Advances in Respiratory Medicine

174 KiB

Open AccessReview

Nowości z Kongresu ERS w Barcelonie, 18–22 września 2010 (Część II)

by Michał Bednarek, Elżbieta Puścińska and Jan Zieliński

Adv. Respir. Med. 2011, 79(3), 253-258; https://doi.org/10.5603/ARM.27662 - 21 Apr 2011

Viewed by 245

Tematyce zaburzeń oddychania w czasie snu poświęcono jak zwykle wiele uwagi, przygotowano im 14 sesji, w tym 2 sympozja, 2 praktyczne seminaria warsztatowe, 2 sesje wystąpień ustnych, 2 sesje komunikacji elektronicznych, 5 sesji plakatowych oraz jeden kurs podyplomowy [...] Full article

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Open AccessReview

Rola Nieinwazyjnej Wentylacji w Leczeniu Przewlekłej Obturacyjnej Choroby Płuc

by Jacek Nasiłowski

Adv. Respir. Med. 2011, 79(3), 246-252; https://doi.org/10.5603/ARM.27666 - 21 Apr 2011

Viewed by 315

Abstract

Nieinwazyjna wentylacja (NIW) jest jednym z najważniejszych osiągnięć w leczeniu chorób płuc w ostatnich kilkunastu latach. Stosując ją, uzyskuje się podobny efekt fizjologiczny jak w przypadku wentylacji inwazyjnej, polegający na zmniejszeniu pracy mięśni oddechowych i poprawie wymiany gazowej, przy jednoczesnym uniknięciu groźnych powikłań [...] Read more.

Nieinwazyjna wentylacja (NIW) jest jednym z najważniejszych osiągnięć w leczeniu chorób płuc w ostatnich kilkunastu latach. Stosując ją, uzyskuje się podobny efekt fizjologiczny jak w przypadku wentylacji inwazyjnej, polegający na zmniejszeniu pracy mięśni oddechowych i poprawie wymiany gazowej, przy jednoczesnym uniknięciu groźnych powikłań intubacji. Podstawowym wskazaniem do NIW jest ciężkie zaostrzenie przewlekłej obturacyjnej choroby płuc (POChP), charakteryzujące się kwasicą oddechową. Kontrolowane badania wykazały zmniejszenie śmiertelności, konieczności intubacji, liczby powikłań związanych z leczeniem oraz skrócenie czasu pobytu na OIOM i w szpitalu u chorych leczonych NIW. Rola NIW w przewlekłym leczeniu chorych z ciężką, hiperkapniczną postacią POChP nie jest ustalona. Chociaż zarówno przesłanki teoretyczne, jak i wyniki badań klinicznych sugerują korzyści z tego leczenia, to nadal nie jest jasne, którzy chorzy odniosą z niego korzyść. Obecnie uważa się, że próbę NIW w warunkach domowych należy podjąć u chorych ze znaczną hiperkapnią, powodującą objawy hipowentylacji, w przypadku częstych zaostrzeń, zwłaszcza wymagających stosowania wspomagania wentylacji oraz przy nieskuteczności domowego leczenia tlenem w utrzymaniu prawidłowego utlenowania krwi. Stosowanie NIW, dzięki zmniejszeniu liczby powikłań i czasu hospitalizacji, szczególnie w warunkach intensywnego nadzoru, jest postępowaniem przynoszącym oszczędności zarówno szpitalowi, jak i systemowi opieki zdrowotnej.
Full article

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Open AccessReview

Profilaktyka Przewlekłej Obturacyjnej Choroby Płuc

by Dorota Górecka and Elżbieta Puścińska

Adv. Respir. Med. 2011, 79(3), 239-245; https://doi.org/10.5603/ARM.27665 - 21 Apr 2011

Viewed by 577

Abstract

Przewlekła obturacyjna choroba płuc (POChP) jest jednym z najważniejszych schorzeń społecznych. Jest przyczyną znacznej śmiertelności (znajduje się na czwartym miejscu najważniejszych przyczyn zgonów na świecie), odpowiada za znaczną chorobowość oraz przyczynia się do pogorszenia jakości życia chorych i ich najbliższych. Dzięki profilaktyce można [...] Read more.

Przewlekła obturacyjna choroba płuc (POChP) jest jednym z najważniejszych schorzeń społecznych. Jest przyczyną znacznej śmiertelności (znajduje się na czwartym miejscu najważniejszych przyczyn zgonów na świecie), odpowiada za znaczną chorobowość oraz przyczynia się do pogorszenia jakości życia chorych i ich najbliższych. Dzięki profilaktyce można zapobiec powstaniu choroby (profilaktyka pierwotna), nie dopuścić do jej postępu (profilaktyka drugorzędowa) oraz zapobiec wystąpieniu powikłań (profilaktyka trzeciorzędowa). Profilaktyka w POChP obejmuje działania skierowane na ograniczenie nałogu palenia tytoniu, zmniejszenie szkodliwych wpływów środowiska oraz stosowanie szczepień ochronnych.
Full article

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Open AccessReview

Nowe Leki w Przewlekłej Obturacyjnej Chorobie Płuc

by Ryszarda Chazan

Adv. Respir. Med. 2011, 79(3), 232-238; https://doi.org/10.5603/ARM.27664 - 21 Apr 2011

Viewed by 258

Abstract

Zastosowanie u chorych na przewlekłą obturacyjną chorobę płuc (POChP) wziewnych leków rozkurczowych z grupy β₂-mimetyków i cholinolityków zapewnia lepszą kontrolę objawów choroby, zmniejsza liczbę zaostrzeń oraz ich nasilenie, zwiększa tolerancję wysiłku i zapewnia lepszą jakość życia. Leki te mają akceptowalny profil bezpieczeństwa. [...] Read more.

Zastosowanie u chorych na przewlekłą obturacyjną chorobę płuc (POChP) wziewnych leków rozkurczowych z grupy β₂-mimetyków i cholinolityków zapewnia lepszą kontrolę objawów choroby, zmniejsza liczbę zaostrzeń oraz ich nasilenie, zwiększa tolerancję wysiłku i zapewnia lepszą jakość życia. Leki te mają akceptowalny profil bezpieczeństwa. U chorych w umiarkowanym i ciężkim stadium choroby rekomendowane jest zastosowanie skojarzone leków rozkurczowych długodziałających z dwóch grup: beta₂-mimetyków i leków muskarynowych (LABA/LAMA). Pierwszym lekiem z grupy LABA, który działa 24 godziny, a jednocześnie ma bardzo szybki początek działania i który można stosować raz na dobę jest indakaterol. Korzyści z zastosowania indakaterolu zarówno w monoterapii, jak i w skojarzeniu z LAMA wiążą się z uproszczeniem sposobu leczenia. U osób, u których choroba nadal postępuje, i które mają częste zaostrzenia, rekomendowana jest terapia trójlekowa: dwa leki rozkurczowe w połączeniu z wziewnym glikokortykosteroidem (LABA/LAMA/wGKS). W ciężkiej postaci POChP dodanie inhibitora PDE4 - roflumilastu do leku rozkurczowego z grupy LABA lub LAMA poprawia czynność płuc i zmniejsza częstość zaostrzeń. Wpływ dodania roflumilastu na zmniejszenie częstości zaostrzeń jest porównywalny z wynikami, jakie uzyskuje się za pomocą leczenia skojarzonego z wGKS. Wykazano korzystne działanie inhibitorów PDE4, zwłaszcza w połączeniu z innymi lekami. Terapia skojarzona stanowi kolejny krok w optymalizacji leczenia chorych na POChP.
Full article

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Open AccessReview

Mega Trials in COPD—Clinical Data Analysis and Design Issues

by Samy Suissa and Pierre Ernst

Adv. Respir. Med. 2011, 79(3), 227-231; https://doi.org/10.5603/ARM.27663 - 21 Apr 2011

Cited by 1 | Viewed by 289

Abstract

The TORCH and UPLIFT randomised controlled trials have provided important data on the benefits of COPD treatments, but also some lessons in study design and data analysis that we will here review. Firstly, it is fundamental that the study question be answerable by [...] Read more.

The TORCH and UPLIFT randomised controlled trials have provided important data on the benefits of COPD treatments, but also some lessons in study design and data analysis that we will here review. Firstly, it is fundamental that the study question be answerable by the study design. The question in the TORCH study was aimed at a comparison with ‘usual care’, but the placebo group was not ‘usual care’. Secondly, TORCH and UPLIFT were among the first trials to follow the intent-to-treat principle, fundamental to avoid bias in randomised trials. However, this principle was followed for the mortality outcome, but not for lung function, so that the findings related to lung function decline are subject to bias from regression to the mean. Finally, a re-analysis of the TORCH study (performed to fully exploit the data as a 2 × 2 factorial trial) shows that a mortality benefit is entirely accounted for by the effect of the long-acting β-agonist salmeterol, with no effect attributable to the inhaled corticosteroid fluticasone component of the combination therapy. Together, these data suggest that long-acting bronchodilators, including anticholinergics such as tiotropium and beta-agonists, are associated with lower mortality of patients with COPD, but not inhaled corticosteroids. With COPD one of the major causes of morbidity and mortality worldwide, mega trials such as TORCH and UPLIFT are much needed, but must achieve the utmost scientific rigour in their design and analysis. Full article

228 KiB

Open AccessCase Report

Chemotherapy in the Management of Disseminated Thymoma: A Case Report and the Authors’ Own Experience

by Izolda Mrochen-Domin, Ewa Chmielik, Danuta Starzyczny-Słota, Elżbieta Nowara and Marlena Sikora

Adv. Respir. Med. 2011, 79(3), 222-226; https://doi.org/10.5603/ARM.27660 - 21 Apr 2011

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Abstract

Thymomas are tumours originating from the epithelial tissue of the thymus. While surgery is the mainstay of therapy in thymoma, chemotherapy may significantly improve the prognosis. Effective chemotherapy may be administered in the neoadjuvant setting (prior to surgery), in the adjuvant setting (following [...] Read more.

Thymomas are tumours originating from the epithelial tissue of the thymus. While surgery is the mainstay of therapy in thymoma, chemotherapy may significantly improve the prognosis. Effective chemotherapy may be administered in the neoadjuvant setting (prior to surgery), in the adjuvant setting (following surgery), may be combined with radiotherapy or be used for palliation in disseminated disease. We report a case of a 66-year-old male with advanced thymoma who received second-line treatment with a good outcome. Full article

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Open AccessCase Report

Recurrent Exudative Pericarditis in the Course of Adult-Onset Still’s Disease—Two Case Reports

by Anna Bilska, Ewelina Wilińska, Monika Szturmowicz, Liliana Wawrzyńska, Anna Fijałkowska, Karina Oniszh, Andrzej Światowiec, Agnieszka Wsół and Adam Torbicki

Adv. Respir. Med. 2011, 79(3), 215-221; https://doi.org/10.5603/ARM.27659 - 21 Apr 2011

Cited by 1 | Viewed by 270

Abstract

Exudative pericarditis is a disease of varied aetiology requiring inclusion of both infectious and non-infectious causes in its differential diagnosis. The possible diagnoses include adult-onset Still’s disease (AOSD), a rare systemic inflammatory disease of unknown aetiology. AOSD typically develops in patients between 16 [...] Read more.

Exudative pericarditis is a disease of varied aetiology requiring inclusion of both infectious and non-infectious causes in its differential diagnosis. The possible diagnoses include adult-onset Still’s disease (AOSD), a rare systemic inflammatory disease of unknown aetiology. AOSD typically develops in patients between 16 and 35 years of age and is characterised by fever, arthralgia, transient salmon-coloured rash and other abnormalities including pharyngitis, serositis (particularly pleuritis and pericarditis) and laboratory abnormalities, such as elevated white blood cell count and elevated markers of inflammation. We report two cases of AOSD with recurrent exudative pericarditis. Full article

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Open AccessReview

Równowaga Proteazowo-Antyproteazowa a Palenie Tytoniu

by Joanna Kołodziejczyk, Milena Wojciechowska, Zbigniew Bartuzi and Andrzej Dziedziczko

Adv. Respir. Med. 2011, 79(3), 207-214; https://doi.org/10.5603/ARM.27661 - 21 Apr 2011

Viewed by 338

Abstract

Smoking tobacco can induce formation of inflammable state in respiratory tract and cause lungs damage. Experimental investigations affirm, that the exposure to tobacco smoke causes growth of penetrability of blood-vessels, which favors the enlarged migration of inflammable cells. The growth of exposure to [...] Read more.

Smoking tobacco can induce formation of inflammable state in respiratory tract and cause lungs damage. Experimental investigations affirm, that the exposure to tobacco smoke causes growth of penetrability of blood-vessels, which favors the enlarged migration of inflammable cells. The growth of exposure to reactive forms of oxygen and concentration changes of cellular antioxidants enzymes, leads to disorders in balance of proteinases and antiproteinases and oxidative stress. As the years go, the disorders mentioned above can lead to deterioration of ventilating efficiency of lungs, and consequently to pronouncement chronic obstructive pulmonary disease (COPD), which becomes serious problem on a world scale. Full article

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Open AccessArticle

Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) for Staging of Non-Small-Cell Lung Cancer (NSCLC)

by Marcin Zieliński, Łukasz Hauer, Jolanta Hauer, Juliusz Pankowski, Artur Szlubowski and Tomasz Nabiałek

Adv. Respir. Med. 2011, 79(3), 196-206; https://doi.org/10.5603/ARM.27658 - 21 Apr 2011

Cited by 6 | Viewed by 371

Abstract

Introduction: The aim of the study is to analyze diagnostic yield of the new surgical technique — the Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) in preoperative staging of Non-Small-Cell Lung Cancer (NSCLC). Material and methods: Operative technique included 5–8 cm collar incision in the [...] Read more.

Introduction: The aim of the study is to analyze diagnostic yield of the new surgical technique — the Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) in preoperative staging of Non-Small-Cell Lung Cancer (NSCLC). Material and methods: Operative technique included 5–8 cm collar incision in the neck, elevation of the sternal manubrium with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves and dissection of all mediastinal nodal stations except of the pulmonary ligament nodes (station 9). Results: 698 patients (577 men, 121 women), of mean age 62.8 (41–79) were operated on from 1.1.2004 to 31.1.2010, including 501 squamous-cell carcinomas, 144 adenocarcinomas, 25 large cell carcinomas and 28 others. Mean operative time was 128 min. (45 to 330 min.) and 106.5 min. in the last 100 patients. 30-day mortality was 0.7% (unrelated causes) and morbidity 6.6%. The mean number of dissected nodes during TEMLA was 37.9 (15 to 85). Metastatic N2 and N3 nodes were found in 152/698 (21.8%) and 26/698 patients (3.7%), respectively. Subsequent thoracotomy was performed in 445/ 513 patients (86.7%) after negative result of TEMLA. During thoracotomy, omitted N2 was found in 7/445 (1.6%) patients. Sensitivity of TEMLA in discovery of N2–3 nodes was 96.2%, specificity was 100%, accuracy was 99,0%, Negative Predictive Value (NPV) was 98.7% and Positive Predictive Value (PPV) was 100%. Conclusions: TEMLA is a new minimally invasive surgical procedure providing unique possibility to perform very extensive, bilateral mediastinal lymphadenectomy with very high diagnostic yield in staging of NSCLC. Full article

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Open AccessArticle

Variability in the Clinical Profile of Children with Asthma Referred to Allergy Clinic: A 10-Year Observation

by Ewa Bąk-Walczak, Joanna Jerzyńska, Iwona Stelmach, Jan Krakowiak and Włodzimierz Stelmach

Adv. Respir. Med. 2011, 79(3), 189-195; https://doi.org/10.5603/ARM.27657 - 21 Apr 2011

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Abstract

Background: Asthma is the most common chronic respiratory disease in the paediatric population. Underdiagnosis is a frequent phenomenon and is associated with undertreatment, which results in increased morbidity and mortality. The delay in the diagnosis of asthma reflects problems with the correct implementation [...] Read more.

Background: Asthma is the most common chronic respiratory disease in the paediatric population. Underdiagnosis is a frequent phenomenon and is associated with undertreatment, which results in increased morbidity and mortality. The delay in the diagnosis of asthma reflects problems with the correct implementation of diagnostic goals set by the Global Initiative for Asthma (GINA). The aim of our study was to describe the clinical profile of children referred to the Clinic of Allergic Diseases and subsequently diagnosed with asthma. We evaluated the reasons for referral, demographic data and social data. Material and methods: We analysed a group of 907 children up to 18 years of age diagnosed with asthma at allergy clinic between 2000 and 2009. This was a cross-sectional study to assess the patients’ demographic, social and clinical data. Results: Our study revealed a shift in the clinical profile of children referred to allergy clinics over a period of ten years, subsequently diagnosed with asthma. The profile is characterised by a younger age, a higher incidence of recurrent infections and a lower incidence of wheezing and atopy as the reasons for referral to allergologists. Conclusions: The new clinical profile of children referred to allergologists reveals the necessity of conducting the costly differential diagnosis of asthma at specialist facilities. These data should be taken into account while developing new healthcare strategies in Poland. Full article

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Open AccessArticle

The Effect of Physiotherapy on Interleukin-8 Levels in Patients with Chronic Obstructive Pulmonary Disease

by Jan Szczegielniak, Katarzyna Bogacz, Jacek Łuniewski, Edyta Majorczyk, Andrzej Tukiendorf and Marcin Czerwiński

Adv. Respir. Med. 2011, 79(3), 184-188; https://doi.org/10.5603/ARM.27656 - 21 Apr 2011

Cited by 1 | Viewed by 303

Abstract

Introduction: Interleukin-8 (IL-8), a chemokine formed by macrophages and epithelial cells and a potent chemoattractant for neutrophils, plays the principal role in the activation of neutrophils and eosinophils in the airways of patients with chronic obstructive pulmonary disease (COPD) and may be used [...] Read more.

Introduction: Interleukin-8 (IL-8), a chemokine formed by macrophages and epithelial cells and a potent chemoattractant for neutrophils, plays the principal role in the activation of neutrophils and eosinophils in the airways of patients with chronic obstructive pulmonary disease (COPD) and may be used as a marker of inflammation. The inflammation in the course of COPD may be characterised by an increased neutrophil count in the sputum and elevated IL-8 levels. The aim of the study was to assess the effect of physiotherapy on IL-8 levels in induced sputum in patients with COPD. Material and methods: The study included 44 patients (21 men and 23 women, mean age 56.47 ± 9.52) managed at the Ministry of Internal Affairs and Administration Specialist Hospital in Głuchołazy, Poland, and undergoing rehabilitation at the Therapeutic Rehabilitation Facility, with the diagnosis of COPD (FEV₁/VC < 65%), receiving stable drug treatment during physiotherapy. Before physiotherapy all the patients underwent treadmill exercise testing according to the Bruce protocol and had their dyspnoea assessed on the 20-point Borg scale as part of qualification for physiotherapy. All the patients participated a multidirectional three-week respiratory physiotherapy programme based on aerobic training performed on a cycloergometer. The training loads were selected on an individual basis depending on exercise tolerance. The standard physiotherapy programme also included respiratory muscle exercises with a particular emphasis on the abdominal muscles and the diaphragm, saline inhalations, postural drainage and percussion, relaxation and walks. Results: IL-8 levels were significantly lower after completion of the three-week physiotherapy. IL-8 levels in the sputum decreased from 18.91 ± 25.2 to 9.69 ± 14.06 ng/ml (p = 0.0215). The highest reduction of IL-8 levels was observed in patients with the highest baseline values. Conclusions: The decrease of IL-8 levels in induced sputum following comprehensive physiotherapy in patients with COPD suggests suppression of neutrophil activity, which may be one of the reasons for the improved clinical condition of the patients. Full article

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Open AccessArticle

Three-Month Continuous Positive Airway Pressure (CPAP) Treatment Decreases Total and LDL-Cholesterol Levels but Does Not Affect Serum Homocysteine and Leptin Levels in Patients with Obstructive Sleep Apnoea Syndrome (OSAS) without Co-Existent Ischaemic Heart Disease (IHD)

by Marta Kumor, Piotr Bielicki, Tadeusz Przybyłowski, Renata Rubinsztajn, Jan Zieliński and Ryszarda Chazan

Adv. Respir. Med. 2011, 79(3), 173-183; https://doi.org/10.5603/ARM.27655 - 21 Apr 2011

Cited by 1 | Viewed by 291

Abstract

Introduction: Continuous positive airway pressure (CPAP) treatment reduces cardiovascular morbidity and mortality in patients with obstructive sleep apnoea syndrome (OSAS). Homocysteine and leptin may play a role in the development of ischaemic heart disease (IHD) in these patients. The aim of the study [...] Read more.

Introduction: Continuous positive airway pressure (CPAP) treatment reduces cardiovascular morbidity and mortality in patients with obstructive sleep apnoea syndrome (OSAS). Homocysteine and leptin may play a role in the development of ischaemic heart disease (IHD) in these patients. The aim of the study was to assess the effects of 3-month CPAP treatment on the risk factors of IHD in patients with OSAS without co-existing IHD (OSAS without IHD) and on OSAS with co-existing IHD (OSAS with IHD). Material and methods: CPAP treatment was commenced in 42 patients with OSAS without IHD and in 23 patients with OSAS with IHD. Baseline and end-of-treatment levels of homocysteine, leptin, C-reactive protein (CRP), fibrinogen, lipids parameters and visceral obesity related parameters were determined. Results: No significant changes in the levels of homocysteine, leptin, fibrinogen or CRP in either of the study groups were observed at the end of the treatment. No changes in lipid parameters or the degree of obesity were observed in the OSAS with IHD group. A significant reduction in total and LDL-cholesterol levels were observed in the OSAS without IHD group (202.5 ± 38.5 mg/dl v. 186.7 ± 33.5 mg/dl, p = 0.001 and 127.3 ± 32.9 mg/dl v. 116.4 ± 26.9 mg/dl, p = 0.02, respectively). There were no significant changes in body mass index (30.4 ± 3.8 kg/m² v. 30.6 ± 3.6 kg/m², p = 0.5) or the amount of visceral fat, as measured by waist circumference (108.5 ± 8.0 cm v. 107.0 ± 7.5 cm, p = 0.09) and waist-to-hip ratio (1.03 ± 0.04 v. 1.01 ± 0.03, p = 0.07). Conclusions: Three-month CPAP treatment did not affect the levels of homocysteine or leptin in patients with OSAS, although there was a significant reduction in lipid parameters in patients with OSAS without co-existent IHD, which confirms the beneficial effect of this method of treatment on the risk factors of IHD. Full article

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Open AccessEditorial

Non-Invasive Ventilation in Poland—For Whom the Bell Tolls?

by Jacek Nasiłowski and Jan Zieliński

Adv. Respir. Med. 2011, 79(3), 170-172; https://doi.org/10.5603/ARM.27654 - 21 Apr 2011

Viewed by 274

Abstract

In the 17th century the ringing of a church bell at an unusual time always signified some extraordinary event, summoning the entire local community to take action [...] Full article

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Open AccessEditorial

Recurrent Pericarditis—Diagnostic and Therapeutic Implications

by Monika Szturmowicz

Adv. Respir. Med. 2011, 79(3), 167-169; https://doi.org/10.5603/ARM.27653 - 21 Apr 2011

Viewed by 229

Abstract

Exudative pericarditis is the cause of 5% of admissions to accidents and emergency departments with chest pain being the presenting complaint in most of these cases [...] Full article

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Open AccessEditorial

The Lungs Are Not a Lonely Island—A Current View on Respiratory Diseases

by Joanna Chorostowska-Wynimko

Adv. Respir. Med. 2011, 79(3), 165-166; https://doi.org/10.5603/ARM.27652 - 21 Apr 2011

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Abstract

Studies investigating the mechanisms responsible for the development and progression of respiratory diseases conducted in recent years but also the state-of-the-art and increasingly sophisticated technologies that successfully allow us to gain an insight into the structure of the lungs and the microcosm of [...] Read more.

Studies investigating the mechanisms responsible for the development and progression of respiratory diseases conducted in recent years but also the state-of-the-art and increasingly sophisticated technologies that successfully allow us to gain an insight into the structure of the lungs and the microcosm of cells and tissues have become a driving force for the key changes in contemporary opinions on the processes which eventually shape the clinical picture and complaints that prompt the patient to seek a pulmonologist consultation [...] Full article

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Adv. Respir. Med., Volume 79, Issue 3 (April 2011) – 15 articles , Pages 165-258

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