Early detection of asthma and chronic obstructive pulmonary disease in primary care patients.

INTRODUCTION: Asthma and chronic obstructive pulmonary disease are often unrecognized and undertreated. The aim of this study was to describe the frequency of chronic obstructive pulmonary disease and asthma in primary care patients in Serbia, and to examine the agreement between general practitioners and pulmonologists on the diagnosis of chronic obstructive pulmonary disease and asthma. MATERIAL AND METHODS: In this multicenter observational study, the general practitioners identified eligible patients from October 2009 to June 2010. The study included all adult patients with respiratory symptoms and/or smoking history based on structured interview. The patients were referred to a pulmonologist and underwent a diagnostic work-up, including spirometry. RESULTS: There were 2074 patients, 38.4% men, their mean age being 54 +/- 15.5 years. The patients were mostly current (40.3%) or ex-smokers (27.4%). The common symptoms included shortness of breath (84.9%), cough (79.1%) and wheezing (64.3%). The diagnosis of chronic obstructive pulmonary disease was confirmed by pulmonologists in 454 (21.9%) and asthma in 455 (21.9%) patients. The chronic obstructive pulmonary disease was newly diagnosed in 226 (10.9%) and asthma in 269 (13%) of the cases. There was a moderate agreement between the pulmonologists and general practitioners on the diagnosis of chronic obstructive pulmonary disease (kappa 0.41, 95% CI 0.36-0.46) and asthma (kappa 0.42, 95% CI 0.37-0.465). CONCLUSION: A significant number of patients seen in the general practitioner's office were diagnosed with chronic obstructive pulmonary disease or asthma and half of them represent new cases. A substantial proportion of patients referred to a pulmonologist by primary care physicians have been misdiagnosed.

Asthma and chronic bronchitis symptoms among adult population of Belgrade.

INTRODUCTION: Over the last three decades the prevalence of respiratory diseases has been increasing worldwide thus increasing economic burden on the healthcare system. Recent studies have shown that the prevalence of asthma in West European countries ranges from 6-9%, while of chronic obstructive pulmonary diseases (COPD) is 8.0% worldwide. OBJECTIVE: The aim of the study was to estimate the prevalence of respiratory symptoms and smoking habits, and to assess the prevalence of asthma and chronic bronchitis among adults in Belgrade, Serbia. METHODS: To collect data we used a questionnaire based on the European Community Respiratory Health Survey (ECRHS) protocol, which was mailed to 10,208 randomly selected subjects. RESULTS: There were 58.3% of responders to our questionnaire. We noted a higher prevalence of respiratory symptoms in subjects who responded promptly. The majority of the respondents were current or former smokers (37.5% and 17.5% respectively) and 79.9% of them reported respiratory symptoms. The most frequent symptoms were longstanding cough (32.2%), sputum production (30.4%) and wheezing (30.3%). Asthma attacks were reported in 4.4% of cases and 5.6% of subjects were using asthma medications. The prevalence of respiratory symptoms increased with age. Women reported coughing, attacks of breathlessness and coughing, chest tightness by night, allergic rhinitis and chronic coughing, more frequently than men. Productive cough was more frequent in men. The prevalence of almost all symptoms was higher in smokers compared to nonsmokers. CONCLUSION: In Serbia there is a high prevalence of respiratory symptoms, asthma and chronic bronchitis smoking addiction.

[Home-based exercise training in chronic obstructive pulmonary disease].

INTRODUCTION: The role of rehabilitation programmes in chronic obstructive pulmonary disease (COPD) patients is to lower dyspnoea, improve exercise tolerance and quality of life. OBJECTIVE: We have developed a short-course, home-based, rehabilitation programme of physical exercise for lower limb muscles, based on walking at patients' fastest pace. The aim of the study was to investigate the effectiveness of such a programme regarding the exercise tolerance, pulmonary functions and quality of life. METHOD: Twenty-nine individuals with stable COPD (22 males, 7 females), with a mean age of 59.6 +/- 8.9 years participated in the study. Subjects were assessed before and after the 8-week rehabilitation programme using the six-minute walking test (6MWT), Borg breathlessness score, oxygen saturation, St. George's Hospital Respiratory Questionnaire (SGRQ), the Hospital Anxiety and Depression Scale (HADS) and spirometry. RESULTS: The 6MWT distance improved significantly from 337 to 362 m, representing 8.3% (25 m) improvement over baseline. SGRQ activity, impact and total scores improved significantly after the rehabilitation programme (p < 0.01) and quality of life, too. Anxiety and depression scores were significantly lower than the baseline (p < 0.01), as well as dyspnoea sensation (p < 0.01). Pulmonary function improved after an eight-week exercise programme, too (p < 0.01). CONCLUSION: This short-term and simple home-based exercise programme improved health status in COPD. It also improved exercise tolerance, breathlessness sensation and quality of life in COPD patients.

[Disorders of pulmonary gas diffusion in liver cirrhosis]. / Poremecaj difuzije gasova u plucima u cirozi jetre.

UNLABELLED: There is no consensus on the pathogenesis and incidence of diffusion disorder in chronic liver diseases. It is supposed that the pathogenic mechanisms responsible for the reduction of diffusion capacity in liver diseases are multifactorial, including: ventilation-perfusion mismatching, diffuse interstitial pulmonary diseases and reduced transitory time in hyperperfused lung areas [1]. The increase of diffusion of oxygen molecules within dilated blood vessels during the inspiration of 100% O2 in patients with liver cirrhosis is called "diffusion-perfusion defect" or "alveolar-capillary oxygen disequilibrium" [3]. AIM OF THE STUDY: The aim of the study was to determine how the inadequate pulmonary perfusion and intrapulmonary vascular dilatation affect the diffusion disorder in liver cirrhosis. One of the aims was to establish the correlative relations between diffusion disorder and cirrhosis grade according to Child classification. METHOD: The study was performed over the period 1997-2000, including 50 patients with liver cirrhosis. They were diagnosed and treated at the Department of Hepatology and Gastroenterology, Clinical Centre of Serbia, Belgrade. Functional and morphological studies were based on the laboratory tests of liver function and histopathologic findings. The grade of liver insufficiency (A, B or C) was determined according to Child-Pugh score. The alveolar-arterial gradient was calculated from the gas analysis in the arterial blood, in supine and sitting position, in conditions of room air breathing and 100% oxygen. Diffusion parameters were measured by method of single inspiration of carbon monoxide. Spirometry and body pletismography were used for determination of ventilatory disorders. RESULTS: The reduced transfer factor (TLco) was recorded in 27 (54%) patients, while reduced transfer coefficient (Kco) was found in 33 (66%) patients. The mean TLco value was 7.27 (73%) in Child group A (n = 16); 6.98 (73%) in Child B group (n = 20); 6.65 (71%) in Child C group (n = 14). The comparison of these values in Child A, B and C groups by t-test showed no statistically significant difference (p > 0.05). The mean value of TLco was 7.24 (73%) in patients with spider naevi (n = 19), and 6.86 (72%) in patients without spiders (n = 31), without statistically significant difference among these mean values (t-test, p = 0.52). The restrictive ventilation disorders were present in 14 (28%) patients, while the reduced transfer factor was found in 27 (54%) patients. The incidences of restrictive ventilatory disorders and reduced transfer factor were compared (x2-test). The incidence of TLco, decrease was more significant than the incidence of restrictive disorders (p = 0.0082). The elevated alveolar-arterial gradient was present in 29 (58%) patients. No significant difference was found between alveolar-arterial gradient and diffusion disorders (x2-test, p = 0.62). DISCUSSION: There is no consensus on the incidence of diffusion disorder in chronic liver diseases. Robin et al. 1982 reported that only 20% of patients with liver cirrhosis had pathological diffusion, presuming that it was induced by reduction of transit time in hyperperfused lung regions [8]. Hourani et al. 1991 reported that the most frequent functional disorder was TLco decrease (52%) in the group of 116 patients planned for liver transplantation [1]. Krowka et al. 1992 found the lowest values of diffusion capacity in patients with Child C grade of liver cirrhosis [11]. Our results confirm the high incidence (54%) of diffusion disorder in liver cirrhosis, but the grade of liver insufficiency (Child score) does not correlate with the reduction of diffusion capacity. Several studies have reported various degrees of restrictive ventilatory disorders, with disproportionately higher reduction of TLco [1, 14, 15]. Our results confirm the higher incidence of diffusion disorder compared to restrictive disorders. Recent studies report that the isolated reduction of TLco is caused mainly by the intrapulmonary vascular dilatation, but the other factors also play the role (diffuse interstitial lung diseases without restrictive disorders in early stages, the passage through nonventilated alveoli, i.e. ventilatory perfusion mismatching and/or the other pulmonary vascular diseases) [16]. CONCLUSION: The impairment of diffusion capacity is a very common functional disorder in patients with liver cirrhosis and portal hypertension. Disproportionately, higher reduction of the transfer factor compared to restrictive ventilatory disorder, suggests that diffusion disorder is primarily induced by inadequate pulmonary perfusion. The isolated reduction of the transfer factor cannot be only explained in each case by intrapulmonary vascular dilatation.