Transitions between COPD groups: A cross-sectional study in Turkey.

INTRODUCTION: Since GOLD 2017 separates spirometry results from 'ABCD' groups, there have been some changes to the stages of COPD patients. Our aim was to investigate the shifts in COPD groups after GOLD 2017. METHODS: COPD patients from outpatient clinics of 3 hospitals in Turkey were stratified into old and new ABCD groups according to exacerbation history, mMRC evaluation and spirometry results for both GOLD 2011 and 2017 assessments. Treatment protocols were also evaluated if they were suitable for both classifications. RESULTS: There were 578 patients (334 men, 244 women) with a mean age of 65.21±10.42. The distribution of patients from group A to D was 28%, 15%, 15%, 42% (GOLD 2011) and 36%, 22%, 7% and 35% (GOLD 2017) respectively. There were shifts from group C to A (53.4%) and D to B (18.4%). The treatment suitability was 66.3% in GOLD 2011 and 60.9% in GOLD 2017. The most common inappropriate treatment protocol was triple therapy. Presence of exacerbations in last year, mMRC score, FEV1 level (p < 0.01 for three parameters) and proportion of males (p = 0.029) were statistically significantly higher in groups C and D of GOLD 2017 compared with new patients in group A and B of GOLD 2017 (shifted from GOLD 2011's C-D groups). CONCLUSION: There were shifts from group C to A and D to B with GOLD 2017, which means some high-risk COPD patients were reclassified into low-risk groups. Despite guideline updates, there are still many COPD patients with overtreatment. To our knowledge, this is the first study examining transitions between COPD groups after GOLD 2017 in Turkey.

Is an elevated neutrophil-to-lymphocyte ratio a predictor of metabolic syndrome in patients with chronic obstructive pulmonary disease?

OBJECTIVE: This study aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) in early detection of metabolic syndrome (MetS) in patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: We retrospectively enrolled hospital records of 140 COPD patients and 50 sex and age-matched healthy controls. The diagnostic values of NLR were estimated using the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS: In total, 140 patients with COPD of which 63 patients had MetS and 50 healthy subjects were included in the study. We found that the NLR values of the stable COPD patients were significantly higher than those of the controls (p < 0.001). Among patients with COPD, the NLR was significantly higher in patients with than without MetS (p < 0.001). The AUC of the NLR was 0.898 in patients with MetS. The optimal NLR cut-off was 2.56 and was validated in the testing set. For evaluation of MetS, the sensitivity and specificity were 84.1% and 84.4% in patients with COPD under the suggested cut-offs. CONCLUSIONS: The NLR is a simple, effective, and practical predictor of MetS in patients with stable COPD. It has potential value in public health practice for management of patients with COPD.

Case of Behçet's disease presenting with bilateral multiple pulmonary arterial aneurysms.

Pulmonary arterial involvement is a rare but life-threatening complication of Behçet's disease (BD). A 28-year old male, presented with hemoptysis, fever, dyspnea, weight loss and recurrent oral ulcers was diagnosed with Behçet's disease with multiple bilateral pulmonary arterial aneurysms confirmed following a CT and MRI. scan Besides pulmonary involvement, ocular involvement was also shown. Complete regression was noted during the first year of the therapy with cyclophosphamide and corticosteroid. The patient is still under the hospital for follow ups with favourable outcome predicted.

Effect of chemotherapy on pulmonary epithelial permeability in lung cancer.

The aim of this study is to investigate the effect of one-course chemotherapy on the pulmonary epithelial permeability. Eighteen patients (18 male; mean age: 59+/-10 years) with lung cancer (11 non-small cell, 7 small cell) inhaled 40 mCi (1,480 MBq) (99m)Tc-diethylenetriaminepentaacetic acid (DTPA). Thirty images of 1-min duration were acquired from posterior projection. The first 7 min of the decay-corrected time activity curves were used to calculate lung clearance half-time. Clearance half-times of (99m)Tc-DTPA from the peripheral regions of the lungs were 42+/-19 min before and 56+/-34 min after chemotherapy (p=0.009); from the central regions, clearance half-times were 112+/-94 min before and 160+/-125 min after chemotherapy (p=0.005). This decrease in clearance rate might be related to decreasing mucociliary clearance rate due to the toxic effect of the chemotherapy regimen on cilia movement and/or mucus structure. (99m)Tc-DTPA radioaerosol study can be used to monitor the toxic effects of chemotherapy on the pulmonary epithelium and possibly on mucociliary function.

Combining transbronchial aspiration with endobronchial and transbronchial biopsy in sarcoidosis.

This study was carried out to evaluate the diagnostic yield and safety of flexible transbronchial needle aspiration (TBNA), endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB) combinations in stages I-III sarcoidosis (SA). Between 1989 and 1997, 74 patients suspected of having SA underwent fibreoptic bronchoscopy along with TBNA + EBB + TBLB or EBB + TBLB. During the same fibreoptic bronchoscopy, TBNA (using a 19-gauge histological needle and contrast-enhanced computed tomography (CT) guidance), EBB (from abnormal or normal bronchial mucosa) and TBLB were performed in stages I (n = 33) and II (n = 25), and EBB and TBLB in stage III (n = 16). The diagnosis of SA required the presence of noncaseating granulomas and the absence of "allergic granulomatosis and angiitis with eosinophilic infiltration" or foreign body reaction, with negative Ziehl-Neelson and methenamine silver stains, as well as negative cultures for acid-fast bacilli, fungi and other organisms. TBNA was diagnostic in 20 (61%) and 10 (42%) cases of stages I and II, whereas EBB was diagnostic in 15 (45%), 12 (50%) and seven (58%) cases, of stages I, II and III, respectively, and TBLB in 17 (52%), 15 (63%) and 10 (83%). By means of TBNA, EBB and TBLB alone, the diagnostic yields were nine (27%), four (12%) and six (18%) cases in stage I, two (8%), four (17%) and seven (29%) in stage II, and two (17%) and five (42%) by EBB and TBLB in stage III, respectively. The diagnostic yield of TBNA + EBB + TBLB was 30 (91%) in stage I and 21 (88%) in stage II, and that of EBB + TBLB was 12 (100%) in stage III. Overall, 63 (91%) cases of SA were diagnosed by TBNA + EBB + TBLB and EBB + TBLB. In six of the eleven bronchoscopically-negative cases, mediastinoscopy (four) or thoracotomy (two) established the diagnosis of SA, whereas the remaining five were diagnosed along with non-sarcoidosis diseases (one case in stage II and four in stage III) by various tissue biopsies in the follow-up. The combination of TBNA + EBB + TBLB and EBB + TBLB provided an overall sensitivity and accuracy of 90% and a specificity of 100%. All six (9%) significant complications--pneumothorax (four) and 40-100 mL haemorrhage (two)--were attributable to TBLB. It is, therefore, inferred that the combination of transbronchial needle aspiration, endobronchial biopsy and transbronchial lung biopsy in stages I and II, and that of endobronchial biopsy and transbronchial lung biopsy in stage III, is safe and cost-effective as well as increasing the diagnostic yield, and should therefore be performed routinely in the diagnosis of sarcoidosis.

A case of bronchogenic carcinoma and concomitant Swyer-James syndrome.

A 46-yr-old male patient with the rare concomitance of Swyer-James syndrome in the left lung and small cell lung carcinoma in the right is presented in the light of pertinent literature.

Prednisolone: a beneficial and safe adjunct to antituberculosis treatment? A randomized controlled trial.

SETTING: A referral centre for thoracic diseases in Izmir, Turkey, 1992-1995. OBJECTIVE: To appraise the adjunctive role of prednisolone (PN) in pulmonary tuberculosis (PTB) with toxic reactions. DESIGN: After excluding other febrile causes, and 2 weeks of four/five-drug antituberculosis therapy insufficient to resolve toxic reactions, 178 human immunodeficiency virus (HIV) negative patients with advanced PTB causing persistent high-grade fever (> or =38 degrees C), weight loss (> or =2 kg/week) and/or low serum albumin levels (<3 g/dL) were randomly allocated to receive either a 12-month course of antituberculosis treatment using four first-line drugs and PN (20 mg b.i.d. IV/IM initially, decreasing over 40 days) (91 patients-PN group), or 12 months of antituberculosis treatment only (87 patients-CO group). Twice-weekly sputum bacillary count, temperature recorded every 6 hours, weekly weight, serial albumin level and liver function measurements and chest roentgenograms were used to assess the effects of PN on PTB. RESULTS: Temperature decreased from 39.1+/-0.9 degrees C to 37.9+/-0.7 degrees C (P = 0.0030) within the first 72 (+/-9) hours in those patients on PN treatment, whereas a gradual decline occurred over 22 (+/-3) days in the CO group. In the PN group, patients' weight increased from 49.7+/-4.8 kg to 56.9+/-8.3 kg, compared to 47.1 +/- 6.4 kg to 51.31+/-5.9 kg in the CO group (P = 0.0022). Increases in serum albumin levels in the PN and CO groups were from 2.26+/-0.8 g/dL to 3.32+/-0.6 g/dL and from 2.31+/-0.5 g/dL to 2.90+/-0.7 g/dL, respectively (P = 0.0035). The radiographic regression and drop in bacillary count were more rapid, and the hospital stay shorter (53.4+/-3.1 days vs 71.3+/-5.6 days) in the PN group, although there were no differences in the acid-fast bacilli conversion rates. There were no detrimental side effects and relapses attributable to PN during the 1-3 year follow-up, even in 18 cases with drug resistance. CONCLUSION: Prednosolone is a beneficial and safe adjunct to 12-month antituberculosis treatment in advanced PTB causing toxic reactions, provided that close clinical, radiographic and bacillary monitoring is exercised.