Arzu Yorgancioglu

Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium.

RATIONALE Indacaterol is the first once-daily, long-acting inhaled beta(2)-agonist bronchodilator studied in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVES To demonstrate greater efficacy of indacaterol versus placebo on FEV(1) at 24 hours post dose (trough) after 12 weeks, to compare efficacy with placebo and tiotropium, and to evaluate safety and tolerability over 26 weeks. MEASUREMENTS Patients with moderate-to-severe COPD were randomized to double-blind indacaterol 150 or 300 microg or placebo, or open-label tiotropium 18 microg, all once daily, for 26 weeks. The primary efficacy outcome was trough FEV(1) at 12 weeks. Additional analyses (not adjusted for multiplicity) included transition dyspnea index (TDI), health status (St Georges Respiratory Questionnaire [SGRQ]), and exacerbations. Serum potassium, blood glucose, and QTc interval were measured. RESULTS A total of 1,683 patients (age, 63.3 yr; post-bronchodilator FEV(1), 56% predicted; FEV(1)/FVC, 0.53) were randomized to the four treatment arms. Trough FEV(1) at Week 12 increased versus placebo by 180 ml with both indacaterol doses and by 140 ml with tiotropium (all P < 0.001 vs. placebo). At Week 26, for indacaterol 150/300 microg, respectively, versus placebo, TDI increased (1.00/1.18, P < 0.001) and SGRQ total score decreased (-3.3/-2.4, P < 0.01); corresponding results with tiotropium were 0.87 (P < 0.001) for TDI and (-1.0, P = not significant) for SGRQ total score. The incidence of adverse events, low serum potassium, high blood glucose, and prolonged QTc interval was similar across treatments. CONCLUSIONS Indacaterol was an effective once-daily bronchodilator and was at least as effective as tiotropium in improving clinical outcomes for patients with COPD. Clinical trial registered with clinicaltrials.gov (NCT 00463567).

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008

J. Bousquet, N. Khaltaev, A. A. Cruz, J. Denburg, W. J. Fokkens, A. Togias, T. Zuberbier, C. E. Baena-Cagnani, G. W. Canonica, C. van Weel, I. Agache, N. A t-Khaled, C. Bachert, M. S. Blaiss, S. Bonini, L.-P. Boulet, P.-J. Bousquet, P. Camargos, K.-H. Carlsen, Y. Chen, A. Custovic, R. Dahl, P. Demoly, H. Douagui, S. R. Durham, R. Gerth van Wijk, O. Kalayci, M. A. Kaliner, Y.-Y. Kim, M. L. Kowalski, P. Kuna, L. T. T. Le, C. Lemiere, J. Li, R. F. Lockey, S. Mavale-Manuel , E. O. Meltzer, Y. Mohammad, J. Mullol, R. Naclerio, R. E. O Hehir, K. Ohta, S. Ouedraogo, S. Palkonen, N. Papadopoulos, G. Passalacqua, R. Pawankar, T. A. Popov, K. F. Rabe, J. Rosado-Pinto, G. K. Scadding, F. E. R. Simons, E. Toskala, E. Valovirta, P. van Cauwenberge, D.-Y. Wang, M. Wickman, B. P. Yawn, A. Yorgancioglu, O. M. Yusuf, H. Zar Review Group: I. Annesi-Maesano, E. D. Bateman, A. Ben Kheder, D. A. Boakye, J. Bouchard, P. Burney, W. W. Busse, M. Chan-Yeung, N. H. Chavannes, A. Chuchalin, W. K. Dolen, R. Emuzyte, L. Grouse, M. Humbert, C. Jackson, S. L. Johnston, P. K. Keith, J. P. Kemp, J.-M. Klossek, D. Larenas-Linnemann, B. Lipworth, J.-L. Malo, G. D. Marshall, C. Naspitz, K. Nekam, B. Niggemann, E. Nizankowska-Mogilnicka, Y. Okamoto, M. P. Orru, P. Potter, D. Price, S. W. Stoloff, O. Vandenplas, G. Viegi, D. Williams

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross‐sectional questionnaire‐based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86–0.99) and wheezing (OR: 0.93, CI: 0.87–0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53‐fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08–1.33; OR: 1.21, CI: 1.09–1.34; and OR: 1.32, CI: 1.21–1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country‐specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults

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.

AIRWAYS-ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation

Chronic respiratory diseases (CRDs) are major non-communicable diseases (NCDs) [1, 2] that induce a significant burden. Asthma often occurs along the life cycle from early childhood, affecting 30 million children and adults under 45 years of age in Europe [3]. Chronic obstructive pulmonary disease (COPD) has an estimated annual death rate of over 3 million people globally [1, 2]. The annual direct and indirect costs in the 28 European Union (EU) countries due to COPD or asthma are estimated at 48 billion euros and 34 billion euros respectively [3]. Rhinitis occurs in over 100 million people in Europe, and indirect costs are enormous [4]. Asthma is a common risk factor for COPD [5, 6]. CRDs impact ageing and should be prevented, recognised and managed across the life cycle to promote active and healthy ageing (AHA). There is an urgent need to act globally. AIRWAYS-ICPs is a European Union initiative on multi-sectoral care pathways for chronic respiratory diseases http://ow.ly/Yndtw

The “physician on call patient engagement trial” (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients

In this prospective, multicenter, randomized, controlled, double‐blind study, we investigated the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis (AR) and asthma patients.

Relation between quality of life and morbidity and mortality in COPD patients: Two-year follow-up study.

ABSTRACT Quality of life (QoL) is being recognized as an important outcome when evaluating chronic obstructive pulmonary disease (COPD) patients. This study aims at identifying the relation between QoL parameters and mortality and morbidity in COPD patients by using the St. George Respiratory Questionnaire (SGRQ). In this prospective study, 251 COPD patients as defined by American Thoracic Society (ATS) criteria were included. A total of 218 patients (86.85%) were male and mean age was 65.55 years. A pulmonary function test (PFT) and SGRQ were performed at the beginning, first, and second years. During a two-year follow-up, the first exacerbation day, the number of exacerbations and intubations, the number and duration of hospitalizations, hospitalizations in an intensive care unit, and exitus day were recorded. When the correlation between FEV1, SGRQ scores, and these parameters was investigated, there was significant correlation between these parameters, and this correlation was more significant in SGRQ scores than FEV1 (Pearson correlation test). The activity score of SGRQ was found to be more useful than other scores (Cox regression analysis). Not only PFT but also QoL questionnaires are useful in determining the prognosis of COPD. QoL questionnaires provide a valid and standardized estimate of the overall impact of COPD, and can complement spirometric measurements of baseline assessment of patients in routine practice.

The Global Alliance against Respiratory Diseases (GARD) Country Report

The Global Alliance against Respiratory Diseases (GARD) is a network led by the World Health Organization (WHO), which aims to raise the recognition of the importance of chronic respiratory diseases (CRDs) as one of the most important health problems globally . GARD member countries develop activities against CRD to meet the needs of their own country . This paper aims to evaluate the ongoing activities in member countries while emphasizing the importance of CRDs.

Relationship between BODE index, quality of life and inflammatory cytokines in COPD patients

Background and aimsRecently a multidimensional grading system based on the body mass index (B), degree of airflow obstruction (O), dyspnea (D) and exercise capacity (E) - the BODE index - has begun to be used increasingly for the evaluation of chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to investigate the relationship between the BODE index and disease duration, annual exacerbation and hospitalization rates, health related quality of life and systemic inflammatory markers like C-reactive protein (CRP), tumor necrosis factor (TNF)-α and interleukin (IL)-8.Materials and methodsIn 88 stable COPD patients we evaluated the body-mass index, pulmonary function tests, Modified Medical Research Council dyspnea scale and six-minute walk test (6 MWT). BODE scores were determined. Disease duration, number of exacerbations and hospitalization in the previous year were recorded. We also performed arterial blood gases analysis, administered the St. Georges Respiratory Questionnaire (SGRQ) and measured serum levels of CRP, TNF-α, IL-8.ResultsAccording to BODE score 52% of patients were BODE 1, 21% BODE 2, 15% BODE 3 and 12% were BODE 4. There was a significant relationship between BODE index and COPD stage as classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (p < 0.001). Correlations between BODE score and disease duration (p = 0.011), number of exacerbations (p < 0.001) and hospitalizations (p < 0.001) in the last year were also observed. SGRQ symptom, activity, emotion scores and total scores were found to be significantly correlated to BODE (p < 0.001). Serum CRP levels and BODE were also correlated (p = 0.014); however, no correlation was found between serum levels of TNF-α and IL-8 and BODE.ConclusionsAs the BODE index shows a strong correlation with various prognostic and follow up parameters of COPD and systemic inflammation, its use should be considered for the evaluation of COPD patients.RiassuntoRazionale e scopiNella valutazione dei pazienti con broncopneumopatia cronica ostruttiva (BPCO) è recentemente invalso l’uso in modo crescente di un sistema multidimensionale di misura basato su indice di massa corporea (B), entità dell’ostruzione funzionale respiratoria (O), dispnea (D) e capacità di esercizio fisico (E): l’indice BODE. Scopo del nostro studio era valutare la correlazione tra l’indice BODE e la storia di malattia, il numero di riacutizzazioni annue e il tasso di ospedalizzazioni, la qualità della vita legata alla salute e marker infiammatori sistemici come la proteina C reattiva (PCR), il fattore di necrosi tumorale (TNF)-α e l’interleuchina (IL)-8.Materiali e metodiAbbiamo valutato in 88 pazienti con BPCO stabile l’indice di massa corporea, le prove di funzionalità respiratoria, la scala Modified Medical Research Council della dispnea ed il test del cammino di 6 minuti (6MWT). Sono stati calcolati i punteggi BODE. Sono state registrate la durata della malattia, il numero di riacutizzazioni e di ospedalizzazioni nell’anno precedente. Inoltre sono state effettuate l’emogasanalisi, il St. George’s Respiratory Questionnaire (SGRQ) e determinati i livelli serici di PCR, TNF-α e IL-8.RisultatiSecondo il punteggio BODE 52% dei pazienti erano BODE 1, 21% BODE 2, 15% BODE 3 e 12% erano BODE 4. La correlazione era significativa (p < 0,001) tra indice BODE e stadio della BPCO determinato secondo la stadiazione del Global Initiative for Chronic Obstructive Lung Disease (GOLD). Erano significative anche le correlazioni tra punteggio BODE e durata di malattia (p = 0,011), numero di riacutizzazioni (p < 0,001) e ospedalizzazioni (p < 0,001) nell’ultimo anno. Il punteggio totale del SGRQ e dei campi sintomi, attività e emozioni era significativamente correlato al BODE (p < 0,001). Anche i livelli serici di PCR e il BODE erano correlati (p = 0,014), mentre non si è rilevata alcuna correlazione tra TNF-α e IL-8 con il BODE.ConclusioniDal momento che l’indice BODE mostra una forte correlazione con vari indici di prognosi, di follow up ed infiammatori nella BPCO, una sua applicazione sistematica dovrebbe essere presa in considerazione nella valutazione dei pazienti con BPCO.

Pulmonary function parameters in patients with diabetes mellitus

This study is th e preliminary report of a multicentric study conducted to evaluate the possible association between the microvascular complications of diabetes mellitus (DM) and changes in pulmonary functions. 30 non-smoking diabetics having no overt pulmonary or cardiac disease were included. Glycosylated hemoglobin (HbA 1c) levels were determined, ophthalmologic examination for diabetic retinopathy was done and microalbuminuria (MAU) was measured in order to evaluate diabetic nephropathy. Pulmonary function tests, including the assessment of diffusing capacity [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), FEV1% predicted (FEV 1 %), forced expiratory flow in 25-75% of vital capacity (FEF 2575), carbon monoxide diffusing capacity (DLCO) alveolar volume (VA), DLCO/VA] were performed. The mean age (66.7% male) was 54‐9.97yr. Nine patients (30 %) had had DM for more than 10 years. 19 cases (62%) had high HbA 1c levels (over 7%), 18 (60%) had a body mass index (BMI) over 27.5 kg/m 2 . 70% of patients were using oral antidiabetics (OAD). Diabetic retinopathy was found and degreed in 46.7% of cases. The patient population, subdivided according to HbA 1c levels, BMI, type of treatment, retinal findings, duration of DM, microalbuminuria and pulmonary parameters, was compared; statistical analysis was done by SPSS program using Pearson correlation tests. No statistical difference was found between any of these subgroups (p> 0.05). So, a possible association between diabetic microvascular pathology and pulmonary functional changes was not detected, this is thought to be due to the insufficient number of patients.