Respiratory findings in gun factory workers exposed to solvents

AbstractObjective: Gun factory workers are exposed to many solvents (toluene, acetone, butanol, xylene, benzene, trichloroethylene). We investigated whether chronic exposure to solvents had adverse effect on respiratory system.Material and methods: The workers were questionnaired by modified Medical Research Council's respiratory questionnaire before morning start shift. Then physical examination and measurement of pulmonary functions by portable dry rolling spirometer were performed. The study group consisted of 1091 gun factory workers. The workers were grouped according to their smoking habits (smokers, [exposed n: 353 vs. unexposed n: 339] and non-smokers [exposed n: 58 vs. unexposed n: 341]). Asthma-related symptoms were defined as either definite asthma, probable asthma, and possible asthma.Results: In non-smokers, the report of asthma-related symptoms was more prevalent in exposed workers than unexposed (39.7% vs. 21.7% OR 2.4[1.3–4.3], respectively P=0.003). In smokers, the report of asthma-related symptoms was more common in exposed group than unexposed (50.7% vs. 42.5% OR 1.4[1.0–1.9], respectively P=0.03). Logistic regression analysis showed that smoking (OR 2.8 [2.0–3.8] P=0.00001) and exposure to solvents (OR 1.4[1.1–1.9] P=0.01) were independent risk factors for asthma-related symptoms, after adjusting for age. Logistic regression analysis identified that smoking (OR 3.3[2.3–4.6] P=0.00001) was independent risk factors for chronic bronchitis. Multiple linear regression analysis of lung-function parameters (% forced expiratory volume (FEV1), FEV1/forced vital capacity, FEF25–75) indicated significant effects of smoking.Conclusion: Present study indicated significant effects of smoking and exposure to solvents, with the smoking effect being the most important on asthma-related symptoms of gun factory workers

Effect on perception of bronchoconstriction of moderate-dose fluticason plus salmeterol in elderly asthmatics

Amaç: Orta-doz Flutikazon ve salmeterol tedavisinin bronkokonstriksiyonun algılanmasına etkisinin yaşlı ve genç astımlılarda değerlendirilmesi. Metot: Yirmidokuz yaşlı astımlı ($geq$60 yaş) ve 21 genç astımlı (<60 yaş) hasta çalışmaya katıldı. Yaşlı astımlılar semptom sürelerine göre iki gruba ayrıldı (geç başlangıçlı astım <5 yıl; erken başlangıçlı astım $geq$5 yıl). Orta persistan astımlı 50 hasta bir yıl boyunca günde iki defa 250 ug flutikazon propionat ve 50ug salmeterol tedavisi aldı. Her hastaya başlangıçta ve bir yıl sonra histamin ile bronş provokasyon testi yapıldı. Nefes darlığı modifiye Borg skalası ile değerlendirildi. Birinci saniye zorlu vital kapasite'de (FEVİ) %20'lik bir düşmenin olduğu Borg skoru Algılama skoru 20 (AS20) olarak saptandı.Sonuçlar: Geç başlangıçlı yaşlı astımlılarda başlangıç ortalama AS20 değerleri (1.21 ± 0.18) ile tedavi sonrası ortalama AS20 değerleri (1.32 ± 0.22) arasında anlamlı fark yoktu (p=0.7). Erken başlangıçlı yaşlı astımlılarda başlangıç ortalama AS20 değerleri ile (1.45 ± 0.14) tedavi sonrası ortalama AS20 değerleri (1.11 ± 0.30) arasında anlamlı fark yoktu (p=0.2). Genç astımlılarda başlangıç ortalama AS20 değerleri (2.27 ±0.25) ile tedavi sonrası ortalama AS20 değerleri (2.07 ± 0.29) arasında anlamlı fark yoktu (p=0.3). Yaşlı astımlılarda başlangıç ortalama AS20 değerleri (1.31 ± 0.12; 2.27 ± 0.25 p=0.001) ve tedavi sonrası ortalama AS20 değerleri (1.23 0.18; 2.07 ± 0.29 p=0.01) genç astımlılardan düşüktü. Yorum:Çahşma orta doz flutikazon ve salmeterol tedavisinin yaşlı ve genç astımlılarda bronkokonstriksiyonun algılanmasını değiştirmediğini düşündürmektedir.Ancak yaşlı astımlıların başlangıçtaki ve bir yıl sonraki algılamaları genç astımlılardan daha düşük bulunmuştur.We evaluate the effect of moderate-dose fluticasone plus salmeterol on perception of bronchoconstriction in elderly and in young asthmatics. Twenty-one young asthmatics (aged &lt;60yrs) and 29 elderly asthmatics ($geq$60 yrs ) were studied. The elderly asthmatics were separated into two groups according to the duration of symptoms (late-onset asthma &lt;5 year, early-onset asthma $geq$5 year). 50 patients with moderate asthma were assigned to a 1yr treatment with 250 ug of fluticason propionate plus 50ug salmetorol, twice daily.At entry and after 1 yr , histamine challenge test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in FEVi reduction by 20% was determined as perception score 20 (PS20). Results: There was no significant difference between mean PS20 values at entry (1.21 &plusmn; 0.18) and after the first year(1.32 &plusmn; 0.22) for late onset elderly asthmatics (p=0.7). There was no significant difference between mean PS20 values at entry (1.45 &plusmn; 0.14) and after the first year (1.11 &plusmn; 0.30) for early onset elderly asthmatics (p=0.2). There was no difference between mean PS20 values at entry (2.27 &plusmn; 0.25) and after the first year (2.07 &plusmn; 0.29) for young asthmatics (p=0.3). The mean PS20 value of elderly asthmatics at entry (1.31 &plusmn; 0.12, 2.27 &plusmn; 0.25 p=0001) and after the first year (1.23 &plusmn; 0.18, 2.07 &plusmn; 0.29 p=0.01) was lower than young asthmatics. Conclusion: Our study suggested that the treatment of moderate-dose fluticasone plus salmeterol did not change perception of bronchoconstriction in elderly asthmatics. Perception of elderly asthmatics at entry and after 1 yr was lower than young asthmatics

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Microalbuminuria in chronic obstructive pulmonary disease (conferenceObject)

WOS: 000449650901860

Affect status and perception of exacerbation in patients with asthma

WOS: 000209656300002PubMed: 21708053Exacerbations occur commonly in patients with asthma but factors affecting perception of dyspnea during exacerbation are not well known. This investigation was designed to determine the effects of negative mood on perception of dyspnea during exacerbation. A total of 47 patient aged 28-78 years (mean age, 52.5 years) admitted with acute asthma had recordings of blood gas pressure, negative mood score, forced expiratory volume in 1 second (FEV1), and dyspnea score at admission and at the 72nd hour. Perceived intensity of dyspnea was estimated using a modified Borg scale. The negative mood was assessed with an overall of six mood adjectives (nervous-anxious, sad-blue, and tired-drowsy). High negative mood score was defined as the score above the cutoff point (median score, >7). Borg sore of patients with a high negative mood score was higher than that of patients with a low negative mood score (6.3 +/- 2.5 versus 4.4 +/- 2.4; p +/- 0.01). The high Borg sore of asthmatic patients with high negative mood persisted even at the 72nd hour (1.6 +/- 0.9 versus 1.0 +/- 0.7; p +/- 0.01). FEV1 values of both groups at admission were similar. The negative mood score (beta = 0.68; p = 0.0001) and initial FEV1 (beta = -0.42; p = 0.01) were the important determinants of Borg score at admission in all patients with multivariate analysis but not arterial oxygen pressure, arterial carbon dioxide pressure, asthma duration, and female sex. This study indicated that emotional factors, as well as the level of airways obstruction, predicted the magnitude of dyspnea at exacerbation of asthmatic patients. Thus, the emotional factors should be taken into account in the treatment of dyspnea at exacerbation

Quality of life and metabolic disorders in patients with obstructive sleep apnea

Purpose: Quality of life (QoL) may be poor in patients with sleep apnea depending on multifactorial reasons. In this observational study, we examined the factors determining QoL in patients with obstructive sleep apnea (OSA) and nonapneic snoring subjects. Methods: Complete assessments were obtained on 111 subjects who diagnosed OSA and 18 nonapneic snoring subjects. Fasting blood samples of all of subjects were taken to determine insulin resistance (IR) and oral glucose tolerance tests were performed to diagnose disorders of glucose metabolism (DGM). Quality of life, with short form (SF)-36, and excessive daytime sleepiness, with epwort sleepness scale (ESS), were evaluated. Results: The mean age of the patients with OSA was higher than that of the nonapneic snoring subjects (48.4 ± 9.6 years and 43.0 ± 11.8 years, respectively; p=0.03). BMI was also significantly higher in the patients with OSA than in the nonapneic snorers (31.0 ± 4.5 and 27.1 ± 4.0, respectively; p=0.001). The mental health component in the patients with OSA was slightly but not significantly lower than the nonapneic snoring subjects (p=0.05). A negative correlation among most domains of quality of life with scores of ESS, body mass index (BMI), presence of hypertension (HT) and DGM was found. Only physicial functioning was negatively correlated with apnea hypopnea index (AHI). In linear regression analysis, there were negative associations among physical functioning with BMI, presence of HT and DGM while there was no association between physicial functioning and AHI. In addition, there were negative correlations between mental health component with BMI and presence of HT in the multivariate analysis. Obese patients with OSA had lower physicial and mental components compared with nonobese patients with OSA. Conclusion: The impact of OSA on quality of life can be attributed to excessive daytime sleepiness. Obesity and metabolic disorders in patients with OSA may also negatively affect the quality of life

Quality of life and metabolic disorders in patients with obstructive sleep apnea

WOS: 000302966500008PubMed: 22469102Purpose: Quality of life (QoL) may be poor in patients with sleep apnea depending on multifactorial reasons. In this observational study, we examined the factors determining QoL in patients with obstructive sleep apnea (OSA) and nonapneic snoring subjects. Methods: Complete assessments were obtained on 111 subjects who diagnosed OSA and 18 nonapneic snoring subjects. Fasting blood samples of all of subjects were taken to determine insulin resistance (IR) and oral glucose tolerance tests were performed to diagnose disorders of glucose metabolism (DGM). Quality of life, with short form (SF)-36, and excessive daytime sleepiness, with epwort sleepness scale (ESS), were evaluated. Results: The mean age of the patients with OSA was higher than that of the nonapneic snoring subjects (48.4 +/- 9.6 years and 43.0 +/- 11.8 years, respectively; p=0.03). BMI was also significantly higher in the patients with OSA than in the nonapneic snorers (31.0 +/- 4.5 and 27.1 +/- 4.0, respectively; p=0.001). The mental health component in the patients with OSA was slightly but not significantly lower than the nonapneic snoring subjects (p=0.05). A negative correlation among most domains of quality of life with scores of ESS, body mass index (BMI), presence of hypertension (HT) and DGM was found. Only physicial functioning was negatively correlated with apnea hypopnea index (AHI). In linear regression analysis, there were negative associations among physical functioning with BMI, presence of HT and DGM while there was no association between physicial functioning and AHI. In addition, there were negative correlations between mental health component with BMI and presence of HT in the multivariate analysis. Obese patients with OSA had lower physicial and mental components compared with nonobese patients with OSA. Conclusion: The impact of OSA on quality of life can be attributed to excessive daytime sleepiness. Obesity and metabolic disorders in patients with OSA may also negatively affect the quality of life

Assessment of patients' preferences regarding the characteristics associated with the treatment of chronic obstructive pulmonary disease

WOS: 000334343300001PubMed: 24790426Objective: Patient preferences regarding characteristics associated with the treatment of chronic obstructive pulmonary disease (COPD) must be determined to increase the compatibility between the patients and the treatments, but as yet no studies have been performed regarding these characteristics. Here, we evaluate the preferred characteristics associated with the treatment of patients with COPD. Method: The expectations of patients receiving COPD therapy were assessed in six categories: time allocated by the physician to listen to patients' complaints, treatment to be applied, estimated adverse effect frequency concerning the therapy, ability of patients to visit the same physician each time, integral approach of the physician to the treatment of the patient, and therapy cost. These groups were divided into categories of therapy indicating 25 alternative treatment methods, using conjoint analysis. Patients were sorted to the 25 types of treatment with regard to their preferences. Results: The major expectation of conjoint analysis associated with the treatment of COPD patients is for the therapy to allow the patients to completely recover from their complaints. The order preferred by patients of other treatment expectations is from sufficient time to be allowed by the physician to listen to the patient, to no cost for the treatment, to minimum adverse effects resulting from the treatment, to each follow-up to be performed by the same physician, and to the physician performing an assessment of the patient's well-being, rather than examining only the areas of complaint. Conclusion: The major expectation of COPD patients regarding treatment was to completely recover with the help of the therapy. Considering the expectations of the patient may help improve the compatibility of the patient with the treatment

Kronik Obstrüktif Akciğer Hastaliğinda Metabolik Sendrom Ve Kronik Hastaliklar

Amaç: Kronik obstrüktif akciğer hastalığı (KOAH), metabolik sendrom (MS) ve komorbidite arasındaki ilişki üzerine yapılan önceki çalışmalarda bulunan sonuçlar tartışmalıdır. Bu nedenle biz bu çalışmada, KOAHlı hastalarda eşlik eden metabolik sendrom ve komorbiditeleri ayrı ayrı olacak şekilde inceledik. Yöntem: Bu çalışma periyodu sırasında, 66 KOAH ve kontrol grubu olarak da 40 kişi dahil edildi. Solunum fonksiyon testleri (SFT) flow sensitif spirometri ile ATS kriterlerine göre yapıldı. BODE indeksleri hesaplandı. Kronik hastalıklar şiddet indeksi Modifiye kümülatif hastalıklar değerlendirme ölçeği (MKHDÖ) kullanılarak değerlendirildi. MS, National Cholesterol Education Program (NCEP)a göre tanımlandı. Total metabolik bozukluk skoru da ayrıca hesaplandı. Bulgular: MKHDÖ skoru KOAHlı hastalarda kontrol grubundan anlamlı olarak yüksekti fakat total metabolik skor KOAH ve kontrol grubu arasında farklı değildi. MS KOAHlı hastalarda 18 kişide (%27.3), kontrol grubunda 8 kişide (%20) görüldü. MS görülme oranı evre II KOAHlı hastalarda evre IV KOAHlı hastalardan daha yüksekti (p:0.04). Lineer regresyon analizinde, MKHDÖ skoru BODE indeksi ile pozitif ilişki gösterirken, FEV1%, FVC%, FEV1/FVC% ile anlamlı negatif ilişki gösterdi. Ancak, MKHDÖ PO2 ile anlamlı ilişki göstermedi. Sonuç: Komorbiditeler ve MS KOAHın farklı evrelerinde görülür. Bu nedenle eşlik eden bu hastalıklar birbirinden ayrı ayrı olarak incelenmelidir.Aim: Results of the previous studies on the relationship amongst the comorbidity, metabolic syndrome (MS) and Chronic Obstructive Pulmonary Disease (COPD) are controversial. Therefore, these accompanying comorbidities and MS were assessed on an individual basis in patients with COPD in the present study. Method: During the study period, 66 consecutive patients with COPD and 40 subjects as a control group were enrolled. Pulmonary Function Tests (PFT) were performed with flow sensitive spirometer according to ATS guidelines. The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity (BODE) index was calculated. The index severity of chronic diseases was evaluated using the Modified Cumulative Illness Rating Scale (MCIRS). MS was defined according to National Cholesterol Education Program. Total score of metabolic disorders was also calculated. Results: MCIRS score was significantly greater in patients with COPD than in control group but the total score of metabolic disorders was the same for the patients with COPD and the control group. MS was detected in 18 subjects (27.3%) in patients with COPD as compared to 8 of subjects in control group (20%). The rate of MS in patients with stage II COPD was higher than the patients with stage IV COPD (p: 0.04). In linear regression model, the MCIRS score exhibited significant inverse associations with FEV1%, FVC% and FEV1/FVC% while exhibiting significant positive association with BODE index. However, the MCIRS did not exhibit significant association with PO2

Troublesome cough as the sole manifestation of pulmonary embolism

WOS: 000511444900090PubMed: 31194180Early diagnosis and effective treatment to reduce mortality is the basis of pulmonary embolism. However, the diagnosis can be easily overlooked due to nonspecific clinical presentation. We present 9 cases of pulmonary embolism manifested by a symptom suggestive of an irritating cough due to viral upper respiratory tract infection (patients with no risk factors for PE). Pulmonary embolism should be considered in cases of irritating cough that does not respond to inhaler treatment, d-dimer positive and normal chest X-ray