{"title":"Fatigue in patients with inactive sarcoidosis does not correlate with lung ventilation ability or walking distance. Pilot Study.","authors":"Karolina Zieleźnik, Dariusz Jastrzębski, Dariusz Ziora","doi":"10.5603/PiAP.2015.0002","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0002","url":null,"abstract":"<p><strong>Introduction: </strong>Fatigue is one of many symptoms reported by patients with sarcoidosis. It is believed that fatigue may be the cause of exercise intolerance and reduced quality of life in patients with sarcoidosis. The purpose of the work was to present the frequency of fatigue prevalence in patients with sarcoidosis and to investigate the correlation between fatigue and the results of pulmonary function tests and walking distance.</p><p><strong>Material and methods: </strong>A total of 74 patients with sarcoidosis in a stable phase of the disease, not treated in the past with glucocorticoids or immunosuppressive drugs, and without indications for treatment at the time of the study were examined. In all patients fatigue evaluation was carried out with the use of the Fatigue Assessment Scale questionnaire (FAS); dyspnoea was assessed with the use of the Medical Research Council scale (MRC). Body Mass Index (BMI), spirometry, and a 6-minute walk test were additionally performed. The control group included 30 healthy volunteers who completed the FAS.</p><p><strong>Results: </strong>In the examined group of patients fatigue was diagnosed in 36 patients (50%), and in 5 (6.94%) - strong fatigue was observed. The remaining 31 (43.06%) patients felt no fatigue. The average value of points obtained by FAS questionnaire in sarcoidosis patients was significantly higher than the respective value in the control group (p = 0.02). A significantly higher number of points by FAS questionnaire was observed in female patients with sarcoidosis (p = 0.04) in comparison to men. No significant statistical correlation between fatigue index FAS and BMI (r = 0.22, p = 0.11), FEV1 (r = -0.11, p = 0.3), FEV1% pred. (r = 0.01, p = 0.9), FVC (r = -0.03, p = 0.77), FEF25-75 (r = -0.23, p = 0.1) and the distance in the six-minute walk test (6MWT) (r = -0.01, p = 0.9) was observed. However, there was a weak negative correlation between the age of the patients and the FAS index (r = -0.29, p = 0.01).</p><p><strong>Conclusions: </strong>Fatigue in patients with sarcoidosis does not correlate with the results of lung function tests or with walking distance in 6MWT.</p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32965556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[New dry powder inhalers].","authors":"Andrzej Emeryk, Michał Pirożyński","doi":"10.5603/PiAP.2015.0012","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0012","url":null,"abstract":"<p><p>The most recently approved DPI's - Ellipta™ and NEXThaler® are the most modern inhalers on the market. Both are flow independent in the physiological range of flows seen in patients with asthma and/or COPD. Both require three actions (open-load -inhaler) for a successful inhalation. The Ellipta™ inhaler is the first DPI, which enables simultaneous delivery of two compounds without need for co-formulation. NEXThaler® is the only DPI on the market delivering extra fine aerosol (MMAD < 2 μm) of a combined inhalation product of inhaled corticosteroid and long-action b2-agonist. Both have been approved world wide for products used in treatment of asthma and COPD. </p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32965876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iwona Florentyna Grzelewska-Rzymowska, Joanna Mikołajczyk, Jadwiga Kroczyńska-Bednarek, Paweł Górski
{"title":"Association between asthma control test, pulmonary function tests and non-specific bronchial hyperresponsiveness in assessing the level of asthma control.","authors":"Iwona Florentyna Grzelewska-Rzymowska, Joanna Mikołajczyk, Jadwiga Kroczyńska-Bednarek, Paweł Górski","doi":"10.5603/PiAP.a2015.0044","DOIUrl":"https://doi.org/10.5603/PiAP.a2015.0044","url":null,"abstract":"<p><strong>Introduction: </strong>Global Initiative for Asthma (GINA) reports emphasize the use of validated and simple tools in order to assess the level of asthma control, as the Asthma Control Test (ACT). However, an ACT does not include assessment of airway inflammation, which is better reflected when measuring nonspecific bronchial hyperresponsiveness (BHR). The authors aimed to find out if the level of asthma control quantified by an ACT correlates with BHR and pulmonary function tests.</p><p><strong>Material and methods: </strong>118 asthmatics participated in the study. All patients completed an ACT. The scores of the ACTs were compared with pulmonary function tests and BHR assessed with the methacholine challenge test and expressed as a provocative concentration of methacholine, inducing a 20% decline in the FEV1 (PC20 M in mg/ml).</p><p><strong>Results: </strong>Patients with controlled asthma amounted to 52 (44%) while those with uncontrolled asthma amounted to 66 (56%). In patients with controlled asthma (ACT score ≥ 20) the mean geometric value of PC20M was 2.72 mg/ml (range from 0.25 to > 8.0), whereas 0.94 mg/ml (range from 0.28 to 8.0) (p = 0.02) was observed in patients with uncontrolled asthma (ACT score < 20). Almost 64% (21/33) of uncontrolled asthmatics achieved normal lung function (FEV1 > 80% pred. value) while 19% (5/26) patients with controlled asthma presented an FEV1 < 80% predicted value. Asthma duration in years in controlled asthmatics was significantly shorter than in uncontrolled patients (6.2 ± 8.9 vs. 12.0 ± 11.4, p = 0.005) CONCLUSION: In determining the most accurate level of asthma control it is reasonable to use an ACT in conjunction with BHR, which provides more accurate assessment of bronchial inflammation than ventilatory parameters alone.</p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33312586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Maria Pajor, Sylwia Kwiatkowska, Jadwiga Kroczyńska-Bednarek, Wojciech J Piotrowski
{"title":"Acute laryngeal dyspnea as first presentation of granulomatosis with polyangiitis.","authors":"Anna Maria Pajor, Sylwia Kwiatkowska, Jadwiga Kroczyńska-Bednarek, Wojciech J Piotrowski","doi":"10.5603/PiAP.2015.0035","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0035","url":null,"abstract":"<p><p>Granulomatosis with polyangiitis (GPA) is a multi-organ disease which mostly affects lungs, kidney, and head and neck region. We report a rare case of acute laryngeal dyspnea and rapidly progressive pulmonary changes as first manifestations of disease. A 53 year-old woman presented with symptoms of two-week dyspnea, which aggravated rapidly in the preceding hours. Laryngological examination revealed subglottic infiltrations and vocal fold oedema which required urgent tracheotomy. During few days she developed gingival ulcerations and pulmonary infiltration with negative serum c-ANCA titers. The histopathological examination of subglottic and gingival biopsies and the clinical picture established the diagnosis of GPA. She was treated with prednisone and cyclophosphamide with recovery; however, during over 3 years of follow-up, pulmonary symptoms relapsed and subglottic stenosis persisted. The difficulties in diagnosis and treatment in this unusual presentation of GPA are outlined with conclusion that in patients with subglottic infiltration, which develops rapidly, even when this is a sole presentation of the disease, and when c-ANCA are negative, GPA should always be considered. </p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33366367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Piotr Hantulik, Karola Wittig, Yvonne Henschel, Joachim Ochse, Mikko Vahteristo, Paula Rytila
{"title":"Usage and usability of one dry powder inhaler compared to other inhalers at therapy start: an open, non-interventional observational study in Poland and Germany.","authors":"Piotr Hantulik, Karola Wittig, Yvonne Henschel, Joachim Ochse, Mikko Vahteristo, Paula Rytila","doi":"10.5603/PiAP.2015.0059","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0059","url":null,"abstract":"<p><strong>Introduction: </strong>Inhalation is the preferred route of drug administration for patients with asthma or COPD. It is generally predicted that there is a high error rate in inhaler usage, especially at the therapy start. The primary objective of this study was the validation of a questionnaire that can be used for assessing a successful inhalation technique, patient satisfaction as well as the compliance in daily practice.The secondary objective was to examine the \"real-life\" usage of one inhalation device in comparison with other devices at the start of the therapy.</p><p><strong>Material and methods: </strong>This open, multi centre and non-interventional study was designed to examine usage and usability of dry powder inhaler Easyhaler® (EH) (Orion Pharma, Finland) and other inhalers assessed by the physicians as well as by the patients. Inclusion criteria for patients were a physician-diagnosis of COPD or asthma or children with asthmatic disease, therapy start with an inhalation device and no or only few experiences with inhaler usage (inhaler usage for not more than 3 months). Each physician enrolled an equal number of patients in each group.</p><p><strong>Results: </strong>263 adult/adolescent patients with asthma and 115 with COPD as well as 164 children with asthmatic disease were enrolled. 49.4% of the adult/adolescent patients with asthma used an EH and 50.6% other inhalers. In the case of COPD, 47.8% were treated with an EH and 52.2% used other inhalation devices. Finally, 50.6% of the children with asthmatic disease used an EH and 49.4% were treated with other inhalers. Inhaler usage, patient satisfaction, compliance and patients assessments of usability were better when the patients used an EH. Inconvenient features were mainly documented for other inhalers. The analysis of Cronbachs alpha clearly showed the consistency of the received data from all patients. In addition, there was a large association between the assessment of the inhaler usage and the general assessment of the used inhaler in all patient groups.</p><p><strong>Conclusion: </strong>The results of this study show that investigators found EH easy to teach, the patients found it easy to use and their satisfaction with the device was high in comparison to other inhalation devices. Thus EH can be matched to many patients already at the therapy start. In addition, the high consistency of the received data and large association of the assessment of the inhaler usage and the general assessment of the inhaler indicate that the used questionnaires were appropriate tools to examine usage and usability of inhaler devices in adult patients and children.</p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34012890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Kempisty, Beata Białas-Chromiec, Dagmara Borkowska, Jan Kuś
{"title":"Interferon gamma release assays based on M. tuberculosis-specific antigens in sarcoidosis patients.","authors":"Anna Kempisty, Beata Białas-Chromiec, Dagmara Borkowska, Jan Kuś","doi":"10.5603/PiAP.2015.0020","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0020","url":null,"abstract":"<p><strong>Introduction: </strong>This study is a part of the project on interferon gamma release assays performed in the group of untreated sarcoidosis patients formerly BCG vaccinated. The aim of the study was to assess the rate of positive commercial interferon g release assays in sarcoidosis patients. We discussed the results in the context of hypothesis that M. tuberculosis antigens may play a role in the pathogenesis of sarcoidosis.</p><p><strong>Material and methods: </strong>151 patients, mean age 38 ± 10.3, treatment naive, with newly diagnosed pulmonary sarcoidosis were enrolled into the study. All participants underwent QFT-GIT assay. A subgroup of 81 patients underwent also T-SPOT.TB assay.</p><p><strong>Results: </strong>QFT-GIT was positive in 7/151. T-SPOT.TB was positive in 3/81. There were no indeterminate results in both IGRAs. There was no statistically significant relationship between IGRAs results and sarcoidosis parameters such as the radiologic stage, disease duration and the presence of Löfgren's syndrome.</p><p><strong>Conclusions: </strong>In sarcoidosis patients formerly BCG vaccinated, positive rate of IGRAs was 4.6% for QFT-GIT and 3.7% for T-SPOT. TB. We did not find the influence of the selected parameters of sarcoidosis on IGRAs results.</p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33116206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katarzyna Baran, Krzysztof Pałgan, Marcin Szortyka, Anna Bitner, Zbigniew Bartuzi, Jacek J Klawe
{"title":"Anaphylaxis as a cause of hospitalization--a single academic centre experience.","authors":"Katarzyna Baran, Krzysztof Pałgan, Marcin Szortyka, Anna Bitner, Zbigniew Bartuzi, Jacek J Klawe","doi":"10.5603/PiAP.2015.0030","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0030","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, more and more often the increase in incidence of allergies is observed. According to the WHO, they are getting the fourth position amongst the most frequent diseases after cancers, cardiovascular diseases and AIDS. Anaphylaxis is a severe, life-threatening, systemic or generalised immediate hypersensitivity reaction. The analysis of the causes and the clinical picture of anaphylaxis in patients treated at single academic hospital centre was the purpose of the study.</p><p><strong>Material and methods: </strong>The study was based on retrospective analysis of case records of the patients hospitalised at the Chair and Department of Allergology, Clinical Immunology and Internal Diseases, the Jan Biziel University Hospital in Bydgoszcz in the years 2005-2010. 132 patients, in whom anaphylactic reaction appeared, were analysed. The examined population included 70 men and 62 women at 16-95 years of age.</p><p><strong>Results: </strong>The conducted examinations allowed to obtain information about the causes and the course of anaphylactic reactions. The problem of hypersensitivity to substances of various origin (biological or synthetic) can concern everyone irrespective of sex and age. Nevertheless, the phenomenon of anaphylaxis more often occurred in the examined men than women. Most cases of anaphylactic reactions were reported in the 26-50 age range. Based on the presented results, no regularity was observed in anaphylaxis clinical picture and its causative factor.</p><p><strong>Conclusions: </strong>It is difficult to forecast the course of the reaction based on the causative factor, for anaphylactic reaction is characterised by a great individual changeability and intensity of the first symptoms.</p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33247804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Beata Katarzyna Jankowska-Polanska, Małgorzata Kamińska, Izabella Uchmanowicz, Anna Rycombel
{"title":"Quality of life and health behaviours of patients with tuberculosis - sex differences.","authors":"Beata Katarzyna Jankowska-Polanska, Małgorzata Kamińska, Izabella Uchmanowicz, Anna Rycombel","doi":"10.5603/PiAP.2015.0046","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0046","url":null,"abstract":"INTRODUCTION\u0000Despite the introduction of effective antituberculosis drugs, tuberculosis (TB) is still a serious health problem and one of the most significant causes of death among infectious diseases. Current publications indicate an increase of tuberculosis cases among smokers, diabetics, malnurished subjects and those abusing alcohol and drugs. In the literature, there are only few studies raising the topic of the quality of life (QoL), stress management and health behaviour among patients with tuberculosis. The aim of this study was to evaluate QoL of patients with tuberculosis taking into account gender differences. In the study, the analysis of knowledge, health behaviour and stress management among TB patients depending on sex was carried out.\u0000\u0000\u0000MATERIAL AND METHODS\u0000The study included 80 subjects diagnosed with TB (including 38 females) who were hospitalised at the Regional Hospital Centre of Kotlina Jeleniogórska, Medical Unit Wysoka Łąka, Pulmonology and Phthisiology Department in Kowary between August 2012 and January 2013. The following questionnaires were used in the study: Mini-COPE - evaluating stress management, WHOQoL - assessing the quality of life of patients, IZZ - assessing health behaviour.\u0000\u0000\u0000RESULTS\u0000A difference with regards to sociodemographic profile between females and males was observed. Half of the women surveyed were working (50% vs 19% of men), whereas half of men were entitled to unemployment benefit (50% vs 18.4% of women). More than half of women lived with their family (55.3%), whereas 47.6% of men lived alone. The majority of the subjects consumed alcohol occasionally (60.2% of women vs 45.2% of men), but as many as 31% of male patients vs 7.9% of females admitted that they consumed alcohol frequently. Among the respondents, people who consumed alcohol occasionally dominated (60.2% women vs. 45.2% of men), but as many as 31% of male patients vs. 7.9% of women admitted to consume alcohol frequently. Quality of life (QoL) assessment has shown no statistically significant differences between the sexes in this field. The respondents rated lowest their QoL in the physical domain, 12.4 ± 3.1 (12.9 ± 3.0 women vs. 11.8 ± 3.1 men) and 12.6 ± 2.4 in the environmental domain (13.1 ± 2.3 women vs 12.1± 2.4 men). Women received a higher rating of health behaviour on all subscales of the IZZ questionnaire, with the highest score in the prevention behaviour subscale (3.6 ± 0.7) and the lowest in the subscale of proper eating habits (3.1 ± 0.8). In men the highest score of health behaviour was observed in the subscale of positive mental attitude (3.1 ± 1.0) and the lowest in the subscale of proper eating habits (2.5 ± 0.8).\u0000\u0000\u0000CONCLUSIONS\u00001. There are differences between sociodemographic profile of TB patients: women are younger, better educated, economically active and more likely to remain in relationships; 2. There is no difference in QoL of TB patients between the sexes, whereas there are differences in the strategies of str","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34278667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sonu Sahni, Alexander Blood, Santhosh Paulus, Arunabh Talwar
{"title":"\"Saw-tooth sign\" in upper airway disorders—a case report.","authors":"Sonu Sahni, Alexander Blood, Santhosh Paulus, Arunabh Talwar","doi":"10.5603/PiAP.2015.0022","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0022","url":null,"abstract":"<p><p>Spirometry flow-volume loop measurement is the screening test of choice to rule out obstructive lung diseases. Flow oscillations occasionally seen on flow volume loops, referred to as a \"saw-tooth\" sign, are thought to be due to an upper airway obstructive processes associated with upper airway collapsibility. Widely described in obstructive sleep apnea syndrome, flow oscillations have also been linked to many other upper airway pathologies. The mechanism by which flow oscillations occur is centered on the inspiratory and expiratory flow of air. It has been theorized that the mechanism of flow oscillations result from rapid intermittent changes in driving pressure or airway resistance. Since visual inspection of the flow volume loop can reveal presence of flow oscillations clinicians should be aware of this phenomenon and the presence of flow loop oscillations should clue physicians to rule out upper airway pathology. </p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33117249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular safety of two bronchodilators' fixed-dose combination: indacaterol and glycopyrronium.","authors":"Jerzy Kozielski","doi":"10.5603/PiAP.2015.0026","DOIUrl":"https://doi.org/10.5603/PiAP.2015.0026","url":null,"abstract":"<p><p>Combination therapy with anticholinergics and β2-agonists should be used in COPD patients after failure of previous monotherapy with one of these drugs. Synergistic effect of both mechanisms of bronchodilation can maximize the efficacy of separately administered drugs. The effectiveness of the combination of LABA and LAMA is already confirmed, nevertheless the question about the safety profile of this therapy is still remaining, particularly with regard to the cardiovascular system. The paper discusses the overall safety profile of the combined preparation compare to placebo as well as the active comparators, especially the cardiovascular safety of fixed-dose formulation. Based on the data it has been demonstrated, that the combination of two ultra-long-acting bronchodilators with different complementary mechanisms of action increases the effectiveness of COPD therapy without affecting the safety.</p>","PeriodicalId":20258,"journal":{"name":"Pneumonologia i alergologia polska","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33117253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}