BACKGROUND: Endometrial cancer with microsatellite instability (MSI) involves 30% of diagnosed cases. There are some uncertainty about second-line treatment, after platinum-based first-line treatment. The aim of this stu...BACKGROUND: Endometrial cancer with microsatellite instability (MSI) involves 30% of diagnosed cases. There are some uncertainty about second-line treatment, after platinum-based first-line treatment. The aim of this study was to perform a systematic review on the scientific evidence of immunotherapies for endometrial cancer with MSI. METHODS: PubMed and Embase databases were searched up to May 28, 2024. We included clinical trials about patients with mismatch repair deficiency (dMMR) or high microsatellite instability (MSI-H) diagnosed with advanced and/or metastatic endometrial cancer who had previously received platinum-based chemotherapy. Clinical trials with a dMMR or MSI-H population size of less than 10 patients were discarded. Efficacy results in overall survival, progression-free survival and objective response rate were used to determine the most interesting drugs. A safety analysis of therapies was developed. RESULTS: Fifty-four studies were found in a systematic search. Fourteen clinical trials were selected. The following drugs were evaluated: pembrolizumab monotherapy, pembrolizumab plus lenvatinib, durvalumab, durvalumab-tremelimumab combination, dostarlimab, nivolumab and avelumab. The greatest numerical efficacy effect was achieved by pembrolizumab, followed by pembrolizumab in combination with lenvatinib. The most common adverse events were fatigue and gastrointestinal disorders. CONCLUSION: The efficacy of pembrolizumab and pembrolizumab-lenvatinib regimen appears promising. However, studies with larger sample size, longer follow-up and comparative design with subgroup analysis based on differences in microsatellite repair mechanisms are needed for proper therapeutic positioning.
PURPOSE: To present results of the 2022 SEFH-Survey on Spanish Hospital Pharmacy Departments covering care, staffing, resources, technology, education, and research. METHODS: A cross-sectional descriptive study via a vol...PURPOSE: To present results of the 2022 SEFH-Survey on Spanish Hospital Pharmacy Departments covering care, staffing, resources, technology, education, and research. METHODS: A cross-sectional descriptive study via a voluntary online survey sent to 353 hospitals in Spain. Data were collected from July-December 2022. Long-stay hospitals and correctional facilities were excluded. RESULTS: Response rate was 54.1%. Public hospitals represented 62.6%. Only 10.1% of departments operated 24/7, rising to 39.3% in larger hospitals. Half lacked continuous care service. Outpatients' services operated in mornings and afternoons in 54.8% of them (78.6% in larger centers). Telepharmacy for outpatients reached 57.7% of hospitals. ISO 9000 standards were followed by 70.7% and 14.4% adopted the Joint Commission model. Each department had on average 7.0 specialist pharmacists (8.8 in public; 3.9 in private), increasing to 13.4 in larger hospitals. Of these, 3.8 pharmacists worked at least half-time in clinical units. Pharmacy technicians were the most common non-pharmacist professionals (mean: 6.9). Including residents, 9.936 professionals worked in Hospital Pharmacy Departments nationwide. Automated dispensing carousels averaged 0.4 (horizontal) and 1.1 (vertical) per department. Automated dispensing systems covered 19.8% of beds. Robotic outpatient dispensing existed in 20.0% of hospitals. Technology for sterile workflow was used in 45.3%, 10.0% had robotics for cytostatic compounding and 61.7% smart infusion pumps. Pharmaceutical care was provided in emergency services in 39.8% of hospitals, rising to 67.4 in larger ones. In home hospitalization, it was offered at 32.5% of departments, rising to 60.7% in centers with over 1000 beds. Sterile formulations were prepared in 82.3% of departments; 15.7% managed advanced therapies. Drug level monitoring was measured in 16.1%, and 43.1% issued pharmacokinetics reports. Pharmacogenetic reports were produced in 8.7%. On average pharmacy departments attended 3.635 outpatients, totaling 1,28 million nationwide. Cytostatic preparations averaged 31,199 and 46,263 in hospitals with over 500 and 1000 beds, respectively. Clinical trials per department averaged 424. A total of 321 pharmacists were associate university professors, 401 held board certifications, and there were 2.3 PhD holders per department. CONCLUSION: Hospital Pharmacy Departments are advancing in clinical integration, pharmacokinetics, automation, traceability, and outpatient care, though staffing remains limited and disparities persist. Teaching is strong, yet research remains modest.
The role of a Medication Safety Officer has emerged as a critical element in hospital pharmacy, addressing the persistent issue of medication errors. These errors, which can cause significant patient harm, have been docu...The role of a Medication Safety Officer has emerged as a critical element in hospital pharmacy, addressing the persistent issue of medication errors. These errors, which can cause significant patient harm, have been documented for decades, prompting the establishment of formal roles dedicated to medication safety. Organizations such as the Institute for Safe Medication Practices (ISMP), the American Society of Health System Pharmacists (ASHP) as well as the United Kingdom's Medicines and Healthcare products Regulatory Agency (MHRA) and National Health Service (NHS) have been instrumental in supporting the Medication Safety Officer role. Medication errors can result in severe consequences, including patient harm and death. Landmark publications like the Institute of Medicine's "To Err is Human" and "Crossing the Quality Chasm" have highlighted the prevalence and impact of these errors, advocating for system improvements and the necessity of dedicated safety roles. Medication Safety Officers lead strategies and processes related to medication safety, develop strategic plans, and implement error prevention strategies. They analyze medication error reports, collaborate with healthcare staff, and optimize medication safety technologies. Medication Safety Officers play a key role in fostering a culture of safety within organizations, influencing practices to minimize harm and support second victim programs. Studies have shown that employing a Medication Safety Officer can significantly improve hospital safety scores, demonstrating the effectiveness of this role in enhancing patient safety. The daily responsibilities of a Medication Safety Officer include reviewing medication errors, assessing harm, attending meetings, and collaborating with healthcare practitioners. Overall, the role of a Medication Safety Officer is essential in identifying and mitigating medication risks, making hospitals safer, and ensuring the delivery of high-quality patient care.
OBJECTIVES: To describe the results obtained in terms of effectiveness and safety of intravenous sodium thiosulfate in patients diagnosed with non-uremic calciphylaxis, to identify and analyse possible etiological factor...OBJECTIVES: To describe the results obtained in terms of effectiveness and safety of intravenous sodium thiosulfate in patients diagnosed with non-uremic calciphylaxis, to identify and analyse possible etiological factors of the disease, and to determine the associated morbidity and mortality. METHOD: A multicenter and retrospective study was conducted with patients diagnosed with non-uremic calciphylaxis who received intravenous sodium thiosulfate between 2013 and 2023. Effectiveness was evaluated based on the status of the ulcers at the end of treatment, and safety was assessed according to the main reported adverse effects and the need for dosage adjustment. RESULTS: A total of 33 patients from three university hospitals were evaluated (93.9% Caucasian, 78.8% women, mean age 80 [SD 8.1] years) with non-uremic calciphylaxis confirmed by skin biopsy. The localization pattern was 90.9% distal. The following complementary therapeutic measures were undertaken: topical wound care, removal of precipitating factors (mainly vitamin D supplements and vitamin K antagonists), medications to reduce calcification (bisphosphonates, cinacalcet), and techniques to promote ulcer healing. The main associated factors for developing calciphylaxis were: non-uremic chronic kidney disease (81.8%), vitamin D supplementation (72.7%), and hypoalbuminemia (66.7%). The most commonly used sodium thiosulfate dosage was 25 g (n = 26) three times per week (n = 28) intravenously, with a median treatment duration of 11.4 (IQR 5.7-18) weeks. A complete resolution or improvement of the ulcers was achieved in 78.8% of the cases. Adverse effects were observed in 96.7% of patients, with the most common being metabolic acidosis (n = 19) and nausea and/or vomiting (n = 18). Dosage adjustments due to toxicity were necessary in 9% of cases. The significant morbidity rate was 69.7% (n = 23). The main complications were: 57.6% ulcer superinfection and 24.3% poor pain control. The overall mortality rate was 66.7%; 42.4% within the first 6 months after diagnosis and 39.4% secondary to non-uremic calciphylaxis. CONCLUSIONS: Sodium thiosulfate shows a potential benefit in the treatment of ulcers due to non-uremic calciphylaxis, with a similar safety profile to that reported for uremic calciphylaxis, considering the high morbidity and mortality associated with the condition. Further studies are needed to determine its efficacy and assess the specific contribution of the different treatments used.
INTRODUCTION: The CMO (Capability-Motivation-Opportunity) methodology is an innovative pharmaceutical care model designed to improve the quality of care for people living with HIV (PLWH). This approach evaluates the know...INTRODUCTION: The CMO (Capability-Motivation-Opportunity) methodology is an innovative pharmaceutical care model designed to improve the quality of care for people living with HIV (PLWH). This approach evaluates the knowledge, perception, and willingness to implement the methodology among specialist physicians in Spain. METHODS: This observational and descriptive study utilized a validated questionnaire distributed among clinicians involved in the care of PLWH. The survey assessed their knowledge and perception of the methodology. Associations between variables were analyzed using bivariate tests. RESULTS: Thirty physicians participated. Sixty percent reported moderate-to-high knowledge of the methodology, correlating with a positive perception of its clinical relevance (p = 0.02). Motivational interviewing and remote follow-up were identified as key tools. CONCLUSION: Knowledge of the CMO methodology is limited but positively valued. Its association with improved quality of health care underscores the importance of strategies to enhance its dissemination and adoption in clinical practice.
To promote the transformation of hospital pharmacy in the field of rare diseases, the OrPhar-SEFH Strategic Plan 2024-2027 was developed. Twelve hospital pharmacists from the OrPhar-SEFH group participated in the project...To promote the transformation of hospital pharmacy in the field of rare diseases, the OrPhar-SEFH Strategic Plan 2024-2027 was developed. Twelve hospital pharmacists from the OrPhar-SEFH group participated in the project which was developed in 3 phases: Situation analysis, trends, and current challenges in rare diseases and their impact on the role of hospital pharmacist through literature review, interviews with hospital pharmacists and patients (FundAME and Fedhemo), and SWOT analysis; Definition of lines of action grouped into five strategic axes AEIOU (Alliances, Evidence, Research/Innovation, Optimization, and Union); and Prioritization of lines of action based on impact and feasibility. In order to achieve this, the existing trends and barriers in the field of rare diseases and hospital pharmacy were identified and classified around 4 levers for change: transformation of the care process, patient experience, evaluation and access to orphan drugs, and real-world evidence. The SWOT analysis identified key success factors, and interviews with patients identified their needs in four pillars: role of the hospital pharmacist, patient experience, patient education, and access to treatment. A total of 23 lines of action were agreed upon: Alliances (6), Evidence (3), Research/Innovation (4), Optimization (7), and Union (3). Based on their impact and feasibility, the following were prioritized: promoting hospital pharmacist collaboration in decision-making structures regarding the evaluation and positioning of orphan drugs, enhancing the role of hospital pharmacist in the critical analysis of scientific evidence in rare diseases and its translation to interdisciplinary clinical teams, encouraging the use of Multi-Criteria Decision Analysis methodology in orphan drugs, promoting the integration of hospital pharmacist into interdisciplinary teams managing patients with rare diseases, and creating a network of specialized hospital pharmacist services in rare diseases. Ultimately, the OrPhar-SEFH Strategic Plan 2024-2027 defines the roadmap to enhance the role of hospital pharmacist in addressing rare diseases, improving access and evaluation of orphan drugs, and optimizing the care process to improve health outcomes, quality of life, and patient experience.
INTRODUCTION: High-risk medications (HRMs) are those with a high probability of causing severe or fatal harm when errors occur during their use. Enhancing safety in the management of HRMs is a priority for healthcare aut...INTRODUCTION: High-risk medications (HRMs) are those with a high probability of causing severe or fatal harm when errors occur during their use. Enhancing safety in the management of HRMs is a priority for healthcare authorities. This study presents a multidisciplinary program designed to optimize the safe use of HRMs in adult inpatients at a Level 5 hospital. OBJECTIVES: The objectives of the program are: a) To adapt national and international standards on HRM safety to the local setting. b) To define the competencies and responsibilities of the professionals involved. c) To increase the engagement of stakeholders in HRM safety. d) To establish indicators to evaluate the interventions. METHODS: The program was developed in three phases: 1) Initial situation analysis: Assessment using the Institute for Safe Medication Practices' self-assessment questionnaire on medication safety. 2) Protocol development: Creation of a local protocol based on a literature review and multidisciplinary consensus. 3) Action plan implementation: Dissemination, monitoring, and periodic updates of the protocol. RESULTS: The developed protocol included seven general measures, 29 specific measures, and five indicators to evaluate its impact. After the first year of implementation: 71.5% of HRMs were stored in high-security locations within automated dispensing systems, 71.36% of HRM prescriptions were validated within the first 24 hours and a total of 4,366 pharmaceutical interventions were performed. Additional measures implemented included: Tall Man Lettering across all information systems, automated alerts for maximum doses in prescribing systems and alerts prompting independent double-checking during HRM dispensing. CONCLUSIONS: This program is an effective and transferable model for improving HRM safety in complex hospital settings and fostering a safety culture. Future initiatives should focus on developing a national dashboard with standardized indicators to enable inter-hospital comparisons and identify areas for improvement.
Inclán-Conde M, Vila-Gallego C, Vara-Urruchua M
… +5 more, Aguirrezabal-Arredondo AV, Ferreiro-Benéitez ÓL, Vidal-García M, Ruiz-Rodríguez P, Domínguez-Menéndez JA
OBJECTIVE: Evaluate the impact on improving the appropriateness of prescribing following a pharmaceutical intervention based on the review and optimisation of sulfamethoxazole-trimethoprim prescriptions. METHODS: A befor...OBJECTIVE: Evaluate the impact on improving the appropriateness of prescribing following a pharmaceutical intervention based on the review and optimisation of sulfamethoxazole-trimethoprim prescriptions. METHODS: A before-after intervention study was conducted in a tertiary hospital. The first period, or intervention period, was prospective and ran from September 2021 to January 2022. The second or post-intervention period was retrospective and covered the period March-December 2022. In case of discrepancy between indication and prescribed and recommended dosage, the physician was notified and the degree of acceptance was recorded. In the post-intervention period, we retrospectively analysed the adequacy of the dosage, checking whether any intervention had been carried out by the Pharmacy Department. Statistical analysis was performed using the chi-square test. RESULTS: During the intervention period, 69 prescriptions were analysed, and 18 were found to be inappropriate (26%), 12 related to Stenotrophomonas maltophilia infection. In the post-intervention period, 129 prescriptions were reviewed, and 12 were considered inadequate (9%). Statistical analysis of the results obtained in both periods (18/69 and 12/129) showed statistically significant differences (p = 0.0082). CONCLUSIONS: Pharmaceutical intervention in the review and optimisation of prescriptions improves the use of sulfamethoxazole-trimethoprim. The results obtained provide evidence of the importance of pharmaceutical review of such prescriptions.
Torralba-Fernández L, García-Palomo M, López de Abechuco-Ruiz M
… +5 more, Ramos-Sánchez N, Jiménez-Méndez C, Prieto-Galindo R, Lorenzo-Lozano MC, Aguado-Barroso P
OBJECTIVE: To standardize the drug dilutions administered intravenously in a Pediatric Intensive Care Unit and to characterize these dilutions based on their pH, osmolarity, and vesicant nature. This aims to guide the se...OBJECTIVE: To standardize the drug dilutions administered intravenously in a Pediatric Intensive Care Unit and to characterize these dilutions based on their pH, osmolarity, and vesicant nature. This aims to guide the selection of the most appropriate vascular access device, minimizing associated complications, and preserving the patient's venous capital. METHODS: Through a consensus between Pharmacy and Pediatric Services, the most frequently administered intravenous drugs in the Pediatric Intensive Care Unit were selected. Two different dilutions were established for each drug, followed by the determination of their respective osmolarity and pH values. The vesicant nature of each drug was assessed according to the classification proposed by Clark et al. Additionally, vascular access device selection was guided by the algorithm proposed by Manrique et al., which considers the drug's properties, the duration of intravenous therapy, and the patient's venous capital status. RESULTS: A total of 60 dilutions corresponding to 30 drugs from the following therapeutic groups were analyzed: antimicrobials (56%), antiepileptics (13%), sedatives (7%), diuretics (7%), anti-inflammatory and analgesics (7%), and others (10%). Twenty-five percent of the dilutions exhibited at least one high-risk factor for phlebitis (osmolarity >600 mOsm/L or pH < 4 or > 9), while 35% were classified as intermediate risk (osmolarity 450-600 mOsm/L or pH 4-5 or > 7.5-9). Only 10% of the analyzed drugs were classified as vesicants (acyclovir, phenytoin, and vancomycin). Seventeen dilutions of nine different drugs were identified that should not be administered through a peripheral venous catheter, even in short-term treatments. Of these, 15 had a high risk of causing phlebitis, while 2 had an intermediate risk. CONCLUSIONS: The physicochemical properties (osmolarity and pH) and vesicant nature of drugs are key factors contributing to the development of phlebitis in critically ill pediatric patients. Standardizing and characterizing drug dilutions will facilitate the selection of the most appropriate vascular access device, improving the safety and effectiveness of intravenous therapy.
OBJECTIVE: Sacituzumab govitecan is an antineoplastic therapy composed of a monoclonal antibody directed to the Trop2 antigen, conjugated to SN-38, an active metabolite of irinotecan that inhibits topoisomerase I. It is...OBJECTIVE: Sacituzumab govitecan is an antineoplastic therapy composed of a monoclonal antibody directed to the Trop2 antigen, conjugated to SN-38, an active metabolite of irinotecan that inhibits topoisomerase I. It is indicated for the treatment of metastatic triple-negative breast cancer in patients who have received at least two prior lines of treatment, with at least one in the metastatic context. SN-38 is eliminated by glucuronidation mediated by uridine diphosphate-glucuronosyltransferase-1A1 (UGT1A1) enzymes, present in the liver. Mutations in the UGT1A1 gene decrease the expression of these enzymes, which increases the concentration of SN-38 and, consequently, increases the toxicity of the drug, especially in the form of neutropenia and diarrhea. This study aims to analyze the relationship between UGT1A1 gene polymorphisms and toxicity associated with treatment with sacituzumab govitecan, in addition to reviewing the usefulness of genetic screening prior to starting therapy. METHODS: A non-systematic literature review was conducted on the impact of UGT1A1 gene polymorphisms on the safety of sacituzumab govitecan treatment in patients with triple-negative breast cancer. The search included primary and secondary literature sources and communications from oncology conferences. RESULTS: Patients treated with sacituzumab govitecan with the UGT1A1*28/*28 mutated genotype are more likely to experience grade more than 3 hematologic adverse events: neutropenia (approximate incidence of 60% compared to 40% for 1/*1 and 1/*28 genotypes), febrile neutropenia (18% homozygotes vs. 5% heterozygotes and 3% wild-type), grade more than 3 anemia (15% vs. 6% and 4%, respectively); as well as grade more than 3 diarrhea (24% vs. 13% and 6%, respectively). Additionally, treatment discontinuation rates are higher in *28/*28 individuals (6% compared to 1% heterozygotes and 2% wild-type). CONCLUSIONS: Patients homozygous for the UGT1A1*28 allele are at significantly increased risk of developing serious adverse events. Despite the clear relationship between UGT1A1 polymorphisms and sacituzumab-govitecan toxicity, the review suggests that there is insufficient consensus on the need for systematic genetic screening. However, the findings indicate that such screening could be useful for identifying patients at risk and personalizing sacituzumab govitecan therapy.
OBJECTIVE: To evaluate in patients with a history of keratitis by herpes simplex virus, ocular recurrences, visual acuity, non-ocular recurrences, stromal keratitis and adverse effects after prolonged treatment with anti...OBJECTIVE: To evaluate in patients with a history of keratitis by herpes simplex virus, ocular recurrences, visual acuity, non-ocular recurrences, stromal keratitis and adverse effects after prolonged treatment with antiviral agents. Registered in Prospero CRD42024556228. METHODS: Systematic review of trials identified in CENTRAL, Embase, Medline, www. CLINICALTRIALS: gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp). Trials of patients with a history of at least one episode of herpes simplex keratitis were included. Participants had to be free of active herpetic disease at the time of enrollment in the trial. Trials had to include oral and/or topical antiviral agents versus placebo or other antivirals, administered for at least 4 weeks. A data extraction was performed by pairs with risk of bias assessment for each trial using Cochrane Risk of Bias; GRADE was used to provide the certainty of evidence for each outcome. RESULTS: Four trials were found that included 1,017 patients. Antivirals in prolonged use protected from recurrences of ocular herpetic disease better than placebo (RR 0.56; 95% CI 0.45-0.70) NNT 6 (4-11); acyclovir was better than placebo in this same action (RR 0.59; 95% CI 0.46-0.74) NNT 8 (5-14), but not different from valacyclovir (RR 1.0; 95% CI 0.37-2.70) NNT not calculated. Prolonged use of antivirals also decreased recurrences of non-ocular herpetic disease (RR 0.56; 95% CI 0.44-0.71) NNT 6 (5-11) and recurrences with stromal keratitis (RR 0.55; 95% CI 0.35-0.85) NNT 17 (10-50). No data were found on visual acuity. Regarding adverse effects, there were no differences between interventions (RR 0.96; 95% CI 0.60-1.54) NNT not calculated. The certainty of evidence was high for ocular and non-ocular recurrences, and low for adverse effects, due to imprecision and inconsistency of the findings. CONCLUSIONS: Prolonged use of antivirals protects from ocular, non-ocular recurrences and stromal keratitis safely. The effects on visual acuity are not known.
The need for new antimicrobial treatments that work alternatively or synergistically with antibiotics to address the problem of the emergence and transmission of antimicrobial resistance has increased interest in the use...The need for new antimicrobial treatments that work alternatively or synergistically with antibiotics to address the problem of the emergence and transmission of antimicrobial resistance has increased interest in the use of minority therapies such as phage therapy. For safe and widespread application of this therapy, it is necessary to establish the pharmacokinetic and pharmacodynamic parameters for its use in humans. This systematic review analyzes the criteria necessary to establish the PK/PD of this therapy, as well as its current application, based on a review of 66 clinical cases that catch diverse infections and phage administration routes.
AIMS: Tyrosine kinase inhibitors (TKIs) have been successful in changing the course of chronic myeloid leukaemia (CML) due to their high efficacy. However, their effectiveness is conditioned by adherence to treatment. Th...AIMS: Tyrosine kinase inhibitors (TKIs) have been successful in changing the course of chronic myeloid leukaemia (CML) due to their high efficacy. However, their effectiveness is conditioned by adherence to treatment. The aim of this study was to analyse the adherence of CML patients treated with TKIs and to evaluate the impact of pharmaceutical care on adherence in a prospective and interventional manner. METHODS: Multicentre, prospective study including CML patients on treatment with TKIs attending the outpatient units of the Pharmacy Services. Adherence was assessed using a combination of two methods: the Simplified Adherence Problems Scale and the treatment dispensing register (a patient with a percentage <90% being considered "non-adherent"); patients who demonstrated a non-adherence in either of these two methods were classified as "non-adherent patients". In individuals with inadequate adherence, pharmaceutical care was reinforced for 8 months by means of a specific programme. RESULTS: A total of 130 patients were included, 56.9% had optimal adherence to treatment. Pharmaceutical care in the oncohaematology-specific outpatient units of the Pharmacy Services improved adherence (from 67.1% to 90.9%; p < 0.001) while the generalist outpatient units kept it constant (from 70.2% to 72.4%; p = 0.509). CONCLUSIONS: Adherence is one of the most relevant parameters in the effectiveness of chronic treatments. Approximately half of our CML patients showed inadequate adherence to TKIs. This is the first prospective study to determine that the pharmacist's actions in oncohaematology-specific outpatient units of the Pharmacy Services are capable of influencing adherence and improving it.
OBJECTIVE: Inhaled therapy is essential in cystic fibrosis; however, inhalers have a significant environmental impact due to the greenhouse gases (GHGs) emitted. The environmental impact of a product is estimated by its...OBJECTIVE: Inhaled therapy is essential in cystic fibrosis; however, inhalers have a significant environmental impact due to the greenhouse gases (GHGs) emitted. The environmental impact of a product is estimated by its carbon footprint (CF). Pressurized metered-dose inhalers (pMDIs) have a higher CF than dry powder inhalers (DPIs) and soft mist inhalers (SMIs) due to the incorporation of GHGs. The objectives are to analyze the consumption of inhalers (β2-adrenergic agonist bronchodilators, anticholinergics, and/or corticosteroids) in a cystic fibrosis unit and estimate the generated CF. METHOD: Retrospective determination (January 2018-December 2023) of consumption and CF (tCOeq) by type of inhaler was conducted. Consumption and CF trends were evaluated using linear regression. RESULTS: Annually, 1.529 (1.279-1.613) pMDIs, 1.055 (855-1.333) DPIs, and 28 (20-42) SMIs were dispensed, representing 55.97%, 42.33%, and 1.70%, respectively. A statistically significant positive trend in the consumption of SMIs was observed. The median annual CF was: pMDIs 38.3 (31.2-40.3) tCOeq, DPIs 0.8 (0.6-0.9) tCOeq, and SMIs 0.02 (0.02-0.03) tCOeq, representing 97.86%, 2.04%, and 0.10%, respectively. CONCLUSIONS: pMDIs were the inhalers with the highest consumption and CF, although their consumption appears to be decreasing, with an increase in the consumption of SMIs.