Although abscess formation constitutes a recognized complication of tuberculous lymphadenitis, the concomitant development of multiple tuberculous abscesses in the course of tuberculous lymphadenitis has rarely been described in the literature among HIV-negative patients under appropriate chemotherapy. Adherence and sensitivity to the administered anti-tuberculosis chemotherapy have to be verified in such patients. We report a case of deteriorating tuberculous lymphadenitis, presenting with the development of multiple extrapulmonary abscesses (cervical, psoas, and retroperitoneal) in an HIV-negative patient who had complied with appropriate anti-tuberculosis chemotherapy for four months. Mycobacterium tuberculosis was the identified pathogen in specimens from the abscesses. Continuation of anti-tuberculosis medications and concurrent administration of antibiotics, along with CT-guided percutaneous drainage of the psoas abscess, resulted in gradual resolution of the patient's lesions. Interestingly, our patient had recent childbirth, indicating a potential association between the immunomodulatory processes during the postpartum period and the development of the so-called paradoxical reaction. Awareness of such complications should be raised, as a timely recognition and subsequent therapeutical treatment are essential for a favorable outcome.

Background: Malnutrition is prevalent in COPD. Objective: To assess vitamin D and B12 levels in patients with COPD and evaluate clinical outcomes after combined supplementation. Methods: We analysed a prospective cohort of patients with stable COPD at the Outpatient Department of a tertiary care hospital in Greece. Patients deficient in either vitamin D or B12 received supplementation (cholicalciferol 2500 IU / methylcobalamine 1000μg) for 3 months. Results: Among 77 patients with COPD (56 men, 21 women; mean age 66.56±9.1 years; mean FEV1 59.5±14.9 %predicted), 45.5% presented with normal levels (group A), 27.3% were deficient in vitamin D (group B), 15.6% in vitamin B12 (group C) and 11.7% in both vitamins (group D). Demographic data and baseline lung function parameters were similar between groups, but health-related quality of life was reported worse in group D (median CAT score 17, IQR: 11-21). All patients received supplementation; group A received placebo instead. Follow-up at 6 months revealed no difference in exacerbation rate or lung function. There was significant improvement in health-related quality of life, with reduction in CAT score from baseline values in groups B (13.2±3.4 from 15±3.9, p=0.002) and D (13.9±3 from 17±4.7, p=0.019). Conclusion: Deficiency in vitamin D and B12 is highly prevalent in stable COPD patients. Vitamin supplementation appears to improve health-related quality of life within 6 months. Our findings suggest that patients with COPD may benefit from baseline measurement of vitamin levels and appropriate supplementation.

Background: Smoking impairs lung function in genetically predisposed individuals. Objective: Assessment of smoking status and lung function in a rural population. Methods: We performed a cross-sectional study in rural areas of northern Greece, including participants >35 years old, without previously diagnosed COPD or other respiratory disorders. The study was conducted under the auspices of Hellenic Chest Diseases Society. Results: Among 970 participants (63.6±12.6, range 35-92 years), 38.9% were men (66.1±12.9 years) and 61.1% women (61.9±12.2 years). Never-smokers comprised 40.9%, former-smokers 21.8% and current smokers 37.3% of participants. Current smokers were younger than former- and never-smokers (58.2±12 vs 66.7±12 years, p30 pack-years (py) accounted for 47.8%, 20-30py for 30.7%, 10-20py for 15.4% and 30py (FEV1/FVC: 0.81±0.1, p<0.01 / FEV1%predicted: 97.8±18.2, p=0.99), and to smokers 20-30py (0.81±0.1, p=0.02 / 98.2±2, p=0.84). Never-smokers had similar lung function to smokers 11-20py (0.84±0.1, p=0.11 / 102.4±22.1, p=0.13), although the latter were significantly younger (48.4±12.3 vs 67.6±11.4 years, p<0.01), and to smokers <10py (0.81±0.1, p=0.38 / 105.4±20.6, p=0.09) despite the age difference (52.6±15.4 years, p<0.01). Among current smokers, 19.8% presented with clinical and spirometric findings compatible with COPD. Conclusion: Smoking impairs lung function. Assessment of the small airways is necessary to capture incipient deterioration.

Background: Systemic corticosteroids improve the outcomes of COPD exacerbations at an increased risk of side effects. Inhaled corticosteroids may exert a better benefit to risk ratio. Aims: We aimed to assess the safety and efficacy of inhaled compared to systemic corticosteroids in COPD exacerbations. Methods: We conducted a meta-analysis of randomised controlled trials (RCTs; protocol ID: CRD42021284297). We assessed the outcomes outlined in the ERS COPD Exacerbations Core Outcome Set and rated the certainty of evidence according to GRADE. Results: We included 20 eligible RCTs with 2,160 participants comparing inhaled or nebulised budesonide to systemic corticosteroids in moderate or severe COPD exacerbations. All RCTs entailed high risk of bias. We found with low certainty that both corticosteroid routes had similar impact on treatment failure (relative risk, RR 1.75, 95% confidence intervals [0.76, 4.03], I²=0%, 565 participants), breathlessness (standardised mean difference 0.0 [-0.19, 0.19], I² =0%, n=442), serious adverse events (RR 1.47 [0.56, 3.88], I²=0%, n=246), health-related quality of life, length of hospitalisation, future exacerbations and mortality. Moderate-certainty evidence implied a tendency for less adverse events with inhaled compared to systemic corticosteroids (RR 0.80 [0.64, 1.0], I²=0%, n=480). There was no evidence of higher risk of hospital or critical care admission with inhaled steroids. Data on the subgroup of patients with eosinophilic exacerbations were not reported. Conclusions: Our findings suggest potential non-inferiority of inhaled to systemic corticosteroids in unselected COPD exacerbations. Large and rigorous RCTs assessing eosinophilic exacerbations are warranted.

Background: Smoking is a major risk factor for Chronic Obstructive Pulmonary Disease (COPD), but only 15-20% of smokers get diagnosed. Tobacco dependence may affect smoking patterns that increase tobacco exposure and predispose to lung function decline. Aims: We aimed to assess tobacco dependence among current smokers with and without COPD and evaluate its role in early disease detection. Methods: We performed a cross-sectional study in Greek rural areas using the Fagerström Test for Nicotine Dependence. Current smokers were classified into COPD and non-COPD group based on spirometry parameters. Results: Among 362 current smokers, 288 participants comprised the non-COPD and 71 the COPD group. Both groups presented moderate nicotine dependence (6.2±2.7), but smokers with COPD scored higher in the 1st question (time between awakening and 1st cigarette as an addiction gradient) compared to smokers without COPD. Multiple logistic regression analysis revealed higher COPD prevalence in smokers with higher score in the Fagerström test (odds ratio OR=1.12, 95% confidence interval [1.01 – 1.24]) and older age (OR=1.06 [1.03 – 1.09]). Among smokers with COPD, multiple linear regression analysis showed that the forced expiratory volume in the 1st second (FEV₁), decreases by 2.3% of predicted value for each point increase in the Fagerström test and 0.58% for each year of age, independently of participants’ gender and pack-years smoking index. Conclusions: The Fagerström test for Nicotine Dependence score appears to indicate higher probability for COPD and lung function decline, when assessed along with age in current smokers. Our findings highlight the importance of structured smoking cessation support.