Work-related allergic rhinitis: a contemporary review of the literature

Adverse health effects have been reported in workers exposed to inhaled allergens. Allergic rhinitis is a heterogeneous disorder that significantly affects daily activity, work productivity, sleep, learning, and quality of life in all generations. Occupational-ly-related hazards which contribute to the development of allergic rhinitis represent an important avoidable cause of morbidity. The occupational exposure to chemicals or biological agents is the cause of high incidences of allergic rhinitis and this risk is high when the organization and preparation are inadequate and there is a lacking or insufficient information, education and communication. The prevalence of work-related rhinitis, which encompasses both occupational rhinitis and work-exacerbated rhinitis, is estimated to be 31-61%. Data on occupational rhinitis itself are scarce. Although work-related asthma and allergies are a huge burden for society, investigation of oc-cupational exposures in early work life using an unexposed reference group is rare. Occupational allergic diseases are likely to worsen or become intractable as a result of continuous exposure to high concentrations of causative antigens, and are socioeco-nomically important diseases with which the patients might sometimes lose jobs due to work interruptions. It is important to adequately assess, communicate and manage risks in occupational chemical exposure settings with the aim to protect workers and the necessity to introduce periodic health examinations programs focusing on workers to monitor health and well-being and improve working conditions and the working environment

Update on optimal use of omalizumab in management of asthma

Omalizumab is a humanized monoclonal anti-IgE antibody recently approved for the treatment of severe allergic asthma. This drug inhibits allergic responses by binding to serum IgE, thus preventing interaction with cellular IgE receptors. Omalizumab is also capable of downregulating the expression of high affinity IgE receptors on inflammatory cells, as well as the numbers of eosinophils in both blood and induced sputum. The clinical effects of omalizumab include improvements in respiratory symptoms and quality of life, paralleled by a reduction of asthma exacerbations, emergency room visits, and use of systemic corticosteroids and rescue bronchodilators. Omalizumab is relatively well-tolerated, and only rarely induces anaphylactic reactions. Therefore, this drug represents a valid option as add-on therapy for patients with severe persistent allergic asthma inadequately controlled by high doses of standard inhaled treatments

Ipertensione Polmonare

Il volume, organizzato in 8 sezioni e 34 capitoli, tratta la clinica delle malattie respiratorie, i rapporti con le malattie concomitanti e i relativi aspetti organizzativi e normativi

A single-blind, partial crossover clinical trial of the effects of inhaled fluticasone propionate and nedocromil sodium on airway hyperresponsiveness to methacholine

Background: Airway inflammation plays a central role in the pathogenesis of asthma, even in the mildest forms and at the earliest stages. Therapeutic strategies now aim to relieve bronchoconstriction as well as focus primarily on controlling the underlying inflammatory process. Clinical trials of children and adults with asthma have demonstrated that inhaled corticosteroids and cromones (such as nedocromil sodium [NS]) improve symptoms and lung function, as well as decrease nonspecific bronchial hyperresponsiveness. Objective: The aim of this study was to compare the effects of various antiinflammatory therapeutic regimens using inhaled fluticasone propionate (FP) and/or NS on airway hyperresponsiveness to methacholine. Methods: Patients with mild, persistent asthma., who tested positive to a Dermatophagoides pteronyssinus skin prick test, were randomly assigned to 1 of 4 treatment groups: (1) FP for 16 weeks; (2) FP for 8 weeks, followed by NS for 8 weeks; (3) NS for 8 weeks, followed by FP for 8 weeks, or (4) NS for 16 weeks. Each patient was evaluated every 4 weeks. Results: Thirty-two patients with asthma (16 men and 16 women; age range, 18-48 years) were included in the study; 8 patients were randomly assigned to each of the 4 treatment groups. During treatment with FP alone, the provocative dose of methacholine required to induce a 20% decrease in forced expiratory volume in 1 second (PD20) was significantly higher than that recorded during treatment with NS alone (P < 0.05 at weeks 12 and 16). However, both drugs induced progressive increases in PD20 versus baseline values throughout the study. Moreover, when FP was administered as the second drug (after NS), a further increase in PD20 compared with the values at week 8 occurred at both week 12 (P < 0.01) and week 16 (P < 0.001). In contrast, when NS was administered after 8 weeks of treatment with FP, methacholine PD20 decreased significantly compared with week 8 (P < 0.001 and P < 0.01 at weeks 12 and 16, respectively). Conclusions: Our results suggest that, in this limited population of asthmatic patients who were treated for 16 weeks, FP was effective in increasing the PD20 and that NS exerted an effective, progressive protective action against bronchial hyperresponsiveness to methacholine, thereby partially limiting the negative consequences of FP withdrawal on airway inflammation

Exhaled nitric oxide monitoring in COPD using a portable analyzer

International audienc

Real-life prospective study on asthma control in Italy: Cross-sectional phase results

Objectives: To estimate the prevalence of partly controlled and uncontrolled asthmatic patients, to evaluate quality of life and healthcare resource consumption. Methods: Cross-sectional phase followed by a 12-month prospective phase. Asthma Control Test and the EQ-5D were used. Results: 2853 adult patients recruited in 56 Hospital Respiratory Units in Italy were evaluated: 64.4% had controlled asthma, 15.8% partly controlled asthma and 19.8% were uncontrolled. The mean (SD) EQ-5D score was 0.86 (0.17) in controlled, 0.75 (0.20) in partly controlled and 0.69 (0.23) in uncontrolled patients (p < 0.001 between groups). The number of patients requiring hospitalization or emergency room visits was lower in controlled (1.8% and 1.6%, respectively) than in partly controlled (5.1% and 11.5%) and uncontrolled (6.4% and 18.6%). A combination of an inhaled corticosteroid and a long-acting beta-2 agonist was the reported therapy by 56.0% of patients, with the rate of controlled asthma and improved quality of life being higher in patients on extrafine beclomethasone/formoterol compared to budesonide/formoterol (p < 0.05) and fluticasone/salmeterol (p < 0.05 for quality of life). Conclusions: Asthma control is achieved in a good proportion of Italian patients. Differences may be detected in a real-life setting in favor of extrafine beclomethasone/formoterol combination. © 2011 Elsevier Ltd. All rights reserved