Adv. Respir. Med., Volume 86, Issue 1 (February 2018) – 10 articles , Pages 1-74

Introduction: Lung cancer is the most common cancer in Poland and worldwide, and the leading cause of cancer-related deaths. Compared to the present day, the annual number of new cases of lung cancer will have increased by approximately 50%, by 2030. The overall ratio of mortality to incidence totals 0.87 and is among the highest. The five-year survival rate in Poland has recently achieved 13.4%. In 2015, lung cancer screening using low-dose computed tomography (LDCT) was introduced to routine clinical practice in the United States following the publication of the largest randomised study, The National Lung Screening Trial. The implementation of screening programmes in Poland and the rest of Europe also seems unavoidable. Due to the differences, both in the socioeconomic considerations and healthcare funding, compared to that in the United States, the current approach comes down to the awaited results of the European randomised study, NELSON. Material and methods: During the meeting of an expert panel at the “Torakoneptunalia 2016” conference in Jastarnia, Poland, a decision was made to summarise and publish the current data on LDCT lung cancer screening in the form of recommendations, or a position statement. The document was prepared by a team composed of a radiologist, thoracic surgeons, pulmonologists, clinical oncologists, epidemiologists, internists, health prevention specialists and pathologists. It reflects the current body of knowledge about lung cancer, its diagnosis and treatment, and provides recommendations on early detection of lung cancer using LDCT. The recommendations address the screening procedure, the requirements for the teams conducting the screening, and the requirements for radiologists, pathologists and surgeons involved in the diagnosis and treatment of patients. Results: While awaiting the results of the NELSON study on lung cancer screening methodology, the multidisciplinary group of experts presents their position, laying grounds for the development of an action plan for early detection of lung cancer in the upcoming future in Poland. Conclusions: Primary and secondary prophylaxis are the principal ways to reduce lung cancer mortality. While smoking cessation is a task of utmost importance, it must be accompanied by an effective screening programme if the outcome of the disease is to be improved. Full article

The article briefly presents currently accessible dry powder inhalers (DPI). Basing on the data from the literature, we discussed the most common mistakes related to the utilisation of DPI as well as their clinical and economic consequences. We also extensively analysed all factors that may influence the efficacy and safety of inhaler therapy of asthma and COPD, mostly with the use of DPI. In addition, we indicated the potential to improve the efficacy of inhaler therapy from the doctor and COPD or asthma patient perspective. We also presented a DPI choice algorithm including the patient’s preferences and competences. Full article

Introduction: Castleman’s disease is a rare benign lymphoproliferative disorder of unknown etiology. The disease occurs in two clinical forms with different prognoses, treatments and symptoms: a unicentric form (UCD), which is solitary, localized, and a multicentric form characterized by generalized lymphadenopathy and systemic symptoms. This article aims to review the current literature to consolidate the evidence surrounding the curative potential of surgical treatment to the unicentric type. Material and methods: A systematic review of English-language literature was performed and databases (Medline, Pubmed, the Cochrane Database and grey literature) were searched to identify articles pertaining to the treatment of unicentric form of Castleman’s disease. Each article was critiqued by two authors using a structured appraisal tool, and stratified according to the level of evidence. Results: After application of inclusion criteria, 14 studies were included. There were no prospective randomized control studies identified. One meta-analysis including 278 patients with UCD reported that resective surgery is safe and should be considered the gold standard for treatment. Seven retrospective studies enhance this standpoint. Radiotherapy (RT) has been used in six studies with controversial results. Conclusions: We conclude that surgical resection appears to be the most effective treatment for Unicentric Castleman’s Disease of the thoracic cavity. Radiotherapy can also achieve clinical response and cure in selected patients. Full article

Mycobacterial lung disease is caused by nontuberculous mycobacteria (NTM), also known as atypical mycobacteria. NTM are widely distributed in the environment, particularly in soil and water; they may colonize the airways, gastrointestinal tract and genitourinary system, without the apparent signs of disease. Nevertheless, in some risk groups such as patients with chronic lung diseases or with immunodeficiency, mycobacterial lung disease is identified. Recently, increased recognition of mycobacterial lung disease in chronic obstructive pulmonary disease (COPD) patients has been observed, especially in those treated with high doses of inhaled corticosteroids. In the present paper, we describe the patient treated for many years due to COPD and bronchiectasis, with clinical and radiological picture suggestive of lung tumor, in whom final diagnosis of mycobacterial lung disease caused by Mycobacterium avium was made. Full article

Introduction: Fiber-optic bronchoscopy (FOB) is commonly performed in the first line in diagnostic process of haemoptysis. However, lots of evidences suggest that in haemoptysis FOB do not always provide additional, useful information to radiological diagnostics. Therefore, this study aimed to evaluate the validity of performing FOB as a method of choice in first line diagnostics of haemoptysis. Material and methods: Data comprised consecutively collected results from patients referred for FOB assessment for clinical purposes were retrospectively analysed. We included all examinations, which were performed due to haemoptysis as the only indication, excluding any other lung-related conditions. Results: 114 patients were finally included to the study. The median age was 59 (IQR: 46–64.75). Active bleeding was visualized during examination of 13 (11.4%) patients. Patients with active bleeding did not differ significantly according to age: 59 (54–69) vs. 59 (45–64) years; W = 532.5, p-value = 0.27, and gender: c2 = 1.68, p-value = 0.2. On the other hand, in 29 (25.44%) patients, FOB revealed no visible abnormalities. This subgroup of patients was significantly younger — 46 (34–62) years vs. 60 (53–67) years; W = 782, p-value = 0.003. Conclusion: Low number of visualized active bleeding sites suggest overuse of bronchoscopy in diagnosis of haemoptysis. Indications for this examination should be reconsidered especially in young patients with non-massive haemoptysis. Full article

Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disease in the field of pulmonary medicine. The efficacy of whole-lung lavage (WLL) as the treatment of PAP had never been evaluated in the Iranian population. Therefore, there is a real need to investigate the characteristics of PAP and also to evaluate the efficacy of WLL in this rare disease. The study aimed to investigate demographic features, clinical presentation and treatment outcomes of the disease in Iranian PAP patients. Material and methods: Data of 45 patients with definite diagnosis of PAP, who had regular follow-ups from March 2004 to March 2015 at an Iranian referral respiratory hospital, were collected. Whole-lung lavages (WLL) efficacy was assessed by comparing spirometric, arterial blood gas parameters and six-minute walk test (6MWT) results before and after all lavages. Results: Mean age at diagnosis of disease was 30.33 ± 14.56 years. Four patients (8.8%) reported non-massive hemoptysis and three subjects (6.6%) had concomitant pulmonary tuberculosis. In 71.1% of cases, transbronchial lung biopsy and bronchoalveolar lavage were sufficient for diagnosis. Spirometric results and arterial blood gas parameters and 6MWD improved significantly after all the lavages. Four patients (8.8%) died because of respiratory failure. The only variable capable of predicting treatment failure was the history of hemoptysis. Conclusion: The study revealed sufficiency of WLL as the PAP patients’ treatment. Also hemoptysis was found to be the independent factor that can predict treatment failure. Full article

Introduction: Type 1 diabetes is an insulin deficiency-based chronic disease. It leads to the development of hyperglycaemia, which plays a key role in the initiation and progression of tissue damage in patients with diabetes. This mostly results from oxidative stress, whose increased severity is observed in this group of patients. Increased levels of 8-isoprostanes are seen in many inflammatory diseases, including asthma, COPD and cystic fibrosis. These diseases demonstrated the usefulness of the exhaled breath condensate (EBC) for extracting material for markers of oxidative stress, including 8-isoprostanes. The purpose of this study was to assess the severity of oxidative stress measured with 8-isoprostane concentrations in the exhaled breath condensate in healthy subjects and in patients with type 1 diabetes with and without vascular complications. Material and methods: 33 patients assigned to the control group, type 1 diabetes without complications group and type 1 diabetes group with advanced complications were included in the study. Retinopathy, nephropathy or neuropathy have been reported as a criterion distinguishing between complicated and uncomplicated diabetes. EBC was obtained for each subject. 8-isoprostane concentrations were determined in serum and EBC by ELISA. Results and conclusions: Mean (± SD) blood levels of 8-isoprostane in patients with type 1 diabetes mellitus without complications and those with type 1 diabetes with advanced complications were significantly higher compared to the control group (178.17 [135.73] vs. 183.34 [200.41] vs. 47.13 [25.20] pg/ml; p < 0.05). The mean (± SD) concentration of 8-isoprostane in EBC was lower in diabetic patients with type 1 diabetes with advanced complications than in patients with type 1 diabetes without advanced complications and in the control group (8.32 [4.60] vs. 19.13 [22.35] vs. 28.17 [35.11] pg/ml; p < 0.05). Measurement of 8-isoprostanes in the EBC in patients with type 1 diabetes does not appear to be a good diagnostic tool for monitoring the activity of oxidative stress in these patients. Full article

Inflammatory myofibroblastic tumors (IMT) of the lung, first reported in 1939, are considered a subset of inflammatory pseudo -tumors. They are a distinctive lesions composed of myofibroblastic spindle cells accompanied by an inflammatory infiltrate of plasma cells, lymphocytes, and eosinophils. IMTs may be benign, invade surrounding structures, undergo malignant transformation, recur or may even metastasize. They can occur due to a genetic mutation or can occur secondary to infectious or autoimmune diseases. Patients may be asymptomatic, or present with cough, hemoptysis, dyspnea, pleuritic pain, constitutional symptoms or pneumonia. In this article we review the pathophysiology, genetics, clinical presentation, imaging findings of IMT of the lung. We also discuss the various surgical and non-surgical treatment options and the prognosis associated with this disease. Full article

In this article the co-existence of pulmonary emphysema with lung fibrosis of typical pattern and distribution for usual interstitial pneumonia (UIP) was compared with idiopathic pulmonary fibrosis (IPF) alone. Author discusses the etiopathogenesis of these diseases, differences in signaling pathways and the role of senescent cells. Moreover, clinical course, pulmonary function tests as well as main complications are reviewed. However, the lack of well-established diagnostic criteria for CPFE along with mainly retrospective character of the studies make current knowledge about this entity rather deficient. Full article