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Papers by Alfonso Del Cuvillo

Research paper thumbnail of Author response for "Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Author response for "Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Research paper thumbnail of Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Therapeutic Advances in Respiratory Disease

Background: Chronic cough (CC; cough that lasts 8 weeks or longer) poses major effective assessme... more Background: Chronic cough (CC; cough that lasts 8 weeks or longer) poses major effective assessment challenges. Assessment of CC may vary considerably among medical specialists. Objectives: The aim was to evaluate similarities and consistency of responses across different specialists when performing a basic assessment of CC patients in primary care, and referring patients based on clinical findings or test results. Methods: A modified Delphi approach was used. A survey with 74 statements on initial assessment of CC and referral pathways was addressed to a panel of different specialists, who voted the statements in two rounds. Results: Seventy-seven physicians [18 primary care physicians (PCPs), 24 pulmonologists, 22 allergists, and 13 ear, nose, and throat specialists] from the National Healthcare System of Spain answered the questionnaire. After two rounds, the panel reached a consensus on 63 out of the 74 proposed items (85.1%). Consensus was not reached among the panelists of at ...

Research paper thumbnail of Effect of pollutants upon patients with respiratory allergies

J Investig Allergol Clin …, 2007

Epidemiological studies have revealed an association between pollution and allergic respiratory d... more Epidemiological studies have revealed an association between pollution and allergic respiratory diseases. The main pollutants in this sense are nitric oxide, ozone, and particulate matter. The present review on one hand addresses the chemical characteristics of each of these three groups of pollutants and their main sources, and on the other examines their effects upon allergic respiratory diseases-placing special emphasis on the effects of diesel exhaust particles. For each of the pollutants, the underlying mechanisms capable of infl uencing allergic respiratory diseases are commented. Lastly, an evaluation is made of some of the genetic aspects related to the response to pollutants.

Research paper thumbnail of Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study

Allergy, Asthma & Clinical Immunology

Background Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusi... more Background Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a united airways disease (UAD) perspective remains scarce, despite the frequent coexistence of these entities. We aimed to generate expert consensus-based recommendations for the management of UAD patients. Methods Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7–9), uncertain (4–6) or inappropriate (1–3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median. Results A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and fol...

Research paper thumbnail of Nasal Hyperreactivity: Nonspecific Nasal Provocation Tests. Review by the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology

Journal of investigational allergology & clinical immunology, 2015

Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to... more Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to most people. This response is caused by dysregulation of the autonomic nervous system at various levels of the nasal autonomic reflex arc. Various stimuli (methacholine, histamine, adenosine 5'-monophosphate, cold air, mannitol, rapsaicin, phentolamine, and distilled water) have been used in an attempt to find the test that most reliably differentiates between healthy individuals and patients and also between different types of rhinitis. Despite the small number of publications available, in the present review, we provide an update on current nonspecific nasal provocation techniques. The studies published to date are not comparable: the stimuli applied act through different mechanisms and are used to assess different pathways, and the methodologies differ in terms of selection of participants, concentrations used, and assessment of response (criteria for positivity). Given the limit...

Research paper thumbnail of Tratamiento de la poliposis nasal

Tratamiento de la poliposis nasal

Research paper thumbnail of Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso

Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso

Acta Otorrinolaringológica Española

Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery... more Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Research paper thumbnail of Analysis of Prevalence and Predictive Factors of Long-Lasting Olfactory and Gustatory Dysfunction in COVID-19 Patients

Life

Background: Although smell and taste disorders are highly prevalent symptoms of COVID-19 infectio... more Background: Although smell and taste disorders are highly prevalent symptoms of COVID-19 infection, the predictive factors leading to long-lasting chemosensory dysfunction are still poorly understood. Methods: 102 out of 421 (24.2%) mildly symptomatic COVID-19 patients completed a second questionnaire about the evolution of their symptoms one year after the infection using visual analog scales (VAS). A subgroup of 69 patients also underwent psychophysical evaluation of olfactory function through UPSIT. Results: The prevalence of chemosensory dysfunction decreased from 82.4% to 45.1% after 12 months, with 46.1% of patients reporting a complete recovery. Patients older than 40 years (OR = 0.20; 95% CI: [0.07, 0.56]) and with a duration of loss of smell longer than four weeks saw a lower odds ratio for recovery (OR = 0.27; 95% CI: [0.10, 0.76]). In addition, 28 patients (35.9%) reported suffering from parosmia, which was associated with moderate to severe taste dysfunction at the basel...

Research paper thumbnail of Rinitis, poliposis nasal y su relación con el asma

Archivos de Bronconeumología, 2018

El objetivo de esta revisión es facilitar al neumólogo el manejo de las enfermedades de la vía re... more El objetivo de esta revisión es facilitar al neumólogo el manejo de las enfermedades de la vía respiratoria superior ligadas a la vía respiratoria inferior, especialmente al asma, unidas por una epidemiología, una clínica y un mecanismo inflamatorio comunes e interrelacionados. El documento recoge las definiciones de los diferentes fenotipos nasosinusales ligados al asma: rinitis alérgica o no alérgica y rinosinusitis crónica con o sin pólipos nasales. Asimismo se recogen los criterios diagnósticos y su nivel de gravedad. Se dedica especial atención a los dos síndromes principales asociados al asma: 1) rinitis alérgica, la patología más frecuente, y 2) rinosinusitis crónica con pólipos nasales, la patología más ligada al asma grave. En síntesis, en el manejo del asma debe valorarse siempre la vía respiratoria superior con la finalidad de un diagnóstico unificado y un tratamiento integral de la vía respiratoria única.

Research paper thumbnail of Allergic rhinitis: similarities and differences between children and adults*

Background: Allergic rhinitis (AR) is a highly prevalent disease worldwide. Although a number of ... more Background: Allergic rhinitis (AR) is a highly prevalent disease worldwide. Although a number of studies have described AR, no studies compared children and adult AR populations. The objective was to compare the AR characteristics between two AR cohorts of children and adults. Methods: Two AR cohorts (children and adults) from Spain were studied through observational cross-sectional multicentre studies. AR was classified based on classical (allergen exposure), original (o-ARIA), and modified (m-ARIA) ARIA criteria. AR was evaluated by Total 4-Symptoms Score (T4SS), and disease severity by Visual Analogue Scale (VAS, 0-100 mm). AR comorbidities were also evaluated. Results: A total of 5,405 patients (1,275 children, 4,130 adults) were studied. According to symptom’s duration, intermittent AR was more frequent in children than in adults. Using o-ARIA severity, more children than adults had moderate/severe AR while, using m-ARIA, more children than adults had severe AR. T4SS was higher...

Research paper thumbnail of Validation of the MASK‐air app for assessment of allergic rhinitis

Validation of the MASK‐air app for assessment of allergic rhinitis

Allergy, 2020

1Center for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technische Univer... more 1Center for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany 2Hospital Pharmacy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany 3Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany 4Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

Research paper thumbnail of Position Paper on Nasal Obstruction: Evaluation and Treatment

Journal of Investigational Allergology and Clinical Immunology, 2018

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the... more Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Research paper thumbnail of Adaptation to Spanish and validation of the Rhinitis Control Assessment Test (RCAT) questionnaire

Journal of Investigational Allergology and Clinical Immunology, 2019

Background: The Rhinitis Control Assessment Test (RCAT) is a patient-based questionnaire that is ... more Background: The Rhinitis Control Assessment Test (RCAT) is a patient-based questionnaire that is widely used to evaluate control of rhinitis. Objective: To develop and validate a Spanish version of the RCAT (RCATe). Methods: After translation and cultural adaptation of the original RCAT, this multicenter, observational, prospective study evaluated the properties/attributes of the RCATe by assessing its validity, reliability, responsiveness, effect size, minimal important difference and cut point. Results: The recruited sample comprised 252 allergic rhinitis (AR) patients from 27 allergy and otolaryngology departments in hospitals throughout Spain. Significant and strong correlations were found between the RCATe and the total nasal symptom score and the visual analog scale (-0.79 and-0.77, respectively; P<.0001). The RCATe revealed significant differences between patients grouped in the different categories of severity or duration of AR (P<.001). The internal consistency (Cronbach α) was good (0.84), and the test-retest reliability was moderate (0.54 evaluated by the physician and 0.49 by the patient). The responsiveness to change was high and significant for RCATe (P<.0001) and correlated linearly with the improvement in AR. The overall effect size was 1.62. The cutoff point to identify patients with adequate control of AR was >20 (area under the receiver operating characteristic curve, 0.746; sensitivity, 58.3%; specificity, 90.9%). Conclusion: The psychometric evaluation and validation of the RCATe indicated good reliability, validity, and responsiveness, thus suggesting that it is effective for measuring control of AR symptoms by Spanish-speaking patients.

Research paper thumbnail of SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project

SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project

Journal of investigational allergology & clinical immunology, 2011

SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project. ... Alobid I, Antón E, Armeng... more SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project. ... Alobid I, Antón E, Armengot M, Chao J, Colás C, del Cuvillo A, Dávila I, Dordal MT, Escobar C, Fernández-Parra B, Gras-Cabrerizo JR, Ibáñez MD, Lluch M, Matéu V, Montoro J, Gili JR, Mullol J, Navarro ...

Research paper thumbnail of Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in a pediatric population: The PEDRIAL study

Pediatric Allergy and Immunology, 2011

Allergic rhinitis (AR) is the commonest chronic disease in children. Allergic Rhinitis and its Im... more Allergic rhinitis (AR) is the commonest chronic disease in children. Allergic Rhinitis and its Impact on Asthma (ARIA) classification based on symptom duration (intermittent vs. persistent) and severity (mild vs. moderate/severe) has not been yet validated in children. Thus our objective was to validate ARIA classification in

Research paper thumbnail of Determination of allergenic load and pollen count of Cupressus arizonica pollen by flow cytometry using Cup a1 polyclonal antibody

Cytometry Part B: Clinical Cytometry, 2013

Background: There is an increase in the incidence of pollen related allergy, thus information on ... more Background: There is an increase in the incidence of pollen related allergy, thus information on pollen schedules would be a great asset for physicians to improve the clinical care of patients. Like cypress pollen sensitization shows a high prevalence among the causes of allergic rhinitis, and therefore it is of interest to use it like a model of study, distinguishing cypress pollen, pollen count, and allergenic load level. In this work, we use a flow cytometry based technique to obtain both Cupressus arizonica pollen count and allergenic load, using specific rabbit polyclonal antibody Cup a1 and its comparison with optical microscopy technique measurement. Methods: Airborne samples were collected from Burkard Spore-Trap and Burkard Cyclone Cupressus arizonica pollen was studied using specific rabbit polyclonal antibody Cup a1, labeled with AlexaFluor V R 488 or 750 and analysed by Flow Cytometry in both an EPICS XL and Cyan ADP cytometers (Beckman Coulter V R). Optical microscopy study was realized with a Leica optical microscope. Bland and Altman was used to determine agreement between both techniques measured. Results: We can identify three different populations based on rabbit polyclonal antibody Cup a1 staining. The main region (44.5%) had 97.3% recognition, a second region (25%) with 28% and a third region (30.5%) with 68% respectively. Immunofluorescence and confocal microscopy showed that main region corresponds to whole pollen grains, the second region are pollen without exine and the third region is constituted by smaller particles with allergenic properties. Pollen schedule shows a higher correlation measured by optical microscopy and flow cytometry in the pollen count with a P-value: 0.0008 E 22 and 0.0002 with regard to smaller particles, so the Bland and Altman measurement showed a good correlation between them, P-value: 0.0003. Conclusion: Determination of pollen count and allergenic load by flow cytometry represents an important tool in the determination of airborne respiratory allergens. We showed that not only whole pollen but also smaller particles could induce allergic sensitization. This is the first study where flow cytometry is used for calculating pollen counts and allergenic load. V

Research paper thumbnail of Health-related quality of life in allergic rhinitis: comparing the short form ESPRINT-15 and MiniRQLQ questionnaires

Allergy, 2007

Health-related quality of life (HRQOL) questionnaires are increasingly used in a variety of clini... more Health-related quality of life (HRQOL) questionnaires are increasingly used in a variety of clinical and research settings including clinical trials, health surveys, clinical practice, and economic analyses of health care interventions (1, 2). Such measures are generally multidimensional (3) and include the measurement of symptoms, functional limitations, general health perceptions, and psychological well-being (4). The importance of HRQOL measurement in rhinitis is indicated by the fact that the World Health Organization's Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines base the classification of rhinitis severity on the impact of the disease on daily life (5). Several instruments have been developed to measure HRQOL in rhinoconjunctivitis and allergic rhinitis (AR) (6-8). One of the most frequently used is the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). The original version of the questionnaire, which consists of 28 items in seven dimensions, has proved its usefulness and validity (9-12). A shorter version of the questionnaire Background: We compared the psychometric properties of the ESPRINT-15, the short form of a new Spanish instrument to measure health-related quality of life in allergic rhinitis (AR) patients, with those of the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Methods: The questionnaires were compared in Spanish patients with intermittent allergic rhinitis (IAR) or persistent AR in a prospective, observational study. Floor and ceiling effects, internal consistency (Cronbach's alpha), testretest reliability (intraclass correlation coefficient; ICC), convergent and known groups validity, and sensitivity to change (standardized response means; SRMs) were compared. Results: In terms of content, while the MiniRQLQ has a dimension covering practical problems and places more emphasis on symptoms, the ESPRINT-15 has two dimensions (Sleep and Psychological impact) which are not included in the MiniRQLQ. In the validation study, 400 patients were included and 59% of the sample had persistent AR. There were no significant floor or ceiling effects on any dimension on either questionnaire. Cronbach's alpha values for the ESPRINT-15 and MiniRQLQ overall scores were 0.92 and 0.90, respectively. In 48 clinically stable patients, ICCs were 0.80 and 0.77, respectively. Both instruments discriminated between patients with IAR and persistent AR. Correlations with symptom scores and generic measures were moderate to strong. SRMs for overall scores and individual dimensions on the two questionnaires in the 197 patients reporting a change in health status ranged from 0.7 to 1.3. Conclusions: Both questionnaires performed well in psychometric terms. The ESPRINT-15 is particularly recommended for use in Spanish-speaking populations.

Research paper thumbnail of Cuerpos extraños esofágicos: nuestra experiencia en diez años

Cuerpos extraños esofágicos: nuestra experiencia en diez años

Acta Otorrinolaringológica Española, 2003

ABSTRACT ObjetiveTo study the management of esophageal foreign bodies.Material and methodsA retro... more ABSTRACT ObjetiveTo study the management of esophageal foreign bodies.Material and methodsA retrospective study was made of all rigid esophagoscopies performed for suspected foreign bodies in the esophagus by an otolaryngology department for ten years.ResultsRigid esophagoscopy was performed for suspected foreign bodies in 46 patients (27 females, 19 males); age range 22 months to 88 years. In 40 cases an impacted foreign body was found. The most frequent location was the upper third of the esophagus (33/82,5%). The most common type of foreign body was chicken bones in adults (17/42) and coins in children (2/4). Nine patients (all adults) had complications.Conclusions Due to its low cost and morbility, flexible endoscopy is the first choice for managing esophageal foreign bodies. Rigid esophagoscopy is still an appropriate technique when flexible endoscopy fails or it is not possible.

Research paper thumbnail of A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items

A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items

Journal of Allergy and Clinical Immunology, 2007

Allergic Rhinitis and its Impact on Asthma (ARIA) differentiates mild from moderate/severe patien... more Allergic Rhinitis and its Impact on Asthma (ARIA) differentiates mild from moderate/severe patients on the basis of 4 severity items. The high prevalence of moderate/severe patients suggests the need to differentiate between them. To identify the categorization that maximizes discrimination between moderate and severe allergic rhinitis (AR) by using ARIA guidelines. Observational, cross-sectional study. Clinical characteristics, nasal symptoms (Total Symptom Score 4), and health-related quality of life (HRQL; Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12) were assessed. The association of severity items (sleep, daily activities/sport, work/school, and troublesome symptoms) with symptoms and HRQL was analyzed using linear regression models. ANOVA and effect sizes were used to assess differences in symptoms and HRQL among groups defined by the number of affected ARIA items. Nontreated patients (N = 141) with moderate/severe AR were studied. All severity items showed a similar independent association with symptoms and HRQL scores, and there were no interaction effects, indicating that categorization of patients into moderate and severe could be based only on the number of items affected. Effect sizes were highest between patients with 4 affected ARIA items and those with 3, 2, or 1 affected item (effect sizes greater than 0.8 in all comparisons using Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12 Physical Composite Summary, and greater than 0.5 using the Total Symptom Score 4; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Using ARIA severity items, the criterion that best discriminates AR severity is considering moderate those with 1 to 3 affected items and severe those with 4. Discrimination between patients with moderate and severe AR should help to obtain homogeneous populations for both research and clinical purposes.

Research paper thumbnail of Bilastine and the central nervous system

Journal of investigational allergology & clinical immunology, 2011

Antihistamines have been classifed as first or second generation drugs, according to their pharma... more Antihistamines have been classifed as first or second generation drugs, according to their pharmacokinetic properties, chemical structure and adverse effects. The adverse effects of antihistamines upon the central nervous system (CNS) depend upon their capacity to cross the blood-brain barrier (BBB) and bind to the central H1 receptors (RH1). This in turn depends on the lipophilicity of the drug molecule, its molecular weight (MW), and affinity for P-glycoprotein (P-gp) (CNS xenobiotic substances extractor protein). First generation antihistamines show scant affinity for P-gp, unlike the second generation molecules which are regarded as P-gp substrates. Histamine in the brain is implicated in many functions (waking-sleep cycle, attention, memory and learning, and the regulation of appetite), with numerous and complex interactions with different types of receptors in different brain areas. Bilastine is a new H1 antihistamine that proves to be effective in treating allergic rhinoconju...

Research paper thumbnail of Author response for "Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Author response for "Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Research paper thumbnail of Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists

Therapeutic Advances in Respiratory Disease

Background: Chronic cough (CC; cough that lasts 8 weeks or longer) poses major effective assessme... more Background: Chronic cough (CC; cough that lasts 8 weeks or longer) poses major effective assessment challenges. Assessment of CC may vary considerably among medical specialists. Objectives: The aim was to evaluate similarities and consistency of responses across different specialists when performing a basic assessment of CC patients in primary care, and referring patients based on clinical findings or test results. Methods: A modified Delphi approach was used. A survey with 74 statements on initial assessment of CC and referral pathways was addressed to a panel of different specialists, who voted the statements in two rounds. Results: Seventy-seven physicians [18 primary care physicians (PCPs), 24 pulmonologists, 22 allergists, and 13 ear, nose, and throat specialists] from the National Healthcare System of Spain answered the questionnaire. After two rounds, the panel reached a consensus on 63 out of the 74 proposed items (85.1%). Consensus was not reached among the panelists of at ...

Research paper thumbnail of Effect of pollutants upon patients with respiratory allergies

J Investig Allergol Clin …, 2007

Epidemiological studies have revealed an association between pollution and allergic respiratory d... more Epidemiological studies have revealed an association between pollution and allergic respiratory diseases. The main pollutants in this sense are nitric oxide, ozone, and particulate matter. The present review on one hand addresses the chemical characteristics of each of these three groups of pollutants and their main sources, and on the other examines their effects upon allergic respiratory diseases-placing special emphasis on the effects of diesel exhaust particles. For each of the pollutants, the underlying mechanisms capable of infl uencing allergic respiratory diseases are commented. Lastly, an evaluation is made of some of the genetic aspects related to the response to pollutants.

Research paper thumbnail of Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study

Allergy, Asthma & Clinical Immunology

Background Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusi... more Background Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a united airways disease (UAD) perspective remains scarce, despite the frequent coexistence of these entities. We aimed to generate expert consensus-based recommendations for the management of UAD patients. Methods Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7–9), uncertain (4–6) or inappropriate (1–3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median. Results A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and fol...

Research paper thumbnail of Nasal Hyperreactivity: Nonspecific Nasal Provocation Tests. Review by the Rhinoconjunctivitis Committee of the Spanish Society of Allergy and Clinical Immunology

Journal of investigational allergology & clinical immunology, 2015

Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to... more Nasal hyperreactivity is the abnormal reaction of nasal tissue to a stimulus that is innocuous to most people. This response is caused by dysregulation of the autonomic nervous system at various levels of the nasal autonomic reflex arc. Various stimuli (methacholine, histamine, adenosine 5'-monophosphate, cold air, mannitol, rapsaicin, phentolamine, and distilled water) have been used in an attempt to find the test that most reliably differentiates between healthy individuals and patients and also between different types of rhinitis. Despite the small number of publications available, in the present review, we provide an update on current nonspecific nasal provocation techniques. The studies published to date are not comparable: the stimuli applied act through different mechanisms and are used to assess different pathways, and the methodologies differ in terms of selection of participants, concentrations used, and assessment of response (criteria for positivity). Given the limit...

Research paper thumbnail of Tratamiento de la poliposis nasal

Tratamiento de la poliposis nasal

Research paper thumbnail of Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso

Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso

Acta Otorrinolaringológica Española

Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery... more Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Research paper thumbnail of Analysis of Prevalence and Predictive Factors of Long-Lasting Olfactory and Gustatory Dysfunction in COVID-19 Patients

Life

Background: Although smell and taste disorders are highly prevalent symptoms of COVID-19 infectio... more Background: Although smell and taste disorders are highly prevalent symptoms of COVID-19 infection, the predictive factors leading to long-lasting chemosensory dysfunction are still poorly understood. Methods: 102 out of 421 (24.2%) mildly symptomatic COVID-19 patients completed a second questionnaire about the evolution of their symptoms one year after the infection using visual analog scales (VAS). A subgroup of 69 patients also underwent psychophysical evaluation of olfactory function through UPSIT. Results: The prevalence of chemosensory dysfunction decreased from 82.4% to 45.1% after 12 months, with 46.1% of patients reporting a complete recovery. Patients older than 40 years (OR = 0.20; 95% CI: [0.07, 0.56]) and with a duration of loss of smell longer than four weeks saw a lower odds ratio for recovery (OR = 0.27; 95% CI: [0.10, 0.76]). In addition, 28 patients (35.9%) reported suffering from parosmia, which was associated with moderate to severe taste dysfunction at the basel...

Research paper thumbnail of Rinitis, poliposis nasal y su relación con el asma

Archivos de Bronconeumología, 2018

El objetivo de esta revisión es facilitar al neumólogo el manejo de las enfermedades de la vía re... more El objetivo de esta revisión es facilitar al neumólogo el manejo de las enfermedades de la vía respiratoria superior ligadas a la vía respiratoria inferior, especialmente al asma, unidas por una epidemiología, una clínica y un mecanismo inflamatorio comunes e interrelacionados. El documento recoge las definiciones de los diferentes fenotipos nasosinusales ligados al asma: rinitis alérgica o no alérgica y rinosinusitis crónica con o sin pólipos nasales. Asimismo se recogen los criterios diagnósticos y su nivel de gravedad. Se dedica especial atención a los dos síndromes principales asociados al asma: 1) rinitis alérgica, la patología más frecuente, y 2) rinosinusitis crónica con pólipos nasales, la patología más ligada al asma grave. En síntesis, en el manejo del asma debe valorarse siempre la vía respiratoria superior con la finalidad de un diagnóstico unificado y un tratamiento integral de la vía respiratoria única.

Research paper thumbnail of Allergic rhinitis: similarities and differences between children and adults*

Background: Allergic rhinitis (AR) is a highly prevalent disease worldwide. Although a number of ... more Background: Allergic rhinitis (AR) is a highly prevalent disease worldwide. Although a number of studies have described AR, no studies compared children and adult AR populations. The objective was to compare the AR characteristics between two AR cohorts of children and adults. Methods: Two AR cohorts (children and adults) from Spain were studied through observational cross-sectional multicentre studies. AR was classified based on classical (allergen exposure), original (o-ARIA), and modified (m-ARIA) ARIA criteria. AR was evaluated by Total 4-Symptoms Score (T4SS), and disease severity by Visual Analogue Scale (VAS, 0-100 mm). AR comorbidities were also evaluated. Results: A total of 5,405 patients (1,275 children, 4,130 adults) were studied. According to symptom’s duration, intermittent AR was more frequent in children than in adults. Using o-ARIA severity, more children than adults had moderate/severe AR while, using m-ARIA, more children than adults had severe AR. T4SS was higher...

Research paper thumbnail of Validation of the MASK‐air app for assessment of allergic rhinitis

Validation of the MASK‐air app for assessment of allergic rhinitis

Allergy, 2020

1Center for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technische Univer... more 1Center for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany 2Hospital Pharmacy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany 3Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany 4Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

Research paper thumbnail of Position Paper on Nasal Obstruction: Evaluation and Treatment

Journal of Investigational Allergology and Clinical Immunology, 2018

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the... more Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Research paper thumbnail of Adaptation to Spanish and validation of the Rhinitis Control Assessment Test (RCAT) questionnaire

Journal of Investigational Allergology and Clinical Immunology, 2019

Background: The Rhinitis Control Assessment Test (RCAT) is a patient-based questionnaire that is ... more Background: The Rhinitis Control Assessment Test (RCAT) is a patient-based questionnaire that is widely used to evaluate control of rhinitis. Objective: To develop and validate a Spanish version of the RCAT (RCATe). Methods: After translation and cultural adaptation of the original RCAT, this multicenter, observational, prospective study evaluated the properties/attributes of the RCATe by assessing its validity, reliability, responsiveness, effect size, minimal important difference and cut point. Results: The recruited sample comprised 252 allergic rhinitis (AR) patients from 27 allergy and otolaryngology departments in hospitals throughout Spain. Significant and strong correlations were found between the RCATe and the total nasal symptom score and the visual analog scale (-0.79 and-0.77, respectively; P<.0001). The RCATe revealed significant differences between patients grouped in the different categories of severity or duration of AR (P<.001). The internal consistency (Cronbach α) was good (0.84), and the test-retest reliability was moderate (0.54 evaluated by the physician and 0.49 by the patient). The responsiveness to change was high and significant for RCATe (P<.0001) and correlated linearly with the improvement in AR. The overall effect size was 1.62. The cutoff point to identify patients with adequate control of AR was >20 (area under the receiver operating characteristic curve, 0.746; sensitivity, 58.3%; specificity, 90.9%). Conclusion: The psychometric evaluation and validation of the RCATe indicated good reliability, validity, and responsiveness, thus suggesting that it is effective for measuring control of AR symptoms by Spanish-speaking patients.

Research paper thumbnail of SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project

SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project

Journal of investigational allergology & clinical immunology, 2011

SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project. ... Alobid I, Antón E, Armeng... more SEAIC-SEORL. Consensus Document on Nasal Polyposis. POLINA Project. ... Alobid I, Antón E, Armengot M, Chao J, Colás C, del Cuvillo A, Dávila I, Dordal MT, Escobar C, Fernández-Parra B, Gras-Cabrerizo JR, Ibáñez MD, Lluch M, Matéu V, Montoro J, Gili JR, Mullol J, Navarro ...

Research paper thumbnail of Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in a pediatric population: The PEDRIAL study

Pediatric Allergy and Immunology, 2011

Allergic rhinitis (AR) is the commonest chronic disease in children. Allergic Rhinitis and its Im... more Allergic rhinitis (AR) is the commonest chronic disease in children. Allergic Rhinitis and its Impact on Asthma (ARIA) classification based on symptom duration (intermittent vs. persistent) and severity (mild vs. moderate/severe) has not been yet validated in children. Thus our objective was to validate ARIA classification in

Research paper thumbnail of Determination of allergenic load and pollen count of Cupressus arizonica pollen by flow cytometry using Cup a1 polyclonal antibody

Cytometry Part B: Clinical Cytometry, 2013

Background: There is an increase in the incidence of pollen related allergy, thus information on ... more Background: There is an increase in the incidence of pollen related allergy, thus information on pollen schedules would be a great asset for physicians to improve the clinical care of patients. Like cypress pollen sensitization shows a high prevalence among the causes of allergic rhinitis, and therefore it is of interest to use it like a model of study, distinguishing cypress pollen, pollen count, and allergenic load level. In this work, we use a flow cytometry based technique to obtain both Cupressus arizonica pollen count and allergenic load, using specific rabbit polyclonal antibody Cup a1 and its comparison with optical microscopy technique measurement. Methods: Airborne samples were collected from Burkard Spore-Trap and Burkard Cyclone Cupressus arizonica pollen was studied using specific rabbit polyclonal antibody Cup a1, labeled with AlexaFluor V R 488 or 750 and analysed by Flow Cytometry in both an EPICS XL and Cyan ADP cytometers (Beckman Coulter V R). Optical microscopy study was realized with a Leica optical microscope. Bland and Altman was used to determine agreement between both techniques measured. Results: We can identify three different populations based on rabbit polyclonal antibody Cup a1 staining. The main region (44.5%) had 97.3% recognition, a second region (25%) with 28% and a third region (30.5%) with 68% respectively. Immunofluorescence and confocal microscopy showed that main region corresponds to whole pollen grains, the second region are pollen without exine and the third region is constituted by smaller particles with allergenic properties. Pollen schedule shows a higher correlation measured by optical microscopy and flow cytometry in the pollen count with a P-value: 0.0008 E 22 and 0.0002 with regard to smaller particles, so the Bland and Altman measurement showed a good correlation between them, P-value: 0.0003. Conclusion: Determination of pollen count and allergenic load by flow cytometry represents an important tool in the determination of airborne respiratory allergens. We showed that not only whole pollen but also smaller particles could induce allergic sensitization. This is the first study where flow cytometry is used for calculating pollen counts and allergenic load. V

Research paper thumbnail of Health-related quality of life in allergic rhinitis: comparing the short form ESPRINT-15 and MiniRQLQ questionnaires

Allergy, 2007

Health-related quality of life (HRQOL) questionnaires are increasingly used in a variety of clini... more Health-related quality of life (HRQOL) questionnaires are increasingly used in a variety of clinical and research settings including clinical trials, health surveys, clinical practice, and economic analyses of health care interventions (1, 2). Such measures are generally multidimensional (3) and include the measurement of symptoms, functional limitations, general health perceptions, and psychological well-being (4). The importance of HRQOL measurement in rhinitis is indicated by the fact that the World Health Organization's Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines base the classification of rhinitis severity on the impact of the disease on daily life (5). Several instruments have been developed to measure HRQOL in rhinoconjunctivitis and allergic rhinitis (AR) (6-8). One of the most frequently used is the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). The original version of the questionnaire, which consists of 28 items in seven dimensions, has proved its usefulness and validity (9-12). A shorter version of the questionnaire Background: We compared the psychometric properties of the ESPRINT-15, the short form of a new Spanish instrument to measure health-related quality of life in allergic rhinitis (AR) patients, with those of the Mini-Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ). Methods: The questionnaires were compared in Spanish patients with intermittent allergic rhinitis (IAR) or persistent AR in a prospective, observational study. Floor and ceiling effects, internal consistency (Cronbach's alpha), testretest reliability (intraclass correlation coefficient; ICC), convergent and known groups validity, and sensitivity to change (standardized response means; SRMs) were compared. Results: In terms of content, while the MiniRQLQ has a dimension covering practical problems and places more emphasis on symptoms, the ESPRINT-15 has two dimensions (Sleep and Psychological impact) which are not included in the MiniRQLQ. In the validation study, 400 patients were included and 59% of the sample had persistent AR. There were no significant floor or ceiling effects on any dimension on either questionnaire. Cronbach's alpha values for the ESPRINT-15 and MiniRQLQ overall scores were 0.92 and 0.90, respectively. In 48 clinically stable patients, ICCs were 0.80 and 0.77, respectively. Both instruments discriminated between patients with IAR and persistent AR. Correlations with symptom scores and generic measures were moderate to strong. SRMs for overall scores and individual dimensions on the two questionnaires in the 197 patients reporting a change in health status ranged from 0.7 to 1.3. Conclusions: Both questionnaires performed well in psychometric terms. The ESPRINT-15 is particularly recommended for use in Spanish-speaking populations.

Research paper thumbnail of Cuerpos extraños esofágicos: nuestra experiencia en diez años

Cuerpos extraños esofágicos: nuestra experiencia en diez años

Acta Otorrinolaringológica Española, 2003

ABSTRACT ObjetiveTo study the management of esophageal foreign bodies.Material and methodsA retro... more ABSTRACT ObjetiveTo study the management of esophageal foreign bodies.Material and methodsA retrospective study was made of all rigid esophagoscopies performed for suspected foreign bodies in the esophagus by an otolaryngology department for ten years.ResultsRigid esophagoscopy was performed for suspected foreign bodies in 46 patients (27 females, 19 males); age range 22 months to 88 years. In 40 cases an impacted foreign body was found. The most frequent location was the upper third of the esophagus (33/82,5%). The most common type of foreign body was chicken bones in adults (17/42) and coins in children (2/4). Nine patients (all adults) had complications.Conclusions Due to its low cost and morbility, flexible endoscopy is the first choice for managing esophageal foreign bodies. Rigid esophagoscopy is still an appropriate technique when flexible endoscopy fails or it is not possible.

Research paper thumbnail of A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items

A new criterion by which to discriminate between patients with moderate allergic rhinitis and patients with severe allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma severity items

Journal of Allergy and Clinical Immunology, 2007

Allergic Rhinitis and its Impact on Asthma (ARIA) differentiates mild from moderate/severe patien... more Allergic Rhinitis and its Impact on Asthma (ARIA) differentiates mild from moderate/severe patients on the basis of 4 severity items. The high prevalence of moderate/severe patients suggests the need to differentiate between them. To identify the categorization that maximizes discrimination between moderate and severe allergic rhinitis (AR) by using ARIA guidelines. Observational, cross-sectional study. Clinical characteristics, nasal symptoms (Total Symptom Score 4), and health-related quality of life (HRQL; Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12) were assessed. The association of severity items (sleep, daily activities/sport, work/school, and troublesome symptoms) with symptoms and HRQL was analyzed using linear regression models. ANOVA and effect sizes were used to assess differences in symptoms and HRQL among groups defined by the number of affected ARIA items. Nontreated patients (N = 141) with moderate/severe AR were studied. All severity items showed a similar independent association with symptoms and HRQL scores, and there were no interaction effects, indicating that categorization of patients into moderate and severe could be based only on the number of items affected. Effect sizes were highest between patients with 4 affected ARIA items and those with 3, 2, or 1 affected item (effect sizes greater than 0.8 in all comparisons using Rhinoconjunctivitis Quality of Life Questionnaire and Short Form 12 Physical Composite Summary, and greater than 0.5 using the Total Symptom Score 4; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Using ARIA severity items, the criterion that best discriminates AR severity is considering moderate those with 1 to 3 affected items and severe those with 4. Discrimination between patients with moderate and severe AR should help to obtain homogeneous populations for both research and clinical purposes.

Research paper thumbnail of Bilastine and the central nervous system

Journal of investigational allergology & clinical immunology, 2011

Antihistamines have been classifed as first or second generation drugs, according to their pharma... more Antihistamines have been classifed as first or second generation drugs, according to their pharmacokinetic properties, chemical structure and adverse effects. The adverse effects of antihistamines upon the central nervous system (CNS) depend upon their capacity to cross the blood-brain barrier (BBB) and bind to the central H1 receptors (RH1). This in turn depends on the lipophilicity of the drug molecule, its molecular weight (MW), and affinity for P-glycoprotein (P-gp) (CNS xenobiotic substances extractor protein). First generation antihistamines show scant affinity for P-gp, unlike the second generation molecules which are regarded as P-gp substrates. Histamine in the brain is implicated in many functions (waking-sleep cycle, attention, memory and learning, and the regulation of appetite), with numerous and complex interactions with different types of receptors in different brain areas. Bilastine is a new H1 antihistamine that proves to be effective in treating allergic rhinoconju...