Asthma is a chronic respiratory disease characterized by variable airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. Evidence suggests that air pollution has a negative impact on asthma outcomes in both adult and pediatric populations. The aim of this review is to summarize the current knowledge on the effect of various outdoor and indoor pollutants on asthma outcomes, their burden on its management, as well as to highlight the measures that could result in improved asthma outcomes. Traffic-related air pollution, nitrogen dioxide and second-hand smoking (SHS) exposures represent significant risk factors for asthma development in children. Nevertheless, a causal relation between air pollution and development of adult asthma is not clearly established. Exposure to outdoor pollutants can induce asthma symptoms, exacerbations and decreases in lung function. Active tobacco smoking is associated with poorer asthma control, while exposure to SHS increases the risk of asthma exacerbations, respiratory symptoms and healthcare utilization. Other indoor pollutants such as heating sources and molds can also negatively impact the course of asthma. Global measures, that aim to reduce exposure to air pollutants, are highly needed in order to improve the outcomes and management of adult and pediatric asthma in addition to the existing guidelines.

Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA. One is sensitizer-induced asthma, occuring after a latency period and caused by hypersensitivity to high- or low-molecular weight agents. The other is irritant-induced asthma, which can occur after one or more exposures to high concentrations of irritants without latency period. More than 400 agents causing OA have been identified and its list is growing fast. The best diagnostic approach for OA is a combination of clinical history and objective tests. An important tool is a specific inhalation challenge. Additional tests include assessments of bronchial hyperresponsiveness to methacholine/histamine in patients without airflow limitations, monitoring peak expiratory flow at- and off-work, sputum eosinophil count, exhaled nitric oxide measurement, skin prick tests with occupational allergens and serum specific IgE. Treatment of OA implies avoidance of exposure, pharmacotherapy and education. OA is a heterogeneous disease. Mechanisms of its different phenotypes, their diagnosis, role of new biomarkers and treatment require further investigation.

Along with its high prevalence, the burden of allergic rhinitis rests upon the serious impact on quality of life of patients. Allergic rhinitis is associated with impairments in daily activities, work and school performance, and practical problems. Patients suffer from sleep disorders and emotional problems. Тhe advantages of sublingual immunotherapy on quality of life have only recently begun to emerge. The objective of this prospective real-life study was to evaluate the effect of a three-year course of sublingual immunotherapy with house dust mite (HDM) and grass pollen extracts on quality of life in adults with allergic rhinitis. A total number of 191 adult patients [105 (54,979%) men; mean age 27.3 years (SD-6.14)] with moderate to severe allergic rhinitis and clinically relevant sensitization to house dust mites or grass pollen were prospectively evaluated in the course of management of their disease. Health-related quality of life was assessed by Rhinoconjunctivitis Quality of Life Questionnaire at baseline and after three-year course of sublingual immunotherapy. The mean overall Qol score assessed at baseline and at the end of the third year of treatment decreased significantly in patients treated with HDM extract (from 2.95 to 0.76) as well as with Grass pollen extract (from 2.83 to 1.22) (р < 0.001). The improvements in treated with HDM extract were as followed: activities – 3.52 to 0.68; sleep- 2.48 to 0.31; general problems – 1.79 to 0.49; practical problems – 3.57 to 0.68; nasal symptoms – 3.91 to 0.74; eye symptoms – 2.92 to 0.39; emotions – 3.03 to 0.39. The improvements in grass pollen group were: activities – 3.68 to 1.69; sleep- 1.85 to 0.84; general problems – 1.74 to 0.97; practical problems – 3.52 to 1.37; nasal symptoms – 3.72 to 1.57; eye symptoms – 3.58 to 1.3; emotions – 2.48 to 1.19. Our study conducted in real life provided evidence that a three-year course of SLIT with HDM extract as well as with grass pollen extract significantly increased QoL in patients with allergic rhinitis.

Allergic rhinitis is the most common allergic disorder. Although the management of the disease is successful in many patients, based on guidelines, some of them remain with symptoms uncontrolled with pharmacotherapy. Presently, there is no substantiated information on the control of allergic rhinitis in patients who underwent sublingual immunotherapy. The purpose of this prospective follow-up study was to assess the control of allergic rhinitis in adults after a three-year course of house dust mite sublingual immunotherapy. This prospective real-life study was designed to include adults with moderate to severe allergic rhinitis sensitized to house dust mite who underwent a three-year course of sublingual immunotherapy. Control of symptoms was assessed by Rhinitis Control Assessment Test (RCAT) after three years of house dust mite sublingual immunotherapy. Additionally, patients assessed their symptoms by utilizing a visual analog scale. A total number of 86 consecutively enrolled patients (46 (53.49%) men; mean age 26.10 years (SD = 5.85)) with moderate to severe allergic rhinitis and clinically relevant sensitization to house dust mite were evaluated. When assessed by RCAT on the third year, 74 (86.05%) had well-controlled symptoms and 20 (27.03%) of them were completely controlled. A significant reduction in visual analog scale scores—from 7.52 cm at baseline to 2.31 cm—was established (P < 0.0001). There was a strong negative correlation between RCAT scores and visual analog scale (r = −0.65; P < 0.01). This study provided evidence that a three-year course of house dust mite sublingual immunotherapy appears effective in controlling the symptoms of allergic rhinitis.

Introduction: Allergen specific immunotherapy provides effective treatment of allergic rhinitis. Despite its efficacy, it can be signifi­cantly compromised by a possible treatment dissatisfaction of patients. Aim: To explore determinants and factors of satisfaction with sublingual immunotherapy in patients with allergic rhinitis. Materials and methods: A total number of 191 patients with allergic rhinitis who completed a three-year course of sublingual im­munotherapy were included in the study. Of these, 76 had house dust mite (HDM) allergy - 42 men (55.26%) and 115 had grass pollen allergy - 63 men (54.78%) (mean age 27.3 years, SD: 6.14). The patients assessed their satisfaction using a visual analog scale. Health- Related Quality of Life was assessed by Rhinoconjunctivitis Quality of Life questionnaire. A visual analog scale was used to determine severity of the allergic rhinitis. Results: The mean overall satisfaction, compared with that in previous therapy, increased significantly from 4.80 (SD 2.16) to 7.47 (SD 2.05) in the grass pollen allergy group and from 3.42 (SD 2.31) to 7.61 (SD 2.38) in the patients with HDM SLIT (p< 0.001). No relation between satisfaction and sex, type of immunotherapy extracts and duration of the disease was established. A strong correlation was found between satisfaction with treatment and quality of life (R=0.62) and severity of allergic rhinitis (R=0.69) after a three-year course. Conclusion: The results of this real-life study demonstrated that most patients with allergic rhinitis appeared to be satisfied with a three-year course of sublingual immunotherapy. The study provided evidence that reduction in severity of symptoms and improvement in quality of life could determine satisfaction with treatment.

The training nursing students in the Republic of Bulgaria confirms with the contemporary European requirements. The training is theoretical and practical, with the practical training accounting for at least 50% of the total number of hours in the specialty. The practical training includes clinical practice and pre-graduation traineeship, which complies with the Ordinance on the Unified state requirements regarding the training of nurses. The clinical practice and the pre-graduation traineeship involve a total duration of 2740 hours for students majoring in Nursing (Ordinance on the Unified state requirements). The level of satisfaction of these nursing students is an important indicator of the quality of the practical training. The study involved a sociological method of direct group survey involving an original set of questions with one developed specifically for this survey and others adapted from the questionnaire on job satisfaction of the Institute of Psychology at the Bulgarian Academy of Sciences. This questionnaire on satisfaction comprises 36 statements with three subscales: 1) work organization or organization of the practical training; 2) social-psychological conditions; and 3) material. The approach uses a Likert-type scale from 1 to 4 (1 = “no”, 2 = “to a certain extent”, 3= “very much”, and 4 = “extremely”) to score responses. The opinion of 280 fourth-year nursing students from three universities: the Medical University of Plovdiv, Trakia University of Stara Zagora, and ‘Prof. Dr. Asen Zlatarov’ University of Burgas, is surveyed. The analysis of the results from the conducted empirical survey shows that in their professional activity the surveyed students are primarily motivated by love and care for people (78.8%) followed by the desire to perform an activity that is beneficial to society (63.3%). Then follows the respect on behalf of patients, the team, and society as a whole (52.5%) and subsequently, the emotional attractiveness of the work reflected in the desire to do work that brings pleasure and joy (job satisfaction; 42.4%). The level of student satisfaction with their practical training depends on the organizational-educational, social-psychological, and material and technical conditions of the hospital environment. The analysis of the survey data confirms the significant role of practical training for the professional qualification of these nursing students. However, certain negative trends are also identified. These trends are connected with the satisfaction of the students concerning the procedures they have the opportunity to perform, their relationships with their mentors and medical teams, and that at times they are required to perform inappropriate activities. This calls for increased control on behalf of the tutors.