Endoscopic management of brainstem injury due to ventriculoperitoneal shunt placement.

INTRODUCTION: We report a patient who suffered from brainstem injury following ventriculoperitoneal (VP) shunt placement in the fourth ventricle. DISCUSSION: A 20-year-old man with complex hydrocephalus and trapped fourth ventricle underwent a suboccipital placement of a VP shunt. Postprocedure patient developed double vision. Magnetic resonance imaging showed that the catheter was penetrating the dorsal brainstem at the level of the pontomedullary junction. Patient was referred to our Neuroendoscopic Clinic. Physical exam demonstrated pure right VI cranial nerve palsy. Patient underwent flexible endoscopic exploration of the ventricular system. Some of the endoscopic findings were severe aqueductal stenosis and brainstem injury from the catheter. Aqueductoplasty, transaqueductal approach into the fourth ventricle, and endoscopic repositioning of the catheter were some of the procedures performed. Patient recovered full neurological function. The combination of endoscopic exploration and shunt is a good alternative for patients with complex hydrocephalus. A transaqueductal approach to the fourth ventricle with flexible scope is an alternative for fourth ventricle pathology.

Plasma lycopene and antioxidant vitamins in asthma: the PLAVA study.

OBJECTIVE: Scientific evidence suggests that lycopene and antioxidant vitamins have significant antioxidant and protective effects. METHODS: This case-control study included 96 subjects (40 asthmatics, 56 healthy control subjects). Baseline blood samples, pulmonary function tests, and clinical and alimentary histories were collected. All subjects were grouped by age, sex, cigarette smoking habit, body mass index, alimentary intake, and atopic status. RESULTS: Serum lycopene concentration was significantly lower in asthmatic subjects than in healthy control subjects (0.10+/-0.7 micromoL/L vs. 0.16+/-0.8 micromoL/L--p<0.001). Serum vitamin A concentration was significantly lower in asthmatics (2.38+/-0.37 micromoL/L) in respect to control subjects (3.06+/-0.56 micromoL/L) (p<0.01). Plasma serum concentration of vitamin E and beta-carotene were not found to be different in the two groups. CONCLUSIONS: Dietary supplementation or adequate intake of lycopene and vitamin A rich foods may be beneficial in asthmatic subjects.

Prevalence and severity of airway obstruction in an Italian adult population.

BACKGROUND: This study sets out to estimate the prevalence and the degree of severity of bronchial obstruction in an adult population with three different diagnostic criteria: the European Respiratory Society (ERS), the American Thoracic Society (ATS), and the World Health Organization (WHO) defined as Global Obstructive Lung Disease (GOLD). METHODS: 1514 subjects underwent complete medical evaluation and spirometry. RESULTS: The prevalence of bronchial obstruction was respectively 27.5 % (ERS), 33% (GOLD), and 47.3 % (ATS). The prevalence of bronchial obstruction in the smoker group was 33.4% (ERS), 38.1% (GOLD), and 52.3% (ATS). The prevalence of obstruction in the ex-smoker group was 33% (ERS), 41.4% (GOLD), and 57.1% (ATS). The prevalence of obstruction in the non-smoker group was 21.1% (ERS), 24.9% (GOLD), and 38.6% (ATS). CONCLUSIONS: The results show that the prevalence of airway obstruction increases proportionally with age; the cigarette smoking represents an important conditioning factor. These observations warrant the necessity of a more complete and multi-parametric analysis in the evaluation of patients with airway obstruction using methodologies that explore the functional state and the risk factors that cause the airway obstruction.

Trapped fourth ventricle treated with shunt placement in the fourth ventricle by direct visualization with flexible neuroendoscope.

Shunt placement was the most common procedure used for ventricular dilatation, but in many neurosurgical centers it has been substituted by flexible neuroendoscope; however, none of them had solved the problem of the trapped and dilated fourth ventricle. The combination of the ventricle-peritoneal catheter placement in the center of the fourth ventricle by direct visualization with a flexible neuroendoscope using a single coronal burr-hole has solved this problem. Eleven patients with a trapped fourth ventricle, with previous third ventriculostomy and aqueductal plasty, were treated with this procedure; all patients were evaluated clinically and with computed tomography 8 to 24 months (mean, 18 months) later. Here, we describe the technical procedure.

[Leptin and hypothalamus-hypophysis-thyroid axis]. / Leptina ed asse ipotalamo-ipofisi-tiroide.

The leptin system is a major regulator of food intake and metabolic rate. The leptin, an adipose tissue hormone whose plasma levels reflect energy stores, plays an important rule in the pathogenesis of such eating disorders like bulimia and anorexia. Thyroid hormones are major regulators of energy homeostasis. It is possible that leptin and thyroid hormone exert their actions on thermogenesis and energy metabolism via the same common effector patways. Leptin influences feedback regulation of the hypotalamic TRH-secreting neurons by thyroid hormone. Low serum levels of thyroid hormones reflect a dysfunction of the hypotalamic-pituitary-thyroid (HPT) and hypotalamic-pituitary-adrenal (HPA) axis in patients with nervosa anorexia. Neuroendocrine effects of leptin include effects on the HPT and HPA axis. The aim of this work is to evaluated the interactions between leptina and HPT axis on the basis of recent published works and reviews in literature.

Irritable bowel syndrome and bronchial hyperresponsiveness: is there a link?

BACKGROUND/AIM: Many studies have demonstrated a high prevalence of bronchial hyperresponsiveness in patients with irritable bowel syndrome (IBS). The aim of this 24-month prospective study was to evaluate the prevalence of IBS in asthmatic patients. METHODS: We analyzed 623 asthmatic patients that were evaluated for body mass index, sex, and age before undergoing both a methacholine challenge test (MCHt) and skin prick tests. RESULTS: We found that 276 asthmatic patients (44.3%) were positive on the MCHt, while 347 (55.7%) were negative. We also found that 27 (9.7%) of the 276 patients with a positive MCHt and 44 (12.7%) of the 347 patients with a negative MCHt were affected by IBS. Therefore, there was no statistically significant difference between positive MCHt tests and IBS. The PC(20) (mean provocation concentration of methacholine producing a 20% reduction in forced expiratory volume in 1 s < or =16 mg/ml) in all patients tested was 8.64 +/- 2.58 mg/ml, being 8.75 +/- 2.52 and 8.55 +/- 2.32 mg/ml for males and females, respectively. CONCLUSIONS: These results do not demonstrate a relationship between MCHt and IBS. However, a relationship might still exist in a subpopulation of patients whose symptoms worsen by stress.

Quality of Life and clinical symptoms in asthmatic subjects.

OBJECTIVE: Quality of Life (QoL) measurements are more responsive to clinically significant changes than conventional clinical measures. The aim of the study was to evaluate the relationship between asthma symptoms and QoL in asthmatic patients. METHODS: A total of 277 asthmatics subjects, divided into three groups showing different symptoms, underwent complete clinical evaluation, baseline respiratory function, and methacholine challenge test and completed an Asthma Quality of Life Questionnaire (AQLQ). RESULTS: One hundred and forty-five subjects with asthmatic crisis, chest tightness, and dyspnea (group 3) reported a significantly lower median value in single domains and all items compared to the values scored by the 97 subjects with wheezing, rhinitis, and conjunctivitis (group 2) (p < 0.01). No statistical significance was found between the 35 patients of group 1 (with only cough) and group 3. CONCLUSIONS: The main advantage for the clinician is to evaluate important areas in which QoL could be improved and the possibility to correct and optimize compliance to chronic therapy.

Prevalence of bronchial asthma in patients with endoscopically-documented esophagitis.

The association of gastroesophageal reflux, esophagitis, and asthma has been studied for a long time, but the results are often conflicting. The aim of this study is to evaluate the prevalence of bronchial asthma and the presence of extra-esophageal symptoms in subjects with endoscopically-documented reflux esophagitis. Forty patients were divided into 2 groups: group A (22 patients) affected by endoscopically-documented esophagitis, and group B (18 patients) with positive endoscopic examination for other pathologies of the gastroenteric tract. All of the patients underwent complete medical examination, skin-prick tests, esophageal-gastric-endoscopy, and pulmonary function tests (basal and after methacholine). The prevalence of asthma was 30% in group A vs 10% in group B (odds ratio = 2.57; confidence interval = 0.75-10.25). Relationships between chronic cough and esophagitis (p<0.01) and between chronic cough and asthma (p<0.05) were found. No significant relationships were observed between esophagitis and the other respiratory symptoms considered (wheezing, chest tightness, hoarseness, bronchospasm, and dysphagia). The results confirm the increased prevalence of asthma in patients with esophagitis and they emphasize the role of gastroesophageal reflux as a trigger factor for asthma. Chronic cough represents an important symptom of asthma in subjects with esophagitis.

A randomized controlled trial of amantadine plus interferon-alpha2a vs. interferon-alpha2a alone in naive patients with chronic hepatitis C randomized according to the early virological response to interferon-alpha2a monotherapy.

BACKGROUND: An early virological response to interferon-alpha treatment is a strong predictor of sustained response, but it has never been exploited to stratify patients in clinical trials. AIM: To evaluate the efficacy of amantadine plus interferon-alpha compared with interferon-alpha alone in naive patients with chronic hepatitis C who were randomized on the basis of the early virological response to interferon-alpha. METHODS: One hundred and eighty-one patients received recombinant interferon-alpha2a (3 MU three times weekly) for 2 months and 164 were evaluated for early (i.e. month 2) virological response. Hepatitis C virus (HCV) RNA-negative patients (n = 66) were randomized to receive 3 MU of interferon-alpha three times weekly, with or without amantadine (200 mg/day); HCV RNA-positive patients (n = 98) were randomized to receive 6 MU of interferon-alpha three times weekly, with or without amantadine (200 mg/day). HCV RNA-positive patients at 6 months discontinued treatment, and all others completed 12 months. RESULTS: At month 6, HCV RNA-negative patients made up 54.2% of the interferon + amantadine group and 42.0% of the monotherapy group (P = 0.07). At month 12, HCV RNA-negative patients made up 38.5% of the interferon + amantadine group and 28.4% of the monotherapy group (N.S.). The sustained virological response rates were 21.6% and 20.9%, respectively (N.S.). CONCLUSION: The addition of amantadine does not enhance the sustained virological response to interferon-alpha in naive patients with chronic hepatitis C; however, an additive effect of amantadine occurs in the first 6 months, mainly in patients without an early response to monotherapy. Early response to interferon-alpha is a strong predictor of sustained virological response.

Effect of the two different leukotriene receptor antagonists, montelukast and zafirlukast, on quality of life: a 12-week randomized study.

Many studies analyze the effects of many drugs on quality of life (QOL). The aim of this study is to compare the effectiveness of the leukotriene receptor antagonists on QOL. Forty mild asthmatic patients were randomized for 12 treatment-weeks and divided into two groups: the first group was treated with montelukast (MON; 10 mg daily) and the second one was treated with zafirlukast (ZAF; 40 mg daily). All patients underwent clinical examination, spirometry, and completed the Asthma Quality of Life Questionnaire. For each domain, a value of 1 (maximal impairment) and 7 (no impairment) was used. The MON group had in all items a basal median value of 4.7 compared with 5.5 after the treatment (p < 0.05). For physical activities, the mean value was 5.1 compared with 5.9 (p < 0.05). The median scores of 12 symptoms and 5 emotion items were 5.0 and 4.7, significantly lower than 5.7 and 5.3 (p < 0.05). For the environmental stimuli domain, the mean value was 4.6 compared with 5.3 (p < 0.05). The ZAF group had in all items a basal median value of 4.8 compared with 5.7 after the treatment (p < 0.05). For physical activities, the value was 5.0 compared with 5.7 (p < 0.05). Median scores of 12 symptoms and 5 emotions were 4.9 and 4.8, significantly lower than 5.6 and 5.8 (p < 0.05). For the environmental stimuli domain, the median score was 4.7, significantly lower than 5.6 (p < 0.05). The results did not show many differences between the two treatments, showing significant improvement for both MON and ZAF on QOL.

Bronchial hyperresponsiveness and quality of life in asthmatics.

BACKGROUND: Quality of Life (QoL) measurements are more responsive to clinically significant changes that are not evaluated by conventional clinical measures. OBJECTIVE: The objective of this study is to examine the relationship between bronchial hyperresponsiveness (BHR) and QoL in asthmatic patients. PATIENTS AND METHODS: 394 patients underwent clinical follow-up, pulmonary function tests and the methacholine challenge test (MCHt), and completed the Asthma Quality of Life Questionnaire (AQLQ). RESULTS: 200 patients had a positive MCHt and in 194 it was negative. For all 32 items, asthmatic patients had a median value of 4.7 (4.2-5.9) compared to 5.6 (4.7-6.3) in patients with negative MCHt (p < 0.01). For physical activities, patients with positive MCHt showed a median value of 5.0 (4.5-6.0) compared to 5.7 (4.8-6.3) in patients with negative MCHt (p < 0.05). Median scores of 12 items of symptoms and 5 items of emotions were significantly lower in patients with positive MCHt [4.5 (3.7-5.8) and 5.1 (4.2-6.1)] than in patients with negative MCHt [5.5 (4.4-6.1) and 6.3 (5.2-6.9), respectively, (p < 0.01)]. For items of environmental stimuli the median score was 4.7 (3.7-5.9) in patients with positive MCHt, being significantly lower than in patients with negative MCHt [5.4 (4.2-6.4), p < 0.05]. Patients with positive MCHt had lower values of QoL than patients with negative MCHt. CONCLUSIONS: QoL changes may be more sensitive than evaluation of BHR. The measurement of Qol may be important because it enables us to characterize patients who could be candidates eventually to a pharmacological treatment for BHR because they have an impaired QoL.

Bronchial hyperresponsiveness in adults with seasonal and perennial rhinitis: is there a link for asthma and rhinitis?

Epidemiological studies have shown that asthma and rhinitis often coexist in the same patients and the prevalence of asthma is greater in patients with rhinitis. The aim of this study was to evaluate the differences in bronchial reactivity in subjects with seasonal and perennial rhinitis. We enrolled 128 subjects with seasonal or perennial allergic rhinitis divided into three groups: A with perennial rhinitis and allergy to Dermatophagoides Pteronissynus; B with seasonal rhinitis and allergy to Graminae and Parietaria, who underwent methacholine challenge test (MCHt) during the exposure period (fron March until May); C with seasonal rhinitis and allergy to Graminae and Parietaria, who underwent MCHt during the non exposure period (from June until February). The PC20 mean values of group A (1774.8 ± 20.7) and group B (1740.7 ± 38.8) were not significantly different, but significantly lower than those of group C (3010.0 ± 56.9) (p=0.001). The subjects with group A were positive to the MCHt in 54.54%, against 29.28% of group B and 11.62% of group C (p=0.007). The results show differences in the degree of bronchial responsiveness. The dose-response curves documented a lower value of PC20 in the group with perennial rhinitis and a statistically significant difference of bronchial hyperresponsiveness prevalence between the three groups (p=0.007).

The role of antileukotrienes in the treatment of asthma.

Cysteinyl leukotrienes (Cys-LTs) are mediators released in asthma and are both direct bronchoconstrictors and proinflammatory substances that mediated several steps in the pathophysiology of chronic asthma, including inflammatory cells recruitment, vascular leakage, and possibly airway remodelling. Available evidence from clinical trials and real world experience derived from managing patients with asthma justifies a broader role for antiLTRAs in asthma management than that recommended in the National Asthma Education and Prevention Programm (NAEPP) and National Health Lung and Blood Institute (NHLBI) treatment guidelines. Leukotriene-receptor antagonist drugs (LTRAs) seem to be effective alternatives to inhaled corticosteroids (ICS) either as monotherapy or as adjunctive therapy that reduces the need for higher doses of ICS in patients with mild-to-moderate persistent asthma. LTRAs may be used as adjunctive therapy for al levels of disease severity because they are effective in combination with ICS during long-term maintenance therapy. The agents seem especially effective in preventing aspirin-induced asthma, exercise-induced asthma (EIA) and they may provide an additional advantage of reducing nasal congestion in patients with both asthma and rhinitis.

Effectiveness of montelukast versus budesonide on quality of life and bronchial reactivity in subjects with mild-persistent asthma.

Insufficient data exist to evaluate the comparative effects of inhaled corticosteroids (ICS) versus leukotriene receptor antagonist (LTRA) on airway inflammation and quality of life (QoL). The aim of the study was to compare the effectiveness of montelukast compared to budesonide at different doses on QoL and bronchial reactivity in mild-asthmatic adult patients. 45 subjects with bronchial asthma were randomly assigned to a different treatment and divided in 3 treatment groups: A: 400 mg of budesonide twice a day; B: 10 mg of montelukast daily; C: 10 mg of montelukast daily plus 400 mg of budesonide twice a day. At the beginning of the study and at the end of the treatment period (16 weeks) all patients underwent complete clinical evaluation, pulmonary function testing and methacholine challenge test (MCHt). In group A the increase from baseline was 153.4&#x0025;, in group C was 133.2&#x0025;, and in group B 247.7&#x0025;, the latter increase being statistically significant compared to that in the other 2 groups (p&#x003C; 0.005 Wilcoxon test). In all domains the improvement in quality of life in the group treated with montelukast (group B) was significantly greater than that in the group treated with both medications (group C): in particular, the improvement was consistent in the symptoms (p&#x003C; 0.01) and emotions (p&#x003C; 0.01) domains, and weaker in the physical activity (p&#x003C; 0.05). A similar difference was observed between group B and A, but only in the symptoms (p&#x003C;0.01), emotions (p&#x003C;0.01), and environmental stimuli domains (p&#x003C;0.05). The personal perception of their own disease is important for a correct therapeutic management of asthma. In order to optimize the treatment, a complete adherence of the patient to the treatment itself is required, to be achieved through simplification of therapeutic schedule and easy administration of medications. Montelukast may be considered a valid alternative in the treatment of mild-persistent asthma, both for the clinical and functional benefits and for the great advantage of the once-daily dosage, which consistently improves the compliance with the chronic treatment of the disease.

[Effectiveness and safety of montelukast versus budesonide at various doses on bronchial reactivity in subjects with mild persistent asthma]. / Efficacia e tollerabilità del montelukast verso budesonide a diverso dosaggio sulla reattività bronchiale in soggetti con asma di grado lieve-persistente.

PURPOSE: Insufficient data exist to evaluate the comparative effects of inhaled corticosteroids versus leukotriene receptor antagonists on airway inflammation and remodelling. The aim of the study was to evaluate the effectiveness and safety of montelukast versus budesonide at different doses on bronchial reactivity in mild-asthmatic adult patients. PATIENTS AND METHODS: A total of 40 patients were randomly assigned to a different treatment and divided in 2 treatment groups (A, B) as follows: A-10 mg of montelukast daily; B-400 mg of budesonide twice a day. RESULTS: We studied 40 subjects (21 males, 19 females) divided in two groups of 20 subjects each: group A with mean age 25.16 +/- 7.68 years, group B with mean age 26.18 +/- 6.15 years. After 16 weeks of treatment in the group A the PC20 (provocative concentration of methacholine which cause a fall of FEV1 > or = 20%) was 620.12 +/- 140.54 micrograms/mL significantly highly compared to basal value of 315.75 +/- 100.16 micrograms/mL (p < 0.02). In the group B the PC20 was 795.67 +/- 312.76 micrograms/mL significantly highly compared to basal value of 342.87 +/- 132.38 micrograms/mL (p < 0.001). We not found differences in FEV1, FVC e PEF before and after the treatment. CONCLUSIONS: Montelukast may be considered a valid alternative in the treatment of mild-persistent asthma, both for the benefits on bronchial reactivity and for the great advantage of the once-daily dosage, which consistently improves the compliance with the chronic treatment of the disease.

Large waist circumference and risk of hypertension.

OBJECTIVE: To examine the relationship between 24 h ambulatory blood pressure monitoring and three commonest anthropometric measurements for obesity--body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (W). DESIGN: Cross-sectional survey among outpatients at the Obesity Research Center. SUBJECTS AND METHODS: Four-hundred and sixty-one overweight or obese subjects, non-diabetic, otherwise healthy, aged 20-70 y, of either sex, were consecutively recruited. All subjects underwent 24 h ambulatory blood pressure monitoring. The population study was separated in normotensive and hypertensive males and females and the possible risk factors for hypertension (W, WHR, BMI and age) were subdivided into different classes of values. RESULTS: Logistic regression shows that W is the most important anthropometric factor associated with the hypertensive risk. Among males with W> or =102 cm the odds ratio (OR) for hypertension is three times that of males with W<94 cm using casual BP measure (OR 3.04), nearly four times higher using 24 h BP mean (OR 3.97), and even five times higher using day-time BP mean (OR 5.19). Females with W> or =88 cm have a risk for hypertension twice that of females with W<80 cm, whatever BP measurement was take (casual, 24 h or day-time). Males with WHR> or =0.96 and females with WHR> or =0.86 show significant OR for hypertension only by 24 h BP measurement and by day-time BP measurement. BMI seems to have no significant relationship to hypertensive risk. Age shows a significant relationship to hypertensive risk only considering males aged > or =55 y and females aged > or =50 y. CONCLUSION: The waist circumference seems to have a strong association with the risk of hypertension, principally by the ambulatory BP monitoring, when compared with casual BP measurement.

Effect of natural allergen exposure on non-specific bronchial reactivity in asthmatic farmers.

The aim of the study was to assess the seasonal variability of non-specific bronchial reactivity (NSBR) evaluated with methacholine in asthmatic farmers allergic to pollens. Twenty farmers (16 male and four female) with allergy to pollens, e.g. 'Graminae' and 'Parietaria', entered the study. None of the patients had been previously treated with specific immunotherapy. Patients underwent a methacholine challenge at the first visit and then in the subsequent seasons. Four groups of tests were obtained according to the period when the challenge was performed. Group 1: challenges performed in December, January and February; group 2 in March, April and May; group 3 in June, July and August; group 4 in September, October and November. PD20 values were expressed as the natural logarithm of the cumulative dose of methacholine causing at least a 20% fall in FEV1. Bronchial hyperreactivity was highest in summer, followed by spring and autumn; in winter it was much lower. Multiple group analysis (ANOVA) showed statistically significant differences between the groups (P < 0.01). When the groups were compared individually, statistically significant differences existed only between group 1 (winter) and each of the other groups, respectively 2 (spring) (P = 0.02), 3 (summer) (P = 0.004) and 4 (autumn) (P = 0.02). The results underlined the importance of allergic inflammation in determining changes in NSBR. In the region where the study was carried out (central Italy), the grass and Paretaria pollination lasts from March to November. Therefore, farmers had a progressive increase in NSBR from spring to summer and a decrease in fall as a consequence of the varying pollen concentration in different seasons. The level of allergen exposure is, in fact, the main factor that determines the severity of bronchial inflammation, thus affecting NSBR.

Seasonal variability of non-specific bronchial responsiveness in asthmatic patients with allergy to house dust mites.

The aim of the study was to assess the seasonal variability of non-specific bronchial responsiveness to methacholine in allergic asthma. One hundred sixty-five patients (83 male and 82 female) entered the study: 86 subjects (group A) with allergy exclusively to mites and 79 (group B) with concomitant allergy to pollens, e.g., "Graminae" and "Parietaria." Inclusion criteria were the absence of sensitization to other allergens, no smoking habit, withdrawal from steroids, bronchodilators, sodium cromoglycate, and antihistamines for at least four weeks before enrollment, FEV1 > 70% of the predicted value, and absence of other respiratory diseases and of upper and lower respiratory tract infections for at least one month before the methacholine challenge. None of the patients had been previously treated with specific immunotherapy. Subjects of each group (A and B) underwent methacholine challenge at first visit and were divided into four subgroups according to the period when the challenge was performed. Subgroups A1 and B1 performed the challenge in December, January, and February; subgroups A2 and B2 in March, April, and May; subgroups A3 and B3 in June, July, and August; subgroups A4 and B4 in September, October, and November. PD20 values were expressed as the natural logs of the cumulative dose of methacholine causing at least a 20% fall in FEV1. Statistical analysis was carried out using multiple group analysis and Student's t-test. Results showed that the highest non-specific bronchial responsiveness was observed in autumn (ln PC20 = 4.54 +/- 1.51) in patients allergic to mites only (group A), and in summer (ln PC20 = 4.72 +/- 2.11) in those of group B. Multiple group analysis showed statistical significant differences between subgroups within each group (group A, p = 0.039; group B, p < 0.001). In patients allergic exclusively to house dust mites (group A), multiple comparisons and Student's t-test showed statistically significant differences between non-specific bronchial responsiveness (NSBR) assessed in autumn and those of other seasons (winter, p = 0.002; spring, p < 0.001; summer, p = 0.082). These results confirm that the level of allergen exposure may influence NSBR. Mite-allergic patients showed an increase of NSBR in autumn, possibly as a consequence of higher indoor mite concentration. However, mite- and grass-allergic patients had wider variations of NSBR, possibly reflecting changes in seasonal pollen concentration.

Zafirlukast versus budesonide on bronchial reactivity in subjects with mild-persistent asthma.

Asthma is one of the most common chronic diseases in children and adults. Recent studies have shown that in asthmatic patients treated with inhaled corticosteroids there is a better disease’s control when adding a second drug, than increasing the corticosteroid’s dose. The aim of this study has been to evaluate the effectiveness and tolerance of zafirlukast, a leukotriene receptor antagonist, versus budesonide in clinically steady patients with mild persistent bronchial asthma. We have enrolled 36 subjects non smokers, with mild persistent bronchial asthma and 12 healthy subjects as control group. At the beginning of this study and at the end of the treatment (8 weeks), all patients underwent complete clinical work-up, pulmonary function testing (FEV1, PEF and FVC) and methacholine challenge test. The patients were divided into 3 groups: group A) 20 mg of zafirlukast twice a day; group B) 400 mg of budesonide twice a day; group C) 20 mg of zafirlukast twice a day and 400 mg of budesonide twice a day. Basal FEV1 and PEF presented no significant statistical differences between control subjects and patients of group A, B and C. After eight weeks there were no significant changes for FEV1 and PEF among the three groups. After therapy a strong significant increase of PD20 was documented in group A (p<0.005), group B (p<0.001) and group C (p<0.005), respect to baseline values. The antileukotriene drugs could be taken as an alternative drug, or in association with low-dose inhaled corticosteroids, in patients with mild persistent asthma, both for their clinical effectiveness and their easy ingestion, which is confirmed in compliance studies on inhaled steroids.