Investigation of respiratory physiopathology by determination of pulmonary gas exchange and ventilation dynamics in chronic lung diseases

Kronik akciğer hastalıklarında pulmoner gaz değişimi ve ventilasyon dinamiklerini incelemek amacıyla bu araştırma amaçlanmıştır. Kronik akciğer hastalıklarının toplumda en sık rastlanılanı olması sebepiyle Kronik Obstrüktif Akciğer Hastalığı (KOAH) olan olgular ile akciğer kanseri eşlik ettiği zaman olan değişiklikler ve restriktif paternde solunum yetmezliğine neden olan interstisyel akciğer hastalığı prototiplerinden olan idiyopatik pulmoner fibrozisli olgular hem solunum fonksiyon testleri hem de kardiyopulmoner egzersiz testleri ile değerlendirilmiştir. Ventilasyon volümleri, anaerobik eşik ile ilişkili olarak üç hastalık durumunda fark olup olmadığı araştırılmıştır. Bursa Uludağ Üniversitesi Göğüs Hastalıkları polikliniğine başvuran KOAH’lı (Grup 1) 10, akciğer kanserli (Grup 2) 9 ve idiyopatik pulmoner fibrozisli (Grup 3) 8 olgu çalışmaya alındı. Grupların yaş ortalamaları sırasıyla 65,00 ± 3,17; 66,67 ± 2,70 ve 62,50 ± 3,25 yıl idi. Grup 1 ve 2’de obstrüktif solunum yetmezliği mevcut iken Grup 3’de rekstriktif solunum yetmezliği vardı. Kardiyopulmoner egzersiz testleri (KPET) standart protokol ile uygulandı. Maksimum oksijen tüketimi (VO₂max) Grup 1’de 14,29 ± 1,17 saptanırken Grup 2’de 13,31 ± 1,31, Grup 3’de 12,50 ± 1,76 saptandı. Anaerobik eşik değerleri sırasıyla Grup 1’de 0,70 ± 0,04 ve Grup 2’de 0,68 ± 0,03; Grup 3’de 0,71 ± 0,12 olarak saptandı. Solunum fonksiyon testleri değerlendirildiğinde Grup 3’ün FEV₁, FEV₁/FVC değerleri diğer iki gruba göre anlamlı yüksekti (p<0.05). Oksijen nabzının beklenen değeri ve RR arasında da anlamlı farklılık saptandı (p<0.05). Sonuç olarak kronik akciğer hastalıklarında ventilasyon dinamikleri bozulmaktadır.This study was aimed to examine the pulmonary gas exchange and ventilation dynamics in chronic lung diseases. Since chronic lung diseases are the most common in the society, patients with Chronic Obstructive Pulmonary Disease (COPD), changes when lung cancer accompanies, and cases with idiopathic pulmonary fibrosis, which is one of the prototypes of interstitial lung disease that causes respiratory failure in a restrictive pattern, perform both pulmonary function tests and cardiopulmonary exercise. evaluated with tests. It was investigated whether there was a difference in the three disease states in relation to ventilation volumes and anaerobic threshold. Ten patients with COPD (Group 1) and 9 patients with lung cancer (Group 2) who applied to the Bursa Uludag University Chest Diseases outpatient clinic were included in the study. The mean age of Groups were 65.00 ± 3.17; 66.67 ± 2.70 and 62.50 ± 3.25 years. Group 1 and 2 had obstructive respiratory failure; Group 3 had restrictive respiratory failure. Cardiopulmonary exercise tests (CPET) were performed with a standard protocol. Maximum oxygen consumption (VO₂max) was 14.29 ± 1.17 in Group 1, while it was 13.31 ± 1.31 in Group 2 and 12.50 ± 1.76 in Group 3. Anaerobic threshold values were found to be 0.70 ± 0.04; 0.68 ± 0.03; 0.71 ± 0.12 in Groups 1, 2 and 3. When the pulmonary function test was evaluated, the FEV₁, FEV₁/FVC values of Group 3 were higher than the other two groups (p<0.05). A measurement indicator was also detected between the expected value of the oxygen pulse and the RR (p<0.05). As a result, ventilation dynamics deteriorates in chronic lung diseases

Effects of the COVID-19 pandemic on the follow-up and treatment of patients with idiopathic pulmonary fibrosis: a cross-sectional, multicentre phone call survey

Objective To learn about the attitudes and behaviours of patients with idiopathic pulmonary fibrosis (IPF) in relation to the difficulties experienced during the COVID-19 pandemic. Design A cross-sectional, multicentre phone call survey. Setting Four university hospitals in Turkey. Participants The study included patients with IPF receiving antifibrotics for at least 3 months and with doctor appointment and/or scheduled routine blood analysis between March and May 2020 (the first 3 months after the official announcement of the COVID-19 pandemic in Turkey). Interventions Phone calls (a 5 min interview) were performed in June 2020. A questionnaire and the Hospital Anxiety-Depression Scale were applied. Main outcome measures Patients' preferences for disease monitoring, patients' attitudes and behaviours towards IPF, drug continuation, COVID-19 diagnosis and anxiety/depression status. Results The study included 115 patients with IPF (82 male; mean age, 68.43 +/- 7.44 years). Of the patients, 73.9% had doctor appointment and 52.2% had scheduled routine blood testing; 54.5% of patients with doctor appointment self-cancelled their appointments and 53.3% of patients with scheduled routine blood testing did not undergo testing. Of the patients, 32.2% were on nintedanib and 67.8% were on pirfenidone; self-initiated drug discontinuation rate was 22.6%. The percentage of patients communicating with their physicians was 35.7%. The route of communication was by phone (34.8%). The frequency of depression and anxiety was 27.0% and 38.3%, respectively. The rates of drug discontinuation (35.1% vs 16.7%, p50%) of patients self-cancelled their appointments and nearly a quarter of patients discontinued their medications. Providing a documentation of the problems experienced by patients with IPF about management of the necessary requirements during the COVID-19 pandemic, this study may be a model for patients with chronic diseases

Evaluation of efficacy and safety of pirfenidone 200 mg tablets in patients with idiopathic pulmonary fibrosis in a real-life setting

Background/aim: Phase III trials have demonstrated a significant efficacy and an acceptable safety for pirfenidone in patients having mild to moderate idiopathic pulmonary fibrosis (IPF). Real-life data on the use of pirfenidone 200 mg tablets are limited. This study aimed to investigate the efficacy and safety of pirfenidone 200 mg tablets for the treatment of IPF in a real-life setting. Materials and methods: A retrospective, multicenter study conducted in four university hospitals in Turkey between January 2017 and January 2019. Clinical records of patients diagnosed with mild to moderate IPF and receiving pirfenidone (200 mg tablets, total 2400 mg/day) were reviewed retrospectively and consecutively. Pulmonary function measurements including forced vital capacity (FVC%) and diffusing capacity of the lungs for carbon monoxide (DLCO%) were analyzed at baseline and after 6-month of pirfenidone treatment. Descriptive statistics were expressed as mean, standard error or median (minimum-maximum), number and percentage, where appropriate. Results: The study included 82 patients, of whom 87.8% were males (mean age, 66 years). After 6-month of treatment, 7 patients discontinued the treatment. Of the remaining 75 patients, 71 (94.6%) remained stable, 4 (5.4%) had progressive disease as evident by a decline in the FVC% of at least 10% while on treatment, and 45 (61.3%) had improved cough. At least one adverse event (AE) associated with the treatment was observed in 28 (37.3%) patients. Conclusion: Pirfenidone 200 mg was effective and well tolerated and associated with relatively mild and manageable AEs in IPF patients

Comparison of thoracic hrct and self-reported questionnaires in the assessment of pulmonary involvement in rheumatoid arthritis patients: preliminary results

Bu çalışma, 13-16, Haziran 2018 tarihlerinde Amsterdam[Hollanda]’da düzenlenen Congress of the European-League-Against-Rheumatism (EULAR) Kongresi‘nde bildiri olarak sunulmuştur.European League Against Rheumatis

Tolerability and efficacy of second-line antifibrotics in patients with idiopathic pulmonary fibrosis

Background: The antifibrotic drugs nintedanib and pirfenidone reduce disease progression in idiopathic pulmonary fibrosis (IPF) and have also shown to improve survival. Switching first-line antifibrotic drug may required in IPF due to disease progression or intolerable adverse effects. The aim of this study was to assess the safety and efficacy of second-line antifibrotic treatment in patients with IPF

Elderly idiopathic pulmonary fibrosis patients remain on therapy despite higher incidence of adverse events and dose reductions

Background: Idiopathic pulmonary fibrosis (IPF) predominantly affects people over the age of 60 years and its incidence increases with age. Limited data is available on the use of antifibrotics in the elderly IPF population. We aimed to examine the tolerability and safety of antifibrotics (pirfenidone, nintedanib) in elderly patients with IPF in a real-world setting. Methods: Medical records of 284 elderly (≥75 years) and 446 non-elderly IPF patients (<75 years) were retrospectively analyzed in this multi-center study. Patient characteristics, treatments, adverse events (AEs), tolerability, hospitalizations, exacerbations, and mortality were compared between the elderly and non-elderly group. Results: In the elderly group, the mean age was 79 years and the mean antifibrotic treatment duration was 26.1 months. The most commonly reported AEs were weight loss, loss of appetite and nausea. Elderly IPF patients had a significantly higher incidence of AEs (62.9% vs. 55.1%, p = 0.039) and dose reductions (27.4% vs. 18.1%, p = 0.003) than the non-elderly did, but the rate of discontinuation of antifibrotics was not different between groups (13% vs. 10.8%, p = 0.352). In addition, the severity of the disease, frequency of hospitalizations, exacerbations, and mortality rates were higher in elderly patients. Conclusion: The present study showed that elderly IPF patients experienced significantly increased AEs and dose reductions due to antifibrotic use, while the discontinuation rates of the drugs were similar to those of drugs used by non-elderly patients