Italian survey on prevalence and disease manage- ment of chronic heart failure and chronic obstru... more Italian survey on prevalence and disease manage- ment of chronic heart failure and chronic obstructive pulmonary disease comorbidity in ambulatory patients. SUSPIRIUM study rationale and design. R. Griffo, A. Spanevello, P.L. Temporelli, P. Faggiano, M. Carone, G. Magni, N. Ambrosino, L. Tavazzi and on behalf of the SUSPIRIUM Investigators. Background. Chronic heart failure (CHF) and chronic ob- structive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Through shared risk fac- tors and pathophysiological mechanisms, CHF and COPD fre- quently coexist. The concurrent disease has important thera- peutic implications and independently predicts worsened mor- tality, impaired functional status, and health service use. How- ever, assessment of the comorbidity varies widely according to the population studied, diagnostic criteria and measurement tools applied. Both syndromes have been studied extensively but largely separately, mostly in the domain of the p...
Mitochondrial DNA (MtDNA) has been studied as an expression of oxidative stress in asthma, COPD, ... more Mitochondrial DNA (MtDNA) has been studied as an expression of oxidative stress in asthma, COPD, lung cancer and obstructive sleep apnea, but it has been mainly investigated systemically, although the pathogenetic mechanisms begin in the airways and only later progress to systemic circulation. The aim of this study was to investigate the MtDNA alterations in the exhaled breath condensate (EBC) of patients with asthma, COPD and asthma-COPD overlap syndrome (ACOS). In order to analyze better what happens to mitochondria, both locally and systemically, we compared MtDNA/nDNA in blood and EBC of paired patients. Thirteen (13) COPD patients, 14 asthmatics, 23 ACOS (10 according to Spanish guidelines, 13 in line with GINA guidelines) and 12 healthy subjects were enrolled. Patients underwent clinical and functional diagnostic tests as foreseen by the guidelines. They underwent blood and EBC collection. Content of MtDNA and nuclear DNA (nDNA) was measured in the blood cells and EBC of patients by Real Time PCR. The ratio between MtDNA/nDNA was calculated. For the first time we were able to detect MtDNA/nDNA in the EBC. We found higher exhaled MtDNA/nDNA in COPD, asthmatic and ACOS patients respectively compared to healthy subjects (21.9 ± 4.9 versus 6.51 ± 0.21, p < 0.05; 7.9 ± 2.5 versus 6.51 ± 0.21, p = 0.06; 18.3 ± 3.4 versus 6.51 ± 0.21, p < 0.05). The level of exhaled MtDNA/nDNA was positively correlated with the plasmatic one. The levels of MtDNA/nDNA in the EBC, as expression of oxidative stress, are increased in COPD, asthmatic and ACOS patients compared to healthy subjects. These are preliminary results in a small number of well characterized patients that requires confirmation on a larger population. We support new studies directed toward the analysis of exhaled MtDNA/nDNA as a new exhaled non-invasive marker in other inflammatory/oxidative airways diseases.
The Maugeri Respiratory Failure questionnaire (MRF-28) is the first instrument specifically devel... more The Maugeri Respiratory Failure questionnaire (MRF-28) is the first instrument specifically developed for use with chronic respiratory failure (CRF) patients. The 28 items were selected using classical test theory. The purpose of the current analysis was to further refine the questionnaire using item response theory, specifically, the Rasch model analysis. Three hundred and seventeen CRF patients (mean aged 66.7 yrs; Male 219, Female 98) completed the MRF-28 health status measure. Data were collected through the self-report questionnaire and analyzed using 1-parameter logistic models by means of RUMM software. The 28-item questionnaire has good psychometric properties in terms of discriminant power because the Person Separation Index is 0.896. However, the item-trait interaction was not good as shown by the total-item Chi-square (chi(2)(112), p&amp;amp;lt;0.001). Removing two items that did not fit the Rasch model well, produced a minor improvement in Person Separation Index to 0.899 and the item-trait interaction improved (chi(2)(104), p = NS). In the preliminary analysis we identified 21 patients who were outliers; when they were excluded the distribution of the residuals, according to the Kolmogorov-Smirnov statistics, was normal and factor analysis of the item residuals showed that the components had similar eigenvalues and no strong correlation with items. These results suggest that the MRF-26 is a unidimensional measure of health-related quality of life impairment for chronic respiratory failure patients. A combination of classical psychometric tests and Rasch analysis produced an instrument of moderate size that covers a wide range of effects of CRF and has interval scaling properties.
ABSTRACT Inhaled long-acting bronchodilators (of beta(2)-agonist or muscarinic antagonist type) o... more ABSTRACT Inhaled long-acting bronchodilators (of beta(2)-agonist or muscarinic antagonist type) or corticosteroids are used in stable chronic obstructive pulmonary disease (COPD) treatment in a step-up approach according to disease severity. Consequently, in more severe disease triple therapy with two bronchodilators and an inhaled corticosteroid can often be encountered in clinical practice, but its short- and long-term effects on disease outcomes are not very well known. The results of a study evaluating the short-term effects of budesonide/formoterol (inhaled corticosteroid/inhaled long-acting beta2-agonist combination) and tiotropium (inhaled long-acting muscarinic antagonist) against tiotropium alone are analysed and discussed. On a short-term basis, triple therapy improves lung function, health status and disease morbidity irrespective of disease severity. Long-term benefits of triple inhaled therapy including the effects of its precocious use in less severe COPD subjects should be evaluated.
Italian survey on prevalence and disease manage- ment of chronic heart failure and chronic obstru... more Italian survey on prevalence and disease manage- ment of chronic heart failure and chronic obstructive pulmonary disease comorbidity in ambulatory patients. SUSPIRIUM study rationale and design. R. Griffo, A. Spanevello, P.L. Temporelli, P. Faggiano, M. Carone, G. Magni, N. Ambrosino, L. Tavazzi and on behalf of the SUSPIRIUM Investigators. Background. Chronic heart failure (CHF) and chronic ob- structive pulmonary disease (COPD) are leading causes of morbidity and mortality worldwide. Through shared risk fac- tors and pathophysiological mechanisms, CHF and COPD fre- quently coexist. The concurrent disease has important thera- peutic implications and independently predicts worsened mor- tality, impaired functional status, and health service use. How- ever, assessment of the comorbidity varies widely according to the population studied, diagnostic criteria and measurement tools applied. Both syndromes have been studied extensively but largely separately, mostly in the domain of the p...
Mitochondrial DNA (MtDNA) has been studied as an expression of oxidative stress in asthma, COPD, ... more Mitochondrial DNA (MtDNA) has been studied as an expression of oxidative stress in asthma, COPD, lung cancer and obstructive sleep apnea, but it has been mainly investigated systemically, although the pathogenetic mechanisms begin in the airways and only later progress to systemic circulation. The aim of this study was to investigate the MtDNA alterations in the exhaled breath condensate (EBC) of patients with asthma, COPD and asthma-COPD overlap syndrome (ACOS). In order to analyze better what happens to mitochondria, both locally and systemically, we compared MtDNA/nDNA in blood and EBC of paired patients. Thirteen (13) COPD patients, 14 asthmatics, 23 ACOS (10 according to Spanish guidelines, 13 in line with GINA guidelines) and 12 healthy subjects were enrolled. Patients underwent clinical and functional diagnostic tests as foreseen by the guidelines. They underwent blood and EBC collection. Content of MtDNA and nuclear DNA (nDNA) was measured in the blood cells and EBC of patients by Real Time PCR. The ratio between MtDNA/nDNA was calculated. For the first time we were able to detect MtDNA/nDNA in the EBC. We found higher exhaled MtDNA/nDNA in COPD, asthmatic and ACOS patients respectively compared to healthy subjects (21.9 ± 4.9 versus 6.51 ± 0.21, p < 0.05; 7.9 ± 2.5 versus 6.51 ± 0.21, p = 0.06; 18.3 ± 3.4 versus 6.51 ± 0.21, p < 0.05). The level of exhaled MtDNA/nDNA was positively correlated with the plasmatic one. The levels of MtDNA/nDNA in the EBC, as expression of oxidative stress, are increased in COPD, asthmatic and ACOS patients compared to healthy subjects. These are preliminary results in a small number of well characterized patients that requires confirmation on a larger population. We support new studies directed toward the analysis of exhaled MtDNA/nDNA as a new exhaled non-invasive marker in other inflammatory/oxidative airways diseases.
The Maugeri Respiratory Failure questionnaire (MRF-28) is the first instrument specifically devel... more The Maugeri Respiratory Failure questionnaire (MRF-28) is the first instrument specifically developed for use with chronic respiratory failure (CRF) patients. The 28 items were selected using classical test theory. The purpose of the current analysis was to further refine the questionnaire using item response theory, specifically, the Rasch model analysis. Three hundred and seventeen CRF patients (mean aged 66.7 yrs; Male 219, Female 98) completed the MRF-28 health status measure. Data were collected through the self-report questionnaire and analyzed using 1-parameter logistic models by means of RUMM software. The 28-item questionnaire has good psychometric properties in terms of discriminant power because the Person Separation Index is 0.896. However, the item-trait interaction was not good as shown by the total-item Chi-square (chi(2)(112), p&amp;amp;lt;0.001). Removing two items that did not fit the Rasch model well, produced a minor improvement in Person Separation Index to 0.899 and the item-trait interaction improved (chi(2)(104), p = NS). In the preliminary analysis we identified 21 patients who were outliers; when they were excluded the distribution of the residuals, according to the Kolmogorov-Smirnov statistics, was normal and factor analysis of the item residuals showed that the components had similar eigenvalues and no strong correlation with items. These results suggest that the MRF-26 is a unidimensional measure of health-related quality of life impairment for chronic respiratory failure patients. A combination of classical psychometric tests and Rasch analysis produced an instrument of moderate size that covers a wide range of effects of CRF and has interval scaling properties.
ABSTRACT Inhaled long-acting bronchodilators (of beta(2)-agonist or muscarinic antagonist type) o... more ABSTRACT Inhaled long-acting bronchodilators (of beta(2)-agonist or muscarinic antagonist type) or corticosteroids are used in stable chronic obstructive pulmonary disease (COPD) treatment in a step-up approach according to disease severity. Consequently, in more severe disease triple therapy with two bronchodilators and an inhaled corticosteroid can often be encountered in clinical practice, but its short- and long-term effects on disease outcomes are not very well known. The results of a study evaluating the short-term effects of budesonide/formoterol (inhaled corticosteroid/inhaled long-acting beta2-agonist combination) and tiotropium (inhaled long-acting muscarinic antagonist) against tiotropium alone are analysed and discussed. On a short-term basis, triple therapy improves lung function, health status and disease morbidity irrespective of disease severity. Long-term benefits of triple inhaled therapy including the effects of its precocious use in less severe COPD subjects should be evaluated.
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Papers by Mauro Carone