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Pandémia ochorenia COVID-19 (COronaVIrus Disease 2019) spôsobená koronavírusom SARS -CoV-2 (severe acute respiratory syndrome coronavirus 2) zapríčinila milióny úmrtí a mnoho pacientov má po prekonaní akútneho stavu chronické následky. V snahe o zastavenie šírenia vírusu boli vyvinuté viaceré očkovacie látky, ktoré však majú potenciálne vážne nežiaduce účinky. Prezentujeme kazuistiku pacienta s akútnymi (myokarditída, exacerbácia bronchiálnej astmy) aj dlhodobými (syn- dróm posturálnej ortostatickej tachykardie − POTS) komplikáciami po očkovaní druhou dávkou mRNA vakcíny BNT162b2 (Comirnaty®). Liečba pozostáva z režimových opatrení, početnej farmakoterapie (metoprolol, ivabradín, kortikosteroidy, antihistaminiká, antiflogistiká, bronchodilatanciá) a viacerých nutraceutík (extrakt z borovice prímorskej, kvercetín, vitamíny, horčík, fosfatidylcholín). V diskusii analyzujeme povakcinačné poškodenie a prinášame krátky prehľad z aktuálnej literatúry.

The pandemic of the disease COVID-19 (COronaVIrus Disease 2019) caused by the SARS-CoV-2 coronavirus (severe acute respiratory syndrome coronavirus 2) resulted in millions of deaths and many patients have chronic consequences after overcoming the acute condition. Several vaccines have been developed in an effort to stop the spread of the virus, but they have potentially serious adverse effects. We present a case report of a patient with acute (myocarditis, exacerbation of bronchial asthma) and long-term (postural orthostatic tachycardia syndrome - POTS) complications after vaccination with the second dose of mRNA vaccine BNT162b2 (Comirnaty®). Treatment consists of regimen measures, numerous pharmacotherapy (metoprolol, ivabradine, corticosteroids, antihistamines, antiphlogistics, bronchodilators) and several nutraceuticals (maritime pine bark extract, quercetin, vitamins, magnesium, phosphatidylcholine). In the discussion, we analyze post-vaccination injury and present a short review of the current literature.

Článek

Baseline reticular basement membrane morphology is related to subsequent spirometry deterioration in pediatric chronic airway inflammation: a follow-up study

American journal of physiology. Lung cellular and molecular physiology. 2023 ; 325 (2) : L125-L134. [pub] 20230606

Am J Physiol Lung Cell Mol Physiol
ISSN 1522-1504
Medvik
Zdroj

Reticular basement membrane (RBM) thickening may occur in children with allergic bronchial asthma (BA), cystic fibrosis (CF), and primary ciliary dyskinesia (PCD). Its functional consequences remain unknown. We investigated the relationship between baseline RBM thickness and subsequent spirometry. In our cohort follow-up study, patients aged 3-18 yr with BA, CF, and PCD and controls underwent baseline lung clearance index (LCI) measurement, spirometry, and endobronchial biopsy sampling. Total RBM and collagen IV-positive layer thickness were measured. Trends in forced vital capacity (FVC), forced expired volume in 1 s (FEV1), and FEV1/FVC were analyzed during follow-up, and their relationship to baseline characteristics was studied using univariate analysis and multiple regression models. Complete baseline data were available in 19 patients with BA, 30 patients with CF, 25 patients with PCD, and 19 controls. The RBM was thicker in patients with BA (6.33 ± 1.22 μm), CF (5.60 ± 1.39 μm), and PCD (6.50 ± 1.87 μm) than in controls (3.29 ± 0.55 μm) (all P < 0.001). The LCI was higher in patients with CF (15.32 ± 4.58, P < 0.001) and PCD (10.97 ± 2.46, P = 0.002) than in controls (7.44 ± 0.43). The median follow-up times were 3.6, 4.8, 5.7, and 1.9 years in patients with BA, CF, PCD, and controls, respectively. The z-scores of FEV1 and FEV1/FVC deteriorated significantly in all groups except in controls. In patients with CF and PCD, trends in FEV1z-scores correlated with baseline LCI and RBM; in BA, it correlated with collagen IV. In multiple regression models, RBM morphology and ventilation inhomogeneity could predict up to 84.4% of variability in spirometry trends. In conclusion, baseline LCI value and RBM morphology may predict trends in subsequent spirometry.NEW & NOTEWORTHY This paper deals with the relationship between reticular basement membrane (RBM) morphology at baseline and follow-up spirometry in children with asthma, cystic fibrosis, and primary ciliary dyskinesia. For the first time, to our knowledge, the possibility to predict subsequent lung function development using selected baseline characteristics (reticular basement membrane morphology from endobronchial biopsy and ventilation inhomogeneity from nitrogen multiple breath washout test) is proposed. Corresponding predictive models are presented.

Článek

Chronický kašel
[Chronic cough]

Šestáková, Zuzana
Autor Autorita 1. klinika tuberkulózy a respiračních nemocí 1. LF UK a VFN v Praze

Časopis lékařů českých. 2022 ; 161 (6) : 232-235.

ISSN 0008-7335
Medvik
Zdroj

Kašel je nejčastějším příznakem onemocnění dýchacích cest, ale je také jedním z nejdůležitějším obranných mechanismů lidského organizmu. Často je obtížné stanovit, kdy tento obranný reflex přestane plnit svou fyziologickou úlohu a stane se patologickým. Kašel není diagnózou, je symptomem různých onemocnění a jejich kombinací. Často se nerozlišuje chronický kašel (kašel trvající osm týdnů a déle) od chronické bronchitidy. Ta je definována chronickým produktivním kašlem trvajícím alespoň 3 měsíce ve dvou po sobě jdoucích letech a zároveň vyloučením jiné příčiny kašle. Chronický kašel je spojen se špatnou kvalitou života. Nemoci způsobující chronický kašel jsou nejčastěji astma, eozinofilní bronchitida, gastroezofageální reflux, syndrom zadní rýmy, rinosinusitida, chronická obstrukční plicní nemoc, plicní fibróza a bronchiektázie. Léčba základní etiologie kašle je až v 90 % úspěšná. Příčina chronického kašle často nemusí byt objasněná, a proto vyžaduje multidisciplinární přístup.

Cough is the most common symptom of respiratory diseases, but it is also one of important defense mechanisms of the human body. It is often difficult to determine when this defensive reflex ceases to fulfill its physiological role and becomes pathological. Cough is not diagnosis; it is the symptom of various diseases and their combination and is the most common symptom of diseases of the respiratory system. Often the definition of chronic cough is confused with the definition of chronic bronchitis, which is defined as a chronic productive cough lasting at least three months in two consecutive years, while other causes of cough are excluded. Chronic cough is associated with poor quality of life and can negatively affect quality of life. Diseases causing chronic cough are most commonly asthma, eosinophilic bronchitis, gastroesophageal reflux, post-nasal drip syndrome, rhinosinusitis, chronic obstructive pulmonary disease, pulmonary fibrosis, and bronchiectasis. Treatment of the underlying etiology of the cough leads to a success rate of up to 90 %. The cause of chronic cough may not be clear and therefore requires a multidisciplinary approach.

MeSH
bronchiální astma patologie terapie MeSH
chronická nemoc MeSH
gastroezofageální reflux patologie MeSH
kašel * etiologie patofyziologie MeSH
lidé MeSH
Check Tag
lidé MeSH
Publikační typ
přehledy MeSH

Článek

Novinky v inhalační léčbě astmatu

Bártů, Václava
Autor Autorita Plicní oddělení, Medicon, a.s., Praha

Profi medicína. 2022 ; 7 (8) : 27-28.

ISSN 2571-2527
Medvik
Zdroj

Článek

Etiopatogenéza detskej bronchiálnej astmy ako kľúč k detailnému pochopeniu komplexnej heterogenity ochorenia – 1. časť (fenotypy)
[Ethiopathogenesis of bronchial asthma in children as a key to detailed understanding of complex disease heterogeneity – 1. part (phenotypes)]

Alergie (Praha, Print). 2022 ; 24 (2) : 92-95.

ISSN 1212-3536
Medvik
Zdroj

Model bronchiálnej astmy v kontexte nových poznatkov sa vyznačuje značnou heterogenitou klinického priebehu, vyvolávajúcich príčin, terapeutickou odpoveďou a pridružených komorbidít. Čoraz väčšie úsilie je vynakladané k určeniu jednotlivých subtypov, pretože rozdielnosť definovaných patomorfologických zložiek procesu je príznačná pre celé spektrum ochorenia. Súbor variabilných patologických zápalových kaskád vytvára rozličnú mieru symptomatologickej manifestácie. Súhra mnohých faktorov od predominantných cytokínov zápalu, mikrobiómu bronchov, genetickej predispozície, až po vystavenia exogénnych nox v spleti vzájomných interakcií vytvára u každého pacienta charakteristické klinické vlastnosti ochorenia – fenotypy astmy. Aj najnovšia revízia odporúčaní GINA 2021 (Global Initiative for Asthma) poukazuje na potrebu čo najskoršej detailnej fenotypizácie astmy s cieľom adekvátneho výberu liečebnej stratégie na princípe precíznej, teda personalizovanej medicíny. Začlenením konkrétneho prípadu astmy do fenotypu na základe charakteristickej klinickej symptomatologickej prezentácie v časom slede nám môže pomôcť k predikcii závažnosti a terapeutickej responzivity ochorenia.

Heterogeneity of clinical cases, causing factors and therapeutic effect and associated comorbidities determinates bronchial asthma in the context of new discoveries. Challenging task is to dissect it into subgroups because of the heterogeneity present across the spectrum of the disease. The spectrum of variable pathological inflammatory cascades creates varying degrees of symptomatologic manifestation. Combination of many factors from predominated inflammation cytokines, microbiome of bronchi, genetic predisposition and exposition to exogenous noxes creates characteristic clinical properties of disease – asthma phenotypes. Recent GINA 2021 guidelines (Global Initiative for Asthma) indicate the demand of the earliest detailed phenotypisation of asthma to make an adequate selection in the therapeutic strategy based on the accurate, thus personalized medicine. Incorporating a specific asthma case into a phenotype based on its characteristic clinical symptom presentation over time may help us to predict the severity and therapeutic responsiveness of the disease.