Turkish Thoracic Journal最新文献

Objective: Turkey has recently adopted the regulation of plain and standard packaging for tobacco products and introduced newly designed combined health warnings. In this study, we aimed to reveal how the new combined health warnings are perceived among medical students.

Material and methods: The study was descriptive and the data were collected by a 3-part questionnaire. The first part covered demographic characteristics, the second part was designed to measure the saliency of the combined health warnings, and the third part evaluated their effect on the motivation to quit.

Results: Out of 484 students of medicine, 287 (59%) were included in the study; 54.4% of the participants were female and 45.6% were male; and the average age was 21.18 ± 1.94 years. There were 79 (27.5%) smokers and the mean duration of smoking was 39.07 ± 24.07 months. The combined health warning that reads "Smoking causes laryngeal cancer" had the highest score both in terms of saliency and motivation to quit smoking. The one that reads "Protect children: don't let them inhale your smoke" had the lowest score in both categories. Non-smokers found the stimuli more effective than smokers and quitters (P > .05).

Conclusion: The findings point out that smoking rate is unexpectedly high among participants, and medical students perceived the warnings emphasizing the physical deformities caused by tobacco products on individuals as more effective than combined health warnings aimed at protecting "others." This study suggests that the combined health warnings should be selected in a more nuanced way for different target groups.

Fetal programming is a mechanism whereby stimuli acting on the developing fetus influence the development of the fetus in a way that may set the stage for adult health and disease. These stimuli may be environmental, such as maternal smoking; metabolic, such as the maternal diet and nutrition; or endocrine, such as diabetes or stress, and may extend over several generations. The endocrine system influences fetal programming with effects of insulin, thyroid hormones, and glucocorticoid hormones. Epigenetic information may be modified by DNA methylation, histone modifications, and micro RNAs due to environmental exposures. In this review, we describe the normal development of the lungs and the major factors that may influence lung growth and development with the potential for sequelae into adult life.

Objective: Various studies have suggested that obstructive sleep apnea (OSA) affects bone metabolism. One of the most significant factors is hypoxia which induces certain transcription factors that stimulate bone osteoclastic activity. It also induces respiratory acidosis and oxidative stress which enhances bone resorption. Leptin and melatonin secretions are regulated by the circadian system which is affected due to sleep fragmentation in OSA. Other comorbidities associated with OSA such as vitamin D deficiency, hypogonadism, obesity, and insulin resistance are indirect mechanisms that affect bone mineral density (BMD).

Material and methods: This is a prospective case-control study. All patients having symptoms of sleep-related breathing disorder (excluding post-menopausal females or patients with known case of osteoporosis or any other clinical illness which is a direct cause of osteoporosis) attending the Sleep Out Patient Department (OPD) were screened for OSA as per the STOPBANG questionnaire scoring system. Participants having score >2 constituted the final study population and were subjected to the polysomnography test. Participants with an apnea-hypopnea index (AHI) > 5 in polysomnography were considered as cases and those with AHI <5 were considered as controls. Both the groups were then subjected for dual-energy X-ray absorptiometry (DEXA) scan and vitamin D to establish a comparison.

Results: Out of 93 participants, 59 were taken as cases (OSA group), whose mean age was 48.02 (±8.435) years, mean body mass index (BMI) was 33.73 (±7.48) kg/m2, mean neck circumference was 37.8 cm (±5.08) as compared with the age, sex, and BMI matched non-OSA control group (n = 34). Mean BMD in the case group was found to be significantly on the lower side as compared with the control group (-2.02 ± 1.09 vs. -1.03 ± 0.97) (P < .001) when compared in Z score, while (0.885 ± 0.535 vs. 0.933 ± 0.616) when compared in g/cm2 (P < .001), with negative correlation between AHI and BMD (r = -0.507, P < .001). Mean vitamin D level in the case group was at a lower level as compared to the control group (21.02 ± 7.27 vs. 24.48 ± 6.92, P < .05), with negative correlation between AHI and serum vitamin D level (P < .001, r = -0.286).

Conclusion: OSA affects BMD by various pathophysiologic mechanisms. The AHI is inversely correlated with BMD; that is, with increasing severity of OSA, there is a decrease in BMD.

Objective: To determine the effects of tobacco use on the lungs before respiratory symptoms or basic functional disorders occur.

Material and methods: Forty-six active smokers between June 2018 and June 2019 who did not have any respiratory complaints, had no lung or chronic disease affecting the respiratory system, and consumed at least 20 packs/year were prospectively evaluated. In addition, a control group consisting of 50 non-smokers was formed. After confirming that spirometry and chest radiographs were normal, volunteers were taken to measure carboxymetry, plethysmography, respiratory muscle strength, and diffusion capacity, respectively. The changes in the lungs caused by smoking were analyzed with the data obtained from the measurements.

Results: Carbon monoxide values measured by carboxymetry were higher in smokers than non-smokers. Plethysmography tests showed that TLC, TLC%, FRC, FRC%, and RV values were statistically higher in smokers. No significant difference was found between FVC%, FEV1%, PEF, PEF%, MEF75, MEF75%, MEF50, MEF50%, MEF25, MEF25%, sRaw (eff), sRaw (eff%), Raw (eff), Raw (eff%), Raw (tot), Raw (tot%), IC, IC%, ERV, ERV%, RV% values and FEV1/FVC, FEV3/FVC, IC/TLC, and RV/TLC ratios. MIP, MIP%, MEP, MEP% values which measured respiratory muscle strength were similar in smokers and non-smokers. DLCO%, DLCO/VA, DLCO/VA%, DLCOc%, DLCOc/VA, and DLCOc/VA% were found to be lower in the smoker subjects. DLCO and DLCOc values were similar in both groups.

Conclusion: Smoking causes the accumulation of toxic gas in the lungs, contributes to the development of hyperinflation and disrupts gas exchange. In our study, there was no evidence that airway resistance developed or respiratory muscles were affected.

Objective: We aimed to evaluate the perspective of the Turkish Thoracic Society (TTS) members regarding institutional preparedness, in terms of administrative measures and availability of personal protective equipment (PPE), in the first and third months of the coronavirus disease 2019 (COVID-19) pandemic in Turkey.

Material and methods: A 22-item online survey was e-mailed between the first and third months to TTS members, and participants' responses were evaluated.

Results: The number of participants was 295 in the first survey and 141 in the second. In the second survey, the percentage of answers implying availability increased in all 18 control measures, 16 of which were statistically significant. However, there were still less than half of the respondents who reported the availability of psychological and behavioral support and some PPE, including respirators, facial protectors, goggles, and gowns. Statistical significance was observed for provision of a waiting area (P = .008), rooms for aerosol-generating procedures (P = .042), and special wards for patients with suspected or definite COVID-19 (P < .001); testing healthcare workers (HCWs) with a history of contact with a COVID-19 case (P < .001); and surveillance of symptomatic HCWs (P = .048), between tertiary vs. primary and secondary healthcare facilities in the first survey, but provision of special wards (P = .002) and supply for aprons (P = .027) in the second survey.

Conclusion: Our results showed an improvement in control measures in the third month of the pandemic. However, the persistent low availability of psychological and behavioral support and several items of PPE pointed out the need for action. Considering the health and safety of HCWs, the control measures should be actively monitored and deficiencies eliminated.

Objective: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients.

Material and methods: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia.

Results: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group.

Conclusion: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.

Objective: The most important risk factor for chronic obstructive pulmonary disease (COPD) is smoking. However, more than 25% of patients do not have a history of smoking. The intent of this study is to identify characteristics of COPD patients that are non-smokers.

Material and methods: The records of patients with COPD were retrospectively reviewed. Smoking history, comorbidities, exacerbations, biomass, and environmental tobacco smoke (ETS) exposures were identified. Also, age, gender, pulmonary function test (PFT) values, modified Medical Research Council (mMRC) dyspnea scores were recorded. Non-smokers exposed to any of the COPD risk factors above were grouped and the data were analyzed to determine the specific characteristics of COPD that applied to them.

Results: A total of 706 COPD patients were analyzed with a mean age of 67.2 ± 9.4. Of these patients, 93 (13.2%) were female and 613 (86.8%) were male. Of the 706 patients, 128 (18.1%) were non-smokers. The percentage of male patients having COPD was significantly lower in the non-smoker group (P < .001). However, biomass, ETS exposure in childhood, and a history of previous respiratory infection were significantly higher in the non-smoker group (P < .001). The mean body mass index (BMI) was greater in non-smokers than smokers.

Conclusion: Non-smokers with COPD have more biomass, ETS exposure, and infection history in childhood. They also have less impairment of airflow limitation, better symptom scores, and greater BMIs. Smoking history can be used to determine a different phenotype.

Objective: Interruption or reduction in airflow and desaturation is a theoretically expected result in bronchiectasis accompanied by excessive secretions in the airways, bronchial wall thickening, and destruction of the wall structure. The same mechanism of interruption or reduction in airflow and desaturation is valid for obstructive sleep apnea (OSA). However, data on the association of bronchiectasis with OSA are scarce. We aimed to investigate the frequency of OSA and related parameters in patients with non-cystic fibrosis bronchiectasis (NCFB).

Material and methods: All 43 consecutive patients who presented to the outpatient clinic for bronchiectasis follow-up between January 1, 2018 and January 1, 2019 were included. The polysomnography (PSG) data of the 43 patients were reviewed. Groups of patients with and without OSA, as detected using PSG, were compared in terms of clinical, demographic, and polysomnographic parameters.

Results: The mean age of the 43 patients was 50 ± 15 years; 28 (65.2%) were female. OSA was detected in 24 (55.8%) of 43 patients, of whom 14 (32.6%) had mild, 5 (11.6%) had moderate, and 5 (11.6%) had severe OSA. Three (7.0%) patients were REM-dependent and 7 (16.3%) were position-dependent. When evaluated using logistic regression analysis, REM percentage (16.8% vs. 11.8%, P = .03) and presence of witnessed apnea (33.3% vs. 15.7%, P = .01) were observed to be significantly higher in the patients with OSA. The age factor was found at the significance limit (P = .05).

Conclusion: The frequency of OSA in patients with NCFB is 55.8%. Investigating OSA using PSG is important in patients with NCFB, especially at advanced ages.

Objective: To detect the maternal and fetal problems experienced by patients with non-cystic fibrosis (non-CF) bronchiectasis during pregnancy.

Material and methods: A total of 185 women aged over 18 years with medical records available, who were diagnosed as having non-CF bronchiectasis and followed in the outpatient clinic for bronchiectasis, were interviewed by phone between November 1, 2019 and December 31, 2019. Forty-seven women who accepted to participate, were able to understand and answer the survey, and had experienced at least 1 pregnancy, were included in the study, The survey questions were read and the answers were recorded. The same survey was administered to a control group of 95 women.

Results: It was found that the number of patients experiencing an increase in at least 1 of the symptoms of cough, sputum production, and dyspnea during pregnancy, and the number of visits to emergency departments for respiratory conditions, were statistically significantly higher (P < .001 and P < .001, respectively), and the rate of live births was significantly lower (P = .009) in the non-CF bronchiectasis group compared with the control group. No significant difference was found between the groups in the number of miscarriages, preterm births, cesarean section, extra visits to the obstetrics department, and the presence of anomalies in the infants.

Conclusion: Among patients with non-CF bronchiectasis, it should be kept in mind that an increase may be seen in respiratory symptoms and the number of emergency department visits during pregnancy, and a decrease may be seen in the ratio of live births. These patients should be followed closely for these issues and measures should be taken accordingly.

Objective: The aim of the study was to assess the impact of non-surgical periodontal therapy (NSPT) on periodontal clinical parameters, spirometric indices, and salivary MMP-8 levels in patients with chronic obstructive pulmonary disease (COPD) with concurrence of chronic periodontitis (CP) compared with systemically healthy CP.

Material and methods: In this prospective clinico-biochemical study, a total of 75 patients belonging to various socioeconomic strata were randomly divided into cases, that is, COPD patients as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria with concurrence of CP [at least ≥ 20 teeth with ≥ 2 tooth sites having pocket probing depth (PPD) or clinical attachment loss (CAL) ≥ 4mm and bleeding on probing (BOP)] and controls (systemically healthy CP). Both groups underwent NSPT and were evaluated for plaque index (PI), gingival index (GI), PPD, CAL, and BOP and spirometry (FEV1/forced vital capacity (FVC)) values at baseline, 3, 6, and 12 months and for salivary MMP-8 levels at baseline and 3 months.

Results: Statistical results showed that cases (COPD with CP; n = 37) were significantly older (mean age 56.16 ± 9.01 years), ex-smokers (48.6%) with male preponderance (78.4%), and belonged to the upper middle class (40.5%) as compared to controls (systemically healthy CP; n = 38). After NSPT, significant improvement in mean PI, GI, PPD, CAL, and BOP was observed in both groups at 3, 6, and 12 months with better results in controls. FEV1/FVC was significantly improved (P < .001) in cases with insignificant change in controls at 12 months. After 3 months, MMP-8 levels were significantly reduced in cases (P = .002) and controls (P < .001).

Conclusion: The present study provided substantial evidence that COPD patients have poorer periodontal health as compared to systemically healthy counterparts. Further, these patients showed improvement in FEV1/FVC, however, with higher salivary MMP-8 levels despite NSPT at the end of the study, indicating a possible role of systemic inflammatory overburden of pulmonary disease.