Elderly and aged asthma have different characteristics: results of a multicenter study.

Background/aim: Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderly asthma) years of age. Materials and methods: The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed. Results: A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group. Conclusion: The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed ≥60 years of age did not have more severe disease.

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs in adults: Beyond current classification.

BACKGROUND: Hypersensitivity reactions (HSRs) to nonsteroidal anti-inflammatory drugs (NSAIDs) are a significant clinical issue. Several classifications have been proposed to categorize these reactions, including the current European Academy of Allergy and Clinical Immunology/European Network for Drug Allergy (EAACI/ENDA) classification. This study aimed to evaluate the applicability of this classification in a real-world clinical setting. METHODS: We conducted a national multicenter study involving patients from nine hospitals in four major urban centers in Turkey. All patients had a suggestive clinical history of hypersensitivity reactions to NSAIDs. Researchers collected data using a structured form and classified reactions based on the EAACI/ENDA classification. Oral provocation tests with several NSAIDs were performed using a single-blind challenge per EAACI/ENDA guidelines. RESULTS: Our retrospective study included 966 adult patients with a history of hypersensitivity to NSAIDs. The most common triggers were Acetylsalicylic Acid (ASA), paracetamol, and metamizole. The most prevalent acute NSAID hypersensitivity group was NSAID-induced urticaria/angioedema (NIUA) (34.3%). However, 17.3% of patients did not fit neatly into the current EAACI/ENDA classification. Notably, patients with underlying asthma or allergic rhinoconjunctivitis exhibited unusual reactions, such as urticaria and/or angioedema induced by multiple chemical groups of NSAIDs, blended mixed reactions, and isolated periorbital angioedema in response to multiple chemical groups of NSAIDs. CONCLUSIONS: While the EAACI/ENDA classification system stratifies NSAID-induced hypersensitivity reactions into five distinct endotypes or phenotypes, it may not fully capture the diversity of these reactions. Our findings suggest a need for further research to refine this classification system and better accommodate patients with atypical presentations.

Comparison of 300 mg versus 600 mg daily maintenance doses of aspirin treatment after desensitization in N-ERD: A three-year multicentre experience.

Background: Aspirin treatment after desensitization (ATAD) is effective in preventing nasal polyps recurrence as well as respiratory symptoms in patients with nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory diseases (N-ERD). However, there is no consensus on effective daily maintenance doses in ATAD. Therefore, we aimed to compare the effects of two different maintenance doses of aspirin on clinical outcomes for 1-3 years of ATAD. Methods: This was a retrospective, multicenter study that involved four tertiary centers. The maintenance doses of daily aspirin were 300 mg in one center and 600 mg in the remaining three. The data of patients who were on ATAD for 1-3 years were included. Study outcomes (nasal surgeries, sinusitis, asthma attacks, hospitalization, oral corticosteroid use, and medication uses) were assessed in a standardized way and recorded from case files. Results: The study initially included 125 subjects, 38 and 87 were receiving 300 and 600 mg daily aspirin for ATAD, respectively. Number of nasal polyp surgeries decreased after 1 -3 years compared with before ATAD in both groups (group 1, baseline: 0.44 ± 0.07 versus first year: 0.08 ± 0.05; p < 0.001 and baseline: 0.44 ± 0.07 versus 3rd year: 0.01 ± 0.01; p < 0.001; and group 2, baseline 0.42 ± 0.03 versus first year: 0.02 ± 0.02; p < 0.001 and baseline: 0.42 ± 0.03 versus 3rd year: 0.07 ± 0.03; p < 0.001). Conclusion: Given the comparable effects of 300 mg and 600 mg aspirin daily as maintenance treatment of ATAD on both asthma and sinonasal outcomes in N-ERD, our results suggest using 300 mg of aspirin daily in ATAD owing to its better safety profile.

Platin desensitizations in thoracic malignancies and risk factors for breakthrough reactions.

Although platin desensitization is a safe and effective alternative for patients with hypersensitivity reactions (HSRs), sometimes breakthrough reactions (BTRs) can be encountered. However, data about the risk factors for BTRs are limited. The aim of this study is to define the outcomes of desensitization, the characteristics of BTRs, and to identify the risk factors for BTRs with platins in thoracic malignancies. This is a retrospective report of patients with thoracic malignancies who underwent platin desensitization. Patients' demographics, initial HSR characteristics, skin test results, desensitization outcomes, and BTR characteristics were recorded. Thirty-three lung cancer and 14 malignant pleural mesothelioma (MPM) patients were included in the study. The culprit drug was cisplatin in 29 and was carboplatin in 18 patients. Skin test positivity was 43.5% with cisplatin, 50% with carboplatin, and it was found to be higher if the interval between the initial HSR and skin testing (ST) was ˃20 days (p = 0.027). One hundred and five desensitization courses were performed. Twenty-two patients had 33 BTRs. Skin test positivity was higher in the BTR-positive group (p = 0.025). BTRs (18.2%; n = 6) were more severe than initial HSR. In the case of epinephrine administration during initial HSR, epinephrine administration during the first BTR was found to be more (p = 0.036). The target dose was achieved in 92.4% of desensitization courses. The number of previous platin infusions ≥10 was found to be an independent risk factor for BTR development (p = 0.036 OR:17.641, 95% CI: 1.211-256.971). Identification of risk factors for BTR will guide appropriate management and desensitization approaches for platin HSRs.

Relationships between quality of life, sleep problems, and sleep quality in patients with chronic idiopathic urticaria.

BACKGROUND: In this study, we aimed to evaluate the sleep quality among chronic urticaria patients using the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL), sleep quality assessment tools, and polysomnography and to investigate any relationships between the obtained results. METHODS: The study included 21 patients diagnosed with chronic spontaneous urticaria and 19 healthy controls. We recorded the patients' sleep quality data, including CU-Q2 oL, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and polysomnography results. RESULT: Patients in the chronic urticaria group were more likely to have an ESS score of ≥10 (52.4% vs. 5.3%, p = 0.004) and an apnea-hypopnea index of ≥5 (44.4% vs. 5.3%, p = 0.017) compared to the control group. In the patient group, the CU-Q2 oL total score was positively correlated with sleep latency (r = 0.713, p = 0.004) and PSQI-C1 score (r = 0.726, p = 0.005), while it was negatively correlated with urticaria duration (r = -0.579, p = 0.015), apnea-hypopnea index (r = -0.607, p = 0.021), longest apnea duration (r = -0.583, p = 0.029), total number of respiratory events (r = -0.618, p = 0.018), and apnea count (r = -0.686, p = 0.007). CONCLUSION: We conclude that sleep-related problems exist among a considerably large proportion of patients with chronic spontaneous urticaria.

Validity and Reliability of the Assessment Tool for Asthma (ATA) Questionnaire: the ATA Study.

OBJECTIVES: A multicenter trial was designed to validate the "Assessment Tools for Asthma (ATA)" questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument. MATERIALS AND METHODS: This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flare-up of asthma, control of comorbidities, treatment adherence, and inhaler technique. RESULTS: The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flare-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach's alpha coefficient=0.683). ACT, ATA1, and two specialists' evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coefficient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specificity=82.40%). CONCLUSION: The validated ATA questionnaire may be a practical tool for physicians in asthma management.

Physicians' preference for controller medication in mild persistent asthma.

BACKGROUND: Although the asthma guidelines recommend inhaled corticosteroids(ICS) or leukotriene receptor antagonists-(LTRAs) for the treatment of mild persistent asthma, factors governing the physicians' preference are unknown. We aimed to investigate the preference of physicians for the controller medication and the factors governing their choice. METHODS: A self-administered questionnaire composed of 16 questions that aimed to determine the preference of the physicians for the first choice controller medication in mild persistent asthma and physician and patient related factors that may be associated with this selection was e-mailed to the members of the Turkish National Society of Allergy and Clinical Immunology and distributed to participants in the 21st congress. RESULTS: Of the 670 questionnaires, there were 51% participants and 336 of them were complete enough to be included in the analysis. Low dose ICS was preferred as the first choice controller medication for mild persistent asthma by 84.5% of the physicians. The reasons for physicians' preference were different for ICS and LTRA. In the logistic regression analysis, use of asthma guidelines (OR:3.5, 95%CI:1.3-9.3, p = 0.01), alignment in guidelines (OR:2.9, 95%CI:1.4-5.8, p = 0.002) and the opinion that it is a more effective (OR:2.3, 95%CI:1.1-4.8, p = 0.02) were independently associated with ICS preference. Being a pediatrician (OR:5.4, 95%CI: 2.7-10.5, p < 0.001) and the opinion that it has better patient compliance (OR:4.4, 95%CI: 1.6-12.0, p = 0.004) were independently associated with LTRA preference. CONCLUSION: Surveyed Turkish physicians, the majority of whom were specialists, preferred ICS over LTRA as controller medication in mild persistent asthma. Asthma guidelines, training background (pediatrician versus not) and perceived efficacy and patient compliance appeared to influence their preferences.

Immediate-type hypersensitivity reactions due to antituberculosis drugs: a successful readministration protocol.

BACKGROUND: Little is known about drug hypersensitivity reactions from antituberculosis drugs. OBJECTIVE: To determine the frequency, risk factors, and characteristics of immediate-type hypersensitivity reactions from first-line antituberculosis drugs and to evaluate the usefulness of a readministration protocol for culprit drugs in this group of patients. METHODS: The study population consisted of patients with tuberculosis who were hospitalized and treated in the authors' hospital in 2011. Demographics and disease and treatment characteristics of patients with immediate-type hypersensitivity from antituberculosis drugs were compared with the other patients. Culprit drugs were readministered gradually according to a defined protocol to patients with immediate-type hypersensitivity. RESULTS: Tree hundred seventy-nine patients were included in the study. Eighteen immediate-type hypersensitivity reactions were detected in 13 patients (3.43%). The only identified risk factor was female sex (odds ratio 4.085). Isoniazid, rifampicin, pyrazinamide, and ethambutol were readministered in 11 patients and rifampicin was readministered in 2 patients, with 6- to 8-step protocols for each drug. Only in 2 patients did allergic reactions with rifampicin develop during the procedure. In these patients, after treatment and complete remission of allergic symptoms, the last tolerated dose was administered and the protocol was completed with the same adjustments. CONCLUSION: Immediate-type allergic reactions from antituberculosis drugs are not rare and not related to disease or treatment characteristics. The protocols used in this study provide a useful and safe method for readministration of culprit drugs to patients with antituberculosis drug hypersensitivity.

The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma.

OBJECTIVES: Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population and can complicate asthma management. The aim of this study was to evaluate the presence of OSA in patients with difficult-to-treat asthma (DTA) and to investigate the sleep quality in these patients. METHODS: Patients with DTA were recruited from the adult allergy clinic of a tertiary care hospital. After completing the Sleep Questionnaire and Epworth Sleepiness Scale, all participants underwent overnight polysomnography. The demographic and asthma severity assessments included the following measures: the age at diagnosis, duration of illness, smoking and atopy status, results of pulmonary function tests, number of asthma control medications used, and number of hospitalizations and emergency room visits because of asthma and analgesic hypersensitivity according to apnea-hypopnea index (AHI) scores. RESULTS: We analyzed 47 (M:9/F:38) DTA patients with a mean age of 48.74±9.45 years. The mean duration of asthma was 9.17±6.5 years. Twenty-four (51.1%) patients were atopic. The analgesic hypersensitivity rate was 27.7%. Fourteen patients (29.8%) were former smokers and 2 patients were current smokers. Sleep quality was impaired in all patients. Thirty-five patients (74.5%) had OSA, 11 of whom had mild OSA, and 24 patients had moderate-severe OSA. The presence of OSA was not statistically correlated with asthma characteristics. CONCLUSION: The study showed that there is a remarkably high prevalence of OSA in DTA. Although no statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, all DTA patients should be assessed for OSA.

Allergic sensitization to ornamental plants in patients with allergic rhinitis and asthma.

Ornamental plants (OPs) can lead to immediate-type sensitization and even asthma and rhinitis symptoms in some cases. This study aimed to evaluate sensitization to OPs in patients with asthma and/or allergic rhinitis and to determine the factors affecting the rate of sensitization to OPs. A total of 150 patients with asthma and/or allergic rhinitis and 20 healthy controls were enrolled in the study. Demographics and disease characteristics were recorded. Skin-prick tests were performed with a standardized inhalant allergen panel. Skin tests by "prick-to-prick" method with the leaves of 15 Ops, which are known to lead to allergenic sensitization, were performed. Skin tests with OPs were positive in 80 patients (47.1%). There was no significant difference between OP sensitized and nonsensitized patients in terms of gender, age, number of exposed OPs, and duration of exposure. Skin test positivity rate for OPs was significantly high in atopic subjects, patients with allergic rhinitis, food sensitivity, and indoor OP exposure, but not in patients with pollen and latex allergy. Most sensitizing OPs were Yucca elephantipes (52.5%), Dieffenbachia picta (50.8%), and Euphorbia pulcherrima (47.5%). There was significant correlation between having Saintpaulia ionantha, Croton, Pelargonium, Y. elephantipes, and positive skin test to these plants. Sensitivity to OPs was significantly higher in atopic subjects and patients with allergic rhinitis, food allergy, and indoor OP exposure. Furthermore, atopy and food sensitivity were found as risk factors for developing sensitization to indoor plants. Additional trials on the relationship between sensitization to OPs and allergic symptoms are needed.

Does drug compliance change in asthmatic patients during pregnancy?

BACKGROUND: Pregnant women with asthma are recommended to maintain optimal therapeutic management during pregnancy. Uncontrolled, symptomatic asthma may increase the risk of adverse peri-natal outcomes; thus adequate regular anti-asthmatic treatment must be given to provide optimal asthma control during pregnancy. However, doubts about the safety of asthmatic drugs can affect pregnant asthmatic patients' drug compliance. The aim of this study was to assess behavioral differences in drug compliance among pregnant asthmatic patients. METHODS: Thirty two asthmatic and 121 healthy pregnant women were enrolled in the study. Structured face-to-face interviews were conducted after delivery. The interviews included disease characteristics, drug compliance and patients' own perspective for asthma status prior to and during pregnancy. In addition, medical and pregnancy history, pregnancy complications and outcomes, and newborn characteristics were recorded. RESULTS: In our study group the rates of hospitalization, emergency room visits and systemic steroid use in the year before pregnancy were 13%, 46.9% and 18.8%, respectively. The rate of regular asthma medication use was only 32% at that period and increased to 44% during pregnancy. However, hospitalization, emergency room visits, systemic steroid usage rates remained unchanged and according to patients' own evaluations, 44% of asthmatics pointed out that their asthma had worsened during pregnancy. No statistically significant difference was detected in terms of pregnancy/labour complication between asthmatic and non-asthmatics. CONCLUSIONS: Contrary to some previous studies, in our study regular use of asthma drugs increased during pregnancy. The uncontrolled condition of their asthma before and during pregnancy and the idea that their asthma worsened during pregnancy might force the patients to use medication more regularly.

Two cases of tracheal disease misdiagnosed as difficult-to-treat asthma.

Initial management of patients with difficult-to-treat asthma must begin with confirmation of the diagnosis. We present 2 cases of tracheal disease misdiagnosed as difficult-to-treat asthma. After systemic evaluation, tracheomalacia and tracheobronchial narrowing due to diffuse calcification of the cartilaginous rings were found as mimicking asthma.

Self-reported prevalence of hypersensitivity reactions against drugs among medical students: does awareness cause any difference?

PURPOSE: True epidemiologic data on hypersensitivity reactions to drugs are scarce. More accurate data may be obtained in more specific clinical settings. Considering their educational background, medical students may be an appropriate target audience for evaluating prevalence of drug hypersensitivity. This study is designed to determine the prevalence of self-reported drug hypersensitivity alongside related factors among young adults. METHODS: A structured questionnaire was administered to the students. RESULTS: A total of 1267 students (mean age: 21.71+1.90 years, F/M: 648/619) from all grades responded to the survey. The mean prevalence of self-reported drug hypersensitivity was 4.7% (60/1267). The most frequently involved drugs were beta-lactam antibiotics (55%) followed by non-steroidal anti-inflammatory drugs (28%). The most commonly reported clinical presentations were cutaneous (43.3%), followed by systemic (36.8%), cardiovascular (8.3%) and respiratory (8.3%) symptoms. Factors related with reported reactions were higher grades (p=0.015, OR: 2.09), female gender (p=0.006, OR: 2.13), personal history of allergic diseases (p=0.001, OR: 2.64), and family history of drug hypersensitivity (p<0.001, OR: 5.78). Half of the students sought medical help during the acute stage of their reaction. Only 3.2% of the cases have been referred to an allergist for further evaluation. CONCLUSION: This study, the first of its kind in Turkey, with medical students showed that self-reported hypersensitivity reactions to drugs is highly prevalent and its prevalence seems to be affected by awareness of the individuals in addition to previously reported risk factors. The education of both patients and physicians on the management of drug hypersensitivity seems to be necessary.

Triggers in adult asthma: are patients aware of triggers and doing right?

BACKGROUND: As triggers have a potential to induce asthma exacerbations, awareness of the patients to individual triggers as well as protective measures might be helpful to prevent asthma attacks. Though allergens and allergen avoidance have been studied extensively, there are only few studies on non-allergic triggers and their avoidance for adult patients with asthma. In this study, we wanted to investigate asthma triggers and compliance to the preventive measures in an adult population. METHODS: One hundred and thirty one adult asthma patients were enrolled into the study. A face to face interview was done by using a questionnaire including individual asthma triggers, prevention measures against major modifiable triggers and knowledge sources of the cases. RESULTS: Regardless of asthma severity, 59.5 % of the subjects reported to be triggered by more than 10 factors. The most common triggers were air pollutants (89.3 %) and weather changes (81.7 %). Severe group was more frequently affected by medications, emotional stress, weather changes and indoor pollutants than other severity groups (p=0.017, 0.014, 0.049 and 0.018, respectively) whereas stress was reported more frequently by females than males. Prevention measures were insufficient regarding some major triggers. CONCLUSION: Adult patients are vulnerable to several triggers regardless from underlying severity of the illness. Insufficient compliance to the major preventive measures indicates that new strategies are needed to prevent asthma attacks caused by modifiable triggers.

The role of plasminogen activator inhibitor-1 polymorphism, factor-V-Leiden, and prothrombin-20210 mutations in pulmonary thromboembolism.

Polymorphism in plasminogen activator inhibitor-1 gene is suggested to be associated with an increased risk of venous thromboembolism. The aim of this study was to investigate the association of plasminogen activator inhibitor-1 gene polymorphism and its coexistence with factor-V-Leiden and prothrombin-20210 mutations in pulmonary thromboembolism. The authors investigated plasminogen activator inhibitor-1 4G/5G polymorphism, factor-V-Leiden, and prothrombin-20210 mutations in 143 pulmonary thromboembolism patients and 181 controls. Plasminogen activator inhibitor-1 4G/4G, 4G/5G, and 5G/5G gene polymorphisms and prothrombin-20210 mutations were not different between cases and controls. Factor-V-Leiden mutation was present in 21.0% and 7.7% of the cases and controls, respectively, P = .001. Neither different plasminogen activator inhibitor-1 genotypes and 4G allele nor coexistence of the allele with factor-V-Leiden or prothrombin-20210 was associated with the risk of recurrence. As a result, plasminogen activator inhibitor-1 gene polymorphism or its concomitant presence with mentioned mutations was not found to be associated with increased risk for pulmonary thromboembolism or recurrent disease in this study.

The prevalence of latex allergy in sixth-year medical students: assessment of knowledge, risk, and attitudes about future specialty direction.

BACKGROUND: In the prevention of latex allergy, knowledge levels and risk determination for latex allergy of medical students gain importance. OBJECTIVES: To evaluate the latex allergy knowledge levels of sixth-year medical students and their latex allergy risk. METHODS: Students completed a questionnaire that assessed basic knowledge of latex allergy and that evaluated latex-related symptoms and latex exposure. The specialty branch students were going to choose in the Medical Specialty Examination was also asked. Skin prick tests (SPTs) with latex and inhalant allergens and patch tests with latex-related products were then performed. Finally, students were asked again about any changes in branch selection after learning their individual risks. RESULTS: Two hundred twenty sixth-year students were enrolled. Forty-four percent of the students gave the right answer for description of latex. Correct identification of at least 1 latex-related product used outside and inside hospitals was 55.5% and 95.5%, respectively. The prevalence of latex sensitization was 4.4% according to SPT results. The positivity of SPT to any inhalant allergen was 35% (n = 64). None of the students changed their mind about their specialty branch after learning their latex allergy risk. CONCLUSIONS: Last-year medical students have a remarkably low latex allergy knowledge level, which imposes a serious professional risk. Training strategies based on the benefit to this risk group and reevaluation are strongly recommended before graduation from medical school.

Fasting: an important issue in asthma management compliance.

BACKGROUND: Fasting, neither eating nor drinking anything between dawn (sahur time) and sundown (iftar time), may have an important role in the treatment and follow-up of asthmatic patients in countries where most of the population is Muslim. OBJECTIVE: To analyze the effects of fasting on outpatient asthmatic patients. METHODS: One hundred twenty-one fasting patients were evaluated for attendance at follow-up visits, attitudes about undergoing diagnostic investigations, and opinions and practices regarding medication use during fasting. Their sources of knowledge about asthma, fasting, and medication consumption were also evaluated. RESULTS: Ninety percent of fasting patients reported no harm with respect to religion of visiting physicians while fasting. Although 96% of the patients stated that inhaled medication could be used, only 13% continued to use medication in the same manner as when they were not fasting. Most patients rearranged their medication-consumption hours. Although 96% of the patients received general information about asthma from their physicians, rates of receiving information about the fasting-medication use relationship from physicians and religious sources were similar (37% and 32%, respectively). CONCLUSION: Most Muslim asthmatic patients do not consider asthma to be a drawback to fasting, and they continue fasting by rearranging their medication consumption times. During Ramadan, patients should be questioned about this subject and should be followed up carefully for asthma control at regular visits.

Sensitization to Alternaria and Cladosporium in patients with respiratory allergy and outdoor counts of mold spores in Ankara atmosphere, Turkey.

Sensitization to Alternaria and Cladosporium has been reported to be 3% to 30% in European countries. However, in Turkey, there is limited data about the prevalence of sensitization to these molds and the intensity of the two mold spores in Ankara atmosphere. This study was designed to evaluate the sensitization to Alternaria and Cladosporium in patients with respiratory allergy in Ankara and also the concentration of the two molds in Ankara atmosphere. Allergic rhinitis and asthma patients living in Ankara were included in the study. Demographic and diagnostic data of the patients were recorded. A skin prick test with extracts supplied by three different laboratories was used to evaluate the sensitization to Alternaria and Cladosporium. Mold spores were measured using a Burkard 7-day recording volumetric spore trap in Ankara atmosphere during a year. Overall sensitization to the two molds was found to be 14.8%, and isolated Alternaria or Cladosporiumsensitization was 3%. Considering the positive reaction to at least one of the three suppliers, the sensitization rate was 11.9% and 8.1% for Alternaria and Cladosporium, respectively. Cochran's Q homogenization test demonstrated that the positive and negative reaction were not homogeneous among three laboratories. The total number of mold spores in Ankara atmosphere was 429,264 spores/m3 of which 75.5% and 6% were constituted by Cladosporium and Alternaria, respectively. The prevalence of Cladosporium and Alternaria sensitization in respiratory allergy patients is quite similar to European countries; however, our data indicate that commercial mold extracts should be standardized to establish the real sensitization rates. Additionally, considering the great numbers of these mold spores in Ankara atmosphere, long-term follow-up studies are needed to evaluate the relationship between the mold load and sensitization patterns.

Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis.

OBJECTIVE: Side effects of the most commonly used primary antituberculosis (anti-TB) drugs may be mild as well as fatal. The aim of this study was to evaluate the side effects of and the risk factors for developing side effects against anti-TB drugs. PATIENTS AND METHODS: Records of 1149 patients with established tuberculosis who initially received anti-TB therapy were evaluated retrospectively. The major side effects, which resulted in a definitive termination from 1 or more drugs related to anti-TB therapy, and the risk factors associated with these side effects, were analyzed. RESULTS: Ninety-five patients (8.3%), constituting 104 cases in total, experienced side effects. Although the frequency of drug reactions were increased from 0.6% at ages <20 to 5.2% at ages 20-40, no gender or age differences were observed between patients who did and did not have side effects. While asymptomatic liver function disturbance was established in 56 of the patients (4.9%) with initiation of anti-TB therapy, the rate of hepatotoxicity was found to be 2.4% in this present study. No age or gender differences were observed among those who had hepatotoxicity and who had not. The major side effects were ototoxicity (1.7%), hepatotoxicity (0.8%), neuropsychiatric manifestations (0.7%), and hyperuricemia (0.6%). CONCLUSIONS: It must be remembered that severe side effects associated with anti-TB drugs were encountered with different frequencies especially among patients hospitalized for pulmonary tuberculosis, and these patients should be followed up by closer monitoring for side effects related to anti-TB drugs.

High plasma levels of factor VIII: an important risk factor for isolated pulmonary embolism.

OBJECTIVE: The aim of the study was to investigate whether factor V Leiden and prothrombin G20210A mutations, elevated levels of factor VIII and factor IX are associated with pulmonary embolism (PE). METHODS: Sixty-four patients with objectively documented PE and 64 control subjects were included in this study. The authors divided the 64 subjects with PE into those with PE and deep vein thrombosis (combined form of venous thromboembolism, n = 26) and those with PE without deep vein thrombosis (isolated PE n = 38). RESULTS: There was no significant difference between the PE groups and the control subjects with regard to the presence of factor V Leiden and prothrombin mutations and elevated levels of factor IX. Using the 90th percentile measured in control subjects (P(90) = 168 U/dL) as a cut-off point for factor VIII levels, the authors found an 11-fold increased risk for both isolated PE patients and patients with a combined form of venous thromboembolism who have factor VIII levels >168 U/dL compared with individuals having factor VIII levels below this cut-off point. The risk was not affected by adjustments for other possible risk factors. CONCLUSIONS: Elevated plasma factor VIII levels were found to be a significant, independent risk factor for PE.