Extraintestinal manifestations of inflammatory bowel disease (IBD) are a systemic illness that may affect up to half of all patients. Among the extraintestinal manifestations of IBD, those involving the lungs are relatively rare and often overlooked. However, there is a wide array of such manifestations, spanning from airway disease to lung parenchymal disease, thromboembolic disease, pleural disease, enteric-pulmonary fistulas, pulmonary function test abnormalities, and adverse drug reactions. The spectrum of IBD manifestations in the chest is broad, and the manifestations may mimic other diseases. Although infrequent, physicians dealing with IBD must be aware of these conditions, which are sometimes life-threatening, to avoid further health impairment of the patients and to alleviate their symptoms by prompt recognition and treatment. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment. The treatment of IBD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management. Corticosteroids, both systemic and aerosolized, are the mainstay therapeutic approach, while antibiotics must also be administered in the case of infectious and suppurative processes, whose sequelae sometimes require surgical intervention.

Pulmonary manifestations of inflammatory bowel disease.

Crohn's disease (CD) is a systemic illness with a constellation of extraintestinal manifestations affecting various organs. Of these extraintestinal manifestations of CD, those involving the lung are relatively rare. However, there is a wide array of lung manifestations, ranging from subclinical alterations, airway diseases and lung parenchymal diseases to pleural diseases and drug-related diseases. The most frequent manifestation is bronchial inflammation and suppuration with or without bronchiectasis. Bronchoalveolar lavage findings show an increased percentage of neutrophils. Drug-related pulmonary abnormalities include disorders which are directly induced by sulfasalazine, mesalamine and methotrexate, and opportunistic lung infections due to immunosuppressive treatment. In most patients, the development of pulmonary disease parallels that of intestinal disease activity. Although infrequent, clinicians dealing with CD must be aware of these, sometimes life-threatening, conditions to avoid further impairment of health status and to alleviate patient symptoms by prompt recognition and treatment. The treatment of CD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management.

Pulmonary manifestations of Crohn's disease.

Objective The aim: To study the effect of arterial hypertension on the course of chronic obstructive pulmonary disease in patients with comorbid pathology. Patients and methods Materials and methods: The prospective study included 61 patients with COPD: 32 stable male patients with COPD with comorbid arterial hypertension of stage II 1-3 degrees and 29 stable outpatients of men with COPD of clinical groups A-D with impaired respiratory function II-IV according to GOLD. All patients, in accordance with the goals and objectives of the study, were divided into 2 groups: group I consisted of men with isolated COPD, middle age - 56.0 (8.5) years, average duration of the disease - 16.2 (1.3) years, Group II consisted of male patients with COPD and arterial hypertension (AH), middle age - 59.5 (7.5). The patients underwent a general clinical examination, which included an assessment of complaints, anamnestic data, and a physical examination. The severity of COPD was determined on the basis of the frequency of exacerbations during the year, assessment of dyspnea using the mMRS scale, spirographic data. Statistical materials were processed using the STATISTICA 10.0 program. Results Results: In group I, 20 patients (69%) complained of dyspnea during exercise, in group II - 25 patients (78%) (p = 0.4), 28 patients (96.5%) complained of cough with vague sputum. group and 30 patients in group II (93.8%) (p = 0.09). When assessing the number of exacerbations over the past year, it was determined that patients with isolated COPD had an average of 1.0 (1.0; 2.0) exacerbations, and patients with COPD and AH - 2.0 (1.0; 3.0 ) (p = 0.06). According to the CAT questionnaire, the following data were obtained: in group I - 9.0 (8.0; 11.0) points, and in group II - 17.5 (10.0; 20.0) points (p = 0.02). When conducting spirographic studies, a statistically significant more expressive bronchial obstruction was found in patients with COPD and comorbid hypertension. Conclusion Conclusions: The presence of comorbid arterial hypertension leads to the intermittent effect of diseases: according to the results of mMRC and SAT test, ailments for COPD were examined, they have a more severe course of underlying seizure in the presence of concomitant arterial hypertension. Clinical manifestations in patients with COPD and H are more severe compared to clinical manifestations in patients without aggravated diseases of the cardiovascular system. Concomitant arterial hypertension enhances the manifestations of bronchial obstruction, in the same way as with patients with isolated COPD.

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Aggravating effect of arterial hypertension on the course of chronic obstructive pulmonary disease in patients with comorbid pathology.

Background. Little is known about the effect of statins addition to standard antihypertensive therapy on blood pressure level and vascular stiffness in high-risk hypertensive patients. The aim of the study was to assess the dynamics of vascular stiffness in hypertensive patients of high or very high cardiovascular risk under the influence of rosuvastatin addition to combined two-component amlodipine and lisinopril antihypertensive therapy. Materials and methods. We investigated 60 hypertensive patients who were randomized into two groups: the 1st group received a fixed amlodipine/lisinopril combination, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin. Mean office and ambulatory blood pressure as well as central aortic blood pressure and pulse wave velocity were evaluated in both groups before and after 24-week follow-up period. Results. At end of follow-up period the office and average daily blood pressure significantly decreased in both groups, with more prominent office diastolic blood pressure decline in the 2nd one. The central aortic blood pressure equally decreased in both groups. The augmentation index significantly reduced in both groups, mostly in the 2nd one. The carotid-femoral pulse wave velocity declined in both groups to the same extent. The carotid-radial pulse wave velocity decreased statistically only in the second group. Conclusions. Addition of rosuvastatin to a fixed amlodipine/lisinopril combination in high/very high cardiovascular risk hypertensive patients was accompanied by more pronounced decline of diastolic blood pressure and augmentation index, as well as significantly reduction of pulse wave velocity.

https://www.actabiomedica.ru/jour/article/viewFile/703/664

Влияние статина при добавлении к антигипертензивной терапии на показатели сосудистой жёсткости у больных артериальной гипертензией высокого сердечно-сосудистого риска

Abstract

Purpose of the study. Was to investigate life quality in patients with comorbidly pathology of chronic obstructive pulmonary disease in
combination with arterial hypertension.

Materials and methods. 77 subjects with a diagnosis of chronic obstructive pulmonary disease stage I–III (according to the GOLD criteria) in combination with arterial hypertension I–III stage. The comparison groups included 30 patients with essential hypertension and 45 patients with chronic obstructive pulmonary disease. All groups were completely comparable by the length and disease severity. All patients underwent general clinical examination, blood pressure measurement, spirometry, electrocardiography, and echocardiography. Study of the life quality in patients was carried out by means of self-questioning using General official Russian-language analogue of the MOS SF-36 questionnaire.

Results. It was determined, that life quality parameters of physical status and psychosocial status were reduced in all patients, but to a greater extent in patients with comorbidity than in patients of the comparison group. Disease duration influenced on life quality. In patients with newly diagnosed chronic obstructive pulmonary disease with a history of marked increase in blood pressure, changes in life quality were more expressed in comparison with the comparison group; at the same time there was tendency of it’s increasing over time. When assessing the relationship between quality of life and parameters of pulmonary ventilation, it was found that depending on the severity of respiratory function disturbances it is directly proportional to decreased quality of life, both physical and psychosocial status. Life quality of in patients with chronic obstructive pulmonary disease worsens due to addition and progression of essential hypertension.

Conclusions. Сomorbidly pathology has a negative impact on physical and psychosocial status of patients, which is significantly reduces life quality and depends on the severity of pulmonary ventilation disturbances, «length of the disease» and hypertension degree.

Keywords: chronic obstructive pulmonary disease, arterial hypertension, comorbidly pathology, life quality.

The quality life in patients with chronic obstructive pulmonary disease combined with arterial hypertension

Aim. To evaluate efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA) and concomitant arterial hypertension. Methods. Patients (n=40) with COPD (n=20) or BA (n=20) and hypertension of 1-2 degree were examined. Amlodipine maleate was used as antihypertensive drug. The spirometry, ambulatory blood pressure monitoring, vascular oscillometry (evaluation of arterial stiffness), vascular Doppler imaging (evaluation of endothelial function) was performed initially and in 6 months of treatment. Results. The high efficacy of amlodipine maleate as antihypertensive drug was found in patients with COPD or BA and hypertension without dependence on bronchial obstruction severity. The positive influence of amlodipine on endothelial function and vascular rigidity was also observed. Conclusion: study results confirm the rationales of amlodipine use in patients with COPD or BA and hypertension.

https://www.rpcardio.com/jour/article/download/793/824

Efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease and bronchial asthma with concomitant arterial hypertension

The interest in iatrogenic diseases in general and those of lungs in particular is due to the possibility of elucidating and eliminating their etiological factors for the prevention of progression of pathological changes. However, diagnostics of such conditions is hampered by the lack of their specific clinical and morphological manifestations. The present study considers the relationship between interstitial lung lesions and the use of high doses of melothrexate (30 mg/week) for the treatment of Crohn's disease. The authors emphasize the necessity of regular monitoring the state of the respiratory system in metothrexate-treated patients and vigilance over the risk of alveolitis in such patients. The awareness of the patients of the possible side effects of metothrexate therapy is of primary importance.

Iatrogenic lung diseases

взаимосвязи. Большое значение имеют иммунопато-логические процессы, нарушающие аэрогематический барьер и связанные с течением основного заболевания (ревматоидный артрит, опухоли, воспалительные забо-левания кишечника).При морфологическом исследовании ткани легкого нередко определяются признаки васкулита [5]; в 20% случаев регистрируются явления эозинофильного ва-скулита и гранулематоз [6]. При тяжелом течении бо-лезни появляются интерстициальный отек, диффузное альвеолярное повреждение, гиалиновые мембраны. Особенностью морфологических изменений, инду-цированных метотрексатом, являются диспластиче-ские изменения эпителия, прежде всего гиперплазия пневмоцитов второго порядка, что указывает на риск злокачественной трансформации у таких больных. В эксперименте у животных с легочным фиброзом, индуцированным метотрексатом, наблюдается повы-шение активности фактора роста фибробластов при снижении экспрессии факторов, угнетающих апоптоз, что указывает также на высокий риск появления клеток со свойствами атипии. Дифференциальная диагности-ка интерстициального пневмонита, вызванного мето-трексатом, особенно трудна у лиц с онкологическими заболеваниями из-за частого присоединения бронхоле-гочной инфекции, во многом неотличимой по клини-ко-рентгенологическим и лабораторным проявлениям от лекарственной реакции [7]. Метотрексат сам может Интерес к проблеме лекарственных поражений в целом и легких, в частности обусловлен возможностью выявления четкого этиологического фактора с перспек-тивой его устранения и предотвращения прогрессирова-ния болезни. Вместе с тем диагностировать заболевание легких, индуцированное лекарствами, не всегда просто из-за отсутствия специфических клинических и морфо-логических проявлений [1].Метотрексат становится причиной интерстициаль-ного пневмонита примерно у 3% больных, получающих лечение по поводу неоплазий и неопухолевых состояний [2]. Впервые метотрексат как причина острого пораже-ния легких у 7 детей с лейкозом был описан A. Clarysse и соавт. в 1969 г. [3]. При морфологическом исследовании биоптата ткани легкого были обнаружены признаки ин-терстициального воспаления с гранулематозом. Отмена препарата, назначение кортикостероидов обеспечили обратное развитие лекарственной болезни у 6 детей; 1 ребенок умер при нарастающей дыхательной недоста-точности. Ежегодно в литературе появляется до 100—200 сообщений о токсичности метотрексата у больных с разными типами опухолей, лейкемией, ревматоидным артритом [4]. Ятрогенные последствия применения ме-тотрексата проявляются, как правило, при длительном лечении, однако имеются случаи поражения легких и через несколько недель от начала терапии. Тяжесть те-чения не зависит от длительности приема и недельной дозы препарата, отражая истинно идиосинкразические

http://cyberleninka.ru/article/n/lekarstvennoe-porazhenie-legkih.pdf

N. A. Karoli

Papers

Efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease and bronchial asthma with concomitant arterial hypertension

Iatrogenic lung diseases

Лекарственное поражение легких