Occupational therapy, degree of disability and quality of life in COPD inpatients undergoing pulmonary rehabilitation programs

Asthma in the Elderly: Risk Factors and Mortality Rate

Pharmacological Management of Elderly Patients with Asthma–Chronic Obstructive Pulmonary Disease Overlap Syndrome: Room for Speculation?

Asthma and chronic obstructive pulmonary disease (COPD) are two distinct diseases that share a condition of chronic inflammation of the airways and bronchial obstruction. In clinical settings, it is not rare to come across patients who present with clinical and functional features of both diseases, posing a diagnostic dilemma. The overlap condition has been termed asthma–COPD overlap syndrome (ACOS), and mainly occurs in individuals with long-standing asthma, especially if they are also current or former smokers. Patients with ACOS have poorer health-related quality of life and a higher exacerbation rate than subjects with asthma or COPD alone. Whether ACOS is a distinct nosological entity …

Inhalation therapy devices for the treatment of obstructive lung diseases: the history of inhalers towards the ideal inhaler.

Inhalation therapy allows conveying drugs directly into the airways. The devices used to administer inhaled drugs play a crucial role in the management of obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). To ensure high bronchial deposition of the drug, a device should deliver a high proportion of fine particles, be easy to use, and provide constant and accurate doses of the active substance. Nowadays, four different types of inhalers are widely used: nebulizers, dry powder inhalers (DPIs), pressurized metered-dose inhalers (pMDIs), and soft mist inhalers (SMIs). Nebulizers can be used by patients unable to use other inhalers. However, they require l…

The asthma-COPD overlap syndrome (ACOS): hype or reality? That is, a curiosity for the media or an opportunity for physicians?

Asthma-COPD Overlap Syndrome (ACOS) has been recently defined as a new pathological entity. Most studies support a large difference in the pathophysiology of bronchial asthma and chronic obstructive pulmonary disease (COPD). However, there is evidence of an increasing prevalence of patients in whom the two diseases coexist or in which one condition evolves into the other, leading to the pathological condition named ACOS. This occurs mainly in individuals with long-standing asthma, especially if also current or former-smokers. Indeed, epidemiological studies show that aging is one of the main risk factors for ACOS, creating the basis for the two entities to converge on the same subject. It i…

Prognostic significance of surrogate measures for FVC in an elderly population

Applicability of the asthma control test (ACT) in elderly asthmatics

Additional benefits of beclomethasone/formoterol extrafine combination treatment on small airways function in asthma

Effects on Small Airways of Two Different Combination Treatments for Asthma.

La spirometria nell'anziano

Riproducibilità intraindividuale del FEV6 in soggetti anziani

Month of birth and allergic sensitization in the Mediterranean area of southern Italy

• Efficacy of school prevention programs in rising tobacco awareness in adolescents;

• Efficacy of school prevention programs in rising tobacco awareness in adolescents;

ASTHMA–COPD OVERLAP SYNDROME (ACOS): PREVALENZA, QUALITÀ DI VITA CORRELATA ALLO STATO DI SALUTE E IMPLICAZIONI PROGNOSTICHE DI UNA NUOVA ENTITÀ NOSOLOGICA

FEV6: Behaviour and Correlates in the Elderly

Physician's mistakes in the interpretation of spirometry

Background. The most recent ATS/ERS recommendations on lung function testing include a definition of airflow obstruction based on lower limit of normal (LLN) of FEV1/FVC and suggest to measure total lung capacity (TLC) in suspected cases of “pseudo-restriction” (normal FEV1/FVC ratio because of concomitant reductions in FEV1 and FVC), that can conceal airflow obstruction if the subject does not exhale long enough. Aims. To evaluate the skill of physicians in the interpretation of spirometry. Methods. A questionnaire focusing on the interpretation of five spirograms was administered to 127 physicians (aged 25-67yrs; 39% pulmonologists, 20% geriatrics). Correlates of spirometric misinterpreta…

Authors’ response

Claudio Sorino,1,2 Salvatore Battaglia,1 Nicola Scichilone,1 Claudio Pedone,3 Raffaele Antonelli-Incalzi,3 Duane Sherrill,4 Vincenzo Bellia11Biomedical Department of Internal and Specialist Medicine, Section of Pulmonology, University of Palermo, Italy; 2Division of Pulmonology, S Anna Hospital, Como, Italy; 3Chair of Geriatrics, University Campus Bio-Medico, Roma, Italy; 4Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USABackground: The choice between lower limit of normal or fixed value of forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC) < 0.70 as the criterion for confirming airway obstruction is an open issue. In t…

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was l…

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary anti…

Fifteen-year mortality of patients with asthma-COPD overlap syndrome

Abstract Background The coexistence of asthma and chronic obstructive pulmonary disease (asthma–COPD overlap syndrome: ACOS) is increasingly recognized but data about its prevalence and long-term mortality are needed. Methods Prevalence of ACOS and 15-year mortality rates were assessed in 1065 subjects aged > 65 years, enrolled in the SA.R.A. study, with complete clinical, lung functional and follow-up data. Physical performance, disease-related disability, and health-related quality of life (HRQL) were also evaluated. Results ACOS was found in 11.1% of subjects (29.4% of those previously diagnosed with COPD and 19.7% of those with asthma). ACOS was positively associated with impaired physi…

Disability in moderate chronic obstructive pulmonary disease: Prevalence, burden and assessment-results from a real-life study

<b><i>Background:</i></b> The role of disability and its association with patient-reported outcomes in the nonsevere forms of chronic obstructive pulmonary disease (COPD) has never been explored. <b><i>Objectives:</i></b> The aim of this study was to assess, in a cross-sectional real-life study, the prevalence and degree of disability in moderate COPD patients and to assess its association with health status, illness perception, risk of death and well-being. <b><i>Methods:</i></b> Moderate COPD outpatients attending scheduled visits were involved in a quantitative research program using a questionnaire-based data collec…

Criteri spirometrici per la diagnosi di bronco-ostruzione in soggetti anziani

FEV1/FEV6 and FEV6: sensitivity and specificity in detecting obstructive and restrictive disease of older patients

Correction to: When kidneys and lungs suffer together

A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function. Renal failure in COPD can be unrecognized since elderly and frail patients…

Diagnosis and management of asthma in the elderly.

Bronchial asthma is one of the most common chronic diseases worldwide, and by definition not expected to recover with aging. However, the concept that asthma can affect older individuals has been largely denied in the past. In clinical practice, asthma that occurs in the most advanced ages is often diagnosed as COPD, thus leading to undertreatment or improper treatment. The heterogeneity of clinical and functional presentation of geriatric asthma, including the partial loss of reversibility and of the allergic component, contributes to this misconception. A large body of evidence has accumulated demonstrating that the prevalence of asthma in the most advanced ages is similar to that in youn…

The mini nutritional assessment (MNA) and the perception of dyspnea in elderly subjects with COPD. The MINUTRA project

Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research Question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study Design and Methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidi…

Prognostic value of FEV1/FEV6 in elderly people*

Summary Background:  The ratio of forced expiratory volume in 1 s and forced expiratory volume in 6 s (FEV1/FEV6) has been proposed as an alternative for FEV1/forced vital capacity (FVC) to diagnose obstructive diseases with less effort during spirometry; however, its prognostic value is unknown. We evaluated whether FEV1/FEV6 is a significant predictor of mortality in elderly subjects and compared its prognostic value with that of FEV1/FVC and FEV1. Methods:  One thousand nine hundred and seventy-one subjects, aged >65 years, participated in the population-based SA.R.A. study. During the baseline exam, a multidimensional assessment included spirometry. Vital status was determined during 6 …

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Abstract Background The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results At least 1 risk factor for immunocompromis…

Le cure palliative nel paziente anziano con broncopneumopatia cronica ostruttiva

Asthma-COPD overlap syndrome: recent advances in diagnostic criteria and prognostic significance.

The term asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) has been proposed for individuals with features of both asthma and COPD. Several attempts have been done to define ACOS on the basis of medical history, symptoms, and functional findings. The main diagnostic criteria include airflow obstruction with a strong although incomplete reversibility to bronchodilation tests, a significant exposure to cigarette or biomass smoke, and a history of atopy or asthma. Additional diagnostic elements include eosinophilic airway and systemic inflammation, a good response to corticosteroid treatment, and a high concentration of exhaled nitric oxide. ACOS should be distinguish…

L'applicabilità del test per il controllo dell'asma (ACT) negli asmatici anziani: osservazioni preliminari

Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study

BACKGROUND: Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are available on the worldwide prevalence and risk factors for MRSA pneumonia. We aimed to determine the point prevalence of MRSA pneumonia and identify specific MRSA risk factors in community-dwelling patients hospitalised with pneumonia.METHODS: We did an international, multicentre study of community-dwelling, adult patients admitted to hospital with pneumonia who had microbiological tests taken within 24 h of presentation. We recruited investig…

Allergen sensitizations in southern Italy: a 5-year retrospective study in allergic respiratory patients

The assessment of the distribution of allergen skin test sensitizations is highly recommended for the optimal management of allergic respiratory conditions. We aimed at evaluating the distribution of allergen sensitizations in individuals with asthma and/or rhinitis in the Southern region of ltaly, and at exploring whether changes in the frequency of allergen sensitizations occurred after a 5-year period. Demographic data and skin prick test sensitizations to allergens from asthmatics and/or rhinitis attending the Division of Respiratory Diseases, University of Palermo, Italy in 2005 (Phase 1) and in 2010 (Phase 2) were extrapolated and retained for analysis. A total of 2033 allergic respir…

Acute painful paraplegia in a 49-year-old man with allergic asthma.

We present a case of a 49-year-old man, with a 10-year history of bronchial asthma and nasal polyposis, who developed acutely painful paraplegia and paresthesias. Laboratory data showed elevated blood creatine kinase levels and myoglobinuria, which were diagnostic for rhabdomyolysis but only partially explained the neurological deficit. Electrophysiological studies revealed a sensorimotor neuropathy of multiple mononeuritis type. The patient also had leucocytosis with marked eosinophilia and antineutrophil cytoplasmic autoantibodies. Bronchial biopsies showed inflammatory infiltrates with a prevalence of eosinophils. All these findings led us to diagnose eosinophilic granulomatosis with pol…

Validation of FEV6 in the elderly: correlates of performance and repeatability.

BACKGROUND: Forced expiratory volume in 6 s (FEV6) has been proposed as a more easily measurable parameter than forced vital capacity (FVC) to diagnose airway disease using spirometry. A study was undertaken to estimate FEV6 repeatability, to identify correlates of a good quality FEV6 measurement and of volumetric differences between FEV6 and FVC in elderly patients. METHODS: 1531 subjects aged 65-100 years enrolled in the SA.R.A project (a cross-sectional multicentre non-interventional study) were examined. FEV6 was measured on volume-time curves that achieved satisfactory start-of-test and end-of-test criteria. Correlates of FEV6 achievement were assessed by logistic regression. RESULTS: …

Frequent Exacerbators in COPD: Who Are They?

Smoking cessation, anxiety, mood and quality of life: reassuring evidences.

A close and complex relationship between smoking and mental health problems was found. Different hypotheses have been proposed to explain these associations: 1) smoking and poor mental health may share common causes (genetic factors or environmental mechanisms); 2) for people with poor mental health smoking is a coping strategy to regulate psychiatric symptoms; 3) smokings worsen mental health. Moreover, smokers with psychiatric disorders may have more difficulty quitting and patients with mental diseases who received mental health treatment within the previous year were more likely to stop smoking than those not receiving treatment. Taylor et al. hypothesized that quitting smoking might im…

15-years mortality in asthma-COPD overlap syndrome (ACOS) elderly population

Background: The coexistence of asthma and chronic obstructive pulmonary disease (Asthma-COPD Overlap Syndrome: ACOS) is increasingly recognized. Data about the prevalence of ACOS in the elderly and its prognostic implications are unknown. Aim: To evaluate the long-term mortality of ACOS in an elderly population. Methods: 1970 subjects, aged >65 yrs, were enrolled in the population-based SA.R.A. Study. ACOS was defined as: not fully reversible airflow limitation + a) history of asthma or b) very positive bronchodilator test (increase in FEV1 ≥15% and ≥400 ml) + atopy + weezing. The prevalence of ACOS and 15-years mortality rates were assessed in 1063 subjects with complete clinical, lung fun…

Prognostic significance of surrogate measures for forced vital capacity in an elderly population.

Objectives To evaluate whether measures easier to obtain than the FVC can substitute it as a prognostic marker in elderly people. Design Prospective, observational study. Setting Community. Participants Outpatients (n = 1485) aged 73.4 years (SD: 6.2 range 65–98) enrolled in the Salute Respiratoria nell'Anziano (SaRA) study. Measurements We calculated the risk for mortality associated with a reduction below 80% of the predicted FVC, of the forced expiratory volume at 6 seconds (FEV6), and of a surrogate measure for forced vital capacity (SFVC), defined as the largest volume exhaled in 2 forced maneuvers regardless of its duration and of the presence of plateau. Results Among the 907 partici…

Effects of extra-fine inhaled beclomethasone/formoterol on both large and small airways in asthma

Background: Airway inflammation in asthma involves both large and small airways, and the combination of inhaled corticosteroids (ICS) and long acting beta-2 agonists (LABA) is the mainstay of therapy. Available inhaled combinations differ in terms of drug delivery to the lung and the ability to reach small airways. Aim: To evaluate whether treatment with an extra-fine inhaled combination provides additional effects vs a nonextra-fine combination on airway function. Methods: After a 1- to 4-week run-in period, patients with asthma were randomized to a double blind, double dummy, 12-week treatment with either extra-fine beclomethasone/formoterol (BDP/F) 400/24 lg daily or fluticasone propiona…

Prognostic value of FEV1/FEV6 in elderly people

When kidneys and lungs suffer together

A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one. Subjects suffering from COPD may have systemic inflammation, hypoxemia, endothelial dysfunction, increased sympathetic activation and increased aortic stiffness. As well as the exposure to nicotine, all the foresaid factors can induce a microvascular damage, albuminuria, and a worsening of renal function. Renal failure in COPD can be unrecognized since elderly and frail patients…

Factors affecting the measurement of FVC in the elderly