Характеристика факторів, що обтяжують клінічний перебіг та порушують якість життя хворих з поєднаною патологією бронхіальної астми та хронічного обструктивного захворювання легень

The article studies factors that complicate the clinical course and disturb the life quality of patients with the chronic bronchial-obstructive pathology. Aim. To study factors that complicate the clinical course and disturb the life quality of patients with ACC for their rational modification.Materials and methods. All patients underwent: collection of anamnesis and general clinical examination, evaluation of the function of external respiration, clinical symptoms and risks.Results. At this work there were found factors that complicate the clinical course and life quality of patients with combined bronchial-obstructive pathology, especially clinical ones, such as expressed short breath, decrease of tolerance to physical loads and functional parameters of the external respiration.  Conclusions of this work correspond to introduced recommendations as to the treatment of patients with ACC: effective anti-inflammatory and broncholytic therapy with the special accent on timely detection and adequate treatment of a concomitant pathologyВ статті досліджено фактори, що обтяжують клінічний перебіг та порушують якість життя хворих на хронічну бронхообструктивну патологію. Практичні висновки даної роботи відповідають впровадженим рекомендаціям щодо лікування хворих на сполучену бронхообструктивну патологію: це ефективна протизапальна та бронхолітична терапія з особливим акцентом на своєчасне виявлення та адекватне лікування супутньої патологі

Etiology and efficacy of anti-microbial treatment for community-acquired pneumonia in adults requiring hospital admission in Ukraine

Background and aim: Empiric therapy of community-acquired pneumonia (CAP) remains the standard care and guidelines are mostly based on published data from the United States or Europe. In this study, we determined the bacterial etiology of CAP and evaluated the clinical outcomes under antimicrobial treatment of CAP in Ukraine. Methods: A total of 98 adult subjects with CAP and PORT risk II-IV were recruited for the study. The sputum diagnostic samples were obtained from all patients for causative pathogen identification. Subjects were randomly assigned in a 1:1 ratio to receive delafloxacin 300 mg (n=51) or moxifloxacin 400 mg (n=47) with a blinding placebo. The switch to oral treatment was after a minimum of 6 IV doses according to clinical criteria. The total duration of antibacterial treatment was 5-10 days. In vitro susceptibility of pathogens to delafloxacin and other comparator antibiotics was determined. Results: The most frequently isolated pathogens in adults with CAP were S. pneumoniae – 19.5%, M. pneumoniae – 15.3%, H. influenzae – 13.2%, S. aureus – 10.5%, K. pneumoniae – 10.1%, and H. parainfluenzae – 6.4%. All isolates of S. pneumoniae, S. aureus, M. pneumoniae had sufficient susceptibility to appropriate antibiotics. 9.0% of H. influenzae strains were susceptible to azithromycin. 94.8 % of patients had a successful clinical response to delafloxacin at the end of treatment and 93.9 % – at test-of-cure. Conclusions: In Ukraine, the major bacterial agents that induced CAP in adults were S. pneumoniae, M. pneumoniae, H. influenzae, S. aureus, K. pneumoniae, H. parainfluenzae, E. cloacae, L. pneumophila. Delafloxacin is a promising effective antibiotic for monotherapy of CAP in adults and could be used in cases of antimicrobial-resistant strains. (www.actabiomedica.it

Tiotropium versus Salmeterol for the Prevention of Exacerbations of COPD

BACKGROUND Treatment guidelines recommend the use of inhaled long-acting bronchodilators to alleviate symptoms and reduce the risk of exacerbations in patients with moderate-tovery-severe chronic obstructive pulmonary disease (COPD) but do not specify whether a long-acting anticholinergic drug or a β2-agonist is the preferred agent. We investigated whether the anticholinergic drug tiotropium is superior to the β2-agonist salmeterol in preventing exacerbations of COPD. METHODS In a 1-year, randomized, double-blind, double-dummy, parallel-group trial, we compared the effect of treatment with 18 μg of tiotropium once daily with that of 50 μg of salmeterol twice daily on the incidence of moderate or severe exacerbations in patients with moderate-to-very-severe COPD and a history of exacerbations in the preceding year. RESULTS A total of 7376 patients were randomly assigned to and treated with tiotropium (3707 patients) or salmeterol (3669 patients). Tiotropium, as compared with salmeterol, increased the time to the first exacerbation (187 days vs. 145 days), with a 17% reduction in risk (hazard ratio, 0.83; 95% confidence interval [CI], 0.77 to 0.90; P<0.001). Tiotropium also increased the time to the first severe exacerbation (hazard ratio, 0.72; 95% CI, 0.61 to 0.85; P<0.001), reduced the annual number of moderate or severe exacerbations (0.64 vs. 0.72; rate ratio, 0.89; 95% CI, 0.83 to 0.96; P=0.002), and reduced the annual number of severe exacerbations (0.09 vs. 0.13; rate ratio, 0.73; 95% CI, 0.66 to 0.82; P<0.001). Overall, the incidence of serious adverse events and of adverse events leading to the discontinuation of treatment was similar in the two study groups. There were 64 deaths (1.7%) in the tiotropium group and 78 (2.1%) in the salmeterol group. CONCLUSIONS These results show that, in patients with moderate-to-very-severe COPD, tiotropium is more effective than salmeterol in preventing exacerbations. (Funded by Boehringer Ingelheim and Pfizer; ClinicalTrials.gov number, NCT00563381.

ХАрАктеристикА факторів, щО обтяжуютЬ клінічниЙ перебіГ тА порушуютЬ якістЬ життЯ ХвориХ З поєднаноЮ патологієЮ бронхіальноЇ астмИ тА хрОнічнОгО ОбструктивнОгО захворюваннЯ легенЬ

В статті досліджено фактори, що обтяжують клінічний перебіг та порушують якість життя хворих на хронічну бронхообструктивну патологію. Практичні висновки даної роботи відповідають впровадженим рекомендаціям щодо лікування хворих на сполучену бронхообструктивну патологію: це ефективна протизапальна та бронхолітична терапія з особливим акцентом на своєчасне виявлення та адекватне лікування супутньої патологі

The prevalence, burden and risk factors associated with chronic obstructive pulmonary disease in Commonwealth of Independent States (Ukraine, Kazakhstan and Azerbaijan): results of the CORE study

Abstract Background In the Commonwealth of Independent States (CIS) countries the epidemiology of chronic obstructive pulmonary disease (COPD) is poorly characterized. The objective of this analysis is to present the prevalence, burden and risk factors associated with COPD in three CIS countries as part of the CORE study (Chronic Obstructive Respiratory Diseases), the rationale and design of which have been described elsewhere. Methods A total of 2842 adults (≥18 years) were recruited (964 in Ukraine, Kiev, 945 in Kazakhstan, Almaty and 933 in Azerbaijan, Baku) between 2013 and 2015 during household visits. Two-step cluster randomization was used for the sampling strategy. All respondents were interviewed about respiratory symptoms, smoking status and medical history, and underwent spirometry with bronchodilator. COPD was defined as (i) “previously diagnosed” when the respondent reported that he/she had previously been diagnosed with COPD by a doctor, (ii) “diagnosed by spirometry” using the GOLD criteria (2011) based on spirometry conducted during the study (FEV1/FVC <  0.70), and (iii) “firstly diagnosed by spirometry”, when the patient had received the COPD diagnosis for the first time based on the spirometry results obtained in this study. Results The prevalence of “previously diagnosed” COPD was 10.4, 13.8 and 4.3 per 1000, and the prevalence of COPD “diagnosed by spirometry” was 31.9, 66.7 and 37.5 per 1000 in Ukraine, Kazakhstan, and Azerbaijan, respectively. Almost all respondents with COPD were diagnosed for the first time during this study. A statistically significant relationship was shown between smoking and COPD in Kazakhstan (odds ratio, OR: 3.75) and Azerbaijan (OR: 2.80); BMI in Ukraine (OR: 2.10); tuberculosis in Ukraine (OR: 32.3); and dusty work in Kazakhstan (OR: 2.30). Co-morbidities like cardiovascular diseases and a history of pneumonia occurred significantly (p <  0.05) more frequently in the COPD population compared to the non-COPD population across all participating countries. For hypertension, this was the case in Ukraine and Azerbaijan. Conclusion In CIS countries (Ukraine, Kazakhstan and Azerbaijan), the prevalence of COPD “diagnosed by spirometry” was significantly higher than the prevalence of previously diagnosed COPD. Compared to many other countries, the prevalence of COPD seems to be relatively low in CIS countries. Factors such as limited funding from the government; lack of COPD knowledge and the attitude within the population, and of primary care physicians; as well as low access to high-quality spirometry may play a role in this under-diagnosis of COPD. The information provided in this paper will be helpful for healthcare policy makers in CIS countries to instruct COPD management and prevention strategies and to allocate healthcare resources accordingly

Correction to: Chronic obstructive pulmonary disease, bronchial asthma and allergic rhinitis in the adult population within the commonwealth of independent states: rationale and design of the CORE study

Abstract After publication of this work [1] it was noticed three author names were spelt incorrectly. Liudmila Iashyna should be Liudmyla Iashyna, Marina Polyanskaya should be Maryna Polianska and Elcan Mamamdbayov should be Eljan Mammadbayov

Chronic obstructive pulmonary disease, bronchial asthma and allergic rhinitis in the adult population within the Commonwealth of Independent States: rationale and design of the CORE study

Abstract Background Main treatable Chronic Respiratory Diseases (CRDs) like Chronic Obstructive Pulmonary Disease (COPD), Bronchial Asthma (BA) and Allergic Rhinitis (AR) are underdiagnosed and undertreated worldwide. CORE study was aimed to assess the point prevalence of COPD, BA and AR in the adult population of major cities of Commonwealth of Independent States (CIS) countries – Azerbaijan, Kazakhstan, and Ukraine based on study questionnaires and/or spirometry, and to document risk factors, characterize the COPD, BA and AR population to provide a clearer “epidemiological data”. Methods A descriptive, cross-sectional, population-based epidemiological study conducted from 2013 to 2015 with two-stage cluster geographical randomization. Interviewers conducted face-to-face visits at respondent’s household after informed consent and eligibility assessment including interviews, anthropometry, spirometry (with bronchodilator test) and completion of disease-specific questionnaires. Results Two thousand eight hundred forty-two respondents (Ukraine: 964 from Ukraine; 945 from Kazakhstan; 933 Azerbaijan) were enrolled. Mean age was 40–42 years and males were 37%–42% across three countries. In Kazakhstan 62.8% were Asians, but in Ukraine and in Azerbaijan 99.7% and 100.0%, respectively, were Caucasians. Manual labourers constituted 40.5% in Ukraine, 22.8% in Kazakhstan and 22.0% in Azerbaijan, while office workers were 16.1%, 31.6% and 36.8% respectively. 51.3% respondents in Ukraine, 64.9% in Kazakhstan and 69.7% in Azerbaijan were married. Conclusion CORE study collected information that can be supportive for health policy decision makers in allocating healthcare resources in order to improve diagnosis and management of CRDs. The detailed findings will be described in future publications. Trial registration Study Protocol Summary is disclosed at GlaxoSmithKline Clinical Study Register on Jun 06, 2013, study ID 116757