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This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia). © 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified. publishersversion published

Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p

Background: Early (EOA) and late-onset asthma (LOA) are widely used as phenotypic classifications. Several clusters have been described. This study’s goal is to compare major aspects of these two phenotypes. Methods: A retrospective study of adult patients with asthma diagnosis observed in our Asthma clinic between 2012 and 2016. Patients were divided into EOA (onset 18 years old) groups and their data was statistically analysed. Results: 606 patients were included, 351 had EOA and 233 LOA. In the EOA group, 71.2% were women (N=250), 47.3% (N=116) had smoking history and 27.1% (N=95) were obese. Rhinitis was found in 298 patients (84.9%), gastroesophageal reflux disease (GERD) in 71 (20.2%), anxiety or depression in 30 (8.5%), cardiac disease in 29 (8.2%). Atopy was found in 50.1% (N=176) of patients in which tests were performed. Mean FEV1 was 81.4% (sd 20.2). Mean exacerbation number during follow up period was 1.1 (sd 2.0). In the LOA group, 70.8% (N=165) were women, 33.9% (N=79) had smoking history and 31.3% (N=73) were obese. Rhinitis was found in 197 patients (84.5%), followed by GERD in 82 (35.1%), anxiety or depression in 35 (15.0%), cardiac disease in 30 (12.8%). Atopy was found in 45.5% (N=106) of cases in which tests were made. Mean FEV1 was 86.7% (sd 20.6). Mean exacerbation number during follow up period was 0.9 (sd 1.6). Statistically significant differences regarding atopy (p-value Conclusion: Patients with EOA had more atopy and more severe airway obstruction. Although they exacerbated more often, this was not statistically significant. The lack of other statistically significant differences may be due to small sample size.

Introduction: An increased risk for lung cancer (LC) in interstitial lung disease (ILD) patients, mostly idiopathic pulmonary fibrosis, has been described. Data regarding LC development and clinical features in connective tissue disease (CTD)-related ILD are scarce. Objective: Access the incidence of LC in CTD-ILD patients and its clinical significance. Methods: Patients observed in our ILD clinic between 2012 and 2017 were reviewed. Those with CTD-ILD were selected and characterized regarding demographics, smoking habits, functional and radiologic findings and LC histology, stage and treatment. Results: Among 223 ILD patients, 8.5% (n=19) had CTD-ILD. 63% were female. Mean age at diagnosis was 69.3±11.8 years. 58% were never smokers, 32% previous and 10% current smokers. 42% had rheumatoid arthritis (RA), 16% sjogren syndrome (SjS), 10.5% systemic sclerosis, 10.5% dermatomyositis, 10.5% antisynthetase syndrome and 10.5% systemic lupus erythematosus. Mean follow up since ILD diagnosis was 35.7±23.8 months. During this period, LC incidence was 10.5% (n=2). Both patients were male, above 65 years and former smokers. One had RA-related UIP with GAP index 3 and was on prednisolone. He was diagnosed with squamous cell carcinoma (SCC) stage IB and treated with stereotactic body radiation therapy. 16 months later, disease progressed and he died in 1 month (21.6 months after LC diagnosis). The other was diagnosed with SjS-related NSIP (GAP index 2) and SCC stage IIIB, began chemotherapy and died in 1 month. Both deaths were cancer related. Conclusion: LC in CTD-ILD patients is an important comorbidity with an incidence of 10.5% in our population. ILD limited LC treatment and LC adversely affected overall survival.

Introduction: Obstructive sleep apnea (OSA) is characterized by excessive narrowing or complete obstruction of supraglottic airway during sleep. Variations in subglottic airway function may also influence supraglottic airway. Previous studies have suggested a protective role of increased air trapping in OSA severity but data are limited. Objective: To determine whether there is a relationship between pulmonary function and OSA severity. Methods: A retrospective analysis of patients who performed a cardiorespiratory polygraphy (CRP) in our hospital in 2015 and 2016 was conducted. Adults diagnosed with OSA who performed pulmonary function tests (PFT) were selected and characterized regarding demographics and pulmonary function. Results: 834 CRP were performed and 374 patients were included with a mean age of 61.7±13.3 years. 61% were male. Mean BMI was 34±6.9 kg/m2. OSA was mild (apnea–hypopnea index [AHI] 5-15) in 42%, severe (AHI > 30) in 35% and moderate (AHI 15-30) in 23%. PFT demonstrated an obstructive pattern in 18.2%, restrictive in 11.8%, nonspecific in 5% and were normal in 65%. Mean FEV1 was 88.1±21.7% of predicted and mean RV was 116.2±27.8% of predicted. FEV1 was negatively correlated with AHI. FEV1 30. FEV1 30. RV > 180% of predicted had an odds ratio of 0.3 for AHI > 15. Conclusion: In our population, a decrease in FEV1 (even among normal values) was associated with an increased risk of severe OSA but this was not true for FEV1 180% of predicted. This points to a possible protective role of air trapping in OSA severity.

Introduction: Lisbon has an intermediate incidence of tuberculosis (TB). Flexible bronchoscopy can assist in diagnosing TB in patients with a negative smear microscopy. Earlier diagnosis by means of faster laboratory tests such as nucleic acid amplification tests (NAAT) is essential in controlling disease transmission. Objectives: Analyze the yield of bronchoscopy in diagnosing pulmonary TB and compare smear microscopy, culture and NAAT using GenoType MTBDRplus ver2.0. Methods: A retrospective analysis of TB patients hospitalized in the Infectious Disease’s ward between January 2013 and April 2016 was performed. Patients subjected to flexible bronchoscopy were selected and characterized regarding demographics and microbiological exams. Results: Fifty-eight patients were included with a mean age of 44±19 years and 71% were males. Diagnosis was confirmed by bronchoscopy in 41 (71%). Smear microscopy sensitivity was similar in bronchial wash (BW) and bronchoalveolar lavage (BAL): 39% vs 31%, p value 0.43. Culture sensitivity was also similar in BW and BAL: 70% vs 62%, p value 0.42. Culture sensitivity was superior to smear microscopy in both BW and BAL (BW: 70% vs 39%, p value Conclusion: Bronchoscopy led to diagnosis confirmation in 71% proving its importance in diagnosing pulmonary TB. NAAT sensitivity was similar to culture. NAAT is a faster diagnostic test allowing earlier treatment initiation and contributing to better control disease transmission.

The association between interstitial lung diseases (ILD) and lung cancer (LC) has long been discussed. To better understand this association, we reviewed clinical data of patients with both diagnoses at our institution. In 125 patients diagnosed with ILD (2014-2015), 4 were diagnosed with LC during the follow-up (incidence 3,2%). These were characterized regarding to demographics, smoking habits, environmental exposure, functional and radiologic findings, LC histology and stage, and treatment. All patients were male, smokers and between 61 and 76 years. The ILDs identified were usual interstitial pneumonia associated with connective tissue disease, interstitial pneumonia with autoimmune features and unclassifiable idiopathic interstitial pneumonia in two patients. Three were diagnosed with squamous cell carcinoma (SCC) and one with small cell lung carcinoma (SCLC). SCLC was diagnosed in stage IV and SCC were diagnosed in stage IA, IB and IIIB. A surgical approach was chosen in stage IA and IB SCCs, however one was treated with stereotactic body radiation therapy (poor lung function). ILD also interfered with LC therapy and vice versa in stage IIIB SCC patient, in whom a palliative instead of a curative approach was chosen. This patient died one month after the LC diagnosis. The SCLC stage IV patient is on second-line chemotherapy and the other 2 patients are on follow-up. LC in ILD patients is an important comorbidity with an incidence of 3,2%. Maybe due to CT follow-up performed in ILD, LC was diagnosed in earlier stages, permitting a curative approach in 2 patients. LC and ILD limited each other treatment in 2 patients. This association needs to be investigated in large-scale studies in order to better understand and treat these patients.