Publications by authors named "Annamaria Bosi"

Article Synopsis
  • Several types of severe asthma are linked to immune pathways, specifically type 2 inflammation, but asthma without this inflammation is harder to treat and responds poorly to standard therapies.
  • Epithelial cells play a crucial role in asthma by releasing alarmin cytokines like IL-25, IL-33, and TSLP when triggered by allergens or infections, which increases inflammation and barrier permeability.
  • The biologic drug tezepelumab (TZP) targets TSLP and has shown promise in clinical trials as a safe and effective treatment for severe asthma, with the review providing insights for clinicians on identifying the best candidates for this therapy.
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Over the last two decades, we have witnessed great advancements in our understanding of the immunological pathways of asthma, leading to the development of targeted therapies, such as biologic drugs, that have radically and definitively changed the clinical outcomes of severe asthma. Despite the numerous therapeutic options available, ~4-10% of all people with asthma have severe or uncontrolled asthma, associated with an increased risk of developing chronic oral corticosteroid use, fixed airflow limitation, exacerbations, hospitalization and, finally, increased healthcare costs. The new concept of disease modification in asthma comes from the evolution of asthma management, which encompasses phenotyping patients with different inflammatory endotypes characterizing the disease, followed by the advent of more effective therapies capable of targeting the proximal factors of airway inflammation.

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Type 2 inflammation is a heterogeneous condition due to the complex activation of different immunological pathways. Rapid progress in research to evaluate the efficacy of biologics for chronic rhinosinusitis with nasal polyps and asthma has led to the availability of effective therapeutic options. These drugs are safe, but temporary iatrogenic hypereosinophilia may sometimes be associated with clinical symptoms or organ damage.

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Patients with acute asthma attack usually access the emergency room with severe functional impairment, despite low perception of symptoms. In this scenario, early functional assessment is essential focusing on vital parameters and respiratory function, alongside perceived dyspnea. Impairment of ventilatory mechanics due to progressive dynamic pulmonary hyperinflation should be promptly treated with medical inhalation and/or intravenous therapy, reserving intensive treatment in case of non-response and/or worsening of the clinical conditions.

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