The Coexistence of asthma and Chronic Ostructive Pulmonary Disease (COPD): prevalence and risk factors in young, middle-aged and elderly people from the general population

Background: The joint distribution of asthma and chronic obstructive pulmonary disease (COPD) has not been well described. This study aims at determining the prevalence of self-reported physician diagnoses of asthma, COPD and of the asthma-COPD overlap syndrome and to assess whether these conditions share a common set of risk factors. Methods: A screening questionnaire on respiratory symptoms, diagnoses and risk factors was administered by mail or phone to random samples of the general Italian population aged 20–44 (n = 5163) 45–64 (n = 2167) and 65–84 (n = 1030) in the frame of the multicentre Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Results: A physician diagnosis of asthma or COPD (emphysema/chronic bronchitis/COPD) was reported by 13% and 21% of subjects aged &lt;65 and 65–84 years respectively. Aging was associated with a marked decrease in the prevalence of diagnosed asthma (from 8.2% to 1.6%) and with a marked increase in the prevalence of diagnosed COPD (from 3.3% to 13.3%). The prevalence of the overlap of asthma and COPD was 1.6% (1.3%–2.0%), 2.1% (1.5%–2.8%) and 4.5% (3.2%–5.9%) in the 20–44, 45–64 and 65–84 age groups. Subjects with both asthma and COPD diagnoses were more likely to have respiratory symptoms, physical impairment, and to report hospital admissions compared to asthma or COPD alone (p&lt;0.01). Age, sex, education and smoking showed different and sometimes opposite associations with the three conditions. Conclusion: Asthma and COPD are common in the general population, and they coexist in a substantial proportion of subjects. The asthma-COPD overlap syndrome represents an important clinical phenotype that deserves more medical attention and further research.</br

Latitude variation in the prevalence of asthma and allergic rhinitis in Italy: results from the GEIRD study

BACKGROUND: Earlier studies have pointed out a great variability in the prevalence of asthma and asthma-like symptoms in different geo-climatic areas. AIM: To test the association between latitude and prevalence of asthma and allergic rhinitis in Italian young adults. METHODS: In the frame of Gene-Environment Interaction in Respiratory Diseases study, a postal screening questionnaire on respiratory health and exposure to environmental factors was administered to 18,357 randomly selected subjects aged 20-44 years in 7 centres: 3 in Northern (Torino, Pavia, Verona), 2 in Central (Ancona, Perugia) and 2 in Southern Italy (Salerno, Sassari). RESULTS: 10,494 (57.2%) subjects responded to the questionnaire. The prevalence of self-reported doctor-diagnosed asthma and allergic rhinitis in the lifespan was 10.2% and 26.9%, respectively, and was significantly different across the centres (p&lt;0.05). After adjusting for sex, age, potential risk factors for respiratory diseases and design confounders, the prevalence of asthma (OR: 1.07 per 1°latitude decrease, p&lt;0.001), asthma-like symptoms (wheezing, chest tightness, asthma attacks: OR ranging from 1.04 to 1.06, p&lt;0.05) and allergic rhinitis (OR: 1.03, p=0.04) showed a significant north-to-south trend. Similarly, a 1°C increment in temperature was significantly associated with asthma (OR: 1.10, p&lt;0.001) and asthma-like symptoms (OR from 1.07 to 1.10, p&lt;0.05), but not with allergic rhinitis (OR=1.02, p=0.190). CONCLUSION: The prevalence of asthma and allergic rhinitis increased moving southwards in Italy, suggesting that prolonged exposure to different geo-climatic conditions may affect the onset of asthma and allergic respiratory diseases

Modulation of Nerve Growth Factor receptors in human monocytes and their influence in pulmonary inflammatory diseases

Neurotrophins (NTs) are a family of growth/survival factors with well-established functions in the nervous system. In the last decade, novel biological actions, from oncogenicity to inflammation, have been attributed to these factors. In particular, Nerve Growth Factor (NGF) acts through two different classes of receptors: the high affinity transducing TrKA receptor, associated to proliferation/survival, and the low affinity p75 receptor that, depending on its cross talk with TrKA, induces either apoptosis or survival. Recently, NGF and its receptors have been detected in healthy pulmonary tissues and seem to be involved in pulmonary inflammatory diseases. Since the expression of these NGF receptors in circulating monocytes is controversial, our initial aim was to investigate the role of these receptors both in pulmonary tissues and in peripheral blood monocytes of patients with Chronic Obstructive Pulmonary Disease (COPD). We therefore analyzed 38 healthy control subjects divided in two groups based on their smoking status. Serendipitously, the data obtained in these two control groups may have a value of their own, with potential implications in preventive medicine. We show here that in healthy subjects, smoking induces an early increase in p75 expression in monocytes, while TrKA seems unaffected. Furthermore, our control subjects could be divided in three subsets according to the constitutive TrKA expression in monocytes: TrKA-negatives, -intermediates (up to 50%) or -high (&gt; 50%), independently on their smoking status. Since TrKA activation promotes inflammation, we hypothesize that subjects with high-TrKA monocytes could be more prone to pulmonary inflammatory diseases, such as COPD. In fact, all 28 COPD patients in our series belonged to the high-TrKA subset, while all long term heavy smokers with no evidence of pneumologic diseases belonged to TrKA-negative subset. In conclusion, our data support the hypothesis that, since TrKA expression promotes survival, elevated levels of TrKA-positive monocytes may render subjects more prone to long term inflammatory diseases (e.g., COPD). Moreover, in patients constitutively expressing high levels of TrKA in monocytes, the smoking-dependent increase in p75 may in turn further extend monocytes survival, contributing to a chronic inflammation. Furthermore, the early increase in p75 expression in monocytes following smoking may support the hypothesis that p75 determination might represent a novel marker for passive smoking. Acknowledgments. This study was totally supported by Fondazione Cassa di Risparmio di Tern

Inhalation therapy in the next decade : Determinants of adherence to treatment in asthma and COPD

Peer reviewedPublisher PD

Oxo-Rhenium-Mediated Allylation of Furanoside Derivatives: A Computational Study on the Mechanism and the Stereoselectivity

: Properly substituted tetrahydrofuran (THF) rings are important building blocks in the synthesis of many natural metabolites. Having reliable procedures to control the stereoselectivity at the THF core while decorating it with different substituents is a fundamental requirement to achieve and fulfill the complexity of nature. We recently reported a new chemical approach to control the stereochemistry in the alkylation and arylation of furanoside derivatives by using a rhenium(V) complex to form an intermediate oxo-carbenium species able to react with proper soft nucleophiles. Here, we describe theoretical calculations, performed at the DFT B3LYP level, to disclose the important mechanistic features which regulate the entire catalytic cycle of the reaction of mono- and disubstituted furanosides with allyltrimethylsilane catalyzed by Re(O)Cl3(OPPh3)(Me2S). Moreover, the key factors governing the allylation step were investigated, confirming that the stereoselectivity, which is independent of the anomeric configuration of starting acetal, mainly arises from the orientation of the substituent at C-4, with only marginal contribution of the substituent at C-5. Finally, puckering Cremer-Pople parameters were used to take trace of the structural modifications throughout the catalytic cycle

Using ELISpot technology to improve the diagnosis of tuberculosis infection: from the bench to the T-SPOT.TB assay

Accurate detection and adequate treatment of latent tuberculosis infection represent a fundamental cornerstone to reduce the incidence of tuberculosis, in particular in low-incidence countries and among high-risk (i.e., immunosuppressed) individuals. Until recently, however, only the century-old tuberculin skin test was available as a diagnostic tool; its poor specificity and low sensitivity among immunosuppressed individuals has been a major limit to the implementation of effective tuberculosis control strategies. In the last years, the achievements of basic research on the genetics and immunology of Mycobacterium tuberculosis infection rapidly translated into clinical practice two elements of the vast amounts of knowledge acquired. First, the identification and use of specific antigens, which are absent in the tuberculosis vaccine and in most nontuberculous mycobacteria; and second, the identification of IFN-gamma as the main fundamental cytokine implicated in the effective immune response against M. tuberculosis. In an incredibly powerful combination, this new knowledge has been applied to enzyme-linked immunospot (ELISpot) technology, the most sensitive technique to quantify an in vitro antigen-specific cellular immune response. In only a few years, a new commercial, regulatory-approved, diagnostic assay has entered clinical practice as a substitute to the tuberculin skin test. The T-SPOT.TB test has already been applied to several hundreds of patients in the context of controlled clinical trials in different countries and prevalence areas, showing improved specificity and sensitivity in the diagnosis of latent tuberculosis infection over the skin test, in particular in those settings where the diagnosis is most needed

Exploring the immune response against Mycobacterium tuberculosis for a better diagnosis of the infection

Tuberculosis (TB) still represents a monumental problem, with more than two million deaths every year worldwide. The current diagnostics for TB offer sub-optimal accuracy both for the active and the latent form of infection and are often based on technologies unaffordable in low-income settings. The tuberculin skin test was the first diagnostic based on an acquired immune response towards Mycobacterium tuberculosis (MTB). Advances in molecular and cellular biology and the elucidation of the mechanisms governing the relation between MTB and the human immune system form the basis for new and more accurate assays, potentially able to fill the gaps and limits of classical diagnostics. However, the process of validating new tests is still complex and hampered by specific questions regarding TB immunology and natural history. We present here a summary of the current approaches to validate new diagnostics based on the detection of immunological biomarkers of TB infection