Coexistence of Chronic Bronchitis in Chronic Obstructive Lung Disease.

The incidence of chronic obstructive pulmonary disease (COPD) is on the rise worldwide. Chronic bronchitis is a frequent accompaniment of COPD, which increases the burden of COPD in affected individuals. The aim of this study was to characterize the phenotype of chronic bronchitis in COPD patients. The study was based on the survey data retrospectively retrieved from the Action Health-Lung Cancer Prophylaxis and Health Care Improvement screening program that concerned all the inhabitants, aged over 40, of the Proszowice administrative region situated in the Lesser Poland Voivodeship in southern Poland. Participants with the symptoms suggestive of a lung disease were subject to further evaluation. The findings were that 546 (13.3%) out of the 4105 individuals displayed spirometry features of COPD. Symptoms of chronic bronchitis were present in 92 (16.8%) out of the COPD afflicted persons. Chronic bronchitis was commoner in current smokers and its incidence increased with increasing severity of airway obstruction. In multivariate analysis, chronic bronchitis was independently related to lower FEV1, FVC, FEV1/FVC, and to dyspnea. In regression model, factors related to increased risk of chronic bronchitis were current smoking, asthma, and lower lung function. We conclude that COPD with coexisting chronic bronchitis is linked to severer dyspnea and worse lung function. Current smoking, asthma, and lower lung function are related to increased risk of chronic bronchitis accompanying COPD.

[Effects of biomass combustion and occupational exposures on lung function in random population sample of Malopolska inhabitants]. / Wplyw spalania biomasy i narazen zawodowych na czynnosc pluc w losowej próbie populacyjnej mieszkanców Malopolski.

INTRODUCTION: Risk factors other than tobacco smoking contribute to about 20% of chronic obstructive pulmonary disease cases. Exposure to these risk factors and their influence on lung function has not been adequately studied in the population of Malopolska. MATERIAL AND METHODS: In random population sample of adults at least forty years old, residents of 2 districts of Malopolska, data on exposure to known and probable respiratory risk factors were collected using questionnaire. All subjects without contraindications performed pre- and post-bronchodilatator spirometry. RESULTS: We analyzed data from 618 subjects; 94,8% subjects lived for longer than 6 months in a dwelling where stove using coal or wood has been used for cooking and/or heating. At the time of study as many as 32.5% subjects were still using coal or wood for cooking or heating. Coal or wood were used as fuel on average for more than 30 years; 67% of subjects have ever worked in professions carrying a risk of exposure to potential respiratory risk factors. We have identified an independent relationship of farming with lower FEV1/FVC values as well as increased chronic obstructive pulmonary disease risk. CONCLUSIONS: Significant proportion of Malopolska inhabitants has been exposed to risks associated with cooking or heating with coal or wood. In the studied population farming was related to increased risk of chronic obstructive respiratory disease.

[Measurement of bronchoconstrictive eicosanoids in chronic obstructive pulmonary disease]. / Pomiar bronchospastycznych eikozanoidów w przewleklejobturacyjnej chorobie pluc.

INTRODUCTION: The aim of the study was the evaluation of the concentration of 9α11ß prostaglandin F(2) - a stable metabolite of prostaglandin D(2) (PGD(2)) and leukotriene E(4) (LTE(4)) in stable and exacerbated COPD patients. MATERIAL AND METHODS: 29 COPD patients aged 73 ± 8.34, mean FEV1 = 48.64 ± 15.75% of predictive value and 29 healthy controls aged 57.48 ± 10.86, mean FEV1 = 97.17 ± 13.81% of predictive value participated in this study. Samples of urine and blood were taken from COPD patients during exacerbation and in stable state of the disease; LTE(4) was determined in urine using commercial enzyme immunoassay (EIA) and 9α11ß prostaglandin F(2) (9α11ßPGF(2)) - stable metabolite of PGD(2) was evaluated in blood and urine using GC/MS. RESULTS: LTE(4) concentration in urine (677.15 vs. 436.4 pg/mg of creatinine; p = 0.035) and 9α11ßPGF(2) in blood serum (5.35 vs. 3.07 pg/ml; p = 0.007) were significantly higher in exacerbated COPD patients than in control group. There was no difference in LTE(4) level in urine and 9α11ßPGF2 in blood serum between exacerbated and stable COPD. The urinary 9α11ßPGF(2) concentration did not differ between all studied groups. We found a positive correlation between smoking history and the urine LTE(4) level (r = 0.395; p = 0.002) as well as blood 9α11ßPGF(2) concentration (r = 0.603; p = 0.001) in COPD patients. CONCLUSIONS: 9α11ßPGF(2) and LTE(4) level in urine did not differ between the stable COPD group and the control group. We also did not find any difference between LTE4 level in urine and 9α11ßPGF(2) in blood and urine between exacerbated and stable COPD. Finally, LTE(4) concentration in urine and 9α11ßPGF(2) in blood occurred to be significantly higher in exacerbated COPD patients than in control group.

Symptoms of chronic bronchitis in individuals without chronic obstructive pulmonary disease: prevalence, burden, and risk factors in southern Poland.

Introduction Chronic bronchitis (CB) symptoms are commonly reported in individuals without chronic obstructive pulmonary disease (COPD), but CB is rarely diagnosed in this population. Objectives We aimed to determine the prevalence and burden of CB, as well as its risk factors, in a population of patients without COPD. Patients and methods Data from the "Health Action" program (a lung cancer prevention and health care improvement program conducted in Proszowice County, Poland) were used. All county inhabitants aged 40 years or older without COPD were invited to participate. As part of the program, a questionnaire was administered to assess CB symptoms and risk factors. Spirometry at baseline and after the bronchodilator test was also performed. Results CB symptoms were present in 9.1% of the 3558 participants. The prevalence of CB in the study population was 7.12% (95% CI, 6.70-7.56). Patients with CB had more dyspnea and more often received medical treatment for lung disease or were hospitalized for respiratory disorders than patients without CB. CB was associated with worse lung function and a worse score in the modified Medical Research Council Dyspnea Scale even after adjustment for possible confounders. In a multivariate analysis, male sex, age over 70 years, current smoking, passive exposure to tobacco smoke, gas or wood heating, occupational exposure to chemical agents, lower forced expiratory volume in 1 second, and asthma correlated with an increased risk of CB. Conclusions CB symptoms are common in individuals without COPD aged 40 years or older and are associated with more dyspnea irrespective of lung function and comorbidities.

Pulmonary prevention program in the Proszowice county: description and results.

INTRODUCTION: In the Proszowice county, both lung cancer and chronic obstructive pulmonary disease (COPD) are more common in comparison with other regions of Poland. The purpose of this study was to provide a report on a prevention program carried out in the area to reduce the burden of COPD and lung cancer in the region. MATERIAL AND METHODS: The program consisted of the following: active prevention - questionnaire survey offered to every county inhabitant aged at least 40 and chest X-ray and spirometry performed in selected subjects; and passive prevention - covering multiple educational activities promoting healthy lifestyle. Data obtained from questionnaire survey and spirometry were further analyzed. RESULTS: Education program covered all local children aged 13-15, a majority of adolescents and a significant proportion of adult inhabitants of the county. Questionnaire data were obtained from 14,455 subjects (about 70% of county inhabitants). On the basis of the questionnaire results, the participants were selected to undergo spirometry (5,816 subjects) and chest X-ray (5,514 subjects). Current smokers constituted 24.2% of the total number of participants (33.3% of men and 16.8% of women). Electronic cigarettes were currently used by 0.65% of the subjects. Negative impact of occupational exposures (including farming) on lung function and the presence of respiratory symptoms was observed. Basing on post-bronchodilator spirometry, COPD was diagnosed in 13.2% of the subjects. Physician's diagnosis of asthma was reported by 7.2%. CONCLUSION: Educational activities and questionnaire-based study were targeted at and reached the majority of the county inhabitants. The study provided data on the prevalence and risk factors of COPD, asthma and respiratory symptoms in the Proszowice region.

[The effect of fenspiride on the number of exacerbations and the time of first exacerbation in patients with chronic bronchitis]. / Wplyw fenspirydu na liczbe zaostrzen i czas ich wystapienia u chorych na przewlekle zapalenie oskrzeli.

UNLABELLED: The aim of the work was evaluation of efficacy of fenspiride b.i.d. on the number of exacerbations and the time to the first exacerbation in patients with chronic bronchitis. MATERIAL AND METHODS: Randomized, multicentre study controlled versus placebo was carried out in 12 centers in Poland. All patients, 89 females and 68 males aged between 20 and 74, were treated with fenspiride at the dose of 160 mg/day for a period of 6 months. The following symptoms were recorded every month in order to evaluate the therapeutic efficacy: sputum quality and quantity, cough intensity, dyspnea and bronchospasm. Based on these symptoms diagnosis of exacerbation was performed according to American Thoracic Society criteria. RESULTS: Quality and quantity of sputum and cough significantly improved in the fenspiride group (comparing to the placebo group p= 0.027 and p = 0.049 adequately for sputum and cough). A significant difference between groups was observed in the number of exacerbation episodes and their duration. In the fenspiride group there were 0.53 episodes of exacerbation compared with 1.12 episodes in the placebo group (p = 0.038). Mean duration of exacerbation was 3.3 days in the fenspiride group and 7.3 days in the placebo treated patients (p = 0.034). Time to the first exacerbation differed between groups, but this difference was not statistically significant. Number of side effects observed did not differ between groups. CONCLUSION: Fenspiride treatment was assessed as relatively effective in terms of influence on exacerbations, and well tolerated during six month therapy.

The influence of simvastatin on selected inflammatory markers in patients with chronic obstructive pulmonary disease.

INTRODUCTION: There is growing evidence that chronic obstructive pulmonary disease (COPD) is a risk factor for coronary heart disease. Simvastatin is a hypolipemic drug with proven efficacy in the prevention of cardiovascular diseases. Observational studies showed that statins may be useful in the reduction of mortality from COPD. Experimental studies on animals showed anti-inflammatory effects of statins on the lung tissue. OBJECTIVES: The aim of this study was to evaluate the influence of simvastatin on inflammatory markers in patients with COPD. PATIENTS AND METHODS: Fifty-six patients (aged 44-80 years) with stable COPD (a mean forced expiratory volume in 1 second [FEV1] 55%), were randomly assigned (1:1) to receive simvastatin 40 mg/day or to receive no statin treatment. Blood samples were collected before, 2 weeks, and 3 months after statin administration. The levels of fibrinogen, C-reactive protein (CRP), tumor necrosis factor-alpha, interleukin 6 (IL-6), and matrix metalloproteinase-9 were measured. RESULTS: The groups did not differ significantly in terms of demographic data, clinical symptoms, pharmacological treatment, spirometry, and lipid profile at baseline. Among comorbidities only arterial hypertension was more frequent in the statin group (32.1% vs. 17.9%, P = 0.03). After 2 weeks as well as 3 months of simvastatin treatment, no significant reduction of any measured inflammatory markers was observed. There was a nonsignificant reduction of CRP and IL-6 in the subgroup with FEV1 >50% during simvastatin treatment. There was a decrease in total cholesterol (from 5.7 to 4.7 mmol/l, P = 0.0018) and low-density lipoprotein cholesterol (from 3.46 to 2.47 mmol/l, P = 0.000037) in the statin group. CONCLUSIONS: In COPD patients, a 3-month treatment with simvastatin does not reduce circulating inflammatory markers.

Fibrin clot properties are altered in patients with chronic obstructive pulmonary disease. Beneficial effects of simvastatin treatment.

Increased risk of thrombotic events occurs in chronic obstructive pulmonary disease (COPD). Elevated fibrinogen and C-reactive protein (CRP), being common in COPD, are associated with formation of dense fibrin clots resistant to lysis. Statins have been found to display anti-inflammatory and antithrombotic effects. We investigated fibrin clot properties in COPD patients prior to and following statin therapy. Ex vivo plasma fibrin clot permeability, compaction, and fibrinolysis were assessed in 56 patients with stable COPD, aged 64.9 +/- 9.2 years (mean FEV(1), 54.7 +/- 15.9% predicted), versus 56 controls matched for age, sex and cardiovascular risk factors. Patients were then randomly assigned to receive simvastatin 40 mg/day (n = 28) or to remain without statins for three months (n = 28). Patients with COPD had lower clot permeability (6.1+/- 1.07 versus 9.2 +/- 0.9 10(-9) cm(2), p < 0.0001), decreased compaction (44.9 +/- 4.5 versus 63.9 +/- 6.1%, p < 0.0001), higher maximum D-dimer levels released from clots (4.23 +/- 0.55 versus 3.53 +/- 0.31 mg/l, p < 0.0001) with a decreased rate of this release (75.0 +/- 8.3 versus 80.9 +/- 8.0 microg/l/min, p = 0.03) and prolonged lysis time (9.84 +/- 1.33 versus 8.02 +/- 0.84 min, p < 0.0001) compared with controls. Scanning electron microscopy confirmed denser clot structure in COPD. Multiple linear regression analysis after adjustment for age and fibrinogen showed that in the COPD patients, CRP was the only independent predictor of permeability (R(2) = 0.47, p < 0.001) and lysis time (R(2) = 0.43, p < 0.001). Simvastatin improved clot properties (p < 0.05) despite unaltered CRP and irrespective of cholesterol reduction. Our study shows that fibrin clots in COPD patients are composed of much denser networks that are more resistant to lysis, and these properties can be improved by statin administration.

Prevalence of COPD and tobacco smoking in Malopolska region--results from the BOLD study in Poland.

INTRODUCTION: There is a paucity of population-based data on chronic obstructive pulmonary disease (COPD) prevalence in Poland. To address this problem we participated in the Burden of Obstructive Lung Disease (BOLD) Initiative which was developed to provide standardized methods for estimating the prevalence of COPD and its risk factors. OBJECTIVES: The study aimed to assess the prevalence of COPD and some of its risk factors in adults aged 40 years and older in the Malopolska region in southern Poland. PATIENTS AND METHODS: Region--representative sample was drawn, basing on the current census data. Detailed BOLD questionnaires as well as pre- and post-bronchodilator spirometry were applied to eligible individuals. RESULTS: Six hundred and three subjects provided questionnaire and spirometry data; of those 526 provided spirometry data of appropriate quality and were included in the final analysis. Estimated population prevalence of COPD was 22.1%, whereas 10.9% had COPD in GOLD Stage > or = 2. COPD was far more common in men and its prevalence increased with age and exposure to tobacco smoke, and was inversely related to education level. The prevalence of current tobacco smoking was 28% (34% and 22% in men and women, respectively). Seventy-nine percent of men and 42% of women were ever-smokers. Twenty-nine percent of never smoking individuals were passively exposed to tobacco smoke in their households. CONCLUSIONS: Our results confirm the high prevalence of COPD in the studied region of Poland and emphasize the need to increase efforts to improve COPD awareness and limit tobacco smoking habit.