Bronchoobstructive Diseases Research Articles

Cambios hacia el futuro de la Revista Colombiana de Neumología

Tengo el agrado de presentar este número de la Revista Colombiana de Neumología en el cual se encuentran novedades interesantes. Hemos modificado la portada de presentación de la revista en la que se adoptó un esquema más dinámico y moderno, para darle un espacio más relevante a las imágenes y anticipar el contenido de la misma; además, en conjunto con la nueva Junta Directiva Nacional, tomamos la decisión de alinearnos con la tendencia mundial de conservación ambiental y la iniciativa nacional de “cero papel” en las instituciones, de tal manera que pasamos a publicar nuestra revista solo en formato en línea.Con esta medida disminuimos el uso de recursos renovables tan valiosos como el papel, tenemos más libertad en el manejo, diseño, cantidad y calidad de las imágenes, y pretendemos llegar a muchos más usuarios con cada ejemplar. En este número, la revista tiene contribuciones de neumología, radiología, cirugía de tórax, neumología pediátrica, neumología intervencionista y patología, entre otras, tanto de Colombia como de Latinoamérica; se presenta una revisión sistemática de rehabilitación pulmonar en la que se exploran los resultados de esta intervención en el grupo específico de pacientes que tienen síndrome de superposición de la enfermedad pulmonar obstructiva crónica (EPOC) y asma. Incluye un artículo original que explora la contribución del destete temprano como factor de riesgo para la neumonía muy grave en el infante; en este estudio, más del 50% de la población presentó neumonía y destete temprano, lo que sugiere una relación entre este y la presentación de neumonía muy grave en niños, especialmente entre los niños mayores de 2 meses y menores de 5 años, por lo que se concluye que la lactancia materna sigue siendo un factor protector contra varias patologías, entre estas, las respiratorias.Se presenta un artículo de revisión con respecto al tratamiento con inhaladores de acción prolongada, que son una herramienta terapéutica para el tratamiento de pacientes con enfermedades bronco-obstructivas como la EPOC y el asma bronquial. También hay otro artículo que explora las implicaciones y perfil de seguridad infecciosa de la terapia biológica con omalizumab y mepolizumab en asma severa refractaria, con el fin de dar a conocer los riesgos relacionados con infecciones al usar estas moléculas y generar algunas recomendaciones para la prevención y manejo en el contexto latinoamericano. Además, se incluye una extensa revisión de las manifestaciones radiológicas típicas y atípicas de la sarcoidosis pulmonar, que tienen un amplio espectro desde el compromiso ganglionar típico (adenomegalias hiliares bilaterales y paratraqueales derechas), parenquimatoso (nódulos perilinfáticos, opacidades parahiliares bilaterales y cambios por fibrosis), hasta manifestaciones atípicas de compromiso ganglionar (adenomegalias unilaterales, asimétricas), parenquimatoso (sarcoidosis alveolar y masas pulmonares), enfermedad de vía aérea, pleural y otras (micetomas).En este número también se encuentran varios casos clínicos interesantes como el desarrollo de histoplasmosis en un individuo inmunocompetente, la enucleación de un leiomioma esofágico asistida por cirugía robótica, el diagnóstico y manejo de un tumor mucoepidermoide de la tráquea y el caso clínico de una paciente con fibroelastosis pleuroparenquimatosa idiopática; además de las secciones de glosario patológico, imágenes en broncoscopia y la información para pacientes que, en esta oportunidad, se relaciona con fibrosis quística.Esperamos que disfruten este número y reiteramos la invitación para que envíen sus manuscritos originales, revisiones, reflexiones, imágenes, inquietudes y propuestas, pues la revista es una ventana más de comunicación de nuestra Asociación con el mundo.

EVALUATION OF FUNCTIONAL CONDITION OF RESPIRATORY MUSCLES OF PATIENTS WITH A COMPLICATED BRONCHIAL ASTHMA PATHOLOGY AND CHRONIC OBSTRUCTIVE PULMONARY DISEASES

The aim of the research was to study the functional state of respiratory muscles and neuro-respiratory drive in patients with a combined pathology of bronchial asthma and chronic obstructive pulmonary disease. The functional condition of the respiratory muscles and the tone of the respiratory centre were determined with the help of a device for occlusion spirometry. Also, the patient was observed with a spirometry, a general plethysmography of the body. Materials and methods. 140 patients with combined broncho-obstructive pathology, 34 patients with asthma and 17 patients with COPD were examined. Spirometry, general plethysmography of the body and occlusion spirometry were provided for all patients. Results show a decrease in muscle strength of breath in all categories of patients with broncho-obstructive diseases, especially expressed in patients with bronchial asthma and asthma-COPD intersection. The muscle strength of breath was maintained with a significant increase in COPD patients compared with those with bronchial asthma. With increasing broncho-obstruction in patients with asthma-COPD intersection, there was a progressive and reliable decrease in muscle strength for breath and expiration, as well as a tendency to increase neuron respiratory drive. In patients with asthma-COPD intersection with more expressed symptoms revealed a significant and reliable weakening of muscle strength for breath and increased neuro-respiratory drive. During the work were obtained reliable links of the parameters of respiratory muscle strength not only with the parameters of pulmonary volume and bronchial patency, but also with the degree of neutrophilic inflammation in this category of patients. Conclusions The obtained data on failure of the functional state of the respiratory muscles and the neuro-respiratory drive can be used in the development of rehabilitation programs for the management of patients with combined broncho-obstructive pathology.

Analysis of admissions with bronchial asthma and chronic obstructive pulmonary disease exacerbations

Aim. To study the factors worsening the course of chronic obstructive pulmonary disease and bronchial asthma.Methods. At the first stage, assessment of 1561 case histories of patients with internal diseases was performed, of whom 341 had lung diseases. A more detailed analysis with the assessment of the clinical characteristics of hospitalized patients was conducted at the second stage of our study, which included evaluation of 38 case histories of patients over a 6-month period in 2016.Results. In the structure of mortality from lung disease chronic obstructive pulmonary disease is the dominant cause (53.8%) predominating deaths from pneumonia (46.2%). Mean age of patients who died from chronic obstructive pulmonary disease was 67.2±5.97 years. Exacerbation of chronic obstructive pulmonary disease was the cause of hospitalization in 24 (63.2%) cases, bronchial asthma in 11 (28.9%) cases, chronic obstructive pulmonary disease and asthma overlap syndrome was observed in 3 (7.9%) cases. Exacerbation of chronic bronchoobstructive pathology was mostly caused by respiratory tract infections (84.2% of cases), which required administration of pluripotent antibacterial therapy. In 60.5% cases deterioration of concomitant diseases was observed with cardiovascular diseases prevailing (arterial hypertension, chronic heart failure decompensation).Conclusion. When organizing the strategy of urgent care for patients with chronic bronchoobstructive diseases, paying more attention to assessment of comorbidities is relevant; it is critical to raise awareness of practicing physicians of the criteria for the diagnosis of asthma and chronic obstructive pulmonary disease overlap syndrome.

Rationale for the Use of New Methods of Investigation of Metabolic Syndrome in the Diagnosis and Treatment of Patients with Broncho-Obstructive Diseases

Rationale for the Use of New Methods of Investigation of Metabolic Syndrome in the Diagnosis and Treatment of Patients with Broncho-Obstructive Diseases

THE AIRWAYS MICROBIAL COMMUNITY COMPOSITION IN HEALTHY INDIVIDUALS AND BRONCHIAL ASTHMA PATIENTS

This review summarizes the results of studies on the composition of microbial communities in the airways of healthy individuals and patients with asthma. Modern molecular genetic technology of the microbial identification, which are based on a sequence determination of encoding proteins genes conserved regions. These regions form the 16s-subunit ribosomal RNA in microorganisms of different species. These genes are detected by sequencing markers characteristic of individual microorganisms and their phylogenetic groups, and allow to perform a deep analysis of the microbiota in healthy volunteers and patients with chronic bronchoobstructive diseases. So, apparently healthy human bronchial tree is characterized by low bacterial contamination (most typical representatives here are the genera Pseudomonas, Streptococcus, Prevotella, Fusobacteria and Veilonella, much less potentially pathogenic Haemophilus and Neisseria are represented). In bronchial asthma patients the lower respiratory tract microbiota undergoes a qualitative transformation: as compared to healthy individuals the number of Proteobacteria increases and the number of Bacteroidetes decreases. Severe asthma in children is associated with significant respiratory tract Staphylococcus spp. insemination. Association between the asthma developing higher risk in young children and organisms such as Haemophilus, Moraxella and Neisseria spp. It is of considerable interest to determine the role of the microbiome in the development of human diseases of the bronchopulmonary system, and to understand the impact of the microbes communities as a course of disease and the important factor for the development of resistance to therapy.

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Objective: To evaluate the possibility of using of COPD Assessment Test (CAT) in patients with cardiovascular and bronchoobstructive diseases. Design and method: 178 patients: 52 with arterial hypertension (AH) (gr.1), 33 with coronary heart disease (CHD) (gr.2), 33 with arrhythmia (gr.3), 29 with chronic heart failure (CHF) (gr.4) were included. 62 patients of them had bronchoobstructive diseases (gr.5). Patients were 60 [51;70] years. We assessed in all patients CAT test. Results: In patients with CHF we identified a significant increasing of symptoms compared to patients with AH, CHD and arrhythmia. Detailed analysis of the results of CAT test of different groups is presented in Table1.Conclusions: We identified in patients with AH without broncoobstructive diseases score CAT was 5, patients with CHF – 9. This fact may be were important for the patients with cardiorespiratory pathology and lead to incorrect interpretation severity of the patient with comorbidity pathology, undertreatment of cardiovascular diseases and overtreatment bronchoobstructive diseases.

Safety of beta-agonists with different duration of action in patients with arterial hypertension and broncho-obstructive diseases

Objective. To examine the safety of beta-agonists (BA) with different duration of action in patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) or bronchial asthma (BA).Materials and methods: 40 patients (22 - male, 18 - female) with AH and COPD and AH and asthma aged 18 years were enrolled and examined initially. At the next three month, patients were treated with 3 types of BA: at the 1st month - with salbutamol (SABA), at the 2nd - with formoterol (LABA), at the 3rd - with indacaterol (ULABA). Initially, after one week and at the end of each month blood pressure (BP) and heart rate (HR) on the visit, oxygen saturation of peripheral blood, computer spirometry, serum potassium in blood, electrocardiogram, were evaluate. Initially, after one week and at the end of three month of treatment with SABA, LABA and ULABA all patients underwent holter monitoring and ambulatory blood pressure 24-monitoring.Results. Baseline, 1-month, 2-month, 3-month BP and HR levels on the visit were similar among all patients ( p =NS). At the end of the 3rd month of treatment with BA different duration of action in patients with AH and COPD daily average systolic BP (SBP) was lowered than initially ( p

Современные подходы к этиопатогенетической терапии ронхообструктивных заболеваний в педиатрической практике

The research of effective methods of treatment of broncho-obstructive diseases is one of the most important questions of the pediatric pulmonology. General clinical manifestations are characterized by attacks of breathlessness, prolonged exhalation, unproductive cough, whistling and noisy breathing sometimes with a help of auxiliary muscles. Often this disease leads to bronchial asthma, obstructive bronchitis, and malformations of the lung and bronchus. In the pathogenesis of bronchial obstruction whilst respiratory infections the main factors are inflammatory infiltration of the bronchial mucosa, its swelling, hypersecretion of viscous mucus and bronchospasm due to hyperactivity of the bronchi of the inflammatory nature. To diagnose this disease it is important to establish the presence or absence of the effectiveness of the protective mechanisms of the body at different hierarchic levels. To protect the respiratory tract from exposure to adverse environmental factors in the process of ontogenesis pro-tective mechanisms formed. The first stage of purification of the bronchial system is mucociliary clearance carried out by the cells of the ciliated epithelial cells and glands that produce bronchial secret. If the cause of the disease is established, the etiotropic and pathogenetic treatment of the underlying disease should be carried out. Of special interest in pediatric pulmonology is the experience of the combined drug Kashnol. It simultaneously affects almost all parts of the pathogenesis of acute and chronic broncho-pulmonary diseases.

Безопасность применения β-адреномиметиков разной длительности действия у пациентов с артериальной гипертонией в сочетании с бронхообструктивными заболеваниями

Objective. To examine the safety of beta-agonists (BA) with different duration of action in patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) or bronchial asthma (BA).Materials and methods: 40 patients (22 - male, 18 - female) with AH and COPD and AH and asthma aged 18 years were enrolled and examined initially. At the next three month, patients were treated with 3 types of BA: at the 1st month - with salbutamol (SABA), at the 2nd - with formoterol (LABA), at the 3rd - with indacaterol (ULABA). Initially, after one week and at the end of each month blood pressure (BP) and heart rate (HR) on the visit, oxygen saturation of peripheral blood, computer spirometry, serum potassium in blood, electrocardiogram, were evaluate. Initially, after one week and at the end of three month of treatment with SABA, LABA and ULABA all patients underwent holter monitoring and ambulatory blood pressure 24-monitoring.Results. Baseline, 1-month, 2-month, 3-month BP and HR levels on the visit were similar among all patients ( p =NS). At the end of the 3rd month of treatment with BA different duration of action in patients with AH and COPD daily average systolic BP (SBP) was lowered than initially ( p <0,05), daily average diastolic BP (DBP) during treatment ULABA lower compared to DBP during treatment SABA ( p <0,05) and during treatment LABA for weeks ( p <0,05). On the contrary in patients with AH and asthma daily average SBP became increased than initially ( p <0,05), nightly average SBP during treatment SABA and ULABA for weeks higher compared to nightly average SBP initially. Treatment with BA caused significant serum potassium change in blood in both group. In patients with AH and asthma three patients had hypokalemia.Conclusion. Treatment with BA in patients with AH and bronchoobstructive diseases accompanied by significantly changes BP and significantly decreased levels of serum potassium in the blood in both group. Our results suggested the need for a different treatment of patients with AH and COPD or asthma.

INFLUENCE OF DELIVERY ON PATIENTS’ ADHERENCE TO THERAPY OF BRONCHOOBSTRACTIVE DISEASES

Bronchial asthma (BA) - a global public health problem worldwide. All treatments aimed at improving the control of symptoms of the disease, prevention of exacerbations and improving the quality of life for patients. The use of inhalation therapy is the basis for the treatment of all bronchoobstructive diseases. The effectiveness of treatment depends not only on the quality of the inhaled drug, but also by means of delivery of the drug into the bronchi. Easyhaler - a new dry powder inhaler, inhalation activated enables precise dosing of the drug. According to various studies, the method of delivery of drugs has proven high efficiency, ease to use and adherence of patients to the unit.

Analysis of the quality of treatment and rehabilitation activities in patients with bronchoobstructive diseases and justification of modern approaches to their improvement

The main aspects of providing the patients and disabled people suffering from Chronical Obstructive Pulmonary Diseases (COPD) and asthma with medical and expert assistance by examining health expert documentation of patients in the Institute clinic in 2013 (48 people). Unsatisfactory organization of pulmonology care, poor quality of diagnosing and treatment, as well as imperfection in determining the vital activity of people with bronchoobstructive diseases were found. The methods for improving the quality of rehabilitation of patients and disabled as victims of COPD and asthma were suggested.

Роль внутриклеточных сигнальных систем инсулина в формировании бронхообструктивных заболеваниях

Роль внутриклеточных сигнальных систем инсулина в формировании бронхообструктивных заболеваниях

Состав сообщества микроорганизмов в дыхательных путях у здоровых лиц и больных бронхиальной астмой

This review summarizes the results of studies on the composition of microbial communities in the airways of healthy individuals and patients with asthma. Modern molecular genetic technology of the microbial identification, which are based on a sequence determination of encoding proteins genes conserved regions. These regions form the 16s-subunit ribosomal RNA in microorganisms of different species. These genes are detected by sequencing markers characteristic of individual microorganisms and their phylogenetic groups, and allow to perform a deep analysis of the microbiota in healthy volunteers and patients with chronic bronchoobstructive diseases. So, apparently healthy human bronchial tree is characterized by low bacterial contamination (most typical representatives here are the genera Pseudomonas, Streptococcus, Prevotella, Fusobacteria and Veilonella, much less potentially pathogenic Haemophilus and Neisseria are represented). In bronchial asthma patients the lower respiratory tract microbiota undergoes a qualitative transformation: as compared to healthy individuals the number of Proteobacteria increases and the number of Bacteroidetes decreases. Severe asthma in children is associated with significant respiratory tract Staphylococcus spp. insemination. Association between the asthma developing higher risk in young children and organisms such as Haemophilus, Moraxella and Neisseria spp. It is of considerable interest to determine the role of the microbiome in the development of human diseases of the bronchopulmonary system, and to understand the impact of the microbes communities as a course of disease and the important factor for the development of resistance to therapy.

The effect of inhaled clonidine in patients with asthma.

To study the effect of inhaled clonidine on broncho-obstruction in asthmatics, 10 patients with extrinsic asthma were broncho-provoked twice with an allergen that had been shown to give positive skin prick test results. Before the provocations, saline or clonidine (75 micrograms) was inhaled via a DeVilbiss no. 40 nebulizer. Clonidine slightly improved the basal respiratory function without significantly influencing the blood pressure. There was a reduction in the allergen-evoked broncho-obstruction by 42 to 65% after pretreatment with clonidine. The eosinophilic leukocytes in peripheral blood had a slight tendency to leave the circulatory system during the provocation preceded by the clonidine treatment. These data add further evidence to the finding that clonidine may be of interest in the treatment of broncho-obstructive diseases.