Médecine pulmonaire et respiratoire

Background: Although inhaled corticosteroids and long-acting β2-agonists are well-established as the cornerstone of asthma treatment, patient adherence has been consistently shown to be suboptimal. In fact, non-adherence has a negative impact on asthma control, patient quality of life and therapy cost effectiveness. Non-adherence to prescribed treatments appears to be a mostly predominant phenomenon in the asthma population, sensibly limiting patients’ quality of life, and negatively impacting on the overall sustainability of healthcare systems. Electronic devices can reasonably improve patient’s adherence to treatments by providing regular reminders and motivational messages. Moreover, they can collect real-life data on drug usage to retrieve possible patterns associated with increased compliance.

Objective: The Turbu+TM program aims at collecting daily real-life data of drug usage inhaled doses to estimate treatment adherence to Symbicort® (budesonide, formoterol) Turbuhaler®. Additionally, the program can serve to identify possible patterns of medication usage.

Methods: A total of 497 asthma patients were included in the analysis. Patients were prescribed Symbicort® maintenance therapy or Symbicort® Maintenance and on-demand Anti- inflammatory Reliever Therapy (referred as SMART approach). Treatment adherence was measured every 30 days and calculated over a 360 days follow-up window of time since the recruitment of the patient in the program.

Results: The average medication adherence with the use of Turbu+TM e-device was assessed as 65.9% over the entire follow-up time. Adherence was significantly increased when Symbicort® was associated with prescribed as on-demand Anti-inflammatory Reliever Therapy (SMART approach).

Conclusion: Our evaluation these observations may highlight an overall incrementation of asthma treatment adherence with the utilization of the Turbu+TM e-device as compared with literature. Asthma patients appear to be more compliant with SMART approaches, reflecting a likely improved control over different types of symptoms compared to other therapeutic options.

Acute Respiratory Distress Syndrome (ARDS) is one of the common clinical manifestation of severe COVID-19 and it is also responsible for the high ventilators demand in worldwide. Our study aims to assess the risk factors predicting mortality in patients with ARDS developing as complication of severe COVID -19. We collected clinical data of 289 COVID- 19 related to ARDS patients from 4 hospitals in Baku city, Azerbaijan. The clinical characteristics of the survivors ARDS group and non-survivors ARDS group of COVID-19 patients were clinically, laboratory and radiographically compared.

Results indicated that the median age of non-survivors ARDS patients was 68.4 years old, which was significantly older than those with survivors ARDS by 9,9 years. Male and patients with BMI>30 were more likely to die from ARDS. The prevalence of consolidation (Consolidation\ground glass opacities ratio>1) in lung, secondary bacterial infection, mechanical ventilation and pack of use dexamethasone before intubation were common among non-survivors ARDS.

Carlson index was higher in non-survivors ARDS patients (p=0.001). Among laboratory values most important risk factors predicting death of patients with ARDS were: D-dimer (p=0.0001), creatinine (p<0.009), lymphocytes can’t <0.6 × 10⁹ (p ≤ 0.045), procalcitonin (p<0.01), and brain natriuretic peptide (p<0.0001). SOFA score at the time of admission was higher in non survivors ARDS patients (p<0.05). Partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) at the time of admission also was significantly lower compared to survivors ARDS patients (p<0.05) and arterial blood gas analysis values were significantly differ: partial pressure of carbon dioxide (PaCO₂) was markedly higher (p=0.023), PaO₂ was lower (p=0.026) and acidity of the blood pH was also lower (p=0.02).

We identified predictors of mortality in patients with ARDS related to severe COVID-19. These findings may be helpful for healthcare providers take appropriate measures and impact to clinical outcomes in patients with severe COVID-19 complicated with ARDS.