Vitamin D status of severe COPD patients with chronic respiratory failure.

INTRODUCTION: The aim of the study was to measure the concentrations of vitamin D in serum of COPD patients with chronic respiratory failure in comparison to healthy control group. The correlation between the levels of vitamin D in serum and the selected clinical, spirometric and blood gas parameters was the additional aim of the study. MATERIAL AND METHODS: The study included 61 patients with diagnosed COPD in stadium of chronic respiratory failure (45 men and 16 women) and 37 healthy controls (19 men and 18 women). The following procedure were performed in all studied subjects: detailed history (especially: daily activity, diet, tobacco and alcohol use), post-bronchodilator spirometry, assessment of 25(OH)D in serum and for COPD group only blood gas analysis. Recruitment for the study was conducted from November to April. Statistical analysis was performed using the following statistical methods: t-Student test, Mann-Whitney U test, Spearman correlation test and Chi-kwadrat test. RESULTS: There was no significant differences between COPD and control group for the levels of 25(OH)D in serum. Median and lower; upper quartile were respectively following: 24,75 nmol/l (16,9; 36,4) vs. 24,06 nmol/l (16,3; 37,2), p=0,69. Vitamin D deficiency was present in 60 COPD patients (98,3% of all patients) and in 36 control group subject (97,3% of all healthy volunteers). The difference was not statistically significant. The levels of vitamin D in serum did not significantly correlated with any of studied parameters (spirometry, blood gas, age, the level of activity, BMI, tobacco smoke exposure and others). However, the level of activity in COPD group correlated positively with spirometry values and negatively with age and number of exacerbations. CONCLUSION: The results of the study showed that in autumn-winter time in Poland there are very frequent deficiency of vitamin D in serum not only in COPD patients in respiratory failure stage but also in elderly healthy persons. However, in contrary to expectations the deficiency of vitamin D in COPD patients with respiratory failure were similar to that seen in healthy persons.

Bronchial hyperreactivity in perimenstrual asthma is associated with increased Th-2 response in lower airways.

BACKGROUND: Perimenstrual asthma (PMA) is a commonly observed, usually difficult-to-treat asthma phenotype. The mechanisms underlying this phenomenon remain unexplained. The aim of the study was to assess the degree of airway hyperresponsiveness and its relationship to proinflammatory cytokines concentration in lower airways of PMA compared to non-PMA patients. METHODS: Premenopausal women with regular menstrual cycles diagnosed as: PMA (n=12), non-PMA asthmatics (n=9), and healthy controls (n=10) were prospectively followed for 10 weeks over two consecutive menstrual cycles. The bronchial responsiveness (BR) test to methacholine was performed in each subject prior to the study. The serum for total immunoglobulin E (IgE) concentrations was taken and sputum was induced in the 26th day of each of the two cycles. Sputum concentration of eotaxin, IL-4 and IL-10 were measured by ELISA. RESULTS: Levels of BR to metacholine as well, as total blood IgE concentrations in PMA subjects were significantly higher than in non-PMA asthmatics and healthy controls (P=0.001, P=0.022 respectively) and correlated with each other (P=0.030; r =-0.65). Sputum eotaxin and IL-4 concentrations in luteal phase were increased in PMA patients when compared with non-PMA asthmatics (P=0.016; P=0.041, respectively) and healthy subjects (P<0.001 both cytokines). No differences for the sputum levels of IL-10 among studied groups were seen. CONCLUSIONS: BR level in perimenstrual asthma is higher than in non-PMA asthmatics and correlates with increased total IgE serum concentration. The increased level of BR in PMA patients is associated with a shift in the type-1/type-2 cytokine balance toward a type-2 response.

Lung-heart clinical crosstalk in the course of COPD exacerbation.

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. MATERIAL 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.

Depressiveness, symptoms of anxiety and cognitive dysfunctions in patients with asthma and chronic obstructive pulmonary disease (COPD): possible associations with inflammation markers: a pilot study.

Psychiatric symptoms of anxiety, depression and cognitive dysfunction often occur in patients suffering from somatic conditions such as asthma and chronic obstructive pulmonary disease (COPD) which constitute a major and growing public health problem. In the present study we therefore aimed at analyzing depressive symptoms as well as symptoms of anxiety and cognitive problems in patients with mild to moderate asthma and COPD. 59 participants-17 with asthma, 24 with COPD and 18 healthy controls were enrolled. Depressiveness was assessed with the beck depression inventory (BDI); anxiety symptoms were measured with the State-Trait Anxiety Inventory Part 1 and 2, and cognitive function levels were estimated with the Trail Making Test Part A and B. A score above the threshold indicative for depression was found by 33 % (n = 8) of COPD patients, 29 % (n = 5) of asthma patients compared to 0.05 % (n = 1) of the control group. Clinically relevant anxiety levels were found in 42 % (n = 10) of the COPD group, 41 % (n = 7) of the asthma patients and 17 % (n = 3) of the controls. Patients with COPD performed significantly worse on the TMT than other groups. Psychoemotional state and cognitive functions were found to be correlated with exposure to tobacco smoke (measured in pack-years) and airway obstruction (measured with FEV1). In conclusion, patients with mild to moderate asthma and COPD exhibit significantly higher levels of depressive and anxiety symptoms as well as cognitive dysfunctions than controls. The prevalence of these symptoms is related to the amount of exposure to tobacco smoke and the severity of airflow obstruction.

Perimenstrual asthma as a gynecological and pulmonological clinical problem.

Asthma is one of the most common chronic diseases of the respiratory system. It is estimated that up to 40% of asthmatic women of childbearing age may experience a cyclical exacerbation of asthmatic symptoms during the perimenstrual period, which is called perimenstrual asthma (PMA). The precise prevalence of this particular phenotype of asthma is difficult to determine due to a lack of explicit diagnostic criteria and appropriate epidemiological surveys. According to one of the best documented hypotheses regarding perimenstrual exacerbations of asthma, the impact of female steroid sex hormones on the function of the respiratory system and inflammations in the bronchi may play a central role in this phenomenon. Although the basic medical approach to PMA is similar to that used in other asthma phenotypes, unconventional methods of "experimental" treatment have also been tried. Unfortunately, current knowledge about the pathogenic mechanisms of this phenotype of asthma is incomplete and inconsistent, which justifies the need for further interdisciplinary studies with the participation of specialists in both gynecology and lung diseases. The knowledge thus acquired will help to individualize and focus future therapy on specific cellular and/or hormonal mechanisms to optimize asthma control in patients with PMA.

Analysis of psychoemotional state and intellectual abilities in patients with asthma and chronic obstructive pulmonary disease--preliminary results.

BACKGROUND: In the literature we can find examples of comorbidity of the diseases of the respiratory tract and mental disorders. Among them a particularly significant position is occupied by chronic obstructive pulmonary disease (COPD) and asthma, which may be accompanied by anxiety, depressive and cognitive symptoms. The present research project was aimed to establish a connection between psycho-intellectual functioning and suffering from the aforementioned diseases. SUBJECTS AND METHODS: The patients were divided into 3 groups. In the asthma group there were 11 people, mean age 54, who met the GINA criteria for asthma. The group of patients with COPD was formed by 12 people, mean age 67. The control group included 13 people, mean age 48. Patients from all the groups underwent spirometry, sputum induction and the following tests: Mini-Mental State Examination (MSSE), Trail Making Test (TMT A and B), Beck Depression Inventory - BDI (Beck et al. 1961) and State-Trait Anxiety Inventory for Adults - STAI 1 and 2. RESULTS: In the TMT tests results were the following: We can presume some deficiency when the time required by a patient to complete the task is longer than 78 seconds for Part A and 273 seconds for Part B. In our research the best mean time was obtained in control group (Part A - 30.04 s, Part B - 67.37 s), then in the asthma group (Part A - 35.54 s, Part B - 98.81 s) and in the COPD group (Part A - 42.80 s, Part B - 107.79 s). In our research study the lowest score for the Beck Depression Inventory was obtained in the control group (mean 6.15), then in asthma (mean 9.63) and in COPD (mean 13.61). Results for State-Train Anxiety Inventory were distributed as follows: mean score in the asthma group was 36.48 in Part 1 and 43.27 in Part 2, in the COPD group 36.41 in Part 1 and 42.66 in Part 2 and in the control group 32.61 in Part 1 and 36.75 in Part 2. CONCLUSIONS: In our research the level of anxiety and depression measured by self-assessment questionnaires was higher in the study groups than in the control group. Also cognitive functions were worse than in the healthy controls, especially among COPD patients.

[Respiratory function impairment during treatment of chronic hepatitis C with peginterferon alfa2 and ribavirin. Two cases presentation]. / Zaburzenia czynnosci ukladu oddechowego podczas leczenia przewleklego zapalenia watroby typu C pegylowanym interferonem i rybawiryna. Prezentacja przypadków.

Pulmonary complications during standard therapy of chronic hepatitis C with pegylated interferon and ribavirin are rare but connected with wide spectrum of diseases from sarcoidosis to interstitial pneumonitis. The clinical course of that complications is often serious. In this paper, presentation of two patients with chronic hepatitis C with different anamnesis was shown. In the first case, without pulmonary burden, during therapy the features of pneumonitis were developed. In the second case, in patient with sarcoidosis, the antiviral therapy was carried out without important pulmonary aggravation. In reference to these observations and based on available literature, the pathogenetic mechanisms underlying pulmonary complications during this kind of therapy were discussed. Additionally, the scheme of pulmonary diagnostic proceeding in patients certified and then treated with peginterferon and ribawirin was proposed.

[Usefulness of induced sputum in the diagnostics of selected chronic inflammatory airway diseases]. / Przydatnosc badania plwociny indukowanej w diagnostyce niektórych przewleklych chorób zapalnych ukladu oddechowego.

INTRODUCTION: Usefulness of the cytological analysis in diagnostics some of chronic inflammatory diseases of the respiratory system was assessed on the basis of the normal values for the composition of sputum inflammatory cells among healthy inhabitants of Silesia. MATERIALS AND METHODS: Examined: 96 healthy subjects (control group), 42 patients with bronchial asthma, 49 patients with chronic obstructive pulmonary disease (COPD) and 30 patients with chronic bronchitis (CB). Spirometry, before and 15 minutes after 200 micrograms of salbutamol, and sputum examination were performed in all participants. Airway responsiveness on metacholine was performed in people with no contraindication. RESULTS: In comparison to the control group, the percentage of eosinophils was significantly higher in all patients (p<0.00001). Median values were following: asthma patients--10.3%, COPD patients--1.5%, CB patients--1.6% and control subjects--0.3%. Important statistic differences (p<0.05%) have been observed in the average percentage of the neutrophils in induced sputum between healthy subjects and patients with asthma, COPD and CB. Respective median values were: 45.75%, 38.1%, 77.5% and 58.1%. The percentage of patients whose sputum eosinophils results were above the normal values (>2.8%) was as follows: 85% of the number of patients with bronchial asthma, 38% of patients with COPD, 20% of patients with CB and 6% of healthy subjects. CONCLUSIONS: These results suggest that cytological examination of induced sputum is a good adjunctive test in diagnostics of the chronic inflammatory diseases of the respiratory system. The percentage of eosinophils in induced sputum above 2.8% most probably confirms bronchial asthma diagnosis.

[The influence of occupational exposure to pesticides on the frequency of chronic obstructive pulmonary diseases]. / Wplyw zawodowej ekspozycji na pestycydy na czestosc wystepowania przewleklej obturacyjnej choroby pluc.

UNLABELLED: Chronic obstructive pulmonary disease (COPD) is the most frequent disorder of respiratory tract. Smoking cigarettes and additionally occupational exposure to certain substances are the risk factors of this disease. The aim of our study was to assess the frequency of COPD among works of the pesticides producing factory in Jaworzno, Poland. MATERIAL AND METHODS: The medical history was obtained from 181 workers and spirometry was done in 114 of them. RESULTS: The frequency of COPD (grades 0-2 according to the GOLD) was significantly increased in workers exposed to pesticides compared to not exposed group (19.3 vs. 3%; p = 0.002). The length of exposure to pesticides was significantly longer in COPD compared to healthy group (p = 0.003). Additionally, there was a negative correlation between the values of FEV1/FVC index and respectively length of exposure to pesticides (r = -0.3; p = 0.0003) and the number of packyears of cigarettes smoked (r = -0.39; p < 0.0001). CONCLUSION: We concluded that the frequency of COPD is increased in workers exposed to pesticides at work compared to subjects not exposed. The main risk factors for development of COPD among these patients were the length of exposure to pesticides and to lesser degree number of smoked cigarettes.

[Increased levels of RANTES in induced sputum of chronic asthma but not in seasonal grass pollen-induced rhinitis]. / Podwyzszone stezenia RANTES w indukowanej plwocinie w przewleklej astmie, ale nie w sezonowym alergicznym niezycie nosa.

BACKGROUND: [corrected] Allergic rhinitis is one of risk factors for development of allergic asthma. METHODS: 9 patients with asthma, 16 patients with seasonal allergic rhinitis (SAR) due to grass or rye pollen sensitization and 17 healthy control subjects were recruited to the study. SAR patients were identified by history, skinprick test, specific IgE and positive nasal allergen challenge. Every subject underwent the methacholine bronchial provocation test and sputum induction. Levels of RANTES were measured in supernatant of induced sputum. RESULTS: Increased percentage of eosinophils in induced sputum in asthma compared to control group (p=0.01) but not in SAR patients compared to healthy subjects (p=0.13) were found. Similarly, asthmatic patients (p=0.01) but not SAR patients had increased levels of RANTES in sputum compared to healthy subjects. CONCLUSION: Increased levels of RANTES in induced sputum of patients with chronic asthma but not in SAR patients indicate that RANTES is important in pathogenesis of chronic airway inflammation.

[Range of the normal values for induced sputum cells in Silesian population]. / Zakres wartosci prawidlowych dla komórek wystepujacych w indukowanej plwocinie w populacji slaskiej.

BACKGROUND: The induced sputum is used in the diagnosis of chronic airways diseases. Up to now there has not been performed studies in Poland describing the distribution of cells in sputum. The aim of the study was to work out the range of normal values for cells in sputum, based on a group of healthy Polish people living in Silesia region. METHODS: One hundred healthy volunteers in age 17-79 without respiratory symptoms were examined. They had normal spirometry, no airways hyperresponsiveness to metacholine and no history of allergic diseases. The sputum was obtained from 85 people. Viability, total and differential cell counts was performed. RESULTS: The range of the normal values for induced sputum cells was following [mean (+/- SD)]: macrophages 49.3% (11.5-77.1%), neutrophils 48.5% (9.6-87.2%), eosinophils 0.8% (<4.8), lymphocytes 1.4% (<4.2%). Smoking and age of subjects influenced the number and percentage of cells in sputum. CONCLUSIONS: Finding of high percentage of eosinophils (>4.8%) in sputum may be helpful in the diagnosis of asthma. Counting of neutrophils and other cells is of limited practical value. E.S.; G.G.; A.S.; A.B.; W.P. Range of the normal value for induced sputum cells in people living in Silesian region.

Decreased levels of myeloperoxidase in induced sputum of patients with COPD after treatment with oral glucocorticoids.

BACKGROUND: Inhaled glucocorticoids may decrease exacerbations in some patients with COPD, and oral glucocorticoids may improve FEV(1) and shorten hospital stay during exacerbations. The mechanism of these improvements is unknown. This study examines the effect of oral glucocorticoids on markers of neutrophilic airway inflammation. METHODS: Eighteen patients with COPD received oral prednisone, 0.5 mg/kg/d for 2 weeks. Clinical status, lung function measurements, and sputum induction were performed before and after treatment with oral prednisone. Levels of the neutrophil chemoattractant (interleukin-8 [IL-8]) and neutrophil activation marker (myeloperoxidase [MPO]) were measured in the supernatant of induced sputum by enzyme-linked immunosorbent assay. RESULTS: Levels of MPO decreased significantly after treatment with prednisone (p = 0.0004): before treatment median, 2.54 microg/mL (range, 1.49 to 12.58 microg/mL); after treatment median, 1.79 microg/mL (range, 1.32 to 3.57 microg/mL). Treatment with prednisone did not influence the levels of IL-8. CONCLUSIONS: The treatment of patients with COPD with oral glucocorticoids decreases the activation of neutrophils, which may be partially responsible for clinical improvement in these patients.