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Chiesi has been developing innovative drugs focusing on Research-Development to treat respiratory system diseases for more than 30 years. In its ongoing research for patient health, Chiesi has developed the innovative formulation technology Modulite and by adapting this technology into spray solutions, extra fine particles are ensured to be inhaled into the lungs by spraying (pMDI-Pressurized metered dose inhaler). In addition, using this technology, which enables extra fine particles to be inhaled, with patented dry powder-based medical device (DPI, Dry powder Inhaler – NEXTHALER®), Chiesi has made the drug possible to access into lungs extensively in the treatment of Asthma and COPD.

With these innovative formulations Chiesi wants patients with asthma or chronic obstructive pulmonary disease (COPD) to have safer and more active life.

After all, “to breathe is to live!”

 

ASTHMA

Asthma is one of the most common chronic diseases found in children and young people, although the number of adults and older people being diagnosed is also on the rise. In Turkey, around 13% of children and young people and 8,1% of adults suffer from asthma. In our country it is predicted that approximately 3,5 million people live with Asthma. The World Health Organization (WHO) estimates that there are around 334 million asthmatics worldwide.

As a chronic inflammatory disease involving extreme hypersensitivity of the airways, the typical symptoms of asthma are recurrent and sudden, including shortness of breath, coughing, wheezing and a tight feeling in the chest. These symptoms often arise at night and in the early hours of the morning, and vary widely depending on the severity of the disease.

The main physiological characteristic of asthma is airway narrowing characterized with airway restriction. The most significant syndromes of the disease are swelling in the lung's mucosa with some permanent structural changes and chronic airway inflammation with increased mucosa production.

Asthma can progress with various clinical phenotypes. Some phenotypes have been added to phenotypic approach, which starts with allergic and non-allergic asthma, such as early-late start asthma, asthma with cough, exercise asthma, nocturnal asthma, aspirin sensitive asthma, premenstrual asthma, steroid resistant/dependent asthma, brittle asthma, occupational asthma.

Asthma with cough forms the major of the asthmatic patients that cannot be diagnosed.

Risk factors such as smoking and obesity also trigger asthma formation.

Sources:

[1]   GINA 2017

[2] http://www.toraks.org.tr/uploadFiles/book/file/1242017163146-TTD-Astim-Tani-ve-Tedavi-   Rehberi-2016.pdf

 

 

COPD

Chronic Obstructive Lung Disease is a disease characterized by persistent respiratory symptoms and airway obstruction due to abnormalities in the airway and/or alveoli due to exposure to harmful particulates and gases and it can be usually prevented and treated.

In addition, COPD is a chronic inflammatory disease that causes structural changes in the lung tissue, causing narrowing of the airways and destruction of the parenchyma.

In the National Disease Burden Study, which was conducted by the Ministry of Health in 2000 and aims to estimate the causes of death in Turkey, it was stated that the COPD is the third cause of death.  In this study, COPD was found as in the 8th place among the leading causes of disease burden (DALY).

In the Turkey Chronic Diseases and Risk Factors study, which was conducted by Ministry of Health in 2011, it was stated that COPD prevalence based on spirometry was 5,3% and the prevalence of doctor-diagnosed COPD doctor was 4% in the 15+ age group.

 

The classic COPD symptoms are:

  • Shortness of breath (initially only on physical exertion; as the disease progresses then also when resting)
  • Cough (especially in the mornings)
  • Sputum (increased production of thick mucus)
  • Depending on the decrease in blood oxygen saturation; quick fatigue, decrease in walking distance
  • Depending on heart failure, swollen feet, obstruction in the chest, wheezing, bloated lip respiration

 

These symptoms usually emerge gradually over time.

 

Risk factors for developing COPD include long-term tobacco smoking. Around 90% of those diagnosed with COPD are smokers or have smoked in the past. Environmental factors and genetic predispositions are increasingly being discussed as risk factors. We can sum up the reasons of COPD as follows:

  • Intense smoking
  • Occupational harmful gases, long-term micro-particle inhalation
  • Air pollution

 

Sources:

[1]   Turkish Torax Assocation Chronic Obstructive Lung Disease Diagnose and Treatment Consensus Report 2014

[2] GOLD 2017 Report

 

RHINITIS

Rhinitis is the inflammation disease of the mucosa, which is the inner part of the nose.            

 

Allergic Rhinitis occurs when allergens adhere to the airway mucosa and initiate inflammatory reactions. It is more common in people with allergic diseases, especially those with allergic symptoms. The age of onset of the disease can be often triggered in older ages, as well as at younger ages.

 

In patients with allergic rhinitis, complaints of frequent and sequential sneezing, pruritus, severe nasal flow and/or nasal obstruction are seen. Burning, stinging, itching, irritation in the eyes are typical because this disease is usually accompanied by allergic conjunctivitis. In patients with allergic asthma, symptoms such as shortness of breath, wheezing, coughing can be seen.

 

The allergic rhinitis is called as Seasonal Allergic Rhinitis, also known as Hay Fever, in certain seasons (in spring when pollen fly).

 

There is a type of allergic rhinitis that lasts a yearlong and it is called as Perennial Allergic Rhinitis. The factors of Perennial Allergic Rhinitis can usually be house dust mites, various chemicals, fungus and animal hair. If required precautions are taken and appropriate treatment is given, it is possible to reduce the number of attacks of this disease.

 

Allergic Rhinitis Symptoms

Seasonal

Perennial

Sneezing

Consecutively

Variable

Nasal Flow

Aquaeous, Frequent

Thickened Post-Nasal Drip

Redness/Itching/Burning in Eyes

Frequent

Rare

Nasal Obstruction

Variable

Frequent

Olfaction

Variable

Frequent

Chronic Sinusitis (Coexisting Disease)

Variable

Frequent

Asthma

Variable

Frequent

 

Non Allergic Rhinitis is a medical term that describes sneezing, nasal discharge, nasal obstruction that occur due to unknown allergic cause. The symptoms usually occur year-round, but it may get worsen seasonally (eg, in seasonal changes). This situation does not occur until the adult ages. Although the exact cause of this reason is unknown, complaints are increasing with air pollution, dry air, spicy foods, alcohol and the use of various medicines.

 

 

TREATMENT

 

Asthma Treatment

Today, thanks to modern medicine, asthma is easy to treat and patients are able to live their lives with few to no symptoms.

 

There are two different treatments for asthma; they are called as "rescuer" and "regulatory" treatment. Rescuer medicines are used when complaints of patients increase and they are not always taken. In case of asphyxiation, they are applied to make patient breathe immediately and freely.

 

The "regulatory" therapies, which are the main treatments and aim to control asthma symptoms, are long-term and regularly used under the supervision of a physician and constitute the group of medicines taken for inhalation of asthma attacks.

 

Treatment with oral inhaled medicines (e.g. corticosteroid, beta agonists or combinations of these) as well as avoiding disease-causing factors in daily life constitute an important step in the treatment of asthma.

 

The important things to know and apply about asthma are:

  • Patients with asthma should be protected from cigarette smoke, damp places, cold air.
  • Factors causing allergy should be identified and avoided.
  • Asthma is a chronic disease but it can be controlled and therefore you should not stress.
  • Lung functions normally as a result of regular control therapy.
  • The rare occurrence of complaints does not mean that the illness is completely healed.
  • Drugs should be taken regularly and periodically checked by a specialist.
  • If nasal obstruction is persistent, it is important to make an assessment in terms of allergic rhinitis.
  • Cockroaches, black or white moldy presence on moist walls, moldy clothing and food presence trigger asthma. This requires taking precautions at home.
  • Asthmatic people should not have carpets, hairy toys, woolen blankets in the bedroom.
  • Wet cleaning should be done in the living environment.
  • Individual precautions should be taken during the pollen seasons and the doctor should be consulted for preventive treatment.

Source: http://www.thsk.gov.tr/tr/dosya/kronik_hastaliklar/AKT.pdf

 

COPD Treatment

The treatment of chronic obstructive pulmonary disease, as well as drug-based treatment, consists of avoiding disease-including factors (e.g. tobacco use), muscle strengthening physical therapy and respiratory exercise therapy.

 

Stabilized COPD treatment consists of drug and non-drug approaches. Drug therapy in COPD is used to reduce symptoms, frequency and severity of exacerbations, to increase exercise capacity and quality of life.

 

In drug therapy, drugs are used such as "bronchodilators" (anticholinergic drugs and/or beta-2 agonists) that expend the airways and facilitate breathing, corticosteroids against inflammation in the respiratory tract and/or drugs in spray or powder form containing both drug groups in dosed combinations.

 

Oxygen therapy delivered via the nasal tube during severe cases of respiratory insufficiency (inadequate breathing resulting in inability to provide oxygen to the body) can be added to these treatments. Endoscopic interventions or surgical interventions (lung ventilation or lung transplantation) are potential treatment options for some patients.

[1] Turkish Thorax Association COPD Protection, Diagnose and Treatment Report 2014

[2] GOLD 2017 Report

 

Rhinitis Therapy

In the treatment of allergic and non-allergic rhinitis drug treatment and avoid allergens that trigger the findings are essential. Complaints of many patients can be controlled in this way. The most commonly used drugs are; antihistamines and nasal sprays containing cortisone. Especially if they are used in Seasonal Allergic Rhinitis before exposure to pollen, this period may continue with milder findings.

 

However, all these medicines should definitely be given by the physician by evaluating the severity of the disease and the condition of the patient. Apart from drug treatment, in some cases active allergen can be detected and vaccination treatment with allergen can be applied.

 

Today and tomorrow of Chiesi in Respiration

As Chiesi, we focus on innovative treatment solutions to deliver more stable disease drug therapy and we manage our Research & Development processes accordingly.

For this, we aim to improve the quality of life by facilitating breathing in medicines that patients take by breathing, by reducing the use of multiple medications, by helping our patients concentrate on the solutions of the inhaled medication optimally in the lungs.