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Lauzacco, Italy

Melani A.S.,U.O.C.Fisiopatologia e Riabilitazione Respiratoria | Canessa P.,Pneumologia | Coloretti I.,UOS di Pneumologia Ospedale C.Magati AUSL di Reggio Emilia | Deangelis G.,U.O.C.Riabilitazione Respiratoria | And 8 more authors.
Respiratory Medicine | Year: 2012

Inhalers and nebulisers are devices used for delivering aerosolised drugs in subjects with Chronic Airflow Obstruction (CAO). This multicentre, cross-sectional observational study was performed in a large population of outpatients with CAO regularly using home aerosol therapy and referring to chest clinics. The aims of the study were to compare the characteristics of the group of subjects with CAO who were using home nebulisers but also experienced with inhalers vs. those only using inhalers and to investigate whether the first group of subjects was particularly prone to inhaler misuse. Information was gained evaluating the responses to a standardised questionnaire on home aerosol therapy and the observations of inhaler technique. We enrolled 1527 patients (58% males; mean ± SE; aged 61.1 ± 0.4 years; FEV1% pred 69.9 ± 0.6; 51% and 44% respectively suffering from COPD and asthma) who were only inhaler users (OIU group) and 137 (85% males; aged 67.7 ± 1.3 years; FEV1% pred 62.3 ± 2.9; 60% and 23% respectively suffering from COPD and asthma) who were using both nebulisers and inhalers (NIU group). Nebuliser users were older, had more severe obstruction, related symptoms and health care resources utilisation. Nebulisers users performed more critical inhalers errors than those of the OIU group (49% vs. 36%; p = 0.009). We conclude that our patients with CAO and regular nebuliser treatment had advanced age, severe respiratory conditions and common inhaler misuse. © 2011 Elsevier Ltd. All rights reserved.

De Benedetto F.,UOC di Pneumologia | Del Ponte A.,University of Chieti Pescara | Sevieri G.,Pneumologia
Multidisciplinary Respiratory Medicine | Year: 2011

Over the last century, the fundamental and central role of vitamin D in the regulation of calcium and bone homeostasis has been widely demonstrated. In recent years a great number of investigations have led to the discovery of new and important actions suggestive of a much broader role controlling the risk of many chronic illnesses; these actions involve hormonal secretion, cell proliferation and differentiation, and the immune modulation system: in this context vitamin D regulates antiviral and antibacterial activities by preventing the excessive expression of inflammatory cytokines and stimulating the expression of potent antimicrobial peptides. Knowledge of the effects of vitamin D deficiency is currently focused on its extracalcemic activity in the development of a large number of diseases such as diabetes mellitus, osteoporosis, high blood pressure, obesity and nutritional depletion, metabolic syndrome, cardiovascular diseases, common cancers, and autoimmune diseases. In particular, there is growing evidence of the role that vitamin D might play in controlling acute and chronic illnesses involving the respiratory apparatus (upper and lower respiratory tract infections, tuberculosis, asthma, COPD, cystic fibrosis and interstitial lung diseases). The present review reports the most important data published in the literature, which suggest that vitamin D deficiency is, in the respiratory field, an extremely widespread and largely underestimated problem concerning all age-groups and geographic regions in the world, and that its supplementation might constitute a huge unexploited potential in the standard treatment of acute and chronic respiratory diseases of the upper and lower respiratory tracts. Moreover it has been widely demonstrated that vitamin D deficiency, by means of several mechanisms, may influence the decline of respiratory function, directly and indirectly. For these reasons COPD patients could be the best candidates to benefit from vitamin D supplementation; in fact, a potential vitamin D deficiency, on account of its negative effects on muscular and skeletal functions and the lack of its immunomodulating and antinflammatory actions, could be considered a public health problem that calls for appropriate, simple, inexpensive and safe treatment. Therefore, widespread use of vitamin D supplementation, especially in individuals at risk, should be an option carefully considered not only by respiratory specialists but by all medical professionals.

Milanese M.,Struttura Complessa di Pneumologia | Di Marco F.,University of Milan | Corsico A.G.,University of Pavia | Rolla G.,University of Turin | And 6 more authors.
Respiratory Medicine | Year: 2014

Background The exponential increase of individuals aged >64 yrs is expected to impact the burden of asthma. We aimed to explore the level of asthma control in elderly subjects, and factors influencing it. Methods A multicenter observational study was performed on consecutive patients >64 years old with a documented physician-diagnosis of asthma. Sixteen Italian centers were involved in this 6-month project. Findings A total of 350 patients were enrolled in the study. More than one-third of elderly asthmatic patients, despite receiving GINA step 3-4 antiasthmatic therapy, had an Asthma Control Test score ≤19, with a quarter experiencing at least one severe asthma exacerbation in the previous year. Twenty-nine percent of patients (n = 101) were classified as having Asthma-COPD Overlap Syndrome (ACOS) due to the presence of chronic bronchitis and/or CO lung diffusion impairment. This subgroup of patients had lower mean Asthma Control Test scores and more exacerbations compared to the asthmatic patients (18 ± 4 compared to 20 ± 4, p < 0.01, and 43% compared to 18%, p < 0.01, respectively). Modified Medical Research Council dyspnea mMRC scores and airway obstruction, assessed on the basis of a FEV1/FVC ratio below the lower limit of normal, were more severe in ACOS than in asthma, without any difference in responses to salbutamol. In a multivariate analysis, the mMRC dyspnea score, FEV1% of predicted and the coexistence of COPD were the only variables to enter the model. Interpretation Our results highlight the need to specifically evaluate the coexistence of features of COPD in elderly asthmatics, a factor that worsens asthma control. © 2014 Elsevier Ltd. All rights reserved.

Bisconti M.,Pneumologia | Barbaro M.P.F.,University of Foggia | Serafni A.,Science Pneumologia | Martucci P.,U.O.C. Endoscopia Bronchiale | And 2 more authors.
Rassegna di Patologia dell'Apparato Respiratorio | Year: 2015

The main substances responsible for the diseases of the human respiratory system are marijuana, cocaine, ecstasy and some improperly used medicinal products. Drug epidemic begun in the '50s favoured by the wrong feeling that inhaled drugs were less harmful than injected ones. However they lead as well to sometimes lethal pathologic processes. While D.I.R.D. - Drug Induced Respiratory Diseases - have been thoroughly investigated in Northern Europe and USA they are barely known in Italy. Drug-related respiratory diseases include: asthma, pulmonary oedema, eosinophilic lung disease, COPD, BOOP, pneumothorax, Crack lung syndrome, empyema, granulomatosis, interstitial pulmonary fibrosis, Churg-Strauss Syndrome, ABPA, invasive aspergillosis, RADS, CAP, endocarditis, atelectasis, emphysema, pulmonary arterial hypertension, infections, bronchiectasis, haemoptysis and others.

Melani A.S.,Fisiopatologia e riabilitazione respiratoria | Bonavia M.,Pneumologia | Cilenti V.,Fisiopatologia Respiratoria | Cinti C.,Pneumotisiatria | And 7 more authors.
Respiratory Medicine | Year: 2011

Proper inhaler technique is crucial for effective management of asthma and COPD. This multicentre, cross-sectional, observational study investigates the prevalence of inhaler mishandling in a large population of experienced patients referring to chest clinics; to analyze the variables associated with misuse and the relationship between inhaler handling and health-care resources use and disease control. We enrolled 1664 adult subjects (mean age 62 years) affected mostly by COPD (52%) and asthma (42%). Respectively, 843 and 1113 patients were using MDIs and DPIs at home; of the latter, the users of Aerolizer ®, Diskus®, HandiHaler® and Turbuhaler® were 82, 467, 505 and 361. We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus ® and HandiHaler® and 44% for Turbuhaler ®. Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < 0.0001) and the whole population (p < 0.0001). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling. © 2010 Elsevier Ltd. All rights reserved.

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