The Adverse Effects and Treatment Results of Smoking Cessation Pharmacotherapy During Fasting/Non-Fasting State.

BACKGROUND: Cigarette smoking is one of the most common addictions worldwide. Muslim smokers reduce the number of cigarettes they smoke during Ramadan due to the long fasting hours. OBJECTIVES: We aimed to share our experience in a smoking cessation clinic during Ramadan by analyzing the efficacy and adverse effects of once-daily dosing of bupropion or varenicline in a fasting group compared with conventional dosing in a non-fasting group. METHODS: We analyzed 57 patients who attended our smoking cessation clinic during Ramadan of 2014 and 2015, and at least one follow-up visit. For the fasting patients, we prescribed bupropion or varenicline after dinner (once daily) as the maintenance therapy. We recorded demographic characteristics of the patients, fasting state, drugs taken for smoking cessation, and the dosage of the medication. At the first follow-up visit, adverse effects seen with the treatment were recorded. We conducted telephone interviews 6 months after the first visits of the patients to learn the current smoking status of the groups. RESULTS: Of the total 57 patients, 20 (35.1%) were fasting and 37 (64.9%) were not fasting. Fasting and non-fasting patients were similar for sex, age, smoking pack-years, marital status, educational status, and mean Fagerström scores (p >.05). Adverse effects and quit rates after 6 months of follow-up were similar between the fasting and non-fasting groups (p >.05). CONCLUSION: Although our sample size was small, we found no difference in the rates of adverse effects or smoking cessation using a single daily oral dose of bupropion or varenicline between a fasting group and a non-fasting group that received conventional dosing.

Factors affecting dropout in the smoking cessation outpatient clinic.

The objective of this study was to investigate the prevalence of discontinuation in the smoking cessation outpatient clinic (SCC) and to examine the features of noncompliance. We retrospectively included 1324 smokers into the study. Patients were divided into two groups, as those who discontinued (dropped out) follow-up (group 1) and those who stayed in follow-up (group 2). Of the total 1324 smokers, 540 (40.8%) patients were in group 1. The mean age, smoking pack-years, and Fagerstrom scores of group 1 were lower than group 2 (p = 0.001, p = 0.008, and p = 0.007, respectively). In addition, the choice of treatment was also different between groups (p < 0.001). Motivational/behavioral therapy and nicotine replacement therapy (NRT) were more common in group 1 compared with group 2. There was no difference among groups in gender, having household smokers, history of antidepressant treatment, previous quit attempts, and educational status (p > 0.05). Almost 40% of our patients did not come to their follow-up SCC visit. Younger age, lower Fagerstrom score, low amount of daily cigarette consumption, and being treated only with behavioral therapy or NRT were detected as the characteristics of the dropout group. Awareness of the characteristics of smokers who drop out of SCC programs may provide for the implementation of personalized treatment at the first appointment.

The awareness of chest physicians about nutritional assessment in chronic obstructive pulmonary disease.

INTRODUCTION: The number of studies that target nonpharmacologic treatments for chronic obstructive pulmonary disease (COPD) are increasing because no existing pharmacologic treatment modality for COPD leads to significant improvement in lung function.Positive effects can be observed in patients with COPD using nutritional support alone or as an adjunct to exercise. In this study, we aimed to evaluate the awareness of chest physicians about the nutritional state of patients with COPD. MATERIALS AND METHODS: A questionnaire consisting of 15 multiple choice questions was conducted to 121 chest physicians. The questions were formed to evaluate the awareness of chest physicians on the patients' nutritional state and the importance of nutrition in COPD follow-up. RESULT: In total, of the 121 physicians, only 3 (2.5%) reported undertaking routine assessment for nutritional state of patients with COPD. The rates of physicians who routinely questioned patients about weight loss and loss of appetite were 56.2% (n= 68) and 51.2% (n= 62), respectively. Forty-five (37.2%) physicians said that they usually started nutritional support if they detected weight loss in patients with COPD. CONCLUSION: Although there is limited data on the benefits of nutritional supplementation for patients with COPD, some studies have suggested advantages of nutritional support against the progress of COPD. Our study showed that routine screening for malnutrition in patients with COPD is rare among chest physicians and this did not differ according to the hospitals in which they worked or from where they took their residency training. There is a need for further studies emphasizing the importance of nutritional state in the progress of COPD.

Does the 6-minute walk test predict nocturnal oxygen desaturation in patients with moderate to severe COPD?

Patients with chronic obstructive pulmonary disease (COPD) who have nocturnal oxygen desaturation (NOD) can be treated with nocturnal oxygen therapy (NOT) to avoid possible morbidity and mortality. Although there is no definite data recommending NOT alone, our aim is to evaluate the relationship between desaturation during the six-minute walk test (6MWT) and NOD in COPD. Fifty-five stable patients with COPD were enrolled in this study. The 6MWT and nocturnal oximetry were performed. Patients with comorbid diseases and respiratory failure were excluded. In total, 55 patients (49 males and 6 females, mean age: 65.8 ± 8.4 years) were analysed. Twenty-seven of the patients had moderate COPD and the remainder (n = 28) had severe COPD. Three patients (11%) with moderate COPD and 12 patients (42.9%) with severe COPD desaturated during 6MWT (p = 0.003). NOD was observed in five patients with severe COPD (17.9%). There were no patients with NOD in the moderate COPD group. Three (25%) of patients with severe COPD who desaturated during the 6MWT also had NOD. NOD was more common in patients with severe COPD and the patients with higher carbon dioxide levels (p = 0.02 and p = 0.001). Three patients (11%) with moderate COPD desaturated during the 6MWT; however they did not have NOD. Although the sample size in this study was too small to be conclusive, NOD was more common in desaturators during the 6MWT particularly in patients with severe COPD.

Psychometric properties of the Turkish version of the Fagerström test for nicotine dependence.

INTRODUCTION: The Fagerström Test for Nicotine Dependence (FTND), modified from Fagerström Tolerance Questionnairre (FTQ), is used to determine whether a smoker trying to quit will need nicotine replacement therapy to treat with drawal symptoms. The FTND has been translated into many languages and has been referred to in the smoking literature worldwide. However, only a few studies have examined the psychometric propertiesof the non-English FTND versions. This study aimed to assess the psychometric properties of the Turkish version of the FTND. MATERIALS AND METHODS: Confirmatory factor analysis (CFA) was used to test the factor structure of the Turkish version of the questionnaire using a large sample from two smoking cessation clinics in Istanbul, Turkey. Our study comprised 502 smokers who entered one of these smoking cessation clinics between October 1 and December 31, 2011. All subjects gave informed consent to the study. We assessed the validity of the FTND using CFA, and we calculated Cronbach's alpha coefficients to determine reliability. RESULT: One-factor CFA included all of the items on the FTND. All items loaded on this factor with a score of 0.40 or higher. The goodness of fit statistics were adequate, with a Comparative Fit Index (CFI) of 0.922, a Tucker-Lewis Index (TLI) of 0.902, and a root-mean-square error of approximation (RMSEA) of 0.081. Two-factor CFA comprised the three "morning smoking" items, and the three "smoking pattern" items. The factor loadings and the goodness-of-fit statistics confirmed that the FTND has a two-factor structure. CONCLUSIONS: Analyses confirmed that the Turkish version of the FTND has a two-factor structure with moderate reliability. This study found that using a total score as an estimate of nicotine dependence may limit the assessment of specific smoking dependency and tailoring intervention approaches. We suggest that a two-factor FTND in clinical practice would more accurately determine the nicotine dependence of patients.

Evaluation of the Prevalence of Barotrauma and Affecting Factors in Patients with COVID-19 during Follow-Up in the Intermediate Care Unit.

It is known that pneumothorax (PX) and pneumomediastinum (PM) develop due to COVID-19 disease. The objective of our study was to determine the prevalence of PX/PM due to COVID-19 in the intermediate intensive care unit (IMCU) and to evaluate the factors causing barotrauma and also the clinical outcomes of these patients. A total of 283 non-intubated patients with COVID-19 pneumonia followed up in the IMCU in a 1-year period were included in the study. The patients were classified as group 1 (having barotrauma) and group 2 (without barotrauma). The rate of barotrauma was 8.1% (n = 23, group 1). PX developed on the right hemithorax in 12 (70.6%) patients. Group 1 had statistically significantly higher 28-day mortality rates compared with group 2 (p = 0.014). The eosinophil and d-dimer levels of the patients in group 1 were higher, while C-reactive protein (CRP), fibrinogen, and albumin levels were lower than Group 2 (p < 0.001, p = 0.017, p = 0.001, p < 0.001), and p < 0.001, respectively). The similar rates of NIMV administration in our study groups support that barotrauma is not the only mechanism in the development of PX/PM. The findings of high blood eosinophil count and low blood levels of CRP, albumin, and fibrinogen in the barotrauma group of our study might be a pathfinder for future studies.

Rapid On-site Evaluation and Final Cytologic Diagnoses Correlation During Endobronchial Ultrasonography.

BACKGROUND: The cost-effectiveness and low rate of inadequate sampling with the use of rapid on-site evaluation (ROSE) along with endobronchial ultrasonography (EBUS) is well established. Our aim in this study was to evaluate the correlation of ROSE during EBUS and final cytologic diagnosis and also to see if ROSE might predict the subtype of lung cancer. PATIENTS AND METHODS: All consecutive subjects who attended our clinic between January 2016 and January 2019 for the evaluation of pathologic mediastinal and/or hilar lymph nodes (LNs)/mass using EBUS were enrolled into our prospective study. ROSE was performed in the same operating room with EBUS. ROSE results during EBUS were recorded. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ROSE compared with the final cytologic diagnosis were evaluated. RESULTS: We enrolled 684 LN/mass lesions belonging to 328 patients into this study. When we compared ROSE results and final cytologic diagnosis, these procedures agreed on 91.6% of the LNs (P<0.001). The sensitivity of ROSE and final cytologic diagnosis for granulomatous inflammation was 72.5%, and for lung cancer, it was 89.2% (P<0.001). The sensitivity of ROSE for the adenocarcinoma subtype of lung cancer was 67.7%, and it was 70% for small cell lung cancer. CONCLUSION: ROSE may help to recognize non-small cell lung cancer during EBUS, especially the adenocarcinoma subtype of lung cancer, which will help ensure having sufficient material for molecular analysis.

Interferon-Inducible Protein-10 as a Marker to Detect Latent Tuberculosis Infection in Patients with Inflammatory Rheumatic Diseases.

It is important to identify cases of latent tuberculosis infection (LTBI) who are at risk for tuberculosis (TB) reactivation. We aimed to evaluate the performance of interferon (IFN)-gamma-inducible protein 10 (IP-10) as a marker to detect LTBI in patients with inflammatory rheumatic diseases (IRD). This study comprised 76 consecutive subjects with IRD. Patients with a history of TB or having active TB were excluded. In all patients, IP-10 level was measured and tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. Seventy patients with complete test results were analyzed. Twenty-one (30%) QFT-GIT-positive patients were defined as having LTBI. IP-10 yielded 2197 pg/mL cut-off point. At this cut-off point, IP-10 showed 89% specificity with a sensitivity of 91% (AUC: 0.950, 95% CI 0.906-0.994). TST, QFT-GIT, and IP-10 were positive in 77.1%, 30%, and 44.3% of the patients, respectively. Concordance among the results of TST, QFT-GIT, and IP-10 tests was evaluated. Agreement was poor between IP-10 and TST (58.6%, κ = 0.19), whereas it was good between QFT-GIT and IP-10 (84.3%, κ = 0.65). The results of the present study demonstrated that sensitivity and specificity of released IP-10 were as high as those of QFT-GIT in indicating LTBI in IRD patient group.

The clinical use of impulse oscillometry in neuromuscular diseases.

BACKGROUND: The patients with neuromuscular diseases (NMD) are very fragile and it is hard to evaluate respiratory involvement of the primary disease in this group. Therefore, our study aimed to reveal the relationship between pulmonary function tests (PFT) and impulse oscillometry (IOS) and their correlation with respiratory clinical findings in NMD. MATERIAL AND METHODS: A total of 86 consecutive patients with NMD were included. The clinical findings of respiratory involvement, PFT, and IOS results of the patients were analyzed. RESULTS: Forty patients out of 86 were female. There were 29 patients with amyotrophic lateral sclerosis, four patients with myasthenia gravis, and 53 patients with muscular dystrophies/myopathies. According to the PFT results, 47 patients had restrictive PFT. However, there was no difference in IOS parameters when we compared the patients according to restrictions in PFT. A positive correlation was found with FVC %pred and X5. PEF %pred values were positively correlated with X10, X15, and X20, and negatively correlated with AX and R5-20. The patients with worse swallowing capability had increased Rrs levels, and more negative Xrs levels. The shortness of breath led to lower FEV1 %pred., higher R5, AX and R5-20, and also more negative X10, X15, and X35. CONCLUSION: Clinically reported dysphagia, a decreased capability of coughing, and shortness of breath in patients with NMD make Rrs increase in general, but Xrs parameters, which mainly express rib cage elasticity, turn more negative. In patients with NMD, IOS monitoring may help in evaluating the regression in respiratory functions, however, future studies are needed to understand more.

Bronchoscopy during the COVID-19 pandemic: A survey study.

BACKGROUND: In this study, we aimed to evaluate the attitudes and behaviors of physicians performing bronchoscopy during the COVID-19 outbreak. METHODS: Between March 2020 and May 2020, a total of 153 physicians were included in the study. An invitation letter for the participation in the study with a structured questionnaire of 18 questions were sent to the mail groups twice with five-day intervals. Participation in the study was allowed, until the third day after the second mail was sent. RESULTS: All participants completed the questionnaire. According to the results, 33% of the physicians did not perform bronchoscopy and the majority of the physicians performed very few procedures during the outbreak, although the participants mostly worked at the tertiary hospitals (mean: 7.2±9.3). A total of 20% of the physicians performed bronchoscopy in potential or proven COVID-19 patients. Almost all of the physicians who participated in the survey reported the use of personal protective equipment such as masks and goggles during the procedure. During the pandemic, 9.7% of the physicians who performed bronchoscopy to potential or proven COVID-19 patients and 4.1% of the participants who did not perform bronchoscopy to any potential or proven COVID-19 patients were found to be infected with the virus (p>0.05). CONCLUSION: Physicians who perform bronchoscopy during pandemic act in accordance with the recommendations of guidelines. Although there was no statistically significant difference between the SARS-CoV-2 transmission rates of the teams who performed and did not perform bronchoscopy in potential or proven COVID-19 patients in our study, the high rate of personal protective equipment utilization might have played a role in this result.

Effect of High-Risk Obstructive Sleep Apnea on Clinical Outcomes in Adults with Coronavirus Disease 2019: A Multicenter, Prospective, Observational Clinical Trial.

Rationale: Coronavirus disease (COVID-19) is an ongoing pandemic, in which obesity, hypertension, and diabetes have been linked to poor outcomes. Obstructive sleep apnea (OSA) is associated with these conditions and may influence the prognosis of adults with COVID-19. Objectives: To determine the effect of OSA on clinical outcomes in patients with COVID-19. Methods: The current prospective observational study was conducted in three hospitals in Istanbul, Turkey from March 10 to June 22, 2020. The participants were categorized as high-risk or low-risk OSA according to the Berlin questionnaire that was administered in the out-patient clinic, in hospital, or shortly after discharge from hospital blinded to the clinical outcomes. A modified high-risk (mHR)-OSA score based on the snoring patterns (intensity and/or frequency), breathing pauses, and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models. Results: The primary outcome was the clinical improvement defined as a decline of two categories from admission on a 7-category ordinal scale that ranges from 1 (discharged with normal activity) to 7 (death) on Days 7, 14, 21, and 28, respectively. Secondary outcomes included clinical worsening (an increase of 1 category), need for hospitalization, supplemental oxygen, and intensive care. In total, 320 eligible patients (median [interquartile range] age, 53.2 [41.3-63.0] yr; 45.9% female) were enrolled. In all, 121 (37.8%) were categorized as known (n = 3) or high-risk OSA (n = 118). According to the modified scoring, 70 (21.9%) had mHR-OSA. Among 242 patients requiring hospitalization, clinical improvement within 2 weeks occurred in 75.4% of the mHR-OSA group compared with 88.4% of the modified low-risk-OSA group (P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted odds ratio [OR], 0.42; 95% confidence interval [CI], 0.19-0.92) and male sex (OR, 0.39; 95% CI, 0.17-0.86) predicted the delayed clinical improvement. In the entire study population (n = 320), including the nonhospitalized patients, mHR-OSA was associated with clinical worsening (adjusted hazard ratio, 1.55; 95% CI, 1.00-2.39) and with the need for supplemental oxygen (OR, 1.95; 95% CI, 1.06-3.59). Snoring patterns, especially louder snoring, significantly predicted delayed clinical improvement, worsening, need for hospitalization, supplemental oxygen, and intensive care. Conclusions: Adults with mHR-OSA in our COVID-19 cohort had poorer clinical outcomes than those with modified low-risk OSA independent of age, sex, and comorbidities. Clinical trial registered with www.clinicaltrials.gov (NCT04363333).

COVID-19 Pneumonia and Idiopathic Pulmonary Fibrosis: A Novel Combination.

Coronavirus disease 2019 (COVID-19) has become a game changer in many aspects of clinical practice. Acute exacerbations of idiopathic pulmonary fibrosis (IPF) are known as serious events, which can reach a mortality rate of 50%, where viral infections may play a role. We describe the case of a 64-year-old male patient with a diagnosis of IPF under antifibrotic treatment for 1 year; the patient tested positive for COVID-19 with polymerase chain reaction test of the nasopharyngeal swab, and his chest computed tomography results were compatible with COVID-19 pneumonia described in the literature as well as the findings compatible with interstitial lung disease. The patient was successfully treated in the pulmonology ward according to official guidelines about COVID-19 along with antifibrotic treatment and required only a short course of oxygen therapy. We experienced no drug interactions, serious side effects, or complications during treatment. The patient was discharged after 1 week, and he is still in a good condition after 3 weeks. COVID-19 pneumonia in a patient with IPF who survived under antifibrotic treatment without serious deterioration is a new experience. Such cases will probably change our perspective in treating patients with IPF.

The role of endobronchial ultrasonography elastography for predicting malignancy.

BACKGROUND: This study aims to investigate the role of endobronchial ultrasonography elastography in predicting malignancy. METHODS: Between January 2016 and December 2016, a total of 221 lymph nodes were biopsied using the endobronchial ultrasonography-guided transbronchial needle aspiration from 119 consecutive patients (69 males, 50 females; mean age 63.2±12.4 years; range, 16 to 86 years) were included. Lymph nodes were scored by elastography according to their colors in four categories before the procedure. The strain ratio was calculated based on the region of interest after three measurements. RESULTS: Of the patients, 93 were diagnosed with a malignancy through endobronchial ultrasonography-guided transbronchial needle aspiration biopsy. The mean lymph node score of benign versus malignant lesions was 2.2±1.0 and 3.2±1, respectively (p<0.001). There was a positive correlation between the lymph node scores and lymph node diameter, strain ratio, ≥3 of lymph node scoring, the sensitivity for malignancy was 79% and specificity was 60%. The mean strain ratio for malignant and benign lymph nodes was 22.2±30.1 and 5.2±1.7, respectively (p<0.001). With a cut-off value of ≥2.47 of strain ratio, the sensitivity for malignancy was 75% and specificity was 65%. The combined use of positron emission tomography and lymph node score or strain ratio yielded 80.4% and 61.2% sensitivity and 80% and 70.3% specificity for malignancy, respectively. CONCLUSION: Endobronchial ultrasonography elastography is useful in predicting malignancy of the lymph nodes. When combined with positron emission tomography, specificity and positive predictive value for malignancy increase.

Evaluation of Serum Biomarkers in Patients with Sarcoidosis: Can Visfatin Be a New Biomarker for Sarcoidosis?

OBJECTIVES: Sarcoidosis is a chronic systemic inflammatory disease that affects multiple organ systems. The role of biomarkers in the diagnosis and prognosis of sarcoidosis is increasing. Interest in the role of adipose tissue-mediated inflammation in the pathogenesis of inflammatory diseases has increased in recent years. Visfatin is a proinflammatory adipocytokine that has been studied for several inflammatory diseases such as diabetes mellitus, obesity, and metabolic syndrome. We aimed to assess serum visfatin levels in sarcoidosis and its relationship with other markers of inflammation such as C-reactive protein (CRP), angiotensin-converting enzyme (ACE) and erythrocyte sedimentation rate (ESR). MATERIALS AND METHODS: We enrolled 59 patients with sarcoidosis and 21 healthy controls and measured plasma levels of visfatin, along with serum CRP, ESR, and ACE using ELISA (enzyme-linked immunosorbent assay) kits (Blue Gene Biotech, Shanghai, China). RESULTS: Visfatin levels did not differ significantly between the patients and control subjects (29.9±15.8 ng/mL for patients and 23.93±16.73 ng/mL for controls, p=0.15), and there was no correlation between visfatin and serum CRP, ACE, or ESR in patients with sarcoidosis. CONCLUSION: Visfatin is recently being discussed as a biomarker for inflammatory diseases in several studies, and results are controversial. In our study, no differences were found in the serum levels of visfatin between patients with sarcoidosis and the control group.

Level of pleural invasion effects on prognosis in lung cancer.

OBJECTIVE: To analyze the extent of visceral pleural invasion (VPI) and its effect on survival along with its place in determining the T descriptor in TNM staging in our patients. METHODS: A total of 233 patients underwent lung resection. The data were retrospectively analyzed in terms of sex, age, histopathologic type, stage of the tumor, extent of VPI, and survival. Patients who had neoadjuvant chemotherapy or chemoradiotherapy, distant metastasis, parietal pleural invasion, and operative mortality were excluded. RESULTS: The median follow-up was 59 months (range 4-126). The extent of VPI was PL0 in 119 (65.7%) patients, PL1 in 47 (26%) patients, and PL2 in 15 (8%) patients. The median survival rates were 65 (range 43-96) months for PL0, 54 (range 37-72) months for PL1, and 39 (range 12-69) months for PL2. The 5-year overall survival rates were 74.7% for PL0, 77.8% for PL1, and 53.3% for PL2. There were statistically significant differences in overall survival among PL0, PL1, and PL2 ( p = 0.03). In subgroup analysis, the difference was insignificant in PL0 vs PL1 ( p = 0.81), but significant in PL0 vs PL2 ( p = 0.02) and PL1 vs PL2 ( p = 0.04) groups. CONCLUSIONS: This study emphasizes that the presence of VPI is related with poor prognosis independent of lymph node positivity, histologic subtypes, and tumor size. As the study shows, PL0 and PL1 have similar survival rates and these two groups may be considered as VPI (-) patients whereas PL2 disease affects survival outcomes.

Importance of pulmonary artery to ascending aorta ratio in chronic obstructive pulmonary disease.

INTRODUCTION: Recent articles revealed that an increased main pulmonary artery to ascending aorta ratio (PA/A) in thorax computed tomography (CT) correlated with pulmonary hypertension, and might be linked to a high probability of chronic obstructive pulmonary disease (COPD) exacerbations. OBJECTIVES: In this study, our aim was to evaluate the clinical importance of PA/A in patients with exacerbations of COPD and investigate its relationship with the number of exacerbations in 1 year or short/long-term mortality after hospital discharge. METHODS: One hundred fifty-six patients hospitalized for COPD exacerbations who fulfilled our inclusion criteria were enrolled in the study. We recorded the number of exacerbations in 1 year from hospital records, checked mortality status, and calculated the PA/A ratio from thorax CT images. RESULTS: PA/A ratio positively correlated with the number of hospitalizations for COPD exacerbations and the total number of exacerbations (hospitalized or not) in 1 year, and baseline PaCO2 level during hospitalization (r = 0.376, P < 0.001, r = 0.230, P = 0.004, and r = 0.328, P < 0.001, respectively). There was no relationship between mortality and PA/A. CONCLUSION: Our study showed that PA/A was related with the number of hospitalizations and the total number of exacerbations due to COPD in 1 year. However, there was no relationship between PA/A and mortality.

Our Experience on Silicone Y-Stent for Severe COPD Complicated With Expiratory Central Airway Collapse.

BACKGROUND: Expiratory central airway collapse (ECAC) is abnormal central airway narrowing during expiration. ECAC involves 2 different pathophysiological entities as tracheobronchomalacia and excessive dynamic airway collapse (EDAC). Although the exact cause is unknown, chronic obstructive pulmonary disease (COPD) is frequently accompanied by ECAC. Although there are various publications on the relationship between COPD and ECAC, there are very few data for stent placement in patients with tracheobronchomalacia accompanied severe COPD. We share our results for stenting in ECAC among patients with severe COPD. METHODS: The data in this case series were collected retrospectively. The ECAC diagnosis was made during flexible bronchoscopy with severe COPD. Silicone Y-stents were placed via rigid bronchoscopy under general anesthesia. RESULTS: A total of 9 patients' (7 men) data were evaluated with an average age of 67±10.73 years. One patient experienced stent migration on the second day of stenting prompting stent removal. Another patient died 1 month after stenting. Consequently, we evaluated the follow-up data of remaining 7 patients. The changes in forced expiratory volume 1 was not significant for these 7 cases (P=0.51). The modified Medical Research Council (mMRC) score improvement was statistically significant (P=0.03). Functional status improvement was observed in 4 of 7 patients. Of the 7 patients, mean additional follow-up bronchoscopic interventions requirement was 2.2 times. CONCLUSIONS: Our study showed significant decrease in mMRC score with stenting for ECAC in severe COPD. For 2 patients, we experienced severe complications during short-term follow-up period after stenting. Additional follow-up bronchoscopic interventions were required.

Challenges in the management of severe allergic asthma in the elderly.

Little is known about the features of asthma and allergy in the elderly. A significant number of elderly patients with asthma have uncontrolled and severe asthma. This review aims to provide an analysis of the literature on the assessment and phenotype of severe allergic asthma in the elderly. Gaps and pitfalls in diagnostic and therapeutic approaches, as well as management of severe allergic asthma in the elderly, are also discussed.

An outbreak of multidrug-resistant tuberculosis among a family.

Tuberculosis is a major public health problem and it may be complicated by multidrug-resistant tuberculosis (MDR-TB). Wide transmission among immunocompetent contacts of the index case is possible. If you detect tuberculosis in two contacts of the index case, it is called an outbreak. The aim of our paper is to evaluate the characteristics of a MDR-TB outbreak affecting 7 people in a family treated during 2012-2014 in Istanbul Yedikule Training and Research Hospital for Chest Disease and Thoracic Surgery, Turkey. The cultures, spoligotyping, and DNA fingerprinting revealed the same Mycobacterium tuberculosis species as T1 genotype and ST53 subtype. All patients were negative for human immunodeficiency virus and free of other underlying diseases.