiences and healthcare professionals’ concerns. This will be an attractive app to support patients in self-management of their disease, keeping their asthma in control, having fewer asthma symptoms, and enjoying life. This study will be a framework for fully involving patients, carers and citizens in the iterative co-production development and implementation of an asthma app.

RESUMO A saúde digital pode envolver efetivamente os doentes no controlo da sua doença, mas só alcançará o seu potencial quando as aplicações móveis desenvolvidas estiverem alinhadas com as necessidades percebidas pelos doentes e integradas na prática clínica. O nosso objetivo é testar uma abordagem para o envolvimento de doentes/cuidadores em todas as fases de desenvolvimento e implementação de uma aplicação móvel para a autogestão da asma. Este protocolo foi codesenvolvido com seis pessoas com asma/cuidadores e contempla cinco tarefas. Interações regulares entre doentes, investigadores, programadores e profissionais de saúde serão uma prioridade para a definição dos requisitos do utilizador (tarefa 1) e para o desenvolvimento iterativo até a versão inicial da aplicação (tarefas 2-3). Doentes/cuidadores e profissionais de saúde estarão ativamente envolvidos no estudo observacional sobre o uso da app na vida real (tarefa 4) e nas atividades de gestão/disseminação (tarefa 5). Os critérios de elegibilidade para participar nas tarefas 2-4 são: diagnóstico médico de asma ou cuidador de pessoa com este diagnóstico; pelo menos 18 anos; capacidade de usar aplicações e acesso a um dispositivo móvel com Internet. Antecipamos o uso de questionários como o Questionário de Experiência do Utilizador e a Escala de Usabilidade do Sistema em todas as tarefas que envolvem teste da aplicação. No final do estudo esperamos ter uma versão final da aplicação para a asma que atenda às necessidades e experiência dos doentes/cuidadores e às preocupações dos profissionais de saúde. Esta será uma aplicação atrativa para apoiar os doentes na autogestão da sua doença, ajudando a manter a sua asma controlada, com menos sintomas e melhor qualidade de vida. Este estudo fornecerá uma abordagem para envolver os doentes, cuidadores e cidadãos no desenvolvimento iterativo e coprodução de uma aplicação móvel de saúde para pessoas com asma.

Abstract Neuroendocrine tumors (NETs) are the most common primary lung neoplasms. Clinical manifestations can be subtle, and chest radiograph usually shows non-specific findings, often leading to delayed or inaccurate diagnosis. Despite their indolent nature, NETs have metastatic potential and can cause significant morbidity. Early diagnosis is critical for optimal management, as surgical resection can be curative. The challenge is to correctly diagnose this rare entity while avoiding unnecessary testing. Patients with suspected NETs should be referred to a tertiary hospital for multidisciplinary evaluation, and bronchoscopy should not be delayed. Herein is reported the case of an adolescent with asthma who presented with nonspecific respiratory and constitutional symptoms. The persistence of symptoms and imaging alterations despite multiple treatments for recurrent pneumonia raised clinical suspicion of a more serious underlying condition, leading to the diagnosis of bronchial NET.

Resumo Os tumores neuroendócrinos (TNEs) são as neoplasias pulmonares primárias mais comuns. O diagnóstico pode ser desafiante, pois as manifestações clínicas são geralmente subtis e as alterações imagiológicas inespecíficas. Apesar da sua natureza indolente, os TNEs têm potencial metastático e podem causar morbilidade significativa. O diagnóstico precoce é fundamental para uma abordagem otimizada, uma vez que a ressecção cirúrgica pode ser curativa. O desafio é estabelecer o diagnóstico desta entidade rara evitando avaliações e exames complementares desnecessários. Perante suspeita de TNE, o doente deve ser referenciado para um hospital terciário para avaliação multidisciplinar e realização de broncoscopia. É descrito o caso de um adolescente com asma que se apresentou com sintomas respiratórios e constitucionais inespecíficos. A persistência dos sintomas e alterações imagiológicas apesar da realização de múltiplos tratamentos por pneumonia recorrente motivou a continuação da investigação etiológica e possibilitou o estabelecimento do diagnóstico de TNE endobrônquico.

RESUMEN Objetivo: Comparar las reconsultas por asma al servicio de urgencias (SU) durante la semana posterior al alta y explorar los factores asociados antes y después de la implementación de un protocolo asistencial. Materiales y métodos: Se realizó un estudio de cohorte retrospectivo que incluyó las consultas por crisis asmática de adultos al SU de un hospital universitario en los períodos 2016-2018 (preprotocolo) y 2019-2020 (posprotocolo). Se utilizó un modelo de regresión logística multivariado y se reportaron odds ratios (OR) e intervalo de confianza del 95 % (IC 95 %). Se consideró significativo un valor p < 0,05. Resultados: Las reconsultas fueron 38 (31,40 %) para el período preprotocolo y 33 (26,61 %) para el período posprotocolo. En el modelo de regresión multivariable, no se encontraron diferencias en las reconsultas tempranas al comparar el período posprotocolo con el período preprotocolo (OR 0,68; IC 95 %: 0,26-1,74; p = 0,421). Los factores asociados a las reconsultas tempranas fueron la edad (OR: 1,02; IC 95 %: 1,00-1,04; p = 0,017), el sexo masculino (OR 0,21 IC 95 %: 0,08-0,59; p = 0,003) y el haber tenido más de una consulta al SU en el último año (OR 6,19 IC 95 %: 2,48-15,46; p < 0,001). Conclusión: Aunque las reconsultas tempranas no disminuyeron luego de la aplicación del protocolo, se identificaron la edad y el haber tenido más de una visita al SU por asma dentro del último año como factores de riesgo para las reconsultas dentro de la semana, mientras que el sexo masculino resultó ser un factor protector.

ABSTRACT Objective: To compare revisits for asthma to the emergency department (ED) during the week following discharge and describe associated factors before and after the implementation of an assistance protocol. Materials y methods: A retrospective cohort study was conducted, including visits for asthma exacerbations in adults to the ED of a university hospital during the periods 2016-2018 (pre-protocol) and 2019-2020 (post-protocol). A multivariate logistic regression model was used, and the odds ratios (OR) with their 95% confidence intervals (95 % CI) were reported. A p-value < 0.05 was considered significant. Results: Revisits were 38 (31.40 %) for the pre-protocol period and 33 (26.61%) for the post-protocol period. In the multivariate regression model, no differences were found in early revisits when comparing the post-protocol period with the pre-protocol period (OR 0.68; 95 % CI: 0.26-1.74; p = 0.421). Factors associated with early revisits were age (OR: 1.02; 95 % CI: 1.00-1.04; p = 0.017), male sex (OR: 0.21; 95 % CI: 0.08-0.59: p = 0.003), and having had more than one visit to the ED in the last year (OR: 6.19; 95 % CI: 2.48-15.46; p < 0.001). Conclusion: Although early revisits did not decrease after the protocol implementation, age and having had more than one visit for asthma to the ED in the last year were identified as risk factors for revisits within the week, while male sex was a protective factor.

RESUMEN Introducción: Sulfato de magnesio (MgSO4) y aminofilina son broncodilatadores intravenosos utilizados en el tratamiento de niños con broncoobstrucción (BO). La evidencia disponible para recomendar su uso es escasa. Objetivo: Caracterizar el perfil de uso y la respuesta terapéutica al MgSO4 y aminofilina en el tratamiento de la BO en niños hospitalizados en un centro de referencia de Uruguay. Materiales y métodos: Estudio descriptivo de corte transversal mediante revisión de historias y entrevistas. Se incluyeron a todos los menores de 15 años que utilizaron estos fármacos. Se evaluó la respuesta terapéutica a la administración de ambos fármacos en forma exclusiva y concomitante y la presencia de efectos adversos. Resultados: Se incluyeron 102 niños, mediana de edad 4 años, ≤5 años 62%. Los principales diagnósticos fueron: crisis asmática 56% y neumonía viral 31%. Recibieron ambos fármacos 48%, únicamente aminofilina 28% y exclusiva de MgSO4 24%. Se observó buena respuesta terapéutica a la administración: exclusiva de MgSO4 67%, consecutiva de MgSO4 y aminofilina 45% y exclusiva de aminofilina en 34%. En 38,2% se registró al menos un efecto adverso, 64% eran menores de 5 años, riesgo aumentado en 1,5 veces. Conclusiones: Se registraron variadas indicaciones, la mayoría en niños asmáticos y en un porcentaje menor indicaciones fuera de prospecto. Menos de la mitad presentaron buena respuesta luego de la administración de MgSO4 y/o aminofilina. En un porcentaje no despreciable se registraron efectos adversos, predominaron en menores de 5 años. Son necesarios nuevos estudios para continuar caracterizando el perfil de uso y seguridad de estos fármacos.

ABSTRACT Introduction: Magnesium sulfate (MgSO4) and aminophylline are intravenous bronchodilators used in the treatment of children with bronchoobstruction (BO). The evidence available to recommend their use is scarce. Objective: To characterize the use profile and therapeutic response to MgSO4 and aminophylline in the treatment of BO in children hospitalized in a reference center in Uruguay. Materials and methods: This was a descriptive cross-sectional study through review of clinical histories and interviews. All children under 15 years of age who used these drugs were included. The therapeutic response to the administration of both drugs exclusively and concomitantly and the presence of adverse effects were evaluated. Results: 102 children were included, median age was 4 years, 62% were ≤5 years. The main diagnoses were: asthmatic crisis, 56% and viral pneumonia, 31%. 48% received both drugs, 28% only aminophylline and 24% exclusively MgSO4. Good therapeutic response was observed to the administration: MgSO4 exclusively, 67%, MgSO4 followed by aminophylline, 45% and aminophylline exclusively in 34%. At least one adverse effect was recorded in 38.2%, of these, 64% were under 5 years of age, risk increased by 1.5 times. Conclusions: Various indications were recorded, the majority in asthmatic children and a smaller percentage off-label indications. Less than half had a good response after the administration of MgSO4 and/or aminophylline. Adverse effects were recorded in a non-negligible percentage, predominating in children under 5 years of age. New studies are necessary to continue characterizing the use and safety profile of these drugs.

ABSTRACT Background: Covid-19 pandemic had an important impact on health care, on the approach to respiratory diseases. Aim: To characterize asthmatics patients hospitalized in a tertiary hospital during Covid-19 pandemic. Methods: Retrospective analysis of the clinical data of the patients hospitalized in our Hospital for asthma exacerbation during the first 12 months of Covid-19 pandemic (from March 2020 to February 2021) compared with the corresponding period before the pandemic (from March 2019 to February 2020). In order to identify admitted patients for asthma, we used ICD9 and ICD10 asthma. diagnostic codes attributed to the main diagnosis. Results: A total of 56 hospitalizations were identified, corresponding to 53 patients, 81.1% females and 18.9% males, with a mean age of 47.3 years [± 20.8 years; 8-93 years]. Ten cases were excluded (missing information, in three, and other reason for admission, in seven). We identified 17 hospitalizations in the considered pandemic period and 39 in the pre-pandemic period, representing a significant reduction in asthma hospitalization during covid-19 pandemic (30.4% vs 69.6%, p < 0.001). When comparing the main characteristics between the two groups (pandemic vs pre-pandemic), namely age (47.1 vs 47.3 years, p=0.972), gender (82.4% vs 79.5% female, p=1.0), atopy (50.0% vs 64.5%, p=0.366), hospitalization length (5.8 days vs 5.7 days, p=0.9), previous therapy (37.5% vs 30.8% only SABA/LABA, p=0.754), therapy after discharge (p=0.842) or exacerbation trigger, no statistical differences were found. In both groups, viral respiratory tract infection was the main trigger for asthma exacerbation. In neither case SARS-CoV-2 infection was identified. Conclusion: There was a significant decrease in asthma hospitalizations in the first 12 months of the Covid-19 pandemic, compared to the same period pre-pandemic. However, no statistically significant differences were found between the characteristics of hospitalized patients in the two periods.

RESUMO Introdução: A situação epidemiológica associada à infeção por SARS-CoV-2 modificou, desde o início, a prestação de cuidados de saúde em Portugal. Nesse sentido, visamos caracterizar os internamentos por asma num hospital terciário em contexto de pandemia Covid-19. Métodos: Análise retrospetiva dos processos clínicos dos doentes internados por asma num hospital universitário, durante 12 meses de pandemia (março 2020 a fevereiro 2021), comparativamente ao período homólogo pré-pandemia (março 2019 a fevereiro 2020). Foram utilizados os códigos ICD10 associados a “asma” atribuídos ao diagnóstico principal para identificar os doentes internados. Resultados: Globalmente observaram-se 56 internamentos, correspondentes a 53 doentes, 81,1% do sexo feminino, com uma média de idades de 47,3 anos [±20,8 anos; 8-93 anos]. Foram excluídos 10 doentes da análise, 2 por falta de informação e 8 porque o motivo de internamento não foi exacerbação de asma. No período de pandemia analisado observaram-se 17 internamentos e no período pré-pandemia 39, verificando-se uma redução significativa dos internamentos por asma (30,4% vs 69,6%, p < 0,001). Quando comparamos as principais características dos dois grupos (pandemia vs pré-pandemia), não se verificaram diferenças estatisticamente significativas, nomeadamente em termos de idade (47,1 vs 47,3 anos, p=0,972), sexo (82,4% vs 79,5% feminino, p=1,0), atopia (50,0% vs 64,5%, p=0,366), tempo de internamento (5,82 dias vs 5,67 dias, p=0,9), terapêutica prévia ao internamento (37,5% vs 30,8% exclusivamente SABA/LABA, p=0,754) ou à data da alta (p=0,842). Também não se observaram diferenças relativamente ao motivo de exacerbação da asma (p=0,452). Em ambos os grupos, o principal motivo foi a ocorrência de infeção respiratória, mas em nenhum dos casos foi identificada como infeção por SARS-CoV-2. Conclusões: Verificou-se uma diminuição do número de internamentos por asma nos primeiros 12 meses de pandemia, em comparação com o período homólogo prévio. Contudo, não se observaram diferenças estatisticamente significativas entre as principais características dos doentes internados por asma nestes dois períodos.

ABSTRACT The human toxocariasis is the most important cosmopolite helminth infection in the world. The infection can modulate the immune response of the infected paratenic host, and it is suggested that it is an important risk factor for the development of asthma and be associated with increased levels of different markers of atopy. The aim of this study was to conduct a systematic review and meta-analysis of the association between human toxocariasis with asthma and atopic diseases. The literature search identified 1705 papers on the association of Toxocara spp with asthma, Then, 24 papers were selected based on the inclusion and exclusion criteria, following the PRISMA protocols. These papers served to analyze association data as a risk factor for increased asthma and investigate the association of this infection with the appearance of atopy markers (specific IgE). The results did not indicate association between asthma and Toxocara spp seropositivity, although there was a positive trend (OR 1.47; 95% CI 0.92-2.33). However, when studies were classified by type a positive association in the case-control type studies was found (OR 1.69; 95% CI 1.06-2.70). Furthermore, there was a positive association with this atopic marker in the analysis of the association of toxocariasis with specific IgE (OR 1.77; 95% CI 1.19-2.64). The evidence found was not entirely conclusive regarding the possibility of having T. canis infection as a risk factor for the development of asthma, although there is a positive statistical trend. On the other hand, the association with specific IgE results supports previous findings in the literature, where helminth infections can stimulate the production of this type of antibody, leading to a positive association with atopy.

RESUMEN La toxocariasis humana es la helmintiasis cosmopolita más importante del mundo. La infección puede modular la respuesta inmune del huésped paraténico infectado, y se sugiere que es un factor de riesgo importante para el desarrollo de asma y estar asociado con niveles elevados de diferentes marcadores de atopia. El objetivo de este estudio fue realizar una revisión sistemática y un metanálisis de la asociación entre la toxocariasis humana con asma y enfermedades atópicas. La búsqueda bibliográfica identificó 1705 artículos sobre la asociación de Toxocara spp con asma. Luego, se seleccionaron 24 artículos con base en los criterios de inclusión y exclusión, siguiendo los protocolos PRISMA. Estos trabajos sirvieron para analizar datos de asociación como factor de riesgo de aumento del asma e investigar la asociación de esta infección con la aparición de marcadores de atopia (IgE específica). Los resultados no indicaron asociación entre asma y seropositividad a Toxocara spp, aunque hubo una tendencia positiva (OR 1,47; IC 95% 0.92-2.33). Sin embargo, cuando los estudios se clasificaron por tipo se encontró una asociación positiva en los estudios de tipo caso-control (OR 1,69; IC 95% 1.06-2.70). Además, hubo una asociación positiva con este marcador atópico en el análisis de la asociación de la toxocariasis con la IgE específica (OR 1.77; IC 95% 1.19-2.64). La evidencia encontrada no fue del todo concluyente respecto a la posibilidad de tener infección por T. canis como factor de riesgo para el desarrollo de asma, aunque existe una tendencia estadística positiva. Por otro lado, la asociación con resultados de IgE específica respalda hallazgos previos en la literatura, donde las infecciones por helmintos pueden estimular la producción de este tipo de anticuerpos, lo que lleva a una asociación positiva con la atopia.

Abstract Objectives: To systematize the existing scientific evidence in relation to the pathology “Atopic Disease of the Central Compartment” (CCAD). Study Design: Systematic Bibliographic Review. Material and Methods: Conducting a systematic literature review in the MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature databases, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) model, selecting papers published between January 2010 and December 2022. Results: Of the 3114 studies initially found, a total of 13 articles were selected for full analysis. More than half of the articles (69.2%) were published from 2019 onwards. A total of 1780 patients with CRS were analyzed. Of these, the number of patients with CHD was 372 (20.9%), with a male:female ratio of 2.16. Allergic rhinitis (98.5%), asthma (25.2%) and smoking (8.2%) were identified as comorbidities. Conclusions: CCAD represents a variant of CRS described for the first time in 2017. It is associated with exposure to inhalational allergens and with edematous and polypoid repercussions in the middle and superior turbinates, as well as in the postero-superior region of the nasal septum. The basis of management of this pathology is medical treatment of the allergy, complemented, if necessary, with endoscopic sinus surgery.

Resumo Objetivos: Sistematizar a evidência científica existente em relação à patologia “Doença Atópica do Compartimento Central” (DACC). Desenho do Estudo: Revisão Bibliográfica Sistemática. Material e Métodos: Realização de uma revisão bibliográfica sistemática nas bases de dados MEDLINE, Cochrane Central Register of Controlled Trials e Cumulative Index to Nursing and Allied Health Literature, baseada no modelo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), selecionando trabalhos publicados entre janeiro de 2010 e dezembro de 2022. Resultados: Dos 3114 estudos inicialmente encontrados, foram selecionados para análise na integra um total de 13 artigos. Mais de metade dos artigos (69.2%) foram publicados a partir do ano de 2019, inclusive. Um total de 1780 doentes com RSC foi analisado. Destes, o número de doentes com DACC foi 372 (20.9%), com um rácio masculino:feminino de 2.16. Identificaram-se como comorbilidades a rinite alérgica (98,5%), a asma (25.2%) e o tabagismo (8.2%). Conclusões: DACC representa uma variante de RSC descrita pela primeira vez em 2017. Está associada à exposição a alergénios inalatórios e com repercussões edematosas e polipóides nos cornetos médios e superiores, bem como na região postero-superior do septo nasal. A base da gestão desta patologia é o tratamento médico da alergia, complementado, se necessário, com cirurgia endoscópica nasossinusal.

Resumo: Apresentamos o caso de um paciente de 31 anos de idade que trabalha em um moinho de grãos há 12 anos e desenvolveu asma ocupacional. O objetivo do artigo é apresentar a justificativa da origem ocupacional da asma adquirida. Descrevemos as tarefas realizadas, os materiais e os meios de trabalho utilizados. Analisamos especialmente a exposição ocupacional à poeira orgânica e sua conexão temporal com a sintomatologia respiratória. Essas informações nos permitem entender a importância das condições em que o trabalho é realizado e a exposição a um fator de risco, a poeira orgânica, para o desenvolvimento da patologia respiratória ocupacional. As medições do volume pulmonar expiratório máximo foram realizadas com a técnica de pico de fluxo durante e fora da jornada de trabalho. Observamos variações no fluxo expiratório superiores a 20%, tanto durante quanto fora do horário de trabalho, com um padrão sintomático semelhante ao relatado pelo trabalhador. Concluímos que há evidências de um nexo causal entre asma e trabalho e, portanto, propomos o diagnóstico de asma ocupacional. Destacamos a importância de avaliar os riscos ocupacionais em cada atividade para implementar planos de vigilância da saúde tanto do trabalhador quanto do ambiente de trabalho, a fim de evitar o surgimento e a evolução dessa ou de outras patologias que, em muitos casos, geram incapacidade para a tarefa e deterioração da qualidade de vida dos trabalhadores.

Resumen: Se presenta el caso de un trabajador de 31 años que desempeña tareas en un molino de granos desde hace 12 años y que ha desarrollado asma ocupacional. El objetivo del artículo es presentar los fundamentos utilizados para sostener el origen profesional del asma adquirido. Se describen las tareas laborales que desarrolla, materiales y medios de trabajo que utiliza. Se analiza en particular la exposición laboral a polvo orgánico y su vinculación temporal con la sintomatología respiratoria. Esta información permite comprender la importancia de las condiciones en las que realiza el trabajo y la exposición a un factor de riesgo, el polvo orgánico, para el desarrollo de la patología respiratoria laboral. Se realizaron mediciones de volumen máximo espiratorio pulmonar, con técnica de pico flujo, durante la jornada laboral y fuera de ésta. Se observaron variaciones del flujo espiratorio mayores a 20%, tanto durante la jornada laboral como fuera de ella, con similar patrón sintomático, según relata el trabajador. Se concluyó que existe evidencia del nexo causal entre el asma y el trabajo, por lo que se plantea el diagnóstico de asma ocupacional. Se destaca la importancia de evaluar los riesgos laborales en cada actividad para implementar planes de vigilancia de la salud, tanto del operario como del ambiente de trabajo, para prevenir la aparición como la evolución de esta u otras patologías que en muchos casos generan incapacidad para la tarea y deterioro de la calidad de vida de los trabajadores.

Abstract: We present the case of a 31-year-old worker who has been working in a grain mill for 12 years and has developed work-related asthma. The objective of this article is to present the foundations used to support the occupational origin of the acquired asthma. The study describe the work tasks performed, the materials used, and the working methods. The work-related exposure to organic dust and its temporal relationship with respiratory symptoms is particularly analyzed. This information allows us to understand the importance of working conditions and exposure to organic dust, a risk factor, for the development of this work-related respiratory pathology. Measurements of maximum expiratory lung volume were made using the peak flow technique during and outside of the workday. Expiratory flow variations greater than 20% were observed, both during and outside of the workday, which followed a similar symptomatic pattern as reported by the worker. The study concluded that there is evidence of a causal link between asthma and work, thus suggesting the diagnosis of work-related asthma. The importance of assessing occupational risks in each activity to implement health surveillance plans for both workers and the work environment is highlighted, aiming to prevent the onset and progression of this and other pathologies that often result in work incapacity and deterioration of workers’ quality of life.

ABSTRACT Introduction: the COVID-19 pandemic arises from infection with the SARS-CoV-2 virus. This disease shows interindividual clinical variability due to multiple factors that are currently being investigated. Objective: to analyze the contribution of personal and family history of allergic diseases and asthma to the risk of SARS-CoV-2 infection and the clinical presentation of COVID-19 in Pinar del Río. Method: analytical observational study of cases and controls in Pinar del Río. Personal and family history of allergic diseases and asthma with traditional epidemiological approaches and genetic with family approach were explored. Results: the frequency of allergy and asthma was higher in the cases than in the controls with values of 24,7 % and 15,3 % respectively. Also, excess frequency was found in allergic and asthmatic symptomatic patients with an OR of 2,241 and 3,096; respectively, compared to asymptomatic patients. There was a significant association in favor of the relatives of the cases, with respect to the controls for allergy/asthma (OR=1,38). In addition, an OR of 1,531 and 1,541 was obtained in first- and third-degree relatives; as well as association with maternal grandparents and nephews. Conclusions: Personal and family history of allergic diseases and asthma contribute to the risk of symptomatic SARS-CoV-2 infection. The preferential grouping of allergy and asthma in the relatives of the cases suggests that there is a contribution from the predisposing genetic component of these entities to COVID-19.

RESUMEN Introducción: la pandemia de COVID-19 surge por la infección del virus SARS-CoV-2. Esta enfermedad muestra variabilidad clínica interindividual por múltiples factores que se investigan actualmente. Objetivo: analizar la contribución de los antecedentes patológicos personales y familiares de enfermedades alérgicas y asma al riesgo en la infección por SARS-CoV-2 y la presentación clínica de la COVID-19 en Pinar del Río. Métodos: estudio observacional analítico de casos y controles en Pinar del Río. Se exploraron antecedentes personales y familiares de enfermedades alérgicas y asma con enfoques epidemiológicos tradicional y genético con enfoque familiar. Resultados: la frecuencia de alergia y asma fue mayor en los casos que en los controles con valores de 24,7 % y 15,3 % respectivamente. También, se encontró exceso de frecuencia en los sintomáticos alérgicos y asmáticos con OR de 2,241 y 3,096 respectivamente con respecto a los asintomáticos. Existió asociación significativa a favor de los familiares de los casos, con respecto a los controles para alergia/asma (OR=1,38). Además, se obtuvo OR de 1,531 y 1,541 en familiares de primer y tercer grados; así como asociación con los abuelos maternos y los sobrinos. Conclusiones: los antecedentes patológicos personales y familiares de enfermedades alérgicas y asma contribuyen al riesgo de infección sintomática por SARS-CoV-2. La agrupación preferencial de alergia y asma en los familiares de los casos sugiere que hay contribución del componente genético predisponente de estas entidades a la COVID-19.

RESUMEN Introducción: Dada la existencia de variadas guías para enfermedades respiratorias, se buscó conocer cuáles eligen los médicos para utilizar en su práctica clínica. Materiales y Métodos: se realizó un estudio descriptivo, transversal, mediante una encuesta a neumonólogos de la Asociación Argentina de Medicina Respiratoria. Resultados: La guía más utilizada para EPOC fue la Iniciativa Global para la Enfermedad Pulmonar Obstructiva Crónica (GOLD) (82 %), seguida por GesEPOC (51 %). Para asma las más usadas fueron la Iniciativa Global para el Asma (GINA) 2022 (89 %) y GEMA 5.2 (68 %). En asma de difícil control, se prefirieron GINA 2022 (82 %) y GEMA 2022 (53 %). En espirometría, un 54 % de los respondedores se inclinó por NHANES III y un 22 % utilizó valores teóricos de referencia de Knudson. En neumonía, el 62 % eligió SADI, el 37 %, IDSA y el 20 %, BTS. Para nódulos pulmonares, el 62 % prefirió las guías Fleischner, 35 % se inclinó por Lung-RADS 1.1. Para neumonitis por hipersensibilidad, un 83 % seleccionó las guías de las sociedades conjuntas ATS/JRS/ ALAT. Para imágenes de fibrosis pulmonar, el 89 % utilizó ALAT/ERS/JRS/ALAT y el 18 % White Paper. Discusión: si bien hay estudios sobre adherencia a guías, no los hay acerca de preferencias de utilización entre varias referidas a un mismo tema. En EPOC y asma (incluyendo la de difícil control) se eligieron GOLD y GINA y las de la Sociedad Española de Patología Respiratoria (GesEPOC y GEMA). El uso preferencial de la guía nacional para neumonía es coherente con la necesidad de contemplar la epidemiología local.

ABSTRACT Introduction: Since there are various guidelines for respiratory diseases, we aimed to know which are chosen by physicians in their daily clinical practice. Materials and Methods: A descriptive, cross-sectional study was conducted through a questionnaire sent to pulmonologists of the Argentinian Association of Respiratory Medicine. Results: The most commonly used guideline for COPD (chronic obstructive pulmonary disease) was the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (82 %), followed by GesEPOC (51 %). For asthma, the most commonly used guideline was the Global Initiative for Asthma (GINA) 2022 (89 %) and the Spanish Guideline on the Management of Asthma (known for its acronym in Spanish, GEMA), GEMA 5.2 (68 %). In difficult-to-control asthma, GINA 2022 (82 %) and GEMA 2022 (53 %) were used. With regard to spirometries, 54 % of respondents favored NHANES III (Third National Health and Nutrition Examination Survey) and 22 % used theoretical Knudson reference values. For pneumonia, 62 % chose the guidelines of the SADI (Argentinian Society of Infectious Diseases), 37 % preferred those of the IDSA (Infectious Diseases Society of America) and 20 %, chose the guidelines of the BTS (British Thoracic Society). For pulmonary nodules, 62 % used Fleischner guidelines, and 35 % favored Lung-RADS 1.1. For hypersensitivity pneumonitis, 83 % selected the ATS/JRS/ALAT Guidelines (American Thoracic Society/Japanese Respiratory Society/Latin American Thoracic Society). And with respect to pulmonary fibrosis imaging, 89 % used ALAT/ERS (European Respiratory Society)/JRS recommendations, and 18 % preferred White Paper. Discussion: Although there are studies about adherence to guidelines, none of them shows which are the chosen recommendations within a group of guidelines of the same topic. In COPD and asthma (including difficult-to-control asthma) GOLD, GINA and the guidelines of the Spanish Society of Respiratory Disease (GesEPOC and GEMA) were chosen. The preference for the national guideline for pneumonia is consistent with the need to consider local epidemiology.