Rassegna di Patologia dell'Apparato Respiratorio, Aug 6, 2021
L’ossido nitrico (NO) e una molecola gassosa che funge da mediatore chiave in numerosi processi f... more L’ossido nitrico (NO) e una molecola gassosa che funge da mediatore chiave in numerosi processi fisiologici fondamentali per il nostro organismo. Dalla scoperta della presenza dell’NO nell’esalato umano, ad opera di Gustafsson e collaboratori nel 1991, la ricerca in questo ambito si e notevolmente evoluta fino ad identificarlo come possibile marcatore diagnostico per le malattie dell’apparato respiratorio ed in particolare per l’asma. La procedura di misurazione della concentrazione frazionale dell’NO esalato (FeNO) e stata definita e standardizzata in un documento congiunto dell’American Thoracic Society (ATS) e della European Respiratory Society (ERS) e ad oggi rappresenta una metodologia non invasiva che consente di determinare l’infiammazione delle vie aeree. Nell’asma la misurazione del FeNO correla con altri marcatori di infiammazione di tipo T2, quali gli eosinofili del sangue e dell’espettorato ed insieme ad essi viene utilizzato per descrivere diversi fenotipi di asma. Sono stati identificati valori soglia di FeNO per adulti e bambini asmatici, che possono indicare la mancata aderenza del paziente al trattamento, una possibile risposta positiva al trattamento con corticosteroidi inalatori (ICS) e suggerire la necessita di iniziare un trattamento con ICS. Inoltre essendo il FeNO marcatore di infiammazione T2, esso puo predire una risposta positiva al trattamento con biologici. In asmatici gravi trattati con alte dosi di ICS, FeNO ≥ 25ppb rappresenta un indicatore di efficacia terapeutica del dupilumab. L’utilizzo dei valori di FeNO nello studio di altre patologie come la broncopneumopatia cronica ostruttiva (BPCO) e la bronchite eosinofila non asmatica appare ancora controverso, sebbene studi ne abbiano mostrato una buona attendibilita.
European Journal of Clinical Investigation, Nov 1, 2002
Paranasal sinuses and the nose are important sources of nitric oxide (NO) in humans but the relev... more Paranasal sinuses and the nose are important sources of nitric oxide (NO) in humans but the relevance of NO production to the control of nasal airway plasma exudation and its response to inflammatory mediators such as platelet-activating factor (PAF) in healthy subjects is not well known. In this study we aimed to evaluate the effect of the nitric oxide synthase (NOS) inhibitor NG L-arginine methyl ester (L-NAME) on nasal airway plasma extravasation at baseline and after an acute challenge with PAF that induces most symptoms of rhinitis. Eleven healthy subjects were enrolled in the study. Plasma extravasation in the nasal airway was assessed by measuring the albumin content of nasal lavage. PAF challenge caused a significant increase in concentrations of albumin in the nasal lavage fluid (from 0.59 +/- 0.13 mg dL(-1) to 2.46 +/- 0.45 mg dL(-1)) after placebo. Pretreatment with L-NAME significantly prevented the increase of albumin in the nasal lavage fluid induced by PAF as compared to placebo (from 0.53 +/- 0.11 mg dL(-1) to 1.70 +/- 0.28 mg dL(-1); P < 0.005). Topical administration of a NO inhibitor is able to attenuate the nasal airway plasma extravasation induced by PAF, suggesting that NO release in vivo is involved in the nasal response to PAF.
BACKGROUND Fractional exhaled nitric oxide (FeNO) measurement is a simple and non-invasive method... more BACKGROUND Fractional exhaled nitric oxide (FeNO) measurement is a simple and non-invasive method for monitoring eosinophilic airway inflammation. New portable analyzers for FeNO measurements are constantly being developed. The aim of our study was to evaluate the agreement of FeNO values measured by new portable analyzers. MATERIALS AND METHODS FeNO was measured in 20 healthy subjects, 20 asthmatic and 20 chronic obstructive pulmonary disease patients using the analyzers Niox-VERO, Vivatmo-PRO and HypAir-FeNO. A linear relationship was estimated with Pearson's coefficient (r), and absolute agreement by the intraclass correlation coefficient (ICC) and bias with the limits of agreement (95% of paired differences) were assessed according to the Bland-Altman method. RESULTS In the study population (58 ± 14 years, 20 females), mean values of FeNO with their 95% confidence interval were 24.0 (18.6-29.4) with the Niox-VERO, 19.6 (13.6-25.7) with the Vivatmo-PRO and 20.4 (15.7-25.1) with the HypAir-FeNO. FeNO measured with the Niox-VERO was higher than the Vivatmo-PRO (mean difference of paired values +4.3; limits -16.0 to 25.7 ppb) and the HypAir-FeNO (+3.6; -12.2 to 19.4 ppb); the Vivatmo-PRO and HypAir-FeNO showed large variability of paired differences (-0.7; -16.5 to 15.0 ppb). Measurements linearly correlated with an imperfect absolute agreement: Niox-VERO versus Vivatmo-PRO r = 0.90 and ICC = 0.87; Niox-VERO versus HypAir-FeNO r = 0.93 and ICC = 0.90, Vivatmo-PRO versus HypAir-FeNO r = 0.96 and ICC = 0.93. Most of the disagreement was greater in some asthmatic patients at high values of FeNO. CONCLUSIONS The present study indicates that absolute exhaled NO measurements may differ to a clinically relevant extent using the Niox-VERO, Vivatmo-PRO and HypAir-FeNO analyzers. The devices cannot be used interchangeably.
Introduction: Interstitial lung diseases (ILDs) are a heterogeneous group of lung disorders chara... more Introduction: Interstitial lung diseases (ILDs) are a heterogeneous group of lung disorders characterized by dyspnea on exertion, exercise-induced hypoxemia and reduced exercise tolerance. There are some evidences that pulmonary rehabilitation (PR) successfully treats these manifestations. Objective: To identify if pulmonary rehabilitation can achieve a clinically significant improvement of functional exercise capacity measured by 6-minute walk test (6-MWT) and arterial blood gases analysis (ABG) in patients with ILDs. Methods: A retrospective secondary analysis of the patients’ records from in-patients of a pulmonary rehabilitation center between 2012 and 2015. Profiles of 38 patients who had completed 4-6 PR weeks were included. 6-MWT distance, dyspnea and fatigue Borg score and ABG at baseline and the end of the pulmonary rehabilitation were compared. Results: There was a statistically and clinically significant improvement in 6-MWT distance after PR with a mean difference for change in distance walked of 68.5±54.2 m. The pre post PR variation of dyspnea and fatigue Borg score significantly improved (-2.3±3.7, and -1.7±2.9, always p≤0.001). Among the ABG parameters, only the resting PaO2 showed a significant improvement after PR (Delta PaO2= 4.6±8.5 mmHg, p=0.005). Conclusions: A 4-6 week of PR improves functional exercise capacity and hypoxemia in patients with ILDs. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 245-251)
Rassegna di Patologia dell'Apparato Respiratorio, Aug 6, 2021
L’ossido nitrico (NO) e una molecola gassosa che funge da mediatore chiave in numerosi processi f... more L’ossido nitrico (NO) e una molecola gassosa che funge da mediatore chiave in numerosi processi fisiologici fondamentali per il nostro organismo. Dalla scoperta della presenza dell’NO nell’esalato umano, ad opera di Gustafsson e collaboratori nel 1991, la ricerca in questo ambito si e notevolmente evoluta fino ad identificarlo come possibile marcatore diagnostico per le malattie dell’apparato respiratorio ed in particolare per l’asma. La procedura di misurazione della concentrazione frazionale dell’NO esalato (FeNO) e stata definita e standardizzata in un documento congiunto dell’American Thoracic Society (ATS) e della European Respiratory Society (ERS) e ad oggi rappresenta una metodologia non invasiva che consente di determinare l’infiammazione delle vie aeree. Nell’asma la misurazione del FeNO correla con altri marcatori di infiammazione di tipo T2, quali gli eosinofili del sangue e dell’espettorato ed insieme ad essi viene utilizzato per descrivere diversi fenotipi di asma. Sono stati identificati valori soglia di FeNO per adulti e bambini asmatici, che possono indicare la mancata aderenza del paziente al trattamento, una possibile risposta positiva al trattamento con corticosteroidi inalatori (ICS) e suggerire la necessita di iniziare un trattamento con ICS. Inoltre essendo il FeNO marcatore di infiammazione T2, esso puo predire una risposta positiva al trattamento con biologici. In asmatici gravi trattati con alte dosi di ICS, FeNO ≥ 25ppb rappresenta un indicatore di efficacia terapeutica del dupilumab. L’utilizzo dei valori di FeNO nello studio di altre patologie come la broncopneumopatia cronica ostruttiva (BPCO) e la bronchite eosinofila non asmatica appare ancora controverso, sebbene studi ne abbiano mostrato una buona attendibilita.
European Journal of Clinical Investigation, Nov 1, 2002
Paranasal sinuses and the nose are important sources of nitric oxide (NO) in humans but the relev... more Paranasal sinuses and the nose are important sources of nitric oxide (NO) in humans but the relevance of NO production to the control of nasal airway plasma exudation and its response to inflammatory mediators such as platelet-activating factor (PAF) in healthy subjects is not well known. In this study we aimed to evaluate the effect of the nitric oxide synthase (NOS) inhibitor NG L-arginine methyl ester (L-NAME) on nasal airway plasma extravasation at baseline and after an acute challenge with PAF that induces most symptoms of rhinitis. Eleven healthy subjects were enrolled in the study. Plasma extravasation in the nasal airway was assessed by measuring the albumin content of nasal lavage. PAF challenge caused a significant increase in concentrations of albumin in the nasal lavage fluid (from 0.59 +/- 0.13 mg dL(-1) to 2.46 +/- 0.45 mg dL(-1)) after placebo. Pretreatment with L-NAME significantly prevented the increase of albumin in the nasal lavage fluid induced by PAF as compared to placebo (from 0.53 +/- 0.11 mg dL(-1) to 1.70 +/- 0.28 mg dL(-1); P < 0.005). Topical administration of a NO inhibitor is able to attenuate the nasal airway plasma extravasation induced by PAF, suggesting that NO release in vivo is involved in the nasal response to PAF.
BACKGROUND Fractional exhaled nitric oxide (FeNO) measurement is a simple and non-invasive method... more BACKGROUND Fractional exhaled nitric oxide (FeNO) measurement is a simple and non-invasive method for monitoring eosinophilic airway inflammation. New portable analyzers for FeNO measurements are constantly being developed. The aim of our study was to evaluate the agreement of FeNO values measured by new portable analyzers. MATERIALS AND METHODS FeNO was measured in 20 healthy subjects, 20 asthmatic and 20 chronic obstructive pulmonary disease patients using the analyzers Niox-VERO, Vivatmo-PRO and HypAir-FeNO. A linear relationship was estimated with Pearson's coefficient (r), and absolute agreement by the intraclass correlation coefficient (ICC) and bias with the limits of agreement (95% of paired differences) were assessed according to the Bland-Altman method. RESULTS In the study population (58 ± 14 years, 20 females), mean values of FeNO with their 95% confidence interval were 24.0 (18.6-29.4) with the Niox-VERO, 19.6 (13.6-25.7) with the Vivatmo-PRO and 20.4 (15.7-25.1) with the HypAir-FeNO. FeNO measured with the Niox-VERO was higher than the Vivatmo-PRO (mean difference of paired values +4.3; limits -16.0 to 25.7 ppb) and the HypAir-FeNO (+3.6; -12.2 to 19.4 ppb); the Vivatmo-PRO and HypAir-FeNO showed large variability of paired differences (-0.7; -16.5 to 15.0 ppb). Measurements linearly correlated with an imperfect absolute agreement: Niox-VERO versus Vivatmo-PRO r = 0.90 and ICC = 0.87; Niox-VERO versus HypAir-FeNO r = 0.93 and ICC = 0.90, Vivatmo-PRO versus HypAir-FeNO r = 0.96 and ICC = 0.93. Most of the disagreement was greater in some asthmatic patients at high values of FeNO. CONCLUSIONS The present study indicates that absolute exhaled NO measurements may differ to a clinically relevant extent using the Niox-VERO, Vivatmo-PRO and HypAir-FeNO analyzers. The devices cannot be used interchangeably.
Introduction: Interstitial lung diseases (ILDs) are a heterogeneous group of lung disorders chara... more Introduction: Interstitial lung diseases (ILDs) are a heterogeneous group of lung disorders characterized by dyspnea on exertion, exercise-induced hypoxemia and reduced exercise tolerance. There are some evidences that pulmonary rehabilitation (PR) successfully treats these manifestations. Objective: To identify if pulmonary rehabilitation can achieve a clinically significant improvement of functional exercise capacity measured by 6-minute walk test (6-MWT) and arterial blood gases analysis (ABG) in patients with ILDs. Methods: A retrospective secondary analysis of the patients’ records from in-patients of a pulmonary rehabilitation center between 2012 and 2015. Profiles of 38 patients who had completed 4-6 PR weeks were included. 6-MWT distance, dyspnea and fatigue Borg score and ABG at baseline and the end of the pulmonary rehabilitation were compared. Results: There was a statistically and clinically significant improvement in 6-MWT distance after PR with a mean difference for change in distance walked of 68.5±54.2 m. The pre post PR variation of dyspnea and fatigue Borg score significantly improved (-2.3±3.7, and -1.7±2.9, always p≤0.001). Among the ABG parameters, only the resting PaO2 showed a significant improvement after PR (Delta PaO2= 4.6±8.5 mmHg, p=0.005). Conclusions: A 4-6 week of PR improves functional exercise capacity and hypoxemia in patients with ILDs. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 245-251)
Uploads