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Background In the management of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD), adherence to therapy represents a key to success. Objective The objective was to increase adherence to treatment through the development of educational intervention (EI) for asthma and COPD, addressed to patients and general practitioners (GPs). The educational programme includes group educational sessions and educational materials and was carried out in five Romanian hospitals. The results were assessed through Test of Adherence to Inhalers (TAI) questionnaire. Results Of note, 347 GPs and 435 patients were included. Seventy-six per cent of the GPs considered that the main causes of non-adherence are the disease misunderstanding, difficulty of using inhaled medication, fear of adverse effects, the patient’s conviction that no medicine is useful for his illness and financial nature (20%). Fifty-five per cent of surveyed GPs believed that their patients always or most of the time adhere to inhaled therapy but 57% of the same surveyed GPs checked the inhalation technique of their patients sometimes, rarely or never. Only 44% of the GPs discussed with the pulmonologist about their patient’s disease. Before the EI, only 32% of patients had a good adherence score to therapy; this percentage increases to 57% after EI. The most common reasons for non-adherence were: patient forgets to administer his inhalation medication daily (49%), fear of adverse effects (33%), belief that medication is useless (26%), and fear that inhalation medication affects everyday life of the patient (24%). Nearly half of the patients (47%) give up medication when they feel better. Forty per cent of patients drop off inhalation treatments due to financial reasons. The most influenced behaviours as a result of the EI were psychological component (85%), fear of the adverse events (82%) and social component (79%). Conclusions The non-adherence to therapy remains a real problem in asthma and COPD patients in our study group, but EI had positive effects. Extending medical education programmes for patients focused on main reasons of poor adherence, such as forgetting to take medication daily, use of inhalator devices, not understanding their disease, may significantly increase adherence to inhalation treatment.

In chronic obstructive pulmonary disease (COPD), inhaled long-acting antimuscarinic agents (LAMA) are effective maintenance therapies used across all severity stages of the disease. Most of them are administered via dry powder inhalers, but these devices require a potent inspiratory flow which cannot be effectively achieved by patients with advanced disease. In such patients, inhaled therapy via nebulization might be an option.Revefenacin is a LAMA that was specifically formulated for once daily nebulization and which was authorized by the FDA as a maintenance therapy for COPD. In phase II and III clinical studies discussed in this review, revefenacin demonstrated its rapid onset of action and sustained effect on lung function on both a short- and long-term basis.Nebulized revefenacin with once daily use does not require any particular effort of administration and hence can be used by patients with severe airways obstruction or by those having milder cognitive deficits. Further studies are needed, however, to better document the long-term cardiovascular safety and its ability to reduce the exacerbation rate.

The state of health of the population is determined by a set of factors belonging to human biology, environment, behaviors, and the health system (preventive, curative, and rehabilitative). Any of these factors can alter both individual and community health. The primary reason for tobacco dependence is nicotine addiction. Dopamine is released from the neurons located in the mesolimbic system. Nicotine stimulates the release of dopamine from these receptors. The genetic determination of nicotine dependence is determined by the subtypes of nicotine acetylcholine receptors (nAChRs) and conditioned by chromosome mutations at chromosomes 15q25.1, 8p11.21 or 20q13.12-q13.32. Low-amplitude systemic inflammation is demonstrated in all smokers and is confirmed by elevated levels of C-reactive protein, fibrinogen, Interleukin-6, and increased leukocyte levels. Moreover, coagulation and endothelial function markers such as hematocrit, plasma or blood viscosity, D-dimers, circulating adhesion molecules, tissue plasminogen activator, have also modified values in smokers.

Asthma is defined by The Initiative for Asthma (GINA 2018) as a heterogeneous disease, which include chronic airway inflammation and a history of respiratory symptoms. In the last decades asthma had a rise in prevalence, becoming one of the most frequent diagnosed diseases in the world. The main goals of asthma management are to achieve good symptom control, minimize the risks of exacerbations, decrease rescue medication intake, improve the quality of life by decreasing respiratory system inflammation and ameliorating the patient’s lung function. Beside effective medications, asthma continues to impair quality of life for most patients. Due to the difficulty of controlling symptoms and exacerbations, the need of developing complementary options of treatment is increasing in order to achieve an optimum control and a lower risk of acute episodes or fatal events. Pulmonary rehabilitation is suggested for asthma patients when adequate medical therapy poorly control the symptoms and mental, physical or social consequences of illness persist during the daily life. The following non-drug therapy components are included in the rehabilitation program: physical training, comprehensive smoking cessation program, comprehensive patient education, respiratory physiotherapy, psychosocial support and comprehensive nutritional counseling. These complementary therapies have been proven to improve muscle strength, exercise capacity and symptomatology. Also, it has been associated to fewer exacerbations and a lower use of rescue medication, leading to a better quality of life. Key words: asthma, quality of life, symptomatology, rehabilitation, physiotherapy

Inflammation has an important role in the progression of various viral pneumonia, including COVID-19. Circulating biomarkers that can evaluate inflammation and immune status are potentially useful in diagnosing and prognosis of COVID-19 patients. Even more so when they are a part of the routine evaluation, chest CT could have even higher diagnostic accuracy than RT-PCT alone in a suggestive clinical context. This study aims to evaluate the correlation between inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocytes ratio (PLR), and eosinophils with the severity of CT lesions in patients with COVID-19. The second objective was to seek a statically significant cut-off value for NLR and PLR that could suggest COVID-19. Correlation of both NLR and PLR with already established inflammatory markers such as CRP, ESR, and those specific for COVID-19 (ferritin, D-dimers, and eosinophils) were also evaluated. One hundred forty-nine patients with confirmed COVID-19 disease and 149 age-matched control were evaluated through blood tests, and COVID-19 patients had thorax CT performed. Both NLR and PLR correlated positive chest CT scan severity. Both NLR and PLR correlated positive chest CT scan severity. When NLR value is below 5.04, CT score is lower than 3 with a probability of 94%, while when NLR is higher than 5.04, the probability of severe CT changes is only 50%. For eosinophils, a value of 0.35% corresponds to chest CT severity of 2 (Se = 0.88, Sp = 0.43, AUC = 0.661, 95% CI (0.544; 0.779), p = 0.021. NLR and PLR had significantly higher values in COVID-19 patients. In our study a NLR = 2.90 and PLR = 186 have a good specificity (0.89, p = 0.001, respectively 0.92, p

Chronic obstructive pulmonary disease (COPD) is a disease with increasing prevalence and burden for health systems worldwide. Every country collects its own epidemiological data regarding COPD prevalence, morbidity and mortality while taking steps to educate the population and medical community to improve early detection and treatment. The rising COPD prevalence creates a need for comprehensive guidelines. In 2012 and 2017–2018, the Romanian Society of Pneumology (SRP) organised national inquiries for COPD, while lung physicians in Romania began receiving education regarding the correct algorithms for COPD diagnosis and therapy. During 2019, a Romanian clinical guideline for diagnosis and treatment of COPD was published, and a condensed version of key points from this guideline are presented herein. COPD is diagnosed based on the presence of three major components: relevant exposure history, respiratory symptoms, and airway limitation that is not fully reversible. Clinical evaluation of patients diagnosed with COPD should include the level of symptoms, exacerbation rate, the presence of comorbidities and determination of phenotypes. The present abridged guideline is designed to be accessible and practical for assessing and managing patients with COPD. The application of up-to-date COPD guidelines may enhance the optimism of physicians and patients in managing this disease.

Pulmonary alveolar proteinosis (PAP) is a heterogeneous group of rare diseases characterized by the abnormal production and impaired degradation of pulmonary surfactant as a result of malfunctioning of alveolar macrophages. This is due to the downstream dysregulation of the GM-CSF pathway, which can be caused by specific autoantibodies (autoimmune, aPAP formerly known as idiopathic iPAP), direct injury to alveolar macrophages (e.g. by toxic inhaled agents.), or by genetic defects (hereditary or congenital PAP). Few pharmacotherapy options are currently available to treat this disease.The authors discuss the exogenous administration of GM-CSF, rituximab, and the potential role of cholesterol lowering medications in this review. The authors, furthermore, provide their opinion on the available pharmacotherapeutic options and give their future perspectives.Inhaled GM-CSF remains the most commonly used therapy in patients with iPAP but other inhaled therapies such as PPARγ activators should be considered, especially in patients who are partially responsive or unresponsive to traditional treatments.

Introduction Cortisol is a hormone produced by adrenal glands under the control of pituitary gland which helps the organism to cope with different types of stress. One of these possible stressors might be occupational noise exposure. Our research studied the possible influence of noise exposure on cortisol blood level (CBL) and if noise induced hearing loss (NIHL) may play a role in this relationship. Material and method 118 workers from a silicon carbide facility were initially included of whom 67 completed the study. For each job site noise exposure was assessed and a cumulative exposure was calculated for every subject (number of years spent in the same job x noise level). A complete physical examination, a pre exposure audio-metric test and two blood samples taken at the same time one week interval (one pre noise exposure – afternoon shift; the other post noise exposure – morning shift) were performed. T Test was used to make statistical analysis. Results Mean age = 42.2±6.29 years. Mean exposure time = 16.16±5.41 years. Mean noise level = 84.88±3.71 dB. Mean cumulative exposure = 1,377±470.9 dB-years. Normal hearing (NH) = 33 subjects (49.25%). NIHL = 34 subjects (50.75%). CBL pre exposure = 126.87 µg/l and post exposure = 114.92 µg/l (p = 0.204). CBL in NH subgroup: pre exposure = 110.04±63.35 µg/l, post exposure = 129.44±66.1 µg/l (p = 0.194). CBL in NIHL subgroup: pre exposure = 143.19±59.77 µg/l, post exposure = 100.82±47.24 µg/l (p = 0.000). CBL pre exposure: NH subjects = 110.04±63.35 µg/l, NIHL = 143.19±59.77 µg/l (p = 0.031). CBL post exposure: NH = 129.44±66.1 µg/l, NIHL = 100.82±47.24 µg/l (p = 0.045). Conclusions There was no significant difference in CBL measured pre and post noise exposure in the entire group. However, we found a statistical significant difference in CBL in NIHL subgroup (lower level post exposure). This subgroup also had significant higher values pre exposure and lower post exposure compared to NH subgroup. These findings have to confirmed by more in depth research.