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Background The Italian severe/uncontrolled asthma (SUA) web-based registry encompasses demographic, clinical, functional, inflammatory data; it aims to raise SUA awareness, identifying specific phenotypes and promoting optimal care. Methods 493 adult patients from 27 Italian centres (recruited in 2011-2014) were analyzed. Results Mean age was 53.8yrs. SUA patients were more frequently female (60.6%), with allergic asthma (83.1%). About 30% showed late onset of asthma diagnosis/symptoms (>40yrs); the mean age for asthma symptoms onset was 30.2yrs and for asthma diagnosis 34.4yrs. 97.1% used ICS (dose 2000 BDP), 93.6% LABA in association with ICS, 53.3% LTRAs, 64.1% anti-IgE, 10.7% theophylline, 16.0% oral corticosteroids. Mean FEV1% pred of 75.1%, median values of 300/mm3 of blood eosinophil count, 323 kU/l of serum total IgE, 24 ppb of FENO were shown. Most common comorbidities were allergic rhinitis (62.4%), gastroesophageal reflux (42.1%), sinusitis (37.9%), nasal polyposis (30.2%), allergic conjunctivitis (30.2%). 55.7% of SUA patients had exacerbations in the last 12 months, 9.7% emergency department visits, 7.3% hospitalizations. Factors associated with exacerbation risk were: obesity (OR, 95%CI 2.46, 1.11-5.41), psychic disorders (2.87, 0.89-9.30 - borderline), nasal polyps (1.86, 0.88-3.89 - borderline), partial/poor asthma treatment adherence (2.54, 0.97-6.67 - borderline), anti-IgE use in a protective way (0.26, 0.12-0.53). Comparisons to severe asthma multicentre studies and available registries showed data consistency across European and American populations. Conclusions An international effort in the implementation of SUA patients registries could help to better understand the clinical features and to manage severe asthma, representing a non negligible socio-economic burden for health services. This article is protected by copyright. All rights reserved.

Aim: To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR). Methods: Data on 1820 patients (mean age 41yrs ± 17yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL). Results: AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR. Conclusions: GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma. © 2012 Elsevier Ltd. All rights reserved.

The treatment of patients with angina pectoris refractory to medical therapy and unsuitable for revasculcirization procedures has yet not been well standardized. Previous retrospective studies and small prospective studies have suggested beneficial effects of spinal cord stimulation (SCS) in these patients. We created a Prospective Italian Registry of SCS to evaluate the short- and long-term clinical outcome of patients who underwent SCS device implantation because of severe refractory angina pectoris. Overall, 104 patients were enrolled in the registry (70 men, aged 68 +/- 17 years), most of whom, (83%) had severe coronary artery disease. Average follow-up was 13.2 +/- 8 months. Overall, 17 patients (16%) died,,8 (8%) due to cardiac death. Among clinical variables, only age was found to be significantly associated both with total mortality (p = 0.04) and cardiac mortality (p = 0.02) on Cox regression, analysis. A significant improvement of original. symptoms (greater than or equal to50% reduction of weekly anginal episodes, compared with baseline) occurred in 73% of patients, and Canadian Cardiovacular Society angina class improved by : 1 class in 80% and by greater than or equal to2 classes in 42% of patients, with a relevant reduction in the rate of hospital admission and days spent in the hospital because of angina (p < 0.0001 for both). No life-threatening or clinically serious complications were observed. The most frequent side effect consisted of superficial infections, either at the site of puncture of electrode insertion or of the abdominal pocket, which occurred in 6 patients. In conclusion, our prospective data point out that SCS can be,performed safely and is associated with a sustained improvement of anginal symptoms in a relevant number of patients with refractory stable angina pectoris. (C) 2003 by Excerpta Medica, Inc.

AIM: To evaluate the impact of a medical education course (MEC) on the behaviour of general practitioners (GPs) to treat asthma and allergic rhinitis (AR). METHODS: Data on 1820 patients (mean age 41 yrs ± 17 yrs) with asthma or AR were collected by 107 Italian GPs: 50% attended a MEC and 50% didn't (group B). The adherence for AR and asthma treatment was evaluated according to ARIA and GINA guidelines (GL). RESULTS: AR and asthma were diagnosed in 78% and 56% of patients; 34% had concomitant AR and asthma. Regardless of the MEC, the adherence to GL was significantly higher for AR than for asthma treatment (52 versus 19%). Group B GPs were more compliant to ARIA guidelines in the treatment of mild AR, whereas group A were more compliant in the treatment of moderate-severe AR; the adherence didn't differ between the groups for AR patients with comorbid asthma. Adherence to GINA GL for asthma treatment did not differ between GPs of groups A and B, independently from concomitant AR. Though insignificantly, group A were more compliant to GINA GL in the treatment of patients with only severe persistent asthma (63 versus 46%) as group B were for patients with severe persistent asthma and concomitant AR. CONCLUSIONS: GPs often tend to treat patients independently from GL. The impact of a single MEC did not improve adherence to GL in treating less severe AR and asthma patients, while there was a trend towards the opposite attitude in more severe AR patients without concomitant asthma.

Most health care systems consider continuing medical education a potential tool to improve quality of care and reduce disease management costs. Its efficacy in general practitioners needs to be further explored.This study assesses the effectiveness of a one-year continuing medical education/continuing professional development course for general practitioners, regarding the improvement in knowledge of ARIA and GINA guidelines and compliance with them in asthma management.Sixty general practitioners, covering 68,146 inhabitants, were randomly allocated to continuing medical education/continuing professional development (five residential events +four short distance-learning refresher courses over one year) or no training. Participants completed a questionnaire after each continuing medical education event; key questions were repeated at least twice. The Local Health Unit prescription database was used to verify prescription habits (diagnostic investigations and pharmacological therapy) and hospitalizations over one year before and after training.Fourteen general practitioners (46.7%) reached the cut-off of 50% attendance of the training courses. Knowledge improved significantly after training (p0.001, correct answers to key questions +13%). Training resulted in pharmaceutical cost containment (trained general practitioners +0.5% vs. controls +18.8%) and greater attention to diagnosis and monitoring (increase in spirometry +63.4%, p0.01).This study revealed an encouraging impact of educational events on improvement in general practitioner knowledge of guidelines and daily practice behavioral changes. Long-term studies of large populations are required to assess the effectiveness of education on the behavior of physicians in asthma management, and to establish the best format for educational events.

Objective. Asthma is a disease with elevated prevalence within the general population. Although general practitioners (GPs) are among the first health-care professionals to whom patients refer for their symptoms, there are few evaluations of this disease based on data provided by the GPs. The aim of this observational study is to assess the impact of asthma and comorbid allergic rhinitis on individual/social burden, quality of life, and disease control in asthmatic patients of Italian GPs. Methods. Throughout Italy, 107 GPs enrolled 995 patients diagnosed with asthma and using anti-asthmatic drug prescriptions, or with asthma-like symptoms during the previous 12 months. Data were collected through questionnaires filled out by GPs and patients. Results. Of the 995 asthmatic patients, 60.6 had concomitant allergic rhinitis (RA), 39.4 had asthma alone. The latter, compared to those with RA, showed significantly lower prevalence of intermittent asthma (37.5 vs. 55.6) and higher prevalence of mild, moderate, and severe persistent asthma (28.4 vs. 23.2, 28.7 vs. 18.8, and 5.4 vs 2.4, respectively). Individual/social burden due to asthma was frequent and increased with disease severity: 87.5 of severe persistent asthma patients reported at least one medical consultation in the last 12 months, 37.5 emergency department visits, 26.7 hospitalization, and 62.5 limitations in daily activities. Control and quality of life were inversely associated with disease severity and were worse in patients with RA than in those with asthma alone. Conclusions. This study showed the negative impact of high severity levels and comorbid allergic rhinitis on quality of life of asthmatic patients and on individual/social burden due to asthma in an Italian GPs setting. © 2012 Informa Healthcare USA, Inc.

An epidemiological survey related to atmospheric pollution was carried out during 1991-1992 on a sample of about 2,800 people. Data were collected by means of standardized questionnaires, gathering information on the individual and his family, with special regard to respiratory aspects. Blood samples were taken at the interview and allergometric tests performed, as well as lung function tests. The data collected during the survey were widely inspected during these years within various disciplinary fields, such as epidemiology, lung disease, immunology, allergy, biochemistry, and cytogenetics. A specific characteristic of the study is the detection of antibodies anti-adducts to DNA of benzopyrene in the sera. A geographical approach is currently being applied. A major goal is to develop a geographical model for air quality, derived from the effects of air pollution on human beings. To begin with we are investigating on relationships between health and the environment, analyzing the distribution of a respiratory symptom like wheeze, and the association between estimates of air pollution and the presence of circulating antibodies against specific DNA adducts due to airborne pollutants

This study aims to assess the effetcs of long term exposure to air pollution on human respiratory health status. We selected a general population sub-sample (those who were medicine users in the 1991-93 survey and a matched randomly selected control group). These subjects, in 2005, participated in a telephone interview about demographic characteristics, respiratory symptoms/diseases, comorbidity, and medicines consumption. People were classified on the basis of the distance of their house from atmospheric pollution sources, using GIS technology. Buffers of 100 metres from the main roads and buffer of 1100 metres from an industrial pollution source were considered. Living close to air pollution sources was associated with incidence of respiratory symptoms/diseases.

Objective: to assess, in a population sample living in Pisa (Tuscany, Italy), the relation between the temporal change of health status, risk factors, drugs consumption and long-term exposure to atmospheric pollution sources, using GIS (Geographical Information System) technology. Design: we selected a general population sub-sample (those who were medicine users in the 1991-93 survey and a matched randomly selected control group). These subjects, in 2005, participated in a telephone interview about demographic characteristics, respiratory symptoms/diseases, comorbidity, and medicines consumption. People were classified on the basis of the distance of their house from atmospheric pollution sources, using GIS technology. Buffers of 100 metres from the main roads and buffer of 1100 metres from an industrial pollution source were considered. Results: living close to air pollution sources was associated with incidence of respiratory symptoms/diseases. In particular, there were significant associations: with COPD (OR 2.95, IC 95% 1.07-8.17) and with phlegm (OR 5.25, IC 95% 1.47-18.77) in those exposed to industrial and traffic pollution; with COPD (OR 2,10 IC 95% 1.20-3.69) in those exposed only to traffic pollution. Conclusions: this study has allowed to estimate that the chronic exposure (approximately 13 years) to atmospheric pollution is associated to the development of chronic respiratory conditions, such as COPD and phlegm.

Background: Pisa has an old tradition of horse racing: workers, mainly grooms, have a high risk of accidents during their activities. Aim: to investigate the prevalence of accidents in a group of grooms in Pisa area.

This study aims to assess the effetcs of long term exposure to air pollution on human respiratory health status. We selected a general population sub-sample (those who were medicine users in the 1991-93 survey and a matched randomly selected control group). These subjects, in 2005, participated in a telephone interview about demographic characteristics, respiratory symptoms/diseases, comorbidity, and medicines consumption. People were classified on the basis of the distance of their house from atmospheric pollution sources, using GIS technology. Buffers of 100 metres from the main roads and buffer of 1100 metres from an industrial pollution source were considered. Living close to air pollution sources was associated with incidence of respiratory symptoms/diseases.

Pisa has an old tradition of horse racing: workers, mainly grooms, are exposed to inorganic and organic dusts and allergens. Such exposures were reported to be related to asthma, allergic and chronic respiratory symptoms and to lung function impairment. Aim: to investigate the prevalence of respiratory symptoms and diseases in a group of grooms in Pisa area.