V času epidemije covida-19 so se v zdravljenje bolnikov s covidom v Sloveniji vključevale različne slovenske bolnišnice. Ob centralno koordiniranem vključevanju – glede na potrebe in zmogljivosti ...bolnišnice ter ob upoštevanju strokovne usmerjenosti posameznih bolnišnic – so bile izkušnje ustanov različne. V prispevku prikazujemo izkušnje z obravnavo bolnikov s covidom-19 v obdobju 4. vala epidemije v periferni, pulmološko usmerjeni bolnišnici, kar je prvi prikaz analize kakovosti obravnave teh bolnikov v Sloveniji. Osnovne značilnosti hospitalizacij smo analizirali s pomočjo integriranih rešitev informacijskega sistema Birpis in pregleda elektronske temperaturno-terapevtske liste (eTTL). Kakovost strokovne obravnave smo ocenjevali glede na upoštevanje veljavnih strokovnih priporočil. Analiza je potekala z vgrajenimi statističnimi funkcijami programa Microsoft Excel. 99 bolnikov (58 žensk, 41 moških), starih 67,9 leta, je bilo v povprečju hospitaliziranih 8,1 dneva. Večina so bili prebivalci naše regije (61 %), necepljeni (61,6 %) in s težkim potekom bolezni s potrebo po dodatku kisika (88,9 %). Večina bolnikov je prejela steroide (73,7 %), antibiotik (68,7 %) in vitamin D (71,7 %), v manjši meri so prejeli specifično terapijo (remdesivir 25,3 %, kombinacijo kasirivimab/imdevimab 2 %, tocilizumab 1 %). Neželenih učinkov novih zdravil nismo zabeležili. Umrlo je 17 oseb (celokupna smrtnost 17,2 %). Med osebjem na covidnem oddelku ni prišlo do prenosa okužb. Rezultati kažejo, da je bilo zdravljenje bolnikov s covidom-19 v Bolnišnici Topolšica uspešno, hkrati pa nakazujejo možnost dodatnih izboljšav zlasti na področju predpisovanja antibiotikov.
Reduced physical activity is associated with increased morbidity and mortality in patients with COPD. Studies suggest that treatment with the long-acting muscarinic antagonist tiotropium and the ...long-acting β
-agonist olodaterol increases exercise capacity. This study assessed the effects of a fixed-dose combination (FDC) of tiotropium/olodaterol (delivered via Respimat
) on physical functioning in patients with stable COPD in a "real-world setting".
An international, open-label, single-arm, non-interventional study conducted in nine countries measuring changes in self-reported physical functioning in COPD patients treated with tiotropium/olodaterol 5/5 μg FDC for approximately 6 weeks. The primary endpoint was therapeutic success, defined as a minimum 10-point increase in the 10-question Physical Functioning Questionnaire (PF-10) score. Secondary endpoints included absolute change in PF-10 from Visit 1 to Visit 2, patient general condition (measured by Physician's Global Evaluation score) and patient satisfaction with the treatment and device (assessed by Patient Satisfaction Questionnaire at the end of the study period).
Therapeutic success was observed in 67.8% of 7218 patients (95% CI 66.7, 68.8) in the final analysis set after approximately 6 weeks of treatment with tiotropium/olodaterol. Mean change in PF-10 score between Visit 1 and Visit 2 was 16.6 points (95% CI 16.2, 17.0). Therapeutic success was 64.3% (95% CI 63.0-65.6%) in patients with infrequent (≤1) and 76.1% (95% CI 74.3-77.9%) in patients with frequent (≥2) exacerbations (p<0.0001). Patient general condition improved as indicated by an improvement in Physician's Global Evaluation scores between visits. Most patients were very satisfied or satisfied with tiotropium/olodaterol treatment in general (81%), reported inhalation satisfaction (85%), and satisfactory handling of the device (84%). 1.3% of patients reported an investigator-defined drug-related adverse event.
Treatment with tiotropium/olodaterol led to an improvement in self-reported physical functioning in patients with COPD.
The Clinical COPD Questionnaire (CCQ) is a simple patient-reported tool to measure clinical control of chronic obstructive pulmonary disease (COPD).
This open-label, single-arm, non-interventional ...study (NCT03663569) investigated changes in CCQ score during treatment with tiotropium/olodaterol in clinical practice.
Data were included from consenting COPD patients, enrolled in Bulgaria, Czech Republic, Hungary, Israel, Lithuania, Poland, Romania, Russia, Slovenia, Switzerland and Ukraine, who were receiving a new prescription for tiotropium/olodaterol according to the treating physician in a real-world environment. The primary endpoint was the occurrence of therapeutic success, defined as a 0.4-point decrease in CCQ score after treatment with tiotropium/olodaterol for approximately 6 weeks.
Overall, 4819 patients were treated; baseline and Week 6 CCQ scores were available for 4700 patients, mostly classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B (51.6%) or D (42.7%). After 6 weeks' treatment, 81.4% (95% confidence interval 95% CI 80.24-82.49) of patients achieved therapeutic success; mean improvement in overall CCQ score was 1.02 points (95% CI 1.00-1.05). Improved CCQ score was seen in 92.2% of patients (95% CI 91.43-92.98), 2.5% had no change and 5.3% showed a worsening. When stratified by prior treatment, the greatest benefit was seen in treatment-naïve patients, with 85.7% achieving therapeutic success, compared with 79.5% of those pretreated with long-acting β
-agonist (LABA)/inhaled corticosteroid (ICS) and 74.2% of those pretreated with LABA or long-acting muscarinic antagonist (LAMA) monotherapy. Overall, rescue medication decreased by 1.25 puffs/day (95% CI 1.19-1.31) versus baseline. In total, 29 patients (0.6%) reported drug-related adverse events and 7 patients reported serious adverse events (0.15%).
In 4700 COPD patients, 6 weeks' treatment with tiotropium/olodaterol, as initial treatment or follow-up to LAMA or LABA monotherapy or LABA/ICS, improved CCQ and decreased rescue medication use. The adverse event profile was consistent with the known safety profile of tiotropium/olodaterol.
Z dokumentom želimo smernice, ki jih predlaga GINA, vključiti v slovenski prostor. Želimo, da bi dokument služil enotnemu in dogovorjenemu pristopu k obravnavi bolnikov z astmo na primarni in ...specialistični pulmološki ravni.
Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these ...patients in this region.Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment.3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma-COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma-COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes.The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes.
Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) released a revised consensus report (2017 GOLD Report) 1 in which the formerly defined ABCD classification of patients with ...COPD has been refined. The 2011 GOLD Report and its 2016 Update classified patients on the basis of three variables, i.e. the symptom burden, lung function impairment and exacerbations 2, now the A–D groups are defined solely on the basis of symptoms and history of exacerbations – thus recognising the limitations of the forced expiratory volume in 1 s (FEV1) in influencing therapeutic decisions in COPD 1. The obvious consequence of the new classification is a shift of a proportion of patients from the C to the A group, and from the D to the B group. Nevertheless, the magnitude of such redistribution remains unknown.
The COPD Assessment Test (CAT) has been proposed to help guide therapy in chronic obstructive pulmonary disease (COPD). It is important to understand the distribution of scores in different COPD ...populations and their determinants.
The POPE study is an international, observational cross-sectional study of COPD subjects in 11 Central and Eastern European countries aimed at characterizing COPD phenotypes. Here we report the analysis of CAT scores with the objective of identifying their determinants, evaluating symptom load and investigating the distribution of scores among the participating countries. Additionally, we investigated the discrepancies between the CAT and modified Medical Research Council (mMRC) scores when used to classify patients according to the GOLD strategy.
The study included 3452 patients (69.2% men, mean forced expiratory volume in 1 s (FEV1% predicted) 52.5%). The mean CAT score was 17.5 (SD = 7.8), ranging from 15.1 in Hungary to 21.2 in Bulgaria. Multiple linear regression analysis showed six variables significantly associated with CAT scores: depression, number of previous exacerbations, 6-min walking distance, FEV1(%), mMRC and country and explained 47.2% of the variance of CAT. According to either CAT or mMRC, up to 23.9% patients would be classified in different GOLD groups.
The CAT score may be predicted by factors related to COPD severity, depression and exercise capacity, with significant differences in the distribution of CAT scores in different countries. According to our results CAT >10 is not equivalent to mMRC >2 for assessing symptom burden.
Trial Registration: ClinicalTrials.gov, identifier NCT02119494;
•CAT scores are different in patients from countries of Central and Eastern Europe.•CAT is related to depression, exacerbations, FEV1(%), dyspnoea and country.•CAT and mMRC scores classify up to 23% of patients in different GOLD categories.
First experience with organisation and operation of nurse-led intermediate care department in Slovenia is presented. Organisation of independent non-acute care department led to 5% shortening in ...average length of stay in acute care and 16% decrease in rehospitalization rate. Majority (61.9%) of the patients admitted to the intermediate care department were discharged to their homes, 10.9% to homes for aged people, 7% to other institutional care facilities or departments for long term care, and 9.6% died. After discharge 43% of the patients were independent, 23% managed with some help, and 34% were totaly dependent from help by others. By adaptive programmes of training a success was made by involving next kins and guardians in care for the patients at home. Better economy was achieved by lowering over-head and diagnostic costs (23% of average acute – care department diagnostic cost).
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