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Objective: Although stress and styles of coping with it can have a major impact on one's health and can determine the course and management of chronic diseases, no previous studies have evaluated coping strategies and their relation to emotional distress and clinical symptoms in sarcoidosis., Methods: In two consecutive studies, we investigated differences in coping styles of sarcoidosis patients in comparison to healthy control subjects and the association of identified profiles to an objective measurement of disease (Forced Vital Capacity) and symptoms such as dyspnoea, pain, anxiety and depressive symptoms in 36 patients with sarcoidosis (study 1) and 93 patients with sarcoidosis (study 2)., Results: Across two studies we found that patients with sarcoidosis used emotion-focused and avoidant coping significantly less often than healthy individuals, and that in both groups the profile with dominant problem (task)-focus style was the most beneficial in terms of mental health. Further, the profile of sarcoidosis patients characterized by the lowest intensity of all coping strategies was found to be superior in terms of physical health status (dyspnoe, pain and FVC level)., Conclusion: These findings suggest that successful management of sarcoidosis should include coping styles assessment and call for a multidisciplinary approach in diagnosis and treatment of sarcoidosis patients., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The current lack of reliable methods for quantifying extracellular vesicles (EVs) isolated from complex biofluids significantly hinders translational applications in EV research. The recently developed fluorescence nanoparticle tracking analysis (FL-NTA) allows for the detection of EV-associated proteins, enabling EV content determination. In this study, we present the first comprehensive phenotyping of bronchopulmonary lavage fluid (BALF)-derived EVs from non-small cell lung cancer (NSCLC) patients using classical EV-characterization methods as well as the FL-NTA method. We found that EV immunolabeling for the specific EV marker combined with the use of the fluorescent mode NTA analysis can provide the concentration, size, distribution, and surface phenotype of EVs in a heterogeneous solution. However, by performing FL-NTA analysis of BALF-derived EVs in comparison to plasma-derived EVs, we reveal the limitations of this method, which is suitable only for relatively pure EV isolates. For more complex fluids such as plasma, this method appears to not be sensitive enough and the measurements can be compromised. Our parallel presentation of NTA-based phenotyping of plasma and BALF EVs emphasizes the great impact of sample composition and purity on FL-NTA analysis that has to be taken into account in the further development of FL-NTA toward the detection of EV-associated cancer biomarkers.

Lung cancer is the first cause of death from malignant disease. The distressing epidemiological data show the increasing female to male incidence ratio for this tumor. A high incidence of lung cancer in never smokers with importance of environmental agents makes a problem among women. Adenocarcinoma (ADC) is noted in women with increasing rate and ethnic background impacts female lung cancer with differences in the incidence of genetic aberrations. The conception of different hormonal status is taken into consideration as potential explanation of variant cancer biology and clinical manifestation in women and men. The impact of 17-β-estradiol, estrogen receptors, aromatase expression, pituitary sex hormones receptors in carcinogenesis with relation between estrogens and genetic aberrations are investigated. The response to newest therapies among female is also different than in men. This overview summarizes currently available evidence on the specificity of female lung cancer and presents the direction of necessary studies., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-287). The authors have no conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)

Introduction : Lung cancer is a serious malignant disease with poor prognosis. The methods for improving early recognition and markers of predictive value are widely investigated. Bronchoalveolar lavage (BAL) is a valuable method of respiratory tract investigation. Currently, BAL is rarely used for tumor diagnosis, but for ruling out differential diagnosis, due to its poor sensitivity. The new indication for BAL fluid analysis is evaluation of local immune reaction in lung cancer patients and description of tumor microenvironment (TME). A literature search was performed in bibliography bases from the time of the introduction of BAL in the diagnosis of lung diseases. We analyzed our prior original studies with the bibliography. Area covered : The usefulness of BAL in the diagnosis of peripheral spread of malignant diseases and in the evaluation of TME in lung cancer, as well as a role of BAL in the diagnosis of checkpoint inhibitor pneumonitis is presented. Commentary concerning methodology of BALF analysis in lung cancer is included. Expert opinion : It seems that in the near future BAL will find an important place in the evaluation of lung cancer TME in two aspects. The first could be characteristic of immune reaction by analysis of immune cells and mediators and the second cancer molecular characteristic by free DNA and exosomes analysis.

Lung cancer remains a serious oncological problem worldwide. The delayed diagnosis and a prevalence of advanced stages in up to 70% of cases at recognition are still observed. Thanks to targeted therapies and immunotherapy a significant progress in achieving prolonged survival in some lung cancer patients is reported. A precise histopathological diagnosis, especially the recognition of adenocarcinoma, and a progress in the methods of clinical staging underlie the proper qualification of patients for a tailored therapy. The deep molecular characteristics of lung cancer in liquid biopsy, for example blood, bronchoalveolar lavage fluid (BALF), cell suspension from needle aspirates, are currently available. The molecular characteristic has recently been extended with molecular aberrations of BRAF, KRAS, MET, ERBB2, RET, NTRK next to the well-known EGFR mutations and ALK, ROS-1 relocation. The present paper discusses the usefulness of adequate pathological methods and molecular testing for the identification of a broad spectrum of predictive biomarkers for a molecular-directed lung cancer therapy. Immunotherapy with immune checkpoint inhibitors (ICIs) is approved in the first line therapy of advanced non-small-cell lung cancer. To date only PD-L1 expression on tumor cells has been found to be a marker of response to ICIs. The efficacy of ICIs as well as the susceptibility to immune-related adverse events are highly individual, so immune biomarkers are widely investigated. The candidates for predictive factors for ICIs immunotherapy include cancer cell antigenicity, presence of regulatory/suppressory molecules on cancer cells, cancer stem cells or on exosomes, and, on the other hand, an immune status of the patient. Cancers with high immune infiltration in the tumor milieu, referred to as "hot" tumors, seem to ensure a better response to ICIs than the "cold" ones. BALF analysis may replace cancer tissue examination, which is of limited access in advanced stages, for the recognition of the nature of immune response in the tumor environment. Tumor mutational burden (TMB) was shown to correlate with a good response to ICIs, especially when combined with other anticancer therapies. The present paper demonstrates the results of recent studies on lung cancer characteristics which bring us closer to the definition of useful prognostic/predictive factors., (Copyright © 2019 Domagala-Kulawik.)

The overexpression of programmed death-1 (PD-1) and cytotoxic T cell antigen 4 (CTLA-4) receptors on T cells are among the major mechanisms of tumor immunoevasion. However, the expression pattern of these receptors on T cell subpopulations of a different activation status and at different sites is poorly characterized. Thus, we analyzed the expression of PD-1 and CTLA-4 on the naïve, activated, memory, and activated memory T cells. Bronchoalveolar lavage fluid (BALF) from the lung affected by lung cancer (clBALF), the opposite 'healthy' lung (hlBALF), and peripheral blood (PB) samples were collected from 32 patients. The cells were analyzed by multiparameter flow cytometry. The proportion of memory, activated, and activated memory CD8+ cells with the expression of PD-1 and CTLA-4 were elevated in the clBALF when compared to the hlBALF (insignificantly), but these proportions were significantly higher in the BALF when compared with the PB. The proportions of PD-1+ and CTLA-4+ T cells were elevated in the squamous cell carcinoma when compared to the adenocarcinoma patients. Also, the expression of PD-1 and CTLA-4 on T cells from the BALF was significantly higher than from PB. We report for the first time the differential expression of checkpoint molecules on CD4+ and CD8+ lymphocytes at a different stage of activation in the local environment of lung cancer. Moreover, the circulating T cells have a distinct expression of these receptors, which suggests their poor utility as biomarkers for immunotherapy.

Objectives: An immunotherapy was found to be effective in achieving long-term survival in some lung cancer patients. It has emerged to searching for new immune biomarkers for select the best candidates to this therapy. It is suggested that cancer stem cells (CSCs) are responsible for tumor initiation, maintenance and its metastatic potential. However, a role of CSCs in escape of cancer from immunosurveillance is unknown. The aim of the study was assess the phenotype of putative CSCs and to examine the expression of PD-L1 on CSCs in metastatic lymph nodes (LNs) in lung cancer patients., Material and Methods: Flow cytometry was used for CSCs evaluation in peripheral blood and EBUS/TBNA aspirates from N1,N2 lymph nodes in lung cancer patients., Results: Of 30 patients the LNs metastases were confirmed in 18 patients. We noticed presence of PD-L1 on putative lung CSCs- CD133 + EpCAM+ cells. A higher percentage of CD133 + EpCAM+PD-L1+ cells was observed in patients with metastatic in LNs- median value = 4.38% than in patients without LNs metastases- median value = 0,015% (p < 0.05). The highest proportion of PD-L1+ CSCs was found in adenocarcinoma patients and in those with oncogene addiction what indicate an particular biology of this type of lung cancer., Conclusion: The presence of CSCs with expression of PD-L1 in the metastatic LNs might suggest their immunogenic potential. EBUS/TBNA is commonly used in diagnosis and staging of lung cancer, so the analysis of the cells in metastatic LNs may fit in "immunoscoring" before immunotherapy.

Background: A minority of European countries have participated in international comparisons with high level data on lung cancer. However, the nature and extent of data collection across the continent is simply unknown, and without accurate data collection it is not possible to compare practice and set benchmarks to which lung cancer services can aspire., Methods: Using an established network of lung cancer specialists in 37 European countries, a survey was distributed in December 2014. The results relate to current practice in each country at the time, early 2015. The results were compiled and then verified with co-authors over the following months., Results: Thirty-five completed surveys were received which describe a range of current practice for lung cancer data collection. Thirty countries have data collection at the national level, but this is not so in Albania, Bosnia-Herzegovina, Italy, Spain and Switzerland. Data collection varied from paper records with no survival analysis, to well-established electronic databases with links to census data and survival analyses., Conclusion: Using a network of committed clinicians, we have gathered validated comparative data reporting an observed difference in data collection mechanisms across Europe. We have identified the need to develop a well-designed dataset, whilst acknowledging what is feasible within each country, and aspiring to collect high quality data for clinical research.

Objective: Menopausal asthma is considered a distinct asthma phenotype. Our aim was to identify potential specific features of asthma in postmenopausal women in a cohort of Polish females., Methods: Asthma severity and control, pulmonary function, exhaled nitric oxide (FE NO ), peripheral blood and induced sputum (IS) differential cell count were compared in three groups: women with premenopausal asthma (group 1), menopausal women with pre-existing asthma (group 2A) and menopausal women with asthma onset in the perimenopausal or menopausal period (group 2B)., Results: We enrolled 27 women to group 1, 13 to group 2A and 16 to group 2B. Asthma severity and control, blood eosinophil count and FE NO did not differ among the groups. Menopausal women had a higher incidence of irreversible airway obstruction (84.6% in group 2A and 56.2% in group 2B vs. 22.2% in group 1, p < 0.001 and p = 0.03, respectively). The proportion of patients with sputum eosinophilia was highest in menopausal women with pre-existing asthma, although the difference did not reach statistical significance (88.9% in group 2A vs. 66.7% in group 2B and 65.0% in group 1, respectively, p = 0.86)., Conclusions: Menopausal women with asthma are characterized by an increased incidence of irreversible airway obstruction regardless of disease duration. This may indicate that age may contribute to pulmonary function impairment in asthmatic women independently of their hormonal status at the time of asthma diagnosis. Our results failed to confirm the presence of specific asthma features which would allow to distinguish the phenotype of menopausal asthma.

Background: Fatigue is one of the most common and disabling symptoms of sarcoidosis. The cause of fatigue remains unclear and is usually multifactorial. The majority of previous studies evaluated clinical parameters with only few of them including assessment of psychological factors as contributing to the severity of the symptoms. Objective: The aim of this study was to evaluate the relationship of emotional distress, physical concerns, and dyspnea in explaining fatigue in patients with sarcoidosis. Methods: Fifty-seven patients with sarcoidosis were enrolled to the study and filled out measures of fatigue (FAS), dyspnea (MRC), anxiety sensitivity (ASI-3), and anxiety and depression (HADS). Results: Linear regression revealed that distress and physical concerns subscale of ASI are significant predictors of fatigue explaining jointly 53.5% of fatigue variance. Conclusions: The results of the study emphasize the importance of including emotional distress and physical concerns into the diagnostic procedures and management of fatigue in sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 160-164) ., (Copyright: © 2018.)

Nowadays, cancer immunotherapy is a promising strategy in solid tumour treatment. It has become a breakthrough in achieving long-term survival in many advanced cases. The essence of modern immunotherapy is to improve the host antitumour immune defence. Currently, it is critically important to determine the biomarkers that could be helpful in planning this type of individual therapy. It has turned out that an important prognostic factor is the evaluation of inflammatory infiltration of the tumour mass, including the characteristics of populations of lymphocytes and macrophages, and the expression of suppressive and regulatory molecules. For lung cancer, <30% of the tumours are resectable and available for a complete microscopic examination. In other cases, the material for the study of inflammatory infiltration may be a tumour biopsy, but this is of limited importance. A valuable way to evaluate the microenvironment of tumour growth is a bronchoalveolar lavage (BAL) fluid examination. In the BAL fluid, the cellular and noncellular components determine the specific type of inflammatory response in an environment of developing cancer. BAL fluid analysis may be a valuable addition to peripheral blood analysis during qualification for modern immunomodulatory therapy. Moreover, it is important material to seek biomarkers of clinical significance., Competing Interests: Conflict of interest Disclosures can be found alongside this article at breathe.ersjournals.com

Objective: The purpose of the study was to evaluate the relationship of an objective functional lung parameter (FVC) and a subjective psychological factor (physical symptom concerns) with dyspnea in sarcoidosis. Dyspnea constitutes one of the most common and burdensome symptoms in sarcoidosis, yet little is known about its mechanisms and, in particular, psychological., Method: A total of 107 hospitalized sarcoidosis patients (Female=50, M age =45.3years) volunteered to take part in the correlational research study. Participants underwent spirometry and completed the MRC Dyspnea Scale and the Anxiety Sensitivity Index-3 (ASI) questionnaire. Linear hierarchical regression analysis was used to determine the relationship between the studied predictors and dyspnea severity., Results: The best fitting model predicted 18% of variance in dyspnea severity. Physical symptom concerns subscale of ASI (β=0.24) and FVC (β=-0.23) were significantly related to dyspnea MRC severity, but only physical concerns remained significantly related to dyspnea when both predictors were in the model., Conclusions: The current results suggest that both psychological and physiological factors should be taken into account when explaining subjective dyspnea severity in sarcoidosis. More specifically, these findings call for including cognitive vulnerability factors related to anxiety (physical symptom concerns) into the diagnostic procedures and management of dyspnea in sarcoidosis., (Copyright © 2017. Published by Elsevier Inc.)

Regulatory T cells (Tregs) play an important role in the suppression of the immune response in lung cancer. Cytotoxic T-lymphocyte antigen 4 (CTLA-4) expressed on T lymphocytes is capable of downregulating cytotoxic T cells and is constitutively expressed on Tregs. Little is known about the population of Tregs with two forms of CTLA-4: surface (s) and intracellular (in) in the lung cancer environment. Th17 cells defined by production of IL-17 have pleiotropic functions in anticancer immune response. Our aim was to detect the elements of immune response regulation in lung cancer in three compartments: by analysis of bronchoalveolar lavage fluid (BALF) from the lung affected by cancer (clBALF), healthy symmetrical lung (hlBALF) and peripheral blood (PB) from the same patient. A total of 54 samples were collected. Tregs, (s)CTLA-4, (in)CTLA-4 were detected by flow cytometry with antibodies against CD4, CD25, Foxp3, CD127, CTLA-4, and concentration of IL-17 was estimated by ELISA. We observed a significantly higher proportion of Tregs in clBALF than in hlBALF or PB (8.5 vs. 5.0 vs. 5.1%, respectively, p < 0.05). The median proportion of (in)CTLA-4+ Tregs was higher in clBALF than in hlBALF or PB (89.0, 81.5, 56.0%, p < 0.05). IL-17 concentration was the highest in clBALF-6.6 pg/ml. We observed a significant correlation between the proportion of Tregs and (in)CTLA-4+ Tregs with IL-17A concentration in clBALF. We confirmed significant differences in the proportion of regulatory elements between cancerous lung and healthy lung and PB and the usefulness of BALF analysis in evaluation of immune response regulation in local lung cancer environment., Competing Interests: The authors have no conflict of interest.

A balance between tumor invasion and immune defence system is widely investigated. Objective . The aim of this study was to evaluate lymphocyte phenotype in lymph nodes (LNs) of patients with lung cancer in relation to the presence of metastases. Methods . We investigated 364 LNs resected by transcervical extended mediastinal lymphadenectomy (TEMLA) of 49 patients with squamous cell carcinoma (SCC) or adenocarcinoma (AD) with (A) and without metastases (B). Expression of CD4, CD8, CD25, CTLA-4, and Foxp3 was assessed by immunohistochemical staining. Results . We observed a strong nuclear staining for Foxp3 in lymphocytes and cancer cells and strong membranous/cytoplasmatic reaction for CD4 and CD8, but low for CD25 and CTLA-4. There were significantly higher proportions of CD8+ cells in AD (B) versus AD (A) LNs (80% versus 52.5%, p < 0.05). The Foxp3/CD8 ratio was higher in AD (A) versus AD (B) LNs (0.4 versus 0.25, p < 0.05). No significant differences in the cell markers expression in SCC LNs were found. Conclusion . Significant differences in lymphocyte phenotype in AD may indicate an exceptional biology of this type of lung cancer. TEMLA resected LNs may serve as valuable samples for evaluation of immune status in lung cancer patients.

Over a hundred years after the first description of this disease, lung cancer represents one of the major challenges in oncology. Radical treatment cannot be introduced in more than 70% of cases and overall survival rate does not exceed 15%. The immunosurveillance of lung cancer may be effective in early oncogenesis but is inhibited in the course of developing a clinically detectable tumor. Very low and heterogonous antigenicity of lung cancer cells leads to passive escape from anti-cancer immune defense. The cytotoxic lymphocytes (CTLs) that play a main role in the anticancer response are actively suppressed in the tumor environment and following regulatory mechanisms inhibit the recognition of tumor antigens by antigen presenting cells. The population of regulatory T cells (Tregs) is augmented and the expression of transcription factor-Foxp3 is markedly increased on tumor cells and tumor infiltrating lymphocytes (TIL). It is accomplished by M2 macrophage polarization, the activity of myeloid derived suppressor cells (MDSCs) and a significantly elevated concentration of cytokines: transforming growth factor beta (TGFβ) and IL-10 in the tumor microenvironment. Very active suppression of immune protection is the predominant role of the programmed death 1 (PD-1)-PD-L1 pathway. The blockage of this pathway was found to be an effective treatment approach; therefore the monoclonal antibodies are being intensively investigated in lung cancer patients. Cytotoxic T lymphocyte antigen-4 (CTLA-4) is the molecule capable of inhibiting the activation signal. The antibody anti-CTLA-4 improves CTLs function in solid tumors and lung cancer patients may benefit from use of this agent. The second way in lung cancer immunotherapy is production of anti-cancer vaccines using recognized cancer antigens: MAGE-A3, membrane associated glycoprotein (MUC-1), and EGF. It was recently shown in ongoing clinical trials that combined therapies: immune- and chemotherapy, radiotherapy or targeted therapy seem to be effective. Immunotherapy in lung cancer has an individual character-there is a need to assess the patient's immune status prior to implementation of immunomodulating therapy.

Lung cancer is a leading cause of cancer deaths. As a solid tumor with low antigenicity and heterogenic phenotype lung cancer evades host immune defense. The cytotoxic anticancer effect is suppressed by a complex mechanism in tumor microenvironment. The population of regulatory T cells (Tregs) plays a crucial role in this inhibition of immune response. Tregs are defined by presence of forkhead box P3 (Foxp3) molecule. The high expression of Foxp3 was found in lung cancer cells and in tumor infiltrating lymphocytes (TIL). Cytotoxic T-lymphocyte antigen 4 (CTLA4) is constitutively expressed on Tregs and suppresses T cell activation. The elevated CTLA4 expression in lymphocytes in patients with lung cancer was found. Recently the antibodies blocking CTLA4 showed some clinical efficacy in patients with lung cancer. Cancer cells and immune cells release many cytokines capable to show suppressive immune effect in cancer microenvironment. The most active are transforming growth factorβ (TGFβ) and IL-10. The pleiotropic function of Th17 population is TGFβ related. The myeloid lineage of suppressor cells in lung cancer is represented by tumor associated macrophages (TAM) with phenotype of M2 macrophages and some regulatory properties with releasing amounts of IL-10 and TGFβ. The myeloid derived suppressor cells (MDSCs) control cytotoxic T cell activity in mechanisms which are highly dependent on the context of tumor environment. The mechanisms of anticancer immune response regulation need further investigation as an important target to new way of treatment.

Background: Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. Previous studies demonstrated that patients with sarcoidosis had high rates of depression and anxiety, and high magnitude of stressful life events. To date, however, studies have not examined the anxiety sensitivity in sarcoid patients and the relationship between psychopathology and symptom severity of sarcoidosis.The aims of this study were to evaluate prevalence of depression and anxiety in sarcoid patients, to assess their relationship with the disease symptom severity, and to investigate the relationship between sarcoidosis and anxiety sensitivity., Methods: Thirty three sarcoid patients and thirty three control subjects completed the following:Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index-3., Results: The prevalence of depression (29%) and anxiety (31%) was high among patients and comparable to results from other research groups. Anxiety was significantly correlated with symptom severity and was the main covariate of physical symptoms reported by sarcoid patients. Patients exhibited an increase of their total anxiety sensitivity index and had an increased number of physical concerns., Conclusions: These data confirmed earlier reports that anxiety and depression are common in patients with sarcoidosis and expanded on the previous results by showing that patients exhibited increased anxiety sensitivity and a fear of physical sensations. These results, together with the findings that anxiety was associated with sarcoidosis symptom severity, suggest that targeting anxiety and the physical health concerns may be important in the diagnosis and management of this disease.

Sarcoidosis is a multiorgan granulomatous disease with frequent spontaneous remission. Apoptosis is postulated to participate in the granuloma resolution. Soluble Fas (sFas) is known to inhibit Fas-induced apoptosis. The aim of this study was to determine the sFas concentration in the BALf of ever smoking (S) and never smoking (NS) patients with sarcoidosis. We investigated 57 patients with confirmed SA: 36 NS and 21 S. The sFas concentration was measured by ELISA method. The sFas concentration was lower in the BALf of patients S group compared with NS (median values 68.3 vs. 96.1 pg/mL, p=0.07) and it was significantly lower in active smokers when compared with NS (62.9 vs. 96.1 pg/mL, p=0.03). There was a significant correlation between sFas concentration and proportion of lymphocytes and negative relation with macrophage proportion. Lower concentration of sFas in smoking SA patients may result in higher apoptosis rate of inflammatory cells and hereby promote resolution of granulomas., (Copyright © 2013 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.)

Introduction: Low-grade systemic inflammation plays an important role in the pathogenesis and natural history of chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD). The aim of the study was to analyze plasma concentrations of selected markers of inflammation in patients suffering from PAD with or without coexistent COPD., Material and Methods: Thirty patients (6 women) with advanced PAD (at least IIb stage according to Fontaine scale) hospitalized due to critical limb ischemia were examined. In all patients spirometry was performed to confirm or exclude COPD. Plasma concentration of IL-6, IL-8 and TNF-α was measured using ELISA method. Statistical analysis was performed according to COPD status and according to smoking status independently., Results: In the whole group of patients with PAD, COPD was recognized in 14 cases (for the first time in 10 cases). All patients were smokers (46.7% current, 53.3% ex-smokers). We found a significant correlation between FEV1%N (percent of norm of first second expiratory volume) and the number of years of smoking (r = -0.39; p < 0.05). We found similar concentrations of IL-6 (2.54 pg/ml vs. 2.31 pg/ml), IL-8 (8.55 pg/ml vs. 8.14 pg/ml, TNF-α (0.72 pg/ml vs. 1.75 pg/ml) in the COPD(+) group in comparison to the COPD(-) group (differences were not significant). We observed significant positive correlations (p < 0.05) between concentrations of measured markers and significant negative correlations between pain free walking distance and these markers., Conclusions: Our study confirmed coexistence of PAD with COPD. The character of inflammation is similar in these smoking-related diseases.

Unlabelled: Despite a number of important differences in the pathogenesis, course and prognosis of asthma and chronic obstructive pulmonary disease (COPD), these two entities also have common features with airway inflammation being one of them. Airway remodeling is a characteristic feature of asthma, but data on the bronchial wall thickening in COPD patients are still scarce., Aim: To assess the relation between the inflammatory cell count in the bronchoalveolar lavage fluid (BALF) and thickness of bronchial walls assessed by high resolution computed tomography (HRCT) in asthma and COPD patients., Material and Methods: The study was conducted in 9 patients with mild-to-moderate asthma (M/F 4/5, mean age 35 +/- 10 years) and 11 patients with mild-to-moderate COPD (M/F 7/4, mean age 57 +/- 9 years). In all subjects lung function tests and HRCT scanning of the chest were performed. External (D) and internal (L) diameters of the airways were assessed at five selected lung levels. The lumen area (A(L)), wall area (WA), wall thickness (WT) and bronchial wall thickness (WT/D ratio) were calculated. Eight patients with asthma and 8 patients with COPD underwent fiberoptic bronchoscopy and bronchoalveolar lavage (BAL). Total and differential cell counts were assessed in the BAL fluid., Results: Mean FEV(1)% pred was 80 +/- 19%, and 73 +/- 20% in asthma and COPD patients, respectively (NS). No significant differences in the total and differential cell counts in BALF were found in patients with asthma and COPD. There were no significant differences in the airway diameter or airway wall thickness. The mean inner airway diameter was 1.4 +/- 0.3 and 1.2 +/- 0.3 mm and the mean lumen area was 1.8 +/- 0.7 and 1.6 +/- 0.7 mm(2) in asthma and COPD, respectively (NS). Negative correlations between the eosinophil count in BALF and inner airway diameter (r=-0.7, P<0.05) and lumen area (r=-0.7, P<0.05) were found in asthmatics. There was no significant relationship between the BALF cell count and airway wall thickness in COPD patients. -, Conclusions: In mild-to-moderate asthma and COPD the airway diameter and thickness are similar. In asthmatics, the airway diameter might be associated with eosinophil count in BAL fluid.

The influence of tobacco smoke on human health is still an important problem worldwide. Complex inflammatory processes and changes in the immune system are crucial in the pathogenesis of smoking related disorders like chronic obstructive lung disease (COPD), lung cancer, atherosclerosis. The objective of this review is to present the alterations in the immune system in smokers. The main affected system by cigarette smoke (CS) is the respiratory tract. In bronchial epithelium metaplastic and dysplastic changes are accompanied by elevated expression of adhesion molecules and secretion of many cytokines capable of stimulation immune cells influx. In the population of pulmonary macrophages an elevated proportion of cells, changes in expression surface markers with impaired phagocytic and antigen presenting function are observed. Chronic exposure to CS causes increased production of metalloproteinases (MMP) by macrophages and proteolitic enzymes by neutrophils. These enzymes cause destruction of alveolar wall. Increased apoptosis of lung tissue results in augmentation of foreign material which may play a role of autoantigen and which is a target for cytotoxic/suppressor cells. The role of regulatory T (Treg) cells in this process is recently postulated. Smoking cessation is the most effective method of prophylaxis and treatment of diseases related to tobacco smoking. However many immunological changes in smokers are not completely reversible after quitting smoking.

Eosinophilic airway inflammation is regarded as a typical feature of asthma, while in chronic obstructive pulmonary disease (COPD) neutrophils seem predominant inflammatory airway cells. The aim of the present study was to compare the cellular components of airway inflammation in patients with newly diagnosed mild or moderate COPD and asthma. Seventeen patients with COPD (M/F 10/7, aged 57 +/-11 yr) and 22 patients with asthma (M/F 12/10, aged 36 +/-14 yr) were enrolled into the study. None of the patients has been treated with steroids for at least 3 months. All patients underwent clinical examination, laboratory examinations, skin-prick tests, pulmonary function tests, methacholine challenge test, and sputum induction with the total and differential cell count assessments. We found increased number of eosinophils in both study groups. However, there were no significant differences in the cellular composition of induced sputum between the asthma and COPD patients. We conclude that eosinophils are important inflammatory cells not only in asthma, but also in COPD.

Although the clinical pictures of asthma and chronic obstructive pulmonary disease (COPD) may be similar, the pathogenesis differs in many aspects. The aim of the present study was to compare the cellular and biochemical features of airway inflammation in patients with asthma and COPD. The study was conducted in 22 patients with asthma (M/F 12/10, mean age 36 +/-14 years) and 17 patients with COPD (M/F 10/7, mean age 57 +/-11 years). Each patient underwent sputum induction followed by bronchoscopy, and bronchoalveolar lavage. Total and differential cell counts and the concentration of interleukin-8 (IL-8) and myeloperoxidase (MPO) were measured in induced sputum (IS) and BALF. We found no significant differences in the total and differential cell counts in IS between asthma and COPD patients. However, COPD patients showed an increased total macrophage count in BALF compared with asthma patients. The relative eosinophil count in BALF was significantly higher in patients with asthma vs. COPD. The concentration of IL-8 in IS and BALF was significantly higher in patients with COPD vs. asthma patients. The BALF concentration of MPO was significantly higher in patients with COPD compared with asthma patients. We conclude that the comparison of cellular composition and the concentration of inflammatory mediators in IS does not differentiate between asthma and COPD. The evaluation of BALF reveals more differences in the cellular and biochemical features of airways inflammation in patients with asthma and COPD than that of IS.

Some of interstitial lung diseases have a potential relation to tobacco smoking and are known as smoking-related interstitial lung diseases (sr-ILD). The aim of this study was to present the typical features in bronchoalveolar lavage fluid (BALF) of patients with sr-ILD with special account to the morphology of alveolar macrophages. We have found typical features of sr-LD in 18 patients with interstitial lung disease. All patients were smokers. Pulmonary function was moderately impaired. Control group consisted of 12 asymptomatic smokers and 18 healthy nonsmokers. The median total cell count in BALF of patients with desquamative interstitial pneumonia was 64.5 x 10(6) and was much higher than in asymptomatic smokers--9.0 x 10(6), and healthy nonsmokers--3.25 x 10(6). A high proportion (mean 90%) and number (55.5 x 10(6)) of macrophages with the predominance of pigmented cells was found. Mean proportion of CD14 positive macrophages was 6%, and of CD54 positive macrophages - 62%. We concluded that features in BALF typical for sr-ILD are uncommon among routinely evaluated specimens, but differ markedly from other forms of ILD.

The objective of the present study was to evaluate the prevalence of chronic cough causes and to compare the efficacy of two diagnostic approaches used in ambulatory vs. hospitalized setting. Eighty patients with chronic cough, 40 in each group, were enrolled into the study. The etiology of cough was determined on medical history and on either basic (in out-patients) or detailed (in in-patients) investigations on most common causes of chronic cough. We diagnosed etiology of cough in all subjects. The most frequent causes of cough were gastroesophageal reflux disease (GERD) and upper airway cough syndrome (UACS). Nonasthmatic eosinophilic bronchitis (NAEB) and multiple cough causes were recognized more often in hospitalized patients (P<0.05). We conclude that the main causes of chronic cough were GERD and UACS. An extensive diagnostic approach allows recognizing NEAB more frequently and reveals the complex nature of chronic cough.