Opseg struka ne korelira s funkcionalnom plućnom sposobnosti kod umjerene i teške kronične opstruktivne plućne bolesti

Waist circumference is a good predictor of the risk of heart diseases, but dana on the relationship between waist circumference and pulmonary diseases are sparse. The aim of this study was to investigate its influence on pulmonary function regarding exercise capacity in moderate and severe chronic obstructive pulmonary disease (COPD), according to Global Initiative for Lung Diseases (GOLD) stages. During 2009, a total of 70 COPD patients aged 33 to 80 years were stratified into GOLD 2 and GOLD 3 stages. Diagnostic separation between COPD severity groups was made upon percentage of predicted forced expiratory volume in 1 second. Anthropometric measures, lung function testing and prognostic scoring systems were assessed. Logistic regression analysis was used to make comparisons while taking into account the possible confounding factors. Waist circumference did not show substantial variations between GOLD 2 and GOLD 3 stages (p>0.5). There was a weak positive correlation between waist circumference and percent of predicted 6-minute walking distance (r=0.237; p=0.001). Another parameter, suprailiac skinfold, was significantly different between GOLD 2 and GOLD 3 stages (19.41 vs. 15.32 mm; p=0.047). Although waist circumference is a meaningful marker of abdominal obesity, which influences pulmonary function, we failed to prove its importance in correlation with functional lung capacity in a selected COPD population. However, suprailiac skinfold deserves greater attention and further evaluation.Povećani je opseg struka dobar predskazatelj rizika za razvoj srčanih bolesti, no gotovo da nema podataka o odnosu opsega struka i plućnih bolesti. Cilj ove studije bio je ispitati utjecaj veličine opsega struka na funkcionalnu plućnu sposobnost prema klasifikaciji GOLD (Global Initiative for Lung Diseases). Tijekom 2009. godine 70 bolesnika u dobi od 33 do 80 godina podijeljeno je u skupine GOLD2 i GOLD3 ovisno o težini bolesti. Dijagnostička razdioba ovih skupina temelji se na razlici dobivenih vrijednosti predviđenog forsiranog ekspiracijskog volumena u prvoj sekundi. Analizirane su brojne antropometrijske mjere, testovi plućne funkcije i prognostički bodovni sustavi. U statističkoj je obradi korištena logistička regresijska analiza. Razlika u veličini opsega struka između stupnjeva GOLD2 i GOLD3 nije dosegla statističku značajnost (p>0,5). Nađena je slaba pozitivna korelacija između opsega struka i postotka predviđene udaljenosti u 6-minutnom hodu (r=0,237; p=0,001). No, statistički značajna razlika između dviju ispitivanih skupina nađena je u debljini suprailijačnog nabora (19,41 prema 15,32 mm; p=0,047). Opseg struka je jedan od parametara koji definiraju abdominalnu pretilost. Iako pretilost utječe na plućnu funkciju, ova studija nije dokazala da postoji korelacija između veličine opsega struka i funkcionalne plućne sposobnosti u odabranoj populaciji bolesnika s kroničnom plućnom bolešću. No, daljnju evaluaciju i vrednovanje u kliničkoj praksi zaslužuje mjerenje suprailijačnog nabora

Are women suffering from COPD more sensitive to tobacco and its ingredients?

Cilj: Cilj ovog istraživanja bio je utvrditi postoji li razlika u težini bolesti između muškaraca i žena oboljelih od kronične opstruktivne plućne bolesti (KOPB-a), čija se etiologija pripisuje pušenju. Ispitanici i metode: Istraživanje je obuhvatilo 250 ispitanika oboljelih od KO- PB-a. Ispitivani uzorak činile su 82 žene (32,8 %) i 168 muškaraca (67,2 %) prosječne životne dobi od 68,2 g. Ispitanici su podijeljeni u 2 skupine shodno spolu. Svaka ispitivana skupina potom je podijeljena na podskupine nepušača, bivših pušača i aktivnih pušača. U skupini žena dominirali su nepušači (N = 35; 42 %), a u skupini muškaraca pušači (N = 58; 34,5 %). Ispitanici su podijeljeni prema kriterijima GOLD-a iz 2010. godine u 3 skupine, ovisno o težini bolesti (GOLD I, GOLD II i GOLD III). Rezultati: Usporedba pušačkih godina, tj. broja cigareta popušenih na dan podijeljenog s 20 (broj cigareta u kutiji) i potom pomnoženog s brojem godina pušenja (engl. pack/year; p/y) bivših i aktivnih pušača obaju spolova pokazuje da između spolova postoji razlika u težini bolesti. Ukupno manji broj žena bivših i aktivnih pušača s nižim prosječnim p/y postiže isti stupanj težine bolesti kao muškarci sa znatno većim prosječnim p/y (p = 0,009). Zaključak: Rezultati upućuju na moguću jaču osjetljivost žena na djelovanje duhanskog dima i njegovih sastojaka na dišne puteve od muškaraca.Aim: To determine the possible difference in disease severity between men and women suffering from chronic obstructive lung disease (COPD) attributed to smoking. Sub- jects and methods: The study comprised a total of 250 subjects suffering from COPD: 82 (32,8 %) women and 168 (67,2 %) men with the average age of 68.2 years. Subjects were first divided into two gender-based groups. Each of the latter groups was subsequently subdivided into the following subgroups: non-smokers, ex-smokers and active smokers. The study group comprised of women was dominated by non-smokers (N = 35; i.e. 42 %), while that comprised of men was dominated by smokers (N = 58; i.e. 34.5 %). In line with the GOLD criteria observed back in 2010, subjects were divided into three groups (GOLD I, GOLD II and GOLD III) based on their disease severity. Results: Comparison of the length of smoking expressed in the number of cigarettes smoked per day divided by 20 (no of cigarettes in a single pack) and further multiplied by the number of years of active smoking (pack/year; p/y), made be- tween former and active smokers of both genders, shows inter-gender differences in disease severity. A lower total number of former and active female smokers having a lower p/y attains the same degree of the disease severity as men having a substantially higher p/y (p =0.009). Conclusion: The results of this study suggest that female airways might be more sensitive to tobacco smoke and its ingredients as compared to those of men

Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 6580% predicted. In recent years, an elegant series of studies has shown that "exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment". In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient's physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of "mild COPD". To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with "mild" airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind "mild" COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both

Exogenous lipoid pneumonia after petroleum aspiration: a case report

Cilj: Prikazati slučaj 42-godišnjeg bolesnika koji je upućen zbog aspiracijske pneumonije srednjeg režnja pluća, refrakterne na terapiju, koja je nastala kao posljedica aspiracije nafte. Prikaz slučaja: Nakon učinjene bronhoskopske i radiološke obrade, na nalazu kompjutorizirane tomografije grudnog koša i dalje perzistira infiltrat srednjeg režnja s destrukcijom i nekrozom, pa se torakokirurški odstranila tvorba. Patohistološki nalaz odgovara kroničnoj lipoidnoj bronhopneumoniji. Zaključak: Lipoidna pneumonija je rijedak oblik pneumonije koji predstavlja dijagnostički i terapijski izazov. Potrebno je razmišljati o ovoj bolesti, koja se može javljati u akutnom, ali i kroničnom obliku. Katkad može izazvati destrukciju i nekrozu, refrakternu na svu terapiju, pa torakotomija može biti najbolje rješenje za bolesnika.Aim: To report the case of a 42-year old patient, who was was reffered because of non resolving middle lobe aspiration pneumonia caused by petroleum aspiration. Case report: Fiberopticbronchoscopy and chest radiograph were performed to evaluate the non resolving pneumonia. Chest radiography and bronchoscopy revealed consolidation in the middle lobe. Computerized tomography scan revealed the same consolidation in the middle lobe with cavitation and necrosis, and toracotomy was indicated. Histological analysis revealed chronic lipoid pneumonia. Conclusion: Lipoid pneumonia is a rare condition, which represents a diagnostic and therapeutic challenge. Therefore, physicians should be aware of this disease, which can present in an acute, as well as a chronic respiratory illness. Once diagnosed, it can be progressive, causing necrosis and cavitation, which may require thoracotomy as the best solution for the patient

Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research – a consensus document from six scientific societies

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 ≥80% predicted. In recent years, an elegant series of studies has shown that "exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment". In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient's physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of "mild COPD". To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with "mild" airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind "mild" COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both