Faculty of Medicine

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Relationship between Vitamin D, Inflammation and Lung Function In Patients with Severe Uncontrolled Asthma
(Scientific Foundation SPIROSKI, 2017-12-15)
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Jovkovska-Kaeva, Biserka
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Breskovska, Gorica
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Goseva, Zlatica
BACKGROUND:Recently epidemiological studies showed that low vitamin D is linked toairway hyperresponsiveness, decreasedlung function, poor asthma control, and steroid–resistant asthma.AIM:We investigatedtherelationshipbetween Vitamin D, inflammation with circulating IL-33 and lung function in 30 patients with severe uncontrolled asthma. MATERIALS AND METHODS:The study included 30 patients with severe uncontrolled asthma. In each of them were measured serum levels of IL-33 and Vitamin D by the ELISA method. The pulmonary function is measuredby basic spirometry parameters, FEV1. The results were statistically elaboratedaccording to the Pearson’s Correlation Tests. RESULTS:The results showed statistically insignificant correlation between Vitamin D and IL-33, and Vitamin D with FEV1 (Vit.D/IL-33; r=0.11323, p=0.551); (Vit.D/FEV1; r=-0.1005; p=0.597) Correlation between IL-33 and FEV1 is negative but statistically significant (IL-33/FEV1; r=-0.5248; p=0.003). CONCLUSION:Because there arelittle studies about the link between vitamin D and asthma, further research toclarify the mechanism how vitamin D control the activity of CD4+ T cells and the related Th2-type cytokines in the parthenogenesis of asthma.
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Antibiotics use in relation to asthma in children
(Wiley Blackwell, 2018-05)
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Kimovska, M
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Seckova, L
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Background: Early-life antibiotic exposures have been reported to increase the risk of allergic diseases. The aim of the study was to examine the impact of current antibiotics use on asthma in schoolchildren in The Republic of Macedonia, as developing country with a high rate of antibiotics use and low prevalence of asthma. Method: Data from 2310 schoolchildren aged 5-15 years obtained through a parental-completed questionnaire in randomly selected primary schools in Skopje, the capital of Macedonia, in 2015/2016 was used. The frequency of antibiotics intake ≥3 and <3 times yearly vs never antibiotics intake for respiratory infections, in the last 12 months was correlated to current asthma-like symptoms and ever-diagnosed asthma after adjustment for confounding factors using multiple logistic regression. Results: 50.9% of the children used antibiotics currently and 21.0% out of them used antibiotics ≥3 times yearly. Current wheeze (W) was established in 6.5%, sleep-disturbing W in 3.6%, exercised-induced W in 1.7%, dry night cough apart from a cold in 12.2% and asthma in 2.3%. Current antibiotics use ≥3 times yearly was positively associated with current W (aOR: 13.37; 6.14-29.11; p < 0.001), sleep-disturbing W (aOR: 7.87; 3.34-18.57; p < 0.002), dry night cough (aOR: 3.80; 2.29-6.29; p <0.001), and diagnosed asthma (aOR: 5.68; 1.96-16.50; p = 0.001) while antibiotics use <3 times yearly was positively associated only with current W (p = 0.003) and dry night cough (p = 0.011). Conclusion: The results suggest an aggravating role of antibiotics use on asthma in school age thus further supporting the recommended restriction of antibiotics exposure.
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Exercise-related respiratory symptoms and exercise-induced bronchoconstriction in industrial bakers
(Informa UK Limited, 2013)
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In order to assess prevalence and characteristics of exercise-related respiratory symptoms (ERRS) and exercise-induced bronchoconstriction (EIB) in industrial bakery, the authors performed a cross-sectional study including 57 bakers and an equal number of office workers studied as a control. Evaluation of examined subjects included completion of a questionnaire, skin prick tests to common inhalant and occupational allergens, spirometry, and exercise and histamine challenge. The authors found a similar prevalence of ERRS and EIB in both bakers and controls. EIB was significantly associated with atopy, asthma, family history of asthma, and positive histamine challenge in either group, whereas in bakers it was closely related to sensitization to occupational allergens (p = .032). Bronchial reaction to exercise was significantly higher in bakers with EIB (25.7% vs 19.2%; p = .021). These findings suggest that occupational exposure in industrial bakery may accentuate bronchoconstrictive response to exercise.
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LEUKOTRIENE RECEPTOR ANTAGONISTS IN MANAGING SEVERE UNCONTROLLED ASTHMA
(European Medical Group, 2017-08-03)
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Goseva, Zlatica
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Gjorchev, Angelko
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Total Eosinophyls, ECP and IL-5 in Peripheral Blood During Treatment with Inhaled Cortikosteroids in Patients with Asthma
(Turkish Thoracic Society, 2019)
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Dejan Todevski
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Monika Tushevska Mitkovska
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Nikola Chamurovski
Objectives: The main attribute of asthma is inflammation, which leads to airway remodeling, bronchial hyper-reactivity and reversible or partly reversible airway obstruction. According to GINA, asthma is a chronic inflammatory disorder of the airways in which many cells play a role, in particular mast cells, eosinophils (Eo), and T lymphocytes (GINA). Many cells and mediators take part in creating the asthmatic inflammatory reaction, but eosinophils play a central role. Methods: This study includes 30 patients of the Pulmology and Allergy Clinic, Skopje, with confirmed bronchial asthma, treated with ICS. In all of the patients we followed Eo count, ECP and IL-5 in peripheral blood at the beginning of the study, after 2 and 6 months treatment. Results: At the beginning of the study in all 30 (100 percent) of the patients the serum level of IL-5, Eo count and ECP were increased. Following the parameters during treatment with ICS we registered statistical significant changes in all of the tested parameters. Conclusion: Our conclusion is that the ICS objectively suppress the inflammatory reaction in asthma and the biologic markers (IL-5, Eo and ECP), which we have followed, can measure the accomplished effect. They could be used in every day practice, not only as diagnostic parameters but also as valid therapeutic guides in the treatment of asthma.
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Female patient with sarcoidosis first diagnosed with asthma (case report)
(Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2016)
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Abstract Introduction: Sarcoidosis is a disease in which are present restrictive changes, the functional properties of lung and reduced values of diffusion capacity. Some authors showed the presence of airway obstruction in 2/3 of patients with a confirmed diagnosis of sarcoidosis who were not smokers. Case presentation: A female patient IT, from Skopje, born 09.16.1983 year, pharmacy technician, employed, non-smoker, does not consume alcohol, denied food or drugs allergies.Complaining of shortness of breath, cough with scant sputum, wheezing, the appearance of red spots on the legs, mutual, which withdrawn after two weeks. First she was diagnosed as asthma and a therapy was recommended.Her health situation has not improved and then a computered tomography of lung was performed. After that a bronchoscopy was performed and sarcoidosis histopathological was confirmed. She received corticosteroid therapy for one year, and her health situation become better. Conclusions:Sarcoidosis should be considered in the differential diagnosis of poorly responsive asthma. Obstructive symptoms resulting from airway involvement can occur in patients with pulmonary sarcoidosis but less frequently than a decrease in DLCO and restrictive disease.
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The association between BMI, vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema in children and adolescents: ISAAC Phase Three
(Wiley, 2013-01)
Mitchell, E A
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Beasley, R
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Björkstén, B
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Crane, J
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García-Marcos, L
Background: Several studies have observed an association between obesity and asthma, but whether or not there is an association with rhinoconjunctivitis or eczema is unclear. Aims To examine the relationship between body mass index categories (underweight, overweight and obesity), vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema. Methods: As part of International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, parents or guardians of children aged 6–7 years completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several potential risk factors, such as vigorous physical activity and television viewing, and other information such as the child’s height and weight. Adolescents aged 13–14 years self-completed the questionnaires on these symptoms and potential risk factors and reported their own height and weight. For 28% of children and 24% of adolescents, the height and weight was objectively measured. Results: A total of 76 164 children aged 6–7 years (from 29 centres and 17 countries) and 201 370 adolescents aged 13–14 years (from 73 centres and 35 countries) provided data meeting the inclusion criteria. There were associations between overweight and obesity, but not underweight, and symptoms of asthma and eczema but not rhinoconjunctivitis. Vigorous physical activity was positively associated with symptoms of asthma, rhinoconjunctivitis and eczema in adolescents, but not children. Viewing television for five or more hours/day was associated with an increased risk of symptoms of asthma, rhinoconjunctivitis and eczema in adolescents and symptoms of asthma in children. Conclusions and Clinical Relevance: This study has confirmed the association between overweight and obesity and symptoms of asthma. It has extended these observations to include significant associations with symptoms of eczema, but not rhinoconjunctivitis. There are complex relationships between obesity, vigorous physical activity and sedentary behaviour and the symptoms of asthma, rhinoconjunctivitis and eczema in children.
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Risk Factors for Childhood Asthma and Wheeze: Comparisons from an International Study
(Research Triangle Park, N. C. National Institute of Environmental Health Sciences, 2018-09-24)
Lawson, Joshua
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Brozek, Grzegorz Marek
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Beridze, Vakhtangi
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Shpakov, Andrei
Background: There is variation in childhood asthma between countries with typically higher prevalence in “Westernized” nations. We compared asthma, respiratory symptoms, and medication prevalence in Eastern and Central European regions and Canada. Methods: We conducted a cross-sectional survey study of children (5–15 years) from one urban centre in each of Canada, Belarus, Poland, Republic of Georgia (Adjara), Republic of Macedonia, and Ukraine. Surveys were distributed through randomly selected schools to parents (2013–2015). Results: The prevalence of asthma differed by country from 20.6% in Canada to 1.5% in Ukraine (p < 0.001). This association remained after confounder adjustment. Except for Canada (58.7%) and Poland (42.5%), less than 10% of children with a history of wheeze had a diagnosis of asthma. Regardless of country, more than 50% of children with a diagnosis of asthma used breathing medications in the past year. Finally, except for Georgia (12.1%), all countries had a prevalence of ever wheeze above 20% (23.8% in Poland to 30.9% in Macedonia). Conclusions: Despite large differences in asthma prevalence, respiratory morbidity was more comparable suggesting asthma prevalence may be underestimated. Further validation of asthma diagnosis is needed. It is important to promote best diagnostic practices among first contact physicians.
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Overweight hypothesis in asthma and eczema in young adolescents
(Elsevier BV, 2006)
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Stavric, Katerina
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Seckova, Lidija
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Kimovska, Milica
BACKGROUND: A positive association between body mass index (BMI) and allergic diseases has recently been suggested; however the sex-dependence of this association remains controversial. The aim of the present study was to explore the relationship between BMI and asthma and eczema, as well as its sex-dependence in young adolescents. METHODS: Self-reported data obtained through the standardized International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three written questionnaires of 2926 young adolescents aged 13-14 years old from randomly selected schools in Skopje (Republic of Macedonia) were used. The BMI for each individual was calculated and used-both unadjusted and adjusted for confounding factors-as a variable for analysis. The international cut-off points for BMI for overweight and obesity by sex and age were used. Because of the very low prevalence of obesity (1.5 %), obese respondents were included in the overweight group. The data were statistically analyzed by the chi-square test, the t-test for independent samples and odds ratios (OR, 95 % CI) in binary logistic regression. RESULTS: Being overweight was significantly associated with an increased risk of having a dry night cough without a cold or chest infection (adjusted OR: 1.54; 95 % CI: 1.09-2.16; p = 0.01) and with having had self-reported asthma at some time (adjusted OR: 2.36; 95 % CI: 1.02-5.44; p = 0.04) in boys only. A significant association between overweight and other symptoms of asthma or atopic eczema was not established. CONCLUSION: These findings suggest a male-specific positive association between overweight and a current dry night cough and having received a diagnosis of asthma at some time. No association was found with other asthma symptoms or atopic eczema in young adolescents.
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Influence of physical activity and television-watching time on asthma and allergic rhinitis among young adolescents: preventive or aggravating?
(Elsevier BV, 2008)
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Stavric, Katerina
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Seckova, Lidija
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Kimovska, Milica
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BACKGROUND: Related to exercise hypothesis, the aim of the present study was to explore the influence of physical activity on asthma and allergic rhinitis in a developing country where publicity campaigns about the benefits of exercise are scarce. METHODS: The analysed data were self-reported and obtained through the standardized International Study of Asthma and Allergies in Childhood Phase Three written questionnaires completed by 3026 adolescents 13/14 year old in Skopje (Republic of Macedonia). Vigorous physical activity and television-watching timeboth unadjusted and adjusted for confounding factorswere used as variables for analysis. Odds ratios (OR, 95 % CI) in binary logistic regression were employed for statistic analysis of the data. RESULTS: Vigorous physical activity both > or = 3 times and 1-2 times per week was associated with an increased risk of current wheeze (aOR: 1.66; 1.08-2.55; p = 0.020 and aOR: 1.70; 1.23-2.36; p = 0.001, respectively), speech-limiting wheeze (aOR: 3.15; 1.13-8.77; p = 0.028 and aOR: 4.62; 2.22-9.62; p = 0.000, respectively) and exercise-induced wheeze (aOR: 2.72; 1.93-3.83; p = 0.000 and aOR: 4.01; 3.12-5.14; p = 0.000, respectively). Frequent physical activity was positively associated only with current allergic rhinitis symptoms (aOR: 1.40; 1.04-1.90; p = 0.029). Television watching > or = 3 hours a day increased the risk of current wheeze (aOR: 1.34; 1.01-1.77; p = 0.042) and exercise-induced wheeze (aOR: 1.32; 1.05-1.65; p = 0.016). CONCLUSION: The findings support the aggravating role of sedentary regimen and poor physical fitness on asthma symptoms, but not on allergic rhinitis. Physical activity may trigger asthma symptoms when physical fitness is poor and asthma is not controlled.

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