Clinical Characteristics of EGPA Patients in Comparison to GPA Subgroup with Increased Blood Eosinophilia from POLVAS Registry.

Objective: To characterize the eosinophilic granulomatosis with polyangiitis (EGPA) population from the POLVAS registry depending on ANCA status and diagnosis onset, including their comparison with the granulomatosis with polyangiitis (GPA) subset with elevated blood eosinophilia (min. 400/µl) (GPA HE) to develop a differentiating strategy. Methods: A retrospective analysis of the POLVAS registry. Results: The EGPA group comprised 111 patients. The ANCA-positive subset (n = 45 [40.54%]) did not differ from the ANCA-negative one in clinics. Nevertheless, cardiovascular manifestations were more common in ANCA-negative patients than in those with anti-myeloperoxidase (MPO) antibodies (46.97% vs. 26.92%, p = 0.045). Patients diagnosed before 2012 (n = 70 [63.06%]) were younger (median 41 vs. 49 years, p < 0.01), had higher blood eosinophilia at diagnosis (median 4,946 vs. 3,200/µl, p < 0.01), and more often ear/nose/throat (ENT) and cardiovascular involvement. GPA HE comprised 42 (13.00%) out of 323 GPA cases with reported blood eosinophil count. Both GPA subsets had a lower prevalence of respiratory, cardiovascular, and neurologic manifestations but more often renal and ocular involvement than EGPA. EGPA also had cutaneous and gastrointestinal signs more often than GPA with normal blood eosinophilia (GPA NE) but not GPA HE. The model differentiating EGPA from GPA HE, using ANCA status and clinical manifestations, had an AUC of 0.92, sensitivity of 96%, and specificity of 95%. Conclusion: Cardiovascular symptoms were more prevalent in the ANCA-negative subset than in the MPO-ANCA-positive one. Since EGPA and GPE HE share similarities in clinics, diagnostic misleading may result in an inappropriate therapeutic approach. Further studies are needed to optimize their differentiation and tailored therapy, including biologics.

Polish Adaptation and Psychometric Validation of the PREM-C9 Questionnaire for Patients with Chronic Obstructive Pulmonary Disease.

Introduction: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. The first PREM (patient-reported outcome measure)-type questionnaire that has been dedicated to assess the experience of care in COPD is the PREM-C9. Aim: The aim of this study was to create a Polish version of the PREM-C9 and determine its psychometric characteristics. Methods: The validation procedure involved forward and back translation. We included 42 patients with COPD. The psychometric properties were assessed using Cronbach's alpha, Bartlett's test, the Kaiser-Meyer-Olkin test, and Spearman's correlation coefficient. The validity of the questionnaire was assessed using a principal component analysis for the extracted principal components. The validity of the factor analysis was demonstrated using Bartlett's sphericity test and the Kaiser-Meyer-Olkin (KMO) test. A factor analysis was performed using the Oblimin and Varimax rotation. The reliability of the questionnaire was assessed using Cronbach's alpha. Results: The Polish version of the analyzed questionnaire met all the validation criteria: face, translation, psychometric, functional, and reconstruction equivalence. Spearman's correlation results between the Polish PREM-C9 and CAT were as follows: rho = 0.44, p = 0.003539; HADS-Anxiety: rho = 0.370864, p = 0.015612; and HADS-Depression: rho = 0.387405, p = 0.011253. Conclusions: The developed Polish PREM-C9 questionnaire is a reliable and valid tool that assesses Polish COPD patients' experiences of their disease and the care they receive.

Value-Based Integrated Care (VBIC) Concept Implementation in a Real-World Setting-Problem-Based Analysis of Barriers and Challenges.

Healthcare effectiveness measurement and value in health have been common topics in public health literature since 2006 when value-based healthcare (VBHC) was first defined by Porter and Teisberg. The aim of this study was to identify the barriers and challenges related to the implementation of VBHC solutions in the example of Poland. A case presentation was used as a method. The national integrated care programs (KOS-Infarction, POZ-Plus, and comprehensive treatment of chronic wounds) were used to present general challenges, along with the Integrated Care Model (ICM) for patients with advanced chronic obstructive pulmonary disease (COPD), to determine specific difficulties. ICM has been operating since 2012 in Gdansk and gradually adapted the value-based integrated care (VBIC) approach. An analysis of the available data showed that the greatest difficulties related to the implementation of the VBHC and VBIC concepts are a lack of legal and reimbursement solutions, staff shortages, a lack of educational standards for some members of the multidisciplinary team, and insufficient awareness of the role of integrated care. As the level of preparation to implement VBHC policies varies between individual countries, the conclusions drawn from the experience of ICM and other Polish projects may be a valuable voice in discussion.

Dignity Therapy as an aid to coping for COPD patients at their end-of-life stage.

INTRODUCTION: Observations indicate that struggling with a burden of an incurable disease such as advanced chronic obstructive pulmonary disease (COPD) may result in the weakening of an individual sense of dignity, and be a source of spiritual suffering. Clinicians providing respiratory care to patients should be open to their spiritual needs, in the belief it may improve coping with the end-of-life COPD. The study aimed to assess overall feasibility and potential benefits of Dignity Therapy (DT) in patients with advanced COPD. MATERIAL AND METHODS: Patients with severe COPD, in whom a DT intervention was implemented according to the protocol established by Chochinov et al. were included into the study. An self-designed questionnaire was applied to assess the patients' satisfaction after intervention. Subsequently, the patients' statements were allocated to specific problem categories, corresponding to the spiritual suffering concerns, as structured by Groves and Klauser. RESULTS: DT was completed in 10 patients, with no unexpected side effects. Satisfaction Questionnaire showed a positive effect of DT on the patient' well-being (3.9 on a 5-point Likert scale). The analyses of the patients' original statements enabled an effective identification of the spiritual suffering and spiritual resources and faced by COPD patients. CONCLUSION: DT is an intervention well received by COPD patients, which may help them in recognising and fulfilling their spiritual needs in the last phase of their life. Information acquired on the patients' resources and spiritual challenges may help clinicians improve their care, especially with regard to supporting their patients at the end-of-life stage.

Cost-Effectiveness Analysis of Integrated Care in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease that occurs all over the world. Models of care, initially accessed from the clinical point of view, must also be evaluated in terms of their economic effectiveness, as health care systems are limited. The Integrated Care Model (ICM) is a procedure dedicated to patients suffering from advanced COPD that offers home-oriented support from a multidisciplinary team. The main aim of the present study was to evaluate the cost-effectiveness of the ICM. MATERIAL AND METHODS We included 44 patients in the study (31 males, 13 females) with an average age 72 years (Me=71). Costs of care were estimated based on data received from public payer records and included general costs, COPD-related costs, and exacerbation-related costs. To evaluate cost-effectiveness, cost-effectiveness analysis (CEA) was used. The incremental cost-effectiveness ratio (ICER) was calculated based on changes in health care resources utilization and the value of costs observed in 2 consecutive 6-month periods before and after introducing ICM. RESULTS Costs of care of all types decreased after introducing ICM. Demand for ambulatory visits changed significantly (p=0.037) together with a substantial decrease in the number of emergency department appointments and hospitalizations (p=0.033). ICER was more profitable for integrated care than for standard care when assessing costs of avoiding negative parameters such as hospitalizations (-227 EUR), exacerbations-related hospitalizations (-312 EUR), or emergency procedures (-119 EUR). CONCLUSIONS ICM is a procedure that meets the criteria of cost-effectiveness. It allows for avoiding negative parameters such as unplanned hospitalizations with higher economic effectiveness than the standard type of care used in managing COPD.

End-of-life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: survey among Polish pulmonologists.

INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end­of­life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient's caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists.

Distribution and characteristics of COPD phenotypes - results from the Polish sub-cohort of the POPE study.

Background: This study aimed to examine the distribution of predefined phenotypes, demographic data, clinical outcomes, and treatment of patients who were included in the Polish cohort of the Phenotypes of COPD in Central and Eastern Europe (POPE) study. Patients and methods: This was a sub-analysis of the data from the Polish cohort of the POPE study, an international, multicenter, observational cross-sectional survey of COPD patients in Central and Eastern European countries. The study included patients aged >40 years, with a confirmed diagnosis of COPD, and absence of exacerbation for at least 4 weeks before study inclusion. A total of seven Polish centers participated in the study. Results: Among the 430 Polish COPD patients enrolled in the study, 61.6% were non-exacerbators (NON-AE), 25.3% were frequent exacerbators with chronic bronchitis (AE CB), 7.9% were frequent exacerbators without chronic bronchitis (AE NON-CB), and 5.1% met the definition of asthma-COPD overlap syndrome (ACOS). There were statistically significant differences among these phenotypes in terms of symptom load, lung function, comorbidities, and treatment. Patients with the AE CB phenotype were most symptomatic with worse lung function, and more frequently reported anxiety and depression. Patients with the ACOS phenotype were significantly younger and were diagnosed with COPD earlier than those with other COPD phenotypes; those with the ACOS phenotype were also more often atopic and obese. Conclusion: There is significant heterogeneity among COPD patients in the Polish population in terms of phenotype and clinical outcome. The non-exacerbator phenotype is observed most frequently in Poland, while the frequent exacerbator with chronic bronchitis phenotype is the most symptomatic.

Dosimetrically administered nebulized morphine for breathlessness in very severe chronic obstructive pulmonary disease: a randomized, controlled trial.

BACKGROUND: Systemic morphine has evidence to support its use for reducing breathlessness in patients with severe chronic obstructive pulmonary disease (COPD). The effectiveness of the nebulized route, however, has not yet been confirmed. Recent studies have shown that opioid receptors are localized within epithelium of human trachea and large bronchi, a target site for a dosimetric nebulizer. The aim of this study was to compare any clinical or statistical differences in breathlessness intensity between nebulized 2.0% morphine and 0,9% NaCl in patients with very severe COPD. METHODS: The study was a double-blind, controlled, cross-over trial. Participants received morphine or NaCl during two 4-day periods. Sequence of periods was randomized. The primary outcome measure was reduction of breathlessness intensity now by ≥20 mm using a 100 mm visual analogue scale (VAS) at baseline, 15, 30, 60, 120, 180 and 240 min after daily administration, during normal activities. RESULTS: Ten of 11 patients included completed the study protocol. All patients experienced clinically and statistically significant (p < 0.0001) breathlessness reduction during morphine nebulization. Mean VAS changes for morphine and 0.9% NaCl periods were 25.4 mm (standard deviation (SD): 9.0; median: 23,0; range: 14.0 to 41,5; confidence interval (CI): 95%) and 6.3 mm (SD: 7.8; median: 6.8; range: -11,5 to 19,5; CI: 95%), respectively. No treatment emergent adverse effects were noted. DISCUSSION: Our study showed superiority of dosimetrically administered nebulized morphine compared to NaCl in reducing breathlessness. This may have been achieved through morphine's direct action on receptors in large airways, although a systemic effect from absorption through the lungs cannot be excluded. TRIAL REGISTRATION: Retrospectively registered (07.03.2017), ISRCTN14865597.

Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

Walls and Barriers. Polish Achievements and the Challenges of Transformation: Building a Hospice Movement in Poland.

In this review, the authors discuss the creation and development of hospice-palliative care in Poland and present attempts to move from religious care into spiritual companionship, using examples of concrete activities and challenges, which-like subsequent walls and barriers-have appeared inside and around us.

Acceptance of home support and integrated care among advanced COPD patients who live outside large medical centers.

BACKGROUND: Poor self-management constitutes a risk factor for COPD deterioration. Patients from rural areas located at a considerable distance from large medical centers frequently need home-support in advanced stages of the disease. Integrated care has been proposed as a comprehensive model for appropriate treatment, coordination and holistic support. The aim of the study was to assess whether home visits provided by trained assistants are needed and accepted by advanced COPD patients living in rural areas a to evaluate whether an individual short educational program can actually improve such patients' knowledge of COPD and inhaler use. METHODS: Thirty patients with severe or very severe but stable COPD participated in one-month home-assistance interventions twice a week. RESULTS: The total value ≥70 of SGRQ (St George's Respiratory Questionnaire) was recorded in 18 (60%) patients. At the beginning of the study, the patients' knowledge of COPD and inhalation techniques was highly unsatisfactory. Significant improvement in all items (p=0.00) was obtained after the intervention. The risk for poor self-management was high. All patients had at least one 'factor' that indicated the need for home-support. A total of 240 visits (100%) were completed. Patients expressed high acceptance for home-based support delivered by medical assistants twice a week for one month. No patients opposed this kind of care and most of them expressed interest in receiving it in the future. CONCLUSIONS: The results suggest a compelling need for home care and demonstrate full acceptance of this kind of support on the part of advanced COPD patients.

[Chronic obstructive pulmonary disease in women]. / Przewlekla obturacyjna choroba pluc u kobiet.

For the past several years the number of women suffering from chronic obstructive pulmonary disease (COPD) has been steadily increasing. This fact prompts the debate which factors, in addition to considerably increasing prevalence of cigarette smoking among young women, are responsible for these epidemiologic changes. Differences in the natural history and prognosis of COPD in females and males are presented in the paper, as well as the number of potential ethiopathogenetic and pathophysiologic factors influencing these variations. Among them, differences in the COPD risk factors spectrum in both genders and in airways anatomy are pointed out, and the mechanisms responsible for greater women's susceptibility to components of cigarette smoke, which reflect genetic (enzyme polymorphisms), epigenetic (diminished DNA methylation) and hormonal (estrogens) influences on xenobiotics metabolism. Further, sex-related differences regarding COPD phenotypes (chronic bronchitis vs. emphysema), immunological markers and clinical manifestation of disease are underlined in the paper. More frequent coexistence of anxiety and depression, COPD exacerbations and worse quality of life in women are also emphasized. Other differences, pointed out by authors include autoimmunological conception of pathogenesis of COPD (greater female susceptibility to produce autoantibodies), risk factors of disease exacerbation and, at last, response to certain forms of COPD treatment (nicotine replacement therapy, long-term oxygen therapy).

A portable automatic cough analyser in the ambulatory assessment of cough.

BACKGROUND: Cough is one of the main symptoms of advanced lung disease. However, the efficacy of currently available treatment remains unsatisfactory. Research into the new antitussives requires an objective assessment of cough. METHODS: The aim of the study was to test the feasibility of a new automatic portable cough analyser and assess the correlation between subjective and objective evaluations of cough in 13 patients with chronic cough. The patients' individual histories, a cough symptom score and a numeric cough scale (1-10) were used as a subjective evaluation of cough and a computerized audio-timed recorder was used to measure the frequency of coughing. RESULTS: The pre-clinical validation has shown that an automated cough analyser is an accurate and reliable tool for the ambulatory assessment of chronic cough. In the clinical part of the experiment for the daytime, subjective cough scoring correlated with the number of all cough incidents recorded by the cough analyser (r = 0.63; p = 0.022) and the number of cough incidents per hour (r = 0.60; p = 0.03). However, there was no relation between cough score and the time spent coughing per hour (r = 0.48; p = 0.1). As assessed for the night-time period, no correlation was found between subjective cough scoring and the number of incidents per hour (r = 0.29; p = 0.34) or time spent coughing (r = 0.26; p = 0.4). CONCLUSION: An automated cough analyser seems to be a feasible tool for the ambulatory monitoring of cough. There is a moderate correlation between subjective and objective assessments of cough during the daytime, whereas the discrepancy in the evaluation of night-time coughing might suggest that subjective analysis is unreliable.

Analysis of safety, risk factors and pretreatment methods during rush hymenoptera venom immunotherapy.

BACKGROUND: The safety profile of venom immunotherapy is a relevant issue. We evaluated the frequency of severe adverse events (SAE), associated risk factors, retrospective comparison of pretreatment protocols including solely H1 receptor blockers and a combination of H1 and H2 receptor blockers during rush Hymenoptera venom immunotherapy. METHODS: The study group comprised 118 patients. The treatment was initiated according to a 5-day rush protocol with the use of standardized venom allergens of either wasp or honeybee. RESULTS: During the rush induction, side effects occurred in 18 patients (15.2%), whereas SAE were present in 7 patients (5.9%). Twelve out of 18 (66.6%) developed anaphylactic reactions on the fourth day of the rush protocol, with the majority of cases at a dose of 40 or 60 microg of the venom extract (p = 0.001). The frequency of SAE was also significantly higher on the fourth day than thereafter (p = 0.0001) as well as in patients allergic to bee venom (p = 0.049). All systemic side effects were more frequent in women (p = 0.0065). However, this relation was not true when SAE were consider (p = 0.11). A higher percentage of SAE was observed in the subjects pretreated with both H1 and H2 receptor antagonists than in those pretreated with H1 blocker only (8.8 vs. 4.1%); however, the difference was not significant. CONCLUSIONS: Considerable severity of allergic adverse events requires particular attention to patients allergic to bee venom and during rush phase, especially when rapidly increasing doses are administered. Pretreatment with H2 blockers is debatable and warrants further investigation.

[Hyperlucent lung syndrom caused by pulmonary artery hypoplasia in patient with diagnosed asthma--case report]. / Zespól jednostronnie jasnego pluca w przebiegu hipoplazji tetnicy plucnej u chorej z objawami astmy oskrzelowej--opis przypadku.

We present case of 67-years-old, non-smoking woman with unilateral hyperlucent lung syndrome. She has diagnosed asthma and since 1997 she has been treated with inhaled corticosteroids and long-acting beta-agonists without improvement. She complained of a cough, shortness of breath, pulmonary function test reveal irrvesibility airflow obstruction. The routine X-ray chest showed unilateral hyperlucent left lung. Ct-angiography has shown unilateral hypoplasia of pulmonary artery. It indicates that in all cases of uncontrolled asthma should be considered another or coexisting diagnosis.

[Quality of life of patients with asthma which has been well and poorly controlled]. / Jakosc zycia chorych na astme dobrze i zle kontrolowana.

INTRODUCTION: The aim of the study was to assess the quality of life of patients with asthma who were well and poorly controlled. MATERIAL AND METHODS: 70 patients with diagnosed asthma, aged from 18 to 40, were included into the study between November 2005 and February 2006 at the Specialist Hospital in Chojnice and Allergy out-patient Clinic of Medical University of Gdansk. The diagnosis and stage of asthma, as well as the assessment of the control of disease was performed by the physician. Quality of life was assessed with the use of St. George Respiratory Questionnaire (SGRQ). Statistical analysis was made with the use of computer statistical program Statistica. RESULTS: According to GINA in 26 patients mild asthma was diagnosed, in 31 - moderated and in 13 - severe disease. 41 patients were assessed as well controlled and 29 - as poorly controlled. Older age and longer duration of the disease were related to severe asthma, p = 0.01 and p = 0.003, respectively. In well controlled patients overall score for SGRQ was 48.86, whereas in poorly controlled was - 74.4. There was a significant difference between the overall quality of life in well and poorly controlled patients with asthma, p = 0.0001. This difference was found in all three domains: for symptoms, activity and impact on life, p = 0.014, p = 0.035 and p = 0.003, respectively. CONCLUSIONS: Quality of life is strongly dependent on the control of symptoms in asthmatic patients.

[Treatment of pulmonary hypertension]. / Leczenie nadcisnienia plucnego.

Pulmonary hypertension leading to right heart failure can be related to primary lung disease or hypoventilation. Idiopathic pulmonary hypertension is a progressive disease with poor prognosis. Therapy of idiopathic pulmonary hypertension includes: oxygen, calcium channel blockers, diuretics, anticoagulants, prostanoids, endothelin receptor antagonists and phosphodiesterase-5 inhibitors. Patients with pulmonary arterial hypertension (PAH) and pulmonary hypertension due to chronic thrombotic or embolic disease should be treated with vasodilatators. The potent vasodilatators are: prostacyclin PGI2, prostacyclin analogue and endothelin receptor antagonists. For patients with idiopathic PAH classified as NYHA III (New York Heart Association) bosentan is recommended, whereas for patients classified as NYHA IV--epoprostenol. Combination therapy is an emerging therapeutic option in PAH. In BREATH-2 (Bosentan Randomised Trial of Endothelin Antagonist Therapy for PAH) study the efficacy and safety of combining bosentan and epoprostenol given orally was investigated. No significant difference was established between treatment groups in 6-minutes walking distance or NYHA functional class. However other study investigating the combination of bosentan and prostacyclin analogue showed clinical improvement. Additional bosentan therapy may also reduce the epoprostenol dose and therefore decrease its side-effects. Interventional procedures: atrial septostomy and lung transplantation are indicated in patients with advanced NYHA class III and IV symptoms and refractory to available medical treatment. However, currently no management potent enough to cure pulmonary arterial hypertension is available. The introduction of new class of drugs allowed for the improvement of quality of life and overall survival. The choice of drug depends on a variety of factors including accessibility, approval status and patient's preferences.

[Serum eosinophil cationic protein (ECP) in patients with perennial rhinitis and atopic dermatitis, allergic to house dust mites]. / Eozynofilowe bialko kationowe (ECP) w surowicy chorych na caloroczne alergiczne zapalenie blony sluzowej nosa i atopowe zapalenie skóry, uczulonych na roztocza kurzu domowego.

UNLABELLED: Eosinophil Cationic Protein (ECP) is released from activated eosinophils during the inflammation process. THE AIM: of the study was to evaluate levels of ECP in serum of patients with perennial rhinitis (with and without asthma) and atopic dermatitis allergic to Dermatophagoides farinae and Dermatophagoides pteronyssinus. Further it was designed to compare ECP levels in patients treated with allergen-specific immunotherapy (IT) and in patients treated symptomatically. MATERIAL AND METHODS: The study group included 94 patients allergic to house dust mite: 42 patients with perennial rhinitis not treated with IT, 24 patients with perennial rhinitis and/or asthma treated with IT and 28 patients with atopic dermatitis. In the control group were 21 healthy volunteers. In the group treated with IT questionare of efficacy and safety was performed. RESULTS: The serum level of ECP was measured using immunofluorometric assay. In the group with perennial rhinitis treated with IT mean level of ECP was 6,5 ug/l, whereas in the group not treated with IT--15,78 microg/l (p=<0.05). In patients with atopic dermatitis ECP level was the highest--23,04 microg/l +/- 4,98 and was significantly different than in the group of healthy volunteers-- 7,2 microg/l +/- 1,1 (p=0,0048). CONCLUSIONS: Serum ECP concentration may be prognostic factor in specific immunotherapy.