Cristina Cardini

Background: Severe asthma is associated with an increased risk of osteoporosis, largely due to chronic corticosteroid exposure and persistent systemic inflammation. Data from different international registries indicate a significant prevalence of osteoporosis among patients with severe asthma, with large variations attributed to differences in treatment strategies and optimization of care. Aims and Methods: This study aims to assess the prevalence of osteoporosis among patients with severe asthma enrolled in the Severe Asthma Network Italy (SANI) registry who are receiving treatment with monoclonal antibodies (mAbs) and/or long-acting muscarinic antagonists (LAMAs) and compare the characteristics of patients with and without osteoporosis to identify key risk factors contributing to osteoporosis. Results: A total of 1813 patients receiving Step 5 GINA (mAbs, LAMAs) treatment were included in the final analysis, of whom 282 (15.5%) had osteoporosis. Osteoporosis prevalence was significantly higher in women (20.3%) compared to men (8.0%). The prevalence also increased with age (p < 0.001) and with asthma duration (p = 0.008). Patients with osteoporosis exhibited poorer asthma control, lower lung function (FEV1 and FVC), a higher rate of exacerbations, and more frequent chronic oral corticosteroid (OCS) use compared to those without osteoporosis. Nasal polyposis was not significantly associated with osteoporosis in this cohort. Conclusions: Osteoporosis is highly prevalent in individuals with severe asthma, mainly due to chronic corticosteroid exposure and persistent inflammation, and is associated with asthma duration, sex, age, frequent exacerbations, cumulative exposure to OCS, and reduced lung function. Early recognition of osteoporosis risk is essential, and biologic therapies offer a promising strategy to reduce OCS dependence, mitigate adverse effects, and improve long-term outcomes.

Background: The rapid digital transformation has significantly impacted healthcare, particularly through eHealth solutions that offer great potential for managing chronic respiratory conditions such as asthma. This study explores the impact, attitudes, and acceptance of digital technologies in asthma management in Italy. Methods: A structured 34‐item survey, developed in two versions for patients and physicians, was administered independently and anonymously to adult asthma patients and to specialists in pulmonology and allergology. The questionnaires collected data on demographics, professional background, digital habits (for work and leisure), use of digital tools such as apps and smart inhalers, doctor–patient digital communication, familiarity with online health resources, and perceived barriers to digital adoption. Data were collected anonymously via REDCap, with oversight from the Severe Asthma Network in Italy (SANI). Results: A total of 134 patients and 180 doctors participated. Findings revealed a predominantly positive attitude toward digital tools, with 85% of physicians and 74.4% of patients embracing a “digital mindset.” Nevertheless, digital innovations remain underutilized in clinical practice. While 85.6% of patients reported regularly using digital tools in their daily lives, 91.5% stated that their doctors had never recommended apps or websites for asthma self‐management. Digital solutions such as mobile apps, wearable spirometers, and telemedicine are recognized for their potential benefits—clinicians highlighted symptoms self‐tracking (17.2%), improved adherence (22.7%), and enhanced clinical interventions (11.7%) as key advantages. However, adoption is hindered by concerns such as information technology (IT) compliance (62.5%), legal risks (11.5%), and skepticism about the reliability of remote data (40.6%). Furthermore, 59.9% of clinicians and 66.8% of patients recognized a knowledge gap regarding the potential benefits of smart inhalers and digital therapeutics in respiratory care. Conclusion: The study highlights a positive attitude toward digital tools in asthma management but reveals limited adoption in clinical practice. Key barriers include IT compliance concerns and knowledge gaps. Addressing these challenges through education and regulatory support could enhance digital integration, improving asthma care.