Gyakorlatok EGPA-nál (Churg-Strauss) — asztma-tudatos bemelegítés, szív-szűrés ELŐSZÖR, fázis-tudatos

ACR/EULAR 2022 criteria + 2021 EULAR/ERA AAV management framework. EGPA (eosinophilic granulomatosis with polyangiitis, formerly Churg-Strauss syndrome) is the third ANCA-associated vasculitis alongside GPA and MPA, but it is clinically distinct. The classic triphasic course: allergic phase (asthma + allergic rhinitis often years before vasculitis) → eosinophilic phase (eosinophilic infiltrates in lungs, GI, other organs) → vasculitic phase (small + medium-vessel vasculitis). ANCA positivity is ~40-50% (MPO classic when positive). Asthma is a universal precedent feature — often severe, often late-onset adult-asthma — and many patients are on inhaled steroids + LABA + leukotriene modifier years before the vasculitic diagnosis. Cardiac involvement is the leading cause of mortality (myocarditis, endomyocardial fibrosis, conduction disease) — endomyocardial biopsy if suspected, and routine cardiac MRI is increasingly recommended at diagnosis. Peripheral neuropathy (mononeuritis multiplex with foot-drop or wrist-drop) affects 50-75% of patients. Wechsler 2017 MIRRA trial established mepolizumab (anti-IL-5) as paradigm-changing on top of steroid/rituximab. Exercise priorities are phase-aware (vasculitic = induction limits, then graded post-stabilisation), asthma-aware (bronchodilator pre-exercise + gradual warmup to prevent exercise-induced bronchoconstriction), and cardiac-screen-first (echo + Holter + cardiac MRI per consensus BEFORE any aerobic prescription).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity, wall-push-up for scaled upper-body strength, scapular-retraction for posture, cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic + asthma + ILD-aware breath control, pursed-lip-breathing for bronchospasm + dyspnea management, standing-march for managed cardio after cardiac clearance, ankle-pump for circulation + DVT prevention + neuropathy management. The AI coach also knows the nutrition side — Mediterranean anti-inflammatory backbone (Hocaoglu 2024 + Bichara 2024), omega-3 1-3 g/day EPA+DHA (Stenius-Aarniala 2011 asthma + Hung 2024 eosinophilic + Calder 2017 cardiac triple benefit), cardiac modifier low-sodium <2 g/day + BP control + cardiology team, asthma trigger avoidance (sulphites in wine/dried fruit/processed meats), steroid-induced osteoporosis HIGH risk calcium 1000-1200 + vit D + weight-bearing + bisphosphonate, glucose monitoring (steroid + ICS-LABA), protein 1.2-1.4 g/kg/day during catabolic + neuropathy recovery + B-complex + alpha-lipoic acid per immunology, AVOID grapefruit/Seville orange (methylpred/tacrolimus), infection prevention on cyclophos/rituximab (food safety + vaccines). CRITICAL: Vasculitis Foundation + V-PPRN + ACR + rheumatology + pulmonology + allergy/immunology (asthma + eosinophilia mgmt) + cardiology (cardiac involvement = leading mortality cause) + neurology if peripheral neuropathy + ID for opportunistic infection. This is NEVER a replacement for rheumatology + multispecialty care.