Observational cross-sectional study of 5279 bronchoscopy results for the practical effectiveness of various biopsy techniques in the diagnosis of lung diseases with particular emphasis on lung cancer.

INTRODUCTION: Bronchoscopy is the main method in the diagnosis of various lung diseases. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the most modern bronchoscopic technique useful in diagnosis and staging of lung cancer (LC). OBJECTIVE: The aim of the study was to assess the yield of bronchoscopy in patients with suspected various respiratory diseases including LC. In particular, we examined the efficiency of different biopsy techniques in the diagnosis of LC in correlation with its localisation and pathomorphological type. PATIENTS AND METHODS: The results of pathomorphological examinations from 5279 bronchoscopies performed in 2016-2018 were analysed. The material was collected with EBUS-TBNA, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endobronchial forceps biopsy. Clinical and demographic factors were analysed using the Fisher χ2 test. RESULTS: 5279 patients were diagnosed due to various respiratory symptoms. LC was confirmed in 36.42% of patients. 40.81% of patients had no definitive pathomorphological diagnosis. Among patients with LC, the most frequent diagnosis was non-small cell LC: squamous cell lung cancer (SCC)-32.07% and adenocarcinoma (AC)-30.61%, then small cell LC-25.83% and not otherwise specified non-small cell lung cancer (NSCLC-NOS)-11.49%. Diagnosis of SCC was obtained significantly more often (χ2=43.143, p<0.000001) by forceps biopsy (41.09%) than by EBUS-TBNA/EUS-FNA (26.62%). On the contrary, diagnosis of AC or NSCLC-NOS was significantly more often (χ2=20.394, p<0.000007, and χ2=3.902, p<0.05, respectively) observed in EBUS-TBNA/EUS-FNA (34.31% and 12.6%) than in endobronchial biopsies (24.52% and 9.64%). CONCLUSIONS: The use of bronchoscopy in the diagnosis of various lung diseases is vital but also has many limitations. Effectiveness of EBUS-TBNA and endobronchial forceps biopsy in the diagnosis of lung cancer is strongly affected by tumour localisation and type of cancer.

The relationship between COPD Assessment Test (CAT) scores and Distress Thermometer (DT) results in COPD patients.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a condition that affects over 2 million adults in Poland. In recent years, increasing attention has been focused on improving the quality of life of patients with COPD, which includes alleviating their physical discomfort and relates to their mental health. It is therefore critically important to evaluate research tools that can accurately assess the relationship between the physical and mental health of patients with this disease. OBJECTIVE: This aim of the study is to evaluate the relationship between the COPD Assessment Test (CAT) and the Distress Thermometer and Problem List results in COPD patients. MATERIAL AND METHODS: The research evaluated 70 patients with COPD as defined by the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) criteria. Demographic data was obtained at baseline. Disease-specific quality of life was assessed using the CAT score, while overall distress was determined using the Distress Thermometer (DT) scale and a modified Problem List. The relationship between the CAT scores and the results of the Distress Thermometer and Problem List was statistically compared. The study was approved by the Bioethics Committee, and all patients provided written informed consent. RESULTS: The mean ± SD age was 69.6±9.05 (range 47-90) years. The average distress level was 4.09±1.95. A significant relationship was established between the CAT score and the results of the Distress Thermometer Scale (p<0.001); patients with higher CAT scores showed the highest level of distress. CONCLUSIONS: CAT was shown to be a simple, fast and clear measurement of disease-specific quality of life and was correlated with levels of distress in patients with COPD. Every patient with COPD should be evaluated using a scale such as the DT to measure their level of psychological distress.

Impact of I/D polymorphism of ACE gene on risk of development and course of chronic obstructive pulmonary disease.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) affects more than 10% of the world's population over 40 years of age. The main exogenous risk factor is cigarette smoking; however, only 20% of smokers develop COPD, indicating that some other factors, e.g. genetic, may play an important role in the disease pathogenesis. Recent research indicates that ACE (angiotensin-converting enzyme) may be a susceptibility gene for asthma or COPD. The aim of our study was to determine the influence of I/D (insertion/deletion) polymorphism of the ACE gene (AluYa5, rs4646994) on the risk and course of COPD. MATERIAL AND METHODS: We investigated ACE I/D polymorphism in 206 COPD and 165 healthy Caucasian subjects. RESULTS: In the generalized linear model (GLZ) analysis of the influence of selected factors on presence of COPD we found a significant independent effect for male sex (repeatedly increases the risk of COPD, OR = 7.7, p = 0.049), as well as smoking or lower body mass index, but only in combination with older age (OR = 0.96, p = 0.003 and OR = 1.005, p = 0.04 respectively). Interestingly, analysis of factors which may influence the risk of a higher number of exacerbations demonstrated that occurrence of DD genotype, but only in men, is associated with a lower risk (OR = 0.7, p = 0.03) of this complication. CONCLUSIONS: We suggest that ACE may not be a susceptibility gene for the origin of COPD but a disease-modifying gene. Since the impact of I/D polymorphism of the ACE gene on COPD risk is moderate or negligible, other molecular changes, that will help predict the development of this disease, should still be sought.

The yield of endobronchial biopsy in pulmonary sarcoidosis: connection between spirometric impairment and lymphocyte subpopulations in bronchoalveolar lavage fluid.

BACKGROUND: Sarcoidosis is a multi-organ granulomatous disorder of undetermined aetiology with 90% of patients exhibiting some degree of pulmonary involvement. Transbronchial biopsy and endobronchial biopsy (EBB) with a fiber-optic bronchoscope, which demonstrate giant or epithelial cells of granuloma formation, have been established as standard methods for histological confirmation of sarcoidosis. OBJECTIVES: The analysis of EBB and bronchoalveolar lavage (BAL) specimens was used to assess the frequency of positive EBB findings in patients with pulmonary sarcoidosis. The influence of spirometric abnormalities and BAL findings on EBB-based diagnosis was also evaluated. METHODS: The examined group of patients comprised 60 subjects mean age 39.4 +/- 9.65 years). The results of pulmonary function tests, EBB and BAL were analysed. RESULTS: EBB was performed on 52 patients. Positive histological results were found in 40% of subjects; 12 of them were affected by spirometry impairment. All patients with restriction and almost half of the subjects with obstruction disorders had positive EBB findings. In the BAL fluid, the percentage of CD3+ and CD4+ cells was significantly lower and the percentage of CD19+ and CD8+ lymphocytes was significantly higher in patients with positive biopsies in comparison with the subjects with negative EBB findings. CONCLUSIONS: Positive biopsies are related to the intensity of abnormalities in the pulmonary function tests and BAL, and may reflect an advanced stage of sarcoidosis.

Blood myeloid and lymphoid dendritic cells reflect Th1/Th2 balance in sarcoidosis and extrinsic allergic alveolitis.

Dendritic cells play a specific regulatory role in the immune system. In this paper, the significance of myeloid and lymphoid dendritic cells in sarcoidosis and extrinsic allergic alveolitis (EAA) was evaluated. Myeloid dendritic cells are connected with Th1 type of immunological response, whereas lymphoid ones--with Th2 type. The latest findings indicate that both diseases are characterized by serious disturbances of Th1/Th2 response to Th1 dominance. Our studies seem to confirm these suggestions. In the peripheral blood of patients with sarcoidosis as well as with EAA, myeloid dendritic cells outnumbered lymphoid ones.

Evaluation of an anti-chlamydial antibiotic therapy influence on asthma patients.

Chlamydia pneumoniae is one of the most frequent pathogens causing airways infections. Contribution of chronic chlamydial infection to the following diseases: asthma, POChP, coronary heart disease, abdominal aortic aneurysm, is particularly interesting. The connection between such infection and bronchial asthma was described in the literature in 1991. C. pneumoniae often causes asthma exacerbation; it is suggested that it also may be an etiologic factor of the disease. In a group of 55 subjects with chronic, stable bronchial asthma treated in the Pulmonary Department, serologic characteristic of C. pneumoniae infection was found in 34 patients (61,8%). Thirteen of these subjects agreed to participate in the study. They were divided into two groups; placebo was administered to the first one and azithromycin in a dose of 1000 mg once a week--to the other one. The research was conducted using the double blind trial method. Anti-chlamydial antibody level was evaluated before and after treatment. Spirometry tests as well as subjective estimation of physical fitness and dyspnoea degree were also determined. In comparison with 'the placebo group', statistically significant improvement in respiratory parameters 'in the treated group' was not ascertained.

Incidence of allergic respiratory diseases in the Lublin region in correlation with the level of environmental pollution.

Basing on the standard questionnaires, the incidence of bronchial asthma, seasonal and perennial rhinitis in the population sample of the region of Lublin was evaluated. The study involved a group of 1,511 subjects--500 from each of the three distinct districts (Naleczów, Pulawy, Motycz-Lublin) chosen considering the level of industrial pollution. The information was obtained from 1,223 adults (376, 404 and 443, respectively) and 288 children (60, 94 and 134, respectively). Bronchial asthma was diagnosed in 68 adults (5.6%) and 22 children (7.6%). Allergic rhinitis incidence had a value of 6.7% in adults and 5.6% in children, whereas the incidence of perennial rhinitis was estimated as 2.9% and 1.4%, respectively. Among adults, there was no difference in the incidence of bronchial asthma in each district. Allergic rhinitis was diagnosed more often in rural than in urban areas (p<0.005). Among children, asthma was diagnosed significantly more often in the industrial-urban district (Pulawy) with incidence value of 16% than in the rural-industrial district (Motycz-Lublin) with the value of 1.5% (p=0.0001).