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Cresti A, Baratta P, De Sensi F, Aloia E, Sposato B, Limbruno U. Clinical Features and Mortality Rate of Infective Endocarditis in Intensive Care Unit: A Large-Scale Study and Literature Review. Anatol J Cardiol 2024; 28:44-54. [PMID: 38167795 PMCID: PMC10796247 DOI: 10.14744/anatoljcardiol.2023.3463] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Large-scale multicentric studies reported that, despite advances in diagnosis, antibiotics, and surgical treatment, infective endocarditis (IE) in-hospital mortality remains high. Most data have been obtained from patients treated in infective disease wards, internal medicine, cardiology, or cardiac surgery departments and are therefore heterogeneous. The few studies focused on complicated IE patients leading to intensive care unit (ICU) admission have reported different methodologies and results. The aim of our study was to describe the epidemiological, clinical, and microbial features of critically ill patients admitted to the ICU with a definite IE diagnosis. METHODS We conducted a prospective case-series population study from January 1, 1998, to December 31, 2020. Patients were divided into 2 groups: 'Ward' (group 1) and 'ICU' patients (group 2), and a 1-year follow-up was performed. RESULTS After performing a univariate and multivariate logistic regression analysis, we found that the independent predictors of ICU admission were vegetation diameter >10 mm, abnormal PaO2/FiO2 ratio, and acute heart failure. Five independent mortality risk factors were identified: SOFA score >14, not performing surgery, age >70 years, acute heart failure, and embolic complications. CONCLUSIONS Infective endocarditis in-hospital mortality remains high. ICU admission and mortality can be predicted by independent risk factors.
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Affiliation(s)
- Alberto Cresti
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
| | - Pasquale Baratta
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
| | | | - Elio Aloia
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
| | - Bruno Sposato
- Department of Pneumology, Misericordia Hospital, Grosseto, Italy
| | - Ugo Limbruno
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
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Sposato B, Petrucci E, Lacerenza GL, Micheletto C, Montagnani A, Alessandri M, Cresti A, Serafini A, Lena F, Scala R, Rogliani P, Perrella A, Scalese M. Sex differences in excessive oral corticosteroid exposure in poor adherent adult asthmatics overusing short-acting β-2 agonists. Minerva Med 2023; 114:642-651. [PMID: 34269554 DOI: 10.23736/s0026-4806.21.07645-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We know that excessive short-acting β2-agonists (SABA) use in asthma may be associated to high exacerbation risks. We studied whether such excessive SABA consumption is connected with different higher oral corticosteroid (OC) prescriptions in the two sexes. METHODS In our prescribing database, we searched subjects aged 18-40 years that were prescribed at least one SABA package/year and/or at least two ICS or two ICS/LABA boxes/year to identify asthmatics. Their OC prescriptions/year were also examined. Subjects were divided into 4 groups according to SABA packages/year prescribed (0, 1-2,3-6 and ≥7), considering sexes separately. RESULTS Individuals recruited were 9,102. Subjects with at least one OC prescription were higher in each group and were females (P<0.001). The OC packages/year number was also more elevated in women especially those with >7 SABA prescriptions/year (0.96 in males vs. 2.64 in females, P<0.001). 94.7%/93.6% males/females, who never used SABA, took at least one ICS/LABA (mean 5.84/5.48 packages/year), while the subject percentage adhering to ICS/LABA dropped to 28-47% (mean 0.94-3.82 packages/year) in those who used SABA (P<0.001). Higher SABA prescriptions were associated with an increasing OC dispensation (β=0.057, P<0.0001). We observed also a greater risk of using >3 OC packages/year in subjects with 3-6 (OR: 2.98 [95% CI: 2.19-4.06], P<0.001) and ≥7 (OR: 3.49 [95% CI: 2.39-5.10], P<0.001) SABA prescriptions compared to those that never used SABA. Besides, we found that using ICS (OR:0.51 [95% CI: 0.35-0.75], P<0.001) or ICS/LABA (OR:0.07 [95% CI: 0.05-0.09], P<0.001) may significantly reduce SABA prescriptions. CONCLUSIONS Poor adherence to maintenance treatment appears to associated with excessive SABA prescriptions that may lead to a higher OC consumption particularly noticeable in women.
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Affiliation(s)
- Bruno Sposato
- Department of Pneumology, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy -
- Experimental Medicine and Systems, Department of Systems Medicine, Tor Vergata University, Rome, Italy -
| | - Elisa Petrucci
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Gianluca L Lacerenza
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Claudio Micheletto
- Respiratory Unit, Cardio-Thoracic Department, Integrated University Hospital, Verona, Italy
| | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Massimo Alessandri
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Grosseto, Italy
| | - Alberto Cresti
- Department of Cardiology, Misericordia Hospital, USL Tuscany South-East, Grosseto, Italy
| | - Andrea Serafini
- Department Medical Management, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
| | - Fabio Lena
- Unit of Local Health, Pharmaceutical Department, USL Toscana Sud Est, Grosseto, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Antonio Perrella
- Department of Pneumology, Misericordia Hospital, Azienda USL Toscana Sud-Est, Grosseto, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Sposato B, Bianchi F, Ricci A, Scalese M. Clinical Asthma Remission Obtained with Biologics in Real Life: Patients' Prevalence and Characteristics. J Pers Med 2023; 13:1020. [PMID: 37374008 DOI: 10.3390/jpm13061020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/23/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The prevalence of clinical asthma remission with biologics in severe asthma has not been well understood yet. We do not even know whether there might be characteristics that identify subjects prone to remission of the disease. MATERIALS AND METHODS Retrospectively, four groups of severe asthmatics already treated with Omalizumab, Mepolizumab, Benralizumab and Dupilumab (302, 55, 95 and 34 patients, respectively) for at least 12 months were considered. The number of individuals with clinical asthma remission was sought in each group. This was considered when patients, after a treatment of at least 1 year with one of the aforesaid biologics, showed the disappearance of asthma symptoms (ACT ≥ 20), zero exacerbations, suspension of oral corticosteroids and a FEV1% ≥ 80%. Baseline characteristics of patients with and without remission were also taken into account. RESULTS The prevalence of asthma remission after a mean of 37.8 ± 19.2, 13.5 ± 1.7, 15.4 ± 5.5 and 12 ± 0 months of Omalizumab, Mepolizumab, Benralizumab and Dupilumab treatments was 21.8%, 23.6%, 35.8% and 23.5%, respectively. For each biologic, different baseline characteristics, seem to be associated with failure to achieve clinical asthma remission. Older age, higher BMI, a later age of asthma onset, rhinitis/sinusitis/nasal polyposis, comorbidities and a greater asthma severity may be the characteristics of a suboptimal response to biologic treatments. CONCLUSION All biologics have the potential to induce disease remission in severe asthmatics. For each biologic, there may be several markers that can identify the patients who will not achieve asthma remission. It would be important to detect them (by carrying out targeted studies) as they would allow us to select the best biologic that may induce clinical asthma remission on a larger number of patients.
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Via Senese 161, 58100 Grosseto, Italy
| | - Francesco Bianchi
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Via Senese 161, 58100 Grosseto, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, 00189 Rome, Italy
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, 56124 Pisa, Italy
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Sposato B, Serafini A, Simoncini E, Croci L, Guidoni C, Scalese M, Baratta P, Cresti A, Lacerenza LG, Lena F, Nencioni C, Spargi G, Perrella A. COVID-19 severity appears to be reduced in spring/summer. Epidemiol Prev 2023; 47:34-46. [PMID: 36971236 DOI: 10.19191/ep23.1.a503.016] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND because of different human behaviours, SARS-CoV-2 spread may be lower in spring/summer. On the contrary, it is not clearly known whether the clinical course/severity of hospitalized patients infected by SARS-CoV-2 can be different in the various seasons.. OBJECTIVES to understand whether there were differences in severity of COVID-19 in patients who had contracted the infection in winter versus those infected in spring/summer. DESIGN observational retrospective cohort study. SETTING AND PARTICIPANTS from the administrative database of the SARS-CoV-2 surveillance system and that of hospital discharge, a cohort of patients (8,221, 653 of which were hospitalized) who tested positive to the RT-PCR test for SARS-CoV-2 between 01.12.2020 and 31.07.2021 in the Grosseto province (Tuscany Region, Central Italy) was selected and analysed. MAIN OUTCOME MEASURES hospitalization rate and length, continuous positive airway pressure (CPAP) or non-invasive ventilation (NIV) use, Intensive Care Unite (ICU) admissions, intra-hospital mortality and PaO2/FiO2 values were measured and compared between subjects infected in winter and those who developed COVID-19 in spring/summer. Viral load (cycle threshold, Ct), vitamin D, serum ferritin, IL-6, procalcitonin, D-dimer, and C-reactive protein measured in the two periods were also compared. RESULTS in the considered months, the hospitalization rate among 8,221 patients with COVID-19 was 8%: 370 (8.5%) individuals were hospitalized in winter and 283 (7,3%; p=0.31) in spring/summer; 62 (16.8%), 88 (23.8%), and 63 (17%) in winter and 28 (9.9%), 40 (14.1%), and 36 (12.7%) in spring/summer were admitted in ICU (p=0.01), used CPAP/NIV (p=0.002) and died (p=0.13), respectively. Hospitalization days were 14.5±11.6 in winter and 10.3±8.84 in spring/summer (p=0.001), while minimum PaO2/FiO2, measured during hospital stays was 123.2±38.6 in spring/summer and 112.6±40.8 in winter (p=0.054). Multivariate analysis (adjusted for all confounding factors) also confirmed reduced risks of having ICU admissions (0.53; 95%CI 0.32;0.88; p=0.01) and of using CPAP/NIV (0.48; 95%CI 0.32;0.75; p=0.001) in spring/summer when compared to winter. Hospitalization days and minimum PaO2/FiO2 were also lower in spring/summer (β= -3.9; 95%CI -5.5;-2.2; p=0.001) and winter (β= -17; 95%CI -0.93;35; p=0.06), respectively. The adjusted hazard ratio of mortality in winter, obtained with a Cox model, was higher of about 38% compared to spring/summer. No Ct values (viral load) differences were found either in winter (19.45±6.18) or spring/summer (20.3±6.7; p=0.343). IL-6, ferritin, procalcitonin, D-dimer were similar. Conversely, CRP was lower whereas vitamin D was higher in the warmer seasons. CONCLUSIONS COVID-19 may be less severe during spring/summer in hospitalized patients. This does not seem to be influenced by different SARS-CoV-2 viral load in the different periods considered. C-reactive protein was found to be lower whereas vitamin D higher in the warmer months. It can be hypothesized that higher levels of vitamin D in spring/summer, compared to winter, may be associated to a positive modulation of COVID-19 induced inflammation with a possible disease severity reduction during spring/summer.
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy);
| | - Andrea Serafini
- Medical Management Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Enrico Simoncini
- Medical Management Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Leonardo Croci
- Infectious Disease Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Chiara Guidoni
- Infectious Disease Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Marco Scalese
- Institute of Clinical Physiology, Italian National Research Council, Pisa (Italy)
| | - Pasquale Baratta
- Cardiology Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Alberto Cresti
- Cardiology Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Leonardo Gianluca Lacerenza
- Department of Pharmaceutical Medicine, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Fabio Lena
- Department of Pharmaceutical Medicine, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Cesira Nencioni
- Infectious Disease Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Genni Spargi
- Intensive Care Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
| | - Antonio Perrella
- Pneumology Department, Local Health Unit 'Sud-Est', 'Misericordia' Hospital, Grosseto (Italy)
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5
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Sposato B, Ricci A, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Pelaia G, Palmiero G, Di Tomassi M, Ronchi MC, Cameli P, Bargagli E, Ciambellotti L, Rizzello S, Sglavo R, Coppola A, Lacerenza LG, Gabriele M, Radovanovic D, Perrella A, Rogliani P, Scalese M. Influence of allergic status and nasal polyposis on long-term Benralizumab response in eosinophilic severe asthma. Clin Ter 2023; 174:67-74. [PMID: 36655647 DOI: 10.7417/ct.2023.2499] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective It is unclear whether Benralizumab effectiveness in severe eosinophilic asthma can be influenced by nasal polyposis (NP) or allergic status associations. We evaluated whether Benralizumab long-term efficacy in asthma outcomes could be different in subjects with atopy (SAEA) compared to the effectiveness in those without allergies (SNAEA) and in individuals with NP compared to those without NP. Methods This observational retrospective study considered 95 consecutive patients divided into allergic (SAEA; n:65[68.4%]; skin prick tests positive [SPT] and/or IgE values ≥100 UI/mL), and non-allergic (SNAEA; n:30[31.6%], SPT negative and normal IgE levels<100 UI/mL). Overall population was also divided into two groups according to NP presence (NP+:39[41%] and NP-:56[59%]). Benralizumab treatment mean was19.7±7.2 months (range 12-35). Results No differences in Benralizumab effectiveness were found in asthma outcomes in patients with/without NP. SNOT-22 improvement was higher in NP+ (-22±24) compared to NP- groups (6.33±15.5;p=0.055). FEV1 (16.33±19.22%), ACT(7.45±3.95) increases and frequency of SABA use (3.37±4.99) reduction were higher in SAEA compared to what obtained in non-allergic subjects (FEV1:8.15±15.6%,p=0.043; ACT:4.89±3.57,p=0.005; SABA use:-1.16±1.84;p=0.015). 93.8% of SAEA patients whereas only 72.2% of SNAEA individuals reduced OC doses at least half after Benralizumab (p=0.035). These results were partially confirmed by linear regression models showing associations between allergic status and FEV1, ACT and SABA use changes (β=8.37;p=0.048, β=2.056;p=0.033 and β=-2.184;p=0.042 respectively). Conclusion Benralizumab effectiveness in asthma appears to be independent of NP presence. The allergic eosinophilic disease, compared to just eosinophilic asthma, may be a more severe phenotype. Benralizumab may have greater efficacy in SAEA on some outcomes.
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Affiliation(s)
- B Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - G E Carpagnano
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - C Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - G Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - G Palmiero
- Pneumology Department, Azienda USL Toscana Nord Ovest, "Versilia" Hospital, Lido di Camaiore (LU), Italy
| | - M Di Tomassi
- Pneumology Department, Azienda USL Toscana Sud-Est, "S. Andrea" Hospital, Massa Marittima (GR), Italy
| | - M C Ronchi
- Pneumology Department, Azienda USL Toscana Sud-Est, "S. Andrea" Hospital, Massa Marittima (GR), Italy
| | - P Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - L Ciambellotti
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - S Rizzello
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - R Sglavo
- Division of Pneumology, De-partment of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - A Coppola
- Division of Respiratory Disease, San Filippo Neri Hospital, Rome, Italy
| | - L G Lacerenza
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - M Gabriele
- Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
| | - D Radovanovic
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - A Perrella
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - P Rogliani
- Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
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De Vitis C, D’Ascanio M, Sacconi A, Pizzirusso D, Salvati V, Mancini M, Scafetta G, Cirombella R, Ascenzi F, Bruschini S, Esposito A, Castelli S, Salvucci C, Teodonio L, Sposato B, Catizone A, Di Napoli A, Vecchione A, Ciliberto G, Sciacchitano S, Ricci A, Mancini R. B4GALT1 as a New Biomarker of Idiopathic Pulmonary Fibrosis. Int J Mol Sci 2022; 23:ijms232315040. [PMID: 36499368 PMCID: PMC9738382 DOI: 10.3390/ijms232315040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a disease characterized by progressive scarring of the lung that involves the pulmonary interstitium. The disease may rapidly progress, leading to respiratory failure, and the long-term survival is poor. There are no accurate biomarkers available so far. Our aim was to evaluate the expression of the B4GALT1 in patients with IPF. Analysis of B4GALT1 gene expression was performed in silico on two gene sets, retrieved from the Gene Expression Omnibus database. Expression of B4GALT1 was then evaluated, both at the mRNA and protein levels, on lung specimens obtained from lung biopsies of 4 IPF patients, on one IPF-derived human primary cell and on 11 cases of IPF associated with cancer. In silico re-analysis demonstrated that the B4GALT1 gene was overexpressed in patients and human cell cultures with IPF (p = 0.03). Network analysis demonstrated that B4GALT1 upregulation was correlated with genes belonging to the EMT pathway (p = 0.01). The overexpression of B4GALT1 was observed, both at mRNA and protein levels, in lung biopsies of our four IPF patients and in the IPF-derived human primary cell, in other fibrotic non-lung tissues, and in IPF associated with cancer. In conclusion, our results indicate that B4GALT1 is overexpressed in IPF and could represent a novel marker of this disease.
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Affiliation(s)
- Claudia De Vitis
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | | | - Andrea Sacconi
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Dario Pizzirusso
- UOC Respiratory Disease, Sant’Andrea Hospital, 00189 Rome, Italy
| | - Valentina Salvati
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Massimiliano Mancini
- Morphologic and Molecular Pathology Unit, S. Andrea University Hospital, 00189 Rome, Italy
| | - Giorgia Scafetta
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Roberto Cirombella
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Francesca Ascenzi
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Sara Bruschini
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Antonella Esposito
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Silvia Castelli
- UOC Respiratory Disease, Sant’Andrea Hospital, 00189 Rome, Italy
| | - Claudia Salvucci
- UOC Respiratory Disease, Sant’Andrea Hospital, 00189 Rome, Italy
| | - Leonardo Teodonio
- Division of Thoracic Surgery, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Bruno Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, “Misericordia” Hospital, 58100 Grosseto, Italy
| | - Angela Catizone
- Department of Anatomy, Histology, Forensic-Medicine and Orthopedics, Sapienza University of Rome, 00161 Rome, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Andrea Vecchione
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
- Correspondence:
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University of Rome “Sapienza”, 00185 Rome, Italy
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7
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Pelaia G, Palmiero G, Di Tomassi M, Ronchi MC, Cameli P, Bargagli E, Ciambellotti L, Rizzello S, Sglavo R, Coppola A, Lacerenza LG, Gabriele M, Radovanovic D, Perrella A, Ricci A, Rogliani P. Severe asthma and long-term Benralizumab effectiveness in real-life. Eur Rev Med Pharmacol Sci 2022; 26:7461-7473. [PMID: 36314316 DOI: 10.26355/eurrev_202210_30016] [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: 03/31/2023]
Abstract
OBJECTIVE Long-term efficacy of Benralizumab in real life is not clearly known. We assessed the long-term effectiveness persistence to anti-IL-5R treatment in a group of severe eosinophilic asthmatics. PATIENTS AND METHODS We retrospectively analyzed 95 individuals affected by severe asthma (36 males ̶ 37.9%; mean age 58.1 ± 12.2) treated with Benralizumab (mean time 19.7 ± 7.2 months, range 12-35). Outcomes were evaluated at the beginning and at the end of patients' treatment periods. RESULTS Mean baseline blood eosinophils were 897.5 ± 720.1 cells/μL (11 ± 5.6%) decreasing to 7.4 ± 20.6 cells/μL (0.97 ± 0.26%; p < 0.0001) after Benralizumab. FENO likewise decreased from 63.9 ± 68.4 to 28.4 ± 23.6 ppb, while FEV1% significantly improved (p < 0.0001). Mean FEF25-75 also increased from 45.8 ± 24.6% to 60.7 ± 24.6%, whereas RAW dropped from 202.15 ± 109.6% to 135.2 ± 54.75% (p < 0.0001). Also, lung volumes greatly decreased. ACT/ACQ significantly improved, while exacerbations number fell from 4.1 ± 2.4, before anti-IL-5R, to 0.33 ± 0.77, after treatment (p < 0.0001). Rhinitis severity levels and SNOT-22 also changed favorably. Patients that took long-term OCs were 71.6% before treatment, decreasing to 23.2% after Benralizumab (p < 0.0001), with an OCs dose reduction from 14.8 ± 8.9 to 1.45 ± 2.8 mg/day (p < 0.0001). 51.6% of subjects used SABA as needed before Benralizumab, falling to 4.2% after treatment. Several patients showed a reduction of ICS doses, SABA use and maintenance therapy step-down. Clinical/biological response with anti-IL-5R remained constant or even improved in terms of exacerbations or maintenance therapy reductions over time. On the contrary, FEF25-75% improvement slowed down in the long-term. No relationship was found between baseline blood eosinophil number and therapeutic response. CONCLUSIONS Long-term Benralizumab effectiveness persistence in all outcomes in real life was confirmed.
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Affiliation(s)
- B Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy.
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Sims JT, Chang CY, Poorbaugh J, Daniels M, Beasley SL, Zhang L, Rodgers GH, Lena F, Lacerenza LG, Sposato B, Dupont A, Susen S, Casalini G, Corbellino M, Stebbing J, Krishnan V. Longitudinal assessment of systemic steroid therapy on hyperinflammatory endothelial biomarker profiles and serology responses of COVID-19 patients. Lab Invest 2022; 20:411. [PMID: 36076201 PMCID: PMC9458306 DOI: 10.1186/s12967-022-03583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Jonathan T Sims
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Ching-Yun Chang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Josh Poorbaugh
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Montanea Daniels
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | - Lin Zhang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - George H Rodgers
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Fabio Lena
- Department of Pharmaceutical Medicine, Misericordia Hospital, Grosseto, Italy
| | | | - Bruno Sposato
- Department of Pharmaceutical Medicine, Misericordia Hospital, Grosseto, Italy
| | - Annabelle Dupont
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, University of Lille, 59000, Lille, France
| | - Sophie Susen
- Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, University of Lille, 59000, Lille, France
| | - Giacomo Casalini
- Luigi Sacco Department of Clinical and Biomedical Sciences, University of Milan, Milan, Italy
| | - Mario Corbellino
- Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Venkatesh Krishnan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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Sposato B, Petrucci E, Lena F, Lacerenza LG, Bindi M, Montagnani A, Perrella A, Scalese M. Should a prescription database be used to search uncontrolled severe asthmatics? Adv Respir Med 2022; 90:ARM.a2022.0019. [PMID: 35099058 DOI: 10.5603/arm.a2022.0019] [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: 08/09/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Many uncontrolled severe asthmatics are not on biologic therapy. We hypothesized that using a prescription database could help us identify them. MATERIAL AND METHODS 3,309 patients who received at least one Montelukast prescription in 2019 were extracted from our prescription database. Number of packages/year, types and dosages of ICS, LABA, ICS/LABA, LAMA and monoclonal antibodies were considered for each patient. In our analysis, for subjects that took > 7 packages of ICS/LABA + LTRA +/- LAMA (high adherent) the number of oral corticosteroids (OC) packets prescribed for each of them was also looked upon. RESULTS Patients that took ICS/LABA or ICS/LABA + LAMA continuously with high ICS doses were 188 (25.6%) and 117 (39.3%) respectively (total: 305 - 29.5%). Among them, 58 (30.9%) and 53 (45.3%) (total: 111 - 36.4%) were prescribed more than 2 OC packages. Whereas, 21 (11.2%) and 24 (20.5%) patients (total: 45 - 14.75%) received at least 4 OC package prescriptions. CONCLUSION Approximately 36% of patients in continuous step-4/5 of GINA guidelines treatment may have severe uncontrolled asthma (overusing OC) which needed biologic treatment. In our opinion, a prescription archiving database may be a tool that can help us identify such uncontrolled asthma patients.
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy.
- Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Italy.
| | - Elisa Petrucci
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Fabio Lena
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Leonardo Gianluca Lacerenza
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | | | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Italy
| | - Antonio Perrella
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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10
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Sposato B, Petrucci E, Serafini A, Lena F, Lacerenza LG, Montagnani A, Alessandri M, Cresti A, Scala R, Rogliani P, Ricci A, Perrella A, Scalese M. Which LABA/LAMA should be chosen in COPD patients in real life? Pulm Pharmacol Ther 2021; 71:102076. [PMID: 34530132 DOI: 10.1016/j.pupt.2021.102076] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/16/2021] [Accepted: 09/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Given COPD heterogeneity, we do not know if some LABA/LAMAs are more suitable for some COPD phenotypes. This real-life database study aimed to evaluate retrospectively the 4 LABA/LAMA effectiveness and highlight possible specificities that could better guide us in choosing the right LABA/LAMA to be used. METHODS We searched for subjects (1,779) adherent to umeclidinium/vilanterol (UM/VI), indacaterol/glycopyrronium (IND/GLY), aclidinium/formoterol (ACLI/FOR) and tiotropium/olodaterol (TIO/OLO) treatments in our prescribing/dispensing database. Prescriptions for systemic corticosteroids (SC), antibiotics and salbutamol during one year of LABA/LAMA treatment were analyzed. RESULTS A better adherence was found in individuals taking IND/GLY (10.42 ± 1.86 packages/year) compared with UM/VI (10.09 ± 1.9; p = 0.008), ACLI/FOR (9.8 ± 1.8; p = 0.001) and TIO/OLO (10.1 ± 2.1; p = 0.047). The number of patients that were prescribed at least one package of SC/year and their package numbers/year were similar in males/females, across age groups and in "non-frequent exacerbators" with the 4 LABA/LAMAs. More SC were taken by frequent exacerbators, whereas fewer SC/antibiotic packages were prescribed to subjects aged >80 years with all treatments. In patients treated with ACLI/FOR or TIO/OLO, lower risks to having antibiotic prescriptions were observed when UM/VI (0.698[0.516-0.945] and 0.696[0.491-0.985; p = 0.020 and p = 0.041) and IND/GLY (0.597[0.445-0.802] and 0.595[0.423-0.836]; p = 0.001 and p = 0.003) were considered as landmarks. Lower risks for salbutamol prescriptions were detected with UM/VI (0.678[0.480-0.958]; p = 0.027) and TIO/OLO (0.585[0.365-0.937]; p = 0.026) when ACLI/FOR was used as a reference. CONCLUSION According to our retrospective database study, each LABA/LAMA could have a specific efficacy profile in COPD that might be considered for personalized therapy. However, head-to-head targeted trials aimed to assess the impact of different LABA/LAMAs on COPD are needed to confirm/disprove such results.
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy.
| | - Elisa Petrucci
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Andrea Serafini
- Medical Management Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Fabio Lena
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Leonardo Gianluca Lacerenza
- Department of Pharmaceutical Medicine, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Andrea Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Italy
| | - Massimo Alessandri
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Italy
| | - Alberto Cresti
- Cardiology Department, "Misericordia" Hospital, Grosseto, USL Tuscany South-East, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S Donato Hospital, Arezzo, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy; Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Antonio Perrella
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital, Grosseto, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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Sposato B, Croci L, Di Tomassi M, Puttini C, Olivieri C, Alessandri M, Ronchi MC, Donati E, Garcea A, Brazzi A, Migliorini MG, Chigiotti S, Nikiforakis N, Carli T, Canneti E, Strambio F, Cellini C, Nardangeli C, Allegri MP, Bianchi F, Bettini C, Perruzza M, Lanzarone N, Valentini L, Orselli P, Solari M, Cardaci S, Nofri M, Angeli G, Mangani F, Aloia E, Lanari A, Corridi M, Spargi G, Perrella A, Nencioni C. Spontaneous abdominal bleeding associated with SARS-CoV-2 infection: causality or coincidence? Acta Biomed 2021; 92:e2021199. [PMID: 33988163 PMCID: PMC8182584 DOI: 10.23750/abm.v92i2.10142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 03/29/2021] [Indexed: 01/27/2023]
Abstract
Authors present 6 cases of abdominal bleeding associated with COVID-19, representing 1.35% of all hospitalized COVID-19 patients and hypothesize that there could be, although not very frequently, a relationship between SARS-CoV2 and bleeding. They excluded a side effect of the low molecular weight heparin therapy that all patients underwent during the course of the disease or other possible causes. Alterations of the coagulation state or a weakness of the vascular wall due toa presumed endotheliitis SARS-CoV-2 infection induced, are hypothesized by the authors. Investigation and follow-up for possible hemorrhagic problems in patients with COVID-19 is recommended. In particular, clinicians should be vigilant about retroperitoneal hemorrhage in COVID-19 patients. In addition to the fact that these patients are being treated with anticoagulants, anemia and abdominal pain are the signs that should lead us to suspect this type of haemorrhage. More studies are needed to understand if COVID-19 can be directly associated with bleeding. (www.actabiomedica.it)
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata".
| | - Leonardo Croci
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | | | | | - Elisa Donati
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | | | | | - Tiziana Carli
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | - Claudia Nardangeli
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | | | - Francesco Bianchi
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Claudio Bettini
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy; Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | - Marco Perruzza
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Nicola Lanzarone
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Lucia Valentini
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Paolo Orselli
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marco Solari
- Cardiology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Salvatore Cardaci
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marco Nofri
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Giorgia Angeli
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Francesca Mangani
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Elio Aloia
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Alessandro Lanari
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marta Corridi
- Intensive Care Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Genni Spargi
- Intensive Care Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Antonio Perrella
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Cesira Nencioni
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
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Montagnani A, Mathieu G, Pomero F, Bertù L, Manfellotto D, Campanini M, Fontanella A, Sposato B, Dentali F. Hospitalization and mortality for acute exacerbation of chronic obstructive pulmonary disease (COPD): an Italian population-based study. Eur Rev Med Pharmacol Sci 2021; 24:6899-6907. [PMID: 32633383 DOI: 10.26355/eurrev_202006_21681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Patients with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) have a significant mortality and morbidity. Previous studies have identified a number of independent prognostic factors. However, information on hospital admission databases is limited and data regarding short-term prognosis of these patients in Italian hospitals are lacking. Thus, we performed an epidemiological study on hospital admission for COPD acute exacerbation in Italy. PATIENTS AND METHODS Patients were identified using clinical Modification (ICD-9-CM) codes. Information was collected on baseline characteristics, vital status at discharge, duration of hospitalization, and up to five secondary discharge diagnoses. Comorbidity was evaluated using the Charlson comorbidity index (CCI). RESULTS During the observation period (2013-2014), 170,684 patients with COPD acute exacerbation were hospitalized. Mean length of hospitalization (LOH) was 9.95±8.69 days and mean in-hospital mortality was 5.30%. These data correspond to the 4.1% of all hospitalizations and to the 2.8% of all the days of hospitalization in Italy during the study period. In-hospital mortality and LOH varied among different regions (from 3.13 to 7.59% and from 8.22 to 11.28 days respectively). Old age, male gender, low discharge volume, previous hospitalization for COPD exacerbation and CCI resulted as significantly associated with higher in-hospital mortality. CONCLUSIONS Hospitalization for COPD exacerbation is extremely frequent even in contemporary Italian population. COPD exacerbation is clinically demanding with a not negligible short-term mortality rate and a mean LOH approaching 10 days. These latter findings were quite variable in different regions but should be further analyzed to set up appropriate health-care policies on COPD patients.
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Affiliation(s)
- A Montagnani
- Department of Internal Medicine and Specialties, USL Tuscany South-East, Italy.
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13
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Ricci A, Pagliuca A, D'Ascanio M, Innammorato M, De Vitis C, Mancini R, Giovagnoli S, Facchiano F, Sposato B, Anibaldi P, Marcolongo A, De Dominicis C, Laghi A, Muscogiuri E, Sciacchitano S. Circulating Vitamin D levels status and clinical prognostic indices in COVID-19 patients. Respir Res 2021; 22:76. [PMID: 33658032 PMCID: PMC7928197 DOI: 10.1186/s12931-021-01666-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Several immune mechanisms activate in COVID-19 pathogenesis. Usually, coronavirus infection is characterized by dysregulated host immune responses, interleukine-6 increase, hyper-activation of cytotoxic CD8 T lymphocytes. Interestingly, Vitamin D deficiency has been often associated with altered immune responses and infections. In the present study, we evaluated Vitamin D plasma levels in patients affected with different lung involvement during COVID-19 infection. METHODS Lymphocyte phenotypes were assessed by flow cytometry. Thoracic CT scan involvement was obtained by an image analysis program. RESULTS Vitamin D levels were deficient in (80%) of patients, insufficient in (6.5%) and normal in (13.5%). Patients with very low Vitamin D plasma levels had more elevated D-Dimer values, a more elevated B lymphocyte cell count, a reduction of CD8 + T lymphocytes with a low CD4/CD8 ratio, more compromised clinical findings (measured by LIPI and SOFA scores) and thoracic CT scan involvement. CONCLUSIONS Vitamin D deficiency is associated with compromised inflammatory responses and higher pulmonary involvement in COVID-19 affected patients. Vitamin D assessment, during COVID-19 infection, could be a useful analysis for possible therapeutic interventions. TRIAL REGISTRATION 'retrospectively registered'.
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Affiliation(s)
- Alberto Ricci
- Respiratory Unit, Sant'Andrea Hospital, Sapienza University of Rome, Via di grottarossa, 1035, Rome, Italy.,Sant'Andrea Hospital, Rome, Italy
| | - Alessandra Pagliuca
- Respiratory Unit, Sant'Andrea Hospital, Sapienza University of Rome, Via di grottarossa, 1035, Rome, Italy.,Sant'Andrea Hospital, Rome, Italy
| | - Michela D'Ascanio
- Respiratory Unit, Sant'Andrea Hospital, Sapienza University of Rome, Via di grottarossa, 1035, Rome, Italy.,Sant'Andrea Hospital, Rome, Italy
| | - Marta Innammorato
- Respiratory Unit, Sant'Andrea Hospital, Sapienza University of Rome, Via di grottarossa, 1035, Rome, Italy. .,Sant'Andrea Hospital, Rome, Italy.
| | | | | | | | - Francesco Facchiano
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Bruno Sposato
- Respiratory Unit, Misericordia Hospital, Grosseto, Italy
| | | | | | | | | | | | - Salvatore Sciacchitano
- Respiratory Unit, Sant'Andrea Hospital, Sapienza University of Rome, Via di grottarossa, 1035, Rome, Italy.,Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
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Scalese M, Trivellini G, Sposato B. Public health and clinical approach to proactive Prevalence of symptoms-based diagnosis of mild SARS-CoV-2 infection in southern Tuscany. Ann Ig 2021; 33:533-542. [PMID: 33565568 DOI: 10.7416/ai.2021.2435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background To date, it is unknown how many Italians have had or have a mild SARS-CoV-2 infection, because of the lack of epidemiological studies involving the general population. Study design Aim of this study was to investigate the prevalence/incidence of a symptoms-based mild SARS-CoV-2 infection in southern Tuscany, by using an online survey. Methods An anonymous random middle-aged sample of 3,460 individuals completed the survey. A symptom-score ≥5, calculated on 195 patients with RT-PCR COVID-19 disease (sensitivity/specificity of 0.815/0.780 respectively) was used for the diagnosis. Results This cut-off highlighted that 12.3% of all the population might have had a SARS-CoV-2 infection, while 3.9% of them might have it at the time of the survey. Female sex (OR=1.334 [1.029-1.728]; p=0.030), obesity status (OR=1.961 [1.304-2.949]; p=0.001), asthma (OR=2.035 [1.433-2.890]; p=0.0001), autoim-mune diseases (OR=2.103 [1.381-3.201]; p=0.001), were all risk factors for showing mild SARS-CoV-2 infection. Instead, the elderly had a low probability to develop mild forms of the disease (OR=0.984 [0.975-0.994]; p=0.001). Conclusion A remarkable number of subjects in Southern Tuscany may have already had a mild SARS-CoV-2 infection. Symptoms scores might be used to screen subjects with a suspected infection. Female sex, obesity, asthma, autoimmune diseases may be factors linked with mild forms of COVID-19 disease.
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Affiliation(s)
- M Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - G Trivellini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - B Sposato
- Pneumology Department, "Misericordia" Hospital, Grosseto, Italy
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15
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Sposato B, Scalese M, Ricci A, Rogliani P, Paggiaro P. Persistence of both reversible airway obstruction and higher blood eosinophils may predict lung function decline in severe asthma. Clin Respir J 2021; 15:237-243. [PMID: 33400385 DOI: 10.1111/crj.13325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study analysed whether the persistence of both reversible airway obstruction (RAO) and elevated BE counts was associated to reduced asthma control and accelerated lung function decline in treated severe asthmatics. METHODS About 202 severe asthmatics were studied after 12-120 months of step-5 treatment associated to anti-IgE therapy. Following treatments, reversibility tests, after inhaling 400 mcg of Salbutamol, were performed. FEV1 > 12% or ≤12% changes differentiated RAO+ from RAO- subjects. Blood eosinophil (BE) counts after treatment were considered. RESULTS Pre-/post-treatment bronchodilator FEV1 % and ACT were lower (61% [50-71], 74.4% [62.5-83.7] and 20[18-22]), whereas BE were higher (380 cells/µl [170-590]) in RAO+ compared to RAO- subjects (77% [64-88], p = 0.0001, 81.8% [66.1-94.3], p = 0.0001, 21[18-23], p = 0.045 and 230 cells/µl [80-360], p = 0.003). A negative relationship between SABA-induced FEV1 % changes and pre-bronchodilator FEV1 % (β = -0.551%; p = 0.0001) and ACT (β = -0.059; p = 0.038) was found. Conversely, post-treatment BE levels were positively related (β = 145.565 cells/µl; p = 0.003) to FEV1 > 12% increases. A rising trend of pre-/post-bronchodilator FEV1 % in time was observed in RAO- subjects with BE < 300 cells/µl. Conversely, we highlighted significant declining tendencies of pre/post-bronchodilator FEV1 % in RAO+ patients with BE > 300 cells/µl reaching lower values after more than 36 months of step-5 treatment (59.6% [39.9-72.1] vs 74[66.5-89.2] of RAO+ individuals with BE < 300 cells/µl [p = 0.026] and 81.6% [66.1-91.8] of RAO-subjects with BE > 300 cells/µl [p = 0.009]). CONCLUSION Persistent SABA-induced FEV1 > 12%, especially when associated to BE > 300 cells/ml, may be a marker of accelerated lung function decline in severe asthmatics despite maximal step-5 treatment. The highest bronchodilation associated to the lowest BE levels should be the main goal of asthma treatment to prevent such decline.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy.,Experimental Medicine and Systems, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Paola Rogliani
- Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
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16
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Paggiaro P, Rogliani P. Mepolizumab Effectiveness and Allergic Status in Real Life. Int Arch Allergy Immunol 2020; 182:311-318. [PMID: 33113532 DOI: 10.1159/000511147] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. OBJECTIVE We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. METHOD We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97-72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37-27.6%). They had taken mepolizumab for at least 6 months. RESULTS After 10.9 ± 3.7 months, improvements in FEV1%, FEF25-75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), observed after treatment, were similar in both groups. Only Asthma Control Test (ACT) increases were higher in SNAEA (8 [5-9]) than in SAEA (5 [2.5-8.5]; p = 0.016). However, no differences were found after treatment in percentages of subjects with ACT ≥20, as well as with FEV1 >80%, FEF25-75 >65%, exacerbations ≤2, BE <300 cells/µL, and FENO <25 ppb between SAEA and SNAEA. Besides, no significant relationships were found, comparing SNAEA with SAEA, for FEV1% (β = -0.110; p = 0.266), FEF25-75% (β = -0.228; p = 0.06), BE counts (β = -0.012; p = 0.918), FENO (β = 0.234; p = 0.085), ACT (β = 0.046; p = 0.660), and exacerbations (β = -0.070; p = 0.437). No different associations between lung function and SNAEA occurrence when compared to SAEA condition (FEV1 >80%: OR = 1.04 [95% CI: 0.43-2.55], p = 0.923; FEF25-75 >65%: OR = 0.41 [95% CI: 0.08-2.03], p = 0.272) were detected. Neither all other parameters, such as ACT >20 (OR = 0.73 [95% CI: 0.32-1.63], p = 0.440), presence of exacerbations (OR = 1.35 [95% CI: 0.55-3.27], p = 0.512), SABA discontinuation (OR = 1.16 [95% CI: 0.40-3.39], p = 0.790), and OC cessation/reduction (OR = 3.44 [95% CI: 0.40-29.27], p = 0.258), were differently associated with 1 or the other phenotype. CONCLUSION Mepolizumab can be considered as a valid therapeutic choice for either allergic or nonallergic SEA in real life.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy, .,Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy,
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Corrado Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Division of Pulmonary Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, Telese Terme, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Girolamo Pelaia
- Section of Respiratory Diseases, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplant Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.,Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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17
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Scalese M, Sposato B. An epidemiological study on COVID-19 should be carried out: With a serological test, a pharyngeal swab or both? J Infect Public Health 2020; 13:1680-1681. [PMID: 33055004 PMCID: PMC7522694 DOI: 10.1016/j.jiph.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/01/2020] [Accepted: 09/13/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marco Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy
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18
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Sposato B, Scalese M, Camiciottoli G, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Corsico A, Grosso A, Baglioni S, Murgia N, Folletti I, Pelaia G, Masieri S, Cavaliere C, Musarra A, Bargagli E, Ricci A, Latorre M, Rogliani P, Paggiaro P. Real-life Mepolizumab effectiveness in severe eosinophilic asthmatics with nasal polyposis. Respir Med Res 2020; 78:100791. [PMID: 33039948 DOI: 10.1016/j.resmer.2020.100791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- B Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy.
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - G Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - G E Carpagnano
- Institute of Respiratory Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - C Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - M Maniscalco
- Institute Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Istitute of Telese, 82037 Telese Terme (BN), Italy
| | - A Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - A Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Pavia, Italy
| | - S Baglioni
- Pneumology Department, Perugia Hospital, Perugia, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - I Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - G Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - S Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C Cavaliere
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - A Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - M Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - P Rogliani
- Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata", Rome, Italy; Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Rome, Italy
| | - P Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
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19
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Cavaliere C, Begvarfaj E, Incorvaia C, Sposato B, Brunori M, Ciofalo A, Greco A, de Vincentiis M, Masieri S. Long-term omalizumab efficacy in allergic rhinitis. Immunol Lett 2020; 227:81-87. [PMID: 32798500 DOI: 10.1016/j.imlet.2020.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Omalizumab therapy was found to be safe and effective as an add-on therapy for patients with poorly controlled severe asthma. Although several studies over the last decade have demonstrated its efficacy in other Immunoglobulin E related diseases, its use in such conditions is off-label. OBJECTIVE This study aimed to assess the effectiveness of long-term therapy with Omalizumab in patients with persistent severe allergic rhinitis and inadequately controlled severe asthma. METHODS Patients with poorly controlled severe asthma and persistent allergic rhinitis were enrolled and treated with Omalizumab for 36 months with every four-week subcutaneous administration. The efficacy assessment included the severity of AR symptoms every six months using Visual Analogue Scale, Asthma Control Test, nasal endoscopy, spirometry, and biomarkers (blood eosinophils and neutrophils, fractional exhaled nitric oxide, total IgE). RESULTS Eleven patients aged between 26 and 70 years were enrolled, and 10 completed the study. A significant improvement of allergic rhinitis symptoms, Asthma Control Test, and lung function was observed. There was also a reduction in the status of the biomarkers at the end of the study. CONCLUSION Long-term therapy with Omalizumab was effective and safe in treating severe persistent allergic rhinitis and concomitant asthma.
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Affiliation(s)
- Carlo Cavaliere
- Department of Oral and Maxillo-Facial Sciences, Sapienza University, Piazzale Aldo Moro, 5, 00185, Rome, Italy.
| | - Elona Begvarfaj
- Integrated Activity Head Neck Department, Federico II University, Naples, Italy
| | | | - Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy
| | - Marco Brunori
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Andrea Ciofalo
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillo-Facial Sciences, Sapienza University, Piazzale Aldo Moro, 5, 00185, Rome, Italy
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20
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Sposato B, Scalese M. Why do children seem to be more protected against COVID-19? A hypothesis. Med Hypotheses 2020; 143:110151. [PMID: 32763661 PMCID: PMC7392903 DOI: 10.1016/j.mehy.2020.110151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 01/23/2023]
Abstract
Today it remains unclear why children seem to be less likely to get infected by COVID-19 or why they appear to be less symptomatic after infections. All individuals, especially children, are exposed to various viruses including human coronavirus (CoVs) that can generally lead to respiratory infections. We hypothesize that recurrent CoVs exposure may induce an effective antiviral B and T-cell-mediated adaptive immune response, which could also be protective against COVID-19. Based on the high-homology between the Spike protein epitopes of taxonomically-related coronaviruses, we theorize that past/recurrent contact with CoVs might shield children also against the circulating COVID-19 through a possible neutralizing antibody response previously CoVs-induced. This would open up possible lines of research for the development of live-attenuated virus vaccines from CoVs. Future research is desirable to confirm or disprove such hypothesis.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est, Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy.
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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21
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Sposato B, Scalese M, Rogliani P. Seasonal monitoring of serum IgE and blood eosinophil variability may lead to a better severe asthma phenotyping and to a correct biologic prescription. J BIOL REG HOMEOS AG 2020; 34:315-318. [PMID: 32538068 DOI: 10.23812/19-429-l-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto.,Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata"
| | - M Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | - P Rogliani
- Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata".,Respiratory Unit, department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
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22
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Sposato B, Camiciottoli G, Bacci E, Scalese M, Carpagnano GE, Pelaia C, Santus P, Maniscalco M, Masieri S, Corsico A, Scichilone N, Baglioni S, Murgia N, Folletti I, Bardi G, Grosso A, Cameli P, Latorre M, Musarra A, Bargagli E, Ricci A, Pelaia G, Paggiaro P, Rogliani P. Mepolizumab effectiveness on small airway obstruction, corticosteroid sparing and maintenance therapy step-down in real life. Pulm Pharmacol Ther 2020; 61:101899. [PMID: 31972327 DOI: 10.1016/j.pupt.2020.101899] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mepolizumab (MEP) has been recently introduced to treat severe eosinophilic asthma. Trials have demonstrated a significant effectiveness in this asthma phenotype. We evaluated MEP efficacy on lung function, symptoms, asthma exacerbations, biologic markers, steroid dependence and controller treatment level in real-life. METHODS We retrospectively analyzed 134 severe asthmatics (61 males; mean age 58.3 ± 11; mean FEV1%:72 ± 21), treated with MEP for at least 6 months (mean duration:10.9 ± 3.7 months). RESULTS FEV1% improved significantly after MEP. Mean FEF25-75 also increased from 37.4 ± 25.4% to 47.2 ± 27.2% (p < 0.0001). Mean baseline blood eosinophil level was 712 ± 731/μL (8.4 ± 5.2%) decreasing to 151 ± 384/μL (1.6 ± 1.6%) (p < 0.0001), FENO levels decreased likewise. MEP treatment also led to a significant ACT improvement (mean pre:14.2 ± 4.4; mean post:20.5 ± 28) and exacerbations significantly fell from 3.8 ± 1.9 to 0.8 ± 1.1 (p < 0.0001). 74% of patients were steroid-dependent before MEP. 45.4% and 46.4% of them showed a suspension and dose reduction respectively (p < 0.0001). A significant number reduced also ICS doses. Only 67% of subjects used SABA as needed before MEP, falling to 20% after MEP. About 40% of patients highlighted a maintenance therapy step-down. Subjects showing an omalizumab treatment failure before MEP had a similar positive response when compared with omalizumab untreated patients. CONCLUSION In real-life, MEP improved significantly all outcomes even small airway obstruction, suggesting its possible role also in distal lung region treatment. Furthermore, it demonstrated its high effectiveness in OC/ICS-sparing, in reducing SABA as needed and in stepping-down maintenance therapy. MEP is a valid alternative for patients with previous omalizumab treatment failure.
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Affiliation(s)
- Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy.
| | - Gianna Camiciottoli
- Section of Respiratory Medicine, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Largo A Brambilla 3, 50134, Florence, Italy
| | - Elena Bacci
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Scalese
- Clinic Physiology Institute, National Research Centre, Pisa, Italy
| | | | - Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università Degli Studi di Milano, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Mauro Maniscalco
- Institute Clinic Scientific Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Telese, 82037, Telese Terme, BN, Italy
| | - Simonetta Masieri
- Department of Sense Organs, Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Nicola Scichilone
- Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS), University of Palermo, Palermo, Italy
| | | | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy
| | - Ilenia Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - Giulio Bardi
- Internal Medicine Department, Azienda USL 6 Livorno, Piombino Hospital, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, IRCCS "San Matteo" Hospital Foundation, University of Pavia, Italy
| | - Paolo Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Antonino Musarra
- Allergology Department, Casa della Salute di Scilla, Scilla, RC, Italy
| | - Elena Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant 'Andrea, Rome, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Catanzaro, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Paola Rogliani
- Experimental Medicine and Systems, "PhD Program" Department of Systems Medicine University of Rome "Tor Vergata", Italy; Respiratory Unit, Department of Experimental Medicine, University of Rome "Tor Vergata" Rome, Italy
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23
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Sposato B, Scalese M, Milanese M, Masieri S, Cavaliere C, Latorre M, Scichilone N, Matucci A, Vultaggio A, Ricci A, Cresti A, Paggiaro PL. Different Skin Prick Test Sensitization Patterns Do Not Influence the Response to Omalizumab in Severe Asthma. J Investig Allergol Clin Immunol 2019; 27:388-391. [PMID: 29199967 DOI: 10.18176/jiaci.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- B Sposato
- Pneumology Department, Misericordia Hospital, Grosseto, Italy
| | - M Scalese
- Institute of Clinical Phisiology, CNR, Pisa, Italy
| | - M Milanese
- Pneumology Department, S.Corona Hospital, Pietra Ligure, Italy
| | - S Masieri
- Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - C Cavaliere
- Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - M Latorre
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Pisa, Italy
| | - N Scichilone
- DIMPEFINU, Unit of Pneumology and Medicine, University of Palermo, Palermo, Italy
| | - A Matucci
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - A Vultaggio
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant´Andrea, Rome, Italy
| | - A Cresti
- Cardiology Department, Misericordia Hospital, Grosseto, Italy
| | - P L Paggiaro
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Pisa, Italy
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Cresti A, Baratta P, De Sensi F, Solari M, Sposato B, Minelli S, Cioffi N, Franci L, Scalese M, Limbruno U. Normal Values of the Mitral-Aortic Intervalvular Fibrosa Thickness: A Multimodality Study. J Cardiovasc Echogr 2019; 29:95-102. [PMID: 31728299 PMCID: PMC6829758 DOI: 10.4103/jcecho.jcecho_28_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The avascular region of the fibrous body between the mitral and aortic valves, named mitral-aortic intervalvular fibrosa (MAIVF), is often involved in the periaortic diffusion of infective endocarditis (IE), resulting in abscess or pseudoaneurysm formation. The early recognition of these life-threatening complications is of crucial importance, as urgent surgical correction is necessary. In the first stages of the abscess formation, the only sign is an increased thickness of the MAIVF. To the best of our knowledge, normal transesophageal echocardiography (TEE) examination reference values for MAIVF thickness has not yet been established. The aim of the study was to define the normal ranges of MAIVF thickness in a population of healthy adults who underwent a TEE examination. Materials and Methods: A population of consecutive adult patients who underwent a TEE examination was enrolled in the study. Measurement was performed in short-axis (SAX) and long-axis (LAX) views. Mean-2 standard deviations (mean-2SDs) and 5%, 10%, 90%, and 95% confidence intervals were evaluated. A comparison with MAIVF thickness in patients affected by aortic IE complicated by abscess formation was performed, and receiver operating characteristic (ROC) curves were constructed to achieve the optimal cutoff value of normality. Results: A total of 477 consecutive Caucasian adult patients were enrolled (mean age: 69 years, range: 27–93 years). Mean-2SD MAIVF measurement in SAX view was 0.325 cm (95% confidence interval [CI]: 0.319–0.330 cm) and in LAX view was 0.340 cm (95% CI: 0.334–0.346 cm). Computed tomography–MAIVF mean measurement (±2SD) was 0.237 cm (95% CI: 0.110–0.340 cm). ROC curves showed that a cutoff SAX value measurement of 0.552 (area under the curve [AUC]: 95.2%) had a sensibility of 88.2% and a specificity of 92.4%; a LAX measurement value of 0.623 (AUC: 93.3%) had a sensibility of 82.7% and a specificity of 85.7%. The multivariate analysis showed no significant correlation between MAIVF thickness, age, and sex. Conclusion: In healthy patients, MAIVF thickness should not exceed 0.600 cm. Above these values, the suspicion of a periaortic abscess formation should be raised. MAIVF increased thickness may be an early sign of perivalvular diffusion requiring an urgent endocarditis team evaluation.
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Affiliation(s)
- Alberto Cresti
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
| | - Pasquale Baratta
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
| | | | - Marco Solari
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
| | - Bruno Sposato
- Pneumology Department, Azienda USL Toscana Sudest, Misericordia Hospital, Grosseto, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Minelli
- Pneumology Department, Azienda USL Toscana Sudest, Misericordia Hospital, Grosseto, Italy
| | - Nevada Cioffi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Franci
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Scalese
- Department of Epidemiology and Health Research, Institute of Clinical Physiology, National Council of Research, F. G. Monasterio, Pisa, Italy
| | - Ugo Limbruno
- Cardio-Neurovascular Department, Misricordia Hospital, Grosseto, Italy
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D'Ascanio M, Pezzuto A, Fiorentino C, Sposato B, Bruno P, Grieco A, Mancini R, Ricci A. Metronomic Chemotherapy with Vinorelbine Produces Clinical Benefit and Low Toxicity in Frail Elderly Patients Affected by Advanced Non-Small Cell Lung Cancer. Biomed Res Int 2018; 2018:6278403. [PMID: 30225260 PMCID: PMC6129793 DOI: 10.1155/2018/6278403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/09/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lung cancer is the leading cause of death worldwide. The treatment choice for advanced stage of lung cancer may depend on histotype, performance status (PS), age, and comorbidities. In the present study, we focused on the effect of metronomic vinorelbine treatment in elderly patients with advanced unresectable non-small cell lung cancer (NSCLC). METHODS From January 2016 to December 2016, 44 patients affected by non-small cell lung cancer referred to our oncology day hospital were progressively analyzed. The patients were treated with oral vinorelbine 30 mg x 3/wk or 40 mg x 3/wk meaning one day on and one day off. The patients were older than 60, stage IIIB or IV, ECOG PS ≥ 1, and have at least one important comorbidity (renal, hepatic, or cardiovascular disease). The schedule was based on ECOG-PS and comorbidities. The primary endpoint was progression-free survival (PFS). PFS was used to compare patients based on different scheduled dosage (30 or 40 mg x3/weekly) and age (more or less than 75 years old) as exploratory analysis. We also evaluated as secondary endpoint toxicity according to Common Toxicity Criteria Version 2.0. RESULTS Vinorelbine showed a good safety profile at different doses taken orally and was effective in controlling cancer progression. The median overall survival (OS) was 12 months. The disease control rate (DCR) achieved 63%. The median PFS was 9 months. A significant difference in PFS was detected comparing patients aged below with those over 75, and the HR value was 0.72 (p<0.05). Not significant was the difference between groups with different schedules. CONCLUSIONS This study confirmed the safety profile of metronomic vinorelbine and its applicability for patients unfit for standard chemotherapies and adds the possibility of considering this type of schedule not only for very elderly patients.
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Affiliation(s)
- Michela D'Ascanio
- UOC Pneumologia, Hospital Sant'Andrea “Università Sapienza”, 00189 Rome, Italy
| | - Aldo Pezzuto
- UOC Pneumologia, Hospital Sant'Andrea “Università Sapienza”, 00189 Rome, Italy
| | - Chiara Fiorentino
- UOC Pneumologia, Hospital Sant'Andrea “Università Sapienza”, 00189 Rome, Italy
| | | | - Pierdonato Bruno
- UOC Pneumologia, Hospital Sant'Andrea “Università Sapienza”, 00189 Rome, Italy
| | - Alessio Grieco
- UOC Pneumologia, Hospital Sant'Andrea “Università Sapienza”, 00189 Rome, Italy
| | - Rita Mancini
- Sapienza University Department of Molecular and Clinical Medicine, Italy
| | - Alberto Ricci
- UOC Pneumologia, Hospital Sant'Andrea “Università Sapienza”, 00189 Rome, Italy
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26
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Sposato B, Scalese M, Milanese M, Masieri S, Cavaliere C, Ricci A, Paggiaro P. Should omalizumab be used in severe asthma/COPD overlap? J BIOL REG HOMEOS AG 2018; 32:755-761. [PMID: 30043557] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A large number of patients suffering from asthma or chronic obstructive pulmonary disease (COPD) can show overlapping features of both diseases. Several subjects affected by asthma-COPD overlap (ACO) may be at a severe stage, poorly responsive to triple therapy including inhaled corticosteroids, long-acting β2 agonists and muscarinic antagonists. This review tries to explore whether omalizumab can be used in poorly controlled severe ACO patients. According to the few studies available, omalizumab may improve asthma outcomes in ACO, although the magnitude of improvements may be lower in comparison to those obtained in subjects affected only by severe asthma. Omalizumab, by acting on IgE, might improve the eosinophilic pattern which is characteristic of the ACO asthma inflammation component. It can be hypothesized that a prevalence of Th1/Th17 airway inflammation pathways can modulate a lower response to anti-IgE while a Th2 pattern can lead to a higher effectiveness to omalizumab in ACO. High levels of IgE, FeNO and blood eosinophil count may be markers of a better response to omalizumab. In conclusion, on the basis of the few studies available, omalizumab could be effective in poorly-controlled severe ACO, although to a reduced extent in comparison to patients affected only by asthma.
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Affiliation(s)
- B Sposato
- Pneumology Department, Misericordia Hospital, Grosseto, Italy
| | - M Scalese
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | - M Milanese
- Pneumology Department, S. Corona Hospital, Pietra Ligure (SV), Italy
| | - S Masieri
- Otorhinolaryngology Clinic, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - C Cavaliere
- Otorhinolaryngology Clinic, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU SantAndrea, Rome, Italy
| | - P Paggiaro
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
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27
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Sposato B, Scalese M, Milanese M, Masieri S, Cavaliere C, Latorre M, Scichilone N, Matucci A, Vultaggio A, Ricci A, Cresti A, Santus P, Perrella A, Paggiaro PL. Factors reducing omalizumab response in severe asthma. Eur J Intern Med 2018; 52:78-85. [PMID: 29395935 DOI: 10.1016/j.ejim.2018.01.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite adding Omalizumab to conventional therapy, several severe asthmatics still show poor disease control. We investigated the factors that may affect a reduced Omalizumab response in a large population of severe asthmatics. METHODS 340 patients were retrospectively evaluated. FEV1%, FVC%, Asthma Control Test (ACT), fractional exhaled nitric oxide (FENO), possible step-downs/step-ups of concomitant therapies, exacerbations, disease control levels, ICS doses and SABA use, observed at the end of treatment, were considered as a response to Omalizumab. RESULTS Age was an independent risk factor for a reduced response concerning FEV1%, FVC%, ACT and for a lower asthma control. Obesity (vs normal weight) was a determinant condition for exacerbations (OR:3.114[1.509-6.424], p = 0.002), for a disease partial/no control (OR:2.665[1.064-6.680], p = 0.036), for excessive SABA use (OR:4.448[1.837-10.768], p = 0.002) and for an unchanged/increased level of concomitant asthma medications. Furthermore, obesity also reduced the response in FEV1 (β = -6.981,p = 0.04), FVC (β = -11.689,p = 0.014) and ACT (β = -2.585, p = 0.027) and was associated with a higher FENO level (β = 49.045,p = 0.040). Having at least one comorbidity was a risk factor for exacerbations (OR:1.383[1.128-1.697], p = 0.008) and for an ACT <20 (OR:2.410[1.071-3.690], p = 0.008). Specifically, chronic heart disease was associated with both a lower ACT and FVC% whereas gastroesophageal reflux with a partial/no asthma control. Nasal polyps were a predisposing factor leading both to exacerbations and to the use of higher inhaled corticosteroids doses. Moreover, smoking habits, pollen or dog/cat dander co-sensitizations may negatively influence Omalizumab response. CONCLUSION Age, obesity, comorbidities, smoking habits, nasal polyps, allergic poly-sensitization might reduce Omalizumab effectiveness independently to other asthma-influencing factors.
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Affiliation(s)
- B Sposato
- Pneumology Department, Misericordia Hospital, Grosseto, Italy.
| | - M Scalese
- Institute of Clinical Phisiology, CNR, Pisa, Italy
| | - M Milanese
- Pneumology Department, S.Corona Hospital, Pietra Ligure, Italy
| | - S Masieri
- Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Roma, Italy
| | - C Cavaliere
- Otorhinolaryngology Clinic, Policlinico Umberto I, "Sapienza" University, Roma, Italy
| | - M Latorre
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
| | - N Scichilone
- DIMPEFINU, Unit of Pneumology and Medicine, University of Palermo, Italy
| | - A Matucci
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - A Vultaggio
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - A Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - A Cresti
- Cardiology Department, Misericordia Hospital, Grosseto, Italy
| | - P Santus
- Department of Biomedical And Clinical Sciences (DIBIC), University of Milan, Respiratory Unit, "Luigi Sacco" University Hospital; ASST Fatebenefratelli-Sacco, Milan, Italy
| | - A Perrella
- Pneumology Department, Misericordia Hospital, Grosseto, Italy
| | - P L Paggiaro
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
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28
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Sposato B. Should Inhaler Prescriptions Also Recommend Watching Videos Showing How to Use Inhaling Devices Properly? J Aerosol Med Pulm Drug Deliv 2018; 31:321. [PMID: 29812991 DOI: 10.1089/jamp.2018.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bruno Sposato
- Pneumology Department, Azienda USL Toscana Sud-Est, "Misericordia" Hospital , Grosseto, Italy
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29
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Sposato B, Scalese M, Petruzzelli L, Baldini E, Nikiforakis N, Tosti Balducci M. Could a vitamin D deficiency cause a combined long-term FEV1 and bone mineral density deterioration in female asthmatics? Clin Ter 2018; 168:e388-e391. [PMID: 29209689 DOI: 10.7417/t.2017.2039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We already know that asthma is associated to osteoporosis/osteopenia and characterized by an accelerated lung function decline. Our study aimed at assessing whether lung function decline and bone mineral density (BMD) deterioration in time were associated in a group of female long-standing asthmatics. We also tried to understand whether these two aspects were related to ICS treatment and vitamin D levels. METHODS 35 female asthmatics were retrospectively analysed. Results of methacholine challenge test at asthma onset, FEV1%, bone density scan at moment of recruitment and after at least 5years later were considered. RESULTS A significant positive relationship between femoral-t-scores changes and FEV1 decline was found after a median follow-up time of 7 [6-9] years (r=0.43;p=0.04). Femoral-t-score variations and vitamin D values were also significantly related (r=0.669;p=0.024). Furthermore, we found that FEV1 decline was worse in subjects with lower vitamin D levels (-57.5[-80.4-35.9]ml/year), compared to those with normal vitamin D rates (12[-16-23.6]ml/year;p=0.055). Femoral/vertebral t-score changes, as well as FEV1, decline were not associated to the use of medium/high ICS doses when compared to subjects treated with low ICS dosages. CONCLUSIONS FEV ¹ decline and BMD deterioration in time observed in a group of female asthmatics were associated; low vitamin D levels may be the link.
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Affiliation(s)
- B Sposato
- Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy
| | - M Scalese
- Institute of Clinical Physiology, National Research Council (CNR), Pisa
| | - L Petruzzelli
- Unit of Nuclear Medicine, "Misericordia" Hospital, Grosseto, Italy
| | - E Baldini
- Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy
| | - N Nikiforakis
- Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy
| | - M Tosti Balducci
- Unit of Nuclear Medicine, "Misericordia" Hospital, Grosseto, Italy
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30
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Liccardi G, Calzetta L, Baldi G, Berra A, Billeri L, Caminati M, Capano P, Carpentieri E, Ciccarelli A, Crivellaro MA, Cutajar M, D'Amato M, Folletti I, Gani F, Gargano D, Giannattasio D, Giovannini M, Lombardi C, Schiavo ML, Madonna F, Maniscalco M, Meriggi A, Micucci C, Milanese M, Montera C, Paolocci G, Parente R, Pedicini A, Pio R, Puggioni F, Russo M, Salzillo A, Scavalli P, Scichilone N, Sposato B, Stanziola A, Steinhilber G, Vatrella A, Rogliani P, Passalacqua G. Allergic sensitization to common pets (cats/dogs) according to different possible modalities of exposure: an Italian Multicenter Study. Clin Mol Allergy 2018. [PMID: 29434523 DOI: 10.1186/s12948-018-0081-z.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The query "are there animals at home?" is usually administered for collecting information on anamnesis. This modality to consider exposure to pet allergens constitutes a potential bias in epidemiological studies and in clinical practice. The aim of our study was to evaluate/quantify different modalities of exposure to cat/dog in inducing allergic sensitization. Methods Thirty Italian Allergy units participated in this study. Each centre was required to collect the data of at least 20 consecutive outpatients sensitized to cat/dog allergens. A standardized form reported all demographic data and a particular attention was paid in relieving possible modalities of exposure to cat/dog. Results A total 723 patients sensitized to cat/dog were recorded, 359 (49.65%) reported direct pet contact, 213 patients (29.46%) were pet owners, and 146 subjects (20.19%) were exposed to pets in other settings. Other patients were sensitized by previous pet ownership (150-20.75%) or indirect contact (103-14.25%), in 111 subjects (15.35%) any contact was reported. Conclusions Only 213 patients (29.46%) would be classified as "exposed to animals" and 510 (70.54%) as "not exposed" according to usual query. Our classification has shown that many "not-exposed" subjects (399-55.19%) were "really exposed". The magnitude of exposure to pet allergens at home is not related exclusively to pet ownership. These considerations should be taken into account during the planning of epidemiological studies and in clinical practice for the management of pet allergic individuals.
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Affiliation(s)
- G Liccardi
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy.,2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - L Calzetta
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Baldi
- Respiratory Medicine Unit, ASL (District 66), Salerno, Italy
| | - A Berra
- Respiratory Allergy Unit, G. Da Procida Hospital, Salerno, Italy
| | - L Billeri
- 6Department of Laboratory Medicine, University Hospital Padova, Padua, Italy
| | - M Caminati
- 7Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - P Capano
- Unit of Pulmonary Immunology and Respiratory Diseases Ospedale "Santa Maria Della Speranza", Battipaglia, Salerno Italy
| | - E Carpentieri
- Division of Pneumology, "Santa Maria Novella" Hospital, Galatina, Lecce Italy
| | - A Ciccarelli
- Allergy Unit, Loreto Crispi Hospital, Naples, Italy
| | - M A Crivellaro
- 11Unit of Allergy and Occupational Medicine, University Hospital Padova, Padua, Italy
| | - M Cutajar
- Allergy Center, Division of Internal Medicine, Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy
| | - M D'Amato
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - I Folletti
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - F Gani
- Allergy Unit, S. Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - D Gargano
- 16Allergy Unit, High Speciality "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - D Giannattasio
- Respiratory Physiopathology and Allergy, High Speciality Center, "Mauro Scarlato" Hospital, Scafati, Salerno, Italy
| | - M Giovannini
- Pulmonary Diseases Department, Mirandola Hospital, Modena, Italy
| | - C Lombardi
- 19Departmental Unit of Allergy, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - M Lo Schiavo
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Madonna
- Allergy Unit, ASL (Sanitary District n°12), Caserta, Italy
| | - M Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri, Telese Terme, Benevento Italy
| | - A Meriggi
- 23Allergy and Immunology Unit, Fondazione "Salvatore Maugeri", Institut of Research and Care, Scientific Institute of Pavia, Pavia, Italy
| | - C Micucci
- Division of Pneumology and Allergology Hospital "Carlo Urbani", Jesi, Ancona Italy
| | - M Milanese
- 25Division of Pneumology, S. Corona Hospital, Pietra Ligure, Savona Italy
| | - C Montera
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - G Paolocci
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - R Parente
- 26Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - A Pedicini
- 27Division of Internal Medicine and Allergy, Fatebenefratelli Hospital, Benevento, Italy
| | - R Pio
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Puggioni
- Respiratory Diseases Department-IRCCS Humanitas Research and Clinical Center, Rozzano, Milan, Italy
| | - M Russo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - A Salzillo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - P Scavalli
- Unit of Respiratory Physiopathology, Allergy and Occupational Medicine, ASL Viterbo, Viterbo, Italy
| | - N Scichilone
- 30Biomedical Department of Specialistic and Internal Medicine, University of Palermo, Palermo, Italy
| | - B Sposato
- Pneumology Unit, Azienda Ospedaliera "Misericordia", Grosseto, Italy
| | - A Stanziola
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - G Steinhilber
- 32Division of Pneumology, Spedali Civili Brescia, Brescia, Italy
| | - A Vatrella
- 33Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - P Rogliani
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Passalacqua
- 34Allergy and Respiratory Diseases, Policlinico San Martino, University of Genoa, Genoa, Italy
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31
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Liccardi G, Calzetta L, Baldi G, Berra A, Billeri L, Caminati M, Capano P, Carpentieri E, Ciccarelli A, Crivellaro MA, Cutajar M, D'Amato M, Folletti I, Gani F, Gargano D, Giannattasio D, Giovannini M, Lombardi C, Schiavo ML, Madonna F, Maniscalco M, Meriggi A, Micucci C, Milanese M, Montera C, Paolocci G, Parente R, Pedicini A, Pio R, Puggioni F, Russo M, Salzillo A, Scavalli P, Scichilone N, Sposato B, Stanziola A, Steinhilber G, Vatrella A, Rogliani P, Passalacqua G. Allergic sensitization to common pets (cats/dogs) according to different possible modalities of exposure: an Italian Multicenter Study. Clin Mol Allergy 2018; 16:3. [PMID: 29434523 PMCID: PMC5796344 DOI: 10.1186/s12948-018-0081-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/22/2018] [Indexed: 12/28/2022] Open
Abstract
Background The query “are there animals at home?” is usually administered for collecting information on anamnesis. This modality to consider exposure to pet allergens constitutes a potential bias in epidemiological studies and in clinical practice. The aim of our study was to evaluate/quantify different modalities of exposure to cat/dog in inducing allergic sensitization. Methods Thirty Italian Allergy units participated in this study. Each centre was required to collect the data of at least 20 consecutive outpatients sensitized to cat/dog allergens. A standardized form reported all demographic data and a particular attention was paid in relieving possible modalities of exposure to cat/dog. Results A total 723 patients sensitized to cat/dog were recorded, 359 (49.65%) reported direct pet contact, 213 patients (29.46%) were pet owners, and 146 subjects (20.19%) were exposed to pets in other settings. Other patients were sensitized by previous pet ownership (150–20.75%) or indirect contact (103–14.25%), in 111 subjects (15.35%) any contact was reported. Conclusions Only 213 patients (29.46%) would be classified as “exposed to animals” and 510 (70.54%) as “not exposed” according to usual query. Our classification has shown that many “not-exposed” subjects (399–55.19%) were “really exposed”. The magnitude of exposure to pet allergens at home is not related exclusively to pet ownership. These considerations should be taken into account during the planning of epidemiological studies and in clinical practice for the management of pet allergic individuals.
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Affiliation(s)
- G Liccardi
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy.,2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - L Calzetta
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Baldi
- Respiratory Medicine Unit, ASL (District 66), Salerno, Italy
| | - A Berra
- Respiratory Allergy Unit, G. Da Procida Hospital, Salerno, Italy
| | - L Billeri
- 6Department of Laboratory Medicine, University Hospital Padova, Padua, Italy
| | - M Caminati
- 7Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy
| | - P Capano
- Unit of Pulmonary Immunology and Respiratory Diseases Ospedale "Santa Maria Della Speranza", Battipaglia, Salerno Italy
| | - E Carpentieri
- Division of Pneumology, "Santa Maria Novella" Hospital, Galatina, Lecce Italy
| | - A Ciccarelli
- Allergy Unit, Loreto Crispi Hospital, Naples, Italy
| | - M A Crivellaro
- 11Unit of Allergy and Occupational Medicine, University Hospital Padova, Padua, Italy
| | - M Cutajar
- Allergy Center, Division of Internal Medicine, Ospedali Riuniti Penisola Sorrentina, Sorrento, Naples, Italy
| | - M D'Amato
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - I Folletti
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - F Gani
- Allergy Unit, S. Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - D Gargano
- 16Allergy Unit, High Speciality "San Giuseppe Moscati" Hospital, Avellino, Italy
| | - D Giannattasio
- Respiratory Physiopathology and Allergy, High Speciality Center, "Mauro Scarlato" Hospital, Scafati, Salerno, Italy
| | - M Giovannini
- Pulmonary Diseases Department, Mirandola Hospital, Modena, Italy
| | - C Lombardi
- 19Departmental Unit of Allergy, Clinical Immunology and Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - M Lo Schiavo
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Madonna
- Allergy Unit, ASL (Sanitary District n°12), Caserta, Italy
| | - M Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri, Telese Terme, Benevento Italy
| | - A Meriggi
- 23Allergy and Immunology Unit, Fondazione "Salvatore Maugeri", Institut of Research and Care, Scientific Institute of Pavia, Pavia, Italy
| | - C Micucci
- Division of Pneumology and Allergology Hospital "Carlo Urbani", Jesi, Ancona Italy
| | - M Milanese
- 25Division of Pneumology, S. Corona Hospital, Pietra Ligure, Savona Italy
| | - C Montera
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - G Paolocci
- 14Department of Medicine, Section of Occupational Medicine, Respiratory Diseases and Toxicology, Terni Hospital, University of Perugia, Perugia, Italy
| | - R Parente
- 26Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - A Pedicini
- 27Division of Internal Medicine and Allergy, Fatebenefratelli Hospital, Benevento, Italy
| | - R Pio
- Allergy and Clinical Immunology, "G. Fucito" Hospital, S. Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - F Puggioni
- Respiratory Diseases Department-IRCCS Humanitas Research and Clinical Center, Rozzano, Milan, Italy
| | - M Russo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - A Salzillo
- 1Department of Pulmonology, Haematology and Oncology. Division of Pneumology and Allergology, High Speciality "A. Cardarelli" Hospital, Naples, Italy
| | - P Scavalli
- Unit of Respiratory Physiopathology, Allergy and Occupational Medicine, ASL Viterbo, Viterbo, Italy
| | - N Scichilone
- 30Biomedical Department of Specialistic and Internal Medicine, University of Palermo, Palermo, Italy
| | - B Sposato
- Pneumology Unit, Azienda Ospedaliera "Misericordia", Grosseto, Italy
| | - A Stanziola
- 13Department of Respiratory Disease, "Federico II" University - AO "Dei Colli", Naples, Italy
| | - G Steinhilber
- 32Division of Pneumology, Spedali Civili Brescia, Brescia, Italy
| | - A Vatrella
- 33Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - P Rogliani
- 2Postgraduate School of Respiratory Medicine. Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy.,3Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - G Passalacqua
- 34Allergy and Respiratory Diseases, Policlinico San Martino, University of Genoa, Genoa, Italy
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Cresti A, Cannarile P, Aldi E, Solari M, Sposato B, Franci L, Limbruno U. Multimodality Imaging and Clinical Significance of Congenital Ventricular Outpouchings: Recesses, Diverticula, Aneurysms, Clefts, and Crypts. J Cardiovasc Echogr 2018; 28:9-17. [PMID: 29629254 PMCID: PMC5875147 DOI: 10.4103/jcecho.jcecho_72_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The high spatial resolution of cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) permit the diagnosis of congenital ventricular outpouchings (CVOs), including congenital ventricular diverticula (CVD), congenital ventricular aneurysms (CVA), clefts, and crypts. A unique classification has not been established, and these terms are used interchangeably with confounding terminology. Moreover, their significance is not univocal. A research was performed using PubMed on six subjects: (1) congenital left ventricular outpouchings; (2) congenital ventricular diverticulum; (3) congenital ventricular aneurysm; (4) ventricular clefts; (5) ventricular crypts; and (6) ventricular crevices. Usually, CVOs are small with a preserved contraction and in asymptomatic patients, the clinical relevance may be minimal, although electrocardiographic anomalies are often present. CVA and diverticula may carry an embolic risk and cases of arrhythmia and rupture are described. In the presence of clefts, or crypts a cardiomyopathy should be excluded. A simple classification can be proposed: CVD extend beyond the myocardial wall and fibrous type may be termed CVA, acquired forms should be kept distinct. Clefts, or crypts, are small recesses extending for more than 50% of the ventricular wall but not beyond its margin. The presence of fibrosis may be evaluated by CMR. A multicenter prospective registry would be helpful to investigate potential clinical implications and to exclude dubious forms of hypertrophic cardiomyopathy or ventricular noncompaction. In conclusion, CVOs have been described with different terminologies and classifications. Their significance needs to be interpreted in the clinical setting and with the help of a multimodality imaging, particularly of CMR.
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Affiliation(s)
- Alberto Cresti
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
| | | | - Elena Aldi
- Department of Radiology, University of Siena, Siena, Italy
| | - Marco Solari
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
| | - Bruno Sposato
- Department of Internal Medicine, Misericordia Hospital, Grosseto, Italy
| | - Luca Franci
- Department of Radiology, Misericordia Hospital, Grosseto, Italy
| | - Ugo Limbruno
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
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Incorvaia C, Masieri S, Cavaliere C, Makri E, Sposato B, Frati F. Asthma associated to rhinitis. J BIOL REG HOMEOS AG 2018; 32:67-71. [PMID: 29552876] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A large amount of data show that AR and asthma are associated both epidemiologically and clinically, introducing the definition of united airway disease. The mechanisms underlying such association were initially suggested to start from the nose, including the loss of the protective and homeostatic effects of nasal function, the activation of a naso-bronchial reflex and the spread of allergic inflammation from the nose to the lower airways. Later, other factors such as microbial stimuli and systemic inflammatory mechanisms, involving bloodstream and bone marrow, were advocated. The advance in knowledge made it clear that the link between asthma and AR is multifactorial, with particular importance for inflammatory cells and especially eosinophils. By the model of nasal challenge, important immunological responses were revealed, with particular importance for the increased expression of adhesion molecules (ICAM-1, VCAM-1 and E-selectin) and of cytokines such as interleukin (IL)-13, that was accompanied by a rise of eosinophils in blood and developement of bronchial hyper-responsiveness. The occurrence in AR of a concomitant sinusitis is frequently associated with worse asthma outcomes, as assessed by a lower pulmonary function, increased asthma symptoms and poorer quality-of-life compared to patients with asthma alone.
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Affiliation(s)
- C Incorvaia
- Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy
| | - S Masieri
- Department of Sense Organs, University of Rome Sapienza, Italy
| | - C Cavaliere
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - E Makri
- Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy
| | - B Sposato
- Pneumology Department, Misericordia Hospital, Grosseto, Italy
| | - F Frati
- Master of Rinoallergologia Pratica, Faculty of Medicine and Dentistry, Sapienza University of Rome, Italy
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Sposato B. Predicted Values for Spirometry may Underestimate Long-Standing Asthma Severity. Open Respir Med J 2016; 10:70-78. [PMID: 28144365 PMCID: PMC5220173 DOI: 10.2174/1874306401610010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 12/02/2022] Open
Abstract
Background: Asthma may show an accelerated lung function decline. Asthmatics, although having FEV1 and FEV1/VC (and z-scores) higher than the lower limit of normality, may show a significant FEV1 decline when compared to previous measurements. We assessed how many asymptomatic long-standing asthmatics (LSA) with normal lung function showed a significant FEV1 decline when an older FEV1 was taken as reference point. Methods: 46 well-controlled LSA (age: 48.8±12.1; 23 females) with normal FEV1 and FEV1/VC according to GLI2012 references (FEV1: 94.8±10.1%, z-score:-0.38±0.79; FEV1/VC: 79.3±5.2, z-score:-0.15±0.77) were selected. We considered FEV1 decline, calculated by comparing the latest value to one at least five years older or to the highest predicted value measured at 21 years for females and 23 for males. A FEV1 decline >15% or 30 ml/years was regarded as pathological. Results: When comparing the latest FEV1 to an at least 5-year-older one (mean 8.1±1.4 years between 2 measurements), 14 subjects (30.4%) showed a FEV1 decline <5% (mean: -2.2±2.6%), 19 (41.3%) had a FEV1 5-15% change (mean: -9.2±2.5%) and 13 (28.3%) a FEV1 decrease>15% (mean: -18.3±2.4). Subjects with a FEV1 decline>30 ml/year were 28 (60.8%). When using the highest predicted FEV1 as reference point and declines were corrected by subtracting the physiological decrease, 6 (13%) patients showed a FEV1 decline higher than 15%, whereas asthmatics with a FEV1 loss>30 ml/year were 17 (37%). Conclusion: FEV1 decline calculation may show how severe asthma actually is, avoiding a bronchial obstruction underestimation and a possible under-treatment in lots of apparent “well-controlled” LSA with GLI2012-normal-range lung function values.
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Affiliation(s)
- Bruno Sposato
- Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy
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Sposato B, Scalese M, Latorre M, Scichilone N, Matucci A, Milanese M, Masieri S, Rolla G, Steinhilber G, Rosati Y, Vultaggio A, Folletti I, Baglioni S, Bargagli E, Di Tomassi M, Pio R, Pio A, Maccari U, Maggiorelli C, Migliorini MG, Vignale L, Pulerà N, Carpagnano GE, Foschino Barbaro MP, Perrella A, Paggiaro PL. Effects of omalizumab in severe asthmatics across ages: A real life Italian experience. Respir Med 2016; 119:141-149. [PMID: 27692136 DOI: 10.1016/j.rmed.2016.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting. METHODS 105 consecutive severe asthmatics (GINA step 4-5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18-39, 40-64 and ≥ 65 years. RESULTS Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1 increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049). After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40-64 (OR = 0.284 [CI95% = 0.098-0.826], p = 0.021) and 18-39 (OR = 0.133 [CI95% = 0.026-0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (β = -1.070; p = 0.046) passing from each age class was observed. CONCLUSION Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.
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Affiliation(s)
- B Sposato
- Pneumologia, Ospedale Misericordia, Grosseto, Italy.
| | - M Scalese
- Istituto di Fisiologia Clinica, CNR, Pisa, Italy
| | - M Latorre
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
| | - N Scichilone
- DIMPEFINU, Unit of Pneumology and Medicine, University of Palermo, Palermo, Italy
| | - A Matucci
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - M Milanese
- Pneumologia, Ospedale S.Corona, Pietra Ligure, Italy
| | - S Masieri
- Clinica Otorinolaringoiatrica, Policlinico Umberto I, Università di Roma "Sapienza", Italy
| | - G Rolla
- Allergologia e Immunologia Clinica, Ospedale Mauriziano Umberto I, Università di Torino, Italy
| | | | - Y Rosati
- Pneumologia, Ospedale di Macerata, Italy
| | - A Vultaggio
- Immunoallergology Unit, Department of Medicine and Geriatric, AOU Careggi, Florence, Italy
| | - I Folletti
- Sezione di Medicina del Lavoro, Malattie Respiratorie e Tossicologia Professionale ed Ambientale, Dipartimento di Medicina, Università di Perugia, Az. Ospedaliera Santa Maria, Terni, Italy
| | | | - E Bargagli
- Pneumologia, Ospedale Le Scotte, Università di Siena, Italy
| | - M Di Tomassi
- Pneumologia, Ospedale Misericordia, Grosseto, Italy
| | - R Pio
- Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy
| | - A Pio
- Allergologia e Immunologia Clinica, Ospedale G. Fucito, Mercato S. Severino, Salerno, Italy
| | - U Maccari
- Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy
| | - C Maggiorelli
- Pneumologia e UTIP, Ospedale "S.Donato", Arezzo, Italy
| | | | - L Vignale
- Pneumologia, Ospedale di Fivizzano, Italy
| | - N Pulerà
- Pneumologia, Ospedale di Livorno, Italy
| | - G E Carpagnano
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy
| | - M P Foschino Barbaro
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Italy
| | - A Perrella
- Pneumologia, Ospedale Misericordia, Grosseto, Italy
| | - P L Paggiaro
- Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Italy
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Sposato B, Scalese M, Milanese M, Scichilone N, Scala R, Perrella A. Smoking and Obesity Increase Airway Hyperesponsiveness Risk in the Elderly. Curr Aging Sci 2016; 9:284-294. [PMID: 27071476 DOI: 10.2174/1874609809666160413113604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/22/2016] [Accepted: 04/11/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE of our study was assessing whether smoking and obesity might affect airways hyperresponsiveness (AHR) differently in younger and older subjects and whether this influence might be due to their different impacts on baseline lung function values at different ages. METHODS 3,903 consecutive adult subjects with normal lung function (1,920 males; mean age 35.1±16.2; median FEV1:97.3% of predicted [interquartile range (IQR):89.7-105.2] and FEV1/FVC: 84.6% of predicted [IQR:79.8-89.2]), having performed a methacholine test, were considered. They were subdivided into three groups according to age (18-39, 40-64 and ≥ 65 years) and into different sub-groups according to body mass index (BMI) and smoking habits, considering two AHR level cut-offs (PD20≤ 1600 μg and PD20≤ 800 μg). RESULTS PD20 was significantly lower (p<0.004) in obese subjects aged 18-39 years, in comparison to older patients. Smoking was an AHR risk factor for subjects aged 40-64 and especially for those aged >65 (OR: 12.786 [IQR: 1.450-112.753]; p<0.0001). Obesity caused an AHR risk only in older subjects (>65 years) (OR: 3.120 [IQR: 1.144-8.509]; p<0.0001). FEV1/FVC and FEF25-75% decreased progressively (p<0.001) with age in subjects with different weights/smoking habits. No reductions with age were observed in FEV1% and FVC% except for a significant FVC% decrease in older smokers compared to older non-smokers. CONCLUSION Smoking determined a progressively increasing AHR risk reaching its peak in the elderly. In younger obese individuals, AHR was higher than in obese elderly, whereas obesity was a higher AHR risk factor only in subjects aged >65 years. A small airway age-related reduction may cause the increased smoking/obesity induced AHR risk in older people.
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Affiliation(s)
- Bruno Sposato
- U.O. Pneumologia, Azienda Ospedaliera "Misericordia", Via Senese 161; 58100 Grosseto, Italy
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Sposato B, Lenzi PA, Carelli MR. Could cigarette packaging be used as a tool to make prevention of smoke-induced respiratory diseases? Med Hypotheses 2015; 85:962-4. [PMID: 26364042 DOI: 10.1016/j.mehy.2015.08.027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 08/30/2015] [Indexed: 11/23/2022]
Abstract
The most important consequences of smoking are chronic obstructive pulmonary disease (COPD) and lung cancer (LC). Although the use of shocking images and warning messages on cigarette packaging is a valid tool of smoke dishabituation, unfortunately, millions of people go on smoking. Our hypotheses is that cigarette packet covers could also be used to give further messages, especially meant to spur also a screening of smoke-induced respiratory diseases. Messages on cigarette packaging suggesting smokers to perform a spirometry and a chest X-ray may persuade them not only to quit their habit but also to have a screening for COPD and LC prevention. If our hypotheses is taken into account it will have a strong worldwide impact.
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, "Misericordia" Hospital, Grosseto, Italy.
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Sposato B. Significant gas-exchange improvements reported after roflumilast in two cases of severe COPD. Monaldi Arch Chest Dis 2015. [DOI: 10.4081/monaldi.2013.33] [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
Two cases of 63-year-old men with severe chronic obstructive pulmonary disease (COPD) associated with respiratory failure are presented. Both patients were treated with long acting bronchodilators, inhaled corticosteroids, theophylline, diuretics, long term oxygen therapy, and nocturnal non invasive mechanical ventilation, without achieving any improvement or control of the disease course. We observed a clinical and functional improvement in both patients when we added roflumilast to the pharmacological treatment schedule. In this context, gas exchange parameters were greatly improved, leading us to speculate on the possible mechanisms causing such improvements in these COPD patients.
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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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Sposato B, Scalese M, Moschini G, Migliorini MG. Can we modulate asthma maintenance treatment level with disease seasonal variations? Eur Rev Med Pharmacol Sci 2015; 19:942-949. [PMID: 25855917] [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: 06/04/2023]
Abstract
Asthma can have clinical seasonal fluctuations due to different exposure factors. The analysis of our data and literature confirm a seasonal trend of asthma severity. In this brief review, authors discuss the possibility to adapt maintenance therapy level to clinical seasonal fluctuations, by increasing treatment in some seasons to prevent exacerbations and by decreasing it in others, when symptoms are low, in order to minimize costs and maximize safety. Literature and our data (concerning studies carried out in areas with a temperate climate) indicate that asthma severity is reduced in summer while it tends to increase in the other seasons. Authors conclude that a preventive increasing maintenance treatment level during the season when we know that patients worsen (starting some weeks before symptom worsening) may reduce asthma exacerbation risks. On the contrary, a summer treatment reduction, in patients that improve during this period, may be considered only in asthma phenotypes with a benign disease course in time.
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Affiliation(s)
- B Sposato
- Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy.
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Milanese M, Di Marco F, Corsico AG, Rolla G, Sposato B, Chieco-Bianchi F, Costantino MT, Crivellaro MA, Guarnieri G, Scichilone N. Asthma control in elderly asthmatics. An Italian observational study. Respir Med 2014; 108:1091-9. [PMID: 24958604 DOI: 10.1016/j.rmed.2014.05.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 02/07/2023]
Abstract
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 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. INTERPRETATION Our results highlight the need to specifically evaluate the coexistence of features of COPD in elderly asthmatics, a factor that worsens asthma control.
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Affiliation(s)
- M Milanese
- Struttura Complessa di Pneumologia, Azienda Sanitaria Locale 2 Savonese, Pietra Ligure, Italy.
| | - F Di Marco
- Struttura Complessa di Pneumologia Ospedale S. Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - A G Corsico
- Struttura Complessa di Pneumologia, Fondazione IRCCS Policlinico San Matteo, Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | - G Rolla
- Allergologia e Immunologia Clinica Università di Torino, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - B Sposato
- Pneumologia, Azienda Ospedale Misericordia, Grosseto, Italy
| | - F Chieco-Bianchi
- Struttura Complessa di Fisiopatologia Respiratoria, Azienda Ospedaliera di Padova, Padova, Italy
| | - M T Costantino
- Struttura Complessa di Pneumologia, Azienda Ospedaliera Carlo Poma di Mantova, Mantova, Italy
| | - M A Crivellaro
- Servizio di Allergologia, Medicina del Lavoro, Azienda Ospedaliera Università degli Studi di Padova, Padova, Italy
| | - G Guarnieri
- Fisiopatologia Respiratoria, Medicina del Lavoro, Università di Padova, Padova, Italy
| | - N Scichilone
- DIBIMIS, Università degli Studi di Palermo, Palermo, Italy
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Sposato B, Scalese M, Migliorini MG, Di Tomassi M, Scala R. Small airway impairment and bronchial hyperresponsiveness in asthma onset. Allergy Asthma Immunol Res 2014; 6:242-51. [PMID: 24843800 PMCID: PMC4021243 DOI: 10.4168/aair.2014.6.3.242] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 09/29/2013] [Accepted: 11/27/2013] [Indexed: 11/27/2022]
Abstract
Purpose Our study tried to find a relationship between baseline FEF25-75% and airway hyperresponsiveness (AHR) and whether a greater FEF25-75% impairment may be a marker of a more severe hyperresponsiveness in subjects with normal FEV1 and FEV1/FVC and suggestive asthma symptoms. Besides, we tried to asses a FEF25-75% cut-off value to identify hyper-reactive subjects. Methods 4,172 subjects (2,042 M; mean age: 38.3±14.9; mean FEV1 % predicted: 100.5±12.7 and FEV1/FVC: 85.4±6.8) were examined after performing a methacholine (Mch) test. All subjects reported a symptom onset within 3 years before the test. Subjects with PD20<400 or >400 µg were arbitrarily considered affected by moderate/severe and borderline AHR, respectively. Results PD20 values were 213 (IQR:86-557), 340 (IQR:157-872) and 433 (IQR:196-1032) µg in subjects with baseline FEF25-75≤50%, FEF25-75 between 50 and 70% and FEF25-75>70% respectively (P<0.0001). Only in moderate/severe hyper-reactive subjects (excluded borderlines), PD20 was lower in the FEF25-75≤50% subgroup than in the 1 with FEF25-75>70%. The hyperreactive subjects percentage, was higher in those with FEF25-75≤50% and lower in those with FEF25-75>70% (P<0.0001). FEF25-75<50% (compared to FEF25-75>70%) was a higher AHR risk factor, especially in subjects with moderate/severe AHR (OR: 2.18 [IQR:1.41-3.37]; P<0.0001). Thresholds yielding the highest combined sensitivity/specificity for FEF25-75% were 75.19 (area under curve [AUC]: 0.653) and 74.95 (AUC:0.688) in subjects with PD20<2,400 and <400 µg respectively. FEV1, FVC, and FEV1/FVC measured in subjects with different FEF25-75≤50%, FEF25-75>50 and ≤70% or FEF25-75>70% levels were similar both in normoreactive and hyperreactive subjects. Conclusions At asthma onset, reduced baseline FEF25-75 values with normal FEV1 and FEV1/FVC may predict AHR. Detectable predictive cut-off values do not exist because even normoreactive subjects can show lower FEF25-75 values. Furthermore, a greater FEF25-75 reduction may be associated to a more severe AHR, suggesting a possible FEF25-75 role in the management of asthma when FEV1 and FEV1/FVC are normal.
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Affiliation(s)
- Bruno Sposato
- Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | | | | | - Raffaele Scala
- Unit of Pneumology and UTIP, "S.Donato" Hospital, Arezzo, Italy
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Sposato B, Liccardi G, Russo M, Folletti I, Siracusa A, Scichilone N, Ventura MT, Rolla G, Raie A, Milanese M, Pio R, Pio A, Scala R, Pareo C, Micucci C, Micheletto C, Billeri L, Musarra A, Cavaliere C, Agolli G, Masieri S, Scalese M, Capitani D. Cypress pollen: an unexpected major sensitizing agent in different regions of Italy. J Investig Allergol Clin Immunol 2014; 24:23-28. [PMID: 24765877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES In this multicenter survey, we assessed the impact of sensitization to cypress in atopic patients in Italy and determined whether cypress pollen concentration changed over time. METHODS Allergists were required to collect the results of 100-200 consecutive skin prick tests (SPTs) performed during 2012. Seasonal symptoms were also recorded, as were airborne cypress pollen concentrations (data from the Italian Aerobiology Association) in 1998-2000 and 2010-2012. RESULTS We examined 2258 atopic outpatients (56% females; age, 2-84 years) sensitized to at least 1 of the aeroallergens tested (Dermatophagoides species, grass, pellitory, olive, cypress, birch, Alternaria tenuis, and dog and cat dander). We found that 62.9%, 16.1%, and 32.7% of patients living in central, northern, and southern Italy, respectively, were sensitized to cypress (P < .0001). The cypress pollen concentration peak was delayed from February to March in 1998-2000 and 2010-2012 in all 3 regions, with a shift in pollination towards spring. Patients who were monosensitized to cypress reported mainly rhinitis (90.7%-97.6%) and conjunctivitis (38.1%-100%). In polysensitized patients, the prevalence of rhinitis, conjunctivitis, and asthma increased progressively (P < .0001) from southern to northern Italy. The same trend was observed for the prevalence of reported winter symptoms typical of cypress allergy (28%-65%). CONCLUSIONS Today, cypress pollen is the most frequent sensitizing aeroallergen (assessed by SPT) in several areas of central Italy. Variations in the timing of the cypress pollination period may have favored this increased sensitization. Rhinitis and conjunctivitis are the predominant symptoms. The clinical impact of this allergy was poor in southern Italy and increased in central areas before reaching its peak in northern regions.
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Abstract
OBJECTIVE The aim of this review was to understand whether FEV1 decline measured during the follow-up of asthmatic subjects (FEV1 variation between two different measurements at a distance of at least 5 years) may have a role in their management. METHODS Articles, commentaries and reviews relating to the topic were searched in PubMed. RESULTS Patients with an accelerated FEV1 decline (>30 ml/year) may be either steroid-resistant/difficult-to-treat asthmatics or not adequately treated because they are either under-perceivers or poorly adherent to their therapy. Sometimes they may be unable to use devices correctly. Untreated rhinitis and incorrect lifestyle (obesity status, a high-fat diet and lack of exercise) must be considered when facing a pulmonary function decline. Identifying asthmatics with an accelerated FEV1 decline, even with well controlled symptoms, may allow us to make possible treatment adjustments or to remove potentially harmful environmental exposure and suggest a correct lifestyle. Depending on FEV1 decline severity, we may detect different asthma phenotypes. One type is characterized by no/low lung function reduction. Among moderate/severe 'declining' subjects, there may be a group that might be responsive to treatment and a second one with a quicker loss in lung function that may be unresponsive to therapy. CONCLUSION FEV1 decline calculation should be assessed early in clinical practice over the course of time in order to make all possible variations in treatment, environmental exposure and lifestyle more efficacious overall for declining subjects responsive to anti-inflammatory therapy. Further studies are necessary to validate this approach to asthma.
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Affiliation(s)
- Bruno Sposato
- Unit of Pneumology, Misericordia Hospital , Grosseto , Italy
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Sposato B, Scalese M, Migliorini MG, Riccardi MP, Tosti Balducci M, Petruzzelli L, Scala R. Obesity can influence children’s and adolescents’ airway hyperresponsiveness differently. Multidiscip Respir Med 2013. [DOI: 10.4081/mrm.2013.572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
Background: Literature is still arguing about a possible relationship between airway hyperresponsiveness (AHR) and body mass index (BMI). This study aimed at evaluating the influence of BMI on AHR and pulmonary function in children and adolescents that performed a methacholine test for suggestive asthma symptoms. Methods: 799 consecutive children/adolescents (535 M; mean age: 15 ± 3 yrs; median FEV1% predicted: 101.94% [93.46-111.95] and FEV1/FVC predicted: 91.07 [86.17-95.38]), were considered and divided into underweight, normal, overweight and obese. Different AHR levels were considered as moderate/severe (PD20 ≤ 400 μg) and borderline (PD20 > 400 μg). Results: 536 children/adolescents resulted hyperreactive with a median PD20 of 366 μg [IQR:168–1010.5]; 317 patients were affected by moderate/severe AHR, whereas 219 showed borderline hyperresponsiveness. Obese subjects aged > 13 years showed a lower (p = 0.026) median PD20 (187μg [IQR:110–519]) compared to overweight (377 μg [IQR:204–774]) and normal-weight individuals’ values (370.5 μg [IQR:189–877]). On the contrary, median PD20 observed in obese children aged ≤ 13 years (761 μg [IQR:731–1212]) was higher (p = 0.052) compared to normal-weight children’s PD20 (193 μg [IQR:81–542]) and to obese adolescents’ values (aged > 13 years) (p = 0.019). Obesity was a significant AHR risk factor (OR:2.853[1.037-7.855]; p = 0.042) in moderate/severe AHR adolescents. Females showed a higher AHR risk (OR:1.696[1.046-2.751] p = 0.032) compared to males. A significant relationship was found between BMI and functional parameters (FEV1, FVC, FEV1/FVC) only in hyperreactive females. Conclusions: Obesity seems to influence AHR negatively in female but not in male adolescents and children. In fact, AHR is higher in obese teenagers, in particular in those with moderate/severe hyperresponsiveness, and may be mediated by obesity-associated changes in baseline lung function.
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Sposato B, Scalese M, Migliorini MG, Riccardi MP, Balducci MT, Petruzzelli L, Scala R. Obesity can influence children's and adolescents' airway hyperresponsiveness differently. Multidiscip Respir Med 2013; 8:60. [PMID: 24028436 PMCID: PMC3844670 DOI: 10.1186/2049-6958-8-60] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/23/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Literature is still arguing about a possible relationship between airway hyperresponsiveness (AHR) and body mass index (BMI). This study aimed at evaluating the influence of BMI on AHR and pulmonary function in children and adolescents that performed a methacholine test for suggestive asthma symptoms. METHODS 799 consecutive children/adolescents (535 M; mean age: 15 ± 3 yrs; median FEV1% predicted: 101.94% [93.46-111.95] and FEV1/FVC predicted: 91.07 [86.17-95.38]), were considered and divided into underweight, normal, overweight and obese. Different AHR levels were considered as moderate/severe (PD20 ≤ 400 μg) and borderline (PD20 > 400 μg). RESULTS 536 children/adolescents resulted hyperreactive with a median PD20 of 366 μg [IQR:168-1010.5]; 317 patients were affected by moderate/severe AHR, whereas 219 showed borderline hyperresponsiveness. Obese subjects aged > 13 years showed a lower (p = 0.026) median PD20 (187μg [IQR:110-519]) compared to overweight (377 μg [IQR:204-774]) and normal-weight individuals' values (370.5 μg [IQR:189-877]). On the contrary, median PD20 observed in obese children aged ≤ 13 years (761 μg [IQR:731-1212]) was higher (p = 0.052) compared to normal-weight children's PD20 (193 μg [IQR:81-542]) and to obese adolescents' values (aged > 13 years) (p = 0.019). Obesity was a significant AHR risk factor (OR:2.853[1.037-7.855]; p = 0.042) in moderate/severe AHR adolescents. Females showed a higher AHR risk (OR:1.696[1.046-2.751] p = 0.032) compared to males. A significant relationship was found between BMI and functional parameters (FEV1, FVC, FEV1/FVC) only in hyperreactive females. CONCLUSIONS Obesity seems to influence AHR negatively in female but not in male adolescents and children. In fact, AHR is higher in obese teenagers, in particular in those with moderate/severe hyperresponsiveness, and may be mediated by obesity-associated changes in baseline lung function.
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Affiliation(s)
- Bruno Sposato
- Unit of Pneumology, Azienda Ospedaliera, "Misericordia" Hospital, Via Senese 161, 58100, Grosseto, Italy.
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Bruno P, Ricci A, Esposito MC, Scozzi D, Tabbì L, Sposato B, Falasca C, Giarnieri E, Giovagnoli MR, Mariotta S. Efficacy and cost effectiveness of rapid on site examination (ROSE) in management of patients with mediastinal lymphadenopathies. Eur Rev Med Pharmacol Sci 2013; 17:1517-1522. [PMID: 23771540] [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: 06/02/2023]
Abstract
BACKGROUND The diagnostic and staging approach for the mediastinal lymphadenopathies, with or whithout pulmonary lesions endoscopically visible, is based on transbronchial needle aspiration (TBNA) during fiberoptic bronchoscopy and on mediastinoscopy. One important factor impacting on TBNA sensitivity is the rapid on site cytological examination (ROSE). AIM The aim of this study was to evaluate the economic impact of TBNA and TBNA + ROSE, in the diagnosis of these lesions. PATIENTS AND METHODS 120 patients, affected by mediastinal lymphadenopathies suspected for lung cancer, underwent TBNA during fiberoptic bronchoscopy: 60 patients without ROSE (group A) and other 60 with ROSE (group B). Whenever needle aspirations failed to provide diagnosis, the patient underwent mediastinoscopy. The economic impact of the diagnostic process was performed. RESULTS In group A, 39 patients (65%) obtained a diagnosis with TBNA while 21 patients (35%) required mediastinoscopy. In group B, 48 patients (80%) obtained a diagnosis with TBNA + ROSE, while 12 patients (20%) required mediastinoscopy. With regards to the costs of the procedures performed in the diagnostic process, the use of TBNA with ROSE as first diagnostic approach has saved a considerable amount of euros (19,413) compared to the use of TBNA without ROSE and the combined procedure increased (p < 0.02; chi square test) the sensitivity of TBNA by 15%. CONCLUSIONS ROSE significantly impacts on the diagnostic yield, as well as on the overall management costs of patients with mediastinal lymphadenopathy, suspected for lung cancer.
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Affiliation(s)
- P Bruno
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Sposato B. Cypress-sensitized asymptomatic patients during the pollen season: sensitization or simply cross-reactivity? J Investig Allergol Clin Immunol 2013; 23:74-75. [PMID: 23653986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Sposato B, Scalese M. Prevalence and real clinical impact of Cupressus sempervirens and Juniperus communis sensitisations in Tuscan "Maremma", Italy. Allergol Immunopathol (Madr) 2013; 41:17-24. [PMID: 21982402 DOI: 10.1016/j.aller.2011.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/01/2011] [Accepted: 08/13/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim was to evaluate the impact of Cupressus sempervirens (Cs) and Juniperus communis (Jc) sensitisations in "Maremma" in southern Tuscany. METHODS 811 consecutive outpatients (357 F - 57.86%; age: 36.9 ± 16.6) with suspected allergic respiratory symptoms underwent skin prick tests (SPT) for common allergens and for Cs and Jc. RESULTS SPT resulted negative in 295 (36.37%) subjects. A Cs/Jc sensitisation was found in 294 (36.25%): 289 (98.3%) were sensitised to Cs whereas 198 (67.34%) to Jc. There was a co-sensitisation between Cs and Jc in 193 (65.6%) subjects. Cs/Jc mono-sensitisation was found in 39 (13.6%) subjects. A higher number (p<0.0001) of Cs/Jc sensitised subjects reported winter (131-44.55%) and spring (124-42.2%) symptoms compared to Cs/Jc non-sensitised and non-allergic subjects. Most Cs/Jc sensitised subjects reported rhinitis and conjunctivitis (p<0.0001), whereas only few reported coughing and asthma (p<0.01). The most frequent co-sensitisation was with grass, olive and other trees in Cs/Jc subjects (p<0.001). Those who reported winter symptoms, likely influenced by Cupressaceae, rhinitis was the main symptom whereas asthma was less frequent. Cs/Jc sensitisation resulted to be a risk factor (OR: 1.73 [CI95% 1.18-2.55]) for rhinitis whereas the probability of being asthmatic was reduced (OR: 0.62 [CI95% 0.44-0.85]). CONCLUSION The prevalence of Cs/Jc sensitisation is about 36% in "Maremma". However, only in 44% of the patients, Cs/Jc seem to cause typical winter symptoms. Rhinitis is the predominant symptom, whereas asthma is less frequent. Testing Cupressaceae sensitisation using Jc pollen extract, rather than Cs, may result to be less sensitive.
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Affiliation(s)
- Bruno Sposato
- Unità di Pneumologia, Ospedale "Misericordia", Grosseto, Italy.
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