[The impact of the COVID-19 epidemic on the course of the most common respiratory diseases]

INTRODUCTION

SARS-CoV-2 has defined our everyday lives over the past three years and by constituting a serious risk factor for patients with pre-existing respiratory illnesses, it placed an unexpected burden on the health care systems worldwide.

OBJECTIVE

The aim of this study was to explore the association between COVID-19 and pre-existing respiratory comorbidities such as chronic obstructive pulmonary disease (COPD) and asthma.

METHOD

In our current study, we retrospectively processed the data of nearly 29 000 Hungarian patients.

RESULTS

We found that COPD was directly associated with the severity of COVID-19 and slightly increased the risk of intensive care unit admission and the need for mechanical ventilation during the SARS-CoV-2 infection. On the other hand, the presence of asthma influenced neither the severity of COVID-19 nor the need for intensive care unit admission or mechanical ventilation significantly.

DISCUSSION

International studies suggest that COPD does not significantly increase the risk of SARS-CoV-2 infection. However, the likelihood of hospitalization due to COVID-19 is much higher in COPD patients and the presence of COPD is associated with a more severe disease course. Given the structural alterations and abnormal regeneration processes of the airways that occur during lung injury in COPD patients, these individuals require increased attention and personalized rehabilitation protocols after the onset of the viral infection.

CONCLUSION

Altogether, the assessment of clinical manifestations associated with different COPD phenotypes (as well as other chronic lung diseases) and SARS-CoV-2 infection is essential for the implementation of personalized therapeutic approach in the future. Orv Hetil. 2023; 164(2): 51-56.

[Exacerbation of obstructive pulmonary diseases by SARS-CoV-2 infection in patients treated in the Pulmonology Clinic of Târgu Mures]

INTRODUCTION

Literature data show an increased severity of SARS-CoV-2 infection in patients with cardiovascular, renal comorbidities, chronic obstructive pulmonary disease (COPD), asthma, obesity, diabetes, tumors and immunosuppression.

METHOD

This retrospective study includes 90 patients with SARS-CoV-2 infection associated with COPD or asthma exacerbations from 303 patients hospitalized during a 7-month period (29.7%). The clinical aspect of COPD/asthma exacerbations overlapped to the one by SARS-CoV-2 infection, therefore, we compared our group with 90 patients with SARS-CoV-2 without obstructive disease. We excluded from both groups the patients with known severe cardiac impairment, diabetes, or tumors in order to not having interference with other unfavorable prognostic factors. We assessed the cases severity on clinical basis, pulzoximetry, CT/chest x-ray, and inflammatory markers.

RESULTS

72.2% of our group (48/52 with COPD and 17/38 with asthma) had moderate/severe pneumonia (bilateral interstitial-alveolar infiltrates, increased inflammatory markers, respiratory dysfunction) compared with 56.6% from the nonobstructive group. 14 patients required intensive therapy (including mechanical ventilation). We recorded 4 deaths in COPD group, 1 in asthma group, compared to 2 in non-obstructive patients (fatality 7.6% in COPD compared to 2.2% in nonobstructive group). Treatment included maximized inhaled bronchodilators ± corticosteroids, oxygen, antivirals, anticoagulants, corticosteroids, symptomatic. All patients were referred for clinical-functional and CT scan reassessment 2 months after discharge.

CONCLUSION

The association of SARS-CoV-2 infection in patients with COPD or asthma was common, leading to exacerbation with significant severity. Fatality increased in COPD. Outpatient follow-up aims to restage adjust the treatment and monitor post-COVID-19 possible sequels. Orv Hetil. 2023; 164(2): 43-50.

Paradoxical pulse

For thousands of years, palpation of the peripheral pulse was the most important source of information for the physicians about their patients' circulation. The rate, amplitude, and pattern of the pulse served as a basis of amazing observations, although several of them have been also confirmed and substantiated by modern medicine. One of the classical signs is "paradoxical pulse" (PP), which signals potentially life-threatening conditions with various mechanisms in certain diseases. In our review, we demonstrate the pathophysiological bases of PP, and show the equivalents of this sign provided by modern medical equipments. Orv Hetil. 2020; 161(38): 1629-1635.

[Quality of life of asthmatic patients after complex rehabilitation treatment]

Asthma is a serious public health challenge for all age groups around the world. Heightened attention surrounds the use of the natural therapeutic factors that potentially make medication more cost-efficient in the treatment of diseases. Our research has tried to reveal how the medical conditions, quality of life of asthmatic patients change after medical treatments that are accompanied by climate therapy. Asthma patients (514 patients) participated in a 3-week complex therapy at Mátra Health Resort. Beyond medical examinations and treatments, patients were involved in breathing exercises on the curing terraces or outdoors twice a day, they were to attend the rehabilitative physical exercises led by a physiotherapist once a day, were given dietetic and lifestyle advice and provided with diets that were fitted to their individual medical conditions. Their respiratory function was examined before the commencement of the cure as well as after the therapy just before departing from the institution. The patients' exercise capacities were assessed with the 6-minute walk test before the treatment and then 3 weeks later. For the patients, a questionnaire was compiled to reveal information in relation to their conditions in the first 6 months after leaving the institution. Our results show that values of respiratory function in the sample and 6-minute walk test significantly improved with the treatment. After leaving the institute, the results of the Asthma Control Test in the 1st month after treatment revealed a significantly better quality of life and better control-level of patients than after the 3rd month. Orv Hetil. 2018; 159(27): 1103-1112.