Assessing small airway impairment in mild-to-moderate smoking asthmatic patients

Asthma is characterised by airway inflammation throughout the bronchial tree, including the small airways. In asthma, small airway alterations are associated with poor clinical outcomes [1]. Cigarette smoke is known to induce peripheral airway abnormalities, asthmatic smokers exhibit a more rapid lung function decline, experience more frequent exacerbations and are more likely to be uncontrolled, even when the disease is managed as recommended [2]. The mechanisms accounting for poor responses to treatment in smoking asthmatic patients are currently unclear, although low accessibility to inhaled medications in the peripheral airways is considered a limiting factor for the efficacy of such treatments [3]

Assessing small airway impairment in mild-to-moderate smoking asthmatic patients

Asthma is characterised by airway inflammation throughout the bronchial tree, including the small airways. In asthma, small airway alterations are associated with poor clinical outcomes [1]. Cigarette smoke is known to induce peripheral airway abnormalities, asthmatic smokers exhibit a more rapid lung function decline, experience more frequent exacerbations and are more likely to be uncontrolled, even when the disease is managed as recommended [2]. The mechanisms accounting for poor responses to treatment in smoking asthmatic patients are currently unclear, although low accessibility to inhaled medications in the peripheral airways is considered a limiting factor for the efficacy of such treatments [3]

Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD

Inhaled corticosteroid-containing medications reduce the frequency of COPD exacerbations (mainly infectious in origin) while paradoxically increasing the risk of other respiratory infections. The aim was to determine the effects of inhaled corticosteroids on airway microbial load in COPD patients and evaluate the influence of the underlying inflammatory profile on airway colonisation and microbiome. This is a proof-of-concept prospective, randomised, open-label, blinded endpoint study. Sixty patients with stable moderate COPD were randomised to receive one inhalation twice daily of either a combination of salmeterol 50 \uce\ubcg plus fluticasone propionate 500 \uce\ubcg or salmeterol 50 \uce\ubcg for 12 months. The primary outcome was the change of sputum bacterial loads over the course of treatment. Compared with salmeterol, 1-year treatment with salmeterol plus fluticasone was associated with a significant increase in sputum bacterial load (p=0.005), modification of sputum microbial composition and increased airway load of potentially pathogenic bacteria. The increased bacterial load was observed only in inhaled corticosteroid-treated patients with lower baseline sputum or blood eosinophil (2%) levels but not in patients with higher baseline eosinophils. Long-term inhaled corticosteroid treatment affects bacterial load in stable COPD. Lower eosinophil counts are associated with increased airway bacterial load

Polmonite da ipersensibilità da antigeni aviari in un italiano adulto

Le polmoniti da ipersensibilità (hypersensitivity pneumonitis, HP) o alveoliti allergiche estrinseche (extrinsic allergic alveolitis, EAA), sono infiammazioni del parenchima polmonare sostenute da meccanismi immunopatologici che interessano gli alveoli ed i bronchioli terminali. Si sviluppano in seguito all’inalazione ripetuta, da parte di soggetti sensibilizzati, di antigeni (animali, batterici, fungini, vegetali o sintetici) di dimensioni (diametro <1-5 μm) in grado di raggiungere gli spazi alveolari (1). Il caso descritto, per le modalità della presentazione clinica, può essere classificato nelle forme croniche di HP