Pneumonologia I Alergologia Polska[JOURNAL]
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200 papers
POLASTMA--the Polish National Programme of Early Diagnosis and Therapy of Asthma.
Kuna P, Kupczyk M, Kupryś-Lipińska I
Pneumonol Alergol Pol · 2014 · PMID 25339572 · Publisher ↗
Asthma represents a growing health, social, and economic issue as it affects a considerable part of the population, adversely affecting patients' quality of life, while its chronic character and severity of symptoms impa...
Asthma represents a growing health, social, and economic issue as it affects a considerable part of the population, adversely affecting patients' quality of life, while its chronic character and severity of symptoms impair family life. It has been estimated that 12% of the population of Poland (4.5 million) suffer from asthma and 16% report wheezes (5.7 million). In order to improve asthma care and patient outcomes, evidence-based recommendations must not only be developed, but also disseminated and implemented at a national and local level, which is key for integration into clinical practice. For these reasons, the Polish Society of Allergology (PSA) has decided to undertake actions, leading to some improvement of the epidemiological situation in Poland. The Polish National Programme of Early Diagnosis and Therapy of Asthma has been developed. This initiative is a response to the demand for medical care improvement in patients with asthma. Its goals include early diagnosis of asthma and improved control in the course of the disease, a reduction in the number of subjects with asthma-associated disability for work, an increased use of anti-inflammatory agents vs. rescue medications, a reduced number of patients with severe, uncontrolled bronchial asthma and prevention of complications of the disease and of adverse effects of applied therapy, an increase in social awareness regarding the bulk of problems associated with asthma, and reduction of the total costs of the care of patients suffering from asthma. Details regarding programme assumptions, goals, target groups, and modes of implementation are described in the document.
[Chronic obstructive pulmonary disease and cardiovascular diseases--'cardiopulmonary continuum'].
Batura-Gabryel H, Grabicki M
Pneumonol Alergol Pol · 2014 · PMID 25339571 · Publisher ↗
Chronic obstructive pulmonary disease (COPD) is characterised by persistent airflow limitation and extrapulmonary comorbidities, which contribute to the overall severity. Some risk factors, with tobacco smoking as the mo...
Chronic obstructive pulmonary disease (COPD) is characterised by persistent airflow limitation and extrapulmonary comorbidities, which contribute to the overall severity. Some risk factors, with tobacco smoking as the most serious one, lead to a chronic, systemic inflammation that plays the main role in the pathogenesis of COPD and comorbidities, including cardiovascular diseases (CVD). The course of COPD is diverse; it depends on pathologies in the respiratory system and on other organ dysfunctions. CVDs are the most commonly recognised comorbidities in COPD patients. The severity and natural course of COPD, as well as quality of the patient's life, are influenced by them. CVDs are frequently the reason for hospitalisation and may lead to death. They are also an important prognostic factor. Comorbidities may prolong exacerbation of COPD. On the other hand, COPD is an independent risk factor of CVD. The prevalence of COPD is high in patients suffering from coronary artery disease, and airflow limitation is a major risk factor for chronic heart failure. These complex interactions between heart and lung can be denoted as 'cardiopulmonary continuum'. These dependencies are not recognised in detail. Currently research is being done, which attempts to explain these complicated relations. For many years COPD and CVD were not connected. Today it is known that patients suffering from COPD must be provided comprehensive care. It is necessary to monitor the risk of CVD and their influence on the COPD course. Careful and proper treatment of all diseases is essential. An interdisciplinary team with good cooperation should prepare a plan of COPD treatment with simultaneous therapy of comorbidities.
Severe congestive heart failure as the main symptom of eosinophilic granulomatosis and polyangiitis (Churg-Strauss syndrome).
Załęska J, Wiatr E, Zych J … +5 more , Szopiński J, Oniszh K, Kober J, Piotrowska-Kownacka D, Roszkowski-Śliż K
Pneumonol Alergol Pol · 2014 · PMID 25339570 · Publisher ↗
Patients with cardiovascular symptoms are mainly diagnosed in cardiological wards. However, sometimes the other reasons for acute coronary syndrome and heart failure are found. One of such reasons is hypereosinophilia wh...
Patients with cardiovascular symptoms are mainly diagnosed in cardiological wards. However, sometimes the other reasons for acute coronary syndrome and heart failure are found. One of such reasons is hypereosinophilia which can be recognized if number of blood eosinophils exceeds 1500/mm3. High eosinophilia is connected with production of cytotoxic eosinophilic proteins which can cause eosinophilic vasculitis or eosinophilic myocarditis. One of the better known hypereosinophilic syndromes is EGPA described by the pathomorphologists Churg and Strauss. The further research works allowed for the clinical characteristics of patients with EGPA. In the course of this disease the following three phases were recognized : prodromal-allergic, eosinophilic, vasculitic. The definitive diagnosis can be established only in the third phase, when vasculitis causes organ involvement. Besides symptoms of the respiratory tract (asthma, nasal polyps, eosinophilic lung infiltrations) also cardiovascular symptoms, gastrointestinal tract symptoms, as well as skin lesions and kidneys involvement can appear. The most dangerous for patients is involvement of the nervous and cardiovascular systems. We present a patient with asthma and eosinophilia in whom EGPA was diagnosed in the course of acute recurrent substernal chest pain, with subsequent signs of cardiac insufficiency.
[Obliterative bronchiolitis due to inhalation of toxic gases and fumes--case report].
Winek J, Zych J, Langfort R … +1 more , Roszkowski-Śliż K
Pneumonol Alergol Pol · 2014 · PMID 25339569 · Publisher ↗
Obliterative bronchiolitis is a rare pulmonary disease, characterised by narrowing and eventual obliteration of bronchioles by peribronchial and submucosal fibrosis. One of the identified causes of bronchiolitis is acute...
Obliterative bronchiolitis is a rare pulmonary disease, characterised by narrowing and eventual obliteration of bronchioles by peribronchial and submucosal fibrosis. One of the identified causes of bronchiolitis is acute injury due to inhalation of toxic gases and fumes. Physiological criteria, essential in preliminary diagnostics, include irreversible airflow limitation, forced expiratory volume in 1 second (FEV1) < 60%, and exclusion of other causes of airflow obstruction. Surgical lung biopsy with histologic examination confirms diagnosis definitely. Prognosis of obliterative bronchiolitis, irrespective of aetiology, is rather poor, and treatment is rarely efficacious. We present a young chemist exposed to inhalation of toxic gases and fumes due to lack of usage of any personal protective equipment. He was referred to our lung disease department because of shortness of breath on exertion and irreversible airflow limitation. Definitive diagnosis of obliterative bronchiolitis was established by histological examination of specimen from open lung biopsy.
[Acute interstitial pneumonia in patient with rheumatoid arthritis treated with leflunomide].
Siemion-Szcześniak I, Bartoszuk I, Bartosiewicz M … +3 more , Jakubowska L, Wesołowski S, Kuś J
Pneumonol Alergol Pol · 2014 · PMID 25339568 · Publisher ↗
Leflunomide (LEF) is an isoxazole derivative used as disease-modifying anti-rheumatic drug (DMARD) in the treatment of rheumatoid arthritis (RA). It is effective and safe in patients with active RA, in whom standard trea...
Leflunomide (LEF) is an isoxazole derivative used as disease-modifying anti-rheumatic drug (DMARD) in the treatment of rheumatoid arthritis (RA). It is effective and safe in patients with active RA, in whom standard treatment is insufficient or contraindicated, but it can cause interstitial lung disease (ILD). Identified risk factors for LEF-induced ILD include pre-existing ILD, cigarette smoking, low body weight, and use of loading dose. LEF should be avoided in patients with pre-existing ILD. We present a case of 59-year-old male with RA and a history of smoking and methotrexate (MTX) treatment, who developed dyspnoea, non-productive cough, and fever about two months after the administration of LEF. The clinical and radiological presentation was of acute pneumonia. The patient was treated with methylprednisolone pulse, prednisone, and cyclophosphamide, but he died of respiratory failure.
[Mycobacterial lung disease in patients with cystic fibrosis--report of three cases].
Wyrostkiewicz D, Skorupa W, Jakubowska L … +2 more , Zabost A, Kuś J
Pneumonol Alergol Pol · 2014 · PMID 25339567 · Publisher ↗
Mycobacterial lung disease is caused by nontuberculous mycobacteria (NTM), also known as atypical mycobacteria. NTM are widely distributed in the environment, particularly in soil and water. Although generally of low pat...
Mycobacterial lung disease is caused by nontuberculous mycobacteria (NTM), also known as atypical mycobacteria. NTM are widely distributed in the environment, particularly in soil and water. Although generally of low pathogenicity to humans, NTM can affect patients with underlying chronic lung diseases, such as cystic fibrosis, bronchiectasis, pneumoconiosis, or healed tuberculosis. Some patients with cystic fibrosis (CF) have disease progression due to NTM, others can have NTM cultured intermittently from respiratory specimens without a significant decline in lung function. Identifying which patients will worsen from NTM and therefore need treatment remains difficult because of the similarity of symptoms in CF and NTM lung disease. The most common species of NTM isolated in CF patients are Mycobacterium avium complex (MAC) and Mycobacterium abscessus. In this paper, we present three different cases of mycobacterial lung disease in patients with cystic fibrosis.
[Liposarcoma--a rare primary neoplasm of the thorax].
Załęska M, Langfort R, Oniszh K … +2 more , Roszkowska-Śliż B, Roszkowski-Śliż K
Pneumonol Alergol Pol · 2014 · PMID 25339566 · Publisher ↗
Liposarcoma is a rare tumour localised within the thorax. It can originate from a different thoracic structures (for example: lung parenchyma, mediastinum, pleura) or thoracic wall. We present a case of a 35-year-old wom...
Liposarcoma is a rare tumour localised within the thorax. It can originate from a different thoracic structures (for example: lung parenchyma, mediastinum, pleura) or thoracic wall. We present a case of a 35-year-old woman with a giant tumour of the left hemithorax, who had two weeks history of non-productive cough and progressive dyspnoea from eight months. Chest radiography showed a large, round opacity in the left hemithorax, which displaced the cardiac silhouette to the right. Contrast-enhanced computed tomography showed a huge, heterogeneous, well-circumscribed mass in the left pleural cavity. The tumour expanded locally towards the thoracic wall and left lung, and displaced mediastinal structures to the right. There was no lymphadenopathy on the physical examination and CT scan. Abdominal ultrasonography was normal. There was no proof of tumour in the extremities and trunk. The patient underwent surgical excision of the tumour via thoracotomy, but because of tumour infiltration, part of the third rib and surrounding wall were resected. There was no evidence of lung and mediastinum involvement. The mass measured 17.5 × 18 × 10 cm and weighed 1690 g. A final diagnosis of a well-differentiated liposarcoma - sclerosing subtype - was established after histological and immunohistochemical staining. In our opinion, the liposarcoma in this case originated from the chest wall. Surgical resection was the only treatment. During six months after surgery the patient had no evidence of disease progression.
[False positive result of 18F-FDG PET in patient with lung cancer due to sarcoid-like reaction in regional lymph nodes].
Kuś E, Gabryś J, Czyżewski D
Pneumonol Alergol Pol · 2014 · PMID 25339565 · Publisher ↗
The development of non-caseating granulomas in patients with neoplastic diseases is referred to as a sarcoid-like reaction. This reaction may be found in the primary tumour or near it; however, it is commonly seen in the...
The development of non-caseating granulomas in patients with neoplastic diseases is referred to as a sarcoid-like reaction. This reaction may be found in the primary tumour or near it; however, it is commonly seen in the regional lymph nodes, and usually subsides after treatment of the underlying disease. The pathogenesis of this process has not been fully explained. Sarcoid-like reactions occur in 4.4% of solid tumours, 7.3% of patients with non-Hodgkin's lymphoma, and 13.8% of patients with Hodgkin's lymphoma. The radiological image of increased lymph nodes due to the sarcoid-like reaction is similar to that of lymphadenopathy with neoplastic aetiology, and may create diagnostic difficulties. The paper presents the case of a patient with a sarcoid-like reaction in regional lymph nodes caused by lung cancer, and describes difficulties in the interpretation of results from positron emission tomography (18F-FDG PET), which may have led to inappropriate treatment. False-positive accumulation of radiotracer (fluorodeoxyglucose, FDG) in mediastinal and hilar lymph nodes in the patient, who had chemotherapy and right-side pneumonectomy, was unambiguously interpreted by the radiologists as the relapse of lung cancer. Considering the fact that the patient was in a very good condition and presented with no clinical symptoms that indicated the progression of cancer, we extended the medical diagnostics. The performed procedures ruled out neoplastic process and confirmed our assumptions regarding sarcoid-like reaction. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was the diagnostic procedure that provided conclusive results. Sarcoid granulomas were identified by the pathomorphologist in the specimen. The patient avoided toxic treatment.
[Synchronous multiple primary lung cancers in a 65-year old heavy smoker. Case report].
Swietlik EM, Doboszyńska A, Kupis W … +2 more , Szołkowska M, Opoka L
Pneumonol Alergol Pol · 2014 · PMID 25339564 · Publisher ↗
Here we present a 65-year old ex-smoker with history of recent surgery for vocal cord tumor (histology: moderate grade intraepithelial neoplasia), who reported to the pulmonary outpatient clinic for the nodular lesions i...
Here we present a 65-year old ex-smoker with history of recent surgery for vocal cord tumor (histology: moderate grade intraepithelial neoplasia), who reported to the pulmonary outpatient clinic for the nodular lesions in the left lung seen on chest X-ray. Subsequent chest CT scan revealed focal lesion of 18 mm in diameter with spicular margins located in the right upper lobe, another irregular cyst with septa, 62 × 58 mm in the right lower lobe, and calcified nodule in the left lung, no enlarged lymph nodes or pleural effusion was seen. He underwent upper right lobe resection and wedge resection of the lower right lobe. Histological examination revealed adenocarcinoma in the right upper lobe with lymph node metastasis (pT2aN2M0). Examination of the right lower lobe showed squamous cell carcinoma (pT2bN0M0). He was subsequently treated with adjuvant chemotherapy and radiotherapy. During 20 months of the follow-up, he remained in good health with no signs of the disease progression. Patients with synchronous multiple primary lung cancers have significantly less favorable outcome than those with single primary lung malignancies, although it can be considerably improved with radical surgical treatment. Basing on the above case report, we discussed diagnostic and therapeutical scheme in patients with the primary multiple lung cancers, and have analyzed epidemiological data and some aspects of MPM etiology.
Effects of pulmonary rehabilitation on Fatigue Severity Scale in patients with lung disease.
Talwar A, Sahni S, John S … +3 more , Verma S, Cárdenas-Garcia J, Kohn N
Pneumonol Alergol Pol · 2014 · PMID 25339563 · Publisher ↗
INTRODUCTION: Fatigue is a known symptom of advanced lung disease and impacts quality of life and psychological health. Many of these patients undergo pulmonary rehabilitation as part of their therapy. Understanding the...
INTRODUCTION: Fatigue is a known symptom of advanced lung disease and impacts quality of life and psychological health. Many of these patients undergo pulmonary rehabilitation as part of their therapy. Understanding the effect of pulmonary rehabilitation on fatigue in these patients is important, as one may be able to design more focused rehabilitation programs. The aim of this study is to evaluate the effect of pulmonary rehabilitation on fatigue as measured by the Fatigue Severity Scale (FSS) in patients with advanced lung disease. MATERIAL AND METHODS: Patients were enrolled in a standardized 6 week pulmonary rehabilitation program. They were asked to complete questionnaires to evaluate their self-reported fatigue (FSS), and depression as measured by Geriatric Depression Scale (GDS). The GDS is a self-reported assessment tool used to identify depression in patients. The FSS is a validated instrument that indicates a perception of fatigue that might require medical intervention. Participants completed questionnaires both at baseline and after completing the standardized pulmonary rehabilitation program. Data was analyzed in Statistical Analysis System (SAS). The change in FSS was evaluated using the Wilcoxon signed-rank test. P-values < 0.05 were considered statistically significant. RESULTS: 21 patients (12 females; 9 males; mean age 64.3 ± 11.2 yrs) were considered for the study. Pre-pulmonary rehabilitation FSS scores ranged from 1.6 to 6.7 (mean score of 4.6 ± 1.7). Post pulmonary rehabilitation FSS scores ranged 1.0 to 6.2 (mean score of 3.9 ± 1.6). The median pre-rehabilitation FSS was 5.3 (inter quartile range; Q1-Q3: 3.0-6.1), and median post rehabilitation FSS was 3.9 (inter quartile range; Q1-Q3: 2.6-5.1). There was a significant decrease in FSS scores after completing pulmonary rehabilitation program (p < 0.0208). There was a decrease in GDS (pre-rehabilitation, mean: 5.5 ± 3.6; post-rehabilitation, mean: 4.2 ± 2.9), but this decrease was not statistically significant. The change in GDS correlated with the change in FSS (Spearman Correlation Coefficient 0.525, p < 0.0146). CONCLUSIONS: Patients with advanced lung disease reported a measurable component of fatigue. Participating in pulmonary rehabilitation resulted in significant improvement in patient's self-reported fatigue severity. Further studies are necessary to evaluate and design interventions to improve fatigue in in the setting of advanced lung disease.
Methotrexate as a single agent for treating pulmonary sarcoidosis: a single centre real-life prospective study.
Goljan-Geremek A, Bednarek M, Franczuk M … +18 more , Puścińska E, Nowiński A, Czystowska M, Kamiński D, Korzybski D, Stokłosa A, Kowalska A, Wojda E, Sliwiński P, Burakowska B, Ptak J, Barańska I, Drygalska A, Małek G, Bestry I, Wesołowski S, Kram M, Górecka D
Pneumonol Alergol Pol · 2014 · PMID 25339562 · Publisher ↗
INTRODUCTION: The first-line therapy in chronic sarcoidosis, according to WASOG/ATS/ERS recommendations, is GCS. This therapy is associated with significant adverse effects and finally does not alter the natural history...
INTRODUCTION: The first-line therapy in chronic sarcoidosis, according to WASOG/ATS/ERS recommendations, is GCS. This therapy is associated with significant adverse effects and finally does not alter the natural history of the disease. The objective of our study was to evaluate the efficacy and safety of monotherapy with MTX, as an alternative to GCS, in progressive pulmonary sarcoidosis. MATERIAL AND METHODS: An open prospective real-life, single-centre trial was performed on 50 patients with biopsy proven sarcoidosis, 28M and 22F, mean age 45.55 ± 8.9 years. The average duration of disease before MTX therapy was 12.34 ± 20.49 years, GCS therapy in the past was applied in 41 patients. All patients received MTX (10 mg or 15 mg weekly) between 2004 and 2013 because of chronic progressive pulmonary sarcoidosis. Therapy was planned for 24 months. Patients underwent regular clinical evaluation, pulmonary function assessment, exercise ability testing (6MWT), and chest radiography for therapy effectiveness every six months and side effects monitoring every 4-6 weeks. Forty-nine patients were included for statistical analysis of treatment efficacy. They were retrospectively allocated to "MTX responder" group if an improvement of 10% of FEV1, FVC, TLC, or 15% of DLCO from the initial value was documented for at least one parameter or "non-responders" if the patient did not meet the above-mentioned criteria. RESULTS: Duration of treatment ranged from 6 to 24 months, mean time 60.75 ± 34.1 weeks. For the whole cohort significant improvement after MTX therapy was observed for minimal SaO2 (%) (p = 0.043) and for decrease of DSaO2 (%) (p = 0.048) in six-minute walk test. The results were significantly better for patients treated with 15 mg than for those treated with 10 mg weekly and for those who obtained a greater total amount of MTX during therapy. Significant difference of DLCO%pred was observed after six months of MTX therapy between groups treated 15 mg vs 10 mg weekly (73.27 ± 12.7% vs. 63.15 ± 16.4%, p = 0.03). Twenty-five patients (55%) met the criteria of "MTX responders" group. Patients who responded well to treatment had significantly lower TLC and FVC initial values comparing to "MTX non-responders". After treatment the only significant difference in PFT between groups was noted for DLCO%pred. Eleven patients (22%) stopped the treatment due to adverse events of MTX, mild hepatic abnormalities were observed in ten patients (20%), and concomitant infection was found in four patients. There were no patients with a fatal outcome. CONCLUSIONS: MTX as a single agent in the treatment of sarcoidosis has proved to be a safe and effective steroid alternative. Selected patients with chronic pulmonary sarcoidosis experience definite PFT improvements after MTX treatment. There is need to search for predictors of MTX treatment effectiveness.
Chronic obstructive pulmonary disease in Poland: distribution of patients according to the new GOLD 2011 classification. Cross-sectional survey.
Wesołowski S, Boros PW, Dębowski T
Pneumonol Alergol Pol · 2014 · PMID 25339561 · Publisher ↗
INTRODUCTION: In 2011 new classification for chronic obstructive pulmonary disease (COPD) was introduced, which are not based on the extent of airflow limitation alone, but also on symptoms and risk of exacerbation. The...
INTRODUCTION: In 2011 new classification for chronic obstructive pulmonary disease (COPD) was introduced, which are not based on the extent of airflow limitation alone, but also on symptoms and risk of exacerbation. The objective of our work was to present the characteristics of COPD patients according to the GOLD 2011 categories. MATERIAL AND METHODS: A cross-sectional survey was performed with the participation of 411 specialists in pneumonology or allergology all over from Poland. RESULTS: In the group of 2271 patients we obtained the following distribution of COPD categories: A 687 (30.3%), B 403 (17.7%), C 256 (11.3%), and D 925 (40.7%). There were very few patients with no exacerbation (1.3%). In subgroups A and B there were no such patients at all. The main reason for classification of patients into categories C and D was the number of exacerbations of COPD (66.0% and 40%, respectively). Cardiovascular comorbidities were more frequent in subgroups B and D, with more symptoms (82%) than in subgroups A and C (57%, p < 0.001). CONCLUSIONS: In a large group of patients, representative of the population of COPD patients in Poland, we observed an uneven distribution of patients in the GOLD 2011 categories, with 71% of patients assigned to category A or D. In our study, the main reason for classifying to category C or D was the high risk of disease exacerbation rather than the degree of FEV1 reduction, as noted in other reports.
The influence of sublingual immunotherapy on several parameters of immunological response in children suffering from atopic asthma and allergic rhinitis depending on asthma features.
Ciepiela O, Zawadzka-Krajewska A, Kotuła I … +1 more , Demkow U
Pneumonol Alergol Pol · 2014 · PMID 25339560 · Publisher ↗
INTRODUCTION: The clinical efficacy of sublingual immunotherapy (SLIT) has already been proven and is known to be high. Its influence on the immunological system of patients suffering from bronchial asthma was also exami...
INTRODUCTION: The clinical efficacy of sublingual immunotherapy (SLIT) has already been proven and is known to be high. Its influence on the immunological system of patients suffering from bronchial asthma was also examined. However, it is still unclear how the polysensitisation, coexistence of other atopic disease and asthma treatment step influence the response to treatment with specific immunotherapy. Herein we evaluate the impact of one-year SLIT on selected markers of immunological response depending on different individual and clinical factors of children suffering from atopic asthma and allergic rhinitis. MATERIAL AND METHODS: Twenty-five patients aged 8.1 ± 3.1 years (range 5-15 years), 21 boys and 4 girls, suffering from asthma and allergic rhinitis with polysensitisation to seasonal and non-seasonal allergens, shortlisted for SLIT, were included in the study. Th1 cell and Th2 cell percentages, Bcl-2 expression in T cells, and basophil activation after allergen challenge (house dust mite and/or grass pollen antigen in solution used for skin prick tests) in peripheral blood were measured using flow cytometry. The association between clinical features of asthma and the influence of SLIT on immunological parameters was evaluated with exact Fisher test. RESULTS: No association between the influence of one-year sublingual immunotherapy on immunological system and patients' age, polysensitisation, asthma treatment step, or coexistence of any other atopic diseases was observed. However, an increase of the Th1 percentage in children sensitised against more than three allergens was found more often (at the limit of statistical significance) than in the group of children sensitised against three or less allergens. CONCLUSIONS: Based on our results, we cannot point to any subgroup isolated in the study, in which the response of the immunological system to sublingual immunotherapy is more satisfactory than any other. Nevertheless, the increase of Th1 cells may be more specific for polysensitised children.
Non-tuberculous mycobacterial lung disease (NT MLD ) in patients with chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension.
Wilińska E, Oniszh K, Augustynowicz-Kopeć E … +7 more , Zabost A, Fijałkowska A, Kurzyna M, Wieteska M, Torbicki A, Kuś J, Szturmowicz M
Pneumonol Alergol Pol · 2014 · PMID 25339559 · Publisher ↗
INTRODUCTION: Non-tuberculous mycobacterial lung diseases (NTMLD) occur rarely and are diagnosed mainly in patients belonging to risk groups. Pulmonary hypertension (PH) has not been recognised as a risk factor for NTMLD...
INTRODUCTION: Non-tuberculous mycobacterial lung diseases (NTMLD) occur rarely and are diagnosed mainly in patients belonging to risk groups. Pulmonary hypertension (PH) has not been recognised as a risk factor for NTMLD yet. The aim of the study was to analyse the clinical course and predisposing factors of NTMLD recognised in our centre between 2002 and 2012 in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). MATERIAL AND METHODS: Thirteen patients (10 - CTEPH, 3 - IPAH) entered the study. PH was recognised during right heart catheterisation. Median value of mean pulmonary artery pressure (mPAP) was 49 mm Hg (39-65 mm Hg). NTMLD was diagnosed according to ATS guidelines (2007). RESULTS: M. kansasii was the most frequent pathogen. Most patients complained of the exaggeration of dyspnoea and productive cough. Computed tomography of the chest with angiography revealed infiltrations with cavitation in seven patients and cavities surrounded by micronodules in six patients. In all CTEPH patients, NTMLD developed in the hypoperfused lung areas. No parenchymal abnormalities preceded the development of NTMLD. After diagnosis all of the patients received antituberculous treatment; in 12/13 improvement was achieved. By the end of March 2014 seven patients died due to right heart insufficiency, no deaths due to NTMLD were noted. CONCLUSIONS: NTMLD should be suspected in patients with CTEPH or IPAH, presenting with productive cough and a new pulmonary infiltrate with cavitation. In patients with CTEPH, special attention should be paid to a new cavitary lesions without accompanying thrombus in the artery supplying the area. High mPAP (CTEPH/IPAH) and hypoperfusion (CTEPH) are predisposing to NTMLD.
The utility of oesophageal pH monitoring in diagnosing gastroesophageal reflux disease-related chronic cough.
Rybka A, Malesa K, Radlińska O … +4 more , Krakowiak K, Grabczak EM, Dąbrowska M, Chazan R
Pneumonol Alergol Pol · 2014 · PMID 25339558 · Publisher ↗
INTRODUCTION: Chronic cough is a common medical complaint, which may deteriorate patients' quality of life and cause many complications. Gastroesophageal reflux disease (GERD) is one of the frequent reasons for chronic c...
INTRODUCTION: Chronic cough is a common medical complaint, which may deteriorate patients' quality of life and cause many complications. Gastroesophageal reflux disease (GERD) is one of the frequent reasons for chronic cough. Oesophageal pH monitoring is one of the diagnostic methods performed to confirm diagnosis of GERD-related cough. The aim of the study was to analyse the utility of oesophageal pH monitoring in diagnosing GERD-related cough and to identify the most sensitive pH monitoring parameters for diagnosing GERD-related cough. MATERIAL AND METHODS: 24-hour oesophageal pH monitoring was performed in 204 patients suffering from chronic cough. The group consisted of 65% females and the median age was 59 years. An acid reflux episode was defined as a rapid drop in pH to a value below 4 for at least 12 seconds. The diagnosis of GERD was based on total fraction time of pH < 4, upright or supine fraction time of pH < 4, or DeMeester score. The diagnosis of GERD-related cough was made if cough episodes, marked by the patients, appeared within 2 minutes after the reflux. The association between reflux episode and appearance of cough was analysed using two parameters: symptom index (SI ≥ 50%) and/or symptom association probability (SAP ≥ 95%). RESULTS: Based on results of pH monitoring, 135 patients (135/204, 66%) were diagnosed with GERD. Among them, 117 patients (117/135, 87%) were diagnosed based on DeMeester score. Among patients with GERD, 61 patients met the criteria of GERD-related cough (61/135, 45%), i.e. 30% of the group as a whole. Thirty-six patients (36/61, 59%) were diagnosed based on SAP, 12 patients (20%) based on SI, and 13 (21%) based on both parameters. Spearman rank correlation coefficient for SAP ≥ 95% and SI ≥ 50% was 0.46 (p < 0.05). CONCLUSIONS: Based on pH monitoring results, GERD was diagnosed twice as often as GERD-related cough. SAP index is more sensitive than SI for the diagnosis of GERD-related cough.
[Non-tuberculous mycobacterial lung disease. Rare entity or emerging epidemiological problem?].
Rowińska-Zakrzewska E
Pneumonol Alergol Pol · 2014 · PMID 25339557 · Publisher ↗
Abstract loading — click title to view on PubMed.
[Microbiome of the lung].
Górecka D, Puścińska E
Pneumonol Alergol Pol · 2014 · PMID 25339556 · Publisher ↗
Abstract loading — click title to view on PubMed.
[Ventilator-associated pneumonia and other infections].
Bobik P, Siemiątkowski A
Pneumonol Alergol Pol · 2014 · PMID 25133817 · Publisher ↗
One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, t...
One of the fundamental elements of therapy in patients hospitalised in the Intensive Care Unit (ICU) is mechanical ventilation (MV). MV enables sufficient gas exchange in patients with severe respiratory insufficiency, thus preserving the proper functioning of organs and systems. However, clinical and experimental studies show that mechanical ventilation may cause severe complications, e.g. lung injury (VALI, VILI), systemic inflammatory response syndrome (SIRS), and, on rare occasions, multiple organ failure (MOF). Mechanical ventilation and especially endotracheal intubation are associated also with higher risk of infectious complications of the respiratory system: ventilator-associated respiratory infection (VARI) and ventilator-associated pneumonia (VAP). The complications of the MV listed above have a significant influence on the length of treatment and also on the increase of the costs of therapy and mortality of patients who stay in an ICU. These negative effects of supported breathing are the reasons for intensive research to find new biological markers of inflammation and lung injury, more sensitive and specific diagnostic instruments, more effective methods of therapy, and programs of prevention. The purpose of this article is the presentation of current knowledge concerning VAP-related infections, to allow pulmonologists and general practitioners to become more familiar with the problem. Basic and the most important data concerning the definition, epidemiology, pathophysiology, microbiology, diagnostics, treatment, and prevention of VAP have been included. Additionally, ventilator-associated tracheobronchitis (VAT) was discussed.
[Exercise-induced urticaria and angioedema - case report].
Stelmach I, Sztafińska A, Lechańka J … +2 more , Balcerak J, Jerzyńska J
Pneumonol Alergol Pol · 2014 · PMID 25133816 · Publisher ↗
Urticaria is a heterogeneous group of disorders, with various clinical manifestations and intensity of symptoms. Urticaria can be induced with a wide variety of environmental stimuli, such as cold, pressure, vibration, s...
Urticaria is a heterogeneous group of disorders, with various clinical manifestations and intensity of symptoms. Urticaria can be induced with a wide variety of environmental stimuli, such as cold, pressure, vibration, sunlight, exercise, temperature changes, heat, and water. In a select group of patients, exercise can induce a spectrum of urticaria symptoms, ranging from cutaneous pruritus and warmth, generalised urticaria, angioedema, and the appearance of such additional manifestations as collapse, upper respiratory distress, and anaphylaxis. Specific provocation tests should be carried out on an individual basis to investigate the suspected cause and proper diagnosis. Modification of activities and behaviour is the mainstay of treatment in patients with physical urticaria. The aim of this study was to emphasise that primary care paediatricians should be able to recognise physical urticaria, supply a patient with rescue medications, and refer him/her to a specialist. In the article, the authors present a 13-year-old girl with typical urticaria lesions and angioedema after exercise. According to the history, physical examination, and provocation test, exercise-induced urticaria and angioedema were diagnosed.
[Pneumocystis pneumonia in HIV-infected patients with cytomegalovirus co-infection. Two case reports and a literature review].
Polaczek MM, Zych J, Oniszh K … +3 more , Szopiński J, Grudny J, Roszkowski-Śliż K
Pneumonol Alergol Pol · 2014 · PMID 25133815 · Publisher ↗
Pneumocystis pneumonia (PCP) is one of the infectious lung diseases diagnosed in HIV-infected patients. The pathogen responsible for the development of this opportunistic infection is an atypical fungus called Pneumocyst...
Pneumocystis pneumonia (PCP) is one of the infectious lung diseases diagnosed in HIV-infected patients. The pathogen responsible for the development of this opportunistic infection is an atypical fungus called Pneumocystis jiroveci. PCP remains the most common disorder diagnosed at the onset of acquired immunodeficiency syndrome (AIDS), especially in individuals not aware of their HIV infection. The most important risk factor of PCP development in HIV-infected person is the decrease of T CD4+ cell number below 200/mcL. Clinical symptoms consist of: chronic cough, dyspnoea and weakness. Arterial blood gas analysis often reveals the presence of hypoxaemia, and high-resolution computed tomography imaging shows diffuse ground glass opacities. Treatment is based on intravenous administration of trimetoprim-sulfamethoxasole. In patients with moderate and severe symptoms of PCP it is recommended that corticosteroids are used. Co-infection with cytomegalovirus (CMV) is a poor prognostic sign in PCP. CMV-related organ disease should be suspected in patients with T CD4+ cell number lower than 50/mcL. It is arguable whether CMV infection in symptomatic PCP patients should be treated. There are suggestions that corticosteroids used in PCP patients with CMV co-infection could promote the development of CMV pneumonia. In the present paper we present two patients with PCP, unaware of their HIV infection. In both cases a CMV co-infection was found.
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