Introduction: Sex-specific differences in severe asthma - particularly those affecting women - remain underexplored, despite their potential impact on disease management and outcomes. A better understanding of these differences is key to advancing personalized and equitable care. Multiple population-based cohorts have reported a higher prevalence of asthma in adult women than in men, underscoring the clinical relevance of sex-based differences. The objective is to describe and compare sex-based clinical and pharmacological profiles among patients with severe asthma managed at a Severe Asthma Clinic (SAC) in a tertiary hospital in Spain. Methods: This retrospective cohort study included adult patients with severe asthma followed at the SAC in 2024. Clinical variables (comorbidities, pulmonary function, biomarkers, and asthma control) and pharmacological variables (inhaled therapy prescriptions and adherence, rescue overuse, oral corticosteroid use, biologics, and comorbidity-related treatments) were analyzed using electronic health and pharmacy records. Results: A total of 223 patients were included (157 women and 66 men). Women showed significantly poorer asthma control (Asthma Control Test 18.3 vs. 21.5, p < 0.05), lower fractional exhaled nitric oxide and IgE levels (p < 0.05), and higher rates of depression/anxiety (18.5% vs. 6.1%, p = 0.012). Pulmonary function tests revealed higher forced vital capacity (FVC) but lower forced expiratory volume in 1 s (FEV1)/FVC ratios in women (p < 0.05). Poor adherence to inhaled therapies (26.0% vs. 15.4%, p < 0.05) and intranasal corticosteroids (59% vs. 34.6%, p = 0.038), as well as higher oral corticosteroid use (20.6% vs. 15.1%, p = 0.031), were more frequent in women. Biologic prescription rates and rescue inhaler overuse were similar between sexes. Conclusion: Women with severe asthma exhibit distinct clinical and pharmacological profiles that warrant sex-specific approaches to improve disease management and outcomes.

BACKGROUND:The healthcare sector significantly contributes to greenhouse gas emissions, with pharmaceuticals accounting for 20-35% of the total. Among these, pressurised metered-dose inhalers (pMDIs), commonly used in asthma management, contain hydrofluorocarbon (HFC) propellants with high global warming potential (GWP), representing the medications with the highest carbon footprint. OBJECTIVE:To assess the extent of pMDI use among patients with severe asthma (SA) and to evaluate the feasibility of replacing them with more environmentally sustainable alternatives without affecting treatment adherence or disease control. METHODS:This observational, descriptive study was conducted in a multidisciplinary severe asthma clinic at a tertiary hospital in Spain. Adult patients with SA managed in 2024 were included. Variables analysed included inhaler prescriptions, treatment adherence based on the medication possession ratio (MPR), and the estimated CO2 emissions associated with each inhaler type. RESULTS:Among 223 SA patients (mean age: 61.4 years; 70.4% female), 43.4% were prescribed pMDIs. Triple therapy (LABA-ICS-LAMA) in a single device was predominantly delivered via pMDIs (66.7%). Adherence exceeded 70% for both pMDIs and non-pMDIs. However, over 50% of patients prescribed rescue inhalers were classified as overusers. All prescribed short-acting β2-agonists (SABAs) were delivered via pMDIs, contributing disproportionately to carbon emissions (20-30 kg CO2 per inhaler). Most pMDI prescriptions had viable, lower-emission non-pMDI equivalents. CONCLUSION:A substantial proportion of pMDIs prescribed for SA could be replaced with sustainable alternatives without compromising adherence. The lack of low-emission rescue inhalers highlights a critical area for future innovation in respiratory care.

OBJECTIVES:To evaluate real-world effectiveness of tezepelumab in severe asthma, by type-2 (T2) status and prior biologic exposure, and response predictors. METHODS:Multicentre retrospective cohort in 17 Spanish tertiary hospitals. Adults with ERS/ATS-defined severe asthma initiating tezepelumab were identified from pharmacy dispensing records. Outcomes included Asthma Control Test (ACT), annualised exacerbations, oral corticosteroid (OCS) exposure (maintenance use, prednisone>5mg/day, cumulative dose), spirometry (FEV1; % predicted), blood eosinophils and fractional exhaled nitric oxide (FeNO). Linear regression assessed predictors of change in ACT and exacerbations. RESULTS:Of 307 initiators, 304 had paired assessments. Mean ACT rose from 13.6 to 17.0 (+3.4) and annualised exacerbations fell from 2.9 to 0.8; 47% were exacerbation-free. Maintenance OCS use decreased from 22.4% to 16.8%, and prednisone>5mg/day fell from 22.4% to 6.9% (70% reduction). Cumulative OCS dose declined from 1575 to 1020mg (median 420 to 0mg). Mean FEV1 increased from 1850 to 1930mL and % predicted from 70.4% to 73.7%, with larger gains at baseline FEV1<80% predicted. Clinical remission was achieved in 12.3% of patients. At follow-up, 54.8% had eosinophils<150cells/μL and 74.6% had FeNO<25ppb. Prior biologic exposure predicted smaller improvements in ACT and exacerbations. CONCLUSIONS:In specialist care, tezepelumab was associated with meaningful improvements in asthma control, fewer exacerbations, reduced OCS exposure, modest lung function gains, and reductions in T2 biomarkers across phenotypes. Exploratory analyses identified age, sex, prior OCS use, T2 status and prior biologic exposure as response predictors. Future comparative studies are needed to confirm causality.

Background/Objectives: Accurate diagnosis of lymph node pathology is essential for the management of both malignant and benign diseases. This study compares the diagnostic performance of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a real-world cohort. Methods: A single-center retrospective observational study was conducted, including 91 patients who underwent both cryobiopsy and EBUS-TBNA for lymph node evaluation. EBUS-TBNA was performed with a 19-G needle and cryobiopsy with a 1.1 mm flexible cryoprobe. Clinical characteristics, positron emission tomography-computed tomography (PET-CT) findings, ultrasonographic characteristics of the lymph nodes, diagnostic yield, and procedure-related complications were analyzed. Diagnostic accuracy, sensitivity, specificity, and factors associated with correct diagnosis were assessed. Results: The median age of the cohort was 65 years [interquartile range-IQR-56-74], 63.7% were male, and 74.7% were former or current smokers. Malignant disease was ultimately diagnosed in 60 patients (65.9%), of whom 78.3% had non-lymphoproliferative tumours and 21.7% had lymphoproliferative malignancies. The diagnostic accuracy of cryobiopsy was 89%, compared with 82.4% for EBUS-TBNA. The paired comparison between the two techniques did not reach statistical significance. After exclusion of non-diagnostic samples, sensitivity was numerically higher for cryobiopsy (96.4%, 95% CI 90.7-100) than for EBUS-TBNA (88.9%, 95% CI 79.6-98.2). Factors associated with correct diagnosis included chronic obstructive pulmonary disease for cryobiopsy, cardiovascular comorbidities, and maximum SUV for EBUS-TBNA. In malignant lesions, cryobiopsy showed higher diagnostic accuracy than EBUS-TBNA (90% vs. 80% accuracy), particularly in lymphoproliferative diseases. In benign lesions, both techniques agreed in 17 (54%) of cases, with cryobiopsy showing a higher yield for sarcoidosis and contributing to the diagnosis of tuberculosis. Complications were infrequent and minor, with no major adverse events reported. Conclusions: Cryobiopsy showed numerically higher diagnostic accuracy and sensitivity compared with EBUS-TBNA, particularly in malignant and lymphoproliferative disorders, with a favorable safety profile. These findings support its role as a valuable complement-or alternative-to conventional EBUS-TBNA in the assessment of mediastinal lymph nodes.

Background and Objectives: Krebs von den Lungen-6 (KL-6) is a promising biomarker of interstitial lung disease (ILD), but data in immune-mediated ILD remain limited. We aimed to evaluate the clinical, functional, and radiological correlates of serum KL-6 levels in a real-world cohort of patients with immune-mediated ILD. Materials and Methods: We conducted a retrospective, cross-sectional, single-center study including adults with multidisciplinary follow-up for immune-mediated ILD and at least one serum KL-6 determination between January 2023 and September 2025. Clinical, laboratory, radiological, and pulmonary function data closest to the index KL-6 measurement were collected. KL-6 was analyzed as both a continuous variable and a categorical variable using a predefined cutoff of 500 U/mL. Correlation analyses and multivariable logistic regression were performed to identify factors independently associated with elevated KL-6 levels. Results: A total of 112 patients were included; 72.3% were women, with a median age of 70 years (IQR 63–77). The most frequent underlying diseases were systemic sclerosis (30.4%), rheumatoid arthritis (25.9%), and inflammatory myopathy (14.3%). Median KL-6 concentration was 770.5 U/mL (IQR 437.3–1148.5). Patients with FVC < 80% predicted and DLCO < 60% predicted had significantly higher KL-6 levels than those with better lung function (p = 0.001 and p = 0.004, respectively). KL-6 levels correlated inversely with DLCO (% predicted) (ρ = −0.388, p < 0.001) and FVC (% predicted) (ρ = −0.328, p < 0.001) but not with the presence of radiological fibrosis. In the multivariable analysis, lower DLCO (% predicted) (OR 0.919, 95% CI 0.884–0.955; p < 0.001) and older age (OR 1.063, 95% CI 1.014–1.115; p = 0.012) were independently associated with elevated KL-6 levels. Conclusions: Elevated serum KL-6 concentrations were associated with impaired gas transfer as measured by DLCO % predicted in this cross-sectional cohort. Longitudinal studies are required to determine whether KL-6 can predict functional decline, disease progression, or clinical outcomes.

Background: Overuse of short-acting reliever inhalers, particularly short-acting β2-agonists (SABAs), is linked to poor asthma control, higher exacerbation risk, and increased mortality. Data on reliever overuse in severe asthma and the role of short-acting muscarinic antagonists (SAMAs) remain limited. Objective: This study aims to assess the prevalence of rescue inhaler overuse in adults with severe asthma and examine its associations with maintenance therapy adherence, biologic treatment, oral corticosteroid use, asthma control, lung function, allergic sensitization, and comorbidities. Methods: We conducted a retrospective observational study of 223 adults with severe asthma followed at a tertiary multidisciplinary clinic in 2024. Clinical, functional, pharmacological, and pharmacy-dispensing records were reviewed. Rescue inhaler overuse was defined as dispensing ≥ 3 SABA and/or SAMA canisters per 12 months. Associations with clinical and treatment variables were analyzed. Results: Among 223 patients, 144 (64.6%) had a prescribed rescue inhaler; 85 (38.1%) met the criteria for overuse. Of those prescribed rescue therapy, 59.0% overused, with 47.2% classified as low overuse and 11.1% as high overuse. Overuse was more frequent in patients with maintenance adherence > 50%. Biologic therapy was associated with reduced odds of overuse, while oral corticosteroid use showed no significant effect. Poor asthma control (ACT < 20) was strongly associated with overuse. Lung function did not differ significantly, though overusers tended to have lower FEV1. Allergic sensitization was not associated with overuse; bronchiectasis was the comorbidity most frequently linked. Conclusions: Rescue inhaler overuse is common in severe asthma and closely linked to inadequate disease control. Lower overuse rates among biologic-treated patients suggest improved control reduces reliance on short-acting relievers. Systematic monitoring of reliever use may help identify high-risk patients and guide individualized management strategies.

Uncontrolled, severe asthma remains a significant clinical challenge, affecting a small proportion of asthma patients worldwide. Despite advancements in treatment options, a subset of patients continues to experience frequent exacerbations, uncontrolled symptoms, and impaired quality of life. The advent of biological therapies has revolutionized the management of severe asthma, offering targeted treatments that address specific inflammatory pathways. This review provides a comprehensive overview of the efficacy and response criteria of biological treatments in severe asthma, focusing on clinical, functional, and inflammatory markers used to help in the evaluation of the biologic treatment. Key response criteria include symptom control, reduction in exacerbations, improvement in lung function, and a reduction in or the discontinuation of oral corticosteroids. Biomarkers such as blood eosinophils and exhaled nitric oxide (FeNO) are essential tools in guiding treatment adjustments. Real-world studies underscore the importance of personalized treatment strategies, as variability in response to biological therapies can be significant. The emergence of tools such as the FEOS score and EXACTO questionnaire offer quantitative measures for assessing biological response and guiding clinical decisions. Additionally, predictive factors for better or poorer responses, such as pre-treatment lung function and comorbidities, like obesity and rhinosinusitis, are critical in patient selection. This review highlights the need for ongoing reassessments and potential modifications of therapy in cases of suboptimal response. Practical considerations for switching biological therapies are discussed, emphasizing the importance of tailoring treatments to individual patient profiles and disease phenotypes. With the continued development of personalized medicine, the outlook for patients with severe asthma is improving, selecting specific biomarkers to improve the selection of the biologic treatment.

Background/Objectives: Patients with severe asthma (SA) commonly present with coexisting nasal polyposis (NP), often requiring treatment with intranasal corticosteroids (INC). However, adherence to INC in this population remains inadequately characterized despite its clinical significance. This study aimed to evaluate adherence to INC in patients with SA and NP and to identify clinical and pharmacological factors associated with adherence levels. Methods: We conducted a retrospective observational study including adult patients with SA and NP treated with INC and followed at a tertiary asthma unit in Madrid during 2024. Adherence was assessed via medication possession ratio (MPR) over six months, with poor adherence defined as MPR < 50%. Pharmacological, clinical and demographic variables were analyzed for associations with adherence. Results: Of the 188 patients evaluated, 86 (45.7%) were prescribed INC. Poor adherence was observed in 53.5% of these patients. Women exhibited significantly lower adherence compared to men (p < 0.05). Fluticasone was the most commonly prescribed INC (54.6%), with no significant adherence differences across corticosteroid types. Patients on maintenance systemic corticosteroids had higher adherence (85.7%, p < 0.05), whereas those receiving biologic therapies tended toward lower adherence (51% poor adherence), though this was not statistically significant. Higher adherence was associated with increased disease severity, as indicated by multiple endoscopic sinus surgeries (p < 0.05). No significant differences were observed in spirometry or Asthma Control Test scores. Conclusions: Adherence to INC in patients with SA and NP is suboptimal, particularly among women and patients on biologics. Greater disease severity correlates with improved adherence. Targeted interventions are necessary to enhance adherence and optimize disease management in this population.

OBJECTIVE:The aim of this retrospective multicentre study is to describe the clinical characteristics of patients diagnosed with severe eosinophilic asthma receiving anti-IL-5/anti-IL-5Rα therapies and to compare their effectiveness. METHODS:We collected and analysed results separately for anti-IL-5 and anti-IL-5Rα therapies from January 2016 until December 2021 in multidisciplinary severe asthma units. We collected demographic and clinical data, treatment with previous anti-IgE and/or anti-IL-5 agents, and comorbidities. We compared the number of exacerbations and admissions to the hospital, daily oral corticosteroid intake, pulmonary function tests, and Asthma Control Test scores before and after 12 months of therapy. 261 patients were included: 176 patients in the anti-IL-5 group and 85 in the anti-IL-5Rα group. RESULTS:Both groups led to statistically significant reductions in asthma exacerbations, hospital admissions, and visits to the Emergency Room. Although both groups showed a significant reduction in blood eosinophiliccount, we found a difference, although not significant, in the magnitude of reduction as benralizumab was able to decrease eosinophil counts to zero. Patients in the anti-IL-5 group achieved higher ACT scores after treatment, although this improvement was seen in both treatment groups. CONCLUSION:The anti-IL-5 and anti-IL-5Rα biologics have shown similar effectiveness despite having different mechanisms of action. The anti-IL-5 group appeared to be better than benralizumab at improving ACT scores and FEV1/FVC and at reducing the number of inhalers. Although these differences were not statistically significant, it is not clear whether they may have clinical relevance and they might highlight the need for further head-to-head studies comparing these treatments.

Cystic fibrosis is the most common autosomal recessive disease in the Caucasian race. Its course is chronic and progressive, with pulmonary involvement being associated with greater morbidity and mortality. One of the factors most related to worse prognosis in these patients is respiratory exacerbations. Although limited, there is evidence demonstrating that increased exposure to environmental pollution, both acute and chronic, is associated with an increase in these exacerbations. It is crucial to fully understand this relationship in order to attempt to improve the respiratory health of these patients. That is why the available evidence is reviewed and measures are established to reduce exposure to pollutants.

Introduction: We are assisting to an increase in survival rates among individuals with cystic fibrosis (CF). Until now, renal involvement was a minority issue, but with the rise in life expectancy, we will likely see an increase in its prevalence. Our main objective was to assess renal function in CF and study risk factors associated with its deterioration. Methods: A cross-sectional, retrospective study was conducted, including adults with CF. Clinical, respiratory function, microbiological, blood and urine analysis, and major chronic treatments received were collected. Results: Eighty nine patients with a mean age of 35 f 12 years were analyzed. Mean serum creatinine levels were 0.8 f 0.2 mg/dL. 10.6% had a glomerular filtration rate less than 90 mL/min/1.73 m2. 2 . No patient showed albuminuria. In multivariate model, only age was an independent risk factor for reduced glomerular filtration (OR: 0.344; 95% CI: 0.004-0.017; P = .002). Conclusions: 11% of CF adults show decreased glomerular filtration, with age being the sole independent risk factor. Vigilance for this uncommon condition is crucial. (c) 2024 Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

IntroductionMajor urban pollutants have a considerable influence on the natural history of lung disease. However, this effect is not well known in idiopathic pulmonary fibrosis (IPF).AimThis study aimed to investigate the effects of air pollution on clinical worsening, lung function, and radiological deterioration in patients with IPF.MethodsThis exploratory retrospective cohort study included 69 patients with IPF, monitored from 2011 to 2020. Data on air pollution levels, including carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter ≤ 2.5 μM (PM2.5), ozone (O3), and nitrogen oxides (NOx), were collected from the nearest air quality monitoring stations (<3.5 km from the patients' homes). Patient outcomes such as clinical worsening, lung function decline, and radiological deterioration were assessed over various exposure periods (1, 3, 6, 12, and 36 months). The statistical analyses were adjusted for various factors, including age, sex, smoking status, and treatment.ResultsThere was an association between higher O3 levels and an increased likelihood of clinical worsening over 6 and 36 months of exposure (odds ratio [OR] and 95% confidence interval [CI] = 1.16 [1.01–1.33] and OR and 95% CI = 1.80 [1.07–3.01], respectively). Increased CO levels were linked to lung function decline over 12-month exposure periods (OR and 95% CI 1.63 = [1.01–2.63]). Lastly, radiological deterioration was significantly associated with higher CO, NO2, and NOx levels over 6-month exposure periods (OR and 95% CI = 2.14 [1.33–3.44], OR and 95% CI = 1.76 [1.15–2.66] and OR and 95% CI = 1.16 [1.03–1.3], respectively).ConclusionThis study suggests that air pollution, specifically O3, CO, NO2, and NOx, could affect clinical worsening, lung function, and radiological outcomes in patients with IPF. These findings highlight the potential role of air pollution in the progression of IPF, emphasizing the need for further research and air quality control measures to mitigate its effects on respiratory health.

Introducción Estamos asistiendo a un progresivo incremento de la supervivencia en la fibrosis quística (FQ). Hasta ahora, la afectación renal era minoritaria, pero con la mejoría de la esperanza de vida, probablemente veremos un aumento de su prevalencia. Nuestro objetivo principal fue evaluar la función renal en FQ y estudiar factores de riesgo asociados a su deterioro. Métodos Estudio transversal, retrospectivo en el que se incluyeron adultos con FQ. Se recogieron las características clínicas, de función respiratoria, microbiológicas, análisis de sangre y orina y principales tratamientos crónicos recibidos. Resultados Ochenta y nueve pacientes con una edad media de 35±12 años. Los niveles medios de creatinina sérica fueron de 0,8±0,2mg/dl. El 10,6% tenían un filtrado glomerular menor a 90ml/min/1,73m2. Ningún paciente mostró albuminuria. Solo la edad fue un factor de riesgo independiente para un filtrado glomerular reducido (OR: 0,344; IC95%: 0,004-0,017; p=0,002). Conclusiones El 11% de adultos con FQ tienen disminución del filtrado glomerular y la edad es el único factor de riesgo asociado independientemente. Es importante estar alerta de esta entidad hasta ahora poco frecuente.

Objective: This study examines the association between major urban pollutants and the long-term decline of non-idiopathic pulmonary fibrosis interstitial lung disease [non-IPF ILD]. Materials and methods: A total of 41 patients with non-IPF ILD were analyzed from 2011 to 2020, correlating disease long-term decline with concentrations of key pollutants [SO2, CO, NO2, O3, PM2.5, and PM10] in Madrid. The likelihood of meeting severity criteria was assessed using a generalized linear model, considering the average pollutant levels during severe episodes. Results: At diagnosis, the average age of patients was 62.95 ± 13.13 years, with 47.6% women. The study found no significant association between pollution levels and the probability of meeting severity criteria for non-IPF ILD. The odds ratios were as follows: OR SO2 = 0.92 [0.82–1.03], p = 0.16; OR CO = 0.99 [0.97–1.05], p = 0.70; OR NO2 = 0.97 [0.92–1.03], p = 0.38; OR PM2.5 = 0.79 [0.54–1.17], p = 0.24; OR PM10 = 1.1 [0.94–1.28], p = 0.21; OR O3 = 0.97 [0.92–1.01], p = 0.20. Conclusions: Our study suggests that, within the cohort of 41 patients with non-IPF ILD enrolled in this study, urban air pollutants in Madrid are not significantly linked to increased long-term decline of non-IPF ILD. This is one of the first studies to explore the impact of various urban pollutants on a diverse cohort of non-IPF ILD patients, including rare conditions like LAM and histiocytosis X. Further research with larger sample sizes and comprehensive exposure assessments is recommended.