Mecit Suerdem

Phenotyping of Chronic Obstructive Pulmonary Disease Using the Modified Bhalla Scoring System for High-Resolution Computed Tomography

BACKGROUND Identifying different phenotypes of chronic obstructive pulmonary disease (COPD) is important for both therapeutic options and clinical outcome of the disease. OBJECTIVE To characterize the phenotypes of COPD according to high-resolution computed tomography (HRCT) findings; and to correlate HRCT scores obtained using the modified Bhalla scoring system with clinical and physiological indicators of systemic inflammation. METHODS The present study included 80 consecutive patients with stable COPD. HRCT scans were evaluated by two independent radiologists according to the modified Bhalla scoring system. RESULTS Fifty-four patients exhibited morphological changes on HRCT examination while 26 had no pathological findings. Patients with HRCT findings had lower spirometric measurements and higher levels of inflammation, and reported more exacerbations in the previous year compared with patients with no findings on HRCT. Patients with morphological changes were classified into one of three groups according to their HRCT phenotype(s): emphysema (E) only, E + bronchiectasis (B)⁄peribronchial thickening (PBT) or B⁄PBT only. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1⁄FVC ratio, C-reactive protein (CRP) levels and the number of exacerbations among the groups were significantly different. Pairwise comparisons between the E only and E+B⁄PBT groups showed significantly lower FVC, FEV1 and FEV1⁄FVC values, and higher CRP levels and number of exacerbations compared with the B⁄PBT group. No significant differences were found between the E+B⁄PBT and the B⁄PBT groups. An inverse correlation was found between the total HRCT score and FVC, FEV1 and FEV1⁄FVC; the correlation was positive with CRP level, erythrocyte sedimentation rate and number of exacerbations. CONCLUSION The present study exposed the intimate relationship between phenotype(s) characterized by HRCT and scoring for morphological abnormalities; and clinical and functional parameters and inflammatory markers. The inclusion of HRCT among routine examinations for COPD may provide significant benefits both in the management and prognosis of COPD patients.

Attentional control is partially impaired in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome is associated with executive cognitive impairment. An important question is whether impairment in executive functioning in obstructive sleep apnea syndrome is independent of dysfunction in attention. Attentional control is a subcomponent of executive functioning that is mediated by frontal lobe processing. In the current study, we investigated whether attentional control is deficient in obstructive sleep apnea syndrome. Attentional control processes were investigated through conflict adaptation and conflict frequency paradigms. These neuropsychological paradigms were assessed by using the Simon, Flanker and Stroop tasks. We additionally analysed post‐error slowing data within these tasks. Error processing is another index of cognitive control that is mediated by frontal lobe functioning. Our sample consisted of 14 healthy adults and 24 patients with untreated moderate–severe obstructive sleep apnea syndrome. Results indicated that attentional control is partially dysfunctional among patients with obstructive sleep apnea syndrome. Attentional control processes were deficient when focal attention (Flanker task) processes were involved, but were intact when observed using the Simon and Stroop tasks. A non‐significant trend in post‐error slowing data suggested that error processing, assessed with the Flanker task, was diminished among patients with obstructive sleep apnea syndrome. These results support the view that obstructive sleep apnea syndrome leads to some amount of frontal lobe dysfunction, and that attentional control and error processing might be particularly affected by obstructive sleep apnea syndrome.

Cognitive function in chronic obstructive pulmonary disease: Relationship to global initiative for chronic obstructive lung disease 2011 categories

Recently, comorbidities such as impaired cognitive function have been attracting more focus when considering the management of chronic obstructive pulmonary disease (COPD). Here we investigated the relationship between cognitive function and the categories given in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 2011. Specifically, after controlling for non‐COPD covariates, we assessed the clinical features that may be predictive of cognitive impairment in patients with COPD.

Respiratory Failure Caused by Giant Thymolipoma

The authors present the case of a 31-year-old woman with a massive anterior mediastinal tumor who presented with respiratory failure. A thoracic computed tomographic scan suggested a mediastinal lipomatous mass, and an operation was performed. Resection of the tumor resulted in immediate improvement in the patients pulmonary status, and the histopathologic examination revealed thymolipoma. Because thymolipoma can attain enormous dimensions and compress adjacent structures, it should be immediately resected.

Effects of simvastatin on bleomycin-induced pulmonary fibrosis in female rats

Statins reduce cholesterol levels by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase and have a major place in the treatment of atherosclerotic disease. Recent studies have shown anti-inflammatory properties of statins. The purpose of this study was to evaluate the anti-inflammatory effect of simvastatin on bleomycin (BLM)-induced pulmonary fibrosis in rats. A total of 31 female Sprague-Dawley rats were divided into four groups: (1) intratracheal (IT) phosphate-buffered saline (PBS) + intraperitoneal (IP) PBS (n=7); (2) IT BLM + IP PBS (n=8); (3) IT BLM + low dose (LD) simvastatin (1 mg/kg daily, n=8); (4) IT BLM + high dose (HD) simvastatin (5 mg/kg daily, n=8). Simvastatin was administered IP for 15 days, beginning 1 day prior to IT BLM. The effect of simvastatin on pulmonary fibrosis was studied by measurements of IL-13, PDGF, IFN-γ, TGF-p1 levels in bronchoalveolar lavage (BAL) fluid and lung tissue hydroxyproline (HPL) content and by histopathological examination (Ashcroft score). BLM caused significant change in BAL fluid cytokine levels and increased both HPL content and histopathological score (p<0.001 for all). While LD simvastatin had no effect on cytokine levels, HD significantly reduced IL-13 (15.12 ±7.08 pg/ml vs. 4.43±2.34 pg/mL; p<0.05) and TGF-β1 levels (269.25 ±65.42 pg/mL vs. 131.75±32.65 pg/mL; p<0.05). Neither HD nor LD simvastatin attenuated HPL content or Ashcroft score. In conclusion, this study showed that LD simvastatin had no effect on a BLM-induced pulmonary fibrosis model, while the high dose caused partial improvement in profibrotic cytokine levels.

Flexible bronchoscopy may decrease respiratory muscle strength: premedicational midazolam in focus

BackgroundFlexible bronchoscopy (FB) is a procedure accepted to be safe in general, with low complication rates reported. On the other hand, it is known that patients with pre-existing respiratory failure have developed hypoventilation following FB. In this study the effects of FB on respiratory muscle strength were investigated by measuring maximum respiratory pressures.MethodsOne hundred and forty patients, aged between 25 and 90 years, who had undergone diagnostic bronchoscopy between February 2012 and May 2012, were recruited to the study. Pre- and post-procedure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. A correlation between the MIP and MEP changes and patient characteristics and FB variables were investigated.ResultsSignificant decreases in both MIP and MEP values were observed following FB (p < 0.001 for both). Decreases were attributed to the midazolam used for sedation. Significant decreases in respiratory muscle strengths were observed especially in the high-dose midazolam group, compared to both low-dose and non-midazolam groups.ConclusionsIt was determined that respiratory muscle weakness may arise post-procedure in patients who have undergone FB, and this is constitutively related to midazolam premedication. Respiratory muscle weakness might play a role in potential hypoventilation in critical patients who undergo FB.

Asthma control and adherence in newly diagnosed young and elderly adult patients with asthma in Turkey

ABSTRACT Objective: This study aimed to evaluate the factors that affect asthma control and adherence to treatment in newly diagnosed elderly asthmatics in Turkey compared with younger patients. Methods: This real-life prospective observational cohort study was conducted at 136 centers. A web-based questionnaire was administered to the patients who were followed up for 12 months. Results: Analysis included 1037 young adult asthma patients (age <65 years) and 79 elderly asthma patients (age ≥65 years). The percentage of patients with total control in the elderly and young groups were 33.9% and 37.1% at visit 1, 20.0% and 42.1% (p = 0.012) at visit 2, and 50.0% and 49.8% at visit 3, respectively. Adherence to treatment was similar for both groups. Visit compliance was better in the elderly group than in the young group at visit 1 (72.2% vs. 60.8%, p = 0.045), visit 2 (51.9% vs. 34.9%, p = 0.002), and visit 3 (32.9% vs. 19.4%, p = 0.004). Adherence to treatment increased with asthma control in both groups (both p < 0.001) but decreased with the presence of gastritis/ulcer, gastroesophageal reflux, and coronary artery disease in the elderly. Conclusions: Asthma control and adherence to treatment were similar for the elderly and young asthma patients, though the follow-up rate was lower in young patients. The presence of gastritis/ulcer, gastroesophageal reflux and coronary artery disease had negative impacts on the adherence to treatment in elderly adult patients.

The effect of cognitive functions on the ability to learn how to use a Diskus device in patients with chronic obstructive pulmonary disease

OBJECTIVE: Dry powder inhalers are a group of inhaled medications commonly used for the treatment of chronic obstructive pulmonary disease (COPD). Although they can be more easily administered than metered dose inhalers, there is a high rate of errors in device use. The present study aims to evaluate the relationship between the ability to learn how to use a Diskus device and cognitive functions in patients with COPD. MATERIALS AND METHODS: The study included 30 inhaler-näive patients who were newly diagnosed with COPD. During their first visit, patients were administered a broad array of standardized neuropsychological tests and given a training on inhaler use. During the second visit, patients were divided into two groups according to their performance in the use of Diskus device: effective and ineffective. RESULTS: Twenty-nine patients who completed the study showed a negative correlation between the cognitive test scores and Diskus training parameters. The number of errors and duration of training increased as the cognitive scores decreased. In Visit 2, a comparison between patients with ineffective and effective use of the Diskus device showed that cognitive function scores were higher in those with effective use. CONCLUSIONS: Evaluation of cognitive functions in COPD patients is important in establishing an effective inhalation treatment.

Modification of the GOLD recommendations for chronic obstructive pulmonary disease to broaden their usage in Turkey.

ABSTRACT Despite the introduction of numerous national and international COPD guidelines designed to provide clinicians with optimal evidence-based disease management strategies, COPD remains an underdiagnosed and poorly treated disease. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend disease specific diagnosis and management strategies, and they are widely used internationally. In this short report we present the outcomes of a meeting of respiratory experts in Turkey who reviewed the GOLD guidelines and their applicability to the Turkish healthcare system. In particular, we were interested to investigate the possibility of developing a simplified version of the combined assessment model which we believe will be more acceptable to Turkish pulmonologists and will increase its use in everyday clinical practice.

Aberrant Right Subclavian Artery Syndrome and Chronic Cough

Alındığı tarih / Received date: 13.06.2012; Kabul tarihi / Accepted date: 03.11.2012 Yazışma adresi / Address for correspondence: Baykal Tülek, Selçuk Üniversitesi Selçuklu Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, 42080 Konya, Türkiye; E-posta: baykaltulek@yahoo.com