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    Allergic Bronchopulmonary Aspergillosis in Patients with Moderate and Severe Asthma
    (Aves, 2008) Aydogan, Oznur; Erdinc, Munevver; Aytemur, Zeynep Ayfer; Sin, Aytul; Savas, Recep
    Introduction: Allergic bronchopulmonary aspergillosis (ABPA), which is predominantly a disease of severe asthmatic patients, is caused by hypersensitivity to aspergillus antigens. The prevalence of ABPA is speculative, as the few studies that were performed adopted widely different diagnostic criteria. Material and Method: In this study, we aimed to evaluate the prevalence of ABPA in patients with moderate and severe asthma. ABPA-Central bronchiectasis (ABPA-SB) was diagnosed if a patient had asthma, central bronchiectasis, positive Aspergillus fumigatus skin test or positive serum aspergillus sIgE. ABPASeropositive (ABPA-S) was diagnosed if a patient had asthma, elevated total IgE level, positive Aspergillus fumigatus skin test and positive serum aspergillus sIgE. Results: Of the sixty four patients, 71.9% had moderate asthma and 28.2% severe asthma. Positive Aspergillus sIgE was present in 2 patients (3.1%). Sensitivity to A. fumigatus with skin test was shown in a total of 4 (7.8%) patients. Central bronchiectasis was seen on HRCT in seven of the patients (14.6%) and central mucus impaction was seen in one patient (2%). In this study, ABPA was diagnosed in 2 (3.1%) patients. Two (3.1%) patients were evaluated as aspergillus-sensitive asthma. Conclusion: Patients with ABPA had severe asthma. Therefore, ABPA should be considered in patients with poorly controlled severe asthma.
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    Bronchial Provocation Test Using AMP and Methacholine in Subjects with Asthma and COPD, Healthy Smokers and Non-Smokers
    (Aves, 2008) Toros, Asli; Solak, Zeynep Ayfer; Erdinc, Munevver; Kokuludag, Ali
    A direct stimulus such as methacholine is generally used to measure bronchial hyperresponsiveness. AMP, an indirect airway challenge, has been reported to be a better marker of inflammation than direct challenges and can be used in the differential diagnosis of asthma from other airway diseases. In this study, the effects of bronchial provocation test (BPT) using AMP and methacholine were compared in patients with asthma and COPD as well as healthy smokers and non-smokers. The study population consists of 60 subjects including 16 with mild asthma, 14 with mild-moderate COPD (8 current smokers and 6 ex-smokers), 15 non- smokers, and 15 current smokers. All the subjects underwent BPT using AMP and methacholine. 14 (87.5%) patients with asthma and seven (50%) patients with COPD were AMP responsive at a concentration of PC20 <= 100mg/ml (p=0.046). When asthmatic patients and current smokers with COPD were compared to each other, no significant difference was found related toAMP and methacholine responsiveness. However, one (16.7%) ex-smoker with COPD and 14 ( 87.5%) patients with asthma were AMP responsive at a concentration of PC20 <= 100mg/ml (p=0.004). Re-evaluated at an AMP concentration of PC20 <= 800mg/ml, 15 asthmatics (93.8%) and two ex-smokers with COPD(33.3%) were assessed to be hyperresponsiveness to AMP (p= 0.009). Patients with COPD were more responsive to the maximal concentration of both AMP and methacholine than healthy smokers (p= 0.008, p= 0.009). Provocation test using AMP is more sensitive than methacholine in the differentiating diagnosis of airway inflammation in asthma and COPD and being a current smoker may increase inflammation, and thus the AMP responsiveness in COPD.