Rodrigo Abensur Athanazio

Scopus Publications

Healthcare worker views on antimicrobial resistance in chronic respiratory disease
Sachin Ananth, Adekunle O. Adeoti, Animesh Ray, Peter G. Middleton, Miquel Ekkelenkamp, Stephanie Thee, Anand Shah, , Abayomi Fadeyi, Abdoul Risgou Ouedraogo,et al.
Springer Science and Business Media LLC
Abstract Background and objective Antimicrobial resistance (AMR) is a global crisis, however, relatively little is known regarding its impact in chronic respiratory disease and the specific challenges faced by healthcare workers across the world in this field. We aimed to assess global healthcare worker views on the challenges they face regarding AMR in chronic respiratory disease. Methods An online survey was sent to healthcare workers globally working in chronic respiratory disease through a European Respiratory Society clinical research collaboration (AMR-Lung) focussed on AMR in chronic lung disease. Responses from different geographic regions were analysed. Results 279 responses were received across 60 countries. 54.5% of respondents encountered AMR in chronic respiratory disease weekly. There were differences in perceived high-priority diseases and species with AMR burden between Europe, Asia and Africa. 76.4% of respondents thought that inappropriate antimicrobial prescribing in chronic respiratory disease was common. However, only 43.4% of respondents thought that there were adequate antimicrobial stewardship programmes in their area for chronic respiratory disease, with limited availability in outpatient (29.0%) and ambulatory settings (24.7%). Developing rapid diagnostics for antimicrobial susceptibility (59.5%) was perceived to be the most common challenge in implementing antimicrobial stewardship, with an improved understanding of regional epidemiology of AMR strains the most important factor to improve outcome (55.2%). Conclusions AMR has significant perceived burden in chronic respiratory disease by healthcare professionals globally. However, current implementation of antimicrobial stewardship is limited, with significant challenges related to the availability of rapid diagnostics and understanding of regional epidemiology of AMR strains.

Regional challenges to optimize the management of patients with severe asthma type 2 inflammation: a Delphi consensus in seven countries
Liam G. Heaney, Desiree Larenas-Linnemann, Riyad Al-Lehebi, Rodrigo Athanazio, Paulina Barria, Abraham Ali Munive, Daniel Colodenco, Anahi Yañez, Libardo Jimenez, Marcia M. Pizzichini,et al.
Informa UK Limited
Objective:Severe asthma burdens patients and presents clinical management challenges for healthcare professionals. Biologics are crucial interventions for severe type two (T2) patients with high eosinophil counts. We conducted a Delphi consensus in seven developing or typically underrepresented countries to understand expert agreement on managing severe asthma with type two (T2) inflammation. Methods:The study comprised two online survey rounds and a participant meeting, involving 21 and 20 respiratory experts in the first and second survey, respectively. We developed a 70-statement questionnaire after literature review. Responses were recorded on a Likert scale (0-9) with 75% consensus threshold. Results:Consensus was reached on 37/60 closed-ended questions, including subtypes, in survey-1 and 20/47 closed-ended questions in survey-2. 95% of participants agreed on biomarker use for biologic treatment selection. 100% agreed timely biologic treatment leads to improvement in patients with severe asthma and an eosinophilic phenotype. 90% agreed to avoid maintenance oral corticosteroids (OCS) and start biologic therapy directly. Experts defined clinical remission on treatment as no exacerbations, no OCS use, Asthma Control Questionnaire (ACQ)-5 score < 1.5, and lung function optimization (forced expiratory volume in one second [FEV1] ≥ 80% of predicted or pre-bronchodilator FEV1 increase ≥ 100 mL from baseline). In survey-1, 81% agreed these outcomes are achievable in practice. All referral statements achieved consensus. Conclusions:This Delphi study focused on understanding patients with severe asthma and T2 inflammation in developing/underrepresented countries. Appropriately utilizing biomarkers, timely treatment interventions for best outcomes, expert consensus on clinical remission, and referral are crucial for improving patient management.

Impact of COVID-19 infection on lung function and nutritional status amongst individuals with cystic fibrosis: A global cohort study
Julie Semenchuk, Yumi Naito, Susan C. Charman, Siobhán B Carr, Stephanie Y. Cheng, Bruce C. Marshall, Albert Faro, Alexander Elbert, Hector H. Gutierrez, Christopher H. Goss,et al.
Elsevier BV

Rate of severe exacerbations, healthcare resource utilisation and clinical outcomes in patients with COPD in low-income and middle-income countries: results from the EXACOS International Study
Rodrigo Abensur Athanazio, Laura Bernal Villada, Sergey N Avdeev, Hao-Chien Wang, Alejandra Ramírez-Venegas, Martín Sivori, Jorge Dreyse, Manuel Pacheco, Sin Kit Man, Lorena Noriega-Aguirre,et al.
BMJ
IntroductionTheEXAcerbations ofChronic obstructive lung disease (COPD) and theirOutcomeS(EXACOS) International Study aimed to quantify the rate of severe exacerbations and examine healthcare resource utilisation (HCRU) and clinical outcomes in patients with COPD from low-income and middle-income countries.MethodsEXACOS International was an observational, cross-sectional study with retrospective data collection from medical records for a period of up to 5 years. Data were collected from 12 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Hong Kong, Mexico, Panama, Russia and Taiwan. The study population comprised patients ≥40 years of age with COPD. Outcomes/variables included the prevalence of severe exacerbations, the annual rate of severe exacerbations and time between severe exacerbations; change in lung function over time (measured by the forced expiratory volume in 1 s (FEV1)); peripheral blood eosinophil counts (BECs) and the prevalence of comorbidities; treatment patterns; and HCRU.ResultsIn total, 1702 patients were included in the study. The study population had a mean age of 69.7 years, with 69.4% males, and a mean body mass index of 26.4 kg/m2. The mean annual prevalence of severe exacerbations was 20.1%, and 48.4% of patients experienced ≥1 severe exacerbation during the 5-year study period. As the number of severe exacerbations increased, the interval between successive exacerbations decreased. A statistically significant decrease in mean (SD) FEV1from baseline to post-baseline was observed in patients with ≥1 severe exacerbation (1.23 (0.51) to 1.13 (0.52) L; p=0.0000). Mean BEC was 0.198 x109cells/L, with 64.7% of patients having a BEC ≥0.1 x109 cells/L and 21.3% having a BEC ≥0.3 x109 cells/L. The most common comorbidity was hypertension (58.3%). An increasing number of severe exacerbations per year was associated with greater HCRU.DiscussionThe findings presented here indicate that effective treatment strategies to prevent severe exacerbations in patients with COPD remain a significant unmet need in low-income and middle-income countries.

Respiratory amyloidosis: a case series from a Brazilian referral center
Philippe de Figueiredo Braga Colares1,2, Alfredo Nicodemos Cruz Santana3, Rodrigo Abensur Athanazio1, Ronaldo Adib Kairalla1, and Bruno Guedes Baldi1
Sociedade Brasileira de Pneumologia e Tisiologia

Analyses of 1236 genotyped primary ciliary dyskinesia individuals identify regional clusters of distinct DNA variants and significant genotype–phenotype correlations
Johanna Raidt, Sarah Riepenhausen, Petra Pennekamp, Heike Olbrich, Israel Amirav, Rodrigo A. Athanazio, Micha Aviram, Juan E. Balinotti, Ophir Bar-On, Sebastian F.N. Bode,et al.
European Respiratory Society (ERS)
BackgroundPrimary ciliary dyskinesia (PCD) represents a group of rare hereditary disorders characterised by deficient ciliary airway clearance that can be associated with laterality defects. We aimed to describe the underlying gene defects, geographical differences in genotypes and their relationship to diagnostic findings and clinical phenotypes.MethodsGenetic variants and clinical findings (age, sex, body mass index, laterality defects, forced expiratory volume in 1 s (FEV1)) were collected from 19 countries using the European Reference Network's ERN-LUNG international PCD Registry. Genetic data were evaluated according to American College of Medical Genetics and Genomics guidelines. We assessed regional distribution of implicated genes and genetic variants as well as genotype correlations with laterality defects and FEV1.ResultsThe study included 1236 individuals carrying 908 distinct pathogenic DNA variants in 46 PCD genes. We found considerable variation in the distribution of PCD genotypes across countries due to the presence of distinct founder variants. The prevalence of PCD genotypes associated with pathognomonic ultrastructural defects (mean 72%, range 47–100%) and laterality defects (mean 42%, range 28–69%) varied widely among countries. The prevalence of laterality defects was significantly lower in PCD individuals without pathognomonic ciliary ultrastructure defects (18%). The PCD cohort had a reduced median FEV1z-score (−1.66). Median FEV1z-scores were significantly lower inCCNO(−3.26),CCDC39(−2.49) andCCDC40(−2.96) variant groups, while the FEV1z-score reductions were significantly milder inDNAH11(−0.83) andODAD1(−0.85) variant groups compared to the whole PCD cohort.ConclusionThis unprecedented multinational dataset of DNA variants and information on their distribution across countries facilitates interpretation of the genetic epidemiology of PCD and indicates that the genetic variant can predict diagnostic and phenotypic features such as the course of lung function.

Rheumatoid arthritis-associated airway disease: longitudinal pulmonary function behavior
Maria Laura Bertozo Sabbag1, Camila de Assis Molina1, Márcio Valente Yamada Sawamura2, Karina Bonfiglioli3, Ana Cristina Medeiros-Ribeiro3, Alisson Pugliesi4, Renato Hideo Nakagawa5, Fabio Eiji Arimura6, Rodrigo Abensur Athanazio6, Ronaldo Adib Kairalla6,et al.
Sociedade Brasileira de Pneumologia e Tisiologia

A BEAT-PCD consensus statement: a core outcome set for pulmonary disease interventions in primary ciliary dyskinesia
Renate Kos, Myrofora Goutaki, Helene E. Kobbernagel, Bruna Rubbo, Amelia Shoemark, Stefano Aliberti, Josje Altenburg, Pinelopi Anagnostopoulou, Rodrigo A. Athanazio, Nicole Beydon,et al.
European Respiratory Society (ERS)
BackgroundConsistent use of reliable and clinically appropriate outcome measures is a priority for clinical trials, with clear definitions to allow comparability. We aimed to develop a core outcome set (COS) for pulmonary disease interventions in primary ciliary dyskinesia (PCD).MethodsA multidisciplinary international PCD expert panel was set up. A list of outcomes was created based on published literature. Using a modified three-round e-Delphi technique, the panel was asked to decide on relevant end-points related to pulmonary disease interventions and how they should be reported. First, inclusion of an outcome in the COS was determined. Second, the minimum information that should be reported per outcome. The third round finalised statements. Consensus was defined as ≥80% agreement among experts.ResultsDuring the first round, experts reached consensus on four out of 24 outcomes to be included in the COS. Five additional outcomes were discussed in subsequent rounds for their use in different subsettings. Consensus on standardised methods of reporting for the COS was reached. Spirometry, health-related quality-of-life scores, microbiology and exacerbations were included in the final COS.ConclusionThis expert consensus resulted in a COS for clinical trials on pulmonary health among people with PCD.

Use of elexacaftor+tezacaftor+ivacaftor in individuals with cystic fibrosis and at least one F508del allele: a systematic review and meta-analysis
Luiz Vicente Ribeiro Ferreira da Silva Filho1, Rodrigo Abensur Athanazio2, Carolina Rodrigues Tonon3, Juliana Carvalho Ferreira2, and Suzana Erico Tanni3
Sociedade Brasileira de Pneumologia e Tisiologia
Objective: To evaluate the effect of treatment with the combination of three cystic fibrosis transmembrane conductance regulator (CFTR) modulators-elexacaftor+tezacaftor+ivacaftor (ETI)-on important clinical endpoints in individuals with cystic fibrosis. Methods: This was a systematic review and meta-analysis of randomized clinical trials that compared the use of ETI in individuals with CF and at least one F508del allele with that of placebo or with an active comparator such as other combinations of CFTR modulators, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) methodology. We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to December 26th, 2022. The risk of bias was assessed using the Cochrane risk-of-bias tool, and the quality of evidence was based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: We retrieved 54 studies in the primary search. Of these, 6 met the inclusion criteria and were analyzed (1,127 patients; 577 and 550 in the intervention and control groups, respectively). The meta-analysis revealed that the use of ETI increased FEV1% [risk difference (RD), +10.47%; 95% CI, 6.88-14.06], reduced the number of acute pulmonary exacerbations (RD, -0.16; 95% CI, -0.28 to -0.04), and improved quality of life (RD, +14.93; 95% CI, 9.98-19.89) and BMI (RD, +1.07 kg/m2; 95% CI, 0.90-1.25). Adverse events did not differ between groups (RD, -0.03; 95% CI, -0.08 to 0.01), and none of the studies reported deaths. Conclusions: Our findings demonstrate that ETI treatment substantially improves clinically significant, patient-centered outcomes.

A real-life study of elexacaftor-tezacaftor-ivacaftor therapy in people with cystic fibrosis in Brazil
L.Z. Salomão, R.A. Athanazio, S.Z. Rached, M. Lopes-Pacheco, and M. Camargo
Elsevier BV

Post-TB bronchiectasis: from pathogenesis to rehabilitation
M. A. Martinez-Garcia, W-J. Guan, D. de-la-Rosa, R. Athanazio, G. Oscullo, M-X. Shi, P. Pujal-Montaña, B. N. Endlich, S. Tiberi, R. Centis,et al.
International Union Against Tuberculosis and Lung Disease
The destruction of lung parenchyma caused by TB can result in pulmonary sequelae that are classified as bronchiectasis due to traction (radiological sequelae), and bronchiectasis persisting with an inflammatory bronchial component and opportunistic bronchial infection. There is a lack of studies that comprehensively analyse whether post-TB bronchiectasis differs in clinical, prognostic or therapeutic aspects from bronchiectasis arising from other aetiologies. However, it has been noted that post-TB bronchiectasis tends to appear more frequently in the upper lung lobes. In many countries, TB is the most frequent known cause of bronchiectasis, but there is currently no targeted management of bronchiectasis due to TB as opposed to other aetiologies. It is imperative to first prevent TB, and when that fails to provide early diagnosis and adequate treatment for TB disease. In addition, efforts should be made to limit additional lung insults such as tobacco use and provide management of post TB bronchiectasis to minimise further pulmonary sequelae. The objective of this minireview was to provide an update on post-TB bronchiectasis, its definition, epidemiological data, pathophysiology, and clinical, diagnosis and therapeutic aspects.

Is cystic fibrosis a risk factor for COVID-19 infection or related complications?
Rodrigo A Athanazio1
Sociedade Brasileira de Pneumologia e Tisiologia
1. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil. Since the beginning of the COVID-19 pandemic, pulmonologists all around the world have had to deal with several new challenges and uncertainties. As if the need to understand a new disease and how to manage it was not enough, another major challenge was to assess the impact of COVID-19 on people with respiratory diseases. Rapidly, the presence of respiratory comorbidities has emerged as an independent risk factor for complications related to SARS-CoV-2 infection.(1) However, has every patient with a chronic respiratory disease been at an increased risk of infection and unfavorable evolution related to the new coronavirus?

Computed Tomography Evaluation of the Paranasal Sinuses in Adults with Primary Ciliary Dyskinesia
Diogo Barreto Plantier, Renata R. M. Pilan, Rodrigo Athanazio, Mary Anne K. Olm, Eloisa M. S. Gebrim, and Richard Louis Voegels
Georg Thieme Verlag KG
Abstract Introduction Primary ciliary dyskinesia is a rare inherited disease that results in a malfunction of mucociliary clearance and sinonasal complaints. Aplasia/hypoplasia of the frontal and sphenoid sinuses has been described as more frequent in this population. However, to date, no studies have provided a detailed description of computed tomography findings in adult patients with a diagnosis of this condition. Objective To describe the computed tomography (CT) findings of adult patients with primary ciliary dyskinesia. Methods Retrospective observational study of adult patients with primary ciliary dyskinesia who underwent CT. Results Twenty-one adults were included in the study. Aplasia occurred in 38.1% of frontal sinuses and in 14.3% of sphenoid sinuses. Likewise, hypoplasia occurred in 47.6% of the frontal sinuses, in 54.8% of the sphenoid sinuses and in 40.5% of the maxillary sinuses. Furthermore, trabecular loss was identified in 61.9% ethmoidal sinuses. The mean Lund-Mackay score was 13.5. In addition, 9.5% of the patients had concha bullosa, 47.6% had marked bilateral inferior turbinate hypertrophy, 38.1% had marked middle turbinate hypertrophy, and 47.6% had marked septal deviation. Finally, we identified images suggestive of fungus ball, mucocele, osteoma, a possible antrochoanal polyp, and frontal bone erosions. Conclusion The present study provides a detailed description of CT findings in patients with primary ciliary dyskinesia. We also describe abnormalities that must be identified for safer surgical planning and that suggest a diagnosis of primary ciliary dyskinesia if found in patients with a consistent clinical picture.

Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the sociedade brasileira de pneumologia e tisiologia (sbpt, brazilian thoracic association)
Rodrigo Abensur Athanazio1, Suzana Erico Tanni8, Juliana Ferreira1, Paulo de Tarso Roth Dalcin3,4, Marcelo B de Fuccio5, Concetta Esposito6, Mariane Gonçalves Martynychen Canan7, Liana Sousa Coelho8, Mônica de Cássia Firmida9,et al.
Sociedade Brasileira de Pneumologia e Tisiologia
Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

Changes after 12 years of follow-up severe asthma patients cohort: higher obstruction and comorbidities, but significant better quality of life
N. G. Santos Jr., R. M. Lima, R. A. Athanazio, R. M. Carvalho Pinto, K. Rabe, A. Cukier, and R. Stelmach
Journal of Asthma Informa UK Limited
Background: The Brazilian Cohort of Asthma São Paulo (BRASASP) had a well-characterized severe asthmatic in Brazil, with 12 years of follow-up under standard treatment.Methods: Sequential assessment of patients with uncontrolled asthma from BRASASP cohort was carried out with 12 years of follow-up, performing exams and comparing with previous measurements.Results: 50 from the 60 initial patients were re-evaluated. Twelve years later, FEV1 and the FEV1/FVC ratio have significantly decreased, with a rate of loss of lung function of 11.8 and 14%, respectively, and worsening in small airway parameters such as RV/TLC. BMI, The Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ) scores haven't changed. However, exacerbations decreased by 56%. Mean daily inhaled corticosteroid use was similar over time, but daily oral corticosteroid use decreased, in addition to a significant reduction in induced sputum eosinophilic and neutrophilic profile and serum IgE. Rhinitis, sinusitis, and GERD were the main comorbidities. In quality of life according to respiratory questionnaire SGRQ, total score showed a huge improvement (62% of patients).Conclusions: There was significant decrease in FEV1 and FEV1/FVC. Data of pulmonary functional small airway characteristics show globally affected airways. Although higher doses of medications, patients were still uncontrolled, but with reduction of exacerbations, daily use of oral corticosteroid, less eosinophils and neutrophils in induced sputum and lower levels of IgE. Improvement in quality of life in 62% of patients.

A study of the psychometric properties of the Brazilian…Portuguese version of Bronchiectasis Health Questionnaire
A. Luppo, C.O. de Camargo, S.S. Birring, A.C. Lunardi, S.Z. Rached, R.A. Athanazio, R. Stelmach, and S.D. Corso
Elsevier BV

In-person and online application of the Bronchiectasis Health Questionnaire: are they interchangeable?
A. Luppo, S. Rached, R. Athanazio, R. Stelmach and S. Corso
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia

Factors associated with clinical progression to severe COVID-19 in people with cystic fibrosis: A global observational study
Siobhán B Carr, Elliot McClenaghan, Alexander Elbert, Albert Faro, Rebecca Cosgriff, Olzhas Abdrakhmanov, Keith Brownlee, Pierre-Régis Burgel, Catherine A Byrnes, Stephanie Y Cheng,et al.
Journal of Cystic Fibrosis Elsevier BV

Automated Computed Tomography Lung Densitometry in Bronchiectasis Patients
Marcio Valente Yamada Sawamura, Rodrigo Abensur Athanazio, Maria Cecília Nieves Teixeira Maiorano de Nucci, Samia Zahi Rached, Alberto Cukier, Rafael Stelmach, Antonildes Nascimento Assuncao-Jr, Marcelo Straus Takahashi, and Cesar Higa Nomura
Elsevier BV

Direct Oral Anticoagulants for the Treatment of Cancer-Associated Venous Thromboembolism: A Latin American Perspective
Rodrigo Abensur Athanazio, José Manuel Ceresetto, Luis Javier Marfil Rivera, Gabriela Cesarman-Maus, Kenny Galvez, Marcos Arêas Marques, Aldo Hugo Tabares, Carlos Alberto Ortiz Santacruz, Fernando Costa Santini, Luis Corrales,et al.
Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis SAGE Publications
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in patients with cancer. On the basis of results from randomized controlled trials, direct oral anticoagulants (DOACs) are now recommended for the treatment of cancer-associated VTE. The decision to use a DOAC requires consideration of bleeding risk, particularly in patients with gastrointestinal (GI) malignancies, the cost-benefit and convenience of oral therapy, and patient preference. While efficacy with apixaban, edoxaban, and rivaroxaban versus dalteparin has been consistent in the treatment of cancer-associated VTE, heterogeneity is evident with respect to major GI bleeding, with an increased risk with edoxaban and rivaroxaban but not apixaban. Although cost and accessibility vary in different countries of Latin America, DOACs should be considered for the long-term treatment of cancer-associated VTE in all patients who are likely to benefit. Apixaban may be the preferred DOAC in patients with GI malignancies and LMWH may be preferred for patients with upper or unresected lower GI tumors. Vitamin K antagonists should only be used for anticoagulation when DOACs and low molecular weight heparin are inaccessible or unsuitable.

Prevalence of the eosinophilic phenotype among severe asthma patients in Brazil: the BRAEOS study
Rodrigo Athanazio1, Rafael Stelmach1, Martti Antila2, Adelmir Souza-Machado3, L. Karla Arruda4a, Alcindo Cerci Neto5, Faradiba Sarquis Serpa6, Daniela Cavalet Blanco7, Marina Lima8, Pedro Bianchi Júnior9,et al.
Sociedade Brasileira de Pneumologia e Tisiologia
Objective: To assess the prevalence of the eosinophilic and allergic phenotypes of severe asthma in Brazil, as well as to investigate the clinical characteristics of severe asthma patients in the country. Methods: This was a cross-sectional study of adult patients diagnosed with severe asthma and managed at specialized centers in Brazil. The study was conducted in 2019. Results: A total of 385 patients were included in the study. Of those, 154 had a blood eosinophil count > 300 cells/mm3 and 231 had a blood eosinophil count of = 300 cells/mm3. The median age was 54.0 years, and most of the patients were female, with a BMI of 29.0 kg/m2 and a history of allergy (81.6%). The prevalence of patients with a blood eosinophil count > 300 cells/mm3 was 40.0% (95% CI: 35.1-44.9), and that of those with a blood eosinophil count > 300 cells/mm3 and a history of allergy was 31.9% (95% CI: 27.3-36.6). Age and BMI showed positive associations with a blood eosinophil count > 300 cells/mm3 (OR = 0.97, p < 0.0001; and OR = 0.96, p = 0.0233, respectively), whereas the time elapsed since the onset of asthma symptoms showed an increased association with a blood eosinophil count > 300 cells/mm3 (OR = 1.02, p = 0.0011). Conclusions: This study allowed us to characterize the population of severe asthma patients in Brazil, showing the prevalence of the eosinophilic phenotype (in 40% of the sample). Our results reveal the relevance of the eosinophilic phenotype of severe asthma at a national level, contributing to increased effectiveness in managing the disease and implementing public health strategies.

Brazilian Guidelines for Nutrition in Cystic Fibrosis
Lenycia de Cassya Lopes Neri, Miriam Isabel Souza dos Santos Simon, Valéria Laguna Salomão Ambrósio, Eliana Barbosa, Monique Ferreira Garcia, Juliana Ferreira Mauri, Renata Rodrigues Guirau, Mirella Aparecida Neves, Carolina de Azevedo Pedrosa Cunha, Marcelo Coelho Nogueira,et al.
Einstein (Sao Paulo, Brazil) Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein
ABSTRACT Objective To develop a scientific consensus on nutrition in cystic fibrosis. Methods Sixteen coordinators elaborated relevant questions on nutritional therapy in cystic fibrosis, which were divided into six sections: nutritional assessment, nutritional recommendations, nutritional intervention, dietary counseling, special situations and enzyme replacement, and gastrointestinal manifestations. Two to three specialists in the field were responsible for each section and obtaining answers formulated based on standardized bibliographic searches. The available literature was searched in the PubMed®/MEDLINE database, after training and standardization of search strategies, to write the best level of evidence for the questions elaborated. Issues related to disagreement were discussed until a consensus was reached among specialists, based on the current scientific literature. Results Forty-two questions were prepared and objectively answered, resulting in a consensus of nutritional therapy in cystic fibrosis. Conclusion This work enabled establishing a scientific consensus for nutritional treatment of cystic fibrosis patients.

Essential Features of an Interstitial Lung Disease Multidisciplinary Meeting An International Delphi Survey
Alan K. Y. Teoh, Anne E. Holland, Julie Morisset, Kevin R. Flaherty, Athol U. Wells, Simon L. F. Walsh, Ian Glaspole, Wim A. Wuyts, Tamera J. Corte, Huzaifa Adamali,et al.
American Thoracic Society
RATIONALE The interstitial lung disease (ILD) multidisciplinary meetings (MDM) composing of pulmonologists, radiologists and pathologists, is integral to the rendering of an accurate ILD diagnosis. However, there is significant heterogeneity in the conduct of ILD MDMs and questions regarding its best practice remain unanswered. OBJECTIVE To achieve consensus among ILD experts on essential components of an ILD MDM. METHODS Using a Delphi methodology, semi structured interviews with ILD experts were used to identify key themes and features of ILD MDMs. These items informed two subsequent rounds of online questionnaires that were used to achieve consensus among a broader, international panel of ILD experts. Experts were asked to rate their level of agreement on a five-point Likert scale. An a priori threshold for consensus was set at a median score 4 or 5 with an interquartile range of 0. RESULTS We interviewed 15 ILD experts and 102 ILD experts participated in the online questionnaires. Five items and two exploratory statements achieved consensus on being essential for an ILD MDM following two questionnaire rounds. There was consensus that the presence of at least one radiologist, a quiet setting with a visual projection system, a high-quality chest high resolution computed tomography and a standardized template summarising collated patient data are essential components of an ILD MDM. Experts also agreed that it would be useful for ILD MDMs to undergo an annual benchmarking process and a validation process by fulfilling a minimum number of cases annually. Twenty-seven additional features were considered to be either highly desirable or desirable features based on the degree of consensus. Although our findings on desirable features are similar to the current literature, several of these remain controversial and warrant further research. The study also showed an agreement among participants on several future concepts to improve the ILD MDM such as performing regular self-assessments and conducting research into shared practices to develop an international expert guideline statement on ILD MDMs. CONCLUSION This Delphi study showed consensus among international ILD experts on essential and desirable features of an ILD MDM. Our data represents a first step toward potential collaborative research into future standardisation of ILD MDMs.

Bronchiectasis: moving from an orphan disease to an unpleasant socioeconomic burden
Rodrigo Abensur Athanazio
ERJ Open Research European Respiratory Society (ERS)
Bronchiectasis is a complex and heterogeneous condition characterised by persistent airway dilation, mucus hypersecretion, and recurrent respiratory infectious exacerbations. Numerous diseases and external insults may trigger the process of developing bronchiectasis, which makes the management of this disease even more challenging [1]. Until a few decades ago, bronchiectasis was considered an orphan disease due to its low prevalence, little recognition of its importance even by pulmonologists, and lack of proven effective therapies for its management. However, in recent years, bronchiectasis has no longer been considered an orphan disease [2]. The improvement and greater availability of diagnostic imaging methods associated with new studies aimed to understand the pathophysiology of bronchiectasis has opened a new chapter for this disease [3].

Does peripheral blood eosinophil count predict lung function improvement in adult subjects with asthma?
Juçara Noeli Silva, Alcides Rocha, Ivani Aparecida de Souza, Rodrigo Athanazio, and Eduardo Vieira Ponte
Annals of Allergy, Asthma and Immunology Elsevier BV

Rodrigo Abensur Athanazio

RESEARCH, TEACHING, or OTHER INTERESTS

Scopus Publications