Michele Capasso

Exhaled Nitric Oxide in Children with Allergic Rhinitis and/or Asthma: A Relationship with Bronchial Hyperreactivity

Background. Nowadays, the measure of the fractional concentration of exhaled nitric oxide (FeNO) enables to assess airway inflammation during an office visit and there is international consensus on this testing methodology. The aim of this study was to evaluate whether FeNO measurement is predictable for bronchial hyperreactivity (BHR) in children with allergic rhinitis, asthma, or both. Methods. Two hundred and eighty children with allergic rhinitis, allergic asthma, or both were evaluated. Bronchial function (FEV1 and FEF25–75), BHR (assessed by methacholine challenge), FeNO, and sensitizations were assessed. Results. Bronchial function, BHR, and FeNO were significantly different in the three groups (p < .001). A strong inverse correlation between FeNO and BHR was found in patients with asthma and with asthma and rhinitis (r = −0.63 and r = −0.61, respectively). A cutoff of 32 ppb of FeNO was a predictive factor for BHR. Conclusions. This study highlights the relevance of FeNO as possible marker for BHR in allergic children and underlines the close link between upper and lower airways.

Randomized Comparison of Everolimus-Eluting Stents and Sirolimus-Eluting Stents in Patients With ST Elevation Myocardial Infarction: RACES-MI Trial

OBJECTIVES The aim of the current study was to compare everolimus-eluting stents (EES) with sirolimus-eluting stents (SES) in patients undergoing primary angioplasty. BACKGROUND Drug-eluting stents may offer benefits in terms of repeat revascularization. However, as shown for first-generation drug-eluting stents, they may be counterbalanced by a potential higher risk of stent thrombosis, especially among patients with ST-segment elevation myocardial infarction (STEMI). No data have been reported so far on the long-term benefits and safety of the new generation of drug-eluting stents in STEMI. METHODS Consecutive STEMI patients admitted within 12 h of symptom onset and undergoing primary angioplasty and stent implantation at a tertiary center with 24-h primary percutaneous coronary intervention capability were randomly assigned to SES or EES. The primary endpoint was a major adverse cardiac event at 3-year follow-up. The secondary endpoints were death, reinfarction, definite or probable stent thrombosis, and target vessel revascularization at 3-year follow-up. No patient was lost to follow-up. RESULTS From April 2007 to May 2009, 500 patients with STEMI were randomized to EES (n = 250) or SES (n = 250). No difference was observed in terms of baseline demographic and clinical characteristics between the groups. No difference was observed between the groups in terms of number of implanted stents per patient or total stent length. However, a larger reference diameter was observed with SES (3.35 ± 0.51 mm vs. 3.25 ± 0.51 mm, p = 0.001), whereas patients randomized to EES more often received glycoprotein IIb/IIIa inhibitors (54.4% vs. 42.4%, p = 0.006). Follow-up data were available in all patients (1,095 ± 159 days). No significant difference was observed between EES and SES in major adverse cardiac events (16% vs. 20.8%, adjusted hazard ratio [HR]: 0.75 [95% confidence interval (CI): 0.5 to 1.13], p = 0.17), cardiac death (4.4% vs. 5.6%, adjusted HR: 0.77 [95% CI: 0.35 to 1.71], p = 0.53), recurrent MI (6.4% vs. 10%, adjusted HR: 0.62 [95% CI: 0.33 to 1.16], p = 0.13), and target vessel revascularization (4.8% vs. 4.8%, adjusted HR: 1.00 [95% CI: 0.45 to 2.32], p = 0.99). However, EES was associated with a significant reduction in stent thrombosis (1.6% vs. 5.2%, adjusted HR: 0.3 [95% CI: 0.1 to 0.92], p = 0.035). CONCLUSIONS This study shows that among STEMI patients undergoing primary angioplasty, EES has similar efficacy as SES, but is associated with a significant reduction in stent thrombosis. (Randomized Comparison of Everolimus Eluting Stents and Sirolimus Eluting Stent in Patients With ST Elevation Myocardial Infarction [RACES-MI]; NCT01684982).

Effectiveness of nebulized hypertonic saline and epinephrine in hospitalized infants with bronchiolitis.

The objective of the study is to verify effects of nebulized 3% saline hypertonic solution (HS) in comparison to normal saline (NS) in addition to epinephrine in hospitalized children with bronchiolitis. Infants were randomly assigned either to receive every 6 hours nebulized NS (group I) or 3% HS (group II) in addition to epinephrine (1.5 mg) and to conventional treatment. The main endpoints of this study were the length of stay (LOS) in hospital and the clinical response score (CSS). Patients presented a significant decrease in CSS from the first through the third day of treatment, present in the first group but even more evident in the second group (p=0.0001). Comparison between group I and II data shows significant decrease in CSS in the 3% HS-treated patients both at the second (p<0.005) and at the third day of treatment (p<0.005). Infants in the NS control group had a mean LOS of 5.6±1.6 days, whereas children treated with 3% HS were discharged with a LOS of 4.9±1.3 days, reaching a significant decrease in stay (p<0.05). In hospitalized patients bronchiolitis nebulized 3% HS and epinephrine significantly decreased symptoms and LOS as compared to 0.9% NS and epinephrine.

A forced expiratory flow at 25-75% value >65% of predicted should be considered abnormal: A real-world, cross-sectional study

Forced expiratory volume in 1 second (FEV1) is considered an important parameter for asthma diagnosis and follow-up. However, it has been proposed that forced expiratory flow at 25-75% (FEF(25-75)) could be more sensitive than FEV1 to detect slight airways obstruction. In this regard, a cutoff FEF(25-75) value has been recently established in a group of asthmatic children: FEF(25-75) < 65% of predicted has been considered impaired. However, the considered population was specifically selected. Therefore, the aim of the present study was to confirm an FEF(25-75) cutoff value in a large cohort of asthmatic children. Seven hundred allergic children (493 male subjects; median age, 11 years) with controlled and partly controlled asthma were evaluated by performing spirometry and skin-prick tests. Three hundred thirteen (44.7%) patients had FEF(25-75%) values of <65% of predicted. Two predictors were significantly associated with impaired FEF(25-75) values: (i) sensitization to perennial allergens (adjusted odds ratio [OR(Adj)], 3.4) and (ii) FEV(1) ≤ 86% of predicted (OR(Adj), 3.8). This study, conducted in real life, could suggest that FEF(25-75) value of <65% of predicted may be considered abnormal.

High exhaled nitric oxide levels may predict bronchial reversibility in allergic children with asthma or rhinitis.

Background. Allergic asthma and rhinitis may be associated. Airway inflammation is shared by both disorders. The measure of the fractional concentration of exhaled nitric oxide (FeNO) may be considered as a surrogate marker for airway inflammation, mainly in allergic patients. Reversibility to bronchodilation (BD) testing is a functional characteristic of asthma. Objective. The aim of this study was to evaluate whether FeNO may predict reversibility to BD in a pediatric cohort of allergic subjects with asthma (180) or rhinitis (150). Methods. Lung function (including forced expiratory volume at the first second (FEV1), forced volume capacity (FVC), forced expiratory flow at 25–75% of volume capacity (FEF 25–75)), FeNO measurement, and BD testing were performed in all children. Results. Lung function, FeNO, and sensitization type were significantly different in the two groups. A strong correlation was found between FeNO and ΔFEV1 after BD. Two main predictors of reversibility were FeNO values >34 ppb [Odds RatioAdj (ORAdj) = 1.9] and sensitization to perennial allergens (ORAdj = 1.7). Conclusions. This study provided evidence that FeNO was strongly related with the response to BD testing and could predict bronchial reversibility in children with allergic rhinitis or asthma. Therefore, a simple FeNO measurement could suggest relevant information about bronchial reversibility.

Resveratrol plus carboxymethyl-β-glucan reduces nasal symptoms in children with pollen-induced allergic rhinitis

Abstract Objective: Allergic rhinitis (AR) is caused by an IgE-mediated inflammatory reaction consequent to the exposure to causal allergen. Resveratrol is a natural non-flavonoid polyphenol, exerting anti-inflammatory activity; β-glucan is a polysaccharide with immuno-modulatory properties. Thus, this study aimed to investigate whether these combined compounds are able of relieving nasal symptoms in children with AR due to pollen allergy. Research design and methods: The present study was conducted as placebo-controlled, double-blinded, and randomized. Globally, 68 children (36 males; mean age 7.9 years) were treated with resveratrol plus β-glucan or placebo (the diluent of active drug) two sprays (100 µL/spray) in each nostril three times/day for 2 months. Nasal symptoms, including itching, sneezing, rhinorrhea, and obstruction, were assessed at baseline and after treatment. Use of rescue medication, such as cetirizine syrup, was also evaluated. Clinical trial registration: ClinicalTrials.gov identifier: NCT02130440. Results: Children treated with active drug achieved a significant reduction in all nasal symptoms: itching (p = 0.0001), sneezing (p = 0.0009), rhinorrhea (p = 0.009), and obstruction (0.002) as well as antihistamine use (p = 0.003). Placebo did not affect nasal complaints and cetirizine use. The intergroup analysis showed that active treatment was significantly superior to placebo about reduction of AR symptoms and rescue medication use. Conclusions: The present preliminary study firstly showed that intranasal resveratrol plus carboxymethyl-β-glucan is capable of significantly improving nasal symptoms in children with pollen-induced AR.

EFFECTIVENESS OF ISCHIA THERMAL WATER NASAL AEROSOL IN CHILDREN WITH SEASONAL ALLERGIC RHINITIS: A RANDOMIZED AND CONTROLLED STUDY

Allergic rhinitis is characterized by local inflammation. Nasal lavage may be a useful treatment, however, there are few studies on this topic. This study aims to evaluate the effects of Ischia thermal water nasal irrigation on allergic rhinitis symptoms and airway inflammation during the period of natural exposure to Parietaria pollen in children with allergic rhinitis and intermittent asthma. Forty allergic children were randomly divided into two groups: the first group (Group 1) practiced crenotherapy with thermal water aerosol for 15 days per month, for three consecutive months, the control group (Group 2) was treated with 0.9% NaCl (isotonic) solution. In addition, all children were treated with cetirizine (0.5 gtt./kg/day once daily). Nasal symptom assessment, including Total Symptom Score (TSS), spirometry, and exhaled nitric oxide (FeNO) were considered before the treatment (T0), at the end of the treatment (T1) and again 2 weeks after the end of the treatment (T2). The study was registered in the Clinical Trials.gov (NCT01326247). Thermal water significantly reduced both TSS and FeNO levels and there was a significant relationship between reduction of nasal symptoms and FeNO values at the end of treatment with thermal water. In conclusion, this study shows that nasal crenotherapy with the hyper-mineral chloride-sodium water of Ischia was effective in children with seasonal allergic rhinitis based on the sensitivity to Parietaria. These results demonstrate that this natural treatment may be effective in a common and debilitating disease such as the allergic rhinitis.

Long-term results of the randomized comparison of everolimus-eluting stents and sirolimus-eluting stent in patients with ST elevation myocardial infarction (RACES-MI trial)

BACKGROUND Several concerns have emerged about the higher risk of very late stent thrombosis (ST) with first generation drug-eluting stent (DES), especially in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). New generation DES have demonstrated reduction in ST at mid-term follow-up, however no data are available on long-term follow-up. Therefore, the aim of this study was to report long-term results of the RACES-MI trial conducted to compare Everolimus-Eluting Stent (EES) vs Sirolimus-Eluting Stent (SES) in patients undergoing primary PCI. METHODS The RACES-MI trial enrolled consecutive STEMI patients admitted within 12h of symptom onset, undergoing primary PCI with stent implantation at a tertiary center with 24-hour primary PCI capability, who were randomly assigned to SES or EES. Primary endpoint of this analysis is major adverse cardiac events (MACE) at long-term follow-up. Secondary endpoints are 1) death; 2) reinfarction; 3) definite or probable ST; 4) target-vessel revascularization (TVR) at long-term follow-up. RESULTS From April 2007 to May 2009 500 patients with STEMI were randomized to EES (n=250) or SES (n=250). No difference was observed between the groups either in baseline clinical characteristics, in the number of implanted stent or total stent length per patient. However, a larger reference diameter was observed with SES (3.35±0.51 mm vs 3.25±0.51 mm, p=0.001), whereas patients randomized to EES received Gp IIb-IIIa inhibitors more often (54.4% vs 42.4%, p=0.006). At long-term follow-up (2132±528 days), EES was associated with a significant reduction in MACE (23.8 vs 34.1%, adjusted p=0.028), ST (2.5% vs 7.7%, adjusted p=0.009), without any difference in death (8.7% vs 11.4%, adjusted p=0.47), reMI (9.3% vs 13.1%; adjusted p=0.18) and TVR (8.6% vs 12.3%, adjusted p=0.31). CONCLUSIONS This study shows that among STEMI patients undergoing primary PCI EES, as compared to SES, is associated with significant reduction in MACE and ST at long-term follow-up.

Resveratrol plus carboxymethyl-β-glucan in children with recurrent respiratory infections: a preliminary and real-life experience

BackgroundRecurrent respiratory infections (RRI), such as the presence of at least one of the following criteria: i) >6 RI per year; ii) >1 RI per month involving upper airways from September to April; iii) >3 RI involving lower airways, constitute a social problem for both their pharmaco-economic impact and the burden for the family. However, several treatment have been proposed with controversial results.ObjectiveAs resveratrol plus carboxymethyl-β-glucan is presently available as solution for aerosol, the aim of this study was to evaluate the effects of this compound, compared to saline solution, whether it is able to prevent RRI in children.DesignThe study was designed as real-life, randomized. Globally, 82 children (49 males, mean age 8.1 ± 2.6 years) with acute rhinopharyngitis and RRI were enrolled. Resveratrol plus carboxymethyl-β-glucan or saline isotonic solution was randomly (ratio 1:1) administered immediately after an anti-infective and anti-inflammatory 10-day treatment (tiamphenicol associated with acetylcisteine plus beclomethasone dipropionate) for the acute rhinopharyngitis. Investigated treatments lasted 20 days. Days with respiratory symptoms, fever, medication use, medical visits, and school absences were evaluated. Children were visited 30, 60, and 90 days after starting treatments.ResultsThe active compound was able to significantly reduce the number of days with nasal obstruction (p < 0.001), rhinorrhea (p < 0.001), sneezing (p < 0.001), cough (p = 0.002), fever (p < 0.001), medication use (p < 0.001), medical visits (p < 0.001), and school absence (p < 0.001).ConclusionsThis preliminary and real-life study could suggest that an aerosolized solution containing resveratrol plus carboxymethyl-β-glucan might exert preventive effects in children with RRI.

Forced expiratory flow between 25 and 75% of vital capacity might be a predictive factor for bronchial hyperreactivity in children with allergic rhinitis, asthma, or both.

Allergic rhinitis and asthma are closely associated. Bronchial hyperreactivity (BHR) is a pathophysiological characteristic of asthma. Forced expiratory flow between 25 and 75% of vital capacity (FEF(25-75)) has been previously shown to be able to predict BHR in adult patients with allergic rhinitis. Therefore, the aim of this study was (i) to evaluate the presence of BHR in a large group of children with allergic rhinitis, asthma or both and (ii) to confirm whether FEF(25-75) might be related to BHR and may predict BHR also in a pediatric population. Nine hundred fifty children with allergic rhinitis (350), asthma (300), or both (300) were enrolled. Clinical examination, skin-prick test, spirometry, and methacholine challenge were performed in all patients. Severe BHR was quite frequent in allergic children, mainly in asthmatic patients. FEF(25-75) values were significantly related to BHR grade, mainly in children with rhinitis (r = 0.69). Impaired FEF(25-75) values (such as ≤65% of predicted) constituted a relevant predictive factor for severe BHR, mainly in children with rhinitis (odds ratio, 8.9). In conclusion, this pediatric study confirmed that impaired FEF(25-75) values might predict severe BHR in children, mainly in those with allergic rhinitis. Therefore, low FEF(25-75) values could suggest BHR in children.