ARTICOLE ȘTIINȚIFICE

COPD and comorbidities in the Republic of Moldova

Sat, 01 Jan 2022 00:00:00 GMT

COPD and comorbidities in the Republic of Moldova Corlăteanu, Alexandru; Covanțev, Serghei; Scutaru, Eugenia; Rusu, Doina; Botnaru, Victor; Corlăteanu, Olga; Siafakas, Nikolaos BACKGROUND AND AIM: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide, and the majority of patients have at least one comorbid condition of clinical significance. Therefore, we studied its prevalence and implication based on experience from the Republic of Moldova. METHODS: The study was a prospective cohort study that included 435 patients with COPD from 2015 to 2017. RESULTS: We found heart failure in 38.62% of the patients, hypertension in 50.11%, coronary artery disease in 23.45%, diabetes mellitus in 10.11%, renal failure in 1.15%, rheumatoid arthritis in 3.22%, depression in 4.83%, cognitive impairment in 4.37%, obesity in 29.89%, and cachexia in 3.22%. Only 24.65% of patients did not have comorbidities. One comorbidity was found in 23.73%, two in 24.19%, three or more in 27.42%. The Charlson comorbidity index (CCI) had a medium negative correlation with the 6-minute walking test (r=–0.37, p<0.001) and a weak correlation with the rate of exacerbations (r=0.17, p=0.016). CCI had a strong correlation with ADO (age, dyspnea and airflow obstruction) (r=0.75, p<0.001); moderate with BODE (body mass index, airflow obstruction, dyspnea, and exercise) (r=0.3, p<0.001); and weak with BODEx (body mass index, airflow obstruction, dyspnea, and exacerbations), CODEX (comorbidity, obstruction, dyspnea, and previous severe exacerbations), and DOSE (dyspnea, obstruction, smoking, and exacerbation). CCI had a medium correlation with St. George’s Respiratory Questionnaire (SGRQ) activity (r=0.36, p<0.001), impact (r=0.34, p<0.001), and total (r=0.37, p<0.001) scores, and the overall quality of life assessed by SGRQ and Clinical COPD Questionnaire. CONCLUSIONS: Patients with COPD require a multidisciplinary approach to assess and manage a variety of conditions, which influence the evolution and prognosis of COPD. Patients often have one or two comorbidities of clinical significance, and they are predominantly cardiovascular and metabolic. Patients with comorbidities tend to have a poorer health-related quality of life. Comorbidities can be assessed by multidimensional indexes such as ADO and BODE.

Efficiency of different multidimensional indexes for the assessment of the risk of exacerbations in patients with COPD

Wed, 01 Jan 2020 00:00:00 GMT

Efficiency of different multidimensional indexes for the assessment of the risk of exacerbations in patients with COPD Corlăteanu, Alexandru; Scutaru, Eugenia; Rusu, Doina; Corlăteanu, Olga; Covanțev, Serghei; Botnaru, Victor Background: COPD is a mainly chronic respiratory disease, a great number of patients suffer from exacerbations, which are defined as an acute worsening of respiratory symptoms requiring a change in treatment. Exacerbations are an important medical and healthcare problem at the global level. The aim of the study was to compare the efficiency of different multidimensional indexes for the assessment of the risk of exacerbations in patients with COPD. Methods: The study was conducted in 433 patients with COPD. Spirometric data were analyzed (FEV1, FVC, FEV1/FVC). Were applied different multidimensional indexes: BODE, e-BODE, BODEx, ADO, DOSE and CODEX. Results: The cohort consisted of 433 COPD patients of which 352 (81%) men and 81 (19%) women with mean age 62,7 ± 9,8 years. The multidimensional index E-BODE demonstrated excellent discriminatory power for the assessment of the risk of exacerbations (E-BODE AUC 0.935). CODEX, BODEx and DOSE showed good discriminatory power (CODEX AUC – 0.836, BODEx AUC - 0.829, DOSE AUC - 0.825). While BODE and ADO underestimated the risk of COPD exacerbations (BODE AUC - 0.662 and ADO AUC - 0.613). Conclusions: Our analyses showed best discriminatory performance for the E-BODE index in patients with COPD for the assessment of the risk of exacerbations.

Core outcome set for the management of acute exacerbations of chronic obstructive pulmonary disease: the COS-AECOPD ERS Task Force study protocol

Wed, 01 Jan 2020 00:00:00 GMT

Core outcome set for the management of acute exacerbations of chronic obstructive pulmonary disease: the COS-AECOPD ERS Task Force study protocol Mathioudakis, Alexander G.; Abroug, Fekri; Agusti, Alvar; Bakke, Per; Bartziokas, Konstantinos; Beghe, Bianca; Bikov, Andras; Bradbury, Thomas; Brusselle, Guy; Cadus, Cordula; Coleman, Courtney; Contoli, Marco; Corlăteanu, Alexandru; Corlăteanu, Olga; Criner, Gerard; Csoma, Balazs; Emelyanov, Alexander; Faner, Rosa; Romero, Gustavo Fernandez; Hammouda, Zeineb; Horváth, Peter; Huerta, Arturo Garcia; Jacobs, Michael; Jenkins, Christine; Joos, Guy; Kharevich, Olga; Kostikas, Konstantinos; Lapteva, Elena; Lazar, Zsofia; Leuppi, Joerg D.; Liddle, Carol; López-Giraldo, Alejandra; McDonald, Vanessa M.; Nielsen, Rune; Papi, Alberto; Saraiva, Isabel; Sergeeva, Galina; Sioutkou, Agni; Sivapalan, Pradeesh; Stovold, Elizabeth; Wang, Hao; Wen, Fuqiang; Yorke, Janelle; Williamson, Paula R.; Vestbo, Jørgen; Jensen, Jens-Ulrik Randomised controlled trials (RCTs) on the management of COPD exacerbations evaluate heterogeneous outcomes, often omitting those that are clinically important and patient relevant. This limits their usability and comparability. A core outcome set (COS) is a consensus-based minimum set of clinically important outcomes that should be evaluated in all RCTs in specific areas of health care. We present the study protocol of the COS-AECOPD ERS Task Force, aiming to develop a COS for COPD exacerbation management, that could remedy these limitations. For the development of this COS we follow standard methodology recommended by the COMET initiative. A comprehensive list of outcomes is assembled through a methodological systematic review of the outcomes reported in relevant RCTs. Qualitative research with patients with COPD will also be conducted, aiming to identify additional outcomes that may be important to patients, but are not currently addressed in clinical research studies. Prioritisation of the core outcomes will be facilitated through an extensive, multi-stakeholder Delphi survey with a global reach. Selection will be finalised in an international, multi-stakeholder meeting. For every core outcome, we will recommend a specific measurement instrument and standardised time points for evaluation. Selection of instruments will be based on evidence-informed consensus. Our work will improve the quality, usability and comparability of future RCTs on the management of COPD exacerbations and, ultimately, the care of patients with COPD. Multi-stakeholder engagement and societal support by the European Respiratory Society will raise awareness and promote implementation of the COS.

Bronșiectazii, tuberculoză și aspergillus: dificultăți și perspective

Sun, 01 Jan 2017 00:00:00 GMT

Bronșiectazii, tuberculoză și aspergillus: dificultăți și perspective Munteanu, Oxana; Voloșciu, Irina; Rusu, Doina; Scutaru, Eugenia; Botnaru, Victor Pacienții cu bronșiectazii non-fibroză chistică asociază frecvent un risc sporit de colonizare a căilor aeriene de către bacterii patogene și alte microorganisme, inclusiv și fungi filamentoși. Aspergiloza pulmonară cronică (APC) a fost recunoscută recent ca și una dintre maladiile cu o povară semnificativă la nivel mondial prin evaluarea incidenței acesteea. Este asociată cu o mortalitate și morbiditate importantă, fără a avea strategii de management bine structurate. APC aproape întotdeauna afectează pacienți cu anumite patologii pulmonare cronice subiacente ce au condus la apariția bronșiectaziilor, a unor cavități sau bule. La nivel mondial, cel mai frecvent factor predispozant pentru APC este tuberculoza pulmonară tratată anterior. Considerând un subiect actual și pentru Republica Moldova prin incidența mare a tuberculozei, prezentăm două cazuri clinice care vin să ilustreze atât dificultățile de conlucrare cu unii pacienți diagnosticați cu tuberculoză, dar și subestimarea riscului de asociere a infecției fungice la un pacient cu sechele importante (bronșiectazii, cavități) în lipsa unor protocoale locale ce ar facilita diagnosticarea și tratamentul pacienților cu APC.; In patients with non-cystic fibrosis bronchiectasis, the airway is usually colonized by bacterial pathogens and other microorganisms, including filamentous fungi. Chronic pulmonary aspergillosis (CPA) has recently been recognised as a significant global health burden disease according its incidence. It is associated with significant morbidity and mortality and the optimal management strategy is not well-defined. CPA affects patients with an underlying chronic lung condition that results in the formation of bronchiectasis, an air-filled cavity or bulla. Worldwide, by far the most common predisposing factor for CPA is previously treated TB. Considering the fact that tuberculosis is still a hot topic for Republic of Moldova, we present two clinical cases that illustrate both the difficulties of working with some patients diagnosed with tuberculosis and the underestimation of the risk of superimposed fungal infections in a patient with significant sequelae (bronchiectasis, cavities) in the absence of local protocols that would facilitate the diagnosis and treatment of patients with CPA.; У пациентов с бронхоэктазами повышен риск колонизации дыхательных путей патогенными бактериями и другими микроорганизмами, в том числе грибами. Учитывая показатели заболеваемости, хронический аспергиллез легких (ХАЛ) был недавно признан одним из заболеваний со значительным глобальным бременем. Увеличение заболеваемости и смертности от аспергиллеза происходит на фоне отсутсвия четких стратегий диагностики и лечения. ХАЛ почти всегда развивается у пациентов с некоторыми хроническими заболеваниями легких, обусловившими появление бронхоэктазов, полостей либо эмфизематозных булл. Во всем мире, туберкулез легких является наиболее распространенным фактором, предрасполагающим к ХАЛ. Учитывая высокий уровень заболеваемости туберкулезом в Молдове, представляем два клинических случая, которые иллюстрируют трудности ведения некоторых пациентов с туберкулезом, а также недооценку риска присоединения грибковой инфекции у пациентов с серьезными остаточными изменениями (бронхоэктазы, полости) в условиях отсутствия клинических рекомендации по диагностике и лечению пациентов с ХАЛ.