INTRODUCTION: In recent years, ventilatory efficiency (minute ventilation (V'E)/carbon dioxide production (V'CO2 ) slope) and partial pressure of end-tidal carbon dioxide (PETCO2 ) have emerged as independent predictors of postoperative pulmonary complications (PPC). Single parameters may give only partial information regarding periprocedural hazards. Accordingly, our aim was to create prediction models with improved ability to stratify PPC risk in patients scheduled for elective lung resection surgery. METHODS: This post hoc analysis was comprised of consecutive lung resection candidates from two prior prospective trials. All individuals completed pulmonary function tests and cardiopulmonary exercise testing (CPET). Logistic regression analyses were used for identification of risk factors for PPC that were entered into the final risk prediction models. Two risk models were developed; the first used rest PETCO2 (for patients with no available CPET data), the second used V'E/ V'CO2 slope (for patients with available CPET data). Receiver operating characteristic analysis with the De-Long test and area under the curve (AUC) were used for comparison of models. RESULTS: The dataset from 423 patients was randomly split into the derivation (n=310) and validation (n=113) cohorts. Two final models were developed, both including sex, thoracotomy, "atypical" resection and forced expiratory volume in 1 s/forced vital capacity ratio as risk factors. In addition, the first model also included rest PETCO2 , while the second model used V'E/V'CO2 slope from CPET. AUCs of risk scores were 0.795 (95% CI: 0.739-0.851) and 0.793 (95% CI: 0.737-0.849); both p<0.001. No differences in AUCs were found between the derivation and validation cohorts. CONCLUSIONS: We created two multicomponental models for PPC risk prediction, both having excellent predictive properties.

• Publikační typ
• časopisecké články MeSH

oto stanovisko vypracovali odborníci České pneumologické a ftizeologické společnosti z odborné sekce pro nemoci s bronchiální obstrukcí. Stanoviska a doporučení vycházejí jak z výsledků randomizovaných kontrolovaných studií, tak z údajů průřezových a prospektivních studií z reálné klinické praxe, aby se co nejvíce přiblížila každodenní klinické praxi a současnému systému zdravotní péče v České republice. Chronická obstrukční plicní nemoc (CHOPN) je heterogenní syndrom s řadou plicních i mimoplicních klinických příznaků a doprovodných chronických onemocnění, kterým lze předcházet a které lze léčit. Toto onemocnění je spojeno s významnou úmrtností, morbiditou a sníženou kvalitou života. Mezi hlavní charakteristiky patří přetrvávající respirační příznaky a pouze částečně reverzibilní obstrukce průtoku vzduchu, která vzniká v důsledku abnormální zánětlivé reakce plic na škodlivé částice a plyny. Oxidační stres, nerovnováha proteáz a antiproteáz a zvýšený počet prozánětlivých buněk (především neutrofilů) jsou hlavními příčinami především neinfekčního zánětu u CHOPN. Kromě kouření jsou důležitými rizikovými faktory vzniku CHOPN také znečištění ovzduší v domácnosti, profesní expozice, nízká porodní hmotnost, časté respirační infekce v dětství a také genetické faktory. Progresivní omezení průtoku vzduchu a remodelace dýchacích cest vedou k zadržování vzduchu, statické a dynamické hyperinflaci, poruchám výměny plynů a snížené výkonnosti. Různé rysy onemocnění se u jednotlivých pacientů projevují nerovnoměrně, což vede k různým typům projevů onemocnění, které se projevují jako koncept „klinických fenotypů“ (pro specifické klinické charakteristiky) a „léčitelných rysů“ (pro léčitelné charakteristiky). Odhadovaná prevalence CHOPN v České republice je přibližně 6,7 %, přičemž ročně je hlášeno cca 3 200–3 500 úmrtí. Základními požadavky pro stanovení diagnózy CHOPN jsou spirometricky potvrzená postbronchodilatační obstrukce dýchacích cest (FEV1/VCmax < 70 %) a hodnocení respiračních symptomů [dušnost (škála mMRC), omezení fyzické výkonnosti, kašel a/nebo produkce sputa (skóre CAT)]. Pro stanovení definitivní diagnózy CHOPN by mělo být provedeno pětistupňové hodnocení, které zahrnuje: 1. posouzení inhalačního rizika, 2. zhodnocení příznaků, 3. funkční vyšetření plic, 4. laboratorní vyšetření a 5. zobrazovací vyšetření. Současně by měly být vyloučeny všechny alternativní diagnózy. Pro klasifikaci onemocnění se v tomto stanovisku používají jak stadia GOLD (1 až 4), tak skupiny GOLD (A až D, respektive E) a hodnocení klinického fenotypu (fenotypů). Posouzení prognózy by mělo být provedeno u každého pacienta. Pro tento účel doporučujeme použít index BODE nebo CADOT. Rozpoznává se šest základních klinických fenotypů, mezi něž patří chronická bronchitida, častý exacerbátor, emfyzematózní překryv astmatu a CHOPN (ACO), překryv CHOPN s bronchiektáziemi (BCO) a plicní kachexie. V našem pojetí jsou všechny tyto klinické fenotypy považovány také za samostatně léčitelné znaky. Pro každý léčitelný rys jsou v tomto dokumentu definovány konkrétní farmakologické a nefarmakologické terapie. U jednoho jedince může dojít ke koincidenci dvou nebo více klinických fenotypů (tj. léčitelných znaků), což dává možnost plně individualizované, fenotypově specifické léčby. Léčba CHOPN by měla odrážet složitost a heterogenitu onemocnění a měla by být přizpůsobena jednotlivým pacientům. Hlavními cíli léčby CHOPN jsou redukce symptomů a snížení rizika exacerbace. Strategie léčby se dělí do pěti vrstev: eliminace rizika, základní léčba, léčba specifická pro daný fenotyp, léčba respiračního selhání a paliativní péče a léčba komorbidit. Eliminace rizik zahrnuje zásahy proti kouření tabáku a environmentálním/profesním expozicím. Základní léčba je založena na bronchodilatační terapii, plicní rehabilitaci, očkování, péči o vhodnou výživu, inhalačním tréninku, vzdělávání a psychosociální podpoře. Adekvátní léčba specifická pro jednotlivé fenotypy se liší fenotyp od fenotypu a zahrnuje více než deset různých farmakologických a nefarmakologických strategií. Pokud je přítomen více než jeden klinický fenotyp, měla by se strategie léčby řídit projevy každého fenotypového označení zvlášť. U takových pacientů je zapotřebí multikomponentních terapeutických režimů, které vedou k plně individualizované péči. V budoucnu je třeba přijmout přísnější opatření proti kouření, zlepšit ochranu zdraví při práci a v životním prostředí, zavést strategie včasné diagnózy a identifikovat biomarkery pro pacienty, kteří reagují na specifickou léčbu. Očekává se, že nové třídy léčby (inhalační inhibitory PDE3/4, jednomolekulární duální bronchodilatátory, protizánětlivé léky, molekuly pro úpravu genů nebo nové bronchoskopické postupy) vstoupí do klinické praxe během několika málo let.

• MeSH
• chronická obstrukční plicní nemoc * diagnóza   etiologie   farmakoterapie   patofyziologie   MeSH
• fenotyp MeSH
• individualizovaná medicína * MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• management nemoci MeSH
• respirační funkční testy MeSH
• screeningové diagnostické programy MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

INTRODUCTION: Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published an update on the Global Strategy for Prevention, Diagnosis and Management of COPD, introducing a new classification of chronic obstructive pulmonary disease (COPD). Our aim was to assess the prognostic value of the new GOLD classification system in comparison with the previous GOLD classification systems (GOLD stages I-IV and GOLD groups A-D) and the BODE index. METHODS: We used the data of 784 patients with COPD from the Czech Multicenter Research Database of COPD. Patient survival was analyzed with the use of Kaplan-Meier estimate and Cox model of proportional risks. ROC analysis and area under curve (AUC) were used for comparison of GOLD classifications and BODE index. The analyses were performed with the use of software R (version 4.2.0). RESULTS: We analyzed data of 782 patients with complete data on GOLD classifications. The study population comprised 72.9% of men, 89.1% current or former smokers, with a mean age of 66.6 years, a mean BMI of 27.4 and a mean FEV1 44.9% of predicted. Probability of 5-year survival differed by GOLD classification. Application of the 2023 GOLD classification showed increased risk of death in group B (HR 1.82, 95% CI 1.14-2.92; p = 0.013) and in group E (HR 2.48, 95% CI 1.54-3.99; p˂0.001). The ROC analysis showed that the overall prognostic value of the 2023 GOLD classification was similarly weak to previous A-D GOLD classification schemes (AUCs 0.557-0.576) and was lower compared to the GOLD 1-4 system (AUC 0.614) and even lower when compared to the BODE index (AUC 0.715). CONCLUSION: We concluded that the new GOLD classification system has poor prognostic properties and that specific prediction tools (eg, the BODE index) should be used for mortality risk assessment.

• MeSH
• chronická obstrukční plicní nemoc * diagnóza   terapie   MeSH
• hodnocení rizik MeSH
• lidé MeSH
• prognóza MeSH
• progrese nemoci MeSH
• proporcionální rizikové modely MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Background: Adherence to inhaled medication constitutes a major problem in patients with chronic obstructive pulmonary disease (COPD) globally. However, large studies evaluating adherence in its entirety and capturing a large variety of potentially associated factors are still lacking. Objective: To study both elementary types of adherence to chronic inhaled COPD medication in "real-life" COPD patients and to assess relationships with a wide-ranging spectrum of clinical parameters. Methods: Data from the Czech Multicentre Research Database (CMRD) of COPD, an observational prospective study, were used. Overall adherence (OA) was evaluated with Morisky Medication Adherence Scale (©MMAS-4) and adherence to an application technique (A-ApplT) with the Five Steps Assessment. Mann-Whitney U test, Spearman's correlation, and logistic regression were used to explore relationships between variables. Results: Data of 546 participants (69.6% of all patients from the CMRD) were analyzed. Two-thirds self-reported optimal OA, but only less than one-third demonstrated A-ApplT without any error. OA did not correlate with A-ApplT. Next, better OA was associated with higher education, a higher number of inhalers, a lower rate of exacerbations, poorer lung function, higher degree of upper respiratory tract symptoms (SNOT-22), absence of depressive symptoms, ex-smoking status, regular mouthwash after inhaled corticosteroids (ICS), and flu vaccination. By contrast, better A-ApplT was associated with a lower number of inhalers, better lung function, and regular mouthwash after ICS. Independent predictors of nonoptimal OA included lower degree of education, absence of flu vaccination, anemia, depression, and peptic ulcer history, whereas independent predictors of lower A-ApplT were lower education, absence of regular mouthwash after ICS, and higher COPD Assessment Test score. Conclusions: Parameters associated with OA and A-ApplT differ, and those associated with both adherence domains are sometimes associated inversely. Based on this finding, we understand these as two separate constructs with an overlap.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, and at the same time it is associated with increased mortality and reduced quality of life. Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial. The system of long-term pulmonary rehabilitation care is insufficient. The main reasons for the absence of these outpatient programs are the lack of experience, the lack of interest of insurance companies in secondary prevention programs, and the lack of healthcare facilities in large geographical areas. The possibility of at-home pulmonary rehabilitation models (telemonitoring and telecoaching) could solve this problem. CASE SUMMARY: A 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method. Spirometry, body plethysmography, test of incremental respiratory endurance examination, 6-min walking test, body mass index, airflow obstruction, dyspnea, exercise capacity index, and subjective perception of dyspnea were performed as part of the initial and final examination. The patient performed training at home, and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems. After 8 wk of home training, there was a significant increase in all monitored values: maximal inspiratory pressure, a novel parameter sustained maximal inspiratory pressure, forced expiratory volume in 1 s, total lung capacity, forced vital capacity, peak expiratory flow, and inspiratory capacity. There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale, an increase in exercise tolerance according to the 6-min walking test, and a decrease in the exercise capacity index as a predictor of prognosis. CONCLUSION: Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.

• Publikační typ
• kazuistiky MeSH

OBJECTIVES: The BODE (BMI, Obstruction - FEV1, Dyspnoea - mMRC, Exercise - 6-MWT) and the ADO (Age, Dyspnoea - mMRC, Obstruction - FEV1) indices are widely used prognosis assessment tools for long-term mortality prediction in COPD patients but subject to limitations for use in daily clinical practice. The aim of this research was to construct a prognostic instrument that prevents these limitations and which would serve as a complementary prognostic tool for clinical use in these patients. METHODS AND PARTICIPANTS: The data of 699 COPD subjects were extracted from the Czech Multicentre Research Database (CMRD) of COPD patients (the derivation cohort) and analysed to identify factors associated with the long-term risk of mortality. These were entered into the ROC analysis and reclassification analysis. Those with the strongest discriminative power were used to construct the new index (CADOT). The new index was validated on 187 patients of the CIROCO+ cohort (Netherlands; the validation cohort). RESULTS: The CADOT was constructed by adding two newly identified prognosis-determining factors, chronic heart failure (CHF) and TLCO, to the ADO index. In a head-to-head comparison, the CADOT index showed highest c-statistic values compared to the BODE and ADO indices (0.701 vs 0.677 vs 0.644, respectively). The prognostic power was more definitive when applied to the Dutch validation (CIROCO+) cohort (0.842 vs 0.799 vs 0.825, respectively). CONCLUSIONS: The CADOT index has comparable prognostic power to the BODE and ADO indices. The CADOT is complementary/an alternative to the BODE (if 6-MWT is not feasible) and ADO (with less dependence on the age factor) indices. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01923051).

• MeSH
• chronická obstrukční plicní nemoc * mortalita   MeSH
• dyspnoe MeSH
• index tělesné hmotnosti MeSH
• lidé MeSH
• prognóza MeSH
• respirační funkční testy MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Chronická obstrukční plicní nemoc (CHOPN) je nejčastější chronická plicní nemoc, která postihuje stovky milionů lidí ve světě a je asociována se signifikantní morbiditou a mortalitou. V této přehledné práci autoři představují internistům aktuální koncept péče o pacienty s CHOPN, souhrn nejdůležitějších poznatků a doporučení formulované expertní skupinou České pneumologické a ftizeologické společnosti ČLS JEP. Detailnější verze pozičního dokumentu byla publikována v roce 2020 v anglickém jazyce. Cílem autorů této práce bylo přetavit nejnovější vědecké poznatky do kontextu reálné medicínské praxe v České republice. Koncept péče o pacienty s CHOPN je založen na komplexnosti přístupu k pacientovi s respektováním individuálních rysů jeho nemoci a snahou o maximální možnou míru individualizace léčby.

Chronic obstructive pulmonary disease (COPD) is a heterogenous condition affecting hundreds of millions of people worldwide. COPD is a major health problem associated with significant morbidity and mortality. In this review, the authors present the current concept of care for patients with COPD in the Czech Republic, along with a summary of treatment recommendations formulated by the expert group of the Czech Pneumological and Phthisiological Society. A more detailed version of the position paper was published in 2020. The aim of this work was to transform the most recent scientific knowledge into the context of daily practice in the Czech Republic. Our concept of care for patients with COPD uses a complex approach with special emphasis on individual phenotypic features of the disease. Maximal effort has been put into individualization of treatment according to the presence of certain clinical phenotypes/treatable traits with respect to current scientific knowledge.

• MeSH
• chronická obstrukční plicní nemoc * diagnóza   klasifikace   terapie   MeSH
• fenotyp MeSH
• individualizovaná medicína MeSH
• lidé MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Introduction: The concept of phenotyping emerged, reflecting specific clinical, pulmonary and extrapulmonary features of each particular chronic obstructive pulmonary disease (COPD) case. Our aim was to analyze prognostic utility of: "Czech" COPD phenotypes and their most frequent combinations, "Spanish" phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages + groups in relation to long-term mortality risk. Methods: Data were extracted from the Czech Multicenter Research Database (CMRD) of COPD. Kaplan-Meier (KM) estimates (at 60 months from inclusion) were used for mortality assessment. Survival rates were calculated for the six elementary "Czech" phenotypes and their most frequent and relevant combinations, "Spanish" phenotypes, GOLD grades and groups. Statistically significant differences were tested by Log Rank test. An analysis of factors underlying mortality risk (the role of confounders) has been assessed with the use of classification and regression tree (CART) analysis. Basic factors showing significant differences between deceased and living patients were entered into the CART model. This showed six different risk groups, the differences in risk were tested by a Log Rank test. Results: The cohort (n=720) was 73.1% men, with a mean age of 66.6 years and mean FEV1 44.4% pred. KM estimates showed bronchiectases/COPD overlap (HR 1.425, p=0.045), frequent exacerbator (HR 1.58, p<0.001), cachexia (HR 2.262, p<0.001) and emphysematous (HR 1.786, p=0.015) phenotypes associated with higher mortality risk. Co-presence of multiple phenotypes in a single patient had additive effect on risk; combination of emphysema, cachexia and frequent exacerbations translated into poorest prognosis (HR 3.075; p<0.001). Of the "Spanish" phenotypes, AE CB and AE non-CB were associated with greater risk of mortality (HR 1.787 and 2.001; both p=0.001). FEV1% pred., cachexia and chronic heart failure in patient history were the major underlying factors determining mortality risk in our cohort. Conclusion: Certain phenotypes ("Czech" or "Spanish") of COPD are associated with higher risk of death. Co-presence of multiple phenotypes (emphysematous plus cachectic plus frequent exacerbator) in a single individual was associated with amplified risk of mortality.

• MeSH
• chronická bronchitida * MeSH
• chronická obstrukční plicní nemoc * diagnóza   MeSH
• fenotyp MeSH
• lidé MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Španělsko MeSH

This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax <70%) and respiratory symptoms assessement (dyspnoea, exercise limitation, cough and/or sputum production. In order to establish definite COPD diagnosis, a five-step evaluation should be performed, including: 1/ inhalation risk assessment, 2/ symptoms evaluation, 3/ lung function tests, 4/ laboratory tests and 5/ imaging. At the same time, all alternative diagnoses should be excluded. For disease classification, this position paper uses both GOLD stages (1 to 4), GOLD groups (A to D) and evaluation of clinical phenotype(s). Prognosis assessment should be done in each patient. For this purpose, we recommend the use of the BODE or the CADOT index. Six elementary clinical phenotypes are recognized, including chronic bronchitis, frequent exacerbator, emphysematous, asthma/COPD overlap (ACO), bronchiectases with COPD overlap (BCO) and pulmonary cachexia. In our concept, all of these clinical phenotypes are also considered independent treatable traits. For each treatable trait, specific pharmacological and non-pharmacological therapies are defined in this document. The coincidence of two or more clinical phenotypes (i.e., treatable traits) may occur in a single individual, giving the opportunity of fully individualized, phenotype-specific treatment. Treatment of COPD should reflect the complexity and heterogeneity of the disease and be tailored to individual patients. Major goals of COPD treatment are symptom reduction and decreased exacerbation risk. Treatment strategy is divided into five strata: risk elimination, basic treatment, phenotype-specific treatment, treatment of respiratory failure and palliative care, and treatment of comorbidities. Risk elimination includes interventions against tobacco smoking and environmental/occupational exposures. Basic treatment is based on bronchodilator therapy, pulmonary rehabilitation, vaccination, care for appropriate nutrition, inhalation training, education and psychosocial support. Adequate phenotype-specific treatment varies phenotype by phenotype, including more than ten different pharmacological and non-pharmacological strategies. If more than one clinical phenotype is present, treatment strategy should follow the expression of each phenotypic label separately. In such patients, multicomponental therapeutic regimens are needed, resulting in fully individualized care. In the future, stronger measures against smoking, improvements in occupational and environmental health, early diagnosis strategies, as well as biomarker identification for patients responsive to specific treatments are warranted. New classes of treatment (inhaled PDE3/4 inhibitors, single molecule dual bronchodilators, anti-inflammatory drugs, gene editing molecules or new bronchoscopic procedures) are expected to enter the clinical practice in a very few years.

• MeSH
• bronchodilatancia normy   terapeutické užití   MeSH
• chronická nemoc terapie   MeSH
• chronická obstrukční plicní nemoc diagnóza   genetika   patofyziologie   terapie   MeSH
• dospělí MeSH
• fenotyp * MeSH
• lidé středního věku MeSH
• lidé MeSH
• péče orientovaná na pacienta normy   MeSH
• pneumologie normy   MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH