Factors influencing adherence to treatment in COPD patients and its relationship with disease exacerbations

 Wstęp: Przewlekła obturacyjna choroba płuc (POChP) jest jedną z najczęstszych przyczyn chorobowości i umieralności na świecie. Regularne leczenie pozwala na zmniejszenie nasilenia objawów, a także częstości zaostrzeń i hospitalizacji z powodu choroby. Jednak jedynie około 50% pacjentów przyjmuje regularnie przepisane leki. Celem pracy była ocena czynników wpływających na stosowanie się chorych na POChP, u których doszło do zaostrzenia choroby, do zaleceń lekarskich.Materiał i metody: Badaniem ankietowym objęto 49 pacjentów hospitalizowanych w Samodzielnym Publicznym Zespole Gruźlicy i Chorób Płuc w Olsztynie z powodu zaostrzenia POChP. Oceniano jakość życia, i stosowanie się do zaleceń lekarskich 30 dni po wypisie ze szpitala w zależności od czynników demograficznych, statusu społecznego, przebiegu choroby i hospitalizacji, a także poprawy odczuwanej po stosowanym leczeniu.Wyniki: Większość chorych oceniła swój stan zdrowia jako zły, a chorobę jako ograniczającą codzienną aktywność społeczną i zawodową. Trzydzieści dni po hospitalizacji zalecenia lekarskie wypełniało ściśle jedynie 67% badanych. Wykazano związek pomiędzy systematycznością leczenia a częstością zaostrzeń POChP (p = 0.045) i hospitalizacji (p = 0.005) oraz odczuwaniem poprawy po stosowanym leczeniu (p = 0.023). Płeć, miejsce zamieszkania, wykształcenie, a także rodzaj wykonywanej pracy nie miały związku ze stosowaniem się do zaleceń lekarskich.Wnioski: Czynnikiem mającym największy wpływ na częstość zaostrzeń i hospitalizacji jest systematyczność leczenia. Odczuwanie przez chorych subiektywnej poprawy po lekach poprawia współpracę pomiędzy lekarzem i pacjentem. Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. Systematic treatment of COPD decreases symptoms and reduces the frequency of exacerbations and hospitalisations because of the disease. It is estimated that only 50% of patients use prescribed drugs systematically. The aim of this study was to identify the factors which can influence adherence to treatment of the patients who were treated due to exacerbation of COPD.Material and methods: A questionnaire probe was conducted on 49 patients hospitalised at the Regional Lung and Tuberculosis Hospital in Olsztyn, Poland due to COPD exacerbation. The assessed variables were: quality of life and adherence to treatment 30 days after discharge from hospital in relationship with demographic factors, social status, disease and hospitalisation course, and relief after systematic treatment.Results: Most of the patients assessed their health condition as poor and the disease as limiting their everyday social and occupational activity. 30 days after discharge from hospital the adherence rate to therapy was only 67%. There was an association between systematic treatment and the rate of exacerbations (P = 0.045) and hospitalisations (P = 0.005) but also clinical benefit after long-term treatment (P = 0.023). There were no associations between adherence to treatment and sex, place of residence, education or occupation.Conclusions: Lack of systematic treatment is the main risk factor for COPD exacerbations and hospitalisation rate. A subjective sense of relief after drugs is a factor improving patients’ compliance

Analysis of deaths caused by obstructive pulmonary diseases in Pomerania province in 2001-2004

Wstęp: Choroby płuc, a zwłaszcza przewlekła obturacyjna choroba płuc (POChP), stanowią jedną z głównych przyczyn zgonów. Celem badania była ocena umieralności z powodu obturacyjnych chorób płuc i przewlekłego serca płucnego w latach 2001–2004 w województwie pomorskim. Materiał i metody: Materiał do badania stanowiły karty zgonów zgromadzone w komputerowym rejestrze zgonów Pomorskiego Centrum Zdrowia Publicznego w Gdańsku. Pod uwagę brano karty chorych, u których jako wyjściową przyczynę zgonu podano astmę oskrzelową, stan astmatyczny, przewlekłą obturacyjną chorobę płuc i przewlekłe serce płucne. Wyniki: Wskaźnik umieralności w przypadku POChP wynosił 14,02/100 000 mieszkańców, w przypadku astmy - 2,04/ /100 000 mieszkańców, w przypadku przewlekłego serca płucnego - 2,4/100 000 mieszkańców. W analizowanym okresie stwierdzono systematyczny wzrost liczby wskaźnika umieralności z powodu POChP z 12,5/100 000 w 2001 roku do 15,6/ /100 000 w roku 2004 (p = 0,005, test Χ2). Liczba zgonów z powodu analizowanych chorób płuc rosła w miesiącach zimowych. Największa liczba zgonów dotyczyła osób w wieku powyżej 65 lat. Większość zgonów (71%) miała miejsce w szpitalu, tylko w grupie chorych na astmę oskrzelową 75% osób zmarło w domu przed przybyciem karetki pogotowia (p = 0,0001, test Χ2). Wnioski: Wskaźniki umieralności z powodu badanych chorób układu oddechowego nie odbiegają od stwierdzanych w innych badaniach. Niepokojący jest wzrost liczby zgonów z powodu POChP oraz wysoki odsetek chorych na astmę, którzy umierają w domu przed przybyciem pogotowia ratunkowego.Introduction: Lung diseases, especially COPD, are one of the leading causes of death. The aim of the study was to assess mortality caused by COPD, asthma and cor pulmonale in the years 2001-2004 in the Pomerania province. Material and methods: Death certificates of patients who died of asthma, COPD or cor pulmonale registered in Regional Health Centre were analyzed. Results: The mortality rate for COPD was 14.02/100 000, asthma 2.04/100 000 and cor pulmonale 2.4/100 000 inhabitants. Mortality rate from COPD increased from 12.5/100 000 found in 2001 to 15.6/100 000 found in 2004 (p = 0.005). The number of deaths was higher in the winter time. The peak mortality was found in patients 65 years old. 71% of COPD and cor pulmonale patients died in the hospital, whereas 75% of asthma deaths occurred at home (p = 0.0001). Conclusions: The mortality rates from chronic respiratory diseases in the analyzed population are comparable to data found in other studies. The alarming result is the increase in the number of COPD deaths and high percentage of asthma patients who die at home

Wpływ estrogenu na farmakologiczną aktywację kanałów K+ zależnych od ATP w sercu i mięśniach gładkich naczyń świnki morskiej

Praca wykonana w: Katedra i Zakład Farmakologii, Akademia Medyczna w Gdańsku

Analysis of Deaths Caused by Obstructive Pulmonary Diseases in Pomerania Province in 2001–2004

Introduction: Lung diseases, especially COPD, are one of the leading causes of death. The aim of the study was to assess mortality caused by COPD, asthma and cor pulmonale in the years 2001–2004 in the Pomerania province. Material and methods: Death certificates of patients who died of asthma, COPD or cor pulmonale registered in Regional Health Centre were analyzed. Results: The mortality rate for COPD was 14.02/100,000, asthma 2.04/100,000 and cor pulmonale 2.4/100,000 inhabitants. Mortality rate from COPD increased from 12.5/100,000 found in 2001 to 15.6/100,000 found in 2004 (p = 0.005). The number of deaths was higher in the winter time. The peak mortality was found in patients 65 years old. 71% of COPD and cor pulmonale patients died in the hospital, whereas 75% of asthma deaths occurred at home (p = 0.0001). Conclusions: The mortality rates from chronic respiratory diseases in the analyzed population are comparable to data found in other studies. The alarming result is the increase in the number of COPD deaths and high percentage of asthma patients who die at home

Dietary Habits in Children with Respiratory Allergies: A Single-Center Polish Pilot Study

Background: The rising trend in allergic diseases has developed in parallel with the increasing prevalence of obesity, suggesting a possible association. The links between eating habits and allergies have not been sufficiently clarified. Aim: To evaluate the nutritional status, eating habits, and risk factors of obesity and pulmonary function in children with allergic rhinitis. Materials and methods: We evaluated 106 children with allergic rhinitis (mean age 12.1 ± 3.4 years; M/F 60/46) from the Department of Allergology. Clinical data were collected regarding allergies, physical activity, nutritional status (Bodystat), dietary habits (Food Frequency Questionnaire validated for the Polish population), skin prick test with aeroallergens (Allergopharma), and spirometry (Jaeger). Results: All children suffered from allergic rhinitis; among them, 43 (40.6%) presented symptoms of asthma. There were differences between children with only allergic rhinitis (AR group) and children with both rhinitis and asthma (AA group) in pulmonary function (forced expiratory volume in one second (FEV1) 100 ± 11 vs. 92.1 ± 15.0; p < 0.05). A total of 84 children (79%) presented a normal body mass index (BMI) (10–97 percentile), 8 (7.5%) were underweight, and 14 (13.5%) were overweight or obese. There were no differences in body composition between the AR and AA groups. Incorrect eating habits were demonstrated by most of the children, e.g., consumption of three or fewer meals in a day (38%), sweets every day (44%), snacking between meals every day (80%), and eating meals less than 1 h before bedtime (47%). Compared to the AR group, the AA group was more likely to eat more meals a day (p = 0.04), snack more often (p = 0.04), and eat before sleeping (p = 0.005). Multiple regression analysis showed a significant association between high BMI and snacking between meals and low physical activity (adjusted R2 = 0.97; p < 0.05). Conclusions: The risk factors for obesity in children with allergies include snacking and low physical activity. Most children with respiratory allergies, especially those with asthma, reported incorrect eating habits such as snacking and eating before bedtime. A correlation between pulmonary function and body composition or dietary habits was not found

Dietary Patterns of Treatment–Resistant Depression Patients

Depression is a common mental disorder that occurs all over the world with treatment resistance commonly seen in clinical practice. Ketamine exhibits an antidepressant that is more often used in the case of treatment-resistant depression (TRD) in MDD and BP. Research emphasizes that a healthy diet and the nutrients it contains can lower the risk of developing depression and form a strategy that supports conventional treatment. The aim of the study was to evaluate the patients’ diet and to analyze the effect of ketamine on food intake among patients with TRD. The study involved 15 patients suffering from treatment-resistant depression and 15 healthy volunteers. The data required for the analysis were collected using the food frequency questionnaire (FFQ) and 4-day food diaries. The study group was statistically significantly less likely to consume milk and plain milk beverages, plain white cheese, wholemeal bread, various vegetables, wine, and drinks. Our results show several disorders in the eating habits of patients with treatment–resistant depression. After the administration of ketamine, the patients consumed significantly less protein, fats, monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA), fiber, tryptophan, vitamins, and minerals compared to the control group. There is a lack of research describing the effects of ketamine on nutrition. In order to confirm the results of the study, more participants are required, and the assessment of food diaries filled in at the patient’s home with a longer interval after the last dose of ketamine as well

A Challenge for Allergologist: Application of Allergy Diagnostic Methods in Mast Cell Disorders

Primary and secondary mast cell activation syndromes (MCAS) can occur in patients with mastocytosis. During the past few years our knowledge about the pathogenesis and disease-triggering mechanisms in MCAS and mastocytosis have increased substantially. Whereas mastocytosis is characterized by an accumulation of neoplastic (clonal) mast cells (MC) in various organ systems, MCAS is defined by a massive and systemic activation of these cells. Mast cells are crucial effector cells in allergic diseases, thus their elevated number and activation can cause severe anaphylactic reactions and MCAS in patients with mastocytosis. However, these cells may also degranulate spontaneously or degranulate in response to non-allergic triggers leading to clinical symptoms. In mastocytosis patients, such symptoms may lead to the diagnosis of a primary MCAS. The diagnosis of a concomitant allergy in mastocytosis patients is challenging. In these patients, a mixed form (primary and secondary) of MCAS may be diagnosed. These patients may also suffer from life-threatening anaphylactic reactions when exposed to allergens. In these cases, the possibility of severe side effects of in vivo provocations can sometimes also limit diagnostic evaluations. In the current article, we discuss the diagnosis and management of patients suffering from mastocytosis and concomitant MCAS, with special emphasis on novel diagnostic tests and management, including allergen microarrays, recombinant allergen analysis, basophil activation tests, optimal prophylaxis, and specific therapies

Genome-Wide DNA Methylation and Gene Expression in Patients with Indolent Systemic Mastocytosis

Mastocytosis is a clinically heterogenous, usually acquired disease of the mast cells with a survival time that depends on the time of onset. It ranges from skin-limited to systemic disease, including indolent and more aggressive variants. The presence of the oncogenic KIT p. D816V gene somatic mutation is a crucial element in the pathogenesis. However, further epigenetic regulation may also affect the expression of genes that are relevant to the pathology. Epigenetic alterations are responsible for regulating the expression of genes that do not modify the DNA sequence. In general, it is accepted that DNA methylation inhibits the binding of transcription factors, thereby down-regulating gene expression. However, so far, little is known about the epigenetic factors leading to the clinical onset of mastocytosis. Therefore, it is essential to identify possible epigenetic predictors, indicators of disease progression, and their link to the clinical picture to establish appropriate management and a therapeutic strategy. The aim of this study was to analyze genome-wide methylation profiles to identify differentially methylated regions (DMRs) in patients with mastocytosis compared to healthy individuals, as well as the genes located in those regulatory regions. Genome-wide DNA methylation profiling was performed in peripheral blood collected from 80 adult patients with indolent systemic mastocytosis (ISM), the most prevalent subvariant of mastocytosis, and 40 healthy adult volunteers. A total of 117 DNA samples met the criteria for the bisulfide conversion step and microarray analysis. Genome-wide DNA methylation analysis was performed using a MethylationEPIC BeadChip kit. Further analysis was focused on the genomic regions rather than individual CpG sites. Co-methylated regions (CMRs) were assigned via the CoMeBack method. To identify DMRs between the groups, a linear regression model with age as the covariate on CMRs was performed using Limma. Using the available data for cases only, an association analysis was performed between methylation status and tryptase levels, as well as the context of allergy, and anaphylaxis. KEGG pathway mapping was used to identify genes differentially expressed in anaphylaxis. Based on the DNA methylation results, the expression of 18 genes was then analyzed via real-time PCR in 20 patients with mastocytosis and 20 healthy adults. A comparison of the genome-wide DNA methylation profile between the mastocytosis patients and healthy controls revealed significant differences in the methylation levels of 85 selected CMRs. Among those, the most intriguing CMRs are 31 genes located within the regulatory regions. In addition, among the 10 CMRs located in the promoter regions, 4 and 6 regions were found to be either hypo- or hypermethylated, respectively. Importantly, three oncogenes—FOXQ1, TWIST1, and ERG—were identified as differentially methylated in mastocytosis patients, for the first time. Functional annotation revealed the most important biological processes in which the differentially methylated genes were involved as transcription, multicellular development, and signal transduction. The biological process related to histone H2A monoubiquitination (GO:0035518) was found to be enriched in association with higher tryptase levels, which may be associated with more aberrant mast cells and, therefore, more atypical mast cell disease. The signal in the BAIAP2 gene was detected in the context of anaphylaxis, but no significant differential methylation was found in the context of allergy. Furthermore, increased expression of genes encoding integral membrane components (GRM2 and KRTCAP3) was found in mastocytosis patients. This study confirms that patients with mastocytosis differ significantly in terms of methylation levels in selected CMRs of genes involved in specific molecular processes. The results of gene expression profiling indicate the increased expression of genes belonging to the integral component of the membrane in mastocytosis patients (GRM2 and KRTCAP3). Further work is warranted, especially in relation to the disease subvariants, to identify links between the methylation status and the symptoms and novel therapeutic targets