Sputum metalloproteinase-9/tissue inhibitor of metalloproteinase-1 ratio correlates with airflow obstruction in asthma and chronic bronchitis

Asthma and chronic bronchitis are inflammatory diseases with extracellular matrix (ECM) remodeling and collagen deposition. Collagen homeostasis is controlled by metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). We evaluated MMP and TIMP balance in induced sputum of 10 control, 31 untreated asthmatic, and 16 chronic bronchitic subjects. We first performed zymographic analysis to identify the profile of MMPs. Zymography revealed a similar MMPs profile in all populations studied and that MMP-9 was the major enzyme released. We then measured, using enzyme immunoassay, the concentrations of MMP-9 and of its inhibitor TIMP-1 and evaluated whether airflow limitation m…

Repeated Hyperosmolar Exposure Of Bronchial Epithelial Cells: A Model Of Exercise-Induced Airways Damage

Clinical implications of airway hyper-responsiveness in COPD

COPD represents one of the leading causes of mortality in the general population. This study aimed at evaluating the relationship between airway hyperresponsiveness (AHR) and COPD and its relevance for clinical practice. We performed a MEDLINE search that yielded a total of 1919 articles. Eligible studies were defined as articles that addressed specific aspects of AHR in COPD, such as prevalence, pathogenesis, or prognosis. AHR appears to be present in at least one out of two individuals with COPD. The occurrence of AHR in COPD is influenced by multiple mechanisms, among which impairment of factors that oppose airway narrowing plays an important role. The main determinants of AHR are reduct…

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

Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options

Asthma is a chronic inflammatory disorder of the airways that requires long-term treatment, the goal of which is to control clinical symptoms for extended periods with the least possible amount of drugs. International guidelines recommend the addition of an inhaled long-acting beta2-agonist (LABA) to a low- to medium-dose inhaled corticosteroid (ICS) when low doses of ICS fail to control asthma symptoms. The fixed combined administration of ICS/LABA improves patient compliance, reducing the risk of therapy discontinuation. The relative deposition pattern of the inhaled drug to the target site is the result of a complex interaction between the device used, the aerosol formulation and the pat…

Deep inspiration-induced changes in lung volume decrease with severity of asthma

Summary We have previously reported that the magnitude of deep inspiration (DI)-induced bronchodilation is only slightly reduced in mild asthmatics, compared to healthy subjects. The aim of this study was to evaluate whether increased severity of asthma is associated with impairment in the ability of DI to induce changes in lung volume. Thirty-six consecutive asthmatics recruited from the Pulmonary and the Allergy Outpatient Clinics of the Institute of Respiratory Diseases of the University of Palermo were divided into 3 groups: Intermittent (I), Mild Persistent (MP) and Moderate–Severe (MS), based on GINA guidelines. Single dose methacholine (Mch) bronchoprovocations were performed in the …

Asthma in the Elderly: Risk Factors and Mortality Rate

Lung Compartmentalization of Increased TNF Releasing Ability by Mononuclear Phagocytes in Pulmonary Sarcoidosis

The TNF is a monokine with cytotoxic and tumor-necrosing activities; in addition, TNF may play a role in inflammatory processes. The present study evaluates spontaneous and LPS-mediated release of TNF by AMs and autologous peripheral BMs of normal subjects and patients with pulmonary sarcoidosis. A recently developed cytotoxicity assay, specific for detection of TNF activity, was applied. This study demonstrates that (1) unstimulated mononuclear phagocytes released low levels of TNF with no differences between groups; (2) when effector cells were stimulated with LPS, AMs from patients with active pulmonary sarcoidosis released more TNF than AMs recovered from normal subjects and from patien…

Cytotoxic lymphocytes show reduced expression of cd94/NKG2A and perforin in malignant pleural effusions

The attenuation of bronchodilatory effect of deep inspiration (DI) in COPD is related to reduced airway distensibility as measured by HRCT.

Cigarette smoke upregulates TLR4 expression and enhances TLR4 mediated responses

The Bronchodilatory Ability of Deep Inspiration (DI) Is Impaired in Scleroderma

Quality Control of Spirometry in the Elderly

We evaluated the outcome of the spirometry quality control program of the SA.R.A. multicenter project, the aim of which is the multidimensional assessment of asthma and COPD in the elderly ( ⩾ 65 yr). The factors determining this quality were also evaluated. The program was based on standardized procedures (ATS recommendations), performed by specifically trained and certified personnel; a fully-computerized spirometer with customized software was used for spirometry. A reference center made monthly controls. Overall, 638 cases and 984 controls were examined. Spirometric measurements were obtained in 607 cases and 912 controls; 508 and 747 tests with at least three acceptable curves were obt…

Obstructive sleep apnea does not affect circulating hematopoietic precursors

Physician specialty as a source of heterogeneity in the care of patients with COPD.

GOLD Staging System is Appropriate to Predict Mortality in Older People With Chronic Obstructive Pulmonary Disease

Abstract Introduction In the new GOLD classification the reduction of FEV1, expressed as percentage of predicted value (FEV1PP), is considered an important prognostic factor. However, the use of FEV1PP may introduce bias, especially if based on equations derived from populations different from the one under study. We evaluated how well the GOLD classification stratifies the mortality risk when FEV1PP is based on an equation developed in the same population that gave rise to cases, externally developed equations, or as FEV1 divided by cubed height (FEV1/Ht3). Methods We studied 882 participants aged ≥65 years. Bronchial obstruction was defined using a fixed cut-off of 0.7 for FEV1/FVC. Predi…

Moderately cold weather increases bronchial epithelial cells (BECs) and apoptosis in induced sputum of long-distance runners.

What proportion of chronic obstructive pulmonary disease outpatients is eligible for inclusion in randomized clinical trials?

<b><i>Background and Objective:</i></b> We aimed to explore to what extent an unselected population of chronic obstructive pulmonary disease (COPD) outpatients would be eligible for inclusion in randomized clinical trials (RCTs). <b><i>Methods:</i></b> Retrospective analysis of the clinical records of outpatient subjects with an ascertained diagnosis of COPD. COPD outpatients were assessed against the following inclusion criteria: 40 < age < 80 years, current or former smokers, forced expiratory volume in the first second (FEV<sub>1</sub>) <70% predicted, no long-term oxygen therapy, no other concomitant lung diseases and …

Patologia non neoplastica della pleura

Early Lung Function Abnormalities in Acromegaly.

BACKGROUND: Acromegaly is an insidious disorder caused by a pituitary growth hormone (GH)-secreting adenoma resulting in high circulating levels of GH and insulin-like growth factor I (IGF-I). Respiratory disorders are common complications in acromegaly, and can severely impact on quality of life, eventually affecting mortality. OBJECTIVES: The present study aimed to explore structural and functional lung alterations of acromegalic subjects. METHODS: We enrolled 10 consecutive patients (M/F: 5/5) affected by acromegaly. In all patients, magnetic resonance imaging (MRI) revealed the presence of pituitary tumor. All patients underwent clinical, lung functional, biological, and radiological as…

Tumori polmonari

Malattie dell'apparato respiratorio

L’asma bronchiale

Intensive physical training reduces the airway response to methacholine in healthy subjects

Prognostic significance of surrogate measures for FVC in an elderly population

L'effetto bronchodilatatore dell'inspirazione profonda migliora dopo corticosteroide inalatorio nell'asma

Cellular network in airways inflammation and remodelling

Chronic inflammation and airway remodelling are two key steps in asthma pathophysiology. The development of chronic airway inflammation depends upon the continuous recruitment of inflammatory cells from the bloodstream towards the bronchial mucosa and by their subsequent functional activation. The release of inflammatory mediators by activated cells contributes to the generation of a complex network which involves mobile inflammatory cells and structural cells such as epithelial cells, fibroblasts and myofibroblasts. This network is responsible for the amplification and persistence of the inflammatory process as well as for the development of a peculiar microenvironment which can directly m…

Non-invasive diagnosis in a case of bronchopulmonary sequestration and proposal of diagnostic algorhythm

The case of a 43-year-old woman with intralobar pulmonary sequestration, Pryce type one, is presented. The medical history was characterised by recurrent bronchopneumonia, productive cough with purulent sputum and hemoptysis in the last three years. Diagnosis was made by CT angiography: multiplanar, maximum intensity projection and volume rendering reconstructions were visualised. A volume reduction of middle and lower lobe with multiple cyst-like bronchiectasis was detected and no evident relationship with tracheobronchial tree was pointed out. Reconstructions aimed at evaluating bronchial structures demonstrated no patency of middle and lower lobar bronchi. The study carried out after con…

Cigaretta smoke up-regulates toll like receptor 4 (TLR4) expression and enhances TLR4 mediated responses

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

Asthma in the elderly

Asthma is frequent among older people. Nevertheless, under-recognition, misdiagnosis and under-treatment are still relevant issues. We aim to provide an overview of epidemiology of asthma in the elderly, and a thorough description of its pathology and clinical presentation, with special emphasis on the distinction of late versus early-onset asthma. We also discuss selected treatment topics of special interest for older patients, such as compliance with therapy and ability with the inhalers, which are basic to the success of the prescribed therapy. Finally, we suggest that multidimensional geriatric assessment of older asthmatics could help in tailoring the therapy to the individual needs a…

Malattie dell'Apparato Respiratorio

Characteristics and Prognostic Value of Morning Dipping of Peak Expiratory Flow Rate in Stable Asthmatic Subjects

Characteristics and prognostic relevance of morning dip of peak expiratory flow rate (PEFR) were evaluated in stable asthmatic subjects. Among 246 outpatients monitored four times daily for two weeks, 38 (group A) showed a significant difference between morning reading of PEFR and each of the others; they were compared to 38 randomly selected patients (group B) not showing morning dip in PEFR. Less frequent seasonal course, extrinsic pathogenesis, and sensitization to mites characterized group A; starting airflow limitation was more severe in those with morning dip, but no significant difference between mean PEFR measured throughout two weeks was found. At 6 to 12 weeks, morning dip was not…

Airway cell composition at rest and after an all-out test in competitive rowers

Med Sci Sports Exerc. 2004 Oct;36(10):1723-9. Airway cell composition at rest and after an all-out test in competitive rowers. Morici G, Bonsignore MR, Zangla D, Riccobono L, Profita M, Bonanno A, Paternò A, Di Giorgi R, Mirabella F, Chimenti L, Benigno A, Vignola AM, Bellia V, Amato G, Bonsignore G. SourceDepartment of Experimental Medicine Italian National Research Council (CNR), Palermo, Italy. Abstract PURPOSES: This study was designed to assess: a) whether rowing affects airway cell composition, and b) the possible relationship between the degree of ventilation during exercise and airway cells. SUBJECTS AND METHODS: In nine young, nonasthmatic competitive rowers (mean age +/- SD: 16.2 …

The impact of age on allergen responsiveness in allergic rhinitics and asthmatics in the coastal area of southern Italy

Circulating Progenitors in Healthy Runners after Endurance and Maximal Exercise

Effect of cilomilast (Ariflo) on TNF-α, IL-8, and GM-CSF release by airway cells of patients with COPD

Background: Inflammation in chronic obstructive pulmonary disease (COPD) is characterised by increased neutrophilic infiltration of the airways. Cilomilast, a novel selective phosphodiesterase 4 inhibitor in clinical development for COPD treatment, exerts anti-inflammatory effects. The ability of cilomilast to inhibit the release of neutrophil chemoattractants such as tumour necrosis factor (TNF)-α, interleukin (IL)-8, and granulocyte-macrophage colony stimulating factor (GM-CSF) by bronchial epithelial cells and sputum cells isolated from 10 patients with COPD, 14 normal controls, and 10 smokers was investigated. Methods: Bronchial epithelial cells obtained by bronchial brushing and sputum…

Valutazione della risposta bronchiale ai respiri profondi mediante HRCT nell’asma e nella BPCO

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.

Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010

The prevalence of asthma increased worldwide until the 1990s, but since then there has been no clear temporal pattern. The present study aimed to assess time trends in the prevalence of current asthma, asthma-like symptoms and allergic rhinitis in Italian adults from 1990 to 2010. The same screening questionnaire was administered by mail or phone to random samples of the general population (age 20-44 yrs) in Italy, in the frame of three multicentre studies: the European Community Respiratory Health Survey (ECRHS) (1991-1993; n=6,031); the Italian Study on Asthma in Young Adults (ISAYA) (1998-2000; n=18,873); and the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007-2…

Should atopy be assessed in elderly patients with respiratory symptoms suggestive of asthma?

Aging is associated with modifications of the immune system and this could contribute to a reduced prevalence of allergic disease in the elderly. Atopy has rarely been considered in the clinical assessment of the geriatric respiratory patient. This article is a review of the available literature assessing the impact of age on atopy in the asthmatic patient. In the majority of papers, we found a lower prevalence of atopy in the most advanced ages, both in healthy subjects and in individuals affected by allergic respiratory diseases. No large, longitudinal studies performed in the general population have been conducted to confirm this observation. Although available data seem to favor the dec…

HRCT evaluation of bronchial response to deep inspiration in asthma and chronic obstructive pulmonary disease (COPD)

Purpose Methods and Materials Results Conclusion References Personal Information

Aging and asthma: pathophysiological mechanisms

La spirometria nell'anziano

Riproducibilità intraindividuale del FEV6 in soggetti anziani

Simple Logistic Models in the development of a quality of life questionnaire specific for patients with Chronic Obstructive Pulmonary Disease

Asthma in the Elderly

Background There is a distinct lack of information on the prognosis of asthma in the elderly. Methods In order to compare mortality rates of elderly people with and without asthma and to identify mortality risk factors in those with asthma, 1,233 ambulatory patients aged ≥ 65 years with a diagnosis of asthma (n = 210) or chronic nonrespiratory conditions (n = 1,023) were enrolled in a multicentric study. Patients underwent baseline spirometry and multidimensional assessment and were then followed up for a mean of 57.9 months (SD 16.9). We compared mortality rates in the two groups and identified predictors of death using multivariable survival analysis. Results The 5-year mortality rate in …

Chronic Renal Failure

Background To the best of our knowledge, the association between COPD and chronic renal failure (CRF) has never been assessed. Lean mass is frequently reduced in COPD, and the glomerular filtration rate (GFR) might be depressed in spite of normal serum creatinine (concealed CRF). We investigated the prevalence and correlates of both concealed and overt CRF in elderly patients with COPD. Methods We evaluated 356 consecutive elderly outpatients with COPD enrolled in the Extrapulmonary Consequences of COPD in the Elderly Study and 290 age-matched outpatients free from COPD. The GFR was estimated using the Modification of Diet in Renal Disease Study Group equation. Patients were categorized as …

Fisiopatologia respiratoria

Supramaximal exercise mobilizes hematopoietic progenitors and reticulocytes in athletes

Am J Physiol Regul Integr Comp Physiol. 2005 Nov;289(5):R1496-503. Epub 2005 Jul 14. Supramaximal exercise mobilizes hematopoietic progenitors and reticulocytes in athletes. Morici G, Zangla D, Santoro A, Pelosi E, Petrucci E, Gioia M, Bonanno A, Profita M, Bellia V, Testa U, Bonsignore MR. SourceDepartment of Experimental Medicine, University of Palermo, Italy. Abstract Marathon runners show increased circulating CD34+ cell counts and postexercise release of interleukin-6 (IL-6), granulocyte-colony stimulating factor (G-CSF) and flt3-ligand (Bonsignore MR, Morici G, Santoro A, Pegano M, Cascio L, Bonnano A, Abate P, Mirabella F, Profita M, Insalaco G, Gioia M, Vignola AM, Majolino I, Testa…

Invecchiamento, stress ossidativo e funzione polmonare

On-line Italian register for severe/non-controlled asthma

Background Severe/Non-controlled asthma (SNCA) is a crucial challenge for physicians and a socio-economic burden for National Health Services (NHS). In Italy more than 50% of costs for asthma (1-2% of total NHS expenditure) are due to SNCA and moreover, within the European Community Respiratory Health Survey, Italy was the country with the lowest % of ICS daily use (29%) and with the highest % of subjects with uncontrolled asthma despite treatment (67% vs an overall European mean of 47%). Despite few data from very selected centers, in our country a precise estimate of the epidemiological figures and the disease related costs for SNCA is not available. Thus, we aimed at instituting of an on…

How achievable are guidelines for a healthy lifestyle in stages I-IV COPD evaluated using an activity monitor?

Effects of 12-Week Aerobic Training in Children with Mild Intermittent Asthma

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

Nasal function optimizes the bronchoprotective effect of deep inspiration

The response to methacholine (Mch) bronchoprovocation in the absence of deep inspiration (DI) is dependent on airway smooth muscle (ASM) content

CD40 ligation induces stress-mediated apoptosis in bronchial epithelial cells

Release of transforming growth factor-beta (TGF-β) and fibronectin by alveolar macrophages in airway diseases

Abstract Asthma and chronic bronchitis are associated with airway remodelling, and airway macrophages are present in bronchial inflammation. TGF-β and fibronectin released by alveolar macrophages possess a fibrogenic potency. The potential role of alveolar macrophages in airway remodelling was studied in asthma and chronic bronchitis by the release of TGF-β and fibronectin. Alveolar macrophages were isolated by bronchoalveolar lavage in 14 control subjects, 14 asthmatics and 14 chronic bronchitics. The spontaneous and lipopolysaccharide (LPS)- or concanavalin A (Con A)-induced release of TGF-β and fibronectin was measured by ELISA. Alveolar macrophages from chronic bronchitics spontaneously…

Counteracting effects of apigenin and leptin on lung adenocarcinoma cells.

Generalità anatomofunzionali

The Attenuation of the Bronchodilatory Effect of Deep Inspiration (DI) in COPD Is Related to Reduced Airway Distensibility as Measured by HRCT

Lung penetration and patient adherence considerations in the management of asthma: role of extra fine formulations

The mainstay of management in asthma is inhalation therapy at the target site, with direct delivery of the aerosolized drug into the airways to treat inflammation and relieve obstruction. Abundant evidence is available to support the concept that inflammatory and functional changes at the level of the most peripheral airways strongly contribute to the complexity and heterogeneous manifestations of asthma. It is now largely accepted that there is a wide range of clinical phenotypes of the disease, characterized primarily by small airways involvement. Thus, an appropriate diagnostic algorithm cannot exclude biological and functional assessment of the peripheral airways. Similarly, achievement…

Alternative ways of expressing forced expiratory volume in the first second and long-term mortality in elderly patients with asthma

Abstract Background Clinical and epidemiologic evidence on asthma in the elderly is scant. There is evidence that forced expiratory volume in the first second (FEV 1 ), a commonly used indicator of overall pulmonary function, might not be an independent predictor of 5-year mortality in elderly patients with asthma. Objective To investigate the association between FEV 1 expressed using 3 alternative methods and 5-, 10-, and 15-year mortality in a population of elderly patients with asthma. Methods Participants in the Salute Respiratoria nell' Anziano study were included. Asthma was diagnosed at baseline according to spirometric and clinical data. Vital status at 15 years was assessed using d…

Airway remodeling in asthma.

Chronic inflammation and remodeling may follow acute inflammation or may begin insidiously as a low-grade smoldering response, especially in the case of immune reactions. The histologic hallmarks of chronic inflammation and remodeling are as follows: (1) infiltration by macrophages and lymphocytes; (2) proliferation of fibroblasts that may take the form of myofibroblasts; (3) angiogenesis; (4) increased connective tissue (fibrosis); and (5) tissue destruction. It is clear that changes in the extracellular matrix, smooth muscle, and mucous glands have the capacity to influence airway function and reactivity in asthma patients. However, it is not known how each of the many structural changes …

Simple Logistic Models add criteria to choice the optimal number of items designed for Italian patients affected by Chronic Obstructive Pulmonary Disease

Airway hyperresponsiveness in the elderly: prevalence and clinical implications.

Airway hyperresponsiveness is associated with an increased risk of developing respiratory symptoms. The assessment of airway hyperresponsiveness can provide valuable information regarding the natural course of respiratory diseases. However, little information is available for populations of more advanced age, and data are conflicting. It was assessed whether age influences the occurrence of airway hyperresponsiveness by reviewing those studies that specifically addressed this issue, and attempting to identify the factors responsible for discrepancies between studies. Eighteen studies, published between 1983 and 2002, are included in this review. Overall, the results of the analysis are in f…

Circulating CD34+ cells are decreased in chronic obstructive pulmonary disease (COPD).

FEV6: Behaviour and Correlates in the Elderly

Effetti dell'allenamento aerobico di 12 settimane in bambini con asma lieve intermittente

Increased markers of angiogenesis in peripheral blood in long distance runners after a race

Diagnosis of a Case of Lipoid Pneumonia by Bronchoalveolar Lavage

Exogenous lipoid pneumonia (ELP) was diagnosed by bronchoalveolar lavage (BAL) in a 57-year-old woman with a long history of using oily nose drops. Since clinical and roentgenological presentations are nonspecific, BAL, along with specific staining of recovered alveolar macrophages, represents a safe alternative to more invasive diagnostic procedures whenever a diagnosis of ELP is suspected.

Time couse of changes in airway cells during early training in healthy subjects

Semeiotica clinica dell'apparato respiratorio

Correlates of Energy Expenditure and Sedentary Life in Free-Living COPD.

Comparison Of COPD Disability Impact In Elderly Patients In Canada And Italy

Cigarette smoke up-regulates toll like receptor 4 (TLR4) expression and enhances TLR4 mediated responses

Environmental conditions, air pollutants, and airway cells in runners: a longitudinal field study

Runners have increased numbers of neutrophils in the airways at rest and after exercise compared with sedentary individuals. The aim of this study was to determine whether Mediterranean seasonal changes in temperature, humidity or airborne pollutants affect the airway cells of runners training outdoors in an urban environment. In nine male amateur runners, cell composition, apoptosis, and inflammatory mediators were measured in induced sputum collected at rest (baseline) and the morning after races held in the fall (21 km), winter (12 km), and summer (10 km). Concentrations of air pollutants were below the alert threshold at all times. Neutrophil differential counts tended to increase after…

Questionnaires, spirometry and PEF monitoring in epidemiological studies on elderly respiratory patients.

Questionnaires are the most used subjective instrument of measurement in respiratory epidemiology. The standardisation of the questionnaires aims to limit bias by maximising validity and reliability, and comparability. Within the European Union project BIOMED1, a compendium of respiratory standard questionnaires (CORSQ) was developed for adults covering 18 topics from general information to early life events, through environmental risk factors and respiratory symptoms and diseases. Reliable spirometry data needs a rigorous quality control programme, as in the "Salute Respiratoria nell'Anziano" (Sa.R.A.) project, Italian for "Respiratory Health in the Elderly". Reproducibility rates were 95.…

Alterations of the beneficial effect of deep inspiration in scleroderma: relationships between lung function and imaging.

<i>Background:</i> It has been postulated that the beneficial effects of deep inspiration are dependent on the magnitude of airway distension by virtue of airway to parenchyma interdependence. <i>Objective:</i> This study was designed to examine whether the changes that occur in pulmonary fibrosis affect the beneficial effect of deep inspiration. <i>Methods:</i> Thirty-one subjects with scleroderma underwent lung volume and diffusion capacity assessment as well as high-resolution computed tomography. To assess the effect of deep inspiration, each subject underwent methacholine provocations in the absence of deep breaths. When the targeted change in lung f…

The mini nutritional assessment is associated with the perception of dyspnoea in older subjects with advanced COPD

Serum low density lipoprotein subclasses in asthma

Summary Background The levels of serum low-density lipoproteins (LDL) have been implicated in the inflammatory cascade in a murine model of asthma. Recent findings suggest that LDL may modulate the inflammatory state of the asthmatic airways in humans. Objective We explored whether LDL subclasses are associated with the occurrence and severity of asthma. Methods 24 asthmatics (M/F: 11/13) and 24 healthy individuals, with normal BMI and absence of metabolic syndrome, matched for age and gender. Serum concentrations of LDL subclasses were distributed as seven bands (LDL-1 and -2 defined as large, least pro-inflammatory LDL, and LDL-3 to −7 defined as small, most pro-inflammatory LDL), using t…

Alternative ways of expressing FEV1 and mortality in elderly people with and without COPD

Expressing forced expiratory volume in 1 s (FEV1) as % predicted relies on the assumption of proportional variability and generalisability of prediction equations that may be unrealistic, especially for elderly people. We evaluated the prognostic implications of alternative ways of expressing FEV1. We enrolled 318 patients with chronic obstructive pulmonary disease (COPD) and 475 controls in the Salute Respiratoria nell'Anziano (SARA) study. The risk for 5-, 10- and 15-year mortality associated with FEV1 was studied by expressing FEV1 % pred, standardised by height cubed (FEV1 · Ht(-3)) and as a multiple of the sex-specific first percentile (FEV1 quotient (FEV1Q)). In the group with COPD, t…

Asthma and menopause

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Leptin levels in induced sputum from patients with COPD are sensitive to smoking status

Asthma in the elderly: mortality rate and associated risk factors for mortality.

BACKGROUND: There is a distinct lack of information on the prognosis of asthma in the elderly. METHODS: In order to compare mortality rates of elderly people with and without asthma and to identify mortality risk factors in those with asthma, 1,233 ambulatory patients aged > or = 65 years with a diagnosis of asthma (n = 210) or chronic nonrespiratory conditions (n = 1,023) were enrolled in a multicentric study. Patients underwent baseline spirometry and multidimensional assessment and were then followed up for a mean of 57.9 months (SD 16.9). We compared mortality rates in the two groups and identified predictors of death using multivariable survival analysis. RESULTS: The 5-year mortality …

Validation of lung densitometry threshold at CT for the distinction between senile lung and emphysema in elderly subjects

Background and Aims. An ageing lung is characterised by distal airspace enlargement without alveolar wall destruction: therefore the anatomical distinction between senile lung and emphysema is clear-cut. In clinical settings the definition of precise boundaries between normalcy and pathology is more difficult with the risk of overdiagnosis. CT is an important diagnostic advancement in the field of COPD. Most methods for the evaluation of emphysema are based on the detection and measurement of areas characterised by a density level below a threshold assumed to characterize parenchymal destruction. Methods. Our retrospective study included 47 healthy subjects (65-91 years), 36 never smokers a…

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…

The loss of the beneficial effect of deep inspiration (DI) in COPD is associated with severity of disease

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…

Increased Levels of Elastase and α1-Antitrypsin in Sputum of Asthmatic Patients

Asthma and chronic bronchitis are inflammatory diseases associated with remodeling of the extracellular matrix (ECM). Elastin, a major component of the ECM in the airways, has been previously found to be disrupted in asthma and chronic bronchitis. This study was aimed at evaluating whether elastin disruption might be associated with an imbalance between elastase (active and total) and alpha1-proteinase inhibitor (alpha1-PI), the main inhibitor of elastase. We measured elastase and alpha1-PI in induced sputum obtained from 16 control subjects, 10 healthy smokers, 19 asthmatic patients, and 10 chronic bronchitis patients. We also assessed the possible origin of elastase, evaluating its levels…

Effect of maximal exercise on reticulocytes in athletes

Alveolar nitric oxide and asthma control in mild untreated asthma

Background The role of the peripheral airways in asthma is increasingly being recognized as a potential target for the achievement of optimal control of the disease. We postulated that the inflammatory changes of the small airways are implicated in the lack of asthma control in mild asthma. Objective To test this hypothesis, we measured the alveolar fraction of exhaled NO (C alv NO) in patients with mild asthma with different levels of control of symptoms. Methods Seventy-eight patients with asthma (35 men, age, 37 ± 15 years; FEV 1 percentage of predicted, 100% ± 9%) were studied. Asthma control was assessed by using the Asthma Control Test (ACT). Measurements of exhaled NO at multiple con…

Valutazione della reattività del muscolo liscio nella popolazione geriatrica

The Bronchodilatory effect of deep inspiration (DI) in subjects with pulmonary fibrosis

Causes of Allergic Rhinitis and Asthma

Endurance training increases inflammatory cells in small airways of mice

Effect of age and asthma duration upon elastase and alpha1-antitrypsin levels in adult asthmatics

In asthmatic subjects an imbalance between elastase and alpha1-antitrypsin (alpha1-PI) exists. This study aims to evaluate whether ageing per se affects the levels of elastase. Both young and elderly asthmatics with comparable severity and duration of disease, as well as young and elderly healthy subjects, underwent an induced sputum procedure to measure levels of elastase and alpha1-PI. The percentage of sputum neutrophils and eosinophils was higher in young and elderly asthmatics than in young and elderly controls. The levels of both total and active elastase were significantly higher in young and elderly asthmatics than in young and elderly controls, and directly correlated with the perc…

Semeiotica funzionale

Effetti delle variazioni climatiche sulle cellule delll'espettorato indotto in maratoneti amatoriali

Transcriptional regulation of COX-2: a key mechanism in the pathogenesis of nasal polyposis in aspirin-sensitive asthmatics?

Longitudinal Changes and Apoptosis in Induced Sputum Cells in Long-Distance Runners

Spirometry Reference Values for Women and Men Aged 65–85 Living in Southern Europe: The Effect of Health Outcomes

<i>Background:</i> Spirometry is more and more frequently used for the diagnosis of respiratory diseases in the elderly people. Unfortunately, reliable predictive values for the spirometric variables in the elderly are lacking. <i>Objectives:</i> Data obtained from 429 subjects participating in the multicenter Italian study SARA on respiratory health in the elderly were analyzed in order to derive reference values for spirometry in the age range of 65–85 years. The second aim of this study was to assess the influence of variables describing many dimensions of the health status on the prediction of spirometric variables in that age range. <i>Methods:</i> S…

The bronchodilatory effect of deep inspiration diminishes with aging

AbstractDeep inspirations have the ability to dilate constricted airways. The impairment of this function has been associated with the occurrence of asthmatic symptoms. We evaluated whether the bronchodilatory effect of deep inspiration (DI) is affected by aging. We tested 25 healthy subjects (median age: 54 yrs, range: 25–83 yrs). Single dose methacholine (Mch) provocations were performed in the absence of DI, which induced at least 15% reduction in inspiratory vital capacity (IVC) from baseline. The post-Mch IVC measurement was followed by 4 DIs and by another IVC (post-DI IVC). The fractional difference between post-DI IVC and post-Mch IVC represented the % bronchodilation by DI. The % b…

RELEASE OF HEMOPOIETIC AND ENDOTHELIAL PROGENITORS AFTER ENDURANCE AND MAXIMAL EXERCISE IN RUNNERS

Airway Wall Thickness By HRCT Does Not Affect Airway Distensibility In Asthma And COPD

Effects of repeated hyperosmolar exposure on IL-8 release by bronchial epithelial cells

Differential distribution of inflammatory cells in large and small airways in smokers

BACKGROUND: Smoking induces structural changes in the airways, and is considered a major factor in the development of airflow obstruction in chronic obstructive pulmonary disease. However, differences in inflammatory cell distribution between large airways (LA) and small airways (SA) have not been systematically explored in smokers. Hypothesis: The content of cells infiltrating the airway wall differs between LA and SA. AIMS: To compare the content of neutrophils, macrophages, lymphocytes and mast cells infiltrating LA and SA in smokers who underwent surgery for lung cancer. METHODS: Lung tissue from 15 smokers was analysed. Inflammatory cells in the lamina propria were identified by immuno…

Correlati delle alterazioni della composizione corporea in pazienti anziani con BPCO

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

Broncopneumopatia cronica ostruttiva

Inspiration through the nose increases the bronchoprotective effect of lung inflation

Effects of exercise training on airway closure in asthmatics

We previously reported that responsiveness to methacholine (Mch) in the absence of deep inspiration (DI) decreased in healthy subjects after a short course of exercise training. We assessed whether a similar beneficial effect of exercise on airway responsiveness could occur in asthmatics. Nine patients (male/female: 3/6; mean age ± SD: 24 ± 2 yr) with mild untreated asthma [forced expiratory volume in 1 s (FEV1): 100 ± 7.4% pred; FEV1/vital capacity (VC): 90 ± 6.5%] underwent a series of single-dose Mch bronchoprovocations in the absence of DI in the course of a 10-wk training rowing program (6 h/wk of submaximal and maximal exercise), at baseline ( week 0), and at week 5 and 10. The singl…

Endurance exercise causes mild bronchial epithelial damage in humans

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

The Effect of Intranasal Corticosteroids on Asthma Control and Quality of Life in Allergic Rhinitis with Mild Asthma

BACKGROUND: The mechanisms through which rhinitis affects asthma have not been completely elucidated. We explored whether the effect of nasal treatment on asthma control and respiratory-related quality of life (HRQoL) is mediated by inflammatory changes of the upper and lower airways. METHODS: Allergic rhinitics with mild asthma were randomized to a 14-day treatment period with either nasal budesonide 100 mug, 1 puff per nostril twice a day, or placebo. Clinical, functional, and biological evaluations were performed before and after treatment. RESULTS: Twenty subjects (M/F: 10/10; age: 31 +/- 15 years; mean +/- SD) were enrolled, and a total of 17 individuals completely participated in the …

Alterated expression of leptin and its receptor in the epithelium of asthmatic patients

Effects of chronic airway disease on health status of geriatric patients.

Background and aims: The impact of chronic airway disease on the health status of elderly patients is only to some extent explained by indexes of airflow limitation. The present study was designed to assess to what extent: 1) asthma, chronic obstructive pulmonary disease (COPD) and chronic bronchitis with normal FEV1 (simple bronchitis) differ in their impact on health status; 2) health status depends upon non-respiratory factors. Methods: A total of 1601 outpatients over 65 - 198 with asthma, 228 with COPD, 91 with simple bronchitis, and 1084 with non-respiratory illnesses (control group) -were studied by collection of five health status indexes and multidimensional assessment. Discriminan…

Malformaioni polmonari

Prevalence of Co-morbidities and severity of COPD

Abstract We aimed at exploring whether the prevalence of co-morbidities of chronic obstructive pulmonary disease (COPD) increases with COPD severity. Analysis of medical records of outpatients with established diagnosis of COPD was retrospectively performed. The lower limit of normality (LLN) for FEV1/FVC was applied to establish the occurrence of airway obstruction in the elderly population. The prevalence of co-morbidities was calculated, and the proportion of patients with each co-morbidity along with GOLD stages was analysed by chi-square for trend. A total of 326 (M/F: 256/70) consecutive outpatients with COPD (stage GOLD I to IV), aging 71.8 ± 9.2 years, were included in the analysis.…

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…

Variable Release of Interleukin-8 after Hyperosmolar Exposure of Bronchial Epithelial Cell Lines.

Malattie Respiratorie nell’ anziano

From Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines to Current Clinical Practice

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been promulgated to improve the management of chronic obstructive pulmonary disorder (COPD). Objective: To evaluate the extent to which the current therapeutic approach to COPD conforms to GOLD guidelines. Methods: This was a multicentre observational study of elderly COPD patients enrolled for acute care in general medicine or geriatric wards in tertiary hospitals in Italy in April 2002. Our series consisted of 471 patients >64 years of age consecutively admitted for acute exacerbations of COPD to wards participating in the study. Data describing drugs used prior to exacerbation and prescribed at …

Endurance exercise causes apoptosis of inflammatory cells and no clear inflammatory activation in the airways of endurance athletes

Time course of changes in airway cells during early training in healthy subjects

Aging on Quality of Spirometry

Prevalence of nocturnal asthma in a general population sample: determinants and effect of aging.

Nocturnal asthma (NA) is important because of clinical and prognostic implications. Previous data on prevalence may be overestimated, because they are derived from selected series. Observations on monitoring of peak expiratory flow in elderly asthmatics suggested that prevalence of NA may increase with age. This study was designed to estimate the prevalence of NA-related symptoms in a sample drawn from a general population and evaluate the role of aging. Subjects (1,100, mean age 41.9, SD 22.8 years) were randomly selected from the lists of seven general practitioners. A questionnaire on nighttime and morning NA-associated symptoms was used and frequency of occurrence was rated as never, so…

Urinary leukotriene E4 in the assessment of nocturnal asthma

Urinary leukotriene E4 (LTE4) is a marker of the body's production of cysteinyl LTs, important mediators of airway inflammation. The role of the latter in nocturnal asthma is a topic of increasing interest.This investigation was aimed at determining whether nighttime attacks are associated with increased release of LTs, expressed by urinary LTE4, and the relationship between the two phenomena.Three groups were studied: group A, seven control subjects; group B, nine asthmatic patients without nocturnal attacks; and group C, nine asthmatic patients with a comparable daytime FEV1 but who were experiencing nocturnal exacerbations (morning dips in peak expiratory flow greater than 20%). Urine wa…

The role of small airways in monitoring the response to asthma treatment: what is beyond FEV1?

The definition of asthma has evolved from that of an episodic disease characterized by reversible airways constriction to a chronic inflammatory disease of the airways, with at least partially reversible airway constriction. Increasing evidence supports the notion that small and large airways play a central role in asthma pathophysiology with regard to inflammation, remodeling and symptoms. The contribution of the distal airways to the asthma phenotype carries implications for the delivery of inhaled medications to the appropriate areas of the lung and for the monitoring of the response to asthma treatment. Asthma control is evaluated on the basis of symptoms, lung function and exacerbation…

Sindrome da sofferenza respiratoria acuta (ARDS).

Increased numbers of inflammatory cells but decreased activation of NFkappaB pathway in small airways of endurance-trained mice.

Is quality of life related to upper and lower airways associated with inflammation?

Ageing and COPD affect different domains of nutritional status: the ECCE study

Chronic obstructive pulmonary disease (COPD) and ageing may contribute to malnutrition. We aimed to explore whether COPD and ageing determine malnutrition in different manners. 460 stable COPD outpatients (376 males and 84 females) from the Extrapulmonary Consequences of COPD in the Elderly (ECCE) study database were investigated (age 75.0±5.9 yrs; forced expiratory volume in 1 s 54.7±18.3% predicted). Nutritional status was evaluated using the Mini Nutritional Assessment® (MNA) questionnaire. From the MNA, three scores exploring the domains of the nutritional status were calculated: body composition, energy intake and body functionality scores. Global Initiative for Chronic Obstructive Lun…

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

VEGF is involved in local and systemic aspects of COPD.

Effects of exercise training on airway responsiveness and airway cells in healthy subjects.

J Appl Physiol. 2010 Aug;109(2):288-94. Epub 2010 Jun 10. Effects of exercise training on airway responsiveness and airway cells in healthy subjects. Scichilone N, Morici G, Zangla D, Chimenti L, Davì E, Reitano S, Paternò A, Santagata R, Togias A, Bellia V, Bonsignore MR. SourceDept. of Internal Medicine, Div. of Pulmonology (DIBIMIS Univ. of Palermo, "Villa Sofia-Cervello" Hospital, Via Trabucco 180, 90146 Palermo, Italy. n.scichilone@libero.it Abstract Airway responsiveness to methacholine (Mch) in the absence of deep inspirations (DIs) is lower in athletes compared with sedentary individuals. In this prospective study, we tested the hypothesis that a training exercise program reduces th…

Rapidly progressive organising pneumonia associated with cytomegalovirus infection in a patient with psoriasis.

A 63-year-old woman experienced progressive respiratory distress and psoriatic plaques. The radiographic images showed diffuse interstitial infiltrates. The surgical open lung biopsy revealed an obliteration of the alveolar spaces by plugs of connective tissue distributed within the terminal bronchioles, alveolar ducts and spaces. No relevant cause was determined, and she was diagnosed with idiopathic organising pneumonia. The patient was discharged with oral glucocorticosteroid and supplemental oxygen therapy. One month later, the patient’s pulmonary status had progressively worsened, and she was re-admitted. She required higher oxygen concentrations and mechanical ventilation. Pharmacol…

Searching for chronic obstructive pulmonary disease in the over 65 people: suggestions for a cost-effective approach

Embriologia, sviluppo e invecchiamento dell'apparato respiratorio

Effects of aging on sensation of dyspnea and health-related quality of life in elderly asthmatics

BACKGROUND AND AIMS: As the awareness of sensory stimuli is often impaired in older subjects, it has been hypothesized that the aging process may influence the perception of dyspnea. This study aimed at evaluating the aging-related difference in perception of spontaneously occurring dyspnea in adult asthmatics and at whether any such aging-related differences have an effect on the health-related quality of life (HRQOL). METHODS: 18 elderly asthmatics (EA) aged >65 years and 20 young asthmatics (YA) (age range 16-44 years) were recruited. In all subjects, 12-month asthma symptom score and respiratory function were recorded. Dyspnea was measured at rest by the Visual Analog Scale (VAS) and HR…

Apoptosis in induced sputum cells in long-distance runners: a longitudinal study.

Aging and Disability Affect Misdiagnosis of COPD in Elderly Asthmatics

Study objectives: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis and underdiagnosis of asthma in such patients. Design: A multicenter study involving 24 Italian pulmonary or geriatric institutions. Patients: One hundred twenty-eight asthmatic patients (98 women, 76.6%) aged 73 6.4 years (mean SD) were selected from the cohort of the Salute Respiratoria nell’Anziano (respiratory health in the elderly) study. Methods: All patients underwent a clinical evaluation that included clinical history and spirometry with a bronchodilator test. A diagnosis of…

Anti-inflammatory effects of pre-seasonal Th1-adjuvant vaccine to Parietaria judaica in asthmatics

Nicola Scichilone, Chiara Minaldi, Roberta Santagata, Salvatore Battaglia, Gaetana Camarda, Vincenzo Bellia Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S.), Sezione di Pneumologia, University of Palermo, Palermo, ItalyBackground: The ultra-short course pre-seasonal allergy vaccine, containing appropriate allergoids with the adjuvant monophosphoryl lipid A (MPL), may be effective in treating allergic symptoms. Objective: To explore the timing of the immunological responses to the pre-seasonal allergy vaccine.Methods: Four subcutaneous injections of the active product (Pollinex Quattro) were administered to 20 Parietaria-sensitive intermittent asthmatics (M/F: 12/8; …

Small airways function and molecular markers in exhaled air in mild asthma.

Background: Several studies suggest that the periphery of the lung is the major site of inflammation in asthma. Fractional exhaled nitric oxide (FeNO) and 8-isoprostane have been proposed as biomarkers of inflammation and oxidative stress. We therefore hypothesised that small airway dysfunction in asthma is of inflammatory origin that can be detected by molecular markers in exhaled air. To test this hypothesis, we examined the relationship of FeNO and 8-isoprostane in exhaled air with small airways function as assessed by the single breath nitrogen test. Methods: Sixteen patients (14 women) with mild atopic asthma (forced expiratory volume in 1 second >80% predicted) of mean (SD) age 23.0 (…

Effetti di un programma di esercizio fisico sul grado di reattività bronchiale negli asmatici

EFFETTI DI UN PROGRAMMA DI ESERCIZIO FISICO SUL GRADO DI REATTIVITÀ BRONCHIALE NEGLI ASMATICI N. Scichilone 1, G. Morici 2, D. Zangla 3, R. Arrigo 1, I. Cardillo 1, V. Bellia 1, M.R. Bonsignore 1 1 DIBIMIS, Università degli Studi di Palermo, 2 BIONEC, Università degli Studi di Palermo, 3 DISMOT, Università degli Studi di Palermo SCOPO DEL LAVORO: Il nostro gruppo ha recentemente dimostrato che il grado di reattività bronchiale in assenza di respiri profondi si riduce negli individui sani in seguito ad un intenso programma di allenamento. Nello studio corrente, abbiamo valutato se un simile effetto benefico dell’esercizio fisico potesse realizzarsi negli asmatici. MATERIALI E METODI: Nove as…

Increased numbers of inflammatory cells but decreased activation of NFκB pathway in small airways of endurance-trained mice

Inhaled Corticosteroids and the Beneficial Effect of Deep Inspiration in Asthma

Deep inspiration-induced bronchoprotection and bronchodilation are impaired in asthma. We evaluated the effect of inhaled glucocorticosteroids on these phenomena. Two groups of subjects with asthma, 9 with moderate/severe hyperresponsiveness to methacholine, and 12 with mild/borderline hyperresponsiveness to methacholine, received inhaled fluticasone (880 microg daily) for 12 weeks. Serial bronchoprovocations were performed at Weeks 0, 6, and 12. The impact of deep inspirations on the airway response to methacholine was evaluated on the basis of inspiratory vital capacity and FEV(1). Fluticasone produced a wide spectrum of changes in the beneficial effects of deep inspiration, but the mean …

Mild bronchial epithelial damage after endurance exercise in humans

L’effetto broncodilatatore dell’inspirazione profonda nell’asma

Is Health-Related Quality of Life Associated with Upper and Lower Airway Inflammation in Asthmatics?

Background.Allergic diseases impair health-related quality of life (HR-QoL). However, the relationship between airway inflammation and HR-QoL in patients with asthma and rhinitis has not been fully investigated. We explored whether the inflammation of upper and lower airways is associated with HR-QoL.Methods.Twenty-two mild allergic asthmatics with concomitant rhinitis (10 males, 38 ± 17 years) were recruited. The Rhinasthma was used to identify HR-QoL, and the Asthma Control Test (ACT) was used to assess asthma control. Subjects underwent lung function and exhaled nitric oxide (eNO) test, collection of exhaled breath condensate (EBC), and nasal wash.Results.The Rhinasthma Global Summary sc…

Light smoking and dependence symptoms in high-school students.

Summary In high-school students, prevalence of smoking is high but few studies analyzed smoking in the student population according to nicotine content of smoked cigarettes and gender. We analyzed the responses to a questionnaire, including the modified Fagerstrom Tolerance Questionnaire (FTQ), administered to 555 students (382 males, 173 females) of a professional high school in Palermo, Italy, to assess the prevalence in both genders of: (1) smoking “light” and high nicotine (HN) cigarettes; (2) signs of nicotine dependence and (3) respiratory symptoms. Nicotine content of habitually smoked cigarettes was considered as “light” if ⩽0.8 mg; as high if >0.8 mg. Forty-four percent of students…

Effects of hyperosmolar stimulation on IL-8 release in different bronchial epithelial cell lines

Airway distensibility by HRCT decreases with severity of COPD.

Impaired Bronchodilatory Effect of Deep Inspiration With Increased Asthma Severity

The Risk of Malnutrition Correlates with Perception of Dyspnea in COPD

Bronchodilatory Effect of Deep Inspiration Is Absent in Subjects With Mild COPD

Study objectives To investigate whether the bronchodilatory effect of deep inspiration is impaired in subjects with COPD. Methods We measured deep inspiration-induced bronchodilation in 19 patients with COPD and 17 healthy subjects (mean age, 67.8 ± 7.1 years vs 62.5 ± 9.3 years, respectively [± SEM]). Each subject underwent a series of single-dose methacholine provocations to induce at least a 15% reduction in inspiratory vital capacity (IVC). When this was achieved, subjects were asked to perform four consecutive deep inspirations, after which the IVC measurement was repeated and the percentage of bronchodilation by deep inspiration was calculated. Results The percentage of reduction in I…

Condizione depressiva e percezione dei sintomi nella patologia broncoostruttiva dell'anziano

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 …

Lung penetration and patient adherence considerations in the management of asthma: role of extra-fine formulations

Nicola Scichilone, Mario Spatafora, Salvatore Battaglia, Rita Arrigo, Alida Benfante, Vincenzo BelliaDipartimento di Biomedicina e Medicina Interna e Specialistica, Sezione di Pneumologia, University of Palermo, Palermo, ItalyAbstract: The mainstay of management in asthma is inhalation therapy at the target site, with direct delivery of the aerosolized drug into the airways to treat inflammation and relieve obstruction. Abundant evidence is available to support the concept that inflammatory and functional changes at the level of the most peripheral airways strongly contribute to the complexity and heterogeneous manifestations of asthma. It is now largely accepted that there is a wide range …

Prevalence of the Metabolic Syndrome (MS) in Mediterranean Patients with Suspected Sleep Apnea Syndrome (OSAS)

Effect of age upon airway obstruction and reversibility in adult patients with asthma.

In a cross-sectional study we evaluated the effect of aging (separately from that of duration of disease) on airway obstruction and reversibility by comparing two groups of non-smoker patients with asthma.We compared two groups of patients: group A, which had 50 subjects (8 men and 42 women) aged 59.7+/-4.6 years (mean +/- SD), and group B, comprised of 51 subjects (19 men and 32 women) who were 35.7+/-7.4 years old. The groups were selected because of comparable baseline degree of obstruction (FEV1 % of predicted, 67.8+/-20.3 in group A; 73.0+/-19.6 in group B, NS) and duration of the disease (14.0+/-11.7 years vs 11.2+/-9.1, NS). Spirometric examination, with a bronchodilator test, was pe…

Tubercolosi polmonare

Restrictive pulmonary dysfunction at spirometry and mortality in the elderly

SummaryObjectivesTo evaluate the association between pulmonary restriction and mortality in the elderly, taking into account potential confounders not considered in the past (disability, cognitive dysfunction, diabetes, and visceral obesity).DesignLongitudinal study.SettingCommunity-based.ParticipantsTwelve hundred sixty-five patients (51.9% men) aged 65–97 years old from the Salute Respiratoria nell'Anziano (SaRA) Italian multicentric study.MeasurementsParticipants were divided in 4 groups: normal spirometry (NS): FEV1/FVC≥70%, FVC≥80% of predicted; restrictive ventilatory pattern (RVP): FEV1/FVC≥70%, FVC<80%; obstructive ventilatory pattern (OVP): FEV1/FVC<70%, FVC≥80%, and mixed ventilat…

Bronchiectasie

Il punteggio MNA come correlato indipendente della dispnea nell'anziano con BPCO

Bronchial hyperresponsiveness (BHR) or exhaled nitric oxide concentration (eNO) do not predict exercise-induced bronchoconstriction (EIB) in atopic children with intermittent asthma

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

Noninvasive evaluation of hepatic steatosis and fibrosis in OSA patients at diagnosis

Valutazione mediante hrct delle specifiche alterazioni polmonari nelle diverse forme cliniche di sclerosi sistemica

BODE index or geriatric multidimensional assessment for the prediction of very-long-term mortality in elderly patients with chronic obstructive pulmonary disease? A prospective cohort study

BACKGROUND a multidimensional approach-the BODE index-has been proposed for prognostic purposes in chronic obstructive pulmonary disease (COPD) and theoretically seems to be well suited for elderly people, but there is a lack of data in this population, especially with respect to long-term survival. The objective of this study is to evaluate whether the BODE index can predict both long (5 years) and very-long (10 and 15 years)-term mortality in an unselected population of elderly people with COPD better than a set of variables commonly taken into account in a geriatric multidimensional assessment (MDA). METHODS : this was a multicentre, prospective, population study. We used data from the S…

Safety and efficacy of montelukast as adjunctive therapy for treatment of asthma in elderly patients

Asthma is a disease of all ages. This assumption has been challenged in the past, because of several cultural and scientific biases. A large body of evidence has accumulated in recent years to confirm that the prevalence of asthma in the most advanced ages is similar to that in younger ages. Asthma in the elderly may show similar functional and clinical characteristics to that occurring in young adults, although the frequent coexistence of comorbid conditions in older patients, together with age-associated changes in the human lung, may lead to more severe forms of the disease. Management of asthma in the elderly follows specific guidelines that apply to all ages, although most behaviors ar…

Airway remodelling assessed by sputum and high resolution computed tomography in asthma and COPD

It is not known whether sputum elastase, metalloproteinase (MMP)-9 and tissue-inhibitor metalloproteinase (TIMP)-1 are related to structural changes of the airways, as assessed by high-resolution computed tomography (HRCT) scan. The relationships between these markers and the magnitude of structural changes of the airways in asthma and chronic obstructive pulmonary disease (COPD) were assessed. Induced sputum and HRCT scan were performed in 30 asthmatics (14 mild and 16 severe) and in 12 patients with COPD. A greater extent of HRCT scan abnormalities was found in COPD than in severe and mild asthmatics. HRCT scan abnormalities correlated with the degree of airway obstruction in COPD and in …

Airway Distensibility by HRCT in COPD Patients

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: …

The MRC dyspnoea scale by telephone interview to monitor health status in elderly COPD patients

SummaryDyspnoea is the most common symptom associated with poor quality of life in patients affected by Chronic Obstructive Pulmonary Disease (COPD). While COPD severity is commonly staged by lung function, the Medical Research Council (MRC) dyspnoea scale has been proposed as a more clinically meaningful method of quantifying disease severity in COPD. We wished to assess whether this scale might also be useful during telephone surveys as a simple surrogate marker of perceived health status in elderly patients with COPD.We conducted a comprehensive health status assessment by telephone survey of 200 elderly patients who had a physician diagnosis of COPD. The telephone survey contained 71 it…

Retrospective Analysis On Selection Criteria For Clinical Trials In An Unselected COPD Outpatient Population

Attenuation of the airway response to methacoline after maximal rowing test in healthy subjects

Discriminative and predictive properties of disease-specific and generic health status indexes in elderly COPD patients

Abstract Background The association between bronchial obstruction severity and mortality in Chronic Obstructive Pulmonary Disease (COPD) is well established, but it is unknown whether disease-specific health status measures and multidimensional assessment (MDA) have comparable prognostic value. Methods We analyzed data coming from the Salute Respiratoria nell'Anziano (Respiratory Health in the Elderly – SaRA) study, enrolling elderly people attending outpatient clinics for respiratory and non-respiratory problems. From this population we selected 449 patients with bronchial obstruction (77.3% men, mean age 73.1). We classified patients' health status using tertiles of the Saint George Respi…

Iperreattività bronchiale e inspirazione profonda: correlazioni patogenetiche e implicazioni cliniche

Bronchial hyperreactivity seems to induce a loss of the deep inspiration's bronchoprotective effect which is normally able to dilate the obstructed airways. Studies such as the HRCT on the bronchial gauge's alterations show that the deep inspirations bronchodilator effect is associated with the bronchial distensibility. In fact, it is almost totally absent either in the elderly or in the COPD patients. In asthma, instead, the pathology's seriousness has proved to be associated with the impairment of the deep inspiration's broncho-protective effect which this way becomes an important diagnostic parameter.

Correlates of mortality in elderly COPD patients: focus on health-related quality of life

BACKGROUND AND OBJECTIVE: The Saint George Respiratory Questionnaire (SGRQ) is widely used as a measure of health-related quality of life (HRQL) in patients with COPD. This study tested whether the SGRQ predicts the survival of patients with COPD. METHODS: The study recruited 238 patients with COPD who were participants in the multicentre Salute Respiratoria nell'Anziano (Sa.R.A.) study. Patients' sociodemographic, clinical and functional characteristics were assessed and the association between the SGRQ and mortality, corrected for potential confounders, was estimated. RESULTS: The mean age of study participants was 72.6 years. Over the 5-year observation period there were 88 deaths. After…

Erythrocyte production in obstructive sleep apnea

Reduced exercise capacity and impaired pulmonary function in patients with scleroderma

Resumption of Ventilation at the End of Obstructive Sleep Apneas is not Determined by Diaphragmatic Fatigue

In patients affected by obstructive sleep apnea syndrome (OSAS) a progressive increase of the force developed by the respiratory muscles is usually observed during the occlusive phase before upper airway patency is resumed (Onal and Lopata, 1986).

A rare case of pedunculated bronchial hemangioma

We describe a rare case of pedunculated endobronchial hemangioma observed in a 60 years old patient complaining of chronic productive cough and accessional dyspnea which had been progressively worsening over 20 years. The lesion was first noticed at fiberoptic bronchoscopy; then computed tomography scan was performed and integrated with tridimensional reconstruction techniques. Pathology showed the picture of a vascular neoplasm, compatible with capillary hemangioma. The lesion was submitted to laser-assisted endoscopic removal in order to relieve the obstruction, leading to remission of symptoms.

Non invasive diagnosis in a case of bronchopulmobary sequestration and proposal of diagnostic algorithm

Partecipazione polmonare nella sindrome da immunodeficienza acquisita (AIDS)

Time course of changes in bronchial reactivity during early training in healthy subjects

Evaluation of Health Outcomes in Elderly Patients With Asthma and COPD Using Disease-Specific and Generic Instruments

Abstract Objectives To compare the effects of asthma and COPD on health status (HS) in elderly patients, and to assess the correlation between disease-specific and generic instruments assessing HS. Design Multicenter, cross-sectional, observational study. Setting The Salute Respiratoria nell'Anziano (respiratory health in the elderly) Study network of outpatient departments. Patients One hundred ninety-eight asthma patients and 230 COPD patients ≥ 65 years old. Measurements HS was assessed by the Saint George's Respiratory Questionnaire (SGRQ) and five generic outcomes: Barthel's index, 6-min walk test, mini mental state examination, geriatric depression scale (GDS), and quality-of-sleep in…

The use of bronchodilators in the treatment of airway obstruction in elderly patients

Abstract Ageing is associated with important anatomical, physiological and psychosocial changes that may have an impact on the management of obstructive airway diseases (asthma and chronic obstructive pulmonary disease (COPD)) and on their optimal therapy. Ageing-related modifications might be responsible for a different effectiveness of bronchodilators in the elderly patients as compared to younger subjects. Furthermore, the physiological involution of organs and the frequent comorbidity, often interfere with pharmacokinetics of bronchodilator drugs used in asthma and COPD. This review will focus on the use of bronchodilators in the elderly, with particular attention to the achievable goal…

Association between reduced bronchodilatory effect of deep inspiration and loss of alveolar attachments.

Abstract Background We have previously shown that the bronchodilatory effect of deep inspiration is attenuated in individuals with COPD. This study was designed to investigate whether the impairment in this effect is associated with loss of alveolar attachments. Methods We measured deep inspiration (DI)-induced bronchodilation in 15 individuals with and without COPD (67 ± 2.2 yrs of age, mean ± SEM) undergoing lobar resection for peripheral pulmonary nodule. Prior to surgery, we measured TLCO and determined the bronchodilatory effect of deep inspiration after constricting the airways with methacholine. The number of destroyed alveolar attachments, as well as airway wall area and airway smoo…

MILD BRONCHIAL EPITELIAL DAMANGE AFTER ENDURANCE EXERCISE IN HUMANS

Early effects of training on airway cell composition in healthy subjects

Sleep disorders in the elderly with and without chronic airflow obstruction: the SARA study

Objectives: Our objectives were to test the hypothesis that, in the geriatric population, chronic airway obstruction is associated with a higher prevalence of sleep disturbances; to identify the main correlates of sleep disturbances, and to verify whether asthma and COPD patients have different patterns of sleep disturbances. Methods: The EPESE questionnaire was administered to 734 patients aged 65 years and over with asthma or chronic obstructive pulmonary disease (cases) and 1237 individuals of comparable age who were free of respiratory disease but not of other chronic conditions (controls). Four sleep disturbances were quantified: difficulty in falling asleep, nocturnal awakening, morni…

Endurance Exercise Causes Mild Bronchial Epithelial Damage in Humans.

Asthma in the elderly

OZONE EXPOSURE INCREASES EXERCISE-INDUCED PULMONARY DAMAGE AND INFLAMMATION IN NONASTHMATIC LONG-DISTANCE RUNNERS

Clinical and Biological Heterogeneity in Children with Moderate Asthma

To evaluate the relationship between inflammatory markers and severity of asthma in children, the amount of interleukin-8 (IL-8) and granulocyte/macrophage colony-stimulating factor (GM-CSF) released by peripheral blood mononuclear cells, exhaled nitric oxide (FE NO) levels, p65 nuclear factor-kappaB subunit, and phosphorylated IkBalpha expression by peripheral blood mononuclear cells were assessed in six control subjects, 12 steroid-naives subjects with intermittent asthma, and 17 children with moderate asthma. To investigate their predictive value, biomarker levels were correlated with the number of exacerbations during a 18-month follow-up period. We found that GM-CSF release was higher …

The loss of the beneficial effect of deep inspiration (DI) in COPD is associated with severity of disease

L’effetto broncodilatatore dell inspirazione profonda decresce con la gravità dell’asma

Hypoxemia during Sleep

In most normal subjects arterial oxyhemoglobin saturation (SaO2) remains substantially stable throughout all sleep time: some exceptions however, may be observed especially in elderly subjects, who may show desaturations, sometimes associated with apneas (Block et al., 1979; Krieger et al., 1983; Catterall et al., 1985). Conversely, SaO2 drops during part of, or even the whole sleep time, are a common finding in pathological conditions like obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD).

Monitoring response to treatment in asthma management: food for thought

Asthma is a chronic inflammatory disorder of the airways that is characterized by episodic symptoms. In this regard, asthma management has classically involved periodic re-assessment by the health-care provider, during which therapy is altered mainly based on clinical and physiological parameters, such as assessment of symptoms, spirometry and peak expiratory flow monitoring. In this context, various markers of airway inflammation (e.g. eosinophils in the induced sputum, nitric oxide in the exhaled air) have been proposed to assess the severity of asthma and to adjust the therapy accordingly. The evaluation of airway hyper-responsiveness with different stimuli has also been suggested as a n…

The bronchodilatatory ability of deep inspiration Is impaired in scleroderma.

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…

Il questionario nutrizionale MNA è un predittore migliore della performance fisica rispetto al BMI in soggetti anziani con BPCO - progetto MINUTRA

Mild to moderate chronic airways disease does not carry an excess risk of cognitive dysfunction

Whether chronic obstructive pulmonary disease (COPD) carries a risk of cognitive dysfunction prior to the onset of arterial hypoxemia is not known. Our objective was to assess both the prevalence and main correlates of subclinical cognitive dysfunction in older patients with non-hypoxemic COPD.Home-dwelling non-demented subjects over 64 years of age consecutively attending 24 outpatient Departments of Respiratory Medicine or Geriatrics because of COPD (N = 233), asthma (N = 203), non-obstructive bronchitis (N = 92) or chronic non-respiratory and non-dementing diseases (controls, N = 1080) underwent a multidimensional assessment. Cognitive status was assessed by the Mini-Mental State Examina…

Spontaneous gastroesophageal reflux and airway patency during the night in adult asthmatics

Controversies still exist on the role of nighttime gastroesophageal reflux (GER) in precipitating nocturnal asthma. We tested the relationship between GER and nocturnal bronchoconstriction by continuously and simultaneously monitoring both respiratory resistances and esophageal pH in seven asthmatics with moderate to severe GER disease. Twenty-nine GER episodes were found during the study night lasting more than 5 min (LGER) and 72 not longer than 5 min (SGER). Both long (LGER) and short (SGER) gastroesophageal refluxes were able to maintain significantly higher lower respiratory resistances (RLR) at the resolution of each GER episode (RLR(e)) with respect to baseline values. RLR, expressed…

CD40 ligation influences stress-mediated apoptosis in bronchial epithelial cells

Effects of aerobic training in children with mild intermittent asthma.

Thoracic kyphosis and ventilatory dysfunction in unselected older persons: an epidemiological study in Dicomano, Italy.

OBJECTIVES: To assess whether kyphosis is associated with ventilatory dysfunction in older community dwellers. DESIGN: Cross-sectional study. SETTING: The unselected population of Dicomano, Italy aged>or=65 years. PARTICIPANTS: A total of 323 nonheart failure participants underwent clinical evaluation for the presence of kyphosis and spirometry. The severity of kyphosis was estimated from the difference between standing stature and knee-height-derived stature and from the occiput-wall distance. MEASUREMENTS: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and prevalence of obstructive and restrictive ventilatory pattern. RESULTS: The 130 kyphotic participants (40.2…

International conference on biomedical aspects of aging research December 10-13, 1997 Fondazione Cini, San Giorgio, Venezia, Italy

Concealed renal failure in COPD. The extrapulmonary consequences of COPD in the elderly (ECCE) study

Pulmonary functional and radiological correlations of nutritional status and physical activity in systemic sclerosis

Purpose Methods and Materials Results Conclusion References Personal Information

Leptin and Apigenin: Antagonists in the Apoptotic Pathway of Lung Adenocarcinoma Cell Line

Clinical and anti-inflammatory effects of ultra-short preseasonal vaccine to Parietaria in asthma

Objective: The ultra-short course preseasonal allergy vaccine, containing the adjuvant monophosphoryl lipid A (MPL), is effective in treating allergic symptoms; however, the efficacy in controlling asthmatics symptoms has not been fully demonstrated. We aimed at evaluating whether the ultra-short preseasonal course of immunotherapy contributes to asthma control. Methods: Four subcutaneous injections of the active product (Pollinex Quattro) were administered, before the pollen season, to 20 Parietaria-sensitive mild, untreated asthmatics (M/F: 12/8; age: 38 ± 14 years). After the screening visit (visit 1), asthma control was assessed by the Asthma Control Test (ACT) immediately before the fi…

Effect of endurance and maximal exercise on reticulocytes in athletes

CD40 ligation protects bronchial epithelium against oxidant-induced caspase-independent cell death.

KEYWORDS CLASSIFICATION: 7,8-Dihydro-7,8-dihydroxybenzo(a)pyrene 9,10-oxide;Antigens,CD40;Apoptosis;Bronchi;cytology;Caspases;Cell Cycle;Cell Death;Cell Line,Transformed;Cell Survival;Cell Transformation,Viral;Cytoprotection;drug effects;Epithelial Cells;Humans;Italy;mechanisms of carcinogenesis;metabolism;Oxidants;pharmacology;physiology;Research;Simian virus 40;toxicity;Transcription Factor AP-1. CD40 and its ligand regulate pleiotropic biological responses, including cell proliferation, differentiation, and apoptosis. In many inflammatory lung diseases, tissue damage by environmental or endogenous oxidants plays a major role in disease pathogenesis. As the epithelial barrier is a major t…

Hyperosmolar exposure of different bronchial epithelial cell lines induces variable release of interleukin-8

Low circulating CD34+ cells in chronic obstructive pulmonary disease (COPD)

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…

Aging and COPD affect different domains of nutritional status – The ECCE study.

Exhaled nitric oxide is associated with cyclic changes in sexual hormones

Abstract Background We hypothesized that changes in the levels of sexual hormones during the menstrual cycle influence the concentration of nitric oxide in the exhaled air (FeNO) and alveolar exhaled nitric oxide (CANO). Methods Twelve healthy, non allergic women in their reproductive age (age range 25–37 years) were recruited. Subjects were studied, on alternate days, over the course of their menstrual cycle. At each visit, measurements of FeNO and CANO were performed. Progesterone and 17-β-estradiol concentrations were measured in salivary samples. Results Eight subjects completed the study. The levels of FeNO and CANO were 13 ± 4.7 pbb and 3.5 ± 1.9 pbb, respectively (mean ± SD). The mea…

Corticosteroid-induced changes in nasal allergic inflammation are associated with better asthma control

A new questionnaire specifically designed for patients affected by chronic obstructive pulmonary disease

Summary The aim of this study was to develop a specific and valid questionnaire for Italian COPD patients, living on the north or the south of Italy—which are two culturally distinct areas. The project consisted in three steps: (1) initial item set generation to identify items relevant to both genders, all ages and both regions; (2) item reduction including tests of regional specificity; (3) tests of internal validity using item-response theory using Rasch one-parameter modelling. Ninty-six COPD patients (mean aged 69 yr; 78 Male) completed the original set of 124 items of the Italian Health Status Questionnaire (IHSQ). Item reduction was carried out using an established standardised approa…

Prognostic value of FEV1/FEV6 in elderly people

Bronchial epithelial damage after a half-marathon in nonasthmatic amateur runners.

Am J Physiol Lung Cell Mol Physiol. 2010 Jun;298(6):L857-62. Epub 2010 Apr 2. Bronchial epithelial damage after a half-marathon in nonasthmatic amateur runners. Chimenti L, Morici G, Paternò A, Santagata R, Bonanno A, Profita M, Riccobono L, Bellia V, Bonsignore MR. SourceDept. Biomedico Di Medicina Interna & Specialistica, Section of Pneumology, Univ. of Palermo, Via Trabucco 180, 90146 Palermo, Italy. laurachimenti@yahoo.it Abstract High neutrophil counts in induced sputum have been found in nonasthmatic amateur runners at rest and after a marathon, but the pathogenesis of airway neutrophilia in athletes is still poorly understood. Bronchial epithelial damage may occur during intense exer…

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as inflammation markers in elderly patients with stable chronic obstructive pulmonary disease (COPD)

Erythrocyte sedimentation rate (ESR) might represent a less expensive alternative to C-reactive protein (CRP) as a marker of systemic inflammation in stable chronic obstructive pulmonary disease (COPD). We tried to verify this hypothesis in 223 consecutive outpatients aged 65 years or more with stable COPD enrolled in a multicenter observational study. Patients were grouped according to normal/increased ESR/CRP values and groups were compared with regard to clinical and laboratory characteristics. Correlations between CRP, ESR and selected variables of interest were assessed by Spearman's ζ-test and multivariate linear regression analysis. CRP was weakly and inversely correlated with the fo…

Asma bronchiale

The airway response to deep inspirations decreases with COPD severity and is associated with airway distensibility assessed by computed tomography.

In patients with mild chronic obstructive pulmonary disease (COPD), the effect of deep inspirations (DIs) to reverse methacholine-induced bronchoconstriction is largely attenuated. In this study, we tested the hypothesis that the effectiveness of DI is reduced with increasing disease severity and that this is associated with a reduction in the ability of DI to distend the airways. Fifteen subjects [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I–II: n = 7; GOLD stage III–IV: n = 8] underwent methacholine bronchoprovocation in the absence of DI, followed by DI. The effectiveness of DI was assessed by their ability to improve inspiratory vital capacity and forced expira…

The impact of age on prevalence of positive skin prick tests and specific IgE tests

SummaryAging is associated with modifications of the immune system, defined as immunosenescence. This could contribute to a reduced prevalence of allergic disease in the elderly population. In this regard, atopy has rarely been considered in the clinical assessment of the geriatric respiratory patient. This article is a review of the available literature assessing the impact of age on atopy. In the majority of papers, we found a lower prevalence of atopy in the most advanced ages, both in healthy subjects and in individuals affected by allergic respiratory diseases. Unfortunately, no large, longitudinal studies performed in the general population have been conducted to further explore this …

Lung hyperinflation in COPD attenuates airway distension by deep inspiration (DI) measured with HRCT

Endurance training increases infiammatori cells in small airways of mice.

Alveolar Gas Mixing in Chronic Pulmonary Hyperinflation

It is well known that in chronic pulmonary hyperinflation defects in intrapulmo-nary gas mixing and in V/Q ratio are likely to occur.

Altered CD94/NKG2A and perforin expression reduce the cytotoxic activity in malignant pleural effusions.

CD94/NKG2A is an inhibitory receptor expressed by NK cells and cytotoxic lymphocytes and, upon activation by HLA-E, downregulates the cytolytic activities of these cells thus representing a tumour immune escape mechanism. This study was aimed at assessing whether cytotoxic lymphocytes (CD8+) and NK cells from malignant pleural effusions have a deregulated expression of CD94/NKG2A. The expression of membrane CD94/NKG2A and perforin was evaluated by flow-cytometry in CD8+ and NK cells from pleural effusions and autologous peripheral blood of cancer (n=19) and congestive heart failure (CHF) (n=11) patients. Intracellular CD94/NKG2A expression was evaluated by flow-cytometry in pleural effusion…

Airway distensibility by HRCT in asthmatics and COPD with comparable airway obstruction.

Introduction: Decreased airway distensibility (AD) in response to deep inspirations, as assessed by HRCT, has been associated with the severity of asthma and COPD. Aims: The current study was designed to compare the magnitude of AD by HRCT in individuals with asthma and COPD with comparable degrees of bronchial obstruction, and to explore factors that may influence it. Results: We enrolled a total of 12 asthmatics (M/F:7/5) and 8 COPD (7/1) with comparable degree of bronchial obstruction (FEV1% predicted mean±SEM: 69.1 ± 5.2% and 61.2 ± 5.0%, respectively; p = 0.31). Each subject underwent chest HRCT at FRC and at TLC. A total of 701 airways (range 20 to 38 airway per subject; 2.0 to 23.1 m…

Endurance exercise causes apoptosis of infiammatori cells and no clear infiammatory activation in the airways of endurance athletes.

L’atopia nell’anziano: prevalenza e implicazioni cliniche

Effects of pulmonary rehabilitation on systemic and pulmonary inflammation in COPD patients

Factors affecting the measurement of FVC in the elderly

Nutritional evaluation and physical activity in scleroderma patients

Two approaches to assess physical activities of daily life; steps and energy expenditure