1,721,161 research outputs found
The contribution of small-Airway abnormalities in chronic obstructive pulmonary disease clinical manifestations: More than a functional issue
Full text linkThe contribution of small airways abnormalities - i.e. those occurring in the peripheral membranous bronchioles with internal diameter < 2 mm [1,2] - in driving the clinical manifestations of Chronic Obstructive Pulmonary Disease (COPD) is well recognised and already encapsulated in the definition of the disease [3]. Several studies have already demonstrated the relative contribution of small airway and lung parenchyma abnormalities to the severity of airflow limitation, mainly related to peripheral airway collapse and/or emphysema [1,4]. Furthermore, a milestone study on this topic by Hogg and colleagues [5] showed strong correlations between the severity of lung function impairment and the degree of luminal occlusion and the inflammatory infiltrate of the small airways in COPD patients. Notably, small airways abnormalities seem to antedate the development of spirometrically detectable airflow obstructionm as shown in asymptomatic smokers [6]. Taken together, these observations strongly suggest that small airway inflammatory and structural abnormalities may represent the incipit towards the development and progression of COPD in smokers.
In the current issue, Crisafulli et al. aimed at establishing the prevalence of small airway impairment in COPD patients, evaluated by impulse oscillometry system (IOS). Interestingly, the prevalence of small airway impairment was assessed across COPD severity by means of “A to D grade classification” according to the recent GOLD guidelines [1]. This classification, beside lung function, takes into account the assessment of symptoms/quality of life and the risk of exacerbations as determinants of COPD severity. The authors found a similar higher impairment in small airway function in GOLD stage B (symptomatic patients, with mild airflow obstruction) and C (pauci-symptomatic patients, but with more severe airflow obstruction) compared to GOLD stage A (pauci-symptomatic patients, and mild airflow obstruction); of note, the percentage of patients with small airway impairment [defined as peripheral airway resistance (R5-R20) value >0.07 kPa·s·L-1 at IOS] was significantly lower in GOLD C than in GOLD B. This latter group of patients (individuals who are highly symptomatic despite mild airflow obstruction), has been shown to experience worse long-term survival rates when compared to patients with more severe airflow obstruction but milder symptomatology [7]. Thus the symptomatic and/or COPD patients with poor quality of life can be those characterised by predominant small airway abnormalities which, in turn, contribute to the severity of the clinical manifestation of the disease.
The current paper has also the merit of having identified a proportion of subjects with an established diagnosis of COPD who do not show functional features of small airway abnormalities. These findings confirm that the population of COPD patients is heterogeneous not only in terms of symptoms and lung function, but also with regard to the prevalent component of the disease (i.e. small airway disease vs. emphysema). The current findings, together with previous publications [5,8] showing that small airway abnormalities affect the severity of the clinical manifestation of COPD, call for a more comprehensive lung functional evaluation that should include measurements of the peripheral portion of the airways in a routine manner.
We support the concept that not only small airway impairment contributes to airflow obstruction in COPD but also, and even more importantly, to the clinical manifestations of the disease hampering the symptom-related quality of life and possibly the long term prognosis
ELEMENTI DI VALUTAZIONE E DIAGNOSTICA FUNZIONALE DELL’APPARATO RESPIRATORIO
No full textQuesto manuale è rivolto a tutti ma soprattutto agli studenti di medicina,
di fisioterapia, di scienze motorie, agli specializzandi in malattie
dell’apparato respiratorio ed in medicina dello sport, ai tecnici di fisiopatologia
respiratoria ma anche a tutti quelli che considerano la fisiopatologia
respiratoria un affascinante ponte tra la fisiologia e la diagnostica.
Basandoci su tale premessa, il presente testo cercherà quindi di spiegare
in maniera sintetica ma rigorosa la corretta esecuzione dei principali
test di funzionalità respiratoria e di indicare una serie di algoritmi per la
loro interpretazione. Lo scopo è fornire al lettore gli elementi basilari della
diagnosi funzionale respiratoria che dovrebbero essere patrimonio culturale
comune
Effects of Anti-IL-5 on Virus-induced Exacerbation in Asthma Light and Shadow
No full textNo abstract availabl
The Convoluted Journey to Unveil the Respiratory Syncytial Virus in Chronic Obstructive Pulmonary Disease Exacerbations: Old Paths and New Traces
No full textNo abstract availabl
Attuali progressi nel trattamento dell’asma bronchiale nell’adulto.
No full textNegli ultimi 20 anni ci sono stati miglioramenti sensazionali nel trattamento dell’asma bronchiale, dovuti in gran parte ad un uso più precoce e diffuso dei glucocorticoidi per via inalatoria che rimangono la classe di farmaci più importante per raggiungere il controllo ottimale della malattia. E’ probabile che, data la sua efficacia e sicurezza, l’attuale approccio farmacologico al trattamento dell’asma bronchiale continuerà anche per i prossimi 10 anni
When asthma diagnosis becomes a challenge
No full textAsthma is a worldwide disease affecting an estimated 300 million individuals [1, 2]. Some authors refer to the increased prevalence of asthma reported during the past decades, in many parts of the world, as a wave of ‘‘asthma epidemic’’ [3]. Given the recent increase in asthma-related healthcare costs [4], it has become important, in a time of economical restriction, to critically review the dimensions of this phenomenon and to investigate the underlying causes. First of all, is there a real epidemic threat? Indeed, besides several proposed explanations for increasing asthma preva- lence (e.g. exposure to tobacco smoke, air pollution and specific allergens, change in diet intake, obesity, exposure to infections and microbial substance in the environment) [3], there has also been an improved awareness of the disease over the past few years. Substantial effort has been made in the past decade for the development and the dissemination of international asthma guidelines. Such widespread publicity has certainly contributed to improve asthma management worldwide and to identify and treat new asthmatic patients. However, it might also have caused overdiagnosis of asthma and, more specifi- cally, it may have contributed to the increased proportion of incorrectly diagnosed asthma cases. Inevitably, any misdiag- nosed cases lead to over treatment or inappropriate treatments [5], and increased risk of side-effects in the absence of any pharmacological benefit
Production of reactive oxygen species in microsomes isolated from peripheral blood mononuclear cells of patients affected by allergic asthma
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