Noninvasive ventilation for patients with acute lung injury or acute respiratory distress syndrome.

Respir Care. 2011 Oct;56(10):1583-8

Authors: Nava S, Schreiber A, Domenighetti G

Abstract
Few studies have been performed on noninvasive ventilation (NIV) to treat hypoxic acute respiratory failure in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The outcomes of these patients, for whom endotracheal intubation is not mandatory, depend on the degree of hypoxia, the presence of comorbidities and complications, and their illness severity. The use of NIV as an alternative to invasive ventilation in severely hypoxemic patients with ARDS (ie, P(aO(2))/F(IO(2)) < 200) is not generally advisable and should be limited to hemodynamically stable patients who can be closely monitored in an intensive care unit by highly skilled staff. Early NIV application may be extremely helpful in immunocompromised patients with pulmonary infiltrates, in whom intubation dramatically increases the risk of infection, pneumonia, and death. The use of NIV in patients with severe acute respiratory syndrome and other airborne diseases has generated debate, despite encouraging clinical results, mainly because of safety issues. Overall, the high rate of NIV failure suggests a cautious approach to NIV use in patients with ALI/ARDS, including early initiation, intensive monitoring, and prompt intubation if signs of NIV failure emerge.

PMID: 22008399 [PubMed - in process]

A study on 300 asthmatic children, 300 controls and their parents confirms the genetic transmission of allergy and asthma.

Eur Rev Med Pharmacol Sci. 2011 Sep;15(9):1051-6

Authors: Cantani A, Micera M

Abstract
BACKGROUND: Several studies have shown the role of genetic factors in allergies, and ascertained that atopic diseases are transmitted by parents, especially by mothers.
MATERIALS AND METHODS: In order to explore the genetic risk of a child with a family history (FH) of allergy, we have enrolled into this prospective study 300 children, 173 males and 127 females, aged 3.5 to 7.5 years (median age 4.4 years), that included: family (FH) and personal history skin prick tests (SPTs) and specific IgE (RAST), who attended the Pediatric Allergy and Immunology Division of Rome University because affected with respiratory allergy We have studied the FH of these children asking whether their parents and brothers/sisters had atopic diseases, and detailing whether such diseases were respiratory or food allergies (FA). The parents of all children gave their informed consent. We analyzed data using the X2 method.
RESULTS: One hundred and twentyseven parents were atopic (42.3%), in addition to 20 brothers/sisters. In detail 90.2% of fathers, 84% of mothers and 65% of brothers/sisters had asthma or allergic rhinitis (AR). Very less parents had urticaria, especially the mothers and brothers/sisters suffered with atopic dermatitis (AD), and some mothers with FA. In 23 children from these parents most had AD and respiratory allergy. In 300 children comparable for age and sex with no respiratory illness recruited from our out-patient clinic 40 parents, 14 mothers and 26 fathers and 9 brothers/sisters had asthma or AR (p = 0.0001), some fathers had also urticaria and two brothers AD.
CONCLUSION: A relevant part of respiratory allergy is not transmitted by mothers. Our prospective study stresses that 42.3% of parents are atopic, and FH of their children was positive for respiratory allergy in 82-92% of cases. Thus respiratory allergy can have an autosomal dominant mode of inheritance, but considering the other atopic diseases, the transmission can be polygenic. The impact of genetic factors in these children is emphasized by the high part of asthmatic brothers/sisters.

PMID: 22013728 [PubMed - in process]

Impact of air pollution on allergic diseases.

Korean J Intern Med. 2011 Sep;26(3):262-73

Authors: Takizawa H

Abstract
The incidence of allergic diseases in most industrialized countries has increased. Although the exact mechanisms behind this rapid increase in prevalence remain uncertain, a variety of air pollutants have been attracting attention as one causative factor. Epidemiological and toxicological research suggests a causative relationship between air pollution and the increased incidence of asthma, allergic rhinitis, and other allergic disorders. These include ozone, nitrogen dioxide and, especially particulate matter, produced by traffic-related and industrial activities. Strong epidemiological evidence supports a relationship between air pollution and the exacerbation of asthma and other respiratory diseases. Recent studies have suggested that air pollutants play a role in the development of asthma and allergies. Researchers have elucidated the mechanisms whereby these pollutants induce adverse effects; they appear to affect the balance between antioxidant pathways and airway inflammation. Gene polymorphisms involved in antioxidant pathways can modify responses to air pollution exposure. While the characterization and monitoring of pollutant components currently dictates pollution control policies, it will be necessary to identify susceptible subpopulations to target therapy/prevention of pollution-induced respiratory diseases.

PMID: 22016586 [PubMed - in process]

Global alliance against chronic respiratory diseases in Italy (GARD-Italy): Strategy and activities.

Respir Med. 2011 Oct 22;

Authors: Laurendi G, Mele S, Centanni S, Donner CF, Falcone F, Frateiacci S, Lazzeri M, Mangiacavallo A, Indinnimeo L, Viegi G, Pisanti P, Filippetti G

Abstract
The steady increase in incidence of chronic respiratory disease (CRD) now constitutes a serious public health problem. CRDs are often underdiagnosed and many patients are not diagnosed until the CRD is too severe to prevent normal daily activities. The prevention of CRDs and reducing their social and individual impacts means modifying environmental and social factors and improving diagnosis and treatment. Prevention of risk factors (tobacco smoke, allergens, occupational agents, indoor/outdoor air pollution) will significantly impact on morbidity and mortality. The Italian Ministry of Health (MoH) has made respiratory disease prevention a top priority and is implementing a comprehensive strategy with policies against tobacco smoking, indoor/outdoor pollution, obesity, and communicable diseases. Presently these actions are not well coordinated. The Global Alliance against Chronic Respiratory Diseases (GARD), set up by the World Health Organization, envisages national bodies; the GARD initiative in Italy, launched 11/6/2009, represents a great opportunity for the MoH. Its main objective is to promote the development of a coordinated CRD program in Italy. Effective prevention implies setting up a health policy with the support of healthcare professionals and citizen associations at national, regional, and district levels. What is required is a true inter-institutional synergy: respiratory diseases prevention cannot and should not be the responsibility of doctors alone, but must involve politicians/policymakers, as well as the media, local institutions, and schools, etc. GARD could be a significant experience and a great opportunity for Italy to share the GARD vision of a world where all people can breathe freely.

PMID: 22024553 [PubMed - as supplied by publisher]