In recent years, several national chronic obstructive pulmonary disease (COPD) guidelines have been issued. In Serbia, the burden of COPD is high and most of the patients are diagnosed at late stages. Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is poorly implemented in real-life practice, as many patients are still prescribed inhaled corticosteroids (ICS)-containing regimens and slow-release theophylline. In this document, we propose an algorithm for treating COPD patients in Serbia based on national experts’ opinion, taking into account global recommendations and recent findings from clinical trials that are tailored according to local needs. We identified four major components of COPD treatment based on country specifics: active case finding and early diagnosis in high-risk population, therapeutic algorithm for initiation and escalation of therapy that is simple and easy to use in real-life practice, de-escalation of ICS in low-risk non-exacerbators, and individual choice of inhaler device based on patients’ ability and preferences. With this approach we aim to facilitate implementation of the recommendation, initiate the treatment in early stages, improve cost-effectiveness, reduce possible side effects, and ensure efficient treatment.

Background: Establishing a regional/national/international registry of patients suffering from chronic obstructive pulmonary disease (COPD) is essential for both research and healthcare, because it enables collection of comprehensive real-life data from a large number of individuals. Objective: The aim of this study was to describe characteristics of COPD patients from the Serbian patient registry, and to investigate actual differences of those characteristics among the COPD phenotypes. Methods: The Serbian registry of patients with COPD was established in 2018 at University of Kragujevac, Faculty of Medical Sciences, based on an online platform. Entry in the Registry was allowed for patients who were diagnosed with COPD according to the following criteria: symptoms of dyspnea, chronic cough or sputum production, history of risk factors for COPD and any degree of persistent airflow limitation diagnosed at spirometry. Results: In the Serbian COPD registry B and D GOLD group were dominant, while among the COPD phenotypes, the most prevalent were non-exacerbators (49.4%) and then frequent exacerbators without chronic bronchitis (29.6%). The frequent exacerbator with chronic bronchitis phenotype was associated with low levels of bronchopulmonary function and absolute predominance of GOLD D group. Anxiety, depression, insomnia, hypertension and chronic heart failure were the most prevalent in the frequent exacerbator with chronic bronchitis phenotype; patients with this phenotype were also treated more frequently than other patients with a triple combination of the most effective inhaled anti-obstructive drugs: long-acting muscarinic antagonists, long-acting beta 2 agonists and corticosteroids. Conclusion: In conclusion, the data from the Serbian registry are in line with those from other national registries, showing that frequent exacerbators with chronic bronchitis have worse bronchopulmonary function, more severe signs and symptoms, and more comorbidities (especially anxiety and depression) than other phenotypes. Other studies also confirmed worse quality of life and worse prognosis of the AE-CB phenotype, stressing importance of both preventive and appropriate therapeutic measures against chronic bronchitis.

Background: Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVDs) are closely linked through shared inflammatory and metabolic pathways. Metabolic syndrome (MetS), shared by both conditions, may represent a key mechanistic link between systemic inflammation, cardiovascular disease, and COPD outcomes. Objective: To assess the prevalence and clinical correlates of MetS and examine whether increasing MetS burden is linked to more severe symptoms and a higher comorbidity load in patients with COPD. Methods: We analyzed cross-sectional data from a multicenter COPD registry. MetS was defined by the presence of at least three components: obesity, hypertension, hyperglycemia, or dyslipidemia based on clinical and medication data. Associations between MetS burden and COPD characteristics were evaluated using multivariable models adjusted for age, sex, smoking history, exacerbation status, lung function, inhaled therapy, and study center. Results: Among 5030 patients, MetS was present in 10.4% and was more frequent in women (11.9% vs. 9.6%, p = 0.01). Patients with MetS had greater symptom burden, and more frequent signs of cyanosis, cor pulmonale, and heart failure. MetS was most common in Global Initiative for Chronic Obstructive Lung Disease stage II–III and associated with higher forced expiratory volume in one second but lower forced vital capacity, with similar exacerbation rates between the groups. Cardiovascular, sleep, renal, and connective tissue comorbidities were more prevalent in patients with MetS. A dose–response relationship was observed, with each additional metabolic syndrome component independently associated with increased odds of respiratory symptoms and cardiometabolic comorbidities (all p < 0.01). Conclusions: Our findings suggest that metabolic syndrome is present in approximately 10% of patients with COPD and is associated with greater symptom burden and a higher prevalence of cardiovascular, renal, and sleep-related comorbidities. The observed stepwise relationship supports the presence of a clinically relevant cardiometabolic profile in COPD. However, given the cross-sectional registry-based design, causal inferences cannot be made, and prospective studies are needed to confirm these associations and evaluate targeted interventions.

Objective. Recent research suggests that neuroinflammation may play a crucial role in age-related cognitive dysfunction. Studies have investigated the impact of leukotriene receptor (LTR) antagonist montelukast, a medication commonly used to treat allergies and asthma, on the risk of developing dementia. The aim of this study was to compare cognitive functions in asthmatic patients who used montelukast, those who did not use it, and healthy controls. Methods. In this study 50 asthmatic patients (age 67.34±6.44; 20 montelukast users and 30 non-users) were matched with 50 healthy controls (age 68.08±5.95). Each participant was assessed using the Mini Mental State Examination (MMSE) and the Montreal Cognitive Test (MoCA). Memory coefficients (verbal, visual, general, delayed memory, and attention and concentration) were measured by Wechsler Memory Scale-Revised (WMS-R). Results. Orientation, as MoCA subdomain, was worse in patients with asthma compared to the control group (p=0.048). Asthmatic patients treated with montelukast had a significantly higher MoCA score (p=0.033), dominantly due to delayed recall, (p=0.044) than patients without montelukast treatment. People with asthma on montelukast therapy showed statistically significantly better results on the MoCA test (p=0.037) compared to the control group (dominantly due to attention (p=0.032) and delayed recall (p=0.021)). A multiple linear logistic regression model showed statistical significance (p=0.025). The use of montelukast had significant impact on the results of the MOCA test (p=0.012). Conclusion. Montelukast group had better results on MoCA (dominantly due to delayed recall) compared to montelukast non-users. Studies with a larger number of participants are needed to confirm the effect of montelukast on the cognitive status of the elderly.

Background: The SARS-CoV-2 pandemic raised concerns about severe asthma (SA) patients, especially those on biological therapy. While initial fears of increased risks diminished for the general asthma population, a subset of severe cases undergoing specific treatments continued to be closely monitored. Our study aimed to evaluate COVID-19 occurrence, asthma exacerbations, hospitalizations, and outcomes in severe asthma patients. Methods: This multicenter study gathered data from 237 adult severe asthma patients in Croatia and Serbia to assess COVID-19 impact compared to the general population. Participants received omalizumab, mepolizumab, benralizumab, or reslizumab. Data on demographics, clinical features, and COVID-19 were collected. COVID-19 symptoms and diagnostic testing were assessed as described. Results: No demographic differences were seen between COVID-19-positive and -negative groups, with eosinophilic asthma prevailing. Among patients with SA treated with biologics, the occurrence of COVID-19 did not differ significantly from that in the general population, and biologic therapy was not associated with more severe disease or higher mortality. Importantly, no meaningful differences were observed among different biologics regarding COVID-19 outcomes. Vaccination was associated with a reduction in severe cases and hospitalizations. Conclusions: Biologic therapy for severe asthma appears safe during the COVID-19 pandemic. Patients receiving biologics did not experience worse outcomes than the general population, and no biologic was linked to poorer COVID-19 prognosis. Vaccination further contributed to protection against severe disease.