Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Feb;15(2):e70037.
doi: 10.1002/clt2.70037.

Expert opinion on gray areas in asthma management: A lesson from the innovative project "revolution in asthma" of the Italian thoracic society (AIPO-ITS)

Adriano Vaghi  1 , Raffaele Antonelli Incalzi  2 , Simona Barbaglia  3 , Maria Beatrice Bilò  4   5 , Francesco Bini  6 , Mauro Carone  7 , Lorenzo Cecchi  8 , Alfredo Antonio Chetta  9 , Andrea Claudio Comel  10 , Fausto De Michele  11 , Giuseppe Insalaco  12 , Antonino Musarra  13 , Giovanni Pomponio  14 , Antonio Spanevello  15   16 , Silvia Tognella  17 , Alessandro Vatrella  18 , Lina Zuccatosta  19 , Claudio Micheletto  20
Affiliations
Review

Expert opinion on gray areas in asthma management: A lesson from the innovative project "revolution in asthma" of the Italian thoracic society (AIPO-ITS)

Adriano Vaghi et al. Clin Transl Allergy. 2025 Feb.

Abstract

Background: Despite the availability of numerous guidelines for asthma management, their recommendations are not consistently implemented in clinical practice. This discrepancy between guidelines and real-world practice among Italian healthcare professionals was explored during the "Revolution in Asthma" training program, which identified "gray areas" and barriers preventing clinicians from adopting guideline-based approaches.

Objective: This study aims to analyze the key challenges in asthma management and provide evidence-based solutions to improve adherence to guidelines in clinical practice.

Methods: A group of experts from the Scientific Committee of the Revolution in Asthma project reviewed the program's findings, focusing on three main areas of asthma management: diagnosis, control, and treatment. The experts summarized clinicians' main needs and questions for each area and provided evidence-based responses and practical recommendations.

Results: The study highlights critical challenges in asthma treatment, addressing two key questions: (a) What are the possible uses and indications for short-acting β-agonists in asthma patients? (b) How should asthma treatment be initiated and adjusted based on asthma control? The expert panel developed practical, operational tools to support general practitioners and specialists (pulmonologists and allergists) in optimizing asthma management.

Conclusion: This paper serves as a knowledge co-creation initiative, bridging the gap between clinical guidelines and daily practice. By offering concrete recommendations, it aims to enhance the application of guideline-based asthma management among healthcare professionals.

Keywords: asthma; gray areas; guidelines; real‐life; treatment.

PubMed Disclaimer

Conflict of interest statement

A. Vaghi received payment or honoraria as a speaker from A. Menarini, AstraZeneca, Chiesi and GlaxoSmithKline. R. Antonelli Incalzi received payment or honoraria as a speaker from Angelini, A. Menarini, Aristea Srl, Fenicia Events and Communications, MCC Srl, METIS and consultation fees from Editamed Srl, Ethos, GlaxoSmithKline, LT3, Medineos, Merck Sharp and Dohme, Moderna, and SanitaNova Srl. He owns shares of Recordati. M.B. Bilò received payment or honoraria as a speaker from AstraZeneca, GlaxoSmithKline, Recordati and Sanofi. M. Carone received payment or honoraria as a speaker from Boehringer Ingelheim and GlaxoSmithKline. L. Cecchi received payment or honoraria as a speaker from ALK, AstraZeneca, GlaxoSmithKline, Novartis, Sanofi and Thermofisher and consultation fees from ALK, A. Menarini, AstraZeneca and Thermofisher. A.A. Chetta received payment or honoraria as a speaker from Chiesi and GlaxoSmithKline and a research grant from AstraZeneca. A.C. Comel received payment or honoraria as a speaker from A. Menarini, AstraZeneca, Chiesi, Fujifilm, GlaxoSmithKline and consultation fees from Boston Scientific. F. De Michele received payment or honoraria as a speaker from Chiesi and GlaxoSmithKline and consultation fees from AstraZeneca. G. Insalaco received payment or honoraria as a speaker from Bioprojet and ResMed and consultation fees from Bioprojet and Axome Therapeutics. A. Musarra received payment or honoraria as a speaker from A. Menarini, AstraZeneca and Sanofi. A. Spanevello received payment or honoraria as a speaker and a research grant from A. Menarini, AstraZeneca, Chiesi, GlaxoSmithKline, Merck Sharp and Dohme and Sanofi, and consultation fees from AstraZeneca, Chiesi, GlaxoSmithKline and Merck Sharp and Dohme. A. Vatrella received payment or honoraria as a speaker from A. Menarini, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Laboratori Guidotti, Lusofarmaco and Sanofi and a research grant from GlaxoSmithKline. C. Micheletto received payment or honoraria as a speaker from A. Menarini, AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Chiesi, Firma, GlaxoSmithKline, Laboratori Guidotti, Novartis, Roche, Sanofi and Zambon and consultation fees from AstraZeneca, Chiesi and GlaxoSmithKline. S. Barbaglia, F. Bini, G. Pomponio, S. Tognella, and L. Zuccatosta declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Treatment algorithm for patients with asthma.
See this image and copyright information in PMC

References

    1. Mattiuzzi C, Lippi G. Worldwide asthma epidemiology: insights from the global health data exchange database. Allergy. 2020;10(1):75‐80. 10.1002/alr.22464 - DOI - PubMed
    1. Stern J, Pier J, Litonjua AA. Asthma epidemiology and risk factors. Semin Immunopathol. 2020;42(1):5‐15. 10.1007/s00281-020-00785-1 - DOI - PubMed
    1. Annesi‐Maesano I, Sterlin C, Caillaud D, et al. Factors related to under‐diagnosis and under‐treatment of childhood asthma in metropolitan France. Multidiscip Respir Med. 2012;7(1):24. 10.1186/2049-6958-7-24 - DOI - PMC - PubMed
    1. Aaron SD, Vandemheen KL, FitzGerald JM, et al. Reevaluation of diagnosis in adults with physician‐diagnosed asthma. JAMA. 2017;317(3):269‐279. 10.1001/jama.2016.19627 - DOI - PubMed
    1. García‐Marcos L, Chiang CY, Asher MI, et al. Asthma management and control in children, adolescents, and adults in 25 countries: a Global Asthma Network Phase I cross‐sectional study. Lancet Global Health. 2023;11(2):e218‐e228. 10.1016/S2214-109X(22)00506-X - DOI - PMC - PubMed

Grants and funding

LinkOut - more resources