ABSTRACT
The respiratory muscles (RM) strength is the main indicator of their functional state. However, RM strength is not used as criteria for chronic obstructive pulmonary disease (COPD) stratification. AIM: To evaluate the RM power of COPD patients with various variants of comorbidity and to determine the role of comorbidity in the development of respiratory muscle dysfunction. MATERIALS AND METHODS: RM strength of 64 men with exacerbation of COPD was studied. The severity of comorbidity was assessed by the Charlson index. Depending on the prevalence of comorbidity, patients were divided into 3 groups: cardiovascular, cerebrovascular and metabolic. Maximum inspiratory (MIP) and expiratory (MEP) pressures in the oral cavity, maximum rate of pressure development (MRPD), sniff nasal inspiratory pressure (SNIP), MEP/MIP and SNIP/MIP indexes were determined with MicroRPM device (UK). Measured values of MIP, MEP and SNIP were compared with the proper ones. The most noticeable decrease of RM strength was defined in the group of patients with severe comorbidity. RESULTS: In case of a mild comorbidity MEP and SNIP values were 68 and 78% of the predicted values and MIP value corresponded to the personified standard. RM strength of patients with COPD depended on the clinical variant of comorbidity. Thus, in the group of patients with cardiovascular variant of comorbidity auxiliary inspiratory muscles strength decreased. In the group of patients with cerebrovascular variant of comorbidity the expiratory muscles dysfunction predominated. In the group of patients with metabolic variant of comorbidity diaphragm dysfunction predominated. CONCLUSION: The pathogenetic significance of various factors of COPD comorbidity in the development of RM dysfunction was confirmed by the results of the correlation analysis.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Respiratory Muscles , Comorbidity , Exhalation , Humans , Male , Muscle StrengthABSTRACT
AIM: To analyze the state-of-the-art of consulting medical care to Russian patients with glucocorticoid-induced osteoporosis (GCOP) or its risk. SUBJECTS AND METHODS: This GLUCOST study was organized and conducted by the Russian Association of Osteoporosis. A total of 1129 patients with chronic inflammatory diseases, who had been taking oral glucocorticosteroids (OGCSs) a long time (3 months or more), were examined. The patients filled out an anonymous questionnaire on their own. Whether the measures taken to diagnose, prevent, and treat GCOP complied with the main points of Russian clinical guidelines was assessed. RESULTS: 61.8% of the patients knew that the long-term treatment of GCOP might cause osteoporosis. 48.1% of the respondents confirmed the results of bone densitometry; 78.1% of the patients reported that they had been prescribed calcium and vitamin D supplements by their physician, but their regular intake was confirmed by only 43.4%; 25.4% of the patients had sustained one low-energy fracture or more. Treatment for GCOP was prescribed for 50.8% of the patients at high risk for fractures, but was actually received by 40.2%. Therapeutic and diagnostic measures were implemented in men less frequently than in women. When the patient was aware of GCOP, the probability that he/she would take calcium and vitamin D supplements rose 2.7-fold (95% Cl; 2.1 to 3.5; p = 0.001) and that he/she would follow treatment recommendations did 3.5-fold (95% Cl; 2.3 to 5.3; p = 0.001). Bone densitometry increased the prescription rate for antiosteoporotic medication and patient compliance. CONCLUSION: According to the data of Russia's large-scale GLUCOST survey, every four patients with chronic inflammatory disease who are on long-term OGCS therapy have one low-energy fracture or more. Due to inadequate counseling, the patients are little aware of their health and do not get the care required to prevent the disease. Less than 50% of patients who have GCOP and a high risk for fractures undergo examination and necessary treatment aimed at preventing fractures.
