Challenges and barriers in pediatric to adult Transition in Chronic Pulmonary Diseases (CPD) in Italy: a nationwide Survey

BACKGROUND: Advances in medical research, early diagnosis, and therapeutic strategies have significantly improved survival among children with chronic pulmonary diseases (CPDs), leading to a growing population of adolescents and young adults transitioning to adult care. Despite this demographic shift, healthcare systems, including Italy's, remain inadequately equipped to manage the evolving needs of these patients. This study aims to identify key barriers and unmet needs within the Italian healthcare system regarding the transition from pediatric to adult care for individuals with CPDs. METHODS: A nationwide survey was conducted among members of SIMRI (Italian Society for Childhood Respiratory Diseases) through a questionnaire consisting of thirteen questions. The survey was sent between June and August 2023, with responses collected until July 2024. RESULTS: A total of Fifty-one responses were collected from pulmonologists, hospital-based pediatricians, primary care pediatricians, and adult pulmonologists from 14 Italian regions. Of these, 64.7% reported the absence of a structured transition program within their institutions. Where programs existed, they primarily targeted severe asthma (60.6%) and PCD or non-CF bronchiectasis (24.2%). Only 15.7% of respondents consistently addressed transition with patients and families, and 13.8% of centers had dedicated transition clinics. Proposed improvements included the establishment of specialized clinics (76.5%) and targeted professional training (72.5%). CONCLUSIONS: The transition of CPDs patients in Italy is currently fragmented and underdeveloped. Standardized protocols, dedicated transition services, interdisciplinary collaboration, continuous education, and involvement of patient associations are essential to ensure continuity of care and optimize long-term health outcomes.