Advances in Respiratory Medicine

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Open AccessLetter

Czy Pierścień Naczyniowy Był Przyczyną Duszności?

by Tadeusz M. Zielonka

Adv. Respir. Med. 2015, 83(2), 171-174; https://doi.org/10.5603/PiAP.2015.0027 - 10 Mar 2015

Viewed by 245

Ostatnio w “Pneumonologii i Alergologii Polskiej” ukazał się artykuł zatytułowany “Ring naczyniowy–rzadka przyczyna duszności u pacjenta w podeszłym wieku” [...] Full article

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Open AccessReview

Cardiovascular Safety of Two Bronchodilators’ Fixed-Dose Combination: Indacaterol and Glycopyrronium

by Jerzy Kozielski

Adv. Respir. Med. 2015, 83(2), 164-170; https://doi.org/10.5603/PiAP.2015.0026 - 10 Mar 2015

Cited by 2 | Viewed by 312

Abstract

Combination therapy with anticholinergics and β2-agonists should be used in COPD patients after failure of previous monotherapy with one of these drugs. Synergistic effect of both mechanisms of bronchodilation can maximize the efficacy of separately administered drugs. The effectiveness of the combination [...] Read more.

Combination therapy with anticholinergics and β2-agonists should be used in COPD patients after failure of previous monotherapy with one of these drugs. Synergistic effect of both mechanisms of bronchodilation can maximize the efficacy of separately administered drugs. The effectiveness of the combination of LABA and LAMA is already confirmed, nevertheless the question about the safety profile of this therapy is still remaining, particularly with regard to the cardiovascular system. The paper discusses the overall safety profile of the combined preparation compare to placebo as well as the active comparators, especially the cardiovascular safety of fixed-dose formulation. Based on the data it has been demonstrated, that the combination of two ultra -long-acting bronchodilators with different complementary mechanisms of action increases the effectiveness of COPD therapy without affecting the safety. Full article

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Open AccessReview

Thixotropy of Nasal Medications—Its Role in Clinical Practice

by Maciej Koźmiński and Maciej Kupczyk

Adv. Respir. Med. 2015, 83(2), 157-163; https://doi.org/10.5603/PiAP.2015.0025 - 10 Mar 2015

Cited by 2 | Viewed by 373

Abstract

Optimal medication should be characterized by good bioavailability, rapid onset of action, a long period of therapeutic activity, with preserved high safety profile and the lowest possible risk of side effects. Therefore, in addition to traditional drug administration routes, such as oral or [...] Read more.

Optimal medication should be characterized by good bioavailability, rapid onset of action, a long period of therapeutic activity, with preserved high safety profile and the lowest possible risk of side effects. Therefore, in addition to traditional drug administration routes, such as oral or injection, novel methods for drug applications, for example in the form of a nasal application have been developed. Because of the anatomy of the nose, drugs administered intranasally can be rapidly absorbed and, depending on the nature of the active substance, may act locally on the mucosa or can have a significant systemic effect. Most nasal drugs are developed in the form of solution administered as aerosol. In some cases, these solutions are thixotropic. They are able to change their physical properties under agitation to facilitate supply of the drug and its adhesion to the mucosa. Intranasal corticosteroids represent the mainstay of treatment for any form of chronic allergic rhinitis (AR) and moderate to severe periodic AR, especially with impaired nasal obstruction and frequent occurrence of symptoms. The article discusses the rheological properties of intranasal corticosteroids, their role in therapy and efficacy in the everyday clinical practice. Full article

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Open AccessCase Report

Pulmonary Artery Stenosis Due to Embryonal Carcinoma with Primary Mediastinal Location

by Franciszek Grzegorczyk, Małgorzata Dybowska, Paweł Kuca, Cezary Czajka, Janusz Burakowski, Renata Langfort, Tadeusz Orłowski and Witold Tomkowski

Adv. Respir. Med. 2015, 83(2), 151-156; https://doi.org/10.5603/PiAP.2015.0024 - 10 Mar 2015

Cited by 1 | Viewed by 315

Abstract

A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found. Echocardiography revealed narrowing of pulmonary artery with high pressure gradient. Computed tomography of the chest revealed the [...] Read more.

A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found. Echocardiography revealed narrowing of pulmonary artery with high pressure gradient. Computed tomography of the chest revealed the presence of large tumour localised in the upper anterior mediastinum. Due to the risk of total closure of the pulmonary artery, interventional mediastinotomy was performed and diagnosis of carcinoma embryonale was established. Subsequent chemotherapy (BEP regimen) has brought regression of tumour and significant improvement in haemodynamic parameters (relief of pressure gradient in pulmonary artery). During the second surgery, the resection of all accessible tumour mass together with marginal resection of the right upper lobe was performed. No signs of cardiac or great vessels infiltration was found. Histopathologic examination revealed the necrotic masses and neoplastic foci diagnosed as teratoma immaturum. In a four-month follow-up the patient’s condition remained good. The patient is still under the care of both oncological and cardiological specialists. Thus far he has not required further chemotherapy. Holter ECG monitoring revealed no arrhythmia, but the patient is still treated with mexiletine. The patient is planning to return to work. Full article

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Open AccessCase Report

Allergic Bronchopulmonary Aspergillosis Presenting as Lobar or Total Lung Collapse

by Raj Kumar, Mohammed Noufal Poongadan and Mandeep Singh

Adv. Respir. Med. 2015, 83(2), 144-150; https://doi.org/10.5603/PiAP.2015.0023 - 10 Mar 2015

Cited by 10 | Viewed by 378

Abstract

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a T-helper cell 2 (Th2) mediated hypersensitive lung disorder in response to Aspergillus that usually affects asthmatic and cystic fibrosis (CF) patients. ABPA rarely presents as lung collapse and such kind of presentation is very rare in [...] Read more.

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a T-helper cell 2 (Th2) mediated hypersensitive lung disorder in response to Aspergillus that usually affects asthmatic and cystic fibrosis (CF) patients. ABPA rarely presents as lung collapse and such kind of presentation is very rare in non asthmatic patients. We are presenting a series of three cases in which ABPA presented as lobar or total lung collapse. ABPA presenting as opaque hemithorax is a rarity with only a few of them reported in the literature. Case series—the first case described is a 45-year non-smoker with history suggestive of bronchial asthma and on chest radiological examination was found to have opaque right hemithorax. The second case is of 62-year non-smoker non-asthmatic patient who presented to us as left lung collapse. The last case is of middle lobe collapse in asthmatic male. All cases ultimately were proved to be having ABPA and after treatment showed marked clinical and radiological improvement. Conclusions: The present case series highlights the need for aggressive approach in diagnosing this treatable condition in cases presenting as segmental or total lung collapse. The condition has a good prognosis if detected early. Full article

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Open AccessCase Report

“Saw-Tooth Sign” in Upper Airway Disorders—A Case Report

by Sonu Sahni, Alexander Blood, Santhosh Paulus and Arunabh Talwar

Adv. Respir. Med. 2015, 83(2), 140-143; https://doi.org/10.5603/PiAP.2015.0022 - 10 Mar 2015

Cited by 1 | Viewed by 290

Abstract

Spirometry flow-volume loop measurement is the screening test of choice to rule out obstructive lung diseases. Flow oscillations occasionally seen on flow volume loops, referred to as a “saw-tooth” sign, are thought to be due to an upper airway obstructive processes associated with [...] Read more.

Spirometry flow-volume loop measurement is the screening test of choice to rule out obstructive lung diseases. Flow oscillations occasionally seen on flow volume loops, referred to as a “saw-tooth” sign, are thought to be due to an upper airway obstructive processes associated with upper airway collapsibility. Widely described in obstructive sleep apnea syndrome, flow oscillations have also been linked to many other upper airway pathologies. The mechanism by which flow oscillations occur is centered on the inspiratory and expiratory flow of air. It has been theorized that the mechanism of flow oscillations result from rapid intermittent changes in driving pressure or airway resistance. Since visual inspection of the flow volume loop can reveal presence of flow oscillations clinicians should be aware of this phenomenon and the presence of flow loop oscillations should clue physicians to rule out upper airway pathology. Full article

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Open AccessCase Report

Tracheobronchopathia Osteochondroplastica—Case Report and Literature Review

by Maria Porzezińska, Alicja Janowicz, Piotr Janowiak, Bogumiła Cynowska, Adam Sternau, Rafał Pęksa, Jan Marek Słomiński and Ewa Jassem

Adv. Respir. Med. 2015, 83(2), 135-139; https://doi.org/10.5603/PiAP.2015.0021 - 10 Mar 2015

Cited by 2 | Viewed by 316

Abstract

Tracheobronchopathia osteochondroplastica (TBO) is a rare disease of unknown etiology characterised by a formation of multiple, cartilaginous and osteocartilaginous submucosal nodules in the trachea and major bronchi. The course of the disease is usually benign but the narrowing of the respiratory tract can [...] Read more.

Tracheobronchopathia osteochondroplastica (TBO) is a rare disease of unknown etiology characterised by a formation of multiple, cartilaginous and osteocartilaginous submucosal nodules in the trachea and major bronchi. The course of the disease is usually benign but the narrowing of the respiratory tract can lead to chronic non-specific clinical symptoms. We present a case of a 50-year old man with chronic exertional dyspnoea and stenosis of the trachea visible in imaging tests, in whom the symptoms were caused by TBO. Full article

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Open AccessArticle

Interferon Gamma Release Assays Based on M. tuberculosis-specific Antigens in Sarcoidosis Patients

by Anna Kempisty, Beata Białas-Chromiec, Dagmara Borkowska and Jan Kuś

Adv. Respir. Med. 2015, 83(2), 126-134; https://doi.org/10.5603/PiAP.2015.0020 - 10 Mar 2015

Cited by 7 | Viewed by 341

Abstract

Introduction: This study is a part of the project on interferon gamma release assays performed in the group of untreated sarcoidosis patients formerly BCG vaccinated. The aim of the study was to assess the rate of positive commercial interferon γ release assays [...] Read more.

Introduction: This study is a part of the project on interferon gamma release assays performed in the group of untreated sarcoidosis patients formerly BCG vaccinated. The aim of the study was to assess the rate of positive commercial interferon γ release assays in sarcoidosis patients. We discussed the results in the context of hypothesis that M. tuberculosis antigens may play a role in the pathogenesis of sarcoidosis. Material and Methods: 151 patients, mean age 38 ± 10.3, treatment naive, with newly diagnosed pulmonary sarcoidosis were enrolled into the study. All participants underwent QFT-GIT assay. A subgroup of 81 patients underwent also T-SPOT.TB assay. Results: QFT-GIT was positive in 7/151. T-SPOT.TB was positive in 3/81. There were no indeterminate results in both IGRAs. There was no statistically significant relationship between IGRAs results and sarcoidosis parameters such as the radiologic stage, disease duration and the presence of Löfgren’s syndrome. Conclusions: In sarcoidosis patients formerly BCG vaccinated, positive rate of IGRAs was 4.6% for QFT-GIT and 3.7% for T-SPOT.TB. We did not find the influence of the selected parameters of sarcoidosis on IGRAs results. Full article

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Open AccessArticle

Correlation between Hyperinflation Defined as an Elevated RV/TLC Ratio and Body Composition and Cytokine Profile in Patients with Chronic Obstructive Pulmonary Disease

by Renata Rubinsztajn, Tadeusz Przybyłowski, Marta Maskey-Warzęchowska, Magdalena Paplińska-Goryca, Krzysztof Karwat, Patrycja Nejman-Gryz and Ryszarda Chazan

Adv. Respir. Med. 2015, 83(2), 120-125; https://doi.org/10.5603/PiAP.2015.0019 - 10 Mar 2015

Cited by 8 | Viewed by 429

Abstract

Introduction: Body composition is an important prognostic factor in patients with COPD. The decrease in fat free mass (FFM), muscle mass (MM) and increase in visceral fat is associated with an elevated secretion of cytokines which promote systemic inflammation. The aim of the [...] Read more.

Introduction: Body composition is an important prognostic factor in patients with COPD. The decrease in fat free mass (FFM), muscle mass (MM) and increase in visceral fat is associated with an elevated secretion of cytokines which promote systemic inflammation. The aim of the study was to evaluate body composition and the cytokine profile in patients with COPD in relation with the presence of hyperinflation. Material and Methods: The study group consisted of 149 patients (61F, 88M) with stable COPD in all stages of severity aged 68 ± 8.8 yrs. All the patients underwent spirometry and bodypletysmography with bronchial reversibility testing. Hyperinflation was defined as RV%TLC > 48% and > 126% predicted. Body composition was analyzed by bioimpedance. The following serum inflammatory markers were evaluated: C-reactive protein, IL-6, IL-8, TNF-a, CC16, adiponectin and resistin. Results: Hyperinflation was found in 96 patients (group A) and it was more frequent in women than men (49/61 vs. 47/88, p < 0.001). BMI and age in this group were comparable to those in patients without hyperinflation (group B). Patients with hyperinflation have lover FFM, FFM index, MM and MM index and total body water and higher fat mass and fat mass index. We found significantly higher serum concentrations of inflammatory markers in group A: IL-6 – 6.4 ± 10.9 vs. 3.6 ± 4.2 pg/ml, resistin – 9.3 ± 4.2 vs. 7.6 ± 2.4 ng/ml, CRP 4.1 ± 2.3 vs. 2.9 ± 2.1 mg/l, respectively. Conclusions: Patients with hyperinflation have a lower FFMI, TBW and MMI and a higher proportion of fat tissue. Hyperinflation is associated with elevated concentrations of inflammatory markers what may be associated with more severe disease. Body compositions abnormality and higher activity of systemic inflammation could therefore be a negative prognostic factor in COPD patients. Full article

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Open AccessArticle

Lung Cancer in Podkarpackie Region in the Years 2002−2011

by Monika Grądalska-Lampart, Bożenna Karczmarek-Borowska and Aneta Urszula Radziszewska

Adv. Respir. Med. 2015, 83(2), 109-119; https://doi.org/10.5603/PiAP.2015.0018 - 10 Mar 2015

Cited by 1 | Viewed by 299

Abstract

Introduction: Lung cancer is one of the greatest challenges for modern medicine and in Poland the incidence and mortality rate are one of the highest. The aim of the study was to assess trends in the incidence and mortality rate lung cancer [...] Read more.

Introduction: Lung cancer is one of the greatest challenges for modern medicine and in Poland the incidence and mortality rate are one of the highest. The aim of the study was to assess trends in the incidence and mortality rate lung cancer in the Podkarpackie province in the years 2002−2011. Material and Methods: 9993 cases (8018 men and 1975 women) and 8782 deaths (7211 men and 1571 women) of lung cancer were analyzed. Crude rate and standardized coefficients of incidence and mortality as well as stratum weight, and cumulative risk of incidence and mortality were calculated. Results: In 2011, in Podkarpackie province a decrease number of lung cancer cases in men was observed compared to 2002 amounting to 195 case, but in women, an increase of 39 new cases was noted. Incidence rates in men were in the range of 65.8−93.1/100,000, while in women they ranged 9.6−35.2/100,000. Mortality rates for males ranged from 59.2 to 82.8/100,000, and in women from 6.1 to 29.0/100,000. Considerable diversity in incidence and mortality in different districts of the province of Podkarpackie was observed. Conclusions: In the years 2002−2011 the values of incidence and mortality rates for men in Podkarpackie province were lower than the rates for Poland, in case of women the same rates for Podkarpackie were almost two times lower than the rates for Poland. In the years 2002−2011 the highest value of incidence and mortality rate out of all districts of Podkarpackie Province was observed in the district Lubaczów for men and in Przemyśl in case of women. Full article

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Open AccessArticle

Occurrence of Alert Pathogens in Patients Hospitalised in the Department of Lung Diseases

by Michał Zieliński, Szymon Dworniczak, Anna Dworniczak and Jerzy Kozielski

Adv. Respir. Med. 2015, 83(2), 101-108; https://doi.org/10.5603/PiAP.2015.0017 - 10 Mar 2015

Cited by 2 | Viewed by 300

Abstract

Introduction: Infections caused by multiple drug-resistant pathogens represent an increasingly often encountered challenge in clinical practice. The problem particularly applies to patients with chronic lung diseases resulting in multiple hospitalisations. The aim of this paper was to analyse the incidence of alert [...] Read more.

Introduction: Infections caused by multiple drug-resistant pathogens represent an increasingly often encountered challenge in clinical practice. The problem particularly applies to patients with chronic lung diseases resulting in multiple hospitalisations. The aim of this paper was to analyse the incidence of alert pathogens isolated from patients hospitalised in the department of lung diseases, who were divided into three groups: patients qualified for lung transplantation, patients treated for neoplastic diseases and patients with chronic lung diseases. Materials and methods: Analysis involved microbiological test results of 3950 samples obtained from 3521 patients divided into: 200 patients being qualified for lung transplantation, 1292 patients treated for neoplastic diseases and 2029 patients with chronic lung diseases. Results: Infection with alert pathogen was found in 155 of 3521 patients (4.4%). Most often isolated infectious agent was P. aeruginosa, which accounted for 27% of infections. Other pathogens were as follows A. baumanii ESBL(−) (13%), S. pneumoniae (12%), E. cloacae ESBL(+) (10%), K. pneumoniae ESBL(+) (10%), S. aureus MRSA (8%), E. faecalis (7%), E. coli ESBL(+) (6%), S. maltophilia ESBL(+) (5%) and E. kobei ESBL(+) (2%). Alert pathogens were found in 31 (15%) of 200 patients being qualified for lung transplantation, 89 (4.4%) of 2029 patients with chronic lung diseases and 35 (2.7%) of 1292 patients treated for neoplastic diseases. Difference between infection frequency in patients being qualified for lung transplantation and the remaining groups was statistically significant (p < 0.01). P. aeruginosa infection was the most frequent in all groups. It constituted 35% in patients being qualified for lung transplantation, 29% in patients treated for neoplastic diseases and 22% in patients with chronic lung diseases. Conclusions: Infections caused by alert pathogens were found in more than 4% of patients hospitalised in the department of lung diseases between 2007 and 2011. Their frequency was significantly higher in patients being qualified for lung transplantation than in other analysed groups. In all examined groups the most frequently isolated bacteria was P. aeruginosa (27% of all isolates). Full article

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Open AccessEditorial

Lung Cancer: Our Blood, Sweat and Fears

by Joanna Chorostowska-Wynimko

Adv. Respir. Med. 2015, 83(2), 98-100; https://doi.org/10.5603/PiAP.2015.0016 - 10 Mar 2015

Viewed by 281

Abstract

Lung cancer has been the most common cancer in the world for many years now [...] Full article

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Open AccessEditorial

The IGRA Tests: Where Are We Now?

by Sylwia Kwiatkowska

Adv. Respir. Med. 2015, 83(2), 95-97; https://doi.org/10.5603/PiAP.2015.0015 - 10 Mar 2015

Cited by 3 | Viewed by 275

Abstract

In the early 1990s, WHO declared TB a global emergency [...] Full article

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Adv. Respir. Med., Volume 83, Issue 2 (March 2015) – 13 articles , Pages 95-174

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