Fenotipovi akutnih egzacerbacija kronične opstruktivne bolesti pluća

master's thesis

• Title (english): Phenotypes in acute exacerbation of chronic obstructive pulmonary disease
• Author: Helena Kulundžić
• Mentor: Andrea Vukić Dugac (mentor)
• Committee member: Sanja Popović-Grle (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: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Kronična opstruktivna bolest pluća (KOPB) česta je i progresivna bolest koju karakterizira trajno smanjenje protoka zraka kroz dišne puteve, a najčešće nastaje kao posljedica dugotrajne izloženosti štetnim česticama duhanskog dima. Jedan je od vodećih uzroka pobola i smrtnosti u svijetu sa značajnim ekonomskim i socijalnim opterećenjem. Kroničan i progresivan tijek bolesti povremeno je isprekidan periodima egzacerbacija KOPB-a koje označavaju pogoršanje respiratornih simptoma iznad normalnih svakodnevnih varijacija što zahtjeva promjenu terapije. Pogoršanje respiratornih simptoma se odnosi na progresiju dispneje i kašlja te na povećanje volumena i purulencije sputuma. Akutne egzacerbacije imaju negativan učinak na tijek bolesti stoga je njihovo prepoznavanje i adekvatno liječenje ključno za usporavanje progresije i osiguranje kvalitete života pacijenta. Zbog svoje heterogenosti u kliničkoj slici, uzrocima i odgovoru na terapiju, svrstane su u različite fenotipove koji omogućuju personaliziranu strategiju liječenja i dugoročno bolje ishode za pacijenta. Najčešća klasifikacija akutnih egzacerbacija KOPB-a je prema njihovoj etiologiji, a obuhvaća infektivne uzroke, okolišne čimbenike i unutrašnje mehanizme. Bakterijske i virusne infekcije odgovorne su za više od polovicu uzroka egzacerbacija, a njihovo prepoznavanje važno je radi odabira adekvatne antimikrobne terapije i provedbe preventivnih mjera u vidu imunizacije. Fenotipovi temeljeni na upalnim stanicama mogu predvidjeti učinak kortikosteroidne terapije u liječenju akutnih egzacerbacija. Pacijenti koji boluju od KOPB-a često imaju i druge kronične bolesti koje znatno povećavaju ukupni rizik za razvoj egzacerbacije, a zatim utječu i na tijek i liječenje egzacerbacija. Fenotipizacija prema komorbiditetima osvješćuje njihov učinak na egzacerbaciju i potiče interdisciplinarni pristup zbrinjavanja egzacerbacija. Fenotip čestog egzacerbatora identificira pacijente koji zahtijevaju češće kontrole, modificiranu terapiju i veću angažiranost oko preventivnih mjera kako bi se smanjio broj egzacerbacija. Prevencija egzacerbacija ključni je dio liječenja KOPB-a, a temelji se na redovitom uzimanju propisane terapije i provođenju nefarmakoloških mjera liječenja kao što su prestanak pušenja i plućna rehabilitacija.

Abstract (english)

Chronic obstructive pulmonary disease is a common and progressive disease characterized by permanent decrease of airflow through the airways, and most often occurs as a result of long-term exposure to harmful particles of tobacco smoke. It is one of the leading causes of morbidity and mortality in the world and represents a significant economic and social burden. The chronic and progressive course of the disease is occasionally punctuated by periods of COPD exacerbations that indicate a worsening of respiratory symptoms beyond normal daily variations which require a change in therapy. Worsening of respiratory symptoms refers to the progression of dyspnea and cough and to the increase in volume and purulence of sputum. Acute exacerbations have a negative effect on the course of the disease; therefore, their recognition and adequate treatment are essential to slow down the progression and ensure the patients quality of life. Due to their heterogeneity in the clinical picture, causes and response to therapy, they are classified into different phenotypes that enable a personalized treatment strategy and better long-term patient outcomes. The most common classification of phenotypes is according to their etiology, which includes infectious causes, environmental factors and internal mechanisms. Bacterial and viral infections are responsible for more than half of the causes of exacerbations, and their recognition is important for the selection of adequate antimicrobial therapy and the implementation of preventive measures such as immunization. Inflammatory cell-based phenotypes can predict the effect of corticosteroid therapy in the treatment of acute exacerbations. Patients suffering from COPD often have other chronic diseases that significantly increase the overall risk for the development of an exacerbation, and then affect the course and treatment of exacerbations. Phenotyping by comorbidities raises awareness of their effect on exacerbations and encourages an interdisciplinary approach to managing exacerbations. The frequent exacerbator phenotype identifies patients who require more frequent controls, modified therapy and greater commitment to preventive measures to reduce the number of exacerbations. Prevention of exacerbations is a crucial part of COPD treatment and is based on regular intake of prescribed therapy and implementation of non-pharmacological treatment measures such as smoking cessation and pulmonary rehabilitation.

• Keywords: kronična opstruktivna plućna bolest; egzacerbacije; fenotipovi
• Keywords (english): chronic obstructive pulmonary disease; exacerbation; phenotype
• Language: croatian
• URN:NBN: urn:nbn:hr:105:678588
• 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: 2023-10-25 12:40:11