Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled?

OBJECTIVE: The older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey. METHODS: The data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire. RESULTS: Of the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma. CONCLUSIONS: Herein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors.

Picturing asthma in Turkey: results from the Turkish adult asthma registry.

INTRODUCTION: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Prevention of Scarring of Lung Parenchyma in COVID-19 Patients through Glucocorticoid Treatment.

Objective: The objective of this research was to determine the impact of glucocorticoid treatment on preventing scarring of lung parenchyma in COVID-19 patients by considering their health behavior. Methods: A sample of 65 Turkish patients who had pneumonia and were hospitalized between March/December 2020 were included in this research. The data for this research was collected after the consent of the hospital. The structural equation model approach was used in data analysis and empirical findings. Results: The research identified that the patients with appropriate health behavior were satisfied with their clinical treatment of scarring of lung parenchyma by the method of glucocorticoid treatment. The research also identified that the patient's health behavior was a significant indicator to improve their perception of the clinical treatment. Conclusion: This study has reliable theoretical implications that are significantly important in the literature because of the nature and uniqueness of the findings. However, this research also has some practical implications related to the patient's lungs mostly infected by COVID-19. Furthermore, the findings of this research can be generalized in a significant way because the respondents of this research belonged to a diverse population.

Does Cardiovascular Disease Risk Decrease after Smoking Cessation in Occupational Risk Groups?

Objectives: Smoking cessation is very important for workers due to the possibility of exposure to additional environmental risks in the workplace environment. This study was performed to determine the changes in the Framingham Risk Score (FRS) and 10-year risk of cardiovascular disease (CVD) of employees before smoking cessation and after 6 months. Materials and Methods: Five hundred and sixty-two employees who want to quit smoking were included in the study. In this prospective study, the baseline and 6-month FRS, and 10-year risk of CVD of workers were calculated. Furthermore, the Hospital Anxiety and Depression Scale was used for assessments of employees' anxiety and depression symptoms. Results: After 6 months, 37% of the participants quit smoking. It was determined that 11.9% of employees have a high CVD risk and 10.6% moderate CVD risk. After 6 months, there was a statistically significant reduction in FRS who quit smoking (P < 0.001). In addition, within the 6 months after smoking cessation, 10-year coronary heart disease risk reduction was higher in quitters than those who cannot quit smoking (47.6% decrease in quitters and 14.9% in nonquitters, P < 0.001). Significant decreases in fasting blood glucose levels were determined after smoking cessation (P = 0.003). Conclusions: The FRS and CVD risk of smoker employees were decreased 6 months after smoking cessation. In 6 months, CVD risk is reduced in almost half of those who quit smoking. Even in the short term, it is possible to reduce the CVD risk of a worker who quits smoking.

Pulmonary aspergilloma management: 5 years of experience from a tertiary hospital.

Introduction: Pulmonary aspergilloma (PA) is a chronic lung infection. Lobectomy is the recommended surgical modality. However, recent studies have suggested that wedge resection may be better than lobectomy. Aim: We compared short-term complications and mortality according to surgical methods in pulmonary aspergilloma. Material and methods: In this study, we analyzed the patients diagnosed with PA in the period 2015-2019 at a tertiary hospital. We obtained the data about the age, gender, smoking history, symptoms, radiological findings, operation technique, complications, length of hospital stay, and mortality from the electronic patient files. Then we compared short-term complications and mortality according to surgical methods in PA. Results: Of a total of 27 PA patients, 22 (81.5%) were male, with a mean age of 48.1 ±15.6 years. The most common symptom was dyspnea (48.1%). Nineteen (70.0%) of the patients had wedge resection and 6 (22.3%) of the patients had a lobectomy. Prolonged air leak and empyema were the most common postoperative complications. Prolonged air leak was significantly more common in lobectomy than in wedge resection (p = 0.046). There was no significant difference in other complications, hospital stay length, intensive care unit stay length or mortality between lobectomy and wedge resection. Conclusions: Wedge resection can be safely performed in aspergilloma. Prolonged air leak was less common in wedge resection than in lobectomy.

Effect of MDR C3435T polymorphism on Varenicline treatment in quit smoking

Despite so many global efforts, smoking still remains to be one of the most common addictions worldwide. Even though most smokers wish to quit smoking, many of them fail. In this respect, genetic variants are thought to be remarkable factors in nicotine dependence and in treatment of smoking cessation. This is a paper investigating a single variant p-glycoprotein (P-gp) polymorphisms and its effect on Varenicline efficacy in the smoking cessation. 158 smokers and 52 non-smoker healthy volunteers were included. We determined the P-gp C3435T gene polymorphisms in all subjects. Face to face interviews with smokers were performed for smoking cessation and Varenicline was given for smoking cessation. Cessation success was evaluated in the 6th month and success rates were compared according to the P-gp genotype distributions. In our study, smoking cessation rate by Varenicline was 57.0%. This rate was 55.0% in females, and 57.2% in males (p=0.85). The P-gp C3435T gene distribution was similar in control, quitters and not-quitter groups. Cessation rate was at highest point in genotype CT (62.2%) and at the lowest in TT (47.6%). It was 53.8% in genotype CC and there was no statistically significant difference (p=0.27). Our results suggest that genetic variants of P-gp C3435T did not significantly affect Varenicline treatment for smoking cessation.

Respiratory Systems of Dental Technicians Negatively Affected during 5 Years of Follow-Up.

BACKGROUND: Dental laboratory technician is one of the professions in which dust exposure is frequently experienced and therefore the health of workers has to be monitored. AIMS: In this study, changes in the pulmonary functions and of pneumoconiosis frequencies among dental technicians after five years were investigated by comparing the results of two screenings carried out in 2008 and 2013. STUDY DESIGN: Cohort study. METHODS: In 2008 and 2013, Provincial Health Directorate carried out two different health screenings covering all of the dental technicians working in dental laboratories in Denizli. In both screenings, a questionnaire was applied, with which socio-demographic and workplace properties of the technicians were obtained. In addition, Pulmonary function tests (PFT) and standard chest X-rays of the technicians were performed. The results of these two screenings were evaluated by a chest specialist, and physical examinations were performed as necessary. In 2013, technicians who had pathologies underwent computerized tomography (HRCT). In this study, the study group was composed of dental laboratory technicians that participated in both screenings (2008 and 2013) and the data obtained from the screenings were compared. The gathered data were analyzed using paired student-t and X(2) tests. RESULTS: A total of 125 dental laboratory technicians participated in the two screenings. Overall, 92% of the technicians were male and the mean age of the participants was 35. Technicians were working for 9 hours a day, 6 days a week. Total exposure time was calculated to be around 41 thousand hours. Approximately 60% of workers were smokers. When the results of PFT were analyzed, 73% of the first evaluations were found to be normal; however, this ratio decreased to 51% in the second analysis five years later. In the second PFT measurement, compared to the first, there was a 23% decrease in the forced vital capacity (FVC) value, and a 15.7% decrease in forced expiratory volume in one second (FEV1). While restrictive disorder was found 25% in the first PFT evaluations, this ratio increased to 31% in the second PFT. When the radiological results were considered, 62% of the first X-ray results were found to be normal but this ratio decreased to 18% in 2013. While reticular/reticulonodular opacities were found in 11% of cases in 2008, it increased to 30% in 2013. Seven technicians were diagnosed with pneumoconiosis (5.6%). CONCLUSION: Respiratory tracts of the technicians were negatively affected during the five year period. The number of pneumoconiosis cases (5.6%) shows that it is necessary to adopt comprehensive work health and safety precautions for laboratories.

The evaluation of the dust-related occupational respiratory disorders of dental laboratory technicians working in Denizli Province.

INTRODUCTION: Dental laboratory technicians (DLTs) get exposed to fibrinogen dusts that are very risky dusts in terms of health. In this study, respiration complaints, pneumoconiosis frequencies and working conditions of the dental technicians in Denizli were investigated. METHODS: All of the registered DLTs working in Denizli were included in the study. A 30-item questionnaire was used to gather data about the participants and their working environments. Then, pulmonary function tests (PFTs) were carried out and standard chest X-rays were taken in order to detect how much the respiratory systems of the workers were affected. Standard chest X-rays were evaluated according to International Labour Organizations classification. Depending on the screening results, technicians who were found to have had pathologies and suspected cases were examined. "High-resolution computerized tomography (HRCT)" was taken from those who were found to have pathology in their chest X-rays and they were evaluated according to the classification of Hering et al. RESULTS: There are a total of 166 DLTs working in Denizli Province participated in the study. One hundred and forty-three (86.1%) of the participants were male, and 23 of them were female. The mean age of the participants is 33.5 ± 8.1. Average working time of the workers is 16 years. Total exposure time was calculated 36,177 h. Approximately, 56% of workers were smokers. When the working conditions were considered, it was found that 98.8% of laboratories had a ventilation system. Technicians' use of personal protective equipment is low. Participants' often or continuous use of masks, gloves, goggles, and vacuum device was found 69%, 36%, 47%, and 63% respectively while working. About 21.2% of the technicians have respiratory symptoms while 15.2% of them have eye complaints. At the analysis of PFT results, 27.7% restrictive type pulmonary disorder was determined. At the analysis of chest X-rays; 1/0 profusion sub-category was 25.5%, and the large opacity rate was 16.9%. Ten pneumoconiosis cases (6%) were diagnosed after the analysis of the HRCT results. The ratio of pneumoconiosis was found much higher among male technicians, particularly those who have been working for a long time in the profession and those working at the town hospitals and Department of metal leveling. DISCUSSION: Technicians' use of personal protective tools is not enough and ratio of smoking is rather high. Pneumoconiosis cases clearly show this exposure. It is necessary to adopt comprehensive work health and safety precautions considering the determined risk factors.

Mental health screening and increased risk for anxiety and depression among treatment-seeking smokers.

BACKGROUND: The aim of this study was to compare the risk for mental health disorders between smokers and non-smokers and to assess the risk for depression and anxiety according to addiction severity. METHODS: This cross-sectional study assesses the mental health status and relationship with the severity of nicotine addiction in a sample of smokers admitted to Pamukkale University Hospital Smoking Cessation Clinic (n = 101) from 1 June 2012 to 31 August 2012 compared to a group of non-smokers from the general population (n = 101). We conducted semi-structured face-to-face interviews to collect sociodemographic data; we assessed the participants' mental health status with the General Health Questionnaire-12 (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS), and we measured nicotine addiction severity with the Fagerström Test. RESULTS: The risk for mental illness reported by smokers based on the GHQ-12 was significantly higher than that for non-smokers (p = 0.001). The anxiety and depression scores according to HADS were higher among smokers (16.8% and 22.8%, respectively) than non-smokers (4.0% and 5.0%, respectively) (p = 0.006 and p = 0.001, respectively). The nicotine addiction severity was higher in smokers with higher anxiety and depression scores (p = 0.008). CONCLUSIONS: We found high scores for mental illness in treatment-seeking smokers compared with non-smokers. The risk for anxiety and depression was higher among smokers. Increased nicotine addiction severity was associated with increased risk for mental illness and increased scores of anxiety and depression.