[Early diagnosis and prevention of COPD in Poland; current status and perspectives].
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Adult↗
Biomedical subjects
Dorota Górecka
Publications and source records attributed to Dorota Górecka.
[National Program of Early Detection and Prevention of COPD in the years 2000-2002].
UNLABELLED: COPD is a highly prevalent disease and ranks 4th among main causes of death in Poland. To control the disease national program of early detection and prevention of COPD was proposed. Program, under the auspices of the Ministry of Health, was implemented by the National TB and Lung Diseases Research Institute in Warsaw and run in out-patient chest clinics all over the country. Smokers aged more than 40 years were proposed a free spirometry and antismoking advice. During three years 91,859 subjects were screened, mean age 53.2 +/- 11.5 years, 57.9% males. There were 61.6% of current smokers, 26.7% of former smokers and 9.7% of never smokers. Spirometric measurements were: in 71.8% normal, in 19.9% showed airflow limitation, and in 8.3 % showed restrictive pattern. Severity of airflow limitation was mild in 7.7%, moderate in 6.7% and severe in 5.6% of all investigated subjects. In smokers older then 40 years and a history of more than 10 pack-years AL was diagnosed in 22,75%. Airflow limitation was found in 14.5% of never smokers. IN SUMMARY: Program resulted in a very high (20%) diagnosis of airflow limitation. Subjects screened were not aware of their disease. Even subjects who presented with severe form of airflow limitation were not diagnosed earlier.
Academic Medical Centers↗
[Characteristics of smoking habits in participants of the National Program of Early Detection and Prevention of COPD in the years 2000-2002].
UNLABELLED: We aimed to characterize smoking habits in participants of the large national screening program for COPD run in Poland in the years 2000-2002. MATERIAL AND METHODS: The program was addressed to smokers aged 40+ years with a smoking history of 10+ packyears. Participants were invited by advertisements in local mass media to attend local outpatient chest clinic located through all over the country for free spirometry. Investigations included history of smoking habit based on questionnaire, Fagerström test for nicotine dependence (FTND) and spirometry. RESULTS: During three years 91859 subjects were screened, of whom 81091 (88.3%) were current and former smokers. In male smokers (56.6%), mean age 54.2 +/- 11.4 yr, mean exposure to tobacco smoke was 32.8 +/- 18.7 packyears. There were 33289 (61.7%) of current smokers and 14905 (30,9%) of ex-smokers. In female smokers (41.3%), mean age 51.8 +/- 10.0 yr, mean exposure to tobacco smoke was 22.9 +/- 14.8 packyears. There were 22291 (70.7%) of current smokers and 9226 (29.3%) of ex-smokers. Males started to smoke at younger age of (19.2 +/- 4.6 yr) than females (21.8 +/- 5.9 yr). Males were more nicotine dependent than females, 4.93 +/- 2.4 vs 4.48 +/- 2.5 FTND points, respectively. Nicotine dependence was related to number of packyears (r=0.5, p<0.001). Airflow limitation was more prevalent in ex-smokers (23.9%) than in current smokers (19.6%). CONCLUSIONS: We found differences in smoking habits between males and females. Females started smoking at later age and smoked less than males. Nicotine dependence was related to cumulative exposure to tobacco smoke. Frequency of airflow limitation was related to number of packyears.
Academic Medical Centers↗
[Hyperuricaemia in males with obstructive sleep apnoea (osa)].
UNLABELLED: Previous studies showed that uric acid (UA) excretion in urine is increased in OSA patients and normalized after CPAP therapy. The aim of our study was to assess serum UA in a large group of males with OSA before treatment. METHODS: All subjects had full or limited PSG, measurements of serum uric acid, cholesterol, triglicerydes, glucose levels, lung function tests and medical history for cardiovascular diseases. RESULTS: We studied 260 consecutive, obese males (BMI = 33.1 +/- 6.2 kg/m2), mean age 51.5 +/- 9.9 years, with severe OSA (mean AHI/RDI = 44 +/- 24, mean overnight SaO2 = 89.2 +/- 5.4%, T90 = 43.8 +/- 34.4%. Hyperuricaemia (UA >7 mg%) was found in 56.2% of studied subjects. UA concentration correlated with obesity and overnight oxygenation. Multiple regression analysis revealed significant correlation between UA and BMI. Subjects with hyperuricaemia presented with higher prevalence of systemic hypertension, coronary artery disease, diabetes mellitus and COPD. CONCLUSIONS: Hyperuricaemia is frequent in males with OSA. Elevated UA levels are related to extreme obesity, overnight desaturation and higher prevalence of systemic hypertension, coronary artery disease, diabetes and COPD.
Body Mass Index↗
[Diagnosis and treatment of tobacco dependence].
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Asthma↗
[Methods and cost effectiveness of nicotine abstinence].
Tobacco smoking is responsible for many chronic diseases causing an important burden of morbidity, mortality and economic costs. The treatment of nicotine dependent smokers bases on nicotine replacement therapy and on use of bupropion. Rationales for treatment, methods and results of therapy as well as the cost-effectiveness of these methods are described.
Antidepressive Agents, Second-Generation↗
[The variability of clinical presentation of chronic obstructive pulmonary disease in patients with hereditary alpha-1 antitrypsin deficiency].
Four patients with alpha-1 antitrypsin (alpha-1 AT) deficiency are presented: one woman with severe (phenotype PiZ) and 3 men with moderate (phenotype PiMZ) deficiency of alpha-1 AT. The variability of clinical presentation of hereditary emphysema is described. In all patients tobacco smoking history, spirometric and 6-minutes walking tests as well as HRCT of the lung were performed and compared. The influence of smoking on the functional status is underlined.
Adult↗
Inhibitory capacity of different steroids on neutrophil migration across a bilayer of endothelial and bronchial epithelial cells.
Neutrophil infiltration to the airway lumen is a common feature of respiratory inflammatory processes. The aim of this study was to evaluate whether different corticosteroids exert any selective effect on the migration of isolated neutrophils. A bilayer of cultured human endothelial and bronchial epithelial cells was used as a model for neutrophil migration through the blood-air barrier. Low spontaneous migration of neutrophils (2.8+/-0.9%, n=8; mean+/-S.E.M.) occurred, while in the absence of any steroid, a migration of 28.5+/-7.6% could be induced by lipopolysaccharide. Pre-incubation during 1 h of epithelial cells with dexamethasone, budesonide, or prednisolone (10(-10)-10(-4) M) showed in all instances a concentration-dependent inhibition following a bell-shaped curve. At 10(-7) M, both dexamethasone and budesonide were on the minimum effect peak of the bell-shaped curve. The peak for prednisolone was found at 10(-8) M. However, when steroid pre-incubation was extended to 4 h, a sigmoid curve was observed, with significant inhibition of migration at concentrations >10(-7) M. Steroids can inhibit neutrophil recruitment through two different pathways with distinct result, depending on the length of incubation time.
Bronchi↗
Diagnosis of airflow limitation combined with smoking cessation advice increases stop-smoking rate.
OBJECTIVES: To assess how the diagnosis of airflow limitation (AL) combined with advice to stop smoking in middle-aged smokers influence the smoking cessation rate and to identify predictors of successful outcome. DESIGN: Prospective, single-center, comparative study of the effects of smoking intervention in smokers with diagnosed AL and in smokers with normal lung function (NLF). SETTING: University hospital, out-patient clinic. PARTICIPANTS: Of 659 smokers participating in a population spirometric screening for COPD combined with smoking cessation advice, 558 (AL, 297 smokers; NLF, 261 smokers) were invited for a follow-up after 1 year. INTERVENTION: At follow-up, spirometry was repeated and smoking status was assessed. Nonsmoking status was validated with carbon monoxide measurements in exhaled air. Patients who did not come for the follow-up visit were considered to be smokers. RESULTS: Of 558 smokers invited, 368 (66%) presented for the follow-up visit. All had tried to reduce their smoking habit. The number of cigarettes smoked per day (cpd) at 1 year was - 5.2 (p < 0.01) in patients with AL and - 2.7 (not significant [NS]) in those with NLF. The 1-year cessation rate in smokers with AL was 10.1% vs 8.4% in smokers with NLF (NS). After stratifying the patients according to AL severity, the highest cessation rate was observed in smokers with moderate and severe AL (16.5%) compared to smokers with mild AL (6.4%; p < 0.001) and smokers with NLF (8.4%; p < 0.05). In a univariate analysis, the cessation of smoking was correlated with older age (p < 0.001), later age when starting smoking (p < 0.005), lower tobacco exposure (in pack-years; p < 0.01), fewer cpd (p < 0.001), and lower lung function (p < 0.05). No interaction effect was observed for any of the studied variables using two-way analysis of variance. In a stepwise logistic regression analysis, age (p < 0.001), tobacco exposure (in pack-years; p < 0.001), and FEV(1) percent predicted (p < 0.01) proved to be significant predictors of success in stopping smoking. CONCLUSION: All smokers, irrespective of their lung function, tried to modify their habit as the result of screening for COPD combined with smoking cessation advice. The diagnosis of AL motivated smokers to attempt to quit smoking. Older age, lower tobacco exposure, and lower lung function were the predictors of success in quitting smoking.
Age Factors↗
[Effect of nocturnal hypoxaemia on the development of pulmonary hypertension in patients with COPD].
Majority of subjects with severe COPD develop mild pulmonary hypertension. Those patients usually present with diurnal, resting hypoxaemia. Further hypoxaemic dips during sleep probably contribute to development permanent pulmonary hypertension. However, separation of effects of diurnal from nocturnal hypoxaemia is difficult. Correlations between severity of nocturnal hypoxaemia and pulmonary arterial pressure and pulmonary vascular resistance were week. There was no correlation between time spent in desaturation and pulmonary arterial pressure and pulmonary resistance.
Adult↗
[Effect of treatment for nicotine dependence in patients with COPD].
Stopping smoking is the only known method to slow down the inevitable progression of COPD. Early detection of the disease in smokers at risk of COPD gives a unique opportunity to prevent the disease progression. The aim of the study was to evaluate the effects of smoking intervention in a group of subjects with newly diagnosed airflow limitation (AL). Of 558 current smokers participating in population spirometric screening for COPD combined with smoking cessation advice, 297 were diagnosed to have AL (FEV1/FVC < 0.7). After one year 193 presented for follow-up visit. Thirty subjects (10.1%) quit smoking. Remaining 163 smokers were invited to smokers' clinic. Attendees (n = 70), 40 males, and 30 females, mean age 56 years, were randomized at visit 1 to treatment with nicotine patch (n = 38) or bupropion SR (n = 32). Follow-up was scheduled at 2 weeks, at the end of treatment, 6 months and 12 months. After 12 months a phone call assessed the smoking status. Non smoking was validated with carbon monoxide measurements in exhaled air. Patients who did not attend the follow-up visits were considered smokers. The number of participants at follow-up decreased significantly: from 70 subjects at visit one to 57 after 2 weeks, 34 at end of treatment and 14 subjects at months. Almost all (n = 69) were reached at 12 month by the phone. The validated quit rate after 12 months was 18.5% (13/70), 8 in group treated with nicotine patch and 5 in the group treated with bupropion SR (NS). When total group of smokers with newly diagnosed COPD was considered 10% quit smoking as result of minimal intervention with another 4.5% after pharmacological treatment.
Administration, Cutaneous↗
[Early detection of COPD in smokers from Warsaw using spirometric screening].
COPD is the fourth leading cause of death in Poland. The disease is diagnosed not early enough. The aim of the study was to establish prevalence of COPD in smokers, inhabitants of Warsaw. Therefore, using local mass media, smokers with at least 10 pack-years history of smoking, over 40 years of age, were invited for a free spirometry. The spirometries were performed during 33 weekends. 3340 subjects (51.8% M and 48.2% F) mean age 57 +/- 13.2 years were examined. Most of them were current smokers (57.8%) or ex-smokers (27%) with a history of 31.9 +/- 18.8 packyears, the remaining subjects (15.2%) declared themselves as a life non-smokers. From all screened 1520 (45.6%) presented airflow limitation (AL). Following ERS recommendations, AL was classified as mild in 27.7%, moderate in 11.1% and severe in 6.8% subjects. One third of examined declared morning cough (36.9%) or sputum production (34.8%), or both symptoms (26.7%). Morning cough (p < 0.05) or cough together with sputum production (p < 0.01) were related to result of spirometry. Subjects aged > or = 40 years with a history of > or = 10 packyears had AL diagnosed in 50.1%, in contrast to younger than 40 years and smoking < 10 packyears in whom AL was detected in 14.3%. In life non-smokers AL was diagnosed in 35.9%. The majority of non-smokers were females (70%), 7.5% declared history of bronchial asthma. The great efficacy of AL detection in targeted population (50%) should be an incentive to perform routine spirometric examination in smokers aged 40+ with a history of 10+ packyears of smoking.
Adult↗
[Organizing pneumonia--diagnostic and therapeutic problems].
Organizing pneumonia (OP) is a well histopathologically defined disease, which can be induced by many factors--infections, drugs, connective tissue diseases etc. In many cases a rapidly progressive course is observed with clinical picture of pneumonia. We report a case of organizing pneumonia with an acute onset and rapid deterioration in 58-year-old women. After unsuccessful treatment with antibiotics, prompt biopsy of the lung (videothoracoscopy) helped to establish the diagnosis. A rapid improvement after corticoid therapy was observed. Low dose corticoid treatment is continued. Patients remains well 20 months after onset of symptoms.
Anti-Inflammatory Agents↗
[Primary ciliary dyskinesia--Kartagener's syndrome and fertile male].
Primary ciliary dyskinesia (PCD) is a rare genetic disease, in which a number of human organs are involved: upper and lower respiratory tract, spermatozoa in males and fallopian tube in females. In minority of cases PCD presents as Kartagener's syndrome (KS): sinusitis, bronchiectasis and inversion of internal organs. We report a case of Kartagener's syndrome in 43-year-old fertile male. After clinical and radiological examination and biopsy of the bronchial mucosa diagnosis of KS was established. The problem of fertility in KS males is discussed.
Adult↗
[Education program in COPD].
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Disease Management↗