Breathlessness, but not cough, suggests chronic obstructive pulmonary disease in elderly smokers with stable heart failure.

Chronic obstructive pulmonary disease (COPD) is a common comorbidity of heart failure (HF), but remains often undiagnosed, and we aimed to identify symptoms predicting COPD in HF. As part of an observational, prospective study, we investigated stable smokers with a confirmed diagnosis of HF, using the 8-item COPD-Assessment-Test (CAT) questionnaire to assess symptoms. All the items were correlated with the presence of COPD, and logistic regression models were used to identify independent predictors. 96 HF patients were included, aged 74, 33% with COPD. Patients with HF and COPD were more symptomatic, but only breathlessness when walking up a hill was an independent predictor of COPD (odds ratio=1.33, p=0.0484). Interestingly, COPD-specific symptoms such as cough and phlegm were not significant. Thus, in elderly smokers with stable HF, significant breathlessness when walking up a hill is most indicative of associated COPD, and may indicate the need for further lung function evaluation

Cardiac disease

\u2022 Literature indicates an important link between chronic obstructive lung disease, ischemic heart disease and heart failure. \u2022 The pathogenesis of the association is partially unclear, but probably recognized shared risk factors, such as smoke, altered local and systemic inflammatory response, and alteration in blood gases. \u2022 Patients with cardio-respiratory comorbidities have non-specific symptoms, and often a correct diagnosis is challenging. \u2022 The diagnosis of respiratory disease, as well as the treatment, should not generally deviate from international guidelines and indications, regardless of associated cardiac diseases. Similarly, cardiac diseases should be treated according to guidelines; caution may be advised for beta-blockers and amiodarone

Influence of (22S, 23S)-homobrassinolide on olive rooting

Brassinosteroids (BRs) have been used in woody plants to increase the rooting response. In this research, (22S, 23S)-homobrassinolide (SSHB) was tested, alone and in combination with indole-3-butyric acid potassium salt (K-IBA), to promote olive clonal propagation. In November, cuttings of two Italian cultivars, Leccino (easy-to-root) and Leccio del Corno (difficult-to-root), were collected and forced to root. Two studies were carried out: 1) evaluation of the influence on rooting of K-IBA and of different concentrations of SSHB; 2) evaluation of the simultaneous use of K-IBA and two concentrations of SSHB, on adventitious root formation. Samples were also collected for chemical studies. Results obtained in both studies confirmed the positive effect of K-IBA on rooting percentage and on number of adventitious roots produced. Furthermore, SSHB had a positive influence on the formation of lateral roots; the response is genotype and treatment dependent. Soluble sugars and phenol composition at the rooted cutting base is differentially influenced by the genotype and the growth regulators used

Antibiotic treatment of severe exacerbations of chronic obstructive pulmonary disease with procalcitonin: A randomized noninferiority trial

The duration of antibiotic treatment of exacerbations of COPD (ECOPD) is controversial. Serum procalcitonin (PCT) is a biomarker of bacterial infection used to identify the cause of ECOPD. METHODS AND FINDINGS: We investigated whether a PCT-guided plan would allow a shorter duration of antibiotic treatment in patients with severe ECOPD. For this multicenter, randomized, non-inferiority trial, we enrolled 184 patients hospitalized with ECOPD from 18 hospitals in Italy. Patients were assigned to receive antibiotics for 10 days (standard group) or for either 3 or 10 days (PCT group). The primary outcome was the rate of ECOPD at 6 months. Having planned to recruit 400 patients, we randomized only 183: 93 in the PCT group and 90 in the standard group. Thus, the completed study was underpowered. The ECOPD rate at 6 months between PCT-guided and standard antibiotic treatment was not significant (% difference, 4.04; 90% confidence interval [CI], -7.23 to 15.31), but the CI included the non-inferiority margin of 15. In the PCT-guided group, about 50% of patients were treated for 3 days, and there was no difference in primary or secondary outcomes compared to patients treated for 10 days. CONCLUSIONS: Although the primary and secondary clinical outcomes were no different for patients treated for 3 or 10 days in the PCT group, the conclusion that antibiotics can be safely stopped after 3 days in patients with low serum PCT cannot be substantiated statistically. Thus, the results of this study are inconclusive regarding the noninferiority of the PCT-guided plan compared to the standard antibiotic treatment. The study was funded by Agenzia Italiana del Farmaco (AIFA-FARM58J2XH). Clinical trial registered with www.clinicaltrials.gov (NCT01125098). TRIAL REGISTRATION: ClinicalTrials.gov NCT01125098