Advances in Respiratory Medicine

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Open AccessReview

Arterial and Venous Thromboembolism in Chronic Obstructive Pulmonary Disease: From Pathogenic Mechanisms to Prevention and Treatment

by Filip Mejza, Bernd Lamprecht, Ewa Niżankowska-Mogilnicka and Anetta Undas

Adv. Respir. Med. 2015, 83(6), 485-494; https://doi.org/10.5603/PiAP.2015.0078 - 10 Nov 2015

Cited by 11 | Viewed by 403

Abstract

Chronic obstructive pulmonary disease (COPD) affects approximately 10% of adults older than 40 years and is an important causes of disability and death in elderly subjects. A large proportion of COPD patients suffer from cardiovascular comorbidities. Thromboembolic events contribute considerably to morbidity and [...] Read more.

Chronic obstructive pulmonary disease (COPD) affects approximately 10% of adults older than 40 years and is an important causes of disability and death in elderly subjects. A large proportion of COPD patients suffer from cardiovascular comorbidities. Thromboembolic events contribute considerably to morbidity and mortality in these subjects. This review summarizes the current evidence regarding the association of COPD with increased thromboembolic risk. We discuss multiple mechanisms potentially linking these conditions and available pharmacological interventions reducing the risk of thrombotic arterial and venous events with special attention paid to new oral anticoagulants. Full article

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Open AccessReview

Systematic Review of Telemonitoring in COPD: An Update

by Claudio Pedone and Diana Lelli

Adv. Respir. Med. 2015, 83(6), 476-484; https://doi.org/10.5603/PiAP.2015.0077 - 10 Nov 2015

Cited by 37 | Viewed by 758

Abstract

Telemedicine may support individual care plans in people with chronic obstructive pulmonary disease (COPD), potentially improving the clinical outcomes. To-date there is no clear evidence of benefit of telemedicine in this patients. The aim of this study is to provide an update on [...] Read more.

Telemedicine may support individual care plans in people with chronic obstructive pulmonary disease (COPD), potentially improving the clinical outcomes. To-date there is no clear evidence of benefit of telemedicine in this patients. The aim of this study is to provide an update on the effectiveness of telemedicine in reducing adverse clinical outcomes. We searched the Pubmed database for articles published between January 2005 and December 2014. We included only randomized controlled trials exclusively focused on patients with COPD and with a telemedicine intervention arm. Evaluated outcomes were number of exacerbations, ER visits, COPD hospitalizations, length of stay and death. We eventually included 12 randomized controlled trials. Most of them had a small sample size and was of poor quality, with a wide heterogeneity in the parameters and technologies used. Most studies reported a positive effect of telemonitoring on hospitalization for any cause, with risk reductions between 10% and 63%; however only three studies reached statistical significance. The same trend was observed for COPD-related hospital admission and ER visits. No significative effects of telemedicine was evidenced in reducing length of hospital stay, improving quality of life and reducing deaths. In conclusion, our study confirms that the available evidence on the effectiveness of telemedicine in COPD does not allow to draw definite conclusions; most evidence suggests a positive effect of telemonitoring on hospital admissions and ER visits. More trials with adequate sample size and with adequate consideration of background clinical services are needed to definitively establish its effectiveness. Full article

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Open AccessReview

Selected Molecular Events in the Pathogenesis of Sarcoidosis—Recent Advances

by Justyna Kiszałkiewicz, Wojciech Piotrowski and Ewa Brzeziańska-Lasota

Adv. Respir. Med. 2015, 83(6), 462-475; https://doi.org/10.5603/PiAP.2015.0076 - 10 Nov 2015

Cited by 6 | Viewed by 413

Abstract

Sarcoidosis is an orphan inflammatory disorder that can virtually affect any organ or system in the body, although the lungs and lymph nodes are most frequently involved. Sarcoidosis is believed to derive from an interaction between environmental and genetic agents. Many studies emphasize [...] Read more.

Sarcoidosis is an orphan inflammatory disorder that can virtually affect any organ or system in the body, although the lungs and lymph nodes are most frequently involved. Sarcoidosis is believed to derive from an interaction between environmental and genetic agents. Many studies emphasize a strong association between certain human leukocyte antigen (HLA) alleles and sarcoidosis susceptibility. Several new insights have allowed the further evaluation of other candidate genes with a potential function in the immunopathogenesis of sarcoidosis. This review summarizes recent advances in the identification of novel molecular markers that may play a role in different stages of disease, such as the acute phase of inflammation, granuloma formation and fibrosis. Furthermore, this article elucidates the role of both TGF-β/Smad and (HIF)-1a-VEGF-ING-4 signaling pathways in the development of sarcoidosis. The potential epigenetic regulation of the processes occurring in sarcoidosis by miRNA is also discussed. Full article

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Open AccessCase Report

Left Brachiocephalic Vein Stenosis and Infectious Aortitis: Two Unusual Causes of Ortner’s Syndrome

by Marta Maskey-Warzęchowska, Marta Dąbrowska, Rafał Krenke, Anna Domeracka-Kołodziej, Małgorzata Żukowska and Ryszarda Chazan

Adv. Respir. Med. 2015, 83(6), 457-461; https://doi.org/10.5603/PiAP.2015.0075 - 10 Nov 2015

Cited by 1 | Viewed by 319

Abstract

Ortner’s syndrome (also known as cardiovocal syndrome) is defined as hoarseness due to compression of the left recurrent laryngeal nerve by an enlarged left atrium or enlarged thoracic vessels. We describe two cases of Ortner’s syndrome with an unusual underlying vascular pathology. In [...] Read more.

Ortner’s syndrome (also known as cardiovocal syndrome) is defined as hoarseness due to compression of the left recurrent laryngeal nerve by an enlarged left atrium or enlarged thoracic vessels. We describe two cases of Ortner’s syndrome with an unusual underlying vascular pathology. In the first patient, Ortner’s syndrome was a consequence of left brachiocephalic vein stenosis resulting in collateral circulation filling the aorto-pulmonary window. The second patient developed a thoracic aortic aneurysm due infectious aortitis. Both patients required careful scrutiny in differential diagnosis because of their complex past medical history and concomitant diseases. Full article

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Open AccessCase Report

Atypical Image of Pulmonary Alveolar Proteinosis—A Case Report

by Justyna Fijołek, Elżbieta Wiatr, Lucyna Opoka, Piotr Rudziński, Małgorzata Nierebińska, Małgorzata Szołkowska and Kazimierz Roszkowski-Śliż

Adv. Respir. Med. 2015, 83(6), 453-456; https://doi.org/10.5603/PiAP.2015.0074 - 10 Nov 2015

Cited by 1 | Viewed by 556

Abstract

Pulmonary alveolar proteinosis is a very rare interstitial lung disease caused by abnormal intra-alveolar surfactant accumulation. Usually, it appears as a “crazy-paving” pattern on high-resolution computed tomography. The image is so typical, that together with the characteristic bronchoalveolar lavage examination with presence of [...] Read more.

Pulmonary alveolar proteinosis is a very rare interstitial lung disease caused by abnormal intra-alveolar surfactant accumulation. Usually, it appears as a “crazy-paving” pattern on high-resolution computed tomography. The image is so typical, that together with the characteristic bronchoalveolar lavage examination with presence of Periodic Acid Schiff positive substance is sufficient for establishing diagnosis, without histological confirmation. We present the case of the young woman with severe dyspnoea suspected of acute hypersensitivity pneumonia. The computed tomography showed numerous intralobular nodules uniformly distributed troughout the lungs. Treatment by corticosteroids had no clinical effect and next computed tomography showed progression. Despite the high risk of complications (patient had a respiratory failure), a surgical lung biopsy was performed and the histopathological diagnosis of pulmonary alveolar proteinosis was made. The whole lung lavage procedure performed twice caused regression of radiological lesions and respiratory failure. Full article

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Open AccessArticle

Non-High Risk PE in the Patients with Acute or Exacerbated Respiratory Disease: The Value of the Algorithm Based on D-Dimer Evaluation and Revised Geneva Score

by Monika Szturmowicz, Aneta Kacprzak, Dorota Wyrostkiewicz, Katarzyna Lewandowska, Małgorzata Jędrych, Iwona Bartoszuk, Jarosław Kober, Barbara Burakowska, Inga Barańska, Grzegorz Małek and Jan Kuś

Adv. Respir. Med. 2015, 83(6), 445-452; https://doi.org/10.5603/PiAP.2015.0073 - 10 Nov 2015

Cited by 4 | Viewed by 362

Abstract

Introduction: The diagnostic algorithm of non-high risk pulmonary embolism (PE) is based on probability scoring systems and plasma D-dimer (DD) assessment. The aim of the present study was to investigate the efficacy of Revised Geneva Scoring (RGS) and DD testing for the [...] Read more.

Introduction: The diagnostic algorithm of non-high risk pulmonary embolism (PE) is based on probability scoring systems and plasma D-dimer (DD) assessment. The aim of the present study was to investigate the efficacy of Revised Geneva Scoring (RGS) and DD testing for the excluding of non-high risk PE, in the patients admitted to the hospital due to acute respiratory diseases. Materials and Methods: The consecutive patients, above 18 years of age, referred to the department of lung diseases, entered the study. The exclusion criteria were: the pregnancy and the suspicion of high risk PE. Plasma DD was measured with quick ELISA test, VIDAS D-dimer New, bioMerieux, France. Multislice computed tomography angiography was performed in all of the patients. Results: 153 patients, median age 65 (19−88) years entered the study. The probability of PE was: low—in 58 patients (38%), intermediate—in 90 (59%), high—in 5 (3%). DD < 500 ng/mL was found in 12% of patients with low and intermediate probability of PE. PE was recognized in 10 out of 153 patients (7%). None of the patients with DD < 500 ng/mL was diagnosed with PE (NPV 100%). Median DD value was significantly higher in PE patients comparing to non-PE (4500 ng/mL and 1356 ng/mL respectively, p = 0.006). Conclusion: In the group of the patients with acute respiratory symptoms, low or intermediate clinical probability scoring combined with normal DD had a high NPV in excluding PE. Nevertheless, such approach was not very effective, as the increased DD was noted in 88% of the examined population. Full article

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Open AccessArticle

Adherence to Treatment in Asthma and COPD Patients in Their Doctors’ Assessment

by Przemysław Kardas, Paweł Lewek and Marcin Strzondała

Adv. Respir. Med. 2015, 83(6), 436-444; https://doi.org/10.5603/PiAP.2015.0072 - 10 Nov 2015

Cited by 10 | Viewed by 482

Abstract

Introduction: Adherence to therapy is one of the basic preconditions of successful treatment of asthma and COPD. Unfortunately, many patients take their medication incorrectly. The aim of this study was to assess doctors’ knowledge of this phenomenon, including interventions able to improve [...] Read more.

Introduction: Adherence to therapy is one of the basic preconditions of successful treatment of asthma and COPD. Unfortunately, many patients take their medication incorrectly. The aim of this study was to assess doctors’ knowledge of this phenomenon, including interventions able to improve patient adherence. Materials and Methods: It was a questionnaire-based survey conducted among convenience sample of Polish physicians treating asthma and COPD. Results: One hundred and sixty one physicians, mainly specialists in allergology (44.1%) and pulmonology (37.3%) took part in the study. According to participants, asthma patients took on average 65.4 ± 17.1% of doses of prescribed drugs, whereas COPD patients—61.6 ± 24.2%. Over half of respondents claimed that during the first year of treatment, no more than 20% of asthma and COPD patients discontinue their therapy. Survey participants pointed at patients discourage (41.6%) and lack of knowledge about disease (19.3%) as the main reasons for discontinuation of therapy. Almost 2/3 of participants (65.8%) claimed that they could recognize non-adherence in their patients. Prescribing combination inhaled drugs (72.7%), drugs with infrequent dosing (63.4%), and affordable ones (53.4%) were the most common interventions aimed at improving adherence provided by respondents. Conclusions: Survey participants were aware of the phenomenon of non-adherence in patients with asthma and COPD, but underestimated the real prevalence and seriousness of it. They also overestimated their ability to recognise non-adherence in their patients. Therefore, not necessarily they may obtain better adherence in their asthma and COPD patients. These results point at the issues which should be addressed in pre- and postgraduate education of physicians treating chronic airways conditions. Full article

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Open AccessArticle

Pilot Program on Distance Training in Spirometry Testing—The Technology Feasibility Study

by Adam Nowiński, Emil Romański, Przemysław Bieleń, Michał Bednarek, Elżbieta Puścińska, Anna Goljan-Geremek, Robert Pływaczewski and Paweł Śliwinski

Adv. Respir. Med. 2015, 83(6), 431-435; https://doi.org/10.5603/PiAP.2015.0071 - 10 Nov 2015

Cited by 2 | Viewed by 294

Abstract

Introduction: Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. Materials and Methods: A spirometry counseling network of outpatients clinics [...] Read more.

Introduction: Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. Materials and Methods: A spirometry counseling network of outpatients clinics was created in Poland using portable spirometer Spirotel. The spirometry data were transferred to counseling centre once a week. The tests sent to the counseling centre were analyzed by doctors experienced in the analysis of spirometric data. In justified cases they sent their remarks concerning performed tests to the centres via e-mail. Results: We received 878 records of spirometry tests in total. Data transmission via the telephone was 100% effective. The quality of spirometry tests performed by outpatients clinics was variable. Conclusions: The use of spirometers with data transfer for training purposes seems to be advisable. There is a need to proper face-to-face training of spirometry operators before an implementation of any telemedicine technology Full article

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Open AccessArticle

Dynamics of Body Composition in Male Patients during Chronic Obstructive Pulmonary Disease (COPD) Development

by Aliaksandr Eduard Makarevich and Sviatlana Lemiasheuskaya

Adv. Respir. Med. 2015, 83(6), 424-430; https://doi.org/10.5603/PiAP.2015.0070 - 10 Nov 2015

Cited by 3 | Viewed by 337

Abstract

Introduction: The various distribution of fat mass (FM) and lean mass (LM) during COPD development is not yet researched. Materials and Methods: 82 male patients (40–67 years) with acute exacerbation of COPD and 19 comparable healthy males (the control group) were [...] Read more.

Introduction: The various distribution of fat mass (FM) and lean mass (LM) during COPD development is not yet researched. Materials and Methods: 82 male patients (40–67 years) with acute exacerbation of COPD and 19 comparable healthy males (the control group) were examined by dual-energy X-ray absorptiometry. The patients were divided into 3 groups according to COPD severity: 1^st—19 (GOLD I stage); 2^nd—43 (GOLD II) and 3^rd—20 (GOLD III). Results: The patients of 3^rd group had lower indices of FM, LM, bone mineral component (BMC) vs. the control and 1^st, 2^nd groups. A significant increase in FM share was noted in android and gynoid regions, trunk, legs and arms in 2^nd groups vs. the control with the decline of these parameters in the 3^rd group below the control level. A greater proportion of FM in 1^st and 2^nd groups was distributed in android and trunk regions vs. the control. TNF-α and leptin levels were significantly increased by 12%, 15% 17% and by 18%, 75%, 79% respectively in 1^st, 2^nd, 3^rd groups vs. the control, while free testosterone level was lower in these groups vs. the control (by 28%, 30% and 47% respectively; p < 0.05). Conclusions: Body mass index (BMI) was within the control range in mild-moderate COPD patients in spite of LM, FM and BMC changes. The level of LM and BMC was decreased during COPD progression, while FM was increased in mild-moderate COPD and then it was decreased in severe COPD. Full article

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Open AccessArticle

The Influence of Lung Volume Reduction with Intrabronchial Valves on the Quality of Life of Patients with Heterogeneous Emphysema—A Prospective Study

by Sylwia Szlubowska, Joanna Zalewska-Puchała, Anna Majda, Piotr Kocoń, Jerzy Soja, Maciej Gnass, Ewa Pasko, Adam Ćmiel, Artur Szlubowski and Jarosław Kużdżał

Adv. Respir. Med. 2015, 83(6), 418-423; https://doi.org/10.5603/PiAP.2015.0069 - 10 Nov 2015

Cited by 1 | Viewed by 261

Abstract

Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used—bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial [...] Read more.

Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used—bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Materials and Methods: From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p < 0.001) and in domains and the differences were for: “symptoms” (–8.5; p < 0.001), “activity” (–13.9; p < 0.001) and “influence on life”(–13.5; p < 0.002). Conclusions: The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment. Full article

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Open AccessEditorial

Change is in the Air: Bronchial Valves to Improve Quality of Life in Heterogeneous Emphysema

by Rafal Krenke

Adv. Respir. Med. 2015, 83(6), 415-417; https://doi.org/10.5603/PiAP.2015.0068 - 10 Nov 2015

Viewed by 251

Abstract

Chronic obstructive lung disease (COPD) is a major healthcare problem [...] Full article

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Open AccessEditorial

Telemedicine for the Management of COPD—Near Future or a Hazy Idea?

by Wojciech J. Piotrowski and Paweł Górski

Adv. Respir. Med. 2015, 83(6), 413-414; https://doi.org/10.5603/PiAP.2015.0067 - 10 Nov 2015

Viewed by 269

Abstract

In this issue of PiAP we can read the invited systematic review on telemonitoring in COPD by Claudio Pedone and Diana Lelli from Università Campus Bio-Medico di Roma [...] Full article

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Adv. Respir. Med., Volume 83, Issue 6 (November 2015) – 12 articles , Pages 413-494

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