The role of arterial blood gases, exercise testing, and cardiac examination in asthma.

The severity of bronchial asthma may not be assessed easily in some patients using the current evaluation methods. In this study, we aimed to obtain more objective and detailed data in evaluating patients with stable mild and moderate bronchial asthma and to validate the current parameters against more objective ones in determining the disease severity. One-hundred six stable patients with bronchial asthma were included in the study. These patients underwent spirometric and cardiological examination, 6-minute walk testing (6MWT) and arterial blood gas analysis. Continuous measurement of pulse oxymetry (SpO2) was done during 6MWT. Dyspnea that developed during 6MWT was measured using the modified Borg category scale. Sixteen patients were found severely hypoxemic at rest, and 16 patients were severely desaturated at 6MWT. Nineteen patients had pulmonary hypertension on echocardiography. Patients with oxygenation problems were older and had longer disease duration, lower forced expiratory flow of 25-75%, higher Borg exercise rating, and higher pulmonary artery pressure (p < 0.05). Patients with pulmonary hypertension had earlier disease onset, lower forced expiratory flow of 25-75%, lower arterial oxygen tension and lower pre-6MWT SpO2 (p < 0.05), older age, and lower SpO2 at 6MWT (p < 0.01). Classic evaluation methods correctly operated only on the two-thirds of asthmatic patients. Cardiological examination, 6MWT, and arterial blood gas analysis were needed for the true evaluation of other patients who had potentially progressive disease. We think that evaluation of asthmatic patients with these more objective and detailed methods provides important additional clinical data.

[The principles of mechanical ventilation in ARDS]. / ARDS'de mekanik ventilasyon prensipleri.

Acute respiratory distress syndrome (ARDS) is a real challenge for the pulmonary and critical care physicians. Although it is quite frequently encountered in intensive care clinics, its diagnosis and treatment bare many variations among the clinicians. Since ARDS is a fully dynamic process, there is no uniform application of mechanical ventilation (MV) being one of the inevitable components of ARDS management. This situation makes the clinicians very prone to make mistakes during setting and subsequent adjustments of mechanical ventilation parameters. In this review, we aimed to clarify the most common issues of discussion by presenting the principles of MV in ARDS with regard to some recent modifications.

[Acute oxygen treatment]. / Akut oksijen tedavisi.

Oxygen treatment is commonly used in clinical practice. Although this treatment was taught during medical education under different titles, it is observed that doctors do not administer oxygen treatment in adequate periods and doses. The possible cause of this may be that oxygen is not considered as a drug. The results of inadequate dose and insufficient monitoring in oxygen treatment would be serious. On the other hand, failure to correct hypoxaemia fearing from hypoventilation and carbon dioxide retention is not acceptable. For a safe oxygen treatment, doctor must know its indications, oxygen delivery systems, flow rates and monitoring. The aim of this review is to refresh our knowledge about when, how and how much to start oxygen treatment and how to monitor it.

Asthma, age, and early reversibility testing.

The aim of this study was to assess the effect of age on early reversibility testing (ERT) in patients with asthma. Forty-nine nonsmokers with asthma were investigated. In all cases, disease duration was less than 15 years; the absolute change (absolute variability, AV) in forced expiratory volume in 1 second (FEV1) on ERT was greater than 100 mL; and the increase in FEV1 on ERT was greater than 10%. Patients were categorized as group I (younger than 50 years; n = 24) and group II (50 years or older; n = 25). There were no significant differences between the groups regarding disease duration and severity. The mean patient ages in groups I and II were 40.3 +/- 7.9 years and 59.2 +/- 7.1 years, respectively, and the corresponding mean baseline FEV1 values were 62.2 +/- 23.7% and 67.4 +/- 21.1% of predicted value (p > 0.05). Pulmonary function tests were performed at baseline, and then repeated for ERT 20 minutes after inhalation of 200 microg salbutamol. After ERT, the respective findings for groups I and II were as follows: AV 412 +/- 184 mL and 247 +/- 138 mL; percentage change (PC) in FEV1 21.5 +/- 9.3% and 16.9 +/- 7.5%; and percent of predicted change (PPC) in FEV1 13.6 +/- 6.5% and 9.9 +/- 4.9%. The AV, PC, and PPC values for group I all were higher than the corresponding findings for group II, and the differences in AV and PPC were statistically significant (p = 0.001, p < 0.05). The study showed that elderly asthma patients exhibit significantly lower AV and PPC after ERT. To improve the accuracy of asthma diagnosis in elderly patients, limits of ERT should be redefined.

[The cost of treatment in new case and multidrug resistant case in pulmonary tuberculosis]. / Cok ilaca dirençli akciger tüberkülozu ile yeni olgu akciger tüberkülozunun tedavi maliyeti.

The treatment of multidrug-resistant pulmonary tuberculosis (MDR-Tbc) is quite difficult, and the disease has high morbidity and mortality rates. This study was designed to compare the costs of treatment in new tuberculosis (new-Tbc) cases and MDR-Tbc cases. Data base of the study was composed of the data from therapy principles of new-Tbc cases and MDR-Tbc, and official directives and price lists of Turkish Pharmacology Society in 2001 fiscal year regulating treatment costs. For new-Tbc cases, the treatment cost included expanses for 20 days of hospitalisation, one month work loss and six months drug supply and laboratory costs; for MDR-Tbc cases, it was comprised by expenses for seven months hospitalisation in average, 12 months work loss, 24 months drug supply and laboratory costs, and probable surgical interventions and post-operative intensive care. The service of hospital stuff and medical equipment provided was disregarded. The cost analyses was calculated as charge price of American dollars ($) dated 14.09.2001. It was found that the cost of therapy for new-Tbc cases and MDR-Tbc cases were 1134.89 $ and 17529.15 $, respectively. In MDR-Tbc cases, the costs of hospitalisation, work loss, drug therapy and laboratory procedures were 10.5, 12, 98.7 and 5.3 times higher respectively, when compared with those of new-Tbc. The cost of thoracotomy for one patient including the cost for 10 days period of post-operative care in intensive care unit was 391.93 $. The treatment of MDR-Tbc has a high cost, and 16 new-Tbc cases can be treated with the same cost in our country. In conclusion, we think that successful treatment strategies for both new-Tbc cases and MDR-Tbc cases will lower the cost of tuberculosis treatment.

Proteolytic enzyme sensitivity and decrease in respiratory function (a 10-year follow-up).

OBJECTIVES: In workers, sensitivity and occupational asthma are known to develop in reaction to the proteolytic enzymes used in the manufacture of detergents. This study was conducted to find out how this sensitivity to the proteolytic enzymes affects respiratory function, excluding occupational asthma. METHODS: Workers in the detergent industry ( n = 65) were divided into four groups according to their prick-test results, as follows: those positive for at least one enzyme (Lipolase, Savinase) (group I, n = 15); enzyme-negative cases (group II, n = 50); and from among these, enzyme-positive non-smoking cases (group Ia, n = 11); enzyme-negative non-smoking cases (group IIa, n = 32). Respiratory function tests for the last 10 years from the archives were assessed. For statistic analysis, average values were determined and the standard deviation calculated. For comparison of the groups, the Mann-Whitney U and Fischer Exact chi-square tests were used. RESULTS: The ratio of smokers, the cigarette burden, average age and the period of work were found to be similar between workers of groups I and II, and group Ia and group IIa ( P > 0.05). The average annual fall in the forced vital capacity (FVC) and the forced expiratory volume in the first second (FEV(1)) for the 10-year period was, respectively, found to be: group I, 64.1 +/- 7.8 ml and 58.7 +/- 9.6 ml; group II, 38.7 +/- 6.4 ml and 43.7 +/- 8.2 ml; group Ia, 60.7 +/- 8.1 ml and 56.1 +/- 10.2 ml; group IIa, 37.4 +/- 6.8 ml and 42.9 +/- 8.1 ml. The decrease in FVC and FEV(1) in group I compared with group II, and in group Ia compared with group IIa was statistically significant ( P < 0.001). CONCLUSIONS: In this study, the observation that the FVC and FEV(1) of the workers were much lower than expected, especially among those sensitive to the enzymes, independently of occupational asthma and cigarette smoking, led to the conclusion that it could be due to sensitivity to the enzymes.