Bronchodilator Response in Patients with Persistent Allergic Asthma Could Not Predict Airway Hyperresponsiveness

<p/> <p>Anticholinergics, or specific antimuscarinic agents, by inhibition of muscarinic receptors cause bronchodilatation, which might correlate with activation of these receptors by the muscarinic agonist methacholine. The aim of this study was to determine whether a positive bronchodilator response to the anticholinergic ipratropium bromide could predict airway hyperresponsiveness in patients with persistent allergic asthma. The study comprised 40 patients with mild and moderate persistent allergic asthma. Diagnosis was established by clinical and functional follow-up (skin-prick test, spirometry, bronchodilator tests with salbutamol and ipratropium bromide, and methacholine challenge testing). The bronchodilator response was positive to both bronchodilator drugs in all patients. After salbutamol inhalation, forced expiratory volume in 1 second (FEV₁) increased by 18.39 ± 6.18%, <it>p </it>< .01, whereas after ipratropium bromide, FEV₁increased by 19.14 ± 6.74%, <it>p </it>< .01. The mean value of FEV₁decreased by 25.75 ± 5.16%, <it>p </it>< .01 after methacholine (PC₂₀FEV₁[provocative concentration of methacholine that results in a 20% fall in FEV₁] from 0.026 to 1.914 mg/mL). Using linear regression, between methacholine challenge testing and bronchodilator response to salbutamol, a positive, weak, and stastistically significant correlation for FEV₁was found (<it>p </it>< .05). Correlations between methacholine challenge testing and the bronchodilator response to ipratropium bromide were positive and weak but not statistically significant. The positive bronchodilator response to ipratropium bromide could not predict airway hyperresponsiveness.</p

COPD Phenotypes

Na području liječenja kronične opstruktivne plućne bolesti (KOPB-a) postoji već duga povijest kliničkih smjernica, koje omogućuju liječnicima da kod svojih bolesnika integrirana znanja primijene s pomoću najboljih terapijskih algoritama. U novijim istraživanjima rabe se klasterske analize za grupiranje heterogenih osobina u relativno homogene grupe (subjekti iste grupe sličniji su jedni drugima nego subjektima iz drugih grupa). Na taj način osmišljena je klasifikacija bolesnika oboljelih od KOPB-a u tzv. fenotipove. Fenotip se općenito definira kao zbroj vanjskih karakteristika organizma, a odraz je interakcije genotipa i utjecaja vanjskih faktora. Obuhvaća strukturu, funkciju, morfološke, anatomske, fiziološke, biokemijske i biofizičke karakteristike. U ovom članku prikazali smo nekoliko najčešćih fenotipova KOPB-a koji se spominju u najvećem broju studija: 1. fenotip čestih egzacerbacija, 2. fenotip emfizema i hiperinflacije, 3. fenotip brzoga gubitka plućne funkcije, 4. fenotip kroničnog bronhitisa, 5. fenotip sa sistemskim manifestacijama (komorbiditetom), 6. sindrom preklapanja ili fenotip miješanog KOPB-a i astme. Podjela na fenotipove nastala je zbog činjenice da prognoza i terapijski pristup bolesniku s KOPB-om ovise o kliničkom fenotipu. Cilj klasifikacije jest heterogenu populaciju oboljelih od KOPB-a grupirati u fenotipove koji imaju različitu prognozu i definiraju optimalan terapijski pristup.The treatment of chronic obstructive pulmonary disease (COPD) has a long history of clinical guidelines enabling physicians to apply integrated knowledge through best therapeutic algorithms when treating their patients. The latest studies have used cluster analyses for grouping heterogeneous characteristics into relatively homogenous groups (the subjects in the same group are more similar to each other than to subjects in other groups). This classifies the patients suffering from COPD into the so-called phenotypes. A phenotype is generally defined as a sum of an organism’s external characteristics, and it reflects the interaction of genotypes and the impact of external factors. It encompasses structure and function, as well as morphological, anatomic, physiologic, biochemical and biophysical characteristics. This article deals with the most common COPD phenotypes, mentioned in the largest number of studies: 1. frequent exacerbation phenotype, 2. emphysema-hyperinflation phenotype, 3. rapid decline in lung function phenotype, 4. chronic bronchitis phenotype, 5. systemic manifestations (comorbidities) phenotype, and 6. asthma-COPD overlap syndrome. The phenotype classification has occurred as a result of the fact that the prognosis and therapeutic approach to COPD patients are reliant on the clinical phenotype. The aim of the classification is to group the heterogeneous population of COPD patients into phenotypes with different prognoses and to define an optimal therapeutic approach

Are women suffering from COPD more sensitive to tobacco and its ingredients?

Cilj: Cilj ovog istraživanja bio je utvrditi postoji li razlika u težini bolesti između muškaraca i žena oboljelih od kronične opstruktivne plućne bolesti (KOPB-a), čija se etiologija pripisuje pušenju. Ispitanici i metode: Istraživanje je obuhvatilo 250 ispitanika oboljelih od KO- PB-a. Ispitivani uzorak činile su 82 žene (32,8 %) i 168 muškaraca (67,2 %) prosječne životne dobi od 68,2 g. Ispitanici su podijeljeni u 2 skupine shodno spolu. Svaka ispitivana skupina potom je podijeljena na podskupine nepušača, bivših pušača i aktivnih pušača. U skupini žena dominirali su nepušači (N = 35; 42 %), a u skupini muškaraca pušači (N = 58; 34,5 %). Ispitanici su podijeljeni prema kriterijima GOLD-a iz 2010. godine u 3 skupine, ovisno o težini bolesti (GOLD I, GOLD II i GOLD III). Rezultati: Usporedba pušačkih godina, tj. broja cigareta popušenih na dan podijeljenog s 20 (broj cigareta u kutiji) i potom pomnoženog s brojem godina pušenja (engl. pack/year; p/y) bivših i aktivnih pušača obaju spolova pokazuje da između spolova postoji razlika u težini bolesti. Ukupno manji broj žena bivših i aktivnih pušača s nižim prosječnim p/y postiže isti stupanj težine bolesti kao muškarci sa znatno većim prosječnim p/y (p = 0,009). Zaključak: Rezultati upućuju na moguću jaču osjetljivost žena na djelovanje duhanskog dima i njegovih sastojaka na dišne puteve od muškaraca.Aim: To determine the possible difference in disease severity between men and women suffering from chronic obstructive lung disease (COPD) attributed to smoking. Sub- jects and methods: The study comprised a total of 250 subjects suffering from COPD: 82 (32,8 %) women and 168 (67,2 %) men with the average age of 68.2 years. Subjects were first divided into two gender-based groups. Each of the latter groups was subsequently subdivided into the following subgroups: non-smokers, ex-smokers and active smokers. The study group comprised of women was dominated by non-smokers (N = 35; i.e. 42 %), while that comprised of men was dominated by smokers (N = 58; i.e. 34.5 %). In line with the GOLD criteria observed back in 2010, subjects were divided into three groups (GOLD I, GOLD II and GOLD III) based on their disease severity. Results: Comparison of the length of smoking expressed in the number of cigarettes smoked per day divided by 20 (no of cigarettes in a single pack) and further multiplied by the number of years of active smoking (pack/year; p/y), made be- tween former and active smokers of both genders, shows inter-gender differences in disease severity. A lower total number of former and active female smokers having a lower p/y attains the same degree of the disease severity as men having a substantially higher p/y (p =0.009). Conclusion: The results of this study suggest that female airways might be more sensitive to tobacco smoke and its ingredients as compared to those of men

Exogenous lipoid pneumonia after petroleum aspiration: a case report

Cilj: Prikazati slučaj 42-godišnjeg bolesnika koji je upućen zbog aspiracijske pneumonije srednjeg režnja pluća, refrakterne na terapiju, koja je nastala kao posljedica aspiracije nafte. Prikaz slučaja: Nakon učinjene bronhoskopske i radiološke obrade, na nalazu kompjutorizirane tomografije grudnog koša i dalje perzistira infiltrat srednjeg režnja s destrukcijom i nekrozom, pa se torakokirurški odstranila tvorba. Patohistološki nalaz odgovara kroničnoj lipoidnoj bronhopneumoniji. Zaključak: Lipoidna pneumonija je rijedak oblik pneumonije koji predstavlja dijagnostički i terapijski izazov. Potrebno je razmišljati o ovoj bolesti, koja se može javljati u akutnom, ali i kroničnom obliku. Katkad može izazvati destrukciju i nekrozu, refrakternu na svu terapiju, pa torakotomija može biti najbolje rješenje za bolesnika.Aim: To report the case of a 42-year old patient, who was was reffered because of non resolving middle lobe aspiration pneumonia caused by petroleum aspiration. Case report: Fiberopticbronchoscopy and chest radiograph were performed to evaluate the non resolving pneumonia. Chest radiography and bronchoscopy revealed consolidation in the middle lobe. Computerized tomography scan revealed the same consolidation in the middle lobe with cavitation and necrosis, and toracotomy was indicated. Histological analysis revealed chronic lipoid pneumonia. Conclusion: Lipoid pneumonia is a rare condition, which represents a diagnostic and therapeutic challenge. Therefore, physicians should be aware of this disease, which can present in an acute, as well as a chronic respiratory illness. Once diagnosed, it can be progressive, causing necrosis and cavitation, which may require thoracotomy as the best solution for the patient