Management of COPD: pulmonologists' adherence to Polish guidelines

Literature data suggest that management of COPD in primary care and by specialists differ from national or international guidelines. Aim of this investigation was to evaluate routine management of COPD by Polish pulmonologists and to compare it to COPD guidelines of the Polish Society of Lung Diseases published in 1997 and updated in 2004. Questionnaire containing 33 questions was distributed to 800 participants of a national congress of the Society. Response rate was 10%. Term COPD is used by 95% of responders (R). For 73% of R COPD patients count for more than 20% of their consultations. Clinical signs of cor pulmonale are present in 10% and signs of respiratory failure in 10 to 20% of all patients. Patients with mild, moderate, severe and very severe disease represent respectively 18, 48, 24 and 10% of the total. Spirometry is performed to confirm diagnosis by 81% of R. However, bronchodilating test is performed in all patients only by 34% of R. 97% of R give antismoking advice to all patients. Only 6% of R are current smokers and 61% are life nonsmokers. Bronchodilating treatment is commonly prescribed. Most frequently prescribed drugs are: LABA (65% of patients) short acting anticholinergic (44%) and ICS (21%) of patients. ICS are over prescribed and systemic steroids are still chronically used in somewhat less than 20% of patients. 43% of R give systemic steroids to all patients during exacerbation of severe disease. Results of the study should be taken with caution. Low response rate suggest that only physicians interested in the treatment of COPD patients participated. A real life situation is probably worse than presented. Pneumonol. Alergol. Pol. 2005, 73, 135-141

Treatment of acute respiratory failure in the course of COVID-19. Practical hints from the expert panel of the Assembly of Intensive Care and Rehabilitation of the Polish Respiratory Society

In 2019, a pandemic began due to infection with a novel coronavirus, SARS-CoV-2. In many cases, this coronavirus leads to the development of the COVID-19 disease. Lung damage in the course of this disease often leads to acute hypoxic respiratory failure and may eventually lead to acute respiratory distress syndrome (ARDS). Respiratory failure as a result of COVID-19 can develop very quickly and a small percent of those infected will die because of it. There is currently no treatment for COVID-19, therefore the key therapeutic intervention centers around the symptomatic treatment of respiratory failure. The main therapeutic goal is to main-tain gas exchange, mainly oxygenation, at an appropriate level and prevent the intensification of changes in the lung parenchyma. Depending on the severity of hypoxemia different techniques can be used to improve oxygenation. Medical staff dealing with COVID-19 patients should be familiar with both, methods used to treat respiratory failure and the epidemiological risks arising from their use. In some patients, conventional (passive) oxygen therapy alone is sufficient. In patients with worsening respiratory failure high flow nasal oxygen therapy (HFNOT) may be effective. The continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) methods can be used to a limited extent. With further disease progression, invasive ventilation must be used and in special situations, extracorporeal membrane oxygenation (ECMO) can also be administered.The authors of this article set themselves the goal of presenting the most current knowledge about the epidemiology and patho-physiology of respiratory failure in COVID-19, as well as the methods of its treatment. Given the dynamics of the developing pandemic, this is not an easy task as new scientific data is presented almost every day. However, we believe the knowledge contained in this study will help doctors care for patients with COVID-19. The main target audience of this study is not so much pneumonologists or intensivists who have extensive experience in the application of the techniques discussed here, but rather doctors of other specializations who must master new skills in order to help patients during the time of a pandemic

Report from an Annual Congress of the European Respiratory Society, Stockholm, 15-19 September 2007 (part II)

Żylna choroba zakrzepowo-zatorowa i nadciśnienie płucne nie stanowiły wiodących tematów kongresu [...

Żylna choroba zakrzepowo-zatorowa — wytyczne profilaktyki, diagnostyki i terapii. Konsensus Polski 2017

Polish Consensus Statement 2017 (PCS 2017) comprises updated recommendations on prophylaxis, diagnostic approach and treatment of venous thromboembolism (VTE). For VTE and no cancer, as long-term anticoagulant therapy, the authors of PCS 2017 recommend apixaban, edoxaban, rivaroxaban and dabigatran over vitamin K antagonists (VKA). For VTE and cancer, the authors of PCS 2017 recommend low molecular weight heparins (LMWH) over VKA, apixaban, edoxaban, rivaroxaban and dabigatran. For extended prophylaxis of deep venous thrombosis (DVT), PCS 2017 recommends apixaban, edoxaban, rivaroxaban, dabigatran, VKA and sulodexide. For extended prophylaxis of pulmonary embolism (PE) PCS 2017 recommends apixaban, edoxaban, rivaroxaban, dabigatran and VKA. In extended prophylaxis, for patients with idiopathic DVT and high risk of bleeding complications, the authors of PCS 2017 recommend DO NOT stop anticoagulation and use of sulodexide. In extended prophylaxis, for patients with idiopathic PE and high risk of bleeding, the authors of PCS 2017 recommend DO NOT stop anticoagulation and suggests treatment with apixaban, edoxaban, rivaroxaban and dabigatran in reduced doses — adjusted to the risk of bleeding. For VTE treated with anticoagulants, PCS 2017 recommends against insertion of vena cava filters. For patients with DVT, PCS 2017 suggests USING compression stockings routinely to prevent post thrombotic syndrome. For sub-segmental PE and no proximal DVT, PCS suggests clinical surveillance over anticoagulation with a low risk of recurrent VTE, and anticoagulation over clinical surveillance with a high risk. Polish Consensus Statement 2017 suggests thrombolytic therapy for PE with hypotension and systemic therapy over catheter directed thrombolysis. For recurrent VTE on a non-LMWH anticoagulant, PCS suggests LMWH, and for recurrent DVT and/or PE on LMWH PCS 2017 suggests increasing the LMWH dose.Konsensus Polski opracowany w 2017 roku (KP 2017) zawiera uaktualnione zalecenia dotyczące profilaktyki, diagnostyki i leczenia żylnej choroby zakrzepowo-zatorowej (ŻChZZ). U pacjentów z ŻChZZ bez nowotworu jako długoterminowe leczenie przeciwzakrzepowe autorzy KP 2017 zalecają apiksaban, edoksaban, rywaroksaban i dabigatran jako preferowane w stosunku do antagonistów witaminy K (VKA). U pacjentów z ŻChZZ i nowotworem autorzy KP 2017 zalecają heparyny drobnocząsteczkowe (HDCz) jako preferowane w stosunku do VKA, apiksabanu, edoksabanu, rywaroksabanu i dabigatranu. W ramach przedłużonej profilaktyki przeciwzakrzepowej w celu zapobiegania zakrzepicy żył głębokich (ZŻG) w KP 2017 zaleca się apiksaban, edoksaban, rywaroksaban, dabigatran, VKA i sulodeksyd. W ramach przedłużonej profilaktyki przeciwzakrzepowej w celu zapobiegania zatorowi tętnicy płucnej (ZTP) w KP 2017 zaleca się apiksaban, edoksaban, rywaroksaban, dabigatran i VKA. W przypadku przedłużonej profilaktyki przeciwzakrzepowej u pacjentów z idiopatyczną ZŻG i dużym ryzykiem powikłań krwotocznych autorzy KP 2017 zalecają, aby NIE przerywać antykoagulacji i stosować sulodeksyd. W przypadku przedłużonej profilaktyki przeciwzakrzepowej u pacjentów z idiopatycznym ZTP i dużym ryzykiem krwawienia autorzy KP 2017 zalecają, aby NIE przerywać antykoagulacji i proponują stosowanie apiksabanu, edoksabanu, rywaroksabanu i dabigatranu w zmniejszonych dawkach dostosowanych do ryzyka krwawienia. W przypadku ŻChZZ leczonej przeciwzakrzepowo w KP 2017 opowiedziano się przeciwko wszczepianiu filtrów do żyły głównej dolnej. U pacjentów z ZŻG w KP 2017 zalecono rutynowe stosowanie pończoch uciskowych w celu zapobiegania zespołowi pozakrzepowemu. W przypadku subsegmentalnego ZTP bez proksymalnej ZŻG w KP 2017 zaproponowano raczej nadzór kliniczny niż antykoagulację w przypadku małego ryzyka nawrotu ŻChZZ oraz raczej antykoagulację niż nadzór kliniczny w przypadku dużego ryzyka nawrotu ŻChZZ. W przypadku ZTP z hipotensją w KP 2017 zaproponowano leczenie trombolityczne oraz trombolizę systemową jako preferowaną w stosunku do trombolizy przezcewnikowej. W przypadku nawrotu ŻChZZ podczas stosowania innego leku przeciwzakrzepowego niż HDCz w KP 2017 zaproponowano HDCz, a przypadku nawrotu ZŻG i/lub ZTP podczas stosowania HDCz w KP 2017 zaproponowano zwiększenie dawki HDCz

Venous thromboembolism — recommendations on the prevention, diagnostic approach and management. The 2017 Polish Consensus Statement

The 2017 Polish Consensus Statement (PCS 2017) includes updated recommendations on the prevention, diagnostic approach, and management of venous thromboembolism (VTE). For VTE without cancer, the authors of PCS 2017 recommend apixaban, edoxaban, rivaroxaban, and dabigatran over vitamin K antagonists (VKA) as long-term anticoagulant therapy. For VTE with cancer, the authors of PCS 2017 recommend low molecular weight heparins (LMWH) over VKA, apixaban, edoxaban, rivaroxaban and dabigatran. For extended secondary prevention of deep venous thrombosis (DVT), PCS 2017 recommends apixaban, edoxaban, rivaroxaban, dabigatran, VKA, and sulodexide. For extended secondary prevention of pulmonary embolism (PE), PCS 2017 recommends apixaban, edoxaban, rivaroxaban, dabigatran and VKA. For extended secondary prevention in patients with idiopathic DVT and a high risk of bleeding complications, the authors of PCS 2017 recommend NOT to stop anticoagulation and use sulodexide. For extended secondary prevention in patients with idiopathic PE and a high risk of bleeding, the authors of PCS 2017 recommend NOT to stop anticoagulation and suggest treatment with apixaban, edoxaban, rivaroxaban, and dabigatran in reduced doses adjusted to the risk of bleeding. For VTE treated with anticoagulants, PCS 2017 recommends against insertion of a vena cava filter. For patients with DVT, PCS 2017 suggests USING compression stockings routinely to prevent postthrombotic syndrome. For subsegmental PE without proximal DVT, PCS 2017 suggests clinical surveillance over anticoagulation with a low risk of recurrent VTE, and anticoagulation over clinical surveillance with a high risk of recurrent VTE. The 2017 Polish Consensus Statement suggests thrombolytic therapy for PE with hypotension, and systemic therapy over catheter-directed thrombolysis. For recurrent VTE on a non-LMWH anticoagulant, PCS 2017 suggests LMWH, and for recurrent DVT and/or PE on LMWH, PCS 2017 suggests increasing the dose of LMWH.