No abstract

It has been shown that patients with chronic obstructive pulmonary disease (COPD) develop dynamic hyperinflation (DH), which contributes to dyspnoea and exercise intolerance. Formoterol, salmeterol and oxitropium have been recommended for maintenance therapy in COPD patients, but their effect on DH has only been assessed for salmeterol.The aim of the present study was to compare the acute effect of four inhaled bronchodilators (salbutamol, formoterol, salmeterol and oxitropium) and placebo on forced expiratory volume in one second, inspiratory capacity, forced vital capacity and dyspnoea in COPD patients. A cross-over, randomised, double-blind, placebocontrolled study was carried out on 20 COPD patients.Patients underwent pulmonary function testing and dyspnoea evaluation, in basal condition and 5, 15, 30, 60 and 120 min after bronchodilator or placebo administration.The results indicate that in chronic obstructive pulmonary disease patients with decreased baseline inspiratory capacity, there was a much greater increase of inspiratory capacity after bronchodilator administration, which correlated closely with the improvement of dyspnoea sensation at rest. For all bronchodilators used, inspiratory capacity reversibility should be tested at 30 min following the bronchodilator. On average, formoterol elicited the greatest increase in inspiratory capacity than the other bronchodilators used, though the difference was significant only with salmeterol and oxitropium. The potential advantage of formoterol needs to be tested in a larger patient population. In patients with chronic obstructive pulmonary disease (COPD), bronchodilator reversibility testing is used routinely to exclude a significant asthmatic component. International guidelines recommend that bronchodilator responsiveness be evaluated by the change in forced expiratory volume in one second (FEV1) greater than a cut-off level, calculated in different ways [1,2]. However, in COPD patients, exercise tolerance and dyspnoea are poorly correlated with FEV1 [3][4][5]. Recently, it has been shown that in COPD patients, indices related to dynamic hyperinflation (DH), such as inspiratory capacity (IC), are both reproducible [6] and more closely related to exercise tolerance and dyspnoea than FEV1 and forced vital capacity (FVC) [3,[6][7][8][9][10][11]. PELLEGRINO et al. [11] demonstrated that changes in FEV1 frequently fail to detect significant functional responses to bronchodilators in patients with chronic airflow obstruction. Furthermore, an increase in IC after bronchodilator administration implies a reduction in DH, which is the main cause of reduced exercise capacity and dyspnoea [7][8][9][10][11][12]. Accordingly, an increase in IC should represent the main target for bronchodilator therapy.The effect of bronchodilator administration on IC and other ventilatory variables in COPD patients has been described in several publications [8,10,[13][14][15][16][17][18]. However, bronchodilator-induced changes in IC were correlated with the concurrent chan...

Recently published research contends that anxiety and depression are more common in asthmatic patients than in the general population. Particular psychological profiles could even be a risk factor contributing to deaths caused by asthma. The purpose of our research was to evaluate the anxiety and depression level in a population of 80 asthmatic patients who were treated in our department, and to judge whether data collected on psychological profiles of these asthmatic patients can be of any significance when dealing with their pathology. The study consisted of 40 patients suffering from chronic viral hepatitis B or C, and 40 healthy subjects who served as a control group. Both sets of patients were homogeneous with regard to sex, age and education. All subjects were tested for anxiety and depression levels with the S.T.A.I. and Zung questionnaires. A structured questionnaire was employed to assess the daily approach to living with the disease only in asthmatic patients. The anxiety and depression levels were noticeably higher in asthmatic patients than in patients with chronic liver disease and healthy subjects. In particular, 34 asthmatic patients scored higher than the S.T.A.I. cut-off (40/80) and 27 attained the same results in the Zung questionnaire. Results from the asthmatic population and healthy subjects illustrated that women had a higher incidence of anxiety and depression compared to men, although no statistically significant relationship between sex and questionnaire results was apparent in patients with liver disease. In the year before assessment, hospitalization and emergency treatment due to asthmatic exacerbation was correlated in females with a high incidence of anxiety. Additionally, the asthmatic population's level of education is significantly related to the incidence of anxiety and depression. With higher education, incidence of depression and anxiety decreased. This result was not apparent in control groups. The results of our study were: (1) we confirmed that asthmatic pathology is associated with an increase in incidence of anxiety and depression, whose presence and seriousness should be taken into consideration in therapeutic programmes when dealing with a patient; (2) we indicated that a specific approach towards therapy is crucial when dealing with an asthmatic patient; (3) we suggested how important it is to identify categories of patients that require more care because of their psychological profile. These findings should provide for the optimal use of informational resources with important applications for educational programmes and the future treatment of the asthmatic population.