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In bronchiectasis, poor physical capacity correlates with poor quality of life

Purpose Patients with bronchiectasis (BE) who suffer frequent exacerbations are likely to experience negative effects on quality of life (QoL) and require more healthcare utilization. We aimed to discover, in a cohort of Finnish BE patients, those risk factors that influence QoL. Methods Non-cystic fibrosis BE patients of a Helsinki University Hospital cohort were examined with high-resolution computed tomography (HRCT) of the chest. They completed a disease-specific quality of life-bronchiectasis (QoL-B) questionnaire in Finnish translation. We considered scores in the lowest quarter (25%) of that QoL-B scale to indicate poor QoL. The bronchiectasis severity index (BSI), FACED score, and modified Medical Research Council (mMRC) dyspnoea scale were used. Results Overall, of 95 adult BE patients, mean age was 69 (SD +/- 13) and 79% were women. From the cohort, 82% presented with chronic sputum production and exacerbations, at a median rate of 1.7 (SD +/- 1.6). The number of exacerbations (OR 1.7), frequent exacerbations (>= 3 per year) (OR 4.9), high BSI score (OR 1.3), and extensive disease (>= 3 lobes) (OR 3.7) were all predictive of poor QoL. Frequent exacerbations were associated with bronchial bacterial colonisation, low forced expiratory volume in 1 s (FEV1), and radiological disease severity. Based on the BSI, 34.1% of our cohort had severe disease, with 11.6% classified as severe according to their FACED score. The mMRC dyspnoea score (r = -0.57) and BSI (r = -0.60) correlated, in the QoL-B questionnaire, negatively with physical domain. Conclusion The strongest determinants of poor QoL in the cohort of Finnish BE patients were frequent exacerbations, radiological disease severity, and high BSI score. Neither comorbidities nor BE aetiology appeared to affect QoL. Reduced physical capacity correlated with dyspnoea and severe disease. Study registration University of Helsinki, Faculty of Medicine, 148/16.08.2017.Peer reviewe

Asthma as aetiology of bronchiectasis in Finland

Background: By definition bronchiectasis (BE) means destructed structure of normal bronchus as a consequence of frequent bacterial infections and inflammation. In many senses, BE is a neglected orphan disease. A recent pan-European registry study, EMBARC, has been set up in order to better understand its pathophysiology, better phenotype patients, and to individualize their management. Aim: To examine the aetiology and co-morbidity of BE in the capital area in Finland. Methods: Two hundred five patients with BE diagnosis and follow up visits between 2016 and 2017 in Helsinki University Hospital were invited to participate in the study. Baseline demographics, lung functions, imaging, microbiological, and therapeutic data, together with co-morbidities were entered into EMBARC database. Clinical characteristics, aetiologic factors, co-morbidities, and risk factors for extensive BE were explored. Results: To the study included 95 adult patients and seventy nine percent of the BE patients were women. The mean age was 69 years (SD +/- 13). Asthma was a comorbid condition in 68% of the patients but in 26% it was estimated to be the cause of BE. Asthma was aetiological factor for BE if it had been diagnosed earlier than BE. As 41% BE were idiopathic, in 11% the disorder was postinfectious and others were associated to rheumatic disease, Alpha-1-antitrypsin deficiency, IgG deficiency and Kartagener syndrome. The most common co-morbidities in addition to asthma were cardiovascular disease (30%), gastroesophageal reflux disease (26%), overweight (22%), diabetes (16%), inactive neoplasia (15%), and immunodeficiency (12%). Extensive BE was found in 68% of BE patients in whom four or more lobes were affected. Risk factors for extensive BE were asthma (OR 2.7), asthma as aetiology for BE (OR 4.3), and rhinosinusitis (OR 3.1). Conclusions: Asthma was associated to BE in 68% and it was estimated as aetiology in every fourth patient. However, retrospectively, it is difficult to exclude asthma as a background cause in patients with asthma-like symptoms and respiratory infections. We propose asthma as an aetiology factor for BE if it is diagnosed earlier than BE. Asthma and rhinosinusitis were predictive for extensive BE.Peer reviewe

Isoflavonoids and lignans in legumes : Nutritional and health aspects in humans

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Astman ja keuhkoahtaumataudin sekamuoto ACO - diagnostiikka ja hoito

Vertaisarvioitu. English summary.Astman ja keuhkoahtaumataudin sekamuoto on ahtauttavia keuhkosairauksia sairastavilla potilailla melko tavallinen. Huolellinen anamneesi, status ja tupakointihistorian kartoitus sekä keuhkojen toimintakokeet ovat diagnostiikassa olennaisia. Hoidossa sovelletaan astman ja keuhkoahtaumataudin hoitosuosituksia yksilöllisen harkinnan mukaan. Hengitettävän glukokortikoidin (ICS) ja pitkävaikutteisen β2-agonistin (LABA) yhdistelmään pohjautuvan lääkehoidon ohella elämäntapamuutokset sekä liitännäissairauksien hoitaminen ovat tärkeitä kokonaisvaltaisen hoidon elementtejä.Peer reviewe

Lihavuus vaikeuttaa keuhkosairauksia

Vertaisarvioitu.• Uniapnean, obesiteetti-hypoventilaatio-oireyhtymän (OHS), astman ja keuhkoahtaumataudin liitännäissairauksissa lihavuus on yksi merkittävimmistä riskitekijöistä. • Uniapnea- ja OHS-potilaiden hoidossa painonhallinnan tulee aina olla keskeinen osa hoitoa. • Lihavuus lisää hengitysoireilua, huonontaa astmatasapainoa sekä lisää pahenemisvaiheita astma- ja keuhkoahtaumapotilailla. • Laihduttaminen parantaa keuhkoahtaumapotilaiden elämänlaatua.Peer reviewe