Degree Of Bronchial Obstruction Research Articles

Assessment of inhalation technique in patients with bronchial asthma and chronic obstructive pulmonary disease

Investigate inhalation techniques using different inhalers types and their effect on the course of disease. This cross-sectional study included 110 patients with asthma, chronic obstructive pulmonary disease using the inhaler at least one month. Inhaler errors performed during demonstration were evaluated for each patient and entered in the check-lists. We also collected information about co-morbidities, education, mMRC dyspnea score, rate of exacerbations, and performed spirometry. 80.9% of patients used metered-dose inhaler, 20.9% - single-dose and 21.8% - multiple-dose dry powder inhaler, 22.7% - soft-mist inhaler. Inhaler errors were made by 80.9% patients. The mean number of mistakes in metered-dose inhaler use was 2±1.6, single-dose powder inhaler -1.5±1.3, multiple-dose dry powder inhaler - 1.25±1.4, soft-mist inhaler - 0.68±0.7 (р=0.003). Age, diagnosis, duration of disease, education level, inhalers usage by relatives have no influence on the inhalation technique. A number of errors was related to female gender (р=0.007) and usage of more than 2 inhalers (r=0.3, p=0.002), previous instruction about inhalation technique (r=0.3, p=0.001). On the other hand, there were correlations between the number of errors and degree of bronchial obstruction, asthma control, severity of dyspnea by mMRC score, exacerbation rate. Patients with bronchoobstructive diseases perform many inhaler errors, that substantially influences the severity and course of asthma and chronic obstructive pulmonary disease.

The influence of systemic inflammatory markers on the development of obstetrical complications in pregnant women with chronic obstructive pulmonary disease

The increasing prevalence of chronic obstructive pulmonary disease (COPD) among the female half of the population is the reason for the increased interest of scientists in the course of COPD and its impact on pregnant women. At the same time, the chronic lung inflammatory process leads to the development of obstetrical and perinatal complications during pregnancy. The aim of our study is to establish the features of changes in the cytokine profile in pregnant women with COPD and their role in the development of obstetrical and perinatal complications. Materials and methods. 77 pregnant women with clinically and instrumentally verified signs of COPD were examined, who were divided into 2 subgroups depending on the degree of bronchial obstruction: IA – 43 pregnant women with FEV1 ≥80 %, IB – 34 pregnant women with FEV1 50–79 %. The control group consisted of 27 healthy pregnant women. The cytokine profile was determined and a correlational interaction with the degree of bronchial obstruction and the frequency of obstetrical and perinatal complications was established. Results. Our analysis of cytokine profile indicators in pregnant women with COPD at the stage of mild and moderate bronchoobstruction has shown a characteristic and significant increase in the level of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) and a simultaneous decrease in the level of anti-inflammatory IL-10 (P ≤ 0.05). Dysregulation of the inflammatory response in COPD in pregnant women became the main basis for the development of obstetrical and perinatal complications. We have established that an increase in the degree of bronchoobstruction was also associated with a higher detection frequency of such pregnancy and childbirth complications as anemia by 3.1 times, the threat of preterm birth by 9 times, preeclampsia by 7 times, placental dysfunction by 3.4 times, intrauterine growth restriction by 8 times, premature birth by 3.5 times, premature rupture of membranes during labor by 4 times, and fetal distress by 3 times. Conclusions. In pregnant women with COPD, an increase in the level of pro-inflammatory cytokines – IL-1β (rI = -0.81, rII = -0.67), IL-6 (rI = -0.88, rII = -0.78), IL-8, TNF-α was found to be directly proportional to the degree of bronchial obstruction, and inversely proportional level of anti-inflammatory IL-10 (rI = 0.80, rII = 0.86), which can be an early prognostic criterion for the development of obstetrical and perinatal complications.

¿Se puede utilizar la determinación del pico flujo de tos para valorar la capacidad tusígena en enfermedades respiratorias obstructivas graves?

IntroductionCough capacity is assessed by measuring cough peak flow (CPF). However, this assessment could be altered by obstructive airway diseases. The aim was to assess measurement of cough capacity by CPF in patients with chronic obstructive pulmonary disease (COPD), as well as correlations with pulmonary, respiratory muscle, and oropharyngeal function. MethodsPatients with COPD, and with neuromuscular disease, were selected as well as healthy subjects who had undergone respiratory muscle strength measurement in a healthcare setting. From this population, respiratory function values and lung and oropharyngeal muscle function were analysed. A subgroup of COPD patients underwent a videofluoroscopic swallow study. ResultsThree hundred and seven subjects were included (59.3% COPD, 38.4% neuromuscular diseases, and 2.3% healthy). CPF was found to be statistically significantly decreased in the COPD group compared to both the healthy and neuromuscular disease groups. Of the COPD patients, 70% had a pathological decrease in CPF. There was only a direct correlation between CPF with the degree of bronchial obstruction and expiratory muscle strength. No alteration of inspiratory or oropharyngeal muscle function was found. ConclusionsThe use of CPF in COPD patients does not reflect cough capacity as it is influenced by the degree of bronchial obstruction. Therefore, new diagnostic tests to measure cough capacity should be considered, especially in patients with coexisting neuromuscular diseases and severe bronchial obstructive disease.

THE FEATURES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE INFLUENCE ON THE PREGNANCY COMPLICATIONS DEVELOPMENT


 
 
 
 In recent years, the prevalence of chronic obstructive pulmonary disease (COPD) has been increasingly observed among women, which is one of the reasons for the higher interest of scientists in the influence of COPD on pregnant woman.
 The aim of our study was to establish the features of the development pregnancy complications in pregnant women with COPD.
 Materials and methods. 77 pregnant women with clinically and instrumentally verified signs of COPD were examined and were divided into 2 subgroups depending on the degree of bronchial obstruction: IA - 43 pregnant women with FEV1≥80%, IB - 34 pregnant women with FEV1 50-79%. The control group consisted of 27 healthy pregnant women. The cytokine profile was determined and a correlational interaction with the degree of bronchial obstruction and the frequency of obstetric and perinatal complications was established.
 The results. Our analysis of cytokine profile indicators in pregnant women with chronic obstructive pulmonary disease at the stage of mild and moderate bronchial obstruction showed a characteristic and reliable increase in the level of pro-inflammatory cytokines (IL-1β, IL-6) and a simultaneous decrease in the level of anti-inflammatory IL-10 (p≤0.05).
 We established that an increase in the degree of bronchial obstruction is also associated with a higher frequency of detection of such pregnancy and childbirth complications as anemia, respectively, by 3.1 times, the threatened of premature birth by 9 times, preeclampsia by 7 times, placental dysfunction by 3.4 times, intrauterine growth restriction 8 times, premature birth 3.5 times, premature rupture of membranes during labor 4 times, and fetal distress 3 times higher compared to the control group.
 Conclusions. COPD in pregnant women is characterized by systemic disturbances in the cytokine balance and is accompanied by a significant increase in the frequency of obstetric and perinatal complications, the frequency of which depends on the degree of bronchial obstruction.
 
 
 

Влияние анемии на течение хронической обструктивной болезни легких

The study presents the results of examination of 92 patients with chronic obstructive pulmonary disease (COPD) aimed at identifying anemic syndrome. Anemia as a systemic manifestation of the disease was diagnosed in 29% of patients. It was found that in women this syndrome develops significantly more often and at an earlier stage than in men. By the erythrocytes morphology and the degree of iron saturation, anemia was normocytic and hypochromic in most patients. Reliable clinical features of the COPD course in patients with anemic syndrome were identified: anemia significantly worsens the condition of patients, mostly females, who often complain of shortness of breath; with the same degree of bronchial obstruction as male patients, women often suffer from impaired health and more frequently need hospital treatment.

NEW POSSIBILITIES FOR MODIFYING THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE: THE EFFECT OF TIOTROPIUM BROMIDE ON CERTAIN PATHOGENETIC LINKS OF NEOCOLLAGENOGENESIS AND LOCAL IMMUNE DEFENCE OF THE BRONCHIAL TREE

The aim: To evaluate the dynamics of the interferon and collagen-IV systems in bronchoalveolar lavage in the treatment of chronic obstructive pulmonary disease using the tiotropium bromide medication. Materials and methods: The study involved 60 COPD patients with bronchial obstruction of the II degree before and on days 30 and 60 of therapy using conventional treatment regimens and inhalations of tiotropium bromide a the dose of 18 mcg once a day. The collagen-IV levels in bronchoalveolar fluid were determined by means of enzyme-linked immunoassay using “StatFax 303 Plus” analyzer and “Biotrin Collagen IV EIA” reagents. The level of IFN-γ was identified with the help of enzyme-linked immunoassay using “StatFax 303 Plus” analyzer and “ProKon” reagents (LLC “Protein Contour”, Russia) in bronchoalveolar fluid obtained during fiber-optic bronchoscopy. Results: When examining Group I patients on the 30th day we found out that the content of collagen-IV in the bronchoalveolar fluid had decreased by only 10.29% (p <0.05). Detection of collagen-IV indices in Group II patients on the 30th day of tiotropium bromide use showed the 29.43% (p <0.05) decrease in its content as compared to the initial indices. In Group III patients, the concentration of collagen-IV had a maximum tendency to normalize and made up (24.72 ± 1.15) ng/ml, and decreased by 2.44 times (p <0.05) as compared to the initial indices. Our examination of 12 patients from the comparison group I on the 60th day of treatment revealed even a slight increase in the content of collagen-IV in the bronchoalveolar fluid, as compared with the data obtained on the 30th day. The identified IFN-γ deficiency is indicative for the COPD of the II degree of bronchial obstruction, and its indices were 2.29 times lower than those observed in people from the control group. On day 30, we found out that the content of IFN-γ in Group I patients increased by only 10.29% (p>0.05). Detection of IFN-γ in Group II patients showed 42.27% (p<0,05) increase in its content as compared to the initial indices. The most favorable dynamics of IFN-γ levels in bronchoalveolar contents was observed in Group III patients, and at the time of observation it made up (1.16 ± 0.08) pg/ml, having 2 times (p<0.05) increased as compared to the initial indices. However, in contrast to those taking tiotropium bromide, we examined 12 patients from Group I on the 60th day of treatment and found no significant positive dynamics of IFN-γ content in bronchoalveolar fluid as compared to the indices obtained on day 30. Conclusions: The obtained findings indicate the effect of tiotropium bromide on the reduction of interferon-γ and reduce of collagen-IV levels, which depend on the duration of its use.

ОСОБЛИВОСТІ СТІЙКОСТІ ДО ГІПОКСІЇ У ХВОРИХ ПОХИЛОГО ВІКУ З ХРОНІЧНИМ ОБСТРУКТИВНИМ ЗАХВОРЮВАННЯМ ЛЕГЕНЬ

FEATURES OF RESISTANCE TO HYPOXIA IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE E. O. Asanov, Yu. I. Golubova, I. A. Dyba, S. O. Asanova Abstract Aim: to study the features of resistance to hypoxia in elderly patients with COPD. Material and methods. We examined 46 elderly patients with COPD and 18 apparently healthy elderly people. Hypoxia resistance was determined by performing a hypoxic test with inhalation of 12 % O2 for 20 minutes. The state of ventilation and blood saturation were assessed. Results. Hypoxia caused the reduction of SpO2 and the development of arterial hypoxemia in elderly patients with COPD, which were more significant than in healthy elderly people. It was found that among elderly patients with COPD and healthy elderly subjects there were people with preserved and reduced resistance to hypoxia. However, reduced resistance to hypoxia was much more common in elderly patients with COPD. Decreased resistance to hypoxia in elderly patients with COPD was associated with the degree of bronchial obstruction: deterioration of bronchial passability led to reduced resistance to hypoxia. Elderly patients with COPD with reduced resistance to hypoxia had a decrease in the ΔVE/ ΔSpO2 ratio and a slow ventilation response to hypoxic exposure. Conclusions. Among healthy elderly people and elderly patients with COPD there were subjects with reduced and preserved resistance to hypoxia. Decreased resistance to hypoxia was much more common in elderly patients with COPD. Decreased resistance to hypoxia was more common in patients with moderate than mild bronchial obstruction. Elderly patients with COPD with reduced resistance to hypoxia had reduced ventilation response to hypoxia and chemoreflex sensitivity. Key words: COPD, older age, resistance to hypoxia, ventilation, saturation. Ukr. Pulmonol. J. 2021;29(3):36–40:

The Differences in the Levels of Oxidative Status Marker and Soluble CD95 in Patients with Moderate to Severe COPD during an Exacerbation and a Stable Period.

Studying the features of changes in markers of oxidative stress (OS) and inflammation indicators in COPD patients depending on the degree of bronchial obstruction is one of the priority directions for improving the prognosis and monitoring of the course of this pathology. We conducted a comparative investigation of changes in markers of OS and apoptosis at the systemic and local levels in patients with moderate to severe COPD during exacerbation and stable phase. 105 patients with COPD aged 46-67 and 21 healthy nonsmoking volunteers comparable in age were examined. COPD patients were divided into four groups: moderate COPD (GOLDII) during the exacerbation (GOLDIIex, n = 25) and in the stable phase (GOLDIIst, n = 27), severe COPD (GOLDIII) during the exacerbation (GOLDIIIex, n = 29), and in the stable phase (GOLDIIIst, n = 24). We studied the levels of such lipid peroxidation (LPO) products as diene conjugates (DC) and Schiff bases (SB) and parameters of induced chemiluminescence (Imax, total light sum-S, Imax/S) in blood serum, as well as sCD95 concentration in blood and exhaled breath condensate (EBC). The relationship between the values of the OS system indicators with sCD95, as well as with the parameters of lung function, was investigated. Multidirectional changes in OS indicator levels in COPD patients depending on the severity of obstructive airway disorders have been established. The maximum values of DC (0.26 ± 0.046 RU), Imax (0.265 ± 0.19 RLU), and Imax/S (0.13 ± 0.05) were typical for patients with moderate COPD, while the highest SB level (5.7 ± 2.3 RU) was observed in severe COPD during an exacerbation. The exacerbation of the disease was characterized by an increase in DC concentration in both GOLDIIex (0.26 ± 0.046 RU) and GOLDIIIex (0.209 ± 0.02 RU) compared to the stable moderate and severe COPD (0.202 ± 0.028 RU and 0.19 ± 0.03 RU, respectively, p < 0.05). The established decrease in high values of DC, Imax, Imax/S, and sCD95 and an increase in SB concentration in GOLD III can serve as quantitative indicators of the prognosis of the severity of the disease. The serum concentration of sCD95 in GOLDIIex (366.4 ± 70.5 U/ml) and GOLDIIst (361.4 ± 72.8 U/ml) did not differ from the control group (393.7 ± 80.9 U/ml, p > 0.05). In patients with FEV1 < 49% during the exacerbation and stable phase, the serum levels of Imax/S (0.058 ± 0.01 and 0.062 ± 0.01) and sCD95 (318.2 ± 66.3 U/ml and 321.4 ± 42.5 U/ml) were lower than the values of healthy volunteers (0.08 ± 0.01 and 393.7 ± 80.9 U/ml, respectively, p < 0.05). A positive correlation between sCD95 concentration and airway obstruction degree in all examined COPD patients was established. The revealed numerous associations between sCD95 and OS marker levels in GOLDIII indicate a relationship between systemic radical stress and apoptosis processes both in the respiratory tract and the whole body under conditions of severe inflammation. The established correlations between the values of DC, Imax, and sCD95 in the blood serum and the lung function parameters in all studied patients allow us to consider these indicators as additional prognostic indicators of disease intensification. Our work results help clarify the participation and detail of FRO and apoptosis processes in developing pathophysiological features in moderate to severe COPD in different periods and, accordingly, improve the efficiency of diagnosis and treatment of the disease.

Pulmonary hemodynamics and remodeling of the right heart in patients with COPD depending on the risk group, the direction of drug correction

Objective : to assess pulmonary hemodynamics and the presence of systolic and/or diastolic dysfunction of the myocardium of the right and left ventricles in patients with COPD, depending on the risk groups (A, B, C, D); to determine the possible directions of pharmacological correction. Methods. Patients (n = 119, including 87 men, mean age - 62.5 ± 14.8 years) with COPD of risk group A (n = 21) and B (n = 98) (GOLD, 2019). In addition to the routine clinical and instrumental examinations, pulmonary and aortic pulse wave velocity was determined using MRI diagnostics. Results. The right ventricular diastolic dysfunctions (DD) were revealed in all patients with COPD (E/A TV = 0.85 ± 0,03 vs 0.97 ± 0,03; groups A and B respectively, p &lt; 0,05). 28.6% of patients of group B had a restrictive type of transtricuspid blood flow (p &lt; 0,05). The pulmonary blood pressure was increased: 24.3 ± 7.6 mm Hg in patients with COPD group A, 17.2 ± 6.8 mm Hg - in group B. Patients of group B had a higher pulmonary pulse wave velocity (pPWV) (B: 3.13 [2.93-3.44] ms-1 vs A: 1.97 [1.62-2.68] ms-1, p = 0.005) and stroke volume of RV (B: 33.5 [27.3-37.9] mL vs A: 29.1 [24.0-35.7] mL, p = 0.005). The correlation between pPWV and the degree of bronchial obstruction, ejection fraction and end-diastolic volume of the RV, and mean pulmonary arterial pressure (mPAP) was strong for patients of group B and moderate for patients of group A. Conclusion. Thus, patients with COPD risk group A have the borderline indicators of mPAP with DD of LV and RV. The progression of hemodynamic disorders is associated with the aggravation of of clinical symptoms and respiratory disorders, that were more pronounced in group B. This progression led to mandatory broncholytic drug correction.

EARLY DIAGNOSIS OF KIDNEY DISEASE IN CHRONIC OBSTRUCTIVE DISEASE OF LUNG PROBLEMS COMBORIDE STATES IN THE CONDITIONS OF THE LOW ALTITUDE

&#x0D; &#x0D; &#x0D; The high incidence of concomitant pathology on the part of the renal system can lead to a mutual burden of various diseases, which in turn requires additional methods of examination, prevention, and further mandatory medical correction in patients with chronic obstructive pulmonary disease.Objective: to identify a moderately increased albuminuria and analysis of the functional state of the kidneys in chronic obstructive pulmonary disease in low altitude at an earlier stage of its manifestation.Material and methods: 82 low-altitude patients (Tokmok) were examined with COPD of varying severity, as well as 10 healthy individuals. The average age was 60.53 + 15.48 years. In addition to general clinical examination, patients underwent an early marker of damage to the MIA, assessment of the function of external respiration and indicators of renal function, which included the calculation of glomerular filtration rate (GFR), analyzes of proteinuria, leukocyturia, hematuria, total protein and serum creatinine.Results: In patients with COPD, an early and significant change in renal function indices is noticeably observed, which in turn tends to correlate with the degree of bronchial obstruction.&#x0D; &#x0D; &#x0D;

Features of existing functional disturbances in patients with chronic obstructive pulmonary disease stage II in the process of integrated therapy with the use of tiotropium bromide

The peculiarities of the disturbances of external respiratory function (ERF) in patients with the second stage of COPD, who received tiotropium bromide are presented.The aim of the study. To evaluate the effect of the baseline therapy of COPD II degree of bronchial obstruction with the use of tiotropium bromide preparation on the parameters of external respiration.Materials and methods. We examined 151 patients with the second stage of COPD. Verification of the diagnosis and its formulation were performed on the basis of the order of the Ministry of Health of Ukraine No. 555 dated June 27, 2013 "On Approval and Implementation of Medical-Technological Documents on Standardization of Medical Assistance in Chronic Obstructive Pulmonary Disease". The examination was perfomed prior to and on the 30th, 90th and 180th days of standard treatment combined with tiotropium bromide.Research results. The analysis of aggregate results showed that the highest efficacy was observed in patients who took tiotropium bromide during 180 days, for in this very period external respiratory function parameters maximally increase. Consequently, such a pronounced effect of the used drug tiotropium bromide as a composite basic treatment for stabilizing the function of external respiration in chronic obstructive pulmonary disease II degree, in our opinion, is due to the mechanism of action characteristic of the drug chosen by us, namely, the clear prolonged bronchodilator effect.Conclusions. Our treatment regimens have a pronounced influence on a number of important pathogenetic links in the course and progression of chronic obstructive pulmonary disease, especially in the initial stages, which clearly confirms the need for early detection of this pathology and early onset of its therapy. They are characterized by simplicity and accessibility, high clinical efficacy, the absence of adverse reactions and complications.

Chronic obstructive pulmonary disease as a predictor of unfavourable prognosis in patients after myocardial revascularization

Purpose. We aimed to analyze the results of the annual follow-up of the patients underwent coronary artery bypass grafting (CABG) depending on the presence of concomitant respiratory diseases. Materials and methods. In a year after CABG the prognosis of 646 patients, divided into three groups, was analyzed. A criterion for the formation of the groups was the presence of chronic pulmonary pathology and obstructive ventilatory type of disorders. The first group included 46 (7.1%) patients with coronary artery disease (CAD) and respiratory disease without the signs of obstructive disorder, the second group - 241 (37.3%) patients with CAD and chronic obstructive pulmonary disease (COPD) and the third - 359 (55.6%) patients with isolated CAD. Death, hospitalizations (both for cardiovascular events and respiratory diseases, non-fatal cardiovascular events, exacerbation and complications of COPD, as well as repeated revascularization procedures were evaluated as end points. Results. One year after CABG in patients with COPD the incidence of deaths, hospitalizations for acute cardiovascular events, as well as percutaneous coronary interventions was higher than in patients with isolated CAD. According to the analysis of variance, it was demonstrated that along with age, reduced myocardial systolic function and smoking, both COPD itself and the degree of bronchial obstruction are the potential risk factors for the development of fatal outcome. Conclusion. Comorbid COPD in patients with CAD is the predictor of unfavourable prognosis within a year after CABG.

Features clinical of a current it is bronchial obstruction at children of early age

Introduction.In young children, acute obstructive bronchitis is one of the most common forms of respiratory tract damage. In the structure of the morbidity of respiratory organs, they are determined in 30 - 50% of cases. Of these, 90% of patients are children of the first 2 years of life. The transferred obstructive bronchitis at an early age is dangerous because of the possibility of a recurrent course, and in 47-57% of cases - the transformation into bronchial asthma. The urgency of studying acute obstructive bronchitis is due to the increase in frequency, regional features of the clinic, the severity of the course and the prognosis of the disease, endangered life of young children, which led to these studies.Purpose of the study. To study the features of the clinical course of acute obstructive bronchitis in children-Kyrgyz at an early age.Material and methods.The results of clinical observation and examination of 138 children with acute obstructive bronchitis aged from 2 months to 3 years are presented. According to the age periodization, all sick children were divided into 2 groups. The first group consisted of children from 2 months to 1 year (89 children), the second group - from 1 year to 3 years (49 children).A complete clinical examination of a sick child was carried out according to generally accepted standards, with an assessment of the severity of the disease. The severity of the condition was assessed by the presence of dangerous signs, the degree of respiratory failure and intoxication according to the manual "Pocket Guide. Provision of inpatient care for children "(WHO, 2012).All our results are subjected to statistical processing using the SPSS 16.0 software.Results and its discussion.The leading clinical syndromes noted in acute obstructive bronchitis in young children are: obstructive syndrome, intoxication syndrome and respiratory failure syndrome. In boys, the disease occurs more often and occurs in a more severe form. Local symptomatology of the disease manifests itself as an expiratory or mixed dyspnea, local or widespread boxed hue of percussion sound, remote dry whistling and variously different wet wheezes against the background of hard breathing with prolonged exhalation. In severe forms of acute obstructive bronchitis in children of both age groups, symptoms of intoxication and respiratory insufficiency (p &lt;0.01), more pronounced in infants (p &lt;0.05), are more often noted. With increasing severity of the disease, the anxiety of children is replaced by lethargy, acrocyanosis - diffuse cyanosis. The third degree of bronchial obstruction and prolonged dry, painful, unproductive cough, the mixed character of expiratory dyspnea, the entrainment of all malleable areas, up to the sternum of the sternum, are observed with a severe form of acute obstructive bronchitis (p &lt;0.05). Physical pathological abnormalities in the form of a widespread pronounced boxed sound with percussion, hard breathing with an abundance of dry and variegated wet wheezes in auscultation of the lungs are also more characteristic for severe disease (p &lt;0.001).Conclusions.Features of the clinical course of acute obstructive bronchitis in young children indicate the need for further study of this problem due to the high risk of chronic bronchio-pulmonary disease in subsequent years of life.

High Dose Rate Endobronchial Brachytherapy: Our institutional experience as an Effective Palliative Treatment Modality in Bronchial Carcinoma

Background: Treatment of inoperable carcinoma lung poses a challenge both due to the magnitude and local symptoms with resultant worsening of performance status of the patients. Endobronchial brachytherapy is an established modality for palliation of symptoms, namely dyspnoea, haemoptysis and coughthat result from disease infiltration of the airways. This study was aimed at evaluating the role of HDR endobronchial brachytherapy with external radiotherapy for symptomatic improvement and compliance for such patients at our institution. Method: 50 patients of inoperable Ca Lung with significant bronchial component, includingnon-small cell and small cell, were assessed. Patients were evaluated with fibre optic bronchoscopy regarding degree of bronchial obstruction. They were randomized into two treatment arms, Arm A: Endobronchial brachytherapy(EBBT) followed by External RT. Arm B: External beam Radiotherapy followed by endobronchial brachytherapy. Endobronchial Brachytherapy was delivered using remote afterloading HDR brachytherapy with Ir192 source. Dosefor external RT was 30Gy/10#, on Linear Accelerator or Co-60 teletherapy unit.Endobronchial brachytherapy doserange was 6.5Gy-10Gy in single or two fractions, one week apart. Bronchoscopic assessment was done after one week of each fraction of endobronchial brachytherapy as well as after completion of treatment at every 1 month for 3 months. In some patients with good response, follow up bronchoscopy was performed after 6 months. Response to the therapy was also assessed with the Speiser scoring criteria. Results: Total 50 patients were randomised into two arms according to presenting symptoms and Bronchoscopic feasibility for the catheter insertion. There were 20 patients in arm A and 30 patients in arm B. In short follow up, complete response for haemoptysis was achieved in 98% of patients (n=14), 80% patients showed complete response to dyspnoea(n=46). Symptoms like chest pain and cough showed less improvement after endobronchial brachytherapy. Re-expansion of atelectasis was seen in 100% patients (n=29). Values in both the arms were compared using Pearson Chi-square test. The pre- and post-treatment symptomatic differences were comparable in both the arms and statistically significant for dyspnoea, chest pain, cough, haemoptysis while it was found to be insignificant in patients with change of voice. Conclusion: Endobronchial brachytherapy, as documented, is an important palliative modality to relieve the obstructive symptoms like dyspnoea and hemoptysis, in patients with intrabronchial malignant mass.

Acoustic biomechanical relationships of human forced exhalation in bronchial obstruction

A statistically significant bidirectional influence of the incidence and degree of bronchial obstruction on the acoustic parameters of forced expiration and the spirometry/body plethysmography indicators of lung function has been revealed by means of nonparametric analysis of variance in a sample of 218 subjects. It has been shown that the acoustic band pass times and energies of forced expiratory tracheal noises coordinate with both tidal resistance and residual volume.

Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea. Association, consequences and treatment

Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two diseases that often co-exist within an individual. This co-existence, known as overlap syndrome (OS), is the result of chance rather than a pathophysiological linkage and epidemiological studies indicate a prevalence of 1% in adult males. Patients vith OS have a more important sleep-related O2 desaturation than COPD patients with the same degree of bronchial obstruction and show an increased risk of developing hypercapnic respiratory failure and pulmonary hypertension when compared with patients affected by only one of he diseases. COPD and OSAS are independent risk factors for cardiovascular events and their co-existence in OS probably increases this risk. Evidence of systemic inflammation in COPD and sleep apnea and consequentely OS, is interesting because it may contribute to the pathogenesis of cardiovascular diseases. Treatment consists of continuous positive airway pressure (CPAP) or non-invasive positive pressure ventilation (NIPPV), with or without associated O2, for correction of the upper airway obstructive episodes and hypoxemia during sleep.

Emotional Intelligence: A Novel Outcome Associated with Wellbeing and Self-Management in Chronic Obstructive Pulmonary Disease.

Individuals with chronic obstructive pulmonary disease (COPD) often struggle with diminished autonomy and quality of life. Emotional factors play a crucial role in the well-being of patients with COPD; they are independently associated with critical outcomes such as dyspnea, quality of life, and health care use. Emotional intelligence is the capacity to understand and manage personal thoughts and feelings, as well as to positively influence interpersonal communication and social well-being. Emotional intelligence is a trainable skill that is extensively used in corporate business to improve well-being and performance, and it may also be significant in the self-management of emotions in patients with chronic disease. Importantly, research supports the proposition that emotional intelligence may be developed and learned at any time or any age, and training programs have been associated with increased well-being and better emotional regulation in patients with chronic disease. However, to date, no research has been done to investigate its value in patients with COPD. We aimed to investigate the association between emotional intelligence and two meaningful outcomes in COPD: quality of life and self-management abilities. Participants with moderate to severe COPD completed a disease-specific quality of life tool (Chronic Respiratory Questionnaire), the Trait Emotional Intelligence Questionnaire, the Self-Management Abilities Scale, the modified Medical Research Council Dyspnea Scale, and pulmonary function tests, and also provided information about living conditions and self-reported health care use. A total of 310 patients with COPD (mean age, 69 ± 9 yr; 40% female; mean FEV1%, 42.4 ± 15.8) participated in the study. Emotional intelligence was significantly and independently associated with self-management abilities (P < 0.0001) and all domains of quality of life assessed (dyspnea, fatigue, emotions, and mastery; P < 0.0001) after adjusting for age, degree of bronchial obstruction, breathlessness, and other significant confounders. Emotional intelligence may represent an important attribute in COPD, as it is associated with self-management abilities and all domains of quality of life, regardless of age or disease severity. Emotional intelligence can be learned and may complement existing rehabilitation efforts. Attention to it may address the current gap that exists in the treatment of emotional components of COPD responsible for decreased quality of life and increased health care use.

Clinical-anthropometric characteristics of COPD outpatients belonging to the different groups and having different severity of airway obstruction.

The aim of the study was to compare the clinical and anthropometric characteristics of patients with COPD, which differ in the degree of airways obstruction and belong to groups A, B, C, D in accordance with GOLD, 2011 classification. A total of 112 ambulatory COPD patients in remission made the study sample. Anthropometric data, body mass index, medical history, dyspnea by mMRC scale, and spirometry was performed for all patients. There was confirmed that outpatients with COPD is a heterogeneous group, in which the majority are those with moderate (48.22 %) and severe (30.36 %), airway obstruction. Despite the vast majority of men among outpatients, the percentage of women among patients with mild to moderate obstruction (22.58±5.31 %) was significantly higher (p=0.002) as compared with those with severe or very severe limitation of airflow (6.00±3.36 %). Patients with severe and very severe obstruction were of significantly older age (p = 0.024). At the same time, the distribution of patients according to the GOLD, 2011 classification, demonstrate that all groups did not differ on any of the anthropometric indicators, including gender and age (p > 0.050). Distribution of patients by groups with different risk for future exacerbations is not a mirror image of gradation in accordance with the degree of airway obstruction. Every second (50.00±4.43 % of cases) patient is included in group C and every tenth (10.20±4.32 %) belongs to the group D not due to degree of bronchial obstruction, but due to the number of exa­cerbations in the past year. Therefore, in future studies it is advisable to use both principles of patients’ classification.

Serum cytokine profile in stable patients with work8related chronic obstructive pulmonary disease and relationship to other inflammatory markers

The aim of this study was to investigate serum cytokine profile in stable patients with chronic obstructive pulmonary disease (COPD) caused by siliconcontaining dust exposure and to evaluate relationships between cytokines and some inflammatory biomarkers. Methods. Patients (n = 234) with stable workrelated COPD were involved. To assess inflammation severity, we measured interleukins IL1β, IL4, IL6, IL8, tumor necrosis factor α (TNFα) in blood serum using immunoassay. Cytokine level was compared with inflammatory marker levels, such as Creactive protein (CRP), ferritin, erythrocyte sedimentation rate (ESR), blood leukocyte number, nitric oxide metabolites, immunoglobulins (IgG, IgA, IgM). Reparation of damaged airway epithelium was assessed by serum concentration of Clara cell protein (CC16) using immunoassay. Results . There was no difference between cytokine and inflammatory marker levels in most patients with stable workrelated COPD and control subjects. This means that inflammation tin the airways was mild and only slightly depended on degree of bronchial obstruction. Systemic inflammation in COPD was confirmed by elevated CRP level (5.0 – 10.0 mg/L) found in a half of patients with workrelated COPD.

Changes of Arterial Blood Gases After Different Ranges of Surgical Lung Resection

Introduction:In recent years there has been increase in the number of patients who need thoracic surgery – first of all different types of pulmonary resection because of primary bronchial cancer, and very often among patients whose lung function is impaired due to different degree of bronchial obstruction so it is necessary to assess functional status before and after lung surgery to avoid the development of respiratory insufficiency.Objective:To show the changes in the level of arterial blood gases after various ranges of lung resection.Material and methods:The study was done on 71 patients surgically treated at the Clinic for Thoracic Surgery KCU Sarajevo, who were previously treated at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 06. 2009. to 01. 09. 2011. Different types of lung resection were made. Patients whose percentage of ppoFEV1 was (prognosed postoperative FEV1) was less than 30% of normal values of FEV1 for that patients were not given a permission for lung resection. We monitored the changes in levels-partial pressures of blood gases (PaO2, PaCO2 and SaO2) one and two months after resection and compared them to preoperative values. As there were no significant differences between the values obtained one and two months after surgery, in the results we showed arterial blood gas analysis obtained two months after surgical resection. Results were statistically analyzed by SPSS and Microsoft Office Excel. Statistical significance was determined at an interval of 95%.Results:In 59 patients (83%) there was an increase, and in 12 patients (17%) there was a decrease of PaO2, compared to preoperative values. In 58 patients (82%) there was a decrease, and in 13 patients (18%) there was an increase in PaCO2, compared to preoperative values. For all subjects (group as whole): The value of the PaO2 was significantly increased after lung surgery compared to preoperative values (p <0.05) so is the value of the SaO2%. The value of the PaCO2 was significantly decreased after lung surgery compared to preoperative values (p <0.05). Respiratory insufficiency was developed in none of patients.Conclusion:If the % ppoFEV1 (% prognosed postoperative FEV1) is bigger than 30% of normal values of FEV1 (according to sex, weight, height, age) in patient planned for lung resection surgery there is no development of respiratory insufficiency after resection.