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Purpose of Review This expert opinion, prepared by a panel of chest disease specialists, aims to review the current knowledge on practice patterns in real-life management of mild asthma and to address the relevant updates in asthma treatment by The Global Initiative for Asthma (GINA) to guide clinicians for the best clinical practice in applying these new treatment paradigms. Recent Findings On the basis of the emerging body of evidence suggesting the non-safety of short-acting beta 2-agonists (SABA)-only therapy and comparable efficacy of the as-needed inhaled corticosteroids (ICS)-formoterol combinations with maintenance ICS regimens, GINA recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The new GINA 2019 recommendations no longer support the SABA-only therapy in mild asthma but instead includes new off-label recommendations such as symptom-driven (as-needed) low-dose ICS-formoterol and "low dose ICS taken whenever SABA is taken." The GINA 2019 asthma treatment recommendations include a major shift from long-standing approach of clinical practice regarding the use of symptom-driven SABA treatment alone in the management of mild asthma. This expert opinion supports the transition from a long-standing SABA-only approach to a risk reduction-based strategy, with the use of symptom-driven (as-needed) low-dose ICS/LABA in mild asthma patients, particularly in those with poor adherence to controller medications. The thoughtful and comprehensive approach of clinicians to these strategies is important, given that the exact far-reaching impact of this major change in management of mild asthma in the real-world settings will only be clarified over time.

WOS:000578603800011 Humanity encountered a coronavirus (severe acute respiratory syndrome-coronavirus-2 (sars-cov-2)) pandemic on december 31, 2019 that is threatening the human race. The disease was first identified in the city of wuhan in china. It causes widespread pneumonia in the lungs, with the most significant laboratory findings being lymphopenia and eosinopenia in the blood count and elevated c-reactive protein and d-dimer. The findings increase with the progression of the clinical picture. Comorbidities in an individual determine the course of the disease, with the most important risk factors among those indicating a severe course being hypertension, ischemic heart disease, diabetes and chronic obstructive pulmonary disease. Asthma represents no increased risk in terms of catching the coronavirus disease-2019 (covid-19), and no report has been published to date associating its risk with a more severe disease course. Covid-19, as with all other respiratory infections, interferes with control of asthma. It is important to keep asthma under control during this period, as always. Patients should not stop taking their inhaled steroids, nor should they reduce the dose. Similarly, systemic steroids should not be stopped if prescribed to keep asthma under control. The use of anti-ige, anti il-5/il-5 alpha and anti il-4 alpha does not increase the risk of contracting covid-19, and these drugs may also be used to maintain asthma under control. A "to do" list should be provided to patients by their physicians as an action plan in the event of a worsening of asthma symptoms. Patients with allergic rhinitis can safely use their nasal steroid and antihistaminic drugs. Hand disinfectants that contain chlorhexidine may cause asthma attacks, and are not active against sars-cov-2. Using latex gloves to ensure hand hygiene may also lead to asthma attacks in individuals with a latex allergy. Washing the hands with water and soap should be preferred rather than using gloves. In conclusion, covid-19 does not constitute a greater risk to patients with asthma. Inhaled steroids and systemic steroids that keep the asthma under control can be used safely. Lowering a step in the treatment of asthma is not recommended in this period.

ÖZETAmaç:Kronik solunum sistemi hastalıkları, bireylerin yaşamında yol açtığı sorunlar nedeniyle yoğun psikolojik sıkıntılar yaşamasına neden olabilmektedir. Bu araştırmada, kronik solunum sistemi hastalığı olgularının anksiyete ve depresyon yönünden değerlendirilmesi amaçlandı.Böylece hastaların psikolojik yönden gereksinimlerinin belirlenebileceği ve bu durumun tedaviye katkısı olacağı düşünüldü.Yöntem:İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı polikliniğimize başvuran hastalardan KOAH, astım, bronşektazi tanısı almış olan ve son 4 haftadır stabil dönemdeki 41 KOAH, 45 astım, 37 bronşektazi, toplam 123 hasta ve bu grup ile yaş uyumu gösteren gönüllü sağlıklı bireylerden oluşan kontrol grubundan 111 kişi olmak üzere toplam 223 kişi prospektif olarak çalışmaya dahil edilmiştir.Olgulara BECK depresyon ölçeği, BECK anksiyete ölçeği verilerek kendilerinin doldurmaları istendi. Ayrıca yapılan SFT sonuçları, komorbid hastalıkları ve kişisel bilgileri kaydedildi. BECK depresyon ölçeğinde ≥17 depresyon, anksiyete için ≥16 klinik olarak anlamlı kabul edildi. Kullanılan tüm parametrelerin depresyon ve anksiyete ilişkileri araştırıldı.Bulgular:Çalışma %45'i (n=105) erkek, %55'i (n=129) kadın, yaş ortalaması 52.21±15.66, %18'i (n=41) KOAH, %19'u (n=45) astım, %16'sı (n=37) bronşektazi olduğu tespit edilmiştir. Ayrıca %47'si (n=111) ise kontrol grubu olarak görülmektedir.Komorbiditesi olmayan %46 (n=107), komorbiditesi olan %54 (n=127) olarak görülmektedir.Olguların SFT sonucuna göre % 22'si (n=24) hafif, %59'u (n=64) orta, %17'si (n=19) ağır; %2'si (n=2) çok ağır değerlerde olduğu görüldü.Tanı gruplarında yer alan bronşektazi hastalarının %57'sinde (n=21), KOAH hastalarının %54'ünde (n=22), astım hastalarının %47'sinde (n=21), kontrol grubu %16'sında (n=18) anksiyete olduğu tespit edilmiştir. Depresyon değerlendirildiğinde bronşektazi hastalarının %46'sında (n=17), KOAH hastalarının %44'ünde (n=18), astım hastalarının %33'ünde (n=15) , Kontrol grubu %10'unda (n=11) ise depresyon olduğu tespit edilmiştir. Sonuç: Sonuç olarak bu araştırma kronik solunum sistemi hastalığı olan bireylerin depresyon ve anksiyete gibi psikolojik problemlere eğilim gösterdiğini ortaya koymuştur. Kronik olgularda sık görülen anksiyete ve depresyon varlığı dikkate alınmalı, hastaların semptomlarına yönelik farmakolojik tedavi yaklaşımları ile birlikte, psikolojik problemlerin kontrolü, tedavisi ve rehabilitasyon programları uygulanmalı, multidisipliner yaklaşım ihmal edilmemelidir. ABSTRACTObjective:Chronic respiratory disease may lead to intense psychological distress as individuals, it may affect us psychologically, it may cause intense psychological distress as a result.The aim of this study is to evaluate the chronic respiratory disease patients in terms of anxiety and depression.Therefore according to our study, we thought that psychological needs of patients can be determined and this condition can make a contribution to the treatment.Method:We have included 123 patients in our study diagnosed with COPD, asthma, bronchiectasis, and 111 control group of healthy volunteers indicate a total of 223 people, submitted at the Istanbul University Cerrahpasha Medical Faculty Pulmonary Diseases Department. Patients were stable during the last four weeks and were evaluated prospectively.BECK depression scale and BECK anxiety scale were given to the patients and they were asked to fill it by themselves. Also made PFT results, comorbid diseases and personal information were saved. The BECK depression scale ≥ 17, BECK anxiety scale ≥16 were considered clinically significant for depression and anxiety.Results: %45 (n =105) male and %55 (n =129) female were included in the study, mean age was 52.21 ± 15.66, %18 (n = 41) COPD, %19 (n = 45) asthma, %16 (n = 37) were found to have bronchiectasis. In addition, %47 (n = 111) are regarded as the control group, and %46 (n =107) were observed without comorbidities and %54 (n = 127) with comorbidities.The values of pulmonary function test were %22 of patients (n = 24) had mild, %59 (n = 64) moderate, %17 (n = 19) severe, %2 (n = 2) very severe.%57 of patients with bronchiectasis, %54 of patients with COPD, %47 of patients with asthma, %16 of control group detected as anxiety. When depression assessed at %46 of bronchiectasis patients, %44 of COPD patients, %33 of asthma patients and control group %10 were found having depressed.Conclusion:Consequently, this study demonstrated that individuals with chronic respiratory disease tending to have psychological problems such as depression and anxiety.According to this result, treating the symptoms of anxiety and depression should be going long with pharmacological approaches, in other way pharmacological approaches, control of psychological problems and rehabilitation programs should be implemented, all these multidisciplinary approaches should not be neglected. 57