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Copyright of Rassegna di Patologia dell'Apparato Respiratorio is the property of AIPO - Associazione Italiana Pneumologi Ospedalieri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Asthma is one of the most common chronic diseases in both pediatric age and adulthood, often underdiagnosed and undertreated. Over the past 20 years, numerous guidelines have been published with the aim of translating evidence into recommendations for good clinical practice; however, their impact was modest. The multilevel training program “Revolution in asthma” was created with the dual objective of improving the knowledge of the main guidelines on asthma and investigating the level of agreement of the participants with the recommendations of the guidelines, as well as their real-life application. Materials and methods. The survey was conducted from February to October 2021 on a representative sample of 400 Italian general practitioners, pulmonologists and algologists. Four guidelines (BTS/SIGN, NICE, AEPP-NHLBI-EPR and GINA) were compared and the concordances/ discrepancies between the recommendations of the guidelines relating to seven thematic areas were analyzed. Agreement/disagreement with the recommendations was measured with a Likert scale. The level of adherence in clinical practice was also assessed through questions aimed at estimating participants’ “opinions/beliefs” (as indicator of self-efficacy, i.e., confidence that the recommendations can be applied in daily practice). Results and conclusions. This e-learning project increased the participants’ guidelines knowledge (at the end of the course, 80% of the participants thought it was more useful to use several guidelines than one). The analysis highlighted the areas of agreement with the guidelines, and the “grey areas”, i.e. the areas with moderate agreement, such as patients monitoring and PEF use. Besides, barriers that interfere with the application of the recommendations into clinical practice were identified. In conclusion, the project allowed the participants to re-elaborate their own “mental guidelines” and to compare them with the published ones, thus driving a paradigm shift in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Copyright of Rassegna di Patologia dell'Apparato Respiratorio is the property of AIPO - Associazione Italiana Pneumologi Ospedalieri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rassegna di Patologia dell'Apparato Respiratorio is the property of AIPO - Associazione Italiana Pneumologi Ospedalieri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The imbalance between the prevalence of patients with acute respiratory failure (ARF) and acute-on-chronic respiratory failure and the number of intensive care unit (ICU) beds requires new solutions. The increasing use of non-invasive respiratory tools to support patients at earlier stages of ARF and the increased expertise of non-ICU clinicians in other types of supportive care have led to the development of adult pulmonary intensive care units (PICUs) and pulmonary intermediate care units (PIMCUs). As in other European countries, Italian PICUs and PIMCUs provide an intermediate level of care as the setting designed for managing ARF patients without severe non-pulmonary dysfunction. The PICUs and PIMCUs may also act as step-down units for weaning patients from prolonged mechanical ventilation and for discharging patients still requiring ventilatory support at home. These units may play an important role in the on-going coronavirus disease 2019 pandemic. This position paper promoted by the Italian Thoracic Society (ITS-AIPO) describes the models, facilities, staff, equipment, and operating methods of PICUs and PIMCUs. [ABSTRACT FROM AUTHOR]

Asthma, asthma treatment, biologics, infections, virus Severe asthma in adults does not significantly affect the outcome of COVID-19 disease: Results from the Italian Severe Asthma Registry Keywords: asthma; asthma treatment; biologics; infections; virus EN asthma asthma treatment biologics infections virus 902 905 4 03/09/21 20210301 NES 210301 To the Editor, Severe asthma is a chronic disease affecting around 3%-8% of adult asthma population in Europe, with the refractory form estimated to occur in 0.1% of the general population.1,2 Severe asthma is characterized by increased use of healthcare resources (ie, emergency room/hospital admissions, access to intensive care units (ICU), and use of biologics) due to exacerbations compared with the less severe form. [Extracted from the article]

Severe asthma (SA) is a complex and heterogeneous syndrome due to the presence of many phenotypes-endotypes with different inflammatory and pathophysiological characteristics, and to the coexistence of many comorbidities. Important issues yet to be solved are also present such as near fatal asthma (NFA). The Pulmonologist plays a central role in the complex process to diagnose “severe asthma” including: (a) the confirmation of asthma diagnosis, (b) the identification of risk factors that can exacerbate asthma, (c) the verification of an appropriate therapy and adequate adherence, (d) the diagnosis and treatment of comorbidities, (e) and finally the identification of a definite phenotype permitting a personalization of therapy. The results of the “omics” science have allowed to integrate the search for treatable traits with the analysis of “treatable mechanisms”. A key example is represented by adultonset eosinophilic severe asthma. Much evidence has shown that peripheral eosinophilia is associated with greater asthma severity, more exacerbations, worse airways obstruction and higher doses of steroids to control symptoms and comorbidities, particularly those affecting the upper airways; this can be considered a real “treatable mechanism”. Despite recent scientific and therapeutic advances, severe asthma still has an important negative impact on both the health care system and the patient’s quality of life due to frequent exacerbations, which in the most serious cases can be life-threatening (episodes of NFA). These areas of need represent the current challenge for the Pulmonologist who remains the central figure, even when operating in a context of multidisciplinary care, and underline the need to rearrange more effectively the management of patients with severe asthma. [ABSTRACT FROM AUTHOR]

Italian Pulmonology played a central role in the containment of the SARS-CoV-2 pandemic by multiplying efforts, respiratory specialist assistance and beds availability for patients with COVID-19 pneumonia. The effectiveness of Pulmonologist intervention was due mainly to the several years’ experience of the Pulmonology Intensive Care Units (PICU), integrated at hospital level within Pulmonology Wards (PW). By mid-May, about 10,000 patients had been treated and discharged from Italian Pulmonology Units, of these the 42% treated with noninvasive ventilation (in March in full pandemic they were the 82%) and the 17% with invasive mechanical ventilation. PICUs have played a strategic role in connecting the activities between Intensive Care Units (ICU) and lower intensity of care settings. The 22% of patients admitted in PICU and PW were transferred from ICU (step down), while the 11% of them, following a clinical aggravation, were moved from PICU and PW to ICU (step up). The clinical outcome of this management was particularly positive: the overall mortality of hospitalized COVID-19 patients in Italian Pulmonology Units (PICU and PW) was 12%, very similar to what is recorded in General Medicine Wards during the winter months. These data confirm that non-invasive ventilation is truly effective if performed by expert specialized physicians, in this case Pulmonologists. There is a pulmonary network on the national territory that can ensure a rapid response in the event of a second wave of COVID-19 pneumonia, or in the event that treatment of critically ill patients is required, increasing and reconverting the activity towards a particular pathology as has already occurred with good results during the first phase of COVID-19 pandemic. There are about 920 pulmonology beds allocated in I and II level Emergency department that have already employed in the routine care of critically ill patients and for ventilatory treatment: they should represent a first amount, rapidly available, out of the 4,225 RICU beds recommended to be implemented by the National Health Ministry. Italian respiratory societies believe that the enhancement of pulmonological skills does not simply represent a recognition of the commitment and the contribution of Italian Pulmonology in the management of the COVID-19 epidemic, but it is also a unique opportunity for the entire National Health Service to implement quickly an efficient treatment response for all patients suffering from respiratory diseases. [ABSTRACT FROM AUTHOR]

Pneumonia represents the main cause of hospitalization and mortality secondary to SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection. The etiological diagnosis of COVID-19 pneumonia requires confirmation of the presence of viral genetic material detected with RT-PCR (Reverse Transcriptase - Polymerase Chain Reaction) test, usually obtained using nasopharyngeal or oropharyngeal swab; however, several evidences demonstrate that a significant proportion of swabs, in particular at the first determination, results negative even in the presence of COVID-19 pneumonia. These patients may be erroneously hospitalized in a non-COVID-19 area and therefore contribute to the nosocomial transmission of the virus. For this reason the Italian Thoracic Society (ITS) promoted the production of a document that recommends a pragmatic approach to the COVID-19 pneumonia diagnosis with negative RT-PCR using a decisional clinical-radiological algorithm as a proxy to the commonly adopted gold standard, represented by RT-PCR, aimed at isolating patient and promoting investigations for a correct clinical-therapeutic classification. Difficulties in the first COVID-19 epidemic phase allowed us to know better characteristics and virus dangerousness. What we have learned has to be usefully implemented in clinical practice in order to contain the infection in the second and third phases to prevent a possible second wave of the infection during the autumnal period. [ABSTRACT FROM AUTHOR]

The asthmatic endotype T2 is the result of a complex interaction between innate and acquired immunopathological mechanisms. The approach of omics sciences and transcriptomics has allowed to identify two important endotypes in asthma, "T2" and "not T2". Subjects with T2 asthma usually show peripheral and tissue eosinophilia, subepithelial basal membrane thickening, an increased bronchial hyperreactivity and a better response to steroids than non T2 asthmatics. Patients with T2 severe asthma and particularly with T2 high endotype are less responsive to steroids and most frequently show important comorbidities as chronic rhinosinusitis and nasal polyposis. In these patients, the treatment with biological drugs has become a fundamental therapeutic strategy. [ABSTRACT FROM AUTHOR]