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Celik GE, Aydin O, Gokmen D, Koycu Buhari G, Celebi Sozener Z, Gemicioglu B, Bulut I, Beyaz S, Orcen C, Ozdemir SK, Keren M, Damadoglu E, Yakut T, Kalpaklioglu AF, Baccioglu A, Yalim SA, Yilmaz I, Koca Kalkan I, Uysal MA, Ozgun Niksarlioglu EY, Kalyoncu AF, Karakaya G, Erbay M, Nayci S, Tepetam FM, Gelincik AA, Dirol H, Goksel O, Karaoglanoglu S, Oner Erkekol F, Isik SR, Yildiz F, Yavuz Y, Karadogan D, Bozkurt N, Seker U, Oguzulgen IK, Basyigit I, Baris SA, Yilmazel Ucar E, Erdogan T, Polatli M, Ediger D, Gunaydin FE, Turk M, Pur L, Katran ZY, Sekibag Y, Aykac EF, Mungan D, Gul O, Cengiz A, Akkurt B, Ozden S, Demir S, Unal D, Aslan AF, Can A, Gumusburun R, Bogatekin G, Akten HS, Inan S, Erdinc M, Ogus AC, Kavas M, Polat Yulug D, Cakmak ME, Kaya SB, Alpagat G, Ozgur ES, Uzun O, Tas Gulen S, Pekbak G, Kizilirmak D, Havlucu Y, Donmez H, Arslan B, Cetin GP, Soyyigit S, Kara BY, Pasaoglu Karakis G, Dursun AB, Kendirlinan R, Ozturk AB, Sevinc C, Omeroglu Simsek G, Abadoglu O, Cerci P, Yucel T, Yorulmaz I, Tezcaner ZC, Tatar EC, Suslu AE, Ozer S, Dursun E, Yorgancioglu A. Picturing asthma in Turkey: results from the Turkish adult asthma registry. J Asthma 2023; 60:1973-1986. [PMID: 37096963 DOI: 10.1080/02770903.2023.2206902] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.
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Affiliation(s)
- Gulfem Elif Celik
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Omur Aydin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Derya Gokmen
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Zeynep Celebi Sozener
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
| | - Bilun Gemicioglu
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ismet Bulut
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sengul Beyaz
- Ankara City Hospital Clinic of Immunology and Allergic Diseases, Ankara, Turkey
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Cihan Orcen
- Clinic of Allergy and Immunology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Secil Kepil Ozdemir
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Metin Keren
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ebru Damadoglu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Tugce Yakut
- Clinic of Immunology and Allergic Diseases, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Ayse Fusun Kalpaklioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Ayse Baccioglu
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Sumeyra Alan Yalim
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Insu Yilmaz
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Ilkay Koca Kalkan
- Department of Immunology and Allergy, University of Health Sciences, Ankara Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mehmet Atilla Uysal
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Elif Yelda Ozgun Niksarlioglu
- Department of Chest Diseases, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Fuat Kalyoncu
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gul Karakaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Muge Erbay
- Clinic of Immunology and Allergy Diseases, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Sibel Nayci
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Fatma Merve Tepetam
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Asli Akkor Gelincik
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Hulya Dirol
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ozlem Goksel
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Selen Karaoglanoglu
- Department of Pulmonology, Ordu University, Training and Research Hospital, Ordu, Turkey
| | - Ferda Oner Erkekol
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
- Division of Allergy and Immunology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Sacide Rana Isik
- Adult Allergy and Immunology Department, American Hospital, Istanbul, Turkey
| | - Fusun Yildiz
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
- School of Medicine, Department of Pulmonary Diseases, Cyprus Internatıonal Unıversıty, Cyprus
| | - Yasemin Yavuz
- Department of Biostatistics and Informatics, Ankara University School of Medicine, Ankara, Turkey
| | - Dilek Karadogan
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nurgul Bozkurt
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Ummuhan Seker
- Clinic of Immunology and Allergic Diseases, Bursa City Hospital, Bursa, Turkey
| | | | - Ilknur Basyigit
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Serap Argun Baris
- Faculty of Medicine, Department of Pulmonary Diseases, Kocaeli University, Kocaeli, Turkey
| | - Elif Yilmazel Ucar
- Faculty of Medicine, Department of Pulmonary Disease, Ataturk University, Erzurum, Turkey
| | - Tuba Erdogan
- Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergy, Baskent University, Ankara, Turkey
| | - Mehmet Polatli
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Dane Ediger
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Fatma Esra Gunaydin
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Murat Turk
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
- Clinic of Immunologic and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Leyla Pur
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Zeynep Yegin Katran
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yonca Sekibag
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Enes Furkan Aykac
- Cerrahpaşa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Dilsad Mungan
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ozcan Gul
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Cengiz
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Bulent Akkurt
- Department of Chest Diseases, Division of Allergy and Immunology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Seyma Ozden
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semra Demir
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ayse Feyza Aslan
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Ali Can
- Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University, Istanbul, Turkey
| | - Reyhan Gumusburun
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Gulhan Bogatekin
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Hatice Serpil Akten
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Sinem Inan
- Faculty of Medicine, Pulmonary, Immunology and Allergy, Ege University, Izmir, Turkey
| | - Munevver Erdinc
- Faculty of Medicine, Department of Pulmonology, Ege University, Izmir, Turkey
| | - Aliye Candan Ogus
- Faculty of Medicine, Department of Chest Diseases, Akdeniz University, Antalya, Turkey
| | - Murat Kavas
- Department of Immunology and Allergy, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Demet Polat Yulug
- Clinic of Chest Diseases, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Mehmet Erdem Cakmak
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Saltuk Bugra Kaya
- Faculty of Medicine, Department of Chest Diseases, Division of Allergy and Clinical Immunology, Hacettepe University, Ankara, Turkey
| | - Gulistan Alpagat
- Faculty of Medicine, Department of Allergy and Immunology, Kirikkale University, Kirikkale, Turkey
| | - Eylem Sercan Ozgur
- Faculty of Medicine, Department of Chest Diseases, Mersin University, Mersin, Turkey
| | - Oguz Uzun
- Department of Pulmonary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sule Tas Gulen
- School of Medicine, Department of Pulmonology, Aydin Adnan Menderes University, Aydin, Turkey
| | - Gulseren Pekbak
- Faculty of Medicine, Department of Chest Diseases, Division of Immunology and Allergy, Bursa Uludag University, Bursa, Turkey
| | - Deniz Kizilirmak
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Yavuz Havlucu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
| | - Halil Donmez
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Bahar Arslan
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Gulden Pacaci Cetin
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Erciyes University, Kayseri, Turkey
| | - Sadan Soyyigit
- Faculty of Medicine, Ankara City Hospital, Clinic of Immunology and Allergic Diseases, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bilge Yilmaz Kara
- School of Medicine, Department of Chest Diseases, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Gulden Pasaoglu Karakis
- School of Medicine, Department of Chest Diseases, Adult Allergy-Immunology Unit, Biruni University, Istanbul, Turkey
| | - Adile Berna Dursun
- School of Medicine, Department of Chest Diseases, Division of Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Turkey
- Medical School, Department of Respiratory Medicine, Lokman Hekim University, Ankara, Turkey
| | - Resat Kendirlinan
- Clinic of Immunology and Allergic Diseases, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ayse Bilge Ozturk
- Faculty of Medicine, Department of Allergy and Immunology, Medeniyet University, Istanbul, Turkey
| | - Can Sevinc
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | - Gokcen Omeroglu Simsek
- School of Medicine, Department of Respiratory Diseases, Dokuz Eylul University, Izmir, Turkey
| | | | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Van Regional Training and Research Hospital, Van, Turkey
| | - Taskin Yucel
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Irfan Yorulmaz
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Zahide Ciler Tezcaner
- School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara University, Ankara, Turkey
| | - Emel Cadalli Tatar
- Department of Otolaryngology, University of Health Sciences, Etlik City Hospital, Ankara, Turkey
| | - Ahmet Emre Suslu
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
- Ahmet Emre Suslu Private Ear Nose and Throat Clinic, Ankara, Turkey
| | - Serdar Ozer
- School of Medicine Department of Ear Nose and Throat, Hacettepe University, Ankara, Turkey
| | - Engin Dursun
- Faculty of Medicine, Department of Otorhinolaryngology, Lokman Hekim University, Ankara, Turkey
| | - Arzu Yorgancioglu
- Faculty of Medicine, Department of Pulmonology, Manisa Celal Bayar University, Manisa, Turkey
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Tiotiu A, Novakova P, Baiardini I, Bikov A, Chong-Neto H, de-Sousa JC, Emelyanov A, Heffler E, Fogelbach GG, Kowal K, Labor M, Mihaicuta S, Nedeva D, Novakova S, Steiropoulos P, Ansotegui IJ, Bernstein JA, Boulet LP, Canonica GW, Dubuske L, Nunes C, Ivancevich JC, Santus P, Rosario N, Perazzo T, Braido F. Manifesto on united airways diseases (UAD): an Interasma (global asthma association - GAA) document. J Asthma 2021; 59:639-654. [PMID: 33492196 DOI: 10.1080/02770903.2021.1879130] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The large amount of evidence and the renewed interest in upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). METHODS Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto developed by Interasma scientific network (INES) members. RESULTS The manifesto describes the evidence gathered to date and defines, states, advocates, and proposes issues on UAD (rhinitis, rhinosinusitis and nasal polyposis), and concomitant/comorbid lower airways disorders (asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, obstructive sleep apnoea) with the aim of challenging assumptions, fostering commitment, and bringing about change. UAD refers to clinical pictures characterized by the coexistence of upper and lower airways involvement, driven by a common pathophysiological mechanism, leading to a greater burden on patient's health status and requiring an integrated diagnostic and therapeutic plan. The high prevalence of UAD must be taken into account. Upper and lower airways diseases influence disease control and patient's quality of life. CONCLUSIONS Patients with UAD need to have a timely and adequate diagnosis, treatment, and, when recommended, referral for management in a specialized center. Diagnostic testing including skin prick or serum specific IgE, lung function, fractional exhaled nitric oxide (FeNO), polysomnography, allergen-specific immunotherapies, biological therapies and home based continuous positive airway pressure (CPAP) whenever these are recommended, should be part of the management plan for UAD. Education of medical students, physicians, health professionals, patients and caregivers on the UAD is needed.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Nancy, France.,EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | - Plamena Novakova
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andras Bikov
- Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Herberto Chong-Neto
- Division of Allergy and Immunology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
| | - Jaime Correia- de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University named after I.I.Mechnikov, St-Petersburg, Russia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Guillermo Guidos Fogelbach
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria.,Instituto Politécnico Nacional, Escuela Nacional de Medicina y Homeopatía, Laboratorio de Bioquímica Estructural, Ciudad de México, México
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | | | - Stefan Mihaicuta
- Pulmonology Department, Cardio Prevent Foundation, University of Medicine and Pharmacy "Dr Victor Babes", Timisoara, Romania
| | - Denislava Nedeva
- Clinic of Clinical Allergy, Medical University Sofia, Sofia, Bulgaria
| | - Sylvia Novakova
- Allergy Unit of Internal Consulting Department, University Hospital "St. George", Plovdiv, Bulgaria
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Jonathan A Bernstein
- Department of Internal Medicine, Division of Immunology, Allergy Section University of Cincinnati, Cincinnati, OH, USA
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Lawrence Dubuske
- Division of Allergy and Immunology, Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Carlos Nunes
- Centro de ImmunoAlergologia de Algarve, Porto, Portugal
| | - Juan Carlos Ivancevich
- Immunology Department, Faculty of Medicine, del Salvador University, Buenos Aires, Argentina
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences, University of Milan, Division of Respiratory Diseases "L. Sacco" Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Tommaso Perazzo
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Fulvio Braido
- Department of Internal Medicine, University of Genoa, Genova, Italy.,Respiratory Unit for Continuity of Care IRCCS, Ospedale Policlinico San Martino, Genova, Italy
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