{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:04:16Z","timestamp":1785146656648,"version":"3.55.0"},"reference-count":16,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>In Italy, demographic aging, increasing multimorbidity, and the growing burden of chronic respiratory conditions have highlighted the need for a reorganization of community-based respiratory services, as outlined by the Italian Ministerial Decree 77\/2022, which promotes integrated, proximity-based models of care. Community-based pulmonology care represents a potentially pivotal component of healthcare systems for the management of chronic and complex respiratory diseases. A national, anonymous, web-based survey was conducted among Italian pulmonologists working in territorial and community healthcare settings. The questionnaire explored organizational structures, clinical and diagnostic activities, availability of technological resources, care pathways, continuity of care, and integration with hospital services. A total of 168 valid questionnaires were collected and analyzed using descriptive methods. The survey revealed substantial heterogeneity across regions and healthcare organizations in terms of structural models, availability of diagnostic and interventional procedures, multidisciplinary teams, and access to telemedicine solutions. While several community services provide advanced outpatient and home-based respiratory care, significant gaps persist in standardized care pathways, timely access to functional respiratory diagnostics, and structured follow-up of chronic patients. Limitations in direct access to hospitalization pathways further contribute to fragmentation of care and potentially optimizable use of emergency medical services. This survey provides an initial, comprehensive overview of the current state of community-based pulmonology in Italy. The collected data represent a foundational framework for further in-depth analyses aimed at defining shared minimum standards, strengthening hospital\u2013community integration, and supporting the development of a more equitable, efficient, and patient-centered model of respiratory care.<\/jats:p>","DOI":"10.4081\/monaldi.2026.4135","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:13:47Z","timestamp":1785143627000},"source":"Crossref","is-referenced-by-count":0,"title":["The Italian Community-based Pulmonology Manifesto: a national survey exploring the current state, critical issues, and perspectives for a national reference model"],"prefix":"10.4081","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2731-5809","authenticated-orcid":false,"given":"Marco","family":"Contoli","sequence":"first","affiliation":[{"name":"Respiratory Medicine, Department of Translational Medicine, University of Ferrara; Community-based Pulmonology, Ferrara Local Health Authority"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2997-4178","authenticated-orcid":false,"given":"Marco","family":"Biagini","sequence":"additional","affiliation":[{"name":"Community-based Pulmonology, Toscana Sud-Est Local Health Authority \u2013 Arezzo, Siena, Grosseto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Onorati","sequence":"additional","affiliation":[{"name":"Pulmonology and Respiratory Pathophysiology Unit, Alghero Health District, Sassari Local Health Authority-1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Sotgiu","sequence":"additional","affiliation":[{"name":"Department of Medical, Clinical Epidemiology and Medical Statistics Unit, Surgical and Experimental Sciences, University of Sassari"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Trevisan","sequence":"additional","affiliation":[{"name":"Community-based Pulmonology, Territorial Specialist Department, Giuliano Isontina University Health Authority, Gorizia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Castellani","sequence":"additional","affiliation":[{"name":"Respiratory Unit, P. Palagi Hospital, Toscana Centro Local Health Authority, Florence"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"83739","unstructured":"Italian Ministry of Health. Ministerial Decree no. 77 of May 23, 2022. Regolamento recante la definizione di modelli e standard per lo sviluppo dell\u2019assistenza territoriale nel Servizio Sanitario Nazionale. GU Serie Generale n. 144 del 22-06-2022."},{"key":"83740","unstructured":"WHO. Chronic respiratory diseases in the WHO European Region. Available from: https:\/\/iris.who.int\/handle\/10665\/381512. ."},{"key":"83741","doi-asserted-by":"crossref","unstructured":"Boers E, Barrett M, Su JG, et al. Global burden of chronic obstructive pulmonary disease through 2050. JAMA Netw Open 2023;6:e2346598.","DOI":"10.1001\/jamanetworkopen.2023.46598"},{"key":"83742","doi-asserted-by":"crossref","unstructured":"Chronic Respiratory Diseases Collaborators. Global burden of chronic respiratory diseases and risk factors, 1990\u20132019: an update from the Global Burden of Disease Study 2019. eClinicalMedicine 2023;59:101936.","DOI":"10.1016\/j.eclinm.2023.101936"},{"key":"83743","doi-asserted-by":"crossref","unstructured":"Chen S, Kuhn M, Prettner K, et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modelling study. Lancet Glob Heal 2023;11:e1183-93.","DOI":"10.1016\/S2214-109X(23)00217-6"},{"key":"83744","doi-asserted-by":"crossref","unstructured":"Santoni A, Wait S, van Boven JFM , et al. Improving care for people with chronic respiratory diseases: taking a policy lens. Adv Ther 2025;42:2569-86.","DOI":"10.1007\/s12325-025-03191-x"},{"key":"83745","unstructured":"Italian Republic. Legislative Decree No. 502 of 30 December 1992, as amended. Reorganization of healthcare regulation pursuant to Article 1 of Law No. 421 of 23 October 1992. GUn. 350 del 1-01-1993."},{"key":"83746","doi-asserted-by":"crossref","unstructured":"Dai Z, Ma Y, Zhan Z, et al. Analysis of diagnostic delay and its influencing factors in patients with chronic obstructive pulmonary disease: a cross-sectional study. Sci Rep 2021;11:14213.","DOI":"10.1038\/s41598-021-93499-9"},{"key":"83747","doi-asserted-by":"crossref","unstructured":"Parretti C, Regina ML, Tortu C, et al. Telemedicine in Italy, the starting point. Intern Emerg Med 2023;18:949-51.","DOI":"10.1007\/s11739-022-03176-6"},{"key":"83748","doi-asserted-by":"crossref","unstructured":"The Italian health data system is broken. Lancet Reg Health Eur 2025;48:101206.","DOI":"10.1016\/j.lanepe.2024.101206"},{"key":"83749","unstructured":"European Commision. European Health Data Space Regulation (EHDS) 2025. Available from: https:\/\/health.ec.europa.eu\/index_en?prefLang=it."},{"key":"83750","doi-asserted-by":"crossref","unstructured":"Agusti A, Alcazar B, Cosio B, et al. Time for a change: anticipating the diagnosis and treatment of COPD. Eur Respir J 2020;56:2002104.","DOI":"10.1183\/13993003.02104-2020"},{"key":"83751","doi-asserted-by":"crossref","unstructured":"Singh D, Litewka DF, Soriano JB, et al. Delaying disease progression in COPD with early escalation to triple therapy: a modelling study (DEPICT-2). ERJ Open Res 2025;11:00438-02024.","DOI":"10.1183\/23120541.00438-2024"},{"key":"83752","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Available from: https:\/\/goldcopd.org\/wp-content\/uploads\/2026\/01\/GOLD-REPORT-2026-v1.3-8Dec2025_WMV2.pdf."},{"key":"83753","doi-asserted-by":"crossref","unstructured":"Piscitelli P, Miani A, Schittulli F, et al. Recognizing the limits of the 21 different Italian healthcare regional systems: an opportunity for change? Lancet Reg Heal Eur 2025;51:101250.","DOI":"10.1016\/j.lanepe.2025.101250"},{"key":"83754","doi-asserted-by":"crossref","unstructured":"Evans T, Elliott MW, Ranieri M, et al. Pulmonary medicine and (adult) critical care medicine in Europe. Eur Respir J 2002;19:1202-6.","DOI":"10.1183\/09031936.02.00307502"}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4135\/2247","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4135\/2248","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4135\/2247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:13:53Z","timestamp":1785143633000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/4135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":16,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2026.4135","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}