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Introduction: Asthmatics can experience recurrent exacerbations (AEs), irrespectively of asthma severity. Airway inflammatory monitoring could be fundamental to optimize the asthma management. The present study evaluated whether exhaled NO concentrations in proximal and distal respiratory compartments are different in AE-prone patients in combination with T2 blood biomarkers and resting oxygen saturation (SpO2). Methods: In this observational cross-sectional study, 91 mild-to-severe asthmatics were enrolled. Clinical characteristics, blood and lung function parameters including SpO2, and FENO were evaluated. On 50 randomly selected patients, CANO and JawNO were also analyzed. Then, patients were stratified in frequent exacerbators (FEs) or non-frequent exacerbators (nFEs), according to AE frequency in the previous year (phase I). Chart data were re-evaluated through a 12-month follow-up period post exhaled NO measurement to detect occurrence of novel AE (phase II). Results: FE asthmatics had poorer asthma control and required higher therapeutic intensity (p < 0.05). FENO, CANO, and JawNO were similar between FE and nFE. FE exhibited higher total serum IgE levels and residual volume values but reduced SpO2 than nFE (p < 0.05); SpO2ANO was higher in the group with novel AE at 1-month post-NO measurement (p < 0.05), but not afterward. A higher prevalence of CANO >6 ppb was detected in asthmatics who developed AE within 1 month, suggesting its potential clinical use as biomarker in predicting near-future AE (RR = 11.20). Conclusion: AE-susceptible asthmatics are characterized by air trapping and distal airway inflammation in conjunction with lower oxygen saturation. CANO and SpO2 could exert specific roles, respectively, in predicting AE and monitoring FE asthmatics.

Background: The possible gender impact on asthma arouses current and outstanding interest, but few studies addressed this issue in the real-world setting. Objective: This cross-sectional study tested the hypothesis of a potential difference between asthmatic males and females in a real-life setting, such as a third-level asthma clinic. Methods: A total of 499 asthmatic outpatients (301 females and 198 males, mean age 58.25 years) were consecutively visited. The visit included history, asthma control, and severity grade, physical examination, lung function, fractional exhaled nitric oxide assessment, and blood sample for biomarkers. Results: There were more females than males (about 3 of 5). Asthmatic females smoked less (p < 0.0001) than males and had higher FEV1 (p = 0.0022) and FVC (p = 0.0004) values than asthmatic males. Conclusions: Gender difference was associated with smoking and lung function impairment; thus, this issue should be carefully considered in asthmatic patients in daily clinical practice.

Background Chronic rhinosinusitis (CRS) includes 2 main phenotypes: CRS without nasal polyps (CRSsNP) and CRS with nasal polyps (CRSwNP). CRS has been reported to be a comorbidity of asthma. Objective This study aimed to investigate the role of CRS in outpatients with asthma visited in real-world setting. Methods This cross-sectional study enrolled 499 consecutive outpatients with asthma. Age, sex, body mass index, smoking status, lung function, Asthma Control Test, inflammatory type 2 biomarkers (including fractional exhaled nitric oxide, blood eosinophils, serum total immunoglobulin E, and allergy), treatment step according to the Global Initiative for Asthma, and comorbidities (obstructive sleep apnea syndrome, arterial hypertension, bronchiectasis, diabetes mellitus type 2, and osteoporosis) were evaluated. Results A total of 179 (35.87%) patients had CRS, in particular 93 (18.64%) had CRSsNP and 86 (17.23%) had CRSwNP. Type 2 inflammation (defined by at least 1 positive biomarker) was present in 81.44% of patients (fractional exhaled nitric oxide > 30 parts per billion in 46.9%, blood eosinophil count > 300 cell/μL in 39.67%, serum total immunoglobulin E >100 IU/mL in 51.54%, and allergy in 53.71%). By multivariate analysis, type 2 inflammation and blood eosinophils greater than 300 cell/μL were the main predictors (odds ratio [OR] 2.54 and 2.26, respectively) of CRS-asthma association. In particular, CRSwNP comorbidity was predicted by type 2 inflammation (OR 3.4) and blood eosinophils greater than 300 cell/μL (OR 3.0). Smoking had conflicting outcome. Conclusion This study confirmed that CRS is a frequent asthma comorbidity because it affects more than one-third of outpatients with asthma. CRSwNP is associated with type 2 inflammation and blood eosinophilia. These outcomes underline that CRSwNP asthma phenotype deserves adequate attention for careful management and optimal identification of the best-tailored therapy.

Paediatric Asthma contributes in paediatric global burden of diseases, as the most common chronic disease in children. Children are exposed to many environmental risk-factors, able to determine or worsen respiratory diseases, and contributing to asthma and asthma-like symptoms increases, especially in metropolitan areas. In urban settings, surrounding vegetation (greenness) may provide important benefits to health, including the promotion of physical activity and the mitigation of air and noise pollution. The aim of this study was to investigate the association between greenness and respiratory health. A total of 187 children (10&ndash, 13 yrs old) were recruited in Turin, the north-western part of Italy. The prevalence of asthma and asthma-like symptoms was calculated from self-reported data collected by SIDRIA questionnaire. Spirometry test was performed to obtain respiratory flow measurements. Greenness was measured at individual level through the Normalised Difference Vegetation Index (NDVI) estimations from remote-sensing images. Higher exposure (3rd tertile vs. 1st tertile) to NDVI was associated to significantly lower ORs for asthma [0.13 CI 95% 0.02&ndash, 0.7, p = 0.019], bronchitis [0.14 CI 95% 0.05&ndash, 0.45, p = 0.001], and current wheezing [0.25 CI 95% 0.09&ndash, 0.70, p = 0.008]. A significative positive association was found between greenness and FEF25&ndash, 75, since children exposed to the 2nd tertile of NDVI reported a significantly decreased FEF25&ndash, 75 compared to those in the 3rd tertile [B: &minus, 2.40, C.I.95%: &minus, 0.48&ndash, 0.01, p = 0.049]. This cross-sectional study provided additional data on still inconsistent literature referring to respiratory health in children and green spaces, attesting a positive effect of greenness in a specific area of Italy. Further research is still needed.

Coronavirus disease 2019 (COVID-19) is an acute respiratory disease that has rapidly spread to become a global pandemic. Bronchoscopy is clearly a high-risk manoeuvrer, so to continue endoscopic activity safely it was necessary to make many changes. We created different ways to access and exit the endoscopy theatre and reinforced our dressing/undressing regimens as well as equipment cleaning techniques. To prevent aerosol dispersion we used a bag valve mask with an antibacterial-antiviral filter, introducing the flexible bronchoscope orally rather than through the nose. For procedures with increased contagious risk a nasopharyngeal swab was required. From the date of the first case of COVID-19 in our hospital to December 31 2020, we performed 1027 bronchoscopies, in both negative and positive patients. No outbreaks occurred within the staff and no patients are known to have developed COVID-19 after a procedure. Our experience underscores how it is possible to continue endoscopic activity safely.

Background: Asthma exacerbation is episodic worsening of respiratory symptoms in conjunction with the deterioration of lung function, which may occur independently from the asthma severity hampering asthmatics&rsquo, quality of life. This study aimed to characterize the patient phenotype more prone to asthma exacerbation (oral corticosteroid burst &ge, 2 per year) to allow the proper identification of such patients. Methods: This real-life, observational, cross-sectional study evaluated 464 asthmatic patients stratified according to the asthma exacerbations experienced in the previous year. Clinical, functional, and blood parameters were retrieved from chart data and were representative of patients in stable conditions. Results: The frequent asthma exacerbator was more commonly female, suffered from chronic rhinosinusitis with nasal polyposis, had reduced lung function and peripheral oxygen saturation, and had increased daily activity limitations. These patients often had severe asthma and more frequently needed hospitalization in their lives. Furthermore, the frequent asthma exacerbator had higher concentrations of serum immunoglobulin E (IgE) and exhaled nitric oxide with cut-off risk values of 107.5 kU/L (OR = 4.1) and 43.35 ppb (OR = 3.8), respectively. Conclusions: This study illustrates the clinical features of the frequent asthma exacerbator phenotype. Nevertheless, serum IgE and exhaled nitric oxide could allow the identification of this phenotype and the establishment of an appropriate therapeutic approach.

Background: forced oscillation technique (FOT) is a non–invasive method used to assess respiratory mechanics. The main parameters, resistance (R) and reactance (X); inspiratory (Rinsp), expiratory (Rexp) and total (Rtot); can be obtained at different frequencies and with a minimal cooperation. This makes FOT fit for epidemiological studies. Aim: to investigate reproducibility and acceptability of FOT in assessing the respiratory function in school-aged children and adolescents. Methods: 159 subjects have been studied by FOT, 100 from primary and 59 from high school. The measurements were considered of high quality (HQ) if the standard deviations (SD) of Rinsp, Rexp and Rtot were less than 0,7 and the ratio between SD and each R parameter was less than 0,3. If just one condition was met, the measurement was considered acceptable (AQ). Results: HQ and AQ measurements were obtained respectively from 81% and 98% of subjects. Learning and age effect on the variance was considered. The best reproducibility was achieved at 5 Hz in 151 children. The distribution of the results is reported in the table. Conclusions: measurements obtained by FOT have proved to have high acceptability and good reproducibility. This confirms that FOT can be efficiently used in epidemiological studies, particularly in school age.

Background: environmental pollution, mostly in urban area, represents an increasing burden in human health (WHO, Global update 2005). However, the effects of pollutants on the respiratory impedance are not well known, especially in childhood and adolescence. Aim: to investigate the impact of environmental exposure on the respiratory function in school-aged children. Methods: 175 children (from 7 to 19 years) underwent to spirometry and impedance measurement by using forced oscillation technique (FOT, Resmon PRO FULL, Restech, Italy). Total respiratory resistance at 5 Hz (R tot5 ), total respiratory reactance at 5 Hz (X tot5 ) and FEV 1 /FVC% were compared to the level of exposure to pollutants, reported by patients through questionnaire and measured through a urinary biomarker of tobacco smoke exposure (cotinine). The relative risk (OR) of abnormal R tot5 , X tot5 and FEV 1 /FVC% have been computed by means of logistic regression analysis for the level of exposure to pollutants (table). Results: both spirometry and FOT parameters revealed a risk of impairment of the respiratory function in active smokers. Furthermore, FOT parameters demonstrated a reduction of the respiratory function also in children exposed to passive smoking and high traffic. Conclusions: high traffic exposure and active and passive exposure to tobacco smoke can reduce the respiratory function in childhood.

Risk monitoring in childhood is useful to estimate harmful health effects at later stages of life. Thus, here we have assessed the effects of tobacco smoke exposure and environmental pollution on the respiratory health of Italian children and adolescents using spirometry and the forced oscillation technique (FOT). For this purpose, we recruited 188 students aged 6&ndash, 19 years living in Chivasso, Italy, and collected from them the following data: (1) one filled out questionnaire, (2) two respiratory measurements (i.e., spirometry and FOT), and (3) two urine tests for Cotinine (Cot) and 15-F2t-Isoprostane (15-F2t-IsoP) levels. We found a V-shape distribution for both Cotinine and 15-F2t-IsoP values, according to age groups, as well as a direct correlation (p = 0.000) between Cotinine and tobacco smoke exposure. These models demonstrate that tobacco smoke exposure, traffic, and the living environment play a fundamental role in the modulation of asthma-like symptoms (p = 0.020) and respiratory function (p = 0.007). Furthermore, the results from the 11&ndash, 15-year group indicate that the growth process is a protective factor against the risk of respiratory disease later in life. Lastly, the FOT findings highlight the detrimental effects of tobacco smoke exposure and urbanization and traffic on respiratory health and asthma-like symptoms, respectively. Overall, monitoring environmental and behavioral factors in childhood can provide valuable information for preventing respiratory diseases in adulthood.