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Urdova V, Rogers L, Jesenak M, Seys SF. Real-life studies and registries of severe asthma: The advent of digital technology. Respir Med 2023; 220:107429. [PMID: 37926182 DOI: 10.1016/j.rmed.2023.107429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
Severe asthma is a chronic and heterogeneous disease that negatively affects the quality of life of our patients and health care utilization. Given the remaining burden of uncontrolled disease in many of these patients, better understanding of its epidemiology, disease mechanisms, effectiveness of novel therapies such as biologics are still highly needed. Asthma treatment guidelines are largely informed by randomized controlled trials (RCTs) and meta analyses of RCTs, however inclusion criteria of many efficacy RCTs of asthma treatments often exclude a high number of patients with asthma in the community. Data from real-life studies and registries of severe asthma can complement efficacy studies by not only providing evidence on how a treatment performs in everyday clinical practice, post marketing safety information, data to support subsequent clinical trial design, but also helping to delineate the natural history of a disease and supporting important translational research endeavors. In the current review, we summarise available national and international collaborative studies and registries, the variables studies and the novel data and insights they provide. The key source of information for most asthma registries are real-life data from patient's electronic health records. Advent of digital technology in collecting data and their analysis is obvious and we draw attention to generation of new knowledge from registries of severe asthma to improve current diagnostic and therapeutic guidelines and asthma control.
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Affiliation(s)
- V Urdova
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia.
| | - L Rogers
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Jesenak
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Allergology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - S F Seys
- Research Unit, Galenus Health, Hasselt, Belgium
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Crimi C, Calabrese C, D'Amato M, Blasi F, Canonica GW, Guida G, Heffler E, Paggiaro P, Carpagnano GE. Patient and physician perspectives on biological treatment in severe asthma: a Severe Asthma Network Italy survey. ERJ Open Res 2023; 9:00560-2023. [PMID: 37965229 PMCID: PMC10641582 DOI: 10.1183/23120541.00560-2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/20/2023] [Indexed: 11/16/2023] Open
Abstract
Patients with severe asthma perceive beneficial effects of biologics and good self-reported adherence to treatment, even when self-administered at home https://bit.ly/48vP70w.
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Affiliation(s)
- 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
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria D'Amato
- Department of Respiratory Medicine, University “Federico II” of Naples, Naples, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giuseppe Guida
- Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital – Orbassano, Turin, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University “Aldo Moro”, Bari, Italy
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Caminati M, Guarnieri G, Paggiaro P, Vianello A, Crisafulli E, Vaia R, Senna G. Relevance of Smoking Habit in Severe Asthma Patients: Evidence from the Severe Asthma Network in Italy (SANI) Registry. J Clin Med 2022; 11:jcm11247465. [PMID: 36556081 PMCID: PMC9784435 DOI: 10.3390/jcm11247465] [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: 11/22/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Smoking habit is still fairly common among asthmatics. So far, the impact of smoke on severe asthma burden has not been specifically investigated. We aimed to estimate the frequency of smoking habit among severe asthma patients, their clinical features, and the impact of smoke on asthma outcomes. The Severe Asthma Network in Italy (SANI) registry was analyzed. Demographic, clinical, and functional features of smokers, never and former smokers were compared. Data from 1194 patients were explored. Smokers were younger, with a lower asthma onset age. Atopy, BMI and respiratory/systemic comorbidities were equally distributed. In former smokers pre- and post-FEV1/FVC was significantly lower; no other significant differences were detected. Similar findings were confirmed when stratifying the former smokers by pack-years and length of smoking cessation. Among former smokers, lymphocytes and neutrophils were higher in the <15 years of smoking cessation group. Blood eosinophils were comparable in never and former smokers. When clustering the population by blood eosinophils, no significant differences in pulmonary function and exacerbations were observed. Our data suggest that a personal smoking history has a relatively low impact on disease burden. It remarks the importance of smoking cessation as a main intervention, particularly in severe asthma.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, University of Verona, 37134 Verona, Italy
- Correspondence:
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padua, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy
| | - Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padua, Italy
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona and Verona University Hospital, 37134 Verona, Italy
| | - Rachele Vaia
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, 37134 Verona, Italy
- Allergy Unit and Asthma Center, Verona University Hospital, 37134 Verona, Italy
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Maio S, Murgia N, Tagliaferro S, Angino A, Sarno G, Carrozzi L, Pistelli F, Bacci E, Paggiaro PL, Latorre M, Baldacci S, Viegi G. The Italian severe/uncontrolled asthma registry (RItA): A 12-month clinical follow-up. Respir Med 2022; 205:107030. [PMID: 36370538 DOI: 10.1016/j.rmed.2022.107030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND follow-up studies on registries of severe/uncontrolled asthma (SUA) patients are scanty. OBJECTIVE to analyze baseline and follow-up characteristics of SUA patients and their longitudinal patterns. METHODS 180 adult patients (age ≥15 yrs) were investigated at baseline and 12-month follow-up through the Italian SUA registry (RItA). Latent transition analysis (LTA) was performed to detect cross-sectional SUA phenotypes and longitudinal patterns. Risk factors for longitudinal patterns were assessed through logistic regression. RESULTS a significant/borderline improvement of asthma control outcomes in the last 2-4 weeks emerged at follow-up with respect to baseline for: daily activities limitations (Δ -16%), frequent diurnal symptoms (Δ -25%), uncontrolled asthma symptoms according to ACT (Δ -26%). Last 12-month use of oral corticosteroids was less frequent at follow-up than at baseline (Δ -25%). Health status improvement was confirmed by lung function test results. Through LTA, two longitudinal patterns were detected considering last 12-month control outcomes: "persistence/worsening" (53.9%), "under control/improvement" (46.1%). A lower likelihood of having "persistence/worsening" SUA was exhibited by patients under anti-IgE (OR 0.38, 95% CI 0.17-0.84) and inhaled corticosteroids-bronchodilator association treatment (OR 0.13, 95% CI 0.01-1.26, borderline value), while a higher likelihood was shown by older age at first asthma diagnosis (OR 1.04, 95% CI 1.01-1.07). CONCLUSION the implementation of a SUA registry, the availability of patient-level data and the application of an innovative longitudinal analysis allowed to observe a general improvement in asthma control, one year after baseline, and a lower risk of SUA "persistence/worsening" in patients under anti-IgE and regular ICS-bronchodilator association use.
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Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy.
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Medicine, Dept., Perugia University, Italy
| | - Sofia Tagliaferro
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Anna Angino
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Giuseppe Sarno
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy; Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Francesco Pistelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy; Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Elena Bacci
- Cardio-Thoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Pier Luigi Paggiaro
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Manuela Latorre
- Pulmonary Unit, Department of Medical Specialties, Nuovo Ospedale Apuano, Massa, Italy
| | - Sandra Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
| | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology (IFC), Pisa, Italy
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Di Bona D, Spataro F, Carlucci P, Paoletti G, Canonica GW. Severe asthma and personalized approach in the choice of biologic. Curr Opin Allergy Clin Immunol 2022; 22:268-275. [PMID: 35779061 DOI: 10.1097/aci.0000000000000829] [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: 11/25/2022]
Abstract
PURPOSE OF REVIEW Severe asthma requires intensive pharmacological treatment to achieve disease control. Oral corticosteroids are effective, but their use is burdened with important side effects. Biologics targeting the specific inflammatory pathways underpinning the disease have been shown to be effective but not all patients respond equally well. As we treat more patients than those who can respond, our inability to predict responders has important healthcare costs considering that biologics are expensive drugs. Thus, a more precise choice of the 'right patients' to be prescribed with the 'right biologics' would be desirable. RECENT FINDINGS Machine learning techniques showed that it is possible to increase our ability to predict outcomes in patients treated with biologics. Recently, we identified by cluster analysis four different clusters within the T2 high phenotype with differential benralizumab response. Two of these clusters, characterized by higher levels of inflammatory markers, showed the highest response rate (80-90%). SUMMARY Machine learning holds promise for asthma research enabling us to predict which patients will respond to which drug. These techniques can facilitate the diagnostic workflow and increase the chance of selecting the more appropriate treatment option for the individual patient, enhancing patient care and satisfaction.
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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
| | - Federico Spataro
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari
| | - Palma Carlucci
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari
| | - Giovanni Paoletti
- IRCCS Humanitas Research Hospital
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giorgio W Canonica
- IRCCS Humanitas Research Hospital
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Roberto B, Silvia P, Veronica B, Francesca M, Stefano F, Mattia T, Gianenrico S, Albino P, Andrea V, Marco C. Clinical response to biologics for severe asthma: any relevance for sex in different age ranges? ERJ Open Res 2022; 8:00670-2021. [PMID: 35854871 PMCID: PMC9289375 DOI: 10.1183/23120541.00670-2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background Whether sex can influence the clinical response to biological treatment in patients with severe asthma has not been fully addressed. Aims and methods The aim of this study was to investigate in patients with severe asthma undergoing biological treatment the individual evolution of lung function measurements and patient-reported asthma control scores over a 12-month follow-up period, in relation to patients’ sex, in different age ranges. Second, the change in the administered dose of oral corticosteroids (OCS) before and after 12 months of treatment was investigated. Results 64 patients (58% female and 42% male) with a median age of 52 years were enrolled in the study. There were no relevant differences between sexes in terms of lung function, patient-reported asthma control, exacerbation rate and daily OCS dose within the study timeframe. A separate sub-analysis by biological treatment confirmed the same finding. Stratifying individuals by age, we showed that older men had lower lung function parameter values (forced expiratory volume in 1 s (FEV1) % predicted and FEV1/forced vital capacity index) than older women, whereas an opposite trend was observed in terms of Asthma Control Test score. No other relevant differences were detected after age stratification. Conclusion According to our findings, sex does not act as a determinant of treatment response to biologicals in people with severe asthma. Although to be confirmed in larger studies, our data suggest that neither sex nor age should limit biological treatment prescription, once the eligibility criteria for that therapy are satisfied. Sex does not seem to act as a determinant of treatment response to biologicals in severe asthma. Neither sex nor age should limit biological treatment prescription, once the eligibility criteria for that therapy are satisfied.https://bit.ly/370frEP
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Kim SH, Lee H, Park SY, Park SY, Song WJ, Kim JH, Park HW, Cho YS, Yoon HJ. The Korean Severe Asthma Registry (KoSAR): real world research in severe asthma. Korean J Intern Med 2022; 37:249-260. [PMID: 35184515 PMCID: PMC8925953 DOI: 10.3904/kjim.2021.403] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
Severe asthma constitutes a serious health burden with significant morbidity and socioeconomic costs. The development and introduction of new biologics targeting type 2 inflammation changed the paradigm for management of severe asthma and initiated a biological era. These changes impose a challenge to clinicians in managing difficult-to-treat and severe asthma. To understand the characteristics and heterogeneity of severe asthma and to develop a better strategy to manage it, the Korean Academy of Asthma, Allergy and Clinical Immunology, Working Group on Severe Asthma, has organized the Korean Severe Asthma Registry (KoSAR). In this review, we describe the challenges of severe asthma management regarding diagnosis, disease burden, heterogeneity, guidelines, and organization of severe asthma clinics. This review also examines the current global activities of national and regional registries and study groups. In addition, we present the KoSAR vision and organization and describe the findings of KoSAR in comparison with those of other countries.
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Affiliation(s)
- Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - So-Young Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - So Young Park
- Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
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Caminati M, Camiciottoli G, Baiardini I, Antonicelli L, Beghè B, Crimi N, Favero E, Stanziola AA, Valenti G, Visca D, Del Giacco S. Patients and doctors group meetings: an innovative way to explore severe asthma backstage. Multidiscip Respir Med 2022; 17:854. [PMID: 36158780 PMCID: PMC9491102 DOI: 10.4081/mrm.2022.854] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Severe asthma patients' life is heavily influenced by the disease, which has impact on personal and professional choices or general lifestyle. Despite the available tools to help physicians investigating the patient-reported outcomes there is a need for a more standardised and structured approach to include the evaluation of quality of life together with the emotions of patients into the routine clinical interaction. We hereby report the use of an active listening and insight approach to understand the emotions of patients with severe asthma through dedicated in-person meetings involving a group of patients with their doctors, caregivers and an external moderator. The initiative "Patients insight meeting" was organized within 17 specialist referral centres for severe asthma in Italy in 2019 and involved 149 patients. Insights related to 4 different items were collected and a task force composed by the external moderators produced a general report including the suggestions from the participating centres. This experience of group-meetings involving both patients and doctors together represents an innovative way to investigate real life experience and the emotions of asthmatic patients, highlighting unmet needs related to patient's experience of his/her disease that need to be included in severe asthmatics' management strategy.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Cardio-Thoraco-Vascular Department, AOUC Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | | | - Bianca Beghè
- Department of Medicine, Section of Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - Nunzio Crimi
- Respiratory Medicine Unit, AOU "Policlinico-Vittorio Emanuele" and Department of Clinical and Experimental Medicine, University of Catania
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergy Clinic Ca' Foncello Hospital, Treviso
| | | | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo
| | - Dina Visca
- Department of Medicine and Surgery, University of Insubria, Varese and Department of Medicine and Cardiopulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate (VA)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato-Cagliari, Italy
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Braido F, Blasi F, Canonica GW, Paggiaro P, Beghè B, Bonini M, Carpagnano GE, Del Giacco S, Lavorini F, Milanese M, Patella V, Santus P, Contoli M. Mild/Moderate Asthma Network in Italy (MANI): a long-term observational study. J Asthma 2021; 59:1908-1913. [PMID: 34469268 DOI: 10.1080/02770903.2021.1968895] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The prevalence of asthma in Italy is estimated to be around 4%; it affects approximately 2,000,000 citizens, and up to 80-90% of patients have mild-to-moderate asthma. Despite the clinical relevance of mild-to-moderate asthma, longitudinal observational data are very limited, including data on disease progression (worsening vs. improvement), the response to treatment, and prognosis. Studies are needed to develop long-term, observational, real-life research in large cohorts. The primary outcomes of this study will be based on prospective observation and the epidemiological evolution of mild and moderate asthma. Secondary outcomes will include patient-reported outcomes, treatments over time, disease-related functional and inflammatory patterns, and environmental and life-style influences. METHODS This study, called the Mild/Moderate Asthma Network of Italy (MANI), is a research initiative launched by the Italian Respiratory Society and the Italian Society of Allergology, Asthma and Clinical Immunology. MANI is a cluster-based, real world, cross-sectional, prospective, observational cohort study that includes 20,000 patients with mild-to-moderate asthma. (ClinicalTrials.gov Identifier: NCT04796844). RESULTS AND CONCLUSION Despite advances in asthma care, several research gaps remain to be addressed through clinical research. This study will add important new knowledge about long-term disease history, the transferability of clinical research results to daily practice, the efficacy of currently recommended strategies, and their impact on the burden and evolution of the disease. ABBREVIATIONS MANI:Mild/Moderate Asthma Network of ItalySANI:Severe Asthma Network ItalyGINA:Global Initiative for AsthmaSABA:short acting β2-agonistsICS:inhaled corticosteroidsCRF:Case Report Form.
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Affiliation(s)
- Fulvio Braido
- Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Personalized Medicine, Asthma and Allergy, Rozzano, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Bianca Beghè
- Section of Respiratory Medicine, Department of Medical and Surgical Sciences, University Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Rome, Rome, Italy
| | - Giovanna Elisiana Carpagnano
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Stefano Del Giacco
- Unit of Allergy and Clinical Immunology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Manlio Milanese
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, "Santa Maria della Speranza" Hospital, Salerno, Italy.,Postprogram in Allergy and Clinical Immunology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences "L. Sacco" - Division of Respiratory Diseases, University of Milan, Sacco University Hospital, Milano, Italy
| | - Marco Contoli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Canonica GW, Blasi F, Crimi N, Paggiaro P, Papi A, Fanelli F, Stassaldi A, Furneri G. Defining type 2 asthma and patients eligible for dupilumab in Italy: a biomarker-based analysis. Clin Mol Allergy 2021; 19:5. [PMID: 34020658 PMCID: PMC8140446 DOI: 10.1186/s12948-021-00146-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/10/2021] [Indexed: 12/04/2022] Open
Abstract
Background Asthma is a chronic disease characterized by airway hyperresponsiveness, inflammation and mucus production. In Type 2 asthma, two phenotypic components are often co-expressed (eosinophilic and allergic). Elevated biomarker levels, such as eosinophils (EOS), fraction of exhaled nitric oxide (FeNO) and immunoglobulin E (IgE), are key clinical indicators of Type 2 inflammation. Dupilumab has been recently approved for the treatment of uncontrolled severe Type 2 asthma. Type 2 asthma includes allergic and/or eosinophilic phenotypes. The aim of this analysis was to estimate the dupilumab-eligible population in Italy and characterize it by expected biomarker status. Methods A 4-step approach was carried out to calculate dupilumab-eligible population. The approach consisted in: (1) estimating the total number of asthma patients in Italy (using 2016–2017 Italian-adapted Global Initiative for Asthma -GINA- guidelines); (2) estimating the number of severe asthma patients with poorly controlled or uncontrolled disease (using the findings of two recent administrative claim analyses conducted in Italy); (3) stratifying the severe uncontrolled population by biomarker levels (EOS, FeNO and IgE) according to the outcomes of the QUEST trial (a clinical study assessing the efficacy of dupilumab in patients with uncontrolled moderate-to-severe asthma; NCT02414854); (4) identifying the sub-populations of severe uncontrolled asthma patients characterised by raised blood EOS and/or FeNO level (thus indicated to receive dupilumab). Results According to these estimates, about 3.3 million asthmatic patients live in Italy (6.10% of the population). Of them, almost 20 thousand (N = 19,960) have uncontrolled severe asthma. Dupilumab-eligible patients would be N = 15,988, corresponding to 80.1% of the total uncontrolled severe population. Most of these patients (89.3%; N = 14,271) have at least an increase of EOS level, while slightly more than half (51.9%; N = 8,303) have raised levels of both biomarkers. Increased FeNO levels without increased EOS are observed less frequently (N = 1,717; 10.7% of the eligible population). Conclusions There is a strong rationale for testing all asthma biomarkers during diagnosis and disease follow-up. Given the large availability and the limited costs, these tests are cost-effective tools to detect severe Type 2 asthma, stratify patients by phenotype, and drive appropriate treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12948-021-00146-9.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nunzio Crimi
- Respiratory Medicine Unit, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Alberto Papi
- Respiratory Medicine Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Gianluca Furneri
- EBMA Consulting S.R.L., Via per Carpiano 2, 20077, Melegnano, MI, Italy.
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11
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Bousquet J, Bedbrook A, Czarlewski W, De Carlo G, Fonseca JA, González Ballester MA, Illario M, Koskinen S, Laatikainen T, Onorato GL, Palkonen S, Patella V, Pham-Thi N, Puggioni F, Ventura MT, Joos G, Kuna P, Louis R, Makris M, Zalud P, Zuberbier T, Bachert C, Brussino L, Carreiro-Martins P, Carrion Y Ribas C, Chalubinski M, Costa EM, de Vries G, Gemicioglu B, Gennimata D, Micheli Y, Niedoszytko M, Regateiro FS, Romantowski J, Taborda-Barata L, Toppila-Salmi S, Tsiligianni I, Viart F, Laune D. Digital Health Europe (DHE) Twinning on severe asthma-kick-off meeting report. J Thorac Dis 2021; 13:3215-3225. [PMID: 34164213 PMCID: PMC8182538 DOI: 10.21037/jtd-21-792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jean Bousquet
- Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany.,University Hospital Montpellier, Montpellier, France.,Maladies Chroniques pour un Viellissement Actif, (Macvia-France), Montpellier, France
| | - Anna Bedbrook
- Maladies Chroniques pour un Viellissement Actif, (Macvia-France), Montpellier, France.,Allergic Rhinitis and its Impact on Asthma (ARIA), Montpellier, France.,Mobile Airways Sentinel nekworK (MASK-air), Montpellier, France
| | - Wienczyslawa Czarlewski
- Allergic Rhinitis and its Impact on Asthma (ARIA), Montpellier, France.,Mobile Airways Sentinel nekworK (MASK-air), Montpellier, France.,Medical Consulting Czarlewski, Levallois, France
| | - Giuseppe De Carlo
- European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Joao A Fonseca
- Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Medida, Lda Porto, Portugal
| | - Miguel A González Ballester
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain, ICREA, Barcelona, Spain
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D Unit and Department of Public Health), Naples, Italy
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Gabrielle L Onorato
- Maladies Chroniques pour un Viellissement Actif, (Macvia-France), Montpellier, France
| | - Susanna Palkonen
- European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
| | - Nhân Pham-Thi
- Ecole Polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
| | - Francesca Puggioni
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Maria Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, and GIGA I3 Research Group, Liege, Belgium
| | - Michael Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | | | - Torsten Zuberbier
- Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium.,International Airway Research Center, First Affiliated Hospital, Sun Yat-sen University, Guangzou, China.,Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - Pedro Carreiro-Martins
- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carme Carrion Y Ribas
- School of Health Sciences and UOC eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Maciej Chalubinski
- Department of Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Elisio M Costa
- Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | | | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Dimitra Gennimata
- Department of Pharmacy, Athens General Hospital "Korgialenio-Benakio" Hellenic Red Cross, Athens, Greece
| | | | - Marek Niedoszytko
- Medical University of Gdańsk, Department of Allergology, Gdańsk, Poland
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jan Romantowski
- Medical University of Gdańsk, Department of Allergology, Gdańsk, Poland
| | - Luis Taborda-Barata
- Health Sciences, University of Beira Interior, Covilhã, Portugal.,Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece.,International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
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12
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Papaioannou AI, Mplizou M, Porpodis K, Fouka E, Zervas E, Samitas K, Markatos M, Bakakos P, Papiris S, Gaga M, Papakosta D, Loukides S. Long-term efficacy and safety of omalizumab in patients with allergic asthma: A real-life study. Allergy Asthma Proc 2021; 42:235-242. [PMID: 33980337 DOI: 10.2500/aap.2021.42.210014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The efficacy and safety of omalizumab in patients with severe allergic asthma have been established in both randomized controlled trials and real-life studies. Objective: To evaluate the sustained effectiveness and safety of long-term treatment with omalizumab in a real-world setting. Methods: In this retrospective study, we included patients treated with omalizumab for at least 8 years in four asthma clinics in Greece. Pulmonary function, asthma control, oral corticosteroids (OCS) dose, and exacerbations were recorded before treatment, 6 months later, and annually thereafter. Adverse events were also recorded. Results: Forty-five patients (66.7% women), mean ± standard deviation (SD) age 55.3 ± 12.2 years, were included. The duration of treatment with omalizumab was 10.6 ± 1.2 years. The annual exacerbation rate decreased from 4.1 before omalizumab initiation to 1.1 after 1 year of treatment and remained low up to the 8th year of treatment (p < 0.001). From the 19 patients who were receiving OCS at baseline, 21.1% patients discontinued after 6 months, 47.4% were still on OCS after 4 years of therapy, and 31.6% were on OCS after 8 years. With regard to the OCS dose, 36.8% of the patients reduced the dose ≥ 50% after 6 months and 68.4% achieved 50% reduction after 2 years. The mean daily OCS dose before omalizumab initiation was 7.8 mg of prednisolone or the equivalent, reduced to 4.7 mg/day after 6 months, which reached 1.6 mg/day after 8 years (p < 0.001). Treatment with omalizumab resulted in significant improvements of asthma control and lung function. No severe adverse events were reported. Conclusion: In this real-life study, omalizumab resulted in significant and sustained improvements in asthma exacerbations, asthma control, and lung function, and had a steroid sparing effect and a good safety profile.
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Affiliation(s)
- Andriana I. Papaioannou
- From the 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, 2nd Respiratory Medicine Department, “Attikon” University Hospital, Chaidari, Athens, Greece
| | - Myrto Mplizou
- From the 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, 2nd Respiratory Medicine Department, “Attikon” University Hospital, Chaidari, Athens, Greece
| | - Konstantinos Porpodis
- Prof, Respiratory Medicine Department, Aristotle University of Thessaloniki, G Papanikolaou Hospital, Thessaloniki, Greece
| | - Evangelia Fouka
- Prof, Respiratory Medicine Department, Aristotle University of Thessaloniki, G Papanikolaou Hospital, Thessaloniki, Greece
| | | | | | | | - Petros Bakakos
- National and Kapodistrian University of Athens National and Kapodistrian University of Athens, 1st Respiratory Medicine Department, “Sotiria” Hospital, Athens, Greece
| | - Spyridon Papiris
- From the 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, 2nd Respiratory Medicine Department, “Attikon” University Hospital, Chaidari, Athens, Greece
| | - Mina Gaga
- 7th Respiratory Medicine Department, Sotiria Hospital, Athens. Greece
| | - Despoina Papakosta
- Prof, Respiratory Medicine Department, Aristotle University of Thessaloniki, G Papanikolaou Hospital, Thessaloniki, Greece
| | - Stelios Loukides
- From the 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, 2nd Respiratory Medicine Department, “Attikon” University Hospital, Chaidari, Athens, Greece
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13
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Carpagnano GE, Resta E, Povero M, Pelaia C, D'Amato M, Crimi N, Scichilone N, Scioscia G, Resta O, Calabrese C, Pelaia G, Barbaro MPF. Clinical and economic consequences of switching from omalizumab to mepolizumab in uncontrolled severe eosinophilic asthma. Sci Rep 2021; 11:5453. [PMID: 33750842 DOI: 10.1038/s41598-021-84895-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/12/2021] [Indexed: 11/09/2022] Open
Abstract
Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS), which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab (OMA) to mepolizumab (MEP) in patients eligible for both biologics, but not optimally controlled by omalizumab. We retrospectively enrolled uncontrolled severe asthmatic patients who switched from OMA to MEP during the last two years. Information included blood eosinophil count, asthma control test (ACT), spirometry, serum IgE, fractional exhaled nitric oxide (FeNO), OCS intake, drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-MEP 12-month standardized total cost per patient was calculated. 33 patients were enrolled: five males, mean age 57 years, disease onset 24 years. At OMA discontinuation, 88% were OCS-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to MEP improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03–0.14), OCS-dependent patients (OR = 0.02, 95% CI 0.005–0.08), and number of lost working days (Δ = − 7.9, 95% CI − 11.2 to − 4.6). Pulmonary function improved, serum IgE, FeNO and eosinophils decreased. Mean annual costs were €12,239 for OMA and €12,639 for MEP (Δ = €400, 95% CI − 1588–2389); the increment due to drug therapy (+ €1,581) was almost offset by savings regarding all other cost items (− €1,181). Patients with severe eosinophilic asthma, not controlled by OMA, experienced comprehensive benefits by switching to MEP with only slight increases in economic costs.
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14
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Bagnasco D, Povero M, Pradelli L, Brussino L, Rolla G, Caminati M, Menzella F, Heffler E, Canonica GW, Paggiaro P, Senna G, Milanese M, Lombardi C, Bucca C, Manfredi A, Canevari RF, Passalacqua G. Economic impact of mepolizumab in uncontrolled severe eosinophilic asthma, in real life. World Allergy Organ J 2021; 14:100509. [PMID: 33598095 PMCID: PMC7846931 DOI: 10.1016/j.waojou.2021.100509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/14/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIMS Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS) which worsen patients' health and increase healthcare spending. Aim of this study was to assess the clinical and economic effect of adding mepolizumab (MEP) for the treatment of these patients. METHODS Patients >18 years old, referred to 8 asthma clinics, starting MEP between May 2017 and December 2018, were enrolled and followed-up for 12 months. Information in the 12 months before mepolizumab were collected retrospectively. The evaluation parameters included: OCS use, number of exacerbations/hospitalizations, concomitant therapies, comorbidity, and annual number of working days lost due to the disease. The primary objective was to compare the annual total cost per patient pre- and post-MEP. Secondary outcomes included rates of exacerbations and number of OCS-dependent patients. RESULTS 106 patients were enrolled in the study: 46 male, median age 58 years. Mean annual cost pre- and post-MEP (cost of biologic excluded) was €3996 and €1,527, respectively. Total savings due to MEP resulted in €2469 (95%CI 1945-2993), 62% due to exacerbations reduction and 33% due to productivity increase. Such savings could fund about 22% of the total cost of MEP for one year. The introduction of MEP induced a clinical benefit by reducing both OCS-dependent patients (OR = 0.12, 95%CI 0.06-0.23) and exacerbation rate (RR = 0.19, 95%CI 0.15-0.24). CONCLUSIONS Patients with severe eosinophilic asthma experienced a clinical benefit in asthma control adding MEP to standard therapy. Biologic therapy can be, partially, funded by the savings produced by patients' improvement.
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Key Words
- ACT, Asthma Control Test
- Anti IL-5
- CI, Confidence Intervals
- COPD, chronic obstructive pulmonary disease
- Comorbidities
- FeNO, fractional nitric oxide
- GERD, gastroesophageal reflux disease
- ICS, inhaled corticosteroids
- IQR, interquartile range
- LABA, long acting beta 2 agonist
- LAMA, long acting muscarinic antagonist
- LOS, Length of stay
- MEP, Mepolizumab
- Mepolizumab
- OCS
- OCS, Oral Corticosteroids
- OR, Odds Ratio
- Pharmacoeconomics
- RCTs, Randomized Controlled Trials
- RR, Rate Ratio
- SD, Standard Deviation
- Severe asthma
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Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino – University of Genoa, Italy
| | | | | | - Luisa Brussino
- Mauriziano Hospital of Torino, Department of Medical Science, University of Torino, Italy
| | - Giovanni Rolla
- Mauriziano Hospital of Torino, Department of Medical Science, University of Torino, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Menzella
- Azienda USL di Reggio Emilia-IRCSS, Santa Maria Nuova Hospital- Pneumology Unit, Reggio Emilia, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center – IRCCS – Rozzano (Milan), Italy
- Department of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center – IRCCS – Rozzano (Milan), Italy
- Department of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Verona, Italy
| | - Manlio Milanese
- Division of Pneumology, S.Corona Hospital, Pietra Ligure, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Caterina Bucca
- Azienda Ospedale-Università Città della Salute e della Scienza, S.C. Pneumologia, Dept. of Medical Sciences University of Turin, Turin
| | - Andrea Manfredi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino – University of Genoa, Italy
| | - Rikki Frank Canevari
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino – University of Genoa, Italy
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15
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Senna G, Latorre M, Bugiani M, Caminati M, Heffler E, Morrone D, Paoletti G, Parronchi P, Puggioni F, Blasi F, Canonica GW, Paggiaro P. Sex Differences in Severe Asthma: Results From Severe Asthma Network in Italy-SANI. Allergy Asthma Immunol Res 2021; 13:219-228. [PMID: 33474857 PMCID: PMC7840868 DOI: 10.4168/aair.2021.13.2.219] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/06/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
Abstract
Purpose After adolescence, asthma is more frequent in females than in males due to different hormonal, immunologic, and occupational/environmental factors. The higher prevalence and severity of the disease in females have already been reported in international registries. The aim of this study was to explore the difference in terms of clinical, functional, and biological characteristics between male and female patients with severe asthma in a real-life, registry-based setting. Methods Baseline data from the Severe Asthma Network in Italy registry were analyzed in 1,123 patients with severe asthma, according to sex. Results Almost 2/3 of severe asthmatics were female. Late-onset asthma, obesity and gastro-esophageal reflux were more frequent in females than in males, while previous smoking habits and nasal polyposis were more frequent in males. Females had poor asthma control and a higher number of severe exacerbations leading to hospitalization, in comparison to males. Biomarkers of type 2 inflammation (blood eosinophil, exhaled nitric oxide, and serum immunoglobulin E levels) were significantly higher in males than in females. The type 2 profile (defined by a combination of these 3 biomarkers) was significantly more frequent in males than in females. In multivariate analysis, late-onset asthma and a normal body mass index were only independent variables associated with the type 2 profile, while male sex and age showed only a trend toward the association with the type 2 profile. Conclusions Significant differences may be observed between male and female patients with severe asthma, influencing the asthma pheno-endotyping in both sexes.
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Affiliation(s)
- Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine and Molecular Biology and Critical Care, Nuovo Ospedale Apuano, University of Pisa, Pisa, Italy
| | - Massimo Bugiani
- Pneumology and Tisiology Unit, National Health Service (ASL TO2), Turin, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Daniela Morrone
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Paola Parronchi
- Department of Clinical and Experimental Medicine,University of Florence, Florence, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesco Blasi
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine and Molecular Biology and Critical Care, Nuovo Ospedale Apuano, University of Pisa, Pisa, Italy.
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16
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Agache I, Akdis CA, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Chu DK, Del Giacco S, Eiwegger T, Flood B, Firinu D, Gern JE, Hamelmann E, Hanania N, Hernández‐Martín I, Knibb R, Mäkelä M, Nair P, O’Mahony L, Papadopoulos NG, Papi A, Park H, Pérez de Llano L, Pfaar O, Quirce S, Sastre J, Shamji M, Schwarze J, Palomares O, Jutel M. EAACI Biologicals Guidelines-Recommendations for severe asthma. Allergy 2021; 76:14-44. [PMID: 32484954 DOI: 10.1111/all.14425] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [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: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/20/2022]
Abstract
Severe asthma imposes a significant burden on patients, families and healthcare systems. Management is difficult, due to disease heterogeneity, co-morbidities, complexity in care pathways and differences between national or regional healthcare systems. Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals. However, there are still many issues that require further clarification. These include selection of a certain biological (as they all target overlapping disease phenotypes), the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home-based) and its cost-effectiveness. The EAACI Guidelines on the use of biologicals in severe asthma follow the GRADE approach in formulating recommendations for each biological and each outcome. In addition, a management algorithm for the use of biologicals in the clinic is proposed, together with future approaches and research priorities.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Transylvania University Brasov Romania
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine‐Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS Rozzano Italy
| | - Thomas Casale
- Division of Allergy and Immunology University of South Florida Morsani College of Medicine Tampa FL USA
| | - Tomas Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | | | - Derek K. Chu
- Department of Health Research Methods, Evidence and Impact Division of Immunology and Allergy, and Department of Medicine McMaster University Hamilton ON Canada
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute Hospital for Sick Children Toronto ON Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Hospital for Sick Children Departments of Paediatrics and Immunology University of Toronto Toronto ON Canada
| | - Breda Flood
- European Federation of Allergy and Airway Diseases Brussels Belgium
| | - Davide Firinu
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - James E. Gern
- Department of Pediatrics School of Medicine and Public Health University of Wisconsin Madison WI USA
| | - Eckard Hamelmann
- Children’s Center Bethel Evangelical Hospital Bethel University of Bielefeld Bielefeld Germany
| | - Nicola Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine Baylor College of Medicine Houston TX USA
| | | | - Rebeca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Mika Mäkelä
- Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Parameswaran Nair
- Division of Respirology Department of Medicine McMaster University Hamilton ON Canada
- Firestone Institute for Respiratory Health St Joseph's Healthcare Hamilton ON Canada
| | - Liam O’Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic National Kapodistrian University of Athens Athens Greece
| | - Alberto Papi
- Research Center on Asthma and COPD Department of Medical Sciences University of Ferrara Ferrara Italy
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University Ajou Korea
| | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Santiago Quirce
- Department of Allergy La Paz University Hospital IdiPAZ CIBER of Respiratory Diseases (CIBERES) Universidad Autónoma de Madrid Madrid Spain
| | - Joaquin Sastre
- Facultad de Medicina Universidad Autónoma de Madrid Madrid Spain
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair, Development National Heart and Lung Institute London UK
- Imperial College NIHR Biomedical Research Centre Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Jurgen Schwarze
- Centre for Inflammation Research, Child Life and Health The University of Edinburgh Edinburgh UK
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- All‐MED Medical Research Institute Wroclaw Poland
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17
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Latorre M, Bacci E, Seccia V, Bartoli ML, Cardini C, Cianchetti S, Cristofani L, Di Franco A, Miccoli M, Puxeddu I, Celi A, Paggiaro P. Upper and lower airway inflammation in severe asthmatics: a guide for a precision biologic treatment. Ther Adv Respir Dis 2020; 14:1753466620965151. [PMID: 33263506 PMCID: PMC7716065 DOI: 10.1177/1753466620965151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
Background and aims: Severe asthma may require the prescription of one of the biologic drugs currently available, using surrogate markers of airway inflammation (serum IgE levels and allergic sensitization for anti-IgE, or blood eosinophils for anti-IL5/IL5R). Our objective: to assess upper and lower airway inflammation in severe asthmatics divided according to the eligibility criteria for one of the target biologic treatments. Methods: We selected 91 severe asthmatics, uncontrolled despite high-dose ICS-LABA, and followed for >6 months with optimization of asthma treatment. Patients underwent clinical, functional and biological assessment, including induced sputum and nasal cytology. They were then clustered according to the eligibility criteria for omalizumab or mepolizumab/benralizumab. Results: Four clusters were selected: A (eligible for omalizumab, n = 23), AB (both omalizumab and mepolizumab, n = 26), B (mepolizumab, n = 22) and C (non-eligible for both omalizumab and mepolizumab, n = 20). There was no difference among clusters for asthma control (Asthma Control Test and Asthma Control Questionnaire 7), pre-bronchodilator forced expiratory volume in 1 s, serum IgE and fractional exhaled nitric oxide levels. Sputum eosinophils were numerically higher in clusters AB and B, in agreement with the higher levels of blood eosinophils. Allergic rhinitis was more frequent in clusters A and AB, while chronic rhinosinusitis with nasal polyps prevalence increased progressively from A to C. Eosinophils in nasal cytology were higher in clusters AB, B and C. Conclusion: Eosinophilic upper and lower airway inflammation is present in the large majority of severe asthmatics, independently from the prescription criteria for the currently available biologics, and might suggest the use of anti-IL5/IL5R or anti IL4/13 also in patients without blood eosinophilia. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Manuela Latorre
- Pulmonary Unit, Nuovo Ospedale Apuano, UO Pneumologia, Via Enrico Mattei 21, Massa, Italy.,Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Elena Bacci
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | | | - Maria Laura Bartoli
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Cristina Cardini
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Silvana Cianchetti
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | | | - Antonella Di Franco
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Ilaria Puxeddu
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Alessandro Celi
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
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18
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Puggioni F, Brussino L, Canonica GW, Blasi F, Paggiaro P, Caminati M, Latorre M, Heffler E, Senna G. Frequency of Tiotropium Bromide Use and Clinical Features of Patients with Severe Asthma in a Real-Life Setting: Data from the Severe Asthma Network in Italy (SANI) Registry. J Asthma Allergy 2020; 13:599-604. [PMID: 33204116 PMCID: PMC7667506 DOI: 10.2147/jaa.s274245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/19/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose Patients with uncontrolled asthma despite high doses of inhaled corticosteroid therapy plus another controller are defined as severe asthmatics. Tiotropium bromide respimat (TBR) is the only long-acting muscarinic antagonists (LAMA) approved for severe asthma. The aim of this study was to explore the frequency of severe asthmatics treated with TBR and characterize their clinical features in a real-life, registry-based setting. Materials and Methods Baseline data from the Severe Asthma Network in Italy (SANI) registry have been analyzed to determine the use of TBR and other LAMA, and to compare clinical, functional and inflammatory features associated with the use of LAMA. Results Among a total of 698 enrolled patients, 35.9% were treated with LAMA (23.3% TBR, 4.5% tiotropium bromide handihaler, 4.5% aclidinium, 3.4% glycopyrronium bromide 0.3% umeclidinium bromide). Age of asthma onset was higher in patients taking LAMA, whom, compared to others were more frequently former smokers. They also had a higher annual exacerbation rate, experienced worst asthma control, worst disease-related quality of life and poorer lung function. Bronchiectasis was more frequently found in LAMA users (25.9% vs 13.1%). Conclusion TBR is still underused in severe asthma in a real-life setting, while a relevant proportion of patients are treated with other LAMA that are not approved for severe asthma treatment. Patients taking LAMA have features characteristic of even more severe asthma.
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Affiliation(s)
- Francesca Puggioni
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS - Rozzano (MI), Milan, Italy.,Department of Biomedical Sciences, Humanitas University - Pieve Emanuele (MI), Milan, Italy
| | - Luisa Brussino
- Dipartimento di Scienze Mediche, SSDDU Allergologia e Immunologia Clinica, Università degli Studi di Torino, AO Ordine Mauriziano Umberto I - Torino, Torino, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS - Rozzano (MI), Milan, Italy.,Department of Biomedical Sciences, Humanitas University - Pieve Emanuele (MI), Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy.,Allergy Unit and Asthma Center, Verona University Hospital, Verona, Verona, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Center, IRCCS - Rozzano (MI), Milan, Italy.,Department of Biomedical Sciences, Humanitas University - Pieve Emanuele (MI), Milan, Italy
| | - Gianenrico Senna
- Department of Medicine, University of Verona, Verona, Italy.,Allergy Unit and Asthma Center, Verona University Hospital, Verona, Verona, Italy
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19
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Malipiero G, Paoletti G, Blasi F, Paggiaro P, Senna G, Latorre M, Caminati M, Carpagnano GE, Crimi N, Spanevello A, Aliberti S, Canonica GW, Heffler E. Clinical features associated with a doctor-diagnosis of bronchiectasis in the Severe Asthma Network in Italy (SANI) registry. Expert Rev Respir Med 2020; 15:419-424. [PMID: 33100041 DOI: 10.1080/17476348.2021.1840983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several severe asthma comorbidities have been identified: an emerging one is bronchiectasis. We evaluated the frequency of bronchiectasis on severe asthma in a real-life setting, through the 'Severe Asthma Network Italy' (SANI) registry. METHODS SANI registry encompasses demographic, clinical, functional and inflammatory data of Italian severe asthmatics. Data obtained by the enrolled patients were analyzed, focusing the attention on those patients with concomitant clinically relevant bronchiectasis. RESULTS About 15.5% patients have bronchiectasis. Bronchiectasis diagnosis was associated with a higher prevalence of chronic rhinosinusitis with nasal polyps (54.6% vs. 38%, p = 0.001) and higher serum IgE levels (673.4 vs. 412.1 kUI/L, p = 0.013). Patients with bronchiectasis had worse asthma control (ACT: 16.7 vs 18.2, p = 0.013), worse quality of life (AQLQ: 4.08 vs. 4.60, p = 0.02) and lower lung function (FEV1% predicted 67.3 vs. 75.0, p = 0.002). A higher rate of severe asthma exacerbations in the previous 12 months (85.2% vs. 61.5%, p < 0.001) was found in patients with bronchiectasis. CONCLUSION severe asthma associated with bronchiectasis represents a particularly severe asthma variant, possibly driven by an eosinophilic endotype. We, therefore, suggest that bronchiectasis should necessarily be assessed in severe asthmatic patients.
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Affiliation(s)
- Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Giovanna Elisiana Carpagnano
- Respiratory Medicine Section, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Nunzio Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Spanevello
- Faculty of Medicine and Surgery, University of Insubria, Varese, Italy.,Division of Pulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy 3
| | - Stefano Aliberti
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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20
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Scichilone N, Barnes PJ, Battaglia S, Benfante A, Brown R, Canonica GW, Caramori G, Cazzola M, Centanni S, Cianferoni A, Corsico A, De Carlo G, Di Marco F, Gaga M, Hawrylowicz C, Heffler E, Matera MG, Matucci A, Paggiaro P, Papi A, Popov T, Rogliani P, Santus P, Solidoro P, Togias A, Boulet LP. The Hidden Burden of Severe Asthma: From Patient Perspective to New Opportunities for Clinicians. J Clin Med 2020; 9:jcm9082397. [PMID: 32727032 PMCID: PMC7463666 DOI: 10.3390/jcm9082397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Severe asthma is an important topic in respiratory diseases, due to its high impact on morbidity and mortality as well as on health-care resources. The many challenges that still exist in the management of the most difficult-to-treat forms of the disease, and the acknowledgement of the existence of unexplored areas in the pathophysiological mechanisms and the therapeutic targets represent an opportunity to gather experts in the field with the immediate goals to summarize current understanding about the natural history of severe asthma and to identify gaps in knowledge and research opportunities, with the aim to contribute to improved medical care and health outcomes. This article is a consensus document from the “International Course on Severe Asthma” that took place in Palermo, Italy, on May 10–11, 2019. Emerging topics in severe asthma were addressed and discussed among experts, with special focus on patient’s needs and research opportunities, with the aim to highlight the unanswered questions in the diagnostic process and therapeutic approach.
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Affiliation(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, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
- Correspondence: ; Tel.: +39-091-655-2146
| | - Peter John Barnes
- Airway Disease Section, National Heart & Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK;
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Robert Brown
- Department of Anesthesiology and Critical Care Medicine, Medicine, Department of Medicine, Division of Pulmonary Medicine, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Giorgio Walter Canonica
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Gaetano Caramori
- Respiratory Medicine Unit, Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging (BIOMORF), University of Messina, 98122 Messina, Italy;
| | - Mario Cazzola
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Antonella Cianferoni
- Pediatrics Department, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics – University of Pavia, 27100 Pavia, Italy;
| | - Giuseppe De Carlo
- The European Federation of Allergy and Airways Diseases Patients Associations (EFA), 1000 Brussels, Belgium;
| | - Fabiano Di Marco
- Respiratory Unit, ASST - Papa Giovanni XXIII Hospital, Bergamo, University of Milan, 24127 Milan, Italy;
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Asthma Cen, Athens Chest Hospital, 11527 Athens, Greece;
| | - Catherine Hawrylowicz
- Division of Asthma, Allergy and Lung Biology, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Enrico Heffler
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Maria Gabriella Matera
- Unit of Pharmacology, Dept. Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50139 Florence, Italy;
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy;
| | - Alberto Papi
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Todor Popov
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, 1431 Sofia, Bulgaria;
| | - Paola Rogliani
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy;
| | - Paolo Solidoro
- Pneumology Unit U, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy;
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20814, USA;
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21
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Malipiero G, Heffler E, Pelaia C, Puggioni F, Racca F, Ferri S, Spinello L, Merigo M, Lamacchia D, Cataldo G, Sansonna M, Canonica GW, Paoletti G. Allergy clinics in times of the SARS-CoV-2 pandemic: an integrated model. Clin Transl Allergy 2020; 10:23. [PMID: 32566128 PMCID: PMC7299638 DOI: 10.1186/s13601-020-00333-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/29/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Almost the entire World is experiencing the Coronavirus-Disease-2019 (COVID-19) pandemic, responsible, at the end of May 2020, of more than five million people infected worldwide and about 350,000 deaths. In this context, a deep reorganization of allergy clinics, in order to ensure proper diagnosis and care despite of social distancing measures expose, is needed. MAIN TEXT The reorganization of allergy clinics should include programmed checks for severe and poorly controlled patients, application of digital medicine service for mild-to-moderate disease in well-controlled ones, postponement of non urgent diagnostic work-ups and domiciliation of therapies, whenever possible. As far as therapies, allergen immunotherapy (AIT) should not be stopped and sublingual immunotherapy (SLIT) fits perfectly for this purpose, since a drug home-delivery service can be activated for the entire pandemic duration. Moreover, biologic agents for severe asthma, chronic spontaneous urticaria and atopic dermatitis should be particularly encouraged to achieve best control possible of severe disease in times of COVID-19 and, whenever possible, home-delivery and self-administration should be the preferred choice. CONCLUSION During COVID-19 pandemic, allergists have the responsibility of balancing individual patients' needs with public health issues, and innovative tools, such as telemedicine and digital medicine services, can be helpful to reduce the risk of viral spreading while delivering up-to-date personalized care.
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Affiliation(s)
- Giacomo Malipiero
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, University “Magna Grecia” of Catanzaro, Catanzaro, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Lina Spinello
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Morena Merigo
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Giuseppe Cataldo
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Melissa Sansonna
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni 56, Rozzano, MI Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
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22
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Cameli P, Bergantini L, d'Alessandro M, Perruzza M, Cekorja B, Perillo F, Massa E, Ruzza A, Fossi A, Beltrami V, Sestini P, Bargagli E. A Comprehensive Evaluation of Mepolizumab Effectiveness in a Real-Life Setting. Int Arch Allergy Immunol 2020; 181:606-612. [PMID: 32516771 DOI: 10.1159/000507996] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Interleukin-5 (IL-5) is the principal cytokine regulating eosinophil growth, differentiation, activation, and expression. It is a specific target of mepolizumab, an anti-IL-5 monoclonal antibody used in the treatment of severe eosinophilic asthma. This new drug can improve symptoms, reduce asthma exacerbations and steroid use. Few data are available on its efficacy for nasal symptoms. OBJECTIVE To describe the all-round clinical impact of mepolizumab in a real-life setting, evaluating the efficacy and safety of the drug in severe eosinophilic asthma patients. POPULATION AND METHODS We retrospectively collected the clinical and functional data on 27 patients (16 males) affected with severe eosinophilic asthma, diagnosed at the Siena Regional Referral Centre and monitored for 6 months. Clinical, immunological, and functional data at baseline and follow-up were entered in a database together with comorbidities, number of exacerbations, steroid treatment, multiple-flow exhaled nitric oxide, and validated questionnaires. RESULTS A significant reduction in asthma exacerbations was observed in all patients after 6 months of the biological therapy (p = 0.0009), and 4/6 patients discontinued chronic oral steroids. A significant improvement in ACT, FEV1, SNOT22, and alveolar nitric oxide was observed after 1 month of mepolizumab (p = 0.003, p = 0.007, p = 0.047, and p = 0.019, respectively) and maintained after 6 months of treatment. After 6 months, FeNO 50 was reduced as well (p = 0.030). Mepolizumab was very well tolerated, and no major side effects were observed. CONCLUSIONS Our study suggests that mepolizumab is effective in improving control of asthma, lung function parameters, exhaled biomarkers, and nasal symptoms in patients with severe eosinophilic asthma.
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Affiliation(s)
- Paolo Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy,
| | - Laura Bergantini
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Miriana d'Alessandro
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Marco Perruzza
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Behar Cekorja
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Felice Perillo
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Evaluna Massa
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Annamaria Ruzza
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Antonella Fossi
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Valerio Beltrami
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Piersante Sestini
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Elena Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
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23
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Canonica GW, Malvezzi L, Blasi F, Paggiaro P, Mantero M, Senna G, Heffler E. Chronic rhinosinusitis with nasal polyps impact in severe asthma patients: Evidences from the Severe Asthma Network Italy (SANI) registry. Respir Med 2020; 166:105947. [PMID: 32250875 DOI: 10.1016/j.rmed.2020.105947] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinical and laboratory features of patients enrolled in the Severe Asthma Network in Italy (SANI) registry, a web-based observatory collecting demographic, clinical, functional and inflammatory data of patients with severe asthma were evaluated, with a special emphasis to chronic rhinosinusitis with nasal polyposis (CRSwNP). METHODS For each eligible patients the following information has been collected: demographic data, clinical features, asthma control in the previous month according to the GINA (Global INitiative for Asthma) Guidelines and standardized questionnaires, concomitant regular and on demand treatments and inflammatory markers. RESULTS 695 patients with severe asthma enrolled in 66 SANI centers were analyzed. The prevalence of chronic rhinosinusitis with nasal polyposis was 40.6%. Atopic dermatitis and bronchiectasis was significantly more frequent in patients with CRSwNP than in subjects without nasal polyposis; similarly, FeNO values are significantly higher in subject with CRSwNP than in patients without nasal polyposis. Finally, patients with CRSwNP had a significantly higher number of asthma exacerbations per year, more days on oral corticosteroids and were more likely to be OCS long term users. CONCLUSION OCS sparing is needed in patients with severe asthma, mainly in subjects with CRSwNP, adopting adequate strategies such as a better adherence to the treatment with inhaled therapy according to the GINA recommendations, the use of biologic agents and a multidisciplinary approach of the patient.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Luca Malvezzi
- Otolaryngology, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Mantero
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Heffler E, Carpagnano GE, Favero E, Guida G, Maniscalco M, Motta A, Paoletti G, Rolla G, Baraldi E, Pezzella V, Piacentini G, Nardini S. Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Multidiscip Respir Med 2020; 15:36. [PMID: 32269772 PMCID: PMC7137762 DOI: 10.4081/mrm.2020.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment, asthma can be a very severe condition (even leading to death), however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, University of Foggia; Section of Respiratory Diseases, Hospital d'Avanzo, Foggia
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergologic Clinic Ca' Foncello Hospital, Treviso
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce e Carle, Cuneo
| | - Mauro Maniscalco
- Respiratory Rehabilitation Unit, ICS Maugeri, Institute of Telese Terme IRCCS
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (NA)
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin and A.O. Mauriziano, Turin
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padua
| | - Vincenza Pezzella
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples
| | - Giorgio Piacentini
- Paediatric Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona
| | - Stefano Nardini
- Italian Respiratory Society-Società Italiana di Pneumologia, Milan, Italy
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Canonica GW, Colombo GL, Rogliani P, Santus P, Pitotti C, Di Matteo S, Martinotti C, Bruno GM. Omalizumab for Severe Allergic Asthma Treatment in Italy: A Cost-Effectiveness Analysis from PROXIMA Study. Risk Manag Healthc Policy 2020; 13:43-53. [PMID: 32158289 PMCID: PMC6986414 DOI: 10.2147/rmhp.s211321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/05/2019] [Accepted: 11/28/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Inadequately controlled severe asthma patients require additional therapy accounting for significant clinical and economic burden. Our analysis aims to determine the cost-effectiveness of omalizumab in the management of severe allergic asthma in Italy based on observational data from the PROXIMA study. Methods Observational data on efficacy, healthcare resource utilization and changes in quality of life at 12 months after the initiation of omalizumab were examined to estimate the cost-effectiveness compared to pre-omalizumab period and results were expressed with Incremental Cost-Effectiveness Ratio (ICER). The cost–utility analysis estimated the cost per quality-adjusted life-year (QALY) gained. Direct health costs were assessed from the perspective of the Italian National Health Service (NHS). Results Omalizumab reduced the incidence of exacerbations, number of hospitalizations, physician visits, and improved quality of life after 12 months of treatment. Omalizumab had a greater effectiveness than pre-omalizumab treatment involving 0.132 QALYs gained and led to a €3729 per patient reduction in direct healthcare costs, excluding the add-on treatment cost. Nevertheless, the addition of omalizumab cost led to €7478 increase in total direct costs with respect to pre-omalizumab period. Based on difference in total direct cost and difference in QALY between post and pre-omalizumab period, the ICER was €56,847. According to sensitivity analysis, omalizumab provided a cost-effective use of NHS resources, already at 20% discounted price. Conclusion This study offers a real-world evidence of omalizumab effectiveness in Italy. Despite the high acquisition cost of the innovative drug, omalizumab is a sustainable treatment option for patients with uncontrolled severe allergic asthma.
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Affiliation(s)
| | - Giorgio Lorenzo Colombo
- S.A.V.E. S.r.l. Studi Analisi Valutazioni Economiche Health Economics & Outcomes Research - Research Center, Milan, Italy.,Drug Science Department, Pavia University, Pavia, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
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International Severe Asthma Registry: Mission Statement. Chest 2019; 157:805-814. [PMID: 31838187 DOI: 10.1016/j.chest.2019.10.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/23/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Abstract
Regional and/or national severe asthma registries provide valuable country-specific information. However, they are often limited in scope within the broader definitions of severe asthma, have insufficient statistical power to answer many research questions, lack intraoperability to share lessons learned, and have fundamental differences in data collected, making cross comparisons difficult. What is missing is a worldwide registry which brings all severe asthma data together in a cohesive way, under a single umbrella, based on standardized data collection protocols, permitting data to be shared seamlessly. The International Severe Asthma Registry (ISAR; http://isaregistries.org/) is the first global adult severe asthma registry. It is a joint initiative where national registries (both newly created and preexisting) retain ownership of their own data but open their borders and share data with ISAR for ethically approved research purposes. Its strength comes from collection of patient-level, anonymous, longitudinal, real-life, standardized, high-quality data (using a core set of variables) from countries across the world, combined with organizational structure, database experience, inclusivity/openness, and clinical, academic, and database expertise. This gives ISAR sufficient statistical power to answer important research questions, sufficient data standardization to compare across countries and regions, and the structure and expertise necessary to ensure its continuance and the scientific integrity and clinical applicability of its research. ISAR offers a unique opportunity to implement existing knowledge, generate new knowledge, and identify the unknown, therefore promoting new research. The aim of this commentary is to fully describe how ISAR may improve our understanding of severe asthma.
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Colombo GL, Di Matteo S, Martinotti C, Oselin M, Valentino MC, Bruno GM, Pitotti C, Menzella F. Omalizumab and long-term quality of life outcomes in patients with moderate-to-severe allergic asthma: a systematic review. Ther Adv Respir Dis 2019; 13:1753466619841350. [PMID: 31035904 PMCID: PMC6492364 DOI: 10.1177/1753466619841350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/28/2022] Open
Abstract
Background: Asthma is a highly prevalent chronic inflammatory airways disease, with a
considerable impact on quality of life (QoL). To express the effects of
asthma on patients’ subjective experience, patient-reported outcomes (PROs)
represent an important instrument. The asthma QoL questionnaire (AQLQ) is
one of the main PROs among these. Materials and methods: To identify long-term asthma-related QoL outcomes associated with omalizumab
therapy in patients with moderate-to-severe asthma, we developed a
systematic review according to the PRISMA guidelines. Published real-world
effectiveness studies of adults or adolescents (12 years or older) with
moderate-to-severe allergic asthma treated with omalizumab for at least 48
weeks were reviewed. Sources used were Medline
(PubMed), the Cochrane Library and
Google Scholar up to February 2018. In addition, a
cross-referencing search was conducted to complete the revision. Results: A total of 255 potential papers were identified in the first search through
the database. After full-text viewing, eight articles were finally included
in the review. We summarized the results according to the study design,
patient baseline characteristics and effectiveness outcomes assessed by AQLQ
score results: variation from baseline to the end of study. Results
confirmed the long-term benefits of omalizumab as an add-on therapy in
patients with uncontrolled moderate-to-severe allergic asthma. Since there
is a lot of evidence on omalizumab effectiveness, we aimed to focus on how a
therapy can change patient’s QoL in a long time period. Data showed
long-term effects of omalizumab treatment on subjective (PROs) and objective
(lung function, corticosteroid use, hospitalizations, asthma exacerbation)
effectiveness measures. Conclusion: Studies included in our review were observational trials that, due to their
design, present a potential risk of selection bias in the patients included.
Beyond this limit, the evaluation of QoL using the AQLQ showed a clear
increase over time, following both 48 weeks and 9 years of observation,
where QoL improvements still were significant over baseline values.
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Affiliation(s)
- Giorgio Lorenzo Colombo
- Department of Drug Sciences, University of Pavia, Via G. Previati 74 20149 Milano c/o S.A.V.E., Pavia, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Martina Oselin
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Giacomo Matteo Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | | | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova- IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
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Heffler E, Bagnasco D, Canonica GW. Strategies to reduce corticosteroid-related adverse events in asthma. Curr Opin Allergy Clin Immunol 2019; 19:61-7. [PMID: 30407207 DOI: 10.1097/ACI.0000000000000493] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized. RECENT FINDINGS Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease). SUMMARY The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents.
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Canonica GW, Colombo GL, Bruno GM, Di Matteo S, Martinotti C, Blasi F, Bucca C, Crimi N, Paggiaro P, Pelaia G, Passalaqua G, Senna G, Heffler E. Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry. World Allergy Organ J 2019; 12:100007. [PMID: 30937132 PMCID: PMC6439414 DOI: 10.1016/j.waojou.2018.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [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: 08/08/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Asthma is one of the most common non-communicable respiratory diseases, affecting about 6% of the general population. Severe asthma, even if afflicts a minority of asthmatics, drives the majority of costs of the disease. The aim of this study is to create a pharmacoeconomic model to predict the costs of corticosteroid-related adverse events in severe asthmatics and applying it to the first published epidemiologic data from the Severe Asthma Network in Italy (SANI) registry. METHODS The analysis was conducted from the perspective of the Italian National Healthcare System (INHS). Model inputs, derived from literature, included: asthma epidemiology data, frequency of adverse events, percentage of severe asthma treated with OCS and adverse event cost (Diagnosis-Related Group (DRG) national tariffs). We estimated costs per different patient groups: non-asthma controls, mild/moderate and severe asthmatics. Final results report estimated direct cost per patient and total direct cost for overall target population, showing economic impact related to corticosteroid complication. RESULTS Based on epidemiological data input, in Italy, asthmatic subjects resulted about 3,999,600, of which 199,980 with severe asthma. The number of patients with severe asthma OCS-treated was estimated at 123,988. Compared to the non-asthma control cohort and to that with moderate asthma annual cost per severe asthmatic patient resulted respectively about €892 and €606 higher, showing a corticosteroids shadow cost ranging from 45% to 30%.Applying the cost per patient to the target population identified for Italy, the budget impact model estimated a total annual cost related to OCS-related adverse events of €242.7 million for severe asthmatics. In respect with non-asthmatic and moderate population, an incremental expenditure of about € 110.6 million and €75.2, respectively, were shown. CONCLUSIONS Our study provides the first estimates of additional healthcare costs related to corticosteroid induced adverse events in severe asthma patient. Budget impact model results highlighted the relevant economic impact of OCS-related adverse events in severe asthma patients. The future extrapolation of additional data from SANI registry will support the development of a model to investigate the role of corticosteroids sparing drugs.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Lorenzo Colombo
- Drug Science Department, Pavia University, Italy
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Giacomo Matteo Bruno
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Sergio Di Matteo
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Chiara Martinotti
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS “Cà Granda – Ospedale Maggiore Policlinico”, Milan, Italy
| | - Caterina Bucca
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Molinette “Città della Salute e della Scienza”, Department of Medical Sciences, University of Torino, Italy
| | - Nunzio Crimi
- Allergy and Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Respiratory Unit – University Magna Graecia of Catanzaro, Italy
| | - Giovanni Passalaqua
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI) – University of Genoa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Novelli F, Bacci E, Latorre M, Seccia V, Bartoli ML, Cianchetti S, Dente FL, Franco AD, Celi A, Paggiaro P. Comorbidities are associated with different features of severe asthma. Clin Mol Allergy 2018; 16:25. [PMID: 30524206 PMCID: PMC6276160 DOI: 10.1186/s12948-018-0103-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/08/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022] Open
Abstract
Background According to ATS/ERS document on severe asthma (SA), the management of these patients requires the identification and proper treatment of comorbidities, which can influence the control of asthma. Methods The aim of this study was to assess the independent effect of different comorbidities on clinical, functional and biologic features of SA. Seventy-two patients with SA according to GINA guidelines were examined. We collected demographic data, smoking habit, asthma history, and assessment of comorbidities. Pulmonary function, inflammatory biomarkers, upper airway disease evaluation, asthma control and quality of life were carefully assessed. Results The mean age of patients was 59.1 years (65.3% female, 5.6% current smokers). Comorbidities with higher prevalence were: chronic rhinosinusitis with or without nasal polyps (CRSwNP or CRSsNP), obesity and gastro-esophageal reflux (GERD), with some overlapping among them. In an univariate analysis comparing patients with single comorbidities with the other ones, asthmatics with CRSwNP had lower lung function and higher sputum eosinophilia; obese asthmatics had worse asthma control and quality of life, and tended to have lower sputum eosinophils; asthmatics with GERD showed worse quality of life. In multivariate analysis, obesity was the only independent factor associated with poor asthma control (OR 4.9), while CRSwNP was the only independent factor associated with airway eosinophilia (OR 16.2). Lower lung function was associated with the male gender and longer duration of asthma (OR 3.9 and 5.1, respectively) and showed a trend for the association with nasal polyps (OR 2.9, p = 0.06). Conclusion Our study suggests that coexisting comorbidities are associated with different features of SA. Electronic supplementary material The online version of this article (10.1186/s12948-018-0103-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federica Novelli
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Elena Bacci
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Manuela Latorre
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Veronica Seccia
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.,21st Otorinolaryngology Unit, University Hospital of Pisa, Pisa, Italy
| | - Maria Laura Bartoli
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Silvana Cianchetti
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Federico Lorenzo Dente
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Antonella Di Franco
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Alessandro Celi
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Pierluigi Paggiaro
- 1Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy.,3Cardio-Thoracic and Vascular Department, Respiratory Pathophysiology Unit, University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy
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Sá-Sousa A, Fonseca JA, Pereira AM, Ferreira A, Arrobas A, Mendes A, Drummond M, Videira W, Costa T, Farinha P, Soares J, Rocha P, Todo-Bom A, Sokolova A, Costa A, Fernandes B, Chaves Loureiro C, Longo C, Pardal C, Costa C, Cruz C, Loureiro CC, Lopes C, Mesquita D, Faria E, Magalhães E, Menezes F, Todo-Bom F, Carvalho F, Regateiro FS, Falcão H, Fernandes I, Gaspar-Marques J, Viana J, Ferreira J, Silva JM, Simão L, Almeida L, Fernandes L, Ferreira L, van Zeller M, Quaresma M, Castanho M, André N, Cortesão N, Leiria-Pinto P, Pinto P, Rosa P, Carreiro-Martins P, Gerardo R, Silva R, Lucas S, Almeida T, Calvo T. The Portuguese Severe Asthma Registry: Development, Features, and Data Sharing Policies. Biomed Res Int 2018; 2018:1495039. [PMID: 30584531 PMCID: PMC6280304 DOI: 10.1155/2018/1495039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022]
Abstract
The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient's clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients' electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients' confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma.
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Affiliation(s)
- Ana Sá-Sousa
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - João Almeida Fonseca
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Community Medicine, Information, and Health Sciences (MEDCIDS), Faculdade de Medicina Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Community Medicine, Information, and Health Sciences (MEDCIDS), Faculdade de Medicina Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Ana Ferreira
- Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Arrobas
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Mendes
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Marta Drummond
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
- Pulmonology Department, Faculty of Medicine University of Porto, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Wanda Videira
- Pulmonology Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | | | | | | | | | - Ana Todo-Bom
- Immunoallergology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Immunoallergology Department, Faculdade de Medicina, Universidade do Coimbra, Coimbra, Portugal
| | - Anna Sokolova
- Immunology and Allergy Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - António Costa
- Pulmonology Department, Hospital da Senhora da Oliveira, Guimarães EPE, Guimarães, Portugal
| | | | - Carla Chaves Loureiro
- Department of Pediatrics, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cecília Longo
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Cecília Pardal
- Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Célia Costa
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Cíntia Cruz
- Immunology and Allergy Department, Centro Hospital de Setúbal, EPE, Setúbal, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal
- Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Immunology and Allergy Department, Hospital Pedro Hispano Unidade Local de Saúde Matosinhos, EPE, Matosinhos, Portugal
- Immunology Dpeartment, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Duarte Mesquita
- Novartis Farma-Produtos Farmacêuticos, S.A., Porto Salvo, Portugal
| | - Emília Faria
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eunice Magalhães
- Pulmonology Department, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal
| | - Fernando Menezes
- Pulmonology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Filipa Todo-Bom
- Pulmonology Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Francisca Carvalho
- Immunology and Allergy Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Frederico S. Regateiro
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Helena Falcão
- Immunology and Allergy Department, Centro Hospitalar do Porto, EPE, Porto, Portugal
| | - Ivone Fernandes
- Pulmonology Department, Centro Hospital de Setúbal, EPE, Setúbal, Portugal
| | - João Gaspar-Marques
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Jorge Viana
- Immunology and Allergy Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Immunology and Allergy Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - José Manuel Silva
- Pulmonology Department, Unidade Local de Saúde da Guarda, EPE, Guarda, Portugal
| | - Laura Simão
- Pulmonology Department, Centro Hospitalar Tâmega e Sousa, EPE, Penafiel, Portugal
| | - Leonor Almeida
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
| | - Lígia Fernandes
- Pulmonology Department, Hospital Distrital Figueira da Foz, EPE, Figueira da Foz, Portugal
| | | | - Mafalda van Zeller
- Pulmonology Department, Centro Hospitalar de S. João, EPE, Porto, Portugal
- I3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Pulmonology Department, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Márcia Quaresma
- Department of Pediatrics, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | | | - Natália André
- Pulmonology Department, Centro Hospitalar do Oeste, Torres Vedras, Portugal
| | - Nuno Cortesão
- Pulmonology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Paula Leiria-Pinto
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Paula Pinto
- Pulmonology Department, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
- ISAMB, Instituto de Saúde Ambiental Faculdade de Medicina de Lisboa. Lisboa, Portugal
| | - Paula Rosa
- Pulmonology Department, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Pedro Carreiro-Martins
- Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal
| | - Rita Gerardo
- Pulmonology Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
| | - Rui Silva
- Immunology and Allergy Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - Susana Lucas
- Pulmonology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Teresa Almeida
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Calvo
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
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Heffler E, Blasi F, Latorre M, Menzella F, Paggiaro P, Pelaia G, Senna G, Canonica GW. The Severe Asthma Network in Italy: Findings and Perspectives. J Allergy Clin Immunol Pract 2018; 7:1462-1468. [PMID: 30368004 DOI: 10.1016/j.jaip.2018.10.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Severe Asthma Network in Italy (SANI) is a registry of patients recruited by accredited centers on severe asthma. OBJECTIVE To analyze epidemiological, clinical, inflammatory, functional, and treatment characteristics of severe asthmatics from the SANI registry. METHODS All consecutive patients with severe asthma were included into the registry, without exclusion criteria to have real-life data on demographics, asthma control, treatments (including biologics), inflammatory biomarkers, and comorbidities. RESULTS A total of 437 patients (mean age: 54.1 years, 57.2% females, 70.7% atopics, 94.5% in Global Initiative for Asthma severity step V) were enrolled into the study. The mean annual exacerbation rate was 3.75. The mean blood eosinophil level was 536.7 cells/mcL, and the average serum total IgE was 470.3 kU/L. Approximately 64% of patients were on regular oral corticosteroid treatment, 57% with omalizumab and 11.2% with mepolizumab. Most common comorbidities were rhinitis, nasal polyposis, and bronchiectasis. Patients with nasal polyposis had higher age of disease onset, higher blood eosinophil count, and lower frequency of atopy and atopic eczema. Bronchiectasis was associated with more frequent severe exacerbations, higher blood eosinophils, and total IgE. Stratifying patients, those with late-onset asthma were less frequently atopic (with less frequent allergic rhinitis and food allergy), and more frequently with nasal polyposis and higher serum total IgE levels. CONCLUSIONS This study revealed a high frequency of relevant comorbidities and that a substantial proportion of patients have late-onset asthma; all these features define specific different disease phenotypes. Severe asthma complexity and comorbidities require multidisciplinary approaches, led by specifically trained pulmonologists and allergists.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova-IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Respiratory Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Bulathsinhala L, Eleangovan N, Heaney LG, Menzies-Gow A, Gibson PG, Peters M, Hew M, van Boven JFM, Lehtimäki L, van Ganse E, Belhassen M, Harvey ES, Perez de Llano L, Maitland-van der Zee AH, Papadopoulos NG, FitzGerald JM, Porsbjerg C, Canonica GW, Backer V, Rhee CK, Verhamme KMC, Buhl R, Cosio BG, Carter V, Price C, Le T, Stagno d'Alcontres M, Gopalan G, Tran TN, Price D. Development of the International Severe Asthma Registry (ISAR): A Modified Delphi Study. J Allergy Clin Immunol Pract 2018; 7:578-588.e2. [PMID: 30179741 DOI: 10.1016/j.jaip.2018.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The lack of centralized data on severe asthma has resulted in a scarcity of information about the disease and its management. The development of a common data collection tool for the International Severe Asthma Registry (ISAR) will enable standardized data collection, subsequently enabling data interoperability. OBJECTIVES To create a standardized list of variables for the first international registry for severe asthma via expert consensus. METHODS A modified Delphi process was used to reach consensus on a minimum set of variables to capture in ISAR: the core variables. The Delphi panel brought together 27 international experts in the field of severe asthma research. The process consisted of 3 iterative rounds. In each round, all Delphi panel members were issued an electronic ISAR Delphi workbook to complete and return to the ISAR Delphi administrator. Workbooks and result summaries were anonymously distributed by the Delphi administrator to all panel members at subsequent rounds. Finalization of the core variable list was facilitated by 2 face-to-face meetings. RESULTS Of the initial 747 selected variables, the Delphi panel reached a consensus on 95. The chosen variables will allow severe asthma to be assessed against patient demographics and medical history, patient-reported outcomes, diagnostic information, and clinical characteristics. Physician-reported outcomes such as nonadherence and information about treatment and management strategies will also be recorded. CONCLUSIONS This is the first global attempt to generate an ISAR using a common set of core variables to ensure that data collected across all participating countries are standardized.
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Affiliation(s)
| | | | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Andrew Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield National Health Service (NHS) Foundation Trust, London, UK
| | - Peter G Gibson
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Matthew Peters
- University of Sydney Medical School, Sydney, NSW, Australia
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia
| | - Job F M van Boven
- Department of General Practice, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, University of Tampere, Tampere, Finland
| | | | | | - Erin S Harvey
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | | | - Anke H Maitland-van der Zee
- Amsterdam University Medical Center, University of Amsterdam, Department of Respiratory Medicine, Amsterdam, The Netherlands
| | | | | | | | - G Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy; SANI-Severe Asthma Network Italy, Italy
| | - Vibeke Backer
- Bispebjerg Hospital, Copenhagen University, Copenhagen, Denmark
| | | | | | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | | | | | - Thao Le
- Optimum Patient Care, Cambridge, UK
| | | | | | | | - David Price
- Optimum Patient Care, Cambridge, UK; Observational and Pragmatic Research Institute, Singapore; Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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Canonica GW, Ferrando M, Baiardini I, Puggioni F, Racca F, Passalacqua G, Heffler E. Asthma: personalized and precision medicine. Curr Opin Allergy Clin Immunol 2018; 18:51-8. [PMID: 29189350 DOI: 10.1097/ACI.0000000000000416] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In this review, we herein describe the progress in management of severe asthma, evolving from a 'blockbuster approach' to a more personalized approach targeted to the utilization of endotype-driven therapies. RECENT FINDINGS Severe asthma characterization in phenotypes and endotypes, by means of specific biomarkers, have led to the dichotomization of the concepts of 'personalized medicine' and 'precision medicine', which are often used as synonyms, but actually have conceptual differences in meaning. The recent contribute of the omic sciences (i.e. proteomics, transcriptomics, metabolomics, genomics, …) has brought this initially theoretic evolution into a more concrete level. SUMMARY This step-by-step transition would bring to a better approach to severe asthmatic patients as the personalization of their therapeutic strategy would bring to a better patient selection, a more precise endotype-driven treatment, and hopefully to better results in terms of reduction of exacerbation rates, symptoms, pulmonary function and quality of life.
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Galeone C, Scelfo C, Bertolini F, Caminati M, Ruggiero P, Facciolongo N, Menzella F. Precision Medicine in Targeted Therapies for Severe Asthma: Is There Any Place for "Omics" Technology? Biomed Res Int 2018; 2018:4617565. [PMID: 29992143 PMCID: PMC6016214 DOI: 10.1155/2018/4617565] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/23/2018] [Accepted: 05/17/2018] [Indexed: 12/28/2022]
Abstract
According to the current guidelines, severe asthma still represents a controversial topic in terms of definition and management. The introduction of novel biological therapies as a treatment option for severe asthmatic patients paved the way to a personalized approach, which aims at matching the appropriate therapy with the different asthma phenotypes. Traditional asthma phenotypes have been decomposing by an increasing number of asthma subclasses based on functional and physiopathological mechanisms. This is possible thanks to the development and application of different omics technologies. The new asthma classification patterns, particularly concerning severe asthma, include an increasing number of endotypes that have been identified using new omics technologies. The identification of endotypes provides new opportunities for the management of asthma symptoms, but this implies that biological therapies which target inflammatory mediators in the frame of specific patterns of inflammation should be developed. However, the pathway leading to a precision approach in asthma treatment is still at its beginning. The aim of this review is providing a synthetic overview of the current asthma management, with a particular focus on severe asthma, in the light of phenotype and endotype approach, and summarizing the current knowledge about "omics" science and their therapeutic relevance in the field of bronchial asthma.
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Affiliation(s)
- Carla Galeone
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Chiara Scelfo
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Francesca Bertolini
- Department of Bio and Health Informatics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University Hospital, Piazzale L.A. Scuro, 37134 Verona, Italy
| | - Patrizia Ruggiero
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Nicola Facciolongo
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
| | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia-IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy
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Maio S, Baldacci S, Bresciani M, Simoni M, Latorre M, Murgia N, Spinozzi F, Braschi M, Antonicelli L, Brunetto B, Iacovacci P, Roazzi P, Pini C, Pata M, La Grasta L, Paggiaro P, Viegi G. RItA: The Italian severe/uncontrolled asthma registry. Allergy 2018; 73:683-695. [PMID: 29072882 DOI: 10.1111/all.13342] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Italian severe/uncontrolled asthma (SUA) web-based registry encompasses demographic, clinical, functional, and inflammatory data; it aims to raise SUA awareness, identifying specific phenotypes and promoting optimal care. METHODS Four hundred and ninety three adult patients from 27 Italian centers (recruited in 2011-2014) were analyzed. RESULTS Mean age was 53.8 years. SUA patients were more frequently female (60.6%), with allergic asthma (83.1%). About 30% showed late onset of asthma diagnosis/symptoms (>40 years); the mean age for asthma symptoms onset was 30.2 years and for asthma diagnosis 34.4 years. 97.1% used ICS (dose 2000 BDP), 93.6% LABA in association with ICS, 53.3% LTRAs, 64.1% anti-IgE, 10.7% theophylline, and 16.0% oral corticosteroids. Mean FEV1 % pred of 75.1%, median values of 300/mm3 of blood eosinophil count, 323 kU/L of serum total IgE, and 24 ppb of FENO were shown. Most common comorbidities were allergic rhinitis (62.4%), gastroesophageal reflux (42.1%), sinusitis (37.9%), nasal polyposis (30.2%), and allergic conjunctivitis (30.2%). 55.7% of SUA patients had exacerbations in the last 12 months, 9.7% emergency department visits, and 7.3% hospitalizations. Factors associated with exacerbation risk were obesity (OR, 95% CI 2.46, 1.11-5.41), psychic disorders (2.87, 0.89-9.30-borderline), nasal polyps (1.86, 0.88-3.89-borderline), partial/poor asthma treatment adherence (2.54, 0.97-6.67-borderline), and anti-IgE use in a protective way (0.26, 0.12-0.53). Comparisons to severe asthma multicenter studies and available registries showed data consistency across European and American populations. CONCLUSIONS An international effort in the implementation of SUA patients' registries could help to better understand the clinical features and to manage severe asthma, representing a non-negligible socioeconomic burden for health services.
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Affiliation(s)
- S. Maio
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - S. Baldacci
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Bresciani
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Simoni
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Latorre
- Cardio-Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - N. Murgia
- Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - F. Spinozzi
- Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - M. Braschi
- Allergy Unit; Internal Medicine Department; AOU Ospedali Riuniti; Ancona Italy
| | - L. Antonicelli
- Allergy Unit; Internal Medicine Department; AOU Ospedali Riuniti; Ancona Italy
| | - B. Brunetto
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - P. Iacovacci
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - P. Roazzi
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - C. Pini
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - M. Pata
- Roche S.p.A.; Monza Milano Italy
| | | | - P. Paggiaro
- Cardio-Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - G. Viegi
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
- Institute of Biomedicine and Molecular Immunology (IBIM) “A. Monroy”; CNR; Palermo Italy
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