OBJECTIVES: Chronic obstructive pulmonary disease (COPD) increases the risk of lung cancer. The relationships between COPD and
Asthma COPD Overlap (ACO), and between the histopathological types of lung cancer and driver mutations remain unclear and need
further study. The aim of this retrospective study was to examine the relationships between the histopathological type, frequency of epidermal growth factor receptor (EGFR) driver mutations, and anaplastic lymphoma receptor tyrosine kinase (ALK) rearrangements in the
lung cancers of patients with COPD and ACO.
MATERIALS AND METHODS: Patients with pure COPD (n=198) or ACO (n=318) who were admitted to our hospital were reviewed
retrospectively.
RESULTS: Lung cancers were identifid in 43 (21.7%) patients with pure COPD and 54 (17.0%) patients with ACO. The following lung
cancers types were observed: patients with pure COPD had 19 (44.2%) adenocarcinomas, 13 (30.2%) squamous cell lung carcinomas
(SCC), 8 (18.6%) small cell lung carcinomas (SCLC); patients with ACO had 23 (42.6%) adenocarcinomas, 23 (42.6%) SCC, 2 (3.70%)
SCLC. SCLC was signifiantly more prevalent in patients with pure COPD (p<0.05) than in those with ACO. Differences between the
numbers of other histological types of lung cancer and the numbers of driver mutations in the 2 groups of patients were not signifiant.
CONCLUSION: The differences in the rate of lung cancer and prevalence of EGFR driver mutations between the patients with pure
COPD and those with ACO were not signifiant.
|
OBJECTIVES: To assess the state of pulmonary vascular mediator systems during the stepwise formation of the chronic obstructive pulmonary disease (COPD) model.
MATERIALS AND METHODS: The COPD model was induced in rats by nitrogen dioxide (NO2) inhalation for 60 days. At different stages
of COPD (15, 30, and 60 days), the effect of reagents-vasodilators (β-adrenoceptor agonist isoproterenol, nitric oxide donor nitrosorbide,
acetylcholine, activator of C-fiers capsaicin, corticosteroid beclometasone) on the isolated pulmonary arteries (diameter <0.5 mm)
was studied. Vascular reactivity was assessed by determining isometric contraction (tension in milligrams) of arterial rings by using an
electromechanical transducer.
RESULTS: All vasodilators dose-dependently decreased the vascular tone of pulmonary arteries isolated from intact rats. After 15 days of
NO2 exposure, dilatation effect of low doses of vasodilators did not differ from that of intact specimens. The functional state of the adrenergic system deteriorated faster than that of the nonadrenergic noncholinergic system as reflcted by the weakening of the isoproterenol
relaxation effect. On prolonged NO2 exposure, pulmonary arteries responded to the impact of all vasodilators with smaller relaxation.
Dose dependence of the dilatation reaction disappeared for isoproterenol, capsaicin, beclometasone, and was less expressed for nitrosorbide and acetylcholine after 60 days of exposure.
CONCLUSION: In the course of COPD model generation, the functioning of almost all neurotransmitter systems of pulmonary artery
wall was negatively affected. This led to a decrease in the inflence of vasodilators on pulmonary artery vascular tone and could facilitate
the development of pulmonary hypertension, which is typical of COPD.
|
OBJECTIVES: The aim of this study was to evaluate the effect of comprehensive, 8-week outpatient pulmonary rehabilitation (PR) programme consisting of 60-min sessions twice a week under supervision on dyspnea and exercise capacity of patients who were lung
transplantation (LTx) candidates.
MATERIALS AND METHODS: Between March 2012 and December 2014, medical data of 23 patients on the waiting list for LTx who
were referred to our PR unit and completed 16-session outpatient under direct supervision were retrospectively analyzed. Data on exercise capacity as assessed by 6-minute walking test (6MWT) and the rate of perceived dyspnea as assessed by the Borg scale and Medical
Research Council (MRC) dyspnea scale were recorded.
RESULTS: Of 23 patients 57% were males; the mean age was 35±10 (range: 16–48) years. Four patients were operated early, as an appropriate donor was available. Diagnosis was as follows: bronchiectasis (n=10, 44%), silicosis (n=7, 30%), sarcoidosis (n=2, 9%), idiopathic
pulmonary firosis (n=1, 4%), chronic obstructive pulmonary disease (n=1, 4%), and others (n=2, 9%). At the end of the program, there
was a signifiant improvement (median: 60 m) in 6MWT scores (360 [70–254] m vs. 300 [139–489] m; p=0.018). In addition, a clinical
improvement was observed in Borg (p=0.000) and MRC scores (p=0.008).
CONCLUSION: Our study results suggest that 8-week outpatient PR programme consisting of training twice a week is effective to decrease perceived dyspnea and to improve exercise capacity in patients who are on the waiting list for LTx.
|
OBJECTIVES: The aim of this study is to specify the reasons and extents of illicit Roll-Your-Own (RYO) and waterpipe tobacco (WPT) markets which broke out in Turkey and to determine the destruction of these markets over the effectiveness of main tobacco control measures, the effect of this destruction on increase in tobacco use and the measures that can be taken.
MATERIALS AND METHODS: Reliable data about illicit trade are quite limited. This study was prepared through using the recommended methods on illicit trade in "Methods for Evaluating Tobacco Control Policies" published by the International Agency For Research On Cancer (IARC) and “Understand, Measure, and Combat Tobacco Smuggling” published by the World Bank.
RESULTS: RYO and WPT markets are almost totally illicit in Turkey. These markets serve to tobacco outbreak by increasing total tobacco use far beyond the official data through its size surpassing 30% of total consumption and they have begun to invalidate all of the principle tobacco control measures by hindering and undermining them.
CONCLUSION: In order to implement tobacco control measures effectively in Turkey, these illicit markets must be included in system by doing necessary regulations promptly. It is strongly needed that illicit RYO and WPT production and trade should be described as newly emerged threat areas in tobacco control literature, since other countries may suffer from similar problems.
|
OBJECTIVES: In the recent years, it has been observed that the use of hookah, a tobacco product, has increased in children and young people in Turkey. This study was conducted to determine the prevalence of cigarette and hookah use in children and young people specific to age and gender and to define the factors relevant to the use of hookah.
MATERIALS AND METHODS: The study was conducted with secondary/high school students between 11 and 17 years of age (Survey 1, n=4718) and with university students between 18 and 23 years of age (Survey 2, n=1588) as two groups, which made a total of 6306 students. The students were asked to fill in a questionnaire which consisted of questions about socio-demographic data and the use of tobacco and tobacco products.
RESULTS: It was determined that the use of cigarette and hookah was high in males, and it increased as the age increased in both genders (p<0.05). It was also determined that parents and friends using cigarette and hookah affected the use of cigarette and hookah in the study groups in both surveys (p<0.05). Additionally, it was determined that the educational level of the parents and being of a high social class were the social determiners of hookah use (p<0.05).
CONCLUSION: It is important that we fight against the use of all tobacco products, especially in young people. Education about the damages of tobacco and applying tobacco products should start at an early age, and accurate tobacco control models may provide support in this field.
|
OBJECTIVES: To estimate economic burden of pediatric asthma in Turkey from payer perspective.
MATERIALS AND METHODS: This cost of illness study was based on identification of per patient annual direct medical costs for the management of pediatric asthma in Turkey from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations and interventions, drug treatment and equipment, and co-morbidities/complications.
RESULTS: Based on total annual per patient costs calculated for outpatient admission ($113.14), laboratory-radiological tests ($35.94), hospitalizations ($725.92), drug treatment/equipment ($212.90) and co-morbidities/complications ($144.62) cost items, total per patient annual direct medical cost related to management of pediatric asthma was calculated to be $1,232.53 from payer perspective. Hospitalizations and interventions (58.9%) was the main cost driver. Direct cost for managing controlled and uncontrolled pediatric asthma were calculated to be $530.17 [key cost driver: drugs/equipment (40.0%)] and $1,023.16 [key cost driver: hospitalization/interventions (59.0%)], respectively.
CONCLUSION: Our findings indicate that managing patients with pediatric asthma pose a considerable burden to health economics in Turkey, with hospitalizations identified as the main cost driver and two-fold cost increment in case of uncontrolled disease.
|
OBJECTIVES: Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improving skills in coping with the disease. We aimed to examine the effect of self-management training on the quality of life and functional parameters in patients with moderate to severe COPD.
MATERIALS AND METHODS: Sixty-one consecutive patients with COPD were recruited in the study prospectively. The patients were randomized into two groups: self-management training (n=31) and standard care (n=30). Each patient was evaluated by spirometry, COPD assessment test (CAT), St George’s respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), modified British Medical Research Council (mMRC) dyspnea scale, and short form-36 (SF-36). A team of physiotherapists, psychologists, pulmonary disease specialists, and dietitians provided self-management training and biweekly counseling via phone. At the end of three months, both the groups were re-evaluated using the same assessment parameters.
RESULTS: We found no significant difference between the baseline demographic characteristics of the self-management training and standard care groups. We observed a reduction in CAT (p<0.001), SGRQ impact (p=0.013), activity subscales (p<0.001) and the total scores (p=0.020), and HADS anxiety (p=0.012) and depression (p=0.014) scores in the self-management training group after the education session. A significant increase in SF-36 physical function score was also observed (p=0.008). No significant improvement in the functional parameters was observed in either group; however, the change in FEV1 was more pronounced in the self-management training group than in the control group (p=0.017). The hospital readmissions and 1-year survival rates were similar for both the groups after receiving education (p>0.05).
CONCLUSION: Our results suggest that the self-management training of the patients with COPD improves the quality of life and reduces the symptoms of depression and anxiety. Therefore, at the least, self-management training should be done as the first step of pulmonary rehabilitation in patients with COPD who cannot access pulmonary rehabilitation facilities.
|
|
|
|
|
|
|
