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Introduction: Spirometry is an excellent tool in diagnosis of airway obstruction, but is less reliable in restrictive diseases. Diagnosis of lung restriction on the ground of reduced forced vital capacity (FVC) is saddled with a lot of mistakes. According to American Thoracic Society/European Respiratory Society (ATS/ERS) 2005 guidelines restrictive pattern in spirometry consists of a reduction in vital capacity and increase in forced expiratory volume in 1 second/vital capacity (FEV(1)/VC) 〉 85-90%. However, to our knowledge, this recommendation has not been validated. The aim of the study was to check how inclusion of an increased FEV(1)/FVC as a mandatory condition affects value of spirometry in detection of restrictive ventilatory defect., Material and Methods: Material consisted of pulmonary test results obtained from consecutive patients referred to our lab during the year 2009, who had undergone spirometry and lung volumes measurements at the same visit., Results: Out of 1739 test results, 1402 non-obstructive patients, 679 females (48.4%) and 723 males (51.6%); mean age 49.7 ± 14.5 years were included into analysis. ERS 1993 reference equations were applied to all parameters. Lower limit of normal was set at -1.645 SR level. Restrictive ventilatory defect (TLC 〈 LLN) was found in 283 patients (20.2%). Reduced FVC only, as a condition of restrictive ventilatory defect diagnosis, was found in 202 patients (14.4%) (sensitivity 59%, specificity 97%). Reduced FVC together with increased FEV(1)/FVC 〉 85% was found in only 76 patients (5.4%) (sensitivity 23%, specificity 99%). Only 14% of mild, 26% of moderate, and 64% of severe restriction could be detected with reduced FVC and increased FEV(1)/FVC condition., Conclusions: Dual condition of reduced FVC and increased FEV(1)/FVC greatly diminishes sensitivity of the test, and hampers diagnosis of restrictive ventilatory defect in spirometry, especially in mild and moderate stages.

Unlabelled: Obstructive sleep apnea can be associated with daytime chronic hypercapnia in some patients, but the prevalence of the phenomenon is highly variable in the published literature. The most often it is found in patients with coexisting COPD. There is also an evidence of persisting hypercapnia in OSA patients without other respiratory disease. In previous studies lung function impairment, obesity, gender, severity of OSAS have been considered to contribute to daytime hypercapnia. Several studies demonstrated that the defect in control of breathing can play a role in the development of chronic hypercapnia in patients with OSAS. The aim of the study was to estimate respiratory responses to hypercapnic stimulation in patients with OSAS and chronic daytime hypercapnia. Material consisted of 38 patients with OSAS and chronic hypercapnia (COPD was present in 24-group B, "pure" OSA in 14-group A) and 40 normocapnic OSA patients (group C). Lung function testing, blood gases and chemical control of breathing tests were performed in all of them before initiating therapy with nCPAP. Diagnosis of OSAS was stated with standard polisomnography and AHI was similar in mentioned groups., Results: Respiratory responses to hypercapnic stimulation were significantly lower in hypercapnic patients (A 10.6+/-4.6; B 9.5+/-5.6) in opposition to normocapnics (C 23.3+/-14.0 l/min/kPa). In all studied patients PaCO2 level significantly correlated with respiratory responses to hypercapnic stimulation (r=-.61), lung function indices (VC r=-.69 and FEV1 r=-.71), mean SaO2 during sleep (r=-.68), and BMI (r=.49), but not with the factors like age, AHI or minimal SaO2 during sleep. Analysis with multiple regression revealed that hypercapnic drive, mean SaO2 during sleep, FEV1 and BMI were the best predictors of hypercapnia in studied group, being responsible for 72% of the total variance in PaCO2 in our OSA patients (R2=0.72; p<0.0001)., Conclusion: predisposition to daytime hypercapnia in our OSA patients was related to dimished chemosensitivity to CO2, mean desaturation during sleep, the severity of obesity and impairment of lung function mainly due to coexisting COPD.

Unlabelled: Reduction of FEV1%FVC ratio together with lowered FVC often is interpreted as "mixed" ventilatory disturbances. The aim of this study was to evaluate the real frequency of the overlapping obstructive and restrictive impairments in patients with FEV1%FVC<0.7 and FVC<80% of predicted, which is often described as "mixed" ventilatory defect., Material and Methods: Retrospective, cross-sectional analysis of pulmonary function data. Only 748 out of 6673 patient's data met inclusion criteria: performed bodypletysmography and FEV1%FVC<0.7 together with FVC<80%pred. in spirometry. In all cases spirometry and whole body pletysmography were performed according to ERS standards by experienced staff using MasterLab-"Jaeger" equipment. Reference values according to ERS guidelines were applied., Results: We found volume restriction defined as TLC below lower limit of normal in only 17% of the patients. There was also inverse correlation between FEV1%pred. and RV%TLC%pred. ratio. So, the basic mechanism of reduction in VC and FVC in patients with normal TLC is increased RV., Conclusion: "Mixed" ventilatory impairment in majority cases represents airway obstruction with lung hyperinflation. Such a coincidence of reduced FVC and FEV1%FVC ratio requires further investigations (pletysmography) to clarify the reason for the diminished vital capacity.

Diagnosis of tuberculosis is based on clinico-radiological symptoms and on identification of mycobacteria. Accuracy of both methods is limited. Therefore reliable serologic test would have considerable advantage. The goal of our study was to evaluate serologic response against A60 mycobacterial antigen in group of 270 patients (pts) (137 pts with active tuberculosis (TB), 15 pts with mycobacterial infections other than TB (MOTT), 58 pts with sarcoidosis, 26 pts with lung cancer and 34 healthy controls. We used commercially available ELISA based kits against antigen A60 (ANDA-TB). Specificity of 87% for IgG, of 94% for IgA and for IgM, of 85% for IgG + IgA, of 89% for IgA + IgM, of 80% for IgG + IgM, and of 79% for IgG + IgA + IgM was achieved. Sensitivity of 40% for IgG, of 30% for IgA, of 18% for IgM, of 56% for IgG + IgA, of 35% for IgM + IgA, of 50% for IgG + IgM, and of 59% for IgG + IgA + IgM was obtained. The results demonstrated that humoral response differs depends on the immunoglobulin class. Measurements of IgG or IgG and IgA as most sensitive against A60 are potentially more useful serological tests in clinical practice. It is not recommended to use tests based on antigen A60 for differentiation tuberculosis and MOTT.

We investigated cellular composition of bronchoalveolar lavage fluid and changes in pulmonary function tests in patients with histopathologically proven sarcoidosis. We analyzed BAL, lung volumes, lung compliance, and diffusing capacity in 33 nonsmoking patients (18 males, 15 females, age 22-60 years, mean 40 years). In 39% of the patients we observed decreased static compliance and in 18% of patients reduction in diffusing capacity. The total cell count, percentage of lymphocytes and CD4/CD8 ratio and pulmonary function parameters in I, II and III radiological stages of sarcoidosis were similar. We found a moderate negative correlation between the carbon monoxide diffusing capacity (DLco% of pred.) and CD4/CD8 ratio (r = -0.40, p < 0.05). No correlation was observed between other pulmonary function indices and total cell count in BAL, percentage of lymphocytes and CD4/CD8 ratio. Our results suggest, that reduction in diffusing capacity may reflect an insensitivity of alveolitis, but correlation is moderate and it usefulness for making therapeutic decision is not clear.

Patients with OSA have many episodes of increased airway resistance because of repeated collapses of upper airways during night. The aim of this work was to evaluate respiratory response during chemical stimulation without and with added inspiratory resistive load (10 cmH2O/L/sec). The studies were performed during quiet breathing with air and during hypercapnic and hypoxic rebreathing tests without and with inspiratory resistive loading in 23 obese (BMI = 34.4 +/- 4.3 kg/m2) patients with OSA and in 10 healthy subjects with similar weight (BMI = 32.4 +/- 4.3 kg/m2). The measurements of respiratory responses (ventilation, mouth occlusion pressure) were performed with the use of computerized equipment. During quiet breathing in response to added load an increase of P0.1 in controls and in OSA patients was observed. During hypercapnic stimulation the ventilatory response with additional load decreased in patients as well as in controls. The slope of mouth occlusion pressure response increased significantly in controls (from 4.40 to 6.83 cmH2O/kPa, p < 0.001) and slightly weaker in OSA patients (from 4.21 to 5.43 cmH2O/kPa, p < 0.05). Although the difference between the slopes was not significant, we found that the absolute increase of P0.1 measured at point 8 kPa of PEtCO2 during loaded breathing was significantly smaller in OSA patients in comparison to controls. (2.1 vs. 10.3 cm H2O; p < 0.001). During hypoxic stimulation occlusion pressure responses were similar in both examined groups. In conclusion we postulate that OSA patients have impaired respiratory compensation of additional inspiratory load, what was demonstrated during hypercapnic rebreathing test.

Work place environment plays an important role in development diseases because of the time spend in and different toxic factors placed in it. The aim of study was to assess the ventilatory efficiency in individuals employed in Generating Plant (GP) in relation to the pollution of the work place and the tobacco smoking habit during 3 years. The study covered a group of 144 male individuals employed at GP. (age 39.3 +/- 8.7 yrs, period of employment 20.3 +/- 8.6 yrs, smokers 53.5%. Lung function tests consisted of VC, FVC, FEV1, FEV1%VC, PEF, FEF50 counted from flow-volume curve and TGV, Rt measured using pletysmographic method. All tests were performed using pletysmograph (Masterlab) "Jaeger" placed on the ambulance near to the work place. The measurements were taken in May 1993 and 1996. Results were compared to with normal values (acc. ECSC). The anamnesis was obtained from all workers in the form of questionnaire projected for this study. All measurements were done during work time (9.00 a.m. to 2.00 p.m.). Mean values of the ventilation indices remained within the normal range but comparing results in smokers and non-smokers group significant differences in FEV1 and TGV were found. The symptoms of chronic bronchitis were present in 20.8% of persons. Spirometric criteria for the COPD diagnosis were found in 16 persons (11%). Only 5 persons (31%) were symptomatic. The mean decrease of FEV1 was 16.2 ml/yr, in the COPD group it was 82.5 ml/yr. The greater annual loss of FEV1 was found in the smokers and symptoms groups.

Unlabelled: The aim of this study was to evaluate the influence of the work place environment on the function of the respiratory system., Material: Study covered 211 male from Mechanical Plant of Plock Refinery (M.P. group 1) and the control group consisted of 53 male employed in Design Office (D.O. Group II). Group I was exposed to toxic substances (NO2, SO2, dust, manganese and iron oxides)., Methods: Lung function tests were performed using laboratory "Compact-Lab" (JAEGER). The FVC, FEV1, FEV1%FVC, PEF, FEF50 were obtained from flow-volume curve and TGV, Rt measured using plethysmography method. Information concerning symptoms and cigarette smoking were obtained from questionnaire designed for this study., Results: Mean values of respiratory indices were within normal range and did not differ between groups. The percentage of abnormal results was similar in groups. Air flow limitation (FEV1%FVC < 70%) was observed in 15.2% of total. Smokers have had significantly lower indies of air flow limitation but still within normal range. Symptoms (cough, expectoration, dyspnea) were equally frequent in M.P. and D.O. and significantly more frequent in smokers., Conclusion: In our study we did not find the influence of work place environment on the function of the respiratory system.