Interval Versus Continuous Aerobic Exercise Training in Overweight and Obese Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CONTROLLED STUDY.

PURPOSE: The aim of this study was to compare the efficacy of the supervised pulmonary rehabilitation programs consisting of either an interval or continuous aerobic exercise program, with a home-based exercise program in patients with chronic obstructive pulmonary disease (COPD) who were overweight or obese. METHODS: In this randomized controlled study, 72 overweight and obese patients diagnosed as having COPD were randomly assigned to 3 groups. Group 1 received an interval-type (IT) aerobic exercise program, group 2 received a continuous-type (CT) aerobic exercise program (both groups performed home exercises as well) and group 3 was only given a home-based exercise (HE) program. For the evaluation of patients, anthropometric measures, cardiopulmonary exercise testing (CPX), 6-min walk test (6MWT), modified-Borg dyspnea and leg fatigue scores, St George's Respiratory Questionnaire, and Hospital Anxiety and Depression Scale were used. RESULTS: Both IT and CT groups showed significant improvement on CPX parameters, 6MWT distances, mental health, and health-related quality of life (HRQoL) compared with the HE group in overweight and obese patients with COPD (P < .001). Moreover, the IT group demonstrated a significant decrease in the modified-Borg dyspnea and leg fatigue during the CPX compared with both CT and HE groups (P < .001). Furthermore, the Borg dyspnea and leg fatigue during training were lower in the IT group than in the CT group (P < .05). CONCLUSIONS: An interval or continuous aerobic exercise program added onto a home-based exercise program improved exercise capacity and HRQoL, and reduced anxiety and depression levels in overweight and obese patients with COPD.

Work-Related Symptoms of Patients with Asthma: A Multicenter Study.

OBJECTIVES: It is considered that occupational exposure accounts for up to 25% of all cases of adult asthma. We need detailed individual-level data regarding the relationship between asthma, occupation, and work-related symptoms in Turkey to inform policies on workplace safety. This study aimed to investigate the association between asthma symptoms, occupation type, and workplace exposure in patients with asthma. MATERIALS AND METHODS: In this cross-sectional multicenter study, adult patients with asthma were investigated by a questionnaire in terms of relationship between asthma symptoms and workplace exposure. The study population was adult patients who had been diagnosed with asthma for at least six months prior to study and who were under follow-up in Ankara, Istanbul, Erzurum, Düzce, Trabzon, Denizli, and Diyarbakir. RESULTS: The mean age of the 345 cases (188 females) was 41±13 years. The majority of the patients (36.8%) were "housewives"; other common occupations were office workers (6.7%), textile workers (4%), students (3.8%), hospital staff (3.5%), and cleaners (2.9%). Thirty-five percent of patients described worsening of asthma during working periods. Among patients with a history of increased symptoms in workplace, 100 (83%) developed asthma after starting work, while 20 patients (17%) had pre-existing asthma. Half of the patients described workplace exposure to dust, fume, and gases. Exposure to cleaning supplies at home was present in 43% of the subjects. Of all housewives, 12% (n=15) described an increase in their asthma symptoms during housework. The frequency of bleach or hydrochloric acid use alone among housewives was 60% and 34%, which was significantly higher than other occupations. The FEV1/FVC ratio of housewives who frequently used hydrochloric acid (FEV1/FVC=71.5) was lower than that of non-users (FEV1/FVC=74.9) (p=0.024). CONCLUSION: Patients with asthma experience significant workplace exposures that exacerbate their symptoms. Housewives experience significant exposure that triggers allergic and asthma symptoms. It is important to raise awareness about the prevalence and risks of occupational (including in-home) exposures in asthmatics patients and physicians to minimize asthma triggers and exacerbations.

New aspect for systemic effects of COPD: eye findings.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has multisystemic implications and comorbidities. Hypoxia and systemic inflammation are thought to involve oculary structures. In this study, our aim is to evaluate retinal nerve fiber and choroidal thickness and retinal vessel diameter using the spectral-domain optical coherence tomography (SD-OCT) in COPD subjects. METHODS: Forty-three subjects diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease criteria at the Pulmonology Department of Pamukkale University were enrolled in the study. All subjects underwent respiratory function testing and a carbon monoxide diffusion test. To determine hypoxic state, arterial blood gas analysis was performed. The control group consisted of 31 subjects with comparable age and gender distribution. All participants underwent a standard ophthalmic examination including visual acuity assessment, biomicroscopy, air-puff tonometry, indirect retinoscopy, and SD-OCT measurements. RESULTS: The mean subfoveal choroidal thickness (SFCT), foveal thickness, and retinal arteriolar caliber were found to be similar in both groups, while the mean retinal venular caliber value was markedly higher in the COPD group. The mean peripapillary retinal nerve fiber layer (RNFL) thickness was 100.2±11.8 µm in the COPD group and 105.6 ± 8.1 µm in the control group (P = .03). The inferior quadrant RNFL was significantly thinner in the COPD group. CONCLUSIONS: The results of this study showed increasing diameter of the retinal veins, thinning of the RNFL, and SFCT may be associated to chronic inflammation and hypoxia in subjects with COPD. Future guidelines may include ocular findings to the present systemic manifestations of COPD.

Environmental asbestos disease: pleural plaque volume measurement with Chest Tomography is there a correlation between pulmonary function?

Objectives: Chest X-ray is correlated with pulmonary function of asbestos related disease. These correlations limited by low specific and sensitive. Computed tomography (CT) more sensitive. There was no adopted for the measurement of CT. Our aim in this study was to determine correlation between pleural plaque (PP) volume and lung function for use improving classification with CT. Methods: The study included 75 patients with environmental asbestos exposure. PP areas measured in patients were divided by the patient lung area to determine PP ratio with CT. Diffusing capacity and six minute walking distance (6MWD) measured and evaluated quality of life. Results:PP identified in 66 (88%) of the patients with CT. PP most frequently noted in the front right quadrant and had an average plaque volume of 7729,17 mm3. Plaque ratio taken as the percentage of the ratio to the lung volume, mean plaque percentage was 0,37±0,45% (0,003-2,3). In 12(18,1%) of the patients, asbestosis not seen with chest X-ray was detected with CT. Conclusions: PP volume and ratios were not statistically significantly correlated with respiratory functions, exercise capacity, cumulative amount of exposure. Patient of asbestos disease total lung capacity was lower, 6MWD distance was shorter and quality of life was poorer. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 336-342).

Coal Mining in Turkey: State and Private Sector Interactions Subcontracting and Redevance.

In this introductory report, coal mining accidents in Turkey, the historical perspective of the subcontracting and redevance system, and its effects on coal mining accidents are briefly reviewed.

Long term effects of tear gases on respiratory system: analysis of 93 cases.

AIM: This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. MATERIALS AND METHODS: A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. RESULTS: The mean numbers of total exposure and last 2 years exposure were 8.4 ± 6.4 times, 5.6 ± 5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P > 0.05). Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P = 0.046 and 89.9% versus 109.6%, P = 0.0004, resp.). % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P = 0.05). Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. CONCLUSION: The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis.

Symptom prevalence and risk factors for asthma at the rural regions of Denizli, Turkey.

OBJECTIVE: This study was conducted using a standardised method (ECRHS) to identify the prevalence of asthma symptoms and risk factors in adults who lives in the rural regions of Denizli province. METHODS: This study was designed as a cross-sectional study to investigate the prevalence of asthma and asthma symptoms in adults older than 18 years old, around the rural regions of Denizli. Data were collected by personal interview and filling in questionnaires between July 2009 and September 2009. RESULTS: A total of 1,343 individuals were enrolled. Prevalence of current asthma was 5.9%, having an asthma-like symptom was 34.0% and allergic rhinitis was 2.5%. Most common asthma symptoms were woken by an attack of breathlessness (20.5%, n=275), woken by attack of cough (19.9%, n=267) and wheezing (12.7%, n=171). CONCLUSIONS: Asthma is an important disease that may occur not only in cities but also at country sides. In rural areas risk factors for asthma and asthma-like symptoms compared to urban areas may show some differences.

Occupational exposure and thoracic malignancies, is there a relationship?

OBJECTIVES: The aim of this study was to evaluate the effect of occupational exposure in the occurrence of lung cancer. METHOD: Three-hundred lung cancer cases diagnosed between September 1, 1999, and September 31, 2007, and 300 healthy controls were enrolled in this case-control study. Life-long occupational history, gender, age, exposure to asbestos, comorbidities, and smoking status were collected. RESULTS: The mean age of the 300 lung cancer cases was 60.3 ± 9.9 year (91.7% male and 8.3% female), and the mean age of healthy control group was 60.4 ± 10.5 year (95.0% male and 5.0% female). The most frequent histological types were squamous (172, 57.3%), adeno (69, 23.1%), and small cell (37, 12.3%). There was an increased risk of lung cancer occurrence among agriculture workers (OR=1.89, 95% Cl=1.17-2.98) (p=0.009). Inorganic dust exposure (OR=1.81, 95% Cl=1.0-3.25) (p=0.049) and organic dust exposure (OR=1.89, 95% Cl=1.0-3.59) (p=0.05) were found to be related with high frequency of having lung cancer. CONCLUSION: Workers who had occupational exposure to organic and inorganic dust, especially in the agricultural field, had higher risk of lung cancer occurrence when compared with office workers.

Respiratory symptoms and pulmonary functions of workers employed in Turkish textile dyeing factories.

Dyes are known to be a causative agent of occupational asthma in workers exposed to them. We have evaluated respiratory symptoms among textile workers. The study population comprised 106 exposed workers and a control (unexposed) group. Data were collected by a questionnaire. PFTs (Pulmonary Function Test) were performed. Among the exposed workers 36.8% defined phlegm. Respiratory symptoms were not significantly different between two groups. The employment duration of the exposed workers with phlegm was longer than those without phlegm (p = 0.027). The mean % predicted of FEF(25-75) of the exposed workers was found to be significantly lower than the control (unexposed) group (p = 0.01). Our study suggests that textile dyeing might cause respiratory symptoms in workers.

Peripheral neuropathy in chronic obstructive pulmonary disease.

The aim of this study was to evaluate the frequency and characteristics of peripheral nervous system involvement in chronic obstructive pulmonary disease and its relation with proinflammatory cytokines such as TNF-alpha, IL-6, IGF-1 and CRP. Forty chronic obstructive pulmonary disease patients with a mean age 62.8 +/- 5.5 years and 33 healthy controls with a mean age of 61.8 +/- 7.4 were included into this study. All subjects were evaluated with standard motor and sensory nerve conduction studies. Serum TNF-alpha, IL-6, CRP and IGF-1 were measured. The muscle strengths of three muscle groups (knee extensors, shoulder abductors and flexors) were assessed with a hand-held dynamometer. Peripheral neuropathy was detected at 15% of chronic obstructive pulmonary disease patients. Ulnar motor and sensory nerves, left sural nerve distal latencies were found significantly prolonged than healthy volunteers (p = 0.011), peroneal nerve conduction velocities was found lower in patients than in healthy controls (p = 0.021), tibial nerve amplitudes was found lower in patients than healthy controls (p = 0.046). CRP and TNF-alpha were found significantly higher in chronic obstructive pulmonary disease patients and IGF-1 was found significantly lower in chronic obstructive pulmonary disease patients. There was no correlations between proinflammatory cytokines, CRP and electrophysiological findings. Left sural nerve's sensory nerve action potential amplitude was correlated positively with FEV(1)% (r = 0.425; p = 0.009). Muscle strength at the shoulder and knee were significantly reduced in patients with COPD when compared with controls. The frequency of neuropathy was higher in chronic obstructive pulmonary disease when compared with the healthy controls. Chronic obstructive pulmonary disease patients have subclinical peripheral nerve involvements.

Bilateral pneumothorax following acute inhalation injury.

INTRODUCTION: Inhalation injury can be thermal and/or chemical. We report bilateral pneumothorax following acute inhalation injury. CASE REPORT: A male worker in an upholstery factory was confined in the tanning machine for 15 min. The device was used to contain sodium sulfate, sulfur dioxide, and sulfuric acid. On admission, he was confused with Glasgow coma scale score as 9. His vital signs were as follows: blood pressure, 80/58 mmHg; pulse rate, 114 bpm; respiratory rate, 30 bpm; temperature, 37.1 degrees C; and oxygen saturation, 48%. He was intubated. Physical examination disclosed extensive subcutaneous emphysema on the neck and pinkish foamy discharge from the mouth. Chest X-ray showed bilateral pneumothoraces and pneumomediastinum that warranted bilateral tube thoracostomy. Bronchoscopy demonstrated web-shaped hyperemic areas on the upper airway mucosa with aphtous lesions in the base. Extensive hemorrhage and edema were evident around epiglottis. The patient was admitted to the intensive care unit and mechanically ventilated. He was discharged without any sequelae on day 8. CONCLUSION: Exposure to irritant gases such as sulfuric acid and sulfur dioxide can cause severe pulmonary injury leading to pneumothorax and pneumomediastinum.

[Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism]. / Pulmoner emboli tanili olgularin klinik ve laboratuvar bulgularinda erkek-kadin farklari.

Pulmonary embolism (PE) could not be diagnosed correctly in 2/3 of patients saving of that pathology, and unfortunately mortality in them could be as high as 30%. In the present study, we aimed to investigate the gender differences in clinical, electrocardiography (ECG) and laboratory findings of PE patients diagnosed with contrast-enhanced helical computerized tomography of thorax. 31 patients (18 females, 58% and 13 males, 42%) were included into the study. Symptoms, risk factors, ECG and arterial blood gases were evaluated, and then Wells, Geneva and ECG scores were obtained in each subject. Alveolo-arterial (A-a) oxygen gradient was calculated as P(A-a)O2= 150-(PCO2/0.8)-PO2. Mean pulmonary artery pressure (PAP) was measured by echocardiography. In female and male patients, Wells score (4.8 +/- 1.9 and 3.2 +/- 2.2, p= 0.017); ECG score (5.9 +/- 3.6 and 3.1 +/- 1.8, p= 0.036) and mean PAP (33.5 +/- 12.3 mmHg and 23.2 +/- 10.0 mmHg, p= 0.017) were significantly different. However, between female and male patients Geneva score (4.8 +/- 1.7 and 5.0 +/- 1.6), A-a gradient (35.2 +/- 17.3 and 42.9 +/- 12.3) and PaCO2 (33.5 +/- 15.1 and 29.8 +/- 5.4) did not differ significantly (p> 0.05). Immobilization and surgical interventions as risk factors for PE were established significantly higher in females than males (50%-30.8%, p= 0.02 and 50%-23.1%, p= 0.01). In female patients with PE, Wells and ECG scores, immobilization, surgical interventions and mean PAP are significantly higher than male patients. So, in the clinical practice, these parameters may help to diagnose acute PE especially in females.

A squamous cell lung carcinoma with abscess-like distant metastasis.

This is a metastatic spread of squamous cell lung carcinoma to lungs, liver, lymph node, bone and subcutanous region as multiple abscess-like lesions. A fifty-five years old man admitted to the out-patient clinic with fever, cough, hemopthysis, night sweats, chest pain, abdominal pain and weight loss. In a short period of time abcess like lesions developed in his lungs, liver, lymph node, bone and subcutanous region. Though the clinical presentation is suggestive for an infectious condition, no success to antimicrobial treatment and negative results of microbiological studies have arised a need to further investigations. Histopathological studies of the abscess wall ultimately gave the definitive diagnosis as metastatic squamous cell carcinoma. We believe that case report is interesting because of the uncommon metastatic lesions masquerading the abscesses and also wide-spread multiple distant invasions of a squamous cell lung carcinoma in a short time period.

Effects of CPAP on left ventricular structure and myocardial performance index in male patients with obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea (OSA) has the potential to cause heart failure. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on left ventricular structure and myocardial performance index (MPI) in severe OSA patients. METHODS: Sixty-seven subjects without any cardiac or pulmonary disease had overnight polysomnography and echocardiography. In 33 males with severe OSA, thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler. RESULTS: Eight males were non-compliant with CPAP. Mean age was 47.9+/-8.2 years, and 20 of 25 patients (80.0%) were hypertensive. Patients had high body mass index (BMI: 31.0+/-3.9 kg/m(2)), but there was no change in BMI from baseline after 6 months. Thickness of IVS (11.0+/-1.1mm) and LVPW (11.0+/-1.0mm) at baseline were significantly decreased after 6 months of CPAP therapy (10.5+/-0.9 mm, P<0.001 and 10.4+/-0.7 mm, P<0.0001, respectively). Left ventricular MPI (60.1+/-13.8%) significantly decreased (53.0+/-10.7%, P<0.0001) after CPAP usage. CONCLUSIONS: In male patients with severe OSA, CPAP therapy significantly decreases left ventricular wall thickness and improves global function even with 6 months of usage.

Effects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension.

OBJECTIVES: Obstructive sleep apnoea (OSA) might cause right ventricular dysfunction and pulmonary hypertension. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on right ventricular myocardial performance index (MPI) in OSA patients without hypertension. METHODS: 49 subjects without hypertension, diabetes mellitus, any cardiac and pulmonary disease had overnight polysomnography and echocardiography. In 18 moderate-severe OSA (apnea-hypopnea index > or = 15) patients, right ventricular free wall diameter (RVFWD) was measured by M-mode, and right ventricular MPI was calculated as (isovolumic contraction time+ isovolumic relaxation time) / pulmonary ejection time using Doppler at baseline and after 6 months CPAP therapy. RESULTS: Mean age was 46.5 +/- 4.9 year. Patients had high body mass index (BMI: 30.6 +/- 4,0 kg/m2), but there was no change in either BMI or blood pressures after 6 months. Right ventricular end-diastolic and end-systolic diameters were in normal limits at baseline, and did not change after CPAP usage. Baseline RVFWD (7.1 +/- 2.1 mm) significantly decreased after CPAP therapy (6.2 +/- 1.7 mm, p < 0.001). 15 of patients (83%) had right ventricular diastolic dysfunction at baseline, and it was completely improved in 11 of them (73%) by CPAP usage. Right ventricular global dysfunction was shown in 11 patients (61%) with a high MPI (62.2 +/- 9.3%) at baseline; and MPI was significantly decreased after CPAP therapy (47.3 +/- 8.4%, p < 0.0001), and it was completely corrected in 4 of them (36%). CONCLUSION: CPAP therapy significantly decreases RVFWD and improves right ventricular diastolic and global functions (MPI) in OSA patients without hypertension.

Gender differences in global cardiovascular risk factors of obstructive sleep apnea patients.

The morbidity and mortality of obstructive sleep apnea (OSA) are related principally to its cardiovascular complications. Metabolic syndrome (MBS) is recognized as raising the risk of cardiovascular disease. In this study, we analysied the diagnostic value of MBS to predict the diagnosis of severe OSA. Eight-seven subjects (54 males and 33 females) without any cardiac or pulmonary disease referred for evaluation of OSA, had overnight polysomnography. MBS were diagnosed according to NCEP criteria. According to apnea-hypopnea index (AHI), subjects were divided into two groups: severe OSA (AHI>or=30, 26 males, 15 females) and non-severe OSA (AHI<30, 28 males, 18 females). Ages were similar in both OSA groups for both genders. In the severe OSA group, number of patients with MBS was especially higher (in females n=13, 86.6%; in males n=19, 73%) than non-severe OSA (in females 6, 33%, in males 9, 32%). The mean values of the five diagnostic criteria of MBS were significantly higher in severe OSA than non-severe groups in both genders. Analysis of diagnostic value (criteria>or=3) of MBS for predicting the diagnosis of severe OSA in males and females revealed the sensitivity 73% and 86.6%, the specificity 67.8% and 94.4%, positive predictive value 67.9% and 86.7%, negative predictive value 73% and 85.7% respectively. Especially in female patients referred to the sleep clinics, evaluation of MBS criteria may play an important role in predicting severe OSA with high sensitivity and negative predictivity. Furthermore, the presence of MBS in OSA patients might increase cardiovascular complications.

Binasal cannula versus face mask for oxygen therapy in patients with chronic pulmonary disease.

Oxygen therapy, which is ordered frequently for patients with chronic pulmonary disease, remains a cornerstone of modern medical practice. This study was conducted to compare the efficiency and comfort of a binasal cannula versus a face mask during oxygen therapy. Sixty hypoxemic patients participated in this randomized controlled study. While each patient was hypoxemic, arterial blood gas analysis was performed before oxygen supplementation was begun. Arterial oxygen saturation was continuously monitored during oxygen therapy with a face mask or a binasal cannula. Subjects were allowed to return to their oxygen saturation level in room air before the device for oxygen treatment was changed. The same procedure was then repeated with the other device. Patient comfort was evaluated through the use of a questionnaire that was completed after each treatment period. The mean age+/-standard deviation was 62+/-13 y. No statistically significant difference was noted in oxygen saturation levels achieved with the 2 devices. The binasal cannula reached target oxygen levels (P=.007) more quickly than the face mask. The binasal cannula was reported to be significantly more comfortable (P=.0001), and had significantly fewer reports of dyspnea and restlessness, and was less of a nuisance (P=.019, P=.0001, and P=.0001, respectively). The binasal cannula was preferred for oxygen therapy by 71% of study patients. Although the efficiency of the 2 devices did not differ remarkably, the binasal cannula was regarded as a more comfortable and time-saving device for delivery of oxygen therapy to hypoxic patients.