Summary
Chronic respiratory diseases affect a large number of subjects in Italy and are characterized by high socio-health costs. The aim of the Social Impact of Respiratory Integrated Outcomes (SIRIO) study was to measure the health resources consumption and costs generated in 1 year by a population of patients with chronic obstructive pulmonary disease (COPD) in a real-life setting. This bottom-up, observational, prospective, multicentric study was based on the collection of demographic, clinical, diagnostic, therapeutic and outcome data from COPD patients who reported spontaneously to pneumological centers participating in the study, the corresponding economic outcomes being assessed at baseline and after a 1-year survey. A total of 748 COPD patients were enrolled, of whom 561 [408 m, mean age 70.3 years (SD 9.2)] were defined as eligible by the Steering Committee. At the baseline visit, the severity of COPD (graded according to GOLD 2001 guidelines) was 24.2% mild COPD, 53.7% moderate and 16.8% severe. In the 12 months prior to enrollment, 63.8% visited a general practitioner (GP); 76.8% also consulted a national health service (NHS) specialist; 22.3% utilized Emergency Care and 33% were admitted to hospital, with a total of 5703 work days lost. At the end of the 1-year survey, the severity of COPD changed as follows: 27.5% mild COPD, 47.4% moderate and 19.4% severe. Requirement of health services dropped significantly: 57.4% visited the GP; 58.3% consulted an NHS specialist; 12.5% used Emergency Care and 18.4% were hospitalized. Compared to baseline, the mean total cost per patient decreased by 21.7% (po0.002). In conclusion, a significant reduction in the use of health resources and thus of COPD-related costs (both direct and indirect costs) was observed during the study, likely due to a more appropriate care and management of COPD patients.

Relevance
Due to the strategic value of the initiative—something of a novelty in our country—SIRIO was promoted by UIP (Unione Italiana per la Pneumologia–Italian Union for
Pneumology) and endorsed by the following scientific societies: AIPO—Associazione Italiana Pneumologi Ospeda- lieri (Italian Association of Hospital Pneumologists) and SIMeR—Societ`a Italiana Medicina Respiratoria (Italian So- ciety of Respiratory Medicine).
Materials and methods The SIRIO/COPD study consisted in the creation of an on-line pharmacoeconomic network on COPD in Italy. The study was not designed to evaluate pharmaceutical drugs, nor ther- apeutic strategies, nor diagnostic procedures: its aim was purely to provide an updated estimate of the economic cost of COPD in an Italian population affected by this disease. The choice of a prospective design allowed a greater precision in describing the different items for expenditure, the quality, specificity and speed of data calculation being optimized by a dedicated software system for the collection and on-line analysis of data.