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.
Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are "treatable traits" in asthma. ...Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in exacerbation rates.This review summarises recent data about the prevalence, clinical impact and treatment effects of ENT comorbidities in asthma including allergic rhinitis, chronic rhinosinusitis with and without nasal polyposis, aspirin-exacerbated respiratory disease, obstructive sleep apnoea and vocal cord dysfunction.Many of these comorbidities are possible to be managed by the pulmonologist, but the collaboration with the ENT specialist is essential for patients with chronic rhinosinusitis or vocal cord dysfunction. Further rigorous research is needed to study the efficacy of comorbidity treatment to improve asthma outcomes, in particular with the development of biotherapies in severe asthma that can also be beneficial in some ENT diseases.
Exhaled breath temperature (EBT) has recently been used as a tool to assess the level of inflammation in airways. The newest technology can also assess EBT coming from different fractions of exhaled ...air (fEBT). We aimed to assess the changes in fEBT after a maximal cardio-pulmonary exercise test in healthy athletes. Forty-four healthy professional athletes (two females) were included. Their mean (±SD) age was 22.9 ± 4.8 years. An innovative device (FractAir
) was used for fEBT measurement, dividing the exhaled air into three fractions (V1, V2 and V3) coming from different parts of the lungs; the large airways (anatomic dead space), conductive airways (functional dead space) and the peripheral part. For V3 an EBT point measured at 1200 ml of exhaled volume was used to obtain the information about the distant parts of the lungs while eliminating the difference in the volume of total exhaled air before and after the exercise. The difference (temperature gain) between the starting and peak EBT for each fraction was also calculated. The peak fEBT values before and after exercise did not differ significantly (p > 0.05 for all three fractions). Temperature gain analysis for each fEBT showed a significant fall after exercise for V2 (1.71 °C ± 0.43 versus 1.38 °C ± 0.50, p < 0.001), but not for the other two fractions (p > 0.05 for both). The lower heat emission from this part of the airway (conductive airway) after exercise could mean that during hyperventilation heat emission is increased in this specific fraction. We can conclude that the changes of fEBT after physical exercise are not linear. They affect different fractions of the lungs in different ways, and the relationship between flow and volume on one side and the temperature of exhaled air on the other can vary significantly.
Coronary tortuosity has been recognized as a potential pathophysiological mechanism in the development of non-obstructive coronary artery disease (CAD). The aim of this study was to examine the role ...of two coronary tortuosity measurement methods in the detection of clinically significant coronary tortuosity. The study included 160 patients with angina symptoms and myocardial ischemia detected by cardiac stress tests in chronic settings and those diagnosed with acute coronary syndrome. After coronary angiography, tortuosity of coronary arteries was assessed by two methods, including measurement of tortuosity angles and calculating of tortuosity index. Significantly more tortuous coronary arteries were detected in the group with non-obstructive CAD (
< 0.01 for all three arteries), with significantly higher tortuosity index (TI) for all three coronary arteries in this group of patients, compared to patients with obstructive CAD. The highest TI for LCX was found in patients with lateral ischemia (
< 0.001) and for LAD in patients with anterior ischemia (
< 0.001). When measured by the angle method, the only association was found between LCX tortuosity and lateral ischemia (OR 4.9,
= 0.046). In conclusion, coronary tortuosity represents a pathophysiological mechanism for myocardial ischemia in non-obstructive CAD. The coronary tortuosity index could be a reliable and widely applicable tool for the quantification of coronary tortuosity.
Astma i depresija Labor, Slavica; Labor, Marina
Medicus (Zagreb, Croatia : 1992),
10/2021, Letnik:
30, Številka:
2 Astma i KOPB
Journal Article
Recenzirano
Odprti dostop
Poznato je da se anksioznost i depresija pojavljuju u bolesnika s astmom i povezani su s lošom kontrolom astme, češćim pogoršanjima i povećanom uporabom zdravstvenih resursa. Sličnost i preklapanje ...simptoma depresije i nekontrolirane astme čine liječenje astme izazovnijim i složenijim što može dovesti do nedovoljnog dijagnosticiranja i lošijeg liječenja komorbiditeta. Nema jasnih stajališta o tome jesu li osobe s astmom depresivnije od onih bez astme, ima li depresija „aditivan“ štetni učinak na normalno smanjenje kvalitete života povezano s astmom, jesu li subjektivni simptomi astme jače povezani s depresijom nego objektivne mjere, postoje li simptomi depresije koji su češće povezani s astmom, mogu li tuga i depresija uzrokovati respiratorne učinke sukladne pogoršanjima astme, u kojoj mjeri depresija negativno utječe na liječenje astme, je li uporaba kortikosteroida u astmi povezana s depresijom i kako, koje su fizičke, psihološke i socijalne posljedice depresije u astmi te kako liječiti takve bolesnike. Postoji potreba za daljnjim istraživanjima kako bi se razvili standardizirani algoritmi utemeljeni na dokazima kojima bi se usmjerila klinička praksa.
Although asthma is one of the most serious diseases causing complications during pregnancy, half of the women discontinue therapy thus diminishing the control of the disease, mostly due to the ...inadequate education and fear of adverse events. Sadly, this is sometimes encouraged by insufficiently educated physicians. Since the incidence and the prevalence of asthma is increasing, it is important to arouse the importance of proper asthma therapy during pregnancy. Inadequate therapy, as well as interrupting or discontinuing therapy, may result in adverse perinatal outcomes for both mother and child.
The main goal of asthma control during pregnancy is control of symptoms and prevention of exacerbations, same as in every asthmatic, but even more important. Maintaining optimal lung function, as well as regular daily activities, ensures maintenance of optimal fetal oxygenation. The therapy should be adapted depending on the frequency and severity of daily and nocturnal symptoms, demand for reliever therapy, by the limitations in everyday activities and the frequency of emergency asthma-related hospitalizations. Pre-conceptual education and therapy are very important and should be supported by an asthma action plan adjusted for the period of pregnancy. It is very important to note that most of the drugs used before pregnancy can be safely continued during pregnancy. Pharmacological and non-pharmacological therapy should be used in parallel. Pregnant women should be informed about the nature of the disease, therapy used during pregnancy, possible complications, avoidance of triggers, proper administration of therapy and, most important, why should the therapy be continued throughout the pregnancy on individual basis. Although drug treatment should be based on using drugs with less harm risk, if control of severe symptoms is needed to be achieved in order to protect both mother and child, any anti-asthmatic drug would have the beneficial benefit/harm ratio.
There is no solid evidence that asthma treatment during pregnancy causes adverse outcomes for the mother and child but for many, especially new drugs, there is not enough data gathered. On the other hand, harmfulness of uncontrolled asthma during pregnancy is well documented so every effort should be put on preserving good control of asthma during pregnancy.
Progress in Occupational Asthma Tiotiu, Angelica I; Novakova, Silviya; Labor, Marina ...
International journal of environmental research and public health,
06/2020, Letnik:
17, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about ...clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.
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 (PI
) and endurance (T
), measured as time to maintain inspiration at or above 80% of PI
. The difference in end-tidal oxygen tension (ΔPETO
) between VT2 and maximal effort was significantly associated with resting heart rate (HR) and systolic blood pressure (BP), PI
, and lean body mass (LBM) (r
=0.26, p=0.016; multivariate regression analysis). The difference in carbon dioxide output (ΔVCO
) was significantly associated with body mass index (BMI), resting HR, systolic BP, and PI
(r
=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.
Population-based studies provide conflicting evidence about how inhaled corticosteroids (ICS) impact COVID-19 outcomes among COPD patients. We investigated whether regular ICS exposure affects risk, ...severity, or survival in SARS-CoV-2 infection, using a nationwide linked Swedish population register database.
During January-December 2020, we studied two defined Swedish adult populations - Whole population ≥40 years (N = 5243479), and COPD subpopulation ≥40 years (N = 133372), in three study cohorts, respectively: 1. Overall cohort (index date 1 Jan 2020), 2. COVID-19 diagnosed sub-cohort (index date = diagnosis date), and 3. COVID-19 hospitalized sub-cohort (index date = admission date). Regular exposure was defined as ≥3 ICS prescriptions in the year before index. Hazard ratios (HRs) for outcomes (COVID-19 onset, hospitalization, ICU admission, or death) related to ICS exposure were estimated using Cox regression. Confounding was controlled by propensity score methods applying Average Treatment effect in the Treated (ATT) weighting.
Regular ICS use was associated with only very slightly increased onset of COVID-19, hospitalization, ICU admission, and death in the overall whole population cohort and in the overall COPD subpopulation cohort, except for ICU admission (marginally non-significant HRs, up to 1.13); and no clear increase in the diagnosed sub-cohorts. However, in the COVID-19 hospitalized COPD sub-cohort, ICS therapy showed reduced risks against progression to ICU admission and death, significant for death (HR 0.82 95% CI 0.67-0.99).
For COPD patients, ICS therapy offers some protection against progression to ICU admission and death among COVID-19 hospitalized patients. Our findings alleviate concerns about increased risks of COVID-19 by ICS treatment and provide evidence supporting the continuation of ICS therapy for COPD patients.
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