The information campaign “And if it were severe asthma” aims to improve knowledge of the pathology also in relation to the presence of chronic rhinosinusitis with nasal polyposis. A therapy is possible
Daniela is a 52-year-old teacher, married, with two children. She teaches Italian in middle school, she loves the mountains. Suddenly one day, during a lesson, she feels a sharp pain in her chest: she is short of breath, her voice. In one word that feeling is pure anguish. In the emergency room the diagnosis speaks of a bronchial asthma attack. Not a disease of children, as many think, but a pathology that can also arise as adults. After starting the inhalation therapy, things seem to get better, but it is only a temporary illusion because in truth, Daniela suffers from grave asthmabut the path that led her to a diagnosis and effective therapy that now allows her to keep the disease under control has been long and tortuous, with many ups and downs, between the desire to hide alternating with the desire to fight.
Daniela’s story is told in a podcast that can be listened to for free on all major platforms and is part of the information campaign “And if it were severe asthma?” promoted by GSK Italia with the patronage of the National Patient Association Breathe Together. The goal, thanks to a dedicated Facebook page and the “And if it were severe asthma” website, full of schematic and clear information, is to spread greater awareness of severe asthma and the Chronic rhinosinusitis with nasal polyposisdisease often associated but difficult to diagnose.
Severe asthma associated with chronic rhinosinusitis with nasal polyposis
I’m in Italy 300,000 patients suffering from severe asthma and 4 out of 10 of these also suffer from chronic rhinosinusitis with nasal polyposis. Often, however, the presence of one is not connected to the other or even one arises before the other, not allowing the patient to correlate the two pathologies. It can therefore be a long time before arriving at a diagnosis and treating the symptoms properly with a major impact on quality of life. «The attacks began to occur more frequently, in an absolutely sudden way – recalls Daniela – and what made me suffer was their unpredictability. I coughed, I had shortness of breath, but the biggest difficulty was living with the idea that it could happen to me at any moment. So I chose to hide.”
Symptoms: difficulty expelling air
Asthma is a disease characterized by respiratory symptoms that vary over time and in intensity (wheezing, shortness of breath, chest tightness and cough), along with a airflow limitation during exhalation. It is still Daniela who remembers that terrible sensation: «It was as if my lungs were full of air and they struggled to expel it all». In asthma, especially if severe, a reduction in air during expiration is characteristic. This means that the air is expelled more slowly during exhalation. This happens because in asthma there is an obstruction of the airways due to inflammation of the bronchi. The walls of the bronchi are thickened, with excess mucus and contraction of the bronchial muscles. This also explains the typical wheezing
When asthma becomes severe (and uncontrolled)
Asthma becomes severe when it is not controlled despite adherence to maximum dose inhaler therapy. Uncontrolled asthma is defined as: the patient has at least two asthma attacks a year that require the use of oral corticosteroid medications or if the patient has at least one severe asthma attack a year that requires hospitalization . But not only that: it is possible that asthma is not controlled if symptoms such as wheezing, wheezing, coughing and chest tightness occur more than twice a week, if they limit daily activities, if they cause night awakenings or require the use of bronchodilators more than twice a week.
The inflammatory mechanisms
Asthma, especially severe asthma, is frequently accompanied by comorbidities that can increase respiratory symptoms and reduce disease control. One of these is chronic rhinosinusitis with nasal polyposis, in the presence of which the asthma can also be more severe and more difficult to control with symptoms such as reduced sense of smell and nasal congestion. Patients with both conditions suffer from asthma that is more difficult to control and with a greater risk of having asthma attacks.
The inflammatory mechanisms underlying severe asthma and chronic rhinosinusitis with nasal polyposis may be similar. Asthma is a chronic inflammation of the lower airways (bronchi), chronic rhinosinusitis with nasal polyposis is a chronic inflammation of the upper airways (nasal cavities). When coexisting, severe asthma and chronic rhinosinusitis with nasal polyposis may share the same type of inflammation, called type 2 inflammation. White blood cells called “eosinophils”. A correlation has been shown between blood eosinophil levels and asthma outcomes, such as severe attacks and the level of asthma control. Patients suffering from severe asthma and chronic rhinosinusitis with nasal polyposis have elevated levels of eosinophils both in the blood and in the nasal mucosa and this may be associated with decreased sense of smell.
The diagnosis
The diagnosis of severe asthma is possible when asthma remains uncontrolled despite maximal dose inhalation therapy or when it requires such therapy to be controlled. There spirometry it is the first step in diagnosing asthma, with control for other modifiable factors. If, despite inhalation therapy, asthma is still uncontrolled, then it may be necessary to check for the presence of other pathologies such as chronic rhinosinusitis with nasal polyposis, by examining the nasal cavities. Conversely, in the case of chronic rhinosinusitis with nasal polyposis, it is possible to verify the presence of pathologies affecting the lower airways such as severe asthma. “Living with severe asthma and chronic rhinosinusitis with nasal polyposis is definitely challenging. – he observes Simon Barbaglia, president of the National Association of Patients Breathe Together APS – Although it is not yet talked about as often as we would like, in Italy, it is estimated there are about 120,000 patients with severe asthma who also suffer from chronic rhinosinusitis with nasal polyposis. These data indicate that there is a strong need for awareness not only because this condition compromises the quality of life of those who suffer from it, but also because of the highly negative impact from a psychological point of view. For this reason, as an association we sponsor the campaign “And if it were severe asthma?” which aims to inform patients and encourage them to take a active role in one’s own therapeutic path without adapting to a non-optimal quality of life and without giving up adequate care”.
The path of care
Reaching a diagnosis of severe asthma with chronic rhinosinusitis with nasal polyposis is almost never an easy path but theThe disease can be kept under control if you rely on a specialized center with a multidisciplinary teamThis is why it is important to see your GP when your asthma symptoms are not controlled. «The treatment path of a patient with severe asthma and chronic rhinosinusitis with nasal polyposis can be very long and complex with delays regarding both diagnosis and access to therapies. – specifies the professor Gianna Camiciottoli, Associate Professor, “Mario Serio” Department of Experimental and Clinical Biomedical Sciences, University of Florence and Head of the Severe Asthma Unit AOU Careggi, Florence. – For this reason it is essential to make patients aware of the importance of a personalized diagnostic-therapeutic path based on multidisciplinarity and precision medicine, which allows the team of specialists to promptly provide a correct diagnosis and to choose the most effective therapy. In this regard, we have recently made available new targeted therapeutic strategies that have improved the management of both severe asthma and nasal polyposis, when the two diseases share the same mechanism of inflammation. These patients with severe asthma and nasal polyposis must be identified and started on a correct path of diagnosis and treatment”
December 20, 2022 (change December 20, 2022 | 15:05)
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