Aysin Sakar Coskun

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.

Factors affecting the interval from diagnosis to treatment in patients with lung cancer.

AIMS AND BACKGROUND We aimed to investigate the factors affecting the interval from the beginning of the symptoms until diagnosis and treatment in patients with lung cancer. METHODS Records of 119 lung cancer patients diagnosed in our pulmonary diseases clinic between 2004 and 2006 were evaluated retrospectively. Demographic data, histopathological tumor type, TNM stage, ECOG performance status, presence of endobronchial lesions, and radiological localization of the tumor were determined. Intervals from the first symptom to contacting a doctor, to diagnosis and to treatment were calculated. The interval from first admission to a clinic and referral to a chest physician was also calculated. RESULTS Of 119 patients, 74% were diagnosed as non-small cell and 26% were as small cell lung cancer. Forty-eight percent of the patients were at stage 3B and 36% were at stage 4. ECOG performance status was 0 in 6%, 1 in 52%, 2 in 36%, 3 in 3%, and 4 in 2%. Endobronchial lesions were observed in 50% of the patients, and the lesions had a central radiological localization in 59%. Fifty-four percent of the patients presented to a chest physician first. Patients who first presented to an internal medicine clinic were referred to our pulmonary disease clinic significantly later than those who presented to other clinics (P = 0.005). The median period from the beginning of the symptoms until contacting a doctor was 35 days (range, 1-387), until diagnosis was 49 days (range, 12-396), and until beginning the treatment was 57 (range, 9-397) days. The presence of endobronchial lesions, radiological localization, TNM stage and ECOG performance status were not found to be related to the intervals from the first symptom to presentation to a doctor, to diagnosis or to the beginning of the treatment. CONCLUSIONS Lung cancer patients consult a doctor after a relatively long symptomatic period. Patient delays may be shortened by increasing the awareness of patients about lung cancer symptoms. Diagnostic procedures should be performed more rapidly to shorten doctor delays.

Does asthma control as assessed by the asthma control test reflect airway inflammation

Background and aimsThe treatment of asthmatic patients is particularly focused on the control of symptoms as well as functional and inflammatory parameters. In our study, we investigated the relationship between the asthma control test (ACT) which evaluates symptoms and airway inflammation and functional parameters.Materials and methodsStable asthmatic patients admitted to our pulmonary outpatient clinic were enrolled in the study consecutively and underwent the ACT, pulmonary function tests and methacholine bronchial provocation test (MBPT). Additionally, fractional exhaled nitric oxide level (FeNO) and induced sputum cell distribution were assessed. All these parameters were re-evaluated at the third month after adjusting medications of the patients according to baseline ACT scores.ResultsOf the 101 patients screened, we analyzed 83 who proceeded to the follow up visit. At the baseline visit, 8 were totally controlled, 36 partially controlled and 39 uncontrolled according to ACT. At the follow up visit, 10 were totally controlled, 39 partially controlled and 34 uncontrolled. Comparison of the two visits in terms of all parameters revealed significant reductions only in the percentages of patients with MBPT positivity (p = 0.029) and FeNO levels > 20 ppb (p = 0.025) at follow up. The percentages of patients with FeNO > 20 ppb, MBPT positivity, induced sputum eosinophilia or induced sputum neutrophilia did not show significant differences between totally controlled, partially controlled and uncontrolled groups at both baseline and follow up visits.ConclusionAlthough the ACT scores did not show significant correlations with the airway inflammation parameters tested in this study, a marked reduction in the percentage of patients with MBPT positivity and FeNO > 20 ppb at follow up may suggest the importance of the control concept in the management of asthma.RiassuntoRazionale e scopoIl trattamento dei pazienti asmatici si concentra in modo particolare sul controllo dei sintomi, parallelamente ai sui parametri funzionali e infiammatori. Nel nostro studio abbiamo indagato i rapporti fra l’“asthma control test” (ACT), che valuta la sintomatologia, con l’infiammazione delle vie aeree e i parametri funzionali.Materiali e metodiSono stati arruolati pazienti asmatici consecutivi in fase stabile afferenti al nostro ambulatorio di pneumologia, e sottoposti a compilazione dell’ACT, test di funzionalità respiratoria, test di provocazione bronchiale con metacolina (MBPT), misurazione della frazione espiratoria di ossido nitrico (FeNO) e citologia dell’espettorato indotto. Tutti questi parametri sono stati rivalutati a tre mesi dopo aggiustamento per il trattamento farmacologico sulla base dei punteggi ACT di base.RisultatiSu 101 pazienti sottoposti a screening, ne sono stati valutati 83 che si sono ripresentati alla visita di follow up. Alla prima visita 8 pazienti erano totalmente controllati, 36 parzialmente controllati e 39 non controllati in base all’l’ACT. Nella visita di follow up, 10 pazienti erano completamente controllati, 39 parzialmente controllati e 34 non controllati. La comparazione fra le due visite ha evidenziato, fra tutti i parametri, una riduzione significativa solo nella percentuale di pazienti con positività a MBPT (p = 0,029) e livelli di FeNO > 20 ppb (p = 0,025) al follow up. La percentuale di pazienti con FeNO > 20 ppb, positività al MBPT, eosinofilia neutrofilia nell’espettorato indotto non hanno mostrato significative differenze tra i gruppi di pazienti ben controllati, parzialmente controllati e non controllati sia alla prima visita che al follow up.ConclusioniAnche se i punteggi dell’ACT non hanno mostrato correlazioni significative con i parametri di infiammazione delle vie aeree valutati in questo studio, la marcata riduzione della percentuale di pazienti con positività al MBPT e FeNO > 20 ppb alla visita di follow up può implicare l’importanza del concetto di controllo nella gestione dell’asma.

Does high-frequency chest wall oscillation therapy have any impact on the infective exacerbations of chronic obstructive pulmonary disease? A randomized controlled single-blind study:

Objective: To investigate the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with infective exacerbation. Design: Clinical randomized controlled trial. Setting: Patients received high-frequency chest wall oscillation therapy at the Department of Pulmonology. Subjects: Stage III-IV chronic obstructive pulmonary disease patients hospitalized with acute infective exacerbation who had received high-frequency chest wall oscillation therapy were studied. Interventions: Patients were randomized into two groups, which were classified as I and II. All patients have been treated with bronchodilators, antibiotics, if necessary oxygen and patient education, as part of acute chronic obstructive pulmonary disease exacerbation protocol. Group II patients received additional high-frequency chest wall oscillation therapy. Main measures: Body mass index (B), forced expiratory volume in the first second (O), modified Medical Research Council dyspnea scale (D) and 6-minute walking test (E) (BODE) index, forced expiratory volume in the first second, dyspnea, exercise capacity, oxygenation parameters and hospitalization of duration were recorded at baseline and at three-days and five-days follow-up. Results: From April 2009 to July 2011, a total of 99 patients were assessed for eligibility, 50 patients were enrolled and randomized into two groups. A total of 50 (100%) patients (25 in Group I and 25 in Group II) were followed up for five days. Application of high-frequency chest wall oscillation therapy resulted in no significant advantage in all outcomes (p > 0.05). Mean (SD) baseline BODE index value in Group I was 7.72 (1.76), in Group II was 7.72(1.89) (p = 0.55). On the fifth-day assessment, mean (SD) BODE index value in Group I was 7.24 (1.83), in group II was 6.44 (2.46) (p = 0.18). Conclusions: The application of high-frequency chest wall oscillation therapy offers no additional advantages on infective exacerbations in chronic obstructive pulmonary disease.

Varenicline disrupts prepulse inhibition only in high-inhibitory rats.

Varenicline, a widely used smoking cessation drug, has partial agonistic activity at α4β2 nicotinic receptors, and full agonistic activity at α7 nicotinic receptors. Thus it may interact with cognitive processes and may alleviate some of the cognitive disturbances observed in psychotic illnesses such as schizophrenia. We aimed to test the effects of varenicline on sensorimotor gating functioning, which is crucial for normal cognitive processes, especially for the integration of sensory and cognitive information processing and the execution of appropriate motor responses. Prepulse inhibition (PPI) of the acoustic startle reflex was used to test the sensorimotor gating functioning. First, the effects of varenicline and nicotine on rats having high or low baseline PPI levels were evaluated; then, varenicline was applied prior to apomorphine (0.5 mg/kg), and MK-801 (0.15 mg/kg), which are used as comparative models of PPI disruption. Varenicline (0.5-3 mg/kg) did not change PPI when given alone in naïve animals. When rats were selected according to their baseline PPI values, varenicline (1 mg/kg) significantly decreased PPI in high-inhibitory (HI) but not in low-inhibitory (LI) rats. Nicotine (1 mg/kg; tartrate salt) produced a similar activity in LI and HI groups. In combination experiments, varenicline did not reverse either apomorphine or the MK-801-induced disruption of PPI. These results demonstrate that the effects of both varenicline and nicotine on sensorimotor gating are influenced by the baseline PPI levels. Moreover, varenicline has no effect on apomorphine or the MK-801-induced disruption of PPI.

Pneumococcal and influenza vaccination status of hospitalized adults with community acquired pneumonia and the effects of vaccination on clinical presentation

ABSTRACT Background: Previous reports have shown that vaccination rates of adult at-risk populations are low in Turkey. There are differing reports with regards to the effectiveness of the influenza and the pneumococcal polysaccharide vaccine (PPSV23) on the clinical outcomes of community acquired pneumonia (CAP). The purpose of this study was to analyze the influenza (FV) and pneumococcal vaccination (PV) status, the factors that influence the receipt of influenza/pneumococcal vaccine and the effects of prior vaccination on the clinical outcomes in adults hospitalized with CAP. Patients and Methods: Patients hospitalized with CAP between March 2009 and October 2013 and registered at the web-based Turkish Thoracic Society Pneumonia Database (TURCAP) were included in this multicentric, observational study. Of a total of 787 cases, data were analyzed for 466 patients for whom self-reported information on PV and FV was available. Results: In this adult population with CAP, the vaccination rate with both the pneumococcal and influenza vaccines was found to be 6%. Prior FV was found to be the sole variable that was associated with the receipt of PV [OR 17.8, 95% CI (25–75:8.56–37.01), p < 0.001]. Conversely, being vaccinated with PPSV23 was the only predictor of receipt of FV [OR 18.1, 95% CI (25 – 75:8.75 – 37.83), p < 0.001]. Compared to the unvaccinated cases, the chest radiograms of the vaccinated patients revealed less consolidation. The latter also reported fatigue, muscle pain and gastrointestinal symptoms less frequently. Although there was a trend for lower 30-day mortality and for lower rates of intensive care unit (ICU) admission, these did not reach statistical significance. A pneumonia severity index (PSI) score ≥ 90, CURB-65 score ≥3 and multilobar involvement, but not the vaccination status, were identified as independent determinants of ICU admission. Conclusions: This study showed that, among patients hospitalized with CAP, the FV and/or PV rates are low. Prior vaccination does not appear to significantly affect the clinical outcomes.

The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis

Bronchofiberscopy (BFS) with endobronchial biopsy (EBB) was performed in 66 patients with pulmonary sarcoidosis (PS). Transbronchial biopsy (TBB) was made in 49 patients from this group to compare the diagnostic value of EBB and TBB. The normal endoscopic picture was observed in 19.6% of patients. Bronchial mucosal hypervascularization and thickening were found in 25.7% of cases; the signs of enlarged bronchopulmonary lymph nodes were detected in 13.6%; catarrhal endobronchitis in 10.6%, and tuberosity changes in 4.5%. Epithelioid granulomas in the bronchial mucosa were identified in 37.8% of cases (30.75 and 39.6% in the intact and abnormal mucosa, respectively). The diagnostic value of TBB was 65.3%. EBB could reveal epithelioid-cell granulomas in 4 of the 17 patients with negative TBB. The findings suggest that BFS with EBB should be included as a necessary diagnostic method for the examination of patients with PS.

Effect of smoke-free legislation on smoking cessation rates in teachers in Manisa, Turkey

Objective: This study investigated the attitudes of Turkish adults towards the ban on smoking in public areas and compared annual smoking cessation rates before (pre-2009) and after (post-2009) the ban became law, using data from a survey of teachers. Methods: A self-reported questionnaire was used to collect data from teachers in Manisa, Turkey. Annual smoking rates were calculated. Joinpoint regression analysis was used to identify when a significant change occurred in the annual smoking cessation rate. Results: Questionnaire response rate was 79.6% (579/727); 47.8% (277) of respondents were male. Smoking prevalence among men and women was 32.7% and 24.7%, respectively, and 97.3% of nonsmokers and 75.5% of current everyday smokers supported the law changes. Results of the Joinpoint analysis showed no significant change in annual smoking cessation rate between 2001–2002 and 2006–2007; but there were significant reductions in smoking rates between 2007–2008 and 2010–2011. Conclusions: Teachers in Turkey have a positive attitude to the law on smoking. The smoking cessation rate in teachers was significantly increased by changes in legislation.