1,721,243 research outputs found
Prospects of rehabilitation in respiratory diseases
No full textLe malattie respiratorie sono fra le prime cause di mortalità e morbilità. In particolar modo la Broncopneumopatia Cronica Ostruttiva (BPCO), tra le malattie respiratorie, si impone oggi, e lo farà ancor di più nel futuro, alla nostra attenzione per la sua rilevanza clinico-epidemiologica e socio-assistenziale fino a costituire una delle aree prioritarie in pubblica sanità. La BPCO è una sindrome clinica eterogenea e complessa caratterizzata da limitazione al flusso espiratorio, nonostante presenti una storia naturale variabile, è una malattia irreversibile ed evolutiva.
Sono molteplici gli approcci terapeutici, farmacologici e non, nel trattamento di tale patologia, aventi come obiettivi principali quello di prevenire e controllare i sintomi, ridurre la frequenza e la gravità delle riacutizzazioni, con conseguente riduzione di ricoveri ospedalieri, migliorare la qualità di vita e la tolleranza allo sforzo. Un ruolo fondamentale è rivestito dalla terapia farmacologica che tuttavia si è rivelata incapace di arrestare e/o modificare la progressiva riduzione del quadro funzionale respiratorio, elemento caratteristico della malattia. Tra le modalità di trattamento non farmacologico emerge, raccomandata da forti evidenze scientifiche che ne documentano l’efficacia, specie in rapporto alla riduzione del numero di riacutizzazioni e quindi di ospedalizzazioni, la Riabilitazione Respiratoria (RR). Approcci globali di trattamento della patologia respiratoria comprendenti Programmi Riabilitativi, si sono sviluppati in questi ultimi anni assumendo un ruolo primario nella gestione dei pazienti, soprattutto se anziani, con problemi respiratori, tanto da avere una influenza preminente nella storia naturale delle malattie respiratorie. I Programmi di Riabilitazione Respiratoria (PRR) sono rivolti alla gestione di tutta la storia naturale della malattia,dalla insorgenza dei primi sintomi fino alla gestione della invalidità conseguente alla Insufficienza Respiratoria (IR) in fase terminale. Dunque, se fino a pochi anni fa i PRR potevano essere considerati una parte (forse secondaria) della pneumologia, oggi la RR è idealmente una strategia di trattamento globale indirizzata a tutte le componenti della malattia polmonare cronica e progressiva. Definita come “un insieme multidimensionale di servizi diretti a persone con malattie polmonari e alle loro famiglie, disolito da parte di un team interdisciplinare di specialisti con lo scopo di raggiungere e mantenere il massimo livello di indipendenza di attività nella comunità”, la RR pur non arrestando il progressivo peggioramento fisiopatologico si è dimostrata capace di incidere sulla storia naturale della malattia. Infatti, vi è evidenza scientifica che i PRR in pazienti con malattie croniche respiratorie hanno effetti clinici positivi, migliorano la dispnea e il controllo della malattia
Assembly 5: Airway diseases
Full text linkMeet ERS Assembly 5: airway diseases http://ow.ly/M4ou306WbrQ
Chronic bronchial asthma from challenge to treatment: epidemiology and social impact.
No full textAsthma is an important cause of chronic morbidity and a crucial health problem among children and adults worldwide, with high prevalence rates particularly in many developed countries.Increasing morbidity, hospital admission rates, use of medical services, drug use and, in some countries, increasing mortality rates have been reported.3 However, controversy still exists regarding the epidemiology of asthma. There are two serious problems which need to be considered when trying to obtain reliable data on the prevalence, morbidity, and mortality of asthma. The first relates to definition; despite substantial advances in understanding the pathogenesis, genetics, and clinical characteristics of asthma, we do not have a useful definition of asthma for epidemiological purposes.2 The second problem concerns the different methods used to collect epidemiological data and information. More recently two international studies—the European Community Respiratory Health Survey (ECRHS)4 and the International Study of Asthma and Allergies in Childhood (ISAAC)5—have used the same internationally standardised questionnaire to provide important data on the prevalence of asthma
A new Editorial Board of Monaldi Archives for Chest Disease
No full textIn recent years, Monaldi has reached a widespread diffusion and consolidated its reputation as a good quality scientific journal in the field of cardiopulmonary rehabilitation. Many of these achievements are due to the hard work of many pulmonary physicians, most of them, including the last two former Editors, Claudio F. Donner and Ciro Rampulla, part of the FSM and distinguished leaders of research groups in their field. Commercing in 2002, Monaldi has divided the published issues in a Cardiologic and in a Pulmonary Series, issued separately.
This year, FSM decided to renew also the Editorial Board of the Pulmonary series. Beginning with the present issue we (Antonio Spanevello and Bruno Balbi) are the two new Co-Editors. We are currently Head and Scientific Secretary, respectively, of the Pulmonary Rehabilitation Department, the organization that comprises the Pulmonary Physicians working at FSM. As Editors we will work together with two Deputy Editors (Dr. Mirco Lusuardi, Head of Pulmonary Rehabilitation, Health Authority of Reggio Emilia and Dr. Maurizio Luisetti, Head of Biochemistry and Genetics in Pulmonary Medicine, University of Pavia) and two Executive Editors (Dr. Giuseppe Brunetti and Dr. Luca Bianchi, both at FSM). This “under fifty” Editorial Board, is deeply committed to doing the best for our Journal and to continue and extend the precious work done by the previous Editors.
We heritage a healthy and well-nourished scientific journal. It is an honor and a privilege to take over as Editors from Ciro Rampulla and we thank him for his wise and culturally rich contribution to Monaldi. As Editor in Chief of the past Editorial Board in the last 2 years Ciro worked hard and refined the editorial and administrative procedures, with the full support of the FSM. His example will be a guide for us to chair the Editorial Board of the Journal
Towards a practical clinical use of fractioned exhaled nitric oxide levels in chronic cough
No full textThe fight against tobacco
Full text linkThis issue of Monaldi Archives for Chest Diseases – Respiratory Series –, the first of 2013, is almost
entirely dedicated to papers dealing with the fight against tobacco and its deleterious effects on human
health, particularly on respiratory health.
Along the last 10 years our Journal published many reports on this important if not crucial issue inside
the section denominated “Tobacco Pouch”. This issue is thus to be seen as a ... bigger Tobacco Pouch, one
that can possibly contain an up to date of the huge burden of problems that tobacco smoke poses to each
and every one of the Health Systems throughout the world.
The fight against tobacco can start from an educational approach addressed to school children, as it is
described in the Di Paco article [1] where the Authors evaluated their educational strategy in a cohort of
school children. Another important point is the fight against exposure of tobacco smoke of “innocent bystanders”
as people living, working in indoor environment shared with smokers can be somehow defined.
Ferrante and Coll. described this last frontier of the fight against tobacco [2]. This fight is of course firstly
addressed to smokers (i.e. first hand smoke), to people who live and work with smokers, while they
smoke (second hand smokers) but also to people, including infants, babies, children and adolescents, living
in houses or anyhow sharing indoor ambient air with smokers who smoke when they are not present
(third hand smoke). The combination of tobacco smoke pollutants which remain in an indoor environment,
the so-called ‘third-hand smoke’, represent a new concept in the field of tobacco control.
Once the smoking habit is already in place, different strategies can be adopted to get smokers to quit.
Pharmacological approaches have been proved successful but only in a minority of smokers, as the article
by Santus et al review [3]. Even more difficult is the approach to patients with COPD who, despite appropriate
advice and counseling, do not quit. Jimenez Ruiz reviewed for us the pharmacological and counseling
strategies to be used in these difficult cases [4, 5].
Last but not least, we decided to include also an article on the controversial yet currently heavily present
in the news of the so called “electronic cigarettes” or Electronic Nicotine Delivery Systems (ENDS)
[6]. In our Country, as the accompanying Editorial of Stefano Nardini points out [7] ENDS are becoming
a big issue for many reasons. Commercial interest, lack of clear indications from the Health Authorities related
to the lack of any certain evidence on their effects, poor knowledge by the vast majority of Physicians
on this topic are just some of the many faces of the problems related to the diffusion in the last two
years of ENDS in Italy. In this context, we decided to publish the article by Caponnetto et al [6], knowing
that this is a controversial issue, that there are conflicting interests between the need for more research and
the current wide use of ENDS. Certainly Monaldi is not sponsoring any strategy that involves the use of
ENDS of any brand before a clear indication is released by National and International Regulatory Agencies.
We just wanted our Journal to deal somehow with this problem to raise the interest of our readers on
the many questions that our patients are asking to us every day.
Finally a word of gratitude to Stefano Nardini who helped us with a great deal of work in this enterprise.
Without his commitment this “Big Tobacco Pouch” issue of Monaldi simply would not be available
to our readers
Biomarkers nell’ Espettorato Indotto
No full textRecentemente, nei programmi di ricerca, un certo numero di ipotesi sono state avanzate sulle varie metodiche in grado di valutare e misurare biomarkers infiammatori. In particolar modo, negli ultimi decenni, sono state messe a punto metodiche meno invasive, rispetto ai gold standard per la misurazione dello stato di flogosi bronchiale, rappresentati dal BAL e dalle biopsie bronchiali, quali quelle dell'analisi dei gas esalati, dell'esalato condensato e dell'espettorato indotto. tra queste emerge, in particolare, l'analisi dell'espettorato indotto, metodica standardizzata e validata, che, per l'alto grado di sensibilità e non-invasività, ha assunto, nell'ultima decade, un ruolo sempre più centrale nel caratterizzare il profilo infiammatorio alla base delle più comuni patologie dell'apparato respiratorio, tra le quali: l'Asma, la BPCO e la tosse cronica. A questo proposito, evidenze scientifiche supportano la sua importanza nel fornire utili indicazioni sia nella diagnostica, migliorando la comprensione della patogenesi, sia nella gestione clinica. Pertanto, è lecito pensare che sia giunto il momento per tale metodica di uscire dal campo della ricerca per entrare a pieno titolo in quello della pratica clinica
Inhaled corticosteroids in COPD - Author's reply (2)
No full textAUTHORS’ REPLY We would like to thank Drs
Brightling and Pavord for their interesting
comments. As stated in our article, we
enrolled only patients with stable COPD,
diagnosed according to a recent European
Consensus Conference, and none of them
had a previous history of asthma.1 The
percentage of sputum eosinophils in the global
COPD study population (34 subjects;
mean (SE) 2.7 (0.7)) was not significantly
different from that of the healthy subjects (16
subjects; mean (SE) 0.98 (0.2)) by the
Mann-Whitney U test (p = 0.08). Indeed, if
we consider the treated and control groups
separately, a significant increase in the
proportion of sputum eosinophils is seen in
both COPD groups compared with the
healthy subjects (p = 0.02).
We suggest that the sputum eosinophilia in
our patients with smoking related COPD
could be explained by their current smoking
habit. In fact, recent experimental and
clinical data seem to support the hypothesis
that exposure to cigarette smoke can induce
eosinophilic airway inflammation both in
animals and humans.2 3
Although there was no overall change in
the sputum eosinophil count after two
months of treatment with beclomethasone
dipropionate, we have analysed separately the
seven subjects with eosinophils of >2% in the
treated group. In these subjects, not only
neutrophils but also sputum eosinophils
decreased (from a mean (SE) of 4.5 (1.2)%
to 2.0 (0.4)%) after two months of treatment,
although the difference did not reach statistical
significance (p = 0.06). Moreover, these
subjects did not show a significant increase in
FEV1 after two months of treatment with
inhaled corticosteroids (from 60.1 (5.6)% to
64.9 (4.1)% predicted).
We also analysed separately the subgroup of
treated patients with COPD with sputum
eosinophils <2% in order to verify the changes
in sputum neutrophils after two months of
treatment with inhaled beclomethasone dipropionate.
These patients showed a significant
reduction in both total cell and neutrophil
counts after treatment. In fact, the mean
difference from baseline of the total cell count
(cells/ml ́ 104) was 191 (51.8) (95% CI 68.5
to 314), and the mean difference from baseline
of the neutrophils was 27 (1.7) (95% CI 22.9
to 31.1).
We are grateful to the authors of this letter
for their careful consideration that provides a
good insight into our paper. Nevertheless, the
results of our study do not change since a
reduction in sputum neutrophils also occurred
after treatment with high dose inhaled
beclomethasone dipropionate in the subgroup subgroup
of patients with COPD without
sputum eosinophilia
IL LAVAGGIO NASALE
No full textIl Lavaggio Nasale:
- è una metodica di semplice esecuzione, non invasiva, ben tollerata dai pazienti e ripetibile anche a breve distanza di tempo nello stesso soggetto;
- permette una valutazione quantitativa del grado di infiammazione leucocitaria delle cavità nasali;
- permette una valutazione contemporanea delle cellule e dei mediatori dell'infiammazione;
- permette di determinare l'efficacia clinica dei farmaci e di seguire nel tempo l'andamento clinico della malattia.
Queste conclusioni ricavate dai dati di letteratura permettono di affermare che l'utilizzo del lavaggio nasale può essere esteso sia alla ricerca che alla clinica
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