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Chronic respiratory diseases: knowing them is the key to treating them better

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In the months from October to March, airway diseases are the order of the day for just about everyone, regardless of age, lifestyle habits and general health condition. Blame the massive spread of viruses and bacteria that predominantly affect the respiratory system, but also the cold, temperature changes and air pollution, which exert an irritating effect on the mucous membranes of the nose, throat and bronchi and reduce their immune defenses.

But for those suffering from a chronic respiratory disease such as chronic obstructive pulmonary disease (COPD) or asthma, the fall-winter period carries particularly significant risks because any inflammatory stress, induced by pathogens or chemical/physical stimuli, can trigger flare-ups of the underlying disease. Relapses that are sometimes so severe that they require hospitalization and result in persistent worsening of respiratory function, even after their resolution.

Protecting yourself from the flu by taking the seasonal flu vaccine early, as recommended by the Ministry of Health and all scientific societies concerned with respiratory diseases, is essential for those with COPD or asthma, but it is only one of the necessary precautions. Equally important is to avoid prolonged exposure to cold air, smog, and smoking (active or passive, conventional or from electronic cigarettes).

Above all, it is crucial to regularly take the therapies prescribed by the doctor-something that patients with COPD or asthma, in many cases, underestimate or forget. A problem long known to pulmonologists and other referring specialists (internists, allergists, respiratory physiology specialists), but one that seems to have no solution.

To emphasize the importance of treatment adherence and remind patients of the characteristics of asthma and COPD and the key actions to be implemented for their optimal management, at the 20th National Congress of Italian Pneumology AIPO “Globalization and the new frontiers. The comparison and proposals of Italian Pneumology” (Florence, Nov. 13-16) the“ABCDEF of Good Breathing” Awareness Campaign was launched. “The idea is to make patients understand what their rights are, but also their duties,” explained Michele Vitacca, director of the Department of Rehabilitation Pneumology ICS “S. Maugeri” of Pavia and Head of the UO Pneumology Rehabilitation Unit Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane (Brescia), who presented the initiative.

“Through simple, direct and effective communication, we want to raise awareness of the symptoms of the disease and the right to access the best treatment and care services and pharmacological opportunities available in treatment, regardless of the region in which one lives and the organizational arrangements,” Vitacca stressed. “Citizens have the right to prevention, diagnosis, access to the best drugs and rehabilitation, and to be followed over time, taking into account their frailties. The goal is to arrive at a patient who is increasingly the protagonist of his or her own care journey, in a process that values informed choices, care priorities, and the context of family life.”

The awareness campaign will involve about twenty Clinical Centers and will be spread throughout the country, including through the collaboration of Trenitalia Frecciarossa trains, in order to reach as many people as possible. Because everyone-it should be pointed out-can develop a chronic respiratory disease later in life, and implementing effective prevention from a young age, facilitating early diagnosis and undertaking appropriate therapies as soon as possible, and following them regularly, is the only way to protect the most fundamental of the body’s functions: breathing.

Regarding COPD, it should be remembered that it is an evolving and progressively disabling chronic respiratory disease that is increasingly prevalent in people everywhere, mainly due to smoking and air pollution. The World Health Organization (WHO) estimates that in 2020 COPD will be the third leading cause of death, after cardiovascular disease and cancer, and the fifth leading cause of disability globally. The prevalence of COPD increases with advancing age, to affect more than one in ten people over75 (10.8%), compared with 3.1% of the population of all ages. But among smokers the disease is much more prevalent (15-50% estimated).

Doctors believe that COPD is largely under-diagnosed, especially among young people, who tend to underestimate respiratory symptoms and fail to report them to the doctor, especially if they are smokers. Specifically, an estimated 10 percent of young people aged 20 to 44 years have signs of the disease, such as cough and sputum without or with bronchial obstruction (3.6 percent). Data from WHO and theNational Observatory on Medicines Use (National Report 2015) indicate that underestimation of COPD persists even after diagnosis and results in poor adherence to therapy in as many as one in four patients (26 percent), reducing the chances of keeping it under control and slowing its progression.

Relative to asthma, there are more than 30 million people in Europe who suffer from asthma, and the number is growing steadily in view of both increased life expectancy and the increasing prevalence of respiratory allergies, which are the predominant cause. In Italy, the incidence of asthma is 4.5 percent of the population, corresponding to about 2.6 million people affected by the disease, in the different shades of severity.

Asthma, like COPD, is also often under-diagnosed and under-treated, especially in the early stages and mild-to-moderate forms (which, if poorly managed, will worsen over time). Severe asthma affects about one in ten asthma patients, but it constitutes a major medical concern, both because of the difficulty of identifying and maintaining effective treatment that can minimize the risk of severe flare-ups and related complications and because of the significant negative impact on the everyday life and quality of life of sufferers.

Source: Italian Association of Hospital Pneumologists (AIPO)(http://www.pneumologia2019.it/)

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