Avtor/Urednik		Fležar, Matjaž
Naslov		Biopsijska raziskava in vloga inhalacijskih glukokortikoidov v zdravljenju KOPB
Prevedeni naslov		Biopsy study and the role of inhaled glucocorticoids in the management of COPD
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 45, št. Suppl 1
Leto izdaje		2006
Obseg		str. 139-43
Jezik		eng
Abstrakt		Chronic obstructive pulmonary disease affects many components of the respiratory system: the airways, lung parenchyma and chest wall. It also has certain systemic effects due to lung inflammation, the most common ones being loss of striated muscle mass and cardiovascular involvement. The effects of inhaled corticosteroids that are nowadays indicated only for the treatment of moderate to severe disease can be assessed by their effects on physiological parameters (lung volumes and flows), symptoms (cough, sputum and dyspnea) and quality of life. However, since chronic obstructive pulmonary disease is defined as an inflammatory disease, the action of these drugs on the lungs and systemic inflammation should also be considered. This can only be achieved by invasive procedures - lung biopsy. Last year, the largest lung biopsy study to date showed some evidence regarding cellular and tissue effects of antiinflammatory drugs used to treat chronic obstructive pulmonary disease. The main result of the study was the comparison of lung biopsy specimens before and after three-week treatment with a fixed combination of salmeterol and fluticasone, 50/500 mg bid. This treatment resulted in a major reduction of CDB+ positive cells in bronchial tissue (36% reduction compared to placebo) concerning reduction in both CD4+ and neutrophils. Significantly lower neutrophil counts (in terms of percentage of all cells) and eosinophil counts were found in induced sputum specimens, and there were fewer cells that produce proinflammatory cytokines TNF alpha and IF gamma. The patients also had fewer exacerbations during that period and a positive effect was seen regarding lung function parameters. This study confirmed that a fixed combination of salmeterol and fluticasone used in the treatment of moderate and severe chronic obstructive pulmonary disease has important benefits for such patients due to the suppression of systemic and pulmonary inflammation.
Izvleček		Kronična obstruktivna pljučna bolezen je bolezen dihalnega sistema - dihalnih poti, pljučnega perenhima, žilja in dihalnega meha, pa tudi bolezen s sistemskimi posledicami. Med temi prednjačita izguba telesne mase na račun izgube mišične mase in srčnožilna prizadetost. Učinke inhalacijskih glukokortikoidov, ki se dandanes uporabljajo samo za zdravljenje hude in zelo hude pljučne prizedetosti, lahko ocenjujemo po učinkih na fiziološke parametre (kot so pretoki zraka, vzdržljivost in vsebnost kisika v krvi), bolnikove simptome (izmeček, kašelj, občutek težke sape) in kakovost življenja. Ker pa je kronična obstrukiivna pljučna bolezen po definiciji tudi bolezen, ki je vezana na nenormalen vnetni odziv na vdihane škodljivosti v pljučih, je pri uporabi zdravil racionalno razmišljati tudi o tkivno specifičnih učinkih teh zdravil, kar pa lahko preučujemo le z invazivnim odvzemkom prizadetih tkiv. V preteklem letu končana biopsijska raziskava, ki je preučevala učinke na celičnem nivoju v pljučih bolnikov s kronično obstruktivno pljučno bolezenijo, je dokazala, da se že po tritedenskem zdravljenju s fiksno kombinacijo visokih odmerkov salmeterol/flutikazona 50/500 mcg za 36% zmanjša število CDB+ (citotoksičnih) limfociiov. Zmanjša se število CD4+ limfocitov in nevtrofilcev v sluznici dihalne poti. Pomembno se zniža odstotek nevtrofilcev in eozinofilcev v vzorcu izzvanega izmečka, zmanjša pa se tudi število celic, ki izločajo posrednike sistemske vnetne reakcije, kot sta TNF alfa in interferon gama. Bolniki so imeli manj poslabšanj v trimesečnem poteku raziskave, ugoden je bil tudi učinek na parametre pljučne funkcije. Raziskava je potrdila dejstvo, da dodatek fiksne kombinacije zdravila salmeterol/flutikazon k zdravljenju hude oblike kronične obstruktivne pljučne bolezni bolniku koristi, med drugim tudi zaradi zaviralnega učinka na vnetje v pljučih, ki vodi v nepopravljivo okvaro organa.
Deskriptorji		LUNG DISEASES, OBSTRUCTIVE GLUCOCORTICOIDS, SYNTHETIC ADMINISTRATION, INHALATION BIOPSY