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Buongiorno F, Buonauro A, Canora A, Canonico ME, Esposito R, Sanduzzi A, Bocchino M, Esposito G, Santoro C. 766 NON-INVASIVE ASSESSMENT OF RIGHT VENTRICLE TO ARTERIAL COUPLING FOR PROGNOSIS STRATIFICATION OF FIBROTIC INTERSTITIAL LUNG DISEASE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance non-invasively estimable by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD).
Methods
Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF), (M=37; mean age 67±7 yrs) were studied with standard and speckle tracking echocardiography and compared to 30 age-matched healthy volunteers. Mean patients follow-up was of 70±4 months.
Results
Fibrotic-ILD patients had a larger right ventricle (RV) and a worst diastolic function as RV-global longitudinal strain (GLS) was significantly lower along with higher systolic pulmonary artery pressure (sPAP) estimates in comparison with controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV-GLS/sPAP were significantly reduced in f-ILDs patients (p<0.0001). Patients with a RV-GLS/sPAP below the median value had a shorter survival (61 vs. 74 months, p=0.01), this parameter being an independent predictor of worse outcome.
Conclusion
Low estimates of RV-GLS/sPAP are predictive of worse outcome in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis repercussions.
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Santoro C, Buonauro A, Canora A, Rea G, Canonico ME, Esposito R, Sanduzzi A, Esposito G, Bocchino M. Non-Invasive Assessment of Right Ventricle to Arterial Coupling for Prognosis Stratification of Fibrotic Interstitial Lung Diseases. J Clin Med 2022; 11:jcm11206115. [PMID: 36294435 PMCID: PMC9605359 DOI: 10.3390/jcm11206115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance that can be non-invasively estimated by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD). Methods: Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF) (M = 37; mean age 67 ± 7 years), were studied with standard and speckle-tracking echocardiography and compared with 30 age-matched healthy volunteers. The mean patient follow-up was 70 ± 4 months. Results: Fibrotic ILD patients had a larger right ventricle (RV) and worse diastolic function because the RV global longitudinal strain (GLS) was significantly lower and the systolic pulmonary artery pressure (sPAP) estimates were higher in comparison with those of controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV GLS/sPAP were significantly reduced in f-ILD patients (p < 0.0001). Patients with an RV GLS/sPAP below the median value had a shorter survival time (61 vs. 74 months, p = 0.01); this parameter was an independent predictor of a worse outcome. Conclusion: Low estimates of RV GLS/sPAP are predictive of worse outcomes in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis implications.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Angelo Canora
- Respiratory Medicine Unit at the Monaldi Hospital, AO dei Colli, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, AO dei Colli, 80131 Naples, Italy
| | - Mario Enrico Canonico
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Roberta Esposito
- Department of Clinical Medicine and Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Alessandro Sanduzzi
- Respiratory Medicine Unit at the Monaldi Hospital, AO dei Colli, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Marialuisa Bocchino
- Respiratory Medicine Unit at the Monaldi Hospital, AO dei Colli, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-770-2773
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de Blasio F, Scalfi L, Castellucci B, Sacco AM, Berlingieri GM, Capitelli L, Alicante P, Sanduzzi A, Bocchino M. Poor Nutritional Status and Dynapenia Are Highly Prevalent in Post-Acute COVID-19. Front Nutr 2022; 9:888485. [PMID: 35719154 PMCID: PMC9205211 DOI: 10.3389/fnut.2022.888485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Poor nutritional status is common (estimated prevalence 5–69%) in acute coronavirus disease-2019 (COVID-19), and has been associated with hospitalization, the need for intensive care, and mortality. Body composition (BC) and muscle function have also been related in such patients to poor disease outcomes. As the evidence in the literature is limited, a cross-sectional study was carried out to determine the frequency of malnutrition in a cohort of post-acute COVID-19 patients referred to a rehabilitation center after hospital discharge. BC and muscle strength were assessed and the differences between bedridden and not bedridden patients were specifically evaluated. The study sample was composed of 144 post-acute COVID-19 patients (mean age 64.8 years; males = 95), 37% of whom were bedridden (males = 60%). Nutritional status was evaluated with Mini-Nutritional Assessment (MNA) and Controlling Nutritional status (CONUT). Fat-free mass (FFM) and skeletal muscle mass (SM) were estimated using bioelectrical impedance analysis (BIA). Raw BIA variables (phase angle = PhA and impedance ratios = IRs) were also determined and handgrip strength (HGS) was measured. Dynapenia was identified according to the 2019 EWGSOP criteria. According to MNA, 18% (n. 26) of patients were malnourished and 62% (n. 89) were at risk of malnutrition. As for CONUT, 21% (n. 31) of cases had moderate–severe malnutrition and 58% (n. 83) had light malnutrition. Abnormalities of raw BIA variables (low PhA and high IRs) and low HGS were more common in bedridden patients, in those who were malnourished, or had low FFM or SM. Dynapenic patients were 65% men and 47% women. In conclusion, malnutrition, BC alterations, and low HGS occur in post-acute COVID-19 patients and are more common in bedridden patients. Further studies are needed to identify reliable algorithms for assessing nutritional status in post-acute COVID-19 patients undergoing rehabilitation.
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Affiliation(s)
- Francesco de Blasio
- Respiratory Medicine and Pulmonary Rehabilitation, Clinic Center, Private Hospital, Naples, Italy
| | - Luca Scalfi
- Department of Public Health, Federico II University, Naples, Italy
| | - Bianca Castellucci
- Respiratory Medicine and Pulmonary Rehabilitation, Clinic Center, Private Hospital, Naples, Italy
| | - Anna Maria Sacco
- Department of Public Health, Federico II University, Naples, Italy
| | | | - Ludovica Capitelli
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paola Alicante
- Department of Public Health, Federico II University, Naples, Italy
| | - Alessandro Sanduzzi
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marialuisa Bocchino
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
- *Correspondence: Marialuisa Bocchino
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Patella V, Sanduzzi A, Bruzzese D, Florio G, Brancaccio R, Fabbrocini G, Delfino G. A Survey Among Italian Physicians During COVID-19 Outbreak. Could Bacillus Calmette-Guérin Vaccine Be Effective Against SARS-CoV2? Front Pharmacol 2021; 12:646570. [PMID: 34012395 PMCID: PMC8126664 DOI: 10.3389/fphar.2021.646570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/08/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Epidemiological studies show that BCG-vaccinated population seems to be more likely protected from COVID-19 infection, but WHO gave a stark warning on use of BCG vaccine without confirmed COVID-19 trials. The aim of the study is to evaluate whether TB vaccination, performed several years earlier, could confer protection against COVID-19. Methods: After the Ethical Committee authorization, professional orders were used to contact physicians with an online survey. Specialty, COVID-19 infection and previous BCG vaccination were recorded. Statistical data analysis was performed. Results: 1906 physicians answered the questionnaire, (M = 1068; F = 838; mean age 50.7 ± 13.3 years; range 24–87), more than half (1062; 55.7%) experienced BCG vaccination. Professional activity was recorded, and only 49 subjects (2.6%) of them were infected by SARS-CoV2. Among the group of infected people, asymptomatic form occurred in 12 subjects (24.5%); a pauci-symptomatic form in 24 subjects (49.0%); and a severe form (pneumonia and/or respiratory distress) in 13 (26.5%). Considering only the clinically relevant form of COVID-19, period prevalence was 2.2% (23/1062) in the vaccinated group and 1.7% (14/844) in the unvaccinated group (OR: 1.31, 95% C.I.: 0.68–2.63, p = 0.427). Conclusion: Our experience does not confirm the possible protective role of BCG vaccination, performed years earlier, against COVID-19. Although recent epidemiological studies point out in BCG-vaccinated population a lower prevalence of SARS-CoV2 infection, in our cohort of physicians no significant difference was found in terms of prevalence of COVID-19 infection. Our data underline the necessity to follow the WHO warning about the indiscriminate use of BCG vaccine, until clear evidence of protection by BCG vaccination against COVID-19 is fully demonstrated.
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Affiliation(s)
- Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria Della Speranza" Hospital, Salerno, Italy.,Postgraduate Program in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Naples, Italy.,Staff of UNESCO Chair on Health Education and Sustainable Development, University Federico II, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanni Florio
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria Della Speranza" Hospital, Salerno, Italy
| | - Raffaele Brancaccio
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria Della Speranza" Hospital, Salerno, Italy.,Postgraduate Program in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Staff of UNESCO Chair on Health Education and Sustainable Development, University Federico II, Naples, Italy.,Department of Clinical Medicine and Surgery, Dermatology, Section of Dermatology, University of Naples Federico II, Naples, Italy.,Laboratory of Clinical Biochemistry, Monaldi Hospital, Naples, Italy
| | - Gabriele Delfino
- Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria Della Speranza" Hospital, Salerno, Italy
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Perna F, Bruzzaniti S, Piemonte E, Maddaloni V, Atripaldi L, Sale S, Sanduzzi A, Nicastro C, Pepe N, Bifulco M, Matarese G, Galgani M, Atripaldi L. Serum levels of SARS-CoV-2 nucleocapsid antigen associate with inflammatory status and disease severity in COVID-19 patients. Clin Immunol 2021; 226:108720. [PMID: 33819577 PMCID: PMC8017913 DOI: 10.1016/j.clim.2021.108720] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Francesco Perna
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy,Corresponding author
| | - Sara Bruzzaniti
- Laboratorio di Immunologia, Istituto per l'Endocrinologia e l'Oncologia Sperimentale "G. Salvatore", Consiglio Nazionale delle Ricerche, Naples, Italy,Dipartimento di Biologia, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Erica Piemonte
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Valeria Maddaloni
- UOC Biochimica Clinica, AORN Ospedale dei Colli, Ospedale Monaldi, Naples, Italy
| | - Lidia Atripaldi
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania “Vanvitelli”, Naples, Italy
| | - Silvia Sale
- UOC Biochimica Clinica, AORN Ospedale dei Colli, Ospedale Monaldi, Naples, Italy
| | - Alessandro Sanduzzi
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Carmine Nicastro
- UOC Biochimica Clinica, AORN Ospedale dei Colli, Ospedale Monaldi, Naples, Italy
| | - Nicola Pepe
- UOC Biochimica Clinica, AORN Ospedale dei Colli, Ospedale Monaldi, Naples, Italy
| | - Maurizio Bifulco
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Giuseppe Matarese
- Laboratorio di Immunologia, Istituto per l'Endocrinologia e l'Oncologia Sperimentale "G. Salvatore", Consiglio Nazionale delle Ricerche, Naples, Italy,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli “Federico II”, Naples, Italy
| | - Mario Galgani
- Laboratorio di Immunologia, Istituto per l'Endocrinologia e l'Oncologia Sperimentale "G. Salvatore", Consiglio Nazionale delle Ricerche, Naples, Italy,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli “Federico II”, Naples, Italy,Corresponding author at: Laboratorio di Immunologia, Istituto per l'Endocrinologia e l'Oncologia Sperimentale "G. Salvatore", Consiglio Nazionale delle Ricerche, Naples, Italy, Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli studi di Napoli Federico II, Italy
| | - Luigi Atripaldi
- UOC Biochimica Clinica, AORN Ospedale dei Colli, Ospedale Monaldi, Naples, Italy
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Maniscalco M, Ambrosino P, Fuschillo S, Stufano S, Sanduzzi A, Matera MG, Cazzola M. Bronchodilator reversibility testing in post-COVID-19 patients undergoing pulmonary rehabilitation. Respir Med 2021; 182:106401. [PMID: 33873099 PMCID: PMC8041746 DOI: 10.1016/j.rmed.2021.106401] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
Background The usefulness of bronchodilators in coronavirus diseases 2019 (COVID-19) survivors is still uncertain, especially for patients with a concomitant obstructive lung disease. We aimed at verifying the level of bronchodilator reversibility in COVID-19 patients undergoing multidisciplinary pulmonary rehabilitation after the acute phase. Methods We enrolled 105 consecutive patients referring to the Pulmonary Rehabilitation Unit of Istituti Clinici Scientifici Maugeri Spa SB, IRCCS of Telese Terme, Benevento, Italy after being discharged from the COVID-19 acute care ward and after recovering from acute COVID-19 pneumonia. All subjects performed a spirometry before and after inhalation of salbutamol 400 μg to determine the bronchodilation response within 48 h of admission to the unit. Results All patients had suffered from a moderate to severe COVID-19, classified 3 or 4 according to the WHO classification, Seventeen patients had concomitant obstructive lung disease (14 suffering from COPD and 3 from asthma). FEV1 after salbutamol improved on average by 41.7 mL in the entire examined sample, by 29.4 mL in subjects without concomitant obstructive lung diseases, by 59.3 mL in COPD patients and by 320.0 mL in asthma patients. Mean FVC after salbutamol improved by 65.7 mL in the entire examined sample, by 52.5 mL in subjects without concomitant obstructive lung diseases, by 120.0 mL in COPD patients, and by 200.0 mL in asthma patients. Conclusions This study suggests that a treatment with bronchodilators must always be taken into consideration in post-COVID-19 patients because it can induce a functional improvement that, even if small, can facilitate the breathing of these patients.
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Affiliation(s)
| | | | | | - Silvia Stufano
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Alessandro Sanduzzi
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, Naples, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
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Scotto R, Pinchera B, Perna F, Atripaldi L, Giaccone A, Sequino D, Zappulo E, Sardanelli A, Schiano Moriello N, Stanziola A, Bocchino M, Gentile I, Sanduzzi A. Serum KL-6 Could Represent a Reliable Indicator of Unfavourable Outcome in Patients with COVID-19 Pneumonia. Int J Environ Res Public Health 2021; 18:ijerph18042078. [PMID: 33672761 PMCID: PMC7924557 DOI: 10.3390/ijerph18042078] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 01/08/2023]
Abstract
KL-6 is a sialoglycoprotein antigen which proved elevated in the serum of patients with different interstitial lung diseases, especially in those with a poorer outcome. Given that interstitial pneumonia is the most common presentation of SARS-CoV2 infection, we evaluated the prognostic role of KL-6 in patients with COVID-19 pneumonia. Patients with COVID-19 pneumonia were prospectively enrolled. Blood samples were collected at the time of enrolment (TOE) and on day 7 (T1). Serum KL-6 concentrations were measured by chemiluminescence enzyme immunoassay using a KL-6 antibody kit (LUMIPULSE G1200, Fujirebio) and the cut-off value was set at >1000 U/mL. Fifteen out of 34 enrolled patients (44.1%) died. Patients with unfavourable outcome showed significantly lower P/F ratio and higher IL-6 values and plasmatic concentrations of KL-6 at TOE compared with those who survived (median KL-6: 1188 U/mL vs. 260 U/mL, p < 0.001). KL-6 > 1000 U/mL resulted independently associated with death (aOR: 11.29, p < 0.05) with a positive predictive value of 83.3%. Our results suggest that KL-6 is a reliable indicator of pulmonary function and unfavourable outcome in patients with COVID-19 pneumonia. A KL-6 value > 1000 U/mL resulted independently associated with death and showed good accuracy in predicting a poorer outcome. KL-6 may thus represent a quick, inexpensive, and sensitive parameter to stratify the risk of severe respiratory failure and death.
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Affiliation(s)
- Riccardo Scotto
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
- Correspondence:
| | - Francesco Perna
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Lidia Atripaldi
- Laboratory of Clinical Biochemistry, Monaldi Hospital, 80131 Naples, Italy;
| | - Agnese Giaccone
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Davide Sequino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Emanuela Zappulo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Alessia Sardanelli
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Nicola Schiano Moriello
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Anna Stanziola
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Marialuisa Bocchino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
- Staff of United Nations Educational, Scientific and Cultural Organization (UNESCO), Health Education and Sustainable Development, University Federico II of Naples, 80131 Naples, Italy
| | - Alessandro Sanduzzi
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
- Staff of United Nations Educational, Scientific and Cultural Organization (UNESCO), Health Education and Sustainable Development, University Federico II of Naples, 80131 Naples, Italy
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Riccardi A, Marcoccia A, Fasano S, Guastafierro T, Irace R, Messiniti V, Bondanini F, Sanduzzi A, Bocchino M, Ciani A, D’alto M, Argiento P, De Matteis GM, Spanò A, Valentini G. SAT0340 A REDUCED NUMBER OF CAPILLARIES AND AN INCREASED NUMBER OF MEGACAPILLARIES PREDICT THE DEVELOPMENT OF SYSTEMIC SCLEROSIS IN RAYNAUD’S PHENOMENON PATIENTS AT RISK. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Undifferentiated connective tissue disease at risk for systemic sclerosis (UCTD-risk-SSc) is a condition characterised by Raynaud’s phenomenon and either SSc marker autoantibodies or typical capillaroscopic findings or both, unsatisfying classification criteria for SSc and evolving into definite SSc in about 30-50% of cases (1,2). Recently, we developed a weighted score based on a baseline IF-ANA titer ≥1:320, marker autoantibody positivity and presence of avascular areas at videocapillaroscopy identifying patients who will evolve with a 91.3% sensitivity and a 73.2% specificity (3).Objectives:To improve the predictivity of the score assessing the role of marker autoantibody ELISA titer and further capillaroscopic items.Methods:The 102 UCTD-risk-SSc patients investigated for the development of the previous score were reassessed for anti-Scl-70 and anti-centromere antibody titers detected by ELISA and for the mean number of capillaries observed in the same capillaroscopic field (Cs) and the total number of giant capillaries (GC) by videocapillaroscopy (4). Each patient was evaluated every 6 months to assess disease progression. Risk prediction was assessed by Cox regression analyses. The predictive value of the score was determined by receiver operating curve (ROC) analysis.Results:Table 1 shows the resulting predictive variables in multivariate Cox analysis and their relative weight in a 10-point scale. No increase in the predictivity was detected by adding the anti-Scl-70 and anti-centromere antibody ELISA titers. However, a mean number of Cs≤5/mm and GC>5 improved the score. At ROC analysis (Figure 1) a score >3.25 predicted evolution to SSc with a sensitivity of 93.5% and a 75% specificity (AUC=0.91).Table 1.Indipendent predictive variables in multivariate regression analysis and the resulting weighted prediction model *VariableβHR95% CIPWeightAnti-Scl70Cs≤5/mm2.95531.909319.216.754.87-75.762.07-22.00<0.0010.0013.252ANA ≥ 1:3201.74025.701.42-22.850.012ACA1.67405.331.51-1.900.011.75GC>51.00492.731.44-5.170.0021*β: regression coefficients; HR: hazard ratio; 95% CI: 95% confidence interval; Cs: Capillaries; ANA: anti-nuclear antibodies; ACA: anti-centromere antibodies; GC: giant capillariesConclusion:Assessing the mean number of capillaries/mm and the total number of giant capillaries instead of avascular areas at videocapillaroscopy, resulted in improving the sensitivity and specificity of the score recently developed to predict the evolution of UCTD-risk-SSc into definite SSc.References:[1]Valentini G. Autoimmun Rev 2015;[2]Valentini G. et al. Arthritis Care Res (Hoboken). 2014;[3]Riccardi A. et al. Autoimmun Rev. 2019;[4]Sambataro et al. Arthritis Research & Therapy 2014, 16:462.Disclosure of Interests:Antonella Riccardi: None declared, Antonella Marcoccia: None declared, SERENA FASANO: None declared, Tiziana Guastafierro: None declared, Rosaria Irace: None declared, Valentina Messiniti: None declared, Francesco Bondanini: None declared, Alessandro Sanduzzi: None declared, Marialuisa Bocchino: None declared, Aldo Ciani: None declared, Michele D’Alto: None declared, Paola Argiento: None declared, Giovanni Maria De Matteis: None declared, Alberto Spanò: None declared, Gabriele Valentini Grant/research support from: BMS, MSD, NOVARTIS, LILLY, PFIZER, ABBVIE, CELGENE
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Annunziata G, Sanduzzi Zamparelli M, Santoro C, Ciampaglia R, Stornaiuolo M, Tenore GC, Sanduzzi A, Novellino E. May Polyphenols Have a Role Against Coronavirus Infection? An Overview of in vitro Evidence. Front Med (Lausanne) 2020; 7:240. [PMID: 32574331 PMCID: PMC7243156 DOI: 10.3389/fmed.2020.00240] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/06/2020] [Indexed: 12/22/2022] Open
Abstract
The coronavirus infection is constantly diffusing worldwide and the incidence of death is dramatically increasing, representing one of the greatest disasters in human history. Nowadays, no effective therapeutic approaches have been licensed, despite the rising interest of the scientific research in this specific field, and the daily growing number of publications, while the need to find novel strategies is urgent. Evidence in the literature reported the antiviral activity of polyphenols, the largest class of bioactive compounds in nature. Interestingly, a limited number of studies investigated the efficacy of polyphenols from different raw materials, directly against coronaviruses. The present manuscript aimed to report this evidence and provide a viewpoint on the possibility to use it as a start point for the development of novel natural approaches against this viral infection, eventually designing further appropriate researches.
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Affiliation(s)
| | | | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples Federico II, Naples, Italy
| | | | | | - Gian Carlo Tenore
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Naples, Italy.,Chair Staff for Health Education and Sustainable Development, UNESCO, Naples, Italy
| | - Ettore Novellino
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
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10
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Sanduzzi A, Canora A, Belfiore P, Bocchino M, Liguori R, Liguori G. Impact of 13Valent Vaccine for Prevention of Pneumococcal Diseases in Children and Adults at Risk: Possible Scenarios in Campania Region. Infect Disord Drug Targets 2020; 19:403-408. [PMID: 30124160 DOI: 10.2174/1871526518666180820161630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pneumonias are the most frequent infectious diseases, characterized by a high prevalence especially among children and adults at risk. The socio-economic impact caused by Streptococcus pneumoniae is evaluated in terms of morbidity, death rate and hospitalizations. OBJECTIVE The aim of the study was to demonstrate the potential economic advantages by implementation of an active anti-pneumococcal 13-valent vaccine strategy in Campania region (Southern Italy) in two different categories of subjects, children (aged 0-12), and adults (aged 50- 79) at risk (hypertension, nephropathies, COPD and heart diseases). METHODS Vaccination costs were compared with costs necessary to treat avoidable diseases in the presence and absence of a vaccination program. RESULTS Offering anti-pneumococcal 13-valent vaccine to the paediatric population was quantified as saving one million euros for Italian national health service in two years. In addition, offering anti-pneumococcal vaccine to adults at risk would generate a return of around 29 million euros. CONCLUSION In both cases, offering anti-pneumococcal 13-valent vaccine was proven to be a helpful political health strategy, not only in consideration of a reduction of cases but also in view of the favourable economic impacts.
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Affiliation(s)
- Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University of Naples Federico II; Naples, Italy
| | - Angelo Canora
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University of Naples Federico II; Naples, Italy
| | - Patrizia Belfiore
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples, Parthenope, Italy
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University of Naples Federico II; Naples, Italy
| | - Renato Liguori
- Department of Sciences and Technologies, University of Naples, Parthenope, Italy
| | - Giorgio Liguori
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples, Parthenope, Italy
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11
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Sanduzzi A, Sanduzzi Zamparelli S. Nasopharyngeal and Oropharyngeal Swabs, And/Or Serology for SARS COVID-19: What Are We Looking For? Int J Environ Res Public Health 2020; 17:ijerph17093289. [PMID: 32397262 PMCID: PMC7246850 DOI: 10.3390/ijerph17093289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/26/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022]
Abstract
Governments and clinicians that were fully involved in the dramatic SARS-CoV-2 outbreak during the last few weeks in Italy (and more or less all over the world) are fiercely debating the use of methods for screening this viral infection. Thus, all countries are employing a lot of resources in order to test more and more subjects. For this purpose, there are different strategies, based on either direct or indirect tests. Among the first category, the main assays used for SARS-CoV-2 are based on a real-time reverse transcriptase polymerase chain reaction (RT-PCR). Such tests can be performed on nasopharyngeal and oropharyngeal swabs for the categories of those with symptoms and those potentially exposed. In order to integrate the molecular assays in the diagnosis of SARS-CoV-2, a wide range of serology immunoassays (IAs) have also been developed. If we want to identify "immune" people in order to let them to come back to work, serology is the best (and probably the only) approach.
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Affiliation(s)
- Alessandro Sanduzzi
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University, 80138 Naples, Italy;
- Staff of The United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair on Health Education and Sustainable Development, Federico II University, 80131 Naples, Italy
- Correspondence:
| | - Stefano Sanduzzi Zamparelli
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University, 80138 Naples, Italy;
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12
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Faverio P, Bocchino M, Caminati A, Fumagalli A, Gasbarra M, Iovino P, Petruzzi A, Scalfi L, Sebastiani A, Stanziola AA, Sanduzzi A. Nutrition in Patients with Idiopathic Pulmonary Fibrosis: Critical Issues Analysis and Future Research Directions. Nutrients 2020; 12:nu12041131. [PMID: 32316662 PMCID: PMC7231241 DOI: 10.3390/nu12041131] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 02/07/2023] Open
Abstract
In idiopathic pulmonary fibrosis (IPF), several factors may have a negative impact on the nutritional status, including an increased respiratory muscles load, release of inflammation mediators, the coexistence of hypoxemia, and physical inactivity. Nutritional abnormalities also have an impact on IPF clinical outcomes. Given the relevance of nutritional status in IPF patients, we sought to focus on some critical issues, highlighting what is known and what should be further learned about these issues. We revised scientific literature published between 1995 and August 2019 by searching on Medline/PubMed and EMBASE databases including observational and interventional studies. We conducted a narrative review on nutritional assessment in IPF, underlining the importance of nutritional evaluation not only in the diagnostic process, but also during follow-up. We also highlighted the need to keep a high level of attention on cardiovascular comorbidities. We also focused on current clinical treatment in IPF with Nintedanib and Pirfenidone and management of gastrointestinal adverse events, such as diarrhea, induced by these antifibrotic drugs. Finally, we concentrated on the importance of pulmonary rehabilitation program, including nutritional assessment, education and behavioral change, and psychological support among its essential components. More attention should be devoted to the assessment of the undernutrition and overnutrition, as well as of muscle strength and physical performance in IPF patients, taking also into account that an adequate clinical management of gastrointestinal complications makes IPF drug treatments more feasible.
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Affiliation(s)
- Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
- Respiratory Unit, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
| | - Marialuisa Bocchino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Antonella Caminati
- Unit of Pneumology and Respiratory Semi-Intensive Care Unit, Respiratory Pathophysiology and Pulmonary Hemodynamics Service, San Giuseppe Hospital—MultiMedica IRCCS, 20123 Milan, Italy;
| | - Alessia Fumagalli
- Unit of Pulmonary Rehabilitation, IRCCS INRCA (Italian National Research Centre on Aging), 23880 Casatenovo, Italy;
| | - Monica Gasbarra
- Association “Un Respiro di Speranza” in Collaboration with the Department of Pulmonary Diseases of San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Salerno, Italy;
| | - Alessandra Petruzzi
- MEDICA—Editoria e Diffusione Scientifica, 20124 Milan, Italy
- Correspondence: ; Tel.: +39-02-76281337
| | - Luca Scalfi
- Applied Nutrition and Health-Related Fitness, Department of Public Health, School of Medicine, Federico II University, 80131 Naples, Italy;
| | - Alfredo Sebastiani
- Department of Respiratory Diseases, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Anna Agnese Stanziola
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University, 80131 Naples, Italy; (A.A.S.); (A.S.)
| | - Alessandro Sanduzzi
- Section of Respiratory Disease, Department of Clinical Medicine and Surgery, Monaldi Hospital, Federico II University, 80131 Naples, Italy; (A.A.S.); (A.S.)
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13
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D'Argenio V, Casaburi G, Precone V, Gioacchino Moccia L, Postiglione I, Bocchino M, Sanduzzi A. A common microbial signature is present in the lower airways of interstitial lung diseases including sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2020; 35:354-362. [PMID: 32476923 PMCID: PMC7170129 DOI: 10.36141/svdld.v35i4.7061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 12/14/2022]
Abstract
Background: The etiology of pulmonary sarcoidosis is not well established. Although the mechanism triggering pulmonary sarcoidosis remains to be established, inflammatory reactions seem to play an important role in this process. Objectives: The aim of this study was to define the composition of the lower airway microbiota in the bronchoalveolar lavage (BAL) of patients affected by interstitial lung diseases, including sarcoidosis, to determine whether the bacterial signature differs among these diseases. Methods: Ten patients affected by pulmonary sarcoidosis and 9 patients affected by other interstitial lung diseases were enrolled. 16S rRNA next-generation sequencing was used to study BAL microbial composition of these patients, and were also compared with already published microbial content in higher airways of such diseases. Results: Four phyla dominated the lower airway microbiota, Bacteroidetes being the most abundant phylum in both groups (56.9%). Diversity analysis showed no significant differences between the various diseases, particularly between pulmonary sarcoidosis and other interstitial lung diseases affecting lower airways. Conclusions: Our data indicate that the bacterial lower airways microbiota share the same signature and, therefore, cannot be used as a diagnostic tool to discriminate among different interstitial lung diseases, including sarcoidosis, while microbial diversity is present when considering lower or higher respiratory airways. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 354-362).
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Affiliation(s)
- Valeria D'Argenio
- CEINGE-Biotecnologie Avanzate s.c.a r.l. Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy.,Task Force on Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Giorgio Casaburi
- CEINGE-Biotecnologie Avanzate s.c.a r.l. Naples, Italy.,Evolve Biosystems, Inc. Davis, CA, USA
| | - Vincenza Precone
- CEINGE-Biotecnologie Avanzate s.c.a r.l. Naples, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Livio Gioacchino Moccia
- Department of Clinical Medicine and Surgery, Respiratory Medicine Section, University of Naples Federico II, Italy
| | | | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, Respiratory Medicine Section, University of Naples Federico II, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Respiratory Medicine Section, University of Naples Federico II, Italy
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14
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D'Amato G, Stanziola A, Sanduzzi A, Liccardi G, Salzillo A, Vitale C, Molino A, Vatrella A, D'Amato M. Treating severe allergic asthma with anti-IgE monoclonal antibody (omalizumab): a review. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2014.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Increased asthma severity is not only associated with enhanced recurrent hospitalization and mortality but also with higher social costs.Several cases of asthma are atopic in nature, with the trigger for acute asthma attacks and chronic worsening of inflammation being allergens inducing an immune, IgE mediated response.
Anti-inflammatory treatments are effective for most of asthma patients, but there are subjects whose disease is incompletely controlled by inhaled or systemic corticosteroids and these patients account for about 50% of the healthcare costs of asthma.Omalizumab is a biological engineered, humanized recombinant monoclonal anti-IgE antibody developed for the treatment of allergic diseases and with clear efficacy in adolescent and adult patients with severe allergic asthma. The anti-IgE antibody inhibits IgE functions blocking free serum IgE and inhibiting their binding to cellular receptors. By reducing serum IgE levels and IgE receptor expression on inflammatory cells in the context of allergic cascade, omalizumab has demonstrated to be a very useful treatment of atopic asthma, improving quality of life of patients with severe persistent allergic asthma that is inadequately controlled by currently available asthma medications. Several trials have demonstrated that this therapy is well tolerated and significantly improves symptoms and disease control, reducing asthma exacerbations and the need to use high dosage of inhaled corticosteroids.
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15
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Polito R, Nigro E, Pecoraro A, Monaco ML, Perna F, Sanduzzi A, Genovese A, Spadaro G, Daniele A. Adiponectin Receptors and Pro-inflammatory Cytokines Are Modulated in Common Variable Immunodeficiency Patients: Correlation With Ig Replacement Therapy. Front Immunol 2019; 10:2812. [PMID: 31827477 PMCID: PMC6890605 DOI: 10.3389/fimmu.2019.02812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/15/2019] [Indexed: 11/13/2022] Open
Abstract
Adiponectin exerts beneficial pleiotropic effects through three receptors, AdipoR1, AdipoR2, and T-cadherin; it also exerts immunomodulatory effects. We previously demonstrated that adiponectin levels are altered in common variable immunodeficiency disease (CVID). The purpose of the present study was to investigate further the specific involvement of adiponectin in CVID by characterizing (i) the expression profile of adiponectin receptors on peripheral blood mononuclear cells; (ii) the levels of another relevant adipokine, namely leptin; (iii) the levels of five other cytokines (IL-2, IL-6, IL-10, TNFα, and IFNγ) in 24 patients on maintenance therapy, in 18 treatment-naïve patients (before and 24 h after the first Ig infusion) and in 28 healthy controls. We found that (i) adiponectin was down-expressed in patients on maintenance therapy and in treatment-naïve patients, and that it increased in treatment-naïve patients 24 h after the first Ig infusion; (ii) leptin expression did not differ between maintenance patients and controls either before or after the first Ig infusion; (iii) AdipoR1 expression was significantly higher on B lymphocytes, monocytes and NK cells of CVID patients than in controls; (iv) the expression of AdipoR1 and AdipoR2 on B lymphocytes, monocytes and NK cells was higher after the first Ig infusion than in treatment-naïve patients; (v) T-cadherin expression did not differ between treatment- naïve CVID patients and controls, and was not affected by Ig infusion; and (vi) IL-6, IL-8, IL-10, and TNFα levels were differently expressed in CVID patients on therapy maintenance and were not affected by the first Ig replacement therapy. This is the first study to demonstrate that the expression of AdipoRs in peripheral blood mononuclear cells from CVID patients differs from that of controls, and changes after the first Ig infusion. The specificity of adiponectin involvement in CVID is supported by the absence of changes in leptin levels and in the levels of the cytokines investigated. Taken together, these results suggest that the adiponectin system plays an important and specific role in CVID. A better understanding of adiponectin as a link in the cross-talk between the immune system and adipose tissue may provide additional benefits for the management of CVID patients.
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Affiliation(s)
- Rita Polito
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania "Luigi Vanvitelli," Caserta, Italy.,CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
| | - Ersilia Nigro
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Scienze Mediche Traslazionali, Allergologia e Immunologia Clinica, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Antonio Pecoraro
- Dipartimento di Scienze Mediche Traslazionali, Allergologia e Immunologia Clinica, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Franco Perna
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Alessandro Sanduzzi
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II," Naples, Italy
| | - Arturo Genovese
- Dipartimento di Scienze Mediche Traslazionali, Allergologia e Immunologia Clinica, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Giuseppe Spadaro
- Dipartimento di Scienze Mediche Traslazionali, Allergologia e Immunologia Clinica, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Aurora Daniele
- Dipartimento di Scienze e Tecnologie Ambientali Biologiche Farmaceutiche, Università degli Studi della Campania "Luigi Vanvitelli," Caserta, Italy.,CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy
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16
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Canora A, Nicoletta C, Ghinassi G, Bruzzese D, Rea G, Capaccio A, Castaldo S, Coppola A, Polistina GE, Sanduzzi A, Bocchino M. First Description of the Hyperpnea-Hypopnea Periodic Breathing in Patients with Interstitial Lung Disease-Obstructive Sleep Apnea: Treatment Implications in a Real-Life Setting. Int J Environ Res Public Health 2019; 16:ijerph16234712. [PMID: 31779226 PMCID: PMC6926841 DOI: 10.3390/ijerph16234712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/16/2022]
Abstract
There is evidence that hypopneas are more common than apneas in obstructive sleep apnea (OSA) related to idiopathic pulmonary fibrosis (IPF). We investigated the frequency distribution of hypopneas in 100 patients with interstitial lung diseases (ILDs) (mean age 69 yrs ± 7.8; 70% males), including 54 IPF cases, screened for OSA by home sleep testing. Fifty age- and sex-matched pure OSA patients were included as controls. In ILD-OSA patients the sleep breathing pattern was characterized by a high prevalence of hypopneas that were preceded by hyperpnea events configuring a sort of periodic pattern. This finding, we arbitrarily defined hyperpnea–hypopnea periodic breathing (HHPB), was likely reflecting a central event and was completely absent in control OSA. Also, the HHPB was highly responsive to oxygen but not to the continuous positive pressure support. Thirty-three ILD-OSA patients (42%) with a HHPB associated with a hypopnea/apnea ratio ≥3 had the best response to oxygen with a median residual AHI of 2.6 (1.8–5.6) vs. 28.3 (20.7–37.8) at baseline (p < 0.0001). ILD-OSA patients with these characteristics were similarly distributed in IPF (54.5%) and no-IPF cases (45.5%), the most of them being affected by moderate–severe OSA (p = 0.027). Future studies addressing the pathogenesis and therapy management of the HHPB should be encouraged in ILD-OSA patients.
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Affiliation(s)
- Angelo Canora
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Carmine Nicoletta
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Giacomo Ghinassi
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Dario Bruzzese
- Dipartimento di Sanità Pubblica, Università Federico II, 80131 Napoli, Italy;
| | - Gaetano Rea
- Dipartimento dei Servizi Diagnostici e Generali, Ospedali dei Colli, Monaldi-Cotugno, 80131 Napoli, Italy;
| | - Annalisa Capaccio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Sabrina Castaldo
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Antonietta Coppola
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Giorgio Emanuele Polistina
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Alessandro Sanduzzi
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
| | - Marialuisa Bocchino
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie dell’Apparato Respiratorio, Università Federico II, 80131 Napoli, Italy; (A.C.); (C.N.); (G.G.); (A.C.); (S.C.); (A.C.); (G.E.P.); (A.S.)
- Correspondence: ; Tel.: +30-081-7062773
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17
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Riccardi A, Marcoccia A, Borgia A, Guastafierro T, Bondanini F, Fasano S, Irace R, Messiniti V, Sanduzzi A, Bocchino M, Ciani A, D'Alto M, Argiento P, De Matteis GM, Spanò A, Valentini G. Undifferentiated connective tissue disease at risk of systemic sclerosis: A weighted score to identify patients who will evolve. Autoimmun Rev 2019; 18:102358. [DOI: 10.1016/j.autrev.2019.102358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
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18
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Bocchino M, Bruzzese D, D'Alto M, Argiento P, Borgia A, Capaccio A, Romeo E, Russo B, Sanduzzi A, Valente T, Sverzellati N, Rea G, Vettori S. Performance of a new quantitative computed tomography index for interstitial lung disease assessment in systemic sclerosis. Sci Rep 2019; 9:9468. [PMID: 31263199 PMCID: PMC6603022 DOI: 10.1038/s41598-019-45990-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/21/2019] [Indexed: 01/24/2023] Open
Abstract
Quantitative high resolution computed tomography (HRCT) may objectively assess systemic sclerosis (SSc)-interstitial lung disease (ILD) extent, using three basic densitometric measures: mean lung attenuation (MLA), skewness, and kurtosis. This prospective study aimed to develop a composite index - computerized integrated index (CII) – that accounted for MLA, skewness, and kurtosis by means of Principal Component Analysis over HRCTs of 83 consecutive SSc subjects, thus eliminating redundancies. Correlations among CII, cardiopulmonary function and immune-inflammatory biomarkers (e.g. sIL-2Rα and CCL18 serum levels) were explored. ILD was detected in 47% of patients at visual HRCT assessment. These patients had worse CII values than patients without ILD. The CII correlated with lung function at both baseline and follow-up, and with sIL-2Rα and CCL18 serum levels. The best discriminating CII value for ILD was 0.1966 (AUC = 0.77; sensitivity = 0.81 [95%CI:0.68–0.92]; specificity = 0.66 [95%CI:0.52–0.80]). Thirty-four percent of patients without visual trace of ILD had a CII lower than 0.1966, and 67% of them had a diffusing lung capacity for CO <80% of predicted. We showed that this new composite CT index for SSc-ILD assessment correlates with both lung function and immune-inflammatory parameters and could be sufficiently sensitive for capturing early lung density changes in visually ILD-free patients.
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Affiliation(s)
- Marialuisa Bocchino
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
| | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Argiento
- Department of Cardiology, Monaldi Hospital - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessia Borgia
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Capaccio
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Emanuele Romeo
- Department of Cardiology, Monaldi Hospital - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Barbara Russo
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Sanduzzi
- Respiratory Medicine Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | - Serena Vettori
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
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19
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Terlizzi M, Colarusso C, De Rosa I, De Rosa N, Somma P, Curcio C, Sanduzzi A, Micheli P, Molino A, Saccomanno A, Salvi R, Aquino RP, Pinto A, Sorrentino R. Correction: Circulating and tumor-associated caspase-4: a novel diagnostic and prognostic biomarker for non-small cell lung cancer. Oncotarget 2018; 9:29537. [PMID: 30034638 PMCID: PMC6047678 DOI: 10.18632/oncotarget.25751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Michela Terlizzi
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Chiara Colarusso
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy.,PhD Program in Drug Discovery and Development, Department of Pharmacy, University of Salerno, Fisciano, SA, Italy
| | - Ilaria De Rosa
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Nicolina De Rosa
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Pasquale Somma
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Alessandro Sanduzzi
- Department of Respiratory Medicine, Respiratory Division, University of Naples Federico II, Fisciano, SA, Italy
| | - Pietro Micheli
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Antonio Molino
- Department of Respiratory Medicine, Respiratory Division, University of Naples Federico II, Fisciano, SA, Italy
| | - Antonello Saccomanno
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Rosario Salvi
- Thoracic Surgery Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Rita P Aquino
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Aldo Pinto
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Rosalinda Sorrentino
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
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20
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D'Amato M, Annesi-Maesano I, Molino A, Mormile M, Vitale C, Vatrella A, Sanduzzi A, D'Amato G. [Thunderstorm and asthma outbreaks during pollen season]. Epidemiol Prev 2018; 41:208-211. [PMID: 28929717 DOI: 10.19191/ep17.3-4.p208.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing body of evidence shows the occurrence of asthma epidemics, sometimes also severe, during thunderstorms in the pollen season in various geographical zones. The main hypothesis explaining association between thunderstorms and asthma claims that thunderstorms can concentrate pollen grains at ground level; these grains may then release allergenic particles of respirable size in the atmosphere after their rupture by osmotic shock. During the first 20-30 minutes of a thunderstorm, patients suffering from pollen allergy may inhale a high concentration of the allergenic material dispersed into the atmosphere, which can, in turn, induce asthmatic reactions, often severe. Subjects without asthma symptoms but affected by seasonal rhinitis can also experience an asthma attack. All subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe bronchial obstruction. Considering this background, it is useful to predict thunderstorms during pollen season and, thus, to prevent thunderstorm-related clinical event. However, it is also important to focus on therapy, and it is not sufficient that subjects at risk of asthma follow a correct therapy with bronchodilators, but they also need to inhale corticosteroids, using both in case of emergency.
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Affiliation(s)
- Maria D'Amato
- Divisione di pneumologia, Azienda ospedaliera dei colli, Università Federico II, Napoli
| | - Isabella Annesi-Maesano
- Département d'epidémiologie des maladies allergiques et respiratoires, Institut national de la santé et de la recherche médicale (INSERM), Parigi
| | - Antonio Molino
- Divisione di pneumologia, Azienda ospedaliera dei colli, Università Federico II, Napoli
| | - Mauro Mormile
- Divisione di pneumologia, Azienda ospedaliera dei colli, Università Federico II, Napoli
| | | | | | - Alessandro Sanduzzi
- Divisione di pneumologia, Azienda ospedaliera dei colli, Università Federico II, Napoli
| | - Gennaro D'Amato
- Divisione di malattie respiratorie e allergiche, Dipartimento di malattie respiratorie, Azienda ospedaliera ad alta specialità di rilievo nazionale "A. Cardarelli", Napoli.
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21
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Terlizzi M, Colarusso C, De Rosa I, De Rosa N, Somma P, Curcio C, Sanduzzi A, Micheli P, Molino A, Saccomanno A, Salvi R, Aquino RP, Pinto A, Sorrentino R. Circulating and tumor-associated caspase-4: a novel diagnostic and prognostic biomarker for non-small cell lung cancer. Oncotarget 2018; 9:19356-19367. [PMID: 29721208 PMCID: PMC5922402 DOI: 10.18632/oncotarget.25049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/17/2018] [Indexed: 02/06/2023] Open
Abstract
Late diagnosis limits therapeutic options and survival rate of non-small cell lung cancer (NSCLC) patients. Therefore the identification of biomarkers represents an emerging medical need. A highly sensitive and specific test was developed to identify/quantify a novel/selective diagnostic biomarker for NSCLC patients, caspase-4. This test was validated by using i) plasma from 125 NSCLC patients and 79 healthy (non-pathological) subjects, ii) plasma from 139 smokers and iii) from 70 chronic-obstructive pulmonary disease (COPD) patients. Caspase-4 quantification was also assessed in the lung tumor mass of 98 paired NSCLC patients compared to 10 non-tumor lung tissues (i.e. tuberculosis). Circulating caspase-4 was detected in both healthy and NSCLC patients; however at different range values: 2.603–3.372 ng/ml for NSCLC patients (95% CI) compared to 0.3994-0.6219 ng/ml for healthy subjects (95% CI). The sensitivity of the test ranged from 97.07% to 100%; the specificity was 88.1% with a positive predictive value of 92.54%, accuracy of 95.19% and AUC of 0.971. Smokers (95% CI, 0.3947–0.6197 ng/ml) and COPD patients (95% CI, 1.703–2.995 ng/ml) showed intermediate values of circulating caspase-4. Tissue levels of caspase-4 in the tumor mass showed that 72 (72.7%) out of 99 patients were positive. More importantly, higher levels (cut-off value = 0.307 ng/ml) of caspase-4 in the tumor mass were associated to reduced overall survival (median 0.92 years) compared to NSCLC patients with lower levels (median 3.02 years). We report for the first time caspase-4 as a novel diagnostic and prognostic biomarker, opening new therapeutic perspectives for NSCLC patients.
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Affiliation(s)
- Michela Terlizzi
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Chiara Colarusso
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy.,PhD Program in Drug Discovery and Development, Department of Pharmacy, University of Salerno, Fisciano, SA, Italy
| | - Ilaria De Rosa
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Nicolina De Rosa
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Pasquale Somma
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Carlo Curcio
- Thoracic Surgery Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Alessandro Sanduzzi
- Department of Respiratory Medicine, Respiratory Division, University of Naples Federico II, Fisciano, SA, Italy
| | - Pietro Micheli
- Anatomy and Pathology Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Antonio Molino
- Department of Respiratory Medicine, Respiratory Division, University of Naples Federico II, Fisciano, SA, Italy
| | - Antonello Saccomanno
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Rosario Salvi
- Thoracic Surgery Unit, Ospedale dei Colli, AORN, "Monaldi", Naples, Italy
| | - Rita P Aquino
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Aldo Pinto
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
| | - Rosalinda Sorrentino
- Department of Pharmacy, University of Salerno, ImmunePharma S.r.l., Fisciano, SA, Italy
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22
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Riccardi A, Irace R, Di Stefano I, Iudici M, Fasano S, Bocchino M, Capaccio A, Sanduzzi A, Valentini G. Lung involvement in “stable” undifferentiated connective tissue diseases: a rheumatology perspective. Clin Rheumatol 2017; 36:1833-1837. [DOI: 10.1007/s10067-017-3704-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 11/30/2022]
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23
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Buonauro A, Galderisi M, Santoro C, Canora A, Bocchino ML, Lo Iudice F, Lembo M, Esposito R, Castaldo S, Trimarco B, Sanduzzi A. Obstructive sleep apnoea and right ventricular function: A combined assessment by speckle tracking and three-dimensional echocardiography. Int J Cardiol 2017; 243:544-549. [PMID: 28526545 DOI: 10.1016/j.ijcard.2017.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/04/2017] [Accepted: 05/02/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Little is known on right ventricular (RV) involvement in obstructive sleep apnoea (OSA). This study aimed at evaluating early RV dysfunction by standard and advanced echocardiography in OSA. METHODS Fifty-nine OSA patients without heart failure and 29 age-matched controls underwent standard, speckle tracking and real time 3D echocardiography of right ventricle. OSA patients performed lung function tests and overnight cardio-respiratory monitoring with evaluation of apnea-hypopnea index (AHI). RESULTS OSA had significantly higher body mass index and systolic blood pressure (BP) than controls. RV diameters and systolic pulmonary arterial pressure (sPAP) were significantly higher in OSA, in presence of comparable tricuspid annular plane systolic excursion (TAPSE). OSA showed marginally lower RV global longitudinal strain (GLS) (p<0.05) and RV lateral wall strain (RV LLS) (p=0.04). Three-dimensional RV ejection fraction did not differ between the two groups. By stratifying patients according to sPAP, 18 OSA patients with sPAP≥30mmHg had lower TAPSE (p<0.05), RV GLS and RV LLS (both p<0.001) than 37 patients with normal sPAP. By separate multivariate analyses, RV GLS and RV LLS were independently associated with sPAP (both p<0.0001), AHI (p=0.035 and p=0.015 respectively) and BMI (p<0.05 and p=0.034) but not with age and systolic BP in OSA. CONCLUSIONS A subclinical RV dysfunction is detectable by speckle tracking in OSA. The impairment of RV GLS and RV LLS is more prominent than that of TAPSE and is evident when RVEF is still normal. GLS is independently associated with sPAP and OSA severity.
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Affiliation(s)
- Agostino Buonauro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Angelo Canora
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Luisa Bocchino
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Francesco Lo Iudice
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Sabrina Castaldo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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24
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Sanduzzi A, Marchetiello I, Bocchino M, Boccia G, De Caro F. Tuberculin skin test and/or interferon gamma release assay: is it still time to debate? Infez Med 2017; 25:80-81. [PMID: 28353462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Not available.
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Affiliation(s)
- Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, University "Federico II", Medical School, Naples, Italy
| | | | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, University "Federico II", Medical School, Naples, Italy
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25
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Aiello M, Bertorelli G, Bocchino M, Chetta A, Fiore-Donati A, Fois A, Marinari S, Oggionni T, Polla B, Rosi E, Stanziola A, Varone F, Sanduzzi A. The earlier, the better: Impact of early diagnosis on clinical outcome in idiopathic pulmonary fibrosis. Pulm Pharmacol Ther 2017; 44:7-15. [PMID: 28257817 DOI: 10.1016/j.pupt.2017.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/03/2017] [Accepted: 02/27/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a complex disease with a highly variable clinical course and generally poor prognosis. Classified as a rare disease, significant increases in incidence have been recorded worldwide in recent years. Left untreated IPF is extremely debilitating with substantial personal, social and economic implications. OBJECTIVES To discuss how IPF is diagnosed and managed in real life clinical practice with particular reference to Italy and to determine how new and effective therapies can be incorporated into a patient-centred management approach in order to improve the lives of patients with IPF. OUTCOMES Barriers to early diagnosis are discussed. Cited reasons for delays in diagnosing IPF in Italy include: inherent difficulties in diagnosis; lack of knowledge/awareness of the condition among point-of-contact healthcare professionals; delays in referral to centres of excellence and underestimation of symptoms by both patients and healthcare workers. Valid therapeutic options with demonstrated efficacy in slowing the decline in lung function are now available for patients with IPF. The ASCEND trial confirmed the effects of pirfenidone, approved for the treatment of IPF on the basis of the four phase III trials. Nintedanib, a tyrosine kinase inhibitor that targets the PDGF receptors α/β, FGF receptors 1 to 3, and VEGF receptors 1-3, is approved in the USA and the EU for the treatment of IPF. The TOMORROW and the INPULSIS placebo controlled trials in patients with IPF confirm the efficacy and safety of nintedanib and recent interim analyses endorse its long-term effects in slowing disease progression. CONCLUSIONS The importance of early and accurate diagnosis of IPF cannot be underestimated and it is the duty of all healthcare professionals to be vigilant to the symptoms of IPF and to involve a multidisciplinary team in diagnosing and managing IPF early in the course of disease.
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Affiliation(s)
- Marina Aiello
- Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Italy.
| | - Giuseppina Bertorelli
- Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Italy.
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Italy.
| | - Alfredo Chetta
- Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Italy.
| | - Alfeo Fiore-Donati
- Direttore UOC di Pneumologia ed UTSIR, ASL 01 Abruzzo OC San Salvatore, L'Aquila, Italy.
| | - Alessandro Fois
- Department of Clinical and Experimental Medicine- Lung Disease Unit, University of Sassari, Italy.
| | - Stefano Marinari
- Pneumology Department, SS Annunziata Hospital, University of Chieti, Italy.
| | - Tiberio Oggionni
- Cardiothoracic and Vascular Department, Pneumology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Biagio Polla
- Department of Pneumology, AO "SS. Antonio e Biagio", Alessandria, Italy.
| | - Elisabetta Rosi
- Department of Cardiology and Thoracic Medicine, Respiratory Disease Unit, AOU Careggi, Florence, Italy.
| | - Anna Stanziola
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Italy.
| | - Francesco Varone
- Cardio-Thoracic Department, Fondazione Policlinico Universitario "A. Gemelli", Roma, Italy.
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Italy.
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26
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D'Amato G, Vitale C, D'Amato M, Cecchi L, Liccardi G, Molino A, Vatrella A, Sanduzzi A, Maesano C, Annesi-Maesano I. Thunderstorm-related asthma: what happens and why. Clin Exp Allergy 2016; 46:390-6. [PMID: 26765082 DOI: 10.1111/cea.12709] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 12/21/2015] [Accepted: 01/05/2016] [Indexed: 01/07/2023]
Abstract
The fifth report issued by the Intergovernmental Panel on Climate Change forecasts that greenhouse gases will increase the global temperature as well as the frequency of extreme weather phenomena. An increasing body of evidence shows the occurrence of severe asthma epidemics during thunderstorms in the pollen season, in various geographical zones. The main hypotheses explaining association between thunderstorms and asthma claim that thunderstorms can concentrate pollen grains at ground level which may then release allergenic particles of respirable size in the atmosphere after their rupture by osmotic shock. During the first 20-30 min of a thunderstorm, patients suffering from pollen allergies may inhale a high concentration of the allergenic material that is dispersed into the atmosphere, which in turn can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack. All subjects affected by pollen allergy should be alerted to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe exacerbations. In light of these observations, it is useful to predict thunderstorms and thus minimize thunderstorm-related events.
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Affiliation(s)
- G D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality A. Cardarelli Hospital, Napoli, Italy
| | - C Vitale
- First Division of Pneumology, High Speciality Hospital 'V. Monaldi' and University 'Federico II' Medical School Naples, Napoli, Italy
| | - M D'Amato
- First Division of Pneumology, High Speciality Hospital 'V. Monaldi' and University 'Federico II' Medical School Naples, Napoli, Italy
| | - L Cecchi
- University of Florence, Florence, Italy.,Allergy and Clinical Immunology Section, Azienda Sanitaria di Prato, Prato, Italy
| | - G Liccardi
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality A. Cardarelli Hospital, Napoli, Italy
| | - A Molino
- First Division of Pneumology, High Speciality Hospital 'V. Monaldi' and University 'Federico II' Medical School Naples, Napoli, Italy
| | - A Vatrella
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - A Sanduzzi
- First Division of Pneumology, High Speciality Hospital 'V. Monaldi' and University 'Federico II' Medical School Naples, Napoli, Italy
| | - C Maesano
- Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), UPMC Univ Paris 06, INSERM, Saint-Antoine Medical School, Sorbonne Universités, Paris, France
| | - I Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), UPMC Univ Paris 06, INSERM, Saint-Antoine Medical School, Sorbonne Universités, Paris, France
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27
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D’Amato G, Vitale C, Molino A, Stanziola A, Sanduzzi A, Vatrella A, Mormile M, Lanza M, Calabrese G, Antonicelli L, D’Amato M. Asthma-related deaths. Multidiscip Respir Med 2016; 11:37. [PMID: 27752310 PMCID: PMC5059970 DOI: 10.1186/s40248-016-0073-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/17/2016] [Indexed: 11/10/2022] Open
Abstract
Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthma deaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide.
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Affiliation(s)
- Gennaro D’Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality “A. Cardarelli” Hospital, Napoli, Italy
| | - Carolina Vitale
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Anna Stanziola
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Alessandro Sanduzzi
- Second Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | | | - Mauro Mormile
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Maurizia Lanza
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Giovanna Calabrese
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
| | - Leonardo Antonicelli
- Service of Immunoallergology, University Hospital “Ospedali Riuniti”, Ancona, Italy
| | - Maria D’Amato
- First Division of Pneumology, High Speciality Hospital ‘V. Monaldi’ and University ‘Federico II’ Medical School Naples, Napoli, Italy
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28
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D’Amato G, Vitale C, Molino A, Stanziola A, Sanduzzi A, Vatrella A, Mormile M, Lanza M, Calabrese G, Antonicelli L. Asthma-related deaths. Multidiscip Respir Med 2016. [DOI: 10.4081/mrm.2016.331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthma deaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide
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29
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Sanduzzi A, Ponticiello A, Bocchino M, Perna F, Vatrella A. Latent tuberculosis infection (LTBI): a real host defence or a permanent threat? Infez Med 2016; 24:179-182. [PMID: 27668896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Screening of latent infection by Mycobacterium tuberculosis (LTBI) and treatment of positive subjects is the key point in the prevention of TB; such a strategy should be performed mainly among individuals with risk of progression. Progression from LTBI to active TB is highest both in recent contacts of patients with active TB, and in immunocompromised subjects. Therefore, LTBI could either be considered a permanent host defence or, seen from the opposite point of view, it could represent a long-lasting threat if the efficiency of the immune system declines over a lifetime. Interferon gamma release assays (IGRAs) show better sensitivity and specificity than the Mantoux test.
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Affiliation(s)
- Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, University "Federico II", Medical School, Naples, Italy
| | - Antonio Ponticiello
- Department of Clinical Medicine and Surgery, University "Federico II", Medical School, Naples, Italy
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, University "Federico II", Medical School, Naples, Italy
| | - Francesco Perna
- Department of Clinical Medicine and Surgery, University "Federico II", Medical School, Naples, Italy
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De Martino M, Cobuccio R, Bruzzese D, Rea G, Meoli I, Stefanelli F, Canora A, Capaccio A, Sanduzzi A, Matarese A, Bocchino M. Exercise related ventilation dynamics and clinical correlates in patients with fibrotic idiopathic interstitial pneumonias. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:157-165. [PMID: 27537719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/18/2016] [Indexed: 06/06/2023]
Abstract
Assessment of exercise performance is a key component in the management of interstitial lung diseases, as its limitation may occur very early. Aim of the present study was to assess ventilation dynamics in combination with pulse-oximetry changes in 54 clinically stable patients affected by idiopathic pulmonary fibrosis or idiopathic fibrotic nonspecific interstitial pneumonia. Testing was successfully performed with the Spiropalm 6-MWT Hand-held spirometer by the majority of cases (94%). End test oxygen saturation (SpO2) values <88% were common in most of patients (76%), with a mean distance walked of 403 meters. Ventilation significantly increased due to the contribution of the tidal volume and the respiratory frequency (RF). This finding was associated with a decrease of the end of test respiratory reserve (RR), that was <20% in 9 cases (17.6%). Lung function was inversely related to the end of test RF, while a positive correlation occurred with the end of test RR and the estimated maximal voluntary ventilation (MVV). RR was also a predictive factor of declining forced vital capacity and lung diffusion capacity for carbon monoxide (DLCO) over a 6-month period. Further factors of DLCO impairment were low SpO2 and MVV. Comparison with the cardio-pulmonary exercise test (CPET) showed that the 6-MWT end of test RR was inversely related to the CPET-derived peak RF and VE/VCO2 suggesting RR as pivotal in exercise limitation assessment. Our results open challenging perspectives in an unexplored field. Future research will include management of latent respiratory failure and monitoring of disease progression and therapy response.
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Moccia LG, Castaldo S, Sirignano E, Napolitano M, Barra E, Sanduzzi A. Sarcoidosis with prevalent and severe joint localization: a case report. Multidiscip Respir Med 2016; 11:27. [PMID: 27358732 PMCID: PMC4926288 DOI: 10.1186/s40248-016-0064-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/05/2016] [Indexed: 02/01/2023] Open
Abstract
Background Sarcoidosis is a systemic granulomatous disease of unknown origin, characterized by the formation of granulomas without central necrosis. Each organ and tissue can be affected by the disease, but in most cases mainly the lungs and mediastinal lymph nodes but also skin, heart, eyes and joints are involved, the latter are mainly the metacarpophalangeal joints and bone lesions are often associated with involvement of the overlying skin. The diagnosis is often of exclusion, based on clinical and radiological suspicion, and should be confirmed by biopsy, although in each case it is necessary to exclude other possible causes of granulomatosis, including infections by mycobacteria. Here it is reported a case of particularly aggressive sarcoidosis with primitive involvement of the small joints of the hands and feet, and mediastinal lymph nodes. Case presentation The subject, a man, 60 years old, born in Morocco but living in Italy for many years, presented important involvement of bone structures and soft periarticular tissue, and was affected by the formation of granulomas without “caseum necrosis”. The painful symptoms and the skin ulceration had led to surgical amputation of the distal phalanges of most fingers of his hands and feet, but with subsequent resurgence of lesions in acral locations after surgery. The PET/CT scan showed an amount of radiotracer in mediastinal lymph nodes, while the lymph nodes sampled by TBNA were normal and the CD4/CD8 ratio was less than 3 in the bronchoalveolar lavage. We ruled out any possible infectious cause, including mycobacterial infection (both tubercular and atypical), so the patient was treated with systemic corticosteroids, with an excellent clinical and radiological response. Conclusions Such a case shows how the disease can have variable expressions, without primitive lung involvement; therefore, it should be necessary to consider any possible, unpredictable localization of the disease.
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Affiliation(s)
- Livio G Moccia
- Division of Pneumology, Department of Clinical Medicine and Surgery, University "Federico II" Medical School, Naples, Italy
| | - Sabrina Castaldo
- Division of Pneumology, Department of Clinical Medicine and Surgery, University "Federico II" Medical School, Naples, Italy
| | - Emanuela Sirignano
- Division of Pneumology, Department of Clinical Medicine and Surgery, University "Federico II" Medical School, Naples, Italy
| | - Maddalena Napolitano
- Division of Dermatology, Department of Clinical Medicine and Surgery, University "Federico II" Medical School, Naples, Italy
| | - Enrica Barra
- Department of Pathology, High Speciality Hospital "V. Monaldi", Naples, Italy
| | - Alessandro Sanduzzi
- Division of Pneumology, Department of Clinical Medicine and Surgery, University "Federico II" Medical School, Naples, Italy
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D'Amato G, Vitale C, Lanza M, Sanduzzi A, Molino A, Mormile M, Vatrella A, Bilò MB, Antonicelli L, Bresciani M, Micheletto C, Vaghi A, D'Amato M. Near fatal asthma: treatment and prevention. Eur Ann Allergy Clin Immunol 2016; 48:116-122. [PMID: 27425166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Near-fatal asthma (NFA) is described as acute asthma associated with a respiratory arrest or arterial carbon dioxide tension greater than 50 mmHg, with or without altered consciousness, requiring mechanical ventilation. Risk factors for near fatal asthma have not been fully elucidated. In 80-85% of all fatal events, a phenotype, characterized by eosinophilic inflammation associated with gradual deterioration occurring in patients with severe and poorly controlled asthma, has been identified. Regarding to the management, acute severe asthma remains a significant clinical problem, which needs to be identified to facilitate early and appropriate therapeutic interventions. The assessment relies on clinical signs, but additional information might be obtained from chest radiography or blood gas analysis. No investigation should delay the initiation of appropriate therapy. The goals of therapy are the maintenance of oxygenation, relief of airflow obstruction, reduction of airways edema and mucus plugging (with Increased use of medications such as beta-agonists via metered dose inhalers and nebulizers, oral and/or intravenous (other than by inhalation) corticosteroids and oral or intravenous theophylline) whereas supporting ventilation as clinically indicated. Of course, the emergency physician needs to consider the wide range of potential complications, as attention to these problems when managing severe acute asthma might significantly improve outcome. An understanding of the available agents and potential pitfalls in the management of NFA is mandatory for the emergency physician.
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Affiliation(s)
- G D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases High Speciality, A. Cardarelli Hospital, Napoli, Italy. University "Federico II", Medical School of Respiratory Diseases, Naples, Italy. E-mail:
| | - C Vitale
- Department of medicine and surgery, University of Salerno, Italy
| | - M Lanza
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - A Sanduzzi
- Second Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - A Molino
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - M Mormile
- Autonomic Service of Pneumology, Policlinical University Federico II, Naples, Italy
| | - A Vatrella
- Department of medicine and surgery, University of Salerno, Italy
| | - M B Bilò
- Service of Immunoallergology, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - L Antonicelli
- Service of Immunoallergology, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - M Bresciani
- Service of Allergology, Hospital san Paolo, Civitavecchia, Italy
| | - C Micheletto
- Division of Pneumology, Hospital Mater Salutis, Legnago,Verona, Italy
| | - A Vaghi
- Division of Pneumology, Hospital Salvini, Garbagnate, Milan, Italy
| | - M D'Amato
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
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Moccia LG, Castaldo S, Sirignano E, Napolitano M, Barra E, Sanduzzi A. Sarcoidosis with prevalent and severe joint localization: a case report. Multidiscip Respir Med 2016. [DOI: 10.4081/mrm.2016.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Sarcoidosis is a systemic granulomatous disease of unknown origin, characterized by the formation of granulomas without central necrosis. Each organ and tissue can be affected by the disease, but in most cases mainly the lungs and mediastinal lymph nodes but also skin, heart, eyes and joints are involved, the latter are mainly the metacarpophalangeal joints and bone lesions are often associated with involvement of the overlying skin. The diagnosis is often of exclusion, based on clinical and radiological suspicion, and should be confirmed by biopsy, although in each case it is necessary to exclude other possible causes of granulomatosis, including infections by mycobacteria. Here it is reported a case of particularly aggressive sarcoidosis with primitive involvement of the small joints of the hands and feet, and mediastinal lymph nodes. Case presentation: The subject, a man, 60 years old, born in Morocco but living in Italy for many years, presented important involvement of bone structures and soft periarticular tissue, and was affected by the formation of granulomas without “caseum necrosis”. The painful symptoms and the skin ulceration had led to surgical amputation of the distal phalanges of most fingers of his hands and feet, but with subsequent resurgence of lesions in acral locations after surgery. The PET/CT scan showed an amount of radiotracer in mediastinal lymph nodes, while the lymph nodes sampled by TBNA were normal and the CD4/CD8 ratio was less than 3 in the bronchoalveolar lavage. We ruled out any possible infectious cause, including mycobacterial infection (both tubercular and atypical), so the patient was treated with systemic corticosteroids, with an excellent clinical and radiological response. Conclusions: Such a case shows how the disease can have variable expressions, without primitive lung involvement; therefore, it should be necessary to consider any possible, unpredictable localization of the disease.
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D'Amato G, Pawankar R, Vitale C, Lanza M, Molino A, Stanziola A, Sanduzzi A, Vatrella A, D'Amato M. Climate Change and Air Pollution: Effects on Respiratory Allergy. Allergy Asthma Immunol Res 2016; 8:391-5. [PMID: 27334776 PMCID: PMC4921692 DOI: 10.4168/aair.2016.8.5.391] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/16/2015] [Indexed: 12/17/2022]
Abstract
A body of evidence suggests that major changes involving the atmosphere and the climate, including global warming induced by anthropogenic factors, have impact on the biosphere and human environment. Studies on the effects of climate change on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, such as meteorological variables, airborne allergens, and air pollution. Urbanization with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases and bronchial asthma observed over recent decades in most industrialized countries. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in the general population and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could also be an effect of air pollution and climate change. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last 5 decades. Pollen allergy is frequently used to study the relationship between air pollution and respiratory allergic diseases, such as rhinitis and bronchial asthma. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions, and westernized lifestyle are correlated with an increased frequency of respiratory allergy prevalently in people who live in urban areas in comparison with people living in rural areas. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc.) can affect both components (biological and chemical) of this interaction.
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases High Speciality, A. Cardarelli Hospital, Napoli, Italy. .,University "Federico II", Medical School, Naples, Italy
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Carolina Vitale
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Maurizia Lanza
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Anna Stanziola
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Alessandro Sanduzzi
- University "Federico II", Medical School, Naples, Italy.,Second Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | | | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
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Balestro E, Calabrese F, Turato G, Lunardi F, Bazzan E, Marulli G, Biondini D, Rossi E, Sanduzzi A, Rea F, Rigobello C, Gregori D, Baraldo S, Spagnolo P, Cosio MG, Saetta M. Immune Inflammation and Disease Progression in Idiopathic Pulmonary Fibrosis. PLoS One 2016; 11:e0154516. [PMID: 27159038 PMCID: PMC4861274 DOI: 10.1371/journal.pone.0154516] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/14/2016] [Indexed: 11/18/2022] Open
Abstract
The clinical course in idiopathic pulmonary fibrosis (IPF) is highly heterogeneous, with some patients having a slow progression and others an accelerated clinical and functional decline. This study aims to clinically characterize the type of progression in IPF and to investigate the pathological basis that might account for the observed differences in disease behavior. Clinical and functional data were analyzed in 73 IPF patients, followed long-time as candidates for lung transplantation. The forced vital capacity (FVC) change/year (< or ≥10% predicted) was used to define “slow” or “rapid” disease progression. Pathological abnormalities were quantified in the explanted lung of 41 out of 73 patients undergoing lung transplantation. At diagnosis, slow progressors (n = 48) showed longer duration of symptoms and lower FVC than rapid progressors (n = 25). Eleven slow and 3 rapid progressors developed an acute exacerbation (AE) during follow-up. Quantitative lung pathology showed a severe innate and adaptive inflammatory infiltrate in rapid progressors, markedly increased compared to slow progressors and similar to that observed in patients experiencing AE. The extent of inflammation was correlated with the yearly FVC decline (r = 0.52, p = 0.005). In conclusion an innate and adaptive inflammation appears to be a prominent feature in the lung of patients with IPF and could contribute to determining of the rate of disease progression.
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Affiliation(s)
- Elisabetta Balestro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Graziella Turato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesca Lunardi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Erica Bazzan
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giuseppe Marulli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Davide Biondini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Emanuela Rossi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Federico II University, Napoli, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Chiara Rigobello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Simonetta Baraldo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Paolo Spagnolo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Manuel G. Cosio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
- Respiratory Division Meakins-Christie Laboratories, McGill University, Montreal, Canada
| | - Marina Saetta
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
- * E-mail:
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Matera MG, Sanduzzi A, Alfano R, Cazzola M. Aclidinium bromide inhalation powder for the long-term, maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease including chronic bronchitis and emphysema. Expert Rev Clin Pharmacol 2016; 9:771-7. [PMID: 26998725 DOI: 10.1586/17512433.2016.1169173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aclidinium is a twice-daily long-acting muscarinic receptor antagonist (LAMA) with an interesting pharmacological profile. Recent evidence indicates that this LAMA, in addition to causing a significant improvement in lung function and other important supportive outcomes, such as health related quality of life, dyspnea and nighttime/early morning symptoms in patients suffering from COPD, is also able to significantly reduce the rate of exacerbations of any severity, is extremely effective in controlling the COPD symptoms, is able to reduce lung hyperinflation, and has an excellent cardiovascular safety profile. Consequently, aclidinium should be considered a first-line approach at least for the symptomatic treatment of COPD although there are still few head-to-head studies comparing this LAMA with other bronchodilators. In any case, aclidinium can be taken into account in the treatment of different COPD phenotypes (emphysema, chronic bronchitis, exacerbators and patients with overlap COPD asthma).
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Affiliation(s)
| | - Alessandro Sanduzzi
- b Department of Respiratory Diseases , Monaldi Hospital, University Federico II , Naples , Italy
| | - Roberto Alfano
- c Department of Anaesthesiological, Surgical and Emergency Sciences , Second University of Naples , Naples , Italy
| | - Mario Cazzola
- d Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
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Capolongo G, Xu LHR, Accardo M, Sanduzzi A, Stanziola AA, Colao A, Agostini C, Zacchia M, Capasso G, Adams-Huet B, Moe OW, Maalouf NM, Sakhaee K, Hsia CCW. Vitamin-D status and mineral metabolism in two ethnic populations with sarcoidosis. J Investig Med 2016; 64:1025-34. [PMID: 27053725 DOI: 10.1136/jim-2016-000101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2016] [Indexed: 01/23/2023]
Abstract
Vitamin-D insufficiency and sarcoidosis are more common and severe in African Americans (AA) than Caucasians. In sarcoidosis, substrate-dependent extrarenal 1,25-dihydroxyvitamin-D (1,25-(OH)2D) production is thought to contribute to hypercalciuria and hypercalcemia, and vitamin-D repletion is often avoided. However, the anti-inflammatory properties of vitamin-D may also be beneficial. We prospectively examined serum vitamin-D levels, calcium balance, and the effects of vitamin-D repletion in 86 AA and Caucasian patients with biopsy-proven active sarcoidosis from the USA (US) and Italy (IT) in university-affiliated outpatient clinics. Clinical features, pulmonary function, and calciotropic hormones were measured. 16 patients with vitamin-D deficiency and normal serum ionized calcium (Ca(2+)) were treated with oral ergocalciferol (50,000 IU/week) for 12 weeks. Baseline mineral parameters were similar in US (93% AA) and IT (95% Caucasian) patients irrespective of glucocorticoid treatment. Pulmonary dysfunction was less pronounced in IT patients. Nephrolithiasis (in 11% US, 17% IT patients) was associated with higher urinary calcium excretion. Vitamin-D deficiency was not more prevalent in patients compared to the respective general populations. As serum 25-hydroxyvitamin-D (25-OHD) rose postrepletion, serum 1,25-(OH)2D, γ-globulins, and the previously elevated angiotensin converting enzyme (ACE) levels declined. Asymptomatic reversible increases in Ca(2+) or urinary calcium/creatinine (Ca/Cr) developed in three patients during repletion. In conclusion, Caucasian and AA patients show similar calcium and vitamin D profiles. The higher prevalence of hypercalciuria and nephrolithiasis in sarcoidosis is unrelated to endogenous vitamin-D levels. Vitamin-D repletion in sarcoidosis is generally safe, although calcium balance should be monitored. A hypothesis that 25-OHD repletion suppresses granulomatous immune activity is provided.
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Affiliation(s)
- Giovanna Capolongo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Cardio-thoracic & Respiratory Sciences, Division of Nephrology, Second University of Naples, Naples, Italy
| | - Li Hao Richie Xu
- Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mariasofia Accardo
- Department of Clinical Medicine & Surgery, Division of Respiratory disease, University Federico II of Naples, Naples, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine & Surgery, Division of Respiratory disease, University Federico II of Naples, Naples, Italy
| | - Anna Agnese Stanziola
- Department of Clinical Medicine & Surgery, Division of Respiratory disease, University Federico II of Naples, Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine & Surgery, Unit of Endocrinology, University Federico II of Naples, Naples, Italy
| | - Carlo Agostini
- Department of Medicine (DIMED), Clinical Immunology Unit, Padua University, Italy
| | - Miriam Zacchia
- Department of Cardio-thoracic & Respiratory Sciences, Division of Nephrology, Second University of Naples, Naples, Italy
| | - Giovambattista Capasso
- Department of Cardio-thoracic & Respiratory Sciences, Division of Nephrology, Second University of Naples, Naples, Italy
| | - Beverley Adams-Huet
- Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Orson W Moe
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Khashayar Sakhaee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA Charles & Jane Pak Center for Mineral Metabolism & Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Connie C W Hsia
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Esposito A, Valentino MR, Bruzzese D, Bocchino M, Ponticiello A, Stanziola A, Sanduzzi A. Effect of CArbocisteine in Prevention of exaceRbation of chronic obstructive pulmonary disease (CAPRI study): An observational study. Pulm Pharmacol Ther 2016; 37:85-8. [DOI: 10.1016/j.pupt.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/18/2016] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
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Matera MG, Sanduzzi A, Cazzola M. Specific role of combination aclidinium: formoterol in the treatment of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016; 11:73-9. [PMID: 26792987 PMCID: PMC4708173 DOI: 10.2147/copd.s78000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Co-administration of a long-acting β2-agonist and a long acting muscarinic antagonist produces superior bronchodilation compared with their individual effects. Our preclinical data indicated that combining aclidinium bromide (ACLI) and formoterol fumarate (FORM) provides synergistic benefit on smooth muscle relaxation of both large and small human airways. Data from more than 2,000 patients in eleven clinical trials documented that ACLI/FORM, a twice-daily fixed-dose combination, produces a greater degree of bronchodilation than ACLI or FORM monotherapy alone and is safe and well tolerated. Two large key trials have shown that there is a benefit in using ACLI/FORM when the clinical target is the variability of symptoms and mainly nighttime and/or early morning symptoms. ACLI/FORM is the only long acting muscarinic antagonist/long acting β2-agonist fixed-dose combination that has been studied for this therapeutic indication.
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Affiliation(s)
| | - Alessandro Sanduzzi
- Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy
| | - Mario Cazzola
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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D'Amato G, Vitale C, De Martino A, Viegi G, Lanza M, Molino A, Sanduzzi A, Vatrella A, Annesi-Maesano I, D'Amato M. Effects on asthma and respiratory allergy of Climate change and air pollution. Multidiscip Respir Med 2015; 10:39. [PMID: 26697186 PMCID: PMC4687168 DOI: 10.1186/s40248-015-0036-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
The major changes to our world are those involving the atmosphere and the climate, including global warming induced by anthropogenic factors, with impact on the biosphere and human environment. Studies on the effects of climate changes on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, like meteorological variables, airborne allergens and air pollution. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions and westernized lifestyle are correlated with an increased frequency of respiratory allergy, mainly in people who live in urban areas in comparison with people living in rural areas. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in general and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could be also considered an effect of air pollution and climate changes. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last five decades. Pollen allergy is frequently used to study the interrelationship between air pollution and respiratory allergic diseases such as rhinitis and bronchial asthma. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. Scientific societies should be involved in advocacy activities, such as those realized by the Global Alliance against chronic Respiratory Diseases (GARD).
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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality A.Cardarelli Hospital, Via Rione Sirignano,10, 80121 Naples, Italy ; University "Federico II", Medical School, Naples, Italy
| | - Carolina Vitale
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | | | - Giovanni Viegi
- Institute of Biomedicine and Molecular Immunology and Institute of Clinical Physiology, National Research Council, Palermo and Pisa, Italy
| | - Maurizia Lanza
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Antonio Molino
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | - Alessandro Sanduzzi
- University "Federico II", Medical School, Naples, Italy ; Second Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
| | | | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory diseases department (EPAR), Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, INSERM, Medical School Saint-Antoine, F75012 Paris, France
| | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital "V. Monaldi" and University "Federico II" Medical School, Naples, Italy
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D’Amato G, Vitale C, De Martino A, Viegi G, Lanza M, Molino A, Sanduzzi A, Vatrella A, Annesi-Maesano I, D'Amato M. Effects on asthma and respiratory allergy of Climate change and air pollution. Multidiscip Respir Med 2015. [DOI: 10.4081/mrm.2015.356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The major changes to our world are those involving the atmosphere and the climate, including global warming induced by anthropogenic factors, with impact on the biosphere and human environment. Studies on the effects of climate changes on respiratory allergy are still lacking and current knowledge is provided by epidemiological and experimental studies on the relationship between allergic respiratory diseases, asthma and environmental factors, like meteorological variables, airborne allergens and air pollution. Epidemiologic studies have demonstrated that urbanization, high levels of vehicle emissions and westernized lifestyle are correlated with an increased frequency of respiratory allergy, mainly in people who live in urban areas in comparison with people living in rural areas. However, it is not easy to evaluate the impact of climate changes and air pollution on the prevalence of asthma in general and on the timing of asthma exacerbations, although the global rise in asthma prevalence and severity could be also considered an effect of air pollution and climate changes. Since airborne allergens and air pollutants are frequently increased contemporaneously in the atmosphere, enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of respiratory allergy and asthma in atopic subjects in the last five decades. Pollen allergy is frequently used to study the interrelationship between air pollution and respiratory allergic diseases such as rhinitis and bronchial asthma. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. Scientific societies should be involved in advocacy activities, such as those realized by the Global Alliance against chronic Respiratory Diseases (GARD).
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Bocchino M, Brancaccio G, Rea G, De Martino M, Gaeta GB, Sanduzzi A. Increased liver stiffness in idiopathic pulmonary fibrosis: a pilot study. Sarcoidosis Vasc Diffuse Lung Dis 2015; 32:176-180. [PMID: 26278699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE There is evidence that pulmonary, hepatic and renal fibrosis may share common pathogenetic pathways. Aim of our study was to measure liver stiffness in patients affected by clinically stable idiopathic pulmonary fibrosis (IPF). METHODS Twenty-nine cases (24 M; mean age±SD: 67±8.3 yrs; 19 ex-smokers) along with fifteen age- and sex-matched healthy volunteers were enrolled. Liver conventional ultrasound examination and transient ultrasound elastography (TUE) were realized by two independent operators. RESULTS Mild/moderate steatosis was identified in 1 control and 8 IPF cases (6.6% and 27.5%); severe steatosis in 2 IPF patients (7%). Mean TUE measurements were increased in 11 IPF cases (38%) as compared to controls (6.4±2.2 kPa vs 5.2±0.4 kPa; p=0.02). CONCLUSIONS To our knowledge, this is the first report suggesting that liver stiffness is increased in more than one-third of IPF patients. Application of novel methodologies should be encouraged for investigating further IPF.
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Santus P, Radovanovic D, Paggiaro P, Papi A, Sanduzzi A, Scichilone N, Braido F. Why use long acting bronchodilators in chronic obstructive lung diseases? An extensive review on formoterol and salmeterol. Eur J Intern Med 2015; 26:379-84. [PMID: 26049917 DOI: 10.1016/j.ejim.2015.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/27/2015] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Abstract
Long-acting β2-adrenoceptor agonists, formoterol and salmeterol, represent a milestone in the treatments of chronic obstructive lung diseases. Although no specific indications concerning the choice of one molecule rather than another are provided by asthma and COPD guidelines, they present different pharmacological properties resulting in distinct clinical employment possibilities. In particular, salmeterol has a low intrinsic efficacy working as a partial receptor agonist, while formoterol is a full agonist with high intrinsic efficacy. From a clinical perspective, in the presence of low β2-adrenoceptors availability, like in inflamed airways, a full agonist can maintain its bronchodilatory and non-smooth muscle activities while a partial agonist may be less effective. Furthermore, formoterol presents a faster onset of action than salmeterol. This phenomenon, combined with the molecule safety profile, leads to a prompt amelioration of the symptoms, and allows using this drug in asthma as an "as needed" treatment in patients already on regular treatment. The fast onset of action and the full agonism of formoterol need to be considered in order to select the best pharmacological treatment of asthma and COPD.
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Affiliation(s)
- P Santus
- Dipartimento di Scienze della Salute. Pneumologia Riabilitativa Fondazione Salvatore Maugeri, Istituto Scientifico di Milano-IRCCS. Università degli Studi di Milano, Italy
| | - D Radovanovic
- Dipartimento di Scienze della Salute. Pneumologia Riabilitativa Fondazione Salvatore Maugeri, Istituto Scientifico di Milano-IRCCS. Università degli Studi di Milano, Italy
| | - P Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - A Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - A Sanduzzi
- Section of Respiratory Diseases, Department of Surgery and Clinical Medicine, University of Naples, Italy
| | - N Scichilone
- Department of Internal Medicine, Section of Pulmonology (DIBIMIS), University of Palermo, Italy
| | - F Braido
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCS AOU San Martino-IST, Genoa, Italy.
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Cantini F, Nannini C, Niccoli L, Iannone F, Delogu G, Garlaschi G, Sanduzzi A, Matucci A, Prignano F, Conversano M, Goletti D. Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice. Autoimmun Rev 2015; 14:503-9. [DOI: 10.1016/j.autrev.2015.01.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
INTRODUCTION Understanding variability in the response to asthma medications is essential to ensure appropriate prescribing. Given that there are increased asthma treatment failures observed in ethnic minorities receiving asthma therapeutics, it is fundamental to understand the factors related to ethnicity that can modify the response to asthma therapy. AREAS COVERED Race/ethnicity is an important determinant of drug response and therefore contributes to interindividual variability. It is generally recognized that its effects on drug response are determined by both genetic and environmental factors to a varying extent, depending on the ethnic groups and probe drugs studied. Also, adherence to therapy can influence pharmacological response to asthma therapeutics. EXPERT OPINION Health-care professionals might never use the treatment in their patients irrespective of their ethnicity and thus inadvertently increase ethnic health inequality. However, our understanding of whether and/or how ethnicity influences pharmacological response to asthma therapeutics is still very scarce. A holistic, integrative systems biology approach that combines large-scale molecular profiling traits (e.g., transcriptomic, proteomic, metabolomic traits) and genetic variants could help to personalize the treatment of asthmatic patients regardless of race/ethnicity.
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Affiliation(s)
- Mario Cazzola
- University of Rome Tor Vergata, Department of Systems Medicine, Respiratory Clinical Pharmacology Unit , Via Montpellier 1, 00133 Rome Italy
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Scichilone N, Benfante A, Bocchino M, Braido F, Paggiaro P, Papi A, Santus P, Sanduzzi A. Which factors affect the choice of the inhaler in chronic obstructive respiratory diseases? Pulm Pharmacol Ther 2015; 31:63-7. [PMID: 25724817 DOI: 10.1016/j.pupt.2015.02.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/13/2015] [Accepted: 02/14/2015] [Indexed: 10/23/2022]
Abstract
Inhalation is the preferred route of drug administration in chronic respiratory diseases because it optimises delivery of the active compounds to the targeted site and minimises side effects from systemic distribution. The choice of a device should be made after careful evaluation of the patient's clinical condition (degree of airway obstruction, comorbidities), as well as their ability to coordinate the inhalation manoeuvre and to generate sufficient inspiratory flow. These patient factors must be aligned with the specific advantages and limitations of each inhaler when making this important choice. Finally, adherence to treatment is not the responsibility of the patient alone, but should be shared also by clinicians. Clinicians have access to a wide selection of pressurised metered dose inhalers (pMDIs) and dry powder inhalers (DPIs) that can be used effectively when matched to the needs of individual patients; this should be perceived as an opportunity rather than a limitation.
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Affiliation(s)
- Nicola Scichilone
- Dipartimento di Biomedicina e Medicina Specialistica (DIBIMIS), Sezione di Pneumologia, University of Palermo, Italy.
| | - Alida Benfante
- Dipartimento di Biomedicina e Medicina Specialistica (DIBIMIS), Sezione di Pneumologia, University of Palermo, Italy
| | - Marialuisa Bocchino
- Università degli Studi di Napoli "Federico II", Dipartimento di medicina clinica e chirurgia, Napoli, Italy
| | - Fulvio Braido
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCS AOU San Martino-IST, Genoa, Italy
| | - Pierluigi Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Italy
| | - Alberto Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Pierachille Santus
- Dipartimento di Scienze della Salute, Pneumologia Riabilitativa Fondazione Salvatore Maugeri, Istituto Scientifico di Milano-IRCCS, Università degli Studi di Milano, Italy
| | - Alessandro Sanduzzi
- Università degli Studi di Napoli "Federico II", Dipartimento di medicina clinica e chirurgia, Napoli, Italy
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D'Amato M, Vitale C, Sanduzzi A, Stanziola A, Lanza M, Vatrella A, Molino A, Annesi-Maesano I, D'Amato G. Social Networks, Asthma and Much More... J Investig Allergol Clin Immunol 2015; 25:445-447. [PMID: 26817145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Sanduzzi A, Balbo P, Candoli P, Catapano GA, Contini P, Mattei A, Puglisi G, Santoiemma L, Stanziola AA. COPD: adherence to therapy. Multidiscip Respir Med 2014; 9:60. [PMID: 25485108 PMCID: PMC4256899 DOI: 10.1186/2049-6958-9-60] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/30/2014] [Indexed: 11/10/2022] Open
Abstract
Adherence to medical therapies is a growing issue, so much so that the World Health Organization defined it as “a new pharmacological problem”. The main factors affecting compliance are: frequency of administration, rapid onset of action, role of device. The most severe consequence of non-adherence is the increased risk of poor clinical outcome, associated with worsening of the quality of life and increase in health-care expenditure. It appears crucial to identify those COPD patients who are “poorly or not at all compliant with their treatment”. In order to evaluate adherence to the medical therapy, several methods were proposed, the most effective of which turned out to be self-reports, i.e. simple, brief questionnaires (e.g. Morisky test). To increase the likelihood of quickly identifying non-compliant patients, it may be useful to administer a simple questionnaire to naïve subjects (for example, in the waiting room before an examination) including six specific items allowing to identify the patient’s key characteristics. Depending on the answers, patients who do not comply with their pharmacological treatment may be classified as belonging to 6 phenotypes. For patients who are already under treatment it might be useful to administer another short questionnaire during follow up examination. Once the risk of non-compliance is identified, four possible types of measures can be taken: prescription-related, educational, behavioral and complex combined measures (combination of two or more actions). Therefore, while it is clear that adherence in COPD is a critical issue, it is also obvious that raising awareness on the disease and improving cooperation among specialists, general practitioners, health-care professionals, and patients is the starting point at which this evolution should immediately begin. Each medication is able to foster good compliance with the therapy, and consequently to maximize the efficacy, by virtue of its specific inhaler and its own active ingredient.
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Affiliation(s)
- Alessandro Sanduzzi
- Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy
| | - Piero Balbo
- Pneumology Thoracic Unit, Ospedale Maggiore della Carità, Novara, Italy
| | - Piero Candoli
- Pulmonary and Endoscopic Thoracic Unit, AUSL, Ravenna, Italy
| | - Giousuè A Catapano
- Clinical Researcher, Respiratory Diseases, Institute of Clinical Physiology, G. Monasterio Tuscany Foundation/National Research Council, Pisa, Italy
| | - Paola Contini
- Department of Respiratory Diseases, Bellaria Hospital, Bologna, Italy
| | - Alessio Mattei
- Department of Pulmonary Diseases, Città della Salute e della Scienza Molinette, Torino, Italy
| | - Giovanni Puglisi
- Department of Pulmonary Diseases, S. Camillo - Forlanini Hospital, Rome, Italy
| | | | - Anna A Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy
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Sanduzzi A, Balbo P, Candoli P, Catapano GA, Contini P, Mattei A, Puglisi G, Santoiemma L, Stanziola AA. COPD: adherence to therapy. Multidiscip Respir Med 2014. [DOI: 10.4081/mrm.2014.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Adherence to medical therapies is a growing issue, so much so that the World Health Organization defined it as “a new pharmacological problem”. The main factors affecting compliance are: frequency of administration, rapid onset of action, role of device. The most severe consequence of non-adherence is the increased risk of poor clinical outcome, associated with worsening of the quality of life and increase in health-care expenditure. It appears crucial to identify those COPD patients who are “poorly or not at all compliant with their treatment”. In order to evaluate adherence to the medical therapy, several methods were proposed, the most effective of which turned out to be self-reports, i.e. simple, brief questionnaires (e.g. Morisky test). To increase the likelihood of quickly identifying non-compliant patients, it may be useful to administer a simple questionnaire to naïve subjects (for example, in the waiting room before an examination) including six specific items allowing to identify the patient’s key characteristics. Depending on the answers, patients who do not comply with their pharmacological treatment may be classified as belonging to 6 phenotypes. For patients who are already under treatment it might be useful to administer another short questionnaire during follow up examination. Once the risk of non-compliance is identified, four possible types of measures can be taken: prescription-related, educational, behavioral and complex combined measures (combination of two or more actions).
Therefore, while it is clear that adherence in COPD is a critical issue, it is also obvious that raising awareness on the disease and improving cooperation among specialists, general practitioners, health-care professionals, and patients is the starting point at which this evolution should immediately begin. Each medication is able to foster good compliance with the therapy, and consequently to maximize the efficacy, by virtue of its specific inhaler and its own active ingredient.
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Zuccarini G, Bocchino M, Assante LR, Rea G, Sanduzzi A. Metformin/glibenclamide-related interstitial lung disease: a case report. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31:170-173. [PMID: 25078646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/25/2013] [Accepted: 10/28/2013] [Indexed: 06/03/2023]
Abstract
Interstitial lung disease (ILD) may be caused by a wide panel of recognized drugs. Despite the increasing number of reports in the literature, high-lightings of ILD related to oral hypoglycemic drugs are very infrequent. Herein, we describe the case of a 78-yr-old Caucasian diabetic woman who developed mild dyspnoea at rest, asthenia and fever while on treatment with oral metformin (2000 mg/day) and glibenclamide (12.5 mg/day). On hospital admission, pulmonary function testing (PFT), chest x-ray and thorax high resolution computed tomography (HRCT) were consistent with a diagnosis of ILD. The patient's clinical conditions significantly improved soon after the initiation of insulin therapy instead of oral anti-diabetics due to poor glycemic control. After excluding other known etiologies, the significant improvement in PFT along with the complete resolution of the radiologic findings in the absence of any additional therapeutic effort at 3 months suggested the causal link between previous oral hypoglycemic therapy and lung toxicity. Clinicians should always consider the role of drugs as causative agent in the diagnostic work-up of patients with suspected ILD. To our knowledge, this is the second report in the literature of a case of ILD related to the treatment with high doses of anti-diabetic drugs in a poorly controlled diabetic woman.
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