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Asthma is a chronic inflammatory disorder of the airways that manifests as wheezing, shortness of breath, chest tightness, and coughing. Among the evaluation tools there is a new method, namely Impulse Oscillometry or IOS. It is a simple and non-invasive technique, based on the measurement of sound waves reflected by the resistance of the airways. The IOS machine produces and transmits small pulses of pressure along the tracheobronchial tree and records changes in pressure and flow to the mouth. A prospective study was conducted on 55 asthmatic patients assessed by IOS at time 0 and 3 months after initiation of inhaled corticosteroid (ICS) or ICS/LABA therapy, which demonstrated the value of IOS as a method of evaluation of the clinical response of the treatment implemented in the asthmatic patient. [ABSTRACT FROM AUTHOR]

This study aims to develop and validate a composite index, based on the integration of biomarkers, lung function parameters and clinical scores, for more accurate and informative risk stratification in patients with asthma. Through advanced multivariate analyses, the parameters most predictive of loss of control will be identified. An AI-based diagnostic algorithm will integrate these variables to construct the composite index, which will be prospectively validated in an independent cohort of patients. The objective is to evaluate the clinical applicability of the index, the impact on therapeutic management and outcomes of patients with asthma, to support clinicians in precision medicine for this complex disease. [ABSTRACT FROM AUTHOR]

Artificial intelligence algorithms are increasingly finding their way into the diagnosis, early treatment, prevention and monitoring of chronic respiratory diseases. Diagnosis of asthma often requires the use of various instrumental and laboratory investigations for better framing and phenotyping, including analysis of the fraction of exhaled nitric oxide (FeNO) for profiling eosinophilic inflammation and the forced oscillation technique (FOT), which plays a role not codified by guidelines. This project aims to develop a new predictive model for the early diagnosis of asthma by modelling data from the analysis of FeNO and FOT combined with clinical, laboratory and spirometric data using machine learning algorithms [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Airways are covered by a thin layer of fluid known as airway lining fluid (ALF), which is made up of a complex mixture of proteins, peptides, lipids, electrolytes, and water. Exhaled breath condensate (EBC) represents an extremely valid biological matrix for the study of ALF. EBC is obtained by oral breathing through a mouthpiece equipped with a saliva trap and a one-way valve that diverts the flow of air through a tube into a cooling chamber. The exhaled air saturated with water vapor and the aerosolized ALF particles condense on the surface of the chamber so that the condensed liquid can be collected. EBC includes over 2,000 compounds and several biomarkers indicated for the evaluation of airway inflammation, screening and early diagnosis, evaluation of environmental and professional exposure, pharmacological monitoring, exercise physiology. [ABSTRACT FROM AUTHOR]

“Wandering prevention: Pneumology on the road” born as a free pneumological screening project to “reach” the most disadvantaged population in our mountain area of Aosta Valley. It consists of the organization of 12 “Pneumological Days”, one for each of the reference villages of the 12 collateral Valleys, in which the population will be allowed to perform simple spirometry, thoracic ultrasound and assessment of oxygen saturation. The objective is the early diagnosis of asthma/ COPD and the referral of patients with spirometric or ultrasound anomalies to the Pneumology Center of Aosta. The project would, then, include home spirometric monitoring for patients selected based on severity and distance from the Hospital. [ABSTRACT FROM AUTHOR]

The small airways (SA), i.e., branches of the tracheo-bronchial tree with a diameter of less than 2 millimetres, not only conduct airflow but also represent an important determinant of lung mechanics. Their involvement in broncho-obstructive diseases, such as asthma and COPD, correlates closely with worsening of the underlying disease. However, there is still no gold standard for functionally defining the presence of SA obstruction. The most widely used parameters in the clinical practice are based on the use of spirometry or the Impulse Oscillometry System, which provide non-concordant and complementary information on the function of SA. Further studies are required to define the standard criteria for SA obstruction. [ABSTRACT FROM AUTHOR]

The transition of adolescents with asthma is a complex pathway, which must meet the educational and psychosocial needs that characterize this delicate phase of life, to enable the adolescent to acquire the ability to self-manage the disease. Therefore, the transition process must consider the clinical characteristics of the adolescent with asthma to identify possible risk factors for the persistence of asthma and possible evolution into chronic obstructive pulmonary disease in adulthood, and also comorbidities and factors that may lead to failure to control symptoms, such as obesity, functional breathing disorders, psychiatric issues, vaping, smoking, and the social context. In fact, adolescence is characterized by the desire to become progressively independent from the family; while this can be a limitation in adherence to therapy and self-management of the disease, it can however be an opportunity for healthcare providers to support adolescents to develop the knowledge, skills, and confidence needed to manage the disease and cope with the changes typical of the age. Therefore, a multidisciplinary, person-centered approach would be desirable to address important psychological, cultural, and social aspects typical of this age. Recently published guidelines from the European Academy of Allergy and Clinical Immunology provide evidence-based recommendations to guide the transition process, which needs to be adapted in the Italian national and regional context. This review aims to discuss the peculiarities of the management of the asthmatic adolescent and the transition process in close collaboration with adult services, to share priorities and goals in terms of care. [ABSTRACT FROM AUTHOR]

Type 2 chronic rhinosinusitis with nasal polyps (CRSwNP) is a severe condition often associated with comorbidities including asthma. In recent years biologics are an emerging treatment option for patients with severe uncontrolled forms, with well-known outcomes in asthma and recently recognized for CRSwNP as well. The multidisciplinary management is essential to select the patients elegible for treatment while also taking into account comorbidities and response to therapy. Currently the main area for future research should involve defining clinical predictors of disease response to treatment, to ensure patients receive personalized therapy while reducing financial burden and improving quality of life. [ABSTRACT FROM AUTHOR]

Induced sputum is a minimally invasive methodology useful to evaluate airway inflammation. Sputum induction with the nebulization of a saline hypertonic solution favours accumulation and production of airway sputum. The collected sample is processed with mucolytic agent. Eosinophils are usually scarcely represented in the sputum sample of healthy subjects and when their percentage is ≥ 3%, we can define the inflammatory pattern as eosinophilic. Increase of neutrophils (≥ 61%) can be a characteristic of the disease or be induced by infections, pollution or smoking habit and it defines a neutrophilic pattern. When both eosinophils and neutrophils are high, a mixed granulocytic pattern is defined. Asthmatic patients frequently present an eosinophilic inflammation which can be reduced with inhaled corticosteroid (ICS) therapy. There are asthmatic patients without a significant airway inflammation, either because the inhaled therapy is successful in maintaining low the inflammatory profile or because bronchoconstriction, thickening of the airway wall are the major components of the disease, in this case the inflammatory pattern is defined paucigranulocytic. In severe asthmatic patients, ICS is not sufficient to maintain the control of the disease and if the patient has a T2 endotype (increased blood and or sputum eosinophils or fractional exhaled nitric oxide (FeNO) or high IgE), biologic therapy could be attempted. Blood eosinophils are a modest surrogate evaluation for sputum eosinophils. FeNO levels, which mildly correlate with sputum eosinophils, are high when a T2 pattern is present. Patients with chronic obstructive pulmonary disease (COPD), usually have mucopurulent sputum samples with a high percentage of neutrophils. However, in a subgroup of subjects, an eosinophilic airway inflammation with a lower correlation with blood eosinophils has been detected. In conclusion, induced sputum methodology can be useful when the characterization of airway inflammation is needed in order to phenotype patients or to evaluate an insufficient response to therapy. [ABSTRACT FROM AUTHOR]

Machine Learning (ML) represents a valid and effective tool to support medicine, in diagnosis as well as in therapeutic choice, as a method for analyzing the characteristics, behavior and development of pathologies. In the field of respiratory diseases, this technique can represent a valid support in the prediction of exacerbations of acute events and the related causes, in the identification of clinical phenotypes, in the diagnosis and in the prediction of rehabilitation outcomes. The purpose of this article is to offer an overview of the method and the potential clinical implications of ML in respiratory diseases. [ABSTRACT FROM AUTHOR]

Introduction. Asthma is one of the most common chronic diseases in both pediatric age and adulthood, often underdiagnosed and undertreated. Over the past 20 years, numerous guidelines have been published with the aim of translating evidence into recommendations for good clinical practice; however, their impact was modest. The multilevel training program “Revolution in asthma” was created with the dual objective of improving the knowledge of the main guidelines on asthma and investigating the level of agreement of the participants with the recommendations of the guidelines, as well as their real-life application. Materials and methods. The survey was conducted from February to October 2021 on a representative sample of 400 Italian general practitioners, pulmonologists and algologists. Four guidelines (BTS/SIGN, NICE, AEPP-NHLBI-EPR and GINA) were compared and the concordances/ discrepancies between the recommendations of the guidelines relating to seven thematic areas were analyzed. Agreement/disagreement with the recommendations was measured with a Likert scale. The level of adherence in clinical practice was also assessed through questions aimed at estimating participants’ “opinions/beliefs” (as indicator of self-efficacy, i.e., confidence that the recommendations can be applied in daily practice). Results and conclusions. This e-learning project increased the participants’ guidelines knowledge (at the end of the course, 80% of the participants thought it was more useful to use several guidelines than one). The analysis highlighted the areas of agreement with the guidelines, and the “grey areas”, i.e. the areas with moderate agreement, such as patients monitoring and PEF use. Besides, barriers that interfere with the application of the recommendations into clinical practice were identified. In conclusion, the project allowed the participants to re-elaborate their own “mental guidelines” and to compare them with the published ones, thus driving a paradigm shift in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Chronic respiratory diseases (PRC) constitute an important part of chronic diseases and are the subject of specific treatment of the National Chronicity Plan (PNC) as they are relevant from an epidemiological point of view, severity, disability and weight assistance. They also represent a large chunk of pharmaceutical spending for the health system. Nevertheless, there are few studies that have analyzed in real life the use and consumption of inhaled drugs in patients with chronic respiratory diseases, putting together all the information flows available at the ASLs. This project was born with the intention of analyzing all the administrative flows existing in the databases of the ASL of Lecce, relating to the three main chronic diseases of the respiratory system (COPD, Asthma and Respiratory Insufficiency), and through them evaluate the consumption of resources health care in particular those relating to the expenditure for respiratory drugs. The study found that the most commonly used inhaled drugs, for which at least one pack was withdrawn, were inhaled steroids (61.6%), followed by the ICS/LABA combination (43.7%) and LABA (32.4%). However, less than third of patients (31%) withdraw at least 3 ICS or ICS/ LABA packs during the year, while the percentage is reduced to less than 15% for the remaining combinations, an indication of low therapeutic adherence. Finally, over 90% of subjects changed drugs or devices during the year. The study shows, on a large population, how the consumption of inhaled drugs in real life among subjects with chronic respiratory diseases is extremely variable and overall well below the minimum acceptable values to define a subject adhering to the therapy. The data collected through the analysis of information flows can therefore be an important tool for defining actions aimed at increasing therapeutic adherence and optimizing the resources of the Health System. [ABSTRACT FROM AUTHOR]

Nitric oxide (NO) is a gaseous molecule acting as a key mediator in several fundamental physiologic processes of the human body. Since Gustafsson and colleagues showed the presence of NO in the exhaled breath of humans in 1991, NO gained a growing interest of researchers which consider this molecule as a suitable diagnostic biomarker in respiratory diseases and asthma. The American Thoracic Society (ATS) and European Respiratory Society (ERS) released reccomandations that standardize the measurement of the fractional exhaled NO (FeNO), that is defined as a non-invasive procedure capable of characterize airway inflammatory status. In asthmatic patients FeNO concentrations and levels of other T2 inflammation biomarkers, such as peripheral and sputum eosinophilia, correlate and can be used to describe asthma phenotypes. Researchers have identified, both for adults and children with asthma, several FeNO cut-offs that could suggest to start a treatment with inhaled corticosteroids (ICS) and help to determine poor adherence to treatment or positive response to ICS. In addition, as a biomarker of T2 inflammation FeNO can predict the response of asthmatic patients to biologics. Moreover, FeNO ≥ 25ppb in severe asthmatics is a criterion for dupilumab treatment, despite high dose ICS therapy. The use of FeNO in chronic obstructive pulmonary disease (COPD) and non-asthmatic eosinophilic bronchitis is until under debate, although recent evidence shows FeNO reliability [ABSTRACT FROM AUTHOR]

Since the beginning of the Coronavirus Disease 19 (COVID-19) pandemic, the management of chronic respiratory diseases has undergone significant changes. The generalized lockdown, the need for social distancing, the redistribution of medical and allied health professionals increased the difficulty in accessing ordinary health services. Consequently, doctors and patients had to adopt alternative strategies for the management of chronic respiratory diseases. In this review we will analyze all the effects of the COVID-19 pandemic on these diseases and what solutions can be adopted. [ABSTRACT FROM AUTHOR]

Respiratory symptoms can affect activities of daily living and quality of life of patients with asthma. Tailored pulmonary rehabilitation (PR), including educational programs and exercise training, are recommended in all stages of severity. PR can ensure good control of respiratory symptoms and minimize the risks related to poor control of disease (i.e. exacerbations, airway remodelling, adverse effects of medications). [ABSTRACT FROM AUTHOR]

Severe asthma (SA) is a complex and heterogeneous syndrome due to the presence of many phenotypes-endotypes with different inflammatory and pathophysiological characteristics, and to the coexistence of many comorbidities. Important issues yet to be solved are also present such as near fatal asthma (NFA). The Pulmonologist plays a central role in the complex process to diagnose “severe asthma” including: (a) the confirmation of asthma diagnosis, (b) the identification of risk factors that can exacerbate asthma, (c) the verification of an appropriate therapy and adequate adherence, (d) the diagnosis and treatment of comorbidities, (e) and finally the identification of a definite phenotype permitting a personalization of therapy. The results of the “omics” science have allowed to integrate the search for treatable traits with the analysis of “treatable mechanisms”. A key example is represented by adultonset eosinophilic severe asthma. Much evidence has shown that peripheral eosinophilia is associated with greater asthma severity, more exacerbations, worse airways obstruction and higher doses of steroids to control symptoms and comorbidities, particularly those affecting the upper airways; this can be considered a real “treatable mechanism”. Despite recent scientific and therapeutic advances, severe asthma still has an important negative impact on both the health care system and the patient’s quality of life due to frequent exacerbations, which in the most serious cases can be life-threatening (episodes of NFA). These areas of need represent the current challenge for the Pulmonologist who remains the central figure, even when operating in a context of multidisciplinary care, and underline the need to rearrange more effectively the management of patients with severe asthma. [ABSTRACT FROM AUTHOR]

Asthma and obstructive sleep apnea (OSA) are common respiratory disorders with an increase in prevalence in the coming years. Recent studies show the presence of correlations between asthma and OSA with a secondary complication of the affected subjects. Healthcare professionals must be vigilant to identify these conditions in to order to promptly an appropriate therapy. [ABSTRACT FROM AUTHOR]

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This double-blind, randomized, placebo-controlled trial aimed to investigate the impact of DOxofylline compaRed tO THEOphylline (DOROTHEO 1 study) on functional and clinical outcomes in asthma. Patients with asthma ≥ 16 years of age (with Forced Expiratory Volume in 1 second [FEV1] ≥ 50% and < 80% and with ≥ 15% post-bronchodilator increase in FEV1) were randomized in a 1:1:1:1 ratio to receive doxofylline 200 mg, doxofylline 400 mg, theophylline 250 mg, or placebo. All double-blind treatments were taken orally with immediate release formulations and three times daily for 12 weeks. Data evaluating the effect of doxofylline 400 mg, theophylline 250 mg and placebo on peak FEV1, asthma events rate, use of salbutamol as rescue medication and Adverse Events (AEs) were investigated. The analysis of 263 patients demonstrated that both doxofylline 400 mg and theophylline 250 mg significantly increased peak FEV1, reduced the rate of asthma events and use of salbutamol to relieve asthma symptoms compared to placebo (p < 0.05). No significant differences were detected between doxofylline 400 mg and theophylline 250 mg. Doxofylline 400 mg did not significantly (p > 0.05) increase the risk of AEs compared to placebo, conversely in patients treated with theophylline 250 mg the risk of AEs was significantly (p < 0.05) greater than in those that received placebo. The analysis on doxophylline 200 mg is ongoing for non-inferiority vs. theophylline 250 mg, and will be reported in a further publication. Doxofylline offers a promising alternative to theophylline with similar efficacy and superior safety profile in the management of patients with asthma. [ABSTRACT FROM AUTHOR]

Background. Asthma and Chronic Obstructive Pulmonary Disease (COPD) have a strong epidemiological burden in Italy and their management leads to high costs. The therapy of these diseases is based on inhalation devices requiring healthcare professionals to teach the patients how to use them. Educational activity has a crucial role in inhalation therapy prescription, but it is not recognized as a healthcare performance, so it is often conducted in not-ideal settings, with potential consequences on its quality. Objective. To investigate the diffusion, implementation, timing and setting of educational activity, who are the healthcare professionals involved and finally which are facilitating and hindering factors. Methods. An on-line survey was submitted to all AIPO members. Results. Answers have underlined that educational activity is conducted predominantly in inpatients and outpatients, during the visits and without dedicated space and time. The most common instrument is the direct demonstration of the device. Responders indicate as possible improvement the production of audiovideo material from scientific societies, the acknowledgement as healthcare performance and the training of healthcare professionals. Conclusion. Educational activity seems to be diligently conducted with good modalities and times, but performed predominantly during the visits. We underline the need to acknowledge educational activity as rated performance, obtaining dedicated and optimal timing. Moreover, production of standardized educational material by the scientific societies would facilitate educational activity providing reliable and certified material. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) and asthma are major causes of morbidity and mortality, and their management requires a rehabilitative multidisciplinary approach. The presence of anxiety and/or depression in COPD and asthma patients is associated with poor adherence, increased mortality, exacerbation rates and length of hospital stay and decreased quality of life and functional status. In a rehabilitation team, the psychologist could improve the screening of patients' psychological needs and their treatments. Based on available evidence, this study proposes a multidisciplinary team-working model to support early screening and the integration of psychological contributions to the care of inpatients with COPD or asthma. For patients who are also experiencing clinical or sub-threshold psychological upset, low to high intensity psychosocial interventions could include brief and targeted cognitive behavioural therapy (CBT), relaxation and self-management of emotional states, and multidisciplinary educational sessions. The aims of this project are to activate early assessment to search for the burden of psychological needs in COPD or asthmatic patients and to improve quality of care. [ABSTRACT FROM AUTHOR]

The pathological mechanisms leading to neutrophilic asthma are only partly understood. A dysregulated innate response and oxidative metabolism have been associated to the neutrophilic asthma phenotype. Other immune mechanisms linking the allergic response, commonly observed in asthma, to neutrophilic inflammation have been described. In this context, studying the severe equine asthma model could reveal biological processes that might be translated or applied to the human asthma field. Severe equine asthma is a naturally-occurring, late-onset, neutrophilic model. Different inflammatory phenotypes have been associated with the disease: predominantly Th2, Th1, and/or Th17. Disease exacerbations are triggered by exposure to environmental antigens such as those commonly found in hay and straw, and disease remission is achieved by means of corticosteroid treatment or prolonged antigen avoidance. This aspect, together with the horse's lifespan, dimensions and easy handling represent advantages of this animal model that allows prospective trials to be performed with no need to sacrifice the animal. In this review article, an overview of the current knowledge on severe equine asthma and its similarities with human neutrophilic asthma is presented, together with some possible research applications. [ABSTRACT FROM AUTHOR]

Copyright of Giornale Italiano di Medicina del Lavoro ed Ergonomia is the property of Giornale Italiano di Medicina del Lavoro ed Ergonomia Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Contradictory aspects apparently coexist in relation to the causes of bronchial allergic inflammation in agriculture. It's worth notion that either exposure to inhalable dust and endotoxins or exposure to molecular patterns play a role in such a pathology; in particular endotoxins should protect against the onset of allergic diseases. Likewise, the exposure to pesticides would not lead to allergic asthma, but could facilitate the onset of pollinosis and contact dermatitis in gardeners. Moreover, the risk of anaphylaxis from bee sting would be lower in repeatedly bitten beekeepers if compared to sensitized and less exposed population, while atopy by itself is not evaluable as a risk factor for sensitization to hymenoptera. In conclusion either frequency and strength of exposure or distinctive feature of the subject are able to determine the occurrence of allergic disease in an almost different manner. [ABSTRACT FROM AUTHOR]