Picturing asthma in Turkey: results from the Turkish adult asthma registry

INTRODUCTION

National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention.

METHODS

Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes.

RESULTS

The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions.

CONCLUSION

The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Changes in the Number of Newly Diagnosed Lung Cancer Patients Before and During the COVID-19 Pandemic: A Single-Center Experience

OBJECTIVE:

The coronavirus disease-2019 pandemic has affected the entire health system and patients other than coronavirus-infected patients. Hospital admissions of cancer patients decreased during the closure periods due to the pandemic. This study was conducted to determine whether there was an effect on the hospital admissions of newly diagnosed lung cancer patients in Turkey during the coronavirus disease-2019 pandemic.

MATERIAL AND METHODS:

In this retrospective study, newly diagnosed lung cancer patients were recorded from the Hospital Information Management System between January 1, 2017, and December 31, 2020, at our tertiary hospital. The number of newly diagnosed lung cancer patients diagnosed in 2020 was compared with each year from 2017 to 2019.

Results:

Between 2017 and 2020, 15 150 newly diagnosed lung cancer cases were analyzed. According to Global Cancer Observatory data, in 2018, 34 703 newly diagnosed lung cancer cases, and in 2020, 41 264 newly diagnosed lung cancer cases were observed in Turkey. Although a decrease was not observed in the number of patients according to Global Cancer Observatory data, both the total number of patients admitted to our hospital and the number of newly diagnosed lung cancer patients decreased in 2020. The number of newly diagnosed lung cancer patients by year was 4030 patients in 2017, 4004 patients in 2018, 4391 patients in 2019, and 2725 in 2020, respectively. In 2020, newly diagnosed lung cancer patients decreased by 38%, 32%, and 32% compared to 2019, 2018, and 2017, respectively. Also, a significant decrease was seen in the number of newly diagnosed lung cancer patients in the months with closure due to the pandemic compared to the months without closure.

Conclusion:

There was a significant decrease in hospital admissions of newly diagnosed lung cancer cases in the coronavirus disease-2019 pandemic in our referral hospital. Precautions should be considered to diagnose and treat lung cancer patients in specialized centers during a pandemic due to epidemic diseases such as coronavirus disease-2019.

Dopamine D4 Receptor Gene Exon III VNTR Variant Influences Smoking Status in Turkish Population

Introduction

Dopaminergic gene variants may affect nicotine dependence through their possible impact on the dopamine reward pathway. The purpose of this study is to investigate the relationship between the variable number tandem repeat (VNTR) variant in exon III of the Dopamine D4 receptor (DRD4) gene and genetic predisposition of smoking status in a Turkish population.

Methods

We performed a study comparing 154 subjects as the smoker group, and 111 subjects as the non-smoker group. Genotyping for the DRD4 VNTR variant was performed using a PCR method.

Results

There was a significant difference between smoker and non-smoker groups regarding the distribution of the alleles and genotypes of the DRD4 gene (p=0.000, p=0.000, respectively). The 2R allele was higher in the non-smoker group compare to the smoker group (p=0.000). We found that the 2/7 and 4/9 genotypes were more common in smokers than non-smoker group (p=0.037, p=0.028, respectively) while 2/4 genotype was more prevalent in non-smokers than smokers (p=0.000). When the number of repeat alleles (48 bp) are accepted as short (S) if six or less, and as long (L) if seven or more, it was found that the frequency of S/S genotype of the DRD4 VNTR variant was lower in the smoker group and S/L genotype was higher in the smoker group (p=0.006, p=0.006, respectively). The subjects carrying the S/L genotype have a 2.25-fold increased risk for smoking than a non-smoker.

Conclusion

The results indicated that the subjects carrying DRD4 exon III VNTR S/L genotype have a risk for smoking status in a Turkish population.

An elderly patient and an adult patients with isolated unilateral pulmonary arterial hypoplasia: Two cases reports and literature review of the literature

Unilateral hypoplasia of a pulmonary artery (UHPA) is a rare condition that is usually associated with cardiac anomalies in childhood. In the absence of cardiac anomalies, patients may not be diagnosed until respiratory symptoms develop. We present two patients who were diagnosed as having isolated unilateral right pulmonary artery hypoplasia, one a woman aged 80 years, the other, a man aged 55 years. To our knowledge, woman is the oldest patient with UHPA in the English medical literature. Awareness of this condition may contribute to the early recognition of these cases and planning of appropriate treatment.

The Adverse Effects and Treatment Results of Smoking Cessation Pharmacotherapy During Fasting/Non-Fasting State

BACKGROUND

Cigarette smoking is one of the most common addictions worldwide. Muslim smokers reduce the number of cigarettes they smoke during Ramadan due to the long fasting hours.

OBJECTIVES

We aimed to share our experience in a smoking cessation clinic during Ramadan by analyzing the efficacy and adverse effects of once-daily dosing of bupropion or varenicline in a fasting group compared with conventional dosing in a non-fasting group.

METHODS

We analyzed 57 patients who attended our smoking cessation clinic during Ramadan of 2014 and 2015, and at least one follow-up visit. For the fasting patients, we prescribed bupropion or varenicline after dinner (once daily) as the maintenance therapy. We recorded demographic characteristics of the patients, fasting state, drugs taken for smoking cessation, and the dosage of the medication. At the first follow-up visit, adverse effects seen with the treatment were recorded. We conducted telephone interviews 6 months after the first visits of the patients to learn the current smoking status of the groups.

RESULTS

Of the total 57 patients, 20 (35.1%) were fasting and 37 (64.9%) were not fasting. Fasting and non-fasting patients were similar for sex, age, smoking pack-years, marital status, educational status, and mean Fagerström scores (p >.05). Adverse effects and quit rates after 6 months of follow-up were similar between the fasting and non-fasting groups (p >.05).

CONCLUSION

Although our sample size was small, we found no difference in the rates of adverse effects or smoking cessation using a single daily oral dose of bupropion or varenicline between a fasting group and a non-fasting group that received conventional dosing.

Does Short Message Service Increase Adherence to Smoking Cessation Clinic Appointments and Quitting Smoking?

BACKGROUND

Using innovative and scientific methods increases the rate of quitting in smokers. Short message service (SMS) is a communication tool widely used and well integrated in many people's daily lives. To increase adherence to appointments in smoking cessation clinics (SCC), it is thought that increased compliance could be achieved by falling outside the traditional methods. SMS has been shown to increase the compliance of patients with SCC appointments.

AIMS

In this study, we aimed to evaluate the effect of SMS in the compliance of patients with SCC follow-up visits and smoking cessation success.

STUDY DESIGN

Case-control study.

METHODS

Our study was a controlled, open, prospective study. We enrolled 436 cases applied to SCC of Yedikule Training and Research Hospital between 01.10.2013-30.06.2014 and agreed to follow-up with SMS. SMS was sent to the patients to remind them of appointments at the SCC and to query their smoking state.

RESULTS

Two hundred-and-eighty seven (65.8%) of the patients were male and 149 (34.2%) were female. The mean age was 45±12 years. In this study, 296 (67.9%) patients had graduated from primary school. Our patients' smoking state was queried by telephone at the 6-month follow-up and we contacted 348 patients. According to this, 88 (25.3%) patients were not smoking, and 260 (74.7%) patients were smokers. Therefore, the smoking cessation rate was 24% (n=60) in patients who did not respond to SMS reminders at all, and 28.6% (n=28) in patients answering any SMS at least once (p=0.377). Smoking cessation rate of the patients invited by SMS but who did not attend any control visits was 19.1%, and it was 34.5% in patients coming to a control visit at least once. This difference was statistically significant (p=0.001).

CONCLUSION

In our study, there was increased success of smoking cessation in patients coming to control visits. We think that this may result from the possibly increased compliance to SCC appointments following reminders by SMS, and that this may also increase smoking cessation success.

Psychometric properties of the Turkish version of the Fagerström test for nicotine dependence

INTRODUCTION

The Fagerström Test for Nicotine Dependence (FTND), modified from Fagerström Tolerance Questionnairre (FTQ), is used to determine whether a smoker trying to quit will need nicotine replacement therapy to treat with drawal symptoms. The FTND has been translated into many languages and has been referred to in the smoking literature worldwide. However, only a few studies have examined the psychometric propertiesof the non-English FTND versions. This study aimed to assess the psychometric properties of the Turkish version of the FTND.

MATERIALS AND METHODS

Confirmatory factor analysis (CFA) was used to test the factor structure of the Turkish version of the questionnaire using a large sample from two smoking cessation clinics in Istanbul, Turkey. Our study comprised 502 smokers who entered one of these smoking cessation clinics between October 1 and December 31, 2011. All subjects gave informed consent to the study. We assessed the validity of the FTND using CFA, and we calculated Cronbach's alpha coefficients to determine reliability.

RESULT

One-factor CFA included all of the items on the FTND. All items loaded on this factor with a score of 0.40 or higher. The goodness of fit statistics were adequate, with a Comparative Fit Index (CFI) of 0.922, a Tucker-Lewis Index (TLI) of 0.902, and a root-mean-square error of approximation (RMSEA) of 0.081. Two-factor CFA comprised the three "morning smoking" items, and the three "smoking pattern" items. The factor loadings and the goodness-of-fit statistics confirmed that the FTND has a two-factor structure.

CONCLUSIONS

Analyses confirmed that the Turkish version of the FTND has a two-factor structure with moderate reliability. This study found that using a total score as an estimate of nicotine dependence may limit the assessment of specific smoking dependency and tailoring intervention approaches. We suggest that a two-factor FTND in clinical practice would more accurately determine the nicotine dependence of patients.

Factors related to depression and anxiety in adults with bronchiectasis

INTRODUCTION AND BACKGROUND

Patients with chronic lung diseases frequently have depressive and anxiety symptoms, but there are very few studies looking at this in patients with bronchiectasis.

AIM

This study aimed to investigate depression and anxiety and related factors among patients with non-cystic fibrosis bronchiectasis.

PATIENTS AND METHODS

This was a prospective study of 133 patients with bronchiectasis. Patients with confirmed diagnosis of bronchiectasis with high-resolution computed tomography were enrolled in the study. Patients that were clinically stable in the previous 4 weeks were evaluated with the Hospital Depression and Anxiety scale. Symptoms, pulmonary function tests, and medical treatments were recorded.

RESULTS

The mean age of patients was 49.5±14.5 years (range, 18-77 years), and 81 (60.9%) patients were females. Twenty-eight (21.1%) patients had depression, and 53 (39.8%) had anxiety. Depression score was related to family situation (living with a partner), previous depression history and admission to an emergency department within the last year. Anxiety score was related to female gender, the family situation (living with a partner), previous depression history, and admission to an emergency department within the last year (P<0.05). Depression was positively correlated with hemoptysis, admission to an emergency department within the last year and living with a partner. Anxiety was positively correlated with education level, previous depression history, admission to an emergency department within the last year, and living with a partner.

CONCLUSION

Patients with non-cystic fibrosis bronchiectasis are at increased risk for depression and anxiety. Untreated and undetected depressive/anxiety symptoms may increase physical disability, morbidity, and health care utilization. It is important for clinicians to be aware of the presence of depression and anxiety in bronchiectasis.

Asthma control test via text messaging: could it be a tool for evaluating asthma control?

INTRODUCTION

Originally, the Asthma Control Test (ACT) was designed for English-speaking patients using a paper-and-pencil format. The Turkish version of the ACT was recently validated. This article compares the paper-and-pencil and web-based texting formats of the Turkish version of the ACT and evaluates the compatibility of these ACT scores with GINA-based physician assessments of asthma control.

METHODS

This multicentre prospective study included 431 asthma patients from outpatient clinics in Turkey. The patients were randomized into a paper-and-pencil group (n = 220) and a text messaging group (n = 211). Patients completed the ACT at Visit 1, after 10 ± 2 days, and at 5 ± 1 week to demonstrate the reliability and responsiveness of the test. At each visit, physicians assessed patients' asthma control levels.

RESULTS

The ACT administered via texting showed an internal consistency of 0.82. For the texting group, we found a significant correlation between the ACT and physician assessments at Visit 1 (r = 0.60, p < 0.001). The AUC was 0.87, with a sensitivity of 78.0% and a specificity of 77.5% for a score of ≤19 for screening "uncontrolled" asthma in the texting group.

CONCLUSION

When the Turkish version of the ACT was administered via either the paper-and-pencil or text messaging test, scores were closely associated with physician assessments of asthma control.

Determinants of asthma control in tertiary level in Turkey: a cross-sectional multicenter survey

OBJECTIVE

Recent data demonstrate that control of asthma is far from optimal worldwide. The aim of this study was to evaluate the level of asthma control in tertiary health services by the use of Asthma Control Test (ACT) and to assess the factors which might influence the control of the disease.

METHODS

A total of 2336 patients with asthma were recruited from 28 tertiary hospitals in the study. Asthma severity was classified by the frequency of asthma symptoms, pulmonary function tests, and medication requirements according to asthma guidelines. The level of asthma control was assessed by the Turkish version of ACT and determinants of asthma control were evaluated with medical history, physical examination, patients' and disease characteristics.

RESULTS

Due to missing data, 1188 subjects' records were evaluated. Nearly half of the patients (51.5%) were found to be "controlled" (ACT > or =20) and 48.5% was defined as "uncontrolled" (ACT < 20). The ratio of uncontrolled asthmatic patients was significantly higher in severe asthmatics than in mild and moderate asthmatics (p < .01). Female sex, education below secondary level, forced expiratory volume in one second (FEV(1)) value <80%, peak expiratory flow (PEF) value <80%, hospitalization/emergency department visits in the last year, and systemic steroid use were found to be significantly associated with inadequate control (p < .01).

CONCLUSIONS

This study demonstrated that asthma control was still inadequate in the tertiary level although overall control was better than previous reports in Turkey. Patients with severe asthma were more likely to have uncontrolled disease; worse asthma control was also associated with increased hospitalizations and emergency care admissions.

Fire-eater's pneumonia characterized by pneumatocele formation and spontaneous resolution

Liquid hydrocarbons derived from petroleum are widely used in industry and in households. Aspiration of massive amounts may lead to an acute and fatal form of exogenous lipoid pneumonia (fire-eater's pneumonia). We present a rare case of chemical pneumonitis following accidental lamp oil aspiration characterized by pneumatocele formation and spontaneous resolution. Initial findings on posteroanterior chest radiographs were smoothly circumscribed lower zone masses with and without air-fluid levels. Chest computed tomography also showed multiple thin-walled cavities with and without air-fluid levels. Complete resolution of findings despite initial severe presentation without corticosteroid or antibiotic treatment is noteworthy.

Smoking habits among physicians in Istanbul and their attitudes regarding anti-smoking legislation

The purpose of this study was to analyze smoking related beliefs, attitudes and knowledge on anti-smoking legislation among physicians practicing in Istanbul, Turkey. Questionnaires were sent to 18.000 physicians who were also members of Istanbul Chamber of Medicine. Three hundred-seventy and four physicians responded. Two hundred-fifty of the respondents were males (66.8%) and 124 were females (33.2%). Sixty out of 374 physicians were smokers. Eighteen of them (30%) were females, 42 of them (70%) were males. 91.5% of physicians who smoked tobacco and 98.4% of non-smoker physicians agreed that smoking is a serious health issue. 91.1% of nonsmoker physicians and 70.7% of smokers asked their patients about their smoking habits. The difference between smokers and non-smokers was statistically significant in both comparisons (p= 0.012 and p= 0.00, respectively). 25% of smoking physicians and 34.5% of non-smokers referred their patients to smoking cessation centers. 21.7% of smoking physicians and 28.8% of non-smokers believed in the success of pharmacological therapy. The difference between smokers and non-smokers was statistically non significant (p= 0.167 and p= 0.262, respectively). This results suggests that physicians have insufficient knowledge on smoking cessation therapies and the law regarding the use of tobacco and that smoking cessation techniques should be incorporated in the curriculum of the faculties and post graduation training programs.

[Comparison of computed tomography and magnetic resonance imaging to diagnose brain metastasis in non-small cell lung cancer]

To investigate the value of simultaneously obtained brain computed tomography (CT) and magnetic resonance imaging (MRI) to diagnose brain metastasis in non-small cell lung cancer (NSCLC) patients with or without neurological symptoms. Sixty-two patients (58 male, 4 female) who were admitted to Yedikule Chest Hospital and Thoracic Surgery Center between January 2000-December 2003 and whom were diagnosed with NSCLC were included in the study. Ages of patients varied between 40-85 (61 +/- 11). All patients had hemogram and routine blood chemistry as well as chest X-ray, thorax CT, brain CT, brain MRI, FOB and a complete neurological exam. Brain metastasis were detected in 22 of 62 (35.5%) patients by using brain MRI and 16 (72.7%) of these hadn't had any neurological symptoms or signs. The difference to detect the brain metastasis between brain MRI and CT was statistically significant (p < 0.01). Nine of the 22 cases (14.5%) who were found to have brain metastasis by using MRI were stage I. While brain CT showed solitary brain metastasis in five patients, 4 (80%) of them were found to have multiple metastases when MRI studies were used. We concluded that, in an attempt to make correct staging and treatment of NSCLC and hence to investigate the brain metastasis in NSCLC patients including early stage ones, brain MRI is superior to brain CT study.