Eosinophilic pneumonias. A clinical case of acute eosinophilic pneumonia associated with sertraline and literature review

Background: Acute eosinophilic pneumonia (AEP) is one of the heterogeneous group of disorders termed eosinophilic lung diseases showing an abnormal accumulation of eosinophils in distal airways, air spaces, and the interstitial compartment of the lung. AEP is characterized by acute febrile respiratory failure, a typical radiographic pattern similar to that of acute pulmonary edema, eosinophilia in bronchoalveolar lavage (BAL), a dramatic response to corticosteroid therapy with no relapse when tapering or withdrawing treatment in the absence of infection. It can be idiopathic o secondary to known causes such as drugs, or fungal and parasitic infections. Clinical case: We report a case of a 76-year-old woman who developed symptoms, respiratory signs, and radiological and histological findings compatible with secondary AEP, we assessed as being associated with sertraline assumption (second case in literature). Discussion: The AEP we detected could be related to a secondary hypersensitivity syndrome to drug exposure (DRESS syndrome: Drug Rush with Eosinophilia and Systemic Symptoms) characterized by 1) skin rush, 2) increased eosinophilia, and 3) systemic involvement. The presence of all three criteria confirmed our diagnosis

Inappropriatezza prescrittiva dell'ossigenoterapia domiciliare a lungo termine

Long-term oxygen therapy (LTOT) at home is an established treatment, which is potentially subjected to inappropriate prescription. This retrospective study aims to identify the determinants of inappropriate prescription through the analysis of existing prescribing information for LTOT and routes of supply within the Northern area of the Emilia-Romagna Region. We selected all first time prescriptions for LTOT released in 2009 in the provinces of Modena, Parma, Piacenza and Reggio Emilia. A specific questionnaire with data collection through an electronic database allowed to analyze both organizational / administrative and clinical variables related to LTOT prescription. We analyzed a total of 364 prescriptions: 62 from Modena, 96 from Parma, 73 from Reggio Emilia, and 133 from Piacenza. The data collected highlighted several differences in the prescribing process between the four provinces. Among the most frequently omitted information in the prescription we identified: a) values of PaO2 and PaCO2 (absent in more than 90% of prescriptions dispensed at the AUSL Modena, while present in about 70% of prescriptions in Parma and in almost all of those of Piacenza and Reggio Emilia); b) differential information on oxygen flow at night or during exercise (absent in the prescriptions from Parma, Modena and Piacenza and present in more than 60% of prescriptions from Reggio Emilia); c) indications concerning the follow-up (not covered in the prescriptions from Modena and Parma). Finally, definition of the diagnosis that justifies the need for prescription of LTOT is often missing or incomplete. Therefore the results of the study have allowed the identification of some factors of inappropriateness both on the clinical side and on the management side. This analysis indicates the need for interventions aimed at improving and standardizing the process of LTOT prescription

Time trends in smoking habits among Italian young adults

Background: In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy. Methods: In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20\u201345 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan\u2013Meier survival curves and log-rank test were used to compare probability of remaining a life-time non-smoker across birth cohorts (1953\u201358, 1959\u201363, 1964\u201368, 1969\u201373, 1974\u201378). Probability to quit smoking was also evaluated among ever-smokers. Results: Probability to persist as a non-smoker significantly increased across subsequent generations in both sexes. At the age of 20 years this probability amounted to 41.7% (95% CI 39.4\u201344.0%) in men and 52.7% (50.4\u201354.9%) in wome

Home Oxygen Saturation Monitoring And Quality Of Life Evaluation In Patients With Idiopathic Pulmonary Fibrosis: Preliminary Results From A Prospective Multicenter Trial

Introduction. Long-term follow-up of patients with idiopathic pulmonary fibrosis (IPF) is an important component of their clinical management. While oxygen saturation (SpO2) measurement is widely used in both routine practice and clinical trials, feasibility and clinical relevance of long-term SpO2 monitoring has not been studied yet. Methods. We designed a 1-year multicenter prospective study aimed at evaluating the long-term feasibility of home daily SpO2 monitoring and its clinical relevance by assessment of correlation with a symptoms and quality of life (QoL) questionnaire. Enrolled patients received a multi-parameter digital recorder (Sally® Personal Assistant, Medigas, Italy), allowing acquisition, transmission and online web-based storage of SpO2 measurements, together with the data of a short questionnaire on symptoms and QoL. SpO2 data were acquired three times a day, for at least one minute, in resting conditions, while answers to the questionnaire were provided once a day. All data were transmitted daily to a dedicated server through the telephone landline. Spearman’s rank correlation coefficient () was used to calculate the correlation between SpO2 values and the QoL scores. Results. Six months interim analysis was based on 21 IPF patients (15 males, mean age 75 years; 9 receiving long-term oxygen therapy): 17 of them (81%) provided valid data for a mean time (± SD) of 175 (±78) days). The majority (66%) of patients provided sufficient data for calculating the correlation coefficient. In most patients (86%) SpO2 values decreased while QoL score increased (i.e. QoL deteriorated): in 5 the correlation was statistically significant. Patients monitored for longer time were more likely to show a statistically significant correlation between these two parameters. Home SpO2 monitoring was accepted positively by all patients; the majority of them (63%) was able to self-perform all required tasks. Missing data accounted for 41% of all expected data and were mostly due to technical issues during the first weeks of study. Conclusions. Non-invasive home daily monitoring of oxygen saturation is feasible and well accepted in IPF patients. SpO2 seems to correlate with changes in symptoms and QoL scores, thus confirming the clinical relevance of this parameter

The Role of climate on the geographic variability of asthma, allergic rhinitis and respiratory symptoms: results from the Italian study of asthma in young adults

Background: Variations in the prevalence of respiratory symptoms according to geo-climatic factors could provide important clues to the knowledge of the aetiology of asthma. Methods: Geo-climatic variations in the prevalence of current asthma, allergic rhinitis and chronic cough, and phlegm were assessed on a random sample of 18 873 subjects (response rate = 72.7%) from different climatic regions of Italy. An ecological analysis, supported by robust statistical methods, was employed to investigate potential trends. Results: The prevalence of all symptoms was significantly heterogeneous throughout the peninsula. Only asthma-like symptoms showed a north–south trend: the prevalence increased at a decreasing latitude [odds ratio (OR) varies from 0.92 to 0.96, P <0.05], at a decreasing distance from the sea (OR: 0.90–0.93 for 30 km distance, P < 0.05), at higher annual mean temperatures (OR: 1.11–1.14, P < 0.05) and at smaller annual temperature ranges (OR: 0.94–0.95, P < 0.05). Of the geo-climatic variables considered, temperature range had the greatest influence on most asthma-like symptoms. No association was found between geo-climatic variables and allergic rhinitis or chronic cough and phlegm. Conclusions: Asthma prevalence seems to be significantly affected by climate as asthma-like symptoms were more common in central-southern Italy, with a Mediterranean climate, than in areas with a continental climate (northern Italy)

The Control of asthma in Italy. A multicentre descriptive study on young adults with doctor diagnosed current asthma

Background: Few data are available on the management of asthma in the general population. The aim of this study was to evaluate the level of asthma control in Italian patients, a decade after the publication of the international guidelines. Materials and methods: Within the framework of a multicentre, population-based study on people aged 20–44 years, 18 873 subjects replied to a postal screening questionnaire (response rate = 72.7%) on the presence of asthma symptoms and exacerbations, and their impact on daily life. All subjects reporting having ever had a doctor diagnosis of asthma and either taking medicine for asthma when interviewed or having had an asthma attack in the last 12 months, were considered current asthmatics. Results: Of the screened subjects, 649 (3.4%) were current asthmatics. Of these, only 14% did not report exacerbations or had been symptom-free in the last 12 months. More than 20% of current asthmatics had their daily life activities seriously impaired and 54 patients (8%) had at least one hospital/emergency department admission as a result of asthma exacerbation in the last 12 months. The life impairment and the rates of hospitalization significantly increased as the control of the symptoms worsened. The use of asthma drugs was quite common in current asthmatics: 586 (90.2%) reported having been under pharmacological treatment in the last 12 months. Only 63 patients (10%) had the disease under control (neither symptoms nor life impairment): they had a significantly higher percentage of drug use (100%vs 89%) and of daily use prescriptions (50%vs 36%) than non/moderately controlled asthmatics. Poorly controlled asthmatics had a significantly higher percentage of women (63%vs 44%), of patients with the coexistence of chronic cough and phlegm (47%vs 30%) than moderately/well-controlled asthmatics. The comparison between our data and similar data collected in 1991 in Italy showed that the use of asthma drugs increased by about 12%, while the control of symptoms did not improve in the last decade. Conclusion: Despite the high percentage of drug users, the control of symptoms and exacerbations was overall poor in Italy and resulted in a heavy individual and social burden, pointing out that the guideline goals have far from been reached in Italy