Transthoracic Echocardiography and Chest Computed Tomography Arteriography in Patients with Acute Pulmonary Embolism: A Two-Year Follow-Up Study.

BACKGROUND: Pulmonary hypertension (PH) is frequently found at the time of diagnosis of pulmonary embolism (PE). An incomplete resolution of PE can lead to chronic thromboembolic pulmonary hypertension (CTPH). Transthoracic echocardiogram (TTE) is the first step to diagnose an abnormality of the pulmonary vasculature. Based on computed tomography (CT), the Qanadli vascular obstruction index has been extensively used to assess acute PE. OBJECTIVES: Our aim was to ascertain whether at the time of diagnosis of an acute PE episode TTE variables and a Qanadli CT index score may be associated with CTPH 2 years later. METHOD: Patients with PE were prospectively enrolled. TTE was performed and the Qanadli CT obstruction index was calculated on admission to the hospital, while only TTE was repeated at the 2-year follow-up. The NYHA (New York Heart Association) functional classification was evaluated. Correlation analyses were performed. RESULTS: Twenty patients (11 males, median age 69.5 years) were considered for the study. There was no significant correlation between TTE parameters and the Qanadli CT obstruction index. A significant distribution (χ2 = 5.69, p = 0.017) was found in the analysis among patients with CTPH at 24 months and the Qanadli CT index, categorized by a receiver operating characteristic curve cutoff value of 42.5%. Additionally, a significant distribution (χ2 = 4.09, p = 0.043) was found in the analysis among patients with CTPH at 24 months and right ventricular systolic pressure on admission, categorized as PH (>31 mm Hg). CONCLUSION: Our study demonstrates that in patients with acute PE there is no relationship between the Qanadli CT obstruction index and TTE parameters on admission to the hospital. However, the occurrence of CTPH at the 24-month follow-up is associated with PH and with a high Qanadli CT obstruction index score.

Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease.

BACKGROUND: We investigated whether a relationship between small airways dysfunction and bronchodilator responsiveness exists in patients with chronic obstructive pulmonary disease (COPD). METHODS: We studied 100 (20 female; mean age: 68±10 years) patients with COPD (forced expiratory volume in 1 second [FEV1]: 55% pred ±21%; FEV1/forced vital capacity [FVC]: 53%±10%) by impulse oscillometry system. Resistance at 5 Hz and 20 Hz (R5 and R20, in kPa·s·L(-1)) and the fall in resistance from 5 Hz to 20 Hz (R5 - R20) were used as indices of total, proximal, and peripheral airway resistance; reactance at 5 Hz (X5, in kPa·s·L(-1)) was also measured. Significant response to bronchodilator (salbutamol 400 µg) was expressed as absolute (≥0.2 L) and percentage (≥12%) change relative to the prebronchodilator value of FEV1 (flow responders, FRs) and FVC (volume responders, VRs). RESULTS: Eighty out of 100 participants had R5 - R20 >0.03 kPa·s·L(-1) (> upper normal limit) and, compared to patients with R5 - R20 ≤0.030 kPa·s·L(-1), showed a poorer health status, lower values of FEV1, FVC, FEV1/FVC, and X5, along with higher values of residual volume/total lung capacity and R5 (P<0.05 for all comparisons). Compared to the 69 nonresponders and the 8 FRs, the 16 VRs had significantly higher R5 and R5 - R20 values (P<0.05), lower X5 values (P<0.05), and greater airflow obstruction and lung hyperinflation. CONCLUSION: This study shows that peripheral airway resistance is increased in the vast majority of patients with COPD, who showed worse respiratory reactance, worse spirometry results, more severe lung hyperinflation, and poorer health status. Small airway dysfunction was also associated with the bronchodilator responsiveness in terms of FVC, but not in terms of FEV1.

Small airway dysfunction is associated to excessive bronchoconstriction in asthmatic patients.

BACKGROUND: We investigated whether a relationship between small airways dysfunction and bronchial hyperresponsiveness (BHR), expressed both in terms of ease of airway narrowing and of excessive bronchoconstriction, could be demonstrated in asthma. METHODS: 63 (36 F; mean age 42 yr ± 14) stable, mild-to-moderate asthmatic patients (FEV1 92% pred ±14; FEV1/FVC 75% ± 8) underwent the methacholine challenge test (MCT). The degree of BHR was expressed as PD20 (in µg) and as ∆FVC%. Peripheral airway resistance was measured pre- and post-MCT by impulse oscillometry system (IOS) and expressed as R5-R20 (in kPa sL-1). RESULTS: All patients showed BHR to methacholine (PD20 < 1600 µg) with a PD20 geometric (95% CI) mean value of 181(132-249) µg and a ∆FVC% mean value of 13.6% ± 5.1, ranging 2.5 to 29.5%. 30 out of 63 patients had R5-R20 > 0.03 kPa sL-1 (>upper normal limit) and showed ∆FVC%, but not PD20 values significantly different from the 33 patients who had R5-R20 ≤ 0.03 kPa sL-1 (15.8% ± 4.6 vs 11.5% ± 4.8, p < 0.01 and 156(96-254) µg vs 207 (134-322) µg, p = 0.382). In addition, ∆FVC% values were significantly related to the corresponding pre- (r = 0.451, p < 0.001) and post-MCT (r = 0.376, p < 0.01) R5-R20 values. CONCLUSIONS: Our results show that in asthmatic patients, small airway dysfunction, as assessed by IOS, is strictly associated to BHR, expressed as excessive bronchoconstriction, but not as ease of airway narrowing.

Maximal exercise in obese patients with COPD: the role of fat free mass.

BACKGROUND: Obese patients (OB) with COPD may better tolerate exercise as compared to normal weight (NW) COPD patients, even if the reason for this is not yet fully understood. We investigated the interactions between obesity, lung hyperinflation, fat-free mass (FFM) and exercise capacity in COPD. METHODS: Forty-four patients (16 females; age 65 ± 8 yrs) were assessed by resting lung function and body composition and exercised on a cycle-ergometer to exhaustion. RESULTS: Twenty-two OB and 22 NW patients did not differ in age, gender and airflow obstruction degree, but in FFM (p < 0.05). OB had significantly higher values in inspiratory capacity/total lung capacity ratio (IC/TLC) at rest (p < 0.01), but not at peak of exercise and showed significantly higher values in peak workload (p < 0.05) and in peak oxygen uptake (VO2), when expressed as absolute value (p < 0.05), but not when corrected by FFM. OB compared to NW experienced lower leg fatigue (p < 0.05), but similar dyspnea on exertion. In all patients, the regression equation by stepwise multiple regression analysis for peak workload and VO2, as dependent variables included both FFM and IC/TLC at rest, as independent variables (r(2) = 0.43 and 0.37, respectively). CONCLUSIONS: OB with COPD, as compared to NW patients matched for age, gender and airflow obstruction, had greater FFM and less resting lung hyperinflation and showed greater maximal exercise capacity. Pulmonary and non-pulmonary factors may explain the preservation of exercise tolerance in patients with COPD associated with obesity.

Excess ventilation and ventilatory constraints during exercise in patients with chronic obstructive pulmonary disease.

We assessed the relationship between minute ventilation/carbon dioxide output (VE/VCO2) and ventilatory constraints during an incremental cardiopulmonary exercise testing (CPET) in patients with chronic obstructive pulmonary disease (COPD). Slope and intercept of the VE/VCO2 linear relationship, the ratios of inspiratory capacity/total lung capacity (IC/TLC) and of tidal volume (VT) over vital capacity (VTpeak/VC) and IC (VTpeak/IC) and over forced expiratory volume at 1st second (VTpeak/FEV1) at peak of exercise were measured in 52 COPD patients during a CPET. The difference peak-rest in end-tidal pressure of CO2 (PETCO2) was also measured. VE/VCO2 intercept showed a negative correlation with IC/TLC peak (p<0.01) and a positive one with VTpeak/FEV1 (p<0.01) and with PETCO2 peak-rest (p<0.01). VE/VCO2 slope was negatively related to VTpeak/VC, VTpeak/IC and VTpeak/FEV1 (all correlations p<0.05) and to PETCO2 peak-rest (p<0.01). In COPD, VE/VCO2 slope and intercept provide complementary information on the ventilatory limitation to exercise, as assessed by changes in the end-expiratory lung volume and in tidal volume excursion.

Ventilatory response to carbon dioxide output in subjects with congestive heart failure and in patients with COPD with comparable exercise capacity.

BACKGROUND: Patients with congestive heart failure or COPD may share an increased response in minute ventilation (V̇E) to carbon dioxide output (V̇CO2 ) during exercise. The goal of this study was to ascertain whether the V̇E/V̇CO2 slope and V̇E/V̇CO2 intercept can discriminate between subjects with congestive heart failure and those with COPD at equal peak oxygen uptake (V̇O2 ). METHODS: We studied 46 subjects with congestive heart failure (mean age 61 ± 9 y) and 46 subjects with COPD (mean age 64 ± 8 y) who performed a cardiopulmonary exercise test. RESULTS: The V̇E/V̇CO2 slope was significantly higher in subjects with congestive heart failure compared with those with COPD (39.5 ± 9.5 vs 31.8 ± 7.4, P < .01) at peak V̇O2 < 16 mL/kg/min, but not ≥ 16 mL/kg/min (28.3 ± 5.3 vs 28.9 ± 6.6). The V̇E/V̇CO2 intercept was significantly higher in both subgroups of subjects with COPD compared with the corresponding values in the subjects with congestive heart failure (3.60 ± 1.7 vs -0.16 ± 1.7 L/min, P < .01; 3.63 ± 2.7 vs 0.87 ± 1.5 L/min, P < .01). According to receiver operating characteristic curve analysis, when all subjects with peak V̇O2 < 16 mL/kg/min were considered, subjects with COPD had a higher likelihood to have the V̇E/V̇CO2 intercept > 2.14 L/min (0.92 sensitivity, 0.96 specificity). Regardless of peak V̇O2 , the end-tidal pressure of CO2 (PETCO2 ) at peak exercise was not different in subjects with congestive heart failure (P = .42) and was significantly higher in subjects with COPD (P < .01) compared with the corresponding unloaded PETCO2 . CONCLUSIONS: The ventilatory response to V̇CO2 during exercise was significantly different between subjects with congestive heart failure and those with COPD in terms of the V̇E/V̇CO2 slope with moderate-to-severe reduction in exercise capacity and in terms of the V̇E/V̇CO2 intercept regardless of exercise capacity.

Fat-free mass depletion is associated with poor exercise capacity irrespective of dynamic hyperinflation in COPD patients.

BACKGROUND: In patients with COPD, we investigated the effect of the fat-free mass (FFM) on maximal exercise capacity and the relationship with changes in operational lung volumes during exercise. METHODS: In a cross-sectional study 57 patients (16 females; age 65 ± 8 y) were consecutively assessed by resting lung function, symptom-limited cardiopulmonary exercise test, and body composition by means of bioelectrical impedance analysis to measure the FFM index (FFMI; in kilograms per square meter). RESULTS: Patients were categorized as depleted (n = 14) or nondepleted (n = 43) according to FFMI. No significant difference in gender, age, and resting lung function was found between depleted and nondepleted patients. When compared with nondepleted COPD patients, the depleted COPD patients had a significantly lower O2 uptake at the peak of exercise and at anaerobic threshold as well as at peak oxygen pulse, oxygen uptake efficiency slope (OUES), and heart rate recovery (HRR) (P < .05 for all comparisons), but similar inspiratory capacity/total lung capacity at the peak of exercise. Moreover, they also reported significantly higher leg fatigue (P < .05), but not dyspnea on exertion. In all patients, significant correlations (P < .01) were found between FFMI and peak oxygen pulse, OUES, HRR, and leg fatigue. CONCLUSIONS: This study shows that FFM depletion plays a part in the reduction of exercise capacity in COPD patients, regardless of dynamic hyperinflation, and is strictly associated with poor cardiovascular response to exercise and to leg fatigue, but not with dyspnea.

Pulmonary rehabilitation improves cardiovascular response to exercise in COPD.

BACKGROUND: Pulmonary rehabilitation (PR) has emerged as a recommended standard of care in symptomatic COPD. OBJECTIVES: We now studied whether PR may affect cardiovascular response to exercise in these patients. METHODS: Twenty-seven patients (9 females aged 69 ± 8 years) with moderate-to-severe airflow obstruction admitted to a 9-week PR course performed a pre-to-post evaluation of lung function test and symptom-limited cardiopulmonary exercise test (CPET). Oxygen uptake (VO2), tidal volume (V(T)), dyspnea and leg fatigue scores were measured during CPET. Cardiovas-cular response was assessed by means of oxygen pulse (O2Pulse), the oxygen uptake efficiency slope and heart rate recovery at the 1st min. RESULTS: A significant increase in peak VO2 and in all cardiovascular parameters (p < 0.05) was found following PR when compared to baseline. Leg fatigue (p < 0.05), but not dyspnea, was significantly reduced after PR. When assessed at metabolic and ventilatory iso levels [% VCO2max and % minute ventilation (VEmax)], O2Pulse and V(T) were significantly higher (p < 0.05) at submaximal exercise (75 and 50% of VCO2max and VEmax) after PR when compared to baseline. V(T) percent changes at 75% VCO2max and 75% VEmax after PR significantly correlated with corresponding changes in O2Pulse (p < 0.01). CONCLUSIONS: In COPD patients, a PR training program improved the cardiovascular response during exercise at submaximal exercise independent of the external workload. This change was associated with an enhanced ventilatory function during exercise.

Small airway dysfunction by impulse oscillometry in asthmatic patients with normal forced expiratory volume in the 1st second values.

Small airways are relevant to the pathophysiology of asthma. We investigated whether in asthmatic patients with normal forced expiratory volume in the 1st second (FEV(1)) values, impulse oscillometry system (IOS), as a measure of small airway function, contributed additional information to spirometry either at baseline or after bronchodilator, and whether it was related to the disease control. The fall in resistance from 5 to 20 Hz (R5-R20) and reactance at 5 Hz (X5) by IOS and spirometry measures of small airway function (forced expiratory flow at 25-75% [FEF(25-75)] and forced vital capacity/slow inspiratory vital capacity [FVC/SVC]) at baseline and after 400 micrograms of salbutamol were prospectively measured in 33 asthmatic patients (18 women; age range, 18-66 years). Disease control was assessed by the Asthma Control Test (ACT). R5-R20 but not X5 values were significantly related to FEF(25-75) and FVC/SVC values (p < 0.05 for both correlations). When the bronchodilator response was assessed, no correlation was found among IOS and spirometry changes. ACT scores were related to R5-R20, FEF(25-75), and FVC/SVC values (p < 0.01 for all correlations). In asthmatic patients with normal FEV(1) values, R5-R20 values were related to spirometry measures of small airway function. However, when the bronchodilator response was assessed, IOS and spirometry provided quite different results. Moreover, small airway dysfunction, as assessed by IOS and spirometry, was associated with poor disease control and history of asthma exacerbations. The results of this study confirm the value of IOS, as an investigative tool, and suggest that in asthmatic patients with normal FEV(1) values and poor disease control, small airway function should be investigated.

Overweight is associated with airflow obstruction and poor disease control but not with exhaled nitric oxide change in an asthmatic population.

BACKGROUND: The role of an elevated body mass index (BMI) in asthma remains controversial. OBJECTIVES: To investigate the relationship between overweight (BMI >25 and ≤30), lung function, disease control, and airway inflammation in an asthmatic population. METHODS: We consecutively studied 348 patients (age 43 ± 16 years; 211 females). In all patients, BMI, spirometry, the Asthma Control Test (ACT), and fractional exhaled nitric oxide (FeNO; ppb) were measured. RESULTS: One hundred forty-five patients were overweight and, as compared to those with normal BMI, had lower values of FVC, FEV(1), and FEV(1)/FVC and of FEF(25-75) even when normalized for FVC (p < 0.05 for each comparison). The ratio between the number of patients with well-controlled asthma (ACT ≥20) and that of patients with poorly controlled asthma (ACT < 20) was significantly lower in overweight patients (1.07 vs. 1.84; χ(2) = 6.030, p < 0.01). In overweight patients, the odds ratio of uncontrolled asthma expressed by logistic regression analysis was 1.632 (95% CI = 1.043-2.553), independently of gender, atopy, smoking habit, and inhaled steroid therapy. No difference was observed in FeNO values between overweight and normal weight patients (27.7 ± 2.3 vs. 27.9 ± 2.2 ppb). CONCLUSIONS: Our results show that, in an asthmatic population, overweight is associated with airflow obstruction and poor disease control but not with FeNO change. The findings of the present study support the view that other factors besides airway inflammation alone may explain the relationship between asthma and an elevated BMI.

Dynamic hyperinflation is associated with a poor cardiovascular response to exercise in COPD patients.

BACKGROUND: Pulmonary hyperinflation has the potential for significant adverse effects on cardiovascular function in COPD. The aim of this study was to investigate the relationship between dynamic hyperinflation and cardiovascular response to maximal exercise in COPD patients. METHODS: We studied 48 patients (16F; age 68 yrs ± 8; BMI 26 ± 4) with COPD. All patients performed spirometry, plethysmography, lung diffusion capacity for carbon monoxide (TLco) measurement, and symptom-limited cardiopulmonary exercise test (CPET). The end-expiratory lung volume (EELV) was evaluated during the CPET. Cardiovascular response was assessed by change during exercise in oxygen pulse (ΔO2Pulse) and double product, i.e. the product of systolic blood pressure and heart rate (DP reserve), and by the oxygen uptake efficiency slope (OUES), i.e. the relation between oxygen uptake and ventilation. RESULTS: Patients with a peak exercise EELV (%TLC) ≥ 75% had a significantly lower resting FEV1/VC, FEF50/FIF50 ratio and IC/TLC ratio, when compared to patients with a peak exercise EELV (%TLC) < 75%. Dynamic hyperinflation was strictly associated to a poor cardiovascular response to exercise: EELV (%TLC) showed a negative correlation with ΔO2Pulse (r = - 0.476, p = 0.001), OUES (r = - 0.452, p = 0.001) and DP reserve (r = - 0.425, p = 0.004). Furthermore, according to the ROC curve method, ΔO2Pulse and DP reserve cut-off points which maximized sensitivity and specificity, with respect to a EELV (% TLC) value ≥ 75% as a threshold value, were ≤ 5.5 mL/bpm (0.640 sensitivity and 0.696 specificity) and ≤ 10,000 Hg · bpm (0.720 sensitivity and 0.783 specificity), respectively. CONCLUSION: The present study shows that COPD patients with dynamic hyperinflation have a poor cardiovascular response to exercise. This finding supports the view that in COPD patients, dynamic hyperinflation may affect exercise performance not only by affecting ventilation, but also cardiac function.

Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial.

Pharmacological therapy of back pain with analgesics and anti-inflammatory drugs is frequently associated with adverse effects, particularly in the elderly. Aim of this study was to compare mesotherapic versus conventional systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in patients with acute low back pain. Eighty-four patients were randomized to receive anti-inflammatory therapy according to the following protocols: (a) mesotherapy group received the 1st and 4th day 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 40 mg (1 mL), then on 7th, 10th, and 13th day, 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 20 mg (1 mL) (b) conventional therapy group received ketoprofen 80 mg × 2/die and esomeprazole 20 mg/die orally for 12 days, methylprednisolone 40 mg/die intramuscularly for 4 days, followed by methylprednisolone 20 mg/die for 3 days, and thereafter, methylprednisolone 20 mg/die at alternate days. Pain intensity and functional disability were assessed at baseline (T0), at the end of treatment (T1), and 6 months thereafter (T2) by using visual analogic scale (VAS) and Roland-Morris disability questionnaire (RMDQ). In both groups, VAS and RMDQ values were significantly reduced at the end of drug treatment and after 6 months, in comparison with baseline. No significant differences were found between the two groups. This suggests that mesotherapy may be a valid alternative to conventional therapy in the treatment of acute low back pain with corticosteroids and NSAIDs.

Measurement of fractional exhaled nitric oxide by a new portable device: comparison with the standard technique.

BACKGROUND: Fractional exhaled nitric oxide (FeNO) measurement is a reliable, noninvasive marker of airway inflammation. The use of portable FeNO analyzers may enable the assessment of airway inflammation in primary care. OBJECTIVE: The authors compared FeNO values obtained by a new portable device (NObreath, Bedfont, UK) to those of the standard stationary analyzer (NIOX, Aerocrine, Sweden) in a large cohort of asthmatic patients. METHODS: One hundred and fifty-four (age range: 14-83 years, forced expiratory volume in one second [FEV(1)] range: 48-134% predicted, asthma control test [ACT] range: 7-25) out of 168 recruited patients completed the study. Each patient performed at least two valid FeNO measurements at a constant flow rate of 50 ml/s on each of the two analyzers. RESULTS: A significant relationship between the FeNO values obtained by the two devices (r = .95, p < .001) was found. Altman-Bland plot confirmed this agreement. Within-patient repeatability was excellent in both devices. Intraclass correlation coefficients for NIOX and NObreath values were .925 and .967, respectively. By means of receiver operating characteristic curve analysis, the FeNO cutoff points that better identified patients with ACT ≥ 20 were 15 ppb (0.84 sensitivity and 0.42 specificity) by NIOX and 25 ppb (0.53 sensitivity and 0.69 specificity) by NObreath. Easiness to use of both devices, assessed by visual analogue scale was not different. CONCLUSION: FeNO measurements obtained by the new portable FeNO analyzer are reliable because they are directly comparable with those obtained by the stationary standard device. The use of portable instruments may facilitate the FeNO measurement in primary care.

Respiratory function in subjects with chronic obstructive pulmonary disease (COPD) and atmospheric pollution in the city of Parma. Preliminary analysis.

A hospital case record study was carried out enlisting urgently hospitalized subjects for chronic obstructive pulmonary disease (COPD) in order to study the percentage values variations of Vital Capacity (VC), Forced Vital Capacity (FVC) and maximum expiratory volume in 1 second (FEV1) based on atmospheric pollution trend in Parma city evaluated by PM10, NO2 and O3 concentrations. The results showed an association only between PM10 and hospitalizations for COPD with statistically significant differences between PM10 concentrations assessed 3-4 days before hospitalizations of the study subjects and the ones established in the days without any hospitalization. The regression analysis between PM10 and respiratory function concerning PM10 concentration at 24, 48, 72, 96 hours before the hospitalization showed significant association between FVC% and FEV1% and PM10 concentrations at 96 hours. The calculated odd ratio resulted equal to 1016 (L.C. 1001-1032) which corresponds to an increase of hospitalization probability for COPD equal to 1.6% for PM10 increment unit.

Smoking cessation: aspects of prevention and therapy. The activity of the Smoking Cessation Center of Parma-Italy.

The World Health Organization states that only a reduction in tobacco use would lower the number of deaths from cancer. It is possible to decrease the number of deaths by means of prevention and/or smoking cessation. Smoking cessation therapy includes both psychological support and pharmacological treatment: Nicotine Replacement Therapy (NRT), Bupropion Sustained-Release, and Varenicline. The aim of the Smoking Cessation Center of Parma is to provide instruments, methodologies and individual therapies for achieving abstinence or a decrease in tobacco use. The program of the Smoking Cessation Center consists in eight meetings. During the first meeting the smoker undergoes a medical check up, and smoking history, exhaled single breath CO and dependence of nicotine are recorded and a personal therapy is planned. During each follow-up visit (after 15 days and then at 1,2,3,6,9 and 12-month intervals) the compliance of the patient to the treatment and abstinence symptoms are assessed. Since 2000, we achieved tobacco abstinence in 28% of patients. Combined treatment (Bupropion/NRT) provided a higher percentage of success (39.9%).

Lung Diffusion Capacity can Predict Maximal Exercise in Apparently Healthy Heavy Smokers.

Chronic exposure to tobacco smoking may damage lung and heart function. The aim of this study was to assess maximal exercise capacity and its relationship with lung function in apparently healthy smokers. We recruited 15 heavy smokers (age 47 years ± 7, BMI 25 kg/m(2) ± 3, pack/years 32 ± 9) without any cardiovascular or pulmonary signs and symptoms. Fifteen healthy non smoking subjects were enrolled as a control group. All subjects underwent pulmonary function tests, electrocardiograms at rest and graded cycle exercise tests. In smokers and controls, resting lung and cardiac function parameters were in the normal range, apart from diffusing lung capacity (TLCO) values which were significantly lower in smokers (p < 0.05). As compared to controls, smokers presented lower maximal exercise capacity with lower values at peak of exercise of oxygen uptake (peak VO2), workload, oxygen uptake/watt ratio and oxygen pulse (p < 0.05) and higher dyspnoea perception (p < 0.05). Moreover, peak VO2, maximal workload and oxygen pulse at peak exercise were related to and predicted by TLCO (p < 0. 05). Our study confirms that maximal exercise capacity is reduced in apparently healthy heavy smokers, and shows that TLCO explains some of the variance in maximal exercise. Key pointsChronic exposure to tobacco smoking may damage lung and heart function.Smokers present lower diffusion capacity and maximal exercise capacity.In smokers maximal exercise capacity can be predicted by resting diffusion lung capacity.

Walking capacity and fitness to fly in patients with chronic respiratory disease.

INTRODUCTION: In this study, we tested the hypothesis that walking capacity, assessed by the 6-min walk test (6MWT), could be related to the effect of flight simulation at sea level obtained by the hypoxia-altitude simulation test (HAST) in patients with chronic respiratory disease. METHODS: There were 15 patients with interstitial lung disease and 15 patients with chronic obstructive pulmonary disease who were recruited. Their baseline SpO2 values ranged from 88 to 98%. All patients performed the 6MWT and HAST according to standardized methods. RESULTS: Patients covered a walking distance ranging from 185 to 592 m without stopping while experiencing no to severe dyspnea. No correlation was found between dyspnea perception during walking, walking distance, and oxygen desaturation during HAST. The oxygen desaturation induced by the 6MWT was related to that after HAST (r = 0.52, p < 0.01). The bias and limits of agreement between the oxygen desaturation after the 6MWT and after the HAST were 0.8 and -6.6 to 8.2%, respectively. The baseline SpO2 could reliably predict the oxygen desaturation during HAST (r2 = 0.51). CONCLUSIONS: Our results showed that measurement of SpO2 during 6MWT can provide useful information for the preflight assessment and the in-flight oxygen prescription of patients with chronic respiratory disease.

Respiratory effects of surgery and pulmonary function testing in the preoperative evaluation.

Advanced age, smoking habit, obesity or malnutrition, the coexistence of hypercapnia, bronchospasm or bronchial hypersecretion, the lack of pre-operative preparation and/or a prolonged duration of anaesthesia can negatively influence respiratory function in patients undergoing abdominal or thoracic surgery. Spirometric testing of pulmonary function is recommended in patients with a history of tobacco use or dyspnoea who are considered for cardiac or upper abdominal surgery and for all patients who are candidated for lung resection. Spirometry can provide cut-off values of acceptable risk in patients that are candidated for abdominal and thoracic surgery. At-risk patients having resective lung surgery should undergo a split lung function study with quantitative lung scanning or computed tomography in order to estimate the function of residual parenchyma after surgery. In patients with borderline estimated values, a cardiopulmonary exercise test is useful to further stratify surgical risk.(www.actabiomedica.it)

[Particulate matter (PM10) air pollution, daily mortality, and hospital admissions: recent findings]. / Inquinamento atmosferico da particellato (PM10) e mortalità giornaliera e ricoveri ospedalieri. Recenti acquisizioni.

The first studies conducted to evaluate a possible association between air pollution and mortality date back to the serious events that occurred in the Mosa Valley, Belgium (1930), in the small city of Donora ("killer fog" incident of 1948) and in London (1952). The latter episode led to the introduction of air pollution control policies. Following the introduction of air pollution control measures in economically advanced cities in the 60s and 70s, the concentration levels of pollutants reached were believed, for many years, to be risk free. However, despite improvements in air quality achieved by many industrialized countries the negative effects of air pollution remain today an important public health problem. Among all air pollutants, particulate matter is the type of air pollution that causes the most numerous and serious effects on human health, because of the broad range of diverse toxic substances it contains,. For this reason, when assessing human health risk, PM10 may be considered to be a reliable indicator of the impact of global air pollution. Various epidemiologic studies conducted in the last 10 years, such as the Air Pollution and Health-European Approach (APHEA) project, the National Morbidity, Mortality and Air Pollution (NMMAPS) Study and Italian Meta-analysis of Studies on the short-term effects of Air pollution (MISA), have shown that current ambient concentrations of PM10 may lead to increased mortality and morbidity. Various studies have reported mean increases in mortality below 1% for 10 ?g/mc increases of ambient PM10. Studies have also underscored the role of particulate matter in aggravating cardiorespiratory diseases and consequently increasing hospital admissions. Air quality standards have been recently revised by legislation. The EU has issued a directive that sets limiting values and, where appropriate, threshold values, for the different air pollutants.

Psychological implications of respiratory health and disease.

The possibility that a subject's psychological status may influence respiratory sensations and that chronic respiratory disease may have psychological consequences has sparked great interest among clinicians and researchers. This paper reviews the existing research on the association between respiratory symptom perception and the psychological status and between chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease, and psychological disturbances. Moreover, it focuses on the role of stressful events in determining asthma exacerbations. The recent literature suggests that in patients with chronic respiratory diseases, the evaluation of breathlessness perception, psychological disturbances and the recording of any stressful events should be considered as relevant as the physical and functional assessment of respiration.