The assessment of effectiveness, tolerance, and patient satisfaction with the use of a new fixed-dose combination product, containing salmeterol and fluticasone propionate, Salflumix Easyhaler® in the treatment of asthma in the daily clinical practice.

BACKGROUND: The effectiveness of a fix-dose salmeterol/fluticasone combination therapy in asthma was previously shown for the original product. The study aim was to evaluate the clinical effectiveness and safety of a second entry DPI - dry powder inhaler (Salflumix Easyhaler) in patients with asthma in everyday clinical practice. PATIENTS AND METHODS: This multicenter Investigator-Initiated Study that enrolled 2,037 adult outpatients with asthma treated with Salflumix Easyhaler, was conducted by 220 pulmonologists across Poland. Asthma control was assessed during 3 visits with 6 ± 2 weeks intervals based on the Asthma Control Test (ACT). In addition, patient Satisfaction with Asthma Treatment Questionnaire (SATQ) and adherence and adverse events (AEs) were monitored. RESULTS: During the observation (86 ± 30 days) the percentage of patients with controlled asthma (ACT 20-25 pts) increased from 35.5% at the first visit to 86.5% at the third visit (p < 0.001). In the subgroup analysis, there were more patients not obtaining asthma control among patients that switched from the treatment with other devices than in naive ones. Global SATQ scores increased from 5.8 ± 0.7 to 6.2 ± 0.6 during the observation. Patients' satisfaction with the use of the Salflumix Easyhaler was high. Adherence exceeded 95%. Eight AEs were reported. CONCLUSIONS: Salflumix Easyhaler is highly effective and well-tolerated by naïve patients with asthma and those switching from another device. In general, patients show good compliance with medical product and are satisfied with the use of this new device, and not reporting difficulties and errors related to its' use. Their physicians' overall perception of Salflumix Easyhaler use is very positive.

The Precision Allergy Molecular Diagnosis (PAMD@) in Monitoring the Atopic March in a Child with a Primary Food Allergy: Case Report.

The case of a 9-month-old boy with an initial diagnosis of atopic dermatitis and confirmed allergy to hen's egg, cow's milk allergens with episodes of anaphylaxis who developed birch allergy whilst under observation with asthma symptoms was presented. The precision allergy molecular diagnosis (PAMD @) allowed for individualisation of dietary recommendations and observing the early progression of food sensitisation to the main birch molecule. The presented identification of major allergic molecules with PAMD@ in the preclinical phase of asthma contributes to the discussion related to early specific immunotherapy to suppress molecular spread and allergic march. However, more research is needed to verify this hypothesis.

COVID-19 Vaccination and Ukrainian Refugees in Poland during Russian-Ukrainian War-Narrative Review.

The outbreak of the Russian-Ukrainian war contributed to the largest migration movement in the 21st century. As a result, over 3 million refugees, mainly women, children and the elderly, arrived in Poland in a short space of time. Despite the ongoing war, it is important to remember that the COVID-19 pandemic is still present in the world, and before the outbreak of the war, Ukraine was struggling with its fifth wave. Furthermore, Ukraine has one of the lowest vaccination rates in Europe, not exceeding 40%. It is, therefore, reasonable to suspect that the vast majority of migrants have not been vaccinated. This situation may pose a significant epidemiological risk. Therefore, it is necessary to implement appropriate steps to determine the vaccination status of refugees and to supplement the vaccination with both the core and booster doses. In response to these needs, the government of Poland, like many other countries, has made it possible to provide free COVID-19 vaccination to persons fleeing war. In the face of massive migration, the overriding priority should be to ensure adequate medical care for refugees, including free COVID-19 vaccinations. However, it seems that the lack of willingness to vaccinate among Ukrainians is also replicated on migration. It seems reasonable that appropriate steps should be taken to increase awareness and confidence in vaccination, which may ultimately translate into increased vaccination uptake. Analyzing previous experiences, it is advisable to consider that the first step should be to promote vaccination and remind refugees of the possibility of free COVID-19 vaccination. Additionally, refugees should be encouraged to be vaccinated during every contact with health care workers.

Attitudes of Parents with Regard to Vaccination of Children against COVID-19 in Poland. A Nationwide Online Survey.

Within a few months, the scientific world achieved a great success, developing effective and safe vaccines against COVID-19. Many countries with full access to vaccines have introduced recommendations for the vaccination of not only people who are at risk of developing severe COVID-19, i.e., the elderly and chronically ill, but all members of society, including children aged 12 and above as the currently registered preparations can be used above the said age. However, the use of COVID-19 vaccines in children arouses strong emotions, with their sense being frequently questioned. The aim of the paper was to assess the attitudes of Polish parents with regard to vaccinations against COVID-19 administered to their children. The study was conducted with the use of the authors' original questionnaire, which was distributed online. The questionnaire was completed 4732 times, and 4432 surveys were qualified for the final analysis. The vast majority of the respondents were women (77.6%), people aged 36-44 (40.3%), with higher education (86.2%) and people living in the city with more than 250,000 inhabitants (48%). The mean age of the study group was 37.5 ± 6.61 years. Out of the studied group, 28.2% of parents are healthcare professionals. The study was conducted prior to the EMA's decision that permitted the use of BNT162b2 in children. Results: The vast majority of the respondents were mothers, who showed significantly more favorable attitudes toward the vaccinations than fathers. Forty-four percent of parents want to vaccinate their children as soon as possible, while every fourth parent does not want to vaccinate their child at all. Main concerns about the vaccines include concerns that the preparation has not been adequately tested and that it is ineffective, as well as the lack of information concerning potential complications in the future. The main sources of information on childhood vaccinations are the media, including the Internet and television. Vaccination of the pediatric population against COVID-19 raises many emotions and doubts in parents and it is also debated by experts. The decision to vaccinate should rest on child's parents. Both the individual benefits of protection against COVID-19 and the population benefits of pandemic control must be considered. There is a need for ongoing monitoring of the safety of administering COVID-19 vaccinations in children, as well as for evaluating their effectiveness and benefits in reducing individual risk of severe course of COVID-19 and complications after this disease, and for evaluating the population benefits of vaccines in children.

Response to Comment on Jaworska, J. et al. Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children. Diagnostics 2020, 10, 935.

Thank you for the opportunity to respond to the issues raised by Nenna et al [...].

Serum Vitamin D and Immunogenicity of Influenza Vaccination in the Elderly.

Vaccination is the most effective preventive measure that reduces the risk of influenza and post-influenza complications. It prevents influenza-related hospitalizations and deaths in 50-60% and about 80% of patients aged over 65, respectively. There is the clinical plausibility of the association between serum vitamin D (VIT D) content and viral respiratory infections. In this study, we addressed the issue of a vitamin D modulatory effect on the immune response to seasonal influenza vaccination in elderly persons. The study comprised 96 participants aged 60-75 during the 2016/17 epidemic season. After the determination of the baseline content of VIT D and anti-hemagglutinin antibodies (H1, H3, and HB), participants were vaccinated with a trivalent vaccine. The content of the anti-hemagglutinin antibodies was rechecked 4-5 weeks afterward, showing inappreciable alterations. The negative findings of this study make the influence of serum VIT D content on the immunogenicity of influenza vaccination highly unlikely in elderly persons.

Oleosins: A Short Allergy Review.

In patients having a history of anaphylaxis after consumption of peanuts, sunflower seeds, or soy and skin or blood tests negative for the allergen extracts, oleosins could be the culprit. Oleosins are common and largely underestimated allergy inducers of plant origin, causing severe allergy symptoms, including the anaphylactic shock. They are resistant to high temperatures and digestive enzymes. The consumption of heat-treated oleosins has been associated with a higher risk of a severe anaphylactic reaction. Recent studies have shown that oleosins could be a biomarker of the allergy severity to peanuts. Oleosins have a hydrophobic structure and thus, are poorly soluble in aqueous solutions. The aqueous extraction, separation, and purification procedures do not guarantee their solubility. Oleosins dissolve only in the presence of detergents, which limits their use in both in vivo and in vitro allergy tests. Recently, a multiparameter allergy test that detects the allergen-specific immunoglobulin E (sIgE) against oleosins has become available. This capability may help to unravel the presence of oleosin source during the routine diagnostic of allergy, which is conducive to assessing the risk for severe anaphylaxis and may also help to clarify the ambiguous allergy cases.

Pruritus Characteristics in Severe Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is classified as a most common inflammatory skin disease. The condition is characterized by recurrent eczematous lesions and intense pruritus or itch, a hallmark of AD. The aim of this study was to identify the provoking factors of itch in severe AD adult patients. There were 34 adult patients suffering from AD of the median age of 40 years enrolled into the study and a control group that consisted of 20 healthy subjects. The severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) index, pruritus intensity was assessed on a visual analog scale (VAS), and itch aggravating factors were assessed with a questionnaire. Specific IgE (sIgE) antibodies and interleukin IL-33 were measured in venous blood. We found that all the patients with severe AD had intensive itch (VAS: 9-10 points) during the whole day and 30 (88.2%) patients had it during nighttime. The most significant factors aggravating itch were the following: dry skin (27 patients; 79.4%), exposure to dust mite (22 patients; 64.7%,), and emotional distress (17 patients; 50%). Moreover, there was a positive correlation between the intensity of itch and the level of sIgE antibodies to dust mite (p < 0.001). The content of IL-33 was significantly higher in AD patients with severe skin lesions. This exploratory study shows that skin dryness, dust exposure, and distress play an essential role in the exacerbation of AD in the adult population.

Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children.

This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature search was done in PubMed database. Statements were established based on a review of full-text articles published in English up to December 2019. The development of this consensus was conducted according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations)-adopted and Delphi method. Initially, 22 proposed statements were debated over 3 rounds of on-line discussion and anonymous voting sessions. A total of 17 statements were agreed upon, including four statements referring to general issues, nine referring to pneumonia and four to bronchiolitis. For five statements experts did not achieve an agreement. The evidence supporting each statement was evaluated to assess the strength of each statement. Overall, eight statements were rated strong, five statements moderate, and four statements weak. For each statement, experts provided their comments based on the literature review and their own experience. This consensus is the first to establish the role of lung ultrasound in the diagnosis and management of pneumonia and bronchiolitis in children as an evidence-based method of imaging.

Angioedema. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society (PTD) and Polish Society of Allergology (PTA).

Angioedema is a non-inflammatory oedema of the subcutaneous tissue and/or mucosal membranes. It most commonly coexists with urticaria wheals and is considered to be a deep form of urticaria. Less commonly, it occurs in isolation and can take two basic forms: acquired angioedema and hereditary angioedema. Currently, there are 4 defined types of acquired angioedema and 7 types of hereditary angioedema. Treatment of angioedema depends on its form and etiological factors. Especially the genetic form, i.e. hereditary angioedema, is a considerable challenge for medical specialists, particularly dermatologists and allergists.

The herbal medicine containing of ivy leaf dry extract in the treatment of productive cough in children.

OBJECTIVE: The aim: The assessment of the therapeutic effects of the herbal medicine containing of ivy leaf dry extract administered twice a day in children with productive cough and their guardians' satisfaction with the use of this syrup. PATIENTS AND METHODS: Material and methods: A multicenter, observational survey was conducted by 268 doctors working in Primary Health Care. The survey was conducted during two routine, consecutive outpatient visits (including first supplemented retrospectively) resulting from the needs of therapy. RESULTS: Results: The study group consisted of 5162 patients treated for productive cough with the herbal medicine containing of ivy leaf dry extract administered twice a day. In 75.7%, productive cough was intense, in 61.6% it occurred at night, in 49.8% it was very common (several times per hour), and in 62.7% it affected daily activity. Most often the syrup containing of ivy leaf dry extract was used in doses twice a day for 2 ml or 4 ml. During observation the percentage of children with intensive, very common, night and affected daily activities cough decreased significantly. Very satisfied with a therapeutic effect of the preparation containing of ivy leaf dry extract administered twice a day were 68.2% of children guardians. CONCLUSION: Conclusions: The use of the herbal medicine containing of ivy leaf dry extract administered twice a day may be a good alternative to current therapeutic regimens in the treatment of productive cough in children. This recommendation is supported by effectiveness comparable to other medicines and a high level of satisfaction with its use by patients and guardians of chidren.

Depression and Serum Content of Serotonin in Adult Patients with Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic skin disease with the etiology not yet conclusively established. Recent reports demonstrate the role of serotonin (5-hydroxytryptamine; 5-HT) in the pathogenesis of AD. The aim of this study was to investigate the relationship between the serum content of serotonin and depression in adult patients suffering from severe AD. There were 31 patients of the median age of 41 years enrolled into the study, who suffered from AD since childhood, and a control group that consisted of 14 healthy subjects. AD was diagnosed on the basis of Hanifin and Rajka criteria. The severity of skin lesions was assessed with the SCORing Atopic Dermatitis (SCORAD) index and that of depression with the Montgomery-Åsberg Depression Rating Scale (MADRS) questionnaire. We found that all of the patients with severe AD characterized by SCORAD >50 had depression. Depression was classified as mild and moderate according to the MADRS score. Serotonin content was significantly lower in the patients with severe AD (MADRS >12), and there was an adverse relation between the serotonin content and the score of depression, the features not noticed in the control group. We conclude that severe AD, as expressed by the intensification of skin lesions, associates with depression and with the lowering of serum serotonin content. The findings point attention to the cognitive and affective problems in AD patients which could worsen the course of the skin disease.

Cat Allergy as a Source Intensification of Atopic Dermatitis in Adult Patients.

Atopic dermatitis (AD) is characterized by exacerbations and remissions of eczematous skin, underlain by impaired skin barrier and aberrant Th2-type and Th-22 cytokine production. A number of allergens, in particular contact with fur animals, may aggravate the disease. This study seeks to define the influence of having a regular contact with a pet cat at home on the severity of symptoms and signs of AD. We addressed the issue using the SCORing Atopic Dermatitis (SCORAD) and visual analog (VAS) scores to assess the intensity of pruritus and by measuring the blood content of specific IgE and IL-4, IL-13, and IL-22 cytokines. The study group consisted of 47 adult patients suffering from AD since childhood, 18 of whom declared having regular contact with a cat and the remaining 29 who denied it. There also was a control group consisted of 16 healthy volunteers with no AD signs. The SCORAD and VAS scores were significantly higher in patients in contact with a cat than in those without it (median SCORAD 61.0 vs. 50.4 and VAS 9.0 vs. 4.0 points, respectively). The sIgE of a majority of patients (94.4%) in contact with a cat was in Class V-VI, compared with just a few patients (3.4%) with no such contact, having sIgE in the same classes (p < 0.001). Significant correlations were revealed between SCORAD and VAS scores and the class level of serum sIgE value. In addition, IL-22 was a single elevated cytokine, only in the patients in contact with a cat, and it correlated with pruritus severity. The results of the study underline the need to beware of the cat fur allergen, and they stress forethought and caution in acquiring and keeping a pet cat by patients suffering from AD.

Acute subglottic laryngitis. Etiology, epidemiology, pathogenesis and clinical picture.

In about 3% of children, viral infections of the airways that develop in early childhood lead to narrowing of the laryngeal lumen in the subglottic region resulting in symptoms such as hoarseness, abarking cough, stridor, and dyspnea. These infections may eventually cause respiratory failure. The disease is often called acute subglottic laryngitis (ASL). Terms such as pseudocroup, croup syndrome, acute obstructive laryngitis and spasmodic croup are used interchangeably when referencing this disease. Although the differential diagnosis should include other rare diseases such as epiglottitis, diphtheria, fibrinous laryngitis and bacterial tracheobronchitis, the diagnosis of ASL should always be made on the basis of clinical criteria.

Factors affecting the choice of therapeutic regimens in asthma and chronic obstructive pulmonary disease patients and patient adherence to the therapies prescribed.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) and asthma are the most common chronic respiratory diseases worldwide. At the moment, there is no information about the preferences of Polish specialists as regards the treatment of asthma and COPD or factors influencing the choice of particular treatment regimens. AIM: To determine the treatment options most commonly used by experienced pulmonologists and allergists for asthma and COPD and to identify the factors affecting the choice of a particular therapy. MATERIAL AND METHODS: The survey included 224 doctors (pulmonologists and allergists) across Poland and concerned patients diagnosed with asthma (n = 4358) and COPD (n = 3062). RESULTS: In the case of asthma, the most common therapy applied was inhaled glucocorticosteroids and long-acting ß2 agonists. According to 27.2% of doctors, combination therapy was used in 70-80% of patients while 23.7% declared that the proportion of patients receiving such a treatment exceeded 80%. In the case of COPD, anticholinergics were most frequently prescribed when inhaled glucocorticosteroids and long-acting ß2 agonists had proved insufficient. According to 21% of specialists, the percentage of patients treated so was 41-50%, while 19% declared the use of this treatment in 71-80% of patients. CONCLUSIONS: The most common treatments for asthma and COPD in Poland are inhaled glucocorticosteroids and long-acting ß2 agonists. The main factors influencing treatment decisions are the current GINA and GOLD recommendations as well as patients' age, comorbidities, and price of treatment.

Comparison of lung ultrasound and chest X-ray findings in children with bronchiolitis.

Respiratory syncytial virus is the main pathogen responsible for bronchiolitis. Usually, there is no indication to perform diagnostic imaging or run laboratory tests in patients with bronchiolitis since the diagnosis is based on the clinical presentation. Chest radiogram can be useful in severe cases. So far, lung ultrasound has not been considered as an alternative in guidelines for imaging diagnosis of bronchiolitis. The aim of the study was to compare lung ultrasound and chest X-ray findings in children with bronchiolitis. In our study we retrospectively compared diagnostic imaging findings in children with confirmed respiratory syncytial virus infection. The study included 23 children aged 2 weeks to 24 months and 3 children older than 24 months. Chest X-ray showed lesions in only 4 cases, whereas ultrasound abnormalities were found in 21 patients. Pathologies revealed by chest X-ray were the same for all 4 cases and consisted of an enlarged hilus and peribronchial cuffing. Sonographic lesions included inflammatory consolidations larger than 10 mm in 11 patients, small consolidations (<10 mm diameter) in 8 patients, interstitial syndromes in 6 patients, and alveolar-interstitial syndromes in 11 patients. A small amount of pleural effusion was detected in 3 patients. Considering safety, short time of examination, high sensitivity in finding pleural effusion, small consolidations and signs of interstitial infiltrations, transthoracic lung ultrasound may be useful in the diagnosis of bronchiolitis.

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.

Inhibition of Cross-Reactive Carbohydrate Determinants in Allergy Diagnostics.

Despite being clinically largely irrelevant, antibodies against cross-reactive carbohydrate determinants (CCD) are an important issue in the in vitro diagnostics, as they may produce false positive or falsely elevated results of the immunoglobulin E class (asIgE) in relation to the actually present level of asIgE. The present chapter demonstrates an effective resolution of this diagnostic issue by the use of a CCD inhibitor in in vitro tests. A synthetic CCD inhibitor, Polycheck® CCD inhibitor, was used in the laboratory diagnostics of 24 children diagnosed with allergic diseases. The anti-CCD antibody content was measured in the serum using a Polycheck® Atopic 30-I panel (Biocheck GmbH; Münster, Germany), a screening assay for the quantitative determination of multiple allergen-specific IgE. We found that the baseline anti-CCD antibody content, without the CCD inhibitor, ranged from 0.7 to 3.5 kU/L in the sera of the majority of 16 out of 24 children. When the CCD inhibitor was applied, the anti-CCD antibody content decreased in 16, remained unchanged in 3, and increased in 5 samples. In samples positive for plant allergens, the asIgE content dropped by an average of 72% when the CCD inhibitor was used in the assay, except the antibodies to tree and grass pollen allergens, for which the asIgE content remained above 100 kU/L. We conclude that the use of a CCD inhibitor in in vitro assays is a viable option to mitigate the influence of anti-CCD antibodies on the measured level of asIgE immunoglobulin, which increase the reliability of testing particularly in cases displaying multiple allergies.

Recommendations for the management of tuberculosis in children - KOMPASS TB. Part 1: Tuberculosis prevention.

Since the second half of the 20th century the incidence of tuberculosis has been declining in Poland. Despite this, current epidemiological data still support the need for the continued mass BCG vaccination in Poland in the near future. Apart from the protection against severe hematogenous forms of tuberculosis, vaccination lowers the risk of infection with Mycobacterium tuberculosis. Primary and acquired immunodeficiency, including immunity disorders associated with an ongoing treatment, are contraindications to BCG vaccination. The most common adverse effects following BCG vaccination are reactions at the site of injection and in regional lymph nodes, which usually does not require treatment. Methods of tuberculosis prevention, particularly recommended in low-incidence countries, include: diagnostic investigations of patients who had contacts with pulmonary tuberculosis as well as an active detection and treatment of latent Mycobacterium tuberculosis infection. Latent tuberculosis infection can be identified on the basis of positive results of the tuberculin skin test or interferon-gamma release assays after the active disease has been ruled out. This condition does require prophylactic treatment.

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.