Introduction: Obstructive sleep apnea (OSA) is a respiratory disorder with comorbidities of several nature, from cardiovascular to renal ones. OSA is typically treated through continuous positive airway pressure (CPAP), but more investigations are needed to confirm its benefits. Methods: In this work, survival analysis has been exploited and enhanced with eXplainable Artifical Intelligence (XAI) to investigate the impact of comorbidities and compare the model reliability. The dataset encompasses both clinical and polysomnography-based data for a total of 45 different features. Results: A total of 1,394 OSA patients followed for 15 years were enrolled. All the selected features have been studied by means of DL-models and time-dependent XAI techniques. The variables impacting on mortality are reported below in descending order with respect their importance: (1) age, years of CPAP, renal dysfunction, COPD, body mass index categories, sex, and anemia for the CoxTime; (2) age, apnea hypopnea index, renal dysfunction, SaO2 min, years of CPAP, COPD, and anemia for the LogHazard. Conclusion: Advancing age, severity of OSA, comorbidity, including chronic kidney disease, COPD, and anemia, are crucial contributors to increased mortality.

Chronic obstructive pulmonary disease (COPD) is associated with persistent dyspnea, reduced functional capacity, and significant cognitive and affective impairments. Pulmonary rehabilitation improves the physical and psychological condition, however residual symptoms often remain, especially in patients with advanced disease. Respiratory biofeedback training (RBT) may help modulate autonomic and emotional responses to dyspnea, offering a potential adjunctive intervention. This pilot study investigated the effects of RBT integrated into a standard program of pulmonary rehabilitation for hospitalized patients with very severe COPD (GOLD stage 4 and an mMRC dyspnea score of ≥ 3 despite maximal pharmacological therapy). Thirty patients were randomized to receive either standard pulmonary rehabilitation alone (control group) or in combination with daily RBT sessions for three weeks (biofeedback group). Pre- and post-treatment assessments included measures of dyspnea, functional performance, quality of life, cognitive function and mood. Data were analyzed using Bayesian repeated-measures ANOVA, and results were normalized using Minimal Clinically Important Differences (MCIDs). Both groups showed significant improvements in respiratory and functional outcomes (e.g., mMRC, 6MWT), with no group differences. However, the biofeedback group demonstrated greater improvements in cognitive performance (MoCA) and depressive symptoms (HADS-D). While RBT did not enhance dyspnea or physical performance in patients receiving inpatient pulmonary rehabilitation, it was associated with significant gains in cognitive and emotional outcomes. These findings suggest that RBT may serve as a valuable neuropsychological adjunct in the management of late-stage COPD.

Dyspnea in chronic obstructive pulmonary disease (COPD) is often treated as the perceptual consequence of altered airflow, lung volume, gas exchange, or work of breathing. Yet breathlessness is not a unitary symptom or a direct readout of pulmonary dysfunction. It comprises at least three partially dissociable sensations-air hunger, breathing effort, and chest tightness-with distinct physiological triggers and affective salience. Current models suggest that conscious breathlessness emerges from the interaction of respiratory motor drive, corollary discharge, sensory afferent feedback, central integration, and higher-order interoceptive inference. In COPD, this framework helps explain why dyspnea may diverge from spirometric impairment and why symptom burden can remain high despite appropriate treatment. This Perspective develops a hypothesis-generating conceptual model for pulmonary rehabilitation, rather than a systematic or scoping review. We argue that respiratory biofeedback may be relevant not only because it can modify breathing pattern, but also because it may help test whether changing perceived control, autonomic regulation, and affective responses to respiratory signals can influence rehabilitation-relevant outcomes. Our recent pilot trial in late-stage COPD is compatible with this interpretation, but it did not directly test cognitive-affective mechanisms of action. From this perspective, neurofeedback should not be considered an established treatment for dyspnea, but a plausible future translational research question for selected highly symptomatic patients. Extension of this framework beyond COPD to other chronic respiratory diseases requires condition-specific validation.

OBJECTIVE:To synthesize available evidence on electroencephalography (EEG) correlates of cognitive impairment in chronic respiratory disorders. METHODS:This systematic review followed PRISMA guidelines and was preregistered on the Open Science Framework. PubMed/MEDLINE, Scopus, and Web of Science were searched through 14 March 2026. Eligible studies included adults with chronic respiratory disorders, EEG-based measures, and cognitive outcomes. Findings were synthesized narratively, and methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT), version 2018. RESULTS:Forty-four studies met the inclusion criteria. Evidence was dominated by obstructive sleep apnea (OSA), with limited data on chronic obstructive pulmonary disease, asthma, and chronic respiratory failure/encephalopathy. Three recurrent patterns emerged: prolonged event-related latencies, especially P300 latency; alterations in sleep EEG microstructure, including spindle and slow-oscillation abnormalities; and resting-state EEG slowing. Across modalities, EEG abnormalities were most consistently associated with impairments in attention, executive functioning, working memory, memory consolidation, and broader cognitive efficiency. CONCLUSIONS:EEG abnormalities are recurrent correlates of cognitive vulnerability in chronic respiratory disorders, particularly in OSA, although the evidence remains heterogeneous. SIGNIFICANCE:EEG may offer clinically relevant markers of neurocognitive vulnerability in respiratory populations, but broader representation of non-OSA disorders and greater methodological standardization are needed.

Dear Editor, Over the past two decades, the role of the cardiorespiratory physiotherapist has become increasingly prominent within clinical care pathways, significantly contributing to the management of both acute and chronic respiratory diseases...

Background and aim:Non-Cystic Fibrosis (CF) bronchiectasis is associated with reduced exercise tolerance and symptoms such as dyspnea and fatigue, impairing functional capacity and limiting physical activity. In addition to airway clearance techniques, pulmonary rehabilitation (PR), including aerobic and resistance training, is recommended in these individuals. This retrospective, multicentric study covering a ten-year period compared in non-CF bronchiectasis people with and without COPD the effectiveness of PR, including exercise training, on exercise tolerance (primary objective) and other patient-centered outcomes. Measurements:Before and after PR, the following assessments had been performed: Six-minute walking test (6MWT), Barthel Index (BI), Barthel Index dyspnea (BId), COPD assessment test (CAT), Short physical performance battery (SPPB). Results:125 participants without and 1,346 with concomitant COPD were studied. Non-COPD bronchiectasis was more prevalent in females, showed a higher association with asthma, whereas Chronic Respiratory Failure (CRF) and pneumonia were more prevalent in COPD-related bronchiectasis, resulting in more prevalent referral from acute care hospitals or need for oxygen therapy. All baseline outcome measures, except CAT, were worse in people with concomitant COPD. After PR, 6MWT improved significantly in both groups [by 39 (11-70) and 40 (10-75) meters for non-COPD and COPD-related bronchiectasis, respectively, p = 0.7469], without any between-group difference. The other outcome measures also improved significantly in both groups. The proportions of participants reaching the minimal clinically important difference in assessed outcomes were not significantly different between the studied populations. Conclusion:Pulmonary rehabilitation, including exercise training, yields l equivalent benefits in exercise capacity and patient-reported outcomes in non-CF bronchiectasis people with or without COPD. Our results suggest the routine clinical provision of PR to people with non-CF bronchiectasis, regardless of concomitant COPD.

The human immune system is closely linked to microbiota such as a complex symbiotic relationship during the coevolution of vertebrates and microorganisms. The transfer of microorganisms from the mother’s microbiota to the newborn begins before birth during gestation and is considered the initial phase of the intestinal microbiota (IM). The gut is an important site where microorganisms can establish colonies. The IM contains polymicrobial communities, which show complex interactions with diet and host immunity. The tendency towards dysbiosis of the intestinal microbiota is influenced by local but also extra-intestinal factors such as inflammatory processes, infections, or a septic state that can aggravate it. Pathogens could trigger an immune response, such as proinflammatory responses. In addition, changes in the host immune system also influence the intestinal community and structure with additional translocation of pathogenic and non-pathogenic bacteria. Finally, local intestinal inflammation has been found to be an important factor in the growth of pathogenic microorganisms, particularly in its role in sepsis. The aim of this article is to be able to detect the current knowledge of the mechanisms that can lead to dysbiosis of the intestinal microbiota and that can cause bacterial translocation with a risk of infection or septic state and vice versa.

Abstract Background Despite the availability of numerous guidelines for asthma management, their recommendations are not consistently implemented in clinical practice. This discrepancy between guidelines and real‐world practice among Italian healthcare professionals was explored during the “Revolution in Asthma” training program, which identified “gray areas” and barriers preventing clinicians from adopting guideline‐based approaches. Objective This study aims to analyze the key challenges in asthma management and provide evidence‐based solutions to improve adherence to guidelines in clinical practice. Methods A group of experts from the Scientific Committee of the Revolution in Asthma project reviewed the program's findings, focusing on three main areas of asthma management: diagnosis, control, and treatment. The experts summarized clinicians' main needs and questions for each area and provided evidence‐based responses and practical recommendations. Results The study highlights critical challenges in asthma treatment, addressing two key questions: (a) What are the possible uses and indications for short‐acting β‐agonists in asthma patients? (b) How should asthma treatment be initiated and adjusted based on asthma control? The expert panel developed practical, operational tools to support general practitioners and specialists (pulmonologists and allergists) in optimizing asthma management. Conclusion This paper serves as a knowledge co‐creation initiative, bridging the gap between clinical guidelines and daily practice. By offering concrete recommendations, it aims to enhance the application of guideline‐based asthma management among healthcare professionals.

In recent years, it was recognized that type-2 inflammation connects nasal polyposis and severe asthma (SA) in addition to other type-2 diseases. Thus, some biological drugs developed for SA appeared to exert a favourable effect also in nasal polyposis. So far, there are several trials supporting this concept; therefore, some monoclonal antibodies already used for SA were assessed also in chronic rhinosinusistis with nasal polyposis (CRSwNP), with promising results.Since different specialists are involved in the management of nasal polyposis (eg, pulmonologists, ENT specialists, allergists, immunologists, pediatricians), it was felt that an updated educational and informative document was needed to better identify the indications of biological therapies in nasal polyposis. We collected the main Italian scientific societies, and prepared (under the umbrella of Allergic Rhinitis and its Impact on Asthma, ARIA) a document endorsed by all societies, to provide a provisional statement for the future use of monoclonal antibodies (MAbs) as a medical treatment for polyposis, possibly associated with SA. The above mentioned document was the first endorsed document on this aspect, and the additional evidence required an update. The current pathogenic knowledge and the experimental evidence are herein reviewed, and some suggestions for a correct prescription and follow-up are provided.

Chronic obstructive pulmonary disease (COPD) represents an important health challenge, despite being preventable and manageable thanks to up-to-date recommendations. In Italy, the pharmaceutical care of COPD patients is still ill-timed and inaccurate. This study aimed to describe the treatment of COPD patients in Italy and possible switches following an exacerbation. This observational retrospective analysis of Italian administrative healthcare data from the Fondazione Ricerca e Salute (ReS) database identified patients aged ≥ 45 years with COPD in 2019 and 2020. At least 6 years of look-back period and absence of concomitant asthma were required. COPD patients were categorized by treatment (SI–single/MI–multiple inhalers, TT–triple therapy, DT–dual therapy, other respiratory treatments, untreated) at index date (first dispensation during accrual period). Occurrence of moderate/severe exacerbation during one-year preceding index date and treatments during one-year preceding the exacerbation (possible switch) were evaluated. From 4.7 million beneficiaries of the Italian National Health Service in 2019 and 2020, respectively, 105,828 and 103,729 (43 and 41 × 1,000 inhabitants aged ≥ 45 years) were identified as having COPD. Of 2019/2020 patients: 3.4

Metabolic syndrome (MetS) is a combination of metabolic disorders that concurrently act as factors promoting systemic pathologies such as atherosclerosis or diabetes mellitus. It is now believed to encompass six main interacting conditions: visceral fat, imbalance of lipids (dyslipidemia), hypertension, insulin resistance (with or without impairing both glucose tolerance and fasting blood sugar), and inflammation. In the last 10 years, there has been a progressive interest through scientific research investigations conducted in the field of metabolomics, confirming a trend to evaluate the role of the metabolome, particularly the intestinal one. The intestinal microbiota (IM) is crucial due to the diversity of microorganisms and their abundance. Consequently, IM dysbiosis and its derivate toxic metabolites have been correlated with MetS. By intervening in these two factors (dysbiosis and consequently the metabolome), we can potentially prevent or slow down the clinical effects of the MetS process. This, in turn, may mitigate dysregulations of intestinal microbiota axes, such as the lung axis, thereby potentially alleviating the negative impact on respiratory pathology, such as the chronic obstructive pulmonary disease. However, the biomolecular mechanisms through which the IM influences the host’s metabolism via a dysbiosis metabolome in both normal and pathological conditions are still unclear. In this study, we seek to provide a description of the knowledge to date of the IM and its metabolome and the factors that influence it. Furthermore, we analyze the interactions between the functions of the IM and the pathophysiology of major metabolic diseases via local and systemic metabolome’s relate endotoxemia.

Background: Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses.CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma.CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13.Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease.Methods: As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immunoallergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results: Two hundred and fifty-five experts and specialists participated in the survey. Conclusions:The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn.The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated.Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.

Introduction Patients with chronic obstructive pulmonary disease (COPD) frequently have cardiovascular comorbidities, increasing the risk of hospitalised COPD exacerbations (H-ECOPDs) or death. This pragmatic study examined the effects of adding an inhaled corticosteroid (ICS) to long-acting bronchodilator(s) (LABDs) in patients with COPD and cardiac comorbidities who had a recent H-ECOPD. Methods Patients >60 years of age with COPD and ≥1 cardiac comorbidity, within 6 months after discharge following an H-ECOPD, were randomised to receive LABD(s) with or without ICS, and were followed for 1 year. The primary outcome was the time to first rehospitalisation and/or all-cause death. Results The planned number of patients was not recruited (803/1032), limiting the strength of the conclusions. In the intention-to-treat population, 89/403 patients (22.1 %) were rehospitalised or died in the LABD group (probability 0.257 [95 % confidence interval 0.206, 0.318]), vs 85/400 (21.3 %) in the LABD+ICS group (0.249 [0.198, 0.310]), with no difference between groups in time-to-event (hazard ratio 1.116 [0.827, 1.504]; p = 0.473). All-cause and cardiovascular mortality were lower in patients receiving LABD(s)+ICS, with relative reductions of 19.7 % and 27.4 %, respectively (9.8 % vs 12.2 % and 4.5 % vs 6.2 %), although the groups were not formally statistically compared for these endpoints. Fewer patients had adverse events in the LABD+ICS group (43.0 % vs 50.4 %; p = 0.013), with 4.9 % vs 5.4 % reporting pneumonia adverse events. Conclusions Results suggest addition of ICS to LABDs did not reduce the time-to-combined rehospitalisation/death, although it decreased all-cause and cardiovascular mortality. ICS use was not associated with an increased risk of adverse events, particularly pneumonia.

Summary:Background. Asthma affects millions of people worldwide, with a subgroup suffering from severe asthma (SA). Biologics have revolutionized SA treatment, but challenges remain in managing different patient traits. This study analyzed data from the Italian Registry on Severe Asthma (IRSA) to investigate changes in SA characteristics and effectiveness of treatments after one year of follow-up, and to identify factors associated with response to treatments in a real-world setting. Methods. Data on SA patients with one year of follow-up were extracted from IRSA. Asthma control, exacerbations, lung function, and treatments, were assessed at follow-up and analyzed against baseline characteristics. Results. After one year of follow-up, notable improvements were observed in all the outcomes of SA of the included patients (n = 570). The effectiveness of biologic therapies was particularly evident, as they contributed significantly to these positive outcomes. Additionally, certain factors were found to be associated with improvement, namely T2 phenotype, baseline eosinophil count (BEC), and area of residence. On the other hand, comorbidities (obesity, gastro-esophageal reflux disease) and poor lung function were risk factors. Notably, poor-responders to biologics exhibited lower level of education, BEC, and exacerbations, and higher frequency of atopy and ACT score ≥ 20. Conclusions. The findings demonstrate the effectiveness of biologics in asthma management, when implemented as part of a planned follow-up strategy aimed at optimizing and fine-tuning the therapy. Moreover, the study highlights the importance of considering key traits such as the T2 phenotype, BEC, education, and comorbidities when tailoring SA treatment. Overall, this study contributes to enhancing our understanding of SA management and guiding the development of personalized treatment approaches for patients with SA.

Background: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two chronic diseases that afflict many individuals worldwide with negative effects on health that may overlap in Overlap Syndrome (OS). The aim of our study was to investigate the differences in mortality between OSAS alone and OS and the risk factors involved.Methods: The study was conducted on patients with OSAS or OS diagnosis that completed 15-year follow-up between 2005 and 2023. Of these, the clinical, functional, sleep and survival data were registered and ana-lysed. Risk factors were found by regression analysis.Results: 501 patients (428 OSAS and 73 OS) were enrolled. Patients with OS had higher mortality than OSAS (p < 0,001). The morality risk factors for the overall population found were age >65 years (odds ratio (OR) symbolscript 10.69 (95%CI 3,85-29,69), p < 0,001) and low forced-expiratory volume in 1-s (FEV1) (OR symbolscript 10.18 (95%CI 2,32-44,68), p symbolscript 0,002). In patients with OSAS, age and nocturnal hypoxemia (NH) (OR symbolscript 2.41 (95%CI 1,07-5,41), p symbolscript 0,03) were risk factors, while adherence to nighttime positive airway pressure (PAP) reduced mortality (OR symbolscript 0,36 (95%CI 0,15-0,83), p symbolscript 0,017). Multivariate analysis confirmed age and FEV1 as risk factors in OS. Conversely, the risk factors for the overall population under 65 years were NH, which is confirmed in patients with OSAS alone (OR symbolscript 4,72 (95%CI 1,07-20,77), p symbolscript 0,04) in whom, on the other hand, PAP compliance reduced the mortality risk. Conclusions: The study suggests that NH is a risk factor for all-cause mortality in sleep disorders by excluding the age; conversely, nighttime PAP improves the survival.

To provide the overall rate for all types of neurologic iatrogenic injuries during urogynaecologic surgery from textual data.

(1) Background: We investigated the differences in the neuropsychological profile as well as the pneumological and motor functions in two groups of patients admitted to rehabilitation who received different respiratory support during their COVID-19 infection. (2) Methods: Group-1 (n = 18; 15 male, median age 67.5) consisted of patients who received non-invasive mechanical ventilation; Group-2 (n = 19; 16 male, median age 63) consisted of patients who received invasive mechanical ventilation. All patients underwent a neuropsychological assessment including Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (R-BANS) to evaluate the patients' cognition. Depression and anxiety were also measured at admission and discharge to rehabilitation. (3) Results: At admission, patients impaired at MMSE were 44% in Group-1 and 5% in Group-2, while patients impaired at FAB were 88% in Group-1 and 26% in Group-2. Wilcoxon's effect size revealed meaningful differences between groups for FAB, R-BANS global score, immediate and delayed memory, and attention-coding task, with Group-2 performing better than Group-1 across all measures. At discharge, 52% of the 25 patients re-assessed still had mild to moderate cognitive deficits, while 19% had depression and 35% had anxiety. (4) Conclusions: Patients who received oxygen therapy experienced higher levels of acute and chronic stress compared to those who benefitted from invasive mechanical ventilation. Despite patients showing a meaningful improvement at discharge, cognitive impairment persisted in a great number of patients; therefore, long-term neuropsychological follow-up and treatment for COVID-19 patients are recommended.