Healthcare, study: new standards of diagnosis and treatment on type 2 inflammation

Management model for pathologies such as asthma and atopic dermatitis presented in the Senate

Recognize the different chronic manifestations of type 2 inflammation such as asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyposis or eosinophilic esophagitis, develop new diagnostic standards for not only effective but also efficient management, and integrate care according to a multidisciplinary care model that allows fairer and more timely access to specialist services throughout the patient’s life cycle. These are some of the operational proposals contained in the Policy Paper created by the Institute for Competitiveness (I-Com) together with Sanofi as part of the project entitled ‘The management of patients with type 2 inflammatory pathologies’, a cycle of three meetings – explains a note – which involved 4 patient associations and 16 scientific societies, as well as representatives of institutions, with the aim of drawing attention to the importance of managing the complexity that characterizes patients with pathologies deriving from type inflammation 2 and the current healthcare approach.

The study was presented today in the Senate during an institutional event created on the initiative of Senator Ignazio Zullo, X Commission for Social Affairs, Health, Public and Private Work, Social Security. Present at the event were: Fulvia Filippini Public Affairs Country Head of Sanofi; the president of I-Com Stefano da Empoli and the senators Elena Murelli and Ylenia Zaiuto, both from the X Commission for Social Affairs, Health, Public and Private Work, Social Security.

As the document highlights, to encourage therapeutic appropriateness, the classification of pathologies due to a deregulation of the type 2 inflammatory response in the management of the patient, who is often young, is essential. In fact, while the prevalence of other chronic pathologies increases with age (66% of people aged between 75 and 84 are affected by at least one), type 2 inflammatory diseases often arise already in childhood and then manifest themselves in different subsequent moments in the patient’s life. The common denominator then emerges from the data regarding the possible concomitances. Specifically, approximately 48% of patients with eosinophilic esophagitis also have allergic rhinitis, approximately half have food allergies, between 19 and 39% of patients also suffer from asthma and approximately 1 in 5 patients also have atopic dermatitis. By contrast, severe asthma is associated with allergic rhinitis in approximately 45% and nasal polyposis in approximately 43% of patients. 9.6% of Italian patients with severe asthma also suffer from atopic dermatitis.

Precisely due to their characteristics, these pathologies require a specific but at the same time holistic approach, from diagnosis to management, up to the choice of therapy and adherence throughout the life cycle. The current healthcare approach – we read in the note – presents various critical issues, which lead the system not only to not recognize them promptly but to produce potential waste and generate relatively unsatisfactory results. In this context, patients are often disoriented and use many resources in managing their health, not always with the desired outcomes.

The effect of the failure to recognize type 2 inflammatory diseases as a group of diseases in their own right, evident in the absence of a unified and coherent approach to their treatment, entails the risk that healthcare professionals do not investigate or recognize the underlying cause pathologies and, consequently, mainly treat the symptoms, relying for example on systemic corticosteroids which, due to potential side effects, are not suitable for these chronic pathologies. According to the scientific community, overdose and abuse of oral corticosteroids are underestimated and not adequately addressed by healthcare systems, with obvious indirect costs due to the subsequent management of associated side effects.

Among the actions to be carried out and indicated in the document, the following stand out: an update of the National Chronicity Plan (Pnc) that takes these pathologies into account; a timely implementation of the services included in the essential levels of assistance (Lea), which also includes the test of the fraction of exhaled nitric oxide (FeNo) as well as an expansion of the co-pay-free services. And again, a strengthening of the centers of excellence, also supported by digital applications, for a homogeneous classification of these pathologies and more effective patient care in the long term. The report also invites the drawing up of national guidelines to support the creation of a diagnostic therapeutic care pathway (PDTA) to be applied to pathologies deriving from type 2 inflammation to guarantee a unitary and coherent approach as desired by the PNC, without excluding the integration of taken care of and cured of other concomitant manifestations.