Registri bolesnika s hroničnim opstruktivnim bolestima pluća – zašto su važni?

COPD is most probably not just a single disease, but a syndrome made up of numerous individual overlapping diseases. The concept of phenotyping COPD patients would not be feasible without major population-based studies and patient registries. The aim of setting up a COPD registry has been defined as the need to establish the disease prevalence, phenotype incidence, clinical features, co-morbidities, treatment specificities, together with monitoring of the disease’s natural course and its outcome on a large sample of patients. In Serbia, an online registry of COPD patients has been operational since 2016, and the recent insight (before the manuscript’s submission) shows over 4,200 entries. Analysis of the population of patients entered shows that an average patient is male (63%), smoker or ex-smoker (90.48%), over 60 years of age (82.01%). Pulmonary function analysis shows that the majority of enrolled patients (82%) have moderate to severe obstruction, with an average FEV1 of 52.82% of the predicted value, while 45% of patients have FEV1 value below 50% of the predicted value. The Charlson Comorbidity Index shows that half of the patients (49.97%) have one comorbidity. Most common comorbidities are arterial hypertension, diabetes mellitus, liver disease, congestive heart failure, and coronary ischemic disease. Comorbidities such as osteoporosis, depression, and anxiety have been reported very rarely. The phenotype analysis showed equal shares of two predominant groups: non-exacerbators (51.12%), and exacerbators (48.88%) within which there are groups of patients with pulmonary emphysema (34.35%) and patients with chronic bronchitis (14.53%). The data indicate that strategy for COPD treatment in our environment is changing towards adoption of modern recommendations and guidelines for treatment of this disease. The data enable a comprehensive insight into the disease and drawing up of feasible treatment strategies that give us hope for success.HOBP verovatno nije samo jedna bolest već sindrom sačinjen od brojnih, pojedinačnih bolesti koje se preklapaju. Koncept fenotipizacije pacijenata sa HOBP-om ne bi bio moguć bez velikih, populacionih studija i registara pacijenata. Cilj kreiranja registara pacijenata sa HOBP-om je definisan potrebom da se na velikom uzorku utvrdi prevalenca bolesti, učestalost fenotipova, kliničke karakteristike, komorbiditeti, specifičnosti terapije, uz praćenje prirodnog toka bolesti do njenog ishoda. U Srbiji od 2016. godine postoji elektronski (onlajn) registar pacijenata sa hroničnom opstruktivnom bolešću pluća, koji je u momentu pisanja ovog teksta brojao više od 4200 unosa. Analiza populacije pacijenta unetih u registar HOBP-a ukazuje na to da je prosečan pacijent muškarac (63% pacijenata), pušač ili bivši pušač (ukupno 90,48% pacijenata), stariji od 60 godina (82,01% pacijenata). Analiza plućne funkcije pokazuje da većina pacijenata (82%) ima umerenu i srednje tešku opstrukciju, sa prosečnom vrednošću FEV1 od 52,82% predviđene vrednosti, dok 45% pacijenata ima vrednost FEV1 nižu od 50% predviđene vrednosti. Čarlsonov indeks komorbiditeta je pokazao da polovina pacijenata (49,97%) ima jedan komorbiditet. Najučestaliji komorbiditeti su: arterijska hipertenzija, dijabetes melitus, bolesti jetre, kongestivna srčana slabost i koronarna ishemijska bolest. Komorbiditeti poput osteoporoze, depresije i anksioznosti su vrlo retko prijavljivani. U pogledu fenotipova zapaža se da je učestalost dve dominirajuće grupe bolesnika izjednačena: grupa neegzacerbatora (51,12%), zatim egzacerbatora (48,88%), u okviru kojih se nalaze grupe pacijenata sa emfizemom pluća sa 34,35% zastupljenosti i pacijenata sa hroničnim bronhitisom sa 14,53% zastupljenosti. Podaci ukazuju na to da se strategija lečenja HOBP-a u našoj sredini ipak menja, uz usvajanje savremenih preporuka i smernica za lečenje ove bolesti. Ovakvi podaci nam omogućavaju da sagledamo bolest iz svih uglova i kreiramo realno izvodljive strategije lečenja koje daju nadu za postizanje uspeha

Silent sinus syndrome: One more reason for an ophthalmologist to have a rhinologist as a good friend

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Allergic asthma and rhinitis comorbidity

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Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer

Introduction: Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer. Methods: In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment. Results : There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001). Conclusion : Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD

The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good?

Background: The COVID-19 pandemic has put pressure on health-care services forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods: In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results: 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions: Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic, and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic