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Purpose: Alpha-1 antitrypsin deficiency (AATD) is a rare hereditary condition characterized by decreased serum alpha-1 antitrypsin (AAT) levels. We aim to identify AATD in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, or asthma and to report the frequency of AAT variants in Turkey., Patients and Methods: This non-interventional, multicenter, prospective study was conducted between October 2021 and June 2022. Adult patients with COPD, bronchiectasis, asthma, liver symptoms, or family members with AATD were included. Demographic and clinical characteristics, pulmonary diagnosis, respiratory symptoms, and AAT serum levels were assessed. Whole blood samples were collected as dried blood spots, and the most common AATD mutations were simultaneously tested by allele-specific genotyping., Results: A total of 1088 patients, mainly diagnosed with COPD (92.7%) and shortness of breath (78.7%), were assessed. Fifty-one (5%) were found to have AATD mutations. Fifteen (29.4%) patients had Pi*S or Pi*Z mutations, whereas 36 (70.6%) patients carried rare alleles Pi*M malton (n=18, 35.3% of mutations), Pi*I (n=8, 16%), Pi*P lowell (n=7, 14%), Pi*M heerlen (n=2, 4%), and Pi*S iiyama (n=1, 2%). The most common heterozygous combinations were Pi*M/Z (n=12, 24%), and Pi*M/M malton (n=11, 22%). Ten patients with severe AATD due to two deficiency alleles were identified, two with the Pi*Z/Z genotype, four with the genotype Pi*M malton/M malton, three with Pi*Z/M malton, and one with Pi*Z/M heerlen., Conclusion: Our results identified AATD mutations as a genetic-based contributor to lung disease in patients with COPD or bronchiectasis and assessed their frequency in a population of Turkish patients., Competing Interests: AN and BD are full-time employees of Grifols. DK reports honoraria paid to her institution, as speaker, from AstraZeneca, Abdi İbrahim, Novartis and Grifols, outside the submitted work. The remaining authors have no conflicts of interest to declare for this work., (© 2023 Tural Onur et al.)

Introduction: Chronic obstructive pulmonary diseases are common causes of disease in the community and account for considerable percent of the caseload in primary health care facilities. For this reason, it is important to question and improve the knowledge of primary health care physicians. This study is designed to assess the level of knowledge for bronchial asthma and COPD of the primary healthcare physicians, both before and immediately after an educational course structured in the context of GARD Chronic Airway Diseases National Control Program., Materials and Methods: The participating physicians attended an intensive educational course on asthma and COPD. Twenty five item questionnaires for asthma and COPD were administered to the participants both before and immediately after the end of the course. Contribution of education to the level of knowledge was investigated by comparing the percentages of the correct answers in the pre-and post-test., Result: From 11 different cities, 1817 and 1788 primary health care physician were attended to the asthma and COPD educations, respectively. The accuracy rate of ≥ 75% was obtained from only 4 questions in pre-test asthma questionnaire. On the contrary, in 15 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 45.8%, and this rate raised to 69.6% after education course. The accuracy rate of ≥ 75% could not be obtained from any of the questions in pre-test COPD questionnaire. On the contrary, in 19 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 42.0%, and this rate raised to 71.3% after education course., Conclusions: It has been shown that, in primary care settings, the level of knowledge in asthma and COPD should be enhanced and that this increase can be achieved with an education course.

Introduction: Chronic pulmonary diseases cause significant morbidity and mortality. However awareness about the risk factors, symptoms, diagnosis and traetment of these disorders is low among patients and health care providers. Our aim was to evaluate the awareness of asthma and chronic obstructive pulmonary disease among primary care doctors. This study was performed by the national Global Alliance Against Chronic Respiratory Diseases programme., Materials and Methods: Primary care doctors employed by the Ministry of Healthy were included to the study. Turkish Statistical Institute randomly selected 680 doctors. Questionnaires evaluating the awareness of asthma and COPD which were developed by the Turkish Thoracic Society COPD and asthma assemblies were completed online by these doctors., Result: 84% of the doctors described asthma as airway obstruction. Dyspnea was reported as the most common symptom of asthma (78.8%) and inspiratory rhonci was reported as the most common physical exam finding (42.3%). Around 50% of doctors thought impairment of pulmonary function tests (PFT) was important for diagnosis and evaluation of severity of asthma while 24.2% thought physical exam was more important. When treatment options were evaluated 87.6% chose inhaled treatment for asthma. COPD was described as bronchiectasis and chronic bronchitis by 9.1%, chronic bronchitis and emphysema by 61.6%, chronic bronchitis and asthma by 22.2% and asthma and emphysema by 7.1%. 1.2% of the doctors did not consider cigarette smoking as a risk factor for COPD. PFT was recommended for diagnosis by 83%. Most correctly differentiated asthma and COPD. Bronchodilators were the first choice for COPD by 72.5%., Conclusions: Awareness is low for asthma and COPD among primary care doctors. Awareness should be raised among health care professionals for these diseases with high economical burden to improve outcome.

Introduction: Chronic diseases are the major causes of death in the world, and chronic respiratory diseases are important public health problems in our country due to theirhigh mortality and morbidity rates. Adherence to medication is an important issue in the treatment of these diseases. Morisky-8 item medication adherence questionnaire is one of the most widely used instruments for this purpose in the world. This study aimed to validate this scale in Turkish patients., Materials and Methods: Turkish translation of Morisky-8 item scale consisted forward translation to Turkish, Turkish linguistic controls, back translation into English, English linguistic controls, and reporting of the process by the physician. Then, Turkish version of the scale was applied to the patients, and evaluated whether the patients understand the questions accurately. Fifty nine patients were included in this study, whomwere consulted in Gazi University Faculty of Medicine Department of Chest Diseases, and met the inclusion criteria., Results: Mean ages of patients with asthma and chronic obstructive pulmonary disease (COPD) were 46.2 ± 15.1 and 64.0 ± 12.1 years, and duration of these diseases were 96.5 ± 102.3 and 66.2 ± 71.5 months, respectively. Patients had similar lengths of drug use. There was no significant differences for responses between groups, but two patients misunderstood two questions, and the remaining questions understood well by the patients. Medication adherence was 74.2% in patients with asthma, and 46.4% in patients with COPD., Conclusion: Turkish version of Morisky-8 scale was shown to be a reliable tool for determining the medication adherence in patients with asthma and COPD.

This study was designed to describe the cellular inflammation, thickness of basement membrane (BMT) and epithelial desquamation (ED) in bronchial biopsies from patients with chronic obstructive pulmonary disease (COPD) compared with asthma and healthy individuals. Thirteen subjects with COPD, 12 asthmatic subjects, and 10 healthy individuals enrolled in the study. Bronchial biopsies obtained by fiberoptic bronchoscopy were stained with hematoxylin and eosin to perform cell counts and descriptive analysis. Neutrophils were found in higher numbers in epithelium and lamina propria in subjects with COPD compared with asthma and control groups (p< 0.001, p< 0.05) whereas eosinophils were observed higher in epithelium and lamina propria in asthmatic subjects (p< 0.001, p< 0.001). There were no significant differences in numbers of neutrophils and eosinophils in submucosa in the three groups (p> 0.05). There were no significant correlations between the inflammatory cell counts and FEV1 or smoking history in either group (p> 0.05). In subjects with COPD only 6 (46.2%) of the subjects showed BMT whilst 2 (15.4%) of the subjects showed ED. In asthma group, 11 (91.7%) of the subjects presented increased BMT and ED. In healthy individuals 1 (10%) of the subjects had increased BMT and no one had ED. As a result, we may conclude that the predominant cells of bronchial mucosa in COPD are the neutrophils whereas they are eosinophils in asthma. Thickening of basement membrane and epithelial desquamation are the major features of asthmatics. However in COPD, these features would be focally present and variable.