Publications (33)113.32 Total impact
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Article: 1-year prospective real life monitoring of asthma control and quality of life in Italy.
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ABSTRACT: Objectives The study aimed at prospectively evaluating the evolution of asthma control in Italy, to evaluate the reasons for lack of asthma control, perceived quality of life (QoL) and association with level of asthma control, the impact of pharmacological treatment, the number of exacerbations and the healthcare resource consumption. METHODS: PRISMA (PRospectIve Study on asthMA control) was an observational study performed in asthmatic patients including a cross-sectional phase and a 12-month prospective phase. Asthma control was assessed with the Asthma Control TestTM (ACT) and QoL was evaluated with EuroQoL-5D questionnaire filled in and collected during 5 clinic visits together with all the other data. RESULTS: The prospective phase included 1017 patients with uncontrolled (55.7%) or partly controlled asthma (44.3%). Out of the 739 patients evaluable after 12 months, 22.2% achieved full asthma control (ACT score = 25), 58.7% reached a good control (ACT score: 20--24). The improvement in asthma control was associated with improved QoL and reduced hospital visits. The main reasons for lack of asthma control were comorbidities, continued exposure to irritants/triggers and poor adherence to therapy. The frequency of exacerbations was lower in patients with controlled asthma.A fixed combination therapy with an inhaled corticosteroid and a long-acting beta2 agonist was reported by 77.0% of patients. A better asthma control and improved QoL were achieved with extrafine beclomethasone/formoterol compared to budesonide/formoterol or fluticasone/salmeterol. CONCLUSIONS: An improvement in asthma control and QoL can be achieved during a 1-year monitoring in a real life setting. Extrafine beclomethasone/formoterol was associated with significant benefit in terms of asthma control and QoL compared to large-particles combinations.ClinicalTrials.gov number NCT01110460.Respiratory research 12/2012; 13(1):112. · 3.36 Impact Factor -
Article: How air pollution influences clinical management of respiratory diseases. A case-crossover study in Milan.
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ABSTRACT: BACKGROUND: Environmental pollution is a known risk factor for multiple diseases and furthermore increases rate of hospitalisations. We investigated the correlation between emergency room admissions (ERAs) of the general population for respiratory diseases and the environmental pollutant levels in Milan, a metropolis in northern Italy. METHODS: We collected data from 45770 ERAs for respiratory diseases. A time-stratified case-crossover design was used to investigate the association between air pollution levels and ERAs for acute respiratory conditions. The effects of air pollutants were investigated at lag 0 to lag 5, lag 0--2 and lag 3--5 in both single and multi-pollutant models, adjusted for daily weather variables. RESULTS: An increase in ozone (O3) levels at lag 3--5 was associated with a 78% increase in the number of ERAs for asthma, especially during the warm season. Exposure to carbon monoxide (CO) proved to be a risk factor for pneumonia at lag 0--2 and in the warm season increased the risk of ERA by 66%. A significant association was found between ERAs for COPD exacerbation and levels of sulphur dioxide (SO2), CO, nitrate dioxide (NO2), and particulate matter (PM10 and PM2.5). The multipollutant model that includes all pollutants showed a significant association between CO (26%) and ERA for upper respiratory tract diseases at lag 0--2. For chronic obstructive pulmonary disease (COPD) exacerbations, only CO (OR 1.19) showed a significant association. CONCLUSIONS: Exposure to environmental pollution, even at typical low levels, can increase the risk of ERA for acute respiratory diseases and exacerbation of obstructive lung diseases in the general population.Respiratory research 10/2012; 13(1):95. · 3.36 Impact Factor -
Article: Real-life prospective study on asthma control in Italy: cross-sectional phase results.
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ABSTRACT: To estimate the prevalence of partly controlled and uncontrolled asthmatic patients, to evaluate quality of life and healthcare resource consumption. Cross-sectional phase followed by a 12-month prospective phase. Asthma Control Test and the EQ-5D were used. 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). 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.Respiratory medicine 02/2012; 106(2):205-14. · 2.33 Impact Factor -
Article: Hyaluronic acid : perspectives in lung diseases.
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ABSTRACT: Hyaluronic acid (HA) is a non-sulphated glycosaminoglycan. It is a natural polymer characterised by a coiled linear chain in particularly well-hydrated configuration composed of repeating disaccaride units. In mammals, its molecular weight can be extremely wide, ranging from 20 to 4,000 kDa. High molecular mass forms are provided with anti-inflammatory properties. A unique characteristic of HA is hydration (up to 6,000 molecules water/molecule of HA) with a major role in the regulation of fluid balance in the interstitium, a fundamental activity on the amorphous colloidal matrix gluing connective cell and fibers, and many other biological functions including lubrication, solute transport and microcirculatory exchange. HA has been widely used in the treatment of eye, ear, joint and skin disorders; in the last 15 years HA has been also proposed successfully in the treatment of a number of lung diseases in vitro, experimental animals and humans. In particular, inhaled HA at relatively high molecular weight has been proven to prevent bronchoconstiction induced in asthmatics by direct and indirect challenges such as inhalation of methacholine, inhalation of ultrasonically nebulised distilled water, muscular exercise. More recently, in patients affected by chronic obstructive pulmonary diseases, we have demonstrated that repeated administrations of inhaled HA (daily, for 8 weeks) induce significant increase in bronchial patency as well as progressive lung deflation with decrease of residual volume. In conclusion there are elements that can let us state that is perhaps time to change the focus to connective tissue and extracellular matrix substances such as HA, in order to prevent and treat chronic lung diseases.Handbook of experimental pharmacology 01/2012; -
Article: Asthma Control As Patient Reported Outcome (PRO) In Asthmatics Treated With ICS/LABA Combinations In The Cross-Sectional Phase Of The Prospective Study On Asthma Control (PRISMA).
American Journal of Respiratory and Critical Care Medicine 01/2011; 183:A1292. · 11.08 Impact Factor -
Article: Asthma Control In Italy: Results Of The Cross-Sectional Phase Of The Prospective Study On Asthma Control (PRISMA)
American Journal of Respiratory and Critical Care Medicine 01/2011; 183:A1360. · 11.08 Impact Factor -
Article: Asthma Control In Italy: Results Of The Cross-Sectional Phase Of The Prospective Study On Asthma Control (PRISMA).
American Journal of Respiratory and Critical Care Medicine 01/2011; · 11.08 Impact Factor -
Article: Asthma Control As Patient Reported Outcome (PRO) In Asthmatics Treated With ICS/LABA Combinations In The Cross-Sectional Phase Of The Prospective Study On Asthma Control (PRISMA).
American Journal of Respiratory and Critical Care Medicine 01/2011; · 11.08 Impact Factor -
Article: Comorbidity, hospitalization, and mortality in COPD: results from a longitudinal study.
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ABSTRACT: We evaluated comorbidity, hospitalization, and mortality in chronic obstructive pulmonary disease (COPD), with special attention to risk factors for frequent hospitalizations (more than three during the follow-up period), and prognostic factors for death. Two hundred eighty-eight consecutive COPD patients admitted to respiratory medicine wards in four hospitals for acute exacerbation were enrolled from 1999 to 2000 in a prospective longitudinal study, and followed up until December 2007. The Charlson index without age was used to quantify comorbidity. Clinical and biochemical parameters and pulmonary function data were evaluated as potential predictive factors of mortality and hospitalization. FEV(1), RV, PaO(2), and PaCO(2) were used to develop an index of respiratory functional impairment (REFI index). Hypertension was the most common comorbidity (64.2%), followed by chronic renal failure (26.3%), diabetes mellitus (25.3%), and cardiac diseases (22.1%). Main causes of hospitalization were exacerbation of COPD (41.2%) and cardiovascular disease (34.4%). Most of the 56 deaths (19.4%) were due to cardiovascular disease (67.8%). Mortality risk depended on age, current smoking, FEV(1), PaO(2), the REFI index, the presence of cor pulmonale, ischemic heart disease, and lung cancer. Number and length of hospital admissions depended on the degree of dyspnea and REFI index. The correct management of respiratory disease and the implementation of aggressive strategies to prevent or treat comorbidities are necessary for better care of COPD patients.Beiträge zur Klinik der Tuberkulose 08/2010; 188(4):321-9. · 1.90 Impact Factor -
Article: Evaluating health-related quality of life, work ability, and disability in pulmonary arterial hypertension: an unmet need.
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ABSTRACT: To our knowledge, there are no specific and validated measures of quality of life (QoL) or degree of disability for pulmonary arterial hypertension (PAH). A review of the literature shows that, with the exception of one recently designed specifically for pulmonary hypertension, QoL questionnaires used in PAH studies are generic measures. These are selected because of shared symptoms that do not necessarily correlate well with functional or physiologic measures and have not been validated for applicability in PAH. In this review, we present the available QoL tools for pulmonary artery hypertension and describe the need for more specific instruments that consider the physical and emotional implications of the diseases associated with PAH and the impact of various treatment options. We also discuss the impact of PAH on work ability and the need for provisions to address medical disability status and Social Security benefit status.Chest 09/2009; 136(2):597-603. · 5.25 Impact Factor -
Article: Chlamydia pneumoniae and acute aortic syndrome: a call for a multi-institutional study.
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ABSTRACT: Chlamydia Pneumoniae (CP) infection is strongly associated with coronary artery disease, as well as with atherosclerosis of the carotid and peripheral arteries. However, the role of CP in the pathogenesis of aortic disease remains controversial. Our present experience suggests no correlation between a current infection with C. pneumoniae and acute aortic dissection. Well-designed large prospective studies are needed in order to clarify the pathophysiologic role of CP infection in acute and chronic aortic disease.Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 07/2008; 70(2):68-70. -
Article: [Echocardiography and pulmonary arterial hypertension].
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ABSTRACT: Pulmonary Arterial Hypertension (PAH) is an heterogeneous condition brought on by a wide range of causes. It is characterized by structural changes in small pulmonary arteries, that produce a progressive increase in pulmonary artery pressure and pulmonary vascular resistance, ultimately leading to right ventricle failure and death. Given the non-specific nature of its early symptoms and signs, PAH is often diagnosed in its advanced stages. Along with a careful clinical assessment and an accurate electrocardiogram/Chest X-ray interpretation, echocardiography is an essential test in the evaluation of patient with PAH. In fact it not only provides an accurate estimate of pulmonary pressure at rest and during exercise, but may also help to exclude any secondary causes, predict the prognosis, monitor the efficacy of specific therapeutic interventions and detect the preclinical stage of the disease.Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 01/2008; 68(4):219-26. -
Article: Echocardiography in pulmonary arterial hypertension: An essential tool.
Chest 03/2007; 131(2):339-41. · 5.25 Impact Factor -
Article: Chlamydophila pneumoniae induces a sustained airway hyperresponsiveness and inflammation in mice.
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ABSTRACT: It has been reported that Chlamydophila (C.) pneumoniae is involved in the initiation and promotion of asthma and chronic obstructive pulmonary diseases (COPD). Surprisingly, the effect of C. pneumoniae on airway function has never been investigated. In this study, mice were inoculated intranasally with C. pneumoniae (strain AR39) on day 0 and experiments were performed on day 2, 7, 14 and 21. We found that from day 7, C. pneumoniae infection causes both a sustained airway hyperresponsiveness and an inflammation. Interferon-gamma (IFN-gamma) and macrophage inflammatory chemokine-2 (MIP-2) levels in bronchoalveolar lavage (BAL)-fluid were increased on all experimental days with exception of day 7 where MIP-2 concentrations dropped to control levels. In contrast, tumor necrosis factor-alpha (TNF-alpha) levels were only increased on day 7. From day 7 to 21 epithelial damage and secretory cell hypertrophy was observed. It is suggested that, the inflammatory cells/mediators, the epithelial damage and secretory cell hypertrophy contribute to initiation of airway hyperresponsiveness. Our study demonstrates for the first time that C. pneumoniae infection can modify bronchial responsiveness. This has clinical implications, since additional changes in airway responsiveness and inflammation-status induced by this bacterium may worsen and/or provoke breathlessness in asthma and COPD.Respiratory research 02/2007; 8:83. · 3.36 Impact Factor -
Article: Prulifloxacin: a brief review of its potential in the treatment of acute exacerbation of chronic bronchitis.
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ABSTRACT: Exacerbations of chronic bronchitis (AECB) are a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), and their impact on public health is increasing. The new fluoroquinolones have an excellent spectrum providing cover for the most important respiratory pathogens, including atypical and "typical" pathogens. Not surprisingly, different guidelines have inserted these agents among the drugs of choice in the empirical therapy of AECB. The pharmacokinetic and dynamic properties of the new fluoroquinolones have a significant impact on their clinical and bacteriological efficacy. They cause a concentration-dependent killing with a sustained post-antibiotic effect. This review discusses the most recent data on the new fluoroquinolone prulifloxacin and critically analyses its activity and safety in the management of AECB.International Journal of COPD 02/2007; 2(1):27-31. -
Article: Chlamydophila pneumoniae induces a sustained airway hyperresponsiveness and inflammation in mice
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ABSTRACT: Abstract Background It has been reported that Chlamydophila (C.) pneumoniae is involved in the initiation and promotion of asthma and chronic obstructive pulmonary diseases (COPD). Surprisingly, the effect of C. pneumoniae on airway function has never been investigated. Methods In this study, mice were inoculated intranasally with C. pneumoniae (strain AR39) on day 0 and experiments were performed on day 2, 7, 14 and 21. Results We found that from day 7, C. pneumoniae infection causes both a sustained airway hyperresponsiveness and an inflammation. Interferon-γ (IFN-γ) and macrophage inflammatory chemokine-2 (MIP-2) levels in bronchoalveolar lavage (BAL)-fluid were increased on all experimental days with exception of day 7 where MIP-2 concentrations dropped to control levels. In contrast, tumor necrosis factor-α (TNF-α) levels were only increased on day 7. From day 7 to 21 epithelial damage and secretory cell hypertrophy was observed. It is suggested that, the inflammatory cells/mediators, the epithelial damage and secretory cell hypertrophy contribute to initiation of airway hyperresponsiveness. Conclusion Our study demonstrates for the first time that C. pneumoniae infection can modify bronchial responsiveness. This has clinical implications, since additional changes in airway responsiveness and inflammation-status induced by this bacterium may worsen and/or provoke breathlessness in asthma and COPD.Respiratory Research. 01/2007; -
Article: Anxiety and depression in COPD patients: The roles of gender and disease severity.
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ABSTRACT: The aim of our study was to assess the prevalence of anxiety and depression in the whole chronic obstructive pulmonary disease (COPD) population and in subgroups according to sex and severity classification. A secondary objective was to evaluate the possible differences between patients with and without a significant high level of anxiety, depression, or both, and finally to find out a correlation between psychological aspects, symptoms, functional parameters, and quality of life (QoL). Two hundred and two COPD patients were enrolled. Their levels of anxiety, depression, dyspnea, and QoL were assessed using specific questionnaires. One hundred and fourteen sex- and age-matched healthy subjects were used as the control population. The prevalences of anxiety and depression were high (28.2% and 18.8%) in COPD even when it was of mild degree, compared to the control group, in which the prevalence of anxiety and depression were 6.1% and 3.5%, respectively. Female patients had higher levels of anxiety and depression and worse symptom-related QoL. Female patients reported a higher level of dyspnea than males for the same level of ventilatory impairment. Dyspnea was more strongly correlated with depression in women than in men. Anxiety and depressive symptoms are common in patients affected by COPD, even when their disease is mild in terms of FEV1 and respiratory symptoms. Female patients appear to be more exposed to psychological impairment, which correlates well with some specific symptomatic aspects of the disease, such as dyspnea. Psychological aspects need to be carefully assessed in COPD patients, particularly in females.Respiratory Medicine 11/2006; 100(10):1767-74. · 2.47 Impact Factor -
Article: Role of Macrolides as Immunomodular Agents
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ABSTRACT: In addition to being effective antimicrobial agents, macrolides have been associated with interesting nonantibacterial antiinflammatory properties. It appears that they may exert nontraditional antimicrobial effects against difficult organisms such as Pseudomonas aeruginosa by interfering with bacterial virulence factors (eg, alginate production, quorum-sensing mechanisms, biofilm formation). It has been suggested they have the potential for being used in the treatment of chronic airway inflammatory conditions. Growing evidence indicates that macrolides may exert disease-modifying effects in conditions such as asthma, cystic fibrosis, bronchiectasis, and in posttransplant bronchiolitis. They inhibit synthesis and/or secretion of proinflammatory cytokines, inhibit phagocytosis, decrease eosinophilic inflammation, increase mucociliary transport, reduce goblet cell secretion, decrease bronchoconstriction, and inhibit cholinergic responses of airway smooth muscle. Among the many factors involved in the inflammatory cascade, macrolides appear to interfere particularly with neutrophil recruitment and activation. Undoubtedly, the role of macrolides in the treatment of the inflammatory component of chronic disorders needs to be more firmly established.Clinical Pulmonary Medicine 08/2006; 13(5):274-281. -
Article: Additional clinical benefit of enoxaparin in COPD patients receiving salmeterol and fluticasone propionate in combination.
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ABSTRACT: It is now well recognised that heparin possesses numerous anti-inflammatory properties in addition to its anticoagulant properties. Thus, the aim of this study was to investigate the effects of the low molecular weight heparin, enoxaparin (ENX), as an add-on therapy for a period of 12 weeks, to inhaled salmeterol/fluticasone propionate (SLM/FP) combination in patients with stable chronic obstructive pulmonary disease (COPD). Forty-six patients were randomised to receive 12 weeks of treatment in one of two treatment groups: (1) fixed combination of SLM 50 microg and FP 500 microg Diskus, one inhalation twice daily; or (2) as group 1 plus 20 mg ENX administered subcutaneously once daily for 12 weeks. Patients attended the clinic before and after 4, 8 and 12 weeks of treatment for evaluations of lung function, blood gas tensions, dyspnoea and supplemental salbutamol use. Thirty-six patients completed the 12-week treatment period, 20 from group 1 and 16 from group 2. A significant increase in forced expiratory volume in 1 s (FEV1) over baseline was observed after 12 weeks of treatment in group 1 (0.145 L, 95% CI: 0.994-1.406, p<0.01), whilst significant increases in FEV1 over baseline were observed in group 2 after 4, 8 and 12 weeks of treatment with a maximum increase at 12 weeks of 0.244 L (95% CI: 1.175-1.596, p<0.01). Both treatment groups experienced similar improvements in blood gas tensions, dyspnoea and supplemental salbutamol use. Our results suggest that addition of ENX to conventional therapy of COPD may provide additional clinical benefit and must be further investigated as a treatment for COPD.Pulmonary Pharmacology & Therapeutics 02/2006; 19(6):419-24. · 2.80 Impact Factor -
Article: Highlights on the appropriate use of fluoroquinolones in respiratory tract infections.
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ABSTRACT: The impact of respiratory infections on public health is increasing, and lower respiratory tract infections are a major cause of morbidity and mortality. Moreover, most antibiotic prescriptions are related to respiratory infections and this is probably one of the main determinants of the increasing rate of bacterial resistance in both community and hospital settings. This has been the catalyst for the development of new drugs, such as the new fluoroquinolones. The new fluoroquinolones have an excellent spectrum providing cover for the most important respiratory pathogens, including atypical and "typical" pathogens. The pharmacokinetic and dynamic properties of the new fluoroquinolones have a significant impact on their clinical and bacteriological efficacy. They cause a concentration-dependent killing with a sustained post-antibiotic effect. Fluoroquinolones combine exceptional efficacy with cost-effectiveness. Not surprisingly, different guidelines have inserted these agents among the drugs of choice in the empirical therapy of LRTIs. This review discusses the most recent data on the bacteriological and clinical activity of the new fluoroquinolones and critically analyses the risks of a potential overuse of this valuable new class of drugs.Pulmonary Pharmacology & Therapeutics 02/2006; 19 Suppl 1:11-9. · 2.80 Impact Factor
Top co-authors
Top Journals
Institutions
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2012
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Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Milano, Lombardy, Italy
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2002–2012
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University of Milan
Milano, Lombardy, Italy
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2010
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Sapienza University of Rome
Roma, Latium, Italy
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2006
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Cardarelli Hospital
Napoli, Campania, Italy
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