- He is Medical Director of Mondo Medico, Multidisciplinary and Rehabilitation Clinic, Borgomanero (NO). From 1985 to 2... moreHe is Medical Director of Mondo Medico, Multidisciplinary and Rehabilitation Clinic, Borgomanero (NO). From 1985 to 2006 he was Chief of the Division of Pulmonary Disease, Scientific Institute of Veruno, “Salvatore Maugeri" Foundation, Italy. From 1999 to 2001 he was Director of the Department of Pulmonary Rehabilitative Medicine of the "Salvatore Maugeri" Foundation throughout Italy.He was President (1995-1997) of the Italian Association of Hospital Pulmonologists (AIPO).he was Secretary General of the European Respiratory Society (ERS) for the period 1998-2004 He was President (2003-2012), of the Italian Interdisciplinary Association for Research in Lung Disease (AIMAR), and he From September 2013 he is president of the non-profit Italian Foundation “ Mondo Respiro, Centro Studi per le Malattie Respiratorie ,Onlus”.edit
Asthma is a chronic disease and should be treated with both controller and reliever drugs. Asthma controller therapy is not used sufficiently widely, probably due to low compliance with inhaled drugs, lack of response in some patients to... more
Asthma is a chronic disease and should be treated with both controller and reliever drugs. Asthma controller therapy is not used sufficiently widely, probably due to low compliance with inhaled drugs, lack of response in some patients to low-medium doses of inhaled steroids and possible adverse events. This review analyses a new class of antiasthmatic drugs, leukotriene receptor antagonists (antileukotrienes). At present, two antileukotrienes are available in Italy: zafirlukast and montelukast. Antileukotrienes improve symptoms and also inhibit the effects of some of the inflammatory mediators involved in the pathogenesis of asthma; therefore, antileukotrienes may be used in monotherapy. In addition, the oral administration route is an advantage for compliance. Antileukotrienes significantly improve pulmonary function, asthma symptoms and inhaled and oral steroid and short-acting beta 2-agonist use. Moreover, antileukotrienes produce a 50% mean reduction in the incidence of asthma exacerbations compared with placebo. From the economic point of view, asthma controller therapy using antileukotrienes is associated with a > 50% (compared with placebo) reduction in healthcare costs (hospitalization due to asthma exacerbation, healthcare contact and absenteeism from work or school), which globally account for 93% of asthma-related costs. Antileukotrienes are indicated in the treatment of persistent mild-to-severe asthma, seasonal allergic asthma, exercise-induced asthma and aspirin-induced asthma. Antileukotrienes are well tolerated independently of the duration of treatment and the incidence of the observed adverse events is substantially similar to that observed using placebo. Owing to good tolerability and compliance and the economic advantages, these agents may be considered a valid therapeutic option for the control and management of asthma as a chronic disease.
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... Project. S. Nardini, MD 1 , F. De Benedetto, MD 2 , CF Donner, MD 3 and CM Sanguinetti, MD 4 . on behalf of the Italian ... Italy; 3 Mondo Medico, Borgomanero, NO, Italy and 4 UOC Pneumologia, ACO San Filippo Neri, Roma, Italy. ...
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Between January 1989 and February 1993, 52 patients were evaluated at Niguarda Hospital for lung or heart and lung transplantation. Of the 35 that entered the waiting list, a total of 19 were transplanted (14 at other institutes before... more
Between January 1989 and February 1993, 52 patients were evaluated at Niguarda Hospital for lung or heart and lung transplantation. Of the 35 that entered the waiting list, a total of 19 were transplanted (14 at other institutes before our surgical programme became operative, and 5 at our hospital). Recipient selection and evaluation criteria, and timing of transplantation in the different diseases are discussed.
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Intensive care unit (ICU) management of patients on partial ventilatory support is very costly. We opened an intermediate respiratory care unit (RCU), with the aim of providing cost beneficial in-hospital and home care for patients who... more
Intensive care unit (ICU) management of patients on partial ventilatory support is very costly. We opened an intermediate respiratory care unit (RCU), with the aim of providing cost beneficial in-hospital and home care for patients who require mechanical ventilation for at least 8 h.day-1. Prior to admission to an intermediate RCU, it is mandatory to take into consideration not only the patient's overall health status but also his or her prognosis, and rehabilitation chances and environmental factors have to be evaluated.
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ABSTRACT
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... S. Nardini, MD 1 , R. Boffi, MD 2 , S. Conte, MD 1 , F. De Benedetto, MD 3 , CF Donner, MD 4 , CM Sanguinetti, MD 5 , A. ... Annunziata, Chieti, Italy; 4 Mondo Medico, Borgomanero, NO, Italy; 5 UOC Pneumologia, ACO San Filippo Neri,... more
... S. Nardini, MD 1 , R. Boffi, MD 2 , S. Conte, MD 1 , F. De Benedetto, MD 3 , CF Donner, MD 4 , CM Sanguinetti, MD 5 , A. ... Annunziata, Chieti, Italy; 4 Mondo Medico, Borgomanero, NO, Italy; 5 UOC Pneumologia, ACO San Filippo Neri, Roma, Italy and ...
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The adequate control of asthma includes the absence of nocturnal symptoms, minimal use of medication, normal or nearly normal lung function and no limitations to physical activity. The choice of a more sedentary lifestyle can lead to... more
The adequate control of asthma includes the absence of nocturnal symptoms, minimal use of medication, normal or nearly normal lung function and no limitations to physical activity. The choice of a more sedentary lifestyle can lead to physical de-conditioning, thereby aggravating asthma symptoms and increasing the risk of obesity. This study aimed at performing a battery of function-related assessments in patients with asthma and comparing them to a healthy control group. A prospective, transversal and case-control study was designed. It was set up at Santa Casa de Misericórdia Hospital -Sao Paulo and Nove de Julho University on a population of outpatients. Subjects of the study were patients affected by moderate to severe asthma. A case-control study was carried out involving 20 patients with moderate to severe asthma and 15 healthy individuals (control group). All participants underwent body composition analysis (BMI and BIA) and a controlled walk test (Shuttle test), resistance mu...
The main complaint of patients with chronic obstructive pulmonary disease (COPD) is shortness of breath with exercise, that is usually progressive. The principal mechanism that explains this symptom is the development of lung... more
The main complaint of patients with chronic obstructive pulmonary disease (COPD) is shortness of breath with exercise, that is usually progressive. The principal mechanism that explains this symptom is the development of lung hyperinflation (LH) which is defined by an increase of functional residual capacity (FRC) above predicted values. Patients with COPD may develop static LH (sLH) because of destruction of pulmonary parenchyma and loss of elastic recoil. In addition, dynamic LH (dLH) develops when patients with COPD breathe in before achieving a full exhalation and, as a consequence, air is trapped within the lungs with each further breath. Dynamic LH may also occur at rest but it becomes clinically relevant during exercise and exacerbation. Lung hyperinflation may have an impact beyond the lungs and the effects of LH on cardiovascular function have been extensively analysed. The importance of LH makes its identification and measurement crucial. The demonstration of LH in COPD leads to the adoption of strategies to minimise its impact on the daily activities of patients. Several strategies reduce the impact of LH; the use of long-acting bronchodilators has been shown to reduce LH and improve exercise capacity. Non pharmacologic interventions have also been demonstrated to be useful. This article describes the pathophysiology of LH, its impact on the lungs and beyond and reviews the strategies that improve LH in COPD.
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The management of patients with complex forms of bronchial asthma and COPD is not usually addressed in the major international guidelines and management documents which exclusively address pure forms. AIMAR thus undertook a survey to... more
The management of patients with complex forms of bronchial asthma and COPD is not usually addressed in the major international guidelines and management documents which exclusively address pure forms. AIMAR thus undertook a survey to obtain information about: a) the perceived frequency of complex forms of asthma/COPD in adult patients and in the elderly; b) patient management regarding the complex forms (focus on therapeutic goals and consequent treatment); c) the management problems perceived in diagnosis, management, monitoring, indices of appropriateness in pharmacological treatment and adherence to treatment. The survey consisted of 18 multiple choice questions, completed by means of a web-based electronic form published in internet. All the data and responses inserted in the system were checked on-line for coherence and completeness directly during the phase of insertion and each participant had one only possibility of participating. The data thus collected were memorized direc...
The Italian Costs for Exacerbations in COPD ("ICE") study, following a pharmacoeconomic assessment of costs due to COPD exacerbations (primary endpoint), aimed also at evaluating (secondary endpoint) which clinical factors,... more
The Italian Costs for Exacerbations in COPD ("ICE") study, following a pharmacoeconomic assessment of costs due to COPD exacerbations (primary endpoint), aimed also at evaluating (secondary endpoint) which clinical factors, among those considered for cost-analysis, may, at follow up, present a risk of new exacerbations and re-admission to hospital. A prospective, multicentre study was carried out on COPD patients admitted to 25 Hospital Centres as a result of an exacerbation from October-December 2002. Following discharge, a 6-month follow-up was performed in each patient via three bi-monthly telephone interviews with a questionnaire administered by an investigator clinician. 570 patients were eligible for data processing, mean age 70.6 years (+/- 9.5 standard deviation, SD), males 69.2%. According to GOLD, severity stratification was as follows: moderate 36.4%; severe 31.3%; very severe 32.3%. 282 patients experienced at least one exacerbation at follow up, 42% of exacerb...
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Community-Acquired Pneumonia (CAP) is still a significant problem in terms of incidence, mortality rate, particularly in infants and the elderly, and socioeconomic burden. General Practitioners (GPs) are the first reference for patients... more
Community-Acquired Pneumonia (CAP) is still a significant problem in terms of incidence, mortality rate, particularly in infants and the elderly, and socioeconomic burden. General Practitioners (GPs) are the first reference for patients with this disease, but there are few published studies regarding the outpatient treatment of CAP. The ISOCAP study aimed to identify the type and outcome of the diagnostic-therapeutic management of CAP by GPs in Italy, within the framework of developing a closer interrelationship between GPs and pulmonary specialists. Thirty-six Pulmonary Divisions throughout Italy each contacted 5 local GPs who agreed to recruit the first 5 consecutive patients who consulted them for suspected CAP within the study's 1-year observation period. A total of 183 GPs took part in the study and enrolled, by the end of the observation period, 763 CAP patients; of these, complete data was available for 737 patients [males=373, females=364, mean age (+/- SD) 58.8 +/- 19.6...
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The interest in measuring HS or QoL in patients with respiratory diseases has increased progressively over the last decade, but only recently has it been applied to patients with more severe disease (ie, patients with CRF who are... more
The interest in measuring HS or QoL in patients with respiratory diseases has increased progressively over the last decade, but only recently has it been applied to patients with more severe disease (ie, patients with CRF who are receiving LTOT or NIPPV). The impact of CRF on the daily life and well being of patients can be measured in a number of different ways. There is evidence, however, that it is not possible to predict patients' health from surrogate measures (eg, spirometry or exercise performance) and that the size of the health gain following treatments or interventions cannot be predicted from changes in physiologic measurements. Adequate assessments of HS can be measured directly only through the use of valid and reliable QoL questionnaires. A range of different instruments is available in the literature. The SGRQ and MRF28 have been shown to be applicable and reliable in patients on long-term ventilation.
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1) to evaluate the long-term efficacy of nocturnal IPPV either via tracheostomy (tIPPV) or a nasal mask (nIPPV) as a means to improve alveolar ventilation in patients with chronic severe hypercapnia caused by kyphoscoliosis; and 2) to... more
1) to evaluate the long-term efficacy of nocturnal IPPV either via tracheostomy (tIPPV) or a nasal mask (nIPPV) as a means to improve alveolar ventilation in patients with chronic severe hypercapnia caused by kyphoscoliosis; and 2) to assess the effect of MV on hospitalizations and life-style. Twenty six patients with kyphoscoliosis in chronic respiratory failure were enrolled in the study. Patients were divided into two groups. The first group comprised 13 subjects who had been clinically stable for at least 1 month (arterial carbon dioxide tension (Pa,CO2) 81 +/- 1.5 kPa (60.8 +/- 10.9 mmHg), arterial oxygen tension (Pa,O2) 7.3 +/- 0.8 kPa (54.6 +/- 6.1 mmHg)). The second group comprised 13 patients who were either suffering or recovering from an episode of acute respiratory insufficiency (Pa,CO2 9.0 +/- 1.8 kPa (67.8 +/- 13.3 mmHg), Pa,O2 6.8 +/- 1.1 kPa (51.2 +/- 8.2 mmHg), breathing supplemental oxygen in seven cases). Patients in the first group were treated with nocturnal IPP...
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Ambroxol is a mucus-modifying drug with a known ability to stimulate surfactant secretion and inhibit, in vitro, the production of proinflammatory cytokines, neutrophil chemotaxis, and Na+ absorption by the airway epithelium. In dogs... more
Ambroxol is a mucus-modifying drug with a known ability to stimulate surfactant secretion and inhibit, in vitro, the production of proinflammatory cytokines, neutrophil chemotaxis, and Na+ absorption by the airway epithelium. In dogs inhaling ozone, bronchial hyperreactivity can be inhibited by aerosolized Ambroxol. To verify the possibility of producing anti-inflammatory effects in a clinically relevant condition, 20 patients with chronic bronchitis, randomly divided into two balanced matched groups, were submitted to a 14 day trial with Ambroxol, 150 mg.day-1, or placebo, according to a double-blind design. A bronchoalveolar lavage (BAL) was performed the day before starting treatment (T0) and at the 14th day (T14). The analysis of the cellular and soluble (total proteins, albumin, immunoglobulin G and A (IgG and IgA)) BAL components demonstrated no clear modifications. In particular, neutrophil values from the bronchial aliquot showed a large dispersion, with no significant diffe...
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The short-term protective effect on exercise-induced asthma (EIA) and the duration of action of formoterol, given by metered dose aerosol at a dose of 24 micrograms, were compared with salbutamol (200 micrograms) and placebo in twelve... more
The short-term protective effect on exercise-induced asthma (EIA) and the duration of action of formoterol, given by metered dose aerosol at a dose of 24 micrograms, were compared with salbutamol (200 micrograms) and placebo in twelve asthmatic EIA-positive patients in a double-blind, placebo-controlled, three period cross-over study. On each treatment day the patients were given one of the drugs or placebo and two exercise tests were performed at the second and at the eighth hour after dosing. Using a standard procedure, exercise was performed by treadmill in well-controlled environmental conditions. In the first test at 2 h a significant difference relative to placebo (p less than 0.001) at each incremental time after exercise (i.e. 5, 10, 15, 20, 30 min) was obtained with both formoterol and salbutamol, without any significant difference between formoterol and salbutamol. After the eighth hour test formoterol still protected against EIA in comparison to both salbutamol and placeb...
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Research Interests: Respiratory Medicine, Humans, Chronic Disease, Female, Male, and 17 morePseudomonas, Staphylococcus aureus, Risk factors, Respiratory Failure, Pseudomonas aeruginosa, Clinical Sciences, Aged, Middle Aged, Neuromuscular Disease, Adult, Serratia marcescens, Respiratory Tract Infections, Chronic obstructive pulmonary disease, Tracheostomy, Risk Factors, Pseudomonas Aeruginosa, and Immunoglobulin
Oxidative stress caused by airway inflammation is increased in chronic obstructive pulmonary disease (COPD) and may account for the progressive deterioration of structure and function of the respiratory tract observed in this disease.... more
Oxidative stress caused by airway inflammation is increased in chronic obstructive pulmonary disease (COPD) and may account for the progressive deterioration of structure and function of the respiratory tract observed in this disease. Antioxidant defences of the respiratory tract may be overwhelmed by the oxidant burden in COPD and possibly restored with antioxidant therapy. The level of hydrogen peroxide (H(2)O(2)) concentration in exhaled air condensate (EAC) is a valuable tool for assessing and monitoring oxidative stress. This study aimed to verify the effect of 2-month oral N-acetylcysteine (NAC) treatment compared to placebo on the H(2)O(2) content in EAC of 55 clinically stable COPD patients (48 males), mean age 65.93+/-9.3 years. After clinical examination, pulmonary function tests, and collection of EAC for the basal (T0) assay of H(2)O(2), patients were randomly allocated to group A (usual therapy plus oral NAC 600 mg b.i.d. for 2 months) or group B (usual therapy plus placebo b.i.d. for 2 months). H(2)O(2) assay in EAC was repeated at 15 (T15), 30 (T30), and 60 (T60) days after the start of therapy in each group. All patients were non-smokers or ex smokers for at least 5 years and the two groups were comparable in terms of demographic, respiratory function, and EAC data at baseline. The H(2)O(2) level in EAC of group A was significantly decreased at T15 (1.00+/-0.38 SD microM; p=0.003), T30 (0.91+/-0.44 microM; p=0.007), and T60 (0.83+/-0.41 microM; p=0.000) compared to T0 (1.28+/-0.61 microM). No significant decrease in H(2)O(2) of group B was found at any time point. We conclude that oral NAC 600 mg b.i.d. for 2 months rapidly reduces the oxidant burden in airways of stable COPD patients.
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Chronic obstructive pulmonary disease (COPD) is an important public health issue in many countries which is estimated to become the fifth cause of disability and the third cause of mortality in the world within 2020.The objective of this... more
Chronic obstructive pulmonary disease (COPD) is an important public health issue in many countries which is estimated to become the fifth cause of disability and the third cause of mortality in the world within 2020.The objective of this study was to identify the clinical characteristics in the real clinical practice of a sample of patients with COPD followed in a pulmonology clinic. The initial sample contained 207 subjects with respiratory claims that searched for specialized treatment and initiated regular monitoring between 2004 and 2009 in a private clinic localized in Cascavel, in the state of Parana, Brazil. Demographic data (weight, height, body mass index - BMI), history of comorbidities, use of respiratory and non respiratory drugs were also registered. The main cause related to the development of COPD was current or prior smoking (92.0%); the most frequently reported symptom was dyspnea (95.0%), followed by cough (86.1%), wheezing (69.4%) and sputum production (40.0%). Du...
The multicomponent nature of chronic obstructive pulmonary disease (COPD) has provided a challenging environment in which to develop successful treatments. A combination of pharmacological and non-pharmacological approaches is used to... more
The multicomponent nature of chronic obstructive pulmonary disease (COPD) has provided a challenging environment in which to develop successful treatments. A combination of pharmacological and non-pharmacological approaches is used to combat this problem, and an overview of these approaches and their possible future direction is given. Bronchodilators are the mainstay of COPD treatment and can be combined with inhaled corticosteroids for greater efficacy and fewer side effects. A new generation of pharmacotherapeutic agents, most notably phosphodiesterase-4 inhibitors, which are already in the advanced stages of clinical development, and leukotriene B4 inhibitors (in early clinical development), may shape future treatment as further insight is gained into the pathological mechanisms underlying COPD. Non-pharmacologic treatments for COPD include long-term oxygen therapy (LTOT), nasal positive pressure ventilation (nPPV), pulmonary rehabilitation and lung-volume-reduction surgery (LVRS). Apart from smoking cessation, LTOT is the only treatment to date which has been shown to modify survival rates in severe cases; thus its role in COPD is well defined. The roles of nPPV and LVRS are less clear, though recent progress is reported here. In the future, it will be important to establish the precise value of the different treatments available for COPD--evaluating both clinical and physiological endpoints and using the data to more accurately define candidate patients accordingly. The challenge will be to develop this base of knowledge in order to shape future research and allow clinicians to deliver tailored COPD management programmes for the growing number of patients afflicted with this disease.
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Formoterol action may decrease progressively after its inhalation. It is unknown if this decrease of bronchodilation following formoterol use could be associated with worsening hyperinflation. To investigate whether the use of an extra... more
Formoterol action may decrease progressively after its inhalation. It is unknown if this decrease of bronchodilation following formoterol use could be associated with worsening hyperinflation. To investigate whether the use of an extra daily dose of formoterol could promote a greater reduction in lung hyperinflation and a greater improvement in inspiratory capacity (IC) compared to usual doses. 56 hyperinflated COPD patients were divided into two groups: F2 and F3. Basal evaluation was carried out after 5 days of formoterol washout. In order to evaluate the acute effect, spirometry and body plethysmography were performed 8 h after the first formoterol dose in both groups and repeated 1 h after an additional formoterol dose (F3) or placebo (F2). The short-term effect was evaluated by measuring the resting lung function after a 14-day period of formoterol t.i.d. (F3) or formoterol b.i.d. + placebo (F2). A second formoterol dose inhaled 8 h after the previous dose promoted additional improvements in lung function, as demonstrated by higher IC (118 ± 140 mL, p < 0.001) and lower functional residual capacity (FRC) (-383 ± 367 mL, p < 0.001). On day 15, the mean differences from baseline regarding all lung function variables were similar between the groups. An extra daily dose of formoterol inhaled 8 h after a previous dose could result in an acute additional peak of bronchodilation. However, short-term formoterol t.i.d. showed no advantages over formoterol b.i.d. concerning reduction of hyperinflation in resting lung function.
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Interstitial lung disease (ILD) can determine severe lung function impairment both at rest and during exercise. Usually, resting measurements of lung and cardiac function give enough information on the degree of the disease. Thus,... more
Interstitial lung disease (ILD) can determine severe lung function impairment both at rest and during exercise. Usually, resting measurements of lung and cardiac function give enough information on the degree of the disease. Thus, exercise testing should be reserved only for particular situations such as presence at the same time of cardiac and respiratory involvement, symptomatic patients with normal spirometry, and to check the response to therapy. A better understanding of the pathophysiology and cardiorespiratory consequences of ILD can give an important contribution in improving methods of exercise testing to assess disability. In this perspective, we analyze the factors limiting exercise performance: the progressive hypoxemia that appears or is worsened by exertion; the ventilatory abnormalities that lead to a rapid shallow breathing pattern with a VE that reach the MVV; and the cardiovascular limitation with low maximum heart rate, low cardiac output and high PVR and PAP.
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The aim of this study was to develop a specific and valid questionnaire for Italian COPD patients, living on the north or the south of Italy-which are two culturally distinct areas. The project consisted in three steps: (1) initial item... more
The aim of this study was to develop a specific and valid questionnaire for Italian COPD patients, living on the north or the south of Italy-which are two culturally distinct areas. The project consisted in three steps: (1) initial item set generation to identify items relevant to both genders, all ages and both regions; (2) item reduction including tests of regional specificity; (3) tests of internal validity using item-response theory using Rasch one-parameter modelling. Ninty-six COPD patients (mean aged 69 yr; 78 Male) completed the original set of 124 items of the Italian Health Status Questionnaire (IHSQ). Item reduction was carried out using an established standardised approach employing classical psychometric test theory. The internal construct validity of the 47 items that survived this process were tested to determine whether they constituted a unidimensional construct "impaired health due to COPD" using Rasch analysis. This showed that the questionnaire had very...
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/ Thematic Poster Session / Sunday, May 16/8:15 AM-4:00 ... PM / Area J, Hall G (First Level), Morial Convention Center ... Airway Wall Thickness Correlates With Smoking History, Lung Function And Bronchodilator Response In COPD ... , HO... more
/ Thematic Poster Session / Sunday, May 16/8:15 AM-4:00 ... PM / Area J, Hall G (First Level), Morial Convention Center ... Airway Wall Thickness Correlates With Smoking History, Lung Function And Bronchodilator Response In COPD ... , HO Coxson , S. Pillai ...
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Summary HERMES is a project to promote better "Harmonised education and training in Respiratory Medicine for European Specialists". The first aim of the project was to devel- op a European core syllabus... more
Summary HERMES is a project to promote better "Harmonised education and training in Respiratory Medicine for European Specialists". The first aim of the project was to devel- op a European core syllabus listing core competencies that all respiratory specialists should possess. This report presents the resulting consensus-based document. A total of 50 experts in respiratory medicine from 29 countries took