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Products & services that promote respiration, from newborn to adult.

The Air brand pillar is a portfolio of products and services related to the act of breathing, and the quality of air we breathe.

The current range of respiratory drugs falls under the Air brand pillar, as do neonatal products, as they are also focused on the respiratory system.



Chiesi Farmaceutici is fully committed to the care and improvement of the quality of life of people suffering from respiratory diseases including asthma and COPD (Chronic Obstructive Pulmonary Disease). Asthma and COPD are characterised by a reduction in the respiratory flow although they are driven by a different pathophysiological pathway.

According to the latest estimates of the WHO (World Health Organisation), there are 235 million people across the globe – mainly children - suffering from asthma, whilst 64 million people suffering from COPD (WHO 2004 estimate), which is predicted as being the third leading cause of mortality by 2030. If measures aimed at reducing disease-related risk factors – i.e. cigarette smoke - are not adopted, it is estimated that COPD-related deaths will increase by 30% in the next 10 years1.

In the search for continuous improvement in the health of patients, Chiesi Farmaceutici researches and develops new therapeutic solutions based on the innovative formulation technology Modulite®, which allows the creation of spray solutions(pMDI, pressurised Metered Dose Inhaler) for inhalation able to deliver extrafine particles. Chiesi Farmaceutici has patented and introduced into the market a dry powder-based medical device for inhalation(DPI, dry powder inhaler), NEXThaler, which is also able to deliver extrafine particles.


Asthma is a chronic inflammatory disease characterised by recurrent respiratory symptoms such as breathlessness, cough and wheezing as well as chest tightness. In normal conditions, the air is free to move within our lungs through a complex conductive system also called airways. In specific conditions and when asthmatic patient conditions are uncontrolled, the airways are more prone to inflammation, triggering an asthma attack. As a consequence, several changes occur including bronchoconstriction, thickening of the internal mucosa and plugging of small airways, which in turn make breathing more difficult. However, these clinical manifestations are basically reversible, although varying greatly over time or among patients. Generally, the asthmatic status tends to deteriorate during the night or the early hours of the morning. Although it is not possible to recover from asthma, optimal disease control is achievable, ensuring patients maintain an adequate quality of life. But what causes asthma? An asthmatic attack is triggered when a susceptible person encounters irritants. In particular, predisposing factors are genetic (which explains the greater incidence in those related to sufferers), the presence of allergies, female gender, obesity and ethnic origin. At the same time, factors such as allergens, professional pollutants, tobacco smoke, environmental pollution and airway infections may trigger an asthmatic attack if inhaled in significant quantities. Asthma occurs more frequently in children and adolescents, although in recent years diagnosis in adults and the elderly are becoming more and more frequent.2



 COPD is a respiratory disease characterised by a persistent bronchial obstruction (irreversible), associated with an increased chronic inflammatory response of the airways to noxious particles or gas. The classic symptoms associated with COPD are dyspnoea,  chronic coughing and chronic productive sputum. In some cases, an acute worsening of the abovementioned symptoms may occur, triggering COPD exacerbation. A double mechanism is at work in the bronchial obstruction in COPD patients: on one hand, an inflammation of the small airways together with the thickening of the airways walls and increased airflow resistance may occur,  on the other, a progressive destruction of lung parenchyma (emphysema) associated with the loss of elastic retraction of the lung may take place. It is important to underline that both mechanisms may coexist, leading to a global airflow reduction throughout the lungs. What are the main risk factors associated with COPD? First of all, there are genetic risk factors that may predispose some subjects to developing the disease. The most important risk factor is cigarette smoke, as well as exposure to domestic pollutants (linked to the cooking of food or gas emitted from biofuel combustion) or environmental pollution. Secondary factors are age, sex, socio-economic status, respiratory infections, asthma or chronic bronchitis. In general, COPD patients are more prone to developing cardiovascular diseases, osteoporosis, diabetes, lung cancer and bronchiectasis, which in turn increase hospitalisation and/or risk of death. Unlike asthma, COPD is a late onset disease, being more common among adults (it does not exist among young patients), since its development involves a slow and progressive exposure to risk factors.3



As a registered Benefit Corporation and the largest global biopharmaceutical group to be awarded B Corp™ Certification, Chiesi Group has taken active steps to formalize and apply its commitment to long-term sustainability and as a pharmaceutical company this gives us a dual role: taking care of our patients, but also of the environment.  

We support continuous research, investing in innovation to create more effective and environmentally friendly products while enhancing and preserving patient health.

In 2019 Chiesi was the first pharmaceutical company to announce its commitment to address the impact of propellant in pMDI, in line with our goal to become Carbon Neutral by 2035 also for scope 3 (read more here). We have committed €350 million in an investment plan to developing a new environmental-friendly solution that will preserve patients’ choice by replacing the current propellant in inhalers with an innovative low environmental impact propellant to reduce the impact of the propellant in pMDI (HFA152a), reducing the carbon footprint of our pMDI by nearly 90% in 2025, while continuing to invest in our DPI platform. 

We are proud to have taken decisive and ambitious action to ensure patients can continue to access the inhaled treatment options that best suit their needs, while continuing the research activities to find the most ecological solution available. We encourage other industry players to join us.



Physiological delivery takes place between the 37th and the 42nd week of gestation. By that time, the foetus is fully formed and developed enough to be able to adapt to extra-uterine life. However, in some cases, delivery may occur before the 37th week of gestation. In that case, the neonate is considered preterm.

The gestational age of the neonate determines the degree of development of many organs: for this reason, among the most common complications of prematurity, the maturation and functionality of the lungs is particularly important, as it is critical for survival. Based on the degree of prematurity, lungs can be partially or even completely immature, and thus unable to ensure an adequate respiratory function.

For nearly 30 years, Chiesi has been deeply committed to Neonatology. Working alongside the medical community and investing in Neonatal Research & Development, Chiesi has the ultimate mission to offer innovative and effective treatment options to improve the level of care for preterm babies. Thanks to this continuous commitment and working towards the sharing of best clinical practices, Chiesi has become a global partner for neonatologists, bringing its life-saving medicinal products in nearly 100 countries worldwide.


The incomplete development of the respiratory system and the areas of the brain that regulate respiration is a common issue in preterm infants, with severity increasing in babies with a low birthweight. Immaturity of the central nervous system often results in episodes of spontaneous apnoea, which is usually defined as a cessation of breathing lasting more than 20 seconds. Clinically, this interruption may be accompanied by a slower heart rate and/or a reduction of the quantity of oxygen in the blood. Visually, an apnoeic infant experiencing an apnoeic episode shows pale or cyanotic skin tone, together with a reduction in muscle tone. Lower gestational age is associated with a higher risk of apnoeic episodes, which generally begin between 2 and 3 days of life.

Milder episodes can be resolved by tactile stimulation of the neonate, while more severe episodes need pharmacological intervention with stimulant drugs, such as caffeine.

Adenosine is a neurotransmitter that modulates neuronal activity and reduces the breathing effort. Caffeine directly opposes this effect by blocking the interaction of adenosine with its cellular receptors, thus resulting in an enhanced breathing rate.


RDS (Respiratory Distress Syndrome)

Neonatal respiratory distress syndrome is a frequent condition in preterm infants. Rather than identifying a single pathology, RDS is usually used to identify a complex clinical picture whose symptoms are due to an under-development of the respiratory system. Severity and incidence of RDS are directly linked with the degree of prematurity, with infants born before the 28th week of gestation being at greater risk.

Respiratory failure in preterm infants with RDS is due to a shortage in the pool of pulmonary surfactant, which helps to create a film covering the inner walls of the alveoli. The physiological role of surfactant is to allow the lungs to expand and avoid collapse (atelectasis) during the expiratory phases. Lack of surfactant results in difficulty in breathing, with low oxygenation, increased breathing effort and the need for respiratory support.

The pool of available surfactant in a preterm infant is usually extremely limited compared to that of a term neonate and further decreases as a result of RDS itself. When necessary, the administration of exogenous surfactant can alleviate the symptoms of this syndrome, by supplementing the endogenous pool of surfactant, thereby enabling the surfactant film to be replenished.



Cystic fibrosis is a hereditary genetic disease. A mutation of the CF gene causes an alteration in a protein called CFTR, which is present in all the organs and regulates the exchange of sodium chloride and water through cell membranes. The organs most affected by the disease are the lungs and the pancreas; in the former, thick, sticky secretions occur, thus helping to create the ideal environment for the development of bacteria such as Pseudomonas aeruginosa, meaning that sufferers are prone to recurrent infections and inflammation, which can in turn also represent serious conditions such as pneumonia.

Chronic inflammatory processes can damage lung tissue over the course of time and subsequently lead to impaired respiratory function, which is the main cause of mortality in these patients. The symptoms of infection are numerous and the degree of severity varies from case to case and from moment to moment: persistent cough, breathing difficulties, expectoration, reduced stamina for physical activity, loss of appetite, a sense of feeling generally unwell and temperature.