Attitude and Practice Toward Use of Cigarettes and Electronic Cigarettes Among Pregnant Women: A Questionnaire-Based Survey.

OBJECTIVE: This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. MATERIAL AND METHODS: A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. RESULTS: Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001). CONCLUSION: Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.

The utility of neutrophil-to-lymphocyte ratio determined at initial diagnosis in predicting disease stage and discriminating between active and stable disease in patients with sarcoidosis: a cross-sectional study.

OBJECTIVE: To evaluate the utility of neutrophil-lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. METHODS: A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis. RESULTS: Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34-4.31) vs. 2.29 (1.67-3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62-0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002). CONCLUSION: Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.

An Uncommon Coexistence of Sarcoidosis and Cutaneous Leukocytoclastic Vasculitis in an Adult.

The skin is the second most commonly involved organ after pulmonary system in sarcoidosis, a multisystemic granulomatous disease. Cutaneous small-vessel vasculitis (leukocytoclastic vasculitis [LCV]) is a disorder characterized by neutrophilic inflammation of small blood vessels. Although the skin is the organ where LCV is seen most frequently, extracutaneous involvements are also seen. Herein, we present a coexistence of sarcoidosis and cutaneous LCV, which is an uncommon condition in adult.

A comparative analysis of errors in inhaler technique among COPD versus asthma patients.

PURPOSE: This study was designed to evaluate errors in inhaler technique in COPD vs asthma patients and to investigate the association of poor inhaler technique with patient demographics and clinical variables. PATIENTS AND METHODS: A total of 509 adult patients with COPD (n=328) or asthma (n=181) who were currently using an inhaler device were included in this study. Data on patient demographics, duration of disease, type and duration of inhaler therapy, and assessment of inhaler technique were recorded. RESULTS: Metered dose inhaler (MDI) was the most common type of inhaler used by a similarly high percentage of patients in both COPD (83.2%) and asthma (77.3%) groups. Failure to exhale before inhaling through device (75.8% and 68.5% for MDIs; 73.2% and 71.8% for Aerolizer®/Handihaler®; 53.1% and 66.7% for Turbuhaler®) was the most common error in inhaler technique, in both COPD and asthma groups. Device-specific errors in inhaler techniques were more common in asthma patients as compared with COPD patients, particularly for MDIs (P-values ranged from 0.046 to 0.0005), as associated with female gender (failure to press the buttons on both sides of Aerolizer®/Handihaler®, P=0.006), shorter duration of disease (failure to hold MDI or head in a vertical position, P<0.001, and to keep Turbuhaler® upright, P=0.005), and shorter duration of inhaler usage (failure to hold head in a vertical position during MDI usage, P=0.006, and to keep Turbuhaler® upright, P=0.012). CONCLUSION: In conclusion, our findings revealed that errors in inhaler technique in terms of inhalation maneuvers and device handling were similarly common in COPD and asthma patients. Errors in certain device handling maneuvers, particularly with MDIs, were more common among asthma patients than among COPD patients and associated with female gender and shorter durations of disease and inhaler therapy.

Right Ventricular Functional Improvement after Pulmonary Rehabilitation Program in Patients with COPD Determined by Speckle Tracking Echocardiography / Melhora da Função Ventricular Direita após Programa de Reabilitação Pulmonar em Pacientes com DPOC Avaliada por Ecocardiografia Speckle Tracking

Abstract Background: Although right ventricular (RV) dysfunction in pulmonary diseases has been associated with increased morbidity, tools for RV dysfunction identification are not well defined. Objective: The aim of this study was to evaluate the magnitude of RV dysfunction by means of speckle tracking echocardiography (STE) in patients with chronic obstructive pulmonary disease (COPD) and to investigate whether STE could be used as an index of RV improvement after a pulmonary rehabilitation (PR) program. Methods: Forty-six patients with COPD undergoing PR program and 32 age-sex matched healthy subjects were enrolled. RV function was evaluated at admission and after PR program by conventional two-dimensional echocardiography (2DE) and STE. In addition, exercise tolerance of subjects was evaluated using the six-minute walk test (6MWT). Results: COPD patients had worse RV function according to STE and 2DE as well. STE was more sensitive than conventional 2DE in determining RV improvement after PR program - RV global longitudinal strain (LS): 20.4 ± 2.4% vs. 21.9 ± 2.9% p < 0.001 and RV free wall LS: 18.1 ± 3.4% vs. 22.9 ± 3.7%, p < 0.001). RV free wall LS was directly related to distance walked at baseline 6MWT (r = 0.58, p < 0.001) and to the change in the 6MWT distance (6MWTD ∆) (r = 0.41, p = 0.04). Conclusions: We conclude that STE might be as effective as 2DE for evaluation of global and regional RV functions. STE may become an important tool for assessment and follow-up of COPD patients undergoing PR program to determine the relationship between RV function and exercise tolerance.

Resumo Fundamento: Embora a disfunção do ventrículo direito (VD) nas doenças pulmonares tenha sido associada ao aumento da morbidade, as ferramentas para a identificação da disfunção do VD não estão bem definidas. Objetivo: O objetivo deste estudo foi avaliar a disfunção do VD por ecocardiografia speckle tracking (STE) em pacientes com doença pulmonar obstrutiva crônica (DPOC), e se a STE pode ser usada como indicador de melhora da função ventricular direita após um programa de reabilitação pulmonar (RP). Métodos: Quarenta e seis pacientes com DPOC submetidos ao programa de RP e 32 controles sadios pareados por sexo e idade foram incluídos no estudo. A função do VD foi avaliada na admissão e após o programa de RP por ecocardiografia bidimensional convencional e por STE. Além disso, a tolerância ao exercício foi avaliada pelo teste de caminhada de seis minutos (TC6M). Resultados: Pacientes com DPOC apresentaram pior função do VD segundo STE e ecocardiografia bidimensional convencional. Em comparação ao método convencional, a STE mostrou maior sensibilidade em determinar melhora da função ventricular direita após o programa de RP - strain longitudinal (SL) global do VD: 20,4 ± 2,4% vs. 21,9 ± 2,9% p < 0,001; SL da parede livre do VD: 18,1 ± 3,4% vs. 22,9 ± 3,7%, p < 0,001. O SL da parede livre do VD relacionou-se diretamente com a distância percorrida no TC6M basal (r = 0,58, p < 0,001) e com a variação no TC6M ∆ (TC6M) (r = 0,41, p = 0,04). Conclusões: Concluímos que a STE pode ser tão eficaz como a ecocardiografia bidimensional convencional na avaliação das funções globais e regionais do VD. Ainda, a STE pode se tornar uma importante ferramenta de avaliação e acompanhamento de pacientes com DPOC submetidos à RP para determinar a relação entre função ventricular direita e tolerância ao exercício.

The impact of exposure to biomass smoke versus cigarette smoke on inflammatory markers and pulmonary function parameters in patients with chronic respiratory failure.

PURPOSE: The aim of this study was to evaluate the impact of exposure to biomass smoke vs cigarette smoke on serum inflammatory markers and pulmonary function parameters in patients with chronic respiratory failure (CRF). PATIENTS AND METHODS: A total of 106 patients with CRF divided into age and gender-matched groups of cigarette-smoke exposure (n=55, mean [SD] age: 71.0 [12.0] years, 92.7% were females) and biomass smoke exposure (n=51, mean [SD] age: 73.0 [11.0] years, 94.1% were females) were included in this retrospective study. Data on patient demographics (age and gender), inflammatory markers, including neutrophil-to-lymphocyte ratio, C-reactive protein, platelet/mean platelet volume ratio, arterial blood gas analysis, and pulmonary function test findings, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were obtained from medical records. RESULTS: Carbon dioxide partial pressure levels were significantly higher in the biomass smoke exposure than in the cigarette smoke exposure group (mean [SD] 51.0 [8.0] vs 47.0 [8.0] mmHg, p=0.026, respectively). Spirometry revealed similarly low levels for FEV1 (%) (38.0 [16.0] vs 40.0 [12.0]%) and FVC (%) (45.0 [19.0] vs 39.0 [19.0]%) in cigarette-smoke and biomass smoke exposure groups, whereas biomass smoke exposure was associated with significantly higher FEV1/FVC (75.0 [14.0] vs 58.0 [12.0]%, p=0.001), lower FVC (mL) (mean [SD] 744.0 [410.0] vs 1,063.0 [592.0] mL, p=0.035) and lower percentage of patients with FEV1/FVC <70% (36.8% vs 82.0%, p<0.001) than cigarette smoke exposure. CONCLUSION: Our findings indicate similarly increased inflammatory markers and abnormally low pulmonary function test findings in both biomass smoke exposure and cigarette smoke exposure groups, emphasizing the adverse effects of biomass smoke exposure on lungs to be as significant as cigarette smoke exposure. Association of biomass smoke exposure with higher likelihood of FEV1/FVC ratio of >70% and more prominent loss of vital capacity than cigarette smoke exposure seems to indicate the likelihood of at least 18 years of biomass exposure to be sufficiently high to be responsible for both obstructive and restrictive pulmonary diseases.

Analysis of the Role of Physicians in the Cessation of Cigarette Smoking Based on Medical Specialization.

OBJECTIVE: Physicians do not adequately use their unique professional privilege to prevent patients from smoking. The aim of this study was to investigate the type and extent of advice given to patients by physicians of different medical specialties regarding smoking cessation. METHODS: In total, 317 volunteer physicians were included in this study. The participants rated their attitudes toward the smoking habits of their patients by completing a questionnaire. The approaches used to address the smoking habits of patients significantly differed among physicians working at polyclinics, clinics and emergency service departments (p<0.001). Physicians working at clinics exhibited the highest frequency of inquiring about the smoking habits of their patients, while physicians working at emergency service departments exhibited the lowest frequency. RESULTS: Physicians from different medical specialties significantly differed in their responses. Physicians specializing in lung diseases, thoracic surgery, and cardiology were more committed to preventing their patients from cigarette smoking. CONCLUSIONS: The role of physicians, particularly pulmonologists and thoracic surgeons, is critical in the fight against cigarette smoking. Promoting physician awareness of this subject is highly important in all other branches of medicine.

Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?

PURPOSE: Noninvasive mechanical ventilation (NIMV) usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF). We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward. PATIENTS AND METHODS: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20-7.25) and group 2 (pH=7.26-7.30). RESULTS: Group 1 included 59 patients (mean age: 70±10 years, 30.5% female) and group 2 included 171 patients (mean age: 67±11 years, 28.7% female). On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2) ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward. CONCLUSION: NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success.