The relationship between asthma control and quality-of-life impairment due to chronic cough: a real-life study.

BACKGROUND: The objective of asthma therapy is to achieve optimal disease control and quality-of-life (QoL) improvements. Good correlation is reported between a composite evaluation of asthma control (the Asthma Control Test [ACT]) and QoL, with emphasis on asthma as a frequent cause of chronic cough and worsening of QoL due to chronic cough. OBJECTIVES: To investigate asthma control in real life and to evaluate chronic cough-related impairment of QoL in patients with different degrees of asthma control evaluated by the ACT. METHODS: Outpatients awaiting physician visits for asthma evaluation were asked to complete the ACT, the Chronic Cough Impact Questionnaire (CCIQ), and a rhinitis symptom score (Total Symptom Score [TSS] 5). RESULTS: A total of 122 patients (mean [SD] age, 44 [15] years; age range, 15-75 years; 61.5% female) were enrolled in the study, of whom 74% reported rhinitis in conjunction with asthma. Overall asthma control was substantially less than optimal (ACT mean score, 14) in 44% of patients. Asthma control correlated to a limited degree with the CCIQ among the total sample. In patients with asthma alone, the correlation between the ACT and the CCIQ was much improved. In patients with comorbid rhinitis, only those with significant symptoms (as determined by the TSS5) reported using rhinitis treatment; among these, no significant correlation between the ACT and the CCIQ was found. CONCLUSIONS: Asthma control in real life is less than optimal in substantially few patients. The importance of cough in asthma is highlighted by good correlation between cough and the ACT score in patients without comorbid rhinitis. In patients with comorbid rhinitis, cough appears related more to rhinitis than to asthma control. The combined use of the ACT and the CCIQ may be useful to improve asthma management, especially among patients in whom cough remains a prominent symptom.

The role of Pneumococcal vaccine.

Streptococcus pneumoniae pathologies represent a health problem of primary importance worldwide in terms of morbidity, mortality, and costs. S. pneumoniae is the main aetiological agent of bacterial pneumonia, and is frequently involved in bacterial meningitis, chronic obstructive pulmonary disease (COPD) exacerbations and upper airway pathologies. The high incidence, the level of morbidity and mortality due to pneumococcal pathology despite of adequate therapy, and the emergence of antibiotic-resistant strains emphasize the importance of an effective vaccine strategy against this bacterium. The present review proposes an analysis of current vaccine strategies and their efficacy, with particular stress on their effectiveness in preventing pneumonia.

Effects of the association of lansoprazole, clarithromycin and metronidazole for helicobacter Pylori eradication therapy, measured by the 13C Aminopyrine breath test.

BACKGROUND: Lansoprazole (LAN) is a proton pump inhibitor drug (PPI) metabolized by the P-450 liver cytochrome (CYP-450) system. LAN is used in association with antimicrobial agents in Helicobacter pylori (HP) eradication therapy. The 13C-Aminopyrine breath test (ABT) is a non-invasive tool exploring liver CYP-450 metabolic activity. Since pharmacological interactions may occur during PPI administration, we attempted to evaluate possible interference with liver CYP-450 activity during HP eradication therapy. MATERIAL/METHODS: Fourteen HP positive patients received LAN (30 mg b.i.d.), clarithromycin (500 mg b.i.d.) and metronidazole (500 mg b.i.d.) for one week. Prior to therapy, and at day 8, each patient underwent 13C-ABT. The 13CO2 concentration in breath samples was measured every 15 minutes from t0 to t120. Results are expressed as cumulative percentage of the administered dose of 13C recovered over time (% 13C dose cum), and as a percentage of the administered dose of 13C recovered per hour (% l3C dose/h). Comparisons were carried out by the Wilcoxon test. Data are presented as mean +/- SD. RESULTS: At day 8, mean ABT was no different from baseline values, both considering % 13C dose cum and% 13C dose/h at each sampling time (e.g.,% 13C dose cum120 which is the most expressive value of the parameters taken into consideration, baseline vs day 8: 10.88 +/- 3.81 vs 10.13 +/- 3.57). CONCLUSIONS: These results show that LAN administration and the concomitant use of antimicrobial drugs during HP eradication therapy do not seem to be associated with significant modifications in liver CYP-450 activity.

Can inclusion of serum creatinine values improve the Child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients?

BACKGROUND: The model for end-stage liver disease (MELD) score is a useful tool to assess prognosis in critically ill cirrhotic patients. However, its short-term prognostic superiority over the traditional Child-Turcotte-Pugh (CTP) score has not been definitely confirmed. The creatinine serum level is an important predictor of survival in patients with liver cirrhosis. AIMS: To evaluate and compare the short-term prognostic accuracy of the CTP, the creatinine-modified CTP, and the MELD scores in patients with liver cirrhosis. METHODS: CTP, creatinine-modified CTP, and MELD scores were calculated in a cohort of 145 cirrhotic patients. The creatinine-modified CTP was calculated as follows: we assessed the mean creatinine serum level and standard deviation (SD) of the 145 study patients, then assigned a score of 1 to patients with creatinine serum levels < or = to the mean, a score of 2 to patients with creatinine levels between the mean and the mean+1 SD, and a score of 3 to patients with creatinine levels above the mean+1 SD. The creatinine-modified CTP was then calculated by simply adding each patients' creatinine score to their traditional CTP scores. We calculated and compared the accuracy (c-index) of the three parameters in predicting 3-month survival. RESULTS: The creatinine-modified CTP score showed better prognostic accuracy as compared with the traditional CTP (P=0.049). However, the MELD score proved to be better at defining patients' prognosis in the short-term as compared with both the traditional CTP score (P=0.012) and the creatinine-modified CTP (P=0.047). The excellent short-term prognostic accuracy of the MELD score was confirmed even when patients with abnormal creatinine serum levels were excluded from the analysis (c-index=0.935). CONCLUSIONS: Adding creatinine values to the CTP slightly improves the prognostic usefulness of the traditional CTP score alone. The MELD score has a short-term prognostic yield that is better than what is provided by both the CTP and CTP creatinine-modified scores, even in cirrhotic patients who are not critically ill. The positive results obtained by using the MELD score were confirmed even after excluding patients with impaired renal function.