Introdução: A respiração diafragmática (RD) é uma técnica que integra um conjunto de ações de auto-cuidado no programa de reabilitação pulmonar com objetivo de melhorar a mecânica ventilatória e reduzir a dispnéia em pacientes com doença pulmonar obstrutiva crônica (DPOC). No entanto, questiona-se sua indicação e seus efeitos. Nesse contexto avaliamos o efeito da RD no padrão respiratório, movimento toracoabdominal e ventilação em pacientes com DPOC. Método: Foram estudados 44 indivíduos entre 45 e 75 anos conforme o grau de obstrução da via aérea (VEF1), divididos em grupos controle, DPOC moderado e DPOC grave. Avaliou-se padrão respiratório, movimento toracoabdominal e ventilação por meio de sistemas de pletismografia respiratória por indutância (Respitrace) e análise metabólica de gases (MGC) durante 10 minutos. Após quatro minutos de respiração tranqüila os indivíduos realizavam dois minutos de respiração diafragmática e novamente, quatro de respiração tranqüila. Dispnéia foi avaliada antes, durante e após a RD (escala de Borg modificada). Mobilidade diafragmática foi avaliada utilizando radiografias de tórax. Resultados: Verificou-se aumento do volume corrente e redução da freqüência respiratória durante a RD a partir da elevação do fluxo inspiratório médio e do tempo inspiratório. Houve maior participação do compartimento abdominal com o grupo moderado apresentando incoordenação. A ventilação pulmonar se elevou em associação à redução na ventilação em espaço morto, no equivalente ventilatório para o gás carbônico, e elevação da saturação periférica de oxigênio. Mobilidade diafragmática, ausência de dispnéia, menor grau de hipoxemia e movimento toracoabdominal coordenado associaram-se ao melhor desempenho da RD. Conclusões: A respiração diafragmática é capaz de promover melhora no padrão respiratório e eficiência ventilatória sem conduzir a dispnéia naqueles pacientes com sistema muscular respiratório preservado. / Introduction: Diaphragmatic breathing (DB) is a technique which is part of a set of self-care actions in the lung rehabilitation program for the purpose of improving the ventilatory mechanical and reducing dyspnea. There are doubts, however, as to its effects and recommended use. In this context we assessed the effect of the DB on respiratory pattern, thoracoabdominal motion and ventilation in patients with chronic pulmonary obstructive disease (COPD). Method: Forty-four subjects aged between 45 and 75 years were studied according to the degree of obstruction of the airway (FEV1). This group was subdivided into three: a control group and two others, respectively, of moderate and severe COPD. Their breathing pattern, thoracoabdominal motion and ventilation by means of respiratory inductive plethysmograph (Respitrace) and metabolic analysis of gases (MGC) systems were assessed during ten minutes. After four minutes of quiet breathing, the subjects would perform two minutes of the DB and four other minutes of quiet breathing. Dyspnea was assessed before, during and after diaphragmatic breathing (modified Borg scale). Diaphragmatic mobility was assessed by thoracic radiography. Results: An increase in tidal volume and a reduction in breathing frequency were found during DB as from the rise in mean inspiratory flow and inspiratory time. There was greater participation of the abdominal compartment with the moderate group presenting asynchronous motion. The pulmonary ventilation increased together with the reduction of the ventilation in the dead space and of the ventilatory equivalent for carbonic gas, with the increase in arterial oxygen saturation. Diaphragmatic mobility, absence of dyspnea, minor degree of hypoxemia and coordinated thoracoabdominal motion were associated with the better DB performance. Conclusions: Diaphragmatic breathing is capable of promoting an improvement in the breathing pattern and ventilatory efficiency without provoking dyspnea in patients whose muscular respiratory system has been preserved.

De nos jours, la voie inhalée constitue le mode d’administration optimal dans le traitement de nombreuses affections respiratoires, et suscite beaucoup d’intérêt pour la délivrance systémique de médicaments. Cependant, le poumon est un organe complexe doté de mécanismes de défense efficients qui limitent la déposition des particules inhalées et les éliminent très rapidement. Cette voie d’administration fait donc l’objet de programmes de recherche intensifs visant à améliorer l’efficacité de la délivrance et la compliance du patient. Il faut néanmoins signaler que le nombre d’excipients dont l’innocuité a été démontrée en inhalation (sous forme de poudre sèche) reste extrêmement limité à l’heure actuelle. A cet égard, l’utilisation de microparticules lipidiques solides (mPLS), constituées d’un mélange de cholestérol et de phospholipides biodégradables et caractérisés par une température de transition de phase élevée, a été envisagée. Le procédé retenu pour la préparation de ces mPLS est la technique d’atomisation à température modérée (spray-drying).<p><p>\ / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

There are few recommendations on how best to apply certain modes of mechanical ventilation. The application of Airway Pressure Release Ventilation (APRV) includes strategic implementation of specific inspiratory times (I-times) and particular mean airway pressures (MAWP) neither of which is standardized. This study utilized a retrospective analysis of archived electronic health record data to evaluate the clinical outcomes of adult patients that had been placed on APRV for at least 8 hours. 68 adult subjects were evaluated as part of a convenient purposive sample. All outcomes of interest (surrogates) for short-term clinical outcomes to include the PaO2/FiO2 (P/F) ratio, Oxygen Index and Oxygen Saturation Index (OI; OSI), and Modified Sequential Organ Failure Assessment (MSOFA) scores showed improvement after at least 8 hours on APRV. Most notably, there was significant improvement in P/F ratio (p = .012) and OSI (p = .000). Results of regression analysis showed P low as a statistically significant negative predictor of pre-APRV P/F ratio with a higher initial P low coinciding with a lower P/F ratio. The regression analysis also showed MAWP as a significant positive predictor of post-APRV OSI and P high and P low as significant negative predictors of post-APRV MSOFA scores. In summary, it was found that settings for P high, Plow, and T low in addition to overall MAWP and Body Mass Index (BMI) had significant correlation to impact at least one of the short-term clinical outcomes measured.

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No description available.

<p>Uvod: Tematika ove doktorske teze, usmerena je na analizu respiratornih poremećaja tokom spavanja, uzimajući u obzir činjenicu da se većina trudnica žali na poremećaje u ovoj sferi. Akcenti na ovom polju, odnose se na identifikaciju ovih patolo&scaron;kih stanja u trudnoći. Zato se ovi poremećaji moraju posmatrati integrisano sa rizičnim trudnoćama, ne samo kao njihovi pratioci, već najverovatnije i uzročnici i bitni činioci.<br />Cilj istraživanja: Cilj nam je bio da ukažemo na neophodnost primene neinvazivne ventilacije kod selektovane grupe trudnica, koja ima poremećeno disanje tokom spavanja, prema praktičnom kliničkom protokolu koji će, nadamo se, proisteći iz ovog istraživanja<br />Metodologija: Istraživanje je sprovedeno u formi prospektivne studije, na Klinici za ginekologiju i aku&scaron;erstvo, Kliničkog centra Vojvodine i u Centru za medicinu sna, Instituta za plućne bolesti Vojvodine, u periodu: od maja 2009. do juna 2011 godine.i obuhvatilo je finalno 110 trudnica. Studija je po tipu bila kohortna i eksperimentalna, po&scaron;to je identifikovala ispitanice na osnovu prisustva određenog faktora (SDB) i uticaj prisustva, odnosno odsustva predložene terapijske intervencije na tok i ishod trudnoće.<br />Rezultati:<br />- Respiratorni poremećaji tokom spavanja (SDB) su većinom tranzitornog karaktera tokom trudnoće, bez razlike između rizičnih trudnoća i onih uobičajenog toka;<br />- SDB tokom rizičnih trudnoća, uop&scaron;teno gledano, negativno utiču na tok i ishod istih;<br />- Primenom neinvazivne ventilacije (NIV), postiže se signifikatno smanjenje dnevne pospanosti (mereno sa ESS) i pobolj&scaron;anje oksigenacije, te redukcija kardiovaskularnih i metaboličkih komplikacija bez statistički značajne razlike sa i bez NIV-a;<br />- Trudnice lečene sa NIV (grupa 1) imaju duže trajanje gestacije u odnosu na nelečene (grupa 2) bez statistički značajne razlike;<br />- Rezultati Apgar-skora takođe su vi&scaron;ih vrednosti kod grupe 1 u odnosu na grupu 2 (bez NIV-a) bez statistički značajne razlike;<br />- Nije zabeležena statistički značajna razlika telesne mase novorođenčadi između grupe 1 i grupe 2, kao ni kod obe grupe u odnosu na kontrolnu (grupu 3);<br />- Pojava hipertenzivnog sindroma u grupama 1 i 2 je bez signifikantne razlike iako je manje trudnica imalo ovaj sindrom u grupi 1;<br />- Prisustvo SDB nije uticalo na način zavr&scaron;etka porođaja u svim ispitivanim grupama, ali su rizične trudnoće če&scaron;će zavr&scaron;avane operativnim putem.<br />Zaključak: Naučna opravdanost disertacije, ogleda se u tome, da se po prvi put, na na&scaron;im prostorima, uvođenjem neinvazivne ventilacije, kod pacijentkinja sa rizičnim trudnoćama, utiče na parametre perinatalnog ishoda i bolje zdravstveno stanje trudnica i njihovih novorođenčadi. Velika ekspanzija naučnog istraživanja u vodećim svetskim centrima o ovoj problematici, a imajući u vidu izražen trend negativnog prirodnog prira&scaron;taja u na&scaron;oj sredini, navela nas je na neophodnost re&scaron;avanja ovog problema na domaćem terenu, kao jednom od prioriteta u naučno-istraživačkom radu i praktičnom medicinskom delovanju.</p> / <p>Background: The theme of this thesis is focused on the analysis of respiratory disorders during sleep, since most pregnant women complain of sleep disturbances. The goal is to identify pathological respiratory disorders in pregnancy, considering them an integral part of high risk pregnancy, being most likely a cause of some of them, not only a side effect.<br />Objective: The aim of the study was to point out the necessity of application of non-invasive ventilation in selected pregnant women who have disrupted breathing during sleep. Based on the results of this research, a clinical protocol is developed.<br />Method: The research was conducted in the form of prospective studies in the Department of Gynecology and Obstetrics, Clinical Center and the Center for sleep medicine, Institute for Pulmonary Diseases of Vojvodina, in the period from May 2009 through June 2011 godine.U covered the final 110 pregnant women. The study by the type of the cohort and experimental, as the respondent identified by the presence of certain factors (SDB) and the effect of the presence or the absence of the proposed therapeutic interventions on the course and outcome of pregnancy.<br />Results:<br />- respiratory disorders during sleep (SDB) are mostly transitory nature during pregnancy, with no difference between risk pregnancies and those ordinary course;<br />- SDB during high-risk pregnancies, in general, negatively affect the course and outcome of the same;<br />- Application of non-invasive ventilation (NIV), achieved statistical significance reduce daytime sleepiness (measured with the ESS) and improve oxygenation and reduce cardiovascular and metabolic complications with no statistically significant differences with and without NIV;<br />- Pregnant women treated with NIV (group 1) have a longer duration of gestation compared to untreated (Group 2) with no statistically significant differences;<br />- Results Apgar-score values were also higher in group 1 compared to group 2 (without NIV) with no statistically significant differences;<br />- Not statistically significant difference in body weight between newborns Group 1 and Group 2, or in both groups compared to the control group (group 3);<br />- The emergence of hypertensive syndrome in groups 1 and 2 is no significant difference although less of pregnant women have this syndrome in group 1;<br />- The presence of SDB did not affect the ending of delivery in all groups, but risk pregnancies often ends with surgically.&nbsp;</p><p>Conclusion: For the first time in the region, non-invasive ventilation in patients with high-risk pregnancies is introduced, which will influence perinatal outcomes and improve health of pregnant women and their newborns. Since there is a negative trend of natural population increase in Serbia, new scientific developments in this field enable better medical care, as one of the priorities of scientific research.</p>

<p>Uvod: Astma i hronična opstruktivna bolest pluća (HOBP) najče&scaron;će su hronične respiratorne bolesti u čijoj terapiji prednost imaju inhalatorni lekovi. Pacijenti na inhalatornoj terapiji imaju povećan rizik od nastanka dentalnih erozija i karijesnih lezija, usled promena u količini lučenja pljuvačke i njene pH vrednosti. Cilj: Cilj ovog istraživanja je verifikacija dentalnih erozija i karijesnih lezija kod pacijenata s astmom i hroničnom opstruktivnom bolesti pluća, koji koriste inhalatornu terapiju. Materijal i metode rada: Istraživanjem je obuhvaćeno 80 ispitanika, životne dobi od 18 do 65 godina. Eksperimentalnu grupu sačinjavalo je 40 ispitanika, s dijagnostikovanom astmom ili hroničnom opstruktivnom bolesti pluća, koji uzimaju inhalatornu terapiju duže od 5 godina. Kontrolnu grupu činilo je 40 zdravih ispitanika istog godi&scaron;ta i pola kao u eksperimentalnoj grupi. Upitnik se koristio za prikupljanje podataka o osnovnom oboljenju, simptomima koji se mogu javiti kao nuspojave inhalatornih lekova, navikama, ishrani i održavanju oralne higijene. Kliničkim stomatolo&scaron;kim pregledom određeni su erozivni indeks, KEP indeks, indeks krvarenja iz interdentalne gingive i indeks mekih naslaga na zubima. Laboratorijskim ispitivanjem određeni su količina izlučene nestimulisane pljuvačke, te pH vrednost i koncentracije kalcijuma i fosfata u pljuvački. Rezultati: Kod pacijenata na inhalatornoj terapiji ustanovljena je vi&scaron;a prevalencija dentalnih erozija i karijesnih lezija, te vi&scaron;e vrednosti indeksa krvarenja iz interdentalne gingive i indeksa mekih naslaga na zubima, u odnosu na ispitanike kontrolne grupe. U eksperimentalnoj grupi ispitanika količina i pH vrednosti nestimulisane pljuvačke su statistički značajno niže u odnosu na ista obeležja kontrolne grupe. Vrednosti koncentracije kalcijuma u pljuvački između ispitivanih grupa se ne razlikuju statistički značajno. Vrednosti koncentracije fosfata u eksperimentalnoj grupi ispitanika su statistički značajno vi&scaron;e nego u kontrolnoj grupi ispitanika. Zaključak: Pacijenti na inhalatornoj terapiji spadaju u grupu osoba s visokim rizikom od nastanka dentalnih erozija i karijesnih lezija. Uvođenje lokalne strategije preventivnih mera, te uspostavljanje međusobne saradnje stomatologa i lekara &ndash; pulmologa, dovelo bi do očuvanja i unapređenja zdravlja zuba kod pacijenata na inhalatornoj terapiji.</p> / <p>Introduction: Asthma and chronic obstructive pulmonary disease (COPD) are predominant chronic respiratory diseases in whose treatment a priority is given to inhalation drugs. The patients receiving inhalation therapy are at an increased risk of dental erosion and caries lesions due to changes in the amount of salivary flow rate and its pH value. Objective: The study objective was to investigate the prevalence of dental erosion and caries lesions in patients with asthma and chronic obstructive pulmonary disease who use inhalation therapy. Materials and methods: The study included 80 participants between the age of 18 and 65. The experimental group comprised of 40 participants previously diagnosed with asthma or chronic obstructive pulmonary disease undergoing inhalation therapy for more than 5 years. The control group involved 40 healthy participants of the same age and gender status as those in the experimental group. The questionnaire was designed to collect informations on underlying disease, symptoms that can occur as side effects of inhaled drugs, habits, dietary and oral hygiene habits. The clinical dental examination established the basic erosive wear examination (BEWE index), DMFT index, papilla bleeding index (PBI) and dental plaque index. The laboratory investigation comprised measurements of the salivary flow rates of non-stimulated saliva, pH value and calcium and phosphate concentrations in the saliva. Results: The subjects receiving inhalation therapy were found to have a higher prevalence of dental erosion and caries lesion as well as higher mean papilla bleeding index scores and mean plaque index scores in comparison to the control group. In the experimental group, the mean value of the salivary flow rate and pH value were lower as compared to the control group. Calcium concentrations in the saliva were similar in both groups, but the results were not statistically significant. However, phosphate concentration was statistically significantly higher in the experimental group than in the control group. Conclusion: The patients undergoing inhalation therapy have a high risk of dental erosion and caries lesion. The introduction of local strategy of preventive dental care and establishing mutual cooperation between dentists and pulmonary specialists would contribute to the promotion and preservation of the dental health in the patients on inhalation therapy.</p>

A research report submitted in partial fulfilment of the requirements for the degree Master of Science in Medicine in the Field of Emergency Medicine in the Division of Emergency Medicine, University of the Witwatersrand / Introduction: Control over the patient bears time-critical importance in emergency medicine. In the entrapment situation after a Motor Vehicle Collision (MVC), emergency care including airway management may need to be initiated before extrication and thus with restricted access. Objective: This manikin study aimed at answering the question of which advanced airway device can be inserted the fastest and most reliably by paramedics in the simulated entrapped patient. Methods: Paramedics were asked to insert four airway devices (endotracheal tube with the Macintosh laryngoscope, endotracheal tube with the Airtraq® optical laryngoscope, Laryngeal Mask Airway - SupremeTM, and Laryngeal Tube Suction - DisposableTM) in randomised order into a manikin seated in the driver seat of a light motor vehicle. Time to first successful ventilation and number of attempts required for successful insertion were measured. Following each insertion, participants were asked by means of a questionnaire to rate the degree of insertion difficulty (scale 1 – 10) and provide reasons for this rating. Finally, participants were asked which device they preferred and why. Results: Prospectively collected data from 26 paramedics were analysed. The LMA-SupremeTM had the shortest mean time to first successful ventilation (16.7 seconds (CI [0.95]; 14.9 - 18.6)), followed by the LTS-DTM (19.4 seconds (CI [0.95]; 18.0 - 20.8)), ETI using the Macintosh laryngoscope (37.7 seconds (CI [0.95]; 31.8 - 43.5)) and ETI using the Airtraq® (41.2 seconds (CI [0.95]; 36.7 - 45.6)). Both face-to-face ETI with the Macintosh laryngoscope and the insertion of the LMA-SupremeTM had 100% first-attempt success. Five participants required a second attempt to successfully intubate the manikin using the Airtraq® and one participant had to re-insert the LTS-DTM for correct placement. In terms of insertion difficulty, the LMA-SupremeTM received the lowest mean score (1.7/10 (CI [0.95]; 1.2 - 2.1)) followed by the LTS-DTM (2.5/10 (CI [0.95]; 1.8 – 3.2)), face-to-face ETI using the Macintosh laryngoscope (3.7/10 (CI [0.95]; 2.9 - 4.5)), and ETI with the Airtraq® (4.5/10 (CI [0.95]; 3.7 - 5.3)). Most participants chose the Macintosh laryngoscope for ETI as their preferred device (10/26; 38%) followed closely by the LMA-SupremeTM (9/26; 35%). These participants stated clinical experience and ease of insertion respectively as the primary reasons for their preference. Conclusion: Besides ETI, Supraglottic Airway Devices are beneficial alternative airway devices to be considered by paramedics in the entrapped patient after a MVC. The LMA-SupremeTM was the fastest and least difficult airway device to insert. Face-to-face endotracheal intubation with the Macintosh laryngoscope remains an important definitive airway that was shown to be performed competently by participating paramedics. The Airtraq® can be used for face-to-face ETI and enables improved laryngoscopy.

Introdução: A desobstrução rinofaríngea retrógrada (DRR) é uma técnica de fisioterapia respiratória aplicada em lactentes para desobstrução de vias aéreas superiores, podendo, inclusive, ser associada à irrigação nasal com salina isotônica para remoção de muco viscoso aderido às paredes das vias aéreas. Objetivo: Caracterizar o perfil de motociclistas profissionais expostos à poluição urbana no que se refere a transporte mucociliar nasal (TMCN), inflamação das vias aéreas superiores e sintomas nasais, e comparar o efeito da DRR isolada e associada à instilação de salina isotônica (DRR+S) nesta população. Métodos: Vinte e quatro voluntários divididos aleatoriamente em dois grupos (DRR e DRR+S) submeteram-se a 15 dias consecutivos de tratamento. A avaliação basal e a pós-intervenção constituíram-se da análise do teste de trânsito da sacarina, da celularidade total e diferencial do lavado nasal e dos sintomas de vias aéreas superiores por meio do questionário SNOT-20, bem como do estudo da exposição pessoal à poluição do ar, por meio da análise da concentração do NO2 de amostradores passivos. O TMCN foi avaliado pelo teste ANOVA não paramétrico com medidas repetidas e o SNOT-20 pelo teste Mann-Whitney. As correlações entre a concentração de NO2 e os desfechos das vias aéreas superiores foram testadas por meio do coeficiente de correlação de Spearman. Resultados: Os grupos apresentaram dados clínicos e demográficos semelhantes. O TMCN apresentou-se alterado em 25% dos voluntários e 100% deles apresentavam sintomas de vias aéreas superiores. Após os tratamentos, os sintomas de vias aéreas e o TMCN evidenciaram melhora significativa, apesar do aumento no número de macrófagos e células ciliadas do lavado nasal. Não houve correlação entre o NO2 e o TMCN, tampouco em relação aos sintomas de vias aéreas superiores. CONCLUSÃO: Técnicas não farmacológicas, simples e de baixo custo são efetivas para recuperar o TMCN alterado e melhorar os sintomas de vias aéreas superiores em adultos não tabagistas / Introduction: Rhinopharyngeal Retrograde Clearance (RRC) is a respiratory therapy technique applied to infants with upper airway obstruction that may also be associated with nasal irrigation with isotonic saline for removal of viscous mucus adhered to the walls of the airways. OBJECTIVE: Characterize the profile of professional motorcycles exposed to urban pollution in relation to the nasal mucociliary transport (NMCT), inflammation of the upper airways and nasal symptoms and compare the effect of DRR alone and associated with instillation of isotonic saline (RCC + S). Methods: Twenty-four volunteers were randomly divided into two groups (RCC and RCC + S) and were submitted to 15 consecutive days of treatment. The baseline and post-intervention consisted of analysis of the transit saccharin test, the total and differential cellularity nasal lavage, and symptoms of upper airway through the SNOT-20, as well as the study of personal exposure to air pollution, by analyzing the concentration of diffuse nitrogen dioxide monitoring system. The NMCT was evaluated with ANOVA for repeated measures and the SNOT-20 with the Mann-Whitney test. The correlations between the concentration of NO2 and the upper airway outcomes were tested using the Spearman correlation coefficient. Results: The groups showed similar demographic and clinical data. The NMCT was abnormal in 25% of the volunteers and 100% of the volunteers had symptoms of upper airways. After treatment the upper airway symptoms and the NMCT showed significant improvement despite the increase in the number of macrophages and ciliated cells on the nasal lavage. No correlation was observed between dioxide nitrogen and TMCN and with the symptoms of the upper airways. Conclusion: Nonpharmacological, simple and inexpensive techniques are effective to treat abnormal NMCT and improve symptoms of upper airway in nonsmoking adults

<p>Hronična opstruktivna bolest pluća (HOBP) jedna je od vodećih uzroka morbiditeta i mortaliteta &scaron;irom sveta. Uprkos stalnom napretku u medicini, uvođenju novih prognostičkih biomarkera, otkrivanju novih bronhodilatatornih, antiniflamatornih i antiinfektivnih lekova, ova bolest i danas beleži stalan porast broja obolelih i umrlih. Prema savremenom tumačenju HOBP je heterogena bolest koja je udružena sa brojnim komorbiditetima i sistemskim manifestacijama. Zajednički faktori rizika su osnova za javljanje udruženih hroničnih bolesti. Komorbiditeti i akutne egzacerbacije doprinose ukupnoj težini bolesti. S obzirom da se HOBP manifestuje i izvan pluća kod svakog pacijenta je neophodno proceniti postojanje sistemskih manifestacija i tragati za komorbiditetima. U reviziji &bdquo;Globalne strategije za dijagnozu, lečenje i prevenciju hronične opstruktivne bolesti pluća GOLD‖ iz 2011. godine navedene sledeće pridružene bolesti za kojima je potrebno aktivno tragati: kardiovaskularne bolesti, disfunkcija skeletnih mi&scaron;ića, metabolički sindrom, osteoporoza, depresija i karcinom pluća, bronhiektazije. Lečenje HOBP delimo u dve velike grupe: farmakolo&scaron;ko i nefarmakolo&scaron;ko. Farmakolo&scaron;ko lečenje prema GOLD-u, danas se zasniva na stepenastom pristupu. Treba ga sprovodi kod svakog pacijenta sa simptomima. Poslednjih godina na značaju veoma dobija nefarmakolo&scaron;ko lečenje pacijenata sa HOBP, zbog sve vi&scaron;e dokaza o pozitivnom efektu na smanjenje simptoma bolesti, popravljanja tolerancije na napor, smanjenje egzacerbacija. U nefarmakolo&scaron;ko lečenje ubrajamo: aktivno izbegavanje faktora rizika, prestanak pu&scaron;enja, oksigenoterapiju, vakcinaciju protiv gripa, psihosocijalnu podr&scaron;ku, respiratornu rehabilitaciju (RR) i hirur&scaron;ko lečenje. Danas se zna da RR ostvaruje brojne benefite kod pacijenata sa HOBP, kao i da je većina tih benefita zasnovana na dokazima (GOLD 2013): pobolj&scaron;ava kapacitet za vežbanje, smanjene osećaja nedostatka vazduha, pobolj&scaron;ava kvalitet života, smanjuje broj hospitalizacija i dužinu hospitalizacije, smanjuje anksioznost i depresiju povezane sa HOBP, efekti traju i nakon zavr&scaron;enog programa rehabilitacije, pobolj&scaron;ava preživljavanje ovih pacijenata. Primarni ciljevi na&scaron;eg istraţivanja bili su da se utvrdi procenat ispitanika kod kojih je ostvaren pozitivan ishod respiratorne rehabilitacije, da se odredi povezanost sledećih faktora sa ishodom respiratorne rehabilitacije: pol, godine života, &bdquo;pack/years―, dužina trajanja bolesti, broj egzacerbacija u prethodnoj godini, pridružena oboljenja: ishemijska bolest srca, srčana insuficijencija, hipertenzija, osteoporoza, depresija, dijabetes, bronhiektazije, karcinom pluća, tuberkuloza pluća. Takođe smo želeli da utvrdimo i uticaj sledećih parametara na ishod rr:FEV1, BMI, satO2, 6-minutni test hoda, &bdquo;CAT― upitnik, &bdquo;mMRC― upitnik, BODE indeks. Urađena je retrospektivno-prospektivna studija, koja je uključila 500 pacijenata sa HOBP, svih stadijuma I-IV , u stabilnoj fazi bolesti, koji su u toku dvogodi&scaron;njeg perioda odradili kompletan program ambulantne respiratorne rehabilitacije. Program je sprovođen u Poliklinici za plućne bolesti, Instituta za plućne bolesti Vojvodine. Dobijeni rezultati pokazali su da je 452 pacijenta (90,4%) ostvarilo pozitivan ishod RR: najvi&scaron;e ispitanika 142 (28,4%) bilo je u kategoriji vrlo dobar, potom slede kategorije dobar sa 129 ispitanika (25,8%), zadovoljavajući sa 102 ispitanika (20,4%), i na kraju kategorija odličan sa ukupno 79 (15,8%) ispitanika. Nakon programa RR do&scaron;lo je do statistički značajnih pobolj&scaron;anja u vrednostima FEV1, 6MTH, satO2, CAT, mMRC, BODE indeksa. Pol, starost, pu&scaron;ački status, dužina trajanja bolesti i &ge;2 egzacerbacije u prethodnoj godini nemaju uticaja na uspe&scaron;an ishod RR. Utvrđeno je postojanje statistički značajne negativne korelacije između srčane slabosti i pozitivnog ishoda respiratorne rehabilitacije, dok nije nađena statistički značajna povezanost ostalih ispitivanih komorbiditeta sa pozitivnim ishodom respiratorne rehabilitacije. Kao statistički značajni univarijantni prediktori pozitivnog ishoda respiratorne rehabilitacije jesu: manji broj pridruženih bolesti, odsustvo srčane slabosti, niža saturacija hemoglobin kiseonikom, veći BMI, mMRC &ge; 2, CAT &ge; 10, B i D stadijumi bolesti, dok je multivarijantnom logističkom regresionom analizom pokazano da su nezavisni prediktori pozitivnog ishoda respiratorne rehabilitacije: manji broj pridruženih bolesti, odsustvo srčane slabosti, veći BMI, CAT &ge; 10.</p> / <p>Chronic obstructive pulmonary disease (COPD) is one of the leading morbidity and mortality causes all over the world. Despite the steady advance in scientific research, introduction of novel prognostic biomarkers, new and potent bronchodilation, anti-inflammatory and anti-infectious drugs, a constant increase in the number of the affected and deceased from chronic obstructive pulmonary diseas has still been permanently evidenced in the 21st century. In a modern concept, the chronic obstructive pulmonary disease (COPD) is understood as a heterogenous disorder associated with numerous comorbidities and systemic manifestations. Common risk factors represent the basis for concomitant chronic diseases to develop. Comorbidities and acute exacerbations contribute to the overall disease severity. As a COPD may develop extrapulmonary manifestations as well, each patient should be evaluated for systemic manifestations and comorbidities. The 2011 update of the &bdquo;Global Strategy for Chronic Obstructive Lung Disease Diagnosis, Management, and Prevention &ndash;GOLD‖ lists the following comorbidities to be actively searched for: cardiovascular diseases, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, lung cancer and bronchiectases. The treatment of COPD can be devided in two groups: pharmacological and non-pharmacological. Pharmacological treatment is today, according to GOLD, based on incremental approach. It should be carry out in every patient with simptoms. In last few years, non-pharmacological treatment of COPD is very popular, due to the evidence of positive effects on decreasing the simptoms, increasing the tolerance to exertion and decreasing the exacerbations. Non-pharmacological treatment consider: active avoiding the risk factors, smoking cessation, oxigenotherapy, vaccination against the flu, psicho-social support, respiratory rehabilitation and surgery. It is well known today that respiratory rehabilitation achieve numerous benefits in COPD patients and most of that benefits are evidence based (GOLD 2013): increasing the exercise capacity, decreasing the shortness of breath, increasing the quality of life, reduces the number and length of hospital stay, decreasing the anxiety and depression conected to COPD, the effects lasts and after the rehabilitation program, improves the survival of this patients. The primary goals of this investigation were to establish the percentage of patients with positive outcome after the respiratory rehabilitation, to determine the conection of the following factors with the outcome of respiratory rehabilitation: gender, age, &bdquo;pack/years―, duration of the disease, the number of exacerbations in previous year, comorbidities: ischemic heart disease, heart failure, arterial hypertension, osteoporosis, depression, diabetes mellitus, bronchiectasis, lung cancer, tuberculosis. The other goals were to establish the influence of some parametars on the outcome of respiratory rehabilitation: FEV1, BMI, SaO2 ,6 minute walk test, &bdquo;CAT― questionnaire, &bdquo;mMRC― questionnaire, BODE index. This was retrospective-prospective study the included 500 patients with COPD, from I to IV stadium, in stable disease, who have done the two years complete program of ambulatory respiratory rehabilitation. The program have been done in polyclinic for respiratory diseases, Institute for pulmonary disesases of Vojvodina, Sremska Kamenica. The results showed that 452 patients (90,4%) achieved positive outcome of respiratory rehabilitation. The majority of patients 142 (28,4%) were in ―very good‖ caterogy, the 129 patients (25,8%) in category ―good‖, ―satisfied‖ 102 patients (20,4%) and ―excellent‖ 79 patients (15.8%). After completion of the respiratory rehabilitation program, statistically significant improvements of the following parameters have been achieved: FEV1, 6MTH, SaO2, mMRC, BODE index. Gender, age, smoking, duration of the disease and &ge;2 exacerbations in previous year did not have influence on the successful respiratory rehabilitation outcome. The statistically significant negative correlation between the heart failure and positive respiratory rehabilitation outcome has been achieved, while there were no statistically significant correlations among other comorbidities and the successful respiratory rehabilitation outcome. The statistically significant univariant predictors of positive outcome of respiratory rehabilitation are: less comorbidities, absence of heart failure, lower oxygen saturation, higher BMI, , mMRC &ge; 2, CAT &ge; 10, B i D stadium of disease, while multivariant logistic regression analysis showed that the independent predictors of positive outcome of respiratory rehabilitation are: less comorbidities, absence of heart failure, higher BMI, CAT &ge; 10.</p>