Incidence of deep venous thrombosis in patients with both Pulmonary Embolism and COPD.

BACKGROUND: There are no studies investigating populations of patients with both pulmonary embolism and chronic obstructive pulmonary disease (PE-COPD) with and without deep venous thrombosis (DVT). AIM OF THE STUDY: To define prevalence of DVT in COPD with PE and to compare characteristics of COPD patients who develop PE, with and without DVT. Secondly, we aimed to assess differences in the localization of PE among study groups.  METHODS. 116 patients with PE were enrolled in a retrospective study. Clinical data as well as echocardiographic and lower limb ultrasonography records were collected for all subjects. Subjects were divided into two groups according to the presence of COPD: Group 1, 54 patients with diagnosis of PE without COPD and Group 2, 66 patients diagnosed of PE with  COPD. Then, individuals of Group 2 were subdivided in two subgroups according to the presence (n=21) or absence (n=45) of DVT. RESULTS: 33% of patients with COPD and PE showed DVT.  These subjects had higher PaCO2 and ejection fraction (p<0.05 for all) and higher percentage of chronic renal failure and diabetes mellitus compared to those without DVT (p<0.05 for all). Moreover, in COPD-PE patients with DVT, the most frequent localization was proximal (54% of total), whereas COPD-PE patients without DVT showed a more frequent segmental localization (60% of total). No difference was found in clinical presentation and blood-chemistry tests. CONCLUSIONS: DVT was non-common in PE-COPD patients. Chronic renal failure, and type 2 diabetes mellitus are more frequent in PE-COPD patients with DVT, that showed a higher frequency of proximal localization, thereby indicating a greater risk of more severe clinical implications. Conversely, PE- COPD subjects without DVT showed a more frequent segmental localization and were less hypercapnic. PE should be taken into account in COPD with worsening of respiratory symptoms, also in absence of DVT.

The role of the nasal valve in patients with obstructive sleep apnea syndrome.

The nasal valve area has the minimal cross-sectional area of the upper airways. A problem at this level may easily induce impaired breathing. Obstructive sleep apnea syndrome (OSAS) is a common disorder. It has been reported that nasal obstruction may be associated with OSAS. The aim of this study was to investigate the role of nasal valve in a group of OSAS patients. Polysomnography was performed. Patients with bilateral valve incontinence had lower SaO2-nadir than patients with unilateral (or no) one. In conclusion, the present study demonstrates that a bilateral nasal valve incontinence is associated with more severe nocturnal respiratory pattern in patients with OSAS.

Internal nasal dilator in patients with obstructive sleep apnea.

The nasal valve area has the minimal cross-sectional area of the upper airways. Obstructive sleep apnea (OSA) is a common disorder. It has been reported that nasal obstruction may be associated with OSA. The aim of this study was to investigate whether the use an internal nasal dilator may be able to affect respiratory pattern in a group of patients with OSA. The use of internal nasal dilator was able to significantly reduce two relevant respiratory outcomes, such as the apnea-hypopnea index and the oxygen desaturation index, notably there was also a positive trend for the reduction of total sleep time with HbO2 <90%). Nas-air® was also able to significantly improve restorative sleep performance. In conclusion, the present study demonstrates that Nas-air® is a new internal nasal dilator potentially capable to significantly improve respiratory outcomes and sleep quality.

Internal nasal dilator in patients with obstructive sleep apnea syndrome and treated with continuous positive airway pressure.

The nasal valve area has the minimal cross-sectional area of the upper airways. Obstructive sleep apnea syndrome (OSAS) is a common disorder. It has been reported that nasal obstruction may be associated with OSAS. The aim of this study was to investigate whether the use an internal nasal dilator may be able to affect respiratory pattern in a group of patients with OSAS and treated with continuous positive airway pressure (CPAP). The use of internal nasal dilator significantly reduced the pressure of CPAP (from 11.4±1.5 to 10.8±1.5; p=0.012) able to resolve apnea episodes. In conclusion, this study showed that Nas-air® is a new internal nasal dilator potentially capable to significantly improve adherence and compliance to CPAP.

Voluntary lung function screening to reveal new COPD cases in southern Italy.

BACKGROUND: Underdiagnosis of COPD is a relevant issue, and most frequently involves patients at early stages of the disease. Physicians do not routinely recommend smokers to undergo spirometry, unless they are symptomatic. AIMS: To investigate the effectiveness of voluntary lung function screening in bringing to light patients with previously unknown COPD and to evaluate the relationships among symptoms, smoking status, and airway obstruction. METHODS: A voluntary screening study for COPD was conducted during two editions of the annual Fiera del Levante (2014 and 2015), an international trade fair in Bari. Subjects were eligible for the study if they fulfilled the following inclusion criteria: age ≥35 years, smoker/ex-smoker ≥5 pack-years (PYs), or at least one chronic respiratory symptom (cough, sputum production, shortness of breath, and wheezing). A free post-ß2-agonist spirometry test was performed by trained physicians for each participant using portable spirometers. Post-ß2-agonist forced expiratory volume in 1 second (FEV1):forced vital capacity ratio <0.7 was chosen to establish the diagnosis of COPD. Sensitivity, specificity, and negative and positive predictive values (NPVs and PPVs) of symptoms for the presence of obstruction were calculated. RESULTS: A total of 1,920 individuals were eligible for the study; 188 subjects (9.8%) met COPD criteria. There was a 10.4% prevalence of COPD in subjects with one or more symptoms who had never smoked or smoked ≤5 PYs. Among COPD patients, prevalence of symptoms increased in the presence of FEV1 <80%. COPD smokers were more symptomatic than smokers without COPD. Sensitivity and specificity in all subjects with one or more symptoms were 87% and 32%, respectively, whereas in smoker subgroups, sensitivity and specificity were 71% and 41% (≥5 PYs) and 74% and 35% (≥10 PYs), respectively. In all subjects, the presence of at least one symptom was associated with a low PPV for COPD of 11%, but a very high NPV (96%). These data did not change if the analysis was limited to smokers. CONCLUSION: Voluntary public lung function screening programs in Italy are effective, and may detect a large number of undiagnosed subjects with COPD in early stages. In our population, COPD symptoms had low specificity and PPV, even considering smokers only.