Luís Taborda-Barata

Background: The evolution of mite sensitization profiles from childhood to adulthood is associated with distinct clinical outcomes. Longitudinal sensitization trajectories have never been addressed across two generations over an extended time frame. Using molecular diagnosis, we aimed to investigate how the evolution of mite sensitization relates to the expression of rhinitis and asthma in adult versus pediatric patients over a 20‐year period. Methods: Specific IgE (sIgE) to mite molecular allergens was determined using the MeDALL allergen chip (Der p 1, 2, 4, 5, 7, 10, 11, 14, 15, 37, 18, 21 and 23; Der f 1, Der f 2, Lep d 2, Blot t 5). Assessment was made in adult ( n = 21), adolescent ( n = 11), and pediatric patients ( n = 19) with rhinitis and/or asthma, in T1 (20‐years ago) and in T2 (current time). Results: After the 20‐year period, the adult cohort significantly decreased the number of sIgE responses to mite components—T1: 7 [3–9] versus T2: 4 [2–6], median [IQR], p = .0040. A strong negative correlation was observed between age and the 20‐year variation of sensitization count ( r = −0.5305; p < .0001). In adults, the reduction in mite molecular IgE responses was associated with improvement in rhinitis ( p = .0010) and asthma ( p = .0020), reflecting disease progression patterns not observed in the pediatric cohort. Conclusions: This is the first analysis to show that molecular mite sensitization declines with aging, and this reduction may relate to decreased asthma and rhinitis symptoms and severity. This age‐associated decline highlights the importance of careful clinical interpretation in older adults to avoid overtreatment and missed diagnoses.

Background: The evolution of mite sensitisation profiles from childhood to adulthood is associated with distinct clinical outcomes. Longitudinal sensitisation trajectories have never been addressed across two generations over an extended time frame. Using molecular diagnosis, we aimed to investigate how the evolution of mite sensitisation relates to the expression of rhinitis and asthma in adult versus paediatric patients over a 20-year period. Methods: Specific IgE (sIgE) to mite molecular allergens was determined using MeDALL allergen chip (Der p 1, 2, 4, 5, 7, 10, 11, 14, 15, clone 16, 18, 21 and 23; Der f 1, Der f 2, Lep d 2, Blot t 5). Assessment was made in adult (n=21), adolescent (n=11) and paediatric patients (n=19) with rhinitis and/or asthma, in T1 (20-years-ago) and in T2 (current time). Results: After the 20-year-period, the adult cohort significantly decreased the number of sIgE responses to mite components - T1: 7 [3-9] versus T2: 4 [2-6], median [IQR], p=0.0040. A strong negative correlation was observed between age and the 20-year variation of sensitisation count (r = - 0.5305; p<0.0001). In adults, the reduction in mite molecular IgE responses was associated with improvement in rhinitis (p=0.0010) and asthma (p=0.0020), reflecting disease progression patterns not observed in the paediatric cohort. Conclusions: This is the first analysis to show that molecular mite sensitisation declines with ageing, and this reduction may relate to decreased asthma and rhinitis symptoms and severity. This age-associated decline highlights the importance of careful clinical interpretation in older adults to avoid overtreatment and missed diagnoses.

Background: The evolution of mite sensitisation profiles from childhood to adulthood is associated with distinct clinical outcomes. Longitudinal sensitisation trajectories have never been addressed across two generations over an extended time frame. Using molecular diagnosis, we aimed to investigate how the evolution of mite sensitisation relates to the expression of rhinitis and asthma in adult versus paediatric patients over a 20-year period. Methods: Specific IgE (sIgE) to mite molecular allergens was determined using MeDALL allergen chip (Der p 1, 2, 4, 5, 7, 10, 11, 14, 15, clone 16, 18, 21 and 23; Der f 1, Der f 2, Lep d 2, Blot t 5). Assessment was made in adult (n=21), adolescent (n=11) and paediatric patients (n=19) with rhinitis and/or asthma, in T1 (20-years-ago) and in T2 (current time). Results: After the 20-year-period, the adult cohort significantly decreased the number of sIgE responses to mite components - T1: 7 [3-9] versus T2: 4 [2-6], median [IQR], p=0.0040. A strong negative correlation was observed between age and the 20-year variation of sensitisation count (r = - 0.5305; pConclusions: This is the first analysis to show that molecular mite sensitisation declines with ageing, and this reduction may relate to decreased asthma and rhinitis symptoms and severity. This age-associated decline highlights the importance of careful clinical interpretation in older adults to avoid overtreatment and missed diagnoses.

Background: Validated questionnaires for adequately assessing knowledge about asthma are scarce. Thus, the primary objective of the present study was to develop and validate an asthma self-knowledge questionnaire, based on international recommendations on the disease. The secondary objectives were to compare knowledge about asthma between asthmatic patients and non-asthmatic individuals; assessing whether asthma affects the level of self-knowledge of the disease and what factors may be associated with poorer self-knowledge of the disease. Methods: The Bronchial Asthma Self-Knowledge Questionnaire was developed, and validation studies were performed: logical or apparent validity, content validity, construct validity; internal consistency (Cronbach’s alpha test), test-retest or reproducibility, in a face-to-face survey with 104 asthmatic patients and 131 non-asthmatic individuals (n = 235). Other questionnaires were also applied: Mini Mental State Examination (in individuals over 65 years of age), Depression Scales (CES-D for individuals under 65 and GDS for individuals over 65 years of age), Demographic Questionnaire, Health Literacy, and the Characterization Questionnaire for bronchial asthma. Results: Regarding development of the questionnaire, content validity, determined using I-CVI allowed reducing the questionnaire to 21 items. The test proved to have an acceptable value of in-ternal consistency and the data were considered as normally distributed; the questionnaire presented good temporal stability, by test-retest, although Spearman rho values were significantly stronger in the asthmatic group. Finally, confirmatory factorial analysis yielded acceptable values for PCFI and PGFI, as well as a satisfactory value for RMSEA. In terms of the application of the questionnaire, both groups under study (asthmatics and non-asthmatics) showed statistically significant differences in replies of self-knowledge questionnaire items. Finally, factors such as health literacy disturbances seem to marginally influence self-knowledge of bronchial asthma. Conclusions: The developed and validated questionnaire showed adequate psychometric robustness. In terms of construct validity, by known group (bronchial asthma) validity, the test was able to discriminate between patients with asthma and participants without asthma, regarding self-knowledge of the disease.

Objectives: The advent of massively parallel next-generation sequencing (MP-NGS) offers potential advantages over sequential molecular profiling (SMP) in the management of non-small cell lung cancer (NSCLC). This study compares the two methodologies using samples obtained through endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), focusing on actionable mutation detection, turnaround time (TAT), and clinical outcomes. Methods: A retrospective analysis was conducted on NSCLC patients who underwent EBUS-TBNA and molecular characterization between January 2020 and December 2023. SMP and MP-NGS were compared in terms of actionable mutation detection rates, TAT, and impact on overall survival (OS). Results: Among 106 patients, MP-NGS demonstrated a significantly higher detection rate of actionable mutations compared to SMP (40.9% vs. 22.2%, p=0.042). The median TAT was slightly shorter with SMP than with externally outsourced MP-NGS (17 days vs. 23 days, p=0.076). Patients diagnosed via MP-NGS were more frequently allocated to targeted therapies (44.26% vs. 22.2%, p=0.038), which may have positively influenced overall survival (672 days vs. 138 days, p=0.053). Conclusion: MP-NGS provided superior diagnostic and clinical advantages over SMP in NSCLC, supporting its adoption as a standard diagnostic approach to enhance personalized therapy and improve patient outcomes.

ObjectivesAtopic/allergic diseases impose a growing burden on public health, affecting millions of patients worldwide. The main objective of this study was to develop a national expert consensus on relevant clinical questions related to type 2 inflammation.MethodsWe conducted: a comprehensive literature review with a qualitative analysis to identify the most repeated themes on the overlap of conditions; a modified 3-round Web-Delphi (or e-Delphi); and a final online decision conference.ResultsWe included 51 studies. Following three Web-Delphi rounds, we ended up with 30 statements with a 76% overall full agreement rate, 16% agreement, 2% disagreement, and 0% full disagreement. The decision conference enabled adjustments, and the expert panel agreed unanimously on the final set of statements. The consensus used evidence synthesis, Web-Delphi, and decision conference to produce 30 statements on type 2 inflammation as a driver for multimorbidity in asthma, certain rhinitis phenotypes, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis grouped under five domains in underlying pathophysiology, multimorbidity, diagnosis and management, multidisciplinary management, and impact on mental health.ConclusionWe expect the first Portuguese expert consensus INFLAT2-PT to promote understanding of type 2 inflammation diseases, multidisciplinary care, integrated care pathways, future research, and inform health authorities.

Air pollution is a major global environment and health concern. Recent studies have suggested an association between air pollution and COVID-19 mortality and morbidity. In this context, a close association between increased levels of air pollutants such as particulate matter ≤2.5 to 10 µM, ozone and nitrogen dioxide and SARS-CoV-2 infection, hospital admissions and mortality due to COVID 19 has been reported. Air pollutants can make individuals more susceptible to SARS-CoV-2 infection by inducing the expression of proteins such as angiotensin converting enzyme (ACE)2 and transmembrane protease, serine 2 (TMPRSS2) that are required for viral entry into the host cell, while causing impairment in the host defence system by damaging the epithelial barrier, muco-ciliary clearance, inhibiting the antiviral response and causing immune dysregulation. The aim of this review is to report the epidemiological evidence on impact of air pollutants on COVID 19 in an up-to-date manner, as well as to provide insights on in vivo and in vitro mechanisms.

To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population. Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances. Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.