Pavia, Italy
Pavia, Italy

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Pellegrino R.,Allergologia e Fislopatologia Respiratoria | Pompilio P.,Polytechnic of Milan | Quaranta M.,Polytechnic of Milan | Aliverti A.,Polytechnic of Milan | And 8 more authors.
Journal of Applied Physiology | Year: 2010

Peribronchial edema has been proposed as a mechanism enhancing airway responses to constrictor stimuli. Acute exposure to altitude in nonacclimatized lowlanders leads to subclinical interstitial pulmonary edema that lasts for several days after ascent, as suggested by changes in lung mechanics. We, therefore, investigated whether changes in lung mechanics consistent with fluid accumulation at high altitude within the lungs are associated with changes in airway responses to methacholine or exercise. Fourteen healthy subjects were studied at 4,559 and at 120 m above sea level. At high altitude, both static and dynamic lung compliances and respiratory reactance at 5 Hz significantly decreased, suggestive of interstitial pulmonary edema. Resting minute ventilation significantly increased by ∼30%. Compared with sea level, inhalation of methacholine at high altitude caused a similar reduction of partial forced expiratory flow but less reduction of maximal forced expiratory flow, less increments of pulmonary resistance and respiratory resistance at 5 Hz, and similar effects of deep breath on pulmonary and respiratory resistance. During maximal incremental exercise at high altitude, partial forced expiratory flow gradually increased with the increase in minute ventilation similarly to sea level but both achieved higher values at peak exercise. In conclusion, airway responsiveness to methacholine at high altitude is well preserved despite the occurrence of interstitial pulmonary edema. We suggest that this may be the result of the increase in resting minute ventilation opposing the effects and/or the development of airway smooth muscle force, reduced gas density, and well preserved airwayto-parenchyma interdependence. Copyright © 2010 the American Physiological Society.


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.


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.


Crotti S.,Intensive Care Unit Evecla | Iotti G.A.,Anestesia e Rianimazione 2 | Lissoni A.,Intensive Care Unit Evecla | Belliato M.,Anestesia e Rianimazione 2 | And 12 more authors.
Chest | Year: 2013

Background: The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is still being debated. Methods: We performed a retrospective two-center analysis of the relationship between ECMO bridging duration and survival in 25 patients. Further survival analysis was obtained by dividing the patients according to waiting time on ECMO: up to 14 days (Early group) or longer (Late group). We also analyzed the impact of the ventilation strategy during ECMO bridging (ie, spontaneous breathing and noninvasive ventilation [NIV] or intubation and invasive mechanical ventilation [IMV]). Results: Seventeen of 25 patients underwent a transplant (with a 76% 1-year survival), whereas eight patients died during bridging. In the 17 patients who underwent a transplant, mortality was positively related to waiting days until LTX (hazard ratio [HR], 1.12 per day; 95% CI, 1.02-1.23; P = .02), and the Early group showed better Kaplan-Meier curves (P = .02), higher 1-year survival rates (100% vs 50%, P = .03), and lower morbidity (days on IMV and length of stay in ICU and hospital). During the bridge to transplant, mortality increased steadily with time. Considering the overall outcome of the bridging program (25 patients), bridge duration adversely affected survival (HR, 1.06 per day; 95% CI, 1.01-1.11; P = .015) and 1-year survival (Early, 82% vs Late, 29%; P = .015). Morbidity indexes were lower in patients treated with NIV during the bridge. Conclusions: The duration of the ECMO bridge is a relevant cofactor in the mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.


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.


PubMed | Instituto Fondazione Renato Piatti, Divisione di Pneumologia, Centro anti fumo, Fisiopatologia Respiratoria and 6 more.
Type: | Journal: Respiratory care | Year: 2016

Regardless of the device used, many patients have difficulty maintaining proper inhaler technique over time. Repeated education from caregivers is required to ensure persistence of correct inhaler technique, but no information is available to evaluate the time required to rectify inhaler errors in experienced users with a baseline faulty technique and whether this time of re-education to restore inhaler mastery can differ between devices.This was a multi-center, single-visit, open-label, cross-sectional study in a large group of 981 experienced adult subjects (mean SD age 64 15 y), mainly suffering from COPD and asthma, who showed faulty inhaler technique at a follow-up visit in chest clinics. These subjects received face-to-face practical education from trained caregivers until proper inhaler use could be demonstrated, and the time of instruction was recorded.The mean times (95% CIs) in minutes of instruction required for rectifying misuse and demonstrating inhaler mastery were 5.0 (3.6-6.4) min for the Diskus (n = 199), 5.3 (3.7-6.8) min for the HandiHaler (n = 219), 8.1 (5.6-10.5) min for the metered-dose inhaler (MDI) (n = 532), and 6.0 (5.0-7.0) min for the Turbuhaler (n = 169). The time to demonstrate good inhaler use for MDIs was higher (P < .05) than for all dry powder inhalers (DPIs). Between the DPIs, only the HandiHaler required more time for achieving mastery than the Diskus (P = .005). The variables associated with increasing time for correcting inhaler errors were an older age (0.05 min/y, 95% CI 0.03-0.07), a lower level of education (0.4 min/schooling level, 95% CI 0.7-0.1), and no reported previous instruction in inhaler use (1.96 min, 95% CI 1.35-2.58).In experienced subjects with baseline faulty inhaler use, the mean time of education required to achieve and demonstrate mastery with DPIs was lower than with MDIs.


PubMed | University of Padua, University of Pavia, Struttura Complessa di Fisiopatologia Respiratoria, Pneumologia and 4 more.
Type: Journal Article | Journal: Respiratory medicine | Year: 2014

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.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.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 FEV(1)/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, FEV(1)% of predicted and the coexistence of COPD were the only variables to enter the model.Our results highlight the need to specifically evaluate the coexistence of features of COPD in elderly asthmatics, a factor that worsens asthma control.


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.


Scartozzi M.,Marche Polytechnic University | Mazzanti P.,Marche Polytechnic University | Giampieri R.,Marche Polytechnic University | Berardi R.,Marche Polytechnic University | And 4 more authors.
Lung Cancer | Year: 2010

A not negligible proportion of NSCLC patients may be considered eligible for a third-line therapy with a palliative intent. Unfortunately, it is not uncommon to observe toxic side-effects with lack of efficacy. Aim of our study was to analyse clinical factors potentially influencing the global outcome of advanced NSCLC patients receiving third-line therapy. Patients with histologically proven inoperable (IIIB) or metastatic (IV) NSCLC, who received a second- and third-line treatment (either with EGFR-TKIs or chemotherapy), were eligible for our analysis. 143 patients received a second-line treatment after failing a first line cisplatin-based chemotherapy. 52 patients from this series were offered a third-line treatment. In the third-line setting, a better overall survival (months) was related to sex and to response to second-line. Globally, our findings seem to indicate that an improved overall survival in third-line is more strictly dependent on response to second-line, thus suggesting that when planning a third-line treatment, response to second-line should be considered as a relevant factor for the decision making process. © 2009 Elsevier Ireland Ltd.

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