Managing Bronchiectasis: 13 Years of Experience from Sputum to Lung Transplantation.

OBJECTIVES: Bronchiectasis and especially related mortality has gained growing interest in recent years. The aim of our retrospective study was to determine the factors which may influence and indicate mortality in our bronchiectasis patients throughout 13 years. MATERIAL AND METHODS: Patients with ICD-10 code J47 depicting bronchiectasis between 1.1.2003 to 31.12.2015 were evaluated using database of our hospital.694 out of 1470 patients who had high-resolution computed tomography (HRCT) scan confirming the presence of bronchiectatic lesions were included. RESULTS: Female/male ratio was 1.09. Mean age of the patients was 45.9±15.7 years. Sputum culture results were available in 365 (52.6%)of the patients. Pseudomonas aeruginosa was the leading pathogen, which was found in 68 (20.7%) patients. 28 (4%) patients have died during the 13 year period, and the overall survival was 125,3 months. In general 5 (4.4%) out of 112 patients who underwent surgery were lost, 3 of them belonging to the transplantation group. 3 out of 9 patients (33%) who underwent lung transplantation were lost within 3 years. There was no statistically significant difference in survival between patients who underwent surgery or not (p>0.05).In univariate Cox regression mortality analysis age, FEV1, P. aeruginosa, E.coli, hospitalisation and ICU admission had p value <0.01. When these factors were evaluated in the multivariate analysis, only P.aeruginosa reached statistical significance in predicting mortality. CONCLUSION: Isolation of P.aeruginosa in a patient with bronchiectasis should be taken seriously. It can be suggested that eradication treatment according to guidelines will help reduce mortality of bronchiectasis worldwide. Surgery is still an option of treatment in severe bronchiectasis and lung transplantation may be a life-saving way of managing end-stage disease.

A Basic Question: Are Patients with Chronic Obstructive Pulmonary Disease Aware of Their Disease?

OBJECTIVES: Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is important for its management, but there are limited data regarding the basic knowledge among patients with COPD. This study aimed to evaluate the basic information and knowledge of patients who were specifically provided with a medical exemption certificate for COPD. MATERIAL AND METHODS: This cross-sectional, observational, single-center study was conducted at an outpatient clinic of our hospital and included 201 consecutive ambulatory patients who visited the outpatient clinic between January 01, 2015 and June 30, 2015. Data regarding sex, age, educational level, symptoms, smoking history, years since diagnosis, years since obtaining the exemption certificate, and COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease-GOLD) stage were obtained. A questionnaire comprising 15 questions was used. RESULTS: The question regarding the organ primarily affected by COPD was correctly answered as "lung" by 145 (72%) of patients. In addition, 152 (76%) patients declared that they knew the localization of the affected organ; only 44 (22%) patients correctly located the organ on an image. Only seven (3.5% of the total) patients could correctly write "chronic obstructive pulmonary disease." CONCLUSION: The lack of awareness among patients with COPD emphasizes the lack in the field of patient education. Simple questionnaires can be used to determine and also to improve the awareness and basic knowledge among patients with chronic diseases.

Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis).

Sarcoidosis is an idiopathic granulomatous disease. It usually affects the lung. The diagnosis may be problematic since the known causes of granulomatous inflammation must be excluded. This multicenter study aimed to evaluate the clinical presentations and diagnostic approaches of sarcoidosis. The study protocol was sent via internet, and the participants were asked to send the information (clinical, radiological and diagnostic) on newly diagnosed sarcoidosis cases. 293 patients were enrolled within two years. Pulmonary symptoms were found in 73.3% of the patients, and cough was the most common one (53.2%), followed by dyspnea (40.3%). Constitutional symptoms were occured in half of the patients. The most common one was fatigue (38.6%). The most common physical sign was eritema nodosum (17.1%). The most common chest radiograhical sign was bilateral hilar lymphadenomegaly (78.8%). Staging according to chest X-ray has revealed that most of the patients were in Stage I and Stage II (51.9% and 31.7%, respectively). Sarcoidosis was confirmed histopathologically in 265 (90.4%) patients. Although one-third of the bronchoscopy was revealed normal, mucosal hyperemi (19.8%) and external compression of the bronchial wall (16.8%) were common abnormal findings. The 100% success rate was obtained in mediastinoscopy among the frequently used sampling methods. Transbronchial biopsy was the most frequently used method with 48.8% success rate. Considering sarcoidosis with its most common and also rare findings in the differential diagnosis, organizing the related procedures according to the possibly effected areas, and the expertise of the team would favour multimodality diagnosis.