Metal hypersensitivity in hip, knee and spine surgery.

The number of implanted joint prostheses and damaged spinal components is steadily increasing. At the same time, rejection of the implanted material is observed in operated patients, which manifests itself in both skin and general reactions, as well as loosening and earlier wear of implanted prostheses, which was previously referred to as aseptic reactions. However, it has been shown that in a significant proportion of patients, rejection of implanted material may be caused by hypersensitivity to a specific metal. For this reason, patients qualified for implantation of foreign material, mainly nickel, titanium, chromium, molybdenum, and other alloys, should be subjected to allergy tests to detect possible risks in the form of metal sensitivity reactions.

[Is aseptic loosening of joint prostheses aseptic?] / Czy aseptyczne obluzowanie protez stawów jest aseptyczne?

The observed changes in the periarticular space may be caused by both mechanical action and biological reactions. Periprosthetic infections are the most common cause of loosening and destructive changes in the joints, however, the diagnosis of an aseptic reaction is not always fully obvious. Micromovements between the implant and the surrounding bone can cause remodeling of the bone trabeculae and migration of fibroblasts into the voids between the implant surface and the bone. In addition, repetitive stresses can induce fibroblast proliferation. On the other hand, the residues arising from the wear of implanted materials in the joints may play an important role in the process of loosening of prostheses - both aseptic and septic. Direct interactions between the released molecule and the macrophage surface are sufficient to activate osteoclastogenic signaling pathways. You cannot ignore allergic reactions to metals used in prostheses in patients undergoing arthroplasty. Demonstration of hypersensitivity to the components of dentures in some cases requires the use of appropriate material in order not to cause an inflammatory allergic reaction. Emerging treatment strategies using mesenchymal stem cells (MSCs) are aimed at improving the initial implant integration and preventing periprosthetic osteolysis. It should be emphasized, however, that the diagnosis of aseptic loosening in many clinical situations raises doubts, because it is at the root of everyone.

Analysis of mortality between 2019-2020 at the Neuroorthopedic and Traumatic Orthopedic Departments.

The number of deaths from skeletal injuries is still significant, but is declining with advances in emergency medicine. The adopted principles of emergency procedures and the availability of specialist centres enable the treatment to be effective. AIM: The aim of the study was to analyse the deaths of patients with spine and limb injuries who required surgery. MATERIALS AND METHODS: The analysis covered 22 deaths in the years 2019-2020. The assessment took into account: the cause of admission, the condition of the patient and comorbidities, the medical scales which were used to assess the possible risk of complications, the diagnostic correctness and qualification for surgical treatment, the waiting time for surgery and the cause of death and prior course of action. RESULTS: It can be stated that in 2019, the mortality rate was 0.21 (10 deaths out of 4658 hospitalized), in 2020, the mortality rate was 0.31 (12 deaths out of 3852 hospitalized). The mortality rate in the Department of Traumatic Orthopedics was: 0.30 in 2019 (8 deaths out of 2625 hospitalized) and 0.39 in 2020 (8 deaths in 2020 hospitalized). 10 patients with hip fractures (trochanteric and femoral neck) underwent surgery within 2.7 days (from 1 to 4 days). The causes of death within 1-9 days (average 4.86 days) from admission in this group were complex, and associated with the presence of chronic diseases, including: circulatory failure (9), septic shock (1), heart rhythm disturbances (7), renal failure (6), pulmonary congestion (4), hyperkalemia (1), coagulation disorders (1). In patients after spinal injury with quadriplegia, decompression (1), stabilization (1) and disc removal (1) were performed on the day of admission to the hospital. The patients were hospitalized in the ICU, and deaths occurred on days 9, 15 and 187 from admission due to respiratory and circulatory failure and sudden cardiac arrest. Patients after arthroplasty of the knee (1) and hip (2) were operated on day 2 from admission, and deaths occurred on day 4, 22 and 53 due to: sepsis (1), pulmonary embolism (1), respiratory failure in the course of pneumonia (1). CONCLUSIONS: The deceased were admitted in a serious general condition, burdened with numerous concomitant chronic diseases and their age ranged from 66 to 97 years. The surgical treatment was undertaken for life saving reasons but 5 of the deceased did not undergo surgery due to the extreme general condition leading to respiratory and circulatory failure.

[Recognizing Alzheimer's disease in daily practice]. / Rozpoznawanie choroby Alzheimera w codziennej praktyce.

Early diagnosis of Alzheimer's disease (AD) is of great practical importance. The process of differentiating a disease with symptoms of dementia caused by another pathology of the nervous system is based on a subjective assessment. The pathogenesis of AD emphasizes the importance of neuropil beta-amyloid deposition in the brain and the tau protein inside neurons, which is found 20 years before the onset of clinical symptoms of the disease. The number of people suffering from AD doubles every 20 years and in 2050 there will be 115.4 million of them worldwide. The level of education and constant intellectual activity may be a factor protecting against the occurrence of AD. The diagnosis of AD takes into account information obtained from interviews as well as from additional imaging and laboratory tests. The available criteria for AD diagnosis are constantly modified and changed, which makes their application in everyday practice difficult.

Management of patients with chronic obstructive pulmonary disease (COPD) during COVID-19.

COPD is one of the risk factors for contracting COVID-19. Good management of patients, appropriate treatment with inhaled preparations, including inhaled glucocorticosteroids, with simultaneous monitoring concomitant infections, and the use of vaccinations allow to reduce the risk of developing COVID-19. At the same time, it is necessary to limit the performance of spirometric tests to reduce the probability of SARS-CoV-2 infection. In the case of a confirmed infection, it is necessary to continue basic treatment, with strict adherence to the recommended dosage of drugs, which may significantly protect the patient against post-inflammatory fibrosis in the pulmonary parenchyma.

[Pro-health cycle lane versus environmental pollution and trauma]. / Prozdrowotne sciezki rowerowe a zanieczyszczenie srodowiska naturalnego i urazowosc.

A bicycle as a mean of transport and recreation, but is it a healthy lifestyle? The construction of numerous cycle lanes in cities and promotion of physical activity aims to encourage the public to move around by bicycle. The aim of mass cycling is to reduce car exhaust emissions and, on the other hand, to improve public health. The paper presents the potential benefits of cycling, but also its negative effects on the human body. Minimizing the danger of using a bicycle lies not only with cyclists, but also with people who are planning to build cycle lane.

Treatment of patients with asthma during COVID-19.

Good management of patients with bronchial asthma protects against SARS-CoV-2 infection, which is associated with the activity limiting the virus penetration into the respiratory epithelial cells. A relationship between asthma exacerbation and SARS-CoV-2 infection has not yet been demonstrated. The available recommendations state that patients with asthma should use inhaled glucocorticosteroids (GCS) on a regular basis. In the case of exacerbation of asthma symptoms, it is necessary to administer higher doses of inhaled GCSs and to quickly add systemic GCSs, mainly methylprednisolone. Treatment with biological preparations does not increase the risk of SARS-CoV-2 infection, and is effective in reducing the number of asthma exacerbations.

[Pathogenesis and the contemporary picture of polyneuropathy]. / Patogeneza i wspólczesny obraz polineuropatii.

Demyelinating changes in peripheral nerves are responsible for the neurological symptoms found. Diabetes mellitus is one of the most common causes of polyneuropathy and is found in 8-54% of patients with type I diabetes, 13-46% of patients with type II and 22-66% of alcohol abusers. In turn, chemotherapy, depending on the therapeutic regimens used, is responsible for the symptoms of polyneuropathy in 10-90% of patients. Separate disease syndromes create immunologically determined polyneuropathies. Chronic compression or irritation of the spinal nerves or their roots in diseases of the spine leads to ischemia and neuropathy. The spinal nerve is most often pinched and then there are mixed motor-sensory symptoms. In order to prevent the onset of polyneuropathy, it is necessary to release the nerves from pressure and ischemia as quickly as possible.

[Sotrovimab in controlling SARS-CoV-2 infection]. / Sotrowimab w kontrolowaniu zakazenia SARS-CoV-2.

The new monoclonal antibodies - VIR -7831 (sotrovimab) and VIR- 7832 - show an action directly targeting the SARS-CoV-2 spike glycoprotein. Moreover, they strongly neutralize in vitro the wild-type Corona virus variants and the omicron variant. Sotrovimab is a monoclonal antibody capable of neutralizing SARS-CoV-2 as well as other sarbecoviruses (SARS-CoV-1 and SARS-CoV). The administration of 500 mg sotrovimab as a 1-hour intravenous infusion in 291 patients with COVID-19 with mild to moderate severity of symptoms prevented disease progression and the need for hospitalization.

[Assessment of the effectiveness of early treatment in SARS-CoV-2 infection]. / Ocena skutecznosci wczesnego podejmowania leczenia w zakazeniu SARS-CoV-2.

Treatment of SARS-CoV-2 infection has been undertaken in all medical centers in the world. Based on the experience gained, in some of them it was possible to effectively control the course of the Corona virus infection depending on the stage of infection. AIM: The aim of the study was to assess the effectiveness of early treatment depending on the stage of SARS-CoV-2 infection and the severity of symptoms, mainly in the respiratory system. MATERIALS AND METHODS: Outpatient treatment included 104 patients infected with SARS-CoV-2, in whom infection was confirmed according to the adopted criteria. The first group of patients were infected with SARS-CoV-2 with mild symptoms, the time of probable infection was 3- 5 days ago. They were given arechin (Arechin, Adamed) 2 times 1 tablet (250 mg) for 6 days, azithromycin (Sumamed, Teva) 1 time a day 1 tablet (500 mg) for 6 days. After confirmation of persistence of cracks at the base of the lungs, treatment was continued by administering methylprednisolone (Metypred, Orion) orally at a dose of 0.2 mg/kg in reducing doses every 5 days and ciclesonide (Alvesco, Takeda Pharma) by inhalation 2 x 160 µg each. The second group consisted of people infected with SARS-CoV-2, who had not been treated, but were taking only antipyretic drugs and reported 7-10 days after the onset of infection. After revealing "ground-glass opacity" changes in chest CT, it was recommended to take levofloxacin (Levoxa, Actavis Polska) twice a day, 1 tablet (500 mg) for 3 days, and then once a day for the next 5-7 days, of methylprednisolone orally in a dose of 0.3 mg/kg in weight in decreasing doses every 5 days, according to changes found in imaging tests, and inhalation of ciclesonide 2 x 160 µg. Patients after COVID-19, hospitalized with respiratory disorders and changes in imaging tests, were the third group. They were treated according to the extent of the changes in chest CT and comorbidities, using methylprednisolone orally at a dose of 0.5 mg/kg in doses reducing every 5-10 days, depending on the rate of symptom relief and regression of changes in the tests. imaging and inhaled ciclesonide 2 x 320 µg. In each case, the treatment was individually selected according to the severity of the course of the disease. RESULTS: In all patients, a significant improvement in general condition was achieved in the form of relief of dyspnea, cough and weakness, which correlated with a significant remission of the initial changes in the pulmonary parenchyma in the form of a "ground-glass opacity". In the first group, after the treatment (from 3-5 days after infection), only 17.6% of patients in the CT examination of the chest showed the presence of peripheral lesions of the "ground-glass opacity" type with an extent of 1-25%, and in 35.3% of patients "cotton foci". In the second group (treated from 7-10 days after infection), 18.7% of patients revealed the presence of "ground-glass opacity" lesions, which occupy more than 50% of the pulmonary parenchyma, and in 31.2% more than 25% of patients. After treatment, COVID-19 symptoms resolved, and chest CT showed a significant reduction in lesions - in 21.8% of patients <25% and in 25% of patients <10%. In the third group of COVID-19 patients after hospitalization, symptoms of the "groundglass opacity" type dominated, including in as many as 37.5% they affected more than 50% of the pulmonary parenchyma, and over 25% in 42.8% of the treated. After treatment, a significant reduction in the symptoms of the disease and an improvement in the CT image of the chest were achieved - in 50% of patients lung involvement <5% and in 28.6% with lesions <10%. CONCLUSIONS: The effectiveness of azithromycin, arechin, methylprednisolone and ciclesonide in controlling inflammation caused by SARSCoV- 2 infection has been confirmed in treated patients with symptoms of COVID-19 on an outpatient basis. The use of the assessed drugs should take into account the time of onset of SARS-CoV-2 infection and the severity of the disease course, including comorbidities. The presented analysis of the effectiveness of early treatment in patients infected with SARS-CoV-2 requires further clinical trials.

Antibiofilm and Antimicrobial-Enhancing Activity of Chelidonium majus and Corydalis cheilanthifolia Extracts against Multidrug-Resistant Helicobacter pylori.

Helicobacter pylori is a Gram-negative bacterium that colonizes the stomach of about 60% of people worldwide. The search for new drugs with activity against H. pylori is now a hotspot in the effective and safe control of this bacterium. Therefore, the aim of this research was to determine the antibacterial activity of extracts from selected plants of the Papaveraceae family against planktonic and biofilm forms of the multidrug-resistant clinical strain of H. pylori using a broad spectrum of analytical in vitro methods. It was revealed that among the tested extracts, those obtained from Corydalis cheilanthifolia and Chelidonium majus were the most active, with minimal inhibitory concentrations (MICs) of 64 µg/mL and 128 µg/mL, respectively. High concentrations of both extracts showed cytotoxicity against cell lines of human hepatic origin. Therefore, we attempted to lower their MICs through the use of a synergistic combination with synthetic antimicrobials as well as by applying cellulose as a drug carrier. Using checkerboard assays, we determined that both extracts presented synergistic interactions with amoxicillin (AMX) and 3-bromopyruvate (3-BP) (FICI = 0.5) and additive relationships with sertraline (SER) (FICI = 0.75). The antibiofilm activity of extracts and their combinations with AMX, 3-BP, or SER, was analyzed by two methods, i.e., the microcapillary overgrowth under flow conditions (the Bioflux system) and assessment of the viability of lawn biofilms after exposure to drugs released from bacterial cellulose (BC) carriers. Using both methods, we observed a several-fold decrease in the level of H. pylori biofilm, indicating the ability of the tested compounds to eradicate the microbial biofilm. The obtained results indicate that application of plant-derived extracts from the Papaveraceae family combined with synthetic antimicrobials, absorbed into organic BC carrier, may be considered a promising way of fighting biofilm-forming H. pylori.

Can we minimize carbon footprint by using "greener" inhalers and improve clinical outcome at the same time in asthma therapy?

The treatment of patients with obstructive airway diseases is based on the use of inhalation preparations. Some of them, mainly including pressurized metered dose inhalers (pMDIs), contain compressed gases - hydrofluoroalkanes, which generate carbon dioxide emissions, creating the so-called carbon footprint. AIM: The aim of the study was to evaluate the consumption of individual active substances, the types of inhalers used and calculation of the carbon footprint of therapies in patients with asthma in 2018 and 2019 in Poland. MATERIALS AND METHODS: The ratio of pMDI vs DPI (dry powder inhaler) data and the data on using in patients with asthma long-acting ß2-agonists (LABAs), short-acting ß2-agonists antagonists (SABAs), long-acting muscarinic antagonists (LAMAs), LAMA+LABAs, LAMA+LABA+ICSs (inhaled corticosteroids) on Polish market during 2018 and 2019 were analyzed. The carbon footprint of such therapies was counted. Then, we studied the reduction of the carbon footprint for scenario A (reducing pMDI by 50%) and scenario B (reducing pMDI by 80%) in the following steps of analysis. RESULTS: The general structure of pMDI/DPI in Poland in asthma patients was not changed in 2019 vs 2018. The carbon footprint is primarily created by pMDI SABAs. In 2019 in Poland pMDI SABAs were 1.9 mio units (the same as in 2018), which generated 36.8 kt CO2e annually. Scenario A gives us a benefit of 17.4 kt CO2e reduction and scenario B brings us a benefit of 28.0 kt CO2e reduction of emissions. CONCLUSIONS: Despite Poland's ratification the Kigali amendment did not affect pMDI consumption by asthma patients and did not reduce the carbon footprint. The lower carbon footprint of DPIs should be considered alongside other factors when choosing inhalation devices.

Hip arthoplasty in a forester after numerous tick bites.

Arthritis is one of the most important symptoms of late-stage borreliosis, observed in approximately 60% of untreated patients with Lyme disease. In several percent of them, this manifestation is of interest to orthopedic surgeons. The authors present a case of a patient, working as a forester, who underwent left hip replacement arthroplasty having contracted a Borrelia burgdorferi infection in the past, and who was hospitalized 12 years before in the infectious ward due to suspected neuroborreliosis for which he was treated with Ceftriaxone 2 × 2.0 g intravenously for 4 weeks. At that time, a tomographic examination of the spinal cord revealed herniated nuclei at levels L4/L5 and L5/S1, which filled the left lateral recess, narrowing the intervertebral holes and compressing the nerve roots on the left side of L4 and L5. In September 2019, total hip replacement in the patient's left hip joint was performed. It is concluded that an active role of neuroborreliosis in this process of hip joint destruction may be suggested. Int J Occup Med Environ Health. 2021;34(5):693-9.

[Anti-inflammatory effects of amantadine and memantine in SARS-CoV-2 infection]. / Przeciwzapalne dzialanie amantadyny i memantyny w zakazeniu SARS-CoV-2.

Amantadine and memantine, apart from their action on cholinergic receptors and dopamine secretion, have a significant influence on the inflammatory process, including the so-called "cytokine storm" and reduction of apoptosis and oxidative stress. Amantadine also inhibits the induction of inflammatory factors such as RANTES, activates kinase p38 of mitogen-activated protein (MAP) and c-Jun-NH2-terminal kinases (JNK), which inhibit viral replication. It also significantly inhibits the entry of SARS-CoV-2 into the bronchial epithelial cell and blocks the viroporin proton channel of the virus. In addition, it has the ability to pass through the membrane of lysosomes into their interior and act as an alkalizing agent, which prevents the release of viral RNA into the cell, which may be a key element in therapeutic management. Memantine also reduces inflammation, mainly in the nervous system, but also acts as a lysosomotropic factor, inhibiting viral replication. However, it is important to bear in mind when undertaking amantadine or memantine therapy with side effects that may overlap with COVID- 19 symptoms, worsening the condition of patients. Currently, the effectiveness of amantadine and memantine in the treatment of patients with COVID-19 symptoms has been demonstrated in a few clinical trials, mainly in patients treated for neurodegenerative diseases. The obtained results are of considerable value, but require confirmation in further studies.

The actual threat of COVID-19.

A pandemic (in Greek, pan "all", demos "people") is a term used to describe an epidemic of an infectious disease that causes significant mortality over a large area, including countries and continents. Could a virus currently spreading around the world that causes pseudoinfluenza symptoms be the basis for changing the criterion for determining a pandemic? According to WHO data from May 15, 2020, out of 153,517 confirmed COVID-19 cases, 5,735 deaths were recorded, allowing to determine the mortality rate at about 3.7%, which decreased significantly in the following months. The presented analysis from USA indicated that the elderly and those burdened with comorbidities are the most at risk groups, among them mainly those with cardiovascular diseases, diabetes, and chronic obstructive pulmonary disease. Similar data were obtained in Sweden, a country where no strict sanitary regimen was introduced, adopting the principle of creating herd immunity. On the other hand, Polish information is not corroborated by reliable studies, both in terms of the number and quality of diagnostic tests performed and the treatment used in individual groups infected with SARS-CoV-2 and patients. This leads to questioning the legitimacy of the introduced epidemiological restrictions. Wellknown mechanisms of SARS-CoV-2 infection and actions of basic drugs indicate the possibility of controlling the potential infection of the whole society.

Chloroquine in controlling biological infections.

From the middle of the 17th century, Cinchona tree's bark, which contains quinine, was used as an anti-malarial agent. It wasn't until the midtwentieth century that chloroquine was synthesized, followed by its further derivatives. Chloroquine inhibits protozoan polymerase activity, leading to an increase in heme, which is toxic to Plasmodium. The sensitivity of the protozoan to chloroquine depends on its ability to accumulate the drug in aquatic vacuolas. The medicine is also directly toxic to protozoa of the genus Entamoeba histolytica. The immunomodulatory properties of chloroquine have led to its use in collagen diseases, rheumatic disease, chronic rheumatoid and ankylosing arthritis and autoimmune skin disease. Chloroquine has recently been shown to be effective in controlling infection caused by the new Corona virus 2019- nCov (SARS-CoV-2). The drug inhibits viral infectivity by increasing endosomal pH in cells and blocking virus-cell interference by glycosylating SARS-CoV-2 cell receptors. Chloroquine has been shown to be able to bind sialic acid and gangliosides effectively by blocking the combination of virus S protein with gangliosides, which prevents the infection from starting. The effectiveness of the drug in the first stage of infection by SARS-CoV-2 was confirmed in clinical observations and the drug was included in the developed therapeutic recommendations.

[Options for controlling new Corona virus infection - 2019-nCoV]. / Mozliwosci kontrolowania zakazenia nowym wirusem Corona ­ 2019-nCoV.

According to the Situation Report 65 of the World Health Organization of March 25, 2020, the COVID-19 incidence rate indicates 413 467 confirmed cases and 18 433 deaths. Genetic diversification of the Corona virus has resulted in strains that cause severe respiratory tract infections in humans via drip and animal mediation. S-proteins covering its surface, which bind to the cell receptor - angiotensin converting enzyme 2 (ACE-2) and transmembrane serine protease (TMPRSS2) are important in shaping virus activity. The course of infection varies from mild to severe. The ability to control infection is limited because there are no drugs that fully inhibit 2019-nCoV. Interferon-alpha (5 million U twice daily by inhalation), lopinavir/ritonavir (400/100 mg twice daily orally), as well as chloroquine (500 mg twice daily orally for 10 days) and azithromycin (500 mg twice per day) cause a milder course of the disease and reduce the duration of treatment. The administration of glucocorticosteroids and research drugs (tocilizumab) is acceptable for massive infiltrative lesions in the pulmonary parenchyma causing severe lung injury (ALI) and acute respiratory distress syndrome (ARDS). In the system operation it is necessary to create the socalled a safety matrix that would take into account the existing threat on the one hand and all available services and resources on the other. Precise analysis and separation of individual tasks can enable the creation of a real crisis management plan.

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial.

BACKGROUND: Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. METHODS: We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. RESULTS: Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization. CONCLUSION: In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03733158. 7th November 2018.

Azithromycin in the treatment of patients with exacerbation of chronic obstructive pulmonary disease.

The beneficial effects of low dose azithromycin on reducing the number of exacerbations in patients with chronic obstructive pulmonary disease (COPD) have been the subject of many clinical studies. Long-term administration of low dose azithromycin is known to suppress proinflammatory cytokine production, potentiate macrophage phagocytosis and anti-inflammatory cytokine expression. The effect of azithromycin is also associated with a decrease in the expression of human HLA (human leukocyte antigen) complex molecules in the respiratory tract, including HLA-A, HLA-B, HLA-DPA1, HLA-DRA, HLA-DRB4. In contrast, inhibition of viral infections by azithromycin is caused by a suppressive effect on the production of viral interferon. In the COLUMBUS study conducted in 92 COPD patients with frequent exacerbations who were given azithromycin for a year, inflammatory markers, eosinophilia, and GOLD severity were analyzed. It was found that the antibiotic therapy was most effective in patients with COPD with frequent exacerbations in GOLD 1 and 2 and GOLD C, as well as in patients with blood eosinophilia over 2%. An analysis of the costs of prophylactic administration of chronic azithromycin in patients with COPD in Belgium showed that the cost would be EUR 595 million, saving EUR 950 million for the treatment of COPD exacerbations. According to the recommendations in GOLD2020, azithromycin (250 mg or 500 mg daily three times a week) for 1 year in COPD patients significantly reduces the number of exacerbations.

Carbon footprint of inhalers in COPD therapy in 2018 and 2019 in Poland in response to the Kigali amendment.

The treatment of patients with obstructive airway diseases is based on the use of inhalation preparations. Some of them, mainly including pressurized metered dose inhalers (pMDIs), contain compressed gases - hydrofluoroalkanes, which generate carbon dioxide emissions, creating the so-called carbon footprint. AIM: The aim of the study was to evaluate the consumption of individual active substances, the types of inhalers used and calculation of the carbon footprint of popular therapies in 2018 and 2019 in Poland. MATERIALS AND METHODS: The ratio of pMDI vs DPI (dry powder inhaler) data and the data on using long-acting ß2-agonists (LABAs), shortacting muscarinic antagonists (SAMAs), long-acting muscarinic antagonists (LAMAs), LAMA+LABAs, LAMA+LABA+ICSs (inhaled corticosteroids) on Polish market during 2018 and 2019 were analyzed. The carbon footprint of such therapies was counted. Then, we studied the reduction of the carbon footprint for scenario A (reducing pMDI by 50%) and scenario B (reducing pMDI by 80%) in the following steps of analysis. RESULTS: The general structure of pMDI/DPI in Poland in COPD area was not changed in 2019 vs 2018. The carbon footprint is primarily created by pMDI SAMAs. In 2019 in Poland pMDI SAMAs were 1.6 mio units (the same as in 2018), which generated 33.5 kt CO2e annually, but the whole category generates 40.8 kt CO2e. Scenario A gives us a benefit of 18.8 kt CO2e reduction and scenario B brings us a benefit of 29.9 kt CO2e reduction of emissions. CONCLUSIONS: Despite Poland's ratification the Kigali amendment did not affect pMDI consumption and did not reduce the carbon footprint. The lower carbon footprint of DPIs should be considered alongside other factors when choosing inhalation devices.