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Background: Since December 2019 SARS-CoV-2 has been identified as the causal agent for severe cases of pneumonia in China and it spread all over the world, putting great pressure on Health Systems. Despite regarded as the standard procedure, sensitivity of nasopharyngeal swab (NPS) is suboptimal. In clinical/radiological suspicion of SARS-CoV-2 infection despite negative NPS test, other tests may be required to rule out the infection. Objectives: To evaluate correlations between lower respiratory tract (LRT) testing for SARS-CoV-2 in suspect patients with 2 negative NPSs and clinical symptoms, laboratory values and the CT scan review score by the Radiological Society of North America. Method: Retrospective analysis of radiological, clinical and laboratory data from patients who underwent LRT sampling (blind nasotracheal aspiration or bronchial washing) for suspected COVID-19 after 2 negative NPS. Chest CTs were reviewed by two blinded radiologist using the Radiological Society of North America score for analysis purpose.Results: SARS-CoV-2 was detected in 7 out of 59 patients (11.9%). No clinical or laboratory value were found to correlate with positive test. CT scan showed good sensitivity (71.4%) and accuracy (81.3%), with a very high NPV (95.7%). Features scored as 'typical' showed good correlation with SARS-CoV2 detection on LRT. No complications nor staff’s infections were reported. Conclusions: In suspect cases with at least 2 negative swabs CT scan revision can be helpful in ruling out SARS-CoV-2 infection. In selected cases lower respiratory tract sampling can help in confirming COVID-19 in cases with consistent CT features.

Background: Understanding the level of patients’ satisfaction with treatment and its determinants have the potential to impact therapeutic management and clinical outcome in chronic conditions such as chronic obstructive pulmonary disease (COPD). Methods: A national, multicenter, longitudinal, observational study of COPD from 20 Italian pulmonary centers to explore patients’ satisfaction to treatment [assessed by the Treatment Satisfaction Questionnaire, 9 items (TSQM-9)] and association with clinical parameters [including dyspnea score, COPD Assessment Test (CAT) score, exacerbation rate], adherence to treatment [Morisky Medication-Taking Adherence Scale (MMAS-4)], illness perception [evaluated by Brief Illness Perception Questionnaire (B-IPQ)] in a 1-year follow up. Results: A total of 401 COPD patients were enrolled [69.4% group B Global Initiative for COPD (GOLD), considering 366 patients with available GOLD 2017 classification at enrollment]. At enrollment, satisfaction with treatment was moderate, being TSQM-9 mean scores for effectiveness 64.2 [95% confidence interval (CI) 62.5–65.9], for convenience 75.8 (95% CI 74.2–77.3), and for global satisfaction 65.7 (95% CI 64.0–67.4). Global satisfaction was negatively associated with disease perception (β = −0.4709, p Conclusions: The results of this real-life study showed that the patients’ satisfaction with treatments is only moderate in COPD. A high grade of patients’ satisfaction is associated mainly with a low perception of the disease, high adherence to treatment and lower level of dyspnea. Trial Registration: Clinicaltrials.gov identifier: NCT02689492 The reviews of this paper are available via the supplemental material section.

Introduction: small-airway impairments contribute to the severity of the clinical manifestation of asthma. Small airway abnormalities are key elements in the pathogenesis of COPD Aims: to evaluate small-airway impairment in patients with severe asthma (SA), moderate controlled asthma (CA) and COPD. To evaluate correlation between small airway abnormalities and symptoms in these patients Methods: COPD (n=21), SA patients (n=35; of which 45% treated with monoclonal antibody biological therapies) and CA patients (n=19) matched for age, gender and degree of pre¬bronchodilator airflow obstruction were enrolled into the study. The inhomogeneity of small airways ventilation was evaluated by SBNWT (dN2) phase 3 slope and the contribution of small airways resistance by iOS (R5¬R20). Patients were asked to record daily symptom severity scores for dyspnoea, sputum and cough. The use of rescue medication (puffs/week) was also recorded Results: In SA patients dN2 and R5-R20 levels were significantly higher compare to CA patients (p Conclusions: Higher level of small-airway impairment was found in COPD compare to asthma. Among asthmatics, the small-airway impairment was significantly higher in SA and in particular in patients not receiving biologics. In SA patients the magnitude of small-airway impairment correlated with the severity of the clinical manifestation of the disease

Introduction: Some patients with COPD are prone to develop frequent exacerbations. The identification of biomarkers able to predict exacerbation frequency will give the opportunity to apply tailored pharmacological strategies to these patients. Recently, there has been interest in blood eosinophils as predictor of corticosteroid responsiveness in preventing exacerbation. Aim: To evaluate blood eosinophil levels in COPD patients with frequent (≥2 episodes per year) or infrequent (≤1 episodes per year) exacerbations. Methods: Single-centre retrospective cohort study. Patients were included in the analysis if regularly followed for at least 2 years and if a blood cell count was performed as routine practice in stable condition within 6 months prior to study analysis. Results: 142 COPD patients were included in the analysis (age 72.5±6.8 years; post-BD FEV1% 55.5±13.8% predicted). 32% of patients met the criteria of frequent exacerbators. No difference in: lung function; demographic characteristics and inhaled treatments were found between frequent and infrequent excacerbators. Significant higher blood eosinophil levels were found in frequent vs infrequent excacerbators (296±37 vs 202.60±14 cells/mcl respectively; p 0.05). Among subjects with severe airflow obstruction, patients with frequent exacerbations had significantly higher eosinophil levels than those with infrequent exacerbations (p Conclusions: In our cohort of COPD patients, higher levels of blood eosinophil counts were found in subjects with frequent exacerbations.

Inhaled corticosteroid-containing medications reduce the frequency of COPD exacerbations (mainly infectious in origin) while paradoxically increasing the risk of other respiratory infections.The aim was to determine the effects of inhaled corticosteroids on airway microbial load in COPD patients and evaluate the influence of the underlying inflammatory profile on airway colonisation and microbiome.This is a proof-of-concept prospective, randomised, open-label, blinded endpoint study. Sixty patients with stable moderate COPD were randomised to receive one inhalation twice daily of either a combination of salmeterol 50 μg plus fluticasone propionate 500 μg or salmeterol 50 μg for 12 months. The primary outcome was the change of sputum bacterial loads over the course of treatment.Compared with salmeterol, 1-year treatment with salmeterol plus fluticasone was associated with a significant increase in sputum bacterial load (p=0.005), modification of sputum microbial composition and increased airway load of potentially pathogenic bacteria. The increased bacterial load was observed only in inhaled corticosteroid-treated patients with lower baseline sputum or blood eosinophil (≤2%) levels but not in patients with higher baseline eosinophils.Long-term inhaled corticosteroid treatment affects bacterial load in stable COPD. Lower eosinophil counts are associated with increased airway bacterial load.

There are increasing data to support the "hygiene" and "microbiota" hypotheses of a protective role of infections in modulating the risk of subsequent development of asthma. There is less evidence that respiratory infections can actually cause the development of asthma. There is some evidence that rhinovirus respiratory infections are associated with the development of asthma, particularly in childhood, whereas these infections in later life seem to have a weaker association with the development of asthma. The role of bacterial infections in chronic asthma remains unclear. This article reviews the available evidence indicating that asthma may be considered as a chronic infectious disease.

Cigarette smoking enhances small airways impairment in asthmatic patients http://ow.ly/WWUky

Rationale: The use of inhaled corticosteroid (ICS) in COPD reduces the risk of exacerbations but it is associated with increased risk of pneumonia Aims and objectives: We compared the effects of 1-year treatment with either Fluticasone propionate/Salmeterol (SALM/FP) or Salmeterol (SALM) alone on sputum bacterial and viral loads in moderate COPD patients Methods: 60 stable moderate COPD patients were recruited and randomized to receive either SALM/FP 50/500 mcg bid or SALM 50 mcg bid for 12 months. After baseline assessment, patients were seen every 3 months. At each visit lung function was assessed and induced sputum collected to evaluate the inflammatory cell profile and quantitative/qualitative bacteriology/virology Results: After 1-year treatment, sputum total bacterial load significantly increased in the SALM/FP group (Δ +1.3[-3 – 5] Log 10 CFU/ml, p 10 CFU/ml, p>0.05). A non-significant increase of potentially pathogen bacterial load was observed in sputum samples of SALM/FP treated patients. No difference in respiratory virus detection rate was observed between the two arms. The increase in airway total bacterial load did not correlate with any of the clinical outcomes assessed during the study. Among SALM/FP treated patients, the increase in total bacterial load occurred in those subjects with no sputum eosinophil detection throughout the study (p=ns) Conclusions: In moderate COPD patients ICS-treatment is associated with a significant increase in airway total bacterial load, not related to clinical outcomes, when eosinophils are persistently absent in sputum samples The study was supported by unrestricted grant from GlaxoSmithKline.

Background. Inhalation of thermal water with antioxidant properties is empirically used for COPD.Aims. To evaluate the effects of sulphurous thermal water (reducing agents) on airway oxidant stress and clinical outcomes in COPD.Methods. Forty moderate-to-severe COPD patients were randomly assigned to receive 12-day inhalation with sulphurous thermal water or isotonic saline. Patients were assessed for superoxide anion (O2-) production in the exhaled breath condensate and clinical outcomes at recruitment, the day after the conclusion of the 12-day inhalation treatment, and one month after the end of the inhalation treatment.Results. Inhalation of reducing agents resulted in a significant reduction ofO2-production in exhaled breath condensate of COPD patients at the end of the inhalatory treatment and at followup compared to baseline. A significant improvement in the COPD assessment test (CAT) questionnaire was shown one month after the end of the inhalatory treatment only in patients receiving sulphurous water.Conclusion. Thermal water inhalation produced anin vivoantioxidant effect and improvement in health status in COPD patients. Larger studies are required in order to evaluate whether inhalation of thermal water is able to modify relevant clinical outcomes of the disease (the study was registered at clinicaltrial.gov—identifier:NCT01664767).

There are increasing data to support the "hygiene" and "microbiota" hypotheses of a protective role of infections in modulating the risk of subsequent development of asthma. There is less evidence that respiratory infections can actually cause the development of asthma. There is some evidence that rhinovirus respiratory infections are associated with the development of asthma, particularly in childhood, whereas these infections in later life seem to have a weaker association with the development of asthma. The role of bacterial infections in chronic asthma remains unclear. This article reviews the available evidence indicating that asthma may be considered as a chronic infectious disease.