Search

Background: Idiopathic pulmonary fibrosis (IPF) primarily affects old patients. Old age is a predictor of mortality. Nintedanib, the only antifibrotic drug approved in Italy for patients aged >80 years, can slow the progression of IPF by reducing the rate of decline in forced vital capacity (FVC) and the risk of exacerbations. Objectives: The primary aim of the study was to compare the decline of FVC after 12 months of nintedanib in patients aged >80 years versus younger patients. Differences related to other functional data, safety, tolerability, hospitalizations, exacerbations, and mortality were evaluated. Methods: An observational, retrospective, multicenter study was carried out in Italy. Results: 159 (122 [76.7%] males) patients were recruited: 106 (66.7%) aged ≤80 years and 53 (33.3%) aged >80 years. FVC decline after 12 months of therapy was not significantly different (−45 mL [−170; 75] vs. −20 mL [−138; 110] mL; p: 0.51). No differences were found for other functional data. Diarrhea was the most frequent adverse event (AE). Rate and type of any AEs, permanent/temporary dose reduction, or drug discontinuation were not significantly different between patients aged ≤80 vs. >80 years. Furthermore, acute exacerbations, hospitalization, and mortality were not significantly different. Conclusions: Nintedanib is effective and safe in patients with IPF aged >80 years, and no significant differences were found when clinical outcomes were compared with those of younger patients. Thus, older age should not be a barrier for the early prescription of antifibrotic treatment in IPF patients.

Introduction: Severe asthmatic patients(SAP) show a reduced exercise capacity,with a likely role of deconditioning and a reduction of daily physical activity(DPA).We hypothesised that oxygen uptake at peak exercise(peakVO2) measured through cardiopulmonary exercise testing(CPET) could be used as outcome for the assessment of SAP after introduction of biological therapy. Aims and objectives: Our primary objective was to assess exercise capacity in SAP in a clinical context before and 16weeks after introduction the biological therapy, as proposed in a previous study on Omalizumab(Schaper C.et al,Respir Med 2011).We also evaluated changes in DPA and quality of life after therapy. Material and methods: We enrolled 11 severe asthmatic patients with the indication to the biological therapy. The following tests were conducted before the first administration of the biological and after 16weeks: -Pulmonary function tests -CPET -Asthma Quality of Life Questionnaire -Stepcount (measured by metabolic monitor) Results: There were no significant differences in our outcomes 16weeks after starting therapy(tab.1) Conclusion: Our data suggest that these CPET and DPA variables are not relevant outcomes to monitor the efficacy of biological drugs in SAP,probably due to the short time after the first assessment and possibly to a poor engagement of patients in increasing these specific aspects.More conclusive data would come from extending evaluation 52 weeks after the start of therapy.

Background: Understanding the level of patients’ satisfaction with treatment and its determinants have the potential to impact therapeutic management and clinical outcome in chronic conditions such as chronic obstructive pulmonary disease (COPD). Methods: A national, multicenter, longitudinal, observational study of COPD from 20 Italian pulmonary centers to explore patients’ satisfaction to treatment [assessed by the Treatment Satisfaction Questionnaire, 9 items (TSQM-9)] and association with clinical parameters [including dyspnea score, COPD Assessment Test (CAT) score, exacerbation rate], adherence to treatment [Morisky Medication-Taking Adherence Scale (MMAS-4)], illness perception [evaluated by Brief Illness Perception Questionnaire (B-IPQ)] in a 1-year follow up. Results: A total of 401 COPD patients were enrolled [69.4% group B Global Initiative for COPD (GOLD), considering 366 patients with available GOLD 2017 classification at enrollment]. At enrollment, satisfaction with treatment was moderate, being TSQM-9 mean scores for effectiveness 64.2 [95% confidence interval (CI) 62.5–65.9], for convenience 75.8 (95% CI 74.2–77.3), and for global satisfaction 65.7 (95% CI 64.0–67.4). Global satisfaction was negatively associated with disease perception (β = −0.4709, p Conclusions: The results of this real-life study showed that the patients’ satisfaction with treatments is only moderate in COPD. A high grade of patients’ satisfaction is associated mainly with a low perception of the disease, high adherence to treatment and lower level of dyspnea. Trial Registration: Clinicaltrials.gov identifier: NCT02689492 The reviews of this paper are available via the supplemental material section.

Il controllo della funzione tiroidea e affidato principalmente a tre sistemi di regolazione: il primo e costituito dalla liberazione ipofisaria di TSH (a sua volta controllata dalla liberazione ipotalamica di TRH con un meccanismo a feedback); il secondo, intratiroideo, consiste nella possibilita di autoregolazione della liberazione di T3 e T4 in funzione dei livelli di iodio organico intracellulare; il terzo, periferico, e rappresentato dall’attivita delle selenodesiodasi e dalla conseguente trasformazione della T4 in T3, biologicamente piu attiva. Mentre i primi due processi sono altamente regolati al fine di garantire la costanza delle concentrazioni plasmatiche di ormone, il terzo livello puo subire notevoli alterazioni che consentono forti fluttuazioni di ormone attivo a livello nucleare. Le conseguenze di tali variazioni sono state oggetto di numerosi studi negli ultimi decenni e le piu recenti scoperte sono di seguito descritte.

Malignancy is the main haemoptysis aetiology in our Italian cohort http://ow.ly/goUb30gRT5b

The major product secreted by the thyroid is thyroxine (T4), whereas most of the biologically active triiodothyronine (T3) derives from the peripheral conversion of T4 into T3. The deiodinase enzymes are involved in activation and inactivation of thyroid hormones. Type 1 and type 2 deiodinase (D1 and D2) convert T4 into T3 whereas D3 degrades T4 and T3 into inactive metabolites and is thus the major physiological thyroid hormone inactivator. The hypothalamic-pituitary-thyroid axis maintains circulating thyroid hormone levels constant, while the deiodinases tissue-specifically regulate intracellular thyroid status by controlling thyroid hormone action in a precise spatio-temporal fashion. Here we review the data related to the recent identification of a paraneoplastic syndrome called “consumptive hypothyroidism”, which exemplifies how deiodinases alter substantially the concentration of thyroid hormone in blood. This syndrome results from the aberrant uncontrolled expression of D3 that can induce a severe form of hypothyroidism by inactivating T4 and T3 in defined tumor tissue. This rare thyroid hormone insufficiency generally affects patients in the first years of life, and has distinct features in terms of diagnosis, treatment and prognosis with respect to other forms of hypothyroidism.