Asthma and Depression

Poznato je da se anksioznost i depresija pojavljuju u bolesnika s astmom i povezani su s lošom kontrolom astme, češćim pogoršanjima i povećanom uporabom zdravstvenih resursa. Sličnost i preklapanje simptoma depresije i nekontrolirane astme čine liječenje astme izazovnijim i složenijim što može dovesti do nedovoljnog dijagnosticiranja i lošijeg liječenja komorbiditeta. Nema jasnih stajališta o tome jesu li osobe s astmom depresivnije od onih bez astme, ima li depresija „aditivan“ štetni učinak na normalno smanjenje kvalitete života povezano s astmom, jesu li subjektivni simptomi astme jače povezani s depresijom nego objektivne mjere, postoje li simptomi depresije koji su češće povezani s astmom, mogu li tuga i depresija uzrokovati respiratorne učinke sukladne pogoršanjima astme, u kojoj mjeri depresija negativno utječe na liječenje astme, je li uporaba kortikosteroida u astmi povezana s depresijom i kako, koje su fizičke, psihološke i socijalne posljedice depresije u astmi te kako liječiti takve bolesnike. Postoji potreba za daljnjim istraživanjima kako bi se razvili standardizirani algoritmi utemeljeni na dokazima kojima bi se usmjerila klinička praksa.It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with poor asthma control, greater frequency of exacerbations and increased use of healthcare resources. There are no clear views whether persons with asthma are more depressed than those without asthma; whether depression has an “additive” adverse effect on the normal asthma-related decline of quality of life; whether subjective asthma symptoms are more strongly associated with depression than objective measures; are there any symptoms of depression that are more commonly associated with asthma; can sadness and depression produce respiratory effects consistent with asthma exacerbations; the extent to which depression has an adverse effect on the treatment of asthma; whether corticosteroid use in asthma is associated with depression and how; what are the physical, psychological and social consequences of depression in asthma and how to treat such patients. There is a need for further research in order to develop evidence-based standardized algorithms to guide clinical practice

The Prevalence and Pulmonary Consequences of Anxiety and Depressive Disorders in Patients with Asthma

The aim of this study was to determine the prevalence of anxiety and depression symptoms in outpatients with treated asthma and to determine the influence of anxiety and depression symptoms on lung function and asthma symptoms. The study was conducted in the pulmonary clinic of the Department of Pulmonary Diseases, Osijek University Hospital Centre, on 200 outpatients with asthma, aged 18–50 years, of which there were 65.5% women and 35.5% men. Each patient underwent a clinical examination with an extensive anamnesis and lung auscultation. The lung function was tested by spirometry. Demographic data and data on general and socioeconomic characteristics were evaluated using a questionnaire created internally for the purposes of this research, psychological status was assessed by HAD questionnaire, and Q test was used as a measure of asthma control. Based on the HAD questionnaire, 44.5% of asthma patients met the criteria for anxiety, and 24.5% of asthma patients met the criteria for depression. There was no significant correlation between asthma symptoms and the degree of anxiety or depression, while the pulmonary function of asthma patients negatively correlated with the degree of anxiety and depression. Pulmonary function in asthma patients with symptoms of anxiety and depression was significantly poorer than in asthma patients without anxiety and/or depression symptoms. The results show that among asthma patients there are large number of those who have symptoms of anxiety and depression. Asthma patients with symptoms of anxiety and depression have poorer lung function than patients with only asthma symptoms, however there is no significant correlation between the lung function and symptoms of asthma. We have confirmed that patients with anxiety symptoms visit general practitioners or EMS significantly more when compared to patients with depression symptoms

The Prevalence and Pulmonary Consequences of Anxiety and Depressive Disorders in Patients with Asthma

The aim of this study was to determine the prevalence of anxiety and depression symptoms in outpatients with treated asthma and to determine the influence of anxiety and depression symptoms on lung function and asthma symptoms. The study was conducted in the pulmonary clinic of the Department of Pulmonary Diseases, Osijek University Hospital Centre, on 200 outpatients with asthma, aged 18–50 years, of which there were 65.5% women and 35.5% men. Each patient underwent a clinical examination with an extensive anamnesis and lung auscultation. The lung function was tested by spirometry. Demographic data and data on general and socioeconomic characteristics were evaluated using a questionnaire created internally for the purposes of this research, psychological status was assessed by HAD questionnaire, and Q test was used as a measure of asthma control. Based on the HAD questionnaire, 44.5% of asthma patients met the criteria for anxiety, and 24.5% of asthma patients met the criteria for depression. There was no significant correlation between asthma symptoms and the degree of anxiety or depression, while the pulmonary function of asthma patients negatively correlated with the degree of anxiety and depression. Pulmonary function in asthma patients with symptoms of anxiety and depression was significantly poorer than in asthma patients without anxiety and/or depression symptoms. The results show that among asthma patients there are large number of those who have symptoms of anxiety and depression. Asthma patients with symptoms of anxiety and depression have poorer lung function than patients with only asthma symptoms, however there is no significant correlation between the lung function and symptoms of asthma. We have confirmed that patients with anxiety symptoms visit general practitioners or EMS significantly more when compared to patients with depression symptoms

Učinci tjelesne aktivnosti na kroničnu subkliničku sustavnu upalu

Chronic subclinical systemic inflammation (CSSI) is a pathogenic event and a common risk factor for many noncommunicable diseases like atherosclerosis, metabolic syndrome, cardiovascular disease, insulin resistance and type 2 diabetes, cancer, and obstructive lung disease. On the other hand, regular physical activity has been found to reduce this risk. Many studies of different design were conducted to assess the association between inflammatory mediators as markers of CSSI and regular physical activity. The aim of this review was to present the current level of evidence and understanding of potential mechanisms by which physical activity reduces inflammatory mediators involved in CSSI and the types of physical activity required for the expected effect. We have found that observational studies consistently report a positive association between regular physical activity and lower CSSI, but the design of these studies does not allow to infer a causal relationship. Interventional studies, in contrast, were not consistent about the causal relationship between regular physical activity and lower CSSI. The problem in interpreting these results lies in significant differences between these interventional studies in their design, sample size, study population, and intervention itself (intensity and extent, follow up, weight loss). We can conclude that the scientific community has to invest a significant effort into high-quality interventional trials focused on finding the type, intensity, and extent of physical activity that would produce the most favourable effect on CSSI.Kronične nezarazne bolesti najznačajniji su javnozdravstveni problem. Kronična subklinička upala kao osnovni patološki supstrat zajednički je rizični čimbenik za većinu tih bolesti i stanja, kao što su arterioskleroza, metabolički sindrom, kardiovaskularne bolesti, rezistencija na inzulin i šećerna bolest tipa 2, novotvorine, opstruktivne plućne bolesti i mnoge druge. Nasuprot tomu, utvrđeno je da je redovita tjelesna aktivnost protektivni čimbenik u spomenutim bolestima. Provedene su mnoge studije različitoga dizajna s ciljem razotkrivanja povezanosti između kronične subkliničke upale i upalnih medijatora i redovite tjelesne aktivnosti. Cilj je ovog pregleda bio predočiti trenutačnu razinu dokaza te poimanja potencijalnih mehanizama u podlozi smanjenja kronične subkliničke upale kao posljedice redovite tjelesne aktivnosti, uključenih medijatora upale te oblika tjelesne aktivnosti potrebnih kako bi se postigao očekivani učinak. Utvrdili smo da su studije povezanosti predočile konzistentne dokaze u korist pozitivne povezanosti između redovite tjelesne aktivnosti i smanjenja kronične subkliničke upale. Dizajn tih studija ne dopušta zaključke o uzročno-posljedičnoj povezanosti ispitivanih fenomena. S druge strane, rezultati intervencijskih studija nisu konzistentni. Problem pri interpretaciji tih rezultata prouzročen je značajnom heterogenošću u dizajnu provedenih intervencijskih studija vezano uz veličinu uzorka, tip ispitanika te uz oblik intervencije (intenzitet i ekstenzitet tjelesne aktivnosti, trajanje intervencije, udruženost s gubitkom tjelesne mase). Na temelju trenutačne razine dokaza možemo zaključiti da je potrebno provesti više kvalitetnih intervencijskih studija radi definiranja tipa, intenziteta i ekstenziteta tjelesne aktivnosti koja će imati najznačajniji utjecaj na smanjenje kronične subkliničke upale

Snaga inspiratorne dišne muskulature utječe na anaerobnu izdržljivost u vrhunskih sportaša

To the best of our knowledge, little is known about the role of respiratory muscle strength and endurance on athlete performance in anaerobic conditions of maximal exertion. The aim of this cross-sectional study was therefore to examine the association between the strength/endurance of inspiratory muscles in a group of 70 healthy male professional athletes (team sports) and their ventilatory and metabolic parameters at the anaerobic threshold (second ventilatory threshold; VT2) and beyond it at maximum load during the cardiopulmonary exercise test (CPET) on a treadmill. Ventilatory parameters at VT2, at maximal effort, and their differences were tested for association with inspiratory muscle strength (PImax) and endurance (Tlim), measured as time to maintain inspiration at or above 80% of PImax. The difference in end-tidal oxygen tension (ΔPETO2) between VT2 and maximal effort was significantly associated with resting heart rate (HR) and systolic blood pressure (BP), PImax, and lean body mass (LBM) (r2=0.26, p=0.016; multivariate regression analysis). The difference in carbon dioxide output (ΔVCO2) was significantly associated with body mass index (BMI), resting HR, systolic BP, and PImax (r2=0.25, p=0.022; multivariate regression analysis). Our findings suggest that it is the inspiratory muscle strength and not endurance that affects the performance of professional athletes and that it should be tested and trained systematically.Cilj ovog presječnog istraživanja, u kojem je sudjelovalo 70 zdravih muškaraca vrhunskih sportaša (momčadskih sportova) bio je ispitati povezanost snage/izdržljivosti inspiratorne muskulature i ventilacijskih i metaboličkih parametara na anaerobnom pragu (drugi ventilacijski prag; VT2) te nakon njega pri maksimalnom opterećenju tijekom kardiopulmonalnog testiranja na tekućoj traci (CPET). Ventilacijski parametri na VT2, pri maksimalnom naporu te njihova razlika testirani su na povezanost sa snagom inspiratorne muskulature (PImax) i izdržljivošću (Tlim), koja je izmjerena kao vrijeme tijekom kojega se zadržava ventilacija na ili iznad 80% PImax. Razlika tlaka kisika na kraju izdaha između VT2 i maksimalnog napora (ΔPETO2) značajno je bila povezana sa srčanom frekvencijom (HR) i sistoličkim krvnim tlakom (SBP) u mirovanju, s PImax i bezmasnom masom tijela (LBM) (r2=0,26, p=0,016; multivarijatna regresijska analiza). Razlika izdahnutog CO2 (ΔVCO2) značajno je bila povezana s indeksom tjelesne mase (BMI), HR-om i SBP-om u mirovanju te s PImax (r2=0,25, p=0,022; multivarijatna regresijska analiza). Rezultati ovog istraživanja upućuju na to da snaga, a ne izdržljivost inspiratorne muskulature značajno utječe na radni učinak (izvedbu) vrhunskih sportaša te da ju je potrebno sustavno mjeriti i trenirati

Comparison of Emotion Recognition from Facial Expression and Music

The recognition of basic emotions in everyday communication involves interpretation of different visual and auditory clues. The ability to recognize emotions is not clearly determined as their presentation is usually very short (micro expressions), whereas the recognition itself does not have to be a conscious process. We assumed that the recognition from facial expressions is selected over the recognition of emotions communicated through music. In order to compare the success rate in recognizing emotions presented as facial expressions or in classical music works we conducted a survey which included 90 elementary school and 87 high school students from Osijek (Croatia). The participants had to match 8 photographs of different emotions expressed on the face and 8 pieces of classical music works with 8 offered emotions. The recognition of emotions expressed through classical music pieces was significantly less successful than the recognition of emotional facial expressions. The high school students were significantly better at recognizing facial emotions than the elementary school students, whereas girls were better than boys. The success rate in recognizing emotions from music pieces was associated with higher grades in mathematics. Basic emotions are far better recognized if presented on human faces than in music, possibly because the understanding of facial emotions is one of the oldest communication skills in human society. Female advantage in emotion recognition was selected due to the necessity of their communication with the newborns during early development. The proficiency in recognizing emotional content of music and mathematical skills probably share some general cognitive skills like attention, memory and motivation. Music pieces were differently processed in brain than facial expressions and consequently, probably differently evaluated as relevant emotional clues

Platypnea-orthodeoxia syndrome related to the patent foramen ovale and atrial septal aneurysm

The platypnea-orthodeoxia syndrome is a rare condition characterized by postural dyspnea and hypoxemia that disappear or diminish in lying position, so it can be difficult to recognize without close assessment of the patient\u27s pattern of dyspnea. The syndrome is commonly associated to an intra-cardiac right-to-left shunt through a patent foramen ovale as the most frequently reported site of the shunt. Platypnea-orthodeoxia syndrome can be the cause of refractory hypoxemia leading to pulmonary hypertension, whereby, if suspected, contrast echocardiography in supine as well as in upright position should be performed. We are presenting a case of an unrecognized platypnea-orthodeoxia syndrome because of a patent foramen ovale and atrial septal aneurysm, with developed chronic complications due to long-standing hypoxemia. This case highlights the need of a high index of suspicion to diagnose the syndrome on time and the necessity of careful echocardiographic evaluation

Presječna studija dinamike temperature izdaha nakon popušene cigarete i njezina povezanost s promjenama plućne funkcije u pušača prediktivnima za rizik od KOPB-a

Exhaled breath temperature (EBT) is a biomarker of inflammation and vascularity of the airways already shown to predict incident COPD. This cross-sectional study was aimed to assess the potential of EBT in identifying “healthy” smokers susceptible to cigarette smoke toxicity of the airways and to the risk of developing COPD by analysing the dynamics of EBT after smoking a cigarette and its associations with their demographics (age, smoking burden) and lung function. The study included 55 current smokers of both sexes, 29–62 years of age, with median smoking exposure of 15 (10–71.8) pack-years. EBT was measured at baseline and 5, 15, 30, 45, and 60 min after smoking a single cigarette. Lung function was measured with spirometry followed by a bronchodilator test. To compare changes in EBT between repeated measurements we used the analysis of variance and the area under the curve (EBTAUC) as a dependent variable. Multivariate regression analysis was used to look for associations with patient characteristics and lung function in particular. The average (±SD) baseline EBT was 33.42±1.50 °C. The highest significant increase to 33.84 (1.25) °C was recorded 5 min after the cigarette was smoked (p=0.003), and it took one hour for it to return to the baseline. EBTAUC showed significant repeatability (ICC=0.85, p<0.001) and was significantly associated with age, body mass index, number of cigarettes smoked a day, baseline EBT, and baseline FEF75 (R2=0.39, p<0.001 for the model). Our results suggest that EBT after smoking a single cigarette could be used as early risk predictor of changes associated with chronic cigarette smoke exposure.Temperatura izdaha (EBT) biomarker je upale i vaskularizacije dišnih putova za koji je utvrđeno da može predvidjeti nastanak KOPB-a. Cilj ove presječne studije bio je procijeniti potencijal EBT-a u identifikaciji “zdravih” pušača čiji su dišni putovi osjetljivi na toksični učinak duhanskoga dima uz rizik od nastanka KOPB-a. Taj se cilj planirao postići utvrđivanjem povezanosti dinamike EBT-a nakon popušene cigarete s demografskim karakteristikama (dob, spol, pušačka navika) i plućnom funkcijom ispitanika. U ispitivanje je bilo uključeno 55 aktivnih pušača obaju spolova u dobi od 29 do 62 godine, čiji je medijan izloženosti duhanskom dimu bio 15 (10 – 71,8) pušačkih godina (pack-years). EBT je mjeren na početku te 5, 15, 30, 45 i 60 minuta nakon popušene cigarete. Plućnu funkciju mjerili smo spirometrijski, uz susljedni bronhodilatacijski test. Za analizu dinamike EBT-a koristili smo se analizom varijance te smo izračunali površinu ispod krivulje u odnosu na početno mjerenje (EBTAUC) te EBTAUC upotrijebili kao zavisnu varijablu. Multivarijatna regresijska analiza korištena je za utvrđivanje povezanosti EBTAUC s karakteristikama ispitanika, posebice s plućnom funkcijom. Prosječni (±SD) izmjereni početni EBT bio je 33,42±1,50 °C, a najveće značajno izmjereno povećanje zabilježeno je 5 minuta nakon popušene cigarete (33,84 (1,25) °C, p=0,003). Bilo je potrebno 60 minuta kako bi se EBT vratio na početnu vrijednost. Utvrđena je značajna ponovljivost EBTAUC (ICC=0,85, p<0,001). Ispitivanjem je utvrđeno je da je EBTAUC značajno nezavisno povezan s dobi, indeksom tjelesne mase, brojem popušenih cigareta dnevno, početnim EBT-om te s početnim FEF75 (R2=0,39, p<0,001 za model). Rezultati ove studije sugeriraju da EBT nakon popušene cigarete može biti koristan kao rani prediktor rizika od promjena koje su povezane s kroničnom izloženosti duhanskom dimu

Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation

Aim To determine in-hospital and post-discharge mortality, readmission rates, and predictors of invasive mechanical ventilation (IMV) in patients treated at intensive care unit (ICU) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods A retrospective observational cohort study included all patients treated at a respiratory ICU for AECOPD during one year. A total of 62 patients (41 men) with mean age 68.4 ± 10.4 years were analyzed for outcomes including in-hospital and post-discharge mortality, readmission rates, and IMV. Patients’ demographic, hematologic, biochemical data and arterial blood gas (ABG) values were recorded on admission to hospital. Mean duration of followup time was 2.4 years. Results Of 62 patients, 7 (11.3%) died during incident hospitalization and 21 (33.9%) died during the follow-up. The overall 2.4-year mortality was 45.2%. Twenty nine (46.8%) patients were readmitted due to AECOPD. The average number of readmissions was 1.2. Multivariate analysis showed that blood pH, bicarbonate levels, low albumin, low serum chloride, and low hemoglobin were significant predictors of IMV during incident hospitalization (P < 0.001 for the overall model fit). Conclusion High in-hospital and post-discharge mortality and high readmission rates in our patients treated due to AECOPD at ICU indicate that these patients represent a high risk group in need of close monitoring. Our results suggested that anemia, hypoalbuminemia, and elevated troponin levels were risk factors for the need of IMV in severe AECOPD. Identification of such high-risk patients could provide the opportunity for administration of an appropriate and timely treatment

Development and the initial validation of a new self-administered questionnaire for an early detection of health status changes in smokers at risk for chronic obstructive pulmonary disease (MARKO questionnaire)

Aim To develop and do an initial validation of a new simple tool (self-administered questionnaire) that would be sensitive and specific enough to detect early changes in smokers leading to future development of chronic obstructive pulmonary disease (COPD). Methods 224 consecutive participants (50.9% women), with mean ± standard deviation age of 52.3 ± 6.7 years, 37.5 ± 16.7 pack-years smoking history (85.8% active smokers), and no prior diagnosis of COPD were recruited. The MARKO questionnaire was self-administered twice; at the general practitioner’s office and after 2-4 weeks at the tertiary care hospital. Participants were assessed for COPD by a pulmonologist after filling in a quality of life (QoL) questionnaires, historytaking, physical examination, lung function test, 6-minute walk test, and laboratory tests. They were divided into four subgroups: “healthy” smokers, symptomatic smokers, and smokers with mild and moderately severe COPD. Results Psychometric analyses indicated that the 18-item questionnaire had a very good internal consistency (Cronbach’s alpha = 0.91) and test-retest reliability for a four week period (ρc = 0.89, 95% confidence interval [CI] 0.85-0.92, Lin’s concordance). A significant correlations of MARKO scores were found with two QoL questionnaires; r = 0.69 (P < 0.001) and r = 0.81 (P < 0.001). Receiver operating characteristic curve analysis showed an area under the curve of 0.753 (95% CI 0.691-0.808, P < 0.001), with a sensitivity of 71.83% and specificity of 64.24% to discriminate “healthy” smokers from other subgroups. Conclusion Based on psychometric analyses and high convergent validity correlation with already validated QoL questionnaires, the newly developed MARKO questionnaire was shown to be a reliable self-administered short health status assessment tool