Lutfi Coplu

Prevalence of asthma and allergic diseases in primary school children in Ankara, Turkey: two cross-sectional studies, five years apart.

The prevalence of allergic diseases is reported to have increased worldwide. Two questionnaire surveys, five years apart, were conducted to evaluate the trend of prevalence rates and possible risk factors among primary school children in Ankara, Turkey. A previous survey in 1992 revealed the lifetime prevalences of asthma, wheezing, allergic rhinitis and atopic dermatitis were 17.4%, 23.3%, 28% and 6.1%, and the prevalences for the preceding 12 months were 8.3%, 11.9%, 15.4% and 4%, respectively. The survey was repeated with the same questionnaire in the same age group (6–13 years) of the same school in May 1997. The parents of 358 boys and 380 girls completed the questionnaire. The lifetime and last 12 months’ prevalences of asthma, wheezing, rhinitis and atopic dermatitis were 16.8%, 22.5%, 18.7%, 6.5%, and 9.8%, 13.3%, 14.1%, 4.3%, respectively. There was a significant change only for the lifetime prevalence of rhinitis (p < 0.001). The rate of indoor smoking had declined from 73.9% to 64%, and pet ownership had risen from 7.9% to 22.9% (p < 0.001 for both). Atopic family history was the most prominent risk factor for all types of allergic disorders. Male gender was a significant risk factor for current asthma and wheezing [odds ratio (OR) = 1.80 and 1.59; 95% confidence intervals (CI) = 1.09–2.98 and 1.01–2.48, respectively], and passive smoking affected the occurrence of allergic rhinitis (OR = 1.84; CI = 1.13–3.00). The prevalence rates of allergic diseases among primary school children in Ankara stabilized during a 5‐year period for all diseases other than allergic rhinitis. However, there are changing behavior patterns, i.e. indoor smoking and keeping pet animals, which that may have affected these rates.

Prevalence of childhood asthma and allergic diseases in Ankara, Turkey

Kalyoncu AF, Selçuk ZT, Karakoca Y, Emri AS, Çöplü L, Şahin AA, Bariş YI. Prevalence of childhood asthma and allergic diseases in Ankara, Turkey.

Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzkoy, Cappadocia, Turkey.

OBJECTIVES The high incidence of malignant mesothelioma in some villages of Cappadocia (Turkey) is due to environmental exposure to erionite fibres. The aim was to evaluate the fibre burden in bronchoalveolar lavage fluid (BALF) from inhabitants of an erionite village and compare it with Turkish subjects with or without environmental exposure to tremolite asbestos. METHODS Ferruginous bodies (FBs) and fibres were measured and analyzed by light and transmission electron microscopy (TEM) in the BALF of 16 subjects originating from Tuzköy. RESULTS FBs were detected in the BALF of 12 subjects, with concentrations above 1 FB/ml in seven of them. Erionite was the central fibre of 95.7% of FBs. Erionite fibres were found in the BALF of all subjects, by TEM, and these fibres were low in Mg, K, and Ca compared with erionite from Tuzköy soil. The mean concentration of erionite fibres in BALF was similar to that of tremolite fibres in Turks with environmental exposure to tremolite. The proportion of fibres longer than 8 μm in BALF represented 35.6% for erionite compared with 14.0% for tremolite. The asbestos fibre concentrations in erionite villagers was not different from that in Turks without environmental exposure to tremolite. CONCLUSION Analysis of BALF gives information about fibre retention in populations environmentally exposed to erionite for whom data on fibre burden from lung tissue samples are scarce. This may apply to exposed Turks having emigrated to other countries.

Survey of the allergic status of patients with bronchial asthma in Turkey: a multicenter study

Patients diagnosed with bronchial asthma (BA) were prospectively enrolled to assess their allergen spectra and atopic status. The patients came from five major cities (Ankara. Ízmir, Samsun. ElazíǵC, and Adana) in different regions of Turkey. Atopic status, total IgE levels, and allergen speelra were determined in 1149 patients and 210 controls who were spouses of the patients sharing the same environment hut not consanguinity with the patients. Total IgF. levels were significant higher in the asthmatic patients. For both groups, total IgE. levels were higher in both alopic and male subjects. Atopy rates were 42% in asthmatics and 26.1% in controls, declining notably by age in both groups. The most common allergen in both groups was house‐dust mite (RDM), which was more frequency detected in coastal regions (Samsun. Izmir, and Adana). Allergen spectra of the patients included HDM. pollens, cockroach, pet animals, and molds in decreasing order of frequency. Phleum praiensi: and Artemisia vulgam were the most common pollens in all regions, whereas Olea europaea was the most common in Izmir. Pollen sensitivity was least frequent in hlazig. For all of the regions, pet sensitivity was less common than, and mold sensitivity was comparable to, that of Western countries. In conclusion. BA patients in Turkey displayed significant differences in their allergen spectra and total IgE levels from control subjects and BA patients in Western countries.

Effect of the long-term use of inhaled corticosteroids on bone mineral density in asthmatic women

Objective: Inhaled corticosteroids have become a key element in the maintenance treatment of bronchial asthma. Recent studies have shown that administration of inhaled corticosteroids is associated with evidence of derangement in bone turnover. Therefore, we studied the bone mineral density (BMD) of asthmatic women receiving long‐term inhaled corticosteroids and compared them with healthy individuals matched for age, sex, menopausal status and body mass index.

Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status

BackgroundThere are limited number of studies investigating extrapulmonary manifestations of bronchiectasis. The purpose of this study was to compare peripheral muscle function, exercise capacity, fatigue, and health status between patients with bronchiectasis and healthy subjects in order to provide documented differences in these characteristics for individuals with and without bronchiectasis.MethodsTwenty patients with bronchiectasis (43.5 ± 14.1 years) and 20 healthy subjects (43.0 ± 10.9 years) participated in the study. Pulmonary function, respiratory muscle strength (maximal expiratory pressure – MIP - and maximal expiratory pressure - MEP), and dyspnea perception using the Modified Medical Research Council Dyspnea Scale (MMRC) were determined. A six-minute walk test (6MWT) was performed. Quadriceps muscle, shoulder abductor, and hand grip strength (QMS, SAS, and HGS, respectively) using a hand held dynamometer and peripheral muscle endurance by a squat test were measured. Fatigue perception and health status were determined using the Fatigue Severity Scale (FSS) and the Leicester Cough Questionnaire (LCQ), respectively.ResultsNumber of squats, 6MWT distance, and LCQ scores as well as lung function testing values and respiratory muscle strength were significantly lower and MMRC and FSS scores were significantly higher in patients with bronchiectasis than those of healthy subjects (p < 0.05). In bronchiectasis patients, QMS was significantly associated with HGS, MIP and MEP (p < 0.05). The 6MWT distance was significantly correlated to LCQ psychological score (p < 0.05). The FSS score was significantly associated with LCQ physical and total and MMRC scores (p < 0.05). The LCQ psychological score was significantly associated with MEP and 6MWT distance (p < 0.05).ConclusionsPeripheral muscle endurance, exercise capacity, fatigue and health status were adversely affected by the presence of bronchiectasis. Fatigue was associated with dyspnea and health status. Respiratory muscle strength was related to peripheral muscle strength and health status, but not to fatigue, peripheral muscle endurance or exercise capacity. These findings may provide insight for outcome measures for pulmonary rehabilitation programs for patients with bronchiectasis.

A comparison of muscle strength and endurance, exercise capacity, fatigue perception and quality of life in patients with chronic obstructive pulmonary disease and healthy subjects: a cross-sectional study

BackgroundChronic obstructive pulmonary disease (COPD) has significant systemic effects that substantially impact quality of life and survival. The purpose of this study was to assess and compare peripheral muscle strength and endurance, exercise capacity, fatigue perception and quality of life between patients with COPD and healthy subjects.MethodsTwenty COPD patients (mean FEV1 49.3 ± 19.2%) and 20 healthy subjects were included in the study. Pulmonary function testing and six-minute walk test (6MWT) were performed. Peripheral muscle strength was measured with a hand-held dynamometer, peripheral muscle endurance was evaluated with sit-ups, squats and modified push-ups tests. Fatigue perception was assessed using the Fatigue Impact Scale (FIS) and Fatigue Severity Scale (FSS). General quality of life was determined with the Nottingham Health Profile (NHP), and cough-specific quality of life was evaluated with the Leicester Cough Questionnaire (LCQ).ResultsPulmonary functions, strength of shoulder abductor and flexor muscles, numbers of sit-ups and squats, 6MWT distance and 6MWT% were significantly lower in COPD patients than in healthy subjects (p < 0.05). FIS psychosocial sub-dimension and total scores, NHP scores for all sub-dimensions except pain sub-dimension of the COPD group were significantly higher than those of healthy subjects (p < 0.05). The LCQ physical, psychological and social sub-dimensions and total scores were significantly lower in COPD patients than in healthy subjects (p < 0.05).ConclusionsPulmonary functions, peripheral muscle strength and endurance, exercise capacity and quality of life were adversely affected in patients with COPD. There are greater effect of fatigue on psychosocial functioning and general daily life activities and effect of cough on the quality of life in patients with COPD. This study supports the idea that COPD patients must be evaluated in a comprehensive manner for planning pulmonary rehabilitation programs.

Fatigue and multidimensional disease severity in chronic obstructive pulmonary disease

Background and aimsFatigue is associated with longitudinal ratings of health in patients with chronic obstructive pulmonary disease (COPD). Although the degree of airflow obstruction is often used to grade disease severity in patients with COPD, multidimensional grading systems have recently been developed. The aim of this study was to investigate the relationship between perceived and actual fatigue level and multidimensional disease severity in patients with COPD.Materials and methodsTwenty-two patients with COPD (aged 52-74 years) took part in the study. Multidimensional disease severity was measured using the SAFE and BODE indices. Perceived fatigue was assessed using the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS). Peripheral muscle endurance was evaluated using the number of sit-ups, squats, and modified push-ups that each patient could do.ResultsThirteen patients (59%) had severe fatigue, and their St Georges Respiratory Questionnaire scores were significantly higher (p < 0.05). The SAFE index score was significantly correlated with the number of sit-ups, number of squats, FSS score and FIS score (p < 0.05). The BODE index was significantly associated with the numbers of sit-ups, squats and modified push-ups, and with the FSS and FIS scores (p < 0.05).ConclusionsPeripheral muscle endurance and fatigue perception in patients with COPD was related to multidimensional disease severity measured with both the SAFE and BODE indices. Improvements in perceived and actual fatigue levels may positively affect multidimensional disease severity and health status in COPD patients. Further research is needed to investigate the effects of fatigue perception and exercise training on patients with different stages of multidimensional COPD severity.RiassuntoRazionale e scopo dello studioLa sensazione di fatica si collega, nella valutazione longitudinale dello stato di salute, con la broncopneumopatia cronica ostruttiva (BPCO). Sebbene il livello di ostruzione del flusso delle vie aeree sia spesso utilizzato per stratificare la gravità di malattia nella BPCO, sono stati recentemente sviluppati sistemi di stadiazione multidimensionali. Scopo di questo studio è indagare il rapporto tra il livello di fatica percepito e reale con il livello di gravità multidimensionale nei pazienti con BPCO.Materiali e metodi22 pazienti con BPCO (età 52-74 anni) hanno preso parte allo studio. Gli indici SAFE e BODE sono stati utilizzati per valutare in modo multidimensionale la gravità di malattia. La fatica percepita è stata valutata con le scale FSS (Fatigue Severity Scale) e FIS (Fatigue Impact Scale). La resistenza dei muscoli periferici è stata indagata con il numero di ripetizioni degli esercizi seduto-in piedi, flessione sulle gambe e sollevamento modificato che ogni paziente era in grado di sostenere.Risultati13 pazienti (59%) hanno riferito grave fatica e il loro punteggio al St George’s Respiratory Questionnaire era significativamente più elevato (p < 0,05). Il punteggio dell’indice SAFE era correlato in modo significativo con il numero di ripetizioni degli esercizi seduto-in piedi, flessione sulle gambe e sollevamento modificato e con i punteggi FSS e FIS (p < 0,05).ConclusioniLa resistenza dei muscoli periferici e la percezione di fatica nei pazienti con BPCO è risultata correlata con il livello di gravità multidimensionale della patologia stimata sia con l’indice SAFE che col BODE. I miglioramenti nei livelli di fatica percepiti e reali possono perciò avere conseguenze positive sul quadro multidimensionale di gravità della malattia e sulla condizione di salute nei pazienti con BPCO. Ulteriori ricerche sono necessarie per valutare gli effetti della percezione di fatica e del riallenamento allo sforzo in pazienti con differenti stadi di gravità multidimensionale della BPCO.

Mycobacterium smegmatis pneumonia

Abstract:  Mycobacterium smegmatis is a non‐tuberculous mycobacterium that is usually associated with soft tissue or wound infections in humans. Pulmonary infections secondary to this pathogen are rarely seen and occur only in patients with an underlying condition, such as lipoid pneumonia. This report presents the first case of M. smegmatis pneumonia in an otherwise healthy individual who had no predisposing condition.

Pulmonary hypertension in systemic lupus erythematosus: pulmonary thromboembolism is the leading cause.

BackgroundPulmonary hypertension (PH) is a life-threatening complication of systemic lupus erythematosus (SLE). Pulmonary hypertension in SLE has a variety of causes. Diagnosing early and defining the cause of PH accurately can provide better clinical outcome in SLE. We investigated the causes and characteristics of PH in patients with SLE. MethodsOne hundred twenty-one patients with SLE who had a visit in a 6-month period were assessed retrospectively. Patients who ever had a systolic pulmonary arterial pressure of 40 mm Hg or greater by Doppler echocardiography were considered to have PH. ResultsAmong 122 patients, 65 had echocardiography for some reason, and 10 (8.2%) were diagnosed as having PH by echocardiographic examination. This number reduced to 9 (7.4%) when we excluded the patient with normal pulmonary artery pressure at right heart catheterization. Causes of PH were as follows: thromboembolic events in 4 patients (44.4%) (2 of them had chronic thromboembolic PH), left-sided heart disease in 2 patients (22.2%), pulmonary arterial hypertension in 1 patient (11.1%), high cardiac output state in 1 patient (11.1%), and transient elevation of systolic pulmonary artery pressure in 1 patient (11.1%) who had a history of venous thromboembolism. Venous thromboembolic disease was significantly higher in patients with SLE with PH in comparison to patients with SLE without PH (7 patients [6.3%] vs 5 patients [50.0%]; P = 0.001). All patients improved clinically during their short-term follow-up. ConclusionsPatients with SLE are at increased risk for PH. This study highlights the complexity of the differential diagnosis of PH in patients with SLE once again and emphasizes the importance of pulmonary thromboembolism as a cause of PH. One should investigate patients with SLE with unexplained symptoms and/or signs related to PH for possible treatable causes.