Chronic obstructive pulmonary disease (COPD) is a destructive inflammatory disease and the genes expressed within the lung are crucial to its pathophysiology. We have determined the RNAseq transcriptome of bronchial brush cells from 312 stringently defined ex-smoker patients. Compared to healthy controls there were for males 40 differentially expressed genes (DEGs) and 73 DEGs for females with only 26 genes shared. The gene ontology (GO) term "response to bacterium" was shared, with several different DEGs contributing in males and females. Strongly upregulated genes TCN1 and CYP1B1 were unique to males and females, respectively. For male emphysema (E)-dominant and airway disease (A)-dominant COPD (defined by computed tomography) the term "response to stress" was found for both sub-phenotypes, but this included distinct up-regulated genes for the E-sub-phenotype (neutrophil-related CSF3R, CXCL1, MNDA) and for the A-sub-phenotype (macrophage-related KLF4, F3, CD36). In E-dominant disease, a cluster of mitochondria-encoded (MT) genes forms a signature, able to identify patients with emphysema features in a confirmation cohort. The MT-CO2 gene is upregulated transcriptionally in bronchial epithelial cells with the copy number essentially unchanged. Both MT-CO2 and the neutrophil chemoattractant CXCL1 are induced by reactive oxygen in bronchial epithelial cells. Of the female DEGs unique for E- and A-dominant COPD, 88% were detected in females only. In E-dominant disease we found a pronounced expression of mast cell-associated DEGs TPSB2, TPSAB1 and CPA3. The differential genes discovered in this study point towards involvement of different types of leukocytes in the E- and A-dominant COPD sub-phenotypes in males and females.

Chronic obstructive pulmonary disease (COPD) is induced by cigarette smoking and characterized by inflammation of airway tissue. Since smokers with COPD have a higher risk of developing lung cancer than those without, we hypothesized that they carry more mutations in affected tissue. We called somatic mutations in airway brush samples from medium-coverage whole genome sequencing data from healthy never and ex-smokers (n = 8), as well as from ex-smokers with variable degrees of COPD (n = 4). Owing to the limited concordance of resulting calls between the applied tools we built a consensus, a strategy that was validated with high accuracy for cancer data. However, consensus calls showed little promise of representing true positives due to low mappability of corresponding sequence reads and high overlap with positions harbouring known genetic polymorphisms. A targeted re-sequencing approach suggested that only few mutations would survive stringent verification testing and that our data did not allow the inference of any difference in the mutational load of bronchial brush samples between former smoking COPD cases and controls. High polyclonality in airway brush samples renders medium-depth sequencing insufficient to provide the resolution to detect somatic mutations. Deep sequencing data of airway biopsies are needed to tackle the question.

Introduction Methotrexate therapy improves lung function in selected sarcoidosis patients. Variation in TNF gene was associated with response to treatment. Aim: To determine the predictive role of-308 G/A, -857C/T, -863 C/A and -1031 T/C TNF-α polymorphism in the efficacy of MTX for progressive pulmonary sarcoidosis. Material and Methods Twenty-eight sarcoidosis patients treated with MTX (6-24 months) were genotyped for TNF-α polymorphisms: -1031 T/C, -857C/T, -308 G/A and -863 C/A. Pulmonary function test (PFT) were performed every 6 months to determine treatment response, until the drug withdrawal. Results No correlation between the initial clinical presentation of sarcoidosis and TNF α polymorphisms was found, neither for every allele nor for combined genotypes distribution. According to PFT evaluation we have discovered 3 types of response to MTX: early (ER), late (LR) and No-response (NR). TNF-α-308 A allele carriers have got significantly higher chance to be LR, p=0.02, RRI:83%. TNF-α-308 GG genotype transferred the 3-fold higher probability of early vs late response to MTX, p=0.02. Combined genotyping allowed to distinguish LR from ER and NR groups. ER and NR patients are genetically similar (-857CC-308GG). LR are "genetically" different group of patients (-857C/T-308GG or -857CC-308A/G) with 5-fold greater probability to be LR than TNF-α-857CC-308GG patients, p=0,005 sensitivity 85%, specificity: 43%, PPV 58%, NPV 75%. TNF-α-308GG-857CC patients have significantly lower chance to be LR comparing to other response type p=0.03 OR=0,075 95% CI=0.07-0.08. Conclusion Two types of positive response to MTX therapy (early and late) in chronic respiratory sarcoidosis are associated with polymorphic changes in TNF gene.

BACKGROUND:Changes in microbial community composition in the lung of patients suffering from moderate to severe COPD have been well documented. However, knowledge about specific microbiome structures in the human lung associated with CT defined abnormalities is limited.METHODS:Bacterial community composition derived from brush samples from lungs of 16 patients suffering from different CT defined subtypes of COPD and 9 healthy subjects was analyzed using a cultivation independent barcoding approach applying 454-pyrosequencing of 16S rRNA gene fragment amplicons.RESULTS:We could show that bacterial community composition in patients with changes in CT (either airway or emphysema type changes, designated as severe subtypes) was different from community composition in lungs of patients without visible changes in CT as well as from healthy subjects (designated as mild COPD subtype and control group) (PC1, Padj = 0.002). Higher abundance of Prevotella in samples from patients with mild COPD subtype and from controls and of Streptococcus in the severe subtype cases mainly contributed to the separation of bacterial communities of subjects. No significant effects of treatment with inhaled glucocorticoids on bacterial community composition were detected within COPD cases with and without abnormalities in CT in PCoA. Co-occurrence analysis suggests the presence of networks of co-occurring bacteria. Four communities of positively correlated bacteria were revealed. The microbial communities can clearly be distinguished by their associations with the CT defined disease phenotype.CONCLUSION:Our findings indicate that CT detectable structural changes in the lung of COPD patients, which we termed severe subtypes, are associated with alterations in bacterial communities, which may induce further changes in the interaction between microbes and host cells. This might result in a changed interplay with the host immune system.

EvA (Emphysema versus Airway disease) is a multicentre project to study mechanisms and identify biomarkers of emphysema and airway disease in chronic obstructive pulmonary disease (COPD). The objective of this study was to delineate objectively imaging-based emphysema-dominant and airway disease-dominant phenotypes using quantitative computed tomography (QCT) indices, standardised with a novel phantom-based approach.441 subjects with COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1-3) were assessed in terms of clinical and physiological measurements, laboratory testing and standardised QCT indices of emphysema and airway wall geometry.QCT indices were influenced by scanner non-conformity, but standardisation significantly reduced variability (p<0.001) and led to more robust phenotypes. Four imaging-derived phenotypes were identified, reflecting "emphysema-dominant", "airway disease-dominant", "mixed" disease and "mild" disease. The emphysema-dominant group had significantly higher lung volumes, lower gas transfer coefficient, lower oxygen (PO2 ) and carbon dioxide (PCO2 ) tensions, higher haemoglobin and higher blood leukocyte numbers than the airway disease-dominant group.The utility of QCT for phenotyping in the setting of an international multicentre study is improved by standardisation. QCT indices of emphysema and airway disease can delineate within a population of patients with COPD, phenotypic groups that have typical clinical features known to be associated with emphysema-dominant and airway-dominant disease.

Chronic respiratory diseases are an important cause of morbidity and mortality worldwide. Tuberculosis is responsible for 2 million deaths annually, COPD for another 3 million with an ever increasing trend. It is estimated that COPD will be the third most important cause of all deaths in 2020 and the fifth most important cause of DALY’s. COPD, asthma and chronic rhinitis are important causes of morbidity resulting in high costs to society, both direct medical costs and indirect social costs. The World Health Organisation makes estimation in relation to mortality and morbidity in every country relying on available, usually official data. There is however, a general lack of epidemiological studies in most of the countries in Central and Eastern Europe and countries that formed the previous Soviet Union. Global Alliance against Respiratory Disease (GARD), a recently created an organization under the auspices of WHO, is promoting recognition of the importance of respiratory diseases worldwide and is also collecting available data on the prevalence of chronic respiratory diseases [1]. The study by Chkhaidze et al in the current issue of Monaldi Archives of Chest Diseases [2] was performed in the scope of GARD initiatives. It is an important contribution trying to present real life prevalence of chronic respiratory diseases in Georgia. The study they have undertaken is a pilot study of two health districts near the capital Tibilisi comprising approximately 70.000 population. A physician’s administered questionnaire was applied to patients 5+ years old attending primary health care centres. It requested information on the physician’s diagnosis of tuberculosis, asthma and symptoms of asthma, chronic bronchitis, allergy and allergic rhinitis. In a sample of patients with symptoms of chronic cough and sputum of three years duration spirometry was performed. Additional questions assessed demographics, smoking status, occupational exposures and respiratory infections (pneumonia) in the past. The results of the study were compared to official statistics on the aforementioned diseases. A total of 3646 patients were studied, 41% were males, 15% were aged between 5-14. Most of the patients had secondary school education. A total of 733 patients were ever smokers, 712 men and 24 women. Asthma was diagnosed in 4.8%, tuberculosis in 2%, chronic cough in 20%, COPD in 7%, allergic rhinitis in 4%. Among 92 patients with chronic cough and phlegm in whom spirometry was performed COPD was diagnosed in 62 (67%). The prevalence of asthma, tuberculosis, allergic rhinitis complied with official data on these diseases. Incidence (notification) rate of tuberculosis is high, similarly to majority of former Soviet Union countries except the Baltic states [3]. However, government data on COPD grossly underestimated the prevalence of this disease. The most detailed part of survey concerned COPD. All subjects reporting symptoms of chronic bronchitis, complying with the current definition of the disease were subjected to post bronchodilator spirometry. Almost all were more than 40 years of age. The signs of not completely reversible obstruction was found in 24% of them. This is very high figure most probably influenced by the fact that a highly selected population was studied, i.e. a population with a very high probability of the disease [4]. Interestingly, frequency of different stages of COPD in the Chkhaidze study was very close to that found in a family physician setting in Poland [5]. Vast majority of subjects had mild or moderate stage of the disease. Georgian study supports the idea of spirometric screening for COPD in population of high risk for COPD to prevent progression of COPD to severe stage [6]. The prevalence of smoking was low (20%) in the population studied. Among the total population 14+ years the prevalence of tobacco smoking was 24%. One has to note that the prevalence among men was 48% and among women 0,01%. According to The Tobacco Atlas the prevalence of smoking in Soviet Union satellite countries was 50-60% in males and less than 20% in females [7]. The study has several limitations. It was not an epidemiological study, but an assessment of diagnosis of patients attending their primary care physicians. No data on occupational exposure was presented. Countries of Central and Eastern Europe and Central Asia that, since the end of the second World War or since 1918, were separated from the free world present with much higher mortality rates than Monaldi Arch Chest Dis 2009; 71: 4, 139-140.

Background: Poor self-management constitutes a risk factor for COPD deterioration. Patients from rural areas located at a considerable distance from large medical centers frequently need home-support in advanced stages of the disease. Integrated care has been proposed as a comprehensive model for appropriate treatment, coordination and holistic support. The aim of the study was to assess whether home visits provided by trained assistants are needed and accepted by advanced COPD patients living in rural areas a to evaluate whether an individual short educational program can actually improve such patients' knowledge of COPD and inhaler use.Methods: Thirty patients with severe or very severe but stable COPD participated in one-month home-assistance interventions twice a week.Results: The total value >= 70 of SGRQ(St George's Respiratory Questionnaire) was recorded in 18 (60%) patients. At the beginning of the study, the patients' knowledge of COPD and inhalation techniques was highly unsatisfactory. Significant improvement in all items (p = 0.00) was obtained after the intervention. The risk for poor self-management was high. All patients had at least one 'factor' that indicated the need for home-support. A total of 240 visits (100%) were completed. Patients expressed high acceptance for home-based support delivered by medical assistants twice a week for one month. No patients opposed this kind of care and most of them expressed interest in receiving it in the future.Conclusions: The results suggest a compelling need for home care and demonstrate full acceptance of this kind of support on the part of advanced COPD patients. (C) 2016 Elsevier Inc. All rights reserved.

The aim of this study was to identify the frequency and prevalence of comorbidities in sarcoid patients and to assess their influence on overall mortality in the cohort of patients with sarcoidosis.

Leptin is a hormone secreted by adipocytes, with a variety of physiological activities including control of metabolism,energy homeostasis,neuroendocrine regulation,activation of the immune system. Aim: the aim of the study was to explore possible relationships between serum concentration of leptin and selected proinflammatory cytokines in patients with sarcoidosis(pts). Methods: 40 pts(22M 18F) mean age 45y±11.5y, were enrolled in to the study. Mean time of observation was 5.6±5.0y. Blood samples were collected in the morning and stored at -80°C until assayed. Serum leptin(sL), tumour necrosis factor(TNF-α), interleukin(IL)-1ß,5,6 and C-reactive protein(CRP) were quantified. Bioelectrical impedance was used to measure fat-free mass(FFM),fat mass(FM) using a Bodystat 1500 and the FFMI(fat-free mass index) was defined. Results: on average male subjects showed lower level of sL (7.03±5.07 ng/ml) compared with females (28.7±38.5ng/ml) which is explained by the different distribution of adipose tissue. Statistically significant correlation (p<0.0001) between sL and FM among men and weak correlation between sL and FFMI among men and sL and FM in women was found. There was no correlation between sL and serum concentrations of CRP,TNF-α, IL-5,6. The statistically significant (p<0.001) correlations were found: between serum concentrations of CRP and TNF-α and CRP and IL-6 and TFN-α and IL-6 for whole group and among men, also between TNF-α and IL-6 among women. Conclusions: our findings could support the role of CRP as a biomarker among sarcoid patients but does not support correlation between sL and TNF-α, IL-5 and 6 in the studied group. All these findings need to be verified with large-scale studies.

Chronic sarcoidosis is marked by the heterogeneity of clinical phenotypes. Some patients may enter spontaneous remission without medication, in others the disease progress despite therapy. While there is no cure for sarcoidosis, immunosuppression is often employed to control inflammation, although the clinical response is variable. Objective: to analyze patients clinical characteristics, inflammatory findings that point to those individuals who will most likely respond to treatment. Methods: in a cohort of 50, previously described MTX treated, chronic sarcoid patients (1) we compared the initial clinical status (sex, age, disease duration, smoking habits, radiological picture) and disease activity (RBC, WBC, CRP, Ca, P serum levels, proteinogramme, ddimers, fibrinogene, serum and BAL TNFα, TGFβ, IL2, IL2R, IL12, IL10 levels) between MTX responders vs MTX nonresponders groups. Results: No association with patient clinical status was found. Predictors of MTX response were high serum albumins (52,8 vs 48,9, p<0,001),low serum phosphor concentration (1,74 vs 1,98; p<0,001)and basophils (% 0,49 vs 0,65, p<0,001; k/ul 0,029 vs 0,038, p<0,001). Fibrinogene level was increased in responders (18,2vs8,3 NS). Higher values of CRP (7,2vs5,5 NS), ddimers (714,5vs 445,9, NS) and the BAL IL2 concentration (91,8 vs34,6; p<0,001) were observed in nonresponders. Conclusion: Defining initial inflammatory status of potential candidates for therapy might be helpful in further therapeutic decisions and enhance prognostication. Goljan Geremek A. et al. Methotrexate as a single agent for treating pulmonary sarcoidosis: a single centre real-life prospective study Pneumonol Alergol Pol, 2014, 82, 518-33.

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.

Objective: The quality of spirometry in primary care is far from optimal, usually 60% of recordings fulfil the ATS/ERS criteria for good quality measurements. Traditional personnel trainings need frequent repeating to improve the results. We proposed a website platform to provide quality and interpretation feedback training for family doctors and practice nurses. Methods: Six primary care doctors and nurses with no previous experience in spirometry were invited to participate. They were equipped with NLHEP feature spirometer and held an 8 hour training including the theory and hands-on-practice. Each team sent 10 spirometries of any indication weekly for reference pulmonary function testing (PFT) centre via website. Three of the doctor/nurse teams were randomly chosen for feedback learning, the remaining three were controls. Feedback teaching was provided by PFT centre commenting on performed measurements with advices how to improve. Results: During 12 months of project duration 3215 spirometric tests including 9656 flow-volume loops were evaluated. The effects of e-learning intervention are shown in table. Conclusions: The main technical fault in spirometry performed in primary care was the lack of reproducibility of FEV1 and FVC. E-learning feedback intervention was successful to gain better quality by 10%. Supported by: Grant NN4040818343.

W ostatnim dziesięcioleciu dużym zainteresowaniem zaczęła się cieszyć teoria wskazująca na znaczący wpływ na zdrowie człowieka różnych mikroorganizmów—bakterii [...]

Rationale: Sarcoidosis is a multisystem inflammatory disease of unknown etiology. Sarcoidosis may affect many tissues by the presence of noncaseating granulomas, but the inflammatory process can potentially trigger other comorbidities in sarcoid patients. Aim: The aim of this study was to identify the prevalence of comorbidities in sarcoid patients. Materials and methods: A cohort of 557 patients with histologically confirmed sarcoidosis diagnosed between 2007 and 2011 was observed. All patients were carefully examined for comorbidities. Results: 291 males (52,2%) and 266 females (47,8%) with mean age 48,4 ±12,0 yrs were observed. Majority of studied patients had radiological stage II (62,1%) and stage III (20,8%) of the disease. Stage I was diagnosed in 14,1% patients and extrapulmonary involvement in 32,3% patients. Most frequent of comorbidities were: hyperlipidemia N=121 (21,7%), obesity N=79 (14,2%), thyroid disease N=73 (13,1%), diabetes N=41 (7,4%), bronchiectases N=35 (6,3%), neoplasm N=33 (5,9%), osteoporosis N=32 (5,7%), anaemia N=26 (4,7%), coronary heart disease N=25 (4,5%), asthma N=21 (3,8%), gastric/duodenal ulcer N=16 (2,9%), allergy N=14 (2,5%), sleep apnea N=12 (2,2%), hypertension N=9 (1,6%), chronic renal disease N=6 (1,1%). Conclusion: We have found significant number of comorbidities in patients with sarcoidosis. Screening for these conditions, especially thyroid and neoplastic disorders, should be considered in these patients.

OBJECTIVE : Steroid treatment of sarcoidosis is associated with significant morbidity and has often been disappointing. Our objective was to evaluate the efficacy and safety of monotherapy with MTX in chronic sarcoidosis patients. METHODS : Between 2005 and 2013 MTX was used as a monotherapy in 53 patients (pts) (F:22, M: 31) with progressive disease. The dose ranged from 7,5mg to 20mg weekly. In 9 cases MTX was the first line therapy. 44 pts (83%) were refractory after steroid treatment. RESULTS : The duration of treatment ranged from 3 to 25 months. The subjective intolerance was seen in 4pts. No severe adverse effects were observed in any case. The symptomatic improvement was seen in 27pts (51%). The objective improvement was noted in: 27 pts (51%)- radiological improvement 23 pts (43%)- PFT and 6MWT improvement 6 pts (11%) had extra thoracic lesions reduction In 12 pts (23%) progression of sarcoidosis was observed and steroid therapy was introduced. In 7 patients sarcoidosis relapsed after MTX being withdrawn. The concomitant infection was the reason of discontinuation of therapy in 4 patients. 5 severe complication of sarcoidosis developed after the MTX therapy was finished: 2 cases of invasive aspergillosis (one fatal), 2 fatal cases of cardiovascular complications and 1 case of HCV infection. CONCLUSION: MTX as a single agent has proved to be safe and effective steroid alternative in selected sarcoidosis patients with chronic progressive sarcoidosis. Chronic progressive sarcoidosis is often associated with other comorbidities that may complicate the treatment. There is need to search for selection criteria to determine who may benefit from monotherapy with MTX.

Wstęp: Kortykosteroidoterapia jest według aktualnych wytycznych WASOG/ATS/ERS leczeniem pierwszego rzutu u chorych na przewlekłą sarkoidozę. Jest to leczenie obarczone wysokim ryzykiem wystąpienia objawów ubocznych, które pogarszają rokowanie odległe. J ednocześnie nie ma pewności, że glikokortykosteroidy (GKS) modyfikują naturalny przebieg choroby. Celem pracy była ocena skuteczności i bezpieczeństwa leczenia metotreksatem (MTX) w monoterapii chorych na przewlekłą sarkoidozę płucną. Materiał i metody: Do leczenia zakwalifikowano 50 chorych na przewlekłą sarkoidozę płuc potwierdzoną badaniem histopatologicznym, 28 M i 22 K, w średnim wieku 45.55 ± 8.9 roku, ze średnim czasem trwania choroby do włączenia MTX wynoszącym 12.34 ± 20.49 roku. W latach 2004–2013 zastosowano u tych chorych MTX w monoterapii, w dawkach 10 mg lub 15 mg tygodniowo. Czterdziestu jeden pacjentów było wcześniej leczonych GKS. Wszyscy mieli wykonywane badania laboratoryjne, czynnościowe oraz radiologiczne układu oddechowego przed rozpoczęciem leczenia i w trakcie monitorowania skuteczności (co 6 miesięcy) oraz bezpieczeństwa terapii (co 4–6 tygodni). Do analizy statystycznej oceniającej skuteczność leczenia włączono 49 chorych. Na podstawie retrospektywnej analizy wyników badań czynnościowych (FEV1, FVC, TLC, DLCO) wykonanych na zakończenie leczenia, w porównaniu z wynikami badań czynności płuc przed podaniem MTX (poprawa o 10% w zakresie FEV1, FVC, TLC lub o 15% DLCO), wyodrębniono chorych, u których stwierdzono obiektywną, istotną poprawę wskaźników czynnościowych płuc po leczeniu (grupa “z obiektywną poprawą po leczeniu”). Wyniki: Okres leczenia wynosił od 6 do 24 miesięcy, średnio 60.75 ± 34.1 tygodnia. W całej grupie istotną poprawę po leczeniu MTX stwierdzono dla SaO2 min (%) (p = 0.043) oraz dla DSaO2 (%) (p = 0.048) ocenianej w czasie testu 6-minutowego marszu. Istotnie lepsze efekty leczenia uzyskano w grupie otrzymującej 15 mg MTX tygodniowo oraz u chorych, którzy otrzymali sumarycznie większą dawkę MTX podczas całej kuracji. Istotną statystycznie różnicę po 6 miesiącach leczenia między grupami leczonymi 15 mg v. 10 mg tygodniowo stwierdzono dla DLCO% pred (73.27 ± 12.7 vs. 63.15 ± 16.4; p = 0.03). Obiektywną poprawę po leczeniu stwierdzono u 25 pacjentów (55%). Chorzy, u których stwierdzono obiektywną poprawę po MTX, mieli wyjściowo istotnie niższe wartości TLC i FVC w porównaniu z grupą bez poprawy po MTX. Po zakończeniu leczenia jedyną istotnie statystycznie różnicę między obiema grupami obserwowano w zakresie DLCO. U 11 chorych (22%) przerwano leczenie z powodu objawów ubocznych. Najczęściej obserwowanym objawem ubocznym leczenia był wzrost wskaźników wątrobowych (10 chorych, 20%). U 4 osób stwierdzono powikłania infekcyjne. U żadnego chorego nie stwierdzono powikłań zagrażających życiu. Wnioski: Metotreksat w monoterapii może być bezpieczną i skuteczną alternatywą dla steroidów. U części chorych należy spodziewać się obiektywnej poprawy czynności płuc po leczeniu. Wskazane są dalsze badania w poszukiwaniu wskaźników prognozujących skuteczność leczenia.

Pierwsze krajowe “Zalecenia postępowania w przewlekłej obturacyjnej chorobie płuc (POChP)” powstały w 1998 roku z inicjatywy profesorów Jana Zielińskiego i Józefa Małolepszego oraz dr. hab [...]

Aim : The aim of the study was to examine mortality and underlying causes of death among decedents with sarcoidosis in our Department between 2007-2011. Materials and methods : The study was designed in 2007. The cohort of the patients(pts) with histologically confirmed sarcoidosis was observed. Between 2007 and 2011, 557 pts were admitted to our Department. In Jan 2014 a surveillance follow-up was performed using the Electronic Beneficiary Entitlement Verification platform provided by the National Health Insurance System. Pts who were not in the system were contacted personally to confirm their status. Results: Among 557 pts(291men, 266 women) with mean age 48,4 ±12,0 yrs, 16 died (6 women and 10 men) with mean age 57,6±7,8y. At the time of diagnosis 12pts were classified as radiological stage II, 4 pts as stage III. Extrapulmonary sarcoidosis was found in 9 pts (56%) and only 2 pts(12.5%) were not treated with steroids and/or methotrexat. Most frequent comorbidities were hypertension 12(75%), hyperlipidemia 4(25%), thyroid disease 3(18,7%), diabetes 1, chronic renal disease 1, uterine cancer 1 and aortic stenosis 1. 7 pts died of causes unrelated to sarcoidosis (cancers), whereas death was related to sarcoidosis in 7 pts. The most prevalent cause of death was advanced pulmonary involvement (5pts) with various late complications: cardiorespiratory failure, fungal infections or extrapulmonary sarcoidosis: cardiac(1pt) and central nervous system(1pt). Others causes included stroke and complications from a stenosis surgery. Conclusion: The leading cause of death in sarcoid patients in our Department were cancers, but just as often, sarcoidosis was the underlying cause of death.

INTRODUCTION:Dyspnoea and decreased exercise tolerance are symptoms of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Anaemia is a risk factor for reduced functional capacity and dyspnoea in stable COPD. There is limited information about the impact of anaemia on functional capacity and dyspnoea of patients during AECOPD. The aim of this study was to evaluate the impact of decreased blood haemoglobin concentration on the results of six-minute walking test (6MWT) in patients during AECOPD.MATERIAL AND METHODS:A post hoc analysis of data collected from prospective long-term studies on AECOPD. Haemoglobin concentration from the first obtainable hospital measurement were included in the assessment. 6MWT was performed after clinical improvement of the patient. Dyspnoea at baseline and after exercise and oxygen saturation (SpO(2)) during exercise was measured.RESULTS:(presented as means ± SD): 402 patients with exacerbation of COPD (COPD stage 3.5 ± 0.6) were examined. Patients with anaemia (26% of those studied, age 74.5 ± 8.2 years) achieved 258.1 ± 125.1 m during 6MWT, with exertional desaturation of 2.9 ± 2.6%. Patients without anaemia (74% of those studied, age 70.2 ± 8.7 years) achieved 271 ± 136.0 m during 6MWT with exertional desaturation of 3.8 ± 3.7%. The haemoglobin concentration did not correlate with 6MWT, dyspnoea during 6MWT, or exercise oxygenation and blood desaturation during exercise.CONCLUSION:Mildly decreased blood haemoglobin concentration did not influence the results of 6MWT in patients with AECOPD.

Aim :The relationship of smoking with some interstitial lung diseases (ILDs) has been published.The aim of the study was to evaluate smoking habits among our ILDs patients(pts). Methods :Consecutive pts admitted to the hospital were divided into two groups; sarcoid-group1, other ILDs-group2. Results :236 pts were studied.Group1-177pts(98M /79F) vs 59pts(27M/32F) - group2.The average age was 49±12.1y.In group1,103pts(58%) were ever smokers(ES), 26(14%) current smokers(CS), in group2, 37pts(63%)were ES, 4(7%) CS.The average age of smoking initiation was 18.7±3,4y in group1 and 18.5±4.2y in group2,p=ns.In group1 women started smoking later than men (19.8±3.4y vs 17.9±3.1),p>0.05.In group2 the mean number of cigarettes per day was 13.4±8.1 for women vs 19.5±8.2 for men,p>0.05.The average age of sarcoid smokers was significantly lower vs to non-smokers; 46.11± 12.02y vs 52±11.06y,p>0.05.The average age of CS was significantly lower than ex-smokers(XS) 41±13.3y vs 49±11.3y,p>0.05.Among CS, smoking exposure was longer vs XS 20.3±8.9y vs 13.4±8.6y,p>0.05.In group1 150 pts(89 smokers(S)/61 never smokers(NS) were exposed to secondhand smoke(shs) at home, 108(68 S /40 NS) at work vs 45(29 S/16 NS) were exposed to shs at home, 36(22 S/14 NS) at work from group2.Smokers (90) exposed to shs at work vs smokers (50) not exposed, smoked longer 19.3 vs 13.7 y,p>0.05 and smoked in average more cigarettes per day 14.7 vs 12.1,p>0.05.Sarcoid smokers (68) exposed to shs at work, smoked more cigarettes per day vs those who were not exposed (35), 14.1 vs 11.0,p>0.05. Conclusions :The prevalence of smoking was high among pts with ILDs.Exposure to shs must be taken into account regardless of whether a patient is a smoker himself.SHS may affect smoking habits.