Predikcija ishoda skrbi bolesnika s kroničnom opstruktivnom plućnom bolesti u obiteljskoj medicini

master's thesis

• Title (english): Prediction of care outcomes in patients with chronic obstructive pulmonary disease in family medicine
• Author: Anera Lazić
• Mentor: Milica Katić (mentor)
• Committee member: Stanislava Stojanović-Špehar (predsjednik povjerenstva)
• Committee member: Venija Cerovečki Nekić (član povjerenstva)
• Committee member: Milica Katić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Family Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Family Medicine

Abstract

Kronična opstruktivna plućna bolest (KOPB) u suvremenoj medicinskoj znanosti ima daleko
veće značenje od tradicionalnog poimanja iste kao ireverzibilne opstrukcije dišnih puteva
dijagnosticirane spirometrijskim nalazom smanjenja forsiranog ekspiratornog volumena u prvoj
sekundi (FEV1). To je bolest koja u najvećem broju slučajeva ostaje nedijagnosticirana i
neprepoznata u kliničkoj praksi, koja smanjuje kvalitetu života bolesnika i povećava rizik
smrtnosti. Procjenjuje se da će do 2020. godine postati treći vodeći uzrok smrti u svijetu. Iako je
postavljanje dijagnoze naoko jednostavno sve se više govori o različitim fenotipovima KOPB-a
koji su od posebne važnosti za prepoznavanje i procjenjivanje ishoda skrbi. Osvještavanjem
činjenice da bolest uzrokuje sistemnu upalu u organizmu čovjeka pažnja kliničara mora se
usmjeravati na interakciju ove bolesti sa drugim kroničnim bolestima u komorbiditetu. Poznato je
da one zbog međusobne negativne interakcije utječu na mortalitet bolesnika. Pristupajući na taj
način, bolest se prepoznaje kao izrazito heterogena što zahtjeva od zdravstvenih
profesionalaca vrlo široki i istovremeno specifičan pristup svakom bolesniku ponaosob. Među
brojnim zdravstvenim profesionalcima koji sudjeluju u skrbi bolesnika s KOPB-om ključnu ulogu
u skrbi ima liječnik obiteljske medicine (LOM) kao liječnik prvog kontakta i liječnik koji provodi
kontinuiranu, sveobuhvatnu skrb populacije. Zadaci LOM su da aktivno pristupi reduciranju
rizičnih čimbenika za razvoj KOPB, dijagnosticiranju bolesti u ranoj fazi, te postizanje partnerstva
s bolesnikom u podijeljenoj trajnoj skrbi. Glavna kompetencija LOM-a je pružanje
bolesniku/osobi usmjerene skrbi što podrazumijeva procjenjivanje i liječenje bolesnika prema
individualnim značajkama bolesti. Razumijevanje specifične kliničke slike (fenotipa) u svakog
bolesnika i korištenje prognostičkih indeksa od iznimne je važnosti za izbor terapije i uspješnost
liječenja. Cilj ovog rada je prikazati najnovije spoznaje, probleme i kontroverze u pristupu
bolesniku oboljelom od KOPB-a u suvremenoj kliničkoj praksi.

Abstract (english)

Chronic obstructive pulmonary disease (COPD) in modern medical science has a far greater
significance than the traditional concept of the same as irreversible airway obstruction diagnosed
by spirometry reduction in forced expiratory volume in first second (FEV1). This disease in most
cases remains undiagnosed and unrecognized in clinical practice, reducing the quality of
patient’s life and increasing the risk of mortality. It is estimated that, by the year 2020., COPD
will be the third leading cause of death in the world. Although diagnosing COPD seems to be
simple, healthcare professionals validate new phenotypes of COPD that are of particular
importance for identifying and evaluating patient care outcomes. Recognizing that this disease
causes systematic inflammation, healthcare specialist must be aware of interaction with other
chronic diseases in comorbidity. Diseases in comorbidity potentiate mortality of COPD. COPD is
now widely recognized as a complex heterogeneous syndrome, which requires broad and, at the
same time, specific approach to each individual by healthcare professional. Among the many
healthcare professionals involved in patients care, general/family practitioners (GPs) play the
main role in COPD patient’s care, as doctors of first contact who provide permanent and
comprehensive care of population. Reducing risk factors for development of COPD, diagnosing
disease in early stage and achieving partnership with a patient in dividing continuous care, are
some of main tasks for GPs. According to the core competence of GPs, which is provision of
patient centred care, patient should be assessed and treated according to their individual
treatable characteristic. Recognition and validation of COPD phenotypes in each patient and
application of prognostic indices is of great importance in the selection of therapy and successful
treatment. The aim of this paper is to present new knowledge, issues and controversies in the
approach to patient suffering of COPD in contemporary clinical practice.

• Keywords: kronična opstruktivna plućna bolest; fenotipovi; prognostički indeksi; opća/obiteljska medicina
• Keywords (english): chronic obstructive pulmonary disease; fenotypes; prognostic indices; general/family medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:078922
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-27 08:24:09