Efficacy assessment of the combined anti-inflammatory treatment in the improvement of asthma control in regard to the smoking habit

Uvod: Pušenje predstavlja jedan od najznačajnijih uzroka loše kontrole astme, zbog iritativnog dejstva duvanskog dima na disajne puteve i razvoja rezistencije na inhalatorne kortikosteroide. Stoga je pušače sa astmom često potrebno lečiti kombinovanom antiinflamatornom terapijom, iako je efikasnost ovakvog tretmana još uvek nedovoljno ispitana. Cilj: utvrditi efikasnost kombinovane antiinflamatorne terapije: inhalatorni kortikosteroidi (ICS) u kombinaciji sa dugodelujućim beta2-adrenergičkim agonistima (DDBA) u odnosu na ICS u kombinaciji sa antagonistima leukotrijenskih receptora (ALTR) u postizanju dobre kontrole astme, poboljšanju kvaliteta života i plućne funkcije kod pušača u odnosu na nepušače sa astmom. Metod: Pacijenti starosti od 18-50 godina sa astmom (≥6meseci), FEV1 većim od 60%, podeljeni su u grupu nepušača –NP (N=60) i aktivnih pušača –PU (≤2 ≥15 p/g i ≥10≤40 cigareta na dan; N=60). Obe grupe su randomizovane u jednu od dve, otvorene, terapijske grupe (ICS uz dodatak DDBA ili ALTR) u trajanju od 24 nedelje. Rezultati: u svakoj od 4 randomizovane grupe (NP-DDBA, NP-ALTR, PU-DDBA, PU-ALTR) je bilo po 30 pacijenata. Tokom 24 nedelje, PU su imali lošije kontrolisanu astmu od NP (p=0,02), bez ralizke između DDBA vs ALTR (0,677 vs 0,634). Konstantno dobru kontrolu astme (ACQ 60%, were subclassified into the group of nonsmokers –NS (N=60), and the group of active smokers - SM (≤2 ≥15 p/g and ≥10≤40 cigarettes a day; N=60). Both groups were randomized into one of the two open therapy groups (ICS combined to DDBA or ALTR), receiving the selected treatment for 24 weeks. Results: Any of the four randomized groups (NS-LABA, NS-LTRA, SM-LABA, SM-LTRA) consisted of 30 patients. During the 24-week period, SM had a worse control of their asthma than NS (p=0.02), but no difference was registered between DDBA vs. ALTR therapy subgroups (0.677 vs. 0.634). Over the 24-week period, a constantly good asthma control (ACQ≤0,75) was achieved by 48% of NS and 32% of SM (p=0.094), and no significant difference related to the applied therapy regimen (LABA vs. LTRA; p=1.000). NS had a better life quality than SM, but this difference remained statistically insignificant (p=0.056). Both the NS and the SM group in either treatment modality (LABA, ALTR) had a statistically significant change of the AQLQ score (p<0.001). FEV1 (%) improvement was statistically significant t in both the NS and the SM group (p=0.001 vs. p=0.002). The LABA and LTRA treated patients had their FEV (%) improvement at the level of p=0.001, and p=0.005 respectively. The multivariate analysis has established the following independent factors of a good asthma control: BMI≥24, nonsmoker, FEV1≥90%, ACQ≤2.2, and AQLQ≥4.2. Conclusion: The combined anti-inflammatory therapy is more efficient in NS than in SM asthmatics, while in the population of active smokers, both additional drugs (LABA, LTRA) were equally efficient in improving asthma control, life quality, and lung function

Registri bolesnika s hroničnim opstruktivnim bolestima pluća – zašto su važni?

COPD is most probably not just a single disease, but a syndrome made up of numerous individual overlapping diseases. The concept of phenotyping COPD patients would not be feasible without major population-based studies and patient registries. The aim of setting up a COPD registry has been defined as the need to establish the disease prevalence, phenotype incidence, clinical features, co-morbidities, treatment specificities, together with monitoring of the disease’s natural course and its outcome on a large sample of patients. In Serbia, an online registry of COPD patients has been operational since 2016, and the recent insight (before the manuscript’s submission) shows over 4,200 entries. Analysis of the population of patients entered shows that an average patient is male (63%), smoker or ex-smoker (90.48%), over 60 years of age (82.01%). Pulmonary function analysis shows that the majority of enrolled patients (82%) have moderate to severe obstruction, with an average FEV1 of 52.82% of the predicted value, while 45% of patients have FEV1 value below 50% of the predicted value. The Charlson Comorbidity Index shows that half of the patients (49.97%) have one comorbidity. Most common comorbidities are arterial hypertension, diabetes mellitus, liver disease, congestive heart failure, and coronary ischemic disease. Comorbidities such as osteoporosis, depression, and anxiety have been reported very rarely. The phenotype analysis showed equal shares of two predominant groups: non-exacerbators (51.12%), and exacerbators (48.88%) within which there are groups of patients with pulmonary emphysema (34.35%) and patients with chronic bronchitis (14.53%). The data indicate that strategy for COPD treatment in our environment is changing towards adoption of modern recommendations and guidelines for treatment of this disease. The data enable a comprehensive insight into the disease and drawing up of feasible treatment strategies that give us hope for success.HOBP verovatno nije samo jedna bolest već sindrom sačinjen od brojnih, pojedinačnih bolesti koje se preklapaju. Koncept fenotipizacije pacijenata sa HOBP-om ne bi bio moguć bez velikih, populacionih studija i registara pacijenata. Cilj kreiranja registara pacijenata sa HOBP-om je definisan potrebom da se na velikom uzorku utvrdi prevalenca bolesti, učestalost fenotipova, kliničke karakteristike, komorbiditeti, specifičnosti terapije, uz praćenje prirodnog toka bolesti do njenog ishoda. U Srbiji od 2016. godine postoji elektronski (onlajn) registar pacijenata sa hroničnom opstruktivnom bolešću pluća, koji je u momentu pisanja ovog teksta brojao više od 4200 unosa. Analiza populacije pacijenta unetih u registar HOBP-a ukazuje na to da je prosečan pacijent muškarac (63% pacijenata), pušač ili bivši pušač (ukupno 90,48% pacijenata), stariji od 60 godina (82,01% pacijenata). Analiza plućne funkcije pokazuje da većina pacijenata (82%) ima umerenu i srednje tešku opstrukciju, sa prosečnom vrednošću FEV1 od 52,82% predviđene vrednosti, dok 45% pacijenata ima vrednost FEV1 nižu od 50% predviđene vrednosti. Čarlsonov indeks komorbiditeta je pokazao da polovina pacijenata (49,97%) ima jedan komorbiditet. Najučestaliji komorbiditeti su: arterijska hipertenzija, dijabetes melitus, bolesti jetre, kongestivna srčana slabost i koronarna ishemijska bolest. Komorbiditeti poput osteoporoze, depresije i anksioznosti su vrlo retko prijavljivani. U pogledu fenotipova zapaža se da je učestalost dve dominirajuće grupe bolesnika izjednačena: grupa neegzacerbatora (51,12%), zatim egzacerbatora (48,88%), u okviru kojih se nalaze grupe pacijenata sa emfizemom pluća sa 34,35% zastupljenosti i pacijenata sa hroničnim bronhitisom sa 14,53% zastupljenosti. Podaci ukazuju na to da se strategija lečenja HOBP-a u našoj sredini ipak menja, uz usvajanje savremenih preporuka i smernica za lečenje ove bolesti. Ovakvi podaci nam omogućavaju da sagledamo bolest iz svih uglova i kreiramo realno izvodljive strategije lečenja koje daju nadu za postizanje uspeha

Efficacy assessment of the combined anti-inflammatory treatment in the improvement of asthma control in regard to the smoking habit

Uvod: Pušenje predstavlja jedan od najznačajnijih uzroka loše kontrole astme, zbog iritativnog dejstva duvanskog dima na disajne puteve i razvoja rezistencije na inhalatorne kortikosteroide. Stoga je pušače sa astmom često potrebno lečiti kombinovanom antiinflamatornom terapijom, iako je efikasnost ovakvog tretmana još uvek nedovoljno ispitana. Cilj: utvrditi efikasnost kombinovane antiinflamatorne terapije: inhalatorni kortikosteroidi (ICS) u kombinaciji sa dugodelujućim beta2-adrenergičkim agonistima (DDBA) u odnosu na ICS u kombinaciji sa antagonistima leukotrijenskih receptora (ALTR) u postizanju dobre kontrole astme, poboljšanju kvaliteta života i plućne funkcije kod pušača u odnosu na nepušače sa astmom. Metod: Pacijenti starosti od 18-50 godina sa astmom (≥6meseci), FEV1 većim od 60%, podeljeni su u grupu nepušača –NP (N=60) i aktivnih pušača –PU (≤2 ≥15 p/g i ≥10≤40 cigareta na dan; N=60). Obe grupe su randomizovane u jednu od dve, otvorene, terapijske grupe (ICS uz dodatak DDBA ili ALTR) u trajanju od 24 nedelje. Rezultati: u svakoj od 4 randomizovane grupe (NP-DDBA, NP-ALTR, PU-DDBA, PU-ALTR) je bilo po 30 pacijenata. Tokom 24 nedelje, PU su imali lošije kontrolisanu astmu od NP (p=0,02), bez ralizke između DDBA vs ALTR (0,677 vs 0,634). Konstantno dobru kontrolu astme (ACQ 60%, were subclassified into the group of nonsmokers –NS (N=60), and the group of active smokers - SM (≤2 ≥15 p/g and ≥10≤40 cigarettes a day; N=60). Both groups were randomized into one of the two open therapy groups (ICS combined to DDBA or ALTR), receiving the selected treatment for 24 weeks. Results: Any of the four randomized groups (NS-LABA, NS-LTRA, SM-LABA, SM-LTRA) consisted of 30 patients. During the 24-week period, SM had a worse control of their asthma than NS (p=0.02), but no difference was registered between DDBA vs. ALTR therapy subgroups (0.677 vs. 0.634). Over the 24-week period, a constantly good asthma control (ACQ≤0,75) was achieved by 48% of NS and 32% of SM (p=0.094), and no significant difference related to the applied therapy regimen (LABA vs. LTRA; p=1.000). NS had a better life quality than SM, but this difference remained statistically insignificant (p=0.056). Both the NS and the SM group in either treatment modality (LABA, ALTR) had a statistically significant change of the AQLQ score (p<0.001). FEV1 (%) improvement was statistically significant t in both the NS and the SM group (p=0.001 vs. p=0.002). The LABA and LTRA treated patients had their FEV (%) improvement at the level of p=0.001, and p=0.005 respectively. The multivariate analysis has established the following independent factors of a good asthma control: BMI≥24, nonsmoker, FEV1≥90%, ACQ≤2.2, and AQLQ≥4.2. Conclusion: The combined anti-inflammatory therapy is more efficient in NS than in SM asthmatics, while in the population of active smokers, both additional drugs (LABA, LTRA) were equally efficient in improving asthma control, life quality, and lung function

The importance of the interface in the management of acute respiratory failure

Non-invasive ventilation is a form of mechanical ventilatory support that doesn't require endotracheal intubation of the patient. The interface (mask) is a connection between the device and the patient that allows the set pressure gradient supplied by the ventilator to be transmitted to the airways. Today, there are different types of interfaces, which differ in shape, size, mechanical properties, and comfort. Despite the wide of different mask, common reasons for poor patient adaptation to NIV are related to side effects of the interface such as air loss, skin damage, and mask discomfort. We can prevent these side effects with a basic knowledge of the principles of handling and selecting the optimal interface

Chilaiditi's sign and syndrome: Theoretical facts and a case report

Introduction. Chilaiditi's syndrome is a rare condition manifested by gastrointestinal symptoms, and radiologically verified by transposition of the large intestine loop. This radiological finding with no manifested symptoms is termed the Chilaiditi's sign. The aim of this case report was to remind the clinicians of the possibility of this rare syndrome, whose symptoms and signs may be misinterpreted and inadequately treated, with consequent diverse complications. Case report. We presented the theoretical facts and a patient in whom the diagnosis of Chilaiditi's syndrome was established incidentally, when hospitalized for an exacerbation of his chronic obstructive pulmonary disease. The Chilaiditi's sign was verified as an incidental finding on chest X-ray performed to evaluate the primary disease. Conclusion. Chilaiditi's syndrome is a benign condition which rarely requires surgery. Its clinical importance lies in adequate differential diagnostic approach and timely management of potentially serious complications

Incidence of sensitization to specific inhalatory allergens in patients suffering from allergic rhinitis

Backgound/Aim. Allergic rhinitis is the most frequent type of rhinitis affecting more than 600 million people worldwide. As incidence increases, it is important to know about the characteristics, the allergens that exacerbate it as well as effects of allergic rhinitis on population. The aim of this study was to determine among patients with chronic rhinitis the number of patients positive to standard inhaled allergens, their distribution by sex, age and to determine the type and frequency of allergic sensitization to specific inhalatory allergens. Methods. Data was collected from 514 patients tested for standard inhalatory allergens via the skin prick test from 01.01.2016 to 31.12. 2016. Age, sex and concomitant diseases as well an analysis of type and frequency of hypersensitivity to different allergens were assessed and recorded. Results. Of 514 patients, 307 patients, with an average age of 29.6 ± 8.88 years had a positive skin prick test. The sex ratio was 1.2 : 1 in favor of the females. Outdoor allergens affected 81.2% of all patients while indoor allergens 66.4% of them. Weed pollen (71%), grass pollen (61%) and Dermatophagoides pteronyssinus (46%) were the most common allergens. Most patients were sensitized to 1 (22%) or 2 (22%) allergens, while 20% of patients were simultaneously sensitized to 3 allergens. Conclusion. Most patients with the symptoms of chronic rhinitis had a positive allergic reaction. Those in their third decade of life were the most commonly affected. Outdoor allergens were the most prevalent allergen group, and weed pollen was the most frequent type of allergen

Allergic asthma and rhinitis comorbidity

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COVID-19 vaccination acceptance, safety and side-effects in European patients with severe asthma.

peer reviewedBACKGROUND: Vaccination is vital for achieving population immunity to severe acute respiratory syndrome coronavirus 2, but vaccination hesitancy presents a threat to achieving widespread immunity. Vaccine acceptance in chronic potentially immunosuppressed patients is largely unclear, especially in patients with asthma. The aim of this study was to investigate the vaccination experience in people with severe asthma. METHODS: Questionnaires about vaccination beliefs (including the Vaccination Attitudes Examination (VAX) scale, a measure of vaccination hesitancy-related beliefs), vaccination side-effects, asthma control and overall safety perceptions following coronavirus disease 2019 (COVID-19) vaccination were sent to patients with severe asthma in 12 European countries between May and June 2021. RESULTS: 660 participants returned completed questionnaires (87.4% response rate). Of these, 88% stated that they had been, or intended to be, vaccinated, 9.5% were undecided/hesitant and 3% had refused vaccination. Patients who hesitated or refused vaccination had more negative beliefs towards vaccination. Most patients reported mild (48.2%) or no side-effects (43.8%). Patients reporting severe side-effects (5.7%) had more negative beliefs. Most patients (88.8%) reported no change in asthma symptoms after vaccination, while 2.4% reported an improvement, 5.3% a slight deterioration and 1.2% a considerable deterioration. Almost all vaccinated (98%) patients would recommend vaccination to other severe asthma patients. CONCLUSIONS: Uptake of vaccination in patients with severe asthma in Europe was high, with a small minority refusing vaccination. Beliefs predicted vaccination behaviour and side-effects. Vaccination had little impact on asthma control. Our findings in people with severe asthma support the broad message that COVID-19 vaccination is safe and well tolerated

The effect of the COVID-19 pandemic on severe asthma care in Europe: Will care change for good?

Background The coronavirus disease 2019 (COVID-19) pandemic has put pressure on healthcare services, forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic

The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good?

Background: The COVID-19 pandemic has put pressure on health-care services forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods: In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results: 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions: Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic, and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic