| Abstract | Cilj istraživanja
Cilj ovog specijalistiĉkog rada bio je prikupiti i analizirati podatke iz znanstvene i struĉne literature
vezane uz Respiratornu bolest uzrokovanu nesteroidnim protuupalnim lijekovima (AERD) s naglaskom
na postojeće i buduće terapijske mogućnosti.
Materijali i metode
Prilikom izrade ovog rada sustavno je pretraţena znanstvena i struĉna literatura, trenutno vaţeće
terapijske smjernice, publikacije struĉnih udruga i institucija, baza lijekova Agencije za lijekove i
medicinske proizvode te drugi raspoloţivi izvori u svrhu dobivanja informacija vezanih uz Respiratornu
bolest uzrokovanu nesteroidnim protuupalnim lijekovima. Za pisanje rada odabrano je 76 radova na
temelju kojih su izvedena vlastita razmatranja i zakljuĉci.
Rezultati
Ovaj specijalistiĉki rad daje pregled recentnih istraţivanja epidemiologije, patofizioloških mehanizama,
kliniĉkih manifestacija, dijagnostiĉkih postupaka te aktualnih i potencijalnih terapijskih mogućnosti
lijeĉenja Respiratorne bolesti uzrokovane nesteroidnim protuupalnim lijekovima.
Zakljuĉak
Respiratorna bolest uzrokovana nesteroidnim protuupalnim lijekovima kompleksna je upalna bolest ĉija
patogeneza još uvijek nije do kraja razjašnjena. Iako su bolest i njezine kliniĉke znaĉajke poznate već
dugi niz godina još uvijek nije poznato što uzrokuje ovu bolesti i kako je uspješno lijeĉiti. Kako raste
razumijevanje patofiziologije ove bolesti tako raste i broj potencijalnih terapija. Trenutno su fokusu
istraţivanja biološki lijekovi i antagonisti P2Y12 i CRTH2 receptora kao moguće terapijske opcije. Unatoĉ
ovim novim terapijskim opcijama desenzibilizacija acetilsalicilnom kiselinom i kasnija prolongirana
primjena acetilsalicilne kiseline ostaje specifiĉan postupak od kojeg koristi ima većina oboljelih od
AERD-a. Ovaj postupak dovodi do poboljšanja simptoma bolesti, smanjuje potrebu za primjenom
sistemskih kortikosteroida, usporava ponovni rast polipa i dovodi do tolerancije acetilsalicilne kiseline
(ASK) i drugih nesteroidnih protuupalnih lijekova (NSAIL). Da bi se izbjegle komplikacije poput plućne
fibroze, remodeliranja dišnih putova pa ĉak i smrti bolest je potrebno što ranije prepoznati i
dijagnosticirati. Trenutno ne postoji pouzdan in vitro test za dokazivanje bolesti stoga je oralni
provokacijski test acetilsalicilnom kiselinom i dalje zlatni standard za postavljanje dijagnoze. Razvoj
osjetljivog i specifiĉnog biomarkera trebao biti jedan od primarnih ciljeva znanstvenika koji prouĉavaju
ovu bolest. Nesteroidni protuupalni lijekovi ĉesto su propisivani i korišteni lijekovi. S obzirom da izmeĊu
NSAIL-a koji su jaki inhibitori COX-1 postoji 100% kriţna reakcija da bi se izbjegle po ţivot opasne
situacije oboljele i njihove obitelji potrebno je na vrijeme upozoriti na ovaj problem. Ljekarnici su
najdostupniji zdravstveni djelatnici i kao takvi moraju biti upoznati s ovim sindromom kao bi mogli
ispravno savjetovati, educirati i pomoći oboljelima od AERD-a koji dolaze u ljekarnu. |
| Abstract (english) | Objectives
The aim of this paper was to collect and analyse data from scientific and professional literature
regarding the Respiratory disease caused by non-steroidal anti-inflammatory drugs (AERD), with an
emphasis on existing and future treatment options.
Material and Methods
In the process of writing this paper, in order to obtain AERD-related information, systematic search of
the following sources was conducted: scientific and professional literature, the treatment guidelines
applicable at the moment, publications by specialist associations and institutions, the drug database of
the Croatian Agency for Medicinal Products and Medical Devices and other available sources. Seventysix
papers were included in the analysis, based on which considerations and conclusions were
deduced.
Results
This paper reviews the recent studies in epidemiology, pathophysiological mechanisms, clinical
manifestations, diagnostic procedures, current and potential AERD treatment options.
Conclusion
AERD is a complex inflammatory disease whose pathogenesis has still not been fully explained. Even
though the disease itself and its clinical features have been known for a long number of years, we still
do not know what causes this disease and how we can treat it successfully. The number of potential
treatments grows with the understanding of the pathophysiology of this disease. Biological drugs and
P2Y12 and CRTH2 receptor antagonists are currently in focus as possible treatment options. In spite of
these new treatment options, acetylsalicylic acid desensitisation and subsequent prolonged
acetylsalicylic acid administration remain the specific procedures that most patients suffering from the
disease benefit from. This procedure improves the symptoms of the disease, reduces the need for the
administration of systemic corticosteroids, slows down polyp recurrence, improves the quality of life, and
leads to acetylsalicylic acid and nonsteroidal anti-inflammatory drug tolerance. To avoid complications
such as pulmonary fibrosis, airway remodelling and even death, it is essential to recognise and
diagnose the disease in time. There is no reliable in vitro test available at the moment to provide proof of
the disease, and the oral provocation test with acetylsalicylic acid remains the golden diagnosis
standard. The development of a sensitive and specific biomarker should be one of the primary
objectives for the scientists studying this disease. Non-steroidal anti-inflammatory drugs (NSAID) are
often prescribed and used. Considering the 100% cross-reaction between NSAID, which are strong
COX-1 inhibitors, the patients and their families need to be warned about this problem in time in order to
avoid life-threatening situations. Pharmacists are the most widely available healthcare workers, and as
such need to be informed about this syndrome to be able to provide correct advice, information and help
to AERD patients visiting their pharmacies. |
