Search

Pljučnica je najpogostejši vzrok za težji potek okužbe z virusom SARS-CoV-2 in s hospitalizacijo. Potek covidne pljučnice je lahko različen; infiltrati, vidni na rentgenski sliki, se lahko resorbirajo spontano, včasih pa je potrebno zdravljenje s sistemskimi glukokortikoidi. Ob odpustu iz bolnišnice zdravljenje običajno še ni končano, zato je Združenje pulmologov Slovenije v želji po enotnem obravnavanju bolnikov s covidno pljučnico izdelalo mnenje za obravnavo in sledenje bolnikov po odpustu iz bolnišnice. Zavedamo se, da ob novi bolezni ne gre za dokončno mnenje, saj bodo nova spoznanja o covidni pljučnici zanesljivo zahtevala obnavljanje mnenj.

To the Editor: We read with great interest the article by Cardinale et al[1][1] on ![Formula][2] delivered by noninvasive ventilation (NIV) compared with long-term oxygen therapy (LTOT) at the same flow. We would like to add some comments regarding this study. The article offers evidence

Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respira-tory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preserva-tion of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation. Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed.

Telemonitoring seems to be a useful tool for patients' management. The aim of our project was to test the applicability and potential effects of a 12-month telemonitoring of patients with asthma supported by information and communication technologies.We included 100 patients with asthma followed in the outpatient pulmonary clinic in a randomized controlled clinical trial. The patients' data were collected by study questionnaires and lung function tests at the inclusion and at the end of interventional period. In the interventional group, asthma control test (ACT) and peak expiratory flow measurements (PEF) were stimulated to be regularly reported by Short Message Service (SMS). As a response to reported values, the patients automatically received a preformed text or a call from a study nurse in case of detected predefined critical values.The compliance of reporting PEF and ACT values was higher than 80% in 96% of patients. Although we did not detect significant differences in ACT score improvement between the two study groups, we found more prominent improvement of ACT score in the subgroup of patients with two or more exacerbations prior to inclusion in the interventional group, compared to the control group. 40 (78%) patients in the interventional group listed at least one positive effect of telemonitoring on management of asthma.The developed program for home monitoring of patients with asthma was applicable and offered the patients support in managing their disease. Further studies with more selected patients are needed to confirm its usefulness in improving asthma control.

The use of continuous positive airway pressure (CPAP) in asthma has been a point of debate over the past several years. Various studies, including those on animals and humans have attempted to understand the role and pathophysiology of CPAP in patients with either well controlled or poorly controlled asthma. The aim of this manuscript is to review the currently available literature on the physiologic and clinical effects of CPAP in animal models of asthma and on humans with stable asthma.

Introduction: Little is known about subjective perception of benefit and burden of noninvasive ventilation (NIV) in patients on home NIV, and the association of benefit perception and adherence to NIV. Methods: Consecutive patients established on NIV attending an NIV outpatient clinic completed a self-administered questionnaire on their perceived benefit of NIV use consisting of 7 items (scored 1- never true to 5 – always true) and an item on NIV burden (reverse coded). Results: Final sample consisted of 174 patients (mean age 65±12yrs., 65% male) with daily adherence to NIV 6.6 h (IQR 5.5-7,9); in 74% adherence was good. Underlying disease groups were: COPD (45%), OHS (46%) and kyphoscoliosis (9%). Responses are summarized in Table 1. In multivariate analysis adjusted for sex, persistent hypercapnia and diagnosis, only sum score predicted good adherence (OR 1.09, CI 1.01-1.16). Conclusions: Dyspnea relief was the only perceived benefit that differed across disease groups, with OHS perceiving greatest benefit. Perception of NIV burden was low and did not differ across groups. Sum score of the questionnaire predicted adherence to NIV.

Introduction: Patients on chronic noninvasive ventilation must adapt to NIV. Little is known how side effects and associated symptoms influence adherence to NIV. Methods: Consecutive patients at outpatient NIV clinic were included, with underlying diseases: obesity hypoventilation syndrome (OHS), kyphoscoliosis (KS) and COPD. Side effects and associated symptoms on NIV were recorded systematically with a questionnaire. Results: 231 patients (47% OHS, 9% KS, 44% COPD) were included, 66% men, age 64 ± 12 years. Of these, 85% were adherent to NIV, with no difference between disease groups. Patients reported nocturia (62%), insomnia (34%), mask leaks (27%), stomach distention (15%), skin issues (13%), deventilation dyspnea (11%), headache (8%), chest pain (4%). In multivariate analysis adjusted for sex, residual hypercapnia, insomnia, headaches, nocturia, mask leaks, deventilation dyspnea, chest pain, stomach distention, only deventilation dyspnea (OR 0.29, CI 0.088-0.94, p=0.039) was independently negatively associated with adherence. In the same model for each disease group, hypercapnia (OR 0.03, CI 0.002-0.41, p=0.009), insomnia (OR 0.014, CI 0.01-0.26, p Conclusions: Overall adherence to NIV was good. Deventilation dyspnea was associated with worse adherence. In the COPD group female sex was associated with worse adherence. In the OHS group, residual hypercapnia and insomnia were associated with worse and improvement of nocturia with good adherence.

Introduction: Endurance tests are commonly used to assess endurance capacity and improvement of it in patients with chronic pulmonary diseases who are attending pulmonary rehabilitation programs (PR). The aim of our study was to determine, whether endurance time after PR measured with endurance shuttle walk test (ESWT) and cycle endurance test (CET) improves and to compare the results of both tests to assess correlations. Methods: We included patients who successfully concluded our 4 week long inpatient PR. ESWT and CET were performed before and after PR. Pearsons correlation was used to assess relationships. Results: 39 patients (34 COPD, 4 asthma, 1 pulmonary fibrosis) were included in the study (mean age 63.7 ± 6.8 years, 51,3 % male), mean FEV1 1301ml±644ml (46% predicted). Mean ESWT time before PR was 282±214s and after PR 465±313s. Endurance time improved statistically significantly (p Conclusion: We found an improvement of endurance capacity after completion of PR measured with both tests. We found a moderate correlation before PR and no significant correlation between the two tests after PR. We assume that tests don’t correlate because they measure different type of activity (cycling vs. walking) which don’t improve equally after PR with high variability of individual improvement.

Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries. info:eu-repo/semantics/publishedVersion

Introduction: Low fat free mass index (FFMI) is a component of the ESPEN diagnosis criteria of malnutrition, and when accompanied with weight loss is considered to be a determinant of malnutrition. FFMI alone was found to predict mortality in chronic obstructive pulmonary disease (COPD) in previous studies. Our aim was to assess independent effect of low FFMI according to the ESPEN criteria cut-offs on mortality of COPD patients. Methods: Subjects of the study were COPD patients assessed for nutritional status from 2015 to 2017 in our institution. Body composition was measured by bioelectrical impedance analysis. Low fat-free mass index (FFMI) was defined as Results: We identified 221 patients (age 66±8y, men 57%, FEV1 39±18% predicted, BMI 24±7 kg/m2). Low FFMI was present in 59% of patients. During median follow-up of 376 days (IQR 182-686 days), 51 (23%) patients died. More patients with low FFMI died (34.4% vs 6.7%, p Conclusion: Low FFMI according to the ESPEN criteria was present in 59% of patients with COPD. The risk of mortality was 5-fold in patients with low FFMI compared to normal FFMI, independent of BMI or spirometric severity of COPD. Low FFMI when using ESPEN criteria cut-offs is a very strog predictor of mortality in COPD patients.

Background Insomnia is the most common sleep disorder. Patients with obstructive sleep apnea (OSA) also suffer from insomnia, but the latter is often underdiagnosed. The aim of this study was to evaluate residual insomnia in patients treated with positive airway pressure therapy (PAP) for OSA. Methods We prospectively recruited patients on PAP therapy. They filled the Insomnia severity index questionnaire, adherence to PAP therapy was obtained from device software and medical records were analyzed for comorbidities, demographic and medical data. Results 71 patients (15 women (21%), age 56.6±10.7 years, body mass index36.0 kg/m2± 9.1 kg/m2, ESS 11.4±5.7) were recruited.61 (86%) used CPAP and 10 (14%) BIPAP therapy, 47 (66%) used nasal mask, initial apnea hypopnea index (AHI) was 48.4/h±22.3/h, AHI on PAP therapy was 5.1/h±5.4/h, average usage was 5.2h±2.3h. 45 (63%) of patients were adherent to PAP therapy. 46 (65%) patients had arterial hypertension, 8 (11%) ischemic heart disease, 19 (27%) diabetes mellitus (DM), 11 (16%) chronic heart failure, 4 (6%) atrial fibrillation, 12 (17%) had either asthma or COPD, and 11 (15%) had severe restless leg syndrome (RLS). 9 (13%) of patients suffered from clinical insomnia and 24 (34%) from subthreshold insomnia. In patients with clinical insomnia DM (26% vs. 8%, p=0.038) and severe RLS (55% vs 3.3%, p Conclusions Clinical insomnia is not very common in patients with OSA on PAP therapy, but is more frequently present in patients with comorbid diabetes mellitus and severe restless leg syndrome.

Background Obstructive sleep apnea (OSA) is one of the diseases related to restless leg syndrome (RLS). RLS often persists after positive airway pressure therapy (PAP) for OSA has been prescribed and can be the reason for lower adherence. The aim of this study was to evaluate residual RLS in patients on PAP therapy. Methods We prospectively recruited patients on PAP therapy. They filled the Restless Leg Syndrome Rating Scale. Adherence to PAP therapy was obtained from machines software and medical records were analyzed. Results 71 patients (21% women, age 56.6 ± 10.7 years, BMI 36.0 ± 9.1, ESS 11.4 ± 5.7) were recruited. Initial apnea hypopnea index (AHI) was 48.4 ± 22.3, mean AHI on PAP therapy was 5.1 ± 5.4, average usage was 5.2h ± 2.3h. 63% of patients were adherent to PAP therapy.65% patients had arterial hypertension (AH), 11% ischemic heart disease,27% diabetes mellitus (DM), 16%chronic heart failure, 6% atrial fibrilation, 17% had either asthma or COPD. Only 23 (33%) patients reported no symptoms of RLS, 20 (29%) complained of mild RLS, 16 (23%) of moderate, and 11 (15%) of severe RLS. Those with severe RLS had higher initial ESS (15.0 ± 2.4 vs. 10.8 ± 5.9, p=0.004), had more often DM (32% vs 10%, p=0.025), asthma (50% vs. 11%, p=0.004), and clinically significant insomnia (67% vs. 8%, p Conclusions RLS is common in patients with OSA on PAP therapy. Those with severe RLS have higher ESS when diagnosed with OSA, more often have diabetes mellitus, asthma, and clinically significant insomnia. AH is more common in patients with comorbid RLS.

Rationale and aims Adherence to treatment guidelines in chronic obstructive pulmonary disease (COPD) has been shown to be less than optimal over the COPD continuum. This retrospective study aimed to assess the implementation of COPD guidelines and potential association with long-term mortality in patients with COPD. Methods All consecutive patient discharges in the period of February 2002–June 2007 from the University Clinic of Pulmonary and Allergic Diseases Golnik, Slovenia, were screened for a primary discharge diagnosis of COPD. Results Data on 1185 patients (mean age 70 ± 9 years, 72% men, 64% GOLD stage III/IV) were analysed. In the discharge letters 62% of patients had three or more drugs prescribed; 3% had no regular prescription. Most patients were discharged with short-acting (91%) and long-acting β2-agonists (LABAs, 65%) and inhaled corticosteroids (61%), and 23% received long-term oxygen therapy. Prescription rates of LABAs, tiotropium and inhaled corticosteroids increased over the disease continuum (P

Introduction: Thymic stromal lymphopoietin (TSLP) is an epithelial-cell–derived cytokine that is produced in response to proinflammatory stimuli, leading to inflammation driven by type 2 helper T (Th2) cells. TSLP thus may contribute to the mechanisms of airway remodelling in asthma and represent a potential targets for biologic asthma treatment. Aims and objectives: The aim of our study was to find out whether there is a difference in serum concentrations of TSLP in asthma patients, COPD and healthy controls. Methods: We analysed serum TSLP concentrations in 41 stable asthmatic patients, 24 COPD (12 stable and 12 during exacerbation) and 14 healthy controls. We used ELISA test for TSLP analyse. Results: Asthma patients have significantly higher systemic TSLP concentrations (median 203 pg/ml) comparing to patients with COPD (median 34 pg/ml; p=0.0022) and comparing to healthy controls (median 44 pg/ml, p=0.0012). There was no difference between stable and exacerbated COPD patients. ![Figure][1] Conclusions: TSLP is an asthma biomarker and might represent an immunological tool in differential diagnosis in obstructive lung disease. Further studies are needed see if there are any differences between patient with different asthma severity and/or phenotypes. [1]: pending:yes

Adherence to treatment guidelines in chronic obstructive pulmonary disease (COPD) has been shown to be less than optimal over the COPD continuum. This retrospective study aimed to assess the implementation of COPD guidelines and potential association with long-term mortality in patients with COPD.All consecutive patient discharges in the period of February 2002-June 2007 from the University Clinic of Pulmonary and Allergic Diseases Golnik, Slovenia, were screened for a primary discharge diagnosis of COPD.Data on 1185 patients (mean age 70 ± 9 years, 72% men, 64% GOLD stage III/IV) were analysed. In the discharge letters 62% of patients had three or more drugs prescribed; 3% had no regular prescription. Most patients were discharged with short-acting (91%) and long-acting β2-agonists (LABAs, 65%) and inhaled corticosteroids (61%), and 23% received long-term oxygen therapy. Prescription rates of LABAs, tiotropium and inhaled corticosteroids increased over the disease continuum (P0.001). In total, 48% of patients died during a median follow-up of 1149 days. Deceased patients had been less often treated with LABAs, inhaled corticosteroids and tiotropium. In multivariate Cox proportional-hazards analysis, advanced age, current smoking status, lower body mass index, longer hospital stay and cancer were associated with higher mortality (P0.05 for all), and inhaled corticosteroids predicted lower mortality (hazard ratio 0.72, 95% confidence interval 0.55-0.94).Implementation of guideline-recommended therapy was not optimal, particularly in patients who died during follow-up. The high long-term mortality calls for careful risk assessment and appropriate adherence to treatment guidelines.