The effects of comorbidities on systemic inflammation markers in stable asthmatics and the consequences of such effects have not been well evaluated. We aimed to evaluate the effect of comorbidities on clinical manifestations and systemic inflammation in asthmatic patients under control. The study group consisted of asthmatic patients who applied to our pulmonology outpatient clinic and volunteered to participate. 120 clinically stable asthma patients (71 females and 49 males) and 35 healthy controls (19 females and 16 males) with similar age, gender, and body mass index distributions were admitted to the study. The levels of osteopontin, interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 13 (IL-13), eosinophilic cationic protein, adiponectin, and high-sensitivity C-reactive protein of the individuals were evaluated using commercial ELISA kits by taking venous blood samples. Of 120 asthmatic subjects, 47 (39,2%) had comorbidities and allergic rhinitis (15%) coexisted most frequently. Other comorbidities associated with asthma were gastroesophageal reflux, sinusitis, hypertension, diabetes, gastritis, and peptic ulcus respectively. There was no physician-diagnosed comorbidity in the control group. The levels of IL-6 and IL-8 were found higher in asthma group with comorbidities when compared to those with no comorbidities (p values were 0.032 and 0.046, respectively). Comorbidities interfere with the diagnosis and treatment of asthma, besides affecting the disease control. Our findings suggest the possibility of the impact of comorbidities on systemic inflammation markers, especially IL-6 and IL-8. To evaluate the impact of comorbidities on asthma control and systemic markers, further studies are needed.

Optimal management of respiratory diseases like asthma and chronic obstructive pulmonary disease, in patients of all ages, requires sufficient drug delivery to the airways by inhaler devices 1 ; a proper inhaling technique is also essential. Inhaler therapy is the most effective approach to treat respiratory disease patients; however, the reported proportion of patients using incorrect inhalation techniques varies widely, between 27% and 89%. 2,3 Patients should learn to use inhaler devices effectively to ensure sufficient delivery of the drug to the airways; one of the major weaknesses of aerosol therapy is the need for a specific inhalation technique for proper use of each of the different types of inhaler devices. 4 The different kinds of inhalers available have their own specific features. 5 Patient characteristics associated with a

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Introduction: Chronic obstructive pulmonary disease (COPD) is a debilitating disorder that restricts the physical activity of patients who are deprived of sunlight, which is a source of vitamin D. The purpose of this study was to assess the relationship between vitamin D and the frequency of exacerbation and hospitalization among patients with COPD. Material and Method: In the main analysis, 303 patients with COPD (stage GOLD A to D) were included in a retrospective cohort study in Turkey. Serum levels of vitamin D (25-hydroxyvitamin D) were measured in 303 patients with COPD and were associated with pulmonary function, AECOPD frequency and hospitalization in the previous year. Results: For COPD patients, the mean reference level of 25 hydroxyvitamin D in serum was 12.5 ng/dL. In comparison to patients with a serious 25-hydroxyvitamin D deficiency (< 10 ng/dL, n=119 [39,3%]), patients with a moderate deficiency (10-19.99 ng/dL, n=100 [33%]), inadequate levels (20-29.99 ng/dL, n=49 [16,2%]) presented a different risk of exacerbation (incidence rate ratio, 2.3 [95% CI, 1.9-2.6], 1.6 [95% CI, 1.2-2.0], and 0.8 [95% CI, 0.3-1.2] respectively). In patients with desirable levels (> 30 ng/dL, n=34 [11,2%]), the risk was lower but not significant (incidence ratio, 0.7 [95% CI, 0.2-1.2]. In COPD patients, 25-hydroxyvitamin D rates are low correlated with 1-s forced expiratory volume (FEV1) (r=0.187, p=0.0013). Conclusion: 25-hydroxyvitamin D deficiency is a frequent occurrence in COPD and is correlated with the frequency of exacerbation and hospitalization in COPD patients.