<p> The cellular, molecular, and genetic mechanisms underlying the pathogenesis of Chronic Obstructive Pulmonary Disease (COPD) are not well understood. The purpose of this thesis was to address the hypothesis that microbial infection is important for the development and/or progression of COPD through investigation of how cigarette smoke alters the response to a bacterial challenge in a mouse model of cigarette smoke-exposure. To this end, in chapter 2 of this thesis we tested the hypothesis that cigarette smoke-exposure attenuates the ability of alveolar macrophages to sense microbial antigens through innate pattern recognition receptors. The central point of this study was the observation that alveolar macrophages isolated from cigarette smoke-exposed mice had attenuated expression of typical inflammatory cytokines following microbial stimulation. Building on this main observation, in chapter 3 we questioned what the consequences of this would be to an in vivo bacterial challenge with nontypeable Haemophilus influenzae. We demonstrated that cigarette smoke-exposure resulted in chronic inflammation, this inflammation was exacerbated following bacterial challenge, and perhaps most importantly, the nature of the inflammatory response was altered. Interestingly, an observation from the study in chapter 3 indicated that exacerbated inflammation in cigarette smoke-exposed mice may be beneficial for clearance of the bacteria, but may come at the expense of damage to the lungs. Consequently, in chapter 4 we questioned the strain and dose/ frequency stringencies of cigarette smoke-exposure on the observation of accelerated bacterial clearance. We demonstrated a role for antibodies in bacterial clearance. Collectively, this thesis provides insight into our understanding of COPD by demonstrating that cigarette smoke-exposure alters the pulmonary immune/ inflammatory response to a microbial challenge, which has a detrimental impact on the lungs. </p> / Thesis / Doctor of Philosophy (PhD)

Bakgrund: KOL är den tredje vanligaste dödsorsaken världen över. Pulmonary rehabilitation är en vanlig del av behandlingen som fysioterapeuter ofta utgår ifrån vid rehabilitering för patienter som lider av KOL. Telerehabilitering är ett alternativ till pulmonary rehabilitation. Forskning som jämför effektiviteten av telerehabilitering hos patienter som lider av KOL är dock begränsad. På senare tid har det på grund av bland annat coronapandemin uppkommit ett ökat behov av att utvärdera hur effektiv telerehabilitering är jämfört med pulmonary rehabilitation eller obehandlad kontrollgrupp.  Syfte: Syftet med denna litteraturstudie var att systematiskt granska vetenskapliga artiklar vad gäller effekten av telerehabiltering på livskvalité samt, kondition och muskelstyrka hos patienter med KOL och att bedöma tillförlitligheten av artiklarnas sammanvägda resultat. Metod: Metoden som valdes var en litteraturstudie. Sökningen genomfördes i Pubmed och CINAHL. Kvalitén av åtta studier från sökningen granskades med PEDro och resultatets tillförlitlighet bedömdes med GRADEstud. Resultat: Kvalitén i de åtta studierna som inkluderades varierade mellan medelgod och hög. För utfallsmåttet livskvalité påvisades att telerehabilitering är lika effektivt som pulmonary rehabilitation och tillförlitligheten bedömdes som måttligt hög (+++). För utfallsmåttet fysisk kapacitet kunde man inte påvisa att telerehabilitering är lika effektivt som pulmonary rehabilitation där tillförlitligheten bedömdes som låg (++). Endast två studier hade med utfallsmåttet muskelstyrka vilket gjorde resultatet svårbedömt.  Konklusion: Telerehabilitering bedömdes vara lika effektivt som pulmonary rehabilitation avseende livskvalité men detsamma kunde inte påvisas för fysisk kapacitet. Mer forskning inom området behövs och framtida forskning bör försöka eftersträva mer likhet i interventionerna. / Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Pulmonary rehabilitation is a common part of the treatment that is often used by physical therapists. Telerehabilitation is an alternative to traditional pulmonary rehabilitation, but it has a limited amount of research. Lately, partially because of the Covid-19 pandemic there has been an increased need to evaluate the effects of telerehabilitation.  Objective: The objective of this systematic review was to systematically review scientific studies regarding the effects of telerehabilitation on health-related quality of life, physical capacity and muscle strength among patients suffering from COPD. The aim of this study was also to assess the reliability of the combined results of the studies. Method: A systematic search was conducted in Pubmed and CINAHL. Eight studies were reviewed using PEDro and the reliability of the result was assessed using GRADEstud. Results: The quality of the studies varied between good and excellent. Telerehabilitation was deemed to be equally effective as pulmonary rehabilitation regarding the outcome health related quality of life and the reliability for the result was rated as moderately high (+++). The effectiveness of telerehabilitation for the outcome physical capacity proved not to be certain with a low (++) reliability. Only two studies included the outcome muscle strength which meant it could not be assessed.  Conclusion: Telerehabilitation was deemed to be equally effective as pulmonary rehabilitation for the outcome health related quality of life but not for the outcome physical capacity. More research on the subject is needed and future studies should aim to have the interventions be more similar.

No / Context. The End of Life Care Strategy for England highlights effective communication between patients and professionals as key to facilitating patient involvement in advance care planning. The strategy emphasizes that, currently, communication in patients with noncancer life-limiting conditions is likely to be inadequate, and research has identified that patients with chronic obstructive pulmonary disease and heart failure have a poor understanding of their condition. Objectives. To identify existing interventions of patient-professional communication developed for life-limiting conditions and explore the applicability of interventions developed within a cancer framework to other diagnostic groups. Methods. A comprehensive literature review of studies describing communication interventions for patients receiving end-of-life care was undertaken. Ten electronic databases were searched. Inclusion criteria were all English language studies relating to patient-professional communication interventions for patients with life-limiting conditions receiving end-of-life care. Results. Of the 755 articles initially identified, 16 met the inclusion criteria. Three core themes emerged from the synthesis of the literature: using education to enhance professional communication skills, using communication to improve patient understanding, and using communication skills to facilitate advance care planning. Conclusion. Although limited, evidence relating to the development and evaluation of communication interventions for patients with life-limiting illnesses would suggest that a successful intervention should include combined components of training, patient discussion, and education. In a context of limited resources and an increasing number of patients living and dying with chronic life-limiting conditions, the need for appropriate and effective communication strategies should be seen as a priority for both research and policy.

From a BPS perspective, COPD and other chronic diseases may have a significant negative impact on those living with them and may be associated with higher rates of depression and anxiety and lower levels of health-related quality of life (HRQOL). Certain factors, such as spirituality, may influence the negative impact of chronic disease on the relationship between mood and functional independence and HRQOL. Also, gender may influence the relationship between mood, spirituality, and HRQOL for men and women living with chronic diseases. The current study included 136 patients undergoing physical rehabilitation at an IRF. Anxiety, depression, spirituality, HRQOL, and functional independence were evaluated for all. Mediation models were tested to determine the impact of spirituality on the relationships between mood and HRQOL and functional independence, and moderation models were tested to evaluate the impact of gender on the relationships between mood, spirituality, functional independence, and HRQOL. The current study yielded some inconclusive results but did evidence that COPD patients in acute inpatient physical rehabilitation facilities (IRF) have higher levels of anxiety than patients without COPD and also revealed that men with COPD have better HRQOL than do women with COPD. Spirituality was found to partially mediate the relationship between depression and HRQOL in IRF patients with COPD, but gender did not appear to moderate the relationships between mood, spirituality, functional independence, or HRQOL in IRF patients. As few studies on IRF patients with chronic diseases exist, continuing to evaluate patients in IRFs is important to enhance our BPS understanding of chronic disease.

Asthma is a chronic disease of the airways and affects many people regardless of their age, gender, race and socioeconomic status. Since asthma is recognised as one of the major causes of morbidity and mortality in people and especially in South Africa, the prescribing patterns, prevalence and medication cost of asthma in South Africa are saliently important and need to be investigated. A non-experimental, quantitative retrospective drug utilisation review was conducted on medicine claims data of a pharmaceutical benefit management company in a section of the private health care sector of South Africa. The study period was divided into four annual time periods (1 January 2008 to 31 December 2008, 1 January 2009 to 31 December 2009, 1 January 2010 to 31 December 2010 and 1 January 2011 to 31 December 2011). The prescribing patterns and cost of asthma medication were investigated and stratified according to province, age and gender. Patients were included if the prescriptions which were provided by the health care practitioners matched the Chronic Disease List (CDL) of South Africa and the International Classification of Disease (ICD-10) coding for asthma and chronic obstructive pulmonary disease (COPD). Data analysis was conducted by means of the SAS 9.3® computer package. Asthma patients were divided according to different age groups (there were five different age groups for this study), gender and geographical areas of South Africa. The study indicated a steady increase in the prevalence of asthma patients from 0.82% (n = 7949) in 2008 to 1.18% (n = 15 423) in 2009 and reached a minimum of 0.79% (n = 8554) in 2011. Analysis of the prevalence regarding geographical areas in South Africa suggested that Gauteng had the highest number [n = 17 696, (0.85%)] of asthma patients throughout the study period, followed by KwaZulu Natal [n = 8 628, 1.16%)] and the Western Cape [(n = 8513, 0.97%) (p < 0.05)]. The prevalence of asthma in female patients [0.89% (n = 26 588)] was higher than in their male counterparts [0.79% (n = 19 244)] (p > 0.05). The results showed that asthma was not as common chronic disease in children. The total number of asthma patients younger than 7 years represented 0.64% (n = 2 909). It was found that patients over 65 years of age showed the highest prevalence of the five age groups [1.94% (n = 13 403) (p < 0.05)]. The average number of asthma prescriptions per patient per year was 8.28 (95% CI, 8.16- 8.40) and 5.15 (95% CI, 5.06-5.23) in 2008 and 2011, respectively. The number of asthma items per prescription varied from 1.55 (95% CI, 1.55-1.56) in 2008 to 1.40 (95% CI, 1.39- 1.40) in 2011. Medication from the MIMS® pharmacological group (anti-asthmatics and bronchodilators) was used to identify asthma medication. The top three asthma medication with the highest prevalence in the study period were the anti-inflammatory inhaler of fluticasone (n = 39 721) followed by the single item combination product of budesonide/ formoterol (n = 25 121) and salbutamol (n = 24 296). The influence of COPD on asthma treatment and the costimplication thereof were investigated. Medication from the MIMS® pharmacological group (anti-asthmatics and bronchodilators) was used to identify COPD medication. This study also showed that COPD had an influence in the economic burden of the South African asthma population. The cost of medication is responsible for the single largest direct cost involved in the economic burden of asthma. This study showed that asthma represented 0.88% of the direct medication cost in the study (excluding hospitalisation and indirect cost). The average cost per prescription and average cost per asthma item both increased throughout the study period. The prescribing patterns for the different medication used in the treatment of asthma were investigated and recommendations for further research in this field of study were made. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

<p>Astma i hronična opstruktivna bolest pluća (HOBP) su najče&scaron;će hronične nezarazne bolesti respiratornog sistema i predstavljaju značajan zdravstveni problem. U dijagnostici i proceni stepena poremećaja disajne funkcije u ovih bolesnika najče&scaron;će se koriste spirometrija i telesna pletizmografija. Impulsna oscilometrija predstavlja novu metodu u dijagnostici poremećaja plućne funkcije. Ova metoda je jednostavna za izvođenje i minimalno zavisi od saradnje pacijenta.Osnovni cilj ove doktorske disertacije bio je da se uporede parametri dobijeni impulsnom oscilometrijom, spirometrijom i telesnom pletizmografijom kod pacijenata sa astmom i hroničnom opstruktivnom bolesti pluća, utvrdi senzitivnost navednih metoda u detekciji opstruktivnog poremećaja ventilacije kao i povezanost parametara impulsne oscilometrije, spirometrije i telesne pletizmografije i stepena težine dispnoičnih tegoba kod odraslih pacijenata sa astmom i HOBP. Korelacijom parametara dobijenih impulsnom oscilometrijom i spirometrijom dobijena je umerena negativna korelacija vrednosti R5 sa FEV1 kod pacijenata sa astmom (r= -0.47, r&lt;0.001) i HOBP (r= -0.50, r&lt;0.001), kao i umerena pozitivna korelacija X5 sa FEV1 (r= 0.54, r&lt;0.001, kod pacijenata sa astmom; r= 0.56, r&lt;0.001 kod pacijenata sa HOBP). Registrovana je dobra korelacija Rt sa vrednostima R5 (r=0.63, r&lt;0.001) i H5 (r= -0.55, r&lt;0.001) kod pacijenata sa astmom, kao dobra korelacija Rt sa R5 (r=0.73, r&lt;0.001) i H5 (r= -0.74, r&lt;0.001) kod pacijenata sa HOBP. Kod pacijenata sa astmom nije registrovana razlika između tri metode u detekciji opstruktivnog poremećaja ventilacije kod pacijenata sa simptomima bolesti, dok se upotrebom sve tri metode povećala se senzitivnost. Sve tri metode bile su u slaboj korelaciji sa stepenom dispnoičnih tegoba kod pacijenta sa astmom. Svi HOBP pacijenti imali su spirometrijski registrovanu opstrukciju disajnih puteva. Senzitivnost impusne oscilometrije raste sa stepenom opstrukcije disajnih puteva, te je sposobnost detekcije opstruktivnog poremećaja ventilacije kod pacijenata sa FEV1%&lt;80 % iznosila 55%, 95% CI 43-67 %, a kod pacijenata sa FEV1%&lt;70 % 61%, 95% CI 47-73%. Registrovana je statistički značajna razlika vrednosti oscilometrijskih parametara u odnosu na spirometrijski stadijum HOBP. Kod pacijenata sa HOBP, sve tri metode bile su u umerenoj korelaciji sa stepenom dispnoičnih tegoba. Zaključujemo da postoji umerena korelacija impulsne oscilometrije sa spirometrijom i telesnom pletizmografijom kod pacijenta sa astmom i HOBP. Impulsna oscilometrija bolje korelira sa telesnom pletizmografijom u poređenju sa spirometrijom. Korelacija tri metode raste sa stepenom opstrukcije disajnih puteva. Komplementarna upotreba tri metode daje sveobuhvatniju sliku respiratorne funkcije kod pacijenata sa astmom i HOBP.</p> / <p>Asthma and chronic obstructive pulmonary disease (COPD) are most common chronic noninfectious diseases of the respiratory system, representing a major health issue. Spirometry and body plethysmography are the procedures which are most often performed to diagnose these diseases and evaluate the lung function impairment of the affected patients. Impulse oscillometry is a novel procedure to establish the lung function impairment. It is easy to perform, and minimally depends on a patient&#39;s cooperation. The major objective of this Ph. D. thesis is to compare the parameters obtained by impulse oscillometry, spirometry and body plethysmography in patients with asthma and COPD, establish the sensitivity of these procedures in detecting an obstructive ventilation disorder, and correlate the parameters of impulse oscillometry, spirometry and body plethysmpography to the severity of dyspneic symptoms in adult asthma and COPD patients. Correlating the parameters obtained by impulse oscillometry and spirometry, a moderate negative correlation of R5 values to FEV1 in asthma (r= -0.47, р&lt;0.001) and COPD patients (r= -0.50, р&lt;0.001) has been obtained, as well as a moderate positive correlation of X5 to FEV1 (r= 0.54, р&lt;0.001, in asthmatics; r= 0.56, р&lt;0.001 in COPD patients). A good correlation of Rt to R5 (r=0.63, р&lt;0.001) and Х5 values (r= -0.55, р&lt;0.001) has been registered in asthmatics, as well as a good correlation of Rt to R5 (r=0.73, р&lt;0.001) and Х5 (r= -0.74, р&lt;0.001) in COPD patients. In asthma patients, the three analysed procedures exhibited no difference in detecting an obstructive ventilation disorder in the patients with manifested symptoms, while the sensitivity improved when the procedures were complementary performed. Any of the three procedures correlated poorly to the severity of dyspneic symptoms in asthma patients. All COPD patients had a spirometry-registered airway obstruction. The sensitivity of impulse oscillometry increased with the severity of the airway obstruction, so its capacity to detect an obstructive ventilation disorder in the patients with FEV1%&lt;80 % was 55%, 95% CI 43-67 %, and in the patients with FEV1%&lt;70 %, it amounted to 61%, 95% CI 47-73%. A statistically significant difference in the values of all oscillometry parameters was registered depending on the spirometric COPD stage. In COPD patients, all the three procedures were moderately correlated to the severity of dyspenic symptoms. In conclusion, there is a moderate correlation of impulse oscillometry to spirometry and body plethysmography in asthma and COPD patients. Impulse oscillometry correlates better to body plethysmography than to spirometry. The correlation of the three procedures increases with the severity of the airway obstruction. The complementary application of these three procedures provides a more accurate assessment of the respiratory function in asthma and COPD patients.</p>

<p>Hronične inflamatorne bolesti disajnih organa su&nbsp;jedan od vodećih uzroka morbiditeta i mortaliteta&nbsp;&scaron;irom sveta. I pored stalnog napretka u naučnim&nbsp;istraživanjima, u otkrivanju molekularnih i ćelijskihmehanizama koji doprinose progresiji bolesti, uvođenju novih prognostičkih biomarkera, novim&nbsp;metodama detektovanja infektivnih uzročnika,&nbsp;primeni novih moćnih bronhodilatatornih,&nbsp;antiniflamatornih i antiinfektivnih lekova, hronične&nbsp;plućne bolesti i danas u dvadeset prvom veku beleže&nbsp;stalan porast broja obolelih i umrlih. Prema savremenom tumačenju HOBP je&nbsp; heterogena bolest koja je udružena sa brojnim komorbiditetima i&nbsp;sistemskim manifestacijama. Zajednički faktori rizika&nbsp;su osnova za javljanje udruženih hroničnih bolesti. Komorbiditeti i akutne egzacerbacije doprinose&nbsp;ukupnoj težini bolesti . S obzirom da se HOBP&nbsp;manifestuje i izvan pluća kod svakog pacijenta je&nbsp;potrebno proceniti postojanje sistemskih&nbsp;manifestacija&nbsp; i tragati za komorbiditetima. U reviziji&nbsp;&bdquo;Globalne strategije za dijagnozu, lečenje i prevenciju hronične opstruktivne bolesti pluća H GOLD&ldquo;&nbsp; iz 2011. godine navedene sledeće pridružene bolesti za&nbsp;kojima je potrebno aktivno tragati: kardiovaskularne&nbsp;bolesti, disfunkcija skeletnih mi&scaron;ića, metabolički&nbsp;sindrom, osteoporoza, depresija i karcinom pluća.&nbsp;Bronhiektazije sepredstavljaju hronično oboljenje&nbsp;pluća koje se karakteri&scaron;e abnormalnim pro&scaron;irenjem&nbsp;lumena bronha koje je uzrokovano slabljenjem ili&nbsp;destrukcijom mi&scaron;ićnih i elastičnih komponenti&nbsp;bronhijalnog zida, smanjenim klirensom mukusa i&nbsp;čestim infekcijama respiratornog trakta. Bronhiektazije se nekim svojim&nbsp; kliničkim&nbsp;karakteristikama preklapaju&nbsp; sa hroničnom opstruktivnom bolesti pluća. Metabolički sindrom&nbsp;predstavlja skup metaboličkih poremećaja koji&nbsp;povećavaju rizik za razvoj kardiovaskularnih bolesti i tipa 2 &scaron;ećerne bolesti. Za na&scaron;e istraživanje smo&nbsp;koristili definiciju NCEPHATPIII prema kojoj se metabolički sindrom zasniva na prisustvu tri od pet&nbsp;komponenti: Abdominalna gojaznost (obim struka&nbsp;preko 102 cm za&nbsp; mu&scaron;karce i preko 88 cm za žene),&nbsp;povi&scaron;ene vrednosti triglicerida na&scaron;te preko 1,7 mmol/l ili od ranije lečen poremećaj, snižen nivo HDL&nbsp;holesterola manje od 1,03 mmol/l za mu&scaron;karce i&nbsp;manje od 1,29 mmol/l za žene ili već lečen&nbsp;poremećaj, povi&scaron;en sistolni krvni pritisak preko 130 mmHg i/ili dijastolni preko 85 mmHg ili već lečena&nbsp;hipertenzija, povi&scaron;en nivo glukoze na&scaron;te preko 5,6 mmol/l ili već postojeći tip 2 &scaron;ećerne bolesti.&nbsp;Istraživenje je sprovedeno u Institutu za plućne&nbsp;bolesti Vojvodine u Sremskoj Kamenici. Cilj je bio&nbsp;da se utvrdi učestalost metaboličkog sindroma i&nbsp;komponenti među bolesnicima sa HOBP i&nbsp;bronhiektazijama. Sledeći cilj je bio da analizira&nbsp;i uporedi&nbsp; zastupljenosti metaboličkog sindroma i pojedinih komponenti među ispitivanim grupama u&nbsp;odnosu na pol, starost bolesnika i dužinu lečenja&nbsp;HOBP. Bilo je uključeno ukupno 193 ispitanika. Od&nbsp;ovog broja 163 su činili bolesnici od HOBP i&nbsp;bronhiektazija&nbsp; koji su bili podeljeni u tri grupe:&nbsp;pacijenti oboleli od hronične opstruktivne bolesti&nbsp;pluća (n=55, grupa 1), pacijenti oboleli od bronhiektazija (n=50, grupa 2) i pacijenti sa&nbsp;udruženom hroničnom opstruktivnom bolesti pluća i&nbsp;bronhiektazijama (n=58, grupa 3). Kontrolna grupa,&nbsp;koja je označena kao grupa 4, formirana je od 30&nbsp;ispitanika bez bronhiektazija i hronične opstruktivne bolesti pluća, tako da je ukupan broj ispitanika u&nbsp;istraživanju bio 193. Učestalost metaboličkog&nbsp;sindroma prema kriterijumuma NCEP/ATP III kod&nbsp;bolesnika hroničnim bolestima respiratornog sistema&nbsp;(hroničnom opstruktivnom bolesti pluća,&nbsp;bronhiektazijama i udružena ova dva oboljenja) je&nbsp;iznosila je kod 37,3 % . Metabolički sindrom je bio&nbsp;učestaliji kod ispitanika sa hroničnim opstruktivnom<br />bolesti pluća i/ili bronhiektazijama u odnosu na&nbsp;ispitanike iz kontrolne grupe bez&nbsp; hroničnih bolesti&nbsp;respiratornog trakta. Kod bolesnika sa hroničnom&nbsp;opstruktivnom bolesti pluća dokazano je prisustvo&nbsp;metaboličkog sindroma kod 38,2%&nbsp; ispitanika, kod&nbsp;bolesnika sa bronhiektazijama kod 54% ispitanika i&nbsp;IV kod pacijenata sa udruženom hroničnom&nbsp;opstruktivnom bolesti pluća i bronhiektazijama kod&nbsp;36,2% ispitanika. Prosečan broj komponenti&nbsp;metaboličkog sindroma kod bolesnika sa hroničnom&nbsp;opstruktivnom bolesti pluća je iznosio 2,18, kod&nbsp;bolesnika sa bronhiektazijama je bio 2,56, a kod&nbsp;bolesnika sa udružena ova dva oboljenja 2,1.<br />Komponente metaboličkog sindroma nisu učestalije i&nbsp;nisu statistički vi&scaron;e kod bolesnika sa udruženom&nbsp;hroničnom opstruktivnom bolesti pluća i&nbsp;bronhiektazijama u odnosu na obolele sa HOBP i&nbsp;bronhiektazijama kao samostalnim oboljenjima.<br />Razlika u pojedinačnim vrednostima komoponenti&nbsp;metaboličkog sindroma i učestalosti pojedinih&nbsp;komponenti među posmatranim grupama bolesnika sa<br />hroničnim plućnim bolestima nije statistički značajna.&nbsp;Učestalost metaboličkog sindroma kod bolesnika sa&nbsp;hroničnim bolestima respiratornog sistema nije u vezi sa polom i ne zavisi od starosti ispitanika. Nije&nbsp;dokazano da je metabolički sindrom učestaliji kod&nbsp;mu&scaron;karaca i i nije dokazano da je učestaliji kod&nbsp;ispitanika koji imaju vi&scaron;e od &scaron;esdeset i pet godina&nbsp;u odnosu na mlađe bolesnike među ispitivanim.&nbsp;Učestalost metaboličkog sindroma kod ispitanika sa&nbsp;hroničnom opstruktivnom bolesti pluća ne zavisi od&nbsp;dužine lečenja hronične opstruktivne bolesti pluća.&nbsp;Dokazano je da učestalost&nbsp; metaboličkog sindoma&nbsp;nije veća kod bolesnika kojima je dijagnoza bolesti postavljena pre vi&scaron;e od pet godina i koji se od HOBP&nbsp;leče duže od pet godina. Na osnovu rezultata koje&nbsp;smo dobili u na&scaron;em istraživanju zaključili smo da&nbsp;hronične plućne bolesti, bronhiektazije i hronična&nbsp;opstruktivna bolest pluća, predstavljaju stanja sa povi&scaron;enim kardiometaboličkim rizikom.</p><p>&nbsp;</p> / <p>Chronic inflammatory diseases of the respiratory&nbsp;organs are one of the leading morbidity and&nbsp;mortality causes all over the world. Despite the&nbsp;steady advance in scientific research, discovery&nbsp;of&nbsp; the disease-progression-contributing molecular<br />and cellular mechanisms, introduction of novel&nbsp;prognostic biomarkers, new detection methods of&nbsp;infectious agents, application of&nbsp; new, potent&nbsp;bronchodilation, anti-inflammatory and anti-infectious drugs,&nbsp; a constant&nbsp; increase in&nbsp; the&nbsp;number of the affected and deceased from chronic&nbsp;pulmonary diseases has still been permanently<br />evidenced in the 21st century. In a modern&nbsp;concept, the chronic obstructive pulmonary<br />disease (COPD) is understood as a heterogenous&nbsp;disorder associated with numerous comorbidities&nbsp;and systemic manifestations. Common risk factors&nbsp;represent the basis for concomitant chronic&nbsp;diseases to develop. Comorbidities and acute&nbsp;exacerbations contribute to the overall disease&nbsp;severity. As a COPD may develop extrapulmonary manifestations as well, each&nbsp;patient should be evaluated for systemic&nbsp;manifestations and comorbidities. The 2011&nbsp;update of the &bdquo;Global Strategy for Chronic&nbsp;Obstructive Lung Disease Diagnosis,&nbsp;Management, and Prevention &ndash;GOLD&rdquo; lists the&nbsp;following comorbidities to be actively searched&nbsp;for: cardiovascular diseases, skeletal muscle<br />dysfunction, metabolic syndrome, osteoporosis,&nbsp;depression, and lung cancer. Bronchiectases&nbsp;represent a chronic lung disorder marked by&nbsp;VII excessively dilated bronchial lumen&nbsp; induced by&nbsp;weakened or destructed muscular and elastic&nbsp;components of the bronchial wall, reduced mucus&nbsp;clearance, and recurrent respiratory infections.&nbsp;Bronchiectases and COPD have some clinical&nbsp;features in common. The metabolic syndrome is a&nbsp;group of metabolic disorders which increase the&nbsp;risk of&nbsp; cardiovascular diseases and type 2&nbsp;diabetes. In our investigation, we utilized the&nbsp;NCEP HATPIII definition of the metabolic&nbsp;syndrome based on the presence of three of five&nbsp;components: abdominal obesity (&gt; 102 cm and &gt;<br />88 cm waist&nbsp; measure for males and females&nbsp;respectively), elevated (&gt;1.7 mmol/l) triglyceride&nbsp;levels on an empty stomach, or a former history of&nbsp;the disorder treatment, reduced&nbsp; HDL cholesterol&nbsp;(&lt; 1.03 mmol/l and &lt;1.29 mmol/l for males and&nbsp;females respectively), or a former history of the&nbsp;disorder treatment, elevated systolic blood<br />pressure of &gt;130 mmHg and/or diastolic blood&nbsp;pressure of &gt; 85 mmHg, or a former history of&nbsp;treated hypertension, elevated glucose levels&nbsp; (&gt;5.6 mmol/l), or already existing type 2 diabetes&nbsp;mellitus. The investigation has been carried out in<br />the Institute for Pulmonary Diseases of&nbsp;Vojvodina, Sremska Kamenica, aimed at 1)<br />establishing the frequency of the metabolic&nbsp;syndrome and its components among the patients&nbsp;with COPD and bronchiectases; 2) analyze and&nbsp;compare the frequency of metabolic syndrome&nbsp;and its components in the examined groups related&nbsp;to the patients&rsquo; sex, age, and COPD treatment&nbsp;length. The study included 193 subjects, 163 of&nbsp;whom suffered from COPD and bronchiectases,&nbsp;classified into three groups: COPD patients (n=55,&nbsp;Group 1), patients with bronchiectases (n=50,&nbsp;Group 2), and patients with concurrent COPD and&nbsp;bronchiectases (n=58, Group 3). The control&nbsp;group, designated as Group 4, included 30&nbsp;subjects&nbsp; free of bronchiectases and COPD, so the&nbsp;total of 193 subjects were included in the&nbsp;investigation. The NCEP/ATP III criteria<br />established metabolic syndrome frequency among&nbsp;the patients with chronic respiratory diseases&nbsp;(COPD, bronchiectases, and concomitant COPD&nbsp;and bronchiectases) amounted to 37.3 % . The&nbsp;metabolic syndrome was more frequent in the&nbsp;patients with COPD and/or bronchiectases than in&nbsp;the control group patients free of any chronic&nbsp;respiratory disease. The metabolic syndrome was&nbsp;VIII confirmed in 38.2% of COPD patients, 54% of the&nbsp;patients with bronchiectases, and in 36.2% of the<br />patients with&nbsp; concomitant COPD and&nbsp;bronchiectases. The mean number of the<br />metabolic syndrome components was&nbsp; 2.18 in&nbsp;COPD patients,&nbsp;&nbsp; 2.56 in patients with<br />bronchiectases, and 2.1 in patients with&nbsp;concomitant COPD and bronchiectases. The<br />metabolic syndrome components were neither&nbsp;more frequent, nor statistically higher in the&nbsp;patients with concomitant COPD and&nbsp;bronchiectases as compared to the patients with a&nbsp;single presence of any of the two diseases. The&nbsp;difference in the single values of the metabolic&nbsp;syndrome components and the frequency of&nbsp;certain components in the examined groups of the&nbsp;patients with chronic pulmonary diseases was not&nbsp;statistically significant. Among the patients with&nbsp;chronic respiratory diseases, no correlation was&nbsp;observed between the metabolic syndrome&nbsp;frequency and the patients&rsquo; sex or age. The&nbsp;metabolic syndrome was not confirmed to be&nbsp;more frequent in males, or in&nbsp;&nbsp; &gt;65 yr old patients,&nbsp;as compared to younger patients. Among COPD<br />patients, no correlation was registered between the&nbsp;metabolic syndrome frequency and&nbsp;&nbsp; COPD&nbsp;treatment duration. It was confirmed that the&nbsp;metabolic syndrome frequency was not higher in&nbsp;the patients with &lt;5Hyear long COPD treatment<br />than in those treated for COPD longer. On the&nbsp;basis of the results obtained in our investigation,&nbsp;we conclude that chronic respiratory diseases,&nbsp;COPD and &nbsp;bronchiectases, are the conditions with&nbsp;a higher cardiometobolic risk.</p>

<p>Hronična opstruktivna bolest pluća (HOBP) je rastući zdravstveni problem radno sposobne populacije. Akutne egzacerbacije hronične opstruktivne bolesti pluća (AEHOBP) značajno doprinose pogor&scaron;anju bolesti i sa aspekta kvaliteta života bolesnika i sa aspekta tro&scaron;kova. Cilj istraživanja je bila identifikacija faktora visokih tro&scaron;kova lečenja AEHOBP koja može pomoći u definisanju strategija smanjenja HOBP egzacerbacija ove bolesti i analiza podataka o prehospitalnom lečenju obolelih od HOBP. Materijal i metode: Istraživanjem je obuhvaćeno 130 pacijenata koji su ispunjavali uključujuće kriterijume studije. Rezultati: Ukupni godi&scaron;nji direktni tro&scaron;kovi hospitalizacija usled AEHOBP čine17,3% od tro&scaron;kova svih hospitalizovanih pacijenata. Prosečna dužina hospitalizacije je bila duža kod pacijenata sa te&scaron;kom AEHOBP u odnosu na srednje te&scaron;ku, razlika je statistički značajna (p = 0,044). Prema rezultatima istraživanja o potro&scaron;nji lekova godinu dana pre hospitalizacije, adekvatnu terapiju je koristilo 41,7% pacijenata, a neadekvatnu 58,3% pacijenata i postojala je negativna korelacija između adekvatnosti lečenja i stepena težine akutne egzacerbacije. Multivarijantnom logističkom regresijom dobijena je formula za predikciju ukupnih tro&scaron;kova. Zaključak: Nezavisni prediktori direktnih tro&scaron;kova lečenja su: mu&scaron;ki pol, pu&scaron;ačka navika, te&scaron;ka AEHOBP, postojanje acidoze, primena neadekvatne ili adekvatne terapije trajanja kraćeg od devet meseci tokom godine koja je prethodila hospitalnom lečenju egzacerbacije.</p> / <p>Chronic obstructive pulmonary disease (COPD) is a rising health issue of working population. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are significantly contributing to worsening of the disease prognosis, consequently leading to decline of patient&rsquo;s quality of life and increasing costs of treatment. Objective of the study was identification of factors for high AECOPD treatment costs, which can help in defining strategy for decreasing COPD exacerbations and data analysis of prehospital treatment of COPD patients. Material and Methods: The study included 130 patients who fulfilled including criteria of the study. Results: Total direct costs of AECOPD hospitalizations demonstrated 17.3% of all hospitalized patients costs. Average length of hospitalization was longer in patients with severe AECOPD compared to patients with moderate AEHOBP, there was statistically significant difference (p= 0,044). According to research results of medication usage one year before the hospitalization, adequate treatment used 41.7% of patients, and inadequate 58.3%; there was negative correlation between adequate treatment and level of severance of acute exacerbations. Multivariate logistic regression was used for obtaining total costs predictions formula. Conclusion: Independent predictors of direct treatment costs were: male patients, smokers, prehospital treatment, inadequate or adequate, not longer than nine months per year.</p>

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease, characterized by progressive and largely irreversible airflow limitation due to alveolar destruction (emphysema), small airway narrowing, and chronic bronchitis. It is one of the leading causes of morbidity and mortality worldwide and in the UK, it may affect approximately 1.5 per cent of the population; and up to one in eight emergency admissions may be due to COPD,corresponding to over one million bed days, with some 24160 people in the UK dying as a result of COPD in 2005 (Burden of Lung Disease 2nd Edition,British Thoracic Society 2006). Most cases of COPD are triggered by chronic inhalation of cigarette smoke.However, some people do not suffer from COPD even if they smoke for many years. COPD cannot be cured, and patients usually live with poor life quality. Treatments include giving up smoking, medication and oxygen therapy. Genetic factors contribute to the development of COPD. In Northern Europe,Z-AT homozygotes (342Glu Lys) develop emphysema in their third or forth decade. One explanation is AT deficiency because they form inactive polymers. However, this cannot explain why bronchoalveolar lavage fluid (BALF) from Z-AT homozygotes with emphysema contains more neutrophils than BALF from individuals with emphysema and normal AT (M-AT). Inhaling pollutants which include smoking (cigarettes, pipes, cigars, etc.) and other fumes such as those found in many industrial work environments probably also plays a role in an individual’s development of COPD. Previously, it has been shown that the polymeric conformer of AT is present in BALF from Z-AT homozygotes and that it is a chemoattractant for neutrophils in vitro (Parmar JS, 2002). These findings have been confirmed by others (Mulgrew AT, 2004). However, it is unknown where the polymers form and if 4 they are chemotactic in vivo. My colleague Dr Carl Atkison† showed that polymers of Z 1-AT are present in the alveolar wall of Z-AT homozygotes with emphysema, which accounts for 20% of the total AT from lung homogenates.These Z-AT individuals also have an excess of neutrophils in the alveolar wall compared with M-AT homozygotes. Furthermore, neutrophils and polymeric AT co-localize in the alveolar wall (Mahadeva R, 2005). To investigate whether there was a direct relationship between polymers of Z-AT and the excess neutrophils, polymers of AT were instilled into the lungs of wild-type mice (Mahadeva R, 2005). This produced a significant increase in neutrophil influx into the lungs compared with instillation of the native protein.Examination of the time course demonstrated that the influx of neutrophils was closely linked to the presence of polymeric AT. The mechanism of neutrophil recruitment in this mouse model was subsequently shown to be a direct chemotactic effect rather than stimulation of IL-8 homologues or other CXC chemokines. Oxidized AT (Ox-AT) promotes release of human monocyte chemoattractant protein-1 (MCP-1) and IL-8 from human lung type epithelial cells (A549) and normal human bronchial epithelial (NHBE) cells. Native, cleaved, polymeric AT and secretory leukoproteinase inhibitor (SLPI) and oxidized conformations of cleaved, polymeric AT and SLPI did not have any significant effect on MCP-1 and IL-8 secretion. These findings were supported by the fact that instillation of Ox-AT into murine lungs resulted in an increase in JE (mouse MCP-1) and increased macrophage numbers in the bronchoalveolar lavage fluid. The effect of Ox-AT was dependent on NF- B and activator protein-1 (AP-1)/JNK. These findings have important implications. They demonstrate that the oxidation of methionines in AT by oxidants released by cigarette smoke or inflammatory cells not only reduces the anti-elastase lung protection, but also converts AT into a proinflammatory stimulus. Ox-AT generated in the airway † My colleagues’ contributions are acknowledged in future text where appropriate by the following superscripts: (a) Dr Sam Alam, (b) Dr Jichun Wang, (c) Dr Carl Atkinson, (d) Dr Sabina Janciauskiene. 5 interacts directly with epithelial cells to release chemokines IL-8 and MCP-1,which in turn attracts macrophages and neutrophils into the airways. The release of oxidants by these inflammatory cells oxidizes AT, perpetuating the cycle, potentially contributing to the pathogenesis of COPD. Furthermore, this demonstrates that molecules such as oxidants, anti-proteinases, and chemokines, rather than acting independently, collectively interact to cause emphysema (Li Z, 2009). To investigate the molecular basis for the interaction between Z-AT and Ox-AT associated with cigarette smoking, female mice transgenic for normal (MAT)or Z-AT on CBA background were exposed to cigarette smoke (CS). Transgenic mice for Z-AT developed a significant increase in pulmonary polymers following acute CS exposure. Increased levels of neutrophils in CSZ lungs were tightly correlated with polymer concentrations. Oxidation of human plasma Z-AT by CS or -chlorosuccinimide greatly accelerated polymerization, which could be abrogated by antioxidants. The results showed that cigarette smoke accelerated polymerization of Z-AT by oxidative modification, which in so doing further reduced pulmonary defense and increased neutrophil influx into the lungs. These novel findings provided a molecular explanation for the striking observation of premature emphysema in ZZ homozygote smokers, and raised the prospect of anti-oxidant therapy in ZAT related COPD (Alam S, 2011).

Introduction. Les mécanismes physiopathologiques du remodelage vasculaire pulmonaire chez le patient BPCO sont encore mal élucidés. L'inflammation pourrait jouer un rôle déterminant.Objectifs. Déterminer le rôle de l'interleukine 6 (IL6) dans la physiopathologie de l'hypertension pulmonaire (HTP) associée à la BPCO.Méthodes. Nous avons étudié le lien entre l'IL6 et l'HTP sur une population de patients atteints de BPCO, l'effet de l'hypoxie sur le développement d'une HTP chez des souris IL6-/- et l'effet in vitro de l'IL6 sur les cellules endothéliales et les cellules musculaires lisses d'artère pulmonaire humaine.Résultats. Les patients BPCO avec HTP présentaient un taux plasmatique d'IL6 circulante plus élevé. Le génotype GG de l'IL6 était corrélé à un risque plus élevé de développer une HTP. L'IL6 est produite par tous les acteurs cellulaires impliqués dans la physiopathologie du remodelage vasculaire pulmonaire et en particulier la cellule musculaire lisse. Sa synthèse, ainsi que celle de ses récepteurs, est très nettement stimulée par l'hypoxie aigue et chronique. L'IL6 participe probablement à l'entretien de la dysfonction endothéliale, à la migration des cellules musculaires lisses et au recrutement des cellules inflammatoires. Les souris IL6-/- sont partiellement protégées de l'hypertension pulmonaire hypoxique et présentent un moindre recrutement pulmonaire de cellules inflammatoires induit par l'hypoxie. Le taux d'IL6 est corrélé à une longueur télomérique plus courte chez les patients BPCO, témoignant d'un processus de vieillissement biologique accéléré. L'HTP associée à la BPCO ou à l'hypoxie chronique pourrait résulter d'une accentuation du processus de sénescence des cellules vasculaires pulmonaires, favorisé par l'inflammation.Conclusion. L'inflammation et plus particulièrement l'IL6 semblent fortement impliquées dans la physiopathologie du remodelage vasculaire pulmonaire chez le patient BPCO. / Introduction. The pathophysiological mechanisms responsible for pulmonary vascular remodeling in COPD remain poorly understood. Inflammation may play a major role.Objectives. To study the role of interleukin-6 (IL6) in the pathophysiology of pulmonary hypertension associated with COPD.Methods. We studied the relationship between IL6 and PH in a population of patients with COPD, the effect of hypoxia on the development of PH in mice IL6-/- and the effect of IL-6 on endothelial cells and smooth muscle cells of human pulmonary artery in vitro.Results. COPD patients with PH were characaterised by a more pronounced hypoxia and higher plasma levels of circulating IL-6. The GG genotype of IL-6 also correlated with a higher risk of developing PH in these patients. Each of the different cellular elements that promote pulmonary vascular remodeling are known to produce IL-6, with smooth muscle cells known to be a particularly important source of this cytokine In addition, synthesis of IL-6 and its associated receptors is increased in response to acute and chronic hypoxia. It is likely that IL-6 contributes to endothelial dysfunction, the migration and, indirectly, proliferation of smooth muscle cells, and recruitment of inflammatory cells. Indeed, IL6-/- mice are partially protected from hypoxia-associated pulmonary hypertension and demonstrate attenuated hypoxia-induced lung recruitment of inflammatory cells. Levels of IL-6 also correlate with shorter telomere length in patients with COPD, indicating a process of accelerated biological aging. This suggests that pulmonary hypertension secondary to COPD or chronic hypoxia may be due to inflammation-associated acceleration of normal pulmonary vascular cell sénescence.Conclusion. Inflammation in general, and IL-6 in particular, appear to be strongly involved in the pathophysiology of pulmonary vascular remodeling in patients with COPD