PNEUMOLOGIA

Advances in pulmonary medicine during the last few years are reviewed, with special regard to the pathophysiological, clinical, technological and therapeutical aspects. Important studies on respiratory mechanics, such as those on pulmonary hyperinflation, tissue resistance to airflow and respiratory muscles function (with particular attention on the concepts of transdiaphragmatic pressure and diaphragmatic fatigue) have given a great contribution to the knowledge of the most significant aspects of respiratory pathophysiology. Opportunist respiratory infections related to AIDS have aroused, as expected, great interest, while new diagnostic procedures (using molecular biology techniques, such as monoclonal antibodies and DNA probes) have opened new perspectives in early diagnosis and treatment of traditional respiratory infections diseases. Some recent studies have supported the hypothesis of bronchial epithelium hyperosmolarity as a significant factor involved in the pathogenesis of exercise-induced bronchial asthma. The importance of bronchial microcirculation changes and the role of inflammation have also been emphasized. Epidemiological studies have shown an increase of mortality in some groups of patients with bronchial asthma (the so-called 'fatal asthma') and have tried to explain the possible causes of this phaenomenon. The role of macrophages in interstitial lung diseases has been analysed in recent surveys. In pulmonary thromboembolism the use of rt-PA has opened new therapeutical perspectives. In 1987 a newer 'staging' of lung cancer has been suggested, with a better relation to prognosis. With regard to therapeutic aspects of chronic obstructive lung diseases, further contributions have been acquired on the pharmacokinetics and pharmacodynamics of newer drugs. Conclusive data are still lacking on the long-term effectiveness of vasodilator drugs (calcium-channel blockers and converting enzyme inhibitors) in the treatment of pulmonary hypertension, while the important role of domiciliary oxygen therapy in improving prognosis in patients with chronic respiratory insufficiency has been confirmed.