Effects of omalizumab in severe asthmatics across ages: A real life Italian experience.

BACKGROUND: This retrospective study aimed at evaluating long-term effects of Omalizumab in elderly asthmatics in a real-life setting. METHODS: 105 consecutive severe asthmatics (GINA step 4-5; mean FEV1% predicted:66 ± 15.7) treated with Omalizumab for at least 1 year (treatment mean duration 35.1 ± 21.7 months) were divided into 3 groups according to their age at Omalizumab treatment onset: 18-39, 40-64 and ≥ 65 years. RESULTS: Comorbidities, number of overweight/obese subjects and patients with late-onset asthma were more frequent among older people. A similar reduction of inhaled corticosteroids dosage and SABA on-demand therapy was observed in all groups during Omalizumab treatment; a similar FEV1 increased was also observed. Asthma Control Test (ACT) improved significantly (p < 0.001) in the three groups, increasing from 15 [IQR:12-18] to 24 [IQR:22-25] in younger subjects, from 14 [IQR:10-16] to 21 [IQR:20-23] in the 40-64-year-group and from 15 [IQR:12-16] to 20 [IQR:18-22] in elderly patients where improvement was lower (p = 0.039) compared to younger people. Asthma exacerbations decreased significantly after Omalizumab but the percentage of exacerbation-free patients was higher in younger people (76.9%) compared to middle aged patients (49.2%) and the elderly (29%) (p = 0.049). After Omalizumab treatment, the risk for exacerbations was lower in subjects aged 40-64 (OR = 0.284 [CI95% = 0.098-0.826], p = 0.021) and 18-39 (OR = 0.133 [CI95% = 0.026-0.678], p = 0.015), compared to elderly asthmatics. Also, a significantly reduced ACT improvement (ß = -1.070; p = 0.046) passing from each age class was observed. CONCLUSION: Omalizumab improves all asthma outcomes independently of age, although the magnitude of the effects observed in the elderly seems to be lower than in the other age groups.

[Neuroleptic malignant syndrome. A case report]. / Sindrome maligna da neurolettici. Caso clinico.

A lethal case of neuroleptic malignant syndrome in a 42-year-old woman with a history of bipolar psychiatric disorder under treatment with haloperidol is reported. The patient, hospitalized many times in the past for psychiatric treatment, was then admitted for treatment of a relapse of the disease during a exceedingly hot period. The patient complained of hallucinations and stomach ache. It was necessary to increase the dose of haloperidol to 2 mg, 3 times a day, and to give a single dose of perphenazine enanthate 100 mg. All tests proved normal except for CPK 274 U/l and urea 14 mg/dl. On hospital day 2, went into coma with high temperature, diaphoresis, polyuria, leucocytosis (WBC count 15,440 U/mm3), urea 7 mg/dl, LDH 425 U/l, Na 114 mEq/l, K 2.5 mEq/l. The rapid improvement following hypertonic saline treatment encouraged a diagnosis of water intoxication. On hospital day 7, continuing with the haloperidol treatment, the patient developed a high temperature and deterioration torpor. On hospital day 9, the patient went back into coma with temperature over 40 degrees C (104 degrees F), with fine myoclonia most visible on the face, and muscular rigidity. The CPK, rose from 5,169 to 28,060 U/l in less than 24 hours; the serum myoglobin rose to 41,000 ug/l. On day hospital 11 developed renal, cardiac and respiratory insufficiency. The picture deteriorated and dantrolene was no longer of use in controlling the fever. Then with a fever of over 42 degrees (108 degrees F) and the CPK at 50,000 the patient died. The autopsy demonstrated widespread rhabdomyolysis, a picture of widespread aspecific shock in all organs and picture of myoglobin-induced tabular necrosis of the kidney.

Tracheal bronchus associated with bronchiectasis. Case report.

The authors describe a case of ectopic tracheal bronchus (TB) in a 42 years old female. This TB presented bronchiectasis determining various episodes of inflammation in the pulmonary district depending on it. The result of those episodes was atelectasis and fibrotic alterations of the superior right lobe. The mean diagnostic procedure was bronchography. Surgical treatment was performed (superior right lobectomy) with a good result controlled in a 5 year follow-up.

[Pulmonary involvement in a case of CREST syndrome]. / Interessamento polmonare in un caso di sindrome CREST.

The paper describes the clinical, X-ray and functional aspects of lung involvement in a case of CREST syndrome, a variant of systemic sclerosis. The characteristic signs of the disease were associated in this patient with lung involvement in the form of widespread interstitial fibrosis complicated by the presence of alveolar cysts in the lower lobes. The state of severe chronic respiratory insufficiency was the most unfavourable factor in the prognosis for this patient, in particular in the light of the disappointing response to corticosteroid therapy.

[Cytological exam of the pleural fluid in the diagnosis of neoplastic pleuritis. Cases contribution]. / L'esame citologico del liquido pleurico nella diagnostica delle pleuriti neoplastiche. Contributo casistico.

The relevance of cytologic procedures in the diagnosis of malignant pleural effusions is evaluated. Pleural fluid sample obtained from 48 patients with malignant disease (39 metastatic tumors, 9 mesotheliomas), were studied to search for cancer cells. The results were: 32 (66.6%) patients had a cytologic diagnosis of malignant pleural effusions; 16 malignant specimens were not confirm by pleural fluid cytologic analysis. In our experience the cytologic diagnosis of malignant pleural effusions are more frequent in metastatic disease, especially in lung cancer.

[ARDS in MOFS (multiple organ failure syndrome). How to direct the therapy? A case report of MOFS in AIDS]. / ARDS componente della MOFS (multiple organs failure syndrome) come orientare la terapia? Descrizione di MOFS in AIDS.

A young AIDS patient was admitted to the Intensive Therapy ward of our hospital with ARDS. The case raised the question of how medical and nursing personnel should face the problem of "suitable treatment for a terminally ill patient". Therapy was based on invasive methods such as mechanical ventilation and the insertion of catheters to monitor vital parameters. The evolution of ARDS in MOFS revealed the difficulty of sustaining vital parameters and avoiding pluriorganic damage.

[Operative central unit for coordinating the emergencies-urgencies department. Proposal for a mini-unit to solve the problems caused by the relation between volunteer associations and the public structure]. / La centrale operativa di coordinamento nel dipartimento della emergenza-urgenza. Proposta di una "mini-COC" per la risoluzione dei problemi di rapporto tra le associazioni del volontariato e la struttura pubblica.

One of the most important problems, of very difficult solution, in organizing an A/E department is to co-ordinate the emergency in the field. This peculiar task is carried on by an operative central station, the core of an A/E Dept. The organizer in Arezzo try to find out the efficiency and a cost benefit ratio of this central station and try to jump over an historical hindrance to operate by mutual consent with voluntary service. This seems to be possible with the technological development of telephone system and broadcast system. Staff, technical qualifications, connections, reception, modulation, sorting out of different calls are discussed in conjunction with problems of health education concerning the operative central station that coordinates A/E Dept in Arezzo.

[Survey carried out by land of the intervention time for territorial health care]. / Rilevazione via terra dei tempi di intervento per il soccorso sanitario territoriale.

While organizing the Catchment area of A/E Department in Arezzo, a recording of intervention time of prehospital care system (primary transport) was made by land. The analysis recorded that one third of the field on the Catchment area of the A/E Dept was in a red dangerous zone reachable in 15 minutes and more. Such analysis confirmed the importance of local operation bonds all for a correct redistribution of ambulances in the Catchment area and a rational choice of vans and staff suitable for an advanced life support only where and when really necessary.

[Evaluation of the bronchial tonus, basal and following bronchodilators, in subjects with allergic rhinitis]. / Valutazione del tono bronchiale, basale e dopo broncodilatatore, in soggetti con rinite allergica.

Data emerging from forced, basal and postbronchodilator expirograms in asymptomatic allergic rhinitis patients have been compared with those from a group of normal controls. Basal averages and average percentage variations after the bronchodilator show that MEF 75, FEF 25-75 and, to a lesser extent, FEV1 are able to differentiate atopic rhinitis patients from the normal. Comparison between percentages in patients arbitrarily considered bronchodilator positive in the two groups reveals significant differences in MEF 75 and FEF 25-75 but not in FVC and FEV1. Atopic rhinitis patients feature increased basal bronchial tone largely maintained by latent bronchospasm. Measurement of forced, basal and postbronchodilator flows can supply useful indications for the study of allergic rhinitis patients.

Breathing pattern assessment in normocapnic and hypercapnic patients in chronic obstructive pulmonary disease.

Thirty-six patients, 24 normocapnic (mean age +/- SD: 60 +/- 10) and 12 hypercapnic (mean age +/- SD: 64 +/- 9) were compared with a control group (10 volunteers, mean age +/- SD: 46 +/- 8) for the following patterns of respiratory drive and respiratory timing: (1) mean inspiratory flow (Vt/Ti); (2) mouth occlusion pressure 100 ms after the onset of inspiration (P 0.1) and minute ventilation (Ve); (3) inspiratory duty cycle Ti/Tt). The data suggest COPD "respiratory patterns" which may be characterized by the following features: (1) increased mean inspiratory flow (Vt/Ti); (2) increased P 0.1 (in absolute values), P 0.1/Ve and P 0.1/Vt/Ti; (3) reduction in inspiratory duty cycle (Ti/Tt). Changes are more evident in inspiratory duty cycle among hypercapnic pts. When respiratory obstruction becomes worse and hypercapnia appears, the Ti/Tt decrease could be explained by a reduction in diaphragm muscle work, that can prevent the failure of diaphragmatic contractility.

[Study of the respiratory profile in symptomatic asthma patients]. / Studio del profilo ventilatorio negli asmatici in fase sintomatica.

The following indexes were measured in 10 normal volunteers and 25 symptomatic asthmatic patients: --tidal volume (VT), breathing frequency (f), minute ventilation (Ve); --forced expiratory volume in 1 s. (FEV1), vital capacity (VC), residual volume (RV) and partial pressure of 02-C02 in arterial blood (Pa02-C02); --mean inspiratory flow (VT/Ti); --inspiratory duty cycle (Ti/Tt). Our data suggest a "ventilatory pattern" of the asthmatic patients may be characterized by the following features: --increasing of tidal volume (VT) and minute ventilation (Ve); --increasing of the mean inspiratory flow (Vt/Ti); --reduction of inspiratory duty cycle (Ti/Tt). This suggest that the breathing pattern may help to differentiate symptomatic asthmatic patients form patients with chronic obstructive pulmonary disease who have similar degrees of pulmonary hyperinflation, but breathe with faster rates and slightly elevated tidal volumes.