Adam Barczyk

Depressiveness, symptoms of anxiety and cognitive dysfunctions in patients with asthma and chronic obstructive pulmonary disease (COPD): possible associations with inflammation markers: a pilot study

Psychiatric symptoms of anxiety, depression and cognitive dysfunction often occur in patients suffering from somatic conditions such as asthma and chronic obstructive pulmonary disease (COPD) which constitute a major and growing public health problem. In the present study we therefore aimed at analyzing depressive symptoms as well as symptoms of anxiety and cognitive problems in patients with mild to moderate asthma and COPD. 59 participants—17 with asthma, 24 with COPD and 18 healthy controls were enrolled. Depressiveness was assessed with the beck depression inventory (BDI); anxiety symptoms were measured with the State-Trait Anxiety Inventory Part 1 and 2, and cognitive function levels were estimated with the Trail Making Test Part A and B. A score above the threshold indicative for depression was found by 33xa0% (nxa0=xa08) of COPD patients, 29xa0% (nxa0=xa05) of asthma patients compared to 0.05xa0% (nxa0=xa01) of the control group. Clinically relevant anxiety levels were found in 42xa0% (nxa0=xa010) of the COPD group, 41xa0% (nxa0=xa07) of the asthma patients and 17xa0% (nxa0=xa03) of the controls. Patients with COPD performed significantly worse on the TMT than other groups. Psychoemotional state and cognitive functions were found to be correlated with exposure to tobacco smoke (measured in pack-years) and airway obstruction (measured with FEV1). In conclusion, patients with mild to moderate asthma and COPD exhibit significantly higher levels of depressive and anxiety symptoms as well as cognitive dysfunctions than controls. The prevalence of these symptoms is related to the amount of exposure to tobacco smoke and the severity of airflow obstruction.

Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE Study

Chronic obstructive pulmonary disease (COPD) represents a major health problem in Central and Eastern European (CEE) countries; however, there are no data regarding clinical phenotypes of these patients in this region. Participation in the Phenotypes of COPD in Central and Eastern Europe (POPE) study was offered to stable patients with COPD in a real-life setting. The primary aim of this study was to assess the prevalence of phenotypes according to predefined criteria. Secondary aims included analysis of differences in symptom load, comorbidities and pharmacological treatment. 3362 patients with COPD were recruited in 10 CEE countries. 63% of the population were nonexacerbators, 20.4% frequent exacerbators with chronic bronchitis, 9.5% frequent exacerbators without chronic bronchitis and 6.9% were classified as asthma–COPD overlap. Differences in the distribution of phenotypes between countries were observed, with the highest heterogeneity observed in the nonexacerbator cohort and the lowest heterogeneity observed in the asthma–COPD cohort. There were statistically significant differences in symptom load, lung function, comorbidities and treatment between these phenotypes. The majority of patients with stable COPD in CEE are nonexacerbators; however, there are distinct differences in surrogates of disease severity and therapy between predefined COPD phenotypes. Distinct phenotypes of COPD in Central and Eastern Europe have differences in symptoms, comorbidities and treatment http://ow.ly/oMZI307ndr5

Interleukin 17 and RANTES levels in induced sputum of patients with allergic rhinitis after a single nasal allergen challenge.

BACKGROUNDnInterleukin 17 (IL-17) is produced by T(H)17 cells and was recently implicated in the development of the T(H)2 cell response. RANTES (regulated on activation of normal T cells expressed and secreted), among other chemokines, plays a crucial role in chemotaxis of eosinophils into airway mucosa. According to the united airway hypothesis, markers of inflammation in allergic diseases are elevated in the upper and lower airways.nnnOBJECTIVEnTo assess the impact of a single nasal allergen challenge on IL-17 and RANTES levels in induced sputum of patients with allergic rhinitis (AR).nnnMETHODSnEighteen patients with a history of AR due to grass pollen confirmed by positive skin prick test results and 10 control subjects entered the study. Initially, all the patients underwent sputum induction. A single nasal placebo challenge was performed 24 hours later, with repeated sputum induction 24 hours after challenge. After 4 weeks of washout, these procedures were repeated with allergen challenge. Differential cell counts in sputum were determined, and concentrations of IL-17 and RANTES were measured by means of enzyme-linked immunosorbent assay.nnnRESULTSnLevels of IL-17 and RANTES significantly increased in sputum of patients with AR after allergen (but not placebo) challenge (P = .03 and P = .007, respectively). Postallergen levels of both cytokines in sputum were positively correlated (r = 0.570, P = .02). Allergen challenge led to increased total inflammatory cell (P = .005) and eosinophil (P = .03) counts in induced sputum of patients with AR.nnnCONCLUSIONSnNasal allergen challenge induces the enhanced secretion of IL-17 and RANTES in the lower airways of nonasthmatic patients with AR.

POPE study: rationale and methodology of a study to phenotype patients with COPD in Central and Eastern Europe

Introduction Chronic obstructive pulmonary disease (COPD) constitutes a major health challenge in Central and Eastern European (CEE) countries. However, clinical phenotypes, symptom load, and treatment habits of patients with COPD in CEE countries remain largely unknown. This paper provides a rationale for phenotyping COPD and describes the methodology of a large study in CEE. Methods/design The POPE study is an international, multicenter, observational cross-sectional survey of patients with COPD in CEE. Participation in the study is offered to all consecutive outpatients with stable COPD in 84 centers across the CEE region if they fulfill the following criteria: age >40 years, smoking history ≥10 pack-years, a confirmed diagnosis of COPD with postbronchodilator FEV1/FVC <0.7, and absence of COPD exacerbation ≥4 weeks. Medical history, risk factors for COPD, comorbidities, lung function parameters, symptoms, and pharmaceutical and nonpharmaceutical treatment are recorded. The POPE project is registered in ClinicalTrials.gov with the identifier NCT02119494. Outcomes The primary aim of the POPE study was to phenotype patients with COPD in a real-life setting within CEE countries using predefined classifications. Secondary aims of the study included analysis of differences in symptoms, and diagnostic and therapeutic behavior in participating CEE countries. Conclusion There is increasing acceptance toward a phenotype-driven therapeutic approach in COPD. The POPE study may contribute to reveal important information regarding phenotypes and therapy in real-life CEE.

GOLD 2017 on the way to a phenotypic approach? Analysis from the Phenotypes of COPD in Central and Eastern Europe (POPE) Cohort

Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) released a revised consensus report (2017 GOLD Report) [1] in which the formerly defined ABCD classification of patients with COPD has been refined. The 2011 GOLD Report and its 2016 Update classified patients on the basis of three variables, i.e. the symptom burden, lung function impairment and exacerbations [2], now the A–D groups are defined solely on the basis of symptoms and history of exacerbations – thus recognising the limitations of the forced expiratory volume in 1 s (FEV1) in influencing therapeutic decisions in COPD [1]. The obvious consequence of the new classification is a shift of a proportion of patients from the C to the A group, and from the D to the B group. Nevertheless, the magnitude of such redistribution remains unknown. The distribution of patients based on exacerbations solely is the most profound consequence of the 2017 GOLD Report http://ow.ly/4UJa309fLbM

Inhalation Techniques Used in Patients with Respiratory Failure Treated with Noninvasive Mechanical Ventilation

The administration of aerosolized medication is a basic therapy for patients with numerous respiratory tract diseases, including obstructive airway diseases (OADs), cystic fibrosis (CF), and infectious airway diseases. The management and care for patients requiring mechanical ventilation remains one of the greatest challenges for medical practitioners, both in intensive care units (ICUs) and pulmonology wards. Aerosol therapy is often necessary for patients receiving noninvasive ventilation (NIV), which may be stopped for the time of drug delivery and administered through a metered-dose inhaler or nebulizer in the traditional way. However, in most severe cases, this may result in rapid deterioration of the patients clinical condition. Unfortunately, only limited number of original well-planned studies addressed this problem. Due to inconsistent information coming from small studies, there is a need for more precise data coming from large prospective real life studies on inhalation techniques in patients receiving NIV.

Vitamin D status of severe COPD patients with chronic respiratory failure

INTRODUCTIONnThe aim of the study was to measure the concentrations of vitamin D in serum of COPD patients with chronic respiratory failure in comparison to healthy control group. The correlation between the levels of vitamin D in serum and the selected clinical, spirometric and blood gas parameters was the additional aim of the study.nnnMATERIAL AND METHODSnThe study included 61 patients with diagnosed COPD in stadium of chronic respiratory failure (45 men and 16 women) and 37 healthy controls (19 men and 18 women). The following procedure were performed in all studied subjects: detailed history (especially: daily activity, diet, tobacco and alcohol use), post-bronchodilator spirometry, assessment of 25(OH)D in serum and for COPD group only blood gas analysis. Recruitment for the study was conducted from November to April. Statistical analysis was performed using the following statistical methods: t-Student test, Mann-Whitney U test, Spearman correlation test and Chi-kwadrat test.nnnRESULTSnThere was no significant differences between COPD and control group for the levels of 25(OH)D in serum. Median and lower; upper quartile were respectively following: 24,75 nmol/l (16,9; 36,4) vs. 24,06 nmol/l (16,3; 37,2), p=0,69. Vitamin D deficiency was present in 60 COPD patients (98,3% of all patients) and in 36 control group subject (97,3% of all healthy volunteers). The difference was not statistically significant. The levels of vitamin D in serum did not significantly correlated with any of studied parameters (spirometry, blood gas, age, the level of activity, BMI, tobacco smoke exposure and others). However, the level of activity in COPD group correlated positively with spirometry values and negatively with age and number of exacerbations.nnnCONCLUSIONnThe results of the study showed that in autumn-winter time in Poland there are very frequent deficiency of vitamin D in serum not only in COPD patients in respiratory failure stage but also in elderly healthy persons. However, in contrary to expectations the deficiency of vitamin D in COPD patients with respiratory failure were similar to that seen in healthy persons.