Az összefoglaló célja az inhalációs antikolinerg szerek cardiovascularis veszélyének tárgyalása krónikus obstruktív tü-dőbetegségben. A tiotropium-használat adatainak néhány metaanalízise felvetette ilyen mellékhatások (arrhythmia, angina, szívinfarktus stb.) fokozott lehetőségét. Az összefoglaló áttekinti a retrospektív adatbázis-feldolgozásokat, a randomizált kontrollcsoportos vizsgálatokat és a klinikai vizsgálatok metaanalíziseit. Az adatbázis-vizsgálatok eredményei inkonzisztensek. A legtöbb klinikai vizsgálatban a cardiovascularis mellékhatások incidenciája azonos volt az aktív kezelésű és a placebocsoportban, jellemzően azoknál a betegeknél is, akik előzőleg cardiovascularis betegségben szenvedtek. A metaanalízisekben kevés a bizonyíték vagy egyáltalán nincs arra nézve, hogy összefüggés van az antikolinergek és a cardiovascularis tünetek között. A szerző áttekinti a humán szív kolinergreceptor-altípusait és funkcióját, a szívműködés ezen receptorok útján történő autonóm szabályozását, ezek lehetséges szerepét és az inhalált antikolinerg szerek farmakokinetikai tulajdonságait. Megállapítja, hogy nincs bizonyíték az inhalációs antikolinerg szerek fokozott cardiovascularis ártalmára. Orv. Hetil., 2015, 156(31), 1246-1252. Kulcsszavak: krónikus obstruktív tüdőbetegség, inhalációs antikolinerg szerek, cardiovascularis szövődmények Are there cardiovascular adverse effects of inhaled anticholinergics?The purpose of this review is to discuss the cardiovascular risk associated with inhaled anticholinergics in chronic obstructive pulmonary disease. Several meta-analyses of data for tiotropium raised the possibility of an increased risk for arrhythmia, angina, myocardial infarction, etc. This review includes the data of retrospective studies of databases using databases, randomized controlled trials, and meta-analyses of clinical trials. The conclusions of studies were inconsistent. In most clinical trials the incidence of cardiovascular adverse events was similar in active treatment and placebo groups, especially in patients with previous cardiovascular diseases. Considering meta-analyses, there is little, if any, evidence for the association between anticholinergics and the development of cardiovascular symptoms. The author discusses the presence and function of cholinergic receptor subtypes in human heart, and cardiac functions controlled by the autonomic nervous system via these receptors, their possible role, and pharmacokinetic properties of inhaled anticholinergics. The author concludes that it is not possible to fi nd evidence of increased cardiovascular harm of inhaled anticholinergics.Keywords: chronic obstructive pulmonary disease, inhaled anticholinergics, adverse cardiovascular events Nagy, L. B. [Are there cardiovascular adverse effects of inhaled anticholinergics?]. Orv. Hetil., 2015, 156(31), 1246-1252. (Beérkezett: 2015 elfogadva: 2015. május 18.) Rövidítések cAMP = ciklikus adenozin-monofoszfát; COPD = krónikus obstruktív tüdőbetegség; FEV1 = forszírozott másodpercvolu-men; ISZB = ischaemiás s...

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It is increasingly recognized that the bronchial asthma is a heterogeneous entity, encompassing a variety of different phenotypes. The identification of specific phenotypes is the key to develop more effective personalised treatment. The earliest attempt to phenotype asthma was proposed classifying into extrinsic and intrinsic subtypes. Clinical asthma is mainly divided into allergic (atopic) and non-allergic (non-atopic) asthma. Other phenotypes are based on trigger factors. Later the phenotyping based on the predominant cellular nature of inflammation: It can be divided into eosinophilic and non-eosinohilic. The non-eosinophilic asthma may be neutrophilic, combined, and paucigranulocytic. The discovery of Ig E represented a major breakthrough in asthma research. Ig E is an immunglobulin that plays a central role in pathomechanisms. Later identify with novel immune phenotypes: T-helper-2 high and T-helper-2 low subtypes. Neutrophilic asthma is mostly dependent of T-helper-17 cell induced mechanisms. The cluster analysis have been used increasingly to identify phenotypes. New data have been identified molecular pathways. However phenotyping of asthma is complex because of the overlap of the various phenotypes. The limitations of the studies need future research. Biomarkers e.g. levels of eosinophils in blood and sputum, exhaled nitric oxide fraction, serum immunglobulin E, serum periostin identify different asthma phenotypes. Orv. Hetil., 2017, 158(13), 491-498.

Electronic cigarettes are becoming increasingly popular with smokers worldwide. This has created an entirely new public health dilemma. The central issue in the debate is the disease risk imposed by e-cigarettes. It is generally acknowledged that e-cigarettes are unlikely to be as harmful as conventional cigarettes, but there are little data that quantify their relative harms. Experiments in cell cultures and animal studies show that e-cigarettes can have multiple negative effects. Scientific evidence regarding their human acute health effects is limited. The long term effects in humans are unknown, and there is no evidence that e-cigarettes are safer than tobacco in the long term. This review higlights the recent data regarding e-cigarettes toxicity impact on lung and cardiovascular system. Orv Hetil. 2019; 160(45): 1767–1773.