Aydanur Ekici

Effect of Azithromycin on the Severity of Bronchial Hyperresponsiveness in Patients with Mild Asthma

The effect of azithromycin on bronchial hyperresponsiveness was measured in a group of 11 patients with mild asthma. Azithromycin 250 mg orally was administered intermittently to all the patients twice a week for eight weeks. The only other treatment was inhaled β2 agonist, when required. A histamine inhalation test was performed at the beginning and at the fourth and the eighth week of the study. The mean PC20 values increased significantly over the initial value at the eighth week after the administration of azithromycin (p < 0.05) but mean values for FEV1 and FEV1 percent predicted did not differ significantly. These results suggested that eight weeks of intermittent, low-dose administration of azithromycin in patients with mild asthma might reduce the severity of bronchial hyperresponsiveness.

Perception of Bronchoconstriction in Elderly Asthmatics

The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37; group 2, ≥ 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma 1A and 2A, < 5 years, early-onset asthma 1B and 2B, ≥ 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in 1 sec (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 ± 0.17; group 2, PS20 = 1.37 ± 0.12; p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (1A, 2.63 ± 0.30 and IB, 2.07 ± 0.16; p = 0.101; 2A, 1.36 ± 0.19 and 2B, 1.59 ± 0.120; p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and %FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly asthmatics perceive less intense respiratory distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly asthmatic patients should be followed up more frequently and closely.

Effect of chronic diseases and associated psychological distress on health-related quality of life.

Background: The purpose of this study was to clarify the correlations between the presence of comorbidities and psychological distress and health‐related quality of life (HRQL). This was a population‐based cross‐sectional study.

Evaluation and impact of chronic cough: comparison of specific vs generic quality-of-life questionnaires.

BACKGROUND Chronic cough is a common condition that has a significant impact on health-related quality of life (HRQoL). OBJECTIVE To investigate whether chronic cough is associated with adverse psychological and physical effects on quality of life (QoL) using different HRQoL questionnaires. METHODS Forty patients were recruited for the study. The diagnostic workup was mainly based on the pathogenic triad in chronic cough: postnasal drip syndrome, asthma, and gastroesophageal reflux disease. The HRQoL was evaluated with the cough-specific quality-of-life questionnaire (CQLQ), Leicester Cough Questionnaire (LCQ), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale. RESULTS Symptom scores were significantly correlated with the CQLQ and LCQ (beta = .415 and beta = -.272, respectively) but not with the SF-36. A statistically significant difference was found in all questionnaires, except the physical component summary domain of the SF-36, after specific therapy. Correlation between the 2 specific HRQoL questionnaires was moderate to high when pretreatment and posttreatment scores were compared (r = -0.42 and r = -0.60). Concurrent validity of the LCQ was higher than the CQLQ when compared with the SF-36 domains. The effect size of each specific QoL questionnaire was 1 or higher after treatment, whereas it was much less in the SF-36. There was no change in depression with treatment despite anxiety. Posttreatment symptom scores were related with anxiety (r > 0.40) CONCLUSIONS Because HRQoL is important to patients, a cough-specific HRQoL instrument, either the CQLQ or LCQ, should be routinely used to optimally evaluate the impact of cough on patients and to evaluate the efficacy of cough-modifying agents.

Negative mood and quality of life in patients with asthma

The aim of this study was to evaluate the effect of negative mood states at the moment of questionnaire, and other patient and disease characteristics on quality of life (QoL) in patients with asthma. The study groups were composed of 116 stable adult asthmatic patients and 116 age and sex matched healthy subjects. We used Short-Form Health Survey-36 (SF-36) for the assessment of general QoL in all participants, and the Asthma Quality of Life Questionnaire (AQLQ) for the assessment of disease specific QoL in patients with asthma. We evaluated negative mood in all subjects with a questionnaire including six mood subscales in three categories (nervous-anxious, hostile-angry and fearful-panicky). Negative mood scores were not different between asthmatic and comparison groups (p=0.4), but both SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were significantly lower in asthmatic group (p=0.003 and p=0.001, respectively). Multiple linear regression analysis in all study population indicated that both reduced PCS and MCS scores of SF-36 were associated with negative mood score (β=−0.28, p<0.001 and β=−0.37, p<0.001, respectively) and with FEV1% (β=0.19, p=0.001 and β=0.25, p<0.001, respectively) after adjusting for age, female sex, and the presence of asthma. On the other hand, multiple linear regression analysis in patients with asthma revealed that negative mood score and disease severity score were significant predictors for overall score of AQLQ after adjusting for other patient and disease characteristics (β=−0.17, p=0.008 and β=−0.64, p<0.001, respectively). The level of negative mood and disease severity in asthmatics significantly impair QoL. Thus, considering that one of the main objectives of health care should be preserving a satisfactory QoL in asthmatics, the presence and seriousness of negative mood and their effects on QoL should be taken into account as part of the clinical evaluation in asthmatics.

Chronic Airway Diseases in Adult Life and Childhood Infections

Background: Respiratory disorders in childhood may predispose to pulmonary disease in late adult life. Objectives: The aim of this study was to evaluate the relationship between their effects in adult life and the characteristics of the respiratory system in childhood. Methods: A total of 10,224 parents and grandparents of students from 14 randomly selected primary schools in the city center were asked to answer questionnaires given to their children. 9,853 of 10,224 persons (the overall response rate was 96.3%) were eligible for analysis. In the questionnaire subjects were asked about respiratory system-related symptoms and characteristics. Results: Chronic cough [14.3 vs. 4.7%, OR 3.4 (2.6–4.4), p < 0.001], chronic bronchitis [35.3 vs. 11.8%, OR 4.0 (3.4–4.8), p < 0.001] and asthma [34.2 vs. 5.1%, OR 9.6 (8.0–11.5), p < 0.001] in the childhood respiratory infection group were more common than in the control group. Childhood respiratory infections were associated with an increased risk of asthma (OR 5.6, p < 0.001), chronic bronchitis (OR 2.3, p < 0.001) and chronic cough (OR 1.5, p < 0.001), after adjusting for possible confounding factors. In addition, the presence of dampness or visible mould, wall-to-wall carpets, pets at home and parents’ smoking during childhood were associated with an increased risk of frequent childhood respiratory infections. Conclusion: These results indicated that frequentrespiratory infections during childhood might play an important role in the occurrence of chronic airway diseases in adult life. The removing of risk factors for frequent childhood respiratory infections may reduce the subsequent risk of chronic airway disease in late adult life.

CT assessment of the effect of fluticasone propionate aqueous nasal spray treatment on lower turbinate hypertrophy due to vasomotor rhinitis

Conclusion. Fluticasone propionate (FP) aqueous nasal spray was objectively found to be effective and safe for the treatment of lower turbinate enlargement in patients with vasomotor rhinitis. Objective. To assess the efficacy of FP aqueous nasal spray treatment in lower turbinate hypertrophy due to vasomotor rhinitis using CT. Material and methods. Of 35 patients with hypertrophic lower turbinates due to vasomotor rhinitis, 20 were treated twice daily with FP aqueous nasal spray (200 µg/day) for 3 months continuously and 15 were treated with placebo vehicle as a control group. The local effect of the nasal spray was studied using CT and visual analog scales. Results. Treatment with FP provided significantly greater relief from the symptom of nasal obstruction compared with placebo over the entire 3-month treatment period (p < 0.001). When the change from baseline was compared between the two groups, FP produced statistically significant reductions in the mucosal area of the lower turbinates and in the thickness of the nasal mucosa after 3 months (p < 0.05).

Microalbuminuria in Chronic Obstructive Pulmonary Disease

Abstract Background: Microalbuminuria is an important risk factor for cardiovascular diseases. Microalbuminuria may be seen due to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). Objectives: In this study, we investigated prevalence and relationship of microalbuminuria with clinical and physiological parameters in patients with COPD. Method: During the research, 66 consecutive patients with COPD and 40 cases smokers with normal spirometry were included. The urinary albumin creatinin ratio (UACR) was calculated according to previously described formula. The presence of microalbuminuria was defined as UACR being ≥20 in men and ≥30 in women. The severity index of chronic diseases was evaluated by using MCIRS. Results: The rate of presence of microalbuminuria and UACR were higher in patients with COPD than smokers with normal spirometry. Pearson correlation analysis showed a significant inverse relationship between UACR and PaO2, FEV1%, FVC%. On the other hand, there was a positive relationship between UACR and BODE index. There was a significant relationship between the presence of microalbuminuria with PaO2 and BODE index. In the linear regression model, there was a negative relationship between UARC and PaO2 yet there was a significantly positive relationship between UARC and MCIRS score, BODE index. In the logistic regression model, the presence of microalbuminuria showed significant associations with PaO2, BODE index. Conclusion: Microalbuminuria may be seen in patients with COPD, depending on the severity of disease and hypoxemia. Microalbuminuria in patients with severe COPD should be examined in regular periods for risk of cardiovascular morbidity or mortality.

Emotional effects of nasal packing measured by the Hospital Anxiety and Depression Scale in patients following nasal surgery.

The aim of this study was to test the validity of the Hospital Anxiety and Depression (HAD) Scale in patients who underwent nasal surgery as a method of screening for emotional disorders during their hospital stay. The study group consisted of 50 adult patients (29 male, 21 female) who underwent nasal surgery for different reasons, such as chronic sinusitis, nasal polyposis, and nasal septal deviation. Functional endoscopic sinus surgery and/or septoplasty were managed in these patients, and all of the patients had nasal packing applied bilaterally for 2 days. The HAD Scale was given to all of the patients 1 day before surgery and 1 day after surgery, with anterior nasal packing bilaterally during the hospital stay. The anxiety and depression levels of the male group were under the cutoff points. For the female group, the depression levels were under the cutoff points, and the anxiety levels were high in the preoperative period and decreased after the operation. Anxiety and depression levels in the pre- and postoperative periods for the male and female groups were analyzed by Paired t-test. No statistically significant result was found (p > .05). It was concluded that, for patients well informed about nasal packing and hospital conditions, nasal packing may be used safely, without any psychological disturbance. The HAD Scale should be a more useful screening method to diagnose emotional disorders, especially in patients who are hospitalized for a long time.

Endobronchial lipomatous hamartoma: CT and MR imaging features (2004:5b).

Hamartomas may occur in the lung parenchyma or endobronchially. Endobronchial hamartoma is a special form of the usual intrapulmonary hamartoma, which originates from a large bronchus and grows into the lumen. When the tumour becomes large enough, it may obstruct a bronchus causing atelectasis and recurrent pneumonia. Early examination is important for the detection of these tumours, before the lung distal to the obstruction is irreversibly destroyed. If irreversible lung damage has occurred because of chronic obstruction and suppurations, pulmonary resection may be indicated [1]. Endobronchial hamartomas have a low prevalence in all previous studies, and their characteristics are poorly described. There are only five reports about endobronchial lipomatous hamartoma in the literature [2, 3, 4, 5, 6], and MR imaging findings have not been described previously. We report the CT and MR imaging findings of a patient who had an endobronchial lipomatous hamartoma which occluded the superior bronchus of the right lower lobe.