Background Obstructive lung diseases have a significant impact on outcomes of patients with obstr... more Background Obstructive lung diseases have a significant impact on outcomes of patients with obstructive sleep apnea (OSA). Alternatively, functional changes in OSA may alter pulmonary mechanics, particularly the upper airway resistance. Aim To examine the pulmonary function test parameters in patients with OSA. Methods A cross-sectional study of patients who underwent overnight polysomnography at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia between November 2012 and May 2014. Spirometry, whole body plethysmography (BP) and impulse oscillometry (IOS) were performed in all patients. Results There were 118 patients, 85 (73%) men, mean age 49.5±18.1 years, mean BMI 30.3±12.1kg/m2. OSA was confirmed in 53 (44.9%) patients: 24 (20.2%) mild, 14 (11.8%) moderate and 15 (12.7%) severe. Obstructive ventilatory disorder consistent with chronic obstructive pulmonary disease (COPD) was confirmed by spirometry in 6/118 (5.1%) patients. There was no difference in the presence of COPD between patients with and without OSA (4/53, 7.55% vs. 2/63, 3.1%, p=0.46).When patients with COPD (n=6) and possible asthma (n=8) were excluded from the analysis airway resistance measured by BP (Rt median 0.2 IQR 1.015-0.26 vs. 0.16 IQR 0.12-0.21, p=0.01) and IOS (R5% median 120 IQR 92-187 vs. 104 IQR 85-122, p =0.01; R 20% median 123 IQR 97-164 vs. 108 IQR 81-129, p=0.03) were higher in patients with OSA compared to patients without OSA. When adjusted for age, gender, BMI and smoking, R5% was associated with the presence of OSA (OR 1.15 95%CI 1.03-1.32). Conclusions There is no difference in prevalence of COPD in patients with and without OSA. In patients without obstructive airway diseases, airway resistance measured by IOS is higher in OSA patients.
Background: The major aim of this stud y was to investigate what patients with advanced stage lun... more Background: The major aim of this stud y was to investigate what patients with advanced stage lung cancer, enrolled in a clinical trial, thought about their treatment. We also wanted to investigate if there exist any characteristics that could influence patients’ opinion about the clinical trial. Patients and methods: Over the period from June 2008 to June 2009, 59 eligible patients were enrolled in this study. The major inclusion criteria were: participation in a clinical trial, previously treated advanced stage lung cancer, and good performance status (ECOG 0-2). All patients were asked to answer a questionnaire designed to investigate their impressions about participation in a clinical trial. The questionnaire was deposited in a sealed box which was opened at the end of the study. We investigated a possible influence of age, gender, education, lung cancer stage, chemotherapy line and tumor type on the patients' opinion about some aspects of the clinical trial. Results: The ma...
Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a maj... more Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method. The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results. Study included 1,674 patients (956 males, age 65.93 ?} 8.45, current or ex-smokers 94.9%; 21 ? BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities...
Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity ... more Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly diagnosed OSA and evaluate the risk for cardiovascular disease and mortality. The present study also aimed to establish predictors for OSA severity. Materials and Methods: This study included 138 newly diagnosed patients who underwent polysomnographic analysis. The 10-year risk for cardiovascular disease was assessed using a newly validated prediction model: Systematic Coronary Risk Evaluation (SCORE-2). In addition, the Charlson Comorbidity Index (CCI) was assessed as a widely-used example of a mortality comorbidity index. Results: The study population included 138 patients: 86 males and 52 females. Patients were stratified, according to AHI (apnea/hypopnea index), into four...
Aim: To develop a method allowing detailed studies of resistance during the breathing cycle at ex... more Aim: To develop a method allowing detailed studies of resistance during the breathing cycle at exercise by using information from lung mechanics at rest. Material and Methods: The static Pel/V curve recorded at rest is "mirrored" on the P/V loop recorded at exercise, for determination of resistance at each moment of the respiratory cycle. To align the curve and the loop along volume axis, inspiratory and expiratory resistance at the highest volume was set to be equal. 60 healthy males and females, aged 20-65 years were studied and clinical application started. Results: Stable alignment of static curves and dynamic loops was achieved. As ex- pected expiratory resistance RE increases during expiration particularly in COPD, see figure. Conclusion: Detailed information about resistance during the whole respiratory cycle gives insight in the adaptation to exercise in health and in disease and is of potential clinical value.
ABSTRACT Introduction The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy ... more ABSTRACT Introduction The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report provides guidance on effective management of chronic obstructive pulmonary disease (COPD) according to local healthcare systems. However, COPD is a heterogenous disease and certain aspects, including prevalence, disease–time course and phenotype distribution, can differ between countries. Moreover, features of clinical practice and healthcare systems for patients with COPD can vary widely, even in geographically close and economically similar countries. Areas covered Based on an initial workshop of respiratory physicians from eleven countries across Central and Eastern Europe (CEE) in December 2018 and subsequent discussions, this article offers region-specific insights from clinical practice and healthcare systems in CEE. Taking recommendations from the GOLD 2022 report into account, we suggest approaches to adapt these into national clinical guidelines for COPD management in CEE. Expert opinion Several factors should be considered when optimizing management of COPD in CEE compared with other regions, including differences in smoking status, vaccination uptake, prevalence of tuberculosis and nontuberculous mycobacteria, and variations in healthcare systems. We provide guidance and algorithms for pharmacologic and non-pharmacologic management of COPD for the following scenarios: initial and follow-up treatment, treatment of patients with frequent exacerbations, and withdrawal of inhaled corticosteroids where appropriate. PLAIN LANGUAGE SUMMARY Chronic obstructive pulmonary disease (COPD) is a common disease of the lungs. It causes symptoms such as breathlessness, cough, and production of phlegm. In people with COPD, these symptoms often reduce the quality of their lives. From time to time, symptoms may get worse in people with the disease. This worsening is known as ‘exacerbation’. Exacerbations of COPD can be so bad that they lead to hospital admissions. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) regularly gives advice to doctors around the world. This can help them to provide their patients with the best possible treatment for COPD. However, people with the disease and healthcare systems vary from country to country. This means that the guidance may need to be adjusted to the needs and available resources of different regions. This review looks at how COPD is treated in Central and Eastern Europe. We suggest how to adapt the GOLD recommendations to best suit the Central and Eastern European region. Graphical Abstract
Background: The role of small airway disease (SAD)in asthma and COPD patients is still a matter o... more Background: The role of small airway disease (SAD)in asthma and COPD patients is still a matter of debate. Aim: To determine the frequency of SAD in asthma and COPD patients and examine its relationship to the patients9 baseline characteristics. Methods: A cross-sectional study of 100 consecutive outpatients with asthma and 100 with COPD seen at the Centre for Lung Function Testing at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.Patients with acute exacerbations in previous six weeks were excluded from the analysis.SAD was defined as the presence of frequency dependent increase in pulmonary resistance measured by impulse oscillometry (R5-R20). Results: The SAD was more common in COPD compared to asthma patients (34% vs.11%,p Conclusion: SAD is more common in COPD compared to asthma patients.Presence of SAD is associated with higher BMI.In asthmatics, SAD was related to the asthma duration,while in COPD SAD was associated with the number of exacerbations in previous year.
Background Obstructive lung diseases have a significant impact on outcomes of patients with obstr... more Background Obstructive lung diseases have a significant impact on outcomes of patients with obstructive sleep apnea (OSA). Alternatively, functional changes in OSA may alter pulmonary mechanics, particularly the upper airway resistance. Aim To examine the pulmonary function test parameters in patients with OSA. Methods A cross-sectional study of patients who underwent overnight polysomnography at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia between November 2012 and May 2014. Spirometry, whole body plethysmography (BP) and impulse oscillometry (IOS) were performed in all patients. Results There were 118 patients, 85 (73%) men, mean age 49.5±18.1 years, mean BMI 30.3±12.1kg/m2. OSA was confirmed in 53 (44.9%) patients: 24 (20.2%) mild, 14 (11.8%) moderate and 15 (12.7%) severe. Obstructive ventilatory disorder consistent with chronic obstructive pulmonary disease (COPD) was confirmed by spirometry in 6/118 (5.1%) patients. There was no difference in the presence of COPD between patients with and without OSA (4/53, 7.55% vs. 2/63, 3.1%, p=0.46).When patients with COPD (n=6) and possible asthma (n=8) were excluded from the analysis airway resistance measured by BP (Rt median 0.2 IQR 1.015-0.26 vs. 0.16 IQR 0.12-0.21, p=0.01) and IOS (R5% median 120 IQR 92-187 vs. 104 IQR 85-122, p =0.01; R 20% median 123 IQR 97-164 vs. 108 IQR 81-129, p=0.03) were higher in patients with OSA compared to patients without OSA. When adjusted for age, gender, BMI and smoking, R5% was associated with the presence of OSA (OR 1.15 95%CI 1.03-1.32). Conclusions There is no difference in prevalence of COPD in patients with and without OSA. In patients without obstructive airway diseases, airway resistance measured by IOS is higher in OSA patients.
Background: The major aim of this stud y was to investigate what patients with advanced stage lun... more Background: The major aim of this stud y was to investigate what patients with advanced stage lung cancer, enrolled in a clinical trial, thought about their treatment. We also wanted to investigate if there exist any characteristics that could influence patients’ opinion about the clinical trial. Patients and methods: Over the period from June 2008 to June 2009, 59 eligible patients were enrolled in this study. The major inclusion criteria were: participation in a clinical trial, previously treated advanced stage lung cancer, and good performance status (ECOG 0-2). All patients were asked to answer a questionnaire designed to investigate their impressions about participation in a clinical trial. The questionnaire was deposited in a sealed box which was opened at the end of the study. We investigated a possible influence of age, gender, education, lung cancer stage, chemotherapy line and tumor type on the patients' opinion about some aspects of the clinical trial. Results: The ma...
Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a maj... more Introduction/Objective. The chronic obstructive pulmonary disease (COPD) exacerbations have a major impact on outcomes of COPD patients. Pulmonary rehabilitation (PR) interrupts the vicious circle caused by exacerbations. It has not been widely implemented as standard of COPD treatment yet. The aim of study was to examine the effectiveness of PR in prevention of exacerbations. Method. The prospective observation study included stable COPD patients between January 2015 and December 2018. The effects of PR on exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account age, comorbidity, vaccination status (against seasonal flu), body mass index (BMI). Results. Study included 1,674 patients (956 males, age 65.93 ?} 8.45, current or ex-smokers 94.9%; 21 ? BMI 1,406 patients, 84%, FEV1 < 80% 1,448 patients, 86.5%). The PR rate was 48.1%. There was significant difference in PR status with respect to age (p = 0.020), comorbidities...
Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity ... more Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly diagnosed OSA and evaluate the risk for cardiovascular disease and mortality. The present study also aimed to establish predictors for OSA severity. Materials and Methods: This study included 138 newly diagnosed patients who underwent polysomnographic analysis. The 10-year risk for cardiovascular disease was assessed using a newly validated prediction model: Systematic Coronary Risk Evaluation (SCORE-2). In addition, the Charlson Comorbidity Index (CCI) was assessed as a widely-used example of a mortality comorbidity index. Results: The study population included 138 patients: 86 males and 52 females. Patients were stratified, according to AHI (apnea/hypopnea index), into four...
Aim: To develop a method allowing detailed studies of resistance during the breathing cycle at ex... more Aim: To develop a method allowing detailed studies of resistance during the breathing cycle at exercise by using information from lung mechanics at rest. Material and Methods: The static Pel/V curve recorded at rest is "mirrored" on the P/V loop recorded at exercise, for determination of resistance at each moment of the respiratory cycle. To align the curve and the loop along volume axis, inspiratory and expiratory resistance at the highest volume was set to be equal. 60 healthy males and females, aged 20-65 years were studied and clinical application started. Results: Stable alignment of static curves and dynamic loops was achieved. As ex- pected expiratory resistance RE increases during expiration particularly in COPD, see figure. Conclusion: Detailed information about resistance during the whole respiratory cycle gives insight in the adaptation to exercise in health and in disease and is of potential clinical value.
ABSTRACT Introduction The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy ... more ABSTRACT Introduction The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report provides guidance on effective management of chronic obstructive pulmonary disease (COPD) according to local healthcare systems. However, COPD is a heterogenous disease and certain aspects, including prevalence, disease–time course and phenotype distribution, can differ between countries. Moreover, features of clinical practice and healthcare systems for patients with COPD can vary widely, even in geographically close and economically similar countries. Areas covered Based on an initial workshop of respiratory physicians from eleven countries across Central and Eastern Europe (CEE) in December 2018 and subsequent discussions, this article offers region-specific insights from clinical practice and healthcare systems in CEE. Taking recommendations from the GOLD 2022 report into account, we suggest approaches to adapt these into national clinical guidelines for COPD management in CEE. Expert opinion Several factors should be considered when optimizing management of COPD in CEE compared with other regions, including differences in smoking status, vaccination uptake, prevalence of tuberculosis and nontuberculous mycobacteria, and variations in healthcare systems. We provide guidance and algorithms for pharmacologic and non-pharmacologic management of COPD for the following scenarios: initial and follow-up treatment, treatment of patients with frequent exacerbations, and withdrawal of inhaled corticosteroids where appropriate. PLAIN LANGUAGE SUMMARY Chronic obstructive pulmonary disease (COPD) is a common disease of the lungs. It causes symptoms such as breathlessness, cough, and production of phlegm. In people with COPD, these symptoms often reduce the quality of their lives. From time to time, symptoms may get worse in people with the disease. This worsening is known as ‘exacerbation’. Exacerbations of COPD can be so bad that they lead to hospital admissions. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) regularly gives advice to doctors around the world. This can help them to provide their patients with the best possible treatment for COPD. However, people with the disease and healthcare systems vary from country to country. This means that the guidance may need to be adjusted to the needs and available resources of different regions. This review looks at how COPD is treated in Central and Eastern Europe. We suggest how to adapt the GOLD recommendations to best suit the Central and Eastern European region. Graphical Abstract
Background: The role of small airway disease (SAD)in asthma and COPD patients is still a matter o... more Background: The role of small airway disease (SAD)in asthma and COPD patients is still a matter of debate. Aim: To determine the frequency of SAD in asthma and COPD patients and examine its relationship to the patients9 baseline characteristics. Methods: A cross-sectional study of 100 consecutive outpatients with asthma and 100 with COPD seen at the Centre for Lung Function Testing at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.Patients with acute exacerbations in previous six weeks were excluded from the analysis.SAD was defined as the presence of frequency dependent increase in pulmonary resistance measured by impulse oscillometry (R5-R20). Results: The SAD was more common in COPD compared to asthma patients (34% vs.11%,p Conclusion: SAD is more common in COPD compared to asthma patients.Presence of SAD is associated with higher BMI.In asthmatics, SAD was related to the asthma duration,while in COPD SAD was associated with the number of exacerbations in previous year.
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