Diagnostic Yield of Transbronchial Biopsy in Comparison to High Resolution Computerized Tomography in Sarcoidosis Cases

This study aimed to evaluate the diagnostic yield of fiberoptic bronchoscopic (FOB) transbronchial biopsy and its relation with quantitative findings of high resolution computerized tomography (HRCT). A total of 83 patients, 19 males and 64 females with a mean age of 45.1 years diagnosed with sarcoidosis with complete records of high resolution computerized tomography were retrospectively recruited during the time period from Feb 2005 to Jan 2015. High resolution computerized tomography scans were retrospectively assessed in random order by an experienced observer without knowledge of the bronchoscopic results or lung function tests. According to the radiological staging with HRCT, 2.4% of the patients (n=2) were stage 0, 19.3% (n=16) were stage 1, 72.3% (n=60) were stage 2 and 6.0% (n=5) were stage 3. This study showed that transbronchial lung biopsy showed positive results in 39.7% of the stage I or II sarcoidosis patients who were diagnosed by bronchoscopy. Different high resolution computerized tomography patterns and different scores of involvement did make a difference in the diagnostic accuracy of transbronchial biopsy (p=0.007).

Respiratory Bronchiolitis-Associated Interstitial Lung Disease in Childhood: New Sequela of Smoking

Childhood interstitial lung diseases are rare disorders of largely unknown etiology characterized by variable types and degrees of parenchymal inflammation. Disease spectrum and prognosis considerably from those in adults. Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) is a well-described entity occurring almost exclusively in adults who are current heavy cigarette smokers. We describe an 11-year-old boy with failure to thrive, dry cough, and exertional dyspnea for 1 year who was diagnosed with RB-ILD due to heavy passive smoking exposure. Although RB-ILD is well defined in smoking adults, there are no reports in the English literature in nonactive smokers, especially in childhood.

Asthma phenotypes in Turkey: a multicenter cross-sectional study in adult asthmatics; PHENOTURK study

BACKGROUND AND AIMS

To evaluate asthma phenotypes in patients with asthma from different regions of Turkey.

METHODS

A total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011-January 2012.

RESULTS

The disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P < 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P < 0.01). Uncontrolled asthmatics have more severe disease (P < 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P < 0.01). Chronic rhino-sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P < 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P < 0.05).

CONCLUSION

In conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes.

A Case of Sarcoidosis Associated With Anti-Tumor Necrosis Factor Treatment

Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology. It predominantly involves the lungs but can affect many organs or tissues in the body, such as the lymphatic system, skin, eyes, and liver. Typical histopathological lesions are noncaseating granulomas in the affected organ or tissue. Indications, type of treatment, and duration of sarcoidosis treatment is currently debated. Despite studies showing that anti–tumor necrosis factor-α (TNF-α) treatment can successfully be used in refractory sarcoidosis, there are some case reports regarding the development of sarcoidosis with these agents. There have been reports of 47 anti-TNF-associated cases of sarcoidosis until 2012. The patient is a 54-year-old Caucasian male. During routine examinations of the patient who had been followed for psoriasis vulgaris for 20 years and who had been on several anti-TNF regimens thereafter, new pulmonary pathologies due to sarcoidosis were detected. We present here a case of sarcoidosis that developed after infliximab treatment and showed obvious radiologic regression with discontinuation of treatment. During anti-TNF treatment, it should be kept in mind that autoimmune and granulomatous diseases may develop and particular care should be given to patient follow-ups.

Asthma control test via text messaging: could it be a tool for evaluating asthma control?

INTRODUCTION

Originally, the Asthma Control Test (ACT) was designed for English-speaking patients using a paper-and-pencil format. The Turkish version of the ACT was recently validated. This article compares the paper-and-pencil and web-based texting formats of the Turkish version of the ACT and evaluates the compatibility of these ACT scores with GINA-based physician assessments of asthma control.

METHODS

This multicentre prospective study included 431 asthma patients from outpatient clinics in Turkey. The patients were randomized into a paper-and-pencil group (n = 220) and a text messaging group (n = 211). Patients completed the ACT at Visit 1, after 10 ± 2 days, and at 5 ± 1 week to demonstrate the reliability and responsiveness of the test. At each visit, physicians assessed patients' asthma control levels.

RESULTS

The ACT administered via texting showed an internal consistency of 0.82. For the texting group, we found a significant correlation between the ACT and physician assessments at Visit 1 (r = 0.60, p < 0.001). The AUC was 0.87, with a sensitivity of 78.0% and a specificity of 77.5% for a score of ≤19 for screening "uncontrolled" asthma in the texting group.

CONCLUSION

When the Turkish version of the ACT was administered via either the paper-and-pencil or text messaging test, scores were closely associated with physician assessments of asthma control.

Extrapulmonary involvement in patients with sarcoidosis in Turkey

BACKGROUND AND OBJECTIVE

Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey.

METHODS

This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected.

RESULTS

One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 ± 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007).

CONCLUSIONS

Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.

Asthma in obese women: outcomes and factors involved

OBJECTIVE

It has been shown that the prevalence of asthma in obese people has increased in recent years. The aim of this study was to evaluate factors involved in the relationship between asthma and obesity in women,

METHODS

We evaluated serum leptin levels, fractional exhaled nitric oxide (FE(N0), asthma control (using theAsthma Control Test [ACT]), and presence of atopy in 41 obese women with asthma and 40 non-obese women with asthma. We also compared the relationship between body mass index (BMI) and these parameters between the 2 groups.

RESULTS

Serum leptin levels were significantly higher in obese asthmatics than in nonobese asthmatics (P < .05). In the obese group, leptin levels were positively correlated with FE(O) levels (r = 0.439, P = .004). Uncontrolled asthma (ACT score <20) was detected in 61% of women in the obese group compared to just 38% of those in the nonobese group (P = -.035). In atopic patients, total immunoglobulin E levels were positively correlated with leptin levels (r = 0.329, P = .038). When the 81 women were classified according to asthma control, high BMI was found to be the only significant factor that contributed to poor asthma control.

CONCLUSION

We have shown that serum leptin levels might have a role in poor asthma control in obese patients, and can conclude that obesity is an important factor in uncontrolled asthma.

Determinants of asthma control in tertiary level in Turkey: a cross-sectional multicenter survey

OBJECTIVE

Recent data demonstrate that control of asthma is far from optimal worldwide. The aim of this study was to evaluate the level of asthma control in tertiary health services by the use of Asthma Control Test (ACT) and to assess the factors which might influence the control of the disease.

METHODS

A total of 2336 patients with asthma were recruited from 28 tertiary hospitals in the study. Asthma severity was classified by the frequency of asthma symptoms, pulmonary function tests, and medication requirements according to asthma guidelines. The level of asthma control was assessed by the Turkish version of ACT and determinants of asthma control were evaluated with medical history, physical examination, patients' and disease characteristics.

RESULTS

Due to missing data, 1188 subjects' records were evaluated. Nearly half of the patients (51.5%) were found to be "controlled" (ACT > or =20) and 48.5% was defined as "uncontrolled" (ACT < 20). The ratio of uncontrolled asthmatic patients was significantly higher in severe asthmatics than in mild and moderate asthmatics (p < .01). Female sex, education below secondary level, forced expiratory volume in one second (FEV(1)) value <80%, peak expiratory flow (PEF) value <80%, hospitalization/emergency department visits in the last year, and systemic steroid use were found to be significantly associated with inadequate control (p < .01).

CONCLUSIONS

This study demonstrated that asthma control was still inadequate in the tertiary level although overall control was better than previous reports in Turkey. Patients with severe asthma were more likely to have uncontrolled disease; worse asthma control was also associated with increased hospitalizations and emergency care admissions.

Value of fractional exhaled nitric oxide (FE NO) for the diagnosis of pulmonary involvement due to inflammatory bowel disease

BACKGROUND

Pulmonary involvement due to inflammatory bowel disease (IBD) is frequent when evaluating a patient with IBD and pulmonary involvement remains complicated. Most of the patients are asymptomatic and the methods used are mostly invasive or expensive procedures. The aim of this prospective study is to evaluate the value of the fractional exhaled nitric oxide (FE(NO)) level for the diagnosis of pulmonary involvement due to IBD and to investigate any correlation between FE(NO) level and disease activity.

METHODS

Thirty-three nonsmoker patients with IBD (25 ulcerative colitis [UC] and 8 Crohn's Disease [CD]) who were free of corticosteroid treatment and 25 healthy subjects as a control group were enrolled in this study. All patients with IBD were investigated for pulmonary involvement with medical history, physical examination, chest roentgenogram, oxygen saturation, blood eosinophil levels, pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and FE(NO) level.

RESULTS

Pulmonary involvement was established in 15 patients (45.5%) with IBD. The FE(NO) level was higher in patients with pulmonary involvement than without pulmonary involvement and healthy controls independent from the pulmonary symptoms, eosinophil count, duration of disease, activity of disease, and surgery history (FE(NO): 32 +/- 20; 24 +/- 8; 14 +/- 8 ppb, respectively) (P < 0.05). In addition, diffusion capacity (DLCO) was found to be significantly lower in patients with CD compared with UC (P < 0.05).

CONCLUSIONS

This study showed that an increased FE(NO) level may be used for identifying patients with IBD who need further pulmonary evaluation.

The effect of low-dose inhaled budesonide on PC20 AMP levels in patients with mild asthma: a 3-month follow-up study

Adenosine monophosphate (AMP) challenge is a diagnostic tool for asthma. The aim of this study is to evaluate the effect of low dose inhaled budesonide (IB) on PC(20)AMP levels. Seventeen stable mild asthmatic patients were prospectively recruited. After initial testing, patients were administered 400 microg of inhaled budesonide. AMP challenge was then repeated at the 12th hour and 5th,15th, 30th, and 90th days of the treatment. AMP challenge resulted in negative in 47% of the patients at 12(-)hour testing. This study suggests that low-dose IB may return airway responsiveness as early as 12 hours and AMP challenge may be effectively used for treatment monitorization.

Esophageal candidiasis and Candida colonization in asthma patients on inhaled steroids

The aim of this study was to evaluate the risk of esophageal candidiasis in asthma patients who are on inhaled steroids without any other risk factors for esophageal candidiasis by comparing the treatment group with the control group. Moreover, the oropharyngeal and esophageal Candida colonizations were evaluated in the subgroups of both control and treatment groups. Upper gastrointestinal system endoscopic evaluation was performed in 40 asthma patients who were on inhaled steroids for at least 1 month. The control group consisted of 40 steroid naïve patients without asthma. Oral and esophageal samples were obtained for performing quantitative culture. Candida growth in cultures without any clinical signs and symptoms was described as colonization. Candida growth accompanied by clinical signs and symptoms was described as infection. None of the patients in the control group had either esophageal or oropharyngeal candidiasis; however, one (2.5%) asthma patient had esophageal candidiasis and two (5%) asthma patients had oropharyngeal candidiasis. Esophageal and oropharyngeal Candida colonization was determined in 5 (22.7%) and 11 (50%) of the asthma patients and 7 (31%) and 9 (41%) of the control group, respectively. Although the mean numbers of Candida colonies were higher in the asthma group in both localizations, there were no statistically significant differences between the two groups regarding esophageal or oropharyngeal Candida colonization. The risk of esophageal candidiasis due to inhaled steroids is low and inhaled steroids may be used safely in terms of esophageal candidiasis. Future prospective studies are needed to draw more definitive conclusions.

The impact of bronchiectasis in clinical presentation of asthma

BACKGROUND

Though asthma and bronchiectasis are two different diseases, their coexistence has been shown in many patients. The aim of this study was to evaluate the clinical features of asthmatics with bronchiectasis compared with pure asthmatics.

METHODS

We evaluated 1680 asthmatics followed-up in our clinic. Fifty-one asthmatics had the diagnosis of bronchiectasis. These patients were compared with fifty-one age and gender matched asthmatics without bronchiectasis.

RESULTS

The prevalence of bronchiectasis among the asthmatics was 3%. Asthma diagnosis was made at the age of 33.2 +/- 16.8 years for asthmatics with bronchiectasis and 39.5 +/- 16.2 years for pure asthmatics (P = 0.05). Asthmatics with bronchiectasis mostly had severe persistent asthma (49.0%), while pure asthmatics mostly had mild persistent and intermittent asthma (69.4%). History of hospitalization due to severe asthma exacerbation and presence of chronic respiratory failure was significantly higher in bronchiectatic group.

CONCLUSIONS

These data show that bronchiectasis can contribute to severe and difficult to control asthma with pulmonary complications like chronic respiratory failure.

What can predict the exacerbation severity in asthma?

There are many well-defined risk factors for fatal asthma exacerbation; however, few data exist about the link between the severity of asthma and severity of exacerbation. The aim of this study was to determine if there is any patient and disease-related factor that predicts the severity of asthma exacerbation. The retrospective data of asthmatic patients followed up in our clinic were analyzed. Asthmatic patients who had at least one exacerbation were included. Patient and disease characteristics, comorbidities, and compliance were evaluated. We analyzed 335 asthma exacerbations of 189 asthmatic patients. Eighteen patients had intermittent asthma, 115 patients had mild persistent asthma, 45 patients had moderate persistent asthma, and 11 patients had severe persistent asthma. Of the 189 asthmatic patients 8.1% of the exacerbations were mild, 52.5% were moderate, and 39.4% were severe. There was a significant correlation between the severity of asthma and severity of exacerbation (r = 0.32; p < 0.001). When elderly (> or =60 years old) and younger (<60 years old) asthmatic patients were compared, elderly asthmatic patients had severe asthma exacerbation significantly at a higher rate than younger asthmatic patients (severe asthma exacerbation rates are 67.3 and 33.9% in elderly patients and younger asthmatic patients, respectively; p < 0.001). A significant correlation was found between the severity of exacerbation and age (r = 0.25; p < 0.001). Among the other patient and disease-related factors, asthma severity and older age were the only significant factors that contributed to the severity of exacerbation. These data show that older age as a patient-related factor and worse asthma severity as a disease-related factor could contribute to exacerbation severity in asthmatic patients.

Toxocara seroprevalence in adults with bronchial asthma

The aim of this study was to determine the seroprevalence of toxocariasis in adult asthmatics and to assess its relationship with risk factors. A total of 124 asthmatic and 60 control group subjects were included in the study. Of the asthmatic patients, 61 (49.2%) were atopic and 63 non-atopic (50.8%). The anti-Toxocara IgG (Toxocara IgG CELISA Cellabs, Australia) positivity rate for all asthmatic cases was 9.7%. There was no significant difference between the asthmatic cases and the control group regarding anti-Toxocara IgG positivity (P>0.05). When risk factors were analyzed, there was a statistically significant difference between the control group subjects and patients with non-atopic asthma and also between the atopic asthmatic patients and the patients with non-atopic asthma regarding pets being under veterinary control (P<0.05). The percentages of those who had their pets defecate indoors were 0, 15 and 8.6%, respectively, for the control subjects, patients with non-atopic asthma and those with atopic asthma. There was a statistically significant difference when the control group subjects were compared to the patients with atopic asthma (P<0.05).

A randomized clinical trial of magnesium sulphate as a vehicle for nebulized salbutamol in the treatment of moderate to severe asthma attacks

Although it is well known that intravenous administration of MgSO4 as an adjunct to conventional therapy is effective in treating asthma attacks, the effect of nebulized MgSO4 as a vehicle for salbutamol has been less evaluated. The aim of this study was to compare the effects of nebulized salbutamol administrated through either MgSO4 or isotonic saline solution on the 'peak expiratory flow rate' (PEFR), other respiratory and clinical parameters, and hospitalization rate of patients suffering from moderate to severe asthma attacks. Twenty-six patients with asthma attack were enrolled in the study in a randomized single blind fashion. After obtaining initial peak expiratory flow measurements (PEFR) and clinical evaluation, all patients received 1mg/kg corticosteroids and oxygen therapy and then either isotonic MgSO4 (2.5 ml, 6.3%)+salbutamol (2.5 ml) or saline (2.5 ml)+salbutamol (2.5 ml) through a jet nebulizer (group 1 (n=14) vs group 2 (n=12), respectively). The nebulizations were repeated every 20 min for the first hour and every hour for the rest of 4 h. The PEFR measurements and clinical assessment were performed after nebulization at 20th, 60th, 120th, 180th and 240th minutes. Patients were discharged when PEFR reached the target level of 70% of predicted. The baseline PEFRs and clinical parameters were similar between groups 1 and 2 (50.2+/-18.5 vs 44.1+/-13.9, respectively, p>0.05). The mean% increase in PEFR at different measurement levels was similar between the groups. When the treatment response was evaluated within the groups, group 2 showed statistically significant increase in PEFR (% of predicted) 1h earlier than group 1 (60th vs 120th minute, p=0.003 vs p=0.007). The mean duration of achieving target-PEFRs was 105.7+/-72.1 min for group 1 and 118.3+/-96.7 min for group 2 (p>0.05). This study suggested that the additional usage of MgSO4 to nebulized salbutamol has no beneficial effect on the treatment of asthma attacks.

Pulmonary veno-occlusive disease in a patient with a history of Hashimoto's thyroiditis

Pulmonary veno-occlusive disease (PVOD), a rapidly progressive and fatal disorder, is a rare cause of pulmonary hypertension. We report the occurrence of PVOD in a female patient with Hasimoto's thyroiditis. This report emphasises that PVOD can co-exist with Hashimoto's thyroiditis and a high index of clinical suspicion is required to confirm the diagnosis of PVOD.

Atopic status in patients with sarcoidosis

Sarcoidosis is a multisystem disorder that is characterized by T helper 1 (Th1)-mediated immune response at the sites of disease. Studies showed that T cells derived from patients with sarcoidosis have been able to release Th2 cytokine profile. However, they are believed to be suppressed and nonactive. This study investigated the rate of atopy, a Th2 condition, in sarcoidosis. Atopic status was assessed in 41 patients (13 men and 28 women; mean age, 47.6 +/- 12.2 years) with sarcoidosis. Current history of atopic diseases, including asthma and allergic rhinitis, was assessed in clinical evaluation. Skin-prick tests were performed using a standardized panel. Total immunoglobulin E was measured by chemiluminescence automatic immunoassay. Results are discussed with the conjunction of previous epidemiological studies conducted in adult Turkish populations. Three patients (7%) had a diagnosis of asthma, whereas one patient (2%) had isolated allergic rhinitis. Skin-prick tests were positive in two patients (5%). This rate is much lower than the atopy prevalence in Turkey (5% versus 25%). Our data suggest that sarcoidosis may be associated with a lower incidence of atopy and allergic disease; further data are needed in other populations.

Effect of nasal continuous positive airway pressure in uncontrolled nocturnal asthmatic patients with obstructive sleep apnea syndrome

The mechanisms of nocturnal asthma are intimately related to circadian rhythms, which influence inflammatory cells and mediators, hormone levels and cholinergic tone. Nocturnal airway narrowing in asthma is sometimes associated with sleep disorders, such as obstructive sleep apnea syndrome (OSAS). The aims of this study were to evaluate the association of nocturnal asthma and OSAS, and investigate the influence of continuous positive airway pressure (CPAP) therapy to improve nighttime symptoms in asthmatic patients with OSAS. Forty-three asthmatic patients who had nocturnal symptoms in spite of the optimal medical treatment according to the Global Initiative for Asthma guidelines and associated with snoring were studied. Pulmonary function tests (PFTs), asthma nighttime symptom scores, and polysomnography were performed on all patients. We treated the patients with an apnea-hypopnea index (AHI) 15 (moderate-severe OSAS) (n=16) with CPAP during 2 months. After 2 months, PFT, asthma nighttime symptom scores were reperformed. There was no significant difference in PFT values before and after CPAP treatment in OSAS patients. Asthma nighttime symptom scores were improved significantly (P<0.05) after CPAP treatment. In conclusion, in some patients with nocturnal asthma, OSAS may be responsible disease for nocturnal symptoms. In this condition, CPAP improves nocturnal symptoms without amelioration in PFT abnormalities.

Tracheal adenoid cystic carcinoma masquerading asthma: a case report

Background

Tracheal tumors are often misdiagnosed as asthma and are treated with inhaled steroids and bronchodilators without resolution.

Case Presentation

Here, a patient with tracheal adenoid cystic carcinoma who had been previously diagnosed with difficult asthma was reported. The possibility of the presence of localized airway obstruction was raised when the flow-volume curve suggesting fixed airway obstruction, was obtained.

Conclusion

The presenting case report emphasizes the fact that not all wheezes are asthma. It is critical to bear in mind that if a patient does not respond to appropriate anti-asthma therapy, localized obstructions should be ruled out before establishing the diagnosis of asthma.

A subglottic mass mimicking near-fatal asthma: a challenge of diagnosis

Upper airway obstruction due to a subglottic tumor can be easily misdiagnosed as bronchial asthma. We report on a 50-year-old woman who was ultimately diagnosed with subglottic tumor, but who presented with near-fatal asthma. According to her medical history she had been treated with high doses of prednisolone and bronchodilators for the past year for difficult asthma. The patient presented to the Emergency Department (ED) in severe respiratory distress. The chest X-ray study revealed bilateral hyperinflation. The flow-volume curve suggested a fixed airway obstruction. After performing a laryngoscopic examination, a subglottic mass was discovered and an urgent tracheotomy was performed. After the operation, all symptoms and respiratory distress disappeared. This case report emphasizes the fact that not all wheezes are attributable to asthma. Upper airway obstructions can lead to asthma-like symptoms in which establishment of the correct diagnosis may be challenging.

Correlation of exhaled nitric oxide levels and airway inflammation markers in stable asthmatic patients

Monitoring of inflammation is an important factor in asthma management. The gold standard for measuring direct airway inflammation is bronchial biopsy specimens taken from proximal airways through a fiberoptic bronchoscope. As a noninvasive procedure, the use of exhaled nitric oxide (FENO) for monitoring airway inflammation has been reported in many studies. The aim of this study was to evaluate the correlation of FENO with direct measurements of airway inflammation in biopsy specimens and pulmonary function tests (PFT). Histopathologic features were observed on bronchial biopsy specimens obtained from nine stable mild-moderate asthmatics. Each subject had measurements of PFT, FENO levels, blood eosinophil count, and bronchoscopy with bronchial biopsies and bronchoalveolar lavage. Five subjects with forced expiratory volume in 1 second >80% had methacholine challenge test. None of the subjects had prior anti-inflammatory therapy for asthma. No correlation was found between PFT, blood eosinophil count, and FENO levels. There was a negative correlation between PC20 and FENO. Though there was no correlation between bronchial biopsy eosinophil, monocyte and lymphocyte counts, and FENO, we found a weak positive correlation between total inflammatory cell count in bronchial biopsies and FENO levels. A negative significant correlation was found between FENO levels and epithelial desquamation (p<0.05, r=-0.7). These results suggest that, FENO levels reflect the increased number of activated inflammatory cells in airways and the negative correlation with epithelial desquamation reflects the role of epithelium in NO syntheses. FENO should not be interpreted as a specific inflammation marker for asthma.

Airway inflammation in premenstrual asthma

Premenstrual asthma (PMA) is a clinical picture with worsening of asthmatic symptoms and pulmonary functions in the late luteal phase of the menstrual cycle. The aim of this study was to evaluate the inflammatory changes in asthmatic women who complain of PMA. Forty asthmatic women attending our outpatient clinic were questioned about worsening of their asthma before menstruation. Eleven women (aged 17-40) who complained of PMA participated in the study. Subjects were asked to record peak expiratory flow rates, symptom scores, and beta-agonist use daily. After the first menses on the seventh day of their cycle, and before the onset of the next menstruation, on the 26+/-3rd day of the cycle, patients were evaluated with pulmonary function tests, methacholine challenge test, and fractionated exhaled nitric oxide (FE(NO)) levels. Eosinophils in peripheral blood and induced sputum were also evaluated. When comparing the two groups of results, the significant changes were in FENO levels, day-time symptom scores, and eosinophils in induced sputum (29.25 ppb/9.16 ppb p < 0.05, 1/0.45 p = 0.05, %6.63/%4.09 p < 0.01, respectively, before and after menstruation). These results show that PMA is not only a clinical picture with a decrease in airway calibre that can be related to the regulation of 2 receptors, but also a complex state with worsening of airway inflammation.

Pulmonary alveolar microlithiasis with the absence of technetium-99m MDP uptake of lungs

The authors report a patient with alveolar microlithiasis who was treated for miliary tuberculosis eight years earlier and whose Tc-99m MDP scan revealed absent lung uptake. Diagnosis was established by bronchoalveolar lavage. Both the roentgenogram and computed tomography of the chest confirmed alveolar microlithiasis.