Search

Introduction: Observations indicate that struggling with a burden of an incurable disease such as advanced chronic obstructive pulmonary disease (COPD) may result in the weakening of an individual sense of dignity, and be a source of spiritual suffering. Clinicians providing respiratory care to patients should be open to their spiritual needs, in the belief it may improve coping with the end-of-life COPD. The study aimed to assess overall feasibility and potential benefits of Dignity Therapy (DT) in patients with advanced COPD., Material and Methods: Patients with severe COPD, in whom a DT intervention was implemented according to the protocol established by Chochinov et al. were included into the study. An self-designed questionnaire was applied to assess the patients' satisfaction after intervention. Subsequently, the patients' statements were allocated to specific problem categories, corresponding to the spiritual suffering concerns, as structured by Groves and Klauser., Results: DT was completed in 10 patients, with no unexpected side effects. Satisfaction Questionnaire showed a positive effect of DT on the patient' well-being (3.9 on a 5-point Likert scale). The analyses of the patients' original statements enabled an effective identification of the spiritual suffering and spiritual resources and faced by COPD patients., Conclusion: DT is an intervention well received by COPD patients, which may help them in recognising and fulfilling their spiritual needs in the last phase of their life. Information acquired on the patients' resources and spiritual challenges may help clinicians improve their care, especially with regard to supporting their patients at the end-of-life stage.

Introduction: The aim of the study was to assess the quality of life of patients with asthma who were well and poorly controlled., Material and Methods: 70 patients with diagnosed asthma, aged from 18 to 40, were included into the study between November 2005 and February 2006 at the Specialist Hospital in Chojnice and Allergy out-patient Clinic of Medical University of Gdańsk. The diagnosis and stage of asthma, as well as the assessment of the control of disease was performed by the physician. Quality of life was assessed with the use of St. George Respiratory Questionnaire (SGRQ). Statistical analysis was made with the use of computer statistical program Statistica., Results: According to GINA in 26 patients mild asthma was diagnosed, in 31 - moderated and in 13 - severe disease. 41 patients were assessed as well controlled and 29 - as poorly controlled. Older age and longer duration of the disease were related to severe asthma, p = 0.01 and p = 0.003, respectively. In well controlled patients overall score for SGRQ was 48.86, whereas in poorly controlled was - 74.4. There was a significant difference between the overall quality of life in well and poorly controlled patients with asthma, p = 0.0001. This difference was found in all three domains: for symptoms, activity and impact on life, p = 0.014, p = 0.035 and p = 0.003, respectively., Conclusions: Quality of life is strongly dependent on the control of symptoms in asthmatic patients.

Pulmonary hypertension leading to right heart failure can be related to primary lung disease or hypoventilation. Idiopathic pulmonary hypertension is a progressive disease with poor prognosis. Therapy of idiopathic pulmonary hypertension includes: oxygen, calcium channel blockers, diuretics, anticoagulants, prostanoids, endothelin receptor antagonists and phosphodiesterase-5 inhibitors. Patients with pulmonary arterial hypertension (PAH) and pulmonary hypertension due to chronic thrombotic or embolic disease should be treated with vasodilatators. The potent vasodilatators are: prostacyclin PGI2, prostacyclin analogue and endothelin receptor antagonists. For patients with idiopathic PAH classified as NYHA III (New York Heart Association) bosentan is recommended, whereas for patients classified as NYHA IV--epoprostenol. Combination therapy is an emerging therapeutic option in PAH. In BREATH-2 (Bosentan Randomised Trial of Endothelin Antagonist Therapy for PAH) study the efficacy and safety of combining bosentan and epoprostenol given orally was investigated. No significant difference was established between treatment groups in 6-minutes walking distance or NYHA functional class. However other study investigating the combination of bosentan and prostacyclin analogue showed clinical improvement. Additional bosentan therapy may also reduce the epoprostenol dose and therefore decrease its side-effects. Interventional procedures: atrial septostomy and lung transplantation are indicated in patients with advanced NYHA class III and IV symptoms and refractory to available medical treatment. However, currently no management potent enough to cure pulmonary arterial hypertension is available. The introduction of new class of drugs allowed for the improvement of quality of life and overall survival. The choice of drug depends on a variety of factors including accessibility, approval status and patient's preferences.