Despina Papakosta

Exercise capacity in idiopathic pulmonary fibrosis: the effect of pulmonary hypertension.

Background and objective:  Increased pulmonary arterial pressure (PAP) usually coexists with impaired lung function in IPF. Data on the effect of pulmonary hypertension (PH) on cardiopulmonary responses during exercise in IPF patients is very limited. We sought to investigate the impact of PH on exercise capacity and the correlation between systolic PAP (sPAP) and pulmonary function testing, as well as cardiopulmonary exercise parameters, in patients with IPF and PH.

Pulmonary Hypertension in Idiopathic Pulmonary Fibrosis: A Review

Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse parenchymal disease with a poor prognosis. Pulmonary hypertension (PH) often complicates the course of IPF and may even be found in patients with preserved lung function. Possible pathogenetic mechanisms of PH in IPF include vascular destruction, pulmonary hypoxic vasoconstriction and vascular remodeling due to overexpression of cytokines and growth factors. PH in IPF patients is associated with decreased exercise capacity and a worse prognosis. Due to its prognostic significance, it seems important to investigate for PH in these patients. As the symptoms of PH in IPF are nonspecific, the development of PH in a patient with known IPF can be easily overlooked. Noninvasive methods provide clues for the diagnosis, but their sensitivity is limited. Doppler echocardiography is a useful tool for the detection of PH which also provides additional information regarding associated cardiac abnormalities. However, right heart catheterization remains the gold standard diagnostic test. Therapeutic options for PH in IPF are limited. Long-term oxygen administration for the correction of hypoxemia should be recommended. The availability of new pharmacological agents in the treatment of PH has raised the possibility of therapy in patients with IPF and associated PH. Whether these PH-targeted therapies may be of benefit in this patient group, in terms of improving functional outcomes and survival, remains uncertain.

Asthma Control Test Is Correlated to FEV1 and Nitric Oxide in Greek Asthmatic Patients: Influence of Treatment

Background. Asthma is a common chronic disease affecting patients’ health status and quality of life. Although recent guidelines focus on asthma control, asthma remains poorly controlled in many patients even under specialist care. Asthma Control Test™ (ACT) is a short, simple, patient-based tool that provides consistent assessment of asthma. Objective. The aim of this study was to estimate the relationship of ACT with objective measures of lung function and inflammation such as forced expiratory volume in 1st second (FEV1) and exhaled nitric oxide (FeNO) in outpatients admitted for initial diagnosis of asthma and at follow-up. Methods. One hundred and sixty (104 women and 56 men, mean age 39.7 ± 16.6 years) asthmatic patients with newly diagnosed asthma were included in the study. Patients completed the ACT questionnaire and underwent a detailed clinical examination, FeNO measurement, and prebronchodilator spirometry before (visit 1) and 4–12 weeks after initiation of treatment (visit 2). Results. At visit 1, the mean ACT score was 21.27 ± 3.74. According to ACT score, 37 patients (23.1%) were completely controlled, 85 patients (53.1%) were partly controlled, and 38 patients (23.8%) were uncontrolled. Patients with uncontrolled asthma had statistically higher FeNO values than patients with partly controlled (p = .038) and completely controlled asthma (p = .016). ACT score was found to have a positive correlation with prebronchodilator %FEV1 (r = 0.177, p = .025) and negative correlation with FeNO ( r = −0.211, p = .007). At visit 2, the mean ACT score was 23.00 ± 2.19. The change in ACT score between the two visits was significantly correlated to changes in FEV1 (r = 0.538, p < .001) and in FeNO (r = −0.466, p < .001). Patients treated with inhaled corticosteroids (ICSs) showed significant improvement in FEV1 and in ACT score and a decrease in FeNO compared with patients without ICS treatment. Conclusion. Although FEV1 remains the main objective parameter for evaluating asthma, ACT score was found to reflect lung function and inflammation in a Greek asthmatic population.

Hydrocarbon pneumonitis following liquid paraffin aspiration during a fire-eating performance: a case report

IntroductionHydrocarbon pneumonitis is an acute, intense pneumonitis resulting from aspiration of volatile hydrocarbon compounds with low viscosity and surface tension, most of which are members of the paraffin, naphthene and aromatic classes.Case presentationSix hours after participating in a party for teenagers, a 16-year-old boy developed dyspnea, cough, a fever (39°C) and chest pain. A chest radiograph showed infiltration in the right middle lobe. The patient reported alcohol abuse during the party and an episode of vomiting a few hours thereafter. He also reported practicing a fire-eating performance at the party using liquid paraffin, but was unaware of inhaling any of it. The radiographic infiltration was diagnosed as an aspiration pneumonia and he was treated at the local health center with antibiotics. Five days later, because of clinical deterioration, he was referred to a pulmonary clinic. A chest computed tomography scan was performed which showed consolidation with an air bronchogram in the right middle lobe and areas of atelectasis and ground glass opacities in the middle and lower right lobes. Spirometry revealed severe restriction of lung function. A bronchoscopy revealed inflamed, hyperemic mucosa. Bronchoalveolar lavage fluid revealed lipid-laden alveolar macrophages, which were detected by lipid staining, and neutrophilia. The patient was finally diagnosed with hydrocarbon pneumonitis and he was treated with systemic steroids and antibiotics. After 6 days of treatment there was complete clinical and significant radiologic regression.ConclusionHydrocarbon pneumonitis should be included in the differential diagnosis of pneumonias. Recent exposure to volatile hydrocarbons provides a basis for clinical diagnosis, as symptoms and radiologic findings are not specific.

Allergic conjunctivitis and the most common allergens in Northern Greece

BackgroundOcular allergies affect a great part of the general population and often co exist with other allergic manifestations. In the present study, the prevalence of allergic conjunctivitis and the commonest allergens in allergic patients at an outpatient unit in Thessaloniki, Greece were evaluated.MethodsThis is a retrospective study regarding allergic patients who referred to an outpatient clinic between the 1st of January of 1996 and the 31st of December 2010. They completed relative questionnaires concerning their allergic condition. The patients who were included in our study had allergic conjunctivitis confirmed by ophthalmologists and were divided into 4 groups. The criteria used were the existence of allergic conjunctivitis alone or with other allergic co- morbidities. The patients then underwent skin prick tests after consent according to current guidelines.ResultsThe archives of 1239 allergic patients were evaluated and 497 patients (40,11%) who manifested eye allergic symptoms were included in our study. 448 patients (90.14%) had allergic conjunctivitis in conjunction with asthma or rhinitis or both. 370 patients underwent skin prick tests and 284 of them (124 males-160 females) were positive for at least 1 of the 8 tested allergens (76.75%). 166 were positive to a grass mix (58.45%), 130 to olea European (45.77%), 124 to dust mites mix (43.66%), 58 to cypress (20.42%), 71 to parietaria officinalis (25.00%), 67 to cat dander (23.59%), 35 to dog dander (12.32%) and 32 to Altenaria (11.26%).ConclusionsSymptoms of ocular allergy are very common in patients with allergic rhinitis and asthma. Men had slightly higher percentages of positive skin prick tests, except for dog dander and Altenaria. Conjunctivitis should not be overlooked as an allergic entity when evaluating allergic patients.

Influence of Pindolol on Asthmatics and Effect of Bronchodilators

Bronchospasm is a known side effect of the administration of beta-blockers to asthmatics. The purpose of this study was to investigate the frequency of bronchospasm caused by the administration of relatively low doses (2.5-7.5 mg) of pindolol, a beta-blocker with intrinsic sympathetic activity (ISA) to asthmatics, the severity of the bronchospasm and its reversibility and the probable correlations of bronchial asthma (BA) characteristics (severity, duration, allergy and airway hyperreactivity) with existing or nonexisting bronchospasm. Seventeen asthmatic patients: 10 men and 7 women, with a mean age of 44 +/- 10 years, participated in this study. The duration and severity of BA, the presence of allergy determined by skin tests and the bronchial hyperreactivity to methacholine inhalation challenge were observed on the first day of study. On the following days, the respiratory function parameters forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), and the pulse rate were measured before and 30, 60 and 90 min after the administration of placebo and pindolol. Then salbutamol was administered by a dosimetric aerosol (DA) at the usual dosage (200 micrograms) and the change in FEV1 was observed at 60 min; thereafter 40 micrograms of ipratropium bromide (IB) were administered by DA and FEV1 was measured after 60 min. Pindolol was administered gradually by mouth (2.5 mg every 30 min), the maximal total dose being 7.5 mg. Administration of pindolol caused a significant fall of FEV1 of 12 +/- 11% compared to placebo. A significant total decrease of FEV1 (greater than or equal to 20% of baseline) was observed in 9 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-Term Prognosis of Asthma Is Good—A 12-Year Follow-Up Study. Influence of Treatment

The number of studies on the prognosis of bronchial asthma (BA) is rather limited. The aim of the study was to determine the evolution of BA in a long-term 12-year follow-up and to investigate possible contributing factors. One hundred and sixty-three patients who visited the Out-patient Clinic for BA from1989 to1993 (Visit 1) were included in the study. They were re-evaluated during 2003–2005 (Visit 2). At both visits, the patients filled in a special questionnaire, underwent skin tests, spirometry, methacholine challenge and they were classified into three severity groups according to GINA of 1992 as: Mild, Moderate, and Severe asthma. At Visit 1, 95 (58.3%) patients were classified in the mild asthma group, 45 (27.6%) in moderate and 23 (14.1%) in severe; whereas at Visit 2, 107 (65.6%) patients had mild asthma, 44 (27%) moderate and 12 (7.4%) severe. At Visit 1 asthma severity was associated with male gender, younger age, and the absence of rhinitis. At Visit 2 on the other hand, asthma severity was associated with older age, longer duration of disease, smoking and again the absence of rhinitis and increased BHR at both visits. Inhaled corticosteroid use correlated with improvement in lung function. Long-term prognosis of BA was good and outcome was favorably influenced by male gender, early and mild onset of disease, absence of smoking and presence of rhinitis.

Ozone exposure assessment for children in Greece - Results from the RESPOZE study

Ozone exposure of 179 children in Athens and Thessaloniki, Greece was assessed during 2013-2014, by repeated weekly personal measurements, using passive samplers. O3 was also monitored at school locations of participants to characterize community-level ambient exposure. Average personal concentrations in the two cities (5.0 and 2.8ppb in Athens and Thessaloniki, respectively) were considerably lower than ambient concentrations (with mean personal/ambient ratios of 0.13-0.15). The temporal variation of personal concentrations followed the -typical for low-latitude areas- pattern of cold-warm seasons. However, differences were detected between temporal distributions of personal and ambient concentrations, since personal exposures were affected by additional factors which present seasonal variability, such as outdoor activity and house ventilation. Significant spatial contrasts were observed between urban and suburban areas, for personal concentrations in Athens, with higher exposure for children residing in the N-NE part of the area. In Thessaloniki, spatial variations in personal concentrations were less pronounced, echoing the spatial pattern of ambient concentrations, a result of complex local meteorology and the smaller geographical expansion of the study area. Ambient concentration was identified as the most important factor influencing personal exposures (correlation coefficients between 0.36 and 0.67). Associations appeared to be stronger with ambient concentrations measured at school locations of children, than to those reported by the nearest site of the air quality monitoring network, indicating the importance of community-representative outdoor monitoring for characterization of personal-ambient relationships. Time spent outdoors by children was limited (>90% of the time they remained indoors), but -due to the lack of indoor sources- it was found to exert significant influence on personal concentrations, affecting inter-subject and spatiotemporal variability. Additional parameters that were identified as relevant for the determination of personal concentrations were indoor ventilation conditions (specifically indoor times with windows open) and the use of wood-burning in open fireplaces for heating as an ozone sink.

Bronchoalveolar lavage fluid and blood natural killer and natural killer T-like cells in cryptogenic organizing pneumonia.

Natural killer (NK) cells appear to be involved in the development of interstitial lung diseases (ILD). The purpose of this study was to investigate the involvement of NK and natural killer T (NKT)‐like cells in two recognized cytotoxic ILD with systemic character, hypersensitivity pneumonitis (HP) and cryptogenic organizing pneumonia (COP), compared with idiopathic pulmonary fibrosis (IPF) and controls.

Spirometry values in a Greek population: Is there an appropriate reference equation?

Background and objective:  Most published reference values for lung function test (LFT) parameters introduce systematic bias. The aim of this study was to compare measured values of FEV1 and FVC with the corresponding normal predicted values in a Greek population, and to produce reference equations for LFT parameters in this population.