Although in textbooks asthma and chronic obstructive pulmonary disease (COPD) are viewed as disti... more Although in textbooks asthma and chronic obstructive pulmonary disease (COPD) are viewed as distinct disorders, there is increasing awareness that many patients have features of both. This article reviews the asthma-COPD overlap syndrome.
Introduction Current guidelines focus more on levels of asthma control than on severity of asthma... more Introduction Current guidelines focus more on levels of asthma control than on severity of asthma. The original version of the Asthma Control Test (ACT), a self-administered instrument to determine asthma control levels, was designed for English-speaking patients. More recently, the ACT has been translated into many languages and has been validated for many cultures, but this is the first study to evaluate the Turkish version. Purpose We aimed to evaluate the reliability, validity, and responsiveness of the Turkish version of the ACT among outpatients with asthma. Method This multicenter prospective study included 220 asthma patients in outpatient clinics in Turkey. The ACT was completed at admission (Visit 1), after 10 ± 2 days (Visit 2), and at 5 ± 1 weeks (Visit 3). At each visit, physicians assessed patients’ asthma control levels. Results The Turkish version of the ACT showed an internal consistency reliability of 0.84 (Cronbach’s alpha). Test‐retest reliability was 0.85 in stable patients. There was a significant correlation between the ACT and physicians’ assessments at admission (r = 0.68, p \ 0.001). The AUC was 0.91, with a sensitivity of 89.06 % and a specificity of 78.26 % for a score of B19 for screening ‘‘uncontrolled’’ asthma. A minimally important difference of three points on the ACT was consistent with the GINA physician assessment scores between the baseline and the follow-up visits. Conclusion The Turkish version of the ACT is a valid and reliable tool for assessing asthma control in patients in outpatient settings. The test may facilitate the designation of asthma patients’ symptoms as either controlled or uncontrolled.
We evaluated the frequency of exacerbations and hospitalizations in chronic obstructive pulmonary... more 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.
Objectives: The aim of this study was to evaluate factors affecting the usage of continuous posit... more 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.
Environmental tobacco smoke (ETS) has been regarded as one of the most important public health is... more Environmental tobacco smoke (ETS) has been regarded as one of the most important public health issues. It has been estimated that approximately 75% of Turkish children are exposed to ETS. In this study the parental smoking habits were determined. Then, the relationship between parent-reported estimates of children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exposure to ETS in the home and children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s urinary cotinine levels was examined. According to the reports of parents, 57.8% of the fathers and 23.3% of the mothers were current smokers, 69.8% of the children came from homes with smokers, and 53.4% had daily exposure to ETS. Urinary cotinine levels were significantly higher in the exposed group than the nonexposed group. This data showed that ETS exposure was prevalent and a combination of a parent-report and a biological measures is suggested as the most informative estimate of ETS exposure in children.
Background and AimsTo evaluate asthma phenotypes in patients with asthma from different regions o... more Background and AimsTo evaluate asthma phenotypes in patients with asthma from different regions of Turkey.MethodsA total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011–January 2012.ResultsThe disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P &lt; 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P &lt; 0.01). Uncontrolled asthmatics have more severe disease (P &lt; 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P &lt; 0.01). Chronic rhino‐sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P &lt; 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P &lt; 0.05).ConclusionIn conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes.
OBJECTIVE Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specif... more OBJECTIVE Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5 and has anti-inflammatory effects. The aim of the study was to evaluate the effects of sildenafil on smoke-induced lung inflammation. MATERIAL AND METHODS Twenty-nine Wistar-Albino rats were enrolled into 3 groups as control, smoker and sildenafil groups. Smoker and sildenafil groups were exposed to cigarette smoke for 2 hours per day for 8 weeks. Sildenafil 10 mg/kg/day was administered to the sildenafil group by nasogastric lavage after smoke exposure. The degree of lung inflammation was scored histopathologically for each group. RESULTS The inflammation score was 7.25±0.93 in the control group, 8.18±1.21 in the smoker group and 7.08±1.66 in the sildenafil group. There was a non-significant decrease of inflammation score in sildenafil group with respect to control or smoker groups. While there was no significant difference of oedema, hyperemia, hemorrhage and m...
Although in textbooks asthma and chronic obstructive pulmonary disease (COPD) are viewed as disti... more Although in textbooks asthma and chronic obstructive pulmonary disease (COPD) are viewed as distinct disorders, there is increasing awareness that many patients have features of both. This article reviews the asthma-COPD overlap syndrome.
Introduction Current guidelines focus more on levels of asthma control than on severity of asthma... more Introduction Current guidelines focus more on levels of asthma control than on severity of asthma. The original version of the Asthma Control Test (ACT), a self-administered instrument to determine asthma control levels, was designed for English-speaking patients. More recently, the ACT has been translated into many languages and has been validated for many cultures, but this is the first study to evaluate the Turkish version. Purpose We aimed to evaluate the reliability, validity, and responsiveness of the Turkish version of the ACT among outpatients with asthma. Method This multicenter prospective study included 220 asthma patients in outpatient clinics in Turkey. The ACT was completed at admission (Visit 1), after 10 ± 2 days (Visit 2), and at 5 ± 1 weeks (Visit 3). At each visit, physicians assessed patients’ asthma control levels. Results The Turkish version of the ACT showed an internal consistency reliability of 0.84 (Cronbach’s alpha). Test‐retest reliability was 0.85 in stable patients. There was a significant correlation between the ACT and physicians’ assessments at admission (r = 0.68, p \ 0.001). The AUC was 0.91, with a sensitivity of 89.06 % and a specificity of 78.26 % for a score of B19 for screening ‘‘uncontrolled’’ asthma. A minimally important difference of three points on the ACT was consistent with the GINA physician assessment scores between the baseline and the follow-up visits. Conclusion The Turkish version of the ACT is a valid and reliable tool for assessing asthma control in patients in outpatient settings. The test may facilitate the designation of asthma patients’ symptoms as either controlled or uncontrolled.
We evaluated the frequency of exacerbations and hospitalizations in chronic obstructive pulmonary... more 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.
Objectives: The aim of this study was to evaluate factors affecting the usage of continuous posit... more 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.
Environmental tobacco smoke (ETS) has been regarded as one of the most important public health is... more Environmental tobacco smoke (ETS) has been regarded as one of the most important public health issues. It has been estimated that approximately 75% of Turkish children are exposed to ETS. In this study the parental smoking habits were determined. Then, the relationship between parent-reported estimates of children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exposure to ETS in the home and children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s urinary cotinine levels was examined. According to the reports of parents, 57.8% of the fathers and 23.3% of the mothers were current smokers, 69.8% of the children came from homes with smokers, and 53.4% had daily exposure to ETS. Urinary cotinine levels were significantly higher in the exposed group than the nonexposed group. This data showed that ETS exposure was prevalent and a combination of a parent-report and a biological measures is suggested as the most informative estimate of ETS exposure in children.
Background and AimsTo evaluate asthma phenotypes in patients with asthma from different regions o... more Background and AimsTo evaluate asthma phenotypes in patients with asthma from different regions of Turkey.MethodsA total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011–January 2012.ResultsThe disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P &lt; 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P &lt; 0.01). Uncontrolled asthmatics have more severe disease (P &lt; 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P &lt; 0.01). Chronic rhino‐sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P &lt; 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P &lt; 0.05).ConclusionIn conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes.
OBJECTIVE Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specif... more OBJECTIVE Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5 and has anti-inflammatory effects. The aim of the study was to evaluate the effects of sildenafil on smoke-induced lung inflammation. MATERIAL AND METHODS Twenty-nine Wistar-Albino rats were enrolled into 3 groups as control, smoker and sildenafil groups. Smoker and sildenafil groups were exposed to cigarette smoke for 2 hours per day for 8 weeks. Sildenafil 10 mg/kg/day was administered to the sildenafil group by nasogastric lavage after smoke exposure. The degree of lung inflammation was scored histopathologically for each group. RESULTS The inflammation score was 7.25±0.93 in the control group, 8.18±1.21 in the smoker group and 7.08±1.66 in the sildenafil group. There was a non-significant decrease of inflammation score in sildenafil group with respect to control or smoker groups. While there was no significant difference of oedema, hyperemia, hemorrhage and m...
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