Browsing by Author "Coskun, AS"

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    Asthma Control Test and Asthma Quality of Life Questionnaire Association in Adults
    Alpaydin, AO; Bora, M; Yorgancioglu, A; Coskun, AS; Celik, P
    Asthma control and quality of life are expected to be correlated. We aimed to evaluate the association of asthma control test (ACT) with asthma quality of life questionnaire (AQLQ) and guideline based control assessment. We also aimed to investigate the impact of therapy adjustment according to ACT score on AQLQ A total of 101 asthmatic patients were included. ACT, AQLQ and Global Initiative for Asthma (GINA) based control assessments were performed. Based on ACT, treatment was adjusted by stepping down in controlled and stepping up in uncontrolled/partly controlled patients. In some controlled/partly controlled patients, no therapy adjustment was done. After 3-months the same parameters were reevaluated. We found a statistically significant association between ACT and AQLQ, a one point increase in ACT was associated with a 0.129 point increase in AQLQ. ACT scores increased significantly in the step-up group; however AQLQ total scores were not affected after therapy adjustment. We found that ACT was concordant with GINA recommended control classification in the first (kappa=0.511, 7.718) and third months (kappa=0.599, 7.912) (P<0.001 for both). We determined an association between ACT and AQLQ. ACT was also found fairly concordant with GINA. However, treatment adjustment according to ACT was not found satisfactory in terms of quality of life.
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    The validity and reliability of the Turkish version of the Leicester Cough Questionnaire in COPD patients
    Kurhan, F; Göktalay, T; Havlucu, Y; Sari, S; Yorgancioglu, A; Çelik, P; Coskun, AS
    Background/aim: The reliability and validity of the Turkish version of the Leicester Cough Questionnaire (LCQ) have been evaluated before. This study aimed to validate the Turkish version of the LCQ in chronic obstructive puhnonary disease (COPD) patients with cough. Materials and methods: COPD (GOLD B, C, D) patients over age 40 (n = 75) and healthy volunteers as a control group (n = 75) were included. A sociodeinographic data form, the LCQ, the Short Form-36 (SF-36) quality of life questionnaire, and the World Health Organization Quality of Life Brief Form for Turkish people were completed. The internal reliability of the LCQ was determined using the Cronbach alpha coefficient (>0.6) and its repeatability by the intraclass consistency coefficient (P < 0.05) was accepted as significant. Results: For internal consistency, Cronbach alpha coefficients of all subscales of the LCQ, physical, psychological, and social, were found as 0.72, 0.86, and 0.83, respectively, with 0.92 for the total index. There was significant internal consistency for all subscales and the total index (Cronbach alpha coefficients of >0.6). In test-retest reliability, the correlation coefficient ranged between 0.71 and 0.80 for each question and was calculated as r = 0.89 for total LCQ score (P < 0.001). Conclusion: The Turkish version of the LCQ has been found to have acceptable reliability and validity for use in Turkish COPD patients with chronic cough.
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    A Case of Bilateral Tuberculosis with a Presenting Symptom of Massive Haemoptysis
    Özgen, A; Çelik, P; Gülcü, A; Konyar, I; Coskun, AS; Göktan, C; Yorgancioglu, A
    Haemoptysis may be observed in one third of patients with pulmonary tuberculosis at any time during their disease. Tuberculosis may present with atypical radiological findings in patients with underlying diseases such as Diabetes Mellitus (DM). We presented a 58-year-old male with DM who haemorrhaged from the right bronchial artery although having a radiological lesion in the left lung. He had a glassful of haemoptysis in a single episode lasting two days. Chest computarized tomography (CT) showed a consolidation partially forming a massive lesion in the left upper lobe. Bronchoscopy revealed a haemorrhagic residue in the right main bronchus and a blood clot in the left upper lobe. After aspiration a major hemorrhage was observed and bronchial arterial embolization (BAE) was performed to the right bronchial artery where extravasion of the contrast agent was determined. However, in the follow-up, as the findings of BAE were not consistent with the bronchoscopic and radiological findings, a CT angiography was performed for the evaluation of the vascular structures. No vascular pathology was determined although there were acinary infiltrations in both lungs. Also, the mycobacterial culture of the sputum was positive. Radiological, bronchoscopic and angiographic findings may not always correlate in patients with haemoptysis. Heamoptysis may result from different causes in pulmonary tuberculosis and bronchial arterial system is usually the source.
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    The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis
    Göktalay, T; Çelik, P; Alpaydin, AÖ; Havlucu, Y; Coskun, AS; Isisag, A; Yorgancioglu, A
    OBJECTIVES: This study aimed to investigate the additional diagnostic value of endobronchial biopsy (EBB) in the diagnosis of pulmonary sarcoidosis. MATERIALS AND METHODS: This retrospective cross-sectional study included 59 patients with a preliminary diagnosis of sarcoidosis who were admitted to the Pulmonary Diseases Outpatient Clinic of a tertiary healthcare center between January 2005 and October 2012. The socio-demographic characteristics of the patients as well as clinical and radiological findings were recorded. All patients, irrespective of the presence of an endobronchial lesion (EBL), underwent fiberoptic bronchoscopy (FOB); two to four specimens were taken using EBB from the carina of the right middle lobe in the patients with EBL. RESULTS: Of the patients, 39 (66.1%) had normal bronchoscopic findings, while 5 had EBL. Diagnosis was based on EBB in 11 patients (18.6%). Six patients (15.3%) with normal bronchial mucosae were pathologically diagnosed by EBB. There was no statistically significant relationship between the diagnostic ratio of EBB and disease stage, extrapulmonary involvement, FOB findings, elevated lymphocyte rate in bronchoalveolar lavage (>= 13%), a CD4/CD8 ratio of >= 3.5, and serum angiotensin-converting enzyme (ACE) level (p > 0.05). CONCLUSION: EBB not only offers the advantage of a high diagnostic ratio in patients with mucosal abnormalities but also contributes to pathological diagnosis in patients with normal mucosa. We recommend using EBB to support diagnosis with a low complication rate for patients undergoing FOB with a preliminary diagnosis of sarcoidosis in healthcare centers, where endobronchial ultrasound (EBUS) is unavailable.
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    Evaluation of physians, patients, relatives and society of opinions on the told lung cancer diagnosis
    Datli, U; Çelik, P; Havlucu, Y; Göktalay, T; Coskun, AS; Yorgancioglu, AA
    Introduction: In our country, this is usually done by patient relatives. In this study, we aimed to investigate the thought of doctors who done the diagnosis, doctors who arrange the treatment, first degree relatives of patients with lung cancer, and population as a control. Materials and Methods: 310 subjects (100 doctors, 110 first degree realtives of patients, and 100 subjects as a control) were included to the study. The mean age was 39.77 +/- 11.44 years and there was 170 females. 46% of doctors were giving cancer treatment (chemotheraphy/radiotheraphy). Results: 84.5% of subjects were answered the question (Do you want to know the diagnosis of lung cancer if you are lung cancer?) as yes and the answers were not different between groups (p> 0.05). 72 of doctors were giving information about diagnosis of patients. This ratio was 89.1% in doctors who arrange lung cancer treatment whereas it was 57.4% in doctors who do not arrange cancer treatment. The percent age of learning of diagnosis of lung cancer throughout the time in doctors, population, and patient's relatives were 19%, 34%, and 59% respectively (p< 0.05). Information about quality of life was more important in relatives of patients (87%) than population (65%) and doctors (63%) (p< 0.05). Quality of life was more important for doctors who arrange lung cancer treatment (76.7)% than doctors who did not (48.8%) (p< 0.05). Patients who were more children wanted to stay with their family at end stage of disease (p< 0.05). Conclusion: According to this study we think that doctors should say the diagnosis of lung cancer in the form of they understand, inform the patients and relatives about treatment, and quality of life and this can increase patient trust to doctor and compliance of patients to the treatment.
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    Use of Tobacco Products in Turkish Children and Young People: Is there an Alarm for Hookah Use?
    Göktalay, T; Coskun, AS; Havlucu, Y; Horasan, GD
    OBJECTIVES: In the recent years, it has been observed that the use of hookah, a tobacco product, has increased in children and young people in Turkey. This study was conducted to determine the prevalence of cigarette and hookah use in children and young people specific to age and gender and to define the factors relevant to the use of hookah. MATERIALS AND METHODS: The study was conducted with secondary/high school students between 11 and 17 years of age (Survey 1, n=4718) and with university students between 18 and 23 years of age (Survey 2, n=1588) as two groups, which made a total of 6306 students. The students were asked to fill in a questionnaire which consisted of questions about socio-demographic data and the use of tobacco and tobacco products. RESULTS: It was determined that the use of cigarette and hookah was high in males, and it increased as the age increased in both genders (p<0.05). It was also determined that parents and friends using cigarette and hookah affected the use of cigarette and hookah in the study groups in both surveys (p<0.05). Additionally, it was determined that the educational level of the parents and being of a high social class were the social determiners of hookah use (p<0.05). CONCLUSION: It is important that we fight against the use of all tobacco products, especially in young people. Education about the damages of tobacco and applying tobacco products should start at an early age, and accurate tobacco control models may provide support in this field.
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    Serum and pleural fluid N-Terminal-Pro-B-Type natriuretic peptide concentrations in the differential diagnosis of pleural effusions
    Yorgancioglu, A; Alpaydin, AÖ; Yaman, N; Taneli, F; Bayturan, Ö; Coskun, AS; Çelik, P
    Currently, new biomarkers like N-Terminal-Pro-B-Type natriuretic peptide (NT-proBNP) have been used in the differential diagnosis of pleural effusions. In our study, we aimed to investigate the diagnostic value of NT-proBNP, especially in cardiac originated pleural effusions. Forty-five patients with pleural effusions were included in the study. NT-proBNP levels and biochemical markers involved in the Light's criteria were analyzed in pleural fluid and serums of the patients. Pleural fluid culture, AFB smear, cytology were performed where they were indicated according to the clinical evaluation. In patients, to whom cardiac pathology was considered to be; cardiological evaluation and echocardiography were also done. Thirtyeight pleural effusions were exudative and, 7 were transudative according to the Light's criteria. Final diagnosis were malignant effusion in 13, infection (tuberculosis/pneumonia) in 10, congestive heart failure in 21, and other conditions related with pleural effusion in 1 of the patients. Median (25th to 75th percentiles) NT-proBNP levels of serum and pleural fluid due to congestive heart failure (CHF) were 4747 pg/mL (931-15754) and 4827 pg/mL (1290-12.430) while median NTproBNP levels of serum and pleural fluid related with non-cardiac reasons were 183 pg/mL (138-444) and 245 pg/mL (187556) respectively. NT-proBNP levels of serum and pleural fluid were significantly high in CHF (p<0.001 for both). When four groups were compared serum and pleural fluid NT-proBNP levels were highest in the CHF group which was followed by malignancy, infection and others (p<0.001 for both). Fourteen of 21 patients who were accepted to have congestive heart failure as the final diagnosis by a cardiological evaluation had an exudative pleural fluid according to the Light's criteria. Serum and pleural fluid NT-proBNP levels were higher in transudates and this reached statistically significance for pleural fluid (p= 0.009). We suggest that measurement of pleural fluid NT-proBNP is a smart approach and pleural fluid NTproBNP can reflect cardiac origin of effusions better than serum NT-proBNP and Light's criteria
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    Reliability and validity of a Turkish version of Leicester cough questionnaire
    Gonen, NA; Havlucu, Y; Yorgancioglu, A; Goktalay, T; Coskun, AS; Celik, P
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    Relationship between BODE index, quality of life and inflammatory cytokines in COPD patients
    Sarioglu, N; Alpaydin, AO; Coskun, AS; Celik, P; Ozyurt, BC; Yorgancioglu, A
    Background and aims: Recently a multidimensional grading system based on the body mass index (B), degree of airflow obstruction (O), dyspnea (D) and exercise capacity (E) - the BODE index - has begun to be used increasingly for the evaluation of chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to investigate the relationship between the BODE index and disease duration, annual exacerbation and hospitalization rates, health related quality of life and systemic inflammatory markers like C-reactive protein (CRP), tumor necrosis factor (TNF)-alpha and interleukin (IL)-8. Materials and methods: In 88 stable COPD patients we evaluated the body-mass index, pulmonary function tests, Modified Medical Research Council dyspnea scale and six-minute walk test (6MWT). BODE scores were determined. Disease duration, number of exacerbations and hospitalization in the previous year were recorded. We also performed arterial blood gases analysis, administered the St. George's Respiratory Questionnaire (SGRQ) and measured serum levels of CRP, TNF-alpha, IL-8. Results: According to BODE score 52% of patients were BODE 1, 21% BODE 2, 15% BODE 3 and 12% were BODE 4. There was a significant relationship between BODE index and COPD stage as classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (p < 0.001). Correlations between BODE score and disease duration (p = 0.011), number of exacerbations (p < 0.001) and hospitalizations (p < 0.001) in the last year were also observed. SGRQ symptom, activity, emotion scores and total scores were found to be significantly correlated to BODE (p < 0.001). Serum CRP levels and BODE were also correlated (p = 0.014); however, no correlation was found between serum levels of TNF-alpha and IL-8 and BODE. Conclusions: As the BODE index shows a strong correlation with various prognostic and follow up parameters of COPD and systemic inflammation, its use should be considered for the evaluation of COPD patients.
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    Does asthma control as assessed by the asthma control test reflect airway inflammation?
    Bora, M; Alpaydin, AO; Yorgancioglu, A; Akkas, G; Isisag, A; Coskun, AS; Celik, P
    Background and aims: The treatment of asthmatic patients is particularly focused on the control of symptoms as well as functional and inflammatory parameters. In our study, we investigated the relationship between the asthma control test (ACT) which evaluates symptoms and airway inflammation and functional parameters. Materials and methods: Stable asthmatic patients admitted to our pulmonary outpatient clinic were enrolled in the study consecutively and underwent the ACT, pulmonary function tests and methacholine bronchial provocation test (MBPT). Additionally, fractional exhaled nitric oxide level (FeNO) and induced sputum cell distribution were assessed. All these parameters were re-evaluated at the third month after adjusting medications of the patients according to baseline ACT scores. Results: Of the 101 patients screened, we analyzed 83 who proceeded to the follow up visit. At the baseline visit, 8 were totally controlled, 36 partially controlled and 39 uncontrolled according to ACT. At the follow up visit, 10 were totally controlled, 39 partially controlled and 34 uncontrolled. Comparison of the two visits in terms of all parameters revealed significant reductions only in the percentages of patients with MBPT positivity (p = 0.029) and FeNO levels > 20 ppb (p = 0.025) at follow up. The percentages of patients with FeNO > 20 ppb, MBPT positivity, induced sputum eosinophilia or induced sputum neutrophilia did not show significant differences between totally controlled, partially controlled and uncontrolled groups at both baseline and follow up visits. Conclusion: Although the ACT scores did not show significant correlations with the airway inflammation parameters tested in this study, a marked reduction in the percentage of patients with MBPT positivity and FeNO > 20 ppb at follow up may suggest the importance of the control concept in the management of asthma.
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    Mannose binding lectin (MBL) gene polymorphism and relationship between serum MBL concentrations in COPD patients
    Ulutas, GS; Taneli, F; Alpaydin, AO; Cetinkaya, C; Ulman, C; Guvenc, Y; Dinc, G; Coskun, AS
    Aim: We aimed to assess mannose-binding lectin (MBL) gene polymorphisms and serum MBL concentrations in a sample of Turkish chronic obstructive pulmonary disease (COPD) patients as well as in cigarette smokers. Furthermore, we looked for the possible correlations of serum MBL concentrations with pulmonary function tests. Materials and methods: Forty COPD patients and 40 healthy volunteers were included. The subjects were thereafter divided into 2 groups according to smoking status. Circulating MBL concentrations were assessed by ELISA and MBL gene polymorphisms were assessed by real time PCR method. Spirometry was performed to all subjects except healthy nonsmokers. Results: In the whole study population MBL gene frequencies were found 82.5%(66/80) for A/B genotype, 15%(12/80) for D/D genotype and 2.5%(2/80) for B/B genotype. Circulating MBL concentrations were found 2103 +/- 1311 ng/ml and 2324 +/- 1001 ng/ml in smoker and nonsmoker COPD patients, respectively, whereas they were 1746 +/- 1142 ng/ml in smoker and 2040 +/- 879 ng/ml in nonsmoker controls. No statistical difference was found between the study groups for serum MBL concentrations. Serum MBL concentration correlated positively with cigarette smoking (r=0.280, p=0.030) and negatively with pulmonary functions (FEV1 (r=-0.246, p=0.058). Conclusion: To our knowledge, no previous study has been performed in healthy Turkish population to detect the MBL gene polymorphisms. A/B genotype was the most frequent MBL variant in our study population; however serum MBL concentrations were not found compatible with MBL deficiency. We believe these results need further investigation which includes larger series to evaluate whether serum MBL concentration is a risk factor for COPD.
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    Does one year change in quality of life predict the mortality in patients with chronic obstructive pulmonary disease? - Prospective cohort study
    Havlucu, Y; Yorganatoglu, A; Coskun, AS; Celik, P
    Background: Subjects with chronic obstructive pulmonary disease (COPD) present increased mortality and poor health-related quality of life (HRQoL) as compared with the general population. The objective of this study was to evaluate whether an improvement in QoL. after 1 year of proper management is a predictor of survival in a cohort of patients followed up for 10 years. Methods: In this prospective study, 306 COPD patients were assessed for eligibility between January 2003 and September 2003. Thirty-five patients were excluded due to failure to meet inclusion criteria or declining to participate and 20 patients were also excluded subsequently because they could not complete the questionnaire. Two hundred and fifty one patients were assessed at the beginning. St. George Respiratory Questionnaire (SGRQ) and pulmonary function test (PFT) were performed at the initial visit and the end of the first year. Mortality information was obtained from hospital records and direct family interviews. Results: A comparison between respiratory diseases mortality according to baseline paramaters reveals that age and presence of cardiac comorbidity indicates a higher risk of death and associated with worse QoL. After a cox regression analysis, the relative risk of death of any cause related to baseline QoL score was 1.042 (95% CI: 1.028-1.057), and 1.030 (95% CI: 1.011-1.050) for respiratory cause mortality. However, the relative risk of death when there was a deterioration in QoL, after one year of follow up was 1.175 (95% CI: 1.130-1.221) for all-cause mortality and 1.214 (95% CI: 1.151-1.280) for respiratory cause mortality. Conclusions: A QoL. worsening in the initial year of follow up more strongly predicts 10-year mortality of any cause and for respiratory diseases than the baseline assessment alone predicts, among patients with COPD.
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    A health survey in the workers of municipality
    Góktalay, T; Coskun, AS; Havlucu, Y; Akdemir, SE; Datli, U; Gümeli, F; Yorgancioglu, A
    Introduction: Internal and external air pollution that is gradually increasing due to urbanization and industrialization has a negative impact on the lung health. A health survey has been applied to evaluate the respiratory symptoms, respiration functions and smoking habbits of the workers of Izmir Konak Municipality whom have been reported to have a high rate of smoking habbit and be affected by the external air pollution due to their being working in the field by the Municipality's doctor. Materials and Methods: Questionnaire that are composed of the topics of work anamnesis, environmental anamnesis, curriculum vitae, symptoms (coughing, sputum, wheezing, dyspnea, hemoptysis) and smoking have been executed to 301 workers by face to face interview and their chest X-rays have been reviewed. Results: Dyspnea on exertion, sputum in the morning, wheezing and morning cough have been the most frequently observed complaints (respectively 37.2%, 32.2%, 27.9% and 24.9%). Sanitary workers have reported sputum in the morning more while maintanance shop workers have reported wheezing more (p values respectively 0.009, 0.008). No significance has been observed while the workers are evaluated one by one regarding to their work groups. No significant difference was identified between the addiction of smoking and nicotin addiction or pulmonary function test and chest X-rays (p> 0.05) but active smoking was much more seen in drivers (p= 0.047). Conclusion: Although working on the hazardous work branch does not institute a sharp distinction, it becomes significant to trace and lead the workers in order to obtain their lung health protection in long term. Informing and influencing the workers about the harms of smoking and the ways to quit has been the most considerable acquisition of this survey.
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    Epidemiological changes of patients with lung cancer over Years
    Havlucu, Y; Celik, P; Durmaz, F; Coskun, AS; Goktalay, T; Yorgancioglu, A
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    Occupational asthma in welders and painters
    Temel, O; Coskun, AS; Yaman, N; Sarioglu, N; Alkaç, Ç; Konyar, I; Alpaydin, AÖ; Çelik, P; Özyurt, BC; Keskin, E; Yorgancioglu, A
    We aimed to investigate the frequency of occupational asthma (OA) and the factors associated with OA development in a bicycle factory, subsequently after the diagnosis of OA in three workers at the same department. Forty one welders, 23 painters and 46 controls (office workers), a total number of 110 cases were included in the study. Turkish Thoracic Society Occupational and Environmental Diseases Evaluation Questionnaire and physical examination, chest-X ray, pulmonary function tests were performed as needed. Peak expiratory flow (PEF) follow-up was done in welders and painters. Cases having symptoms related with work and >= 20% PEF variability were diagnosed as OA. Wheezing were more frequent in welders and painters than the control group, although there wasn't a statisticall significance. Dyspnea, cough and sputum production were more frequent in welders and painters with respect to controls (p<0.05). Nine (22%) welder, 4 (18%) painter were diagnosed as OA. Working duration of welders and painters with OA (72, 156 months, respectively) were longer than the welders and painters without OA (45, 76 months, respectively), but it did not have any statistically significance. We suggest that working in welding and painting departments may cause respiratory symptoms and OA.
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    Asthma control with omalizumab treatment in severe allergic asthma and severe non-allergic asthma patients
    Havlucu, Y; Yorgancioglu, A; Kurhan, F; Goktalay, T; Coskun, AS; Celik, P
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    Factors affecting the interval from diagnosis to treatment in patients with lung cancer
    Yaman, N; Ozgen, A; Celik, P; Ozyurt, BC; Nese, N; Coskun, AS; Yorgancioglu, A
    Aims and background. We aimed to investigate the factors affecting the interval from the beginning of the symptoms until diagnosis and treatment in patients with lung cancer. Methods. Records of 119 lung cancer patients diagnosed in our pulmonary diseases clinic between 2004 and 2006 were evaluated retrospectively. Demographic data, histopathological tumor type, TNM stage, ECOG performance status, presence of endobronchial lesions, and radiological localization of the tumor were determined. Intervals from the first symptom to contacting a doctor, to diagnosis and to treatment were calculated. The interval from first admission to a clinic and referral to a chest physician was also calculated. Results. Of 119 patients, 74% were diagnosed as non-small cell and 26% were as small cell lung cancer. Forty-eight percent of the patients were at stage 3B and 36% were at stage 4. ECOG performance status was 0 in 6%, 1 in 52%, 2 in 36%, 3 in 3%, and 4 in 2%. Endobronchial lesions were observed in 50% of the patients, and the lesions had a central radiological localization in 59%. Fifty-four percent of the patients presented to a chest physician first. Patients who first presented to an internal medicine clinic were referred to our pulmonary disease clinic significantly later than those who presented to other clinics (P = 0.005). The median period from the beginning of the symptoms until contacting a doctor was 35 days (range, 1-387), until diagnosis was 49 days (range, 12-396), and until beginning the treatment was 57 (range, 9-397) days. The presence of endobronchial lesions, radiological localization, TNM stage and ECOG performance status were not found to be related to the intervals from the first symptom to presentation to a doctor, to diagnosis or to the beginning of the treatment. Conclusions. Lung cancer patients consult a doctor after a relatively long symptomatic period. Patient delays may be shortened by increasing the awareness of patients about lung cancer symptoms. Diagnostic procedures should be performed more rapidly to shorten doctor delays.