Carotid intima‐media thickness in chronic obstructive pulmonary disease and survival: a multicenter prospective study

Introduction: Chronic obstructive pulmonary disease (COPD) is associated withincreased 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 andCIMT.Methods: CIMT was measured using Doppler ultrasound (USG) in 668 stable COPDpatients at 24 centers. Patients were followed-up for 2 years.Results: There were 610 patients who completed the study. There were 200 patientsCIMT with 0.05).Conclusion: This study is the first regarding CIMT with combined GOLD assessmentgroups. It has revealed important findings supporting the increase in atherosclerosisrisk in COPD patients. We recommend Doppler USG of the carotid artery inCOPD patients at severe stages

Factors associated with noninvasive ventilation response in the first day of therapy in patients with hypercapnic respiratory failure

Background and Aim: Noninvasive ventilation (NIV) decreases mechanical ventilation indication in the early period of acute hypercapnic respiratory failure (AHcRF) and factors for success have been studied well. But, less is known about the factors influencing the NIV response in the subacute period. This study was aimed to determine the factors influencing the reduction of PaCO 2 levels within first 24 hours of therapy. Methods: NIV response was defined as reduction of PaCO 2 level below 50 mmHg within first 24 hours. Patients with AHcRF, treated with NIV, were divided into 2 groups according to this criterion; group 1 as the nonresponsive, group 2 as the responsive. The differences in NIV methods and characteristics of the two groups were evaluated and compared in this retrospective study. Results: A total of 100 patients were included in the study; 66 of them in group 1 and 34 in group 2. No significant differences were identified between the length of NIV application and intensive care unit (ICU) stay, intubation and mortality rates, across the groups. Ninety-one percent of the patients in group 2 had received all night long NIV therapy; this was just 74% in group 1 (P=0.036). Results of multivariate analysis showed that while nocturnal application was significantly associated with better response, prior home ventilation and requirement of higher pressure support (PS) levels significantly and independently associated with poorer response to NIV therapy. Conclusion: In patients with AHcRF, all night long use of NIV may accelerate healing by improving PaCO 2 reduction within the first 24 hours. A rapid response in PaCO 2 levels should not be expected in patients requiring higher PS levels and using prior home ventilation

Chronic obstructive pulmonary disease phenotypes in Turkey: the COPET study-a national, multicenter cross-sectional observational study

Background/aim: While mortality rates decrease in many chronic diseases, it continues to increase in COPD. This situation has led to the need to develop new approaches such as phenotypes in the management of COPD. We aimed to investigate the distribution, characteristics and treatment preference of COPD phenotypes in Turkey. Materials and methods: The study was designed as a national, multicenter, observational and cross-sectional. A total of 1141 stable COPD patients were included in the analysis. Results: The phenotype distribution was as follows: 55.7% nonexacerbators (NON-AE), 25.6% frequent exacerbators without chronic bronchitis (AE NON-CB), 13.9% frequent exacerbators with chronic bronchitis (AE-CB), and 4.8% with asthma and COPD overlap (ACO). The FEV 1 values were significantly higher in the ACO and NON- AE than in the AE-CB and AE NON-CB (p < 0.001). The symptom scores, ADO (age, dyspnoea and FEV 1) index and the rates of exacerbations were significantly higher in the AE-CB and AE NON-CB phenotypes than in the ACO and NON-AE phenotypes (p < 0.001). Treatment preference in patients with COPD was statistically different among the phenotypes (p < 0.001). Subgroup analysis was performed in terms of emphysema, chronic bronchitis and ACO phenotypes of 1107 patients who had thoracic computed tomography. A total of 202 patients had more than one phenotypic trait, and 149 patients showed no features of a specific phenotype. Conclusion: Most of the phenotype models have tried to classify the patient into a certain phenotype so far. However, we observed that some of the patients with COPD had two or more phenotypes together. Therefore, rather than determining which phenotype the patients are classified in, searching for the phenotypic traits of each patient may enable more effective and individualized treatment