Osobitosti pneumonija u bolesnika s kroničnom opstruktivnom bolesti pluća

master's thesis

• Title (english): Characteristics of pneumonia in patients with chronic obstructive pulmonary disease
• Author: Andrea Burić
• Mentor: Andrea Vukić Dugac (mentor)
• Committee member: Mateja Janković Makek (predsjednik povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Committee member: Andrea Vukić Dugac (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Kroničnu opstruktivnu plućnu bolest (KOPB) karakterizira trajna prisutnost respiratornih
simptoma uz ograničenje protoka zraka kroz dišne puteve kao posljedica abnormalnosti dišnih puteva
i/ili alveola. Obično je uzrokovana značajnim i dugotrajnim izlaganjem štetnim česticama ili
plinovima. Osnovu liječenja čine inhalacijski bronhodilatatori, sami ili u kombinaciji sa inhalacijskim
kortikosteroidima. Egzacerbacije se definiraju kao akutno pogoršanje respiracijskih simptoma koje
dovode do promjene terapije. Vodeći su uzrok hospitalizacija, ali i mortaliteta.
Pneumonija je akutno upalno stanje plućnog parenhima čiji uzročnici mogu biti bakterije, virusi ili
gljive. Najviša incidencija pneumonija je opisana upravo u pacijenata s kroničnom opstruktivnom
bolesti pluća. Bitni rizični čimbenici koji pridonose razvoju pneumonija u bolesnika s KOPB-om su
muški spol, starija životna dob, teži stadij KOPB-a, pojava češćih egzacerbacija, prisutnost malignih
bolesti i nizak ITM. Pacijenti koji su na terapiji inhalacijskim kortikosteroidima također imaju
povećani rizik od pneumonije. Rizik je veći što je doza IKS veća, ali je pokazana i različita povezanost
ovisno o vrsti molekule te se najveći rizik veže uz flutikazon. Streptococcus pneumoniae je uzročnik
koji se najčešće povezuje s pneumonijama u bolesnika s KOPB-om te se procjenjuje da je ta bakterija
odgovorna za čak 85-90% infekcija. Također je ustanovljena veća učestalost pneumonija uzrokovanih
Pseudomonas aureginosa u odnosu na opću populaciju.
Pneumoniju kod bolesnika s KOPB-om karakterizira teži klinički tijek te češće dolazi do razvoja
respiratorne insuficijencije. Također, u laboratorijskim nalazima se češće može naći prisutnost
acidoze, hipoksemije, hipoproteinemije, hipoalbuminemije kao i znatno više vrijednosti upalnih
parametara. Liječenje pneumonija u KOPB-u ovisi o dobi pacijenata, težini kliničke slike i
epidemiološkim osobitostima. Pneumonije se ne smatraju egzacerbacijom KOPB-a te ih je važno
razlikovati od egzacerbacija najviše zbog odabira načina liječenja.

Abstract (english)

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory
symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by
significant exposure to noxious particles or gases. First-line treatment for COPD are ronchodilators,
which can be prescribed alone or in combination with inhaled corticosteroids. Exacerbations of COPD
are defined as an acute worsening of respiratory symptoms that results in additional therapy. They are
leading cause of hospitalization and mortality.
Pneumonia is an acute inflammation of lungs which is caused by bacteria, viruses and fungi. The
highest incidence of pneumonia has been reported in patients with chronic obstructive pulmonary
disease. Important risk factors for pneumonia in patients with COPD are male sex, older age, severe
stage of COPD, co-morbid conditions, history of previous exacerbations and lower BMI. The use of
inhaled corticosteroids has been associated with increased risk of pneumonia. The risk seems to be
dose dependant, but also varies between different ICS molecules and it is mostly related to fluticasone.
Streptococcus pneumoniae has been shown to be the most common causative agent of pneumonia in
patients with COPD - it is estimated that S.pneumoniae is responsible for 85-90% infections.
Furthermore, pneumonia caused by Pseudomonas aureginosa is more often reported in patients with
COPD than in the general population.
Pneumonia in patients with COPD is characterized by more severe clinical course and more often
causes respiratory failure. Laboratory data more often show acidosis, hypoxemia, hypoproteinaemia,
hypoalbuminemia and higher levels of inflammatory markers. Treatment depends on the age of the
patients, severity of disease and epidemiologic characteristics. Pneumonia is not considered to be
COPD exacerbation and it is important to differentiate these two diseases mostly because of different
method of treatment.

• Keywords: KOPB; egzacerbacije KOPB-a; pneumonija; inhalacijski kortikosteroidi; flutikazon
• Keywords (english): COPD; exacerbations of COPD; pneumonia; inhaled corticosteroids; fluticason
• Language: croatian
• URN:NBN: urn:nbn:hr:105:225411
• 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: 2020-02-18 08:00:43