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

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

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

Superior vena cava syndrome: A rare clinical manifestation of Behçet;s disease

PubMedID: 15349796[No abstract available

The evaluation of latent tuberculosis in rheumatologic diseases for anti-TNF therapy: Experience with 192 patients

PubMedID: 18320137It is recommended to evaluate the presence of latent tuberculosis infection (LTBI) before initiating antitumor necrosis factor ? (anti-TNF) therapy for rheumatologic diseases. We aimed to present the follow-up results of 192 patients with rheumatologic diseases before anti-TNF therapy for LTBI. We enrolled 192 patients who were given anti-TNF therapy for their rheumatologic diseases between April 2005 and January 2008. The demographic characteristics of the patients were recorded. Chest X-ray was obtained and tuberculin skin test (TST) was performed in all patients before anti-TNF therapy. LTBI was assessed by detailed history of close contact with infectious cases within the last year, abnormal chest radiography, and positive TST (?5 mm) before initiating anti-TNF therapy. Patients with anti-TNF therapy were followed with 2-month intervals for active tuberculosis by pulmonary and extrapulmonary symptoms, physical examination, and chest X-ray. Of 192 patients, 104 (54.2%) patients were women, age (mean±SD) 43.1±12.7 years and 88 (45.8%) patients were men, age (mean±SD) 39.3±11.2 years. Ninety-one (47.4%) of them had rheumatoid arthritis (RA); 92 (47.9%) had ankylosing spondylitis (AS), and nine (4.7%) had psoriatic arthritis. Isoniazid treatment was started in 129 (67.2%) patients in whom LTBI was detected. No significant difference was observed for TST positivity (TST±5 mm) between the patients with RA and AS (p = 0.101). Similarly, no significant difference was also observed for TST positivity between the patients who received immunosuppressive therapy and those who did not (p = 10.154). Only three (1.6%) patients developed active tuberculosis at the study period. We suggested that in despite of the presence of rheumatologic disease and/or immunosuppressive therapy, TST is an acceptable and available diagnostic test for detecting LTBI before anti-TNF therapy. © Clinical Rheumatology 2008

There is no significant association between death receptor 4 (dr4) gene polymorphisms and lung cancer in Turkish population

PubMedID: 23661154Death receptor 4 (DR4) gene is a candidate tumor supressor gene that has a role in apoptotic pathway. It was reported in literature that polymorphisms in DR4 gene lead to susceptibility to many cancers. In accordance with this information, we aimed to investigate the association between G422A, C626G, A683C and A1322G polymorphisms in DR4 gene and lung cancer. We selected 60 patients with lung cancer (LC) and 30 healthy, sex and age matched volunteers randomly. Four polymorhisms, G422A, C626G, A683C and A1322G, in DR4 gene were analyzed with Polymerase Change Reaction (PCR) - Restriction Fragment Lenght Polymorphism (RFLP) and Amplification Refractory Mutation System (ARMS) techniques in both groups. Our results showed that there are no statistically significances between the patients and controls in terms of the G422A, C626G, A683C and A1322G polymorphisms in DR4 gene (p > 0,05). Our findings showed no role of DR4 gene polymorhisms in susceptibility to LC and provide a plausible explanation for DR4 genetic heterogeneity in LC susceptibility. © 2013 Arányi Lajos Foundation.TF2005D1Acknowledgments This work was funded, in part, by a grant from the University of Çukurova, Adana, Turkey (TF2005D1)

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

Isoniazid intervention for latent tuberculosis among 86 patients with rheumatologic disease administered with anti-TNF?

PubMedID: 17332973In this study, we investigated the safety and toxicity of isoniazid (INH) intervention therapy to the patients with latent tuberculosis who were given tumor necrosis factor ? (TNF?) for the treatment of their rheumatologic diseases. In this prospective clinical study, we enrolled 86 patients receiving anti-TNF? therapy for their rheumatologic diseases between April 2005 and September 2006. Of all the subjects, 45 had rheumatoid arthritis, 36 had ankylosing spondylitis, and 5 had psoriatic arthritis. In addition to anti-TNF? therapy, 60 of the 86 patients were given INH intervention for revealed latent tuberculosis. INH at a dosage of 300 mg daily was given for 9 months. Hepatotoxicity due to the INH therapy was considered when the serum alanine aminotransferase (ALT) and/or aspartate aminotransaminase (AST) levels showed at least threefold increase with respect to their baseline serum levels. Serum ALT and AST levels were measured by enzymatic colorimetric method in fasting peripheral blood samples at 0 (baseline), 1, 2, 3, 6, and 9 months. Of 86 patients, 47 (54.7%) were women (mean age±SD, 44.1±9 years) and 39 (45.3%) were men (38.8±1 years). Except five patients (8.3%), liver toxicity due to the INH therapy was not encountered among the patients, and after temporarily discontinuing the INH therapy of these five subjects, serum transaminase levels returned to the normal ranges. No hepatotoxicity was observed in the non-INH group. However, there was no statistical significance between INH-treated and non-INH-treated group (p = 0.317). In addition, none of the 86 patients developed active tuberculosis infection during the treatment period. In conclusion, for those patients who were assigned to the TNF? L treatment for their rheumatologic disorders and carrying risk for latent tuberculosis, INH intervention therapy was found to be safe and efficacious. © Clinical Rheumatology 2007

Detection of latent tuberculosis infection in rheumatologic diseases before anti-TNF? therapy: Tuberculin skin test versus IFN-? assay

PubMedID: 22095393We aimed to evaluate tuberculin skin test (TST) and interferon-gamma (IFN-?) test results for latent tuberculosis infection (LTBI) in patients with rheumatologic diseases prior to anti-TNF? therapy. Ninety patients were evaluated in the study at the Departments of Chest Diseases and Rheumatology for anti-TNF? therapy for their rheumatologic diseases. Tuberculin skin test was performed (Mantoux method) and peripheral blood samples were collected for IFN-? assay (QuantiFeron TB-Gold In Tube) before the anti-TNF? therapy. Of 90 patients, TST positivity was detected in 56 (62.2%) patients, while IFN-? positivity was detected in 34 (37.8%) patients. Among 56 TST positive patients, IFN-? positivity was detected in 24 (42.9%) patients, and among 34 TST negative patients, IFN-? positivity was detected in 10 (29.4%) patients. There was no significant agreement between TST and IFN-? assay results (Kappa = 0.12, P = 0.2). Forty-three (47.8%) patients were using immunosuppressive drugs owing to their rheumatologic diseases. In this group, TST and IFN-? positivity is significantly lower than in those who did not receive immunosuppressive treatment (P<0.05). We conclude that the IFN-? assay may not be preferred to TST as a diagnostic test in patients with rheumatologic diseases prior to anti-TNF? treatment. © Springer-Verlag 2011

The Oxidant-Antioxidant Balance in Mild Asthmatic Patients

PubMedID: 14749939We investigated the oxidant-antioxidant balance and the effect of inhaled corticosteroids on this balance in mild stable asthmatics. Included in the study were 30 mild asthmatic patients (11 male, 19 female, mean age (year) ± SD: 35.1 ± 9.7) and 26 healthy adults (7 male, 19 female, mean age (year) ± SD: 40.8 ± 13.3). In all study groups, the peripheral venous blood samples were taken for plasma malonyldialdehyde (MDA), a parameter of lipid peroxidation caused by the oxidants, and erythrocyte superoxide dismutase (SOD), an antioxidant enzyme. The mean plasma MDA level was lower in the asthmatic group (5.7 ± 1.2 nmol/ml) than in the healthy group (6.3 ± 1.7 nmol/ml); and the mean erythrocyte SOD level was higher in asthmatic group (1086.4 ± 247.4 U/gHb) than in the healthy group (1028.0 ± 230.0 U/gHb). However, there were no significant differences in measurements of both plasma MDA levels and erythrocyte SOD enzyme activities between the groups (respectively, p = 0.1 and p = 0.4). When asthmatic patients were divided into subgroups as "inhaled steroid user" and "no inhaled steroid user", no significant differences were observed in the measurements of either plasma MDA level or erythrocyte SOD enzyme activity between the mentioned subgroups. According to the results of our study, we can say that oxidant-antioxidant balance is not significantly affected in mild asthmatics or measurement of plasma level of MDA and erythrocyte SOD enzyme activity is not sensitive to the oxidant-antioxidant balance in mild asthmatics