Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Monaldi Arch Chest Dis · Apr 2000
ReviewBronchiolitis obliterans syndrome after lung transplantation: medical treatment.
Obliterative bronchiolitis (OB) or the clinical correlate bronchiolitis obliterans syndrome (BOS) is the main cause of late morbidity and mortality after heart-lung and lung transplantation. Although several risk factors for the development of OB/BOS have already been identified, very effective preventive therapy remains Utopian, although there has been much improvement in recent years. ⋯ The current treatment options, however, are rather anecdotal and mostly single-centre experiences. Therefore, multicentre studies are definitely needed to try to identify the most appropriate drug regimen either to prevent and to treat obliterative bronchiolitis/bronchiolitis obliterans syndrome.
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Monaldi Arch Chest Dis · Apr 2000
ReviewPathology of emphysema in chronic obstructive pulmonary disease.
Emphysema is an almost constant finding in the lungs of chronic obstructive pulmonary disease patients. Several types of emphysema are recognized by pathologists, but only the centrilobular (CLE) and panlobular (PLE) emphysemas are found in association with smoking. ⋯ In contrast, in PLE: 1) the destruction of the lung is even; 2) the small airways appear less narrowed and less inflammed than in CLE; 3) the compliance of the lung is increased and related to the extent of the emphysema; and 4) the decrease in flow is related mainly to the loss of elastic recoil and not to the abnormalities in the airways. The authors would propose that centrilobular emphysema and panlobular emphysema are distinct entities, centrilobular emphysema an airborne disease related to airway reactivity, panlobular emphysema a blood-borne disease related to abnormalities in lung protective mechanisms against inflammatory insults.
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The relationship between asbestos exposure, lung cancer and asbestosis is reviewed. Studies have demonstrated the risk of lung cancer to be raised in asbestos-exposed workers whether asbestosis is present or not. ⋯ Consensus opinion recommends that attribution of lung cancer to asbestos exposure should be based on clinical and occupational histories. The risk of lung cancer in those who both smoke and are exposed to asbestos is increased in a multiplicative way, putting subjects at very great risk.
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Monaldi Arch Chest Dis · Apr 2000
Respiratory responses to chemical stimulation in patients with obstructive sleep apnoea.
Chemical control of breathing in obstructive sleep apnoea (OSA) patients has been studied by many authors. The results of previous studies, especially those dealing with hypoxic drive, are discordant. Respiratory responses were studied during hypercapnic and hypoxic stimulation in a group of 37 normocapnic patients with OSA during wakefulness. ⋯ The mean P0.1 response in OSA patients was higher but did not differ significantly from those in the control group (delta P0.1/delta Sa,O2) 0.43 +/- 0.38 versus 0.35 +/- 0.12 cmH2O.%-1). The results demonstrated that respiratory responses to chemical stimulation in awake normocapnic patients with obstructive sleep apnoea were in the normal range, similar to those in control obese subjects. During hypoxic stimulation some of them had increased ventilatory (35%) and mouth occlusion pressure (16%) responses.
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All patients with bronchial asthma are at risk of developing severe episodes of airway narrowing that do not respond to the usual medical treatment, a life-threatening situation referred to as status asthmaticus. In some cases, ventilatory failure occurs, necessitating mechanical ventilation to support gas exchange and to unload the respiratory muscles, giving time for other therapeutic interventions to improve the functional status of the patient. Mechanical ventilatory support poses additional risks to the patients, due to interaction between the pathophysiology of the disease and the process of mechanical ventilation. ⋯ Setting the ventilator, such as to minimize the dynamic hyperinflation, is a key point in the management of mechanically ventilated patients with status asthmaticus. Strategies to reduce dynamic hyperinflation, such as hypoventilation (permissive hypercapnia), increase of expiratory time and promotion of patient-ventilator synchrony are mandatory and significantly decrease the morbidity and mortality of the disease. Continuous monitoring of the effectiveness of these strategies, as well as the functional status of the patient, is crucial in order to limit complications associated with mechanical ventilation and to identify the time that weaning can start.