FEV1 after 3 years of observation in patients with bronchial asthma and patients with chronic obstructive pulmonary disease

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 l, FVC - 2,3 l, MEF 50 - 1,9 l/s, After 3 years FEV1 decreased 180 ml. In patients with CRAO mean ventilatory parameters were FEV1-1,6 l, FVC- 2,1 l, MEF 50 - 1,8 l/s. After 3 years FEV1 decreased by 70 ml. In COPD patients mean ventilatory parameters were FEV1-1,2 l, FVC - 1,9 l, 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. Pneumonol. Alergol. Pol. 2005, 73, 142-147

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.Wstęp: Celem pracy było porównanie rozkładu POChP według nowej gradacji GOLD ze stadium ocenianym wyłącznie na podstawie spirometrii.Materiał i metody: Pacjenci spełniający warunki byli w wieku 64,8 roku i palili papierosy co najmniej 10 paczkolat. POChP było zdefiniowane według GOLD z wartością FEV1/FVC < 0,70 po teście odwracalności obturacji. Kategorie zostały określone według skali duszności mMRC i skali CAT. Oceniano zaostrzenia POChP w ciągu ostatniego roku i wskaźniki wentylacji. Opracowanie statystyczne wykonano przy użyciu testu t-studenta.Wyniki: W badaniach analizowano 315 pacjentów z POChP: 99 (31,4%) kobiet i 216 (68,6%) mężczyzn. Palenie papierosów określone średnią wartością paczkolat w całej grupie wynosiło 47,1 ± 17,8, ale średnia paczkolat u kobiet była krótsza niż u mężczyzn, odpowiednio 43,7 ± 19,2 vs 49,5 ± 16,5 (p > 0,05). Przy przystępowaniu do badania 144 osoby (45,7%) nadal paliły papierosy, większość z nich (n-87 — 60,4%) należała do kategorii D — 36/66 (54,5%) kobiet i 51/102 (50%) mężczyzn. Na podstawie tylko spirometrii POChP umiarkowaną sklasyfikowano u 144 pacjentów (45,71%), ciężką u 154 (48,89%), a bardzo ciężka u 17 (5,4%). Według raportu GOLD 2011 60 pacjentów (19,04%) zostało zakwalifikowanych do kategorii A, 63 (20%) do kategorii B, 24 (7,62%) do kategorii C i 168 (53,33%) do kategorii D, chociaż 21 (12,5%) z nich było w kategorii B, lecz liczba zaostrzeń spowodowała zakwalifikowanie ich do kategorii D.Wnioski: Populacja z POChP jest heterogenna pod względem objawów, wartości FEV1 i podatności na zaostrzenia. Objawy kliniczne oceniane przy użyciu zwalidowanych kwestionariuszy lepiej charakteryzują pacjentów z POChP niż wskaźniki spirometryczne, które są konieczne w diagnozowaniu tej choroby. Niektórych pacjentów trudno sklasyfikować, szczególnie tych do kategorii C

Exacerbations of chronic obstructive pulmonary disease and the role of sputum bacteriological examination

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 identifi cation 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

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

sICAM-1 w surowicy chorych na alergiczny nieżyt nosa leczonych feksofenadyną lub flutykazonem

The aim of the study was to examine the level of sICAM-1in 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:200mcg/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-1l 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-212ng/ml before treatment, 214ng/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 212ng/ml to 185ng/ml(

C-Kit Binding Properties of Hesperidin (a Major Component of KMP6) as a Potential Anti-Allergic Agent

Accumulation of mast cells can be causally related to several allergic inflammations. Stem cell factor (SCF) as a mast cell chemotaxin induces mast cell migration. To clarify a new effect of Pyeongwee-San extract (KMP6, a drug for indigestion) for the treatment of allergy, we investigated the effects of KMP6 on SCF-induced migration of rat peritoneal mast cells (RPMCs). A molecular docking simulation showed that hesperidin, a major component of KMP6, controls the SCF and c-kit binding by interaction with the active site of the c-kit. KMP6 and hesperidin significantly inhibited SCF-induced migration of RPMCs (P<0.05). The ability of the SCF to enhance morphological alteration and F-actin formation was also abolished by treatment with KMP6 or hesperidin. KMP6 and hesperidin inhibited SCF-induced p38 MAPK activation. In addition, SCF-induced inflammatory cytokine production was significantly inhibited by treatment with KMP6 or hesperidin (P<0.05). Our results show for the first time that KMP6 potently regulates SCF-induced migration, p38 MAPK activation and inflammatory cytokines production through hindrance of SCF and c-kit binding in RPMCs. Such modulation may have functional consequences during KMP6 treatment, especially mast cell-mediated allergic inflammation disorders

Addition to inhaled corticosteroids of long-acting beta2-agonists versus anti-leukotrienes for chronic asthma

Asthma patients who continue to experience symptoms despite being on regular inhaled corticosteroids (ICS) represent a management challenge. Long-acting beta2-agonists (LABA) or anti-leukotrienes (LTRA) are two treatment options that could be considered as add-on therapy to ICS.ObjectivesWe compared the efficacy and safety profile of adding either daily LABA or LTRA in adults and children with asthma who remain symptomatic on ICS.Search strategyWe searched the Cochrane Airways Group Specialised Register (up to and including March 2010). We consulted reference lists of all included studies and contacted authors and pharmaceutical manufacturers for other published or unpublished studies.Selection criteriaWe included randomised controlled trials (RCTs) conducted in adults or children with recurrent asthma that was treated with ICS and where a fixed dose of a long-acting beta2-agonist or leukotriene agent was added for a minimum of 28 days.Data collection and analysisTwo authors independently assessed the risk of bias of included studies and extracted data. We sought unpublished data and further details of study design, where necessary.Main resultsWe included 17 RCTs (7032 participants), of which 16 recruited adults and adolescents (6850) and one recruited children aged 6 to 17 years (182). Participants demonstrated substantial reversibility to short-acting beta-agonist at baseline. The studies were at a low risk of bias. The risk of exacerbations requiring systemic corticosteroids was lower with the combination of LABA and ICS compared with LTRA and ICS, from 11% to 9% (RR 0.83, 95% CI 0.71 to 0.97; six studies, 5571 adults). The number needed to treat (NNT) with LABA compared to LTRA to prevent one exacerbation over 48 weeks was 38 (95% CI 22 to 244). The choice of LTRA did not significantly affect the results. The effect appeared stronger in the trials using a single device to administer ICS and LABA compared to those using two devices. In the absence of data from the paediatric trial and the clinical homogeneity of studies, we could not perform subgroup analyses. The addition to ICS of LABA compared to LTRA was associated with a statistically greater improvement from baseline in several of the secondary outcomes, including lung function, functional status measures and quality of life. Serious adverse events were more common with LABA than LTRA, although the estimate was imprecise (RR 1.35, 95% CI 1.00 to 1.82), and the NNT to harm for one additional patient to suffer a serious adverse event on LABA over 48 weeks was 78 (95% CI 33 to infinity). The risk of withdrawal for any reason in adults was significantly lower with LABA and ICS compared to LTRA and ICS (RR 0.84, 95% CI 0.74 to 0.96).Authors' conclusionsIn adults with asthma that is inadequately controlled on low doses of inhaled steroids and showing significant reversibility with beta2-agonists, LABA is superior to LTRA in reducing oral steroid treated exacerbations. Differences favouring LABA in lung function, functional status and quality of life scores are generally modest. There is some evidence of increased risk of SAEs with LABA. The findings support the use of a single inhaler for the delivery of LABA and inhaled corticosteroids. We are unable to draw conclusions about which treatment is better as add-on therapy for children.PLAIN LANGUAGE SUMMARYWhat are the effects of long-acting beta2-agonists compared with anti-leukotrienes when added to inhaled steroids?People who continue to experience asthma symptoms despite regularly taking inhaled corticosteroids are a challenge for management. It is not clear whether the addition of a long-acting beta2-agonist (LABA) such as formoterol or salmeterol would provide more benefit in comparison with an oral anti-leukotriene agent (LTRA), for example zafirlukast or montelukast.Seventeen trials (16 in adults and one in children) were included in this review and were of good quality. We found that the addition of a LABA provides significantly greater protection against exacerbations requiring oral steroids when compared with a LTRA for adults. Based on the results of our analyses, approximately 38 adults (with a range of between 22 and 244) would need to be treated with a LABA rather than a LTRA for 48 weeks to prevent one experiencing an exacerbation needing a course of oral steroids. The trial on children did not contribute data on the main outcome and therefore we could not draw any conclusions for children.LABAs also led to a greater improvement in lung function, improvement in symptoms, use of rescue medication, quality of life and symptoms compared to the use of LTRAs. The magnitude of the improvements was modest. Serious adverse events were more frequent with LABA than with LTRAs although this result was imprecise. Based on our analyses, around 78 people would need to be treated for 48 weeks with a LABA rather than a LTRA for one of them to experience a serious adverse event. However, due to the lack of precision around our result, the true number could be between 33 and infinity. There are currently insufficient data to draw any conclusions about the effects of these drugs in children