Alev Gurgun

Effects of nutritional supplementation combined with conventional pulmonary rehabilitation in muscle-wasted chronic obstructive pulmonary disease: A prospective, randomized and controlled study

Nutritional depletion in chronic obstructive pulmonary disease (COPD) adversely affects health status and mortality. We aimed to evaluate the effects of nutritional supplementation (NS) with pulmonary rehabilitation (PR) on body composition, mid‐thigh cross‐sectional area (CSA), dyspnoea, exercise capacity, health‐related quality of life, anxiety and depression in advanced COPD patients.

Comparison of Bronchoalveolar Lavage and Mini-Bronchoalveolar Lavage in the Diagnosis of Pneumonia in Immunocompromised Patients

Background: Pneumonia is a major cause of morbidity and mortality in immunocompromised patients. Bronchoalveolar lavage (BAL) is commonly used to help diagnose and characterize pneumonia in these patients. Mini-BAL is a less-invasive, less-costly and less-cumbersome diagnostic tool than BAL. Objectives: In this study, we compared the diagnostic value of BAL and mini-BAL in the evaluation of pneumonia in immunocompromised patients with respiratory failure. Methods: Sixty-four respiratory samples were collected from 32 immunocompromised patients admitted to our respiratory intensive care unit with a clinical diagnosis of pneumonia and respiratory failure requiring invasive mechanical ventilation. A single BAL sample and a single mini-BAL sample were collected from each patient. Samples were examined for bacteriologic, mycologic, mycobacteriologic, and viral organisms. Results: The mean age of the patients was 56.0 ± 14.4 years. Of the 32 BAL samples, bacterial isolates were detected in 11 patients (34.4%) and on the other hand bacterial isolates were detected in 10 patients (31.3%) of the mini-BAL samples. Fungal isolates were detected in 11 patients (34.4%) from BAL samples and 13 patients (40.6%) from mini-BAL samples. Our analysis demonstrated a strong positive correlation between the results of BAL and mini-BAL testing (r = 0.850 and r = 0.821, respectively). Conclusion: In this study, we demonstrated a strong correlation between the isolation rates of bacteria and fungi in BAL and mini-BAL samples obtained from immunocompromised patients with pneumonia and respiratory failure. The data strongly support the use of mini-BAL sampling in such patients as a less-invasive, less-costly and simpler alternative to traditional BAL.

Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study.

Objective To determine distribution of COPD assessment categories and physicians’ adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in >70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient =0.993, P<0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient =0.237, P<0.0001) were noted. Conclusion Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected.

Efficacy and safety of the direct switch to indacaterol/glycopyrronium from salmeterol/fluticasone in non-frequently exacerbating COPD patients: The FLASH randomized controlled trial: Direct switch from SFC to IND/GLY: FLASH

Combination long‐acting β2‐agonist/long‐acting muscarinic antagonist (LABA/LAMA) has demonstrated superior clinical outcomes over LABA/inhaled corticosteroid (ICS) in chronic obstructive pulmonary disease (COPD) patients; however, data from blinded randomized controlled trials on direct switching from LABA/ICS to LABA/LAMA are lacking. FLASH (Assessment of switching salmeterol/Fluticasone to indacateroL/glycopyrronium in A Symptomatic COPD patient coHort) investigated if direct switch, without a washout period, from salmeterol/fluticasone (SFC) to indacaterol/glycopyrronium (IND/GLY) in COPD patients improves lung function and is well tolerated.

The View of the Turkish Thoracic Society on the Report of the GOLD 2017 Global Strategy for the Diagnosis, Management, and Prevention of COPD

Since the Global Initiative for Obstructive Lung Disease (GOLD) published its first guidelines on chronic obstructive pulmonary disease (COPD) in 2001, much has changed till 2017. Previous versions of GOLD guidelines mentioned the forced expiratory volume in one second (FEV1)-based approach for staging and treatment modalities. Since 2011, a composite multi-dimensional approach has been introduced to cover various aspects of the disease. Unfortunately, this approach was not found to be correlated with mortality as well as the FEV1-based approach, despite the fact that it was better for estimating exacerbation rates. Although this assessment tool has been considered as a big step in personalized medicine, the system was rather complex to use in daily practice. In 2017, GOLD introduced a major revision in many aspects of the disease. This mainly includes a revised assessment tool and treatment algorithm. This new ABCD algorithm has excluded spirometry for guiding pharmacological therapy. Treatment recommendations are mainly based on symptoms and exacerbation rates. Escalation and de-escalation strategies have been proposed for the first time. The spirometric measurement has only been retained to confirm the diagnosis and lead to nonpharmacological therapies. In this report, the Turkish Thoracic Society COPD assembly aimed to summarize and give an insight to the Turkish interpretation of GOLD 2017.

Updates in Chronic Obstructive Pulmonary Disease for the Year 2014

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. Research conducted over the past decade has contributed much to our current knowledge of the pathogenesis and treatment of COPD. Additionally, an evolving literature has recently accumulated information about the management of COPD and also about exacerbations. This article reviews a concise summary on the updates in COPD including 1) new pathogenic mechanisms and therapeutic targets, 2) management of patients in Group B, C and D according to GOLD 2014 report; 3) prevention and management of exacerbation; 4) monitoring of natural history; and 5) essential but usually forgotten parts of the management.

Effect of Isolation of Candida Species from Respiratory Specimens on Prognosis

Objective: Candida species are often isolated from respiratory specimens of patients with a history of long duration of hospitalization, immunosuppression, diabetes, alcoholism, history of wide spectrum antibiotic or corticosteroid usage. The aim of this retrospective study is to investigate the effect of isolation of Candida species from respiratory specimens on prognosis. Material and Method: Patients in the Department of Chest Disease in whom Candida species had been grown in ≥2 respiratory specimens obtained at the same or at different time periods within the last two years were enrolled in the study. Demographic features of the patients, risk factors for fungal infection, and the effect of this infection on prognosis were evaluated. Results: Out of 47 cases (mean age 67.6±14.6 yrs, 33 males) enrolled in the study, 29 were diagnosed as pneumonia at admission. The most frequent species isolated was C. albicans (68.1%). Fifty bacterial agents were isolated from respiratory specimens of 29 patients (61.7%) initially or on follow-up along with Candida species. Immunosuppression was detected in 28 patients (59.6%). Mean duration of hospitalization was 22.3±15.2 days and 26 patients (55.3%) died. Radiologically, multiple-zone involvement, C. tropicalis isolation, high APACHE II score, co-existing bacterial infection, low PaO 2 /FiO 2 ratio, and low albumin levels were found to be associated with mortality. Conclusion: This study showed that Candida species could also be isolated in respiratory specimens of non-immunosuppressed patients and mortality was high. It was concluded that bacterial co-infection and C. tropicalis isolation affected the prognosis negatively. (Tur Toraks Der 2011; 12: 153-7)