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Background: Asthma is a chronic airway disease, affecting over 300 million people worldwide. 5–10% of patients suffer from severe asthma and account for 50% of asthma-related financial burden. Availability of real-life data about the clinical course of severe asthma is insufficient. Objectives: The aims of this study were to characterize patients with severe asthma in Switzerland, enrolled in the Swiss Severe Asthma Registry (SSAR), and evaluate predictors for asthma control. Method: A descriptive characterisation of 278 patients was performed, who were prospectively enrolled in the registry until January 2022. Socio-demographic variables, comorbidities, diagnostic values, asthma treatment, and healthcare utilisation were evaluated. Groups of controlled and uncontrolled asthma according to the asthma control test were compared. Results: Forty-eight percent of patients were female and the mean age was 55.8 years (range 13–87). The mean body mass index (BMI) was 27.4 kg/m2 (±6). 10.8% of patients were current smokers. Allergic comorbidities occurred in 54.3% of patients, followed by chronic rhinosinusitis (46.4%) and nasal polyps (34.1%). According to the ACT score, 54.7% had well controlled, 16.2% partly controlled and 25.9% uncontrolled asthma. The most common inhalation therapy was combined inhaled corticosteroids/long-acting β2-agonists (78.8%). Biologics were administered to 81.7% of patients and 19.1% received oral steroids. The multivariable analysis indicated that treatment with biologics was positively associated with asthma control whereas higher BMI, oral steroids, exacerbations, and COPD were negative predictors for asthma control. Conclusion: Biologics are associated with improved control in severe asthma. Further studies are required to complete the picture of severe asthma in order to provide improved care for those patients. [ABSTRACT FROM AUTHOR]

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Background Severe coronavirus disease 2019 (COVID-19) frequently entails complications that bear similarities to autoimmune diseases. To date, there are little data on possible immunoglobulin (Ig) A–mediated autoimmune responses. Here, we aim to determine whether COVID-19 is associated with a vigorous total IgA response and whether IgA antibodies are associated with complications of severe illness. Since thrombotic events are frequent in severe COVID-19 and resemble hypercoagulation of antiphospholipid syndrome, our approach focused on antiphospholipid antibodies (aPL). Methods In this retrospective cohort study, clinical data and aPL from 64 patients with COVID-19 were compared from 3 independent tertiary hospitals (1 in Liechtenstein, 2 in Switzerland). Samples were collected from 9 April to 1 May 2020. Results Clinical records of 64 patients with COVID-19 were reviewed and divided into a cohort with mild illness (mCOVID; 41%), a discovery cohort with severe illness (sdCOVID; 22%) and a confirmation cohort with severe illness (scCOVID; 38%). Total IgA, IgG, and aPL were measured with clinical diagnostic kits. Severe illness was significantly associated with increased total IgA (sdCOVID, P =.01; scCOVID, P <.001), but not total IgG. Among aPL, both cohorts with severe illness significantly correlated with elevated anticardiolipin IgA (sdCOVID and scCOVID, P <.001), anticardiolipin IgM (sdCOVID, P =.003; scCOVID, P <.001), and anti–beta 2 glycoprotein-1 IgA (sdCOVID and scCOVID, P <.001). Systemic lupus erythematosus was excluded from all patients as a potential confounder. Conclusions Higher total IgA and IgA-aPL were consistently associated with severe illness. These novel data strongly suggest that a vigorous antiviral IgA response, possibly triggered in the bronchial mucosa, induces systemic autoimmunity. [ABSTRACT FROM AUTHOR]

The article presents a correction to article "Severe Coronavirus Disease 2019 (COVID-19) is Associated With Elevated Serum Immunoglobulin (Ig) A and Antiphospholipid IgA Antibodies" published in a previous issue of the periodical.

Objectives: To develop a statistical approach that provides a quantitative index measuring the magnitude of the irregularity of the breathing response to exercise for the diagnosis of dysfunctional breathing., Design: Cross-sectional, retrospective, real-world study., Setting: Single-centre study., Participants: A population of 209 patients investigated with cardiopulmonary exercise testing in our institution for unexplained or disproportionate exertional dyspnoea between January and July 2022., Primary and Secondary Outcome Measures: A novel statistical approach providing a quantitative index-proportional tidal volume variation (PTVV)-was developed to measure the magnitude of the irregularity of the breathing response to exercise., Results: PTVV provided a reliable statistical readout for the objective assessment of DB with a prediction accuracy of 78% (95% CI: 72 to 83%). The prevalence of DB in the investigated population was high with more than half of the patients affected by moderate-to-severe DB., Conclusions: PTVV can easily be implemented in the clinical routine. Our study suggests a possible further simplification for the diagnosis of DB with two objective criteria including PTVV and one single criterion for hyperventilation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disorder with a complex clinical picture. The diagnosis may be difficult at times, as COPD may develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in early detection of disease. Suspected COPD may be confirmed by further investigations in collaboration with a pulmonologist. The most recent GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. General practitioners are crucial for implementing non-pharmacological measures such as smoking cessation, regular exercise, vaccinations, and patient self-management education. However, this also underlines the challenges to implement the GOLD recommendations in daily practice., Competing Interests: J. Leuppi est soutenu par des bourses du Fonds national suisse (SNF160072 et 185592) et par le Swiss Personalised Health Network (SPHN 2018DR108). Il a également reçu des honoraires de conférencier et des soutiens sans restriction d’Astra-Zeneca AG Schweiz, Boehringer Ingelheim GmbH Schweiz, GSK AG Schweiz, MSD AG Schweiz, Novartis AG, Schweiz et d’OM Pharma Schweiz. P.-O. Bridevaux a reçu des honoraires de conférencier et des soutiens sans restriction d’AstraZeneca, Boehringer Ingelheim, GSK, Novartis, OM Pharma, Sanofi et de la Ligue Pulmonaire Valaisanne. C. von Garnier a reçu des honoraires d’AstraZeneca, Boehringer Ingelheim, GSK, Mundipharma, Novartis, Pfizer, OM Pharma, PneumRx, Pulmonx, Sanofi et de Pharma Schwabe AG. Il est également récipient d’un financement de recherche par OM Pharma. N. Pavlov a reçu des honoraires de conférencier et d’Advisory Board d’AstraZeneca, CSL Behring, GSK, Novartis, Olympus, OM Pharma, Sanofi. F. Charbonnier a reçu des honoraires de conférencier et des soutiens sans restriction d’AstraZeneca, GSK, Mundipharma, Novartis, OM Pharma, et Sanofi. C. Clarenbach a reçu des honoraires de conférencier et d’Advisory Board de la part de Roche, Novartis, Boehringer, GSK, Astra Zeneca, Sanofi, Vifor, OM Pharma, CSL Behring, Grifols, Daiichi Sankyo et de MSD. Ces auteurs n’ont aucun autre lien ou intérêt financier particulier avec des organisations ou des entreprises qui ont un intérêt financier ou un conflit financier avec les sujets ou les documents traités dans le manuscrit à l’exception des liens divulgués. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

COPD - An Underestimated Disease Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice.

For general practitioners there have been important novelties in the treatment of asthma due to recent modifications of the international guidelines from Global Initiative for Asthma (GINA). In Step 1, use of short-acting beta2-agonists (SABA) without concomitant inhaled corticosteroids (ICS) as controller is no longer recommended for lack of efficacy and safety reasons. Instead, low dose ICS-formoterol as needed is recommended. In Step 5, in patients with severe uncontrolled asthma GINA recommends targeted biologic therapies like interleukin antibodies. Asthma patients presenting simultaneously with symptoms of chronic obstructive pulmonary disease (COPD) should receive treatment containing ICS. Independent of the current corona pandemic, GINA recommendations stay in place., Competing Interests: Les auteurs ont perçu des honoraires pour la participation à des travaux de formation, de conseils ou de participation à des groupes d’experts: Pr Jörg Leuppi: AstraZeneca, Boehringer Ingelheim, GSK, Munidpharma, Novartis et Sanofi. Pr Pierre-Olivier Brideveaux: AstraZeneca, GSK, Novartis, Sanofi, Boehringer Ingelheim. Dr Christian Clarenbach: Roche, Novartis, Boehringer Ingelheim, GSK, AstraZeneca, Sanofi, Vifor, OM Pharma, CSL Behring, Grifols, Daiichi Sankyo and Mundipharma. Dr Florian Charbonnier: AstraZeneca, GSK, Novartis, Sanofi. Dr Pietro Gianella: AstraZeneca, GSK, Novartis, Sanofi. Dr Nikolay Pavlov: AstraZeneca, CSL Behring, GlaxoSmithKline, Novartis, Olympus, OM Pharma, Sanofi. Dr Claudia Steurer: AstraZeneca, GSK, Novartis, OM Pharma. Pr Christophe von Garnier: AstraZeneca, Boehringer Ingelheim, GSK, Mundipharma, Novartis, Pfizer, OM Pharma, PneumRx et Pulmonx, Sanofi. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article. AstraZeneca AG a soutenu la rédaction du manuscrit en mettant à disposition un rédacteur médical, sans influence exercée sur le contenu.