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

KOAH’lı ve astımlı olgularda akut alevlenme ve stabil dönemde; N-asetil sistein’in oksidan-antioksidan dengesi, solunum fonksion testleri ve yaşam kalitesi üzerine etkileri

Tez (Tıpta Uzmanlık) -- Kırıkkale Üniversitesi79099

The effects of n-actylcysteine therapy on oxidant-antioxidant balance, respiratory function tests and quality of life in patients with acute or stable copd and asthma

YÖK Tez ID: 164469ÖZET KOAH ve astım patogenezinde oksidatif stresin önemli rol oynadığına dair kanıtlar artmaktadır. Çalışmamız akut ve stabil dönemdeki KOAH ve astımlı hastalarda antioksidan bir ilaç olan N-Acetylcysteine (NAC)'in oksidatif stres, solunum fonksiyon testleri ve yaşam kalitesi üzerine etkilerini araştırmak amacıyla düzenlendi. 20 stabil KOAH'h ve 20 stabil astımlı hasta çalışmaya dahil edildi. Bu hastalara mevcut medikal tedavilerine ek olarak 600 mg/gün NAC tedavisi verildi. NAC tedavisi öncesi ve sonrası oksidanlardan plazma malondialdehid (MDA), antioksidanlardan glutatyon peroksidaz (GPx), katalaz ve süperoksid dismutaz (SOD) düzeyleri çalışıldı. Ayrıca ekzeserbasyondaki 20 akut KOAH'h ve 20 akut astımlı hasta hastanede yatarak tedavi gördüler. Bu hastalar NAC tedavisi alıp almamalarına göre 2 alt gruba ayrıldılar. Stabil KOAH'h grupta NAC (3 ay süreyle 600 mg/gün) tedavisi ile katalaz değerlerinde artış saptandı (tedavi öncesi 4.78±2.21 nmol/dk/ml ve tedavi sonrası 6.40±2.82 nmol/dk/ml; p=0.04). Stabil KOAH'hlarda tedavi sonrası FEVİ değerlerinde farklılık saptanmazken (p>0.05) yaşam kalitesinin fiziksel işlev parametresinde iyileşme görüldü (75.50±22.58 ve 83. 25± 15.24, p=0.01). Akut KOAH'h hastalarda NAC tedavisi alan ve almayan gruplar arasında GPx değerlerinde önemli farklılıklar saptandı. NAC alan grupta GPx değerlerinin diğerlerine göre daha yüksek olduğu tespit edildi (p=0.001). Yine aynı grupta duygu gösteriminde belirgin bir iyileşme mevcuttu (p=0.01). Stabil astımlı hastalarda ise tedavi sonrası antioksidan enzimlerde (GPx, katalaz ve SOD) belirgin bir artış saptandı. Ortalama değerleri sırasıyla; tedavi öncesi 169.28±35.88 nmol/dk/ml, 4.00±3.30 nmol/dk/ml ve 0.85±0.42 U/ml iken tedavi sonrası 199.40±36.90 nmol/dk/ml, 5.87±2.68 nmol/dk/ml ve 1.21±0.41 U/ml (p=0.01, p=0.04 ve p=0.01) bulundu. Aynı grupta FEVj ve yaşam kalitesi parametrelerinde tedavi öncesi ve tedavi sonrası fark yoktu. Stabil astımlı hastalarda 3 ay süreyle NAC 600 mg/gün kullanımının oksidan-antioksidan düzeyleri üzerine etkisi olmazken, akut astımlı hastalarda genel sağlık algılamasını artırdığı saptandı (52.16+21.53 vs 31.24±16.46, p=0.02). KOAH ve astımlı hastalar başlangıç ve tedavi sonrası karşılaştırıldığında; Stabil KOAH'h ve astımlı hastaların ilk başvurulan sırasındaki oksidan-antioksidan düzeyleri arasında fark bulunmazken (p>0.05) NAC tedavisi sonrası stabil astımlı hastalarda SOD düzeyi KOAH'hlara göre belirgin olarak yüksekti (1.21±0.41 U/ml ve 0.88±0.48 U/ml, iip=0.02). Yine her iki grup arasında tedavi öncesi-tedavi sonrası SFT ve yaşam kalitesinde anlamlı farklılık yoktu. Akut KOAH ve akut astımlı hastaların başlangıç ve stabilleştikten sonraki A oksidan-antioksidan düzeyleri ve A FEVı değerleri arasındaki farklar karşılaştırıldığında anlamlı değişiklik saptanmazken (p>0.05), A genel sağlık algılaması akut astımlı hastalarda KOAH'lılara göre belirgin olarak daha fazla iyileşmiş bulundu (p=0.01). Sonuç olarak; akut KOAH ve akut astım ekzeserbasyonunda oksidatif stresin arttığı ve bunun da tedavi ile düzeldiği saptanmıştır. Ancak NAC tedavisinin oksidatif stres üzerine akut astımda etkisi bulunmazken, akut KOAH'da pozitif yönde etkilediği görülmüştür. Diğer taraftan, stabil hastalarda NAC tedavisi hem KOAH hem de astımda antioksidan enzim seviyelerini artırmaktadır. NAC tedavisi ile stabil astımda yaşam kalitesi düzelmezken; stabil KOAH, akut KOAH ve akut astımda NAC tedavisi yaşam kalitesini artırmaktadır. KOAH ve astımlı hastalar karşılaştırıldığında ise stabil astımlı hastalarda NAC tedavisi SOD düzeyini stabil KOAH'lılara göre belirgin olarak arttırmaktadır. Benzer olarak NAC tedavisi akut astımlı hastalarda yaşam kalitesini akut KOAH'lı hastalara göre çok daha fazla iyileştirmektedir. Yaşam kalitesi ve oksidatif hasar üzerine pozitif etkilerinden dolayı astımlı hastalarda NAC kullanımının KOAH'lı hastalara göre daha yararlı olacağı düşünülebilir. Anahtar Kelimeler: KOAH, astım, ekzeserbasyon, NAC, oksidatif stres, solunum fonksiyon testleri, yaşam kalitesi illABSTRACT There is an increasing evidence that shows the role of oxidative stress in the pathogenesis of the COPD and asthma. In our study, we investigated the effects of N- Acetylcysteine (NAC) which is an antioxidant drug, on oxidant-antioxidant system, pulmonary function and quality of life (QoL) in COPD and asthma during stable period and acute exacerbation. 20 stable patients with COPD and asthma were included. In addition to their medical treatment, NAC 600 mg/day was given to the stable patients.The { values of plasma malonyldialdehyde (MDA), glutathion peroxidase (GPx), catalase and superoksid dismutase (SOD) were studied in patients before and after the NAC treatment. 20 patients with acute COPD and 20 with acute asthmatic patients were hospitalised and they were randomly divided into two subgroups according to taken NAC 600 mg/day therapy during their hospitalisation period. The value of catalase was increased by NAC therapy (600 mg/day during 3 months) in stable COPD group (before treatment 4.78±2.21 nmol/min/ml and after treatment 6.40±2.82 nmol/min/ml; p=0.04). In addition, there was an improvement in the physical functioning domain of QoL questionare after the therapy (75.50±22.58 vs. 83.25±15.24, p=0.01), but no difference was found in FEVi. In patients with acute COPD, a significance was determined in the value of GPx between the groups who taken NAC therapy or not. An increase was found in the NAC taken group (p=0.001). There was a significant improvement in the role limitation due to emotional problems in the same group (p=0.01). A significant increase was found in antioxidant enzyme values (GPx, catalase and SOD) after therapy in stable asthmatic patients. The mean values before therapy were respectively 169.28±35.88 nmol/min/ml, 4.00±3.30 nmol/min/ml and 0.85±0.42 U/ml. After therapy they were respectively 199.40±36.90 nmol/min/ml, 5.87±2.68 nmol/min/ml and 1.21±0.41 U/ml (p=0.01, p=0.04 and p=0.01). In the same group, no significant difference was found in FEVi and in QoL between before and after the treatment. Although NAC 600mg/day during 3 months didn't affect the oxidant-antioxidant levels and FEVi (p>0.05); NAC increased the general health perception in acute asthmatic patients (52.16±21.53 vs. 31.24±16.46, p=0,02). The differences in the values of antioxidant enzymes, FEVt and QoL before and after treatment were compared for stable COPD and asthma. Although the oxidant- ivantioxidant levels in stable COPD and asthma initially were similar (P>0.05); after the NAC treatment SOD levels in stable COPD were significantly higher than in stable asthmatic patients (1.21±0.41 U/ml vs. 0.88±0.48 U/ml, p=0.02). There was no significant difference on pulmonary functions and quality of life between stable COPD and asthma, before and after the treatment. When the differences in antioxidant enzymes, pulmonary functions and quality of life before and after trejatment were compared for acute COPD and acute asthma; the values of A antioxidant enzymes and A FEVi were similar (P>0.05), but A general health perception was improved in acute asthmatic patients more than the patients with acute COPD (p=0.01). Conclusively, oxidative stress is found to be increased in acute exacerbation of COPD and asthma and is found to be decreased after the treatment. NAC therapy has no effect in acute asthma, but it has positive effect in acute COPD on oxidative stress. On the other hand, in stable patients NAC therapy increased antioxidant enzyme levels both in COPD and asthma. Although quality of life was improved by NAC treatment in stable COPD, acute COPD and acute asthma; there was no effect in stable asthma. When the patients with COPD and asthma were compared; NAC therapy increased SOD levels in stable asthmatic patients more than the patients with stable COPD. Similarly, in acute asthmatic patients quality of life was improved by NAC treatment more than the patients with acute COPD. Therefore the use of NAC may be assumed to improve the quality of life and oxidative damage in asthma more than in COPD. Key Words: COPD, asthma, exacerbation, NAC, oxidative stress, pulmonary function tests, quality of lif

Evaluation of Dynamic Disulphide/Thiol Homeostasis in Silica Exposed Workers

Background: Oxidative stress is implicated as one of the main molecular mechanism underlying silicosis. Aims: In this study, our aim was to asses the redox status in occupationally silica-exposed workers, by evaluating the dynamic thiol-disulphide homeostasis. Study Design: Case-control study. Methods: Thirty-six male workers occupationally exposed to silica particles and 30 healthy volunteers, working as office workers were included to the study. Posteroanterior chest radiographs and pulmonary function tests of both groups were evaluated. Also serum thiol disulphide levels were measured using the spectrophotometric method described by Erel and Neşelioğlu. Results: Among the 36 workers that underwent pulmonary function tests 6 (17%) had obstructive, 7 (19%) had restrictive, 6 (17%) had obstructive and restrictive signs whereas 17 (47%) had no signs. The mean PFTs results of silica-exposed workers were significantly lower than control subjects. The serum disulphide levels of silica-exposed workers were significantly higher than control subjects (23.84±5.89 μmol/L and 21.18±3.44 μmol/L, respectively p=0.02). Conclusion: The serum disulphide levels, a biomarker of oxidative stress, are found to be higher in silica-exposed worker