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Supplemental material, sj-docx-1-tar-10.1177_17534666211042533 for Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia by Cecilia Calabrese, Pia Clara Pafundi, Mariano Mollica, Anna Annunziata, Pasquale Imitazione, Maurizia Lanza, Giorgio Polistina, Martina Flora, Salvatore Guarino, Cristiana Palumbo and Giuseppe Fiorentino in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-docx-2-tar-10.1177_17534666211042533 for Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia by Cecilia Calabrese, Pia Clara Pafundi, Mariano Mollica, Anna Annunziata, Pasquale Imitazione, Maurizia Lanza, Giorgio Polistina, Martina Flora, Salvatore Guarino, Cristiana Palumbo and Giuseppe Fiorentino in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-docx-2-tar-10.1177_17534666211042533 for Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia by Cecilia Calabrese, Pia Clara Pafundi, Mariano Mollica, Anna Annunziata, Pasquale Imitazione, Maurizia Lanza, Giorgio Polistina, Martina Flora, Salvatore Guarino, Cristiana Palumbo and Giuseppe Fiorentino in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-docx-3-tar-10.1177_17534666211042533 for Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia by Cecilia Calabrese, Pia Clara Pafundi, Mariano Mollica, Anna Annunziata, Pasquale Imitazione, Maurizia Lanza, Giorgio Polistina, Martina Flora, Salvatore Guarino, Cristiana Palumbo and Giuseppe Fiorentino in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-docx-3-tar-10.1177_17534666211042533 for Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia by Cecilia Calabrese, Pia Clara Pafundi, Mariano Mollica, Anna Annunziata, Pasquale Imitazione, Maurizia Lanza, Giorgio Polistina, Martina Flora, Salvatore Guarino, Cristiana Palumbo and Giuseppe Fiorentino in Therapeutic Advances in Respiratory Disease

Supplemental material, sj-docx-1-tar-10.1177_17534666211042533 for Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia by Cecilia Calabrese, Pia Clara Pafundi, Mariano Mollica, Anna Annunziata, Pasquale Imitazione, Maurizia Lanza, Giorgio Polistina, Martina Flora, Salvatore Guarino, Cristiana Palumbo and Giuseppe Fiorentino in Therapeutic Advances in Respiratory Disease

The Combined Pulmonary Fibrosis and Enphysema (CPFE)is a typical example of “coexisting pattern” of great importance from a clinical point of view.

Purpose of review Current guidelines recommend a stepwise approach for pharmacological therapy aimed to achieve and maintain asthma control. Despite these recommendations, at least 50% of patients continue to be uncontrolled with risk of asthma exacerbations that can often be serious and are associated with deterioration of quality of life. In recent years, the interest in anticholinergic bronchodilators, which have been primarily used in the treatment of chronic obstructive pulmonary disease, has increased patients with uncontrolled asthma. This review analyzes the mechanisms for the proposed clinical use of anticholinergic bronchodilators as an adjunctive therapy in asthma. Recent findings Based on existing and recent evidence, the use of anticholinergic bronchodilators, particularly long-acting muscarinic antagonists (LAMAs), plays an important role as add-on therapy in patients uncontrolled on existing therapies. In particular, the use of anticholinergics in asthma may have a role in patients intolerant to long-acting β2 agonist, in patients with certain pharmacogenetic profiles and in those patients with asthma symptoms mostly at night. Summary Data from clinical trials and from real-life confirm the safety and efficacy of LAMAs, especially tiotropium, in patients who remain uncontrolled despite the use of inhaled corticosteroid therapy.

Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthma deaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide.

A body of evidence suggests that major changes involving the atmosphere and the climate, including global warming induced by anthropogenic factors, have impact on the biosphere and human environment. Studies on the effects of climate change on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, such as meteorological variables, airborne allergens, and air pollution. Urbanization with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases and bronchial asthma observed over recent decades in most industrialized countries. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in the general population and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could also be an effect of air pollution and climate change. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last 5 decades. Pollen allergy is frequently used to study the relationship between air pollution and respiratory allergic diseases, such as rhinitis and bronchial asthma. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions, and westernized lifestyle are correlated with an increased frequency of respiratory allergy prevalently in people who live in urban areas in comparison with people living in rural areas. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc.) can affect both components (biological and chemical) of this interaction.