Association between asthma control test, pulmonary function tests and non-specific bronchial hyperresponsiveness in assessing the level of asthma control.

INTRODUCTION: Global Initiative for Asthma (GINA) reports emphasize the use of validated and simple tools in order to assess the level of asthma control, as the Asthma Control Test (ACT). However, an ACT does not include assessment of airway inflammation, which is better reflected when measuring nonspecific bronchial hyperresponsiveness (BHR). The authors aimed to find out if the level of asthma control quantified by an ACT correlates with BHR and pulmonary function tests. MATERIAL AND METHODS: 118 asthmatics participated in the study. All patients completed an ACT. The scores of the ACTs were compared with pulmonary function tests and BHR assessed with the methacholine challenge test and expressed as a provocative concentration of methacholine, inducing a 20% decline in the FEV1 (PC20 M in mg/ml). RESULTS: Patients with controlled asthma amounted to 52 (44%) while those with uncontrolled asthma amounted to 66 (56%). In patients with controlled asthma (ACT score ≥ 20) the mean geometric value of PC20M was 2.72 mg/ml (range from 0.25 to > 8.0), whereas 0.94 mg/ml (range from 0.28 to 8.0) (p = 0.02) was observed in patients with uncontrolled asthma (ACT score < 20). Almost 64% (21/33) of uncontrolled asthmatics achieved normal lung function (FEV1 > 80% pred. value) while 19% (5/26) patients with controlled asthma presented an FEV1 < 80% predicted value. Asthma duration in years in controlled asthmatics was significantly shorter than in uncontrolled patients (6.2 ± 8.9 vs. 12.0 ± 11.4, p = 0.005) CONCLUSION: In determining the most accurate level of asthma control it is reasonable to use an ACT in conjunction with BHR, which provides more accurate assessment of bronchial inflammation than ventilatory parameters alone.

Stratification of patients with COPD according to the 2011 GOLD report.

INTRODUCTION: The authors aimed to compare the distribution of COPD based on the new GOLD grading with stadium based exclusively on spirometry. MATERIAL AND METHODS: Eligible patients had an average age of 64.8 years and smoked at least 10 pack-years. COPD was defined according to GOLD fixed cut-off criterion FEV1/FVC < 0.70. In all patients postbronchodilator spirometry was performed. Categories were defined with the mMRC dyspnoea scale and CAT scale. COPD exacerbations in the previous year and lung function were evaluated. Statistical comparisons were done using t-student test. RESULTS: 315 COPD patients, 99 (31.4%) women and 216 (68.6%) men, were examined. Mean pack-years in the whole group was 47.1 ± 17.8. In women this figure was less than in men, 43.7 ± 19.2 vs 49.5 ± 16.5 (p > 0.05), respectively. At study entry, 144 subjects (45.7%) were current smokers, and the majority of them (n-87, 60.4%) belonged to category D - 26/66 (54.5%) women and 51/102 (50%) men. Based on spirometry alone, the patients were classified as moderate COPD 144 (45.71%), severe - 154 (48.89%), and very severe 17 (5.4%). According to the 2011 GOLD report stratification, 60 patients (19.04%) were graded as category A, 63 (20%) as category B, 24 (7.62%) as category C, and 168 (53.33%) as category D, although 21 (12.5% of them) were in category B, but the number of exacerbations classified them as category D. CONCLUSIONS: The COPD population is heterogeneous in reference to the symptoms, value of FEV1, and susceptibility to exacerbations. Clinical symptoms assessed using validated questionnaires characterized COPD patients better than the value of spirometric parameters (which are necessary for diagnosis of this disease). Some patients were difficult to classify, especially those belonging to category C.

[Effect of natural allergens exposure on serum concentration of soluble form of intercellular adhesion molecule 1 in patients with seasonal airway allergy]. / Wplyw naturalnej ekspozycji na alergeny na stezenie rozpuszczalnej formy czasteczki adhezji miedzykomórkowej 1 w surowicy chorych z sezonowa alergia dróg oddechowych.

UNLABELLED: Chronic inflammation is a feature of bronchial asthma and allergic rhinitis. Intercellular adhesion molecules, especially ICAM-1 and its soluble form sICAM-1 present in systemic liquids play an important role in allergic inflammation. The aim of this study was to assess the effect of natural pollen exposure to plants on serum sICAM-1 concentration in patients with different clinical expression of seasonal allergy and to determine the relation between concentrations of these molecules to clinical symptom score and nonspecific bronchial hyperresponsiveness (BHR). MATERIAL AND METHODS: The study comprised 48 patients with isolated seasonal allergic rhinitis (SAR), 26 patients with seasonal asthma (SA) and 16 healthy volunteers. Serum s/CAM-1 concentration using an immunoenzymatic ELISA method and BHR to methacholine were measured twice, before grass season and during symptomatic period of SAR and SA. Clinical symptoms severity were evaluated by pointing method from patients diary cards. RESULTS: The study revealed no differences in mean concentration of serum sLCAM-1 between patients with SAR and SA but significant increase of serum sICAM-1 level during natural allergen exposure in all patients was observed. CONCLUSION: Serum concentration of sICAM-1 was not correlated to symptom score and BHR in both SAR and SA patients in and out of season.

[Chemical structure of Mycobacterium tuberculosis. Part I--lipids]. / Budowa chemiczna prqtka gruzlicy. Czesc I--lipidy.

Tuberculosis is a burning health issue in the contemporary world. Recognition of mechanisms by means of which pathogenic bacilli affect host cells and their virulence factors is indispensable to developing and synthesis of new drugs and vaccines. The authors discuss groups of the most important chemical compounds from the pathological point of view, which are responsible for morbidity and virulence of tubercle bacillus. They also point out the construction of cellular structures with reference to their functions. High content of lipid compounds especially in bacterial cell wall is a specific feature of tubercle bacillus. These molecules play different and very important roles both in growth and virulence of Mycobacterium tuberculosis.

[Chemical structure of Mycobacterium tuberculosis. Part II--proteins]. / Budowa chemiczna pratka gruzlicy. Czesc II--Bialka.

In this paper the structure of M. tuberculosis cell, especially mycobacterial proteins were analized. Cytoplasmatic and secretory proteins were reviewed according to their function and the role in immunological reactions. Some diagnostic and therapeutic aspects were demonstrated.

Intercellular adhesion molecule 1 and tumor necrosis factor alpha in asthma and persistent allergic rhinitis: relationship with disease severity.

BACKGROUND: Tumor necrosis factor alpha (TNF-alpha) is involved in the up-regulation of intercellular adhesion molecule 1 (ICAM-1). Allergic rhinitis is often associated with bronchial hyperresponsiveness. OBJECTIVE: We investigated the relationship between allergic airway disease severity and serum concentrations of soluble ICAM-1 (sICAM-1) and TNF-alpha and nasal expression of ICAM-1. METHODS: Serum concentrations of TNF-alpha and sICAM-1 were investigated in 85 adults with persistent rhinitis and 90 patients with asthma. Seventy patients with rhinitis were challenged with methacholine. Nasal biopsy for ICAM-1 expression was performed in 6 patients with moderate-severe rhinitis and in 6 patients with mild rhinitis. RESULTS: In patients with rhinitis, serum sICAM-1 concentrations were as follows: group without bronchial hyperresponsiveness (n = 29), 206.85 ng/mL; group with bronchial hyperresponsiveness but without asthma symptoms (n = 20), 233.39 ng/mL; and group with newly recognized asthma (n = 21), 260.06 ng/mL. The sICAM-1 level was significantly lower in patients with mild rhinitis (216.21 ng/mL) than in patients with moderate-severe rhinitis (244.08 ng/mL). Nasal ICAM-1 expression was significantly higher in the moderate-severe rhinitis group than in the mild rhinitis group. In patients with asthma, serum concentrations of sICAM-1 were as follows: patients with mild asthma, 272.8 ng/mL; patients with moderate asthma, 340.16 ng/mL; patients with severe asthma without oral corticosteroids therapy, 426.74 ng/mL; and patients with severe asthma with oral corticosteroids therapy, 314 ng/mL. The serum TNF-alphaa concentration differed between patients with rhinitis (n = 15) (1.065 pg/mL) and patients with asthma (n = 12) (3.46 pg/mL). Among patients with asthma, TNF-alpha concentrations were similar in all groups classified according to the disease severity. CONCLUSIONS: sICAM and ICAM-1 expression correlates with airways diseases severity.

[Exacerbations of chronic obstructive pulmonary disease and the role of sputum bacteriological examination]. / Zaostrzenia przewleklej obturacyjnej choroby pluc z uwzglednieniem bakteriologicznego badania plwociny.

Bacteriological examination of sputum is the simplest and widely accessible diagnostic method of respiratory infections. However its value in nonspecific respiratory infections, especially in exacerbations of COPD, is questionable because they can be caused by factors other than bacterial or by viral infections. The evaluation of bacteriological examination of sputum in patients with exacerbations of COPD and the evaluation of interaction between clinical course, some laboratory markers and bacteriology of sputum was the aim of the study. 109 patients hospitalized with exacerbations of COPD were examined. Semi-quantitative bacteriological examination of sputum, total blood count, erythrocytes sedimentation rate, gasometry and spirometry were performed in each patient. The identification of pathogens was conducted by microtests API from Bio-Merieux. In 39 patients (36%) pathogenic bacteria were cultured from sputum. The most prevalent organisms were: A. baumanii-21% and S. aureus-17%. Positive culture was seen most often in patients with severe and very severe COPD. Bacterial infection as a cause of COPD exacerbation should be suspected especially in patients with severe-staged disease of long duration, when bacterial cells and predominant neutrophil-count are present in sputum. In patients with severe COPD, often treated in hospital and with antibiotics, Gram-negative flora should be considered as an etiologic agent.

[Comparison of oxidative stress markers in exhaled breath condensate and in serum of patients with tuberculosis and sarcoidosis]. / Porównanie wybranych wykladników stresu oksydacyjnego w kondensacie powietrza wydechowego oraz w surowicy u chorych na gruzlice i sarkoidoze.

UNLABELLED: Tuberculosis and sarcoidosis represent the granulomatous diseases. The aim of the study was to compare the markers of oxidative stress: in exhaled breath condensate (EBC) and in serum of patients with tuberculosis and sarcoidosis. MATERIAL AND METHODS: 19 patients with active lung tuberculosis and 15 patients with sarcoidosis were enrolled into the study. As a control served 15 healthy subjects. Hydrogen peroxide (H2O2) was measured in EBC and the ends products of lipid peroxidation (TBARs) were assessed in serum. RESULTS: The concentrations of H202 and TBARs (1022.96+/-186.02 nM and 4.22+/-0. 80 microM, respectively) were significantly higher in patients with tuberculosis as compared with the controls (398.15+/-37.10 nM and 0.48+/-0.17 microM, respectively). The patients with sarcoidosis revealed only the significantly elevated levels of hydrogen peroxide (963.30+/-105.77 nM) in breath condensate. CONCLUSIONS: It was found that local and systemic oxidative stress were present in patients with tuberculosis, while in those with sarcoidosis existed only the local reaction.

[Correlation of serum concentration of tumor necrosis factor alpha, clinical course, ventilation and nonspecific bronchial hyperresponsiveness in patients with isolated seasonal rhinitis and seasonal asthma]. / Zaleznosci miedzy stezeniem czynnika martwicy nowotworu alpha w surowicy a przebiegiem klinicznym, wentylacja i nieswoista nadreaktywnoscia oskrzeli u chorych na izolowany sezonowy niezyt nosa i sezonowa astme.

UNLABELLED: Tumor necrosis factor alpha (TNF-alpha) plays a central role in pathogenesis of many inflammatory diseases including asthma and allergic rhinitis. Its capability for cell activation, chemotaxis and upregulation of adhesion molecule expression on surface of inflammatory cells suggests that TNF-alpha may be responsible for bronchial hyperresponsiveness (BHR) and clinical symptoms of atopic diseases. THE AIM: Relationships between serum concentration of TNF-alpha and clinical course as well as nonspecific BHR in patients with isolated seasonal rhinitis (SR) and seasonal bronchial asthma (SA) were assessed. MATERIAL AND METHODS: The study was performed in 19 subjects with SR and 26 subjects with asthma sensitized to pollens, with measurable BHR during symptomatic phase of disease. Control group consists of 16 healthy volunteers. Serum concentration of TNF-alpha, ventilatory parameters, BHR to methacholine, asthma and seasonal rhinitis score were assessed two times--during and outside pollen season. RESULTS: Nonspecific BHR was find in 10 (21%) patients with SR and 18 (69%) patients with asthma symptoms out of season. In both groups postseasonal mean geometric values of PC20M were significant higher than during season. There were no marked changes in ventilatory parameters accompanied the increase in BHR. TNF-alpha concentration in serum in both groups of patients was significant higher than in healthy subjects. Further increase of its activity about 50-70% compared to baseline values was observed during pollen season. There was no correlation between serum concentration of TNF-alpha, BHR and symptom score. There is increased serum concentration of TNF-alpha in patients with seasonal airway allergy even in asymptomatic period of disease. CONCLUSIONS: Natural exposure to allergens causes significant increase of TNF-alpha concentration in patients with rhinitis and asthma. Although level of BHR and intensification of clinical symptoms coexist with changes in TNF-alpha concentration there is no correlation between them.

[FEV1 after three years of observation in patients with bronchial asthma and patients with chronic obstructive pulmonary disease]. / FEV1 po trzech latach obserwacji u chorych na ciezka astme i przewlekla obturacyjna chorobe pluc.

Obstruction of airways is characteristic for both asthma and COPD. It can be measured with spirometric tests. The most important ventilatory parameter is forced expiratory volume in first second--FEV1. The aim of our study was to characterise patients with severe asthma and COPD by ventilatory parameters after 3 years of observations. We examined 49 patients with asthma and 23 patients with COPD. We found an incomplete reversibility of airflow obstruction in 20 asthmatic patients, further analyses was performed for two asthmatics' groups with complete (CRAO) and incomplete reversibility of airflow obstruction (IRAO). In patients with IRAO ventilatory parameters were: mean FEV1--1,8 1, FVC--2,3 1, MEF 50--1,9 l/s. After 3 years FEV1 decreased 180 ml. In patients with CRAO mean ventilatory parameters were FEV1--1,6 1, FVC--2,1 1, MEF 50--1,8 l/s. After 3 years FEV1 decreased by 70 ml. In COPD patients mean ventilatory parameters were FEV1--1,2 1, FVC--1,9 1, MEF 50--1,2 l/s. After 3 years FEV1 decreased by 170 ml. Although in patients who did not smoke FEV1 decreased less than in current smokers. In non-smokers FEV1 decreased 130 ml and in smokers 200 ml. Thus in asthmatics with IRAO, the decrease of FEV1 was similar to one observed in smokers with COPD, so we concluded the long treatment with corticosteroids in some patients with asthma did not stoppe the progress of the disease. It is also possible that in some asthma patients changes in airways characteristic for asthma coexisted with that characteristic for COPD.

[Exacerbations of chronic obstructive pulmonary disease]. / Zaostrzenia przewleklej obturacyjnej choroby pluc.

The problems of exacerbations of chronic obstructive pulmonary disease were presented in this study. The methods of diagnosis and treatment was discussed in this article.

[Role of tumor necrosis factor-alpha in allergic inflammation and airway hyperresponsiveness]. / Rola czynnika martwicy nowotworu w rozwoju alergicznej reakcji zapalnej i nadreaktywnosci oskrzeli.

TNF-alpha is a potent multifunctional cytokine that plays a central role in the pathogenesis of many inflammatory diseases such as asthma and allergic rhinitis. This proinflammatory cytokine is produced by a variety of cells in the airways and is released via the IgE-dependent activation of mast cells. The elevated levels of TNF-alpha can be detected in the airways, bronchoalveolar lavage (BAL) fluid and nasal lavage from asthmatic and rhinitic patients. Leucocytes and monocytes isolated from BAL fluid of asthmatics were shown to release more TNF-alpha than cells from control subjects. Recent research indicates that TNF-alpha maybe associated with acquired airway hyperresponsiveness a pathophysiological hallmark of asthma. It was suggested that TNF-alpha upregulates adhesion molecules and is directly responsible for transendothelial migration of inflammatory cells a central feature underlying the inflammatory response. A direct chemotactic effect has also been attributed to TNF-alpha. This cytokine is a chemoatractant for neutrophils and monocytes, can also induce transepithelial migration of neutrophils through production of IL-8.

[Role of intra cellular adhesion molecule-1 (ICAM-1) and its soluble form (sICAM) in chronic airway inflammation]. / Rola czasteczek adhezji miedzykomórkowej (ICAM-1) i ich rozpuszczalnej formy (sICAM-1) w rozwoju przewleklego zapalenia alergicznego.

Mucosal inflammation is the feature of both bronchial asthma and allergic rhinitis with evident of tissue eosinophilia, mast cells, eosinophils and T-lymphocytes activation. The initial phase of cell recruitment is the margination and adhesion of leucocytes to the endothelium, prior to their transendothelial migration under a directed chemotactic stimulus. This adhesion occurs through specific ligand-receptor couplets involving leucocyte-endothelial adhesion molecules. One of these cell adhesion molecules is ICAM-1, an important early marker of immune activation and response. Its ligand, leukocyte function-associated antigen one (LFA-1) is expressed on neutrophils, eosinophils and T-cells. ICAM-1 was found to be expressed on epithelial and endothelial cells in rhinitis patients and in bronchial biopsies obtained from asthmatics also after allergen challenge. Circulating forms of these adhesion molecules have been identified in the peripheral blood, bronchoalveolar lavage (BAL) fluid and nasal lavage in patients with asthma and rhinitis. Systemic and local up-regulation of sICAM-1 suggests a function role for this soluble form of ICAM in the allergic inflammation.

[Serum sICAM-1 in patients suffering from allergic rhinitis treated with fexofenadine or fluticasone]. / sICAM-1 w surowicy chorych na alergiczny niezyt nosa leczonych feksofenadyna lub flutykazonem.

UNLABELLED: The aim of the study was to examine the level of sICAM-1 in serum of patients suffering from allergic rhinitis treated with fexofenadine or fluticasone. The study was performed after two weeks' duration of the pollen season. Thirty -eight patients sensitized to grass pollen were participated in this study: 15 patients were treated for 10 days with oral fexofenadine (dose: 120 mg/d), 13 patients were treated with intranasal fluticasone (dose: 200 mcg/d), 10 patients were given oral placebo. Blood sample were collected both in the first and the last day of the treatment. The efficacy was evaluated with the use of symptom score. sICAM-1 level in serum was measured with ELISA method. THE RESULTS: Mean sICAM-1 level in serum was: in group treated with fexofenadine- 224,5 ng/ml before treatment, 228 ng/ml - after treatment; in group treated with fluticasone- 212 ng/ml before treatment, 214 ng/ml- after treatment; in placebo group- 226 ng/ml before treatment, 229 ng/ml- after treatment. There was no difference in statistical analysis between sICAM-1 values. (p > 0.05). In 7 patients treated with fexofenadine serum levels of sICAM-1 significantly decreased from 212 ng/ml to 185 ng/ml (p < 0.05), the same decrease was observed in 7 patients treated with fluticasone: from 233 ng/ml to 209 ng/ml (p < 0.01), and in 6 patients from placebo group: from 219 ng/ml to 205 ng/ml (p < 0.01). However in the rest of patient's level of sICAM-1 significantly increased after treatment. Patients treated with fexofenadine showed significant improvements of clinical symptoms (mean symptom score before treatment: 11, 3, after treatment-5, 3) and symptoms evaluated during laryngological examination (mean symptom score before treatment: 9, 5, after treatment- 5, 5). Significant improvement of clinical symptoms was also observed in patients treated with fluticasone (mean symptom score before treatment: 10, 7, after treatment 3, 6) and symptoms evaluated during laryngological examination (mean symptom score before treatment: 9, 2, after treatment- 5, 0). No changes were noticed in placebo group (mean clinical symptom score before treatment: 9, 0, after treatment 10, 3 and mean laryngological symptom score before treatment: 7, 5, after treatment 7, 7).

[Occurrence of atopy in asthmatic children]. / Wystepowanie atopii u dzieci chorych na astme.

Asthma is one of the most common chronic diseases among children. The prevalence of asthma among adult and children has systematically increased for the last thirty years. It was hypothesized that atopy was a strong background predisposing to asthma. The aim of the study was to assess the occurrence of atopy in children suffering from asthma. Two groups of children were examined. The study group consisted of 24 children aged 3-7 suffering from asthma and 26 children with bronchitis. Data about each patient's personal and family allergic history were collected. Each child had skin prick tests with common allergens made, total and specific IgE level was measured and blood eosinophil count and spirometry were performed. The result showed that asthma in 88% of the children had an atopic background. Above 70% of the children had allergic diseases other than asthma--the most common was allergic rhinitis (54%) and atopic dermatitis (37.5%). Skin tests revealed that the examined children were mostly sensitized to the allergens of house dust (85.7%), house dust mite (66.6%), and grass pollen (33.3%). Atopic features were also found in children suffering from recurrent bronchitis.

[Chemotactic activity of neutrophils to fMLP and IL-8 in patients with severe asthma with reversible and irreversible airflow obstruction and in patients with chronic obstructive pulmonary disease]. / Chemotaksja neutrofili do fMLP i IL8 u chorych na ciezka astme z odwracalna i utrwalona obturacja oraz u chorych na przewlekla obturacyjna chorobe pluc.

Asthma is a chronic inflammatory disease of the airways in which many cell types play a role. Although the most important cells are eosinophils, there are suggestions that also neutrophils may play a role in asthma. The aim of the study was to measure and compare chemotactic activity of neutrophils in patients with severe asthma and with COPD. We examined 49 patients with severe asthma and 23 patients with COPD. The mean number of neutrophils in peripheral blood of 20 asthmatics with irreversible airflow obstruction was 3.96 x 10(6)/ml. The chemotactic activity of neutrophils to FMLP was 2.69 SEM +/- 0.4, to IL-8 in concentration 10-7 microg/ml - 1.64, SEM +/- 0.2, and to IL-8 in concentration 10-8 microg/ml - 1.17, SEM +/- 0.1. The mean number of neutrophils in 29 asthmatics with reversible airflow obstruction was 3.08 x 10(6)/ml. Their chemotactic activity to fMLP was 1.7, SEM +/- 0.1 to IL-8 in concentration 10-7 microg/ml - 1.51. SEM +/- 0.2, and to IL-8 in concentration 10-8 microg/ml - 1.08, SEM +/- 0.1. The mean number of neutrophils in COPD patients was 4.05 x 10(6)/ml and their chemotactic activity to FMLP was 1.9, SEM +/- 0.1 to IL-8 - 1.35, SEM +/- 0.1. All asthmatic patients were treated with inhaled corticosteroids and some of them with oral corticosteroids. Despite of that treatment the number of neutrophils isolated from patients with asthma with irreversible airflow obstruction was almost the same like in COPD patients and chemotactic activity of neutrophils in this group was the highest. We concluded that corticosteroids treatment did not diminished chemotactic activity of neutrophils isolated from patient suffering from asthma with irreversible airflow obstruction.

[The prevalence of atopic diseases among children and adolescents and describing the strongest risk factor of developing these diseases]. / Czestosc wystepowania chorób atopowych wsród dzieci i mlodziezy oraz okreslenie najsilniejszych czynników ryzyka ich rozwoju.

The aim of shown study was the prevalence atopic diseases among children and adolescents living in the community of Radomsko and the label of frequency risk on factors of possible connection with the risk of developing atopic diseases. The examination has been done between 2000--2002 among children and adolescents attending to different kinds of schools situated in the territory of Radomsko. It has consisted of two parts: a survey which was based on the questionnaire ISAAC and also the additional examination which depends on gathering detailed allergic interviews, physical examination and execution skin test. To diagnostic investigation has been qualified the groups of children and adolescents selected on the base of the questionnaire with diagnostic asthma--examining people and with suspicion of asthma without earlier diagnosis--100 examining people and 36 earlier diagnosed children.. The frequency of appearing the allergy among analysing the trial of children and adolescents from the district of Radomsko established on the level 9,08% (115/1267) whereas the percentage of atopic diseases has been: 3,47% (44/1267) for asthma, 7,02% (89/1267) for allergic rhinitis and 1,4% (18/1267) for atopic dermatitis. Atopic diseases were at the most of examined people diagnosed by paediatrist's doctors and general's practitioners. During the presented study the diagnosis of asthma was placed only among 8 children and at 18 children was placed diagnosis of allergic rhinitis. The strongest risk factor of atopic diseases occurred: bad living conditions (humidity and/or mildew at home), passive tobacco smoking, pets at home, infection of lower airways during the last year and in the earliest years of life.