A valid option for asthma control: Clinical evidence on efficacy and safety of fluticasone propionate/formoterol combination in a single inhaler.

A good level of asthma control improves the quality of life of asthmatic patients and may prevent future risk in term of exacerbations and decline of pulmonary function. However, in a real-life setting, several factors contribute to generally low compliance to the treatment. A rapid-onset, long-lasting medication with few adverse effects may contribute to improve adherence to therapy, along with an effective patient education and a good physician-patient communication. Many clinical studies demonstrated the comparable efficacy of the new fluticasone propionate/formoterol (FP/F) combination in a single inhaler to other combinations of inhaled corticosteroids and ß2agonists and the superiority of FP/F as compared to its individual components. Also the safety profile of this combination was encouraging in all studies, even at higher doses. By effectively and safely targeting both airway inflammation and smooth muscle dysfunction, the two pathological facets of asthma, and allowing the patient to adapt dose strength, FP/F combination in a single device represents a valid option to improve asthma control in patients with different levels of asthma severity.

The role of the expiratory phase in obstructive sleep apnoea.

The role of the expiratory phase in obstructive sleep apnoea (OSA) is not well known. The aim of our study was to verify the contribution of expiratory narrowing to apnoea in a group of OSA patients by evaluating the effects of short-term treatment with continuous positive airway pressure (CPAP), intermittent positive pressure ventilation (IPPV) and bi-level positive airway pressure (BIPAP). We studied a selected group of 10 OSA patients whose therapeutic pressure level of CPAP was at least 10 cm H2O. During CPAP therapy the mean apnoea/hypopnoea index (AHI) and oxyhaemoglobin desaturation index (ODI) decreased from 64.8 to 6.3 (P < 0.001) and from 58.5 to 6.1 (P < 0.001), respectively and mean nadir SAO2 increased from 62.0 to 91.6 (P < 0.001). None of the patients reached optimal setting (elimination of snoring, reduction of apnoeas and non-apnoeic desaturation events at least to 15 or less per hour of sleep and maintenance of oxygen saturation approximately 90%) during IPPV and two patients did not tolerate final IPAP pressure levels. When a critical level of EPAP (BIPAP) was applied in the same night to these patients, optimal setting was reached in all subjects. During BIPAP, mean AHI decreased from 64.8 to 7.4 (P < 0.001); ODI decreased from 58.5 to 7.6 (P < 0.001) and nadir SAO2 increased from 62.0 to 91.2 (P < 0.001). Our study confirms the essential role of a critical level of EPAP in successful ventilatory treatment in OSA, thereby indicating, in agreement with few previous studies, the critical role of end of expiratory occlusion in OSA pathogenesis.

Clinical efficacy of azithromycin in lower respiratory tract infections.

A total of 51 patients with acute exacerbation of chronic bronchitis and pneumonia were enrolled: 27 treated with azithromycin (500 mg once a day for 3 days), and 24 with roxithromycin (150 mg every 12 hours for 7 days). The two regimens were equally effective, with clinical cure in 80% and 72% of patients respectively. Bacteriological eradication on day 19-23 was obtained in 7/11 cases (64%) and in 6/13 cases (46%) in the two groups, respectively. No side effects occurred in patients treated with azithromycin, while they occurred in the roxithromycin group (2 vomiting and 1 gastritis). Clinical and bacteriological efficacy, excellent tolerability, simplified dosage (single daily dose) and short-course (3 days) therapeutic regimen make azithromycin, in our experience, efficacious for the treatment of acute exacerbation of chronic bronchitis and community-acquired pneumonia.

Pollinex Parietaria (Bencard Parietaria), a new allergoid for treatment of patients sensitive to Parietaria pollen.

Two matching groups each of eleven patients suffering from allergy to Parietaria pollen were treated either with tyrosine-adsorbed glutaraldehyde-modified extract of Parietaria judaica pollen (Bencard Parietaria/Pollinex Parietaria) or with alum-adsorbed pyridine-extract (Alavac). The side effects of therapy were similar in both groups and were mostly local in nature. Nasal symptoms were significantly less at the end of treatment in the group of patients treated with Pollinex. P. judaica-specific IgG levels were significantly higher in patients following treatment with Pollinex. The majority of patients in both groups showed reduced nasal and/or skin sensitivity following therapy as measured by provocation testing. The results indicate that Pollinex Parietaria is an effective vaccine for the treatment of immediate hypersensitivity to Parietaria pollen.

[Asthma improved by acetylsalicylic acid]. / Asthme amélioré avec l'acide acétylsalicilique.

It is known that in some asthmatic subjects the administration of acetylsalicylic acid (ASA) and non-steroid anti-inflammatory drugs (NSAID) results in bronchodilatation. We have administered 750 mg of ASA intravenously to 100 asthmatic patients who were without history of ASA intolerance. Functional assessment (FEV) was performed under basal conditions and after 5, 10, 15, 30, 60, 90, 120, 150 and 180 minutes after the administration of ASA. 64 patients had no functional variations, 14 showed a percentage variation of less than 20% in FEV and 14 had a doubtful bronchodilatation (FEV 15-20%). The test was repeated after an interval of 1 week in those patients who showed an increase of 20% in FEV and only 2 confirmed the bronchodilatation. The pathogenesis of asthma that is improved by ASA is not entirely clear, but it is an extremely interesting model for study of the role of different mediators in the asthma syndrome.