Ewa Sozańska

Vitamin D status of severe COPD patients with chronic respiratory failure

INTRODUCTION The 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. MATERIAL AND METHODS The 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. RESULTS There 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. CONCLUSION The 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.

Bronchial hyperreactivity in perimenstrual asthma is associated with increased Th-2 response in lower airways

BACKGROUND Perimenstrual asthma (PMA) is a commonly observed, usually difficult-to-treat asthma phenotype. The mechanisms underlying this phenomenon remain unexplained. The aim of the study was to assess the degree of airway hyperresponsiveness and its relationship to proinflammatory cytokines concentration in lower airways of PMA compared to non-PMA patients. METHODS Premenopausal women with regular menstrual cycles diagnosed as: PMA (n=12), non-PMA asthmatics (n=9), and healthy controls (n=10) were prospectively followed for 10 weeks over two consecutive menstrual cycles. The bronchial responsiveness (BR) test to methacholine was performed in each subject prior to the study. The serum for total immunoglobulin E (IgE) concentrations was taken and sputum was induced in the 26th day of each of the two cycles. Sputum concentration of eotaxin, IL-4 and IL-10 were measured by ELISA. RESULTS Levels of BR to metacholine as well, as total blood IgE concentrations in PMA subjects were significantly higher than in non-PMA asthmatics and healthy controls (P=0.001, P=0.022 respectively) and correlated with each other (P=0.030; r =-0.65). Sputum eotaxin and IL-4 concentrations in luteal phase were increased in PMA patients when compared with non-PMA asthmatics (P=0.016; P=0.041, respectively) and healthy subjects (P<0.001 both cytokines). No differences for the sputum levels of IL-10 among studied groups were seen. CONCLUSIONS BR level in perimenstrual asthma is higher than in non-PMA asthmatics and correlates with increased total IgE serum concentration. The increased level of BR in PMA patients is associated with a shift in the type-1/type-2 cytokine balance toward a type-2 response.

Lung-heart clinical crosstalk in the course of COPD exacerbation

INTRODUCTION COPD exacerbation is a life-threatening condition with acute dyspnoea caused by respiratory or circulatory distress. The significance and co-presence of lung hyperinflation, bronchial obstruction, and changes in haemodynamics in the course of COPD exacerbation treatment have not been well described yet in course of a single study. Our aim was to evaluate the influence of COPD exacerbation treatment on bronchial obstruction, pulmonary hyperinflation, and possible changes of right and left ventricle haemodynamics in relation to the patients clinical status. MATERIAL AND METHODS A total of 40 patients (90% males), 67 ± 8 years old, with COPD were assessed pre- and post-exacerbation treatment by the following: respiratory function tests, transthoracic echocardiography, 6MWT, endothelin-1 (ET-1) and NT-proBNP serum concentrations, and MRC scale. RESULTS A significant decrease in RV%TLC (%) and mean pulmonary artery pressure (PAPmean) [mm Hg] was observed: pre -RV%TLC: 64.3 ± 9.0; post-RV%TLC 60.6 ± 11.1; p = 0.03; pre-PAPmean: 41.2 ± 11.2; post-PAPmean: 39.1 ± 12.1; p = 0.029, coupled with a significant increase of FEV1 [L]-preFEV1: 1.0 ± 0.4, post-FEV1: 1.2 ± 0.5; p < 0.001. A trend for reduced right ventricle systolic pressure (RVSP) [mm Hg]: pre-treatment: 44.5 ± 12.9; post-treatment: 36.3 ± 14.3; p = 0.068 and ET-1 [fmol/ml]: pre-treatment: 1.7 ± 2.8; post-treatment: 1.3 ± 1.9; p = 0.076, but not for NT-proBNP was noticed. Improvement of both, 6MWT [m]: pre-treatment: 294 ± 132; post-treatment: 415 ± 102; p < 0.001 and MRC [pts.]: pre-treatment: 3.3 ± 0.8; post-treatment: 1.8 ± 0.9; p < 0.001, were noticed. 6MWT correlated with RV%TLC (p < 0.05; r = -0.46; r = -0.53; respectively) and FEV1 (p < 0.05; r = 0.55; r = 0.60, respectively) on admission as well as on discharge. There was no such correlation with RVSP or PAPmean. CONCLUSIONS Pulmonary hyperinflation and bronchial obstruction may be reduced by effective COPD exacerbation treatment and are accompanied by clinical improvement. The mPAP reduction observed in the course of treatment was not correlated with the results of 6MWT and MRC score.