Pidotimod: the state of art.

Despite the use of antibiotics and vaccines, the frequency of respiratory tract infections is still high and these infections interest a wide range of patients, from children to aged people, including in particular these extreme categories because of the deficiency of their immune system, due to immaturity in the former case and to "immunosenescence" in the latter. For that reason immunostimulant drugs are getting more important to prevent and to attenuate infections. Pidotimod (3-L-pyroglutamyl-L-thiazolidine-4carboxylic acid) is a synthetic dipeptide with immunomodulatory properties. We reviewed studies conducted on different categories of patients, with particular attention on children and senile patients suffering from recurrent respiratory tract infections, associated, or not, with asthma or COPD. The outcomes considered are both clinical and laboratory parameters. The common end-point of these studies is that Pidotimod has an immunomodulatory activity which is able both to improve the clinical conditions of patients and to enhance and stimulate their immunity cells (lymphocytes but not only) functions acting on adaptive and innate immunity. Pidotimod is also able to increase the concentration of salivary IgA directed against bacteria; furthermore, it can modulate airway epithelial cells functions up-regulating the expression of toll-like receptors and acting on adhesion molecules. According to studies conducted on patients with atopic asthma, it seems that Pidotimod could affect T-lymphocytes balance with a possible addictional anti-allergic activity. Furthermore, it has been demonstrated an improvement of FEV1 and PEF in asthmatic patients treated with Pidotimod. Main clinical outcomes are the reduction of the number of infectious episodes, lesser severity of signs and symptoms and, consequently, a reduction in use of antibiotics and symptomatic drugs, less working and school days lost, less mortality and morbidity. The studies considered give positive results, confirming Pidotimod's efficacy. Furthermore, many studies show a good safety profile of the drug, without recording serious adverse events and mutagenic potential, and a very low incidence of side effects. Pidotimod is also a more safe solution in patients subjected to vaccination, if compared to lyophilized polibacterial, which can't be administered for thirty days before vaccination.

Rhinitis: adherence to treatment and new technologies.

PURPOSE OF REVIEW: Nonadherence to treatment is a major issue in approximately 50% of patients suffering from chronic diseases. The availability of new technologies could represent a possible way to improve patients' engagement and adherence in a real-life setting. Research and technology tools made available or in process of being made available to patients with allergic diseases and their physicians could potentially improve the management of these disease in daily life by improving adherence. In this review, we sought to outline many of the recent advances in these technological approaches. RECENT FINDINGS: Short Message Service (SMS) reminder, social networks, wearable devices, mobile applications (Apps), monitoring systems of inhaled device use, often presented as 'serious game' are changing the way of approaching to chronic disease, such as rhinitis, management. SUMMARY: Studies of the role played by various technologies in improving adherence to treatment in rhinitis are still limited as compared with other diseases such as asthma, but the results are encouraging. Further studies in this area may lead to the discovery of novel management approaches that is easy to be integrated in patients' daily life.

Choose your outcomes: From the mean to the personalized assessment of outcomes in COPD. An exploratory pragmatic survey.

BACKGROUND: Patient's expectations and needs may influence adherence in chronic obstructive pulmonary disease (COPD). The objectives of this survey were to assess the specific outcomes that patients expected their COPD treatment to improve (patient's personal outcome [PPO]) and to evaluate how the ongoing therapy was able to reach this objective. METHODS: We performed an exploratory pragmatic survey of COPD patients attending 2 university hospitals for scheduled follow-up visits. Patients had to indicate their PPO, the effect of ongoing treatment on the PPO, the symptom COPD of they expected treatment to improve and how this symptom is currently bothering them. Patients also underwent assessment of lung function and completed the COPD assessment test (CAT). RESULTS: We analyzed data from 144 consecutive patients, (62.5% males; age range 54-94; mean age 73.88±8.33). A total of 23 different PPOs were scored, and 44.5% of patients reported an improvement ≥6 (mean 4.93±2.27 on a 0-10 points scale) due to ongoing treatment. The correlation between perceived improvement in PPO and CAT score was weak and negative (r=-0.13, p=0.11), whereas it was high and significant with FEV1 (r=.35, p=0.007). The clinical features patients most expected their ongoing treatment to improve were breathlessness (64.6% of patients), cough (13.9%), sputum production (11%) and episodes of exacerbation (8.3%), for which their scores were, respectively, 7.12±1.99, 6.8±2.24, 6.63±2.13, and 8.0±0.94. CONCLUSION: Appropriate assessment of PPO could lead to better long-term management of COPD.