Advanced chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe — below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort.Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe - below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort

The incidence of chronic obstructive pulmonary disease in advanced non-small cell lung cancer patients

Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients.Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients

Zaawansowana postać przewlekłej obturacyjnej choroby płuc

Przewlekła obturacyjna choroba płuc (POChP) jest jedną z najczęstszych przewlekłych chorób i czwartą przyczyną zgonów na świecie. Zaawansowane postaci (ciężka - w przypadku wskaźnika FEV1 poniżej 50% należnej normy - i bardzo ciężka - poniżej 30%) z reguły prowadzą do inwalidztwa oddechowego i przedwczesnego zgonu. Rokowanie chorych na zaawansowane postaci POChP nie różni się od rokowania u chorych na raka płuca. Na przebieg choroby znaczący wpływ mają jej zaostrzenia oraz schorzenia współistniejące, takie jak choroby układu sercowo-naczyniowego, cukrzyca, rak płuca i choroba wrzodowa. Cele leczenia obejmują: zahamowanie postępu choroby, zapobieganie zaostrzeniom i uśmierzanie dokuczliwych objawów, do których należą przede wszystkim duszność, przewlekły kaszel i zmniejszająca się tolerancja wysiłku

Terapia trójlekowa przewlekłej obturacyjnej choroby płuc z jednego inhalatora a przestrzeganie zaleceń terapeutycznych

Przewlekła obturacyjna choroba płuc (POChP) stanowi istotny problem zdrowotny i ekonomiczny, który wiąże się ze zwiększonąchorobowością i umieralnością. Prowadzi do rozwoju niewydolności oddechowej i inwalidztwa oddechowego. Celem wczesnegowykrycia POChP jest zmniejszenie powikłań oddechowych oraz sercowo-naczyniowych. Prawidłowa farmakoterapia zmniejszanasilenie objawów choroby, poprawia tolerancję wysiłku fizycznego oraz zmniejsza liczbę i stopień ciężkości zaostrzeń. Istotnąrolę w procesie terapii chorych na POChP odgrywają długodziałające leki rozszerzające oskrzela (b-mimetyki i cholinolityk). W zaawansowanychpostaciach POChP (grupa C i D) możliwe i wskazane jest dodanie do leczenia wziewnych glikokortykosteroidów(wGKS). Takie postępowanie jest korzystne, szczególnie gdy chorzy na POChP mają częste zaostrzenia choroby, wysoką eozynofiliękrwi obwodowej lub nakładanie się astmy na POChP. W 2017 roku zarejestrowano pierwszy potrójny lek złożony (w jednym inhalatorzetypu pMDI) przeznaczony do leczenia POChP — TRIMBOW (dipropionian beklometazonu/formoterol/bromek glikopironium).Terapia potrójna w jednym inhalatorze LAMA/LABA/wGKS zmniejsza objawy POChP, poprawia status zdrowotny i czynność płucoraz zmniejsza ryzyko zaostrzeń w porównaniu z monoterapią LAMA i terapią LABA/wGKS.Celem pracy było przedstawienie możliwości terapeutycznych stosowania LAMA/LABA/wGKS w jednym inhalatorze w codziennejpraktyce klinicznej

Oxygen therapy with high-flow nasal cannulas in children with acute bronchiolitis

Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed.Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed

From the Difficult Airway Management to Diagnosis of Retropharyngeal Synovial Cell Carcinoma

Respiratory complications are among the most common problems addressed in neonatology in the first hours after birth, whereas the risk of any cancer in the neonatal period is 28 per million. Sarcomas, malignant mesenchymal neoplasms, account for about 8% of all neoplasms in the neonatal period. We report on a male neonate born at 36 + 4/7 weeks of gestation, diagnosed with retropharyngeal synovial carcinoma. Ineffective respiratory movements and generalized cyanosis were the first symptoms to be noted. On the ultrasound examination of the neck, a tumor of the retropharyngeal space was exposed, then visualized by an MRI of the head and neck. The biopsy analysis revealed the diagnosis of an extremely rare tumor in a neonate. The location of its growth was atypical, contributing to a diagnostic challenge. The neoplasm was treated solely with chemotherapy concordantly with the CWS protocol, individually customized for our patient. Preterm birth, as in our case, 36 + 4/7 weeks of gestation, may imply a possible need for resuscitation or support in the transition period. Aggressive high-grade tumors of the head and neck region are locally invasive and prone to metastasize. However, prognosis in infants is hard to estimate, therefore both individualized treatment and multidisciplinary care should be tailored to the needs of the patient

Prediction Model for Bronchopulmonary Dysplasia in Preterm Newborns

OBJECTIVE: To develop a multifactorial model that allows the prediction of bronchopulmonary dysplasia (BPD) in preterm newborns. MATERIALS AND METHODS: A single-center retrospective study of infants born below 32 + 0 weeks gestational age. We created a receiver operating characteristic curve to assess the multifactorial BPD risk and calculate the BPD risk accuracy using the area under the curve (AUC). BPD risk was categorized using a multifactorial predictive model based on the weight of the evidence. RESULTS: Of the 278 analyzed preterm newborns, 127 (46%) developed BPD. The significant risk factors for BPD in the multivariate analysis were gestational age, number of red blood cell concentrate transfusions, number of surfactant administrations, and hemodynamically significant patent ductus arteriosus. The combination of these factors determined the risk of developing BPD, with an AUC value of 0.932. A multifactorial predictive model based on these factors, weighted by their odds ratios, identified four categories of newborns with mean BPD risks of 9%, 59%, 82%, and 100%. CONCLUSION: A multifactorial model based on easily available clinical factors can predict BPD risk in preterm newborns and inform potential preventive measures

Terapia trójlekowa przewlekłej obturacyjnej choroby płuc z jednego inhalatora a przestrzeganie zaleceń terapeutycznych

Przewlekła obturacyjna choroba płuc (POChP) stanowi istotny problem zdrowotny i ekonomiczny, który wiąże się ze zwiększoną chorobowością i umieralnością. Prowadzi do rozwoju niewydolności oddechowej i inwalidztwa oddechowego. Celem wczesnego wykrycia POChP jest zmniejszenie powikłań oddechowych oraz sercowo-naczyniowych. Prawidłowa farmakoterapia zmniejsza nasilenie objawów choroby, poprawia tolerancję wysiłku fizycznego oraz zmniejsza liczbę i stopień ciężkości zaostrzeń. Istotną rolę w procesie terapii chorych na POChP odgrywają długodziałające leki rozszerzające oskrzela (β-mimetyki i cholinolityk). W zaawansowanych postaciach POChP (grupa C i D) możliwe i wskazane jest dodanie do leczenia wziewnych glikokortykosteroidów (wGKS). Takie postępowanie jest korzystne, szczególnie gdy chorzy na POChP mają częste zaostrzenia choroby, wysoką eozynofilię krwi obwodowej lub nakładanie się astmy na POChP. W 2017 roku zarejestrowano pierwszy potrójny lek złożony (w jednym inhalatorze typu pMDI) przeznaczony do leczenia POChP—TRIMBOW (dipropionian beklometazonu/formoterol/bromek glikopironium). Terapia potrójna w jednym inhalatorze LAMA/LABA/wGKS zmniejsza objawy POChP, poprawia status zdrowotny i czynność płuc oraz zmniejsza ryzyko zaostrzeń w porównaniu z monoterapią LAMA i terapią LABA/wGKS. Celem pracy było przedstawienie możliwości terapeutycznych stosowania LAMA/LABA/wGKS w jednym inhalatorze w codziennej praktyce klinicznej

High maternal-fetal HLA eplet compatibility is associated with severe manifestation of preeclampsia

IntroductionPreeclampsia is responsible for more than 70 000 and 500 000 maternal and fetal deaths, respectively each year. Incomplete remodelling of the spiral arteries in placenta is the most accepted theory of preeclampsia pathogenesis. However, the process is complexed with immunological background, as pregnancy resembles allograft transplantation. Fetus expresses human leukocyte antigens (HLA) inherited from both parents, thus is semiallogeneic to the maternal immune system. Therefore, induction of fetal tolerance is crucial for physiological outcome of pregnancy. Noteworthy, the immunogenicity of discordant HLA antigens is determined by functional epitopes called eplets, which are continuous and discontinuous short sequences of amino acids. This way various HLA molecules may express the same eplet and some HLA incompatibilities can be more immunogenic due to different eplet combination. Therefore, we hypothesized that maternal- fetal HLA incompatibility may be involved in the pathogenesis of gestational hypertension and its progression to preeclampsia. We also aimed to test if particular maternal-fetal eplet mismatches are more prone for induction of anti- fetal HLA antibodies in gestational hypertension and preeclampsia.MethodsHigh resolution next-generation sequencing of HLA-A, -B, -C, -DQB1 and -DRB1 antigens was performed in mothers and children from physiological pregnancies (12 pairs) and from pregnancies complicated with gestational hypertension (22 pairs) and preeclampsia (27 pairs). In the next step HLA eplet identification and analysis of HLA eplet incompatibilities was performed with in silico approach HLAMatchmaker algorithm. Simultaneously maternal sera were screened for anti-fetal HLA class I, class II and anti-MICA antibodies with Luminex, and data were analyzed with HLA-Fusion software.ResultsWe observed that high HLA-C, -B, and DQB1 maternal-fetal eplet compatibility was associated with severe preeclampsia (PE) manifestation. Both quantity and quality of HLA epletmismatches affected the severity of PE. Mismatches in HLA-B eplets: 65QIA+76ESN, 70IAO, 180E, HLA-C eplets: 193PL3, 267QE, and HLA-DRB1 eplet: 16Y were associated with a mild outcome of preeclampsia if the complication occurred.ConclusionsHigh HLA-C, HLA-DQB1 and HLA-B eplet compatibility between mother and child is associated with severe manifestation of preeclampsia. Both quantity and quality of maternal-fetal HLA eplet mismatches affects severity of preeclampsia