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Introduction: Colorectal cancer (CRC) is a major public health burden among malignant diseases worldwide affecting over 1 million people each year. In Croatia it is the second cause of cancer mortality in men (N=1063, 49.77/100.000), as well as women (N=803, 34.89/100.000) in 2009. There is clear evidence that early detection and removal of CRC or its precursor lesions by population screening can reduce mortality and improve outcomes. In almost all of the developed EU countries some screening programs are organized. Methods: Croatian National population program for CRC screening was established by the Ministry of Health and Social Welfare and its implementation started at September, 2007. The coordinators in each county institute of public health are obliged to ensure performing of fecal occult blood testing (FOBT), followed by colonoscopy in all positive cases. The FOBT is performed by hypersensitive guaiac-based Hemognost card test with detection limit of 0.2 ml blood in 500 g of stool. The test and short questionnaire are delivered to home addresses of all citizens age 50–74 consecutively during two years. Each participant is required to fulfill the questionnaire, and send it together with the stool specimen on 3 test cards back to the institute for further analysis. According to screening results of other authors, it was expected that 4% FOBT positive cases would be found in normal risk population and model calculations pointed out a need for 24000 colonoscopies per year. Results: Till the end of 2010 total of 1056694 individuals were invited to screening (born between 1933-1945. and 1952-1957.). 203 846 persons (19.3%) returned envelope with fulfilled questionnaire and 178 570 of them returned correctly done FOB test cards. Until now, 12 523 positive FOBT patients were found (7.2%). Colonoscopy was performed in 7 736 cases (compliance 62%). Screening has identified colorectal cancers in 462 patients (3.6% of FOBT-positive and 0.26% of all screened individuals). Polyps were found and removed in 3089 (39% of FOBT-positive) patients. Conclusion: Characteristics of Croatian CRC National program in first three years were: low percentage of returned FOBT, higher number of FOBT-positive tests than usually can be expected in normal population, and very high number of pathologic findings (polyps and cancers). These results suggest a need for further strengthening of Croatian CRC screening National program. Successful intervention strategies include organizational changes, improving colonoscopy network, providing reminders to users about screening opportunities, educational strategies to improve awareness of usefulness of CRC screening and multifactor interventions aimed at increasing participation rates.

Background: Both colorectal cancer incidence and mortality rates, in Croatia, are on the increase. Currently it is ranking second in both men ( after lungs ) and women ( after breast ) with the total incidence rate of 62.4/100, 000 ( 2006 ). High mortality rates heve been recorded ( 40.6/100, 000, 2006 ), probably due to a low percent ( less than 10% ) of newly diagnosed cases with localised lesions. In the Osijek-Baranja County ( Eastern region ), more rapid increase in mortality rates, compared to the whole of Croatia, can be observed. The Osijek-Baranja County has a long-lasting experience in performing activities on primary prevention on early detection of colorectal cancer. The east region of Croatia has been faced with the devaststing effects of the war and the overwhelming poverty in the post-war period. Based on unfavourable statistics, The Croatian Governament has passed the Conclusion on The National Program of the Prevention and Early Detection of Colorectal Cancer, which has started on 1th Nowember 2007. Main goals of the program are: to decrease prevalence of risk factors in the population, to reduce mortality rates by 15% 5 years after the program started and to increase percentage of diagnosed pre-clinical and localised cancers. Methods: Conventional screening method for the early detection of colorectal cancer Faecal Occult Blood Test ( FOBT ) by 2 yearly examination protocol is being applied in asymptomatic population at average risk, aged 50-74 years. Target population accounts approximately 1, 200, 000 persons ; 600, 000 persons are accepted to be tested every year with minimum coverage of 60%. The Croatian Public Health Institute in collaboratio with the county institutes is responsible for the invitation organization, coordination and the monitoring of the action, collecting and evaluation of data. Invitation letters have been sent by mail. In an envelope, , there are three testing cards together with the instructions for their use, questionnaire about risk factors and educational brochure to ensure invited persons be informed on the screening. Invited persons have been asked to mail applied testind-cards back, together with filled questionnaire. Persons testing positive have been invited for colonoscopy in the nearest endoscopic unit. Results: A total of 206000 invitation letters heve been sent until the end of January 2009 to persons born 1933-1937. According to preliminary results, responding rates are low ( average 20.5%, 38.5% maximum ) ; in the Osijek-Baranja County 22.8%. Estimations are based on the total number of envelopes mailed back, while some samples are useless. The percent of FOBT positive tests is 9.7%, and 11.8% in Osijek-Baranja County. There are123 newly discovered carcinomas ( 5, 6% of thoose who underwent colonoscopy), 25 in Osijek-Baranja County, 653 polyps, 102 in Osijek-Baranja County, 266 diverticula, 28 in Osijek-Baranja County. Conclusions: Initial analyses indicate a weak response, therefore, the activities which motivate the population for being tested, must be intensified. In order to achieve that, it is required to improve the collaboration with family doctors, a more intensive media campaign and simplified instructions. In order to mantain monitoring, appropriate software is necessary, currently it is inadequate.

Background: Both colorectal cancer incidence and mortality rates, in Croatia, are on the increase. Currently, it is ranking second in both men (after lungs) and women (after breast) with the total incidence rate of 62.4/100, 000 (2006). High mortality-rates have been recorded (40.6/100, 000, 2006), probably due to a low percent (less than 10%) of newly diagnosed cases with localized lesions. In the Osijek-Baranya County (Eastern Region), more rapid increase in mortality rates, compared to the whole of Croatia, can be observed. The Osijek-Baranya County has a long-lasting experience in performing activities on primary prevention and early detection of colorectal cancer. The East region of Croatia has been faced with the devastating effects of the war and the overwhelming poverty in the post-war period. Based on unfavourable statistics, The Croatian Government has passed the Conclusion on The National Program of the Prevention and Early Detection of Colorectal Cancer, which has started on 1st November 2007. Main goals of the Program are: to decrease prevalence of risk factors in the population, to reduce mortality rates by 15% 5 years after the Program started and to increase percentage of diagnosed pre-clinical and localised cancers. Methods: Conventional screening method for the early detection of colorectal cancer Faecal Occult Blood Test (FOBT) by 2 yearly examination protocol is being applied in asymptomatic population at average risk, aged 50-74 years. Target population accounts approximately 1, 200, 000 persons ; 600, 000 persons are expected to be tested every year with minimum coverage of 60%. The Croatian Public Health Institute in collaboration with the county institutes is responsible for the invitation organization, coordination and the monitoring of the action, collecting and evaluation of data. Invitation letters have been sent by mail. In an envelope, there are three testing-cards together with instructions for their use, questionnaire about risk factors and educational brochure to ensure invited persons be informed on the screening. Invited persons have been asked to mail applied testing-cards back, together with filled questionnaire. Persons testing positive have been invited for colonoscopy in the nearest endoscopic unit. Results: A total of 206 000 invitation letters have been sent until the end of January 2009 to persons born 1933- 1937. According to preliminary results, responding rates are low (average 20.5%, 38.5% maximum) ; in the Osijek-Baranya County 22, 8%. Estimations are based on the total number of envelopes mailed back, while some samples are useless. The percent of FOBT positive tests is 9.7%, and 11, 8% in Osijek-Baranya County. There are 123 newly discovered carcinomas (5, 6% of those who underwent colonoscopy), 25 in Osijek-Baranya County, 653 polyps, 102 in Osijek-Baranya County, 266 diverticula, 28 in Osijek-Baranya County. Conclusions: Initial analyses indicate a weak response, therefore, the activities which motivate the population for being tested, must be intensified. In order to achieve that, it is required to improve the collaboration with family doctors, a more intensive media campaign and simplified instructions. In order to maintain monitoring, appropriate software is necessary, currently it is inadequate.

Cilj : Cilj ovog rada bio je na sažet način prikazati rezultate dobivene studijom „Globalno opterećenje bolešću, ozljedama i rizičnim čimbenicima 2017. godine“, a koji se odnose na Hrvatsku 2017. godine te analizom istih utvrditi trendove proširenosti bolesti i rizičnih čimbenika i ukazati na mogućnost primjene ovih podataka u stvaranju zdravstvene slike zajednice. ----- Metode : Svi prikazani podaci prikupljeni su iz kataloga podataka Global Health Data Exchange (GHDx) i njegovih alata za rezultate i vizualizaciju. ----- Rezultati : Prema GBD 2017, Republika Hrvatska ima 4.275.000 stanovnika, totalnu stopu fertiliteta 1,42, očekivano trajanje života za žene odnosno muškarce rođene te godine 80,9 odnosno 74,9 godina, HALE 69,88 godina za žene te 64,91 godinu za muškarce, stopu mortaliteta djece do 5. godine života 4,3/1.000 živorođene djece. Najveće stope DALY (na 100.000 osoba) među uzrocima 2.razine imaju kardiovaskularne bolesti (muškarci:5.205,96; žene: 2.994,56), novotvorine (muškarci: 4.591,54; žene: 2.531,50) i poremećaji mišićno-koštanog sustava (muškarci: 1.833,54; žene: 1.885,66), među rizicima 2.razine duhan (muškarci:4.717,95; žene: 1.933,71). Najveća stopa YLD (na 100.000 osoba) je za poremećaje mišićno-koštanog sustava i iznosi 1.838 godina. Vrijednost SDG indeksa je 67,1. ----- Zaključak: Korištenjem podataka iz GBD-a, posebice DALY stopa, mogla bi se poboljšati učinkovitost javnozdravstvenih intervencija u Hrvatskoj., Objective: The aim of this study was to summarise the Croatian data from the 2017 iteration of the 'Global Burden of Disease Injuries, and Risk Factors Study 2017' and by analysing those results to establish the distribution of diseases and risk factors and also to point to the possibility of application of GBD data in creating health image of the community. ----- Methods: Data were collected from the Global Health Data Exchange (GHDx) data catalog, using its results and visualisation tools. ----- Results: According to GBD 2017, Croatia had population of 4,275,000, total fertility rate was 1.42, life expectancy for women and men born in 2017 was 80.9 and 74.9 years respectively, HALE was 69.88 years for women and 64.91 years for men, while the under 5 mortality rate was 4.3/1,000 live births. Among 2𝑛𝑑 level causes, cardiovascular diseases (men:5,205.96; women: 2,994.56), neoplasms (men: 4,591.54; women: 2,531.50) and musculoskeletal disorders (men: 1,833.54; women : 1,885.66) had highest DALY rates (per 100,000 people), whereas for 2𝑛𝑑 level risk factors it was tobacco (men:4,717.95; women: 1,933.71). Highest YLD rate (per 100,000 people) was for musculoskeletal disorders (1,838 years). SDG index value was 67.1. ----- Conclusion: Usage of GBD data, especially DALY, could improve efficiency of public health interventions in Croatia.

U radu su uvodno uspoređeni opći sociološki i ekonomski parametri dviju država, a nakon toga bitni zdravstveni pokazatelji. Dio njih pokriva zdravlje žena i djece, a dio se odnosi na opću populaciju. Odabrani su parametri koji se ili bitno razlikuju u Hrvatskoj i Norveškoj ili koji pokazuju dinamiku u svojim trendovima. Pokazalo se da, iako su dvije države u ekonomskom razvoju smislu drugačije, u mnogim zdravstvenim pokazateljima su usporedive i općenito gledajući imaju zdrava društva. Hrvatska nešto zaostaje u područjima u kojima bi preventivne aktivnosti dugoročno mogle pokazati pozitivne trendove, poput navika pušenja, kulture vožnje, a nažalost i smrtnosti od tumora dojki, prostate i dišnog sustava. No Hrvatska ima općenito nižu incidenciju pojave tumora, a i nižu stopu elektivnih abortusa i kongenitalnih malformacija. Što se organizacije zdravstvenih sustava tiče, obje države imaju općenito decentralizirani pristup organizaciji, no dok je Norveška općenito podijeljena u 4 regije, Hrvatska svoju decentralizaciju usklađuje s 20 županijskih organizacija i Gradom Zagrebom. Obje su države socijalne države i građani imaju univerzalan pristup zdravstvenom sustavu, iako je to u Hrvatskoj donekle ograničeno regresivnim financiranjem zdravstva te općenitom ekonomskom nestabilnošću i nižim socioekonomskim standardom većeg broja stanovnika., The paper starts with a comparison of general social and economic parameters of the two countries and afterwards important health indicators are compared. Some indicators cover health of woman and children and a part covers the health of the general population. The chosen parameters either differ considerably between Croatia and Norway or show a dynamic in their trends. It is shown that although the two countries are different in the sense of economic prosperity, they are comparable in many health indicators and generally speaking have healthy societies. Croatia lags in areas in which preventive measures could show positive results on the long run, such as smoking habits, culture of driving, and unfortunately breast, prostate and respiratory system cancers as well. However, Croatia generally has a lower incidence of tumors, as well as a lower rate of elective abortions and congenital malformations. As far as the organization of healthcare systems is concerned, both countries use a generally decentralized approach, however while Norway is divided into 4 regions, Croatia aligns its decentralization with 20 county organizations and the City of Zagreb. Both are welfare states and their citizens have universal healthcare access, although this is somewhat restricted in Croatia due to regressive healthcare financing as well as general economic instability and a lower socioeconomic standard of a significant part of the population.

Cilj: Cilj ovog rada bio je izračunati i analizirati trendove incidencije i mortaliteta raka debelog crijeva u Republici Hrvatskoj za razdoblje od 2001.-2014. godine, napraviti analizu kretanja epidemioloških mjera učestalosti za Hrvatsku te po županijama, te odrediti postoji li razlika između jadranskog i kontinentalnog dijela Hrvatske. ----- Metode: Podaci o incidenciji karcinoma debelog crijeva za period od 2001. do 2014. godine, preuzeti su iz Registra za rak Republike Hrvatske, a podaci o mortalitetu iz podataka Državnog zavoda za statistiku i Hrvatskog zavoda za javno zdravstvo. Dobno standardizirane stope incidencije i mortaliteta izračunate su metodom direktne standardizacije koristeći popis stanovništva Republike Hrvatske iz 2011. godine. Trendovi incidencije i mortaliteta analizirani su pomoću Joinpoint programa, verzija 4.4.0.0. iz siječnja 2017. godine. ----- Rezultati: Prosječna dobno standardizirana stopa incidencije u muškaraca na 100 000 stanovnika, za razdoblje od 2001.-2014. godine, iznosi 81,55 za kontinentalnu regiju te 86,51 za jadransku. Stopa mortaliteta u muškaraca iznosi 53,43 (kontinentalna regija) te 52,52 (jadranska regija). Te iste stope incidencije u žena, za promatrano razdoblje, iznose 54,58 za kontinentalnu regiju te 57,82 za jadransku, dok stope mortaliteta u žena iznose 36,69 (kontinentalna regija) te 35,66 (jadranska regija). ----- Zaključak: Podaci iz ovog rada pokazuju da je dobno standardizirana stopa incidencije i za muškarce i za žene viša u jadranskoj, nego u kontinentalnoj Hrvatskoj. Stopa mortaliteta podjednaka je u obje regije., Objective: The aim of this paper was to calculate and analyze the trends of incidence and mortality of colorectal cancer in the Republic of Croatia for the 2001-2014 period, to make an analysis of epidemiological time trends for Croatia and for Croatia's counties and to determine whether there is a difference in incidence and mortality between the Adriatic region and the continental region of Croatia. ----- Methods: Incidence data for 2001-2014 period was taken from the Croatian National Cancer Registry. Mortality data was taken from the National Bureau of Statistics and the Croatian Institute of Public Health. The age standardized rates of incidence and mortality were calculated using the direct standardization method on the basis of the 2011 Croatian census. Incidence and mortality trends were analyzed using the Joinpoint program, version 4.4.0.0. from January 2017. ----- Results: The age standardized incidence rates per 100 000 in male patients for the 2001-2014 period were 81.55 for the continental region and 86.51 for the Adriatic region. Mortality rates in male patients were 53.43 (continental region) and 52.52 (Adriatic region). Incidence in female patients for the observed period amounts to 54.58 for the continental region and 57.82 for the Adriatic region. Mortality rates in female patients were 36.69 (continental region) and 35.66 (Adriatic region). ----- Conclusion: Study data shows that the age standardized incidence rate for both men and women is higher in the Adriatic region than in the continental region of Croatia. The mortality rate is the same in both regions.

Celijakija ili glutenska enteropatija je kronična autoimuna bolest koja najčešće zahvaća tanko crijevo, a karakterizira ju nepodnošljivost glutena, široko upotrebljavanog sastojka u prehrambenoj industriji. Nastaje u osoba u kojih postoji genska podloga, promjena normalne crijevne bakterijske flore kao i infekcije. U oboljelih se nalazi povećana propusnost međustaničnih spojeva u crijevnim resicama što dovodi do ulaska čestica glutena u međustanične prostore i razvoja upalne reakcije. Najčešće su zahvaćene crijevne resice duodenuma i početnog dijela jejunuma koje su atrofične, infiltrirane intraepitelnim limfocitima i ostalim upalnim stanicama, enterociti pokazuju određen stupanj oštećenja, a postoji i hiperplazija kripti, što se klasificira prema Marsh-Oberhuber patohistološkoj klasifikaciji. Zlatni standard za dijagnostiku bolesti je biopsija sluznice koju nadopunjuje određivanje serumskih antitijela. Zasada se ne provodi masovni probir na bolest jer za to nisu zadovoljeni uvjeti. Klinička slika je raznolika i obuhvaća nekoliko tipova bolesti te simptome ne samo gastrointestinalnog već i ostalih organskih sustava, ovisno također i o dobi u kojoj se bolest javlja, što uvelike otežava diferencijalnu dijagnozu. Prevalencija bolesti u svijetu i Republici Hrvatskoj je u porastu, i prema procjenama iznosi oko 1%, iako se bolest često ne dijagnosticira na vrijeme te se pacijenti vode pod drugim dijagnozama što povećava učestalost komplikacija bolesti, hospitalizacija i invaliditeta te visinu troškova liječenja što predstavlja opterećenje za zdravstveni sustav. Kvaliteta života brojnih pacijenata je smanjena. Liječenje celijakije obuhvaća uvođenje bezglutenske prehrane koja je skupa, ima brojne nuspojave i ne dovodi uvijek do povlačenja simptoma, stoga se velik dio pacijenata ne pridržava uputa o pravilnoj prehrani. U različitim fazama istraživanja su moguće alternativne terapije. U Hrvatskoj je u 2015. evidentirano nekoliko tisuća oboljelih od celijakije, na listama HZZO su tri namirnice za pacijente s dokazanom celijakijom, a troškovi liječenja iznose i do nekoliko milijuna kuna. Može se zaključiti kako je celijakija trenutno neprepoznati rastući globalni javno zdravstveni problem te bi za bolji nadzor i pravovremeno liječenje trebalo podizati svijest o ovoj bolesti., Celiac disease or gluten enteropathy is chronic, autoimmune disease which mostly affects small intestine and is characterized with gluten intolerance, widely used ingredient in food industry. Genetics, reduction of normal bacterial flora and infections also play the role in the etiology of the disease. Intercellular connections have higher permeability for gluten particles what causes inflammatory response. Intestinal villi of duodenum and jejunum are atrophic, infiltrated with intraepithelial lymphocytes and other inflammatory cells, enterocytes are also damaged and there is crypt hyperplasia, which is all classified in Marsh-Oberhuber pathohistology classification. Biopsy is a gold standard in diagnostics which is complemented with determination of specific serum antibodies. At the moment, there is no mass screening for the disease because there are yet no conditions for it. Clinical presentation is diverse, there are several clinical types, and symptoms vary from gastrointestinal to extraintestinal, depending also on the age of onset, making it more difficult to set a proper diagnosis. The prevalence of the disease is rising and is currently estimated around 1%, although most patients are not diagnosed on time and have the wrong diagnosis which increases the frequency of complications, number of hospitalizations, disability and also expenses which is a great burden for the health care system. The quality of life is also reduced. The treatment is gluten-free diet which is expensive, has side-effects and does not always lead to improvement so many patients do not follow instructions on their proper diet. Also, there are some alternative therapy options that are currently in different research stages. In Croatia in 2015 there have been several thousand patients registered with the diagnosis of celiac disease. On the Croatian Health Insurance Fund lists there are three groceries available for diagnosed patients and total therapy expenses rise up to several billion kuna. In conclusion it can be said that celiac disease is not yet recognized as a global public health burden that is rising in its importance. The main goal should be rising the awareness about this disease for better supervision and timely diagnosis.

Uvod: Rak tijela maternice je na šestom mjestu među sijelima raka u žena u svijetu. U zapadnjačkim zemljama je mnogo češći, nego u zemljama istočne Europe. Nema preporučene metode preventivnog pregleda kojom bi se rak mogao otkriti ranije. ----- Cilj: Cilj rada je prikazati učestalosti i smrtnosti raka tijela maternice u Republici Hrvatskoj u razdoblju između 1990. do 2012. godine, analizirati trend prema dobnim skupinama te ukazati na problematiku ovog sijela raka među ženskom populacijom. ----- Metode: Prikazat će se podaci o učestalosti i smrtnosti raka tijela maternice u Republici Hrvatskoj u razdoblju 1990. do 2012. Koristit će se podaci Registra za rak Hrvatskog zavoda za javno zdravstvo i standardizirane stope smrtnosti iz baze „Health for all“ Svjetske zdravstvene organizacije za Europu. Koristit će se deskriptivna metoda, a dobno standardizirane stope izračunate su prema popisu stanovništva Republike Hrvatske za 2011. godinu. ----- Rezultati: Rezultati pokazuju kako je pojavnost ovog sijela raka u Republici Hrvatskoj u porastu. Pojavnost je najčešća u dobi između 50. i 69. godine života. Prema stopama incidencije raka tijela maternice u RH u razdoblju između 1990. Do 2012. godine, možemo zaključiti da je u stratumima od 50 do 59, 60 do 69, te 70 do 80+ trend uzlazan. Jedino u stratumu od 0 do 49 trend stagnira, odnosno lagano je silazan. ----- Zaključak: Incidencija u odnosu na Europu i zemlje Europske unije ne razlikuje se značajno. Dobno standardizirana stopa smrtnosti je veća u odnosu na europski i svjetski prosjek, te pripadamo među zemlje s visokim mortalitetom. Kako nema preporučene metode preventivnog pregleda (engl. screening) za ovo sijelo raka, ovi podaci upućuju na potrebu edukacije i podizanja svijesti žena u menopauzi o pravovremenom odlasku na ginekološki pregled u slučaju vaginalnog krvarenja., Aim: The aim of this analysis was to describe and interpret incidence and mortality trends in Croatia in women with corpus uteri carcinoma for the period between 1990 and 2012. ----- Methods: Incidence data were obtained from the Croatian National Cancer Registry. The mortality data were obtained from the World Health organization (WHO) mortality database. Standardized death rates were obtained from World Health Organization (WHO) Health for all database. ----- Results: Corpus uteri cancer showed an increasing incidence trend in Croatia. The incidence is highest between ages 50. and 69. The annual number of corpus uteri cancer death cases is stagnating – i.e., has slightly increased from 216 in 1990 to 246 in 2012. ----- Conclusion: The incidence trends of corpus uteri cancer in Croatia are similar to the trends observed in most of the European countries. Standardised death rate is higher in Croatia than in the European countries or some World countries. The data suggest suboptimal cancer prevention and control.

Astma je kronična upalna bolest dišnih puteva. Kliničke manifestacije bolesti su odraz pojačanog intenziteta upale. Astma je vrlo heterogena bolest. Smatra se kako je uvjetovana kombinacijom genetskih i okolišnih čimbenika. Temeljne patogenetske karakteristike astme su upala dišnih puteva i hiperreaktivnost bronha. Klinička slika i simptomi su promjenjivi. U astmi se izmjenjuju razdoblja potpune odsutnosti simptoma sa egzacerbacijama bolesti. U dijagnostici astme se rabe brojni testovi, no nijedan nije dovoljno osjetljiv i specifičan. Testovi plućne funkcije imaju najveće značenje u postavljanju dijagnoze i procijeni težine astme. Liječenje astme zahtijeva opsežan plan koji uključuje opće mjere, farmakoterapiju i edukaciju bolesnika. Kortikosteroidi su smatrani najkorisnijim lijekovima za kontrolu bolesti, a beta2–agonisti kratkog djelovanja su najčešće korišteni lijekovi za trenutno olakšanje simptoma. Liječenje se provodi prema GINA smjernicama. Astma je jedna od najčešćih kroničnih bolesti u svijetu. Procjenjuje se da je 2011. Godine 250 – 300 milijuna ljudi u svijetu bolovalo od astme, a godišnje od nje umire 250 000 ljudi. Prevalencija i incidencija astme je posljednjih desetljeća u porastu kod djece i kod odraslih. Prevalencija astme u svijetu se trenutno kreće između 1-18%. Viša prevalencija se primjećuje u razvijenijim državama. Iako se smrtnost od astme u zadnjih nekoliko godina smanjila, još uvijek postoji. Smatra se da astma uzrokuje 1 od 250 smrti u svijetu. Prema zdravstvenim troškovima, astma je 5. u svijetu i ima veliko javnozdravstveno značenje. Prevalencija astme u Hrvatskoj se kreće između 5-8% u djece i školske mladeži, a pretpostavlja se da je prevalencija u općoj populaciji između 3-4%. Astma je odgovorna za oko 0,13% smrti godišnje u Hrvatskoj, a dobno standardizirana stopa smrtnosti iznosi 0,86/100.000 stanovnika. Astma se smatra globalnim problemom i „bremenom“ populacije. Istraživanje uzroka astme i provedba primarne i sekundarne prevencije su ključ strategije za smanjenje pobola i smrtnosti od astme., Asthma is a chronic inflammatory disease of the airways. Clinical manifestations of the disease are a result of increased intensitiy of the inflammation. Asthma is a heterogenous disease. It is believed that asthma is caused by combination of genetic and environmental factors. Main pathogenetic features of asthma are inflammation of the airways and bronchial hyperreactivity. Signs and symptoms of asthma vary. Periods of complete absence of symptoms alternate with exacerbations of the disease. Many tests are being used in diagnosis of asthma, but none of them are sufficiently sensitive nor specific enough. Lung function tests have the most value in diagnosing and assesing the severity of asthma. Treatment of asthma requires a comprehensive plan that includes general measures, drug therapy and patient education. Corticosteroids are considered to be the most useful drugs in disease control, and short – acting beta2-agonists are most common medication used for the temporary relief of symptoms. Patients are treated according to GINA guidelines. Asthma is one of the most common chronic diseases in the world. As of 2011, 250–300 million people worldwide are affected by asthma, and approximately 250,000 people die per year from the disease. The prevalence and incidence of asthma in recent decades are increasing in both children and adults. The prevalence of asthma in the world is currently between 1-18%. Higher prevalence is observed in countries with higher economic standard. Although mortality from asthma has been reduced in recent years, it still exists. It is believed that asthma is the cause of 1/250 deaths in the world. Asthma is fifth in the world in health care costs and has a large significance in public health. The prevalence of asthma in Croatia ranges between 5-8% in children, and it is assumed that the prevalence in the general population ranges between 3-4%. Asthma is responsible for approximately 0.13% of all the deaths in Croatia, and the age-standardized death rate was 0.86/100,000. Asthma is considered a global problem and the "burden" to the population. Future research of the causes of asthma and implementation of primary and secondary prevention methods is the key strategy for reducing morbidity and mortality of asthma.