1,721,038 research outputs found
[Rhinitis and asthma]. FT Rinite e asma.
No full textA randomized, controlled study of specific immunotherapy in monosensitized subjects with seasonal rhinitis: effect on bronchial hyperresponsiveness, sputum inflammatory markers and development of asthma symptoms
Inhaled corticosteroids in COPD: Trying to make a long story short
Full text linkThe use of inhaled corticosteroids (ICSs) in long-term treatment of COPD has been a debated topic for a long time. According to the evidence produced till now, ICSs are presently advocated in combination with long-acting bronchodilators for high-risk sympto-matic COPD patients with a history of frequent COPD exacerbations. However, the hetero-geneity of COPD patients in terms of prevalent underlying disease, with its associated biological and functional characteristics, and different types of exacerbation makes this recommendation highly questionable. This review aims to discuss the usefulness of ICSs in the pharmacological management of COPD and trys to detect those aspects that may likely anticipate a beneficial response following their therapeutic use related to respiratory function, functional decline, prevention of exacerbation, and quality of life. In this respect, the BERN acronym, meaning Bronchiolitis, Eosinophilia, Responsiveness to bronchodilator, and Non-smoker, may be of practical utility to select among COPD patients those that can take more advantage from ICS adoption when positive and vice versa when negative
Airway hyperresponsiveness in a large group of subjects with alpha(1)-antitrypsin deficiency: a cross-sectional controlled study
No full textBackground. It has been suggested that subjects with alpha(1) -antitrypsin (AAT) deficiency, lacking a major antiprotease defence against airway inflammation, might be more susceptible of development of airway hyperresponsiveness (AHR). Moreover, lower AAT blood levels might also be able to influence the severity of AHR. Objectives. This study was aimed to investigate the prevalence of AHR in a large group of subjects with AAT deficiency included in the Italian Registry and to evaluate the relationship between AAT blood levels and the severity of AHR in this population. Design. Cross-sectional controlled study. Setting. Regional Reference Centre for AAT deficiency in Brescia, Italy. Methods. A total of 114 subjects with AAT deficiency underwent pulmonary function tests. Eighty-six were eligible to perform a bronchial provocation test with methacholine (MCh) (baseline FEV1 > 60% predicted) to assess the provocative dose producing a 20% fall of FEV1 (PD20 FEV1 ). Similar measurements were performed in a control group of 27 age-matched normal subjects. Results. The prevalence of AHR (PD20 FEV1 < 2000 mug MCh) was not different between AAT deficiency subjects and controls (16.3% and 11.1%, respectively; P = 0.66), and also amongst two subgroups of AAT deficiency subjects divided according to different protease inhibitor (Pi) phenotypes (PiMZ-MS, PiSZ-ZZ). Hyperresponsive subjects with AAT deficiency, however, showed a positive correlation between AAT blood levels and PD20 FEV1 values (r = 0.71, P < 0.01). Conclusions. These findings indicate that AAT deficiency subjects did not exhibit a greater prevalence of airway hyperresponsiveness as compared with control subjects, but suggest that, in the subset of AAT deficiency subjects hyperresponsive to MCh, lower levels of AAT are associated with a higher severity of AHR
Autonomic neuropathy increases the risk of obstructive sleep apnea in obese diabetics
No full textFluid shift from the legs to the neck induced by LBPP (lower-body positive pressure) increases UA
(upper airway) collapsibility in healthy men. Rostral fluid displacement during recumbency may
therefore contribute to the pathogenesis of OSA (obstructive sleep apnoea). There is a higher
prevalence of OSA in men than in women. We therefore hypothesized that UA collapsibility in-
creases more in men in response to rostral fluid displacement than in women. UA collapsibility
was assessed in healthy, non-obese men and women while awake by determining UA Pcrit (critical
closing pressure) during application of different suction pressures to the UA. Subjects were
randomized to 5 min control or LBPP arms after which they crossed-over into the other arm
following a 30 min washout. LBPP was applied by inflating anti-shock trousers wrapped around
both legs to 40 mmHg. Pcrit, leg fluid volume and neck circumference were measured at baseline
and after 5 min of both control and LBPP periods. LBPP caused a decrease in leg fluid vol-
ume and an increase in neck circumference that did not differ between men and women. However,
compared with the control period, LBPP induced a much greater increase in Pcrit in men than in
women (7.2 +
−1.8 compared with 2.0 +
−
1.5 cmH2O, P=0.035). We conclude that rostral fluid
displacement by LBPP increases UA collapsibility more in healthy, non-obese men than in women.
This may be one mechanism contributing to the higher prevalence of OSA in men than in
women
[Pharmacologic control of breathing]. FT Controllo farmacologico della ventilazione.
No full textRecent advances in respiratory neuropharmacology and neurophysiology have allowed the assessment of the effects of different drugs on the control of the ventilation both qualitatively (alterations of ventilatory pattern) and quantitatively (size and duration of the ventilatory and haemogasometric alterations). In the control mechanism of ventilation, the pharmacological intervention can act both on the respiratory input (basal metabolism, peripheral chemo-receptors, pulmonary receptors, bulbar neurons, cortical nervous system) and on the respiratory output (respiratory muscles). Based on personal experience in this field and the recent literature, the Authors briefly discuss the seat and the mechanism of action of the drugs with stimulating effect (respiratory analeptics, almitrines, progesterone, acetazolamide, salicylates, protriptyline, theophylline) and depressing effect (narcotics and narcotic-antagonists, anaesthetics, barbiturates and benzodiazepines) on the ventilation, as well as the role of the neurotransmitters and modulators. The clinical (positive and negative) effects of these drugs, particularly related to the patients with chronic lung disease, are also illustrated
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