Vitamin D and health status in elderly.

Recently, vitamin D has aroused considerable interest for several reasons. Many epidemiological studies have shown a widespread deficiency of vitamin D at all ages, and the recent finding that many organs and tissues have vitamin D receptors has fostered the clinical and biological relevance of vitamin D. Elderly people are at high risk for vitamin D deficiency if their life style entails few outdoor activities, their skin is thick and they exhibit impairment of renal function. In the elderly, vitamin D deficiency is very important because it can affect the function of many organs such as the muscle-skeletal, cardio-vascular systems and kidney, and may be involved in various diseases and pathological conditions including type II diabetes, cancer and cognitive decline. In the present review, the most relevant features of vitamin D are described as well as the clinical consequences of hypovitaminosis D in the elderly. Finally, the role of an adequate oral supplementation in the geriatric population is stressed.

Increased prevalence of silent myocardial ischaemia and severe ventricular arrhythmias in untreated patients with Alzheimer's disease and mild cognitive impairment without overt coronary artery disease.

OBJECTIVE: To assess the prevalence and the characteristics of silent myocardial ischaemia (SMI) and ventricular arrhythmias (VA) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and their relationships with QT interval dispersion (QTD). METHODS: Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy control subjects matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled. Each subject underwent clinical and cognitive examination, a structural brain imaging study, electrocardiogram (ECG), 24-h ECG recording, 24-h blood pressure monitoring, and echocardiogram. Detection and characterization of QT dispersion, SMI and VA were performed. RESULTS: The three groups were comparable regarding demographic and basal cardiovascular characteristics: notwithstanding this, SMI episodes were observed only in AD and MCI patients (19 and 14, respectively). A significantly greater prevalence of repetitive ventricular premature beats was observed in AD (mean 8.56+/-13.1) and in MCI (1.8+/-7.2) vs. control (0.7+/-1.7). The QTD, the ischaemic burden and the number of repetitive ventricular beats revealed to be significantly related. CONCLUSIONS: Increased prevalence of SMI and potentially ominous VA were found in AD and, to a lesser extent, in MCI. SMI and repetitive VA were significantly related with QTD. These findings could be related to an increased risk of sudden cardiac death in AD and MCI patients.

QT dispersion and left ventricular hypertrophy in elderly hypertensive and normotensive patients.

Inhomogeneity of ventricular repolarization as detected by QT dispersion may be a potential leading mechanism of sudden death in hypertensive and normotensive (age related) left ventricular hypertrophy. Aim of this study was to investigate QT dispersion, ventricular arrhythmias, and left ventricular mass index in elderly hypertensive and normotensive patients. Study population consisted of 60 consecutive patients (sex: 34 men/26 women; age: 63 +/- 11 years) with essential arterial hypertension and 48 age and sex-matched control subjects (24 men/24 women; 64 +/- 16 years). Measurements included QTc dispersion, ventricular arrhythmias, and left ventricular hypertrophy. Hypertensive patients had greater left ventricular mass index (P = .006) and higher QTc dispersion (P = .004) than controls. Left ventricular hypertrophy was diagnosed in 57 (31 men/26 women) of all subjects. These patients had higher blood pressure (P < .05), Lown's score (P < .001), and QTc dispersion (P < .001). QTc dispersion and Lown's score were independent predictors of left ventricular mass index (P < .001). Conclusively, QTc dispersion is a strong indicator of left ventricular mass index and might be used in risk stratification of hypertensive and normotensive elderly patients.

Exhaled nitric oxide levels in systemic sclerosis with and without pulmonary involvement.

BACKGROUND: Systemic sclerosis (SSc) is a connective tissue disorder of unknown etiology that is often complicated by pulmonary involvement, with pulmonary hypertension (PH) and interstitial lung disease (ILD) being the major causes of death. It has been suggested that the amount of nitric oxide (NO) in exhaled air may predict the onset of complications. The aim of the study was to measure exhaled NO in SSc patients and investigate its relationship with pulmonary involvement with and without PH. METHODS: Fifty patients (5 men and 45 women; mean age, 59.1 +/- 11.7 years [+/- SD]) with a diagnosis of SSc based on the preliminary criteria of the American Rheumatism Association, and 40 healthy control subjects (5 men and 35 women; mean age, 58.3 +/- 12.2 years) underwent exhaled NO measurements by means of a chemiluminescence analyzer, pulmonary function tests, high-resolution thorax CT, and Doppler echocardiography. RESULTS: Exhaled NO concentrations were significantly higher in SSc patients than control subjects (p = 0.02), and significantly lower in the patients with ILD and/or PH than in those without PH (p < 0.01). There was a significant inverse correlation between pulmonary artery systolic pressure and exhaled NO concentration in all of the studied patients (r = - 0.5, p < 0.001). CONCLUSIONS: Our results indicate that exhaled air NO concentrations are lower in SSc patients with lung involvement than in those without, and that SSc patients without ILD or PH have higher exhaled NO values than healthy subjects.

From Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines to current clinical practice : an overview of the pharmacological therapy of stable chronic obstructive pulmonary disorder.

BACKGROUND: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have been promulgated to improve the management of chronic obstructive pulmonary disorder (COPD). OBJECTIVE: To evaluate the extent to which the current therapeutic approach to COPD conforms to GOLD guidelines. METHODS: This was a multicentre observational study of elderly COPD patients enrolled for acute care in general medicine or geriatric wards in tertiary hospitals in Italy in April 2002. Our series consisted of 471 patients >64 years of age consecutively admitted for acute exacerbations of COPD to wards participating in the study. Data describing drugs used prior to exacerbation and prescribed at discharge were collected using a standardised protocol. Changes in prescription at discharge were then compared with home therapy. Demographic variables and indices of COPD severity and co-morbidity were tested as potential correlates for the main outcome measure 'variant prescription', i.e. prescription of a drug considered as a third-line treatment (e.g. methylxanthines) or not recommended (e.g. mucolytics) by GOLD guidelines. The correlation was assessed first by univariate analysis and then by logistic regression analysis. RESULTS: At discharge, prescription of short-acting beta(2)-adrenoceptor agonists had decreased from 26.3% to 14.0%. Conversely, increases in prescription of long-actingbeta(2)-adrenoceptor agonists (from 43.1% to 68.4%), inhaled corticosteroids (50.7% to 69.6%) and anticholinergics (17.2% to 22.3%) were seen. The rate of use of methylxanthines was 49.7% before admission and 44.8% at discharge, with previous use being the main correlate of discharge prescription for this class of drugs (odds ratio [OR] = 4.35; 95% CI 2.88, 6.54). The rate of use of mucolytics was 26.3% before admission and 26.8% at discharge, with use of mucolytics prior to admission being the only correlate of discharge prescription (OR = 4.10; 95% CI 2.47, 6.82). CONCLUSIONS: Hospitalisation resulted in increased adherence to GOLD guidelines in patients with COPD, but the rate of use of anticholinergics was distinctly low and that of methylxanthines and mucolytics surprisingly high. A carry-over effect (i.e. of therapy prescribed by general practitioners on that prescribed by hospital-based physicians) likely accounts for most of the 'variant prescriptions' seen at discharge from the acute care hospital.

Use of antibiotics in elderly patients with exacerbated COPD: the OLD-chronic obstructive pulmonary disease study.

OBJECTIVES: To verify how frequently geriatric patients hospitalized for exacerbated chronic obstructive pulmonary disorder (COPD) had not been given antibiotics at home and to identify the relationship between the patient's condition and the prescribing practice. DESIGN: Observational study. SETTING: General medicine acute care wards. PARTICIPANTS: Four hundred fifty-nine elderly patients admitted to the hospital because of exacerbated COPD. MEASUREMENTS: Indices of severity of COPD exacerbation, such as age, St. George Respiratory Questionnaire (SGRQ) score, number of exacerbations in the previous year, and Cumulative Illness Rating Scale score were considered in the analyses. RESULTS: Ninety (19.6%) patients had an antibiotic prescribed before admission. The prescription was not associated with older age and was weakly associated with greater comorbidity. Having more than four exacerbations (odds ratio (OR)=2.16, 95% confidence interval (CI)=1.27-3.66) and a SGRQ symptoms subscore greater than 70 (OR=1.61, 95% CI=1.0-2.68) were independent correlates of the use of antibiotics before admission, although 67% of patients reporting more than four exacerbations in the previous year and 73.1% of patients with a SGRQ symptoms subscore greater than 70 had not been given any antibiotic prescription at home. CONCLUSION: The majority of older patients hospitalized for exacerbated COPD had not been given antibiotics at home, although they had at least one index of exacerbation severity.

Bone ultrasonometric features and growth hormone secretion in asthmatic patients during chronic inhaled corticosteroid therapy.

BACKGROUND: Quantitative ultrasound bone densitometry (QUBD) is a new method to assess bone mineral density and bone microarchitecture. Corticosteroid (CS) therapy may diminish bone mass, alter bone quality and may influence growth hormone (GH) secretion and bone metabolism markers. Therefore, the aim of this study was to evaluate the effects of long-term therapy with inhaled CSs (ICSs) on structural bone characteristics and their correlations with GH secretion and bone markers in asthmatic patients. METHODS: In a cross-sectional study, we enrolled 60 adult patients with mild to moderate persistent asthma: 22 on chronic (>1 year) ICS therapy, 10 naive to ICSs treatment and 28 healthy control subjects. The groups were matched for age and BMI. Each subject underwent to QUBD at the phalanxes to assess bone microarchitecture by ultrasound bone profile index (UBPI), bone density by amplitude-dependent speed of sound (AdSos); test with GH-releasing hormone (GHRH) injection with calculation of peak GH and the Delta GH (peak GH-basal GH); and hormonal and bone markers measurements. RESULTS: Asthmatics treated with long-term ICS therapy showed a lower UBPI (P < 0.01) compared to controls (49.8 +/- 19.3 vs. 77.0 +/- 10.1, respectively) and to asthmatics never taking ICSs (73.2 +/- 9.6). In ICS-treated asthmatics, DeltaGH and GH-peak showed a significant correlation with UBPI. A significant difference was observed comparing asthmatics treated with ICSs to controls and asthmatics naive to ICSs in GH response to GHRH iv bolus. Serum osteocalcin was significantly reduced in asthmatic patients treated with ICSs. CONCLUSIONS: In asthmatic patients, long-term ICSs treatment produces negative effects on bone quality assessed by QUBD, and such effects are associated to an impaired GH secretion.

Diagnostic flow chart for targeted detection of alpha1-antitrypsin deficiency.

BACKGROUND: Alpha1-antitrypsin (AAT) deficiency is under-recognized, probably because many individuals affected show no clinical impairment. The targeted detection is a tool to increase its recognition. METHODS: We prospectively submitted to AAT serum levels determination, phenotyping and, if doubtful, genotyping: (i) patients with the early onset of emphysema, emphysema in absence of recognized risk or pneumothorax (path P), antineutrophil cytoplasm antibodies (ANCA) positive vasculitis (path V), cervical artery dissection (path A), Periodic acid-Schiff (PAS) positive bodies in the liver cell or unexplained abnormal transaminase level (Path L) [index cases: IC] and (ii) subjects with low-serum alpha1-globulin (path e) and close relatives of patients with AAT deficiency (path r) [non index cases: NIC]. We determined and compared gender, age, AAT serum levels values, the ratio between AAT deficiency subjects identified and all subjects examined (identified/examined). Receiver operating characteristic (ROC) curve was plotted to find the best threshold for AAT serum levels. RESULTS: Two hundred and eighty-five individuals were examined and 211 with AAT deficiency identified: 66 were IC and 145 NIC. The ratio identified/examined resulted 0.74. A serum level of 120 mg/dL was able to identify AAT deficiency with a specificity of 73% and a sensitivity of 97%. IC showed male prevalence (P=0.005), more advanced age (P=0.02), lower AAT serum levels (P=0.008). CONCLUSIONS: Our protocol is effective to detect AAT deficiency in a selected population. About 120 mg/dL (nephelometric method) is a reliable AAT serum level cut-off for selecting subjects/patients to submit to phenotype or genotype; as compared to NIC, IC are older, mostly male and with lower AAT serum levels.

Increased QT dispersion: a negative prognostic finding in chronic obstructive pulmonary disease.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a highly prevalent syndrome, deeply affecting the cardiovascular system as well as the lungs. We investigated the prognostic role of the QT interval and QT dispersion (QTD) in predicting all-cause, respiratory and cardiovascular mortality in COPD, and the relationship between these electrocardiographic parameters and pulmonary function in a prospective longitudinal study. METHODS: We studied 246 COPD patients without significant co-morbidities, with a mild to moderate functional impairment, admitted to the Department of Internal Medicine from January 1995 to December 2001, performing a 5-year mean follow-up (5-116 months) up to August 2004. After clinical stabilisation, an electrocardiogram and functional respiratory tests were obtained, allowing measurement of the QT interval and QTD, forced vital capacity (FVC), forced expiratory volume at 1 s (FEV1), inspiratory capacity, FEV1/FVC ratio, partial oxygen pressure and partial carbon dioxide pressure in arterial blood. RESULTS: At the end of the follow-up period, 81 patients were dead, 165 still alive; 36 died because of respiratory causes, 23 because of cardio-cerebrovascular events, 21 because of cancer (mainly lung cancer). A significant high incidence of sudden cardiac death was observed. QTD and QTcD showed a significant relationship with respiratory functional parameters. Maximal QT interval, QTcD and QTD appear to be independent predictors of all-cause, cardiovascular and respiratory mortality (relative risk 1.94, 3.22, 2.88, respectively). Age > 65 years, partial oxygen pressure < 60 mmHg and inspiratory capacity < 80% of the predicted value were the only other independent predictive parameters. CONCLUSIONS: Maximal QT interval, QTD and QTcD are independent predictors of mortality. A significant incidence of cardiac sudden death was observed. These findings suggest the need for a global and multidisciplinary risk assessment in COPD patients. Intriguing relationships between the QTD and functional respiratory parameters were also observed.

[Pneumonia: state-of-art and perspectives]. / Polmoniti: oggi e domani.

Pneumonia is a constellation of symptoms and signs in combination with at least one opacity on chest radiography. Pneumonia affects 4 million adults per year in the USA (with the highest rates at the extremes of age and during the winter months), about 20% of whom are admitted to a hospital for treatment; in fact pneumonia is the sixth leading cause of death and the most common lethal infectious disease with an annual cost of 10 billion. Pneumonia can be broadly categorized as: community acquired pneumonia, health -care associated, hospital acquired (nosocomial) pneumonia and ventilator-associated. These categories provide a rough guide as to likely pathogens, disease severity and treatment. In light of the significant morbidity and potential mortality of pneumonia, appropriate measures of prevention should be instituted as: smoking cessation, optimising the patient's nutritional status and current pneumococcal and flu vaccines. Because the microbiological etiology of pneumonia is frequently unknown, initial antibiotic therapy is often empirical. There are currently three sets of North American guidelines for empirical antibiotic treatment of pneumonia. Under current guidelines, patients are stratified with respect to where treatment is initiated, the presence of underlying cardiopulmonary disease and other modifying factors such as whether the patient is likely to be infected with drug resistant S. pneumoniae, gram negative enteric bacilli or P. aeruginosa.

[Celiac disease in the elderly: a case report]. / Malattia celiaca in età geriatrica: un caso clinico.

Celiac disease is not a negligible cause of malabsorption in the elderly. Diarrhea, loss of weight and abdominal discomfort are often absent so that celiac disease has indeed a subtle, paucisymptomatic, course in the elderly. More than 50% of the patients have extraintestinal symptoms; only 10-40% have typical complaints pointing to small-intestinal biopsy. Elimination of gluten from diet is the cornerstone of the therapy. A 73-year-old woman with hyporexia, loss of weight, depression, bowel abnormalities and progressive deterioration of her abilities in the instrumental activities of daily living was referred to our department. Antigliadin and antiendomysial antibodies were present. A subsequent small-intestinal biopsy of the second and third portion of duodenum showed subtotal villous atrophy, increase of intra-epithelial lymphocytes as well as hyperplastic glands (type III Marsh score). All these pathological findings were compatible with celiac disease diagnosis so that a gluten-free diet was then initiated.

QT dispersion and heart rate variability abnormalities in Alzheimer's disease and in mild cognitive impairment.

OBJECTIVES: To investigate the effect of cardiovascular changes (i.e., QT interval, QT dispersion (QTD), heart rate variability (HRV), and other cardiovascular measures) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI). DESIGN: Each subject underwent clinical and cognitive examination, a structural brain imaging study, echocardioDoppler, electrocardiogram (ECG), HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring. SETTING: Community population-based sample of patients admitted to an AD center for investigation of cognitive disturbances. PARTICIPANTS: Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy subjects (controls) matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled consecutively. MEASUREMENTS: Clinical and cognitive examination, structural brain imaging study, echocardioDoppler, ECG, HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring. RESULTS: QTD and QT corrected dispersion mean values were significantly higher in patients with AD than in patients with MCI and controls and higher in patients with MCI than in controls. HRV time and domain parameters were lower in patients with AD than in patients with MCI and controls. No difference in other cardiovascular measures was found. QTD and HRV were found to be significantly correlated with the degree of cognitive impairment. CONCLUSION: These findings support the presence of a peculiar neuroanatomic dysfunction in patients with AD and MCI that parallels the disease progression. These noninvasive parameters might prove to be powerful predictive tools in the worsening of cognitive function and mortality risk.

Homocysteine and disability in hospitalized geriatric patients.

Elevated total homocysteine (tHcy) concentrations have been found to be associated with cardiovascular disease and dementia in old age. The present study was performed to identify the prevalence of hyperhomocysteinemia (HHcy) and to analyze the association between tHcy concentration and sociodemographic characteristics, nutritional parameters, and cognitive and functional status in this sample of hospitalized geriatric patients. A total of 214 patients (77% females) 65+ years old admitted into an acute care geriatric ward of an internal medical department in the Northern Italy were studied. tHcy concentration was measured using a high-performance liquid chromatography with fluorescence detection (HPLC-F). Information about nutrition (body mass index [BMI], serum albumin, cholesterol, and transferrin) was collected on admission. Functional status was investigated with the Basic Activities of Daily Living scale (ADL) and the Instrumental Activities of Daily Living scale (IADL); cognitive and affective status were assessed by the Mini-Mental State Evaluation (MMSE) and the Geriatric Depression Scale (GDS). The mean tHcy concentration was 18.4 +/- 13.1 micromol/L; 74.2% of males and 68.9% of females had HHcy (> 12 micromol/L). Sixty-four percent of patients with normal serum vitamin B12 and folate concentrations had HHcy. Elevated tHcy concentrations were associated with older age, male gender, increasing serum creatinine, lower MMSE score, and disability. The mean tHcy concentration depended on the occurrence of different diseases. Patients affected by atherosclerotic diseases, such as ischemic heart diseases, cerebrovascular diseases, and dementia had higher mean tHcy concentration than those without diagnosed vascular diseases. In multivariate analysis, vitamin B12, folate, serum albumin, creatinine, and disability emerged as factors associated with tHcy, adjusted for age, gender, education, MMSE score, and atherosclerotic diseases. Our results suggest that the prevalence of HHcy in hospitalized patients is very high, even in subjects with normal cobalamin and folate concentrations. High Hcy concentration can be associated with functional impairment.

Effect of twelve-months therapy with oral ambroxol in preventing exacerbations in patients with COPD. Double-blind, randomized, multicenter, placebo-controlled study (the AMETHIST Trial).

The objective of this prospective, randomized, double-blind, placebo-controlled, multicenter parallel-group study was to evaluate the effect of long-term ambroxol treatment in preventing exacerbations of chronic obstructive pulmonary disease (COPD). Two hundred and forty-two outpatients with COPD defined by ATS criteria with value of FEV1 between > or =60 and 80% of predicted and history of one or more exacerbations in the previous year were recruited by 26 Respiratory Medicine Centers in Italy and treated for 1 year with one ambroxol retard capsule of 75 mg twice daily or placebo. The percentage of patients free from exacerbation at 6 months was 63% with ambroxol and 60% with placebo (p=0.366) and at 12 months 56% with ambroxol and 53% with placebo (p=0.363). In a subset of 45 patients with more severe baseline symptoms, ambroxol therapy was associated with a significant higher percentage of patients free from exacerbation compared to placebo: 63 vs. 38% (p=0.038). In conclusion, we did not find a significant difference between long-term ambroxol therapy and placebo, in preventing exacerbations in patients with COPD. In patients with more severe respiratory symptoms at baseline, however, we observed a significant difference in the cumulative exacerbation-free persistence between ambroxol and placebo, suggesting that long-term muco-regulatory therapy with ambroxol could be useful in highly symptomatic patients with COPD.

Cardiac arrhythmia monitoring during bronchial provocation test with methacholine.

STUDY OBJECTIVES: During a bronchial provocation test (BPT), the performance of maximal inspiratory-expiratory maneuvers, causing abrupt and marked shifts in intrathoracic pressure, may increase the risk of cardiac arrhythmias. Moreover, the inhalation of methacholine (MCh), a cholinergic agonist agent, could favor the development of unwelcome cardiovascular events, namely, cardiac arrhythmias. SUBJECTS AND METHODS: We studied the number and severity of cardiac arrhythmias by ECG-Holter monitoring before, during, and after BPTs with MCh challenge in a group of 46 consecutive nonselected subjects (28 men and 18 women) with clinical indications for BPT, without preexisting cardiovascular diseases, and not receiving arrhythmogenic drugs. The subjects performed a routine pulmonary function test (PFT), followed by BPT, during ECG-Holter monitoring. Determination of the serum potassium concentration, a baseline arterial blood gas analysis, and monitoring of oxyhemoglobin saturation also were performed. RESULTS: We found no significant increase in the number of supraventricular and ventricular arrhythmias during the performance of PFTs and of BPTs with MCh in the subjects, either with or without bronchial hyperresponsiveness (BHR). However, during the performance of BPTs, we observed a significant reduction in mean heart rate. CONCLUSIONS: Our results indicate that the performance of PFTs and BPTs with MCh does not increase the cardiac arrhythmogenic risk in subjects without cardiovascular diseases, as well as in those with BHR, suggesting that these tests are safe to perform in most subjects.

[Chronic obstructive lung disease. Systemic manifestations]. / Broncopneumopatia cronica ostruttiva. Le manifestazioni sistemiche.

Chronic obstructive lung diseases (COPD) are a complex disease state which not rarely can be associated with significant systemic manifestations. These alterations, though recognized since long time, are currently under extensive research, due to the increasing appreciation of their relevant negative role in the prognosis and health-related quality of life (Hr-QoL) of the COPD patients. The most clinically important are the decrease in body weight with loss of skeletal muscle mass (cachexia), osteoporosis, hypercapnia-induced peripheral edema, neuro-psychiatric disorders, such as oxygen-related cognitive impairment and depression, excessive polycytaemia and sleep disorders. Chronic systemic inflammation, oxidative stress and chronic hypoxia are believed as the main factors involved in the pathogenesis of systemic effects seen in COPD. Their adequate control with nutritional support, change of life-style and targeted pharmacological treatment is able to improve the prognosis and Hr-QoL among these COPD patients.

[Oxygen therapy. The new objectives: from survival to quality of life in correlation with state of health]. / Ossigenoterapia: i nuovi obiettivi. Dalla sopravvivenza alla qualità di vita correlata allo stato di salute.

The aim of this review is to give new insights on the effects, and consequently, on the prescription criteria of long-term oxygen therapy in chronic obstructive pulmonary disease (COPD), on the basis of the evidence accumulated in the recent past. Since the demonstration of the beneficial effect on survival offered by long-term oxygen therapy in severely hypoxemic COPD patients, further potential endpoints of this treatment in such subjects have been progressively evaluated. At present, knowledge of the favorable biochemical effects, especially on the skeletal muscles and brain tissue, and the widespread appreciation of the positive impact on the health-related quality of life parameters provided by long-term oxygen therapy in COPD patients should prompt us to reassess its indications in these subjects.

[Chronic obstructive pulmonary disease: brief review]. / Broncopneumopatia cronica ostruttiva: una breve rassegna.

The aim of this short review is to draw attention to chronic obstructive pulmonary disease (COPD), a clinical syndrome associated with emphysema and/or chronic bronchitis, in the light of the current scientific knowledge. The reason is that COPD has high socio-economic costs and the most recent projections place it among the first causes of mortality and morbidity due to chronic disease. The nosography, the clinical picture, including the systemic manifestations, the pathogenesis and the pathophysiological mechanisms, with special emphasis on expiratory flow limitation and pulmonary hyperinflation, leading to the most relevant symptoms and signs of the disease, have been reviewed. Finally a brief analysis of the costs due to the disease is also provided.