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Luca Fasano

Publications and source records attributed to Luca Fasano.

6 recordsLinked to original sources
PubMed2006

The presence of emphysema further impairs physiologic function in patients with idiopathic pulmonary fibrosis.

BACKGROUND: Emphysema, especially in the upper lobes, is frequently observed in association with idiopathic pulmonary fibrosis (IPF). However, the combination of emphysema plus IPF has received little attention. OBJECTIVE: To investigate the additional functional impairment from emphysema in IPF patients. METHODS: Twenty-one patients (mean age 66 y, 20 men) (Group I) who had both IPF (mean 35% of total lung volume) and emphysema (mean 14% of total lung volume) were compared to a group of 21 subjects who had IPF but no emphysema (Group II). The groups were matched for (among other criteria) the total extent of disease. Pulmonary function tests, Medical Research Council dyspnea score, 6-min walk test, and radiographic extents of both IPF and emphysema were obtained for each patient. The Composite Physiologic Index was calculated. In the total population (n = 42), the independent contributions of IPF and emphysema to several physiologic variables were investigated by using stepwise multiple regression analysis. RESULTS: Despite the limited extent of emphysema, Groups I and II had similar physiologic impairment. Only residual volume and total lung capacity were significantly higher in Group I. According to stepwise multiple regression analysis, the extent of IPF and either the presence or the extent of emphysema in the total population were independent and significant predictors of dyspnea score, 6-min walk test, P(aO2), forced expiratory volume in the first second (FEV(1)), forced vital capacity (FVC), FEV1/FVC, the diffusing capacity of the lung for carbon monoxide, carbon monoxide diffusing capacity adjusted for alveolar volume (gas-transfer coefficient), and residual volume. The Composite Physiologic Index was closely related to the extent of IPF (r = 0.65, p < 0.0001) and to the dyspnea score (rho = 0.59, p < 0.0001). CONCLUSIONS: In former smokers with IPF, the presence and the extent of emphysema have a profound influence on physiologic function in terms of both further impairment and confounding effects.

Adult↗
PubMed2005

Bullous emphysema versus diffuse emphysema: a functional and radiologic comparison.

The contribution of bullous emphysema (BE) to the functional impairment of patients with concomitant diffuse emphysema (DE) and the confounding effects of BE on functional measurements were investigated. Twenty-nine patients (Group I), with BE and DE were compared with a group of patients without BE matched, among other criteria, for radiographic extent of DE (Group II). Group I showed significantly lower PaO2, FEV1 and DLCO values and higher MRC score than Group II. In Group I the radiographic extent of BE and the extent of DE did not predict the functional impairment. The FEV1/FVC ratio in the subgroup with BE extent > 25% of total lung volume was higher than in subgroups with BE extent > 20% and 15%, respectively. In the same subgroups the correlation between DE and DLCO increased with the extent of BE. We conclude that BE contributes to the functional impairment of patients with concomitant DE. The confounding functional effect of bullae depends on BE extent: relatively milder obstruction can be observed with severe BE, whereas moderate BE causes modest deterioration of diffusing capacity, explaining the lack of functional-radiologic correlations in Group I. Therefore the computed tomographic scan is very useful in the work-up of BE with DE associated.

Aged↗
PubMed2005

Inflammatory activity is still present in the advanced stages of idiopathic pulmonary fibrosis.

OBJECTIVE: The role of active inflammation in idiopathic pulmonary fibrosis (IPF) is controversial. A gallium-67 citrate (Ga(67) scan) is a sensitive indicator of inflammatory activity. The aim of this study was to assess the Ga(67) uptake and other markers of inflammation at different stages of IPF and to investigate its prognostic role. METHODOLOGY: Twenty-two patients (aged 66 +/- 11 years, 18 males) with IPF were monitored for a period of 6-20 months (mean 13 months). At presentation (T0), high resolution CT (HRCT) scans showed reticular opacities and traction bronchiectasis with bi-basilar and peripheral distribution in all cases. At both T0 and follow-up (T1), we measured pulmonary function (PaO(2), FVC, DLco), overall radiographic extent of fibrosis (HRCT visual score), Ga(67) uptake, serum concentrations of lactate dehydrogenase (LDH) and C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). RESULTS: All parameters showed a significant deterioration during the T0-T1 interval, though the increase in Ga(67) uptake and serum markers was not significant. Patients with Ga(67) uptake indices graded as normal or mildly increased (group I), and graded as considerably or severely increased (group II) at presentation, were compared. There was no significant difference with respect to lung function or HRCT score between the two groups at T1. Ga(67) uptake, LDH, CRP and ESR at presentation did not correlate significantly with the interval change in pulmonary function and disease extent. CONCLUSIONS: Our findings indicate that inflammatory activity in the advanced stage of IPF is still relevant, although a Ga(67) scan is not predictive of the clinical course.

Adult↗
PubMed2004

Does technetium-99m diethylenetriaminepentaacetate clearance predict the clinical course of idiopathic pulmonary fibrosis?

Clearance of inhaled technetium-99m diethylenetriaminepentaacetate (99mTc-DTPA) is a potential indicator of disease activity and progression in idiopathic pulmonary fibrosis (IPF). The objective of the present study was to evaluate the prognostic value of 99mTc-DTPA scans in IPF. A total of 22 patients (18 males), aged 33 to 80 years with IPF were followed for six to 20 months (mean 13 months). At diagnosis, high resolution computed tomography (HRCT) scans showed a honeycomb pattern with bibasilar reticular opacities in all cases. At T0 (diagnosis) and T1 (follow-up), each patient had pulmonary function tests (forced vital capacity, diffusing capacity of the lung for carbon monoxide and partial arterial O2 pressure), extension of fibrosis evaluated by HRCT visual score and 99mTc-DTPA lung clearance. Results at T0 and T1 were compared, taking into account the whole population and patients with relatively fast and slow 99mTc-DTPA wash-out. 99mTc-DTPA clearance did not show any significant correlation with functional tests or HRCT score. These findings indicate that clearance of inhaled 99mTc-DTPA is not of value in following the progress of IPF.

Administration, Inhalation↗
PubMedDate not supplied

Progressive worsening of idiopathic pulmonary fibrosis. High resolution computed tomography (HRCT) study with functional correlations.

PURPOSE: To evaluate the usefulness of the high-resolution computed tomography (HRCT) visual score in idiopathic pulmonary fibrosis (IPF) and its correlation with respiratory function tests. MATERIAL AND METHODS: We studied the pulmonary function tests and HRCT scans of 42 IPF patients, at presentation (T0) and follow-up (T1: mean 13.7 months post-diagnosis). Of the 42 patients, 21 had been treated with steroid and immunosuppresion therapy. The pulmonary function tests considered were vital capacity (VC), diffusion lung capacity for carbon monoxide (D(L)CO) and arterial blood oxygen partial pressure (PaO(2)). The main HRCT parameters were type of lesion, and site and extent, the latter calculated by means of the visual score. RESULTS: Between T0 and T1, both mean HRCT score (from 43.57% to 50.64%) and lung function tests worsened (VC from 68.43% to 64.18%; D(L)CO from 36.31% to 28.97%; PaO(2) from 76.31 to 68.89 mmHg), without considerable differences between treated and untreated patients. At presentation (T0), the HRCT visual score had a significant correlation with lung function tests and these correlated with one another. Similar correlations were found at T1, but not for HRCT score and D(L)CO. In the interval between T0 and T1 the variations correlated significantly with each other, with two exceptions: HRCT score and D(L)CO, and D(L)CO and PaO(2). DISCUSSION AND CONCLUSIONS: IPF exhibited a progressive deterioration both in HRCT extent of disease and lung function impairment. There is a significant correlation between HRCT visual score and lung function tests both at diagnosis and at follow-up. The HRCT study is able to identify and quantify anatomic IPF and also to evaluate the progression of the disease. In clinical practice, the HRCT visual score of disease extent can be used in association with function tests to monitor IPF evolution, and to evaluate prognosis and therapy. In the future, helical CT with 3D model construction will provide a more precise IPF quantification with automatic score.

Aged↗