Evaluation of a home telemonitoring service for adult patients with cystic fibrosis: a pilot study.

We have conducted a pilot trial of a home telemonitoring system involving 60 adult patients with cystic fibrosis (CF) enrolled at four Italian CF centres. Thirty randomly selected patients received a home device to perform spirometry and to measure oxygen saturation. The data were transferred to a data centre which forwarded them to the patient's CF clinic. The telemonitoring system was evaluated using questionnaires completed by patients and their doctors. The doctors reported that telemonitoring was useful in monitoring their patients' health status and in decreasing the CF centre workload. The data transfer procedure posed no particular problems for the patients. The major difficulties reported by the patients were night-time saturimetry measurements, and in the first week of the study, data transmission to the data centre. The pilot trial was positive and therefore merits a larger study.

The IGF system and cytokine interactions and relationships with longitudinal growth in prepubertal patients with cystic fibrosis.

OBJECTIVE: Growth delay is a feature of patients with cystic fibrosis (CF). CF is a condition characterized by chronic inflammation that has been shown to modify the IGF system, which is essential for normal growth, and is related to pulmonary function in CF patients. We aimed to verify whether circulating levels of tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, insulin and the IGF system were related and/or had relationships with linear growth in children with CF. DESIGN AND PATIENTS: Seventeen prepubertal CF patients (nine males and eight females) in a stable clinical condition were enrolled. Auxological parameters, pulmonary function and the Shwachman-Kulczycki (S-K) score were assessed, and serum samples were drawn at baseline and after 12 months. MEASUREMENTS: TNF-alpha, IL-6, IGF-I, IGF-II, IGFBP-1, IGFBP-2, IGFBP-3 and insulin were assayed using specific commercial kits. RESULTS: At baseline, TNF-alpha serum concentration was related to serum IGF-I concentration (R = 0.53), IGF-II bioactivity (IGF-II/IGFBP-3 molar ratio, R = +0.52) and insulin concentration (R = +0.63). Changes in serum IL-6 and IGFBP-2 concentrations during the 12-month observation were positively correlated (R = +0.63). Changes in height standard deviation score (Ht SDS) were correlated with IGF-I serum concentrations at baseline (R =+0.67) and after 12 months (R = +0.70), with IGF-I bioavailability and with IGFBP-1 serum concentrations (R = -0.88). Body mass index (BMI) SDS correlated with IGF bioavailability. CONCLUSIONS: This study showed a relationship between inflammatory status and the IGF system, and an effect of these interactions on longitudinal growth. Moreover, a role for insulin in growth was identified. Better control of inflammation and preservation of insulin secretion could benefit these patients.

Correlation between HRCT and pulmonary functional tests in cystic fibrosis.

PURPOSE: To compare the HRCT score by Oikonomou and air trapping in expiratory scans with pulmonary functional tests and evaluate which radiological criteria are more useful to predict clinical impairment. MATERIALS AND METHODS: From January to September 2003, pulmonary HRCT study was performed in 37 patients (23 males), aged between 7 and 41 years, with cystic fibrosis. In the same day of CT examination they also received a complete functional evaluation. HRCT studies were evaluated by three radiologists blinded to the clinical data and were correlated with the lung function tests. RESULTS: We obtained a high correlation (p=0.01) for two of the HRCT signs: extent of mucus plugging and mosaic perfusion pattern and all function tests. DISCUSSION: Previous studies have demonstrated good correlation between lung function tests, in particular with FEV1,and HRCT signs. Our study differed from previous ones in that we analysed the correlation between lung function tests and with both single and combined CT criteria. CONCLUSIONS: Our results suggest that a simplified HRCT score could be useful to evaluate patients with cystic fibrosis.

Effectiveness of intranasal corticosteroids.

Intranasal corticosteroids (IC) are most commonly prescribed to treat allergic rhinitis (perennial and seasonal). There are now many IC available to treat rhinitis, all effective on nasal obstruction, rhinorrhea, sneezing, itching and post-nasal drip. IC are superior to oral antihistamines for the relief of all nasal symptoms; however, antihistamines are first line therapy if allergic conjunctivitis coexists. At present the data do not support the use of IC in the management of otitis media with effusion (OME), nasal polyposis and sinusitis, but when topical IC are administered together with antibiotic therapy they facilitate a more rapid improvement of symptoms.