Tadeusz Przybyłowski

Incidence and aetiology of eosinophilic pleural effusion

Although eosinophilic pleural effusion (EPE) has been a subject of numerous studies, its clinical significance still remains unclear. The aim of our study was to evaluate: 1) the relative incidence and aetiology of EPE; 2) the predictors of malignancy in patients with EPE; and 3) the relationship between repeated thoracentesis and pleural fluid eosinophilia. A retrospective analysis of 2,205 pleural fluid samples from 1,868 patients treated between 1995 and 2007 was performed. We identified 135 patients with EPE (7.2% of all patients with pleural effusion) and 153 EPE samples. The most common condition associated with EPE was malignancy (34.8%) followed by infectious (19.2%), unknown (14.1%), post-traumatic (8.9%) and miscellaneous (23.0%) pleural effusions. The incidence of malignancy was significantly higher in patients with a lower (≤40%) pleural fluid eosinophil percentage. 40 patients with EPE underwent a second thoracentesis. In 16, eosinophilia was present in both pleural fluid samples, 14 revealed pleural fluid eosinophilia only after the second thoracentesis and 10 had eosinophilia only in the first pleural fluid sample. Pleural fluid eosinophilia should not be regarded as a predictor of nonmalignant aetiology. Probability of malignancy is lower in effusions with a high eosinophil percentage. The incidence of EPE in patients undergoing second thoracentesis is not different to that found during the first thoracentesis.

Pulmonary Toxicity of 1‐D Nanocarbon Materials

Abstract 1‐D (one‐dimensional) nanocarbon materials possess unique properties. However, they could become airborne and reach the lungs. In the present study the pulmonary toxicity of nanotubes was investigated. Guinea pigs were intratracheally instilled with different nanotubes and inflammatory response was measured. The results show that both the duration of exposure and material characteristics can affect the respiratory process and induce pathological reaction in lung tissue.

Comparing supplementary oxygen benefits from a portable oxygen concentrator and a liquid oxygen portable device during a walk test in COPD patients on long-term oxygen therapy

BACKGROUND Differences in oxygen delivery between portable oxygen concentrators (POC) and liquid oxygen (LO) portable units, pose a question if POCs are equally effective as LOs in reducing exercise-induced hypoxaemia. DESIGN Randomized, single-blind clinical trial. PATIENTS Thirteen COPD patients (means: age 66+/-11 year, FEV(1) 35.2+/-13.7% predicted) and respiratory failure (means: PaO2 52+/-5mmHg, PaCO2 51.3+/-7.5mmHg). METHODS All patients underwent a series of 6-min walk tests (6MWT) carried out in random order among one of the three devices: POC, LO cylinder and cylinder with compressed air (CA). Oxygen supplementation was 3lpm for LO and an equivalent to 3lpm in a pulse flow system for POC. RESULTS The mean SpO2 was equally improved at rest: 92.9+/-2.8% with POC and 91.7+/-2.0% with LO compared to CA-87.8+/-2.7% (POC and LO vs. CA p<0.05). POC and LO significantly improved oxygenation during 6MWT (mean SpO(2) was 84.3+/-5% and 83.8+/-4.2%, respectively) compared to breathing CA-77.6+/-7.4%, p<0.05. Mean 6MWT distance increased with LO (350+/-83m) and POC (342+/-96m) when compared to CA (317+/-84m), however, these differences were not statistically significant. Dyspnoea score assessed at the end of the exercise (Borg scale) was significantly lower when breathing oxygen (4.2+/-1.2 with POC and 4.1+/-1.7 with LO vs. 5.4+/-1.9 with CA, p<0.05). CONCLUSIONS Effectiveness of oxygen supplementation from a POC did not differ from the LO source during 6MWT in COPD patients with respiratory failure. Oxygen at 3lpm flow was not sufficient to prevent hypoxaemia during strenuous exercise.

Nontuberculous mycobacterial infections among patients suspected of pulmonary tuberculosis.

The purpose of this study was to present a retrospective analysis of the frequency of nontuberculous mycobacteria (NTM)-related pulmonary infections among the AFB-positive and/or culture-positive patients in the Warsaw region who were suspected of tuberculosis (TB) and hospitalized in the university hospital between 1999 and 2005. All the AFB-positive pulmonary samples were examined with a molecular method using the Amplicor MTB test (Roche) for detection of Mycobacterium tuberculosis complex, and all mycobacterial isolates were speciated by high performance liquid chromatography (HPLC) analysis of mycolic acids. Patients who met clinical, radiological, and bacteriological criteria of mycobacteriosis were classified according to the American Thoracic Society (ATS) guidelines for diagnosis of NTM related disease. Among the 445 smear-positive or/and culture-positive patients, 142 subjects (31.9%) were found to be infected with M. tuberculosis. Among 303 non-TB patients, mycobacteriosis was found in 27 (8.9%) subjects. The frequency of NTM-related lung disease as compared to the bacteriologically-confirmed lung TB was estimated at 1:5. The rapid, precise methods of NTM speciation are necessary for progress in diagnostics of NTM related diseases.

Continuous Positive Airway Pressure Treatment Increases Bronchial Reactivity in Obstructive Sleep Apnea Patients

Background: The effects of continuous positive airway pressure (CPAP) treatment on the function of the lower airways are poorly understood. One of the methods used to determine the influence of positive pressure breathing on lower airways is the bronchial hyperreactivity test. Some authors report that CPAP increases bronchial hyperreactivity, while others report decreases. Objectives: To assess the influence of CPAP treatment on bronchial reactivity and the effects of bronchial hyperreactivity on compliance to CPAP treatment. Methods: The study group consisted of 101 obstructive sleep apnea syndrome patients (88 men and 13 women) with a mean age of 51 ± 11 years, mean apnea-hypopnea index of 53 ± 20 and mean body mass index of 32.6 ± 5.4. Patients were randomly assigned to a treatment group that received 3 weeks of CPAP therapy (group 1) or to a nontreatment control group (group 2). Pulmonary function tests and the methacholine bronchial provocation test were performed at baseline and 3 weeks later. Results: There were no statistically significant differences between treated and control groups in anthropometry and polysomnography variables. At baseline, bronchial hyperreactivity was found in 6 patients from group 1 and 5 patients from group 2. A significant increase in bronchial reactivity was observed after CPAP treatment. Log PC20M decreased from 1.38 ± 0.30 at baseline to 1.26 ± 0.50 (p < 0.05). In group 2, changes were statistically insignificant. Patients with bronchial hyperreactivity during CPAP treatment were characterized by significantly lower FEV1, FVC and MEF50 values. Conclusions: CPAP produces statistically significant bronchial hyperreactivity. However, there were no clinical symptoms and it is not necessary to withdraw previous therapies.

Thyroid Hormone Levels and TSH Activity in Patients with Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is characterized by complete cessation of inspiratory flow (apnea) or upper airway airflow limitation (hypopnea) with increased respiratory muscle activity, which is repeatedly observed during sleep. Hypothyroidism has been described as a rare cause of OSAS, but it is considered to be the main cause of breathing disorders during sleep in patients in whom an improvement of OSAS is observed after thyroid hormone replacement therapy. Nevertheless, euthyreosis due to thyroxine replacement in patients with OSAS often does not improve the breathing disorder and treatment with continuous positive airway pressure is usually applied. The aim of this study was to assess thyroid function in patients with OSAS. We studied 813 patients in whom severe OSAS was diagnosed; the mean apnea-hypopnea index was 44.0. Most of the patients were obese (mean BMI 33.1 ± 6.6 kg/m2) and had excessive daytime sleepiness (ESS 12.8 ± 6.6). With the thyroid stimulating hormone (TSH) concentration as the major criterion, hypothyroidism was diagnosed in 38 (4.7%) and hyperthyroidism was diagnosed in 31 (3.8%) patients. Analysis of basic anthropometric data, selected polysomnography results, and TSH, fT3, and fT4 values did not reveal any significant correlations. In conclusion, the incidence of thyroid function disorders seems to be no different in OSAS than that in the general population. We did not find correlations between TSH activity and the severity of breathing disorders during sleep.

Hemoptysis in a patient with multifocal primary pulmonary angiosarcoma

Primary pulmonary angiosarcoma (PPA) is a rare tumour arising from arterial or venous pulmonary vessels of various size. It is characterized by aggressive course and poor prognosis. The early diagnosis is difficult due to diverse clinical and radiological manifestations. We present a case report of 70 year-old man, active cigarette-smoker, with a 2-month history of non-massive hemoptysis. The thorax CT revealed several solid pulmonary nodules surrounded by areas of ground glass opacity. As bronchoscopy failed to deliver adequate tissue samples, video assisted thoracic surgery (VATS) with pleura and lung biopsy was necessary. Histopathological findings were consistent with pulmonary angiosarcoma. Since no extrapulmonary lesions were demonstrated, the final diagnosis of primary pulmonary angiosarcoma was made. The patient died three months after the onset of symptoms. Our case report highlights that differential diagnosis in patients with hemoptysis and pulmonary nodules should include primary pulmonary sarcoma.

Methods of airway resistance assessment.

Airway resistance is the ratio of driving pressure to the rate of the airflow in the airways. The most frequent methods used to measure airway resistance are whole-body plethysmography, the interrupter technique and the forced oscillation technique. All these methods allow to measure resistance during respiration at the level close to tidal volume, they do not require forced breathing manoeuvres or deep breathing during measurement. The most popular method for measuring airway resistance is whole-body plethysmography. The results of plethysmography include among others the following parameters: airway resistance (Raw), airway conductance (Gaw), specific airway resistance (sRaw) and specific airway conductance (sGaw). The interrupter technique is based on the assumption that at the moment of airway occlusion, air pressure in the mouth is equal to the alveolar pressure . In the forced oscillation technique (FOT), airway resistance is calculated basing on the changes in pressure and flow caused by air vibration. The methods for measurement of airway resistance that are described in the present paper seem to be a useful alternative to the most common lung function test - spirometry. The target group in which these methods may be widely used are particularly the patients who are unable to perform spirometry.

Polish Respiratory Society guidelines for the methodology and interpretation of the 6 minute walk test (6MWT).

283 Assoc. Prof. Tadeusz Przybyłowski, MD, PhD Prof. Waldemar Tomalak, MD, PhD Prof. Zenon Siergiejko, MD, PhD Prof. Dariusz Jastrzębski, MD, PhD Dr Marta Maskey-Warzęchowska, MD, PhD Assoc. Prof. Tomasz Piorunek, MD, PhD Dr Emil Wojda, MD, PhD Assoc. Prof. Piotr Boros, MD, PhD Department of Internal Medicine, Pneumonology and Allergology, Medical University of Warsaw, Poland Department of Physiopathology of the Respiratory System, Rabka-Zdrój Branch of the Institute of Tuberculosis and Lung Diseases, Poland Laboratory of Respiratory Diagnostics and Bronchoscopy, Medical University of Białystok, Poland Department of Lung Diseases and Tuberculosis, Medical University of Silesia, Poland Department of Pulmonology Allergology and Pulmonary Oncology, Poznań University of Medical Sciences, Poland Department of Lung Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland Department of Physiopathology of the Respiratory System, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland Reviewers: Prof. Ryszarda Chazan, MD, PhD Prof. Władysław Pierzchała, MD, PhD Prof. Wacław Droszcz, MD, PhD Prof. Adam Antczak, MD, PhD

Exacerbations of Chronic Obstructive Pulmonary Disease and Quality of Life of Patients

Exacerbations of chronic obstructive pulmonary disease (COPD) are one of the most important factors which influence the course of disease and quality of life in COPD patients. The aim of the study was to assess the exacerbation frequency in COPD patients in relation to COPD severity and to evaluate the impact of the number of exacerbations on quality of life. The study included 445 COPD patients in all four progressive stages of the disease according to GOLD classification. The patients recorded exacerbations in diaries. Spirometry, St. Georges Respiratory Questionnaire, and dyspnea score were assessed at baseline and after 12 and 24 months from enrollment. After 24 months, 261 diaries were returned. The mean number of exacerbations per year in the sequential GOLD 1-4 stages of COPD was as follows: 1.3 ± 2.1, 1.4 ± 2.0, 1.7 ± 1.8, and 3.4 ± 4.5. A statistical difference in the exacerbation frequency was noted for GOLD 4 and the remaining groups. A significant negative correlation was found between the number of exacerbations and functional status for GOLD 2 and 3 stages. We conclude that the number of exacerbations is the highest in the most severe stage of the disease. The quality of life of patients with moderate and severe COPD correlates negatively with the number of exacerbations.