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S Cossi

Publications and source records attributed to S Cossi.

9 recordsLinked to original sources
PubMed2001

Changes in FVC during methacholine-induced bronchoconstriction in elderly patients with asthma: bronchial hyperresponsiveness and aging.

STUDY OBJECTIVE: We evaluated whether aging may produce changes in bronchial hyperresponsiveness, risk of enhanced bronchoconstriction, and changes of bronchoconstriction perception. SETTING: Each subject underwent a methacholine bronchial challenge. Methacholine challenge was stopped when one of the following conditions occurred: (1) plateau of bronchoconstriction; (2) decrease of FEV(1) > 40%; (3) FEV(1) drop below 1 L; or (4) excessive respiratory discomfort. Methacholine dose-response curves were plotted both for FVC and FEV(1). The provocative dose of methacholine causing a 20% decrease in FEV(1) with respect to baseline (PD(20)) and the fall in FVC (DeltaFVC) at PD(20) were computed. The Borg scale was used for scoring the perception of respiratory discomfort. PATIENTS: We compared 17 young asthmatic patients (aged 22 to 45 years) with 17 older asthmatic patients (aged 63 to 78 years) selected on the basis of similar baseline pulmonary function and disease duration. RESULTS: No significant between-group difference was found in PD(20) and in plateau development. Conversely, DeltaFVC was significantly higher in the older group (mean +/- SD, 15.5 +/- 3.9% vs 11.6 +/- 5.5% in younger patients). In addition, DeltaFVC showed a positive linear relationship with age (p = 0.0026). Elderly subjects were less aware of bronchoconstriction during the methacholine challenge (p = 0.04). CONCLUSIONS: In elderly patients with asthma having comparable pulmonary function and disease duration, bronchial responsiveness is not different from that observed in younger asthmatic patients. Nevertheless, in such patients, an age-related tendency to an enhanced bronchoconstriction and a reduced perception of the degree of bronchoconstriction exist.

Adult↗
PubMed1997

[Respiratory medicine in the aged. Therapeutic problemsd].

Chronic obstructive pulmonary disease (COPD) is very common in the elderly, and its treatment needs special concern. Data from two clinical studies (in-patients of an Internal Medicine Department and Nursing-Home, respectively) have been evaluated in order to compare therapeutic approaches to COPD in three separate settings: home, hospital and Nursing-Home. Less than 50% of the overall patients received medical treatment according to the guidelines emerged in the literature. Although cardiovascular problems were highly common in out-patients, their bronchodilator therapy included systemic beta 2-agonists. Theophylline was the main drug prescribed to in-patients discharged from hospital, although inhaling beta 2-agonists were also recommended in few cases. Topical steroids have been widely used. Nursing-Home patients received mostly systemic steroids and few of them had theophylline and inhaling steroids. Anti-cholinergic drugs have never been employed in the overall population of elderly patients. Data concerning medical treatment of infectious respiratory diseases of Nursing-Home patients (both with and without COPD) have also been evaluated. Antimicrobial therapy has been performed according to the special needs of the elderly. During COPD reacutizations, beta 2-agonists and, again, theophylline consumption increased.

Adrenal Cortex Hormones↗
PubMed1996

[Reversible broncho-obstruction (asthma and COPD) in the elderly patient. Epidemiologic, diagnostic, and therapeutic features].

In the field of respiratory diseases during aging, obstructive diseases hold a prominent position because they are frequent and are potentially "tractable" and thus subjected to careful therapeutic intervention. Bronchial asthma and chronic obstructive pulmonary disease are most important clinical patterns. Bronchial asthma (in chronic and in uncommon, newly diagnosed, forms) in the elderly are more frequent than commonly known. Wider and deeper studies of chronic obstructive pulmonary disease, besides, have demonstrated that a component of reversibility is present even in the older patients, in a ratio of 20-40%. The reversible bronchial obstruction appears therefore, in the older patients, as a qualitatively and quantitatively important event, in the clinical and therapeutical field. The recent production of international Guidelines (ATS/ERS, 1995) gives the possibility--for this type of diseases--of utilizing more accurate diagnostic criteria and new therapeutic approaches.

Aged↗
PubMed1995

[Respiratory medicine in geriatrics. A cultural niche of relevant theoretical and practical importance].

Respiratory medicine in the elderly represents a topic of increasing interest in the developed countries, because of its peculiar clinical and therapeutical implications. In this respect, a deeper knowledge of the biology and physiology of aging lung is desirable: namely, the age-related immunological and structural changes involving the respiratory system do influence clinical presentation and response to the treatment in older people. A better understanding of the pharmacology in the elderly which is recognized to be different for several aspects from that of the general population, is mandatory in order to better approach these practical problems. This short review emphasizes the need of the "longitudinal", rather than "transversal", epidemiological surveys which are uniquely able to give useful information on the natural history, even in older populations. In addition, clinical and therapeutical peculiarities of some respiratory illnesses such as infectious lung diseases, including pulmonary tuberculosis, COLD and bronchial asthma, sleep-related respiratory disorders will be underlined. Finally, a few problems concerning the management of the geriatric subject with chronic respiratory disease will be analyzed, focusing mainly on the difficulties inherent in the inhalant therapy and functional evaluation of this kind of patients.

Aged↗
PubMedDate not supplied

[Cognitive deficiency in internal medicine].

Although patients admitted to Internal Medicine Departments are often older than 65 years, the "new geriatric culture" comes into conflict with the traditional goals of Medicine (diagnosis-therapy-recovery). Multidimensional assessment permits global evaluation of the needs and problems of the elderly patient and consequently guarantees an adequate and complete therapeutic plan. This approach is particularly valid if applied in a Medical Division because acute illnesses can compromise a functional state that is already in precarious equilibrium due to frequent multiple pathologies. Moreover, thanks to an accurate evaluation of this type, it is possible to recognize patients with cognitive deficits and diagnose dementia early. In the present study, we utilized a geriatric multidimensional assessment in our Department of Internal Medicine to search for cognitive impairment. Dementia was found in 20% of the geriatric patients: 29% were affected by Alzheimer's disease and 44% had vascular dementia. We evaluated the physical health, functional ability, psychological and socio-economical status together with behavioral syndromes.

Aged↗