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Parisi G, Leonardi S, Ciprandi G, Corsico A, Licari A, Miraglia del Giudice M, Peroni D, Salpietro C, Marseglia G. Antihistamines in children and adolescents: A practical update. Allergol Immunopathol (Madr) 2020; 48:753-762. [PMID: 32448753 DOI: 10.1016/j.aller.2020.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 01/01/2023]
Abstract
Histamine is a chemical mediator, released predominantly by tissue mast cells, circulating basophils, and neurons, which are activated in response to various immunological and non-immunological stimuli. Histamine has to bind to specific receptors to exert its physiological and pathophysiological functions. Endogenous histamine is the main mediator of the immediate allergic response, which moreover, performs other multiple functions, including regulation of gastric secretion, neurotransmission in the central nervous system, and immunomodulatory activity. The involvement of histamine in various disorders and the importance of receptors in the clinical features have relevant implications in clinical practice. Anti-H1 antihistamines contrast the histamine-dependent effects, mainly concerning nasal symptoms and cutaneous itching and wheal. Antihistamines are among the most prescribed drugs in pediatric care. This review updates the practical use of antihistamines in children and adolescents.
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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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Milanese M, Terraneo S, Baiardini I, Di Marco F, Corsico A, Molino A, Scichilone N. Effects of a structured educational intervention in moderate-to-severe elderly asthmatic subjects. World Allergy Organ J 2019; 12:100040. [PMID: 31316712 PMCID: PMC6593309 DOI: 10.1016/j.waojou.2019.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/04/2019] [Accepted: 05/13/2019] [Indexed: 11/18/2022] Open
Abstract
Background Adherence to inhaled drugs is linked to patients’ satisfaction with their device, and an incorrect use can negatively affect the outcomes of asthma treatment. We speculated that this is particularly true in elderly asthmatic subjects. Aim We performed a national pre-post interventional multicentre study, enrolling moderate-to-severe asthmatic subjects aged ≥65 years treated with fixed inhaled combination drugs by dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Adherence and critical errors were evaluated by means of validated questionnaires at first visit (V1) and after 3–6 months (V2). At V1, subjects underwent intensive training on the correct use of their device by physical demonstration. Results A total of 411 asthmatics (F/M: 238/173, mean age±SD: 72 ± 5 years) participated to the study. At V1, 50% of the study subjects showed an Asthma Control Test (ACT) score ≤19 despite GINA step 3 and 4 treatment, and 40% had experienced at least one severe asthma exacerbation in the previous year. Poor adherence to treatment was recorded in 43% of subjects, and at least one error in using the device was registered in 56% of subjects. At V2, available for 318 patients, both the percentage of individuals with poor adherence and with at least one critical error significantly decreased (from 46% to 25%, and from 49% to 25%, respectively; p < 0.001 for both comparisons) with a significant increase of the ACT score (from 19 ± 4.9 to 20 ± 4.0, p < 0.001). Conclusions Asthma in the elderly is characterized by low levels of symptom control. Educational interventions are strongly advocated in this age group in order to increase adherence to treatment and inhaler techniques.
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Key Words
- ACT, asthma control test
- AHDS, hospital anxiety depression scale
- Asthma
- CFC, chlorofluorocarbons
- Device misuse
- EDUCA, elderly and device use in chronic asthma
- Education
- Elderly
- FEV1, forced expiratory volume 1s second
- FVC, forced vital capacity
- ICS, inhaled corticosteroids
- LABA, long-acting β2 agonist
- LAMA, long-acting muscarinic antagonists
- MCS, mental health composite score
- PCS, physical health composite score
- PROs, patient-reported outcomes
- SAE, severe asthma exacerbation
- SF12, short form health survey
- mMRC, modified medical research council
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Affiliation(s)
- M. Milanese
- Department of Medicine, Respiratory Unit, ASL2 Savonese, Savona, Italy
- Corresponding author.
| | - S. Terraneo
- Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - I. Baiardini
- Department of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCS San Martino, Genoa, Italy
| | - F. Di Marco
- Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A. Corsico
- Department of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
| | - A. Molino
- Department of Respiratory Diseases, Division of Pneumology, University of Naples Federico II, Napoli, Italy
| | - N. Scichilone
- Department of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - EDUCA GroupAlbiciniF.hBenfanteA.iBraidoF.jCaminatiM.kCostantinoM.T.lCottiniM.mCrivellaroM.nDe TullioR.oGiniE.pGrossoA.pGuarnieriG.qLombardiC.rPatellaV.sPirinaP.tPolverinoM.uRaccanelliR.vRidoloE.wRollaG.xSteinhilberG.yVianelloA.zDepartment of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, ItalyDepartment of Biomedicine and Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, ItalyDepartment of Internal Medicine, Respiratory Diseases and Allergy Clinic, University of Genova, Azienda Policlinico IRCCS San Martino, Genoa, ItalyUnità Operativa di Allergologia Azienda Ospedaliero-Universitaria Integrata di Verona, Verona, ItalyInternal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini, ItalyAllergy and Pneumology Outpatient Clinic, Bergamo, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyOspedale consorziale Policlinico di Bari, Unità di Pneumologia, Bari, ItalyDepartment of Internal Medicine and Therapeutics, Pneumology Unit, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyDepartmental Unit of Allergology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, ItalyUnità Operativa di Allergologia ed Immunologia, Dipartimento di Discipline Mediche, Battipaglia SA, ItalyDepartment of Clinical and Experimental Medicine, University of Sassari, Sassari, ItalyDepartment of Pneumology and Endoscopic Unit, Ospedale Scarlato, Scafati SA, ItalyFondazione Salvatore Maugeri, Istituto Scientifico di Milano, IRCCS, MilanoDepartment of Medicine and Surgery, University of Parma, Parma, ItalyAllergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, ItalyAO Spedali Civili di Brescia, Divisione di Pneumologia, Brescia, ItalyDepartment of Cardiologic, Thoracic, and Vascular Science, University of Padua, Padua, Italy
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Ghio S, Morsolini M, Corsico A, Klersy C, Mattiucci G, Raineri C, Scelsi L, Vistarini N, Oltrona Visconti L, D'Armini AM. Pulmonary arterial compliance and exercise capacity after pulmonary endarterectomy. Eur Respir J 2014; 43:1403-9. [DOI: 10.1183/09031936.00195313] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Braido F, Bagnasco D, Scichilone N, Santus P, Solidoro P, Di Marco F, Corsico A, Canonica GW. Biomarkers in obstructive respiratory diseases: an update. Panminerva Med 2012; 54:119-127. [PMID: 22525566] [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: 05/31/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation of the airways, with the involvement of many inflammatory cells and mediators. Traditionally, this inflammation is thought to spread to a systemic level, thus inducing damage of different organs. However, other pathogenetic mechanisms could take part to the above-described process, and some open questions need to be solved. Due to the burden and increasing prevalence of COPD, the opportunity to find biomarkers that can potentially be useful in identifying individuals with the disease, or better, prior to symptoms onset, to diagnose and properly manage the respiratory symptoms, as well as to evaluate the response to treatment and to select specific subtypes of patients for tailored treatments is strongly advocated. Several mediators, enzymes, hormones and cells have been claimed to adhere to this objective. Moreover, the presence of comorbid or concomitant diseases can variably influence the concentration of specific biomarkers in samples of individuals with COPD, and age-related functional and structural changes (inflammaging) can further confuse the biological pattern. Several observations have been performed in the last decades; nevertheless, no biomarker is currently considered as satisfying all the above-mentioned issues. The "Evaluation of COPD longitudinally to identify predictive surrogates and points (ECLIPSE)" study has specifically explored the possibility to identify novel biomarkers that correlate with clinically relevant COPD subtypes and with markers of disease progression. Among the thirty-four biomarkers considered, 15 resulted to be increased in COPD patients rather than in smoker and non-smoker controls. Specific lung proteins such as CC-16 and SPD are promising in detecting lung damage, exacerbation susceptibility or responsiveness to treatment. The ECLIPSE findings confirm that, to date, the use of a single biomarker is not sufficient, but the combination of novel biomarkers with the already existing tools could improve our skills in optimizing treatment of COPD patients.
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Affiliation(s)
- F Braido
- Allergy and Respiratory Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
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Surguladze SA, Elkin A, Ecker C, Kalidindi S, Corsico A, Giampietro V, Lawrence N, Deeley Q, Murphy DGM, Kucharska-Pietura K, Russell TA, McGuffin P, Murray R, Phillips ML. Genetic variation in the serotonin transporter modulates neural system-wide response to fearful faces. Genes Brain Behav 2008; 7:543-51. [PMID: 18266983 DOI: 10.1111/j.1601-183x.2008.00390.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A distributed, serotonergically innervated neural system comprising extrastriate cortex, amygdala and ventral prefrontal cortex is critical for identification of socially relevant emotive stimuli. The extent to which a genetic variation of serotonin transporter gene 5-HTTLPR impacts functional connectivity between the amygdala and the other components of this neural system remains little examined. In our study, neural activity was measured using event-related functional magnetic resonance imaging in 29 right-handed, white Caucasian healthy subjects as they viewed mild or prototypical fearful and neutral facial expressions. 5-HTTLPR genotype was classified as homozygous for the short allele (S/S), homozygous for the long allele (L/L) or heterozygous (S/L). S/S showed greater activity than L/L within right fusiform gyrus (FG) to prototypically fearful faces. To these fearful faces, S/S more than other genotype subgroups showed significantly greater positive functional connectivity between right amygdala and FG and between right FG and right ventrolateral prefrontal cortex (VLPFC). There was a positive association between measure of psychoticism and degree of functional connectivity between right FG and right VLPFC in response to prototypically fearful faces. Our data are the first to show that genotypic variation in 5-HTTLPR modulates both the amplitude within and the functional connectivity between different components of the visual object-processing neural system to emotionally salient stimuli. These effects may underlie the vulnerability to mood and anxiety disorders potentially triggered by socially salient, emotional cues in individuals with the S allele of 5-HTTLPR.
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Affiliation(s)
- S A Surguladze
- Institute of Psychiatry, King's College London, London, United Kingdom.
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Siroux V, Boudier A, Anto JM, Cazzoletti L, Accordini S, Alonso J, Cerveri I, Corsico A, Gulsvik A, Jarvis D, de Marco R, Marcon A, Marques EA, Bugiani M, Janson C, Leynaert B, Pin I. Quality-of-life and asthma-severity in general population asthmatics: results of the ECRHS II study. Allergy 2008; 63:547-54. [PMID: 18394129 DOI: 10.1111/j.1398-9995.2008.01638.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [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: 11/30/2022]
Abstract
BACKGROUND Health-related quality-of-life (HRQL) has been poorly studied in large samples of asthmatics from the general population. HRQL and its relationship to asthma-severity were assessed among 900 asthmatics enrolled in the European Community Respiratory Health Survey. METHODS Among asthmatics, 864 completed the short form-36 (SF-36) questionnaire and 477 also completed the Asthma Quality-of-life Questionnaire (AQLQ). A 4-class asthma-severity scale, combining clinical items, forced expiratory volume in 1 s and the level of treatment and the different asthma-severity components (each of the clinical items and hospitalization) were studied in relation to HRQL. RESULTS Mean SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores (45.5 and 48.8 respectively) were lower than expected in a general population. The mean total AQLQ score was 5.8. The AQLQ score and to a lesser extent the PCS score were significantly related to the 4-class asthma-severity scale, although the risk of having a lower HRQL score did not vary proportionally across the levels of severity. Asthma-severity had no impact on the MCS score. Asthma attack frequency and hospitalization were associated with both total AQLQ and PCS scores, whereas nocturnal symptoms and lung function were more strongly related to the AQLQ and PCS score respectively. CONCLUSION In population-based asthmatics, the specific AQLQ questionnaire, and also to a lesser extent the generic SF-36 questionnaire, were sensitive to asthma-severity. Frequencies of asthma attacks, of nocturnal symptoms and hospitalization for asthma have independent impact on HRQL.
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Accordini S, Corsico A, Cerveri I, Gislason D, Gulsvik A, Janson C, Jarvis D, Marcon A, Pin I, Vermeire P, Almar E, Bugiani M, Cazzoletti L, Duran-Tauleria E, Jõgi R, Marinoni A, Martínez-Moratalla J, Leynaert B, de Marco R. The socio-economic burden of asthma is substantial in Europe. Allergy 2008; 63:116-24. [PMID: 18053021 DOI: 10.1111/j.1398-9995.2007.01523.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [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: 11/30/2022]
Abstract
BACKGROUND Few data are available on the asthma burden in the general population. We evaluated the level and the factors associated with the asthma burden in Europe. METHODS In 1999-2002, 1152 adult asthmatics were identified in the European Community Respiratory Health Survey (ECRHS)-II and the socio-economic burden (reduced activity days and hospital services utilization in the past 12 months) was assessed. RESULTS The asthmatics with a light burden (only a few reduced activity days) were 13.2% (95% CI: 11.4-15.3%), whereas those with a heavy burden (many reduced activity days and/or hospital services utilization) were 14.0% (95% CI: 12.1-16.1%). The burden was strongly associated with disease severity and a lower quality of life. Obese asthmatics had a significantly increased risk of a light [relative risk ratio (RRR) = 2.17; 95% CI: 1.18-4.00] or a heavy burden (RRR = 2.77; 95% CI: 1.52-5.05) compared with normal/underweight subjects. The asthmatics with frequent respiratory symptoms showed a threefold (RRR = 2.74; 95% CI: 1.63-4.61) and sixfold (RRR = 5.76; 95% CI: 3.25-10.20) increased risk of a light or a heavy burden compared with asymptomatic asthmatics, respectively. Moreover, the lower the forced expiratory volume in 1 s % predicted, the higher the risk of a heavy burden. The coexistence with chronic cough/phlegm only increased the risk of a heavy burden (RRR = 1.88; 95% CI: 1.16-3.06). An interaction was found between gender and IgE sensitization, with nonatopic asthmatic females showing the highest risk of a heavy burden (21.6%; 95% CI: 16.9-27.1%). CONCLUSIONS The asthma burden is substantial in Europe. A heavy burden is more common in asthmatics with obesity, frequent respiratory symptoms, low lung function, chronic cough/phlegm and in nonatopic females.
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Affiliation(s)
- S Accordini
- Unit of Epidemiology and Medical Statistics, Department of Medicine and Public Health, University of Verona, Verona, Italy
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Janson C, de Marco R, Accordini S, Almar E, Bugiani M, Carolei A, Cazzoletti L, Cerveri I, Corsico A, Duran-Tauleria E, Gislason D, Gulsvik A, Jõgi R, Marinoni A, Martínez-Moratalla J, Pin I, Vermeire P, Jarvis D. Changes in the use of anti-asthmatic medication in an international cohort. Eur Respir J 2006; 26:1047-55. [PMID: 16319334 DOI: 10.1183/09031936.05.00031905] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to describe changes in pharmacotherapy for asthma since the early 1990s in an international cohort of young and middle-aged adults. A total of 28 centres from 14 countries participated in a longitudinal study. The study included 8,829 subjects with a mean follow-up time of 8.7 yrs. Change in the prevalence of use for medication was expressed as absolute net change (95% confidence interval) standardised to a 10-yr period. The use of anti-asthmatics was found to have increased by 3.1% (2.4-3.7%) and the prevalence of symptomatic asthma by 4.0% (3.5-4.5%). In the sample with asthma in both surveys (n=423), the use of inhaled corticosteroids increased by 12.2% (6.6-17.8%). Despite this, only 17.2% were using inhaled corticosteroids on a daily basis at follow-up. Females with continuous asthma were more likely, compared with males, and smokers with asthma, to have started using inhaled corticosteroids since the first survey. The use of anti-asthmatics has increased in a pattern consistent with current consensus on treatment. However, despite increased use of inhaled corticosteroids, a large majority of subjects with symptomatic asthma do not use this treatment on a daily basis, particularly males and smokers with asthma.
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Affiliation(s)
- C Janson
- Dept of Medical Sciences, Respiratory Medicine and Allergology, Akademiska sjukhuset, SE 751 85 Uppsala, Sweden.
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Bugiani M, Carosso A, Migliore E, Piccioni P, Corsico A, Olivieri M, Ferrari M, Pirina P, de Marco R. Allergic rhinitis and asthma comorbidity in a survey of young adults in Italy. Allergy 2005; 60:165-70. [PMID: 15647036 DOI: 10.1111/j.1398-9995.2005.00659.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [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: 11/29/2022]
Abstract
BACKGROUND Several studies have provided evidence of a strong association between asthma and allergic or nonallergic rhinitis, leading to the hypothesis that allergic rhinitis (AR) and asthma represent a continuum of the same disease. AIM THE AIMS OF OUR STUDY WERE (i) to measure the comorbidity of AR and asthma and asthma-like symptoms and (ii) to assess whether asthma, AR, and their coexistence share a common pattern of individual risk factors. METHODS The subjects are participants from the Italian multicentre, cross-sectional survey on respiratory symptoms in the young adult general population (Italian Study of Asthma in Young Adults, ISAYA). The relationship between individual risk factors and asthma, AR and their coexistence, was studied by means of a multinomial logistic regression. RESULTS About 60% of asthmatics reported AR. On the other hand, subjects with AR presented an eightfold risk of having asthma compared to subjects without AR. Age was negatively associated with asthma [OR = 0.89, 95% confidence interval (CI): 0.82-0.96], AR (OR = 0.92, 95% CI: 0.86-0.98), and asthma associated with AR (OR = 0.83, 95% CI: 0.79-0.88). The risk of AR without asthma was significantly higher in the upper social classes (OR = 1.23, 95% CI: 1.08-1.39). Active current smoking exposure was positively associated with asthma alone (OR = 1.24, 95% CI: 1.09-1.41) and negatively associated with AR with (OR = 0.69, 95% CI: 0.54-0.88) or without (OR = 0.76, 95% CI: 0.69-0.84) asthma. CONCLUSIONS Asthma and AR coexist in a substantial percentage of patients; bronchial asthma and AR, when associated, seem to share the same risk factors as AR alone while asthma without AR seems to be a different condition, at least with respect to some relevant risk factors.
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Affiliation(s)
- M Bugiani
- Unit of Pneumology NHS-CPA-ASL 4 Turin, Italy
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Eley TC, Sugden K, Corsico A, Gregory AM, Sham P, McGuffin P, Plomin R, Craig IW. Gene-environment interaction analysis of serotonin system markers with adolescent depression. Mol Psychiatry 2004; 9:908-15. [PMID: 15241435 DOI: 10.1038/sj.mp.4001546] [Citation(s) in RCA: 435] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report analyses from a study of gene-environment interaction in adolescent depression. The sample was selected from 1990 adolescents aged 10-20 years: those with depression symptoms in the top or bottom 15% were identified and divided into high or low environmental risk groups. DNA was obtained from 377 adolescents, representing the four quadrants of high or low depression and high or low environmental risk. Markers within, or close to, each of the serotonergic genes 5HTT, HTR2A, HTR2C, MAOA (monoamine oxidase type A) and tryptophan hydroxylase (TPH) were genotyped. Environmental risk group was a nonsignificant predictor and sex was a significant predictor of the depression group. HTR2A and TPH significantly predicted the depression group, independent of the effects of sex, environmental risk group and their interaction. In addition, there was a trend for an effect of 5HTTLPR, which was significant in female subjects. Furthermore, there was a significant genotype-environmental risk interaction for 5HTTLPR in female subjects only, with the effect being in the same direction as another recent study, reaffirming that an important source of genetic heterogeneity is exposure to environmental risk.
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Affiliation(s)
- T C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London SE5 8AF, UK.
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Beccaria M, Luisetti M, Rodi G, Corsico A, Zoia MC, Colato S, Pochetti P, Braschi A, Pozzi E, Cerveri I. Long-term durable benefit after whole lung lavage in pulmonary alveolar proteinosis. Eur Respir J 2004; 23:526-31. [PMID: 15083749 DOI: 10.1183/09031936.04.00102704] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [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: 11/05/2022]
Abstract
Whole lung lavage (WLL) is still the gold-standard therapy for pulmonary alveolar proteinosis (PAP). The few studies on the duration of the effect of WLL, belonging to a rather remote period, show significant but transient benefits. In 21 patients with idiopathic PAP, the duration of any benefit and, in 16 of them, the time course of lung function improvement (at baseline, 1 week, 6 months, 1 yr and then every 2 yrs after WLL) were evaluated. The present WLL technique takes longer, is invasively monitored and partially modified with respect to past techniques. More than 70% of patients remained free from recurrent PAP at 7 yrs. The bulk of the improvement in spirometric results was almost completely gained in the immediate post-WLL period due to the efficient clearance of the alveoli. At a median of 5 yrs, recovery of diffusing capacity of the lung for carbon monoxide was incomplete (75 +/- 19% of the predicted value) and there were residual gas exchange abnormalities (alveolar to arterial oxygen tension difference 3.6 +/- 1.5 kPa (27 +/- 11 mmHg)) and exercise limitation, probably explained by engorgement of lymphatic vessels. In conclusion, whole lung lavage for idiopathic pulmonary alveolar proteinosis is currently a safe procedure in an experienced setting, and provides long-lasting benefits in the majority of patients.
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Affiliation(s)
- M Beccaria
- Respiratory Diseases Division, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico S. Matteo, University of Pavia, Pavia, Italy.
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13
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de Marco R, Accordini S, Cerveri I, Corsico A, Sunyer J, Neukirch F, Künzli N, Leynaert B, Janson C, Gislason T, Vermeire P, Svanes C, Anto JM, Burney P. An international survey of chronic obstructive pulmonary disease in young adults according to GOLD stages. Thorax 2004; 59:120-5. [PMID: 14760151 PMCID: PMC1746950 DOI: 10.1136/thorax.2003.011163] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.0] [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: 11/03/2022]
Abstract
BACKGROUND The recently published GOLD guidelines provide a new system for staging chronic obstructive pulmonary disease (COPD) from mild (stage I) to very severe (stage IV) and introduce a stage 0 (chronic cough and phlegm without airflow obstruction) that includes subjects "at risk" of developing the disease. METHODS In order to assess the prevalence of GOLD stages of COPD in high income countries and to evaluate their association with the known risk factors for airflow obstruction, data from the European Community Respiratory Health Survey on more than 18,000 young adults (20-44 years) were analysed. RESULTS The overall prevalence was 11.8% (95% CI 11.3 to 12.3) for stage 0, 2.5% (95% CI 2.2 to 2.7) for stage I, and 1.1% (95% CI 1.0 to 1.3) for stages II-III. Moderate to heavy smoking (> or =15 pack years) was significantly associated with both stage 0 (relative risk ratio (RRR)=4.15; 95% CI 3.55 to 4.84) and stages I+ (RRR=4.09; 95% CI 3.17 to 5.26), while subjects with stages I+ COPD had a higher likelihood of giving up smoking (RRR=1.39; 95% CI 1.04 to 1.86) than those with GOLD stage 0 (RRR=1.05; 95% CI 0.86 to 1.27). Environmental tobacco smoke had the same degree of positive association in both groups. Respiratory infections in childhood and low socioeconomic class were significantly and homogeneously associated with both groups, whereas occupational exposure was significantly associated only with stage 0. All the GOLD stages showed a significantly higher percentage of healthcare resource users than healthy subjects (p<0.001), with no difference between stage 0 and COPD. CONCLUSIONS A considerable percentage of young adults already suffered from COPD. GOLD stage 0 was characterised by the presence of the same risk factors as COPD and by the same high demand for medical assistance.
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Affiliation(s)
- R de Marco
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
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14
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Zanolin ME, Pattaro C, Corsico A, Bugiani M, Carrozzi L, Casali L, Dallari R, Ferrari M, Marinoni A, Migliore E, Olivieri M, Pirina P, Verlato G, Villani S, Marco R. The role of climate on the geographic variability of asthma, allergic rhinitis and respiratory symptoms: results from the Italian study of asthma in young adults. Allergy 2004; 59:306-14. [PMID: 14982513 DOI: 10.1046/j.1398-9995.2003.00391.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [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: 11/20/2022]
Abstract
BACKGROUND Variations in the prevalence of respiratory symptoms according to geo-climatic factors could provide important clues to the knowledge of the aetiology of asthma. METHODS Geo-climatic variations in the prevalence of current asthma, allergic rhinitis and chronic cough, and phlegm were assessed on a random sample of 18 873 subjects (response rate = 72.7%) from different climatic regions of Italy. An ecological analysis, supported by robust statistical methods, was employed to investigate potential trends. RESULTS The prevalence of all symptoms was significantly heterogeneous throughout the peninsula. Only asthma-like symptoms showed a north-south trend: the prevalence increased at a decreasing latitude [odds ratio (OR) varies from 0.92 to 0.96, P < 0.05], at a decreasing distance from the sea (OR: 0.90-0.93 for 30 km distance, P < 0.05), at higher annual mean temperatures (OR: 1.11-1.14, P < 0.05) and at smaller annual temperature ranges (OR: 0.94-0.95, P < 0.05). Of the geo-climatic variables considered, temperature range had the greatest influence on most asthma-like symptoms. No association was found between geo-climatic variables and allergic rhinitis or chronic cough and phlegm. CONCLUSIONS Asthma prevalence seems to be significantly affected by climate as asthma-like symptoms were more common in central-southern Italy, with a Mediterranean climate, than in areas with a continental climate (northern Italy).
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Affiliation(s)
- M E Zanolin
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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15
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Cerveri I, Accordini S, Corsico A, Zoia MC, Carrozzi L, Cazzoletti L, Beccaria M, Marinoni A, Viegi G, de Marco R. Chronic cough and phlegm in young adults. Eur Respir J 2004; 22:413-7. [PMID: 14516128 DOI: 10.1183/09031936.03.00121103] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines underline that the presence of chronic cough and sputum production before airflow obstruction offers a unique opportunity to identify subjects at risk of chronic obstructive pulmonary disease for an early intervention. Current epidemiological data on these subjects are scant. Between 1998-2000, the authors evaluated the prevalence and characteristics of these symptoms by a multicentre cross-sectional survey of Italian people aged between 20-44 yrs from the general population (Italian Study on Asthma in Young Adults (ISAYA)). Besides the questions on asthma, more than 18,000 subjects answered the question: "Have you had cough and phlegm on most days for as much as 3 months per year and for at least two successive years?" The adjusted prevalence of subjects with chronic cough and phlegm was 11.9%, being 11.8% in males and 12.0% in females. From these subjects approximately 20% reported coexisting asthma and approximately 30%, predominately females, were nonsmokers. The survey showed that sex (female), smoking and low socioeconomic status were significantly and independently associated with chronic cough and phlegm, current smoking playing the major role. The prevalence of subjects with chronic cough and phlegm is startlingly high among young adults. Further follow-up studies are needed to establish how many of them will go on to develop chronic obstructive pulmonary disease.
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Affiliation(s)
- I Cerveri
- Division of Respiratory Diseases, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
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16
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Abstract
BACKGROUND Italian data on the prevalence of allergic rhinitis are sparse and with wide variations, maybe because of different diagnostic criteria and methods of investigation. This study analyzes the information on rhinitis collected in northern Italy through standardized methods within the European Community Respiratory Health Survey. METHODS A screening questionnaire was sent by mail to a random sample of the general population aged 20-44 years, and nonresponders were contacted again by phone, achieving a final response rate of 86% (6031/7000). Among the responders, 914 randomly selected underwent a standardized clinical interview, skin prick test (SPT) and total and specific immunoglobulin (Ig)E determination. RESULTS The overall prevalence of self-reported allergic rhinitis was 15.9% (95% CI 15.0-16.8%). Allergic rhinitis was more common in men below 35 years and in women older than that (P = 0.006), in urban areas (P < 0.001) and in early responders (P < 0.001). A larger percentage of subjects (37.7%) reported nasal symptoms when exposed to indoor or outdoor allergens. Atopy was present in 79% of the subjects reporting allergic rhinitis. CONCLUSIONS This study demonstrates that the prevalence of allergic rhinitis in northern Italy is similar to the prevalence observed in other European countries and that this disease is more common in urban areas.
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Affiliation(s)
- M Olivieri
- Servizio de Medicina del Lavoro, Dipartimento di Medicina e Sanità Pubblica, Università de Verona, Italy
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Zoia MC, D'Armini AM, Beccaria M, Corsico A, Fulgoni P, Klersy C, Piovella F, Viganò M, Cerveri I. Mid term effects of pulmonary thromboendarterectomy on clinical and cardiopulmonary function status. Thorax 2002; 57:608-12. [PMID: 12096204 PMCID: PMC1746368 DOI: 10.1136/thorax.57.7.608] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [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: 11/04/2022]
Abstract
BACKGROUND Chronic thromboembolic pulmonary hypertension (CTEPH) can be successfully treated surgically by pulmonary thromboendarterectomy (PTE) but there are few data on mid-term cardiopulmonary function, particularly on exertion, and clinical benefits following pulmonary PTE. METHODS A 2 year follow up study was undertaken of clinical status, haemodynamic and lung function indices, gas exchange, and exercise tolerance in 38 patients of mean (SD) age 50 (15) years who had undergone PTE. RESULTS In-hospital mortality was about 10%. Before PTE all the patients were severely impaired (NYHA classes III-IV). There was no time difference in the improvement in the parameters: nearly all the improvement in cardiac output, gas exchange, and clinical status was achieved in the first 3 months as a result of the relief of pulmonary obstruction. At 3 months the percentage of patients with normal cardiac output and PaO(2) and of those with reduced clinical impairment increased to 97%, 59%, and 87%, respectively, without any further change. Only mean pulmonary artery pressure (mPAP), carbon monoxide transfer factor (TLCO), and exercise tolerance improved gradually during the second year, probably due to the recovery of the damaged small vessels. TLCO was overestimated before PTE but afterwards the trend was similar to that of mPAP. CONCLUSIONS At mid term only a few patients did not have a satisfactory recovery because of lack of operative success, hypertension relapse, or the effect of preoperative hypertension on vessels in non-obstructed segments. Most of the patients, even the more compromised ones, had excellent long lasting results.
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Affiliation(s)
- M C Zoia
- Clinic of Respiratory Diseases, IRCCS San Matteo Hospital, University of Pavia, Italy
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Abstract
OBJECTIVE To present an overview on current progress and future directions in psychiatric genetics. METHODS The review of studies that have demonstrated a genetic contribution to a wide range of psychopathology using family, twin, adoption studies and exploration of the methods and limitations of molecular genetic studies. RESULTS Single gene disorders has been the area that is most straightforward with striking advances in disorders such as Huntington Disease and early onset familial Alzheimer disease. Complex phenotypes such as schizophrenia and affective disorder have presented greater difficulties but late onset Alzheimer disease and dyslexia are examples where replicated molecular genetic findings suggest that gene identification is feasible even for multifactorial disorders. CONCLUSION The combination of increasingly complete information on the genome together with accessibility to this on the internet provide the essential tools for the search for susceptibility genes. Another essential requirement in trying to identify genes of small effect is well characterized large scale collections of cases and this demands the interaction of epidemiological and clinical researchers. Advances in genomics will also allow tailoring of pharmaceuticals pointing at treatment response and side effects. Hopefully all this perspectives together, will improve our understanding of the neurobiological pathogenesis of diseases such as Schizophrenia, Depression and Bipolar disorder 'legitimizing' them in the public view.
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Affiliation(s)
- A Corsico
- Social Genetic and Developmental Psychiatry (SGDP) Research Centre, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
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Beccaria M, Corsico A, Fulgoni P, Zoia MC, Casali L, Orlandoni G, Cerveri I. Lung cancer resection: the prediction of postsurgical outcomes should include long-term functional results. Chest 2001; 120:37-42. [PMID: 11451813 DOI: 10.1378/chest.120.1.37] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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 To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (O(2)max) as a criterion for operability and as a predictor of long-term disability. DESIGN Prospective study. SETTING Outpatients and inpatients of a university hospital. PARTICIPANTS Sixty-two consecutive patients (mean +/- SD age, 62 +/- 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). MEASUREMENTS Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV(1) (ppoFEV(1)) was < 40%, patients underwent exercise testing; if O(2)max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. RESULTS All the patients with ppoFEV(1) > or = 40%-even those patients (26%) with FEV(1) < 80%-underwent thoracotomy without further tests. Seven patients with ppoFEV(1) < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV(1) > or = 40%. ppoFEV(1) significantly underestimated the actual postoperative FEV(1) (poFEV(1); p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV(1) after lobectomy. Two patients with predicted postoperative O(2)max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. CONCLUSIONS ppoFEV(1) > or = 40% reliably identifies patients not requiring further tests and not at long-term risk of respiratory disability. O(2)max, effective for defining the immediate surgical risk, is not useful in predicting long-term disability.
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Affiliation(s)
- M Beccaria
- Clinic of Respiratory Diseases, University of Pavia-IRCCS, Policlinico "S.Matteo", Pavia, Italy
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Cerveri I, Accordini S, Verlato G, Corsico A, Zoia MC, Casali L, Burney P, de Marco R. Variations in the prevalence across countries of chronic bronchitis and smoking habits in young adults. Eur Respir J 2001; 18:85-92. [PMID: 11510810 DOI: 10.1183/09031936.01.00087101] [Citation(s) in RCA: 97] [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: 11/05/2022]
Abstract
The present work aims to assess the international variation in the prevalence of chronic bronchitis and its main risk factor, smoking habits, in young adults of 35 centres from 16 countries. Respiratory symptoms and pulmonary function were assessed in 17,966 subjects (20-44 yrs), randomly selected from the general population, in the frame of the European Community Respiratory Health Survey. The median prevalence of chronic bronchitis was 2.6%, with wide variations across countries (p<0.001; 0.7-9.7%). The prevalence of current smokers ranged 20.1-56.9%, (p<0.001) with a median value of 40%. Current smoking was the major risk factor for chronic bronchitis, especially in males. Its effect increased according to number of pack-yrs: in males, the odds ratio of chronic bronchitis was 3.51 (95% confidence interval (CI) 2.31-5.32) in 1-14 pack-yrs smokers and increased to 17.32 (9.97-30.11) in > or = 45 pack-yrs smokers with respect to nonsmokers. Only 30% of the geographical variability in prevalence could be explained by differences in smoking habits, suggesting that other environmental and/or genetic factors may play an important role. In conclusion, chronic bronchitis is a substantial health problem even in young adults. The impressive prevalence in current smokers in most countries highlights the need to improve the quality of prevention.
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Affiliation(s)
- I Cerveri
- Institute of Respiratory Disease, IRCCS Policlinico S. Matteo, University of Pavia, Italy
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21
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Marzo A, Monti NC, Tettamanti RA, Crivelli F, Dal Bo L, Mazzucchelli P, Meoli A, Pezzuto D, Corsico A. Bioequivalence of inhaled formoterol fumarate assessed from pharmacodynamic, safety and urinary pharmacokinetic data. Arzneimittelforschung 2000; 50:559-63. [PMID: 10918951 DOI: 10.1055/s-0031-1300249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This paper deals with a crossover trial on healthy volunteers performed to obtain combined pharmacodynamic, safety and pharmacokinetic data in order to assess the bioequivalence of formoterol fumarate (CAS 43229-80-7) delivered by mono-dose dry powder inhalers, as test and reference. The trial was carried out on 24 Caucasian healthy male and female volunteers treated with 12 micrograms formoterol fumarate bihydrate capsules for inhalation route. Pharmacodynamics was evaluated through a challenge test with methacholine on the forced expiratory volume in 1 s (FEV1). Safety was achieved from glucose and potassium serum levels assayed on timed samples over a 12-h period cost-dosing and from blood pressure, heart rate and ECG recording. Pharmacokinetics was obtained from urinary excretion of formoterol, assessed by a highly sensitive analytical method (LC-MS-MS). Pharmacodynamic, safety and pharmacokinetic results evidenced the bioequivalence of the two formulations investigated. This investigation is an interesting approach how to assess bioequivalence when the classical approach based on the similarity of plasma concentrations can not be applied.
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Affiliation(s)
- A Marzo
- IPAS SA, Institute for Pharmacokientic and Analytical Studies, Ligornetto, Switzerland.
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22
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Cerveri I, Pellegrino R, Dore R, Corsico A, Fulgoni P, van de Woestijne KP, Brusasco V. Mechanisms for isolated volume response to a bronchodilator in patients with COPD. J Appl Physiol (1985) 2000; 88:1989-95. [PMID: 10846010 DOI: 10.1152/jappl.2000.88.6.1989] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [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: 11/22/2022] Open
Abstract
We hypothesized that an altered effect of lung inflation on airway caliber may in part explain the isolated volume response to bronchodilators, i.e., an increase of forced vital capacity (FVC) without change in 1-s forced expiratory volume (FEV(1)). Small-airway caliber was measured by high-resolution computed tomography at functional residual capacity and total lung capacity in five chronic obstructive pulmonary disease patients with an isolated increase of FVC (FVC responders) and five with an increase of both FVC and FEV(1) (FVC-FEV(1) responders) after inhalation of salbutamol. In FVC-FEV(1) responders, the airway diameter increased with the cube root of increase in lung volume but was unchanged or even decreased in four of five FVC responders. FVC responders had more severe emphysema, as inferred from lung function and imaging studies, than FVC-FEV(1) responders. We speculate that longitudinal traction or space competition (Verbeken EK, Cauberghs M, and Van de Woestijne KP, J Appl Physiol 81: 2468-2480, 1996) are possible underlying mechanisms. We conclude that the isolated volume response to bronchodilators is associated with severe emphysema and likely results from an altered effect of lung inflation on airway caliber.
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Affiliation(s)
- I Cerveri
- Clinica di Malattie dell' Apparato Respiratorio and Istituto di Radiologia Medica, Istituo di Recovero e Cura a Carattere Scientifico, Pavia, Italy
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Corsico A, Pellegrino R, Zoia MC, Barbano L, Brusasco V, Cerveri I. Effects of inhaled steroids on methacholine-induced bronchoconstriction and gas trapping in mild asthma. Eur Respir J 2000; 15:687-92. [PMID: 10780760 DOI: 10.1034/j.1399-3003.2000.15d11.x] [Citation(s) in RCA: 23] [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: 12/17/2022]
Abstract
According to a recent hypothesis, airway smooth muscle regulates airway calibre mostly at high lung volume, whereas the mucosa and adventitia dimensions dominate at low lung volumes. It was thought that if inhaled steroids decrease the thickness of airway wall in asthma, then forced vital capacity (FVC), which reflects the functional changes at low lung volume, should decrease less during induced bronchoconstriction than flow at high volume. The study was conducted in 31 mild asthmatics under control conditions and during a methacholine challenge before and after 4-weeks treatment with inhaled fluticasone dipropionate (1.5 mg daily, 16 patients) or placebo (15 patients). After fluticasone dipropionate treatment, control forced expiratory volume in one second (FEV1), and maximal flow at 50% of control FVC during forced expiration after a maximal (V'max,50) and a partial inspiration (V'p,50) significantly increased. During methacholine challenge, FVC decreased less than did FEV1 or V'max,50, and so did inspiratory vital capacity compared to V'p,50. Both the provocative dose of methacholine causing a 20% fall in FEV1 and the bronchodilator effect of deep inhalation significantly increased. The latter was assessed by means of the regression coefficient of all V'max,50 plotted against V'p,50. No significant changes in these parameters occurred after placebo. These data show that inhaled steroids remarkably blunt the occurrence of gas trapping during induced bronchoconstriction in mild bronchial asthma, possibly due to their effect on airway wall remodelling.
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Affiliation(s)
- A Corsico
- Clinica di Malattie dell'Apparato Respiratorio, IRCCS Policlinico S. Matteo, Pavia, Italy
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Beluffi G, Corsico A, Peroni R, De Giacomo C. [An ulcer of the pyloric canal in a nursing infant]. Radiol Med 2000; 99:288-9. [PMID: 10884834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- G Beluffi
- Sezione di Radiologia Pediatrica, IRCCS Policlinico S. Matteo, Pavia
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Abstract
STUDY OBJECTIVES To evaluate lung function in patients cured from childhood acute lymphoblastic leukemia (ALL) with chemotherapy alone or plus bone marrow transplantation (BMT). Pulmonary toxicity is a well-recognized side effect of many ALL treatments. DESIGN Cross-sectional study conducted at least 3 years after cessation of therapy. SETTING Outpatient pneumology department of the University Hospital. PATIENTS Forty-four subjects (age range at observation, 6 to 23 years): 21 treated only with intensive Berlin-Frankfurt-Munster (BFM)-type chemotherapy for newly diagnosed ALL (group A), and 23 treated with chemotherapy plus BMT (group B). MEASUREMENTS A detailed history of smoking habit, respiratory symptoms, and diseases was recorded directly from the patients with the aid of their parents. A complete physical examination and lung function testing (lung volumes and diffusion capacity for carbon monoxide [DLCO]) were performed in all subjects. RESULTS No patient reported acute or chronic respiratory symptoms or diseases. In group A patients, lung function was in the normal range, except for three subjects in whom there was an isolated impairment of DLCO. In group B patients, lung function was markedly impaired, with more than half the patients having an abnormal DLCO. A statistically significant difference was found between the two groups for FVC (p = 0.022) and DLCO (p = 0.004). CONCLUSIONS Intensive, BFM-type frontline chemotherapy is not associated with late pulmonary dysfunction; however, retreatment including BMT can frequently injure the lung. Thus, in patients who undergo BMT and whose life expectancy is long, careful monitoring of lung function and counseling about avoiding additional lung risk factors is recommended.
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Affiliation(s)
- P Fulgoni
- Institute of Respiratory Diseases, IRCCS Policlinico "S. Matteo," University of Pavia, Italy
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Cerveri I, Locatelli F, Zoia MC, Corsico A, Accordini S, de Marco R. International variations in asthma treatment compliance: the results of the European Community Respiratory Health Survey (ECRHS). Eur Respir J 1999; 14:288-94. [PMID: 10515403 DOI: 10.1034/j.1399-3003.1999.14b09.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [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: 11/23/2022]
Abstract
Noncompliance to medication is a major barrier to effective asthma management. Its real extent and geographical variation throughout the world are not yet known. The data on compliance, collected in the framework of the European Community Respiratory Health Survey (ECRHS) on 1771 subjects (aged 20-44 yrs) with current asthma identified in 14 countries, offer a unique opportunity to assess the extent of noncompliance and its variation across countries. The median percentage of current asthmatics who had received a medical prescription at least once was 95%. The compliance of those patients who had received a medical prescription was found to be low in all countries (median 67%) but with wide variations, the rate ranging from 40% (USA) to 78% (Iceland). During exacerbations patients' rate of compliance increased to 72%. Age was the only variable which influenced compliance to treatment. A significant, although weak, negative correlation was found between patients' compliance and rate of hospital casualty department or emergency room admissions. This study documents that compliance to the treatment of asthma is poor worldwide and that there are large variations between countries. These results emphasize the necessity for further efforts to improve patients' education and to promulgate the international guidelines.
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Affiliation(s)
- I Cerveri
- Institute of Respiratory Diseases, IRCCS S. Matteo, University of Pavia, Italy
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Cerveri I, Zoia MC, Fulgoni P, Corsico A, Casali L, Tinelli C, Zecca M, Giorgiani G, Locatelli F. Late pulmonary sequelae after childhood bone marrow transplantation. Thorax 1999; 54:131-5. [PMID: 10325917 PMCID: PMC1745418 DOI: 10.1136/thx.54.2.131] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [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: 11/04/2022]
Abstract
BACKGROUND Respiratory function in transplanted children is important because of the long life expectancy of bone marrow transplant recipients, particularly children. Attention is now being focused on the late sequelae of treatment on organ system function. A few papers have been published but available data are somewhat conflicting. METHODS A cross sectional study aimed at evaluating the late effects of transplantation on lung function was performed in a group of 52 young patients who were given autologous or allogeneic bone marrow transplants during childhood for haematological malignancies. RESULTS No patients reported chronic respiratory symptoms. The distribution of respiratory function patterns showed that only 62% of patients had respiratory function within the normal limits; 23% had a restrictive pattern and 15% had isolated transfer factor impairment. The percentage of patients with lung function abnormalities was higher in those who (1) received a bone marrow transplant after two or three complete remissions compared with those who were transplanted immediately after the first remission (54% vs 21%; p < 0.02), (2) underwent allogeneic bone marrow transplantation rather than an autologous transplantation (45% vs 26%; p = 0.06), and (3) had a pulmonary infection compared with those without (56% vs 26%; p = 0.07). CONCLUSIONS In spite of the absence of chronic respiratory symptoms there is a high prevalence of children with late pulmonary sequelae after bone marrow transplantation. Regular testing is recommended after transplantation, in particular in subjects at higher risk of lung injuries, such as those receiving transplants after more than one remission, those receiving allogeneic transplants, and those having suffered from pulmonary infections. When lung function abnormalities become apparent, long term follow up is necessary to see whether they become clinically relevant. All patients should remain non-smokers after transplantation and should have active early and aggressive treatment for respiratory illnesses.
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Affiliation(s)
- I Cerveri
- Institute of Respiratory Diseases, University of Pavia, Italy
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Beluffi G, Corsico A, Peroni R, Fiori P. [Disk battery as nasal foreign body in a boy]. Radiol Med 1998; 96:104-6. [PMID: 9819629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- G Beluffi
- Sezione di Radiologia Pediatrica, IRCCS Policlinico San Matteo, Pavia
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Zoia MC, Corsico A, Fulgoni P, Spagnolatti L, Volpini E, Barbano L. Prediction of FEV1 reductions in patients undergoing pulmonary resection. Monaldi Arch Chest Dis 1998; 53:259-61. [PMID: 9785807] [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: 02/09/2023] Open
Abstract
In the assessment of functional operability of lung cancer the simple calculation of predicted postoperative forced expiratory volume in one second (ppoFEV1) based on the number of the bronchopulmonary segments removed, has recently been found to underestimate the actual postoperative forced expiratory volume in one second (FEV1). We checked whether this could be accounted for by lesions causing uneven ventilation or perfusion. We performed a retrospective study of 12 patients with atelectasis, hilar disease or endobronchial involvement (Group A) versus 24 patients with peripheral lung cancer (Group B). Baseline and postoperative FEV1 were measured and ppoFEV1 and ppoFEV1/actual postoperative FEV1 were calculated. In all subjects in Group A ppoFEV1 grossly underestimated the measured postoperative FEV1 (mean (SD) ratio between the two parameters: 67.0 (12.1)%). In Group B, ppoFEV1 was almost identical to the measured value in all but three patients, in whom it only slightly underestimated the actual postoperative value (mean ratio between the two parameters: 94.9 (12.6) %). In conclusion, predicted postoperative forced expiratory volume in one second is useful in the preoperative assessment of patients undergoing lung resection for lesions other than those causing uneven ventilation or perfusion. When this condition is suspected, before declaring a given case ineligible for surgery or at high risk of complications, more sophisticated procedures, such as radionuclide perfusion studies, should be performed.
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Affiliation(s)
- M C Zoia
- Institute of Respiratory Diseases IRCCS Policlinico S. Matteo, University of Pavia, Italy
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Abstract
A multicentre survey of prevalence, determinants and management of asthma (the European Community Respiratory Health Survey (ECRHS)) has shown that the ratio of subjects declaring current use of antiasthmatic drugs to those reporting asthma attacks in the previous 12 months was particularly low (0.54) in the north of Italy. In this study, we used a standardized clinical interview to gather a more detailed insight into the issue of asthma undertreatment in the north of Italy. A total of 1,104 subjects were interviewed, 116 of whom had been defined as asthmatic by the family doctor. Fifty subjects had current asthma and 66 had a history of previous asthma. A considerable percentage (26%) of subjects with current asthma were not being treated with antiasthmatic therapy. Even when only patients with severe asthma were considered, the percentage of untreated patients was still high (21%). Forty two per cent of subjects used inhaled beta2-agonists alone, 28% inhaled steroids plus beta2-agonists, 2% inhaled steroids alone and 2% other drugs. Only 19% of the asthmatics on treatment, 85% of whom had more severe asthma, received daily treatment. Only 65% of the subjects who had received antiasthmatic drug prescriptions declared they had taken all the drugs prescribed; this percentage was 74% when respiratory symptoms were worsening. Of the patients with past asthma, 18% had taken antiasthmatic drugs. Most of these patients were those who had had more severe asthma. In conclusion, antiasthmatic drugs are underused in the north of Italy, at least in part due to low compliance.
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Affiliation(s)
- I Cerveri
- Istituto di Malattie Respiratoire, Università di Pavia, IRCCS S. Matteo, Italy
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Spagnolatti L, Zoia MC, Volpini E, Convertino G, Fulgoni P, Corsico A, Vitulo P, Cerveri I. Pulmonary function in patients with systemic sclerosis. Monaldi Arch Chest Dis 1997; 52:4-8. [PMID: 9151512] [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: 02/04/2023] Open
Abstract
The lungs are frequently affected in systemic sclerosis (SSc), a generalized connective tissue disorder. We evaluated the prevalence of respiratory functional abnormalities and their correlation with symptoms and radiograph features in a group of 34 patients who fulfilled the American Rheumatism Association criteria for the diagnosis of systemic sclerosis. Patients were submitted to a specific respiratory questionnaire and to lung function tests. Measurements were performed according to the European Coal and Steel Community (ECSC) recommendations and results expressed as a SD score, an accurate method that, taking into account the dispersion of the parameters in the reference population, allows precise definition of pathological subjects. Of the patients examined, 38% reported dyspnoea at rest or on exertion. No other respiratory symptoms were reported. Fifty percent had a normal chest radiograph. This study documents the high prevalence of respiratory functional abnormalities in patients with SSc. A restrictive pattern was found in 41% and an isolated diffusion impairment in 18%. No significant relationship was found between the isolated impairment of transfer factor of the lungs for carbon monoxide (TL,CO) and the mean duration of the scleroderma: thus, it does not seem to represent an early sign of severe restrictive disease. No bronchial or bronchiolar obstructive patterns were observed: it can be stated that small airways dysfunction is not a characteristic manifestation of SSc as considered previously. A significant association was found between the group of subjects with chest radiographic abnormalities and that with a restrictive pattern or isolated TL,CO alteration (p = 0.018). Chest radiographic abnormalities were also found in 29% and dyspnoea in 35% of the patients with normal respiratory function. The mean duration of scleroderma was not significantly different between the groups with and without abnormalities on chest radiography, between the groups with and without a restrictive pattern or isolated diffusion impairment, and between the groups of patients with and without dyspnoea. In conclusion, an accurate evaluation of respiratory function is recommended in the assessment of patients with systemic sclerosis, since the functional involvement of the lung cannot be predicted on the basis of the chest radiograph and the respiratory symptoms.
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Affiliation(s)
- L Spagnolatti
- Institute of Respiratory Disease, University of Pavia, IRCCS Policlinico San Matteo, Italy
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Bossi G, Cerveri I, Volpini E, Corsico A, Baio A, Corbella F, Klersy C, Arico M. Long-term pulmonary sequelae after treatment of childhood Hodgkin's disease. Ann Oncol 1997; 8 Suppl 1:19-24. [PMID: 9187424] [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: 02/04/2023] Open
Abstract
BACKGROUND Pulmonary sequelae have been reported in patients treated for Hodgkin's disease (HD). Few data are available about patients treated for childhood HD followed over several years. PATIENTS AND METHODS In a cross-sectional study carried out for 76 months (median time) after treatment completion, we evaluated the lung function abnormalities and respiratory symptoms in 27 patients (16 males and 11 females) with HD diagnosed between 1983 and 1994 (median age at diagnosis 11 years, range 2-16 years). They had been treated with chemotherapy and radiotherapy according to current protocol AIEOP-MH 83 (n = 14) or AIEOP-MH 89 (n = 13). At the time of the study, 26 patients were in first complete remission and one in second remission. Of the 27 patients, 19 had had mediastinal irradiation at a dose of 20 Gy (n = 5) or 20.8-44 Gy (n = 14). Forced vital capacity (FVC), functional residual capacity (FRC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, and maximal expiratory flow at 25% of FVC were registered; diffusion capacity for carbon monoxide (DLCO) was determined. Data were expressed as standard deviation (SD) score. Four patterns of respiratory function abnormalities were defined: restrictive, obstructive, isolated bronchiolar impairment, isolated diffusing impairment. RESULTS Twelve patients (44%) were asymptomatic and showed completely normal pulmonary function tests. Three patients reported dyspnea on exertion, and one of them also cough and phelgm: out of these symptomatic subjects, only 1 had functional abnormality (isolated DLCO impairment). A restrictive pattern was found in 5 patients (18%), including 2 who also had a pathological DLCO SD score. Eight additional patients (30%) had isolated diffusing impairment. Oxygen saturation was normal in all patients. Forty-seven percent of patients with normal DLCO had had lower dose irradiation (20 Gy) compared to 10% of patients with impaired DLCO (P = 0.054). Similarly, patients with normal DLCO had had significantly less chemotherapy as compared to patients with abnormal DLCO (P = 0.003). Occurrence of lung abnormalities was not significantly associated with sex, age at treatment, mediastinal irradiation, and time elapsed from treatment completion. CONCLUSION Adolescents and young adults treated for childhood HD are at risk for lung function abnormalities, significantly more frequent in patients who received more intense treatment, as mediastinal irradiation at a higher dose (> 20 Gy) and more chemotherapy blocks. Long-term follow-up should be offered to these patients because of their possible limited potential for pulmonary function and possible lesser resistance to adverse agents such as smoke, pollution, infections and aging.
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Affiliation(s)
- G Bossi
- Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Italy
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Bossi G, Cerveri I, Volpini E, Corsico A, Baio A, Corbella F, Klersy C, Arico M. Long-term pulmonary sequelae after treatment of childhood Hodgkin's disease. Ann Oncol 1997. [DOI: 10.1093/annonc/8.suppl_1.s19] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moscato G, Niniano R, Corsico A, Cretti L, Colli MC, Perfetti L, Bianchi P. Patients' interest in educational programmes on asthma. Monaldi Arch Chest Dis 1995; 50:319-22. [PMID: 7550211] [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: 01/25/2023] Open
Abstract
The compliance of patients in educational programmes on asthma is sometimes lacking and this may be due in part to patients' scarce interest or refusal to expand their knowledge of the disease. In the present study, we aimed to evaluate the interest of a group of asthmatic patients in education on asthma and to point out the asthma-related topics considered particularly worth discussing. The study was conducted before starting the educational programme. Sixty adult patients with mild-to-moderate asthma were asked to complete a questionnaire, including a group of 14 questions aimed at evaluating the level of patients' interest in various asthma-related topics, one question regarding patients' willingness to attend a small-group educational course on asthma, and a further question asking patients to suggest topics of particular interest for discussion. For each of the first 14 questions, patients indicated their level of interest according to a score ranging 1-3. The sum of the scores obtained for each topic (partial score) and the sum of partial scores (total score) were calculated and classified into three classes of interest (I: low, II: medium; III: high), and the distribution of patients into the three classes was analysed (chi-squared test).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Moscato
- School of Allergology and Clinical Immunology, University of Pavia, Italy
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Affiliation(s)
- G L Rossi
- School of Allergology and Clinical Immunology, University of Pavia, Italy
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Moscato G, Dellabianca A, Corsico A, Biscaldi G, Gherson G, Vinci G. Bronchial responsiveness to ultrasonic fog in occupational asthma due to toluene diisocyanate. Chest 1993; 104:1127-32. [PMID: 8404179 DOI: 10.1378/chest.104.4.1127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 01/30/2023] Open
Abstract
To determine the validity of ultrasonic nebulization of distilled water (UNDW, "fog") in comparison with methacholine challenge, in the assessment of toluene diisocyanate (TDI) asthma, we evaluated 75 subjects exposed to TDI with work-related respiratory symptoms. Subjects were submitted to bronchial challenge with methacholine at first, thereafter to UNDW inhalation and to specific challenge with TDI. The diagnosis of TDI-asthma was made in 30 of 75 patients (40 percent) who developed a bronchoconstrictive response to the specific challenge (reactors). Sensitivity and specificity of UNDW alone, methacholine alone, and of the combination of the two tests were determined with the results of the specific challenge with TDI as the "gold standard." Both frequency and severity of bronchoconstrictive response to UNDW (FEV1 decrease > or = 15 percent) and the degree (PD15 FEV1) and frequency of bronchial hyperresponsiveness to methacholine were significantly higher in TDI reactors than in nonreactors. The UNDW had higher specificity (82.2 percent vs 51.1 percent) but lower sensitivity (40 percent vs 76.7 percent) than methacholine. The combination in parallel (positivity of any of the two challenges) of methacholine and UNDW challenge did not change sensitivity to a great extent (80 percent vs 76.7 percent), whereas combination in series (positivity of both challenges) had considerably greater specificity (86.7 percent vs 51.1 percent) than methacholine alone. We conclude that in the assessment of TDI-asthma, the validity of UNDW challenge alone is limited since it is insufficiently sensitive. Instead, combining UNDW and methacholine challenge when methacholine is positive improves our ability in identifying subjects with TDI-asthma diagnosed with the specific challenge. This procedure constitutes a first objective confirmation of a suggestive history of TDI-asthma that is useful for clinical purposes. However, especially for medicolegal purposes, the definitive diagnosis requires the specific challenge.
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Affiliation(s)
- G Moscato
- Specalization School of Allergology and Clinical Immunology, University of Pavia, Italy
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Rossi GL, Corsico A, Roggeri A, Moscato G. Human health and air conditioning systems. G Ital Med Lav 1991; 13:51-4. [PMID: 1845458] [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: 12/29/2022]
Abstract
In air-conditioned buildings indoor air quality is closely dependent on the efficiency of air-conditioning and humidifier systems since these systems provide a suitable environment for the proliferation of microorganisms. Pollutants released by microorganisms are termed 'bioaerosols' and may be spread in the indoor environment through the air-conditioning system. Moreover, the tightening of the buildings in which central air-conditioning systems are usually located increases the levels of indoor pollutants. Both hypersensitivity and infectious diseases are associated with bioaerosol exposure, whereas the sick building syndrome (a complex of symptoms described among workers in modern office buildings which are hermetically sealed and mechanically ventilated) is very unlikely to have a bioaerosol component.
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Affiliation(s)
- G L Rossi
- Postgraduate School of Allergology and Clinical Immunology, University of Pavia
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