Sleep disturbances in patients with lung cancer in Turkey.

INTRODUCTION: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. MATERIALS AND METHODS: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. RESULT: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. CONCLUSIONS: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

Are treatment guides and rational drug use policies adequately exploited in combating respiratory system diseases?

The aim of the present study was to increase awareness regarding the rational use of medicines. The data were obtained via the Material Resources Management System Module of the Ministry of Health. For the appropriateness of treatments, the Global Initiative for Asthma, the Global Initiative for Chronic Obstructive Lung Disease, and the guidelines for the rational use of medicines were used. We also investigated whether any de-escalation method or physical exercise was performed. Statistical analyses were performed using descriptive statistics to determine the mean, standard deviation, and frequency. The results showed that healthcare providers ignored potential drug reactions or adverse interactions, and reflecting the lack of adherence to the current treatment guides, 35.8% irrational use of medicines was recorded. Thus, de-escalation methods should be used to decrease costs or narrow the antibiotic spectrum, antibiotic selection should consider the resistance patterns, culturing methods should be analyzed, and monotherapy should be preferred over combination treatments.

Relationship between plasma chemerin levels and disease severity in COPD patients.

BACKGROUND AND AIMS: Chronic inflammation of the lung is a characteristic finding in chronic obstructive pulmonary disease (COPD). The protein chemerin has been identified in inflammatory fluid and in inflamed tissues. This study aimed to determine the association between serum chemerin levels and the severity of COPD. METHODS: Forty-three COPD patients and 38 healthy subjects were enrolled in this study. Fasting plasma samples were obtained from the patient and the control group. Serum chemerin levels were measured using a commercial enzyme-linked immunosorbent assay. C-reactive protein levels, the erythrocyte sedimentation rate, and fibrinogen analysis were used to assess the inflammation status of the patients. Spirometric measurements with reversibility testing were performed in all the subjects. RESULTS: Serum chemerin levels were significantly elevated in the COPD patients (6.44 ± 0.52 vs 5.22 ± 0.59; P < 0.001). A Mann-Whitney U-test revealed that the serum chemerin levels of stage 2 COPD patients were higher than those of stage 1 and 3 COPD patients (P = 0.651). Cigarette smoking and plasma chemerin relation was also understudied; however, there was no significant relationship between current smokers and ex-smokers (P > 0.05). Pearson's correlation analysis indicated that serum chemerin levels were positively correlated only with total cholesterol (T. cholesterol) (P < 0.05, r = 0.382). In the linear regression analysis, chemerin levels were associated with age (ß = 0.321), triglycerides (ß = 0.299) and T. cholesterol (ß = 0.555). CONCLUSION: Our study points to a relation between plasma chemerin levels and COPD. Larger patient groups are needed to verify the role of chemerin in the severity of COPD.

Association between cytokines in induced sputum and severity of chronic obstructive pulmonary disease.

Cytokines are known to be increased in induced sputum in chronic obstructive pulmonary disease (COPD). In this study, the relationship between the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumour necrosis factor-alpha (TNF-alpha) in induced sputum of patients with exacerbation of COPD, and the severity of the disease, pulmonary function tests (PFT), arterial blood gases (ABG) were studied. Twenty-four patients with exacerbation of COPD were included in the study. The patients were grouped according to their PFT into two as: Group 1 (FEV1 below 50% of the predicted value, severe-very severe COPD, n=12) and, Group 2 (FEV1 above 50% of the predicted value, mild-moderate COPD, n=12). The levels of IL-6, IL-8 and TNF-alpha in induced sputum of the subjects were measured. The mean levels of IL-6, IL-8 and TNF-alpha in induced sputum were found to be higher in Group 1 (severe-very severe COPD) than in Group 2 (mild-moderate COPD). The differences in IL-6 and IL-8 levels between groups were statistically significant (P<0.05). A significant correlation was observed between the IL-6 value and FEV(1) (r=-0.435, P=0.034), FEV1/FVC (r=-0.446, P=0.029), PaO2 (r=-0.711, P=0.000), SaO2 (r=-0.444, P=0.030) and disease duration (r=0.427, P=0.037), respectively. Also, the level of IL-8 in induced sputum was inversely correlated with FEV1 (r=-0.562, P=0.004), PaO2 (r=-0.540, P=0.006) and SaO2 (r=-0.435, P=0.034). However, all three cytokines were positively correlated with the smoking load (r=0.653, P=0.001; r=0.439, P=0.032; r=0.649, P=0.001). We conclude, therefore, that in exacerbated COPD cases with greater degrees of obstruction of the airways have higher levels of cytokines in induced sputum. This can be interpreted to mean that these cytokines are related to the clinical parameters like the ABG and PFT and seem to be the determinant of the severity of the disease.