[Relationship between quality of life and BODE index of stable ex-smokers with chronic obstructive pulmonary disease]. / Vztah mezi kvalitou zivota a BODE indexem u bývalých kuráku ve stabilní fázi chronické obstrukcní plicní nemoci.

BACKGROUND AND AIM: This study was carried out to assess relationship between quality of life (QoL) and disease severity expressed by multifactorial prognostic index (BODE) in ex-smokers suffering from chronic obstructive pulmonary disease (COPD), minimally 8 weeks free of exacerbation. MATERIALS AND METHODS: The evaluation was performed in 98 randomly recruited COPD patients enrolled into a cross-sectional, observational CILIARY study at the Department of Pneumology, Charles University, Faculty of Medicine in Hradec Králové. In them, quality of life evaluation using the SGRQ questionnaire and the BODE index calculation was performed. We statistically compared interrelationship between BODE and COPD stages, SGRQ and COPD stages and interrelation of BODE and SGRQ. RESULTS: We found significant differences in QoL of COPD patients and QoL in group of healthy volunteers (p <0.001). Lower QoL and higher BODE score were associated with a higher stages of COPD (p < 0.001), with the exception non-significant difference in QoL (SGRQ score) and BODE index between stages I and II. Our study found positive correlation between the all SGRQ scores and multidimensional prognostic BODE index (r = 0.431-0.704). The strongest correlation (r = 0.704) was evident in activity domain of SGRQ. CONCLUSION: Our results proved close correlation ofquality of life (SGRQ) and multidimensional prognostic score (BODE) in stable COPD exsmokers' population. Both these scoring systems are useful tools for the assessment of clinical course and stratification of severity of COPD. However at present both scales are minimally used in the Czech Republic.

[Examination of function and structure of respiratory cilia of adult patients suffering from chronic obstructive pulmonary disease (COPD)--comparison of nasal and bronchial mucosa (pilot of CILIARY STUDY)]. / Porovnání struktury a funkce nazální a bronchiální sliznice u nemocných s CHOPN (pilotní projekt ciliární studie).

INTRODUCTION: Borderline between upper and lower respiratory tract pathology is probably artificial (bronchial asthma). Also inflammation of bronchial mucosa during chronic obstructive pulmonary disease (COPD) is likely combined with inflammatory involvement of nasal mucosa. Ciliary edge of respiratory epithelium is very important part of mucosa layer. AIM: To investigate and compare nasal and bronchial ciliary beat frequency (CBF), degree of nasal and bronchial ciliary dyskinesia, presence of ciliary akinesia and incidence of spinocellular metaplasia in the both mucosa localities among of stable COPD patients (pts). METHOD: Nasal and bronchial mucosa were obtained in the course of bronchoscopy examination of COPD pts in general intravenous anesthesia. Native samples of mucosa tissue were assessed by digital high-speed video microscopy (1,000x magnification). Paired t-test was used to evaluate differences in average frequencies. Significance level was alpha = 0.05. Mode was used to describe "index of dyskinesia", as a measure of association was used K coefficient. MATERIAL: Seventeen COPD pts (6 weeks free of exacerbation) at the age 47-80 (average 64.2 years +/- 9.7) were examined (13 male), average FEV1 61% predic. value (21-81, +/- 15). All patients were active smokers (average 42 pack years +/- 22.8) and all suffered from bronchitic (daily sputum production) phenotype of COPD. RESULTS: We did not find any difference in average ciliary beat frequencies between nose (6.0 Hz +/- 1.3) and bronchus (5.9 +/- 1.3) locality (p = 0.427). We find weak association between nose and bronchus in "ciliary akinesia" (kappa = 0.282) but medium association in "metaplasia" (kappa = 0.485), in index of dyskinesia (kappa = 0.733). CONCLUSION: We did not find in our data any difference in nasal and bronchial ciliary beat frequencies and we found medium association between nasal and bronchial spinocellular metaplasia and index of ciliary dyskinesia. Possible generalization of these results would require further investigation and analysis.

Decreased peripheral blood gamma delta T cells in patients with bronchial asthma.

Many cell populations are thought to be involved in the etiopathogenesis of bronchial asthma. We examined by flow cytometry the relative and absolute number of CD3+, CD4+, CD8+, alpha beta TcR+ or gamma delta TcR+ T cells, CD19+ B cells; and CD56+ natural killer (NK) cells in the peripheral blood of 26 adult patients with difficult-to-control asthma (DCA) and 22 patients with minimally symptomatic asthma (MSA). Statistically higher relative and absolute numbers of NK cells (18.39 +/- 10.67% and 0.38 +/- 0.17 x 10(9)/l) in comparison with healthy controls (11.77 +/- 8.06% and 0.25 +/- 0.19 x 10(9)/l) and significantly decreased relative and absolute numbers of gamma delta T cells (3.02 +/- 2.16% and 0.06 +/- 0.04 x 10(9)/l) in comparison with controls (5.65 +/- 2.90% and 0.13 +/- 0.08 x 10(9)/l) in the DCA patient group were found. After pooling of data from both MSA and DCA patients and dividing the patients according to the presence of allergy, the relative and absolute numbers of gamma delta T cells were found to be diminished in both the allergy (3.77 +/- 2.98 and 0.07 +/- 0.05 x 10(9)/l) and nonallergy (3.06 +/- 1.78% and 0.06 +/- 0.03 x 10(9)/l) groups in comparison with healthy controls. The reason for the low number of gamma delta T cells in the peripheral blood of patients suffering from bronchial asthma is under investigation.

Some serum activity markers of airways inflammation in difficult-to-control asthma patients.

UNLABELLED: The main aim of the present study was a search for a characteristic serum marker of inflammatory activity in the airways of asthmatics with difficult-to-control disease. Therefore, serum levels of interleukin-4 (IL-4), serum low-affinity Fc Epsilon Receptor II (sFcER II), Interferon-gamma (INF-gamma) Immunoglobulin-E (IgE), Interleukin-2 (IL-2), serum Interleukin Receptor 2 (sIL-2R) and Intercellular Adhesion Molecule-1 (sICAM-1) were measured in 2 groups of asthmatics: 1-26 patients with difficult-to-control asthma (DTCA), 2-22 asthmatics, minimally symptomatic (MSA). RESULTS: No significant difference in either measured parameters between the DTCA and MSA group in peripheral blood samples was found. CONCLUSION: The above mentioned serum markers of T- and B-cell activation as well as the serum ICAM-1 level are not sensitive enough to determine the type, activity and severity of the inflammatory process in the asthmatic airways.

[Analysis of perception in patients during an acute attack of bronchial asthma]. / Analýza pocitu nemocných pri akutním záchvatu asthma bronchiale.

An analysis of subjective sensations during an asthmatic attack in 51 asthma patients was performed. A difficult inspiration or inspiration and expiration was the most prevalent sensation, while isolated difficult expiration was only sparse finding. A tightness on the chest was often noticed as well. The probable explanation for these observation could be the breathing a high lung volume (hyperinflation), caused by closing small airway a mostly due to bronchoconstriction during the asthmatic attack. The authors suggest not to generally use the term "expiratory breathlessness" when describing the clinical picture of an asthmatic attack.

[Perception of dyspnea in asthmatics--long-term study]. / Vnímání dusnosti u astmatiku--dlouhodobá studie.

The authors investigated the relationship between perception of dyspnoea and some respiratory parameters (vital capacity - FVC, one-second vital capacity - FEV 1) in 43 patients with bronchial asthma. They followed up the changes of this relationship during repeated examinations within 3 - 60 months following the first examination. They were also interested to find out whether the patients perceive a reduction of the bronchial obstruction after Berotec. The authors provided evidence that: 1. a small proportion of the patients (18.4%) do not report subjective dyspnoea even in case of major obstruction of the respiratory pathways. 2. Another part of asthmatic patients (23.2%) have an increased perception of dyspnoea, i. e. they report a certain degree of dyspnoea when FEV 1 is higher than 85% of the appropriate value. 3. Acute reduction of bronchial obstruction is inadequately perceived by 39.5% of the patients. 4. During repeated assessment the perception of dyspnoea frequently changed markedly in the same patients. These findings justify the conclusion that treatment of asthmatic patients should depend not only on the score of the patient's symptoms but also on objective monitoring of the degree of obstruction in the home environment.

[Thymoma in the anterior mediastinum and systemic lupus erythematosus]. / Thymóm predního mediastina a systémový lupus erythematosus.

The authors describe an observation of a thymoma and systemic lupus erythematosus (SLE) in a 48-year-old woman with an analysis of clinical and laboratory indicators justifying this diagnosis. Improvement of SLE and the lupus nephropathy was achieved by three pulses of methyl prednisolone à 1000 mg in an intravenous infusion with subsequent Prednisone therapy, using conventional doses. After thymectomy on account of a benign thymoma activation of SLE did not occur. The objective of the presented paper is to draw attention to the infrequent possible concurrent incidence of thymoma and SLE and the influence of thymectomy and the subsequent development of SLE.