RESUMO
Diffuse alveolar hemorrhage (DAH) is an acute often life-threatening condition characterized by a variable combination of hemoptysis, dyspnoea, diffuse and bilateral ground glass pulmonary opacities, anemia and hypoxemia, that can be induced by different causes, including several drugs. We report here the case of a 25-year-old woman who has been admitted to our pulmonary clinic for the onset of chest pain, cough and haemoptysis, started one week after her first treatment with alemtuzumab for multiple sclerosis. Computed tomography (CT) scan of the chest at the admission showed diffuse and bilateral ground glass pulmonary opacities. Her symptoms resolved completely without any treatment, after the interruption of alemtuzumab, and CT scan of the chest performed one month later showed total disappearance of the pulmonary opacities.
Assuntos
Alemtuzumab/efeitos adversos , Pneumopatias/diagnóstico por imagem , Lesão Pulmonar/induzido quimicamente , Esclerose Múltipla/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Adulto , Alemtuzumab/administração & dosagem , Alemtuzumab/uso terapêutico , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Dispneia/induzido quimicamente , Dispneia/diagnóstico , Feminino , Hemoptise/induzido quimicamente , Hemoptise/diagnóstico , Hemorragia/induzido quimicamente , Hemorragia/diagnóstico , Humanos , Pneumopatias/patologia , Lesão Pulmonar/complicações , Suspensão de TratamentoRESUMO
Inflammation is a central feature of asthma and chronic obstructive pulmonary disease (COPD). Despite recent advances in the knowledge of the pathogenesis of asthma and COPD, much more research on the molecular mechanisms of asthma and COPD are needed to aid the logical development of new therapies for these common and important diseases, particularly in COPD where no new effective treatments currently exist. In the future the role of the activation/repression of different transcription factors and the genetic regulation of their expression in asthma and COPD may be an increasingly important aspect of research, as this may be one of the critical mechanisms regulating the expression of different clinical phenotypes and their responsiveness to therapy, particularly to anti-inflammatory drugs.
Assuntos
Asma/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Fatores de Transcrição/antagonistas & inibidores , Animais , Anti-Inflamatórios/uso terapêutico , Asma/metabolismo , Broncodilatadores/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/metabolismo , Teofilina/uso terapêutico , Fatores de Transcrição/metabolismoRESUMO
BACKGROUND: Asthma considerably impairs patients' quality of life and increases healthcare costs. Severity, morbidity, and degree of disease control are the major drivers of its clinical and economic impact. National scientific societies are required to monitor the application of international guidelines and to adopt strategies to improve disease control and better allocate resources. AIM: to provide a detailed picture of the characteristics of asthma patients and modalities of asthma management by specialists in Italy and to develop recommendations for the daily management of asthma in a specialist setting. METHOD: A quantitative research program was implemented. Data were collected using an ad hoc questionnaire developed by a group of specialists selected by the Italian Pneumology Society/Italian Respiratory Society. RESULTS: The records of 557 patients were analyzed. In the next few years, specialists are expected to focus their activity patients with more severe disease and will be responsible for selection of patients for personalized biological therapy; however, only 20% of patients attending Italian specialist surgery can be considered severe. In 84.4% of cases, the visit was a follow-up visit requested in 82.2% of cases by the specialist him/herself. The Asthma Control Test is used only in 65% of patients. When available, a significant association has been observed between the test score and asthma control as judged by the physician, although concordance was only moderate (κ = 0.68). Asthma was considered uncontrolled by the specialist managing the case in 29.1% of patients; nevertheless, treatment was not stepped up in uncontrolled or partly controlled patients (modified in only 37.2% of patients). CONCLUSIONS: The results of this survey support re-evaluation of asthma management by Italian specialists. More resources should be made available for the initial visit and for more severely ill patients. In addition, more extensive use should be made of validated tools, and available drugs should be used more appropriately.
Assuntos
Asma/terapia , Padrões de Prática Médica/estatística & dados numéricos , Qualidade de Vida , Especialização , Adulto , Idoso , Asma/fisiopatologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Tolerance to both the bronchoprotective effect, and, to a lesser extent, the bronchodilator activity, occurs with all inhaled ß2-agonists. Assumed the importance of this topic and the lack of a clinical evaluation specifically designed to assess the impact of chronic administration of indacaterol on the response to salbutamol, we sought to compare the effect of 4-week treatment with indacaterol 150 µg once-daily versus formoterol 12 µg twice-daily on the dose-response curve to inhaled salbutamol (total cumulative dose of 800 µg) in a non-double-blinded, crossover, randomised, and controlled pilot trial that enrolled 20 outpatients with moderate to severe COPD. At the end of 4-week treatments, there was not a statistically significant difference between the two trough FEV1 (p = 0.16), and both indacaterol and formoterol were able to produce a significant (p < 0.001) increase in FEV1 mean differences (L) = indacaterol 0.15 (95% confidence interval (CI) 0.12-0.18); formoterol 0.10, (95% CI 0.08-0.12) 2 h after their inhalation. Salbutamol elicited an evident dose-dependent increase in FEV1 and this occurred also after regular treatment with indacaterol and formoterol with a further mean maximum increase of 0.10L (95% CI 0.05-0.14) and 0.05L (95% CI 0.02-0.08), respectively. The differences between indacaterol and formoterol in FEV1 increases after salbutamol were never statistically significant. The results of this study support the use of salbutamol as rescue medication for rapid relief of bronchospasm in patients suffering from COPD, even when they are under regular treatment with indacaterol.
Assuntos
Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Albuterol/uso terapêutico , Broncodilatadores/uso terapêutico , Indanos/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Quinolonas/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Albuterol/administração & dosagem , Broncodilatadores/administração & dosagem , Estudos Cross-Over , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Etanolaminas/administração & dosagem , Etanolaminas/uso terapêutico , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Fumarato de Formoterol , Humanos , Indanos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Quinolonas/administração & dosagem , Capacidade Vital/efeitos dos fármacosAssuntos
Humanos , Masculino , Adulto , Alveolite Alérgica Extrínseca/complicações , Alveolite Alérgica Extrínseca/diagnóstico , Alveolite Alérgica Extrínseca/tratamento farmacológico , Pleurotus/imunologia , Pleurotus/patogenicidade , Micotoxicose/complicações , Intoxicação Alimentar por Cogumelos/complicações , Intoxicação Alimentar por Cogumelos/diagnóstico , /métodosAssuntos
Alveolite Alérgica Extrínseca/diagnóstico , Interleucinas/sangue , Linfócitos/imunologia , Doenças Profissionais/diagnóstico , Exposição Ocupacional/efeitos adversos , Pleurotus/imunologia , Adulto , Alveolite Alérgica Extrínseca/imunologia , Biomarcadores/sangue , Humanos , Imunidade nas Mucosas , Masculino , Doenças Profissionais/imunologia , Radiografia Torácica , Adulto Jovem , Interleucina 22RESUMO
BACKGROUND: Many respiratory diseases are chronic conditions that are strongly linked with the patient-physician relationship, disease perception and therapy adherence. The aim of the present study was to evaluate patient's viewpoint about the different aspects involved in their respiratory diseases. METHODS: This is a prospective observational survey. 46 Italian medical centres were involved and equally distributed. The interviews were carried out and were performed by means of a questionnaire which consisted of 32 questions regarding lung disease, modality of access to medical facilities, therapy and level of medical assistance. RESULTS: 1116 patients were enrolled and the most important respiratory symptoms referred were: dyspnoea (69%), chronic phlegm (28%), cough (13%). During programmed visits 98.3% and 98.8% of interviewed patients knew were aware of asthma and COPD respectively, percentage that dropped, during emergency accesses, to 1.7% and 1.1% knew to have asthma and COPD respectively. Primarily were prescribed 1.67 spirometry/patient/year while only the 2% of patients referred to have performed a blood gas analysis. The 18% of patients spontaneously discontinued the therapy, considering it too complex. The average time that patients identified as being used by the doctor to perform the visit was of 22 minutes, with an high mean medical assistance satisfaction score. DISCUSSION: There has been little research examining what factors may influence patient acceptance and participation of chronic respiratory diseases. Our national survey demonstrated that a good patient-physician relationship represents one of the first points in the successful management of respiratory diseases.