The small airways, also referred to as the lung's silent zone, are closely associated with poor symptom control and more frequent asthma exacerbations. The oscillometry technique superimposes sound or airwaves onto normal tidal breathing and provides information on resistance and reactance, that is, obstacles to airflow occurring inside and outside of the bronchi. More recently, a management paradigm based on so-called "treatable traits" has been proposed to personalize and improve asthma care for individuals by proactively identifying and targeting modifiable pulmonary, extrapulmonary, and behavioral traits affecting asthma control. In this review article, we evaluate the literature on small airways dysfunction as a potential treatable trait in persistent asthma. In particular, we discuss whole- and intrabreath oscillometry and the impact of extrafine inhaled corticosteroids and systemic biologics on the peripheral airways.

• MeSH
• Asthma * physiopathology   drug therapy   diagnosis   MeSH
• Adrenal Cortex Hormones therapeutic use   MeSH
• Humans MeSH
• Oscillometry * methods   MeSH
• Lung physiopathology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: Sex and gender influence many aspects of chronic obstructive pulmonary disease (COPD). Limited data are available on this topic in alpha-1 antitrypsin deficiency (AATD). We therefore aimed to investigate sex issues in the EARCO registry, a prospective, international, observational cohort study. METHODS: Baseline data from PiZZ individuals, enrolled in the registry with complete data on sex and smoking history were analysed by group comparisons and binary logistic regression analyses. RESULTS: 1283 patients with AATD, 49.3% women were analysed. Females reported less tobacco consumption (16.8±12.2 vs. 19.6±14.5 PY, p=0.006), occupational exposures towards gases, dusts or asbestos (p<0.005 each) and consumed less alcohol (5.5±7.6 vs. 8.4±10.3u/week, p<0.001). Females reported COPD (41% vs. 57%, p<0.001) and liver disease (11% vs. 20%, p<0.001) less often. However, they had a higher prevalence of bronchiectasis (24% vs. 13%, p<0.001). Despite better lung function (FEV1%pred. 73.6±29.9 vs. 62.7±29.5, p<0.001) females reported a similar symptom burden (CAT 13.4±9.5 vs. 12.5±8.9, p=ns) and exacerbation frequency (at least one in the previous year 30% vs. 26%, p=ns) compared to males. In multivariate analyses, female sex was an independent risk factor for exacerbations in the previous year OR 1.6 p=0.001 in addition to smoking history, COPD, asthma and bronchiectasis and was also identified as risk factors for symptom burden (CAT≥10) OR 1.4 p=0.014 besides age, BMI, COPD and smoking history. CONCLUSION: Men had higher rates of COPD and liver disease, women were more likely to have bronchiectasis. Women's higher symptom burden and exacerbation frequency suggest they may need tailored treatment approaches.

• MeSH
• Bronchiectasis epidemiology   etiology   MeSH
• Pulmonary Disease, Chronic Obstructive epidemiology   etiology   MeSH
• alpha 1-Antitrypsin Deficiency * epidemiology   complications   MeSH
• Comorbidity MeSH
• Smoking epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Liver Diseases epidemiology   etiology   MeSH
• Alcohol Drinking epidemiology   MeSH
• Occupational Exposure adverse effects   MeSH
• Prevalence MeSH
• Prospective Studies MeSH
• Registries * MeSH
• Aged MeSH
• Sex Factors MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Comparative Study MeSH

Deficit alfa-1 antitrypsinu (AATD) je jednou z nejčastějších dědičných genetických poruch dospělých na světě postihující kromě funkce plic i jaterní tkáň a zřídka kůži. Stále se jedná o diagnózu, která je výrazně poddiagnostikovaná (1, 2). Poprvé byla popsána před více než 60 lety vědci ve švédské univerzitě Lund a je způsobena poruchou genu pro inhibitory serinových proteáz skupiny A1 (SERPINA1, chromozom 14q32.13, wild type M), který kóduje vznik alfa-1 antitrypsinu (AAT), nejdůležitější antiproteázy v plicích (3). Při AATD dochází k vytváření menšího množství AAT, k vytváření neplnohodnotného AAT nebo k produkci AAT nedochází. Nedostatečná/nesprávná tvorba AAT v játrech vedoucí k nižší sérové hladině, logicky vede ke snížení jeho koncentrace v plicích, což způsobuje časnější vznik panacinárního emfyzému, bronchiektázií (BE) a následně i vznik chronické obstrukční plicní nemoci (CHOPN, COPD). Případné hromadění defektních proteinů v játrech vede v dětství k cholestáze, v pozdějším věku ke zvýšení rizika jaterní cirhózy či dokonce karcinomu (CA) jater. Výše uvedená plicní postižení jsou způsobena převahou proteáz nad účinkem inhibitorů serinových proteáz, jejichž tvorba je u nosičů defektních alel nedostatečná (4–6). Kouření vede k zásadnímu urychlení patologických procesů v plíci, které probíhají také u nekouřící populace s AATD, avšak výrazně pomaleji než u kuřáků. Hlavně u nositelů homozygotní varianty PiZZ a Pi00 (Pi – proteinázový inhibitor) vede kouření poměrně záhy k těžkému snížení hladiny AAT v séru. Cílem současného přístupu k pacientům s AATD je časná diagnostika onemocnění, sledování v čase a správné načasovaní terapie včetně augmentační (4, 7, 8).

Alpha-1 antitrypsin deficiency (AATD) is one of the most common inherited genetic disorders in adults worldwide, affecting not only lung function but also liver tissue and, rarely, the skin. It is still a significantly underdiagnosed diagnosis (1, 2). First described more than 60 years ago by scientists at Lund University in Sweden, it is caused by a defect in the serine protease inhibitor group A1 gene (SERPINA1, chromosome 14q32.13, wild-type M), which codes for the production of alpha-1 antitrypsin (AAT), the major antiprotease in the lungs (3). In AATD, less AAT is produced, insufficient AAT is produced, or no AAT is produced. Inadequate/faulty AAT production in the liver leading to lower serum levels, logically leads to lower AAT concentrations in the lungs, causing earlier onset of panacinar emphysema, bronchiectasis (BE) and subsequently chronic obstructive pulmonary disease (COPD). The eventual accumulation of defective proteins in the liver leads to cholestasis in childhood and to an increased risk of cirrhosis or even carcinoma (CA) of the liver later in life. The abovementioned lung diseases are caused by the predominance of proteases over the effect of serine protease inhibitors, the production of which is deficient in carriers of defective alleles (4-6). Smoking significantly accelerates the pathological processes in the lungs, which also occur in the non-smoking population with AATD, but at a much slower rate than in smokers. Particularly in carriers of the homozygous PiZZ and Pi00 (Pi - proteinase inhibitor) variants, smoking leads to a relatively early and severe reduction in serum AAT levels. The current approach to patients with AATD is to diagnose the disease at an early stage, monitor the disease over time and determine the correct timing of therapy, including augmentation therapy (4, 7, 8).

• MeSH
• Pulmonary Disease, Chronic Obstructive etiology   genetics   therapy   MeSH
• alpha 1-Antitrypsin Deficiency * epidemiology   genetics   complications   MeSH
• Smoking adverse effects   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Inflammatory lung diseases (ILDs) represent a global public health crisis characterized by escalating prevalence, significant morbidity, and substantial mortality. In response to the complex immunopathogenic mechanisms driving these conditions, novel pharmacological strategies targeting resolution pathways have emerged throughout the discovery of specialized pro-resolving lipid mediator (SPM; resolvins, maresins, and protectins) dysregulation across the ILD spectra, positioning these endogenous molecules as promising therapeutic candidates for modulating maladaptive inflammation and promoting tissue repair. Over the past decade, this paradigm has catalyzed extensive translational research into SPM-based interventions as precision therapeutics for respiratory inflammation. In asthma, they reduce mucus hypersecretion, bronchial hyperreactivity, and airway inflammation, with prenatal SPM exposure potentially lowering offspring disease risk. In COPD, SPMs attenuate amyloid A-driven inflammation, normalizing cytokine/chemokine imbalances and oxidative stress and mitigating COVID-19-associated cytokine storm, enhancing survival. This review synthesizes SPMs' pharmacotherapeutic mechanisms in ILDs and evaluates current preclinical and clinical evidence.

• MeSH
• Pulmonary Disease, Chronic Obstructive drug therapy   metabolism   MeSH
• COVID-19 metabolism   MeSH
• Docosahexaenoic Acids therapeutic use   metabolism   MeSH
• Humans MeSH
• Lung Diseases * drug therapy   metabolism   MeSH
• SARS-CoV-2 MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Každý operačný výkon predstavuje u pacienta určité riziko a možnosť vzniku pooperačných komplikácii, hoci ide o bežne vykonávanú operáciu. Najčastejšie sa komplikácie vyskytujú u obéznych pacientov, kedy aj z banálnej operácie môže pacient skončiť na oddelení poskytujúcom intenzívnu starostlivosť a bojovať tak o svoj život. U obéznych pacientov je poskytovanie intenzívnej starostlivosti náročnejšie, nakoľko je potrebné u nich saturovať všetky základné potreby od prijímania potravy cez hygienu až po vyprázdňovanie. Cieľom príspevku je predstaviť a opísať priebeh liečby a ošetrovateľskej starostlivosti u extrémne obéznej pacientky po cholecystektómii, ktorej stav si vyžadoval intenzívnu starostlivosť z dôvodu rozvíjajúcej sa sepsy v oblasti operačnej rany, kde bolo potrebné využitie inovatívnych liečebných postupov a metód pri jej hojení. Metodika: Pomocou kvalitatívneho výskumu formou kazuistiky, opisujeme zaujímavý prípad pacientky, ktorá si vyžadovala 95 dňovú hospitalizáciu na intenzívnom oddelení s ťažkou sepsou, kardiovaskulárnym zlyhávaním, nutnosťou umelej pľúcnej ventilácie (UVP), s využitím VAC systému (vacuum assisted closure) na hojenie rany, dekubitmi rôznych stupňov, infekčnou hnačkou a syndrómom závislosti od UVP. Výsledky: Pacientka preložená z chirurgickej jednotky intenzívnej starostlivosti (JIS) v poruche vedomia, s potrebou zabezpečenia dýchacích ciest, napojenia na UVP, potrebou vazopresorickej podpory, septickým stavom, rozpadom operačnej rany a potrebou korekcie glykémie inzulínom v lineárnom dávkovači. Po cirkulačnej stabilizácii pacientky na 13. deň hospitalizácie bol naložený chirurgom do operačnej rany VAC systém, ktorý sa v pravidelných intervaloch menil. Počas hospitalizácie stav pacientky komplikovaný vznikom dekubitov a Clostridioides difficile infection (CDI). U pacientky postupne vznikol syndróm závislosti na UVP, preto extubovaná až na 91. deň. Na 95. deň pacientka v stabilizovanom stave so zhojenými dekubitmi, preliečenou CDI infekciou a s VAC systémom preložená na oddelenie dlhodobo chorých. Aj banálna operácia môže skončiť bojom o život. U extrémne obéznych pacientov je riziko komplikácii vyššie, nakoľko trpia viacerými ochoreniami, ktoré spomaľujú proces hojenia rán a zároveň zvyšujú nároky na poskytovanú ošetrovateľskú starostlivosť vo všetkých oblastiach. Zachránený život však prevyšuje všetky nároky a je najväčšou odmenou pre celý personál oddelenia.

Every surgical procedure represents a certain risk and possibility of developing a patient. postoperative complications, although it is a commonly performed operation. Most often, complications occur in obese patients, when even a banal operation can cause a end up in an intensive care unit and fight for their lives. In obese patients, the provision of intensive care is more difficult, as it is necessary to restoreall basic needs from foodintake to hygiene to defecation. The aim of the paper is to present and describe the course of treatment and nursing care in an extremely obese cholecystectomy patient who secondition required intensive care for developing sepsis in the area of the surgical wound, as a result of which the wound It fell apart and it was necessary to use innovative treatments and methods to heal it. Methodology: Using qualitative research in the form of a case report, we describe an interesting the case of a patient who required 95 days of hospitalization in an intensive care unit with severe sepsis, cardiovascular failure, the need for artificial pulmonary ventilation (APV), using the VAC system (vacuum assisted closure) wound healing, pressure ulcers of varying degrees, infectious diarrhea and addictionsyndrome UVP. Results: Patient transferred from the surgical intensive care unit (ICU) in a disorder of consciousness, with a need securing the respiratory tract, connection to UVP, the need for vasopressor support, septic condition, disintegration of the surgical wound and the need for glucose correction with insulin in lineardispenser. After circulatory stabilization of the patient on the 13th day of hospitalization, loaded by the surgeoninto the surgical wound of the VAC system, which at regular intervals Changed. During hospitalization, the patient’s condition is complicated by the development of pressure ulcers and Clostridioides difficile infection (CDI). The patient gradually developed UVP dependence syndrome, so shewasextubated on day 91. At the 95. day a patient in a stablecondition with healed pressure ulcers, retreated CDI infection and with the VAC system transferred to the long-term care unit. Even a banal operation can end in a fight for life. In extremely obese patients, it is the risk of complications is higher, as they suffer from several diseases that slowdown the process of wound healing and at the sametimeincrease the demands on the nursing care provided in the allareas. However, a life saved exceed sall claims and is the grea test reward for the entire staff of the department.

• MeSH
• Clostridioides difficile MeSH
• Surgical Wound Dehiscence nursing   therapy   MeSH
• Pressure Ulcer nursing   therapy   MeSH
• Wound Healing MeSH
• Obesity complications   MeSH
• Critical Care Nursing MeSH
• Critical Care MeSH
• Pulmonary Ventilation MeSH
• Postoperative Complications nursing   therapy   MeSH
• Sepsis MeSH
• Negative-Pressure Wound Therapy MeSH
• Treatment Outcome MeSH
• Publication type
• Case Reports MeSH

Autorka v príspevku uvádza kazuistiku pacienta s pokročilou granulomatózou s polyangitídou, ktorý bol privezený po úspešnej kardiopulmonálnej resuscitácii v rámci infarktu myokardu v ťažkom kardiogénnom šoku a vyžadoval umelú pľúcnu ventiláciu. Autorka sa snaží poukázať na závažnosť základného ochorenia, s ktorým sa v súčasnej dobe stretávame čoraz častejšie. Zároveň vyzdvihuje dôležitosť primárnej zdravotnej starostlivosti, ktorá prispieva k správnej diagnostike a liečbe ochorenia.

The author presents a case study of a patient with advanced granulomatosis with polyangiitis, who was admitted after successful cardiopulmonary resuscitation due to myocardial infarction in severe cardiogenic shock and required mechanical ventilation. The author aims to high light the severity of the underlying disease, which is being encountered increasingly often in contemporary practice. At the same time, the author emphasizes the importance of primary healthcare in contributing to the accurate diagnosis and treatment of the disease

• MeSH
• Granulomatosis with Polyangiitis diagnostic imaging   etiology   classification   physiopathology   therapy   MeSH
• Myocardial Infarction nursing   therapy   MeSH
• Shock, Cardiogenic MeSH
• Critical Care Nursing MeSH
• Critical Care MeSH
• Pulmonary Ventilation MeSH
• Treatment Outcome MeSH
• Publication type
• Case Reports MeSH

Díky novým technologiím a vyššímu důrazu kladenému na bezpečnostní profil léčiv dochází k postupnému zlepšování lékových forem, což je také případ inhalačního kortikosteroidu beklometason dipropionátu, kdy jeho extra-fine formulace vede vklinické praxi ke snížení jeho nominální dávky až 2,5krát. Článek podrobněji popisuje dopady této transformace vefixních kombinovaných přípravcích, tj. depozici extra-fine částic vcentrální i periferní části plic, nižší systémovou expozici a v neposlední řadě taky pozitivní vliv u skupiny pacientů s astmatem, CHOPN a snížení rizika výskytu pneumonie.

Thanks to advancements and increased emphasis on the safety profile of medications, there is a gradual improvement in the development of pharmaceutical forms. One such change has been implemented in the inhaled corticosteroid beclomethasone dipropionate, resulting in a 2.5× reduction in its nominal clinical dose. The article provides a detailed description of the effects of this transformation in fixed combination preparations, i.e., the deposition of extra-fine particles in both the central and peripheral parts of the lungs, lower systemic exposure, and, last but not least, the positive impact on patients with asthma, COPD, and a reduced risk of pneumonia.

• MeSH
• Administration, Inhalation MeSH
• Beclomethasone * administration & dosage   pharmacology   therapeutic use   MeSH
• Asthma * drug therapy   MeSH
• Pulmonary Disease, Chronic Obstructive * drug therapy   MeSH
• Drug Combinations MeSH
• Formoterol Fumarate administration & dosage   pharmacology   therapeutic use   MeSH
• Humans MeSH
• Pneumonia prevention & control   MeSH
• Randomized Controlled Trials as Topic MeSH
• Check Tag
• Humans MeSH

Buteykova metoda je známá díky technikám vědomé kontroly dechu, které se zaměřují na zlep- šení funkce dýchacího systému. Cílem této studie bylo zhodnotit vliv Buteykovy metody na kli- dovou spirometrii u aktivní populace. Účastníci studie byli studenti Jihočeské univerzity (n = 22, věk = 23,23 ± 2,39 let; hmotnost = 73,23 ± 12,33 kg; výška = 174,72 ± 9,76 cm), kteří byli náhodně rozděleni do intervenční (n = 11) a kontrolní (n = 11) skupiny. Intervenční skupina podstoupila šestitýdenní program dechových cvičení založený na Buteykově metodě, který zahrnoval redukované dýchání a zádrže dechu při chůzi. Kontrolní skupina neprováděla žádná dechová cvičení. Před a po intervenci byly u všech účastníků naměřeny hodnoty FVC, FEV1 a FEV1/FVC pomocí spirometrie. Výsledky ukázaly mírný pokles FVC v intervenční skupině o 3,33 % z 5,29 ± 0,98 l na 5,10 ± 0,99 l, bez statistické či věcné významnosti (p = 0,85; ηp2 = 0,0009). Změny hodnoty FEV1 v intervenční skupině byly minimální (z 4,35 ± 0,87 l·s−1 na 4,32 ± 0,74 l·s−1), stejně jako u kontrolní skupiny (z 4,19 ± 0,76 l·s−1 na 4,20 ± 0,74 l·s−1), bez věcné i statistické významnosti (p = 0,93; ηp2 = 0,0001). Parametr FEV1/FVC se v obou skupinách mírně zvýšil, přičemž tento vzestup nebyl statisticky vý- znamný (p = 0,73; ηp2 = 0,002). Z výsledků vyplývá, že šestitýdenní intervence Buteykovy metody neměla významný dopad na změny spirometrických parametrů u aktivní populace.

Buteyko method is well-known for its techniques of conscious breath control, which focus on improving respiratory system function. The aim of this study was to assess the impact of the Buteyko method on resting spirometry in an active population. Participants in the study were students of the University of South Bohemia (n = 22, age = 23.23 ± 2.39 years; weight = 73.23 ± 12.33 kg; height = 174.72 ± 9.76 cm), who were randomly assigned to either the intervention (n = 11) or control (n = 11) group. The intervention group underwent a six-week breathing exercise program based on the Buteyko method, which included reduced breathing and breath-holding during walking. The control group did not perform any breathing exercises. Spirometric values, including FVC, FEV1, and FEV1/FVC, were measured before and after the intervention for all participants. The results showed a slight decrease in FVC in the intervention group by 3.33 % from 5.29 ± 0.98 l to 5.10 ± 0.99 l, with no statistical or practical significance (p = 0,85; ηp2 = 0,0009). Changes in FEV1 in the intervention group were minimal (from 4.35 ± 0.87 l.s-1 to 4.32 ± 0.74 l.s-1), as were those in the control group (from 4.19 ± 0.76 l.s-1 to 4.20 ± 0.74 l.s-1), with no practical or statistical significance (p = 0,93; ηp2 = 0,0001). The FEV1/FVC ratio slightly increased in both groups, but this increase was not statistically significant (p = 0,73; ηp2 = 0,002). The results suggest that the six-week Buteyko method intervention did not have a significant impact on changes in spirometric parameters in an active population.

• Keywords
• Buteykova metoda,
• MeSH
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Pulmonary Ventilation physiology   MeSH
• Respiratory Function Tests methods   MeSH
• Spirometry * methods   MeSH
• Healthy Volunteers MeSH
• Healthy Lifestyle * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Publication type
• Clinical Study MeSH

INTRODUCTION: Studies indicate that chronic treatment with mucoactive drugs may reduce COPD exacerbation rates. This real-world, multicenter, prospective, observational study aimed to determine the effect of long-term mucoactive treatment on exacerbations in patients with COPD in the Czech Republic. METHODS: 452 adult patients on the Czech Multicenter Research Database of COPD with post-bronchodilator FEV1 ≤ 60% of predicted value received standard of care and were followed up for 5 years. For the first 24 months, 81 patients received regular thiol-based mucoactive drugs (77 erdosteine, 4 N-acetylcysteine) at the discretion of the treating physician and 371 patients had no mucoactive treatment (control group). Erdosteine was fully reimbursed, and NAC was partially reimbursed for COPD patients. The annual number/rate of COPD exacerbations over 5 years was monitored. RESULTS: Patients receiving mucoactive treatment for 24 months had a significantly larger reduction from baseline in all exacerbations compared to the control group (- 0.61 vs - 0.18, p = 0.026; - 0.54 vs - 0.09, p = 0.007; - 0.55 vs 0.04, p = 0.005; - 0.67 vs 0.13, p = 0.002; - 0.53 vs 0.10, p = 0.019 in the first to fifth year, respectively). The reduction in moderate exacerbations was also significantly larger in those receiving mucoactive treatment versus no mucoactive treatment. The exacerbation rate was reduced to a greater extent in the subgroups with cough or with stage 3‒4 COPD who received mucoactive treatment but was independent of the use of inhaled corticosteroids (ICS). CONCLUSION: Mucoactive treatment for two years reduced the number of COPD exacerbations (all, moderate) over five years of follow-up. The reduction in exacerbations was more pronounced in patients with cough or with stage 3‒4 COPD but was independent of the use of ICS.

• MeSH
• Acetylcysteine * therapeutic use   MeSH
• Time Factors MeSH
• Pulmonary Disease, Chronic Obstructive * drug therapy   physiopathology   diagnosis   MeSH
• Expectorants * therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Disease Progression MeSH
• Prospective Studies MeSH
• Aged MeSH
• Forced Expiratory Volume MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Geographicals
• Czech Republic MeSH

• Keywords
• erdostein,
• MeSH
• Adrenergic beta-2 Receptor Agonists administration & dosage   pharmacology   therapeutic use   MeSH
• Muscarinic Antagonists administration & dosage   pharmacology   therapeutic use   MeSH
• Administration, Inhalation MeSH
• Pulmonary Disease, Chronic Obstructive * etiology   therapy   MeSH
• Expectorants pharmacology   therapeutic use   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH