[Evaluation of asthma and COPD awareness in primary care doctors in Turkey]. / Türkiye'de birinci basamak hekimlerinde astim ve KOAH farkindaliginin degerlendirilmesi.

INTRODUCTION: Chronic pulmonary diseases cause significant morbidity and mortality. However awareness about the risk factors, symptoms, diagnosis and traetment of these disorders is low among patients and health care providers. Our aim was to evaluate the awareness of asthma and chronic obstructive pulmonary disease among primary care doctors. This study was performed by the national Global Alliance Against Chronic Respiratory Diseases programme. MATERIALS AND METHODS: Primary care doctors employed by the Ministry of Healthy were included to the study. Turkish Statistical Institute randomly selected 680 doctors. Questionnaires evaluating the awareness of asthma and COPD which were developed by the Turkish Thoracic Society COPD and asthma assemblies were completed online by these doctors. RESULT: 84% of the doctors described asthma as airway obstruction. Dyspnea was reported as the most common symptom of asthma (78.8%) and inspiratory rhonci was reported as the most common physical exam finding (42.3%). Around 50% of doctors thought impairment of pulmonary function tests (PFT) was important for diagnosis and evaluation of severity of asthma while 24.2% thought physical exam was more important. When treatment options were evaluated 87.6% chose inhaled treatment for asthma. COPD was described as bronchiectasis and chronic bronchitis by 9.1%, chronic bronchitis and emphysema by 61.6%, chronic bronchitis and asthma by 22.2% and asthma and emphysema by 7.1%. 1.2% of the doctors did not consider cigarette smoking as a risk factor for COPD. PFT was recommended for diagnosis by 83%. Most correctly differentiated asthma and COPD. Bronchodilators were the first choice for COPD by 72.5%. CONCLUSIONS: Awareness is low for asthma and COPD among primary care doctors. Awareness should be raised among health care professionals for these diseases with high economical burden to improve outcome.

Correlation between nasal eosinophils and nasal airflows in children with asthma and/or rhinitis monosensitised to house dust mites

BACKGROUND: Allergic rhinitis and asthma due to mite sensitisation are diseases which are frequently associated and characterised by persistent inflammation. In the present study, we aimed to investigate the relationship between nasal airflows and nasal eosinophils in patients with asthma and/or rhinitis due to house dust mite sensitisation. METHODS: Twenty-four children with both rhinitis and asthma (R + A), 13 children with rhinitis and no asthma (R) and 10 non-allergic healthy children were evaluated prospectively. The patients belonging to the first two groups had moderate-severe grade of nasal obstruction. Total nasal symptom scores, peak nasal inspiratory flows (PNIFs) obtained by anterior rhinomanometry, skin prick tests, nasal eosinophils and FEV1 values were all assessed. RESULTS: Percentages of nasal eosinophils and PNIFs in patients with R + A and R (r = −0.415, p = 0.04) were found to be statistically significant and to have an inverse correlation. Skin prick tests were also significantly correlated with nasal eosinophils and PNIFs (r = 0.372, p = 0.01 and r = −0.306, p = 0.04, respectively). Both PNIFs and nasal eosinophils of patients with R + A were significantly correlated with FEV1 values (r = −0.641, p = 0.001 and r = 0.548, p = 0.007, respectively). CONCLUSION: In this study, a close relationship was demonstrated between eosinophil infiltration and nasal airflows in children having asthma and/or rhinitis monosensitised to mites. Additionally, the significant association found between FEV1 values and nasal eosinophils or PNIFs supported the close link of upper and lower airways

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[The evaluation of asthma and COPD awareness in Turkey (GARD Turkey Project-National Control Program of Chronic Airway Diseases)]. / Türkiye'de astim ve KOAH farkindaliginin degerlendirilmesi (GARD Türkiye Projesi-Kronik Hava Yollari Hastaliklari Ulusal Kontrol Programi).

INTRODUCTION: Although chronic respiratory disorders are important causes of morbidity and mortality, health care workers, patients and caretakers are not well informed about these disorders. Therefore these problems are underdiagnosed and undertreated; also preventive measures are not widely taken. Our aim was to evaluate the knowledge of asthma and chronic obstructive pulmonary disease (COPD) in Turkey. This study was designed and performed as a Global Alliance Against Respiratory Disorders (GARD) project. MATERIALS AND METHODS: People greater than 15 years of age who lived in cities with a population of 200 or greater were eligible for the study. A questionnaire including demographic data and questions regarding asthma and COPD was used for the evalution of the participants. RESULTS: 12.000 people were selected (6000 in rural and 6000 in urban areas); 8527 people were reached. 8342 people who completed the questionnaire were included to the study. There were 4182 (50.1%) female and 4160 (%49.9) male subjects. 49.6% of the subjcets knew that COPD is a lung disease, 51.1% indicated that smoking is the most important risk factor for COPD and 48% identified quitting smoking as the most important preventive measure. Every other person had baseline knowledge on COPD. However only 25.2% knew that there are treatment options for COPD. 80% of subjects said astma can be seen in all age groups. 51.1% knew asthma is a genetic disease and 58% said it is not an infectious disease. However when whether asthma medications caused drug dependency only 27% answered as "No" while 55.2% said "They do not know". CONCLUSION: Awareness of COPD and asthma seem to be infsufficient among Turkish people. Since these disorders are important causes of morbidity and mortality and have high impact on work and economic loss, it is important to increase knowledge among public.

Evaluation of efficacy of immunotherapy in children with asthma monosensitized to Alternaria.

In this study, we aimed to evaluate the efficacy of specific immunotherapy (SIT) in children monosensitized to Alternaria. Sixteen children with bronchial asthma monosensitized to Alternaria were enrolled in the study. Patients were divided into two groups as the immunotherapy group (Group I; 9 patients) and control group (Group II; 7 patients). A significant reduction in bronchial responsiveness to methacholine and Alternaria was found in Group I after one year of SIT (p = 0.03, p = 0.006) in comparison to controls. Specific IgE levels were decreased in the immunotherapy group (p = 0.001). Following allergen provocation, a rise in sputum eosinophil count was found to be lower in the SIT group compared to controls after one year (p = 0.011), and sputum eosinophil cationic protein (ECP) levels did not change in the SIT group, while there was a statistically significant increase in controls. Our results demonstrated that SIT with Alternaria caused clear changes in airway responsiveness and serum-specific IgE levels. However, further long-term studies in large series should be carried out for clinical documentation of the efficacy of SIT in the treatment of children with Alternaria allergy.

Exposure to house dust endotoxin and allergic sensitization in allergic and nonallergic children living in Adana, Turkey.

It has been suggested that exposure to elevated levels of endotoxin decreases the risk of allergic sensitization. The objective of our study was to analyze associations between house dust endotoxin levels and allergic sensitization in children. One hundred children with self-reported allergic diseases and 100 healthy children were randomly selected from a list of a previous prevalence study in school children. These children attended the study center again to complete a detailed questionnaire and medical examination including skin prick test and pulmonary function test. Of these children, 65 had allergen sensitization. Parents of a total 100 children (50 allergic and 50 healthy) agreed to house dust sampling in their homes. Thirty-five allergic children had asthma and 25 had rhinitis. Thirteen allergic and 14 healthy children lived in rural areas. The endotoxin content was quantified using a chromogenic kinetic Limulus amoebocyte lysate test. Endotoxin was at a detectable level in all dust samples. Endotoxin levels ranged from 0.05 to 309 EU/ml, with a geometric mean of 61.8 (confidence interval [CI] %) (50-73) EU/ml. There were no differences in house dust endotoxin levels between allergic and nonallergic children (p=0.153). On the whole, the mean level of endotoxin in rural homes was higher than that of urban homes, but this was not statistically significant (p=0.354). The highest endotoxin level was found in the homes of nonallergic children living in the rural areas and the lowest level in the homes of allergic children living in an urban area; however, this was not important statistically (p=0.320). Exposure to endotoxin was not associated with a risk of allergic sensitization (odds ratio [OR]=0.98; 95% CI: 0.91-1.05, p=0.609). In conclusion, supposing that the current level of endotoxin may reflect that in the past, the levels of endotoxin in living room floor dust of homes of allergic and nonallergic children in our study population were not associated with allergic sensitization. Further studies are needed on this topic.

Cathepsin S deficiency confers protection from neonatal hyperoxia-induced lung injury.

RATIONALE: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that adversely affects long-term pulmonary function as well as neurodevelopmental outcomes of preterm infants. Elastolytic proteases have been implicated in the pathogenesis of BPD. Cathepsin S (cat S) is a cysteine protease with potent elastolytic activity. Increased levels and activity of cat S have been detected in a baboon model of BPD. OBJECTIVES: To investigate whether deficiency of cat S alters the course of hyperoxia-induced neonatal lung injury in mice. METHODS: Newborn wild-type and cat S-deficient mice were exposed to 80% oxygen for 14 days. Histologic and morphometric analysis were performed and bronchoalveolar lavage protein and cells were analyzed. Lung elastin was assessed by real-time polymerase chain reaction, in situ hybridization, desmosine analysis, and Hart's stain. Distribution of myofibroblasts was analyzed by immunofluorescence. Hydroxyproline content of lung tissues was measured. MEASUREMENTS AND MAIN RESULTS: Hyperoxia-exposed cat S-deficient mice were protected from growth restriction and had improved alveolarization, decreased septal wall thickness, lower number of macrophages, and lower protein concentration in bronchoalveolar lavage fluid. alpha-Smooth muscle actin-expressing myofibroblasts accounted for at least some of the increased interstitial cellularity in hyperoxia-exposed mouse lungs and were significantly less in cat S-deficient lungs. Lung hydroxyproline content was increased in hyperoxia-exposed wild-type, but not in cat S-deficient lungs. Desmosine content was significantly reduced in both genotypes with hyperoxia. CONCLUSIONS: Cathepsin S deficiency improves alveolarization, and attenuates macrophage influx and fibroproliferative changes in hyperoxia-induced neonatal mouse lung injury.

SERPINB1 upregulation is associated with in vivo complex formation with neutrophil elastase and cathepsin G in a baboon model of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) continues to be a major cause of morbidity in premature infants. An imbalance between neutrophil elastase and its inhibitors has been implicated in BPD. Serine protease inhibitor (SERPIN)B1 is an inhibitor of neutrophil proteases, including neutrophil elastase (NE) and cathepsin G (cat G). Recent studies suggest that SERPINB1 could provide protection in the airways by regulating excess protease activity associated with inflammatory lung disorders. In this study, we determined the distribution and ontogeny of SERPINB1 in the baboon lung and characterized the expression of SERPINB1 in baboon models of BPD. SERPINB1 expression was detected in the conducting airway and glandular epithelial cells in addition to neutrophils, macrophages, and mast cells. SERPINB1 mRNA and protein expression increased with advancing gestational age and in the new BPD model. In contrast, SERPINB1 expression levels were decreased in the old BPD model. Furthermore, SERPINB1 was detected as a high-molecular-mass (HMM) complex in lung tissue and bronchoalveolar lavage fluid samples from the BPD group. Analysis of the HMM complex by coimmunoprecipitation showed that these complexes were formed between SERPINB1 and NE or cat G. High-performance liquid chromatography (HPLC) ion trap mass spectrometry verified the presence of SERPINB1 in HMM complexes. Finally, NE activity level was compared between new and old baboon models of BPD and was found to be significantly lower in new BPD. Thus SERPINB1 upregulation in new BPD may be protective by contributing to the regulation of neutrophil proteases NE and cat G.

Effects of physical exercise on quality of life, exercise capacity and pulmonary function in children with asthma.

OBJECTIVE: To investigate the effects of regular submaximal exercise on quality of life, exercise capacity and pulmonary function in asthmatic children. PATIENTS AND METHODS: Sixty-two children with mild-moderate asthma (mean age 10.4 (SD 2.1) years) were randomly allocated into exercise and control groups. The exercise group underwent a moderately intensive basketball training program for 8 weeks. A home respiratory exercise program was advised to both groups. Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was used for the evaluation of activity limitation, symptoms and emotional functions. Exercise capacity was evaluated through the physical work capacity (PWC 170 test) on a cycle ergometer and 6-minute walk test. Spirometric tests were also performed and medication and symptom scores were recorded. RESULTS: Although PAQLQ scores improved in both groups, the improvement in the exercise group was significantly higher. The exercise group performed better in the PWC 170 and 6-minute walk tests, whereas no improvement was detected in the control group at the end of the trial. Medication scores improved in both groups, but symptom scores improved only in the exercise group. No significant changes were detected in pulmonary function in either group, except for peak expiratory flow values in the exercise group. CONCLUSION: Eight weeks of regular submaximal exercise has beneficial effects on quality of life and exercise capacity in children with asthma. Submaximal basketball training is an effective alternative exercise program for asthmatic children.

Imbalance between cysteine proteases and inhibitors in a baboon model of bronchopulmonary dysplasia.

RATIONALE: Bronchopulmonary dysplasia (BPD) continues to be a major morbidity in preterm infants. The lung pathology in BPD is characterized by impaired alveolar and capillary development. An imbalance between proteases and protease inhibitors in association with changes in lung elastic fibers has been implicated in the pathogenesis of BPD. OBJECTIVE: To investigate the expression and activity levels of papain-like lysosomal cysteine proteases, cathepsins B, H, K, L, S, and their inhibitors, cystatins B and C, in a baboon model of BPD. METHODS: Real-time reverse transcriptase-polymerase chain reaction, immunohistochemistry, immunoblotting, active site labeling of cysteine proteases, and in situ hybridization were performed. MEASUREMENTS AND MAIN RESULTS: The steady-state mRNA and protein levels of all cathepsins were significantly increased in the lung tissue of baboons with BPD. In contrast, the steady-state mRNA and protein levels of two major cysteine protease inhibitors, cystatin B and C, were unchanged. Correlating with these alterations, the activity of cysteine proteases in lung tissue homogenates and bronchoalveolar lavage fluid was significantly higher in the BPD group. The levels of cathepsin B, H, and S increased and cathepsin K decreased with advancing gestation. All cathepsins, except for cat K, were immunolocalized to macrophages in BPD. In addition, cathepsin H and cystatin B were colocalized in type 2 alveolar epithelial cells. Cathepsin L was detected in some bronchial epithelial, endothelial, and interstitial cells. Cathepsin K was localized to some perivascular cells by in situ hybridization. CONCLUSIONS: Cumulatively, these findings demonstrate an imbalance between cysteine proteases and their inhibitors in BPD.

The prevalence of asthma and allergic diseases in children of school age in Adana in southern Turkey.

The aim of this study was to determine the prevalence of asthma and other allergic disorders as well as the factors affecting these disorders in school-children in Adana. This cross-sectional population-based study using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was carried out on 3164 school-children aged between 6-18 years during March to June 1997. There were 1521 (48.1%) boys and 1643 (51.9%) girls. The prevalence of asthma, allergic rhinitis and eczema in the 6-18 year-old children was found to be 12.6%, 13.6% and 8.3%, respectively. The prevalence of asthma was highest in 6-10 year-old school-children (14.7%), and lowest (6.0%) in 15-18 year-old children. The prevalence of asthma diagnosed by a doctor was 5.0%. The cumulative and current prevalences of wheezing were found to be 19.0% and 13.5%, respectively. The cumulative prevalence of allergic disorders was found to be 23.4%. The presence of domestic animals at home and dampness of the home were found to be important risk factors for asthma. Family histories of asthma, eczema, and diagnosis made by a doctor, and history of frequent sinusitis were found to be significantly higher in asthmatics. In conclusion, asthma is an important chronic disease of childhood in Adana in southern Turkey.