Faced with a significant incidence in the population of respiratory diseases, such as asthma and COPD, there are now new tools to reduce their impact and improve the management of the pathology. It was discussed yesterday 8 November in Genoa, at the Auditorium of the Carlo Felice Theatre, during the public meeting “Breathless: how asthma and COPD are recognized and treated”, dedicated to the population and which brought together Professor Fulvio Braido , director of the Respiratory Diseases and Allergology Clinic of the Irccs Policlinico San Martino in Genoa, Simona Barbaglia, president of the “Breathe Together” association and various figures from healthcare institutions.
The event shed light on the tools in use today and on the methods of access to local services, such as the outpatient services available at San Martino in Genoa but also to anticipate the two days dedicated to “Highlights in respiratory diseases allergies”, in course today and tomorrow, in which national and international experts will share the latest tools on the treatment of asthma, COPD and other bronchial obstructive diseases.
10% of the Italian population, equal to approximately 150 thousand people in Liguria, are affected by asthma and COPD, with very variable severity. Two pathologies that constitute the cornerstone of obstructive diseases and which share a series of symptoms, such as cough and difficulty breathing but which have different dynamics and require specific treatments. Currently, in fact, 90% of asthmatics are able to control their symptoms with inhaled drugs, but for 10% the response comes thanks to new biological drugs that allow them to control the type 2 inflammatory state, which involves some cells and mediators. An important result since this form of inflammation can correspond, in addition to asthma, to related manifestations such as nasal polyposis, affecting 50% of severe asthmatic patients, atopic dermatitis, allergic rhinitis and eosinophilic esophagitis. Problems which therefore also involve clinicians from other specialties, with whom it is essential to build coordination.
“The discussion between specialists is necessary to find the exact strategy – states Fulvio Braido, director of the Respiratory Diseases and Allergology Clinic of the Irccs Policlinico San Martino in Genoa -. Today we can lead to clinical remission of asthma, thus having control of the disease without flare-ups and an optimal quality of life. Interdisciplinary collaboration for clinical management, but also for research, is fundamental.”
Regarding the age of asthmatic patients, allergic asthma prevails during youth, while in adults the cases mainly concern eosinophilic asthma. 10% are affected by a severe form of the disease. “For the forms in which the eosinophil cell, present in the blood, releases substances that induce bronchial muscle contraction, mucus, inflammation and edema of the mucosa, we are able to act on the mediators that lead to the survival of the eosinophils or even block the receptors of these molecules – continues Braido -. In cases where it is not sufficient and we are faced with exacerbations, “we must take these drugs into consideration, because over time we lead the patient to no longer have to use cortisone, to have stable lung function and an optimal quality of life. In several cases, there is even remission of the disease because the mechanisms underlying the asthma are turned off.” Until 5-6 years ago, only one biological drug was available. “Today we have five, they are indicated for multiple pathologies and could be effective for the treatment of other problems – continues Braido -. They certainly allow a personalized approach to the extent of the symptom.”
There are also encouraging responses on the COPD front. “The form we know best is that induced by cigarette smoking, mainly in patients over the age of 45 who then, as they age, develop a chronic progressive pathology associated with other cardiovascular phenomena, or that which develops in more fragile patients with metabolic syndrome or diabetes”. Chronic obstructive pulmonary disease is the third cause of death for non-communicable diseases, i.e. not transferable from one individual to another and which depend on lifestyle. Not only smoking but also prolonged exposure to a polluted environment can be a predisposing factor. “We are moving towards a personalization of therapy: we have biological drugs in experimentation and we adopt a specific approach for each individual patient – continues the director of the Respiratory Diseases and Allergology Clinic of San Martino in Genoa -. We not only have protocols based on inhaled drugs but also replacement therapies up to endoscopic surgical interventions on the lung, for some specific cases, home ventilation and transplant”.
Finally, we need to better inform citizens about the methods of taking charge and encourage integration between local medicine and hospital. “The specialist center must be available to general medicine for diagnostics, especially at second level. With such a large patient population, the hospital-territory interaction must lead to treatment of mild and moderate cases by the family doctor, with recourse to a specialist if necessary”, adds Braido. The goal is not to see asthmatic patients admitted to hospital, in order to free up resources for more complicated cases. “The present allows us to improve many parameters with non-invasive tools, whereas in the long term – concludes Braido – we look at lung regeneration and reducing the speed of lung aging”.