Background/aim:Determining the current burden of asthma in countries is important in the diagnosis and follow-up of asthma patients and for the development of national health policies. Our study aimed to clarify the epidemiological and clinical data regarding asthmatic adults in Türkiye. Materials and methods:The study was designed as a nationwide descriptive, observational cross-sectional study. Data on adult patients who were followed with the diagnosis of asthma in all public, private, and university hospitals in Türkiye between January 2016 and December 2022 were obtained from the e-Nabız database of the Ministry of Health and analyzed. Results:The number of patients followed with a diagnosis of asthma in Türkiye between 2016 and 2022 was 2,700,183. The mean age of these patients was 45.70 years (standard deviation: 15.87) and 74.5% of them were female. Of the patients, 92.3% were prescribed dry powder inhalers, 98.41% metered dose inhalers, and 80.38% montelukast. The short-acting beta-2 agonist (SABA) prescription rate was 65.74% and SABA was prescribed as the sole medication for 0.10% of patients. The percentage of patients prescribed nebulized treatment was found to be 69.83%. Among asthmatic adults, the rate of at least one emergency room visit was 12.4%, the rate of hospitalization in the ward was 5.6%, and the rate of intensive care unit admission was 0.1%. Conclusion:Asthma is a major health burden in Türkiye, as is the case around the world. National planning for the diagnosis and follow-up of patients needs to be improved and continued.

INTRODUCTION:Identifying the eosinophilic, neutrophilic, or infectious phenotypes of exacerbations, particularly those occurring during biologic agent therapy, may provide valuable guidance for determining maintenance therapy for patients and preventing recurrent exacerbations. Our study primarily aimed to evaluate the clinical phenotypic features of exacerbations in patients with severe asthma receiving biologic agent therapy. METHODS:The first asthma exacerbation experienced by the patients after the 16th week of biological agent treatment was evaluated in terms of inflammatory phenotype and clinical features. White blood cell counts and C-reactive protein levels, related season, antibiotic use, and hospitalization during the exacerbation were recorded from patients' medical file records. RESULTS:Data of 75 patients with severe asthma receiving biological treatment were analyzed. Subjects were aged 48.0 (mean) ± 11.0 (standard deviation), and 52 (69.3%) of them were female. Biological agent used in treatment was omalizumab in 53 (70.7%) subjects and mepolizumab in 22 (29.3%) subjects. The majority of exacerbations in asthmatics treated with either biologic agent were eosinophilic. In patients using omalizumab, the median eosinophil count was significantly higher compared to those using mepolizumab (p=0.032). CONCLUSION:Phenotyping of asthma exacerbations that persist in spite of biologic therapy will guide treatment adjustments and decisions to switch biologic agents to improve outcomes.

OBJECTIVE:Real-life studies are needed to evaluate the clinical outcomes of add-on tiotropium therapy in patients with asthma. The effects of adding tiotropium bromide to the treatment of asthmatic patients on pulmonary functions and asthma control using real-life data. METHODS:In a retrospective study, spirometric measures and asthma control states were compared before and one year after of tiotropium treatment in asthmatic adults whose disease was not adequately controlled with a combination of inhaled corticosteroids and long-acting β2-agonists. RESULTS:One year after tiotropium treatment, mean FEV1, FEV1%, and FEV1/FVC ratio increased significantly compared to pretreatment values. Among 32 patients added tiotropium due to symptomatic asthma, 28 (87.5%) patients achieved well-controlled (ACT ≥ 20) end of the year and GINA treatment step-down in 4 (12.5%) patients. Monoclonal antibody therapies (mepolizumab or omalizumab) were initiated in 9 patients (28.1%). FEV1 values and FEV1/FVC ratios showed a statistically significant improvement from baseline measurements obtained prior to the initiation of tiotropium therapy, independent of monoclonal antibody use (p < .001 for each). The mean age of these patients was 48.78 ± 11.64 (range: 28-81) years, and 25 (78.1%) of them were female. CONCLUSIONS:Tiotropium bromide is an effective and reliable add-on therapy for symptomatic asthma when combined with ICS plus LABA, also leads to improvements in respiratory function and asthma control.

Background: Although the relationship of seasonal allergens with allergic rhinitis is well known, conflicting results exist with regard to their association with asthma. Objective: To investigate the effect of seasonal allergen sensitization on the severity of bronchial hyperreactivity (BHR) and variables that affect BHR in individuals without any chronic respiratory disease who presented to the outpatient clinic with asthma symptoms. Methods: Adult subjects who were admitted to our hospital's allergy outpatient clinic between January 2016 and May 2023, presented with at least one of the symptoms of dyspnea, wheezing or cough, and underwent bronchial provocation test (BPT) for the differential diagnosis of asthma were included in the study. Patients with any chronic respiratory disease, such as chronic obstructive pulmonary disease (COPD) or bronchiectasis, were excluded. Demographic characteristics and clinical features of the patients, including admission symptoms, BPT results, skin-prick test results, IgE results, and allergy history were obtained by reviewing patient records. Results: A total of 325 patients were included in the study, 248 (76.3%) of whom were women, and the median (min-max) age was 40 years (18-82 years). Aeroallergen sensitization was positive in 131 patients (40.3%), of whom 38 (11.7%) had single and 93 (28.6%) had multiple allergen sensitization. Sensitization was to perennial allergens in 53 patients (16.3%), to seasonal allergens in 40 patients (12.3%), and to both in 38 patients (11.7%). BPT was positive in 105 patients (32.3%). Among the patients with BHR, 73 (69.5%) had at least one allergen sensitization. The BHR risk was 7.13 times higher in patients sensitized to perennial allergens, 4.14 times higher in those sensitized to seasonal allergens, and 8.67 times higher in patients with sensitization to both. There was no significant difference in PC20 values according to the type of allergen sensitization (perennial allergens, seasonal allergens, mixed type) (p = 0.878). Conclusion: Both seasonal and perennial allergens can elevate the risk of BHR.

Severe asthma can limit social and work life and negatively impact emotional well-being. This study aimed to evaluate loneliness among patients with severe asthma. This cross-sectional study was conducted between December 2023 and June 2024 in an allergy clinic. Patients diagnosed with severe asthma and treated with systemic steroids or biologics were included. Data were collected through face-to-face interviews using a patient information form, the Asthma Control Test (ACT), and the UCLA Loneliness Scale. A total of 84 patients (mean age: 48.8 ± 9.6 years; 69.0

Background: Pulmonary embolism (PE) is a life-threatening condition with significant morbidity and mortality. Recent studies have suggested a potential link between vitamin D deficiency and increased risk of thromboembolic events, including PE. However, large-scale, population-based evidence remains limited. Objective: To investigate the association between vitamin D deficiency and the occurrence of pulmonary embolism using nationwide retrospective data from Turkey. Methods: We conducted a retrospective study including 3,169 adult patients who underwent pulmonary computed tomography (CT) angiography between 2017 and 2019 in Turkey. Patients with available serum vitamin D levels measured within 24 months prior to imaging were included. The cohort was divided into two groups: patients diagnosed with PE and those without PE. Vitamin D levels were compared between the groups, and statistical analyses were performed to assess the association between vitamin D deficiency and PE. Results: The mean serum vitamin D level was significantly lower in the PE group compared to the non-PE group (p < 0.05). Vitamin D deficiency (< 20 ng/mL) was more prevalent among patients with PE. However, the discriminatory power of vitamin D levels for predicting PE was limited, as indicated by receiver operating characteristic (ROC) curve analysis. Multivariate analysis adjusting for potential confounders confirmed that vitamin D deficiency was independently associated with an increased risk of PE. Conclusion: Our nationwide retrospective study demonstrates a significant association between vitamin D deficiency and pulmonary embolism. Although vitamin D levels alone may not serve as a strong predictor for PE, these findings highlight the importance of considering vitamin D status in the risk assessment of thromboembolic diseases. Further prospective studies are warranted to clarify the causal relationship and underlying mechanisms.

Background/aim:There is currently no data from Türkiye on whether, following a diagnosis of asthma, patients are given an asthma action plan to implement. There is also no data on whether patients can manage their treatment based on the provided asthma action plans. The present study aimed to determine the use of asthma action plans in Türkiye and the awareness levels of patients about these plans. Materials and methods:A multicenter, cross-sectional descriptive study was conducted in the outpatient immunology, allergy, and pulmonology clinics of secondary and tertiary healthcare centers. Adult asthmatics filled out a case registration form regarding age, sex, educational status, duration of asthma, and smoking history. Subjects answered the Global Initiative for Asthma (GINA) assessment of control questions, indicated whether they had previously been offered an asthma action plan, and if they had received one, whether they benefited from it. Results:Data from 265 asthmatic adults (mean age: 48.4 years, standard deviation: 13.4 years), including 194 (73.2%) females were analyzed. The asthma of 212 (80.0%) patients was controlled, and was uncontrolled in 53 (20.0%) patients. An asthma action plan had been mentioned to 91 (34.3%) of the 265 patients. Among these 91 patients, 85 (93.4%) had been given a written asthma action plan, and 85 (93.4%) stated that they had benefited from the plan. The rate of being given an asthma action plan was significantly lower for illiterate patients than for patients with any education (p < 0.001). Conclusion:The rate of mentioning an asthma action plan to asthmatic patients is low. However, almost all patients who received an asthma action plan benefitted significantly from the plan. Thus, it is important to give asthmatic patients an action plan, ideally in written form.

Background: Asthma controller medications can be delivered via pressurized metered dose inhaler (pMDI) or dry powder inhaler (DPI) devices. Objective: This study aimed to evaluate the frequency of exacerbations and satisfaction rate with device use in asthmatics using pMDIs or DPIs. Methods: A multicenter, cross-sectional study was conducted in adults who used pMDIs or DPIs with correct inhaler technique and good adherence for asthma treatment. Demographic and asthma-related characteristics of the subjects and data regarding device satisfaction were collected through a face-to-face interview in the outpatient clinic. Rates of pMDI and DPI users and the data were compared between the two groups. Results: The study included 338 patients (mean age: 48.6 ± 14.5 years, 253 [74.9%] women). Among participants, 96 (28.4%) were using pMDI and 242 (71.6%) were using DPI. The age of patients using pMDI were significantly lower compared with DPI users. No significant difference was observed in terms of device satisfaction and clinical outcomes of asthma between pMDI and DPI users with good inhaler technique and good adherence. Conclusion: More asthmatics use DPIs, however, pMDIs are used in younger asthmatic patients. No significant difference in terms of device satisfaction and clinical outcomes of asthma was observed between pMDI and DPI users.

BACKGROUND AND AIM: The relationship between bronchial hyperreactivity (BHR) and lung function parameters and blood eosinophilia in suspected asthmatics is not clear. This study aimed to investigate the relationship between FEF 25-75 values and blood eosinophilia levels and BHR in patients with asthma symptoms. MATERIALS AND METHODS: Demographic and spirometric data and blood eosinophil counts were compared between patients with and without significant BHR. Receiver operating characteristic (ROC) curve analysis was performed to evaluate FEF25–75 and blood eosinophil count cutoff values to distinguish BHR in these patients. RESULTS: According to the data of 894 patients, with BHR in 182 (20.4%), FEF25%–75% were significantly lower and blood eosinophil counts were significantly higher in patients with BHR. The best discriminatory values to assess the nonevident BHR were 64.5% for FEF25–75 (sensitivity: 94.2% and specificity: 18.7%) and 164/μL for blood eosinophil count (sensitivity: 59.6% and specificity 60.2%). The rate of nonevident BHR was significantly different between patients with FEF25–75 <65% and ≥65% (54.7% and 81.9%, respectively, P < 0.001). Although significant, the rates of nonevident BHR in patients with blood eosinophil counts below and above the cutoff (85.5% and 72.6%, respectively, P = 0.012) were not as different as the rates in patients with FEF25–75 values below and above the cutoff. CONCLUSION: FEF25–75 is associated with BHR in patients with asthma symptoms. Nonevident BHR is more likely if FEF25–75 ≥65 in suspected asthmatics. However, blood eosinophil count is not helpful in predicting the absence of BHR in suspected asthmatics.

Objective: It is obvious that adherence to inhaler treatments is insufficient in patients with obstructive lung diseases. In this study, we aimed to evaluate the consistency of the information provided by patients with obstructive pulmonary disease and their households on medication adherence. Material and Methods: A cross-sectional study was conducted between January and March 2020 in a tertiary chest diseases hospital, where patients with asthma and chronic obstructive pulmonary disease (COPD) were regularly followed up. The study included patients who had been followed up with a diagnosis of asthma or COPD for at least 1 year, were using maintenance inhaler therapy, and attended the follow-up visit with a member of the same household. Patients and their household members were independently questioned about patients' medication adherence. According to the information provided by the patients and their households, medication adherence of the patients and the consistency of the information were evaluated. Results: Of the 66 patients with obstructive lung disease, 59 (89.39%) were adherent and 7 (10.60%) were non-adherent according to their own statements. Seventeen (28.81%) of 59 patients who were adherent according to their own statements were non-adherent to treatment with respect to household members. The mean age, gender distribution, smoking status, diagnosis of asthma or COPD, and education level did not differ significantly between self-reported adherent and non-adherent patients or between adherent and non-adherent patients with respect to household members. Conclusion: Adding information from household members to the use of patient self-reports may increase the clinician's judgment in monitoring adherence.

We appreciate the valuable comments on our study (1). As stated, early mortality after acute pulmonary embolism (PE) can be predicted using well-documented prognostic scores, including the original and simplified versions of the PE severity index (PESI) (2, 3). However, the data on long-term mortality are scarce (4). Due to the lack of such scoring for the late mortality after acute PE, we investigated the value of both versions of the PESI to predict long-term mortality in acute PE patients. Thus, our results reflect the usability of the PESI as an option to evaluate the longterm mortality after acute PE.

Objective:Obstructive sleep apnea (OSA) and cardiovascular diseases have some common pathophysiologic characteristics and effects on the outcomes of each other. This study is conducted to determine the characteristics of obstructive sleep apnea patients with a history of a cardiovascular event.Materials and Methods:For this multicenter study, the patients with obstructive sleep apnea [apnea-hypopnea index (AHI) >5/hour] who had a history of coronary angioplasty, coronary bypass grafting, or cerebrovascular event after the onset of the symptoms related to OSA were recruited as the study group. The control group included patients without a history of a cardiovascular event. The weight, subjective sleep duration, smoking, and menopausal status, and the presence of comorbidities before and after the cardiovascular event were also questioned during the follow-up visits and by phone calls. This data was compared with the control group.Results:This multicenter study comprised 281 patients (100 study group and 181 control group), 83% of whom had moderate/severe obstructive sleep apnea. Age, family history for cardiovascular event and, Epworth sleepiness scale score were statistically higher in the study group (p<0.001). Polysomnographic data showed that the study group had higher central AHI (p=0.002), non-supine AHI (p=0.017) and lower NREM3% (p=0.001), mean and minimum oxygen saturation (p=0.002). A subgroup analysis proved that polysomnographic data, which had statistically significant differences, can vary according to gender.Conclusion:The results of this study guide for phenotyping obstructive sleep apnea patients with cardiovascular events. It has also been shown that cardiovascular events may have different effects on sleep parameters in women.

Introduction: This study is designed to determine the factors for predicting the PAP compliance in mild obstructive sleep apnea syndrome (OSAS) for improving the cost-effectiveness in the treatment choices of these patients. Method: The study group comprises 27 mild OSAS patients who underwent automatic positive airway pressure (APAP) titration between July 2016 and December 2017. Demographic, clinic and polysomnographic characteristics of the patients were retrospectively evaluated. Compliance with PAP treatment was defined as the usage of 5 nights/week and 4 hours/night at least. Data of compliant patients were statistically compared with non-compliant patients. Results: Most of the patients (23 patients, 85,2%) were prescribed APAP devices. Acceptable compliance at the end of the first year of therapy was achieved by 11 patients (40,2%) whereas 8 patients used PAP device 2 months at most (29,6%) The remaining 8 patients had not taken the device at all and were considered as non-adherent to PAP treatment (29,6%). The nonadherent/non-compliant group showed statistically the same demographic, clinic, and polysomnographic characteristics when compared to the compliant group. The level of maximum pressure during the titration test was lower in the compliant group (p=0,040). Conclusion: The sleep-related symptoms, scores of ESS or polysomnographic parameters can not be used to predict compliance for mild OSAS. The patients with mild OSAS, especially the ones who reach higher maximum pressure on titration test, must be followed up closely during the first 2 months of PAP treatment to detect nonadherence/non-compliance earlier.

Aim: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) have common pathophysiological mechanisms affecting the prognosis of each other. This study aims to investigate the relationship between the presence of OSA risk and the severity of COPD and to determine the possible clinical features for OSA risk for COPD patients. Material and Method: The patients (n=181) who applied to the outpatient clinics of pulmonology between September - November 2019 with the diagnosis of COPD, were analyzed cross-sectionally. Demographic features, anthropometric measurements, comorbidities, smoking status, and severity of dyspnea, respiratory functions, and exacerbation frequency in the last year were evaluated. All patients were questioned with the Epworth sleepiness scale (ESS) for detecting excessive daytime sleepiness (EDS), and the STOP-Bang for determining the risk of OSA. Results: The rate of diabetes, waist and hip circumference measurements, median ESS score, and EDS ratio were found to be higher in patients with moderate/high OSA risk when compared to patients with low OSA risk. In the multivariate regression model; lower oxygen saturation (OR: 0.83; p=0.007) and higher ESS score (OR=1.28; p

OBJECTIVEFailure to achieve high levels of medication adherence in obstructive lung diseases is a major cause of uncontrolled disease. The purpose of this study is to reveal clinicians' opinions on the level of patient adherence and the change in adherence during the COVID-19 pandemic.METHODSA questionnaire containing multiple-choice questions about treatment adherence in patients with obstructive lung diseases was voluntarily applied to doctors working in a tertiary hospital for chest diseases.RESULTSEighty-one doctors (mean age, 37.2 years [standard deviation, 9.7 years]; 57 (70.4%) women) answered the questionnaires. Almost all clinicians participating in the study reported that they always or frequently asked patients if they adhered to treatment. Most clinicians think that in 20-50% of patients with asthma and less than 20% of patients with chronic obstructive pulmonary disease, a decrease in medication adherence appears in the first year of treatment. Most clinicians think the main reason for patients with obstructive lung diseases not adhering is patients' reluctance to be treated regularly. Regarding the impact of the COVID-19 pandemic on patients' drug adherence, 43.2% of clinicians observed that adherence increased after the start of the pandemic.CONCLUSIONSAdherence to medication is not at the desired levels in patients with obstructive lung diseases. However, when faced with a serious health threat, such as the COVID-19 pandemic, patients realize the severity of their illness and begin using their treatments more regularly.

Background and Objectives: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms. Methods: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features. Results: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively). Conclusion: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity.