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INTRODUCTION: The goals of chronic obstructive pulmonary disease (COPD) treatment are to relieve dyspnea, increase exercise capacity, and improve quality of life. The relation of exercise capacity, dyspnea level, and quality of life with long-term mortality is unclear. Aim of the study was to assess the effect of exercise capacity, dyspnea level and quality of life on long-term mortality risk in patients with COPD. MATERIALS AND METHODS: Dyspnea level was assessed using the modified Medical Research Council (mMRC), Borg and Baseline Dyspnea Index (BDI) and Body Obstruction Dyspnea Exercise (BODE), health-related quality of life with St. George's Respiratory Questionnaire, and exercise capacity with the 6-minute walking test (6MWT) and cardiopulmonary exercise test. At the end of 8-year follow-up period, the relation between these tests and mortality was examined. RESULT: A total of 42 patients with stable COPD were included in the study. Sixteen patients died during the approximately 8-year follow-up period. Univariate analysis revealed that VO2 peak [HR: 1.845; CI: (1.336-2.55); p<0.001], BODE index [HR: 0.787; CI: (0.703-0.880); p<0.001], and SGRQ [HR: 1.073; CI: (1.028-1.119); p= 0.001] were significantly correlated to mortality risk. Multivariate Cox regression analysis revealed VO2 peak [HR: 1.031; CI: (0.683-1.120); p= 0.01] as the single significant predictor of mortality. VO2 peak less than 22.5 had a sensitivity of 82%, specificity of 80%, and area under the curve of 0.142 [95% CI: (0.027-0.257); p< 0.001] for mortality risk with ROC analysis. CONCLUSIONS: Cardiopulmonary disturbances during maximal exercise may be an important indicator of mortality risk.
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Disnea/fisiopatología , Tolerancia al Ejercicio/fisiología , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Calidad de Vida , Anciano , Análisis de Varianza , Ejercicio Físico , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Curva ROC , Sensibilidad y Especificidad , Encuestas y CuestionariosRESUMEN
The application quality of pulmonary function tests (PFT) carries high importance since it affects the quality of health services. "Chronic Diseases and Risk Factors in Turkey Study," which was published in 2013 showed that only 22.6% of PFTs performed in the secondary care institutions in our country were compatible with the standards. This finding reveals the standardization problem in spirometry applications in our country. Currently, the criteria for the application and evaluation of spirometer measurements were defined by American and European Respiratory Societies standards. Several laboratories use these standards in our country as in the world. But, national laboratory standards that are suitable for the conditions in our country have not been defined yet. This report was prepared to ensure the application of spirometry in optimal conditions, to minimize intra-laboratory and inter-laboratory differences and mistakes, and to standardize in our country. In this report, we focused on the standards concerning laboratory conditions, equipment, and technician specifications, test application, evaluation of test quality, infection control, and reference values.
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Laboratorios/normas , Pruebas de Función Respiratoria/normas , Sociedades Médicas/normas , Espirometría/normas , Humanos , TurquíaRESUMEN
Asthma and chronic obstructive pulmonary disease (COPD) are common lung diseases characterized by chronic airway inflammation and airway obstruction. Among patient with COPD and asthma; there is a group of patients with an overlap between clinical, functional characteristics and airway inflammation patterns, named "Asthma-COPD Overlap Syndrome" (ACOS). ACOS is a syndrome characterized by reversible but persistant airflow limitation (postbronchodilator FEV1/FVC < 70%) which has some features of both asthma and COPD. ACOS should be suspected in a patient > 40 years, with smoking history, previous asthma diagnosis or history of childhood asthma who has persistant airflow limitation and reversible ariway obstruction (defined by an increase of > %12 of FEV1 pred or increase of FEV1 > 200 mL after inhalation of 400 mcg salbutamol or 1000 mcg terbutaline). The prevalence for ACOS has been reported 11-55% in different case series to date and increases by age and is more frequent in females in different age groups. Patients with ACOS are younger than COPD patients and older than asthma patients. Frequent and severe exacerbations and related hospitalization and emergency room visits are common in ACOS and this causes an impaired quality of life. Current recommendations of guidelines for pharmacologic treatment of ACOS have been composed of a combination with optimal COPD and asthma treatment. Future therapeutic approaches should be based on endotypes. Clinical phenotype and underlying endotype driven clinical studies may be the base of ACOS guidelines.
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Asma/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto , Anciano , Albuterol/uso terapéutico , Asma/tratamiento farmacológico , Comorbilidad , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Calidad de Vida , Factores de Riesgo , SíndromeRESUMEN
Chronic obstructive pulmonary disease (COPD) and asthma are airway diseases with acute exacerbations. Natural course of both disease are affected by exacerbations. COPD exacerbations may be caused by infections and other causes; indoor and outdoor pollution, cardiovascular diseases, asthma-COPD overlap syndrome, COPD- obstructive sleep apnea syndrome, pulmonary embolism, gastro-oesophageal reflux, anxiety-depression, pulmonary hypertension. Exposure to triggering factors, viral infections, treatment insufficiency may cause asthma exacerbations. Smoking cessations, prevention of infections, long-acting anticholinergics, long-acting ï¢2 agonists, inhaled corticosteroids, phosphodiesterase-4 inhibitors, mucolytics, prophilactic antibiotics can be effective on the prevention of COPD exacerbations. Asthma exacerbations may be decreased by the avoidance of allergens, viral infections, occupational exposures, airpollution, treatment of comorbid diseases. Effective treatment of asthma is required to prevent asthma exacerbations. Inhaled steroids and combined treatments are the most effective preventive therapy for exacerbations. Patient education and cooperation is an element of the preventive measures for asthma attacks. Compliance to therapy, inhalation techniques, written asthma plans are required. The essential of COPD and asthma exacerbation treatment is bronchodilator therapy. Steroids are also implemented to the therapy, targeting the inflammation. Specific treatments of the cause (infection, airpollution, pulmonary embolism etc.) should be administered.
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Asma/patología , Progresión de la Enfermedad , Enfermedad Pulmonar Obstructiva Crónica/patología , Administración por Inhalación , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Expectorantes/uso terapéutico , Humanos , Inflamación/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológicoRESUMEN
INTRODUCTION: This study aimed to determine the relationship of 6 minute walking test (6MWT) and cardiopulmonary exercise test (CPET) with each other and with the measures of lung functions in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Pulmonary function tests, 6MWT, and CPET were performed in 36 (35 males, 1 female) patients with moderate and severe COPD. RESULTS: Maximum oxygen uptake was significantly correlated with 6 minute walking distance. Both exercise tests were correlated with pulmonary function tests. However, maximum exercise capacity was more closely correlated with measures of lung function than 6MWT. Both tests were significantly correlated with static lung volumes. Inspiratory capacity (IC) was significantly correlated with 6MWT and CPET parameters. CPET was significantly correlated with diffusion capacity and maximal inspiratory pressure. Airway conductance and resistance tests showed no correlation with the exercise tests. CONCLUSION: 6MWT is a simple and valuable test to determine the exercise capacity of COPD patients. Both 6MWT and CPET are correlated with ventilatory impairment determined by the lung function tests, particularly FEV1, maximum voluntary ventilation (MVV), and IC. However, CPET is an exercise test that more accurately evaluates and provides more detailed information about hyperinflation and respiratory musce strength than 6MWT does.
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Prueba de Esfuerzo , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Ejercicio Físico , Tolerancia al Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pruebas de Función Respiratoria , CaminataRESUMEN
Severe asthmatics account 10% of the all asthmatic population. Those asthmatics whose disease is inadequately controlled account for up to half of the cost for asthma, because they have more emergency room visits, more hospital admission and greater absenteeism from work. New therapeutic options were tried in those patients whose asthma was uncontrolled with standart high dose inhaled corticosteroid and long acting beta-2 agonsit combination therapy. In this paper taking into account the conditions of our country, current literature was reviewed and treatment options was discussed and graded recommendations are made for daily clinical practice in patients with severe treatment-refractory asthma.
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Corticoesteroides/uso terapéutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Corticoesteroides/administración & dosificación , Asma/fisiopatología , Quimioterapia Combinada , Servicio de Urgencia en Hospital , Testimonio de Experto , Hospitalización , Humanos , Índice de Severidad de la EnfermedadRESUMEN
Introduction: Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) have a greater disease burden than those with COPD or asthma alone. In this study, it was aimed to determine the prevalence, risk factors, and clinical features of ACO because there are limited national data in Türkiye. Materials and Methods: The study was conducted in a cross-sectional design in nine tertiary-care hospitals. The patients followed with a diagnosis of asthma or COPD for at least one year were enrolled in the study. The frequency of ACO and the characteristics of the patients were evaluated in the asthma and COPD groups. Result: The study included 408 subjects (F/M= 205/203, mean age= 56.24 ± 11.85 years). The overall prevalence of ACO in both groups was 20.8% (n= 85). The frequency was higher in the COPD group than in the asthma group (n= 55; 33.3% vs. n= 22; 9.8%), respectively (p= 0.001). Patients with ACO had similarities to patients with COPD in terms of advanced age, sex, smoking, exposure to biomass during childhood, being born in rural areas, and radiologic features. Characteristics such as a history of childhood asthma and allergic rhinitis, presence of chronic sinusitis, NSAID hypersensitivity, atopy, and high eosinophil counts were similar to those of patients with asthma (p<0.001). The annual decline in FEV1 was more prominent in the ACO group (mean= -250 mL) than in the asthma (mean change= -60 mL) and COPD (mean change= -230 mL) groups (p= 0.003). Conclusions: This study showed that ACO was common among patients with asthma and COPD in tertiary care clinics in our country. ACO should be considered in patients with asthma and COPD who exhibit the abovementioned symptoms.
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Síndrome de Superposición de la Enfermedad Pulmonar Obstructiva Crónica-Asmática , Humanos , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Anciano , Turquía/epidemiología , Adulto , Síndrome de Superposición de la Enfermedad Pulmonar Obstructiva Crónica-Asmática/epidemiología , Asma/epidemiología , Asma/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiologíaRESUMEN
The social patterns of smoking have changed significantly in the past two decades but smoking is still as prevalent in the lowest socioeconomic groups as it was widespread. For the solution of this enormous problem many kinds of treatment modalities have been proposed but there is no single successful method for quitting. To determine the smoking cessation rates with behavioural treatment, behavioural + pharmacological treatments and compare the differences between each approaches. 371 smokers were prospectively evaluated between 2004 and 2008. At the beginning subjects were classified into two groups: behavioral treatment group (I) and pharmacological + behavioural treatment group (II). Numbers of patients per group were 88 and 283 respectively. According to pharmacological therapy group II was also divided into three subgroups: nicotine replacement treatment (NRT) (regardless of the type and dosage) (IIa), bupropion (IIb) and combination treatment modalities group (IIc). Numbers of patients per subgroups were 185, 70 and 28 respectively. All of the patients were attended the one year follow up visits. According to the baseline characteristics there was no significant difference between the groups and subgroups. At the end of the fist year, in group I smoking cessation rate was 41% and in group II 51% and this was not statistically significant (p< 0.05). In the sub group analysis the success rates for group IIa, IIb and IIc; 44.8%, 62.8% and 64% respectively and bupropion is significantly superior to the NRT (p= 0.01). In study subjects, smoking cessation rates were less with comorbid diseases (p= 0.004), baseline airway obstruction (p= 0.04) and high CO levels (p= 0.008). Results of this analysis confirm that, there is a significant difference between pharmacological treatment and behavioral treatments. Additionally, in the pharmacological approaches, bupropion seems to be superior. Besides, comorbid conditions have been a huge problem to solve.
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Bupropión/uso terapéutico , Nicotina/uso terapéutico , Psicoterapia de Grupo , Cese del Hábito de Fumar/métodos , Tabaquismo/terapia , Adulto , Terapia Combinada , Femenino , Humanos , Masculino , Nicotina/administración & dosificación , Resultado del TratamientoRESUMEN
The recommendation of conducting pulmonary function tests (PFTs) from different societies during and after the coronavirus disease (COVID-19) pandemic was rated by the experts of the Turkish Thoracic Society (TTS) and presented as the TTS experts consensus report. Information about the topic has been provided.Globally, as of mid-May 2020, there have been over 4.4 million confirmed cases of COVID-19. There are two main routes of transmission of COVID-19: respiratory droplets and contact transmission. PFTs are non-invasive tests that are commonly performed in routine assessment and follow-up of patients in the pulmonology units. However, PFTs may generate aerosols and require sharing common surfaces. With regard to the high prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community, PFTs should not be performed routinely in confirmed or suspected patients with COVID-19 during the pandemic. Because of the risk of human-to-human transmission of COVID-19, PFTs should be restricted to a small patient population with selected indications. Triage for COVID-19 should be performed prior to testing. Only essential PFTs such as spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), arterial blood gas analysis, or pulse oximetry should be performed in the selected cases. Tests should be scheduled to allow sufficient time for donning and doffing of the technical personnel with the full personal protective equipment (PPE) (gown, a filtering respirator mask, goggles or full-face shield, and disposable gloves), ventilation of the room, and application of post-test cleaning and disinfection procedures of the equipment and the testing room.
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BACKGROUND: Data on the use and efficacy of complementary and alternative medicine (CAM) in patients with asthma are limited, and there is a lack of studies documenting the use of CAM in patients with chronic obstructive pulmonary disease (COPD) in Turkey. AIM: To determine the prevalence of CAM usage in patients with asthma and COPD and to assess the clinical and demographic factors associated with the use of CAM. MATERIALS AND METHODS: A total of 521 patients (313 with asthma and 208 with COPD) were randomly enrolled into this cross-sectional survey. A face-to-face interview was conducted using a structured questionnaire. RESULTS: One hundred sixty-three patients (52%) with asthma and 70 patients (33%) with COPD were reported to be using some form of CAM (p < 0.001). The most popular modalities were herbal remedies (46% and 28% in the two groups, respectively) and animal products (28% and 5% in the two groups, respectively). CAM-practicing asthma patients were typically younger with longer duration of disease and higher income than the CAM-practicing COPD patients. For the patients, the main source of information on CAM practices was their relatives and friends. Only a small number of the patients consulted with their physicians about CAM. The main reasons to use CAM for patients with asthma and COPD were harmlessness and symptomatic relief, respectively. CAM-related adverse effects and difficulties to obtain CAM were significantly higher in patients with asthma than in patients with COPD. CONCLUSION: There is a high prevalence of CAM usage in patients with asthma and COPD in Turkey. Hence, becoming familiar with CAM therapy and inquiring about patient practice of CAM as part of the routine medical history will allow the physicians to provide reliable information to their patients on these medical practices.
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Asma/terapia , Terapias Complementarias/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Anciano , Información de Salud al Consumidor , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , TurquíaRESUMEN
Pulmonary computed tomography angiography (PCTA) is the initial imaging test for the diagnosis of pulmonary thromboembolism (PTE). In the study, it was aimed to determine the clinical, radiological findings in patients diagnosed PTE by PCTA, to investigate the relationship between the thrombus localisation and the clinical, laboratory parameters. 172 patients diagnosed PTE by PCTA between 2004 and 2007 were included in the study. The clinical, laboratory parameters, thrombus localisation were evaluated. Mean age (female/male: 99/73) was 58.27 +/- 15.11, mean Wells score was 2.99 +/- 2.40. 39.5% (n= 68) of patients had low risk, 50.6% (n= 87) intermediate, 9.9% (n= 17) high risk. The most common comorbidities were cardiovascular diseases (n= 46, 26.7%), COPD (n= 26,15%). Recent operation history (n= 47, 27.3%), immobilisation (n= 37, 21.5%) were the most frequent risk factors. Dyspnea (89%), chest pain (59.9%) were the most common complaints. Deep venous thrombosis was detected by Doppler USG in 56.4% of patients. The most common site of thrombus was the right lower lobe artery (44.2%). In 30% of patients, the most proximal level of thrombus was the main pulmonary arteries (MPA). Mean age of patients with MPA thrombus (61.96 +/- 14.47), was higher than patients with distal thrombus (56.62 +/- 15.16, p= 0.03). Patients with the recent operation history (41% vs. 21%, p= 0.009), cancer (24% vs. 2.5%, p< 0.001) had higher rates of MPA thrombus. In patients presented with syncope,16.9% of them had a MPA thrombus compared to others having 3.3% rate of other thrombus localisations (p= 0.004). Mean Wells score in patients with MPA thrombus was higher compared to others (3.59 +/- 2.38/2.72 +/- 2.37, p= 0.02), however it didn't differ the extent of proximal thrombus between low, intermediate and high risk patients. The mean level of D-dimer was not different between patients with MPA thrombus and the others. D-dimer level was significantly higher in patients with thrombus localized at truncus pulmonalis (1357 microg/mL vs. 724 microg/mL). There was no significant difference between Doppler USG positive and negative patients for DVT. In conclusion, it was determined that the thrombus was at MPA in one third of the patients, a significant relationship between the presence of the recent operation, cancer history and syncope with MPA thrombus. In patients with a thrombus at truncus pulmonalis, D-dimer levels were higher.
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Angiografía , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Antifibrinolíticos/análisis , Enfermedades Cardiovasculares/complicaciones , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/patología , Medición de Riesgo , Factores de Riesgo , Ultrasonografía Doppler en Color , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/patologíaRESUMEN
PURPOSE: Combined pulmonary fibrosis and emphysema (CPFE) has emerged as a new syndrome with characteristics of both fibrosis and emphysema. We determined the impacts of radiologic emphysema severity on pulmonary function tests (PFTs), exercise capacity and mortality. PATIENTS AND METHODS: IPF patients (n = 110) diagnosed at the Chest Diseases Clinic between September 2013 and January 2016 were enrolled in the study and followed up until June 2017. Visual and digital emphysema scores, PFTs, pulmonary artery pressure (sPAP), 6-minute walking test, composite physiologic index (CPI), and survival status were recorded. Patients with emphysema and those with pure IPF were compared. RESULTS: The CPFE-group had a significantly greater ratio of men(p < 0.001), lower BMI (p < 0.001), lower mean PaO2 (p = 0.005), higher mean sPAP (p = 0.014), and higher exercise desaturation (p < 0.001). The CPFE group had a significantly higher FVC(L)(p = 0.016), and lower FEV1/FVC ratio (p = 0.002), DLCO, and DLCO/VA ratio(p = 0.03 and p = 0.005, respectively). Lung volumes of the CPFE group had significantly higher VC(p = 0.017), FRC (p < 0.001), RV(p < 0.001), RV/TLC(p < 0.001), and TLC(p < 0.001). There were significant correlations between emphysema scores and FVC (L)(p = 0.01), FEV1/FVC(p = 0.001), DLCO (p = 0.003), VC(p = 0.014), FRC (L)(p < 0.001), RV(p < 0.001), TLC(p < 0.001), and RV/TLC (p < 0.001). Mortality rates were comparable between the two groups. CPI (p = 0.02) and sPAP (p = 0.01) were independent predictors of mortality in patients with CPFE. CONCLUSIONS: The presence and severity of emphysema affects pulmonary function in IPF. Patients with CPFE have reduced diffusion capacity, more severe air trapping, worse muscle weakness, more severe exercise desaturation, and pulmonary hypertension. CPI and pulmonary hypertension are two independent risk factors for mortality in subjects with CPFE.
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Enfisema Pulmonar/mortalidad , Enfisema Pulmonar/patología , Fibrosis Pulmonar/mortalidad , Fibrosis Pulmonar/patología , Anciano , Ecocardiografía , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Enfisema Pulmonar/metabolismo , Fibrosis Pulmonar/metabolismo , Pruebas de Función Respiratoria , Factores de RiesgoRESUMEN
ÖZET: Günümüzde spirometre ölçümlerinin uygulama ve yorumlama nitelik güvencesi "American Thoracic Society / European Respiratory Society" standartlari ile belirlenmistir. Dünyada oldugu gibi ülkemizde de birçok laboratuvar bu standartlari kullanmaktadir. Buna karsin, farkli laboratuvarlardan farkli degerlendirme sonuçlari görebilmek mümkündür. Bu rapor, ülkemizdeki solunum fonksiyon testi laboratuvarlarinda yapilan degerlendirmelerin standardizasyonunu saglamak amaci ile hazirlanmistir.
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INTRODUCTION: In 2017 update, GOLD separated spirometry from ABCD classification. OBJECTIVES: The aim was to investigate the predictive reliability of GOLD 2017 grading system in terms of future moderate and severe exacerbations. METHODS: COPD patients were classified into A to D groups according to GOLD 2011 and 2017. Patients who were assigned to C/D groups according to GOLD 2011 were divided into subgroups C 1/D1, C2/D2, C3/D3 according to FEV1 % of predicted and exacerbation history. C1/D1 patients defined as FEV1 < 50% predicted and without ≥2 exacerbations or hospitalization in the last year. RESULTS: A total of 225 patients were enrolled. Among them, 25.8% were in groups C1/D1 according to GOLD 2011. These patients shifted to A/B according to GOLD 2017. C1/D1 patients had a significantly higher risk of future moderate and severe exacerbation compared to A/B (P = 0.018). The risk of future moderate and severe exacerbation was significantly higher in patients with a FEV1 < 50% (P = 0.018).The risk of future moderate and severe exacerbation was higher in GOLD 2017 groups A and B compared to GOLD 2011 groups A and B. CONCLUSION: Low FEV1 was an important risk factor for future exacerbations. Downstaging of C1/D1 patients caused heterogeneity in A/B with including patients with low and high risk of future exacerbation. This resulted in a low discriminative power of GOLD 2017 regarding the risk of future exacerbation in groups A and B. This may cause underestimation of disease severity and inadequate treatment especially in A/B patients with low FEV1 .
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Volumen Espiratorio Forzado/fisiología , Enfermedad Pulmonar Obstructiva Crónica/clasificación , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Anciano , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Bronchiectasis is a common disabling but rarely fatal disease. However the long-term prognosis and risk factors for mortality are not well known. OBJECTIVE: The aim of this study was to determine prospectively the survival and predictive factors of mortality in patients with bronchiectasis, during 4-year follow-up. PATIENTS AND METHODS: From September 2000 to January 2005 survival of bronchiectasis (as evaluated by computed tomography) and predictors of mortality were assessed in 98 outpatients. Fifty-one of the patients had self-reported history of pulmonary infection including tuberculosis. Baseline data, reevaluated in every single year according to scheduled visits. RESULTS: The mean age was 61+/-10 and 74% of the patients were female. In total, 16 patients (16.3%) died; mean survival time was 44.06+/-1.6 months. The survival rates were 97%, 89%, 76%, 58% at 1, 2, 3 and 4 years, respectively. Cox proportional hazard model revealed that long-term mortality was significantly associated with age, body mass index (BMI), Medical Research Council (MRC) dyspnea scale, vaccination, radiographic extent, hypoxemia, hypercapnia and functional parameters. However, MRC and BMI had more significant effects on the mortality than the functional parameters. CONCLUSIONS: These results suggest that high BMI, regular vaccination and scheduled visits may have beneficial effects on the survival of bronchiectasis. Besides, presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent were more closely correlated with mortality.
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Bronquiectasia/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Bronquiectasia/complicaciones , Bronquiectasia/fisiopatología , Dióxido de Carbono/sangre , Métodos Epidemiológicos , Femenino , Humanos , Hipercapnia/etiología , Hipoxia/etiología , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Presión Parcial , Pronóstico , Mecánica Respiratoria , Turquía/epidemiología , Vacunación/estadística & datos numéricosRESUMEN
OBJECTIVE: To analyze the factors affecting survival of patients with chronic obstructive pulmonary disease (COPD) during the follow-up period using a 4-year prospective study. METHODS: The study included 276 out-patients with COPD. The study took place in Ankara University, Cebeci Hospital, Ankara, Turkey between September 2000 and January 2005. We used cox proportional hazards model in investigating the effects of clinical variables on survival. Risk factors related with mortality were analyzed. RESULTS: Forty-nine patients (17.8%) died and the mean survival time was 43.40 +/- 0.65 months. The survival rates were 97% at one year, 89% at 2 years, 84% at 3 years, and 73% at 4 years. Cox proportional hazard model revealed that long-term mortality was significantly associated with age (relative risks [RR]: 1.13, 95% confidence interval: 1.09-1.17), the level of dyspnea (RR: 1.99, 95% confidence interval: 1.44-2.74), the number of hospital admission for acute exacerbation of COPD (RR: 1.33, 95% CI: 1.07-1.67) and the number of scheduled physician visits (RR: 0.75, 95% CI: 0.58-0.95). Also, the presence of hypoxemia was correlated with survival of COPD patients (RR: 0.99, 95% CI: 95-1.00). CONCLUSION: Patient's age, level of dyspnea, hypoxemia and the number of hospital admission were more closely correlated with mortality in COPD. The regular follow-up patients increased the survival of this disease. According to this study patients with COPD may be followed in the specialized out-patient COPD clinics to decrease their morbidity and mortality rates.
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Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Factores de Riesgo , Tasa de Supervivencia , Factores de TiempoRESUMEN
The effects of anticholinergic agents or long acting beta(2)-agonists on exercise capacity in chronic obstructive pulmonary disease (COPD) improves various out come measures but there is not enough double-blind study which included comparison of different medications. The aim of this study was to compare the effect of ipratropium bromide and formoterol on exercise capacity and also to determine the relationship between this improvement in functional parameters and exercise capacity for each treatment in patients with COPD. This study was performed as randomized, double blind and two period crossover design. Ten volunteer stable COPD patients were recruited from outpatient COPD clinic. At the initial visit medical data were recorded. One week later baseline measurements; pulmonary function tests and cardiopulmonary exercise testing were performed, afterwards, patients received ipratropium bromide 40 microg four times a day or formoterol 12 microg two times a day for two weeks. After a washout period, medications were crossed for another two weeks. After each of treatment period, all tests were performed. Nine subjects were male and mean age was 51.1 +/- 5.45 years, all of them were heavy smokers, level of COPD was mild to moderate (FEV(1)= 69%, FEV(1)/FVC= 68%). While formoterol significantly improved FEV(1), FEV(1)/FVC %, ipratropium significantly improved FEV(1), FEF(25-75), peak oxygen uptake and minute ventilation. Moreover, both of the medications increased exercise time. There were no differences between effects of ipratropium bromide and formoterol on exercise capacity and functional parameters. We observed that ipratropium bromide and formoterol have similar improvement in exercise capacity in COPD patients. The improvement in exercise capacity also correlated with increase in FEV(1).
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Broncodilatadores/uso terapéutico , Etanolaminas/uso terapéutico , Ipratropio/uso terapéutico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Administración por Inhalación , Adulto , Broncodilatadores/administración & dosificación , Estudios Cruzados , Método Doble Ciego , Etanolaminas/administración & dosificación , Prueba de Esfuerzo , Femenino , Fumarato de Formoterol , Humanos , Ipratropio/administración & dosificación , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Pruebas de Función Respiratoria , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: There is limited information about the rate and modifiers of mortality in noncystic fibrosis bronchiectasis. MATERIALS AND METHODS: This study enrolled a total of 56 bronchiectasis patients. Patients' body mass index, smoking habit, previous therapies, comorbid disorders, history of vaccination, bronchiectasis type and radiological extent, arterial blood gas analysis, respiratory function tests, and laboratory results were recorded. RESULTS: After a follow-up of 65.38 ± 18.62 months the overall mortality rate was 35.7%. The mean survival duration was 46.42 ± 8.25 months. Advanced age significantly increased mortality (HR: 2.031; CI: 0.991-4.072, P = 0.035). A significant correlation was found between mortality rate and the partial oxygen pressure level (HR: 0.886 (CI: 0.817-0.960); P = 0.039). Pulmonary artery pressure was directly proportional to mortality rate (HR: 9.015 (CI: 3.272-94.036); P = 0.03). There was also a significant correlation between Pseudomonas aeruginosa proliferation in sputum and mortality (HR: 7.014 (CI: 2.812-17.962); P = 0.00). Comorbidities increased mortality (HR: 1.984 (CI: 0.972-2.996); P = 0.04). CONCLUSION: Bronchiectasis is a disease with high mortality. Advanced age, comorbid conditions, reduced partial oxygen pressure, pulmonary hypertension, and Pseudomonas aeruginosa proliferation in sputum increase its mortality rate.
Asunto(s)
Bronquiectasia , Humanos , Infecciones por Pseudomonas , Pseudomonas aeruginosa , Pruebas de Función Respiratoria , EsputoRESUMEN
BACKGROUND AND OBJECTIVE: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Aims of this prospective study are to evaluate degree of impairment in pulmonary function tests (PFT), arterial blood gas analysis (ABG), respiratory muscle strength, exercise capacity and correlation of these parameters with radiological stages; to further evaluate the use of cardiopulmonary exercise testing in assessment of extent of pulmonary disease; and to discuss the pathophysiologic mechanisms of limitation in exercise capacity in patients with sarcoidosis. PATIENTS AND METHOD: 29 patients with sarcoidosis were grouped according to their radiological stages (stage I: group 1; stage II, group 2; stage III, group 3). Groups 1, 2 and 3 included 11, 13 and 5 patients, respectively. PFT, cardiopulmonary exercise testing and ABG were performed for each patient. RESULTS: Evaluation of all patients showed a significant decrement in exercise capacity. Patients in stage III had decreased diffusing capacity and exercise capacity. There was limitation in exercise capacity in stage I patients who had completely normal spirometry and diffusing capacity. We also found a correlation between radiological stages of the disease and exercise capacity, diffusing capacity and ABG. CONCLUSIONS: Exercise capacity is impaired also in early stages of sarcoidosis and it was found to be the earliest impaired physiological parameter in sarcoid patients. Exercise intolerance, having mutifactorial basis, is correlated with radiological stages. Circulatory impairment and impaired heart rate response to exercise have effects on limitation in exercise capacity. Especially in advanced radiological stages of disease, ventilatory and gas exchange impairment also seems to be effective on limiting exercise in patients with sarcoidosis.
Asunto(s)
Sarcoidosis Pulmonar/fisiopatología , Anciano , Ejercicio Físico/fisiología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Pruebas de Función Respiratoria , Sarcoidosis Pulmonar/diagnóstico por imagenRESUMEN
BACKGROUND: Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey. OBJECTIVES: To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists. DESIGN: A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded. RESULTS: Study included 719 patients (mean age: 62.9±9.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II, 14.7%; III, 84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting ß2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid. CONCLUSION: Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages.