Bronchiectasis in Türkiye: Data from a Multicenter Registry (Turkish Adult Bronchiectasis Database).

Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry-based studies and drug research. Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in Türkiye to those of other countries. Study Design: A multicenter prospective cohort study. Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in Türkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non-cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 ± 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research council dyspnea scale score (OR: 1,952; 95% CI: 1,459-2,611), presence of chronic renal failure (OR: 4,172; 95% CI: 1,249-13,938) and use of inhaled steroids (OR: 2,587; 95% CI: 1,098-6,098) were significant risk factors for mortality. Mortality rates were higher in patients with COPD than in those with no COPD (21.7-9.1%, p = 0.016). Patients with bronchiectasis and COPD exhibited more frequent exacerbations, exacerbation-related hospitalizations, and hospitalization in the intensive care unit in the previous year than patients without COPD. Conclusion: This is the first multicenter study of bronchiectasis in Türkiye. The study results will provide important data that can guide the development of health policies in Türkiye on issues such as infection control, vaccination, and the unnecessary use of antibiotics and steroids.

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.

Changes in the Number of Newly Diagnosed Lung Cancer Patients Before and During the COVID-19 Pandemic: A Single-Center Experience.

OBJECTIVE: The coronavirus disease-2019 pandemic has affected the entire health system and patients other than coronavirus-infected patients. Hospital admissions of cancer patients decreased during the closure periods due to the pandemic. This study was conducted to determine whether there was an effect on the hospital admissions of newly diagnosed lung cancer patients in Turkey during the corona- virus disease-2019 pandemic. MATERIAL AND METHODS: In this retrospective study, newly diagnosed lung cancer patients were recorded from the Hospital Information Management System between January 1, 2017, and December 31, 2020, at our tertiary hospital. The number of newly diag- nosed lung cancer patients diagnosed in 2020 was compared with each year from 2017 to 2019. RESULTS: Between 2017 and 2020, 15 150 newly diagnosed lung cancer cases were analyzed. According to Global Cancer Observatory data, in 2018, 34 703 newly diagnosed lung cancer cases, and in 2020, 41 264 newly diagnosed lung cancer cases were observed in Turkey. Although a decrease was not observed in the number of patients according to Global Cancer Observatory data, both the total number of patients admitted to our hospital and the number of newly diagnosed lung cancer patients decreased in 2020. The number of newly diagnosed lung cancer patients by year was 4030 patients in 2017, 4004 patients in 2018, 4391 patients in 2019, and 2725 in 2020, respectively. In 2020, newly diagnosed lung cancer patients decreased by 38%, 32%, and 32% compared to 2019, 2018, and 2017, respectively. Also, a significant decrease was seen in the number of newly diagnosed lung cancer patients in the months with clo- sure due to the pandemic compared to the months without closure. CONCLUSION: There was a significant decrease in hospital admissions of newly diagnosed lung cancer cases in the coronavirus dis- ease-2019 pandemic in our referral hospital. Precautions should be considered to diagnose and treat lung cancer patients in specialized centers during a pandemic due to epidemic diseases such as coronavirus disease-2019.

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

INTRODUCTION: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey. MATERIALS AND METHODS: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials. RESULT: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency. CONCLUSIONS: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

Factors related to depression and anxiety in adults with bronchiectasis.

INTRODUCTION AND BACKGROUND: Patients with chronic lung diseases frequently have depressive and anxiety symptoms, but there are very few studies looking at this in patients with bronchiectasis. AIM: This study aimed to investigate depression and anxiety and related factors among patients with non-cystic fibrosis bronchiectasis. PATIENTS AND METHODS: This was a prospective study of 133 patients with bronchiectasis. Patients with confirmed diagnosis of bronchiectasis with high-resolution computed tomography were enrolled in the study. Patients that were clinically stable in the previous 4 weeks were evaluated with the Hospital Depression and Anxiety scale. Symptoms, pulmonary function tests, and medical treatments were recorded. RESULTS: The mean age of patients was 49.5±14.5 years (range, 18-77 years), and 81 (60.9%) patients were females. Twenty-eight (21.1%) patients had depression, and 53 (39.8%) had anxiety. Depression score was related to family situation (living with a partner), previous depression history and admission to an emergency department within the last year. Anxiety score was related to female gender, the family situation (living with a partner), previous depression history, and admission to an emergency department within the last year (P<0.05). Depression was positively correlated with hemoptysis, admission to an emergency department within the last year and living with a partner. Anxiety was positively correlated with education level, previous depression history, admission to an emergency department within the last year, and living with a partner. CONCLUSION: Patients with non-cystic fibrosis bronchiectasis are at increased risk for depression and anxiety. Untreated and undetected depressive/anxiety symptoms may increase physical disability, morbidity, and health care utilization. It is important for clinicians to be aware of the presence of depression and anxiety in bronchiectasis.