Andrzej Bozek

Publications (10)19.64 Total impact

• Article: Montelukast as an add-on therapy to inhaled corticosteroids in the treatment of severe asthma in elderly patients.

  Andrzej Bozek, Barbara Warkocka-Szoltysek, Agata Filipowska-Gronska, Jerzy Jarzab
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  ABSTRACT: Severe asthma remains a worldwide medical problem. However, this disease has not been adequately explored in the elderly. This study was performed to determine how the addition of montelukast to antiasthmatic therapy improves the control of severe asthma in elderly patients. Elderly patients (>60 years old) with diagnoses of severe asthma were observed over 24 months of therapy: the first 12 months using inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) and the second 12 months with oral montelukast added in two-thirds of the patients, with the remaining third representing the control group. The primary efficacy endpoint of the study was the percentage of days without asthma symptoms in the first 12 months of treatment compared with the percentage after adding montelukast therapy. A total of 512 elderly, asthmatic patients were included in the study: seventy-one (13.9%) patients had well-controlled asthma, 211 (41.2%) had partly controlled asthma, and 230 (44.9%) had uncontrolled asthma. During the first year of treatment using ICS and LABA, an increase in the median percentage of days without asthma was observed from 50.1% to 62.1%, as well as a decrease in the percentage of days with short beta-receptor agonist use, from 52.2% to 46.8%. These differences were significantly greater after 12 months, when montelukast was added to the therapy (78.4% and 39.5%, respectively). This improvement was not observed in the control group. After 2 years of observation, the median number of asthma exacerbation incidents per patient decreased from 1.6 per year to 1.2 per year when montelukast was added. Severe asthma in elderly patients is very poorly treated, with this population exhibiting very low compliance with antiasthmatic therapy. Adding montelukast provides benefits and improved control; however, it does not resolve severe asthma control problems.
  Journal of Asthma 05/2012; 49(5):530-4. · 1.52 Impact Factor
• Article: Clinical features and immunological markers of atopic dermatitis in elderly patients.

  Andrzej Bozek, Andreas Fisher, Barbara Filipowska, Bogdan Mazur, Jerzy Jarzab
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  ABSTRACT: Atopic dermatitis (AD) is increasing among the elderly. Staphylococcus aureus colonization is one of the most important aggravating factors in AD. This study analyses the clinical features of AD in elderly patients and determines the pathogenic roles of staphylococcal superantigens in AD with low and high total IgE levels. S. aureus enterotoxin genes were evaluated using PCR. Additionally, S. aureus-specific IgE levels and peripheral blood lymphocyte profiles were assessed. A total of 44 women and 77 men diagnosed with AD with a mean age of 68.92 ± 6.51 years were evaluated. In 17 (68%) patients with AD and low levels of total IgE, there was a positive correlation between the positive results for enterotoxin B, S. aureus-specific IgE antibodies and Th1 cytokine profiles (Spearman's rank correlation test, r = 0.89, p < 0.05). Our results indicate that AD patients with low total IgE levels differ in immunopathogenesis from AD patients with high circulating levels of total IgE AD.
  International Archives of Allergy and Immunology 11/2011; 157(4):372-8. · 2.40 Impact Factor
• Article: The effect of pimecrolimus on expression of genes associated with skin barrier dysfunction in atopic dermatitis skin lesions.

  Alicja Grzanka, Jadwiga Zebracka-Gala, Regina Rachowska, Andrzej Bozek, Małgorzata Kowalska, Jerzy Jarzab
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  ABSTRACT: The mechanism of action of pimecrolimus (PIM) on atopic lesions is still under consideration. Thus far, we have evidence of its anti-inflammatory and immunomodulatory activity, and recent papers focus on its effect on epidermal barrier function. This study analysed changes in the expression of genes associated with skin barrier dysfunction in atopic dermatitis (AD) skin lesions after 2 weeks of exposure to PIM 1% cream. A real-time quantitative PCR analysis of selected epidermal differentiation complex genes and three alternative pathway keratins was performed in skin biopsies from 11 individuals with AD before and after PIM exposure. The real-time quantitative PCR analysis was compared to non-lesional skin in the same patients. Involucrin, a small proline-rich region (SPRR) 2C gene, and alternative pathway keratin 16 showed significant over-expression in lesional skin followed by significant decrease after PIM therapy. The SPRR1A gene, S100A9, and keratin 6A were also increased; however, the decrease after PIM treatment was not significant. The changes in S100 A2, A7 and A8 followed a similar course with borderline significance. SPRR4 had a significant decrease in expression in lesional versus non-lesional skin, which persisted after PIM treatment. No significant changes were detected in mRNA expression levels of filaggrin and loricrin. Our results suggest that PIM can be effective in restoring the epidermal barrier in patients with AD at least in part by its impact on expression of genes, which are important for the normal barrier function of skin.
  Experimental Dermatology 11/2011; 21(3):184-8. · 3.54 Impact Factor
• Article: Improved activity and mental function related to proper antiasthmatic treatment in elderly patients with Alzheimer's disease.

  Andrzej Bozek, Jerzy Jarzab
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  ABSTRACT: Alzheimer's disease (AD) and bronchial asthma are common diseases in elderly patients. Untreated chronic diseases, such as chronic obstructive pulmonary disorder, diabetes, heart failure, and asthma can be associated with declining cognitive function. The objective of this study was to evaluate the influence of asthma therapy performed according to Global Initiative for Asthma (GINA) guidelines (GINA. Global strategy for asthma management and prevention. Report. Available online at http://www.ginasthma.com/Guidelineitem.asp??l1=2&l2=1&intId=60 last accessed Oct. 2009) on cognitive function and functional status in patients diagnosed with AD. A total of 302 participants who were diagnosed with bronchial asthma and mild or moderate AD (138 women and 164 men) with a mean age of 68.2 ± 5.1 years were included in the study. Cognitive function was assessed based on the Mini-Mental State Examination (MMSE) and the clock drawing test at the beginning of the study, after 6 months, and after 1 year. Results were compared with a control group of patients with AD but not asthma. Several patients (68.9%) had uncontrolled asthma (confirmed at the beginning of the study) and AD. After 1 year of antiasthmatic treatment, the mean MMSE score increased significantly from the baseline values of 17.2 ± 3.2 to 19.5 ± 2.1 (mean ± SD; p < 0.05). This change was significant compared with the control group. Significant improvement in instrumental activity was observed after 1 year of treatment in patients with asthma. Finally, 63.6% of patients met the criteria of well-controlled asthma. Adequate treatment of chronic asthma could improve some cognitive and instrumental activities. Asthma in patients with AD is commonly underdiagnosed and undertreated.
  Allergy and Asthma Proceedings 09/2011; 32(5):341-5. · 2.17 Impact Factor
• Article: The improvement of cognitive functions in patients with bronchial asthma after therapy.

  Andrzej Bozek, Jolanta Krajewska, Jerzy Jarzab
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  ABSTRACT: The severity of asthma in older people is frequently underestimated because of underdiagnosis and undertreatment. There are a number of reasons for this. In elderly patients, chronic diseases can be related to declining cognitive function. This situation could influence diagnosis and treatment. The objective of this study was to evaluate the influence of appropriate asthma therapy on cognitive function. A total of 359 participants diagnosed with bronchial asthma, 219 women and 140 men with a mean age of 69 ± 4.03 years, were included in this study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) at the beginning of this study and after 1 year. Patients were divided into three subgroups based on their initial MMSE scores dementia, mild cognitive impairment (MCI), and good cognition. At the beginning of this study, 31.2% of patients presented uncontrolled asthma, 46.2% exhibited partly controlled asthma, and 25.1% had well-controlled asthma. A significant improvement in control over the patients' asthma was observed over the course of this study. After 1 year of treatment, the mean MMSE score significantly increased in initially demented patients, from 18.2 ± 3.1 (mean ± SD) to 21.9 ± 2.1 (p < .01); in subjects with MCI, from 25.4 ± 0.9 to 27.2 ± 1.2; and in patients with good cognition, from 27.4 ± 0.7 to 29.7 ± 0.4 (chi-square test, p < .01). Proper control of asthma in patients with cognitive impairments can improve some cognitive functions.
  Journal of Asthma 11/2010; 47(10):1148-52. · 1.52 Impact Factor
• Article: Nasal nitric oxide and other diagnostic procedures in seasonal allergic rhinitis: elderly vs juvenile patients.

  Andrzej Bozek, Jolanta Krajewska, Jerzy Jarzab
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  ABSTRACT: The type of allergy and other diagnostic procedures were analyzed in a group of elderly seasonal allergic rhinitis (SAR) patients and were compared with young SAR people and a control group. Study group consisted of 248 patients with mean age 64.1 ± 4.2 years. They were compared with 289 young SAR people (mean age, 23.7 ± 5.8 years) and with a control group. Allergic sensitization was assessed using the skin prick test (SPT) and specific immunoglobulin (Ig) E measurements. The SAR symptoms were monitored using visual graphic scale. Measurement of nasal fractional exhaled nitric oxide (FeNO) level obtained with handheld chemiluminescence analyzer during and after pollen season was compared with control groups. In the elderly patient group, a prevalence of allergy to grass, rye, and mugwort was noticed. In 134 (54%) patients, SPT results to grass were positive; and the specific IgE level was elevated (mean value, 22.8 ± 13.1 IU/mL), whereas in 83 (33%) subjects, positive SPT results to mugwort and elevated serum specific IgE concentration (mean value, 31.9 ± 9.1 IU/mL) were observed. During the pollen season, a significantly higher FeNO level was noted in both young and elderly SAR patients in comparison with their respective control groups. In young patients, the mean FeNO level was 61.8 ± 17.2 parts per billion, whereas in the elderly group, it was 58.2 ± 11.8 parts per billion. SAR in elderly patients is a problem that cannot be neglected. The natural course of SAR in the elderly is similar to other age groups. However, hypersensitivity to different pollens in the analyzed group needs further study.
  American journal of otolaryngology 04/2010; 32(2):105-8. · 0.77 Impact Factor
• Article: Adherence to asthma therapy in elderly patients.

  Andrzej Bozek, Jerzy Jarzab
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  ABSTRACT: To assess the adherence to antiasthmatic therapy by the use of questionnaire and objective methods in elderly people, as well as to evaluate the association between cognition, depressive symptoms, functional status, and compliance. Patients aged 65 to 102 with chronic asthma under therapy were analyzed retrospectively to evaluate adherence using the Modified Morisky (MM) scale and a visual analog scale (VAS). In the second part of the study, a 1-year monitoring of asthma based on electronic diary and assessment of drug usage was performed. The MM scale and VAS as well as the estimation of cognition, depression symptoms, and functional status were carried out at the beginning and at the end of the observations. Among 117 participants at the beginning of the study, only 9% and 21% had high adherence to therapy according to the MM scale and VAS, respectively. After 1 year of monitoring, the compliance assessed by the MM scale increased from 3.08 +/- 0.97 to 3.85 +/- 1.01 and by the VAS from 44% +/- 7.8% to 90% +/- 5.9%. Adherence by electronic diary and drug packages was lower than in both MM scale and VAS. Cognition status correlated with the results of MM and VAS tests but did not influence other methods of assessment. There was a statistical correlation between depression symptoms, cognition, and adherence (p >.01) in contrast to functional status. Compliance correlated with asthma control tests and PEFR. Low adherence to antiasthmatic treatment is common in elderly people. Proper monitoring of asthma by the use of diary or assessment of drugs packages with estimation of depression symptoms and cognition status could increase the compliance and asthma control in this group of patients.
  Journal of Asthma 03/2010; 47(2):162-5. · 1.52 Impact Factor
• Article: HLA status in patients with chronic spontaneous urticaria.

  Andrzej Bozek, Jolanta Krajewska, Barbara Filipowska, Jolanta Polanska, Regina Rachowska, Alicja Grzanka, Jerzy Jarzab
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  ABSTRACT: Chronic spontaneous urticaria (CSU) is the most common form of chronic urticaria. A considerable amount of data supports an immunological basis for CSU. Some research has focused on the association between chronic urticaria and specific human leukocyte antigen (HLA) alleles. The aim of this study was to investigate the HLA status of Polish patients diagnosed with CSU. The standard complement-dependent microlymphocytotoxicity assay and PCR amplification with sequence-specific primers were used to analyze HLA alleles in 115 patients diagnosed with CSU, and the results were compared to those from 162 healthy, genetically unrelated individuals. Among the HLA-A alleles, A-33 occurred significantly more often in the control group (p < 0.01). Analysis of the HLA-B allele frequencies revealed the prevalence of the B44 antigen in the study group (p < 0.0001). Frequencies of HLA-C alleles and HLA-DQ did not differ significantly between the groups. Among the HLA class II alleles, DRB1*04 was observed significantly more often in the study population (p < 0.001), mainly in the autoimmunological subtype of urticaria. HLA alleles may be involved in CSU development or play a protective role in CSU.
  International Archives of Allergy and Immunology 01/2010; 153(4):419-23. · 2.40 Impact Factor
• Article: Locus 1q21 Gene expression changes in atopic dermatitis skin lesions: deregulation of small proline-rich region 1A.

  Jerzy Jarzab, Barbara Filipowska, Jadwiga Zebracka, Małgorzata Kowalska, Andrzej Bozek, Regina Rachowska, Elzbieta Gubala, Alicja Grzanka, Ewa Hadas, Barbara Jarzab
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  ABSTRACT: Discovery of the significant impact of filaggrin (FLG) mutations on the genetic predisposition to atopic dermatitis (AD) focused attention on the 1q21 locus, where not only FLG but also other epidermal genes are located. In the present study, we compared 1q21 gene expression in lesional versus nonlesional AD skin. A real-time quantitative PCR analysis of 10 1q21 genes, selected on the basis of a previous microarray study, was performed in skin biopsies from 33 individuals with AD. Three alternative pathway keratins were also evaluated. In chronic AD skin lesions, we observed an increase in RNA encoding involucrin, S100 calcium-binding proteins A2 and A7-A9 and small proline-rich region (SPRR) proteins 1A and 2C, with fold changes ranging from 2.0 for S100A2 to 15.4 for S100A8 (p < 0.001, Bonferroni corrected), in parallel to the overexpression of the alternative pathway keratins 6A, 6B and 16. The loricrin (LOR) expression level was significantly decreased in lesional AD skin (fold change 0.5; p < 0.01). The expression of the majority of 1q21 genes and alternative keratins was closely correlated; however, for SPRR1A (and SPRR2C) in lesional skin, the correlation with other genes was lost. We hypothesize that the deregulated increase in SPRR1A expression in chronic atopic skin lesions reflects an insufficient rise in SPRR transcripts, unable to compensate for the lack of LOR and thus contributing to the persistence of chronic AD skin lesions. Turning off the stress response in the skin may be regarded as a goal in the treatment of AD skin lesions, and SPRR genes might be targets for such an approach.
  International Archives of Allergy and Immunology 09/2009; 151(1):28-37. · 2.40 Impact Factor
• Article: [Asthma in the elderly--estimation of natural disease course].

  Andrzej Bozek, Santa Besser, Jerzy Jarzab
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  ABSTRACT: Bronchial asthma in the elderly is the significant medical problem because it is often underdiagnosed and insufficiently treated. The aim of the study was the assessment of natural course of bronchial asthma and its diagnostic procedures and treatment in patients after 65 yrs. The study group consisted of 181 patients suffering from asthma, at mean age 69 +/- 2.1 yrs. Apart from retrospective analysis, spirometry, skin tests and serum IgE concentration were performed. RESULTS: The mean duration of asthma was 23 +/- 7.2 yrs and in most cases time of proper diagnosis was prolonged. 49% of elderly patients bad a positive history to atopy. In spirometry the mean value of FEV1 was 2.78 +/- 1.3 l/s. House dust mites were the most common allergen confirmed by skin prick tests and specific serum IgE level. CONCLUSION: The observations proved underdiagnosis and insufficient treatment of asthma in the elderly. Positive skin test and specific IgE observed in a large group of elderly objects can indicate atopic mechanism in these cases.
  Polskie archiwum medycyny wewnȩtrznej 12/2005; 114(5):1079-83. · 1.37 Impact Factor