Outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema.

Background: This study aims to evaluate the outcomes of bronchoscopic lung volume reduction coil treatment in patients with severe emphysema. Methods: Between February 2016 and March 2019, a total of 20 severe emphysema patients (19 males, 1 female; mean age: 65.2±5.2 years; range, 52 to 73 years) who underwent bronchoscopic lung volume reduction coil treatment were included. Each patient underwent pre- and post-treatment (6 and 12 months) pulmonary function tests, 6-min walking distance, modified Medical Research Council dyspnea scores, and diffusing capacity of the lung for carbon monoxide tests. Results: An mean number of 12.0±3.8 coils was placed in each lobe. There were significant improvements in the patients' pulmonary function tests and quality of life 12 months after the treatment. There was a significant difference in dyspnea as assessed by the modified Medical Research Council dyspnea scores 12 months after treatment compared to pre-treatment scores (p<0.05). There was no change in the pulmonary function tests six months after treatment, while a significant improvement was seen at 12 months (p<0.05). Conclusion: Bronchoscopic lung volume reduction coil treatment seems to be a promising modality for severe emphysema patients with significant improvements in the pulmonary function test results, modified Medical Research Council dyspnea scores, and 6-min walking distance.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Is a small-bore catheter efficient for most pleural pathologies?

PURPOSE: Chest tubes are used for drainage of the pleural cavity. Traditionally, large-bore catheters are inserted for all indications, but there has been a recent tendency to use small-bore catheters. We share the results of our experience of using small-bore catheters for almost all indications routinely in our clinic. METHODS: A collective total of 309 small-bore chest catheters (10 F) were inserted via the Seldinger technique in 287 patients during a 5-year-period. Malignant pleural effusion and pneumothorax were the most common indications for chest tube insertion. RESULTS: The mean catheter duration was 5.6 days, being 5 days for pneumothorax and 6 days for malignant pleural effusion. Pleurodesis was performed effectively for malignant pleural effusions. In this series, the failure rate of small-bore catheters was 7.2 %. CONCLUSION: Based on our clinical experience of using small-bore catheters, we believe that they are potentially effective for almost all pleural pathologies. Our results concur with those in the literature, but this series also includes different pleural diseases requiring chest tube insertion.

Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases.

BACKGROUND: Autofluorescence (AF) examination in thoracoscopy has not been used frequently. Here, our aim was to determine whether AF examination contributes additional information to white-light (WL) examination when attempting to detect malignant pleural lesions. We also liked to know whether the effectiveness of WL and AF-mode combination would be different for various pathologies or lesions of the pleura. METHODS: It is a retrospective study. Thirty-three patients with unexplained exudative pleural effusions underwent AF-assisted video-assisted thoracic surgery (VATS). Patients' data from the files were evaluated. In each case, the pleural cavity was thoroughly examined under WL alone and then in AF mode. RESULTS: The sensitivity and specificity of AF-assisted VATS for detecting malignant pleural lesions were 78.7 and 85%, respectively, and there were 21.3% false negatives. In the group with metastatic pleural disease, AF VATS correctly identified all lesions as AF positive, whereas sensitivity was lower for the group with malignant mesothelioma. Seven lesions, which were not diagnosed under WL, were detected in AF mode. CONCLUSION: The overall sensitivity of AF-assisted VATS for detecting pleural malignancies was not satisfactory because of diagnostic errors in malignant mesothelioma. But it would be useful in detecting small malignant pleural lesions, which are not diagnosed under WL.

Prevalence of chronic obstructive pulmonary disease in kocaeli: an industrialised city in Turkey.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an important cause of mortality worldwide. AIMS: The aim of this study was to establish the prevalence of chronic obstructive pulmonary disease (COPD) in residents who were ≥40 years old and living in a heavily industrialised city of Turkey, Kocaeli, using the Burden of Obstructive Lung Disease Initiative questionnaire. STUDY DESIGN: Cross-sectional study. METHODS: 1035 residents ≥40 years old and living in Kocaeli were surveyed. Spirometry and the basic BOLD questionnaire was performed. RESULTS: 946 subjects entered into the analysis. The prevalence of stage I or higher COPD was 13.3% (8.7% for women and 16.5% for men), the prevalence of COPD at GOLD stage II or higher was 7.1% (4.1% for women and 9.2% for men). We also noted a high prevalence of COPD in never-smokers. CONCLUSION: Besides cigarette smoking, occupational exposure to fumes, chemicals and dusts might have also contributed to the high prevalence of COPD noted in residents who were ≥40 years old and living in Kocaeli, Turkey.

Conventional vs. endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathies.

The aim of this study was to determine whether or not radial probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is superior to conventional TBNA in the diagnosis of mediastinal lymphadenopathies in routine clinical practice. Consecutive patients, who were referred for TBNA, were randomized to conventional TBNA and EBUS-guided TBNA groups. Patients were also grouped according to the anatomic location of the pathologic lymph nodes to evaluate if there was a difference in the diagnostic yield with respect to lymph node station. Patients with subcarinal lymph nodes were designated as group A and patients with lymph nodes at station 2 (upper paratracheal), 3 (prevascular and retrotracheal), and 4 (lower paratracheal) were designated as group B. A 21-G aspiration needle was used during the procedure. Sixty patients with a mean age of 56.15 ± 15.32 years were included in the study. Thirty patients each underwent EBUS-TBNA and conventional TBNA. The overall diagnostic yield of conventional TBNA was 33.3% (10/30), while EBUS-TBNA had a yield of 66.7% (20/30; p= 0.010). In patients with subcarinal lymph nodes, the yield of conventional TBNA was 33.3% (4/12) compared to 62.5% (5/8) in the EBUS-guided group (p= 0.362). In patients with mediastinal lymph nodes other than subcarinal lymph nodes, EBUS-TBNA had a significantly higher yield compared to conventional TBNA [33.3% (6/18) vs. 68.2% (15/22) for conventional and EBUS-TBNA groups, respectively; p= 0.028]. In conclusion, the diagnostic yield of EBUS-TBNA was superior to the yield of conventional TBNA at stations other than subcarinal region. We suggest that EBUS is a useful tool to guide TBNA in the evaluation of mediastinal lymph nodes.

Prevalence of smoking and chronic obstructive pulmonary disease amongst teachers working in Kocaeli, Turkey.

AIM: To evaluate smoking and COPD prevalence amongst teachers working in the schools of Kocaeli City, Turkey. METHOD: In this cross-sectional study, a questionnaire focusing on respiratory symptoms and smoking habits was administered to all participants who accepted to join the study.All subjects also underwent a physical examination and a pulmonary function test performed with portable spirometer. According to GOLD criteria, subjects who had post-bronchodilator FEV1/FVC < 70% and negative reversibility test were classified as COPD. RESULTS: A total of 685 teachers were included [female n = 307 (45%), male n = 378 (55%)] with mean age 38.9 ± 8.9 years. Smoking habit was evaluated in 660 subjects: 291 (44.1%) were smokers, 252 (38.2%) were non-smokers and 117 (17.7%) were ex-smokers. Pulmonary function test was available in 651 subjects and 510 (78.3%) were defined as normal on spirometric analysis. Small airway obstruction was found in 115 of the cases (17.7%) in whom FEF25-75 level was found to be lower than 70% predicted. FEV1/FVC level was lower than 70% in 16 subjects (2.5%). Five subjects who had positive reversibility test were excluded from the study. The remaining 11 subjects who were considered as COPD consisted of 2 (18%) females and 9 (82%) males. Six of these subjects were aged over 40 years. CONCLUSION: Spirometry has an important role in early diagnosis of COPD. Spirometric evaluation of cases with risk factors for COPD could be helpful in diagnosing patients before the progressive decline in lung function begins. Further studies are needed to evaluate whether the interventional strategies at this stage such as smoking cessation could prevent the progression of disease.

MR spectroscopy findings in tuberculous spondylitis; comparison with Modic type-I end-plate changes and metastatic vertebral disease.

PURPOSE: To define single-voxel proton magnetic resonance spectroscopy (MRS) findings of vertebral tuberculous spondylitis (TBS), Modic type-I end-plate changes (MTEC) and metastatic vertebral disease (MVD). MATERIALS AND METHODS: Fifteen patients with TBS, 15 with MTEC and 15 with MVD were included. MRS from the diseased vertebral body as well as normal vertebral body was examined. Water and lipid peak were measured, water-to-lipid ratio (WLR) and for each patient lesion water index (LWI, the ratio of WLRs from diseased to normal vertebrae) were calculated. RESULTS: The mean WLR of normal and pathologic vertebra was 0.91 and 7.13 in TBS group, 0.84 and 3.49 in MTEC group and 0.65 and 3.17 in MVD group, respectively. The mean LWI was 10.68 in TBS, 6.04 in MTEC and 6.42 MVD groups. Statistical significance was not achieved between the WLR and LWI of the TBS, MTEC nor MVD group (p>0.05). CONCLUSION: The mean values of WLR and LWI in the TBS group are relatively higher than MTEC and MVD groups, with the difference being statistically insignificant.

[The effect of postgraduate education on COPD knowledge level of primary care physicians]. / Mezuniyet sonrasi egitimin pratisyen hekimlerin KOAH ile ilgili bilgi düzeyine etkisi.

Besides chest disease specialists, primary care physicians also have a great role in prevention and treatment of chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the knowledge levels of primary care physicians about COPD before and after post graduate course. The level of knowledge was evaluated by a questionnaire including questions about COPD definition, prevalence, etiology, pathology, diagnostic methods, physical examination findings and treatment. Then a postgraduate course was performed about COPD and questionnaire forms were refilled. Ninety two physicians filled the questionnaire forms before and after seminar. Fifty of the physicians were female, 42 were male, mean age was 33.7 +/- 8.5 and duration of profession was 9.6 +/- 8 years. Thirty-six (39.2%) of physicians have attended a post graduate seminar on COPD previously. All physicians answered the questions about the most dominant sex that COPD was seen and etiologic agents correctly. Most of the physicians answered the questions about diseases that defined as COPD, pathology and physical examination findings incorrectly. There was no difference in number of correct answers between the physicians who have previously attended a post graduate seminar or not. Duration of profession was not correlated with correct answers. After the seminar, the number of correct answers increased significantly. Since most of the physicians answered the questions which are quite important in primary care such as COPD definition and physical examination findings incorrectly, it is thought that post graduate seminars about COPD should be performed more frequently. After the seminar, we observed significant increase in correct answers however long-term stability of this knowledge is needed to be determined in future studies.

Different bronchodilator combinations have similar effects on health status in COPD.

BACKGROUND: The main treatment in COPD consists of bronchodilator agents. As the severity of disease increases, combined bronchodilators are preferred in place of single agents. Since there is a weak correlation between well being and spirometric parameters, additional life quality questionnaires are used. OBJECTIVES: The main aim of this study was to investigate whether different bronchodilator combinations have similar effects on quality of life measures in COPD. METHODS: Sixty male patients with COPD were randomized into three groups. After a two-week run-in period, life quality scores were determined using the Turkish version of St George's Respiratory Questionnaire (SGRQ). Group 1 was given ipratropium + theophylline (IP + THEO); Group 2 formoterol + theophylline (FOR + THEO) and Group 3 ipratropium + formoterol (IP + FOR). After a 12-week treatment period, symptom, activity and impact scores were again determined. RESULTS: When compared with baseline, all component scores and total scores improved significantly (Delta total score: 16, 15 and 17 units in Groups I, II, and III, respectively), but there was no significant change between groups (p > 0.05). CONCLUSIONS: According to these results, combined bronchodilator treatments have a significant effect on life quality in COPD, but the effects were observed to be similar between the three different combinations tested.

Protective effects of N-acetylcysteine on the peroxidative changes of rat lungs exposed to inhalation of thinners.

OBJECTIVE: Long-term inhalation of thinners may cause damage, both to the lungs and to other organ systems. It causes cellular damage via formation of reactive oxygen species. The lung is protected from oxidative stress by the glutathione (GSH) antioxidant system which can be augmented by the thiol drug, N-acetylcysteine (NAC). This study investigated the protective effect of NAC on peroxidative changes in rat lungs exposed to inhalation of thinners for 8 weeks. METHODOLOGY: Seventy-two male Wistar albino rats were used and divided into two groups: one group inhaled only thinners (TI), while the other inhaled TI plus NAC. Rats in the TI and TI + NAC groups were divided into four subgroups (each consisting of eight rats) according to the duration of exposure to TI: 2, 4, 6 and 8 weeks. A control group (n = 7) of rats inhaled neither TI nor NAC. Malondialdehyde (MDA) and GSH levels, and superoxide dismutase (SOD) activities were determined in the lung tissues. Histopathological findings were evaluated as acute and chronic changes in the alveoli and interstitium in the TI and TI + NAC groups and compared with those in the control group. RESULTS: While tissue MDA levels in the groups inhaling TI for 4, 6 and 8 weeks were significantly higher than those in the control groups (P < 0.01, P < 0.01, P < 0.0001, respectively), GSH levels were significantly lower (P < 0.05, P < 0.01, P < 0.01, respectively). Tissue SOD activities in the groups inhaling TI for 6 and 8 weeks were significantly lower than those in the control group (P < 0.05, P < 0.01, respectively). In the TI group, MDA levels were significantly increased (P < 0.01) with increasing duration of inhalation (from the second week through to the eighth week), while GSH levels and SOD activities were significantly decreased (P < 0.01, P < 0.01). Tissue MDA levels were significantly lower in the TI + NAC groups across all inhalation periods, when compared with the TI groups (P < 0.01, P < 0.0001, P < 0.0001, P < 0.0001, respectively). Tissue GSH levels in the TI + NAC groups were significantly higher than those of the TI groups (respective values: P < 0.05, P < 0.01, P < 0.01, P < 0.0001). Tissue SOD activities in the TI + NAC groups were significantly higher than those of the TI groups (respective values: P < 0.05, P < 0.0001, P < 0.05, P < 0.0001). Pathological examinations with light microscopy did not show any beneficial effect of NAC application in terms of deferring or alleviating the negative effects of TI. CONCLUSIONS: Thinners are agents that cause imbalance between oxidants and antioxidants produced by aerobic cellular systems. This imbalance between oxidant and antioxidant systems is decreased by the effect of NAC. However, ultrastructural studies may be needed to substantiate this evidence morphologically, as light microscopy was inconclusive.

The effects of levofloxacin on ECG parameters and late potentials.

In this study, our aim was to investigate the proarrhythmic effects of levofloxacin. Twenty-six patients who were diagnosed as having community-acquired pneumonia were enrolled in the study. Intravenous levofloxacin, 500 mg daily, was given, and 12-lead ECG measurements were obtained before the infusion, at 30 and 60 minutes during infusion, and 10 minutes after its cessation. Resting late potentials were recorded before and after infusion. Twelve female and 14 male patients were participated the study. Mean age was 51.3 +/- 22.3 years. Levofloxacin infusion increased the heart rate (HR) and prolonged the corrected QT (QTc) intervals significantly (baseline HR: 84.6 +/- 18.8 vs. HR at 60 minutes: 88.6 +/- 18, P = 0.02; baseline QTc: 413.5 +/- 36.9 milliseconds vs. QTc at 60 minutes: 426.1 +/- 34.7, P = 0,006). There was no significant difference between the late potential values obtained before and after infusion. None of our patients experienced severe arrhythmia that required stopping the treatment. A single dose of IV levofloxacin prolongs the QTc interval without significant change in late potentials. Monitoring ECG during levofloxacin infusion might be necessary in patients who have a condition that could affect the QTc interval.

Addition of inhaled corticosteroid on combined bronchodilator therapy in patients with COPD.

PURPOSE: Bronchodilator therapy is the first step treatment in patients with COPD. The beneficial effects of corticosteroids either in health status or in airway inflammation in COPD have been previously studied. The aim of this study was to evaluate whether adding inhaled corticosteroids to combined bronchodilator therapy has additive clinical and anti-inflammatory effects in COPD patients. SUBJECTS AND METHODS: Thirty patients with COPD were included in the study. All patients were receiving inhaled anticholinergic and long-acting beta-2 agonist. Inhaled corticosteroid (budesonide 800 microg daily) was added to their current medications for 12 weeks. Before and after this treatment period, spirometric values and arterial blood gas parameters were determined, blood was drawn for measurement of serum inflammatory markers and sputum was induced. RESULTS: All patients were male, mean age was 67.7+/-8.7 years and duration of disease was 9.7+/-4.3 years. The induced sputum total cell counts, eosinophil and neutrophil counts decreased with corticosteroid treatment. The induced sputum IL-8 and TNF-alpha levels decreased significantly (IL-8; 835.9+/-217 versus 378.4+/-105 pg/ml, p=0.0001, TNF-alpha; 320.7+/-129 versus 201.3+/-52 pg/ml, p=0.003). Serum inflammatory markers and sputum LTB4 levels did not change with treatment. CONCLUSION: These results suggested that the addition of inhaled corticosteroids to combined bronchodilator therapy might have anti-inflammatory effects in patients with COPD.

Effects of Different Combined Bronchodilator Therapies on Airway Inflammation in COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by chronic progressive airway obstruction and inflammation. Only a few studies have evaluated the effects of bronchodilator therapy on airway inflammation in patients with COPD. OBJECTIVE: The aim of this study was to investigate the effects of different combinations of bronchodilator therapies on airway inflammation in COPD. METHODS: Thirty patients with COPD and ten healthy nonsmoker subjects were included in the study. COPD patients were randomly classified into three groups. Groups 1, 2 and 3 were treated with ipratropium bromide plus formoterol (IP + FOR), theophylline plus ipratropium bromide (IP + THEO), and formoterol plus theophylline (FOR + THEO), respectively, for 12 weeks. Pulmonary function tests were performed, blood was drawn for arterial blood gas analyses, and sputum was induced before and after treatment. The induced sputum total and differential cell counts, serum and sputum inflammatory markers including interleukin (IL)-8, tumour necrosis factor (TNF)-alpha and leukotriene (LT)-B4 were measured. RESULTS: When compared with the control group, total sputum cell counts, number of neutrophils, and sputum and serum inflammatory marker levels were significantly higher in COPD patients. Although there were no statistically significant differences among the groups, inflammatory parameters were found to be significantly reduced in all three treatment groups at the end of treatment. Total cell counts were: 2.4 +/- 0.9 versus 1.28 +/- 0.5 x 10(6)cells/g in the IP + FOR group (p < 0.05), 2.32 +/- 0.4 versus 1.37 +/- 0.6 x 10(6)cells/g in the IP + THEO group (p < 0.05), and 3.05 +/- 1.3 versus 1.6 +/- 0.8 x 10(6)cells/g in the FOR + THEO group (p < 0.05). Sputum IL-8 levels were: 1738.5 +/- 292 versus 848 +/- 262 ng/L in the IP + FOR group (p < 0.05), 1543.2 +/- 378 versus 800.2 +/- 224 ng/L in the IP + THEO group (p < 0.05), and 1561.2 +/- 412 versus 815.7 +/- 259 ng/L in the FOR + THEO group (p < 0.05). CONCLUSION: Different combinations of bronchodilator therapies caused significant changes in sputum and blood IL-8, TNF-alpha and LTB4 levels of COPD patients without significantly improving pulmonary function tests or arterial blood gas parameters.

Effects of different anti-asthmatic agents on induced sputum and eosinophil cationic protein in mild asthmatics.

OBJECTIVES: Inhaled corticosteroids, leukotriene receptor antagonists, and theophylline are recommended for the treatment of mild persistent asthma. The aim of this study was to compare the changes in sputum total cell and eosinophil counts, and eosinophil cationic protein (ECP) levels in serum and sputum following treatment with leukotriene receptor antagonists, inhaled corticosteroids, and theophylline in patients with mild persistent asthma. METHODOLOGY: Total cell counts, eosinophil percentage, and ECP levels in induced sputum and serum were determined both before and after treatment. Prior to sputum induction, FEV1 and PEF values and symptom scores were recorded at baseline and after 8 weeks of treatment. After baseline measurements, the asthmatic patients (n = 30) were randomized into three groups. A total of 10 patients were treated with zafirlukast, 20 mg bd, 10 with budesonide inhaler 200 microg bd, and 10 with theophylline 200 mg bd. RESULTS: There were significant decreases in sputum total cell counts and eosinophil percentage in all treatment groups. However, the decrease in sputum eosinophil counts was more significant in the corticosteroid-treated group. Although sputum ECP levels decreased significantly in the groups treated with zafirlukast and budesonide (zafirlukast group, 580-135 microg/L, P < 0.01; budesonide group, 683-268 microg/L, P < 0.01), the decrease was not statistically significant in the theophylline-treated group (498-361 microg/L, P > 0.05). In contrast, there were no significant changes in serum ECP levels in any of the treatment groups. CONCLUSIONS: All three treatments resulted in significant decreases in sputum total cell counts and eosinophil percentage, but the decrease in sputum ECP level was only seen in the groups treated with budesonide and zafirlukast. These results suggest that although all three treatments are considered as first-line treatments in most consensuses, theophylline seems to have less of an inhibitory effect on eosinophil activation.

Extrapulmonary tuberculosis: clinical and epidemiologic spectrum of 636 cases.

BACKGROUND: The aim of this study was to evaluate the percentage and characteristics of extrapulmonary tuberculosis (EPTB) cases in a Turkish industrial city, Kocaeli (population: 1,203,335) and to illustrate its extent as a serious health problem for this city and country. METHODS: We investigated the results of microbiologic, radiologic, and histopathologic findings of patients with extrapulmonary tuberculosis, retrospectively, who were admitted to four Tuberculous Dispensaries between 1996 and 2000. RESULTS: Six hundred thirty six cases were diagnosed with EPTB. Three hundred forty five were males (54.2%) and 291, females (45.8%). Mean age of patient cases was 22.5+/-17.1 years (range, 1-86 years); 41.4% of cases were <15 years of age and 30.9%, between 20 and 39 years of age. Contact history with tuberculosis cases was determined in 242 cases (38%); of these, 194 were <15 years of age (80.2%). The most common form of EPTB was observed to be lymph node tuberculosis (56.3%); of these cases, 256 (71.5%) had involvement in intrathoracic, 92 (25.7%) in cervical, and 10 (2.8%) in axillary lymph nodes. The second most frequent extrapulmonary form was pleural tuberculosis (31.1%). EPTB was diagnosed by histopathologic methods in 229 patients (36.0%) and by microbiologic methods in 27 (4.2%); tuberculin skin test was significantly positive (>10 mm) in 95.5% of patients. When cases were classified according to severity, 87 cases (13.7%) were found severe and 549 (86.3%) as less severe EPTB. Five hundred sixty one cases (88.2%) lived in urban areas and 75 (11.8%), in rural areas. CONCLUSIONS: EPTB is very common in early adulthood in the Kocaeli region, with lymph nodes the most common localization.

Inhaled corticosteroid effects both eosinophilic and non-eosinophilic inflammation in asthmatic patients.

AIM: To determine induced sputum cell counts and interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-alpha) and leukotriene B4 (LTB4) levels as markers of neutrophilic inflammation in moderate persistent asthma, and to evaluate the response to inhaled steroid therapy. METHODS: Forty-five moderate asthmatic patients and 10 non-smoker controls were included in this study. All patients received inhaled corticosteroid (800 microg of budesonide) for 12 weeks. Before and after treatment pulmonary function tests were performed, and symptom scores were determined. Blood was drawn for analysis of serum inflammatory markers, and sputum was induced. RESULTS: Induced sputum cell counts and inflammatory markers were significantly higher in patients with asthma than in the control group. The induced sputum eosinophil counts of 12 patients (26%) were found to be less than 5%, the non-eosinophilic group, and sputum neutrophil counts, IL-8 and TNF-alpha levels were significantly higher than the eosinophilic group (neutrophil, 50+/-14% versus 19+/-10%, p<0.01). In both groups, there was a significant decrease in sputum total cell counts and serum and sputum IL-8, TNF-alpha and LTB4 levels after the treatment. There was no change in sputum neutrophil counts. Although the sputum eosinophil count decreased only in the eosinophilic subjects, there was no significant difference in inflammatory markers between the groups. The symptom scores were significantly improved after treatment, while the improvement did not reach statistical significance on pulmonary function test parameters. CONCLUSION: Notably, in chronic asthma there is a subgroup of patients whose predominant inflammatory cells are not eosinophils. Sputum neutrophil counts and neutrophilic inflammatory markers are significantly higher in these patients. In the non-eosinophilic group, inhaled steroid caused an important decrease in inflammatory markers; however, there was no change in the sputum eosinophil and neutrophil counts.

Does addition of inhaled steroid to combined bronchodilator therapy affect health status in patients with COPD?

OBJECTIVE: Withdrawal of corticosteroid is associated with a deterioration of health status in COPD. In this study the aim was to determine whether high dose inhaled corticosteroid improves quality of life in patients with COPD. METHODOLOGY: In total, 38 male patients with moderate COPD were included in the study. Baseline quality of life scores were determined using a Turkish version of the St George's Respiratory Questionnaire (SGRQ). Patients were randomly divided into two groups. Group 1 consisted of 20 patients who received existing bronchodilator therapy plus inhaled corticosteroid (800 micro g budesonide) for 12 weeks, while 18 patients in group 2 received bronchodilator and placebo. The SGRQ was repeated after the treatment period. RESULTS: All patients were male and mean age was 67 +/- 8.2 years. Symptom, activity, impact, and total scores were assessed and a difference of four units with treatment was considered to be clinically significant. Total score and activity score were decreased by six units and eight units, respectively, in the placebo group while symptom and impact scores did not change significantly. Total scores and the three component scores improved significantly in the corticosteroid group compared to the placebo group (Deltatotal score: -22 in corticosteroid group, -6 in placebo group, P < 0.01). CONCLUSION: Inhaled corticosteroid improved quality of life scores in patients with COPD, without significant improvement in airflow obstruction parameters. Since improvement of health status is one of the important aims in COPD treatment, use of inhaled corticosteroids should be considered from this perspective.

[Determination of environmental tobacco smoke in primary school children with urine cotinine measurements]. / Ilkokul çocuklarinda çevresel sigara dumanina maruziyetin idrar kotinin düzeyi ile degerlendirilmesi.

Environmental tobacco smoke (ETS) has been regarded as one of the most important public health issues. It has been estimated that approximately 75% of Turkish children are exposed to ETS. In this study the parental smoking habits were determined. Then, the relationship between parent-reported estimates of children's exposure to ETS in the home and children's urinary cotinine levels was examined. According to the reports of parents, 57.8% of the fathers and 23.3% of the mothers were current smokers, 69.8% of the children came from homes with smokers, and 53.4% had daily exposure to ETS. Urinary cotinine levels were significantly higher in the exposed group than the nonexposed group. This data showed that ETS exposure was prevalent and a combination of a parent-report and a biological measures is suggested as the most informative estimate of ETS exposure in children.

[Body mass index and serum and sputum TNF-alpha levels relation in asthma and COPD]. / Astimli ve KOAH'li hastalarda vücut kitle indeksi ile balgam ve serum TNF-alpha düzeyi arasindaki iliski.

Previous studies have revealed the relationship between asthma with obesity and low body mass index (BMI) with chronic obstructive pulmonary disease (COPD). Tumor necrosis factor-alpha (TNF-alpha) is thought to be related with low BMI. The aim of this study was to determine sputum and serum TNF-alpha levels in patients with COPD and asthma and to evaluate whether these parameters had correlation with BMI. Thirty patients with moderate persistent asthma and 26 patients with moderate -severe COPD were included. After BMI values were calculated, sputum was induced by inhalation of hypertonic saline solution and blood was drawn for analysis of serum TNF-alpha levels. There were significant differences in age, serum and sputum TNF-alpha levels between asthma and COPD subjects (Sputum TNF-alpha: asthma; 513 +/- 151 pg/mL-COPD: 333 +/- 126 pg/mL, p< 0.001; Serum TNF-alpha: asthma; 332 +/- 114 pg/mL-COPD: 197 +/- 81 pg/mL, p< 0.001), however there was no difference in BMI (asthma; 28 +/- 5.7-COPD; 26.6 +/- 12.9, p= 0.1). Patients were divided into four categories according to their BMI values as underweight, normal, overweight and obese. In asthmatics; there were 12 (40%) obese and 11 (36%) overweight patients while 9 (34%) of COPD patients were underweight. No significant difference was observed among these four groups according to serum-sputum TNF-alpha and smoking history both in asthmatics and in COPD subjects. While there was no correlation between BMI and serum-sputum TNF-alpha levels, BMI was significantly correlated with both smoking history and duration of disease in COPD patients. As a result, most of the asthmatic patients were described as overweight and obese while no such variation was noted in the COPD patients. The induced sputum TNF-alpha levels has no additional benefit on serum TNF-alpha levels which has already known to be associated with BMI.