Szymon Skoczynski

Short-term continuous positive airway pressure therapy reverses the pathological influence of obstructive sleep apnea on blood rheology parameters

Our aim was to analyze rheological properties of blood and plasma in patients (n=31) with obstructive sleep apnea (OSA) before and after five nights of continuous positive airway pressure (CPAP) therapy as compared with a well-matched control group (n=19). Rheology measurements included blood viscosity, plasma viscosity, erythrocyte elongation and erythrocyte deformability variables specific to the aggregation process. The mean whole blood viscosity of the OSA groups was 18.6% higher than that of the control group (P<0.001), plasma viscosity was 7.2% higher (P<0.001), and the blood count was 6% higher (P<0.001). The corrected viscosity of the OSA group was elevated 6.6% (P<0.05) and the aggregation index was 9.3% higher (P<0.05) relative to the control group. Aggregation half-time of the OSA group was 23.5% shorter than that of the control group (P<0.05). Following CPAP therapy, the rheological variables of the OSA group were significantly reduced: whole blood viscosity was 10.5% lower (P<0.001), plasma viscosity was 4.1% lower (P<0.05), corrected blood viscosity was 4.8% lower (P<0.05), and the aggregation index was 7% lower (P<0.05), while the aggregation half-time was increased 25.4% (P<0.05). There were significant correlations between rheologic and polysomnographic variables for the OSA group. Therefore, five consecutive nights of CPAP therapy improved blood rheological properties in patients with OSA. These findings may help to determine cardiovascular prognoses in these patients.

The use of iloprost in the treatment of ‘out of proportion’ pulmonary hypertension in chronic obstructive pulmonary disease

Case Pulmonary hypertension secondary to respiratory disease most often occurs as a complication of chronic obstructive pulmonary disease, which currently constitutes one of the leading causes of death. Some patients with hypoxaemia reveal “out of proportion” pulmonary hypertension with inappropriate increase of pulmonary artery pressure. Iloprost, analogue of prostacyclin, dilates systemic vessels and pulmonary vessels in particular if administered by inhalation. It appears to be important, life-saving, complementary therapy. However, there is no evidence for its routine use in out of proportion arterial pulmonary hypertension. This case study presents a 44-year old man with chronic obstructive pulmonary disease and “out of proportion” pulmonary hypertension. We present the results of his treatment with iloprost. Conclusion In a patient with “out of proportion” pulmonary hypertension due to chronic obstructive pulmonary disease, inhaled iloprost led to improvement in clinical status and echocardiographic parameters, including a reduction of right ventricular systolic pressure.

Doing Science: Writing conference abstracts

In this edition of Doing Science, we will address abstract writing, with a focus on conference abstracts. By providing an opportunity for discussing your work with your peers in specialised meetings, writing and submitting an abstract is often the very first step when you want to show the world the results of your work; be it your research, a clinical case or a review of the literature [1]. However, it can be be a daunting task to condense hours and hours of hard work into abstract format. But fear not! This edition of Doing Science will give you several approaches to writing abstracts, using your own data as well as that of others. Before we begin, a key message: always remember that writing an abstract follows typically the same path as writing a paper [2]. Begin by planning it, before actually writing it, proofreading it, sharing it with colleagues and finally doing the final revision and editing before you submit. In most cases, the keys to success are an important research question and interesting material to analyse in the hope of answering it. That being said, good abstract writing skills will increase your acceptance rate even for data of moderate importance, or seemingly complicated research ideas. So let’s begin... As every researcher knows, the function of a scientific abstract is to provide an overview of your work. But keep in mind that the abstract is what the referees will use to decide whether your work is accepted or rejected for presentation on the meeting. Also, have you remembered that the abstract is the only part of a paper that is published in conference proceedings [3]? Many researchers will even acknowledge that when they scroll through a conference programme, they look only at the titles …

HERMES European Accreditation of Training Centres in Adult Respiratory Medicine: criteria validation and revision.

Four respiratory medicine disease categories appear in the global top 10 causes of mortality [1], resulting in 600 000 people dying from respiratory disease in Europe each year. The economic burden of respiratory diseases in Europe exceeds 380 billion euros. In a fast-developing environment, new clinical challenges have arisen for pulmonary specialists; techniques and procedures have evolved and become more complex.

News from the Underground: What were the most important scientific/clinical take-home messages for juniors?

The ERS International Congress has traditionally been a splendid opportunity to present current updates in clinical respiratory medicine and new research findings. This year’s programme was packed, making it impossible to attend all sessions, but juniors interested in specific fields were there for you to highlight the most important take home messages from the 2014 ERS International Congress in Munich. Amongst the most important news for the clinicians was the publication of a Global Initiative for Asthma (GINA) guidelines update [1]. In the updated guidelines, the heterogeneity of asthma is emphasised, suggesting the need of “4P” (Personalised, Predictive, Preventive and Participatory) treatment regimes. Another clinically important issue recognised in GINA and the Global Initiative for Obstructive Lung Disease (GOLD) guidelines [2], is asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS). ACOS has a special pathophysiological and clinical characteristic and large-scale studies have been initiated to investigate it. In the future of individualised medicine, validated biomarkers are urgently required that can assist in the correct phenotyping of lung diseases and may help to predict treatment responsiveness. A huge number of novel molecules has been introduced for the treatment of airway disorders. The presented studies clearly highlighted the priorities of future research topics, namely the need to investigate methodological and physiological factors and to cross-validate biomarker studies between different centres in large cohorts of subjects. A number of sessions at Munich showed that epidemiology and environmental exposure are vital factors in translational research. The biggest buzz was surrounding the Sunday Grand Round session “Chemicals made to harm”. New …

Novel method of noninvasive ventilation supported therapeutic lavage in pulmonary alveolar proteinosis proves to relieve dyspnea, normalize pulmonary function test results and recover exercise capacity: a short communication

Whole lung lavage (WLL) under general anesthesia with a double-lumen endobronchial intubation has remained standard treatment option for pulmonary alveolar proteinosis (PAP) for over fifty years now. To the best of our knowledge, this is the first description of noninvasive ventilation (NIV) as an innovative alternative, which enables safe and effective treatment. NIV support enabled cost-effective lavage of the most affected segments and resulted in restoration and long-term maintenance of exercise capacity and diffusion, without WLL related hypoxaemia, volume overload, intubation, or mechanical ventilation related complications. The study presents all details of performed procedure, including anesthesia, NIV technique and bronchoscopy, therefore this may be easily implemented into clinical practice at other centers conducting PAP treatment. We assume that presented technique of therapeutic lung lavage (TLL) with NIV support may be considered a novel PAP treatment method, however, target population who will benefit the most from such therapy modification must be assessed in large scale prospective trials.

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.

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.

Intensive care unit patients with lower respiratory tract nosocomial infections: The ENIRRIs project

The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI. This article describes the methodology of this study. A specific interest is the clinical impact of non-ICU-acquired nosocomial pneumonia requiring ICU admission, non-ventilator-associated LRTIs occurring in the ICU, and ventilator-associated tracheobronchitis. The clinical meaning of microbiologically negative infectious episodes and specific details on antibiotic administration modalities, dosages and duration are also highlighted. Recently released guidelines address many unresolved questions which might be answered by such large-scale observational investigations. In light of the paucity of data regarding such topics, new interesting information is expected to be obtained from our network research activities, contributing to optimisation of care for critically ill patients in the ICU. Methodology for the first European network for ICU-related respiratory infections (ENIRRIs) project http://ow.ly/sud930fU1e7

Impact of Comorbidities on Noninvasive Mechanical Ventilation Response: Key Practical Implications

Comorbidities play an important role in noninvasive mechanical ventilation (NIV) treatment, response, and safety. In real life in clinics, the presence of potentially dangerous comorbidities is frequent, but this problem is poorly addressed in the literature. The aim of this chapter is to revise the key practical implications of respiratory and non-respiratory comorbidities for NIV in respiratory failure treatment.