Search Results (20)

Introduction: COPD exacerbation is a life-threatening condition with acute dyspnoea caused by respiratory or circulatory distress. The significance and co-presence of lung hyperinflation, bronchial obstruction, and changes in haemodynamics in the course of COPD exacerbation treatment have not been well described yet in course of a single study. Our aim was to evaluate the influence of COPD exacerbation treatment on bronchial obstruction, pulmonary hyperinflation, and possible changes of right and left ventricle haemodynamics in relation to the patient’s clinical status. Materials and Methods: A total of 40 patients (90% males), 67 ± 8 years old, with COPD were assessed pre- and post-exacerbation treatment by the following: respiratory function tests, transthoracic echocardiography, 6MWT, endothelin-1 (ET-1) and NT-proBNP serum concentrations, and MRC scale. Results: A significant decrease in RV%TLC (%) and mean pulmonary artery pressure (PAPmean) [mm Hg] was observed: pre -RV%TLC: 64.3 ± 9.0; post-RV%TLC 60.6 ± 11.1; p = 0.03; pre-PAPmean: 41.2 ± 11.2; post-PAPmean: 39.1 ± 12.1; p = 0.029, coupled with a significant increase of FEV₁ [L]-preFEV₁: 1.0 ± 0.4, post-FEV₁: 1.2 ± 0.5; p < 0.001. A trend for reduced right ventricle systolic pressure (RVSP) [mm Hg]: pre-treatment: 44.5 ± 12.9; post-treatment: 36.3 ± 14.3; p = 0.068 and ET-1 [fmol/ml]: pre-treatment: 1.7 ± 2.8; post-treatment: 1.3 ± 1.9; p = 0.076, but not for NT-proBNP was noticed. Improvement of both, 6MWT [m]: pre-treatment: 294 ± 132; post-treatment: 415 ± 102; p < 0.001 and MRC [pts.]: pre-treatment: 3.3 ± 0.8; post-treatment: 1.8 ± 0.9; p < 0.001, were noticed. 6MWT correlated with RV%TLC (p < 0.05; r = –0.46; r = –0.53; respectively) and FEV₁ (p < 0.05; r = 0.55; r = 0.60, respectively) on admission as well as on discharge. There was no such correlation with RVSP or PAPmean. Conclusions: Pulmonary hyperinflation and bronchial obstruction may be reduced by effective COPD exacerbation treatment and are accompanied by clinical improvement. The mPAP reduction observed in the course of treatment was not correlated with the results of 6MWT and MRC score. Full article

Nieinwazyjna wentylacja mechaniczna (NIV) jest nowoczesną metodą leczenia przewlekłej niewydolności oddychania (CRF). Wraz z rozwojem medycyny oraz społeczeństwa określanego mianem “zachodniego” wzrasta liczba osób w podeszłym wieku, u których występuje kilka chorób przewlekłych mogących współistnieć, między innymi przewlekła obturacyjna choroba płuc (POChP). W populacji dorosłych pacjentów NIV znajduje zastosowanie w leczeniu chorób nerwowo-mięśniowych, między innymi stwardnienia zanikowego bocznego (ALS) czy rdzeniowego zaniku mięśni. Do pozostałych podstawowych wskazań należą choroby restrykcyjne (wśród nich kifoskolioza), choroby płuc (głównie POChP) oraz zespół bezdechu centralnego i zespół hipowentylacji osób otyłych (OHS). W poszczególnych wskazaniach, u różnych chorych, tryb i intensywność wentylacji mogą się istotnie różnić. Celem niniejszego opracowania jest upowszechnienie wiedzy na temat roli NIV w CRF u osób dorosłych. W pracy podjęto próbę syntezy aktualnej wiedzy na temat NIV. Zwrócono również uwagę na potencjalne patomechanizmy CRF w aspekcie NIV, które powinny stać się tematem przyszłych badań naukowych. Full article

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by an airflow limitation that is usually progressive. The progression of COPD expressed as the rate of an annual decline in FEV₁ is very heterogeneous. Exercise capacity in COPD patients is often diminished and becomes worsened over the time. The purpose of the study was to examine how the change in FEV₁ and exercise capacity would deteriorate over long-term observation. Material and Methods: A total of 22 men with COPD were examined. At the beginning the average age was 59 ± 8.1 years and the mean post-bronchodilator FEV₁ was 52 ± 14.9% predicted. Pulmonary function testing was performed at entry and then each year for 10 years, and exercise testing on a cycle ergometer was performed at entry and after 10 years. Results: FEV₁ and maximum oxygen uptake (VO_2max), maximum mechanical work (W_max), maximum minute ventilation (V_Emax) and maximum tidal volume (V_Tmax) declined significantly over the observation time. The mean annual decline in FEV₁ was 42 ± 37 mL, and the mean decline for VO 2max was 30 ± 15 mL/min/yr and 0.44 ± 0.25 mL/min/kg/yr. Regression analysis revealed that the changes in FEV₁ do not predict changes in VO_2max. We observed a correlation between the annual change in V_Emax and annual change in VO_2max (r = 0.51; p < 0.05). The baseline FEV₁ (expressed as a percentage of predicted and in absolute values) is the predictor of FEV₁ annual decline (r = 0.74 and 0.82; p < 0.05). Conclusions: We observed over time deterioration in exercise capacity in COPD patients which is independent of decline in airflow limitation. The long term follow-up of exercise capacity is important in monitoring of COPD patients in addition to pulmonary function. Full article

Introduction: Adult patients with diagnosis of asthma remain largely under the care of primary care physicians (general practitioners). Thus, they play an important role in diagnosing and treating this population. The aim of the study was to characterize of adults with asthma remaining under the care of Polish general practitioners (GP) as well as to evaluate the use of diagnostic tools and treatment in light of GINA recommendations. Material and methods: This questionnaire study included a representative sample of 1852 general practitioners (GPs) who were asked to complete questionnaires on the diagnosis and treatment of their patients with asthma. Results: Altogether 1250 GPs provided information about 10,981 patients. Controlled asthma had 21.2% patients, 46.9% partly controlled, and 31.9% uncontrolled asthma. Allergy skin prick tests were performed in 64.8%, bronchial reversibility tests in 58.1% and bronchial provocation tests in 9.8% of patients. Spirometry results were obtained for 41.9% of patients. In the last year 16.6% of patients underwent emergency intervention due to asthma exacerbation and 18.1% required hospitalization. Conclusions: In Polish asthma patients the frequency of allergological and pulmonological visits as well as the frequency of spirometric assessment are poorly associated with asthma control level. The diagnostic tests recommended by international and national guidelines for the management of asthma are performed too seldom. Hospitalizations and emergency interventions related to asthma exacerbations are found in a large portion of patients and depend on their gender and asthma control level. Asthma has a negative impact on everyday activity in more than half of patients. Proper assessment of the level of causes asthma control according to GINA guidelines poses problems to Polish general practitioners. Full article

Introduction: Based on the normal values for inflammatory cell counts in induced sputum produced by healthy individuals living in the region of Silesia, Poland, we assessed the usefulness of cytological examination of induced sputum in the diagnostic evaluation of asthma, chronic obstructive pulmonary disease (COPD) and chronic bronchitis. Material and methods: We analyzed the results of examinations performed in 96 healthy individuals (controls), 42 patients with asthma, 49 with COPD and 30 with chronic bronchitis. We performed spirometry with salbutamol reversibility testing and examination of induced sputum in all the subjects. Those without contraindications underwent methacholine challenge testing. Results: We found a significantly elevated percentage of eosinophils in all the patient groups compared to the controls (p < 0.00001). Median values were 10.3% for asthma, 1.5% for COPD, 1.6% for chronic bronchitis and 0.3% for the controls. We found statistically significant differences in the mean neutrophil percentages in induced sputum between healthy individuals and asthma patients, COPD patients and chronic bronchitis patients (p < 0.05). The median values were 45.75%, 38.1%, 77.5% and 58.1%, respectively. The percentage of subjects with positive eosinophil counts (>2.8%) in the sputum of patients with asthma, COPD, chronic bronchitis and in the controls was 85%, 38%, 20% and 6%, respectively. Conclusions: 1. Cytological examination of induced sputum is a good test supporting the diagnostic evaluation of chronic inflammatory diseases of the respiratory tract. 2. The percentage of eosinophils in induced sputum exceeding 2.8% is a very good indicator of asthma. Full article

Introduction: Pleural effusion secondary to various diseases is associated with the presence of different inflammatory cells. The C-C chemokines (MCP-1 and MIP-1α), produced by pleural mesothelial cells, plays an important role in the recruitment of inflammatory cells to the pleural space. The purpose of the study was to evaluate predictive value of MCP-1 and MIP-1α in the differential diagnosis of pleural effusion. Material and methods: Based on Light’s criteria in 29 cases exudates and in 10 transudates were recognized. We investigated 39 patients with pleural effusion (congestive heart failure — 10, parapneumonic — 11, tuberculous — 6, malignant — 12). The C-C chemokines MCP-1 and MIP-1α levels in pleural effusion and serum were measured by ELISA. Results: The MCP-1 was significantly higher (p = 0.009) in the patient with exudates than in patients with transudates (2436 pg/ml and 794 pg/ml respectively). ROC curve analysis revealed however that this parameter has limited value in the differentiation of exudates an transudates (MCP-1 cut off value 1060 pg/ml, sensitivity 48%, specificity 90%, PPV 93%, NPV 37%). The chemokine MIP-1α were significantly higher (p = 0.001) in tuberculous than in the malignant effusion (405 pg/ml and 30 pg/ml respectively). Based on the ROC curve analysis, as a cut off value in the differentiation of tuberculous and malignant pleural effusion a value 120 pg/ml was accepted. The sensitivity of this test was 66% and specificity 99%, PPV 80%, NPV 84%. Conclusions: The chemokine MCP-1 has a limited value in the differentiation between transudate and exudates; MIP-1α could be helpful in the differentiation between tuberculous and malignant pleural effusion.
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Samoistne śródmiąższowe zapalenia płuc to niejednorodna grupa chorób o podobnych objawach klinicznych. Podstawą ich obecnie stosowanej klasyfikacji są w głównej mierze różnice w obrazie histologicznym, jednak istotnym dopełnieniem całości procesu diagnostycznego, pomagającym w ustaleniu precyzyjnego rozpoznania, jest obraz tomograficzny o wysokiej rozdzielczości. Jedną z rzadziej występujących form samoistnego śródmiąższowego zapalenia płuc jest złuszczające śródmiąższowe zapalenie płuc występujące częściej u mężczyzn obciążonych wywiadem nikotynowym w 4.–5. dekadzie życia. W pracy przedstawiono przypadek 50-letniego mężczyzny przyjętego na Oddział Pneumonologii Śląskiego Uniwersytetu Medycznego w celu dalszej diagnostyki przewlekającego się obustronnego zapalenia płuc, z objawami upośledzonej tolerancji wysiłkowej, produktywnym kaszlem i stanami podgorączkowymi. Na podstawie wykonanych badań dodatkowych, zgodnych z zalecanym algorytmem postępowania diagnostycznego, obejmujących również wideotorakoskopię z pobraniem wycinków tkankowych, dokonano ostatecznego rozpoznania złuszczającego śródmiąższowego zapalenia płuc. Po zastosowaniu steroidoterapii systemowej obserwowano remisję choroby. Full article

Several epidemiological and diagnostic studies reported increasing prevalence of allergic reactivity to fungi assessed with the use of skin testing or IgE detection. The role of sensitization to fungi in relation to the prevalence and clinical importance in atopic patients remains largely unknown. Although an allergic reaction to fungal allergens is suggested as an important contributing factor in the development of respiratory symptoms, other mechanisms, such as increased exposure to fungal metabolites, mycotoxins and other compounds of immuno-supressant or irritant properties, may also be important. Sensitivity to fungal allergens has been recognized as a risk factor for the development and persistence of asthma, asthma severity and potentially fatal asthma exacerbations, the increased number of episodes of respiratory arrest and admissions to intensive care unit. Thus far, the role of fungi as the dominant exogenous trigger of asthma has not been completely explored. Some authors suggest, that sensitization to fungal allergens is related with specific phenotype of severe asthma. It remains to be clarified, whether this association is caused by colonization of the airways with fungi or an extreme response to exogenous spores.This review critically discusses the present state of knowledge on the prevalence of IgE-mediated allergy to fungi, as well as the contribution of sensitization to fungi to the allergic manifestations, on the basis of the recent literature. We also try to assess the importance of these connections for the future treatment of allergic disorders of the respiratory tract. Full article

Introduction: Hypoxia, reduced cerebral perfusion and sleep fragmentation as the result of recurrent apnea-related episodes in sleep apnea patients may have impact on mental performance such as memory and concentration. Increased number of traffic accidents has been observed in OSAS patients. Patients often complain of concentration and memory problems, as well as sleepiness. The diagnosis of perception processes requires neuropsychological diagnosis. Material and methods: 22 sleep apnea patients were involved in the study. Results: Correlation between the number of mistakes in Benton Test and AHI has been observed (r = 0.63; p < 0.005), as well as between AHI and memory in Number Repeating Test based on Wechsler-R (r = 0.49; p < 0.05). No correlations have been found between results of Benton Test and sleepiness scale. Mean saturation and lowest saturation didn’t show any correlation with neuropsychological tests. Qualitative analysis of mistakes in both Benton and Bender-Gestalt Tests did not suggest any organic changes in the brain. AHI seems to be more important predictor of memory dysfunction than sleepiness scale score. Conclusions: Specific tests, specially used in neuropsychological diagnosis, could be useful in the diagnosis of memory perception disorders and treatment effectiveness assessment in OSAS patients. Full article