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Zinna G, Pipitò L, Colomba C, Scichilone N, Licata A, Barbagallo M, Russo A, Almasio PL, Coppola N, Cascio A. COVID-19: The Development and Validation of a New Mortality Risk Score. J Clin Med 2024; 13:1832. [PMID: 38610597 PMCID: PMC11012743 DOI: 10.3390/jcm13071832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has found the whole world unprepared for its correct management. Italy was the first European country to experience the spread of the SARS-CoV-2 virus at the end of February 2020. As a result of hospital overcrowding, the quality of care delivered was not always optimal. A substantial number of patients admitted to non-ICU units could have been treated at home. It would have been extremely useful to have a score that, based on personal and clinical characteristics and simple blood tests, could have predicted with sufficient reliability the probability that a patient had or did not have a disease that could have led to their death. This study aims to develop a scoring system to identify which patients with COVID-19 are at high mortality risk upon hospital admission, to expedite and enhance clinical decision making. Methods: A retrospective analysis was performed to develop a multivariable prognostic prediction model. Results: Derivation and external validation cohorts were obtained from two Italian University Hospital databases, including 388 (10.31% deceased) and 1357 (7.68% deceased) patients with confirmed COVID-19, respectively. A multivariable logistic model was used to select seven variables associated with in-hospital death (age, baseline oxygen saturation, hemoglobin value, white blood cell count, percentage of neutrophils, platelet count, and creatinine value). Calibration and discrimination were satisfactory with a cumulative AUC for prediction mortality of 0.924 (95% CI: 0.893-0.944) in derivation cohorts and 0.808 (95% CI: 0.886-0.828) in external validation cohorts. The risk score obtained was compared with the ISARIC 4C Mortality Score, and with all the other most important scores considered so far, to evaluate the risk of death of patients with COVID-19. It performed better than all the above scores to evaluate the predictability of dying. Its sensitivity, specificity, and AUC were higher than the other COVID-19 scoring systems when the latter were calculated for the 388 patients in our derivation cohort. Conclusions: In conclusion, the CZ-COVID-19 Score may help all physicians by identifying those COVID-19 patients who require more attention to provide better therapeutic regimens or, on the contrary, by identifying those patients for whom hospitalization is not necessary and who could therefore be sent home without overcrowding healthcare facilities. We developed and validated a new risk score based on seven variables for upon-hospital admission of COVID-19 patients. It is very simple to calculate and performs better than all the other similar scores to evaluate the predictability of dying.
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Affiliation(s)
- Giuseppe Zinna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
- Department of Surgery, Dentistry, Paediatrics, and Gynaecology, Division of Cardiac Surgery, University of Verona Medical School, 37129 Verona, Italy
| | - Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
- Pediatric Infectious Disease Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy
| | - Nicola Scichilone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Anna Licata
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Mario Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Antonio Russo
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80131 Naples, Italy; (A.R.); (N.C.)
| | - Piero Luigi Almasio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Nicola Coppola
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80131 Naples, Italy; (A.R.); (N.C.)
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
- Infectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
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Benfante A, Tomasello A, Caponetto C, Battaglia S, Scichilone N. Are nighttime respiratory symptoms assessed by asthma control test affected by comorbidities? J Asthma 2024:1-6. [PMID: 38446620 DOI: 10.1080/02770903.2024.2327036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Nocturnal symptoms are common in the asthmatic population, reflecting an exaggerated airway narrowing overnight due to several factors; it is questioned to what extent the awakenings documented in the clinical assessment of asthma control are due to the disease itself or to comorbidities. To answer this question, we aimed to evaluate to what proportion rhinitis, gastroesophageal reflux and the likelihood of being affected by OSAS were related to poor asthma control, by means of ACT evaluation. METHODS Asthmatics attending the outpatient clinic were enrolled and administered the following questionnaires: ACT, Total 5 Symptom Score, GERD Impact Scale, Pittsburgh Sleep Quality Index and the Sleep Disorders Questionnaire. RESULTS One-hundred consecutive patients (M/F: 42/58, mean age 52 ± 15 years) were recruited. According to the ACT findings, 14 asthmatics resulted as fully controlled (FC, ACT equal to 25), 55 partially controlled (PC, 25 < ACT >19) and 31 as uncontrolled (UC, ACT <19). GERD was not associated with the ACT score neither did rhinitic symptomatology. On the other hand, the PSQI scores appeared to significantly increase with the lack of symptom control: FC, 2.0 (1-4); PC, 3.5 (2-5); UC, 6.6 (4-8) (p = 0.002). The SA-SDQ questionnaire results significantly increased with the loss of asthma control: FC, 11.0 (9-12); PC, 12.5 (10-14); UC, 15.1 (14-16) (p = 0.005). CONCLUSIONS These results confirm and extend previous findings showing that there is a higher likelihood that underlying unknown sleep disturbances worsen asthma control, suggesting that a more comprehensive assessment is necessary to clarify the cause of nocturnal symptoms in asthma.
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Affiliation(s)
- Alida Benfante
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Alessandra Tomasello
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Chiara Caponetto
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Salvatore Battaglia
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
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Santus P, Di Marco F, Braido F, Contoli M, Corsico AG, Micheletto C, Pelaia G, Radovanovic D, Rogliani P, Saderi L, Scichilone N, Tanzi S, Vella M, Boarino S, Sotgiu G, Solidoro P. Exacerbation Burden in COPD and Occurrence of Mortality in a Cohort of Italian Patients: Results of the Gulp Study. Int J Chron Obstruct Pulmon Dis 2024; 19:607-618. [PMID: 38444551 PMCID: PMC10913796 DOI: 10.2147/copd.s446636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/28/2024] [Indexed: 03/07/2024] Open
Abstract
Objective To describe the burden of moderate to severe exacerbations and all-cause mortality; the secondary objectives were to analyze treatment patterns and changes over follow-up. Design Observational, multicenter, retrospective, cohort study with a three year follow-up period. Setting Ten Italian academic secondary- and tertiary-care centers. Participants Patients with a confirmed diagnosis of COPD referring to the outpatient clinics of the participating centers were retrospectively recruited. Primary and Secondary Outcome Measures Annualized frequency of moderate and severe exacerbations stratified by exacerbation history prior to study enrollment. Patients were classified according to airflow obstruction, GOLD risk categories, and divided in 4 groups: A = no exacerbations; B = 1 moderate exacerbation; C = 1 severe exacerbation; D = ≥2 moderate and/or severe exacerbations. Overall all-cause mortality stratified by age, COPD category, and COPD therapy. A logistic regression model assessed the association of clinical characteristics with mortality. Results 1111 patients were included (73% males), of which 41.5% had a history of exacerbations. As expected, the proportion of patients experiencing ≥1 exacerbation during follow-up increased according to pre-defined study risk categories (B: 79%, C: 84%, D: 97.4%). Overall, by the end of follow-up, 45.5% of patients without a history of exacerbation experienced an exacerbation (31% of which severe), and 13% died. Deceased patients were significantly older, more obstructed and hyperinflated, and more frequently active smokers compared with survivors. Severe exacerbations were more frequent in patients that died (23.5%, vs 10.2%; p-value: 0.002). Chronic heart failure and ischemic heart disease were the only comorbidities associated with a higher odds ratio (OR) for death (OR: 2.2, p-value: 0.001; and OR: 1.9, p-value: 0.007). Treatment patterns were similar in patients that died and survivors. Conclusion Patients with a low exacerbation risk are exposed to a significant future risk of moderate/severe exacerbations. Real life data confirm the strong association between mortality and cardiovascular comorbidities in COPD.
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Affiliation(s)
- Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, Università degli Studi di Milano Pneumology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fulvio Braido
- Department of Internal Medicine (DiMI), Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Marco Contoli
- Department of Translational Medicine, Respiratory Section, University of Ferrara, Ferrara, Italy
| | - Angelo Guido Corsico
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Claudio Micheletto
- Cardio-Thoracic Department, Respiratory Unit, University Integrated Hospital, Verona, Italy
| | - Girolamo Pelaia
- Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy
| | - Dejan Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome ”Tor Vergata”, Division of Respiratory Medicine, University Hospital ”Tor Vergata”, Rome, Italy
| | - Laura Saderi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | | | | | | | - Giovanni Sotgiu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Paolo Solidoro
- Department of Medical Sciences, University of Turin, S.C. Pneumologia, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, Italy
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Chessari C, Simonetta E, Amati F, Nigro M, Stainer A, Sotgiu G, Puci M, Gramegna A, Blasi F, Morlacchi LC, Buscemi AAMD, Conio V, Sanci V, Corsico AG, Faverio P, Michalak W, Luppi F, Crimi C, Vancheri C, Campisi R, Vulpi MR, Carpagnano GE, Cicchetti M, Sekretna K, Scichilone N, Battaglia S, Aliberti S. Diagnostic delay in bronchiectasis: an Italian perspective. ERJ Open Res 2024; 10:00713-2023. [PMID: 38500794 PMCID: PMC10945380 DOI: 10.1183/23120541.00713-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/10/2023] [Indexed: 03/20/2024] Open
Abstract
It takes ∼3.5 years to reach a diagnosis of bronchiectasis from onset of symptoms: the long patient's journey in Italy https://bit.ly/46XMWAz.
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Affiliation(s)
- Carlo Chessari
- PROMISE Department, University of Palermo, Palermo, Italy
| | | | - Francesco Amati
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mattia Nigro
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Anna Stainer
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Letizia Corinna Morlacchi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Agata Alba Maria Domenica Buscemi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Valentina Conio
- Respiratory Diseases Division, Cardiac, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Vincenzo Sanci
- Respiratory Diseases Division, Cardiac, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Angelo G. Corsico
- Respiratory Diseases Division, Cardiac, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Weronika Michalak
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabrizio Luppi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Carlo Vancheri
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Raffaele Campisi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Maria Rosaria Vulpi
- Respiratory Diseases Section, University Hospital Policlinico di Bari, University of Bari, Bari, Italy
| | | | - Marianna Cicchetti
- Respiratory Diseases Section, University Hospital Policlinico di Bari, University of Bari, Bari, Italy
| | - Kseniia Sekretna
- Department of Occupational Diseases, Clinical Immunology and Clinical Pharmacology, Dnipro State Medical University, Dnipro, Ukraine
| | | | | | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Carpagnano GE, Portacci A, Nolasco S, Detoraki A, Vatrella A, Calabrese C, Pelaia C, Montagnolo F, Scioscia G, Valenti G, D’Amato M, Caiaffa MF, Triggiani M, Scichilone N, Crimi C. Features of severe asthma response to anti-IL5/IL5r therapies: identikit of clinical remission. Front Immunol 2024; 15:1343362. [PMID: 38327518 PMCID: PMC10848329 DOI: 10.3389/fimmu.2024.1343362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Clinical remission (CliR) achievement has been recognized as a new potential outcome in severe asthma. Nevertheless, we still lack a detailed profile of what features could better identify patients undergoing clinical remission. In this study, we aim to address this issue, tracing a possible identikit of patients fulfilling remission criteria. Methods We enrolled 266 patients with severe eosinophilic asthma (SEA) treated with a 12-month course of anti-IL5/IL5 receptor (IL5r) monoclonal antibodies. Patients with no exacerbation, OCS withdrawal, ACT ≥ 20 and FEV1 ≥ 80% after 1 year of biologic treatment were classified as in clinical remission. Results 30.5% of the enrolled patients achieved remission after biologic administration. CliR group showed a lower number of baseline asthma exacerbations and better lung function parameters, with a trend for higher ACT scores and a less frequent history of a positive skin prick test. CliR achievement was unlikely in presence of a higher BMI, a positive skin prick test, an increased number of asthma exacerbations before biologic treatment, anti-muscarinic administration, and a previous diagnosis of EGPA, bronchiectasis or osteoporosis. In contrast, a better lung function, an increased blood eosinophilic count, the presence of chronic rhinosinusitis with nasal polyps and a more frequent use of reliever therapy predicts remission development. Changes in exacerbations number, OCS use, ACT scores and FEV1% between remittent and non-remittent patients arise at specific follow up timepoints and are positively associated with CliR achievement. Discussion anti-IL5/IL5r biologics can induce CliR in a proportion of patients with SEA. Patients achieving remission demonstrate specific clinical, functional and inflammatory features, as well as a specific moment of improvement in all the CliR items.
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Affiliation(s)
- Giovanna Elisiana Carpagnano
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University “Aldo Moro”, Bari, Italy
| | - Andrea Portacci
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University “Aldo Moro”, Bari, Italy
| | - Santi Nolasco
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aikaterini Detoraki
- Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity, Azienda Ospedaliera Universitaria Federico II, Napoli, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cecilia Calabrese
- Unitá Operativa (UO) Clinica Pneumologica SUN, Dipartimento Pneumologia ed Oncologia, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Francesca Montagnolo
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University “Aldo Moro”, Bari, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Maria D’Amato
- Unitá Operativa Semplice Dipartimentale (UOSD) Malattie Respiratorie “Federico II”, Ospedale Monaldi, Azienda Ospedaliera (AO) Dei Colli, Naples, Italy
| | - Maria Filomena Caiaffa
- Department of Medical and Surgical Sciences, School and Chair of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Scichilone N, Whittamore A, White C, Nudo E, Savella M, Lombardini M. The patient journey in Chronic Obstructive Pulmonary Disease (COPD): a human factors qualitative international study to understand the needs of people living with COPD. BMC Pulm Med 2023; 23:506. [PMID: 38093262 PMCID: PMC10720133 DOI: 10.1186/s12890-023-02796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient's daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance. The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease. METHODS Adults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs. RESULTS The 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32-70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families. CONCLUSIONS These results could aid in the creation of new ideas and concepts to improve our patient's quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs.
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Affiliation(s)
- Nicola Scichilone
- Division of Respiratory Medicine, Department PROMISE, "Giaccone" University Hospital, University of Palermo, Palermo, Italy.
| | | | | | - Elena Nudo
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
| | - Massimo Savella
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
| | - Marta Lombardini
- Chiesi Farmaceutici S.P.A, Via Paradigna 131/A - 43122, Parma, Italy
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Fallucca A, Ferro P, Mazzeo L, Zagra L, Cocciola E, Oliveri R, Tuttolomondo A, Benfante A, Battaglia S, Scichilone N, Veronese N, Affronti M, Barbagallo M, Casuccio A, Vitale F, Restivo V. Impact of Actively Offering Influenza Vaccination to Frail People during Hospitalisation: A Pilot Study in Italy. Vaccines (Basel) 2023; 11:1829. [PMID: 38140235 PMCID: PMC10747536 DOI: 10.3390/vaccines11121829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Despite the worldwide recommendations for influenza immunisation, vaccination coverage for patients exposed to the highest risk of severe complications is still far from the optimal target. The need to take advantage of alternative methods to provide vaccination is essential. This study presents a hospital-based strategy which offers influenza vaccination to inpatients at discharge. This study was conducted during the 2022-2023 influenza season at the University Hospital of Palermo. A questionnaire was administered to identify the determinants for the acceptance of influenza vaccination in the frail population. Overall, 248 hospitalised patients were enrolled, of which 56.1% were female and 52.0% were over 65 years of age. The proportion of patients vaccinated against influenza during hospitalisation was 62.5%, an increase of 16% in influenza vaccination uptake among frail people in comparison with the previous influenza season (46.8% vaccinated during the 2021-22 influenza season). Factors significantly associated with vaccination acceptance were the following: to have received influenza vaccine advice from hospital healthcare workers (OR = 3.57, p = 0.001), to have been previously vaccinated for influenza (OR = 3.16 p = 0.005), and to have had a low level of education (OR = 3.56, p = 0.014). This study showed that offering influenza vaccination to hospitalised patients could be an effective strategy to increase vaccination coverage in the most vulnerable population, and these findings could be useful for planning and improving future influenza vaccination campaigns.
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Affiliation(s)
- Alessandra Fallucca
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy; (P.F.); (L.M.); (L.Z.); (A.C.); (F.V.)
| | - Patrizia Ferro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy; (P.F.); (L.M.); (L.Z.); (A.C.); (F.V.)
| | - Luca Mazzeo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy; (P.F.); (L.M.); (L.Z.); (A.C.); (F.V.)
| | - Luigi Zagra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy; (P.F.); (L.M.); (L.Z.); (A.C.); (F.V.)
| | - Elena Cocciola
- Internal Medicine and Stroke Care Ward, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties “G. 6 D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.C.); (R.O.); (A.T.)
| | - Roberta Oliveri
- Internal Medicine and Stroke Care Ward, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties “G. 6 D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.C.); (R.O.); (A.T.)
| | - Antonino Tuttolomondo
- Internal Medicine and Stroke Care Ward, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties “G. 6 D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.C.); (R.O.); (A.T.)
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Nicola Veronese
- Geriatric Unit, Department of Medicine, University of Palermo, 90133 Palermo, Italy; (N.V.); (M.B.)
| | - Marco Affronti
- Internal Medicine Unit, AOU Paolo Giaccone Policlinic, General Hospital, 90133 Palermo, Italy;
| | - Mario Barbagallo
- Geriatric Unit, Department of Medicine, University of Palermo, 90133 Palermo, Italy; (N.V.); (M.B.)
| | - Alessandra Casuccio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy; (P.F.); (L.M.); (L.Z.); (A.C.); (F.V.)
| | - Francesco Vitale
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy; (P.F.); (L.M.); (L.Z.); (A.C.); (F.V.)
| | | | - the AOUP Inpatient Vaccination Team
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy; (P.F.); (L.M.); (L.Z.); (A.C.); (F.V.)
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8
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Sousa-Pinto B, Louis G, Rodrigues J, Giuliano AFM, Baiardini I, Braido F, Czarlewski W, Bedbrook A, Haahtela T, Valiulis A, Brussino L, Cecchi L, Cruz AA, Gemicioglu B, Fokkens WJ, Ivancevich JC, Klimek L, Kraxner H, Kuna P, Kupczyk M, Kvedariene V, Larenas-Linnemann D, Louis R, Nadif R, Niedoszytko M, Okamoto Y, Ollert M, Papadopoulos NG, Patella V, Pawankar R, Pham-Thi N, Pfaar O, Regateiro FS, Roche N, Rouadi PW, Samolinski B, Sastre J, Savouré M, Scichilone N, Sheikh A, Taborda-Barata L, Toppila-Salmi S, Yorgancioglu A, Zidarn M, Anto JM, Zuberbier T, Canonica GW, Ventura MT, Fonseca JA, Pétré B, Bousquet J. Impairment of EQ-5D-5L Domains According to Allergic Rhinitis and Asthma Control: A MASK-air Real-World Study. J Allergy Clin Immunol Pract 2023; 11:3742-3751.e9. [PMID: 37572753 DOI: 10.1016/j.jaip.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND EQ-5D-5L (EuroQOL, 5 Domains, 5 Levels) is a widely used health-related quality-of-life instrument, comprising 5 domains. However, it is not known how each domain is impacted by rhinitis or asthma control. OBJECTIVE To assess the association between rhinitis or asthma control and the different EQ-5D-5L domains using data from the MASK-air mHealth app. METHODS In this cross-sectional study, we assessed data from all MASK-air users (2015-2021; 24 countries). For the levels of each EQ-5D-5L domain, we assessed rhinitis and asthma visual analog scales (VASs) and the combined symptom-medication score (CSMS). We built ordinal multivariable models assessing the adjusted association between VAS/CSMS values and the levels of each EQ-5D-5L domain. Finally, we compared EQ-5D-5L data from users with rhinitis and self-reported asthma with data from users with rhinitis alone. RESULTS We assessed 5354 days from 3092 users. We observed an association between worse control of rhinitis or asthma (higher VASs and CSMS) and worse EQ-5D-5L levels. In multivariable models, all VASs and the CSMS were associated with higher levels of pain/discomfort and daily activities. For anxiety/depression, the association was mostly observed for rhinitis-related tools (VAS nose, VAS global, and CSMS), although the presence of self-reported asthma was also associated with worse anxiety/depression. Worse mobility ("walking around") was particularly associated with VAS asthma and with the presence of asthma. CONCLUSIONS A worse rhinitis control and a worse asthma control are associated with higher EQ-5D-5L levels, particularly regarding pain/discomfort and activity impairment. Worse rhinitis control is associated with worse anxiety/depression, and poor asthma control with worse mobility.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Gilles Louis
- Department of Public Health, University of Liège, Liège, Belgium
| | - Jorge Rodrigues
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; Otorhinolaryngology Department, Centro Hospitalar Universitário de S João, EPE, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Antonio Francesco Maria Giuliano
- Department of Internal Medicine 'A. Murri' and Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - Ilaria Baiardini
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fulvio Braido
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Anna Bedbrook
- MASK-air, Montpellier, France; ARIA, Montpellier, France
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Arunas Valiulis
- Interdisciplinary Research Group of Human Ecology, Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania; European Academy of Paediatrics, (EAP/UEMS-SP), Brussels, Belgium
| | - Luisa Brussino
- Department of Medical Sciences, University of Torino, Torino, Italy; Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | | | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Pathology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Désirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Rachel Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Yoshitaka Okamoto
- Chiba Rosai Hospital, Chiba, Japan; Chiba University Hospital, Chiba, Japan
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark; Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
| | | | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy; Agency of Health ASL, Salerno, Italy; Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Nhân Pham-Thi
- Ecole Polytechnique de Palaiseau, Palaiseau, France; IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France; Université Paris Cité, Paris, France
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Nicolas Roche
- Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France; UMR 1016, Institut Cochin, Paris, France
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain
| | - Marine Savouré
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | | | - Aziz Sheikh
- Usher Institute, the University of Edinburgh, Edinburgh, United Kingdom
| | - Luís Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal; UBIAir-Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia; University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Torsten Zuberbier
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria Teresa Ventura
- Department of Internal Medicine 'A. Murri' and Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy; Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy
| | - João A Fonseca
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - Jean Bousquet
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Institute of Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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9
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Canonica GW, Blasi F, Carpagnano GE, Guida G, Heffler E, Paggiaro P, Allegrini C, Antonelli A, Aruanno A, Bacci E, Bagnasco D, Beghè B, Bonavia M, Bonini M, Brussino L, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Caruso C, Cavallini M, Chieco Bianchi F, Conte ME, Corsico AG, Cosmi L, Costantino M, Costanzo G, Crivellaro M, D'Alò S, D'Amato M, Detoraki A, Di Proietto MC, Facciolongo NC, Ferri S, Fierro V, Foschino MP, Latorre M, Lombardi C, Macchia L, Milanese M, Montagni M, Parazzini EM, Parente R, Passalacqua G, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ridolo E, Rolo J, Scichilone N, Scioscia G, Senna G, Solidoro P, Varricchi G, Vianello A, Yacoub MR, Yang B. Severe Asthma Network Italy Definition of Clinical Remission in Severe Asthma: A Delphi Consensus. J Allergy Clin Immunol Pract 2023; 11:3629-3637. [PMID: 37558162 DOI: 10.1016/j.jaip.2023.07.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
Severe asthma affects about 10% of the population with asthma and is characterized by low lung function and a high count of blood leukocytes, mainly eosinophils. Various definitions are used in clinical practice and in the literature to identify asthma remission: clinical remission, inflammatory remission, and complete remission. This work highlights a consensus for asthma remission using a Delphi method. In the context of the Severe Asthma Network Italy, which accounts for 57 severe asthma centers and more than 2,200 patients, a board of six experts drafted a list of candidate statements in a questionnaire, which has been revised to minimize redundancies and ensure clear and consistent wording for the first round (R1) of the analysis. Thirty-two statements were included in the R1 questionnaire and then submitted to a panel of 80 experts, which used a 5-point Likert scale to measure agreement regarding each statement. Then, an interim analysis of R1 data was performed, and items were discussed and considered to produce a consistent questionnaire for round 2 (R2) of the analysis. Then, the board set the R2 questionnaire, which included only important topics. Panelists were asked to vote on the statements in the R2 questionnaire afterward. During R2, the criteria of complete clinical remission (the absence of the need for oral corticosteroids, symptoms, exacerbations or attacks, and pulmonary function stability) and those of partial clinical remission (the absence of the need for oral corticosteroids, and two of three criteria: the absence of symptoms, exacerbations or attacks, and pulmonary stability) were confirmed. This Severe Asthma Network Italy Delphi analysis defined a valuable and independent tool that is easy to use, to test the efficacy of different treatments in patients with severe asthma enrolled into the SANI registry.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Translational Biomedicine and Neuroscience DiBraiN, University of Bari Aldo Moro, Bari, Italy; Section of Respiratory Diseases, Policlinico Hospital of Bari, Bari, Italy
| | - Giuseppe Guida
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy; Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
| | - Chiara Allegrini
- Unit Asma Grave, Ambulatorio Asma Grave Pneumologia e Fisiopatologia ToracoPolmonare, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Andrea Antonelli
- Responsabile SS Allergologia e Fisiopatologia Respiratoria, Ospedale S Croce e Carle, Cuneo, Italy
| | - Arianna Aruanno
- Allergologia dell'Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy
| | - Elena Bacci
- Fisiopatologia Respiratoria e Riabilitazione, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Diego Bagnasco
- UO Clinica Malattie Respiratorie e Allergologia, IRCCS-AOU San Martino, San Martino, Italy
| | - Bianca Beghè
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, Maternal, Infant and Adult, University of Modena and Reggio Emilia, Emilia-Romagna, Italy
| | - Marco Bonavia
- SS Pneumologia Riabilitativa, SC Pneumologia, Dipartimento Specialità Mediche, Ospedale la Colletta, Arenzano, Genoa, Italy
| | - Matteo Bonini
- UOC Pneumologia, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Luisa Brussino
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, Turin, Italy
| | - Maria Filomena Caiaffa
- Malattie Apparato Respiratorio, Dipartimenti delle funzioni Mediche e Sanitarie, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Cecilia Calabrese
- UO Clinica Pneumologica SUN, Dipartimento Pneumologia ed Oncologia, Azienda Ospedaliera Specialistica dei Colli, Naples, Italy
| | - Gianna Camiciottoli
- Unit Asma Grave, Ambulatorio Asma Grave Pneumologia e Fisiopatologia ToracoPolmonare, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Caminati
- USD Allergologia, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Cristiano Caruso
- Allergologia dell'Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy; UOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | - Mirta Cavallini
- Broncopneumologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Maria Elisabetta Conte
- Struttura Complessa di Pneumologia, Azienda per l'Assistenza Sanitaria n. 5 Friuli Occidentale, Pordenone, Italy
| | | | - Lorenzo Cosmi
- SOD Immunologia e Terapie Cellulari, AOUC Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mariateresa Costantino
- Centro Day Hospital, Allergologia e Immunologia Clinica, Dipartimento Medico, Ospedale Carlo Poma, ASST-Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Giulia Costanzo
- Allergologia e Immunologia Clinica, Policlinico Universitario di Cagliari, Cagliari, Italy
| | | | - Simona D'Alò
- UO Allergologia, Azienda Sanitaria Unica Regionale Marche, Civitanova Marche, Marche, Italy
| | - Mariella D'Amato
- UOC Pneumofisiologia Università Federico II, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Aikaterini Detoraki
- UODS Allergologia ed Immunodeficienze, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | | | | | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vincenzo Fierro
- UOC Allergologia, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Maria Pia Foschino
- Malattie Apparato Respiratorio, Azienda Ospedaliera Universitaria, Foggia, Italy
| | - Manuela Latorre
- UO Pneumologia, Ospedale Nuovo Apuano di Massa, Massa, Italy
| | - Carlo Lombardi
- Unità di Allergologia, Immunologia e Malattie Respiratorie, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luigi Macchia
- Unità Dipartimentale di Allergologia ed Immunologia Clinica, AO Universitaria Policlinico di Bari, Bari, Italy
| | - Manlio Milanese
- SC Pneumologia - Dipartimento Specialità Mediche, Ospedale S Corona, Pietra Ligure, Pietra Ligure, Savona, Italy
| | - Marcello Montagni
- Unità Dipartimentale di Allergologia, Ospedale Guglielmo da Saliceto AUSL Piacenza, Piacenza, Italy
| | | | - Roberta Parente
- UO di Diagnosi e Terapia delle Malattie Allergiche e del Sistema Immunitario, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giovanni Passalacqua
- Clinica di Malattie Respiratorie e Allergologia, Dip. Medicina Interna, Univ degli Studi di Genova, IRCCS-AOU San Martino, San Martino, Italy
| | | | - Girolamo Pelaia
- UO Malattie dell'Apparato Respiratorio, AOU Mater Domini, Catanzaro, Italy
| | - Laura Pini
- Ambulatorio Asma Grave, UOC Medicina Generale 2, Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luisa Ricciardi
- Allergologia e Immunologia Clinica, AOU Policlinico G Martino, Università di Messina, Messina, Italy
| | - Erminia Ridolo
- Ambulatorio di Allergologia ed Immunologia Clinica, UO Lungodegenza, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy
| | - Joyce Rolo
- SC Pneumologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicola Scichilone
- UOC Pneumologia, Azienda Ospedaliera Universitaria Policlinico P Giaccone di Palermo, Palermo, Italy
| | - Giulia Scioscia
- Malattie Apparato Respiratorio, Dipartimenti delle funzioni Mediche e Sanitarie, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Gianenrico Senna
- USD Allergologia, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Paolo Solidoro
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gilda Varricchi
- Dipartimento di Scienze Mediche Translazionali, Centro per la Ricerca di Base ed Immunologia Clinica, Università Federico II, Naples, Italy
| | - Andrea Vianello
- UOC Fisiopaologia Respiratoria, Azienda Ospedaliera di Padova, Padua, Italy
| | - Mona Rita Yacoub
- Unità di Immunologia, Reumatologia, Allergologia e Malattie Rare, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Baoran Yang
- Centro Day Hospital, Allergologia e Immunologia Clinica, Dipartimento Medico, Ospedale Carlo Poma, ASST-Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
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10
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Scarlata S, Zotti S, Finamore P, Osadnik CR, Scichilone N, Antonelli Incalzi R, Claudio P, Cesari M. Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns. Aging Clin Exp Res 2023; 35:2573-2581. [PMID: 37644258 DOI: 10.1007/s40520-023-02535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood. AIMS To evaluate the association between frailty index and 5-year mortality across different "spirometric" patterns and the variation in their occurring frailty determinants. METHODS This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex. RESULTS Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10-3.32) for the overall cohort, 2.24 (95% CI 1.48-3.40) for obstructive defects, 2.45 (95% CI 1.12-5.36) for restrictive defects, and 2.79 (95% CI 1.41-3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37-2.84) for the overall cohort, 2.08 (95% CI 1.37-3.18) for obstructive defects, 2.27 (95% CI 1.04-1.17) for restrictive defects, and 2.21 (95% CI 1.20-3.08) for mixed airflow defects. CONCLUSION Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Sonia Zotti
- Department of Medicine and Surgery, Internship Program in Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Panaiotis Finamore
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Christian R Osadnik
- Department of Physiotherapy, Monash University, Moorooduc Hwy, Frankston, Melbourne, VIC, 3199, Australia
- Monash Lung and Sleep Department, Monash Health, 246 Clayton Road, CLAYTON, Melbourne, VIC, 3168, Australia
| | - Nicola Scichilone
- PROMISE Department, University of Palermo, Via del Vespro 133, 90127, Palermo, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Pedone Claudio
- Operative Research Unit of Geriatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milano, Italy
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Portacci A, Campisi R, Buonamico E, Nolasco S, Pelaia C, Crimi N, Benfante A, Triggiani M, Spadaro G, Caiaffa MF, Scioscia G, Detoraki A, Valenti G, Papia F, Tomasello A, Scichilone N, Pelaia G, Crimi C, Carpagnano GE. Real-world characteristics of "super-responders" to mepolizumab and benralizumab in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis. ERJ Open Res 2023; 9:00419-2023. [PMID: 37908397 PMCID: PMC10613971 DOI: 10.1183/23120541.00419-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/17/2023] [Indexed: 11/02/2023] Open
Abstract
Background The current definition of severe eosinophilic asthma (SEA) super-responders to biologic treatment does not include patients with other eosinophil-based comorbidities. Although eosinophilic granulomatosis with polyangiitis (EGPA) is frequently associated with SEA, we lack data on a possible super-response to biologic treatments in patients suffering from these two diseases. We aim to assess super-responder features in real-life patients with SEA and EGPA treated with mepolizumab and benralizumab. Methods We enrolled 39 patients with SEA and EGPA eligible for treatment with mepolizumab or benralizumab. Super-responder assessment was performed considering oral corticosteroid (OCS) cessation, lack of exacerbations, forced expiratory volume in 1 s and Asthma Control Test (ACT) improvement. Results Super-responders showed worse clinical baseline characteristics than non-super-responder patients, with a greater improvement in severe asthma exacerbations, OCS dose reduction and ACT score increase. Definition of super-responders was consistent only considering a 12-month course of monoclonal antibody, lacking sensitivity in earlier evaluations. Conclusion Mepolizumab and benralizumab are safe and effective in patients with EGPA and SEA, since a consistent proportion of patients show a super-response after 12 months of treatment. Further studies will address specific criteria for super-responder assessment in these patients.
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Affiliation(s)
- Andrea Portacci
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
- These authors contributed equally
| | - Raffaele Campisi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- These authors contributed equally
| | - Enrico Buonamico
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
| | - Santi Nolasco
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Giuseppe Spadaro
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Maria Filomena Caiaffa
- Department of Medical and Surgical Sciences, School and Chair of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Aikaterini Detoraki
- Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandra Tomasello
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
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12
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Sousa-Pinto B, Louis R, Anto JM, Amaral R, Sá-Sousa A, Czarlewski W, Brussino L, Canonica GW, Chaves Loureiro C, Cruz AA, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann DE, Okamoto Y, Ollert M, Pfaar O, Pham-Thi N, Puggioni F, Regateiro FS, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura MT, Agache I, Bedbrook A, Becker S, Bergmann KC, Bosnic-Anticevich S, Bonini M, Boulet LP, Brusselle G, Buhl R, Cecchi L, Charpin D, de Blay F, Del Giacco S, Ivancevich JC, Jutel M, Klimek L, Kraxner H, Kuna P, Laune D, Makela M, Morais-Almeida M, Nadif R, Niedoszytko M, Papadopoulos NG, Papi A, Patella V, Pétré B, Rivero Yeverino D, Robalo Cordeiro C, Roche N, Rouadi PW, Samolinski B, Savouré M, Shamji MH, Sheikh A, Suppli Ulrik C, Usmani OS, Valiulis A, Yorgancioglu A, Zuberbier T, Fonseca JA, Costa EM, Bousquet J. Adherence to inhaled corticosteroids and long-acting β2-agonists in asthma: A MASK-air study. Pulmonology 2023:S2531-0437(23)00130-7. [PMID: 37543524 DOI: 10.1016/j.pulmoe.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting β2-agonists (ICS+LABA) in users of the MASK-air® app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. MATERIALS AND METHODS We analysed complete weeks of MASK-air® data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. RESULTS In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication ≥80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). CONCLUSIONS In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.
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Affiliation(s)
- B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Louis
- Department of Pulmonary Medicine, CHU Liège, Liège, Belgium; GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - J M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - R Amaral
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Sá-Sousa
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France; MASK-air, Montpellier, France
| | - L Brussino
- Department of Medical Sciences, University of Torino, Torino, Italy; Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
| | - G W Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Center, Rozzano, Milan, Italy
| | - C Chaves Loureiro
- Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal
| | - A A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - M Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - V Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Y Okamoto
- Chiba Rosai Hospital, Chiba, Japan; Chiba University Hospital, Chiba, Japan
| | - M Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg; Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - O Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - N Pham-Thi
- Ecole Polytechnique de Palaiseau, Palaiseau, France; IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France; Université Paris Cité, Paris, France
| | - F Puggioni
- IRCCS Humanitas Research Center, Personalized Medicine Asthma & Allergy, Rozzano, Milan, Italy
| | - F S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Romantowski
- Medical University of Gdańsk, Department of Allergology, Gdansk, Poland
| | - J Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - L Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal; UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - M T Ventura
- Allergy and Clinical Immunology, University of Bari Medical School, Bari, Italy; Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy
| | - I Agache
- Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - A Bedbrook
- MASK-air, Montpellier, France; ARIA, Montpellier, France
| | - S Becker
- Department of Otorhinolaryngology, University of Tübingen, Tübingen, Germany
| | - K C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - S Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Macquarie Medical School, Macquarie University, Macquarie Park, NSW, Australia
| | - M Bonini
- Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy; National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - L-P Boulet
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - D Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - F de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France; Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; ALL-MED Medical Research Institute, Wroclaw, Poland
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - H Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - D Laune
- KYomed INNOV, Montpellier, France
| | - M Makela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - R Nadif
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - M Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - A Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy; Agency of Health ASL, Salerno, Italy; Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - B Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - D Rivero Yeverino
- Servicio de Alergia e Inmunología clínica, Hospital Universitario de Puebla, Puebla, México
| | - C Robalo Cordeiro
- Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal
| | - N Roche
- Pneumologie, AP-HP Centre Université de Paris Cité, Hôpital Cochin, Paris, France; UMR 1016, Institut Cochin, Paris, France
| | - P W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon; Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - B Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - M Savouré
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - M H Shamji
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - C Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - O S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK; Royal Brompton Hospital, Airways Disease Section, London, UK
| | - A Valiulis
- Interdisciplinary Research Group of Human Ecology, Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania; European Academy of Paediatrics (EAP/UEMS-SP), Brussel, Belgium
| | - A Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS@RISE - Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - E M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - J Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France; University Hospital Montpellier, Montpellier, France.
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Nolasco S, Portacci A, Campisi R, Buonamico E, Pelaia C, Benfante A, Triggiani M, Spadaro G, Caiaffa MF, Scioscia G, Detoraki A, Valenti G, Papia F, Tomasello A, Crimi N, Scichilone N, Pelaia G, Carpagnano GE, Crimi C. Effectiveness and safety of anti-IL-5/Rα biologics in eosinophilic granulomatosis with polyangiitis: a two-year multicenter observational study. Front Immunol 2023; 14:1204444. [PMID: 37457743 PMCID: PMC10349177 DOI: 10.3389/fimmu.2023.1204444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis characterized by asthma, systemic manifestations, and blood and tissue eosinophilia. Objective To assess the effectiveness and safety of mepolizumab (anti-IL-5) and benralizumab (anti-IL-5Rα) in EGPA for 24 months. Methods We conducted a multicenter observational study, including patients with EGPA treated with anti-IL-5/Rα biologics in 9 Italian specialized facilities. Systemic disease activity, remission and relapse rate were evaluated from 3 to 24 months after treatment initiation. Respiratory outcomes, hematological parameters, corticosteroid (OCS) and immunosuppressants consumption were also assessed. Results 49 patients with relapsing-refractory EGPA were included [26 (53.1%) benralizumab 30mg, 20 (40.8%) mepolizumab 100mg, 3 (6.1%) mepolizumab 300mg]. Overall, 38.8% and 57.1% achieved remission after 12 and 24 months, respectively (69.2% benralizumab and 43.5% mepolizumab). Lower OCS intake and higher blood eosinophil count at baseline were associated with remission at 24 months. Both biologics exerted beneficial effects on severe asthma outcomes. Indeed, 61.2% (61.5% benralizumab and 60.8% mepolizumab) remained exacerbation-free during treatment. Lung function parameters showed improvements in the overall cohort (all p<0.05), but began to decline from month 12, especially with mepolizumab. Marked reduction in blood eosinophils was registered with mepolizumab (p<0.0001), while benralizumab depleted both eosinophils (p<0.0001) and basophils (p<0.0001). In general, 69.6% (76% benralizumab and 61.9% mepolizumab) of OCS-dependent patients lowered their daily dose by 75%, while 28.3% discontinued these drugs. Immunosuppressants were suspended in 88.2% of cases. Adverse events were reported in 8.2% of patients. Conclusions These real-world data suggest that anti-IL-5/Rα biologics are effective and safe in the long-term as add-on treatments for patients with EGPA.
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Affiliation(s)
- Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Andrea Portacci
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
| | - Raffaele Campisi
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Enrico Buonamico
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Giuseppe Spadaro
- Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Maria Filomena Caiaffa
- Department of Medical and Surgical Sciences, School and Chair of Allergology and Clinical Immunology, University of Foggia, Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Aikaterini Detoraki
- Division of Internal Medicine and Clinical Immunology, Department of Internal Medicine and Clinical Complexity University of Naples Federico II, Naples, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandra Tomasello
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
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14
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Campisi R, Nolasco S, Pelaia C, Impellizzeri P, D'Amato M, Portacci A, Ricciardi L, Scioscia G, Crimi N, Scichilone N, Foschino Barbaro MP, Pelaia G, Carpagnano GE, Vatrella A, Crimi C. Benralizumab Effectiveness in Severe Eosinophilic Asthma with Co-Presence of Bronchiectasis: A Real-World Multicentre Observational Study. J Clin Med 2023; 12:3953. [PMID: 37373648 DOI: 10.3390/jcm12123953] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: The co-presence of bronchiectasis (BE) in severe eosinophilic asthma (SEA) is common. Data about the effectiveness of benralizumab in patients with SEA and BE (SEA + BE) are lacking. Aim: The aim of this study was to evaluate the effectiveness of benralizumab and remission rates in patients with SEA compared to SEA + BE, also according to BE severity. Methods: We conducted a multicentre observational study, including patients with SEA who underwent chest high-resolution computed tomography at baseline. The Bronchiectasis Severity Index (BSI) was used to assess BE severity. Clinical and functional characteristics were collected at baseline and after 6 and 12 months of treatment. Results: We included 74 patients with SEA treated with benralizumab, of which 35 (47.2%) showed the co-presence of bronchiectasis (SEA + BE) with a median BSI of 9 (7-11). Overall, benralizumab significantly improved the annual exacerbation rate (p < 0.0001), oral corticosteroids (OCS) consumption (p < 0.0001) and lung function (p < 0.01). After 12 months, significant differences were found between SEA and SEA + BE cohorts in the number of exacerbation-free patients [64.1% vs. 20%, OR 0.14 (95% CI 0.05-0.40), p < 0.0001], the proportion of OCS withdrawal [-92.6% vs. -48.6, p = 0.0003], and the daily dose of OCS [-5 mg (0 to -12.5) vs. -12.5 mg (-7.5 to -20), p = 0.0112]. Remission (zero exacerbations + zero OCS) was achieved more frequently in the SEA cohort [66.7% vs. 14.3%, OR 0.08 (95% CI 0.03-0.27), p < 0.0001]. Changes in FEV1% and FEF25-75% were inversely correlated with BSI (r = -0.36, p = 0.0448 and r = -0.41, p = 0.0191, respectively). Conclusions: These data suggest that benralizumab exerts beneficial effects in SEA with or without BE, although the former achieved less OCS sparing and fewer respiratory-function improvements.
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Affiliation(s)
- Raffaele Campisi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, 95123 Catania, Italy
| | - Santi Nolasco
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, 95123 Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Pietro Impellizzeri
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Maria D'Amato
- Department of Respiratory Medicine, University "Federico II" of Naples, 80138 Naples, Italy
| | - Andrea Portacci
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University "Aldo Moro", 70121 Bari, Italy
| | - Luisa Ricciardi
- Department of Clinical and Experimental Medicine, University of Messina, 98166 Messina, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90128 Palermo, Italy
| | | | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Translational Biomedicine and Neuroscience, Institute of Respiratory Disease, University "Aldo Moro", 70121 Bari, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, 95123 Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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15
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Iacono S, Schirò G, Davì C, Mastrilli S, Abbott M, Guajana F, Arnao V, Aridon P, Ragonese P, Gagliardo C, Colomba C, Scichilone N, D’Amelio M. COVID-19 and neurological disorders: what might connect Parkinson's disease to SARS-CoV-2 infection. Front Neurol 2023; 14:1172416. [PMID: 37273689 PMCID: PMC10232873 DOI: 10.3389/fneur.2023.1172416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
SARS-CoV-2 infection leading to Coronavirus disease 19 (COVID-19) rapidly became a worldwide health emergency due to its elevated infecting capacity, morbidity, and mortality. Parkinson’s disease (PD) is the second most common neurodegenerative disorder and, nowadays the relationship between SARS-CoV-2 outbreak and PD reached a great interest. Apparently independent one from the other, both diseases share some pathogenetic and clinical features. The relationship between SARS-CoV-2 infection and PD is complex and it depends on the direction of the association that is which of the two diseases comes first. Some evidence suggests that SARS-CoV-2 infection might be a possible risk factor for PD wherein the exposure to SARS-CoV-2 increase the risk for PD. This perspective comes out from the increasing cases of parkinsonism following COVID-19 and also from the anatomical structures affected in both COVID-19 and early PD such as olfactory bulb and gastrointestinal tract resulting in the same symptoms such as hyposmia and constipation. Furthermore, there are many reported cases of patients who developed hypokinetic extrapyramidal syndrome following SARS-CoV-2 infection although these would resemble a post-encephalitic conditions and there are to date relevant data to support the hypothesis that SARS-CoV-2 infection is a risk factor for the development of PD. Future large, longitudinal and population-based studies are needed to better assess whether the risk of developing PD after COVID-19 exists given the short time span from the starting of pandemic. Indeed, this brief time-window does not allow the precise estimation of the incidence and prevalence of PD after pandemic when compared with pre-pandemic era. If the association between SARS-CoV-2 infection and PD pathogenesis is actually putative, on the other hand, vulnerable PD patients may have a greater risk to develop COVID-19 being also more prone to develop a more aggressive disease course. Furthermore, PD patients with PD showed a worsening of motor and non-motor symptoms during COVID-19 outbreak due to both infection and social restriction. As well, the worries related to the risk of being infected should not be neglected. Here we summarize the current knowledge emerging about the epidemiological, pathogenetic and clinical relationship between SARS-CoV-2 infection and PD.
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Affiliation(s)
- Salvatore Iacono
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giuseppe Schirò
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Chiara Davì
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Sergio Mastrilli
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone di Palermo, Palermo, Italy
| | - Michelle Abbott
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Fabrizio Guajana
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Valentina Arnao
- UO Neurologia e Stroke Unit, Azienda di Rilievo Nazionale ad Alta Specializzazione, Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Paolo Aridon
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Cesare Gagliardo
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Marco D’Amelio
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
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16
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Bousquet J, Shamji MH, Anto JM, Schünemann HJ, Canonica GW, Jutel M, Del Giacco S, Zuberbier T, Pfaar O, Fonseca JA, Sousa-Pinto B, Klimek L, Czarlewski W, Bedbrook A, Amaral R, Ansotegui IJ, Bosnic-Anticevich S, Braido F, Loureiro CC, Gemicioglu B, Haahtela T, Kulus M, Kuna P, Kupczyk M, Matricardi PM, Regateiro FS, Samolinski B, Sofiev M, Toppila-Salmi S, Valiulis A, Ventura MT, Barbara C, Bergmann KC, Bewick M, Blain H, Bonini M, Boulet LP, Bourret R, Brusselle G, Brussino L, Buhl R, Cardona V, Casale T, Cecchi L, Charpin D, Cherrez-Ojeda I, Chu DK, Cingi C, Costa EM, Cruz AA, Devillier P, Dramburg S, Fokkens WJ, Gotua M, Heffler E, Ispayeva Z, Ivancevich JC, Joos G, Kaidashev I, Kraxner H, Kvedariene V, Larenas-Linnemann DE, Laune D, Lourenço O, Louis R, Makela M, Makris M, Maurer M, Melén E, Micheli Y, Morais-Almeida M, Mullol J, Niedoszytko M, O'Hehir R, Okamoto Y, Olze H, Papadopoulos NG, Papi A, Patella V, Pétré B, Pham-Thi N, Puggioni F, Quirce S, Roche N, Rouadi PW, Sá-Sousa A, Sagara H, Sastre J, Scichilone N, Sheikh A, Sova M, Ulrik CS, Taborda-Barata L, Todo-Bom A, Torres MJ, Tsiligianni I, Usmani OS, Valovirta E, Vasankari T, Vieira RJ, Wallace D, Waserman S, Zidarn M, Yorgancioglu A, Zhang L, Chivato T, Ollert M. Patient-centred digital biomarkers for allergic respiratory diseases and asthma: the ARIA-EAACI approach. Allergy 2023. [PMID: 37042071 DOI: 10.1111/all.15740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023]
Abstract
Biomarkers for the diagnosis, treatment and follow-up of patients with rhinitis and/or asthma are urgently needed. Although some biologic biomarkers exist in specialist care for asthma, they cannot be largely used in primary care. There are no validated biomarkers in rhinitis or allergen immunotherapy (AIT) that can be used in clinical practice. The digital transformation of health and health care (including mHealth) places the patient at the centre of the health system and is likely to optimise the practice of allergy. ARIA (Allergic Rhinitis and its Impact on Asthma) and EAACI (European Academy of Allergy and Clinical Immunology) developed a Task Force aimed at proposing patient-reported outcome measures (PROMs) as digital biomarkers that can be easily used for different purposes in rhinitis and asthma. It first defined control digital biomarkers that should make a bridge between clinical practice, randomised controlled trials, observational real-life studies and allergen challenges. Using the MASK-air app as a model, a daily electronic combined symptom-medication score for allergic diseases (CSMS) or for asthma (e-DASTHMA), combined with a monthly control questionnaire, were embedded in a strategy similar to the diabetes approach for disease control. To mimic real-life, it secondly proposed quality-of-life digital biomarkers including daily EQ-5D visual analogue scales and the bi-weekly RhinAsthma Patient Perspective (RAAP). The potential implications for the management of allergic respiratory diseases were proposed.
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Affiliation(s)
- Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- University Hospital Montpellier, France
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Joao A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Anna Bedbrook
- MASK-air, Montpellier, France
- ARIA, Montpellier, France
| | - Rita Amaral
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Fulvio Braido
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lotz, Poland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lotz, Poland
| | - Paolo M Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (ICBR) Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
- Institute of Sciences of Food Production, National Research Council (Ispa-CNR), Bari, Italy
| | - Cristina Barbara
- Portuguese NaTional Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
| | - Karl C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Michael Bewick
- University of Central Lancashire Medical School, Preston, UK
| | - Hubert Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France
| | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | | | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino, Torino, Italy
- Mauriziano Hospital, Torino, Italy
| | - Roland Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
- ARADyAL Research Network, Barcelona, Spain
| | - Thomas Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - Elisio M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto (Porto4Ageing), Portugal
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Philippe Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Zhanat Ispayeva
- Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Violeta Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | | | - Olga Lourenço
- Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU, Liège, Liège, Belgium
- GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Michael Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sach´s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | | | - Robyn O'Hehir
- Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yoshitaka Okamoto
- Chiba Rosai Hospital, Chiba, Japan
- Chiba University Hospital, Chiba, Japan
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | - Alberto Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
- Agency of Health ASL, Salerno, Italy
- Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - Nhân Pham-Thi
- Ecole Polytechnique de Palaiseau, Palaiseau, France
- IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France
- Université Paris Cité, Paris, France
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Spain
| | - Nicolas Roche
- Pneumologie, AP-HP, Centre Université de Paris, Hôpital Cochin, Paris, France
| | - Philip W Rouadi
- Department of Otolaryngology, Head and Neck Surgery, Eye and Ear, University Hospital, Beirut, Lebanon
- Department of Otolaryngology, Head and Neck Surgery, Dar Al Shifa Hospital-, Salmiya, Kuwait
| | - Ana Sá-Sousa
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, Madrid, Spain
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Milan Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital Brno, Czech Republic
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
- Institute of Cinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luis Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
- UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Ana Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria J Torres
- Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Omar S Usmani
- Royal Brompton Hospital, Airways Disease Section, London, UK
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland
| | - Tuula Vasankari
- FIHLA, Finnish Lung Health Association, Helsinki, Finland
- Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Rafael José Vieira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dana Wallace
- Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, Florida, USA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Slovenia
- University of Ljubljana, Ljubljana, Slovenia
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Manisa, Turkey
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, Beijing, China
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Centre, Odense University Hospital, Research Center for Anaphylaxis (ORCA), Odense, Odense, Denmark
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17
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Principe S, Richards LB, Hashimoto S, Kroes JA, Van Bragt JJMH, Vijverberg SJ, Sont JK, Scichilone N, Bieksiene K, Ten Brinke A, Csoma Z, Dahlén B, Gemicioglu B, Grisle I, Kuna P, Lazic Z, Mihaltan F, Popović-Grle S, Škrgat S, Marcon A, Caminati M, Djukanovic R, Porsbjerg C, Maitland Van Der Zee AH. Characteristics of severe asthma patients on biologics; a real-life European registry study. ERJ Open Res 2023; 9:00586-2022. [PMID: 37143845 PMCID: PMC10152256 DOI: 10.1183/23120541.00586-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/21/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundThe use of anti-IL5 for severe asthma is based on criteria from randomized controlled trials(RCTs) but in real-life patient might not fulfil eligibility criteria but benefit from biologics. We aimed to: characterise patients starting in anti-IL5(R) in Europe and evaluate the discrepancies between initiation of anti-IL5(R) in real-life and in RCTs.Material and methodsWe performed a cross-sectional analysis with data from the severe asthma patients at the start of anti-IL5(R) in the Severe Heterogeneous Asthma Research collaboration Patient-centered(SHARP-Central)registry. We compared the baseline characteristics of the anti-IL5(R) from 11 European countries within SHARP with the baseline characteristics of the severe asthma patients from 10 RCTs (4 for mepolizumab, 3 for benralizumab and 3 for reslizumab). Patients were evaluated following eligibility criteria from the RCTs of anti-IL5 therapies.ResultsPatients anti-IL5(R) starters in Europe (n=1231) differed in terms of smoking history, clinical characteristics and medication use. The characteristics of severe asthma patients in SHARP Registry differed from the characteristics of patients in RCTs. Only 327(26,56%) fulfilled eligibility criteria of all the RCTs; 24 patients were eligible for mepolizumab,100 for benralizumab and 52 reslizumab. The main characteristics of ineligibility were: pack/years≥10, respiratory diseases other than asthma, ACQ score≤1.5, low dose ICS.ConclusionA large proportion of patients in the SHARP registry would not have been eligible for anti-IL-5(R) treatment RCTs, demonstrating the importance of real life cohorts in describing the efficacy of biologics in a broader population of patients with severe asthma.
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18
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Benfante A, Pirrello G, Sala F, Seminara G, Scichilone N. Coronavirus disease 2019 and severe asthma. Curr Opin Allergy Clin Immunol 2023; 23:193-198. [PMID: 36752375 DOI: 10.1097/aci.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the most severe forms of asthma has been an object of discussion. Indeed, it is not clear whether asthma is among the risk factors for the occurrence of severe coronavirus disease 2019 (COVID-19) disease, or rather it plays a protective role against the worsening of the respiratory involvement in the SARS-CoV-2 infection. On the other hand, the extent to which coronavirus infection may trigger asthma attacks is still partly unknown. The current investigation aims at reviewing the available literature on the topic to address factors influencing this relationship. RECENT FINDINGS Based on recent observations, it is likely that type 2 inflammation plays a protective role against SARS-CoV-2 infection and disease. In particular, asthmatics show different expression of angiotensin-converting enzyme2 (ACE2) and Transmembrane protease, serine 2 (TMPRSS2) that are responsible for a reduced risk of infection as well as lower risk of hospitalization. Interestingly, studies showed a safe profile of inhaled corticosteroids and biological drugs in SARS-CoV-2 infection. In addition, inhaled corticosteroid could play a protective role against worsening of asthma. SUMMARY The current findings suggest that current treatment for asthma should be maintained to avoid severe exacerbations. Severe asthmatics under biological treatment should continue their medications, and be encouraged to receive COVID-19 vaccines.
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Affiliation(s)
- Alida Benfante
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
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19
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Sousa-Pinto B, Jácome C, Pereira AM, Regateiro FS, Almeida R, Czarlewski W, Kulus M, Shamji MH, Boulet LP, Bonini M, Brussino L, Canonica GW, Cruz AA, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann D, Louis R, Niedoszytko M, Pham-Thi N, Puggioni F, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura MT, Vieira RJ, Agache I, Bedbrook A, Bergmann KC, Amaral R, Azevedo LF, Bosnic-Anticevich S, Brusselle G, Buhl R, Cecchi L, Charpin D, Loureiro CC, de Blay F, Del Giacco S, Devillier P, Jassem E, Joos G, Jutel M, Klimek L, Kuna P, Laune D, Luna Pech J, Makela M, Morais-Almeida M, Nadif R, Neffen HE, Ohta K, Papadopoulos NG, Papi A, Pétré B, Pfaar O, Yeverino DR, Cordeiro CR, Roche N, Sá-Sousa A, Samolinski B, Sheikh A, Ulrik CS, Usmani OS, Valiulis A, Vandenplas O, Vieira-Marques P, Yorgancioglu A, Zuberbier T, Anto JM, Fonseca JA, Bousquet J. Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study. Lancet Digit Health 2023; 5:e227-e238. [PMID: 36872189 DOI: 10.1016/s2589-7500(23)00020-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Validated questionnaires are used to assess asthma control over the past 1-4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA). METHODS We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16-90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test-retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician. FINDINGS We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68-0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59-0·68). They also displayed high test-retest reliability (intraclass correlation coefficients range 0·79-0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69-0·79; effect size measures range 0·57-0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61-0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68-0·78). INTERPRETATION e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation. FUNDING None.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Jácome
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra and Institute of Immunology, and Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rute Almeida
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College & National Institutes for Health Imperial Biomedical Research Centre, London, UK
| | | | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, Ear, Nose, and Throat, and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; National Heart and Lung Institute, Imperial College London, London, UK
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and Global Alliance Against Chronic Respiratory Diseases and WHO Planning Group, Salvador, Bahia, Brazil
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology and Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Desirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Renaud Louis
- Department of Pulmonary Medicine, Centre Hospitalier Universitaire Liege, and GIGA Infection, Immunity, Inflammation Laboratories research group, University of Liege, Liege, Belgium
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Nhân Pham-Thi
- Institut de Recherche bio-Médicale des Armées, Bretigny sur Orge, France; École Polytechnique de Palaiseau, Palaiseau, France; Université Paris Cité, Paris, France
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Faculty of Medicine Universidad Autonoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Luis Taborda-Barata
- University of Beira Interior Air, Clinical & Experimental Lung Centre and Centro de Investigação em Ciências da Saúde-University of Beira Interior Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - Rafael José Vieira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ioana Agache
- Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
| | - Anna Bedbrook
- Allergic Rhinitis and its Impact on Asthma, Montpellier, France
| | - Karl C Bergmann
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Rita Amaral
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, and Sydney Local Health District, Sydney, NSW, Australia
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Roland Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Lorenzo Cecchi
- Struttura Organizzativa Semplice Allergology and Clinical Immunology Unita Sanitaria Locale, Toscana Centro, Prato, Italy
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - Claudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Frédéric de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France; Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital Duilio Casula, University of Cagliari, Cagliari, Italy
| | - Philippe Devillier
- Virologie et Immunologie Moléculaires Suresnes, Unités Mixtes de Recherche 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Ewa Jassem
- Medical University of Gdańsk, Department of Pneumonology, Gdansk, Poland
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; All-Medicine Medical Research Institute, Wroclaw, Poland
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | | | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Rachel Nadif
- Université Paris-Saclay, Université Versailles-St Quentin, Université Paris-Sud, Paris, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France
| | - Hugo E Neffen
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan; JATA Fukujuji Hospital, Tokyo, Japan
| | | | - Alberto Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Benoit Pétré
- Department of Public Health, University of Liege, Liege, Belgium
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Daniela Rivero Yeverino
- Allergy and Clinical Immunology Department, Hospital Universitario de Puebla, Puebla, Mexico
| | | | - Nicolas Roche
- Pneumologie, Assistance Publique - Hôpitaux de Paris, Centre Université de Paris Cité, Hôpital Cochin, Paris, France
| | - Ana Sá-Sousa
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton Hospital, Airways Disease Section, London, UK
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences and Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium; Université Catholique de Louvain, Yvoir, Belgium
| | - Pedro Vieira-Marques
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Türkiye
| | - Torsten Zuberbier
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - João A Fonseca
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France; University Hospital Montpellier, Montpellier, France.
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20
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Buscemi S, Davoli C, Trecarichi EM, Morrone HL, Tassone B, Buscemi C, Randazzo C, Barile AM, Colombrita P, Soresi M, Giannitrapani L, Cascio A, Scichilone N, Cottone C, Sbraccia P, Guglielmi V, Leonetti F, Malavazos AE, Basilico S, Carruba M, Santini F, Antonelli A, Viola N, Romano M, Cesana BM, Torti C. The three facets of the SARS-CoV-2 pandemic during the first two waves in the northern, central, and southern Italy. J Infect Public Health 2023; 16:520-525. [PMID: 36801631 PMCID: PMC9902343 DOI: 10.1016/j.jiph.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND There is a scarcity of information in literature regarding the clinical differences and comorbidities of patients affected by Coronavirus disease 2019 (COVID-19), which could clarify the different prevalence of the outcomes (composite and only death) between several Italian regions. OBJECTIVE This study aimed to assess the heterogeneity of clinical features of patients with COVID-19 upon hospital admission and disease outcomes in the northern, central, and southern Italian regions. METHODS An observational cohort multicenter retrospective study including 1210 patients who were admitted for COVID-19 in Infectious diseases, Pulmonology, Endocrinology, Geriatrics and Internal Medicine Units in Italian cities stratified between north (263 patients); center (320 patients); and south (627 patients), during the first and second pandemic waves of SARS-CoV-2 (from February 1, 2020 to January 31, 2021). The data, obtained from clinical charts and collected in a single database, comprehended demographic characteristics, comorbidities, hospital and home pharmacological therapies, oxygen therapy, laboratory values, discharge, death and Intensive care Unit (ICU) transfer. Death or ICU transfer were defined as composite outcomes. RESULTS Male patients were more frequent in the northern Italian region than in the central and southern regions. Diabetes mellitus, arterial hypertension, chronic pulmonary and chronic kidney diseases were the comorbidities more frequent in the southern region; cancer, heart failure, stroke and atrial fibrillation were more frequent in the central region. The prevalence of the composite outcome was recorded more frequently in the southern region. Multivariable analysis showed a direct association between the combined event and age, ischemic cardiac disease, and chronic kidney disease, in addition to the geographical area. CONCLUSIONS Statistically significant heterogeneity was observed in patients with COVID-19 characteristics at admission and outcomes from northern to southern Italy. The higher frequency of ICU transfer and death in the southern region may depend on the wider hospital admission of frail patients for the availability of more beds since the burden of COVID-19 on the healthcare system was less intense in southern region. In any case, predictive analysis of clinical outcomes should consider that the geographical differences that may reflect clinical differences in patient characteristics, are also related to access to health-care facilities and care modalities. Overall, the present results caution against generalizability of prognostic scores in COVID-19 patients derived from hospital cohorts in different settings.
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Affiliation(s)
- Silvio Buscemi
- Clinical Nutrition Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Chiara Davoli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University - "Mater Domini" Teaching Hospital, Catanzaro, Italy.
| | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University - "Mater Domini" Teaching Hospital, Catanzaro, Italy
| | - Helen Linda Morrone
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University - "Mater Domini" Teaching Hospital, Catanzaro, Italy
| | - Bruno Tassone
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University - "Mater Domini" Teaching Hospital, Catanzaro, Italy
| | - Carola Buscemi
- Clinical Nutrition Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Cristiana Randazzo
- Clinical Nutrition Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Anna Maria Barile
- Clinical Nutrition Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Piero Colombrita
- Clinical Nutrition Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Maurizio Soresi
- COVID Internal Medicine Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Lydia Giannitrapani
- COVID Internal Medicine Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Maternal and Child Care, Internal Medicine, and Medical Specialties "G. D'Alessandro ", University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- COVID Pneumology Unit, Department of Health Promotion, Maternal and Childhood, Internal and Specialized Medicine of Excellence (PROMISE), University of Palermo, Palermo, Italy
| | - Carlo Cottone
- COVID Internal Medicine Unit, Petralia Sottana Hospital, ASP 6, Palermo, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, Internal Medicine Unit-Obesity Center, Tor Vergata University of Rome, Tor Vergata Polyclinic, Rome, Italy
| | - Valeria Guglielmi
- Department of Systems Medicine, Internal Medicine Unit-Obesity Center, Tor Vergata University of Rome, Tor Vergata Polyclinic, Rome, Italy
| | - Frida Leonetti
- Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnology, Santa Maria Goretti Hospital, "La Sapienza" University of Rome, Latina, Italy
| | - Alexis Elias Malavazos
- Endocrinology, Clinical Nutrition and Cardiovascular Prevention Service Unit, IRCCS Polyclinic San Donato, Milan, Italy; Department of Biomedicine, Surgery and Dental Sciences, University of Milan, Milan, Italy
| | - Sara Basilico
- Endocrinology, Clinical Nutrition and Cardiovascular Prevention Service Unit, IRCCS Polyclinic San Donato, Milan, Italy; Department of Biomedicine, Surgery and Dental Sciences, University of Milan, Milan, Italy
| | - Michele Carruba
- Center for Studies and Research on Obesity, Department of Biomedical Technologies and Translational Medicine, University of Milan, Milan, Italy
| | - Ferruccio Santini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Nicola Viola
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Bruno Mario Cesana
- Medical Statistics Unit, Biometrics and Bioinformatics "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University - "Mater Domini" Teaching Hospital, Catanzaro, Italy
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21
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Pelaia C, Benfante A, Busceti MT, Caiaffa MF, Campisi R, Carpagnano GE, Crimi N, D’Amato M, Foschino Barbaro MP, Maglio A, Minenna E, Nolasco S, Paglino G, Papia F, Pelaia G, Portacci A, Ricciardi L, Scichilone N, Scioscia G, Triggiani M, Valenti G, Vatrella A, Crimi C. Real-life effects of dupilumab in patients with severe type 2 asthma, according to atopic trait and presence of chronic rhinosinusitis with nasal polyps. Front Immunol 2023; 14:1121237. [PMID: 37063895 PMCID: PMC10098307 DOI: 10.3389/fimmu.2023.1121237] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BackgroundThe efficacy of dupilumab as biological treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) depends on its ability to inhibit the pathophysiologic mechanisms involved in type 2 inflammation.ObjectiveTo assess in a large sample of subjects with severe asthma, the therapeutic impact of dupilumab in real-life, with regard to positive or negative skin prick test (SPT) and CRSwNP presence or absence.MethodsClinical, functional, and laboratory parameters were measured at baseline and 24 weeks after the first dupilumab administration. Moreover, a comparative evaluation was carried out in relation to the presence or absence of SPT positivity and CRSwNP.ResultsAmong the 127 recruited patients with severe asthma, 90 had positive SPT, while 78 reported CRSwNP. Compared with the 6 months preceding the first dupilumab injection, asthma exacerbations decreased from 4.0 (2.0-5.0) to 0.0 (0.0-0.0) (p < 0.0001), as well as the daily prednisone intake fell from 12.50 mg (0.00-25.00) to 0.00 mg (0.00-0.00) (p < 0.0001). In the same period, asthma control test (ACT) score increased from 14 (10-18) to 22 (20-24) (p < 0.0001), and sino-nasal outcome test (SNOT-22) score dropped from 55.84 ± 20.32 to 19.76 ± 12.76 (p < 0.0001). Moreover, we observed relevant increases in forced expiratory volume in one second (FEV1) from the baseline value of 2.13 L (1.62-2.81) to 2.39 L (1.89-3.06) (p < 0.0001). Fractional exhaled nitric oxide (FeNO) values decreased from 27.0 ppb (18.0-37.5) to 13.0 ppb (5.0-20.0) (p < 0.0001). These improvements were quite similar in subgroups of patients characterized by SPT negativity or positivity, and CRSwNP absence or presence. No statistically significant correlations were detected between serum IgE levels, baseline blood eosinophils or FeNO levels and dupilumab-induced changes, with the exception of FEV1 increase, which was shown to be positively correlated with FeNO values (r = 0.3147; p < 0.01).ConclusionOur results consolidate the strategic position of dupilumab in its role as an excellent therapeutic option currently available within the context of modern biological treatments of severe asthma and CRSwNP, frequently driven by type 2 airway inflammation.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- *Correspondence: Corrado Pelaia,
| | - Alida Benfante
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Maria Teresa Busceti
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | | | - Raffaele Campisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria D’Amato
- Department of Respiratory Medicine, University “Federico II” of Naples, Naples, Italy
| | | | - Angelantonio Maglio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Elena Minenna
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe Paglino
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Francesco Papia
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Andrea Portacci
- Department of Basic Medical Science, Neuroscience and Sense Organs, University “Aldo Moro”, Bari, Italy
| | - Luisa Ricciardi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nicola Scichilone
- Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Triggiani
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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22
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Bousquet J, Melén E, Haahtela T, Koppelman GH, Togias A, Valenta R, Akdis CA, Czarlewski W, Rothenberg M, Valiulis A, Wickmann M, Aguilar D, Akdis M, Ansotegui IJ, Barbara C, Bedbrook A, Bindslev Jensen C, Bosnic-Anticevich S, Boulet LP, Brightling CE, Brussino L, Burte E, Bustamante M, Canonica GW, Cecchi L, Celedon JC, Chaves-Loureiro C, Costa E, Cruz AA, Erhola M, Gemicioglu B, Fokkens WJ, Garcia Aymerich J, Guerra S, Heinrich J, Ivancevich JC, Keil T, Klimek L, Kuna P, Kupczyk M, Kvedariene V, Larenas-Linnemann DE, Lemonnier N, Lodrup Carlsen KC, Louis R, Makris M, Maurer M, Momas I, Morais-Almeida M, Mullol J, Naclerio RN, Nadeau K, Nadif R, Niedoszytko M, Okamoto Y, Ollert M, Papadopoulos NG, Passalacqua G, Patella V, Pawankar R, Pham-Thi N, Pfaar O, Regateiro FS, Ring J, Rouadi PW, Samolinski B, Sastre J, Savouré M, Scichilone N, Shamji MH, Sheikh A, Siroux V, Sousa-Pinto B, Standl M, Sunyer J, Taborda-Barata L, Toppila-Salmi S, Torres MJ, Tsiligianni I, Valovirta E, Vandenplas O, Ventura MT, Weiss S, Yorgancioglu A, Zhang L, Abdul Latiff AH, Aberer W, Agache I, Al-Ahmad M, Alobid I, Arshad HS, Asayag E, Baharudin A, Battur L, Bennoor KS, Berghea EC, Bergmann KC, Bernstein D, Bewick M, Blain H, Bonini M, Braido F, Buhl R, Bumbacea R, Bush A, Calderon M, Calvo G, Camargos P, Caraballo L, Cardona V, Carr W, Carreiro-Martins P, Casale T, Cepeda Sarabia AM, Chandrasekharan R, Charpin D, Chen YZ, Cherrez-Ojeda I, Chivato T, Chkhartishvili E, Christoff G, Chu DK, Cingi C, Correia da Sousa J, Corrigan C, Custovic A, D'Amato G, Del Giacco S, De Blay F, Devillier P, Didier A, do Ceu Teixeira M, Dokic D, Douagui H, Doulaptsi M, Durham S, Dykewicz M, Eiwegger T, El-Sayed ZA, Emuzyte R, Emuzyte R, Fiocchi A, Fyhrquist N, Gomez RM, Gotua M, Guzman MA, Hagemann J, Hamamah S, Halken S, Halpin DMG, Hofmann M, Hossny E, Hrubiško M, Irani C, Ispayeva Z, Jares E, Jartti T, Jassem E, Julge K, Just J, Jutel M, Kaidashev I, Kalayci O, Kalyoncu O, Kardas P, Kirenga B, Kraxner H, Kull I, Kulus M, La Gruta S, Lau S, Le Tuyet Thi L, Levin M, Lipworth B, Lourenço O, Mahboub B, Mäkelä MJ, Martinez-Infante E, Matricardi P, Miculinic N, Migueres N, Mihaltan F, Mohamad Y, Moniusko M, Montefort S, Neffen H, Nekam K, Nunes E, Nyembue Tshipukane D, O'Hehir RE, Ogulur I, Ohta K, Okubo K, Ouedraogo S, Olze H, Pali-Schöll I, Palomares O, Palosuo K, Panaitescu C, Panzner P, Park HS, Pitsios C, Plavec D, Popov TA, Puggioni F, Quirce S, Recto M, Repka-Ramirez R, Roballo-Cordeiro C, Roche N, Rodriguez-Gonzales M, Romantowski J, Rosario Filho N, Rottem M, Sagara H, Sarquis-Serpa F, Sayah Z, Scheire S, Schmid-Grendelmeier P, Sisul JC, Sole D, Soto-Martinez M, Sova M, Sperl A, Spranger O, Stelmach R, Suppli Ulrik C, Thomas M, To T, Todo-Bom A, Tomazic PV, Urrutia-Pereira M, Valentin-Rostan M, van Ganse E, Van Hage M, Vasankari T, Vichyanond P, Viegi G, Wallace D, Wang DY, Williams S, Worm M, Yiallouros P, Yiallouros P, Yusuf O, Zaitoun F, Zernotti M, Zidarn M, Zuberbier J, Fonseca JA, Zuberbier T, Anto JM. Rhinitis associated with asthma is distinct from rhinitis alone: The ARIA-MeDALL hypothesis. Allergy 2023; 78:1169-1203. [PMID: 36799120 DOI: 10.1111/all.15679] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
Asthma, rhinitis and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease", coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitisation and multimorbidity, (iii) advances in mHealth for novel phenotype definition, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis". This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitisation patterns (mono- or pauci-sensitisation versus polysensitisation), (iii) severity of symptoms and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and auto-immune diseases.
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Affiliation(s)
- J Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
| | - E Melén
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - G H Koppelman
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, GRIAC Research Institute, Groningen, the Netherlands
| | - A Togias
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, USA
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - W Czarlewski
- Medical Consulting Czarlewski, Levallois, France.,MASK-air, Montpellier, France
| | - M Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - A Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Vilnius, Lithuania.,Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - M Wickmann
- Institute of Environmental medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Aguilar
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBEREHD), Barcelona, Spain
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - C Barbara
- Portuguese Nacional Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
| | | | - C Bindslev Jensen
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland
| | - S Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - L P Boulet
- Quebec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - C E Brightling
- Institute of Lung Health, NIHR Biomedical Research Centre, Department of Respiratory and Infection Sciences, University of Leicester, Leicester, UK
| | - L Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino, Torino, Italy.,Mauriziano Hospital, Torino, Italy
| | - E Burte
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Bustamante
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - G W Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - L Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - J C Celedon
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Chaves-Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - A A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - M Erhola
- Pirkanmaa Welfare district, Tampere, Finland
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - J Garcia Aymerich
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - S Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - J Heinrich
- Ludwig Maximilians University Munich, University Hospital Munich - Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich
| | - J C Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - L Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - M Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - V Kvedariene
- Institute of Clinical medicine, Clinic of Chest diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - D E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - N Lemonnier
- Institute for Advanced Biosciences, UGA - INSERM U1209 - CNRS UMR5309, Site Santé, Allée des Alpes, La Tronche, France
| | | | - R Louis
- Department of Pulmonary Medicine, CHU, Liege, Liège, Belgium.,GIGA I3 research group, University of Liege, Belgium
| | - M Makris
- Allergy Unit "D Kalogeromitros", 2nd Dpt of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - M Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - I Momas
- Department of Public health and health products, Paris Descartes University-Sorbonne Paris Cité, EA 4064 and Paris Municipal Department of social action, childhood, and health, Paris, France
| | | | - J Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain.,Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Spain
| | - R N Naclerio
- Department of Otolaryngology - Head and Neck Surgery - Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - K Nadeau
- Stanford University School of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford, USA
| | - R Nadif
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - M Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Y Okamoto
- Chiba University Hospital, Chiba, Japan.,Chiba Rosai Hospital, Chiba, Japan
| | - M Ollert
- Odense Research Center for Anaphylaxis (ORCA), and Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Finland.,Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | - V Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy.,Agency of Health ASL, Salerno, Italy
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - N Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - O Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - F S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (ICBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Ring
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany.,Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - P W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.,Department of Otorhinolaryngology-Head and Neck Surgery, Dar Al Shifa Hospital, Salmiya, Kuwait
| | - B Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland
| | - J Sastre
- Fundacion Jimenez Diaz, CIBERES, Faculty of Medicine, Autonoma University of Madrid, Madrid, Spain
| | - M Savouré
- Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France
| | - N Scichilone
- PROMISE Department, University of Palermo, Palermo, Italy
| | - M H Shamji
- National Heart and Lung Institute, Imperial College, and NIHR Imperial Biomedical Research Centre, London, UK
| | - A Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - V Siroux
- INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
| | - B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - M Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - J Sunyer
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - L Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal.,UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - S Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - M J Torres
- Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
| | - I Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland.,Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
| | - E Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland.,Terveystalo Allergy Clinic, Turku, Finland
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, and Université Catholique de Louvain, Yvoir, Belgium
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - S Weiss
- Harvard Medical School and Channing Division of Network Medicine, Boston, USA
| | - A Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
| | - A H Abdul Latiff
- Allergy & Immunology Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - I Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - M Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait
| | - I Alobid
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | - H S Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton.,David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - E Asayag
- Argentine Society of Allergy and Immunopathology, Buenos Ayres, Argentian
| | - A Baharudin
- Department of Otorhinolaryngology, Head and Neck, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - L Battur
- Mongolian Association of Hospital Managers, Ulaanbaatar, Mongolia
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - E C Berghea
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - K C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - D Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - M Bewick
- University of Central Lancashire Medical School, Preston, UK
| | - H Blain
- Department of Geriatrics, Montpellier University hospital, MUSE, Montpellier, France
| | - M Bonini
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy and National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, UK
| | - F Braido
- University of Genoa, Department of Internal Medicine (DiMI), and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - R Buhl
- Dept of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - R Bumbacea
- Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | - A Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | - M Calderon
- Imperial College and National Heart and Lung Institute, London, UK
| | - G Calvo
- Pediatrics Department, Universidad Austral de Chile, Valvidia, Chile
| | - P Camargos
- Federal University of Minas Gerais, Medical School, Department of Pediatrics, Belo Horizonte, Brazil
| | - L Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer piso, Cartagena, Colombia
| | - V Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,ARADyAL research network, Barcelona, Spain
| | - W Carr
- Allergy & Asthma Associates of Southern California, A Medical Group , Southern California Research, Mission Viejo, CA, USA
| | - P Carreiro-Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC), Lisbon, Portugal.,Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - T Casale
- Division of Allergy/immunology, University of South Florida, Tampa, FLA, USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia and SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Branquilla, Columbia
| | - R Chandrasekharan
- Department of ENT, Badr al Samaa Hospital, Salalah, Sultanate of Oman
| | - D Charpin
- Clinique des bronches, allergie et sommeil, Hôpital Nord, Marseille, France
| | - Y Z Chen
- The capital institute of pediatrics, Beijing, China
| | - I Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - T Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - E Chkhartishvili
- David Tatishvili Medical Center; David Tvildiani Medical University-AIETI Medical School, Tbilisi, Georgia
| | - G Christoff
- Medical University - Sofia, Faculty of Public Health, Sofia, Bulgaria
| | - D K Chu
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - C Cingi
- skisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - J Correia da Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - C Corrigan
- Division of Asthma, Allergy & Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
| | - A Custovic
- National Heart and Lung Institute, Imperial College London, UK
| | - G D'Amato
- Division of Respiratory and Allergic Diseases,Hospital 'A Cardarelli', University of Naples Federico II, Naples, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - F De Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - P Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - A Didier
- Department of Respiratory Diseases, Larrey Hospital, Toulouse University Hospital, Toulouse, France
| | - M do Ceu Teixeira
- Hospital Dr Agostinho Neto,Praia, Faculdade de Medicina de Cabo Verde
| | - D Dokic
- University Clinic of Pulmology and Allergy, Medical Faculty Skopje, Republic of Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algiers, Algeria
| | - M Doulaptsi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Crete, Heraklion, Crete
| | - S Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College London, London, UK
| | - M Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - T Eiwegger
- The Hospital for Sick Children, Department of Paediatrics, Division of Clinical Immunology and Allergy, Food allergy and Anaphylaxis Program, The University of Toronto, Toronto, Ontario, Canada
| | - Z A El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Emuzyte
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Fiocchi
- Allergy, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - N Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R M Gomez
- School of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - M Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - M A Guzman
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - J Hagemann
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - S Hamamah
- Biology of reproduction department, INSERM 1203, University hospital, Montpellier, France
| | - S Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - D M G Halpin
- University of Exeter, Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - M Hofmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - E Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - M Hrubiško
- Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia
| | - C Irani
- Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Z Ispayeva
- President of Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and clinical immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | - E Jares
- Servicio de Alergia, Consultorios Médicos Privados, Buenos Aires, Argentina
| | - T Jartti
- EDEGO Research Unit, University of Oulu, Oulu, Finland
| | - E Jassem
- Medical University of Gdańsk, Department of Pneumology, Gdansk, Poland
| | - K Julge
- Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia
| | - J Just
- Sorbonne université, Hôpital américain de Paris, Neuilly, France
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.,ALL-MED Medical Research Institute, Wroclaw, Poland
| | | | - O Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - O Kalyoncu
- Hacettepe University, School of Medicine, Department of Chest Diseases, Immunology and Allergy Division, Ankara, Turkey
| | - P Kardas
- Department of Family Medicine, Medical University of Lodz, Poland
| | - B Kirenga
- Makerere University Lung Institute, Kampala, Uganda
| | - H Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - I Kull
- Sach´s Children and Youth Hospital, Södersjukhuset, and Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - M Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Poland
| | - S La Gruta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - S Lau
- Department of Paediatric Respiratory Medicine, Immunology and Crital Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - L Le Tuyet Thi
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - M Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, UK
| | - O Lourenço
- Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - M J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - P Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - N Migueres
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, and Federation of translational medicine, University of Strasbourg, Strasbourg, France
| | - F Mihaltan
- National Institute of Pneumology M Nasta, Bucharest, Romania
| | - Y Mohamad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia and Syrian Private University-, Damascus, Syria
| | - M Moniusko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystock, Poland
| | - S Montefort
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, MSD, Malta
| | - H Neffen
- Director of Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - K Nekam
- Hungarian Allergy Association, Budapest, Hungary
| | - E Nunes
- Eduardo Mondlane University · Faculty of Medicine, Maputo, Mozambique
| | | | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - I Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - K Ohta
- National Hospital Organization Tokyo National Hospital, and JATA Fukujuji Hospital, Tokyo, Japan
| | - K Okubo
- Dept of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - H Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - I Pali-Schöll
- Dept of Comparative Medicine; Messerli Research Institute of the University of Veterinary Medicine, Medical University, and University of Vienna, Vienna, Austria
| | - O Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - K Palosuo
- Department of Dermatology, University of Helsinki and Hospital for Skin and Allergic Diseases, Helsinki, Finland
| | - C Panaitescu
- OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - C Pitsios
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - D Plavec
- Srebrnjak Children's Hospital, Zagreb; Medical Faculty, University JJ Strossmayer of Osijek, Croatia
| | - T A Popov
- Clinic of Occupational Diseases, University Hospital Sveti Ivan Rilski, Sofia, Bulgaria
| | - F Puggioni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - S Quirce
- QDepartment of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - M Recto
- Asian Hospital And Medical Center, Manilla, Philippines
| | - R Repka-Ramirez
- Division of Allergy, Asthma and Immunology, Clinics Hospital, San Lorenzo, Paraguay
| | | | - N Roche
- Pneumologie, AP-HP, Centre Université de Paris Cité, Hôpital Cochin, Paris, France.,UMR 1016, Institut Cochin, Paris, France
| | - M Rodriguez-Gonzales
- Pediatric Allergy and Clinical Immunology, Hospital Espanol de Mexico, Mexico City, Mexico
| | - J Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - N Rosario Filho
- Department of Pediatrics, Federal University of Parana, Curitiba, Brazil
| | - M Rottem
- Division of Allergy, Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - H Sagara
- Showa University School of Medicine, Tokyo, Japan
| | - F Sarquis-Serpa
- Asthma Reference Center - School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil
| | - Z Sayah
- SMAIC Société Marocaine d' Allergologie et Immunologie Clinique, Rabat, Morocco
| | - S Scheire
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zürich, Switzerland
| | - J C Sisul
- Allergy & Asthma, Medical Director, CLINICA SISUL, FACAAI, SPAAI, Asuncion, Paraguay
| | - D Sole
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - M Soto-Martinez
- Division of Respiratory Medicine, Department of Pediatrics, Hospital Nacional de Niños, Universidad de Costa Rica, San Jose, Costa Rica
| | - M Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital, Brno, Czech Republic
| | - A Sperl
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Germany
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, and Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - M Thomas
- University of Southampton, Southampton, UK
| | - T To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - A Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Portugal
| | - P V Tomazic
- Dept of General ORL, H&NS, Medical University of Graz, ENT-University Hospital Graz, Austria
| | | | | | - E van Ganse
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon1, Lyon, France
| | - M Van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - T Vasankari
- Fihla, Finnish Lung Association, Helsinki, Finland.,University of Turku, Turku, Finland
| | - P Vichyanond
- Division of Allergy and Immunology, Department of Pediatrics, Siriraj Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa
| | - D Wallace
- Nova Southeastern University, Florida, USA
| | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - S Williams
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - M Worm
- Division of Allergy and Immunology Department of Dermatology, Allergy and Venerology Charité Universitätsmedizin Berlin Berlin, Germany
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - P Yiallouros
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - F Zaitoun
- Lebanese-American University, Clemenceau Medical Center DHCC, Dubai, UAE
| | - M Zernotti
- Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Argentina
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - J Zuberbier
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research; University of Porto, Porto, Portugal.,RISE - Health Research Network; University of Porto, Porto, Portugal
| | - T Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - J M Anto
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.,ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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23
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Bousquet J, Anto JM, Sousa‐Pinto B, Czarlewski W, Bedbrook A, Haahtela T, Klimek L, Pfaar O, Kuna P, Kupczyk M, Regateiro FS, Samolinski B, Valiulis A, Yorgancioglu A, Arnavielhe S, Basagaña X, Bergmann KC, Bosnic‐Anticevich S, Brussino L, Canonica GW, Cardona V, Cecchi L, Chaves‐Loureiro C, Costa E, Cruz AA, Gemicioglu B, Fokkens WJ, Ivancevich JC, Kraxner H, Kvedariene V, Larenas‐Linnemann DE, Laune D, Louis R, Makris M, Maurer M, Melén E, Micheli Y, Morais‐Almeida M, Mullol J, Niedoszytko M, Okamoto Y, Papadopoulos NG, Patella V, Pham‐Thi N, Rouadi PW, Sastre J, Scichilone N, Sheikh A, Sofiev M, Taborda‐Barata L, Toppila‐Salmi S, Tsiligianni I, Valovirta E, Ventura MT, Vieira RJ, Zidarn M, Amaral R, Ansotegui IJ, Bédard A, Benveniste S, Bewick M, Bindslev‐Jensen C, Blain H, Bonini M, Bourret R, Braido F, Carreiro‐Martins P, Charpin D, Cherrez‐Ojeda I, Chivato T, Chu DK, Cingi C, Del Giacco S, de Blay F, Devillier P, De Vries G, Doulaptsi M, Doyen V, Dray G, Fontaine J, Gomez RM, Hagemann J, Heffler E, Hofmann M, Jassem E, Jutel M, Keil T, Kritikos V, Kull I, Kulus M, Lourenço O, Mathieu‐Dupas E, Menditto E, Mösges R, Murray R, Nadif R, Neffen H, Nicola S, O’Hehir R, Olze H, Palamarchuk Y, Pépin J, Pétré B, Picard R, Pitsios C, Puggioni F, Quirce S, Raciborski F, Reitsma S, Roche N, Rodriguez‐Gonzalez M, Romantowski J, Sá‐Sousa A, Serpa FS, Savouré M, Shamji MH, Sova M, Sperl A, Stellato C, Todo‐Bom A, Tomazic PV, Vandenplas O, Van Eerd M, Vasankari T, Viart F, Waserman S, Fonseca JA, Zuberbier T. Digitally-enabled, patient-centred care in rhinitis and asthma multimorbidity: The ARIA-MASK-air ® approach. Clin Transl Allergy 2023; 13:e12215. [PMID: 36705508 PMCID: PMC9823305 DOI: 10.1002/clt2.12215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/19/2022] [Indexed: 01/09/2023] Open
Abstract
MASK-air® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.
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Affiliation(s)
- Jean Bousquet
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany,University Hospital MontpellierMontpellierFrance,InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance
| | - Josep M. Anto
- ISGlobalBarcelona Institute for Global HealthBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain,Universitat Pompeu Fabra (UPF)BarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Bernardo Sousa‐Pinto
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | | | | | - Tari Haahtela
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck SurgeryUniversitätsmedizin MainzMainzGermany,Center for Rhinology and AllergologyWiesbadenGermany
| | - Oliver Pfaar
- Section of Rhinology and AllergyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology UnitCentro Hospitalar e Universitário de CoimbraCoimbraPortugal,ICBR, Coimbra Institute for Clinical and Biomedical Research, CIBBFaculty of MedicineUniversity of CoimbraCoimbraPortugal,Institute of ImmunologyFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health SciencesVilniusLithuania,Medical Faculty of Vilnius UniversityVilniusLithuania
| | - Arzu Yorgancioglu
- Department of Pulmonary DiseasesCelal Bayar University, Faculty of MedicineManisaTurkey
| | | | - Xavier Basagaña
- ISGlobalBarcelona Institute for Global HealthBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain,Universitat Pompeu Fabra (UPF)BarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Karl C. Bergmann
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Sinthia Bosnic‐Anticevich
- Quality Use of Respiratory Medicine GroupWoolcock Institute of Medical ResearchThe University of SydneySydneyNSWAustralia,Sydney Local Health DistrictSydneyNSWAustralia
| | - Luisa Brussino
- Department of Medical SciencesAllergy and Clinical Immunology UnitUniversity of TorinoTorinoItaly,Mauriziano HospitalTorinoItaly
| | - G. Walter Canonica
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Victoria Cardona
- Allergy SectionDepartment of Internal MedicineHospital Vall d'HebronBarcelonaSpain,ARADyAL Research NetworkBarcelonaSpain
| | - Lorenzo Cecchi
- SOS Allergology and Clinical ImmunologyUSL Toscana CentroPratoItaly
| | - Claudia Chaves‐Loureiro
- Pneumology UnitHospitais da Universidade de CoimbraCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Elisio Costa
- UCIBIO, REQUINTEFaculty of Pharmacy and Competence Center on Active and Healthy AgeingUniversity of Porto (Porto4Ageing)PortoPortugal
| | - Alvaro A. Cruz
- Fundaçao ProARFederal University of Bahia and GARD/WHO Planning GroupSalvadorBahiaBrazil
| | - Bilun Gemicioglu
- Cerrahpasa Faculty of MedicineDepartment of Pulmonary DiseasesIstanbul University‐CerrahpasaIstanbulTurkey
| | - Wytske J. Fokkens
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, location AMCAmsterdamthe Netherlands
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck SurgerySemmelweis UniversityBudapestHungary
| | - Violeta Kvedariene
- Faculty of MedicineInstitute of Clinical MedicineClinic of Chest Diseases and AllergologyVilnius UniversityVilniusLithuania,Faculty of MedicineDepartment of PathologyInstitute of Biomedical SciencesVilnius UniversityVilniusLithuania
| | | | | | - Renaud Louis
- Department of Pulmonary MedicineCHU LiegeLiègeBelgium,GIGA I3 Research GroupUniversity of LiegeLiègeBelgium
| | - Michael Makris
- Allergy Unit “D Kalogeromitros”2nd Department of Dermatology and VenereologyNational & Kapodistrian University of Athens“Attikon” University HospitalAthensGreece
| | - Marcus Maurer
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | - Erik Melén
- Sach's Children and Youth HospitalSödersjukhusetStockholmSweden,Department of Clinical Science and EducationSödersjukhusetKarolinska InstitutetStockholmSweden
| | | | | | - Joaquim Mullol
- Rhinology Unit & Smell ClinicENT DepartmentHospital ClínicBarcelonaSpain,Clinical & Experimental Respiratory ImmunoallergyIDIBAPS, CIBERESUniversity of BarcelonaBarcelonaSpain
| | | | | | | | - Vincenzo Patella
- Division of Allergy and Clinical ImmunologyDepartment of Medicine“Santa Maria della Speranza” Hospital, BattipagliaSalernoItaly,Agency of Health ASLSalernoItaly
| | - Nhân Pham‐Thi
- Ecole Polytechnique PalaiseauIRBA (Institut de Recherche Bio‐Médicale des Armées)BretignyFrance
| | - Philip W. Rouadi
- Department of Otolaryngology, Head and Neck SurgeryEye and Ear University HospitalBeirutLebanon,Department of Otorhinolaryngology, Head and Neck SurgeryDar Al Shifa HospitalSalmiyaKuwait
| | - Joaquin Sastre
- Fundacion Jimenez Diaz, CIBERESFaculty of MedicineAutonoma University of MadridMadridSpain
| | | | - Aziz Sheikh
- Usher InstituteThe University of EdinburghEdinburghUK
| | | | - Luis Taborda‐Barata
- Department of ImmunoallergologyCova da Beira University Hospital CentreCovilhãPortugal,UBIAir ‐ Clinical & Experimental Lung Centre and CICS‐UBI Health Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | - Sanna Toppila‐Salmi
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group IPCRGAberdeenScotland,Health Planning UnitFaculty of MedicineDepartment of Social MedicineUniversity of CreteCreteGreece
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical ImmunologyUniversity of TurkuTurkuFinland,Terveystalo Allergy ClinicTurkuFinland
| | | | - Rafael José Vieira
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic DiseasesGolnikSlovenia,Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Rita Amaral
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | | | - Annabelle Bédard
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Samuel Benveniste
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO)Broca HospitalParisFrance,Mines ParisTech CRI ‐ PSL Research UniversityFontainebleauFrance
| | - Michael Bewick
- University of Central Lancashire Medical SchoolPrestonUK
| | - Carsten Bindslev‐Jensen
- Odense Research Center for Anaphylaxis (ORCA)OdenseDenmark,Department of Dermatology and Allergy CentreOdense University HospitalOdenseFinland
| | - Hubert Blain
- Department of GeriatricsMontpellier University Hospital, MUSEMontpellierFrance
| | - Matteo Bonini
- Department of Clinical and Surgical SciencesFondazione Policlinico Universitario A Gemelli IRCCSRomeItaly,National Heart and Lung InstituteRoyal Brompton Hospital & Imperial College LondonLondonUK
| | | | - Fulvio Braido
- Department of Internal Medicine (DiMI)University of GenoaGenovaItaly,IRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Pedro Carreiro‐Martins
- NOVA Medical School/Comprehensive Health Research Centre (CHRC)LisbonPortugal,Serviço de ImunoalergologiaHospital de Dona EstefâniaCentro Hospitalar Universitário de Lisboa CentralLisbonPortugal
| | - Denis Charpin
- Clinique des BronchesAllergie et SommeilHôpital NordMarseilleFrance
| | - Ivan Cherrez‐Ojeda
- Universidad Espíritu SantoSamborondónEcuador,Respiralab Research GroupGuayaquil, GuayasEcuador
| | - Tomas Chivato
- School of MedicineUniversity CEU San PabloMadridSpain
| | - Derek K. Chu
- Department of Health Research Methods, Evidence, and Impact & Department of MedicineMcMaster UniversityHamiltonONCanada
| | - Cemal Cingi
- Medical FacultyENT DepartmentEskisehir Osmangazi UniversityEskisehirTurkey
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical ImmunologyUniversity Hospital “Duilio Casula”University of CagliariCagliariItaly
| | - Frédéric de Blay
- Allergy DivisionChest Disease DepartmentUniversity Hospital of StrasbourgStrasbourgFrance,Federation of Translational MedicineUniversity of StrasbourgStrasbourgFrance
| | - Philippe Devillier
- VIM Suresnes, UMR 0892Pôle des Maladies des Voies RespiratoiresHôpital FochUniversité Paris‐SaclaySuresnesFrance
| | | | - Maria Doulaptsi
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of CreteHeraklion, CreteGreece
| | - Virginie Doyen
- Department of Chest MedicineCentre Hospitalier Universitaire UCL NamurNamurBelgique,Université Catholique de LouvainYvoirBelgium
| | | | | | | | - Jan Hagemann
- Department of Otolaryngology, Head and Neck SurgeryUniversitätsmedizin MainzMainzGermany,Center for Rhinology and AllergologyWiesbadenGermany
| | - Enrico Heffler
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Maja Hofmann
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Berlin Institute of HealthBerlinGermany
| | - Ewa Jassem
- Department of PneumologyMedical University of GdańskGdańskPoland
| | - Marek Jutel
- Department of Clinical ImmunologyWrocław Medical UniversityWrocławPoland,ALL‐MED Medical Research InstituteWroclawPoland
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health EconomicsCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute for Clinical Epidemiology and BiometryUniversity of WuerzburgWuerzburgGermany,State Institute of Health, Bavarian Health and Food Safety AuthorityErlangenGermany
| | - Vicky Kritikos
- Quality Use of Respiratory Medicine GroupWoolcock Institute of Medical ResearchThe University of SydneySydneyNSWAustralia
| | - Inger Kull
- Sach's Children and Youth HospitalSödersjukhusetStockholmSweden,Department of Clinical Science and EducationSödersjukhusetKarolinska InstitutetStockholmSweden
| | - Marek Kulus
- Department of Pediatric Respiratory Diseases and AllergologyMedical University of WarsawWarsawPoland
| | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBIHealth Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | | | - Enrica Menditto
- CIRFFDepartment of PharmacyUniversity of Naples Federico IINaplesItaly
| | - Ralph Mösges
- CRI‐Clinical Research International‐LtdHamburgGermany
| | - Ruth Murray
- Medical Communication ConsultantMedscript Ltd, DundalkIreland and WellingtonNew Zealand,Research FellowOPCCambridgeUK
| | - Rachel Nadif
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Hugo Neffen
- Center of Allergy, Immunology and Respiratory DiseasesSanta FeArgentina
| | - Stefania Nicola
- Department of Medical SciencesAllergy and Clinical Immunology UnitUniversity of TorinoTorinoItaly
| | - Robyn O’Hehir
- Department of Allergy, Immunology and Respiratory MedicineAlfred Hospital and Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Heidi Olze
- Berlin Institute of HealthBerlinGermany,Department of OtorhinolaryngologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | | | - Jean‐Louis Pépin
- Université Grenoble AlpesLaboratoire HP2GrenobleFrance,INSERMU1042VillejuifFrance
| | | | - Robert Picard
- Conseil Général de l'Economie Ministère de l'Economiede l'Industrie et du NumériqueParisFrance
| | | | - Francesca Puggioni
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly,Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Santiago Quirce
- Department of AllergyHospital La Paz Institute for Health Research (IdiPAZ)MadridSpain
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Sietze Reitsma
- Department of OtorhinolaryngologyAmsterdam University Medical Centres, AMCAmsterdamthe Netherlands
| | - Nicolas Roche
- PneumologieAP‐HP Centre Université de Paris CitéHôpital CochinParisFrance,UMR 1016Institut CochinParisFrance
| | | | - Jan Romantowski
- Department of AllergologyMedical University of GdańskGdanskPoland
| | - Ana Sá‐Sousa
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Faradiba S. Serpa
- Asthma Reference Center ‐ School of Medicine of Santa Casa de Misericórdia of VitóriaVitoria, Espirito SantoBrazil
| | - Marine Savouré
- InsermEquipe d’Epidémiologie Respiratoire IntégrativeCESPVillejuifFrance,Université Paris‐Saclay, UVSQUniversity Paris‐SudVillejuifFrance
| | - Mohamed H. Shamji
- National Heart and Lung InstituteImperial CollegeLondonUK,NIHR Imperial Biomedical Research CentreLondonUK
| | - Milan Sova
- Department of Respiratory Medicine and TuberculosisUniversity HospitalBrnoCzech Republic
| | - Annette Sperl
- Center for Rhinology and AllergologyWiesbadenGermany
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”University of SalernoSalernoItaly
| | - Ana Todo‐Bom
- ImunoalergologiaCentro Hospitalar Universitário de CoimbraFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Peter Valentin Tomazic
- Department of General ORLH&NSMedical University of GrazENT‐University Hospital GrazGrazSteiermarkAustria
| | - Olivier Vandenplas
- Department of Chest MedicineCentre Hospitalier Universitaire UCL NamurNamurBelgique,Université Catholique de LouvainYvoirBelgium
| | | | - Tuula Vasankari
- Fihla, Finnish Lung AssociationHelsinkiFinland,University of TurkuTurkuFinland
| | | | - Susan Waserman
- Department of Medicine, Clinical Immunology and AllergyMcMaster UniversityHamiltonOntarioCanada
| | - Joao A. Fonseca
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Health Research NetworkFaculty of Medicine, University of PortoPortoPortugal,RISE – Health Research Network, MEDCIDSFaculty of Medicine, University of PortoPortoPortugal
| | - Torsten Zuberbier
- Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
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Quaranta VN, Dragonieri S, Vulpi MR, Crimi N, Crimi C, Santus P, Menzella F, Pelaia C, Scioscia G, Caruso C, Bargagli E, Scichilone N, Carpagnano GE. High Level of Blood Eosinophils and Localization of Bronchiectasis in Patients with Severe Asthma: A Pilot Study. J Clin Med 2023; 12:jcm12010380. [PMID: 36615179 PMCID: PMC9821283 DOI: 10.3390/jcm12010380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
Background. Severe asthma and bronchiectasis are heterogeneous diseases that frequently coexist. The location of bronchiectasis is generally determined by specific underlying pathophysiological mechanisms. The aim of this study was to determine whether in a population suffering from both severe asthma and bronchiectasis there was a correlation between eosinophilic inflammation and localization of bronchiectasis. Methods. We enrolled 41 patients with coexisting bronchiectasis from eight different severe asthma center outpatient clinics and collected the following data: baseline characteristics, Asthma Control Test, Asthma Control Questionnaire, IgE level, blood count, high-resolution computed tomography and bronchiectasis-related parameters, skin prick test, FeNO50 and flow-volume spirometry. The study was retrospectively registered. Results. The presence of eosinophils > 1000 cells/μL was related to distribution of lower pulmonary bronchiectasis (9.1% upper lobes vs. 53.3% lower lobes, p = 0.014). Indeed, the presence of eosinophilic counts > 1000 increased the probability of lower localization of bronchiectasis compared to upper lobes (ODD 0.088 (0.010−0.772), p = 0.028). Conclusions. An increase in blood eosinophils > 1000 cells/μL seems to be associated with lower preferential localization of bronchiectasis with sparing of the upper lung lobes. This could represent a new potential radiological phenotype that could have a dedicated therapeutic strategy in the future.
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Affiliation(s)
- Vitaliano Nicola Quaranta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Silvano Dragonieri
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
- Correspondence:
| | - Maria Rosaria Vulpi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
| | - Nunzio Crimi
- Department of Internal Medicine and Specialistic Medicine, Section of Respiratory Diseases, University of Catania, 95100 Catania, Italy
| | - Claudia Crimi
- Department of Internal Medicine and Specialistic Medicine, Section of Respiratory Diseases, University of Catania, 95100 Catania, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, Division of Respiratory Diseases, “L.Sacco” University Hospital, Università degli Studi di Milano, 20100 Milan, Italy
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS 2 Marca Trevigiana, 31044 Montebelluna, Italy
| | - Corrado Pelaia
- Department of Health Sciences, Section of Respiratory Disease, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University Hospital Policlinico Riuniti of Foggia, University of Foggia, 71100 Foggia, Italy
| | - Cristiano Caruso
- Department of Medical and Surgical Sciences, UOSD DH Gastroenterology, Polyclinic Foundation a. Gemelli IRCCS Cattolica University del Sacro Cuore, 00186 Rome, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, 53100 Siena, Italy
| | | | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70124 Bari, Italy
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Benfante A, Tomasello A, Gianquinto E, Cicero MN, Scichilone N. Diagnostic and therapeutic approaches for elderly asthma patients: the importance of multidisciplinary and multidimensional management. Expert Rev Respir Med 2023; 17:459-468. [PMID: 37194689 DOI: 10.1080/17476348.2023.2215432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Asthma is commonly considered a disease of younger ages; however, it is not infrequent to pose a diagnosis of the disease in older individuals. Although current recommendations do not distinguish between young and old asthmatics in terms of diagnostic and therapeutic approaches, asthma in the elderly may present with peculiar features that contribute to complicate its management. AREAS COVERED The current review focuses on the challenges that arise when approaching an older individual with suspected asthma. Age-associated changes of the lung may complicate the diagnostic approach. Measurement of the forced expiratory volume in the first 6 s (FEV6) in an easier and faster alternative to FVC estimation, and residual volume should always be assessed. Older individuals are often affected by concomitant diseases, both age- and drug-related, that need to be considered when approaching elderly asthmatics, since they can affect the efficacy of the treatment as well as the control of the disease. EXPERT OPINION The potential drug to drug interaction should be routinely investigated, and documented in medical records. The effect of aging on the response to pharmacological therapy in older asthmatics should be explored. Therefore, the need of a multidisciplinary and multidimensional approach to the elderly asthmatics is strongly encouraged.
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Affiliation(s)
- Alida Benfante
- PROMISE Department, University of Palermo, Palermo, Italy
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26
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Latorre M, Pistelli R, Carpagnano GE, Celi A, Puxeddu I, Scichilone N, Spanevello A, Canonica GW, Paggiaro P. Symptom versus exacerbation control: an evolution in GINA guidelines? Ther Adv Respir Dis 2023; 17:17534666231159261. [PMID: 37646243 PMCID: PMC10469243 DOI: 10.1177/17534666231159261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 02/07/2023] [Indexed: 09/01/2023] Open
Abstract
The article traces the concept of asthma control within GINA guidelines over the past 25 years. In the first 15 years after 1995, the main objective of asthma management was to obtain the control of all clinical and functional characteristics of asthma. A landmark study (GOAL) showed for the first time that a good control of asthma is a reasonable outcome that can be achieved in a large proportion of asthmatics with a regular appropriate treatment. In the following years, more emphasis was placed on the role of exacerbations as critical manifestations of poor asthma control, whose frequency is associated with excessive FEV1 decline and increased risk of death. Accordingly, the 2014 GINA report makes a clear distinction between the control of the day-by-day symptoms and the reduction in the risk of severe exacerbations, stating that both conditions should be obtained. The 2019 update included a significant change in the management of mild asthma, prioritizing the prevention of exacerbations to that of mild symptoms. This view was repeated in the 2021 update, where the prevention of exacerbations, together with an acceptable symptom control with a minimal use of rescue medication, appeared to be the real main goal of asthma management. While a discrepancy between current symptoms and exacerbations may be present in mild asthma, a significant relationship between these two features is observed in moderate-severe asthma: a persistent poor symptom control is a major risk factor for exacerbations, whereas achieving symptom control through regular treatment is associated with a reduction in exacerbation rate. Thus, the opinion that frequent symptoms are not important in the absence of acute exacerbations should be discouraged, whereas education of patients to a good symptom perception and to improve adherence to regular treatment should be implemented. Furthermore, the persistence of risk factors, such as increased airway inflammation, even in a patient with minor daily symptoms, should be considered for optimizing treatment.
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Affiliation(s)
| | | | - Giovanna Elisiana Carpagnano
- Section of Respiratory Diseases, Department of Basic Medical Science, Neuroscience and Sense Organs, ‘Aldo Moro’ University of Bari, Bari, Italy
| | - Alessandro Celi
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Ilaria Puxeddu
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Scichilone
- Department of PROMISE, AOUP Giaccone, University of Palermo, Palermo, Italy
| | - Antonio Spanevello
- Department of Medicine and Surgery, Pulmonary Diseases Unit, Insubria University, Varese, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma and Allergy Clinic, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa 5124, Italy
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Abstract
Asthma is a complex, heterogeneous disease that necessitates a proper patient evaluation to decide the correct treatment and optimize disease control. The recent introduction of new target therapies for the most severe form of the disease has heralded a new era of treatment options, intending to treat and control specific molecular pathways in asthma pathophysiology. Precision medicine, using omics sciences, investigates biological and molecular mechanisms to find novel biomarkers that can be used to guide treatment selection and predict response. The identification of reliable biomarkers indicative of the pathological mechanisms in asthma is essential to unravel new potential treatment targets. In this chapter, we provide a general description of the currently available -omics techniques, focusing on their implications in asthma therapy.
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Affiliation(s)
- Stefania Principe
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) c/o Pneumologia, AOUP "Policlinico Paolo Giaccone", University of Palermo, Palermo, Italy.
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mahmoud I Abdel-Aziz
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Nicola Scichilone
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) c/o Pneumologia, AOUP "Policlinico Paolo Giaccone", University of Palermo, Palermo, Italy
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28
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Incalzi RA, Blasi F, Canonica GW, Foschino MP, Prediletto R, Simoni L, Ori A, Giovannetti C, Barsanti S, Scichilone N. The Prescribing Practice for COPD: Relationship to Circadian Rhythm, Disease Severity, and Clinical Phenotype in the STORICO Observational Study. Adv Ther 2022; 39:5582-5589. [PMID: 36219388 DOI: 10.1007/s12325-022-02331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/22/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION While selected clinical and laboratory findings are taken into account to find the best therapeutic strategies for chronic obstructive pulmonary disease (COPD), it is unknown whether the circadian rhythm of respiratory symptoms, a distinctive feature of COPD, affects the prescription pattern of pharmacological therapy. The main aim of this study was to verify whether the circadian rhythm of symptoms correlates with bronchodilating therapy prescribed to COPD patients as per clinical practice. A secondary objective was to assess the relationship between Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and circadian rhythm of symptoms and health status. METHODS Five hundred sixty-six COPD patients were enrolled in the Italian multicenter STORICO study. Patients underwent a multidimensional assessment, and correlates of prescribed therapy were assessed through a multivariate multilevel model. RESULTS As expected, patients in GOLD D stage were more likely to receive triple inhaled therapy than GOLD A-C patients, but the circadian rhythm of symptoms, assessed by the nighttime, morning, and daytime symptoms of the COPD questionnaire, was unrelated to the prescription pattern. The multivariate model showed that emphysematous (EM) patients had a 50% increased risk compared with patients affected by chronic bronchitis (CB) of being prescribed long-acting β2-agonists (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combination (FDC) instead of triple therapy [relative risk (RR) EM versus CB 1.50, 95% CI 1.11, 2.03]. Symptoms, mainly in the early morning and daytime, were highly prevalent, even in GOLD B stage (76%). CONCLUSION Even if we cannot infer about causality of the symptoms-therapy relationship, based on the structured recording of circadian symptoms clearly shows that symptoms are poorly controlled as the circadian rhythm of symptoms does not correlate with the prescription pattern, and many patients are symptomatic both at daytime and by nighttime. Thus, therapy should be better tailored to the individual needs, with special attention to control nocturnal symptoms. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03105999.
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Affiliation(s)
| | - Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma and Allergy Clinic, Humanitas University Humanitas Research Hospital Rozzano (Milan), Via Manzoni, 56, 20089, Rozzano (Milan), Italy
| | - Maria Pia Foschino
- MAR4 Univ., D'Avanzo Hospital, Viale degli Aviatori, 1, 71122, Foggia, Italy
| | - Renato Prediletto
- Pneumology, Institute of Clinical Physiology, National Research Council of Italy and Toscana G. Monasterio Foundation, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Lucia Simoni
- Medineos Observational Research, Viale Virgilio 54/U, 41123, Modena, Italy
| | - Alessandra Ori
- Medineos Observational Research, Viale Virgilio 54/U, 41123, Modena, Italy
| | | | | | - Nicola Scichilone
- DIBIMIS, University of Palermo, Piazza delle Cliniche, 2, 90127, Palermo, Italy
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29
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Bousquet J, Sousa-Pinto B, Anto J, Amaral R, Brussino L, Canonica G, Cruz A, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann D, Louis R, Pham-Thi N, Puggioni F, Regateiro F, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura M, Agache I, Bedbrook A, Bergmann K, Bosnic-Anticevich S, Bonini M, Boulet LP, Brusselle G, Buhl R, Cecchi L, Charpin D, Chaves-Loureiro C, Czarlewski W, de Blay F, Devillier P, Joos G, Jutel M, Klimek L, Kuna P, Laune D, Pech J, Makela M, Morais-Almeida M, Nadif R, Niedoszytko M, Ohta K, Papadopoulos N, Papi A, Yeverino D, Roche N, Sá-Sousa A, Samolinski B, Shamji M, Sheikh A, Suppli Ulrik C, Usmani O, Valiulis A, Vandenplas O, Yorgancioglu A, Zuberbier T, Fonseca J. Identification by cluster analysis of patients with asthma and nasal symptoms using the MASK-air® mHealth app. Pulmonology 2022:S2531-0437(22)00252-5. [DOI: 10.1016/j.pulmoe.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
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Di Simone M, Corsale AM, Lo Presti E, Scichilone N, Picone C, Giannitrapani L, Dieli F, Meraviglia S. Phenotypical and Functional Alteration of γδ T Lymphocytes in COVID-19 Patients: Reversal by Statins. Cells 2022; 11:cells11213449. [PMID: 36359845 PMCID: PMC9656060 DOI: 10.3390/cells11213449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Background: statins have been considered an attractive class of drugs in the pharmacological setting of COVID-19 due to their pleiotropic properties and their use correlates with decreased mortality in hospitalized COVID-19 patients. Furthermore, it is well known that statins, which block the mevalonate pathway, affect γδ T lymphocyte activation. As γδ T cells participate in the inflammatory process of COVID-19, we have investigated the therapeutical potential of statins as a tool to inhibit γδ T cell pro-inflammatory activities; (2) Methods: we harvested peripheral blood mononuclear cells (PBMCs) from COVID-19 patients with mild clinical manifestations, COVID-19 recovered patients, and healthy controls. We performed ex vivo flow cytometry analysis to study γδ T cell frequency, phenotype, and exhaustion status. PBMCs were treated with Atorvastatin followed by non-specific and specific stimulation, to evaluate the expression of pro-inflammatory cytokines; (3) Results: COVID-19 patients had a lower frequency of circulating Vδ2+ T lymphocytes but showed a pronounced pro-inflammatory profile, which was inhibited by in vitro treatment with statins; (4) Conclusions: the in vitro capacity of statins to inhibit Vδ2+ T lymphocytes in COVID-19 patients highlights a new potential biological function of these drugs and supports their therapeutical use in these patients.
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Affiliation(s)
- Marta Di Simone
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AUOP Paolo Giaccone, 90127 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnosis (BIND), University of Palermo, 90127 Palermo, Italy
| | - Anna Maria Corsale
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AUOP Paolo Giaccone, 90127 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnosis (BIND), University of Palermo, 90127 Palermo, Italy
| | - Elena Lo Presti
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), 90146 Palermo, Italy
| | - Nicola Scichilone
- Division of Respiratory Medicine, AUOP Paolo Giaccone, 90127 Palermo, Italy
- Internal Medicine Department Unit, Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialities Department (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Carmela Picone
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AUOP Paolo Giaccone, 90127 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnosis (BIND), University of Palermo, 90127 Palermo, Italy
| | - Lydia Giannitrapani
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), 90146 Palermo, Italy
- Internal Medicine Department Unit, Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialities Department (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Francesco Dieli
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AUOP Paolo Giaccone, 90127 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnosis (BIND), University of Palermo, 90127 Palermo, Italy
| | - Serena Meraviglia
- Central Laboratory of Advanced Diagnosis and Biomedical Research (CLADIBIOR), AUOP Paolo Giaccone, 90127 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnosis (BIND), University of Palermo, 90127 Palermo, Italy
- Correspondence:
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Benfante A, Sousa-Pinto B, Pillitteri G, Battaglia S, Fonseca J, Bousquet J, Scichilone N. Applicability of the MASK-Air® App to Severe Asthma Treated with Biologic Molecules: A Pilot Study. Int J Mol Sci 2022; 23:ijms231911470. [PMID: 36232771 PMCID: PMC9569460 DOI: 10.3390/ijms231911470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
MASK-air®, a good practice of the DG Santé, has been fully validated in allergic rhinitis, but little is known about its applicability to asthmatics. We explored whether the MASK-air® application is applicable to patients with severe asthma. Severe asthmatics were proposed to use the MASK-air® application for 6 months, along with best practice treatment. Treatment of the patients was not changed based on the application results. The evolution of the visual analogue scales (VAS) for asthma, shortness of breath, rhinitis, conjunctivitis, work, and sleep was monitored using MASK-air®. Adherence to MASK-air® and to the asthma treatment was also checked. Thirteen patients reported on 1229 days of MASK-air® use. The average application adherence was 51.8% (range: 19.7–98.9%). There was no correlation between application and medication adherence. Highly variably trends were found for the VAS for asthma. Five patients had over 90% well-controlled days, four had well- or moderately controlled asthma (with up to 20% uncontrolled days), one patient had moderately controlled asthma with approximately 20% uncontrolled days, and one patient had 80% uncontrolled days. Highly significant correlations were found for the VAS for asthma, and other patients reported VASs for work, dyspnea, sleep, and rhinitis. MASK-air® can be used in patients with severe asthma. VAS asthma appears to be an interesting patient-reported outcome highly correlated with dyspnea and impacts on work. Adherence to the application was better than that for rhinitis, but it needs to be improved.
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Affiliation(s)
- Alida Benfante
- PROMISE—Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n. 2, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-0916552681
| | - Bernardo Sousa-Pinto
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- CINTESIS—Center for Health Technology and Services Research, University of Porto, 4200-450 Porto, Portugal
- RISE—Health Research Network, University of Porto, 4200-450 Porto, Portugal
| | - Gianluca Pillitteri
- PROMISE—Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n. 2, 90127 Palermo, Italy
| | - Salvatore Battaglia
- PROMISE—Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n. 2, 90127 Palermo, Italy
| | - Joao Fonseca
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- CINTESIS—Center for Health Technology and Services Research, University of Porto, 4200-450 Porto, Portugal
- RISE—Health Research Network, University of Porto, 4200-450 Porto, Portugal
| | - Jean Bousquet
- MACVIA-France, 34000 Montpellier, France
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
- Centre Hospitalier Universitaire, 34295 Montpellier, France
| | - Nicola Scichilone
- PROMISE—Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche n. 2, 90127 Palermo, Italy
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Cazzola M, Braido F, Calzetta L, Matera MG, Piraino A, Rogliani P, Scichilone N. The 5T approach in asthma: Triple Therapy Targeting Treatable Traits. Respir Med 2022; 200:106915. [PMID: 35753188 DOI: 10.1016/j.rmed.2022.106915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
Using a therapeutic strategy that is free from traditional diagnostic labels and based on the identification of "treatable traits" (TTs), which are influential in clinical presentations in each patient, might overcome the difficulties in identifying and validating asthma phenotypes and endotypes. Growing evidence is documenting the importance of using the triple therapy with ICS, LABA, and LAMAs in a single inhaler (SITT) in cases of asthma not controlled by ICS/LABA and in the prevention of exacerbations. The identification of TTs may overcome the possibility of using SITT without considering the specific needs of the patient. In effect, it allows a treatment strategy that is closer to the precision strategy now widely advocated for the management of patients with asthma. There are different TTs in asthma that may benefit from treatment with SITT, regardless of guideline recommendations. The airflow limitation and small airway dysfunction are key TTs that are present in different phenotypes/endotypes, do not depend on the degree of T2 inflammation, and respond better than other treatments to SITT. We suggest that the 5T (Triple Therapy Targeting Treatable Traits) approach should be applied to the full spectrum of asthma, not just severe asthma, and, consequently, SITT should begin earlier than currently recommended.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Fulvio Braido
- Department of Allergy and Respiratory Diseases, University of Genoa, Genoa, Italy
| | - Luigino Calzetta
- Unit of Respiratory Diseases and Lung Function, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessio Piraino
- Respiratory Area, Medical Affairs, Chiesi Italia, Parma, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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Principe S, Grosso A, Benfante A, Albicini F, Battaglia S, Gini E, Amata M, Piccionello I, Corsico AG, Scichilone N. Comparison between Suspected and Confirmed COVID-19 Respiratory Patients: What Is beyond the PCR Test. J Clin Med 2022; 11:jcm11112993. [PMID: 35683382 PMCID: PMC9181151 DOI: 10.3390/jcm11112993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022] Open
Abstract
COVID-19 modified the healthcare system. Nasal-pharyngeal swab (NPS), with real-time reverse transcriptase-polymerase (PCR), is the gold standard for the diagnosis; however, there are difficulties related to the procedure that may postpone it. The study aims to evaluate whether other elements than the PCR-NPS are reliable and confirm the diagnosis of COVID-19. This is a cross-sectional study on data from the Lung Unit of Pavia (confirmed) and at the Emergency Unit of Palermo (suspected). COVID-19 was confirmed by positive NPS, suspected tested negative. We compared clinical, laboratory and radiological variables and performed Logistic regression to estimate which variables increased the risk of COVID-19. The derived ROC-AUCcurve, assessed the accuracy of the model to distinguish between COVID-19 suspected and confirmed. We selected 50 confirmed and 103 suspected cases. High Reactive C-Protein (OR: 1.02; CI95%: 0.11–1.02), suggestive CT-images (OR: 11.43; CI95%: 3.01–43.3), dyspnea (OR: 10.48; CI95%: 2.08–52.7) and respiratory failure (OR: 5.84; CI95%: 1.73–19.75) increased the risk of COVID-19, whereas pleural effusion decreased the risk (OR: 0.15; CI95%: 0.04–0.63). ROC confirmed the discriminative role of these variables between suspected and confirmed COVID-19 (AUC 0.91). Clinical, laboratory and imaging features predict the diagnosis of COVID-19, independently from the NPS result.
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Affiliation(s)
- Stefania Principe
- Department of Pulmonology–Palermo (PA) (Italy), AOUP Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy; (S.P.); (A.B.); (S.B.); (M.A.); (I.P.)
- Department of Respiratory Medicine–Amsterdam, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Amelia Grosso
- Department of Pulmonology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.G.); (F.A.); (E.G.); (A.G.C.)
| | - Alida Benfante
- Department of Pulmonology–Palermo (PA) (Italy), AOUP Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy; (S.P.); (A.B.); (S.B.); (M.A.); (I.P.)
| | - Federica Albicini
- Department of Pulmonology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.G.); (F.A.); (E.G.); (A.G.C.)
| | - Salvatore Battaglia
- Department of Pulmonology–Palermo (PA) (Italy), AOUP Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy; (S.P.); (A.B.); (S.B.); (M.A.); (I.P.)
| | - Erica Gini
- Department of Pulmonology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.G.); (F.A.); (E.G.); (A.G.C.)
| | - Marta Amata
- Department of Pulmonology–Palermo (PA) (Italy), AOUP Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy; (S.P.); (A.B.); (S.B.); (M.A.); (I.P.)
| | - Ilaria Piccionello
- Department of Pulmonology–Palermo (PA) (Italy), AOUP Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy; (S.P.); (A.B.); (S.B.); (M.A.); (I.P.)
| | - Angelo Guido Corsico
- Department of Pulmonology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.G.); (F.A.); (E.G.); (A.G.C.)
| | - Nicola Scichilone
- Department of Pulmonology–Palermo (PA) (Italy), AOUP Policlinico Paolo Giaccone, University of Palermo, 90127 Palermo, Italy; (S.P.); (A.B.); (S.B.); (M.A.); (I.P.)
- Correspondence:
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Sousa‐Pinto B, Fonseca JA, Gemicioglu B, Regateiro FS, Scichilone N, Ventura MT, Bousquet J. Patient-reported outcome measures (PROMs) using the MASK-air ® app in severe asthma. Allergy 2022; 77:1600-1602. [PMID: 35137430 DOI: 10.1111/all.15248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Bernardo Sousa‐Pinto
- Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal
- Center for Health Technology and Services Research University of Porto Porto Portugal
| | - Joao A. Fonseca
- Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal
- Center for Health Technology and Services Research University of Porto Porto Portugal
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases Cerrahpasa Faculty of Medicine Istanbul University‐Cerrahpasa Istanbul Turkey
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology Unit Centro Hospitalar e Universitário de Coimbra, and Institute of Immunology Faculty of Medicine University of Coimbra, and ICBR ‐ Coimbra Institute for Clinical and Biomedical Research(iCBR), Facutly of Medicine, University of Combra Coimbra Portugal
| | | | | | - Jean Bousquet
- Institute of Allergology Charité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu Berlin and Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany Germany
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Contoli M, Santus P, Menzella F, Rocchi C, Radovanovic D, Baraldi F, Martelli C, Casanova S, Barbetta C, Micheletto C, Scichilone N, Beghè B, Carpagnano E, Papi A. Effects of anti‐IL5 biological treatments on blood IgE levels in severe asthmatic patients: A real‐life multicentre study (BIONIGE). Clin Transl Allergy 2022; 12:e12143. [PMID: 35423001 PMCID: PMC8988861 DOI: 10.1002/clt2.12143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Mepolizumab and benralizumab are clinically effective biological treatments for severe eosinophilic asthmatic patients by hampering eosinophilic inflammation. The effects of these compound on the immunoglobulin (Ig)E T2 component are virtually unknown. Objectives To evaluate the change in total IgE levels at 4 ± 2 months after initiation of the mepolizumab (primary outcome) or benralizumab. When available, the changes of blood inflammatory cell counts, lung function and asthma control test (ACT) were also assessed and correlated with changes in total IgE levels. Methods Observational, retrospective, multicentre, cohort study. Severe eosinophilic atopic asthmatic patients treated with mepolizumab or benralizumab were included in the analysis. Results Three‐month treatment (on average) with mepolizumab (n = 104) or benralizumab (n = 82) resulted in significantly higher reduction of blood eosinophil and basophil levels in patients treated with benralizumab compared to mepolizumab. Mepolizumab did not significantly modified the levels of blood total IgE during the study period, whereas benralizumab significantly reduced (−35%, p < 0.001) total blood IgE levels. In patients treated with benralizumab the reduction of blood total Ig‐E levels correlated with the reduction of blood basophils (but not eosinophils) and weakly with the improvement of asthma control. Conclusion Benralizumab but not mepolizumab, treatment led to a significant reduction of circulating IgE level. The study provides different and specific mechanisms of action for anti‐IL5‐pathway treatments.
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Affiliation(s)
- Marco Contoli
- Respiratory Medicine Department of Translational Medicine University of Ferrara Ferrara Italy
- Emergency Department University Hospital S. Anna Ferrara Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale Luigi Sacco Polo Universitario, ASST Fatebenefratelli‐Sacco Department of Biomedical and Clinical Sciences (DIBIC) Università Degli Studi di Milano Milan Italy
| | - Francesco Menzella
- Pneumology Unit Arcispedale Santa Maria Nuova, Azienda USL‐IRCCS di Reggio Emilia Reggio Emilia Italy
| | - Cindy Rocchi
- Respiratory Medicine Department of Translational Medicine University of Ferrara Ferrara Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco Polo Universitario, ASST Fatebenefratelli‐Sacco Department of Biomedical and Clinical Sciences (DIBIC) Università Degli Studi di Milano Milan Italy
| | - Federico Baraldi
- Respiratory Medicine Department of Translational Medicine University of Ferrara Ferrara Italy
| | - Chiara Martelli
- Respiratory Medicine Department of Translational Medicine University of Ferrara Ferrara Italy
| | - Serena Casanova
- Respiratory Medicine Department of Translational Medicine University of Ferrara Ferrara Italy
| | - Carlo Barbetta
- Department of Pulmonary Medicine Ospedale Santa Maria degli Angeli Pordenone Italy
| | - Claudio Micheletto
- Cardio‐Thoracic Department, Respiratory Unit Integrated University Hospital Verona Italy
| | - Nicola Scichilone
- Dipartimento Universitario di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Division of Respiratory Medicine "Paolo Giaccone" University Hospital University of Palermo Palermo Italy
| | - Bianca Beghè
- Respiratory Diseases Unit Department of Medical and Surgical Sciences University of Modena Reggio Emilia Italy
| | - Elisiana Carpagnano
- Division of Respiratory Diseases Department of Medical and Surgical Sciences Respiratory and Critical Care Unit University of Foggia Polyclinic University Hospital Bari Italy
| | - Alberto Papi
- Respiratory Medicine Department of Translational Medicine University of Ferrara Ferrara Italy
- Emergency Department University Hospital S. Anna Ferrara Italy
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Adamo G, Amata M, Cannizzaro N, Chessari C, Sapienza GM, Capizzi GM, Battaglia S, Benfante A, Scichilone N. Transient asymptomatic bradycardia and Remdesivir in COVID-19 patients. Minerva Med 2022:S0026-4806.22.08035-1. [PMID: 35332758 DOI: 10.23736/s0026-4806.22.08035-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND COVID-19 is an infectious disease caused by a coronavirus in humans, namely SARS-CoV-2, which has quickly become a global pandemic. The infection is responsible for a severe form of pneumonia, which may lead to lung failure and death. Among the therapeutic strategies, the antiviral agent Remdesivir has become one of the most used drugs. The current literature reports a causal correlation between Remdesivir administration and the incidence of cardiovascular effects. We aimed at further investigating this relationship, by exploring the association between the use of Remdesivir and the onset of bradyarrhythmic disorders. METHODS We reviewed medical records, blood exams and chest imaging of 85 patients with COVID-19 pneumonia (M/F: 57/28, age 61±12 years) admitted between September 2020 and May 2021 to the Division of Respiratory Diseases in Palermo, Italy. RESULTS We found a significant correlation between treatment with Remdesivir and the occurrence of bradycardia, lasting for at least 3 days, which returned to normal values after the discontinuation of the drug. A significant reduction in heart rate (HR) was observed in the days following Remdesivir administration (L. Ratio 47.4, p<0.0001) in 24 patients (HR on the first day of observation: 75±14 bpm; at discharge: 72±14 bpm). Cardiac events occurred more frequently in subjects with extensive pulmonary involvement (greater than 50% of the total parenchyma, as assessed by chest CT). CONCLUSIONS We suggest to carefully monitor the administration of the drug in patients with risk factors for arrhythmic or cardiovascular events.
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Affiliation(s)
- Giuseppe Adamo
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Marta Amata
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Nunzia Cannizzaro
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Carlo Chessari
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Giuseppe M Sapienza
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Giada M Capizzi
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Alida Benfante
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy -
| | - Nicola Scichilone
- Division of Respiratory Diseases, Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza G. D'Alessandro (PROMISE), Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
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Crimi C, Scichilone N. A Key to Unlocking the Mysteries of COVID-19 Pulmonary Sequelae: Are We There? Respiration 2022; 101:529-530. [PMID: 35263740 PMCID: PMC9059025 DOI: 10.1159/000522519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Nicola Scichilone
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), University of Palermo, Palermo, Italy
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Braido F, Corsico AG, Paleari D, Piraino A, Cavalieri L, Scichilone N. Why small particle fixed dose triple therapy? An excursus from COPD pathology to pharmacological treatment evolution. Ther Adv Respir Dis 2022; 16:17534666211066063. [PMID: 35044875 PMCID: PMC8796083 DOI: 10.1177/17534666211066063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
Although bronchodilators are the cornerstone in chronic obstructive pulmonary disease (COPD) therapy, the treatment with a single-agent bronchodilator may not provide adequate symptoms control in COPD. The combination of drugs with different mechanisms of action may be more effective in inducing bronchodilation and preventing exacerbations, with a lower risk of side-effects in comparison with the increase of the dose of a single molecule. Several studies comparing the triple therapy with the association of long-acting ß2 agonist (LABA)/inhaled corticosteroid (ICS) or long-acting muscarinic antagonist (LAMA)/LABA reported improvement of lung function and quality of life. A significant reduction in moderate/severe exacerbations has been observed with a fixed triple combination of beclometasone dipropionate (BDP), formoterol fumarate (FF) and glycopyrronium (G) in a single inhaler. The TRILOGY, TRINITY and TRIBUTE studies have provided confirming evidence for a clinical benefit of triple therapy over ICS/LABA combination treatment, LAMA monotherapy and LABA/LAMA combination, with prevention of exacerbations being a key finding. A pooled post hoc analysis of the published clinical studies involving BDP/FF/G fixed combination demonstrated a reduction in fatal events in patients treated with ICS-containing medications, with a trend of statistical significance [hazard ratio = 0.72, 95% confidence interval (CI) 0.50-1.02, p = 0.066], that becomes significant if we consider reduction in fatal events for non-respiratory reasons (hazard ratio = 0.65, 95% CI 0.43-0.97, p = 0.037). In conclusion, a fixed combination of more drugs in a single inhaler can improve long-term adherence to the therapy, reducing the risk of exacerbations and hospital resources utilization. The twice a day administration may provide a better coverage of night, particularly in COPD patients who are highly symptomatic. The inhaled extrafine formulation that allows drug deposition in both large and small - peripheral - airways, is the value added.
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Affiliation(s)
- Fulvio Braido
- Associate Professor of Respiratory Medicine University of Genoa Head of Respiratory Unit for continuity of care IRCCS Ospedale Policlinico San Martino - Genova
| | - Angelo G. Corsico
- Division of Respiratory Diseases, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia 27100, Italy
| | - Davide Paleari
- Medical Affairs, Chiesi Italy. Chiesi Farmaceutici S.p.A. Parma, Italy
| | - Alessio Piraino
- Medical Affairs, Chiesi Italy. Chiesi Farmaceutici S.p.A. Parma, Italy
| | - Luca Cavalieri
- Medical Affairs, Chiesi Italy. Chiesi Farmaceutici S.p.A. Parma, Italy
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Pelaia C, Crimi C, Crimi N, Ricciardi L, Scichilone N, Valenti G, Bonavita O, Andaloro S, Morini P, Rizzi A, Pelaia G. Indacaterol/glycopyrronium/mometasone fixed dose combination for uncontrolled asthma. Expert Rev Respir Med 2021; 16:183-195. [PMID: 34845963 DOI: 10.1080/17476348.2021.2011222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma symptoms can be relieved through a maintenance treatment combining long-acting β2-agonist and inhaled corticosteroids (LABA/ICS). However, for patients with inadequately controlled asthma, the LABA/ICS combination might not be sufficient, and clinical guidelines recommend the administration of inhaled long-acting muscarinic antagonists (LAMA) as an add-on therapy to better control asthma and improve lung function. For nearly two decades, the only LAMA to be approved on the market has been tiotropium. AREAS COVERED We reviewed recent clinical studies evaluating the safety and efficacy of LABA/LAMA/ICS fixed dose combinations by searching the PubMed database. Molecular mechanisms and clinical data support the use of a once-daily, single-inhaler fixed dose combination of the LABA/LAMA/ICS indacaterol/glycopyrronium/mometasone (IND/GLY/MF), the first therapy combining three agents in a fixed dose approved in Europe for the treatment of uncontrolled asthma. EXPERT OPINION IND/GLY/MF was superior to both IND/MF and salmeterol/fluticasone, a well-established LABA/ICS combination improving the lung function in uncontrolled asthma. Moreover, IND/GLY/MF, delivered through the Breezhaler inhaler in a single inhalation, is the first inhaled therapy prescribed alongside a digital companion, a sensor and the Propeller app, allowing for improved treatment adherence, reduced rescue inhaler usage and hospitalizations, increased patient satisfaction and asthma control.
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Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Claudia Crimi
- Respiratory Disease Unit, University Hospital of Catania, Catania, Italy
| | - Nunzio Crimi
- Respiratory Disease Unit, University Hospital of Catania, Catania, Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, A.O.U. Policlinico "G. Martino", Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nicola Scichilone
- Medicine of the Respiratory System, Hospital 'P. Giaccone', University of Palermo, Palermo, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Pta Biondo, ASP Palermo, Italy
| | | | | | - Paolo Morini
- Medical Department, Novartis Farma Origgio, Varese, Italy
| | - Andrea Rizzi
- Medical Department, Novartis Farma Origgio, Varese, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
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Di Bona D, Crimi C, D'Uggento AM, Benfante A, Caiaffa MF, Calabrese C, Campisi R, Carpagnano GE, Ciotta D, D'Amato M, Pelaia C, Pelaia G, Pellegrino S, Scichilone N, Scioscia G, Ribecco N, Spadaro G, Valenti G, Vatrella A, Crimi N, Macchia L. Effectiveness of benralizumab in severe eosinophilic asthma: Distinct sub-phenotypes of response identified by cluster analysis. Clin Exp Allergy 2021; 52:312-323. [PMID: 34608696 PMCID: PMC9293293 DOI: 10.1111/cea.14026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Benralizumab is effective in severe eosinophilic asthma (SEA), but suboptimal responses are observed in some patients. Although several factors have been associated with benralizumab response, no cluster analysis has yet been undertaken to identify different responsiveness sub-phenotypes. OBJECTIVE To identify SEA sub-phenotypes with differential responsiveness to benralizumab. METHODS One hundred and five patients diagnosed with SEA who had completed 6 months of benralizumab treatment were included in a hierarchical cluster analysis based on a set of clinical variables that can be easily collected in routine practice (age, age at disease onset, disease length, allergen sensitization status, blood eosinophil count, IgE levels, FEV1 % predicted, nasal polyposis, bronchiectasis). RESULTS Four clusters were identified: Clusters 2 and 3 included patients with high levels of both IgE and eosinophils (type-2 biomarkers high), whereas Clusters 1 and 4 included patients with only one type-2 biomarker at a high level: IgE in Cluster 1 and eosinophils in Cluster 4. Clusters 2 and 3 (both type-2 biomarkers high) showed the highest response rate to benralizumab in terms of elimination of exacerbations (79% and 80% respectively) compared to Clusters 1 and 4 (52% and 60% respectively). When super-response (the absence of exacerbation without oral corticosteroid use) was assessed, Cluster 2, including patients with more preserved lung function than the other clusters, but comparable exacerbation rate, oral corticosteroid use and symptom severity, was the most responsive cluster (87.5% of patients). CONCLUSIONS Our cluster analysis identified benralizumab differential response sub-phenotypes in SEA, with the potential of improving disease treatment and precision management.
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Affiliation(s)
- Danilo Di Bona
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Alida Benfante
- Department of Biomedicine and Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | | | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Raffaele Campisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, Bari, Italy
| | - Domenico Ciotta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Maria D'Amato
- Division of Pneumology, "V. Monaldi" University Hospital, Naples, Italy
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Simona Pellegrino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Nicola Scichilone
- Department of Biomedicine and Internal and Specialistic Medicine, University of Palermo, Palermo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Nunziata Ribecco
- Department of Economics and Finance, University of Bari - Aldo Moro, Bari, Italy
| | - Giuseppe Spadaro
- Allergology and Immunology Unit, University "Federico II" of Naples, Naples, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy
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Sousa-Pinto B, Eklund P, Pfaar O, Klimek L, Zuberbier T, Czarlewski W, Bédard A, Bindslev-Jensen C, Bedbrook A, Bosnic-Anticevich S, Brussino L, Cardona V, Cruz AA, de Vries G, Devillier P, Fokkens WJ, Fuentes-Pérez JM, Gemicioğlu B, Haahtela T, Huerta-Villalobos YR, Ivancevich JC, Kull I, Kuna P, Kvedariene V, Larenas Linnemann DE, Laune D, Makris M, Melén E, Morais-Almeida M, Mösges R, Mullol J, O'Hehir RE, Papadopoulos NG, Pereira AM, Prokopakis EP, Psarros F, Regateiro FS, Reitsma S, Samolinski B, Scichilone N, da Silva J, Stellato C, Todo-Bom A, Tomazic PV, Salmi ST, Valero A, Valiulis A, Valovirta E, van Eerd M, Ventura MT, Yorgancioglu A, Basagaña X, Antó JM, Bousquet J, Fonseca JA. Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK-air®. Clin Transl Allergy 2021; 11:e12062. [PMID: 34567526 PMCID: PMC8449952 DOI: 10.1002/clt2.12062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/07/2021] [Accepted: 08/02/2021] [Indexed: 01/10/2023] Open
Abstract
Background MASK-air® is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs. Methods Daily monitoring VAS data were assessed in MASK-air® users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol-5 Dimensions (EQ-5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire (work and activity impairment scores). Intra-rater reliability was assessed in users providing multiple daily VASs within the same day. Test-retest reliability was tested in clinically stable users, as defined by the EQ-5D VAS, CARAT, or "VAS Work" (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ-5D-VAS or "VAS Work" indicating clinical change. Results A total of 17,780 MASK-air® users, with 317,176 VAS days, were assessed. Concurrent validity was moderate-high (Spearman correlation coefficient range: 0.437-0.716). Intra-rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test-retest reliability ICCs ranged between 0.604 and 0.878-"VAS Work" and "VAS asthma" presented the highest ICCs. Moderate/large responsiveness effect sizes were observed-the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness. Conclusion In MASK-air®, daily monitoring VASs have high intra-rater reliability and moderate-high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine, University of Porto Porto Portugal.,CINTESIS - Center for Health Technology and Services Research University of Porto Porto Portugal.,RISE - Health Research Network University of Porto Porto Portugal
| | - Patrik Eklund
- Department of Computing Science Umeå University Umeå Sweden
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps Universität Marburg Marburg Germany
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery Universitätsmedizin Mainz Mainz Germany.,Center for Rhinology and Allergology Wiesbaden Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Comprehensive Allergy Center Charité Universitätsmedizin Berlin Humboldt-Universität zu Berlin Berlin Germany
| | - Wienczyslawa Czarlewski
- MASK-air Montpellier France.,Medical Consulting Czarlewski Levallois France.,MACVIA-France Montpellier France
| | - Annabelle Bédard
- ISGlobAL Universitat Pompeu Fabra (UPF) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain.,Equipe d'Epidémiologie Respiratoire Intégrative Université Paris-Saclay UVSQ Université Paris-Sud INSERM CESP Villejuif France
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - Anna Bedbrook
- MASK-air Montpellier France.,MACVIA-France Montpellier France
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group Woolcock Institute of Medical Research The University of Sydney Sydney New South Wales Australia.,Sydney Local Health District Glebe New South Wales Australia
| | - Luisa Brussino
- Department of Medical Sciences Allergy and Clinical Immunology Unit University of Torino & Mauriziano Hospital Torino Italy
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL research network Barcelona Spain
| | - Alvaro A Cruz
- Fundação ProAR - Federal University of Bahia Salvador Brazil.,WHO GARD Planning Group Salvador Brazil
| | | | - Philippe Devillier
- Laboratoire de Pharmacologie UPRES EA220 Pôle des Maladies des Voies Respiratoires Hôpital Foch Université Paris-Saclay Suresnes France
| | - Wytske J Fokkens
- Department of Otorhinolaryngology Amsterdam University Medical Centres Amsterdam the Netherlands
| | - José Miguel Fuentes-Pérez
- Hospital General Regional IMSS General Regional Hospital 1 Dr. Carlos Mac Gregor Sanchez Navarro Mexico City Mexico
| | - Bilun Gemicioğlu
- Department of Pulmonary Diseases Istanbul University-Cerrahpaşa Cerrahpasa Faculty of Medicine Istanbul Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
| | | | | | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Poland
| | - Violeta Kvedariene
- Department of Pathology Faculty of Medicine Institute of Biomedical Sciences Vilnius University Vilnius Lithuania.,Clinic of Chest Diseases and Allergology Faculty of Medicine Institute of Clinical Medicine Vilnius University Vilnius Lithuania
| | | | | | - Michael Makris
- Allergy Unit "D Kalogeromitros" 2nd Dpt of Dermatology and Venereology National & Kapodistrian University of Athens "Attikon" University Hospital Athens Greece
| | - Erik Melén
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden.,Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | | | - Ralph Mösges
- Medical Faculty Institute of Medical Statistics, and Computational Biology University of Cologne Cologne Germany.,CRI-Clinical Research International-Ltd Hamburg Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic Clinical & Experimental Respiratory Immunoallergy IDIBAPS University of Barcelona CIBERES Barcelona Spain
| | - Robyn E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine Central Clinical School Monash University Melbourne Victoria Australia.,Alfred Health Melbourne Victoria Australia
| | - Nikolaos G Papadopoulos
- Center for Pediatrics and Child Health Institute of Human Development Royal Manchester Children's Hospital University of Manchester Manchester UK.,Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital "P&A Kyriakou" University of Athens Athens Greece
| | - Ana Margarida Pereira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine, University of Porto Porto Portugal.,CINTESIS - Center for Health Technology and Services Research University of Porto Porto Portugal.,RISE - Health Research Network University of Porto Porto Portugal
| | - Emmanuel P Prokopakis
- Department of Otorhinolaryngology University of Crete School of Medicine Heraklion Greece
| | - Fotis Psarros
- Allergy Department Athens Naval Hospital Athens Greece
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit Institute of Immunology Faculty of Medicine Centro Hospitalar e Universitário de Coimbra University of Coimbra Coimbra Portugal.,Faculty of Medicine ICBR - Coimbra Institute for Clinical and Biomedical Research CIBB University of Coimbra Coimbra Portugal
| | - Sietze Reitsma
- Department of Otorhinolaryngology Amsterdam University Medical Centres Amsterdam the Netherlands
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | | | - Jane da Silva
- Allergy Service Internal Medicine Department University Hospital of Federal University of Santa Catarina (HU-UFSC) Florianópolis Brazil
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" University of Salerno Salerno Italy
| | - Ana Todo-Bom
- Allergy and Clinical Immunology Unit Institute of Immunology Faculty of Medicine Centro Hospitalar e Universitário de Coimbra University of Coimbra Coimbra Portugal.,Faculty of Medicine ICBR - Coimbra Institute for Clinical and Biomedical Research CIBB University of Coimbra Coimbra Portugal
| | | | | | - Antonio Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy IDIBAPS University of Barcelona Spain
| | - Arunas Valiulis
- Department of Public Health Vilnius University Institute of Clinical Medicine Clinic of Children's Diseases Institute of Health Sciences Vilnius Lithuania.,European Academy of Paediatrics (EAP/UEMS-SP) Brussels Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology University of Turku Turku Finland.,Terveystalo Allergy Clinic Turku Finland
| | | | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases Faculty of Medicine Celal Bayar University Manisa Turkey
| | - Xavier Basagaña
- ISGlobAL Universitat Pompeu Fabra (UPF) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain.,Universitat Pompeu Fabra (UPF) Barcelona Spain.,CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Josep M Antó
- ISGlobAL Universitat Pompeu Fabra (UPF) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain.,Universitat Pompeu Fabra (UPF) Barcelona Spain.,CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain.,IMIM (Hospital del Mar Research Institute) Barcelona Spain
| | - Jean Bousquet
- Department of Dermatology and Allergy Comprehensive Allergy Center Charité Universitätsmedizin Berlin Humboldt-Universität zu Berlin Berlin Germany.,MACVIA-France Montpellier France.,Centre Hospitalier Universitaire Montpellier France
| | - João Almeida Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences Faculty of Medicine, University of Porto Porto Portugal.,CINTESIS - Center for Health Technology and Services Research University of Porto Porto Portugal.,RISE - Health Research Network University of Porto Porto Portugal
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Principe S, Benfante A, Battaglia S, Maitland Van Der Zee AH, Scichilone N. The potential role of SP-D as an early biomarker of severity of asthma. J Breath Res 2021; 15. [PMID: 34428746 DOI: 10.1088/1752-7163/ac20c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022]
Abstract
Surfactant decreases the surface tension of peripheral airways and modulates the immunological responses of the lung. The alterations of surfactant due to the airway inflammation suggest a role in the pathogenesis of asthma. We aim to test the hypothesis that serum levels of SP-A (Surfactant Protein A) and SP-D (Surfactant Protein-D) are altered in patients with mild asthma compared to healthy controls and those alterations are related to functional abnormalities of peripheral airways, which are an early marker of progression of asthma. In this pilot study, we recruited 20 mild asthmatics and 10 healthy controls. We measured serum SP-A and SP-D and all subjects underwent clinical, lung functional and biological assessments. Serum SP-D was significantly higher in asthmatics compared to healthy controls (mean (SD) values: 7.9(4.65) vs 3.31(1.71) ng ml-1,p-value: 0.008). In the asthmatic group, serum SP-D was significantly correlated to CalvNO (alveolar NO concentration) (R-squared: 0.26;p-value: 0.014). These preliminary findings suggest that serum SP-D could be used as a lung-specific biomarker of small airways damage thus predicting the progression to the most severe forms of asthma.
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Affiliation(s)
- Stefania Principe
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy.,Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Alida Benfante
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy
| | - Salvatore Battaglia
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy
| | - Anke H Maitland Van Der Zee
- Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Nicola Scichilone
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, University of Palermo, Medicina Interna e Specialistica di Eccellenza 'G. D'Alessandro' (PROMISE) c/o Pneumologia, AOUP 'Policlinico Paolo Giaccone', 90127 Palermo, Italy
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Nolasco S, Crimi C, Pelaia C, Benfante A, Caiaffa MF, Calabrese C, Carpagnano GE, Ciotta D, D'Amato M, Macchia L, Pelaia G, Pellegrino S, Scichilone N, Scioscia G, Spadaro G, Campisi R, Valenti G, Vatrella A, Crimi N. Benralizumab Effectiveness in Severe Eosinophilic Asthma with and without Chronic Rhinosinusitis with Nasal Polyps: A Real-World Multicenter Study. J Allergy Clin Immunol Pract 2021; 9:4371-4380.e4. [PMID: 34419679 DOI: 10.1016/j.jaip.2021.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) affects around 60% of patients with severe eosinophilic asthma (SEA). Benralizumab was recently approved for SEA add-on treatment. OBJECTIVE To assess the real-world effectiveness of benralizumab in SEA with or without CRSwNP. METHODS We conducted a multicenter observational study, including patients with SEA treated with benralizumab for 24 weeks in 12 Italian specialized facilities. Asthma exacerbations, Asthma Control Test (ACT), lung function, oral corticosteroid (OCS) dosage, and eosinophil and basophil count in peripheral blood were recorded at baseline and after 4, 12, and 24 weeks. The 22-item Sino-Nasal Outcome Test (SNOT-22) and Lund-Mackay scores were assessed at baseline and after 24 weeks in SEA+CRSwNP. RESULTS A total of 137 patients with late-onset SEA were included; 57.7% (79 of 137) showed the copresence of CRSwNP. Overall, severe asthma exacerbations decreased from 4 (3-6) to 0 (0-2) (P < .0001) after 24 weeks of treatment, and significant improvements were observed as early as 4 weeks in ACT score, OCS dosage, forced expiratory volume in the 1st second (FEV1)%, FEV1 (L), forced vital capacity (FVC)%, FEV1/FVC% (P < .0001), and forced expiratory flow between 25% and 75% of FVC (FEF25-75)% (P = .0022). Eosinophils and basophils in peripheral blood were rapidly depleted. In patients with SEA+CRSwNP, SNOT-22 decreased from 46 (39.5-64.5) to 32 (19-46) (P < .0001). Furthermore, in comparison with SEA, they showed enhanced responses with regard to ACT minimal clinically important difference (P = .0387), FEV1% (P = .017), FEV1 (L) (P = .02), and FEF25-75% (P = .0362). CONCLUSIONS These real-world data suggest that benralizumab can represent a valid add-on therapeutic option for patients with SEA, especially with comorbid CRSwNP.
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Affiliation(s)
- Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy.
| | - Corrado Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Alida Benfante
- PROMISE Department, University of Palermo, Palermo, Italy
| | | | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanna Elisiana Carpagnano
- Respiratory Medicine Section, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Domenico Ciotta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Maria D'Amato
- Respiratory Department, Division of Respiratory Diseases, "Federico II" University, Naples, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Simona Pellegrino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Campisi
- Respiratory Medicine Unit, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo, Palermo, Italy
| | - Alessandro Vatrella
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Nunzio Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Respiratory Medicine Unit, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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Blasi F, Antonelli Incalzi R, Canonica GW, Schino P, Cuttitta G, Zullo A, Ori A, Scichilone N. Clinical Evolution and Quality of Life in Clinically Based COPD Chronic Bronchitic and Emphysematous Phenotypes: Results from the 1-Year Follow-Up of the STORICO Italian Observational Study. Int J Chron Obstruct Pulmon Dis 2021; 16:2133-2148. [PMID: 34345170 PMCID: PMC8325060 DOI: 10.2147/copd.s310428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Understanding clinical evolution of chronic obstructive pulmonary disease (COPD) is crucial for improving disease management. Materials and Methods STORICO (NCT03105999), an Italian, multicenter, non-interventional, observational study conducted in 40 pulmonology centers, aimed to describe the 1-year clinical evolution and health status of clinicallbased phenotypes. Baseline and follow-up data of COPD subjects with a chronic bronchitis (CB) or emphysema (EM) phenotype were collected. The frequency of COPD symptoms during the 24 hours (gathered via the night-time, morning and day-time symptoms of COPD questionnaire) and the anxiety and depression levels (via the HADS Scale) were recorded at each visit. Results A total of 261 CB and 159 EM patients were analyzed. CB patients with ≥1 night-time symptom seemed to be more frequent (51.7%, 41.8% and 41.4% at baseline, 6-month and 12-month follow-up, respectively) than EM (37.7%, 32.1% and 30.2% at study visits) even if no statistical differences were observed at time points between phenotypes (chi-square test p-values presence/absence of night-time symptoms in CB vs EM at study visits >0.0007). In the first 6 months, the frequency of patients with ≥1 night-time symptom decreased of 9.9% in CB and of 5.6% in EM. A clinically relevant decline of DLCO % predicted over 1 year in EM was observed, the mean (SD) being 61.5 (20.8) % at baseline and 59.1 (17.4) % at 12-month follow-up. EM had higher levels of anxiety and depression than CB (median (25th-75th percentile) HADS total score in CB: 7.0 (4.0–13.0) and 7.0 (3.0–12.0), in EM: 9.0 (3.0–14.0) and 9.5 (3.0–14.0) both at baseline and at 6-month follow-up, respectively), considering 1.17 as minimally clinical important difference (MCID) for the total score. Conclusion EM patients, evaluated in a real-world setting, seem to suffer from a worse clinical condition and health status compared to CB patients, appearing to have “more treatable” traits.
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Affiliation(s)
- Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | | | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Personalized Medicine, Asthma and Allergy, 20089, Rozzano, Milan, Italy
| | - Pietro Schino
- Miulli Hospital, Acquaviva delle Fonti, Bari, 70021, Italy
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45
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Benfante A, Messina R, Piccionello I, Di Liberti R, Principe S, Scichilone N. The impact of SARS-COV2 pandemic on the management oF IPF patients: Our narrative experience. Pulm Pharmacol Ther 2021; 69:102038. [PMID: 33965569 PMCID: PMC8221991 DOI: 10.1016/j.pupt.2021.102038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
Background The SARS-CoV-2 pandemic has changed the health-care systems around the world in a remarkable way. We describe the strategies adopted to cope with the limitations imposed by the pandemic to the access to health care by patients diagnosed with idiopathic Pulmonary Fibrosis (IPF). Material and methods We conducted a retrospective observational analysis including IPF patients under antifibrotic drugs (nintedanib and pirfenidone) that accessed to the Outpatient clinic of the University of Palermo, Italy. Patients received a phone number and an email address in case of any urgency and a virtual meeting was settled up monthly. Results 40 patients (M/F: 30/10) were followed up, 33 under nintedanib treatment, 7 under pirfenidone. Among patients under nintedanib, 1 patient reported high fever (T max 39 °C) and purulent sputum with no sign of infections, 1 had hemoptysis that was spontaneously resolved. 2 patients accessed to the emergency department for the worsening of dyspnea; 5 patients had diarrhea that resolved with symptomatic drugs in few days. 3 patients had an increase of alkaline phosphatase levels, leading to the withdrawal of the antifibrotic drug for 15 days, and subsequent normalization of the plasmatic levels. Among patients under pirfenidone, one subject had an increase of ferritin serum levels with no symptoms. The remaining subjects were in stable clinical conditions. None of the patients reported hospitalization or exacerbations, and did not experience antifibrotic withdrawal. Conclusions We were able to demonstrate that by implementing alternative ways to monitor the disease, patients did not incur in increased rates of acute exacerbations or higher frequency of side effects and antifibrotic treatment withdrawal.
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Affiliation(s)
- Alida Benfante
- Dipartimento Universitario di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo; Palermo; Italy.
| | - Riccardo Messina
- Dipartimento Universitario di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo; Palermo; Italy
| | - Ilaria Piccionello
- Dipartimento Universitario di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo; Palermo; Italy
| | - Rosangela Di Liberti
- Dipartimento Universitario di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo; Palermo; Italy
| | - Stefania Principe
- Dipartimento Universitario di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo; Palermo; Italy
| | - Nicola Scichilone
- Dipartimento Universitario di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo; Palermo; Italy
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46
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Bousquet J, Pfaar O, Agache I, Bedbrook A, Akdis CA, Canonica GW, Chivato T, Al-Ahmad M, Abdul Latiff AH, Ansotegui IJ, Bachert C, Baharuddin A, Bergmann KC, Bindslev-Jensen C, Bjermer L, Bonini M, Bosnic-Anticevich S, Bosse I, Brough HA, Brussino L, Calderon MA, Caraballo L, Cardona V, Carreiro-Martins P, Casale T, Cecchi L, Cepeda Sarabia AM, Chkhartishvili E, Chu DK, Cirule I, Cruz AA, Czarlewski W, Del Giacco S, Demoly P, Devillier P, Dokic D, Durham SL, Ebisawa M, El-Gamal Y, Emuzyte R, Gamkrelidze A, Fauquert JL, Fiocchi A, Fokkens WJ, Fonseca JA, Fontaine JF, Gawlik R, Gelincik A, Gemicioglu B, Gereda JE, Gerth van Wijk R, Gomez RM, Gotua M, Grisle I, Guzmán MA, Haahtela T, Halken S, Heffler E, Hoffmann-Sommergruber K, Hossny E, Hrubiško M, Irani C, Ivancevich JC, Ispayeva Z, Julge K, Kaidashev I, Kalayci O, Khaitov M, Klimek L, Knol E, Kowalski ML, Kraxner H, Kull I, Kuna P, Kvedariene V, Kritikos V, Lauerma A, Lau S, Laune D, Levin M, Larenas-Linnemann DE, Lodrup Carlsen KC, Lombardi C, Lourenço OM, Mahboub B, Malling HJ, Manning P, Marshall GD, Melén E, Meltzer EO, Miculinic N, Milenkovic B, Moin M, Montefort S, Morais-Almeida M, Mortz CG, Mösges R, Mullol J, Namazova Baranova L, Neffen H, Nekam K, Niedoszytko M, Odemyr M, O'Hehir RE, Ollert M, O'Mahony L, Ohta K, Okamoto Y, Okubo K, Pajno GB, Palomares O, Palkonen S, Panzner P, G Papadopoulos N, Park HS, Passalacqua G, Patella V, Pawankar R, Pham-Thi N, Plavec D, Popov TA, Recto M, Regateiro FS, Riggioni C, Roberts G, Rodriguez-Gonzales M, Rosario N, Rottem M, Rouadi PW, Ryan D, Samolinski B, Sanchez-Borges M, Serpa FS, Sastre J, Scadding GK, Shamji MH, Schmid-Grendelmeier P, Schünemann HJ, Sheikh A, Scichilone N, Sisul JC, Sofiev M, Solé D, Sooronbaev T, Soto-Martinez M, Soto-Quiros M, Sova M, Schwarze J, Skypala I, Suppli-Ulrik C, Taborda-Barata L, Todo-Bom A, Torres MJ, Valentin-Rostan M, Tomazic PV, Valero A, Toppila-Salmi S, Tsiligianni I, Untersmayr E, Urrutia-Pereira M, Valiulis A, Valovirta E, Vandenplas O, Ventura MT, Vichyanond P, Wagenmann M, Wallace D, Walusiak-Skorupa J, Wang DY, Waserman S, Wong GW, Yorgancioglu A, Yusuf OM, Zernotti M, Zhang L, Zidarn M, Zuberbier T, Jutel M. ARIA-EAACI care pathways for allergen immunotherapy in respiratory allergy. Clin Transl Allergy 2021; 11:e12014. [PMID: 34136127 PMCID: PMC8190541 DOI: 10.1002/clt2.12014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/08/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jean Bousquet
- Department of Dermatology and Allergy Comprehensive Allergy Center Charité Universitätsmedizin Berlin Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Allergology University Hospital Montpellier Montpellier France.,MACVIA-France Montpellier France
| | - Oliver Pfaar
- Department of Otorhinolaryngology Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps-Universität Marburg Germany
| | - Ioana Agache
- Allergy and Clinical Immunology Transylvania University Brasov Brasov Romania
| | | | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - G Walter Canonica
- Department of Biomedical Sciences Humanitas University Pieve Emanuele (MI) and Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milano Italy.,Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS Rozzano Milano Italy
| | - Tomas Chivato
- School of Medicine University CEU San Pablo Madrid, Spain
| | - Mona Al-Ahmad
- Department of Allergy and Microbiology Faculty of Medicine Al-Rashed Allergy Center Kuwait University Kuwait City Kuwait.,Department of Allergy Al-Rashed Allergy Center Kuwait City Kuwait
| | | | - Ignacio J Ansotegui
- Department of Allergy and Immunology Hospital Quironsalud Bizkaia Erandio, Spain
| | - Claus Bachert
- ENT Department Upper Airways Research Laboratory Ghent University Hospital Ghent Belgium.,International Airway Research Center First Affiliated Hospital Guangzou Sun Yat-sen University Guangzhou China.,Division of ENT Diseases Department of ENT Diseases CLINTEC Karolinska Institutet Karolinska University Hospital Stockholm Sweden
| | - Abdullah Baharuddin
- Department of Otorhinolaryngology-Head and Neck Surgery School of Medical Sciences Universiti Sains Malaysia Kubang Kerian Kelantan Malaysia
| | - Karl-Christian Bergmann
- Department of Dermatology and Allergy Comprehensive Allergy Center Charité Universitätsmedizin Berlin Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark.,Division of ENT Diseases Department of ENT Diseases CLINTEC Karolinska Institutet Karolinska University Hospital Stockholm Sweden.,Research Center for Anaphylaxis (ORCA) Odense Denmark
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology University Hospital Lund Sweden
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy.,National Heart and Lung Institute Royal Brompton Hospital & Imperial College London UK
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research University of Sydney Australia.,Woolcock Emphysema Centre and Sydney Local Health District Glebe New South Wales Australia
| | | | - Helen A Brough
- Paediatric Allergy Department of Asthma, Allergy and Respiratory Science Guys' Hospital King's College London London UK
| | - Luisa Brussino
- Department of Medical Sciences Allergy and Clinical Immunology Unit University of Torino & Mauriziano Hospital Torino Italy
| | | | - Luis Caraballo
- Institute for Immunological Research University of Cartagena Cartagena Colombia.,Foundation for the Development of Medical and Biological Sciences (Fundemeb) Cartagena Colombia
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall d'Hebron & ARADyAL Research Network Barcelona, Spain
| | - Pedro Carreiro-Martins
- Serviço de Imunoalergologia Hospital de Dona Estefânia Centro Hospitalar de Lisboa Central Lisbon Portugal.,NOVA Medical School CEDOC Comprehensive Health Research Center (CHRC) Lisboa Portugal
| | - Tomas Casale
- Division of Allergy/immunology University of South Florida Tampa Fla USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy
| | - Alfonso M Cepeda Sarabia
- Allergy and Immunology Laboratory Metropolitan University Simon Bolivar University Barranquilla Colombia.,SLaai, Sociedad Latinoamericana de Allergia Asma e Immunologia Branquilla Colombia
| | - Ekaterine Chkhartishvili
- David Tatishvili Medical Center David Tvildiani Medical University-AIETI Medical School Tbilisi Georgia
| | - Derek K Chu
- Departments of Medicine and Health Research Methods McMaster University Hamilton ON Canada
| | - Ieva Cirule
- Latvain Association of Allergists University Children Hospital Riga Latvia
| | - Alvaro A Cruz
- Fundação ProAR Federal University of Bahia and GARD/WHO Planning Group Salvador Brazil
| | | | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology University Hospital "Duilio Casula" University of Cagliari Cagliari Italy
| | - Pascal Demoly
- Department of Pulmonology Division of Allergy Hôpital Arnaud de Villeneuve University Hospital of Montpellier France.,Equipe EPAR - IPLESP Sorbonne Université Paris France
| | - Philippe Devillier
- Unité de Recherche en Pharmacologie Respiratoire Pôle des Maladies des Voies Respiratoires, Hôpital Foch Université Paris Saclay Suresnes France
| | - Dejan Dokic
- Medical Faculty University Clinic of Pulmology and Allergy Skopje Republic of Macedonia
| | | | - Motohiro Ebisawa
- Clinical Reserch Center for Allergy and Rheumatology NHO Sagamihara National Hospital Sagamihara Japan
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt
| | - Regina Emuzyte
- Faculty of Medicine Clinic of Children's Diseases Vilnius University Vilnius Lithuania
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia Tbilisi Georgia
| | - Jean Luc Fauquert
- CHU Clermont-Ferrand Unité d'Allergologie de l'Enfant Pole pédiatrique Hopital Estaing Clermont-Ferrand France
| | - Alessandro Fiocchi
- Division of Allergy The Bambino Gesu Children's Hospital IRCCS Rome Italy
| | - Wytske J Fokkens
- Department of Otorhinolaryngology Academic Medical Centers Amsterdam The Netherland.,EUFOREA Brussels Belgium
| | - Joao A Fonseca
- Faculdade de Medicina CINTESIS, Center for Health Technology and Services Research Universidade do Porto Porto Portugal.,Allergy Unit CUF Porto Portugal
| | | | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology Silesian University of Medicine Katowice Poland
| | - Asli Gelincik
- Division of Allergy and Immunology Dışkapı Yıldırım Beyazıt Training and Research Hospital Ankara Turkey
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases Cerrahpasa Faculty of Medicine Istanbul University-Cerrahpasa Istanbul Turkey
| | - Jose E Gereda
- Allergy and Immunology Division Clinica Ricardo Palma Lima Peru
| | - Roy Gerth van Wijk
- Department of Internal Medicine Section of Allergology Erasmus MC Rotterdam the Netherlands
| | | | - Maia Gotua
- Center of Allergy and Immunology Georgian Association of Allergology and Clinical Immunology Tbilisi Georgia
| | - Ineta Grisle
- Latvian Association of Allergists Center of Tuberculosis and Lung Diseases Riga Latvia
| | | | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital Odense University Hospital Odense Denmark
| | - Enrico Heffler
- Department of Biomedical Sciences Humanitas University Pieve Emanuele (MI) and Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milano Italy
| | | | - Elham Hossny
- Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt
| | - Martin Hrubiško
- Department of Clinical Immunology and Allergy Oncology Institute of St Elisabeth Bratislava Slovakia
| | - Carla Irani
- Department of Internal Medicine and Infectious Diseases St Joseph University Hotel Dieu de France Hospital Beirut Lebanon
| | | | - Zhanat Ispayeva
- Department of Allergology and Clinical Immunology of the Kazakh National Medical University Kazakhstan Association of Allergology and Clinical Immunology Kazakhstan
| | - Kaja Julge
- Allergy Center of Childrens's Clinic of Tartu University Hospital Tartu Estonia
| | - Igor Kaidashev
- Ukrainina Medical Stomatological Academy Poltava Ukraine
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit Hacettepe University School of Medicine Ankara Turkey
| | - Musa Khaitov
- National Research Center Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular Immunology Russia
| | - Ludger Klimek
- Department of Otolaryngology Head and Neck Surgery Universitätsmedizin Mainz Mainz Germany.,Center for Rhinology and Allergology Wiesbaden Germany
| | - Edward Knol
- Departments of Immunology and Dermatology/Allergology University Medical Center Utrecht The Netherlands
| | - Marek L Kowalski
- Department of Immunology and Allergy Healthy Ageing Research Center Medical University of Lodz Poland
| | - Helga Kraxner
- Department of Otorhinolaryngology Head and Neck Surgery Semmelweis University Budapest Hungary
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden.,Sach´s Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Poland
| | - Violeta Kvedariene
- Department of Pathology Faculty of Medicine Institute of Biomedical Sciences Vilnius University Vilnius Lithuania.,Faculty of Medicine Institute of Clinical Medicine Clinic of Chest Diseases and Allergology Vilnius University Vilnius Lithuania
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines Group Woolcock Institute of Medical Research University of Sydney Sydney NSW Australia.,Department of Respiratory and Sleep Medicine Royal Prince Alfred Hospital Sydney Australia
| | - Antti Lauerma
- Department of Dermatology and Allergology University of Helsinki and Helsinki University Helsinki Finland
| | - Susanne Lau
- Department of Pediatric Pneumology and Immunology Charité Universitätsmedizin Berlin Germany
| | | | - Michael Levin
- Division of Paediatric Allergology University of Cape Town Cape Town South Africa
| | | | - Karin C Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases Fondazione Poliambulanza Brescia Italy
| | - Olga M Lourenço
- Faculty of Health Sciences and CICS - UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | - Bassam Mahboub
- Department of Pulmonary Medicine Rashid Hospital Dubai UAE
| | | | - Patrick Manning
- Department of Medicine (RCSI) Bon Secours Hospital Dublin Ireland
| | - Gailen D Marshall
- The University of Mississippi Medical Center Division of Clinical Immunology and Allergy Laboratory of Behavioral Immunology Research Jackson Mississippi USA
| | - Erik Melén
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden.,Sach´s Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Eli O Meltzer
- Allergy Allergy and Asthma Medical Group and Research Center San Diego California USA
| | | | - Branislava Milenkovic
- Faculty of Medicine Clinic for Pulmonary Diseases Clinical Center of Serbia University of Belgrade Belgrade Serbia.,Serbian Association for Asthma and COPD Belgrade Serbia
| | - Mostafa Moin
- Immunology and Asthma and Allergy Research Institute Tehran University of Medical Sciences Tehran Iran
| | - Stephen Montefort
- Faculty of Medicine and Surgery Mater Dei Hospital Malta University of Medicine La Valette Malta
| | | | - Charlotte G Mortz
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark
| | - Ralph Mösges
- CRI-Clinical Research International-Ltd Hamburg Germany
| | - Joaquim Mullol
- ENT Department Rhinology Unit & Smell Clinic Hospital Clínic Barcelona Spain.,Clinical & Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Spain
| | - Leyla Namazova Baranova
- Scientific Centre of Children's Health Russian National Research Medical University Moscow Russia
| | - Hugo Neffen
- Center of Allergy, Immunology and Respiratory Diseases Santa Fe Argentina
| | - Kristof Nekam
- Hospital of the Hospitaller Brothers in Buda Budapest Hungary
| | - Marek Niedoszytko
- Department of Allergology Medical University of Gdańsk Gdańsk Poland
| | - Mikaëla Odemyr
- EFA European Federation of Allergy and Airways Diseases Patients' Associations Brussels Belgium
| | - Robyn E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine Central Clinical School Monash University Victoria Australia.,Alfred Health, Melbourne Victoria Australia
| | - Markus Ollert
- Department of Infection and Immunity Luxembourg Institute of Health Esch-sur-Alzette Luxembourg.,Department of Dermatology and Allergy Centre Odense Research Center for Anaphylaxis (ORCA) Odense University Hospital Odense Denmark
| | - Liam O'Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital Tokyo Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Kimi Okubo
- Department of Otolaryngology Nippon Medical School Tokyo Japan
| | - Giovanni B Pajno
- Department of Pediatrics Allergy Unit University of Messina Messina Italy
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology School of Chemistry Complutense University of Madrid Madrid, Spain
| | - Susanna Palkonen
- Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G Papadopoulos
- Division of Infection Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino -University of Genoa Italy
| | - Vincenzo Patella
- Department of Medicine Division of Allergy and Clinical Immunology Agency of Health ASL Salerno "Santa Maria della Speranza" Hospital Battipaglia Salerno Italy
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Nhân Pham-Thi
- Ecole Polytechnique Palaiseau IRBA (Institut de Recherche bio-Médicale des Armées) Bretigny France
| | - Davor Plavec
- School of Medicine Children's Hospital Srebrnjak, Zagreb University J.J. Strossmayer Osijek Croatia
| | | | - Marysia Recto
- Department of Pediatrics Section of Allergy and Immunology UP-PGH Manila Philipinnes
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit Centro Hospitalar e Universitário de Coimbra Coimbra Coimbra Portugal.,Faculty of Medicine Institute of Immunology University of Coimbra Coimbra Portugal.,Faculty of Medicine ICBR - Coimbra Institute for Clinical and Biomedical Research CIBB University of Coimbra Coimbra Portugal
| | - Carmen Riggioni
- Pediatric Allergy and Clinical Immunology Department Hospital Sant Joan de Déu Barcelona Spain.,Institut de Recerca Sant Joan de Déu Barcelona Spain
| | - Graham Roberts
- Salford Royal NHS Foundation Trust NHS England North Salford UK
| | | | | | - Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology Emek Medical Center Afula Israel.,Rappaport Faculty of Medicine Technion-Israel Institute of Technology Haifa Israël
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery Eye and Ear University Hospital Beirut Lebanon
| | - Dermot Ryan
- Usher Institute Medical School University of Edinburgh Edinburgh UK
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards Allergology and Immunology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department Centro Medico-Docente La Trinidad Caracas Venezuela
| | - Faradiba S Serpa
- Asthma Reference Center - Escola Superior de Ciencias Santa Casa de Misericórdia of Vitória-Espírito Santo Vitoria Brazil
| | - Joaquin Sastre
- Faculty of Medicine Fundacion Jimenez Diaz, CIBERES Autonoma University of Madrid Spain
| | | | - Mohamed H Shamji
- Immunomodulation and Tolerance Group Imperial College London London UK.,Allergy and Clinical Immunology Imperial College London London UK
| | | | - Holger J Schünemann
- Departments of Medicine and Health Research Methods McMaster University Hamilton ON Canada
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | | | - Juan Carlos Sisul
- Sociedad Paraguaya de Alergia Asma e Inmunologıa Clinica Sisul, Allergy & Asthma Asuncion Paraguay
| | | | - Dirceu Solé
- Department of Pediatrics Division of Allergy, Clinical Immunology and Rheumatology Federal University of São Paulo São Paulo Brazil
| | - Talant Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal Medicine Euro-Asian Respiratory Society Bishkek Kyrgyzstan
| | - Manuel Soto-Martinez
- Department of Pediatrics Division of Respiratory Medicine Hospital Nacional de Niños Universidad de Costa Rica San Jose Costa Rica
| | | | - Milan Sova
- Department of Respiratory Medicine University Hospital Olomouc Czech Republic
| | - Jürgen Schwarze
- Centre for Inflammation Research Child Life and Health The University of Edinburgh Edinburgh UK
| | - Isabel Skypala
- Royal Brompton and Harefield NHS Foundation Trust London UK
| | - Charlotte Suppli-Ulrik
- Department of Respiratory Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark.,Institute of Cinical Medicine University of Copenhagen Copenhagen Denmark
| | - Luis Taborda-Barata
- Department of Immunoallergology Faculty of Health Sciences Cova da Beira Covilhã Portugal.,University Hospital Centre Covilhã Portugal
| | - Ana Todo-Bom
- Imunoalergologia Centro Hospitalar Universitário de Coimbra Coimbra Portugal.,Faculty of Medicine University of Coimbra Coimbra Portugal
| | - Maria J Torres
- Allergy Unit Málaga Regional University Hospital-IBIMA Málaga Spain
| | | | - Peter-Valentin Tomazic
- Department of General ORL, H&NS ENT-University Hospital Graz Medical University of Graz Graz Austria
| | - Antonio Valero
- Pneumology and Allergy Department CIBERES Clinical & Experimental Respiratory Immunoallergy, IDIBAPS University of Barcelona Barcelona Spain
| | | | - Ioanna Tsiligianni
- Department of Social Medicine Health Planning Unit Faculty of Medicine University of Crete Crete Greece.,International Primary Care Respiratory Group IPCRG Aberdeen Scotland
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | | | - Arunas Valiulis
- Faculty of Medicine Vilnius University Institute of Clinical Medicine & Institute of Health Sciences Vilnius Lithuania.,European Academy of Paediatrics (EAP/UEMS-SP) Brussels Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology University of Turku Turku Finland.,Terveystalo Allergy Clinic Turku Finland
| | - Olivier Vandenplas
- Department of Chest Medicine Centre Hospitalier Universitaire UCL Namur Université Catholique de Louvain Yvoir Belgium
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Pakit Vichyanond
- Division of Allergy and Immunology Department of Pediatrics Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Martin Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik Universitätsklinikum Düsseldorf Germany
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale Florida USA
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Lodz Poland
| | - De Yun Wang
- Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Gary Wk Wong
- Department of Paediatrics Prince of Wales Hospital The Chinese University of Hong Kong Shatin, New Territories Hong Kong China
| | | | | | - Mario Zernotti
- Universidad Católica de Córdoba Universidad Nacional de Villa Maria Argentina
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Beijing China.,Otolaryngology Beijing Institute of Otolaryngology Beijing China
| | - Mihaela Zidarn
- Respiratory and Allergic Diseases University Clinic Golnik Slovenia
| | - Torsten Zuberbier
- Department of Dermatology and Allergy Comprehensive Allergy Center Charité Universitätsmedizin Berlin Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wroclaw Poland.,ALL-MED Medical Research Institute Wroclaw Poland
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Carpagnano GE, Pelaia C, D'Amato M, Crimi N, Scichilone N, Scioscia G, Resta O, Calabrese C, Pelaia G, Quarato CMI, Foschino Barbaro MP. Switching from omalizumab to mepolizumab: real-life experience from Southern Italy. Ther Adv Respir Dis 2021; 14:1753466620929231. [PMID: 32482128 PMCID: PMC7268123 DOI: 10.1177/1753466620929231] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Current availability of several biologic treatments for severe asthma makes it possible to choose the most appropriate for each patient. Sometimes a good percentage of patients with severe asthma may be eligible for biologics that target either the allergic phenotype or the eosinophilic one, but not all respond to that selected as first choice. The aim of our real-life study was to assess whether, for patients with severe eosinophilic allergic asthma, not previously controlled by the anti-IgE omalizumab, the shift to another biologic targeting interleukin-5, such as mepolizumab, may represent a good therapeutic choice. METHODS A total of 41 consecutive patients with severe, persistent allergic, eosinophilic asthma, uncontrolled despite treatment with omalizumab, were enrolled in seven certified Clinical Respiratory Units of Southern Italy (Catania, Catanzaro, Foggia, Bari, Palermo, and two University Respiratory Units of Naples) and shifted to mepolizumab without a wash-out period. Data at baseline, after at least 12 months of therapy with omalizumab, and after at least 12 months of treatment with mepolizumab were collected. RESULTS After at least 12 months of therapy with mepolizumab, patients experienced a significant decrease in the number of exacerbations/year (5.8 ± 1.8 versus 0.7 ± 0.9, p < 0.0001), an increment of asthma control test score (12 ± 2.7 versus 21.9 ± 2.7, p < 0.0001), an increase in pre-bronchodilator forced expiratory volume in 1 s (1.56 ± 0.45 l versus 1.86 ± 0.52 l, p < 0.0001), and a reduction of blood eosinophils (584 ± 196 cells/µl versus 82 ± 56 cells/µl, p < 0.0001). The percentage of patients who were dependent on corticosteroids significantly decreased from 46% at baseline to 5% during treatment with mepolizumab. CONCLUSION Results of our real-life multicentric experience confirms that the shift to mepolizumab could be a good therapeutic strategy in severe eosinophilic allergic asthma not previously controlled by omalizumab. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Giovanna Elisiana Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, Bari, Italy
| | - Corrado Pelaia
- Department of Health Sciences, Section of Respiratory Disease, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Maria D'Amato
- Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Nunzio Crimi
- Department of Internal Medicine and Specialistic Medicine, Section of Respiratory Diseases, University of Catania, Catania, Italy
| | - Nicola Scichilone
- Department of Medicine, Pneumology, Physiology and Nutrition, University of Palermo, Palermo, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Disease, University of Foggia, Policlinico Riuniti di Foggia - Viale Pinto, 1, 71122, Italy
| | - Onofrio Resta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University "Aldo Moro" of Bari, Bari, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, Section of Respiratory Disease, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Girolamo Pelaia
- Department of Health Sciences, Section of Respiratory Disease, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico Riuniti di Foggia, Foggia, Italy
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48
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Usmani OS, Mignot B, Kendall I, Maria RD, Cocconi D, Georges G, Scichilone N. Predicting Lung Deposition of Extrafine Inhaled Corticosteroid-Containing Fixed Combinations in Patients with Chronic Obstructive Pulmonary Disease Using Functional Respiratory Imaging: An In Silico Study. J Aerosol Med Pulm Drug Deliv 2021; 34:204-211. [PMID: 33052749 PMCID: PMC8219200 DOI: 10.1089/jamp.2020.1601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Functional respiratory imaging (FRI) is a computational fluid dynamics-based technique using three-dimensional models of human lungs and formulation profiles to simulate aerosol deposition. Methods: FRI was used to evaluate lung deposition of extrafine beclomethasone dipropionate (BDP)/formoterol fumarate (FF)/glycopyrronium bromide (GB) and extrafine BDP/FF delivered through pressurized metered dose inhalers and to compare results with reference gamma scintigraphy data. FRI combined high-resolution computed tomography scans of 20 patients with moderate-to-severe chronic obstructive pulmonary disease (mean forced expiratory volume in 1 second 42% predicted) with in silico computational flow simulations, and incorporated drug delivery parameters to calculate aerosol airway deposition. Inhalation was simulated using profiles obtained from real-life measurements. Results: Total lung deposition (proportion deposited in intrathoracic region) was similarly high for both products, with mean ± standard deviation (SD) values of 31.0% ± 5.7% and 28.1% ± 5.2% (relative to nominal dose) for BDP/FF/GB and BDP/FF, respectively. Pairwise comparison of the deposition of BDP and FF gave a mean intrathoracic BDP/FF/GB:BDP/FF deposition ratio of 1.10 (p = 0.0405). Mean intrathoracic, central and peripheral deposition ratios for BDP were 1.09 (95% confidence interval [CI]: 1.05-1.14), 0.92 (95% CI: 0.89-0.96), and 1.20 (95% CI: 1.15-1.26), respectively, and for FF were 1.11 (95% CI: 1.07-1.15), 0.94 (95% CI: 0.91-0.98), and 1.21 (95% CI: 1.15-1.27), within the bioequivalence range (0.80-1.25) for intrathoracic and central regions, and slightly exceeding the upper boundary in the peripheral region. Mean ± SD central:peripheral deposition (C:P) was 0.48 ± 0.13 for BDP/FF/GB and 0.62 ± 0.17 for BDP/FF, indicating a higher proportion of drug deposition in the small airways than in the large airways. Conclusion: FRI demonstrated similar deposition patterns for extrafine BDP/FF/GB and BDP/FF, with both having a high lung deposition. Moreover, the deposition patterns of BDP and FF were similar in both products. Furthermore, the C:P ratios of both products indicated a high peripheral deposition, supporting small airway targeting and delivery of these two extrafine fixed combinations, with a small difference in ratios potentially due to mass median aerodynamic diameters.
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Affiliation(s)
- Omar S. Usmani
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
| | | | | | - Roberta De Maria
- Chemistry Manufacturing and Controls, Chiesi Farmaceutici SpA, Parma, Italy
| | - Daniela Cocconi
- Chemistry Manufacturing and Controls, Chiesi Farmaceutici SpA, Parma, Italy
| | - George Georges
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (Promise), G. D'Alessandro, University of Palermo, Palermo, Italy
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Campisi R, Crimi C, Nolasco S, Beghè B, Antonicelli L, Guarnieri G, Scichilone N, Porto M, Macchia L, Scioscia G, Foschino Barbaro MP, Papi A, Crimi N. Real-World Experience with Dupilumab in Severe Asthma: One-Year Data from an Italian Named Patient Program. J Asthma Allergy 2021; 14:575-583. [PMID: 34079295 PMCID: PMC8167193 DOI: 10.2147/jaa.s312123] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/09/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Dupilumab is a monoclonal antibody targeting IL-4Rα recently licensed for severe asthma (SA). A Named Patients Program (NPP) was created in Italy before its commercial availability for SA patients with no other available therapeutic options. We aimed to assess the real-world effectiveness of dupilumab in patients with SA and unmet needs. METHODS We performed a multicentre retrospective study, including SA patients admitted to the NPP treated with dupilumab for 12 months. Data on the number of exacerbations, Asthma Control Test (ACT), pre-bronchodilator FEV1%, oral corticosteroids (OCSs) use, FeNO and eosinophils count in peripheral blood were recorded at baseline and after 3, 6, and 12 months. RESULTS We included 18 SA patients (mean age 53.3±12.4 years, 66.7% female). Eleven (61.1%) were OCSs dependent. Five patients (27.8%) received previous anti-IgE and/or anti-IL-5 agents. A significant improvement in ACT score (from 15.7±5.1 to 18.8±4.8, p=0.023), OCSs intake [10 (5-25) mg/day to 0 (0-5) mg/day, p=0.0333] and FeNO [from 25 (20-80) ppb to 21 (10.9-55.3) ppb, p=0.0190] was already detected after 3 months of treatment. After 12 months, a statistically significant decrease in the number of exacerbations from 2 (0-3) to 0 (0-1) (p<0.0068) and increase in FEV1% from 73.5±19.5% to 87.1±19.2% (p=0.0407) and ACT to a mean value of 22.4±1.7 (p<0.0001) and the interruption of OCSs in all the patients (p<0.0001) was observed. A transient increase in the eosinophil count was observed in five patients (above 1000 cells/μL in 2 cases) after 3 months, without any clinical effect. CONCLUSION Dupilumab improved all the explored clinical outcomes after 12 months, and the transient hypereosinophilia did not modify treatment response. These real-world data confirm the results reported in randomized controlled trials and provide an important opportunity to characterize the clinical impact of the treatment in a non-trial setting. Further real-world studies with a larger cohort of patients are needed to confirm these findings.
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Affiliation(s)
- Raffaele Campisi
- Respiratory Medicine Unit, A.O.U. Policlinico “G. Rodolico -San Marco”, Catania, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, A.O.U. Policlinico “G. Rodolico -San Marco”, Catania, Italy
| | - Santi Nolasco
- Department of Clinical and Experimental Medicine, Section of Respiratory Diseases, University of Catania, Catania, Italy
| | - Bianca Beghè
- Respiratory Medicine Unit, Department of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Antonicelli
- Allergy Unit, Department of Internal Medicine, Ancona University Hospital, Ancona, Italy
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic and Vascular Sciences, University-City Hospital of Padova, Padova, Italy
| | - Nicola Scichilone
- University of Palermo, PROMISE Department, University of Palermo, Palermo, Italy
| | - Morena Porto
- Department of Clinical and Experimental Medicine, Section of Respiratory Diseases, University of Catania, Catania, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari, Bari, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Alberto Papi
- Respiratory Medicine Unit, S. Anna University Hospital, Ferrara, Italy
| | - Nunzio Crimi
- Respiratory Medicine Unit, A.O.U. Policlinico “G. Rodolico -San Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, Section of Respiratory Diseases, University of Catania, Catania, Italy
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50
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Paggiaro P, Barbaglia S, Centanni S, Croce D, Desideri E, Giustini S, Micheletto C, Musarra A, Scichilone N, Trama U, Zedda MT, Canonica GW. Overcoming Barriers to the Effective Management of Severe Asthma in Italy. J Asthma Allergy 2021; 14:481-491. [PMID: 34007186 PMCID: PMC8121981 DOI: 10.2147/jaa.s293380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/21/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction People with severe asthma (SA) often have poor disease control and quality of life, and are at high risk of exacerbations, lung function decline and asthma-related death. The present expert opinion article aimed to identify unmet needs in the management of SA in Italy, and propose possible solutions to address these needs. Methods At five multidisciplinary events in Italy, attendees identified factors that interfered with the effective management of SA and suggested how these barriers could be overcome. A core group of 12 Italian experts (pulmonologists, general practitioners, allergists, payers and patients) identified the main issues and proposed possible solutions based on the results from the meetings and relevant articles from the literature. Results and Conclusions We reviewed the gap between real-world practice and guidelines, oral corticosteroid overuse, SA-related mortality, and barriers to effective SA treatment. Common themes were lack of awareness about SA among both patients and clinicians, and lack of networking/information exchange between those involved in the treatment of SA. Participants agreed on the need to implement patient education and create multidisciplinary groups of specialists to improve SA management through multidisciplinary educational initiatives, meetings with local experts, development of a flow chart for referral/connection with local experts and specialized centers. Clinical instruments that might help specialists improve SA management included referral networks, integrated care pathways, phenotyping and treatment algorithms, exacerbation tracking, and examination of electronic medical records for patients with uncontrolled asthma. The following actions need to be implemented in Italy: i) maximize the use of advanced therapies, eg, biologics; ii) increase/improve education for physicians and patients; iii) improve multidisciplinary communication and care coordination; iv) introduce regional and local protocols for SA diagnosis and treatment; and v) change the structure of healthcare services to reduce specialist waiting times and facilitate access to biologic therapies.
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Affiliation(s)
- Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
| | - Simona Barbaglia
- Associazione Nazionale Pazienti "Respiriamo Insieme", Padova, Italy
| | - Stefano Centanni
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Davide Croce
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | | | - Saffi Giustini
- Italian General Practitioners' Association "SIMG", Florence, Italy.,Local Health Unit of Montale, Pistoia, Italy
| | - Claudio Micheletto
- Cardio-Thoracic Department, Respiratory Unit, Integrated University Hospital, Verona, Italy
| | - Antonino Musarra
- Allergy Unit, National Healthcare System, Reggio Calabria, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Ugo Trama
- Dirigente UOD 06 Politica del Farmaco e Dispositivi, Naples, Italy
| | - Maria Teresa Zedda
- Italian General Practitioners' Association "SIMG", Florence, Italy.,General Practice, Cagliari, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University and Research Hospital-IRCCS, Milan, Italy
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