Introduction: The efficacy of the fixed extrafine combination of beclomethasone/formoterol/glycopyrronium (BDP/FF/G 87/5/9 μg) has been evaluated in randomized controlled trials of patients with chronic obstructive pulmonary disease (COPD). However, only few data exist on its effectiveness on small airways dysfunction (SAD). Methods: The MASCOT (MAnaging Small airways dysfunction in COPD patients in real life on the fixed Triple combination of BDP/FF/G 87/5/9 μg pMDI) prospective observational study evaluated the effectiveness of this combination on SAD in a period of 4 weeks, after direct switch from long-acting β₂-agonists (LABA) and long-acting muscarinic antagonists (LAMA) in COPD patients with SAD (forced expiratory flow at 25– 75% of the vital capacity, FEF25-75% < 60% predicted). The primary endpoint was improvement in R5-19 in oscillometry; secondary endpoints included other oscillometry parameters, lung function and health status (COPD assessment test-CAT, Saint-George’s Respiratory Questionnaire-SGRQ). Results: Between May 2022 and July 2023 we recruited 93 COPD patients (mean age 68.5 years, 82% men) with forced expiratory volume in 1 second (FEV₁, mean ± SD) 1.53 ± 0.47L (53.4 ± 14.5% predicted) and small airways dysfunction (FEF25-75% predicted 27.7 ± 15.4%). We observed statistically significant improvement in R5-19 between baseline (V1) and follow-up (V2) visits [median (IQR) V2 0.70 (0.41– 1.10) vs V1 0.90 (0.60– 1.83); mean change (95% CI) − 0.49, − 0.66 to − 0.33 cmH₂O/L/sec, p < 0.0001). There were improvements in multiple parameters, including FEF25-75% (3.43, 1.20% to 5.66%, p = 0.0005), FEV₁ (0.142, 0.078 to 0.205 L, p < 0.0001) and RV/TLC (− 6.09, − 9.61% to − 2,56% predicted, p < 0.0001), as well as improvement in CAT score − 4.09 (− 5.09 to − 3.08) και SGRQ total score (− 8.75, − 11.58 to − 5.93 points, p < 0.0001). Conclusion: Extrafine triple therapy improved SAD and spirometric parameters, leading to improvement in health status at 4 weeks. These results need to be confirmed in longer studies.

Background: Uric acid (UA) is the final product of purine metabolism and a marker of oxidative stress that may be involved in the pathophysiology of cardiovascular and thromboembolic disease. The aim of the current study is to investigate the potential value of UA to creatinine ratio (UA/Cr) as a diagnostic tool for the outcome of patients admitted with acute pulmonary embolism (PE) and the correlations with other parameters. Methods: We evaluated 116 patients who were admitted for PE in a respiratory medicine department. PE was confirmed with computed tomography pulmonary angiography. Outcomes evaluated were hospitalization duration, mortality or thrombolysis and a composite endpoint (defined as mortality or thrombolysis). Patients were assessed for PE severity with the PE Severity Index (PESI) and the European Society of Cardiology (ESC) 2019 risk stratification. Results: The median (interquartile range) UA/Cr level was 7.59 (6.3–9.3). UA/Cr was significantly associated with PESI (p < 0.001), simplified PESI (p = 0.019), and ESC 2019 risk stratification (p < 0.001). The area under the curve (AUC) for prediction of 30-day mortality by UA/Cr was 0.793 (95% CI: 0.667–0.918). UA/Cr levels ≥7.64 showed 87% specificity and 94% negative predictive value for mortality. In multivariable analysis UA/Cr was an independent predictor of mortality (HR (95% CI): 1.620 (1.245–2.108), p < 0.001) and composite outcome (HR (95% CI): 1.521 (1.211–1.908), p < 0.001). Patients with elevated UA/Cr levels (≥7.64) had longer hospitalization (median (IQR) 7 (5–11) vs. 6 (5–8) days, p = 0.006)), higher mortality (27.3% vs. 3.2%, p = 0.001) and worse composite endpoint (32.7% vs. 3.4%, p < 0.001). Conclusion: Serum UA/Cr ratio levels at the time of PE diagnosis are associated with disease severity and risk stratification, and may be a useful biomarker for the identification of patients at risk of adverse outcomes.

Introduction: Self-monitoring has a recognized place in achieving asthma control. Traditionally, patients record symptoms and peak flow measurement in a paper diary, which they use to adjust therapy in accordance with written asthma plans. Telemonitoring augments disease management by...

Aim: Inhaled corticosteroid (ICS)/long-acting β 2-agonist combinations are crucial for the effective treatment of asthma. ICS/formoterol regimens serve both as controller and reliever medications, as recommended by GINA 2019 onwards. In the six-month real-life NOTOS study, we aimed to evaluate the real-life effectiveness of budesonide/formoterol (BUD/FOR) administered with the Elpenhaler^® device as controller and/or reliever medication on asthma control, quality of life, and lung function in patients with asthma. Methods: We performed a multicenter open-label observational prospective study of adult asthma patients receiving BUD/FOR via Elpenhaler. Assessments were performed with Asthma Control Questionnaire (ACQ-6), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), and spirometry. The incidence of exacerbations, frequency of rescue therapy use, and safety data were also recorded. Results: In the 1107 patients recruited, we observed statistical and clinically relevant improvements at 6 months from baseline, in ACQ-6 [mean change (95% CI) − 1.55 (− 1.61, − 1.4) points, p< 0.001], MiniAQLQ [1.76 (1.68, 1.82) points, p< 0.001], and FEV₁ [0.35 (0.31,0.38) L, p< 0.001]. Subgroup analyses, according to the maintenance (A: BUD/FOR 200/6 μg “as needed”, B: BUD/FOR 200/6 maintenance, or C: BUD/FOR 400/12 μg maintenance) and the reliever treatments (none, BUD/FOR or short-acting β 2-agonists), showed significant improvements across all groups, with greater improvements observed in the higher maintenance dose of BUD/FOR group. The frequency of rescue therapy use was overall markedly reduced, and we observed no safety issues. Conclusion: In this real-life study, treatment with BUD/FOR, as controller and/or reliever via the Elpenhaler device, was associated with significant improvement in patients’ asthma control, quality of life, and lung function, over 6 months.

Introduction: Hemoptysis is a common clinical problem in emergency departments with a broad differential diagnosis that includes life-threatening causes, hence the patient should be thoroughly assessed. Aim: The aim of this study was to evaluate the epidemiological profile of patients admitted for hemoptysis in a Respiratory medicine department and assess the role of imaging modalities in the diagnostic approach. Methods: We analyzed the medical records of 161 patients admitted with hemoptysis in the Respiratory medicine department of the University Hospital of Ioannina, between July 2020 - December 2022. Results: The mean age was 68±19.2 years, the majority (79%) were men and 80% had a smoking history. Infections and malignancy were the most frequent causes of hemoptysis (24%), followed by drug-related hemoptysis (21%) and bronchiectasis (13%). Pulmonary embolism and tuberculosis were identified in 6% and 3% of the cases, while definite diagnosis was not established in 11% of the cases. In terms of imaging, abnormal findings were reported in 60% and 86% of Xrays and CT scans, respectively. The main findings were indicative of infection or carcinoma (mass, lymphadenopathy). Massive hemoptysis was present in 5% of the cases and was attributed either to carcinoma or infection with the concurrent use of anticoagulants. Conclusions: Infections and carcinoma were the primary causes of hemoptysis in our analysis, which is in accordance with the literature. Drug-related hemoptysis, seems to be an emerging cause of hemoptysis, which could be attributed to the increasing use of anticoagulants (40% in our dataset). The diagnostic yield of CT scan was verified, while we are assessing the contribution of bronchoscopy.

Introduction: Severe asthma is affecting 3-10% of the adult asthma population worldwide. In the last years biologic agents targeting IL-5/5R have been approved; their efficacy and safety have been evaluated in randomised controlled trials, which however are conducted under ideal conditions with strict inclusion and exclusion criteria. Aim: We performed a systematic literature review in PubMed, in order to assess the effectiveness of anti-IL5/5R agents based on data from real-world observational studies. Methods: We searched PubMed (until December 31st, 2022) for observational studies regarding anti-IL-5/5R biologics. Results: The search resulted in 3542 studies, and after excluding studies in conference proceedings, RCTs, systematic reviews, meta-analyses and duplicates, 107 studies were evaluated, with 8,338 participants (45.4% female), mean age (SD) 48.3 (11.7) years. The distribution of the studies was: mepolizumab (74 studies-69.1%), benralizumab (29 studies-27.2%) and reslizumab (4 studies-3.7%). The following outcomes were available: FEV1 (81 studies-75.7%), exacerbations (76 studies-71%), hospitalisations (58 studies-54.2%), asthma control questionnaire (77 studies-71.9%), asthma quality of life questionnaire (71 studies-66.3%), oral corticosteroids reduction (72 studies-67.2%), FENO (35 studies-32.7%) and adverse events (42 studies-39.2%). Conclusions: In this systematic review of observational studies on the effectiveness of anti-IL5/5R agents in severe asthma we have confirmed their efficacy in the treatment of the disease. More real-world studies are needed, especially for reslizumab, in order to assess and quantify their effectiveness rigorously.