Asthma in obese women: outcomes and factors involved.

OBJECTIVE: It has been shown that the prevalence of asthma in obese people has increased in recent years. The aim of this study was to evaluate factors involved in the relationship between asthma and obesity in women, METHODS: We evaluated serum leptin levels, fractional exhaled nitric oxide (FE(N0), asthma control (using theAsthma Control Test [ACT]), and presence of atopy in 41 obese women with asthma and 40 non-obese women with asthma. We also compared the relationship between body mass index (BMI) and these parameters between the 2 groups. RESULTS: Serum leptin levels were significantly higher in obese asthmatics than in nonobese asthmatics (P < .05). In the obese group, leptin levels were positively correlated with FE(O) levels (r = 0.439, P = .004). Uncontrolled asthma (ACT score <20) was detected in 61% of women in the obese group compared to just 38% of those in the nonobese group (P = -.035). In atopic patients, total immunoglobulin E levels were positively correlated with leptin levels (r = 0.329, P = .038). When the 81 women were classified according to asthma control, high BMI was found to be the only significant factor that contributed to poor asthma control. CONCLUSION: We have shown that serum leptin levels might have a role in poor asthma control in obese patients, and can conclude that obesity is an important factor in uncontrolled asthma.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey).

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Epidemiological features of Turkish patients with sarcoidosis.

Epidemiological characteristics of sarcoidosis differ according to geographical distribution. The aim of our study was to disclose epidemiological characteristics in our country. The data was collected from investigators, who sent information on newly-diagnosed patients via internet. In 2 years 198 female and 95 male patients were enrolled to the study (f/m:2.08). Mean age of patients was 44+/-13 years (17-90). Mean age of male patients was 38+/-12 while mean age of female patients was 48+/-13 (p<0.001). 73.4% of patients were nonsmokers (85.4% of females; 48.4% of males; (p<0.001)). About 50% of our 293 patients were housewives. Familial sarcoidosis was found in 3 patients' first degree relatives. Estimated annual incidence of sarcoidosis for Turkey was calculated as 4 per 100,000 person. According to our study, 2/3 of sarcoidosis patients were women; mean age of patients was 45 and the disease began 10 years later in female patients. 80% of patients were nonsmokers; negative relation between sarcoidosis and smoking was evident especially in women. Familial sarcoidosis frequency was lower compared to other studies in the literature. There was no occupational exposure history in our patients. Our incidence rate, is similar with the results of other European studies.

A randomized clinical trial of magnesium sulphate as a vehicle for nebulized salbutamol in the treatment of moderate to severe asthma attacks.

Although it is well known that intravenous administration of MgSO4 as an adjunct to conventional therapy is effective in treating asthma attacks, the effect of nebulized MgSO4 as a vehicle for salbutamol has been less evaluated. The aim of this study was to compare the effects of nebulized salbutamol administrated through either MgSO4 or isotonic saline solution on the 'peak expiratory flow rate' (PEFR), other respiratory and clinical parameters, and hospitalization rate of patients suffering from moderate to severe asthma attacks. Twenty-six patients with asthma attack were enrolled in the study in a randomized single blind fashion. After obtaining initial peak expiratory flow measurements (PEFR) and clinical evaluation, all patients received 1mg/kg corticosteroids and oxygen therapy and then either isotonic MgSO4 (2.5 ml, 6.3%)+salbutamol (2.5 ml) or saline (2.5 ml)+salbutamol (2.5 ml) through a jet nebulizer (group 1 (n=14) vs group 2 (n=12), respectively). The nebulizations were repeated every 20 min for the first hour and every hour for the rest of 4 h. The PEFR measurements and clinical assessment were performed after nebulization at 20th, 60th, 120th, 180th and 240th minutes. Patients were discharged when PEFR reached the target level of 70% of predicted. The baseline PEFRs and clinical parameters were similar between groups 1 and 2 (50.2+/-18.5 vs 44.1+/-13.9, respectively, p>0.05). The mean% increase in PEFR at different measurement levels was similar between the groups. When the treatment response was evaluated within the groups, group 2 showed statistically significant increase in PEFR (% of predicted) 1h earlier than group 1 (60th vs 120th minute, p=0.003 vs p=0.007). The mean duration of achieving target-PEFRs was 105.7+/-72.1 min for group 1 and 118.3+/-96.7 min for group 2 (p>0.05). This study suggested that the additional usage of MgSO4 to nebulized salbutamol has no beneficial effect on the treatment of asthma attacks.

Effects of inactivated influenza virus vaccination on bronchial reactivity symptom scores and peak expiratory flow variability in patients with asthma.

Even though annual influenza vaccinations are recommended by many authorities, some doctors may be reluctant to vaccinate asthmatic patients because of the risk of inducing bronchial reactivity and exacerbating the asthma. In this study we investigated the effect of inactivated trivalent influenza vaccine on airway reactivity symptom scores and peak expiratory flow (PEF) variability in 24 patients with mild stable asthma. Baseline spirometry and methacholine challenge tests were performed on all patients. Patients were then asked to record their peak expiratory flow every morning and evening, complete daily symptom score charts (morning tightness, daytime asthma, cough, and night asthma), and note bronchodilator usage for 1 week. After baseline measurements, the patients were allocated to inactivated vaccine and placebo in a random and single-blind manner. The lung function measurements and methacholine challenge tests were repeated 1 week after vaccination and placebo administration at the same time of day. PD20 (mg/mL) methacholine doses were 3.06+/-3.0 mg/mL before vaccination, 2.96+/-3.2 mg/mL after vaccination, and 2.76+/-2.91 mg/mL after placebo administration. There were no significant changes in PD20 methacholine after influenza vaccination (p>0.05). There were also no significant changes in symptom scores, bronchodilator usage, and PEFR after vaccination (p>0.05). None of the patients experienced significant local or systemic side effects after vaccination. Immunization with inactivated influenza vaccine does not induce clinical exacerbations of asthma or airway hyperreactivity in patients with mild asthma.

Comparison of sputum and serum eosinophil cationic protein (ECP) levels in nonatopic asthma and chronic obstructive pulmonary disease.

The aim of the present study was to investigate whether sputum eosinophil cationic protein (ECP) concentrations could be a useful marker in the differential diagnosis between intrinsic asthma and chronic obstructive pulmonary disease (COPD). For this purpose total blood eosinophil counts were obtained and concentrations of serum and sputum ECP from 10 nonatopic asthmatics with a mild attack and 9 COPD patients with acute exacerbation were measured by radioimmunoassay. Mean serum ECP concentration was 54.3 +/- 23.0 micrograms/L in the asthmatic group and 83.3 +/- 79.2 micrograms/L in the COPD group (p: n.s.). In the group of asthmatics mean sputum ECP level was 984.5 +/- 1245.5 micrograms/L/g sputum and in the COPD group it was 417.5 +/- 363.5 micrograms/L/g sputum. There was no significant difference in sputum ECP levels between patients with asthma and COPD. We conclude that neither sputum nor serum ECP levels are useful markers in differential diagnosis of asthma attack and acute exacerbation of COPD.

Hepatotoxicity of antituberculosis therapy (rifampicin, isoniazid and pyrazinamide) or viral hepatitis.

SETTING: Department of Chest Diseases, Gazi University Faculty of Medicine and Atatürk Chest Diseases Hospital, Ankara, Turkey. OBJECTIVE: The primary purpose of this study was to assess the contributory role of viral hepatitis in antituberculosis drug hepatotoxicity. DESIGN: Serologic markers for viral hepatitis were studied in 57 patients who developed acute hepatitis during antituberculosis therapy with rifampicin and isoniazid. RESULTS: Among 705 adult tuberculous patients, 57 (8.1%) developed acute hepatitis during therapy with rifampicin and isoniazid. Serologic markers confirmed the presence of hepatitis B in 6 (10.5%) and hepatitis C in 4 (7%) of the 57 patients. Acute hepatitis A was not diagnosed in any of the patients. CONCLUSION: Hepatitis occurring during antituberculosis therapy may not be drug-induced in all patients. Apart from the other factors mentioned above the endemicity of viral hepatitis in developing countries could be responsible for the higher incidence of antituberculosis-drug hepatitis.

Pulmonary alveolar microlithiasis with the absence of technetium-99m MDP uptake of lungs.

The authors report a patient with alveolar microlithiasis who was treated for miliary tuberculosis eight years earlier and whose Tc-99m MDP scan revealed absent lung uptake. Diagnosis was established by bronchoalveolar lavage. Both the roentgenogram and computed tomography of the chest confirmed alveolar microlithiasis.