F. De Michele - Academia.edu (original) (raw)
Papers by F. De Michele
Respiratory Research, 2022
Background Data from phase 3 trials have demonstrated the efficacy and safety of benralizumab in ... more Background Data from phase 3 trials have demonstrated the efficacy and safety of benralizumab in patients with severe eosinophilic asthma (SEA). We conducted a real-world study examining the baseline characteristics of a large SEA population treated with benralizumab in clinical practice and assessed therapy effectiveness. Methods ANANKE is an Italian multi-center, retrospective cohort study including consecutive SEA patients who had started benralizumab therapy ≥ 3 months before enrolment (between December 2019 and July 2020), in a real-world setting. Data collection covered (1) key patient features at baseline, including blood eosinophil count (BEC), number and severity of exacerbations and oral corticosteroid (OCS) use; (2) clinical outcomes during benralizumab therapy. We also conducted two post-hoc analyses in patients grouped by body mass index and allergic status. Analyses were descriptive only. Results Of 218 patients with SEA enrolled in 21 Centers, 205 were evaluable (mean...
Current Therapeutic Research-clinical and Experimental, 1985
Results: Cluster analysis showed that some BD patients maintain a high functioning, while other p... more Results: Cluster analysis showed that some BD patients maintain a high functioning, while other patients suffer of a loss of global functioning. Multivariate analysis showed that a lower social functioning, independently from premorbid social functioning, can be associated with a loss of executive functions (p = .009). In this analysis the effects of bipolar type (I or II), age at onset, current social roles and duration of illness were absent or not significant (p > .05). Discussions: This is the first study to distinguish levels of global functioning in euthymic BD patients that had the same premorbid social functioning. These important differences in the course of the BD can be assessed through psychosocial and neuropsychological assessment tools for a more appropriate management of the variables able to modify the course of disorder, also in euthymic phase. This practice becomes crucial in the definition and implementation of specific psychosocial treatments in the short and ...
Objective The links between parenting and mental health are a major topic of research in psychiat... more Objective The links between parenting and mental health are a major topic of research in psychiatry. Research on the correlates of dysfunctional or inadequate parenting relies on the availability of valid and reliable measures of parental style. Our main aim was to develop and validate the Italian version of the Measure Of Parental Style (MOPS). A secondary aim was to test the reliability of an Italian version of the Parental Bonding Instrument (PBI) that was specifically designed for this study.
European Annals of Allergy and Clinical Immunology, 2018
European Annals of Allergy and Clinical Immunology will accept for publication suitable manuscrip... more European Annals of Allergy and Clinical Immunology will accept for publication suitable manuscripts dealing with the aetiology, diagnosis, and treatment of allergic and immunologic diseases. These might include the study of methods of controlling immunologic and allergic reactions, human and animal models of hypersensitivity and other aspects of basic and applied clinical allergy in its broadest sense.We encourage case reports that focus on topic(s) of extreme contemporary interest. Paper reporting the results of drug trials will be considered. European Annals of Allergy and Clinical Immunology also publishes solicited and usolicited review articles on subjects of topical interest to clinical and experimental allergy.
Multidisciplinary Respiratory Medicine, 2014
COPD is a chronic pathological condition of the respiratory system characterized by persistent an... more COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD “a preventable and treatable disease”. The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represent...
Archivio Monaldi per le malattie del torace
High Blood Pressure & Cardiovascular Prevention, 2008
Introduction. Obstructive Sleep Apnoea Syndrome (OSAS) is often associated with hypertension and ... more Introduction. Obstructive Sleep Apnoea Syndrome (OSAS) is often associated with hypertension and is a new cardiovascular risk factor independent of age, gender and body mass index (NEJM 342: 1378-84,2000). OSAS occurs in all age groups and both genders and hypertensive target organ damage in the young people is not known. We have calculated the cardiovascular risk in a young people with serious OSAS (RDI>30). Methods. 20 young people (mean age: 39± 6,9; Male: 18 Female; We were evaluated with office blood pressure measurements (OBPM) and AMBP, ECG, echocardiography, carotid echography and plasma total LDL Cholesterol. Results. 14 young people are obese with mean BMI: 37,6±6, 16 smoker. Familiarity hypertension is in 15/20 young people. At clinic blood pressure mean SBP 132±10 mmHg and mean DBP 86± 12 mmHg, 8/20 people with hypertension. At ambulatory monitoring of blood pressure the mean PAS= 145± 16 mmHg and PAD: 92±12 mmHg, 14/20 people with hypertension and 10 people no dippers. At the ECG the Romhilt-Estes point 2±1. At the echocardiography the LV mass/ h2,7 41,35±6,5 gr/m with diastolic dysfunction in 8/20 people. The carotid artery intima/media thickness is 0,96±0,2 mm. Mean LDL Cholesterol levels are 124±36mg/dl. Conclusions. The clinic blood pressure in young people with OSAS isn't good method for to diagnose the hypertension in young people with OSAS because there are many people with masked hypertension. In these people, the best method of monitoring blood pressure is the AMBP because it diagnoses the alteration of circadian profile of blood pressure. The masked nocturnal hypertension went up with an elevated nocturnal BP and normal OBP levels had a bigger target organ damage.
Respiratory Medicine, 2006
Background: Patients with severe chronic airway obstruction might suffer dangerous hypoxemia afte... more Background: Patients with severe chronic airway obstruction might suffer dangerous hypoxemia after administration of a b-agonist despite bronchodilation. Methods: We first compared the acute effects on gas exchange of two doses of formoterol Turbuhaler (9 and 18 mg) in 10 patients with acute exacerbation of COPD. Afterwards, we compared the acute effects of formoterol Turbuhaler 9 mg with those of formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 mg in 10 other patients with acute exacerbation of COPD. Finally, we compared the changes in PaO 2 induced by formoterol Turbuhaler 9 mg or formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 mg with those in FEV 1 in 10 other patients with acute exacerbation of COPD. Each agent was given on separate days, and the patients' arterial blood gases were measured at baseline and at intervals of 120 min. Results: Small but statistically significant declines in PaO 2 were found after administration of both formoterol 9 and 18 mg. In the second group of patients, formoterol 9 mg alone again induced a significant decrease in PaO 2. However, the simultaneous administration of budesonide 320 mg significantly reduced the acute effect of formoterol on PaO 2. In a third group of 10 patients we confirmed a small but significant decrease in PaO 2 after formoterol alone and the reduction of this effect when budesonide was administered simultaneously. Moreover, we also documented that addition of budesonide amplified the fast onset of action of formoterol. Conclusions: These results suggest that when treating patients suffering from acute exacerbation of COPD with formoterol, it is prudent to check their arterial blood
Cancer Treatment Reviews, 2010
Background: Approximately 25% of breast cancers is HER2/Neu overexpressed and/or amplified being ... more Background: Approximately 25% of breast cancers is HER2/Neu overexpressed and/or amplified being both prognostic and predictive factors associated with worse disease-free and overall survivals. HER2/Neu patients with metastatic tumor or in adjuvant systemic therapies are eligible for treatment with Trastuzumab, a monoclonal antibody that targets the extracellular domain of HER2, according to results of the major phase III, clinical trials that do not include small (pT1a or pT1b) node-negative breast cancer. Patients with nodenegative breast carcinoma have a good prognosis but in~20-30% a recurrence of disease is present. The aim of this study is to evaluate the risk of recurrence in women with pT1a e pT1b, N0, M0, HER2 positive breast cancer. Methods: We collected 279 women with small breast cancer, pT1, N0, M0 from 2004 to 2009. In this study we considered 89 out of 279 (32.3%), <1 cm sized (pT1a and b) node-negative (median age 56 ys). In all cases ER, PgR, Ki-67 status and expression of Her2/Neu using immunoistochemistry methods, were evaluated. Hormonal receptors and Ki-67 were scored in accordance with guidelines St Gallen conference; expression of Her2/Neu was detected using HercepTest (DAKO) and scored in accordance to FDA guidelines. Results: 18 out of 89 were pT1a (20.2%) and 71 pT1b. 68 tumors (76.4%) were ER+, 65 (73%) were PgR+ and 23 cases (26%) showed a high proliferative activity (Ki-67 index >20%). 10 out of 89 (11.2%), 2 pT1a and 8 pT1b, evidenced Her2/Neu overexpression, only one case was G1, 2 were ER+/PgR+ and 7 showed high expression of Ki-67. Follow up data (mean FU: 44.4 months; range 18-156 months) of 10 patients overexpressing Her2/Neu were available and evidenced one relapse (local and metacronous cancer) in a woman only treated with radio therapy; no relapse occurred in 5 patients treated with herceptin. Conclusions: Our results suggest that Her2/Neu expression could be a significant marker of risk to relapse of disease, being a prognostic and predictive factor in small breast carcinoma with pT1a or pT1b, N0, M0 and it could be considered for systemic, anti-HER2, adjuvant therapy.
Cancer Treatment Reviews, 2010
European Annals of Allergy and Clinical Immunology, 2021
Background. The Italian Registry on Severe Asthma (IRSA) is the most recent and largest registry ... more Background. The Italian Registry on Severe Asthma (IRSA) is the most recent and largest registry in Italy. Objective. To improve the knowledge on the clinical and biological features of severe asthma (SA), and to monitor its treatments. Methods. To analyze clinical, functional, inflammatory, and treatment characteristics of severe asthmatics from the IRSA registry. Results. 851 subjects were enrolled. 31.8% and 64.5% of patients were submitted to oral corticosteroids (OCS), and monoclonal antibodies (MABs), respectively. At least two comorbidities affected 77.4% patients. Asthma was uncontrolled in 62.2% patients. Uncontrolled patients had a higher frequency of exacerbations, and hospitalization, showing a higher eosinophilic phenotype, a greater use of OCS, and being treated with MAB less frequently. However, uncontrolled patients treated with MAB had a lower use of OCS and a lower rate of hospitalization. Comparing SA patients with atopy and without atopy, the latter showed a greater use of OCS, and more frequent nasal polyposis and osteoporosis. Among SA patients with atopy treated with MAB, 36% were on a treatment targeting the IL-5 pathway. Conclusions and clinical relevance. This study shows the features of the greatest Italian registry of SA patients, revealing at the time of enrollment a poor disease control, and the use of OCS and MABs in about one third and two thirds of patients, respectively. SA is a complex disease that requires a more precise phenotyping and a greater disease control.
Multidisciplinary Respiratory Medicine, 2014
COPD is a chronic pathological condition of the respiratory system characterized by persistent an... more COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV1 < 60% predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO 2 ≤ 55 mmHg (SO 2 < 88%) or PaO 2 values between 56 and 59 mmHg (SO 2 < 89%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit > 55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to (Continued on next page)
Pulmonary Pharmacology & Therapeutics, 2013
Background: Even after publication of the 2011 update of GOLD report, some fundamental questions ... more Background: Even after publication of the 2011 update of GOLD report, some fundamental questions in the management of COPD are still open and this may weaken the applicability of these guidelines in everyday clinical practice. Objective: To assess the level of consensus amongst Italian respirologists on different topics related to diagnosis, monitoring and role of bronchodilator therapy in COPD, by using the Delphi technique. Methods: A Delphi study was undertaken between July and November 2011, when two questionnaires were consecutively sent to a panel of experts to be answered anonymously. After each round, the data were aggregated at group level of question topics and structured feedback was given to the panel. Results: A first-round questionnaire was sent to 208 pulmonologists randomly selected from different Italian regions. The 132 respondents (63% of those initially selected) were from northern (53%), central (19%) and southern (28%) Italy. A second-round questionnaire was sent to all the first-round respondents, and a response was received from 110 of them (83%). The main topics that reached the pre-defined cut off for consensus (67% or more) were: a) bronchodilator therapy with long-acting bronchodilators could be beneficial in patients with airflow limitation even in the absence of symptoms, b) in patients not fully controlled with one long-acting bronchodilator, maximizing bronchodilation (i.e. adding another bronchodilator with a different mechanism of action) is the preferable option; and c) the use of inhaled corticosteroids (ICSs) as add on therapy should be considered in severe patients with frequent exacerbations. Conclusions: Italian specialists agree on several aspects of the diagnosis and treatment of COPD and expert opinion could support everyday decision process in the management of COPD.
Respiratory Research, 2022
Background Data from phase 3 trials have demonstrated the efficacy and safety of benralizumab in ... more Background Data from phase 3 trials have demonstrated the efficacy and safety of benralizumab in patients with severe eosinophilic asthma (SEA). We conducted a real-world study examining the baseline characteristics of a large SEA population treated with benralizumab in clinical practice and assessed therapy effectiveness. Methods ANANKE is an Italian multi-center, retrospective cohort study including consecutive SEA patients who had started benralizumab therapy ≥ 3 months before enrolment (between December 2019 and July 2020), in a real-world setting. Data collection covered (1) key patient features at baseline, including blood eosinophil count (BEC), number and severity of exacerbations and oral corticosteroid (OCS) use; (2) clinical outcomes during benralizumab therapy. We also conducted two post-hoc analyses in patients grouped by body mass index and allergic status. Analyses were descriptive only. Results Of 218 patients with SEA enrolled in 21 Centers, 205 were evaluable (mean...
Current Therapeutic Research-clinical and Experimental, 1985
Results: Cluster analysis showed that some BD patients maintain a high functioning, while other p... more Results: Cluster analysis showed that some BD patients maintain a high functioning, while other patients suffer of a loss of global functioning. Multivariate analysis showed that a lower social functioning, independently from premorbid social functioning, can be associated with a loss of executive functions (p = .009). In this analysis the effects of bipolar type (I or II), age at onset, current social roles and duration of illness were absent or not significant (p > .05). Discussions: This is the first study to distinguish levels of global functioning in euthymic BD patients that had the same premorbid social functioning. These important differences in the course of the BD can be assessed through psychosocial and neuropsychological assessment tools for a more appropriate management of the variables able to modify the course of disorder, also in euthymic phase. This practice becomes crucial in the definition and implementation of specific psychosocial treatments in the short and ...
Objective The links between parenting and mental health are a major topic of research in psychiat... more Objective The links between parenting and mental health are a major topic of research in psychiatry. Research on the correlates of dysfunctional or inadequate parenting relies on the availability of valid and reliable measures of parental style. Our main aim was to develop and validate the Italian version of the Measure Of Parental Style (MOPS). A secondary aim was to test the reliability of an Italian version of the Parental Bonding Instrument (PBI) that was specifically designed for this study.
European Annals of Allergy and Clinical Immunology, 2018
European Annals of Allergy and Clinical Immunology will accept for publication suitable manuscrip... more European Annals of Allergy and Clinical Immunology will accept for publication suitable manuscripts dealing with the aetiology, diagnosis, and treatment of allergic and immunologic diseases. These might include the study of methods of controlling immunologic and allergic reactions, human and animal models of hypersensitivity and other aspects of basic and applied clinical allergy in its broadest sense.We encourage case reports that focus on topic(s) of extreme contemporary interest. Paper reporting the results of drug trials will be considered. European Annals of Allergy and Clinical Immunology also publishes solicited and usolicited review articles on subjects of topical interest to clinical and experimental allergy.
Multidisciplinary Respiratory Medicine, 2014
COPD is a chronic pathological condition of the respiratory system characterized by persistent an... more COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD “a preventable and treatable disease”. The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represent...
Archivio Monaldi per le malattie del torace
High Blood Pressure & Cardiovascular Prevention, 2008
Introduction. Obstructive Sleep Apnoea Syndrome (OSAS) is often associated with hypertension and ... more Introduction. Obstructive Sleep Apnoea Syndrome (OSAS) is often associated with hypertension and is a new cardiovascular risk factor independent of age, gender and body mass index (NEJM 342: 1378-84,2000). OSAS occurs in all age groups and both genders and hypertensive target organ damage in the young people is not known. We have calculated the cardiovascular risk in a young people with serious OSAS (RDI>30). Methods. 20 young people (mean age: 39± 6,9; Male: 18 Female; We were evaluated with office blood pressure measurements (OBPM) and AMBP, ECG, echocardiography, carotid echography and plasma total LDL Cholesterol. Results. 14 young people are obese with mean BMI: 37,6±6, 16 smoker. Familiarity hypertension is in 15/20 young people. At clinic blood pressure mean SBP 132±10 mmHg and mean DBP 86± 12 mmHg, 8/20 people with hypertension. At ambulatory monitoring of blood pressure the mean PAS= 145± 16 mmHg and PAD: 92±12 mmHg, 14/20 people with hypertension and 10 people no dippers. At the ECG the Romhilt-Estes point 2±1. At the echocardiography the LV mass/ h2,7 41,35±6,5 gr/m with diastolic dysfunction in 8/20 people. The carotid artery intima/media thickness is 0,96±0,2 mm. Mean LDL Cholesterol levels are 124±36mg/dl. Conclusions. The clinic blood pressure in young people with OSAS isn't good method for to diagnose the hypertension in young people with OSAS because there are many people with masked hypertension. In these people, the best method of monitoring blood pressure is the AMBP because it diagnoses the alteration of circadian profile of blood pressure. The masked nocturnal hypertension went up with an elevated nocturnal BP and normal OBP levels had a bigger target organ damage.
Respiratory Medicine, 2006
Background: Patients with severe chronic airway obstruction might suffer dangerous hypoxemia afte... more Background: Patients with severe chronic airway obstruction might suffer dangerous hypoxemia after administration of a b-agonist despite bronchodilation. Methods: We first compared the acute effects on gas exchange of two doses of formoterol Turbuhaler (9 and 18 mg) in 10 patients with acute exacerbation of COPD. Afterwards, we compared the acute effects of formoterol Turbuhaler 9 mg with those of formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 mg in 10 other patients with acute exacerbation of COPD. Finally, we compared the changes in PaO 2 induced by formoterol Turbuhaler 9 mg or formoterol/budesonide combination in a single inhaler (Turbuhaler) 9/320 mg with those in FEV 1 in 10 other patients with acute exacerbation of COPD. Each agent was given on separate days, and the patients' arterial blood gases were measured at baseline and at intervals of 120 min. Results: Small but statistically significant declines in PaO 2 were found after administration of both formoterol 9 and 18 mg. In the second group of patients, formoterol 9 mg alone again induced a significant decrease in PaO 2. However, the simultaneous administration of budesonide 320 mg significantly reduced the acute effect of formoterol on PaO 2. In a third group of 10 patients we confirmed a small but significant decrease in PaO 2 after formoterol alone and the reduction of this effect when budesonide was administered simultaneously. Moreover, we also documented that addition of budesonide amplified the fast onset of action of formoterol. Conclusions: These results suggest that when treating patients suffering from acute exacerbation of COPD with formoterol, it is prudent to check their arterial blood
Cancer Treatment Reviews, 2010
Background: Approximately 25% of breast cancers is HER2/Neu overexpressed and/or amplified being ... more Background: Approximately 25% of breast cancers is HER2/Neu overexpressed and/or amplified being both prognostic and predictive factors associated with worse disease-free and overall survivals. HER2/Neu patients with metastatic tumor or in adjuvant systemic therapies are eligible for treatment with Trastuzumab, a monoclonal antibody that targets the extracellular domain of HER2, according to results of the major phase III, clinical trials that do not include small (pT1a or pT1b) node-negative breast cancer. Patients with nodenegative breast carcinoma have a good prognosis but in~20-30% a recurrence of disease is present. The aim of this study is to evaluate the risk of recurrence in women with pT1a e pT1b, N0, M0, HER2 positive breast cancer. Methods: We collected 279 women with small breast cancer, pT1, N0, M0 from 2004 to 2009. In this study we considered 89 out of 279 (32.3%), <1 cm sized (pT1a and b) node-negative (median age 56 ys). In all cases ER, PgR, Ki-67 status and expression of Her2/Neu using immunoistochemistry methods, were evaluated. Hormonal receptors and Ki-67 were scored in accordance with guidelines St Gallen conference; expression of Her2/Neu was detected using HercepTest (DAKO) and scored in accordance to FDA guidelines. Results: 18 out of 89 were pT1a (20.2%) and 71 pT1b. 68 tumors (76.4%) were ER+, 65 (73%) were PgR+ and 23 cases (26%) showed a high proliferative activity (Ki-67 index >20%). 10 out of 89 (11.2%), 2 pT1a and 8 pT1b, evidenced Her2/Neu overexpression, only one case was G1, 2 were ER+/PgR+ and 7 showed high expression of Ki-67. Follow up data (mean FU: 44.4 months; range 18-156 months) of 10 patients overexpressing Her2/Neu were available and evidenced one relapse (local and metacronous cancer) in a woman only treated with radio therapy; no relapse occurred in 5 patients treated with herceptin. Conclusions: Our results suggest that Her2/Neu expression could be a significant marker of risk to relapse of disease, being a prognostic and predictive factor in small breast carcinoma with pT1a or pT1b, N0, M0 and it could be considered for systemic, anti-HER2, adjuvant therapy.
Cancer Treatment Reviews, 2010
European Annals of Allergy and Clinical Immunology, 2021
Background. The Italian Registry on Severe Asthma (IRSA) is the most recent and largest registry ... more Background. The Italian Registry on Severe Asthma (IRSA) is the most recent and largest registry in Italy. Objective. To improve the knowledge on the clinical and biological features of severe asthma (SA), and to monitor its treatments. Methods. To analyze clinical, functional, inflammatory, and treatment characteristics of severe asthmatics from the IRSA registry. Results. 851 subjects were enrolled. 31.8% and 64.5% of patients were submitted to oral corticosteroids (OCS), and monoclonal antibodies (MABs), respectively. At least two comorbidities affected 77.4% patients. Asthma was uncontrolled in 62.2% patients. Uncontrolled patients had a higher frequency of exacerbations, and hospitalization, showing a higher eosinophilic phenotype, a greater use of OCS, and being treated with MAB less frequently. However, uncontrolled patients treated with MAB had a lower use of OCS and a lower rate of hospitalization. Comparing SA patients with atopy and without atopy, the latter showed a greater use of OCS, and more frequent nasal polyposis and osteoporosis. Among SA patients with atopy treated with MAB, 36% were on a treatment targeting the IL-5 pathway. Conclusions and clinical relevance. This study shows the features of the greatest Italian registry of SA patients, revealing at the time of enrollment a poor disease control, and the use of OCS and MABs in about one third and two thirds of patients, respectively. SA is a complex disease that requires a more precise phenotyping and a greater disease control.
Multidisciplinary Respiratory Medicine, 2014
COPD is a chronic pathological condition of the respiratory system characterized by persistent an... more COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV1 < 60% predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO 2 ≤ 55 mmHg (SO 2 < 88%) or PaO 2 values between 56 and 59 mmHg (SO 2 < 89%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit > 55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to (Continued on next page)
Pulmonary Pharmacology & Therapeutics, 2013
Background: Even after publication of the 2011 update of GOLD report, some fundamental questions ... more Background: Even after publication of the 2011 update of GOLD report, some fundamental questions in the management of COPD are still open and this may weaken the applicability of these guidelines in everyday clinical practice. Objective: To assess the level of consensus amongst Italian respirologists on different topics related to diagnosis, monitoring and role of bronchodilator therapy in COPD, by using the Delphi technique. Methods: A Delphi study was undertaken between July and November 2011, when two questionnaires were consecutively sent to a panel of experts to be answered anonymously. After each round, the data were aggregated at group level of question topics and structured feedback was given to the panel. Results: A first-round questionnaire was sent to 208 pulmonologists randomly selected from different Italian regions. The 132 respondents (63% of those initially selected) were from northern (53%), central (19%) and southern (28%) Italy. A second-round questionnaire was sent to all the first-round respondents, and a response was received from 110 of them (83%). The main topics that reached the pre-defined cut off for consensus (67% or more) were: a) bronchodilator therapy with long-acting bronchodilators could be beneficial in patients with airflow limitation even in the absence of symptoms, b) in patients not fully controlled with one long-acting bronchodilator, maximizing bronchodilation (i.e. adding another bronchodilator with a different mechanism of action) is the preferable option; and c) the use of inhaled corticosteroids (ICSs) as add on therapy should be considered in severe patients with frequent exacerbations. Conclusions: Italian specialists agree on several aspects of the diagnosis and treatment of COPD and expert opinion could support everyday decision process in the management of COPD.