Prevalence of copd in Denizli resting house and short term efficiency and safety of long acting anticholinergics in copd therapy

Amaç: Genel olarak ileri yasta, sosyoekonomik düzeyi düsük olan kisilerin olusturduğu huzurevi toplumunda, KOAH sıklığının ve KOAH tedavisinde yeni kullanım alanı bulan uzun etkili antikolinerjiğin, kısa süreli etkinlik ve güvenirliliğinin arastırılması. Metod: Denizli huzurevinde yasayan çalısma kriterlerini sağlayan 71 erkeğe, European Community Respiratory Healt Survey II (ECRHS II) anketinden modifiye edilerek hazırlanan anket, hekim tarafından yüz yüze uygulandı. Solunum fonksiyon testi ile, GOLD kriterlerine göre KOAH prevalansı bulundu. GOLD kriterlerine göre Evre2 hastalar ve Evre3 olup FEV1'i %40'ın üzerinde olanlar, randomizasyonla ikiye ayrılıp çift kör plasebo kontrollü çalısmaya alındı. Etken madde (tiotropium) ve plasebo aynı tip cihazla bir ay günde tek doz uygulandı. Çalısma öncesi ve sonrasında SFT, altı dakika yürüme testi ve üroflovmetrik inceleme yapıldı. Bulgular: En sık solunumsal yakınma nefes darlığıydı (%53,5). Bunu %40,8 ile sabah balgamı ve %35,2 sabah öksürüğü takip etti. GOLD kriterlerine göre 27 kisiye (%39,1) KOAH tanısı kondu. En fazla hasta, Evre 2 ve 3 grubunda yer almaktaydı (%29,6). KOAH tanısı alanların içtiği sigara ortalama 65,67 ± 41,03 paket.yıldı. Çalısma sonunda ilaç alan gruptaki FEV1 yüzde değerindeki artıs istatiksel olarak anlamlı bulundu ( p= 0,007). Çalısma sonunda hem istirahat hem de egzersiz satürasyon değeri ilaç alan grupta, plasebo alan gruba göre yüksekti. İlaç alan grup çalısma sonunda toplam 360 saniye olan altı dakika yürüme testini tamamlarken her iki grup ortalama olarak aynı mesafeyi yürüdüler (304 metre). Üroflovmetrik inceleme sonrasında ilaç alan grupta çalısma bitimindeki ölçümde saptanan mesanede kalan idrar miktarı, baslangıca göre 20 ml'den fazla idi. Bu da istatistiksel olarak anlamlıydı (p=0,025). Sonuç: Eğitim ve gelir düzeyi düsük, sigara öyküsü yoğun olan huzurevi erkek topluluğunda KOAH prevalansı yüksek bulundu. Her ne kadar antikolinerjik tedavisi solunum fonksiyonlarını düzeltsede yaslılarda üriner yan etkiler açısından dikkatli izlenmelidir.Aim: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) among the population lived in resting house who were at advanced aged and poor socioeconomic status. We also studied short term efficiency and safety of long acting anticholinergics in COPD therapy. Methods: Seventy-one male subjects filled a questionnaire which was modified from European Community Respiratory Health Survey II (ECRHS II) that was applied face to face by a physician. COPD prevalence was detected according to GOLD criteria. Double blind placebo controlled randomized two groups were formed according to stage II and stage 3 but FEV1 less than 40%. Tiotropium or placebo treatment was applied by similar equipment once a day. Pulmonary function tests (PFTs), six minute walking tests, and uroflowmeter were applied to the patients. Results: The most frequent respiratory symptom was dyspnea (53.5%), followed by morning expectoration (40.8%) and morning cough (35.2%). According to GOLD criteria, 27 males have been diagnosed as COPD. Most of the cases were in Stage 2 and 3 (29.6%). Mean cigarette smoking was 65.67±41.03 pacs.year. In the drug group, there was a statistically significant improvement in FEV1 %pred (p=0.007). In comparison with placebo group, the oxygen saturation at rest and exercise were higher in the Tiotropium group. All the patients in Tiotropium group were completed 6 minute duration and in both groups walking distance was same (304m). By uroflowmeter examination, the residue urine was increased 20ml with Tiotropium treatment. When compared with the placebo group, the difference was statistically significant. Conclusion: The COPD prevalence was found high among the resting house male residents, whom the level of education and income was low and the smoking was frequent. However the anticolinegic treatment improves pulmonary function, it must be supervised carefully according to urinary side effects in elderly

Case Report - A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

The natural history of chronic obstructive pulmonary disease (COPD) is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH). Noninvasive positive pressure ventilation (NPPV) treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO2 and decrease PaCO2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment

A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

The natural history of chronic obstructive pulmonary disease (COPD) is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH). Noninvasive positive pressure ventilation (NPPV) treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO2 and decrease PaCO2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment

Idiopathic Chronic Eosinophilic Pneumonia: Retrospective Analysis of 17 Cases from a Single Center in Turkey

Objective: Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare eosinophilic lung disorder with an unknown etiology and is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or peripheral eosinophilia, and the accumulation of eosinophils in the lungs. We aimed to present diagnostic test results and follow-up outcomes of 17 patients who were diagnosed with ICEP in our hospital in light of literature. Methods: Between 2008 and 2013, we examined 17 cases of ICEP. We evaluated clinical and laboratory findings together with the long-term follow-up data. Results: The patients had a mean age of 40.8 years at presentation, and the female/male ratio was 0.8. The most common symptoms were cough (94%), shortness of breath (76%), and high fever (35%). Bronchoalveolar lavage eosinophil percentages of the patients ranged from 3% to 80%. Nine (53%) patients experienced recurrence. Six patients were maintained on low dose steroid due to repeating relapses. Among these patients, 7 (77.7%) had a total IgE level of above 500/IU/mL. Conclusion: Relapses are common in ICEP after the withdrawal of corticosteroid treatment or during dose reduction. We point out the importance of the close monitoring of patients for identifying relapse. A higher total IgE level during diagnosis may serve as a predictor of recurrence

Pulmonary Hamartomas: A Report of 13 Parenchymal and Endobronchial Cases

Objective: To analyze clinical, radiographic, bronchoscopic, and therapeutic characteristics of a series of patients in whom pulmonary hamartoma had been diagnosed. Methods: Retrospective review of cases of pulmonary hamartomas diagnosed by biopsy between January 2007 and May 2012 in a tertiary referral hospital in İstanbul, Turkey. Results: Of the 13 patients with histologically confirmed pulmonary hamartoma, seven were men and six were women (male/female 1.2/1). Their age ranged from 45 to 68 years old. Three patients were asymptomatic. The duration of symptoms ranged from one week to two years. Chest radiograph findings were abnormal in all patients. The lesions were located in the right lung in nine cases, with lower lobe predilection. Among the patients with pulmonary hamartoma, four (30.8%) had endobronchial hamartoma. Treatment modality was wedge resection in five cases, enucleation in four cases, bronchoscopic procedures in three cases and lobectomy in one case. Follow-up ranged from one month to 54 months. No tumor recurrence was encountered in the follow-up period. Conclusion: Pulmonary hamartomas are uncommon benign lesions of the lung. They can be parenchymal or endobronchial in location. Parenchyma sparing surgical procedures such as wedge resection or enucleation and bronchoscopic intervention should be preferred in the treatment of pulmonary hamartomas

Familial Sarcoidosis: An Analysis of Twenty-Eight Cases

Objective: Sarcoidosis is a multisystemic disease, exact cause of disease is unknown but it is assumed that genetic predisposition and ethnic factors play a role in etiology. Studies related with familial sarcoidosis is limited and only case reports about familial sarcoidosis is available from our country. We aimed to evaluate the prevelance of familial sarcoidosis and clinical findings of cases with familial sarcoidosis. Methods: We retrospectively documented file records of 678 patients diagnosed with sarcoidosis and followed up in outpatient clinic of sarcoidosis from January 1996 to February 2016. 28 familial sarcoidosis cases in 14 families were enrolled into the study. Their demographic findings, family relationship, symptoms, laboratory and pulmonary function test results, radiological apperances, diagnostic methods, treatments were recorded. Results: Twenty-eight sarcoidosis patients out of 678 reported as familial cases, giving a prevelance of familial sarcoidosis as 4%. There were 8 sarcoidosis sib, 4 sarcoidosis mother-child, 1 sarcoidosis father-child and 1 sarcoidosis cousin relationship. Female/male ratio was 1.8, mean age of the study population was 43, most freguent symptoms were cough and dyspnea, stage 2 was mostly seen according to chest X-ray, most common CT appearance was mediastinal lymphadenopathy and mediastinoscopy was the most freguent diagnostic method. Conclusion: This study is important to lead interrogation of family in patients with suspected sarcoidosis and future studies investigating familial aggregation in sarcoidosis