Kurtuluş Aksu

C-reactive protein levels are raised in stable Chronic obstructive pulmonary disease patients independent of smoking behavior and biomass exposure.

BACKGROUND The aim of this case control study is to assess the relationship between serum C-reactive protein (CRP) levels and well-known clinical parameters in Chronic obstructive pulmonary disease (COPD) considering the impact of smoking behavior, biomass exposure and accompanying clinical entities, namely pulmonary hypertension, systemic hypertension and diabetes mellitus. METHODS Spirometry, echocardiography, arterial oxygen saturation (SpO2) measurements, BODE scores and serum CRP levels were investigated in stable COPD patients. Associations between CRP levels and clinical parameters were evaluated. RESULTS CRP levels are significantly higher in COPD patients than in healthy controls. CRP levels were not significantly different between COPD patients treated with inhaled corticosteroids and those not treated. CRP levels significantly correlated with age, FEV1% predicted, FVC% predicted, SpO2, MMRC, 6 minute walk distance, BODE scores and haemoglobin levels. In multivariate analysis BODE scores and concomitant systemic hypertension manifested the strongest association with CRP levels. CRP levels in COPD patients with and without pulmonary hypertension were significantly different. CRP levels did not differ significantly according to smoking status or biomass exposure, moreover COPD cases due to biomass exposure who never smoked also had higher CRP levels compared to healthy controls. CONCLUSIONS Systemic inflammation is inherent to COPD independent of ever-smoking status and correlates with disease severity, concomitant systemic hypertension and pulmonary hypertension.

Nasal eosinophilia can predict bronchial hyperresponsiveness in persistent rhinitis: evidence for united airways disease concept.

Background Nasal eosinophils may be indicative of bronchial hyperresponsiveness (BHR) in rhinitis concerning the “united airways disease” theory. This study was designed to evaluate the relationship between nasal eosinophilia and BHR in persistent perennial rhinitis patients. Methods Thirty-seven patients (12 males and 25 females, mean age: 33.3 ± 10.4 years) were included in the study. Skin-prick test, nasal symptom score, nasal smears, methacholine bronchial challenge test, and nasal rhinometry were obtained in all patients. Eosinophil count in nasal smears was expressed as a percentage of the total cells. None of the patients had asthma. Results There was no difference between the number of atopic and nonatopic patients having BHR (4/20 versus 4/17; chi-squared = 0.07; p > 0.05). Total nasal flow was lower and percentage of nasal eosinophils was higher in the patients with BHR than in patients without BHR (p = 0.012 and p = 0.009, respectively). A cutoff point of 68% nasal eosinophils yielded a sensitivity of 100% (63.1–100) and a specificity of 58.6% (38.9–76.5) to determine the presence of BHR. Positive likelihood ratio for the value of eosinophils above cutoff value was 2.42 (1.8–3.3). Conclusion This study shows the relationship between nasal eosinophils and BHR in persistent perennial rhinitis patients. Nasal eosinophil percentage below cutoff value indicates that a patient does not have BHR.

Effect of aspirin desensitization on T-cell cytokines and plasma lipoxins in aspirin-exacerbated respiratory disease.

The pathogenesis of aspirin-exacerbated respiratory disease (AERD) is thought to be based on, mainly, overproduction of eicosanoid lipid mediators and on defective anti-inflammatory regulators. Aspirin desensitization treatment, the mainstay of controlling asthma and rhinitis in AERD patients, however, is the least understood aspect of the disease. The study was designed to determine the effect of aspirin desensitization on T-lymphocyte cytokine expression and on plasma lipoxin levels in AERD. Spirometry, skin-prick test and asthma control test were documented and intracellular cytokine expression in T lymphocytes and plasma lipoxin levels were measured in 23 AERD patients, 17 aspirin-tolerant asthmatic (ATA) patients, and 16 healthy controls. In the AERD group nasal symptom and smell scores were assessed. Of the 23 AERD patients 15 accepted to undergo aspirin desensitization protocol and 14 of them were desensitized successfully. In the desensitized AERD group, cytokine and lipoxin measurements were repeated after 1-month aspirin treatment. CD4(+) IL-10 levels were higher in AERD patients than in healthy controls and CD4(+) interferon (IFN) gamma levels were higher in AERD and ATA patients than in controls. Plasma lipoxin-A4 and 15-epi-lipoxin-A4 levels were similar among the three study groups. In the AERD group, subjects underwent aspirin desensitization followed by a 1-month aspirin treatment. Clinical parameters improved and CD4(+) IFN-gamma levels decreased significantly. No significant change in lipoxin levels was recorded. CD4(+) IFN-gamma and CD4(+) IL-10 levels in AERD patients after 1-month aspirin desensitization treatment were similar to the healthy controls. The study confirms aspirin desensitization is effective clinically in AERD patients and suggests that IFN gamma and IL-10 expression in CD4(+) T lymphocytes may be related to the mechanism of action.

Bronchial hyperresponsiveness in seasonal allergic rhinitis patients is associated with increased IL-18 during natural pollen exposure

BACKGROUND The mechanism of bronchial hyperresponsiveness (BHR) is not certain in seasonal allergic rhinitis (SAR) patients. OBJECTIVE We aimed to investigate the effects of natural pollen exposure on IL-18 and its relationship with BHR. METHODS Thirty-two SAR patients with grass pollen sensitivity, 14 nonallergic rhinitis (NAR) patients and 17 normal-controls were included. Sixteen SAR patients had BHR during pollen season and off-season. Serum IL-18 levels were measured in SAR patients during pollen season between May-August and off-season between November-February. IL-18 levels were measured in NAR patients and normal controls once. RESULTS During pollen season, SAR patients with BHR had significantly increased levels of IL-18 than those without BHR (279.2 ± 161.1 versus 145.3 ± 101.0 pg/ml, p=0.012). Serum IL-18 levels were not different between SAR patients with and without BHR during off-season (233.8 ± 139.7 versus 183.2 ± 162.9 pg/ml, p=0.16). Serum IL-18 levels in SAR patients during pollen season (212.3 ± 148.8 pg/ml) and off-season (208.5 ± 151.5 pg/ml) were not different than those NAR patients (224.8 ± 180.1 pg/ml, p=0.98 and p=1.0, respectively) and normal controls (174.8 ± 76.0 pg/ml, p=0.60 and p=0.76, respectively). CONCLUSION The results suggested us that BHR in SAR patients is associated with increased IL-18 during natural pollen exposure.

Effect of training by a physician on dynamics of the use of inhaler devices to improve technique in patients with obstructive lung diseases.

BACKGROUND Pharmacotherapies for obstructive lung diseases are dependent on agents delivered via inhaler devices, and the correct technique is essential for efficiency of these drugs. OBJECTIVE To determine the rate of incorrect inhaler techniques among patients with pulmonary diseases and the efficacy of delivering physician-provided training to patients by letting them practice with their inhaler devices. METHODS Patients ages ≥18 years with asthma, chronic obstructive pulmonary disease, or asthma chronic obstructive pulmonary disease overlap syndrome were enrolled. At the first visit, the patients were requested to use their own inhalers that they were currently on for initial evaluation of their inhalation technique. Correct and incorrect techniques were determined according to steps previously described in the literature. At the same visit, the physician provided practical training on faulty techniques detected, and a control visit was scheduled. RESULTS The study involved 108 patients, and 158 different inhalation techniques were assessed. Types of inhaler devices included in the study were metered-dose inhaler and five types of dry-powder inhalers. Fifty-six incorrect practices (35.4%) were noted. Although 64 patients (59.3%) used all of their inhaler devices with the correct technique, 44 (40.7%) used one or more inhalers inappropriately. At the control visit, the patients who misused their inhalers decreased significantly, to 8.3% (p < 0.001). The faulty technique ratio was decreased to 7.0%, which yielded the success of practical training as 80.4%. CONCLUSION Incorrect inhaler technique is still a problem for patients with obstructive lung diseases even in urbanized areas. Physician-provided practical training on the use of inhaler devices was an effective tool in the correction of inhaler techniques.

Immediate reaction to articaine

A 50-year-old woman was referred from dental clinic to be evaluated for hypersensitivity for articaine. Previously 3 years ago she had urticaria in 10-15 min after administration of a local anaesthetic agent for a dental procedure. She did not know the name of the local anaesthetic agent. For the last 6 years she had been followed with diagnoses of chronic urticaria and angioedema in dermatology department. She was treated with various antihistamines, systemic corticos-teroids, montelukast, azathiopurine and cyclosporine. In her previous examinations she was allergic to house dust mite and autologous serum skin test was found to be negative. She did not report any adverse drug reactions apart from the one she had with local anaesthetic mentioned above. The patient had no family history of allergy. She was on daily levocetirizine therapy for the last 4 months. Skin tests were planned with articaine after cessation of antihistamines for 5 days and provided informed consent for allergologic workup. Positive (histamine) and negative (normal saline solution) controls were also carried out. Skin prick test was negative for articaine HCl/epinephrine HCl (Ultracaine; Sanofi aventis) (1/1). During intradermal test with articaine (1/100) in the tenth minute 30 mm × 30 mm endurance and redness ensued together with globus hyster-icus and paraesthesia in tongue and the test was ended. The physical examination did not reveal any systemic sign of allergic reaction and the symptoms resolved completely in a few minutes without any medical intervention. This result suggested the involvement of a type I allergic reaction. Sub-cutaneous challenge was not performed for ethical reasons since intradermal test with articaine HCl/epinephrine HCl (1/100) was positive. Since no product containing articaine HCl without epinephrine is not available in the market, in order to exclude hypersensitivity to epinephrine, we also performed skin prick and intradermal tests with epinephrine HCl and found negative. Accordingly the patient was evaluated to be allergic to articaine. Afterwards an allergologic workup with prilocaine was planned to determine its safety for the patient. The patient presented negative prick and intradermal test with prilocaine HCl (Citanest; Astra Zeneca). Subcutenous challenge with prilocaine 0.1 ml and 1 ml was performed and came out to be negative and no adverse reactions were observed. In the following day dental procedure was performed successfully without any adverse reaction with prilocaine. Local anaesthetics drugs are widely used since they allow performance of procedures to be safely and comfortably especially in dental …

The association of month of birth with atopy in adult patients with asthma and rhinitis in Anatolia, Turkey

BACKGROUND Exposure to allergens in early life may predispose subjects to develop allergies and diseases related to allergic sensitisation. OBJECTIVE To determine the association between month of birth and atopic sensitisation in adult Turkish patients with rhinitis and/or asthma using the diagnostic method of skin prick tests. METHODS This prospective cross-sectional study included all adult patients who underwent skin prick testing with rhinitis and asthma from November 2009 to June 2010. Sensitisation was categorised as any sensitisation, pollen sensitisation, and house dust mite sensitisation. Multivariate logistic regression model was employed with the primary predictor being month of birth. Diagnosis (asthma, rhinitis and both), age, gender and family history of atopy were considered as potential confounders in the model. The associations were presented with both unadjusted and adjusted odds ratios (OR) and their 95% confidence interval (CI). RESULTS A total of 616 subjects were evaluated. Three-hundred and forty-one subjects had sensitisation to allergens according to skin prick tests. Analyses showed that subjects born in September were less likely to have documented skin test positively with pollen sensitisation [0.27 (0.09-0.84), p=0.023]. CONCLUSION The results support the hypothesis that being born at the end of the pollen season may protect subjects from pollen sensitisation.