Aim: Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by eosinophilic inflammation. Patients with EGPA are treated with systemic glucocorticoids and immunosuppressive drugs to induce and maintain remission. However, most patients relapse after tapering glucocorticoids, and there are refractory cases with inadequate response to glucocorticoids. Mepolizumab, a humanized anti-IL-5 antibody, is approved for relapsing or refractory EGPA. Furthermore, recent studies have reported the efficacy of benralizumab, a humanized anti-IL-5 receptor α antibody, in EGPA. Here, we investigate the efficacy of biologics on consecutive cases of EGPA. Methods: We retrospectively collected patients with EGPA treated with mepolizumab in addition to glucocorticoids at the Department of Pulmonary Medicine in Kagoshima University Hospital and Imakiire General Hospital. In this study, we compared the effects of biologics on inflammatory parameters between pre- and post-treatment of biologics in patients with EGPA. Results: Ten patients were included in the study. All patients were treated with mepolizumab, and one was switched to benralizumab later. Treatment with biologics markedly reduced EGPA relapse from 70% (pre-treatment) to 20% (post-treatment), Birmingham Vasculitis Activity Score from 8.4 to 4.0, peripheral blood eosinophil counts from 470.3 /µL to 40.5 /µL, and glucocorticoid doses from 7.3 mg/dL to 1.6 mg/dL. In contrast, lung function and fractional exhaled nitric oxide levels were not affected by treatment with biologics. Furthermore, the duration of biologics was positively correlated with symptom improvement. Conclusions: Treatment with mepolizumab for EGPA was effective in glucocorticoid sparing, symptom reduction, and relapse prevention. Mepolizumab is expected to reduce the risk of glucocorticoid-related adverse events. Therefore, continued administration as well as early intervention with mepolizumab for EGPA might be important to conserve future medical resources and control the disease.

Chronic rhinosinusitis (CRS) is an inflammatory disorder of the paranasal sinuses and the nasal cavity lasting longer than 12 weeks. This disease is a common clinical syndrome with significant monetary burden due to the high costs of medical visits, diagnostic tests, medications, and surgical therapies. CRS without nasal polyposis (CRSsNP) is the most common subtype of CRS, accounting for about 70% of all patients. Other subtypes include CRS with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS). CRSwNP has the worldwide prevalence of 2% to 4% and is often accompanied by type 2 inflammation and asthma as a comorbid condition. Pediatric chronic sinusitis is distinct from adult chronic sinusitis and is currently considered an infectious process, characterized by persistent inflammation representing an exaggerated immune response to an external stimulus. The medical and surgical management of CRS has been remarkably modified in the past two decades. The aim of this study was to present an update on CRS based on the recent years’ literature.

Asthma is a complex inflammatory airway disease affecting a significant global population, spanning from childhood through adulthood. Despite advances in treatment modalities, a significant subset of patients, approximately 10%, grapple with severe asthma, characterized by increased healthcare utilization and diminished quality of life. Tezepelumab, a monoclonal antibody targeting thymic stromal lymphopoietin (TSLP), offers promising therapeutic potential. TSLP is a protein released by a variety of cells, with a predominance of epithelial cells, in reaction to plenty of stimuli, such examples as viruses, aeroallergens, and others. Its action is upstream and pertains to initiating numerous subsequent innate and adaptive immune reactions, contributing to the continuation of asthma pathophysiological processes. Tezepelumab’s unique efficacy spans diverse severe asthma phenotypes, significantly reducing exacerbation rates across eosinophilic and non-eosinophilic subtypes. Its favorable safety profile and clinically meaningful improvements in asthma control, accompanied by reductions in cytokine levels and baseline biomarkers, underscore its broad impact on asthma inflammation. Its efficacy, irrespective of type 2 (T2) endotype, reinforces the idea that TSLP blockade broadly inhibits pathways crucial to asthma pathophysiology, rather than narrowly focusing on individual downstream factors, as previous biological treatments have. This review discusses the rationale for TSLP blockade and the efficacy of tezepelumab in severe asthma using data from key trials.

Bronchiectasis is a heterogeneous chronic lung disease, characterised by irreversible dilatation of the airways and attributed to a wide spectrum of other underlying conditions, usually underdiagnosed and inadequately treated with a high burden for both the patients and the healthcare system. The way bronchiectasis is viewed by physicians has drastically changed over the last decades, with the topic of eosinophilia in the context of the disease being one of the substantially highlighted. Eosinophilia was traditionally considered as a means for distinguishing bronchiectasis from asthma, whereas bronchiectasis was primarily associated with neutrophilic inflammation. However, eosinophilic bronchiectasis is nowadays identified as a distinct disease endotype and is associated with a specific clinical course and response to treatment. Further research is needed to better characterise this endotype and improve its personalised investigation and management in daily clinical practice.

Aim: Epidemiological surveys show substantial modification over time of pollens sensitization profiles, with relevant difference across geo-climatic zone. Climate changes can affect the onset, duration and production of the pollen season. Aim of the present study has been to assess the evolution over 33 years of the patients’ sensitization profile, together with pollen count and climate in a resident population of the Po Valley. Methods: Retrospective study of primary sensitizations to 6 major pollens (grass, pellitory, birch, olive, ragweed mugwort) from 1986 to 2019 on patients aged 12 years or older with respiratory allergic diseases living in Mantua suburbs. Pollen counts and season durations were recorded by the monitoring station of Parma. Meteorologic data have been downloaded from the historical archive of Mantua monitoring station. Results: A population of 3,489 patients who tested positive to pollens have been considered (34% to one pollen only; 66% poly-sensitized, 68% out of them to two or more pollens). Average annual temperature has risen of 1.4°C. An overall trend for extension of seasons duration and increase of pollen load has been observed. Sensitization rate to grass remained stable over time when pellitory showed a sudden decline. Sensitization rates to birch, olive and ragweed displayed a sharp increase. Conclusions: The present study proves that significant change on phenological phases of main allergenic plants, pollen load and sensitization profile of patients have occurred over the last decades. Global warming seems to be one of the main causes for these changes. More epidemiological studies differentiated by regional geo-climatic zone and a multidisciplinary approach to research on topic are needed.

This review delves into the complex role of 12/15-lipoxygenase (12/15-LOX) in asthma pathogenesis, focusing on its contributions to mitochondrial dysfunction, oxidative stress, epithelial injury, and airway remodeling. We provide new insights into potential therapeutic strategies aimed at improving asthma management. Additionally, we examine the pro-inflammatory functions of interleukin-4 (IL-4) and its regulatory mechanisms that upregulate 12/15-LOX, leading to increased oxidative stress and airway remodeling. Key interventions such as vitamin E, esculetin, and baicalein are highlighted for their potential to inhibit 12/15-LOX activity, reduce oxidative stress, and restore mitochondrial function. Vitamin E suppresses IL-4 transcription, reducing 12/15-LOX expression and its inflammatory metabolites, while esculetin and baicalein directly inhibit 12/15-LOX, mitigating inflammation and oxidative damage. These antioxidants also promote mitochondrial biogenesis, protect mitochondrial DNA, and enhance respiratory efficiency, contributing to improved cellular metabolism and reduced apoptosis. This comprehensive approach emphasizes the therapeutic potential of targeting 12/15-LOX pathways to alleviate asthma symptoms and improve patient outcomes, paving the way for novel treatment strategies that significantly enhance asthma therapy.

Aim: To determine temporal changes in the frequency of asthma and mental illness in California emergency department (ED) visits and examine predictors of both asthma diagnosis and non-routine discharge from asthma visits. Methods: Public-use, all-payer ED data from non-federal, acute-care hospitals (2005–2014) were obtained for cross-sectional analysis. Due to substantial missing data, we used fully conditional specification multiple imputation with discriminant functions for age group, sex, race, and ethnicity. Multivariable logistic regression was used to examine asthma diagnosis (yes/no) among all ED visits and non-routine discharge (sent home vs. all else) among visits with asthma diagnosis. Primary independent variables were mental illness and the 3-digit zipcode of the patient’s residence. Covariates included demographics, payer type, and hospital characteristics. Results: During 2005–2014 there were 96,180,176 visits at 349 hospitals, and asthma diagnosis increased from 3.3% of ED visits in 2005 to 5.9% in 2014. However, asthma as a primary diagnosis decreased from 1.7% to 1.4% of ED visits. Among visits with asthma diagnosis ( n=4,419,629), co-occurring mood disorders increased from 2.1% in 2005 to 9.2% in 2014. Predictors of asthma diagnosis included attention deficit/conduct disorders [adjusted odds ratio (AOR) 1.41, 95% confidence interval (1.40–1.42)] and mood disorders [AOR 1.37, (1.36–1.37)]. Compared to Los Angeles, cities/areas most associated with asthma diagnosis were Richmond [zipcode 948, AOR 1.22 (1.20–1.24)], Bakersfield [933, AOR 1.21 (1.19–1.24)], and San Bernardino [924, AOR 1.20 (1.19–1.22)]. Ninety-six percent of ED visits with asthma resulted in routine discharge. Predictors of non-routine discharge included suicide/self-harm [AOR 4.74 (4.67–4.81)], schizophrenia [1.97 (1.94–1.99)], and mood disorders [1.35 (1.34–1.36)]. Areas associated with non-routine discharge included the Bakersfield vicinity [932, 1.29 (1.17–1.41)] and Ventura [930, 1.23 (1.10–1.38)]. Conclusions: Increased co-occurring mental illness among asthma-related ED visits suggests a need to improve care among those having co-occurrence. Understanding regional differences in asthma-related ED visits and hospitalization may improve interventions.