Background Despite optimal pharmacological treatment, a substantial proportion of adult asthma patients remain symptomatic. Breathing exercises have emerged as a non-pharmacological adjunct specifically targeting dysfunctional breathing patterns (chronic hyperventilation, tachypnea, and aberrant ventilatory mechanics) that pharmacotherapy does not adequately address. Evidence for their efficacy across outcomes and delivery formats warrants systematic evaluation. Methods We searched five databases (Cochrane Library, PubMed/MEDLINE, Scopus, Web of Science, PEDro) for RCTs, controlled quasi-experimental studies, and uncontrolled pre-post pilot studies in which breathing exercises were the primary intervention for adults with confirmed asthma, published between January 2013 and March 2025. Methodological quality was assessed using the PEDro scale; risk of bias was assessed using the Cochrane RoB 2 tool for randomised trials and descriptively for non-randomised studies. A narrative synthesis was performed due to significant clinical, methodological, and statistical heterogeneity. Results Six primary studies (n = 1,098; PEDro scores 3–6) were included: four randomised controlled trials (RCTs) and two uncontrolled pre-post/pilot studies. Several included studies reported significant improvements with breathing retraining in health-related quality of life (AQLQ, Mini-AQLQ, SGRQ) and asthma control scores (ACT, ACQ). Among the modalities studied, the Buteyko method showed relatively consistent benefits, including a ~ 20% reduction in rescue bronchodilator and inhaled corticosteroid use. In one large RCT, digital self-guided delivery was equivalent to face-to-face physiotherapist instruction. Static spirometric volumes (FEV₁, FVC) and airway inflammation markers (FeNO) were not significantly modified. Severe exacerbation rates were unchanged. Conclusions Available evidence suggests that structured breathing exercises are safe and potentially effective adjunctive interventions in adult asthma, improving patient-reported outcomes (health-related quality of life and asthma control) by correcting dysfunctional breathing patterns, without altering the underlying airway inflammatory process. Breathing exercises may be considered as part of multidisciplinary asthma management for adults who remain symptomatic despite optimised pharmacological therapy.

Tezepelumab is a human monoclonal antibody directed against thymic stromal lymphopoietin that inhibits initiation of the type 2 inflammatory cascade. Several pivotal studies demonstrating tezepelumab effectiveness and leading to regulatory and marketing authorization have since been complemented by further evidence, most notably from the following studies: (a) for severe uncontrolled asthma, the PASSAGE phase 4 clinical trial, conducted in a routine clinical practice setting, found that tezepelumab significantly reduced exacerbations, including in underrepresented populations (African-Americans, adolescents, smokers, individuals with chronic obstructive pulmonary disease), and improved lung function, disease control, and quality of life. (b) For corticosteroid-dependent asthma, the WAYFINDER phase 3b clinical trial reported tezepelumab's effectiveness in reducing both dependency and the number of exacerbations as well as clinical remission in around a quarter of patients. (c) For chronic rhinosinusitis with nasal polyps, the WAYPOINT phase 3 clinical trial found that tezepelumab, after therapeutic optimization, decreased nasal polyp size and nasal congestion, improved clinical impact and sense of smell, and reduced the need for surgery. (d) For moderate-to-very severe chronic obstructive pulmonary disease, the COURSE phase 2a clinical trial reported a non-significant reduction in exacerbations, but also that reductions were greater for the type 2 phenotype (eosinophils ≥150 cells/μL). In conclusion, up-to-date evidence confirms tezepelumab safety and efficacy in treating severe uncontrolled asthma in routine clinical practice and in managing corticosteroid-dependent asthma and chronic rhinosinusitis with nasal polyps.

El asma es una enfermedad que debido a su creciente prevalencia y a sus amplias repercusiones sigue siendo objeto de estudio con el fin de poder comprender mejor sus mecanismos subyacentes y así mejorar tanto su manejo como la calidad de vida de las personas que la padecen.En el contexto del desarrollo de un documento de recomendaciones basado en opinión de expertos siguiendo la metodología RAND/UCLA a través de una encuesta Delphi sobre infección y asma, esta revisión no sistemática de la bibliografía profundiza en las complejas interacciones entre microorganismos y asma, proporcionando una visión integral, en modo preguntas y respuestas, sobre seis grandes aspectos que relacionan infección y asma: 1) el posible origen infeccioso del asma, con referencia a la microbiota respiratoria y a la influencia de determinados virus respiratorios, 2) el papel que algunas inmunodeficiencias pueden tener en el desarrollo de hiperrespuesta bronquial e infecciones bronquiales, 3) la asociación bidireccional entre bronquiectasias y asma y su identificación como fenotipo distinguible, 4) la importancia del fenotipo hipersecretor y de las exacerbaciones infecciosas en el control del asma y en la valoración de la respuesta a los tratamientos biológicos, 5) la utilidad de las estrategias de prevención y tratamiento de las infecciones para controlar el asma y 6) la curiosa asociación entre infección y enfermedad tuberculosas y el desarrollo de atopia y asma.

La hipersecreción bronquial de moco (HBM) es una característica común en pacientes asmáticos, tradicionalmente asociada al concepto de “bronquítico crónico” y a factores externos como el tabaco, infecciones o bronquiectasias; sin embargo, cada vez se vincula más con un fenotipo eosinofílico no alérgico, mayor edad, evolución prolongada del asma, mayor gravedad, peor control de la enfermedad, menor calidad de vida, peor función pulmonar y la presencia de poliposis nasal, rinosinusitis crónica y bronquiectasias asociadas. En la práctica clínica, se dispone de herramientas como el cuestionario T-sec, el Score de Dunican y los fenotipos de moco medidos mediante tomografías computarizadas torácicas para valorar la HBM. La correlación entre estos hallazgos radiológicos y la pérdida de función pulmonar, aumento de resistencias pulmonares, engrosamiento de la pared bronquial y mayor atrapamiento aéreo es objeto de estudio, destacando el potencial beneficio de los tratamientos biológicos en pacientes con asma grave.

Asthma is a disease that, due to its increasing prevalence and wide-ranging impact, continues to be studied in order to better understand its underlying mechanisms and thus improve both its management and the quality of life of those who suffer from it.In the context of developing a document of recommendations based on expert opinion following the RAND/UCLA methodology through a Delphi survey on infection and asthma, this non-systematic review of the literature delves into the complex interactions between microorganisms and asthma, providing a comprehensive view, in question and answer mode, on six major aspects relating infection and asthma: 1) the possible infectious origin of asthma, with reference to the respiratory microbiota and the influence of certain respiratory viruses, 2) the role that certain immunodeficiencies may play in the development of bronchial hyperresponsiveness and bronchial infections, 3) the bidirectional association between bronchiectasis and asthma and its identification as a distinguishable phenotype, 4) the importance of the hypersecretory phenotype and infectious exacerbations in the control of asthma and in the assessment of the response to biological treatments, 5) the usefulness of infection prevention and treatment strategies to control asthma, and 6) the curious association between tuberculous infection and disease and the development of atopy and asthma.

Background The healthcare sector contributes significantly to global greenhouse emissions, with inhalers being major contributors. Objective To develop a framework for reducing the environmental footprint of inhalers in Spain by implementing greener prescription practices. Methods A multidisciplinary working group was formed, including hospital pharmacists, pulmonologists, and environmental experts. We created a comprehensive database on the environmental impact of inhalers marketed in Spain, incorporating product specifications and environmental data from the Spanish Agency of Medicines and Medical Devices and pharmaceutical companies. We developed a decision-making algorithm integrating clinical and environmental criteria and performed scenario projections to estimate potential benefits of transitioning from pressurised metered-dose inhalers (pMDIs) to dry powder inhalers (DPIs) and other eco-friendly alternatives. Scenarios included global and individual projections, as well as comparisons between sustainable prescriptions and waste-management strategies. Results The national database revealed significant variability in the carbon footprint across inhaler types, with pMDIs showing the highest emissions. A shift of 10% from pMDIs to DPIs could reduce CO2 emissions by approximately 40 000 tonnes/year, and a 50% shift by up to 200 000 tonnes. The decision-making algorithm effectively combined clinical and environmental considerations, facilitating the selection of more sustainable inhalers. Conclusion The study highlights the importance of incorporating environmental criteria into inhaler prescribing choices to reduce healthcare's carbon footprint. Transitioning from pMDIs to DPIs when clinically indicated offers considerable environmental benefits without compromising patient health. The developed decision-making algorithm provides a practical tool for healthcare professionals, balancing clinical efficacy with sustainability. Future research should refine these practices and explore their application in other medical devices.

INTRODUCTION:A common complaint in patients is chronic cough (CC), which may be refractory (RCC) or unexplained (UCC). Recent studies point, as a possible cause of CC, to the hereditary cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS), with an estimated carrier prevalence of 1 in 20000. AIM:In patients with CC, determine the prevalence of the biallelic (AAGGG)exp mutation in replication factor C subunit 1 (RFC1) responsible for CANVAS, test the usefulness of the Rydel-Seiffer fork test, and evaluate patient quality of life (QoL). METHODS:Clinical and functional data were collected for the 33 included patients undergoing CC studies in our specialized unit. Performed were an etiological study of CC following European Respiratory Society recommendations, a genetic study of RFC1 mutations, and Rydel-Seiffer fork testing to detect possible peripheral vibratory sensitivity impairment. Administered to evaluate QoL were 4 questionnaires. RESULTS:Prevalence of biallelic (AAGGG)exp in RFC1 was 6.1% (n=2) overall, increasing to 7.1% in the RCC subgroup, and to 33.3% in the Rydel-Seiffer fork altered results subgroup. Prevalence of monoallelic (AAGGG)exp in RFC1 was 18.2% (n=6) overall, rising to 50.0% (n=2) in the UCC subgroup. CONCLUSION:Genetic screening for (AAGGG)exp in RFC1, and also use of the Rydel-Seiffer fork test, should be considered in specialized CC consultations for patients with RCC and UCC. Detecting possible CANVAS symptoms in CC studies would identify candidates for early genetic screening, of interest in reducing the disease burden for patients and health systems alike.

Eosinophil-related diseases represent a group of pathologic conditions with highly heterogeneous clinical presentation and symptoms ranging from mild to critical. Both systemic and localized forms of disease are typically treated with glucocorticoids. The approval of novel biologic therapies targeting the interleukin-5 pathway can help reduce the use of systemic glucocorticoids (SGC) in eosinophilic diseases and reduce the risk of SGC-related adverse effects (AEs). In this article, a panel of experts from different medical specialties reviewed current evidence on the use of SGC in two systemic eosinophilic diseases: Eosinophilic Granulomatosis with PolyAngiitis (EGPA) and HyperEosinophilic Syndrome (HES); and in two single-organ (respiratory) eosinophilic diseases: Chronic RhinoSinusitis with Nasal Polyps (CRSwNP) and Severe Asthma with Eosinophil Phenotype (SA-EP), and contrasted it with their experience in clinical practice. Using nominal group technique, they reached consensus on key aspects related to the dose and tapering of SGC as well as on the initiation of biologics as SGC-sparing agents. Early treatment with biologics could help prevent AEs associated with medium and long-term use of SGC.

Introduction: Severe asthma management is associated with increased healthcare resource use. The CARABELA initiative employs lean methodology to optimize severe asthma management in Spain.Material and Methods: Scientific Societies, clinicians, healthcare management and industry stakeholders implemented lean methodology to reorganize and optimize processes and design a practical, individualized approach to improve quality of care for the management of severe asthma patients. This initiative involved four phases: Phase 1 characterized severe asthma management models in six pilot hospitals, identifying improvement areas; Phase 2 validated and prioritized these areas and healthcare quality indicators in a National Workshop; Phase 3 focused on regional meetings to co-create and refine solutions; and Phase 4 is disseminating and implementing results locally by applying a digital tool and organizing tailored workshops.Results: This CARABELA initiative identified 87 improvement areas, mainly in diagnosis and care coordination, and developed solutions emphasizing awareness, nursing roles, patient education, and communication. National and regional meetings produced 112 cocreated solutions and established healthcare quality indicators. Thirty-six hospitals are now implementing tailored improvement plans.Conclusions: The CARABELA-SA initiative revealed variability in severe asthma management across Spain, underscoring the need for standardized healthcare quality indicators. By engaging nearly 200 professionals, the initiative fostered collaboration and innovation and established a framework for ongoing improvement in managing severe asthma and other chronic diseases. The CARABELA initiative promotes patient-centered care and interdisciplinary collaboration with the objective of enhancing patient outcomes and healthcare efficiency.

Background: Refractory chronic cough (RCC) and unexplained chronic cough (UCC) adversely affect patients' quality of life (QoL). This multicenter, non-interventional study evaluates the relationship between cough severity and QoL and other patient-reported outcomes (PROs) in Spanish outpatients. Methods: RCC/UCC patients self-administered a printed survey comprising the cough-severity visual analog scale (VAS), adapted Cough Severity Diary (CSD), and Leicester Cough Questionnaire (LCQ), plus purpose-designed items regarding the physical and everyday-life impact of cough. Patients were stratified into VAS score ter- tiles. The impact of cough on QoL and other PROs in each tertile, and relationships between LCQ scores and the tertiles, were assessed. Results: The VAS was completed by 189 patients, and VAS score tertiles were identified as 0-50, 60-70, and 80-100 mm. The only between-tertile difference in demographic or cough characteristics was cough duration. VAS score tertiles were linearly associated with mean LCQ domain and total scores, as well as the proportion of patients with the highest scores on all adapted CSD items, and almost all physical and everyday-life impact items. In multiple linear-regression models, an increase of one tertile in the VAS score was associated with a decrease of 2.23 points in the LCQ total score, indicating poorer cough-related QoL. Conclusion: As self-assessed in patients with RCC/UCC, cough-severity VAS scores were strongly associated with the impact of cough on QoL and everyday life. Patients with VAS scores of 60-100 mm reported the greatest impact and thus may benefit the most from targeted cough therapies.

Background: Stress urinary incontinence (SUI) is common in women with chronic cough but may be overlooked. Objective: To determine the frequency of underdiagnosis of cough-related SUI and its impact on women's general health status and quality of life (QoL). Methods: Data were analyzed for 147 women with refractory/unexplained chronic cough. Relevant details were collected from clinical charts and a patient-completed survey. General health status was assessed using the EuroQoL visual analogue scale (EQ-VAS) and QoL with the cough-specific Leicester Cough Questionnaire (LCQ). Results: Women were classified into diagnosed (n = 32; 21.8%) or undiagnosed (n = 33; 22.4%) cough-related SUI, and no SUI (n = 82; 55.6%) groups. Women with versus without cough-related SUI perceived poorer health status and greater impact of cough on everyday lives. Mean LCQ scores were significantly lower in cough-related SUI groups versus no SUI group. In multivariate analysis, the presence of cough-related SUI was significantly associated with lower EQ-VAS and LCQ scores. Conclusion: In our cohort, 44% of women had cough-related SUI, and half were undiagnosed. Irrespective of diagnosis, impairment to everyday lives and QoL was similar. Diagnosing cough-related SUI may identify additional patients who can benefit from therapies to suppress cough and improve QoL.