Can the Rome classification of chronic obstructive pulmonary disease exacerbation severity be applied in the hospital setting?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) exacerbations (ECOPDs) are crucial events in the natural history of the disease. The recent Rome proposal defines exacerbations and their grade of severity using objective parameters derived from published data. AIMS: A) To evaluate the applicability of the Rome proposal in current clinical practice in different hospitals settings, B) to compare the resulting degree of severity with the conventional non-objective classification, C) to evaluate the relationship between ECOPD severity and mortality and D) the outputs in different hospital specialist wards. METHODS: Observational retrospective study in patients admitted to the University Hospital of Ferrara (Italy) with a primary diagnosis of ECOPD in the year 2021. The items of severity of the Rome proposal at admission were acquired from clinical records. A clinical-based score surrogated the missing VAS data on dyspnoea. RESULTS: Data were collected at admission form 320 patients. The data collected allowed the classification of severity based on the Rome proposal in 88.5 % of eligible cases. 18.5 %, 50.5 % and 31 % of ECOPD admissions were categorised as mild, moderate or severe ECOPDs respectively. In-hospital mortality increased with the ECOPD severity and mortality at 12 months was 27 % and 53.2 % in patients who have had a mild vs severe ECOPD, respectively (p = 0.059). Severe ECOPDs were more frequent and mortality rate was lower in patients admitted to Respiratory as compared to Internal Medicine wards. CONCLUSION: The Rome classification is ready to use in hospitalised ECOPD. It could allow for a better identification of the hospital setting most appropriate for ECOPD management.

Training and learning ultrasound: survey on a sample of Italian students, impact and role inside the core curriculum of degree courses in medicine and surgery.

PURPOSE: Ultrasound is essential in the clinical practice of many medical specialties due to non-invasiveness, rapidity of examination, low costs and simplicity. Many specialized companies and universities pointed out its potential as a teaching tool for medical students. The aim of our study is to evaluate the impact of an ultrasound course on a sample of students attending the fourth, fifth and sixth year of the degree course in Medicine, highlighting changing in satisfaction and preparation. Another target is to verify the capability of a course on ultrasound to positively impact on participants knowledge and competences. METHODS: Students attending 6 training courses of Medicine held between 2017 and 2019 were recruited. Five trainings held during an Italian society of ultrasound in medicine and biology (SIUMB) congress, in a session dedicated to students, and one during an elective didactic activity (ADE) held in Chieti University. A questionnaire was given to the students before and after the course, in order to assess the impact of the course on the motivation and knowledge. Moreover, a test was also administered at the end of the theoretical part, with questions relating to the notions learned. RESULTS: There was an 81% of correct response to the learning questionnaire by calculating the mean of 5 SIUMB courses performed. The students are strongly motivated to continue learning ultrasound already from the beginning of the course, and this result remains unchanged in the questionnaire administered at the end. The interest of students towards this method is high, and they would ultrasound courses within the Medicine degree, even before participating in the training. It was evident how students positively assessed the course in relation to the acquisition of skills and knowledge, albeit with a tendency to acquire more knowledge rather than skills. CONCLUSIONS: Our data support the usefulness of including ultrasound into the curriculum of medical students and on its use as a teaching tool. Students are highly motivated and perceive a significant improvement in both skills and knowledge following the proposed courses. Hands-on part is necessary in the training course on ultrasonography.

Update on virus-induced asthma exacerbations.

INTRODUCTION: Viral infections are common triggers for asthma exacerbation. Subjects with asthma are more susceptible to viral infections and develop more severe or long-lasting lower respiratory tract symptoms than healthy individuals owing to impaired immune responses. Of the many viruses associated with asthma exacerbation, rhinovirus (RV) is the most frequently identified virus in both adults and children. AREAS COVERED: We reviewed epidemiological and clinical links and mechanistic studies on virus-associated asthma exacerbations. We included sections on severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), the latest evidence of coronavirus disease 2019 (COVID-19) in asthma patients, and past and future searches for therapeutic and prevention targets. EXPERT OPINION: Early treatment or prevention of viral infections might significantly reduce the rate of asthma exacerbation, which is one of the key points of disease management. Although it is hypothetically possible nowadays to interfere with every step of the infectious cycle of respiratory tract viruses, vaccination development has provided some of the most encouraging results. Future research should proceed toward the development of a wider spectrum of vaccines to achieve a better quality of life for patients with asthma and to reduce the economic burden on the healthcare system.