Je li to astma ili nešto drugo? Jusufović, Edin
Medicus (Zagreb, Croatia : 1992),
10/2021, Letnik:
30, Številka:
2 Astma i KOPB
Journal Article
Recenzirano
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Prevalencija astme odraslih u svijetu varira od 0,2 % do 21,0 %. Populacijske studije pokazuju da 20 – 70 % ljudi s astmom ostaje nedijagnosticirano. Na suprotnoj strani, 30 – 35 % odraslih i djece ...kojima je dijagnosticirana astma zapravo nemaju astmu koja im je dijagnosticirana. Prekomjerna dijagnoza trenutačne astme može se pojaviti iz različitih razloga: 1. neuspjeh liječnika da potvrdi ograničenje zračnog protoka; 2. novi znakovi i simptomi u pacijenta s trajnom kliničkom remisijom prethodne astme; 3. alternativne dijagnoze koje oponašaju znakove i simptome astme. Najčešća diferencijalna dijagnoza astme u odraslih su disfunkcija glasnica, mehanička opstrukcija dišnih putova (npr. tumori i strana tijela), kongestivno zatajenje srca, kronična opstruktivna plućna bolest (KOPB), kronični sinusitis i infekcije gornjih dišnih putova. Posljedice prekomjerne dijagnoze astme su: 1. nedijagnosticiranje i neliječenje stvarnog oboljenja; 2. produljena uporaba lijekova u liječenju astme u pacijenta bez astme čini apsolutnu pojavu nuspojava i komplikacija lijekova; 3. nepotrebni troškovi liječenja ili povišene stope osiguranja.
INTRODUCTIONExercise-induced laryngeal obstruction (EILO) is a differential diagnosis for asthma and prevalent in athletes referred for exercise-induced dyspnoea. The aim of this study was to ...estimate the prevalence of EILO in elite cross-country skiers, known for a high prevalence of asthma.
METHODElite cross-country skiers were invited for screening of EILO. Screening consisted of clinical assessment, questionnaires, skin prick test, spirometry, eucapnic voluntary hyperventilation test, and continuous laryngoscopy during exercise test. Current asthma was defined as physician-diagnosed asthma and use of asthma medication during the last 12 months. EILO was defined as ≥2 points at the supraglottic or glottic level during exercise at maximal effort, using a visual grade score system.
RESULTA total of 89 (51% female) cross-country skiers completed the study. EILO was identified in 27% of the skiers, 83% of whom were female. All skiers with EILO had supraglottic EILO, there was no glottic EILO. Current asthma was present in 34 (38%) of the skiers, 10 (29%) of whom had concomitant EILO. In the skiers with EILO, a higher proportion reported wheeze or shortness of breath following exercise, compared to skiers without EILO. In skiers with EILO and current asthma, compared to skiers with asthma only, a higher proportion reported wheeze or shortness of breath following exercise. Asthma medication usage did not differ between these groups.
CONCLUSIONEILO is common in elite cross-country skiers, especially females. Asthma and EILO may co-exist, and the prevalence of respiratory symptoms is higher in skiers with both. Testing for EILO should be considered in cross-country skiers with respiratory symptoms.
Bronchial asthma due to complex etiopathogenesis, the frequency of exacerbations is a serious medical and social problem 10. At the root of the disease lies the chronic inflammatory process, which is ...the main cause of symptoms 5,18. In the therapy of bronchial asthma, the basis is drugs administered directly to the affected area of the inflammatory process by various inhalation techniques. Ignorance of drug inhalation techniques and/or failure of the patient/caregivers to make pharmacotherapy recommendations is associated with a risk of many side effects. In order for patient therapy to be safe and effective, it is necessary to carry out large-scale educational activities both among medical staff as well as patients and their caregivers in the field of aerosol therapy techniques.
Streszczenie
Astma oskrzelowa ze względu na złożoną etiopatogenezę, częstość zaostrzeń stanowi poważny problem medyczny jak i społeczny 10. U podłoża choroby leży przewlekły proces zapalny, który jest główną przyczyną objawów 5,18. W terapii astmy oskrzelowej podstawę stanowią leki podawane bezpośrednio do miejsca objętego procesem zapalnych za pomocą różnych technik inhalacyjnych. Nieznajomość technik inhalacji leków i / lub niestosowanie się pacjenta / jego opiekunów do zaleceń w zakresie farmakoterapii wiąże się z ryzykiem wielu działań niepożądanych. Aby terapia pacjentów była bezpieczna i skuteczna konieczne jest prowadzenie na szeroką skalę działań edukacyjnych zarówno wśród personelu medycznego jak też pacjentów i ich opiekunów z zakresu technik aerozoloterapii.
Słowa kluczowe: astma oskrzelowa, techniki aerozoloterapii.
We report the case of a 38-year-old woman suffering from allergic asthma since the age of 4. In the last 10 years, the patient presented with severe uncontrolled asthma with frequent exacerbations, ...despite stage-5 treatment according to GINA guidelines, including constant high doses of methylprednisolone. Long-time treatment with high doses of systemic corticosteroids induced many side effects including arterial hypertension, diabetes, GERD, hypercholesterolemia and obesity (weight 121kg, height 176cm, BMI 39kg/m2). Despite the treatment, asthma control remained poor, and quality of life and lung function test results were low (ACQ: 4,71 p, miniAQLQ: 3,2 p, FEV1 2,04 L 60,3% pred., FEV1/FVC 60,85%). The patient was enrolled into the omalizumab treatment program in March 2014. After 24 months of omalizumab treatment, the dose of methylprednisolone was reduced by 30mg/day. At the same time, asthma control and quality of life improved significantly (ACQ 1,85, miniAQLQ 4,73). Body weight was reduced by 30kg (BMI 29kg/m2) as well. Asthma exacerbation rate was also significantly reduced, and there was no asthma exacerbation in the last 12 months of the treatment. Unexpectedly, we observed improvement and further normalization of spirometry with finally normal FEV1/FVC ratio and FEV1 (FEV1 2,87 L 86,4% pred.). The patient has resumed her all daily-life activities.
Urticaria is one of the most common skin disorders. A characteristic feature of this disease is the sudden appearance and rapid regression (up to 24hours) of blisters, angioedema, or both of these ...simultaneously. Often, the above changes are accompanied by symptoms of itching and pain. Chronic urticaria, i.e. one that lasts for at least 6 weeks, is divided into spontaneous (CSU) and induced. CSU, because of its unpredictable nature, strongly reduces the quality of life, especially the patient's active professionally and socially. Below is a description of a 38-year-old female patient, with the profession of teacher diagnosed with atopic chronic severe asthma coexisting with CSU, which has been qualified for the program with omalizumab in 2013, i.e., one year before the registration of the drug in the latter diagnosis. Since the inclusion of the patient into the program in addition to the vast improvement in asthma control in spite of the withdrawal of systemic corticosteroids (sGCS) and the reduction of inhaled glucocorticosteroids (ICS), any episode of CSU is not repeated which is undoubtedly the added benefit of applied therapy.
COVID-19, bolest uzrokovana novim koronavirusom (SARS-CoV-2), akutna je respiracijska bolest koja može uzrokovati teški akutni respiracijski sindrom, dovesti do zatajenja disanja i smrtnog ishoda. ...Obje bolesti su, rjeđe od očekivanog, prijavljene kao pridružene bolesti COVID-19, ali je prijavljen povećan mortalitet kod bolesnika koji su imali KOPB kao pridruženu bolest. Trenutno nisu poznati potencijalni štetni ili zaštitni učinci inhalacijskih kortikosteroida i ostalih lijekova, koji se koriste u liječenju astme i KOPB-a, na rizik inficiranja SARS-CoV-2 virusom ili pogoršanje COVID-19. Ne preporučuju se izmjene u temeljnom liječenju astme i KOPB-a i bolesnike treba liječiti sukladno aktualnim smjernicama, s ciljem postizanja maksimalne kontrole bolesti i održavanja optimalne plućne funkcije. Dok se bolesnici s astmom ne smatraju populacijom povećanog rizika u slučaju COVID-19, bolesnici s KOPB-om moraju se tretirati kao osobe povećanog rizika i kod njih treba provoditi mjere pojačane zaštite, sukladno aktualnim epidemiološkim preporukama. Primjena inhalacijske terapije predstavlja povećan rizik širenja novoga koronavirusa te se preporučuju posebne mjere za smanjivanje tog rizika. Dijagnostički postupci kod kojih se stvara aerosol trebaju se odgoditi do povoljnije epidemiološke situacije ako nisu žurni. Žurne postupke treba provoditi uz odgovarajuće zaštitne mjere, po mogućnosti nakon obavljenog testiranja na COVID-19.
Izhodišče: Skoraj 50 % bolnikov z astmo ima v klinični praksi kljub zdravljenju po merilih GINA (Global Initiative for Asthma) neurejeno bolezen. Najpogostejši vzroki neurejene astme so: nepravilna ...uporaba vdihovalnika, slabo sodelovanje bolnika, nepravilna diagnoza astme, pridružene bolezni (rinosinuzitis, GERB (gastroezofagealna refluksna bolezen), debelost, depresija, obstruktivna nočna apneja) in tudi stalna izpostavljenost specifičnim sprožilcem astme (alergeni, zdravila in kajenje).Metode: Med 323 bolniki z neurejeno astmo v 14 zunajbolnišničnih pnevmoloških ambulantah je med decembrom 2017 in aprilom 2018 potekala opazovalna raziskava. Raziskovalci so v svojih ambulantah vnašali podatke o najpogostejših vzrokih za neurejeno astmo in hudih poslabšanjih v zadnjem letu v elektronski sistem za zbiranje podatkov.Rezultati: Najpogostejši dejavniki, povezani z neurejeno astmo, so bile pridružene bolezni v 70 % (debelost 33 %, rinosinusitis 28 %, GERB 22 %), specifični sprožilci v 56 % (izpostavljenost alergenom 39 %, zdravila 35 %, kajenje 10 %) in slabo sodelovanje bolnikov v 53 %. Trideset odstotkov bolnikov je imelo vsaj eno hudo poslabšanje v zadnjem letu. Logistična regresijska analiza je pokazala, da sta nerazumevanje vloge zdravil (95 % IZ: 1,4; 4,8; p = 0019) in odsotnost individualiziranega načrta samozdravljenja (95 %IZ:1,3; 4,3; p = 0,042) najpomembnejša vzroka za huda poslabšanja. Težko astmo po merilih GINA je imelo 23 % bolnikov, vključenih v raziskavo.Zaključek: Najpogostejši dejavniki, ki so povezani z neurejeno astmo pri vzorčni populaciji odraslih bolnikov z neurejeno astmo v zunajbolnišničnih pnevmoloških ambulantah po Sloveniji, so pridružene bolezni, specifični sprožilci in slaba adherenca bolnikov. Ti bolniki imajo še vedno huda poslabšanja. V prihodnosti bo potrebno bolnike z astmo še bolje izobraziti in jih vse oskrbeti z individualiziranim načrtom samozdravljenja astme.
MicroRNAs (miRNAs) are small noncoding RNAs that control gene expression at the post-transcriptional level, thereby serving as important cellular regulators.1 However, miRNA expression in specific ...human cellular subtypes, especially at the single-cell level, remains largely unexplored. In this study, a novel method called the PrimeFlow™ RNA Assay2 was used to directly monitor miRNA expression in the cell. Notably, we demonstrate for the first time that human innate lymphoid cells (ILCs) express miR-155. We further demonstrate a clear distinction between the sexes, with a significant increase in the number of ILCs expressing miR-155 in female-derived cells compared with male-derived cells upon in vitro stimulation.
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