Importance of GOLD Guidelines for Chronic Obstructive Pulmonary Disease.

In December 2011, a major revision of GOLD 2011 guidelines was published based on the evidence-based medicine. The goal of GOLD 2011 is to determine the severity of the disease, its impact on the patient's health, and the risk of future events; all of which eventually guide therapy. A combined COPD assessment according to GOLD 2011 considers the patient's level of symptoms, spirometry abnormalities, risk of exacerbation, and the presence of comorbidities. GOLD 2011 stratifies patients into four basic groups labeled A, B, C, and D. The aim of the present study was to assess the importance of updated GOLD guidelines for the diagnosis, treatment, and prevention of COPD. We found that the multicomponent 2011 guidelines offer a significant advantage over the previous mono-component COPD assessment according to GOLD 2006 in terms of disease control and therapy management, with patients enjoying better spirometry values and a higher arterial oxygen content considered the primary outcomes of interest.

[Occupational tuberculosis in Slovakia and in the Czech Republic]. / Profesionálna TBC na Slovensku a v Ceskej republike.

STUDY OBJECTIVE: To conduct a retrospective 15-year study to monitor trends in the number of employees at risk for occupational tuberculosis (TB) (levels III and IV) in the Slovak Republic, and in particular in the sector of economic activities Q (health care and social assistance). Furthermore, to analyze reported cases of occupational TB and to compare the incidence and sex-specific and age-specific prevalence with the data reported in the Czech Republic. MATERIAL AND METHODS: Data on the number of employees at risk of exposure to occupational TB were derived from the Automated Risk Classification System of the Slovak Republic. Data on cases of occupational TB were taken from health statistics (Institute of Health Information and Statistics/National Health Information Center in the Slovak Republic and the National Institute of Public Health in the Czech Republic). A retrospective analysis was conducted (for 1998-2012) of reported cases of occupational TB, selected from Article 24 of the List of occupational diseases (infectious and parasitic diseases except tropical infectious and parasitic diseases and diseases transmissible from animals to humans). The selection criterion was a TB diagnosis according to ICD-10. In the Czech Republic, the data were derived from Article 5.1.02 (tuberculosis), Chapter V. of the List of Occupational Diseases. The data obtained were analyzed by methods of descriptive statistics. RESULTS: The numbers of employees with a level III risk of exposure to occupational TB in the Slovak Republic declined by 30% over the 15 years of study and by 40% in category Q. In 2012, 2027 employees were classified in category III and 1442 of them belonged to group Q. Females accounted for 81-84% of employees at risk of exposure to occupational TB. Eighty-six and 181 cases of occupational TB were reported in the Slovak Republic and in the Czech Republic, respectively, in 1998-2012, with the incidence showing a downward trend in both countries. TB of the respiratory tract was reported most often (83.7% of the total of reported cases of occupational TB). As expected, more cases occurred in females than in males (1.9 times as many cases in females as in males in the Slovak Republic and three times as many cases in females as in males in the Czech Republic). The incidence of occupational TB was the highest in sector Q, with the highest absolute numbers reported in nurses. In 2012, the incidence rates of occupational TB were 0.22 cases per 100,000 sick benefit policy holders in the Slovak Republic and 0.13 cases per 100,000 sick benefit policy holders in the Czech Republic. CONCLUSION: The incidence of occupational TB has a downward trend in both countries, similarly to TB incidence in the general population. A negative aspect in both countries is the incidence of occupational TB at the middle productive age, in contrast to the population occupationally non-exposed to TB. Slovakia is surrounded by higher prevalence countries, with the exception of the Czech Republic. It cannot be ruled out that, in addition to the known factors influencing the prevalence of TB, including occupational TB, migration from eastern countries, including job search migration, can also play a role in increase in TB cases. It is vital to continue epidemiological surveillance and to reduce the risk of TB as much as possible also in healthcare settings by adhering to barrier nursing practices. Cases of active TB need early and adequately long, controlled treatment in order to reduce, among others, the incidence of multi-drug resistant TB.

The impact of hypertonic saline inhalation on mucociliary clearance and nasal nitric oxide.

Nitric oxide (NO) has an influence on airway physiology by mediation in ciliary activity, inflammation, host defence, bronchial tone, and pulmonary vascular resistance. However, the clinical relevance of the measurement of nasal NO (nNO) in different physiological and pathological conditions has yet to be established before it can be used as a diagnostic tool. The aim of our study was to establish the relation between nNO and mucociliary clearance (MCC) and the impact of hypertonic saline inhalation on these markers. We examined 43 subjects. nNO was measured in the right (RnNO) and left (LnNO) nostrils before and after inhalation of hypertonic saline (HS) using a NIOX® analyser. MCC was measured before and after inhalation of HS by saccharin test. The levels of nNO before inhalation of HS (RnNO 806 ppb, IQR-337.6; LnNO 854 ppb, IQR 295.8) were significantly lower than levels after inhalation (RnNO 841.8 ppb, IQR 342.3; LnNO 897.4 ppb, IQR 304.1) (p<0.05, Wilcoxon T-test). The difference between RnNO and LnNO before and after inhalation of HS was not statistically significant. However, the difference in MCC before inhalation (507 s, IQR 233) and after inhalation of aerosol (360 s, IQR 238) was statistically significant (p<0.0001, Wilcoxon T-test). We did not confirm a correlation between nNO and MCC. An increase in osmolarity of the airway surface increases MCC and nNO, which could help to clear accumulated secretions in the airways and prevent respiratory tract infections.

Exhaled nitric oxide - circadian variations in healthy subjects.

OBJECTIVE: Exhaled nitric oxide (eNO) has been suggested as a marker of airway inflammatory diseases. The level of eNO is influenced by many various factor including age, sex, menstrual cycle, exercise, food, drugs, etc. The aim of our study was to investigate a potential influence of circadian variation on eNO level in healthy subjects. METHODS: Measurements were performed in 44 women and 10 men, non-smokers, without respiratory tract infection in last 2 weeks. The eNO was detected at 4-hour intervals from 6 a.m. to 10 p.m. using an NIOX analyzer. We followed the ATS/ERS guidelines for eNO measurement and analysis. RESULTS: Peak of eNO levels were observed at 10 a.m. (11.1 +/- 7.2 ppb), the lowest value was detected at 10 p.m. (10.0 +/- 5.8 ppb). The difference was statistically significant (paired t-test, P<0.001). CONCLUSIONS: The daily variations in eNO, with the peak in the morning hours, could be of importance in clinical practice regarding the choice of optimal time for monitoring eNO in patients with respiratory disease.

Bidirectional link between upper and lower airways in patients with allergic rhinitis.

OBJECTIVE: Exhaled nitric oxide has been proposed as a noninvasive marker of eosinophilic airway inflammation in lower airways. The aim of the study was to investigate the impact of atopy, pollen exposure, and pharmacological treatment on NO production in lower airways of patients with allergic rhinitis. SUBJECTS AND METHODS: Measurements of exhaled NO were performed in 79 non-asthmatic subjects with seasonal allergic rhinitis outside and in pollen season, before and after pharmacological treatment, and in 54 healthy controls. RESULTS: Patients with allergic rhinitis had significantly higher levels of exhaled NO (18.3 +/-11.0 ppb) than healthy controls (13.0 +/-7.2 ppb) measured outside the pollen season (P=;0.0024). Increased exhaled NO levels were also found in patients with allergic rhinitis in the pollen season (27.0 +/-20.0 ppb) compared with the levels outside pollen season (P=0.0001), before pharmacological treatment. In rhinitic patients treated by nasal corticosteroids and antihistamines in the pollen season, the levels of exhaled NO were significantly lower (17.0 +/-16.4 ppb; P=0.045) than those before treatment. No difference was found in NO levels in rhinitic patients outside and in pollen season after pharmacological treatment. CONCLUSIONS: This study has shown the presence of eosinophilic airway inflammation in the lower airways in allergic rhinitis patients. A significant increase of exhaled NO after pollen exposure in rhinitic patients underlies the impact of inflammation on the upper respiratory tract. A bidirectional link between upper and lower airways is confirmed by a decrease in exhaled NO in the pollen season, almost to the starting levels, after application of topic corticosteroids and antihistamines.

The effectiveness for prevention of tuberculosis in patients with inflammatory rheumatic diseases treated with TNF inhibitors.

BACKGROUND: New biologic therapies blocking TNF undoubtly constitute a considerable advancement in the management mentioned diseases, but are also associated with higher risk of activation of tuberculosis. METHODS: An assessment of tuberculosis activation rate in the group of patients with rheumatoid arthritis, juvenile idiopatic arthritis, ankylosing spondylitis and psoriatic arthritis threated by anti-TNF inhibitors since January 1st 2001 to June 30th 2007 in Slovakia and went in for special anti-tuberculosis screening before start of therapy. RESULTS: A total 537 rheumatic patients received the anti-TNF therapy. There were 346 rheumatoid arthritis patients, 68 juvenile idiopatic arthritis patients, 71 patients suffered from ankylosing spondylitis and 52 from psoriatic arthritis. Duration of anti-TNF therapy was 843 of patient-years. Infliximab took 203 patients with duration of therapy 348 patient-years, etanercept 201 patients with duration of therapy 331 patient-years and adalimumab 133 patients with duration of therapy 164 patient-years. The activation of tuberculosis reached the incidence 0.37% (2 cases for 537 patients) representing 0.237 cases for 100 patient-years. Both patients had extrapulmonary forms of tuberculosis which was in one patient disseminated, but they fully recovered after the anti-TNF drugs were stopped and chemotherapy was completed. CONCLUSION: Our results demonstrate a low incidence of tuberculosis activation during anti-TNF treatment in patients with inflammatory rheumatic diseases in the Slovak Republic and confirm the high effectiveness ours specified complex screening measures (Tab. 3, Ref. 13). Full Text (Free, PDF) www.bmj.sk.

[Pharmacotherapy of chronic obstructive pulmonary disease in patients with indications for long-term home oxygen therapy]. / Farmakoterapia chronickej obstrukcnej choroby plúc u pacientov indikovaných na dlhodobú domácu liecbu kyslíkom.

The authors submit a cross-sectional analysis of out-patient pharmacotherapy of chronic obstructive lung disease in 138 patients where long-term home oxygen therapy was indicated. To this group of patients no inhalatory bronchodilatating drugs were administered in 19.6% of the patients! The authors provide evidence of a non-significant better survival of patients who used inhalatory bronchodilatating drugs. From the mentioned group during the follow up period 41 (29.7%) died with a mean survival of 16.5 +/- 11.9 (0-39) months. Based on the mentioned results the authors draw attention to the relatively late indication of long-term home oxygen therapy and also to the fact that pharmacotherapy of patients with chronic obstructive lung disease indicated for long-term home oxygen therapy is not fully exploited and its optimalization could lead to better patient survival.

[Potential predictors of therapeutic response in patients with cryptogenic fibrosing alveolitis]. / Potenciálne prediktory liecebnej odpovede u pacientov s kryptogénnou fibrotizujúcou alveolitídou.

The authors present a clinical observation with the objective to test which objective indicators make it possible to predict the effect of treatment in patients with cryptogenic fibrotizing alveolitis. Retrospective analysis of the documentation of a longitudinal follow up of 34 patients with this diagnosis revealed that the presence of fibroproliferative changes on the high resolution CT image predicts significantly the absence of a therapeutic effect and conversely the absence of such changes predisposes for significant improvement of pulmonary functions during treatment. They found also a significant correlation between he ratio of lymphocytes in the bronchoalveolar lavage fluid and the dynamics of the development of pulmonary functions. The age of establishment of the diagnosis correlates also significantly with indicators of the therapeutic response. Based on these results the authors conclude that a favourable therapeutic effect can be expected in patients without fibroproliferative changes, with a significant lymphopcytosis in the bronchoalveolar lavage fluid and a younger age at the time of manifestation. On the other hand, in patients with a marked fibroproliferation and absence of alveolitis there is no point in attempting to influence the disease by pharmacological gents.

[Levels of alpha 1-antitrypsin in the blood of patients with chronic bronchitis]. / Hladiny alfa 1-antitrypsínu v sére chorých na chronickú bronchitídu.

Serum levels of alpha 1-antitrypsin were studied in 80 patients with chronic bronchitis. As a manifestation of the inflammatory response, nonsignificant increase was recorded compared to the group of healthy subjects. In discordance with literary data, no significant differences were found between bronchitics smokers and non-smokers. In 5 patients (6.2%), alpha 1-antitrypsin serum levels were below the lower limit of the reference range. The patients complained of cough, expectoration, and dyspnea. As a preventive measure, it is recommended to determine serum alpha 1-antitrypsin levels in smokers before they take up a job in a dusty environment and in bronchitics before inhalation treatment with proteolytic enzymes is administered. In alpha 1-antitrypsin deficit the value of substitution therapy in patients with emphysema is being emphasized.