Efficacy and safety of budesonide/formeterol combination therapy in asthma patients.

Budesonide/formoterol as single inhaler was developed for treating asthma patients who are not adequately controlled on glucocorticoides alone. The aim of this study was to evaluate efficacy, safety and patient/physician satisfaction of budesonide/formoterol therapy.Total of 268 asthma patients (120 men, mean age 38.8 +/- 37.2 years, and 148 women, mean age 42.2 +/- 32 years) were included in the study. All patients received budesonide/formoterol bid (640 mcg of budesonide and 18 mcg of formoterol daily) during run-in period for three weeks. Patients were followed during 14 weeks at 5 visits. At each visit lung function (FEV1 and PEF) was measured,presence of side affects was recorded and questionnaire was given to patients and physicians to estimate the level of satisfaction with budesonide/formoterol therapy (1 very unsatisfied to 5 very satisfied). Significant improvement was noticed in FEV1, from 76.25% of predicted value to 86.94% (p < 0.01); and in PEF from 380.84 L/min to 442.29 L/min (p < 0.01) in all patients. At the end of the study patients' satisfaction with budesonide/formeterol therapy was significantly improved comparing with satisfaction with previously taken therapy, in average grade, from 2.94 to 4.56 (p < 0.01), and similar results were noticed with physicians' satisfaction, from 2.60 to 4.41 (p < 0.01). Budesonide/formoterol in single inhaler, significantly improved lung function in patients with asthma.

Pulmonary compliance values provide prognosis in mechanically ventilated patients--a randomized prospective study.

Our aim was to evaluate the influence of static pulmonary compliance (Cst) on the choice of Mechanical Ventilation(MV) method and treatment outcome. A prospective, randomized trial conducted out at the multidisciplinary Intensive Care Unit (ICU) included 387 patients, randomized in two groups: noninvasive MV group and invasive MV group. Furthermore, each group was divided in two groups: Cst < or = 0.025 and Cst > 0.025 L/cm H2O. In patients with Cst > 0.025 L/cm H2O MV duration, noninvasive vs invasive, was 92 vs 114 h, p = 0.039, time spent in ICU 118 vs 164 h, p = 0.004. In patients with Cst < or = 0.025, MV duration was 141 vs 189 h, p < 0.001, time spent in ICU 190 vs 246 h, p = 0.001, all patients were intubated. Need for tracheostomy was 6 (11%) vs 39 (46%) patients, p = 0.005, and ICU mortality was 15 (26%) vs 21 (25%) patients. Statistical significance in favor of noninvasive method was confirmed in patients with Cst > 0.025 L/cm H2O in MV duration, time spent in ICU, need for tracheostomy and intubation rate. In the group with Cst < or = 0.025 no significant difference in treatment failure was recorded between the two MV methods.

Screening for depression disorders in patients with chronic somatic illness.

Depression is one of the most common complications in patients with chronic somatic illnesses. Comorbidity of depression with physical illness often remains unrecognized and untreated, additionally aggravating the somatic illness itself, its treatment and prognosis. The aim of this study was to investigate the prevalence of depression in chronic somatic patients suffering from diabetes, epilepsy, asthma, chronic obstructive pulmonary disease (COPD) and hypothyroidism. Patients, who were regularly attending control examinations in neurological and internal medicine out-patient departments, were tested for the presence of depression with Beck Depression Inventory. The sample comprised 2153 chronic somatic patients aged between 18 and 80 years. Out of this total, 228 patients (10.6%) did not complete the study, (5.12%) refused to participate, and (5.5%) of the patients were technical failures. 1925 patients completed the study, and 1383 of them were not depressive. In 542 patients (28.5%) depression was confirmed, being almost twice more frequent in women, 346 (64%) vs. 196 (36%) male. Among these depressed examinees, mild depression was found in 284 (52.4%), major in 186 (34.3%) and severe in 72 (13.3%) chronic somatic patients. The majority of patients were aged over 55 yrs (49%). This population contained the largest number of depressed examinees (49.9%). The prevalence of depression with regard to subgroups shows that (25.6%) of asthma patients were depressed, as well as (26.6%) of those with COPD. These two groups did not present statistically significant differences regarding gender. The depression level of (32.2%) was found in patients with diabetes, of (29.6%) in patients with epilepsy and of (24.2%) among those with hypothyroidism. As for gender, statistically significant difference was found in the last three groups of patients (p < 0.001).

[Guidelines for diagnosis and management of asthma in adults of the Croatian Respiratory Society]. / Smjernice Hrvatskoga pulmoloskog drustva za dijagnosticiranje i lijecenje astme u odraslih.

The global use of guidelines for proper diagnosis and management of asthma was worldwide aimed toward obtaining effective control of asthma. Until now, the most often used guidelines in Croatia were the ones issued by the Global Initiative for Asthma (GINA). Their implementation significantly improved and uniformed the diagnosis and management of asthma at different levels of the national health system. The obtained level of knowledge has enabled the making of local guidelines which acknowledge economic, cultural and even traditional specificities of Croatia. It was supposed that Croatian medical professionals would more effectively use guidelines they actively supported to prepare and which were appropriated to local work environment and medicines available. Therefore, based on current scientific evidence, the Croatian Respiratory Society has prepared Croatian Guidelines for Diagnosis and Management of Asthma in Adults purposed for wide use among Croatian doctors and other health professionals.

Montelukast in asthma treatment in Croatia.

The aim of this study was to determine the efficacy and safety of montelukast added to previous medication in the treatment of a mild and moderate asthma. Data were obtained via questionnaires given to the physicians and given further to their patients. Patients were divided in two groups, first followed 4 weeks (612 patients) and second followed 8 weeks (91 patients). We found out that there was a significant improvement in FEV1 (forced expiratory volume in first second) and general condition of patients and decreased number of salbutamol inhalations after using montelukast. In the second group of patients we find out the same significant improvement in FEV1, general condition and decrease in salbutamol inhalations after 4 weeks of using montelukast and further improvement after the next month of therapy. We conclude that montelukast is an efficient drug with little side effects and with a good compliance. Montelukast managed to achieve a good asthma control; therefore it has a significant place in asthma therapy.

The consequences of insulin-like growth factors/receptors dysfunction in lung cancer.

The aim of this study was to investigate the consequences of insulin-like growth factors (IGF) and IGF receptor dysfunction in lung carcinomas. A correlation between increased expression (at mRNA and protein levels) for IGF-1 and IGF-1R and decreased apoptosis were found in large-cell carcinomas and adenocarcinomas. In 40% of informative adenocarcinomas expressing the highest values of IGF-2 and Ki-67 proteins, M6P/IGF-2R gene had LOH at one allele and a mutation in another allele. All four squamous cell carcinoma samples expressed LOH/mutation in the M6P/IGF-2R gene. The alphaIR3 strongly diminished proliferation and increased apoptosis in cultures established from squamous cell carcinomas overexpressing IGF-2 and IGF-1R. Telomerase activity was assessed in four squamous cell carcinomas. Cell treatment with IGF-1 increased telomerase activity. The opposite was observed when the cells were treated with alphaIR3, which inhibits the activity of IGF-1 receptors. Our findings suggest that disruption of the IGF/IGF receptors axis is involved in lung cancer formation.

Ventilatory functions in Croatian population in comparison with European reference values.

AIM: To compare ventilatory capacity of Croatian population with the ventilatory function values predicted by conventional equations based on measurements among European populations. METHODS: Ventilatory capacity and respiratory symptoms were determined in a group of 2,482 healthy non-smokers (1,162 men and 1,320 women). The measurements were performed with a pneumotach spirometer. Maximum expiratory flow volume curves (MEFV) were registered, and forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and flow rates at 50% (MEF50) and the last 25% of the vital capacity (MEF25) were recorded. Anthropometric data were also noted. Reference values were calculated using multiple linear regressions. RESULTS: Comparisons of our values with the prediction summary equations issued by the European Community for Steel and Coal (ECSC) and the European Respiratory Society (ERS) showed that healthy Croatians had consistently lower values of FVC (92.1-/+14.0% of the predicted volume for men and 86.2-/+11.7% for women) and FEV1 (93.7-/+14.8% of the predicted values for men and 95.3-/+13.1% for women), but higher values of MEF50 (107.8-/+30.1% of the predicted values for men and 103.4-/+22.8% for women) and MEF25 (117.3-/+41.0% of the predicted values for men and 117.9-/+34.0% for women) than the ECSC/ERS recommendations. The comparison was also made with the most commonly used North American reference standards based on populations of European origin, with similar findings. On the basis of the results of multiple linear regressions, we constructed prediction equations for ventilatory function in Croatian population. CONCLUSION: The ECSC/ERS recommendations are not satisfactory for the Croatian population.