Chronic obstructive pulmonary disease exacerbations and progression in relation to ambient air pollutants exposure.

BACKGROUND: The information for the impact of air pollutants on the severity of chronic obstructive pulmonary disease (COPD) and hospital admissions in Bulgaria is scarce. The aim of the study is to assess the relationship between some ambient air pollution and exacerbations levels as well as hospital admissions of patients with COPD in Bulgaria. METHODS: A multi-center, prospective, one-year observational study was conducted among 426 COPD patients. Data from pollution monitoring are collected from the Executive Environment Agency (EEA). RESULTS: The results showed that the pollution with sulfur dioxide (SO2) is less than limit concentrations recommended by the European Union and World Health Organization (WHO), while the pollution with PM exceeds limits values of WHO two times. The mean rate of exacerbations in selected towns are between 0.5-3, the number of exacerbations with hospitalization are between 0.2-1.8 and length of hospital stay is between 1-14 days. CONCLUSIONS: The study confirms that air pollution leads to increased number of exacerbations and hospital stay. The patients with mild level of COPD have 0.86 exacerbations and 2.61 days in hospital per year, while in case of very severe COPD these values increase 4 times. Outside pollutions lead to worsening of the disease severity and hospitalizations due to a higher rate of COPD exacerbations.

Clinical characteristics, treatment patterns, and socio-economic burden of COPD in Bulgaria.

BACKGROUND: While the impact of COPD in Western-Europe is known, data from Eastern-Europe is scarce. This study aimed to evaluate clinical characteristics, treatment patterns, and the socio-economic burden of COPD in Eastern-Europe, taking Bulgaria as a reference case. METHODS: A representative sample of Bulgarian patients with COPD was randomly chosen by pulmonologists, based on the following inclusion criteria: COPD diagnosis with at least 1 year of living with COPD, ≥40 years of age, and use of COPD medication. Patient characteristics, treatment, quality-of-life, healthcare resource use, and costs were systematically assessed. RESULTS: A total of 426 COPD patients were enrolled. Approximately 69% were male, 40% had occupational risk factors, 45% had severe and 11% had very severe COPD. Mean CAT scores were 13.80 (GOLD A), 21.80 (GOLD B), 17.35 (GOLD C), and 26.70 (GOLD D). Annual per-patient costs of healthcare utilization were €579. Yearly pharmacotherapy costs were €693. Indirect costs (reduced and lost work productivity) outnumbered direct costs three times. CONCLUSIONS: Bulgaria has relatively high percentages of (very) severe COPD patients, resulting in considerable socio-economic burden. High smoking rates, occupational risk factors, air pollution, and a differential health system may be related to this finding. Eastern-European COPD strategies should focus on prevention, risk-factor awareness, and early detection.

Epidermal growth factor receptor gene copy number changes in lung cancer.

OBJECTIVE: The objective of this study was to assess the implication of copy number changes of epidermal growth factor receptor (EGFR) in lung cancer pathogenesis. MATERIALS AND METHODS: We used the highly reliable method of FISH, applied on tissue microarray (TMA), containing 306 lung tumors of different histological types, grades and tumor stage, in order to analyze the correlations between gene copy number changes and tumor phenotype. RESULTS: The frequency of EGFR copy number changes was 22.2%-2.8% amplifications and 19.4% gains. EGFR gains occurred more commonly in the squamous cell cancers (23.5%) than in adenocarcinomas (11.8%). Amplifications of EGFR were found only in the squamous cell cancers. Regarding cancer phenotype, there was a statistically significant correlation between EGFR copy number changes and histological grade (p = 0.001). No statistically significant relation could be observed with the metastatic spread of the tumors (lymphogenic and haematogenic) (p = 0.082 and p = 0.1, respectively). In our study EGFR could not be determined as a prognostic factor of survival (p = 0.6115). CONCLUSION: EGFR copy number changes could supplement the clinical significance of EGFR as a marker related to its pathogenesis and targeted therapy.