Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
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Bronchial asthma is a chronic inflammatory disease of the airways. Several mediators are involved in the inflammatory process, including leukotrienes B4, C4, D4 and E4. These compounds promote bronchoconstriction, mucus hypersecretion, eosinophil infiltration, monocyte/macrophage activation, and smooth muscle proliferation. ⋯ However, the response rate for leukotriene modifiers approximates 70 to 80% suggesting that there are "responders" as well as "non-responders" for whom leukotrienes, as inflammatory mediators, may be less important. A 2 to 4-week therapeutic trial, with objective monitoring of response, may be a reasonable approach to initiating leukotriene modifier therapy. Additional controlled trials will be required to define more fully the role of these new drugs for long-term control and treatment of asthma.
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Ann. Ital. Med. Int. · Jan 1998
[Effectiveness of long-term ACE-inhibition on pulmonary diffusion and ventilation-perfusion ratio in chronic heart failure: correlation with physical performance].
Pulmonary dysfunction contributes to exercise intolerance in patients with chronic heart failure, and ACE-inhibition improves the functional capacity of these subjects. In this study, we investigated whether and how ACE-inhibitors affect pulmonary function and ventilatory response during exercise in chronic heart failure. Twenty patients with idiopathic dilated cardiomyopathy and left ventricular ejection fraction < 35% underwent pulmonary function tests and exercise evaluation with analysis of expired gases before and after 1 year of treatment with enalapril (10 mg bid). ⋯ A negative correlation was found between the variations in oxygen consumption and those in dead space to tidal volume ratio at peak exercise. We conclude that in patients with chronic heart failure, ACE-inhibition restores diffusing lung properties and improves ventilation-perfusion matching during exercise. In this syndrome, sustained reduction in gas exchange resistance is a fundamental therapeutic property of this class of drugs.