Turkish Thoracic Journal最新文献

Objective: Aspirin desensitization is recommended for patients with nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, in whom asthma is uncontrolled despite medical treatment, and/or frequent endoscopic sinus surgery (ESS) is required due to nasal polyps. There are few studies in the literature on long-term follow-up of patients undergoing regular aspirin treatment after desensitization. This study aims to evaluate the effect of regular aspirin treatment on respiratory function, symptom control, quality of life, and the number of nasal surgeries required during a period of 12 years.

Material and methods: A total of 18 patients were included in the study in 2006; 11 patients were excluded and 7 patients regularly taking aspirin for 12 years were evaluated. Oral aspirin desensitization was performed at 4-6 weeks following the ESS. Patients receiving 300 mg/day aspirin were followed up in control visits every 3 months. Nasal and respiratory system examinations and pulmonary function test were performed, and all patients responded to the SF-36 Quality of Life scale during each visit.

Results: There was no change in respiratory function parameters following the12-year aspirin treatment. There was no statistically significant improvement in the quality of life; however, the need for ESS due to the recurrence of nasal polyps decreased significantly (P = .000). At the 12-year follow-up, all symptom scores improved, but improvement in the postnasal drip score was statistically significant (P = .046).

Conclusion: Long-term regular treatment with aspirin at a dose of 300 mg/day in patients with N-ERD improved symptom scores, and alleviated the need for ESS due to nasal polyp recurrence.

Objective: Chronic obstructive pulmonary disease (COPD) is an important health problem. The disease management consists of avoiding risk factors, therapy for maintenance of disease stability, and prevention and treatment of exacerbations. Patient education and motivational interviewing are thought to be effective approaches in disease management. This study aimed to investigate the effects of repeated education and motivational interviewing conducted by a multidisciplinary team, and the outcomes in COPD patients.

Material and methods: This was a randomized controlled study. The study included 40 COPD patients (21 cases and 19 controls) hospitalized for exacerbation of COPD between June 2015 and June 2017. The patients were randomized in a ratio of 1 : 1 based on age, gender, and socioeconomic status. After a baseline assessment for all patients, patients in the study group were subjected to a total of 3 educational sessions and 4 motivational interview sessions through intermittent invitations over a period of one year. At the end of the first year, baseline assessment tests, the technique of drug use, the number of moderate/severe COPD exacerbations, and mortality status were evaluated for all patients.

Results: There was no difference between the groups in terms of age, gender, and pulmonary function tests (FEV1%, FEV1/FVC) and partial oxygen and carbon dioxide pressures (pO2 and pCO2). At the end of the 12 months, there was a statistically significant difference between the groups in terms of the levels of theoretical knowledge of COPD and the Morisky scale scores. All patients in the study group survived, whereas 4 patients died in the control group, with a statistically significant difference between the 2 groups.

Conclusion: One-to-one education and motivational interviews (MI) on COPD, which are based on a multidisciplinary approach, are proposed, because they increase the level of knowledge of the disease and adherence to treatment, and have positive effects on mortality rates.

Objective: The efficiency and safety of American Society of Anesthesiologists (ASA) in predicting peri-bronchoscopic morbidity and mortality is an increasing concern as endobronchial ultrasound (EBUS) gains popularity. The purpose of this study is to investigate whether the ASA classification is useful in risk stratification for EBUS.

Material and methods: The patients who underwent EBUS and had anesthesia assessment before the procedure, were enrolled. Data about the age, gender, comorbidity, ASA score, and complications were collected retrospectively from their medical files.

Results: A total of 221 patients with ASA class documentation in anesthesia assessment before EBUS, were enrolled in the study. The study population comprised 125 (56.6%) male and 96 (43.4%) female patients with a mean age of 59.08 ± 11.15 years. Comorbidity was present in 161 patients (72.9%), of which hypertension (64%) was the most common. There was no significant difference between the pre-bronchoscopic and post-bronchoscopic values of oxygen saturation (SpO2), systolic and diastolic blood pressure, and heart rate (respectively P = .83, P = .12, P = .15, P = .89). The most frequent complication during EBUS was desaturation that happened in 109 (49.3%) patients. There was no correlation between ASA score and complications (P > .999). There was no statistically significant difference in ASA scores with respect to complications (P = .14). The sensitivity and the specificity of pre-bronchoscopic evaluation in predicting the post-anesthesia care unit (PACU)/intensive care unit (ICU) requirement, were 83.3% and 61%, respectively. The significant deciding factors for post-bronchoscopic follow-up sites were found to be as ASA and age (respectively, P = .025, P < .001).

Conclusion: There was no correlation between ASA and complications. To organize PACU/ICU beds more efficiently, a better scoring system is required.

Objective: Readmission after hospitalization for a chronic disease is a major concern of interest for health care quality. Our aim was to investigate the predictors and rates of early readmission after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary care hospital.

Material and methods: Over a 3-year period, patients hospitalized in our pulmonary disease clinic with a diagnosis of chronic obstructive pulmonary disease (COPD) and who had an index hospitalization for AECOPD were included. Readmission was defined as rehospitalization within 30 days of AECOPD discharge. Demographics, comorbidities, exacerbations, prior intensive care unit (ICU) stay, and long-term oxygen therapy (LTOT), blood eosinophil count, and antibiotic and/or steroid treatment at the index AECOPD admission were recorded.

Results: Fifty-two (17.3%) readmissions occurred in 300 patients. Readmissions were due to AECOPD in 46.2%, pneumonia in 19.2%, and cardiovascular disease in 15.4% patients. Twenty-one (40%) of the readmitted patients were frequent exacerbators. After adjusting for individual and clinical predictors, the odds ratio for readmission was 2.11 (95% CI, 1.07-4.15, P = .03) for those with congestive heart failure, 3.30 (95% CI, 1.05-9.75, P = .04) for those with arrhythmia, and 1.99 (95% CI, 1.04-3.81, P = .04) for LTOT users prior to AECOPD.

Conclusion: A significant majority of patients readmitted after an AECOPD mainly suffered from recurrent AECOPD. Associated congestive heart failure, arrhythmia, and prior LTOT were risk factors identified for early AECOPD readmissions in our study. Better recognition of readmission risk factors might help to reduce readmission rates of AECOPD.

Objective: The aim of the study is to develop a scale that could assess illness perception and reaction in patients with chronic obstructive pulmonary disease (COPD).

Material and methods: The study was conducted in patients who were admitted in the pulmonary disease departments of a public and a private hospital. The study included 271 COPD patients. The COPD Perception and Reaction Scale, consisting of 54 items, was prepared as a Likert-type 5-point rating scale. In the validity phase of the study, expert judgments were obtained for content validity, and explanatory and confirmatory factor analyses (EFA and CFA) were then performed. The reliability of the scale in terms of internal consistency was tested with the Cronbach's alpha coefficient.

Results: According to the results of the EFA, the COPD Perception and Reaction Scale consists of 3 subdimensions and 23 items. Factors are termed behavioral reaction, emotional reaction, and spiritual reaction. According to the CFA, the goodness-of-fit indices obtained (χ2/df = (676.47/227) 2.98 and RMSEA = 0.056, NFI = 0.80, CFI = 0.96, NFI = 0.91, and AGFI = 0.85) suggest that the recommended model for the scale is acceptable. The Cronbach's alpha coefficient was 0.74; Cronbach's alpha values for the subdimensions were calculated as 0.87 for "emotional reaction," 0.76 for "behavioral reaction," and 0.79 for "spiritual reaction."

Conclusion: The 23-item form of the COPD Illness Perception and Reaction Scale was demonstrated to be a valid and reliable scale for determining the perception and the reaction toward illness in COPD patients in Turkey.

Objective: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity worldwide. The aim of this study was to reveal the trend in direct costs related to COPD between 2012 and 2016, and to evaluate hospital costs in 2016, together with their subcomponents.

Material and methods: A population-based descriptive study was conducted using administrative healthcare data in Turkey. The total direct cost of COPD diagnosis-treatment for each year from 2012 to 2016, was calculated. The distribution of the hospital's COPDrelated costs for the year 2016 was also examined, together with morbidity data.

Results: The direct costs of the patients who were admitted to step 1, step 2, and step 3 health care centers between 2012 and 2016 increased by 41% [895 041 403TL ($496 930 501) in 2012 to 1 263 288 269TL ($417 834 197) in 2016]; the increase was 60% and 24%, for inpatient and outpatient groups respectively. In the year 2016, the direct total cost was 1003TL ($332) per patient. In 2016, mean specialist consultations per patient with mean cost per specialist consultation, and mean emergency visits per patient with mean cost per emergency visit, were 1.7, 42 TL ($14), and 0.4, 71TL ($23) respectively. For the inpatient group, the mean number of hospitalizations per patient, mean number of hospitalization days, and the mean cost per hospitalization were 0.4, 6.5, and 1926TL ($637), respectively.

Conclusion: When the readmissions of patients with COPD were evaluated together with the costs, and compared with the statistics from other countries, it was found that the costs per patient were lower in Turkey. However, the reasons for the significant rise in inpatient costs compared to outpatient costs should be investigated. Further investigations are required regarding pulmonary rehabilitation, home health care services, preventive measures for infections, management of comorbidities, and treatment optimization, which may reduce hospitalizations.

Objective: Disseminated tuberculosis (dTB) is an important health issue resulting from the hematogenous spread of Mycobacterium tuberculosis, and is associated with a globally significant burden of morbidity and mortality. Despite several studies from various countries, there are no data from Turkey specifically evaluating this special population. Our study aimed to evaluate the characteristics and treatment outcomes of dTB patients followed in our institution.

Material and methods: In the current case series, patients with dTB followed between 2017 and 2020 in our institution were retrospectively examined. Data regarding patient characteristics, diagnostic methods, organ involvement, radiological patterns, treatment regimen, and outcomes were recorded. Descriptive statistics were performed.

Results: In the present study, 23 dTB patients (median age 36, 56.5% male) were evaluated. The most common extrapulmonary manifestations were observed in the skeletal (n = 13) and genitourinary systems (n = 5). Multidrug-resistant TB was detected in 3 patients. The most common risk factors for dTB were living in a country with a high TB burden, and HIV infection.

Conclusion: Foreign-born patients were at high risk for disseminated TB in our study. HIV infection was also defined as the most important risk factor. Our data contribute to the current knowledge on the characteristics and outcomes of dTB patients in Turkey.

Objective: Although the damages to health that are caused by asbestos exposure are known, the mineral continues to be in use. Our main purpose in the study was to determine the relationship between awareness and asbestos use.

Material and methods: A total of 100 residents from the Armutova village of Ergani District in the Diyarbakir province of Turkey, with previous asbestos exposure were studied between January 2010 and December 2010. Exposure to asbestos was questioned in all participants. Asbestos doses were measured in the setting where they lived. The pulmonary function tests (PFTs) including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were performed, and chest radiography was taken.

Results: The duration of asbestos exposure was found to be associated with reduced PFTs and the pathological lung findings on radiology. Although 97% of the participants were aware of asbestos and its health risks, the rates of its use were significantly higher, and associated with excessive exposure levels. Longer duration of asbestos exposure was significantly associated with reduced FVC. There were more prominent reductions in FEV1 with longer durations of asbestos exposure.

Conclusion: The high rates of asbestos use indicate that changing habits, particularly among individuals residing in rural areas, is difficult. In our country, the main route of asbestos exposure is through the environment, which is at least as hazardous as occupational exposure.