Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

A rare pleural effusion: Pseudochylothorax: Differential diagnosis [Nadir görülen bir plevral efüzyon: Psödoş ilotoraks]

Pseudochylothorax is an odorless and milky pleural effusion with high levels of cholesterol and/or cholesterol crystals. Lipids in the effusion are suggested to accumulate in the pleural fluid as a result of pleural thickening and calcification due to chronic pleurisy. Tuberculous pleurisy, chronic romatoid pleurisy and theurapetic pneumothorax are the common causes of pseudochylothorax. The differential diagnosis of pseudochylothorax and chylothorax, which have completely different etiologies, pathogeneses and treatments, should be made and patients should be followed closely for tuberculosis reactivation. In this article, we presenteted a 70 years old man with pseudochylothorax in whose pleural fluid culture. Copyright © 2007 by Türkiye Klinikleri

association of the Nramp1 gene polymorphisms and clinical forms in patients with tuberculosis

PubMedID: 23137204Background: Recent studies have reported that Nramp1 polymorphisms might have an important role in the development of tuberculosis in various populations. In this study, we aimed to determine Nramp1 polymorphisms in our patients with tuberculosis population. Methods: We enrolled 127 patients with active tuberculosis and 116 healthy adults with similar age and gender. Peripheral blood samples were taken for determining the Nramp1 polymorphisms. By using Polymerase Chain Reaction (PCR)-Restriction Fragment Length Polymorphisms (RFLP) technique, we evaluated the polymorphisms of Nramp1 at the regions of D543N and INT4. Results: We found that the Nramp1 polymorphisms at the region of D543N (OR: 0.44, 95%CI: 0.09-2.06 for GA allele) were not a risk factor for tuberculosis. Furthermore, we could not able to detect Nramp1 polymorphism at the regions of INT4 (OR: 0.97, 95%CI: 0.55-1.72 for GC allele and OR: 0.90, 95%CI: 0.21-3.77 for CC allele). Conclusion: The findings of the present study do not support the hypothesis that Nramp1 at the regions of D543 and INT4 might play a role in influencing the growth of bacilli and progression of cavitary tuberculosis rather than susceptibility to M. tuberculosis infection. Future studies are needed to elucidate the role of Nramp1 variants in the pathogenesis of tuberculosis

Profile of respiratory impairment in patients with amyotrophic lateral sclerosis at initial admittance

PURPOSE: To evaluate the initial respiratory impairments [pulmonary functions and arterial blood gases (ABGs)] in patients with amyotrophic lateral sclerosis (ALS) according to Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) at the time of admission. METHOD: Forty-five patients with ALS were evaluated between January 2004 and December 2007 by pulmonary function tests (PFTs) and ABG results at the time of admission. ALSFRS-R was used to quantify the severity of ALS patients. ALS patients were divided into 2 subgroups according to their ALSFRS-R scores as equal or below 26 (group 1, moderate-severe) and above 26 (group 2, mild). PFTs and ABG results were compared between these 2 subgroups. RESULTS: As 13 of the 45 patients with ALS were unable to perform PFTs, data of only 32 patients were evaluated (n=7 for group 1, n=25 for group 2). PFTs and ABG results except for forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) % (P=0.003) and partial arterial oxygen tension (pO2) (P=0.02) did not differ significantly between the 2 groups. While FEV1/FVC (r=-0.42, P=0.01) was negatively correlated with ALSFRS-R score, pO2 (r=0.36, P=0.02) was positively correlated. CONCLUSIONS: We thought that the increase in FEV1/FVC (%) was more susceptible for reflecting early respiratory impairments than FVC (%) in ALS patients at the initial admittance. Copyright © 2010 by Lippincott Williams & Wilkins

The Effectiveness, Safety, and Tolerability of Pirfenidone in Idiopathic Pulmonary Fibrosis: A Retrospective Study

PubMedID: 30900199Introduction: In this study we aimed to investigate the effectiveness and safety profile of pirfenidone for the treatment of idiopathic pulmonary fibrosis (IPF) in a real-life setting. Methods: Clinical records of patients diagnosed with mild-to-moderate IPF and receiving pirfenidone treatment across three centers in Turkey between January and September 2017 were retrospectively collected. Pulmonary function measurements, including percentage of forced vital capacity (FVC%) and percentage of diffusion capacity (DLCO%) were analyzed in patients who received pirfenidone treatment for at least 6 months. Decline in lung function, defined as an absolute decline of at least 10% in FVC from baseline, or death at 6 months was also analyzed. Safety data were included for all follow-up visits. Results: In the pooled cohort (n = 60), patients were mostly men (73.4%) and current or former smokers (61.7%). Average baseline FVC% and DLCO% were 68.4% and 48.7%, respectively. Forty-seven patients (78.3%) had a high-resolution computed tomography scan with a definite interstitial pneumonia (UIP) pattern, and 18 patients (30%) had a surgically proven UIP pattern. Forty-six (76.7%) patients with IPF remained stable and 14 (23.3%) patients had progressed according to decline in FVC of at least 10% during the therapy course. After 6 months of therapy, cough decreased in 58.3% of patients. At least one side effect due to therapy was encountered in 33 (55.0%) IPF patients. Dyspepsia (36.4%), nausea (27.3%), and rash/photosensitivity (24.2%) were the most frequent side effects in our cohort. Sixteen patients (26.7%) needed dose adjustment, one patient (1.7%) discontinued therapy, and one patient (1.7%) died in the study period. Conclusions: This study shows that pirfenidone seems to be an effective treatment for IPF and also had tolerable and relatively acceptable side effects. Funding: Roche. © 2019, Springer Healthcare Ltd., part of Springer Nature

The effect of different treatment modalities on oxidative stress in COPD

PubMedID: 18592146Introduction: Oxidant/antioxidant interactions are known to be important processes in the pathogenesis of chronic obstructive pulmonary disease (COPD). We aimed to evaluate the effects of corticosteroids (CS), and N-acetylcysteine (NAC) on plasma oxidant/antioxidant levels in patients with COPD. Methods: This study utilised a single-blind, randomised, placebo-controlled, parallel-group methodology. We enrolled 58 patients with stable COPD and 30 healthy controls with similar demographic profiles. The patients with COPD were randomly divided into three treatment groups. Group 1 received basal treatment (regular ipratropium bromide and beta-2 agonist as needed), placebo CS and placebo NAC. In addition to basal treatment, group 2 received oral CS (methylprednisolone 40 mg/day) and placebo NAC. Group 3 received basal treatment plus NAC (600 mg/day) and placebo CS. Each group received treatment for 15 days. We measured plasma malondialdehyde (MDA) and superoxide dismutase (SOD) at the start and the end of study. Results: Post-treatment plasma MDA levels were significantly lowered only in group 2 (P=0.004). No significant differences were found with respect to erythrocyte SOD levels. Conclusion: This study demonstrates that oral CS, by aiding the oxidant/antioxidant system, may offer a new therapeutic option in COPD treatment.The page charges for this article were funded by Sanofi Pasteur Turkey, Acetelion Turkey, Novartis Turkey, and the authors