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Dimic-Janjic S, Hoda MA, Milenkovic B, Kotur-Stevuljevic J, Stjepanovic M, Gompelmann D, Jankovic J, Miljkovic M, Milin-Lazovic J, Djurdjevic N, Maric D, Milivojevic I, Popevic S. The usefulness of MMP-9, TIMP-1 and MMP-9/TIMP-1 ratio for diagnosis and assessment of COPD severity. Eur J Med Res 2023; 28:127. [PMID: 36935521 PMCID: PMC10026402 DOI: 10.1186/s40001-023-01094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/10/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Inflammation, oxidative stress and an imbalance between proteases and protease inhibitors are recognized pathophysiological features of chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate serum levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with COPD and to assess their relationship with lung function, symptom severity scores and recent acute exacerbations. METHODS In this observational cohort study, serum levels of MMP-9 and TIMP-1 and the MMP-9/TIMP-1 ratio in the peripheral blood of COPD patients with stable disease and healthy controls were determined, and their association with lung function (postbronchodilator spirometry, body plethysmography, single breath diffusion capacity for carbon monoxide), symptom severity scores (mMRC and CAT) and exacerbation history were assessed. RESULTS COPD patients (n = 98) had significantly higher levels of serum MMP-9 and TIMP-1 and a higher MMP-9/TIMP-1 ratio than healthy controls (n = 47) (p ≤ 0.001). The areas under the receiver operating characteristic curve for MMP-9, TIMP-1 and the MMP-9/TIMP-1 ratio for COPD diagnosis were 0.974, 0.961 and 0.910, respectively (all p < 0.05). MMP-9 and the MMP-9/TIMP-1 ratio were both negatively correlated with FVC, FEV1, FEV1/FVC, VC, and IC (all p < 0.05). For MMP-9, a positive correlation was found with RV/TLC% (p = 0.005), and a positive correlation was found for the MMP-9/TIMP-1 ratio with RV% and RV/TLC% (p = 0.013 and 0.002, respectively). Patients with COPD GOLD 3 and 4 presented greater MMP-9 levels and a greater MMP-9/TIMP-1 ratio compared to GOLD 1 and 2 patients (p ≤ 0.001). No correlation between diffusion capacity for carbon monoxide and number of acute exacerbations in the previous year was found. CONCLUSIONS COPD patients have elevated serum levels of MMP-9 and TIMP-1 and MMP-9/TIMP-1 ratio. COPD patients have an imbalance between MMP-9 and TIMP-1 in favor of a pro-proteolytic environment, which overall indicates the importance of the MMP-9/TIMP-1 ratio as a potential biomarker for COPD diagnosis and severity.
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Affiliation(s)
- Sanja Dimic-Janjic
- Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Dr Subotica 8, Belgrade, Serbia.
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Dr Subotica 8, Belgrade, Serbia
| | - Jelena Kotur-Stevuljevic
- Faculty of Pharmacy, Department for Medical Biochemistry, University of Belgrade, Belgrade, Serbia
| | - Mihailo Stjepanovic
- Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Dr Subotica 8, Belgrade, Serbia
| | - Daniela Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jelena Jankovic
- Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Dr Subotica 8, Belgrade, Serbia
| | - Milica Miljkovic
- Faculty of Pharmacy, Department for Medical Biochemistry, University of Belgrade, Belgrade, Serbia
| | - Jelena Milin-Lazovic
- Faculty of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - Natasa Djurdjevic
- Clinic for Pulmonology, University Clinical Center of Serbia, Koste Todorovica 26, Belgrade, Serbia
| | - Dragana Maric
- Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Dr Subotica 8, Belgrade, Serbia
| | - Ivan Milivojevic
- Clinic for Pulmonology, University Clinical Center of Serbia, Koste Todorovica 26, Belgrade, Serbia
| | - Spasoje Popevic
- Faculty of Medicine, University of Belgrade, Clinic for Pulmonology, University Clinical Center of Serbia, Dr Subotica 8, Belgrade, Serbia
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Vukoja M, Kopitovic I, Lazic Z, Milenkovic B, Stankovic I, Tomic-Spiric V, Zvezdin B, Hromis S, Cekerevac I, Ilic A, Vukcevic M, Dimic-Janjic S, Stjepanovic M. Diagnosis and treatment of adult asthma patients in Serbia: a 2022 experts group position statement. Expert Rev Respir Med 2022; 16:1133-1144. [PMID: 36448775 DOI: 10.1080/17476348.2022.2153674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma management is limited due to the lack of a systematic approach, drug availability and regulatory affairs. In addition, the global coronavirus disease pandemic has posed a significant challenge, particularly in resource-limited settings. AREAS COVERED In this paper, we propose an algorithm for treating adult asthma patients in Serbia. We performed PubMed database search on published asthma clinical trials and guidelines from 1 January 2015 to 10 March 2020. The consensus process incorporated a modified Delphi method that included two rounds of e-mail questionnaires and three rounds of national asthma expert meetings. We focus on 1) objective diagnosis of asthma, 2) the implementation of up-to-date therapeutic options, and 3) the identification and referral of severe asthma patients to newly established severe asthma centers. EXPERT OPINION Regional specificities and variations in healthcare systems require the adaptation of evidence-based knowledge. Practical, clinically oriented algorithms designed to overcome local barriers in healthcare delivery may facilitate timely and adequate asthma diagnosis and the local implementation of current advances in asthma management.
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Affiliation(s)
- Marija Vukoja
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Kopitovic
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zorica Lazic
- Pulmonary Department, University Clinical Centre Kragujevac, Kragujevac, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Ivana Stankovic
- Department for Asthma and Chronic Obstructive Pulmonary Diseases, Clinic for Lung Diseases, University Clinical Centre of Nis, Nis, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Vesna Tomic-Spiric
- Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia.,Diagnostic-polyclinic Department, Clinic of Allergology and Immunology, University Clinical Center of Serbia
| | - Biljana Zvezdin
- Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department for Allergy and Obstructive Pulmonary Diseases, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Sanja Hromis
- Department for Allergy and Obstructive Pulmonary Diseases, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Nursing, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Cekerevac
- Pulmonary Department, University Clinical Centre Kragujevac, Kragujevac, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Ilic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Miodrag Vukcevic
- Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia.,Pulmonary Department, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Mihailo Stjepanovic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
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Stjepanovic MI, Stojanovic MR, Stankovic S, Cvejic J, Dimic-Janjic S, Popevic S, Buha I, Belic S, Djurdjevic N, Stjepanovic MM, Jovanovic D, Stojkovic-Laloševic M, Soldatovic I, Bonaci-Nikolic B, Miskovic R. Autoimmune and immunoserological markers of COVID-19 pneumonia: Can they help in the assessment of disease severity. Front Med (Lausanne) 2022; 9:934270. [PMID: 36106319 PMCID: PMC9464912 DOI: 10.3389/fmed.2022.934270] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Immune dysregulation and associated inefficient anti-viral immunity during Coronavirus Disease 2019 (COVID-19) can cause tissue and organ damage which shares many similarities with pathogenetic processes in systemic autoimmune diseases. In this study, we investigate wide range autoimmune and immunoserological markers in hospitalized patients with COVID-19. Methods Study included 51 patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 infection and hospitalized due to COVID-19 pneumonia. Wide spectrum autoantibodies associated with different autoimmune inflammatory rheumatic diseases were analyzed and correlated with clinical and laboratory features and pneumonia severity. Results Antinuclear antibodies (ANA) positivity was found in 19.6%, anti-cardiolipin IgG antibodies (aCL IgG) in 15.7%, and anti-cardiolipin IgM antibodies (aCL IgM) in 7.8% of patients. Positive atypical x anti-neutrophil cytoplasmic antibodies (xANCA) were detected in 10.0% (all negative for Proteinase 3 and Myeloperoxidase) and rheumatoid factor was found in 8.2% of patients. None of tested autoantibodies were associated with disease or pneumonia severity, except for aCL IgG being significantly associated with higher pneumonia severity index (p = 0.036). Patients with reduced total serum IgG were more likely to require non-invasive mechanical ventilation (NIMV) (p < 0.0001). Serum concentrations of IgG (p = 0.003) and IgA (p = 0.032) were significantly lower in this group of patients. Higher total serum IgA (p = 0.009) was associated with mortality, with no difference in serum IgG (p = 0.115) or IgM (p = 0.175). Lethal outcome was associated with lower complement C4 (p = 0.013), while there was no difference in complement C3 concentration (p = 0.135). Conclusion Increased autoimmune responses are present in moderate and severe COVID-19. Severe pneumonia is associated with the presence of aCL IgG, suggesting their role in disease pathogenesis. Evaluation of serum immunoglobulins and complement concentration could help assess the risk of non-invasive mechanical ventilation NIMV and poor outcome.
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Affiliation(s)
- Mihailo I. Stjepanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
- *Correspondence: Mihailo I. Stjepanovic ;
| | - Maja R. Stojanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Stankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Cvejic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Spasoje Popevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Buha
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Slobodan Belic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Djurdjevic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Dragana Jovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milica Stojkovic-Laloševic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute of Medical Statistics and Informatic, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branka Bonaci-Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Rada Miskovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
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Buha I, Mirić M, Agić A, Simić M, Stjepanović M, Milenković B, Nagorni-Obradović L, Škodrić-Trifunović V, Ilić B, Popević S, Dimic-Janjic S, Ilić A. A randomized, double-blind, placebo-controlled study evaluating the efficacy of propolis and N-acetylcysteine in exacerbations of chronic obstructive pulmonary disease. Eur Rev Med Pharmacol Sci 2022; 26:4809-4815. [PMID: 35856373 DOI: 10.26355/eurrev_202207_29206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) accelerate the progressive impairment of lung function and general health. Together with maintenance therapy for chronic obstructive pulmonary disease (COPD), N-acetylcysteine (NAC) and natural propolis have demonstrated pharmacological properties that address crucial pathophysiological processes underlying COPD and may prevent AECOPDs. This study aims at responding to dose-dependent efficacy and safety concerns regarding a propolis-NAC combination for the reduction of COPD exacerbation rates. PATIENTS AND METHODS This was a single-center, randomized, double-blind, phase IV trial with three treatment arms: Placebo and two active substance groups, one (AS-600) received 600 mg of NAC + 80 mg of propolis while the other (AS-1,200) received 1,200 mg of NAC + 160 mg of propolis. Following an AECOPD, frequent-exacerbation phenotype patients (n=46) were assigned a once-daily three-month therapy with the study drug and one year follow-up. The primary endpoint was the COPD exacerbation incidence rate during the follow-up period as a measure of dose-dependent efficacy of NAC-propolis combination compared to placebo. RESULTS There was a statistically significant difference in the AECOPD incidence rate: 52.6% in patients that received placebo, 15.4% that received AS-600 and only 7.1% that received AS-1,200 (Fisher's exact test, p = 0.013). Compared to placebo, AECOPD frequency was significantly lower only in AS-1,200 (p=0.009). Compared to placebo, the relative risk for exacerbation was 0.29 in AS-600 and 0.13 in AS-1,200. No adverse events related to the treatment were reported. CONCLUSIONS Oral combination of natural propolis with NAC confirmed formulation efficiency with a favorable safety profile. Our results need to be confirmed by larger clinical trials.
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Affiliation(s)
- I Buha
- Clinic for Pulmonology, University Clinical Centre of Serbia, Belgrade, Serbia.
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Eger K, Paroczai D, Bacon A, Schleich F, Sergejeva S, Bourdin A, Vachier I, Zervas E, Katsoulis K, Papapetrou D, Kostikas K, Csoma Z, Heffler E, Canonica GW, Grisle I, Bieksiene K, Palacionyte J, Ten Brinke A, Hashimoto S, Smeenk FWJM, Braunstahl GJ, van der Sar S, Mihălţan F, Nenasheva N, Peredelskaya M, Zvezdin B, Čekerevac I, Hromiš S, Ćupurdija V, Lazic Z, Milenkovic B, Dimic-Janjic S, Yasinska V, Dahlén B, Bossios A, Lazarinis N, Aronsson D, Egesten A, Munir AKM, Ahlbeck L, Janson C, Škrgat S, Edelbaher N, Leuppi J, Jaun F, Rüdiger J, Pavlov N, Gianella P, Fischer R, Charbonnier F, Chaudhuri R, Smith SJ, Doe S, Fawdon M, Masoli M, Heaney L, Haitchi HM, Kurukulaaratchy R, Fulton O, Frankemölle B, Gibson T, Needham K, Howarth P, Djukanovic R, Bel E, Hyland M. The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good? ERJ Open Res 2022; 8:00065-2022. [PMID: 35582679 PMCID: PMC8994963 DOI: 10.1183/23120541.00065-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has put pressure on healthcare services, forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care. Methods In this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021. Results 1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%). Conclusions Change to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic.
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Affiliation(s)
- Katrien Eger
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Co-first authors
| | - Dora Paroczai
- Csongrad County Hospital and Dept of Pulmonology, University of Szeged, Szeged, Hungary
- Co-first authors
| | - Alison Bacon
- School of Psychology, University of Plymouth, Plymouth, UK
| | | | | | - Arnaud Bourdin
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Isabelle Vachier
- PhyMedExp, CHU Montpellier, University of Montpellier, Montpellier, France
| | | | | | | | | | - Zsuzsanna Csoma
- National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy - IRCCS Humanitas Research Hospital - Rozzano (MI), Italy
- Departmento of Biomedical Sciences - Humanitas University - Pieve Emanuele (MI), Italy
| | | | | | | | | | - Simone Hashimoto
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | - Natalia Nenasheva
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Marina Peredelskaya
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Biljana Zvezdin
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- Medical Faculty Novi Sad, University of Novi Sad, Bucharest, Romania
| | - Ivan Čekerevac
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sanja Hromiš
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Vojislav Ćupurdija
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Zorica Lazic
- Clinic for Pulmonology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Dept of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade Medical faculty, Belgrade, Serbia
| | - Valentyna Yasinska
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Dahlén
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Bossios
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Nikolaos Lazarinis
- Karolinska Severe Asthma Center, Dept of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge and Dept of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David Aronsson
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Arne Egesten
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Abul Kashem Mohammad Munir
- Respiratory Medicine and Allergology, Dept of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Christer Janson
- Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sabina Škrgat
- Dept for Pulmonary Diseases, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Joerg Leuppi
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | - Fabienne Jaun
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Nikolay Pavlov
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | | | - Simon Doe
- Royal Victoria Infirmary, Newcastle, UK
| | | | | | - Liam Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queens University Belfast, Belfast, UK
| | | | | | | | | | | | | | - Peter Howarth
- Global Medical Affairs, Specialty Medicine TA, GSK, Brentford, UK
| | | | - Elisabeth Bel
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Milenković B, Radic S, Stojanovic-Ristic S, Cvejic J, Jankovic J, Dimic-Janjic S, Ilic D. Prevalence of respiratory symptoms among university students in Belgrade. Epidemiology 2017. [DOI: 10.1183/1393003.congress-2017.pa1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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