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Biomedical subjects

G Ciappi

Publications and source records attributed to G Ciappi.

At least 19 recordsLinked to original sources
PubMed1992

Effects of environment and passive smoking on the respiratory health of children.

A cross-sectional survey was conducted to evaluate the possible effects of outdoor air pollution and of parental smoking on the respiratory health of children. A total of 3092 primary schoolchildren living in two polluted areas (an industrial town, Civitavecchia, and the city of Rome) and in a rural area, were chosen. A self-administered questionnaire was filled in by the parents of 2929 children (94.2%). A broad spectrum of respiratory symptoms and illnesses were taken as outcome variables. The frequency of most outcome variables was higher among children from the polluted areas than among those growing up in the non-polluted area (e.g. asthma: odds ratio (OR) = 1.4 for Civitavecchia, OR = 1.3 for Rome). Exposure to any passive smoking increased OR of having night cough (OR = 1.8), snoring (OR = 1.4), and respiratory infections during the first 2 years of life (OR = 1.3). A further increase in risk was observed in children whose mothers smoked or if both parents were smokers (asthma, OR = 1.5). When the separate and joint effects of the two exposures were studied, the patterns of OR did not suggest synergism between the two factors. The study indicates that both air pollution and passive smoking cause an increase in respiratory symptoms in children, although there would seem to be no additional effects of the two exposures together.

Child↗
PubMed1992

Associations between atopy, asthma history, respiratory function and non-specific bronchial hyperresponsiveness in unselected young asthmatics.

We evaluated the relationship between bronchial hyperresponsiveness and atopic status, clinical symptoms and airway calibre in a group of Italian conscripts who reported having bronchial asthma. 126 subjects were studied. Bronchial responsiveness was measured by the methacholine test, and atopic status was assessed by skin tests. A measurable PC20 was detected in 106 subjects. On the basis of the methacholine threshold concentration the sample was divided into four categories. Subjects with a low threshold response had an earlier onset of the disease and tended to take more drugs. The four categories also differed in lung function and skin reactivity towards Dermatophagoides pteronyssinus whereas no difference was found in skin reactivity towards grasses or the overall panel of tested allergen extracts. In conclusion, we found that bronchial hyperresponsiveness is related to both clinical history and lung function, whereas the relationship with atopic status seems to be allergen specific.

Adolescent↗
PubMed1992

Population values of lung volumes and flows in children: effect of sex, body mass and respiratory conditions.

The functional relationship of gender, anthropometric measures and respiratory condition in predicting respiratory function in children was explored, using data collected in a random sample survey in Central Italy (2,176 subjects). Regression equations for the logarithmic transformation of the functional data were obtained, using sex, ln(height), ln(body mass index) (BMI) and ln(age) as predicting variables. The fit of the model was better for forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) (R2 = 0.655, 0.603 and 0.312, respectively) than for maximal expiratory flows. Variables indicating the presence of respiratory conditions (recent respiratory infections, asthma, cough and/or phlegm) were forced in the models; only a marginal change in the predictions was observed. Data analysis while controlling for FVC, as a proxy for total lung capacity, revealed no substantial sex difference in airways; furthermore, airways size relative to lung size falls with increasing FVC in both sexes. In overweight subjects (BMI greater than 90th percentile) the relationship between height and lung volume was modified by sex, the coefficient for ln(height) being higher in girls and lower in boys. A comparison between equations from the present study and available reference data revealed that our population differs from standards derived from laboratory data and is more similar to those derived from population studies.

Asthma↗
PubMed1992

[The nonspecific bronchial stimulation test with methacholine and an ultrasonic mist of distilled water: which is to be preferred in the military sphere?].

The authors compare the methacholine (Mch) and the nebulized ultrasonic distilled water (NUDW) bronchial challenge as regard sensitivity and time required to perform them. For military service fitness, were studied 24 asthmatic patients. Each subject performed random a bronchial challenge by Mch (Yan method) and by NUDW (Allegra method) in two different days; for each bronchial challenge has been measured the time required to perform it. The atopic status has been evaluated by skin-prick test. All the subjects have shown a positive response to Mch test (PD 20 FEV1 mean: 352 mcg, range 80-850) whereas 13 subjects (54%) have shown a positive response to NUDW. The time required to evaluate all the subjects by Mch test has been 199.5 minutes whereas the total time required to evaluate all the subjects by NUDW test (127 minutes) and to evaluate by Mch test the non responders to NUDW (100 minutes) has been 227 minutes. The most of subjects were skin reactors. No difference was found as regard onset of disease, basal lung function and atopic status between responders and non responders to NUDW test. We conclude that NUDW test has shown a lack of sensitivity in this sample (50% of asthmatic patients could be misdiagnosed) and that the Mch test is preferable to determine a rapid method for measurement of bronchial responsiveness.

Adolescent↗
PubMed1991

Bilateral bronchoalveolar lavage in progressive systemic sclerosis: interlobar variability, lymphocyte subpopulations, and functional correlations.

Bilateral bronchoalveolar lavage (BAL) was carried out in right middle and left upper lobes of 22 nonsmoking females suffering from progressive systemic sclerosis in order to assess interlobar differences and functional correlation of the BAL composition. The patients' age ranged from 20 to 66 years, and the mean disease duration was 10.4 years. The most frequent finding was a mild BAL lymphocytosis (right in 11 of 22 patients; left in 8 of 22), but eosinophilic (right in 11 of 22; left in 5 of 22 patients) and neutrophilic (right in 9 of 22 patients; left in 1 of 22) alveolitis was recognized as well. Differential counts suggestive of alveolitis limited to one of the lavaged lobes were demonstrated in about one fourth of the cases. Including increased cellularity among the criteria of pathological BAL fluid composition, 14% of the subjects showed bilateral BAL results within the normal range. OKT8-positive lymphocytes were significantly increased in 3 patients, but the mean values were not. Total lung capacity, vital capacity, and forced expiratory volume in 1 s correlated inversely with BAL neutrophil (p less than 0.05) and granulocytic (p less than 0.01) differential counts; the strongest, positive correlation was demonstrated regarding the lymphocyte/granulocyte ratios (p less than 0.0005). In conclusion, several patterns of alveolitis as well as a bilaterally normal BAL composition were found in our series; moreover, even if inhomogeneous alveolitis did occur, a single lavage performed in the right middle lobe correctly detected or excluded the presence of an alveolitis in 95% of our patients.

Adult↗
PubMed1991

Factors affecting variations in pulmonary diffusing capacity resulting from postural changes.

The relation of postural changes to the diffusing capacity of the lung for carbon monoxide (DLCO) was investigated in 12 normal nonsmokers in order to evaluate the influence of body position on several components of lung resistance to gas diffusion. The well-known increase in CO diffusing capacity in the supine position was obtained only for data corrected for alveolar volume (KCO: 6.18 +/- 0.75 vs. 5.45 +/- 0.67 ml/min/mm Hg/l; p less than 0.005). Moreover, only the membrane component (Dm) increased significantly in supine subjects (KDm = 2.81 +/- 1.32 vs. 1.82 +/- 0.54 ml/min/mm Hg/l; p less than 0.05), the increase in capillary blood volume (Vc) being not significant (KVc = 12.54 +/- 4.22 vs. 11.17 +/- 3.79 ml/l; NS). These data could be interpreted as a demonstration of a more homogeneously distributed ventilation with respect to diffusion surface in healthy young people in a supine position. The amount of surface available for diffusion seems therefore to be a limiting factor to gas flow across the lungs in these subjects. Thus a straightforward attribution of posturally influenced changes in CO diffusing capacity exclusively to factors affecting Vc is not recommended, particularly in pathological conditions, if information about variation in distribution of ventilation is unavailable.

Adult↗
PubMed1991

Indices of nonspecific bronchial responsiveness in a pediatric population.

A cross-sectional survey of the prevalence of asthma and bronchial hyperreactivity among schoolchildren (7 to 11 years old) was carried out in three areas of the Latium region (Central Italy). Out of 1,777 children tested with methacholine challenge (MCT), 15.1 percent had a 20 percent fall in FEV1 after a provocative concentration (PC20FEV1) of 4 mg/ml of methacholine or less; 69.7 percent had a PC20FEV1 less than 64.0 mg/ml, whereas 50.3 percent were nonresponders. Two continuous measures of bronchial responsiveness, the slope (percentage of change in FEV1 per mg/ml of methacholine) and the area under the dose response curve, were calculated in order to avoid the loss of information in nonresponders. Applying a receiver operating characteristic (ROC) curve analysis, the three estimators did not show any statistically significant difference in their overall performance in detecting asthma (ROC areas: PC20FEV1 = 0.683, slope = 0.681, area = 0.702 or asthma-like symptoms. The log transformation of slope, having a unimodal and slightly skewed shape, is an appealing continuous measure of bronchial responsiveness useful for epidemiologic studies. The final choice of an appropriate estimator of the concentration-response curve to methacholine, however, depends upon both the statistical tests or the modelling procedures to be used and clarification of the prognostic value of different indices of bronchial responsiveness.

Asthma↗
PubMed1991

[Marked hematic hypereosinophilia caused by Giardia Lamblia infestation in a subject with Churg-Strauss syndrome].

We report a Churg-Strauss syndrome case complicated by Giardia Lamblia infection which increased markedly the number of blood eosinophils with appearance of eosinophils able to form rosettes with unsensitized sheep red blood cells. Metronidazolo therapy reduces markedly the blood hypereosinophilia. The strong relationship between blood hypereosinophilia and Giardia Lamblia in this patient, suggests that there is an interaction between different eosinophilopoietic stimuli.

Churg-Strauss Syndrome↗
PubMed1991

[The measurement of bronchial hyperreactivity for military service fitness].

The authors discuss the efficacy of methacholine challenge to discriminate fit subjects to military service. We evaluated the relation between bronchial hyperreactivity and clinical symptoms, airways caliber and atopic status in a group of italian conscripts who reported to have bronchial asthma. Five-hundred-four subjects were studied. Bronchial hyperreactivity was measured by methacholine test, and atopic status was assessed by skin-tests. A measurable PC20 FEV1 was detected in 424 subjects. On the basis of the methacholine threshold concentration the overall sample was divided in four categories. The four categories differed as regards onset of disease, lung function and skin reactivity towards Dermatophagoides Pter, whereas no difference was found as regards skin reactivity towards Grass. In the group evaluated in spring, the four categories differed as regards skin reactivity towards Grass. In conclusion we found that bronchial hyperreactivity is related to clinical history, lung function and atopic status; the measurement of bronchial hyperreactivity is important to evaluate conscripts referring bronchial asthma.

Adolescent↗
PubMed1989

Bronchial hyperresponsiveness in atopic dermatitis.

We investigated the prevalence of bronchial asthma, immediate skin reactivity and bronchial hyperresponsiveness in 40 patients with atopic dermatitis (AD). Eight patients reported to have asthma while 29 were found responders to methacholine test (PC20 Mch less than 64 mg/ml) and 21 were skin reactors. The prevalence of skin positive reactions did not differ in responder and non-responder (PC20 Mch greater than 64 mg/ml) groups. Males were more likely both to have bronchial asthma and be responders to methacholine test than females. Moreover, responders had an earlier age of onset of AD than the non-responders. We suggest that bronchial responsiveness should be evaluated in children with AD.

Adolescent↗
PubMed1989

Comparison of the performance of two mini peak flow meters.

Two mini peak flow meters commonly used to monitorize the peak expiratory flow rate (PEFR) are compared to assess their agreement, precision and, with respect to a standard pneumotachygraph, accuracy. Precision of the mini-Wright peak flow meter is greater, possibly as result of a systematic overestimation of PEFR values. The Assess peak-flow meter is more accurate, but its ability to reproduce the actual well-known PEFR variability is dependent from the absolute level of air flow. The agreement between two instruments is very poor, both in asthmatics and in normals, so that it is mandatory to use always the same mini peak flow meter in population studies and during the follow-up of asthmatic patients.

Adolescent↗
PubMed1988

Probit analysis applied to the allergen dose-response curve: a method for epidemiologic surveys.

The degree of skin sensitivity to five common allergens (grass, Dermatophagoides pteronyssinus, mugwort, birch, and Parietaria) was determined by the threshold dilution technique in all the skin test reactors of a random sample of 295 schoolchildren (142 male and 153 female subjects, age range 11 to 14 years), and the frequency distribution of responders at each concentration was analyzed by probit analysis. The potency of each allergen was presented in terms of median effective dose (ED50), and comparison between different allergens and between symptomatic and asymptomatic subjects was made by computing the relative potency. The ED50 of the allergens was found to be nearly identical (grass, 13.5; D. pteronyssinus, 12.3; mugwort, 9.6 activity units by RAST (AUR)/ml) with the exception of birch (22 AUR/ml). Grass and D. pteronyssinus demonstrated a lower ED50 in symptomatic subjects (3.3 and 2.8 AUR/ml, respectively) than in asymptomatic subjects (85 and 27 AUR/ml, respectively). The lower fiducial limits of ED50 in symptomatic subjects demonstrated to be a cutoff point, since they included only 5% and 12% of asymptomatic reactors to grass and D. pteronyssinus, respectively. We conclude that probit analysis applied to the distribution of threshold doses of allergen extracts is a useful method to evaluate skin sensitivity in epidemiologic surveys. We believe that the ED50 is a practical and reliable allergy index.

Allergens↗
PubMed1987

Effects of two doses of cromolyn on allergen-induced late asthmatic response and increased responsiveness.

We selected five atopic children with asthma with previously documented late asthmatic response (LAR) associated with increased hyperresponsiveness to methacholine after the inhalation of Dermatophagoides pteronyssinus. The children had four allergen inhalation tests on 4 different days, at least 14 days apart. On days 1 and 4, saline placebo was inhaled 1 hour before the expected onset of LAR, and FEV1 was measured hourly until FEV1 returned within 10% of baseline value; then methacholine challenge was performed. On days 2 and 3, 20 and 40 mg of cromolyn was inhaled double blind 1 hour before the expected onset of LAR. FEV1 and methacholine responsiveness were measured as on days 1 and 4. The two doses of cromolyn significantly delayed the LAR onset without altering the overall LAR magnitude and prevented the allergen-induced increase in methacholine responsiveness. Both these effects were greater at the maximal dose used. We conclude that cromolyn can prevent the allergen-induced increase in methacholine responsiveness and that this effect is not due to alteration in the magnitude of LAR. Our findings reveal a possible explanation of the effectiveness of this drug in the treatment of allergic asthma.

Adolescent↗
PubMed1987

The effect of indomethacin on the refractory period occurring after the inhalation of ultrasonically nebulized distilled water.

We examined the involvement of inhibitory prostaglandins in refractoriness induced by repeated ultrasonically nebulized distilled water (UNDW) challenge. Six male subjects with asthma who developed both UNDW-induced bronchoconstriction and refractoriness after UNDW were studied on 3 separate days, 1 week apart. On each study day, subjects had an initial UNDW challenge. UNDW responsiveness was assessed with dose-response curves of UNDW volume output versus the percent fall in FEV1. The output provoking a 20% fall in FEV1 (PO20 UNDW) was calculated. FEV1 was measured again at 5-minute intervals until it returned to within 5% of baseline value. UNDW challenge was then repeated. On day 1, the two successive UNDW challenges were performed in absence of any treatment (control day). Before days 2 and 3, subjects received placebo capsules or indomethacin, 100 mg per day, in a double-blind, randomized fashion for 3 days. On both the control and placebo days, repeated UNDW inhalation provoked a significant increase in PO20 UNDW (p less than 0.01), indicating refractoriness. On the indomethacin day, the mean PO20 UNDW during the second UNDW challenge was not significantly different from that obtained during the initial test on that day (p greater than 0.05), indicating that refractoriness did not occur. We suggest that inhibitory prostaglandins are involved in the development of refractoriness after UNDW inhalation.

Adolescent↗
PubMed1987

Allergy indices based on allergen dose-response curve in a randomly selected sample of schoolchildren.

Skin-test sensitivity was computed in 61 schoolchildren drawn from a stratified random sample in order to generate two allergy indices based on a quantitative skin-test assay: Individual Allergy Index (IAI) and Population Allergy Index (PAI). The former to quantitate IgE-mediated skin test sensitivity of each subject, the latter to describe the degree of skin reactivity of our sample to a single allergen. Five allergen extracts were tested at 4-fold dilutions. Sensitivity endpoint data were used to generate IAI. Frequency distribution of IAI seemed to be bimodal as asymptomatic subjects gathered at the lower part while symptomatic children showed a peak in the middle. By means of criteria based on the relation between IAI and the prevalence of symptoms we were able to classify atopy in five classes from normal (all asymptomatic subjects) to severe atopy (all symptomatic subjects). Each positive reaction was plotted as a function of the allergen concentration eliciting the weal, and linear regression with confidence limits was calculated for grass and Dermatophagoides pteronyssinus only. PAI was represented by the slope, which depends on the reactivity of the sample, and the intercept, which involves the potency of the allergen as well. Grass and D. pteronyssinus showed the same slope while the intercepts differed. The slope increased if we considered symptomatic subjects only. We propose both these indices for clinical and epidemiological studies.

Adolescent↗
PubMed1987

Effect of two doses of inhaled diltiazem on exercise-induced asthma.

Seven asthmatic children with moderately to severely increased bronchial responsiveness to methacholine took part in a double-blind placebo-controlled study to assess the effect of a calcium channel blocker, diltiazem, on exercise-induced asthma (EIA), and its duration. On the control day, bronchial response to exercise was found to be highly reproducible when performed 2 h apart (intraclass correlation coefficient 0.92). Normal saline and diltiazem at concentrations of 1.75 and 3.50 mg/ml (estimated nebulized doses 5 and 10 mg, respectively) were given in random order before exercise on a bicycle ergometer. Exercise challenge was performed 20 min and 2 h after each treatment, and bronchial response was expressed as percent fall in the forced expiratory volume in 1 s. In the overall group, diltiazem did not significantly change resting bronchial tone and produced no significant (p = 0.18) attenuation of EIA. An almost complete protection was detected only in two subjects 20 min after diltiazem 10 mg. This limited effect waned 2 h after the administration.

Administration, Inhalation↗
PubMed1987

Refractory period to ultrasonic mist of distilled water: relationship to methacholine responsiveness, atopic status, and clinical characteristics.

Twenty asthmatic subjects had two successive methacholine challenges, two successive challenges with ultrasonically nebulized distilled water (UNDW) and an UNDW followed by methacholine on three separate days. Only ten subjects showed a refractory period to repeated UNDW stimulation. Prior stimulation with UNDW provoked increased methacholine responsiveness in the non-refractory group and a more rapid recovery from methacholine-induced bronchoconstriction in the refractory subset.

Adult↗