This document constitutes a summary of the Clinical Practice Guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select 6 clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established: 1) We do not recommend the use of an ICS plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-IL-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL−1 for mepolizumab and above 400 cells·µL−1 for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL−1). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.

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Objetivo: Evaluar la prevalencia de riesgo de asma en adolescentes expuestos a ceniza volcánica a un año de la erupción del Volcán Calbuco, en 2 ciudades con diferentes grado de afectación. Métodologia: Estudio de Corte Transversal, en adolescentes de 13-14 años en dos ciudades con diferente grado de exposición a ceniza volcánica: San Carlos de Bariloche y Cipolletti. Se aplicó cuestionario y video-cuestionario ISAAC para determinar riesgo de asma. Las variables demográficas y percepción de exposición, se obtuvieron por cuestionario previo a la aplicación de metodología ISAAC. Resultados: Se encuestaron 511 sujetos en total. Se reportó prevalencia de síntomas de riesgo de asma en Bariloche resultó de 14% comparado con Cipolletti que reportó 10% (p=0.32). Se informó mayor exposición a ceniza volcánica en la ciudad de Bariloche vs. Cipolletti; 14% y 6% respectivamente con p<0.05. Conclusiones:La falta diferencia estadisticamente significativa respecto a la prevalencia de sintomas de riesgo de asma entre ambas poblaciones con diferente nivel de exposición y tras 18 meses de la erupción volcánica mas exposición respiratoria a ceniza volcánica, pareciera no presentar impacto clínico en la salud respiratoria.

Objective: To evaluate COVID-19 knowledge, attitudes, and practices among health care workers (HCWs) practicing in Latin American countries during the first surge of the COVID-19 pandemic. Methods: This was a multinational cross-sectional survey study, using an online self-administered questionnaire. The final version of the questionnaire comprised 40 questions, organized in five sections: demographic and professional characteristics; COVID-19 knowledge; attitudes toward COVID-19; COVID-19 practices; and institutional resources. Results: The study involved 251 HCWs from 19 Latin American countries who agreed to participate. In our sample, 77% of HCWs participated in some sort of institutional training on COVID-19, and 43% had a low COVID-19 knowledge score. COVID-19 knowledge was associated with the type of health center (public/private), availability of institutional training, and sources of information about COVID-19. Concerns about not providing adequate care were reported by 60% of the participants. The most commonly used ventilatory strategies were protective mechanical ventilation, alveolar recruitment maneuvers, and prone positioning, and the use of drugs to treat COVID-19 was mainly based on institutional protocols. Conclusions: In this multinational study in Latin America, almost half of HCWs had a low COVID-19 knowledge score, and the level of knowledge was associated with the type of institution, participation in institutional training, and information sources. HCWs considered that COVID-19 was very relevant, and more than half were concerned about not providing adequate care to patients.

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PurposeAsthma is a highly prevalent noncommunicable lung disease. The aim of this study was to evaluate the longitudinal association of obesity/adiposity with wheezing and atopy.MethodsThe population of the study was composed of participants from the 1993 Pelotas (Brazil) Birth Cohort. The following outcome variables were measured at 22 years: wheezing in the last 12 months, wheezing with atopy, wheezing without atopy, only atopy, and persistent wheezing at 18 and 22 years. Exposure variables were obesity body mass index, percent fat mass (FM), and fat mass index, which were obtained by precise methods (BOD POD and dual-energy X-ray absorptiometry [DXA]). Crude and adjusted logistic and multinomial logistic regressions were used in the analyses.ResultsThe prevalence of wheezing (with and without atopy), wheezing without atopy, only atopy, and persistent wheezing were 10.6%, 3.9%, 30.9%, and 4.0%, respectively. To be obese or to belong to the highest tertile of obesity/adiposity at two follow-ups showed a cumulative and positive association with wheezing in the adjusted analysis; for atopy there was no significant association. The odds ratio (OR) for wheezing according to the percentage of total FM measured by DXA in the highest tertile at both follow-ups was 1.58 (95% CI: 1.14–2.20) against an OR of 1.16 (95% CI: 0.92–1.47) for atopy. Persistent wheezing was also associated with adiposity, but without statistical significance.ConclusionsWe found a positive longitudinal association between several measures of adiposity and wheezing at 22 years old. The effect was higher for cumulative adiposity; the results for atopy were not consistent.

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