Matteo Bonini

Bio: Matteo Bonini is an academic researcher from Catholic University of the Sacred Heart. The author has contributed to research in topics: Asthma & Medicine. The author has an hindex of 32, co-authored 118 publications receiving 3392 citations. Previous affiliations of Matteo Bonini include Brigham and Women's Hospital & National Research Council.

Fit Yourself and Take Your Lungs to Heart

Abstract: nificantly reduces odds of hospital admissions and deaths following acute exacerbations, as well as consistently improves the quality of life and exercise tolerance of COPD patients [6] . However, no prospective studies on the role of physical rehabilitation in influencing the number and severity of future exacerbations have been performed yet. The paper by Ramponi et al. [7] , published in this issue of Respiration , aims to assess whether a 9-week pulmonary rehabilitation program may affect cardiovascular response to exercise in COPD patients. In an observational prospective trial, according to the ATS/ERS recommendations, 27 patients with COPD were referred to a rehabilitation program consisting of 3-hour sessions, three times a week, with a minimum of 21 sessions required. Data obtained show a significant improvement in maximal exercise tolerance, such as peak oxygen uptake, and in some cardiovascular parameters following rehabilitation. Leg fatigue was also significantly reduced, supporting the reported positive effect of physical exercise on muscle function. The novel aspect of the study is to compare cardiopulmonary exercise variables at ‘submaximal’ exercise levels, isometabolic and isoventilatory levels (‘isolevels’) before and after rehabilitation. Of note, the O 2 pulse (peak oxygen uptake/heart rate) and tidal volume were significantly higher after rehabilitation. Furthermore, tidal volume changes correlated significantly with changes in O 2 pulse. The authors concluded that the most likely explanation for their observations was an improvement in cardiovascular function due to a reduction It has been estimated that physical inactivity is worldwide responsible for 6–10% of the major non-communicable diseases. Furthermore, sedentary lifestyle causes 9% of premature mortality [1] . Moreover, recent studies have consistently shown that messages emphasizing the benefits of being active are more effective at changing physical activity behaviour than those stressing the consequences of inactivity [2] . Chronic obstructive pulmonary disease (COPD) is a complex disease mainly characterized by structural abnormalities of the airways and lungs, but it is very often associated with concomitant comorbidities. The presence of comorbidities strongly influences not only the severity of symptoms, but also the risk of hospitalization and death [3] . The relationship between COPD and cardiovascular disease is particularly notable and of clinical relevance, as cardiovascular disease represents the most common comorbidity and the leading cause of hospitalization in patients with mild-to-moderate COPD [4] . Exercise-based pulmonary rehabilitation is a well-established intervention for patients with COPD. Physical training, by improving skeletal muscle function, positively influences exercise tolerance and symptoms; this is mainly due to a reduction in lung dynamic hyperinflation but also to a desensitization to central dyspnea [5] . There is now emerging evidence to support the efficacy of exercise-based pulmonary rehabilitation also in the management of COPD exacerbations. An up-to-date Cochrane meta-analysis shows that pulmonary rehabilitation sigPublished online: May 30, 2013

Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis

Abstract: Background To inform the development of the European Academy of Allergy and Clinical Immunonology's (EAACI) Guidelines on Allergen Immunotherapy (AIT) for allergic asthma, we assessed the evidence on the effectiveness, cost-effectiveness and safety of AIT Methods We performed a systematic review, which involved searching nine databases Studies were screened against pre-defined eligibility criteria and critically appraised using established instruments Data were synthesized using random-effects meta-analyses Results 98 studies satisfied the inclusion criteria Short-term symptom scores were reduced with a standardized mean difference (SMD) of -111 (95%CI -166, -056) This was robust to a pre-specified sensitivity analyses, but there was evidence suggestive of publication bias Short-term medication scores were reduced SMD -121 (95%CI -187, -054), again with evidence of potential publication bias There was no reduction in short-term combined medication and symptom scores SMD 017 (95%CI -023, 058), but one study showed a beneficial long-term effect For secondary outcomes subcutaneous immunotherapy (SCIT) improved quality of life and decreased allergen specific airways hyperreactivity (AHR) but this was not the case for sub-lingual immunotherapy (SLIT) There were no consistent effects on asthma control, exacerbations, lung function, and non-specific AHR AIT resulted in a modest increased risk of adverse events (AEs) Although relatively uncommon, systemic AEs were more frequent with SCIT; however no fatalities were reported The limited evidence on cost-effectiveness was mainly available for sublingual immunotherapy (SLIT) and this suggested that SLIT is likely to be cost-effective Conclusions AIT can achieve substantial reductions in short-term symptom and medication scores in allergic asthma It was however associated with a modest increased risk of systemic and local AEs More data are needed in relation to secondary outcomes, longer-term effectiveness and cost-effectiveness This article is protected by copyright All rights reserved

Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)-a EAACI position paper.

Abstract: NSAID-exacerbated respiratory disease (N-ERD) is a chronic eosinophilic, inflammatory disorder of the respiratory tract occurring in patients with asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP), symptoms of which are exacerbated by NSAIDs, including aspirin. Despite some progress in understanding of the pathophysiology of the syndrome, which affects 1/10 of patients with asthma and rhinosinusitis, it remains a diagnostic and therapeutic challenge. In order to provide evidence-based recommendations for the diagnosis and management of N-ERD, a panel of international experts was called by the EAACI Asthma Section. The document summarizes current knowledge on the pathophysiology and clinical presentation of N-ERD pointing at significant heterogeneity of this syndrome. Critically evaluating the usefulness of diagnostic tools available, the paper offers practical algorithm for the diagnosis of N-ERD. Recommendations for the most effective management of a patient with N-ERD stressing the potential high morbidity and severity of the underlying asthma and rhinosinusitis are discussed and proposed. Newly described sub-phenotypes and emerging sub-endotypes of N-ERD are potentially relevant for new and more specific (eg, biological) treatment modalities. Finally, the document defines major gaps in our knowledge on N-ERD and unmet needs, which should be addressed in the future.

The efficacy of sublingual immunotherapy for house dust mites respiratory allergy: results of a GA2LEN meta-analysis.

Abstract: Recent meta-analyses documented the efficacy and safety of sublingual immunotherapy (SLIT) in patients with allergic rhinitis (AR) and asthma (AA). Although SLIT appeared globally effective, the sub-analyses for single allergens provided uncertain results. This study is aimed to investigate the efficacy of SLIT with house dust mite (HDM) extracts in AR and AA through an updated reassessment of randomized controlled trials. Electronic databases were searched up to March 31, 2008, for randomized DBPC trials, assessing the efficacy of SLIT in AR and AA due to HDM sensitization. Outcomes were symptom scores and rescue medications use. For AR, eight studies fulfilled the selection criteria. A significant reduction in symptoms of AR (SMD −0.95; CI 95%−1.77 to −0.14 P = 0.02) was found in 194 patients (adults and children) receiving SLIT compared to 188 receiving placebo. For AA, with nine studies, similar results were found for symptoms (SMD −0.95; CI 95%−1.74 to −0.15 P = 0.02) in 243 patients (adults and children) receiving SLIT compared to 209 receiving placebo. A reduction in rescue medication use was found for AR (SMD −1.88; CI 95%−3.65 to −0.12 P = 0.04) in 89 patients, and AA (SMD −1.48; CI 95%−2.70 to −0.26 P = 0.02) in 202 patients. A relevant inter-study heterogeneity was detected. Promising evidence of efficacy for SLIT, using mite extract in allergic patients suffering from AR and AA, are herein shown. These findings suggest that more data are needed, derived from large-population-based high quality studies, and corroborated by objective outcomes, mainly for AA.

EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma.

Abstract: Allergen immunotherapy (AIT) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence-based recommendations for the use of house dust mites (HDM) AIT as add-on treatment for HDM-driven allergic asthma. This guideline was developed by a multi-disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT-tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add-on to regular asthma therapy for adults with controlled or partially controlled HDM-driven allergic asthma (conditional recommendation, moderate-quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM-driven allergic asthma as the add-on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low-quality evidence).

Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Abstract: Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations. In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease. This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work. The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available. Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed. The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

Abstract: The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

British guideline on the management of asthma: A national clinical guideline

Abstract: These guidelines have been replaced by British Guideline on the Management of Asthma. A national clinical guideline. Superseded By 2012 Revision Of 2008 Guideline: British Guideline on the Management of Asthma. Thorax 2008 May; 63(Suppl 4): 1–121.

Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision

Abstract: Background: Allergic rhinitis represents a global health problem affecting 10% to 20% of the population. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines have been widely used to treat the approximately 500 million affected patients globally. Objective: To develop explicit, unambiguous, and transparent clinical recommendations systematically for treatment of allergic rhinitis on the basis of current best evidence. Methods: The authors updated ARIA clinical recommendations in collaboration with Global Allergy and Asthma European Network following the approach suggested by the Grading of Recommendations Assessment, Development and Evaluation working group. Results: This article presents recommendations about the prevention of allergic diseases, the use of oral and topical medications, allergen specific immunotherapy, and complementary treatments in patients with allergic rhinitis as well as patients with both allergic rhinitis and asthma. The guideline panel developed evidence profiles for each recommendation and considered health benefits and harms, burden, patient preferences, and resource use, when appropriate, to formulate recommendations for patients, clinicians, and other health care professionals. Conclusion: These are the most recent and currently the most systematically and transparently developed recommendations about the treatment of allergic rhinitis in adults and children. Patients, clinicians, and policy makers are encouraged to use these recommendations in their daily practice and to support their decisions.

TFOS DEWS II Diagnostic Methodology report

Abstract: The role of the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II Diagnostic Methodology Subcommittee was 1) to identify tests used to diagnose and monitor dry eye disease (DED), 2) to identify those most appropriate to fulfil the definition of DED and its sub-classifications, 3) to propose the most appropriate order and technique to conduct these tests in a clinical setting, and 4) to provide a differential diagnosis for DED and distinguish conditions where DED is a comorbidity. Prior to diagnosis, it is important to exclude conditions that can mimic DED with the aid of triaging questions. Symptom screening with the DEQ-5 or OSDI confirms that a patient might have DED and triggers the conduct of diagnostic tests of (ideally non-invasive) breakup time, osmolarity and ocular surface staining with fluorescein and lissamine green (observing the cornea, conjunctiva and eyelid margin). Meibomian gland dysfunction, lipid thickness/dynamics and tear volume assessment and their severity allow sub-classification of DED (as predominantly evaporative or aqueous deficient) which informs the management of DED. Videos of these diagnostic and sub-classification techniques are available on the TFOS website. It is envisaged that the identification of the key tests to diagnose and monitor DED and its sub-classifications will inform future epidemiological studies and management clinical trials, improving comparability, and enabling identification of the sub-classification of DED in which different management strategies are most efficacious.