Comorbidities: assessment and treatment

COPD is an umbrella term that is associated with several systemic manifestation, lung involvement, and comorbidities [1, 2]. Currently, the description of comorbidity is complicated and has three different domains: “(1) the coexistence of one or more diseases with no other causation, (2) coexistence of diseases that share common risk factors and pathogenic pathways, (3) coexistence of diseases that are complicated by the interaction with the lung and systemic manifestation of COPD” [3]. In a very recent study, BODE Investigator Group suggested that COPD is interlinked with several comorbidities larger than non-COPD controls indicating common pathobiological process [4]. The importance of comorbidities is their impact on clinical outcomes of a patient life. COPD is a life-threatening and disabling disease and comorbidities cause additional impact revealing impairment in quality of life and increasing mortality [3]

Cryptogenic and secondary organizing pneumonia: Clinical presentation, radiological and laboratory findings, treatment, and prognosis in 56 cases

OBJECTIVES: Organizing pneumonia is an important disease that is associated with non-specific clinical findings and radiographic appearance. Our aim was to examine the clinical and radiological features, laboratory findings, diagnostic approach, and response to therapy in subjects with cryptogenic (COP) and secondary organizing pneumonia (SOP). MATERIALS AND METHODS: Patients’ medical records were retrospectively reviewed between 2010 and 2016 in our hospital. We analyzed the symptoms, radiological features, pulmonary function tests, laboratory data, bronchoalveolar lavage findings, treatment, and prognosis. RESULTS: Thirty-seven patients were diagnosed with COP and 19 patients with SOP. The most common causes of SOP were determined as rheumatologic diseases. The most common symptoms were cough (71.4%) and dyspnea (66.1%). Bilateral symmetrical consolidations were the most prominent radiological appearance in both COP and SOP. The general radiographic findings were not different in COP and SOP. However, pulmonary lesions were located rather in the central (p=0.023) and middle (p=0.001) zones in patients with SOP. Corticosteroid (CS) therapy was administered to 34 (60.7%) patients. Two patients showed deterioration despite CS therapy. CONCLUSION: The clinical and radiographic findings, treatment response, prognosis were similar in patients with COP and SOP

Cryptogenic and secondary organizing pneumonia: Clinical presentation, radiological and laboratory findings, treatment, and prognosis in 56 cases

OBJECTIVES: Organizing pneumonia is an important disease that is associated with non-specific clinical findings and radiographic appearance. Our aim was to examine the clinical and radiological features, laboratory findings, diagnostic approach, and response to therapy in subjects with cryptogenic (COP) and secondary organizing pneumonia (SOP). MATERIALS AND METHODS: Patients’ medical records were retrospectively reviewed between 2010 and 2016 in our hospital. We analyzed the symptoms, radiological features, pulmonary function tests, laboratory data, bronchoalveolar lavage findings, treatment, and prognosis. RESULTS: Thirty-seven patients were diagnosed with COP and 19 patients with SOP. The most common causes of SOP were determined as rheumatologic diseases. The most common symptoms were cough (71.4%) and dyspnea (66.1%). Bilateral symmetrical consolidations were the most prominent radiological appearance in both COP and SOP. The general radiographic findings were not different in COP and SOP. However, pulmonary lesions were located rather in the central (p=0.023) and middle (p=0.001) zones in patients with SOP. Corticosteroid (CS) therapy was administered to 34 (60.7%) patients. Two patients showed deterioration despite CS therapy. CONCLUSION: The clinical and radiographic findings, treatment response, prognosis were similar in patients with COP and SOP

Evaluation of COPD patient’s relatives assessment of disease awarness, load of care giving and loss of workforce: Turkish Thoracic Society COPD working group

Objective: Our aim is to measure the level of awareness of patient’s relatives COPD, to determine the caregiver burden of patient's relatives, and to determine whether there is a work day loss. Material and method: 252 COPD patients and 252 patient’s relatives from 11 centers were included in this questionnaire study. Ethics committee was approval. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the patient’s relatives were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days and Zarit Scale used in chronic diseases were used. Results: 128(50.8%) of the patients according to GOLD were group-D.97(38.5%) of the patient's relatives were working. 253(94.4%) knew that COPD was a lung disease. 62(24.7%) were not able to go to work for 1-14 days. 125(57.1%) spent outside the home from 1 to 14 nights, because those accompanied to patients. In univariate analysis were detected mMRC(p<0.001), CAT(p<0.001), the number of comorbidities of patients(p=0.027),Conclusion: In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psycho-social and legal regulations should be investigated and solutions should be produced for the person who gives care to COPD patients

Covid-19 The biggest threat of the 21st century in respectful memory of the warriors all over the world

Since the first case was diagnosed in China, the new coronavirus infection (COVID-19) has become the number one issue in the world and it seems to remain trend-topic for a long time. Until 17 April, it affected 210 countries, infected over 2 million people and caused approximately 150000 deaths. Although the course of the disease ranges from asymptomatic state to severe ARDS; the majority of patients reveal only mild symptoms. Though adults are the most commonly affected group; it can also be seen in newborns and elderly patients. Unfortunately, elderly patients are the most vulnerable group with higher mortality. Elderly patients, smokers and patients with comorbid conditions are most affected by the disease. In certain diagnostical tool is the real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test. However, it can be resulted in false-negative results and in this case the computed thorax tomography (CT) is one of the most important tools with high sensitivity. Besides the supportive treatment, most commonly used agents are immunomodulatory drugs such as plaquenil and azitromycin, and anti-virals including oseltamivir, ritonavir-lopinavir, favipiravir. Until a vaccine or a specific therapy invented, the most important intervention to control the disease is to fight against transmission. This is a real war and the doctors are the soldiers

The effect of blood urea nitrogen/albumin ratio in the short-term prognosis of chronic obstructive pulmonary disease

Objective: There is no definite laboratory parameter in predicting short-term prognosis in patients with chronic obstructive pulmonary disease (COPD). Our aim was to evaluate the prognostic effect of serum blood urea nitrogen (BUN)/albumin ratio in COPD patients. Materials and Methods: A retrospective study comprising of 264 COPD patients who were in exacerbation period and selected from 4 centers was carried out. Data on demographic characteristics, disease characteristics, comorbid conditions and short-term prognosis of patients were obtained. and analyzed. Results: The BUN/Albumin ratio was higher in patients with oxygen saturation <90% (p=0.004). There was no difference between global obstructive lung disease (GOLD) stages means of BUN/Albumin ratio but this rate was higher in those with infective exacerbations (p=0.019). The BUN/albumin ratio of patients who were discharged (5.3±2.2) was significantly high er than the patients who were transferred to the intensive care unit [ICU] (11.7±6.0) (p<0.0001). The cut-off level of BUN/ albumin ratio in prediction of the need for ICU was7.2 (sensitivity 80%, specificity 85.4%) and the area under the receiver operating characteristic (ROC) curve was 0.911 (95% CI: 0.861–0.961) (p<0.001). The cut-off level of BUN/albumin ratio in prediction of mortality was 8.1 (sensitivity 88.2%, specificity 85.4%) and the area under the ROC curve was 0.963 (95% CI: 0.930–0.995) (p<0.001). Conclusion: BUN/albumin ratio can be used as an affordable, inexpensive and practical method for determining the short term prognosis in hospitalized COPD patients. Prospective studies involving more patients are needed

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients

he COVID-19-related death rate varies between countries and is affected by various risk factors. This multi center registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corre sponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ?65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Sex difference in chronic obstructive lung disease. Does it matter? a concise review

Chronic obstructive lung disease (COPD) primarily affects men; however, its epidemiology has been changing because more women have become smokers. Recently, investigators found that although women and men were exposed to the same amount of smoke fume, women tended to have more severe disease and higher mortality rate. They also complain of more dyspnoea and may experience more severe exacerbations than men. This led to the question of whether sex has an impact on COPD course and whether women have a higher susceptibility to smoke fumes than men. That may be explained by multiple complex factors highlighting the relationship between sex, epidemiology, method of diagnostics and the clinical course of the disease. In this review, sex differences in epidemiology, clinical presentation, exacerbation, co-morbidities and treatment are covered