Eleni Karetsi

COPD prevalence and the differences between newly and previously diagnosed COPD patients in a spirometry program.

AIMS To evaluate the prevalence and severity of COPD in a primary care population participating in a spirometry program. Differences between newly and previously diagnosed COPD patients were identified. METHODS A spirometry program was conducted in 15 primary care centres. Visitors aged over 30 years who were willing to perform spirometry were included in this program. RESULTS A total of 1,526 subjects provided acceptable spirometries. COPD prevalence in our population was 18.4%, of whom 69.0% were newly diagnosed. Most patients were classified as GOLD stages I and II (26.0% and 54.0%, respectively). COPD diagnosis was related to gender (men), age (older subjects), history of repeated respiratory infection in childhood, smoking (>10 pack-years) and presence of symptoms (cough, dyspnoea, wheezing). Variables related to newly diagnosed COPD were younger age and absence of chronic cough. CONCLUSIONS A primary care spirometry program may identify a large proportion of undiagnosed COPD patients especially in the early stages of the disease. Newly diagnosed COPD patients were of younger age and presented with less symptoms. These results support the need for spirometry programs in primary care for early COPD detection.

One-year non-invasive ventilation in chronic hypercapnic COPD: Effect on quality of life

The data on long-term application of non-invasive ventilation (NIV) in patients with chronic respiratory failure due to COPD are contradictory. We evaluated the effect of the addition of NIV to optimal treatment for 1 year on the quality of life of stable hypercapnic COPD patients. NIV was offered to 49 of 58 initially enrolled consecutive patients, of whom 22 refused NIV and comprised the standard treatment group whereas 27 received NIV. Quality of life was assessed with the SF-36 questionnaire. Additional measurements included blood gases, pulmonary function tests, dyspnea, daytime sleepiness, exacerbations and hospitalizations. The NIV group showed a significant improvement in quality of life in the third month, both in the Physical (31+/-4 to 38+/-8, p<0.0001) and the Mental Component Summary Score (28+/-7 to 40+/-10, p=0.009), that was maintained until the twelfth month. PaCO2 decreased by the first month in the NIV group (54+/-4.5 to 44.6+/-5.6 mmHg, p<0.0001), and PaO2 rose during the sixth month (58.9+/-5.7 to 64.4+/-6.5 mmHg, p=0.004). Dyspnea and diurnal sleepiness improved significantly. No significant improvements were observed in the control group. Patients on NIV spent less days in the hospital compared to controls. NIV when added to optimal medical treatment has beneficial effects on quality of life in stable hypercapnic COPD patients, with additional improvements in arterial blood gases, dyspnea and daytime sleepiness.

Noninvasive Ventilation in Chronic Respiratory Failure: Effects on Quality of Life

Background: Noninvasive ventilation (NIV) has been found to be an essential technique to treat chronic respiratory failure (CRF) resulting from restrictive thoracic disorders (RTD). The last decades were characterized by the expansion of NIV to treat patients suffering from various other conditions, such as chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS). Objectives: The aim of this study was to evaluate the effect of NIV on health-related quality of life (HRQoL) of patients with CRF during 2 years and to identify parameters associated with changes in HRQoL. Methods: Ninety-one patients with CRF [35 COPD; 17 RTD; 28 OHS; 11 neuromuscular diseases (NMD)] participated. HRQoL was assessed with the SF-36 questionnaire. Additional measurements included blood gases, pulmonary function tests, dyspnea, daytime sleepiness, exacerbations and hospitalizations. The patients were evaluated every 3–6 months. Results: Improvements in SF-36 physical component summary (PCS, p < 0.0001) and mental component summary (MCS, p < 0.0001) scores in RTD and MCS in OHS (p = 0.01) and COPD (p = 0.003) were observed by the third month. PCS in OHS and COPD patients improved by the sixth month (p = 0.003 and p < 0.0001, respectively). NMD patients did not present improvements in HRQoL. Improvements in HRQoL were associated with improvements in PaO2 and dyspnea in COPD patients, and with total hours of daily ventilator use, improvement in dyspnea, pressure support and expiratory positive airway pressure in RTD patients. Conclusion: Home NIV is consistently effective in improving HRQoL and physiological parameters in patients with CRF. Randomized trials to identify subgroups of COPD responders are justified by our results.

The Association of Metabolic Syndrome with Adipose Tissue Hormones and Insulin Resistance in Patients with COPD without Co-morbidities

Chronic obstructive pulmonary disease (COPD) and metabolic syndrome represent common causes of morbidity and mortality in ageing populations. The effect of the co-existence of COPD and metabolic syndrome on adipose tissue hormones and insulin resistance as well as the differences between COPD patients with and without metabolic syndrome have not been adequately studied. The prevalence of metabolic syndrome, based on Adult Treatment Panel III (ATP III) criteria, was evaluated in 114 male patients with COPD without significant co-morbidities. Pulmonary functions tests (PFTs), arterial blood gases, quality of life and BODE index were assessed. Blood samples were obtained for the assessment of adipose tissue hormones and insulin resistance. The overall prevalence of metabolic syndrome was 21%, being more prevalent in earlier stages of COPD. Patients with COPD and metabolic syndrome were younger with higher body-mass index (BMI), had better pulmonary function, less static hyperinflation and air-trapping, better diffusing capacity for carbon monoxide and BODE index. These patients had higher levels of leptin, lower levels of adiponectin and increased insulin resistance, as expressed by HOMA index, compared with patients without metabolic syndrome. Metabolic syndrome was more prevalent in younger patients with less severe COPD. These patients may constitute a specific COPD phenotype with greater leptin to adiponectin imbalance and insulin resistance, despite smaller impairment in PFTs. The prognosis and differences of these patients compared with other COPD phenotypes needs to be determined in prospective studies.

Smoking among adolescents in Northern Greece: a large cross-sectional study about risk and preventive factors

BackgroundThe aim of the present study was to investigate epidemiological data about cigarette smoking in relation with risk and preventive factors among Greek adolescents.MethodsWe randomly selected 10% of the whole number of schools in Northern Greece (133 schools, 18,904 participants were included). Two anonymous questionnaires (smokers and non-smokers) were both distributed to all students so they selected and filled in only one. A parental signed informed consent was obtained using an informative leaflet about adolescent smoking.ResultsThe main findings of the study were: a) 14.2% of the adolescents (mean age+/−SD: 15.3+/−1.7 years) reported regular smoking (24.1% in the age group 16–18 years), b) 84.2% of the current smokers reported daily use, c) students who live in urban and semirural areas smoke more frequently than those in rural areas, d) students in technically oriented schools smoke twice as frequent compared to those in general education, e) risk factors for smoking: male gender, low educational level of parents, friends who smoke (OR: 10.01, 95%CI: 8.53-11.74, p<0.001), frequent visits to internet cafes (OR:1.53, 95%CI: 1.35-1.74, p<0.001), parents, siblings (OR:2.24, 95%CI: 1.99-2.51, p<0.001) and favorite artist (OR:1.18, 95%CI: 1.04-1.33, p=0.009) who smoke, f) protective factors against smoking: participation in sports (OR:0.59, 95%CI: 0.53-0.67, p<0.001), watching television (OR:0.74, 95%CI 0.66-0.84, p<0.001) and influence by health warning messages on cigarette packets (OR:0.42, 95%CI: 0.37, 0.48, p<0.001).ConclusionsEven though prevalence of cigarette smoking is not too high among Greek adolescents, frequency of everyday cigarette use is alarming. We identified many social and lifestyle risk and preventive factors that should be incorporated in a national smoking prevention program among Greek adolescents.

Resting tension effect on airway smooth muscle: the involvement of epithelium.

We studied the influence of resting tension (RT) on rabbit tracheal smooth muscle (TSM) contractions induced by acetylcholine or KCl as well as the role of epithelium and the endogenously produced nitric oxide, prostanoids and endothelin on these responses. The alteration of RT from 0.5 to 2.5 g increased the responsiveness of TSM to KCl. The presence of atropine decreased KCl-induced contractions obtained only at 2.5 g RT. The removal of epithelium increased acetylcholine-induced contractions, only at 2.5 g RT. At 0.5 g RT, the presence of L-NAME had no effect on acetylcholine-induced contractions while indomethacin decreased contractions induced by 10(-3) M acetylcholine. At 2.5 g RT, the presence of L-NAME increased acetylcholine-induced contractions while indomethacin, BQ-123 and BQ-788 had no effect. These results demonstrate that RT affects the responsiveness of TSM differentially, depending on the agonist or integrity of the epithelium. Airway epithelium modulates acetylcholine-induced contractions, only at 2.5 g RT partly via NO release. At 0.5 g RT, the endogenous production of prostanoids by sources other than epithelium modulates the contractility of TSM to acetylcholine.

8-Isoprostane levels in serum and bronchoalveolar lavage in idiopathic pulmonary fibrosis and sarcoidosis

OBJECTIVE AND DESIGN Sarcoidosis and idiopathic pulmonary fibrosis (IPF) are both associated with deregulated inflammatory mechanisms partially triggered by aggravated oxidative stress. 8-Isoprostane has been proposed as a reliable marker of oxidative stress, linked to several pulmonary diseases. We aimed to explore differences in 8-isoprostane levels in IPF and sarcoidosis patients, and controls. METHODS We included 16 IPF and 55 sarcoidosis patients, as well as 17 controls in the study. 8-Isoprostane levels were measured in serum and in bronchoalveolar lavage (BAL). RESULTS Serum 8-isoprostane levels were increased in all patient groups vs controls (p<0.001). The systemic 8-isoprostane concentrations were higher in sarcoidosis patients as compared to IPF subjects and controls (p=0.017 and p<0.001, respectively). IPF patients exhibited increased serum 8-isoprostane levels when compared to controls (p<0.001). Sarcoidosis patients presented significantly increased 8-isoprostane BAL levels when compared to IPF patients (p=0.002). CONCLUSION Our data indicate that the level of oxidative stress, as reflected by 8-isoprostane concentrations, is enhanced in patients with sarcoidosis, and to a lesser extent, in IPF patients when compared to controls, suggesting a potential implication of redox imbalance in both diseases.

Differential expression of hypoxia-inducible factor 1α in non-small cell lung cancer and small cell lung cancer.

OBJECTIVES: The aim of this study was to compare the expression of hypoxia-inducible factor 1α and vascular endothelial growth factor in small cell lung cancer and subtypes of non-small cell lung cancer and examine their relationships with clinicopathologic factors, response to treatment and survival. METHODS: We examined samples obtained by bronchial endoscopic biopsy from 55 patients with inoperable lung cancer (16 with adenocarcinoma, 17 with squamous cell carcinoma, and 22 with small cell lung cancer). Hypoxia-inducible factor 1α and vascular endothelial growth factor were detected using immunohistochemistry. The diagnosis, treatment, and follow-up of patients were conducted according to the standard practice. RESULTS: A significant difference (p = 0.022) in hypoxia-inducible factor 1α expression was observed between non-small cell lung cancer (75.8% positive) and small cell lung cancer (45.5% positive). The frequency of hypoxia-inducible factor 1α nuclear expression was 88.2% in squamous cell carcinoma, 62.5% in adenocarcinoma, and 45.5% in small cell lung cancer. A significant correlation was observed between hypoxia-inducible factor 1α and vascular endothelial growth factor expression (Fishers exact test, p = 0.001) when all types of lung cancer were examined, either collectively or separately. CONCLUSIONS: The expression of hypoxia-inducible factor-1α differs significantly between subtypes of lung cancer. These findings could help elucidate the biology of the different types of non-operable lung carcinomas and have implications for the design of new therapeutic approaches for lung cancer.

Changes in Respiratory Parameters and Fin-Swimming Performance Following a 16-Week Training Period with Intermittent Breath Holding.

Abstract The purpose of this study was to examine the effects of training with intermittent breath holding (IBH) on respiratory parameters, arterial oxygen saturation (SpO2) and performance. Twenty-eight fin-swimming athletes were randomly divided into two groups and followed the same training for 16 weeks. About 40% of the distance of each session was performed with self-selected breathing frequency (SBF group) or IBH (IBH group). Performance time of 50 and 400 m at maximum intensity was recorded and forced expired volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and SpO2 were measured before and after the 50 m test at baseline and post-training. Posttraining, the respiratory parameters were increased in the IBH but remained unchanged in the SBF group (FEV1: 17 ±15% vs. -1 ±11%; FVC: 22 ±13% vs. 1 ±10%; PEF: 9 ±14% vs. -4 ±15%; p<0.05). Pre compared to post-training SpO2 was unchanged at baseline and decreased post-training following the 50 m test in both groups (p<0.05). The reduction was higher in the IBH compared to the SBF group (p<0.05). Performance in the 50 and 400 m tests improved in both groups, however, the improvement was greater in the IBH compared to the SBF group in both 50 and 400 m tests (p<0.05). The use of IBH is likely to enhance the load on the respiratory muscles, thus, contributing to improvement of the respiratory parameters. Decreased SpO2 after IBH is likely due to adaptation to hypoventilation. IBH favours performance improvement at 50 and 400 m fin-swimming.

Adolescent Finswimmers: Early Myocardial Adaptations in Different Swimming Styles

Background: The purpose of our study was to investigate early differences in the adolescent female finswimmers’ echocardiography parameters, possibly associated with different swimming-style training and different training equipment (monofin (MF) versus bifin (BF)). Method: Forty-three female finswimmers participated in our study (age: 15.6 ± 2.1 years, body mass index: 20.4 ± 2.2 kg/m2, body surface area: 1.56 ± 0.04 m2, body fat: 11.2 ± 0.6%) and were divided into two groups, according to the swimming style practiced (MF vs BF). Anthropometric characteristics, echocardiography and arterial pressure were measured. The independent t-test was used for statistical comparisons between groups. Stepwise multivariate regression analysis was applied to investigate associations between various variables. Results: The two groups used training equipment with different weights (p < 0.001). Female adolescent finswimmers presented signs of myocardial hypertrophy depicted by the increased left ventricle myocardial mass indexed to body surface area (101.34 ± 23.65). Different patterns of myocardial hypertrophy were observed for the two groups; MF swimmers presented concentric hypertrophy, while BF swimmers presented eccentric hypertrophy (relative wall thickness MF = 0.46 ± 0.08 vs BF = 0.39 ± 0.06 cm, p < 0.05). MF swimmers had also higher left ventricular posterior wall diameters (p < 0.05), lower stroke volume values (p < 0.05) and lower ejection fraction (p < 0.05) compared to BF athletes. Conclusion: Adolescent female finswimmers presented different patterns of myocardial hypertrophy possibly related to different training protocols and modes of exercise.