Ways and purpose to detect alpha-1-antitrypsine deficiency in patients with chronic obstructive pulmonary disease

W bieżącym numerze “Pneumonologii i Alergologii Polskiej” opublikowano artykuł poglądowy Struniawskiego i wsp [...

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

Standards for diagnosis and care of patients with inherited alpha-1 antitrypsin deficiency Recommendations of the Polish Respiratory Society, Polish Society of Pediatric Pulmonology and Polish Society of Pediatric Gastroenterology

Alpha-1 antitrypsin (AAT) deficiency is the most common genetic disorder in the adult popu-lation of European descent [...

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

European Spirometry Driving Licence w Polsce — pierwsze polskie szkolenie spirometryczne w ramach ERS HER MES Spirometry Project

Inicjatywa Harmonized Education of Respiratory Medicine in European Specialties (HERMES) zrodziła się w Europejskim Towarzystwie Oddechowym w 2005 roku [...

Pulmonary artery stenosis due to embryonal carcinoma with primary mediastinal location

Mężczyzna (29-letni) został przyjęty na oddział intensywnej terapii pneumonologiczno-kardiologicznej po utracie przytomności. W badaniu przedmiotowym stwierdzono głośny szmer skurczowy nad sercem, a w badaniu echokardiograficznym zwężenie pnia tętnicy płucnej do 6−7 mm, z istotnym gradientem ciśnień oraz cechy podwyższonego ciśnienia w prawej komorze. W tomografii komputerowej klatki piersiowej uwidoczniono masę guzowatą zlokalizowaną w przednim, górnym śródpiersiu. Z powodu ryzyka całkowitego zamknięcia pnia płucnego przeprowadzono interwencyjną mediastinotomię i uzyskano rozpoznanie nowotworu zarodkowego o rzadkiej — śródpiersiowej lokalizacji. Chemioterapia według schematu BEP, doprowadziła do regresji guza, i znacznej poprawy hemodynamicznej (ustąpienie cech ucisku guza na pień płucny). Podczas torakotomii resekowano pozostałe masy guza. Nie stwierdzono naciekania serca i dużych naczyń przez nowotwór. W badaniu histopatologicznym stwierdzono obszary martwicy i naciek nowotworowy o utkaniu niedojrzałego potworniaka. Podczas czteromiesięcznej obserwacji stan chorego pozostawał dobry. Pacjent nadal jest objęty opieką onkologiczną i kardiologiczną. Jak dotychczas nie wymagał kolejnego leczenia cytostatycznego. W kontrolnych zapisach holterowskich EKG nie obserwowano zaburzeń rytmu, ale chory nadal otrzymuje meksyletynę jako leczenie antyarytmiczne. Pacjent planuje powrót do pracy.A 29-year old man was admitted to the intensive care unit after losing consciousness. On physical examination, a loud systolic murmur over the heart was found. Echocardiography revealed narrowing of pulmonary artery with high pressure gradient. Computed tomography of the chest revealed the presence of large tumour localised in the upper anterior mediastinum. Due to the risk of total closure of the pulmonary artery, interventional mediastinotomy was performed and diagnosis of carcinoma embryonale was established. Subsequent chemotherapy (BEP regimen) has brought regression of tumour and significant improvement in haemodynamic parameters (relief of pressure gradient in pulmonary artery). During the second surgery, the resection of all accessible tumour mass together with marginal resection of the right upper lobe was performed. No signs of cardiac or great vessels infiltration was found. Histopathologic examination revealed the necrotic masses and neoplastic foci diagnosed as teratoma immaturum. In a four-month follow-up the patient’s condition remained good. The patient is still under the care of both oncological and cardiological specialists. Thus far he has not required further chemotherapy. Holter ECG monitoring revealed no arrhythmia, but the patient is still treated with mexiletine. The patient is planning to return to work

The insufficiency of low molecular weight heparin (LMWH) prophylaxis in patients with hereditary antithrombin (AT) deficiency

39-letni mężczyzna został przyjęty na oddział intensywnej opieki pneumonologiczno-kardiologicznej ze zdiagnozowanym w angio-CT masywnym zatorem tętnicy płucnej w przebiegu zakrzepicy żył głębokich kończyny dolnej. W 1999 roku u pacjenta rozpoznano wrodzony niedobór antytrombiny (AT). W 2006 roku doznał on urazu kolana, który leczono zachowawczo opatrunkiem gipsowym. Ze względu na rozpoznany niedobór AT chory otrzymał heparynę drobnocząsteczkową - enoksaparynę w dawce 1 mg/kg mc./dobę. Mimo stosowania profilaktyki przeciwzakrzepowej po 6 tygodniach unieruchomienia stan ogólny pogorszył się. Wdrożono leczenie przeciwzakrzepowe, stosując heparynę niefrakcjonowaną. Choremu przetaczano koncentraty AT i rozpoczęto nasycanie doustnym koagulantem (DA). Przebieg hospitalizacji był powikłany wystąpieniem masywnego krwioplucia oraz przejściowego nasilenia cech nadciśnienia płucnego w kontrolnych badaniach echokardiograficznych. Skutecznie kontynuowano leczenie DA.A 39 year old man with normal, stable blood pressure was admitted to the Cardio-Pulmonary Intensive Care Unit due to diagnosed spiral CT pulmonary embolism (PE) and deep venous thrombosis (DVT). In 1999, a hereditary antithrombin (AT) deficiency was confirmed in the presented case. In 2006, because of a knee injury, the patient was provided with a plaster cast and primary antithrombotic prophylaxis with low molecular weight heparin (LMWH) (80 mg of enoxaparin) was administered subcutaneously once a day (patient’s weight was 80 kg). Despite prophylaxis PE and DVT occurred after 6 weeks of treatment. The patient was successfully treated with unfractioned heparin, repeated infusions of AT concentrate and oral anticoagulants (OA). Transient pulmonary hypertension documented by echocardiography and hemoptysis complicated course of PE. Secondary prophylaxis with OA, and INR maintenance between 2-3, was successfully continued