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Thesis (Ph.D.)--Ohio University, August, 2006. / Title from PDF t.p. Includes bibliographical references.

<p>Uvod: Pu&scaron;enje predstavlja jedan od najznačajnijih uzroka lo&scaron;e kontrole astme, zbog iritativnog dejstva duvanskog dima na disajne puteve i razvoja rezistencije na inhalatorne kortikosteroide. Stoga je pu&scaron;ače sa astmom često potrebno lečiti kombinovanom antiinflamatornom terapijom, iako je efikasnost ovakvog tretmana jo&scaron; uvek nedovoljno ispitana. Cilj: utvrditi efikasnost kombinovane antiinflamatorne terapije: inhalatorni kortikosteroidi (ICS) u kombinaciji sa dugodelujućim beta2-adrenergičkim agonistima (DDBA) u odnosu na ICS u kombinaciji sa antagonistima leukotrijenskih receptora (ALTR) u postizanju dobre kontrole astme, pobolj&scaron;anju kvaliteta života i plućne funkcije kod pu&scaron;ača u odnosu na nepu&scaron;ače sa astmom. Metod: Pacijenti starosti od 18-50 godina sa astmom (&ge;6meseci), FEV1 većim od 60%, podeljeni su u grupu nepu&scaron;ača &ndash;NP (N=60) i aktivnih pu&scaron;ača &ndash;PU (&le;2 &ge;15 p/g i &ge;10&le;40 cigareta na dan; N=60). Obe grupe su randomizovane u jednu od dve, otvorene, terapijske grupe (ICS uz dodatak DDBA ili ALTR) u trajanju od 24 nedelje. Rezultati: u svakoj od 4 randomizovane grupe (NP-DDBA, NP-ALTR, PU-DDBA, PU-ALTR) je bilo po 30 pacijenata. Tokom 24 nedelje, PU su imali lo&scaron;ije kontrolisanu astmu od NP (p=0,02), bez ralizke između DDBA vs ALTR (0,677 vs 0,634). Konstantno dobru kontrolu astme (ACQ&lt;0,75) tokom 24 nedelje je postiglo 48% NP i 32% PU (p=0,094), bez značajne razlike u odnosu na terapiju (DDBA vs ALTR; p=1,000). NP su imali bolji kvalitet života od PU, ali razlika nije dostigla statističku značajnost (p=0,056)- Kod NP i kod PU u oba modaliteta lečenja (LABA, ALTR) je do&scaron;lo do statistički značajne promene srednjeg skora AQLQ (p&lt;0,001). Povećanje FEV1(%) je bilo statistički značajno i u grupi NP i u grupi PU (p=0,001 vs. p=0,002). Kod pacijenata lečenih DDBA povećenje FEV(%) je bilo na nivou p=0,001, dok je u grupu ALTR bilo na nivou p=0,005. Multivarijantnom analizom je utvrđeno da su nezavisni faktori postizanja dobre kontrole astme BMI&ge;24, nepu&scaron;ač, FEV1&ge;90%, ACQ&le;2,2 i AQLQ&ge;4,2 Zaključak: Kombinovana antiinflamatorna terapija je efikasnija kod NP u odnosu na PU, dok su u populaciji aktivnih pu&scaron;ača, oba dodatna leka (DDBA, ALTR) bila podjednako efikasna u pobolj&scaron;anju kontrole astme, kvaliteta života i plućne funkcije.</p> / <p>Introduction: Smoking is one of the major causes of a bad asthma control, due to negative effects of the tobacco smoke on the airways and consequent resistance to inhalant corticosteroids. Smoking asthmatics should therefore often be treated with combined anti-inflammatory therapy, although the efficacy of this treatment regimen has not been completely examined yet. Objective: To examine the efficacy of the combined anti-inflammatory therapy (ICS combined to LABA vs.LTRA) in achieving a good asthma control, better quality of life and improved lung function in smoking vs. nonsmoking asthmatics. Method: The patients at 18-50 years of age with asthma (&ge;6 months), FEV1 &gt; 60%, were subclassified into the group of nonsmokers &ndash;NS (N=60), and the group of active smokers - SM (&le;2 &ge;15 p/g and &ge;10&le;40 cigarettes a day; N=60). Both groups were randomized into one of the two open therapy groups (ICS combined to DDBA or ALTR), receiving the selected treatment for 24 weeks. Results: Any of the four randomized groups (NS-LABA, NS-LTRA, SM-LABA, SM-LTRA) consisted of 30 patients. During the 24-week period, SM had a worse control of their asthma than NS (p=0.02), but no difference was registered between DDBA vs. ALTR therapy subgroups (0.677 vs. 0.634). Over the 24-week period, a constantly good asthma control (ACQ&le;0,75) was achieved by 48% of NS and 32% of SM (p=0.094), and no significant difference related to the applied therapy regimen (LABA vs. LTRA; p=1.000). NS had a better life quality than SM, but this difference remained statistically insignificant (p=0.056). Both the NS and the SM group in either treatment modality (LABA, ALTR) had a statistically significant change of the AQLQ score (p&lt;0.001). FEV1 (%) improvement was statistically significant t in both the NS and the SM group (p=0.001 vs. p=0.002). The LABA and LTRA treated patients had their FEV (%) improvement at the level of p=0.001, and p=0.005 respectively. The multivariate analysis has established the following independent factors of a good asthma control: BMI&ge;24, nonsmoker, FEV1&ge;90%, ACQ&le;2.2, and AQLQ&ge;4.2. Conclusion: The combined anti-inflammatory therapy is more efficient in NS than in SM asthmatics, while in the population of active smokers, both additional drugs (LABA, LTRA) were equally efficient in improving asthma control, life quality, and lung function.</p>