Background: Adherence to therapy in bronchial asthma is essential for the control of the disease. Several studies show that non -adherence seems to be the result of different factors and barriers associated with the patient, but also with the prescriber. The most important are the psychological, economic and social aspects. In clinical practice, there are few resources that allow the physician to objectify the degree of compliance of his prescription. The aim of this study was to analyze the degree of adherence to therapy in asthmatic patients followed in a Hospital Immunoallergology Department. Methods:The clinical trials of 63 asthmatic patients followed at the Immunoallergology Department from January to December of 2016 (T0) and from January to December of 2017 (T1) were retrospectively studied. The number of packs prescribed to the patients by the attending physician and the number of packs actually purchased in pharmacies were analyzed in T0 and T1 by means of Electronic Medicines Prescriptions (PEM) records for the following drugs: bronchodilators (BD), inhaled corticosteroids isolated or in combination with bronchodilators (OUT), oral antihistamines (AH), leukotriene antagonists (LCRA), nasal corticosteroids (CN) and oral corticosteroids (CO). The following demographic and clinical variables were analyzed: age, sex, clinical diagnosis, atopy, allergen sensitization and specific immunotherapy treatment (ITE). Results:We found a compliance of 64.76% to the prescription. The drugs which the patients most adhere were oral corticosteroids (73%), followed by leukotriene antagonists and antihistamines (70%). When analysing associations between variables, it was observed that patients who were not under ITE had greater adhesion to the inhalers (BD and CI) (p <0.05). The asthmatic group had a positive association with adherence to the LCRA (p <0.05) and in the analysis by age, we found that the infant population had a positive association with adherence to AH (p <0.05). Conclusions: To improve adherence to therapy in asthma, it is important to address and know patient's compliance. The study of each patient's adherence based on computerized drug prescription and retrieval systems in pharmacies allows prescribing physicians to introduce this variable into the analysis of asthma control.

Cutaneous delayed reactions to antihypertensive drugs have been described in a limited number of case reports but the mechanisms remain mostly unknown. We report the case of a 60-year-old female patient with a 3-week history of an itchy erythematous maculopapular eruption. Although the patient was polymedicated, irbesartan was the most likely culprit. Patch tests and a lymphocyte transformation test to irbesartan were both positive, which was useful for diagnosis and suggested an immunological reaction. No new lesions appeared after irbesartan was stopped or after the introduction of candesartan. Despite its similar chemical structure, candesartan may be tried in patients allergic to irbesartan. LEARNING POINTS Irbesartan can induce immunological cell-mediated skin reactions. Allergy to irbesartan does not imply a class allergy. Patch tests and a lymphocyte transformation test were useful in the diagnosis of irbesartan allergy.

Introduction: The impact of air pollution on respiratory diseases, particularly in asthma, has been the subject of several studies. The impact of pollution on the daily symptoms of patients with asthma has been less studied. The aim of this study is to assess the association between the intensity of asthma symptoms and the variation of pollution levels.Material and Methods: Patients with a diagnosis of asthma were instructed to record the intensity of their respiratory symptoms daily, expressed on a scale from 0 to 5, in the months of March and April 2018. The website of the Portuguese Environment Agency was consulted in order to obtain the daily levels of pollutants measured by the two local monitoring stations during the same period of time. Data was analyzed using a temporal causal model to study the association between pollutant levels – particulate matter, ozone, nitrogen dioxide and carbon monoxide – and the intensity of respiratory symptoms.Results: From the 135 schedules delivered, 35 were correctly filled out and returned. The patient median age was 47.0 years, 18 being females. The best statistical model obtained identified ozone as the most relevant ‘Granger cause’ of asthma symptoms. Particulate matter, carbon monoxide and nitrogen also appeared as lower impact factors. The quality of the model was expressed by an R2 of 0.92. The correlation between ozone values and asthma symptoms was more significant after five days. For the other identified factors there was a lag of four to five days.Discussion: Our results support the existence of a daily variation of asthma symptoms that is associated with the pollution levels, even if these are within acceptable limits according to national and international standards. Regretfully, the small number of participants was a limitation in term of the conclusions that could be drawn and did not allow the analysis of clinical or other factors that are potentially involved.Conclusion: In the place and period studied the air pollutants behaved as factors of variation in the intensity of asthma symptoms. The ozone level was the best predictive factor of symptom variation. Levels of particulate matter, carbon monoxide and nitrogen were identified as secondary markers. The time lag between the variables with the best correlation suggests there could be a delayed effect of pollutants on respiratory symptoms.

No abstract

N/a.