[How exactly can we predict the prognosis of COPD]. / KOAH hastalarinin progresyonlarini ne ölçüde tahmin edebiliriz?

Predictive models play a pivotal role in the provision of accurate and useful probabilistic assessments of clinical outcomes in chronic diseases. This study was aimed to develop a dedicated prognostic index for quantifying progression risk in chronic obstructive pulmonary disease (COPD). Data were collected prospectively from 75 COPD patients during a three years period. A predictive model of progression risk of COPD was developed using Bayesian logistic regression analysis by Markov chain Monte Carlo method. One-year cycles were used for the disease progression in this model. Primary end points for progression were impairment in basal dyspne index (BDI) score, FEV(1) decline, and exacerbation frequency in last three years. Time-varying covariates age, smoking, body mass index (BMI), severity of disease according to GOLD, PaO2, PaCO(2), IC, RV/TLC, DLCO were used under the study. The mean age was 57.1 + or - 8.1. BDI were strongly correlated with exacerbation frequency (p= 0.001) but not with FEV(1) decline. BMI was found to be a predictor factor for impairment in BDI (p= 0.03). The following independent risk factors were significant to predict exacerbation frequency: GOLD staging (OR for GOLD I vs. II and III = 2.3 and 4.0), hypoxemia (OR for mild vs moderate and severe = 2.1 and 5.1) and hyperinflation (OR= 1.6). PaO2 (p= 0.026), IC (p= 0.02) and RV/TLC (p= 0.03) were found to be predictive factors for FEV(1) decline. The model estimated BDI, lung function and exacerbation frequency at the last time point by testing initial data of three years with 95% reliability (p< 0.001). Accordingly, this model was evaluated as confident of 95% for assessing the future status of COPD patients. Using Bayesian predictive models, it was possible to develop a risk-stratification index that accurately predicted progression of COPD. This model can provide decision-making about future in COPD patients with high reliability looking clinical data of beginning.

Relationship between airway colonization, inflammation and exacerbation frequency in COPD.

RATIONALE: To evaluate bacterial colonization and the airway inflammatory response, and its relationship to the frequency of exacerbation in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: Quantitative bacteriologic cultures, neutrophil elastase, myeloperoxidase (MPO), tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-8 were measured in bronchoalveoler lavage (BAL) in 39 patients with stable COPD [19 with frequent exacerbation (> or = 3/year), and 20 with infrequent] and in 18 healthy controls (10 smokers and 8 non-smokers). RESULTS: BAL revealed the microorganisms with potential pathogenicity above the established threshold (> or = 10(3)cfu/ml) in 68.4% of patients with frequent exacerbation, 55% of infrequent exacerbation, 40% of smokers and 12.5% of non-smokers controls (P=0.05). BAL MPO, IL-8 and TNF-alpha levels were found to be significantly higher in COPD as compared to controls (P=0.001). However, only IL-8 level was significantly higher in COPD patients with frequent exacerbation as compared to infrequent (P=0.001). Airway bacterial load correlated with levels of airway inflammation markers in COPD (P<0.05). CONCLUSION: The bacterial load and airway inflammation contributes to each other in stable COPD. However, there is a link only between interleukine (IL)-8 and frequent exacerbations. Clearly, the relationship between bacterial colonization, airway inflammation and frequent exacerbations is of major importance in understanding of the COPD pathogenesis.

Lung function impairment in women aged over 40 years: The critical role of abdominal obesity.

SUMMARY: It is known that obesity causes to impairment of pulmonary functions. This impairment worsens with aging. There are studies about obesity showing that the uses of abdominal measurements instead of BMI are more accurate.: PURPOSE: The aim of our study is to investigate the correlation of waist circumference in the women aged over 40 years with obesity to the respiratory function tests and chest expansion. MATERIALS AND METHODS: In our study, BMI, waist circumference and chest expansion of 64 women over 40-year old were measured and the values obtained were compared with the results of respiratory function tests. RESULTS: There was a positive correlation between the age of the patients with waist circumference and DLCO/VA. A negative correlation was found between the age and MVV. The weight increase was associated with an increase in waist circumference and DLCO/VA. It was observed that waist circumference and DLCO/VA were increased and chest expansion was decreased when BMI was increased. A positive correlation was determined between MVV and the other respiratory function parameters, FEV1, FVC, FEV1/FVC and FIVC (p < 0.01). Similarly, the increase in DLCO was found to be correlated with the values of FEV1, FVC and FIVC. FIVC was correlated only with FEV1 and FVC. CONCLUSION: In this study, it was observed that respiratory function tests of women over 40-year old with obesity were associated with anthropometric measurements. But, studies with larger sample sizes and prospective studies are needed to provide more accurate information about the importance of DLCO/VA for the assessment of pulmonary function in obese women.