Tele-pulmonary rehabilitation with face to face in COVID-19 pandemic: A hybrid modeling.

Introduction: Post-illness pulmonary rehabilitation indications of Coronavirus disease-2019 (COVID-19) may include fatigue, respiratory restriction, exercise limitation, muscle weakness, deterioration in body composition, quality of life, and psychological status. Since tele-pulmonary rehabilitation (tele-PR) is the prominent approach in the current situation and questions such as who, how, and when are still unclear, in this study we aimed to investigate the efficacy of tele-PR as a hybrid model with face-to-face in post-COVID-19 patients. Materials and Methods: Thirty one patients who had completed viral infection treatment with the diagnosis of COVID-19 but still had persistent symptoms were enrolled in an eight-week synchronized video-conference mediated telePR program in a hybrid format, with the initial and final assessments and the first two sessions conducted in person. Before and after the tele-PR, pulmonary functions, exercise capacity, respiratory and peripheral muscle strength, body composition, quality of life, and psychological states were evaluated. Result: After the tele-PR program; a statistically significant improvement was observed in dyspnea sensation evaluated with modified Medical Research Council (mMRC) and BORG levels, body mass index (BMI), incremental shuttle walk test (ISWT), endurance shuttle walk test (ESWT), handgrip test, deltoid, and quadriceps 1-repetition maximum (1RM) results, maximal inspiratory and expiratory pressure (MIP, MEP), peripheral muscle strengths, fatigue severity scale and Nottingham extended activities of daily living scale (NEADLS). Conclusions: In this study, it has been shown that the hybrid model of tele-PR enables a comprehensive evaluation as well as the effective and safe applicability of a multidisciplinary and remotely directed program even in high workloads for post-COVID-19 patients.

Relationship between exercise capacity and impulse oscillometry parameters after COVID-19 infections.

BACKGROUND: After COVID-19 infection, persistent exercise intolerance, changes in lung function have been shown. Our aim is to investigate the correlation between impulse oscillometry (IOS) parameters and exercise capacity by using incremental and endurance shuttle walk tests (ISWT, ESWT) and investigate the factors and parameters which might have an effect on both IOS parameters and exercise capacity tests. METHOD: The patients who had a history of COVID-19 were enrolled into cross-sectional study according to inclusion criteria. The IOS parameters, ISWT, ESWT, smoking status, time since COVID-19 diagnosis, length of hospital stay, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), body mass index (BMI), fat-free mass index (FFMI), dyspnea, hospital anxiety-depression and fatigue severity scores were recorded. RESULTS: The study comprised 72 patients, 71% of whom were male, with a mean age of 54 ± 10 years. After COVID-19 diagnosis, the median duration was 3 (min: 1, max: 5) months and 51 (71%) of the patients were hospitalized. The FEV1 and FVC values were in normal range. The area of reactance (AX), resonance frequency (Fres), reactance at 20 Hz (X20) and the difference between resonance at 20 and 5 Hz (R5-20) correlated with both ISWT and ESWT. The FEV1 correlated with all IOS parameters (p < 0.05). Reactance correlated with FFMI (p = 024, r = 0.267), different according to hospitalization (p = 0.02). CONCLUSION: In COVID-19 survivors, there could be correlations between IOS parameters and exercise capacity; and between these parameters and FEV and FVC. Furthermore, small airway disease with normal spirometric functions could be related to decreased exercise capacity in COVID-19 survivors regardless of concomitant diseases, BMI, smoking status and time since COVID-19 diagnosis.

The Differentiation of Metastatic Mediastinal Lymph Nodes From Benign Hypermetabolic Lesions.

Background Anthracosis may cause a positron emission tomography/computed tomography (PET/CT) false positivity in mediastinal and hilar lymph nodes. We aimed to evaluate the radiological features and the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes with anthracosis or squamous cell lung cancer metastasized. Methodology Patients diagnosed with anthracosis or squamous cell lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between January 1, 2015, and November 15, 2020, in a tertiary hospital were enrolled. The squamous cell subtype of lung cancer was selected due to its association with tobacco use, biomass, and air pollution. Anthracosis may occur due to the same etiologic reasons. Results A total of 190 patients met the study enrollment criteria, of which 86 were diagnosed with anthracosis and 33 with squamous cell lung cancer lymph metastasis. Median values for short axis, long axis, SUVmax, shape features, and presence of calcification were found significantly different between the groups. In receiver operating characteristic (ROC) analysis, the SUVmax cut-off value was calculated as 6.61. With this cutoff value, the negative predictive value (NPV) was 92.5% and the positive predictive value (PPV) was 54% for differentiating anthracosis and malignant lymph nodes metastasis. Conclusions We conclude that the evaluation of the shape and metabolic activities of the anthracotic lymph nodes detected by PET/CT together with EBUS-TBNA granted a more accurate staging of the patients and more cancer patients will benefit from surgical treatment.

Association of depression with improper use of inhaler devices by patients with obstructive disease.

INTRODUCTION: Obstructive pulmonary disease may cause some psychiatric disorders such as depression, similar to other chronic diseases. Patients with chronic obstructive pulmonary disease or asthma are especially susceptible to inhaler technique errors. The aim of this study was to evaluate the depression that can affect improper use of inhaler devices and to show the contribution of age, sex, and education to correct usage. MATERIALS AND METHODS: In this study, trained health care workers in the presence of Chest specialist requested patients to demonstrate their inhaler technique and assessed it according to the checklist. If any of the steps were missing or done incorrectly, it was marked as an incorrect technique. RESULTS: We included 188 participants, mean age of 58.3 ± 12.7 years. Significant variables of individual risk were having comorbidities, age, sex, smoking status, and educational level. There was an inverse relationship between education level and incorrect inhaler technique. Even after controlling for age, gender, and education, depressive symptoms were a significant and independent predictor of improper use of inhaler devices. High levels of depressive symptoms were associated with a 22-fold increase (95% confidence interval, 8.9 to 53.5) in the odds of improper use of inhaler devices after adjustment for potential confounders. CONCLUSIONS: As a result, the presence of depression symptoms may increase the improper use of inhaler devices. Further research is needed to determine if screening for and treating depression improves improper use of inhaler devices and obstructive disease outcomes in this population.

Efficacy of pulmonary rehabilitation for bronchiectasis and related factors: which patients should receive the most treatment?

INTRODUCTION: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. RESULTS: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = -0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = -0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = -0.563) and ΔSGRQ (p < 0.001, r = -0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = -0.176) and Δanxiety (p = 0.007, r = -0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = -0.267) and ΔSGRQ (p < 0.001, r = -0.648). CONCLUSIONS: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program.

Relationship between ghrelin and obestatin levels and ghrelin/obestatin ratio in patients with asthma.

INTRODUCTION: This study aimed to evaluate serum levels of ghrelin and obestatin as well as the ghrelin/obestatin ratio in non-obese patients with asthma and in healthy non-asthmatic controls and analyzed the relationships to clinical outcomes. MATERIALS AND METHODS: 51 patients with stable persistent asthma and 36 healthy controls were included to the study. Pulmonary function tests were conducted in all case. Skin prick test and an asthma control test were conducted in patients with asthma. All patients and controls were compared in terms of ghrelin and obestatin levels, as well as the ghrelin/obestatin ratio. Plasma concentrations of ghrelin and obestatin were detected by enzymelinked immunosorbent assay. Homeostasis model assessment-insulin resistance (HOMA-IR) scores were calculated as an index of insulin resistance. RESULT: No differences in ghrelin or obestatin levels or the ghrelin/obestatin ratio were detected between patients with asthma and the control group. Ghrelin levels were significantly lower in obese patients. The HOMA-IR score was significantly higher in patients with asthma than in controls. CONCLUSIONS: Ghrelin and obestatin levels, and the ghrelin/obestatin ratio, were similar in controls and patients with stable asthma. Although the groups were similar in terms of body mass index and waist circumference, the HOMA-IR score was significantly higher in patients with asthma.

Swyer-James-Macleod syndrome mimicking an acute pulmonary embolism: a report of six adult cases and a retrospective analysis.

BACKGROUND AND AIM: In patients with pulmonary embolism (PE), a pulmonary radiograph may reveal oligemic fields (the Westermark sign) associated with sites of occlusion of the pulmonary arteries, interruption or loss of the artery line (the knuckle sign), and even unilateral hyperlucency attributable to reduced overall lung vascularity. In Swyer-James-Macleod syndrome (SJMS), which develops as a result of bronchiolitis obliterans, unilateral hyperlucency is evident because of emphysema and hypoplasia of the pulmonary artery and its branches. Therefore, SJMS cases with clinical and laboratory data compatible with PE may in fact be confused with PE. The cases of six adult patients who were initially presumed to have PE but on further investigation were diagnosed with SJMS are presented in this report, which thus can serve as a guide for diagnosis of similar cases in future. METHODS: We studied six adult patients who presented with dyspnea. Their pulmonary radiographs revealed lobar/unilateral hyperlucency and PE was initially suspected. The pulmonary artery and branches thereof exhibited parenchymal emphysema and hypoplasia, and we thus diagnosed SJMS. RESULTS: We studied 4 males and 2 females with a mean age of 51 years (range, 20-73 years). Left lung involvement was evident in five cases. CONCLUSION: Unilateral hyperlucency may be a feature of both PE and SJMS. Although these conditions are very different, both present similarly in radiographic terms and may be easily confused when the clinical data and the anamnesis raise a suspicion of PE, causing unnecessary testing and treatment.

Usefulness of admission red blood cell distribution width as a predictor of severity of acute pulmonary embolism.

BACKGROUND: Previous researches have represented a considerable relation between acute pulmonary embolism (PE) and red blood cell distribution width (RDW). To the authors' knowledge no research has been informed in subjects with PE severity. Pulmonary arterial obstruction index (PAOI) is associated with the severity of acute PE. OBJECTIVES: In our investigation, we purposed to assess the relation between PAOI and RDW and the benefit of these factors in the detection of PE severity. METHODS: We retrospectively investigated the demographic information, probability of clinical scores, laboratory parameters, serum D-dimer levels, and echocardiographic findings of systolic pulmonary artery pressure (PAP) in Acute PE individuals who were diagnosed by computed tomography of pulmonary arterial angiography. Right ventricular dysfunction (RVD) on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans). RESULTS: The information of 131 patients with acute PE and 51 (64.6%) female and 28 (35.4%) male healthy control were evaluated. Acute PE group's RDW values were higher than control subjects (P < .0001). RDW (%) level was remarkable higher in patients with massive PE than in patients with nonmassive PE. There were statistically considerable differences in terms of PAOI and systolic pulmonary arterial pressure (sPAP) between nonmassive and massive PE patients (P < .0001 for all). CONCLUSIONS: PAOI was correlated with PE severity, D-dimer level, sPAP and clinical probability scores. PAOI was correlated with RDW levels. RDW levels, an inexpensive and easily measurable laboratory factor, were considerable associated with the severity and presence of PE.

Mounier-Kuhn syndrome (tracheobronchomegaly): An analysis of eleven cases.

BACKGROUND AND AIM: Mounier-Kuhn syndrome (MKS) is a congenital disorder characterized by tracheobronchomegaly resulting from the absence of elastic fibers in the trachea and main bronchi or atrophy and thinning of the smooth muscle layer. In this syndrome, dead space associated with tracheobronchomegaly increases and discharge of secretions decreases because of ineffective coughing. The most common complications are recurrent lower respiratory tract infections and bronchiectasis. We examined the clinical characteristics, radiological features, and related complications of patients with MKS. METHODS: The cases were obtained between September 2007 and November 2015. Computed tomography scans of the chest were used to diagnose tracheobronchomegaly. RESULTS: All cases (a total of 11) were males with a mean age of 63 ± 13 (range, 38-80) years. The mean diameter of the trachea was 31.53 ± 2.99 mm; the mean transverse diameter was 31.69 ± 3.10 mm and the mean sagittal diameter was 31.36 ± 3.01 mm. Complaints at the time of presentation included chronic cough, purulent sputum, dyspnea, and hemoptysis. There were recurrent pulmonary infections in seven cases, bronchiectasis in six, and tracheal diverticulum in four at the time of diagnosis. CONCLUSIONS: In this article, 11 cases with various rarely seen complications are presented and evaluated in the light of current literature. We recommend that if chronic cough, recurrent pulmonary infections, and bronchiectasis seen in a patient, MKS should be kept in mind.

Major Depression in Long-Term Oxygen Therapy Dependent Chronic Obstructive Pulmonary Disease.

PURPOSE: We aimed to investigate the frequency of major depression (MD) in long-term oxygen therapy (LTOT) dependent chronic obstructive pulmonary disease (COPD) patients and the effect of depression on patients' compliance with the treatment. DESIGN AND METHODS: Fifty-four consecutive patients were enrolled in the study and diagnosed as stage 4 COPD according to Global Initiative for Chronic Obstructive Lung Disease guideline. MD was diagnosed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. FINDINGS: Thirty-four (63.0%) patients had MD. MD frequency was significantly higher in patients who were noncompliant with LTOT compared with compliant patients. PRACTICE IMPLICATIONS: MD is a common psychiatric disorder in COPD patients receiving LTOT.

Polysomnographic findings in persistent allergic rhinitis.

PURPOSE: Persistent allergic rhinitis (PAR) is characterized by a chronic, eosinophilic inflammation with nasal congestion and rhinorrhea. Nasal congestion can constitute to sleep-disordered breathing problems that range from simple snoring to obstructive sleep apnea syndrome (OSAS). The purpose of this study was to investigate the effect of PAR on sleep quality and severity of OSAS. METHODS: The study included 150 patients presenting with typical symptoms of sleep apnea. Fifty-five patients were diagnosed as PAR (group-1) and were compared with age and body mass index matched 95 individuals (group-2) without any nasal disease. Skin prick tests and polysomnography were performed in all patients. RESULTS: There were no differences between groups for polysomnographic findings including sleep architecture, arousal and respiratory index, and mean and minimal oxygen saturations. Simple snoring was determined in 41.8 % allergic and 32.6 % non-allergic patients. Mild OSAS was determined in 32.7 % allergic and 29.4 % non-allergic patients. Moderate OSAS was determined in 9 % allergic and 17.8 % non-allergic patients. Severe OSAS was determined in 16.3 % allergic and 20 % non-allergic patients. Their entire Epworth sleepiness scale index was also found similar. CONCLUSIONS: Our data pointed out that in patients with sleep-related breathing disorders symptoms, presence of PAR does not affect polysomnographic parameters compared with other patients without any nasal inflammation. Besides, prevalence of OSAS was similar between groups.

Lung damage due to low-voltage electrical injury.

Contact with high- or low-voltage electricity can cause injury. Low-voltage damage is more common and widespread, although there is little information on it in the literature. Exposure to an electrical current can effect every organ system in the body. The degree of damage is related to many factors, including the duration of exposure, type of current, and nature of the affected tissue. An unusual low-voltage electrical injury with a serious pulmonary lesion is presented, including the clinical intervention and imaging findings. We present a 20-year-old male electrician who sustained direct electrical damage to the pulmonary parenchyma, with no signs of chest wall damage, when exposed to a 380 V shock while working. Imaging demonstrated an electrical burn of the posterior right lower lobe. This case demonstrates that a low-voltage electric current can cause lung damage. A timely diagnosis is required for treatment.

Increased Exhaled 8-Isoprostane and Interleukin-6 in Patients with Helicobacter pylori Infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection triggers both local inflammation, usually in gastric mucosa, and chronic systemic inflammation. It is assumed that this local and systemic inflammation is caused by extracellular products excreted by H. pylori. The aim of this study was to investigate the possible association between H. pylori infection and a local inflammatory response in the airway by using exhaled breath condensate technique. MATERIALS AND METHODS: This study includes 41 H. pylori seropositive patients who have gastric symptoms and 27 healthy control subjects. Pulmonary function tests (PFT), chest X ray, and physical examination were performed in all patients and interleukin-6 (IL-6), 8-isoprostane and nitrotyrosine levels were measured in exhaled breath condensate. RESULTS: Levels of IL-6 and 8-isoprostane in exhaled breath condensate (EBC) were significantly higher in H. pylori positive patients than control subjects (p < 0.05). Nitrotyrosine levels were also higher in H. pylori positive patients but the difference was not statistically significant. Both groups had similar leukocyte counts, C-reactive protein (CRP) levels and PFT parameters. CONCLUSION: H. pylori infection causes an asymptomatic airway inflammation which can be detected by exhaled breath condensate. The clinical importance of this inflammation remains unclear.

Influence of obstructive sleep apnea on ischemia-modified albumin levels and carotid intima-media thickness.

Obstructive sleep apnea (OSA) is associated with an increased risk of atherosclerosis. Carotid intima-media thickness (CIMT) is strongly associated with the presence of significant risk factors for cardiovascular disturbances. A disturbance in the oxidative/antioxidative balance is involved in the pathogenesis of OSA and cardiovascular diseases. Ischemia-modified albumin (IMA) is suggested as a novel marker of oxidative stress; IMA can be defined as decreased binding of transitional metal ions to serum albumin in oxidative status. The purpose of this research was to evaluate the influence of OSA on IMA levels and CIMT. In total, 61 individuals with OSA with no comorbidities and 24 healthy controls with a similar body mass index and age were enrolled in this study. Serum levels of IMA, CIMT (estimated radiologically), and polysomnographic parameters, were determined and interpreted. Serum IMA levels were significantly higher in individuals with OSA compared with the control group (p=0.0003). CIMT was significantly higher in the OSA group compared with the control group (0.88± 0.26 mm vs 0.75±0.17 mm, p=0.005). The CIMT and serum IMA levels were positively correlated with the apnea-hypopnea index (r=0.35 and r=0.32, respectively), and with the oxygen desaturation index (r=0.34 and r=0.29, respectively) at baseline. Increased IMA levels and CIMT may be related to increased oxidative stress and risk of atherosclerosis in individuals with OSA.

Electrophysiological assessment in patients with long term hypoxia.

OBJECTIVE: To evaluate visual evoked potentials (VEP) patterns in chronic obstructive pulmonary disease (COPD) patients who were compliant with supplemental oxygen treatment relative to non-compliant COPD patients. METHODS: This prospective study protocol was reviewed and approved by the local ethical committee of Selcuk University and the research was performed in the Department of Neurology, Elbistan State Hospital, Kahramanmaras, Turkey from May to October 2014. Blood gas measurements and pulmonary function tests were carried out in patients with advanced stage COPD. The VEP was assessed in both eyes in both compliant and non-compliant patients. RESULTS: The study included 43 patients; 24 (55.8%) of the patients were not in compliance with their supplemental oxygen treatment, while 19 patients (44.2%) received adequate oxygen treatment. There was no statistically significant difference between patients with regards to pulmonary function test results and blood gas measurements. The VEP latency was significantly greater in both eyes of the non-compliant patients. CONCLUSION: Previous studies have reported prolonged VEP latencies in inflammatory diseases of the central nervous system. Similar electrophysiological findings were observed in our study and we propose that this may be due to oxidative stress, and inflammation that occurs secondary to chronic ischemia.

Depressive Symptoms in Patients with Obstructive Sleep Apnea.

OBJECTIVES: Different studies have investigate depressive symptom degree within sleep disordered patients with obstructive sleep apnea (OSA). However, little is known and unclear about OSA in patients with depression symptom in the literature. The purpose of this study was to investigate patients with OSA would have a higher prevalence of depression symptom relative to control patients. MATERIAL AND METHODS: 72 patients with OSA (AHI ≥ 5) and 24 control subjects (AHI < 5) were assessed for depression symptom using the Beck Depression Inventory. Participants were underwent an overnight polysomnography assessment. An apnea-hypopnea index ≥ 5 events per hour was used as diagnosis for OSA. The associations between each total score on the Beck Depressive Inventory (BDI) and polysomnographic parameters were examined by correlation analysis. RESULTS: We demonstrated that BDI scores has statistically significant correlation with the OSA in our present study according to similar previous studies (p= 0.008). Oxygen Desaturation Index (ODI) has correlated with BDI (r= 0.31). CONCLUSION: These findings show that the frequency depression symptom is higher among individuals with OSA. Patients with OSA should be screened cautiously for depressive disorders.

A prediction model based on artificial neural networks for the diagnosis of obstructive sleep apnea.

BACKGROUND: Recently, artificial neural networks (ANNs) have been widely applied in science, engineering, and medicine. In the present study, we evaluated the ability of artificial neural networks to be used as a computer program and assistant tool in the diagnosis of obstructive sleep apnea (OSA). Our hypothesis was that ANNs could use clinical information to precisely predict cases of OSA. METHOD: The study population in this clinical trial consisted of 201 patients with suspected OSA (140 with a positive diagnosis of OSA and 61 with a negative diagnosis of OSA). The artificial neural network was trained by assessing five clinical variables from 201 patients; efficiency was then estimated in this group of 201 patients. The patients were classified using a five-element input vector. ANN classifiers were assessed with the multilayer perceptron (MLP) networks. RESULTS: Use of the MLP classifiers resulted in a diagnostic accuracy of 86.6 %, which in clinical practice is high enough to reduce the number of patients evaluated by polysomnography (PSG), an expensive and limited diagnostic resource. CONCLUSIONS: By establishing a pattern that allows the recognition of OSA, ANNs can be used to identify patients requiring PSG.

Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients.

BACKGROUND: A number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD) COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function. METHODS: The present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: <26 points) and MMSE (cutoff: ≤24 points) scores were compared between these two groups. RESULTS: The nonuser LTOTD-COPD group had a significantly lower MoCA score than that of the regular-user LTOTD-COPD group (19.38±2.99 vs 21.68±2.14, respectively) as well as a significantly lower MMSE score. Moreover, the absence of supplemental oxygen therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014), and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year. CONCLUSION: In the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as continuous supplemental oxygen treatment, should be considered during the management of COPD in this population. In addition, the MoCA score was superior to the MMSE score for the determination of cognitive impairment in the nonuser LTOTD-COPD patients.

Airway inflammation and tiotropium treatment in stable COPD patients.

BACKGROUND/AIM: Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lung associated with progressive airflow limitation. The aim of this study is to assess the influence of tiotropium treatment on airway inflammation and symptoms in stable COPD patients. MATERIALS AND METHODS: Inflammatory markers were measured in the expired breath condensate fluid (EBC) before starting tiotropium treatment and at the end of the first month. RESULTS: Twenty-two patients (81% men) with a mean age of 65.4 ± 10.1 years completed the study. The mean nitrotyrosine and 8-isoprostane levels for oxidative stress markers in EBC before and after treatment were 4.5 ± 2.3, 3.5 ± 1.9 pg/mL (P = 0.06) and 7.3 ± 10.8, 8.1 ± 11.7 pg/mL (P = 0.28), respectively. The mean interleukin-6 and tumor necrosis factor-alpha levels for inflammation markers in EBC before and after treatment were 1.03 ± 1.1, 0.77 ± 0.8 pg/mL (P = 0.41) and 27.8 ± 2.6, 29.2 ± 5.7 pg/mL (P = 0.36) respectively. The mean symptom scores decreased significantly with tiotropium and a mean increase of 124.6 ± 0.86 mL was observed in a lung function test (FEV1). CONCLUSION: Although a 4-week treatment with tiotropium did not modify any of the inflammatory or oxidative stress markers in EBC fluid, tiotropium treatment helps to control symptoms in COPD.