Picturing asthma in Turkey: results from the Turkish adult asthma registry.

INTRODUCTION: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. METHODS: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. RESULTS: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. CONCLUSION: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Impact of COVID-19 pneumonia on interstitial lung disease: semi-quantitative evaluation with computed tomography.

OBJECTIVES: To evaluate the CT scores and fibrotic pattern changes in interstitial lung disease (ILD) patients, with and without previous COVID-19 pneumonia. METHODS: Patients with ILD (idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated ILD (CTD-ILD)) were retrospectively enrolled in the study which consisted of patients who had COVID-19 pneumonia while the control group had not. All patients had two CT scans, initial and follow-up, which were evaluated semi-quantitatively for severity, extent, and total CT scores, fibrosis patterns, and traction bronchiectasis. RESULTS: A total of 102 patients (pneumonia group n = 48; control group n = 54) were enrolled in the study. For both groups, baseline characteristics were similar and CT scores were increased. While there was a 4.5 ± 4.6 point change in the total CT score of the COVID-19 group, there was a 1.2 ± 2.7 point change in the control group (p < 0.001). In the IPF subgroup, the change in total CT score was 7.0 points (95% CI: 4.1 to 9.9) in the COVID-19 group and 2.1 points (95% CI: 0.8 to 3.4) in the control group. Seven patients (14.6%) in the COVID-19 group progressed to a higher fibrosis pattern, but none in the control group. CONCLUSIONS: Semi-quantitative chest CT scores in ILD patients demonstrated a significant increase after having COVID-19 pneumonia compared to ILD patients who had not had COVID-19 pneumonia. The increase in CT scores was more prominent in the IPF subgroup. There was also a worsening in the fibrosis pattern in the COVID-19 group. KEY POINTS: • The impact of COVID-19 pneumonia on existing interstitial lung diseases and fibrosis is unclear. • COVID-19 pneumonia may worsen existing interstitial lung involvement with direct lung damage and indirect inflammatory effect. • COVID-19 pneumonia may affect existing lung fibrosis by triggering inflammatory pathways.

COVID-19: vaccination vs. hospitalization.

OBJECTIVE: Vaccination is the most efficient way to control the coronavirus disease 2019 (COVID-19) pandemic, but vaccination rates remain below the target level in most countries. This multicenter study aimed to evaluate the vaccination status of hospitalized patients and compare two different booster vaccine protocols. SETTING: Inoculation in Turkey began in mid-January 2021. Sinovac was the only available vaccine until April 2021, when BioNTech was added. At the beginning of July 2021, the government offered a third booster dose to healthcare workers and people aged > 50 years who had received the two doses of Sinovac. Of the participants who received a booster, most chose BioNTech as the third dose. METHODS: We collected data from 25 hospitals in 16 cities. Patients hospitalized between August 1 and 10, 2021, were included and categorized into eight groups according to their vaccination status. RESULTS: We identified 1401 patients, of which 529 (37.7%) were admitted to intensive care units. Nearly half (47.8%) of the patients were not vaccinated, and those with two doses of Sinovac formed the second largest group (32.9%). Hospitalizations were lower in the group which received 2 doses of Sinovac and a booster dose of BioNTech than in the group which received 3 doses of Sinovac. CONCLUSION: Effective vaccinations decreased COVID-19-related hospitalizations. The efficacy after two doses of Sinovac may decrease over time; however, it may be enhanced by adding a booster dose. Moreover, unvaccinated patients may be persuaded to undergo vaccination.

Knowledge of Physicians About Influenza and Pneumococcal Vaccination.

OBJECTIVES: The aim of this study was to evaluate the knowledge of physicians on influenza and pneumococcal vaccine. MATERIALS AND METHODS: A questionnaire was administered to physicians working in Kyrenia University Hospital and Near East University School of Medicine. RESULTS: There were 38 female (56.7%) and 29 male (43.3%) participants. The mean age was 39.3±12.5 years. There were 24 general practitioners (GP) and 43 specialists participating in the study. Influenza vaccine and its risk minimization for infection were well known among 92.5% of the participants. However, 76.1% of them mentioned that they had knowledge about the pneumococcal vaccine, and this ratio about its reducing the risk of infection was 73.1%. 83.7% of specialists and 79.2% of GP thought that adult vaccines were effective (p=0.6). The rate of influenza vaccination among specialists was higher than that of GP (67.4% vs. 41.7%, p=0.04). However, the rates of pneumococcal vaccination were low and similar in both groups (p=0.3). In both specialists and GP, the most common reason for not receiving the vaccine was the belief of not being in the risk group (p=0.9). The knowledge level of pneumococcal vaccination in GP was found to be statistically lower than in specialists (p<0.05). CONCLUSION: Although influenza vaccine and its risk minimization for infection are well known among physicians, the pneumococcal vaccine is not well known. It is suggested that training about vaccination for both specialists and GP are important for preventive medicine.

Frequency of Exacerbations and Hospitalizations in COPD Patients Who Continue to Smoke.

We evaluated the frequency of exacerbations and hospitalizations in chronic obstructive pulmonary disease (COPD) patients who continue to smoke.: We retrospectively analyzed the medical records of the COPD patients treated in Chest Diseases Clinic of Kocaeli University School of Medicine in 2007-2013. Their demographic characteristics, smoking status (non-smoker, current smoker, ex-smoker), Charlson Comorbidity Index (CCI), and history of COPD exacerbation and hospitalizations were evaluated. The cases of 120 patients (11 females, 9.2%; 109 males, 90.8%) were analyzed. Sixteen (13.3%) of the patients were current smokers, and 104 patients were ex-smokers (n=99) or non-smokers (n=5). The mean age was 69.7±7.9 years in the ex-smokers and 62.94±6.8 years in the current smokers. There were no significant differences between the current and ex-smokers regarding smoking history, FEV1 value, frequencies of exacerbations and hospitalization per year, or duration of follow-up. The initial stage of the COPD and the frequency of exacerbations were significantly correlated (p=0.003). The CCI values were significantly higher in the ex-smokers compared to current smokers (p=0.02). A correlation analysis of age, hospitalization and CCI revealed that age was significantly correlated with the hospitalization rate (p=0.02). Older age and the presence of comorbidities in ex-smokers might explain the similar rates of exacerbation and hospitalization between these current and ex-smokers.

Tongue carcinoma with endobronchial metastasis: a rare case.

Endobronchial metastases of extrapulmonary malignant tumors are quite rare. We present a patient with endobronchial metastasis previously operated for tongue carcinoma. A 71-year-old female patient presented with the complaint of cough. She had a history of tongue carcinoma operation 2 years before. Chest x-ray revealed an air-fluid level in the lower zone of the right hemithorax. There was a big cavitary lesion in the right lower lobe and bilateral multiple nodular lesions, some of which had cavity formation on computed tomography. Bronchoscopy re- vealed a polypoid lesion with necrotic appearance and pathologic examination showed squamous cell carcinoma. The lesion was accepted as a metastasis of tongue carcinoma after evaluation of the materials taken from the tongue on previous operation. There was no finding suggestive of local recurrence; however, the patient died from hemoptysis and respiratory insufficiency. In conclusion, endobronchial metastasis should be considered in patients with extrapulmonary malignancies and bronchoscopic examination should be performed in such cases, even in the presence of atypical radiological findings.

Positive airway pressure device compliance of the patients with obstructive sleep apnea syndrome.

OBJECTIVES: The aim of this study was to evaluate factors affecting the usage of continuous positive airway pressure (CPAP) device in patients with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: This study included 47 patients with OSAS who were suggested to use CPAP device at home and expected to use the device for at least 6 months. The compliance of CPAP device was determined by 2 different methods. In subjective evaluation, total time for usage of the device was recorded according to patients' declaration. In objective evaluation, total time of usage was recorded from the counter on device and it was divided into the number of days passed from the beginning of the treatment and at least 4 h of usage in a day was accepted as an effective usage. Data of compliant and non-compliant patients were compared in order to determine the factors affecting CPAP treatment. RESULTS: Ten patients were female, 37 of them were male and mean age was 52.98 ± 20.4 years. Mean Apnea Hypopnea Index (AHI) was 54.4 ± 20, mean oxygen saturation (SO2) was 87.3 ± 4.6 and mean CPAP pressure was 7.4 ± 1.9 in the whole study population. The compliance of CPAP treatment was found to be 48.9% according to objective evaluation whereas it was 80.9% according to subjective evaluation. Five of 8 patients (62.5%) who did not use the device stated the problems about the device mentioning the mask as a reason for their non-compliance. Treatment compliance was better in the patients with high Epworth sleepiness scale (16.5 ± 5.5 vs. 11.8 ± 4.1, p < 0.05). Epworth sleepiness scale of the patients who were compliant to the treatment was significantly decreased after the treatment both in subjective and objective evaluation. Treatment compliance wasn't different between male and female patients, however it was significantly lower in active smokers compared to non-smokers and ex-smokers. CONCLUSIONS: It was concluded that the most important factor associated with compliance to CPAP treatment in the patients with OSAS was Epworth sleepiness scale while mask related side effects might be a reason of treatment withdrawal and all these issues should be addressed carefully in order to increase compliance.

[Smoking prevalence in Kocaeli]. / Kocaeli'de sigara içme prevalansi

A questionnaire was performed in order to determine smoking prevalence in the target population just before the initiation of a social responsibility project which is aimed to increase the smoking cessation rates in Kocaeli. The sample selection was made based on population numbers in 12 town of Kocaeli city and smoking habits of population over the age of 18 were evaluated by a questionnaire survey by phone. There was 2721 person included in the study. The overall prevalence of active smokers was 32.3% (n= 902) and ex-smokers was 21.5% (n= 587). There was no statistical significance of smoking prevalence among towns except the lower smoking rates in Gebze (25.7%). The percentage of the current smokers was 42.5% in male population which was significantly higher than females (21.8%). The highest smoking prevalence was found between the ages of 35-44 (41.2%) while the lowest prevalence was observed in the subjects older than 55 years (19.8%). The mean age for smoking initiation was 19 years (17-20) and daily cigarette consumption was 17 sticks. Previous attempts for quitting smoking were found in 67.7% of current smokers. The mean number of smoking cessation attempts was 3 times and the mean duration of cessation was 5 months. The most common reason for smoking cessation was health issues. Eighty percent of cases harnessed their willpower to stop smoking while only 5% of them received medical treatment. It is suggested that determination of demographic features of the smokers might constitute a corner stone for smoking cessation projects.