As a novel respiratory viral infection, coronavirus disease 2019 (COVID-19) has influenced asthma in unpredictable ways. In the post-COVID era, there is a need to review asthma care and the new challenges and opportunities that are presented. Long COVID is a new and complex syndrome that has arisen. Treatable traits (TTs) have already been developed to address complex asthma and can be adapted to manage long COVID. Consumers are seeking more information on and answers to what to expect with a dual diagnosis of asthma and COVID-19. People with asthma identify a strong need for research into COVID and asthma. Completion of a national survey (n=593) resulted in a list of research themes. From these, participants prioritized 10 asthma research themes. Among the top 10 asthma research priorities, the theme of COVID and asthma was ranked as the second priority in the overall rank list. Addressing these issues has the potential to improve global asthma health.

Chronic rhinosinusitis (CRS) is a prevalent and burdensome condition worldwide, characterized by inflammation of the paranasal sinuses. Ideally, instead of treating CRS, we would identify ways to prevent the development of this chronic condition. Occupational exposures may be an excellent target for prevention. Occupational exposures have been shown to play a critical role in the pathogenesis of multiple lower airway diseases, such as asthma, silicosis, asbestosis, and hypersensitivity pneumonitis. However, evidence for the association between occupational exposures and the development of upper airway disease, like CRS, is less well-defined. This manuscript examines the association between occupational exposures and CRS. A scoping review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 19 relevant studies. The populations examined and the methods and criteria used for defining CRS diagnosis and occupational variables significantly varied between the studies. Diagnosis of CRS was most often determined by self-reported symptoms or medical record review. Occupational variables ranged from employment status to occupation type to specific exogenous compounds encountered. Overall, substantial evidence demonstrates a general association between occupational exposures and CRS diagnosis; however, limitations in study methodologies, including variations in CRS diagnostic criteria, occupational exposures, assessment methods, and populations, hinder drawing more specific conclusions. Moving forward, rigorous research methodologies and standardized criteria are essential to draw conclusions supported by multiple studies. Critical components of future studies should include large, diverse populations, use of consensus CRS diagnostic criteria, and inclusion of many specific and quantitatively defined exposures. Ultimately, such efforts can help inform preventative measures and interventions for CRS, thus mitigating the burden of CRS on individuals and populations worldwide.

Aim: Evaluation of real-world data regarding the use of omalizumab on lung function, asthma control, exacerbations, and oral corticosteroid (OCS). Methods: The single-centre, retrospective study included data from adult patients with severe allergic asthma treated with omalizumab for at least five years to ten years to evaluate its long-term efficacy. The primary outcome parameters were lung function (FEV₁), the asthma control test (ACT) score, the number of exacerbations, and OCS use. Results: Data from 74 adults (mean age 51 years, 61% females, median IgE 276 kU/L), with severe allergic asthma, due to perennial allergens, who were treated for at least 5 years with omalizumab in one centre could be evaluated up to 10 years. The mean improvement in FEV₁ from baseline was 13.4% in the first year and constantly remained high throughout the duration of the treatment. The ACT improved from baseline (12.4 points) to 16.4 in the first year and reached 18.8 after 5 years, followed by values nearly reaching 20 (19.2 in year 8). The rate of exacerbations decreased from 3.3 events in the last 12 months before omalizumab initiation to 0.4 in the first year and remained low (e.g., 0.2 after 5 years). The mean OCS use was 20.9 mg/day in 44/74 patients before the first injection of omalizumab and decreased to 5 mg/day in the same patients within the first year. Following 6 years of omalizumab treatment, OCSs were used by 22 patients, and by 12 patients after 8 years. Conclusions: The consistent improvement in lung function, asthma control, reduction in exacerbations, and OCS use throughout a minimum of five up to ten years confirms that omalizumab remains effective for many years. There were no signs of tolerance or tachyphylaxis against the biologic.

In recent decades, atopic diseases, such as atopic dermatitis (AD), allergic asthma (AA), allergic rhinitis (AR), and food allergy (FA) have been estimated rapidly increasing in prevalence. These diseases are characterized by the presence of specific immunoglobulin E (sIgE) and often relate to each other and develop in sequence (the so-called “atopic march”). AD may be the first early manifestation in infants followed by FA often within the first year of life. Moreover, AD is a risk factor for developing sensitization to airborne allergens later in life that can cause clinical manifestations of AA and AR. According to the dual-allergen exposure hypothesis, allergic sensitization to food allergens is promoted through cutaneous exposure, rather than the oral route. Moreover, there is evidence that exposure to food allergens, in particular peanuts, in the airway would also lead to food sensitization. The most frequent route of sensitization for inhalant allergens is still debated. Of note, a recent case report supports the development of sensitization to cat dander through a cat bite. Our review aims to provide an overview of current knowledge and unmet needs in the pathophysiology of respiratory and FAs.

Aim: This study investigated changes in pediatric respiratory health resulting from the easing of COVID-19-related social restrictions, following a noted decrease in respiratory infections during the lockdown. The COVID-19 restrictions have inadvertently influenced the epidemiology of other viruses and contributed to changes in patterns of recurrent respiratory infections (RRIs) in children. Methods: This cross-sectional study analyzed the records of children who underwent at “Respiratory Diseases of Pediatric Interest Unit” at the University Hospital “Luigi Vanvitelli” in Naples, Italy, between October 2022 and June 2023. The study aimed to assess associations with RRIs, the occurrence of febrile episodes, and antibiotic usage. Results: Out of 262 patients (38.2% females, median age 6 years), 81.7% experienced at least one respiratory infection over six months, and 23.7% suffered from RRIs [RRIs in the last six months (RRIS)]. Notably, being underweight was significantly associated with RRIs in the last six months (P-value 0.043), resulting in a 47% increased incidence of respiratory infections (P-value 0.012). No significant associations were observed with sex or age. With increasing age, there was a decreasing incidence rate of 3% for the number of RRIs (P-value 0.019), 4% for febrile episodes (P-value 0.031), and 7% for the number of antibiotic courses (P-value < 0.001). Conclusions: The study emphasizes age and weight’s role in children’s post-COVID-19 RRI prevalence. It signifies the need for proactive preparedness, targeting younger underweight populations and tailored interventions for recurrent cases.

Multiple chemical sensitivity (MCS) is an unexplained acquired medical condition that includes multiple, vague, recurrent, and non-specific symptoms in different organs. They are attributed to exposures to various and structurally unrelated environmental chemicals at concentration levels that are well tolerated by the majority of people and normally considered not to have toxic effects in humans. The aim of this review is to examine the multiple explanatory hypotheses for the pathophysiology of MCS: genetic, metabolic, neurological, immunological, and psychological. Several publications suggest a neurological and immunological activation. However, this neurological and immunological hyperresponse is not always observed when performing challenge tests. This suggests that behavioral conditioning could be an important mechanism in the pathogenesis of MCS. Even if psychiatric conditions appear not to be a major cause of MCS, in the case of genuine psychiatric disease, psychotherapeutic therapy is mandatory. Because of the complexity of the pathophysiology, there is no specific drug to treat MCS. However, the use of cognitive behavioral therapy is encouraged, as it has a significant positive impact on patients’ perception of their illness.

Aim: The impact of complete bilateral nasal obstruction [nasal polyp score (NPS)=8/8] on treatment outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) is unclear. This post hoc analysis assessed disease burden and dupilumab efficacy in patients with severe CRSwNP and baseline NPS=8 in SINUS-24/-52 (NCT02912468/NCT02898454). Methods: Efficacy outcomes assessed: NPS, peak nasal inspiratory flow (PNIF), Lund-Mackay computed tomography (LMK-CT), nasal congestion/obstruction (NC), loss of smell (LoS), rhinosinusitis visual analog scale (rhino-VAS), University of Pennsylvania Smell Identification Test (UPSIT), 22-item Sinonasal Outcome Test (SNOT-22) in patients receiving dupilumab 300 mg or placebo every 2 weeks. Responder analyses evaluated clinically meaningful improvements [≥ 1 (NPS, NC, LoS); ≥ 5 (LMK-CT); ≥ 8 (UPSIT); ≥ 8.9 (SNOT-22); ≥ 20 L/min (PNIF)]. Results: Ninety-eight patients were included [59% prior NP surgery, 84% systemic corticosteroids (SCS) use in the previous 2 years, 60% coexisting asthma, 91% anosmic, 97% impaired nasal airflow]. Least squares (LS) mean differences [dupilumab vs. placebo (95% CI)] in change from baseline at week (W) 24: NPS, −2.04 (−2.67, −1.40); PNIF, 65.9 (39.4, 92.4) L/min; LMK-CT, −4.97 (−6.50, −3.44); NC, −1.30 (−1.72, −0.89); LoS, −0.96 (−1.39, −0.54); Rhino-VAS, −3.37 (−4.67, −2.07); UPSIT, 8.55 (4.91, 12.20); SNOT-22, −25.3 (−34.1, −16.4) (all P < 0.0001). For all outcomes, significantly greater proportions of dupilumab vs. placebo patients achieved clinically meaningful improvements at W24. Fewer dupilumab vs. placebo patients required SCS and/or surgery through W24 (11.8% vs. 36.7%; P=0.0005). Efficacy outcomes were similar at W52 (SINUS-52; n=39) with P values vs. placebo of < 0.0001 for NPS and NC; 0.0002 for LMK-CT; 0.0031 for LoS; 0.0014 for rhino-VAS; 0.0013 for UPSIT; 0.0012 for SNOT-22. Conclusions: In patients with CRSwNP with complete bilateral nasal obstruction, dupilumab treatment resulted in clinically significant improvements in NPS, LMK-CT, PNIF, symptoms, and health-related quality of life.