Clinical factors and comorbidities affecting the cost of hospital-treated COPD

WOS: 000389085400001PubMed ID: 27980399Purpose: We aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship between comorbidities and clinical variables. Patients and methods: All patients hospitalized with a diagnosis of COPD exacerbation between January 1, 2014, and December 31, 2014, at all state hospitals of Aydin province, a city located in the western part of Turkey, were included in this study. The costs examined in the study pertained to medications, laboratory tests, hospital stays, and other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. Results: A total of 3,095 patients with 5,237 exacerbations (mean age, 71.9+/-10.5 years; 2,434 males and 661 females) were evaluated. For 880 of the patients (28.9%), or 3,852 of the exacerbations (73.1%), at least one comorbid disease was recorded. The mean cost of each exacerbation was $808.5+/-1,586, including$325.1+/-879.9 (40.7%) for hospital stays, $223.1+/-1,300.9 (27.6$46.3+/-49.6 (0.9%) for laboratory expenditures, and $214+/-1,068 (26.5$1,014.9 in patients with at least one comorbidity, whereas it was $233.6 in patients without comorbidity (P65 years, female gender, hospitalization in an intensive care unit, invasive or noninvasive mechanical ventilation, and a long duration of hospitalization were all found to be significant factors in increasing total costs during the exacerbations requiring hospitalization (P<0.05 for all). Conclusion: Comorbidities have an important role in the total costs of acute exacerbations of COPD. Strategies for the prevention, diagnosis, and effective management of comorbidities would decrease the overall financial burden associated with acute exacerbations of COPD

The evaluation of asthma and COPD patients in emotional status: A cross-sectional study

Background: Psychiatric comorbidities are prevalent in patients with chronic respiratory diseases. But, there is no clear evidence comparing asthma and COPD. The aim of the present study was to investigate and compare the emotional status of patients with asthma and COPD Methods: The study included 132 consecutive patients who were diagnosed with asthma (n=78) and COPD (n=54) who did not receive therapy for pshiciatric disorders. Emotional status were evaluated using the Beck and Hamilton surveys. Results: There was significant difference between patients asthma an COPD in terms of anxiety and depression level. The patients with COPD achieved significantly worse scores in emotional status. Anxiety and depression was significantly greater in patients with uncontrolled asthma. But, there was no significant correlation between GOLD stages and spirometric values and emotional disorders in COPD patients. Conclusions: It was concluded that anxiety and depression are prevalent in patients with COPD and particularly uncontrolled asthma, and patients with such chronic diseases; psychosocial support may be helpful, alongside the treatment of existing disease

The evaluation of asthma and COPD patients in emotional status: A cross-sectional study

Conclusions: It was concluded that anxiety and depression are prevalent in patients with COPD and particularly uncontrolled asthma, and patients with such chronic diseases; psychosocial support may be helpful, alongside the treatment of existing disease

The anti-inflammatory and anti-remodeling effect of tiotropium bromide in the subacute cigarette exposure mouse model

Chronic obstructive pulmonary disease is an inflammatory lung disease mainly caused by cigarette smoke inhalation. We aimed to evaluate the effect of tiotropium bromide, which is an anticholinergic bronchodilator, on inflammation and remodeling in the subacute cigarette exposure mice model. Thirty-five healthy 25-40 g male balbc mice were categorized into 3 groups: control group (n=7), those exposed to cigarette smoke (n=18), and those exposed to cigarette smoke and treated with tiotropium bromide (n=10). After 5 weeks, tiotropium or saline was administered to mice for a period of two weeks by inhalation. The mice were anesthetized, bronchoalveolar lavage was performed and lung tissues removed. Interleukin-1 beta (IL-1 beta), macrophage inflammatory protein-1 alpha (MIP-1 alpha), tumor necrosis factor a (TNF-alpha) measurements were made in BAL fluid. The lung tissues were fixated and sections were stained for morphological evaluation of the lung tissues. The presence of cells undergoing apoptosis and the macrophages were determined by immunohistochemical detection of caspase-3 and MAC387. We found that cigarette exposure significantly increased the IL-1 beta, TNF-alpha and MIP-1 alpha levels. Furthermore, tiotropium significantly improved the IL-1 beta, TNF-alpha and MIP-1 alpha levels (P<0.05). The smoke exposure group exhibited an increased thickness of the alveolar wall, pulmonary edema and hemorrhage, as well as infiltration of the inflammatory cells into the alveolar spaces. In the Thio group the interstitial fibrosis and inflammation were decreased compared to the smoke group. The numbers of MAC387-labeled cells and the caspase-3-labeled cells were higher in the smoke group than in the other groups (P<0.0001). Besides its bronchodilator effect, tiotropium may be a promising therapeutic choice to control inflammation and remodeling due to cigarette exposure

The value of preoperative pulmonary assessment in predicting postoperative pulmonary complications

WOS: 000466857400005OBJECTIVE: We aimed to determine the preoperative parameters that may predict postoperative pulmonary complications (POPCs) and the value of some current practical indexes in predicting POPCs. MATERIALS and METHODS: Our study is a retrospective cohort study carried out in 9 different centers. Patients admitted to the chest diseases outpatient clinic for preoperative evaluation were followed up during the 6-month study period. Patients with or without postoperative complications were evaluated retrospectively, and the effect of some parameters and indexes recorded during the preoperative evaluation of chest diseases on POPC development was investigated statistically. RESULTS: A total of 307 patients were included in the study. POPCs were observed in 100 patients (32.6%). About 13% of these complications were respiratory tract infections, 59% were respiratory failure, 45% were pleural effusion, and 42% were atelectasis, which were the most common pulmonary complications. The probability of experiencing POPCs by patients with chronic obstructive pulmonary disease (COPD) is 2.5 (1.18-5.67) times more than those without COPD. We determined that patients with the history of upper respiratory tract infection during the preoperative period are 5.3 times more likely to have POPCs; similarly, the number was 4.7 for patients undergoing cardiac operation and 3.3 for patients with interstitial infiltration. CONCLUSION: The risk of pulmonary complications was higher for those with the history of upper respiratory tract infection during the preoperative period, those undergoing cardiac surgery, those with the shortness of breath, those with the history of COPD, and those with the reticular/interstitial infiltrations in the chest X-ray. These parameters should be examined carefully in the preoperative period and should be careful in terms of pulmonary complications that may develop during the postoperative period

Factors affecting successful treatment outcomes in pulmonary tuberculosis: a single-center experience in Turkey, 2005-2011

WOS: 000361523100004PubMed: 26322873Introduction: We aimed to describe the treatment outcomes in patients with bacteriologically confirmed pulmonary tuberculosis (PTB) and identify factors associated with successful treatment outcome. Methodology: The medical charts of patients with smear and/or culture-positive PTB who were treated between 2005 and 2011 at the Kocaeli Tuberculosis Dispensary, Turkey, were reviewed. Patients were categorized as having a successful (cured or with a completed treatment) or poor (treatment default, treatment failure, death) treatment outcome. The association of demographic and clinical factors, including gender, age, education, occupation, insurance, family size, living area, smear and culture positivity, retreatment, comorbidity, drug resistance, and cavity on radiography, with the success of treatment, was evaluated by univariate and multivariate analyses. Results: Of 738 patients (258 females, 480 males) with bacteriologically confirmed PTB, 683 (92.6%) had successful treatment outcomes. Of those with a poor outcome, 29 (3.9%) had treatment default, 18 (2.4%) died, and 8 (1.1%) had treatment failure. Young age, no previous treatment, no comorbidity, no drug resistance, and high education level were factors significantly associated with successful PTB treatment outcome (p < 0.05 for all). Conclusions: Treatment outcome was successful in young and educated PTB patients who had drug resistance, previous treatment history, and no comorbidities. Knowledge of the factors affecting treatment success will lead to the undertaking of specific measures in the management of PTB, which may help to decrease treatment failure

Factors affecting TST level in patients undergoing dialysis: a multicenter study

Introduction: The risk of TB is increased in patients with chronic kidney disease (CKD) when compared with individuals with normal renal function. We aimed to determine tuberculin skin test (TST) response and the factors which might affect the response in patients with CKD undergoing dialysis in this study. Methods: The purified protein derivative solution was administered to the patients and the diameter of induration was measured. Additionally, the age, gender and smoking status of the patients were interrogated. Comorbidities were recorded both by patients' self-reports and data from the hospital files. The number of Bacille Calmette-Guerin (BCG) scars was recorded by checking both shoulders. Findings: The study was conducted with a total of 371 patients (194 men and 177 women). The mean age was 60.09 +/- 15.88, TST was 6.99 +/- 6.9, duration of dialysis was 4.44 +/- 4.5 (3.8-0.1,24). A total of 229 patients have comorbodities (61.7%, the most frequent was hypertension). Logistic regression model was performed. Gender, vitamin D treatment and high parathormone (PTH) levels remained in the final stage of the analysis and vitamin D intake and PTH levels were detected to be statistically significant (P = 0.002, 0.007, respectively). Discussion: This study is the first study which showed a correlation between TST negativity and increased PTH levels and receiving vitamin D treatment. Starting from this point, it was concluded that PTH may suppress the immune system and especially cellular immunity

Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study

Introduction Chronic obstructive pulmonary disease (COPD) is associated with increased 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 and CIMT. Methods CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. Results There were 610 patients who completed the study. There were 200 patients CIMT with = 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P 0.05). Conclusion This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages