The objective of this study was to investigate serum levels of leptin, adiponectin and endothelin1 and to search their role in development of osteo
porosis in chronic obstructive pulmonary disease (COPD) patients.

Methods. Lung function, body mass index (BMI), bone mineral density (BMD)
of the lumbar spine and the femoral neck, and serum concentrations of leptin, adiponectin and endothelin1 were measured in 126 patients with COPD diagnosed according to GOLD and in 86 healthy subjects.

Results. Among COPD patients, 43% had osteoporosis, 34% had osteopenia and 23% had normal BMD. Osteopenia was diagnosed in 35% of controls. The mean BMD value in stage 2 COPD patients corresponded to osteope nia; in stage 3 and IV COPD patients corresponded to osteoporosis. Generally, BMD correlated with FEV1 (r = 0.38, p < 0.05 for the lumbar spine; r = 0.43, p < 0.05 for the femoral neck) and with pCO2 (r = –0.46, p < 0.05 and r = –0.39, p < 0.05, respectively) in COPD patients. No significant difference was found for leptin and adiponectin concentrations between stages 1 and 2 COPD patients and controls. Leptin level decreased and adiponectin level increased in stages 3 and 4 COPD patients compared to controls (p < 0.05). There was a direct relationship between BMI and leptin (r = 0.64; p < 0.001) and an inverse relationship between BMI and adiponectin (r = –0.51; p < 0.01). FEV1 and DLCO were related to leptin only (p < 0.001). Leptin was directly related to the femoral neck and the lumbar spine BMDs (r = 0.66, p < 0.001 and r = 0.49, p < 0.05, respectively), while adiponectin was inversely related to BMD (r = –0.43, p <0.05 for the femoral neck; r = –0.49, p <0.001 for the lumbar spine). We found inverse relationships between endothelin1 and the lumbar spine BMD (r = –0.51, p <0.01), leptin (r = –0.46, p < 0.05), FEV1 (r = –0.43, p < 0.05) and PO2 (r = –0.54, p < 0.05) and direct relationships between endothelin1 and pCO2 (r = 0.68, p < 0.001) and adiponectin (r = 0.51, p < 0.05). A relationship between endothelin1 and adipokines was found only in osteoporotic COPD patients.

Conclusion. Our results suggest that serum adipokines and endothelin1 are involved in the pathogenesis of respiratory failure and bone density loss in COPD patients. The most pronounced changes in concentration of these biomarkers and close relationships between them and BMD were observed in patients with osteoporosis.

These clinical recommendations summarized currently available evidence on diagnosis and management of patients with pulmonary embolism. When compared to previous version of recommendations, this document has introduced simplified clinical prognostic scales and a new risk stratification system including intermediate risk. Novel approach to anticoagulant therapy have been also reviewed including systemic thrombolysis, catheterdirected treatment, vitamin K antagonists and new oral anticoagulants.

Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease which is prevalently diagnosed in older patients. The last decade, significant change took place not only in diagnostic approach to IPF, but also in definition of this disease. Recent data on epidemiology of IPF are described in this article, results of new studies on pathogenesis, natural course of IPF, comorbidity and principal approaches to diagnosis are discussed.

Tiotropium is a longacting anticholinergic drug and the firstline therapy in patients with chronic obstructive pulmonary disease (COPD). High efficacy of tiotropium in COPD is based not only on inhibition of parasympathetic cholinergic bronchoconstriction, but also is associated with multiple nonneuronal effects. Recent studies demonstrated polymodality of tiotropium due to influence on Mreceptormediated intracellular signaling pathways participating in regulation of cellmolecular interactions involved in inflammation, proliferation, and remodeling of pulmonary structures. Antiinflammatory, antiproliferative, antiremodeling, antiviral, and antioxidant effects of tiotropium delivered via the new improved device Respimat determine advantages of this drug over other longacting anticholinergics and increase efficacy and safety of therapy in patients with COPD.

This review has summarized clinical trials data on efficacy and safety of new combination of inhaled steroid fluticasione furoate (FF) and longacting beta2agonist vilanterol in patients with bronchial asthma. Treatment with this combination could effectively reduce a risk and frequency of severe asthma exacerbations, improve lung function, quality of life and control of asthma, improve asthma symptoms and need in relief medications, increase number of days without asthma symptoms and without use of asneeded bronchodilators. This combination was equally effective being administered both in the morning and in the evening that, in turn, allowed the most convenient treatment regimen for the patient and could additionally improve control of the disease. Tolerability of the FF / vilanterol combination is similar to that of placebo. The FF / vilanterol combination is delivered via a new inhalation device Ellipta® which is ease and convenient to use.

The aim of this study was to describe particularities of pulmonary circulation in patients with obstructive (chronic obstructive pulmonary disease (COPD)) or restrictive (idiopathic pulmonary fibrosis (IPF)) diseases and to study tendencies of pulmonary blood flow disorders in different pathological mechanisms of chronic respiratory failure (CRF).

Methods. Results of image examination (multislice computed tomography, computed angiography, singlephoton emission computed tomography) were analyzed in 150 patients with severe stage 3–4 COPD (phenotype of emphyse ma) complicated by CRF or right heart failure and in 45 patients with IPF and lung «honeycombing».

Results. Significant pulmonary circulation disorders were seen in patients with both obstructive and interstitial diseases complicated by CRF. These changes were caused by parenchyma remodeling, concomitant vascular lesions (pulmonary embolism, thrombosis in situ), cancer and persistent infectious inflammation.

Conclusions. Timely detection of changes in pulmonary parenchyma and vessels allows adequate treatment, slowing progression of the disease and improving outcomes. In patients with mild to moderate COPD, therapeutic interventions could improve the reduced blood flow in ischemic areas of the lungs significantly more often than in IPF patients. Early treatment could prevent irreversible change in ischemic lung parenchyma which usually results in CRF development. Virtually, treatment has no effect on pulmonary circulation both in patients with obstructive and restrictive diseases with irreversible changes in pulmonary vessels.

This study was aimed at determination relationships between systemic inflammation and endothelial dysfunction biomarkers and different cardiovascular and respiratory parameters in patients with chronic obstructive pulmonary disease (COPD) and comorbid hypertension.

Methods. Sixty five patients (50 males, 15 females) with stage 1–4 COPD and hypertension of different severity were involved in the study.

Results. High levels of inflammation and endothelial dysfunction biomarkers (hsCRP, sICAM1, endothelin1, and sPselectin) were found in patients with COPD and hyper tension. Statistically significant relationships were found between inflammatory biomarkers and endothelial dysfunction biomarkers and between biomarkers and different cardiovascular and respiratory parameters in patients with COPD and comorbid hypertension.

Conclusion. Inflammation and endothelial dysfunction biomarker levels change according to increasing in systemic arterial pressure and worsening of bronchial obstruction. This relationship should be considered while examining patients with COPD and comorbid hypertension.

The aim of this study was to investigate serum cytokine profile in stable patients with chronic obstructive pulmonary disease (COPD) caused by siliconcontaining dust exposure and to evaluate relationships between cytokines and some inflammatory biomarkers.

Methods. Patients (n = 234) with stable workrelated COPD were involved. To assess inflammation severity, we measured interleukins IL1β, IL4, IL6, IL8, tumor necrosis factor α (TNFα) in blood serum using immunoassay. Cytokine level was compared with inflammatory marker levels, such as Creactive protein (CRP), ferritin, erythrocyte sedimentation rate (ESR), blood leukocyte number, nitric oxide metabolites, immunoglobulins (IgG, IgA, IgM). Reparation of damaged airway epithelium was assessed by serum concentration of Clara cell protein (CC16) using immunoassay.

Results. There was no difference between cytokine and inflammatory marker levels in most patients with stable workrelated COPD and control subjects. This means that inflammation tin the airways was mild and only slightly depended on degree of bronchial obstruction. Systemic inflammation in COPD was confirmed by elevated CRP level (5.0 – 10.0 mg/L) found in a half of patients with workrelated COPD.

The aim of the study was to evaluate structural changes in the lung tissue in patients with pulmonary tuberculosis (TB) and coexisting obstructive pulmonary disease (COPD) using highresolution computed tomography (HRCT) and to analyze an influence of CT lesions on the lung function.

Materials and methods. One hundred and sixteen TB patients were involved. HRCT with Nodule Analysis and Lung Volume Analysis additional soft ware, spirometry, body plethysmography and measurement of diffusing capacity of the lungs for carbon monoxide were performed in all patients. We used descriptive statistics and Spearman’s correlation analysis.

Results. Patients with TB + COPD (n = 23) had extensive (> 3 lung segments) specific changes in the lungs more likely than patients without COPD (n = 93): 83% and 44%, respectively; p < 0.05. Patients with TB + COPD also had higher total volume of TB lesions (p < 0.05) and emphysema (61 and 30%, respectively; p < 0.05) on CT scans. Patients with TB + COPD had panlobular emphysema (17%) more often than other variants of emphysema. Patients without COPD had predominantly centrilobular emphysema (13%); panlobular emphysema was seen in a few cases (2%). Ventilation and gas exchange parameters were related to the volume of TB lesions on CT scans. An increase in emphysema volume on CT scans negatively affected the airflow limitation in all patients and deteriorated lung hyperinflation and lung diffusing capacity in patients with TB + COPD.

Conclusions. TBspecific pulmonary lesions were significantly more prominent in
patients with TB + COPD. TBspecific pulmonary lesions could worsen ventilation and gas exchange. More extended emphysema on CT scans could worsen bronchial obstruction in all patients, deteriorate lung hyperinflation and diffusing capacity in patients with TB + COPD.

The aim of this study was to investigate a role of adrenal function stimulation in patients with stage 3 chronic obstructive pulmonary disease (COPD).

Methods. Blood levels of cortisol, aldosterone and testosterone were measured in 82 males with severe COPD and in 25 healthy subjects. The study involved three patient groups: 41 patients with stage 3 COPD who received lowintensity infrared laser radiation with a frequency of 80 Hz applied on the adrenal gland area additionally to the standard therapy; 26 patients with stage 3 COPD who received standard therapy only and 15 patients with COPD who received standard therapy and a placebo exposure using a switched off laser device.

Results. A significant reduction in blood cortisol, aldosterone and testosterone levels in patients with stage 3 COPD was found. A role of adrenal function stimulation was confirmed in patients with stage 3 COPD.

Conclusion. Severity of adrenal hormonal disorders correlates directly to severity of COPD. Treatment of male patients with stage 3 COPD should include adrenal hormone correction using both medication and nonmedication on individual basis. The lowintensity laser radiation of adrenal area could significantly increase blood cortisol level and improve quality of life of the patients.

Two functional levels of mechanical energy intrapulmonary source have been viewed in this article for the first time. The first level is located into the perialveolar space. This level provides inspiratory and expiratory activity of the lungs together with respiratory muscles. Due to this, the inspiratory alveolar pressure is lower than the intrapleural pressure and the expiratory alveolar pressure is higher than the intrapleural pressure. This is deter mined by work of breathing measured as negative elastic hysteresis area and allows overcoming some nonelastic resistance of the lungs. The lung activity on overcoming the elastic resistance is estimated by multiplying the total work of breathing by a functional coefficient of lung elasticity (FCLE). The latter is calculated by dividing the total lung compliance by the dynamic lung compliance and reflects change in the elastic lung tension from spontaneous breathing level to the total lung compliance level. FCLE approximates 1 in healthy subjects and in patients with normal lung elastic recoil (LER). LER is lower and the total lung capacity is higher in lung obstructive diseases. Consequently, the total lung compliance could increase and FCLE could grow up to 10 in such cases (for instance, in severe emphysema). This leads to increasing lung activity on overcoming the elastic resistance up to 10 kgf × m / min or higher. Actually, this huge work of breathing is not performed due to the 2nd level of lung mechanical activity that is an active dilation of the large airways on expiration; this mechanism prevents valvular bronchial obstruction.

The aim of the study was to estimate the glomerular filtration rate (eGFR) in patients with different phenotypes of bronchial asthma (BA).

Material and methods. One hundred and three patients with different BA phenotypes were involved. eGFR was estimated using CKDEPI equation.

Results. eGFR was significantly lower in patients with nonatopic and aspirininduced BA compared to allergic BA patients who had eGFR was within normal range. eGFR was also reduced in BA patients regularly treated with oral steroids but this difference did not reach statistical significance. A number of significant relationships pertinent to eGFR was found in patients with allergic BA; no relationships with eGFR were found in BA patients at regular therapy with oral steroids.

Conclusion. The results rise possible effect of BA pathogenic pathways on the renal function, and vise versa.

Intrapulmonary percussive ventilation (IPV) is a therapeutic method of smallvolume highrate airflow delivery into the airways ('percussion'). IPV allows involving small airways in the breathing (alveolar recruitment) that provides better drainage of the airways. Currently, IPV is a preferable method for treatment of lung atelectasis irrespectively of its origin. A clinical case of 75year old outpatient female with the right middlelobe atelectasis complicating communityacquired pneumonia is reported in this article. The effect of the treatment was confirmed by computed tomography.
This case demonstrates that IPV is a safe, simple and effective therapeutic method for patients with lung diseases which could additionally reduce treatment cost.