Severe T2-high asthma in the biologics era: European experts' opinion.

The European Respiratory Biologics Forum gathered participants from 21 countries in Madrid, Spain, to discuss the management and treatment of severe asthma in the era of biologics. The current insights on the pathophysiology of severe asthma were discussed, as well as the role of respiratory biologics in clinical practice and strategies for eliminating chronic use of oral corticosteroids. The participants also highlighted the key challenges in identifying patients with severe asthma based on phenotypes, biomarkers and treatable traits, and the existing problems in patient referral to specialist care. The monitoring of treatment was debated and the need for a change towards precision medicine and personalised care was emphasised throughout the meeting. This review provides a summary of the discussions and highlights important concerns identified by the participants regarding the current management of severe asthma.

Importance of the relationship between symptoms and self-reported physical activity level in stable COPD based on the results from the SPACE study.

BACKGROUND: The burden of symptoms and risk of exacerbations are the main drivers of the overall assessment of the Chronic Obstructive Pulmonary Disease (COPD) and the adequate treatment approaches per current Global Initiative for Chronic Obstructive Lung Disease (GOLD). Physical activity has emerged as both functional outcome and non-pharmacological intervention in COPD patients, despite the lack of standardized measures or guidelines in clinical practice. This study aimed to explore in more depth the 24-h respiratory symptoms, the physical activity level (PAL) and the relationship between these two determinants in stable COPD patients. METHODS: This was a multinational, multicenter, observational, cross-sectional study conducted in ten European countries and Israel. Dedicated questionnaires for each part of the day (morning, daytime, night) were used to assess respiratory symptoms. PAL was evaluated with self- and interview-reported tools [EVS (exercise as vital sign) and YPAS (Yale Physical Activity Survey)], and physician's judgement. Patients were stratified in ABCD groups by 2013 and 2017 GOLD editions using the questionnaires currently recommended: modified Medical Research Council dyspnea scale and COPD Assessment Test. RESULTS: The study enrolled 2190 patients (mean age: 66.9 years; male: 70.0%; mean % predicted FEV1: 52.6; GOLD groups II-III: 84.5%; any COPD treatment: 98.9%). Most patients (> 90%) reported symptoms in any part of the 24-h day, irrespective of COPD severity. PAL evaluations showed discordant results between patients and physicians: 32.9% of patients considered themselves completely inactive, while physicians judged 11.9% patients as inactive. By YPAS, the overall study population spent an average of 21.0 h/week performing physical activity, and 68.4% of patients were identified as sedentary. In any GOLD ABCD group, the percentage of inactive patients was high. Our study found negative, weak correlations between respiratory symptoms and self-reported PAL (p < 0.001). CONCLUSIONS: Despite regular treatment, the majority of stable COPD patients with moderate to severe disease experienced daily variable symptoms. Physical activity level was low in this COPD cohort, and yet overestimated by physicians. With evidence indicating the negative consequences of inactivity, its adequate screening, a more active promotion and regular assessment of physical activity are urgently needed in COPD patients for better outcomes. TRIAL REGISTRATION: NCT03031769 , retrospectively registered, 23 Jan 2017.

A Comparison of Intradermal Skin Testing and Serum Insect Allergen-specific IgE Determination in Horses With Insect Bite Hypersensitivity From 2008 to 2016.

New techniques in equine veterinary allergy testing include multiple allergen simultaneous tests (MASTs) that cover insect bite hypersensitivity (IBH), respiratory and atopic allergic diseases. The in vivo intradermal test (IDT) method is one of the most widely used techniques in veterinary practice, but recently, in vitro methods have been introduced as possible alternatives. This study was designed to assess the correlation between IDTs and MASTs based on IgE determination in serum. The study was performed on Malopolski breed horses with IBH (n = 26). IDTs were performed, and allergen-specific IgE serum concentrations were measured using a monoclonal anti-IgE antibody during the years 2008-2016. An allergen panel containing Tabanus spp., Culicoides nubeculosus, mosquito (Culex spp.), Simulium equinum, and Stomoxys calcitrans was used. This study shows good agreement and correlation (correlation coefficient rho, 0.413-0.589) between the two tests for four (Tabanus spp, Culicoides nubeculosus, Culex spp., Simulium equinum) of the five tested allergens in horses with IBH. The overall sensitivity (Se) of the allergen-specific IgE insect horse panel was 72.6% (range, 30.8%-91.3%), the specificity (Sp) was 63.6% (range, 50%-70.1%), and the accuracy (Acc) was 73.3% (range, 48%-88.5%) compared with IDTs. This study found good agreement and correlation between IDTs and serological MASTs based on monoclonal antibodies for most of the determined allergens for horses with IBH.

Successful control of disseminated follicular cysts in a dog with low dose isotretinoin.

A case of disseminated cysts in a dog is described. Histopathological examination revealed the presence of follicular infundibular cysts, which were treated with isotretinoin at a dose of 2 mg/kg body weight (BW), q24h for 1 week, followed by a dose of 1 mg/kg BW for 3 months. Symptoms resolved after this course of treatment.

Contrôle réussi de kystes folliculaires disséminés chez un chien à l'aide d'une faible dose d' isotrétinoïne . Nous décrivons un cas de kystes disséminés chez un chien. L'examen histopathologique a révélé la présence de kystes infundibuliformes folliculaires qui ont été traités à l'aide de l'isotrétinoïne à une dose de 2 mg/kg poids corporel (PC), q24h pendant 1 semaine, suivie d'une dose de 1 mg/kg PC pendant 3 mois. Les symptômes se sont résorbés après ce régime de traitement.(Traduit par Isabelle Vallières).

Correlation between transepidermal water loss (TEWL) and severity of clinical symptoms in cats with atopic dermatitis.

The aim of this study was to demonstrate whether there is a correlation between transepidermal water loss (TEWL) and the severity of skin lesions in cats with feline atopic dermatitis (AD). The severity of symptoms was determined by using 2 scoring systems for clinically assessing the skin lesions in cats: Scoring Feline Allergic Dermatitis (SCORFAD) and Feline Extent and Severity Index (FeDESI). Such a correlation between TEWL and systems for clinically evaluating symptoms has already been shown in humans and dogs. Measurements were taken in 18 European Shorthair cats: 11 females and 7 males. Scores were calculated using SCORFAD and FeDESI and TEWL was measured in 7 areas of the body. Correlations were calculated between SCORFAD and TEWL and between FeDESI and TEWL for each body region and the average TEWL was also calculated with each system. Positive correlations were found between SCORFAD and TEWL in 3 of the examined areas: thorax (r = 0.44, P = 0.02); axilla (r = 0.39, P = 0.04); and forelimb (r = 0.55, P = 0.02). A correlation was also found between the average TEWL and SCORFAD (r = 0.41, P = 0.03). In the case of FeDESI, a correlation was found in the forelimb (r = 0.53, P = 0.02), but no correlation was found between FeDESI and the average TEWL. The results obtained showed that TEWL can be used as an additional tool in clinically assessing atopic dermatitis in cats, although it seems to be less useful in cats than in humans.

Les maladies allergéniques de la peau sont un problème très fréquent chez les chats. Les deux systèmes d'évaluation Scoring Feline Allergic Dermatitis (SCORFAD) et Feline Extent and Severity Index (FeDESI) utilisent l'évaluation clinique de la gravité des symptômes cliniques. Chez les humains et les chiens, il existe une corrélation entre la gravité des symptômes cliniques et le Transepidermal Water Loss (TEWL). Le but de l'étude était de démontrer si cette corrélation était observée chez les chats. Des mesures ont été réalisées dans 18 chats européens à courtes poils: 11 femelles, 7 mâles, SCORFAD et FeDESI ont été calculées, les mesures TEWL ont été effectuées dans 7 régions corporelles. Les corrélations entre SCORFAD et FeDESI et TEWL ont été calculées pour chaque région corporelle et entre la TEWL moyenne. Il y avait des corrélations positives entre TEWL et SCORFAD sur la poitrine: (r = 0,44, P = 0,02), alisselle (r = 0,39, P = 0,04) et avant bras (r = 0,55, P = 0,02). La corrélation entre TEWL moyen et SCORFAD a été montrée (r = 0,41, P = 0,03). FeDESI a été trouvé sur l'avant-bras (r = 0,53, P = 0,02). Les résultats montrent que TEWL est un paramètre qui peut être utilisé comme outil supplémentaire dans l'évaluation clinique de la dermatite atopique chez les chats. La pertinence de ce paramètre semble être plus faible chez le chat que chez les humains.(Traduit par les auteurs).

Evaluation of the correlation between Scoring Feline Allergic Dermatitis and Feline Extent and Severity Index and skin hydration in atopic cats.

BACKGROUND: Evaluation of the severity of clinical signs of cats with allergic skin diseases has used two scoring systems: Scoring Feline Allergic Dermatitis (SCORFAD) and the Feline Extent and Severity Index (FeDESI). The integrity of the cutaneous barrier can also be evaluated by measuring skin hydration. A correlation between the clinical score and skin hydration has been observed in humans and dogs with atopic dermatitis (AD). HYPOTHESIS: To demonstrate a correlation between the clinical score and skin hydration of cats affected with presumed AD. ANIMALS: European short hair cats (n = 18): 11 females and seven males with a confirmed diagnosis of AD. METHODS: SCORFAD and FeDESI scores were calculated and the measurements of skin hydration were assessed from seven body sites using corneometry. The correlation between the SCORFAD and FeDESI systems and skin hydration of each site, and the average skin hydration was calculated. RESULTS: There was a positive correlation between the SCORFAD score and skin hydration for the axilla, thorax and forelimb; for FeDESI and axilla and lumbar sites. There was a negative correlation between the FeDESI and skin hydration for the pinna (r = -0.47). CONCLUSIONS AND CLINICAL IMPORTANCE: Measurements of skin hydration could be a useful tool for the evaluation of allergic cats. There is limited evidence of any useful correlation between clinical scoring systems and measurements of hydration. The pinna may be a suitable region for the assessment of skin barrier function in normal and allergic cats.

Seasonal microbiological quality of air in veterinary practices in Poland.

Numerous studies focused on the bioaerosols in the areas of industry, agriculture and animal husbandry, concerning both residential and public buildings, have been conducted continuously for many years. The aim of the present work was to determine the concentration and composition of mesophilic bacterial flora in the air of selected medical and veterinary clinics located in the cities and in the countryside. Air sampling was carried out in 2011-2013 in 44 veterinary practices in autumn-winter and spring-summer seasons. The concentration of bacteria ranged from 39 - 5,034 cfu/m(3) , with higher values recorded in offices operating in the cities. In the examined medical and veterinary offices, Gram-positive bacteria comprised the largest group of microorganisms, among which Gram-positive cocci of the genus Staphylococcus prevailed, with the highest average of 1,074.40 cfu/m(3) in urban offices during the autumn season. The smallest group was represented by Gram-negative bacteria, with a concentration of 0.0 - 215 cfu/m(3). In total, 93 kinds/species of bacteria were identified. A 12-month series of studies showed the highest mean concentrations of microorganisms in autumn for offices located in the city, while the lowest in winter for rural centres. The environment of veterinary offices is a habitat of pathogenic and potentially pathogenic bacteria, which may pose health problems not only for residents, but also for the animals.

Assessment of a correlation between Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) and selected biophysical skin measures (skin hydration, pH, and erythema intensity) in dogs with naturally occurring atopic dermatitis.

Atopic dermatitis is a common allergic skin disease in dogs. The aim of this study was to examine the possibility of a correlation between biophysical skin variables: skin hydration (SH), skin pH, and erythema intensity measured in 10 different body regions and both total Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) and CADESI measured in a given region (CADESI L). The study was conducted using 33 dogs with atopic dermatitis. The assessment of the biophysical variables was done in 10 body regions: the lumbar region, right axillary fossa, right inguinal region, ventral abdominal region, right lateral thorax region, internal surface of the auricle, interdigital region of right forelimb, cheek, bridge of nose, and lateral site of antebrachum. Positive correlations were found between SH and CADESI L for the following regions: the inguinal region (r = 0.73) and the interdigital region (r = 0.82), as well as between total CADESI and SH on digital region (r = 0.52). Also, positive correlations were reported for skin pH and CADESI L in the lumbar region (r = 0.57), the right lateral thorax region (r = 0.40), and the lateral antebrachum (r = 0.35). Positive correlations were found in the interdigital region between erythema intensity and the total CADESI-03 (r = 0.60) as well as the CADESI L (r = 0.7). The results obtained suggest that it may be possible to use skin hydration, pH, and erythema intensity to assess the severity of skin lesion but positive correlation was only found in < 13.3% of possible correlations and usage of these measures in dogs is limited.

La dermatite atopique est une maladie fréquente chez les chiens. Le but de notre étude était d'étudier la corrélation entre la probabilité d'occurrence des paramètres biophysiques de la peau : l'hydratation de l'épiderme (SH), pH de la peau et de la gravité de l'érythème mesurée à 10 zones différentes du corps et à la fois totale CADESI-03 ainsi que Cadesi calculée pour une zone donnée (Cadesi L). Des études ont été effectuées dans 33 chiens atopiques. Évaluation des paramètres biophysiques a été réalisée dans 10 régions du corps : la région lombaire, la fosse axillaire droite, la région inguinale droite, la région ventrale, la région latérale droite du thorax, la surface interne de l'oreille, région interdigitale de la patte avant droite, joue, l'arête du nez et de la surface latérale de l'avant-bras. Corrélation positive entre SH et Cadesi L a été détecté sur l'environnement suivantes : la région inguinale (r = 0,73), et interdigital (r = 0,82), ainsi qu'entre le total Cadesi ­ 03 et SH dans l'espace interdigital (r = 0,52). Une corrélation positive a également été trouvé entre la peau et la érythrocytaire Cadesi L dans la région lombaire (r = 0,57), la zone de la poitrine à droite (r = 0,40), l'avant-bras latéral (r = 0,35). Des corrélations positives ont également été trouvés dans l'espace interdigital entre la sévérité de l'érythème et totale Cadesi 03 (r = 0,60) et Cadesi L (r = 0,7). Les résultats obtenus suggèrent qu'il existe une possibilité d'essai de l'hydratation de la peau, et la sévérité de la réaction de la peau dans l'évaluation de la sévérité de l'érythème gravité retour sur la peau, mais les corrélations positives ont été trouvées uniquement dans < 13,3 % de la corrélation possible, ce qui signifie que l'utilisation de ces paramètres chez les chiens est limité. (Traduit par les auteurs).

Assessment of the relationship between transepidermal water loss (TEWL) and severity of clinical signs (CADESI-03) in atopic dogs.

BACKGROUND: Atopic dermatitis (AD) is a common allergic skin disease of dogs. Objective documentation of disease severity is important for the assessment of responses to therapeutic interventions. One common means of assessing the severity of clinical signs is the Canine Atopic Dermatitis Extent and Severity Index (CADESI)-03. In addition, studies of the biophysical parameters of the skin suggest that assessment of transepidermal water loss (TEWL) may also have value for estimation of disease severity. HYPOTHESIS/OBJECTIVES: The aim of the present study was to verify the correlation between TEWL and CADESI-03 measured at 10 different body sites. ANIMALS: Twenty-six dogs with AD (age range 1-7 years, median age 3 years). METHODS: The assessment was performed at the following 10 body sites: the lumbar, inguinal, ventral abdominal, interdigital regions, axillary fossa, lateral thorax, lateral aspect of the antebrachium, concave surface of the auricle, cheek and bridge of the nose. RESULTS: Positive correlations were found between TEWL and the total CADESI-03 for the auricle (r = 0.59), bridge of nose (r = 0.62) and interdigital skin (r = 0.47). Positive correlations were also observed between TEWL and local CADESI-03 scores for the axillary fossa (r = 0.73), inguinal region (r = 0.55) and interdigital skin (r = 0.77). CONCLUSIONS AND CLINICAL IMPORTANCE: The results indicate that it may be possible to use measurement of TEWL to assess the severity of skin lesions, but a positive correlation was found in only five of 10 body regions examined.

Characteristics of a COPD population categorised using the GOLD framework by health status and exacerbations.

GOLD proposed a COPD assessment framework focussed on symptoms measured by the COPD Assessment Test™ (CAT) or the mMRC and on exacerbation risk based on poor lung function (FEV1 <50%) or a history of ≥2 exacerbations in the previous year. This analysis examined the characteristics of COPD patients recruited from routine clinical settings and classified using the GOLD framework. 1041 European COPD patients (38.5% from primary care) from the Adelphi Respiratory Disease Specific Programme with information on CAT, mMRC, spirometry and exacerbation history in the previous year were analysed. Their mean age was 64.9 ± 9.9 years and mean FEV1 was 62.5 ± 17.8% predicted; 80% were in GOLD 2 spirometric grade or milder. CAT and mMRC cut points identified different groups of patients; using CAT, the composition was: Group A 9.3%, Group B 48.5%, Group C 0.7% and Group D 41.5%. 80% were classified as high risk based on exacerbation history and 25% of patients in a low risk category (GOLD A and B) had 1 exacerbation in the previous year. The incidence of diabetes, hypertension and hyperlipidaemia rose with worsening GOLD group (all p < 0.0001); diabetes GOLD A 4%, GOLD B 16%, GOLD D 29%; hypertension GOLD A 38%, GOLD B 55%, GOLD D 65%; hyperlipidaemia GOLD A 13%, GOLD B 30%, GOLD D 37%. In patients seen in routine clinical settings, 25% of GOLD low risk patients had one exacerbation per year and the incidence of cardio-vascular and metabolic diseases increases with worsening GOLD group.

Relationship between the airway wall area and asthma control score in moderate persistent asthma.

OBJECTIVES: To assess the association between airway wall area and clinical asthma control, assessed by the Asthma Control Test (ACT). METHODS: This cross-sectional study evaluated 96 adults for asthma control ["at least well controlled" (ACT ≥ 20; n = 52) or "not well controlled" (ACT < 20; n = 44) and airway dimensions: luminal area (LA), wall area (WA) and WA%], obtained using automated dedicated software measurements from volumetric CT images. Results were analysed for segmental bronchi, subsegmental bronchi in the right upper lobe and basilar segments, both uncorrected and corrected for body surface area (BSA). RESULTS: For all bronchi corrected for BSA, there was no correlation between airway wall area and ACT score. There was a weak but statistically significant correlation between uncorrected WA and ACT score (r = -0.203; P = 0.047); WA values were numerically higher in the "not well-controlled" versus the "at least well-controlled asthma" subgroups. For sub-segmental bronchi, there was a correlation between the ACT score and both WA/BSA (r = -0.204; P = 0.047) and WA (r = -0.249; P = 0.014), and for upper lobe bronchi, between the ACT score and WA (r = -0.207; P = 0.044). CONCLUSION: We demonstrated a correlation between subsegmental bronchial airway measurements and clinical control of asthma; this is probably a reflection of airway remodelling and structural changes in chronic poorly controlled asthma. KEY POINTS: • Volumetric computed tomography offers new insights into bronchial morphology. • The relationship between current asthma control and airway wall abnormalities is assessed. • Some relationships between airway wall area and clinical control were demonstrated. • We observed less shape variation of bronchi in "not well-controlled" asthma patients.

Comparisons of health status scores with MRC grades in COPD: implications for the GOLD 2011 classification.

The 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document recommends assessment of chronic obstructive pulmonary disease (COPD) using symptoms and future exacerbation risk, employing two score cut-points: COPD Assessment Test (CAT) score ≥ 10 or modified Medical Research Council dyspnoea scale (mMRC) grade ≥ 2. To explore the equivalence of these two symptom cut-points, the relationship between the CAT and the mMRC and St George's Respiratory Questionnaire (SGRQ), the Short-form Health Survey and the Functional Assessment of Chronic Illness Therapy Fatigue scores were retrospectively analysed using a primary care dataset. Data from 1817 patients (mean ± SD forced expiratory volume in 1 s 1.6 ± 0.6 L) showed a significant association between mMRC grades and all health status scores (ANOVA p<0.0001). mMRC grade 1 was associated with significant levels of health status impairment (SGRQ 39.4 ± 15.5 and CAT 15.7 ± 7.0); even patients with mMRC grade 0 had modestly elevated scores (SGRQ 28.5 ± 15.1 and CAT 11.7 ± 6.8). An mMRC grading ≥ 2 categorised 57.2% patients with low symptom (groups A and C) versus 17.2% with the CAT. Using the mMRC cut-point (≥ 1) resulted in similar GOLD group categorisations as the CAT (18.9%). The mMRC showed a clear relationship with health status scores; even low mMRC grades were associated with health status impairment. Cut-points of mMRC grade ≥ 1 and CAT score ≥ 10 were approximately equivalent in determining low-symptom patients. The GOLD assessment framework may require refinement.

Patient-centred assessment of COPD in primary care: experience from a cross-sectional study of health-related quality of life in Europe.

BACKGROUND: Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated in primary care, but perceptions on what guides primary care physicians (PCPs) in managing patients are lacking. AIMS: To describe factors associated with the assessment by PCPs of COPD severity and those associated with impaired health status, as assessed by patient-reported outcomes. METHODS: This cross-sectional study evaluated health-related quality of life (HRQL) in 2,294 COPD patients from five European countries. The severity of COPD was clinically judged by the PCPs and GOLD stage severity was calculated using spirometry data. RESULTS: PCPs' categories of severity reflected a wider range of HRQL scores (St George's Respiratory Questionnaire (SGRQ) total score: mild 30.3; moderate 41.7; severe 55.0; very severe 66.1) than GOLD severity grading (Stage I 38.2; Stage II 41.1; Stage III 49.9; Stage IV 58.5). Multiple ordinal logistic regression models showed that factors most closely related to PCP-rated COPD severity were Medical Research Council (MRC) dyspnoea grade, forced expiratory volume in 1 second (FEV1) percent predicted, HRQL score (either SGRQ or COPD Assessment Test (CAT)), and previous hospitalisations (model generalised R²=0.45 or 0.44 (SQRQ or CAT in model, respectively); all factors p<0.0001). Factors with the highest association with HRQL scores (SGRQ or CAT) were MRC dyspnoea grade, COPD severity (PCP-rated), sputum production, and number of co-morbidities (model R²=0.46 or 0.37 (SQRQ or CAT in multiple linear regression model, respectively); all factors p<0.0001). CONCLUSIONS: PCPs successfully graded COPD severity clinically and appeared to have greater discriminative power for assessing severity in COPD than FEV1-based staging. Their more holistic approach appeared to reflect the patients' HRQL rating and was consistent across five European countries.

The examination of biophysical parameters of skin (transepidermal water loss, skin hydration and pH value) in different body regions of normal cats of both sexes.

The purpose of this study was to evaluate transepidermal water loss (TEWL), skin hydration and skin pH in normal cats. Twenty shorthaired European cats of both sexes were examined in the study. Measurements were taken from five different sites: the lumbar region, the axillary fossa, the inguinal region, the ventral abdominal region and the left thoracic region. In each of the regions, TEWL, skin hydration and skin pH were measured. The highest TEWL value was observed in the axillary fossa (18.22g/h/m(2)) and the lowest in the lumbar region (10.53g/h/m(2)). The highest skin hydration was found in the inguinal region (18.29CU) and the lowest in the lumbar region (4.62CU). The highest skin pH was observed in the inguinal region (6.64) and the lowest in the lumbar region (6.39). Statistically significant differences in TEWL were observed between the lumbar region and the left side of the thorax region (P=0.016), the axillary fossa (P=0.0004), the ventral region (P=0.005), and the inguinal region (P=0.009). There were significant differences in skin hydration between the lumbar region and the left thorax (P=0.000003), the axillary fossa (P=0.002), the ventral abdomen (P=0.03), and the inguinal region (P=0.0003) as well as between the thorax and the ventral abdomen (P=0.005). TEWL was higher in females (15g/h/m(2)) than in males (4.57g/h/m(2)). Skin hydration was higher in females (13.89CU) than in males (12.28CU). Significant differences were not found between males and females for TEWL and skin hydration. Skin pH was higher in males (6.94) than in females (6.54), which was significant (P=0.004).

[The effect of music therapy on anxiety level in hospitalized asthmatic patients]. / Wplyw muzykoterapii biernej na poziom leku u chorych hospitalizowanych z powodu astmy oskrzelowej.

The role of music therapy as a supportive treatment is not well defined. The music therapy cannot be estimated as the isolated method it is often only the part of the complex therapy. The aim of this study was to evaluate the influence of music therapy on anxiety level in hospitalized asthmatic patients. The patient group was consisted of 36 patients with bronchial asthma (23 women and 13 men). In all patients we evaluated the level of anxiety (attribute and state) according to Spielberger and intensity of dyspnoe according to Borg scale at the first day of examination and after 10 days of rehabilitation program. Moreover we performed spirometry. The respiratory rehabilitation program included: exercise of breath control, correction of respiratory pattern, training of diaphragm and additional respiratory muscles. The duration of music therapy lasted 15 min. After 10 days rehabilitation with or without music therapy we found the reduction of anxiety (state) (p<0.0001). However we did not observe the difference between two studied groups with or without music therapy in diminishing of anxiety (p = 0.55). In conclusion, we believe that the music therapy can play important role in treatment of somatic disease but our study did not confirm its additive positive meaning in patients with bronchial asthma.

[Transbronchial lung biopsy as a diagnostic method of diffuse pulmonary diseases]. / Przezoskrzelowa biopsja pluca w diagnostyce chorób sródmiazszowych.

The aim of the study was to assess the diagnostic yield of transbronchial lung biopsy (TBLB) in some of diffuse pulmonary diseases, like: sarcoidosis, organizing pneumonia--(OP), tuberculosis and neoplasmatic infiltrates of the lung. Transbronchial lung biopsy was performed in 123 patients, preceded by high resolution computed tomography (HRCT). The HRCT guidance helped to select the area of lung to be biopsied. In 80 patients (65%) TBLB enabled to diagnose 40 cases of sarcoidosis, 15 cases of OP, 13 cases of neoplasmatic infiltrates of the lung and 5 cases of tuberculosis. There were 43 cases undiagnosed by means of TBLB. In 19 patients the diagnosis was established by means of other methods like videothoracoscopy (8 cases), bronchoscopy with bronchial mucose biopsy (7 cases of sarcoidosis), mediastinoscopy (2 cases of Hodgkin's disease), transthoracic needle biopsy (2 cases of adenocarcinoma). Moreover sarcoidosis was diagnosed in 15 cases by means of clinical, radiological examination and BAL. 9 patients didn't agree for further invasive diagnostics. Transbronchial lung biopsy was shown to be efficient diagnostic method especially in sarcoidosis, OP and neoplasmatic infiltrates of the lung. However, in approximately 35% of cases of diffuse pulmonary diseases this technique doesn't allow to establish a diagnosis. This in turn implicates the necessity for further diagnostic procedures including videothoracoscopic or open lung biopsy.