Lo studio ha mostrato una tendenza alla riduzione in generale dei parametri radiologici che quantizzano la quota di enfisema deponendo per un tendenza alla progressione della patologia.
Tale progressione è risultata associata ad un peggioramento della funzione polmonare espressa come ppFEV1; nessun evidente correlazione si è osservata con la ppDLCO.
Sia il progredire dell’età che il sesso maschile si associano ud una tendenza alla progressione dei parametri radiologici che esprimono un relativo incremento della quota di enfisema.
Le variazioni dell’abitudine al fumo, ed in particolare la cessazione del fumo nel corso dei due anni di follow-up, sono risultate significativamente associate ad un decremento del 15th perc indicativa di una riduzione della densità verosimilmente
spiegabile con una consensuale riduzione di un processo infiammatorio acuto.
Gli studi di screening rappresentano un importante data-base per poter valutare l’evoluzione dell’enfisema polmonare in popolazioni selezionate ad altro rischio. E’ in questo scenario che si inserisce il nostro studio, ottenendo dei risulti in parte concordanti con la letteratura specifica. Numerosi aspetti metodologici ed ulteriori analisi debbono essere condotte. In particolare:
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1. Confermare le analisi fin qui eseguite introducendo la correzione per il volume.
2. Eseguire ulteriori approfondimenti per confermare l’andamento dei parametri radiologici analizzati in relazione alle quattro categorie relative al fumo individuate negli studi a breve termine e confrontarlo con l’andamento opposto osservato negli studi a lungo termine.
3. Nel caso fosse confermato il punto 2 sarebbe ipotizzabile utilizzare il 15th perc
per valutare l’evoluzione longitudinale dell’enfisema, specialmente nel breve termine, soltanto nelle medesime categorie di fumo;
4. Creare un algoritmo che tenga conto della funzione polmonare e dei parametri radiologici (anche combinati) per individuare un cut-off utilizzabile come valore soglia indicativa di patologia enfisematosa.
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RINGRAZIAMENTI
Ringrazio la mia famiglia e tutte le persone che mi sono state vicine in questo percorso nei momenti più facili ed in quelli più difficili.
Ringrazio il Prof. Palla, la Dott.ssa Carrozzi, il Dott. Aquilini per avermi seguito in questo progetto.
Ringrazio tutti i miei Colleghi ed in particolare la Dott.ssa D’Amico, Dott.ssa Villari, Dott.ssa Pancani, Dott.ssa La Torre, il Dott. Airò, la Dott.ssa Mariancini e tutti Colleghi della Scuola di Specializzazione per aver condiviso con me il lavoro e
l’amicizia.
Ringrazio tutti i Medici della Pneumologia Pisana per aver contribuito alla mia formazione, sperando in una collaborazione futura.
Ringrazio tutti coloro che hanno partecipato allo studio ITALUNG consentedomi di poter fare questa tesi.
Infine ringrazio tutti i miei pazienti perché è dentro i loro sguardi che, ogni giorno, ritrovo l’entusiasmo e la bellezza del mio lavoro….
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