Browsing by Author "Mungan D."
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Item Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children(2007) Kurt E.; Metintas S.; Basyigit I.; Bulut I.; Coskun E.; Dabak S.; Deveci F.; Fidan F.; Kaynar H.; Uzaslan E.K.; Onbasi K.; Ozkurt S.; Pasaoglu G.; Sahan S.; Sahin U.; Oguzulgen K.; Yildiz F.; Mungan D.; Yorgancioglu A.; Gemicioglu B.; Fuat Kalyoncu A.The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey. © 2007 The Authors.Item Prevalence and risk factors of allergies in turkey (PARFAIT): Results of a multicentre cross-sectional study in adults(2009) Kurt E.; Metintas S.; Basyigit I.; Bulut I.; Coskun E.; Dabak S.; Deveci F.; Fidan F.; Kaynar H.; Uzaslan E.K.; Onbasi K.; Ozkurt S.; Karakis G.P.; Sahan S.; Sahin U.; Oguzulgen K.; Yildiz F.; Mungan D.; Yorgancioglu A.; Gemicioglu B.; Kalyoncu A.F.The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.211.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.315.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 2.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.311.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country-and population-based environmental factors may contribute to increased prevalence rates of allergic diseases. Copyright © ERS Journals Ltd 2009.Item Geo-climate effects on asthma and allergic diseases in adults in Turkey: Results of PARFAIT study(Taylor and Francis Ltd., 2010) Metintas S.; Kurt E.; Basyigit I.; Bulut I.; Coskun E.; Dabak S.; Deveci F.; Fidan F.; Kaynar H.; Uzaslan E.K.; Onbasi K.; Ozkurt S.; Pasaoglu-Karakis G.; Sahan S.; Sahin U.; Oguzulgen K.; Yildiz F.; Mungan D.; Yorgancioglu A.; Gemicioglu B.; Kalyoncu A.F.The aim of the study was to evaluate the role of geo-climatic factors on the prevalence of allergic diseases in the adult population in Turkey. A total of 25,843 questionnaires using data from parents of 25,843 primary schoolchildren from 14 cities were evaluated. Mean annual temperature was significantly associated with the prevalence of asthma and wheezing in both sexes [respectively; OR: 1.008 (95% CI: 1.003-1.011) and OR: 1.012 (1.006-1.018 in males), OR: 1.007 (1.003-1.012) and OR: 1.01 (1.002-1.018) in females]. In addition, it was associated with eczema in females [OR: 1.007 (1.001-1.012)]. Asthma in females was associated with mean annual humidity in the air [OR: 1.001 (1.000-1.002)]. Annual number of days with snow is associated with wheezing in both sexes [respectively, OR: 1.001 (1.000-1.002) in males and OR: 1.002 (1.000-1.003) in females]. Protective measures could come into priority in certain areas of the country. Allergic diseases may increase as a cause of climate change in the future. © 2010 Taylor & Francis.Item Turkish thoracic society asthma management and prevention guideline: Key points; [Türk toraks derneǧi astım tanı ve tedavi rehberi: Anahtar noktalar](Ankara University, 2011) Yildiz F.; Oǧuzülgen I.K.; Dursun B.; Mungan D.; Gemicioǧlu B.; Yorgancioǧlu A.Asthma still has high morbidity and cost despite all advances in pathogenesis, diagnosis and treatment. Although asthma can be controlled with proper diagnosis and treatment, the low rates of control in our country and in the world can not be attributed to the variable course of the disease and patients' psycho-social behaviours for chronic disease. In this context, Turkish Thoracic Society (TTS) has decided to update Asthma Diagnosis and Management Guide latest published in 2000. National data were collected, compiled and prepared by authors, and final form given by the TTS Asthma and Allergy Study Group, after presenting to consultant individuals and institutions. In June 2009, the National Asthma Management and Prevention Guideline were published in Turkish. In this paper, we aimed to present the national guide in English with its basics and individual differences.Item Asthma control test via text messaging: Could it be a tool for evaluating asthma control?(2013) Uysal M.A.; Mungan D.; Yorgancioglu A.; Yildiz F.; Akgun M.; Gemicioglu B.; Turktas H.; Ozkan G.; Yilmaz I.; Incioglu M.; Boyaci H.; Atis S.; Yalcin A.; Bayram N.G.; Deveci F.; Pulur D.; Ozgur E.S.; Dursun B.; Bulbul Y.; Sulu E.; Yilmaz V.Introduction: Originally, the Asthma Control Test (ACT) was designed for English-speaking patients using a paper-and-pencil format. The Turkish version of the ACT was recently validated. This article compares the paper-and-pencil and web-based texting formats of the Turkish version of the ACT and evaluates the compatibility of these ACT scores with GINA-based physician assessments of asthma control. Methods: This multicentre prospective study included 431 asthma patients from outpatient clinics in Turkey. The patients were randomized into a paper-and-pencil group (n=220) and a text messaging group (n=211). Patients completed the ACT at Visit 1, after 10±2 days, and at 5±1 week to demonstrate the reliability and responsiveness of the test. At each visit, physicians assessed patients' asthma control levels. Results: The ACT administered via texting showed an internal consistency of 0.82. For the texting group, we found a significant correlation between the ACT and physician assessments at Visit 1 (r=0.60, p<0.001). The AUC was 0.87, with a sensitivity of 78.0% and a specificity of 77.5% for a score of ≤19 for screening "uncontrolled" asthma in the texting group. Conclusion: When the Turkish version of the ACT was administered via either the paper-and-pencil or text messaging test, scores were closely associated with physician assessments of asthma control. © 2013 Informa Healthcare USA, Inc.Item The validation of the turkish version of asthma control test(Kluwer Academic Publishers, 2013) Uysal M.A.; Mungan D.; Yorgancioglu A.; Yildiz F.; Akgun M.; Gemicioglu B.; Turktas H.Introduction: Current guidelines focus more on levels of asthma control than on severity of asthma. The original version of the Asthma Control Test (ACT), a self-administered instrument to determine asthma control levels, was designed for English-speaking patients. More recently, the ACT has been translated into many languages and has been validated for many cultures, but this is the first study to evaluate the Turkish version. Purpose: We aimed to evaluate the reliability, validity, and responsiveness of the Turkish version of the ACT among outpatients with asthma. Method: This multicenter prospective study included 220 asthma patients in outpatient clinics in Turkey. The ACT was completed at admission (Visit 1), after 10 ± 2 days (Visit 2), and at 5 ± 1 weeks (Visit 3). At each visit, physicians assessed patients' asthma control levels. Results: The Turkish version of the ACT showed an internal consistency reliability of 0.84 (Cronbach's alpha). Test-retest reliability was 0.85 in stable patients. There was a significant correlation between the ACT and physicians' assessments at admission (r = 0.68, p < 0.001). The AUC was 0.91, with a sensitivity of 89.06 % and a specificity of 78.26 % for a score of ≤19 for screening "uncontrolled" asthma. A minimally important difference of three points on the ACT was consistent with the GINA physician assessment scores between the baseline and the follow-up visits. Conclusion: The Turkish version of the ACT is a valid and reliable tool for assessing asthma control in patients in outpatient settings. The test may facilitate the designation of asthma patients' symptoms as either controlled or uncontrolled. © 2012 Springer Science+Business Media Dordrecht.Item Treatment of severe asthma: Expert opinion; [Aǧi{dotless}r asti{dotless}m tedavisi: Uzman görüşü](Ankara University, 2014) Türktaş H.; Bavbek S.; Çelik G.; Demir T.; Gemicioǧlu B.; Günen H.; Kiyan E.; Mungan D.; Oǧuzülgen I.K.; Polatli M.; Saryal S.; Sayiner A.; Şen E.; Yildirim N.; Yildiz F.; Yorgancioǧlu A.Severe asthmatics account 10% of the all asthmatic population. Those asthmatics whose disease is inadequately controlled account for up to half of the cost for asthma, because they have more emergency room visits, more hospital admission and greater absenteeism from work. New therapeutic options were tried in those patients whose asthma was uncontrolled with standart high dose inhaled corticosteroid and long acting beta-2 agonsit combination therapy. In this paper taking into account the conditions of our country, current literature was reviewed and treatment options was discussed and graded recommendations are made for daily clinical practice in patients with severe treatment-refractory asthma.Item Prevalence of asthmatic smokers: Turkish experience (PASTE Study)(Blackwell Publishing Ltd, 2014) Yildiz F.; Dursun A.B.; Disçi R.; Abadoglu O.; Atalay F.; Ates G.; Buyukoglan H.; Ceyhan B.; Ceylan E.; Deveci F.; Ediger D.; Ekici A.; Erdinc M.; Gemicioglu B.; Goktalay T.; Meral M.; Mungan D.; Ogus C.; Ozge C.Background: Although both asthma and smoking are major health problems worldwide, smokers are often excluded from asthma studies. Objectives: It was aimed to verify the prevalence of asthmatic smokers in Turkey and assess the effects of smoking based on clinical parameters, exacerbations and hospitalizations because of lack of national data about the prevalence of smoking among asthmatics. Methods: The study protocol was comprised of a retrospective questionnaire. The asthmatic patients were followed in the outpatient clinics of 18 tertiary hospitals selected from seven different geographical regions in Turkey. We evaluated demographic data, smoking habits, asthma-related diseases, respiratory function and emergency visits. Results: The study population included 1385 patients (M/F: 343/1042), and the mean age was 45.1±14.0 years. Current and former smoking prevalence was 11.4% and 15.1%, respectively. Smoker rates were higher in males and younger asthmatics compared with females and older asthmatics (P<0.01 and P<0.05, respectively). Smoking history ranged from 0.20 to 90 pack-years (the mean was 12.9), and smokers had a higher level of education compared with nonsmokers (P<0.01). Socioeconomically, the most developed region had the highest rate of smoker asthmatics (33.9%; P=0.014). There was an increase in the number of exacerbations in smoker asthmatics during the previous year, but it was not statistically significant (P>0.05). Conclusion: We showed that the smoking prevalence in Turkey was lower in asthmatics (11.4%) compared with the general population (44.5%). Nevertheless, every effort should be made to encourage asthmatics to stop smoking because smoking is a modifiable risk factor for adverse asthma health outcomes. © 2013 John Wiley and Sons Ltd.Item Asthma-KOAH overlap syndrome; [Astım-KOAH overlap sendromu](Ankara University, 2015) Şen E.; Oğuzülgen K.; Bavbek S.; Günen H.; Kiyan E.; Türktaş H.; Yorgancioğlu A.; Polatli M.; Yildiz F.; Çelik G.; Demir T.; Gemicioğlu B.; Mungan D.; Saryal S.; Sayiner A.; Yildirim N.Asthma and chronic obstructive pulmonary disease (COPD) are common lung diseases characterized by chronic airway inflammation and airway obstruction. Among patient with COPD and asthma; there is a group of patients with an overlap between clinical, functional characteristics and airway inflammation patterns, named “Asthma-COPD Overlap Syndrome” (ACOS). ACOS is a syndrome characterized by reversible but persistant airflow limitation (postbronchodilator FEV1/FVC < 70%) which has some features of both asthma and COPD. ACOS should be suspected in a patient > 40 years, with smoking history, previous asthma diagnosis or history of childhood asthma who has persistant airflow limitation and reversible ariway obstruction (defined by an increase of > %12 of FEV1 pred or increase of FEV1 > 200 mL after inhalation of 400 mcg salbutamol or 1000 mcg terbutaline). The prevalence for ACOS has been reported 11-55% in different case series to date and increases by age and is more frequent in females in different age groups. Patients with ACOS are younger than COPD patients and older than asthma patients. Frequent and severe exacerbations and related hospitalization and emergency room visits are common in ACOS and this causes an impaired quality of life. Current recommendations of guidelines for pharmacologic treatment of ACOS have been composed of a combination with optimal COPD and asthma treatment. Future therapeutic approaches should be based on endotypes. Clinical phenotype and underlying endotype driven clinical studies may be the base of ACOS guidelines. © 2015, Ankara University. All rights reserved.Item Koah ve astımda atak; [KOAH ve astımda atak](Ankara University, 2015) Yildirim N.; Demir T.; Gemicioğlu B.; Kiyan E.; Oğuzülgen K.; Polatli M.; Saryal S.; Sayiner A.; Yorgancioğlu A.; Bavbek S.; Çelik G.E.; Günen H.; Mungan D.; Şen E.; Türktaş H.; Yildiz F.Chronic obstructive pulmonary disease (COPD) and asthma are airway diseases with acute exacerbations. Natural course of both disease are affected by exacerbations. COPD exacerbations may be caused by infections and other causes; indoor and outdoor pollution, cardiovascular diseases, asthma-COPD overlap syndrome, COPD- obstructive sleep apnea syndrome, pulmonary embolism, gastro-oesophageal reflux, anxiety-depression, pulmonary hypertension. Exposure to triggering factors, viral infections, treatment insufficiency may cause asthma exacerbations. Smoking cessations, prevention of infections, long-acting anticholinergics, long-acting β2 agonists, inhaled corticosteroids, phosphodiesterase-4 inhibitors, mucolytics, prophilactic antibiotics can be effective on the prevention of COPD exacerbations. Asthma exacerbations may be decreased by the avoidance of allergens, viral infections, occupational exposures, airpollution, treatment of comorbid diseases. Effective treatment of asthma is required to prevent asthma exacerbations. Inhaled steroids and combined treatments are the most effective preventive therapy for exacerbations. Patient education and cooperation is an element of the preventive measures for asthma attacks. Compliance to therapy, inhalation techniques, written asthma plans are required. The essential of COPD and asthma exacerbation treatment is bronchodilator therapy. Steroids are also implemented to the therapy, targeting the inflammation. Specific treatments of the cause (infection, airpollution, pulmonary embolism etc.) should be administered. © 2015, Ankara University. All rights reserved.Item Evaluation of asthma and COPD awareness in primary care doctors in Turkey; [Türkiye’de birinci basamak hekimlerinde astım ve KOAH farkındalığının değerlendirilmesi](Ankara University, 2016) Ersu R.; Bingöl Karakoç G.; Yildiz F.; Köktürk N.; Mungan D.; Ekinci B.; Gemicioğlu B.; Yorgancioğlu A.A.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. Material 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. Results: 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%. Conclusion: 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. © 2016, Ankara University. All rights reserved.Item Asthma phenotypes in Turkey: a multicenter cross-sectional study in adult asthmatics; PHENOTURK study(Blackwell Publishing Ltd, 2017) Yildiz F.; Mungan D.; Gemicioglu B.; Yorgancioglu A.; Dursun B.; Oner Erkekol F.; Ogus C.; Turktas H.; Bogatekin G.; Topcu F.; Deveci F.; Bayram H.; Tor M.; Kalyoncu A.F.Background and Aims: To evaluate asthma phenotypes in patients with asthma from different regions of Turkey. Methods: A total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011–January 2012. Results: The disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P < 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P < 0.01). Uncontrolled asthmatics have more severe disease (P < 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P < 0.01). Chronic rhino-sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P < 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P < 0.05). Conclusion: In conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes. © 2015 John Wiley & Sons LtdItem Assessing the knowledge in primary health care following an educational course structured in the context of gard chronic airway diseases national control program; [Türkiye kronik hava yolu hastalıkları önleme ve kontrol programı (GARD Türkiye) birinci basamakta çalışan hekim eğitimi bilgi değerlendirme sonuçları](Ankara University, 2017) Öner Erkekol F.; Köktürk N.; Mungan D.; Saçkesen C.; Önen Z.P.; Özkan S.; Balkan A.; Ergün P.; Kocabaş C.N.; Baran Aksakal N.; Ekıcı B.; Özkan Altunay Z.; Gemıcıoğlu B.; Yorgancıoğlu A.Introduction: Chronic obstructive pulmonary diseases are common causes of disease in the community and account for considerable percent of the caseload in primary health care facilities. For this reason, it is important to question and improve the knowledge of primary health care physicians. This study is designed to assess the level of knowledge for bronchial asthma and COPD of the primary healthcare physicians, both before and immediately after an educational course structured in the context of GARD Chronic Airway Diseases National Control Program. Materials and Methods: The participating physicians attended an intensive educational course on asthma and COPD. Twenty five item questionnaires for asthma and COPD were administered to the participants both before and immediately after the end of the course. Contribution of education to the level of knowledge was investigated by comparing the percentages of the correct answers in the pre-and post-test. Results: From 11 different cities, 1817 and 1788 primary health care physician were attended to the asthma and COPD educations, respectively. The accuracy rate of ≥ 75% was obtained from only 4 questions in pre-test asthma questionnaire. On the contrary, in 15 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 45.8%, and this rate raised to 69.6% after education course. The accuracy rate of ≥ 75% could not be obtained from any of the questions in pre-test COPD questionnaire. On the contrary, in 19 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 42.0%, and this rate raised to 71.3% after education course. Conclusion: It has been shown that, in primary care settings, the level of knowledge in asthma and COPD should be enhanced and that this increase can be achieved with an education course. © 2017, Ankara University. All rights reserved.Item Long-Term Omalizumab Treatment: A Multicenter, Real-Life, 5-Year Trial(S. Karger AG, 2018) Yorgancloǧlu A.; Erkekol F.Ö.; Mungan D.; Erdinç M.; Gemicioǧlu B.; Özşeker Z.F.; Bayrak Deǧirmenci P.; Naycl S.; Çilli A.; Erdenen F.; Klrmaz C.; Ediger D.; Yalçln A.D.; Büyüköztürk S.; Öztürk S.; Güleç M.; Işlk S.R.; Kalyoncu A.F.; Göksel Ö.; Aydln Ö.; Havlucu Y.; Baloǧlu Ar I.; Erdoǧdu A.Background: Omalizumab has demonstrated therapeutic benefits both in controlled clinical trials and real-life studies. However, research concerning the long-term effects and tolerability of omalizumab is needed. The main objective of this study was to evaluate the effectiveness and tolerability of treatment with omalizumab for up to 5 years. Methods: A multicenter, retrospective, chart-based study was carried out to compare documented exacerbations, hospitalizations, systemic steroid requirement, FEV1, and asthma control test (ACT) results during 1 year prior to omalizumab treatment versus at 1, 3, and 5 years of treatment. Adverse events and reasons for discontinuation were also recorded at each time point. Results: Four hundred and sixty-five patients were enrolled in the study. Outcome variables had improved after the 1st year and were sustained after the 3rd and 5th years of treatment with omalizumab. Omalizumab treatment reduced the asthma exacerbation rate by 71.3% (p < 0.001) at 1 year, 64.3% (p < 0.001) at 3 years, and 54.8% (p = 0.002) at 5 years. The hospitalization rate also decreased; by the 5th year of the treatment no patients were hospitalized. ACT results had also improved significantly: 12 (p < 0.001) at 1 year, 12 (p < 0.001) at 3 years, and 12 (p = 0.002) at 5 years. Overall, 12.7% of patients reported adverse events (most of these were mild-to-moderate) and the overall dropout rate was 9.0%. Conclusion: Omalizumab had a significant effect on asthma outcomes and this effect was maintained over 5 years. The drug was found to be generally safe and treatment compliance was good. © 2018 S. Karger AG, Basel. Copyright: All rights reserved.Item Economic burden of severe asthma in turkey: A cost of illness study from payer perspective(EDRA S.p.A, 2021) Bavbek S.; Malhan S.; Mungan D.; Misirligil Z.; Erdinc M.; Gemicioglu B.; Kivilcim Oguzulgen I.; Oksuz E.; Yildiz F.; Yorgancioglu A.Objective. To estimate economic burden of severe asthma in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods. This cost of illness study was based on identification of per patient annual direct medical costs for the management of severe asthma in Turkey from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations and interventions, drug treatment and equipment, and co-morbidities/complications. Results. Based on total annual per patient costs calculated for outpatient admission ($ 177.91), laboratory and radiological tests ($ 82.32), hospitalizations/interventions ($ 1,154.55), drug treatment/equipment ($ 2,289.63) and co-morbidities ($ 665.39) cost items, total per patient annual direct medical cost related to management of severe asthma was calculated to be $ 4,369.76 from payer perspective. Drug treatment/equipment (52.4%) was the main cost driver in the management of severe asthma in Turkey, as followed by hospitalizations/interventions (26.4%) and co-morbidities (15.2%). Conclusions. In conclusion, our findings indicate that managing patients with severe asthma pose a considerable burden to health economics in Turkey, with medications as the main cost driver. © 2021 Associazione Allergologi Immunologi Italiani Territoriali e Ospedalieri-AAIITO. Published by EDRA SpA. All rights reserved.Item Short-acting β2-agonist prescription patterns in patients with asthma in Turkey: results from SABINA III(BioMed Central Ltd, 2022) Yorgancıoğlu A.; Aksu K.; Naycı S.A.; Ediger D.; Mungan D.; Gül U.; Beekman M.J.H.I.; Kızılırmak D.; Altıntaş N.; Bulut İ.; Çağatay T.; Gemicioğlu B.; İnce Ö.; Oğuzülgen K.; Kalpaklıoğlu F.; Baççıoğlu A.; Aksu F.; Altuntaş M.; Erkekol F.Ö.; Karakaya G.; Kalyoncu A.F.; Damadoğlu E.; Hanta İ.; Altunok E.; Özer A.; Yuluğ D.P.; Gülbaş G.; Süerdem M.; Yormaz B.; Ceylan E.; Erge D.; Çilli A.; Doğan B.C.; Erel F.; Sevinç C.; Anar C.; Pekbak G.; Erbay M.Background: Over-reliance on short-acting β2-agonists (SABAs) is associated with poor asthma outcomes. However, the extent of SABA use in Turkey is unclear owing to a lack of comprehensive healthcare databases. Here, we describe the demographics, disease characteristics and treatment patterns from the Turkish cohort of the SABA use IN Asthma (SABINA) III study. Methods: This observational, cross-sectional study included patients aged ≥ 12 years with asthma from 24 centres across Turkey. Data on sociodemographics, disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA]) and practice type (primary/specialist care). The primary objective was to describe SABA prescription patterns in the 12 months prior to the study visit. Results: Overall, 579 patients were included (mean age [standard deviation; SD]: 47.4 [16.1] years; 74.3% female), all of whom were treated by specialists. Most patients had moderate-to-severe asthma (82.7%, GINA steps 3–5), were overweight or obese (70.5%), had high school or university/post-graduate education (51.8%) and reported fully reimbursed healthcare (97.1%). The mean (SD) asthma duration was 12.0 (9.9) years. Asthma was partly controlled/uncontrolled in 56.3% of patients, and 46.5% experienced ≥ 1 severe exacerbation in the preceding 12 months. Overall, 23.9% of patients were prescribed ≥ 3 SABA canisters in the previous 12 months (considered over-prescription); 42.9% received no SABA prescriptions. As few patients had mild asthma, only 5.7% were prescribed SABA monotherapy. Therefore, most patients (61.5%) were prescribed SABA in addition to maintenance therapy, with 42.8% receiving ≥ 3 SABA canisters in the previous 12 months. Inhaled corticosteroids (ICS), ICS + a long-acting β-agonist fixed-dose combination and oral corticosteroids were prescribed to 14.5%, 88.3% and 28.5% of all patients, respectively. Additionally, 10.2% of patients purchased SABA over the counter, of whom 27.1% purchased ≥ 3 canisters in the preceding 12 months. Conclusions: Despite all patients being treated by specialists and most receiving fully reimbursed healthcare, nearly a quarter of patients received prescriptions for ≥ 3 SABA canisters in the previous 12 months. This highlights a public health concern and emphasizes the need to align clinical practices with the latest evidence-based recommendations. © 2022, The Author(s).Item Stepwise Approach in Asthma Revisited 2023: Expert Panel Opinion of Turkish Guideline of Asthma Diagnosis and Management Group(AVES, 2023) Çelik G.E.; Aydın Ö.; Damadoğlu E.; Baççıoğlu A.; Özdemir S.K.; Bavbek S.; Ediger D.; Erkekol F.Ö.; Gemicioğlu B.; Işık S.R.; Kalpaklıoğlu A.F.; Kalyoncu A.F.; Karakaya G.; Keren M.; Mungan D.; Oğuzülgen İ.K.; Yıldız F.; Yılmaz İ.; Yorgancıoğlu A.Introduction of inhaled corticosteroids (ICS) has been the cornerstone of the long-term management of asthma. ICSs either alone or in combination with long-acting beta-2 agonists have been shown to be associated with favorable asthma outcomes. However, asthma con-trol is still reported to be below expectations all around the world. Research in the last decades focusing on the use of ICS/formoterol both as maintenance and as needed (maintenance and reliever therapy approach) showed improved asthma outcomes. As a result of recent developments, Turkish Asthma Guidelines group aimed to revise asthma treatment recommendations. In general, we recommend physicians to consider the risk factors for poor asthma outcomes, patients’ compliance and expectations and then to determine “a personalized treatment plan.” Importantly, the use of short-acting beta-2 agonists alone as a symptom reliever in asthma patients not using regular ICS is no longer recommended. In stepwise treatment approach, we primarily recommend to use ICS-based controllers and initiate ICS as soon as possible. We define 2 different treatment tracks in stepwise approaches as maintenance and reliever therapy or fixed-dose therapy and equally recommend each track depending on the patient’s risks as well as decision of physicians in a personalized manner. For both tracks, a strong recommendation was made in favor of using add-on treatments before initiating phenotype-specific treatment in step 5. A strong recommendation was also made in favor of using biologic agents and/or aspirin treatment after desensitization in severe asthma when indicated. © Author(s).Item Picturing asthma in Turkey: results from the Turkish adult asthma registry(Taylor and Francis Ltd., 2023) Celik G.E.; Aydin O.; Gokmen D.; Koycu Buhari G.; Celebi Sozener Z.; Gemicioglu B.; Bulut I.; Beyaz S.; Orcen C.; Ozdemir S.K.; Keren M.; Damadoglu E.; Yakut T.; Kalpaklioglu A.F.; Baccioglu A.; Yalim S.A.; Yilmaz I.; Koca Kalkan I.; Uysal M.A.; Ozgun Niksarlioglu E.Y.; Kalyoncu A.F.; Karakaya G.; Erbay M.; Nayci S.; Tepetam F.M.; Gelincik A.A.; Dirol H.; Goksel O.; Karaoglanoglu S.; Oner Erkekol F.; Isik S.R.; Yildiz F.; Yavuz Y.; Karadogan D.; Bozkurt N.; Seker U.; Oguzulgen I.K.; Basyigit I.; Baris S.A.; Yilmazel Ucar E.; Erdogan T.; Polatli M.; Ediger D.; Gunaydin F.E.; Turk M.; Pur L.; Katran Z.Y.; Sekibag Y.; Aykac E.F.; Mungan D.; Gul O.; Cengiz A.; Akkurt B.; Ozden S.; Demir S.; Unal D.; Aslan A.F.; Can A.; Gumusburun R.; Bogatekin G.; Akten H.S.; Inan S.; Erdinc M.; Ogus A.C.; Kavas M.; Polat Yulug D.; Cakmak M.E.; Kaya S.B.; Alpagat G.; Ozgur E.S.; Uzun O.; Tas Gulen S.; Pekbak G.; Kizilirmak D.; Havlucu Y.; Donmez H.; Arslan B.; Cetin G.P.; Soyyigit S.; Kara B.Y.; Pasaoglu Karakis G.; Dursun A.B.; Kendirlinan R.; Ozturk A.B.; Sevinc C.; Omeroglu Simsek G.; Abadoglu O.; Cerci P.; Yucel T.; Yorulmaz I.; Tezcaner Z.C.; Tatar E.C.; Suslu A.E.; Ozer S.; Dursun E.; Yorgancioglu A.Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3–5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery. © 2023 Taylor & Francis Group, LLC.Item Physical activity and dietary habits in patients with asthma: How is it related to asthma control?(Elsevier Ltd, 2023) Aydın Ö.; Çelebi Sözener Z.; Mungan D.; Özbey Ü.; Balaban S.; Gökmen D.; Zergeroğlu A.M.; Gemicioğlu B.; Yorgancıoğlu A.; Havlucu Y.; Yıldız F.; Argun Barış S.; Çerçi P.; Dursun A.B.; Kalpaklıoğlu F.; Baççıoğlu A.; Atış Naycı S.; Sercan Özgür E.; Kendirlinan R.; Koca Kalkan İ.; Köycü Buhari G.; Yılmaz İ.; Türk M.; Göksel Ö.; Erdinç M.; Damadoğlu E.; Kalyoncu A.F.; Karakaya G.; Ediger D.; Oğuzülgen I.K.; Türktaş H.; Soyyiğit Ş.; Paşaoğlu Karakış G.; Sekibağ Y.; Kızılırmak D.; Dönmez H.; Boğatekin G.; Çakmak M.E.; Kaya S.B.; Günaydın F.E.; Çelik G.Aims: In this study, we aimed to determine the PA and dietary habits of patients with asthma and whether asthma control had a role in these habits. Methods: Adult patients with asthma were included. Three questionnaires were administered to the patients. and daily step counts were recorded for one week. Asthma control level and severe asthma attacks in the previous year were assessed. Results: A total of 277 patients were included. One hundred eighty-two (65.3%) of the patients were overweight/obese. According to FFQ, none of the food groups were comsumed in recommended levels. According to the IPAQ scores, 82.7% of the patients had mild physical activity. The daily step counts and the PA domain of the HLBS-II in obese patients were lower than the nonobese patients (p = 0.001 and p = 0.034,respectively). The rate of obese patients (n = 9; 50%) was higher in the uncontrolled patients. Conclusion: In our study, the majority of patients were physically inactive. Few patients consumed the recommended amount of foods. Being overweight seems to be a significant barrier to the healthy life behaviors. Although these behaviours do not seem to have an effect on asthma controlling this study, further prospective placebo-controlled studies are needed. © 2022 Elsevier LtdItem Economic burden of short-acting beta-2 agonist (SABA) overuse among asthma patients in Türkiye: a cost analysis with respect to the updated GINA treatment recommendations(BioMed Central Ltd, 2024) Yorgancıoğlu A.; Aksu K.; Cura C.; Yaman Y.; Dinç M.; Malhan S.; Erbay M.; Pekbak G.; Ediger D.; Anar C.; Sevinç C.; Erel F.; Doğan B.C.; Çilli A.; Erge D.; Ceylan E.; Yormaz B.; Süerdem M.; Gülbaş G.; Yuluğ D.P.; Naycı S.A.; Özer A.; Altunok E.; Hanta İ.; Damadoğlu E.; Kalyoncu A.F.; Karakaya G.; Erkekol F.Ö.; Altuntaş M.; Aksu F.; Baççıoğlu A.; Kalpaklıoğlu F.; Mungan D.; Oğuzülgen K.; İnce Ö.; Gemicioğlu B.; Çağatay T.; Bulut İ.; Altıntaş N.; Kızılırmak D.Background: This cost of illness study aimed to determine economic burden of short-acting β2-agonist (SABA) overuse in Türkiye from payer perspective with respect to the updated GINA 2022 treatment recommendations. Methods: A total of 3,034,879 asthma patients comprised the study population, via estimations extrapolated from the Türkiye arm of the global SABINA III study. The economic burden (costs related to the drug use and severe exacerbations) was compared in subgroups of overall (≥ 0 canisters/year) vs. GINA-recommended (0–2 canisters/year, hypothetical population) SABA use and in subgroups of appropriate use (0–2 canisters/year, real population) vs. overuse (≥ 3 canisters/year) of SABA with extrapolation of SABINA Türkiye data to the Türkiye asthma population. Results: Recommended SABA use was predicted to prevent 127,505 of 157,512 severe exacerbations per year in mild asthma patients and 2,668,916 of 3,262,800 severe exacerbations per year in moderate-severe asthma patients. Annual cost burden of not applying recommended SABA use (overall [≥ 0 canisters/year] vs. GINA-recommended [0–2 canisters/year] SABA use) in mild asthma and moderate-severe asthma patients was calculated to be €20.43 million and €427.65 million in terms of severe exacerbations, and to be €829,352 and €7.20 million in terms of drug costs, respectively. The total annual economic burden arising from not applying recommended SABA use was estimated to be €456.11 million. Appropriate use (0–2 canisters/year) vs. overuse (≥ 3 canisters/year) of SABA was associated with decreased frequency of severe exacerbations per year in mild asthma (from 129,878 to 27,634) and moderate-severe asthma (from 2,834,611 to 428,189) patients. SABA overuse in mild and moderate-severe asthma patients was estimated to yield an additional annual cost of €16.38 million and €385.59 million, respectively in terms of severe exacerbations, and a total €11.30 million additional drug cost. The overall annual economic burden arising from SABA overuse was estimated to be €413.27 million. Conclusions: The estimated annual total economic burden arising from not applying recommended SABA use (€456.11 million) and SABA overuse (€413.27 million) with respect to the updated GINA 2022 treatment recommendations indicates the substantial cost burden of SABA overuse to the Turkish National Health System, corresponding up to 26% of the total direct cost of asthma reported in our country. © The Author(s) 2024.