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Öğe Association of asthma-related symptoms with snoring and apnea and effect on health-related quality of life(Elsevier, 2005) Ekici, Aynur; Ekici, Mehmet; Kurtipek, Ercan; Keleş, Hatice; Kara, Türkan; Tunçkol, Müge; Koçyiğit, PınarObjectives: This study aimed to investigate the association of asthma-related symptoms with snoring and apnea, and to assess their effects on health-related quality of life (HRQL). Design: Population-based cross-sectional study. Subjects and methods: A total of 10,224 parents and grandparents of students from 14 randomly selected primary schools in city center were asked to answer questionnaires sent by their children. All subjects were questioned for asthma-related symptoms, sleep-related disorders (snoring and apnea), and for HRQL using the Respiratory Questionnaire, Sleep and Health Questionnaire, and Short Form-12 (SF-12) Health Survey, respectively. Results: The overall response rate to questionnaires was 97.7%, and all analysis was performed on 7,469 subjects (3,920 women and 3,549 men) who provided sufficient responses to questions. There were 2,713 subjects who reported asthma-related symptoms. The snoring and the observed apnea were more prevalent in subjects with asthma-related symptoms (54.0% vs 41.4%; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.5 to 1.8; p < 0.001) than those without asthma-related symptoms (16.7% vs 7.0%; OR, 2.7; 95% CI, 2.3 to 3.1; p < 0.001), respectively. Asthma-related symptoms were found to be associated with snoring (OR, 1.5; 95% CI, 1.3 to 1.6; p < 0.001) and observed apnea (OR, 2.2; 95% CI, 1.8 to 2.5; p < 0.001) after adjusting for gender, age, body mass index, income, education, and smoking. Also, HRQL was found to be adversely affected by asthma-related symptoms, snoring, and observed apnea (beta = - 0.26, p < 0.001; beta = - 0.07, p < 0.001; and beta = - 0.08, p < 0.001, respectively, for SF-12 overall score) after adjusting for other confounding factors. Conclusion: Present data suggest that there is a link between the sleep-related breathing disorders and asthma-related symptoms. Moreover, the presence of snoring and observed apnea in individuals with asthma-related symptoms causes further impairment in HRQL. The effects on HRQL of coexistence of these three disorders should be supported by clinical studies.Öğe Effect of body mass index on quality of life in allergic/asthmatic patients(Ocean Side Publications Inc, 2006) Kalpaklıoğlu, A. Füsun; Kara, Türkan; Kurtipek, Ercan; Saygun, MeralEvaluation of quality of life (QoL) is of particular interest in patients suffering from chronic diseases. Although studies have shown an association between QoL and obesity and allergy/asthma, the effect of obesity on QoL is not well known. The aim of this study was to assess the impact of body mass index (BMI) as a contributory factor on QoL in patients with a diagnostic label of allergy/asthma. We surveyed 100 patients (69 F/31 M) (age 34.15 +/- 13.32 years), and 65 healthy controls (42 F/23 M) (age 35.45 +/- 8.96 years). QoL was determined by SF-36. BMI >= 25 kg/m(2) was accepted as overweight/obesity. Forty-five percent of the patients had BMI >= 25 kg/m(2) with no difference between the genders. They were significantly older and more likely to have less education level than those with BMI < 25 kg/m(2). Quality-of-life scores among patients with allergy/asthma were lower than those in the control group, irrespective of BMI. However, increased BMI was found to be related with improved quality of life among controls. Pearson's analysis showed that BMI was inversely correlated with physical functioning among patients (r = -0.229, p = 0.034), but in the control group it was positively correlated with QoL. All the domains of SF-36, except role-physical ones, among female subjects were significantly impaired more than those of male patients. It has been shown that the major determinants of impaired QoL are female sex, older age, and less educational status in patients with allergic/asthmatic symptoms. The impact of BMI on QoL could be undermined, because it seems to play a minor role.Öğe Evaluation and impact of chronic cough: comparison of specific vs generic quality-of-life questionnaires(Elsevier Science Inc, 2005) Kalpaklıoğlu, Ayşe Füsun; Kara, Türkan; Kurtipek, Ercan; Koçyiğit, Pınar; Ekici, Aydanur; Ekici, MehmetBackground: Chronic cough is a common condition that has a significant impact on health-related quality of life (HRQoL). Objective: To investigate whether chronic cough is associated with adverse psychological and physical effects on quality of life (QoL) using different HRQoL questionnaires. Methods: Forty patients were recruited for the study. The diagnostic workup was mainly based on the pathogenic triad in chronic cough: postnasal drip syndrome, asthma, and gastroesophageal reflux disease. The HRQoL was evaluated with the cough-specific quality-of-life questionnaire (CQLQ), Leicester Cough Questionnaire (LCQ), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale. Results: Symptom scores were significantly correlated with the CQLQ and LCQ (beta =.415 and beta = -.272, respectively) but not with the SF-36. A statistically significant difference was found in all questionnaires, except the physical component summary domain of the SF-36, after specific therapy. Correlation between the 2 specific HRQoL questionnaires was moderate to high when pretreatment and posttreatment scores were compared (r = -0.42 and r = -0.60). Concurrent validity of the LCQ was higher than the CQLQ when compared with the SF-36 domains. The effect size of each specific QoL questionnaire was I or higher after treatment, whereas it was much less in the SF-36. There was no change in depression with treatment despite anxiety. Posttreatment symptom scores were related with anxiety (r > 0.40) Conclusions: Because HRQoL is important to patients, a cough-specific HRQoL instrument, either the CQLQ or LCQ, should be routinely used to optimally evaluate the impact of cough on patients and to evaluate the efficacy of cough-modifying agents. Ann Allergy Asthma Immunol. 2005;94:581-585.Öğe Koah'lı ve astımlı olgularda, akut alevlenme ve stabil dönemde; n-asteil sistein'in oksidan-antioksidan dengesi solunum fonksiyon testleri ve yaşam kalitesi üzerine etkileri(Kırıkkale Üniversitesi, 2005) Kara, Türkan; Kalpaklıoğlu, Ayşe FüsunÖZET KOAH ve astım patogenezinde oksidatif stresin önemli rol oynadığına dair kanıtlar artmaktadır. Çalışmamız akut ve stabil dönemdeki KOAH ve astımlı hastalarda antioksidan bir ilaç olan N-Acetylcysteine (NAC)'in oksidatif stres, solunum fonksiyon testleri ve yaşam kalitesi üzerine etkilerini araştırmak amacıyla düzenlendi. 20 stabil KOAH'h ve 20 stabil astımlı hasta çalışmaya dahil edildi. Bu hastalara mevcut medikal tedavilerine ek olarak 600 mg/gün NAC tedavisi verildi. NAC tedavisi öncesi ve sonrası oksidanlardan plazma malondialdehid (MDA), antioksidanlardan glutatyon peroksidaz (GPx), katalaz ve süperoksid dismutaz (SOD) düzeyleri çalışıldı. Ayrıca ekzeserbasyondaki 20 akut KOAH'h ve 20 akut astımlı hasta hastanede yatarak tedavi gördüler. Bu hastalar NAC tedavisi alıp almamalarına göre 2 alt gruba ayrıldılar. Stabil KOAH'h grupta NAC (3 ay süreyle 600 mg/gün) tedavisi ile katalaz değerlerinde artış saptandı (tedavi öncesi 4.78±2.21 nmol/dk/ml ve tedavi sonrası 6.40±2.82 nmol/dk/ml; p=0.04). Stabil KOAH'hlarda tedavi sonrası FEVİ değerlerinde farklılık saptanmazken (p>0.05) yaşam kalitesinin fiziksel işlev parametresinde iyileşme görüldü (75.50±22.58 ve 83. 25± 15.24, p=0.01). Akut KOAH'h hastalarda NAC tedavisi alan ve almayan gruplar arasında GPx değerlerinde önemli farklılıklar saptandı. NAC alan grupta GPx değerlerinin diğerlerine göre daha yüksek olduğu tespit edildi (p=0.001). Yine aynı grupta duygu gösteriminde belirgin bir iyileşme mevcuttu (p=0.01). Stabil astımlı hastalarda ise tedavi sonrası antioksidan enzimlerde (GPx, katalaz ve SOD) belirgin bir artış saptandı. Ortalama değerleri sırasıyla; tedavi öncesi 169.28±35.88 nmol/dk/ml, 4.00±3.30 nmol/dk/ml ve 0.85±0.42 U/ml iken tedavi sonrası 199.40±36.90 nmol/dk/ml, 5.87±2.68 nmol/dk/ml ve 1.21±0.41 U/ml (p=0.01, p=0.04 ve p=0.01) bulundu. Aynı grupta FEVj ve yaşam kalitesi parametrelerinde tedavi öncesi ve tedavi sonrası fark yoktu. Stabil astımlı hastalarda 3 ay süreyle NAC 600 mg/gün kullanımının oksidan-antioksidan düzeyleri üzerine etkisi olmazken, akut astımlı hastalarda genel sağlık algılamasını artırdığı saptandı (52.16+21.53 vs 31.24±16.46, p=0.02). KOAH ve astımlı hastalar başlangıç ve tedavi sonrası karşılaştırıldığında; Stabil KOAH'h ve astımlı hastaların ilk başvurulan sırasındaki oksidan-antioksidan düzeyleri arasında fark bulunmazken (p>0.05) NAC tedavisi sonrası stabil astımlı hastalarda SOD düzeyi KOAH'hlara göre belirgin olarak yüksekti (1.21±0.41 U/ml ve 0.88±0.48 U/ml, iip=0.02). Yine her iki grup arasında tedavi öncesi-tedavi sonrası SFT ve yaşam kalitesinde anlamlı farklılık yoktu. Akut KOAH ve akut astımlı hastaların başlangıç ve stabilleştikten sonraki A oksidan-antioksidan düzeyleri ve A FEVı değerleri arasındaki farklar karşılaştırıldığında anlamlı değişiklik saptanmazken (p>0.05), A genel sağlık algılaması akut astımlı hastalarda KOAH'lılara göre belirgin olarak daha fazla iyileşmiş bulundu (p=0.01). Sonuç olarak; akut KOAH ve akut astım ekzeserbasyonunda oksidatif stresin arttığı ve bunun da tedavi ile düzeldiği saptanmıştır. Ancak NAC tedavisinin oksidatif stres üzerine akut astımda etkisi bulunmazken, akut KOAH'da pozitif yönde etkilediği görülmüştür. Diğer taraftan, stabil hastalarda NAC tedavisi hem KOAH hem de astımda antioksidan enzim seviyelerini artırmaktadır. NAC tedavisi ile stabil astımda yaşam kalitesi düzelmezken; stabil KOAH, akut KOAH ve akut astımda NAC tedavisi yaşam kalitesini artırmaktadır. KOAH ve astımlı hastalar karşılaştırıldığında ise stabil astımlı hastalarda NAC tedavisi SOD düzeyini stabil KOAH'lılara göre belirgin olarak arttırmaktadır. Benzer olarak NAC tedavisi akut astımlı hastalarda yaşam kalitesini akut KOAH'lı hastalara göre çok daha fazla iyileştirmektedir. Yaşam kalitesi ve oksidatif hasar üzerine pozitif etkilerinden dolayı astımlı hastalarda NAC kullanımının KOAH'lı hastalara göre daha yararlı olacağı düşünülebilir. Anahtar Kelimeler: KOAH, astım, ekzeserbasyon, NAC, oksidatif stres, solunum fonksiyon testleri, yaşam kalitesi illÖğe Obstructive airway diseases in women exposed to biomass smoke(Academic Press Inc Elsevier Science, 2005) Ekici, Aydanur; Ekici, Mehmet; Kurtipek, Ercan; Akın, Ahmet; Arslan, Mesut; Kara, Türkan; Demir, SelmaThe majority of women living in rural areas in Turkey use biomass fuels for domestic energy and are exposed to high levels of indoor air pollution every day. The objective of this study was to compare the presence of chronic airway diseases (CAD) in two groups of nonsmoking women older than 40 years with (exposed group, n = 397) and without a history of exposure to biomass cooking (liquid petroleum gas (LPG); control group, n = 199), in 2002 in Kirikkale, Turkey. Detailed respiratory symptoms were collected with a standard questionnaire adapted from that of the British Medical Research Council. Exposure was calculated as the average hours spent daily for cooking multiplied by the number of years. CAD were defined as either chronic airway obstruction (CAO; (forced expiratory volume in 1 s/forced vital capacity) < 0.70), chronic bronchitis, or chronic bronchitis with CAO. The prevalence of CAD in the exposed group was found to be higher than that in the LPG group (28.5% vs. 13.6%, crude odds ratios (ORs) 2.5 (1.5-4.0), P = 0.0001). The fraction of CAD attributed to exposure to biomass smoke after adjusting for possible confounding factors was 23.1% (95% confidence interval (CI) 13.4-33.2). Acute symptoms during exposure to biomass smoke were important predictors for the presence of CAD. Biomass smoke pollution is an important contributing factor in the development of CAD in nonsmoking women living in a rural area. The presence of acute symptoms during cooking in women in rural areas should signal to general practitioners the possibility of CAD. (c) 2005 Elsevier Inc. All rights reserved.Öğe Perception of dyspnea during exacerbation and histamine-related bronchoconstriction in patients with asthma(Elsevier Science Inc, 2006) Ekici, Mehmet; Ekici, Aydanur; Kara, Türkan; Keleş, Hatice; Karlıdağ, Ali; Altunkaya, Volkan; Bulcun, EmelBackground: Numerous studies have been performed concerning the perception of dyspnea during changes in airway caliber provoked in the laboratory setting, but studies of asthma exacerbation are scarce. Objective: To investigate whether the perception of dyspnea during histamine-induced bronchoconstriction might be used to identify patients with asthma who sense dyspnea poorly during exacerbation. Methods: The perception of dyspnea in 50 patients (45 female, 5 male) with asthma was evaluated at admission with exacerbation and during a stable period. Perceived intensity of dyspnea was estimated using a modified Borg scale. The perception of dyspnea in the stable period 4 to 6 weeks after exacerbation was measured with the histamine challenge test. Perception parameters were defined as the change in Borg score divided by the change in forced expiratory volume in 1 second (FEV1) as a percentage of the baseline FEV1 (Delta Borg/Delta FEV1) and as the Borg score at 20% decrease (PS20Histamine) or increase (PS20Exacerbation) in FEV1. Results: The perception of dyspnea during asthma exacerbation was unrelated to the perception of dyspnea during histamine-induced bronchoconstriction (for Delta Borg/Delta FEV1, beta = .08, P = .50; for PS20, beta = -.11, P = .40). The K value for the agreement of poor perceivers at exacerbation and during the stable period was -0.21 (P = .10). However, the intensity of dyspnea caused by histamine-induced bronchoconstriction was lower than that caused by asthma exacerbation (PS20: 1.6 +/- 1.1 vs 2.8 +/- 2.5. respectively. P = .004; Delta Borg/Delta FEV1: 0.08 +/- 0.05 vs 0.21 +/- 0.28, respectively, P = .001). Conclusion: The perception of dyspnea during asthma exacerbation is not correlated with the perception of dyspnea during histamine-induced bronchoconstriction. Therefore, the perception of dyspnea during histamine-induced bronchoconstriction cannot be used to identify the asthmatic patients who perceive dyspnea poorly.Öğe Respiratory findings in gun factory workers exposed to solvents(W.B. Saunders Ltd, 2004) Çakmak, Aytül; Ekici, Aydanur; Ekici, Mehmet; Arslan, Mesut; İteginli, Ahmet; Kurtipek, Ercan; Kara, TürkanObjective: Gun factory workers are exposed to many solvents (toluene, acetone, butanol, xylene, benzene, trichloroethylene). We investigated whether chronic exposure to solvents had adverse effect on respiratory system. Material and methods: The workers were questionnaired by modified Medical Research Council's respiratory questionnaire before morning start shift. Then physical examination and measurement of pulmonary functions by portable dry rolling spirometer were performed. The study group consisted of 1091 gun factory workers. The workers were grouped according to their smoking habits (smokers, [exposed n: 353 vs. unexposed n: 339] and non-smokers [exposed n: 58 vs. unexposed n: 341]). Asthma-related symptoms were defined as either definite asthma, probable asthma, and possible asthma. Results: In non-smokers, the report of asthma-related symptoms was more prevalent in exposed workers than unexposed (39.7% vs. 21.7% OR 2.4[l.3-4.3], respectively P=0.003). In smokers, the report of asthma-related symptoms was more common in exposed group than unexposed (50.7% vs. 42.5% OR 1.4[l.0-1.9], respectively P=0.03). Logistic regression analysis showed that smoking (OR 2.8 [2.0-3.8] P=0.00001) and exposure to solvents (OR 1.4[l.1-1.9] P=0.01) were independent risk factors for asthma-related symptoms, after adjusting for age. Logistic regression analysis identified that smoking (OR 3.3[2.3-4.6] P=0.00001) was independent risk factors for chronic bronchitis. Multiple linear regression analysis of lung-function parameters (% forced expiratory volume (FEV1), FEV1/forced vital capacity, FEF25-75) indicated significant effects of smoking. Conclusion: Present study indicated significant effects of smoking and exposure to solvents, with the smoking effect being the most important on asthma-related symptoms of gun factory workers. © 2003 Elsevier Ltd. All rights reserved.Öğe Yaşlı astımlılarda orta-doz flutikazon ve salmeterolün bronkokonstriksiyonun algılanmasına etkisi(2005) Ekici, Aydanur; Kara, Türkan; Akın, Ahmet; Koçyiğit, Pınar; Karlıdağ, Ali; Ekici, MehmetAmaç: Orta-doz Flutikazon ve salmeterol tedavisinin bronkokonstriksiyonun algılanmasına etkisinin yaşlı ve genç astımlılarda değerlendirilmesi. Metot: Yirmidokuz yaşlı astımlı ($geq$60 yaş) ve 21 genç astımlı (<60 yaş) hasta çalışmaya katıldı. Yaşlı astımlılar semptom sürelerine göre iki gruba ayrıldı (geç başlangıçlı astım <5 yıl; erken başlangıçlı astım $geq$5 yıl). Orta persistan astımlı 50 hasta bir yıl boyunca günde iki defa 250 ug flutikazon propionat ve 50ug salmeterol tedavisi aldı. Her hastaya başlangıçta ve bir yıl sonra histamin ile bronş provokasyon testi yapıldı. Nefes darlığı modifiye Borg skalası ile değerlendirildi. Birinci saniye zorlu vital kapasite'de (FEVİ) %20'lik bir düşmenin olduğu Borg skoru Algılama skoru 20 (AS20) olarak saptandı.Sonuçlar: Geç başlangıçlı yaşlı astımlılarda başlangıç ortalama AS20 değerleri (1.21 ± 0.18) ile tedavi sonrası ortalama AS20 değerleri (1.32 ± 0.22) arasında anlamlı fark yoktu (p=0.7). Erken başlangıçlı yaşlı astımlılarda başlangıç ortalama AS20 değerleri ile (1.45 ± 0.14) tedavi sonrası ortalama AS20 değerleri (1.11 ± 0.30) arasında anlamlı fark yoktu (p=0.2). Genç astımlılarda başlangıç ortalama AS20 değerleri (2.27 ±0.25) ile tedavi sonrası ortalama AS20 değerleri (2.07 ± 0.29) arasında anlamlı fark yoktu (p=0.3). Yaşlı astımlılarda başlangıç ortalama AS20 değerleri (1.31 ± 0.12; 2.27 ± 0.25 p=0.001) ve tedavi sonrası ortalama AS20 değerleri (1.23 0.18; 2.07 ± 0.29 p=0.01) genç astımlılardan düşüktü. Yorum:Çahşma orta doz flutikazon ve salmeterol tedavisinin yaşlı ve genç astımlılarda bronkokonstriksiyonun algılanmasını değiştirmediğini düşündürmektedir.Ancak yaşlı astımlıların başlangıçtaki ve bir yıl sonraki algılamaları genç astımlılardan daha düşük bulunmuştur.
