Does Adherence to Domiciliary NIMV Decrease the Subsequent Hospitalizations Rates and Cost for Patients Diagnosed with COPD?

Domiciliary noninvasive mechanical ventilation (NIMV) is used for treating patients with hypercapnic chronic obstructive pulmonary disease (COPD). We aimed to evaluate the association between adherence to the treatment and subsequent hospitalizations and costs. Data from 54 (27 adherent; 27 non-adherent) patients with COPD who were undergoing NIMV treatment at home for 6 months. We assessed adherence based on digitally recorded data and checked hospital records for clinical and laboratory data, rehospitalization rates, and costs during the following 6 months. Nocturnal NIMV usage, mean daily usage of the device, and time to first hospitalization were higher in the treatment-adherent group (p < .001, p < .001, and p=.006, respectively). The percentage of active smokers, device leaks above 30 L/min, length of hospital stay, rehospitalization rates, and costs were significantly higher in the treatment-non-adherent group (p = 05, p = 006, p = 004, p = 006, and p = 01, respectively). The most frequent reasons for not using NIMV in the treatment-non-adherent group were a decreased need, dry mouth, mask incompatibility, and gastrointestinal complaints. Adherence to NIMV treatment decreases the subsequent hospitalizations rates and noncompliance leads to complications. Findings of this study may help physicians in convincing patients diagnosed with COPD of the need for correct NIMV use to prevent hospitalizations and reduce the costs of COPD treatment.

The comparative value of pleural fluid adenosine deaminase and neopterin levels in diagnostic utility of pleural tuberculosis.

INTRODUCTION: The aim of the present study was to evaluate and compare the diagnostic accuracy of pleura levels of adenosine deaminase (ADA) and neopterin for the differential diagnosis of pleural tuberculosis (TP). PATIENTS AND METHODS: The study included 50 patients with TB, 27 patients with malignancies, and 24 patients with pleural effusion of non-tuberculous and non-malignant origin as controls. ADA and neopterin levels in pleural fluid were measured by spectrofotometric and ELISA method, respectively. RESULT: Pleural neopterin levels were significantly higher in patients with pleural TB than patients with malignancy (p< 0.001). Pleural ADA levels were significantly higher in patients with pleural TB than patients with malignancy (p< 0.001) and patients with benign non-tuberculosis effusions (p< 0.001). The mean levels of ADA and neopterin in pleural effusion were evaluated according to their underlying diseases for the diagnostic accuracy. As for pleural TB receiving operating characteristic curves identified the following results; The best cut-off value for pleural neopterin was 4.7 U/L and yielded a sensitivity and specificity of 86% and 72.55%, respectively. Taking a cut-off value of 42 U/L for pleural ADA, the sensitivity and the specificity were found to be 88% and 68.63%, respectively. CONCLUSIONS: In the diagnosis of pleural TB pleural neopterin level has a comparable sensitivity to pleural ADA activity. Both markers may find a place as a routine investigation in the coming days for early detection of TB. However, these tests should not be considered an alternative to biopsy and culture.

Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?

Background: Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited. Research Question: Are there any useful markers to predict mortality in COVID-19 patients with COPD?. Study Design and Methods: A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes. Results: Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality. Interpretation: Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.

[The clinical value of autofluorescence bronchoscopy for precancerous lesions in operable primary lung cancer patients]. / Primer akciger karsinomu nedeniyle opere edilecek hastalarda otofloresan bronkoskopi ile prekanseröz lezyonlarin arastirilmasi.

INTRODUCTION: The aim of the present study is to show the role of autofluorescence bronchoscopy (AFB) compare with white light bronchoscopy (WLB) in detecting synchronous cancer and precancerous lesions in cases with operable primary lung cancer. MATERIALS AND METHODS: Fourty-nine patients were included in the study. WLB findings were grouped as group 1 normal, group 2 erithema or edema, group 3 nodular lesions or mucosal abnormality. AFB findings were grouped as group 1 normal, group 2 light brownish abnormal areas, group 3 brownish abnormal areas. Biopsies were obtained from group 2 and 3 patients. In 12 (24.5%) of the patients no areas were suspected and no biopsies were taken. RESULTS: Twenty-six (53%) of 49 patients did not show abnormal biopsy results in any of the specimens. One (2%) patient had metaplasia, 1 (2%) patient had dysplasia, 1 (2%) patient had in situ carcinoma. The diagnostic accuracy rates for the detection of synchronous cancer and precancerous lesions using WLB and AFB were as follows respectively: sensitivity 77.8% vs. 100%; specificity 37.5% vs. 3%; positive predictive value 21.9% vs. 24.3%; negative predictive value 88.2% vs. 100%. The relative sensitivity of AFB to WLB is 1.28. CONCLUSION: This study demonstrated that, AFB is an effective method in detecting synchronous cancer and precancerous lesions because of its low specificity it is more likely to be complementary to WLB.

Organizing pneumonia following ocrelizumab use in a patient with multiple sclerosis: A case report.

Ocrelizumab is an anti-CD20 monoclonal antibody used in the treatment of primary progressive and relapsing multiple sclerosis (MS). Although cases of organizing pneumonia have been reported in association with other antiCD20 agents such as rituximab, there is insufficient data in the literature on Ocrelizumab-associated lung involvement. Herein, we present a case of organizing pneumonia in a 37-year-old female patient with multiple sclerosis following Ocrelizumab use.

The Impact of Effective Vaccination on Clinical and Radiological Involvement in COVID-19 Patients.

Objective: We aimed to analyze clinical, radiological, and laboratory differences between vaccinated and unvaccinated patients admitted to hospital due to coronavirus disease-2019 (COVID-19) pneumonia. Methods: Patients hospitalized in the COVID-19 clinic between February 2022 and August 2022 were included in the study. Demographic, clinical features, and treatment results. Furthermore, the COVID-19 vaccination status of the cases was recorded. The cases were divided into two groups as those with and without COVID vaccination and compared. Results: A total of 215 patients were included in our study, and the patients were divided into 2 groups according to their vaccination status: those who were unvaccinated against COVID-19 (n=100) and those who vaccinated COVID-19 (n=115). The presence of comorbid chronic diseases and cancer was lower in the unvaccinated group. The duration of hospitalization was longer in the unvaccinated group than in the vaccinated group (9.6 and 7.1 days, respectively) (p<0.001). While there was no difference between the two groups in terms of the radiological involvement pattern, the number of involved segments was significantly higher in the unvaccinated group (p<0.05). The number of patients who received high-dose glucocorticoid therapy in the unvaccinated group was higher (28 cases vs. 11 cases; p<0.001). There was no statistically significant difference between the two groups in terms of transfer of patients to the intensive care unit (p>0.05). 11.3% (13/115) of the patients in the vaccinated group died, whereas 14% (14/100) died in the unvaccinated group. Conclusions: The vaccinated cases who were infected with COVID-19 had a shorter duration of hospitalization and lower severity of radiological involvement. The requirement for pulse steroids was also less compared with unvaccinated individuals. Despite having chronic diseases and cancer, which is considered to have a significant effect on mortality in COVID-19 patients. In addition, although the vaccinated group was older, they had mortality rates similar to those of unvaccinated subjects.

Chronic Obstructive Pulmonary Disease with Frequent Exacerbator Phenotype: What is Different in these Patients?

Background: Acute exacerbation events, which can develop during the natural course of chronic obstructive pulmonary disease (COPD) can lead to worsening quality of life, increased hospital costs, and higher rates of morbidity and mortality. In recent years, individuals at heightened risk of COPD exacerbations have been said to display a so-called "frequent exacerbator (FE)" phenotype, defined as having two or more exacerbation events (or ≥ 1 exacerbation with a hospitalization) within 1 year. Materials and Methods: We conducted a retrospective study involving 299 patients with COPD. Patients were divided into 2 groups as non-exacerbator phenotype (group-1, n=195) and FE phenotype (group-2, n=104). Results: FE phenotype was identified in 35.1% of patients. There were no significant differences between these two phenotypes in terms of gender, smoking status, or leukocyte count. However, FEs were found to be older (p=0.04), with more frequent detection of emphysema (p=0.02) and lower eosinophil levels (p=0.02). FEs also demonstrated worse pulmonary function parameters. Conclusion: COPD patients with the FE phenotype likely require a different treatment algorithm due to differing clinical features such as poorer respiratory function, lower eosinophil levels, and more frequent emphysema.

Adenosine deaminase cutoff value when diagnosing tuberculous pleurisy in patients aged 40 years and older.

INTRODUCTION: Tuberculous pleurisy (TBP) is one of the most common manifestations of extra-pulmonary tuberculosis. In patients aged ≥40 years, a closed needle pleural biopsy is recommended with an adenosine deaminase (ADA) level of 40-70 U/L. We aim to investigate whether the cutoff value of ADA and the cancer ratio in patients with TBP aged ≥40 years is different and determine the effects of both compounded biomarkers on diagnosing TBP. MATERIALS AND METHODS: Between 2009 and 2016, the ADA levels were measured in pleural effusions from patients who were admitted to the Chest disease clinic. RESULTS: Of the 196 patients included in the study, 104 were aged ≥40 years. A significant relationship was found between the serum LDH/pleural ADA (sLDH/pADA) ratio and ADA levels in patients aged >40 years (OR: 0.935 and OR: 1.085, respectively). The model using an ADA value ≥30 and an sLDH/pADA ratio <16 yielded a sensitivity of 94.25% (95% CI, 87.1-98.10) in all patients and 69.23% (95% CI, 54.9-81.28) in patients aged >40 years. CONCLUSION: ADA and the sLDH/pADA ratio are simple, cost-efficient, and obtain fast results and, therefore, are the preferred methods in TBP diagnosis. The diagnosis rate in the present study was 91% using ADA levels in combination with the sLDH/pADA ratio, both of which can be obtained only through thoracentesis.

Clinical characteristics and outcomes of hospitalized COVID-19 patients with COPD.

BACKGROUND: Although COPD is not one of the most common comorbidities in COVID-19 patients, it can be more fatal in this group. This study aimed to investigate the characteristics and prognosis of COPD patients among the population with COVID-19. RESEARCH DESIGN AND METHODS: Patients diagnosed with positive PCR test were included in our multicentered, retrospective study. Patients with airway obstruction (previous spirometry) were included in 'COPD group'. RESULTS: The prevalence of COPD in COVID-19 patients was 4.96%(53/1069). There was a significant difference between COPD and non-COPD COVID-19 patients in terms of gender, mean age, presence of dyspnea, tachypnea, tachycardia, hypoxemia and presence of pneumonia. The mortality rate was 13.2% in COPD, 7% in non-COPD patients(p = 0.092). The significant predictors of mortality were higher age, lymphopenia (p < 0.001), hypoxemia (p = 0.028), high D-dimer level (p = 0.011), and presence of pneumonia (p = 0.043) in COVID-19 patients. CONCLUSIONS: Our research is one of the first studies investigating characteristics of COPD patients with COVID-19 in Turkey. Although COPD patients had some poor prognostic features, there was no statistical difference between overall survival rates of two groups. Age, status of oxygenization, serum D-dimer level, lymphocyte count and pneumonia were significantly associated parameters with mortality in COVID-19.

Area under flow-volume loop may predict severe exacerbation in COPD patients with high grade of dyspnea.

OBJECTIVE: Exacerbations in patients with COPD may still be unpredictable, although the general risk factors have been well defined. We aimed to determine the role of a novel parameter, area under flow-volume loop, in predicting severe exacerbations. METHODS: In this single-centre retrospective cohort study, 81 COPD patients over 40 years of age with high grade of dyspnea (having a CAT score of ≥10) and a history of ≥1 moderate exacerbation in the previous year were included. Area under flow-volume curve (AreaFE%) was obtained from pulmonary function test graph and calculated from Matlab programme. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors of the severe exacerbation. RESULTS: Patients with severe exacerbation (n = 70, 86.4 %) were older. They had lower FEV1%, FVC%, 6MWD, AreaFE% and higher CAT score than patients without exacerbation. After performing multivariate analysis, high CAT score and low AreaFE% value were found to be independent risk factors for severe exacerbation (OR: 1.12, 95 % CI: 1.065-1.724; p = 0.01 and OR: 1.18, 95 % CI: 0.732-0.974; p = 0.02). CONCLUSIONS: We found that a low AreaFE% value was an independent risk factor in addition to a high CAT score and these both have an excellent discriminative ability in predicting the risk of severe exacerbation.

Determining emphysema in adult patients with COPD-bronchiectasis overlap using a novel spirometric parameter: area under the forced expiratory flow-volume loop.

BACKGROUND: Defining the optimal therapeutic approach in patients with chronic obstructive pulmonary disease (COPD) bronchiectasis overlap (CBO) is challenging. The presence of emphysema suggests that COPD is the primary problem and it impacts therapeutic decision making. RESEARCH DESIGN AND METHODS: We hypothesized that the AreaFE% performance will be reliable in diagnosing the presence of emphysema such that serial CT scanning may not be needed. In this retrospective chart review study, we included 113 CBO patients (52 having emphysema, 61 not having emphysema). We compared these two groups according to conventional spirometric parameters and AreaFE% values. RESULTS: 54% of all patients were female and mean age was 58 years.FEV1%, FEV1/FVC and AreaFE% were found to be significantly lower in patients with emphysema. 12% is the cutoff value for AreaFE% in determining emphysema with 73% sensitivity,75% specificity, and 72% diagnostic accuracy (AUC: 0.82) and it provides superior estimation than conventional parameters. CONCLUSIONS: We found that AreaFE% is more suitable for determining the presence of emphysema than conventional spirometric parameters in CBO patients. This novel parameter may be helpful instead of scanning thorax CT to indicate the presence of emphysema and manage treatment in the follow-up of CBO patients.

Burden of community-acquired pneumonia in adults over 18 y of age.

This study aimed to determine the economic burden and affecting factors in adult community-acquired pneumonia (CAP) patients (≥ 18 years) by retrospectively evaluating the data of 2 centers in Istanbul province, Turkey. Data of outpatients and inpatients with CAP from January 2013 through June 2014 were evaluated. The numbers of laboratory analyses, imaging, hospitalization days, and specialist visits were multiplied by the relevant unit costs and the costs of the relevant items per patient were obtained. Total medication costs were calculated according to the duration of use and dosage. The mean age was 61.56 ± 17.87 y for the inpatients (n = 211; 48.6% female) and 53.78 ± 17.46 y for the outpatients (n = 208; 46.4% male). The total mean cost was €556.09 ± 1,004.77 for the inpatients and €51.16 ± 40.92 for the outpatients. In the inpatients, laboratory, medication, and hospitalization costs and total cost were significantly higher in those ≥ 65 y than in those <65 y. Besides the hospitalization duration, specialist visit, imaging, laboratory, medication, and hospitalization costs and total cost were significantly higher in those hospitalized more than once than in those hospitalized once. While the specialist visit cost was higher in the inpatients with comorbidities, the imaging cost was higher in the outpatients with comorbidities. CAP poses a higher cost in inpatients, elders, and individuals with comorbidities. Costs can be decreased by rational decisions about hospitalization and antibiotic use according to the recommendations of guidelines and authorities. Vaccination may decrease medical burden and contribute to economy by preventing the disease, especially in risk groups.