Long-acting B-2 agonists (LABA) or long-acting muscarinic antagonists (LAMA): which one may be the first option in group A COPD patients?

INTRODUCTION: Long-acting muscarinic antagonists (LAMA) or beta-2 agonists (LABA) have been recommended for symptom control in group A COPD patients as a first-line bronchodilator treatment in GOLD guidelines. However, there is no mention of priority/superiority between the two treatment options. We aimed to compare the effectiveness of these treatments in this group. METHODS: The study cohort was formed of all subjects from six pulmonology clinics with an initial diagnosis of COPD who were new users of a LAMA or LABA from January 2020 to December 2021. Seventy-six group A COPD patients, in whom LABA or LAMA therapy had been started in the last 1 month as a first-line treatment, were included in our study. Participants were evaluated with spirometry, COPD Assessment Test (CAT), mMRC scale, and St. George Respiratory Questionnaire (SGRQ) for three times (baseline, 6-12th months). RESULTS: There were 76 group A COPD patients with LAMA (67.1%) and LABA (32.9%). The number of patients who improved in CAT score at the end of the first year was significantly higher in patients using LAMA than those using LABA (p = 0.022); the improvement at minimum clinically important difference (MCID) in CAT score of LAMA group at 1st year was also significant (p = 0.044). SGRQ total and impact scores were found to be statistically lower at 1st year compared to baseline in patients using LAMA (p = 0.010 and 0.006, respectively). Significant improvement was detected in CAT and SGRQ scores at the 6th month visit in the LAMA group having emphysema (p = 0.032 and 0.002, respectively). CONCLUSION: According to significant improvements in CAT and SGRQ score, LAMA may be preferred over LABA as a bronchodilator agent in group A COPD patients, especially in emphysema-dominant phenotype.

Impacts of the Covid-19 pandemic on smoking cessation success.

Setting-objective: Current COVID-19 outbreak has led to many behavioural changes, including smoking behaviours. We aimed to investigate the success of quitting smoking of smoking cessation outpatients. Design: Patients who applied to the smoking cessation outpatient clinic of a state hospital during the pandemic were retrospectively analysed. Smoking cessation success, personal views and experiences about COVID-19 were questioned. Hospital Anxiety and Depression (HAD) Scale was applied. Results: The smoking cessation rate in the study population was 14.7%. The reasons for not being able to quit smoking were; stress (51.9%), drug discontinuation (28.4%) and reasons related to COVID-19 (12.3%). According to HADS scores; 35.8% of the participants were at risk for anxiety and 72.6% for depression. Those with pulmonary symptoms at the time of application (p=0.001), those who continued smoking cessation treatment (p=0.016), and those without depressive symptoms (p=0.040) were significantly more successful in quitting smoking. The rate of continuing smoking was significantly higher in patients with a history of COVID-19 <18.9% of participants>(p=0.013). Conclusion: Intense stress and depressive symptoms, discontinuation of smoking cessation treatment and being infected with Coronavirus negatively affect the smoking cessation process in pandemic. These parameters should be considered during smoking cessation interviews and behavioural support should be obtained if necessary.

Characteristics of our hypoxemic COVID-19 pneumonia patients receiving corticosteroids and mortality-associated factors.

BACKGROUND: COVID-19 is a disease associated with diffuse lung injury that has no proven effective treatment yet. It is thought that glucocorticoids may reduce inflammation-mediated lung injury, disease progression, and mortality. We aimed to evaluate our patient's characteristics and treatment outcomes who received corticosteroids for COVID-19 pneumonia. METHODS: We conducted a multicenter retrospective study and reviewed 517 patients admitted due to COVID-19 pneumonia who were hypoxemic and administered steroids regarding demographic, laboratory, and radiological characteristics, treatment response, and mortality-associated factors. RESULTS: Of our 517 patients with COVID-19 pneumonia who were hypoxemic and received corticosteroids, the mortality rate was 24.4% (n = 126). The evaluation of mortality-associated factors revealed that age, comorbidities, a CURB-65 score of ≥ 2, higher SOFA scores, presence of MAS, high doses of steroids, type of steroids, COVID-19 treatment, stay in the intensive care unit, high levels of d-dimer, CRP, ferritin, and troponin, and renal dysfunction were associated with mortality. CONCLUSION: Due to high starting and average steroid doses are more associated with mortality, high-dose steroid administration should be avoided. We believe that knowing the factors associated with mortality in these cases is essential for close follow-up. The use of CURB-65 and SOFA scores can predict prognosis in COVID-19 pneumonia.

Characteristics of hospitalised COVID-19 patients and parameters associated with severe pneumonia.

BACKGROUND: After the first case of coronavirus disease 2019 (COVID-19) was reported in China in December 2019, it caused a global pandemic, including Turkey. OBJECTIVES: The aim of this study was to analyse the characteristics of hospitalised COVID-19 patients and assess the parameters related to severe pneumonia. METHODS: Included in the study were hospitalised COVID-19 patients with positive naso-oropharyngeal swabs. Patients' demographics, admission symptoms, laboratory and radiological findings were recorded retrospectively. RESULTS: Of 1013 patients, 583 were males (57.6%) and 430 were females (42.4%), with a mean age of 53.7 ± 17.9. More than half of the patients had at least one comorbidities, the most common of which were hypertension and diabetes mellitus. Cough (59.8%), fatigue (49.5%) and fever (41.2%) were the most common presenting symptoms. Of the hospitalised COVID-19 patients, 84.9% had pneumonia and 83.5% had typical radiological COVID-19 appearances (94.5%: ground-glass areas). The most common laboratory findings were high C-reactive protein (CRP) (73.6%) and lactate dehydrogenase (LDH) (46.2%) levels, as well as lymphopenia (30.1%). Severe pneumonia was present in 28.1% of COVID-19 patients. Multivariate logistic regression analysis indicated that advanced age, hypotension, anaemia and elevated CRP and LDH serum levels were independent risk factors for the severity of COVID-19 pneumonia (P = .011, .006, .017, .003 and .001, respectively). CONCLUSION: This study, as one of the first multicentre studies about characteristics of COVID-19 in Turkey, may guide about disease-related parameters and severity of pneumonia. Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID-19 pneumonia.

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.

Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. OBJECTIVE: It was aimed to determine relationship and survival between COPD and CIMT. METHODS: CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. RESULTS: There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT ≥ 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). CONCLUSION: This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.

Parameters affecting inhalation therapy adherence in elderly patients with chronic obstructive lung disease and asthma.

AIM: One of the most significant problems in the treatment of elderly patients is incorrect use of inhaler devices. The purpose of the present study was to assess the parameters affecting treatment adherence among elderly patients. METHODS: Spirometry, the Mini-Mental State Examination for cognitive impairment and the Morisky Medication Adherence Scale-4 were carried out in 121 (88 chronic obstructive lung disease patients according to the Global Initiative for Chronic Obstructive Lung Disease, 33 asthma patients according to The Global Initiative for Asthma (GINA) criteria) participants aged over 65 years. RESULTS: The patients with cognitive impairment, low socioeconomic status, a high number of admissions to an emergency service in past year and the presence of dyspnea or sputum had significantly lower inhalation device use scores (P = 0.017, 0.03, 0.025, 0.03 and 0.02). The patients with high Mini-Mental State Examination scores and forced expiratory volume in 1 s (as liter and percentage) were found to be more successful in using inhaler devices (P = 0.005, 0.007 and 0.022). There was a negative correlation between number of hospitalizations and inhalation device score (P = 0.021).The participants without education/training by a doctor about the inhaler device had a significantly poorer treatment adherence (P < 0.001). CONCLUSIONS: Older chronic obstructive lung disease and asthmatic patients have more difficulty with the correct use of inhaler devices. Cognitive impairment might be an important parameter that can affect inhalation device technique. Socioeconomic status, smoking, pulmonary symptoms and admissions to hospital were also thought to have effects on the adherence to inhalation therapy. The type of chronic respiratory disease (chronic obstructive lung disease/asthma) is not a major factor influencing therapy adherence. Assessment of cognitive functions, choosing suitable inhalation devices and educational programs for inhaler use could improve the success of inhaler technique in elderly patients. Geriatr Gerontol Int 2017; 17: 999-1005.

Presence of Headache and Migraine in Asthma Patients.

OBJECTIVES: Migraine is a diseases characterized with severe headaches, with neurological and systemic findings. The purpose of this study is to investigate the prevalence of migraine and to examine whether there is a relationship between atopic disorders, parental history and migraine in asthma patients. MATERIAL AND METHODS: A total of 288 asthma outpatients, who had the diagnosis by an early or late test of reversibility showing a reversible airway obstruction according to hospital database were included. The presence of headache, atopic symptoms and parental history about asthma, atopic disorders and migraine were asked. The patients with headache were consultated by neurology department and investigated about the presence of migraine. The diagnosis of migraine headache was made if patients fulfilled the International Headache Society (IHS) criteria. RESULTS: 60.4% of patients described a headache. There were 94 patients (32.6%) with headaches meeting the IHS criteria for migraine. Only 12 patients had migraine with aura. There were atopic symptoms in 86.8% of patients. According to parental history, there were asthma in 47.9%, atopic symptoms in 39.6% and migraine in 22.2% of parents. Patients with atopic symptoms were found to have significantly high rate of headaches (65.3%) "p=0.007". The prevalence of migraine was significantly high in patients with parental atopic symptoms (54%) "p=0.002". Multiple logistic regression analysis identified that gender, parental history of asthma, allergia and migraine, and smoking were independent risk factors for presence of migraine in asthmatics. CONCLUSION: There is a high prevalence of migraine headaches in patients with asthma. The coexistence of asthma and headaches may be related with a similar pathophysiological mechanism; parental history, common genetic compounds and smoking may play role in this mechanism. The headaches in asthma patients, atopic symptoms and family history should be questioned, and clinicians should be careful about the presence of migraine.

Smoking-Related Behaviors and Effectiveness of Smoking Cessation Therapy Among Prisoners and Prison Staff.

BACKGROUND: Smoking is a serious problem in prisons. This work aimed to assess smoking-related behaviors and the effectiveness of tobacco cessation therapy in prison. METHODS: This study includes four visits to a prison in Bolvadin-Afyon, Turkey. Pharmacologic options for tobacco cessation were offered to the participants who wanted to quit smoking. RESULTS: One hundred seventy-nine subjects (109 prisoners and 70 prison staff) with 68.7% current smokers were included. There was an increase of cigarette smoking in 41.8% (the most common reason was stress) and decrease in 18.7% (the most common reason was health problems) of the participants after incarceration. Fifty-nine participants accepted the offered tobacco cessation treatment. Only 2 participants started their planned medications, but they could not quit smoking. The most common reason for failed attempts to quit was the high prices of cessation therapies. CONCLUSION: Factors like stress and being in prison may provoke smoking. A smoking ban does not seem to be a total solution for preventing tobacco use in prisons. Tobacco cessation programs may be a better option. Cost-free cessation medications may increase quitting rates among prisoners and prison staff.

Adherence to Current COPD Guidelines in Turkey.

UNLABELLED: INTRODUCTION-OBJECTIVE: Despite the availability of national and international guidelines, chronic obstructive pulmonary diseases (COPD) treatment is not always prescribed according to these recommendations. We aimed to see if COPD patients in Turkey have been treated appropriately according to COPD guidelines. METHODS: This is a cross-sectional study carried out in six different chest diseases clinics. The COPD outpatients were categorized by spirometry classification (SC) and the combined classification (CC) of COPD. The treatment protocols were evaluated to check whether they were suitable for both classifications. RESULTS: Overall, 307 patients were included in the study. Of the treatment protocols, 40.4% were suitable for both classifications: 30.9% for CC and 20.8% for SC. A total of 51.8% of the patients were reported to be using an unsuitable therapy for SC and 38.4% for CC. Ninety-eight per cent of the unsuitable treatment was overtreatment. Fifty-eight per cent of the patients were using LABA + LAMA + ICS. Improper ICS usage was identified in 97.1% in CC, 93.1% in SC. The cost savings of all patients in one year would be 17,099$ with an appropriate treatment protocol following COPD guidelines. CONCLUSION: The most common type of inappropriate COPD treatments is overtreatment, generally with ICS. As treatment protocols following COPD guidelines change over time, there is still a low rate of adherence by clinicians in their clinical practice to guideline recommendations. Awareness of these guidelines by pulmonary specialists should be improved.

Erectile dysfunction in COPD patients.

Sexual dysfunction is a common problem in chronic obstructive pulmonary disease (COPD). We aimed to assess the presence of erectile dysfunction (ED) in COPD patients. Ninety-three outpatients who had been diagnosed as COPD and followed in Bolvadin State Hospital, Afyon, Turkey, were included in the study. All patients underwent pulmonary function tests and arterial blood gas analysis. They completed International Physical Activity Questionnaire (IPAQ), Medical Research Council (MRC) Dyspnea Scale, Short Form 36-item Scale (SF-36), and International Index of Erectile Function (IIEF) Questionnaire. The mean age of 10 (10.8%) mild, 46 (49.5%) moderate, 28 (30.1%) severe, and 9 (9.7%) very severe COPD patients was 61.4 ± 9.8 years. Varying degrees of ED were detected in 67.7% of COPD patients. All patients with hypoxemia had ED. IPAQ score and all SF-36 parameters were low in patients with ED, while MRC score was high. Forced expiratory volume in one second, forced vital capacity, partial pressure of oxygen in blood, oxygen (O2) saturation, IPAQ score, and role-physical parameters were statistically low in ED patients (p = 0.04, 0.02, <0.01, <0.01, 0.02, and 0.04, respectively); MRC score was statistically higher in patients with ED (p = 0.02). Patients with moderate and severe ED had statistically lower score of mental health (p < 0.01 and p = 0.02, respectively). There was a positive correlation between IIEF score and IPAQ scores (p < 0.01), MRC scores (p = 0.01), general health (p < 0.01), role-physical (p < 0.01), role-emotional (p < 0.01), physical functioning (p < 0.01), and mental health (p < 0.01) parameters in SF-36. ED is frequently seen in COPD patients. Hypoxemia, smoking, and limitation of physical activity are thought to be associated with ED in COPD as mechanisms. Quality of life and the functional capacity are negatively affected with the presence of ED. It is important for a physician to question the sexual functions in patients with COPD. The presence of ED may be routinely considered in the daily practice of pulmonologists in COPD patients.

[Smoking related behaviours in Izmir]. / Izmir halkinin tütün kullanma özelliklerinin belirlenmesi.

INTRODUCTION: The aim of the study is to determine the people's smoking related behaviours, using tobacco products except cigarette and characteristics about second hand smoke in Izmir. MATERIALS AND METHODS: Questionnaire including 47 questions was performed to 600 people, who were selected by Turkey Statistics Instutition to present population of Izmir. RESULTS: 53.7% of participants were female and 46.3% was male; the mean age was 41.5 ± 15.6. 232 (39%) were smoking, 257 (42%) never smoked and 111 (19%) quited smoking. The average age for a new smoker is 18.7 ± 6.6; men start smoking earlier than women statistically (p= 0.0001). 10.7% of participants were using tobacco products except cigarette. The smoke cessation percentage of women was statistically significantly higher than men(p= 0.006). 70.7% of active smokers were thinking about quitting. CONCLUSION: The frequency of smoking was higher than Turkey's avarage in Izmir. The mean age of starting smoking was below 18. There must be extra effort for preventing women and under 18 age who are the targets of tobacco industry from smoking. Use of tobacco products except cigarette, especially water pipe may be an emerging problem for men, high education level and under age of 35 population. Although most of the participants know about their rights of protection from smoke and the harms of second hand smoke, it is worrying to see that children have to face second hand smoke in special ownerships. Most of the smokers think to quit smoking and use medical methods for quitting. The people who think about quitting should be guided to smoking cessation clinics; by this way, the more we use scientific methods for quitting, the more we get high quit rates of smoking.

[The changes in smoking related behaviours and second hand smoke after the smoking ban in Izmir]. / 4207 sayili yasanin yürürlüge girmesinden sonra sigara içme davranislari ve pasif maruziyet ile ilgili degisikliklerin saptanmasi

INTRODUCTION: The aim of the study is to determine the views about law, change of second hand smoke (SHS) quantity, people's smoking related behaviours after the publishment of law which prohibits use of tobacco products in closed public areas. MATERIALS AND METHODS: Questionnaire including 47 questions was performed to 600 people, who were selected by Turkey Statistics Instutition to present population of Izmir. RESULTS: 53.7% of participants were female and 46.3% was male; the mean age was 41.5 ± 15.6. 98% of all participants were aware of the law and 91.5% of them were supporting it. 42% of participants who succeeded in quitting had managed it after the ban. Restriction of areas, rise of prices and effects of SHS were the most popular reasons of reducing/quitting smoking after the law. Non-smokers were exposed to SHS at homes; 35.1%, at vehicles: 14.9%, at work places: 14.4%. The number of smoking cigarettes was reduced by 3.19 cigarettes/day. The rate of violation of the ban was 32.3%; only 21.3% of violators were warned. 96.4% of law supporters found law successful and sufficient. CONCLUSION: A big amount of participants thinks about quitting in Izmir; law is thought to have important effect on this decision. SHS has reduced mostly in public areas with ban, but law must be enlarged to prevent SHS at private areas such as houses, vehicles and workplaces. As a result; the ban encouraged smokers to quit and reduced SHS at public areas. We believe that paying more attention for law sanction and extending the borders of law and reviewing the ban, will make our country more smoke free from now.