Advances in Respiratory Medicine

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Open AccessCommunication

Using a CD45^dim/CD123^bright/HLA-DR^neg Phenotyping Protocol to Gate Basophils in FC for Airway Allergy. CD123 Does Not Decrease

by Salvatore Chirumbolo, Geir Bjørklund and Antonio Vella

Adv. Respir. Med. 2017, 85(4), 193-201; https://doi.org/10.5603/ARM.2017.0032 - 01 Sep 2017

Cited by 8 | Viewed by 355

Abstract

Physicians in the field of respiratory medicine are particularly concerned about the availability of a reliable diagnostic tool to investigate respiratory allergy. Usually, basophils are easy to obtain from peripheral blood and therefore they represent a reproducible model to assess allergy in individuals. [...] Read more.

Physicians in the field of respiratory medicine are particularly concerned about the availability of a reliable diagnostic tool to investigate respiratory allergy. Usually, basophils are easy to obtain from peripheral blood and therefore they represent a reproducible model to assess allergy in individuals. Cell assays called basophil activation tests (BATs) are widespread tools for allergy diagnosis and are easily available in most of the medical labs. The strategy by which basophils are captured in a flow cytometry protocol has met many suggestions, recommendations and experimental novelties in recent years, yet the debate needs to be further expanded. Concerns still remain about the suitability of the many approaches to make the basophil activation test (BAT) an excellent and practical tool to diagnose allergy, while improving its analytical performance. This technical report describes the methodological aspects of the use of the protocol adopting the panel CD45^dim/CD123^bright/HLA-DR^neg to gate basophils in flow cytometry, trying to highlight the main biases related to an incorrect use of this protocol. Full article

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Open AccessReview

Pulmonary Hypertension in Diffuse Parenchymal Lung Diseases—Is There Any Benefit of PAH-Specific Therapy?

by Monika Szturmowicz, Aneta Kacprzak and Jan Kuś

Adv. Respir. Med. 2017, 85(4), 216-223; https://doi.org/10.5603/ARM.2017.0036 - 28 Aug 2017

Viewed by 336

Abstract

Pulmonary hypertension (PH) is diagnosed in 40–50% of the patients with end-stage diffuse parenchymal lung diseases (DPLD), and it is associated with significant worsening of life expectancy. Latest ERS/ESC guidelines recommend best available treatment of DPLD, and long-term oxygen therapy in the patients [...] Read more.

Pulmonary hypertension (PH) is diagnosed in 40–50% of the patients with end-stage diffuse parenchymal lung diseases (DPLD), and it is associated with significant worsening of life expectancy. Latest ERS/ESC guidelines recommend best available treatment of DPLD, and long-term oxygen therapy in the patients with PaO₂ less than 60 mm Hg. Pulmonary arterial hypertension (PAH)-targeted drugs are not recommended in PH-DPLD patients, due to the risk of increasing the ventilation-perfusion mismatch, and consequently worsening of hypoxaemia. Nevertheless, PAH-oriented treatment may be beneficial to selected groups of patients. The authors try to find the answer to several important questions: is there any benefit of PAH-specific therapy in PH-DPLD, who should be the candidate for PAH-specific therapy, what class of drugs is most promising, and what outcome measures should be employed? Full article

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Open AccessArticle

Exhaled Nitric Oxide Atopy, and Spirometry in Asthma and Rhinitis Patients in India

by Raj Kumar and Nitesh Gupta

Adv. Respir. Med. 2017, 85(4), 186-192; https://doi.org/10.5603/ARM.2017.0031 - 28 Aug 2017

Cited by 14 | Viewed by 438

Abstract

Introduction: Asthma is a chronic airway inflammatory disorder. Nitric oxide (NO) is non-invasively measured in exhaled breath (FeNO). The aim of the study was to investigate the anthropometric and physiologic factors that influence FeNO measurements. Also, to evaluate FeNO correlation with spirometry [...] Read more.

Introduction: Asthma is a chronic airway inflammatory disorder. Nitric oxide (NO) is non-invasively measured in exhaled breath (FeNO). The aim of the study was to investigate the anthropometric and physiologic factors that influence FeNO measurements. Also, to evaluate FeNO correlation with spirometry and inflammatory markers in asthma and rhinitis. Material and methods: The study was a prospective analysis of asthma (BA) and rhinitis (AR) in patients enrolled from outpatient clinics between 2011 and 2015. Healthy controls (HC) were enrolled from the community. All subjects underwent baseline spirometry with reversibility, FeNO measurements, skin prick tests, and blood sampling for absolute eosinophil counts and serum total IgE levels. Results: Of 528 enrolled participants, 215 were BA, 248 were BA-AR and 65 were HC. The mean FeNO was higher in atopic versus nonatopic subjects (34.14 vs. 25.99; p < 0.001); asthmatics versus non-asthmatics (30.46 vs. 12.91; p < 0.001), and in participants with BA-AR, compared to those without BA-AR (32.56 vs. 30.46; p < 0.001). The odds ratio for FeNO in the study population showed a significant positive association with male gender, absolute eosinophil count (AEC), breathlessness, duration of symptoms, family history and atopy. In examining the diagnostic accuracy of FeNO for asthma, the AUC for FeNO value is 0.833 (95% confidence interval [CI], 0.717–0.901), with cut-off levels to screen for asthma being 19.45 at 71.2% sensitivity and 81.8% specificity (p < 0.001). The Positive Predictive Value 96.84% (95% CI: 94.43–98.23) and Negative Predictive Value 30% (95% CI: 23.78–37.05) for asthma prediction with FeNO. Conclusion: The study highlights the importance of estimation of anthropometric parameters and dyspnea assessment in the evaluation of FeNO levels. Also, the presence of atopy may influence the results in the interpretation of FeNO readings. Moreover, the study have demonstrated that spirometry and FeNO have no significant correlation, which further lays emphasis on them as being different physiological parameters of asthma.
Full article

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Open AccessArticle

Selected Aspects of Medical Care for Patients with Asthma and Chronic Obstructive Pulmonary Disease (COPD) in Poland

by Joanna Miłkowska-Dymanowska, Adam J. Białas and Paweł Górski

Adv. Respir. Med. 2017, 85(4), 179-185; https://doi.org/10.5603/ARM.2017.0030 - 28 Aug 2017

Cited by 3 | Viewed by 360

Abstract

Introduction: Noncompliance with healthcare undoubtedly has a strong influence on the high prevalence of uncontrolled obstructive diseases. The aim of our study was to evaluate the quality of medical conduct in patients with asthma or chronic obstructive lung diseases (COPD), with encompassed [...] Read more.

Introduction: Noncompliance with healthcare undoubtedly has a strong influence on the high prevalence of uncontrolled obstructive diseases. The aim of our study was to evaluate the quality of medical conduct in patients with asthma or chronic obstructive lung diseases (COPD), with encompassed two-levelled system of health care. Material and methods: A survey of general practitioners (GP), allergists and pulmonologists practicing in Poland was performed between September and December 2016. The basic survey included the data concerning the number of treated patients, the course of the visits, treatment regimens and whether the patients follow the instructions of the physician. The specialist survey recorded the details of the specialist visits, their frequency and character, an evaluation of the pharmacological and non-pharmacological therapies and an evaluation of the GP’s actions. Results: The basic questionnaire was completed by 807 doctors with an average of 21 ± 9.85 years of medical experience. Most of the interviewed individuals were GPs (56%), followed by pulmonologists (28%) and allergists (16%). The GP reported 47 cases/month with obstructive pulmonary conditions, including 48.94% asthma and 51.06% COPD patients. They diagnosed three new asthma and COPD patients per month. The allergists treated patients with asthma (105 patients/ month), with 19 newly-diagnosed patients/month. The pulmonologists treated fewer asthma cases than COPD: 71 and 98 patients respectively. They reported 14 patients/month of newly-diagnosed COPD cases. The patients took inhaled glucocorticoids and long-acting β adrenoceptor agonists in separate inhalers. The most frequently-used device was a disc. In opinion of the specialists, half of the therapies initiated recently by GPs for patients with asthma and COPD required modifications. Conclusions: There is a disparity between the true state of medical care of asthma and COPD patients and globally-accepted standards. Full article

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Open AccessReview

Network of Breathing. Multifunctional Role of the Diaphragm: A Review

by Janusz Kocjan, Mariusz Adamek, Bożena Gzik-Zroska, Damian Czyżewski and Mateusz Rydel

Adv. Respir. Med. 2017, 85(4), 224-232; https://doi.org/10.5603/ARM.2017.0037 - 31 Jul 2017

Cited by 45 | Viewed by 2835

Abstract

The diaphragm is the primary muscle involved in active inspiration and serves also as an important anatomical landmark that separates the thoracic and abdominal cavity. However, the diaphragm muscle like other structures and organs in the human body has more than one function, [...] Read more.

The diaphragm is the primary muscle involved in active inspiration and serves also as an important anatomical landmark that separates the thoracic and abdominal cavity. However, the diaphragm muscle like other structures and organs in the human body has more than one function, and displays many anatomic links throughout the body, thereby forming a ‘network of breathing’. Besides respiratory function, it is important for postural control as it stabilises the lumbar spine during loading tasks. It also plays a vital role in the vascular and lymphatic systems, as well as, is greatly involved in gastroesophageal functions such as swallowing, vomiting, and contributing to the gastroesophageal reflux barrier. In this paper we set out in detail the anatomy and embryology of the diaphragm and attempt to show it serves as both: an important exchange point of information, originating in different areas of the body, and a source of information in itself. The study also discusses all of its functions related to breathing. Full article

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Open AccessCase Report

Metastasising Leiomyoma of the Uterus with Pulmonary Involvement—Case Report

by Marta Maskey-Warzęchowska, Magdalena Chojnowska, Konrad Ptaszyński, Renata Rubinsztajn, Marzena Padzik-Moczydłowska and Rafał Krenke

Adv. Respir. Med. 2017, 85(4), 211-215; https://doi.org/10.5603/ARM.2017.0035 - 31 Jul 2017

Cited by 1 | Viewed by 319

Abstract

Benign metastasising leiomyoma (BML) is characterised by extrauterine smooth muscle tumours in women after surgical treatment for uterine leiomyoma. Usually manifested as solitary or multiple focal lesions in various organs, it imposes a scrutinous diagnostic work-up to exclude a malignant disease and requires [...] Read more.

Benign metastasising leiomyoma (BML) is characterised by extrauterine smooth muscle tumours in women after surgical treatment for uterine leiomyoma. Usually manifested as solitary or multiple focal lesions in various organs, it imposes a scrutinous diagnostic work-up to exclude a malignant disease and requires confirmation in microscopic examination of the extrauterine focus. The authors present a case of a 56-year-old woman with BML manifesting as bilateral multiple pulmonary nodules, with a tentative diagnosis of a disseminated malignant disease of mesenchymal origin. The patient underwent multiple diagnostic tests, which excluded malignancy. The definite diagnosis was established after the microscopic reevaluation of an excised pulmonary nodule. The patient is monitored with chest magnetic resonance. BML should be considered in the differential diagnosis of multiple pulmonary nodules in asymptomatic women. Patients with BML require long-term monitoring, therefore the selected imaging method should not carry the risk of cumulative side effects. Full article

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Open AccessCase Report

Primary Pleuropulmonary Synovial Sarcoma with Brain Metastases in a Paediatric Patient: An Unusual Presentation

by Pushpak Chandrakant Chirmade, Sonia Parikh, Asha Anand, Harsha Panchal, Apurva Patel and Sandip Shah

Adv. Respir. Med. 2017, 85(4), 206-210; https://doi.org/10.5603/ARM.2017.0034 - 31 Jul 2017

Cited by 3 | Viewed by 424

Abstract

Primary lung neoplasms are rare in children. The most common primary lung malignancies in children are pleuropulmonary blastoma and carcinoid tumour. Synovial sarcoma (SS) accounts for approximately 1% of all childhood malignancies. In absolute terms, the SS of the lungs and pleura are [...] Read more.

Primary lung neoplasms are rare in children. The most common primary lung malignancies in children are pleuropulmonary blastoma and carcinoid tumour. Synovial sarcoma (SS) accounts for approximately 1% of all childhood malignancies. In absolute terms, the SS of the lungs and pleura are extremely rare and pose a diagnostic difficulty. Soft tissue sarcomas usually have a high potential for metastases, however, metastasis to the brain is rare, even in widely disseminated disease, and it has been described only in 3 Case Reports previously. Primary pleuropulmonary SS with brain metastases is even rarer. Here we present a case of an 11-year-old boy who presented with respiratory complaints, viz. fever and cough for 20 days. Initial impression was lung abscess, however, on histopathological, immunohistochemical and molecular study, the disorder was diagnosed as synovial sarcoma. After a week from the first consult, the child developed neurological symptoms, viz., an episode of convulsion and gradually worsening power of the lower limb. Computed tomography scan and Magnetic Resonance Spectroscopy was suggestive of brain metastases. Given the rarity of primary lung neoplasms in children, clinical detection remains a challenge. Delayed diagnoses are common as respiratory symptoms may be attributed to inflammatory or infective processes. Primary pleuropulmonary synovial sarcoma is a rare tumour and it is not known to commonly metastasise to the brain. Though rare, primary pleuropulmonary SS should be considered an important differential among peadiatric primary lung neoplasms due to its potential for curability if detected early, and more aggressive metastatic pattern, e.g., brain metastases making early detection imperative. Full article

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Open AccessCase Report

Primary Pulmonary MALT Lymphoma Presenting as Non-Resolving Pneumonia

by Asma Iftikhar, Albert Magh, Muhammed Azaz Cheema, Sarah Thappa, Sonu Sahni and Stephen Karbowitz

Adv. Respir. Med. 2017, 85(4), 202-205; https://doi.org/10.5603/ARM.2017.0033 - 31 Jul 2017

Cited by 6 | Viewed by 463

Abstract

Primary lung lymphoma (PLL) is a rare unilateral or bilateral lung disorder that is challenging to diagnose solely based on clinical and radiological presentation. PLL may be misdiagnosed as pneumonia or a lung tumor due to non-specific findings. PLL is most frequently a [...] Read more.

Primary lung lymphoma (PLL) is a rare unilateral or bilateral lung disorder that is challenging to diagnose solely based on clinical and radiological presentation. PLL may be misdiagnosed as pneumonia or a lung tumor due to non-specific findings. PLL is most frequently a mucosa-associated lymphoid tissue (MALT) lymphoma, a type of extranodal low-grade B-cell lymphoma most commonly discovered in the gastrointestinal tract. PLL should be considered in the differential diagnosis of non-resolving pneumonias. Herein we present a case of an 84-year-old patient discovered to have a primary pulmonary MALT lymphoma presenting as a non-resolving pneumonia causing a clinical challenge. Full article

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Adv. Respir. Med., Volume 85, Issue 4 (September 2017) – 8 articles , Pages 179-232

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