The Predictive Role of Lactate in the Emergency Department in Patients with Severe Dyspnea

Objective

An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes.

Methods

The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished-arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1-quartile 3) 2 (1-4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated.

Results

The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO2 on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01-2.47), by 80% in VBG (95% CI: 1.13-2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22-2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO2, and pCO2 did not predict short-term mortality.

Conclusions

In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.

Detection of Pneumothorax in Severe Acute Respiratory Distress Syndrome-Lung Ultrasound Pitfalls

Lung ultrasound is gaining popularity as a quick, easy, and accurate method for the detection of pneumothorax. The typical sonographic features of pneumothorax are the absence of lung sliding, the presence of a lung point, the absence of a lung pulse, and the absence of B-lines. However, we found that in some cases, each of these elements might be misleading.

Value, time and outcomes of elevated lactate levels in adult patients on extracorporeal membrane oxygenation

INTRODUCTION

Lactate levels have been recognized as a reliable tool for monitoring critically ill patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or venovenous extracorporeal membrane oxygenation (VV ECMO) but the reasons behind the overproduction of lactate are different and the influance for survival remains controversial. We analyzed the lactate values and lactate clearance in adult patients in these two forms of extracorporeal support.

METHODS

Patient demographics, ECMO duration, 30-day mortality, lactate values and lactate clearance at 24, 48 and 72 h from ECMO initiation of patients supported with VV and VA ECMO at Silesian Centre for Heart Deasese, between January 2011 and April 2020 were retrospectively analyzed. The changes in lactate levels were analyzed using the non-parametric U Mann-Whitney tests and Chi-square test. The ROC curves were draw and the area under the curve was calculated.

RESULTS

The study comprised 91 adult patients, Mortality in the first 30 days from initiation of VV and VA ECMO was 39% and 66%, respectively. Lactate levels were significantly higher in non-survivors that received VV and VA ECMO (p < .001), while lactate clearance was similar (p = .256 and p = 1.000, respectively). Survival curves for patients with elevated (>2.0 mmol/L) vs normal (≤2.0 mmol/L) lactate levels at 72 h were significantly different for VV ECMO (p = .007) and VA ECMO (p = .037) but in both groups of ECMO, lactate levels above 2.0 mmol/L at 72 h from ECMO initiation predicted 30 day-mortality.

CONCLUSION

This results emphasized the importance of lactate levels below 2.0 mmol/L at 72 h from both VV and VA ECMO initiation.

Characteristics of Interstitial Pneumonia With Autoimmune Features (IPAF): Protocol for a Multicenter Prospective Study

BACKGROUND

"Interstitial lung disease" (ILD) is a broad term encompassing diseases of different backgrounds. "Interstitial pneumonia with autoimmune features" (IPAF) is a recent term that implies the presence of autoimmunity.

OBJECTIVE

This study aims to determine the characteristics of Polish patients with IPAF, compare them with patients with other interstitial pneumonias, and search for the prognostic and diagnostic biomarkers of IPAF in serum and bronchoalveolar lavage fluid (BALF).

METHODS

This multicenter prospective study plans to recruit 240 participants divided into 1 study group and 2 control groups. Biological fluid samples will be collected according to Polish Respiratory Society management guidelines and stored at -80°C for further tests. Prospective 5-year observations of 60 newly diagnosed individuals are planned. The study will be divided into subsections. First, we plan to characterize Polish patients with IPAF (study group) against their peers with other ILDs (2 control groups). Control group 1 will comprise patients with idiopathic ILDs, including mainly idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Control group 2 will comprise patients with connective tissue disease-associated interstitial lung diseases, such as rheumatoid arthritis, systemic sclerosis, polymyositis, dermatomyositis, Sjögren's syndrome, mixed connective tissue disease, and systemic lupus erythematosus. Radiological and functional parameters will be analyzed. Patients will be compared in terms of high-resolution computed tomography results, the 6-minute walking test performance, and pulmonary function test parameters. The diagnosis of IPAF will be reassessed on a regular basis through multidisciplinary discussion in order to determine its clinical stability. In the laboratory arm, inflammation and fibrosis pathways will be assessed. Cytokine levels (interleukin 8, transforming growth factor beta 1, chemokine C-C motif ligand [CXCL]18, CXCL1, surfactant protein [SP]-A, SP-D, Krebs von den Lungen-6 protein, and chitinase 1) will be measured in serum and BALF. A comparative analysis of serum and BALF cytokine levels will be performed in order to establish potential differences between systemic and local inflammatory pathways. In the quality of life (QoL) arm of the study, dyspnea and cough and their impact on various aspects of the QoL will be assessed. Depression and anxiety will be measured with the Hospital Anxiety and Depression Modified Scale and the 9-item Patient Health Questionnaire, and potential correlations with symptom prevalence will be assessed.

RESULTS

This study will start recruiting patients to phase 1 in October 2023. The final results will be available in 2028. We plan to publish preliminary results after 2-3 years from the start of phase 1.

CONCLUSIONS

This study will be a step toward a better understanding of IPAF etiopathogenesis and outcomes.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44802.

Autopsy Histopathologic Lung Findings in Patients Treated With Extracorporeal Membrane Oxygenation

CONTEXT.—

Extracorporeal membrane oxygenation (ECMO) is increasingly used in the treatment of respiratory and cardiac failure, but data describing lung histopathology in ECMO recipients are limited.

OBJECTIVE.—

To examine pulmonary histopathologic findings in patients who underwent venovenous (VV) ECMO for pulmonary reasons, or venoarterial (VA) ECMO for cardiac indications shortly before death, and to determine if the pulmonary changes provided insights into therapy that may prevent complications and improve outcome.

DESIGN.—

We conducted a retrospective study of lung autopsies, from VV and VA ECMO recipients and patients with acute respiratory distress syndrome (ARDS) and non-ECMO treatment, between 2008 and 2020 in Silesia Center for Heart Diseases in Zabrze, Poland.

RESULTS.—

Among 83 ECMO patients (42-64 years; male, 57 [68.7%]), the most common histopathologic findings were bronchopneumonia (44 [53.0%]), interstitial edema (40 [48.2%]), diffuse alveolar damage (DAD; 32 [38.6%]), hemorrhagic infarct (28 [33.7%]), and pulmonary hemorrhage (25 [30.1%]). DAD was associated with longer ECMO treatment and longer hospital stay. The use of VV ECMO was a predictor of DAD in patients with ARDS and undergoing ECMO, but it also occurred in 21 of 65 patients (32.3%) in the VA ECMO group, even though VA ECMO was used for heart failure.

CONCLUSIONS.—

Although DAD was significantly more common in lung autopsies of VV ECMO patients, one-third of VA ECMO patients had histopathologic changes characteristic of ARDS. The presence of DAD in lung autopsies of patients treated with VA ECMO indicates that in these patients, protective lung ventilation should be considered.

Window of opportunity for respiratory oscillometry: A review of recent research

Oscillometry has been around for almost 70 years, but there are still many unknowns. The test is performed during tidal breathing and is therefore free from patient-dependent factors that could influence the results. The Forced Oscillation Technique (FOT), which requires minimal patient cooperation, is gaining ground, particularly with elderly patients and children. In pulmonology, it is a valuable tool for assessing obstructive conditions (with a distinction between central and peripheral obstruction) and restrictive disorders (intrapulmonary and extrapulmonary). Its sensitivity allows the assessment of bronchodilator and bronchoconstrictor responses. Different lung diseases show different patterns of changes in FOT, especially studied in asthma and chronic obstructive pulmonary disease. Because of these differences, many studies have analysed the usefulness of this technique in different areas of medicine. In this paper, the authors would like to present the basics of oscillometry with the areas of its most recent clinical applications.

May noninvasive mechanical ventilation and/ or continuous positive airway pressure increase the bronchoalveolar lavage salvage in patients with pulmonary diseases? Randomized clinical trial - Study protocol

PURPOSE

Bronchoalveolar lavage (BAL) procedure is a useful tool in the diagnosis of patients with interstitial lung disease (ILD) and is helpful in clinical research of chronic obstructive pulmonary disease (COPD) patients. Still little is known about predictors of poor BAL salvage. The trial aims to find the most efficient way to improve BAL recovery.

MATERIAL AND METHODS

Our study is a prospective, multicenter, international, two-arm randomized controlled trial. We aim to obtain BAL samples from a total number of 300 patients: 150 with ILD and 150 with COPD to achieve a statistical power of 80 ​%. Patients with initial BAL salvage <60 ​% will be randomized into the non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) arm. The NIV and CPAP will be set according to the study protocol. The influence on BAL salvage will be assessed in terms of BAL volume and content. Multivariable analysis of the additional test results to determine predictors for low BAL recovery will be conducted. In a study subgroup of approximately 20 patients per specific disease, a metabolomic assessment of exhaled air condensate will be performed. All procedures will be assessed in terms of the patient's safety. The trial was registered on clinicaltrials.gov (ID# NCT05631132). Interested experienced centers are invited to join the research group by writing to the corresponding author.

CONCLUSION

The results of our prospective study will address the currently unsolved problem of how to increase BAL salvage in patients with pulmonary diseases without increasing the risk of respiratory failure exacerbation.

The use of non-invasive respiratory assistance to facilitate bronchofiberoscopy performance in patients with hypoxemic (type one) respiratory failure - Study protocol

PURPOSE

Bronchofiberoscopy (FOB) is a procedure routinely performed for: lung cancer, obstruction, interstitial diseases, foreign bodies' removal, airway clearance, and hemoptysis. It causes acute airway narrowing leading to respiratory and cardiovascular stress. Due to increasing number of ill patients with respiratory failure (RF), conventional oxygen therapy (COT) is frequently insufficient to assure accurate oxygenation and prevent RF in patients requiring FOB. In this clinical scenario, patients may be intubated and supported with invasive mechanical ventilation (IMV) with the specific aim of allowing a safe FOB. However, this invasive strategy is associated with an increased risk of IMV-associated complications.

MATERIALS AND METHODS

Our study is a planned prospective multicenter three-arm randomized controlled trial (RCT). The target number of 300 patients was calculated based on the intubation risk in RF patients, which is 0.2-2%. The patients will be assigned to each arm based on Horowitz index. In each arm, the patients will be randomly assigned to one out of two dedicated respiratory support methods in each group i.e. COT/high flow nasal cannula (HFNC), HFNC/non-invasive ventilation (NIV) and NIV/IMV. In the manuscript the current state of art in the area of respiratory support is discussed. We have underlined knowledge gaps in medical evidence which we are planning to reveal with our results.

RESULTS

The results of our study are clinically crucial, because they address current gaps concerning COT/HFNC/NIV/IMV.

CONCLUSION

The expected findings of this study would allow for careful selection of respiratory support method to safely perform FOB in patients with hypoxemic RF.

Actual status and future directions of cardiac telerehabilitation

Telerehabilitation (TR) was developed to achieve the same results as would be achieved by the standard rehabilitation process and to overcome potential geographical barriers and staff deficiencies. This is especially relevant in periodic crisis situations, including the recent COVID-19 pandemic. Proper execution of TR strategy requires both well-educated staff and dedicated equipment. Various studies have shown that TR may have similar effects to traditional rehabilitation in terms of clinical outcomes and may also reduce total healthcare costs per participant, including rehospitalization costs. However, as with any method, TR has its advantages and disadvantages, including a lack of direct contact or prerequisite, rudimentary ability of the patients to handle mobile devices, among other competencies. Herein, is a discussion of the current status of TR, focusing primarily on cardiac TR, describing some technical/organizational and legal aspects, highlighting the indications, examining cost-effectiveness, as well as outlining possible future directions.

Exhaled Air Metabolome Analysis for Pulmonary Arterial Hypertension Fingerprints Identification-The Preliminary Study

Pulmonary arterial hypertension (PAH) is a rare disease with a serious prognosis. The aim of this study was to identify biomarkers for PAH in the breath phase and to prepare an automatic classification method to determine the changing metabolome trends and molecular mapping. A group of 37 patients (F/M: 8/29 women, mean age 60.4 ± 10.9 years, BMI 27.6 ± 6.0 kg/m²) with diagnosed PAH were enrolled in the study. The breath phase of all the patients was collected on a highly porous septic material using a special patented holder PL230578, OHIM 002890789-0001. The collected air was then examined with gas chromatography coupled with mass spectrometry (GC/MS). The algorithms of Spectral Clustering, KMeans, DBSCAN, and hierarchical clustering methods were used to perform the cluster analysis. The identification of the changes in the ratio of the whole spectra of biomarkers allowed us to obtain a multidimensional pathway for PAH characteristics and showed the metabolome differences in the four subgroups divided by the cluster analysis. The use of GC/MS, supported with novel porous polymeric materials, for the breath phase analysis seems to be a useful tool in selecting bio-fingerprints in patients with PAH. The four metabolome classes which were obtained constitute novel data in the PAH population.

Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19

Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65−5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.

Polyurethane-Based Porous Carbons Suitable for Medical Application

The main aim of the study was to synthesize and analyze spectral data to determine the structure and stereometry of the carbon-based porous material internal structure. Samples of a porous biomaterial were synthesized through anionic polymerization following our own patent and then carbonized. The samples were investigated using MALDI ToF MS, FTIR ATR spectroscopy, optic microscopy, SEM, confocal laser scanning microscopy and CMT imaging. The analysis revealed the chemical and stereological structure of the obtained porous biomaterial. Then, the parameters characterizing the pore geometry and the porosity of the samples were calculated. The developed material can be used to collect adsorption of breathing phase samples to determine the parity composition of exhaled air.

Pulmonary function, exercise capacity and dyspnea in patients 7 ​years after Nuss surgery

PURPOSE

Pectus excavatum is a frequent thoracic malformation increasingly treated with minimally invasive methods (MIRPE), which are performed for cardio-respiratory problems and in some centers also for esthetic considerations. Theoretically, MIRPE may increase thoracic elastic recoil, work of breathing and cause emphysema. The aim of the present study was to determine whether teenagers who underwent MIRPE may expect normal thoracic cage development, cardio-respiratory function, exercise capacity and asymptomatic functioning.

MATERIAL AND METHODS

Fifty five patients (21.1 ​± ​3.0 years) who underwent MIRPE between 2000 and 2010 were assessed 6.8 (±2.4) years after surgery. Controls were matched for sex, age and height to the intervention participants. Spirometry, body plethysmography, diffusion capacity and the 6 ​min walking test (6MWT) were performed. Anteroposterior (AP) and transverse chest diameters were measured.

RESULTS

Participants who underwent MIRPE had normal pulmonary function, and exercise capacity. After adjustment for potential confounders, the intervention group had lower mean BMI [-1.88 ​± ​0.56 (kg/m²); p ​= ​0.001] and chest AP diameter [-2.79 ​± ​0.57 (cm); p ​< ​0.001], but higher residual volume (RV%) [12.98 ​± ​5.31 (%); p ​= ​0.001], RV% total lung capacity (TLC) [5.56 ​± ​0.92 (%); p ​< ​0.001], forced expiratory volume in 1 ​s/forced vital capacity (FEV₁/FVC) [2.64 ​± ​1.28 (%); p ​= ​0.039] and 6MWT distance [29.10 ​± ​13.02 (m); p ​= ​0.025].

CONCLUSIONS

Young adults who undergo MIRPE may expect normal pulmonary function and exercise capacity. Observed differences in air trapping require further assessment in terms of emphysema development risk.

Risk factors of complications during noninvasive mechanical ventilation -assisted flexible bronchoscopy

PURPOSE

Flexible bronchoscopy (FB) causes airway narrowing and may cause respiratory failure (RF). Noninvasive mechanical ventilation (NIV) is used to treat RF. Until recently, little was known about noninvasive mechanical ventilation assisted flexible bronchoscopy (NIV-FB) risk and complications.

MATERIALS AND METHODS

A retrospective analysis of NIV-FB performed in 20 consecutive months (July 1, 2018-February 29, 2020) was performed. Indications for: FB and NIV, as well as impact of comorbidities, blood gas results, pulmonary function test results and sedation depth, were analyzed to reveal NIV-FB risk. Out of a total of 713 FBs, NIV-FB was performed in 50 patients with multiple comorbidities, acute or chronic RF, substantial tracheal narrowing, or after previously unsuccessful FB attempt.

RESULTS

In three cases, reversible complications were observed. Additionally, due to the severity of underlining disease, two patients were transferred to the ICU where they passed away after >48h. In a single variable analysis, PaO₂ 69 ​± ​18.5 and 49 ​± ​9.0 [mmHg] (p ​< ​0.05) and white blood count (WBC) 10.0 ​± ​4.81 and 14.4 ​± ​3.10 (p ​< ​0.05) were found predictive for complications. Left heart disease indicated unfavorable NIV-FB outcome (p ​= ​0.046).

CONCLUSIONS

NIV-FB is safe in severely ill patients, however procedure-related risk should be further defined and verified in prospective studies.

Non-invasive ventilation in patients with an altered level of consciousness. A clinical review and practical insights

Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respira-tory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preserva-tion of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation. Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed.

PULMONARY ALVEOLAR MICROLITHIASIS. DISCREPANCIES BETWEEN RADIOLOGICAL FINDINGS AND CLINICAL PATTERN- CASE STUDY

Pulmonary alveolar microlithiasis is a rare genetic disorder, inherited autosomally recessively, which is characterized by intra-alveolar deposition of microliths built mostly of calcium salts and phosphorus. This case study describing management of patient with pulmonary alveolar microlithiasis. A 49-year-old woman, diagnosed with pulmonary microlithiasis in 1979 was admitted to Pneumology Department due to increased dyspnea. On admission there were no clinical signs of active infection. The chest computer tomography scan confirmed the presence of advanced microlithiasis. Pulmonary function test revealed mild restriction with moderate diffusion impairment, due to severe hypoxemia present on 6-minute walking test patient was sent for specific assessment to local lung transplant team in Zabrze for consideration for lung transplantation. According to International Society for Heart & Lung Transplantation guidelines the patient was observed in 6 months intervals to reveal whether further disease progression will be observed. Clinical condition of our patient does not correlate with radiological scans, severe respiratory symptoms and cardiological complications. Computer tomography scan should not be the only indication for lung transplant.

E-cigarette use among young adults in Poland: Prevalence and characteristics of e-cigarette users

PURPOSE

Electronic cigarette (e-cigarette) use is one of the most popular alternatives to conventional cigarette smoking. This study aimed to investigate the prevalence of cigarette and e-cigarette use among university students from Poland, with particular emphasis on ever and current cigarette and e-cigarette use as well as smoking initiation age.

PATIENTS AND METHODS

A cross-sectional survey was conducted between 2017 and 2018 in a group of university students in 5 academic centers in Poland. The questionnaire addressed 46 questions about personal attitudes toward cigarette smoking and e-cigarette use.

RESULTS

Data were collected from 7324 participants (67.3% females, aged 21.9 ± 2.1 years), with an overall response rate of 70.1%. Among participants, 71.2% had ever smoked a cigarette, and almost half of the respondents (45%) declared ever use of an e-cigarette. The mean age of first use of a cigarette was significantly lower (16.5 ± 2.5 y-old) than of an e-cigarette (18.6 ± 2.2 y-old; p < 0.001). Exclusive cigarette smoking was declared by 12.9%, 1.3% were e-cigarette users and 1.5% were dual users. Those in the medical field were less likely to try e-cigarettes (odds ratio, OR = 0.73) or to currently smoke conventional cigarettes (OR = 0.82). Older participants were more likely to have ever smoked conventional cigarettes (OR = 1.06), but less likely to have ever used e-cigarettes (OR = 0.88).

CONCLUSIONS

In this study, we found a high proportion of young adults who have tried e-cigarettes with both regional and demographic differences. The education profile influences cigarette smoking and e-cigarette use behaviors.

Treatment of acute respiratory failure in the course of COVID-19. Practical hints from the expert panel of the Assembly of Intensive Care and Rehabilitation of the Polish Respiratory Society

In 2019, a pandemic began due to infection with a novel coronavirus, SARS-CoV-2. In many cases, this coronavirus leads to the development of the COVID-19 disease. Lung damage in the course of this disease often leads to acute hypoxic respiratory failure and may eventually lead to acute respiratory distress syndrome (ARDS). Respiratory failure as a result of COVID-19 can develop very quickly and a small percent of those infected will die because of it. There is currently no treatment for COVID-19, therefore the key therapeutic intervention centers around the symptomatic treatment of respiratory failure. The main therapeutic goal is to main-tain gas exchange, mainly oxygenation, at an appropriate level and prevent the intensification of changes in the lung parenchyma. Depending on the severity of hypoxemia different techniques can be used to improve oxygenation. Medical staff dealing with COVID-19 patients should be familiar with both, methods used to treat respiratory failure and the epidemiological risks arising from their use. In some patients, conventional (passive) oxygen therapy alone is sufficient. In patients with worsening respiratory failure high flow nasal oxygen therapy (HFNOT) may be effective. The continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) methods can be used to a limited extent. With further disease progression, invasive ventilation must be used and in special situations, extracorporeal membrane oxygenation (ECMO) can also be administered. The authors of this article set themselves the goal of presenting the most current knowledge about the epidemiology and patho-physiology of respiratory failure in COVID-19, as well as the methods of its treatment. Given the dynamics of the developing pandemic, this is not an easy task as new scientific data is presented almost every day. However, we believe the knowledge contained in this study will help doctors care for patients with COVID-19. The main target audience of this study is not so much pneumonologists or intensivists who have extensive experience in the application of the techniques discussed here, but rather doctors of other specializations who must master new skills in order to help patients during the time of a pandemic.

Continuous Positive Airway Pressure (CPAP) in Non-Apneic Asthma: A Clinical Review of Current Evidence

The use of continuous positive airway pressure (CPAP) in asthma has been a point of debate over the past several years. Various studies, including those on animals and humans have attempted to understand the role and pathophysiology of CPAP in patients with either well controlled or poorly controlled asthma. The aim of this manuscript is to review the currently available literature on the physiologic and clinical effects of CPAP in animal models of asthma and on humans with stable asthma.

The influence of chlorine in indoor swimming pools on the composition of breathing phase of professional swimmers

OBJECTIVES

Swimming is one of the most popular forms of physical activity. Pool water is cleaned with chlorine, which - in combination with compounds contained in water - could form chloramines and trichloromethane in the swimmer's lungs. The aim of the present study was to examine the effect of swimming training in an indoor pool on the composition of swimmers' respiratory phase metabolomics, and develop a system to provide basic information about its impact on the swimmer's airway mucosa metabolism, which could help to assess the risk of secondary respiratory tract diseases i.e. sport results, condition, and health including lung acute and chronic diseases).

DESIGN

A group of competitive swimmers participated in the study and samples of their respiratory phase before training, immediately after training, and 2 h after training were assessed.

METHODS

Sixteen male national and international-level competitive swimmers participated in this study. Respiratory phase analysis of the indoor swimming pool swimmers was performed. Gas chromatography combined with mass spectrometry (GCMS) was used in the measurements. All collected data were transferred to numerical analysis for trends of tracking and mapping. The breathing phase was collected on special porous material and analyzed using GCMS headspace.

RESULTS

The obtained samples of exhaled air were composed of significantly different metabolomics when compared before, during and after exercise training. This suggests that exposition to indoor chlorine causes changes in the airway mucosa.

CONCLUSION

This phenomenon may be explained by occurrence of a chlorine-initiated bio-reaction in the swimmers' lungs. The obtained results indicate that chromatographic exhaled gas analysis is a sensitive method of pulmonary metabolomic changes assessment. Presented analysis of swimmers exhaled air indicates, that indoor swimming may be responsible for airway irritation caused by volatile chlorine compounds and their influence on lung metabolism.

Sexual disorders and dyspnoea among women with obstructive sleep apnea

PURPOSE

We aimed to assess sexual function, sexual distress and the prevalence of female sexual dysfunction (FSD) among women with obstructive sleep apnea syndrome (OSA), and to assess if the presence of OSA and dyspnea influences the prevalence of FSD, body image during sexual activity and sexual function.

METHODS

We assessed 23 women with new OSA diagnosis and 23 healthy age and body mass index (BMI) matched controls. Sexual functions were evaluated by Changes in Sexual Functioning Questionnaire (CSFQ), sexual dysfunction was diagnosed based on DSM-5 criteria during the semi-structured sexual interview, whereas body image was evaluated by Body Exposure during Sexual Activities Questionnaire (BESAQ). New York Heart Association score (NYHA) and Visual Analogue Scale (VAS) were used to assess dyspnea.

RESULTS

OSA women had worse general sexual function and lower frequency of desire assessed by CSFQ (37.0 vs. 42 and 5 vs. 6), were at higher risk for FSD (CSFQ; 80% vs. 48%) and had a higher NYHA score (II vs. I). The prevalence of FSD did not differ in both groups, nor did sexual dysfunctions or body image (BESAQ). The multiple regression analysis revealed that OSA was associated with lower desire/frequency, higher NYHA scores with decreased desire/interest and worse body image during sexual activity, whereas higher VAS scores with worse desire/frequency.

CONCLUSIONS

OSA probably does not influence the prevalence of sexual dysfunction in females. However, OSA, as well as the higher level of dyspnea assessed by NYHA, may decrease sexual body image and sexual performance in females.

New ideas, old problems? Heated tobacco products - a systematic review

Heated tobacco products (HTPs) are a form of nicotine delivery intended to provide an alternative to traditional cigarettes. The aim of this systematic review was to present the current state of knowledge on HTPs with an emphasis on the potential impact of HTP use on human health. During the preparation of this systematic review, the literature on HTPs available within Medline/PubMed, EMBASE, CINAHL, ScienceDirect, and Google Scholar was retrieved and examined. In the final review, 97 research papers were included. The authors specifically assessed the construction and operation of HTPs, as well as the chemical composition of HTP tobacco sticks and the generated aerosol, based on evidence from experimental animal and cellular studies, and human-based studies.Heated tobacco products were found to generate lower concentrations of chemical compounds compared to traditional cigarettes, except for water, propylene glycol, glycerol, and acetol. The nicotine levels delivered to the aerosol by HTPs were 70-80% as those of conventional combustion. The results of in vitro and in vivo assessments of HTP aerosols revealed reduced toxicity, but these were mainly based on studies sponsored by the tobacco industry. Independent human-based studies indicated that there was a potentially harmful impact of the active and passive HTP smoking on human health. Currently, a large body of knowledge on HTP exposures and health effects is provided by the tobacco industry (52% of identified studies). Based on the available evidence, HTPs produce lower levels of toxic chemicals, compared to conventional cigarettes, but they are still not risk-free. Int J Occup Med Environ Health. 2019;32(5):595-634.

The importance of fluid balance in critically ill patients: a retrospective observational study

BACKGROUND

Fluid therapy in critically ill patients remains one of the most demanding and difficult aspects of care. This is particularly important in patients admitted to the intensive care unit (ICU) due to cardiovascular disorders.

AIMS

The aim of this study was to investigate whether a cumulative fluid balance (FB) affects mortality in critically ill patients hospitalized at the ICU.

METHODS

Data were obtained from the medical records of the ICU at the Silesian Centre for Heart Diseases. All patients admitted to the ICU between 2012 and 2016 were evaluated. Patients who died or were discharged from the ICU within 48 hours from admission were excluded. Fluid balance and the type of fluids infused during the first 7 days were assessed. The primary outcome was ICU mortality.

RESULTS

Overall, 495 patients were included in the study and 303 (61.2%) survived the ICU stay. Daily FB in the first 24, 48, and 72 hours after admission and the cumulative FB after 7 days were significantly lower in survivors. Fluid balance exceeding 1000 ml and the use of colloid solutions in the first 72 hours were independently associated with mortality, along with the diagnosis of stroke and shock on admission.

CONCLUSIONS

A positive FB exceeding 1000 ml in the first 72 hours from admission to the ICU is independently associated with an increased risk of mortality in critically ill patients with cardiovascular disorders. The use of colloid solutions is associated with a higher positive FB.

Clinical importance of sex differences in dyspnea and its sex related determinants in asthma and COPD patients

PURPOSE

There is an increasing amount of data regarding the influence of sex on dyspnea perception, however, the influence of sex has not been included in clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS

The study included 123 clinically stable subjects. Seventy five patients had COPD, of which 70.6% were men and 29.4% were women. Forty-eight subjects had asthma, comprised of 45.8% and 54.2%, men and women, respectively. Dyspnea was assessed with the use of modified Medical Research Council (mMRC) Visual Analogue Scale VAS, and BORG scale. All patients underwent spirometry with a broncho-reversibility test.

RESULTS

There were no differences in age for neither asthma patients, 56.5 ± 11.6 and 55.0 ± 12.7 (p = 0.5) for males and females, nor for COPD patients, 66.8 ± 9.0 and 66.8 ± 7.7 (p = 0.7) for males and females, respectively. Asthmatic females had more dyspnea than males when assessed with VAS, 1.85 ± 2.24 and 3.84 ± 2.80 (p = 0.01), for males and females, respectively. When assessed with BORGpre 6-MWT, dyspnea results were 0.86 ± 1.83 and 2.43 ± 2.31 (p = 0.005), for males and females, respectively. In the whole group, apart from FEV₁ (for mMRC, VAS, BORGpre) and BMI (BORGpost) the severity of dyspnea was related to female sex when assessed with mMRC (OR=2.83; 95%CI: 1.25-6.42) and VAS (OR = 2.17; 95%CI:1.00-4.73).

CONCLUSIONS

Although more apparent in asthma, it was revealed for the first time, that sex has a strong influence on the magnitude of dyspnea perception, both in asthma and COPD. Therefore, sex related dyspnea sensation should probably be included in clinical assessment and patient treatment.

Serum estradiol concentration, estradiol-to-progesterone ratio and sputum IL-5 and IL-8 concentrations are increased in luteal phase of the menstrual cycle in perimenstrual asthma patients

Summary

Background. The results of the research on perimenstrual asthma (PMA) pathophysiology are inconsistent, and the role of sex hormones remains inconclusive. The aim of the study was to evaluate the influence of serum sex steroid (and other) hormones concentrations on lower airway inflammation of PMA patients. Methods. Thirty-three women of childbearing age diagnosed as: PMA (n = 13), non-PMA asthmatics (n = 10), and healthy controls (n = 10) were prospectively followed for 12 weeks over 2 consecutive menstrual cycles. On the 10^th and 26^th day of each cycle serum 17β-estradiol, progesterone, testosterone, androstendion, dehydroepiandrosteron, cortisol, thyroid-stimulating hormone and prolactin were measured, and sputum was induced. Sputum inflammatory cell count and IL-5, -6, -8, -10 concentrations were determined. Results. When compared to non-PMA asthmatics, the luteal phase of the cycle in PMA subjects was associated with increased serum estradiol concentration, estradiol-to-progesterone ratio (p < 0.001, p = 0.001, respectively) and sputum IL-5 and IL-8 concentrations (p = 0.045, p = 0.039, respectively). Decreased serum testosterone levels (p < 0.05) and a trend to increased serum prolactin levels in both phases of the menstrual cycle in PMA subjects were observed. Sputum analysis in PMA patients revealed increased total inflammatory cell count in both phases of the menstrual cycle (p < 0.05), when compared to non-PMA asthmatics. Conclusions. The luteal phase of the cycle in PMA patients is associated with increased serum estradiol levels with concurrent higher sputum concentration of IL-5 and IL-8. Serum testosterone levels are decreased, and total number of sputum inflammatory cells is increased in PMA patients in both phases of the menstrual cycle.

May Dyspnea Sensation Influence the Sexual Function in Men With Obstructive Sleep Apnea Syndrome? A Prospective Control Study

INTRODUCTION

Dyspnea sensation is frequently present in obstructive sleep apnea syndrome (OSA) patients; however, its possible influence on sexual function and body image has not been well analyzed.

AIMS

To evaluate sexual function, the prevalence of sexual dysfunction (SD), and body image during sexual activity and its relationship with dyspnea in men with OSA.

METHODS

129 men were included in the prospective study, with 61 diagnosed with OSA (cases) and 68 age- and BMI-matched healthy control subjects. Patients were assessed for the severity of heart failure by the New York Heart Association scale and dyspnea by the Visual Analogue Scale. OSA was confirmed by in-laboratory polysomnography.

MAIN OUTCOME MEASURES

International Index of Erectile Function (IIEF) was used as a measure of sexual function, body image during sexual activity was assessed by the Body Exposure During Sexual Activity Questionnaire, whereas SD was diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

RESULTS

The mean age of the studied population was 57.9 ± 10.8 years. Presence of dyspnea interfered with sexual life in 20% of men diagnosed with OSA and with work performance in 33%. Men with OSA had worse scores in IIEF-15 compared with control subjects and higher frequency of sexual distress compared with men with OSA. There were no differences in the rate of SD according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The presence of OSA worsened the perceived body image during sexual activity. The presence of dyspnea was the only negative factor affecting sexual function in general (IIEF-15 score) and 1 of the factors affecting erectile function and orgasmic function.

CONCLUSION

In men with OSA, body image is negatively influenced by the presence of OSA. Furthermore, the presence of dyspnea assessed by the New York Heart Association scale impairs sexual function in that group of men. Skoczyński S, Nowosielski K, Minarowski Ł, et al. May Dyspnea Sensation Influence the Sexual Function in Men With Obstructive Sleep Apnea Syndrome? A Prospective Control Study. Sex Med 2019;7:303-310.

D-dimer value in the diagnosis of pulmonary embolism-may it exclude only?

Background

Pulmonary embolism (PE) is the third most common cause of death for cardiovascular diseases in Europe. Quick PE diagnosis is therefore crucial for prognosis improvement. It is critical to have suitable screening tests both to exclude PE as well to select patient with highest likelihood of PE occurrence. Currently D-dimer test is accepted as important tool useful to exclude PE in low risk patients. Our goal was to assess the D-dimer test positive prognostic value.

Methods

A retrospective study based on medical record analysis of consecutively admitted patients to 9 wards of The University Clinical Center in Katowice who were hospitalized during four consecutive years was performed. Three hundred and seventy patients met the inclusion criteria for the study, which involved the D-dimer tests and computed tomographic pulmonary angiography (CTPA) performed during hospitalization. Assessed patients were divided into two groups: PE confirmed and PE excluded by CTPA.

Results

We have found that patients with D-dimer levels higher than 2,152 ng/mL had significantly increased risk of PE [area under curve (AUC) of 0.69; 95% CI, 0.64-0.75; P<0.05]. Positive predictive value (PPV) reached the level of 53%, whereas negative predictive value (NPV) reached 82%. We also found that patients with the history of neoplasm and at >65 years of age had D-dimer cut-off point moved to the level of 2,652 ng/mL (AUC of 0.67; 95% CI, 0.52-0.81; P<0.05).

Conclusions

Whereas the NPV of the D-dimer test is generally accepted our results suggest that, in selected cases, an increased plasmatic D-dimer levels may have PPV in PE diagnosis. Patients with the history of neoplasm have higher cut-off D-dimer points above which we should consider increased PE likelihood. CTPA should be considered even for patients with low probability of PE when D-dimer values exceed four times the normal level.

Noninvasive ventilation: education and training. A narrative analysis and an international consensus document

Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.

Is It Possible to Predict Whether BAL Salvage Is Going to Be Diagnostic?

Introduction: Bronchoalveolar lavage (BAL) is used in the diagnosis of interstitial lung diseases. BAL is diagnostic when ≥60% of the instilled volume is recovered. There are no reliable markers useful to predict whether BAL volume is going to be diagnostic. Our goal was to search for pulmonary function markers which could anticipate whether the recovered volume of instilled fluid would be ≥60% of administered volume. Material and methods: BAL volumes and quality were analyzed in the context of disease, medical condition and lung function test results of the subjects hospitalized at the Pulmonology Ward from January 2015 to October 2016. The patients’ average age was 61 (29–89). Results: Among 80 procedures, diagnostic BAL (≥60%) has been obtained in 58 cases. The analysis of the group of patients with an interstitial lung disease confirmed that there is a correlation between decreasing BAL recovered volume and an increase of RV[%pred] (r = –0.34) and RV/TLC[%pred] (r = –0.41); p < 0.05. There was no significant correlation with DLCO. RV/TLC[%pred] was the parameter with the highest predictive value for an anticipated correct BAL recovery. The curve analysis of the receiver operating characteristic (ROC) showed a diagnostic accuracy (AUC 0.73, 95% CI 0.61–0.86). Conclusions: Pulmonary hyperinflation may have a predictive role in anticipating a proper recovery of the BAL fluid volume.

Chronic Obstructive Pulmonary Disease and Platelet Count

Recently, it has been shown in the murine model that platelet maturation takes place, to some extent, in the lungs. The extrapolation of these findings to humans leads to the possibility that chronic lung diseases could affect platelet maturation and, consequently, the platelet count. The aim of this study was to investigate whether there are changes in the platelet count in patients with chronic obstructive disease (COPD). The study included 44 patients, aged 66.5 ± 5.5 years, in stage II-IV COPD. The control group consisted of 48 age- and gender-matched patients without any respiratory diseases. We failed to find a significant difference in the platelet count between the two groups: 231 ± 80 vs. 223 ± 63 x 10³/μL, respectively (p = 0.61). However, the number of platelets in the COPD patients was inversely associated with hemoglobin content (r = -0.57; p < 0.001), hematocrit (r = -0.40; p = 0.006), and the red cell count (r = -0.51; p < 0.001); the blood morphology indices that are typically increased in severe COPD. Such associations were absent in the control non-COPD group. We conclude that COPD has no influence on the platelet count in humans.

Antibiotic consumption and antimicrobial resistance in Poland; findings and implications

Background

The problem of inappropriate use of antibiotics and the resulting growth in antimicrobial resistance (AMR) has implications for Poland and the world. The objective of this paper was to compare and contrast antibiotic resistance and antibiotic utilisation in Poland in recent years versus other European countries, including agreed quality indicators, alongside current AMR patterns and ongoing policies and initiatives in Poland to influence and improve antibiotic prescribing.

Methods

A quantitative ten-year analysis (2007–2016) of the use of antibiotics based on European Centre for Disease Prevention and Control (ECDC) data combined with a literature review on AMR rates and antimicrobial stewardship initiatives.

Results

The system of monitoring AMR and appropriate strategies to address AMR rates remain underdeveloped in Poland. The role of microbiological diagnostics and efforts to prevent infections is currently underestimated by physicians. Overall, Poland had one of the highest rates of total consumption of antibiotics in the analysed European countries. Total consumption of antibacterials for systemic use and relative consumption of beta-lactamase sensitive penicillins were characterized by small but statistically significant average annual increases between 2007 and 2016 (from 22.2 DIDs to 23.9 DIDs and from 0.8 to 1.3%, respectively).

Conclusions

The integrated activities around appropriate antibiotic prescribing in the pre- and post-graduate training of physicians and dentists seem to be particularly important, as well as changes in policies on prescribing antibiotics within ambulatory care. AMR and appropriate prescribing of antibiotics should be the focus of health policy actions in Poland.

Survey on accessibility and real-life application of noninvasive ventilation

Noninvasive mechanical ventilation (NIV) is an accepted method of respiratory failure treatment; however, at present, little is known about the global factors limiting NIV application. A survey designed to determine NIV accessibility and limiting factors in world economies and regions was developed. The questionnaire was sent to members of the European Respiratory Society (ERS) Respiratory Intensive Care Assembly and all ERS National Delegates. Replies to the survey were collected from 161 respondents from 46 countries. NIV was found to be provided most frequently by pulmonologists and intensivists. In high-income economies (HIEs), NIV reimbursement in chronic respiratory failure treatment was found to be independent of the underlying disease and supplementary insurance (p<0.0001), whereas in upper-middle-income economies (UMIEs) it was found to be dependent on the underlying disease (p<0.0001). In chronic respiratory failure, NIV was not reimbursed in lower-middle-income economies (LMIEs) (p<0.0001). In LMIEs and UMIEs, the lack of financial resources was the main limiting factor in acute (p=0.007) and chronic respiratory failure (p<0.0001). In the income-level-based assessment, financing was recognised as relevant in LMIEs and UMIEs (p<0.0001), equipment in LMIEs and UMIEs (p=0.03), medical staff in all economies (p=0.02), and legal regulations in LMIEs (p=0.0005). It was confirmed that NIV in acute and chronic respiratory failure is reimbursed based on government regulations in UMIEs and HIEs (p<0.0001), and is not reimbursed and probably will not be reimbursed in the near future in LMIEs (p<0.0001). We conclude that financial constraints are still considered a major limiting factor for NIV use.

Polish recommendations for lung ultrasound in internal medicine (POLLUS-IM)

Objective

The aim of this study was to establish recommendations for the use of lung ultrasound in internal medicine, based on reliable data and expert opinions.

Methods

The bibliography from the databases (Pubmed, Medline, OVID, Embase) has been fully reviewed up to August 2017. Members of the expert group assessed the credibility of the literature data. Then, in three rounds, a discussion was held on individual recommendations (in accordance with the Delphi procedure) followed by secret voting.

Results

Thirty-eight recommendations for the use of lung ultrasound in internal medicine were established as well as discussed and subjected to secret voting in three rounds. The first 31 recommendations concerned the use of ultrasound in the diagnosis of the following conditions: pneumothorax, pulmonary consolidation, pneumonia, atelectasis, pulmonary embolism, malignant neoplastic lesions, interstitial lung lesions, cardiogenic pulmonary edema, interstitial lung diseases with fibrosis, dyspnea, pleural pain and acute cough. Furthermore, seven additional statements were made regarding the technical conditions of lung ultrasound examination and the need for training in the basics of lung ultrasound in a group of doctors during their specialization programs and medical students. The panel of experts established a consensus on all 38 recommendations.

Influence of noninvasive ventilation on clinical status, dyspnea sensation and subsequent copd diagnosis

Chronic obstructive lung disease (COPD) is a common life-threatening disease characterized by exposure to tobacco smoke, dyspnea and persistent lower airway obstruction coexistence of COPD and chronic heart failure (HF) may present a considerable challenge during both diagnostic and therapeutic processes. Herein, we report an elderly, obese male, an ex-smoker, suffering from both COPD and HF, and treated according to the applied guidelines for 15 years. On admission to hospital, the patient was diagnosed and treated for severe type 2 respiratory failure. The patient's COPD diagnosis was questioned at first, but then reconsidered after treatment described below. Noninvasive ventilation (NIV) improved the patient's clinical condition and reduced his dyspnea sensation. As a consequence, during check-ups, spirometry maneuvers could have been performed properly, revealing the underlying bronchial obstruction, which had been beforehand concealed by debilitation of respiratory muscles and decreased lung tissue compliance in a patient with chronic HF. Conclusion: NIV application in a patient with type 2 respiratory failure may significantly improve one's clinical condition, reduce dyspnea sensation and help establish an accurate diagnosis.

E-smoking: Emerging public health problem?

E-cigarette use has become increasingly popular, especially among the young. Its long-term influence upon health is unknown. Aim of this review has been to present the current state of knowledge about the impact of e-cigarette use on health, with an emphasis on Central and Eastern Europe. During the preparation of this narrative review, the literature on e-cigarettes available within the network PubMed was retrieved and examined. In the final review, 64 research papers were included. We specifically assessed the construction and operation of the e-cigarette as well as the chemical composition of the e-liquid; the impact that vapor arising from the use of e-cigarette explored in experimental models in vitro; and short-term effects of use of e-cigarettes on users' health. Among the substances inhaled by the e-smoker, there are several harmful products, such as: formaldehyde, acetaldehyde, acroleine, propanal, nicotine, acetone, o-methyl-benzaldehyde, carcinogenic nitrosamines. Results from experimental animal studies indicate the negative impact of e-cigarette exposure on test models, such as ascytotoxicity, oxidative stress, inflammation, airway hyper reactivity, airway remodeling, mucin production, apoptosis, and emphysematous changes. The short-term impact of e-cigarettes on human health has been studied mostly in experimental setting. Available evidence shows that the use of e-cigarettes may result in acute lung function responses (e.g., increase in impedance, peripheral airway flow resistance) and induce oxidative stress. Based on the current available evidence, e-cigarette use is associated with harmful biologic responses, although it may be less harmful than traditional cigarettes. Int J Occup Med Environ Health 2017;30(3):329-344.

[Profile of adults suffering from COPD in Poland]

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in adults. It is estimated, that in Poland around two million people suffer from COPD.

THE AIM

The aim of this study, was to characterize population of patients with COPD in Poland.

MATERIAL AND METHODS

The study, established and coordinated by the Polish Respiratory Society, included a representative sample of 500 GPs where were asked to fill questionnaires on diagnosis and treatment of their COPD patients. The questions dealt with disease history and clinical presentation, COPD severity stage, diagnostic and therapeutic procedures.

RESULTS

Altogether 298 physicians (59.6% of invited) provided information about 2756 COPD patients aged 61.6 ± 11.1 years (36.3% were women). According to GOLD recommendations 16.6% of patients had mild, 57.0% moderate, 18.6% severe and 2.1% very severe COPD. Smoking history was declared by 97.8% of respondents. 51.4% of COPD patients had continued smoking. Over the last year Ambulance Service intervened in 19.7% of patients and 29.1% of respondents required hospital treatment of COPD. Among more than 80% of patients, doctor diagnosed limitation in exercise tolerance, and shortness of breath at rest, and in approximately 60% of the respondents were presented productive cough, weakened vesicular murmur and prolonged phase of exhalation.

CONCLUSIONS

Despite the diagnosis, more than half of men and women had continued smoking. The number of hospitalizations and emergency intervention positively correlated with the severity of the disease. The survey results emphasize the urgent need for health education in patients with COPD.

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.

[Exacerbations in perimenstrual asthma. Clinical significance of peripheral blood eosinophilia and BMI]

INTRODUCTION

Asthma is a heterogeneous disease characterized by lower airways' obstruction, caused by various factors. There are many asthma phenotypes. Lately, perimenstrual asthma (PMA) with a pattern of exacerbations before and during menstruation as well as obesity associated asthma have been a subject of particular scientific and clinical interest.

MATERIAL AND METHODS

30 women were qualified for this three-arm case-control study(women with a pattern of asthma exacerbations in the perimenstrual period, women with asthma but no perimenstrual exacerbations, healthy control group). All patients performed spirometry and assessed disease control using specific questionnaires. Peripheral blood counts with smear were also performed.

RESULTS

PMA patients differ in a statistically significant way in respect of anthropometric measurements such as BMI: in PMA group 25.8±1.8; in non-PMA asthmatics 23.9 ±2.2; healthy control 23.1±1.5; p=0.018) and spirometry results (FEV1 [%]: 85.1 (36.3-113.0); in PMA asthmatics, 93.1 (81,6-109,7), in nonPMA group, p<0.05; 105.4 (108,3-119,0) in healthy control and Tiffeneau index [%]: 70.1 (41.2-98.1); in PMA vs 83.5 (59.6-94.4); in non-PMA asthmatics 93.1(81,8-97,5) in healthy control p<0.05; ). PMA asthmatics also complain of poorer disease control than non-PMA asthmatics. There were no differences in peripheral blood eosinophilia or CRP between studied groups, p>0.05).

CONCLUSIONS

Asthma exacerbations are not associated with the effect of peripheral blood eosinophilia. Women with greater BMI are more predisposed to perimenstrual asthma.

Juniors' voice at the ERS International Congress, Amsterdam 2015: Juniors' Voice

The ERS structure is developing and so is the JMC. We are no longer considered the underground of ERS. As such, the previous title for this series, “News from the Underground”, is not representative anymore. The team’s work has been accepted and appreciated by both ERS and the Breathe leadership and, therefore, the series has been renamed “Juniors’ Voice” representing the activities we perform and the goals we strive for. We would like to ensure all junior readers that we will continue our dedication and work, create more chances and find more actively interested juniors to start and/or promote their involvement in ERS activities. From now “Juniors’ Voice” will keep you informed about current JMC and Assembly activities, scientific news from flagship ERS scientific activities and new opportunities for active cooperation.

Junior member activities at the ERS International Congress 2015http://ow.ly/R2oIn

The second year has been completed: News from the Underground

Among many other things, the last European Respiratory Society (ERS) International Congress in Munich brought changes to the ERS Junior Members Committee (JMC). The 3-year term of JMC representatives has seen Indre Butiene, who initiated the Committee 3 years ago, finish her tenure as chair, with Anders Bjerg, respiratory epidemiologist from Gothenburg, Sweden, being elected as her replacement. Indre’s departure has also led to the election of a new representative to the ERS Education Council. We congratulate Agnes Boots from the Netherlands on her election to this important position! Also, here in Breathe, the Doing Science series has been taken over by Georgia Hardavella, UK, whose ideas will take this practical educational series to new levels in 2015. The Hot Topics section is now coordinated by Neil Saad, UK, one of many Juniors outside the JMC who have volunteered for different JMC activities.

13th ERS Lung Science Conference. The most important take home messages: News from the Underground

The 13th ERS Lung Science Conference (LSC) was organised to bring academics together from all over the world to present and discuss the latest developments regarding lung infection and immunity. The conference took place in breathtaking Estoril, Portugal; however, it wasn't the beautiful surroundings that were our main motivation to attend, but instead the scientific merit of the conference and the chance to create new scientific collaborations. The scientific programme [1] was packed with the most up-to-date content in the field of lung infection and immunity and included some of the top researchers within this exciting area. Moreover, the convenient size of the LSC offered the opportunity to renew and intensify friendships and collaborations. In particular, for researchers at the start of their career, this is a great feature and we therefore warmly recommend the LSC to ERS Juniors Members!

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 patient's 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.