Francesco De Blasio

Quality standards for the management of bronchiectasis in Italy: A national audit

Although historically considered a neglected disease, bronchiectasis has become a disease of renewed interest over recent decades in light of an increase in prevalence and a substantial burden on healthcare systems [1–3]. In 2010, the British Thoracic Society (BTS) published guidelines on the management of bronchiectasis in adults, along with specific quality standards [4, 5]. To date, these represent the only quality standards available in Europe. These have been tested over a number of years in the UK with progressive improvements in the standard of care [6]. No national guidelines are available in Italy and no indications on which guideline should be followed have been given by the Italian Society of Respiratory Medicine (SIP). There are limited published data on the quality of bronchiectasis care in Europe outside of the UK. The BTS standards have not been tested in continental Europe or in Italy, where information on characteristics and management of bronchiectasis patients are lacking. The majority of the quality standards for the management of bronchiectasis in adults are not met in Italy http://ow.ly/YKMpU

An observational study on cough in children: epidemiology, impact on quality of sleep and treatment outcome.

BackgroundCough is one of the most frequent symptoms in children and is the most common symptom for which children visit a health care provider.MethodsThis is an observational study on acute cough associated with upper respiratory tract infection (URTI) in children. The study evaluates the epidemiology and impact of cough on quality of sleep and childrens activities, and the outcome of cough with antitussive treatments in pediatric routine clinical practice. Study assessments were performed through a pediatric cough questionnaire (PCQ), developed by the Italian Society of Cough Study. A total of 433 children visited by family care pediatricians for acute cough due to a URTI were enrolled in this study, with mean age of 6.1 years (SD 3.6). Cough type, duration, severity and frequency, cough impact on sleep disturbances of children and parents and on school and sport activities were assessed at baseline. In a subset of 241 children who were either treated with antitussive drugs (levodropropizine n = 101, central antitussives n = 60) or received no treatment (n = 80), the outcome of cough after 6 days was analyzed in terms of resolution, improvement, no change, or worsening. Descriptive analysis, χ2 test, and multivariate analysis with stepwise logistic regression were performed.ResultsCough disturbed sleep in 88% of children and 72% of parents. In children treated with cough suppressants, the duration, type, intensity, and frequency cough were similar at baseline in the two groups respectively treated with levodropropizine and central antitussives (cloperastine and codeine). Both levodropropizine and central drugs reduced cough intensity and frequency. However, percentage of cough resolution was higher with levodropropizine than with central antitussives (47% vs. 28% respectively, p = 0.0012).ConclusionsAcute cough disturbs sleep in most children and their parents. Both levodropropizine and central antitussives reduced cough intensity, with levodropropizine producing a higher cough resolution rate.

Current best practice in pulmonary rehabilitation for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a chronic condition that negatively affects several patient-centered outcomes. Among these, exercise capacity, dyspnea, and quality of life are the most relevant. In this article, factors contributing to exercise limitation, increase in exercise-induced dyspnea, quality of life deterioration, and other pathophysiological aspects in patients with COPD are analyzed in detail. Pulmonary rehabilitation (PR) is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. PR has been clearly shown to induce favorable and long-lasting effects on all patient-centered outcomes. In addition, PR appears to have positive (even if not conclusively demonstrated) effects on other important outcomes in patients with COPD: number and severity of exacerbations, healthcare resource utilization, and survival. The organization of PR treatment, its components, outcome assessment, and future directions are discussed in light of the most robust scientific evidence.

A prospective multicentric study of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease and different clinical phenotypes.

Background: Recently, it has been proposed that different clinical phenotypes can be recognized in patients with chronic obstructive disease (COPD), namely predominant airway disease or parenchymal destructive changes. Objectives: The aim of this prospective multicenter study was to evaluate whether these two phenotypes may influence outcomes following a pulmonary rehabilitation program (PRP). Methods: We have prospectively evaluated 364 consecutive COPD patients (70 ± 8 years, 76.3% males) admitted to a standard hospital-based PRP in 6 Italian centers. According to their phenotype, the study cohort was divided into two groups: patients with airway obstructive (group 1, n = 208) or parenchymal destructive COPD (group 2, n = 156). Before and after PRP, values of 6-min walking distance, perceived breathlessness (Medical Research Council), health-related quality of life (St. Georges Respiratory Questionnaire) and respiratory muscle function (maximal inspiratory and expiratory pressure) were recorded. Results: PRP resulted in significant improvements in all outcome measures without any significant differences between groups. Conclusions: Our study confirms that COPD patients may benefit from pulmonary rehabilitation independent of their clinical phenotype.

Efficacy of levodropropizine in pediatric cough.

Cough in children is among the most common problems managed by pediatricians, and occurs more frequently in preschool than in older children. Most acute episodes of cough are due to viral upper respiratory tract infections. The morbidity associated with acute cough in a child extends also to parents, teachers, and other family members and caregivers. Unfortunately, therapeutic options for acute cough in children are severely limited due to the absence of drugs shown to be effective antitussives with an acceptable safety profile. Agents used in the management of adult cough, such as narcotics (codeine, hydrocodone), the non-narcotic opioid dextromethorphan, first-generation, potentially sedating antihistamines, and decongestants such as pseudoephedrine, have all been deemed inadequate for treatment of acute pediatric cough on a risk/benefit basis. A growing body of evidence suggests that the peripherally acting antitussive, levodropropizine, may be an attractive alternative for the treatment of bothersome acute cough in children.

Pulmonary Physicians and Respiratory Physiotherapy: The ‘Other Side’ of the Chest

rehabilitation physicians), i.e. physicians trained in the field of physical medicine and rehabilitation. According to the American Academy of Physical Medicine and Rehabilitation [3] , ‘rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. They design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime’. Despite this clear statement, rehabilitation physicians often treat patients suffering from a variety of chronic pulmonary impairments. At the same time, in their therapeutic protocols, respiratory therapists not fully involved in the field of respiratory insufficiency tend to widely prescribe chest physiotherapy even when treating patients suffering from chronic obstructive airway disorders. Therefore, especially among pulmonary specialists dealing with pulmonary rehabilitation, the need for a systematic review is felt to be a relevant issue [4] . Thus, we Before modern pulmonary rehabilitation became an evidence-based science with more than solid scientific evidence, chest physiotherapy was considered the only ‘thing to do’ for patients suffering from chronic respiratory impairment. This umbrella term included a variety of non-pharmacological therapeutic options utilized in clinical situations not always characterized by airflow obstruction but quite often by mucus hypersecretion. To such an extent, chest physiotherapy (which included, e.g. postural drainage, vibropercussive manoeuvres, cough assistance and diaphragmatic re-education) was the only possible non-pharmacological approach, even if it was not evidence based. Nowadays, chest physiotherapy represents a non-essential component of pulmonary rehabilitation, to be used in a small percentage of chronic respiratory adult patients affected by a marked hypersecretory component (e.g. bronchiectasis) while it remains an important therapeutic tool in pediatric patients with cystic fibrosis or airway hypersecretion complicating neuromuscular disorders (e.g. sequels of perinatal asphyxia) [1, 2] . Nonetheless, it is not rare to observe useless chest physiotherapy prescriptions. Especially on the Old Continent, patients needing a pulmonary rehabilitative approach are always treated in medical facilities by nonpulmonary specialists, mainly physiatrists (also called Published online: November 4, 2008

Treatment Effect of Combination of Nsaid and Antitussives in Patients With URTI-Related Cough

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Eur Respir J. 46 (2015) PA3852, http://dx.doi.org/10.1183/13993003.congress-2015.PA3852. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Combination of NSAID and Antitussives in Treatment of URTI Related Cough: An Observational Study

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Eur Respir J. 46 (2015) PA3852, http://dx.doi.org/10.1183/13993003.congress-2015.PA3852. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Efficacy of Levodropropizine: 2 Meta-analyses in Pediatric and Adult Population

Cough has an impact on quality of life of children and adults, thus often requiring an empiric treatment with antitussive agents. Levodropropizine is a very well tolerated peripheral drug, while central cough suppressants may be associated with side effects, especially in children. The aim of our 2 metanalysis is to evaluate the overall comparative efficacy of levodropropizine in both children and adults. A first standardized metanalysis of 4 controlled clinical studies of levodropropizine (3 vs central antitussives, 1 vs placebo) included a total of 780 children. A second metanalysis of 7 controlled clinical studies of Levodropropizine (5 vs central drugs, 2 vs placebo) included 2633 patients, both children and adults. First metanalysis of all standardized efficacy parameters (cough frequency, severity, night awakenings,) in children, showed highly statistically significant difference in the overall antitussive efficacy in favor of Levodropropizine vs. controls (p = 0.001). Heterogeneity was not statistically significant (p=0.0619). Second metanalysis in adults and children alsoshowed highly statistically significant difference in the overall antitussive efficacy in favor of levodropropizine vs. control treatments (p = 0.0044). Heterogeneity was not statistically significant (p=0.0856). Our two metanalysis indicate that Levodropropizine is an effective antitussive drug both in adults and children, with statistically significant better overall efficacy outcomes vs. central antitussives, in terms of reducing cough intensity, frequency and nocturnal awakenings. These results further reinforce the favorable benefit/risk profile of Levodropropizine in the management of cough in pediatric and adult settings.