Turkish Thoracic Journal最新文献

Objective: Respiratory disease is the major cause of morbidity and mortality in patients with alpha-1 antitrypsin deficiency, mainly in homozygous PI*ZZ individuals. However, this association is uncertain in subjects with other deficiency genotypes. The objective of this study was to assess, in the context of alpha-1 antitrypsin deficiency, the existence of further risk factors that have been associated with respiratory diseases.

Material and methods: Lung function was assessed by spirometry in a sample of 1334 patients with a known genotype for the SERPINA1 gene whose serum alpha-1 antitrypsin levels had been previously determined. Patients with a normal genotype (PI*MM) were compared to 389 patients carrying a deficiency allele.

Results: Statistically significant associations were detected between (i) PI*ZZ genotype and abnormal FEV1 values (χ2 = 26.45; P <.0002), FEV1/FVC (χ2 = 14.8; P < .02) or forced mid-expiratory flow 25%-75% (χ2 =22.66; P < .0009); (ii) chronic obstructive pulmonary disease and PI*ZZ odds ratio: 26.5; 95% CI: (2.6-265.9); P <.005 and or PI*SS genotype odds ratio: 9; 95% CI: (2-40.1); P < .004; (iii) prevalence of COPD in PI*MZ subjects and smoking habit (P < .01), low body weight (P < .01) or older age (P < .0001).

Conclusion: The PI*ZZ and PI*SS genotypes seem to be associated with the prevalence of chronic obstructive pulmonary disease. Tobacco use, low body weight, and older age are risk factors that increase the probability of prevalence of chronic obstructive pulmonary disease by up to 70% in PI*MZ individuals.

Objective: This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women.

Material and methods: A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated.

Results: Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001).

Conclusion: Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.

Pneumoconiosis is a lung disease that develops as a result of a tissue reaction that occurs with the accumulation of inorganic particles. Pathoclinical features may vary depending on the type of inhaled particle. Today, fibrotic and nonfibrotic tissue reactions are well defined in some substances. For example, it is known that exposures such as silica, asbestos, beryllium, and talc are associated with fibrosis in the lung, while exposures such as iron, tin, and barium sulfate cause non-fibrogenic changes. However, the pathoclinic and radiological findings of some rare exposures such as zirconium are not widely known. In a 52-year-old dental technician with a 26-year history of zirconium exposure, more prominent parenchymal emphysematous and fibrotic changes were detected in the upper zones of the thorax high-resolution computed tomography. Since zirconium exposure was clearly defined, radiological findings of this case may be useful to current literature.

Objective: Health hazards of e-cigarettes including "e-cigarette or vaping product use-associated lung injury" are better understood today. Just as e-cigarettes, heated tobacco products release toxic emissions. We aimed to determine the knowledge and attitude about new generation tobacco products among physicians who were the members of an organization for health care professionals, the majority of whom are pulmonologists.

Material and methods: In this cross-sectional study, a self-administered online questionnaire-based survey was conducted among the physicians from April to October 2019. The survey included questions about demographics (gender, age, graduation date from medical institution, and academic title), their smoking status, their knowledge and attitudes toward new generation tobacco products, and additionally about whether new generation tobacco products can be used to aid in smoking cessation.

Results: Among the 506 members who responded to the survey, 56.7 % were female; the mean age was 42.4 ± 10.9 years (20-74). About 74.5% were pulmonologists, 5.5% were thoracic surgeons, and 20% were other physicians. Among the responders, the frequency of those who have not heard of new generation tobacco products before was determined as 9.5%, 24.5%, and 41.3%. At least 58.9% of participants lacked the knowledge necessary to discuss these products with their patients and the rate reached 76.7% for the heated tobacco product. To the question of whether new generation tobacco products can be used in smoking cessation, 68.4% responded "I never agree that they can be used." Non-current smokers (P = .003), elders (P = .001), those who had training on smoking cessation assistance (P = .001), and those who had experience in smoking cessation assistance (P = .009) were significantly more prevalent in the group who answered: "I never agree that they can be used."

Conclusion: Physicians must become considerably more knowledgeable about the new generation tobacco products and hazards. Otherwise, these new tobacco products may pose new threats to national and global tobacco control efforts.

Objective: Our study aimed to evaluate clinical, functional, and prognostic features and to determine the prognosis of idiopathic pulmonary fibrosis, connective tissue disease-associated interstitial lung diseases, and interstitial pneumonia with autoimmune features.

Material and methods: Sixty-nine cases with interstitial lung diseases were recruited in this study prospectively. Demographic features, symptoms, radiological findings, functional measurements, and immunological markers were recorded twice (at the time of initial admission and in the 12th month). Twenty-four of 69 cases were idiopathic pulmonary fibrosis, 32 were connective tissue diseaseassociated interstitial lung diseases, and 13 were interstitial pneumonia with autoimmune features .

Results: Most of the patients with idiopathic pulmonary fibrosis were male, while there were more female patients in connective tissue disease-associated interstitial lung diseases and interstitial pneumonia with autoimmune features groups. Female patients (65.0%) predominated in connective tissue disease-associated interstitial lung diseases group (P <.001). There was no significant difference in the mean ages of the disease groups, yet connective tissue disease-associated interstitial lung diseases patients were generally younger (min- max: 34-82 years). In the idiopathic pulmonary fibrosis group, only low titers of antinuclear antibody positivity were found. Antinuclear antibody positivity in the connective tissue disease-associated interstitial lung diseases group and interstitial pneumonia with autoimmune features group was high (P = .001). The long-term survival of idiopathic pulmonary fibrosis, connective tissue disease-associated interstitial lung diseases, and interstitial pneumonia with autoimmune features patients were 37%, 40 months (median) (95% CI, 5.193- 74.807), 48.6%, 80 months (median) (95% CI, 57.032-102.968), 30.8%, 46 months (median) (95% CI, 26.624-65.376), respectively.

Conclusion: Although a consensus report describing interstitial lung diseases with autoimmune features has been published, diagnostic criteria for this group are still vague. Since the interstitial pneumonia with autoimmune features group had the worst results in terms of functional loss and survival rates, the follow-up parameters and follow-up algorithm should be established for this group. Clinical and immunological evaluation of the interstitial pneumonia with autoimmune features group should include detailed parameters because of follow-up and to estimate survival.

Objective: The purpose of this study was to determine the prevalence of nonalcoholic fatty liver disease in a group of chronic obstructive pulmonary disease patients.

Material and methods: This study comprised 48 stable chronic obstructive pulmonary disease patients who were diagnosed and categorized using the Global Initiative for Chronic Obstructive Lung Disease 2017 criteria. The prevalence of nonalcoholic fatty liver disease in chronic obstructive pulmonary disease patients was determined using noninvasive biomarkers and imaging methods. Steatosis was detected using magnetic resonance mDIXON-Quant sequence imaging, while fibrosis was detected using the acoustic radiation force impulse and FIB-4 index.

Results: A total of 58.3% of the patients investigated had a fat level of 5%, and nearly a quarter of them had a fat content of 10% or more, and 45.8% of the patients studied had severe hepatic fibrosis. The Fibrosis-4 (FIB-4) index revealed advanced fibrosis in 18.75% of them. No statistically significant association was found between chronic obstructive pulmonary disease groups of studied patients and the presence of steatosis and fibrosis (≥F2) using acoustic radiation force impulse. The presence of fibrosis, however, was statistically significant linked with chronic obstructive pulmonary disease groups of examined patients using the FIB-4 index. γ-Glutamyl transferase and alkaline phosphatase levels were greater in Global Initiative for Chronic Obstructive Lung Disease 3/4 and C/D groups.

Conclusion: Nonalcoholic fatty liver disease is a common comorbidity in chronic obstructive pulmonary disease and should be included in the list of chronic obstructive pulmonary disease comorbidities.

Objective: The criteria of hypopnea recommended by the American Academy of Sleep Medicine until 2012 was 3% desaturation and 50% decline in the signal amplitude. The recommended and alternative criteria for hypopnea were determined as 3% desaturation accompanied by a 30% decline in the signal amplitude and 4% desaturation accompanied by a 30% decline in the amplitude by the 2013 update of the guideline was published by the American Academy of Sleep Medicine in 2012. The objective of our study was to investigate to what degree scoring of hypopneas has great importance in the diagnosis and severity grading of obstructive sleep apnea syndrome according to different criteria.

Material and methods: The present study was designed as a retrospective study in which the results of the polysomnography of 62 patients were recorded after evaluation according to 3 different hypopnea criteria. Criteria 1, criteria 2, and criteria 3 were accepted as a 3% drop in SaO2 accompanied by a 30% decline in the amplitude, as a 4% drop in SaO2 accompanied by a 30% decline in the amplitude, and as a 3% drop in SaO2 accompanied with a 50% decline in the amplitude, respectively.

Results: Statistically significant differences were determined between criteria 1 and criteria 2, criteria 1 and criteria 3, and criteria 2 and criteria 3 regarding the numbers of hypopneas.

Conclusion: For the same polysomnography, evaluations with different accepted hypopnea criteria cause different polysomnography results.

Objective: The most appropriate ventilatory mode during fiberoptic bronchoscopy is still not yet known clearly for patients with acute respiratory distress syndrome. Airway pressure release ventilation is used as a recovery treatment for patients with severe acute respiratory distress syndrome. In this study, the aim was to evaluate the safety of the fiberoptic bronchoscopy process in patients with severe acute respiratory distress syndrome ventilated with airway pressure release ventilation mode and its effect on gas exchange and respiratory mechanics.

Material and methods: Single-center retrospective observational study was performed in the intensive care unit of a tertiary referral center from September 2018 to November 2019. Patients with severe ARDS ventilated with APRV mode and undergoing FB were included. Fiberoptic bronchoscopy was performed by an expert intensivist-pulmonologist. All ventilator parameters set by the clinician were kept stable, and no change was made other than O2 concentration. The mechanical ventilation parameters and arterial blood gas values before and after the procedure and fiberoptic bronchoscopy-related complications were recorded for the first 24 hours.

Results: A total of 14 acute respiratory distress syndrome patients who were ventilated with airway pressure release ventilation were enrolled. No significant deteriorations were detected in gas exchange, pulmonary compliance, and airway resistance values in our case series. It was observed that a small reduction in PaO2 and an increase in PaCO2 were present after the 1st hour; however, both were returned to baseline values in the 24th hour. Only 1 patient developed fiberoptic bronchoscopy-induced hypoxemia (7.1%). Complications, such as fiberoptic bronchoscopy-induced barotrauma, pneumothorax, hemodynamic deterioration, and bleeding, were not detected.

Conclusion: According to our preliminary findings, performing fiberoptic bronchoscopy under airway pressure release ventilation mode by an experienced bronchoscopist does not bring additional complication risks in patients with severe acute respiratory distress syndrome.

Objective: It is still unknown how to call the pneumothorax that develops during the recovery period after coronavirus disease 2019. Patients who developed pneumothorax during the recovery period after coronavirus disease 2019 were compared with those who had a primary or secondary spontaneous pneumothorax without a coronavirus disease 2019 history.

Material and methods: Between 2020 and 2021, 160 patients with pneumothorax were retrospectively analyzed. Twenty-three patients had a history of coronavirus disease 2019 (coronavirus disease recovery) confirmed by real-time reverse transcriptase-polyme rase chain reaction, whereas the remaining 137 patients did not have a history of coronavirus disease 2019 (18 of the patients with secondary spontaneous pneumothorax group and 119 patients with primary spontaneous pneumothorax group).

Results: The median time between discharge and readmission to the hospital because of pneumothorax was 9 days in the coronavirus disease recovery group. There were statistically significant differences in regards to age (P < .001), gender (P = .02), the presence of bullae (P = .02), and dystrophic severity lung score (P = .04) between the coronavirus disease recovery and primary spontaneous pneumothorax groups, whereas no difference was found between the coronavirus disease recovery and the secondary spontaneous pneumothorax groups (P > .05). The prolonged air leak was observed in 17.6% (n = 25). Patients who had prolonged air leak were statistically higher in the coronavirus disease recovery group than the primary spontaneous pneumothorax group (56.5% vs. 10.1%), although it was almost similar between the coronavirus disease recovery and secondary spontaneous pneumothorax groups (P = .951). On logistic regression analysis, the coronavirus disease recovery group was the independent factor for prolonged air leak (odds ratio = 9.900, 95% CI = 1.557- 62.500, P = .01).

Conclusion: Pneumothorax may be developed during the recovery period after coronavirus disease 2019 in patients with previously healthy lungs, and it should be called as secondary spontaneous pneumothorax.