Correlation among functional respiratory parameters and disease control in asthma.

Asthma is a complex inflammatory disease involving large and small airways with different degrees of inflammation and remodeling which are responsible for disease symptoms. We evaluated clinical and functional data in a group of 26 patients (18 women, age range 18-75 years) with mild-to-severe asthma in order to correlate functional markers of airways dysfunction and ventilation inequality with clinical data. Global spirometry, single-breath nitrogen washout (SBN2W), body pletysmograph and impulse oscillometry (IOS) were performed, both at baseline and after bronchodilator test with salbutamol 400 mcg. Asthma severity was assessed according to GINA guidelines and disease control was evaluated using the Asthma Control Test (ACT). All IOS parameters (resistance of the respiratory system at 5Hz [R5], and 20Hz [R20], difference of R5 and R20 [Di5-20], reactance area [AX], resonant frequency [FRes]) and airway resistance (Raw) were negatively correlated (p<0,01) with forced expiratory volume in 1 sec (FEV1), forced mid-expiratory flow (FEF25-75) and peak of expiratory flow (PEF) but not with disease severity. None of the IOS parameters directly correlated with the ACT score, but Di5-20 was at limit of the statistical significance (p=0,054). We found a significant negative correlation between the ACT score and the change in N2 concentration in phase 3 (DeltaN2) of the SBN2W test (p<0,05). In a multiple regression model, Di5-20 but not R20 significantly contributed to determination of DeltaN2 (p<0,05). Our results suggest that in asthmatic patients the inequality of ventilation is associated with poor disease control, but is not related to the severity of disease

Are newly launched pharmacotherapies efficacious in treating idiopathic pulmonary fibrosis? Or is there still more work to be done?

Introduction: Idiopathic pulmonary fibrosis (IPF) is a challenging and multifactorial disease that has been thought for some time to lack effective treatments. The approval of two drugs, nintedanib and pirfenidone, has heralded a new era in its management. Areas covered: Currently, there is a growing interest on therapeutic strategies. Many studies have been designed and performed, although few of them turned out to be successful. Nowadays, nintedanib and pirfenidone are considered disease modifying drugs, recommended treatments by current evidence-based guidelines. A combined approach with more than one drug could be an effective strategy in IPF. However, data on combination therapy of the two approved drugs are still scarce, and ongoing trials are evaluating pharmacodynamic interactions and safety. The approved disease modifying drugs are also being assessed in combination with new molecules, showing promising results in preclinical models. Expert opinion: A deeper understanding of pathogenesis and key molecular mechanisms driving disease inception and progression will be key to identify novel agents to be tested both pre-clinically and clinically, possibly in combination with approved treatments. Looking at the near future, it is likely that clinical trials will adopt a phenotype-specific and pathway-specific approach, thus leading towards a personalized approach to IPF management

Inter-hemispheric functional coupling of eyes-closed resting EEG rhythms in adolescents with Down syndrome

We tested the hypothesis that inter-hemispheric directional functional coupling of eyes-closed resting EEG rhythms is abnormal in adolescents with Down syndrome (DS)

Decline of the lung function and quality of glycemic control in type 2 diabetes mellitus

The aim of this study was to verify to which extent in type 2 diabetes mellitus respiratory function and respiratory muscle efficiency decline over time in relation to the quality of glycemic control (GC)

Decline of the lung function and quality of glycemic control in type 2 diabetes mellitus

Decline of the lung function and quality of glycemic control in type 2 diabetes mellitu

The diabetic lung--a new target organ?

Several abnormalities of the respiratory function have been reported in patients with type 1 and type 2 diabetes. These abnormalities concern lung volume, pulmonary diffusing capacity, control of ventilation, bronchomotor tone, and neuroadrenergic bronchial innervation. Many hypotheses have emerged, and characteristic histological changes have been described in the "diabetic lung", which could explain this abnormal respiratory function. Given the specific abnormalities in diabetic patients, the lung could thus be considered as a target organ in diabetes. Although the practical implications of these functional changes are mild, the presence of an associated acute or chronic pulmonary and/or cardiac disease could determine severe respiratory derangements in diabetic patients. Another clinical consequence of the pulmonary involvement in diabetes is the accelerated decline in respiratory function. The rate of decline in respiratory function in diabetics has been found to be two-to-three times faster than in normal non-smoking subjects, as reported in longitudinal studies. This finding, together with the presence of anatomical and biological changes similar to those described in the aging lung, indicates that the "diabetic lung" could even be considered a model of accelerated aging. This review describes and analyses the current insight into the relationship of diabetes and lung disease, and suggests intensifying research into the lung as a possible target organ in diabetes

Computed tomography for evaluation of the small airway disease in asthma.

Small airway dysfunction and remodeling are known to influence the disease control and progression in asthma. We investigated the small airway involvement in asthmatic patients by correlating data derived from computed tomography (CT) and pulmonary function test (PFT). The CT lung scans were acquired at full inspiration and expiration using a portable spirometer to control the respiratory manoeuvers. PFT was performed before and after bronchodilator test with salbutamol 400 mcg, measuring lung volumes and flows, airway resistance (Raw) and single-breath nitrogen washout (SBN2W). Up to now, 25 patients with mild-to-moderate asthma were studied. Fifteen had a good control of the disease at the time of the study as reflected by an Asthma Control Test (ACT) score ≥ 20. The mean lumen area (LA), measured in the left lower lobe posterior-basal segmental bronchus (LB10), correlated directly with the forced expiratory volume in 1 sec (FEV1) (r=0.60, p=0.002) and inversely with Raw (r=-0.52, p=0.011). The wall area percent (WA%) in the LB10 correlated inversely with FEV1 (r=-0.55, p=0.004)and directly with Raw (r=0.50, p=0.014). Air trapping, expressed as expiratory Voxel Index -856 HU (%), correlated inversely with FEV1 (r=-0.82, p<0.0001) and directly with both residual volume (RV)(r=0.72, p<0.0001) and the change in N2 concentration in phase 3 of the SBN2W test (r=0.67, p=0.001). A trend toward a significant increase in air trapping was found in the 10 patients with a poor control of the disease in comparison with the 15 patients in good control (p=0.083). These preliminary data show that both CT and PFT including Raw and SBN2W provide useful information for the study of the small airways in asthma

Severe asthma: One disease and multiple definitions

Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem