The Italian Community-based Pulmonology Manifesto: a national survey exploring the current state, critical issues,...

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-community integration, and supporting the development of a more equitable, efficient, and patient-centered model of respiratory care.