1,721,054 research outputs found
Ruolo delle piccole vie aeree nelle patologie polmonari croniche
No full textL’oscillometria ad impulsi (IOS) è una metodica non invasiva per la misurazione delle vie aeree periferiche più accurata e diretta rispetto ai comuni test di funzionalità respiratoria. Tale strumento è ampiamente utilizzato nella pratica clinica in ambito pediatrico e nei pazienti adulti con patologie respiratorie ostruttive acute e croniche. Recentemente, è stato ipotizzato che un coinvolgimento delle piccole vie aeree possa coesistere in patologie a localizzazione polmonare, sistemiche e non, con pattern non esclusivamente ostruttivo, ma anche misto o restrittivo, come ad esempio la sarcoidosi e la sclerodermia (SSc). Nei pazienti con SSc la possibilità di un’ostruzione bronchiolare è stata suggerita dalla presenza di bronchiolectasie agli esami autoptici, ed dal frequente riscontro di ispessimento delle pareti dei bronchioli alla tomografia computerizzata (TC). Evidenze suggestive di un interessamento delle piccole vie aeree in sarcoidosi derivano dall’osservazione sia di un’elevata prevalenza di air trapping alla TC torace, sia di alterati valori di flusso espiratorio forzato (FEF) 25-75%. Pertanto, l’obiettivo di tale studio era fornire una stima della prevalenza dell’interessamento delle piccole vie aeree valutata mediante IOS in corso di SSc e sarcoidosi ed identificare eventuali associazioni del parametro di interesse con determinate caratteristiche cliniche e funzionali di malattia. Un coinvolgimento delle piccole vie, definito come R5-R20≥0.07 kPa/L/sec, è stato riscontrato nel 30% dei pazienti con SSc e nel 60% dei pazienti con sarcoidosi, ed in entrambe le casistiche tale parametro correlava significativamente con una peggior qualità di vita in termini di percezione dei sintomi respiratori e limitazione funzionale delle attività quotidiane al St. George Respiratory Questionnaire (SGRQ). Nel caso della patologia sclerodermica, è stata riscontrata anche una forte associazione con la variante limitata di malattia. Ulteriori studi si rendono quindi sono necessari per meglio comprendere i meccanismi patogenetici, evoluzione clinica ed i possibili risvolti terapeutici di tale rilevante e precedentemente non noto elemento patologico.Impulse oscillometry (IOS) is a non-invasive physiological instrument that gives a sensitive assessment of small airways function. With IOS, small volume oscillations are applied at the mouth during ordinary tidal breathing; the instantaneous pressure/flow signal produced by the imposed oscillations (impedance,Zrs) is analyzed into its in-phase (resistance, Rrs) and out-of-phase (reactance, Xrs) components. Because Rrs is measured over a range of frequencies, IOS has the potential to distinguish between large and small airway resistance. Little is known about small airways (defined as less than 2mm in diameter) involvement in scleroderma, although a possible obstruction has been suggested by widespread bronchiolectasis and peribronchial fibrosis noted at necropsy. Large airway involvement is prevalent in pulmonary sarcoidosis, but small airway disease and its impact on quality of life is unclear. In order to investigate the prevalence of small airways diseases, patients with pulmonary sarcoidosis and scleroderma were prospectively evaluated by IOS. The relationship between small airways diseases and selected disease-related characteristics were also investigated. The prevalence of small airways diseases, defined as R5-R20≥0.07 kPa/L/sec, was 30% and 60% respectively in scleroderma (n=42) and sarcoidosis (n=63) patients. In both groups, IOS measurements were tightly linked to respiratory symptoms, defined by the score at St. George Respiratory Questionnaire, more than conventional lung-function tests, suggesting a significant contribution of the small airways to symptom burden. In scleroderma patients, the small airways involvement was significantly related to the limited cutaneous subset. Further studies to evaluate the clinical utility of this measurement in “routine practice” are now warranted
Mortality trends in idiopathic pulmonary fibrosis in Europe between 2013 and 2018
Full text linkBackground Previous research has suggested that the incidence of idiopathic pulmonary fibrosis (IPF) is
increasing in the UK and elsewhere. The aim of this study is to provide contemporary estimates of IPF
mortality rates across 24 European Union (EU) countries from 2013 to 2018, using death certificate data
from the European Statistics Institution (EUROSTAT) database.
Methods We extracted country data for IPF (International Classification of Diseases, 10th Revision: code
J84.1) mortality from the EUROSTAT dataset. We calculated country-, age- and sex-specific death
registration rates between 2013 and 2018. We used direct standardisation to compare rates between
countries. We calculated annual trends in mortality rate ratios using a segmented regression model.
Results The overall standardised mortality rate in 24 EU countries during this period was 3.90 (95% CI
3.80–3.90) per 100 000 person-years, with the rate rising from 3.70 in 2013 to 4.00 in 2018 (average
annual percent change 1.74%, 95% CI 0.91–2.59%). We observed substantial inter-country differences,
with the highest rates detected in Ireland, the UK and Finland, the lowest rate in Bulgaria, and middle rates
in Germany, Greece, Italy, the Netherlands, Portugal and Slovenia.
Conclusions The IPF mortality rate is increasing across Europe. There are currently more than 17 000
deaths recorded from IPF each year in Europe but the marked geographical differences we observed
suggest that this figure may underestimate the true rate considerably
Pleural diseases
No full textPURPOSE OF REVIEW:
Due to the increasing burden of pleural diseases worldwide, a personalized cost-effective management of these conditions is essential to optimize the healthcare sources. The current review is focused on latest evidence in diagnostic work-up and management of pleural diseases.
RECENT FINDINGS:
Recent research highlights the increasing role of thoracic ultrasound in both diagnostic and therapeutic interventions and the potential suitability of cytological sampling from pleural effusions for molecular analysis, essential requirement for a satisfactory test in the era of personalized anticancer therapy. The thoracoscopic approach, by means of rigid or semirigid instruments, remains the gold standard, and attractive tools to increase diagnostic yield in semirigid pleuroscopy include insulated-tip diathermic knife and cryprobe. Talc pleurodesis and indwelling pleural catheters are the most effective interventions, and their combination, likely to result in additional benefits, is currently under investigation.
SUMMARY:
Because of the huge variety of possible clinical settings, a proper management of pleural diseases should be tailored on a case-by-case basis and requires a multidisciplinary approach. Recent advances in technologies has conferred to interventional pulmonology an increasing relevant role in this context, leading to the development of a dedicated subspecialty, and training programs are urgently needed to standardize skills and care pathways
Transbronchial needle aspiration: a systematic review on predictors of a successful aspirate.
No full text- …
