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Micco A, Carpentieri E, Di Sorbo A, Chetta A, Del Donno M. Palliative care and end of life management in patients with idiopathic pulmonary fibrosis. Multidiscip Respir Med 2023; 18:896. [PMID: 36909932 PMCID: PMC9994447 DOI: 10.4081/mrm.2023.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic disease with an unknown etiology that causes deterioration of the structure of the lung parenchyma, resulting in a severe and progressive decline in respiratory function and early mortality. IPF is essentially an incurable disease, with a mean overall survival of 5 years in approximately 20% of patients without treatment. The combination of a poor prognosis, uncertainty about the disease's progression, and the severity of symptoms has a significant impact on the quality of life of patients and their families. New antifibrotic drugs have been shown to slow disease progression, but their impact on health-related quality of life (HRQoL) has to be proven yet. To date, studies have shown that palliative care can improve symptom management, HRQoL, and end-of-life care (EoL) in patients with IPF, reducing critical events, hospitalization, and health costs. As a result, it is essential for proper health planning and patient management to establish palliative care early and in conjunction with other therapies, beginning with the initial diagnosis of the disease.
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Affiliation(s)
| | | | | | - Alfredo Chetta
- Pneumology Clinic, Department of Medicine and Surgery, University of Parma, Italy
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Limongelli G, Iucolano S, Monda E, Elefante P, De Stasio C, Lubrano I, Caiazza M, Mazzella M, Fimiani F, Galdo M, De Marchi G, Esposito M, Rubino M, Cirillo A, Fusco A, Esposito A, Trama U, Esposito S, Scarano G, Sepe J, Andria G, Orlando V, Menditto E, Chiodini P, Iolascon A, Franzese A, Sanduzzi Zamparelli A, Tessitore A, Romano A, Venosa A, Nunzia Olivieri A, Bianco A, La Manna A, Cerbone AM, Spasiano A, Agnese Stanziola A, Colao A, De Bellis A, Gambale A, Toriello A, Tufano A, Ciampa A, Maria Risitano A, Pisani A, Russo A, Volpe A, De Martino B, Amato B, De Fusco C, Piscopo C, Selleri C, Tucci C, Pignata C, Cioffi D, Melis D, Pasquali D, De Brasi D, Spitaleri D, De Brasi D, Russo D, Martellotta D, De Michele E, Varricchio E, Miraglia Del Giudice E, Coscioni E, Cimino E, Pane F, Tranfa F, Pollio F, Lonardo F, Nuzzi F, Simonelli F, Trojsi F, Habetswallner F, Valentini G, Cerbone G, Parenti G, Tedeschi G, Capasso G, Battista Rossi G, Gaglione G, Sarnelli G, Argenziano G, Bellastella G, De Michele G, Fiorentino G, Spadaro G, Scala I, Santoro L, Zeppa L, Auricchio L, Elio Adinolfi L, Alessio M, Amitrano M, Savanelli MC, Russo MG, Ferrucci MG, Carbone MT, Pellecchia MT, Salerno M, Melone M, Del Donno M, Vitale M, Triggiani M, Della Monica M, Lo Presti M, Tenuta M, Mignogna MD, Schiavulli M, Zacchia M, Brunetti-Pierri N, Iovino P, Moscato P, Iandoli R, Scarpa R, Russo R, Troisi S, Sbordone S, Perrotta S, Fecarotta S, Sampaolo S, Cicalese V. Diagnostic issues faced by a rare disease healthcare network during Covid-19 outbreak: data from the Campania Rare Disease Registry. J Public Health (Oxf) 2021; 44:586-594. [PMID: 33982102 PMCID: PMC8194710 DOI: 10.1093/pubmed/fdab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background The aims of this study were: to investigate the capacity of the rare disease healthcare network in Campania to diagnose patients with rare diseases during the outbreak of Covid-19; and to shed light on problematic diagnoses during this period. Methods To describe the impact of the Covid-19 pandemic on the diagnosis of patients with rare diseases, a retrospective analysis of the Campania Region Rare Disease Registry was performed. A tailored questionnaire was sent to rare disease experts to investigate major issues during the emergency period. Results Prevalence of new diagnoses of rare disease in March and April 2020 was significantly lower than in 2019 (117 versus 317, P < 0.001 and 37 versus 349, P < 0.001, respectively) and 2018 (117 versus 389, P < 0.001 and 37 versus 282, P < 0.001, respectively). Eighty-two among 98 rare disease experts completed the questionnaire. Diagnostic success (95%), access to diagnosis (80%) and follow-up (72%), lack of Personal Protective Equipment (60%), lack of Covid-19 guidelines (50%) and the need for home therapy (78%) were the most important issues raised during Covid-19 outbreak. Conclusions This study describes the effects of the Covid-19 outbreak on the diagnosis of rare disease in a single Italian region and investigates potential issues of diagnosis and management during this period.
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Affiliation(s)
| | - Stefano Iucolano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Emanuele Monda
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Pasquale Elefante
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Chiara De Stasio
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Imma Lubrano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Caiazza
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | | | - Fabio Fimiani
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Maria Galdo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Giulia De Marchi
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Martina Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Marta Rubino
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Annapaola Cirillo
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Adelaide Fusco
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Augusto Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Ugo Trama
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Salvatore Esposito
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Gioacchino Scarano
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Joseph Sepe
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Generoso Andria
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Valentina Orlando
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Enrica Menditto
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
| | - Paolo Chiodini
- Centro di Coordinamento Malattie Rare, Regione Campania Naples 80131, Italy
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Cattaruzza MS, Gorini G, Bosetti C, Boffi R, Lugo A, Veronese C, Carreras G, Santucci C, Stival C, Pacifici R, Zagà V, Gallus S, Giulietti F, Sarzani R, Spannella F, Del Donno M, Tartaglione S, Marrazzo G, Pelaia G, D'Agosto V, Berti A, Voller F, Cardellicchio S, Cresci C, Foschino Barbaro MP, De Palma R, Negrini S, Sicbaldi V, Serafini A, Bisconti M, Refolo L, Landoni G, Rovere P, Veronesi G, Faverio P, Garavello W, Pesci A, Giacobbe R, Martucci P, Parrella R, Scarano F, Aiello M, Chetta A, Franco C, Mangia A, Carrozzi L, Maggi F, Monzani F, Pistelli F, Russo P, Sanna A, Barreca FM, Conti V, Rossi E, Ruli M, Ruli S, Eslami Varzaneh S, Principe R, Guerrini S, Sebastiani A, Galluccio G, Pezzuto A, Ricci A, Casali E, Mastroianni C, Pirina P, Polo F, Beatrice F, Romagnoli M, Baraldo M, Cojutti PG, Tascini C, Pecori D, Graziano E, Tinghino B. Covid-19 and the role of smoking: the protocol of the multicentric prospective study COSMO-IT (COvid19 and SMOking in ITaly). Acta Biomed 2020; 91:e2020062. [PMID: 32921714 PMCID: PMC7716969 DOI: 10.23750/abm.v91i3.10373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 01/08/2023]
Abstract
The emergency caused by Covid-19 pandemic raised interest in studying lifestyles and comorbidities as important determinants of poor Covid-19 prognosis. Data on tobacco smoking, alcohol consumption and obesity are still limited, while no data are available on the role of e-cigarettes and heated tobacco products (HTP). To clarify the role of tobacco smoking and other lifestyle habits on COVID-19 severity and progression, we designed a longitudinal observational study titled COvid19 and SMOking in ITaly (COSMO-IT). About 30 Italian hospitals in North, Centre and South of Italy joined the study. Its main aims are: 1) to quantify the role of tobacco smoking and smoking cessation on the severity and progression of COVID-19 in hospitalized patients; 2) to compare smoking prevalence and severity of the disease in relation to smoking in hospitalized COVID-19 patients versus patients treated at home; 3) to quantify the association between other lifestyle factors, such as e-cigarette and HTP use, alcohol and obesity and the risk of unfavourable COVID-19 outcomes. Socio-demographic, lifestyle and medical history information will be gathered for around 3000 hospitalized and 700-1000 home-isolated, laboratory-confirmed, COVID-19 patients. Given the current absence of a vaccine against SARS-COV-2 and the lack of a specific treatment for COVID-19, prevention strategies are of extreme importance. This project, designed to highly contribute to the international scientific debate on the role of avoidable lifestyle habits on COVID-19 severity, will provide valuable epidemiological data in order to support important recommendations to prevent COVID-19 incidence, progression and mortality.
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Affiliation(s)
| | - Giuseppe Gorini
- Oncologic network, prevention and research Institute (ISPRO), Florence, Italy .
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Roberto Boffi
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | | | - Giulia Carreras
- Oncologic network, prevention and research Institute (ISPRO), Florence, Italy .
| | - Claudia Santucci
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Roberta Pacifici
- National Observatory on Smoking, Alcohol and Drugs, National Institute of Health, Rome, Italy.
| | | | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antonio Sanna
- Ospedale San Jacopo Azienda USL Toscana Centro, Pistoia.
| | | | | | | | - Mei Ruli
- Ospedale di Stato, Repubblica di San Marino.
| | | | | | | | | | | | | | - Aldo Pezzuto
- Azienda Ospedaliero-Universitaria Sant'Andrea, Roma.
| | - Alberto Ricci
- Azienda Ospedaliero-Universitaria Sant'Andrea, Roma.
| | - Elena Casali
- Azienda Ospedaliero-Universitaria Policlinico Umberto I, Roma.
| | | | - Pietro Pirina
- Azienda Ospedaliero Universitaria di Sassari, Sassari.
| | | | - Fabio Beatrice
- Ospedale San Giovanni Bosco, ASL Città di Torino, Torino.
| | | | | | | | - Carlo Tascini
- Azienza Sanitaria Universitaria Friuli Centrale, Udine.
| | - Davide Pecori
- Azienza Sanitaria Universitaria Friuli Centrale, Udine.
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Nardini S, Sanguinetti CM, De Benedetto F, Baccarani C, Del Donno M, Polverino M, Annesi-Maesano I. SARS-CoV-2 pandemic in Italy: ethical and organizational considerations. Multidiscip Respir Med 2020; 15:672. [PMID: 32499910 PMCID: PMC7256627 DOI: 10.4081/mrm.2020.672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 01/20/2023] Open
Abstract
The current SARS-CoV-2 pandemic is still raging in Italy. The country is currently plagued by a huge burden of virusrelated cases and deaths. So far, the disease has highlighted a number of problems, some in common with other Countries and others peculiar to Italy which has suffered from a mortality rate higher than that observed in China and in most Countries in the world. The causes must be sought not only in the average age of the population (one of the oldest in the world), but also in the inconsistencies of the regional health systems (into which the National Health System is divided) and their delayed response, at least in some areas. Ethical issues emerged from the beginning, ranging from restrictions on freedom of movements and restrictions on personal privacy due to the lockdown, further to the dilemma for healthcare professionals to select people for ICU hospitalization in a shortage of beds in Intensive Care Unit (ICU). Organizational problems also emerged, although an official 2007 document from the Ministry of Health had planned not only what measures had to be taken during an epidemic caused by respiratory viruses, but also what had to be done in the inter-epidemic period (including the establishment of DPIs stocks and ventilators), vast areas of Italy were totally unprepared to cope with the disease, as a line of that document was not implemented. Since organizational problems can worsen (and even cause) ethical dilemmas, every effort should be made in the near future to prepare the health system to respond to a similar emergency in a joint, coherent, and homogeneous way across the Country, as planned in the 2007 document. In this perspective, Pulmonary Units and specialists can play a fundamental role in coping with the disease not only in hospitals, as intermediate care units, but also at a territorial level in an integrated network with GPs.
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Affiliation(s)
| | | | | | | | - Mario Del Donno
- Italian Respiratory Society Research Centre, Milan, Italy.,Pneumology Unit, A.O.R.N. "San Pio" - P.O. "G. Rummo", Benevento, Italy
| | - Mario Polverino
- Italian Respiratory Society Research Centre, Milan, Italy.,Endoscopic Unit, Pulmonary Division, Hospital M. Scarlato, Scafati (SA), Italy
| | - Isabella Annesi-Maesano
- INSERM and Epidemiology of Allergic and Respiratory Diseases Department, Sorbonne University, IPLESP, Paris, France
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Liccardi G, Baldi G, Berra A, Carpentieri E, Cutajar M, D'Amato M, Del Donno M, Del Prato B, Folletti I, Gani F, Gargano D, Giannattasio D, Giovannini M, Infantino A, Lombardi C, Lo Schiavo M, Madonna F, Maniscalco M, Meriggi A, Milanese M, Montera C, Pio A, Russo M, Salzillo A, Scavalli P, Scichilone N, Sposato B, Stanziola A, Starace A, Vatrella A, D'Amato G, Passalacqua G. Non respiratory symptoms in asthma as possible predictors of exacerbations. J Allergy Clin Immunol Pract 2015; 3:798-800.e2. [PMID: 26004306 DOI: 10.1016/j.jaip.2015.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/28/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Gennaro Liccardi
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy.
| | - Gennaro Baldi
- Respiratory Medicine Unit, ASL (district 66), Salerno, Italy
| | - Adriano Berra
- Respiratory Allergy Unit, G.Da Procida Hospital, Salerno, Italy
| | - Emanuela Carpentieri
- Division of Pneumology, "Santa Maria Novella" Hospital, Galatina, Lecce, Italy; Division of Pneumology, "Rummo" Hospital, Benevento, Italy
| | - Marina Cutajar
- Division of Internal Medicine, Allergy Center, Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy
| | - Maria D'Amato
- Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | | | - Bruno Del Prato
- Unit of Bronchial Endoscopy and Broncho-pulmonology Emergencies, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Ilenia Folletti
- Department of Medicine, Unit of Occupational and Environmental Allergy, University of Perugia, Terni Hospital, Terni, Italy
| | - Federica Gani
- Allergy Unit, S. Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - Domenico Gargano
- Allergy Unit, High Speciality "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - Domenico Giannattasio
- Respiratory Physiopathology and Allergy, High Speciality Center, "S. Maria Incoronata dell'Olmo" Hospital, Cava dei tirreni, Salerno, Italy
| | | | - Antonio Infantino
- Respiratory Area, Società Italiana Interdisciplinare per le Cure Primarie, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergy, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Mario Lo Schiavo
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | | | - Mauro Maniscalco
- Section of Respiratory Medicine, Hospital "S. Maria della Pietà", Casoria, Naples, Italy
| | - Antonio Meriggi
- Allergy and Immunology Unit, Fondazione "Salvatore Maugeri", Institute of Research and Care, Scientific Institute of Pavia, Pavia, Italy
| | - Manlio Milanese
- Division of Pneumology, S. Corona Hospital, Pietra Ligure, Savona, Italy
| | - Carmen Montera
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Antonio Pio
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Maria Russo
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Antonello Salzillo
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - Patrizia Scavalli
- Unit of Respiratory Physiopathology, Allergy and Occupational Medicine, ASL, Viterbo, Italy
| | - Nicola Scichilone
- Biomedical Department of Specialistic and Internal Medicine, University of Palermo, Palermo, Italy
| | - Bruno Sposato
- Pneumology Unit, Azienda Ospedaliera "Misericordia", Grosseto, Italy
| | - Anna Stanziola
- Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - Antonio Starace
- Division of Pneumology and Physiopathology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | | | - Gennaro D'Amato
- Division of Pneumology and Allergology, Department of Chest Diseases, High Speciality "A. Cardarelli" Hospital, Naples, Italy
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Nardini S, Annesi-Maesano I, Donno MD, Delucchi M, Bettoncelli G, Lamberti V, Patera C, Polverino M, Russo A, Santoriello C, Soverina P. The AIMAR recommendations for early diagnosis of chronic obstructive respiratory disease based on the WHO/GARD model*. Multidiscip Respir Med 2014; 9:46. [PMID: 25473523 PMCID: PMC4252853 DOI: 10.1186/2049-6958-9-46] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
Respiratory diseases in Italy already now represent an emergency (they are the 3(rd) ranking cause of death in the world, and the 2(nd) if Lung cancer is included). In countries similar to our own, they result as the principal cause for a visit to the general practitioner (GP) and the second main cause after injury for recourse to Emergency Care. Their frequency is probably higher than estimated (given that respiratory diseases are currently underdiagnosed). The trend is towards a further increase due to epidemiologic and demographic factors (foremost amongst which are the widespread diffusion of cigarette smoking, the increasing mean age of the general population, immigration, and pollution). Within the more general problem of chronic disease care, chronic respiratory diseases (CRDs) constitute one of the four national priorities in that they represent an important burden for society in terms of mortality, invalidity, and direct healthcare costs. The strategy suggested by the World Health Organization (WHO) is an integrated approach consisting of three goals: inform about health, reduce risk exposure, improve patient care. The three goals are translated into practice in the three areas of prevention (1-primary, 2-secondary, 3-tertiary) as: 1) actions of primary (universal) prevention targeted at the general population with the aim to control the causes of disease, and actions of Predictive Medicine - again addressing the general population but aimed at measuring the individual's risk for disease insurgence; 2) actions of early diagnosis targeted at groups or - more precisely - subgroups identified as at risk; 3) continuous improvement and integration of care and rehabilitation support - destined at the greatest possible number of patients, at all stages of disease severity. In Italy, COPD care is generally still inadequate. Existing guidelines, institutional and non-institutional, are inadequately implemented: the international guidelines are not always adaptable to the Italian context; the document of the Agency for Regional Healthcare Services (AGE.NA.S) is a more suited compendium for consultation, and the recent joint statement on integrated COPD management of the three major Italian scientific Associations in the respiratory area together with the contribution of a Society of General Medicine deals prevalently with some critical issues (appropriateness of diagnosis, pharmacological treatment, rehabilitation, continuing care); also the document "Care Continuity: Chronic Obstructive Pulmonary Disease (COPD)" of the Global Alliance against chronic Respiratory Diseases (GARD)-Italy does not treat in depth the issue of early diagnosis. The present document - produced by the AIMAR (Interdisciplinary Association for Research in Lung Disease) Task Force for early diagnosis of chronic respiratory disease based on the WHO/GARD model and on available evidence and expertise -after a general examination of the main epidemiologic aspects, proposes to integrate the above-mentioned existing documents. In particular: a) it formally indicates on the basis of the available evidence the modalities and the instruments necessary for carrying out secondary prevention at the primary care level (a pro-active,'case-finding'approach; assessment of the individual's level of risk of COPD; use of short questionnaires for an initial screening based on symptoms; use of simple spirometry for the second level of screening); b) it identifies possible ways of including these activities within primary care practice; c) it places early diagnosis within the "systemic", consequential management of chronic respiratory diseases, which will be briefly described with the aid of schemes taken from the Italian and international reference documents.
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Affiliation(s)
- Stefano Nardini
- Pulmonary and TB Unit, Vittorio Veneto General Hospital, Vittorio Veneto, TV, Italy
| | - Isabella Annesi-Maesano
- EPAR, INSERM UMRS-1136 IPLESP, Paris, France
- EPAR, Paris Université Pierre et Marie Curie, UMRS-1136 IPLESP, Paris, France
| | | | - Maurizio Delucchi
- Internal Medicine Unit , Saluzzo Hospital, ASL CN1 Regione Piemonte, Saluzzo, CN, Italy
| | | | | | - Carlo Patera
- General Practitioner, Regione Veneto, San Donà di Piave, VE, Italy
| | | | - Antonio Russo
- Respiratory Unit, “G. Rummo” Hospital, Benevento, Italy
| | - Carlo Santoriello
- Respiratory Function Unit, Polla Hospital, ASL Salerno Salerno, Italy
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Nardini S, Annesi-Maesano I, Del Donno M, Delucchi M, Bettoncelli G, Lamberti V, Patera C, Polverino M, Russo A, Santoriello C, Soverina P. The AIMAR recommendations for early diagnosis of chronic obstructive respiratory disease based on the WHO/GARD model*. Multidiscip Respir Med 2014. [DOI: 10.4081/mrm.2014.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Respiratory diseases in Italy already now represent an emergency (they are the 3rd ranking cause of death in the world, and the 2nd if Lung cancer is included). In countries similar to our own, they result as the principal cause for a visit to the general practitioner (GP) and the second main cause after injury for recourse to Emergency Care. Their frequency is probably higher than estimated (given that respiratory diseases are currently underdiagnosed). The trend is towards a further increase due to epidemiologic and demographic factors (foremost amongst which are the widespread diffusion of cigarette smoking, the increasing mean age of the general population, immigration, and pollution). Within the more general problem of chronic disease care, chronic respiratory diseases (CRDs) constitute one of the four national priorities in that they represent an important burden for society in terms of mortality, invalidity, and direct healthcare costs. The strategy suggested by the World Health Organization (WHO) is an integrated approach consisting of three goals: inform about health, reduce risk exposure, improve patient care. The three goals are translated into practice in the three areas of prevention (1-primary, 2-secondary, 3-tertiary) as:1) actions of primary (universal) prevention targeted at the general population with the aim to control the causesof disease, and actions of Predictive Medicine - again addressing the general population but aimed at measuring the individual’s risk for disease insurgence; 2) actions of early diagnosis targeted at groups or - more precisely - subgroups identified as at risk; 3) continuous improvement and integration of care and rehabilitation support - destined at the greatest possible number of patients, at all stages of disease severity. In Italy, COPD care is generally still inadequate. Existing guidelines, institutional and non-institutional, are inadequately implemented: the international guidelines are not always adaptable to the Italian context; the document of the Agency for Regional Healthcare Services (AGE.NA.S) is a more suited compendium for consultation, and the recent joint statement on integrated COPD management of the three major Italian scientific Associations in the respiratory area together with the contribution of a Society of General Medicine deals prevalently with some critical issues (appropriateness of diagnosis, pharmacological treatment, rehabilitation, continuing care); also the document “Care Continuity: Chronic Obstructive Pulmonary Disease (COPD)” of the Global Alliance against chronic Respiratory Diseases (GARD)-Italy does not treat in depth the issue of early diagnosis. The present document – produced by the AIMAR (Interdisciplinary Association for Research in Lung Disease) Task Force for early diagnosis of chronic respiratory disease based on the WHO/GARD model and on available evidence and expertise –after a general examination of the main epidemiologic aspects, proposes to integrate the above-mentioned existing documents. In particular: a) it formally indicates on the basis of the available evidence the modalities and the instruments necessary for carrying out secondary prevention at the primary care level (a pro-active,‘case-finding’approach; assessment of the individual’s level of risk of COPD; use of short questionnaires for an initial screening based on symptoms; use of simple spirometry for the second level of screening); b) it identifies possible ways of including these activities within primary care practice; c) it places early diagnosis within the “systemic”, consequential management of chronic respiratory diseases, which will be briefly described with the aid of schemes taken from the Italian and international reference documents.
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Melani AS, Canessa P, Coloretti I, DeAngelis G, DeTullio R, Del Donno M, Giacobbe R, Scarlato I, Serafini A, Barbato N, Vaghi A, Sestini P. Inhaler mishandling is very common in patients with chronic airflow obstruction and long-term home nebuliser use. Respir Med 2012; 106:668-76. [PMID: 22277996 DOI: 10.1016/j.rmed.2011.11.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/17/2011] [Accepted: 11/28/2011] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Andrea S Melani
- U.O.C.Fisiopatologia e Riabilitazione Respiratoria, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy.
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Martucci P, Sestini P, Canessa PA, Brancaccio L, Guarino C, Barbato N, Lodi M, Coloretti I, Del Donno M, Sini A, Cinti C, Melani AS. Smoking cessation in patients requiring bronchoscopy: the Bronchoscopy AntiSmoking Study (BASIS). Respir Med 2009; 104:61-6. [PMID: 19726173 DOI: 10.1016/j.rmed.2009.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 07/17/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
Abstract
We investigated the readiness to quit and the smoking cessation rates of smokers requiring bronchoscopy and receiving advice quitting. This randomized controlled trial evaluated the effectiveness of two smoking cessation interventions, either a brief advice (control group), or a longer support, delivered at the time of bronchoscopy. We consecutively enrolled 233 adult smokers, regardless of the initial level of motivation to quit. Their mean (SD) age was 57 (12) years; males were 192. They had smoked a median of 44.5 pack-years. Their mean (SD) Fagerstrom score was 8 (2). There was no difference between groups. Surprisingly, 45% of participants were in the action stage at baseline; these 105 subjects had quit in the week immediately prior to the bronchoscopy. At 6- and 12-months follow-up visits, respectively 41% and 29% of participants in the intervention group and 27% and 13% in the control group objectively showed a 1-week point prevalence abstinence. The difference was significant at 6 months (p<0.05) but not at 1-year visit (p=0.052), even if there was a trend towards greater cessation rate in the intervention group. In multivariable logistic models, at the final visit being a quitter was positively associated with having been in the action stage at baseline and negatively with the Fagerstrom score and the presence of smokers in household. We conclude that the time of bronchoscopy may possibly predispose smokers to quit. Further efforts are needed to clear whether more protracted support might achieve higher long-term smoking cessation rates.
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Affiliation(s)
- Paola Martucci
- UOC Endoscopia Bronchiale e Urgenze Broncologiche, AORN A. Cardarelli, Napoli, Italy
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Chetta A, Bobbio A, Aiello M, Del Donno M, Castagnaro A, Comel A, Malorgio R, Carbognani P, Rusca M, Olivieri D. Changes in Lung Function and Respiratory Muscle Strength after Sternotomy vs. Laparotomy in Patients without Ventilatory Limitation. Eur Surg Res 2006; 38:489-93. [PMID: 17008793 DOI: 10.1159/000096008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 07/18/2006] [Indexed: 11/19/2022]
Abstract
A relevant ventilatory defect occurs after sternotomy, a very common thoracic surgical opening. The mechanism of the ventilatory impairment is unclear. Moreover, until now, the effect of sternotomy on pulmonary gas exchange has scarcely been investigated. We evaluated the time-course up to recovery and changes in spirometry, maximum static inspiratory (PI(max)) and expiratory (PE(max)) mouth pressures and pulmonary gas exchange in 6 patients after sternotomy and in 8 patients after laparotomy. All patients were free of cardiopulmonary diseases and had normal preoperative lung function. Sternotomy and laparotomy decreased forced vital capacity (FVC) by 67 and 49%, respectively. Moreover, the percent decreases in PI(max), PE(max) and PaO(2) after sternotomy vs. laparotomy were respectively 54 vs. 57%, 54 vs. 60%, and 22.6 vs. 7.5% (p < 0.05). Following sternotomy, the percent decreases in FVC correlated with the percent decreases in PI(max) (p < 0.05) and PE(max) (p < 0.01). The return to baseline values occurred after approximately 2 weeks. The present study shows that sternotomy can induce greater respiratory effects than laparotomy and suggests a relevant involvement of respiratory muscle weakness after surgical opening of the thorax. The study also supports the view that the evaluation of patient's lung function before sternotomy can be clinically relevant.
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Affiliation(s)
- Alfredo Chetta
- Department of Clinical Sciences, Section of Respiratory Diseases, University of Parma, Parma, Italy.
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Foresi A, Pelucchi A, Del Donno M, Marangio E, Olivieri D. [Inhaled corticosteroid therapy in adults with asthma. Current evidences]. Recenti Prog Med 2005; 96:469-73. [PMID: 16491767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Different international guidelines recommend the early introduction of inhaled corticosteroids (ICS) and their regular use to gain clinical and functional control of persistent asthma. There is now evidence that the starting dose of all ICS is lower than previously regarded. Initial moderate ICS doses appear to be more effective than an initial low ICS dose. The lowest effective dose should always be seeked by a step-down procedure. More than 90% of benefit is achieved by approximately a daily regular dose of 200 microg of fluticasone or 400 microg of beclomethasone or budesonide. The beneficial effects of increasing the dose of ICS alone appear to be modest in most cases. Intermittent ICS therapy has been successfully used in the long term treatment of mild asthma. In general, twice-daily administration of ICS provides greater therapeutic benefit than a once-daily regimen in moderate asthma. When asthma control has been obtained, a once-daily regimen can be tried. In clinical practice, this has the potential advantage of increasing patients' compliance. Chlorofluorocarbon-free formulations of old ICS have also remarkably improved their clinical efficacy mainly through an increased peripheral deposition pattern. Despite some limitations due to poor response in neutrophilic asthma and to potential systemic side effects, ICS will certainly be the cornerstone of asthma therapy even the next future.
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Affiliation(s)
- Antonio Foresi
- Servizio di Pneumologia e Fisiopatologia Respiratoria, Ospedale Sesto San Giovanni, Azienda Ospedaliera Ospedale Civile di Vimercate.
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Decramer M, Rutten-van Mölken M, Dekhuijzen PNR, Troosters T, van Herwaarden C, Pellegrino R, van Schayck CPO, Olivieri D, Del Donno M, De Backer W, Lankhorst I, Ardia A. Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomised placebo-controlled trial. Lancet 2005; 365:1552-60. [PMID: 15866309 DOI: 10.1016/s0140-6736(05)66456-2] [Citation(s) in RCA: 406] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increased oxidative stress is important in the pathogenesis of chronic obstructive pulmonary disease (COPD). We postulated that treatment with the antioxidant N-acetylcysteine would reduce the rate of lung-function decline, reduce yearly exacerbation rate, and improve outcomes. METHODS In a randomised placebo-controlled study in 50 centres, 523 patients with COPD were randomly assigned to 600 mg daily N-acetylcysteine or placebo. Patients were followed for 3 years. Primary outcomes were yearly reduction in forced expiratory volume in 1 s (FEV1) and the number of exacerbations per year. Analysis was by intention to treat. FINDINGS The yearly rate of decline in FEV1 did not differ between patients assigned N-acetylcysteine and those assigned placebo (54 mL [SE 6] vs 47 mL [6]; difference in slope between groups 8 mL [9]; 95% CI -25 to 10). The number of exacerbations per year did not differ between groups (1.25 [SD 1.35] vs 1.29 [SD 1.46]; hazard ratio 0.99 [95% CI 0.89-1.10, p=0.85]). Subgroup analysis suggested that the exacerbation rate might be reduced with N acetylcysteine in patients not treated with inhaled corticosteroids and secondary analysis was suggestive of an effect on hyperinflation. INTERPRETATION N-acetylcysteine is ineffective at prevention of deterioration in lung function and prevention of exacerbations in patients with COPD.
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Affiliation(s)
- Marc Decramer
- Respiratory Division, University Hospital, Katholieke Universiteit Leuven, Belgium.
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Chetta A, Castagnaro A, Foresi A, Del Donno M, Pisi G, Malorgio R, Olivieri D. Assessment of breathlessness perception by Borg scale in asthmatic patients: reproducibility and applicability to different stimuli. J Asthma 2003; 40:323-9. [PMID: 12807177 DOI: 10.1081/jas-120018632] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In asthmatics, the score of bronchoconstriction-associated breathlessness at 20% fall in forced expiratory volume at first second (FEV1) evaluated on a Borg scale (PS20) is a tool successfully used to measure the perception of symptoms. This prospective laboratory study evaluated the applicability of PS20 to assess the breathlessness induced by ultrasonically nebulized distilled water (UNDW) and methacholine (M) and its reproducibility. Twenty-two mild and clinically stable asthmatic patients performed UNDW and M challenge tests. The PS20 was calculated by linear interpolation of the last two points of the perception/fall in FEV1 curve of the UNDW and M tests. The reproducibility of PS20 M was assessed by repeating measurements on 2 separate days by 3 weeks. PS20 UNDW and PS20 M did not differ and were respectively 1.82 +/- 1.85 and 2.03 +/- 1.86. They were significantly related (rs=0.63; p<0.01) and the bias between PS20 UNDW and PS20 M was -0.21 with the limits of agreement ranging from -3.2 to 3.6. The intraclass correlation coefficient for repeated measurement of PS20 M was 0.82; the bias between the two measurements was 0.2 with the limits of agreement ranging from -2.8 to 3.2. All patients had a measurable breathlessness perception degree on a Borg scale during both distilled water challenges and methacholine. Asthmatic patients with normal, exaggerated or poor breathlessness perception were also similar for both stimuli. In addition, PS20 showed a good reproducibility and this allows the serial evaluation of patient's breathlessness perception by this technique in clinical settings and in the physiology laboratory.
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Affiliation(s)
- Alfredo Chetta
- Department of Respiratory Diseases, University of Parma, Parma, Italy.
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Chetta A, Zanini A, Foresi A, Del Donno M, Castagnaro A, D'Ippolito R, Baraldo S, Testi R, Saetta M, Olivieri D. Vascular component of airway remodeling in asthma is reduced by high dose of fluticasone. Am J Respir Crit Care Med 2003; 167:751-7. [PMID: 12468439 DOI: 10.1164/rccm.200207-710oc] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a randomized, double-blind, parallel-group study to assess the effect of 6 weeks treatment with low-dose (100 microg twice a day) or high-dose (500 microg twice a day) inhaled fluticasone propionate (FP) on the vascular component of airway remodeling in 30 patients with mild to moderate asthma. We also studied the effect on the inflammatory cells and the basement membrane thickness, and we compared findings from bronchial biopsies taken in patients with asthma with those in eight control subjects. Bronchial responsiveness to methacholine and asthma symptom score were measured before and after treatments. Eight patients in the low-dose FP group and eight patients in high-dose FP group completed the study. At baseline, patients with asthma showed an increase in the number of vessels and in vascular area as compared with control subjects. In the subjects with asthma, number of vessels correlated with vascular area (p < 0.01) and with number of mast cells (p < 0.01). Bronchial responsiveness to methacholine, asthma symptom score, and inflammatory cells decreased significantly after both low- and high-dose FP (p < 0.05). However, the number of vessels, the vascular area, and the basement membrane thickness decreased only after high-dose FP (p < 0.05). In conclusion, this study shows that in patients with mild to moderate asthma, high dose of inhaled FP given over 6 weeks can significantly affect airway remodeling by reducing both submucosal vascularity and basement membrane thickness.
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Affiliation(s)
- Alfredo Chetta
- Department of Clinical Sciences, Section of Respiratory Diseases, University of Parma, Parma, Italy.
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