Evaluation of etiology and cost in patients with chronic cough

Tıpta Uzmanlık TeziÖksürük, akut, subakut veya kronik olsun öksürüğe etkili bir yaklaşım, öksürüğün yaygın sebepleri için seçilmiş tanısal testler ve ampirik tedavi kombinasyonu kullanarak sırayla değerlendirmek ve tedavi etmektir Kronik öksürüğün yaygın sebeplerinin tek klinik görünümünün öksürük olabileceğini bilmek önemlidir. Bu, öksürüğün yanıt verip vermeyeceğini görmek için selektif inceleme ve uygun tedavinin (hem kullanılan ajanlar hem de tedavinin süresi açısından) gerekliliğini vurgulamaktadır. Sıralı ve kombine tedavi çok önemli olabilir çünkü öksürük için birden fazla sebep mevcut olabilir Kronik öksürük algoritması; farklı sebepler ve bu sebeplerin sıklıkları hakkında geniş ölçüde bilginin mevcut olmasına, seçilmiş tanısal testlerin ve ampirik tedavinin değerine ve yanıt için beklenen süreye dayanmaktadır Çalışmamızda Nisan 2007- Temmuz 2008 tarihleri arasında kronik öksürük nedeni ile Trakya Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Polikliniğine başvuran 90 hastanın retrospektif olarak değerlendirilmesi yapıldı Hastaların 64'ü (%71,1) kadın, 26' sı (%28,9) erkek idi. Çalışmamıza alınan hastaların yaş ortalaması 46.24 ±15.42 (17?79) yıl idi. 86 hasta (%95.6) poliklinikten takip edildi. 4 hasta (%4.5) göğüs hastalalıkları servisinde yatırılarak tetkik edildi Ortalama öksürük süresi 17.29 (2?180) ay idi. 70 hastada (%77.8) öksürük kuru öksürük tarzındaydı Otuz üç hastanın (%36.7) öyküsünde sigara kullanımı mevcut idi. Bunların da 9'u halen düzenli sigara içicisi (%10), 24 hasta ise sigarayı bırakmıştı. Ortalama 21.71 (0.5?108) paket yılı sigara kullanımı mevcut idi. 12 hastada (%13.3) Anjiyotensin dönüştürücü enzim inhibitörü kullanımı mevcuttu. Hastaların solunum sistemi muayenelerinin değerlendirilmesinde 69 hastada (%76.6) herhangi bir muyene bulgusu saptanmadı Yirmiki (%24.6) hastada öksürük etiyolojisi olarak astım, 19 (%21.1) hastada gastroösefagial reflü, 8 (%8.8) hastada üsthavayolu öksürük sendromu, 13 (%14.4) hastada ise birden fazla etiyolojik neden saptandı Maliyet hesaplarına baktığımızda 90 hastanın ortalama maliyeti 216.61 ± 335.64 (45.20?2658.20) YTL, toplam ise 19494. 46 YTL olarak hesaplandı. En yüksek maliyet toplamda paket ücret için hesaplanırken, 2. sırada ise ampirik tedavi, 3. sırada ise bilgisayarlı tomografi için hesaplandı. Ortalama maliyetlerde ise ilk sırada 93.77 ± 46.88 YTL ile ampirik tedavi yer almakta idi Çalışmamızın sonuçlarına baktığımızda kronik öksürüklü hastaların tanısında ve maliyet etkinliğinde ampirik yaklaşım modelinin oldukça başarılı olduğu söylenebilir. Fakat özellikle maliyet etkinliği açısından daha fazla çalışmalara ihtiyaç duyulmaktadır Anahtar kelimeler: Kronik öksürük, astım, üst havayolu öksürük sendromu, gastroösefagial reflü, maliyetThe aim of the effective approach for coughing is to find out the frequent causes of coughing such as; acute, subacute and chronic cough by using selective diagnostic tests and empirical treatment combination and to treat these It is important to know that the only clinical apperance of the frequent causes of chronic coughing can be cough. The emphasizes the necessity of selective examination and appropriate treatment to see whether coughing heals or not (from the point of used medicine and span of treatment) should be mentioned. Sequential and combined treatment can be very important because there can be more than one causes for coughing Algorithm for treatment of chronic coughing depends on different causes, the existence of a lot of information about the frequency of the causes and the coherence of selective diagnostic tests, empirical treatment and the span of treatment In our study, which was held between April 2007-July 2008 evaluation of 90 patients who applied to Trakya University, Faculty of Medicine Chest Disease Department clinic because of chronic coughing was done Sixty four (%71.1) of patients were women, 26 (%28.9) of patients were men. The average of the patients? age was 46.24 ± 15.42 (17?79) years The average span of coughing was 17.29 (2-180) months. Seventy (%77.8) patients? coughing character were nonproductive In the 33 (%36.7) patients medical history there was the use of smoking. 9 of them are smokers, 24 of them are ex smokers. The average use of packet years smoking was 21.71 (0.5-108) packets. Twelve (%13.3) of patients were using Angiotensin converting enzyme inhibitor drugs Sixty nine (%76.6) of patients respiratory system examination were normal Twenty two (%24.6) of patients coughing cause was asthma, 19 (%21.1) of patients gastroeosophagial reflux, 8 (%8.8) of patients upper airway cough syndrome and 13 (%14.4) of patients causes of coughing were more than one When we consider the cost analysis for coughing, the average of 90 patients cost was 216.61 ± 335.64 (45.20-2658.20) YTL, total cost was 19494.46 YTL. Maximum cost was for the packet cost, the second was empirical treatment and the third was computerized tomography scanning. The maximum average cost was for empirical treatment According to our results, it can be said that empirical approachment model is successful in diagnosing chronical coughing of patients and the effectiveness of cost effect. However, further studies are need specially about cost-effectiveness Key words: Chronic cough, asthma, upper airway cough syndrome, gastroeosophagial reflux, cost-efectivenes

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey

Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. Methods: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. Results: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. Conclusion: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer