7,169 research outputs found
[Recensione a] Rime del Burchiello comentate dal Doni, edizione critica e commento a c. di Carlo Alberto Girotto
No full text(Recensione a) Rime del Burchiello comentate dal Doni, edizione critica e commento a c. di Carlo Alberto Girotto (Pisa, Scuola Normale Superiore, 2013, pp. LXXX, 684
A new combination therapy for asthma: bridging the gap between effectiveness in trials and clinical practice?
No full texthe goal of asthma management is to achieve and maintain control of symptoms. Although inhaled corticosteroids (ICSs) represent the cornerstone of asthma therapy, the combination of a long-acting β2-agonist (LABA) with an ICS is the treatment option advocated in patients whose asthma is not controlled with low-dose ICS monotherapy. It is well recognized that ICS/LABA therapy can significantly improve asthma symptoms and control compared with simply increasing a patient's ICS dosage. Therapy with an ICS/LABA combination via a single inhaler may offer significant benefits over the use of separate inhalers, facilitating patient adherence to both the ICS and LABA components of the treatment regimen. Furthermore, when ICSs and LABAs are administered as a single-aerosol combination, they may interact synergistically at the molecular level within the lung, enhancing their overall pharmacological, and potentially therapeutic, effect
What can we learn from late-onset and occupational asthma?
No full textLate-onset asthma and occupational asthma may provide interesting models of human asthma to compare with the most frequent type of atopic early-onset asthma. The discovery of similarities and discrepancies in the aetiology and pathogenesis of these different diseases might provide new insights on different mechanisms producing the same phenotype and, thus, by recognizing the different underlying mechanisms of the different forms of asthma, may allow better targeting of prevention and treatment. Occupational asthma, in addition to being a late-onset asthma, provides the unique opportunity to study the development of asthma under measurable exposure conditions, and consequently to examine the effect of cessation of exposure which, at variance with allergen avoidance, is possible in most of the cases
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
Is there a difference between chronic airway inflammation in chronic severe asthma and chronic obstructive pulmonary disease?
No full textPURPOSE OF REVIEW: The lack of a universally accepted definition of chronic severe asthma and the continuous changes in the classification of the severity of stable chronic obstructive pulmonary disease in the last 10 years make it difficult to compare the many studies available. The aim of the review is to compare studies on chronic severe asthma that have a control group of patients with mild to moderate persistent asthma and studies on stable chronic obstructive pulmonary disease that have an age-matched control group of smokers with normal lung function (with or without chronic bronchitis). RECENT FINDINGS: Our review of the recent literature in this field seems to indicate that chronic airway inflammation in chronic severe asthma is characterized in most cases, both in central and peripheral airways, by the same pathological features of mild-moderate persistent asthma with an increased number of activated T lymphocytes, particularly CD4 Th2 cells, and sometimes eosinophils and mast cells. The most notable difference of chronic severe asthma compared with mild to moderate disease is the increased number of neutrophils. Chronic airway inflammation in stable chronic obstructive pulmonary disease is characterized, both in central and peripheral airways, by an increased number of T lymphocytes, particularly CD8+, macrophages and neutrophils. Macrophage and neutrophil counts increase with the progression of the severity of the disease. SUMMARY: These differences in chronic airway inflammation support the consensus that asthma and chronic obstructive pulmonary disease are different diseases along all their stages of severity
Treatment strategies in mild asthma
No full textPURPOSE OF THE REVIEW: More than 10 years ago the category of mild asthma was split into mild intermittent and mild persistent asthma and maintenance therapy with low dose inhaled corticosteroids (ICS) was recommended for mild persistent asthma. The threshold for instituting regular ICS therapy was arbitrarily chosen, in the absence of clinical studies specifically addressing this issue. RECENT FINDINGS: The results of recent trials have questioned the assumption that all patients at the mild end of the asthma severity spectrum should be committed to regular anti-inflammatory treatment with inhaled corticosteroids. As a consequence, the identification of the relevant outcomes for the treatment of mild persistent asthma has become a matter of discussion, which has provided the rationale to test the efficacy and well tolerance of new strategies, other than guidelines-recommended regular low-dose ICS, for the treatment of mild persistent asthma. SUMMARY: Several approaches have been evaluated with some promising results, to include the combination of ICS and long-acting b2-agonists, oral leukotriene antagonists, and the intermittent or as-needed use of ICS in the absence of regular treatment. Conversely, little effort has been made to evaluate therapeutic options other than as-needed bronchodilation in mild intermittent asthma
Inhaled BDP/Formoterol extra-fine combination. Evidence and future perspectives
No full textThe combination of inhaled corticosteroids (ICS) and long acting Beta-2 agonists (LABA) represents the mainstay of current treatment of moderate to severe persistent asthma. Corticosteroids and LABA combine the main pillars of asthma therapy--inhibition of inflammation and bronchodilation--and they may potentiate each other when they simultaneously reach the pharmacological target. A new extra-fine formulation containing the combination of inhaled beclometasone (BDP) and formoterol (F) (with the non polluting HFA-Hydrofluoroalkane-134a as propellant) is now available on the market. The extra-fine formulation increases the deposition into the peripheral airways and a greater proportion of the inhaled compound reaches the pharmacological target. Thus, the dose of ICS can be decreased and the risk-benefit profile improves. The efficacy and tolerance of BDP/F extra-fine combination has been documented in randomized clinical trials into which patients with moderate to severe asthma were included. These trials confirmed that the new extra-fine combination is as effective as the other fixed combinations. Georg Thieme Verlag KG Stuttgart.New York
Bronchial glomus tumor mimicking a COPD exacerbation
No full textWe report the case of a glomus tumor originating in the left main bronchus diagnosed in a 79 year old Caucasian man. A glomus tumor is an extremely rare neoplasm in the bronchi with nonspecific clinical features. Bronchoscopy allows the diagnosis through biopsy and subsequent histopathological examination of the tissue and in selected cases may represent a valid alternative to surgery permitting a radical tumor excision
Rescue treatment in asthma. More than as-needed bronchodilation
No full textInternational guidelines recommend the use of rapid-onset inhaled beta(2)-agonists alone for symptom relief in all asthmatic patients. However, recent clinical trials have shown that the "as-required," or PRN, use of inhaled combinations of a corticosteroid and a rapid-onset beta(2)-agonist provides clinical advantages over the traditional PRN inhaled rapid-onset beta(2)-agonists alone in patients with different degrees of asthma severity. Asthma symptoms are associated not only with bronchoconstriction but also with increased airway inflammation. Inhaled beta(2)-agonists have a rapid onset of bronchodilator action that is mainly mediated by a relaxing effect on airway smooth muscle. Inhaled corticosteroids also have rapid clinical effects that can suppress lower airway inflammation, and there is a rapid synergistic potentiation of the antiinflammatory effect of corticosteroids and of the bronchodilatory action of beta(2)-agonists when the two drugs are given simultaneously. On the basis of this emerging evidence, we propose that the current rescue use of rapid-onset inhaled beta(2)-agonists alone should now be replaced by an inhaled rapid-acting beta(2)-agonist combined with a corticosteroid as preferred PRN strategy. We conclude with a call for clinical trials aimed to test the superiority of this approach in all degrees of asthma severity in a real-world setting in addition to any of the regular treatments recommended by international guidelines. In the future it might even be possible to control asthma entirely with PRN combination inhalers without maintenance therapy, at least in patients with less severe disease
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