Hereditary angioedema (HAE) is a disabling and potentially life-threatening disorder characterized by recurrent attacks of swelling. It is often linked to a deficiency or lack of functionality of the C1 esterase inhibitor (C1-INH), which leads to elevated levels of bradykinin. However, HAE can also occur in the presence of normal levels and activity of C1-INH, which is known as nC1-INH-HAE. Up to 25% of nC1-INH-HAE cases exhibit mutations in the factor XII (FXII) gene that cause an increase in levels of activated FXII, which is involved in the production of bradykinin.

J Investig Allergol Clin Immunol 2021; Vol. 31(5): 446-460 © 2021 Esmon Publicidad pustules, mucosal involvement, skin hyperpigmentation, or desquamation. Her skin lesions resolved spontaneously 7 days after discontinuation of rifaximin. After obtaining the patient’s written informed consent, we performed an allergological work-up, including skin prick test (SPT) and a graded DCT with rifaximin. SPT was performed with rifaximin at 1 mg/mL on the volar aspect of the forearm and yielded a negative result [6]. On the same day, the patient underwent a DCT, consisting of a graded oral challenge starting at 50 mg and followed by 150 mg 30 minutes later, up to a final dose of 200 mg. One hour after the DCT, the patient felt nauseous, with diarrheic stool that resolved spontaneously without medication. The DCT was considered inconclusive and repeated 24 hours later. Three hours after completion of the second DCT, the patient again experienced diarrheic stools. Ten hours after the DCT, she developed a maculopapular erythematous and pruritic skin rash on her abdomen and left arm (Figure). She was treated with oral prednisone 0.5 mg/kg/d for 3 days and loratadine 10 mg/d for 7 days until the skin lesions resolved, without desquamation or residual lesions. The rationale for an allergological study with rifaximin was that the patient had a long history of gastrointestinal infections, in which rifaximin is an effective first-line therapy. Although reactions to rifamycins (eg, fever, rash, flu-like syndrome, acute renal failure, hemolytic anemia, thrombocytopenia, and anaphylaxis) have been reported [7], few reactions to rifaximin have been described since it was approved [3,4]. In the present case, the patient initially developed gastrointestinal symptoms 3 hours after receiving the first dose of rifaximin; these were considered a nonimmune adverse reaction to rifaximin. She continued treatment, developing a mild maculopapular Nonimmediate Hypersensitivity Reaction to Rifaximin Confirmed With a Drug Challenge Test

Background. The purpose of this study was to gather information on the current assessment and management of patients with moderate-to-severe AD in routine daily practice. Methods. A cross-sectional two-round Delphi survey with the participation of dermatologists and allergologists throughout Spain was conducted. They completed a 46-item questionnaire, and consensus was defined when responses of ≥80% of participants coincided in the categories of a 5-point Likert scale for that item. Results. A total of 105 specialists (aged 40–59 years) completed the two rounds. Participants agreed regarding the consideration of AD as a multifaceted disease and the differences in clinical presentation of AD according to the patient’s age. It is recommendable to perform a skin biopsy to exclude early stage T-cell cutaneous lymphoma, psoriasis, or dermatitis herpetiformis, among others (99.1%). Also, consensus was reached regarding the use of the SCORAD index to quantify the severity of the disease (86.7%), the use of wet wraps to increase the effect of topical corticosteroids (90.4%), the usefulness of proactive treatment during follow-up (85.6%) and tacrolimus ointment (91.2%) to reduce new flares, and the fact that crisaborole is not the treatment of choice for severe AD (92.4%). AD was not considered a contraindication for immunotherapy in patients with allergic respiratory diseases (92.4%). In patients with severe AD, the use of immune response modifier drugs (97.6%) or phototherapy (92.8%) does not sufficiently cover their treatment needs. Consensus was also obtained regarding the role of the new biologic drugs (93.6%) targeting cytokines involved in the Th2 inflammatory pathway (92.0%) and the potential role of dupilumab as first-line treatment (90.4%) in moderate-to-severe AD patients. Conclusion. This study contributes a reference framework to the care of AD patients. There is no diagnostic test or biomarkers to direct treatment or to assess the severity of the disease, and many therapeutic challenges remain.

The autologous serum skin test (ASST) has been widely used to try to demonstrate autorreactivity in chronic urticaria (CU), but the possible correlation with the long-term clinical course of the disease is unknown. Our objective was to evaluate if there were clinical and sociodemographic differences between patients affected by CU after five years of follow-up, according to the positive or negative results of the ASST. Clinical and sociodemographic data of patients diagnosed with CU and ASST performed in our hospital between 2009 and 2014, were reviewed. Age, gender, refractoriety to treatment, disease duration, development of thyroiditis and other autoimmune diseases were analyzed and compared between the positive (ASST+) and negative (ASST-) ASST groups. 71 patients, 50 females and 21 males, with an average age of 52.8 years were selected. There were no significant differences in age and sex between the groups. In the ASST+ group, 45% of CU were refractory to the standard treatment (double dose of antihistamines) and 81% of CU were persistent after 3-5 years vs. 6% and 21% in the ASST- group, respectively. After five years, 25% of ASST+ patients were diagnosed with an autoimmune disease and 25% of these had autoimmune thyroiditis vs. 8.5% and 14%, respectively, for ASST- patients. Helicobacter Pylori was detected in 60% of ASST+ patients vs. 4.7% of ASST- patients. ASST could represent a useful and cheap tool as a prognostic factor for the duration and severity of CU in clinical practice, although further investigation is needed.

Atopic dermatitis (AD) is a recurrent and chronic skin disease characterized by dysfunction of the epithelial barrier, skin inflammation, and immune dysregulation, with changes in the skin microbiota and colonization by Staphylococcus aureus being common. For this reason, the therapeutic approach to AD is complex and should be directed at restoring skin barrier function, reducing dehydration, maintaining acidic pH, and avoiding superinfection and exposure to possible allergens. There is no curative treatment for AD. However, a series of measures are recommended to alleviate the disease and enable patients to improve their quality of life. These include adequate skin hydration and restoration of the skin barrier with the use of emollients, antibacterial measures, specific approaches to reduce pruritus and scratching, wet wrap applications, avoidance of typical AD triggers, and topical anti-inflammatory drugs. Anti-inflammatory treatment is generally recommended during acute flares or, more recently, for preventive management. Nevertheless, the selection of the pharmacologic agent, as well as its potency, duration, and frequency of application must be in accordance with the severity of the disease and the distribution and type of the lesion. The objectives of this review are to emphasize the importance of basic skin care and to describe current and novel topical therapies for AD.

Atopic dermatitis (AD) is a multifaceted disease that involves a complex interplay between the skin and the immune system. The course of the disease depends strongly on the genetic background of the patient and on yet poorly-defined environmental factors. Changes in lifestyle could be behind the dramatic rise in the prevalence of AD across continents; including hygienic conditions, food, social habits, skin microbiome or exposure to a number of allergens. Although AD typically develops in childhood and disappears after a few years, in a relatively large number of patients it continues into adulthood. Adult AD can also appear de novo but it is often underdiagnosed and its treatment can be challenging. New, highly effective drugs are being developed to manage moderate and severe forms of the disease in adults. In this review, we highlight the most recent developments in diagnostic tools, current insights into the mechanistic basis of this disease, and therapeutic innovations.

Atopic dermatitis (AD) is a recurrent and chronic skin disease characterized by dysfunction of the epithelial barrier, skin inflammation, and immune dysregulation, with changes in the skin microbiota and colonization by Staphylococcus aureus being common. For this reason, the therapeutic approach to AD is complex and should be directed at restoring skin barrier function, reducing dehydration, maintaining acidic pH, and avoiding superinfection and exposure to possible allergens. There is no curative treatment for AD. However, a series of measures are recommended to alleviate the disease and enable patients to improve their quality of life. These include adequate skin hydration and restoration of the skin barrier with the use of emollients, antibacterial measures, specific approaches to reduce pruritus and scratching, wet wrap applications, avoidance of typical AD triggers, and topical anti-inflammatory drugs. Anti-inflammatory treatment is generally recommended during acute flares or, more recently, for preventive management. Nevertheless, the selection of the pharmacologic agent, as well as its potency, duration, and frequency of application must be in accordance with the severity of the disease and the distribution and type of the lesion. The objectives of this review are to emphasize the importance of basic skin care and to describe current and novel topical therapies for AD.

Few studies have evaluated long-term and progressive beneficial effects of omalizumab uninterrupted treatment for > 5 years in real-life practice. The aim of this study was to evaluate the clinical and functional improvement of patients with persistent severe asthma treated with omalizumab for 5 years. A retrospective, observational study based on medical record reviews of patients treated with omalizumab for minimum 5 years was addressed. Annual asthma exacerbations (AE), emergency visits (EV), hospital admissions (HA), systemic corticosteroid bursts (SCOb), inhaled corticosteroids daily dose (ICS/d) and lung function (FEV1% predicted) were collected during the pre-treatment year and compared after 1 and 5 years of uninterrupted therapy. Adverse reactions (AR) were also reviewed. 14 patients were evaluated. The average age was 41.64, nine patients were female and 13 had allergic asthma. Mean values before omalizumab treatment were total IgE 767.37 KU/L, FEV1 77%, ICS/d 1000 mcg (Fluticasone), SCOb 5.5, AE 7.14, EV 3.57 and HA 0.86. AER, ERV, SCOb reduced by 65%, 80%, 73%, respectively at year 1 and 92%, 96%, 83%, respectively at year 5 of treatment. Mean FEV1 increased up 87% at year 1 and up 105 % at year 5. Pre-treatment ICS/d dose reduced by 28 % at year five and only one patient suffered 1HA at year five. Only 2 patients experienced mild headache and no serious AR were documented. Omalizumab showed an excellent tolerability and a progressive long-term effectiveness over 5 years in real-life practice, although the most improvements were experimented within the first year of treatment.

OBJECTIVES To evaluate the association between serum total IgE levels and disease severity in adult patients with persistent allergic asthma and to explore the main predictors of IgE levels. METHODS We performed a multicenter, retrospective, observational study including adult patients diagnosed ≥ 1 year previously with persistent allergic asthma who were positive to ≥ 1 allergen. Patients also had serum total IgE and spirometry results available from the previous 12 months. Inclusion was stratified by asthma severity according to the GEMA 2009 criteria. RESULTS We included 383 patients with allergic asthma (129 mild, 82 moderate, and 172 severe). Mean (SD) age was 38 (15), 46 (16), and 45 (15) years, respectively (P < 0.001). Serum total IgE levels varied markedly (coefficient of variation, 147%). No association was observed with forced expiratory volume in 1 second (FEV1) or asthma severity: mean (SD)/median (IQR) of 403 (616)/214 (108-409), 361 (516)/204 (126-361), and 473 (676)/211 (98-545) IU/mL in the mild, moderate, and severe subgroups, respectively (P = .951). The severe subgroup had a higher percentage of patients with > 400 IU/mL (36% vs 26.4% [mild] and 18.3% [moderate], P = .010). In a multivariate multiple regression model, the independent predictors of higher IgE were younger age (P = .004), sensitization to ≥ 2 allergens (P = .009), male gender (P = .025), and family history of asthma (P = .122). CONCLUSION Serum total IgE levels in adult patients with persistent allergic asthma were high (two-thirds with levels > 150 IU/mL) and extremely variable. We did not find a significant association between serum total IgE levels and asthma severity or airflow limitation, except for a higher percentage of patients with IgE > 400 IU/mL in the severe subgroup.

Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control.Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control.According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only).Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.

Background: Severe asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents.Methods: Observational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians' criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6-14 years with severe asthma (difficult-to-control or controlled) were included in the second phase.Results: 12,376 asthmatic children were screened in the first phase. According to physicians' criteria, 8.8% (95% CI 8.3-9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7-26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 +/- 2.3 years; 61.4% male; mean of 5.5 +/- 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p < 0.0001, all) and poor HRQoL (p < 0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians' criteria were poorly controlled according to GEMA.Conclusions: Around one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents. (C) 2013 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.

Background: Significant clinical experience has been gained after five years from the approval of omalizumab in Spain. Objective: To describe patterns of use of omalizumab in current clinical practice in Spain. Methods: Retrospective, multicenter, study based on medical records from patients treated with omalizumab between Jan-2006 and Sep-2011. Results: 464 patients (63.8% female, mean age 45.6±19.3 years) were included. Omalizumab was mainly prescribed for the treatment of asthma (84.5%), followed by chronic urticaria (5.6%), food allergy (5.2%), atopic dermatitis (2.4%) and allergic bronchopulmonary aspergillosis (1.7%). The disease was severe in 76.7% of cases. During the year before omalizumab was started, asthma patients required an average of 2.7±3.7 emergency visits and 0.4±1.2 hospital admissions with a mean stay of 10.8±11.2 days. Mean number of unscheduled primary and specialized care visits were 3.5±3.9 and 1.8±2.3 respectively. The average lost working days was 7.9±22.3. The main reasons to start omalizumab treatment were the lack of efficacy with conventional (93.1%) or alternative therapy (22.0%), and the appearance of adverse events with other drugs (18.5%). Modifications of omalizumab dosage/frequency were detected in 17.5% of cases. Overall efficacy of omalizumab was rated as good/excellent in 64.4%. Efficacy was evaluated on the basis of clinical improvement (87.7%), disease control (77.6%), reduction of exacerbations (72.2%) and quality of life (33.4%). Conclusions: Severe asthma was the main indication for omalizumab prescription, albeit other serious and long-standing immunological diseases were identified. Omalizumab is a good therapeutic option for all the evaluated indications.

INTRODUCTION:Despite current treatments, more than half of patients with asthma are not controlled. The objective was to evaluate the correlation between control perceived by patients and physicians, compared with control evaluated according to criteria of the Spanish Guidelines for Asthma Management (GEMA), and to investigate the factors associated with that control. METHODS:Multicenter, cross-sectional, observational study including 343 patients with severe persistent asthma according to GEMA criteria seen in the Department of Pulmonology and Allergology. The correlation between asthma control perceived by the patient, the physician and according to clinical judgment based on the GEMA criteria was calculated, and a multivariate analysis was used to determine variables related to the perception of asthma control. RESULTS:According to GEMA criteria, only 10.2% of patients were well controlled, 27.7% had partial control and 62.1% were poorly controlled. Both the physicians and the patients overestimated control: 75.8% and 59.3% of patients had controlled asthma according to the patient and the physician, respectively, and were not controlled according to GEMA (P<.0001). Patients with uncontrolled asthma according GEMA had higher body mass index (P=.006) and physical inactivity (P=.016). Factors associated with a perceived lack of control by both physicians and patients were: nocturnal awakenings (≥ 1 day/week), frequent use of rescue medication (≥ 5 days/week) and significant limitation in activities. Discrepant factors between physicians and patients were dyspnea and emergency room visits (patients only), FEV1 ≤ 80% and a poorer understanding of the disease by the patient (physicians only). CONCLUSIONS:Only 10% of patients with severe asthma evaluated in this study are controlled according to GEMA criteria. Patients and physicians overestimate control and the overestimation by patients is greater. Physical inactivity and obesity are associated with a lack of control according to GEMA.

Background: Omalizumab is indicated in patients with severe allergic asthma not controlled by high-dose inhaled glucocorticoids and long-acting beta-agonists. Few data are available on the profile of patients treated with this drug in routine clinical practice in Spain.Objective: To describe the profile of patients with severe allergic asthma treated with omalizumab and the course of the disease after a period of treatment.Methods: Retrospective, multicentre study, recording the data on patients of either sex and >= 12 years with uncontrolled severe allergic asthma, previously treated with omalizumab. Data were evaluated in relation to pulmonary function, symptoms, quality of life, and concomitant anti-asthma treatment before the prescription of omalizumab and at the time of the study visit.Results: 214 patients were evaluable (mean age = 48.2 +/- 17.7 years; mean age at the time of diagnosis = 26.6 +/- 16.5 years). 90.7% had experienced exacerbations the year before receiving omalizumab, and the mean total IgE level was 273 +/- 205.4IU/ml. The mean monthly dose was 380.5 +/- 185.4 mg. Compared with the baseline situation, differences were observed after treatment with omalizumab in mean FEV1 (62.7 +/- 15.9% vs. 70.8 +/- 18.7%), in the proportion of patients requiring oral corticosteroids (47.7% vs. 14.0%), and in the ACQ and AQLQ scores. 32.7% of the patients received doses not recommended by the Summary of Product Characteristics (SPC).Conclusions: Profile of asthmatic patients treated with omalizumab predominantly corresponds to uncontrolled severe asthma cases, in accordance with SPC's indications. The results of the study suggest a favourable clinical course similar to that observed in other studies. (C) 2012 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.

printing supported by . Visit Chiesi at Stand D.30 TUESDAY, SEPTEMBER 27TH 2011 identify, understand and manage the patient issues (A) and whether they reviewed key typical COPD issues (B). The primary endpoint of the study is the comparison of the assessment score (A+B) between the arms. The study has >90% power to detect a 3 point (out of 40) difference between the arms. A pilot study was successfully conducted with 10 PCPs to confirm the feasibility of the study. The study is ongoing and results are expected late 2011. P3765 The Breathing Bus – A primary care model for identifying undiagnosed COPD in hard to reach populations. A pilot study June Roberts1, Helena Cullen2, Nawar Diar Bakerly1. 1Respiratory Medicine, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, United Kingdom; 2Adult Services, Salford Community Health, Salford, Greater Manchester, United Kingdom Background: COPD is frequently undiagnosed especially in socio-economically deprived (SED) populations who are most at risk of this condition. Aims: To improve access to hard to reach groups To identify those most at risk of having undiagnosed COPD and to signpost to general practice for further assessment Methods: A mobile health bus was sited in areas of high SED with good footfall and accessibility. Nurses trained to recognise COPD syptoms, perform FEV6 micro-spirometry and experienced in informal, non-medicalised approaches to health and disease staffed the bus. High risk individuals (over 35 yrs, smoker or ex-smoker with symptoms suggestive of COPD) were targeted for FEV6 microspirometry. Consent was gained to share all results with own GP. Those with unexplained respiratory symptoms and/or abnormal FEV6 readings were asked to see their GP for further assessment. Follow up with patient experience survey took place 8 weeks after a visit to the bus. Results: The bus visited 6 sites on 7 occasions. 350 people visited the bus, between 6% and 87% of contacts were from areas of high SED. Of 119 in the high risk group, 67% men and 45% females had symptoms suggesting COPD and of those suitable for FEV6 readings 30% of men and 38% women had airflow obstruction: all were signposted to their GP. 48% were current smokers. Data from the experience survey indicates that many suspected something was wrong; accessibility and convenience prompted them to come forward for testing. Conclusion: Our pilot work suggests that mobile units in non-clinical settings can increase accessibility to SED groups and prompt high risk individuals to be tested for COPD. Further work is needed. P3766 Two year mortality of COPD in primary care in Greece: An observational study Markos Minas, Ioanna Verou-Katsarou, Parthena Mystridou, Eleni Apostolidou, Hatzoglou Chrisi, Konstantinos Gourgoulianis. Respiratory Medicine Department, University of Thessaly Medical School, Larissa, Greece Introduction: COPD remains a significant cause of death worldwide. However, in primary care in Greece there is still a large proportion of undiagnosed COPD patients. Parameters associated with mortality in COPD patients have not been identified. Aims and objectives: To assess the parameters associated with two year mortality in newly diagnosed COPD patients in primary care in Greece Methods: Using an open spirometry programme, 118 newly diagnosed COPD patients were followed up for two years. Phone contact to assess vital status was performed every six months, whereas the study participants were examined and performed spirometry by the study team once a year after the initial diagnosis. Results: During the two year follow up, a great proportion of COPD patients quitted smoking after the initial diagnosis. However, there was no change in respiratory symptoms, and only the 68.2% showed compliance with treatment. Overall mortality was 28.0% (33 out of 118 subjects). Parameters associated with two year mortality in a cox regression model were age (p<0.001), smoking status (current or former smoker, p=0.025) and history of depression (p=0.001). Conclusion: Mortality of COPD patients in primary care in Greece remains significant high. History of depression was associated with increased mortality and should be taken into account when assessing COPD patients. A more intense monitoring and better health care provided at these patients is suggested. P3767 Exhaled nitric oxide: A useful adjunct test in assessing asthma control in primary care – A cross-sectional exploration Evelien Termeer1, Jiska Snoeck-Stroband2, Hanneke Nuiten1, Persijn Honkoop2, Rik Loymans3, Bart Thoonen4, Ivo Smeele5, Jaap Sont2, Chris van Weel1, Tjard Schermer1. 1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; 2Department of Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands; 3Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam, Netherlands; 4Diagnostic Centre, SHO, Primary Care Diagnostic Centre Velp, Velp, Netherlands; 5Diagnostic Centre, SHL, Primary Care Diagnostic Centre Breda, Breda, Netherlands Background: Established markers of asthma control, symptoms and lung function do not measure underlying bronchial inflammation and their results are sometimes contradicting. Measuring fractional exhaled nitric oxide (FeNO) as a marker of eosinophilic airway inflammation might offer benefit. Aim: To explore consequences of adding FeNO as an adjunct to symptoms and spirometry for assessing asthma control in primary care. Methods: We performed a cross-sectional analysis of two available cohorts of adult asthmatics. We assessed FeNO, lung function and Asthma Control Questionnaire (ACQ) levels in all participants. Pearson correlation coefficients were calculated between FeNO, ACQ,%FEV1 predicted and%reversibility. In a scenario analysis, patients’ asthma control was categorized according to two established control markers, and with FeNO as an extra marker. Results: We included 147 and 160 patients (in total 63% female; mean age 35.4). Correlations between FeNO, symptoms and lung function were weak (max 0.240, between FeNO and%reversibility). All three control markers were consistent in interpretation of asthma control in 25.7% of the population. In 28.1% symptoms and lung function were consistent but FeNO was contradicting and in another 46.3% the two established markers were contradicting. Conclusions: We observed weak correlations between FeNO, symptoms and lung function in adults with asthma in primary care, which confirms that FeNO is an independent marker in assessing asthma control. In almost half the population, results of symptoms and lung function were contradicting regarding assessing asthma control; in this group FeNO may fine-tune categorization of asthma control. P3768 A pilot study to detect airflow obstruction in smokers using spirometry in a local GP surgery Bhupinder Mann1, Essam Ramhamadany1, Lesley Seddon2, Emma Loveridge3, Angela Glennon3. 1Respiratory Department, West Middlesex University Hospital, London, Middlesex, United Kingdom; 2Maswell Park GP Surgery, Maswell Park, London, Middlesex, United Kingdom; 3Respiratory Section, Astra Zeneca, London, United Kingdom COPD is under diagnosed worldwide. In our locality, it is thought that a fifth of all COPD cases have been identified. Aim: To carry out a pilot study to screen smokers and ex-smokers in a local GP practice with spirometry to allow earlier COPD diagnosis. Methodology: Over a 7 month period, subjects were identified from a GP practice database. The target population included smokers/ex-smokers over the age of 35 who had smoked a minimum of 10 pack years; recurrent or chronic respiratory symptoms; occupational exposure to respiratory irritants or family history of COPD. Patients known to have COPD or asthma were excluded. Appropriate subjects completed a short questionnaire. Severity of airflow obstruction (AFO) was assessed using the UK NICE COPD 2004 guidelines: mild AFO FEV1 50-79% predicted, moderate AFO FEV1 30-49% predicted, severe AFO FEV1 <30% predicted. Spirometry was carried out by a trained nurse. Results: Out of 5,500 patients, 723 subjects were contacted and 203 had spirometry. In total 169 subjects had reliable spirometry which showed normal results in 80 patients (47.3%). AFO was present in 32/169 (18.9%-using NICE criteria). A further 50/169 (corresponding to GOLD stage 1 disease but not in the NICE guidelines) may be at risk giving a figure of 48.4% with AFO and possible COPD.Out of 92 patients who completed the questionnaire, 71 (77.1%) had not heard of COPD and 51% had respiratory symptoms. Conclusion: Proactive screening of smokers with spirometry can increase COPD identification. We are planning to roll this project out using the new NICE COPD 2010 guidelines, which require post bronchodilator spirometry values. This project was funded by Astra Zenica pharmaceutical company. P3769 Effectiveness of supervised training program about spirometry in primary care Cristina Represas-Represas, Virginia Leiro-Fernández, Maribel Botana-Rial, Ana Isabel González-Silva, Alberto Fernández-Villar. Pneumology. Respiratory and Infectious Disease Research Group. Bio-Medical Research Institute of Vigo, University Hospital Complex of Vigo (CHUVI), Vigo, Pontevedra, Spain Spirometry is an essential technique for diagnosing respiratory diseases but it is underused at Primary Care (PC) level. Training could help to improve the situation. Objectives: To analyze the effectiveness of 2 months supervised training program about spirometry performance and interpretation. Methodology: Interventional study, with measurements before and after, to improve the quality. Target population: doctors and nurses team, of 26 PC centers. Teachers: pulmonologists from our hospital (CHUVI). We designed a structured program showed in figure 1. To assess the effectiveness of the course, students were evaluated with a test-exam composed of 5 spirometries with 2 ques