To determine the predictability of the MARKO questionnaire and/or its domains, individually or in combination with other markers and characteristics (age, gender, smoking history, lung function, ...6-min walk test (6 MWT), exhaled breath temperature (EBT), and hsCRP for the incident chronic obstructive pulmonary disease (COPD) in subjects at risk over 2 years follow-up period).
Patients, smokers/ex-smokers with >20 pack-years, aged 40-65 years of both sexes were recruited and followed for 2 years. After recruitment and signing the informed consent at the GP, a detailed diagnostic workout was done by the pulmonologist; they completed three self-assessment questionnaires-MARKO, SGRQ and CAT, detailed history and physical, laboratory (CBC, hsCRP), lung function tests with bronchodilator and EBT. At the 2 year follow-up visit they performed: the same three self-assessment questionnaires, history and physical, lung function tests and EBT.
A sample of 320 subjects (41.9% male), mean (SD) age 51.9 (7.4) years with 36.4 (17.4) pack-years of smoking was reassessed after 2.1 years. Exploratory factor analysis of MARKO questionnaire isolated three distinct domains (breathlessness and fatigue, "exacerbations", cough and expectorations). We have determined a rate for incident COPD that was 4.911/100 person-years (95% CI 3.436-6.816). We found out that questions about breathlessness and "exacerbations", and male sex were predictive of incident COPD after two years follow-up (AUC 0.79, 95% CI 0.74-0.84,
< 0.001). When only active smokers were analyzed a change in EBT after a cigarette (ΔEBT) was added to a previous model (AUC 0.83, 95% CI 0.78-0.88,
< 0.001).
Our preliminary data shows that the MARKO questionnaire combined with EBT (change after a cigarette smoke) could potentially serve as early markers of future COPD in smokers.
Although only less than one-third of smokers develop COPD, early marker(s) of COPD development are lacking. The aim of this research was to assess the ability of an average equilibrium exhaled breath ...temperature (EBT) in identifying susceptibility to cigarette smoke so as to predict COPD development in smokers at risk. The study was a part of a multicenter prospective cohort study in current smokers (N = 140, both sexes, 40-65 years, ≥20 pack-years) with no prior diagnosis of COPD. Diagnostic workup includes history, physical, quality of life, hematology and highly sensitive CRP, EBT before and after smoking a cigarette, lung function with bronchodilator test, and 6-minute walk test. Patients without a diagnosis of COPD and in GOLD 1 stage at initial assessment were reassessed after 2 years. COPD was additionally diagnosed based on lower level of normal (LLN) lung function criteria. Utility of EBT for disease progression was analyzed using receiver operator curve (ROC) and logistic regression analyses. Change in EBT after smoking a cigarette at initial visit (ΔEBT) was significantly predictive for disease progression (newly diagnosed COPD; newly diagnosed COPD + severity progression) after 2 years (p < 0.05 for both). ΔEBT had an AUC of 0.859 (p = 0.011) with sensitivity of 66.7% and specificity of 98.1% for newly diagnosed COPD using LLN criteria. We conclude that EBT shows potential for predicting the future development of COPD in current smokers. This was best seen using LLN to diagnose COPD, adding further evidence to question the use of GOLD criteria for diagnosing COPD.
Acute exacerbations in chronic obstructive pulmonary disease (AECOPD) lead to poor outcomes and increased burden for patients and healthcare systems. The Global Initiative for COPD (GOLD) includes ...specific recommendations for AECOPD interventions, discharge criteria, and follow-up. Aligning the AECOPD discharge letters (DL) with GOLD guidelines could facilitate dissemination of recommendations among general practitioners (GPs).
This study was conducted to assess the compliance of DL with the GOLD recommendations in Croatia.
Pre-pandemic DL of patients presenting for AECOPD to emergency room (ER) were analyzed and stratified by clinical decision to hospitalize (HDL) or discharge patients for outpatient treatment (ERDL). Experienced pulmonologists checked the information from DL against guidelines by using online study-specific questionnaires.
In total, 225 HDL and 368 ERDL were analyzed. In most cases, the GOLD ABCD categories (85% HDL, 92% ERDL) or the spirometry-based degree of severity (90% HDL, 91% ERDL) were not included. The number of AEs in the previous year was recorded, but the specific frequent exacerbator phenotype not explicitly stated. The AE phenotype was included in two thirds of HDL and one third of ERDL. The blood eosinophil count was frequently available, but not considered decision-relevant information. Adjustments of previous maintenance therapy, mostly escalation, were recommended in 58.4% HDL and 27.9% ERDL, respectively. Education on proper use of inhalers was recommended only in 15.6% of HDL. Smoking cessation measures were advised in 23.1% HDL and 7.9% ERDL; pulmonary rehabilitation in 35.6% HDL and 0.8% ERDL. Early follow-up was frequently advised (>50%), but rarely appointed.
Significant deficiencies in compliance with the GOLD guidelines were identified, translating into a missed opportunity for GPs to become acquainted with GOLD recommendations. These findings emphasize the necessity to increase compliance with guidelines first at specialist level and consequent standardization of DL.
Astma je najčešća plućna bolest, iako s manjim utjecajem na zbroj izgubljenih godina života zbog preuranjene smrtnosti i godina proživljenih s invaliditetom nego neke druge plućne bolesti, kao što je ...kronična opstruktivna plućna bolest. Budući da se radi o bolesti s velikim javnozdravstvenim utjecajem na radnu sposobnost i kvalitetu života oboljelih, kao i s potrošnjom značajnih zdravstvenih i financijskih resursa, potrebno je primijeniti
kvalitetno i standardizirano liječenje. Osnova liječenja astme – primjena temeljnoga protuupalnog lijeka s najmanjom dozom koja može održati dobru kontrolu – nije se značajno promijenila u odnosu na posljednje hrvatske smjernice za dijagnostiku i liječenje astme u odraslih, objavljene prije petnaestak godina. Međutim, u međuvremenu su se u globalnoj strategiji za upravljanje i prevenciju astme dogodile značajne promjene u stavu
prema kratkodjelujućem bronhodilatatoru salbutamolu, gdje se on više ne primjenjuje samostalno u akutnom bronhospazmu ili pri pojavi tegoba, bez inhalacijskog glukokortikoida. Također, značajan je napredak postignut u biološkoj terapiji teške astme, prepoznat je značaj izrade osobnog plana liječenja astme, kao i pojava novih mogućnosti liječenja (fiksna trojna terapija), što je uključeno u nove hrvatske smjernice za liječenje astme.
U svakodnevnoj primjeni, suradljivost s inhalacijskom terapijom je između 10 % i 70 %. Nenamjerna nesuradljivost se odnosi na bolesnike koji nisu donijeli odluku o smanjivanju ili prestanku uzimanja ...terapije, ali svejedno dolazi do neredovitosti i neadekvatnosti primjene preporučenoga lijeka. Jedan oblik nenamjerne nesuradljivosti – nesvjesna nenamjerna suradljivost – koji je inherentan inhalacijskoj terapiji, teže je otkriti. Često je uzrok neadekvatnog terapijskog uspjeha i pogoršanja kontrole bolesti pa i potrebe za hitnim intervencijama i bolničkim liječenjem. Do nje dolazi zbog nepravilne uporabe inhalera. Ta vrsta nesuradljivosti se nalazi u do 40 % bolesnika i teže se otkriva jer bolesnik misli da redovito uzima lijek. Aktualne smjernice inzistiraju na redovitoj provjeri inhalacijske tehnike i nalaženju najprimjerenijeg tipa inhalera za pojedinog bolesnika uz provjeru načina njegove primjene. S vremenom uporabe zna doći do pogoršanja inhalacijske tehnike pa tako i bolesnici koji dulje vrijeme uzimaju isti lijek putem istog inhalera znaju početi griješiti i na koncu neadekvatno uzimati lijek. Laka dostupnost informacija na webu ili putem mobilnih aplikacija omogućuje njihovu uporabu u cilju edukacije bolesnika. Takav način edukacije se pokazao pristupačan bolesniku, omogućuje mu dodatnu edukaciju u kućnim uvjetima i u trenutku koji bolesnik sam odabere te smanjuje rizik pogoršanja bolesti. Razvijeni su senzori koji prate protok zraka pri aktivaciji inhalera ili analiziraju zvučne fenomene pri inhalaciji i prema njima određuju kvalitetu udaha. Takvi uređaji putem bežične veze mogu prebaciti podatke o kvaliteti inhalacije na mobilni uređaj bolesnika koji na taj način, u realnom vremenu, dobiva informaciju o pravilnosti uzimanja terapije, što omogućuje ispravak vremena i načina doziranja lijeka.
Main risk factor for the development of chronic obstructive pulmonary disease (COPD) is smoking, although only less than 1/3 of smokers develop clinically manifest COPD. COPD's progressive nature ...with high disability and mortality makes it plausible to detect it as early as possible thus allowing for an early intervention. The only tool for an early diagnosis that could be used on the global scale is spirometry, even though symptoms and deprivation of health related quality of life (HRQoL) precede relevant spirometric changes. Existing HRQoL questionnaires are too complicated or not developed for an early detection of COPD. The aim of our study was to develop a new simple HRQoL tool that will allow (alone or in combination with other markers) early detection of patients with COPD.
A multicenter prospective cohort study recruiting 500 subjects at risk for COPD (smokers/ex-smokers ≥20 pack-years, 40-65 years, both sexes, with no prior diagnosis of COPD) will be carried out in two phases: (1) cross-sectional - development and validation of a new questionnaire; and (2) prospective - follow-up of a cohort of patients at risk for COPD. Subjects were recruited by 25 GPs and assessed for COPD by dedicated pulmonologists in 7 hospital centers using a predefined protocol: HRQoL, history, physical, blood sampling, exhaled breath temperature (EBT), lung function, 6-min walk test (6MWT). Patients without COPD and those in GOLD stage 1 at initial assessment will be reassessed for disease progression by the same pulmonologist after 2 and 5 years.
This is one of the first cohort studies attempting to establish the incidence of COPD in the pre-symptomatic stage before significant end organ damage. We intend to assess the validity, predictability and discriminative power ('healthy' smokers vs. pre-symptomatic phase in newly developed COPD) of newly developed HRQoL tool alone or in combination with other markers; EBT, lung function, 6MWT, genomics, transcriptomics, proteomics). We expect that the results of this study can improve our understanding of the development of COPD, identify some new underlying pathophysiological pathways, and offer to sensitive smokers/ex-smokers new preventive and early intervention measures thus improving the management of COPD.
Clinicaltrial.gov NCT01550679 retrospectively registered February 28, 2012.
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).
224 consecutive participants (50.9% women), with mean±standard deviation age of 52.3±6.7 years, 37.5±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 practitioner's 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, history-taking, physical examination, lung function test, 6-minute walk test, and laboratory tests. They were divided into four subgroups: "healthy" smokers, symptomatic smokers, and smokers with mild and moderately severe COPD.
Psychometric analyses indicated that the 18-item questionnaire had a very good internal consistency (Cronbach's alpha=0.91) and test-retest reliability for a four week period (c=0.89, 95% confidence interval CI 0.85-0.92, Lin's 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, <0.001), with a sensitivity of 71.83% and specificity of 64.24% to discriminate "healthy" smokers from other subgroups.
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.
Gallbladder (GB) cancer is the most common malignant lesion of the biliary tract. The decision for a cholecystectomy in asymptomatic cholelithiasis as a measure of the secondary prevention of ...gallbladder cancer is based on the data of incidence and selected predictive factors for a specific population. A consecutive series of 3351 cholecystectomies in five year period was reviewed. That data was compared with the data from 2395 consecutive autopsies from the same period. Possible risk factors for gallbladder cancer were analysed. In surgical specimens, the incidence of gallbladder carcinoma was 0.62%. Of those, 24% were in patients younger than 60 years and 95.24% were associated with cholelithiasis. In autopsy material, in cases in which cholelithiasis was present, the incidence of gallbladder carcinoma was 3.4%. All cases were in patients older than 60 years and all were associated with cholelithiasis. Correlation between cholelithiasis and gallbladder carcinoma was most significant for women in the surgical group while it was not as strong for men or in the autopsy group. The results vary whether we analyse surgical or autopsy material, but in both cases female gender and the duration of cholelithiasis were significant risk factors. In our population GB cancer is not uncommon in elderly women with gall stones and is diagnosed in advanced stage if one waits for symptoms.
Our aim was to assess the differences in intraregional prevalence of asthma in adolescents in Split-Dalmatia County to determine asthma risk factors in our population and estimate the specificity and ...sensitivity of the questionnaire used.
We conducted the study using the European Community Respiratory Health Survey II short questionnaire supplemented by some questions from the International Study of Asthma in Childhood questionnaire. The participants suspected to have asthma were invited for examination by an asthma specialist who established the final diagnosis of asthma according to the medical history, physical examination, skin-prick tests, and peak flow measurements.
A total of 4027 students (51.2% male) participated in the study. According to the prevalence of wheezing during the last 12 months, asthma prevalence was estimated at 9.7%. The total prevalence of asthma confirmed by an asthma specialist in the selected population was 5.60% (95% CI, 4.93-6.36%); 6.18% in Split (95% CI, 5.37-7.09), 5.63% in Imotski (95% CI, 3.48-8.58), and 2.90% in Sinj (95% CI, 1.67-4.68) (P=0.0028). We found sensitization to aeroallergens and peanuts, and active smoking to be independent risk factors for asthma.
Split-Dalmatia County has moderate asthma prevalence, with a significant intraregional difference. Asthma prevalence estimated by a questionnaire (9.7%) overestimates the prevalence of asthma confirmed by an asthma specialist (5.6%) in adolescents in Croatia. Our data confirmed the need of a more complex questionnaire to evaluate the accurate prevalence of current asthma or the need for subsequent clinical evaluation of the questionnaire obtained data. Allergic sensitization to aeroallergens and active smoking were important risk factors for asthma.
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