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Summary: Background. Asthma is a disease that combines different biological mechanisms, inflammatory pathways, and phenotypic features. Our aim was to investigate the demographic and disease characteristics of patients with asthma and to reveal the distribution with different phenotypes according to endotype groups. Methods. Patients were identified as eosinophilic if the absolute eosinophil count was measured at least once ≥ 300/µL during the oral corticosteroid free period or ≥ 150/µL under oral corticosteroids. Patients sensitive to at least one inhalant allergen with skin prick test and/ or spIgE measurement were defined as allergic. They were categorized into four main endotypes. Results. Data of 405 asthma patients with a median age of 50.9 years were analyzed. The prominent clinical and phenotypic characteristics of the study group were being obese (43.2%) or overweight (32%), severe asthma (49.6%), adult-onset (56.1%) or late-onset asthma (35.3%). The distribution of the four main endotypes according to eosinophilic and/or allergic status, is as follows: 22.7% allergic-eosinophilic (AE), 27.9% nonallergic-eosinophilic (NAE), 22.9% allergic-noneosinophilic (ANE), 26.4% nonallergic-noneosinophilic (NANE). While most severe asthma patients were in the AE and NAE groups, those with early-onset asthma were in AE and ANE, and those with late-onset asthma were in the NAE and NANE groups. The proportion of uncontrolled patients was higher in the NAE group. Among the severe asthma patients, the rate of uncontrolled disease was higher in those with NANE asthma. Conclusions. Different phenotypes were more closely related to some endotypes. This may allow the clinicians to identify patients and predict appropriate treatment modalities and response for individualized care.
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Asma , Eosinofilia , Adulto , Humanos , Pessoa de Meia-Idade , Asma/diagnóstico , Asma/epidemiologia , Asma/tratamento farmacológico , Contagem de Leucócitos , FenótipoRESUMO
Summary: Objective. To reduce the omalizumab dose in patients with allergic bronchopulmonary aspergillosis (ABPA) who were on long-term omalizumab treatment. Methods. Once asthma was controlled, two approaches were used to reduce total monthly omalizumab dose, 1) both extending dose intervals from 2 to 4 weeks and decrease omalizumab dose, 2) to reduce omalizumab dose while keeping dose intervals stable. Results. Thirteen patients with ABPA (8F/5M, mean age 53.4 ± 13.0 years) were included. Pre-omalizumab, mean blood eosinophil count was 723.1 ± 547.1 cells/mcL, mean numbers of attacks and hospitalizations were 2.5 ± 1.5 and 1.3 ± 0.8, respectively. Median total monthly omalizumab dose was 750 (min 300, max 900) mg. First and 2nd approach to reduce omalizumab dose was used in nine and four patients with a median time of reduction 32 (min 13, max 47) months. The 2nd dose reduction was made in four patients at median of 23.5 months. Pre-omalizumab, mean oral corticosteroid (OCS, as methylprednisolone) dose was 12.2 ± 10.4 mg daily, it decreased to 0.69 ± 0.95 mg (p = 0.001) in the 1st year of omalizumab and could be stopped in 11 patients. Attacks and hospitalizations decreased to 0.31 ± 0.86 (p less than 0.001) and 0 (p = 0.003), respectively, in the 1st year of omalizumab. Total omalizumab dose was reduced by median 40% (min 20, max 60) in 1st intervention and 50% (min 20, max 67) after 2nd intervention. After omalizumab reduction, asthma control did not deteriorate and there was no need to increase the omalizumab or OCS-dose. Conclusions. Decreasing the total omalizumab dose does not cause clinical deterioration in ABPA after the disease is controlled.
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Summary: Objective. To estimate economic burden of severe asthma in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods. This cost of illness study was based on identification of per patient annual direct medical costs for the management of sever easthma in Turkey from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations and interventions, drug treatment and equipment, and co-morbidities/complications. Results. Based on total annual per patient costs calculated for outpatient admission ($ 177.91), laboratory and radiological tests ($ 82.32), hospitalizations/interventions ($ 1,154.55), drug treatment/equipment ($ 2,289.63) and co-morbidities ($ 665.39) cost items, total per patient annual direct medical costrelated to management of severe asthma was calculated to be $ 4,369.76 from payer perspective. Drug treatment/equipment (52.4%) was the main cost driver in the management of severe asthma in Turkey, as followed by hospitalizations/interventions (26.4%) and co-morbidities (15.2%). Conclusions. In conclusion, our findings indicate that managing patients with severe asthma pose a considerable burden to health economics in Turkey, with medications as the main cost driver.
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Antiasmáticos/economia , Asma/tratamento farmacológico , Asma/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Adulto , Antiasmáticos/uso terapêutico , Asma/epidemiologia , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Estresse Financeiro , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Índice de Gravidade de Doença , Turquia/epidemiologiaAssuntos
Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/psicologia , COVID-19/complicações , Adulto , Angioedemas Hereditários/epidemiologia , Angioedemas Hereditários/prevenção & controle , Ansiedade/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/psicologia , Danazol/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Ácido Tranexâmico/uso terapêutico , Turquia/epidemiologiaRESUMO
BACKGROUND-OBJECTIVE: Several factors might affect the adherence to treatment in patients with asthma and COPD. Among these factors, the effect of religious beliefs and behaviours has been less studied so far. In this study, the effect of fasting on drug use behaviours of patients with asthma and COPD were comparatively analysed. METHODS: A total of 150 adult patients with asthma and 150 adult patients with COPD were consecutively enrolled into this cross-sectional study. The patients were asked whether they fast during Ramadan and if the answer was yes, they were kindly asked to respond to further questions related to use of inhaled medications during that particular time. RESULTS: The majority of the cases from both groups [98 (65.3%) of asthma patients and 139 (92.6%) of COPD] were fasting during Ramadan. The majority of the patients with COPD (n=126; 90.6%) reported that they quitted their regular therapy basis during Ramadan. On the other hand, the majority of asthma patients used their controller inhaled medications during Ramadan and preferred to use them on iftar and sahur times (n=81, 82.6%). CONCLUSION: Our results showed that in a Muslim population, the patients with asthma and COPD do not feel their diseases to be an inhibitory factor for fasting during Ramadan. However, fasting seems to be an important determining factor in medication compliance by modifying the drug use behaviours in each group in a different way. Therefore, the patients should be informed about the effects of fasting on their disease and the allowed drugs during fasting.
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Asma/tratamento farmacológico , Jejum , Islamismo , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Religião , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , TurquiaRESUMO
BACKGROUND: Asthma symptoms can be triggered by a variety of factors commonly referred to as "triggers". Some of these factors can also induce severe asthma exacerbations. Thus, it can be assumed that actions taken against such triggers may prevent the progression of the disease. However, limited data exist on the clinical importance of these triggers in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To compare the effect of triggers on symptoms and actions taken against certain modifiable triggers in patients with asthma and COPD. METHODS: The study was conducted in a university hospital between June 2009 and June 2010. Patients with asthma and COPD were asked to complete a questionnaire in which both the factors triggering symptoms and the actions taken against several triggers were assessed. RESULTS: Three hundred consecutive adult patients (150 asthma, 150 COPD) were enrolled to the study. The frequency of triggering factors was similar in both groups. Vaccination rates for influenza and pneumococcus were significantly higher in patients with COPD. However, such anti-allergic approaches as the use of strategies to decrease dust exposure, the use of anti-mite bed sheets, and the removal of pets from the home were more commonly employed by asthmatic patients. CONCLUSION: This study revealed that certain triggers affected COPD and asthma patients to the same degree. Therefore, triggers and strategies for controlling modifiable triggers should be more concentrated on during education in both groups. However, the preventive effect of these strategies on disease progression, particularly in patients with COPD, needs clarification.
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Asma/imunologia , Doença Pulmonar Obstrutiva Crônica/imunologia , Adulto , Asma/complicações , Estudos Transversais , Progressão da Doença , Poeira , Exposição Ambiental/efeitos adversos , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Sensitivity and symptoms related to animal proteins have been investigated in various occupational groups. However, data from pet shops are limited. AIMS: To investigate rates of sensitivity to cats and dogs among pet shop workers, to assess the relationship between sensitivity, allergen levels and symptoms and to investigate whether passive transport from pet shops to homes is possible. METHODS: Pet shop workers underwent interviews with a questionnaire adapted from the European Community Respiratory Health Survey. Dust samples for allergen detection were collected from pet shops using a vacuum cleaner. Skin tests were performed with common allergens. Dust samples were also obtained from the houses of 7 workers and 12 control subjects. RESULTS: Fifty-one workers from 20 pet shops were included in the study. Thirteen (25%) workers reported work-related symptoms. Four workers had sensitivity to animal allergens. The mean cat/dog allergen levels from pet shops were 15.7 and 3.2 µg/g, respectively. There was no significant relationship between cat/dog allergen levels and work-related symptoms and sensitivity to pets. None of the dust samples collected from the homes of pet shop workers contained cat allergens. Dog allergen was detected in only one house (0.58 µg/g). Neither cat nor dog allergens were found in the homes of the 12 control subjects. CONCLUSIONS: Although a quarter of pet shop workers reported work-related symptoms, sensitivity to cat and dog was low. These findings suggest that work-related symptoms may be due to other factors than cat and dog sensitivity.
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Poluição do Ar em Ambientes Fechados/efeitos adversos , Alérgenos/imunologia , Alérgenos Animais/imunologia , Hipersensibilidade Imediata/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Adolescente , Adulto , Idoso , Animais , Estudos de Casos e Controles , Gatos , Cães , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Inquéritos e Questionários , Turquia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Although hazelnut consumption is very high in Turkey, the prevalence of hazelnut allergy is still unknown. This study's objective was to investigate the prevalence of hazelnut sensitisation and to verify its clinical importance using double-blind, placebo-controlled challenge (DBPCFC) in an adult population. METHODS: Prick-to-prick skin tests were performed with fresh hazelnut in 904 patients admitted to the allergy department. Among the 904 subjects, 20 patients with a history of allergic reactions to hazelnut and/or positive skin tests were recalled for further evaluation. Specific IgE was measured in these subjects. Eleven (11/20) patients accepted to undergo DBPCFC with hazelnut. RESULTS: Among the 904 individuals, the history of reactions to hazelnut was positive in 16 subjects (1.8%); prick-to-prick skin tests were positive in 13 (1.4%); prick tests with the commercial product were positive in nine (0.9%); and history plus skin tests were positive in 16 (1.8%). Specific IgE to hazelnut was positive in only three patients. DBPCFC was conducted in 11 subjects with a positivity rate of 63.6% (7/11). We observed six mild and one moderate systemic reactions during the DBPCFC. Among seven subjects with a positive DBPCFC, six (85.7%) had a history of hazelnut allergy, and five (71.4%) had both history and skin test positivity. CONCLUSION: Skin test sensitisation to hazelnut was found to be 1.76% (16/904) which is similar to the sensitisation rate in previous reports. However, DBPCFC was positive in 63% of cases with a history of hazelnut allergy and/or positive skin tests in this study. These results indicate that the presence of history with a positive skin test can be suggestive of hazelnut allergy; however an oral food challenge is needed to confirm the diagnosis.
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Alérgenos/imunologia , Corylus/efeitos adversos , Hipersensibilidade a Noz/diagnóstico , Hipersensibilidade a Noz/epidemiologia , Administração Oral , Adolescente , Adulto , Idoso , Alérgenos/efeitos adversos , Feminino , Humanos , Imunização/métodos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Testes Cutâneos , Turquia/epidemiologia , Adulto JovemRESUMO
For the prevention and control of non-communicable diseases (NCD), an action plan on NCDs is intended to support coordinated, comprehensive and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national and regional levels by World Health Organization (WHO). The Global Alliance against Chronic Respiratory Diseases (GARD) is making every attempt to align with WHO's non-communicable diseases action plan. GARD activities have been commenced in over 40 countries and in 11 countries an integrated NCD action plan is being prepared or has already been initiated. This integrated approach of GARD has also targeted to GARD Turkey project. The Turkish Ministry of Health has decided to apply this national control program in conformity with other NCD action plans. This article is intended to summarize these integration efforts of GARD Turkey (the National Control Program on Chronic Airway Diseases) with other NCD national programs.
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Programas Nacionais de Saúde , Doenças Respiratórias/prevenção & controle , Organização Mundial da Saúde , Doença Crônica , Política de Saúde , Humanos , Doenças Respiratórias/patologia , TurquiaRESUMO
The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.2-11.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.3-15.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 12.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.3-11.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.
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Hipersensibilidade/epidemiologia , Adulto , Animais , Animais Domésticos , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Habitação , Humanos , Modelos Logísticos , Masculino , Ocupações , Prevalência , Fatores de Risco , Inquéritos e Questionários , Turquia/epidemiologiaRESUMO
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.
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Política de Saúde , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/prevenção & controle , Organização Mundial da Saúde , Doença Crônica , Humanos , Prevalência , Doenças Respiratórias/patologia , Índice de Gravidade de Doença , Turquia/epidemiologiaAssuntos
Aspergilose Broncopulmonar Alérgica/imunologia , Dermatite Atópica/imunologia , Imunoglobulina E/sangue , Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose Broncopulmonar Alérgica/diagnóstico , Biomarcadores/sangue , Dermatite Atópica/complicações , Dermatite Atópica/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , RecidivaRESUMO
BACKGROUND: Although Gramineae pollens are the main reason for seasonal allergy in many parts of Europe, the influence of regional flora on sensitisation and symptoms has always been a topic of interest. The aim of this study was to document the sensitisation to pollens and to evaluate their clinical importance in patients with seasonal allergic rhinitis living in Ankara/central Anatolia. METHODS: The study included those subjects with seasonal allergic rhinitis living in Ankara. Skin prick testing with a panel of common aeroallergens as well as grass, individual tree and weed pollens predominant in the region was performed. The patients were followed by symptom-medication scores during the same season in which regional pollens were also counted. RESULTS: The final eligible study consisted of 54 subjects (F/M: 26/28; mean age: 29.4 years). Trees were the most common pollen source consisting of 95 % of the total amount, followed by grasses (3 %) and weeds (2 %). Sensitisation to Gramineae, to at least one weed; and to tree pollens were 100 %, 85.2 % and 94.4 %, respectively. The most common positive skin tests among tree pollens were to Oleaceae (59.2 %), Aesculus (57.4 %); and Tilia (42.5 %) despite low pollen counts. Chenopodiaceae (88 %) and Plantago (63 %) were the most sensitised weed pollens, with high pollen counts. All patients had significant symptoms during May and June. CONCLUSION: Although Gramineae pollens seem to be major allergens for seasonal allergic rhinitis in Ankara, the particular role of tree pollens and weed pollens cannot be discarded on symptom development in sensitised patients.
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Alérgenos/imunologia , Pólen/imunologia , Rinite Alérgica Sazonal/epidemiologia , Rinite Alérgica Sazonal/imunologia , Adulto , Feminino , Humanos , Masculino , Prevalência , Testes Cutâneos , Turquia/epidemiologiaRESUMO
BACKGROUND: Apoptosis may be important in limiting airway eosinophilia. Treatment with leukotriene antagonists decreases the number of eosinophils in both peripheral blood and sputum. AIM: To assess the effect of montelukast on eosinophil apoptosis in a group of patients with mild persistent asthma (MPA) and to compare this effect with the apoptotic effect of fluticasone propionate (FP). METHODS: Randomly selected patients with MPA (n = 22) who had not taken anti-inflammatory therapy within the preceding 12 months were included in the study. The sputum induction procedure was performed and the patients were divided into two groups: group 1 (n = 10) received FP 250 microg/day and group 2 (n = 22) received montelukast 10 mg/day orally for 4 weeks. Sputum induction was repeated after the treatment period. The resulting cytospin slides were stained by Wright's stain and morphologic changes in apoptotic eosinophils were assessed by the use of light microscopy by two blinded expert pathologists. Serum soluble Fas ligand (sFasL) concentrations were measured by an ELISA method at baseline and after treatment in both groups, as well as in a group of healthy subjects. RESULTS: In within-group comparisons, the apoptotic ratio (AR) increased at the end of the study period in group 1 (p = 0.05). In the group treated with FP the ratio of sputum eosinophils significantly decreased (p = 0.02), and the AR significantly increased (p < 0.005). No differences were found in the two study groups in serum sFasL levels at the end of the treatment period compared with baseline values (p > 0.05). CONCLUSION: Our findings demonstrate that 4 weeks' treatment with a CysLT receptor antagonist (montelukast) resulted in an increase in eosinophil apoptosis comparable to that produced by FP, suggesting that induction of apoptosis may be a potential mechanism for the mode of action of CysLT receptor antagonists in asthma.
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Acetatos/farmacologia , Antiasmáticos/farmacologia , Apoptose/efeitos dos fármacos , Asma/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Eosinófilos/efeitos dos fármacos , Antagonistas de Leucotrienos/farmacologia , Quinolinas/farmacologia , Escarro/citologia , Acetatos/uso terapêutico , Adulto , Androstadienos/farmacologia , Androstadienos/uso terapêutico , Antiasmáticos/uso terapêutico , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Asma/sangue , Asma/imunologia , Asma/patologia , Ciclopropanos , Eosinofilia/sangue , Eosinofilia/imunologia , Eosinofilia/patologia , Eosinófilos/patologia , Proteína Ligante Fas , Feminino , Fluticasona , Volume Expiratório Forçado , Humanos , Antagonistas de Leucotrienos/uso terapêutico , Masculino , Glicoproteínas de Membrana/sangue , Pessoa de Meia-Idade , Variações Dependentes do Observador , Quinolinas/uso terapêutico , Método Simples-Cego , Sulfetos , Resultado do TratamentoRESUMO
BACKGROUND: The efficacy of therapy with sublingual allergen extracts is unproven. OBJECTIVE: To evaluate the clinical and immunologic outcome of sublingual immunotherapy and to compare the results with subcutaneous immunotherapy and placebo in 36 patients with rhinitis and asthma due to mite allergy. METHOD: Thirty-six patients with rhinitis and asthma due to mite allergy were randomly divided into three groups in order to receive subcutaneous injections with allergenic extracts, sublingual drops with solutions of purified standardized allergen preparations, or sublingual placebo for a period of 1 year. Assessment of clinical and immunologic efficacy included symptom and medication scores, methacholine provocation tests, skin prick tests, and specific IgE and IgG4 antibody concentrations. RESULTS: Subcutaneous immunotherapy for both rhinitis and asthma was clinically effective. Patients treated with sublingual immunotherapy had decreased rhinitis symptoms (P < .01) but no change in asthma scores. Medication scores significantly decreased in both actively treated groups (P < .01) at the first year compared with baseline. When skin prick tests were evaluated, the subcutaneously treated group had a significant decrease in the wheal diameter of D. pteronyssinus (P < .01), D. farinae (P < .05), and histamine (P < .05) while other two groups showed no difference. There was no significant change in methacholine PC20 values in all groups at the end of the first year when compared with baseline. No change in D. pteronyssinus and D. farinae specific IgE levels were observed; however, specific IgG4 concentrations were significantly higher than baseline both in sublingual and subcutaneous immunotherapy groups (P < .05) after 1 year immunotherapy. No significant difference was obtained in any of these parameters in the placebo group. CONCLUSION: Sublingual immunotherapy may be effective in patients with allergic rhinitis. Further, we believe it is a potential therapy for allergic asthmatic patients. The clinical usefulness of this form of immunotherapy (when administered to larger study groups for a longer time) and the mechanisms underlying its immunologic effect deserve additional studies.
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Asma/imunologia , Imunoterapia , Ácaros/imunologia , Rinite/imunologia , Administração Cutânea , Administração Sublingual , Adolescente , Adulto , Animais , Testes de Provocação Brônquica , Epitopos , Feminino , Humanos , Hipersensibilidade/complicações , Imunização , Imunoglobulina E/imunologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Patients with asthma incur the risk of steroid-induced myopathy, which is a well-known side effect of treatment with corticosteroids. However, the adverse effect of long-term steroid treatment on respiratory muscle function remains controversial. OBJECTIVE: We aimed to evaluate the effects of long-term moderate dose of systemic corticosteroids and high-dose inhaled beclomethasone on maximal inspiratory and expiratory pressures (PImax and PEmax, respectively) in two groups of asthmatic patients exhibiting comparable levels of hyperinflation. METHODS: Twelve steroid-dependent asthmatic patients requiring 10-20 mg/day of prednisone-equivalent corticosteroids for an average of 9.83 +/- (SD) 9.86 years; 14 subjects with moderate to severe asthma who have used inhaled beclomethasone for at least 1 year at a daily dose higher than 1,000 microg and 15 healthy controls were included to the study. RESULTS: No significant difference in pulmonary function tests and arterial blood gases appeared between two asthmatic groups with different treatment modalities. PImax as an absolute value was significantly lower in steroid-dependent asthmatics than in patients treated with inhaled beclomethasone and controls (p < 0.01). %PImax was also lower in steroid-dependent asthmatics than in control groups (p < 0.01). A significant correlation was found between %PImax and hyperinflation assessed by %RV, %FRC, %FRC/TLC (p < 0.05) in all asthmatic patients. CONCLUSIONS: We believe that hyperinflation plays a major role in inspiratory muscle dysfunction in asthma, but the finding of significantly decreased PImax values in steroid-dependent asthmatics when compared with patients on high-dose inhaled beclomethasone with a comparable level of hyperinflation points to a deleterious effect of long-term, moderate-dose systemic corticosteroid but not high-dose beclomethasone on inspiratory muscle function in asthmatics.
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Anti-Inflamatórios/efeitos adversos , Asma/tratamento farmacológico , Doenças Musculares/induzido quimicamente , Músculos Respiratórios/efeitos dos fármacos , Administração por Inalação , Adulto , Anti-Inflamatórios/administração & dosagem , Asma/fisiopatologia , Beclometasona/administração & dosagem , Beclometasona/efeitos adversos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Seasonal exposure to pollens causes the characteristic symptoms of respiratory allergy as well as an increase in specific IgE levels and inflammatory mediator release. However, little is known about the effect of natural allergen exposure on the skin test reactivity of patients with seasonal allergy. OBJECTIVE: The aim of this study was to investigate the monthly variation in skin test reactions with pollen allergens during pollen season and its relation to pollen counts. METHODS: Fifteen subjects with seasonal allergic rhinitis and/or asthma (4 male, 11 female) between the ages of 13 and 52 (mean 33.9 +/- 2.9) who lived in Ankara, Turkey were selected for this study. Patients were monitored from the beginning of March to the end of September 1997, and skin prick tests were performed using 5 grass, 12 tree, and 5 weed pollen allergen extracts every month. Atmospheric pollen grains were counted in the Ankara area between January and December, 1997. RESULTS: There were small but statistically significant increases in tree pollen-induced wheal sizes in May when compared with other months (P < 0.05). Skin test reactivity was correlated with tree pollen counts (r = 0.978, P < 0.05). There was not a significant difference in skin test reactivity to grass and weed pollens between months. CONCLUSIONS: Although skin test reactivity may be slightly greater to tree pollen during the tree pollen season, the timing of skin testing is not a critical determinant in patients with pollen allergy.
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Pólen/imunologia , Rinite Alérgica Sazonal/diagnóstico , Testes Cutâneos/métodos , Adolescente , Adulto , Alérgenos , Exposição Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estações do Ano , Árvores/imunologiaRESUMO
The rise in allergic disorders over the past three decades has been suggested to be related to the decrease in infectious diseases. Recently, a negative association between tuberculin responses and atopic disorders has also been reported. We planned to investigate the effect of natural exposure to Mycobacterium tuberculosis on atopic status in patients with active tuberculosis and to compare the findings with the data of patients with inactive disease. A total of 97 subjects were divided into two groups. Group 1, patients with proven active pulmonary tuberculosis (n = 66); group 2, subjects who had a history of previous tuberculous disease, with negative bacteriologic studies and no clinical and/or roentgenographic evidence of current disease (n = 31). Current history of allergic diseases was recorded by a physician with the use of a questionnaire adapted from the European Community Respiratory Health Survey (ECRHS), and skin-prick tests (SPTs) were performed using a standardized panel. Total IgE and Phadiatop were measured by the Pharmacia uniCAP system. The rate of one or more positive SPTs was significantly lower in the patients with active tuberculosis than the inactive group (15% versus 48.4%, p < 0.001). The current history of atopic diseases was 7.6% and 29% in the active and inactive tuberculosis groups, respectively (p = 0.002). The rate of positive skin tests to inhalant allergens in patients with inactive disease was higher than the rate of healthy adult Turkish people (48.4% versus 25%, p = 0.001). Geometric mean of total IgE levels were lower in patients with inactive disease than patients with active pulmonary tuberculosis (74.97 kU/L versus 106.3 kU/L, p = 0.05). The ratios of Phadiatop positivity were 21% and 38.7% in the active and inactive tuberculosis groups, respectively (p = 0.008). We found lower atopy rates in patients with active pulmonary tuberculosis than subjects with inactive disease. Although our data support the hypothesis that M. tuberculosis may prevent the development of atopic disorders by inducing the production of cytokines antagonistic to Th2 development, we believe prospective and experimental studies are needed before attributing a direct cause-effect link to this association.
Assuntos
Hipersensibilidade Imediata/imunologia , Tuberculose/imunologia , Doença Aguda , Adulto , Alérgenos/imunologia , Fatores de Confusão Epidemiológicos , Feminino , Humanos , Hipersensibilidade Imediata/epidemiologia , Imunoglobulina E/sangue , Masculino , Prevalência , Fatores de Risco , Testes Cutâneos , Inquéritos e Questionários , Tuberculina/imunologia , Tuberculose/epidemiologia , Turquia/epidemiologiaRESUMO
BACKGROUND: Although the role of inhaled fungi in inducing asthma has been repeatedly confirmed, there are few reports about the association of asthma with dermatophyte sensitivity and the causal role of Trichophyton allergy in asthma. The objective was to investigate the presence of Trichophyton sensitivity among patients with allergic and nonallergic asthma in combination with tinea, and to compare the situation with several control groups in order to evaluate the factors determining Trichophyton sensitivity. METHODS: A total of 86 subjects (55 female, 31 male) with a mean age of 38.6 +/- 11.1 years were included in the study. The patients were divided into five groups: 1) nonallergic asthma plus tinea (n = 19) 2) allergic asthma plus tinea (n = 15) 3) asthma without tinea (n = 22) 4) tinea without asthma (n = 17) 5) healthy controls (n = 13). Skin tests with standardized extracts of T. rubrum and specific IgE measurements were performed in all subjects. All patients were also subjected to microscopic evaluation and fungal culture for dermatophyte infection. RESULTS: The skin test positivity rate to Trichophyton extract of groups 1 (63.1%), 2 (46.7%), and 4 (47.1%) was higher than that in groups 3 (4.4%) and 5 (7.7%) (P < 0.05). Although not significant, the rates of sensitivity to T. rubrum (63.1%) and of severe asthma (31.6%) were higher in the group with nonallergic asthma with tinea (group 1) than in other groups. Among 51 patients in whom direct microscopic evaluation revealed dermatophyte infection, 60.8% had positive fungal cultures for T. rubrum (58.1%), T. mentagrophytes (35.5%), and Candida (6.4%). CONCLUSION: According to our data, the presence of fungal infection seems to be an important determinant in hypersensitivity to Trichophyton whether or not the subject is asthmatic and/or allergic. Since a greater proportion of patients with nonallergic asthma--in whom the rate of severe asthma was also higher - showed positive skin tests to Trichophyton extracts in this study, we believe that patients with severe, intrinsic asthma should be examined for signs of fungal infection and tested to determine immediate hypersensitivity to dermatophyte antigens.
Assuntos
Asma/complicações , Asma/etiologia , Hipersensibilidade/complicações , Tinha/etiologia , Trichophyton/imunologia , Adulto , Intervalos de Confiança , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Risco , Índice de Gravidade de Doença , Testes Cutâneos/métodos , Tinha/complicaçõesRESUMO
Asthma is a disease characterized by chronic airway inflammation. Generation of oxygen free radicals by activated inflammatory cells produces many of the pathophysiologic changes associated with asthma and may contribute to its pathogenesis. However, the activities of antioxidant enzymes and their relation with asthma have not been well defined. This study was performed to examine the activities of major intracellular antioxidants in mild asthmatic patients. Twelve asymptomatic mild asthmatic patients who never used any antiasthma medication and 13 age- and sex-matched healthy control subjects were selected. The activities of erythrocyte antioxidant enzymes, superoxide dismutase (SOD), catalase (CAT), and glutathione-peroxidase (GSH-Px) were measured spectrophotometrically. The mean SOD activity of asthmatic patients was found to be significantly lower than that of the controls (p < 0.05). There was no significant difference in CAT and GSH-Px activities between patients and controls (p > 0.05). Although the mechanisms underlying the association between asthma and antioxidant system are unclear, according to our findings, decreased antioxidant protection may contribute to the pathogenesis of mild asthma.