Chronic obstructive pulmonary disease in Poland: distribution of patients according to the new GOLD 2011 classification. Cross-sectional survey

Wstęp: W 2011 roku została wprowadzona nowa klasyfikacja przewlekłej obturacyjnej choroby płuc (POChP), uwzględniająca nie tylko stopień obturacji oskrzeli, ale także nasilenie objawów i ryzyko zaostrzeń choroby. Celem niniejszej pracy było przedstawienie charakterystyki pacjentów z POChP zgodnie z kategoriami GOLD 2011.Materiał i metody: Przeprowadzono badanie przekrojowe z udziałem 411 lekarzy specjalistów pneumonologii i alergologii z całej Polski.Wyniki: W grupie 2271 chorych stwierdzono następujący rozkład pacjentów w poszczególnych kategoriach POChP: A 687 (30,3%), B 403 (17,7%), C 256 (11,3%) i D 925 (40,7%). W całej grupie było bardzo mało pacjentów bez zaostrzeń POChP (1,3%), a w podgrupach A i B takich pacjentów nie było wcale. Głównym powodem kwalifikacji do kategorii C i D była liczba zaostrzeń POChP (odpowiednio 66,0% i 40% pacjentów). Współistnienie chorób układu krążenia stwierdzano częściej w podgrupach o nasilonych objawach B i D (82%) niż w podgrupach A i C (57%, p < 0,001).Wnioski: W dużej grupie pacjentów, reprezentatywnej dla populacji chorych na POChP w Polsce, wykazano nierównomierny rozkład chorych w poszczególnych kategoriach klasyfikacji GOLD 2011. Najliczniejsze były podgrupy A i D, do których zaliczono 71% wszystkich chorych. W niniejszym badaniu główną przyczyną klasyfikacji do kategorii C lub D było wysokie ryzyko zaostrzeń choroby, a nie — jak stwierdzano w innych doniesieniach — stopień zmniejszenia FEV1.Introduction: In 2011 new classification for chronic obstructive pulmonary disease (COPD) was introduced, which are not based on the extent of airflow limitation alone, but also on symptoms and risk of exacerbation. The objective of our work was to present the characteristics of COPD patients according to the GOLD 2011 categories.Material and methods: A cross-sectional survey was performed with the participation of 411 specialists in pneumonology or allergology all over from Poland.Results: In the group of 2271 patients we obtained the following distribution of COPD categories: A 687 (30.3%), B 403 (17.7%), C 256 (11.3%), and D 925 (40.7%). There were very few patients with no exacerbation (1.3%). In subgroups A and B there were no such patients at all. The main reason for classification of patients into categories C and D was the number of exacerbations of COPD (66.0% and 40%, respectively). Cardiovascular comorbidities were more frequent in subgroups B and D, with more symptoms (82%) than in subgroups A and C (57%, p < 0.001).Conclusions: In a large group of patients, representative of the population of COPD patients in Poland, we observed an uneven distribution of patients in the GOLD 2011 categories, with 71% of patients assigned to category A or D. In our study, the main reason for classifying to category C or D was the high risk of disease exacerbation rather than the degree of FEV1 reduction, as noted in other reports

Guidelines of the Polish Respiratory Society for diagnosis and treatment of idiopathic pulmonary fibrosis

Introduction: This document presents the guidelines of the Polish Respiratory Society (PTChP, Polskie Towarzystwo Chorób Płuc) for diagnosis and treatment of idiopathic pulmonary fibrosis (IPF), developed by a group of Polish experts.Material and methods: The recommendations were developed in the form of answers to previously formulated questions concer-ning everyday diagnostic and therapeutic challenges. They were developed based on a current literature review using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Results: We formulated 28 recommendations for diagnosis (8), pharmacological treatment (12) as well as non-pharma-cological and palliative therapy (8). The experts suggest that surgical lung biopsy (SLB) not be performed in patients with the probable usual interstitial pneumonia (UIP) pattern, with an appropriate clinical context and unanimous opinion of a  multidisciplinary team. The experts recommend using antifibrotic agents in IPF patients and suggest their use irrespective of the degree of functional impairment. As regards non-pharmacological and palliative treatment, strong re-commendations were formulated regarding pulmonary rehabilitation, oxygen therapy (in patients with chronic respiratory failure), preventive vaccinations as well as referring IPF patients to transplant centres. Table 1 presents an aggregate list of recommendations.Conclusions: The Polish Respiratory Society Working Group developed guidelines for IPF diagnosis and treatment

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Grading the severity of airways obstruction: new wine in new bottles

The objective of this study was to redesign the current grading of obstructive lung disease so that it is clinically relevant and free of biases related to age, height, sex and ethnic group. Spirometric records from 17 880 subjects (50.4% female) from hospitals in Australia and Poland, and 21 191 records (53.0% female) from two epidemiological studies (age range 18–95 years) were analysed. We adopted the American Thoracic Society(ATS)/European Respiratory Society (ERS) criteria for airways obstruction based on an forced expiratory volume in 1 s (FEV₁)/(forced) vital capacity ((F)VC) ratio below the fifth percentile and graded the severity of pulmonary function impairment using z-scores for FEV₁, which signify how many standard deviations a result is from the mean predicted value. Using the lower limit of normal for FEV₁/(F)VC and z-scores for FEV₁ of -2, -2.5, -3 and -4 to delineate severity grades of airflow limitation leads to close agreement with ATS/ERS severity classifications and removes age, sex and height related bias. The new classification system is simple, easily memorised and clinically valid. It retains previously established associations with clinical outcomes and avoids biases due to the use of per cent predicted FEV₁. Combined with the Global Lung Function prediction equations it provides a worldwide diagnostic standard, free of bias due to age, height, sex and ethnic group

Implications of adopting the Global Lungs Initiative 2012 all-age reference equations for spirometry

The aim of this study was to determine the diagnostic and interpretative consequences of adopting the Global Lungs Initiative (GLI) 2012 spirometric prediction equations. We assessed spirometric records from 17 572 subjects (49.5% females), aged 18-85 years, from hospitals in Australia and Poland. We calculated predicted forced expiratory volume in 1 s (FEV1), forced expiratory volume (FVC), FEV1/FVC and lower limits of normal (LLN) using European Community for Steel and Coal (ECSC), National Health and Nutrition Examination Survey (NHANES) III and GLI 2012 equations. Obstruction was defined as FEV1/FVC<LLN and a restrictive pattern as FEV1/FVC>LLN and FVC<LLN. Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 and higher was defined as FEV1/FVC <0.70 and FEV1 <80% pred. GLI 2012 equations produce similar predicted values for FEV1 and FVC compared with NHANES, but produce larger values than ECSC. Differences in the LLN lead to an important increase in the prevalence rate of a low FVC compared to ECSC, and a significant decrease compared to NHANES prediction equations. Adopting GLI 2012 equations has small effects on the prevalence rate of airway obstruction. GOLD stages 2-4 lead to >20% underdiagnosis of airway obstruction up to the age of 55 years and to 16-23% overdiagnosis in older subjects. GLI 2012 equations increase the prevalence of a "restrictive spirometric pattern" compared to ECSC but decrease it compared to NHANES

Measurement of FEF25–75% and FEF75% does not contribute to clinical decision making

The aim of this study was to determine the added value of measuring the forced expiratory flow at 25-75% of forced vital capacity (FVC) (FEF25-75%) and flow when 75% of FVC has been exhaled (FEF75%) over and above the measurement of the forced expiratory volume in 1 s (FEV1), FVC and FEV1/FVC ratio. We used spirometric measurements of FEV1>, FVC and FEF25-75% from 11654 white males and 11113 white females, aged 3-94 years, routinely tested in the pulmonary function laboratories of four tertiary hospitals. FEF75% was available in 8254 males and 7407 females. Predicted values and lower limits of normal, defined as the fifth percentile, were calculated for FEV1, FVC, FEV1/FVC ratio, FEF25-75% and FEF75% using prediction equations from the Global Lung Function Initiative. There was very little discordance in classifying test results. FEF25-75% and FEF75% were below the normal range in only 2.75% and 1.29% of cases, respectively, whereas FEV1, FVC and FEV1/FVC ratio were within normal limits. Airways obstruction went undetected by FEF25-75% in 2.9% of cases and by FEF75% in 12.3% of cases. Maximum mid-expiratory flow and flow towards the end of the forced expiratory manoeuvre do not contribute usefully to clinical decision making over and above information from FEV1, FVC and FEV1/FVC ratio

Wytyczne Polskiego Towarzystwa Chorób Płuc dotyczące diagnostyki i leczenia idiopatycznego włóknienia płuc

Wprowadzenie: Niniejszy dokument przedstawia rekomendacje Polskiego Towarzystwa Chorób Płuc (PTChP) dotyczące diagnostyki i leczenia idiopatycznego włóknienia płuc (IPF, idiopathic pulmonary fibrosis), opracowane przez grono polskich ekspertów. Materiał i metody: Wytyczne opracowano w formie odpowiedzi na wcześniej sformułowane pytania, dotyczące codziennych problemów diagnostycznych i terapeutycznych. Opracowano je na podstawie bieżącego przeglądu literatury, z wykorzystaniem metodologii GRADE (Grading of Recommendations Assessment, Development and Evaluation).Wyniki: Sformułowano 28 rekomendacji, dotyczących diagnostyki (8), leczenia farmakologicznego (12) oraz leczenia niefarma-kologicznego i terapii paliatywnej (8). Eksperci sugerują niewykonywanie biopsji chirurgicznej u chorych z wzorcem prawdopo-dobnego zwykłego śródmiąższowego zapalenia płuc (UIP, usual interstitial pneumonia), przy odpowiednim kontekście klinicznym i zgodnej opinii zespołu wielospecjalistycznego. Eksperci rekomendują stosowanie leków antyfibrotycznych u chorych na IPF  i sugerują ich stosowanie niezależnie od stopnia upośledzenia czynnościowego. W zakresie leczenia niefarmakologicznego i paliatywnego sformułowano silne zalecenia dotyczące rehabilitacji oddechowej, tlenoterapii (u chorych z przewlekłą niewydolnością oddychania), szczepień ochronnych, a także kierowania chorych na IPF do ośrodków transplantacyjnych. Wnioski: Zespół roboczy PTChP opracował wytyczne diagnostyki i leczenia IPF