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Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. A cost-of-illness study aims to determine the total economic impact of a disease or health condition on society through the identification, measurement, and valuation of all direct and indirect costs. Exacerbations are believed to be a major cost driver in COPD. The aim of this study was to examine direct, mean costs of COPD in Poland under usual clinical practice form societal perspective.It was an observational bottom-up-cost-of-illness study, based on a retrospective sample of patients presenting with COPD in pulmonary ambulatory care facilities in Poland. Total medical resources consumption of a sample were collected in 2007/2008 year by physician - lung specialists. Direct costs of COPD were evaluated based on data from different populations of five clinical hospitals and eight out-patient clinics. Resources utilisation and cost data are summarised as mean values per patient per year. 95% confidence intervals were derived using percentile bootstrapping.Total medicals resources consumption of a COPD patient per year was 1007 EURO (EUR 1 = PLN 4.0; year 2008). Among this cost 606 EURO was directly related to COPD follow up, 105 EURO was related to ambulatory exacerbation, and 296 EURO was related to exacerbation treated in hospital.The burden of COPD itself appeared to be considerable magnitude for society in Poland.

The right management of patients with pneumonia is crucial for effectiveness of therapy and decrease of patient mortality. There are few classifications of type and severity of pneumonias. In clinical practice the most useful is division on community and hospital acquired infections. This paper concerns recommendations and information for diagnosis and treatment of community-acquired pneumonia and hospital-acquired pneumonia.

THE AIM OF STUDY was the evaluation of occurrence frequency of increased concentration of p53 protein in serum of patients with COPD or NSCLC.Participants have been enrolled to the one of three studied groups: patients with COPD, patients with NSCLC and healthy subjects. In each patient serum concentration of p53 protein was measured with ELISA method (photometric immunoassay ELISA, ROCHE Molecular Biochemicals, Manheim, Germany). Comparative analysis of frequency of p53 occurrence in serum in three studied group has been done with respect to nicotine addiction in COPD and NSCLC groups. Chi-squared test was used for statistical analysis. 95% confidence interval was set for statistically significant differences.164 participants was enrolled to the study including: 53 with NSCLC, 59 with COPD and 52 healthy control. Presence of p53 protein in serum was observed in 45% of patients with NSCLC, 34% of patients with COPD, and in 11.5% healthy people. In healthy subjects increased serum concentration of p53 was found out significantly more seldom than in COPD (p = 0.006) and NSCLC (p = 0.0001) groups. There was no significant difference between prevalence of p53 protein in serum of patients with NSCLC or COPD (p = 0.2).P53 protein is observed in serum three times more often in patients with COPD than healthy subjects. Preasumably, chronic inflammation in bronchial tree in course of COPD could be predisposing factor for p53 mutation and synthesis of pathological p53 protein.

Exacerbations of chronic obstructive pulmonary disease (COPD) cause a lot of hospital admissions, mortality, and strongly influence health-related quality of life. Approximately half of COPD exacerbations are associated with bacterial infections and many patients have lower airways colonization. Current guidelines recommend antibotic therapy in course of COPD exacerbation for patients with sputum purulence and suggest correlation between severity of symptoms and the type of infecting pathogen. The most common bacterial pathogens isolated in COPD exacerbation are Haemophilus influenzae and parainfluenzae, Streptococcus pneumoniae and Moraxella catarrhalis. The presence of these bacteria are more common for mild and moderate exacerbations. More virulent organisms such as Staphylococcus aureus and Pseudomonas aeruginosa have been found in more severe cases. Atypical pathogens such Chlamydophila and Mycoplasma could cause exacerbation alone or they could coexist with typical pathogen. Rules of antibiotic therapy and usefulness of macrolides in treatment of COPD exacerbation has been described in the article.

Pharmacoeconomics is the scientific discipline that assess the overall value of pharmaceutical health care products, services, and programs. Several potential uses for pharmacoeconomic analysis are pharmaceutical reimbursement, price negotiations, formulary discussions, clinical practice guideline developments, and communications to prescribing physicians. Bronchodilatator medications, including SABA (slow acting beta-2 agonists) and LABA (long acting beta-2 agonists) are central to the symptomatic management of COPD. LABA in Evidence Based Medicine related treatment of COPD patients is presented in this article. In the second part issues regarding the limitations and interpretations of COPD clinical trials have been discussed. The important role of cost-effectiveness analyses in LABA reimbursement and drug pricing strategy in Poland have been stressed.

Tuberculosis is a contagious disease induced by Mycobacterium species, acid-fast bacilli. These are mostly human type--Mycobacterium tuberculosis, less often cattle type--mycobacterium bovis or other: mycobacterium avium, kansasii, marinom, scrofulaceum, heamophilium, gordonae. The infection can affect all organs, but pulmonary tuberculosis is the most common form. The importance of tuberculosis is definitely rising in the context of massive population migrations in regions affected by its higher incidence, increased HIV infections and AIDS development. Cutaneous tuberculosis is a particular tuberculosis form with differentiated clinical picture. Non-typicalness of skin changes and oligobacilleous course of extrapulmonary tuberculosis forms are repeatedly causing difficulties in adequate diagnosis and early treatment. In differential diagnostics of cutaneous tuberculosis one must take leishmaniasis, actinomycosis, leprosy, syphilis and deep mycosis (among others) into consideration. The study is presenting a case of lupus vulgaris as a complication of past pulmonary tuberculosis. In bacteriological diagnostics of skin changes bioptates, no tuberculosis mycobacteria were found. The disease was diagnosed based on specific granulation presence in histopathology test, tuberculin hypersensivity, bacilli DNA presence in polymerase chain reaction (PCR) test and skin changes regression after anti-mycobacterium treatment. According to authors of the study, the described case confirms the usefulness of PCR nucleonic acids amplification test in cutaneous tuberculosis diagnosis.

The paper introduces a case of 50 years old women who was diagnosed because of solid focal lesions in the lungs with coexist hypereosinophilia in blood smear. During diagnostics neoplastic and infectious diseases were excluded. In the meanwhile secondary causes of hypereosinophilia was not found. The diagnosis of the hypereosinophilic syndrome was diagnosed and atypical (solid) character of focal lesions in the lungs was underlined.

Aeroallergens play an important role in atopic dermatitis (AD). This role is confirmed by widely used skin prick tests and total and specific class E antybodies levels assays. Atopy patch tests (APT) are a new diagnostic method. The aim of this study was to assess the correlation between APT results and specific class E antibodies levels.115 subjects with AD were examined. APT were done using a single allergen extract or their mix from commercially available reagents from Stallergenes (France). The determination of antigen specific IgE (sIgE) were done with fluoroimmunoenzymatic assay using Pharmacia CAP System FEIA set from Pharmacia-LKB (Sweden).Hyperreactivity to house dust mite mix was proved by APT in 45,2%, birch pollen in 32,2%, grass pollen mix in 22,6%, and cat dander in 15,7% of subjects. Increased level of sIgE against house dust mite allergens were proven in 42,6%, against birch pollen allergens in 30,3%, against grass pollen mix allergens in 43,1% and against cat dander allergens in 31,8% of examined subjects. The correlation between positive APT results and increased specific IgE levels was not statistically significant. The intensification of positive APT reactions was correlated positively with the specific IgE levels of allergens against house dust mite, birch pollen, and cat dander.Conducted studies are indicating that APT can be an usefull AD diagnostic tool and are complementing all existing methods.

Exacerbations are the key drivers of the costs of chronic obstructive pulmonary disease (COPD). This was the multicenter study of patients with COPD aimed at evaluating direct and indirect cost of exacerbations under usual clinical practice in primary and secondary care form societal perspective.It was observational, multicenter study with participation of 196 subjects with moderate or severe COPD, defined according to the current GOLD criteria. Patients presenting at the selected health care centres were included into the study in the sequential manner if they fulfilled the inclusion criteria. Exacerbations were divided into three different severity types according to Anthonisen N.R. classification. The management of exacerbations followed the usual clinical practice.The number of exacerbations was 3.8 (3.2-4.4) in hospitalised patients and 1.7 (1.4-1.9) in ambulatory treated patients (1EURO was 3.85 PLN in 2007). The average direct health-care cost per exacerbation was PLN 5548 (95% CI = 4543; 6502) and PLN 524.1 (95% CI = 443; 614) in secondary and primary care respectively. In secondary care, the drug acquisition and oxygen therapy cost represented 18.3% of total direct costs, diagnostic tests costs accounted for 14.5%, the other hospital care and post-discharge followup visit costs 67%. Costs varied considerably with the severity of COPD before the exacerbation as well as the duration of COPD. In primary care the cost structure was as follows: diagnostic tests and medical devices 47.5%, drug acquisition costs 41% and doctors visits 11.4%. The average indirect costs per exacerbation were PLN 127.78 and PLN 100.56, in secondary and primary respectively (n.s)Exacerbations of COPD are costly. Cost of exacerbation managed in secondary care is almost 10-fold higher than in primary care. Prevention of moderate-to-severe exacerbations, requiring hospitalization could be very cost-effective strategy.

Community acquired pneumonia (CAP) is the sixth leading cause of death. Atypical pneumonia caused by Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila accounts for up to 40% of all cases of CAP. Atypical pneumonia due to Mycoplasma and Chlamydophila usually cause milder forms of pneumonia and are characterized by a more drawn out course of symptoms unlike other forms of pneumonia which can come on more quickly with more severe early symptoms. Mycoplasma pneumonia often affects younger people and may be associated with symptoms outside of the lungs (such as anemia and rashes), and neurological syndromes (such as meningitis, myelitis, and encephalitis). Severe forms of Mycoplasma pneumonia have been described in all age groups. Chlamydophila pneumonia occurs year round and accounts for 5-15% of all pneumonias. It is usually mild with a low mortality rate. In contrast, atypical pneumonia due to Legionella accounts for 2-6% of pneumonias and has a higher mortality rate. Elderly individuals, smokers, and people with chronic illnesses and weakened immune systems are at higher risk for this type of pneumonia. Contact with contaminated aerosol systems (like infected air conditioning systems) has also been associated with pneumonia due to Legionella. All of known macrolides, including azythromycin and clarythromycin, have excellent activity against the atypical respiratory pathogens. The are primarily bacteriostatic, by binding to the 50S subunit of the ribosome, they inhibit bacterial protein. The potential indications for treatment lower respiratory tract infections with macrolides were presented in this study.

Airways have a highly sophisticated immune defense system, so an excessive or inappropriate inflammatory response can result in development of numerous complications of respiratory tract diseases. During inflammation, due to increased metabolism of various immune system cells, free oxygen radicals and other chemical compounds are produced, which enhance oxidative stress, playing an important role in the pathogenesis of numerous pulmonary diseases, such as bronchial asthma, cystic fibrosis or COPD. Influence of antibiotics, not related to their bactericidal or bacteriostatic properties, on activity of the immune system is the subject of numerous studies and controversies. Immunomodulatory effect of antibacterial drugs can pose an additional therapeutic benefit, but also can cause an undesirable modification of immune processes as a result of hampering cell immunity or promoting an inflammatory response. It is thought that numerous antibiotics and chemotherapeutics can exert a nonspecific influence on inflammation activity, and such effect can be positively related to the concentration of a particular drug in immune system cells, especially in neutrophils. In some researches immunomodulatory effect of macrolides has been proven. The review presents current knowledge on the modulating properties of macrolides and possibilities of making use of theirs in a treatment of the lung diseases.

Atypical bacteria, including Mycoplasma pneumoniae, Chlamydophila pneumonia and Legionella pneumophila play significant role in respiratory tract infections and account for 40% of all cases of community acquired pneumonia (CAP). These organisms also commonly occur as co-pathogens in mixed infections with mortality rates as high as 25%. The biological mechanisms and diagnosis of atypical infections is presented in this study.

Community-acquired pneumonia (CAP) is a serious lower respiratory tract infection associated with significant morbidity and mortality. Among etiologic pathogens, atypical bacteria, including Mycoplasma pneumoniae and Chlamydophila pneumoniae, Legionella pneumophilla are important. The etiologic diagnosis of these infections still remains difficult. This is mainly due to the absence of characteristic clinical findings and the available detection methods. The potential role of atypical bacteria infection in pathogenesis of asthma is a subject of continuing debate. Macrolides are antibiotics with both antimicrobic and anti-inflammatory activities and thus their use in asthmatic patients could lead to reduction of the airways inflammation and therefore improvement of symptoms and pulmonary function. According to Cochrane Database of Systematic Reviews, there is insufficient evidence to support or to refute the use of macrolides in patients with chronic asthma. The possible role of an association between atypical bacterial infection in antibacterial therapy in the management of asthma and the need for well-designed studies to investigate this is discussed in this article.

Evaluation of the relationship between telomerase activity in transthoracic fine-needle biopsy (TFNB) aspirates collected from peripheral non-small cell lung cancer (NSCLC), cancer advancement, risk of death and free of cancer recurrence survival.The study group consisted of 93 patients with peripheral infiltration of the lung. All of them had TFNB of the focal pulmonary lesion performed. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. Cancer advancement, manner of treatment and survival were assessed in patients with NSCLC.A benign lesion of the lung was recognised in 14 cases. NSCLC was newly diagnosed in 79 subjects. Nobody with benign infiltration had a detectable level of telomerase in lung infiltration. Increased telomerase activity was observed in 56 (70.9%) patients with lung cancer. It was significantly more often detected in patients with non-operable NSCLC (clinical stage IIIB plus IV) and patients with distant metastases (stage IV alone). Cox hazard analysis revealed that presence of telomerase activity in primary NSCLC is an independent prognostic factor of survival. Increased telomerase activity in TFNB aspirates was related to 7 times higher relative risk of death during the study [RR=6.9 (CI: 1.8-26.8); p0.05] and 2.5 times higher risk of cancer recurrence after radical treatment [RR=2.5 (CI: 0.3-9.3); p0.05].Telomerase activity in aspirates collected through TFNB of primary peripheral NSCLC could be a helpful independent prognostic factor of distant metastases and risk of death or cancer recurrence.

The aim of the study was to evaluate knowledge about tobacco toxicity among patients hospitalized in Department of Internal Diseases, Pneumonology and Allergology in Warsaw and to examine their quality of life. The study comprised 51 people at age between 18-80 years, from Warsaw and its environs. They were hospitalized because of many reasons like: COPD or asthma exacerbation, cough and focal pulmonary lesions diagnostics, follow-up examinations because of sarcoidosis or pulmonary fibrosis. Data for analysis were achieved from anonymous questionnaire prepared by authors and filled by patients. Quality of life was assessed with EQ-5D Questionnaire. The tobacco addiction rate was assessed with the Fagerström questionnaire, and the motivation to quit smoking with the Schneider test. It was found that only 14% of hospitalized patients have never smoked cigarettes, 86% smoked in the past, and 29% declare regularly smoking in present. The most common pointed tobacco-related diseases were lung cancer and hearth diseases. People hospitalized because of COPD exacerbation (CHPOChP) had significantly lower level of quality of life than patients hospitalized because of asthma exacerbation (CHA) (p = 0.03), and this both groups had significantly lower level of quality of life than persons without obstructive pulmonary diseases (NCH) (NCH - CHPOChP p = 0.0004; NCH - CHA p = 0.04). The motivation to quit smoking in COPD smokers group was significantly lower than in group treated in the hospital because of other reasons (p = 0.004).

The aim of the study was the evaluation of influence of age, intensity of smoking habit and FEV1 value on the costs of inhospital treatment of COPD exacerbations. 71 cases of COPD exacerbation in current smoking males hospitalized in the Military Institute of Health Service in Warsaw were analyzed. The mean age of subjects was 68.8 +/- 9.5, the mean predicted value of FEV1 49.2 +/- 20.2% and the mean period of hospitalization 7.1 +/- 2.9 days. The mean smoking index (expressed in pack-years) was 41.9 +/- 17.7. The mean direct expenditure for treatment of COPD exacerbation per person amounted to PLN 2187.8 +/- 941.6 and included the cost of medical care PLN 1375.9 +/- 573.6, the cost of drugs PLN 393.3 +/- 287.5 and the cost of additional examinations PLN 415.5 +/- 200.4. In statistical analysis, multiple regression model was used and partial correlation coefficients were calculated for significantly different variables. No influence of age and predicted FEV1 value on the costs of COPD exacerbation was found. A significant relationship was found between the smoking index (expressed in pack-years) and disease severity, on the one side, and the direct costs of exacerbation treatment (r=0.281 and r=0.301 respectively, p0.05). In active smokers male with COPD, smoking index and degree of the disease severity are independent factors, which equally strong determine the direct costs of hospital treatment of COPD exacerbation.

Inhaled glucocorticosteroids are the first choice drugs in the treating of patients with chronic bronchial asthma. Despite the fact that they are considered safe, in some percentage of patients they may cause local and even systemic side effects. Most of those side effects result from low lung / body deposition index of many glucocorticosterois and action of active metabolites of the drugs already in the oral cavity and throat. Ciclesonide is a new steroid characterized by clinical efficacy comparable to that of fluticasone and a lower risk of side effects. Ciclesonide is a prodrug, which is converted into an active metabolite by lung esterases only in the peripheral airways. Due to the use of a novel aerosol propellant--hydrofluoroalkane, available ciclesonide preparations are characterized by a high lung deposition. It is also characterized by low absorption to the systemic circulation. The article presents an current knowledge on pharmacokinetics, clinical efficacy and safety of ciclesonide in patients with bronchial asthma.

The aim of the study was to examine an alexithymia score and depression among people smoking cigarettes and also to examine association between alexithymia, depression and smoking index, nicotine addiction, the motivation to quit smoking. The study comprised 46 people from Warsaw and its environs, without pulmonary, cardiovascular or neoplastic diseases, with at least medium education. The subjects were qualified into two groups: group I (n = 22) - subjects who had never smoked cigarettes, and group II - currently smoking (n=24). The total alexithymia score and scores of alexithymia subscales: difficulty in identifying feelings (TIE), b) difficulty in communicating feelings (TOU), c) externally oriented thinking (OSM) were assessed with Toronto Alexi. thymia Scale 20 (TAS-20). Beck Depression Inventory (Scale) (BDI) was used to evaluate presence and intensification of depression symptoms. The tobacco addiction rate was assessed with the Fagestrom questionnaire, and the motivation to quit smoking with the Schneider test. All data were obtained during individual exami. nations. The mean alexithymia score in the nonsmokers group was 38.6+/-8.8, in the smokers group: 46.6+/-13.0. The differences between the groups were statistically significant (p=0.02). Both difficulty in identifying feelings (TIE) and difficulty in communicating feelings (TOU) scores were significantly higher in the smokers (TIE p=0.01; TOU p=0.03). There were no differences in externally oriented thinking. It was found that people smoking cigarettes had a significantly higher level of intensification of depression symptoms than the controls. There was not any correlation between the total alexithymia score and depression symptoms or smoking index, the degree of nicotine addiction, the motivation to quit smoking.

Telomerase synthesizes telomeric DNA repeats at the ends of eukaryotic chromosomes and inhibits the natural senescence of different cells. Its increased activity in malignant tumors is considered to be an independent prognostic factor of the disease course. Aim of the study was valuation of influence of prolonged tobacco smoking on telomerase expression in non-small cell lung cancer (NSCLC). The study comprised 33 patients with NSCLC (divided into two groups: smokers - n=21 and nonsmokers n=12), who had telomerase activity quantitatively assessed (PCR-ELISAPLUS, ROCHE, Mannheim, Germany) in aspirates collected from peripheral lung tumors through transthoracic fine-needle biopsy. No statistically significant differences were found between the studied groups with regard to the clinical stage of tumor. Telomerase activity in biopsy samples from smoking patients was higher than in samples from nonsmoking patients (statistically insignificant difference p=0.09). It was found that telomerase activity in tumor cells was significantly lower in patients smoking less than 40 pack years in comparison to patients smoking more than 40 pack-years (p=0.01). Telomerase activity in NSCLC cells correlated significantly with clinical stage of tumor in all the patients (r=0.66 for nonsmokers and r=0.58 for smokers; por =0.01), and in the smokers' group - additionally with pack-years (r=0.47; p=0.04). Tobacco smoking by patients with non-small cell lung cancer increases telomerase activity in tumor cells.

The aim of the study was to assess the influence of smoking on the metalloproteinase 1 (MMP-1) concentration in serum in the group of patients with chronic obstructive pulmonary disease (COPD). The study comprised 26 patients with COPD. The control group was created of 15 healthy non-smoking subjects. In the both group spirometry test was performed. The concentration of MMP-1, C-reactive protein, OB level was estimated in serum. Significant differences were noticed in the MMP-1 concentration in serum between groups (p=0.013). Significantly higher OB level (p=0.011) and C-reactive protein concentration (p=0.03) was found in the COPD group. In this same group positive correlation between MMP-1 concentration in serum and the packyears was noticed (r=0.50). No significant correlation was found between inflammatory indicators and the number of packyears. No significant correlation was noticed between MMP-1 level and FEV1 in COPD group. The analysis of the data shows significant influence of smoking on the increase of MMP-1 concentration in serum in the group of COPD patients.

Immunomodulatory activity of bacterial extracts such as Broncho-Vaxom results in stimulation of different immune cells, increase of expression of proinflammatory cytokines and enhancement of resistance to infection. Lyophilized extracts from bacteria are particularly recommended for patients with chronic respiratory tract diseases, in whom infectious exacerbations irreversibly worsen lung damage. Despite the fact that treatment with bacterial lysates is considered safe, it is not clear if such immunomodulation does not negatively affect the proteinase--antiproteinase balance in patients with COPD.Evaluation of influence of treatment with Broncho-Vaxom on the concentration of metalloproteinase-9 in serum of patients with chronic obstructive pulmonary disease.Forty one patients with moderate COPD were included in the study The patients were divided into two groups: smokers and nonsmokers. Each patient received Broncho-Vaxom for the first ten days each month for three consecutive months. The patients were examined twice: before treatment and in the third month of treatment. During each visit clinical symptoms of COPD were assessed, spirometric tests and blood tests were performed, the concentrations of immunoglobulins, C-reactive protein and metalloproteinase-9 in serum (MMP-9) were measured.No significant differences were found between the groups in predicted value of FEV1%, concentrations of immunoglobulins and C-reactive protein in serum and the number of leukocytes in blood after treatment with Broncho-Vaxom. A significant decrease of intensity of COPD symptoms in both groups after immunostimulatory treatment was observed. There were no differences in metalloproteinase-9 concentration in serum between the smokers and nonsmokers. Administration of bacterial extract did not significantly influence MMP-9 concentration in serum of the patients.Treatment with Broncho-Vaxom does not increase the concentration of metalloproteinase-9 in serum of patients with COPD, while it decreases the symptoms of stable COPD.

Telomerase synthesizes telomeric DNA repeats at the ends of eukaryotic chromosomes and inhibits of natural senescence of different cells. Its increased activity has been found in most malignant tumors. This article is a review on current knowledge about diagnostic and prognostic value of telomerase in malignancies.

The aim of the study was to assess differences in tobacco addiction rate and motivation to quit tobacco smoking in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD). The study comprised 384 males from Warsaw and its environs, aiming to quit smoking within the nearest year, without cardiovascular or neoplastic diseases, with at least medium education (17.19). The subjects were qualified into one of three groups: a control group--subjects without pulmonary diseases (n=143), patients with COPD (n=126) and patients with bronchial asthma (n=115). The smoking index (pack-years) was calculated in each group. The tobacco addiction rate was assessed with the Fageström questionnaire, and the motivation to quit smoking with the Schneider test. All data were obtained during individual examinations. The mean smoking index in the study population was 29.0 +/- 20.6 pack-years (control--27.0 +/- 20.6; asthma--25.2 +/- 14.2 and COPD--38.0 +/- 21.4). A high tobacco addiction rate was found in 40.5% of the patients with COPD, 37.1% of the patients with asthma and 30.3% of the subjects from the control group. The differences between the groups were not statistically significant (p0.05). In the asthmatic group the percentage of subjects with a high motivation to quit smoking was significantly lower (48%) than in the COPD group (74%, p=0.005) and the control group (75%, p=0.002). It was found that patients with COPD significantly more frequently than asthmatics and people without pulmonary diseases need medical assistance in overcoming nicotine addiction.

The aim of the study was to analyze to what extend the principles of minimum intervention are applied by basic health care doctors in Mazovia. The study comprised 326 tobacco smokers, divided into two groups: group I--including 160 adults living in towns with a population below 10000 and group II--including 166 inhabitants of towns with a population above 100000. Each subject had their tobacco dependence rate (the Fagerström test) and the period of smoking (pack-years) calculated. Each subject evaluated application of the minimum intervention principles by their basic health care doctor anonymously. The data obtained were statistically analyzed. The study groups did not differ in terms of nicotine addiction rate. It was found that almost half of the patients smoking tobacco had never been asked by their doctor about smoking habit during consultation. An educational material concerning the harmfulness of smoking is received by every seventh smoker, and an attempt of a pharmacological therapy of addiction is undertaken only in every tenth patient. The minimum medical intervention principles in tobacco smokers are twice more often applied by basic health care doctors working in small towns.

The aim of the study was assessment of the influence of tobacco smoking on direct costs of in-hospital treatment of chronic obstructive pulmonary disease exacerbations (COPD). 112 men who underwent in-hospital treatment of exacerbation of moderate COPD in the years 2001-2002 were included in the study. The patients were qualified into one of three groups: I--never-smoking patients (n=40); II--former smokers (n=42); III--active smokers (n=30). The mean age of patients was 70.9 +/- 8.9 years (I--74.8 +/- 7.4; II--68.4 +/- 9.4; III--69.4 +/- 9.8). The mean direct cost of COPD patient treatment was PLN 2162.00 +/- 920.90 (I--PLN 2025.50 +/- 681.30; II--PLN 1875.80 +/- 608.70; III--PLN 2744.60 +/- 1266.20). The mean period of smoking was 18.3 pack-years in the group II and 27.7 pack-years in the group III. No significant differences in FEV1 were found between the groups. No significant differences were found in the treatment costs between the groups I and II. It was demonstrated that the costs of in-hospital COPD treatment are significantly higher in the group III than in the groups I and II. A linear regression formula was calculated, showing a linear relationship between each consecutive pack-year of addiction and the costs of exacerbation treatment in the group III (R=0.39, R2=0.13, standardized BETA index = 24.0; p0.03). No similar relationship was found in the former smokers' group. The analysis of the data shows that: (1) active tobacco smoking by patients is related to significantly higher direct costs of in-hospital treatment of COPD exacerbations than in case of never-smoking patients or patients who smoked in the past, and (2) the costs of in-hospital treatment of COPD exacerbations in case of people who have stopped smoking are comparable to the costs of hospitalization of never-smoking patients with COPD.

Estimation of the influence of some demographical and social factors on degree of nicotine addiction and motivation to quit smoking.208 healthy, smoking people entered the study. The Fagerström test was used for analyzing degree of nicotine addiction (heavy addiction7 points). Motivation for smoking cessation was estimated by Schneider test (high motivation5 positive answers). Tests results were analyzed in connection with age, gender, education and intensity of nicotine addiction defined as pack-years.In 37% of patients (77/208) heavy nicotine addiction was diagnosed. High motivation for quitting smoking was recognized in 74% people (150/208). Subjects with wild nicotine addiction had significantly higher motivation for smoking cessation (chi2, p=0.002). There was not influence of gender, age, education and addiction intensity (defined as pack-years) on the grade of nicotine addiction. We didn't notice relation between gender and motivation to quit. Young, well educated patients are significantly stronger motivated for smoking cessation.There was not direct dependence between the number of smoked cigarettes and degree of nicotine addiction. In the group of healthy subjects, young, well educated people have a better chance for smoking cessation.

Pharmacoeconomics is important in asthma as this condition continues to increase in prevalence throughout the world, consuming a larger and larger share of total health care budgets. Understanding how pharmacoeconomics can be applied in evaluating the cost-effectiveness of asthma treatments can be important in determining proper asthma care in a climate of limited resources in Poland.

The article reviews available data on direct and indirect costs of COPD treatment.

Antimicrobial agents are typically regarded as an exogenous factor responsible only for killing pathogens. However we have more and more data that numerous antibiotics have modulating influence on immunological system, not directly associated with bacteriostatic or bactericidal properties of those antibiotics. The review presents current knowledge about this issue.

Health economics has become accepted as an important aspect, as it provides useful information on the costs to society associated with particular diseases and the cost-effectiveness of different treatment options. These considerations are particularly important in relation to common and chronic conditions such as asthma and chronic obstructive pulmonary disease. The direct and indirect cost associated with asthma and COPD and trends in the use of outpatient care, drugs and inpatient care were presented in this paper. It should be stressed that asthma therapy has changed from inpatient to ambulatory care, while the treatment of COPD is still based to a higher degree on inpatient care.

The key role in the mechanism of immune response to allergenic exposure in bronchial asthma is played by immunoglobulins E (IgE), which bind to specific Fce receptors on mast cells, basophils, B-lymphocytes and eosinophils. The specific recombinant human monoclonal antibodies (rhu-MAb) directed against free IgE are a new promising therapeutic remedy for symptoms of allergic asthma. In this article the review of clinical studies concerning the usefulness of rhu-MAb in treatment of bronchial asthma is presented.

The effectiveness and costs of azithromycin and cefoperazone treatment of COPD exacerbation have been analysed in this study. Forty patients at the mean age of 65.9 (+/- 11.5) years were enrolled. The subjects were randomly selected and treated either with cefoperazone 2 x 1.0 g i.v. daily (group I = 20 persons) or with azithromycin 1 x 0.5 g (group II = 20 persons), in sequential method. Body temperature, cough intensity, quality and quantity of expectorated sputum, number of breaths per minute and adverse events were recorded daily. The values of pulmonary function tests and leucocytosis were assessed three times during the study. Statistically significant differences between both groups have been found with respect to the mean time of staying in hospital (9.1 days--group I vs 6.1 days--group II), mean total duration of antibiotic therapy (10.1 days--group I vs. 6.6 days--group II) and duration of intravenous antibiotic therapy only [7.5 days (group I) vs 2.9 days (group II)] (p0.05). Taking into account the duration of hospitalization, it was shown that the mean total costs of treatment of COPD exacerbation with azithromycin was significantly lower than that of treatment with cefoperazone (2375.9 PLN and 1663.7 PLN, respectively) (p0.05).The effectiveness of treatment with azithromycin in patients with COPD exacerbation was evident. The total costs of treatment of COPD exacerbation with azithromycin is lower than with cefoperazone. Both azithromycin and cefoperazone are safe in the treatment of exacerbation of COPD.

In this study we estimate influence of concomitant diseases and age on risk of death because of community-acquired pneumonia (CAP). We performed retrospective analysis of 405 CAP cases. All patients have been treated in Central Hospital of Military School of Medicine in Warsaw from 1990 to 1997. We showed statistically significant influence of age65 yr. (OR = 5.71; CI: 1.41-23.22; p = 0.015), chronic heart failure (OR = 2.57; CI: 1.1-5.99; p = 0.029) and chronic renal failure (OR = 3.35; CI: 1.06-10.54; p = 0.039) on high risk of death in patients with community-acquired pneumonia.

Tumor Necrosis Factor alfa (TNFa) is a cytokine with cytolytic and cytotoxic properties. First clinical trials in which TNF was administered parenterally date back to early 70-ties. Soon it was noticed that when administered strictly to the tumor mass TNF exhibits high anti-tumor efficacy, exemplified by total or at least substantial regression of the tumor mass while producing minor and controllable symptoms. In this paper the case of local administration of the recombinant TNFa directly into the tumor mass constricting the bronchus was presented.

Introduction: The aim of the study was to examine the direct and indirect costs of COPD exacerbations under usual clinical practice in primary and secondary care from a societal perspective in Poland. Material and methods: An observational, prospective study was conducted among patients with exacerbation of moderate or severe COPD. Seventy-three patients were included in the study—39 treated in hospital (HC) and 34 treated in ambulatory care (AC). The direct costs included the cost of drugs, diagnostic tests, in-hospital and outpatient care. The indirect costs included costs of transportation to the health-care provider and work days lost. Results: The mean duration of COPD exacerbation did not differ significantly between the groups [HC: 11.2 (CI 95%: 9.6–12.8) days; AC: 10.8 (CI 95%: 9.1–12.1); p > 0.05]. The total health-care cost per exacerbation was EUR 1197 (4137.9 PLN) in secondary care (the HC group), and it was 6 times higher than the total cost of exacerbation in primary care (the AC group)— EUR 199.8 (446.9 PLN). The costs of drugs and diagnostic tests were significantly higher in the HC group than in the AC group; however, it was the cost of in-hospital stay and medical visits in the HC group that most influenced expenditure related to COPD exacerbations, as they were 27 times higher than in the AC group. Conclusions: In Poland the costs of COPD exacerbation managed in secondary care are 6-fold higher than in primary care. Therefore, the decisions about admission of patients with COPD exacerbation to hospital should be made carefully.

Respiratory physiotherapy is essential to the treatment of all acute or chronic respiratory disorders which expectoration difficulties are major problem. The Flutter VRP1 is an easy to use physiotherapy device; combines safe endobronchial positive expiratory pressure with vibratory effects. Flutter is a useful device for sputum expectoration and markedly improvement of lung parameters.