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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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    Proteolytic enzyme sensitivity and decrease in respiratory function (a 10-year follow-up)
    (Springer, 2002) Kizkin, O; Suleyman, GT; Hacievliyagil, S; Gunen, H
    Objectives: In workers, sensitivity and occupational asthma are known to develop in reaction to the proteolytic enzymes used in the manufacture of detergents. This study was conducted to find out how this sensitivity to the proteolytic enzymes affects respiratory function, excluding occupational asthma. Methods: Workers in the detergent industry (n = 65) were divided into four groups according to their prick-test results, as follows: those positive for at least one enzyme (Lipolase, Savinase) (group I, n = 15); enzyme-negative cases (group II, n = 50); and from among these, enzyme-positive non-smoking cases (group Ia, n = 11); enzyme-negative non-smoking cases (group IIa, n = 32) Respiratory function tests for the last 10 years from the archives were assessed. For statistic analysis, average values were determined and the standard deviation calculated. For comparison of the groups, the Mann-Whitney U and Fischer Exact chi-square tests were used. Results: The ratio of smokers, the cigarette burden, average age and the period of work were found to be similar between workers of groups I and II, and group Ia and group IIa (P>0.05). The average annual fall in the forced vital capacity (FVC) and the forced expiratory volume in the first second (FEV1) for the 10-year period was, respectively, found to be: group I, 64.1 +/- 7.8 ml and 58.7 +/- 9.6 ml; group II, 38.7 +/- 6.4 ml and 43.7 +/- 18.2 ml; group Ia, 60.7 +/- 8.1 ml and 56.1 +/- 10.2 ml; group IIa, 37.4 +/- 6.8 ml and 42.9 +/- 8.1 ml. The decrease in FVC and FEV1 in group I compared with group II, and in group Ia compared with group IIa was statistically significant (P<0.001). Conclusions: In this study, the observation that the FVC and FEV1 of the workers were much lower than expected, especially among those sensitive to the enzymes, independently of occupational asthma and cigarette smoking, led to the conclusion that it could be due to sensitivity to the enzymes.
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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.
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    Thoracic involvement in Behcet's disease and its correlation with multiple parameters
    (Springer, 2000) Gunen, H; Evereklioglu, C; Kosar, F; Er, H; Kizkin, O
    In Behcet's disease (BD), controversy has existed over the incidence of thoracic involvement, which may be a direct threat to the patient's life. The aim of this study is to evaluate the incidence of thoracic involvement in ED and its correlation with the number of diagnostic ED criteria of The International Study Group (ISG), gender, disease duration, and the presence of symptoms. Forty-two ED patients, who had consecutively applied to different clinics in Turgut Ozal Medical Center Research Hospital, were included in the study. They were either newly diagnosed or already under treatment. All patients were examined by standard chest roentgenogram, spirometry, and thorax CT. Perfusion scintigraphies were obtained in patients with thoracic involvement. Thoracic pathologic conditions were found in five patients (11.9%). All thoracic pathologic conditions appeared in patients with at least four diagnostic criteria (26 patients) of the ISG for ED. In this subgroup, the rate of thoracic involvement was 19.2%. Also, 25% of the patients with pulmonary symptoms (12 patients) had thoracic lesions. Gender and the duration of the disease did not correlate with thoracic involvement. Our findings suggest that the rate of thoracic involvement in ED is greater than is generally believed. An increased number of diagnostic ED criteria of the ISG may indicate other organ system involvement and an increased risk of thoracic pathosis. All ED patients with at least four diagnostic criteria or any pulmonary symptoms should be evaluated for thoracic involvement, which is a major menace to life and necessitates early intervention.
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    Utility of blind forceps biopsy of the main carina and upper-lobe carina in patients with non-small cell lung cancer
    (Elsevier, 2001) Gunen, H; Kizkin, O; Tahaoglu, C; Aktas, O
    Background and objective: Preoperative detection of non-small cell lung cancer (NSCLC) metastasis to the main carina and upper-lobe carina can alter the operative approach, preclude further staging procedures, and save many patients from thoracotomy. This stum assessed whether bronchoscopic forceps biopsy of the normal-appearing main carina and upper-lobe carina (blind biopsy) ipsilateral to the primary NSCLC lesion improved the accuracy of cancer staging and helped guide the management of these patients. Patients and methods: A prospective study of 52 patients was carried out at the SSK Surveyypasa Center for Chest Disease and Cardiothoracic Surgery. Over a 6-month period, we bronchoscopically evaluated 52 consecutive NSCLC patients who were radiologically classified as operable. At least five blind forceps biopsy specimens were obtained from the main carina and/or upper-lobe carina during each patient's initial fiberoptic bronchoscopic examination. Biopsy specimens were collected from the main carina and upper-lobe carina in 51 and 17 patients, respectively. Initially, all patients were staged and evaluated for operability in standard fashion, without histologic assessment of the blind biopsy specimens. We then restaged the disease and reassessed the patients' operability in light of the biopsy findings. Results: Metastasis was histologically diagnosed in seven patients (13.7%) who underwent main carina biopsy and in four patients (23.5%) who underwent upper-lobe carina biopsy. Cancer-positive blind biopsy results changed the status of 25% (6 of 24) of patients from operable to inoperable, and changed the surgical approach in 11.1% (2 of 18) of patients who ultimately did undergo surgery. We found no statistical relationship between metastasis to either carina and tumor type, stage of disease, visibility of the tumor on fiberoptic bronchoscopy, primary tumor location, T status, or N status (p > 0.05). Conclusions: A blind forceps biopsy of the main carina and upper-lobe carina ipsilateral to the lesion site should be done routinely at initial bronchoscopic examination of all radiologically operable patients with suspected lung cancer. This type of screening can save a significant number of NSCLC patients from inappropriate or unnecessary thoracotomy and further staging procedures with their associated morbidity and risk.