[Show abstract][Hide abstract] ABSTRACT: New formulations of extrafine particles of long-acting beta-2 agonists plus inhaled corticosteroids (LABA + ICS) have been shown to reach peripheral regions of the lung. The aim of the study was to assess the effect on small airway obstruction of long-term treatments with two different LABA + ICS formulations in asthma. Ten subjects with moderate persistent asthma were enrolled. After a 4-week washout period they were treated in a randomized crossover design for 24 weeks with formoterol, 12 micrograms, and beclomethasone, 200 micrograms, hydrofluoroalkane (HFA; by metered-dose inhaler) b.i.d. (FB) or salmeterol, 50 micrograms, and fluticasone, 250 micrograms (by dry-powder inhaler), b.i.d. (SF). At baseline and at the end of each period subjects underwent an Asthma Control Test (ACT) and Pulmonary Function Testing. The N(2) phase III slope and closing volume (CV) during single-breath washout test and difference between the maximal expiratory flow rates with air and heliox at isovolume corresponding to 50% [Delta(heliox-air)MEF(50%)] were measured to assess changes on peripheral airways function. Two subjects dropped out and eight completed the study. After SF and FB, forced expiratory volume at 1 second (FEV(1); p < 0.01) and FEV(1)/forced vital capacity (FVC; p < 0.01 for SF and p < 0.05 for FB) increased when compared with baseline. Although both FB and SF treatments slightly increased delta(heliox-air)MEF(50% isovolume) versus baseline, only after FB the N(2) phase III slope and CV decreased from 1.61 ± 0.61%/L to 1.35 ± 0.49 N(2)%/L (p = 0.054) and from 0.98 ± 0.56 L to 0.88 ± 0.58 L (p < 0.05), respectively. ACT score raised from 19 ± 5 (baseline) to 23 ± 1 after FB (p < 0.02) and 23 ± 2 after SF (p < 0.05). When compared with baseline and in contrast to SF (50/250 micrograms b.i.d.), FB HFA (12/200 micrograms b.i.d.) significantly improved functional parameters reflecting small airway obstruction in asthmatic patients. Registered in the public trial registry at www.ClinicalTrials.gov identifier: NCT01255579.
No preview · Article · Nov 2011 · Allergy and Asthma Proceedings
[Show abstract][Hide abstract] ABSTRACT: The impact of undernutrition on lung physiology and respiratory muscle performance is still incompletely investigated. The purpose of this study was to assess the functional consequences of malnutrition on the respiratory system in stable patients with anorexia nervosa (AN).
Pulmonary function tests, maximal inspiratory pressure (Pimax), maximal expiratory pressure (Pemax), and the parameters of control of breathing were obtained in 27 patients with AN (mean [+/- SD] age, 24 +/- 7 years; BMI, 16 +/- 1 kg/m(2); duration of disease, 6 +/- 6 years) and in a group of matched healthy subjects.
Compared with control subjects, significant reductions in the diffusing capacity of the lung for carbon monoxide (Dlco) and lung diffusion capacity corrected for alveolar ventilation (p < 0.001), which progressively worsened with the duration of disease, were found in the AN group. Only the membrane diffusing capacity was reduced in patients with AN (p < 0.05), while pulmonary capillary blood volume was similar to that of control subjects. Lung density measurements based on CT scan analysis were normal in a subgroup of eight patients with AN with low Dlco. Both Pimax and Pemax were decreased in patients with AN (p < 0.001), but the mild-to-moderate impairment to generate force of the respiratory muscles did not progress with time. In these patients with AN, the parameters of control of breathing were in the normal range and were comparable to those of control subjects.
The functional alterations found in patients with AN indicate the presence of the progressive enlargement of peripheral lung units without relevant alveolar septa destruction. In the first 3 years of disease, appreciable weakness of respiratory muscles develops in patients with stable AN without further impairment over time.