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Biomedical subjects

C Fracchia

Publications and source records attributed to C Fracchia.

48 records · Page 3Linked to original sources
PubMed1990

Short term effect of intermittent negative pressure ventilation in COPD patients with respiratory failure.

Ten patients with stable chronic obstructive pulmonary disease (COPD) and hypercapnic respiratory failure were randomly submitted to intermittent negative pressure ventilation (INPV) 6 h per day for 5 consecutive days by either a cuirass or pneumo wrap ventilator. The effects were assessed by measurements of spirometry, blood gases, maximal inspiratory (MIP) and expiratory (MEP) pressures, 12 minutes walking distance test (12 mwd), sensation of dyspnoea by a visual analogue scale (VAS) and diaphragmatic electromyographic activity (Edi). Edi was recorded during INPV sessions in only 7 patients. The same measurements apart from Edi were also performed in 8 matched control patients randomly submitted to conventional physiotherapy. During INPV, Edi activity was reduced, at least temporarily down to 50% of baseline values. Comparison of baseline with post INPV values showed no changes in thoracic gas volume (TGV), forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC), arterial oxygen partial pressure (Pao2) and MEP; significant improvements were seen in MIP, vital capacity (VC), VAS, and 12 mwd only in patients submitted to INPV. A significant improvement in PaCO2 was observed in both groups of patients. We conclude that INPV may be effective in improving the functional reserve of the inspiratory muscles in selected COPD patients with hypercapnic respiratory failure and signs of inspiratory muscle dysfunction.

Breathing Exercises↗
PubMed1989

Relationship between the perception of breathlessness and inspiratory resistive loading: report on a clinical trial.

We investigated the relationship between the sensation of breathlessness and progressively higher resistive inspiratory loadings in nine normal subjects (31 +/- 17 yr; forced expiratory volume in one second (FEV1) = 105 +/- 9% of predicted) and in eighteen chronic obstructive pulmonary disease (COPD) patients (63 +/- 7 yr; FEV1 = 43 +/- 17% of predicted). The sensation of breathlessness correlated with mouth pressure both in normals (r = 0.94) and in COPD patients (r = 0.95), with a steeper slope in patients. On this basis we studied the effect of inspiratory muscle training on the sensation of breathlessness in sixteen COPD patients (63 +/- 8 yr; FEV1 = 52 +/- 19% of predicted). After a baseline assessment of lung function, MIP (maximal inspiratory pressure), inspiratory muscle endurance and the sensation of breathlessness (Borg scale) at different inspiratory loads, the patients were divided into two groups: the first was trained by means of resistive breathing, the second used a placebo device. At the end of the training, MIP increased more in the trained group (56 +/- 10 to 69 +/- 15 cmH2O; p less than 0.001) than in the placebo group (50 +/- 17 to 56 +/- 22 cmH2O; p = NS). The Borg score fell significantly at all the considered inspiratory loads in trained patients, but not in the placebo group. We conclude that the training with inspiratory resistances decreased the sensation of breathlessness via an increase in inspiratory muscle strength and endurance.

Adult↗
PubMed1986

A new bronchodilating agent, procaterol, in preventing exercise-induced asthma.

The aim of the present study was to verify the effectiveness of procaterol, a recent and specific beta-2-adrenoceptor stimulant, in preventing exercise-induced asthma (EIA). Twelve asthmatic patients were selected aged 18.6 +/- 5.6 years with a positive response to EIA and a basal forced expiratory volume of the first second (FEV1) better than 80% of predicted. The patients underwent four bronchoprovocation challenges on four consecutive days. On the first day they performed an inclusion test, and, on the three subsequent days, they were submitted, to three identical standardized challenges according to a randomized design. Fifteen minutes before, procaterol (20 mcg), salbutamol (200 mcg) and a placebo were administered as metered aerosol. No pharmacological treatment was given for 24 h (48 h for antihistamines) before each challenge. The test was carried out running on treadmill (10% grade) for 7 min. Room temperature (20-25 degrees C) and relative humidity (40-55%) were maintained constant. At baseline, 15 min before, 5, 10, 15, 30 and 60 min after the exercise, lung function was assessed. Basal mean values of FEV1 were 94.7, 94.9, 90.7 and 91.5% of predicted for the inclusion and the three protected tests, respectively, without significant differences. The FEV1 mean values showed a mild bronchodilation 15 min after salbutamol (+13.2%, p less than 0.006) and procaterol (+8%, NS). At every considered time all indices showed a significant gap (p less than 0.01) between drugs and the placebo with no appreciable differences between procaterol and salbutamol.

Adolescent↗
PubMed1984

[Functional recovery in pulmonary tuberculosis].

At first Authors explain the stages of tubercular disease in which a programme of functional respiratory rehabilitation can be advised. Then they deal with the main aspects of rehabilitating treatment in some tubercular manifestations, as sero-fibrinous pleural effusion, tubercular empyema, parenchymal fibrosis and surgical reliquates. With regard to surgical reliquates, we mostly consider pulmonary resections and pleural skinning. At last Authors recall the indications to physical exercise training, that are constituted by some reliquates of tubercular pathology, and they resume the accomplishment modalities of such a programme in order to allow every patient wide possibilities of social reintroduction.

Breathing Exercises↗
PubMed1984

Sustained-release anhydrous theophylline in preventing exercise-induced asthma.

A number of drugs have been taken into consideration as to their efficacy in preventing exercise-induced asthma (EIA), which may be a reliable model for the investigation of bronchodilating agents. 15 asthmatic patients (mean age 21.1 +/- 10.7), EIA positive (free running test), were selected for a double-blind cross-over study of a sustained-release theophylline preparation against placebo. Patients underwent four subsequent bronchoprovocation tests by means of free running, at a 3-hours' interval, with a prior administration (3 h before the first test) of the drug at the dose of 7-8 mg/kg or the placebo. Lung function was tested (FEV1.0, FEF50, FEF25, sGaw) after the four induction tests as regards to the plasma concentrations of theophylline. After 6, 9 and 12 h, respectively, from administration of the drug, theophylline plasma levels between 7 and 9 micrograms/ml were found, which are to be considered more than satisfactory after an acute administration. A continuous protective activity has been noted against the exercise stress, with a significant difference between drug and placebo, for all lung function parameters with the obvious exception of the first one in which a satisfactory level of theophylline absorption was not reached. The finding of this new positive aspect of the drug investigated appears to be extremely interesting, particularly if added to the already well-known therapeutic activity, and to the fact that often other classes of drugs do not show a good correlation of protective action against EIA and prevention of spontaneous asthmatic attacks.

Adolescent↗
PubMedDate not supplied

Predictors of mortality in patients with Eisenmenger syndrome and admission to the lung transplantation waiting list.

BACKGROUND: Patients with Eisenmenger Syndrome (ES) have very severe irreversible pulmonary hypertension but the criteria for admitting such patients to a lung transplantation waiting list (LTWL) is not clear. Indeed it has been demonstrated that the natural survival of patients with ES is better than the survival achieved through lung transplantation: it follows that no guidelines are available for these patients' admission to an LTWL. The aim of our study was to identify possible predictors of mortality in ES patients in order to reserve admission to the LTWL solely for those patients who would otherwise have the lowest probability of survival. METHODS: Since 1991, 57 patients with ES from our rehabilitative centre were admitted to the LTWL of the Division of Cardiac Surgery at San Matteo Hospital, University of Pavia. At the time of the retrospective analysis, patients were divided into a group of non-transplanted survivors (27 patients--47% of the total) and a group who had died prior to transplantation (16 patients--28% of the total). The 14 transplanted patients (25% of the total) were not considered in the statistical analysis, considering transplantation as an "external event". Unpaired t tests were used to compare the following factors in the survivors and in those who died: sex, "complexity" of the congenital heart disease underlying the ES, previous cardiac surgery, arterial blood gases, pulmonary function and hemodynamic parameters. Moreover, a stepwise discriminant analysis was performed in order to define a possible set of prognostic factors. RESULTS: PaCO2 was higher in those who subsequently died (36.15 +/- 7.42 mmHg) compared with those who survived (32.5 +/- 5.33 mmHg), although this difference did not reach a statistical significance (p = 0.08). Discriminant analysis defined a model in which (a) complexity of the congenital heart disease, (b) sex (male) and (c) cardiac output were predictive of a higher risk of mortality. CONCLUSIONS: This new knowledge can be used in the decision of admission to LTWL in ES patients.

Adult↗
PubMedDate not supplied

[Rehabilitation of the worker with bronchopneumopathy].

Epidemiological data show that chronic diseases of the respiratory apparatus have constantly increased over the last 20 years or so, often involving relatively young age classes. The increased survival rates due to chemotherapy also increase the importance of rehabilitation in such diseases. The officially accepted concept of a "global" rehabilitation is particularly significant in the case of patients of working age. The main rehabilitation procedures include chest physiotherapy, aerosol therapy, oxygen therapy (where selection criteria have been established and where there are new prospects related to long-term oxygen therapy), intermittent positive pressure breathing and physical retraining. Details on the methods of assessment and training and data concerning three groups of patients suffering from respectively chronic obstructive lung disease, silicosis and asbestosis, are given. The data show a general pattern of a decrease in ventilation (for an unchanged level of O2 uptake and CO2 output) and reflect a rise in muscular efficiency (exercising and respiratory) enabling the body to perform the same work load at a lower energy cost. The authors discuss the vocational rehabilitation of the patient with lung disease and illustrate the most useful procedures in the assessment of the subject, the environment and the place of work, including guidelines to achieve this. Rehabilitation treatment is also summarized into a number of stages, with the goals at different therapeutic levels and the ways to reach them.

Asbestosis↗