Szinergista és antagonista immunmechanizmusok felnőttkori akut súlyos asthmában. Kísérletes és klinikai vizsgálatok. = Acute exacerbations of asthma in adults. Experimental and clinical studies of synergistic and antagonistic immune mechanisms

Terhesség alatt asthma bronchialeban kulminálódó T lymphocyta proliferáció alakul ki. A felszaporodó T sejtek fenotípus tekintetében döntően IFNgamma termelők és ezek száma a perifériás vérben szignifikáns inverz összefüggést mutat a kilégzési csúcsáramlással és az újszülött születési súlyával. Endotoxin expozíció hatására a kísérletes allergiás légúti gyulladás súlyosbodik és szisztémás szteroid kezelésre refrakterré válik. Létrehoztunk egy szteroid refrakter asthma modellt. Az új, szelektív iNOS inhibitor 1400W blokkolja a légúti hyperreaktivitást akkor is, ha az szteroid refrakter. Histaminhiányos egértörzsben kísérletes allergiás asthma enyhébbé válik, kisebb a légúti hyperreaktivitás és a légutak celluláris gyulladása is. A histamin tehát nemcsak egyik mediátora a bronchoconstrictionak, hanem a pathogenezis korai lépéseihez is hozzájárul. A légútak allergizálása nemcsak Th2-es típusú cytokinek és chemokinek, hanem Th1-es típusúak fokozott képződését is maga után vonta. Más kísérleteinkben a postischaemiás akut veseelégtelenség (shock-vese modell) kialakulásában a VEGF és az IL-6 szerepét vizsgáltuk. Igazoltuk, hogy a postischaemiás vesében fokozódik a VEGF fehérjeszint anélkül, hogy a VEGF mRNS tartalom is növekedne. Egyúttal a renalis IL-6 szintézis is jelentősen növekedett és mivel az IL-6 elősegíti a VEGF posttranszkripciós képződés fokozódását, e két intrarenalis szignálnak kapcsolata lehet egymással és a vese postischaemiás regenerációjával. | Culminating T lymphocytosis develops during pregnancy in asthmatic women. Proliferating T cells are those synthesizing IFNgamma, the number of which shows significant inverse correlation with peak exspiratory flow and body weight of the newborn. Exposure to endotoxin exaggerates allergic airway inflammation and airway hyperresponsiveness. In addition, these features become refractory to steroid treatment. A model of steroid resistant asthma has been established. The new, selective inhibitor of iNOS, 1400W successfully reversed airway hyperresponsiveness even if it was refractory to dexamethasone. Experimental allergic asthma is alleviated by genetic deficiency of histamine as indicated by reduced cellular inflammation and hyperresponsiveness of the airways. Thus, histamine is an important early mediator during the development of allergic inflammation of the airways. In this study it was also documented that allergic airway inflammation was associated with a mixed (T2+T1) phenotype of cytokine and chemokine synthesis. In other experiments it was shown that the formation of VEGF and IL-6 were increased in the postischemic kidney (a model of the human shock-kidney). These signals have not been known earlier in this model and may contribute to the postischemic regeneration of the kidney

Clinical effectiveness of budesonide/formoterol fumarate easyhaler for patients with poorly controlled obstructive airway disease: a real-world study of patient-reported outcomes

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Eritropoetin-béta-kezelés tüdőrákban – Hatékonyság és életminőség-javulás a klinikai gyakorlatban = Supportive treatment with beta-erythropoietin in patients with lung cancer – Clinical data analysis of quality of life and effectiveness

Daganatos betegek körében gyakori szövődmény az anaemia, amelyet maga a betegség vagy az onkológiai kezelés okozhat. A vérszegénység rontja a betegek életminőségét, valamint a citotoxikus kezelés dóziscsökkentéséhez, illetve késleltetéséhez vezethet. A jelen retrospektív adatelemzés célja az volt, hogy elemezze 19 egymás után felvett, tüdőrákban szenvedő betegünk kemoterápia okozta anaemiájának béta-eritropoetinnel történő szupportációja során a betegek életminőségének és hemoglobinkoncentrációjának alakulását. A betegek átlagos, eritropoetinterápia előtti hemoglobinkoncentrációja 96,31±6,72 g/L volt (átlag±SD). Az anaemia szupportációjának befejezésekor az átlagos hemoglobinkoncentráció szignifikáns mértékben magasabb, 111,63±14,05 g/L volt (p<0,05). A 19 beteg kezelése során 4 esetben volt szükség transzfúzióra. A betegek eritropoetin bevezetését megelőző átlagos életminőséget jellemző teljes pontszáma 22,89±5,67 volt, és szignifikáns mértékben javult a szupportáció mellett (27,84±6,14; p<0,05). A kemoterápia okozta anaemiában szenvedő betegek életminőségének eritropoetin-béta-szupportáció mellett észlelt szignifikáns mértékű javulása megnyilvánult az alábbi részpontszámok szignifikáns mértékű javulásában: szédülést, tachycardiát, gyengeséget jellemző részpontszámok. A kis betegszám és az alkalmazott saját, csupán a betegdokumentáción alapuló kérdőív validáltságának hiánya természetesen korlátozza az adatok értékelhetőségét, az adatelemzés eredményei azonban felhívják a figyelmet az időben bevezetett erythropoeticus proteinszupportáció által biztosított jobb életminőség és alacsony transzfúziós szükséglet elérésének lehetőségére ebben az egyébként nagyon súlyos betegcsoportban. Orv. Hetil., 2010, 41, 1684–1688. | Anemia is common among patients with malignant tumors, due to the disease and chemotherapy. Anemia decreases patient’s quality of life, and worsens the dose-intensity of chemotherapy. The aim of this retrospective data-analysis was to evaluate quality of life and hemoglobin levels in 19 consecutive lung cancer patients receiving beta-erythropoietin, due to chemotherapy induced anemia. A self developed, patient source data based quality of life questionnaire was used. The mean pre-erythropoietin hemoglobin concentration of the patients was 96.31±6.72 g/L (mean±SD), the post-treatment hemoglobin concentration 111.63±14.05 g/L (p<0.05). During the chemotherapy of the 19 patients with lung cancer, transfusion was given only four times. The mean quality of life total score of the patients increased significantly during erythropoietin treatment that was resulted by the improvements of scores determining dizziness, tachycardia, and fatigue. Main limitations of this real life data analysis are low patient number and the lack of validation in the used questionnaire. In summary, according to our experiences, the use of beta-erythropoietin in patients with lung cancer results improved quality of life and a low rate of transfusions. Orv. Hetil., 2010, 41, 1684–1688

A parlagfű okozta légzőszervi allergiás megbetegedések előfordulása Magyarországon

INTRODUCTION: Although the prevalence of ragweed allergy in Europe is still low, it is increasing according to recent statistics. In contrast, in Hungary ragweed is the most common allergen with very high sensitisation in the general Hungarian population. AIM: We investigated the number and clinical characteristics of ragweed allergy in the Hungarian population, as the first comprehensive study to evaluate ragweed allergy in Hungary. METHOD: One thousand Hungarian adult subjects were screened with a questionnaire for ragweed allergy. People with ragweed allergy answered further specific questions about their disease history, symptoms and medication use. RESULTS: 305 subjects reported allergy from which 218 patients had symptoms during ragweed pollination suggesting ragweed allergy. 40% of these had symptoms for more than 5 years. Asthma was reported in 18.3%. Around 24% of these patients were undiagnosed; they did not take any medications or visited professionals because of their symptoms. Compared to the non-ragweed allergic patients, subjects with ragweed allergy were older and better educated, but the dominance of female gender was less prominent than in the non-ragweed group (all p<0.05). CONCLUSIONS: Around 22% of the Hungarian population suffers from ragweed allergy. Studies should focus on eradication strategy and improvement of patient care. Orv. Hetil., 2016, 157(50), 1989-1993

Asthma bronchiale és krónikus obstruktív tüdőbetegség együttes megjelenése = Asthma and chronic obstructive pulmonary disease overlap

Az asthma bronchiale és a krónikus obstruktív tüdőbetegség a légutak gyulladásával járó leggyakoribb tüdőbetegségek. A nemzetközi és hazai irányelvek jól meghatározzák a két betegség jellemzőit, diagnosztikáját és terápiáját. Mégis, a klinikai gyakorlatban mind gyakrabban észlelhető a két kórforma együttes megjelenése, átfedése. Ez a betegcsoport soha nem kerül az irányelvek alapjául szolgáló nagy, multicentrikus, randomizált, kontrollált tanulmányokba, ezért az asthma bronchiale és a krónikus obstruktív tüdőbetegség együttes megjelenésének diagnosztikájára és főleg kezelésére nem találunk útmutatást. Jelen összefoglaló áttekinti az asthma és a krónikus obstruktív tüdőbetegség együttes megjelenésének klinikai jellemzőit, valamint a mindennapi pulmonológiai gyakorlatban is alkalmazható példákat foglal össze. Orv. Hetil., 2011, 152, 114–118. | Asthma bronchiale and chronic obstructive pulmonary disease are the most prevalent lung diseases characterized by inflammation of the airways. International and Hungarian guidelines privide proper definitions for clinical symptoms, diagnostics and therapy of both diseases. However, in everyday clinical practice, overlap of asthma and chronic obstructive pulmonary disease has become more frequent. As guidelines are mainly based on large, multicenter, randomized, controlled trials that exclude overlap patients, there is a lack of diagnostic and especially therapeutic strategies for these patients. This review summarizes clinical characteristics of asthma and chronic obstructive pulmonary disease overlap, and provides daily practical examples for its management. Orv. Hetil., 2011, 152, 114–118

Inhaler Competence and Patient Satisfaction with Easyhaler: Results of Two Real-Life Multicentre Studies in Asthma and COPD.

OBJECTIVE: The aim of this study was to investigate patients' inhaler competence and satisfaction with the Easyhaler(R) dry powder inhaler. DESIGN: Two open, uncontrolled, non-randomised studies. SETTING: Real life based on patients attending 56 respiratory clinics in Hungary. PARTICIPANTS: Patients with asthma or chronic obstructive pulmonary disease (COPD) (n = 1016). INTERVENTION: In a 3-month study, adult patients (age range 18-88 years; n = 797) received twice-daily inhalations of formoterol via Easyhaler(R), and in a consequential study (from one visit to another, with 3-12 months in-between) children and adolescents (age range 4-17 years; n = 219) received salbutamol via Easyhaler(R) as needed. MAIN OUTCOME MEASURES: Control of six Easyhaler(R) handling steps and patients' satisfaction with Easyhaler(R) based on questionnaires. RESULTS: Correct performances (minimum and maximum of the six steps) were noticed after one demonstration in 92-98 % of the adults, 87-99 % of the elderly, 81-96 % of the children and 83-99 % of the adolescents. These figures had markedly increased at the last visit. Repeat instructions were necessary in 26 % of the cases. Investigators found Easyhaler(R) easy to teach in 87 % of the patients and difficult in only 0.5 %. Patients found Easyhaler(R) easy to learn and use, and the patients' (and parents') satisfaction with the inhaler was very high. Lung function values [forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF)] improved statistically significantly during the studies, indicating good inhaler competence and treatment adherence. CONCLUSION: Investigators found Easyhaler(R) easy to teach and patients found it easy to use, and their satisfaction with the device was high

A tüdőrák hazai epidemiológiai adatai új megközelítésben

In the international publications, in the last decades, incidence and mortality of lung cancer was the highest in Hungary in the ranking of European countries and even worldwide, despite the fact that no lung cancer incidence data were reported from Hungary until 2019. In the studies published by our working group at the end of 2019 and in the first half of 2020, we were the first to publish Hungarian lung cancer incidence and mortality data based on research on the NEAK database. The results of this study showed a significant, 25-30% lower incidence of lung cancer in Hungary than the previously reported data. Based on these findings, it was determined that the previously reported Hungarian lung cancer incidence and mortality data can be compiled due to different methodological applications of inadequately calculated results, and Hungarian lung cancer incidence and mortality are equally high, but not higher than the average in Central European countries. In addition, a decrease in the incidence and mortality of male lung cancer was measured between 2011 and 2016, while increasing values were found for women

Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients

INTRODUCTION: The association between vitamin D and clinical parameters in obstructive lung diseases (OLDs), including COPD and bronchial asthma, was previously investigated. As asthma-COPD overlap syndrome (ACOS) is a new clinical entity, the prevalence of vitamin D levels in ACOS is unknown. AIM: Our aim was to assess the levels of circulating vitamin D (25-hydroxyvitamin D [25(OH)D]) in different OLDs, including ACOS patients, and its correlation with clinical parameters. METHODS: A total of 106 men and women (control, n=21; asthma, n=44; COPD, n=21; and ACOS, n=20) were involved in the study. All patients underwent detailed clinical examinations; disease control and severity was assessed by disease-specific questionnaires (COPD assessment test, asthma control test, and modified Medical Research Council); furthermore, 25(OH)D levels were measured in all patients. RESULTS: The 25(OH)D level was significantly lower in ACOS and COPD groups compared to asthma group (16.86+/-1.79 ng/mL and 14.27+/-1.88 ng/mL vs 25.66+/-1.91 ng/mL). A positive correlation was found between 25(OH)D level and forced expiratory volume in 1 second (r=0.4433; P<0.0001), forced vital capacity (FVC) (r=0.3741; P=0.0004), forced expiratory flow between 25% and 75% of FVC (r=0.4179; P<0.0001), and peak expiratory flow (r=0.4846; P<0.0001) in OLD patient groups. Asthma control test total scores and the 25(OH)D level showed a positive correlation in the ACOS (r=0.4761; P=0.0339) but not in the asthma group. Higher COPD assessment test total scores correlated with decreased 25(OH)D in ACOS (r=-0.4446; P=0.0495); however, this was not observed in the COPD group. CONCLUSION: Vitamin D deficiency is present in ACOS patients and circulating 25(OH)D level may affect disease control and severity