98 research outputs found
ARIA - One Airway, One Disease: What Links Our Research to the Concept
ARIA (Allergic Rhinitis and its Impact on Asthma) jest javnozdravstvena inicijativa Svjetske zdravstvene organizacije (SZO) koja se temelji na koncepciji jedinstvene alergijske bolesti diÅ”nog sustava. PokretaÄ inicijative bio je rastuÄi broj dokaza (epidemioloÅ”kih, anatomskih, patofizioloÅ”kih, kliniÄkih, terapijskih) koji je upuÄivao na pandemijski porast uÄestalosti alergijskih bolesti diÅ”nog sustava (alergijski rinitis i astma), neadekvatnost mjera primarne i sekundarne prevencije te nemoguÄnost zadovoljavajuÄe kontrole tih bolesti postojeÄim strategijama lijeÄenja. Do sada prikupljeni dokazi (anatomski, histoloÅ”ki, etioloÅ”ki, patofizioloÅ”ki mehanizmi, terapijski uspjeh) upuÄuju na izrazitu povezanost alergijskog rinitisa i astme. Stoga je ARIA kao javnozdravstvena inicijativa usmjerena na zajedniÄko zbrinjavanje do sada dviju razdvojenih bolesti. U ovom pregledu biti Äe izneseni dokazi na kojima se temelji koncepcija jedinstvene alergijske bolesti diÅ”nog sustava te doprinos suradnika Instituta za medicinska istraživanja i medicinu rada tim spoznajama.ARIA (Allergic Rhinitis and its Impact on Asthma) is a public health initiative of the World Health Organization (WHO) based on the āone airway, one diseaseā concept. The trigger for the initiative was a growing evidence (from epidemiology, anatomy, pathophysiology, clinical diagnostics, therapy) of a pandemic increase in the prevalence of allergic disorders of the respiratory tract (allergic rhinitis and asthma), of the deficiency of primary and secondary preventive measures, and of incomplete therapeutic control over these conditions using current management strategies. Evidence gathered so far suggest a strong link between allergic rhinitis and asthma (anatomical and histological features, aetiology, similar pathophysiological mechanisms, related therapeutic results). Therefore, ARIA as a public health initiative aims at uniting the management of these, till now separated disorders. This review discusses the evidence on which the "one airway, one disease" concept and ARIA are based, including a contribution made by scientists from the Institute of Medical Research and Occupational Health, Zagreb, Croatia
Inhaled Corticosteroids
Inhalacijski kortikosteroidi (ICS) prva su linija terapije u lijeÄenju kroniÄne astme. Njihovo djelovanje na razliÄite sastavnice procesa upale pridonosi smanjenju pojave simptoma, smanjenju hiperreaktivnosti diÅ”nih putova, smanjenju potrebe za primjenom sistemskih kortikosteroida i bolniÄkog lijeÄenja, poboljÅ”ava pluÄnu funkciju te unapreÄuje kontrolu bolesti i kvalitetu života. Inhalacijski kortikosteroidi jedini su osnovni lijekovi koji smanjuju smrtnost od astme. Najdjelotvorniji su lijekovi trenutaÄno raspoloživi u lijeÄenju astme. Brojne studije potvrÄuju njihov dugotrajni uÄinak u kontroli astme u djece i odraslih. ICS se razlikuju po svojim farmakokinetskim i farmakodinamskim karakteristikama te po jakosti. KliniÄka dobrobit ovih pripravaka uvelike nadilazi rizik od njihovih nuspojava. Potrebni su redoviti kontrolni pregledi za ranu detekciju eventualnih nuspojava.Inhaled corticosteroids (ICS) are the first line treatment in chronic asthma. The broad action of ICSs on the inflammatory process may account for their efficacy. Their clinical effects include reduction in severity of symptoms, diminished airway hyperresponsiveness, prevention of exacerbations, reduction in systemic corticosteroid courses and hospitalizations, and improvement in lung function tests, asthma control and quality of life. The ICSs are the only long-term controllers associated with a reduction in the risk of dying from asthma. They are the most effective drugs currently available in asthma treatment. Numerous studies proved their long lasting effects in asthma control in adults and children. Inhaled glucocorticoids manifest different pharmacokinetic and pharmacodynamic characteristics as well as potency. The clinical benefits of these agents by far surpass their side effects. Clinical follow- up is essential for the early detection of side effects
UÄINAK SPAJANJA BOLNICA U REPUBLICI HRVATSKOJ PROCJENOM POMOÄU UPITNIKA O STAVOVIMA O SIGURNOSTI
On several occasions hospitals in Croatia have been a subject to consolidation. The purpose of the consolidations was savings gained by merging some of the services, especially in the hospitals which are geographically close to each other. The available published research results have shown that the smallest hospitals in Croatia achieve highest results for safety measured by the Safety Attitudes Questionnaire 2006 Short Form (SAQ). Further investigation and management of the SAQ data obtained in 2016 has proven that the analyzed independent hospitals with up to 500 beds, compared to the consolidated hospitals, achieve significantly better results with regard to Working Conditions, Managementās Attitude, Job Satisfaction and overall SAQ results. In terms of expenditures expressed as the index change of expenditures from year 2006 (2006 having an index of 100), no significant differences were found. However, the highest rise in the expenditures is found for consolidated hospitals with >500 beds, while the hospitals with 500 ležaja, dok bolnice s <500 ležaja, bilo konsolidirane ili ne, pokazuju isti trend promjena rashoda za razdoblje od 2006. do 2015. godine. Prilikom odluÄivanja o konsolidaciji bolnica u Hrvatskoj valjalo bi uzeti u obzir i te rezultate
The Importance of Exhaled Breath Condensate Analysis in Diagnostic a Lung Disease
Kondenzat izdahnutog zraka (KIZ) sadržava aerosoliziran sekret diÅ”nih putova i hlapljive sastojke koji pružaju neinvazivan uvid u biokemijske i upalne procese u pluÄima. ZnaÄajan porast interesa za KIZ rezultat je prepoznavanja da u pluÄnim bolestima ta lako skupljiva tekuÄina ima mjerljive karakteristike koje se razlikuju od zdravog stanja. KIZ pruža uvid u redoks reakcije unutar pluÄa, acidobazni status te stupanj i tip upale u akutnoj i kroniÄnoj fazi astme, kroniÄnoj opstruktivnoj pluÄnoj bolesti, adultnom respiratornom distres sindromu, cistiÄnoj fibrozi i drugim bolestima diÅ”nog sustava. Karakteriziran nepoznatim i varijabilnim stupnjevima razrjeÄenja, KIZ ne pruža preciznu informaciju o koncentraciji pojedinog markera unutar sekreta diÅ”nih putova, ali pokazuje kada se koncentracija razlikuje izmeÄu zdravog i bolesnog stanja u diÅ”nom sustavu. Zbog pristupaÄnosti i jednostavnosti izvoÄenja, KIZ postaje integralni dio buduÄih kliniÄkih istraživanja, a nakon Å”to se prevlada problem standardizacije, on bi se mogao iskoristiti u dijagnosticiranju i praÄenju terapije bolesti diÅ”nog sustava.Exhaled breath condensate (EBC) contains aerosolised airway lining fluid and volatile compounds that provide non-invasive insight in biochemical and inflammatory activities in the lung. The interest in EBC has grown rapidly since this easily sampled fluid showed measurable properties that clearly indicate a disease. EBC assays provide evidence of redox deviation, acid-base status, and of the degree and type of inflammation in acute and chronic asthma, chronic obstructive pulmonary disease, cystic fibrosis, adult respiratory distress syndrome, and other lung diseases. Because of uncertain and variable degrees of dilution, EBC does not provide precise assessment of individual solute concentrations within native airway lining fluid. However, it can provide information when concentrations differ substantially between health and disease. Because, EBC assays are approachable and easy to perform, they will become integral components of future clinical studies, and after standardisation is accomplished, they might be used to diagnose and monitor therapy in clinical practice
UÄinci tjelesne aktivnosti na kroniÄnu subkliniÄku 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.KroniÄne nezarazne bolesti najznaÄajniji su javnozdravstveni problem. KroniÄna subkliniÄka upala kao osnovni patoloÅ”ki supstrat zajedniÄki je riziÄni Äimbenik za veÄinu tih bolesti i stanja, kao Å”to su arterioskleroza, metaboliÄki sindrom, kardiovaskularne bolesti, rezistencija na inzulin i Å”eÄerna bolest tipa 2, novotvorine, opstruktivne pluÄne bolesti i mnoge druge. Nasuprot tomu, utvrÄeno je da je redovita tjelesna aktivnost protektivni Äimbenik u spomenutim bolestima. Provedene su mnoge studije razliÄitoga dizajna s ciljem razotkrivanja povezanosti izmeÄu kroniÄne subkliniÄke upale i upalnih medijatora i redovite tjelesne aktivnosti. Cilj je ovog pregleda bio predoÄiti trenutaÄnu razinu dokaza te poimanja potencijalnih mehanizama u podlozi smanjenja kroniÄne subkliniÄke upale kao posljedice redovite tjelesne aktivnosti, ukljuÄenih medijatora upale te oblika tjelesne aktivnosti potrebnih kako bi se postigao oÄekivani uÄinak. Utvrdili smo da su studije povezanosti predoÄile konzistentne dokaze u korist pozitivne povezanosti izmeÄu redovite tjelesne aktivnosti i smanjenja kroniÄne subkliniÄke upale. Dizajn tih studija ne dopuÅ”ta zakljuÄke o uzroÄno-posljediÄnoj povezanosti ispitivanih fenomena. S druge strane, rezultati intervencijskih studija nisu konzistentni. Problem pri interpretaciji tih rezultata prouzroÄen je znaÄajnom heterogenoÅ”Äu u dizajnu provedenih intervencijskih studija vezano uz veliÄinu uzorka, tip ispitanika te uz oblik intervencije (intenzitet i ekstenzitet tjelesne aktivnosti, trajanje intervencije, udruženost s gubitkom tjelesne mase). Na temelju trenutaÄne razine dokaza možemo zakljuÄiti da je potrebno provesti viÅ”e kvalitetnih intervencijskih studija radi definiranja tipa, intenziteta i ekstenziteta tjelesne aktivnosti koja Äe imati najznaÄajniji utjecaj na smanjenje kroniÄne subkliniÄke upale
Promjene uÄestalosti trovanja psihoaktivnim lijekovima u Hrvatskoj
The aim of this study was to analyse the frequency of poisoning with psychoactive drugs (benzodiazepines, antidepressants and neuroleptics) over the last 15 years in Croatia. The analysis was based on poisoning incidents reported over the phone (hot line) to the Zagreb Poison Control Center and included two periods: 1985ā1991 (period I) and 1992ā1999 (period II). The data were analysed separately for children and adults. Each phone call was counted as one poisoning incident. Child poisoning with neuroleptics was significantly higher in period II than in period I and so was the adult poisoning with antidepressants, amytriptyline, and combined psychoactive drugs. The frequency of total psychoactive drug poisoning was significantly higher in adults than in children in both periods. From 1992, the frequency of adult poisoning with antidepressants considerably increased as one of the many consequences of war-related stress. The results indicate a need for careful psychiatric evaluation and more critical use of antidepressants in affected individuals.Retrospektivno su analizirani telefonski pozivi vezani uz ingestije lijekova primljeni u nacionalnom Centru za kontrolu otrovanja u Zagrebu u posljednjih 15 godina. Tri skupine psihoaktivnih lijekova (benzodiazepini, neuroleptici, antidepresivi) bile su od posebnog znaÄenja u ovom radu. Svi sluÄajevi ingestije lijekova analizirani su u dva vremenska intervala: period I (1985.ā1991.) i period II (1992.ā1999.) te u dvije skupine s obzirom na dob otrovanih: djeca (<16 godina) i odrasli (316 godina). Svaki telefonski poziv brojen je kao jedan sluÄaj trovanja, ukljuÄujuÄi i viÅ”estruke ingestije lijekova (ingestije viÅ”e od jedne vrste lijeka u isto vrijeme) koje su ukljuÄivale barem jedan psihoaktivni lijek. Kod djece, uÄestalost akutnih otrovanja neurolepticima bila je znaÄajno veÄa u periodu II nego u periodu I (7.4%:4.4%; P<0.05). UÄestalost otrovanja benzodiazepinima, antidepresivima i amitriptilinom kod djece nije se znaÄajno razlikovala u periodu I i II (benzodiazepini ā 13.5%:9.9%; antidepresivi ā 1.8%:1.8%; amitriptilin ā 0.3%:0.6%), kao ni uÄestalost viÅ”estrukih ingestija lijekova (19.4%:20.5%). Kod odraslih, uÄestalost otrovanja antidepresivima i amitriptilinom bila je znaÄajno veÄa u periodu II nego u periodu I (antidepresivi ā 13.0%:5.9%; P<0.01; amitriptilin ā 7.3%:2.9%; P<0.05), kao i uÄestalost viÅ”estrukih ingestija lijekova (45.3%: 29.1%; P<0.01). UÄestalost otrovanja benzodiazepinima i neurolepticima kod odraslih nije se znaÄajno razlikovala u periodu I i II (benzodiazepini ā 27.5%: 28.4%; neuroleptici ā 20.6%: 19.7%). U oba perioda uÄestalost otrovanja psihoaktivnim lijekovima bila je znaÄajno veÄa u odraslih nego u djece (period I ā 53.9%: 19.4%; P<0.01; period II ā 61.3%:19.1%; P<0.01). Od 1992. u Hrvatskoj se bilježi znaÄajan porast broja akutnih otrovanja antidepresivima, osobito tricikliÄkim, u odraslih osoba, Å”to je vezano vjerojatno uz uÄestalije propisivanje tih lijekova. Ovaj fenomen nije zabilježen u djece. PoveÄanje uÄestalosti akutnih otrovanja psihoaktivnim lijekovima, kao jedna od mnogih posljedica rata i posttraumatskoga stresnog poremeÄaja, upuÄuje na potrebu pažljive psihijatrijske procjene oboljelih, osobito pažljiviju uporabu antidepresiva. Rezultati ovog rada govore u prilog potrebe daljnjeg istraživanja uÄestalosti propisivanja psihoaktivnih lijekova u Hrvatskoj
Prikaz kliniÄko-toksikoloÅ”kih miÅ”ljenja izraÄenih u Centru za kontrolu otrovanja u Zagrebu u 10-godiÅ”njem razdoblju
The aim of this study was to see which harmful substances and which occupational settings most often required toxicological assessment, to evaluate exposure data provided by employers and to see to what extent could this assessment rely on actual measurements of harmful substances in a working environment. We reviewed the documentation that was submitted for toxicological assessment in all patients referred from occupational health physicians between 1992 and 2001. From 1992 to 2001, the Poison Control Centre performed a total of 260 toxicological evaluations of occupational exposure to harmful chemicals. In 162 cases (62 %), measurements of harmful substance concentrations in the working environment would have been of primary significance for the best comparison of potential adverse effects and the level of exposure. The most frequent was exposure to organic solvents in the production line and the use of various paints and varnishes, adhesives and thinners in shoe, chemical and metal-processing industry. Follows exposure to respiratory irritants, mostly in plastic and metal processing. However, measurement data of harmful substances in the working environment were available only in 24 cases, that is, in 9 % of all documents submitted for toxicological assessment. Exposure to organic solvents is characteristic for a large number of work places in industry and small enterprises in Croatia, and it is necessary to carry out a more comprehensive study about the real levels of exposure and modes of effective control. It is important because the EU regulations on the indicative occupational exposure limits (OELs) of harmful substances in the working environment, that will soon be implemented into Croatian legislation, recommend a reduction of maximum allowable concentrations (MAC) for commonly used solvents.Cilj rada bio je utvrditi za koje se Å”tetne tvari i u kojim radnim uvjetima najÄeÅ”Äe tražilo kliniÄko-toksikoloÅ”ko ispitivanje, kakvi su bili podaci o izloženosti dobiveni od poslodavca te dostupnost rezultata ispitivanja Å”tetnosti u radnom okoliÅ”u. Pregledana je dokumentacija za izradu kliniÄko-toksikoloÅ”kih miÅ”ljenja za sve pacijente upuÄene od lijeÄnika medicine rada u desetgodiÅ”njem razdoblju od 1992. do 2001. godine. U navedenom razdoblju u Centru za kontrolu otrovanja izraÄeno je ukupno 260 kliniÄko-toksikoloÅ”kih miÅ”ljenja za procjenu izloženosti Å”tetnim kemijskim tvarima iz radnog okoliÅ”a. U 62 % sluÄajeva podaci o izvrÅ”enim mjerenjima koncentracije Å”tetnih tvari u radnom okoliÅ”u bili bi od prvorazrednog znaÄenja za adekvatnu usporedbu potencijalno Å”tetnog uÄinka i razine izloženosti. VeÄinom se radilo o izloženosti organskim otapalima tijekom proizvodnje ili uporabe razliÄitih boja, lakova, ljepila i razreÄivaÄa i to najviÅ”e u obuÄarskoj, kemijskoj i metalopreraÄivaÄkoj proizvodnji. Na drugom je mjestu izloženost nadražljivcima diÅ”nih puteva najviÅ”e u proizvodnji i preradi plastiÄnih masa i obradi metala. MeÄutim, podaci o Å”tetnostima u radnoj atmosferi bili su dostupni samo u 24 sluÄaja odnosno u svega 9 % od svih priloženih dokumentacija za izradu toksikoloÅ”kog miÅ”ljenja. UtvrÄeno je da je izloženost organskim otapalima karakteristiÄna za veliki broj radnih mjesta u industriji i maloj privredi u Hrvatskoj te je potrebno korisno provesti cjelovitije ispitivanje o stvarnim razinama izloženosti i moguÄnostima njihove kontrole. To je posebno važno jer europske norme, koje Äe se uskoro biti ugraÄene u hrvatsko zakonodavstvo, preporuÄaju dalje sniženje maksimalno dopustivih koncentracija (MDK) za Äesto koriÅ”tena otapala
EXERCISE-INDUCED ASTHMA IN ATHLETES ā A REVIEW
Profesionalni sportaÅ”i Äesto su podvrgnuti treninzima izdržljivosti u okoliÅ”u u kojem su kroniÄno izloženi inhalacijskim oneÄiÅ”ÄivaÄima/iritansima, alergenima ili hladnom zraku. Ti Äimbenici dovode do poveÄanog rizika od razvoja disfunkcije gornjih i donjih diÅ”nih putova. Upravo je u toj specifiÄnoj populaciji dijagnoza astme krucijalna zbog potencijalnog uÄinka ne samo na njihovo opÄe stanje nego i na natjecateljske sposobnosti. Simptomi astme u vrhunskih sportaÅ”a nisu nužno povezani s klasiÄnim obilježjima astme u opÄoj populaciji. I drugi kliniÄki entiteti mogu stvarati simptome sliÄne onima u astmi i zbog toga mogu voditi netoÄnoj dijagnozi i neuspjeÅ”nu lijeÄenju. Zbog toga je za postavljanje konaÄne dijagnoze potrebna kombinacija simptoma i pozitivnih laboratorijskih testova. TrenutaÄno ne postoji dokaz da se postupanje s astmom u sportaÅ”a treba razlikovati od postupanja s astmom u nesportaÅ”a. MeÄutim, neka specifiÄna pitanja treba uzeti u obzir u vrhunskih sportaÅ”a, poput usklaÄenosti s pravilima Svjetske antidopinÅ”ke agencije i MeÄunarodnog olimpijskog odbora.Elite athletes are often subjected to endurance training in the environment in which they are chronically exposed to pollutants/irritants, allergens or cold air. These factors lead to an increased risk of upper and lower respiratory tract dysfunction. The diagnosis of asthma is crucial in elite athletes because of potential implications on athleteās general wellābeing as well as their competitive ability. Symptoms of asthma in elite athletes are not necessarily associated with the classic features of asthma seen in general population. Other clinical entities can create symptoms similar to those of asthma and therefore can lead to an incorrect diagnosis and ineffective treatment. The diagnosis requires a combination of symptoms and positive laboratory tests. Currently, there is no evidence that the treatment of asthma in athletes should be different from the treatment of asthma in non-athletes. However, some specific issues need to be considered in the elite athletes, such as compliance with the rules of World Anti-Doping Agency and International Olympic Committee
Razlike u znanju o tuberkulozi meÄu opÄom urbanom i studentskom populacijom u Zagrebu
Aim of study: The aim of this study is to find out the population knowledge, the most common misconceptions about tuberculosis (TB) and target groups for educational programs. Methods: Through a questionnaire (13 questions about the extent of the disease, symptoms, modes of transmission, risk factors and the curability of tuberculosis) respondents were pre-tested in the Croatian capital city Zagreb. Respondents (N = 328) were divided into groups ranked by two city locations: the Student Centre location, with the expected predominance of the younger student population (N = 157) and the main square area, with the expected predominance of people of different ages and professions (general urban population) (N = 171). Results: The general urban population group showed better knowledge in questions considering droplet transmission, smoking and excessive alcohol use as a risk factor for TB and description of TB as a primary infectious disease and curable disease. Many of the respondents (almost 20%) did not know the symptoms of manifest TB. Some respondents had misconceptions and perhaps the most important is that TB happens to someone else. Conclusion: Misconceptions about TB need to be eliminated through focused health education. Improvement in knowledge about TB can be achieved especially among student (young) population.Cilj: Cilj istraživanja bio je upoznati znanje stanovniÅ”tva o tuberkulozi i najÄeÅ”Äe zablude o njoj i otkriti ciljne skupine za provedbu potencijalnih edukativnih programa. Ispitanici i metode: Upitnik koji se sastoji od 13 pitanja o proÅ”irenosti bolesti, simptomima, naÄinima prijenosa, Äimbenicima rizika i izljeÄivosti tuberkuloze; ispitanici su testirani u Zagrebu. Ispitivanje je provedeno meÄu 328 ispitanika na dvije gradske lokacije: u Studentskom centru (N = 157), kao mjestu na kojem se oÄekuje da Äe predominantno prevladavati mlaÄa studentska populacija, i glavnom zagrebaÄkom trgu, gdje se oÄekuje da Äe biti ljudi razliÄite dobi i zanimanja, tj. uzorak opÄe urbane populacije (N = 171). Rezultati: Uzorak opÄe urbane populacije pokazao je bolje znanje o kapljiÄnom prijenosu bolesti, riziÄnim Äimbenicima za tuberkulozu kao Å”to su puÅ”enje cigareta i alkohol, te definiranju tuberkuloze kao primarno zarazne i izljeÄive bolesti. Mnogi od ispitanika (gotovo 20 %) nisu znali Å”to su simptomi tuberkuloze, a kao možda najvažnija zabluda istiÄe se kako se tuberkuloza dogaÄa nekome drugome. ZakljuÄak: Kroz ciljane edukativne programe trebalo bi raditi na uklanjanju zabluda o tuberkulozi i poboljÅ”anju znanja, posebice meÄu studentskom populacijom
EXERCISE-INDUCED ASTHMA IN ATHLETES ā A REVIEW
Profesionalni sportaÅ”i Äesto su podvrgnuti treninzima izdržljivosti u okoliÅ”u u kojem su kroniÄno izloženi inhalacijskim oneÄiÅ”ÄivaÄima/iritansima, alergenima ili hladnom zraku. Ti Äimbenici dovode do poveÄanog rizika od razvoja disfunkcije gornjih i donjih diÅ”nih putova. Upravo je u toj specifiÄnoj populaciji dijagnoza astme krucijalna zbog potencijalnog uÄinka ne samo na njihovo opÄe stanje nego i na natjecateljske sposobnosti. Simptomi astme u vrhunskih sportaÅ”a nisu nužno povezani s klasiÄnim obilježjima astme u opÄoj populaciji. I drugi kliniÄki entiteti mogu stvarati simptome sliÄne onima u astmi i zbog toga mogu voditi netoÄnoj dijagnozi i neuspjeÅ”nu lijeÄenju. Zbog toga je za postavljanje konaÄne dijagnoze potrebna kombinacija simptoma i pozitivnih laboratorijskih testova. TrenutaÄno ne postoji dokaz da se postupanje s astmom u sportaÅ”a treba razlikovati od postupanja s astmom u nesportaÅ”a. MeÄutim, neka specifiÄna pitanja treba uzeti u obzir u vrhunskih sportaÅ”a, poput usklaÄenosti s pravilima Svjetske antidopinÅ”ke agencije i MeÄunarodnog olimpijskog odbora.Elite athletes are often subjected to endurance training in the environment in which they are chronically exposed to pollutants/irritants, allergens or cold air. These factors lead to an increased risk of upper and lower respiratory tract dysfunction. The diagnosis of asthma is crucial in elite athletes because of potential implications on athleteās general wellābeing as well as their competitive ability. Symptoms of asthma in elite athletes are not necessarily associated with the classic features of asthma seen in general population. Other clinical entities can create symptoms similar to those of asthma and therefore can lead to an incorrect diagnosis and ineffective treatment. The diagnosis requires a combination of symptoms and positive laboratory tests. Currently, there is no evidence that the treatment of asthma in athletes should be different from the treatment of asthma in non-athletes. However, some specific issues need to be considered in the elite athletes, such as compliance with the rules of World Anti-Doping Agency and International Olympic Committee
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