Effect of inhaled heparin on water-induced bronchoconstriction in allergic asthmatics.

Objective: The aim of this study was to investigate the effect of inhaled heparin on bronchoconstriction induced by ultrasonically nebulised distilled water (UNDW) in allergic asthmatics. Methods: Eight atopic asthmatics, hyperresponsive to UNDW, were selected for this randomised, placebo-controlled, crossover double-blind study. On two consecutive days, these subjects underwent a UNDW challenge 45 min after inhaling aerosolised heparin (1000 U/kg) or placebo. Results: Neither heparin nor placebo had a significant effect on base-line forced expiratory volume in 1 s (FEV1), but heparin significantly attenuated UNDW-induced bronchoconstriction, as shown by its efficacy in preventing the decreases in FEV1 produced by all doses of water (in comparison with placebo, P < 0.95 after 2 ml water, P < 0.01 after 4, 8 and 16 ml water). Conclusion: Inhaled heparin is able to exert a protective effect against the bronchoconstrictive response to UNDW in allergic asthmatics, and this action is likely due to inhibition of mast cell degranulation

Comparison of the bronchodilating effects of inhaled formoterol, salmeterol and salbutamol in asthmatic patients.

Ten subjects with various degrees of asthma severity underwent a three-day trial, with the aim of evaluating the bronchodilating effect of inhaled formoterol (12 mg), in comparison with salbutamol (200 mg) and salmeterol (50 mg). The bronchodilation afforded by formoterol paralleled that of salbutamol in rapidity (mean percentage increases in functional measurements (FEV1) vs. baseline recorded 5 min after drug administration: 7.7%, 9.3%, and 0.3% for salbutamol, formoterol and salmeterol, respectively) and that of salmeterol in duration (mean percentage increases in FEV1 vs. baseline recorded 12 h after drug administration: 16.8% and 15.9% for formoterol and salmeterol, respectively). Moreover, the maximal effect of formoterol resulted to be slightly higher in comparison with salbutamol (P50.001) and salmeterol (P50.05); in this regard, the mean percentage increases in FEV1 vs. baseline recorded 2 h after salbutamol and formoterol, and 4 h after salmeterol were 22.3%, 29.5%, and 24.6%, respectively. Therefore, these results suggest that formoterol can be used, in addition to its utilization as long-acting bronchodilator, also as an effective rescue medication for the immediate relief of asthma symptoms

Effects of non-bronchoconstrictive doses of inhaled propranolol on airway responsiveness to methacholine.

Objectives: The aim of this study was to evaluate the effects of non-bronchoconstrictive doses of propranolol on airway hyperresponsiveness to methacholine. Methods: Double increasing concentrations (from 0.03 to 64 mug/ml) of inhaled propranolol were administered to a study population which included ten patients with mild asthma, tell rhinitics, and ten healthy control subjects. After the baseline bronchial responses to propranolol and methacholine, expressed as the cumulative provocative dose producing a 20% fall in forced expiratory volume in 1 a (PD20FEV1), were assessed, methacholine challenge was repeated after pretreatment with non-bronchoconstrictive doses of propranolol. Results: The pharmacologically induced beta -blockade did not cause any effect in normal individuals, but it worsened airway responsiveness to methacholine in all asthmatics (geometric mean PD20 FEV1: 257 and 87 mug, respectively) and some rhinitics (geometric mean PD20 FEV1: 724 and 446 mug, respectively). Conclusion: Asthmatic patients were extremely sensitive to beta -blockers, whereas we observed a variable response to propranolol within the group of rhinitic subjects. This variability in the latter group is possibly because these individuals had different degrees of airway inflammation, increased parasympathetic activity, and beta -adrenoceptor dysfunction

Evidence of angiogenesis in bronchial biopsies of smokers with and without airway obstruction

The involvement of bronchial vasculature in the airway remodelling occurring in symptomatic smokers with normal lung function and with chronic obstructive pulmonary disease (COPD) has been poorly investigated. An immunohistochemical study was performed on bronchial biopsies taken from 8 non-smokers and 18 smokers divided, according to global health initiative on obstructive lung diseases (GOLD) classification of COPD, into two groups, GOLD 0 and GOLD 2, each of 9 subjects. The number of vessels and the percentage of vascular area in the lamina propria were evaluated by mAb anti-collagen IV. Cellular expression of VEGF and vascular expression of alphavbeta3 integrin were evaluated by the specific monoclonal antibodies. An image processing and analysis system was used to quantify the immunohistochemical data. The number of vessels, the vascular area, the cellular expression of VEGF, the number and percentage of alphavbeta3 positive vessels were significantly higher in GOLD 0 and in GOLD 2 smokers than in non-smokers. The comparison between GOLD 0 and GOLD 2 smokers did show a weak but significantly lower number of vessels in GOLD 2, while the vascular area and the percentage of alphavbeta3 positive vessels did not differ between the two groups. A higher cellular VEGF expression was detected in the GOLD 2 than in the GOLD 0 group. Angiogenesis of bronchial vessels is a component of the airway remodelling occurring in symptomatic smokers with normal lung function and with COPD, it seems independent by the development of airway obstruction and not related to its severity

Lung cancer management: challenges in elderly patients

Elderly patients represent the majority of lung cancer cases, but they are often under-represented in clinical cancer treatment trials or excluded from studies because of comorbidities. Due to lack of data, treatment options for this population must be carefully evaluated and preliminary assessment should aim to stratify patients into different risk subgroups. In early NSCLC stages, surgery remains the best therapeutic option in low-moderate risk patients. Conversely, in patients unfit for surgery or in advanced stages, chemotherapy and radiotherapy should be considered as they may offer benefits in terms of clinical outcomes. Recent developments in targeting driver genes mutations as well as immune checkpoints have opened novel horizon in lung cancer management and systematic investigation in elderly population is required. In this review, we examined the more recent results of the literature about the therapeutic scenario in limited and advanced lung cancer stages in elderly and very elderly population