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Chiesi has been developing R&D-oriented innovative therapeutics to treat respiratory system diseases for more than 30 years. In its ongoing research for patient health, Chiesi has developed the patented Modulite technology and by adapting this technology into spray solutions, extra-fine particles are ensured to be inhaled into the lungs by aerosol plume (pMDI-pressurized metered dose inhaler). Thanks to Modulite Technology, which leads to higher velocity and lower duration of the aerosol plume; patients can use their devices easily and comfortably. 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. Thanks to BAM technology, patients use the device easily and comfortably, and both the patients and the healthcare professionals be sure that the treatment is used effectively. 

With these innovative formulations, Chiesi has aimed 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 a common disease with a heterogeneous spectrum that can cause different clinical features as a result of different underlying mechanisms. The clinical features, natural course, pathophysiological mechanisms and treatment response of the disease differ between different types of asthma.  Asthma affects 1-20% of the population in different countries, with an estimated 300 million people worldwide. In our country, the prevalence of asthma in adults has been reported between 1.2% and 9.4% and the prevalence of asthma-like symptoms between 9.8-27.3%.  The prevalence of asthma in children varies widely among countries and regions and this has been explained by genetic and environmental factors.  The disease is often associated with chronic airway inflammation and extreme hypersensitivity of the airways in which many cells and mediators are involved. Symptoms and airflow limitation can be triggered by factors such as viral respiratory infections, exposure to irritants or allergens, exercise and may improve with treatment or spontaneously. Asthma is a disease characterized by frequent and intensive symptoms of wheezing, shortness of breath, cough, chest tightness in patients. Symptoms are associated with variable expiratory airflow limitation. Symptoms' and expiratory airflow limitation variability over time is a typical and defining characteristics of asthma and is important to differentiate asthma from other respiratory system diseases. 

 

 

References:

GINA 2020 kılavuzu

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

https://www.who.int/news-room/fact-sheets/detail/asthmahttps://hsgm.saglik.gov.tr/tr/kronik-hava-yolu-hastaliklari/liste/kronik-hava-yolu-hastaliklari-astim.html

https://www.toraks.org.tr/site/community/downloads/OYHYXiC8BxpNVuUb

https://hsgm.saglik.gov.tr/tr/kronik-hava-yolu-hastaliklari/liste/kronik-hava-yolu-hastaliklari-astim.html

 

 

COPD

 

Chronic Obstructive Lung Disease (COPD) 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 which causes structural changes in the lung tissue, causing narrowing of the small 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 reported that the COPD is the third cause of death in our country. In this study, COPD was determined to be in the 8th place among the leading causes of disease burden- disability-adjusted life years (DALY). Based on the list of reasons for DALY COPD ranks third among the first 26 diseases.

The incidence of COPD is 15-20% in adults aged >40 years who are smokers/ex-smokers. On the other hand, only one out of 10 patients with COPD consulted a doctor and correct diagnosis could be made. In that case, only 300-500 thousand of the 3-5 million patients with COPD in our country know that they have the disease.  According to the data from the Global Study of Disease Burden, COPD causes 2.9 million deaths per year. Today, COPD which has become the third cause of death worldwide, accounts for 5.5% of all deaths. In Turkey, respiratory system diseases are the third leading cause of death and 61.5% of these deaths are due to COPD.

 

In the Turkey, Chronic Diseases and Risk Factors study conducted by the Ministry of Health in 2011, it was stated that COPD prevalence based on spirometry was 5.3% and the prevalence of physician-diagnosed COPD was 4% in the 15+ years of age group.

The age- and gender-standardized COPD prevalence based on PFT results is 5.3%.

The incidence of age- and gender-standardized COPD diagnosed by a physician is 4.0%.

 

The typical COPD symptoms are:

 

  • Shortness of breath
  • Cough
  • Sputum

 

Risk factors for developing COPD include long-term tobacco use. Approximately 90% of COPD-diagnosed individuals are current/ex-smokers. Environmental factors and genetic predispositions are increasingly being discussed as risk factors. We can sum up the reasons of COPD as follows:

  • Heavy smoking
  • Occupational exposure to harmful gases, long-term inhalation of micro-particles
  • Air pollution
  • Genetic factors

 

References:

 Türk Toraks Derneği Kronik Obstrüktif Akciğer Hastalığı Tanı ve Tedavi Uzlaşı Raporu 2017

GOLD 2021 Report

http://www.tip.hacettepe.edu.tr/ekler/pdf/ulusal_program.pdf

https://hsgm.saglik.gov.tr/tr/kronik-hava-yolu-hastaliklari/liste/kronik-hava-yolu-hastalıkları-koah.html

https://sbu.saglik.gov.tr/ekutuphane/kitaplar/khrfat.pdf

 

 

RHINITIS

Rhinitis is inflammation of the mucous membrane, the inner lining 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 and/or those with a family history of allergies. Although the disease usually starts at a younger age, it can also be triggered at an older age.

 

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

 

The rhinitis type that occurs in certain seasons (spring, the pollen season) is called ‘Seasonal Allergic Rhinitis’ , also known as Hay Fever.

 

There is a type of allergic rhinitis that lasts a year-long and it is called as ‘Perennial Allergic Rhinitis’. The factors of perennial allergic rhinitis can usually be house dust mites, various chemicals, fungi 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.

 

Symptoms of Allergic Rhinitis

Seasonal

Perennial

Sneezing

Consecutively

Variable

Nasal Flow

Aqueous, frequent

Thick, post-nasal drip

Redness/itching/burning in eyes

Frequent

Rare

Nasal Obstruction

Variable

Frequent

Olfactory disturbance (disturbed sense of smell)

Variable

Frequent

Chronic sinusitis (concomitant disease)

Variable

Frequent

Asthma

Variable

Frequent

 

 

‘Non Allergic Rhinitis’ is a medical term that describes sneezing, nasal flow, nasal obstruction and post-nasal drip that occurs when there is no known allergic cause. The symptoms usually occur all the year round but may worsen seasonally (eg, in seasonal changes). Although the exact cause is unknown, complaints increase with air pollution, dry air, spicy foods, alcohol and the use of various therapeutic products.

 

Reference:

      ARIA kılavuzu 2019

 

 

 

TREATMENT

 

Asthma Treatment

 

Today, thanks to innovative treatments, asthma is a respiratory disease that can be controlled and that patients can continue their lives with little or no symptoms.

 

There are two different treatments with different purposes for asthma, namely "relievers or rescue medications" and "controller medications". Rescue medications are used in emergency cases where complaints of patients increase, these are not used continuously. They are administered only in case of inability to breathe to make patient breathe immediately and easily.

 

The "controller" medications, which are the main treatments and aim to control asthma symptoms, constitute the group of medicines that is used regularly and for long-term under the supervision of a physician, and is used via inhalation in order to prevent asthma exacerbations, that is, to control asthma.

 

In addition to avoiding the factors that trigger the disease as much as possible in daily life, treatment with inhaled drugs (e.g., corticosteroids, beta agonists or combinations of these) is an important step in the treatment of asthma.

 

The important things to know and apply about asthma are as follows:

  • Patients with asthma should be protected from cigarette smoke, damp places, and cold air.
  • Factors causing allergy should be identified and avoided.
  • Asthma is a chronic but manageable disease.
  • The rare occurrence of complaints does not indicate that the disease is completely cured.
  • Medications should be taken regularly and periodic follow-up by a specialist doctor is required.
  • Influenza may cause breathing problems in people with asthma. Therefore, patients should vaccinated yearly with influenza.
  • If nasal obstruction is persistent, it is important to make an assessment in terms of rhinitis.
  • The presence of cockroaches, black or white molds on the moist wall, moldy clothing and moldy food in the environment triggers asthma. This requires taking precautions at home.
  • Asthmatic people should not have carpets, hairy toys, woolen blankets in their 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.

 

Reference:

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

GINA 2020 Report

 

COPD Treatment

 

The management of COPD involves muscle-strengthening physical therapy, and respiratory exercise therapy, and avoidance of disease-inducing factors (e.g. tobacco use), in addition to drug-based treatment.

 

Stable COPD treatment consists of drug and non-drug approaches. Drug therapy in COPD is used to reduce symptoms, frequency and severity of exacerbations, and 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 expand the airways and facilitate breathing, corticosteroids against inflammation of the respiratory tract and/or drugs in spray or powder form containing both drug groups in metered dose inhaler combinations.

 

In severe cases where respiratory failure (inadequate breathing resulting in inability to provide oxygen to the body) develops, oxygen therapy delivered using a nasal tube can be added to these treatments. Endoscopic or surgical interventions are potential treatment options for some patients.

 

Reference:

  Türk Toraks Derneği KOAH Koruma, Tanı ve Tedavi Raporu 2017

  GOLD 2021 Report

 

 

Treatment of Rhinitis

 

In treatment of allergic and non-allergic rhinitis, drug treatment and avoidance of allergens that trigger the symptoms are essential. Thus, complaints of many patients can be controlled. The most commonly used drugs are antihistamines and nasal sprays containing cortisone. Particularly if used in ‘Seasonal Allergic Rhinitis’ prior to exposure to pollen, this period may continue with milder symptoms.

However, all these medications should definitely be prescribed by the physician by evaluating the severity of the disease and the clinic of the patient.

Aside from drug treatment, causative allergen can be determined and allergy vaccination can be used for the treatment in some cases.

 

Reference:

 ARIA kılavuzu 2019

 

 

Today and tomorrow of Chiesi in Respiration

 

As Chiesi, we focus on innovative treatment solutions in order to offer to patients more than just drug therapy and manage our R&D processes accordingly. For this, we aim to facilitate the inhalation of the medication, reduce the use of multiple medications, support our patients by focusing on solutions to deliver the inhaled drug to the lungs in the most appropriate way, and therefore, increase their quality of life.