Sharing knowledge is the key to success in a patient-physician relationship: how to produce a patient information leaflet on COPD.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, and its prevalence is rising. In Italy, respiratory diseases are the third most common cause of death. The aim of the study is to produce a patient information leaflet (PIL) designed to educate patients about COPD in accordance with the best recommendations based on evidence and guidelines for the production of good quality written information, and to evaluate the impact of this intervention on the patients' knowledge of COPD. METHODS: The study was conducted in the Department of Chest Diseases of the Cardarelli Hospital, Naples, Italy. A total of 166 patients admitted with a diagnosis of COPD participated in the study. Patients were asked to answer 10 multiple-choice questions compiled to assess their knowledge of the disease and then to read the leaflet. Two days later they were asked to complete the questionnaire again to assess their post-intervention knowledge. Analysis of the data was performed using SPSS version 15.0. RESULTS: After reading the leaflet, a statistically significant increase in the proportion of correct responses was noted (p < 0.001 by Wilcoxon signed rank test). Patients had retained the knowledge gained at the one year followup (p < 0.05 by Cochran's Q test). CONCLUSIONS: An educational intervention directed at adults with COPD had a positive impact on the patients' knowledge of COPD and this effect is long lasting.

GENEBU Project. Equipment and drugs used for home nebulizer therapy in Italy.

The GENEBU Project is an open, observational survey evaluating home nebulizer practices in Italy. It consecutively included patients who were referred to one of the 27 participating chest clinics from May to December 1999 and who had been using a home nebulizer in the previous six months. The information source was a self-administered questionnaire compiled by the enrolled subjects. We collected 1257 questionnaires. The nebulizer equipment was heterogeneous, with at least 92 different models. Jet nebulizers were 90% of the total; 53% of these had a glass reservoir. Almost 80% of the patients selected the nebulizer themselves without any medical advice. In addition, most patients (> 80%) did not receive information on both the interface system and the optimal fill volume of the nebulizer. Corticosteroid nebulisation was widespread (74%), for both occasional and regular daily use, for both acute and chronic diseases from upper to lower airways. Beta 2-agonist (55%), anticholinergic (37%), mucolytic (32%) drugs were also often nebulised. More than 90% of patients mixed some active drugs. We conclude that the nebulizer equipment for home aerosol therapy was very heterogeneous and, probably, not always utilised at its best in Italy. The mixing of drugs and the widespread use of corticosteroids were peculiarities of home nebulizer therapy in Italy.

Prevalence, age distribution and aetiology of bronchiectasis: a retrospective study on 144 symptomatic patients.

The incidence of bronchiectasis (BCT) has probably decreased in developed countries in recent years, but reliable statistical data on its occurrence are still lacking. The aim of the present study was to retrospectively evaluate the prevalence, age distribution and aetiology of BCT, diagnosed in a selected series of symptomatic patients of a Western country by using bronchography. The authors analysed the main known predisposing and associated conditions (PACs), and the occurrence and age distribution of BCT in 144 consecutive patients who underwent bronchological examination (fibreoptic bronchoscopy and bronchography) in the years 1987-1994 because of recurrent purulent bronchitis and/or haemoptysis. The overall prevalence of BCT was 34% (49/144); its age distribution was: 17.2% (0-10 yrs), 43.7% (11-20 yrs), 38% (21-30 yrs), 37.5% (31-40 yrs), 33.3% (41-50 yrs), 40% (51-60 yrs), and 20% (61-70 yrs). Thirty-one PACs were found in 29/144 patients of the whole study group. The prevalence of BCT was significantly higher in the subgroup of 29 patients with PACs than in the subgroup of 115 patients without PACs (75.9% versus 23.5%; p < 0000001). The aetiology of BCT was mainly unexplained, as it was only possible to detect 24 PACs in 22/49 patients with BCT (44.9%): congenital, genetic and immune disorders (eight), localized airways obstructive diseases (five), pulmonary infections (three), bronchial asthma (two), pulmonary lobar fibrosis (two), ulcerative colitis (two), dermatomiositis (one), and toxin inhalation (one). The authors conclude that bronchiectasis still occurs in a large percentage of symptomatic patients of a developed country in the post-antimicrobial era, especially in the second to sixth decades, as well as in the presence of predisposing and associated conditions; its aetiology remains unknown in more than half of cases.

Use of altered peptide ligands to modulate immune responses as a possible immunotherapy for allergies.

Allergies are dramatically increasing in prevalence, and the management of these diseases is a heavy burden on the health-care systems of developed countries. In recent years, many efforts have been made to improve the therapy of allergies and to develop new approaches for immunotherapy. Here we briefly review the use of peptides to modulate T-cell responses to allergens. We focus mainly on the possibility of using altered peptide ligands (APLs), i.e., peptides tailored on immunodominant T epitopes and bearing a single amino-acid substitution, as a tool to modulate immune responses to allergens. These peptides may be recognized by the specific T cells triggered by the agonist peptides, but they are unable to elicit T-cell responses; thus, they could be ideal candidates to modulate immune responses to allergens. The availability of these peptides could allow new approaches for immunotherapies.

Use of antagonist peptides to inhibit in vitro T cell responses to Par j1, the major allergen of Parietaria judaica pollen.

Antigenic peptides with substituted side chains inhibit immune responses to a number of recall Ags from infectious agents in vitro. Here we show that the same strategy can be applied to peptides derived from a pollen protein, the major allergen of Parietaria judaica(Par j1), a plant responsible for most allergenic sensitization in the southern Mediterranean area. Three T cell lines responding to Par j1 protein were used to identify a stimulatory peptide. Two different monosubstituted altered peptide ligands (APL) were identified that bound to the HLA-DR of the responders, did not stimulate the T cell lines on their own, and decreased the response to subsaturating amounts of the unmodified stimulatory peptide. Most important, these APL were able to inhibit the response of these cell lines to intact Par j1 protein. A third monosubstituted peptide bound to the HLA-DR but did not show inhibitory activity. The two APL had a lower affinity than the unsubstituted peptide for the HLA-DR. The last two observations make MHC blockade an unlikely explanation for the observed effect. These results indicate the action of a specific peptide-mediated antagonism that may be useful in controlling the T cell component of an allergic response.

Antigenic activity of nonpollen parts (leaves and stems) of allergenic plants (Parietaria judaica and Dactylis glomerata).

In patients with respiratory allergy to pollen it is common to correlate the onset, duration and intensity of clinical symptoms with the count of atmospheric allergenic pollen grains. Pollen counts, however, may not reflect the total airborne allergen exposure since previous data suggest that pollen allergens may also be carried in microaerosol suspensions. These microdroplets may penetrate deeply into the airways, where pollen grains are too large to penetrate, eventually inducing asthma. The origin of these allergenic aerosols is still uncertain. We investigated whether antigenic activity is present in vegetative parts of allergenic plants. We have used extracts from leaves and stems of Parietaria judaica and Dactylis glomerata to evaluate patients with allergic sensitization to pollen allergens of these plants (19 grass-sensitive patients and 23 Parietaria sensitive). By using skin prick testing and RAST to stem and leaf extracts other than pollen extracts we observed that most patients sensitive to grass or Parietaria pollen had small responses to extracts of stem or leaf. We conclude that allergenic components are present throughout most of Parietaria judaica and Dactylis glomerata plants, most highly concentrated in the pollen but present in the leaves with a trace in the stems.

An in vitro study of the possible interaction between human platelets and cephalosporins.

The effects in vitro of four cephalosporins (ceftazidime, cefuroxime, cefotaxime and ceftriaxone) on adenosine diphosphate-induced human platelet aggregation were investigated. Ceftazidime-induced inhibition of platelet aggregation was significant only at a final concentration of 1 mg/ml, whereas ceftriaxone-induced inhibition of platelet aggregation was also significant at a final concentration of 0.01 mg/ml. Cefotaxime and cefuroxime were less active than ceftriaxone.

The effects of cefonicid on the pharmacokinetics of a once-a-day theophylline formulation.

The authors have explored the effects of cefonicid on the steady-state pharmacokinetics of a new sustained-release theophylline formulation in 12 adult patients suffering from chronic obstructive lung disease, by comparing the pharmacokinetic data obtained following four days of medication with theophylline alone with those found at the end of seven days of combined treatment with the same theophylline preparation plus cefonicid. Blood theophylline levels were assessed in duplicate by polarized immunofluorescence with a TDx analyser. Theophylline kinetics were totally unaffected by simultaneous cefonicid treatment, showing that the two drugs may be administered together without any need for adjustment of the theophylline dosage.