47 research outputs found
Asthma and Depression
Poznato je da se anksioznost i depresija pojavljuju u bolesnika s astmom i povezani su s loÅ”om kontrolom astme, ÄeÅ”Äim pogorÅ”anjima i poveÄanom uporabom zdravstvenih resursa. SliÄnost i preklapanje simptoma depresije i nekontrolirane astme Äine lijeÄenje astme izazovnijim i složenijim Å”to može dovesti do nedovoljnog dijagnosticiranja i loÅ”ijeg lijeÄenja komorbiditeta. Nema jasnih stajaliÅ”ta o tome jesu li osobe s astmom depresivnije od onih bez astme, ima li depresija āaditivanā Å”tetni uÄinak na normalno smanjenje kvalitete života povezano s astmom, jesu li subjektivni simptomi astme jaÄe povezani s depresijom nego objektivne mjere, postoje li simptomi depresije koji su ÄeÅ”Äe povezani s astmom, mogu li tuga i depresija uzrokovati respiratorne uÄinke sukladne pogorÅ”anjima astme, u kojoj mjeri depresija negativno utjeÄe na lijeÄenje astme, je li uporaba kortikosteroida u astmi povezana s depresijom i kako, koje su fiziÄke, psiholoÅ”ke i socijalne posljedice depresije u astmi te kako lijeÄiti takve bolesnike. Postoji potreba za daljnjim istraživanjima kako bi se razvili standardizirani algoritmi utemeljeni na dokazima kojima bi se usmjerila kliniÄka praksa.It has been documented that anxiety and depression are prevalent in patients with asthma and are associated with poor asthma control, greater frequency of exacerbations and increased use of healthcare resources. There are no clear views whether persons with asthma are more depressed than those without asthma; whether depression has an āadditiveā adverse effect on the normal asthma-related decline of quality of life; whether subjective asthma symptoms are more strongly associated with depression than objective measures; are there any symptoms of depression that are more commonly associated with asthma; can sadness and depression produce respiratory effects consistent with asthma exacerbations; the extent to which depression has an adverse effect on the treatment of asthma; whether corticosteroid use in asthma is associated with depression and how; what are the physical, psychological and social consequences of depression in asthma and how to treat such patients. There is a need for further research in order to develop evidence-based standardized algorithms to guide clinical practice
The Prevalence and Pulmonary Consequences of Anxiety and Depressive Disorders in Patients with Asthma
The aim of this study was to determine the prevalence of anxiety and depression symptoms in outpatients with treated
asthma and to determine the influence of anxiety and depression symptoms on lung function and asthma symptoms. The
study was conducted in the pulmonary clinic of the Department of Pulmonary Diseases, Osijek University Hospital Centre,
on 200 outpatients with asthma, aged 18ā50 years, of which there were 65.5% women and 35.5% men. Each patient
underwent a clinical examination with an extensive anamnesis and lung auscultation. The lung function was tested by
spirometry. Demographic data and data on general and socioeconomic characteristics were evaluated using a questionnaire
created internally for the purposes of this research, psychological status was assessed by HAD questionnaire, and Q
test was used as a measure of asthma control. Based on the HAD questionnaire, 44.5% of asthma patients met the criteria
for anxiety, and 24.5% of asthma patients met the criteria for depression. There was no significant correlation between
asthma symptoms and the degree of anxiety or depression, while the pulmonary function of asthma patients negatively
correlated with the degree of anxiety and depression. Pulmonary function in asthma patients with symptoms of anxiety
and depression was significantly poorer than in asthma patients without anxiety and/or depression symptoms. The results
show that among asthma patients there are large number of those who have symptoms of anxiety and depression.
Asthma patients with symptoms of anxiety and depression have poorer lung function than patients with only asthma
symptoms, however there is no significant correlation between the lung function and symptoms of asthma. We have confirmed
that patients with anxiety symptoms visit general practitioners or EMS significantly more when compared to patients
with depression symptoms
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
Snaga inspiratorne diÅ”ne muskulature utjeÄe na anaerobnu izdržljivost u vrhunskih sportaÅ”a
To the best of our knowledge, little is known about the role of respiratory muscle strength and endurance on athlete performance in anaerobic conditions of maximal exertion. The aim of this cross-sectional study was therefore to examine the association between the strength/endurance of inspiratory muscles in a group of 70 healthy male professional athletes (team sports) and their ventilatory and metabolic parameters at the anaerobic threshold (second ventilatory threshold; VT2) and beyond it at maximum load during the cardiopulmonary exercise test (CPET) on a treadmill. Ventilatory parameters at VT2, at maximal effort, and their differences were tested for association with inspiratory muscle strength (PImax) and endurance (Tlim), measured as time to maintain inspiration at or above 80% of PImax. The difference in end-tidal oxygen tension (ĪPETO2) between VT2 and maximal effort was significantly associated with resting heart rate (HR) and systolic blood pressure (BP), PImax, and lean body mass (LBM) (r2=0.26, p=0.016; multivariate regression analysis). The difference in carbon dioxide output (ĪVCO2) was significantly associated with body mass index (BMI), resting HR, systolic BP, and PImax (r2=0.25, p=0.022; multivariate regression analysis). Our findings suggest that it is the inspiratory muscle strength and not endurance that affects the performance of professional athletes and that it should be tested and trained systematically.Cilj ovog presjeÄnog istraživanja, u kojem je sudjelovalo 70 zdravih muÅ”karaca vrhunskih sportaÅ”a (momÄadskih sportova) bio je ispitati povezanost snage/izdržljivosti inspiratorne muskulature i ventilacijskih i metaboliÄkih parametara na anaerobnom pragu (drugi ventilacijski prag; VT2) te nakon njega pri maksimalnom optereÄenju tijekom kardiopulmonalnog testiranja na tekuÄoj traci (CPET). Ventilacijski parametri na VT2, pri maksimalnom naporu te njihova razlika testirani su na povezanost sa snagom inspiratorne muskulature (PImax) i izdržljivoÅ”Äu (Tlim), koja je izmjerena kao vrijeme tijekom kojega se zadržava ventilacija na ili iznad 80% PImax. Razlika tlaka kisika na kraju izdaha izmeÄu VT2 i maksimalnog napora (ĪPETO2) znaÄajno je bila povezana sa srÄanom frekvencijom (HR) i sistoliÄkim krvnim tlakom (SBP) u mirovanju, s PImax i bezmasnom masom tijela (LBM) (r2=0,26, p=0,016; multivarijatna regresijska analiza). Razlika izdahnutog CO2 (ĪVCO2) znaÄajno je bila povezana s indeksom tjelesne mase (BMI), HR-om i SBP-om u mirovanju te s PImax (r2=0,25, p=0,022; multivarijatna regresijska analiza). Rezultati ovog istraživanja upuÄuju na to da snaga, a ne izdržljivost inspiratorne muskulature znaÄajno utjeÄe na radni uÄinak (izvedbu) vrhunskih sportaÅ”a te da ju je potrebno sustavno mjeriti i trenirati
Platypnea-orthodeoxia syndrome related to the patent foramen ovale and atrial septal aneurysm
The platypnea-orthodeoxia syndrome is a rare condition characterized by postural dyspnea and hypoxemia that disappear or diminish in lying position, so it can be difficult to recognize without close assessment of the patient\u27s pattern of dyspnea. The syndrome is commonly associated to an intra-cardiac right-to-left shunt through a patent foramen ovale as the most frequently reported site of the shunt. Platypnea-orthodeoxia syndrome can be the cause of refractory hypoxemia leading to pulmonary hypertension, whereby, if suspected, contrast echocardiography in supine as well as in upright position should be performed. We are presenting a case of an unrecognized platypnea-orthodeoxia syndrome because of a patent foramen ovale and atrial septal aneurysm, with developed chronic complications due to long-standing hypoxemia. This case highlights the need of a high index of suspicion to diagnose the syndrome on time and the necessity of careful echocardiographic evaluation
PresjeÄna studija dinamike temperature izdaha nakon popuÅ”ene cigarete i njezina povezanost s promjenama pluÄne funkcije u puÅ”aÄa prediktivnima za rizik od KOPB-a
Exhaled breath temperature (EBT) is a biomarker of inflammation and vascularity of the airways already shown to predict incident COPD. This cross-sectional study was aimed to assess the potential of EBT in identifying āhealthyā smokers susceptible to cigarette smoke toxicity of the airways and to the risk of developing COPD by analysing the dynamics of EBT after smoking a cigarette and its associations with their demographics (age, smoking burden) and lung function. The study included 55 current smokers of both sexes, 29ā62 years of age, with median smoking exposure of 15 (10ā71.8) pack-years. EBT was measured at baseline and 5, 15, 30, 45, and 60 min after smoking a single cigarette. Lung function was measured with spirometry followed by a bronchodilator test. To compare changes in EBT between repeated measurements we used the analysis of variance and the area under the curve (EBTAUC) as a dependent variable. Multivariate regression analysis was used to look for associations with patient characteristics and lung function in particular. The average (Ā±SD) baseline EBT was 33.42Ā±1.50 Ā°C. The highest significant increase to 33.84 (1.25) Ā°C was recorded 5 min after the cigarette was smoked (p=0.003), and it took one hour for it to return to the baseline. EBTAUC showed significant repeatability (ICC=0.85, p<0.001) and was significantly associated with age, body mass index, number of cigarettes smoked a day, baseline EBT, and baseline FEF75 (R2=0.39, p<0.001 for the model). Our results suggest that EBT after smoking a single cigarette could be used as early risk predictor of changes associated with chronic cigarette smoke exposure.Temperatura izdaha (EBT) biomarker je upale i vaskularizacije diÅ”nih putova za koji je utvrÄeno da može predvidjeti nastanak KOPB-a. Cilj ove presjeÄne studije bio je procijeniti potencijal EBT-a u identifikaciji āzdravihā puÅ”aÄa Äiji su diÅ”ni putovi osjetljivi na toksiÄni uÄinak duhanskoga dima uz rizik od nastanka KOPB-a. Taj se cilj planirao postiÄi utvrÄivanjem povezanosti dinamike EBT-a nakon popuÅ”ene cigarete s demografskim karakteristikama (dob, spol, puÅ”aÄka navika) i pluÄnom funkcijom ispitanika. U ispitivanje je bilo ukljuÄeno 55 aktivnih puÅ”aÄa obaju spolova u dobi od 29 do 62 godine, Äiji je medijan izloženosti duhanskom dimu bio 15 (10 ā 71,8) puÅ”aÄkih godina (pack-years). EBT je mjeren na poÄetku te 5, 15, 30, 45 i 60 minuta nakon popuÅ”ene cigarete. PluÄnu funkciju mjerili smo spirometrijski, uz susljedni bronhodilatacijski test. Za analizu dinamike EBT-a koristili smo se analizom varijance te smo izraÄunali povrÅ”inu ispod krivulje u odnosu na poÄetno mjerenje (EBTAUC) te EBTAUC upotrijebili kao zavisnu varijablu. Multivarijatna regresijska analiza koriÅ”tena je za utvrÄivanje povezanosti EBTAUC s karakteristikama ispitanika, posebice s pluÄnom funkcijom. ProsjeÄni (Ā±SD) izmjereni poÄetni EBT bio je 33,42Ā±1,50 Ā°C, a najveÄe znaÄajno izmjereno poveÄanje zabilježeno je 5 minuta nakon popuÅ”ene cigarete (33,84 (1,25) Ā°C, p=0,003). Bilo je potrebno 60 minuta kako bi se EBT vratio na poÄetnu vrijednost. UtvrÄena je znaÄajna ponovljivost EBTAUC (ICC=0,85, p<0,001). Ispitivanjem je utvrÄeno je da je EBTAUC znaÄajno nezavisno povezan s dobi, indeksom tjelesne mase, brojem popuÅ”enih cigareta dnevno, poÄetnim EBT-om te s poÄetnim FEF75 (R2=0,39, p<0,001 za model). Rezultati ove studije sugeriraju da EBT nakon popuÅ”ene cigarete može biti koristan kao rani prediktor rizika od promjena koje su povezane s kroniÄnom izloženosti duhanskom dimu
Anemia, hypoalbuminemia, and elevated troponin levels as risk factors for respiratory failure in patients with severe exacerbations of chronic obstructive pulmonary disease requiring invasive mechanical ventilation
Aim To determine in-hospital and post-discharge mortality,
readmission rates, and predictors of invasive mechanical
ventilation (IMV) in patients treated at intensive care
unit (ICU) due to acute exacerbations of chronic obstructive
pulmonary disease (AECOPD).
Methods A retrospective observational cohort study included
all patients treated at a respiratory ICU for AECOPD
during one year. A total of 62 patients (41 men) with mean
age 68.4 Ā± 10.4 years were analyzed for outcomes including
in-hospital and post-discharge mortality, readmission
rates, and IMV. Patientsā demographic, hematologic, biochemical
data and arterial blood gas (ABG) values were recorded
on admission to hospital. Mean duration of followup
time was 2.4 years.
Results Of 62 patients, 7 (11.3%) died during incident hospitalization
and 21 (33.9%) died during the follow-up. The
overall 2.4-year mortality was 45.2%. Twenty nine (46.8%)
patients were readmitted due to AECOPD. The average
number of readmissions was 1.2. Multivariate analysis
showed that blood pH, bicarbonate levels, low albumin,
low serum chloride, and low hemoglobin were significant
predictors of IMV during incident hospitalization (P < 0.001
for the overall model fit).
Conclusion High in-hospital and post-discharge mortality
and high readmission rates in our patients treated due
to AECOPD at ICU indicate that these patients represent
a high risk group in need of close monitoring. Our results
suggested that anemia, hypoalbuminemia, and elevated
troponin levels were risk factors for the need of IMV in
severe AECOPD. Identification of such high-risk patients
could provide the opportunity for administration of an appropriate
and timely treatment
Development and the initial validation of a new self-administered questionnaire for an early detection of health status changes in smokers at risk for chronic obstructive pulmonary disease (MARKO questionnaire)
Aim To develop and do an initial validation of a new simple
tool (self-administered questionnaire) that would be sensitive
and specific enough to detect early changes in smokers
leading to future development of chronic obstructive pulmonary
disease (COPD).
Methods 224 consecutive participants (50.9% women), with
mean Ā± standard deviation age of 52.3 Ā± 6.7 years, 37.5 Ā± 16.7
pack-years smoking history (85.8% active smokers), and no
prior diagnosis of COPD were recruited. The MARKO questionnaire
was self-administered twice; at the general practitionerās
office and after 2-4 weeks at the tertiary care hospital.
Participants were assessed for COPD by a pulmonologist
after filling in a quality of life (QoL) questionnaires, historytaking,
physical examination, lung function test, 6-minute
walk test, and laboratory tests. They were divided into four
subgroups: āhealthyā smokers, symptomatic smokers, and
smokers with mild and moderately severe COPD.
Results Psychometric analyses indicated that the 18-item
questionnaire had a very good internal consistency (Cronbachās
alpha = 0.91) and test-retest reliability for a four week
period (Ļc = 0.89, 95% confidence interval [CI] 0.85-0.92, Linās
concordance). A significant correlations of MARKO scores
were found with two QoL questionnaires; r = 0.69 (P < 0.001)
and r = 0.81 (P < 0.001). Receiver operating characteristic
curve analysis showed an area under the curve of 0.753
(95% CI 0.691-0.808, P < 0.001), with a sensitivity of 71.83%
and specificity of 64.24% to discriminate āhealthyā smokers
from other subgroups.
Conclusion Based on psychometric analyses and high convergent
validity correlation with already validated QoL questionnaires,
the newly developed MARKO questionnaire was
shown to be a reliable self-administered short health status
assessment tool