Ozkan Yetkin

The role of nebulised budesonide in the treatment of exacerbations of COPD

The present study was designed to evaluate the hypothesis that nebulised budesonide (NB) might be an alternative to systemic corticosteroids (SC) in the treatment of patients with exacerbations of chronic obstructive pulmonary disease (ECOPD). Patients hospitalised with ECOPD (n = 159) were randomised into three groups. Group 1 received only standard bronchodilator treatment (SBDT), group 2 received SC (40 mg prednisolone) plus SBDT, and group 3 received NB (1,500 μg q.i.d.) plus SBDT. Improvement during 10-day hospitalisation was compared with exacerbation and rehospitalisation rates after discharge. While mean±sd age was 64.1±8.9 yrs (female/male = 0.1), mean forced expiratory volume in one second (FEV1) at admission was found to be 37.2±12.2% predicted. Arterial blood gases and spirograms recovered faster in groups 2 and 3. While improvements in arterial oxygen tension (Pa,O2) and forced vital capacity (FVC) in group 2, and improvements in Pa,O2, FVC and FEV1 in group 3, became significant at 24-h control, the first significant improvement in group 1 appeared in arterial oxygen saturation at 72-h control. The mean improvement of Pa,O2 after 10 days was 1.20 and 1.06 kPa (9 and 8 mmHg) higher in group 2 and 3, respectively, than in group 1. Blood glucose exhibited an upward trend only in group 2. The study demonstrates that nebulised budesonide may be an effective and safe alternative to systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease.

CPAP compliance in patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated cessations of breathing during sleep. Major symptoms of this disease are excessive daytime sleepiness, snoring, and witnessed apnea. Most of the patients are treated with CPAP. In this study, we aimed to evaluate the factors affecting adherence to the CPAP treatment. Seventy-one patients were enrolled to this study. Patients were divided into three groups according to CPAP usage. Group I consisted of patients who had never used CPAP, group II consisted of patients who had used CPAP occasionally, and group-III patients had used CPAP treatment regularly. Group-III patients had higher apnea–hypopnea index (AHI) than groups I and II (respectively, 56.6 ± 27.7, 26.3 ± 7.5, and 32.3 ± 7.06; p < 0.000 for both). Oxygen desaturation index was significantly higher in group-III patients comparing to groups I and II (44.6 ± 22.3, 15.9 ± 8.3, and 25.6 ± 9.5; p < 0.000 for all). Our findings have shown that only very severe patients use the CPAP device regularly (mean AHI 56.6 ± 27.7). Compliance to CPAP treatment seemed to be poor in patients with moderate to severe, AHI about 30, OSAS. Considering the well-established benefits of CPAP treatment in patients with true indications, patients should be encouraged to use CPAP regularly, and complications of OSAS should be keynoted.

Venous thromboemboli and exacerbations of COPD

The aim of the present study was to determine the prevalence of and risk factors for venous thromboembolism (VTE) in exacerbations of chronic obstructive pulmonary disease (COPD). COPD patients hospitalised with an exacerbation were included consecutively. Symptoms, signs and clinical, haematological and epidemiological parameters on admission were noted. All patients underwent computed tomographic angiography and ultrasonographic examination for deep vein thrombosis and pulmonary embolism (PE). Wells and Geneva scores were calculated. Patients were followed-up for 1 yr in order to determine mortality. Deep vein thrombosis and PE were detected in 14 and 18 patients, respectively. The prevalence of VTE was three times higher in patients with an exacerbation of unknown origin than in patients with an exacerbation of known origin (p = 0.016). Of patients with VTE, 20 (95%) had high D-dimer levels. The negative predictive value of D-dimer testing was 0.98. Although the moderate- and high-risk categories of both the Wells and Geneva methods covered all PE patients, the Wells method identified 49% less potential patients for PE investigation. Mortality at 1 yr was higher (61.9% versus 31.8%) in VTE patients (p = 0.013). VTE is a common problem in COPD patients hospitalised with an exacerbation, leading to high long-term mortality. D-dimer levels and the Wells criteria can be used to determine whether or not these patients are assessed for a thromboembolic event.

Prevalence of COPD: First epidemiological study of a large region in Turkey

BACKGROUND Although chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide, epidemiological data on COPD is very limited. This study was designed to obtain some baseline data on COPD in the Malatya region of Turkey. METHODS Sixty clusters from urban and rural regions were randomly selected. Ten and seven consecutive households were included in the study from each urban and rural cluster, respectively. A validated questionnaire on the epidemiology of COPD was completed for each participant over 18 by a pulmonary physician. Each subject underwent standard spirometric measurement and early bronchodilation testing. RESULTS A total of 1160 participants completed the study (93%). Some 6.9% of the participants were found to have COPD (F/M=1/4). While the prevalence of COPD was 18.1% in current smokers over 40 years of age, the prevalence was 4.5% among younger smokers. Some 25.5% of the women and 57.2% of the men were current smokers. Biomass exposure, as a sole reason for COPD, was significantly common among female patients living in rural areas (54.5%). In the development of COPD, the relative risk ratio of cigarette smoke was found to be 3.4 and 3.3 times higher than biomass exposure and occupational exposure, respectively. CONCLUSIONS Smoking rate and COPD prevalence were found to be unexpectedly high in the region, and biomass exposure is still an important cause of COPD, particularly among females living in rural areas. We think that national policies against smoking and biomass exposure should be implemented immediately.

Assessment of B‐type natriuretic peptide in patients with pneumonia

The mammalian heart synthesises and secretes B‐type natriuretic peptide (BNP), which has potent diuretic, natriuretic and vascular smooth muscle‐relaxing effects as well as complex interactions with the hormonal and nervous systems. Recent studies described that BNP was acute phase reactant. In this study, we aimed to evaluate BNP levels in patients with pneumonia.

The role of nebulised budesonide in the treatment of acute exacerbations of COPD

From the authors : We have read with interest the letter concerning our manuscript recently published in the European Respiratory Journal 1 and appreciate the concerns raised by A. Singh. Underlining chronic obstructive pulmonary disease (COPD) as a systemic disorder has gained wide acceptance among pulmonary physicians. The main evidence supporting this approach is the increased levels of systemic inflammatory markers (tumour necrosis factor-α, C-reactive protein and interleukins) and the presence of cachexia and muscle weakness/wasting 2, 3. It is not yet known what kind of extrapulmonary problems these increased inflammatory markers indicate or give rise to. They have been shown to be strongly related to the level of inflammation in the lungs, and do not seem to indicate any kind of abnormal systemic process independent of the pathology within the lungs of COPD patients 4 …

Inspiratory capacity and forced expiratory volume in the first second in exacerbation of chronic obstructive pulmonary disease

Object:  Periodic exacerbations of symptoms are the major cause of morbidity, mortality and health care costs in patients with chronic obstructive pulmonary disease (COPD). Dyspnea is the major factor affecting the comfort of patients in the exacerbation of COPD. In this study, we aimed to compare the value of forced expiratory volume in the first second (FEV1) and inspiratory capacity (IC) measured before and after treatment in exacerbations and in the improvement in dyspnea.

UARS presenting with the symptoms of anxiety and depression

Upper airway resistance syndrome (UARS) is a condition where the apnea-hypopnea index is less than 5 and respiratory-effort related arousal index is more than 10. The clinical presentation of UARS may be the same as obstructive sleep apnea-hypopnea syndrome (OSAS); it sometimes shows up with symptoms hardly suggestive of a sleep-disordered breathing. A 17 year-old male patient had applied to a local psychiatry clinic and complained of chronic fatigue, insomnia, behavioral and academic problems and was treated for anxiety and depression. After a period of unresponsive treatment, he was sent to a sleep center for evaluation of insomnia, which turned out to be a fragmented, unrefreshing sleep episode. Polysomnographical evaluation revealed that he had UARS without OSAS. His complaints decreased dramatically after he received CPAP treatment. This case shows that UARS should be considered in young patients with functional somatic syndromes even if the clinical presentation does not apparently imply the condition.

Effect of CPAP on sleep spindles in patients with OSA

OBJECTIVE Consequences of OSAS include excessive daytime sleepiness, divided sleep architecture, impaired neurocognitive performance, and significant psychosocial disruption. In this study we aimed to evaluate sleep spindles changes before and after PAP treatment in patient with OSA. METHODS Seventy-three consecutive patients (M/F:61/12) who applied to Sleep Disorders Center of Inonu University Hospital and met the inclusion criteria were enrolled to this study. Full-night polysomnography and CPAP titration were performed. RESULTS Mean AHI were detected as 43,8±24,4 and mean oxygen saturation was 79% in patients under full-night PSG. Singificant increasing were observed on spindle count under CPAP titration (192±98.vs 347±165 per hour p<0.001)) and also significant increasing was recorded on oxygen saturation (79±15 vs 94±4% p<0.001). CONCLUSION Both spindle count and oxygen saturation were recorded to be significantly increased under CPAP titration while there was a significant decrease in apnea-hypopnea. We have shown that significant increase in number of spindles can be achieved with CPAP treatment, those to be decreased in patient with OSA. Number of spindles may play a role as an indicator of better outcome in OSA patients.