Ocena przyczyn zgonów u chorych na przewlekłą obturacyjną chorobę płuc w podstawowej opiece zdrowotnej w okresie sześcioletniej obserwacji

Introduction: COPD is one of the most frequent respiratory diseases responsible for patients’ disability and mortality. In 2005 a single primary care practice, COPD was diagnosed in 183 out of 1,960 eligible subjects ≥ 40 years (9.3%). The aim of this study was to assess mortality rate and causes of deaths in this group after 6 years. Material and methods: In 2011 we invited all 183 patients with COPD recognised in 2005. We performed spirometry, physical examination, questionnaire of respiratory symptoms, smoking habits, concomitant diseases and treatment. Information about deaths was taken from primary care register, furthermore, family members were asked to deliver medical documentation or death certificate. Results: In 2011 we studied only 74 subjects (40.4%), 43 subjects died (23.5%) and 66 subjects were lost from the follow-up (36.1%). Cardiovascular diseases were the most frequent causes of deaths — 21 subjects (48.8%) (heart attack – 8 patients and stroke – 8 patients). Respiratory failure in the course of COPD exacerbation was the cause of 10 deaths (23.3%). Neoplastic diseases lead to 9 deaths (20.9%) (lung cancer 7 patients). Renal insufficiency was responsible for one death (2.325%), and the causes of 2 deaths remained unknown (4.65%). Subjects who died (predominantly males) were older, had higher MRC score and lower FEV1. Conclusions: Study performed six years after COPD diagnosis revealed that 23.5% of subjects died. The main causes of deaths were the following: cardiovascular diseases (mainly heart attack and stroke), COPD exacerbations and lung cancer (more than 75%). Death risk in COPD patients was associated with age, male sex, dyspnoea and severity of the disease.Wstęp: POChP jest jedną z najczęstszych chorób układu oddechowego, która prowadzi do inwalidztwa oddechowego oraz przedwczesnej śmierci. W 2005 roku w pojedynczej placówce podstawowej opieki zdrowotnej rozpoznano POChP u 183 spośród zbadanych 1960 osób, które ukończyły 40. rok życia (9,3%). Celem pracy była analiza częstości zgonów i ich przyczyn w grupie chorych na POChP po 6 latach obserwacji. Materiał i metody: W 2011 roku na badania kontrolne zaproszono wszystkie 183 osoby, u których rozpoznano POChP w 2005 roku. Badani wypełniali kwestionariusz dotyczący dolegliwości oddechowych, palenia tytoniu, chorób współistniejących oraz aktualnego leczenia. Po weryfikacji kwestionariusza wykonywano badanie przedmiotowe i spirometrię. Informację o śmierci pacjentów uzyskiwano z aktualnej kartoteki POZ oraz od rodzin badanych (na podstawie uzyskanej dokumentacji medycznej — ustalano datę i miejsce zgonu oraz jego przyczyny). Wyniki: W 2011 roku zbadano tylko 74 chorych (40,4%), 43 chorych zmarło (23,5%). Pozostałych 66 chorych nie udało się zbadać ponownie (36,1%). Choroby układu krążenia były najczęstszymi przyczynami zgonów u chorych na POChP — 21 chorych (48,8%) (w tym zawał serca — 8 chorych i udar mózgu — 8 chorych). Niewydolność oddychania w przebiegu POChP była przyczyną śmierci u 10 badanych (23,3%). Choroby nowotworowe były odpowiedzialne za 9 zgonów (20,9%) (rak płuc — 7 chorych). Pozostałe zgony wiązały się z niewydolnością nerek (1 chory; 2,325%) oraz przyczynami nieustalonymi (2 chorych; 4,65%). Chorzy na POChP, którzy zmarli (większość stanowili mężczyźni) byli starsi, mieli większe nasilenie duszności w skali MRC oraz niższe FEV1. Wnioski: Badania kontrolne wykonane po 6 latach od rozpoznania choroby ujawniły wysoką umieralność w badanej grupie (zmarło 43 chorych — 23,5%). Ponad 75% wszystkich zgonów było spowodowane chorobami układu krążenia (najczęściej zawałem serca i udarem mózgu), zaostrzeniami POChP i rakiem płuc. Czynnikami, które wpływały na wzrost ryzyka zgonu w badanej grupie, były: wiek, płeć męska, większe nasilenie duszności oraz cięższą postać choroby

The coexistence of the impaired exercise tolerance in patients with obstructive sleep apnea with gastroesophageal reflux

Wstęp: U chorych na obturacyjny bezdech senny (OBS) często stwierdza się refluks żołądkowo-przełykowy (RŻP), co pogarsza ich komfort życia i wymaga dodatkowego leczenia. Postanowiono sprawdzić, czy obniżenie tolerancji wysiłku u tych chorych ma związek z występowaniem i zaawansowaniem kwaśnego refluksu żołądkowo-przełykowego. Materiał i metody: Zbadano 18 chorych (6K i 12 M) w wieku średnio 55 ± 9 lat, z ciężką postacią OBS, wskaźnik bezdechów i spłycenia oddychania (AHI) wynosił średnio 44 ± 22. Wszyscy byli leczeni z powodu chorób metabolicznych i/lub nadciśnienia tętniczego lub przewlekłej choroby wieńcowej. U wszystkich chorych, poza ogólną oceną stanu zdrowia, stanu układu krążenia i oddychania, wykonano gastroskopię, 24-godzinne badanie pH w dolnym odcinku przełyku (pHmetria) i 6-minutowy test chodu (6MWT). Wyniki: U 12 badanych rozpoznano RŻP. U 14 chorych gastroskopia wykazała zmiany zapalne przełyku (w tym u 3, u których nie stwierdzono refluksu). Chorzy z RŻP w porównaniu z chorymi bez RŻP mieli nieco bardziej nasilony OBS (AHI — 46 ± 24 vs. 39 ± 18), byli nieco młodsi (53 ± 7 vs. 59 ± 11 lat), bardziej otyli (BMI - 38 ± 5 vs. 36 ± 9 kg/m2), a podczas 6MWT pokonali mniejszy dystans (różnica w odsetku wartości należnej: 78 ± 17% vs. 86 ± 22%) i pod koniec wysiłku mieli niższe wysycenie krwi tętniczej tlenem - SaO2: 91 ± 3% vs. 94 ± 3%. Wnioski: Mimo pewnych różnic w tolerancji wysiłku u chorych na OBS z RŻP i bez RŻP, nie stwierdzono statystycznie istotnych zależności między występowaniem RŻP a upośledzoną tolerancją wysiłku. W celu pełnego wyjaśnienia problemu wskazane byłoby zbadanie większej grupy chorych.Introduction: Gastroesophageal reflux (GERD) is a frequent disease in patients with obstructive sleep apnea (OSA). The aim of the study was to evaluate possible correlation between the impairement of exercise tolerance and GERD. Material and methods: We examined 18 patients with OSA, mean AHI - 44 ± 22; 6 females, 12 males, mean age 55 ± 9 years. All patients were treated for metabolic disorders and for hypertension or coronary artery disease. In all patients gastroscopy was performed with 24h pHmetry and 6MWT. Results: In 12 patients GERD was found, in 14 patients esophagitis was diagnosed (among them there were 3 patients without GERD). Patients with GERD were younger (53 ± 7 vs. 59 ± 11 years) and more obese (BMI - 38 ± 5 vs. 36 ± 9 kg/m2). During 6MWT the distance covered was shorter (in % of normal values) in GERD subjects: 78 ± 17 vs. 86 ± 22%) and desaturation was deeper (91 ± 3 vs. 94 ± 3%). Conclusions: Despite some tendencies the relationship between GERD and impairement of exercise tolerance in OSA patients was not statistically significant. Perhaps study in larger group of subjects will be more reliable

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

Pilot program on distance training in spirometry testing — the technology feasibility study

Introduction: Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. Material and methods: A spirometry counseling network of outpatients clinics was created in Poland using portable spirometer Spirotel. The spirometry data were transferred to counseling centre once a week. The tests sent to the counseling centre were analyzed by doctors experienced in the analysis of spirometric data. In justified cases they sent their remarks concerning performed tests to the centres via e-mail. Results: We received 878 records of spirometry tests in total. Data transmission via the telephone was 100% effective. The quality of spirometry tests performed by outpatients clinics was variable. Conclusions: The use of spirometers with data transfer for training purposes seems to be advisable. There is a need to proper face-to-face training of spirometry operators before an implementation of any telemedicine technologyIntroduction: Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. Material and methods: A spirometry counseling network of outpatients clinics was created in Poland using portable spirometer Spirotel. The spirometry data were transferred to counseling centre once a week. The tests sent to the counseling centre were analyzed by doctors experienced in the analysis of spirometric data. In justified cases they sent their remarks concerning performed tests to the centres via e-mail. Results: We received 878 records of spirometry tests in total. Data transmission via the telephone was 100% effective. The quality of spirometry tests performed by outpatients clinics was variable. Conclusions: The use of spirometers with data transfer for training purposes seems to be advisable. There is a need to proper face-to-face training of spirometry operators before an implementation of any telemedicine technolog

Gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnoea syndrome (OSAS)

Gastroesophageal reflux disease (GERD) is a common cause of chronic cough, heartburn, epigastric or retrosternal discomfort, chest pain and abdominal pain or esophagitis. Our patients with OSAS seldom manifest GERD symptoms. We suspected that obesity and high pressure in abdominal cavity may induce acid gastroesophageal reflux in these patients. The aim of the study was to test the hypothesis that obesity, cigarettes smoking or ventilatory and gas exchange abnormalities provoke GERD. We studied 21 consecutive patients with severe OSAS (mean AHI 44.9±23.8) before CPAP treatment, all without GERD clinical symptoms. Standard polysomnography, gastroscopy and 24-h oesophageal pH monitoring was performed. There were 6 females, 15 males, mean age 57±9 years, mean BMI 38±6 kg/m2. All patients presented with normal spirometric and gas exchange values (mean VC 3.64±1.23 1, 90% of normal, mean FEV1 2.61±0.95 1, 83% of normal, mean FEV1%VC 72%, mean PaO2 68.1±7.7 mmHg, mean PaCO2 40.8±5.8 mmHg, mean pH 7.42±0.02). GERD was diagnosed in 14 patients. Patients with GERD were younger, more often were cigarettes smokers (5/14). We did not fi nd statistically signifi cant differences between severity of OSAS, BMI, ventilatory or gas exchange parameters and GERD

Prevalence of stroke in patients with obstructive sleep apnoea

Introduction: Results of earlier population and clinical studies confirmed relationship between stroke and obstructive sleep apnea. Our previous study on epidemiology of sleep-disordered breathing in Warsaw based on 676 subjects, mean age 56.6 ± 8.2 years, confirmed OSA in 76 subjects (11.3%) mean apnea hypopnea index (AHI) — 25.3 ± 16.1 revealed low incidence of stroke in OSA group (2 pts; 2.6%) and in subjects without OSA (20 pts; 3.4%). The aim of this study was to assess prevalence of stroke in newly diagnosed OSA subjects qualified to CPAP therapy. Material and methods: We studied 342 consecutive pts (263 males and 79 females) - mean age - 55.4 ± 10.1 years with severe disease - AHI 39.7 ± 22.5 and obesity - body mass index 35 ± 6.6. History of stroke was confirmed in 16 pts before continuous positive airway pressure (CPAP) introduction (4.7%) - group 1. Group 2 (without history of stroke) comprised of 326 pts (95.3%). Results: Multiple linear regression analysis revealed significant correlation between stroke and time spent in desaturation below 90% during polysomnografhy - T90 (β = -0.22, p = 0.009), diabetes (b = 0.16, p = 0.006), Epworth sleepiness score (β = 0.14, p = 0.02) and coronary artery disease (b = 0.14, p = 0.03). Conclusions: Stroke in OSA pts before CPAP treatment was related to overnight and daytime oxygenation, diabetes, daytime sleepiness and coronary artery disease. Incidence of stroke in our group was low (4.7%) and similar to previous data from population study. Pneumonol. Alergol. Pol. 2010; 78, 2: 121-125Wstęp: Wyniki dotychczasowych badań populacyjnych i klinicznych potwierdziły związek pomiędzy udarem a obturacyjnym bezdechem (OBS). Wyniki poprzedniego badania autorów (epidemiologia zaburzeń oddychania w czasie snu u mieszkańców Warszawy) u 676 badanych w średnim wieku 56,6 ± 8,2 roku, u których wykonano polisomnografię i potwierdzono OBS w 76 przypadkach (11,3%) ze średnim wskaźnikiem bezdech/spłycenie oddechu (AHI) - 25,3 ± 16,1, ujawniły niską częstość występowania udaru w grupie pacjentów z OBS (2 pacjentów; 2,6%) oraz grupie bez OBS (20 pacjentów; 3,4%). Celem obecnego badania była ocena rozpowszechnienia udaru u nowo diagnozowanych chorych na OBS kwalifikowanych do leczenia stałym dodatnim ciśnieniem w drogach oddechowych (CPAP, continuous positive airway pressure). Materiał i metody: Zbadano 342 pacjentów (263 mężczyzn i 79 kobiet) - w średnim wieku 55,4 ± 10,1 lat, z ciężką postacią choroby - AHI 39,7 ± 22,5, z dużą otyłością - wskaźnik masy ciała 35 ± 6,6. Przebyty udar potwierdzono u 16 chorych przed włączeniem leczenia CPAP (4,7%) - grupa 1. Grupa 2 (bez udaru) obejmowała 326 pacjentów (95,3%). Wyniki: Analiza regresji wielokrotnej ujawniła istotną statystycznie korelację między udarem a czasem spędzonym w niedotlenieniu w nocy - T90 (β = -0,22, p = 0,009), cukrzycą (β = 0,16, p = 0,006), skalą senności Epworth (b = 0,14, p = 0,02) oraz chorobą wieńcową (b = 0,14, p = 0,03). Wnioski: Wykazano związek pomiędzy udarem u pacjentów z OBS (przed leczeniem CPAP) i utlenowaniem w czasie snu oraz czuwania, cukrzycą, sennością dzienną i chorobą wieńcową. Częstość udaru w badanej przez nas grupie była niska (4,7%) i podobna do danych uzyskanych we wcześniejszych badaniach populacyjnych. Pneumonol. Alergol. Pol. 2010; 78, 2: 121-12

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 [...

Menopausal status and severity of obstructive sleep apnoea (OSA) in females

Introduction: Prevalence of obstructive sleep apnoea (OSA) is higher in postmenopausal females. The aim of this study was to compare OSA severity in postmenopausal females (group E-) and females with preserved estrogen activity (premenopausal or on hormonal replacement therapy - group E+). Material and methods: We studied 147 OSA females in mean age 58.1 ± 9.4 years. Subjects presented obesity (BMI = 34 ± ± 7.9 kg/m2) and moderate or severe disease (AHI = 35.9 ± 20.9), SaO2 mean - 89.4 ± 5.8%. Group (E-) consisted of 116 pts (75.5%) and group (E+) of 36 pts (24.5%). Results: Group (E+) presented more severe OSA (AHI/RDI = 42 ± 26.6) and obesity (BMI = 37.6 ± 10.1 kg/m2) when compared to group E- (AHI/RDI = 33.9 ± 18.4; p = 0.04 and BMI - 32.8 ± 6.7 kg/m2; p = 0.001). In multiple linear regression analysis we found significant negative correlation between AHI and age (β = -0.29, p = 0.03). After adjustment for BMI and age (analysis of covariance) significant difference was still present between both groups (R = 0.24, p = 0.03). Conclusions: Majority of OSA females qualified to CPAP therapy were postmenopausal (75.5%). Severity of OSA (AHI/RDI) after adjustment for age and BMI was higher in group (E+).Wstęp: U kobiet obturacyjny bezdech senny (OBS) najczęściej występuje po menopauzie. Celem pracy było porównanie zaawansowania OBS u kobiet po menopauzie (grupa E-) oraz u kobiet z zachowaną aktywnością estrogenową (kobiety przed menopauzą lub stosujące hormonalna terapię zastępczą - grupa E+). Materiał i metody: Zbadano 147 kobiet chorych na OBS w średnim wieku 58,1 ± 9,4 roku. Badane kobiety charakteryzowały się otyłością (BMI = 34 ± 7,9 kg/m2) oraz umiarkowanym lub ciężkim OBS (AHI/RDI = 35,9 ± 20,9), średnie SaO2 wynosiło 89,4 ± 5,8%. Grupa E- składała się z 116 chorych (75,5%), a grupa E+ - z 36 (24,5%). Wyniki: Nasilenie choroby było większe w grupie E+ (AHI/RDI = 42 ± 26,6; BMI = 37,6 ± 10,1 kg/m2) w porównaniu z grupą E- (AHI/RDI = 33,9 ± 18,4; p = 0,04 i BMI = 32,8 ± 6,7 kg/m2; p = 0,001). Analiza regresji wielokrotnej ujawniła znamienną ujemną korelację między AHI/RDI i wiekiem (β = -0,29; p = 0,03). Po wyłączeniu wpływu wieku i BMI (analiza kowariancji) badane grupy nadal się różniły wartościami AHI/RDI (R = 0,24; p = 0,03). Wnioski: Większość kobiet chorych na OBS, które zakwalifikowano do leczenia CPAP, było w okresie menopauzy (75,5%). Nasilenie OBS (AHI/RDI) po wyłączeniu wpływu wieku i masy ciała było większe w grupie z zachowaną aktywnością estrogenową

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

Odosobniony guz włóknisty opłucnej u 75-letniej chorej

A 75-year-old asymptomatic woman with stable coronary heart disease presented tumor in lower left lobe on routine chest radiograph. A CT scan showed a large sharply delineated mass at this site (84 x 52 x 90 mm). There were no signs of infiltration, no abnormalities were seen in mediastinal structures and on the right side. The pedunculated tumor was resected during left thoracotomy (posterolateral incision). Histological examination revealed spindle-like cells and rich collagen net. Mitoses and necrosis were absent. Final diagnosis was: solitary fibrous tumor of the visceral pleura. During 7-year follow-up recurrence was not observed