Pub Date : 2025-09-04DOI: 10.1016/j.opresp.2025.100483
Miguel Jiménez-Gómez , Ismael García-Moguel , Rocío Magdalena Díaz-Campos
Small airway disease (SAD) remains a challenging and underrecognized driver of fixed airflow obstruction in severe asthma. Impulse oscillometry (IOS) provides valuable insight into peripheral airway dysfunction and allows characterization of different bronchodilator response patterns. We describe two cases of late-onset severe asthma with confirmed SAD by spirometry and IOS, unresponsive to systemic corticosteroids and to biologics, despite optimized high-dose extrafine triple inhaled therapy and adherence. Both patients exhibited persistent airflow obstruction and abnormal IOS parameters, suggesting a resistant SAD phenotype. Importantly, the role of corticosteroid challenge in this subgroup remains unclear, as it failed to predict subsequent biologic response. These observations highlight the clinical utility of IOS in diagnosing and monitoring SAD and reinforce the need for personalized therapeutic approaches to address this treatment-resistant endotype of severe asthma.
{"title":"Fixed Airflow Limitation in Severe Asthma: Rethinking the Role of Small Airway Disease","authors":"Miguel Jiménez-Gómez , Ismael García-Moguel , Rocío Magdalena Díaz-Campos","doi":"10.1016/j.opresp.2025.100483","DOIUrl":"10.1016/j.opresp.2025.100483","url":null,"abstract":"<div><div>Small airway disease (SAD) remains a challenging and underrecognized driver of fixed airflow obstruction in severe asthma. Impulse oscillometry (IOS) provides valuable insight into peripheral airway dysfunction and allows characterization of different bronchodilator response patterns. We describe two cases of late-onset severe asthma with confirmed SAD by spirometry and IOS, unresponsive to systemic corticosteroids and to biologics, despite optimized high-dose extrafine triple inhaled therapy and adherence. Both patients exhibited persistent airflow obstruction and abnormal IOS parameters, suggesting a resistant SAD phenotype. Importantly, the role of corticosteroid challenge in this subgroup remains unclear, as it failed to predict subsequent biologic response. These observations highlight the clinical utility of IOS in diagnosing and monitoring SAD and reinforce the need for personalized therapeutic approaches to address this treatment-resistant endotype of severe asthma.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100483"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This case series underscores the importance of maintaining a broad differential diagnosis when evaluating potential causes of increased metabolic activity on PET/CT scans, as its specificity is limited. EBUS-TBNA proves to be a key tool for achieving an accurate diagnosis in these scenarios.
Pub Date : 2025-09-03DOI: 10.1016/j.opresp.2025.100482
Pedro Juan Rodríguez Martín, Laura Martínez Vega, Felipe Cristóbal Andreo García
A 44-year-old woman, former smoker, underwent apical segmentectomy of the right lower lobe in 2015 for a typical carcinoid tumor (1.5 cm, Ki 67 < 2%, T1aN0M0R1). In 2024, follow-up CT revealed a suspicious lesion, and PET scan confirmed a 13 mm nodule (SUVmax 6). In January 2025, she had an extended right lower lobectomy with bronchoplasty. Weeks later, flexible bronchoscopy showed reduced bronchial lumen, partially visualizing the middle lobe bronchi (ML). Two months post-surgery, due to increasing dyspnea, an almost complete distal stenosis of the intermediate bronchus was discovered, preventing access to the ML. After unsuccessful balloon dilation and anatomical uncertainty, the procedure was stopped. CT with 3D reconstruction (Fujifilm Synapse 3D software) and virtual bronchoscopy navigation (VBN) was performed with this planner. Guided by VBN, biopsies and successful balloon dilation reopened the ML bronchial orifice. The case highlights the value of VBN and 3D reconstruction for planning and guiding complex endoscopic procedures.
一名44岁女性，前吸烟者，因典型的类癌（1.5 cm, Ki 67 < 2%, T1aN0M0R1）于2015年行右下叶根尖段切除术。2024年随访CT显示可疑病变，PET扫描确认13mm结节（SUVmax 6）。2025年1月，她接受了扩大右下肺叶切除术和支气管成形术。几周后，支气管镜检查显示支气管管腔缩小，支气管中叶部分可见。术后2个月，由于呼吸困难加重，发现中间支气管远端几乎完全狭窄，无法进入ML。由于球囊扩张失败和解剖结构不确定，手术停止。使用该计划仪进行CT三维重建（Fujifilm Synapse 3D软件）和虚拟支气管镜导航（VBN）。在VBN引导下，活检和成功的球囊扩张使ML支气管口重新开放。该病例强调了VBN和3D重建在规划和指导复杂内窥镜手术中的价值。
{"title":"Virtual Navigation Technology for the Functional Restoration of Anastomosis in Oncologic Pulmonary Surgery","authors":"Pedro Juan Rodríguez Martín, Laura Martínez Vega, Felipe Cristóbal Andreo García","doi":"10.1016/j.opresp.2025.100482","DOIUrl":"10.1016/j.opresp.2025.100482","url":null,"abstract":"<div><div>A 44-year-old woman, former smoker, underwent apical segmentectomy of the right lower lobe in 2015 for a typical carcinoid tumor (1.5<!--> <!-->cm, Ki 67<!--> <!--><<!--> <!-->2%, T1aN0M0R1). In 2024, follow-up CT revealed a suspicious lesion, and PET scan confirmed a 13<!--> <!-->mm nodule (SUVmax 6). In January 2025, she had an extended right lower lobectomy with bronchoplasty. Weeks later, flexible bronchoscopy showed reduced bronchial lumen, partially visualizing the middle lobe bronchi (ML). Two months post-surgery, due to increasing dyspnea, an almost complete distal stenosis of the intermediate bronchus was discovered, preventing access to the ML. After unsuccessful balloon dilation and anatomical uncertainty, the procedure was stopped. CT with 3D reconstruction (<em>Fujifilm Synapse 3D software)</em> and virtual bronchoscopy navigation (VBN) was performed with this planner. Guided by VBN, biopsies and successful balloon dilation reopened the ML bronchial orifice. The case highlights the value of VBN and 3D reconstruction for planning and guiding complex endoscopic procedures.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.opresp.2025.100488
Carlos Cabanillas Díez-Madroñero , Beatriz Raboso Moreno , Blanca Urrutia-Royo , Imanol González Muñoz , Marta Erro Iribarren , Cristina Pou Álvarez , Jessica González Gutiérrez
Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs – including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression – emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL−, KPC−, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7–8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance.
{"title":"Nosocomial and Ventilator-associated Pneumonia","authors":"Carlos Cabanillas Díez-Madroñero , Beatriz Raboso Moreno , Blanca Urrutia-Royo , Imanol González Muñoz , Marta Erro Iribarren , Cristina Pou Álvarez , Jessica González Gutiérrez","doi":"10.1016/j.opresp.2025.100488","DOIUrl":"10.1016/j.opresp.2025.100488","url":null,"abstract":"<div><div>Nosocomial pneumonia (NP), including its subtype ventilator-associated pneumonia (VAP), represents a major cause of morbidity, mortality, and increased healthcare utilization in hospitalized patients, particularly in intensive care settings. This comprehensive, question-and-answer formatted review synthesizes current evidence on the epidemiology, pathophysiology, and management of NP and VAP, with a focus on multidrug-resistant organisms (MDROs). Key distinctions between NP and VAP are explored in terms of microbiological profiles, diagnostic approaches, and therapeutic implications. The review provides a detailed analysis of risk factors for MDROs – including prolonged mechanical ventilation, prior antibiotic exposure, and host-related immunosuppression – emphasizing the importance of risk stratification in guiding empirical antibiotic selection. A critical appraisal of international guideline recommendations (IDSA/ATS, ERS, SEPAR) highlights areas of consensus and divergence, particularly regarding empirical treatment strategies and the role of narrow- versus broad-spectrum coverage. The integration of rapid molecular diagnostic tools, such as multiplex PCR, is discussed in depth, including their potential to improve diagnostic yield, facilitate early de-escalation, and enhance antimicrobial stewardship. Recent advances in antimicrobial development are reviewed, covering novel β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins with activity against ESBL−, KPC−, and carbapenemase-producing pathogens. Their appropriate use in critically ill patients is contextualized within the framework of pharmacokinetic/pharmacodynamic optimization. Finally, the review examines current evidence on treatment duration, supporting a 7–8 day course in most cases, with individualized extension in selected high-risk populations. The utility of procalcitonin as a biomarker to guide antibiotic discontinuation is also addressed. This review provides clinicians with a concise, evidence-based reference to inform the complex decision-making required in managing nosocomial pneumonia in the era of antimicrobial resistance.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-31DOI: 10.1016/j.opresp.2025.100485
Carmen Mira Palomino , Mónica Babiano Nodal , Beatriz Raboso Moreno
Pulmonary nocardiosis is a rare opportunistic infection, often misdiagnosed due to its subacute onset and non-specific clinical and radiological findings. We report an 82-year-old man with severe chronic obstructive pulmonary disease (COPD) and bilateral bronchiectasis, who presented with progressive dyspnoea and productive cough unresponsive to conventional antibiotic therapy. Nocardia pneumoniae was isolated from bronchoalveolar lavage at ≥104 CFU/mL. Initial treatment with trimethoprim–sulfamethoxazole (TMP–SMX) was discontinued due to renal impairment and electrolyte disturbances; minocycline was initiated with good tolerance and complete radiological resolution after six months. This case highlights the need to suspect nocardiosis in COPD and bronchiectasis patients, even without classical immunosuppression, particularly after repeated corticosteroid courses. Early diagnosis, communication with the microbiology laboratory, and targeted antibiotic therapy are key to improving outcomes.
{"title":"Pulmonary Nocardiosis in a Patient With COPD and Bronchiectasis","authors":"Carmen Mira Palomino , Mónica Babiano Nodal , Beatriz Raboso Moreno","doi":"10.1016/j.opresp.2025.100485","DOIUrl":"10.1016/j.opresp.2025.100485","url":null,"abstract":"<div><div>Pulmonary nocardiosis is a rare opportunistic infection, often misdiagnosed due to its subacute onset and non-specific clinical and radiological findings. We report an 82-year-old man with severe chronic obstructive pulmonary disease (COPD) and bilateral bronchiectasis, who presented with progressive dyspnoea and productive cough unresponsive to conventional antibiotic therapy. <em>Nocardia pneumoniae</em> was isolated from bronchoalveolar lavage at ≥10<sup>4</sup> <!-->CFU/mL. Initial treatment with trimethoprim–sulfamethoxazole (TMP–SMX) was discontinued due to renal impairment and electrolyte disturbances; minocycline was initiated with good tolerance and complete radiological resolution after six months. This case highlights the need to suspect nocardiosis in COPD and bronchiectasis patients, even without classical immunosuppression, particularly after repeated corticosteroid courses. Early diagnosis, communication with the microbiology laboratory, and targeted antibiotic therapy are key to improving outcomes.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100485"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-31DOI: 10.1016/j.opresp.2025.100486
Francisco Javier Álvarez-Gutiérrez , Marina Blanco Aparicio , Francisco Casas Maldonado , Vicente Plaza , Gregorio Soto Campos , Francisco Javier González-Barcala , Carlos Almonacid , Ebymar Arismendi , Carlos Cabrera , Roberto Cabestre García , José Ángel Carretero , Manuel Castilla Martínez , José Antonio Castillo Vizuete , Carolina Cisneros Serrano , Álvaro Gimeno Díaz de Atauri , David Diaz Pérez , Christian Domingo Ribas , Juan Luis García Rivero , Alejandro López Neyra , Eva Martínez Moragón , José Valverde Molina
Severe asthma is a heterogeneous syndrome with several clinical variants and often represents a complex disease requiring a specialized and multidisciplinary approach, as well as the use of multiple drugs. The prevalence of severe asthma varies from one country to another, and it is estimated that 50% of these patients present a poor control of their disease. For the best management of the patient, it is necessary to have a correct diagnosis, an adequate follow-up and undoubtedly to offer the best available treatment, including biologic treatments with monoclonal antibodies. With this objective, this consensus process was born, which began in its first version in 2018, whose goal is to offer the patient the best possible management of their disease to minimize their symptomatology. For this 2025 consensus update, a literature review was conducted by the authors, and new sections of how to treat asthma comorbidities or pediatric asthma were added, as a paragraph about monoclonal antibody switch. Subsequently, through a two-round interactive Delphi process, a broad panel of asthma experts from SEPAR and the regional pulmonology societies proposed the recommendations and conclusions contained in this document.
{"title":"Documento de consenso de asma grave. Actualización 2025","authors":"Francisco Javier Álvarez-Gutiérrez , Marina Blanco Aparicio , Francisco Casas Maldonado , Vicente Plaza , Gregorio Soto Campos , Francisco Javier González-Barcala , Carlos Almonacid , Ebymar Arismendi , Carlos Cabrera , Roberto Cabestre García , José Ángel Carretero , Manuel Castilla Martínez , José Antonio Castillo Vizuete , Carolina Cisneros Serrano , Álvaro Gimeno Díaz de Atauri , David Diaz Pérez , Christian Domingo Ribas , Juan Luis García Rivero , Alejandro López Neyra , Eva Martínez Moragón , José Valverde Molina","doi":"10.1016/j.opresp.2025.100486","DOIUrl":"10.1016/j.opresp.2025.100486","url":null,"abstract":"<div><div>Severe asthma is a heterogeneous syndrome with several clinical variants and often represents a complex disease requiring a specialized and multidisciplinary approach, as well as the use of multiple drugs. The prevalence of severe asthma varies from one country to another, and it is estimated that 50% of these patients present a poor control of their disease. For the best management of the patient, it is necessary to have a correct diagnosis, an adequate follow-up and undoubtedly to offer the best available treatment, including biologic treatments with monoclonal antibodies. With this objective, this consensus process was born, which began in its first version in 2018, whose goal is to offer the patient the best possible management of their disease to minimize their symptomatology. For this 2025 consensus update, a literature review was conducted by the authors, and new sections of how to treat asthma comorbidities or pediatric asthma were added, as a paragraph about monoclonal antibody switch. Subsequently, through a two-round interactive Delphi process, a broad panel of asthma experts from SEPAR and the regional pulmonology societies proposed the recommendations and conclusions contained in this document.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100486"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-29DOI: 10.1016/j.opresp.2025.100484
Jesús Díez-Manglano , Inmaculada Mediavilla , Javier de Miguel-Diez , Luciano Escudero , the CARABELA-COPD Scientific Committee
Introduction
Chronic obstructive pulmonary disease (COPD) remains a priority in clinical practice, but it still presents gaps in care coordination, diagnosis, and treatment that have tangible impact on patients’ outcomes. The CARABELA-COPD previously identified key improvement areas within the Spanish healthcare system, setting the foundation for enhanced COPD care. As a continuation of the initiative, this document presents expert-driven recommendations to improve COPD care in the Spanish healthcare system.
Material and methods
The CARABELA-COPD methodology involved seven pilot hospitals across Spain and included national and regional expert meetings. Through thematic discussions and prioritization exercises, key areas for COPD care improvement were identified and refined. This manuscript summarizes the resulting recommendations for the areas prioritized by the experts.
Results
The proposed strategies emphasize the importance of early detection, optimizing healthcare resource use, and implementing standardized care pathways to ensure a more uniform and effective management of the disease. Specific focus is placed on the role of specialized nursing, ensuring smooth transitions between levels of care, and integrating digital tools to facilitate clinical decisions.
Conclusions
These recommendations are intended to close the gap between evidence-based guidelines and real clinical practice, so that every patient receives high-quality individualized care. Through collaboration between healthcare professionals, scientific societies, and policymakers, CARABELA-COPD seeks to reduce disparities in care, enhance system effectiveness, and ultimately improve quality of life for patients with COPD.
{"title":"Solutions to Improve COPD Patients’ Clinical Outcomes and Quality of Care: Recommendations From the CARABELA Initiative","authors":"Jesús Díez-Manglano , Inmaculada Mediavilla , Javier de Miguel-Diez , Luciano Escudero , the CARABELA-COPD Scientific Committee","doi":"10.1016/j.opresp.2025.100484","DOIUrl":"10.1016/j.opresp.2025.100484","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic obstructive pulmonary disease (COPD) remains a priority in clinical practice, but it still presents gaps in care coordination, diagnosis, and treatment that have tangible impact on patients’ outcomes. The CARABELA-COPD previously identified key improvement areas within the Spanish healthcare system, setting the foundation for enhanced COPD care. As a continuation of the initiative, this document presents expert-driven recommendations to improve COPD care in the Spanish healthcare system.</div></div><div><h3>Material and methods</h3><div>The CARABELA-COPD methodology involved seven pilot hospitals across Spain and included national and regional expert meetings. Through thematic discussions and prioritization exercises, key areas for COPD care improvement were identified and refined. This manuscript summarizes the resulting recommendations for the areas prioritized by the experts.</div></div><div><h3>Results</h3><div>The proposed strategies emphasize the importance of early detection, optimizing healthcare resource use, and implementing standardized care pathways to ensure a more uniform and effective management of the disease. Specific focus is placed on the role of specialized nursing, ensuring smooth transitions between levels of care, and integrating digital tools to facilitate clinical decisions.</div></div><div><h3>Conclusions</h3><div>These recommendations are intended to close the gap between evidence-based guidelines and real clinical practice, so that every patient receives high-quality individualized care. Through collaboration between healthcare professionals, scientific societies, and policymakers, CARABELA-COPD seeks to reduce disparities in care, enhance system effectiveness, and ultimately improve quality of life for patients with COPD.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-29DOI: 10.1016/j.opresp.2025.100480
M.ª Antonia Gómez Mendieta , Ana Santiago Recuerda , Maria Varela Cerdeira , Baltasar Liebert Alvarez , Miguel Valdazo Alonso , Elena Corpa Rodríguez
This study describes a home-based tracheostomy tube replacement protocol for individuals diagnosed with amyotrophic lateral sclerosis (ALS) requiring invasive mechanical ventilation. Implemented between May 2020 and July 2024, the protocol was offered to 16 eligible patients, with 14 opting for home-based care under the supervision of the Carlos III/La Paz Hospital. Procedures were conducted without sedation by a multidisciplinary team, with the aim of maintaining patient safety and continuity of care. A total of 120 home-based replacements were performed, most without major complications or the need for emergency hospitalization. In comparison to hospital-based procedures, the home protocol was associated with an estimated cost reduction of approximately €340 per case, potentially resulting in annual savings of €10,200. Patients reported high satisfaction, noting decreased caregiver burden and improved perceived quality of care. While limited by patient selection criteria, these preliminary findings suggest that home-based tracheostomy care may be a feasible, safe, and cost-effective alternative for long-term management in ALS.
{"title":"Non-Sedated Cannula Replacement in Home-Care Patients With Amyotrophic Lateral Sclerosis: Cost Reduction and Patient-Family Satisfaction Evaluation","authors":"M.ª Antonia Gómez Mendieta , Ana Santiago Recuerda , Maria Varela Cerdeira , Baltasar Liebert Alvarez , Miguel Valdazo Alonso , Elena Corpa Rodríguez","doi":"10.1016/j.opresp.2025.100480","DOIUrl":"10.1016/j.opresp.2025.100480","url":null,"abstract":"<div><div>This study describes a home-based tracheostomy tube replacement protocol for individuals diagnosed with amyotrophic lateral sclerosis (ALS) requiring invasive mechanical ventilation. Implemented between May 2020 and July 2024, the protocol was offered to 16 eligible patients, with 14 opting for home-based care under the supervision of the Carlos III/La Paz Hospital. Procedures were conducted without sedation by a multidisciplinary team, with the aim of maintaining patient safety and continuity of care. A total of 120 home-based replacements were performed, most without major complications or the need for emergency hospitalization. In comparison to hospital-based procedures, the home protocol was associated with an estimated cost reduction of approximately €340 per case, potentially resulting in annual savings of €10,200. Patients reported high satisfaction, noting decreased caregiver burden and improved perceived quality of care. While limited by patient selection criteria, these preliminary findings suggest that home-based tracheostomy care may be a feasible, safe, and cost-effective alternative for long-term management in ALS.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100480"},"PeriodicalIF":0.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-29DOI: 10.1016/j.opresp.2025.100474
Marina Blanco Aparicio , Luis Pérez de Llano , Javier Domínguez-Ortega
Asthma units in Spain are multidisciplinary hospital-based clinics led by pulmonologists and/or allergists. They are designed to optimize diagnosis, identify and manage comorbidities, and improve asthma control and patients’ quality of life, particularly for those with severe asthma. These units have proven to be clinically effective and economically efficient, representing an innovative model for asthma management.
Accreditation by the Spanish societies of pulmonology and allergology (SEPAR and SEAIC) ensures excellence by establishing quality standards and promoting continuous staff training. However, disparities in resources and availability appear to exist between autonomous communities.
While this model has been successful, it has not yet been widely implemented globally, and its adoption could enhance the management of severe asthma in other countries.
{"title":"Severe Asthma Units in Spain: Enhancing Patient Care and Research in Severe Asthma","authors":"Marina Blanco Aparicio , Luis Pérez de Llano , Javier Domínguez-Ortega","doi":"10.1016/j.opresp.2025.100474","DOIUrl":"10.1016/j.opresp.2025.100474","url":null,"abstract":"<div><div>Asthma units in Spain are multidisciplinary hospital-based clinics led by pulmonologists and/or allergists. They are designed to optimize diagnosis, identify and manage comorbidities, and improve asthma control and patients’ quality of life, particularly for those with severe asthma. These units have proven to be clinically effective and economically efficient, representing an innovative model for asthma management.</div><div>Accreditation by the Spanish societies of pulmonology and allergology (SEPAR and SEAIC) ensures excellence by establishing quality standards and promoting continuous staff training. However, disparities in resources and availability appear to exist between autonomous communities.</div><div>While this model has been successful, it has not yet been widely implemented globally, and its adoption could enhance the management of severe asthma in other countries.</div></div>","PeriodicalId":34317,"journal":{"name":"Open Respiratory Archives","volume":"7 4","pages":"Article 100474"},"PeriodicalIF":0.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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