BackgroundThe use of anti-interleukin-5 (IL5) for severe asthma is based on criteria from randomi... more BackgroundThe use of anti-interleukin-5 (IL5) for severe asthma is based on criteria from randomised controlled trials (RCTs), but in real-life patients might not fulfil the eligibility criteria but may benefit from biologics. We aimed to characterise patients starting anti-IL5(R) in Europe and evaluate the discrepancies between initiation of anti-IL5(R) in real life and in RCTs.Materials and methodsWe performed a cross-sectional analysis with data from the severe asthma patients at the start of anti-IL5(R) in the Severe Heterogeneous Asthma Research collaboration Patient-centred (SHARP Central) registry. We compared the baseline characteristics of the patients starting anti-IL5(R) from 11 European countries within SHARP with the baseline characteristics of the severe asthma patients from 10 RCTs (four for mepolizumab, three for benralizumab and three for reslizumab). Patients were evaluated following eligibility criteria from the RCTs of anti-IL5 therapies.ResultsPatients starting ...
Serbian Journal of Experimental and Clinical Research, 2016
A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt d... more A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO
IntroductionTreatment with biologics for severe asthma is informed by international and national ... more IntroductionTreatment with biologics for severe asthma is informed by international and national guidelines and defined by national regulating bodies, but how these drugs are used in real-life is unknown.Materials and methodsThe European Respiratory Society (ERS) SHARP Clinical Research Collaboration conducted a three-step survey collecting information on asthma biologics use in Europe. Five geographically distant countries defined the survey questions, focusing on seven end-points: biologics availability and financial issues, prescription and administration modalities, inclusion criteria, continuation criteria, switching biologics, combining biologics and evaluation of corticosteroid toxicity. The survey was then sent to SHARP National Leads of 28 European countries. Finally, selected questions were submitted to a broad group of 263 asthma experts identified by national societies.ResultsAvailability of biologics varied between countries, with 17 out of 28 countries having all five ...
Who developed these guidelines? The American College of Physicians (ACP) developed these recommen... more Who developed these guidelines? The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists, which are specialists in the care of adults. What is the problem and what is known about it so far? Chronic obstructive pulmonary disease (COPD) is a disease of the airways and lungs that usually occurs in cigarette smokers. People with COPD get short of breath. Damage to the lungs and symptoms slowly worsen over time. Spirometry is a breathing test that can diagnose COPD on the basis of a measurement called FEV1 (forced expiratory volume in 1 second), which estimates the amount of air that a person exhales in 1 second compared with that of a typical healthy person of the same age and size. A person with a FEV1 of 60% exhales about 60% the amount that a typical healthy person the same age and size exhales in 1 second. Doctors treat COPD with drugs that widen the airways of the lungs (beta-agonist or anticholinergic drugs) and drugs that decrease inflammation (corticosteroids). These drugs come in inhalers that allow patients to breathe in the drugs. Oxygen therapy can help some people with COPD. Pulmonary rehabilitation, which involves patient education and exercise, is another COPD treatment. How did the ACP develop these recommendations? The authors reviewed studies about the benefits and harms of various tests and treatments for COPD published between 1966 and March 2007. What did the authors find? The authors found little evidence that spirometry helps to select treatment. They did find that spirometry can be helpful in diagnosing COPD in patients who present with breathing symptoms, but it is not helpful in patients without symptoms. The authors found strong evidence for a benefit of inhaled beta-agonists, anticholinergics, and corticosteroids in reducing symptoms, hospitalization, and death due to COPD. However, the studies of these drugs were mostly done in patients with an FEV1 less than 60% and might not apply to patients with less severe lung abnormality. Evidence for a benefit of oxygen therapy was found for patients with very low resting blood oxygen levels. Some weak evidence indicated that pulmonary rehabilitation may help patients with COPD symptoms and an FEV1 less than 50%. What does the ACP suggest that patients and doctors do? The ACP strongly recommends that doctors and patients: 1. Use spirometry to diagnose COPD in patients with shortness of breath, but not to look for COPD in patients without symptoms. 2. Treat COPD with 1 of the following drugs if spirometry shows that the FEV1 is less than 60% predicted: a long-acting beta-agonist, a long-acting anticholinergic, or a corticosteroid. 3. Consider oxygen therapy for patients with COPD who have very low blood oxygen levels at rest. The ACP weakly recommends that doctors and patients should: 1. Consider a combination of inhaled drugs if the FEV1 is less than 60% and symptoms continue during treatment with 1 drug. 2. Consider pulmonary rehabilitation for patients with COPD symptoms and an FEV1 less than 50% predicted. What are the cautions related to these recommendations? Recommendations may change as new studies become available.
Histamine produces constriction of tracheal smooth muscle via H1 receptors, but it also decreases... more Histamine produces constriction of tracheal smooth muscle via H1 receptors, but it also decreases tracheal smooth muscle tone via H2 and H3 receptors. In addition, it has already been reported that phenylethylamine is competitive antagonist of histamine N-methyl-transferase (HMT), enzyme responsible for rapid inactivation of histamine. Our results suggest possibility that phenylethylamine as competitive antagonist of histamine N-methyl-transferase leads to potentiation of histamine induced constriction of isolated guinea-pig trachea, which could be consequence of decreased histamine methylation and subsequent histamine inactivation. At the same time, phenylethylamine had no direct effect on basal tone of intact isolated trachea rings, as well as on other mechanisms leading to increased responsiveness of guinea-pig tracheal smooth muscle (acetylcholine, KCl, electro stimulation).
Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired ... more Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The majo...
Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertr... more Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. Material and Methods. In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry. Results. There were 2074 patients, 38.4% men, their mean age being 54?15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (6...
Introduction. Miliary tuberculosis (TB) is a rare and potentially fatal form of disseminated TB. ... more Introduction. Miliary tuberculosis (TB) is a rare and potentially fatal form of disseminated TB. It is caused by a widespread haematogenous dissemination of Mycobacterium tuberculosis from an active caseous focus to different organs. Sometimes it can have an acute presentation with a rapidonset clinical deterioration and death. Miliary TB complicated with an acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) is rare, even in countries with a high incidence of TB. Case report. A 35-yearold woman with Down syndrome (DS) was admitted to the Clinic for Pulmonology, Clinical Centre Kragujevac, due to an evaluation of cough and weight loss during last 2 months. Laboratory findings revealed anaemia, leukocytosis, elevated C-reactive protein (CRP) and hypoalbuminemia. A chest x-ray showed bilateral reticulonodular shadows, predominantly in the mid and lower right lung lobes. A purified protein derivative (PPD) skin test and induced sputum smear for acid-fast ba...
Bacground/Aim. Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and... more Bacground/Aim. Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality in pulmonary pathology. However, apart from its own pulmonary manifestations, this disease is also characterized by systemic effects, including hypogonadism which is described especially in the group of men with COPD. The aim of this study was to evaluate risk factors for hypogonadism in men with COPD. Methods. The study included 96 male patients with COPD in stable phase of the disease. All patients were checked for concentration of free testosterone in serum, markers of systemic inflammation, tumor necrosis factor-? (TNF-?), interleukin-1? (IL-1?) and C reactive protein (CRP), pulmonary function test, gas exchange parameters, a 6-minute walk test (6MWT), nutritional status and condition of skeletal muscle (midthigh muscle cross-sectional area ? MTCSA using computed tomography). Results. Decreased value of free testosterone was found in 37.5% of the patients. In the group wit...
BackgroundThe use of anti-interleukin-5 (IL5) for severe asthma is based on criteria from randomi... more BackgroundThe use of anti-interleukin-5 (IL5) for severe asthma is based on criteria from randomised controlled trials (RCTs), but in real-life patients might not fulfil the eligibility criteria but may benefit from biologics. We aimed to characterise patients starting anti-IL5(R) in Europe and evaluate the discrepancies between initiation of anti-IL5(R) in real life and in RCTs.Materials and methodsWe performed a cross-sectional analysis with data from the severe asthma patients at the start of anti-IL5(R) in the Severe Heterogeneous Asthma Research collaboration Patient-centred (SHARP Central) registry. We compared the baseline characteristics of the patients starting anti-IL5(R) from 11 European countries within SHARP with the baseline characteristics of the severe asthma patients from 10 RCTs (four for mepolizumab, three for benralizumab and three for reslizumab). Patients were evaluated following eligibility criteria from the RCTs of anti-IL5 therapies.ResultsPatients starting ...
Serbian Journal of Experimental and Clinical Research, 2016
A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt d... more A male patient, 54 years old, was initially admitted to the hospital because of fatigue he felt during the last month and swelling of the lower legs. Upon hospital admittance, gas exchange analysis showed global respiratory failure: pO
IntroductionTreatment with biologics for severe asthma is informed by international and national ... more IntroductionTreatment with biologics for severe asthma is informed by international and national guidelines and defined by national regulating bodies, but how these drugs are used in real-life is unknown.Materials and methodsThe European Respiratory Society (ERS) SHARP Clinical Research Collaboration conducted a three-step survey collecting information on asthma biologics use in Europe. Five geographically distant countries defined the survey questions, focusing on seven end-points: biologics availability and financial issues, prescription and administration modalities, inclusion criteria, continuation criteria, switching biologics, combining biologics and evaluation of corticosteroid toxicity. The survey was then sent to SHARP National Leads of 28 European countries. Finally, selected questions were submitted to a broad group of 263 asthma experts identified by national societies.ResultsAvailability of biologics varied between countries, with 17 out of 28 countries having all five ...
Who developed these guidelines? The American College of Physicians (ACP) developed these recommen... more Who developed these guidelines? The American College of Physicians (ACP) developed these recommendations. Members of the ACP are internists, which are specialists in the care of adults. What is the problem and what is known about it so far? Chronic obstructive pulmonary disease (COPD) is a disease of the airways and lungs that usually occurs in cigarette smokers. People with COPD get short of breath. Damage to the lungs and symptoms slowly worsen over time. Spirometry is a breathing test that can diagnose COPD on the basis of a measurement called FEV1 (forced expiratory volume in 1 second), which estimates the amount of air that a person exhales in 1 second compared with that of a typical healthy person of the same age and size. A person with a FEV1 of 60% exhales about 60% the amount that a typical healthy person the same age and size exhales in 1 second. Doctors treat COPD with drugs that widen the airways of the lungs (beta-agonist or anticholinergic drugs) and drugs that decrease inflammation (corticosteroids). These drugs come in inhalers that allow patients to breathe in the drugs. Oxygen therapy can help some people with COPD. Pulmonary rehabilitation, which involves patient education and exercise, is another COPD treatment. How did the ACP develop these recommendations? The authors reviewed studies about the benefits and harms of various tests and treatments for COPD published between 1966 and March 2007. What did the authors find? The authors found little evidence that spirometry helps to select treatment. They did find that spirometry can be helpful in diagnosing COPD in patients who present with breathing symptoms, but it is not helpful in patients without symptoms. The authors found strong evidence for a benefit of inhaled beta-agonists, anticholinergics, and corticosteroids in reducing symptoms, hospitalization, and death due to COPD. However, the studies of these drugs were mostly done in patients with an FEV1 less than 60% and might not apply to patients with less severe lung abnormality. Evidence for a benefit of oxygen therapy was found for patients with very low resting blood oxygen levels. Some weak evidence indicated that pulmonary rehabilitation may help patients with COPD symptoms and an FEV1 less than 50%. What does the ACP suggest that patients and doctors do? The ACP strongly recommends that doctors and patients: 1. Use spirometry to diagnose COPD in patients with shortness of breath, but not to look for COPD in patients without symptoms. 2. Treat COPD with 1 of the following drugs if spirometry shows that the FEV1 is less than 60% predicted: a long-acting beta-agonist, a long-acting anticholinergic, or a corticosteroid. 3. Consider oxygen therapy for patients with COPD who have very low blood oxygen levels at rest. The ACP weakly recommends that doctors and patients should: 1. Consider a combination of inhaled drugs if the FEV1 is less than 60% and symptoms continue during treatment with 1 drug. 2. Consider pulmonary rehabilitation for patients with COPD symptoms and an FEV1 less than 50% predicted. What are the cautions related to these recommendations? Recommendations may change as new studies become available.
Histamine produces constriction of tracheal smooth muscle via H1 receptors, but it also decreases... more Histamine produces constriction of tracheal smooth muscle via H1 receptors, but it also decreases tracheal smooth muscle tone via H2 and H3 receptors. In addition, it has already been reported that phenylethylamine is competitive antagonist of histamine N-methyl-transferase (HMT), enzyme responsible for rapid inactivation of histamine. Our results suggest possibility that phenylethylamine as competitive antagonist of histamine N-methyl-transferase leads to potentiation of histamine induced constriction of isolated guinea-pig trachea, which could be consequence of decreased histamine methylation and subsequent histamine inactivation. At the same time, phenylethylamine had no direct effect on basal tone of intact isolated trachea rings, as well as on other mechanisms leading to increased responsiveness of guinea-pig tracheal smooth muscle (acetylcholine, KCl, electro stimulation).
Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired ... more Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The majo...
Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertr... more Introduction. Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. Material and Methods. In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry. Results. There were 2074 patients, 38.4% men, their mean age being 54?15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (6...
Introduction. Miliary tuberculosis (TB) is a rare and potentially fatal form of disseminated TB. ... more Introduction. Miliary tuberculosis (TB) is a rare and potentially fatal form of disseminated TB. It is caused by a widespread haematogenous dissemination of Mycobacterium tuberculosis from an active caseous focus to different organs. Sometimes it can have an acute presentation with a rapidonset clinical deterioration and death. Miliary TB complicated with an acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) is rare, even in countries with a high incidence of TB. Case report. A 35-yearold woman with Down syndrome (DS) was admitted to the Clinic for Pulmonology, Clinical Centre Kragujevac, due to an evaluation of cough and weight loss during last 2 months. Laboratory findings revealed anaemia, leukocytosis, elevated C-reactive protein (CRP) and hypoalbuminemia. A chest x-ray showed bilateral reticulonodular shadows, predominantly in the mid and lower right lung lobes. A purified protein derivative (PPD) skin test and induced sputum smear for acid-fast ba...
Bacground/Aim. Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and... more Bacground/Aim. Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality in pulmonary pathology. However, apart from its own pulmonary manifestations, this disease is also characterized by systemic effects, including hypogonadism which is described especially in the group of men with COPD. The aim of this study was to evaluate risk factors for hypogonadism in men with COPD. Methods. The study included 96 male patients with COPD in stable phase of the disease. All patients were checked for concentration of free testosterone in serum, markers of systemic inflammation, tumor necrosis factor-? (TNF-?), interleukin-1? (IL-1?) and C reactive protein (CRP), pulmonary function test, gas exchange parameters, a 6-minute walk test (6MWT), nutritional status and condition of skeletal muscle (midthigh muscle cross-sectional area ? MTCSA using computed tomography). Results. Decreased value of free testosterone was found in 37.5% of the patients. In the group wit...
Uploads