Evaluation of inhaler technique and patient satisfaction with fixed-combination budesonide/formoterol dry-powder inhaler in chronic obstructive pulmonary disease (COPD): data on real-life clinical practice in Turkey.

INTRODUCTION: The present study was designed to evaluate inhaler techniques and patient satisfaction with fixed-combination budesonide/formoterol dry-powder inhaler chronic obstructive pulmonary disease (COPD) in Turkey in real-life clinical practice. PATIENTS AND METHODS: A total of 442 patients with COPD [mean (SD) age: 63.2 (10.6) years, 76.5% were males] were included in this cross-sectional study conducted at 25 outpatient clinics across Turkey. Data on socio-demographic characteristics, characteristics of COPD, inhaler technique and satisfaction with dry-powder inhaler were recorded at a single crosssectional visit performed at the study enrolment. RESULTS: Patients were characterized by prominence of moderate to severe (78.1%) COPD, high rate of regular use of overall COPD medications (89.4%) and Turbuhaler® for an average of 33.7 months, predominance of males (76.5%), primary education (85.7%), urban location (68.3), ex-smokers (61.1%) and spending time outdoors for ≥ 4 hour/day (62.0%). Use of correct techniques was evident in majority of patients (≥ 94%), whereas inhalation maneuvers including breathing out gently away from mouthpiece without blowing into it (71.9%) and holding the breath for 5-10 seconds (78.3%) were performed correctly by lesser percent of patients especially in the older group (≥ 65 years, p< 0.05). Overall percent of patients with the feeling that she/he used the inhaler very/fairly correctly was 73.3%, while 86% of patients identified that they were very/fairly satisfied with the inhaler, irrespective of age and educational status. CONCLUSION: In conclusion, our findings revealed the majority of patients are able to use Turbuhaler® correctly regardless of the educational status, while older age was associated with higher rate of errors in inhalation maneuvers in the real clinical practice in Turkey. Majority of our patients identified Turbuhaler® to be very/fairly convenient regarding ease of use, portability, and usability with an overall self-confidence in using the inhaler correctly among 73% and the satisfaction rate of 86%; irrespective of age and educational level.

Effect of Inspiratory Muscle Training in the Management of Patients With Asthma: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: The aim of this study was to investigate the effects of inspiratory muscle training (IMT) on respiratory muscle strength, exercise capacity, dyspnea, fatigue, quality of life, and daily living activities of asthmatic patients. METHODS: Thirty-eight asthmatic patients, between 18 and 65 years of age, were enrolled in the study and randomly divided into 2 groups; IMT (n = 20) or control (n = 18). Participants in the IMT group performed 30 breaths using a patient-specific threshold pressure device, twice daily for 6 wk at 50% maximal inspiratory pressure (MIP), in addition to "breathing training" during this period. Participants in the control group performed only the "breathing training" (sham or no threshold pressure device). Outcome measurements, performed before and after the intervention, included pulmonary function test, respiratory muscle strength, 6-min walk test, modified Medical Research Council dyspnea scale, St George's Respiratory Questionnaire, Fatigue Severity Scale, and London Chest Activity of Daily Living scale. RESULTS: Among the outcomes in the study, changes to key variables including MIP (P < .01); MIP, percent predicted (P < .01); maximal expiratory pressure (MEP), percent predicted (P < .01); 6-min walk test walking distance (P = .001); modified Medical Research Council scale (P =<.001); Fatigue Severity Scale (P = .03); St George's Respiratory Questionnaire symptoms (P = .03); London Chest Activity of Daily Living domestic (P = .03); and London Chest Activity of Daily Living leisure (P = .01) were significantly different in favor of IMT versus control. CONCLUSION: These findings suggest that IMT may be an effective modality to enhance respiratory muscle strength, exercise capacity, quality of life, daily living activities, reduced perception of dyspnea, and fatigue in asthmatic patients.

A 10-year experience of tuberculosis in solid-organ transplant recipients.

OBJECTIVES: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. MATERIALS AND METHODS: We evaluated a total of 999 patients (male/female = 665/334, 661 renal and 338 liver transplants) who underwent solid-organ transplant between 2003 and 2013. The medical records of all patients were retrospectively reviewed. Patients' demographics, transplant type, primary site of tuberculosis specimen culture and pathology results, chest radiograph, and thoracic computed tomography findings, total blood count and chemistry were all recorded. RESULTS: Among the 999 subjects, 19 patients (1.9%) (male/female: 15/4, mean ± SD age, 42 ± 18.5 y) were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. CONCLUSIONS: Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.

Pleural effusion in patients with end-stage liver disease who are candidates for transplant.

OBJECTIVES: The purpose of this retrospective study was to determine the rate of occurrence and features of pleural effusion in patients referred to our institution for liver transplant. MATERIALS AND METHODS: This study included 135 patients (43 women, 92 men) with a mean age of 40 years (range, 16-66 y). Patient characteristics such as history of pulmonary disease and types of respiratory symptoms were recorded. The chest radiographs of every study patient were examined. RESULTS: Of the 135 study patients, 16 (11.9%) had respiratory symptoms upon admission to the hospital, and 49 (36.3%) had abnormalities on their chest radiographs. The most common radiographic abnormality was elevated right hemidiaphragm in 32 patients (23.7%), followed by pleural effusion in 22 (16.2%), atelectasis in 21 (15.5%), hilar enlargement in 18 (13.3%), and elevated left hemidiaphragm in 9 (6.6%). Seventeen of 22 patients (77.3%) had right pleural effusion, 4 (18.2%) had bilateral, and 1 (4.5%) had left pleural effusion. Of the 10 patients undergoing thoracentesis, 9 had transudates and 1 had an exudate. CONCLUSIONS: Preoperative pleural effusion is a common problem in patients who are candidates for a liver transplant. Most of these patients have right transudative pleural effusion.

Early pulmonary complications of liver transplant.

OBJECTIVES: Pulmonary complications are a leading problem after a liver transplant. This study sought to predict postoperative early complications by a chest radiograph performed after a transplant among adult orthotopic liver transplant recipients. MATERIALS AND METHODS: One hundred thirty-five patients (43 women, 92 men; mean age, 40 y; range, 16-66 y) were included and their medical data reviewed retrospectively. A postoperative chest radiograph of each patient was evaluated to check for pulmonary complications. RESULTS: Smoking history was noted in 61 patients (45.2%). Postoperative first chest radiograph evaluation showed normal findings in 56 patients (41.5%). Right pleural effusion was found in 25 patients (18.5%), and atelectasis was found in 25 (18.5%). Bilateral pleural effusion was the second most-frequent finding on postoperative radiograph (14.8%). Effusion accompanied by atelectasis was found in 3 patients (2.2%). Other postoperative chest radiograph findings were consolidation (n=2, 1.5%), left pleural effusion (n=2, 1.5%), and bronchiectasis (n=2, 1.5%). CONCLUSIONS: We investigated the reflection of the first chest radiograph after liver transplant on postoperative early complications. Postoperative first chest radiograph can be an inexpensive and accessible diagnostic tool for predicting postoperative problems.