Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA2 LEN consensus.

BACKGROUND: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. METHODS: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis. RESULTS: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p < .001). CONCLUSIONS: This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.

Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies.

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 ≥80% predicted. In recent years, an elegant series of studies has shown that "exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment". In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient's physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of "mild COPD". To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with "mild" airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind "mild" COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both.

Recombinant factor VIIa in massive haemoptysis associated with chronic necrotising aspergillosis.

The successful use of recombinant activated factor VII (rFVIIa), in treating massive, life-threatening haemoptysis in a 55-year-old male patient with chronic necrotising aspergillosis, is reported. Patient diagnosed with chronic necrotising aspergillosis three months ago was admitted to our department with massive haemoptysis. Patient was treated as outpatient with itraconazole. One day post-admission, two doses of rFVIIa (30 microg x kg(-1)) were administered and the haemoptysis was successfully resolved. Two further doses of rFVIIa (30 microg x kg(-1) were given the following day, and after that there were no more recurrences of pulmonary haemorrhage. No thromboembolic or other adverse events were observed following rFVIIa therapy. Our findings suggest that use of rFVIIa may represent a safe and effective treatment choice for patients with haemoptysis due to aspergillosis.

[Guidelines for diagnosis and management of asthma in adults of the Croatian Respiratory Society]. / Smjernice Hrvatskoga pulmoloskog drustva za dijagnosticiranje i lijecenje astme u odraslih.

The global use of guidelines for proper diagnosis and management of asthma was worldwide aimed toward obtaining effective control of asthma. Until now, the most often used guidelines in Croatia were the ones issued by the Global Initiative for Asthma (GINA). Their implementation significantly improved and uniformed the diagnosis and management of asthma at different levels of the national health system. The obtained level of knowledge has enabled the making of local guidelines which acknowledge economic, cultural and even traditional specificities of Croatia. It was supposed that Croatian medical professionals would more effectively use guidelines they actively supported to prepare and which were appropriated to local work environment and medicines available. Therefore, based on current scientific evidence, the Croatian Respiratory Society has prepared Croatian Guidelines for Diagnosis and Management of Asthma in Adults purposed for wide use among Croatian doctors and other health professionals.