The Finnish Asthma Program, which ran between 1994 and 2004, has long been heralded as a benchmark of success in how to improve management and reduce asthma-related health service utilization. In Australia, there were 38,792 asthma hospitalizations in 2017–18, and 80% of these were considered avoidable (J Asthma Allergy. 2021;14:797–808. doi: 10.2147/JAA.S311721). To address this issue, Asthma Australia has set a strategic objective of halving avoidable asthma presentations to hospital by 2030. This article provides an overview of the Finnish Asthma Program, including an evaluation of critical success factors, outputs, and outcomes, followed by a synthesis of these findings for relevance and applicability to the contemporary Australian context that will inform policy and practice recommendations. Early diagnosis, effective anti-inflammatory medication, guided self-management, and monitoring disease control are still the keys to mitigating asthma burden. In the spirit of the Finnish Program, the digital transformation of healthcare and social media is enabling a new kind of systematic approach, both for patients and professionals.

Indoor air pollution (IAP) is an important cause of concern for human health, leading to millions of deaths worldwide each year. Since people spend most of their time indoor the quality of the air inhaled during routine activities is of primary importance. IAP include particulate matter (PM), volatile organic compounds (VOCs), chemical gases, heavy metals, and biological contaminants. Unfortunately, their sources are various and widespread all over the household and other indoor environments, causing relevant health consequences. This narrative review aims to provide a comprehensive framework of the indoor pollutants effects on subjects affected by asthma, allergic rhinitis, and atopic dermatitis. As pivotal barriers against pollutants, in fact, respiratory and cutaneous districts can be particularly affected by IAP, especially in case of atopic diseases. On the other hand, the application of targeted adjustments, such as the avoidance of cigarette smoking, the use of hoods while cooking, the choice of adequate ventilation systems, and the use of low-emitting building materials and furniture may result in the improvement of indoor quality.

Aim: This study aims at assessing dupilumab’s response in severe chronic rhinosinusitis with nasal polyps (CRSwNP) and its impact on concurrent mild to moderate asthma. Methods: The study involved severe, uncontrolled CRSwNP patients starting dupilumab treatment (300 mg/2 weeks) at the Allergy unit in University General Hospital “Attikon” in Athens, Greece, from May 2020 to July 2022. Assessments were conducted at baseline (week 0) and weeks 2, 4, 16, 24, and 52, covering 22-item Sino-Nasal Outcome Test (SNOT22), blood eosinophil counts, fractional exhaled nitric oxide (FeNO) concentration, Lund-Mackay CT scores (weeks 0, 16, and 52), Asthma Control Test (ACT) scores (weeks 0, 16, and 52), and forced expiratory volume in one second (FEV₁) measurements (weeks 0, 16, and 52). Systemic corticosteroid usage, nasal surgeries, and anosmia improvements were also monitored throughout the study. Results: Six patients (50% male, mean age 53.1 years) with severe CRSwNP had severe uncontrolled baseline symptoms: complete anosmia, impaired quality of life (mean SNOT22: 71.6 ± 16.2), and Lund-Mackay CT score of 19.3 ± 2. Within the past year, 83.3% received over three courses of systemic corticosteroids for CRSwNP, and 50% had more than three polypectomies. After two weeks of dupilumab treatment, notable improvements were seen: reduced SNOT22 scores (week 2: 32.5, week 4: 18.1, week 16: 14, week 24: 13.8, week 52: 9.3), improved olfaction (weeks 4–16), reduced polyp size based on Lund-Mackay CT score (week 16: 13.3, week 52: 12.8), and enhanced lung function (FEV₁ baseline: 3.15 L, week 16: 3.22 L, week 52: 3.22 L). Control was achieved by week 16 (ACT: 25/25). FeNO levels decreased [week 2: (18.2 ± 8.7) ppb, week 4: (16.5 ± 7.4) ppb, week 16: (16.9 ± 7.8) ppb, week 24: (13.7 ± 8.3) ppb, week 52: (13.4 ± 5.6) ppb]. No patients required nasal surgery. Conclusions: Dupilumab effectively targets interleukin 4 (IL4) and IL13, controlling type 2 inflammation spectrum, thus providing significant disease control for CRSwNP patients. Moreover, it improves asthma, even in mild to moderate cases, showcasing its broader therapeutic benefits.

Aim: Chronic migraine (CM) is a condition characterized by attacks of severe headaches leading to an increase in time off work, decrease in work productivity and in physical functioning. The aim of this study was to investigate the role of sinus anatomic variants (SAV) on the evolution of migraine from episodic to chronic form. Methods: Two hundred and seven migraineurs [110 with episodic migraine (EM) and 97 with CM] with no evidence of nasal septal deviation with a contact point on the lateral nasal wall were evaluated for endoscopic, radiologic and anatomic variant (AV) abnormalities using Lund-Kennedy endoscopy (LKES) and Lund-Mackay radiology scores (LMRS). Headache day frequency, duration, severity and lost time at work were compared with regard to the presence of any AV and concha bullosa (CB) as well. Results: There was a very significant difference between EM and CM patients with regard to overall SAV and endoscopy scores. However, no significant difference was seen between the groups with regard to radiology scores and headache pain severity. The presence of one AV increased headache day frequency, severity and days off work in all patients. CB was found to worsen headache severity and lost time at work in all patients. Conclusions: Patients with CM have more SAV and worse endoscopy scores than patients with EM. The presence of any of the AVs increases headache day frequency, pain severity and days off work in migraineurs.

Eosinophilic gastrointestinal diseases (EGIDs) are a group of chronic conditions, characterized by an excessive accumulation of eosinophils in various areas of the mucosal of the gastrointestinal (GI) tract. EGIDs encompass a spectrum of diseases, including eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC), each affecting different segments of the GI tract. The pathogenesis of EGIDs is multifaceted and involves an intricate interplay between genetic predisposition, environmental triggers, and dysregulated immune responses. Although the exact etiology behind EGIDs is not fully understood, it is clear that they are immune-mediated, with eosinophils having a central role in inflammation and tissue damage of GI mucosal. Clinical manifestations depend on the organ that is affected by the disease and on the depth of the eosinophil infiltration of the bowel wall. They range from mild discomfort to severe dysphagia, abdominal pain, malnutrition, and growth failure, particularly in pediatric cases. Regarding EGID management, it is a challenging issue to achieve clinical and histologic remission using pharmacotherapy and dietary elimination. Corticosteroids and proton pump inhibitors can be selected as an effective first-line treatment for certain patients and six-food elimination diet (6-FED) has been proven effective in inducing remission. Furthermore, biologic therapies have emerged as essential tools in controlling eosinophilic-driven inflammation. This review focuses on the complex pathogenesis and treatment of these inflammatory diseases, especially EoE.

There are no plausible arguments to consider that the best evidence-based asthma treatment should be different in low- and middle-income countries (LMICs). A few decades ago, the recognition of asthma as an inflammatory disease of the airways positioned the inhaled corticosteroids (ICS) as the cornerstone of the treatment of this disease, maintaining bronchodilators, especially the short-acting beta-agonists (SABA), as symptom-reliever medications for use as needed. However, adherence to regular use of ICS is very low, especially in LMICs, favoring the overuse of SABA, which has been related to an excess of exacerbations and mortality. Recently, the Global Initiative for Asthma (GINA) strategy has recommended the mandatory use of ICS every time a bronchodilator is used as needed (for symptoms relief), whether only as needed or with a background of regular dose of ICS, and has named it: anti-inflammatory reliever (AIR) therapy. This form of therapy, which has been related to a significant reduction of asthma exacerbations, is very attractive for LMICs where patients do not have guaranteed a proper medical follow-up and the access to on-the-counter medications is high. However, the implementation of AIR therapy in LMICs will face many of the already recognized barriers for the diagnosis and treatment of asthma in these countries, especially related to limited access to care in very different health systems, low education level of patients and communities, insufficient health personnel training in asthma in primary care, the unfordable cost of medications, and the lack of political commitment. This review analyzes some of these challenges and strategies for facing them in LMICs.

Recent data has resulted in an interest in the metabolic shift in cellular metabolism to aerobic glycolysis, increased reactive oxygen species (ROS), and mitochondrial dysfunction associated with asthma. There has been a push to better understand the immune and metabolic changes in allergy to improve understanding of disease pathology and treatment. Aerobic glycolysis seen in epithelial cells in asthma promotes chronic inflammation and the production of inflammatory cytokines. Asthma epithelial cells share a number of features proposed in the stages of cancer initiation including aerobic glycolysis and increased apoptosis with proliferation, all within a chronic inflammatory microenvironment. Metabolic reprogramming in malignant cells has been widely investigated since the glycolytic characteristics were first described last century. It is still debated whether these metabolic changes are the cause or consequence of carcinogenesis and oncogenic cell-selective pressures. Although historic results have been conflicting, recent data has found an increased lung cancer risk in asthma patients, independent of risk factors. A review of emerging research on the metabolic changes seen in asthma helps us to propose a pathway between the initiation of aerobic glycolysis and the selective pressures of the epithelial microenvironment and resulting malignant transformation risk.

Over the last two decades, the emergence of lethal virulent strains of coronavirus (CoV), including the severe acute respiratory syndrome CoV 2 (SARS-CoV-2), which is responsible for the coronavirus disease 2019 (COVID-19) pandemic, has become a matter of great attention to the scientific community. Despite the implementation of preventive measures throughout the world, the spread of this disease and associated co-morbidities and mortality continue in all countries, continents, and populations of all ages. COVID-19 is highly contagious. Clinical manifestations are diverse and range from asymptomatic, mild to severe, life-threatening complications in the elderly and patients with underlying conditions such as cardiovascular disease, diabetes, obesity, and asthma. In addition, viral infections can trigger asthma attacks. To date, there is no specific treatment schema to combat COVID-19 disease. Current patient care revolves around disease severity and supportive treatment of symptoms from home-rest in mild disease to anti-viral therapy, oxygen support, anti-inflammatories, and anti-coagulants in severe COVID-19. Regarding prevention, the World Health Organization recommends vaccination, social distancing, quarantine, the wearing of surgical masks, and handwashing. In many countries, vaccination is optional, and given that parents are often reluctant to vaccinate themselves and their children for fear of side effects, identifying ways to enhance or support the immune system to prevent infection or improve recovery in vulnerable populations is worth investigating. Furthermore, research has focused on the pharmacological management of COVID-19 symptoms and much less has been published on nutrition therapy. Therefore, the scope of this review is to summarize the latest evidence on the use of vitamin D to support the metabolism and the immune system of asthma patients during the COVID-19 pandemic. A brief overview of asthma and COVID-19 pathophysiology, COVID-19 treatment guidelines for asthma patients, and the role of vitamin D in lung health, including the optimal blood level required to enhance immunity, will be suggested.