[Estimation of volume of pleural fluid and its impact on spirometrical parameters]. / Ocena objetosci plynu w jamie oplucnej i jego wplyw na parametry spirometryczne.

UNLABELLED: In the course of various diseases, there is an accumulation of fluid in the pleural cavities. Pleural fluid accumulation causes thoracic volume expansion and reduction of volume lungs, leading to formation of restrictive disorders. The aim of the study was to estimate the volume of pleural fluid by ultrasonography and to search for the relationship between pleural fluid volume and spirometrical parameters. MATERIAL AND METHODS: The study involved 46 patients (26 men, 20 women) aged 65.7 +/- 14 years with pleural effusions who underwent thoracentesis. Thoracentesis was preceded by ultrasonography of the pleura, spirometry test and plethysmography. The volume of the pleural fluid was calculated with the Goecke' and Schwerk' (GS) or Padykula (P) equations. RESULTS: The obtained values were compared with the actual evacuated volume. The median volume of the removed pleural fluid was 950 ml. Both underestimated the evacuated volume (the median volume 539 ml for GS and 648 ml for P, respectively). Pleural fluid removal resulted in a statistically significant improvement in VC (increase 0.20 +/- 0.35 ; p < 0.05), FEV1 (increase 0.16 +/- 0.32 l; p < 0.05), TLC (increase 0.30 +/- 0.58 l; p < 0.05) and PEF (0.37 +/- 1 l/s; p < 0.05) CONCLUSIONS: Pleural fluid removal causes a significant improvement in lung function parameters. The analyzed equations for fluid volume calculation do not correlate with the actual volume.

Comparison of airway wall remodeling in asthma and COPD: biopsy findings.

BACKGROUND: Bronchial remodeling is currently known to affect not only patients with asthma, but also COPD patients. Some studies have demonstrated that basement membrane thickening and destruction of the bronchial epithelium are also found in COPD. The aim of the study was to compare the basement membrane thickness (BMT) and epithelial damage in biopsy specimens from patients with asthma and COPD. METHODS: The study was performed in 20 subjects with asthma and 12 subjects with COPD, who had not been treated with corticosteroids for at least 3 months before study enrollment. Subjects' characteristics were based on the results of clinical assessment, allergic skin-prick tests, lung function testing, and methacholine bronchial challenge. All subjects underwent bronchoscopy with forceps biopsies of bronchial mucosa. Light-microscope and semi-automatic software were used to measure BMT in hematoxylin-eosin stained sections. Total (denudation) and partial epithelial damage were assessed independently by 2 pathologists. RESULTS: The mean BMT in subjects with asthma was 12.54 ± 2.8 µm, and only 7.81 ± 2.0 µm in COPD patients (P < .001). Overall percentage of the basement membrane length lined with damaged epithelium was 45 ± 20% in the asthma group and 47 ± 22% in the COPD group (difference not significant). Complete and partial epithelial damage did not differ between the groups. CONCLUSIONS: BMT might be a histopathological parameter helpful in distinguishing asthma and COPD patients, whereas the extent and pattern of epithelial damage is not.

[Usefulness of selected tests in the diagnosis of exercise induced bronchoconstriction]. / Przydatnosc wybranych testów w rozpoznawaniu powysilkowego skurczu oskrzeli.

INTRODUCTION: Indirect airway challenge tests are commonly used in the diagnosis of exercise-induced bronchoconstriction (EIB), defined as a post-exercise decrease in FEV(1) ≥ 10%. The aim of this study was to evaluate the diagnostic value of bronchial hyperreactivity tests in the diagnosis of EIB. MATERIAL AND METHODS: Forty two subjects were allocated to 3 groups: A - 19 steroid naive asthma patients; D - 11 no-asthma patients reporting symptoms suggestive for EIB (dyspnea, wheeze and cough provoked by exercise) and K - 12 healthy controls. Subjects filled a questionnaire regarding symptoms related to exercise and underwent: inhaled bronchial challenge to methacholine (Mch), adenosine 5'-monophosphate (AMP) and exercise challenge on a treadmill. With a cutoff of ≥ 10% or ≥ 15% decrease in FEV1 post exercise EIB was diagnosed in 47% and 37% of asthma patients, respectively; 27% of subjects in group D and in none of controls, irrespectively of the ΔFEV(1) criterion. RESULTS: The analysis of questionnaire revealed that a single symptom cannot be used to predict EIB. Symptoms occurring after termination of exercise, but not during exercise characterize EIB more precisely. The analysis showed that the most useful measure to diagnose EIB can be a combination of bronchial challenge to AMP and typical symptoms of exercise induced bronchoconstriction (i.e. dyspnea, wheezes and cough provoked by exercise) with a sensitivity of 70%, specifity of 94%, PPV of 78%, NPV of 91% and LR of 11.2. CONCLUSIONS: Symptoms suggestive of EIB do not have acceptable sensitivity and specifity for the diagnosis of exercise-induced bronchoconstriction. The most useful measure to diagnose EIB is a combination of typical symptoms of EIB with positive challenge to AMP.

[Exercise-induced bronchoconstriction]. / Powysilkowy skurcz oskrzeli.

Terms exercise-induced asthma (EIA) or exercise-induced bronchoconstriction (EIB) are used to describe transient bronchoconstriction occurring during or immediately after vigorous exercise in some subjects. For the diagnosis of EIB it is necessary to show at least 10% decrease in FEV1 from baseline following physical exercise. The prevalence of EIB has been reported to be 12-15% in general population, 10-20% in summer olympic athletes, affecting up to 50-70% of winter athletes (particularly ski runners and skaters). There are two key theories explaining EIB: thermal and osmotic. Differential diagnosis of EIB should include chronic cardio-pulmonary diseases, vocal cord dysfunction, hyperventilation syndrome and poor physical fitness or overtraining. According to the ATS guidelines from 1999 for the diagnosis of EIB a standardized exercise on a treadmill or cycle ergometer test with stable environmental conditions regarding temperature and humidity of inhaled air, should be employed. Other laboratory tests assessing bronchial hyperresponsiveness to indirect stimuli including eucapnic voluntary hyperpnea (EVH), mannitol, hypertonic saline, AMP or measurement of exhaled nitric oxide (FENO) are also successfully used. In the prevention of EIB include both pharmacologic and non-pharmacologic treatment. In patients with poorly controlled asthma intensification of anti-inflammatory treatment can decrease the frequency and severity of EIB. Short and long acting beta2-agonists, antileukotriene drugs can be used prior to exercise to prevent EIB.

[Relationship between airway basement membrane thickness and lung function tests in patients with asthma]. / Zaleznosc pomiedzy gruboscia blony podstawnej oskrzeli i wybranymi parametrami czynnosci ukladu oddechowego u chorych na astme.

INTRODUCTION: Airway remodeling is a characteristic feature of asthma. It is believed that airway remodeling affects lung function and bronchial hyper-responsiveness. Therefore, the relationship between remodeling and lung function is still a matter of extensive research. However, the results of many studies are inconsistent. The aim of the study was to assess the relationship between lung function parameters and basement membrane (BM) thickness in patients with asthma. MATERIAL AND METHODS: Twenty asthma patients were chosen for the study (ten male, ten female, mean age 37 +/- 15 yrs). Ten were newly diagnosed, steroid-naive patients and the other ten were patients known to have asthma who had not been treated with steroids for at least three months. The study group was selected based on the results of: clinical assessment, allergic skin-prick tests, lung function testing and bronchial challenge with methacholine. Nine (45%) patients had chronic mild, nine (45%) had moderate and two (10%) had intermittent asthma. Mean FEV1% pred. was 83 +/- 18, mean FEV1%VC 69 +/- 9, mean FVC% pred. 101 +/- 14. All patients underwent research fiberoptic bronchoscopy with BAL and bronchial mucosal biopsies. Light-microscopic measurements of BM thickness were performed in hematoxylin-eosin stained slides of bronchial wall specimens with semi-automatic software analysis MultiScan Base 08.98. RESULTS: Mean BM thickness was 12.8 +/- 2.8 microm (range: 8.5-20.7 microm). No significant correlations between BM thickness and FEV1% pred., FEV1%VC, FVC% pred., RV% pred., TLC% pred., Raw (pre- and post-bronchodilator) and PC20 were observed. CONCLUSIONS: In our group of asthma patients, mean BM was significantly thickened. No relationship between BM thickness and lung function tests, including hyper-responsiveness, was found.

[The relationship between markers of airway inflammation and thickness of the basement membrane in patients with asthma]. / Zwiazek pomiedzy wybranymi wskaznikami zapalenia dróg oddechowych a gruboscia blony podstawnej u chorych na astme.

INTRODUCTION: Airway inflammation and remodeling are well recognized features of asthma. Remodeling is usually regarded as a consequence of chronic inflammation, however there are also data suggesting that remodeling is a relatively independent process in asthma. Neither inflammation nor remodeling is a uniform process. Thus the precise relationship between markers of inflammation and different patterns of remodeling are still matter of investigations. The aim of the study was to assess the relationship between total and differential cell count in induced sputum (IS) and BALF, and thickness of the basement membrane (BM) in patients with stable asthma. MATERIAL AND METHODS: 18 patients with asthma (M/F 9/9, mean age 36 +/- 15 yrs). Duration of symptoms amounted to 12.7 +/- 11.5 years. Patients who have not been treated with steroids for at least 3 months were enrolled to the study. All patients underwent sputum induction and fiberoptic bronchoscopy with BAL and bronchial biopsies. Total and differential cell counts were measured in induced sputum and BALF. Light-microscopic measurements of BM thickness were performed in hematoxylin-eosin stained slides of bronchial wall specimens with semi-automatic software analysis. RESULTS: Mean BM thickness was 12.9 +/- 2.8 microm (range: 8.5-20.7 microm). Total sputum cell count was 3.4 +/- 2.7 x 106 cells/ml, whereas in BALF 9.7 +/- 10.2 x 106 cells/ml. There was no correlation between differential cell count in induced sputum and BALF. No significant correlations between BM thickness and total and differential cell count in IS and BALF were observed. There also was no correlation between BM thickness and length of asthma duration or degree of the disease. CONCLUSIONS: There was no relationship between BM thickness and total number of cells nor number of eosinophils in BALF and/or IS.

[Exhaled nitric oxide in patients with obstructive sleep apnea syndrome]. / Tlenek azotu w powietrzu wydechowym u chorych na obturacyjny bezdech podczas snu.

UNLABELLED: Exhaled nitric oxide has been extensively investigated as a non-invasive marker of airway inflammation. Some authors have suggested that morning FE(NO) in obstructive sleep apnea syndrome (OSAS) patients is elevated due to inflammation of upper airways, while others have not found any differences between patients and healthy subjects. The purpose of this study was to analyze concentration of exhaled nitric oxide (FE(NO)) in OSAS patients. METHODS: 119 (99 M, 20 F) consecutive patients of sleep laboratory participated in this study. Standard overnight sleep studies with polysomnography or portable screening device were carried out in the whole group: OSAS was diagnosed in 66 patients and 53 no-OSAS served as controls. FE(NO) was measured on-line with a flow rate kept at 0.045 - 0.055 l/s, according to the recommendations of ATS using a chemiluminescence analyzer twice: before the sleep study (8-10 p.m.) and after termination of data collection (6 - 8 a.m.). There were no differences in age between patients and controls. Respiratory disturbance index (RDI) was 40.3+/-24.9 in patients and 3.7+/-2.8 in controls (p<0.001). In OSAS patients both evening and morning FE(NO) was significantly higher compared to controls (23.1+/-14.8 ppb vs. 16.8+/-9.8 ppb and 22.4+/-13.2 ppb vs. 15.3+/-8.1 ppb respectively, p<0.05). Weak but statistically significant correlations for the whole group between morning FE(NO) and mean and minimum arterial oxygen saturation (SaO2) during sleep and number of study minutes with SaO2<90% were observed. Lower evening FE(NO) in OSAS patients with coexisting arterial hypertension when compared to normotensive OSAS patients was also noticed (19.1+/-10.8 ppb vs. 27.1+/-19.1 ppb; p<0.05). CONCLUSIONS: The increase in FE(NO) in OSAS patents may be caused by repetitive apneas and hypoxemia during sleep.

[Influence of bronchoscopy on nitric oxide in exhaled air]. / Wplyw bronchoskopii na stezenie tlenku azotu w powietrzu wydechowym.

UNLABELLED: Nitric oxide has been extensively studied as a noninvasive marker of airway inflammation, especially in asthma. Assuming, bronchoscopy can produced not only systemic but also local inflammatory response we hypothesized that bronchofiberoscopy can be responsible for an increase in nitric oxide synthesis with resulting increase in fractional concentration of exhaled nitric oxide (FE(NO)). Seventeen subjects (10 M, 7 F), at mean age of 53.8+/-14.1 yrs undergoing diagnostic bronchoscopy participated in the study. The indications for bronchoscopy were as follows: lung cancer (n=5; 29%), interstitial lung diseases (n=3; 18%), slowly resolving pneumonia (n=3; 18%), hemoptysis (n=3; 18%), differential diagnosis of asthma/ dyspnea (n=3; 18%). During bronchoscopy bronchial washing (n=7) and bronchoalveolar lavage (BAL) (n=10) has been performed. FE(NO) has been analyzed on-line with chemiluminescence analyzer (NIOX, Aerocrine, Sweden) according to American Thoracic Society guidelines, before and at 1, 2, 3 and 24 hours after bronchoscopy. Mean FE(NO) before bronchoscopy was 19.7+/-4.5 ppb (mean +/- SEM), post - bronchoscopy a decrease with a nadir at second hour (12.1+/-1.5 ppb, p<0.05) was observed, FE(NO) 24 hours after bronchoscopy was not different than baseline (18.4+/-2.5 ppb). There were no differences in the FE(NO) profile in BAL patients when compared to those in whom only the bronchial washing has been performed. CONCLUSIONS: Bronchoscopy leads to a significant decrease in exhaled nitric oxide. The underlying mechanisms are unclear. Future studies including analysis of other inflammatory markers are needed to explain these changes.

[Holter ECG monitoring during research bronchofiberoscopy in patients with asthma]. / Wplyw bronchofiberoskopii i plukania oskrzelowo- pecherzykowego na czynnosc serca u chorych na astme.

UNLABELLED: Bronchoscopy is a very useful tool in asthma research studies. The study was undertaken to evaluate the effect of bronchoscopy, BAL and bronchial biopsies on heart rate and arrhytmias in patients with asthma. Twenty patients (12 M, 8 F, mean age 39,6+/-16,3 yrs) with asthma (mean FEV, 81+/-19.5% pred.; mean FEV(1)%VC 69+/-12.3%) participated in the study. Holter ECG monitoring was performed twice: before (1 or 2 days) and on the day of bronchoscopy. Heart rate and cardiac arrhythmias were compared to prebronchoscopy recording at four separate time intervals: during bronchoscopy, first postbronchoscopic hour, second postbronchoscopic hour and total 24 hours. There were no significant differences between mean heart rate at the time of bronchoscopy (88.5+/-14.1 min(-1) vs 83.7+/-11.9 min(-1)), first and second postbronchoscopic hour (80.9+/-15.8 min(-1) vs 85.7+/-13.7 min(-1) and 82.6+/-13.6 min(-1) vs 80.6+/-11.6 min(-1)) as well as total 24 hours (76.1+/-11.2 min(-1) vs 75.9+/-9.4 min(-1)) as compared to prebronchoscopic recordings. Max. heart rate during bronchoscopy was higher as compared to the corresponding time of prebronchoscopic recording (134.5+/-11.5 min(-1) vs 122.5+/-19.6 min(-1), p<0,05). No differences in the number and type of ventricular (VA) and supraventricular arrhythmias (SVA) between the pre- and peribronchoscopic monitoring were observed. Positive correlation between the age and the number of VA during bronchoscopy has been found. CONCLUSION: Bronchoscopic procedures in asthma patients do not increase the risk of cardiac arrhythmias. Some factors influencing the heart rate and number of VA during bronchoscopy can be identified.

[Influence of nasal continuous positive airway pressure on response to exercise in patients with obstructive sleep apnea syndrome]. / Wplyw leczenia za pomoca ciaglego dodatniego cisnienia w drogach oddechowych na reakcje na wysilek fizyczny u chorych na obturacyjny bezdech podczas snu.

UNLABELLED: Obstructive sleep apnea syndrome (OSAS) patients are at risk of cardiovascular complications. The aim of this study was to assess the effect of treatment with continuous positive airway pressure (CPAP) on the response to symptom limited exercise test. METHODS: twenty nine OSAS patients (1 F, 28 M), mean age 50.7+/-9.7 yrs with body mass index of 32.6+/-4.5 kg/m2 participated in the study. OSAS was diagnosed by overnight polysomnography. Incremental cardiopulmonary exercise test (CPET) on a treadmill was performed twice: before and after 2-3 weeks of regular treatment with CPAP. RESULTS: mean apnea + hypopnea index (AHI) before therapy was 57.6+/-12 h(-1). CPAP treatment did not change peak oxygen consumption (VO2max) (38.3+/-9.0 vs. 38.9+/-6.9 mlO2/kg/min, p=ns) or peak heart rate (153.4+/-21 min- vs. 155.5+/-22 min(-1), p=ns). There were no significant changes in ventilation or gas exchange variables. However, a decrease in peak systolic blood pressure from 194.5+/-24 mmHg to 186.7+/-27.9 mmHg (p<0.05) with CPAP treatment was found. During recovery a decrease in heart rate (at 1st minute and minutes 3 - 6) and mean arterial pressure (MAP) (minutes 4-7) with CPAP treatment was observed. Significant correlations between VO2max and AHI (r=-0,38, p<0,05); MAP at peak exercise and: AHI, mean oxygen saturation (SaO2) during sleep, minutes of sleep with SaO2<90% (T90); MAP at recovery (minutes 3-8) and T90 before CPAP treatment were also noted. CONCLUSIONS: OSAS patients are not limited on exercise. Treatment with nasal CPAP attenuates circulatory response to incremental exercise on a treadmill.

[Maximal respiratory pressures and exercise tolerance in patients with COPD]. / Maksymalne cisnienia oddechowe i tolerancja wysilku u chorych na przewlekla obturacyjna chorobe pluc.

UNLABELLED: Many authors reported respiratory muscle function impairment in patients with chronic obstructive pulmonary disease (COPD). Impaired respiratory muscle function may contribute exercise intolerance which is frequently observed in this disease. AIM OF THE STUDY: was to determine the influence of respiratory muscle function on exercise capacity in patients with COPD. METHODS: 23 patients with stable COPD aged 62.7 +/- 9.3 years (6F, 17M; mean post-bronchodilator FEV1 = 47.9 +/-12.4% value predicted) participated in the study. Exercise capacity was assessed by the six-minute walk test and the incremental cardiopulmonary exercise test (CPET) on a treadmill. Maximal respiratory pressures (PImax, PEmax) were evaluated before and directly after CPET. RESULTS: The mean peak oxygen uptake (VO max) was 27.2 +/- 6.1 mlO2/min/kg and the mean distance walked during the 6MWT was 569.4 +/- 101.7 m. Both PIMax and PE max decreased significantly after maximal exercise (71.4 +/-23.0 vs 63.6 +/- 22.2 cmH2O, p = 0.001 and 124.9 +/- 46.5 vs 112.3 +/- 46.6 cm H2O, p = 0.02 respectively). No correlation between VO2max and the 6-minute walk distance and the maximal respiratory pressures was found. We observed a negative correlation between the 6-minute walk distance and the difference between the pre- and post CPET maximal inspiratory pressure. CONCLUSIONS: respiratory muscle function is impaired in patients with COPD but this does not affect exercise performance. Exercise causes a decrease of the respiratory muscle strength.

[Reproducibility of exhaled nitric oxide (FENO) measurements in healthy subjects]. / Powtarzalnosc pomiaru stezenia tlenku azotu w powietrzu wydechowym (FENO) przeprowadzonego z wykorzystaniem zestawu NIOX u zdrowych osób.

UNLABELLED: The aim of the study was to evaluate the short-term variability of FENO in healthy subjects. METHODS: 33 healthy volunteers (26 F, 7 M) aged 32.6 +/- 9.5 yrs with body mass index (BMI) of 23.3 +/- 3 kg/m2 participated in the study. Exhaled nitric oxide was analyzed on 5 consecutive days with a chemiluminescence analyzer (NIOX, Aerocrine, Sweden) according to the ATS recommendations. The exhalation flow was between 0.045 and 0.055 l/s. The measurements were performed at the same time of the day and the subjects were asked to refrain from eating and drinking for at least one hour before the analysis. RESULTS: The mean value of FENO for the whole group was 13.9 +/- 5.4 ppb, there were no correlations between FENO and age, BMI, sex or the concentration of ambient nitric oxide. Day-to-day coefficient of variation was 13.3 +/- 5.3% (range 4.6 - 23.9%), the value of pooled SD - 2.1 ppb and ICC (intraclass correlation coefficient) was 0.84. No relationship was observed between variability of FENO and intervals between measurement of exhaled nitric oxide and intake of food or beverages. CONCLUSION: Chemiluminescence analysis of FENO with NIOX is a highly reproducible method, however one has to take into account the possibility of about 13% variability of FENO within 5 days.

[The effect of asthma and COPD exacerbation on exhaled nitric oxide (FE(NO))]. / Wplyw zaostrzenia astmy oraz przewleklej obturacyjnej choroby pluc na stezenie tlenku azotu w powietrzu wydychanym.

UNLABELLED: Exhaled nitric oxide is a marker of airway inflammation and it is significantly decreased by glucocorticosteroid therapy, especially in patients with asthma. AIM OF THE STUDY: Evaluation of changes in FE(NO) in asthma and COPD exacerbation. MATERIALS AND METHODS: 17 patients with acute asthma and 19 patients with an exacerbation of COPD were enrolled to the study. FE(NO) (chemiluminescence, on-line, restricted breath technique measurement in accordance with the ATS recommendations) was performed for five consecutive days following admission to hospital. Results of the following additional blood investigations: peripheral white blood cell count, ESR, C-reactive protein level, arterial blood gases, spirometry or peak expiratory flow were also analyzed. RESULTS: The average value of FE(NO) on admission was 41.5+/-10.7 ppb (95% CI: 18.8-64.2 ppb) asthma patients and 28.6+/-5.4 ppb (95% CI: 17.4-40.0 ppb) in COPD patients. In asthma patients a significant decrease of FE(NO) on the third day of therapy was observed (41.5 vs 26.1 ppb, p < 0.05). We found a positive correlation between FE(NO) on admission and the peripheral blood eosinophil count. In COPD patients a significant decrease of FE(NO) on the 4th day was noted (28.6 vs 17.5 ppb, p < 0.05). FE(NO) in both groups was higher than that of 19 healthy volunteers previously studied in our laboratory (14.1+/-4.7 ppb; 95% CI: 11.8+/-16.4 ppb). CONCLUSIONS: Exacerbations of asthma and COPD are associated with an increased FE(NO). FE(NO) measurement is a useful tool in the assessment of treatment efficacy. Exhaled nitric oxide may indicate the intensity of allergic inflammation in patients with asthma.

[Tracheobronchopathia osteochondroplastica]. / Tracheobronchopatia osteochondroplastyczna.

Tracheobronchopathia osteochondroplastica (TO) is a rare disease of unknown etiology affecting mainly the trachea and large bronchi. It is characterized by the presence of multiple submucosal osseus and/or cartilaginous nodules. The authors report a case of 74-year-old woman in whom fiberoptic bronchoscopy, performed because of hemoptysis, revealed typical feature of TO. Besides the typical nodules protruding into the lumen of trachea and main bronchi, a small soft nodule in the larynx was found. On histological examination it was showed to be polyp with regions of inflammation and necrosis. The direct relation between such a laryngeal polyp and TO seems to be very unlikely.