Biomedical subjects

Nicola Scichilone

Publications and source records attributed to Nicola Scichilone.

11 recordsLinked to original sources

PubMed2006

Deep inspiration-induced changes in lung volume decrease with severity of asthma.

We have previously reported that the magnitude of deep inspiration (DI)-induced bronchodilation is only slightly reduced in mild asthmatics, compared to healthy subjects. The aim of this study was to evaluate whether increased severity of asthma is associated with impairment in the ability of DI to induce changes in lung volume. Thirty-six consecutive asthmatics recruited from the Pulmonary and the Allergy Outpatient Clinics of the Institute of Respiratory Diseases of the University of Palermo were divided into 3 groups: Intermittent (I), Mild Persistent (MP) and Moderate-Severe (MS), based on GINA guidelines. Single dose methacholine (Mch) bronchoprovocations were performed in the absence of DI, to induce at least 15% reduction in inspiratory vital capacity (IVC) from baseline. The post-Mch IVC was followed by 4 consecutive DI and by another IVC, to determine the bronchodilatory effect of DI. The bronchodilatory effect of DI was found to significantly decrease with increasing severity of asthma (I: 68+/-5.4%, MP: 45+/-7.2%, MS: 4+/-15.6%; ANOVA: P<0.0001). Bronchodilation by DI, but not FEV(1) or FEV(1)/FVC, was also inversely correlated to symptom scores (r=-0.42, P=0.01) and to weekly salbutamol usage (r=-0.47, P=0.004). These observations provide support to the hypothesis that the attenuation of the bronchodilatory effect of DI contributes to the severity of the clinical manifestations of asthma.

Adolescent↗

PubMed2005

Inhaled corticosteroids and the beneficial effect of deep inspiration in asthma.

Deep inspiration-induced bronchoprotection and bronchodilation are impaired in asthma. We evaluated the effect of inhaled glucocorticosteroids on these phenomena. Two groups of subjects with asthma, 9 with moderate/severe hyperresponsiveness to methacholine, and 12 with mild/borderline hyperresponsiveness to methacholine, received inhaled fluticasone (880 microg daily) for 12 weeks. Serial bronchoprovocations were performed at Weeks 0, 6, and 12. The impact of deep inspirations on the airway response to methacholine was evaluated on the basis of inspiratory vital capacity and FEV(1). Fluticasone produced a wide spectrum of changes in the beneficial effects of deep inspiration, but the mean changes were not significant. The magnitude of the steroid-induced changes in bronchoprotection by deep inspiration correlated with baseline log PC(20) (the provocative concentration of methacholine causing a 20% fall in FEV(1); higher log PC(20) predicted improvement of the deep inspiration effect). The steroid-induced changes led to the emergence of strong positive correlations between the effects of deep inspiration and the methacholine log PC(20) that did not exist at baseline. We conclude that deep inspiration-induced bronchoprotection can be restored by inhaled glucocorticosteroids only in individuals with mild hyperresponsiveness. After steroid treatment, the beneficial effects of deep inspiration become significant determinants of the magnitude of airway hyperresponsiveness.

Administration, Inhalation↗

PubMed2005

Association between reduced bronchodilatory effect of deep inspiration and loss of alveolar attachments.

BACKGROUND: We have previously shown that the bronchodilatory effect of deep inspiration is attenuated in individuals with COPD. This study was designed to investigate whether the impairment in this effect is associated with loss of alveolar attachments. METHODS: We measured deep inspiration (DI)-induced bronchodilation in 15 individuals with and without COPD (67 +/- 2.2 yrs of age, mean +/- SEM) undergoing lobar resection for peripheral pulmonary nodule. Prior to surgery, we measured TLCO and determined the bronchodilatory effect of deep inspiration after constricting the airways with methacholine. The number of destroyed alveolar attachments, as well as airway wall area and airway smooth muscle area, were determined in tumor-free, peripheral lung tissue. RESULTS: The bronchodilatory effect of deep inspiration correlated inversely with the % destroyed attachments (r = -0.51, p = 0.05) and directly with the airway smooth muscle area (r = 0.59, p = 0.03), but not with the total wall area (r = 0.39, p = 0.15). CONCLUSION: We postulate that attenuation of airway stretch due to loss of alveolar attachments contributes to the loss of the bronchodilatory effect of lung inflation in COPD.

Aged↗

PubMed2005

Reduced airway responsiveness in nonelite runners.

PURPOSE: The effects of endurance training on airway responsiveness in nonasthmatic subjects are poorly defined. We hypothesized that airway responsiveness may differ between none-lite endurance athletes and sedentary subjects, and studied healthy, nonelite runners and sedentary controls by single-dose methacholine challenges carried out in the absence of deep inspirations, in that deep inspirations are known to oppose airway narrowing in nonasthmatic subjects. METHODS: A total of 20 nonasthmatic none-lite runners (mean age+/- SD: 43.0+/- 8.5 yr; training volume: 68 km.wk; range: 40-100; racing experience: 11+/- 8 yr) and 20 sedentary controls (age: 44.0+/- 20.6 yr) were studied, all of them being normo-reactive to standard methacholine challenge up to 25 mg.mL concentration. All subjects were studied at rest; six runners were also studied about 1 h after completing the Palermo marathon (December 8, 2001). The primary outcome of the study was the inspiratory vital capacity (IVC) obtained after single-dose methacholine inhalation at the end of 20 min of deep inspiration prohibition. RESULTS: At rest, IVC decreased by 10.5+/-8.1% after challenge with methacholine at 75 mg.mL in athletes, and by 24.3+/-16.1% after a methacholine concentration of 52+/-5.7 mg.mL in sedentary controls (P=0.002). The decreased response to methacholine in runners did not correlate with static lung volumes, amount of weekly training, or running experience. CONCLUSION: Methacholine challenge under deep inspiration prohibition revealed that endurance training attenuates airway responsiveness in nonasthmatic, none-lite runners. Airway hyporesponsiveness was potentiated after the marathon, suggesting involvement of humoral (i.e., catecholamine levels), airway factors (i.e., nitric oxide), or both in modulating airway tone after exercise.

Adult↗

PubMed2004

Effects of chronic airway disease on health status of geriatric patients.

BACKGROUND AND AIMS: The impact of chronic airway disease on the health status of elderly patients is only to some extent explained by indexes of airflow limitation. The present study was designed to assess to what extent: 1) asthma, chronic obstructive pulmonary disease (COPD) and chronic bronchitis with normal FEV1 (simple bronchitis) differ in their impact on health status; 2) health status depends upon non-respiratory factors. METHODS: A total of 1601 outpatients over 65-198 with asthma, 228 with COPD, 91 with simple bronchitis, and 1084 with non-respiratory illnesses (control group)--were studied by collection of five health status indexes and multidimensional assessment. Discriminant analysis was used to identify health status profiles of groups. Demographic, anthropometric, clinical and respiratory function correlates of selected health status profiles were identified. RESULTS: Only 26 and 28% of asthma and COPD patients vs 43% of simple bronchitis and 50% of non-respiratory patients showed group-specific health status profiles. These profiles were characterized by lower 6-min walked distance and greater index of disturbed sleep in asthmatics, and by worse performance on Barthel Index, 6-min walking test and Mini-Mental State Examination in COPD patients. More severe bronchial obstruction, a greater index of comorbidity and a longer occiput-wall distance characterized COPD patients with the worst health status. CONCLUSIONS: The health status of elderly patients with COPD or asthma is highly heterogeneous. On average, COPD is characterized by more severe physical impairment, and asthma by poorer quality of sleep. Comorbidity and severity of bronchial obstruction, but not age, contribute toward defining a subset of COPD patients with the worst health status.

Aged↗

PubMed2004

The role of lung inflation in airway hyperresponsiveness and in asthma.

Airway hyperresponsiveness (AHR) is a fundamental phenomenon in asthma that can explain many aspects of the clinical manifestations of the disease. Several theories on the mechanisms of AHR have been proposed, but the true nature of this problem is yet to be defined. During the past decade, the role of lung inflation in airway physiology and its relationship to AHR have attracted major attention. Deep inspirations are known to exert strong beneficial effects on the airways of healthy humans. These effects appear to be of dual nature: bronchoprotective and bronchodilatory. The bronchoprotective effect of deep inspiration is lost in asthma, even in mild disease. It is also lost in individuals with rhinitis and AHR, but no asthma. Therefore, the loss of bronchoprotection is related to AHR. The bronchodilatory effect of deep inspiration is somewhat reduced in mild asthma and is only lost in severe disease, in the presence of significant airway obstruction. Current research is focused on the elucidation of the physiologic mechanisms behind lung inflation-induced bronchoprotection and bronchodilation and on the causes of their loss. This information could open new horizons in asthma therapy and prevention.

Airway Obstruction↗

PubMed2004

The bronchodilatory effect of deep inspiration diminishes with aging.

Deep inspirations have the ability to dilate constricted airways. The impairment of this function has been associated with the occurrence of asthmatic symptoms. We evaluated whether the bronchodilatory effect of deep inspiration (DI) is affected by aging. We tested 25 healthy subjects (median age: 54 yrs, range: 25-83 yrs). Single dose methacholine (Mch) provocations were performed in the absence of DI, which induced at least 15% reduction in inspiratory vital capacity (IVC) from baseline. The post-Mch IVC measurement was followed by 4 DIs and by another IVC (post-DI IVC). The fractional difference between post-DI IVC and post-Mch IVC represented the % bronchodilation by DI. The % bronchodilation significantly diminished with aging (r=0.65, P=0.0005). The bronchodilatory ability of DI was also positively associated with the degree of Mch-induced reduction in IVC (r=0.84, P<0.0001). In multiple regression analysis, where % bronchodilation was the dependent variable, both % reduction in IVC (P<0.0001) and age (P=0.02) entered the model. Our data raise the hypothesis that aging is associated with reduction in DI-induced bronchodilation.

Adult↗

PubMed2004

Bronchodilatory effect of deep inspiration is absent in subjects with mild COPD.

STUDY OBJECTIVES: To investigate whether the bronchodilatory effect of deep inspiration is impaired in subjects with COPD. METHODS: We measured deep inspiration-induced bronchodilation in 19 patients with COPD and 17 healthy subjects (mean age, 67.8 +/- 7.1 years vs 62.5 +/- 9.3 years, respectively [+/- SEM]). Each subject underwent a series of single-dose methacholine provocations to induce at least a 15% reduction in inspiratory vital capacity (IVC). When this was achieved, subjects were asked to perform four consecutive deep inspirations, after which the IVC measurement was repeated and the percentage of bronchodilation by deep inspiration was calculated. RESULTS: The percentage of reduction in IVC from baseline prior to the deep inspirations did not differ between the two groups (COPD, 20.1 +/- 1.6%; healthy, 22.7 +/- 2.4%; p = 0.38); median single methacholine doses employed were 20 mg/mL (range, 0.025 to 75 mg/mL) and 25 mg/mL (range, 10 to 75 mg/mL), respectively (p = 0.19). Deep inspirations were not able to reverse bronchoconstriction in patients with COPD (bronchodilation, 3.9 +/- 2.6%; p = 0.15 by one-sample t test). Bronchodilation by deep inspiration was present in healthy subjects (13.7 +/- 3.0%, p = 0.0003), and was significantly higher than that of patient with COPD (p = 0.02). In patients with COPD, deep inspiration-induced bronchodilation correlated with the percentage of predicted transfer factor of the lung for carbon monoxide (r = 0.53, p = 0.05), but not with airway obstruction, as assessed by FEV(1) or FEV(1)/FVC. CONCLUSIONS: The bronchodilatory ability of deep inspiration is lost in mild COPD. We speculate that the absence of deep inspiration-induced bronchodilation contributes to the development and severity of chronic respiratory symptoms in patients with COPD.

Aged↗

PubMed2003

Sleep disorders in the elderly with and without chronic airflow obstruction: the SARA study.

OBJECTIVE: Our objectives were to test the hypothesis that, in the geriatric population, chronic airway obstruction is associated with a higher prevalence of sleep disturbances; to identify the main correlates of sleep disturbances, and to verify whether asthma and COPD patients have different patterns of sleep disturbances. METHODS: The EPESE questionnaire was administered to 734 patients aged 65 years and over with asthma or chronic obstructive pulmonary disease (cases) and 1237 individuals of comparable age who were free of respiratory disease but not of other chronic conditions (controls). Four sleep disturbances were quantified: difficulty in falling asleep, nocturnal awakening, morning tiredness, and early awakening. Multidimensional assessment of demographic data, personal history, clinical, and functional status was performed. Independent correlates of sleep disturbances were identified by logistic regression analysis. RESULTS: One or more sleep disturbances were reported by 445 cases and 697 controls (60.6% vs. 56.4%, ns). Morning tiredness and early awakenings were more prevalent among cases (38% vs. 27.8%, p < 0.001, and 35.1% vs. 28%, p < 0.001, respectively). Depression, as assessed by the 15-item Geriatric Depression Scale, was the most significant independent correlate for all sleep scores. Both being a case and having arthritis were independent correlates of three out of the four sleep disturbances. CONCLUSIONS: Selected sleep disturbances are more common among elderly patients with chronic airway diseases than in those with chronic non-respiratory diseases. Depressed mood and coexisting arthritis are the most relevant independent correlates of sleep disturbances.

Aged↗

PubMed2003

Aging and disability affect misdiagnosis of COPD in elderly asthmatics: the SARA study.

STUDY OBJECTIVES: This study investigated to what extent a diagnosis of COPD is erroneously made or the disease remains unrecognized in elderly asthmatic patients, and identified factors leading to misdiagnosis and underdiagnosis of asthma in such patients. DESIGN: A multicenter study involving 24 Italian pulmonary or geriatric institutions. PATIENTS: One hundred twenty-eight asthmatic patients (98 women, 76.6%) aged 73 +/- 6.4 years (mean +/- SD) were selected from the cohort of the Salute Respiratoria nell'Anziano (respiratory health in the elderly) study. METHODS: All patients underwent a clinical evaluation that included clinical history and spirometry with a bronchodilator test. A diagnosis of asthma was based on criteria proposed by international guidelines adapted to the elderly population. A multidimensional geriatric assessment was performed to estimate physical and cognitive impairments and mood state. Finally, the diagnosis of respiratory disease previously made by a doctor, if any, was recorded. RESULTS: Of asthmatic patients, COPD had been improperly diagnosed in 19.5%, whereas 27.3% of asthmatic patients did not report any previous diagnosis of asthma. The main correlates of misdiagnosis were older age and disability. Conversely, underdiagnosis was associated with better functional conditions, expressed by spirometry, even when wheezing or a significant response to the bronchodilator test occurred. CONCLUSIONS: Asthma in the elderly is frequently confused with COPD. Misdiagnosis can be related to older age and to greater degree of disability. Asthma in patients with mild functional impairment may be underdiagnosed in spite of overt respiratory symptoms suggestive of asthma.

Age Factors↗

PubMedDate not supplied

Spirometry reference values for women and men aged 65-85 living in southern Europe: the effect of health outcomes.

BACKGROUND: Spirometry is more and more frequently used for the diagnosis of respiratory diseases in the elderly people. Unfortunately, reliable predictive values for the spirometric variables in the elderly are lacking. OBJECTIVES: Data obtained from 429 subjects participating in the multicenter Italian study SARA on respiratory health in the elderly were analyzed in order to derive reference values for spirometry in the age range of 65-85 years. The second aim of this study was to assess the influence of variables describing many dimensions of the health status on the prediction of spirometric variables in that age range. METHODS: Subjects were recruited as consecutive outpatients referred during the study period to 24 geriatric or respiratory institutions distributed throughout Italy. Spirometries were performed using the same equipment by specifically trained and certified personnel supervised by a real-time quality control program. In addition to the standard anthropometric variables, covariates describing the affective, mental, and general health conditions were investigated through standardized questionnaires, to improve the modeling of spirometric outcomes. RESULTS: Reliable predictive values for forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were produced (coefficient of determination, for FVC: R2 = 0.64; for FEV1: R2 = 0.54). The effect of general health conditions on spirometric outcomes accounted for the most part of the between-gender difference in the ageing-dependent decrease in lung function. CONCLUSIONS: We suggest that a multidimensional approach to health problems should be used for a better interpretation of spirometric results in the elderly.

Aged↗