Could the HALP score serve as a biomarker of bronchiectasis exacerbation?

Introduction: Bronchiectasis is a chronic inflammatory lung disease and patients may occasionally experience acute exacerbations. Our study aims to determine the relationship between exacerbation periods and HALP (hemoglobin, albumin, lymphocyte, platelet) scores in patients with bronchiectasis. Materials and Methods: Adult patients diagnosed with bronchiectasis and followed up in our clinic between 02.2020-12.2022 were retrospectively evaluated. After the examinations, the effect of bronchiectasis exacerbation on the HALP score was investigated. Result: A total of 84 patients diagnosed with non-cystic fibrosis bronchiectasis were included in our study. 42 of the patients were male (50%), and 42 were female. The average age of all patients was 52.37 ± 16.2. 35 patients (41.7%) were in the exacerbation period, and 49 patients (58.3%) were in the stable period. The median values of leukocytes, neutrophils, and C-reactive protein (CRP) were significantly higher in patients during the exacerbation period compared to the stable period (respectively p= 0.00, p= 0.00, p= 0.00). The average values of FEV1% and FVC% in patients during the exacerbation period were significantly lower compared to the stable period (p= 0.03, p= 0.00, respectively). The HALP score was significantly lower in patients during the exacerbation period compared to the stable period (p= 0.00). A significant negative correlation was found between the HALP score and leukocytes, neutrophils, and CRP (p= 0.00, p= 0.00, p= 0.00, respectively). Also, a significant positive correlation was found between the HALP score and FEV1% and FVC% (p= 0.00, p= 0.00, respectively). Conclusions: Our study revealed that the HALP score is associated with infectious and pulmonary functional parameters in bronchiectasis patients in the exacerbation period. We propose that the HALP score could serve as a valuable biomarker during exacerbations.

Neglecting the neglected: Tobacco cessation support is essential for the management of asthma and COPD.

INTRODUCTION: Asthma and COPD management have a broad framework, and smoking cessation plays an essential role. We examine the management of asthma and COPD patients not only for inhaler treatment options but also for essential interventions, such as smoking cessation support. METHODS: Data were collected cross-sectionally from pulmonology departments of three government hospitals in Türkiye between May and September 2022. Patients aged ≥18 years who had been diagnosed with asthma or COPD for at least a year, were included in the study. The demographic and clinical characteristics of the patients were investigated. Routine cessation interventions were implemented for current smokers, and they were followed via phone calls after one month regarding their quit status and access to cessation clinics. RESULTS: Data from 145 patients with asthma and 148 patients with COPD were analyzed. The rate of current smoking among patients with asthma and COPD was 18.8% and 34.5%, respectively. Current smoking was negatively associated with age (<65 years) and disease duration (years) for both diseases (p<0.05). In addition, for asthmatics, presence of pulmonary disease in the family (OR:0.28, 95% CI: 0.10-0.79) and for COPD patients presence of hospitalization (OR: 0.26, 95% CI: 0.07-0.93) were negatively associated with current smoking. After one month, 85.1% of current asthmatic smokers had not tried to call a quitline, while 14.8% had tried to contact a quitline. Among current smoker COPD patients, only 1.9% had visited a smoking cessation clinic. CONCLUSIONS: Tobacco cessation support seems to be neglected in asthma and COPD management. Instead, pulmonologists and patients focus on pharmaceutical treatments, which constitute the other component of care.

Efficacy of mepolizumab and omalizumab combination therapy in uncontrolled asthma.

OBJECTIVE: Results of biological therapies are often encouraging for severe asthma who are phenotyped as Type 2 inflammation. Unfortunately, some patients do not achieve the desired responses. In this group of patients, there are often switches between anti Ig E and anti-IL-5s and partial improvements are often is deemed sufficient. METHOD: We planned to start combination therapy with mepolizumab and omalizumab in a 52-year-old patient with uncontrolled allergic asthma whose asthma could not be controlled with omalizumab and mepolizumab treatment, respectively. After complete asthma control was achieved, we aimed to discontinue mepolizumab and continue with omalizumab because it was allergic asthma. RESULT: The combination of omalizumab 300 mg/month and mepolizumab 100 mg/month was tried and emergency admissions and oral corticosteroids were stopped. At the same time, significant improvement was observed in asthma control test, pulmonary function test and comfort of life. CONCLUSION: Combined use of Anti-Ig E (omalizumab) and Anti IL 5 (mepolizumab) with a synergistic effect by acting through both pathways, especially in patients with allergic asthma and high levels of both total Ig E and eosinophilia, was found to be effective and no side effects were observed in long-term follow-up. Combination therapy with omalizumab and mepolizumab may become a safe option in patients with severe allergic asthma with a Type 2 inflammatory phenotype who cannot be controlled with each biologic agent.

Perceived Need for Mental Health Services Among Healthcare Workers During the Coronavirus Disease-19 Pandemic in Turkey: A Multicenter Cross-sectional Study

Background: The coronavirus disease-2019 pandemic has contributed to work-related psychosocial risks in healthcare workers. Aims: To evaluate the perceived need for mental health services and related factors in Turkish healthcare workers practicing in pandemic hospitals. Study Design: Cross-sectional study. Methods: Data were collected from face-to-face interviews with healthcare workers at 19 pandemic hospitals in 13 provinces between September and November 2021. The study survey included the evaluation of the perceived need for and utilization of mental health services in the previous year, as well as sociodemographic, health-related, and work-related characteristics, the General Health Questionnaire-12, the World Health Organization Quality of Life-BREF (WHOQoL-BREF) questionnaire, and the Fear of coronavirus disease-2019 scale (FCV-19S). Results: Of 1,556 participants, 522 (33.5%) reported a perceived need for mental health services, but only 133 (8.5%) reported receiving these services. Multiple logistic regression analysis of the perceived need for mental health services revealed significant relationships with lower age, female sex, being a current smoker, having a chronic disease, having a mental disorder, coronavirus disease-2019 contact within the last three months in settings other than the home or workplace, a positive coronavirus disease-2019 vaccination history, being a physician, being a non-physician healthcare professional, and coronavirus disease-2019 contact within the last three months at work. After adjustment for these characteristics, higher General Health Questionnaire-12 and FCV-19S scores and lower WHOQoL-BREF domain scores were related to the perceived need for mental health services in logistic regression analyses. Conclusion: The findings indicate a substantial need for mental health services amongst Turkish healthcare workers during the pandemic and outline participants' characteristics regarding high-priority groups for the intervention. Future research may focus on developing actions and evaluating their efficiency.

ERS International Virtual Congress 2021: Highlights from the Turkish Thoracic Society Early Career Members.

This review aimed to highlight some important points derived from the presentations of the European Respiratory Society 2021 Virtual International Congress by a committee formed by the Early Career Task Group of the Turkish Thoracic Society. We summarized a wide range of topics including current developments of respiratory diseases and provided an overview of important and striking topics of the congress. Our primary motivation was to give some up-to-date information and new developments discussed during congress especially for the pulmonologists who did not have a chance to follow the congress. This review also committed an opportunity to get an overview of the newest data in the diverse fields of respiratory medicine such as post-coronavirus disease 2019, some new interventional and technologic developments related to respiratory health, and new treatment strategies.

Correlation of the Radiological Emphysema Score of Chronic Obstructive Pulmonary Disease Patients with Clinic Parameters.

OBJECTIVE: To evaluate the association between the degree of emphysema on computed tomography (CT) images and disease severity, in order to predict the clinical characteristics of patients with chronic obstructive pulmonary disease (COPD). STUDY DESIGN: Cross-sectional, observational study. PLACE AND DURATION OF STUDY: University of Health Sciences, Diskapi Training and Research Hospital, Ankara, Turkey between January 2016 and January 2017. The analysis of the medical records of patients was performed in December 2020. METHODOLOGY: Clinically diagnosed COPD patients were included in this study. Based on emphysema severity on CT, the patients were classified into three groups as group I (n=59), group II (n=37), and group III (n=20), and emphysema was not present in the remaining 15 patients. The associations between emphysema severity and the GOLD stage, mMRC dyspnea score and exacerbation frequency were analysed with Chi-square test. RESULTS: In 131 patients, the severity and presence of emphysema was found to be significantly associated with smoking history (p=0.034). However, no significant differences were observed between emphysema severity and exacerbation frequency (p=0.512) and mMRC dyspnea scores (p=0.110). The severity of emphysema was related with the GOLD stage (p=0.001). There was also a significant association between BMI and severity of emphysema, with the severe emphysema cases tending to be underweight (p=0.001). CONCLUSION: CT-emphysema severity can be used to classify COPD to assist in the clinical characterisation of patients. This type of classification is important to determine the underlying pathophysiology and genomic profile of COPD.     Key Words: Chronic obstructive pulmonary disease, Computed tomography, Emphysema.

Evaluation of transcutaneous carbon dioxide and saturation monitoring during fiberoptic bronchoscopy.

INTRODUCTION: The aim of the study was to assess the effects of interventions during bronchoscopy on ventilation and determine the risk factors for hypoventilation related to both interventions and patients' demographical and clinical characteristics. MATERIALS AND METHODS: A total of 74 patients who underwent fiberoptic bronchoscopy (FOB) were included in the study. Oxygen saturation (SpO2) and partial carbon dioxide pressure (PCO2) were measured transcutaneously (TcSO2 and TcPCO2) using a sensor consisting of a probe placed on the earlobe. The demographic characteristics and basal, mean, peak and minimum values of TcSO2 and TcPCO2 during FOB were retrospectively analyzed and assessed in terms of the risk factors for hypoventilation. RESULT: During the procedure, the device automatically recorded the TcSO2 and TcPCO2 values. The mean TcPCO2 level was 37.09 ± 5.6 (27.1-60.6) mmHg. The mean increase in the TcPCO2 level from baseline was 3.25 ± 2.12 mmHg. The mean TcSO2 measurement was 95.9 ± 2.27 (80-100%). The measured mean and peak TcPCO2 values were significantly higher in men. In the whole group, the patients with a history of smoking more than 20 packyears also had significantly higher TcPCO2 values compared to the nonsmokers and light smokers. In the patients with endobronchial lesions, the decrease in the TcSO2 level was higher during FOB (p= 0.03), and the mean difference between the lowest and mean TcSO2 levels was significantly greater (6.2 vs 4.55%, p= 0.03). CONCLUSIONS: Changes in ventilation during FOB have multifactorial causes. The best indicator of ventilation is PCO2, and monitorization of PCO2 is very important in detecting hypoventilation. In this study, we determined some risk factors for hypoventilation in order to predict ventilation problems in patients planned to undergo FOB. We recommend that in male patients with endobronchial lesions, those with a longer smoking history, and those with a longer duration of FOB, SpO2 should be monitored together with PCO2.