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Richeldi L, Schino P, Bargagli E, Ricci A, Rocca A, Marchesani F, Pennisi A, Camiciottoli G, D’Amato M, Macagno F, Scaffidi Argentina U, Ingrassia E, Piraino A. TRITRIAL: The Impact of Fixed Triple Therapy with Beclometasone/Formoterol/Glycopyrronium on Health Status and Adherence in Chronic Obstructive Pulmonary Disease in an Italian Context of Real Life. Int J Chron Obstruct Pulmon Dis 2024; 19:475-487. [PMID: 38435125 PMCID: PMC10907130 DOI: 10.2147/copd.s445858] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose The TRITRIAL study assessed the effects of beclometasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G) fixed combination in patients with chronic obstructive pulmonary disease (COPD) in a real-world setting, focusing on patient's experience and perspective through the use of patients reported outcomes. Patients and Methods TRITRIAL was a multicenter, prospective, observational study conducted on patients with moderate-severe COPD treated with BDP/FF/G fixed therapy for 12 months. The main objective was to evaluate the impact of BDP/FF/G on health status through the COPD Assessment Test (CAT) score. Additional assessments included adherence and satisfaction, measured by the TAI-10/12 questionnaire and a specifically designed eight-item questionnaire, quality of life through the EQ-5D-5L test, sleep quality through the COPD and Asthma Sleep Impact Scale (CASIS), as well as safety and disease-related outcomes. Results Data from 655 patients were analyzed in the study. The mean total CAT score significantly improved (from 22.8 at baseline to 18.1 at 6 months and 16.5 at 12 months; p < 0.0001), as well as all the eight CAT sub-items, which decreased on average by 0.5-0.9 points during the study. Adherence and usability of the inhaler also improved during the study, with a decrease in poor compliance (from 30.1% to 18.3%) and an increase in good compliance (from 51.8% to 58.3%) according to the TAI score. Patients also benefited from significantly improved quality of life (EQ Index from 0.70 to 0.80; EQ-5D VAS score from 55.1 to 63.1) and sleep quality (CASIS score from 41.1 to 31.8). Finally, patients reported a significant reduction in exacerbation during the study. Conclusion TRITRIAL showed that the BDP/FF/G fixed combination is effective and safe in patients with moderate-severe COPD and poorly controlled disease, improving patients' HRQoL, sleep quality, adherence and inhaler usability and reducing COPD symptoms and the risk of exacerbation in a real-life setting.
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Affiliation(s)
- Luca Richeldi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, Neuro Sciences, Siena University Hospital, Siena, Italy
| | - Alberto Ricci
- Department of Medical-Surgical Sciences and Translational Medicine, Via di Grottarossa 1035, Sapienza University of Rome, Rome, Italy
| | - Alberto Rocca
- Department of Respiratory Medicine, Bellaria Hospital, Bologna, Italy
| | | | - Alfio Pennisi
- Department of Respiratory Medicine, Hospital Clinic “Casa di Cura Riabilitativa Calaciura”, Catania, Italy
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
- Department of Cardiothoracovascular, Careggi University Hospital, Firenze, Italy
| | - Maria D’Amato
- UOSD Malattie Respiratorie ”Federico II”, Ospedale Monaldi, Napoli, 80131, Italy
| | - Francesco Macagno
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Canonica GW, Blasi F, Carpagnano GE, Guida G, Heffler E, Paggiaro P, Allegrini C, Antonelli A, Aruanno A, Bacci E, Bagnasco D, Beghè B, Bonavia M, Bonini M, Brussino L, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Caruso C, Cavallini M, Chieco Bianchi F, Conte ME, Corsico AG, Cosmi L, Costantino M, Costanzo G, Crivellaro M, D'Alò S, D'Amato M, Detoraki A, Di Proietto MC, Facciolongo NC, Ferri S, Fierro V, Foschino MP, Latorre M, Lombardi C, Macchia L, Milanese M, Montagni M, Parazzini EM, Parente R, Passalacqua G, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ridolo E, Rolo J, Scichilone N, Scioscia G, Senna G, Solidoro P, Varricchi G, Vianello A, Yacoub MR, Yang B. Severe Asthma Network Italy Definition of Clinical Remission in Severe Asthma: A Delphi Consensus. J Allergy Clin Immunol Pract 2023; 11:3629-3637. [PMID: 37558162 DOI: 10.1016/j.jaip.2023.07.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
Severe asthma affects about 10% of the population with asthma and is characterized by low lung function and a high count of blood leukocytes, mainly eosinophils. Various definitions are used in clinical practice and in the literature to identify asthma remission: clinical remission, inflammatory remission, and complete remission. This work highlights a consensus for asthma remission using a Delphi method. In the context of the Severe Asthma Network Italy, which accounts for 57 severe asthma centers and more than 2,200 patients, a board of six experts drafted a list of candidate statements in a questionnaire, which has been revised to minimize redundancies and ensure clear and consistent wording for the first round (R1) of the analysis. Thirty-two statements were included in the R1 questionnaire and then submitted to a panel of 80 experts, which used a 5-point Likert scale to measure agreement regarding each statement. Then, an interim analysis of R1 data was performed, and items were discussed and considered to produce a consistent questionnaire for round 2 (R2) of the analysis. Then, the board set the R2 questionnaire, which included only important topics. Panelists were asked to vote on the statements in the R2 questionnaire afterward. During R2, the criteria of complete clinical remission (the absence of the need for oral corticosteroids, symptoms, exacerbations or attacks, and pulmonary function stability) and those of partial clinical remission (the absence of the need for oral corticosteroids, and two of three criteria: the absence of symptoms, exacerbations or attacks, and pulmonary stability) were confirmed. This Severe Asthma Network Italy Delphi analysis defined a valuable and independent tool that is easy to use, to test the efficacy of different treatments in patients with severe asthma enrolled into the SANI registry.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Translational Biomedicine and Neuroscience DiBraiN, University of Bari Aldo Moro, Bari, Italy; Section of Respiratory Diseases, Policlinico Hospital of Bari, Bari, Italy
| | - Giuseppe Guida
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy; Severe Asthma and Rare Lung Disease Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology, and Critical Care, University of Pisa, Pisa, Italy
| | - Chiara Allegrini
- Unit Asma Grave, Ambulatorio Asma Grave Pneumologia e Fisiopatologia ToracoPolmonare, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Andrea Antonelli
- Responsabile SS Allergologia e Fisiopatologia Respiratoria, Ospedale S Croce e Carle, Cuneo, Italy
| | - Arianna Aruanno
- Allergologia dell'Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy
| | - Elena Bacci
- Fisiopatologia Respiratoria e Riabilitazione, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Diego Bagnasco
- UO Clinica Malattie Respiratorie e Allergologia, IRCCS-AOU San Martino, San Martino, Italy
| | - Bianca Beghè
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, Maternal, Infant and Adult, University of Modena and Reggio Emilia, Emilia-Romagna, Italy
| | - Marco Bonavia
- SS Pneumologia Riabilitativa, SC Pneumologia, Dipartimento Specialità Mediche, Ospedale la Colletta, Arenzano, Genoa, Italy
| | - Matteo Bonini
- UOC Pneumologia, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
| | - Luisa Brussino
- SSDDU Immunologia Clinica ed Allergologia, AO Mauriziano, Turin, Italy
| | - Maria Filomena Caiaffa
- Malattie Apparato Respiratorio, Dipartimenti delle funzioni Mediche e Sanitarie, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Cecilia Calabrese
- UO Clinica Pneumologica SUN, Dipartimento Pneumologia ed Oncologia, Azienda Ospedaliera Specialistica dei Colli, Naples, Italy
| | - Gianna Camiciottoli
- Unit Asma Grave, Ambulatorio Asma Grave Pneumologia e Fisiopatologia ToracoPolmonare, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Caminati
- USD Allergologia, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Cristiano Caruso
- Allergologia dell'Istituto di Clinica Medica del Policlinico Gemelli, Università Cattolica di Roma, Rome, Italy; UOSD DH Internal Medicine and Digestive Disease, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | - Mirta Cavallini
- Broncopneumologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Maria Elisabetta Conte
- Struttura Complessa di Pneumologia, Azienda per l'Assistenza Sanitaria n. 5 Friuli Occidentale, Pordenone, Italy
| | | | - Lorenzo Cosmi
- SOD Immunologia e Terapie Cellulari, AOUC Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mariateresa Costantino
- Centro Day Hospital, Allergologia e Immunologia Clinica, Dipartimento Medico, Ospedale Carlo Poma, ASST-Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Giulia Costanzo
- Allergologia e Immunologia Clinica, Policlinico Universitario di Cagliari, Cagliari, Italy
| | | | - Simona D'Alò
- UO Allergologia, Azienda Sanitaria Unica Regionale Marche, Civitanova Marche, Marche, Italy
| | - Mariella D'Amato
- UOC Pneumofisiologia Università Federico II, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Aikaterini Detoraki
- UODS Allergologia ed Immunodeficienze, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | | | | | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vincenzo Fierro
- UOC Allergologia, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Maria Pia Foschino
- Malattie Apparato Respiratorio, Azienda Ospedaliera Universitaria, Foggia, Italy
| | - Manuela Latorre
- UO Pneumologia, Ospedale Nuovo Apuano di Massa, Massa, Italy
| | - Carlo Lombardi
- Unità di Allergologia, Immunologia e Malattie Respiratorie, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luigi Macchia
- Unità Dipartimentale di Allergologia ed Immunologia Clinica, AO Universitaria Policlinico di Bari, Bari, Italy
| | - Manlio Milanese
- SC Pneumologia - Dipartimento Specialità Mediche, Ospedale S Corona, Pietra Ligure, Pietra Ligure, Savona, Italy
| | - Marcello Montagni
- Unità Dipartimentale di Allergologia, Ospedale Guglielmo da Saliceto AUSL Piacenza, Piacenza, Italy
| | | | - Roberta Parente
- UO di Diagnosi e Terapia delle Malattie Allergiche e del Sistema Immunitario, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giovanni Passalacqua
- Clinica di Malattie Respiratorie e Allergologia, Dip. Medicina Interna, Univ degli Studi di Genova, IRCCS-AOU San Martino, San Martino, Italy
| | | | - Girolamo Pelaia
- UO Malattie dell'Apparato Respiratorio, AOU Mater Domini, Catanzaro, Italy
| | - Laura Pini
- Ambulatorio Asma Grave, UOC Medicina Generale 2, Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luisa Ricciardi
- Allergologia e Immunologia Clinica, AOU Policlinico G Martino, Università di Messina, Messina, Italy
| | - Erminia Ridolo
- Ambulatorio di Allergologia ed Immunologia Clinica, UO Lungodegenza, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy
| | - Joyce Rolo
- SC Pneumologia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicola Scichilone
- UOC Pneumologia, Azienda Ospedaliera Universitaria Policlinico P Giaccone di Palermo, Palermo, Italy
| | - Giulia Scioscia
- Malattie Apparato Respiratorio, Dipartimenti delle funzioni Mediche e Sanitarie, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Foggia, Italy
| | - Gianenrico Senna
- USD Allergologia, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Paolo Solidoro
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gilda Varricchi
- Dipartimento di Scienze Mediche Translazionali, Centro per la Ricerca di Base ed Immunologia Clinica, Università Federico II, Naples, Italy
| | - Andrea Vianello
- UOC Fisiopaologia Respiratoria, Azienda Ospedaliera di Padova, Padua, Italy
| | - Mona Rita Yacoub
- Unità di Immunologia, Reumatologia, Allergologia e Malattie Rare, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Baoran Yang
- Centro Day Hospital, Allergologia e Immunologia Clinica, Dipartimento Medico, Ospedale Carlo Poma, ASST-Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
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3
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Mascalchi M, Romei C, Marzi C, Diciotti S, Picozzi G, Pistelli F, Zappa M, Paci E, Carozzi F, Gorini G, Falaschi F, Deliperi AL, Camiciottoli G, Carrozzi L, Puliti D. Pulmonary emphysema and coronary artery calcifications at baseline LDCT and long-term mortality in smokers and former smokers of the ITALUNG screening trial. Eur Radiol 2023; 33:3115-3123. [PMID: 36854875 PMCID: PMC10121526 DOI: 10.1007/s00330-023-09504-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality. METHODS In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach. RESULTS Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality. CONCLUSIONS Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile. KEY POINTS • Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental, Biomedical Sciences "Mario Serio, " University of Florence, Viale Pieraccini, 50134, Florence, Italy.
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy.
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Chiara Romei
- Division of Radiology, Cisanello Hospital, Pisa, Italy
| | - Chiara Marzi
- "Nello Carrara" Institute of Applied Physics, National Research Council of Italy, Sesto Fiorentino, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Giulia Picozzi
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Zappa
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Eugenio Paci
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Francesca Carozzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | | | | | - Gianna Camiciottoli
- Department of Clinical and Experimental, Biomedical Sciences "Mario Serio, " University of Florence, Viale Pieraccini, 50134, Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Donella Puliti
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
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4
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Bruni C, Occhipinti M, Pienn M, Camiciottoli G, Bartolucci M, Bosello SL, Payer C, Bálint Z, Larici AR, Tottoli A, Tofani L, De Lorenzis E, Lepri G, Bellando-Randone S, Spinella A, Giuggioli D, Masini F, Cuomo G, Lavorini F, Colagrande S, Olschewski H, Matucci-Cerinic M. Lung vascular changes as biomarkers of severity in systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2023; 62:696-706. [PMID: 35708639 DOI: 10.1093/rheumatology/keac311] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 11/26/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES It has recently become possible to assess lung vascular and parenchymal changes quantitatively in thoracic CT images using automated software tools. We investigated the vessel parameters of patients with SSc, quantified by CT imaging, and correlated them with interstitial lung disease (ILD) features. METHODS SSc patients undergoing standard of care pulmonary function testing and CT evaluation were retrospectively evaluated. CT images were analysed for ILD patterns and total pulmonary vascular volume (PVV) extents with Imbio lung texture analysis. Vascular analysis (volumes, numbers and densities of vessels, separating arteries and veins) was performed with an in-house developed software. A threshold of 5% ILD extent was chosen to define the presence of ILD, and commonly used cut-offs of lung function were adopted. RESULTS A total of 79 patients [52 women, 40 ILD, mean age 56.2 (s.d. 14.2) years, total ILD extent 9.5 (10.7)%, PVV/lung volume % 2.8%] were enrolled. Vascular parameters for total and separated PVV significantly correlated with functional parameters and ILD pattern extents. SSc-associated ILD (SSc-ILD) patients presented with an increased number and volume of arterial vessels, in particular those between 2 and 4 mm of diameter, and with a higher density of arteries and veins of <6 mm in diameter. Considering radiological and functional criteria concomitantly, as well as the descriptive trends from the longitudinal evaluations, the normalized PVVs, vessel numbers and densities increased progressively with the increase/worsening of ILD extent and functional impairment. CONCLUSION In SSc patients CT vessel parameters increase in parallel with ILD extent and functional impairment, and may represent a biomarker of SSc-ILD severity.
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Affiliation(s)
- Cosimo Bruni
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | | | - Silvia Laura Bosello
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Christian Payer
- Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - Zoltán Bálint
- Faculty of Physics, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore.,Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | - Alessandra Tottoli
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Statistics, Computer Science, Applications, University of Florence, Florence
| | - Enrico De Lorenzis
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Gemma Lepri
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Amelia Spinella
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Dilia Giuggioli
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Francesco Masini
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Giovanna Cuomo
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Federico Lavorini
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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5
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Sposato B, Ricci A, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Pelaia G, Palmiero G, Di Tomassi M, Ronchi MC, Cameli P, Bargagli E, Ciambellotti L, Rizzello S, Sglavo R, Coppola A, Lacerenza LG, Gabriele M, Radovanovic D, Perrella A, Rogliani P, Scalese M. Influence of allergic status and nasal polyposis on long-term Benralizumab response in eosinophilic severe asthma. Clin Ter 2023; 174:67-74. [PMID: 36655647 DOI: 10.7417/ct.2023.2499] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective It is unclear whether Benralizumab effectiveness in severe eosinophilic asthma can be influenced by nasal polyposis (NP) or allergic status associations. We evaluated whether Benralizumab long-term efficacy in asthma outcomes could be different in subjects with atopy (SAEA) compared to the effectiveness in those without allergies (SNAEA) and in individuals with NP compared to those without NP. Methods This observational retrospective study considered 95 consecutive patients divided into allergic (SAEA; n:65[68.4%]; skin prick tests positive [SPT] and/or IgE values ≥100 UI/mL), and non-allergic (SNAEA; n:30[31.6%], SPT negative and normal IgE levels<100 UI/mL). Overall population was also divided into two groups according to NP presence (NP+:39[41%] and NP-:56[59%]). Benralizumab treatment mean was19.7±7.2 months (range 12-35). Results No differences in Benralizumab effectiveness were found in asthma outcomes in patients with/without NP. SNOT-22 improvement was higher in NP+ (-22±24) compared to NP- groups (6.33±15.5;p=0.055). FEV1 (16.33±19.22%), ACT(7.45±3.95) increases and frequency of SABA use (3.37±4.99) reduction were higher in SAEA compared to what obtained in non-allergic subjects (FEV1:8.15±15.6%,p=0.043; ACT:4.89±3.57,p=0.005; SABA use:-1.16±1.84;p=0.015). 93.8% of SAEA patients whereas only 72.2% of SNAEA individuals reduced OC doses at least half after Benralizumab (p=0.035). These results were partially confirmed by linear regression models showing associations between allergic status and FEV1, ACT and SABA use changes (β=8.37;p=0.048, β=2.056;p=0.033 and β=-2.184;p=0.042 respectively). Conclusion Benralizumab effectiveness in asthma appears to be independent of NP presence. The allergic eosinophilic disease, compared to just eosinophilic asthma, may be a more severe phenotype. Benralizumab may have greater efficacy in SAEA on some outcomes.
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Affiliation(s)
- B Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - G E Carpagnano
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - C Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - G Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - G Palmiero
- Pneumology Department, Azienda USL Toscana Nord Ovest, "Versilia" Hospital, Lido di Camaiore (LU), Italy
| | - M Di Tomassi
- Pneumology Department, Azienda USL Toscana Sud-Est, "S. Andrea" Hospital, Massa Marittima (GR), Italy
| | - M C Ronchi
- Pneumology Department, Azienda USL Toscana Sud-Est, "S. Andrea" Hospital, Massa Marittima (GR), Italy
| | - P Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - L Ciambellotti
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Rizzello
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - R Sglavo
- Division of Pneumology, De-partment of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - A Coppola
- Division of Respiratory Disease, San Filippo Neri Hospital, Rome, Italy
| | - L G Lacerenza
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - M Gabriele
- Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
| | - D Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - A Perrella
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - P Rogliani
- Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
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6
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Pelaia G, Palmiero G, Di Tomassi M, Ronchi MC, Cameli P, Bargagli E, Ciambellotti L, Rizzello S, Sglavo R, Coppola A, Lacerenza LG, Gabriele M, Radovanovic D, Perrella A, Ricci A, Rogliani P. Severe asthma and long-term Benralizumab effectiveness in real-life. Eur Rev Med Pharmacol Sci 2022; 26:7461-7473. [PMID: 36314316 DOI: 10.26355/eurrev_202210_30016] [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: 03/31/2023]
Abstract
OBJECTIVE Long-term efficacy of Benralizumab in real life is not clearly known. We assessed the long-term effectiveness persistence to anti-IL-5R treatment in a group of severe eosinophilic asthmatics. PATIENTS AND METHODS We retrospectively analyzed 95 individuals affected by severe asthma (36 males ̶ 37.9%; mean age 58.1 ± 12.2) treated with Benralizumab (mean time 19.7 ± 7.2 months, range 12-35). Outcomes were evaluated at the beginning and at the end of patients' treatment periods. RESULTS Mean baseline blood eosinophils were 897.5 ± 720.1 cells/μL (11 ± 5.6%) decreasing to 7.4 ± 20.6 cells/μL (0.97 ± 0.26%; p < 0.0001) after Benralizumab. FENO likewise decreased from 63.9 ± 68.4 to 28.4 ± 23.6 ppb, while FEV1% significantly improved (p < 0.0001). Mean FEF25-75 also increased from 45.8 ± 24.6% to 60.7 ± 24.6%, whereas RAW dropped from 202.15 ± 109.6% to 135.2 ± 54.75% (p < 0.0001). Also, lung volumes greatly decreased. ACT/ACQ significantly improved, while exacerbations number fell from 4.1 ± 2.4, before anti-IL-5R, to 0.33 ± 0.77, after treatment (p < 0.0001). Rhinitis severity levels and SNOT-22 also changed favorably. Patients that took long-term OCs were 71.6% before treatment, decreasing to 23.2% after Benralizumab (p < 0.0001), with an OCs dose reduction from 14.8 ± 8.9 to 1.45 ± 2.8 mg/day (p < 0.0001). 51.6% of subjects used SABA as needed before Benralizumab, falling to 4.2% after treatment. Several patients showed a reduction of ICS doses, SABA use and maintenance therapy step-down. Clinical/biological response with anti-IL-5R remained constant or even improved in terms of exacerbations or maintenance therapy reductions over time. On the contrary, FEF25-75% improvement slowed down in the long-term. No relationship was found between baseline blood eosinophil number and therapeutic response. CONCLUSIONS Long-term Benralizumab effectiveness persistence in all outcomes in real life was confirmed.
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Affiliation(s)
- B Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy.
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7
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Caminati M, Camiciottoli G, Baiardini I, Antonicelli L, Beghè B, Crimi N, Favero E, Stanziola AA, Valenti G, Visca D, Del Giacco S. Patients and doctors group meetings: an innovative way to explore severe asthma backstage. Multidiscip Respir Med 2022; 17:854. [PMID: 36158780 PMCID: PMC9491102 DOI: 10.4081/mrm.2022.854] [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: 04/15/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Severe asthma patients' life is heavily influenced by the disease, which has impact on personal and professional choices or general lifestyle. Despite the available tools to help physicians investigating the patient-reported outcomes there is a need for a more standardised and structured approach to include the evaluation of quality of life together with the emotions of patients into the routine clinical interaction. We hereby report the use of an active listening and insight approach to understand the emotions of patients with severe asthma through dedicated in-person meetings involving a group of patients with their doctors, caregivers and an external moderator. The initiative "Patients insight meeting" was organized within 17 specialist referral centres for severe asthma in Italy in 2019 and involved 149 patients. Insights related to 4 different items were collected and a task force composed by the external moderators produced a general report including the suggestions from the participating centres. This experience of group-meetings involving both patients and doctors together represents an innovative way to investigate real life experience and the emotions of asthmatic patients, highlighting unmet needs related to patient's experience of his/her disease that need to be included in severe asthmatics' management strategy.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Cardio-Thoraco-Vascular Department, AOUC Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | | | - Bianca Beghè
- Department of Medicine, Section of Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - Nunzio Crimi
- Respiratory Medicine Unit, AOU "Policlinico-Vittorio Emanuele" and Department of Clinical and Experimental Medicine, University of Catania
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergy Clinic Ca' Foncello Hospital, Treviso
| | | | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo
| | - Dina Visca
- Department of Medicine and Surgery, University of Insubria, Varese and Department of Medicine and Cardiopulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate (VA)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato-Cagliari, Italy
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8
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Politi L, Monasta L, Rigressi MN, Princivalle A, Gonfiotti A, Camiciottoli G, Perbellini L. Discriminant Profiles of Volatile Compounds in the Alveolar Air of Patients with Squamous Cell Lung Cancer, Lung Adenocarcinoma or Colon Cancer. Molecules 2021; 26:molecules26030550. [PMID: 33494458 PMCID: PMC7866040 DOI: 10.3390/molecules26030550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/10/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
The objective of the present work was to analyze volatile compounds in alveolar air in patients with squamous cell lung cancer, lung adenocarcinoma or colon cancer, to prepare algorithms able to discriminate such specific pathological conditions. The concentration of 95 volatile compounds was measured in the alveolar air of 45 control subjects, 36 patients with lung adenocarcinoma, 25 patients with squamous cell lung cancer and 52 patients with colon cancer. Volatile compounds were measured with ion molecule reaction mass spectrometry (IMR-MS). An iterated least absolute shrinkage and selection operator multivariate logistic regression model was used to generate specific algorithms and discriminate control subjects from patients with different kinds of cancer. The final predictive models reached the following performance: by using 11 compounds, patients with lung adenocarcinoma were identified with a sensitivity of 86% and specificity of 84%; nine compounds allowed us to identify patients with lung squamous cell carcinoma with a sensitivity of 88% and specificity of 84%; patients with colon adenocarcinoma could be identified with a sensitivity of 96% and a specificity of 73% using a model comprising 13 volatile compounds. The different alveolar profiles of volatile compounds, obtained from patients with three different kinds of cancer, suggest dissimilar biological–biochemistry conditions; each kind of cancer has probably got a specific alveolar profile.
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Affiliation(s)
- Leonardo Politi
- Department of Clinical and Experimental Medicine, Careggi University Hospital, 50134 Florence, Italy; (L.P.); (M.N.R.); (A.G.); (G.C.)
| | - Lorenzo Monasta
- Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy
- Correspondence:
| | - Maria Novella Rigressi
- Department of Clinical and Experimental Medicine, Careggi University Hospital, 50134 Florence, Italy; (L.P.); (M.N.R.); (A.G.); (G.C.)
| | - Andrea Princivalle
- Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (A.P.); (L.P.)
| | - Alessandro Gonfiotti
- Department of Clinical and Experimental Medicine, Careggi University Hospital, 50134 Florence, Italy; (L.P.); (M.N.R.); (A.G.); (G.C.)
| | - Gianna Camiciottoli
- Department of Clinical and Experimental Medicine, Careggi University Hospital, 50134 Florence, Italy; (L.P.); (M.N.R.); (A.G.); (G.C.)
| | - Luigi Perbellini
- Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (A.P.); (L.P.)
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9
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Paggiaro P, Rogliani P. Mepolizumab Effectiveness and Allergic Status in Real Life. Int Arch Allergy Immunol 2020; 182:311-318. [PMID: 33113532 DOI: 10.1159/000511147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. OBJECTIVE We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. METHOD We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97-72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37-27.6%). They had taken mepolizumab for at least 6 months. RESULTS After 10.9 ± 3.7 months, improvements in FEV1%, FEF25-75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), observed after treatment, were similar in both groups. Only Asthma Control Test (ACT) increases were higher in SNAEA (8 [5-9]) than in SAEA (5 [2.5-8.5]; p = 0.016). However, no differences were found after treatment in percentages of subjects with ACT ≥20, as well as with FEV1 >80%, FEF25-75 >65%, exacerbations ≤2, BE <300 cells/µL, and FENO <25 ppb between SAEA and SNAEA. Besides, no significant relationships were found, comparing SNAEA with SAEA, for FEV1% (β = -0.110; p = 0.266), FEF25-75% (β = -0.228; p = 0.06), BE counts (β = -0.012; p = 0.918), FENO (β = 0.234; p = 0.085), ACT (β = 0.046; p = 0.660), and exacerbations (β = -0.070; p = 0.437). No different associations between lung function and SNAEA occurrence when compared to SAEA condition (FEV1 >80%: OR = 1.04 [95% CI: 0.43-2.55], p = 0.923; FEF25-75 >65%: OR = 0.41 [95% CI: 0.08-2.03], p = 0.272) were detected. Neither all other parameters, such as ACT >20 (OR = 0.73 [95% CI: 0.32-1.63], p = 0.440), presence of exacerbations (OR = 1.35 [95% CI: 0.55-3.27], p = 0.512), SABA discontinuation (OR = 1.16 [95% CI: 0.40-3.39], p = 0.790), and OC cessation/reduction (OR = 3.44 [95% CI: 0.40-29.27], p = 0.258), were differently associated with 1 or the other phenotype. CONCLUSION Mepolizumab can be considered as a valid therapeutic choice for either allergic or nonallergic SEA in real life.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy, .,Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy,
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Corrado Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Telese Terme, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Girolamo Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.,Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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10
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Canonica GW, Blasi F, Paggiaro P, Senna G, Passalacqua G, Spanevello A, Aliberti S, Bagnasco D, Bonavia M, Bonini M, Brussino L, Bucca C, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Carpagnano GE, Caruso C, Centanni S, Conte ME, Corsico AG, Cosmi L, Costantino MT, Crimi N, D’Alò S, D'Amato M, Del Giacco S, Farsi A, Favero E, Foschino Barbaro MP, Guarnieri G, Guida G, Latorre M, Lo Cicero S, Lombardi C, Macchia L, Mazza F, Menzella F, Milanese M, Montagni M, Montuschi P, Nucera E, Parente R, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ricciardolo FL, Richeldi L, Ridolo E, Rolla G, Santus P, Scichilone N, Spadaro G, Vianello A, Viviano V, Yacoub MR, Zappa MC, Heffler E. Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the Severe Asthma Network in Italy ( SANI). World Allergy Organ J 2020; 13:100464. [PMID: 32999699 PMCID: PMC7509464 DOI: 10.1016/j.waojou.2020.100464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 04/16/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
According to the data derived from several national and international registries, including SANI (Severe Asthma Network Italy), and considering the strong impact that frequent or regular use of oral corticosteroid has on quality of life (QoL) of severe asthmatics, as well as on the costs for managing corticosteroid-related diseases, oral corticosteroid sparing up to withdrawal should be considered a primary outcome in the management of severe asthma. New biologics have clearly demonstrated that this effect is possible, with concomitant reduction in the rate of exacerbations and in symptom control. Then, there is no reason for using so frequently oral corticosteroid before having explored all alternatives currently available for a large part of severe asthmatics.
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Key Words
- Biologics
- CRSwNP, chronic rhinosinusitis with nasal polyposis
- EMA, European Medicines Agency
- FDA, Food & Drug Administration
- FEV1, forced expiratory volume in the 1st second
- GINA, Global Initiative for Asthma
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- ISAR, International Severe Asthma Registry
- OCSs, Oral CorticoSteroids
- Oral corticosteroids
- RW, Real World
- Real-life
- Registr
- SA, severe asthma
- SANI, Severe Asthma Network in Italy
- SARP, Severe Asthma Research Program
- SHARP, Severe Heterogeneous Asthma Research collaboration, Patient-centred
- Severe asthma
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Stefano Aliberti
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Luisa Brussino
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Caterina Bucca
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Maria F. Caiaffa
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gianna Camiciottoli
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
| | - Marco Caminati
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanna E. Carpagnano
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria E. Conte
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
| | - Angelo G. Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria T. Costantino
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
| | - Nunzio Crimi
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
| | - Simona D’Alò
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
| | - Maria D'Amato
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Alessandro Farsi
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
| | - Elisabetta Favero
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
| | - Maria P. Foschino Barbaro
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Francesco Menzella
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
| | - Manlio Milanese
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
| | | | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Nucera
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Vincenzo Patella
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Fabio L.M. Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Vittorio Viviano
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
| | - Mona R. Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria C. Zappa
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - SANI (Severe Asthma Network Italy)
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
- University of Insubria, ICS Maugeri, IRCCS, Varese, Italy
- Respiratory Rehabilitation, ASL3, Genoa, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
- Department of Pneumology, Niguarda Hospital, Milan, Italy
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
- UOC Allergology Department, Piacenza, Italy
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
- Department of Medicine and Surgery, University of Parma, Italy
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
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11
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Rogliani P, Paggiaro P. Real-life Mepolizumab effectiveness in severe eosinophilic asthmatics with nasal polyposis. Respir Med Res 2020; 78:100791. [PMID: 33039948 DOI: 10.1016/j.resmer.2020.100791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- B Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - G E Carpagnano
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - C Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - M Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Telese, 82037 Telese Terme (BN), Italy
| | - A Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - A Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - S Baglioni
- Pneumology Department, Perugia Hospital, Perugia, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - I Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - G Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - S Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - A Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - M Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - P Rogliani
- Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy; Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Rome, Italy
| | - P Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
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12
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Occhipinti M, Bruni C, Camiciottoli G, Bartolucci M, Bellando-Randone S, Bassetto A, Cuomo G, Giuggioli D, Ciardi G, Fabbrizzi A, Tomassetti S, Lavorini F, Pistolesi M, Colagrande S, Matucci-Cerinic M. Quantitative analysis of pulmonary vasculature in systemic sclerosis at spirometry-gated chest CT. Ann Rheum Dis 2020; 79:1210-1217. [PMID: 32606043 DOI: 10.1136/annrheumdis-2020-217359] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/17/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To prospectively investigate whether differences in pulmonary vasculature exist in systemic sclerosis (SSc) and how they are distributed in patients with different pulmonary function. METHODS Seventy-four patients with SSc undergoing chest CT scan for interstitial lung disease (ILD) screening or follow-up were prospectively enrolled. A thorough clinical, laboratory and functional evaluation was performed the same day. Chest CT was spirometry gated at total lung capacity and images were analysed by two automated software programs to quantify emphysema, ILD patterns (ground-glass, reticular, honeycombing), and pulmonary vascular volume (PVV). Patients were divided in restricted (FVC% <80, DLco%<80), isolated DLco% reduction (iDLco- FVC%≥80, DLco%<80) and normals (FVC%≥80, DLco%≥80). Spearman ρ, Mann-Whitney tests and logistic regressions were used to assess for correlations, differences among groups and relationships between continuous variables. RESULTS Absolute and lung volume normalised PVV (PVV/LV) correlated inversely with functional parameters and positively with all ILD patterns (ρ=0.75 with ground glass, ρ=0.68 with reticular). PVV/LV was the only predictor of DLco at multivariate analysis (p=0.007). Meanwhile, the reticular pattern prevailed in peripheral regions and lower lung thirds, PVV/LV prevailed in central regions and middle lung thirds. iDLco group had a significantly higher PVV/LV (2.2%) than normal (1.6%), but lower than restricted ones (3.8%). CONCLUSIONS Chest CT in SSc detects a progressive increase in PVV/LV as DLco decreases. Redistribution of perfusion to less affected lung regions rather than angiogenesis nearby fibrotic lung may explain the results. Further studies to ascertain whether the increase in PVV/LV reflects a real increase in blood volume are needed.
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Affiliation(s)
- Mariaelena Occhipinti
- Dept Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Biomedicine, Division of Rheumatology, University of Florence, Florence, Italy.,Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianna Camiciottoli
- Dept Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.,Dept CardioThoracoVascular, AOUC, Florence, Italy
| | | | - Silvia Bellando-Randone
- Biomedicine, Division of Rheumatology, University of Florence, Florence, Italy.,Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Bassetto
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanna Cuomo
- Precision Medicine, Universita degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, Policlinico di Modena, Universita degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Sara Tomassetti
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Dept CardioThoracoVascular, AOUC, Florence, Italy
| | - Federico Lavorini
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Dept CardioThoracoVascular, AOUC, Florence, Italy
| | - Massimo Pistolesi
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Colagrande
- Dept Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy.,Radiology Unit, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Dept Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Dept Internal Medicine, University of Florence, Florence, Italy
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13
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Bruni C, Occhipinti M, Camiciottoli G, Bartolucci M, Pienn M, Lepri G, Fabbrizzi A, Tottoli A, Ciardi G, Giuggioli D, Cuomo G, Masini F, Olschewski H, Lavorini F, Calistri L, Matucci-Cerinic M. SAT0553 QUANTITATIVE ANALYSIS OF IMAGING FEATURES AT CHEST CT OF PULMONARY ARTERIAL AND VENOUS COMPONENTS IN SYSTEMIC SCLEROSIS-INTERSTITIAL LUNG DISEASE (SSc-ILD). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:Interstitial lung disease (ILD) and pulmonary arterial hypertension carry a negative impact on SSc prognosis. Chest CT is the gold standard in assessing ILD and helps in evaluating associated vascular involvement.Objectives:As qualitative analysis of CT scans is limited by low reproducibility and time constraints, we aimed at evaluating parenchymal and vascular features in SSc-ILD by quantitative analysis (QA) of CT scans and testing the relationship with clinical-functional data.Methods:We prospectively enrolled 80 patients who underwent PFTs and chest CT scan spirometry gated at TLC on the same day. Clinical, lung functional and diffusion data, as well as disability indexes were collected. CT images were analyzed by a computational platform for texture analysis of ILD patterns (CALIPER), through Imbio LTA. It quantified the extent of normal pattern (NP %), ground glass opacities (GG %), reticulation (RET %), honeycombing (HC %), total ILD extent (ILD EXT %) and hyperlucent (HL %). Low density areas, representing emphysematous area, were also quantified (LDA %). For lung vessel analysis, a software program developed by the Ludwig Boltzmann Institute for Lung Vascular Research was used. This software determined total, arterial, and venous vascular volumes (TV, AV, VV), and relative volumes (TV%, AV%, VV%), as well as density and number for total, arterial and venous vessels.Results:43/80 patients/CT scans were eligible for both software analyses, while 36/43 for arterial and venous separation. TV% and total vessel density were correlated positively with mRSS and negatively with %FVC (r=-0.537 and r=-0.382) and %TLC (r=-0.511 and r=-0.648), while vessel tortuosity correlated positively with %DLco. This was confirmed when separately analyzing arterial vessels, while VV% negatively correlated with %FVC, %TLC and %DLco. There was a positive correlation between %ILD patterns and %vascular volumes, being significant for TV%-AV%, total vessels and arterial density. Conversely, %ILD patterns were negatively correlated with VV and number of veins detected, despite positive correlation between VV% and ILD_EXT%. When clustering patients according to %FVC and %DLco with 80% normal cutoff, %FVC allowed clustering according to significantly different ILD patterns extents and vascular features, while %DLCO for vascular features only. Moreover, the consecutive addition of functional impairment and worsening of ILD (from both normal %FVC and %Dlco, to %DLco impairment only to both %FVC and %Dlco impairment), there was a significant increase in %TV, % AV and %VV, with the exception of decrease in %VV and venous density in patients with double impairment versus DLco single impairment.Conclusion:This is the first study showing in SSc a direct correlation between ILD and the increase in lung vascular volume, which is characterized by increase in arterial volume and density and reduction in venous volume and number. These results might be explained by the reduction of pulmonary volume due to fibrosis. However, also a para-physiological mechanism of redistribution of blood flow in lung areas, less involved by ILD, might be considered. Further studies on lung vessel quantification and distribution are ongoing.Disclosure of Interests:Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Mariaelena Occhipinti Consultant of: Imbio, Gianna Camiciottoli: None declared, Maurizio Bartolucci: None declared, Michael Pienn: None declared, Gemma Lepri: None declared, Alessio Fabbrizzi: None declared, Alessandra Tottoli: None declared, Giuglia Ciardi: None declared, Dilia Giuggioli: None declared, Giovanna CUOMO: None declared, Francesco Masini: None declared, Horst Olschewski: None declared, Federico Lavorini: None declared, Linda Calistri: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim
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14
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Bruni C, Occhipinti M, Camiciottoli G, Bartolucci M, Lepri G, Fabbrizzi A, Tottoli A, Bassetto A, Ciardi G, Giuggioli D, Cuomo G, Masini F, Lavorini F, Calistri L, Matucci-Cerinic M. OP0181 FUNCTIONAL CUT-OFFS TO DISTINGUISH PULMONARY VASCULAR AND PARENCHYMAL INVOLVEMENT IN SYSTEMIC SCLEROSIS (SSC): A QUANTITATIVE ANALYSIS OF IMAGING FEATURES AT CHEST COMPUTED TOMOGRAPHY (CT). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2188] [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: 11/03/2022]
Abstract
Background:Interstitial lung disease (ILD) and pulmonary arterial hypertension represent the most frequent causes of morbidity and mortality in SSc, with chest CT representing the gold standard in ILD assessment, while FVC and DLco allow functional assessment.Objectives:As qualitative analysis of given chest CT scans is hampered by low reproducibility, we aimed to perform a quantitative analysis (QA) of CT scans able to investigate the parenchymal and vascular features in SSc-ILD and thus testing the relationship with clinical-functional data.Methods:We prospectively enrolled 80 patients who underwent PFTs and spirometry-gated chest CT scan at TLC on the same day. Clinical, lung functional and diffusion data, as well as disability indexes were collected. CT images were analyzed by a computational platform for texture analysis of ILD patterns (CALIPER) through Imbio LTA. It quantified the extent of normal lung (%N), ground-glass opacities (%GG), reticulation (%RET), honeycombing (%HC), hyperlucent (%HL), absolute (PVV, cm3) and normalized (PVV/LV, %) pulmonary vascular volumes. Cut-offs of normality for %FVC and %DLco of 80% and 70% were tested to differentiate parenchymal and vascular features.Results:73 patients/CT scans were eligible for both software analyses. CALIPER showed GG% as the most frequent radiological pattern (mean 5.5±10.4%). %FVC and % TLC negatively correlated with all ILD patterns, while %DLco with RET% only; PVV and PVV/LV negatively correlated with %FVC and %TLC, while %DLco with PVV/LV only. Positive correlations were found between all ILD patterns and vascular volumes (Table 1).LV (cm3)%N%GG%RET%HC%HLPVV (cm3)% PVV/LVFVC%r.60-.19-.40-.34-.30.35-.26-.44p<.001-<.001.004.01.003.04<.001FEV1%r.58-.02-.38-.25-.24.23-.35-.49p<.001-.002.04.05-.004<.001FEV1/FVCr-.16.33.22.16.21-.35-.15-.08p-.02------TLC%r.71-.14-.42-.37-.48.40-.43-.64p<.001-.001.01<.001.002<.001<.02DLco%r.38-.05-.21-.31-.22.30-.21-.33p.01--.01---.006FVC/DLcor.03-.08-.06-.003-.09.08-.06-.08p--------Cut-offs equal to 80 for %FVC and 70 for %DLco distinguished both parenchymal and vascular features, while 80 for %DLco characterized vascular features only. These results were confirmed also when patients were stratified according to absent/single/combined %FVC and %DLCO impairments with 80% cut-offs (Table 2).FVC<80%FVC ≥80%pDLco<80%DLco ≥80%pDLco <70%DLco ≥70%p%N82.7 (9.6)86.2 (14.7)-86.6 (12.7)80.8 (15.8)-84.1 (13.9)86.4 (13.5)-%GG10.3 (8.9)2.4 (3.9)<.0015.0 (6.7)3.9 (6.9)-6.2 (7.5)2.4 (4.8).002%RET2.9 (2.9)0.8 (1.3)<.0011.6 (2.1)0.7 (0.9)-1.9 (2.4)0.6 (0.8).007%HC0.4 (0.6)0.1 (0.1)<.0010.2 (0.3)0.1 (0.1)-0.2 (0.4)0.05 (0.2).010%HL3.6 (6.8)8.9 (12.1)-5.4 (8.8)14.1 (15.4).0506.3 (10.1)9.2 (12.7)-PVV125.6 (39.1)90.9 (26.9)<.001101.9 (34.8)84.7 (19.4).016106.9 (38.3)87.5 (20.5).012PVV/LV3.8 (1.6)2.0 (0.7)<.0012.51 (1.3)1.7 (0.6).0022.76 (1.4)1.83 (0.6).001Conclusion:In SSc a cut-off at 80 for %DLco may help identifying vascular changes as automatically assessed on chest CT scan, without any underlying ILD. The 80% cut-off for %DLco may be proposed to identify isolated vascular involvement, while %FVC at 80% or %DLco at 70% to identify significant parenchymal involvement. These results need to be confirmed in larger multi-centric cohorts.Disclosure of Interests:Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Mariaelena Occhipinti Consultant of: Imbio, Gianna Camiciottoli: None declared, Maurizio Bartolucci: None declared, Gemma Lepri: None declared, Alessio Fabbrizzi: None declared, Alessandra Tottoli: None declared, Anna Bassetto: None declared, Giuglia Ciardi: None declared, Dilia Giuggioli: None declared, Giovanna CUOMO: None declared, Francesco Masini: None declared, Federico Lavorini: None declared, Linda Calistri: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim
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15
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Sposato B, Camiciottoli G, Bacci E, Scalese M, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Masieri S, Corsico A, Scichilone N, Baglioni S, Murgia N, Folletti I, Bardi G, Grosso A, Cameli P, Latorre M, Musarra A, Bargagli E, Ricci A, Pelaia G, Paggiaro P, Rogliani P. Mepolizumab effectiveness on small airway obstruction, corticosteroid sparing and maintenance therapy step-down in real life. Pulm Pharmacol Ther 2020; 61:101899. [PMID: 31972327 DOI: 10.1016/j.pupt.2020.101899] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 12/03/2019] [Accepted: 01/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mepolizumab (MEP) has been recently introduced to treat severe eosinophilic asthma. Trials have demonstrated a significant effectiveness in this asthma phenotype. We evaluated MEP efficacy on lung function, symptoms, asthma exacerbations, biologic markers, steroid dependence and controller treatment level in real-life. METHODS We retrospectively analyzed 134 severe asthmatics (61 males; mean age 58.3 ± 11; mean FEV1%:72 ± 21), treated with MEP for at least 6 months (mean duration:10.9 ± 3.7 months). RESULTS FEV1% improved significantly after MEP. Mean FEF25-75 also increased from 37.4 ± 25.4% to 47.2 ± 27.2% (p < 0.0001). Mean baseline blood eosinophil level was 712 ± 731/μL (8.4 ± 5.2%) decreasing to 151 ± 384/μL (1.6 ± 1.6%) (p < 0.0001), FENO levels decreased likewise. MEP treatment also led to a significant ACT improvement (mean pre:14.2 ± 4.4; mean post:20.5 ± 28) and exacerbations significantly fell from 3.8 ± 1.9 to 0.8 ± 1.1 (p < 0.0001). 74% of patients were steroid-dependent before MEP. 45.4% and 46.4% of them showed a suspension and dose reduction respectively (p < 0.0001). A significant number reduced also ICS doses. Only 67% of subjects used SABA as needed before MEP, falling to 20% after MEP. About 40% of patients highlighted a maintenance therapy step-down. Subjects showing an omalizumab treatment failure before MEP had a similar positive response when compared with omalizumab untreated patients. CONCLUSION In real-life, MEP improved significantly all outcomes even small airway obstruction, suggesting its possible role also in distal lung region treatment. Furthermore, it demonstrated its high effectiveness in OC/ICS-sparing, in reducing SABA as needed and in stepping-down maintenance therapy. MEP is a valid alternative for patients with previous omalizumab treatment failure.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy.
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - Elena Bacci
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | | | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinic Scientific Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, 82037, Telese Terme, BN, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS), University of Palermo, Palermo, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Giulio Bardi
- Internal Medicine Department, Azienda USL 6 Livorno, Piombino Hospital, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Paolo Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - Elena Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant 'Andrea, Rome, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy; Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
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Occhipinti M, Paoletti M, Bigazzi F, Camiciottoli G, Inchingolo R, Larici AR, Pistolesi M. Emphysematous and Nonemphysematous Gas Trapping in Chronic Obstructive Pulmonary Disease: Quantitative CT Findings and Pulmonary Function. Radiology 2018; 287:683-692. [PMID: 29361243 DOI: 10.1148/radiol.2017171519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To identify a prevalent computed tomography (CT) subtype in patients with chronic obstructive pulmonary disease (COPD) by separating emphysematous from nonemphysematous contributions to total gas trapping and to attempt to predict and grade the emphysematous gas trapping by using clinical and functional data. Materials and Methods Two-hundred and two consecutive eligible patients (159 men and 43 women; mean age, 70 years [age range, 41-85 years]) were prospectively studied. Pulmonary function and CT data were acquired by pulmonologists and radiologists. Noncontrast agent-enhanced thoracic CT scans were acquired at full inspiration and expiration, and were quantitatively analyzed by using two software programs. CT parameters were set as follows: 120 kVp; 200 mAs; rotation time, 0.5 second; pitch, 1.1; section thickness, 0.75 mm; and reconstruction kernels, b31f and b70f. Gas trapping obtained by difference of inspiratory and expiratory CT density thresholds (percentage area with CT attenuation values less than -950 HU at inspiration and percentage area with CT attenuation values less than -856 HU at expiration) was compared with that obtained by coregistration analysis. A logistic regression model on the basis of anthropometric and functional data was cross-validated and trained to classify patients with COPD according to the relative contribution of emphysema to total gas trapping, as assessed at CT. Results Gas trapping obtained by difference of inspiratory and expiratory CT density thresholds was highly correlated (r = 0.99) with that obtained by coregistration analysis. Four groups of patients were distinguished according to the prevalent CT subtype: prevalent emphysematous gas trapping, prevalent functional gas trapping, mixed severe, and mixed mild. The predictive model included predicted forced expiratory volume in 1 second/vital capacity, percentage of predicted forced expiratory volume in 1 second, percentage of diffusing capacity for carbon monoxide, and body mass index as emphysema regressors at CT, with 81% overall accuracy in classifying patients according to its extent. Conclusion The relative contribution of emphysematous and nonemphysematous gas trapping obtained by coregistration of inspiratory and expiratory CT scanning can be determined accurately by difference of CT inspiratory and expiratory density thresholds. CT extent of emphysema can be predicted with accuracy suitable for clinical purposes by pulmonary function data and body mass index. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Mariaelena Occhipinti
- From the Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy (M.O., M. Paoletti, F.B., G.C., M. Pistolesi); and Departments of Pulmonology (R.I.) and Radiological Sciences (A.R.L.), Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Paoletti
- From the Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy (M.O., M. Paoletti, F.B., G.C., M. Pistolesi); and Departments of Pulmonology (R.I.) and Radiological Sciences (A.R.L.), Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bigazzi
- From the Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy (M.O., M. Paoletti, F.B., G.C., M. Pistolesi); and Departments of Pulmonology (R.I.) and Radiological Sciences (A.R.L.), Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianna Camiciottoli
- From the Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy (M.O., M. Paoletti, F.B., G.C., M. Pistolesi); and Departments of Pulmonology (R.I.) and Radiological Sciences (A.R.L.), Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Inchingolo
- From the Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy (M.O., M. Paoletti, F.B., G.C., M. Pistolesi); and Departments of Pulmonology (R.I.) and Radiological Sciences (A.R.L.), Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Rita Larici
- From the Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy (M.O., M. Paoletti, F.B., G.C., M. Pistolesi); and Departments of Pulmonology (R.I.) and Radiological Sciences (A.R.L.), Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Pistolesi
- From the Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Largo A. Brambilla 3, 50134 Florence, Italy (M.O., M. Paoletti, F.B., G.C., M. Pistolesi); and Departments of Pulmonology (R.I.) and Radiological Sciences (A.R.L.), Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
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Lo Conte C, Allegrini C, Matucci A, Bartolucci M, Rosi E, Camiciottoli G, Amendola M, Pistolesi M, Bargagli E. Immunoglobulin replacement therapy for yellow nail syndrome. Scand J Immunol 2018; 87. [PMID: 29280506 DOI: 10.1111/sji.12639] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- C Lo Conte
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, AOUC, Florence, Italy
| | - C Allegrini
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, AOUC, Florence, Italy
| | - A Matucci
- Section of Immunology, University Hospital Careggi, Florence, Italy
| | - M Bartolucci
- Department of Diagnostic Imaging, University Hospital Careggi, Firenze, Italy
| | - E Rosi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, AOUC, Florence, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, AOUC, Florence, Italy
| | - M Amendola
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, AOUC, Florence, Italy
| | - M Pistolesi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, AOUC, Florence, Italy
| | - E Bargagli
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, AOUC, Florence, Italy
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18
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Occhipinti M, Paoletti M, Bigazzi F, Palazzi M, Bonti V, Camiciottoli G, Pistolesi M, Russell K. A predictive model for classifying COPD patients according to CT emphysema extent by using functional data and BMI. Imaging 2017. [DOI: 10.1183/1393003.congress-2017.pa794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Lung densitometry assesses with computed tomography (CT) the X-ray attenuation of the pulmonary tissue which reflects both the degree of inflation and the structural lung abnormalities implying decreased attenuation, as in emphysema and cystic diseases, or increased attenuation, as in fibrosis. Five reasons justify replacement with lung densitometry of semi-quantitative visual scales used to measure extent and severity of diffuse lung diseases: (I) improved reproducibility; (II) complete vs. discrete assessment of the lung tissue; (III) shorter computation times; (IV) better correlation with pathology quantification of pulmonary emphysema; (V) better or equal correlation with pulmonary function tests (PFT). Commercially and open platform software are available for lung densitometry. It requires attention to technical and methodological issues including CT scanner calibration, radiation dose, and selection of thickness and filter to be applied to sections reconstructed from whole-lung CT acquisition. Critical is also the lung volume reached by the subject at scanning that can be measured in post-processing and represent valuable information per se. The measurements of lung density include mean and standard deviation, relative area (RA) at -970, -960 or -950 Hounsfield units (HU) and 1st and 15th percentile for emphysema in inspiratory scans, and RA at -856 HU for air trapping in expiratory scans. Kurtosis and skewness are used for evaluating pulmonary fibrosis in inspiratory scans. The main indication for lung densitometry is assessment of emphysema component in the single patient with chronic obstructive pulmonary diseases (COPD). Additional emerging applications include the evaluation of air trapping in COPD patients and in subjects at risk of emphysema and the staging in patients with lymphangioleiomyomatosis (LAM) and with pulmonary fibrosis. It has also been applied to assess prevalence of smoking-related emphysema and to monitor progression of smoking-related emphysema, alpha1 antitrypsin deficiency emphysema, and pulmonary fibrosis. Finally, it is recommended as end-point in pharmacological trials of emphysema and lung fibrosis.
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Affiliation(s)
- Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences
| | - Gianna Camiciottoli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences.,Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
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20
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Landini N, Diciotti S, Lanzetta M, Bigazzi F, Camiciottoli G, Mascalchi M. Glottis Closure Influences Tracheal Size Changes in Inspiratory and Expiratory CT in Patients with COPD. Acad Radiol 2017; 24:901-907. [PMID: 28341409 DOI: 10.1016/j.acra.2017.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES The opened or closed status of the glottis might influence tracheal size changes in inspiratory and expiratory computed tomography (CT) scans. We investigated if the glottis status makes the tracheal collapse differently correlate with lung volume difference between inspiratory and expiratory CT scans. MATERIALS AND METHODS Forty patients with chronic obstructive pulmonary disease whose glottis was included in the acquired scanned volume for lung CT were divided into two groups: 16 patients with the glottis closed in both inspiratory and expiratory CT, and 24 patients with the glottis open in at least one CT acquisition. Lung inspiratory (Vinsp) and expiratory (Vexp) volumes were automatically computed and lung ΔV was calculated using the following formula: (Vinsp - Vexp)/Vinsp × 100. Two radiologists manually measured the anteroposterior diameter and cross-sectional area of the trachea 1 cm above the aortic arch and 1 cm above the carina. Tracheal collapse was then calculated and correlated with lung ΔV. RESULTS In the 40 patients, the correlations between tracheal Δanteroposterior diameter and Δcross-sectional area at each level and lung ΔV ranged between 0.68 and 0.74 (ρ) at Spearman rank correlation test. However, in the closed glottis group, the correlations were higher for all measures at the two levels (ρ range: 0.84-0.90), whereas in the open glottis group, correlations were low and not statistically significant (ρ range: 0.29-0.34) at the upper level, and moderate at the lower level (ρ range: 0.51-0.55). CONCLUSIONS A closed or open glottis influences the tracheal size change in inspiratory and expiratory CT scans. With closed glottis, the tracheal collapse shows a stronger correlation with the lung volume difference between inspiratory and expiratory CT scans.
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21
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Castaldi PJ, Benet M, Petersen H, Rafaels N, Finigan J, Paoletti M, Marike Boezen H, Vonk JM, Bowler R, Pistolesi M, Puhan MA, Anto J, Wauters E, Lambrechts D, Janssens W, Bigazzi F, Camiciottoli G, Cho MH, Hersh CP, Barnes K, Rennard S, Boorgula MP, Dy J, Hansel NN, Crapo JD, Tesfaigzi Y, Agusti A, Silverman EK, Garcia-Aymerich J. Do COPD subtypes really exist? COPD heterogeneity and clustering in 10 independent cohorts. Thorax 2017. [PMID: 28637835 DOI: 10.1136/thoraxjnl-2016-209846] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND COPD is a heterogeneous disease, but there is little consensus on specific definitions for COPD subtypes. Unsupervised clustering offers the promise of 'unbiased' data-driven assessment of COPD heterogeneity. Multiple groups have identified COPD subtypes using cluster analysis, but there has been no systematic assessment of the reproducibility of these subtypes. OBJECTIVE We performed clustering analyses across 10 cohorts in North America and Europe in order to assess the reproducibility of (1) correlation patterns of key COPD-related clinical characteristics and (2) clustering results. METHODS We studied 17 146 individuals with COPD using identical methods and common COPD-related characteristics across cohorts (FEV1, FEV1/FVC, FVC, body mass index, Modified Medical Research Council score, asthma and cardiovascular comorbid disease). Correlation patterns between these clinical characteristics were assessed by principal components analysis (PCA). Cluster analysis was performed using k-medoids and hierarchical clustering, and concordance of clustering solutions was quantified with normalised mutual information (NMI), a metric that ranges from 0 to 1 with higher values indicating greater concordance. RESULTS The reproducibility of COPD clustering subtypes across studies was modest (median NMI range 0.17-0.43). For methods that excluded individuals that did not clearly belong to any cluster, agreement was better but still suboptimal (median NMI range 0.32-0.60). Continuous representations of COPD clinical characteristics derived from PCA were much more consistent across studies. CONCLUSIONS Identical clustering analyses across multiple COPD cohorts showed modest reproducibility. COPD heterogeneity is better characterised by continuous disease traits coexisting in varying degrees within the same individual, rather than by mutually exclusive COPD subtypes.
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Affiliation(s)
- Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Marta Benet
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Hans Petersen
- COPD Program, Lovelace Respiratory Research Institute, Albuquerque, New Mexico, USA
| | - Nicholas Rafaels
- Center for Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - James Finigan
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Matteo Paoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - H Marike Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith M Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Russell Bowler
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Massimo Pistolesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Milo A Puhan
- Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Josep Anto
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Els Wauters
- Vesalius Research Center (VRC), VIB, Leuven, Belgium.,Laboratory for Translational Genetics, Department of Oncology, KU Leuven, Leuven, Belgium.,Respiratory Division, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Diether Lambrechts
- Vesalius Research Center (VRC), VIB, Leuven, Belgium.,Laboratory for Translational Genetics, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Francesca Bigazzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianna Camiciottoli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Barnes
- Center for Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Stephen Rennard
- Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Clinical Discovery Unit, AstraZeneca, Cambridge, UK
| | - Meher Preethi Boorgula
- Center for Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Jennifer Dy
- Department of Computer Science, Northeastern University, Boston, Massachusetts, USA
| | - Nadia N Hansel
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - James D Crapo
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Yohannes Tesfaigzi
- COPD Program, Lovelace Respiratory Research Institute, Albuquerque, New Mexico, USA
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERES, Barcelona, Spain
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith Garcia-Aymerich
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Camiciottoli G, Bigazzi F, Magni C, Bonti V, Diciotti S, Bartolucci M, Mascalchi M, Pistolesi M. Prevalence of comorbidities according to predominant phenotype and severity of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2016; 11:2229-2236. [PMID: 27695310 PMCID: PMC5028079 DOI: 10.2147/copd.s111724] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Indexed: 12/19/2022] Open
Abstract
Background In addition to lung involvement, several other diseases and syndromes coexist in patients with chronic obstructive pulmonary disease (COPD). Our purpose was to investigate the prevalence of idiopathic arterial hypertension (IAH), ischemic heart disease, heart failure, peripheral vascular disease (PVD), diabetes, osteoporosis, and anxious depressive syndrome in a clinical setting of COPD outpatients whose phenotypes (predominant airway disease and predominant emphysema) and severity (mild and severe diseases) were determined by clinical and functional parameters. Methods A total of 412 outpatients with COPD were assigned either a predominant airway disease or a predominant emphysema phenotype of mild or severe degree according to predictive models based on pulmonary functions (forced expiratory volume in 1 second/vital capacity; total lung capacity %; functional residual capacity %; and diffusing capacity of lung for carbon monoxide %) and sputum characteristics. Comorbidities were assessed by objective medical records. Results Eighty-four percent of patients suffered from at least one comorbidity and 75% from at least one cardiovascular comorbidity, with IAH and PVD being the most prevalent ones (62% and 28%, respectively). IAH prevailed significantly in predominant airway disease, osteoporosis prevailed significantly in predominant emphysema, and ischemic heart disease and PVD prevailed in mild COPD. All cardiovascular comorbidities prevailed significantly in predominant airway phenotype of COPD and mild COPD severity. Conclusion Specific comorbidities prevail in different phenotypes of COPD; this fact may be relevant to identify patients at risk for specific, phenotype-related comorbidities. The highest prevalence of comorbidities in patients with mild disease indicates that these patients should be investigated for coexisting diseases or syndromes even in the less severe, pauci-symptomatic stages of COPD. The simple method employed to phenotype and score COPD allows these results to be translated easily into daily clinical practice.
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Affiliation(s)
- Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine; Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence
| | - Francesca Bigazzi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine
| | - Chiara Magni
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine
| | - Viola Bonti
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, Cesena
| | | | - Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine
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Cappelli S, Bellando Randone S, Camiciottoli G, De Paulis A, Guiducci S, Matucci-Cerinic M. Interstitial lung disease in systemic sclerosis: where do we stand? Eur Respir Rev 2016; 24:411-9. [PMID: 26324802 DOI: 10.1183/16000617.00002915] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Interstitial lung disease (ILD) is common in systemic sclerosis (SSc) patients and despite recent advances in the treatment is, at present, the major cause of death. Today, an early diagnosis of ILD is possible, and is mandatory to improve the prognosis of the disease. Pulmonary function tests and high-resolution computed tomography remain the mainstay for the diagnosis of SSc-ILD, but there is a growing interest in lung ultrasound. Recently, the correlation between severity of fibrosis and some peripheral blood biomarkers has been described. Nonselective immunosuppressors are still the main treatment for ILD, with cyclophosphamide (CYC) most widely used to obtain remission. Novel therapies towards specific molecular and cellular targets have been suggested; in particular, rituximab (RTX) has shown promising results, but further research is needed. It is of paramount importance to define the severity of the disease and the risk of progression in order to define the need for treatment and the treatment intensity. We propose the division of the treatment strategies at our disposal to induce remission into three categories: high intensity (haematopoietic stem cell transplantation), medium intensity (CYC and RTX) and low intensity (azathioprine (AZA) and mycophenolate mofetil (MMF)). After obtaining remission, maintenance treatment with AZA or MMF should be started. In this review we explore new advances in the pathogenesis, diagnosis and treatment of SSc-ILD.
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Affiliation(s)
- Susanna Cappelli
- Dept of Experimental and Clinical Medicine, Division of Rheumatology AOUC, School of Medicine, University of Florence, Florence, Italy
| | - Silvia Bellando Randone
- Dept of Experimental and Clinical Medicine, Division of Rheumatology AOUC, School of Medicine, University of Florence, Florence, Italy
| | - Gianna Camiciottoli
- Dept of Experimental and Clinical Medicine, Division of Pneumology and Lung Physiopathology AOUC, School of Medicine, University of Florence, Florence, Italy
| | - Amato De Paulis
- Dept of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Serena Guiducci
- Dept of Experimental and Clinical Medicine, Division of Rheumatology AOUC, School of Medicine, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Dept of Experimental and Clinical Medicine, Division of Rheumatology AOUC, School of Medicine, University of Florence, Florence, Italy
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Camiciottoli G, Diciotti S, Bigazzi F, Lombardo S, Bartolucci M, Paoletti M, Mascalchi M, Pistolesi M. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD? Int J Chron Obstruct Pulmon Dis 2015; 10:843-52. [PMID: 25960647 PMCID: PMC4423505 DOI: 10.2147/copd.s80558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Indexed: 11/23/2022] Open
Abstract
A substantial proportion of patients with chronic obstructive pulmonary disease (COPD) develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory-expiratory low dose computed tomography (CT) and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28) and in females (n=27). Women with a predominant conductive airway phenotype (n=10) showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001). Intrathoracic tracheal collapsibility was directly correlated with inspiratory-expiratory volume variation at CT and with forced expiratory volume (1 second), and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD are closely correlated. In patients with a predominant emphysematous phenotype, a reduced collapsibility may reflect the mechanical properties of the stiff hyperinflated emphysematous lung. The high collapsibility in patients with predominant airway disease, mild airway obstruction, and in women with this phenotype may reflect chronic airway inflammation. The lack of relationship with such symptoms as wheezing, cough, and dyspnea could indicate that intrathoracic tracheal collapsibility itself should be considered neither an abnormal feature of COPD nor a relevant clinical finding.
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Affiliation(s)
- Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi," University of Bologna, Cesena, Italy
| | - Francesca Bigazzi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Simone Lombardo
- Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Maurizio Bartolucci
- Department of Diagnostic Imaging, Careggi University Hospital, Florence, Italy
| | - Matteo Paoletti
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Massimo Pistolesi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Paoletti M, Cestelli L, Bigazzi F, Camiciottoli G, Pistolesi M. Chronic Obstructive Pulmonary Disease: Pulmonary Function and CT Lung Attenuation Do Not Show Linear Correlation. Radiology 2015; 276:571-8. [PMID: 25848902 DOI: 10.1148/radiol.2015141769] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether the relationship between pulmonary function and computed tomographic (CT) lung attenuation in chronic obstructive pulmonary disease (COPD), which is traditionally described with single univariate and multivariate statistical models, could be more accurately described with a multiple model estimation approach. MATERIALS AND METHODS The study was approved by the local ethics committee. All participants provided written informed consent. The prediction of the percentage area with CT attenuation values less than -950 HU at inspiration (%LAA-950insp) and less than -910 HU at expiration (%LAA-910exp) obtained with single univariate and multivariate models was compared with that obtained with a multiple model estimation approach in 132 patients with COPD. RESULTS At univariate analysis, %LAA-950insp and %LAA-910exp values higher than the mean value of this cohort (19.1% and 22.0%) showed better correlation with percentage of predicted diffusing capacity of lung for carbon monoxide (Dlco%) than with airflow obstruction (forced expiratory volume in 1 second [FEV1]/vital capacity [VC]). Conversely, %LAA-950insp and %LAA-910exp values lower than the mean value were correlated with FEV1/VC but not with Dlco%. Multiple model estimation performed with two multivariate regressions, each selecting the most appropriate functional variables (FEV1/VC for mild parenchymal destruction, Dlco% and functional residual capacity for severe parenchymal destruction), predicted better than single multivariate regression both %LAA-950insp (R(2) = 0.75 vs 0.46) and %LAA-910exp (R(2) = 0.83 vs 0.63). CONCLUSION The relationship between pulmonary function data and CT densitometric changes in COPD varies with the level of lung attenuation impairment. The nonlinear profile of this relationship is accurately predicted with a multiple model estimation approach.
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Affiliation(s)
- Matteo Paoletti
- From the Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Lucia Cestelli
- From the Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesca Bigazzi
- From the Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Gianna Camiciottoli
- From the Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Massimo Pistolesi
- From the Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Nardini S, Camiciottoli G, Locicero S, Maselli R, Pasqua F, Passalacqua G, Pela R, Pesci A, Sebastiani A, Vatrella A. COPD: maximization of bronchodilation. Multidiscip Respir Med 2014; 9:50. [PMID: 25364503 PMCID: PMC4216364 DOI: 10.1186/2049-6958-9-50] [Citation(s) in RCA: 14] [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: 07/14/2014] [Accepted: 09/26/2014] [Indexed: 11/29/2022] Open
Abstract
The most recent guidelines define COPD in a multidimensional way, nevertheless the diagnosis is still linked to the limitation of airflow, usually measured by the reduction in the FEV1/FVC ratio below 70%. However, the severity of obstruction is not directly correlated to symptoms or to invalidity determined by COPD. Thus, besides respiratory function, COPD should be evaluated based on symptoms, frequency and severity of exacerbations, patient's functional status and health related quality of life (HRQoL). Therapy is mainly aimed at increasing exercise tolerance and reducing dyspnea, with improvement of daily activities and HRQoL. This can be accomplished by a drug-induced reduction of pulmonary hyperinflation and exacerbations frequency and severity. All guidelines recommend bronchodilators as baseline therapy for all stages of COPD, and long-acting inhaled bronchodilators, both beta-2 agonist (LABA) and antimuscarinic (LAMA) drugs, are the most effective in regular treatment in the clinically stable phase. The effectiveness of bronchodilators should be evaluated in terms of functional (relief of bronchial obstruction and pulmonary hyperinflation), symptomatic (exercise tolerance and HRQoL), and clinical improvement (reduction in number or severity of exacerbations), while the absence of a spirometric response is not a reason for interrupting treatment, if there is subjective improvement in symptoms. Because LABA and LAMA act via different mechanisms of action, when administered in combination they can exert additional effects, thus optimizing (i.e. maximizing) sustained bronchodilation in COPD patients with severe airflow limitation, who cannot benefit (or can get only partial benefit) by therapy with a single bronchodilator. Recently, a fixed combination of ultra LABA/LAMA (indacaterol/glycopyrronium) has shown that it is possible to get a stable and persistent bronchodilation, which can help in avoiding undesirable fluctuations of bronchial calibre.
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Affiliation(s)
- Stefano Nardini
- />Pulmonary and TB Unit, Vittorio Veneto General Hospital, Vittorio Veneto, TV Italy
| | - Gianna Camiciottoli
- />Department of Experimental and Clinical Medicine, Section of Respiratory Medicine, AOU Careggi, Florence, Italy
| | | | - Rosario Maselli
- />Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Franco Pasqua
- />Pneumology Rehabilitation, Villa delle Querce Hospital, Nemi, Rome, Italy
| | - Giovanni Passalacqua
- />Department of Internal Medicine and Medical Specialities, Respiratory Diseases and Allergology, Università degli Studi di Genova, Genoa, Italy
| | - Riccardo Pela
- />Pneumology Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy
| | - Alberto Pesci
- />Department of Pneumology, San Gerardo Hospital Monza (Mi), Monza, Italy
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Nardini S, Camiciottoli G, Locicero S, Maselli R, Pasqua F, Passalacqua G, Pela R, Pesci A, Sebastiani A, Vatrella A. COPD: maximization of bronchodilation. Multidiscip Respir Med 2014. [DOI: 10.4081/mrm.2014.385] [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
The most recent guidelines define COPD in a multidimensional way, nevertheless the diagnosis is still linked to the limitation of airflow, usually measured by the reduction in the FEV1/FVC ratio below 70%. However, the severity of obstruction is not directly correlated to symptoms or to invalidity determined by COPD. Thus, besides respiratory function, COPD should be evaluated based on symptoms, frequency and severity of exacerbations, patient’s functional status and health related quality of life (HRQoL). Therapy is mainly aimed at increasing exercise tolerance and reducing dyspnea, with improvement of daily activities and HRQoL. This can be accomplished by a drug-induced reduction of pulmonary hyperinflation and exacerbations frequency and severity. All guidelines recommend bronchodilators as baseline therapy for all stages of COPD, and long-acting inhaled bronchodilators, both beta-2 agonist (LABA) and antimuscarinic (LAMA) drugs, are the most effective in regular treatment in the clinically stable phase. The effectiveness of bronchodilators should be evaluated in terms of functional (relief of bronchial obstruction and pulmonary hyperinflation), symptomatic (exercise tolerance and HRQoL), and clinical improvement (reduction in number or severity of exacerbations), while the absence of a spirometric response is not a reason for interrupting treatment, if there is subjective improvement in symptoms. Because LABA and LAMA act via different mechanisms of action, when administered in combination they can exert additional effects, thus optimizing (i.e. maximizing) sustained bronchodilation in COPD patients with severe airflow limitation, who cannot benefit (or can get only partial benefit) by therapy with a single bronchodilator. Recently, a fixed combination of ultra LABA/LAMA (indacaterol/glycopyrronium) has shown that it is possible to get a stable and persistent bronchodilation, which can help in avoiding undesirable fluctuations of bronchial calibre.
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Novelli F, Latorre M, Vergura L, Caiaffa MF, Camiciottoli G, Guarnieri G, Matucci A, Macchia L, Vianello A, Vultaggio A, Celi A, Cazzola M, Paggiaro P. Asthma control in severe asthmatics under treatment with omalizumab: a cross-sectional observational study in Italy. Pulm Pharmacol Ther 2014; 31:123-9. [PMID: 25281265 DOI: 10.1016/j.pupt.2014.09.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 07/04/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 11/26/2022]
Abstract
Few data are available on the proportion of asthmatics achieving a good asthma control (according GINA guidelines) and on the level of airway inflammation during omalizumab treatment. The aim of this cross-sectional national observational study was to assess the level of control (according to GINA guidelines) achieved in a group of asthmatics on omalizumab treatment, and to characterize the factors that influence the lack of control. We studied 306 asthmatics under omalizumab treatment for a median of 32 months (range 4-120). The level of control according to GINA was good in 25.2%, partial in 47.1% and poor in 24.5% of patients (data were missing for the remaining 3.2%). Comparison between poorly controlled and partially or well controlled asthmatics showed a statistically significant higher prevalence of some comorbidities in the first group, namely obesity, gastro-oesophageal reflux disease (GORD), aspirin intolerance and mental disorders (all p < 0.001). Similarly, asthmatics with at least one exacerbation in the last year showed a significantly higher prevalence of obesity, chronic rhinosinusitis, nasal polyps, GORD, and aspirin intolerance (all p < 0.05) than patients without exacerbations. When we selected patients without relevant comorbidities (upper airways disease, GORD, obesity, aspirin intolerance) and not currently smoking (N = 73), the percentage of well or partially controlled asthmatics was significantly higher than in patients with comorbidities (84.9% vs 71.1%, p = 0.02); the rate of asthmatics without exacerbations in the last year was also higher (73.6% vs 51.1%, p = 0.001). During omalizumab treatment, a high percentage of asthmatics obtain a good or partial control of asthma. Comorbidities are associated with the lack of asthma control and persistence of exacerbations.
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Affiliation(s)
- Federica Novelli
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy.
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy.
| | - Letizia Vergura
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy.
| | | | - Gianna Camiciottoli
- Department of Experimental and Clinical Medicine, University of Firenze, Italy.
| | - Gabriella Guarnieri
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Italy.
| | - Andrea Matucci
- Department of Biomedicine, Immunoallergology Unit, AOU Careggi, Florence, Italy.
| | - Luigi Macchia
- Chair and School of Allergology and Clinical Immunology, University of Bari - Aldo Moro, Bari, Italy.
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University-City Hospital of Padova, Italy.
| | - Alessandra Vultaggio
- Department of Biomedicine, Immunoallergology Unit, AOU Careggi, Florence, Italy.
| | - Alessandro Celi
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy.
| | - Mario Cazzola
- Unit of Respiratory Clinical Pharmacology, Department of Systems Medicine, University of Torvergata, Roma, Italy.
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy.
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Lavorini F, Magni C, Chellini E, Camiciottoli G, Pistolesi M, Fontana GA. Different respiratory behaviors disclosed by induced bronchoconstriction in mild asthma patients. Respir Physiol Neurobiol 2013; 189:521-9. [PMID: 23999000 DOI: 10.1016/j.resp.2013.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 07/26/2013] [Accepted: 08/16/2013] [Indexed: 11/16/2022]
Abstract
Respiratory responses to bronchoconstriction in asthma have been partially assessed and their significance is unclear. In 44 mild asthma patients we investigated respiratory responses during increasing levels of methacholine-induced bronchoconstriction. Inspiratory muscle activity, tidal volume, inspiratory and expiratory times were continuously monitored; breathing discomfort was rated. Mean inspiratory flow, respiratory frequency and ventilation were calculated. Lung function was assessed prior to and at maximum bronchoconstriction. Bronchoconstriction "dose-dependently" increased inspiratory muscle activity and breathing discomfort (P<0.01). In 37 patients (84.1%), the increase in inspiratory muscle activity was associated with increases in mean inspiratory flow and ventilation (P<0.01) because of selective rises in breathing depth (volume responders), or rate (frequency responders) or both (dual responders). In seven patients (15.9%) ventilation was unchanged. Individual respiratory responses were reproducible. With bronchoconstriction, frequency responders displayed greater hyperinflation and stronger breathing discomfort than volume responders (P<0.01). Analysis of the responses to induced bronchoconstriction disclosed distinctive and reproducible respiratory adjustments that may identify functionally different asthma subpopulations.
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, Largo Brambilla 3, 50134 Florence, Italy
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Camiciottoli G, Diciotti S, Bartolucci M, Orlandi I, Bigazzi F, Matucci-Cerinic M, Pistolesi M, Mascalchi M. Whole-lung volume and density in spirometrically-gated inspiratory and expiratory CT in systemic sclerosis: correlation with static volumes at pulmonary function tests. Sarcoidosis Vasc Diffuse Lung Dis 2013; 30:17-27. [PMID: 24003531] [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: 06/02/2023]
Abstract
BACKGROUND Spiral low-dose computed tomography (LDCT) permits to measure whole-lung volume and density in a single breath-hold. OBJECTIVE To evaluate the agreement between static lung volumes measured with LDCT and pulmonary function test (PFT) and the correlation between the LDCT volumes and lung density in restrictive lung disease. DESIGN Patients with Systemic Sclerosis (SSc) with (n = 24) and without (n = 16) pulmonary involvement on sequential thin-section CT and patients with chronic obstructive pulmonary disease (COPD)(n = 29) underwent spirometrically-gated LDCT at 90% and 10% of vital capacity to measure inspiratory and expiratory lung volumes and mean lung attenuation (MLA). Total lung capacity and residual volume were measured the same day of CT. RESULTS Inspiratory [95% limits of agreement (95% LoA)--43.8% and 39.2%] and expiratory (95% LoA -45.8% and 37.1%) lung volumes measured on LDCT and PFT showed poor agreement in SSc patients with pulmonary involvement, whereas they were in substantial agreement (inspiratory 95% LoA -14.1% and 16.1%; expiratory 95% LoA -13.5% and 23%) in SSc patients without pulmonary involvement and in inspiratory scans only (95% LoA -23.1% and 20.9%) of COPD patients. Inspiratory and expiratory LDCT volumes, MLA and their deltas differentiated both SSc patients with or without pulmonary involvement from COPD patients. LDCT lung volumes and density were not correlated in SSc patients with pulmonary involvement, whereas they did correlate in SSc without pulmonary involvement and in COPD patients. CONCLUSIONS In restrictive lung disease due to SSc there is poor agreement between static lung volumes measured using LDCT and PFT and the relationship between volume and density values on CT is altered.
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Affiliation(s)
- G Camiciottoli
- Respiratory Medicine Unit, Department of Internal Medicine, University of Florence, Italy.
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Camiciottoli G, Bigazzi F, Paoletti M, Cestelli L, Lavorini F, Pistolesi M. Pulmonary function and sputum characteristics predict computed tomography phenotype and severity of COPD. Eur Respir J 2012; 42:626-35. [PMID: 23258785 DOI: 10.1183/09031936.00133112] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Airway obstruction and parenchymal destruction underlie phenotype and severity in chronic obstructive pulmonary disease (COPD). We aimed to predict, by clinical and pulmonary function data, the predominant type and severity of pathological changes quantitatively assessed by computed tomography (CT). Airway wall thickness (AWT-Pi10) and percentage of lung area with X-ray attenuation values <-950 HU (%LAA-950) were measured in 100 (learning set) out of 473 COPD outpatients undergoing clinical and functional evaluation. Original CT measurements were translated by principal component analysis onto a plane with the novel coordinates CT1 and CT2, depending on the difference (prevalent mechanism of airflow limitation) and on the sum (severity) of AWT-Pi10 and %LAA-950, respectively. CT1 and CT2, estimated in the learning set by cross-validated models of clinical and functional variables, were used to classify 373 patients in the testing set. A model based on diffusing capacity of the lung for carbon monoxide, total lung capacity and purulent sputum predicted CT1 (r = 0.64; p<0.01). A model based on forced expiratory volume in 1 s/vital capacity, functional residual capacity and purulent sputum predicted CT2 (r = 0.77; p<0.01). Classification of patients in the testing set obtained by model-predicted CT1 and CT2 reflected, according to correlations with clinical and functional variables, both COPD phenotype and severity. Multivariate models based on pulmonary function variables and sputum purulence classify patients according to overall severity and predominant phenotype of COPD as assessed quantitatively by CT.
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Affiliation(s)
- Gianna Camiciottoli
- Dept of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Camiciottoli G, Bigazzi F, Bartolucci M, Cestelli L, Paoletti M, Diciotti S, Cavigli E, Magni C, Buonasera L, Mascalchi M, Pistolesi M. BODE-index, modified BODE-index and ADO-score in chronic obstructive pulmonary disease: relationship with COPD phenotypes and CT lung density changes. COPD 2012; 9:297-304. [PMID: 22432964 DOI: 10.3109/15412555.2012.661000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
COPD is a heterogeneous disorder whose assessment is going to be increasingly multidimensional. Grading systems such as BODE (Body-Mass Index, Obstruction, Dyspnea, Exercise), mBODE (BODE modified in grading of walked distance), ADO (Age, Dyspnea, Obstruction) are proposed to assess COPD severity and outcome. Computed tomography (CT) is deemed to reflect COPD lung pathologic changes. We studied the relationship of multidimensional grading systems (MGS) with clinically determined COPD phenotypes and CT lung density. Seventy-two patients underwent clinical and chest x-ray evaluation, pulmonary function tests (PFT), 6-minute walking test (6MWT) to derive: predominant COPD clinical phenotype, BODE, mBODE, ADO. Inspiratory and expiratory CT was performed to calculate mean lung attenuation (MLA), relative area with density below-950 HU at inspiration (RAI(-950)), and below -910 HU at expiration (RAE(-910)). MGS, PFT, and CT data were compared between bronchial versus emphysematous COPD phenotype. MGS were correlated with CT data. The prediction of CT density by means of MGS was investigated by direct and stepwise multivariate regression. MGS did not differ in clinically determined COPD phenotypes. BODE was more closely related and better predicted CT findings than mBODE and ADO; the better predictive model was obtained for CT expiratory data; stepwise regression models of CT data did not include 6MWT distance; the dyspnea score MRC was included only to predict RA-950 and RA-910 which quantify emphysema extent. BODE reflect COPD severity better than other MGS, but not its clinical heterogeneity. 6MWT does not significantly increase BODE predictivity of CT lung density changes.
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Affiliation(s)
- Gianna Camiciottoli
- University of Florence, Department of Internal Medicine, Section of Respiratory Medicine, Florence, Italy. gianna.camiciottoli@unifi .it
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Mascalchi M, Diciotti S, Sverzellati N, Camiciottoli G, Ciccotosto C, Falaschi F, Zompatori M. Low agreement of visual rating for detailed quantification of pulmonary emphysema in whole-lung CT. Acta Radiol 2012; 53:53-60. [PMID: 22114019 DOI: 10.1258/ar.2011.110419] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multidetector spiral computed tomography (CT) has opened the possibility of quantitative evaluation of emphysema extent in the whole lung. Visual assessment can be used for such a purpose, but its reproducibility has not been established. PURPOSE To assess agreement of detailed assessment of pulmonary emphysema on whole-lung CT using a visual scale. MATERIAL AND METHODS Thirty patients with chronic obstructive pulmonary disease underwent whole-lung inspiratory CT. Four chest radiologists rated the same 22 ± 2 thin sections using a visual scale which defines a range of emphysema extent between 0 and 100. Two of them repeated the rating two months later. Inter- and intra-operator agreement was evaluated with the Bland and Altman method. In addition, the percentage of emphysema at -950 Hounsfield units in the whole lung was determined using fully automated commercially available software for 3D densitometry. RESULTS In three of six operator pairs and in one of two intra-operator pairs the Kendall τ test showed a significant correlation between the difference and the average magnitude of visual scores. Among different operators the half-width of 95% limits of agreement (95% LoA) was wide ranging between a score of 14.2-27.7 for an average visual score of 20 and between 18.5-36.8 for an average visual score of 80. Within the same operator the half-width of 95% LoA ranged between a score of 10.9-21.0 for an average visual score of 20 and between 25.1-30.1 for an average visual score of 80. The visual scores of the four radiologists were correlated with the results of densitometry (P < 0.001; r = 0.65-0.81). CONCLUSION The inter- and intra-operator agreement of detailed assessment of emphysema in the whole lung using a visual scale is low and decreases with increasing emphysema extent.
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Affiliation(s)
- Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence
| | - Stefano Diciotti
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence
| | | | | | | | - Fabio Falaschi
- Second Division of Radiology, Cisanello Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa
| | - Maurizio Zompatori
- Department of Radiology, S Orsola Hospital of Bologna, University of Bologna, Bologna, Italy
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Cazzola M, Camiciottoli G, Bonavia M, Gulotta C, Ravazzi A, Alessandrini A, Caiaffa MF, Berra A, Schino P, Di Napoli PL, Maselli R, Pelaia G, Bucchioni E, Paggiaro PL, Macchia L. Italian real-life experience of omalizumab. Respir Med 2010; 104:1410-6. [PMID: 20483574 DOI: 10.1016/j.rmed.2010.04.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/26/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
Abstract
Omalizumab is a humanized murine monoclonal antibody directed toward a portion of the IgE indicated in Europe for the treatment of severe persistent allergic asthma, inadequately controlled despite high-dose of ICS (mean BDP equivalent dose of inhaled corticosteroid 2224.68microg/die) in association with long-acting beta(2) agonists. Our aim was to describe the experience, efficacy and safety in a cohort of Italian patients treated with omalizumab in a real-life clinical setting. One hundred and forty two patients from 13 Italian Centers were observed and analysed. The dosage of omalizumab was established according to the labelling indication, with a median dose of IgE of 297.38IU/ml or kU/l. During the previous year, all patients experienced frequent exacerbations (mean=4.87), emergency visits (mean=4.45) and hospitalisation (mean=1.53). Following treatment with omalizumab, the annual rate of exacerbations, emergency visits and hospitalisation decreased by 79%, 88% and 95%, respectively. The proportion of patients without exacerbation, not needing emergency visits and hospitalization increased by 610%, 154% and 28%, respectively. The response to omalizumab measured with the GETE (global evaluation of treatment effectiveness) scale rated as good to excellent in 77% of patients. Overall, 9.6% (n=9) of the patients experienced one single adverse effect. Only one patient reported a serious adverse event (local reaction at the site of injection) leading to interruption of treatment. The observed reduction of asthma-related events in particularly poorly controlled patients in this Italian real-life setting is consistent with the results of other observational studies.
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Affiliation(s)
- M Cazzola
- Unità di Farmacologia Clinica Respiratoria, Dipartimento di Medicina Interna Università di Roma Tor Vergata, Roma, Italy.
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35
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Dei D, Grazzini G, Luzi G, Pieraccini M, Atzeni C, Boncinelli S, Camiciottoli G, Castellani W, Marsili M, Dico JL. Non-contact detection of breathing using a microwave sensor. Sensors (Basel) 2009; 9:2574-85. [PMID: 22574033 PMCID: PMC3348806 DOI: 10.3390/s90402574] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 04/07/2009] [Accepted: 04/14/2009] [Indexed: 11/17/2022]
Abstract
In this paper the use of a continuous-wave microwave sensor as a non-contact tool for quantitative measurement of respiratory tidal volume has been evaluated by experimentation in seventeen healthy volunteers. The sensor working principle is reported and several causes that can affect its response are analyzed. A suitable data processing has been devised able to reject the majority of breath measurements taken under non suitable conditions. Furthermore, a relationship between microwave sensor measurements and volume inspired and expired at quiet breathing (tidal volume) has been found.
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Affiliation(s)
- Devis Dei
- Department of Electronics and Telecommunications, University of Florence, Via Santa Marta 3, 50139 Firenze, Italy; E-Mails: (G.G.); (G.L.); (M.P.); (C.A.)
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36
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Cavigli E, Camiciottoli G, Diciotti S, Orlandi I, Spinelli C, Meoni E, Grassi L, Farfalla C, Pistolesi M, Falaschi F, Mascalchi M. Whole-lung densitometry versus visual assessment of emphysema. Eur Radiol 2009; 19:1686-92. [PMID: 19224221 DOI: 10.1007/s00330-009-1320-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 11/17/2008] [Accepted: 12/27/2008] [Indexed: 10/21/2022]
Abstract
We compared whole-lung densitometry with visual evaluation of pulmonary emphysema. Thirty patients with chronic obstructive pulmonary disease underwent multi-detector CT (150 mAs and 0.75 collimation) with double reconstruction: thick (5-mm) slices with smooth filter for whole-lung densitometry and thin (1 mm) slices with sharp filter for visual assessment (one of every ten slices). Densitometry and visual assessment were performed by three operators each, and the time required for assessment, the inter-observer agreement and the correlation with the results of the diffusion capacity of carbon monoxide (DL(CO)) in the same patients were computed. The average time for densitometry (8.49 +/- 0.13 min) was significantly longer (p < 0.0001) than that for visual evaluation (5.14 +/- 0.11 min). However, the inter-operator agreement ranged between "moderate" to "almost perfect" for densitometry (kappa range 0.58-0.87) and "slight" for visual (kappa = 0.20) assessment. The correlation coefficients of DL(CO) with relative area at -960 and -970 Hounsfield units (HU) (both r = -0.66) and of the first percentile point of lung density (r = 0.66) were slightly stronger than that of the visual score (r = -0.62). Densitometry should be preferred to visual assessment because it enables a more reproducible evaluation of the extent of pulmonary emphysema, which can be carried out on the entire lung in a reasonable amount of time.
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Affiliation(s)
- Edoardo Cavigli
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, Florence, 50134, Italy
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37
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Bartalesi F, Camiciottoli G, Corti G, Maluccio N, Biliotti E, Bartoloni A, Taliani G. Combination Treatment for Chronic HCV Hepatitis in Lymphangioleiomyomatosis: First Case Report. J Chemother 2009; 21:110-1. [DOI: 10.1179/joc.2009.21.1.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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38
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Damjanov N, Ostojic P, Kaloudi O, Alari S, Guiducci S, Stanflin N, Nestorovic B, Knezevic J, Camiciottoli G, Porta F, Pistolesi M, Ibba-Manneschi L, Conforti M, Candelieri A, Matucci Cerinic M. Induced Sputum in Systemic Sclerosis Interstitial Lung Disease: Comparison to Healthy Controls and Bronchoalveolar Lavage. Respiration 2009; 78:56-62. [DOI: 10.1159/000164720] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 07/11/2008] [Indexed: 11/19/2022] Open
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Pistolesi M, Camiciottoli G, Paoletti M, Marmai C, Lavorini F, Meoni E, Marchesi C, Giuntini C. Identification of a predominant COPD phenotype in clinical practice. Respir Med 2008; 102:367-76. [PMID: 18248806 DOI: 10.1016/j.rmed.2007.10.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 10/25/2007] [Accepted: 10/26/2007] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation caused by small airways increased resistance and/or terminal airspaces emphysematous destruction. Spirometric detection of not fully reversible airflow limitation unifies under the acronym COPD, a spectrum of heterogeneous conditions, whose clinical presentations may be substantially different. In a cross-sectional study we aimed to ascertain whether COPD phenotypes reflecting different mechanisms of airflow limitation could be clinically identified. METHODS Multidimensional scaling was used to visualize as a single point in a two-dimension space the multidimensional variables derived from each of 322 COPD patients (derivation set) by clinical, functional, and chest radiographic evaluation. Cluster analysis assigned then a cluster membership to each patient data point. Finally, using cluster membership as dependent variable and all data acquired as independent variables, we developed multivariate models to prospectively classify another group of 93 COPD patients (validation set) in whom high-resolution computerized tomography (HRCT) density parameters were measured. RESULTS A multivariate model based on nine variables acquired from the derivation set by history (sputum characteristics), physical examination (adventitious sounds, hyperresonance), FEV1/VC, and chest radiography (increased vascular markings, bronchial wall thickening, increased lung volume, reduced lung density) partitioned the validation set into two groups whose clinical, functional, chest radiographic, and HRCT characteristics corresponded to either an airways obstructive or a parenchymal destructive COPD phenotype. CONCLUSION Patients with COPD can be assigned a clinical phenotype reflecting the prevalent mechanism of airflow limitation. The standardized identification of the predominant phenotype may permit to clinically characterize COPD beyond its unifying spirometric definition.
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Affiliation(s)
- Massimo Pistolesi
- Department of Critical Care, Section of Respiratory Medicine, University of Florence, Viale Morgagni 85, 50134 Firenze, Italy.
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40
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Giuntini C, Camiciottoli G, Maluccio NM, Mariani L, Lavorini F, Pistolesi M. Chronic effort dyspnea explained by lung function tests and by HRCT and CRX radiographic patterns in COPD: a post-hoc analysis in 51 patients. COPD 2007; 4:169-76. [PMID: 17729059 DOI: 10.1080/15412550701407854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper is a post-hoc analysis of a previous study performed to investigate the relationship between computerized tomography (CT) and lung function in 51 outpatients with mild-to-moderate COPD. We studied whether changes in lung function and radiographic patterns may help to explain dyspnea, the most disturbing symptom in patients with COPD. The Medical Research Council (MRC) dyspnea scale shows, by univariate analysis, a similar strength of association to CT expiratory lung density and to DL(CO), a functional index of lung parenchymal loss. The MRC dyspnea scale shows a somewhat less strength of association with a small vertical heart on plain chest films. In multivariate analysis, the model with the strongest association to the MRC dyspnea scale (r = 0.76, p < 0.0001) contains 4 explanatory variables (DL(CO), FRC, PaCO(2), and radiographic pattern of pulmonary hypertension). We suggest that diffusing capacity reflects the emphysematous component of hyperinflation, associated by definition with destruction of terminal airspace walls, as distinct from the air trapping component, which is ascribed to airway obstruction and associated with FRC. PaCO(2) mainly reflects the ventilatory components, i.e., ventilatory drive and ventilatory constraints, of pulmonary gas exchange in COPD, while radiographic pattern of pulmonary hypertension likely reflects hypoxic vascular changes, which depend mainly on ventilation/perfusion mismatch and give rise to pulmonary arterial hypertension that may contribute per se to dyspnea. In conclusion, our analysis points out that chronic effort dyspnea variance may account for up to 58% (r(2) = 0.58) by lung function tests and radiographic patterns. Thus, about 42% of the MRC dyspnea variance remains unexplained by this model. On the other hand, dyspnea ascertainment is dependent on subjective behavior and evaluation and in tests is influenced by individual performance and perception. For example in the 6-minute walk test, a similar or higher proportion (60%) of the overall variance is unexplained.
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Affiliation(s)
- Carlo Giuntini
- Section of Respiratory Diseases, Cardiothoracic Department, University of Pisa, Pisa, Italy.
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Lavorini F, Geri P, Camiciottoli G, Pistolesi M, Fontana GA. Agreement between two methods for assessing bioequivalence of inhaled salbutamol. Pulm Pharmacol Ther 2007; 21:380-4. [PMID: 17997115 DOI: 10.1016/j.pupt.2007.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 09/14/2007] [Accepted: 10/06/2007] [Indexed: 11/19/2022]
Abstract
For inhaled medications, bioequivalence testing is becoming increasingly important owing to the availability of many inhalation devices. We evaluated agreement between the Finney bioassay and the Emax model in the assessment of bioequivalence of salbutamol administered via a metered-dose inhaler with a spacer (pMDI+ Volumatic) or via a dry-powder inhaler (Diskus) in asthmatic patients with methacholine-induced bronchoconstriction. Eighteen patients inhaled methacholine until FEV 1 decreased by approximately 35% of control. Following inhalation of placebo, 200 and 400 mcg salbutamol through the pMDI+ Volumatic or the Diskus, changes in FEV 1 were repeatedly measured over a 60-min observation period. Bioequivalence of salbutamol administered via the two inhalation devices was assessed by calculating the relative potency of each device by using the Finney 2-by-2 parallel regression analysis and the non-linear, Emax model. Agreement between these methods in calculating relative potency was evaluated by using the Bland-Altman method. After salbutamol FEV 1 values were similar irrespective of the device employed, and greater (P<0.01) than those after placebo. However, assessment of relative potencies obtained with both the Finney (1.97, 90% CI 1.62-2.32) and the Emax (2.25, 90% CI 1.90-2.60) methods revealed that twice the salbutamol dose was needed to reverse methacholine-induced bronchoconstriction when the drug was inhaled via the Diskus than via the pMDI+ Volumatic. The mean difference in relative potency (-0.28, 90% CI -0.001 to -0.56) calculated with both methods did not significantly differ from zero, and none of the individual differences exceeded the limits of agreement. The Finney and the Emax methods provide comparable results in the evaluation of bioequivalence of different salbutamol formulations. The pMDI+ Volumatic is twice as efficient as the Diskus in lung delivery of salbutamol in asthma patients.
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Affiliation(s)
- Federico Lavorini
- Dipartimento di Area Critica Medico Chirurgica, Unità Funzionale di Medicina Respiratoria, Università degli Studi di Firenze, Viale G B Morgagni 85-50134, Firenze, Italy.
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42
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Camiciottoli G, Orlandi I, Bartolucci M, Meoni E, Nacci F, Diciotti S, Barcaroli C, Conforti ML, Pistolesi M, Matucci-Cerinic M, Mascalchi M. Lung CT densitometry in systemic sclerosis: correlation with lung function, exercise testing, and quality of life. Chest 2007; 131:672-681. [PMID: 17356079 DOI: 10.1378/chest.06-1401] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND To ascertain if analysis of lung density histograms in thin-section CT was more reproducible than visual assessment of lung changes in systemic sclerosis (SSc), and if such density histogram parameters as mean lung attenuation (MLA), skewness, and kurtosis could more closely reflect pulmonary function as well as exercise and quality of life impairment. METHODS The intraoperator and interoperator reproducibility of visual and densitometric lung CT analysis in 48 SSc patients examined with CT were evaluated by means of weighted kappa statistics. Univariate and multivariate regression analyses were applied to evaluate the relationship of visual and densitometric CT measurements with functional parameters including functional residual capacity (FRC), FVC, FEV(1), diffusion capacity of the lung for carbon monoxide (Dlco), 6-min walking testing (6MWT), and health-related quality of life questionnaire (QLQ) parameters. RESULTS The intraoperator and interoperator reproducibility of MLA (intraobserver weighted kappa = 0.97; interobserver weighted kappa = 0.96), skewness (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88), and kurtosis (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88) were higher than those of visual assessment (intraobserver weighted kappa = 0.71; interobserver weighted kappa = 0.69). In univariate analysis, only densitometric measurements were correlated with some exercise and QLQ parameters. In multivariate analysis, MLA (square regression coefficient corrected [R(2)c] = 0.70), skewness (R(2)c = 0.78), and kurtosis (R(2)c = 0.77) were predicted by FRC, FVC, Dlco, 6MWT, and QLQ parameters, while visual assessment was associated only with FRC and FVC (R(2)c = 0.40). CONCLUSIONS In SSc, densitometric analysis is more reproducible than visual assessment of lung changes in thin-section CT and more closely correlated to pulmonary function testing, 6MWT, and QLQ. Density histogram parameters may be useful for cross-sectional and longitudinal studies of lung involvement in SSc.
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Affiliation(s)
- Gianna Camiciottoli
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy.
| | - Ilaria Orlandi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Maurizio Bartolucci
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Eleonora Meoni
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Francesca Nacci
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electronics and Telecommunications, University of Florence, Florence, Italy
| | - Chiara Barcaroli
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Maria Letizia Conforti
- Rheumatology Unit, Department of Internal Medicine, University of Florence, Florence, Italy
| | - Massimo Pistolesi
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Rheumatology Unit, Department of Internal Medicine, University of Florence, Florence, Italy
| | - Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Sanna A, Fargnoli R, Camiciottoli G. Obstructive sleep apnea syndrome as a complication after tracheal surgery. J Clin Sleep Med 2006; 2:458-9. [PMID: 17557477] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We describe a case of obstructive sleep apnea syndrome that occurred after tracheal surgery. The patient refused a tracheal stent placement and any surgical procedure aimed at stabilizing the tracheal walls. She was treated with a continuous positive airway pressure.
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Affiliation(s)
- Antonio Sanna
- Regione Toscana-Azienda USL 3 di Pistoia, Ospedale del Ceppo, U.O. di Pneumologia, Italy.
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Affiliation(s)
- Antonio Sanna
- Regione Toscana — Azienda USL 3 di Pistoia, Ospedale del Ceppo, U.O. di Pneumologia
- Fondazione Don C.Gnocchi - IRCCS - ONLUS, U.O.F. di Riabilitazione Respiratoria, Centro di S.Maria agli Ulivi, Pozzolatico (FI)
| | - Rossana Fargnoli
- Regione Toscana — Azienda USL 4 di Prato, Presidio Ospedaliero Misericordia e Dolce, U.O. di Radiodiagnostica
| | - Gianna Camiciottoli
- Dipartimento di Area Critica Medico-Chirurgica, Sezione di Clinica Medica e Cliniche Specialistiche, Unità Funzionale di Medicina Respiratoria, Università di Firenze, Italy
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Orlandi I, Camiciottoli G, Diciotti S, Bartolucci M, Cavigli E, Nacci F, Matucci-Cerinic M, Villari N, Mascalchi M. Thin-Section and Low-Dose Volumetric Computed Tomographic Densitometry of the Lung in Systemic Sclerosis. J Comput Assist Tomogr 2006; 30:823-7. [PMID: 16954937 DOI: 10.1097/01.rct.0000228159.86096.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To correlate lung density measurements with the results of visual assessment of thin-section computed tomography (CT) and of pulmonary function tests (PFT) in Systemic Sclerosis (SSc). METHODS Thirty-nine SSc patients underwent sequential thin-section CT and spiral low-dose whole-lung acquisitions. The thin-section CT scans were evaluated with a dedicated visual scale. Mean lung density, skewness, and kurtosis were calculated from the lung density histogram. In addition from the spiral low-dose acquisition, the lung volume was computed. The visual score, the densitometric parameters, and the lung volume were correlated with the PFT. RESULTS Mean lung density, skewness, and kurtosis computed from thin-section (R = 0,66; R = -0,74; R = -0,75) and low-dose volumetric (R = 0,72; R = -0,71; R = -0,71) CT and the lung volume (R = -0.54) correlated with the visual score. Densitometric values and lung volume consistently better correlated with PFT than the visual score. CONCLUSIONS In SSc the histogram results are more closely correlated to PFT than the visual score. The low-dose spiral CT seems ideal for longitudinal studies.
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Affiliation(s)
- Ilaria Orlandi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Italy.
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Camiciottoli G, Bartolucci M, Maluccio NM, Moroni C, Mascalchi M, Giuntini C, Pistolesi M. Spirometrically gated high-resolution CT findings in COPD: lung attenuation vs lung function and dyspnea severity. Chest 2006; 129:558-64. [PMID: 16537852 DOI: 10.1378/chest.129.3.558] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to investigate the relationship between high-resolution CT (HRCT) lung attenuation measurements, acquired under spirometric control of inspiratory and expiratory lung volume, and pulmonary dysfunction as well as dyspnea severity in patients with COPD. PATIENTS AND DESIGN In 51 patients with COPD, we compared by linear regression, univariate and multivariate logistic regression airflow limitation (FEV(1)/vital capacity [VC]), hyperinflation (percentage of predicted residual volume [RV%]), parenchymal loss (percentage of predicted diffusing capacity of the lung for carbon monoxide [Dlco%]), and Medical Research Council (MRC) dyspnea scale with relative area with attenuation values < - 950 HU at 90% of VC [RAI(950)] and < - 910 HU at 10% of VC, respectively, and with mean lung attenuation measured at the same levels of VC (mean CT lung density at 10% of VC, and mean CT lung density at 90% of VC [MeanCTEXP]). RESULTS All HRCT attenuation measurements were significantly related with functional abnormalities and dyspnea severity. In multivariate logistic models, with 1 indicating worse changes in dichotomous outcome variables, MeanCTEXP independently predicted FEV(1)/VC (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11 to 0.56), RV% (OR, 0.57; 95% CI, 0.42 to 0.77), and MRC dyspnea scale (OR, 0.63; 95% CI, 0.48 to 0.82), while RAI(950) independently predicted Dlco% (OR, 1.90; 95% CI, 1.37 to 2.65). CONCLUSIONS Spirometrically gated measurements of HRCT lung attenuation reflect differently functional changes and dyspnea perception in COPD. Inspiratory measurements assess the extent of emphysematous tissue loss, and expiratory measurements may reflect airflow limitation and lung hyperinflation with attendant dyspnea perception. Pulmonary dysfunction in COPD cannot be assessed by a single modality of lung attenuation measurement.
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Affiliation(s)
- Gianna Camiciottoli
- Department of Critical Care, Section of Respiratory Medicine, University of Florence, Florence, Italy
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Orlandi I, Moroni C, Camiciottoli G, Bartolucci M, Pistolesi M, Villari N, Mascalchi M. Chronic obstructive pulmonary disease: thin-section CT measurement of airway wall thickness and lung attenuation. Radiology 2005; 234:604-10. [PMID: 15671010 DOI: 10.1148/radiol.2342040013] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate airway wall thickness and lung attenuation at spirometrically gated thin-section computed tomography (CT) in patients with chronic obstructive pulmonary disease (COPD) and to correlate gated CT findings with pulmonary function test (PFT) results. MATERIALS AND METHODS The ethical committee approved the study, and all patients gave informed consent. Forty-two consecutive patients with COPD (20 with and 22 without chronic bronchitis [CB]) underwent gated thin-section CT and PFTs on the same day. The percentage wall area (PWA) and the thickness-to-diameter ratio (TDR) for all depicted bronchi that were round and larger than 2 mm in diameter, the mean lung attenuation (MLA), and the pixel index (PI) at -950 HU were determined. The reproducibility of the airway measurements was preliminarily tested by performing a five-trial examination in a patient with COPD and in a control patient. Differences in airway and lung attenuation measurements between the patients with and those without CB were evaluated at Mann-Whitney U testing. Simple and multiple regression analyses were used to assess the correlation between thin-section CT and PFT measurements. RESULTS The mean intraoperator coefficient of variation for airway measurements was 7.8% (range, 3.8%-13.4%). An average of nine bronchi per patient were assessed. Patients with CB had significantly higher PWAs, TDRs, and MLAs and significantly lower PIs than patients without CB (P < .05 for all values). The combination of PWA, TDR, and PWA normalized to body weight correlated significantly (P < .05) with the forced expiratory volume in 1 second-to-slow vital capacity ratio and the diffusing capacity of the lung for carbon monoxide in patients with but not in patients without CB. PFT results correlated better with MLA and PI in patients without CB. CONCLUSION Bronchial wall measurements differ between patients who have COPD with CB and those who have COPD without CB. The correlation between airway dimensions and indexes of airway obstruction in patients with COPD and CB indicates that the bronchial tree is the site of anatomic-functional alterations in this patient group.
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Affiliation(s)
- Ilaria Orlandi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, Florence 50134, Italy
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Orlandi I, Moroni C, Camiciottoli G, Bartolucci M, Belli G, Villari N, Mascalchi M. Spirometric-Gated Computed Tomography Quantitative Evaluation of Lung Emphysema in Chronic Obstructive Pulmonary Disease. J Comput Assist Tomogr 2004; 28:437-42. [PMID: 15232372 DOI: 10.1097/00004728-200407000-00001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the quantitative assessment of pulmonary emphysema with spirometric-gated computed tomography (gated CT) using 3 different acquisition techniques and to determine if low-current spiral CT could be used effectively to quantitate emphysema. METHODS Eleven patients with chronic obstructive pulmonary disease (COPD) underwent gated CT and pulmonary function tests (PFTs). Spiral whole-lung 10-mm collimation acquisitions at standard (146 mAs) and low (43 mAs) current and sequential 3-slice 1-mm collimation high-resolution computed tomography (HRCT) acquisitions at standard current were obtained at 90% of the patient's vital capacity. The mean lung density (MLD) and the pixel index (PI) derived from the 3 data sets were compared using one-way analysis of variance and correlated with PFTs using linear regression. Moreover, the radiation dose associated with each technique was measured. RESULTS The MLDs were not significantly different. The PIs calculated from the standard- and low-current spiral acquisitions were similar, and both were significantly different from that of HRCT. The MLDs correlated with the PFTs in standard-current spiral and HRCT but not in low-current spiral acquisitions, whereas the PIs correlated with the PFTs in all 3 techniques. High-resolution computed tomography implied the lowest dose (0.08 mSv) compared with low-current (1.2 mSv) and standard-current (4 mSv) spiral techniques. CONCLUSIONS Low- and standard-dose spiral CT provides similar lung density data in COPD. The combination of low-dose whole-lung spiral CT and 3-slice HRCT represents the best compromise between the amount of information provided and radiation exposure to the patient and could be substituted for standard-dose spiral CT for quantitative evaluation of COPD.
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Affiliation(s)
- Ilaria Orlandi
- Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Moroni C, Mascalchi M, Camiciottoli G, Bartolucci M, Falaschi F, Battolla L, Orlandi I, Pistolesi M, Villari N. Comparison of spirometric-gated and -ungated HRCT in COPD. J Comput Assist Tomogr 2003; 27:375-9. [PMID: 12794602 DOI: 10.1097/00004728-200305000-00013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this work was to evaluate feasibility of spirometric-gated high-resolution computed tomography (HRCT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the lung density CT measurements obtained with and without spirometric control of lung volume. METHOD Twenty-nine patients with COPD underwent pulmonary function tests and spirometric-gated (3 slices at 10% and 90% of vital capacity) and -ungated (12 slices at maximum expiration and inspiration) HRCT in the same day. Four lung density measurements (inspiratory pixel index, expiratory pixel index, inspiratory and expiratory mean lung density) derived from gated and ungated acquisitions were compared using the nonparametric Wilcoxon test, the line of equality, and the Bland and Altman test. RESULTS The vital capacity measured at pulmonary function tests and on the CT table showed a substantial agreement. All but one patient completed the gated and ungated examination, but only 8 (28%) of 28 patients reached the expiratory and inspiratory gating level for CT acquisitions at the first attempt. Only the inspiratory mean lung density derived from the 3 gated and 12 ungated slices showed borderline agreement. Other CT measurements, and notably all those from the 3 gated and ungated scans, acquired at the same anatomic level, did not agree. CONCLUSIONS Although the procedure can be difficult for individual patients, spirometric gating significantly influences the lung density CT measurements and might improve standardization of CT evaluation of COPD.
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Affiliation(s)
- Chiara Moroni
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Pisa, Italy
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Lavorini F, Fontana GA, Pantaleo T, Camiciottoli G, Castellani W, Maluccio NM, Pistolesi M. Fog-induced respiratory responses are attenuated by nedocromil sodium in humans. Am J Respir Crit Care Med 2001; 163:1117-20. [PMID: 11316646 DOI: 10.1164/ajrccm.163.5.2005046] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fog inhalation induces cough and bronchoconstriction in patients with asthma, but only cough in normal subjects; whether it also influences the pattern of breathing is unclear. Nedocromil sodium (NCS) inhibits the cough response to inhalation of several pharmacological agents but its effects on fog-induced cough and changes in the pattern of breathing are unknown. We evaluated the effects of no drug, placebo, and 4- and 8-mg NCS administration on the cough threshold and changes in the pattern of breathing during fog inhalation in 14 healthy subjects. Measurements of tidal volume (VT), duration of inspiratory and expiratory times (TI and TE, respectively), total duration of the respiratory cycle (TT), mean inspiratory flow (VT/TI), duty cycle (TI/TT), respiratory frequency (f, 60/TT), and inspiratory minute ventilation (V I) were obtained by inductive plethysmography. Median cough threshold values were unaffected by placebo, but were increased (p < 0.01) by both NCS doses. In no-drug and placebo trials, inhalation of the threshold fog concentration caused increases in both VT/TI and V I (p always < 0.05) due to selective increases (p < 0.01) in VT. These changes were markedly attenuated by both NCS doses administration. Thus, fog induces coughing and increases in VT, VT/ TI, and V I in healthy subjects; NCS possesses antitussive effects and attenuates fog-induced changes in the pattern of breathing, possibly through inhibition of rapidly adapting "irritant" receptors.
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Affiliation(s)
- F Lavorini
- Dipartimento di Area Critica Medico Chirurgica, Sezione di Medicina Respiratoria, Università di Firenze, Florence, Italy
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