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PubMed | Foundation Medicine, University of Parma, University of Insubria, IRCCS Rehabilitation Institute of Tradate and Ospedale Civico
Type: | Journal: International journal of chronic obstructive pulmonary disease | Year: 2015

Individuals with COPD may present reduced peripheral muscle strength, leading to impaired mobility. Comprehensive pulmonary rehabilitation (PR) should include strength training, in particular to lower limbs. Furthermore, simple tools for the assessment of peripheral muscle performance are required.To assess the peripheral muscle performance of COPD patients by the sit-to-stand test (STST), as compared to the one-repetition maximum (1-RM), considered as the gold standard for assessing muscle strength in non-laboratory situations, and to evaluate the responsiveness of STST to a PR program.Sixty moderate-to-severe COPD inpatients were randomly included into either the specific strength training group or into the usual PR program group. Patients were assessed on a 30-second STST and 1-minute STST, 1-RM, and 6-minute walking test (6MWT), before and after PR. Bland-Altman plots were used to evaluate the agreement between 1-RM and STST.The two groups were not different at baseline. In all patients, 1-RM was significantly related to the 30-second STST (r=0.48, P<0.001) and to 1-minute STST (r=0.36, P=0.005). The 30-second STST was better tolerated in terms of the perceived fatigue (P=0.002) and less time consuming (P<0.001) test. In the specific strength training group significant improvements were observed in the 30-second STST (P<0.001), 1-minute STST (P=0.005), 1-RM (P<0.001), and in the 6MWT (P=0.001). In the usual PR program group, significant improvement was observed in the 30-second STST (P=0.042) and in the 6MWT (P=0.001).Our study shows that in stable moderate-to-severe inpatients with COPD, STST is a valid and reliable tool to assess peripheral muscle performance of lower limbs, and is sensitive to a specific PR program.


PubMed | University of Verona, Public Health Trust, University of Insubria, IRCCS Rehabilitation Institute of Tradate and Respiratory Care Unit
Type: Comparative Study | Journal: Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace | Year: 2013

After the implementation of a population-based programme of chest x-ray (CXR) screening on smokers in Varese, Italy, lung cancer (LC) mortality was significantly reduced. Analysis of the incremental costs due to this type of screening programme is needed to evaluate its economic impact on the healthcare system.In July 1997 a population-based cohort, consisting of all high-risk smokers (n=5,815) identified among 60,000 adult residents from the Varese province, was invited to a LC screening programme (an annual CXR for five years) in a general practice setting, and was observed through 2006. Invitees received National Health Service (NHS) usual care, with the addition of CXRs in screening participants. At the end of observation, among the 245 LCs diagnosed in the entire screening-invited cohort the observed LC deaths were 38 fewer than expected. To estimate the incremental direct cost due to screening in the invited cohort for the period July 1997-2006, we compared the direct cost of screening administration, CXR screens and LC management in the invited cohort and in the uninvited and unscreened controls in NHS usual care setting.Over the 9.5 years, the total incremental direct healthcare costs (including screening organization/administration, CXR screens, additional procedures prompted by false-positive tests, overdiagnosed LCs) were estimated to range from euro 607,440 to euro 618,370 (in euros as of 2012), equating to between euro 15,985- euro 16,273 per patient out of the 38 LC deaths averted.In a general practice setting, the incremental cost for a CXR screening programme targeted at all high-risk smokers in a population of 60,000 adults was estimated to be about euro 65,000 per annum, approx. euro 16,000 for each LC death averted.


Pisi R.,University of Parma | Aiello M.,University of Parma | Zanini A.,IRCCS Rehabilitation Institute of Tradate | Tzani P.,University of Parma | And 6 more authors.
International Journal of COPD | Year: 2015

Background: We investigated whether a relationship between small airways dysfunction and bronchodilator responsiveness exists in patients with chronic obstructive pulmonary disease (COPD). Methods: We studied 100 (20 female; mean age: 68±10 years) patients with COPD (forced expiratory volume in 1 second [FEV1]: 55% pred ±21%; FEV1/forced vital capacity [FVC]: 53%±10%) by impulse oscillometry system. Resistance at 5 Hz and 20 Hz (R5 and R20, in kPa·s·L-1) and the fall in resistance from 5 Hz to 20 Hz (R5 – R20) were used as indices of total, proximal, and peripheral airway resistance; reactance at 5 Hz (X5, in kPa·s·L-1) was also measured. Significant response to bronchodilator (salbutamol 400 µg) was expressed as absolute (≥0.2 L) and percentage (≥12%) change relative to the prebronchodilator value of FEV1 (flow responders, FRs) and FVC (volume responders, VRs). Results: Eighty out of 100 participants had R5 – R20 >0.03 kPa·s·L-1 (> upper normal limit) and, compared to patients with R5 – R20 ≤0.030 kPa·s·L-1, showed a poorer health status, lower values of FEV1, FVC, FEV1/FVC, and X5, along with higher values of residual volume/total lung capacity and R5 (P<0.05 for all comparisons). Compared to the 69 nonresponders and the 8 FRs, the 16 VRs had significantly higher R5 and R5 – R20 values (P<0.05), lower X5 values (P<0.05), and greater airflow obstruction and lung hyperinflation. Conclusion: This study shows that peripheral airway resistance is increased in the vast majority of patients with COPD, who showed worse respiratory reactance, worse spirometry results, more severe lung hyperinflation, and poorer health status. Small airway dysfunction was also associated with the bronchodilator responsiveness in terms of FVC, but not in terms of FEV1. © 2015 Pisi et al.


Zanini A.,IRCCS Rehabilitation Institute of Tradate | Zanini A.,University of Insubria | Aiello M.,University of Parma | Adamo D.,IRCCS Rehabilitation Institute of Tradate | And 6 more authors.
Respiration | Year: 2015

Background: International guidelines recommend the inclusion of patients with bronchiectasis in pulmonary rehabilitation (PR) to improve exercise capacity and health-related quality of life (HRQoL). At present, the effect of PR in these patients has been poorly investigated. Objective: The aim of our retrospective analysis was to evaluate the effects and predictors of success for a PR program in patients with bronchiectasis not related to cystic fibrosis (non-CF bronchiectasis). Methods: One hundred and thirty-five non-CF bronchiectasis inpatients, allocated to a 3-week PR program, were retrospectively evaluated. Exercise capacity (6-min walk distance, 6MWD), dyspnea (Baseline/Transition Dyspnea Index, BDI/TDI), and HRQoL [EuroQol visual analogue scale (EQ-VAS)] were assessed before and after PR. The relationship between baseline parameters and changes in outcome measures after PR was assessed. Both univariate and multiple logistic analyses were performed to evaluate the presence of independent predictors of the efficacy of PR. Results: One hundred and eight patients [49 males, mean age 71 years, mean forced expiratory volume in 1 s (FEV1) 76% predicted] were included. After PR, there was a significant improvement in 6MWD, TDI, and EQ-VAS score (p < 0.001). Changes in 6MWD and EQ-VAS score correlated with baseline FEV1, FEV1/vital capacity (VC), residual volume, transfer factor of the lung for carbon monoxide, and the number of exacerbations in the previous year. Both univariate and multivariate logistic regression analyses showed that male gender, baseline FEV1/VC <70%, and >2 exacerbations in the previous year were independent predictors of PR efficacy in terms of an improvement in 6MWD. Conclusions: Our study supports the inclusion of patients with bronchiectasis in PR programs. Clinical and functional baseline findings partially predict the response to PR in terms of exercise tolerance. Further prospective, randomized, controlled trials are needed. © 2015 S. Karger AG, Basel.


Zanini A.,IRCCS Rehabilitation Institute of Tradate | Chetta A.,University of Parma | Imperatori A.S.,University of Insubria | Spanevello A.,IRCCS Rehabilitation Institute of Tradate | And 2 more authors.
Respiratory Research | Year: 2010

In recent years, there has been increased interest in the vascular component of airway remodelling in chronic bronchial inflammation, such as asthma and COPD, and in its role in the progression of disease. In particular, the bronchial mucosa in asthmatics is more vascularised, showing a higher number and dimension of vessels and vascular area. Recently, insight has been obtained regarding the pivotal role of vascular endothelial growth factor (VEGF) in promoting vascular remodelling and angiogenesis. Many studies, conducted on biopsies, induced sputum or BAL, have shown the involvement of VEGF and its receptors in the vascular remodelling processes. Presumably, the vascular component of airway remodelling is a complex multi-step phenomenon involving several mediators. Among the common asthma and COPD medications, only inhaled corticosteroids have demonstrated a real ability to reverse all aspects of vascular remodelling. The aim of this review was to analyze the morphological aspects of the vascular component of airway remodelling and the possible mechanisms involved in asthma and COPD. We also focused on the functional and therapeutic implications of the bronchial microvascular changes in asthma and COPD. © 2010 Zanini et al; licensee BioMed Central Ltd.


Zanini A.,IRCCS Rehabilitation Institute of Tradate | Zanini A.,University of Insubria | Chetta A.,University of Parma | Gumiero F.,IRCCS Rehabilitation Institute of Tradate | And 6 more authors.
BioMed Research International | Year: 2013

Introduction. Conflicting results have been so far reported about baseline lung function, as predicting factor of pulmonary rehabilitation (PR) efficacy. Aim. To ascertain whether or not baseline lung function could predict a benefit in terms of a significant change in 6-min walk test (6MWT) after PR. Methods. Seventy-five stable moderate-to-severe COPD inpatients with comorbidities (complex COPD), allocated to a three-week PR program, were retrospectively evaluated. Pulmonary function, 6MWT, dyspnea (BDI/TDI), and quality of life (EQ-VAS) were assessed before and after PR program. The patients were divided into two groups depending on the change in 6MWT (responders > 30 m and nonresponders ≤ 30 m). Logistic regression analysis was used. Results. After PR, 6MWT performance all outcome measures significantly improved (P < 0.01). Compared to nonresponders (N = 38), the responders (N = 37) had lower values in baseline lung function (P < 0.01). Logistic regression analysis showed that FEV< 50% pred and TL, CO < 50% pred were independent predictors of PR efficacy. Conclusions. Our study shows that in stable moderate-to-severe complex COPD inpatients, baseline lung function may predict the response to PR in terms of 6MWT. We also found that complex COPD patients with poor lung function get more benefit from PR. © 2013 Andrea Zanini et al.


Moroni L.,IRCCS Rehabilitation Institute of Tradate | Neri M.,IRCCS Rehabilitation Institute of Tradate | Lucioni A.M.,IRCCS Rehabilitation Institute of Tradate | Filipponi L.,University of Padua | Bertolotti G.,IRCCS Rehabilitation Institute of Tradate
Sleep Medicine | Year: 2011

Background: The nightly use of continuous positive airway pressure (CPAP) increases the quality of life of patients affected by obstructive sleep apnea syndrome (OSAS). The aim of this study was to develop and validate a questionnaire to assess the psychological and physical impact of OSAS and adherence to the CPAP device. Methods: Ninety-six patients underwent a polygraphic examination to establish a diagnosis of OSAS. They attended educational sessions concerning CPAP and completed the Maugeri Obstructive Sleep Apnea Syndrome (MOSAS) questionnaire before the adaptation phase to the device and after six months, when the number of hours of CPAP use was documented. Results: Exploratory and confirmatory factor analysis of MOSAS section A revealed two factors with good internal consistency: " Sleep Apnea Psychological Impact" (α=. 0.77) and " Sleep Apnea Physical Impact" (α=. 0.75). Structural equation modeling confirmed the goodness of fit of the structure to the observed (RMSEA = 0.034; GFI = 0.95; AGFI = 0.92; and CFI = 0.96). MOSAS section B, which assesses the " discomfort and nuisance of CPAP," is mono-factorial with good internal consistency (α=. 0.663). The Psychological Impact factor positively correlated with the anxiety (r=. 0.44) and depression scores (r=. 0.49) and the physical impact factor positively correlated with daytime sleepiness (r=. 0.65). The discomfort and nuisance of CPAP negatively correlated with recorded CPAP use after six months (r=. -0.52). Conclusions: The statistical quality of MOSAS is good, and it can be used to assess the psychological and physical impact of OSAS and subjective adherence to a CPAP device. © 2011 Elsevier B.V.


Zanini A.,IRCCS Rehabilitation Institute of Tradate | Cherubino F.,IRCCS Rehabilitation Institute of Tradate | Zampogna E.,IRCCS Rehabilitation Institute of Tradate | Croce S.,Allergy and Immunology Unit | And 2 more authors.
International Journal of COPD | Year: 2015

Background: Bronchial hyperresponsiveness (BHR), sputum eosinophilia, and bronchial reversibility are often thought to be a hallmark of asthma, yet it has been shown to occur in COPD as well. Objectives: To evaluate the relationship between BHR, lung function, and airway inflammation in COPD patients. Methods: Thirty-one, steroid-free patients with stable, mild and moderate COPD were studied. The following tests were carried out: baseline lung function, reversibility, provocative dose of methacholine causing a 20% fall in forced expiratory volume in 1 second, a COPD symptom score, and sputum induction. Results: Twenty-nine patients completed the procedures. About 41.4% had BHR, 31.0% had increased sputum eosinophils, and 37.9% had bronchial reversibility. Some of the patients had only one of these characteristics while others had two or the three of them. Patients with BHR had higher sputum eosinophils than patients without BHR (P=0.046) and those with sputum eosinophils ≥3% had more exacerbations in the previous year and a higher COPD symptom score than patients with sputum eosinophils <3% (P=0.019 and P=0.031, respectively). In patients with BHR, the cumulative dose of methacholine was negatively related to the symptom score and the number of exacerbations in the previous year. When patients with bronchial reversibility were considered, bronchodilation was positively related to sputum eosinophils. Conclusion: Our study showed that BHR, sputum eosinophilia, and bronchial reversibility were not clustered in one single phenotype of COPD but could be present alone or together. Of interest, BHR and airway eosinophilia were associated with clinical data in terms of exacerbations and symptoms. Further investigation is needed to clarify this topic. © 2015 Zanini et al.


PubMed | IRCCS Rehabilitation Institute of Tradate
Type: Journal Article | Journal: Sleep medicine | Year: 2011

The nightly use of continuous positive airway pressure (CPAP) increases the quality of life of patients affected by obstructive sleep apnea syndrome (OSAS). The aim of this study was to develop and validate a questionnaire to assess the psychological and physical impact of OSAS and adherence to the CPAP device.Ninety-six patients underwent a polygraphic examination to establish a diagnosis of OSAS. They attended educational sessions concerning CPAP and completed the Maugeri Obstructive Sleep Apnea Syndrome (MOSAS) questionnaire before the adaptation phase to the device and after six months, when the number of hours of CPAP use was documented.Exploratory and confirmatory factor analysis of MOSAS section A revealed two factors with good internal consistency: Sleep Apnea Psychological Impact (=0.77) and Sleep Apnea Physical Impact (=0.75). Structural equation modeling confirmed the goodness of fit of the structure to the observed (RMSEA=0.034; GFI=0.95; AGFI=0.92; and CFI=0.96). MOSAS section B, which assesses the discomfort and nuisance of CPAP, is mono-factorial with good internal consistency (=0.663). The Psychological Impact factor positively correlated with the anxiety (r=0.44) and depression scores (r=0.49) and the physical impact factor positively correlated with daytime sleepiness (r=0.65). The discomfort and nuisance of CPAP negatively correlated with recorded CPAP use after six months (r=-0.52).The statistical quality of MOSAS is good, and it can be used to assess the psychological and physical impact of OSAS and subjective adherence to a CPAP device.


PubMed | IRCCS Rehabilitation Institute of Tradate
Type: Clinical Study | Journal: Respiration; international review of thoracic diseases | Year: 2015

International guidelines recommend the inclusion of patients with bronchiectasis in pulmonary rehabilitation (PR) to improve exercise capacity and health-related quality of life (HRQoL). At present, the effect of PR in these patients has been poorly investigated.The aim of our retrospective analysis was to evaluate the effects and predictors of success for a PR program in patients with bronchiectasis not related to cystic fibrosis (non-CF bronchiectasis).One hundred and thirty-five non-CF bronchiectasis inpatients, allocated to a 3-week PR program, were retrospectively evaluated. Exercise capacity (6-min walk distance, 6MWD), dyspnea (Baseline/Transition Dyspnea Index, BDI/TDI), and HRQoL [EuroQol visual analogue scale (EQ-VAS)] were assessed before and after PR. The relationship between baseline parameters and changes in outcome measures after PR was assessed. Both univariate and multiple logistic analyses were performed to evaluate the presence of independent predictors of the efficacy of PR.One hundred and eight patients [49 males, mean age 71 years, mean forced expiratory volume in 1 s (FEV1) 76% predicted] were included. After PR, there was a significant improvement in 6MWD, TDI, and EQ-VAS score (p < 0.001). Changes in 6MWD and EQ-VAS score correlated with baseline FEV1, FEV1/vital capacity (VC), residual volume, transfer factor of the lung for carbon monoxide, and the number of exacerbations in the previous year. Both univariate and multivariate logistic regression analyses showed that male gender, baseline FEV1/VC <70%, and >2 exacerbations in the previous year were independent predictors of PR efficacy in terms of an improvement in 6MWD.Our study supports the inclusion of patients with bronchiectasis in PR programs. Clinical and functional baseline findings partially predict the response to PR in terms of exercise tolerance. Further prospective, randomized, controlled trials are needed.

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