Abstract: Any therapeutic intervention needs consent from the patient, after have received information from the physician. This is often seen as a bureaucratic accomplishment but it could enhance therapeutic alliance. We propose to divide consent from information, offering a place in which doubts and emotions can be explored, with the assistance of a psychological interview. We believe that this new approach can enhance physician-patient relationship, with an improvement in patient satisfaction and a decrease of claims and complaints.
Abstract: A preliminary report. The objective of this study was to evaluate the possibility of reducing CPAP pressure levels and improving patient adherence to CPAP therapy by stiffening the soft palate tissue with a Pillar palatal implant. Many patients have difficulty complying with CPAP therapy if high levels of airway pressure are necessary for their therapy to be successful. Twenty-one patients (16 males and 5 females) with moderate to severe OSAHS treated with CPAP therapy underwent Pillar palatal treatment in an office-based procedure. The mean age was 49.6 +/- 11.2 years, mean baseline body mass index (BMI) was 31.4 +/- 3.2 Kg/m2. At 3 months follow-up a significant reduction of CPAP pressure levels was found. Mean CPAP pressure levels before and after Pillar application were 11.2 +/- 1.69 cm H2O vs. 9.3 +/- 2.5 cm H2O respectively (p < 0.001). The Pillar system is intended for use in stiffening the soft palate tissue, so this minimally invasive procedure, which was introduced to clinical practice as a treatment for the palatal component of OSAHS, could make it possible to reduce CPAP pressures and improve patient adherence to CPAP therapy. The preliminary results of this combined therapeutic approach indicate the safety and efficacy of the treatment of OSAHS. Further studies are needed to evaluate the long-term results.
Abstract: BACKGROUND: In patients with kyphoscoliosis, long-term mechanical ventilation improves chronic alveolar hypoventilation during spontaneous breathing, improves quality of life, decreases the need for hospitalization, and improves survival. In these patients respiratory infection can precipitate acute respiratory failure (ARF) that requires hospitalization. OBJECTIVE: To study the possibility of home treatment of infection-related ARF in kyphoscoliotic patients on long-term mechanical ventilation. METHODS: During a period of 4 years, 8 kyphoscoliotic patients (3 women, 5 men, mean +/- SD age 61 +/- 10 y, mean Cobb angle 84 +/- 7 degrees ), who had been using overnight mechanical ventilation (delivered by either volume-limited [4] or pressure-limited [4] ventilators) for 31 +/- 32 months, developed infection-related ARF. Seven patients agreed to be treated at home, with an increase of the daily duration of mechanical ventilation to > 20 hours, and antibiotics. Blood oxygen saturation was monitored via pulse oximetry during mechanical ventilation and overnight, to determine whether to add or increase supplemental oxygen. A nurse, a general practitioner, and a chest specialist made scheduled visits to each patient. RESULTS: All 7 patients were successfully treated at home. In 2 patients supplemental oxygen flow was slightly increased. Two patients who had not previously been receiving supplemental oxygen received supplemental oxygen for a few days. The patients progressively decreased the daily duration of mechanical ventilation, according to their ability to breathe comfortably without mechanical assistance, under the supervision of the medical staff, and they all returned to their baseline (pre-ARF) condition in 4 weeks. CONCLUSION: In kyphoscoliotic patients on long-term mechanical ventilation, home treatment of infection-related ARF is possible and effective, provided there is adequate collaboration by the patients and their relatives, and staff well-trained in mechanical ventilation and other aspects of the home care of these patients.
Abstract: BACKGROUND: This study estimated the healthcare resource utilisation and costs of chronic obstructive pulmonary disease (COPD) patients, staged by severity, in the Italian pneumology departments (PDs). METHODS: The project was a multi-centre observational study conducted in 11 Italian PDs throughout the country. A total of 268 patients were recruited and followed prospectively for 1 year. For the purpose of analysis, patients were divided into four groups according to the severity at onset: mild COPD (stage I)-postbronchodilator FEV1/FVC <70% and FEV1 >or=80% of predicted; moderate COPD (stage II)-postbronchodilator FEV1/FVC <70% and 50% <or=FEV1< 80% of predicted; severe COPD (stage III)-postbronchodilator FEV1/FVC <70% and 30% <or=FEV1 <50% of predicted; very severe COPD (stage IV)-postbronchodilator FEV1/FVC <70% and FEV1 <30% of predicted, or clinical signs of either respiratory or cardiac failure. RESULTS: Subgroups differed significantly in the main demographic and clinical variables. Broadly, higher severity was associated with older age, longer disease duration, and more frequent exacerbations. Patients with severe COPD used more resources for almost all services than those with mild and moderate forms. The annual average cost per patient was 3040.2 euros (1046.7 euros for mild, 2319.0 euros for moderate, 3572.1 euros for severe and 5033.3 euros for very severe forms). CONCLUSIONS: This study offers some information on the healthcare costs of COPD induced by PDs in Italy, potentially useful for decision-making in the health care services. Resources and costs rose significantly with disease severity.
Abstract: The antitussive compound Levodropropizine (LD) is active in animal bronchoconstriction induced by histamine and capsaicin and in man protects from bronchoconstriction induced by capsaicin. The primary objective of this study was to evaluate the mechanism of action of LD given at 60 mg t.i.d. as oral drops, for 8 days by means of specific bronchial challenges (allergens) and of aspecific challenges acting via different receptors and fibers (i.e. metacholine via cholinergic receptors and ultrasonically nebulized distilled water (UNDW) via histamine and neuropeptide release). The study design is randomized, double-blind, cross-over versus placebo in 30 allergic asthmatic patients. Baseline bronchial tone and bronchoconstrictor response to metacholine (MCh) were not modified by active treatment nor by placebo. On the contrary, in airway responsiveness to UNDW, the active treatment showed an antagonist effect against induced bronchoconstriction of 59% [activity ratio (AR) as antilog = 0.41; 95% confidence interval 0.35-0.54; p < or = 0.05] in comparison to no effect for placebo. Similarly, in airway responsiveness to specific allergen, active treatment antagonized the bronchoconstrictor effect of grass pollen by 83% and of various allergens (dermatophagoides and grass pollen) by 72%, i.e. AR of 0.17 (95% confidence interval 0.045-0.65; p < 0.01) and of 0.28 (95% confidence interval 0.07-1.04; p < 0.05), respectively. No antagonist effect was evident with placebo at all times. Besides inhibiting cough, LD is also partially effective in inhibiting bronchial hyperreactive response against specific allergen and UNDW bronchoconstriction. Hence, LD might act by partly inhibiting histamine and neuropeptide release.
