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    Association between cytokines in induced sputum and severity of chronic obstructive pulmonary disease
    (W B Saunders Co Ltd, 2006) Hacievliyagil, SS; Gunen, H; Mutlu, LC; Karabulut, AB; Temel, I
    Cytokines are known to be increased in induced sputum in chronic obstructive pulmonary disease (COPD). In this study, the relationship between the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumour necrosis factor-alpha (TNF-alpha) in induced sputum of patients with exacerbation of COPD, and the severity of the disease, pulmonary function tests (PFT), arterial blood gases (ABG) were studied. Twenty-four patients with exacerbation of COPD were included in the study. The patients were grouped according to their PFT into two as: Group 1 (FEV, below 50% of the predicted value, severe-very severe COPD, n = 12) and, Group 2 (FEV, above 50% of the predicted value, mild-moderate COPD, n = 12). The levels of IL-6, IL-8 and TNF-alpha in induced sputum of the subjects were measured. The mean levels of IL-6, IL-8 and TNF-alpha in induced sputum were found to be higher in Group 1 (severe-very severe COPD) than in Group 2 (mild-moderate COPD). The differences in IL-6 and IL-8 levels between groups were statistically significant (P < 0.05). A significant correlation was observed between the IL-6 value and FEV1 (r = -0.435, P = 0.034), FEV1/FVC (r = -0.446, P = 0.029), PaO2 (r = -0.711, P = 0.000), SaO(2) (r = -0.444, P = 0.030) and disease duration (r = 0.427, P = 0.037), respectively. Also, the level of IL-8 in induced sputum was inversely correlated with FEV1 (r = -0.562, P = 0.004), PaO2 (r = -0.540, P = 0.006) and SaO(2) (r = -0.435, P = 0.034). However, all three cytokines were positively correlated with the smoking load (r = 0.653, P = 0.001; r = 0.439, P = 0.032; r = 0.649, P = 0.001). We conclude, therefore, that in exacerbated COPD cases with greater degrees of obstruction of the airways have higher levels of cytokines in induced sputum. This can be interpreted to mean that these cytokines are related to the clinical parameters like the ABG and PFT and seem to be the determinant of the severity of the disease. (c) 2005 Elsevier Ltd. All rights reserved.
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    Asthma, age, and early reversibility testing
    (Taylor & Francis Ltd, 2003) Kizkin, O; Turker, G; Hacievliyagil, SS; Gunen, H
    The aim of this study was to assess the effect of age on early reversibility testing (ERT) in patients with asthma. Forty-nine nonsmokers with asthma were investigated. In all cases, disease duration was less than 15 years; the absolute change (absolute variability, AV) in forced expiratory volume in I second (FEV1) on ERT was greater than 100 mL; and the increase in FEV1, on ERT was greater than 10%. Patients were categorized as group I (younger than 50 years; n = 24) and group 11 (50 years or older; n = 25). There were no significant differences between the groups regarding disease duration and severity. The mean patient ages in groups I and 11 were 40.3 +/- 7.9 years and 59.2 +/- 7.1 years, respectively, and the corresponding mean baseline FEV1 values were 62.2 +/- 23.7% and 67.4 +/- 21.1% of predicted value (p > 0.05). Pulmonary function tests were performed at baseline, and then repeated for ERT 20 minutes after inhalation of 200 mug salbutamol. After ERT, the respective findings for groups I and 11 were as follows: AV 412 +/- 184mL and 247 +/- 138mL; percentage change (PC) in FEV1 21.5 +/- 9.3% and 16.9 +/- 7.5%; and percent of predicted change (PPC) in FEV1 13.6 +/- 6.5% and 9.9 +/- 4.9%. The AV, PC, and PPC values for group I all were higher than the corresponding findings for group 11, and the differences in AV and PPC were statistically significant (p = 0.001, p < 0.05). The study showed that elderly asthma patients exhibit significantly lower AV and PPC after ERT. To improve the accuracy of asthma diagnosis in elderly patients, limits of ERT should be redefined.
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    Factors affecting survival of hospitalised patients with COPD
    (European Respiratory Soc Journals Ltd, 2005) Gunen, H; Hacievliyagil, SS; Kosar, F; Mutlu, LC; Gulbas, G; Pehlivan, E; Sahin, I
    Factors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AECOPD. Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AECOPD were prospectively assessed. Patients were followed-up for 3 yrs. Factors determining short- and long-term mortality were analysed. In total, 17 patients (8.3%) died in hospital. In-hospital mortality was significantly associated with lower arterial oxygen tension (Pa,O-2), higher carbon dioxide arterial tension, lower arterial oxygen saturation and longer hospital stay. The overall 6-month mortality rate was 24%, with 1-, 2- and 3-yr mortality rates of 33%, 39% and 49%, respectively. Cox regression analysis revealed that long-term mortality was associated with longer disease duration (relative risk (RR)=1.158), lower albumin (RR=0.411), lower Pa,O-2 (RR=0.871) and lower body mass index (RR=0.830). When the model was run for the time elapsed since first hospitalisation, it also appeared as statistically significant (RR=1.195). These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival. Prediction of survival status may be enhanced by considering arterial oxygen tension, albumin, body mass index, disease duration and time elapsed since the first hospitalisation.
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    Increased plasma viscosity in patients with history of pulmonary embolism
    (Amer Coll Chest Physicians, 2004) Mutlu, LC; Tek, I; Hacievliyagil, SS; Gunen, H; Kaya, A; Numanoglu, N; Yetkin, O
    [Abstract Not Available]
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    Prevalence and clinical significance of a patent foramen ovate in patients with chronic obstructive pulmonary disease
    (W B Saunders Co Ltd, 2006) Hacievliyagil, SS; Gunen, H; Kosar, FM; Sahin, I; Kilic, T
    Background: A patent foramen ovate (PFO) is not widely recognized as a factor contributing to hypoxemia in patients with chronic obstructive pulmonary disease (CCPD). We therefore sought to clarify the prevalence and clinical significance of a PFO in patients with COPD, and to analyze the factors related to its occurrence. Methods: This study included 52 consecutive stable patients with COPD and 50 healthy controls. The demographic and clinical features of the study group were noted. To test for a PFO, standard and contrast transthoracic echocardiographic examinations were performed while resting and during the Valsalva maneuver (VM). Patients performed 6-min walking tests (6 MWT), and the distances traveled were measured. Results: During VM, we detected a PFO in 23 COPD patients and 10 healthy controls (P < 0.01). A PFO was detected while resting in 11 COPD patients, but in none of the controls (P = 0.001). Comparison of multiple parameters between COPD patients with and without a PFO during VM did not reveal any clinically significant differences. When we compared COPD patients with and without a PFO during resting, however, we found that the former had longer durations of disease, lower PaO2 and SaO(2), higher dyspnea scores, shorter distances walked during 6 MWT and higher desaturation rates (P < 0.05). Logistic regression analysis showed that longer duration of disease, lower SaO(2) and higher systolic pulmonary artery pressure were independent predictors of the occurrence of a PFO in resting COPD patients. Conclusions: The prevalence of a PFO is higher in patients with COPD than in healthy individuals. The presence of a PFO while resting may contribute significantly to the deterioration of arterial oxygenation and performance status. These findings indicate that a PFO may be a principle cause of hypoxemia in patients with COPD. (c) 2005 Elsevier Ltd. All rights reserved.
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    The role of arterial blood gases, exercise testing, and cardiac examination in asthma
    (Ocean Side Publications Inc, 2006) Gunen, H; Hacievliyagil, SS; Kosar, F; Gulbas, G; Kizkin, O; Sahin, I
    The severity of bronchial asthma may not be assessed easily in some patients using the current evaluation methods. In this study, we aimed to obtain more objective and detailed data in evaluating patients with stable mild and moderate bronchial asthma and to validate the current parameters against more objective ones in determining the disease severity. One-hundred six stable patients with bronchial asthma were included in the study. These patients underwent spirometric and cardiological examination, 6-minute walk testing (6MWT) and arterial blood gas analysis. Continuous measurement of pulse oxymetry (SpO(2)) was done during 6MWT. Dyspnea that developed during 6MWT was measured using the modified Borg category scale. Sixteen patients were found severely hypoxemic at rest, and 16 patients were severely desaturated at 6MWT. Nineteen patients had pulmonary hypertension on echocardiography. Patients with oxygenation problems were older and had longer disease duration, lower forced expiratory flow of 25-75%, higher Borg exercise rating, and higher pulmonary artery pressure (p < 0.05). Patients with pulmonary hypertension had earlier disease onset, lower forced expiratory flow of 25-75%, lower arterial oxygen tension and lower pre-6MWT SpO(2) (P < 0.05), older age, and lower SpO(2) at 6MWT (p < 0.01). Classic evaluation methods correctly operated only on the two-thirds of asthmatic patients. Cardiological examination, 6MWT, and arterial blood gas analysis were needed for the true evaluation of other patients who had potentially progressive disease. We think that evaluation of asthmatic patients with these more objective and detailed methods provides important additional clinical data.