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Biomedical subjects

M Bugiani

Publications and source records attributed to M Bugiani.

At least 55 records · Page 3Linked to original sources
PubMed1995

Are asthma-like symptoms due to bronchial or extrathoracic airway dysfunction?

Patients with asthma-like symptoms may not have asthma but obstruction of the extrathoracic airway (EA). To evaluate if dysfunction of the EA causes asthma-like symptoms, we assessed bronchial and EA responsiveness to inhaled histamine in 441 patients who presented with at least one of three key symptoms--cough, wheeze, dyspnoea--but had neither documented asthma nor bronchial obstruction. The histamine concentrations causing a 20% fall in forced expiratory volume in 1 s (PC20FEV1) and a 25% fall in maximal mid-inspiratory flow (PC25MIF50) were used as respective thresholds of bronchial and EA responsiveness. Values 8 mg/mL or less indicated bronchial (B-HR) or EA hyper-responsiveness (EA-HR). The influence of concurrent upper respiratory tract diseases, such as post-nasal drip (PND), pharyngitis, laryngitis and sinusitis, was also assessed. We found four response patterns to the histamine challenge: EA-HR in 26.5% of the patients, B-HR in 11.1%, combined EA-HR and B-HR in 40.6%, and no-HR in 21.8%. Cough was reported by 79% of the patients, wheeze by 53%, and dyspnoea by 40%. Patients with cough as the sole presenting symptom (34.2%), as compared with those with wheeze and/or dyspnoea (20%), had significantly greater probability of having EA-HR (OR 5.35, 95% CI 3.25-8.82) and lower probability of having B-HR (OR 0.45, CI 0.28-0.70); patients with cough plus wheeze and/or dyspnoea (45.8%) had significantly greater probability of having both EA-HR and B-HR than either those with cough alone (OR 2.48, CI 1.49-4.13), or those with wheeze and/or dyspnoea but not cough (OR 1.74, CI 1.36-2.22). EA-HR alone or combined with B-HR was strongly associated with EA diseases, particularly pharyngitis and PND. Cough was significantly associated with PND, either when it was the sole symptom (OR 2.16, CI 1.14-4.09) or when it was combined with wheeze and/or dyspnoea (OR 3.53, CI 1.97-6.33). Our results suggest that extrathoracic airway dysfunction may account for asthma-like symptoms, particularly chronic cough. This abnormality seems to be sustained by chronic diseases of the upper respiratory tract.

Adult↗
PubMed1995

Extrathoracic and intrathoracic airway responsiveness in sinusitis.

BACKGROUND: Asthma associated with sinusitis is supposed to be sustained by bronchoconstrictive reflexes originating in extrathoracic airway (EA) receptors. OBJECTIVE: The study was designed to evaluate the relationship between EA responsiveness and bronchial responsiveness in sinusitis. METHODS: We performed histamine inhalation challenge in 106 patients with chronic sinusitis, during disease exacerbation and after treatment with antimicrobials and nasal flunisolide (100 micrograms daily) for 2 weeks. Forced expiratory volume in 1 second (FEV1) and maximal mid-inspiratory flow (MIF50) were the respective indexes of bronchial and EA narrowing; the histamine concentrations causing a 20% fall in FEV1 (PC20) and 25% drop in MIF50 (PC25MIF50) were used as thresholds of bronchial and EA responsiveness. Thresholds of 8 mg/ml or less were assumed to indicate bronchial hyperresponsiveness (B-HR) or EA hyperresponsiveness (EA-HR). RESULTS: During sinusitis exacerbation 76 patients had EA-HR, which in 46 was associated with B-HR. The values of PC20 were closely related with those of PC25MIF50 (p < 0.001). EA-HR and B-HR were strongly associated with pharyngitis. After treatment, mean PC25MIF50 and PC20 were significantly increased (p < 0.001). The improvement of PC25MIF50 was closely related to that of PC20 (p < 0.001) and to the decrease in neutrophils in nasal lavage (p < 0.05). EA-HR reversed in 58 patients and improved in 10; B-HR reversed in 29 and improved in 12. CONCLUSIONS: Our findings suggest that in sinusitis, B-HR may be sustained by constrictive reflexes originating in pharyngeal receptors, made hypersensitive by seeding of the inflammatory process.

Analysis of Variance↗
PubMed1994

Nonresponse bias in EC Respiratory Health Survey in Italy.

In the three Italian centres involved in the European Community Respiratory Health Survey (ECRHS), prevalence of asthma-like symptoms was assessed through a mailback questionnaire. Since the nonresponse rate was not negligible, ranging 10-18%, we investigated whether nonresponse bias affected the results and, if so, whether the bias could be eliminated from the final estimates of prevalence. A screening questionnaire was sent by mail to 7,000 randomly selected subjects 20-44 yrs of age, and nonresponders were contacted again by phone. Additional information was collected on a subsample of the respondents through a clinical interview. A logistic regression analysis showed that, except for one symptom (awakening for coughing), symptom prevalence significantly decreased from the first to the subsequent contact, when controlling for age, sex, centre and season of interview. The decrease in symptom prevalence was largely independent of smoking habits and socioeconomic status, and was seemingly caused by a symptom-related self-selection. When correcting results according to a linear regression model, observed estimates appeared to be slightly overestimated, by 4-10%. A simulation with the Italian data showed that the bias increased steeply at nonresponse rate higher than 30%, a situation quite common in asthma surveys. In conclusion, nonresponse bias affects the results of ECRHS in Italy, slightly inflating prevalence estimates. To make reliable comparisons on international data in the presence of different nonresponse rates, a correction of the observed prevalence seems necessary.

Adult↗
PubMed1994

[EC Respiratory Health Surgery in the north of Italy: methodological problems of a multicenter study of prevalence of asthma].

The EC Respiratory Health Survey (ECRHS) design is presented: the survey aim is to estimate asthma prevalence and risk factors distribution in the various European countries population. In Italy three centres are involved: Pavia, Turin and Verona. EC Health Respiratory Survey is an international two stages cross-sectional survey on probability samples of general population aimed to asses asthma prevalence in different countries. In the first stage a random sample was sent a Screening Questionnaire by post; in the second stage a subsample was invited to clinical centres in order to undergo lung function tests, allergy tests and a standardised clinical interview. The analysis of the response pattern in Italy shows that both in stage 1 and in stage 2 a selection bias overestimating real prevalence is present. Some methodological issues concerning the design of cross sectional surveys are addressed.

Adult↗
PubMed1993

[The impact of immigration from high incidence countries on the epidemiology of tuberculosis].

Immigration in Italy from developing countries is a recent problem and the possible consequences on public health must be taken into account. The present study reports the results of Tuberculosis control activities performed by the Dispensario di Igiene Sociale of Turin, related to this population. Up to now the available data suggest that the immigrant population (mainly from North Africa and Senegal), in spite of representing a small part of residents (approximately 33,000/1,000,000) contributes to one third of Tuberculosis cases. The consequences on Tuberculosis epidemiology in Italy and our operational experience on Tuberculosis control and prevention are discussed.

Emigration and Immigration↗
PubMed1992

The differential diagnosis of primary lung cancer: inter-observer agreement and contribution of specific diagnostic procedures.

In order to investigate inter-observer variability in the differential diagnosis of primary lung cancer among women and the contribution of specific diagnostic procedures to this diagnosis, a group of 449 suspect cases of this disease was studied. Based on a standard dossier (including clinical data and the reports, if present, of radiology, bronchoscopy and histology) six different physicians independently judged, for each woman, at each diagnostic step, the presence of a primary lung cancer. A final consensus was organized in order to define the true cases. Radiology and especially histology seem to give the most important contribution to the diagnosis. On the other hand bronchoscopy seems to be useful mainly as a guide for biopsy. A predictive value of 90% was found when both radiology and bronchoscopy were positive; in the other cases histology seems to be needed to reach an adequate discrimination. Inter-rater agreement increases with an increasing amount of information but is not very high even when histology is available.

Bronchoalveolar Lavage Fluid↗
PubMed1992

Results of routine patch testing of 834 patients in Turin.

834 consecutive patients (630 female), aged between 26 and 46 years, who were suspected of having allergic contact dermatitis were patch tested with the GIRDCA standard series during 1989-1990. The most frequent sensitizers observed included nickel sulphate, cobalt, Kathon CG, perfumes, potassium dichromate and balsam of Peru. We have evaluated the influence of individual factors such as sex, age and occupation on the patch test results, and the coexistence of 2 or more unrelated but statistically significant sensitivities.

Adult↗
PubMed1992

Bronchial responsiveness, oscillations of peak flow rate and symptoms in patients with mitral stenosis.

To better characterize airway hyperresponsiveness reported in cardiac patients questionnaire-recorded symptoms, bronchial responsiveness to methacholine (Mch) and to ultrasonically nebulized distilled water (UNDW), diurnal oscillations of peak expiratory flow (PEF) rate were evaluated in 32 patients with moderate mitral stenosis. Twenty patients were responsive to Mch (defined as provocative dose producing a 20% fall in forced expiratory volume in one second (PD20 FEV1) less than 3.2 mg) (geometric mean PD20 FEV1 851 +/- 154 micrograms SE). Only two patients showed a fall in FEV1 greater than 20% after UNDW challenge. Patients responsive to Mch challenge had lower FEV1 as percentage of vital capacity (FEV1/VC) (80 +/- 4.8 vs 83 +/- 3.8%, p less than 0.05), higher coefficient of variation of PEF (CV-PEF) (7.1 +/- 2.8 vs 5 +/- 2.4, p less than 0.05) and higher prevalence of wheeze (70 vs 25%, p less than 0.05) in comparison with patients non-responsive to Mch challenge. CV-PEF was significantly related to FEV1 (r = 0.347, p less than 0.05) and maximal expiratory flow at 50% expired volume (MEF50) (r = 0.405, p less than 0.05). The probability of responding to Mch bronchial challenge increased proportionally with the increase in CV-PEF and the decrease in FEV1, FEV1/VC and MEF50. Airway hyperresponsiveness of patients with mitral stenosis seems to be more similar to that reported in bronchitic than in asthmatic patients.

Adult↗
PubMed1990

Hyperresponsiveness of the extrathoracic airway in patients with captopril-induced cough.

It has been suggested that cough from captopril may originate from an increased sensitivity of receptors in the extrathoracic airway (EA). To explore this hypothesis, we assessed the responsiveness of EA and bronchi and the cough sensitivity to inhaled histamine in nine hypertensive patients with captopril-induced cough (group 1) during treatment and one month after withdrawal of the drug treatment. Nine patients who were asymptomatic while receiving captopril (group 2) and nine patients receiving no current treatment (group 3) served as controls. The EA responsiveness was assessed by using the maximal midinspiratory flow (MIF50) as an arbitrary index of EA constriction and was expressed as the histamine concentration causing a 25 percent decrease in MIF50 (PC25MIF50). PC15FEV1 was the index of bronchial responsiveness and PCcough (dose causing five or more coughs) was that of cough sensitivity. Airway hyperresponsiveness (EA-HR or BHR) was diagnosed when PC25MIF50 or PC15FEV1 were 8 mg/ml or lower. Patients with captopril-cough, as compared with controls, had significantly lower values of PC25MIF50, PC15FEV1, and PCcough; EA-HR and BHR were found, respectively, in seven and three of these patients and in none of the control subjects. In all the patients of group 1, cough and EA-HR resolved after withdrawal of captopril treatment, while BHR persisted in one. PC25MIF50, PC15FEV1, and PCcough were all significantly improved. Our findings suggest that cough during captopril therapy may originate from receptors in the EA.

Bronchial Provocation Tests↗
PubMed1990

Hypomagnesemia in chronic obstructive lung disease: effect of therapy.

In 95 patients with severe chronic airway obstruction (FEV1 33.2 +/- 12% of predicted; mean +/- SE), we investigated whether drug therapy had any influence on serum Mg levels. 11/95 patients had a serum Mg less than 1.45 mEq/l (lower normal limit). Multiple-regression analysis showed that the use of diuretics was associated with a significantly lower serum Mg level (1.59 +/- CI 0.06 mEq/l vs. an adjusted mean of 1.71 mEq/l; F = 11, 2, p less than 0.001). There was a significant negative correlation between serum Mg and the length of oral steroid therapy (1.64 +/- CI 0.02 mEq/l for less than 24 months of therapy vs. 1.52 +/- CI 0.06 mEq/l for greater than 24 months of therapy; F = 7, 3, p less than 0.005). No effect of theophylline, inhaled steroids or beta 2-agonists on serum Mg was observed. Because of potential negative effects of hypomagnesemia on respiratory function, routine serum magnesium determination is recommended in patients with chronic obstructive lung disease taking diuretic drugs or corticosteroids.

Administration, Inhalation↗
PubMed1989

Tuberculin survey among Afghan refugee children. Tuberculosis control programme among Afghan refugees in North West Frontier Province (NWFP) Pakistan.

Since 1982 over 2 million Afghan refugees have settled in the North West Frontier Province (NWFP) of Pakistan. Socio-economical factors, sudden urbanisation and psychological stress may influence the pattern of tuberculosis morbidity and infection among refugees as compared with the original population. In order to study the prevalence of tuberculous infection among Afghan children a tuberculin survey was carried out in April and May 1985 on a cluster sample of male children attending the first two grades of primary schools in refugee camps in the NWFP. The sample size was 4108 male children with an average age of 8 years. 1358 of them, average age of 7.8 years, had not been vaccinated with BCG. An infection prevalence of 13.8% was found when using a transverse diameter of 10 mm induration or more for the tuberculin test as the criterion for infection. The findings were compared with the results of a national sample survey carried out in Afghanistan in 1978: a downward trend of the annual risk of infection (ARI) of 7.8% per year was found in children of the same age group. Thus, Afghan children living in refugee camps in NWFP showed a lower ARI than was observed in their homeland 7 years earlier.

Afghanistan↗
PubMed1989

Effects of vitamin C on airway responsiveness to inhaled histamine in heavy smokers.

Histamine bronchial threshold, the provocation concentration of histamine causing a 25% fall in maximal expiratory flow at 50% of forced vital capacity from the control value (PC25MEF50), was measured in seven heavy smokers and in seven sex- and age-matched nonsmokers before and one hour after ingestion, double-blind, of vitamin C (2 g) or placebo. Smokers had significantly lower baseline values of serum ascorbate, maximal expiratory flow at 50% of forced vital capacity (MEF50) and PC25MEF50: the latter was negatively related to serum ascorbate (r = -0.85; p less than 0.001). Acute treatment with vitamin C produced a significant decrease in PC25MEF50 in smokers (95% confidence limit (CL) from 4.87-3.36 to 2.91-2.01 mg.ml-1; p = 0.017), whilst it had no effect in nonsmokers. A preliminary open study on the effect of prolonged administration of vitamin C (1 g daily) was performed in smokers. One week of treatment produced a further significant decrease in PC25MEF50 (p less than 0.0001). Our results suggest that in heavy smokers histamine bronchial responsiveness may be attenuated by chronic ascorbate deficiency. In these circumstances, acute and short-term treatment with vitamin C may increase the bronchoconstrictive response to inhaled histamine.

Adult↗
PubMed1988

Acute effect of intravenous magnesium sulfate on airway obstruction of asthmatic patients.

The bronchodilating effect of magnesium sulfate (MgSO4) was studied in ten asthmatic patients with moderate to severe airway obstruction. Two grams of MgSO4 or saline in double-blind crossover design was administered IV for 20 minutes (0.40 mmol/min) and forced expiratory capacity and forced expiratory volume in one second (FEV1) were studied at intervals. Only at the end of MgSO4 infusion did FEV1 increase significantly (109% of initial values). The bronchodilating effect was short lasting and far less than that observed after salbutamol.

Adult↗
PubMed1987

Reduction of histamine-induced bronchoconstriction by magnesium in asthmatic subjects.

The effects of inhaled MgSO4 on histamine bronchoprovocation test (BPT) were studied in nine asthmatics in clinical remission (FEV1 greater than 80% of predicted). Patients performed histamine BPT on 2 separate days, one day after saline and the other after MgSO4 inhalation, in a randomized double-blind design. Spirometry and flow/volume curve were recorded on each test day before and 5 min after NaCl or MgSO4. No significant difference was observed in lung function measurements 2 days before and after either NaCl or MgSO4. The dose of histamine which produced a 20% decrease in control FEV1 (PD20FEV1) was significantly increased by aerosolized MgSO4 (from 0.177 +/- 0.036 mg after NaCl to 0.350 +/- 0.085 after MgSO4, P less than 0.05. After MgSO4 the dose-steps of histamine concentration increased two-fold in two subjects and one-fold in five.

Administration, Inhalation↗
PubMed1987

Respiratory diseases in wood workers.

A survey was carried out on wood workers and on a group of unexposed, healthy controls. One group of wood workers (group A) were asymptomatic and another (group B) had symptoms either of chronic cough and dyspnoea on exertion (B1) or dyspnoea at work and bronchial hyperreactivity (B2). The control group (group C) was randomly selected from among a population of laboratory workers. No significant differences were found among the groups with respect to the frequency of atopy but the prevalence of a positive skin reaction to wood extracts was significantly higher in the asthmatic subjects. The adjusted FVC and FEV1/FVC% were significantly higher in B1 than in the other groups; the FEV1 was lower in B1 than in B2 and in B2 than in the other groups; TLCO and KCO differed significantly in all four groups. A significant negative correlation was observed between FEV1, MEF50, TLCO and KCO and duration of exposure to wood dusts. The alveolar volumes were not significantly different between the groups and were not correlated with duration of exposure. These results confirm the observation that exposure to wood dust or to some bronchoreactive substances linked with wood working can induce chronic obstructive lung disease (COLD). Some cases of wood dust asthma seem to be related to an immediate allergic reaction, but precipitating antibodies appear to be an index of exposure rather than of disease. The decrease in diffusion capacity can be ascribed to a thickening of the alveolar capillary membranes secondary to an alveolitis like, non-symptomatic, allergic reaction.

Forced Expiratory Volume↗
PubMed1987

Magnesium attenuates methacholine-induced bronchoconstriction in asthmatics.

The effects of inhaled MgSO4 on methacholine bronchoprovocation test (BPT) were studied in 16 asthmatics in clinical remission (FEV1 greater than 80% of predicted). The patients performed methacholine BPT on two separate days, one day after saline, the other day after MgSO4 inhalation, in double-blind cross-over design. Spirometry was recorded on each test day before and 5 min after NaCl or MgSO4. Neither NaCl nor MgSO4 was found to have a significant effect on spirometric measurements. A significant inhibition of reactivity to methacholine was observed with an increase in log PD20 FEV1 from 1.31 +/- 0.11 inhalation units after NaCl to 1.56 +/- 0.11 inhalation units after MgSO4 (p less than 0.01). The most attractive hypothesis to explain the latter, is that Mg2+ might interfere with Ca2+ handling in the bronchial smooth muscle cells similar to that shown for other types of smooth muscle.

Adolescent↗
PubMed1986

Effect of nifedipine on salbutamol-induced bronchodilation in partially reversible airway obstruction.

The effects of the combination of oral nifedipine (20 mg) and inhaled salbutamol (400 mcg) were studied in ten stable patients with chronic partially reversible airway obstruction in a double-blind crossover design. Specific airway conductance (SGaw), forced expiratory volume in 1 second (FEV1), heart rate and blood pressure were recorded before and 30 min after administration of nifedipine or a placebo and 30, 60, 90, 150, 210 and 270 min after salbutamol inhalation. The mean value of FEV1 30 min after nifedipine was significantly (p less than 0.05) higher than after the placebo. The increase of SGaw and FEV1 produced by salbutamol was not significantly affected by pretreatment with nifedipine at any time. Nifedipine produced a significant increase of the heart rate which persisted throughout the study, but it did not influence blood pressure. No untoward effect was noticed during the study.

Adult↗