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Article: Usability of inhaler devices: a parameter currently misused.

Dal Negro, Roberto W

2024 Volume 19

Abstract: Inhalation represents the most convenient route for delivering respiratory drugs. Delivery systems showed a huge technological progress and several pocket inhalers had been engineered over the last decades for clinical use. Despite the growing ... ...

Abstract	Inhalation represents the most convenient route for delivering respiratory drugs. Delivery systems showed a huge technological progress and several pocket inhalers had been engineered over the last decades for clinical use. Despite the growing technological efforts aimed to simplify the inhalation procedures and optimize the therapeutic outcomes, the effectiveness of drug inhalation through inhalers still represents a major challenge in respiratory medicine. Patients may actually incur in different types of critical errors when using all inhalers and are not capable to inhale throughout all devices equally well. Therefore, the choice of the most suitable and convenient device to prescribe still is a critical issue in real life. Usability is the only comprehensive parameter consenting the effective and objective assessment of pocket inhalers' performance, and allowing their objective comparison and ranking. Unpredictable discrepancies are in fact easily detectable between inhalers (even belonging to the same class) in terms of Usability, independently of the patient's awareness. The reasons were described and discussed for each class of inhalers presently available. Usability is a multidimensional parameter that is much more multifaceted and complex than usually presumed. Usability takes origin from the integrated, balanced and objective assessment of the role played by several factors from different domains, such as: factors related to patient's beliefs, to patients' behavioural components, to device engineering and to the overall cost. Usability is the key parameter for assessing and optimizing the appropriateness of any inhalation treatment through whatever device. Usability would also represent a key investigational instrument for supporting the future development of -innovative and more performing inhaler devices objectively.
Language	English
Publishing date	2024-03-04
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2677839-7
ISSN	2049-6958 ; 1828-695X
ISSN (online)	2049-6958
ISSN	1828-695X
DOI	10.5826/mrm.2024.960
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Editorial for "Asthma and Its Impact in Adolescents" Special Issue.

Dal Negro, Roberto W

Children (Basel, Switzerland)

2023 Volume 10, Issue 11

Abstract: Bronchial asthma is a chronic disease related to the atopic condition in most cases but also to other factors (such as infectious diseases; social, economic, environmental, and occupational conditions; exposure to biological irritants; and/or chemical ... ...

Abstract	Bronchial asthma is a chronic disease related to the atopic condition in most cases but also to other factors (such as infectious diseases; social, economic, environmental, and occupational conditions; exposure to biological irritants; and/or chemical aggressions) [...].
Language	English
Publishing date	2023-11-15
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children10111811
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book: Long term oxygen therapy

Dal Negro, Roberto W. / Hodder, Richard

new insights and perspectives

2012

Title variant	Long-term oxygen therapy
Author's details	Roberto Walter Dal Negro ; Richard Hodder ed
Language	English
Size	XV, 235 S. : Ill., graph. Darst.
Publisher	Springer
Publishing place	Milan u.a.
Publishing country	Italy
Document type	Book
HBZ-ID	HT017356737
ISBN	978-88-470-2579-0 ; 88-470-2579-6 ; 9788847025806 ; 884702580X
Database	Catalogue ZB MED Medicine, Health

In stock of ZB MED Cologne/Königswinter

Shelf mark	Loan status	Location
2012 A 3377	order for loan	Magazin

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Article: Trend of Bronchial Hyperresponsiveness to Methacholine as a Cost Predictor of Mild-to-Moderate Asthma: A Twelve-Month Survey in Teenagers.

Dal Negro, Roberto W / Turco, Paola / Povero, Massimiliano

Children (Basel, Switzerland)

2023 Volume 10, Issue 12

Abstract: Bronchial asthma is characterized by variable airflow obstruction, airway inflammation, and bronchial hyperresponsiveness (BHR) to non-specific stimuli. The role of underlying airway inflammation and of related long-lasting BHR has been suboptimally ... ...

Abstract	Bronchial asthma is characterized by variable airflow obstruction, airway inflammation, and bronchial hyperresponsiveness (BHR) to non-specific stimuli. The role of underlying airway inflammation and of related long-lasting BHR has been suboptimally investigated in teenagers with mild-to-moderate asthma, as has the corresponding economic impact over time. The aim of the present study was to calculate the cost of mild-to-moderate atopic asthma in teenagers arising from their degree of persisting BHR over a twelve-month period. Methods: Patients aged 12-18 years with mild-to-moderate symptoms treated with fluticasone fumarate/vilanterol 92/22 mcg daily were retrospectively followed for 12 months. Usual spirometric parameters, BHR to methacholine (MCh), and resource consumption (visits, hospitalizations, systemic steroids and/or antibiotics courses, school days off) were assessed at recruitment (the index date) and after 6 and 12 months. Adherence to treatment was also calculated. The cost of asthma was calculated based on Italian tariffs and published papers. The trend over time in BHR and the association between response to MCh and total cost were investigated by using regression models adjusted for repeated measures. Results: 106 teenagers (53 males, age 15.9 ± 1.6 years) were investigated. The annual cost of asthma proved significantly related to the BHR trend: every increment of a factor 10 in the response to MCh was associated with a saving of EUR 184.90 (95% CI -305.89 to -63.90). BHR was progressively optimized after 6 and 12 months in relation to the patients' compliance to treatment (≥70% of prescribed inhalation doses). Conclusions: the usual spirometric parameters are largely insufficient to reflect the effects of underlying persistent inflammation in milder forms of asthma in teenagers. In terms of clinical governance, the periodic assessment of non-specific BHR is the appropriate procedure from this point of view. Non-specific BHR proves a reliable procedure for predicting and monitoring the economic impact of mild-to-moderate asthma in teenagers over time.
Language	English
Publishing date	2023-11-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children10121876
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Article: Long-lasting dyspnoea in patients otherwise clinically and radiologically recovered from COVID pneumonia: a probe for checking persisting disorders in capillary lung volume as a cause.

Dal Negro, Roberto W / Turco, Paola / Povero, Massimiliano

Multidisciplinary respiratory medicine

2022 Volume 17, Issue 1, Page(s) 875

Abstract: Background: During SARS-CoV-2 infection, diffuse alveolar damage and pulmonary microvascular abnormalities are critical events that result in gas exchange disorders of varying severity and duration. The only measure of carbon monoxide (CO) diffusing ... ...

Abstract	Background: During SARS-CoV-2 infection, diffuse alveolar damage and pulmonary microvascular abnormalities are critical events that result in gas exchange disorders of varying severity and duration. The only measure of carbon monoxide (CO) diffusing capacity (DL Methods: Patients of both genders, aged ≥18 years, who had a CT scan showing complete resolution of COVID-related parenchymal lesions were recruited consecutively. Spirometrical volumes, blood haemoglobin, SpO Results: Forty patients were recruited: 19 in group A and 21 in group B. Groups were comparable for their general characteristics and spirometrical volumes, that were in the normal range. Mean values for DL Conclusions: The single-breath, simultaneous measurement of DL
Language	English
Publishing date	2022-09-30
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2677839-7
ISSN	2049-6958 ; 1828-695X
ISSN (online)	2049-6958
ISSN	1828-695X
DOI	10.4081/mrm.2022.875
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: COPD: The Annual Cost-Of-Illness during the Last Two Decades in Italy, and Its Mortality Predictivity Power.

Dal Negro, Roberto W

Healthcare (Basel, Switzerland)

2019 Volume 7, Issue 1

Abstract: Chronic obstructive pulmonary disease (COPD) is a progressive pathological condition characterized by a huge epidemiological and socioeconomic impact worldwide. In Italy, the actual annual cost of COPD was assessed for the first time in 2002: the mean ... ...

Abstract	Chronic obstructive pulmonary disease (COPD) is a progressive pathological condition characterized by a huge epidemiological and socioeconomic impact worldwide. In Italy, the actual annual cost of COPD was assessed for the first time in 2002: the mean cost per patient per year was €1801 and ranged from €1500 to €3912, depending on COPD severity. In 2008, the mean annual cost per patient was €2723.7, ranging from €1830.6 in mild COPD up to €5451.7 in severe COPD. In 2015, it was €3291, which is 20.8% and 82.7% higher compared to the costs estimated in 2008 and 2002, respectively. In all these studies, the major cost component was direct costs, in particular hospitalization costs due to exacerbations, which corresponded to 59.9% of the total cost and 67.2% of direct costs, respectively. When the annual healthcare expenditure per patient is related to the length of survival by means of the PRO-BODE Index (PBI, which is the implementation of the well-known BODE Index with costs due to annual exacerbations and/or hospitalizations), the annual cost of care proved much more strictly and inversely proportional to patients' survival at three years, with the highest regression coefficient (r = -0.58) of all the multidimensional indices presently available, including the BODE Index (r = -021). In Italy, even though tobacco smoking has progressively declined by up to 21% in the general population, the economic impact of COPD has shown relentless progression over the last two decades, confirming that the present national health system organization is still insufficient for facing the issue of chronic diseases, in particular COPD, effectively. The periodic assessment of costs is an effective instrument for care providers in predicting COPD mortality, and for decision makers for updating and planning their social, economic, and political strategies.
Language	English
Publishing date	2019-03-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare7010035
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Article: Effects of Adherence to Once-Daily Treatment on Lung Function, Bronchial Hyperreactivity and Health Outcomes in Adolescents with Mild-to-Moderate Asthmoka: A Twelve-Month Survey.

Dal Negro, Roberto W / Turco, Paola

Children (Basel, Switzerland)

2022 Volume 9, Issue 12

Abstract: Adolescents with asthma are usually insufficiently adherent to regular inhalation treatments, thus limiting their effectiveness. The aim of this study is to investigate the role of adherence to single-inhaler long-acting LABA/ICS dry-powder combination o. ...

Abstract	Adolescents with asthma are usually insufficiently adherent to regular inhalation treatments, thus limiting their effectiveness. The aim of this study is to investigate the role of adherence to single-inhaler long-acting LABA/ICS dry-powder combination o.d. in affecting lung function, bronchial hyperreactivity, and health outcomes over a twelve-month survey of a group of non-smoking adolescents with mild to moderate asthma. Methods: Age, gender, BMI and atopy, forced expiratory volume in 1 s (FEV1), maximum mid-expiratory flow (MMEF), and maximum expiratory flow at 25% of lung filling (MEF25) were assessed via a Boolean selection process from the institutional database at recruitment, as well as after 6 and 12 months, together with the incidence of exacerbation, school days that were taken off, GP and specialist visits, and systemic steroid and/or antibiotic courses. Adherence was checked monthly via a direct telephone call. Statistics were calculated with an ANOVA trend analysis, assuming p < 0.05. Results: Two well-matched sample groups of 54 subjects each were obtained. The mean annual adherence to treatment ranged from 48.2% doses ± 10.9 sd to 79.3% doses ± 8.8 sd (p < 0.001), regardless of age and gender. Only adolescents that adhered to the o.d. ICS/LABA inhalation regimen progressively achieved complete control of all lung function parameters (FEV1: 0.001; MMEF: p < 0.002; MEF25 < 0.001; <0.001), minimized their bronchial hyperreactivity (p < 0.001), and optimized all health outcomes (p < 0.001—p < 0.002) over the survey duration. Discussion: A good adherence to treatment is essential for asthma management, particularly in young patients. Factors that are totally independent of the complexity of the therapeutic regimen adopted (namely, only a once-daily inhalation in the present survey) probably represent the major reasons limiting the adolescents’ adherence. Cultural, educational, behavioral, and psychological factors are frequently involved, are difficult to control, and can present barriers to adolescents’ asthma management. Further studies aiming to deeply understand and possibly remove the reasons for such adolescents’ attitudes are needed, in cooperation with actions oriented in this direction by families, educators, and health professionals.
Language	English
Publishing date	2022-11-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children9121854
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book: La gestione per la qualità in pneumologia

Dal Negro, Roberto W. / Farina, Martine

aspetti applicativi secondo il modello ISO 9001:2000

2001

Author's details	R. W. DalNegro ; M. Farina
Keywords	Pulmonologie ; Qualitätssicherung
Subject	Beschaffenheitssicherung ; Unternehmen ; Lungenheilkunde ; Pneumologie ; Pulmologie
Language	Italian
Size	X, 203 S. : Ill., 24 cm
Publisher	Springer
Publishing place	Milano u.a.
Publishing country	Italy
Document type	Book
Note	Literaturangaben
HBZ-ID	HT013258896
ISBN	88-470-0140-4 ; 978-88-470-0140-4
Database	Catalogue ZB MED Medicine, Health

In stock of ZB MED Cologne/Königswinter

Shelf mark	Loan status	Location
2002 A 1040	order for loan	Magazin

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Article: The contribution of patients' lung function to the inspiratory airflow rate achievable through a DPIs' simulator reproducing different intrinsic resistance rates.

Dal Negro, Roberto W / Turco, Paola / Povero, Massimiliano

Multidisciplinary respiratory medicine

2021 Volume 16, Issue 1, Page(s) 752

Abstract: Background: The performance of DPIs depends on several physiological (patient-dependent) and technological (device-dependent) factors. The inspiratory airflow rate is the only active force generated and operating in the system for inducing the required ... ...

Abstract	Background: The performance of DPIs depends on several physiological (patient-dependent) and technological (device-dependent) factors. The inspiratory airflow rate is the only active force generated and operating in the system for inducing the required pressure drop and eliciting the resistance-induced turbulence needed to disaggregate the powder through the device. The present study aimed to investigate in the most prevalent respiratory disorders whether and at what extent the inspiratory airflow rate achievable when inhaling through a DPIs' simulator reproducing different intrinsic resistance regimens (low, mid, and high resistance) is affected by peculiar changes in lung function and/or can be predicted by any specific lung function parameter. Methods: The inspiratory airflow rate was assessed in randomized order by the In-Check DIAL G16 at low, mid, and high resistance regimens in a sample of consecutive subjects at recruitment. Independent predictors of the probability to achieve the expected inhalation airflow rate were investigated by means of a multivariate logistic regression model, specific to the disease. Results: A total of 114 subjects were recruited (asthmatics n=30; COPD n=50, restrictive patients n=16, and normal subjects n=18). The mean values of the expected inspiratory airflow rate achieved proved significantly different within the groups (p<0.0001), independently of sex and age. In asthmatics and in COPD patients, the mid-resistance regimen proved highly associated with the highest mean values of airflow rates obtained. Low- and high-resistance regimens were significantly less likely to consent to achieve the expected level of inspiratory airflow rate (OR<1 in all comparisons). Restrictive patients performed the lowest airflow rates at the low-resistance regimen (p<0.01). Unlike FEV Conclusions: The intrinsic resistive regimen of DPIs can play a critical role. The patients' lung function profile also affects the extent of their inhalation airflow rate. Some specific lung function parameters (such as: FIF; RV; I
Language	English
Publishing date	2021-04-15
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2677839-7
ISSN	2049-6958 ; 1828-695X
ISSN (online)	2049-6958
ISSN	1828-695X
DOI	10.4081/mrm.2021.752
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Standard spirometry to assess emphysema in patients with chronic obstructive pulmonary disease: the Emphysema Severity Index (ESI).

Dal Negro, Roberto W / Paoletti, Matteo / Pistolesi, Massimo

Multidisciplinary respiratory medicine

2021 Volume 16, Issue 1, Page(s) 805

Abstract: Background: Chronic obstructive pulmonary disease (COPD) is a generic term identifying a condition characterized by variable changes in peripheral airways and lung parenchyma. Standard spirometry cannot discriminate the relative role of conductive ... ...

Abstract	Background: Chronic obstructive pulmonary disease (COPD) is a generic term identifying a condition characterized by variable changes in peripheral airways and lung parenchyma. Standard spirometry cannot discriminate the relative role of conductive airways inflammatory changes from destructive parenchymal emphysema changes. The aim of this study was to quantify the emphysema component in COPD by a simple parameter (the Emphysema Severity Index - ESI), previously proved to reflect CT-assessed emphysema. Methods: ESI was obtained by fitting the descending limb of MEFV curves by a fully automated procedure providing a 0 to 10 score of emphysema severity. ESI was computed in COPD patients enrolled in the CLIMA Study. Results: The vast majority of ESI values ranged from 0 to 4, compatible with no-to-mild/moderate emphysema component. A limited proportion of patients showed ESI values >4, compatible with severe-to-very severe emphysema. ESI values were greatly dispersed within each GOLD class indicating that GOLD classification cannot discriminate emphysema and conductive airways changes in patients with similar airflow limitation. ESI and diffusing capacity (DL Conclusions: Airflow limitation has heterogenous determinants in COPD. Inflammatory and destructive changes may combine in CT densitometric alterations that cannot be detected by standard spirometry. ESI computation from spirometric data helps to define the prevailing pathogenetic mechanism underlying the measured airflow limitation. ESI could be a reliable advancement to select large samples of patients in clinical or epidemiological trials, and to compare different pharmacological treatments.
Language	English
Publishing date	2021-12-06
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2677839-7
ISSN	2049-6958 ; 1828-695X
ISSN (online)	2049-6958
ISSN	1828-695X
DOI	10.4081/mrm.2021.805
Database	MEDical Literature Analysis and Retrieval System OnLINE

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