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Gunen H, Kokturk N, Naycı S, Ozkaya S, Yıldız BP, Turan O, Gumus A, Akgun M, Gurgun A, Ogus C, Mirici A, Sen E, Bayram N, Eken V, Erkus H. The CO-MIND Study: Chronic Obstructive Pulmonary Disease Management in Daily Practice and Its Implications for Improved Outcomes According to GOLD 2019 Perspective. Int J Chron Obstruct Pulmon Dis 2022; 17:1883-1895. [PMID: 36003323 PMCID: PMC9394660 DOI: 10.2147/copd.s372439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose GOLD 2019 proposed a novel treatment decision tool for follow-up based on the predominant trait (exacerbation or dyspnea) of patients, alongside treatment escalation and de-escalation strategies. This study was designed to provide an up-to-date snapshot of patient and disease characteristics, treatment pathways, and healthcare resource use (HRU) in COPD in real life, and comprehensively examine patients considering GOLD 2019 recommendations. Patients and Methods This mixed design, observational, multicenter (14 pulmonology clinics) study included all patients with a documented COPD diagnosis (excluding asthma-COPD overlap [ACO]) for ≥12 months, aged ≥40 years at diagnosis who had a COPD-related hospital visit, spirometry test and blood eosinophil count (BEC) measurement under stable conditions within the 12 months before enrollment between February and December 2020. Data were collected cross-sectionally from patients and retrospectively from hospital medical records. Results This study included 522 patients (GOLD group A: 17.2%, B: 46.4%, C: 3.3%, D: 33.1%), of whom 79.5% were highly symptomatic and 36.2% had high risk of exacerbation. Exacerbations (n = 832; 46.6% moderate, 25.5% severe) were experienced by 57.5% of patients in the previous 12 months. Inter-rater agreement between investigators and patients regarding the reason for visit was low (κ coefficient: 0.338, p = 0.001). Inhaled treatment was modified in 88 patients at index, mainly due to symptomatic state (31.8%) and exacerbations (27.3%); treatment was escalated (57.9%, mainly switched to LABA+LAMA+ICS), inhaler device and/or active ingredient was changed (36.4%) or treatment was de-escalated (5.7%). 27% had ≥1 hospital overnight stay over 12 months. Emergency department visits and days with limitation of daily activities were higher in group D (p < 0.001). Conclusion Despite being on-treatment, many patients with COPD experience persistent symptoms and exacerbations requiring hospital-related HRU. A treatable trait approach and holistic disease management may improve outcomes by deciding the right treatment for the right patient at the right time.
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Affiliation(s)
- Hakan Gunen
- Department of Pulmonary Medicine, Sureyyapasa Training and Research Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey
| | - Nurdan Kokturk
- Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sibel Naycı
- Department of Pulmonary Medicine, Mersin University School of Medicine, Mersin, Turkey
| | - Sevket Ozkaya
- Department of Pulmonary Medicine, VM Medical Park Samsun Hospital, Samsun, Turkey
| | - Birsen Pınar Yıldız
- University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Pulmonology, Istanbul, Turkey
| | - Onur Turan
- Department of Pulmonary Medicine, Izmir Katip Çelebi University, İzmir, Turkey
| | - Aziz Gumus
- Department of Pulmonary Medicine, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Metin Akgun
- Department of Pulmonary Medicine, Atatürk University School of Medicine, Erzurum, Turkey
| | - Alev Gurgun
- Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey
| | - Candan Ogus
- Department of Pulmonary Medicine, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Arzu Mirici
- Department of Pulmonary Medicine, Canakkale 18 Mart University, Canakkale, Turkey
| | - Elif Sen
- Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Nazan Bayram
- Department of Pulmonary Medicine, Gaziantep University, Sahinbey Research Hospital, Gaziantep, Turkey
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Yildiz F, Mungan D, Gemicioglu B, Yorgancioglu A, Dursun B, Oner Erkekol F, Ogus C, Turktas H, Bogatekin G, Topcu F, Deveci F, Bayram H, Tor M, Kalyoncu AF. Asthma phenotypes in Turkey: a multicenter cross-sectional study in adult asthmatics; PHENOTURK study. Clin Respir J 2015; 11:210-223. [PMID: 26073091 DOI: 10.1111/crj.12326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/14/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS To evaluate asthma phenotypes in patients with asthma from different regions of Turkey. METHODS A total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011-January 2012. RESULTS The disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P < 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P < 0.01). Uncontrolled asthmatics have more severe disease (P < 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P < 0.01). Chronic rhino-sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P < 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P < 0.05). CONCLUSION In conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes.
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Affiliation(s)
- Fusun Yildiz
- Pulmonary Diseases Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Dilsad Mungan
- Department of Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Bilun Gemicioglu
- Pulmonary Diseases Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Arzu Yorgancioglu
- Pulmonary Diseases Department, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Berna Dursun
- Pulmonary Diseases Department, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Ferda Oner Erkekol
- Department of Allergy, Ataturk Chest Diseases and Thoracic Surgery Research Hospital, Ankara, Turkey
| | - Candan Ogus
- Pulmonary Diseases Department, Akdeniz University School of Medicine, Antalya, Turkey
| | - Haluk Turktas
- Pulmonary Diseases Department, Gazi University School of Medicine, Ankara, Turkey
| | | | - Fusun Topcu
- Pulmonary Diseases Department, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Figen Deveci
- Pulmonary Diseases Department, Firat University School of Medicine, Elazig, Turkey
| | - Hasan Bayram
- Pulmonary Diseases Department, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Meltem Tor
- Pulmonary Diseases Department, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - A Fuat Kalyoncu
- Department of Allergy, Hacettepe University School of Medicine, Ankara, Turkey
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Okumus G, Musellim B, Cetinkaya E, Turker H, Uzaslan E, Yenturk E, Uzun O, Saglam L, Kumbasar OO, Celik G, Annakkaya AN, Altiay G, Tabak L, Sakar A, Kiter G, Erturan S, Turktas H, Yalniz E, Akkoclu A, Ogus C, Dogan OT, Ozkan M, Aktogu S, Uzel I, Ongen G. Extrapulmonary involvement in patients with sarcoidosis in Turkey. Respirology 2011; 16:446-50. [PMID: 20946338 DOI: 10.1111/j.1440-1843.2010.01878.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey. METHODS This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected. RESULTS One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 ± 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007). CONCLUSIONS Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.
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Affiliation(s)
- Gulfer Okumus
- Department of Pulmonary Diseases, Istanbul Medical Faculty, Istanbul University, Turkey.
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Uslu A, Ogus C, Ozdemir T, Bilgen T, Tosun O, Keser I. The effect of CYP1A2 gene polymorphisms on Theophylline metabolism and chronic obstructive pulmonary disease in Turkish patients. BMB Rep 2010; 43:530-4. [PMID: 20797314 DOI: 10.5483/bmbrep.2010.43.8.530] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cytochrome P450 (CYP) 1A2 gene polymorphisms are thought to be involved in the metabolism of theophylline (TP). We aimed to investigate the effect of CYP1A2*1C, CYP1A2*1D, CYP1A2*1E, and CYP1A2*1F polymorphisms of the CYP1A2 on TP metabolism by PCR-RFLP in 100 Turkish patients with chronic obstructive pulmonary disease (COPD) receiving TP. One hundred and one healthy volunteers were included as control group. The genotype frequencies of the CYP1A2*1D and CYP1A2*1F were found to be significantly different in the patients compared to the controls. The "T" allele at -2467 delT and the "C" allele at -163 C > A in the CYP1A2 displayed association with a significantly increased risk for COPD. "T" allele at - 2467 delT was also associated with a high risk of disease severity in COPD. In conclusion, our data suggest that genetic alterations in CYP1A2 may play a role both in the pharmacogenetics of TP and in the development of COPD.
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Affiliation(s)
- Ahmet Uslu
- Department of Chest Diseases, Medical Park Hospital, Antalya, Turkey
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Musellim B, Kumbasar O, Ongen G, Cetinkaya E, Turker H, Uzaslan E, Yenturk E, Uzun O, Saglam L, Celik G, Okumus G, Annakkaya A, Altiay G, Tabak L, Sakar A, Kiter G, Erturan S, Turktas H, Yalniz E, Akkoclu A, Ogus C, Dogan O, Ozkan M, Aktogu S, Uzel I. Epidemiological features of Turkish patients with sarcoidosis. Respir Med 2009; 103:907-12. [DOI: 10.1016/j.rmed.2008.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 11/02/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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Boz AB, Celmeli F, Arslan AG, Cilli A, Ogus C, Ozdemir T. A case of allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis. Pediatr Pulmonol 2009; 44:86-9. [PMID: 19061231 DOI: 10.1002/ppul.20934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Allergic bronchopulmonary aspergillosis usually occurs in children with underlying airway disease such as asthma and cystic fibrosis. While the colonization and infection of pre-existing tuberculosis lesions by aspergillus species is well known, occurrence of allergic bronchopulmonary aspergillosis following pulmonary tuberculosis in children has not been reported yet. Here, an 11-year-old girl who developed allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis is reported and the mechanisms of causality are also speculated.
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Affiliation(s)
- Aysen Bingol Boz
- Faculty of Medicine, Department of Pediatrics, Akdeniz University, Antalya, Turkey.
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Cilli A, Ozkaynak C, Onur R, Erogullari I, Ogus C, Cubuk M, Arslan G, Ozdemir T. Lung cancer detection with low-dose spiral computed tomography in chronic obstructive pulmonary disease patients. Acta Radiol 2007; 48:405-11. [PMID: 17453521 DOI: 10.1080/02841850701227776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether low-dose spiral computed tomography (LDCT) can improve the lung cancer detection rate in chronic obstructive pulmonary disease (COPD) subjects. MATERIAL AND METHODS From October 1999 to December 2003, 374 COPD patients underwent LDCT for lung carcinoma screening. All subjects with an abnormal baseline CT scan were followed with serial CT scans as part of our protocol. Follow-up was continued until the demonstration of no change over a minimum of 24 months, or resolution. Sputum samples were also obtained for cytological analysis. RESULTS On the baseline spiral CT scan, 132 of 374 patients (35.2%) had at least one non-calcified nodule that required periodic follow-up with CT scans. The median follow-up time was 21 months (range 2-48 months). Of the 374 COPD subjects, nine patients with primary lung cancer (2.4%) were detected: six were squamous cell carcinomas, two were small-cell lung carcinomas (SCLC), and one was adenosquamous carcinoma. Three of the nine tumors were in stage IA, two in stage IIB, two in stage IIIA, and two were limited SCLC. Potentially curative pulmonary resection was performed in four patients, pulmonary lobectomy in three, and wedge excision in one. One subject with stage IA squamous cell carcinoma received radiotherapy, as pulmonary function was severely impaired. In addition, four patients underwent removal of benign lesions. Sputum was collected in 205 (54.8%) of 374 patients. There were 154 (75 %) metaplasia, 14 (6%) moderate dysplasia, and one (0.4%) malignant case. CONCLUSION LDCT increases early lung carcinoma detection rate in COPD patients, but pulmonary function impairment may reduce its benefit.
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Affiliation(s)
- A Cilli
- Akdeniz University School of Medicine, Department of Respiratory Diseases, Antalya, Turkey
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Ozbudak O, Ogus C, Saba R, Turkay C, Sahin N, Ozbilim G, Kiliçarslan B. The effects of recurrent Pseudomonas aeruginosa infection on pulmonary parenchyma and vasculature in rats fed on a cholesterol-rich diet. Exp Lung Res 2006; 32:275-85. [PMID: 17060172 DOI: 10.1080/01902140600880240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It has been demonstrated that both hypercholesterolemia and infectious agents are contributing factors in atherosclerosis but their combined effect on the pulmonary vascular bed is not known. To answer this question, the authors tried to demonstrate the effects of recurrent infection on pulmonary parenchyma and vascular system in cholesterol-fed rats. Sixty-six rats were randomly divided into 4 groups: Groups I (control), II (cholesterol-rich diet), III (recurrent pulmonary Pseudomonas aeruginosa infection), IV (cholesterol-rich diet + recurrent infection). After 6 months serum cholesterol levels didn't increase in any of the groups. Central pulmonary artery wall thickness was increased in group IV (P < .0001). Although not significant, peripheral pulmonary artery wall thickness was increased in group IV. In rats fed on a cholesterol-rich diet, recurrent infection caused a significant increase in atherosclerosis, although serum cholesterol levels didn't increase. Infection and cholesterol-rich diet have a synergistic effect on atherosclerosis in the pulmonary vascular system in rats even in the absence of hypercholesterolemia.
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Affiliation(s)
- Omer Ozbudak
- Department of Respiratory Diseases, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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Ongut G, Ogunc D, Gunseren F, Ogus C, Donmez L, Colak D, Gultekin M. Evaluation of the ICT Tuberculosis test for the routine diagnosis of tuberculosis. BMC Infect Dis 2006; 6:37. [PMID: 16504161 PMCID: PMC1402301 DOI: 10.1186/1471-2334-6-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 02/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid and accurate diagnosis of tuberculosis (TB) is crucial to facilitate early treatment of infectious cases and thus to reduce its spread. To improve the diagnosis of TB, more rapid diagnostic techniques such as antibody detection methods including enzyme-linked immunosorbent assay (ELISA)-based serological tests and immunochromatographic methods were developed. This study was designed to evaluate the validity of an immunochromatographic assay, ICT Tuberculosis test for the serologic diagnosis of TB in Antalya, Turkey. METHODS Sera from 72 patients with active pulmonary (53 smear-positive and 19 smear-negative cases) and eight extrapulmonary (6 smear-positive and 2 smear-negative cases) TB, and 54 controls from different outpatient clinics with similar demographic characteristics as patients were tested by ICT Tuberculosis test. RESULTS The sensitivity, specificity, and negative predictive value of the ICT Tuberculosis test for pulmonary TB were 33.3%, 100%, and 52.9%, respectively. Smear-positive pulmonary TB patients showed a higher positivity rate for antibodies than smear-negative patients, but the difference was not statistically significant. Of the eight patients with extrapulmonary TB, antibody was detected in four patients. CONCLUSION Our results suggest that ICT Tuberculosis test can be used to aid TB diagnosis in smear-positive patients until the culture results are available.
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Affiliation(s)
- Gozde Ongut
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Dilara Ogunc
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Filiz Gunseren
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Candan Ogus
- Department of Respiratory Medicine, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Levent Donmez
- Department of Public Health, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Dilek Colak
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Meral Gultekin
- Department of Medical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
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Dinmezel S, Ogus C, Erengin H, Cilli A, Ozbudak O, Ozdemir T. The prevalence of asthma, allergic rhinitis, and atopy in Antalya, Turkey. Allergy Asthma Proc 2005; 26:403-9. [PMID: 16450576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Bronchial asthma is a common chronic inflammatory disorder of the airways that causes serious morbidity and mortality. The prevalence of the disorder has been increasing, especially in developed countries. The population-based asthma prevalence studies provide data from Ankara, Istanbul, Gaziantep, Trabzon, Izmnir, and Kayseri in our country and asthma prevalence ranges between 1.4 and 3%. However, the prevalence of adult asthma in our city was not known. We aimed to determine the prevalence of asthma, allergic rhinitis, and atopy in the adult population of Antalya and compare the data with other countries and other regions of our country. The European Commission Respiratory Health Survey, the first study to assess the geographical variation in asthma and allergic diseases, provided comparable data from 22 countries and 140,000 individuals. Therefore, the European Commission Respiratory Health Survey protocol was preferred in our study. The first stage consisted of 1000 subjects; of these 1000 subjects, 200 subjects were randomly selected for the second stage. The response rates were 99.5 and 55.4% for stages I and II, respectively. The current prevalence of asthma, allergic rhinitis, and atopy in Antalya was 9.4, 27.7, and 31.1%, respectively. The most prevalent type of sensitization was mite allergy detected in 31 (20.9%) subjects. Sensitization to more than one allergen was frequent in subjects with asthma and allergic rhinitis. Bronchial asthma, allergic rhinitis, and atopy are frequent in our city and when compared with previous studies performed in Turkey, the highest results were in Antalya.
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Affiliation(s)
- Semra Dinmezel
- Department of Chest Medicine, Akdeniz University Medical Faculty, Antalya, Turkey
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Uslu A, Ogus C, Ozdemir T. A 22-year-old woman with pleural effusion. Respiration 2004; 71:424-7. [PMID: 15316221 DOI: 10.1159/000079652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2002] [Accepted: 06/03/2003] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ahmet Uslu
- Department of Chest Diseases, University of Akdeniz, Antalya, Turkey.
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Affiliation(s)
- S Dinmezel
- Akdeniz Universitesi Tip Fakültesi Gögüs Hastaliklari Anabilim Dali 100, Antalya, Turkey
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