Browsing by Author "Mendes, Ana"
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- The effects of benralizumab on lung volumes and airway resistance in severe eosinophilic asthma: a real-world studyPublication . Gerardo, António Madeira; Alves, Carolina da Silva; Gomes, Margarida; Pardal, Cecília; Sokolova, Anna; Liberato, Hedi; Mendes, Ana; Tonin, Fernanda; Duarte-Ramos, Filipa; Lopes, CarlosIntroduction: Add-on biological monoclonal antibodies such as benralizumab (anti-IL-5Ra) are recommended by international guidelines to reduce exacerbations in severe eosinophilic asthma (SEA). However, few studies have assessed the impact of these therapies on lung function-related outcomes. Our goal was to evaluate the effectiveness of benralizumab on lung function, including lung volumes and airway resistance, in SEA patients in Portugal. Methods: This was a real-world, observational, prospective, multicentric study including adult patients diagnosed with SEA (January-June 2023). Spirometry and plethysmography were performed at baseline (T0) and after six months of treatment (T6) with benralizumab to assess: total lung capacity (TLC), residual volume (RV), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), mean forced expiratory flow between 25% and 75% of FVC (mFEF-25/75), intrathoracic gas volume (ITGV), and respiratory airway resistance (Raw). Descriptive statistics (with categorical variables described as frequencies and continuous values as mean and standard deviation (SD)) and paired t-test and Cohen's d effect size were calculated (analyses performed in StataCorp v.15.1; StataCorp LLC, TX, USA). Results: Overall, 30 SEA patients were evaluated, mostly women (n=18, 60.0%), with atopy (n=22, 73.3%), a mean age of 58.4 years (SD 11.7), and assisted by pulmonology (n=19, 63.3%) or immunology-allergology (n=11, 36.7%) services. Mean eosinophilia at baseline was 1103.57 cells/mcL (SD 604.88; minimum-maximum 460-2400); after the use of benralizumab, the count dropped to zero. After six months of treatment, a significant increase (p<0.0001) in FVC (15.3%), FEV1 (22.6%), and mFEF-25/75 (17.7%) were observed from baseline (Cohen's d between 0.78 and 1.11). ITGV, RV, RV/TLC, and Raw significantly decreased (p<0.0001) during the study period (-17.3%, -29.7%, -8.9%, and -100.6%, respectively) (Cohen's d between -0.79 and -1.06). No differences in TLC were obtained (p=0.173). No differences between sexes were observed for any measure. Patients with more significant eosinophilia (>900 cells/mcL count; n=15) presented better responses in FEV1 (p=0.001) and mFEF-25/75 (p=0.007). Conclusions: A notable eosinophil depletion with add-on benralizumab led to significant improvements in SEA patients' respiratory function (static lung volumes and airway resistance) in real-world settings after six months. The significant deflating effect of benralizumab on patients' hyperinflated lungs led to enhanced expiratory flow (increased FEV1 and mFEF-25/75) and air trapping (decreased RV/TLC), suggesting this antibody improves bronchial obstruction, lung hyperinflation, and airway resistance. Further studies in a larger population are required to confirm these findings.
- The impact of indoor air quality on respiratory health of older people living in nursing homes: spirometric and exhaled breath condensate assessmentsPublication . Belo, Joana; Carreiro-Martins, Pedro; Papoila, Ana L.; Palmeiro, Teresa; Caires, Iolanda; Alves, Marta; Nogueira, Susana; Aguiar, Fátima; Mendes, Ana; Cano, Manuela; Botelho, Maria A.; Neuparth, NunoIn the Portuguese Geriatric Study of the Health Effects of Indoor Air Quality in Senior Nursing Homes, we aimed to evaluate the impact of indoor air contaminants on the respiratory symptoms and biomarkers in a sample of elderly living in nursing homes. A total of 269 elderly answered a health questionnaire, performed spirometry and 150 out of these collected an exhaled breath condensate sample for pH and nitrites analysis. The study included the evaluation of indoor chemical and microbiological contaminants. The median age of the participants was 84 (78-87) years and 70.6% were women. The spirometric data indicated the presence of airway obstruction in 14.5% of the sample. Median concentrations of air pollutants did not exceed the existing standards, although increased peak values were observed. In the multivariable analysis, each increment of 100 µg/m3 of total volatile organic compounds was associated with the odds of respiratory infection in the previous three months ( OR̂ =1.05; 95% CI: 1.00-1.09). PM2.5 concentrations were inversely associated with pH values ( β̂ = -0.04, 95%: -0.06 to -0.01, for each increment of 10 µg/m3). Additionally, a direct and inverse association were found between total bacteria and FEV1/FVC and FVC, respectively.
- The impact of indoor air quality on respiratory health of older people: spirometric and exhaled breath condensate assessmentsPublication . Belo, Joana; Carreiro-Martins, Pedro; Papoila, Ana L.; Palmeiro, Teresa; Caires, Iolanda; Alves, Marta; Nogueira, Susana; Aguiar, Fátima; Mendes, Ana; Cano, Manuela; Botelho, Maria A.; Neuparth, NunoIn general, seven million deads are dur to the indoor and outdoor environment exposure. The elderly are identified as the one of the principal risk groups: the progressive decline of biological functions; cumulative environmental exposure; 90% of the time is in indoor spaces. The main goal of this study was to describe the impact of environmental exposure from the point of view of IAQ in respiratory health in a sample of elderly people living in nursing homes. The elderly were evaluated through spirometry and exhaled breath condensate (EBC).
- The role of benralizumab in eosinophilic immune dysfunctions: a case report-based literature reviewPublication . Gomes, Margarida; Mendes, Ana; Ferreira, Filipa; Branco, Joana; Tonin, Fernanda; Pedro, M. ElisaIn the past years, the knowledge of eosinophils playing a primary pathophysiologic role in several associated conditions has led to the development of biologics targeting therapies aiming at normalizing the immune response, reducing chronic inflammation, and preventing tissue damage. To better illustrate the potential relationship between different eosinophilic immune dysfunctions and the effects of biological therapies in this scenario, here, we present a case of a 63-year-old male first referred to our department in 2018 with a diagnosis of asthma, polyposis, and rhinosinusitis and presenting a suspicion of nonsteroidal anti-inflammatory drugs' allergy. He also had a past medical history of eosinophilic gastroenteritis/duodenitis (eosinophilia counts >50 cells/high-power field HPF). The use of multiple courses of corticosteroid therapy failed to completely control these conditions. In October 2019, after starting benralizumab (an antibody directed against the alpha chain of the IL-5 cytokine receptor) as an add-on treatment for severe eosinophilic asthma, important clinical improvements were reported both in the respiratory (no asthma exacerbations) and gastrointestinal systems (eosinophilia count 0 cells/HPF). The patient's quality of life also increased. Since June 2020, systemic corticosteroid therapy was reduced without worsening gastrointestinal symptoms or eosinophilic inflammation. This case warns of the importance of early recognition and appropriate individualized treatment of eosinophilic immune dysfunctions and suggests the conduction of further larger studies on the use of benralizumab in gastrointestinal syndromes aiming at better understanding its relying mechanisms of action in the intestinal mucosa.