Search Results (303)

Background/Objective: Single-inhaler triple therapy (SITT) with budesonide/formoterol/glycopyrronium (B/F/G) is an option for COPD patients with frequent exacerbations. We evaluated its long-term efficacy in real life on emergency room visits/hospitalizations (primary endpoints), lung function, oral corticosteroid (OC), antibiotics and salbutamol (SABA) prescriptions (secondary endpoints). Methods: The aim of this single-center, retrospective observational study was to evaluate, in 65 COPD patients with recurrent exacerbations, the effects of B/F/G treatment after 18–24 months compared to therapies with LABA/LAMA, ICS/LABA, ICS/LABA + LAMA or other SITT taken in the previous 18–24 months. Results: After 22.8 ± 4.6 months, 20.12 ± 4.24 B/F/G packages were prescribed, while packs of other therapies given in the 23.35 ± 4.7 months (p = 0.587) before using B/F/G were 15.58 ± 9.8 (p = 0.0009). Emergency room visits (0.34 ± 0.56) and hospitalizations (0.52 ± 0.81) during about 2 years of B/F/G therapy were lower compared to the ones during pre-B/F/G treatments (0.65 ± 1.2, p = 0.015 and 0.83 ± 1.25, p = 0.019, respectively). After B/F/G treatment, the mean FEV₁% value (48.5 ± 16.7%) was higher compared to that measured after the therapies taken before switching to B/F/G (45 ± 15.3%; p = 0.013). Conversely, there were no differences in FVC% values. OCs (2.96 ± 2.6) and SABA (1.41 ± 2.06) packages prescribed during B/F/G were lower than those observed during pre-B/F/G treatments (3.86 ± 2.35, p = 0.026 and 2.48 ± 4.57, p = 0.046, respectively). No differences in antibiotic prescriptions were observed during both therapies. Conclusions: Our real-life evaluation highlighted that B/F/G treatment may be effective, even in the long term, in reducing exacerbations, OC and SABA consumption and in improving lung function in COPD patients with high persistence/adherence to B/F/G compared to other non-persistent inhaled therapies previously taken. Optimizing treatment adherence should be one important goal of COPD patients’ management to maximize the therapy benefits. Full article

Elexacaftor/tezacaftor/ivacaftor (ETI) is a cystic fibrosis (CF) transmembrane conductance regulator modulator, which has shown efficacy in people with CF (pwCF) carrying the F508del (F) variant, both in homozygosity and heterozygosity with a minimal function (MF) variant. Limited data exist on the effects of ETI in pwCF with advanced lung disease. Our aim was to investigate ETI safety and effectiveness in this patient group in a real-life setting over 2 years. A multicenter observational cohort study was designed to gather real-world information on the effect of ETI treatment on CF patients (aged >12 years, genotype: F/MF mutation) with advanced lung disease as defined by a FEV1 < 40% predicted. Retrospective demographic and clinical data were recorded for the two years preceding and the two years following ETI initiation. The following outcomes were investigated: treatment-associated adverse events (AEs), drug interruptions (temporary or permanent), variations in percent predicted FEV1 (ppFEV1), sweat chloride concentration (SwCl), antibiotic use, body mass index (BMI), and quality of life. A total of 124 (51.6% males) pwCF were treated with ETI over 2 years. The median (IQR) age and ppFEV₁ were 34 (26, 43) years and 34 (29, 41) percentage points, respectively. ETI was discontinued in two pwCF due to lung transplantation, and temporarily interrupted in two because of skin rash, and in three following elevated levels of aminotransferase. Most AEs were mild and short-lasting. In 12.1% pwCF, we registered an increase greater than twice the upper limit of the normal range in alanine aminotransferase, and in 16% we registered an increase in conjugated bilirubin with no increase in aminotransferase. Both increases were recurrent in about half of the subjects. The mean differences (95% CI) for ppFEV₁ and SwCl, assessed as mean values in the pre-ETI and ETI treatment periods, were +11.8 (11.1 to 12.6) and −43.7 (−47.6 to −39.9) mmol/L. A modest increase in ppFEV₁ persisted during the second year of treatment. Number of oral and IV antibiotic cycles/year, as well as hospitalizations/year, decreased significantly from 3.6 to 1.2, from 2.4 to 0.6, and from 2.1 to 0.5 during ETI treatment. A total of 8 of 16 (50%) pwCF were taken off the waiting list for lung transplantation, and significant reductions in the percentages of pwCF using long-term oxygen therapy and non-invasive ventilation were observed. A poor concordance between ppFEV1 and SwCl was found. In only 3/82 (3.7%), subjects with chronic airway infection by Pseudomonas aeruginosa cultures were always negative during ETI treatment. In CF patients with advanced lung disease on ETI treatment, we observed an improvement in a number of clinically significant outcomes over a 2-year study period. However, several additional observations, such as liver dysfunction, variable degrees of lung function improvement, and limited impact on chronic airway infection, underscore the fact that the benefit–risk profile of ETI treatment in cystic fibrosis patients with advanced lung disease has not been fully elucidated and warrants prolonged-term monitoring. Full article

Background: The skeletal muscle extracellular matrix (ECM) is critical for muscle force and the regulation of important physiological processes. A growing body of evidence demonstrates that in aging, altered ECM composition profoundly hinders the capacity for muscle adaptation in response to exercise training. We evaluated the pattern of ECM expression in response to exercise training between healthy young participants and patients with chronic obstructive pulmonary disease (COPD), to provide insight into how normal adaptive processes differ under conditions of chronic disease. Methods: Vastus lateralis muscle biopsies from 29 patients (mean ± SD FEV1: 43 ± 16% predicted) and 14 healthy subjects were analyzed before and after an interval exercise training program for myofiber distribution and size. A selection of ECM molecules was quantified using ELISA. Results: Compared to healthy participants, patients exhibited a lower capacity to increase myofiber type I distribution (by 4.7 ± 3.4 vs. 1.3 ± 2.2%) and mean fiber cross-sectional area (by 13.6 ± 3.2 vs. 9.1 ± 1.9%). Exercise training induced a diverse protein expression between the two cohorts in ECMs regulating tissue structure (collagens: up-regulated only in COPD), myogenesis (SPARC: up-regulated only in healthy), necroptosis (tenascin C: up-regulated only in COPD), adherence to muscle-cell precursors (Fibronectin: up-regulated only in healthy) and tissue integrity (biglycan: down-regulated only in COPD). Conclusions: Impaired ECM remodeling may underlie the reduced exercise training muscle adaptation observed in COPD patients. Full article

Background: Severe asthma is associated with an increased risk of osteoporosis, largely due to chronic corticosteroid exposure and persistent systemic inflammation. Data from different international registries indicate a significant prevalence of osteoporosis among patients with severe asthma, with large variations attributed to differences in treatment strategies and optimization of care. Aims and Methods: This study aims to assess the prevalence of osteoporosis among patients with severe asthma enrolled in the Severe Asthma Network Italy (SANI) registry who are receiving treatment with monoclonal antibodies (mAbs) and/or long-acting muscarinic antagonists (LAMAs) and compare the characteristics of patients with and without osteoporosis to identify key risk factors contributing to osteoporosis. Results: A total of 1813 patients receiving Step 5 GINA (mAbs, LAMAs) treatment were included in the final analysis, of whom 282 (15.5%) had osteoporosis. Osteoporosis prevalence was significantly higher in women (20.3%) compared to men (8.0%). The prevalence also increased with age (p < 0.001) and with asthma duration (p = 0.008). Patients with osteoporosis exhibited poorer asthma control, lower lung function (FEV1 and FVC), a higher rate of exacerbations, and more frequent chronic oral corticosteroid (OCS) use compared to those without osteoporosis. Nasal polyposis was not significantly associated with osteoporosis in this cohort. Conclusions: Osteoporosis is highly prevalent in individuals with severe asthma, mainly due to chronic corticosteroid exposure and persistent inflammation, and is associated with asthma duration, sex, age, frequent exacerbations, cumulative exposure to OCS, and reduced lung function. Early recognition of osteoporosis risk is essential, and biologic therapies offer a promising strategy to reduce OCS dependence, mitigate adverse effects, and improve long-term outcomes. Full article

Background: Asthma is the most common chronic disease during childhood. Spirometry is recommended as a reliable lung function test. Several studies have demonstrated the lack of use of spirometry for both diagnostic confirmation and monitoring. Using subjective symptom control tests alone may underestimate the risk for future asthma attacks. Methods/Objectives: We conducted a retrospective, observational study in a single pediatric centre in Romania. The main objectives of the study were to analyse the quality of spirometry in children and to emphasise the importance of performing accurate spirometry for asthma monitoring. The secondary objective was to evaluate if forced expiratory volume in the first second (FEV1) and mid-maximum expiratory flow (MMEF) values are predictive markers for future exacerbations in children with asthma. Results: The study group included 416 patients between 5 and 18 years who performed at least one spirometry. The success rate for spirometry in our study was 66.3%. In a subsequent study group of 88 patients we monitored spirometry initially and after 12 months. We found a statistically significant difference between FEV1 and MMEF in the controlled, partially controlled and uncontrolled groups (p = 0.0102 and p = 0.0001). Our study showed no association between FEV1 and risk for exacerbations (Rs = −0.156, p = 0.146) and an acceptably negative (Rs = −0.30) and statistically significant (p = 0.040) correlation between initial MMEF values and the number of exacerbations. Conclusions: Low initial MMEF values correlate with the number of exacerbations in a 12-month follow-up period. This suggests that evaluating MMEF alongside FEV1 in children with asthma could contribute to better identification of the risk of exacerbation. Full article

Background/Objectives: Cognitive impairment (CI) in patients with chronic obstructive pulmonary disease (COPD) has been associated with reduced physical activity and decreased adherence to inhalation therapy. The primary aim of this study is to examine the prevalence of CI in patients with severe COPD and secondly compare outcomes with non-COPD comparators. Methods: Patients with severe COPD defined as forced expiratory volume in first second (FEV₁) <50% were recruited between January 2021 to January 2023 along with non-COPD comparators. CI was defined as a MoCA score < 26, adding one point for participants with ≤12 years of education. Additionally, two functional cognitive tests were included: the Continuous Reaction Time test (CRT) and a driving simulator. Results: Eighty patients with COPD (mean age 64 years) and 22 non-COPD comparators (mean age 61 years) participated. CI was identified in 32 patients with COPD (40%) and six non-COPD comparators (27%) with a 0.87 non-significant difference (95% CI: −0.15–1.88). The functional tests showed a 0.267 difference in CRT index (95% CI: 0.023–0.511) and a 0.056 difference in standard deviation from center of the road (95% CI: 0.002–0.11) revealing a significantly poorer performance in functional tests among patients compared to non-COPD comparators. Nineteen patients with COPD and one non-COPD comparator failed the driving test (p = 0.04). Conclusions: CI was found in 40% of patients with severe COPD based on MoCA score. While MoCA score did not differ between the two groups, functional tests demonstrated significantly reduced abilities in patients compared with non-COPD comparators. Full article

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV₁ (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF_25–75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (R_tot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV₁, FEF_25–75, and R_tot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up. Full article

Objective: We aimed to assess the expression and localization of renin-angiotensin system (RAS) receptors in lung tissue and the plasma concentration of related peptides in IPF patients. Materials and Methods: This case–control study involved 19 patients from southern Brazil undergoing lung resection or transplantation. Plasma levels of Angiotensin I, II, A, 1-7, Alamandine were measured via liquid chromatography–tandem mass spectrometry. Lung tissue expression and localization of angiotensin type 1 (AT1), Mas, and Mas-related G-protein-coupled receptor D (MrgD) receptors were evaluated using Western blot and immunohistochemistry. Clinical data and the 6-min walk test were analyzed to correlate receptor expression with lung function and oxygen dependence. Results: IPF patients showed reduced forced vital capacity (FVC) at 49 ± 13% and forced expiratory volume (FEV1) at 51 ± 14%, with a 60% increase in oxygen dependence. Plasma peptide concentrations were similar between the groups, except for Angiotensin I, which was significantly higher in the control group. In IPF lungs, AT1 and Mas receptors were expressed 2.31 and 2.13 times more, respectively, while MrgD expression was lower. Mas receptors were mostly found in bronchiole areas, whereas MrgD was predominant in the lung parenchyma. Conclusions: This study indicates that the RAS operates independently within tissue, in addition to its systemic functions, highlighting distinct differences between tissue and plasma RAS activities. The distinct roles of MrgD and Mas receptors in lung structure and function could be pivotal for new therapies, potentially leading to more effective IPF treatments. Full article

Background: Computed Tomography (CT) is considered a highly accurate tool for assessing body composition. The aim of this study is to assess the usefulness of chest CT for malnutrition diagnosis in people with cystic fibrosis (PwCF), compared with other body composition techniques, as well as to assess possible associations with nutritional and respiratory status. Methods: A cross-sectional study was carried out in clinically stable adult PwCF. Subjects who had undergone a CT including the twelfth thoracic vertebra (T12) during the 6 months prior to or after our assessment were included and body composition was assessed using FocusedON-BC. The results were compared with anthropometry, bioelectrical impedance analysis (BIA), muscle ultrasonography, and handgrip strength (HGS). Respiratory parameters were collected, and nutritional status was assessed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: A total of 55 PwCF were included. Muscle area assessed by CT correlated significantly with fat-free mass determined by BIA (r = 0.725) and anthropometry (r = 0.645), muscle mass evaluated by ultrasonography (r = 0.657), HGS (r = 0.593), Bhalla score (r = 0.403), and FEV1 (r = 0.488). Differences were observed when comparing muscle area in CT based on the Bhalla score (94.6 ± 21.1 cm² in normal/mild involvement vs. 79.3 ± 20.9 cm² in moderate/severe involvement; p = 0.009) and on nutritional status (96.3 ± 17.9 cm² in normo-nourished vs. 75.9 ± 22.1 cm² in malnourished; p < 0.001). Conclusions: In adult PwCF, measurements obtained from CT image analysis correlate adequately with anthropometry, BIA, muscle ultrasound, and HGS. Muscle area in CT is related to nutritional and respiratory status. Full article

Background and Objectives: Coronavirus disease 2019 (COVID-19) has affected multiple physiological systems, including respiratory function, which is critical for athletic performance. Although alterations in pulmonary dynamics have been observed in high-level athletes recovering from COVID-19, the effects on respiratory function remain unclear. In this context, the present study aimed to examine the impact of COVID-19 on the interrelationships among respiratory function parameters in high-level athletes. Materials and Methods: Sixty-eight high-level athletes participated in the present study, including 34 with a history of COVID-19 and 34 controls without prior infection. Respiratory function and respiratory muscle strength were assessed using a digital spirometer (Pony FX, Cosmed, Italy). Key variables included Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF), Maximum Voluntary Ventilation (MVV), Forced Expiratory Volume in one second (FEV₁), and Maximum Inspiratory/Expiratory Pressure (MIP/MEP). Results: High-level athletes with prior COVID-19 infection exhibited significant differences in the correlations (p < 0.05) between FVC and PEF, FVC and MVV, FEV₁ and FEV₁/FVC, and MIP and MVV compared to controls. Conclusions: These findings suggest that COVID-19 can disrupt the interrelationships among respiratory function parameters in high-level athletes, highlighting the need for further longitudinal investigations. Full article

Background. Sex-based disparities in chronic obstructive pulmonary disease (COPD) diagnosis remain underexplored, particularly in primary care settings. This study assessed sex differences in clinical burden, diagnostic delay, and missed diagnostic opportunities using conventional and composite metrics. Methods. A cross-sectional analysis was conducted in 166 newly diagnosed COPD patients (76 women, 90 men) from Spanish primary care. Clinical severity, healthcare use, and diagnostic timing were compared using Mann–Whitney and chi-squared tests. Composite indices included the Symptom Intensity Score, Diagnostic Inertia Indices, DOSE Index, and Diagnosis Complexity Score. Multivariable regressions evaluated independent associations. Results. At diagnosis, women showed a greater clinical and functional burden (FEV₁ % predicted: 50.4% vs. 61.4%, p < 0.001; symptom intensity z-score: 0.13 vs. −0.67, p < 0.001), higher diagnostic complexity (Diagnosis Complexity Score: 403.5 vs. 272.0, p < 0.001), and longer diagnostic delay (median: 133.0 vs. 66.5 days, p < 0.001). Stratified and composite analyses confirmed consistent sex-based asymmetries. In adjusted models, being female independently predicted a longer diagnostic delay (β = 0.888, p = 0.005), but was not significantly associated with the burden of missed diagnostic opportunities (MDOs) (β = 0.112, p = 0.395). Conclusions. Women with newly diagnosed COPD experience greater symptom burden and longer diagnostic delays. Composite metrics may improve the identification of diagnostic disparities in routine clinical settings. Full article

Aim: This study aimed to evaluate the nutritional status of children with cystic fibrosis (CF) and investigate the correlation between malnutrition and the decline of pulmonary function in this population. Methods: We retrospectively analyzed the clinical data of children with CF admitted to four large tertiary centers in Upper Egypt. We compared clinical characteristics among children with different nutritional statuses and evaluated the correlation between malnutrition and pulmonary functions. Results: A total of 104 children with CF, including 54 males (52%), aged 3 to 18 years, were analyzed. Respiratory symptoms were present in all cases (100%). Malnutrition was observed in 72% (75/104) of the participants, with affected children exhibiting significantly lower body weight and serum albumin levels. Pulmonary function tests showed that vital capacity (VC) and the predicted values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), FEV₁/FVC, and expiratory flow at 25%, 50%, and 75% of FVC were all lower in the malnourished group compared to children with normal nutrition. Correlation analysis demonstrated that the body mass index (BMI) Z-score was positively correlated with these pulmonary function indicators. Conclusions: Malnutrition is highly prevalent among Egyptian children with CF and is associated with decreased pulmonary function. Improving nutritional status may enhance lung function in this population. Full article

Background/Objectives: The measurement of body fat percentage (%BF) could alert us to potential respiratory problems; however, differences in %BF values have been reported depending on the method used. Therefore, the objectives of this study were to determine whether there are differences in %BF obtained through skinfold measurements (SF) and bioelectrical impedance analysis (BIA), and their correlation with airflow limitation (AFL), and secondly, to observe the relationship between leptin and AFL. Materials and Methods: A cross-sectional study was conducted with 80 participants (40 men and 40 women, aged 18–30 years). Assessments of %BF were made using SF and BIA. Spirometric parameters and pulmonary volumes were measured. Plasma leptin levels were determined using ELISA. Bivariate correlations and gender differences were analyzed. Results: When comparing %BF measured by SF and BIA, no significant differences were found between the two methods in either females or males. Furthermore, in both men and women, there was a direct and significant correlation between %BF obtained through BIA and SF (r = 0.936; r = 0.789, p < 0.001, respectively). Leptin showed a significant correlation with airway resistance (Raw) and specific airway resistance (sRaw) in men (r = 0.506; r = 0.553, p < 0.001, respectively) and women (r = 0.537, p = 0.001; r = 0.489, p = 0.003, respectively). Leptin also showed a significant correlation with %BF measured by both SF and BIA in men (r = 0.675; r = 0.687, p < 0.001, respectively) and women (r = 0.583; r = 0.682, p < 0.001, respectively). Conclusions: BIA and SF offer comparable results in estimating %BF. The significant correlation between leptin, %BF, and FEV1/FVC suggests a possible pathophysiological mechanism mediated by adiposity that could affect pulmonary function even in young and clinically healthy individuals. Full article

Background/Objectives: The advancing technological developments of recent decades have also changed the stress profile of pilots of high-performance aircraft (HPA) immensely. Pilots are exposed to different gravitational (G)-forces and are only able to fly with anti-G suits that compensate for the physiological loss of cerebral perfusion by applying external pressure to the body, and positive pressure breathing during G [PBG]. The present study therefore aims to investigate long-term effects of PBG on the lung capacity of fighter pilots. Methods: In a retrospective data analysis (1972–2024), the clinical findings of all German military pilots were analyzed. In total, 1838 subjects were included in the analysis, divided into three groups: HPA with PBG, HPA without PBG, and fixed-wing aircraft. Results: Lung function analysis showed that no significant decrease in FVC was found in the HPA group with PBG, but a decrease was found in the HPA group without PBG. FEV1 and FEV1/FVC decreased significantly in all groups. Multiple regression analyses indicated that the variables age and aircraft type were significant predictors of the changes in FVC and FEV1, but not for the Tiffeneau index. Conclusions: Our study showed that the lung function of HPA pilots who were exposed to both PBG and repeated increased G-forces did not deteriorate to a significantly greater extent compared with other pilots without these conditions; in some cases, it even deteriorated to a lesser extent. Overall, age has primarily been shown to be the predisposing factor for a deterioration in lung function parameters over time. Full article

Background: Small airway dysfunction (SAD) plays a critical role in the management of severe asthma, particularly in patients at risk of requiring biological therapies (BTs). Short-term studies have shown that switching to single-inhaler triple therapy (SITT) with extrafine beclomethasone–formoterol–glycopyrronium improves outcomes and helps achieve quiet asthma, a state marked by symptom control, no exacerbations or oral steroids, reduced inflammation, and better small airway function. This study investigated whether, over one year, patients could maintain this state as Steady Quiet Asthma (SQA) and whether baseline measures could predict this sustained response. Methods: Twenty-six patients with severe asthma and SAD were transitioned from open triple-inhaler therapy to a closed, single-inhaler triple therapy containing extrafine beclomethasone–formoterol–glycopyrronium. Assessments at baseline (T0) and at one-year follow-up (T12) included clinical evaluations, spirometry, and impulse oscillometry, with a focus on Fres as a predictor for the need for BT. When prescribed, biologic therapies included mepolizumab, benralizumab, and dupilumab. Results: Of the 26 patients, 9 (34.6%) achieved SQA and did not require biologic therapy at the one-year follow-up, while 17 patients (65.4%) initiated biologic treatment. At T0, patients who required biologics had significantly higher median Fres (21 (19.47; 24.58) vs. 17.61 (15.82; 20.63); p = 0.049) compared to those who remained biologic-free. They also exhibited higher residual volume to total lung capacity ratio (%RV/TLC) values and lower forced expiratory volume in one second/forced vital capacity ratios (FEV₁/FVC). At T12, patients spared from BT showed significant reductions in Fres (p = 0.014) and improvements in small airway function (difference in airway resistance between 5 Hz and 20 Hz (R5–20), forced expiratory flow between 25% and 75% of FVC (%FEF25–75), and better asthma control (ACT). In contrast, patients on BT demonstrated less favorable changes in these parameters. Conclusions: Baseline Fres, FEV1/FVC ratio, and %FEV25–75 are valuable predictors of achieving Steady Quiet Asthma (SQA) and sparing biologic therapy. These findings support the use of SITT in severe asthma and highlight the importance of early functional assessments to guide personalized management. Full article