Improvements in health status

Mediterranean diet results in a significant improvement in health status, as seen by a significant reduction in overall mortality (13%) in PD and AD patients (Fig. 9.3) (Sofi et al 2008). 

In order to determine whether or not the growth in pharmaceutical expenditure entails an increase in the price of the resources used in health production, the important factor to determine is the significance or otherwise of the innovation and its marginal contribution to health production. The large number of new products in some markets, such as Spain, Italy and Germany that provide a very small degree of innovation may constitute an indication of increasing prices rather than an increase in value (contribution to the improvement of health status and welfare). 

The health-promoting effect of lactobacilli was first hypothesized by Metchnikoff at the beginning of the last century (Metchnikoff 1905). In the last four decades there have been growing attempts to improve the health status of the indigenous intestinal flora by living microbial adjuncts, probiotics. Salminen and coworkers (1999) proposed that probiotics are microbial cell preparations or components of microbial cells that have beneficial effect on the health and well-being of the host. The probiotics do not have to be viable as nonviable forms of probiotics have also been shown to exert health-promoting effect. 

The next stage in the model is the reduction of risk by having known adverse agents of injury or illness controlled or removed. The reduction in risk leads to the final stage, which is an improvement in health and safety status of the workforce. This general model leads to a more specific approach that can be applied at specific workplaces. 

Worth et al. [123] investigated whether 1,8-cineole can, due to its mucolytic, bronchodilating, and anti-inflammatory activity, reduce the exacerbation rate and improve the health status when applied as a concomitant therapy in COPD patients. The substance possesses positive effects on the beat frequency of the cilia in the mucus. 1,8-Cineole reduced the exacerbation rate and improved lung function by improving the airflow obstmction and reducing severity of dyspnoea. Due to its positive effect on the health status, lack of side effects, and relative low cost, concomitant therapy can be recommended with therapy of the rather costly COPD, in the opinion of the authors. 

Probiotics are live microorganisms that improve the health status of the host, and exert their effects primarily in the intestinal tract. A broad range of applications of probiotic cultures has emerged, and the application of probiotic cultures is restricted only by the ability of the cultures to survive in the different food types. Probiotic bacteria in the genera Lactobacillus and Bifidobacterium are most commonly used. The most important and well-documented health benefits of these genera are their effects on lactose digestion, intestinal microbial balance and dysfunction, immune modulation, hypersensitivity, carcinogenesis, and blood cholesterol levels. 

Inhaled steroids (commonly used are beclomethasone, budesonide, triamcinolone, fluticasone, flunisolide) appear to attenuate the inflammatory response, to reduce bronchial hyperreactivity, to decrease exacerbations and to improve health status they may also reduce the risk of myocar dial infar ction, but they do not modify the longterm decline in lung function. Whether- steroids affect mortality remains unclear. Many patients appear to be resistant to steroids and large, long-term trials have shown only limited effectiveness of inhaled corticosteroid ther apy. Certainly, the benefit from steroids is smaller in COPD than in asthma. Topical side-effects of inhaled steroids are oropharyngeal candidiasis and hoarse voice. At the normal doses systemic side-effects of inhaled steroids have not been firmly established. The current recommendation is that the addition of inhaled gluco-coiticosteroids to bronchodilator treatment is appropriate for patients with severe to veiy sever e COPD. 

In symptomatic patients with severe COPD and frequent exacerbations, regular treatment with inhaled corticosteroids decreases the number of exacerbations per year and improves health status however, corticosteroids do not slow the longterm decline in pulmonary function. 

Pulmonary rehabilitation results in significant and clinically meaningful improvements in dyspnea, exercise capacity, health status, and health care utilization.10 It should be considered for patients with COPD who have dyspnea or other respiratory symptoms, reduced exercise capacity, a restriction in activities because of their disease, or impaired health status.1... 

The role of inhaled corticosteroids in COPD is controversial. Major clinical trials have failed to demonstrate any benefit from chronic treatment in modifying long-term decline in lung function. However, other important benefits have been observed in some patients, including a decrease in exacerbation frequency and improvements in overall health status. 

Several studies have shown an additive effect with the combination of inhaled corticosteroids and long-acting bronchodilators. Combination therapy with salmeterol plus fluticasone or formoterol plus budesonide is associated with greater improvements in FEVj, health status, and exacerbation frequency than either agent alone. The availability of combination inhalers makes administration of both drugs convenient and decreases the total number of inhalations needed daily. 

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