Chronic obstructive pulmonary disease guidelines in Europe: a look into the future.

Clinical practice guidelines are ubiquitous and are developed to provide recommendations for the management of many diseases, including chronic obstructive pulmonary disease. The development of these guidelines is burdensome, demanding a significant investment of time and money. In Europe, the majority of countries develop their own national guidelines, despite the potential for overlap or duplication of effort. A concerted effort and consolidation of resources between countries may alleviate the resource-intensity of maintaining individual national guidelines. Despite significant resource investment into the development and maintenance of clinical practice guidelines, their implementation is suboptimal. Effective strategies of guideline dissemination must be given more consideration, to ensure adequate implementation and improved patient care management in the future.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

Diagnosing COPD: advances in training and practice – a systematic review

Vladimir Koblizek,1,2 Barbora Novotna,1–3 Zuzana Zbozinkova,3 Karel Hejduk31Department of Pneumology, University Hospital Hradec Kralove, Hradec Králové, Czech Republic; 2Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Králové, Czech Republic; 3Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech RepublicAbstract: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung syndrome, caused by long-term inhalation of noxious gases and particles, which leads to gradual airflow limitation. All health care professionals who care for COPD patients should have full access to high-quality spirometry testing, as postbronchodilator spirometry constitutes the principal method of COPD diagnosis. One out of four smokers 45 years or older presenting respiratory symptoms in primary care, have non-fully reversible airflow limitation compatible with COPD and are mostly without a known diagnosis. Approximately 50.0%–98.3% of patients are undiagnosed worldwide. The majority of undiagnosed COPD patients are isolated at home, are in nursing or senior-assisted living facilities, or are present in oncology and cardiology clinics as patients with lung cancers and coronary artery disease. At this time, the prevalence and mortality of COPD subjects is increasing, rapidly among women who are more susceptible to risk factors. Since effective management strategies are currently available for all phenotypes of COPD, correctly performed and well-interpreted postbronchodilator spirometry is still an essential component of all approaches used. Simple educational training can substantially improve physicians’ knowledge relating to COPD diagnosis. Similarly, a physician inhaler education program can improve attitudes toward inhaler teaching and facilitate its implementation in routine clinical practices. Spirometry combined with inhaled technique education improves the ability of predominantly nonrespiratory physicians to correctly diagnose COPD, to adequately assess its severity, and to increase the percentage of correct COPD treatment used in a real-life setting.Keywords: education, inhaled technique, overdiagnosis, primary care, spirometry, underdiagnosi

Hand grip endurance test relates to clinical state and prognosis in COPD patients better than 6-minute walk test distance

Miroslav Kovarik,1,2 Vera Joskova,1,2 Anna Patkova,1,2 Vladimir Koblizek,3 Zdenek Zadak,2 Miloslav Hronek1,2 1Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; 2Department of Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; 3Department of Pulmonary Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: Patients with COPD present peripheral muscle dysfunction and atrophy, expressed as muscle strength and endurance reduction. The goal of this study was direct dynamometric assessment of hand grip endurance and strength in relation to the stage of disease, multidimensional predictors of mortality, and 6-minute walk test (6MWT). To the best of our knowledge, there has been no previous study determining these parameters.Patients and methods: In this observational study, 58 consecutive outpatients with stable COPD and 25 volunteers without respiratory problems were compared. All COPD subjects underwent a comprehensive examination to determine COPD severity, prognostic scales, and 6MWT. Body composition, basic spirometric parameters, and hand grip strength and endurance were determined in all study participants.Results: Patients in the COPD group had a 15% decrease in maximum strength (P=0.012) and a 28% decrease in area under the force/time curve (AUC) of the endurance test (P<0.001) compared to the control group. Dynamometric parameters were significantly negatively associated with the stage of disease and values of multivariable prediction indexes, and positively associated with the results of 6MWT. In most cases, closer associations were found with AUC than with 6MWT and in the gender-specific groups.Conclusion: Both hand grip strength and endurance are impaired in COPD patients in comparison with the control group. In particular, AUC could be considered as an attractive option not only to assess exercise capacity but also as a predictive marker with a better prognostic value than 6MWT in COPD patients. This is the first study to observe the dependence of hand grip endurance on combined COPD assessment. Keywords: dynamometry, muscle strength, muscle endurance, BODE inde

Analyza epidemii strevnich bakterialnich onemocneni v okrese Havlickuv Brod v letech 1979 - 1998

Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi