Background. Oxidative stress plays a role in the pathogenesis of many chronic inflammatory lung diseases. Exhaled breath condensate (EBC) collection is a noninvasive method to investigate pulmonary oxidative stress biomarkers such as malondialdehyde (MDA). Subjects and Methods. We measured MDA levels in EBC in a large number of patients (N = 194) with respiratory diseases: asthma (N = 64), bronchiectasis (BE, N = 19), chronic obstructive pulmonary disease (COPD, N = 73), idiopathic pulmonary fibrosis (IPF, N = 38). Fourteen healthy nonsmoking subjects were included as controls. Results. Excluding IPF subjects, MDA levels were significantly higher in all disease groups than in control group. MDA was significantly higher in COPD than asthmatic and BE subjects. Among asthmatics, corticosteroids-treated subjects had lower MDA levels than untreated subjects. COPD subjects showed an inverse correlation between MDA concentrations and FEV1% (rho:  −0.24, P < .05). Conclusions. EBC-MDA is increased in subjects with chronic airway disorders, particularly in COPD, and it is related to FEV1 reduction.

ACT score is a valid tool to simply assess the current level of asthma control in terms of symptoms, rescue medication use, and PEF variability. Pulmonary function and biomarkers of airway inflammation are not related to the clinical asthma control as assessed by ACT and may represent additional measurements potentially useful in asthma management.

BackgroundTuberculosis (TB) surveillance systems have some pitfalls outside of a National Tuberculosis Program and lack of efficient surveillance hampers accurate epidemiological quantification of TB burden.In the present study we assessed the quality of surveillance at the University Hospital in Pisa (UHP), Italy, and TB incidence rates over a ten year period (1999–2008).MethodsAssessment of underreporting was done by record-linkage from two sources: databases of TB diagnoses performed in the UHP and the Italian Infectious Disease Surveillance (IIDS) system. Two different databases were examined: a) TB diagnoses reported in the Hospital Discharge Records (HDR) from three Units of UHP (Respiratory Pathophysiology, Pulmonology and Infectious Diseases Units) (TB database A); b) TB diagnoses reported in HDR of all Units of UHP plus TB positive cases obtained by the Laboratory Register (LR) of UHP (TB database B). For the TB database A, the accuracy of TB diagnosis in HDR was assessed by direct examination of the Clinical Record Forms of the cases. For the TB database B, clinical and population data were described, as well as the trend of incidence and underreporting over 10 yrs.ResultsIn the first study 293 patients were found: 80 patients (27%) with a confirmed TB diagnosis were underreported, 39 of them were microbiologically confirmed. Underreporting was related to age (Reported vs Non Reported, mean age: 49.27 ± 20 vs 55 ± 19, p < 0.005 ), diagnosis (smear positive vs negative cases 18.7 vs 81.2%, p = 0.001), microbiological confirmation (49% vs 51%, p < 0.05), X-ray findings (cavitary vs non-cavitary cases: 12.5 vs 87.5%, p = 0.001) but not to nationality.In the second study, 666 patients were found. Mean underreporting rate was 69.4% and decreased over time (68% in 1999, 48% in 2008). Newly diagnosed TB cases were also found to decrease in number whereas immigration rate increased. Underreporting was related to nationality (Immigrants vs Italians: 18% vs 68%, p < 0.001), diagnosis (microbiological confirmation: 25% vs 75%, p < 0.01), kind of hospital regimen (hospitalized patients vs Day Hospital: 70% vs 16%, p < 0.001), and position of TB code in the HDR (TB code in first position vs in the following position: 39,5% vs 45% p < 0.001).ConclusionsTB is underreported in Pisa, particularly in older patients and those without microbiological confirmation. The TB code in first position of HDR seems fairly accurate in confirming TB diagnosis.

The modulatory effect of nasal respiration on integrative brain functions and hence consciousness has recently been unambiguously demonstrated. This effect is sustained by the olfactory epithelium mechanical sensitivity complemented by the existence of massive projections between the olfactory bulb and the prefrontal cortex. However, studies on slow nasal breathing (SNB) in the context of contemplative practices have sustained the fundamental role of respiratory vagal stimulation, with little attention to the contribution of the olfactory epithelium mechanical stimulation. This study aims at disentangling the effects of olfactory epithelium stimulation (proper of nasal breathing) from those related to respiratory vagal stimulation (common to slow nasal and mouth breathing). We investigated the psychophysiological (cardio-respiratory and electroencephalographic parameters) and phenomenological (perceived state of consciousness) aftereffects of SNB (epithelium mechanical – 2.5 breaths/min) in 12 experienced meditators. We compared the nasal breathing aftereffects with those observed after a session of mouth breathing at the same respiratory rate and with those related to a resting state condition. SNB induced (1) slowing of electroencephalography (EEG) activities (delta-theta bands) in prefrontal regions, (2) a widespread increase of theta and high-beta connectivity complemented by an increase of phase-amplitude coupling between the two bands in prefrontal and posterior regions belonging to the Default Mode Network, (3) an increase of high-beta networks small-worldness. (4) a higher perception of being in a non-ordinary state of consciousness. The emerging scenario strongly suggests that the effects of SNB, beyond the relative contribution of vagal stimulation, are mainly ascribable to olfactory epithelium stimulation. In conclusion, slow Pranayama breathing modulates brain activity and hence subjective experience up to the point of inducing a non-ordinary state of consciousness.