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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.

Background and Aims: Gastroesophageal reflux disease (GERD) is a common condition present in daily practice with a wide range of clinical phenotypes. In this line, respiratory conditions may be associated with GERD. The Romanian Societies of Gastroenterology and Neurogastroenterology, in association with the Romanian Society of Pneumology, aimed to create a guideline regarding the epidemiology, diagnosis and treatment of respiratory conditions associated with GERD.Methods: Delphi methodology was used and eleven common working groups of experts were created. The experts reviewed the literature according to GRADE criteria and formulated 34 statements and recommendations. Consensus (>80% agreement) was reached for some of the statements after all participants voted.Results: All the statements and the literature review are presented in the paper, together with their correspondent grade of evidence and the voting results. Based on >80% voting agreement, a number of 22 recommendations were postulated regarding the diagnosis and treatment of GERD-induced respiratory symptoms. The experts considered that GERD may cause bronchial asthma and chronic cough in an important number of patients through micro-aspiration and vagal-mediated tracheobronchial reflex. GERD should be suspected in patients with asthma with suboptimal controlled or after exclusion of other causes, also in nocturnal refractory cough which needs gastroenterological investigations to confirm the diagnosis. Therapeutic test with double dose proton pump inhibitors (PPI) for 3 months is also useful. GERD induced respiratory conditions are difficult to treat; however,proton pump inhibitors and laparoscopic Nissen fundoplication are endorsed for therapy.Conclusions: This guideline could be useful for the multidisciplinary management of GERD with respiratory symptoms in current practice.

Obesity and Overweight have the highest rate of incidence and prevalence in the past 3 decades, as global pathologies. The purpose of this study was to evaluate cardiovascular, classic and modern risk factors in overweight and obese patients by studying lipid metabolism (total cholesterol, HDL-cholesterol, non-HDL-cholesterol, LDL-cholesterol, serum triglycerides), glucose metabolism, insulin resistance and insulin sensitivity, the prevalence of hypertension (HBP) and the prevalence of metabolic syndrome (MS). This analytical study was performed on 111 subjects divided as follows: Group I consisting of 27 normal weight subjects - NW; Group II consisting of 84 overweight and obese subjects - OW + O: 36 overweight patients - OW; 33 patients with grade I obesity - O-I; 13 patients with grade II obesity - O-II; 2 patients with grade III obesity - O-III. The overweight and obese, although unknown with heart disease, have significant metabolic changes, such as atherogenic dyslipidemia, dysglycemia, high insulin resistance and low insulin sensitivity, metabolic syndrome, these being the first steps towards endothelial dysfunction and early atherosclerosis.

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

Implementation of precision medicine in lung cancer has benefited from intense research in the past years, developing subsequently an improved quality of life and increased overall survival of the patients. Targeted therapy has become one of the most important therapeutic innovations for the non-small cell lung cancer (NSCLC) category with anaplastic lymphoma kinase (ALK) gene rearrangement. The aim of this review is to provide a through overview of the main molecules of ALK tyrosine kinase inhibitors (TKI) with their general and particular mechanisms of resistance, the main methods of ALK gene detection, each with advantages and limits and the future perspectives currently under research which try to overcome the mechanisms of resistance. We have used two of the most reliable medical databases EMBASE and PubMed to properly select the latest and the most relevant articles for this topic. Encouraged by the promising results, the clinical practice was enriched by the approval of tyrosine kinase inhibitor molecules, three generations being developed, each one with more powerful agents than the previous ones. Unfortunately, the resistance to TKI eventually occurs and it may be induced by several mechanisms, either known or unknown. Crizotinib was the most intensely studied TKI , becoming the first molecule approved into clinical practice and although four other drugs have been broadly used (alectinib, ceritinib, brigatinib and lorlatinib) it seems that even the most recently developed one remains imperfect due to the resistance mutations that developed. There are two types of resistance generally described for the entire class and for the particular drugs, but half of them remain unknown Read more in PDF.

The coronavirus disease 2019 (COVID-19) brought in 2020 an important challenge for health-care systems and authorities. Smoking and its influence on this disease remain, after months of the pandemic, one of the debatable risk factors. From the literature point of view, the focus of most articles is on smoking as a possible general risk factor for all analyzed populations. Women tend to represent a more significant population in exposed occupations. In our mini-review, we try to dig deeper, looking for gender-related health effects of smoking in this pandemic context, its effects on the infection with this novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on illness severity, and on the rate of hospitalization and mortality. Despite the fact that the male gender is reported in many articles as a predictor of a poor outcome, we suggest that further research is needed to confirm or deny these relationships. Moreover, studies focusing specifically on women in these study populations are required.

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.

Background: The novel coronavirus disease, COVID 19, is a highly contagious infectious disease declared by the World Health Organization pandemic and a global public health emergency. During outbreaks, health care workers are submitted to enormous emotional burden as they must balance the fundamental “duty to treat” with the parallel duty to family and loved ones. The aims of our study is to evaluate disease perceptions, levels of stress, emotional distress, and coping strategies among medical staff (COVID 19 versus non-COVID 19 department) in tertiary pulmonology teaching hospital in the first month after the outbreak of COVID 19. Methods: One hundred fifteen health care workers completed four validated questionnaires (the brief illness perception questionnaire, perceived stress scale, the profile of emotional distress emotional, cognitive coping evaluation questionnaire) that were afterward interpreted by one psychologist. Results: There was a high level of stress and psychological distress among health care workers in the first month after the pandemic outbreak. Interestingly, there was no difference between persons that work on COVID 19 department versus those working in non-COVID 19 department. Disease perceptions and coping mechanism were similar in the two groups. As coping mechanism, refocusing on planning and positive reappraisal were used more than in general population. Conclusions: there is no difference in disease perceptions, levels of stress, emotional distress, and coping strategies in medical staff handling COVID 19 patients versus personal that does not handle COVID patients the first month after the pandemic outbreak

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.

Background and aims. Cigarette smoking has negative effects on general health, including oral health. The aim of our study was to assess the correlations between nicotine dependence, exhaled carbon monoxide levels and oral hygiene status.Methods. Smoker and non-smoker participants were enrolled in this observational study. The Fagerström test was used to classify nicotine dependences: low (score: 0-3), medium (score: 4-6) or high (score: 7-10). The oral hygiene status was classified according to the oral hygiene indices of plaque, calculus and gingival inflammation. Lastly, the exhaled carbon monoxide levels were measured with a MicroSmokelyzer (Bedfont Scientific Ltd., Kent, United Kingdom).Results. Sixty five participants (50 smokers in the study group and 15 non-smokers in the control group) were enrolled between 11th and 29th of January 2016. No statistical differences were observed between the study group and the control group in terms of age (mean age±SD 23.5±1.9 and 24.0±1.5, respectively) or gender (50% and 26.6%, respectively). A statistically significant difference was observed between the 2 groups in terms of plaque, (p=0.036), calculus (p=0.001) and gingival indices (p

Smoking during pregnancy is the leading cause of prenatal morbidity and is associated with increased risk for numerous maternal, fetal, and infant complications. The aim of this paper was to assess the level of knowledge about maternal and fetal risk factors associated with tobacco use in pregnancy. An online self report questionnaire, concerning smoking behavior during pregnancy, was applied to women who were either pregnant, either recently gave birth using social networking and dedicated sites, from November 2016 to February 2017 in Romania. 1347 women replied and were eligible to be included in the study. They were divided into active smokers, former smokers and never smokers. 85% of all women knew that smoking has bad effects on their health and their babies. 42.9% among former smokers, 33.8% of active smokers and 31.5 % of never smokers had a good knowledge about smoking effects. Despite that 75% of them continued smoking even though they knew that the nicotine reaches breast milk. Among all respondents 43.21% gave up smoking, 36.8 % reduced the number of cigarettes when learning that they were pregnant. The main reason for giving up smoking among pregnant women was family pressure (75.1%) The most frequent complications was preeclampsia, which interestingly was higher among never smokers that smokers (1.2% active smokers, 2.2% of former smokers (p=0.0016), never smokers 3.21%). Smoking during pregnancy, both passive and active, is a health problem that needs to be address, not only through health policies but also through behavioral therapy.

Early diagnosis of interstitial lung disease is a challenge for clinicians and HRCT is considered the gold standard technique. Some studies demonstrated that transthoracic lung ultrasound (US) can play a complementary role for diagnosis and monitoring the course of interstitial lung diseases. The aims of our study is to find the correlation between the US lung semiquantitative score, chest HRCT score, values of force vital capacity, diffusing capacity of the lung for monoxide test and symptoms in patients with differential interstitial lung disease. We have investigated 10 intercostal space with ultrasound for B lines and correlated a total score with HRCT score, forced vital capacity and diffusing capacity value, gasometric parameters, Borg scale Dyspnea score and six Minutes Walk Test results. We used Sygma Plot V12 for statistical analyse. We have found mean value with standard deviation for all investigated parameters. We have applied the Pearson Correlation Score and evalueted the coefficients correlation. We had 14 patients with idiopathic pulmonary fibrosis, 6 with NSIP, 11 with collagen tissue disseases, 7 with pulmonary sarcoidosis. The mean value for HRCT score was 50.52 and for ultrasound score was 20.02. The pair of variables had positive correlation coefficients (the variables increase together with P value below 0.05). The transthoracic lung ultrasound can be considered as a valid non invasive method for the assessment of interstitial pulmonary fibrosis and can be used as a complementary method for screening of early diagnosis in symptomatic patients before High Resolution Computed Tomography.

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.