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Seda Tural Onur,1 Antonino Natoli,2 Bettina Dreger,2 Sibel Arınç,3 Nurhan Sarıoğlu,4 Mustafa Çörtük,1 Dilek Karadoğan,5 Abdurrahman Şenyiğit,6 Birsen Pınar Yıldız,1 Nurdan Köktürk,7 Serap Argun Barıs,8 Sümeyye Kodalak Cengiz,7 Mehmet Polatli9 1Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye; 2Scientific and Medical Affairs, Scientific Innovation Office, Grifols, Frankfurt, Deutschland; 3Clinic of Chest Diseases, University of Health Sciences Turkey, S.B.Ü. Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye; 4Department of Pulmonology, Balıkesir University Faculty of Medicine, Pulmonology Clinic, Balıkesir, Türkiye; 5Department of Chest Diseases, Recep Tayyip Erdoğan University, School of Medicine, Rize, Türkiye; 6Department of Chest Diseases, Dicle University Faculty of Medicine Hospital, Diyarbakır, Türkiye; 7Department of Pulmonary Medicine, Gazi University, School of Medicine, Ankara, Türkiye; 8Department of Pulmonary Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye; 9Faculty of Medicine, Aydin Adnan Menderes University, Aydin, TürkiyeCorrespondence: Mehmet Polatli, Faculty of Medicine, Aydin Adnan Menderes University, Zafer Mahallesi, Efeler, Aydin, 09100, Türkiye, Email mpolatli09@gmail.comPurpose: 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.Keywords: alpha-1 antitrypsin deficiency, genotype, diagnosis, chronic obstructive pulmonary disease

Hakan Gunen,1 Nurdan Kokturk,2 Sibel Nayc&inodot;,3 Sevket Ozkaya,4 Birsen P&inodot;nar Y&inodot;ld&inodot;z,5 Onur Turan,6 Aziz Gumus,7 Metin Akgun,8 Alev Gurgun,9 Candan Ogus,10 Arzu Mirici,11 Elif Sen,12 Nazan Bayram,13 Volkan Eken,14 Hakan Erkus14 1Department of Pulmonary Medicine, Sureyyapasa Training and Research Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey; 3Department of Pulmonary Medicine, Mersin University School of Medicine, Mersin, Turkey; 4Department of Pulmonary Medicine, VM Medical Park Samsun Hospital, Samsun, Turkey; 5University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Pulmonology, Istanbul, Turkey; 6Department of Pulmonary Medicine, Izmir Katip Çelebi University, &Idot;zmir, Turkey; 7Department of Pulmonary Medicine, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey; 8Department of Pulmonary Medicine, Atatürk University School of Medicine, Erzurum, Turkey; 9Department of Pulmonary Medicine, Ege University School of Medicine, &Idot;zmir, Turkey; 10Department of Pulmonary Medicine, Akdeniz University Medical Faculty, Antalya, Turkey; 11Department of Pulmonary Medicine, Canakkale 18 Mart University, Canakkale, Turkey; 12Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey; 13Department of Pulmonary Medicine, Gaziantep University, Sahinbey Research Hospital, Gaziantep, Turkey; 14GlaxoSmithKline, Istanbul, TurkeyCorrespondence: Hakan Gunen, Department of Pulmonary Medicine, Sureyyapasa Training and Research Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey, Tel +90 532 621 16 99, Fax +90 216 421 41 10, Email hgunen@yahoo.com Nurdan Kokturk, Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey, Tel +90 532 627 91 11, Fax +90 312 212 90 19, Email nkokturk@gazi.edu.tr; kokturk.nurdan@gmail.comPurpose: GOLD 2019 proposed a novel treatment decision tool for follow-up based on the predominant trait (exacerbation or dyspnea) of patients, alongside treatment escalation and de-escalation strategies. This study was designed to provide an up-to-date snapshot of patient and disease characteristics, treatment pathways, and healthcare resource use (HRU) in COPD in real life, and comprehensively examine patients considering GOLD 2019 recommendations.Patients and Methods: This mixed design, observational, multicenter (14 pulmonology clinics) study included all patients with a documented COPD diagnosis (excluding asthma-COPD overlap [ACO]) for ≥ 12 months, aged ≥ 40 years at diagnosis who had a COPD-related hospital visit, spirometry test and blood eosinophil count (BEC) measurement under stable conditions within the 12 months before enrollment between February and December 2020. Data were collected cross-sectionally from patients and retrospectively from hospital medical records.Results: This study included 522 patients (GOLD group A: 17.2%, B: 46.4%, C: 3.3%, D: 33.1%), of whom 79.5% were highly symptomatic and 36.2% had high risk of exacerbation. Exacerbations (n = 832; 46.6% moderate, 25.5% severe) were experienced by 57.5% of patients in the previous 12 months. Inter-rater agreement between investigators and patients regarding the reason for visit was low (κ coefficient: 0.338, p = 0.001). Inhaled treatment was modified in 88 patients at index, mainly due to symptomatic state (31.8%) and exacerbations (27.3%); treatment was escalated (57.9%, mainly switched to LABA+LAMA+ICS), inhaler device and/or active ingredient was changed (36.4%) or treatment was de-escalated (5.7%). 27% had ≥ 1 hospital overnight stay over 12 months. Emergency department visits and days with limitation of daily activities were higher in group D (p < 0.001).Conclusion: Despite being on-treatment, many patients with COPD experience persistent symptoms and exacerbations requiring hospital-related HRU. A treatable trait approach and holistic disease management may improve outcomes by deciding the right treatment for the right patient at the right time.Keywords: COPD, GOLD, exacerbation, COPD treatment, eosinophilia

Nurdan Kokturk,1 Wael Abuharbid,2 Amr S Albanna,3 Hakan Gunen,4 Alev Gurgun,5 Mousa Khadadah,6 Elmas Malvolti,7 Medhat Soliman,8 Richard van Zyl-Smit,9 Noureddine Zidouni,10 Ashraf Alzaabi11 1Department of Chest Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey; 2AstraZeneca, Dubai, United Arab Emirates; 3King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 4Clinic of Chest Diseases, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey; 5Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey; 6Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait; 7AstraZeneca, Luton, UK; 8Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt; 9University of Cape Town Lung Institute, Department of Medicine and Division of Pulmonology, Groote Schuur Hospital, Cape Town, South Africa; 10Department of Pulmonology, University Hospital Issad Hassani, Béni Messous, Alger, Algeria; 11Respiratory Medicine Division, Zayed Military Hospital, Abu Dhabi, UAECorrespondence: Nurdan KokturkDepartment of Pulmonary Medicine, Gazi University School of Medicine, Emniyet Mahallesi, Mevlana Bulvarı, No 29, Yenimahalle, Ankara 06560, TurkeyTel +90 312 202 61 21Email kokturk.nurdan@gmail.comPurpose: This study was performed to assess symptom variability and its impact on morning activities in stable patients with severe COPD in the Middle East and Africa (MEA) countries.Patients and methods: Non-interventional, cross-sectional study (NCT03425760) in patients with severe COPD (GOLD 2015, C, or D categories). Symptom variability was assessed directly by interviewing the patient and using the Global Chest Symptoms Questionnaire (GCSQ). The impact on morning activities was assessed using the Capacity of Daily Living during the Morning (CDLM) and the Morning Activities and Symptoms Questionnaire (MASQ).Results: A total of 3253 patients (mean±SD age: 64.1±9.5 years, 90.3% males) were enrolled. Overall, 81.6% and 83.4% of patients reported weekly and daily symptom variability, respectively. The number of exacerbations in the previous year, smoking cessation, and COPD GOLD D were the most consistent factors associated with symptom variability. The GCSQ score was significantly higher (p

Nurdan Kokturk,1 Mehmet Polatli,2 I Kivilcim Oguzulgen,1 Sarfraz Saleemi,3 Mohammed Al Ghobain,4 Javed Khan,5 Adam Doble,6 Luqman Tariq,7 Fayaz Aziz,7 Abdelkader El Hasnaoui7 1Department of Pulmonary Medicine, School of Medicine, Gazi University, Besevler, Turkey; 2Department of Pulmonary Medicine, School of Medicine, Adnan Menderes University, Aydin, Turkey; 3Section of Pulmonary Medicine, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; 4Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Department of Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia; 6Foxymed, Paris, France; 7GlaxoSmithKline, Dubai, UAE Background: COPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia. Methods: An observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity. Results: Four hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 15) compared to 58.4% reporting medium/high adherence (p=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; p10 was associated with lower adherence (OR 2.50 [95% CI: 1.43–4.39] and 2.43 [95% CI: 1.39–4.25], respectively; p=0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33–0.98] and 0.38 [95% CI: 0.15–1.00], respectively; p=0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33–0.95]; p=0.0314). Conclusion: Adherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence. Keywords: COPD, non-adherence, 8-item Morisky Medication Adherence Scale, MMAS-8, EuroQol Five-Dimension questionnaire, EQ-5D, COPD Assessment Test, CAT, Turkey, Saudi Arabia

Hakan Gunen,1 Mehmet Yilmaz,2 Oguz Aktas,1 Pinar Ergun,3 Mediha Gonenc Ortakoylu,4 Atike Demir,5 Pelin Cetinkaya,6 Alev Gurgun,7 Muge Otlu,8 Aykut Cilli,9 Ufuk Yilmaz,5 Nurdan Kokturk,10 Ipek Candemir,3 Halil Ibrahim Yakar,1 Idilhan Ar,11 Aylin Konya111Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; 2Department of Chest Diseases, Safranbolu State Hospital, Karabuk, Turkey; 3Department of Chest Diseases, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey; 4Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; 5Department of Chest Diseases, Dr Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey; 6Department of Chest Diseases, Cukurova Dr Askim Tufekci State Hospital, Adana, Turkey; 7Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey; 8Department of Chest Diseases, Bingol State Hospital, Bingol, Turkey; 9Department of Chest Diseases, Akdeniz University, Faculty of Medicine, Antalya, Turkey; 10Department of Chest Diseases, Gazi University Faculty of Medicine, Ankara, Turkey; 11Medical Department, Novartis Pharmaceuticals, Istanbul, TurkeyObjective: To determine distribution of COPD assessment categories and physicians’ adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients.Methods: A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed.Results: Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in >70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient =0.993, P

Hatice Kilic,1 Nurdan Kokturk,2 Gulcin Sari,3 Mustafa Cakir41Department of Pulmonary Medicine, Ankara Atatürk Training and Research Hospital, 2Department of Pulmonary Medicine, School of Medicine, Gazi University School of Medicine, 3Department of Pulmonary Medicine, Dr. Nafiz Körez Sincan Devlet Hastanesi, 4Department of Public Health, School of Medicine, Gazi University, Ankara, TurkeyIntroduction: Little is known about whether there is any sex effect on chronic obstructive lung disease (COPD) exacerbations. This study is intended to describe the possible sex-associated differences in exacerbation profile in COPD patients.Methods: A total of 384 COPD patients who were hospitalized due to exacerbation were evaluated retrospectively for their demographics and previous and current exacerbation characteristics.Results: The study was conducted on 109 (28%) female patients and 275 (72%) male patients. The mean age was 68.30±10.46 years. Although females had better forced expiratory volume in 1 second and near-normal forced vital capacity, they had much impaired arterial blood gas levels (partial oxygen pressure [PO2] was 36.28 mmHg vs 57.93 mmHg; partial carbon dioxide pressure [PCO2] was 45.97 mmHg vs 42.49 mmHg; P=0.001), indicating severe exacerbation with respiratory failure. More females had two exacerbations and two hospitalizations, while more men had one exacerbation and one hospitalization. Low adherence to treatment and pulmonary embolism were more frequent in females. Females had longer time from the onset of symptoms till the admission and longer hospitalization duration than males. Comorbidities were less in number and different in women (P

Abstract 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.