Home-Based Spirometry in Patients with Interstitial Lung Diseases: A Real-Life Pilot "FACT" Study from Serbia.

(1) Background: home-based spirometry, as a form of telemedicine in pulmonology, was previously successfully implemented in clinical practice in developed countries. However, experiences from developing countries are lacking. The aim of this study was to assess the reliability and feasibility of home-based spirometry in patients with interstitial lung diseases from Serbia. (2) Methods: 10 patients were given a personal hand-held spirometer with operating instructions and asked to perform daily domiciliary spirometry for the next 24 weeks. The K-BILD questionnaire was used to assess patients' quality of life, while the questionnaire designed specifically for this study was used to assess their attitudes toward and satisfaction with domiciliary spirometry. (3) Results: there was a significant positive correlation between office- and home-based spirometry at the beginning (r = 0.946; p < 0.001) and end of the study (r = 0.719; p = 0.019). The compliance rate was nearly 70%. The domiciliary spirometry did not affect patients' overall quality of life or anxiety levels, as measured via different domains of the K-BILD. Patients expressed positive experiences and high satisfaction with the home spirometry program. (4) Conclusions: home-based spirometry may represent a reliable form of spirometry, exploited in routine clinical practice; however, additional research in developing countries with a larger sample size is required.

Comorbidity Profile and Predictors of Obstructive Sleep Apnea Severity and Mortality in Non-Obese Obstructive Sleep Apnea Patients.

Backgrounds and Objectives: Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality. OSA is an independent risk factor for many different conditions, especially cardiovascular diseases. The purpose of this study was to ascertain the comorbidity profile of non-obese patients with newly diagnosed OSA and evaluate the risk for cardiovascular disease and mortality. The present study also aimed to establish predictors for OSA severity. Materials and Methods: This study included 138 newly diagnosed patients who underwent polysomnographic analysis. The 10-year risk for cardiovascular disease was assessed using a newly validated prediction model: Systematic Coronary Risk Evaluation (SCORE-2). In addition, the Charlson Comorbidity Index (CCI) was assessed as a widely-used example of a mortality comorbidity index. Results: The study population included 138 patients: 86 males and 52 females. Patients were stratified, according to AHI (apnea/hypopnea index), into four groups: 33 patients had mild OSA (5 ≤ AHI < 15), 33 patients had moderate OSA (15 ≤ AHI < 30), 31 patients had severe OSA (AHI ≥ 30), and 41 individuals had AHI < 5, which were a part of the control group. SCORE-2 increased in line with OSA severity and was higher in OSA groups compared to the control group (H = 29.913; DF = 3; p < 0.001). Charlson Index was significantly higher in OSA patients compared to controls (p = 0.001), with a higher prevalence of total comorbidities in the OSA group of patients. Furthermore, CCI 10-year survival score was significantly lower in the OSA group, suggesting a shorter survival of those patients with a more severe form of OSA. We also examined the prediction model for OSA severity. Conclusions: Determining the comorbidity profile and estimation of the 10-year risk score of OSA patients could be used to classify these patients into various mortality risk categories and, according to that, provide them with adequate treatment.

Diagnosis and treatment of adult asthma patients in Serbia: a 2022 experts group position statement.

INTRODUCTION: Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma management is limited due to the lack of a systematic approach, drug availability and regulatory affairs. In addition, the global coronavirus disease pandemic has posed a significant challenge, particularly in resource-limited settings. AREAS COVERED: In this paper, we propose an algorithm for treating adult asthma patients in Serbia. We performed PubMed database search on published asthma clinical trials and guidelines from 1 January 2015 to 10 March 2020. The consensus process incorporated a modified Delphi method that included two rounds of e-mail questionnaires and three rounds of national asthma expert meetings. We focus on 1) objective diagnosis of asthma, 2) the implementation of up-to-date therapeutic options, and 3) the identification and referral of severe asthma patients to newly established severe asthma centers. EXPERT OPINION: Regional specificities and variations in healthcare systems require the adaptation of evidence-based knowledge. Practical, clinically oriented algorithms designed to overcome local barriers in healthcare delivery may facilitate timely and adequate asthma diagnosis and the local implementation of current advances in asthma management.

Recommendations for COPD management in Central and Eastern Europe.

INTRODUCTION: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report provides guidance on effective management of chronic obstructive pulmonary disease (COPD) according to local healthcare systems. However, COPD is a heterogenous disease and certain aspects, including prevalence, disease-time course and phenotype distribution, can differ between countries. Moreover, features of clinical practice and healthcare systems for patients with COPD can vary widely, even in geographically close and economically similar countries. AREAS COVERED: Based on an initial workshop of respiratory physicians from eleven countries across Central and Eastern Europe (CEE) in December 2018 and subsequent discussions, this article offers region-specific insights from clinical practice and healthcare systems in CEE. Taking recommendations from the GOLD 2022 report into account, we suggest approaches to adapt these into national clinical guidelines for COPD management in CEE. EXPERT OPINION: Several factors should be considered when optimizing management of COPD in CEE compared with other regions, including differences in smoking status, vaccination uptake, prevalence of tuberculosis and nontuberculous mycobacteria, and variations in healthcare systems. We provide guidance and algorithms for pharmacologic and non-pharmacologic management of COPD for the following scenarios: initial and follow-up treatment, treatment of patients with frequent exacerbations, and withdrawal of inhaled corticosteroids where appropriate.

Chronic obstructive pulmonary disease (COPD) is a common disease of the lungs. It causes symptoms such as breathlessness, cough, and production of phlegm. In people with COPD, these symptoms often reduce the quality of their lives. From time to time, symptoms may get worse in people with the disease. This worsening is known as 'exacerbation'. Exacerbations of COPD can be so bad that they lead to hospital admissions. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) regularly gives advice to doctors around the world. This can help them to provide their patients with the best possible treatment for COPD. However, people with the disease and healthcare systems vary from country to country. This means that the guidance may need to be adjusted to the needs and available resources of different regions. This review looks at how COPD is treated in Central and Eastern Europe. We suggest how to adapt the GOLD recommendations to best suit the Central and Eastern European region.

Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement.

In recent years, several national chronic obstructive pulmonary disease (COPD) guidelines have been issued. In Serbia, the burden of COPD is high and most of the patients are diagnosed at late stages. Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is poorly implemented in real-life practice, as many patients are still prescribed inhaled corticosteroids (ICS)-containing regimens and slow-release theophylline. In this document, we propose an algorithm for treating COPD patients in Serbia based on national experts' opinion, taking into account global recommendations and recent findings from clinical trials that are tailored according to local needs. We identified four major components of COPD treatment based on country specifics: active case finding and early diagnosis in high-risk population, therapeutic algorithm for initiation and escalation of therapy that is simple and easy to use in real-life practice, de-escalation of ICS in low-risk non-exacerbators, and individual choice of inhaler device based on patients' ability and preferences. With this approach we aim to facilitate implementation of the recommendation, initiate the treatment in early stages, improve cost-effectiveness, reduce possible side effects, and ensure efficient treatment.

Pattern of Response to Bronchial Challenge with Histamine in Patients with Non-Atopic Cough-Variant and Classic Asthma.

BACKGROUND: The aim of this study was to establish whether non-atopic patients with cough variant asthma (CVA) have different pattern of response to direct bronchoconstrictors than non-atopic patients with classic asthma (CA). METHOD: A total of 170 patients of both sexes with stable CVA and CA were screened for the study and 153 were included. Patients with proven atopy were not included and 17 patients with worsening of their condition or with verified bronchial obstruction during screening were excluded. All included patients performed spirometry and underwent a bronchial challenge with histamine according to long-standing protocol in our laboratory. RESULTS: Significantly higher frequency of bronchial hyper-responsiveness (BHR) was found in patients with CA than in patients with CVA (63.9% vs. 44.9%, respectively; p < 0.05). Sensitivity was significantly lower in patients with CVA (p < 0.05), while no significant difference was found in maximal response and responsiveness. Only patients with positive challenge tests were included in the analysis. CONCLUSION: Adult non-atopic patients with CVA and CA have a pattern of response to non-specific bronchial stimuli similar to atopic patients with same conditions, with the exception of similar maximal response, which may reflect the efficacy of previous treatment. We believe that further studies are needed to clarify the mechanisms involved in airway response to non-specific stimuli in CVA and CA, especially in non-atopic patients. Further studies should also clarify whether this response pattern has any implications on clinical presentation or on treatment options.

Sleep quality and daytime sleepiness in patients with COPD and asthma.

INTRODUCTION: Nocturnal symptoms are common and important in both asthma and COPD but the relationship between sleep quality and diseases' characteristics has not been fully studied. OBJECTIVE: To compare sleep quality and daytime sleepiness in asthma and COPD patients and to explore its relation to diseases' characteristics. METHODS: In this cross-sectional study, we examined 217 consecutive asthma and COPD patients who underwent pulmonary function tests at The Center for Pathophysiology of Breathing and Sleep Medicine of The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia between July 2014 and January 2015. All patients completed Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). RESULTS: Study included 117 patients with asthma, 100 patients with COPD, and 102 healthy controls. There was no difference in PSQI and ESS between patients with asthma and COPD (4.9 ± 3.9 vs 5.8 ± 4.3, P = .09 and 4.8 ± 3.4 vs 4.7 ± 3.6, P = .69, respectively). PSQI and ESS did not correlate with lung function parameters. Patients with uncontrolled asthma had higher PSQI scores (uncontrolled 7.0 ± 3.7 vs partially controlled 4.6 ± 3.1 vs controlled 3.2 ± 3.7, P < .001). PSQI scores were higher in COPD group D and B compared to A and C (group D 6.9 ±4.6 vs B 6.8 ± 4.1 vs A 2.9 ± 1.3 vs C 3.1 ± 3.9, P < .001). Compared to asthma, COPD patients had longer sleep latency and used sleep regulating medications more often. CONCLUSIONS: There is no difference in sleep quality and level of daytime sleepiness between patients with asthma and COPD. Poor sleep quality is related to level of asthma control and is associated with COPD groups B and D.

The Differences in Spirometry Predictive Equations in Classifying Presence and Degree of Lung Function Impairment: Which Suit Fits the Best?

PURPOSE: The aim of this study was to compare the differences between three most commonly used predictive equations (PE): ECCS (European Community of Coal and Steel), the third National Health and Nutrition Examination Survey (NHANES III), and GLI (Global Lung Initiative) in healthy individuals and when grading severity of lung function impairment in patients with obstructive lung diseases. METHODS: The study included 200 healthy volunteers and 200 patients with obstructive lung diseases at the Institute for Pulmonary Diseases of Vojvodina. In all subjects, we calculated the absolute and relative (percent) predicted values using ECCS, NHANES III, and GLI reference equations. RESULTS: The mean differences between ECCS and NHANES III predicted values were 5.63% (95% CI  5.29-5.98%, p < 0.001) for FEV1 and 10% (95% CI 9.52-10.79%, p < 0.001) for FVC. Similar differences were observed between ECCS and GLI predicted values. There were minimal differences between NHANES III and GLI predictive values. In healthy subjects, the mean absolute difference between measured FEV1 and FEV1 ECCS predicted was 0.36l (95% CI 0.32l, 0.40l, p < 0.001), FEV1 NHANES predicted was 0.30 l (95% CI 0.27-0.35l, p < 0.001), and FEV1 GLI predicted was 0.31l (95% CI 0.27- 0.35l, p < 0.001). The use of three different PE leads to significant differences in classification of obstruction severity in both asthma and COPD patients. CONCLUSIONS: There were significant differences between FEV1 and FVC predicted when using different PE. The absolute difference between actual and predicted FEV1 in healthy individuals was highest when using ECCS. The use of different PE may change the interpretation of severity of airway obstruction.

Frequency of COPD in health care workers who smoke.

OBJECTIVE: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. METHODS: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. RESULTS: The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). CONCLUSIONS: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.

Frequency of COPD in health care workers who smoke / Frequência de DPOC em profissionais de saúde que fumam

ABSTRACT Objective: COPD is one of the major causes of morbidity and mortality worldwide. Health care providers should counsel their smoking patients with COPD to quit smoking as the first treatment step. However, in countries with high prevalences of smoking, health care workers may also be smokers. The aim of this study was to determine the frequency and severity of COPD in health care workers who smoke. Methods: This was a cross-sectional study. All health care workers who smoke, from nine health care centers in Serbia, were invited to participate in the study and perform spirometry. The diagnosis of COPD was based on a post-bronchodilator FEV1/FVC ratio of < 0.70. All patients completed the COPD Assessment Test and the Fagerström Test for Nicotine Dependence. Results: The study involved 305 subjects, and 47 (15.4%) were male. The mean age of the participants was 49.0 ± 6.5 years. Spirometry revealed obstructive ventilatory defect in 33 subjects (10.8%); restrictive ventilatory defect, in 5 (1.6%); and small airway disease, in 96 (31.5%). A diagnosis of COPD was made in 29 patients (9.5%), 25 (86.2%) of whom were newly diagnosed. On the basis of the Global Initiative for COPD guidelines, most COPD patients belonged to groups A or B (n = 14; 48.2%, for both); 1 belonged to group D (3.6%); and none, to group C. Very high nicotine dependence was more common in those with COPD than in those without it (20.7% vs. 5.4%, p = 0.01). Conclusions: In this sample of health care workers, the frequency of COPD was comparable with that in the general population. The presence of COPD in health care workers who smoke was associated with higher nicotine dependence.

RESUMO Objetivo: A DPOC é uma das principais causas de morbidade e mortalidade em todo o mundo. Os provedores de cuidados de saúde deveriam aconselhar seus pacientes fumantes com DPOC a parar de fumar como primeiro passo de tratamento. Entretanto, em países com altas prevalências de tabagismo, os profissionais de saúde também podem ser fumantes. O objetivo deste estudo foi determinar a frequência de DPOC e sua gravidade em profissionais de saúde que fumam. Métodos: Trata-se de um estudo transversal. Todos os profissionais de saúde fumantes de nove centros de saúde na Sérvia foram convidados a participar do estudo e realizar espirometria. O diagnóstico de DPOC baseou-se em VEF1/CVF pós-broncodilatador < 0,70. Todos os pacientes preencheram o COPD Assessment Test e o Fagerström Test for Nicotine Dependence. Resultados: Participaram do estudo 305 indivíduos, e 47 (15,4%) eram do sexo masculino. A média de idade dos participantes foi de 49,0 ± 6,5 anos. A espirometria revelou defeito ventilatório obstrutivo em 33 indivíduos (10,8%), defeito ventilatório restritivo em 5 (1,6%) e doença das vias aéreas pequenas em 96 (31,5%). O diagnóstico de DPOC foi feito em 29 pacientes (9,5%), 25 (86,2%) dos quais foram recém-diagnosticados. Com base nas diretrizes da Global Initiative for Chronic Obstructive Lung Disease, a maioria dos pacientes com DPOC ficou no grupo A ou B (n = 14; 48,2%, para ambos); 1 ficou no grupo D (3,6%) e nenhum ficou no grupo C. Um grau muito alto de dependência de nicotina foi mais comum nos indivíduos com DPOC que naqueles sem a doença (20,7% vs. 5,4%; p = 0,01). Conclusões: Nesta amostra de profissionais de saúde, a frequência de DPOC foi comparável à observada na população geral. A presença de DPOC em profissionais de saúde que fumam relacionou-se com maior dependência de nicotina.

Influence of inhaler technique on asthma and COPD control: a multicenter experience.

BACKGROUND: The successful management of asthma and chronic obstructive pulmonary disease (COPD) mostly depends on adherence to inhalation drug therapy, the usage of which is commonly associated with many difficulties in real life. Improvement of patients' adherence to inhalation technique could lead to a better outcome in the treatment of asthma and COPD. OBJECTIVE: The aim of this study was to assess the utility of inhalation technique in clinical and functional control of asthma and COPD during a 3-month follow-up. METHODS: A total of 312 patients with asthma or COPD who used dry powder Turbuhaler were enrolled in this observational study. During three visits (once a month), training in seven-step inhalation technique was given and it was practically demonstrated. Correctness of patients' usage of inhaler was assessed in three visits by scoring each of the seven steps during administration of inhaler dose. Assessment of disease control was done at each visit and evaluated as: fully controlled, partially controlled, or uncontrolled. Patients' subjective perception of the simplicity of inhalation technique, disease control, and quality of life were assessed by using specially designed questionnaires. RESULTS: Significant improvement in inhalation technique was achieved after the third visit compared to the first one, as measured by the seven-step inhaler usage score (5.94 and 6.82, respectively; P<0.001). Improvement of disease control significantly increased from visit 1 to visit 2 (53.9% and 74.5%, respectively; P<0.001) and from visit 2 to visit 3 (74.5% and 77%, respectively; P<0.001). Patients' subjective assessment of symptoms and quality of life significantly improved from visit 1 to visit 3 (P<0.001). CONCLUSION: Adherence to inhalation therapy is one of the key factors of successful respiratory disease treatment. Therefore, health care professionals should insist on educational programs aimed at improving patients' inhalation technique with different devices, resulting in better long-term disease control and improved quality of life.

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.

Diagnostic value of autofluorescence bronchoscopy in lung cancer.

The role of autofluorescence bronchoscopy (AFB) was primarily investigated in regard to the detection of precancerous lesions of bronchial mucosa. Most of the results confirmed higher sensitivity for the detection of precancerous bronchial lesions, when compared to white light bronchoscopy (WLB) alone. However, it is commonly known that the specificity of AFB remains low. Our findings agree in terms of the detection of premalignant bronchial lesions and early lung cancer, but regarding the detection of synchronous lesions or in the evaluation of lung cancer extension, the specificity of AFB is significantly higher. There is still an ongoing debate in the scientific community whether or not autofluorescence should be used as a screening tool for lung cancer. Results of the majority of published series did not support the general use of AFB as a screening tool for lung cancer; however, these results suggest its use in groups of patients with a high risk of lung cancer. Despite this, some authors still do not recommend its use even in high-risk cases. In recent years, the indications for AFB have been widening and this tool may find its place in routine bronchoscopy. With new indications for AFB, such as the evaluation of tumor extension or follow up after surgical resection, bronchoscopists may make use of this tool more often. A sharp learning curve and a clear distinction between healthy and pathologically altered mucosa make this technology acceptable for inexperienced bronchoscopists. We also investigate new hardware and software improvements in AFB. The addition of backscattered light analysis, ultraviolet spectra, fluorescence-reflectance or dual digital systems could improve the diagnostic yield of this technology.

Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer.

INTRODUCTION: Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer. METHODS: In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment. RESULTS: There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001). CONCLUSION: Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD.

Autofluorescence imaging videobronchoscopy in the detection of lung cancer: from research tool to everyday procedure.

Autofluorescence imaging videobronchoscopy (AFI) is one of the new systems of autofluorescence bronchoscopy designed for thorough examination of bronchial mucosa. The integration of autofluorescence and videobronchoscopy provides clear images of normal and pathologically altered bronchial mucosa. Major indications for AFI include evaluation of early-stage lung cancer and detection of precancerous lesions. However, in recent years, the indications for AFI are widening, and this tool might find its place in routine daily bronchoscopic practice. With new indications for AFI, such as evaluation of tumor extension or follow-up after surgical resection, this tool might be more often used by bronchoscopists. A sharp learning curve and clear distinction between healthy and pathologically altered mucosa make this technology acceptable for young and inexperienced bronchoscopists. One of the major disadvantages of AFI is low specificity in the detection of premalignant lesions and early-stage lung cancer. This disadvantage could be overcome with the appearance of new and improved technologies in autofluorescence, such as the addition of backscattered light analysis, ultraviolet spectra, fluorescence-reflectance or dual digital systems. Quantitative image analysis is also one of the ways to improve objectivity and minimize observer errors. However, one of the most appropriate solutions would be the addition of AFI to narrow band imaging, and merging the two technologies into one videobronchoscope.

The Serbian version of the Epworth Sleepiness Scale.

PURPOSE: The Epworth Sleepiness Scale (ESS) is extensively used for evaluating daytime sleepiness in patients with sleep apnea-hypopnea syndrome (SAHS). The aim of this study was to translate and validate the ESS in the Serbian language. METHODS: The Serbian version of the ESS (ESSs) was administered to 112 patients with symptoms of sleep disorder breathing referred to Sleep Center of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia and 111 healthy controls. Test-retest reliability was tested in 19 healthy subjects. RESULTS: Patients referred to the Sleep center had significantly higher ESS scores compared to controls (9 vs. 4, p < 0.001). The difference was also present for each item separately, excluding item 5. The ESSs scores were significantly higher in patients with severe (median, 13.5; interquartile range (IQR), 10.3-17.8) compared to moderate (median, 9; IQR, 7.3-9.5; p = 0.005) and mild SAHS (median, 8; IQR, 5.5-9.7; p < 0.001). Item analysis demonstrated good internal consistency of the scale (Cronbach's alpha 0.88 in patients and 0.72 in healthy controls). Test-retest Spearman's correlation coefficient was 0.68 (p = 0.001). CONCLUSION: The Serbian version of the ESS demonstrated good internal consistency and test-retest reliability. The ESSs could be used for both clinical practice and research in Serbian population.

Clinical trials in advanced stage lung cancer: a survey of patients' opinion about their treatment.

BACKGROUND: The major aim of this study was to investigate what patients with advanced stage lung cancer, enrolled in a clinical trial, thought about their treatment. We also wanted to investigate if there exist any characteristics that could influence patients' opinion about the clinical trial. PATIENTS AND METHODS: Over the period from June 2008 to June 2009, 59 eligible patients were enrolled in this study. The major inclusion criteria were: participation in a clinical trial, previously treated advanced stage lung cancer, and good performance status (ECOG 0-2). All patients were asked to answer a questionnaire designed to investigate their impressions about participation in a clinical trial. The questionnaire was deposited in a sealed box which was opened at the end of the study.We investigated a possible influence of age, gender, education, lung cancer stage, chemotherapy line and tumor type on the patients' opinion about some aspects of the clinical trial. RESULTS: The majority of the patients were aware they were participating in the clinical trial and a significant number of them were very satisfied with the treatment. Of the investigated factors, only the level of education had a statistically significant influence on some of the questions raised in the questionnaire. CONCLUSIONS: Patients participating in clinical trials are satisfied with their treatment, ready to proceed with it and would recommend it to other patients. It depends mainly on health professionals to maintain this level of confidence and justify their trust.

Clinical risk factors for early complications after high-dose-rate endobronchial brachytherapy in the palliative treatment of lung cancer.

PURPOSE: This study sought to identify the rate of complications and clinical risk factors for early complications of high-dose-rate endobronchial brachytherapy (HDR-EBBT). The identification of these risk factors could result in a decrease or avoidance of complications. PATIENTS AND METHODS: We analyzed risk factors for complications in 761 patients with advanced-stage lung cancer who were treated with HDR-EBBT as a part of the multimodality therapy. We reviewed patient, radiology, and bronchology charts for complications of HDR-EBBT. Complications were defined as severe hypoxemia, global respiratory failure, cardiac arrhythmia requiring additional treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction > or = 6 months previously, stabilized hypertension, arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external-beam radiation therapy, chemotherapy, and interventional pulmonology treatment. Age, sex, tumor histology, and tumor localization were also subjected to multivariate analyses. RESULTS: The rate of complications was 5.4%. Statistically significant (P = .001) risk factors for complications of HDR-EBBT included stabilized hypertension, controlled chronic cardiac arrhythmias, COPD, and stabilized cardiomyopathy. We found a significant correlation between age and number of risk factors, and the occurrence of complications (P = .001). CONCLUSION: Our results indicate that closer monitoring of patients with identified risk factors is advisable. Such monitoring should be performed both before and after treatment, to avoid complications.