Apnea-hypopnea index and the polysomnographic risk factors for predicting 5- to 8-year mortality in patients with OSA.

BACKGROUND: The purpose of this study was to investigate the long-term mortality rates of patients with obstructive sleep apnea (OSA) who received an overnight polysomnogram (PSG) for obtaining the diagnosis and to determine the relationship between PSG parameters and overall mortality. METHODS: Between 2007 and 2013, patients who had overnight PSG and were diagnosed with OSA were included in the study. Factors which are thought to influence mortality were assessed for 5-year and overall survival using the log rank test and Kaplan-Meier survival curves. Using multivariable Cox regression analysis, a model was constructed for factors influencing 5-year and overall survival. RESULTS: A total of 762 patients with a mean age of 52.7 (±10.8) and a dominance of men (74.7%) were studied. Gender, OSA severity subgroups, and apnea hypopnea index (AHI) were not statistically significantly associated with either 5-year or overall mortality (p<0.05 for both). Age, having a cardiovascular comorbidity, proportion of rapid eye movement (%REM), and total sleep time with an oxyhemoglobin saturation of less than 90% (T90) all showed a significant correlation with overall all-cause mortality in the model. For 5-year mortality and overall mortality, the hazard ration (HR) for T90 was 3.6 (95% CI (1.6-8.0) p=0.001) and 3 (95% CI (1.6-5.7) p=0.001), respectively. CONCLUSION: The study findings suggest that not AHI but PSG parameters of hypoxia, mainly T90, having cardiovascular comorbidity, and %REM sleep were significant risk factors for all-cause mortality in patients with OSA. The association of OSA, hypoxia, and mortality is an area that deserves further study.

The impact of charlson comorbidity index on mortality from SARS-CoV-2 virus infection and A novel COVID-19 mortality index: CoLACD.

OBJECTIVE: The aim of this study is to find out the potential risk factors including charlson comorbidity index (CCI) score associated with death in COVID-19 patients hospitalised because of pneumonia and try to find a novel COVID-19 mortality score for daily use. METHODS: All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalised in our Chest Diseases Education and Research Hospital between March 11, 2020 and May 15, 2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. RESULTS: Over 383 patients (n: 33 deceased, n: 350 survivors) univariate and multivariate regression analysis showed that CCI and lymphocyte ratio were prognostic factors for COVID-19-related mortality. Using this analysis, a novel scoring model CoLACD (CoVID-19 Lymphocyte ratio, Age, CCI score, Dyspnoea) was established. The cut-off value of this scoring system, which determines the mortality risk in patients, was 2.5 points with 82% sensitivity and 73% specificity (AUC = 0.802, 95% CI 0.777-0.886, P < .001). The risk of mortality was 11.8 times higher in patients with a CoLACD mortality score higher than 2.5 points than patients with a score lower than 2.5 (OR = 11.8 95% CI 4.7-29.3 P < .001). CONCLUSION: This study showed that by using the CoLACD mortality score, clinicians may achieve a prediction of mortality in COVID-19 patients hospitalised for pneumonia.

COVID-19 phobia in healthcare workers; a cross-sectional study from a pandemic hospital.

INTRODUCTION: Healthcare workers (HCWs) are at the forefront of the fight against coronavirus. The purpose of this study was to evaluate COVID-19 phobia levels of HCWs of a pandemic hospital and explore associated factors. MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted on HCWs employed in a pandemic hospital. A total of 365 HCWs (95 physicians, 187 nurses and 83 assistant healthcare staffs) were included in the study. In order to evaluate COVID-19 phobia, coronavirus-19 phobia scale (C19P-S) was administrated. Chronophobia levels of frontline and nonfrontline HCWs were compared. Additionally, the effect of working in different departments, profession and associated factors on COVID-19 phobia was evaluated. RESULT: Overall, 172 HCWs completed the C19P-S and agreed to participate in the study. Mean total CP19P-S score of the HCWs included in the study was 50.1 ± 17.3. Of the study population, 59.3% participants were frontline HCWs and 40.7% were non-frontline HCWs. When frontline HCWs and nonfrontline HCWs were compared in terms of total C19P-S and subscales scores (psychological, psycho-somatic, economic, social), no statistically significant differences were found (p= 0.914, p= 0.687, p= 0.766, p= 0.347, p= 0.794, respectively).When the HCWs were divided into three groups according to departments (clinics, intensive care unit (ICU), emergency department) where they worked regardless of whether they cared for patients with COVID-19, HCWs employed in the ICUs had the highest scores regarding total C19P-S and subscales scores (p= 0.002, p= 0.001, p= 0.001, p= 0.012, p= 0.002,respectively) . Profession based comparison revealed no significant difference between the groups regarding total C19P-S score (p= 0.117). CONCLUSIONS: It is essential to make a comprehensive evaluation regarding the effects of pandemics on HCWs, not only for controlling the COVID-19 pandemic but also to protect the mental health of HCWs. Critical care professions appear to need particular attention among HCWs. The C19P-S, which assesses coronaphobia levels with psychological, psycho-somatic, economic, and social aspects could be a convenient screening tool for evaluating COVID-19 phobia levels in HWCs.

Which scoring system is better in association with exercise capacity and health status in noncystic fibrosis bronchiectasis patients?

Background/aim: Two different scoring systems were developed to determine the severity of bronchiectasis: FACED scoring and the bronchiectasis severity index (BSI). In this study, we aim to compare these 2 scoring systems according to the 6-min walking distance test and a disease-specific health status questionnaire in patients with noncystic fibrosis bronchiectasis (NCFB). Materials and methods: Smoking history, emergency and hospital admissions, and body mass index were obtained from NCFB patients admitted to our hospitals' pulmonary rehabilitation unit between 2013 and 2018. Detailed pulmonary function tests were performed for all participants. Dyspnea perceptions were determined according to the mMRC dyspnea scale. The 6-min walking test was used to determine exercise capacity. The Saint George respiratory questionnaire (SGRQ) was applied to determine health status. Both FACED and BSI scores were calculated for all participants. Results: There were a total of 183 participants, 153 of whom were men. A significant and strong correlation was found between FACED and BSI scores. As the severity of bronchiectasis increased, walking distance was significantly decreased and health status was significantly worse in both FACED and BSI scoring. A statistically significant but weak negative correlation was found between FACED score and walking distance. There was a significant negative correlation between BSI and walking distance, a stronger negative correlation than with FACED. Similarly, there was a significant negative correlation between health status and both FACED and BSI, but this correlation was stronger in the BSI score. Conclusions: Although both FACED and BSI scores were negatively correlated with walking distance and health status in patients with NCFB, BSI was more strongly associated.

The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients.

CLINICAL TRIAL NUMBER: NCT03319108.

The effect of obesity on dyspnea, exercise capacity, walk work and workload in patients with COPD.

INTRODUCTION: COPD and obesity are major public health problems that cause mortality and morbidity all over the world. The combined of COPD and obesity is predicted to increase further in the coming years. Obesity primarily affects the pulmonary system by altering respiratory functions, exercise capacity, pulmonary gas exchange, and endurance and power of respiratory muscles. In this study, we aimed to compare the dyspnea sensation, exercise capacity, walk work and workload in obese COPD patients compared to preobese and normal overweight COPD patients. MATERIALS AND METHODS: 218 patients with COPD were included in the study. According to the WHO criteria for body mass index (BMI), the patients were classified as normal-weight (BMI=18.5-24.9 kg/m2), pre-obese (BMI= 25-29.9 kg/m2) and obese (BMI= 30-39.9 kg/m2). All patient respiratory function tests and arterial blood gas analysis were performed. The mMRC dyspnea scale was used to assess the dyspnoea of the patients. The exercise capacities of the patients were determined by the 6-min walking test. Walk work and workload were calculated based on 6 minutes walking distance. The obtained values were compared between the three groups. RESULT: The FEV1/FVC ratio and TLCO value in pulmonary function tests are significantly higher in obese COPD patients than in other patients, while the VC value is significantly lower in patients with COPD (p= 0.001, p< 0.001, p= 0.01). Partial carbon dioxidewas significantly higher in obese COPD patients compared to other patients (p= 0.001). Dyspnea perceptions and walking distances did not differ significantly between groups. Walkwork and workload were significantly higher in obese COPD patients (p< 0.001, p= 0.005). CONCLUSIONS: Obesity causes partial changes in blood gas and pulmonary function tests of patients with COPD. At the same time, it increases walkwork and workload. Despite all these changes, it has no negative effect on dyspnea perception and exercise capacity.

[The effectiveness of smoking cessation program in a workplace with high risk]. / Yüksek riskli bir isyerinde sigara birakma girisim programinin etkinligi.

INTRODUCTION: Initiatives for smoking cessation (SC) at workplace have become more prominent due to both health and safety risks associated with smoking. We aimed to determine 6-month successful SC rates of a group of employees who participated in a SC program as they worked in a workplace that exhibited high risk of fire and explosion. MATERIALS AND METHODS: Having delivered a compulsory smoking training to the paint manufacturing department with 276 employees, we invited 147 smoker employees to participate in a SC initiative (SCI) program. The SCI program was implemented by the occupational health and safety (OHS) staff. Employees were administered a self-reported questionnaire including the age at starting smoking, number of cigarettes smoked (pack years), family members' attitudes towards smoking, reasons for smoking and harms of smoking. Nicotine addiction levels were assessed with Fagerström Nicotine Dependence Test (FNDT). RESULT: 276 employees (270 male and 6 female) had an average age of 36.8 ± 8.4 years. 144 active smokers presented an average age of 38.4 ± 6.9 and smoked on average 18.5 ± 12.8 pack/year. Active smokers started smoking at the age of 19.8 ± 4.9 on average. Their average score in FNDT was 6.6 ± 1.9 points. Fifty-one (35.4%) employees participated in the SCIs. The participants in the SCP training exhibited statistically significant differences with respect to the following parameters: chronic disease (p= 0.03), pack/year (p< 0.001), age at starting smoking (p= 0.001), attempted methods to SC (p= 0.002), average score in self-reported harms of smoking (p< 0.001), average FNDT score (p< 0.001), average score of self-reported smoking addiction (p= 0.001), and whether the smoker considers smoking a means of socialization (p≤ 0.001). After six months, we observed that 12 (23%) of the participants, and 4 (4%) of the non-participants employees quitted smoking (p< 0.001). CONCLUSIONS: In our study, participants in the SCI exhibited higher SC rates compared to the non-participants. Further studies are required to standardize such initiatives, which improve occupational health.

The impact of active and former smoking on the severity of obstructive sleep apnea.

PURPOSE: Although obstructive sleep apnea (OSA) syndrome is a common disorder; the connection between OSA and smoking habits is still controversial. In this study, we investigated whether active smoking and pack × years of smoking have an impact on the severity of the disease regarding the patients with OSA. METHODS: This study included 964 patients referred to the Sleep Disorders Clinic between 01.01.2007 and 01.03.2013 with an overnight polysomnographic diagnosis of OSA. The correlation between smoking habits and polysomnographic parameters has been studied in detail. RESULTS: There were 684 male (79 %) and 280 female (21 %) patients, 367 (50.6 %) of whom never smoked. Of all, 20.7 % of the smokers were current smokers (n = 150) while 28.2 % were former smokers (n = 208). Active smokers had a mean age of 49.53 (SD 10.17) while former smokers and never smokers had a mean age of 51.37 (SD 10.62), 54.2 (SD 11.56), respectively, which was statistically significant (p < 0.0001). There was a significant male predominance in smoking (p < 0.0001). In addition, male patients displayed more severe OSA than female patients. (p = 0.001). Desaturation time during sleep was found to be significantly longer in the group of former smokers in comparison to never smokers (73.84 SD 97.1-52 SD 85.8) (p = 0.005). Besides, as the apnea hypopnea index increased, the mean pack × years rose significantly (p = 0.01). Severe smokers compared to mild smokers had higher AHI, lower NREM 3, higher NREM1-2 stages (p = 0. 017, p = 0.007, p < 0.001). CONCLUSION: In this study, we found that cigarette smoking was associated with early age disease; heavy smokers had more severe OSA.

Assessing the effectiveness of the COPD Assessment Test (CAT) to evaluate COPD severity and exacerbation rates.

AIMS: The CAT is a short, simple eight-item questionnaire for assessing and monitoring COPD. It is not known how reliable the CAT scores are for COPD patients who are frequently exacerbated. The effectiveness of the CAT for assessing COPD severity and exacerbation rates was evaluated. METHODS: This study enrolled 165 stable COPD patients who completed the CAT between April 2011 and February 2012. RESULTS: Patients had a mean forced expiratory volume in one second (FEV1) equal to 43.7% of the predicted value and a mean CAT score of 21.2 (± 7.56) units. There was a good association between the FEV1 (percentage of predicted value) and CAT scores (p < 0.0001). Frequent exacerbators had significantly higher CAT scores than infrequent exacerbators (24.8 ± 6.7 versus 17.5 ± 6.5, p < 0.0001). Also, as the frequency of the COPD exacerbations increased, CAT scores (p < 0.0001) significantly increased. There was a significant association between the frequency of hospitalization and the CAT scores (p = 0.001). CONCLUSIONS: We observed a good relation between the CAT, FEV 1, and disease severity in patients with COPD. We found that the baseline CAT scores are elevated in frequent exacerbators.

The incidence of chronic thromboembolic pulmonary hypertension secondary to acute pulmonary thromboembolism.

INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a curable and partially preventable complication, with a substantial incidence, leading to severe morbidity and mortality. The aim of the present study was to find out the incidence of CTEPH secondary to acute pulmonary thromboembolism (PTE) using non-invasive procedures such as ventilation/perfusion (V/Q) scintigraphy and pulmonary multidetector CT (MDCT) angiography in determining the diagnosis of CTEPH. MATERIALS AND METHODS: The study included a total of 99 patients diagnosed with initial PTE between January 2010 and December 2012. The patients who received anticoagulant therapy at least for three months underwent transthoracic echocardiography (TTE) (n= 85). Thirty one patients with a SPAP value > 30 mmHg and/or an evidence of right ventricular dysfunction in TTE underwent MDCT pulmonary angiography and V/Q scintigraphy. The patients with an evidence of residual chronic thromboembolic signs in MDCT pulmonary angiography and/or segmental perfusion defect(s) in V/Q scintigraphy underwent right heart catheterization (RHC) (n= 7). The mean PAP was measured, and a vasoreactivity test was performed. During RHC, a non-contrast medium was delivered to the pulmonary arteries for pulmonary arteriography imaging. RESULTS: Among patients diagnosed with PTE, 44 were male and 55 were female. The mean age was 60 ± 17 years. Of these patients, 63.6% had history of at least one additional disease and at least one risk factor for PTE. During diagnosis, 24 subjects were considered having massive, 61 submassive and 14 non-massive PTE. Nineteen (19.1%) patients received thrombolythic therapy. Other 80 (80.8%) patients received standard anticoagulant therapy with an INR value within the therapeutic range. In 79.8% of patients, thromboembolism was bilateral, and it was unilateral in 21.8%. After a minimum of 1 year, and maximum of 2 years follow up five subjects (5.5%) were diagnosed with CTEPH. The univariate analysis showed no association between the development of CTEPH and factors like; age, etiologic risk factors for PTE, receiving thrombolytic treatment, prevalence and type of PTE. CONCLUSION: Potentially preventabl complication of pulmonary embolism; CTEPH, had a substantial incidence during follow-up.

Factors Associated with Increasing Costs in Severe Chronic Obstructive Pulmonary Disease Exacerbation: Turkish Thoracic Society Chronic Obstructive Pulmonary Disease Assembly.

Chronic obstructive pulmonary disease (COPD) that is the third leading cause of death in the world is one of the main economic burden. The cost is primarily due to COPD exacerbations and hospitalizations. We aimed to determine the factors associated with increasing costs in severe COPD exacerbation. It was a multicenter and prospective observational recording study. 294 patients who severe COPD exacerbation were included in the study. An amount of more than 429.58 euros was accepted as increasing costs (IC). Factors associated with IC were determined by regression analysis. Mean age was 69.90 ± 9.79/years (minimum: 40 maximum: 95), mean costs were 594.9 ± 70.9 euros. About 83.7% of the patients were male, 24.1% (71) were active smokers, and 81% (238) had at least 1 comorbidity. Factors associated with IC in the regression analysis were delay of discharge (due to prolonged consultation), antibiotic use longer than 7 days, need to enteral/parenteral feeding, application of pulmonary rehabilitation (physiotherapy) at hospitalization, and refusal to be discharged. The increasing costs in severe COPD exacerbation depends not only treatment but also the patient's social status and hospital-related factors. We think that the cost of severe COPD exacerbation can be reduced by interventions on interchangeable factors such as patient's social status and hospital-related factors.

Treatment Results of Multidrug-Resistant Tuberculosis Patients in the Aegean Region.

OBJECTIVE: We aimed to evaluate 109 rifampicin-resistant or multidrug-resistant tuberculosis patients who are treated in Izmir Chest Diseases MDR Tuberculosis Centre. MATERIAL AND METHODS: The patient profile, side effects, treatment success, and mortality of rifampicin-resistant or multidrugresistant tuberculosis patients who were followed up and treated in our hospital's tuberculosis service between 2010 and 2018 were analyzed retrospectively. RESULTS: Of the rifampicin-resistant or multidrug-resistant tuberculosis patients, 83 (76.1%) were male and the mean age was 46.3 ± 16.3 years. Of the cases 13 (11.9%) had rifampicin resistance without isoniazid. Since 5 out of 109 patients diagnosed with multidrugresistant tuberculosis emigrated to other countries, the treatment results of 104 patients were evaluated. As a result of the treatment, the cure was achieved in 81 (77.9%) patients and treatment was completed in 13 (12.5%). Treatment success was found as 90.4%. No patient experienced recurrence. The mortality rate was determined as 9.6%. The cure rate of patients treated with ≥6 drugs (90.9%) was statistically significantly (P = .029) higher than the group treated with ≤5 drugs (71.8%). CONCLUSIONS: Multidrug-resistant tuberculosis treatment is a long-term, financially burdensome practice that may cause serious side effects and complications, and it requires strict discipline. The fight against tuberculosis can be successful with tuberculosis control programs that are pursued with determination.

The frequency and significance of radiologically detected indeterminate pulmonary nodules in patients with colorectal cancer.

OBJECTIVE: To investigate the frequency and significance of pulmonary nodules in patients with colorectal cancer (CRC). SUBJECTS AND METHODS: Medical records of 1,344 patients with CRC who underwent thoracic computerized tomography scans between January 2003 and December 2009 were reviewed. Those with any distant metastatic disease or who were already known to have pulmonary malignancies were excluded. Number, size, shape and location of the nodules were evaluated. A multivariate analysis was performed to determine the predictive factors for evidence of metastases. RESULTS: Of the 1,344 patients, 55 (4.09%) had nodules that met the criteria of an indeterminate pulmonary nodule. The mean follow-up time was 25 ± 17.9 months and the mean time to develop pulmonary metastasis was 15.5 ± 6.4 months. The nodules of 17 (30.9%) patients showed progression at follow-up; 8 had metastasized. Multivariate analysis showed multiple indeterminate pulmonary nodules (p = 0.006) of parenchymal localization (p = 0.016) with an irregular border (p = 0.002), which is predictive of metastatic disease. CONCLUSION: Our study has shown that multiple indeterminate pulmonary nodules with an irregular border in a parenchymal location were more likely to represent metastatic disease. However, the frequency of the occurrence of indeterminate pulmonary metastases of CRC was low.

A cross sectional observational study on the influence of chronic obstructive pulmonary disease on activities of daily living: the COPD-Life study.

INTRODUCTION: This study was designed to identify the impact of chronic obstructive pulmonary disease (COPD) on activities of daily living, life styles and needs in patients. PATIENTS AND METHODS: Participants of this national, multi-centered, cross-sectional observational study included 497 stable COPD patients from 41 centers. The mean age (standard deviation; SD) was 63.3 (9.3) years with 59.0% of the patients under the age of 65, and 89.9% of the participants were male. Sociodemographic and COPD-related data were gathered at enrollment and during the 1-month telephone follow-up. RESULTS: The mean (SD) COPD duration was 7.3 (6.5) years in the overall population while 5.4 (4.6) years for patients who recieved COPD diagnosis at least one year after the onset of symptoms. Dyspnea was the most common (83.1%) symptom and walking up stairs (66.6%) was the most difficult activity to be performed. Majority of the patients were aware of COPD as a chronic disease (63.4%), requiring ongoing treatment (79.7%), mainly caused by smoking (63.5%). 59% of the patients were under the age of 65 years-old. In 84% of patients, graduation from at least a primary school was identified. Results revealed an average number of two dependants that were obliged to look after per patient, ability to go on an outing in 91% of the patients, and going grocery shopping with ease in more than two-thirds of the study population. There was no significant difference in regular use of medication device across different educational or age groups. The top three COPD treatment expectations of the patients were being able to breathe (24.1%), walking (17.1%), and walking up stairs (11.7%), while shortness of breath (43.3%) was the first priority treatment need. CONCLUSION: In contrast to the common view that COPD prevalance is higher in old age population, this study showed that the rate of the disease is higher among younger patients than expected; indispensability of out of the house activities in majority of patients; and use of regular medication device to be independent of educational level and the age of COPD patients. Our findings indicate that the likelihood of COPD patient population to be composed of younger and active individuals who do not spend majority of their time at home/in bed as opposed to popular belief. Therefore, availability of a portable and easy to use device for medication seems to be important to enhance daily living.

Attitude and Practice Toward Use of Cigarettes and Electronic Cigarettes Among Pregnant Women: A Questionnaire-Based Survey.

OBJECTIVE: This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. MATERIAL AND METHODS: A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. RESULTS: Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001). CONCLUSION: Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

2021 Guideline for the Management of COPD Exacerbations: Emergency Medicine Association of Turkey (EMAT) / Turkish Thoracic Society (TTS) Clinical Practice Guideline Task Force.

Chronic obstructive pulmonary disease (COPD) is an important public health problem that manifests with exacerbations and causes serious mortality and morbidity in both developed and developing countries. COPD exacerbations usually present to emergency departments, where these patients are diagnosed and treated. Therefore, the Emergency Medicine Association of Turkey and the Turkish Thoracic Society jointly wanted to implement a guideline that evaluates the management of COPD exacerbations according to the current literature and provides evidence-based recommendations. In the management of COPD exacerbations, we aim to support the decision-making process of clinicians dealing with these patients in the emergency setting.

Inappropriate Utilization of Antibiotics in COPD Exacerbations.

OBJECTIVE: Most exacerbations are mild to moderate, and antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is recommended for patients with severe exacerbations or severe underlying chronic obstructive pulmonary disease (COPD). Therefore, we aimed to investigate the patient factors that are associated with the prescription of antibiotics for inappropriate indication in AECOPD. MATERIAL AND METHODS: This study was an observational cross-sectional study conducted in an outpatient clinic. The patients diagnosed with AECOPD and prescribed an antibiotic by a pulmonary physician were enrolled in the study. These prescriptions were documented by the pharmacist who asked the patient about the three cardinal symptoms. Appropriate and inappropriate prescription groups were defined by the types of exacerbations, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD report. RESULTS: There were 138 patients, predominantly male (83%), with a mean age of 64 (±9) years. A total of 64% of the prescriptions were appropriate; however, there were 50 (36%) patients with inappropriate antibiotic prescription according to the mentioned criteria. When we compared the patient factors between the appropriate and inappropriate antibiotic prescriptions, there was no statistically significant difference in terms of age, Forced expiratory volume in first second % (FEV1%) predicted, FEV1 ml, forced vital capacity (FVC) ml, FEV1/FVC, and amount (packs/year) of smoking (p>0.05 for all parameters). FVC% was statistically significantly lower in the appropriate antibiotic prescription group compared with that in the inappropriate antibiotic prescription group (p=0.049). CONCLUSION: This study shows that most pulmonary physicians have a tendency to prescribe antibiotics for AECOPD according to the defined GOLD criteria. However, some of the physicians also prefer to prescribe antibiotics self-directedly, irrespective of the GOLD criteria. A physician-based questionnaire can be completed for future studies to define the underlying reasons for antibiotic prescription demands for cases of mild AECOPD.