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

Restrictive pattern in spirometry. Does FEV1/FVC need to be increased?

Wstęp: Spirometria jest doskonałym narzędziem w diagnostyce chorób obturacyjnych, ale znacznie mniej wiarygodnym w diagnostyce chorób restrykcyjnych. Rozpoznanie restrykcji na podstawie zmniejszenia natężonej pojemności życiowej (FVC) jest obarczone dużą liczbą błędów. W aktualnych zaleceniach American Thoracic Society/European Respiratory Society (ATS/ERS) z 2005 roku stwierdzono, że na podstawie spirometrii można podejrzewać zaburzenia typu restrykcyjnego, jeśli zmniejszonej pojemności życiowej (VC) towarzyszy podwyższony wskaźnik FEV1/VC ponad 85&#8211;90%. Według wiedzy autorów niniejszej pracy ta rekomendacja nie opiera się na wynikach opublikowanych badań, a jedynie na opinii ekspertów. Celem pracy była analiza wartości diagnostycznej spirometrii w zakresie wykrywania zaburzeń typu restrykcyjnego u osób bez cech obturacji przy użyciu dwóch kryteriów: izolowanego zmniejszenia FVC oraz zmniejszenia FVC łącznie ze zwiększeniem wskaźnika FEV1/FVC. Materiał i metody: Analizie poddano wyniki równoczesnych badań spirometrycznych i pletyzmograficznych wykonanych w Zakładzie Fizjopatologii Oddychania Instytutu Gruźlicy i Chorób Płuc w Warszawie w ciągu całego 2009 roku. Do wszystkich parametrów stosowano zestaw należnych ERS z 1993 roku. Dolną granicę normy (DGN) wyznaczono na poziomie &#8211;1,645 standaryzowanej reszty (SR). Wyniki: Z 1739 badań analizie poddano wyniki 1402 pacjentów bez cech obturacji oskrzeli, 679 kobiet (48,4%) i 723 mężczyzn (51,6%), w wieku 49,7 &#177; 14,5 roku. Na podstawie zmniejszenia całkowitej pojemności płuc (TLC) u 283 chorych (20,2%) rozpoznano zaburzenia typu restrykcyjnego. Zmniejszenie FVC stwierdzono w 202 przypadkach (14,4%) (czułość testu 59%, swoistość 97%). Dołączenie warunku FEV1/FVC powyżej 85% zmniejszyło liczbę przypadków rozpoznanych zaburzeń restrykcyjnych do 76 (5,4%) i obniżyło czułość testu do 23%, a zwiększyło swoistość do 99%. Przy kryterium FVC poniżej DGN łącznie z FEV1/FVC powyżej 85% możliwe było wykrycie jedynie 14% przypadków łagodnej, 26% umiarkowanej i 64% ciężkiej restrykcji. Wnioski: Dołączenie warunku FEV1/FVC powyżej 85% do FVC poniżej DGN jako kryterium rozpoznania zaburzeń typu restrykcyjnego w spirometrii powoduje znaczne zmniejszenie czułości testu i utrudnia wykrycie restrykcji, zwłaszcza łagodnego i umiarkowanego stopnia. Pneumonol. Alergol. Pol. 2011; 79, 6: 382&#8211;387Introduction: Spirometry is an excellent tool in diagnosis of airway obstruction, but is less reliable in restrictive diseases. Diagnosis of lung restriction on the ground of reduced forced vital capacity (FVC) is saddled with a lot of mistakes. According to American Thoracic Society/European Respiratory Society (ATS/ERS) 2005 guidelines restrictive pattern in spirometry consists of a reduction in vital capacity and increase in forced expiratory volume in 1 second/vital capacity (FEV1/VC) > 85&#8211;90%. However, to our knowledge, this recommendation has not been validated. The aim of the study was to check how inclusion of an increased FEV1/FVC as a mandatory condition affects value of spirometry in detection of restrictive ventilatory defect. Material and methods: Material consisted of pulmonary test results obtained from consecutive patients referred to our lab during the year 2009, who had undergone spirometry and lung volumes measurements at the same visit. Results: Out of 1739 test results, 1402 non-obstructive patients, 679 females (48.4%) and 723 males (51.6%); mean age 49.7 &#177; 14.5 years were included into analysis. ERS 1993 reference equations were applied to all parameters. Lower limit of normal was set at &#8211;1.645 SR level. Restrictive ventilatory defect (TLC < LLN) was found in 283 patients (20.2%). Reduced FVC only, as a condition of restrictive ventilatory defect diagnosis, was found in 202 patients (14.4%) (sensitivity 59%, specificity 97%). Reduced FVC together with increased FEV1/FVC > 85% was found in only 76 patients (5.4%) (sensitivity 23%, specificity 99%). Only 14% of mild, 26% of moderate, and 64% of severe restriction could be detected with reduced FVC and increased FEV1/FVC condition. Conclusions: Dual condition of reduced FVC and increased FEV1/FVC greatly diminishes sensitivity of the test, and hampers diagnosis of restrictive ventilatory defect in spirometry, especially in mild and moderate stages. Pneumonol. Alergol. Pol. 2011; 79, 6: 382&#8211;38

Sarcoidosis in coexistence with chronic granulomatous disease

Granulomas formations are present in many lung diseases. Coexistence of one or more of these diseases is very rare. Diagnostics of such cases always poses a challenge. We present a case of coexistence of chronic granulomatous disease (CGD) and sarcoidosis

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

Respiratory responses to CO2 stimulation in hypercapnic patients with obstructive sleep apnea syndrome

Obstructive sleep apnea can be associated with daytime chronic hypercapnia in some patients, but the prevalence of the phenomenon is highly variable in the published literature. The most often it is found in patients with coexisting COPD. There is also an evidence of persisting hypercapnia in OSA patients without other respiratory disease. In previous studies lung function impairment, obesity, gender, severity of OSAS have been considered to contribute to daytime hypercapnia. Several studies demonstrated that the defect in control of breathing can play a role in the development of chronic hypercapnia in patients with OSAS. The aim of the study was to estimate respiratory responses to hypercapnic stimulation in patients with OSAS and chronic daytime hypercapnia. Material consisted of 38 patients with OSAS and chronic hypercapnia (COPD was present in 24 - group B, "pure" OSA in 14 - group A) and 40 normocapnic OSA patients (group C). Lung function testing, blood gases and chemical control of breathing tests were performed in all of them before initiating therapy with nCPAP. Diagnosis of OSAS was stated with standard polisomnography and AHI was similar in mentioned groups. Results: Respiratory responses to hypercapnic stimulation were significantly lower in hypercapnic patients (A 10.6 &plusmn; 4.6; B 9.5 &plusmn; 5.6) in opposition to normocapnics (C 23.3 &plusmn; 14.0 l/min/kPa). In all studied patients PaCO2 level significantly correlated with respiratory responses to hypercapnic stimulation (r = &#8211;.61), lung function indices (VC r = &#8211;.69 and FEV1 r = &#8211;.71), mean SaO2 during sleep (r = &#8211;.68), and BMI (r = .49), but not with the factors like age, AHI or minimal SaO2 during sleep. Analysis with multiple regression revealed that hypercapnic drive, mean SaO2 during sleep, FEV1 and BMI were the best predictors of hypercapnia in studied group, being responsible for 72% of the total variance in PaCO2 in our OSA patients (R2 = 0.72; p < 0.0001). Conclusion: predisposition to daytime hypercapnia in our OSA patients was related to dimished chemosensitivity to CO2, mean desaturation during sleep, the severity of obesity and impairment of lung function mainly due to coexisting COPD

International consensus on lung function testing during COVID-19 pandemic and beyond

COVID-19 has negatively affected the delivery of respiratory diagnostic services across the world due to the potential risk of disease transmission during lung function testing. Community prevalence, reoccurrence of COVID-19 surges, and the emergence of different variants of the SARS-CoV-2 virus have impeded attempts to restore services. Finding consensus on how to deliver safe lung function services for both patients attending and for staff performing the tests are of paramount importance. This international statement presents the consensus opinion of 23 experts in the field of lung function and respiratory physiology balanced with evidence from the reviewed literature. It describes a robust roadmap for restoration and continuity of lung function testing services during the COVID-19 pandemic and beyond. Important strategies presented in this consensus statement relate to the patient journey when attending for lung function tests. We discuss appointment preparation, operational and environmental issues, testing room requirements including mitigation strategies for transmission risk, requirement for improved ventilation, maintaining physical distance, and use of personal protection equipment. We also provide consensus opinion on precautions relating to specific tests, filters, management of special patient groups, and alternative options to testing in hospitals. The pandemic has highlighted how vulnerable lung function services are and forces us to re-think how long term mitigation strategies can protect our services during this and any possible future pandemic. This statement aspires to address the safety concerns that exist and provide strategies to make lung function tests and the testing environment safer when tests are required