OBJECTIVE:Accurate assessment of inhaler adherence is essential for optimizing treatment outcomes in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the validity and reliability of the Turkish version of the Test of Adherence to Inhalers (TAI) in a multicentre COPD cohort. MATERIAL AND METHODS:A total of 277 patients were included. Sociodemographic characteristics and adherence status [assessed by the Turkish version of the Medication Adherence Report Scale-5 (MARS-5); İlaç Uyumunu Bildirim Ölçeği (İUBÖ)] were recorded. Construct validity was evaluated using confirmatory factor analysis (CFA), criterion validity was evaluated by agreement with İUBÖ using kappa statistics, and known-groups validity was evaluated by comparing the number of inhaler devices used. Reliability was assessed using Cronbach's alpha coefficients and item-total correlations. RESULTS:The mean age was 66.3±8.3 years, 81.9% of participants were male. Most patients (73.6%) used at least two inhaler devices, and 28.9% were classified as non-adherent according to İUBÖ. Based on TAI scores, 43.3% of patients had good adherence, 23.8% had intermediate adherence, and 32.9% had poor adherence. CFA supported the two-factor structure of the TAI (Tucker-Lewis Index: 0.965; Comparative Fit Index: 0.972; Root Mean Square Error of Approximation: 0.114). Criterion validity was demonstrated by good agreement between TAI and İUBÖ (kappa: 0.637, P < 0.001). Patients using more than one inhaler device were more likely to be non-adherent according to the TAI-10 (P = 0.02). Internal consistency was high for both the 10- and 12-item versions (Cronbach's alpha >0.90), with item-total correlations indicating adequate reliability. CONCLUSION:The Turkish version of the TAI is a valid and reliable tool for assessing inhaler adherence in patients with COPD and is suitable for both clinical practice and research settings in Türkiye.

Chronic obstructive pulmonary disease (COPD) remains among the leading causes of death. The systemic characteristics of COPD are becoming clearer every day, and the importance of comorbidities is increasingly well understood. Comorbidities are one of the main causes of mortality in COPD. Although there are specific guidelines for each disease, there is limited literature explaining the effects of comorbidities on one another. Non-respiratory comorbidities associated with mortality in COPD include cardiovascular disease (CVD), metabolic, musculoskeletal, and psychiatric disorders. Both COPD and these comorbid conditions share a common aetiology and are associated with complex clinical and therapeutic interactions. CVD and metabolic comorbidities are more symptomatic and can be easily recognised by patients and physicians. However, osteoporosis, anxiety, and depression are often asymptomatic, despite the fact that these are more common than other comorbidities. Current data suggest that diagnosis and treatment of comorbidities improve prognosis in COPD. Instead of focusing solely on COPD treatment, we should adopt a holistic approach to patient care. This narrative review aims to summarise the bidirectional relationships between COPD and its most common fatal extrapulmonary comorbidities. Another aim of the study is to compile a substantial body of scattered information to provide clinicians with an overview.

Objective:The Rome classification was introduced to assess the severity of acute exacerbation (AE) of chronic obstructive pulmonary disease (COPD) based on easily measurable variables. However, its validation for global use has not yet reached a sufficient level. This study aims to evaluate the validity of the Rome criteria in determining the severity and prognosis of COPD AE in Turkey. Methods:This multicenter study, conducted for the first time in Turkey and for the fourth time worldwide, included 750 patients diagnosed with AE-COPD who presented to emergency departments and outpatient clinics. According to the Rome criteria, patients were classified into three groups: mild, moderate, and severe AE-COPD. Results:The study included 99 (13.2%) patients in the mild, 479 (63.9%) in the moderate, and 172 (22.9%) in the severe group. Emergency visits, hospitalizations, and ICU admissions in the past year were more frequent in the moderate and severe groups (p < 0.001 for all comparisons). Regarding outcomes of emergency or outpatient visits, most mild exacerbation cases were discharged (p < 0.001), while most moderate and severe exacerbations required hospitalization (p < 0.001). Compared to the moderate group, the severe exacerbation group had a higher risk of ICU admission (p < 0.001), NIV (p < 0.001), IMV (p < 0.001), in-hospital mortality (p < 0.001), and 30-day mortality (p = 0.015). No significant differences were found in 90-day mortality or 30 and 90-day readmission rates (p = 0.258, p = 0.712, p = 0.681, respectively). Survival analysis revealed no significant difference between the moderate and severe groups (p = 0.764). Conclusion:The findings suggest that the Rome criteria can be successfully used to assess exacerbation severity in AE-COPD patients presenting to secondary and tertiary care hospitals in Turkey.

The COVID-19 pandemic and related public health restrictions have substantially altered healthcare access and delivery, particularly for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the impact of the COVID-19 pandemic and lockdown measures on COPD-related symptoms and hospital admissions, and to compare these outcomes with the pre-pandemic period. This multicenter cross-sectional study was conducted between July 2021 and February 2022 across ten tertiary pulmonary outpatient clinics in Turkey. A total of 347 COPD patients were included. Data on demographics, spirometry, symptom progression, medication access, COVID-19 history, and hospital admissions were collected via structured questionnaire and medical records. Pandemic-related outcomes were compared with data from the pre-pandemic year (March 2019–March 2020). Additional multivariable regression analyses were performed to identify predictors of hospital admission and COVID-19-related hospitalization. The mean number of hospital admissions significantly decreased during the pandemic compared to the pre-pandemic period (p < 0.001), while patient-reported respiratory symptoms increased over time. Hospital admissions were lowest during the first pandemic period, when restrictions were most intense. Regression analyses showed that lower FEV₁, advanced GOLD stage, and inhaled corticosteroid (ICS) use were independently associated with increased hospital admissions. COVID-19 was diagnosed in 21.1

BACKGROUND/AIMS: With the increasing prevalence of chronic respiratory diseases worldwide, the likelihood of healthcare personnel encountering these patients has also risen. The purpose of this study is to determine the awareness of chronic obstructive pulmonary disease (COPD) and asthma among staff working in hospitals in North Cyprus. MATERIALS AND METHODS: A survey was administered to staff in 4 hospitals. In addition to demographic data, the survey consisted of 22 questions related to COPD and asthma, which were part of the GARD-T & uuml;rkiye Project established by the Turkish Ministry of Health in 2013. The data were analyzed using appropriate statistical methods. RESULTS: A total of 316 personnel from 4 hospitals participated in the study. The age range was 18-59 years (36 +/- 9.82 years), and the average duration of work was 11.35 +/- 9.53 years. The group with more than 10 years of work experience had a lower awareness that COPD is seen in individuals over 40 years of age compared to other groups (p=0.008). Additionally, this group had a stronger belief that asthma medications cause addiction (p=0.035). When examining doctors, nurses, paramedics, and technicians as the "healthcare workers group" and auxiliary health staff and clerks as the "other group," it was found that neither group had sufficient knowledge that COPD is a disease affecting individuals over 40 years. Regarding whether COPD is a treatable disease, 46.2% (98) of healthcare workers responded "yes," while 43.9% (93) answered "no". In general, the level of knowledge about COPD and asthma was higher in the healthcare workers group. CONCLUSION: Although the study population is quite heterogeneous and has a low participation rate from doctors, it is thought to represent hospital workers well. Awareness about asthma and COPD is low. In particular, the group with a longer duration of work was less aware of these two diseases than other groups. We believe that hospital staff should receive in-service training on these diseases at regular intervals.

Chronic obstructive pulmonary disease (COPD) that is the third leading cause of death in the world is one of the main economic burden. The cost is primarily due to COPD exacerbations and hospitalizations. We aimed to determine the factors associated with increasing costs in severe COPD exacerbation. It was a multicenter and prospective observational recording study. 294 patients who severe COPD exacerbation were included in the study. An amount of more than 429.58 euros was accepted as increasing costs (IC). Factors associated with IC were determined by regression analysis. Mean age was 69.90 ± 9.79/years (minimum: 40 maximum: 95), mean costs were 594.9 ± 70.9 euros. About 83.7% of the patients were male, 24.1% (71) were active smokers, and 81% (238) had at least 1 comorbidity. Factors associated with IC in the regression analysis were delay of discharge (due to prolonged consultation), antibiotic use longer than 7 days, need to enteral/parenteral feeding, application of pulmonary rehabilitation (physiotherapy) at hospitalization, and refusal to be discharged. The increasing costs in severe COPD exacerbation depends not only treatment but also the patient's social status and hospital-related factors. We think that the cost of severe COPD exacerbation can be reduced by interventions on interchangeable factors such as patient's social status and hospital-related factors.

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

BACKGROUND/AIMS: In this study, we aimed to investigate the frequency of smoking and extent of awareness of second-hand smoke (SHS) among parents. MATERIALS AND METHODS: This is a descriptive study. A total of 2,602 questionnaires were administered to the parents of students in 7 different schools. The questionnaire included 8 questions and collected demographic data. The findings were analyzed using appropriate statistical methods. RESULTS: Participation rate was 61.9% among all parents. 23.2% of mothers and 43.1% of fathers were active smokers. 31% of mothers and 33.8% of fathers were aware of the fact that their children could have many diseases related to SHS. 98.6% of mothers and 98.8% of fathers did not want their children to be exposed to SHS. 60% of mothers and 54.5% of fathers who were active smokers thought that smoking outside the home did not harm their children. 90.9% of mothers (n=1162) and 91.5% of fathers (n=1129) wanted their children to receive education about the harms of tobacco products (HTPs). 60.9% of active smoker mothers, 69% of exsmoker, and 68.6% of never smoked mothers did not want to receive education about the HTPs (p=0.025). These rates were 63.2%, 75%, and 68.9% among fathers, respectively (p=0.002). CONCLUSION: Childhood exposure to SHS in our study is similar to that of previous studies. We think that parents should be educated about SHS, and for those who refuse the education, the reasons behind this should be investigated.

Chronic obstructive pulmonary disease (COPD) frequently results in hospital readmission and contributes to increased morbidity and mortality. This multicenter prospective study aimed to identify factors that increase the risk of readmission within 30 to 90 days of severe COPD exacerbation. A total of 415 patients admitted to the emergency department (ED) or general pulmonology ward after discharge due to severe exacerbations from 13 tertiary centers in Turkey were included. Of the participants, 346 (83.4%) were male and 69 (16.6%) were female, with an average age of 69.0 +/- 9.1 years. Readmissions within 30 and 90 days after the initial hospitalization occurred in 176 (42.4%) and 191 (46%) patients, respectively. Prospective data collection focused on exacerbation severity, disease severity, and the utility of initial admissions. Factors for 30 to 90 day readmission were analyzed using univariate and multivariate regression models. A 30-day readmission correlated significantly with Hospital Anxiety Depression Scale scores above 16 [odds ratio [OR] 95% confidence intervals [CI]: 1.9 (1.1-3.6); P = .042], severe exacerbation history in the previous year [OR 95% CI: 1.7 (1.1-2.9); P = .038], hospital-acquired pneumonia [OR 95% CI: 1.9 (1-4.1); P = .049)], and frequent antibiotic use in the previous year [OR 95% CI: 1.8 (1.2-2.7); P = .007]. Risk factors for 90-day readmissions included: Grades 3 to 4 tricuspid regurgitation [OR 95% CI: 2.2 (1.1-4.4); P = .024], 2 or more moderate COPD exacerbations [OR 95% CI: 1.9 (1.2-3.1); P = .010], severe exacerbation history in the previous year [OR 95% CI: 2.5 (1.5-4.2); P = .001], immunosuppression [OR 95% CI: 2.7 (1.2-5.7); P = .013], frequent antibiotic use the previous year [OR 95% CI: 1.5 (1-2.4); P = .048], hospitalization via the ED [OR 95% CI: 1.6 (1.1-2.6); P = .028]. To mitigate complications and readmissions, patients with a history of frequent severe COPD exacerbations, high anxiety and depression scores, frequent antibiotic requirements, immunosuppression, tricuspid regurgitation, hospital-acquired pneumonia, and those admitted to the ED should be prioritized for remote monitoring after initial discharge.

Exacerbation is an independent risk factor for chronic obstructive pulmonary disease (COPD)-related morbidity and mortality. Despite optimal care, there may be risk factors that lead to difficulties in managing exacerbations that may be associated with prolongation of length of hospital stay (LOS). This is a multicenter prospective observational study of COPD patients hospitalized with exacerbations. Prolonged LOS was calculated according to the 50th percentile and defined as ≥ 9 days. Potentially predicting factors of LOS were stratified into 4 pillars as patient-related, disease and exacerbation-related, treatment-related and, hospital utility-related. These categories were systematically documented throughout the duration of the hospitalization. A total of 434 patients, 361 males and 73 females, with a mean age of 69.2 ± 9.3 years, were included in the study. Variables of each pillar were tested with univariate analysis to identify potential risk factors for prolonged LOS. Subsequently significant factors excluding factors associated with hospital utility were tested with multivariate logistic regression analysis for detecting potential associated factors for difficult-to-manage COPD exacerbation. Biomass exposure, past history of non-invasive mechanical ventilation (NIMV), low bicarbonate levels at admission, antibiotic switching, need for theophylline, increasing oxygen requirement, need for in-hospital non-invasive mechanical ventilation, nutritional support and physiotherapy were found as defining factors. The DiMECO study can help to identify COPD exacerbators who are at risk for prolonged hospitalizations that may associate with difficult-to-manage COPD exacerbations. Difficult to manage COPD exacerbation may serve as a provocative framework, underscoring the necessity for a better understanding of the multifaceted approaches to the management of COPD exacerbations. This conceptualization warrants further investigation across diverse clinical settings to validate its applicability and efficacy.

Bronchial atresia (BA) is a rare condition that appears radiologically as a perihilar mass lesion and increased peripheral aeration.A 29-year-old asymptomatic male patient was identified with a right perihilar mass during a routine medical examination linked to a job application.Before applying to our clinic, the patient had had undergone non-contrast thoracic CT and PET-CT.Physical examination was normal, while contrast-enhanced thorax tomography revealed a right central mass and signs of air trapped in its periphery.A pulmonary function test was normal.All bronchi were open on bronchoscopy, however a small blunt orifice was observed at the right upper lobe posterior segment entrance.We present this case due to it being a rare condition and the potential for confusion with cancer radiologically.BA with mass image and increased peripheral aeration on thorax CT can be diagnosed based on clinical and radiological findings, allowing unnecessary invasive interventions to be avoided.

Background/aim: Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a workday loss. Materials and methods: 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days, and the Zarit Scale were used. Results: 128(50.8%) of the patients according to GOLD were group-D, 97(38.5%) of the patient's relatives were working, 62(24.7%) were not able to go to work for 1-14 days, and 125(57.1%) spent outside the home from 1-14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p < 0.001), CAT (p < 0.001), the number of comorbidities of patients (p = 0.027), forced expiratory volume in 1 FEV1cc (p = 0.009), FEV1% (p < 0.001), the presence of long term oxygen therapy (LTOT), and the number of comorbidities of the patient's relatives (p = 0.06) increased the care load. In multiple linear regression analysis, age (p = 0.03), COPD assessment test (CAT) score (p = 0.001), FEV1% (

Objective: There is no definite laboratory parameter in predicting short-term prognosis in patients with chronic obstructive pulmonary disease (COPD). Our aim was to evaluate the prognostic effect of serum blood urea nitrogen (BUN)/albumin ratio in COPD patients.Materials and Methods: A retrospective study comprising of 264 COPD patients who were in exacerbation period and selected from 4 centers was carried out. Data on demographic characteristics, disease characteristics, comorbid conditions and short-term prognosis of patients were obtained. and analyzed.Results: The BUN/Albumin ratio was higher in patients with oxygen saturation <90% (p=0.004). There was no difference between global obstructive lung disease (GOLD) stages means of BUN/Albumin ratio but this rate was higher in those with infective exacerbations (p=0.019). The BUN/albumin ratio of patients who were discharged (5.3 +/- 2.2) was significantly higher than the patients who were transferred to the intensive care unit [ICU] (11.7 +/- 6.0) (p<0.0001). The cut-off level of BUN/albumin ratio in prediction of the need for ICU was7.2 (sensitivity 80%, specificity 85.4%) and the area under the receiver operating characteristic (ROC) curve was 0.911 (95% CI: 0.861-0.961) (p<0.001). The cut-off level of BUN/albumin ratio in prediction of mortality was 8.1 (sensitivity 88.2%, specificity 85.4%) and the area under the ROC curve was 0.963 (95% CI: 0.930-0.995) (p<0.001).Conclusion: BUN/albumin ratio can be used as an affordable, inexpensive and practical method for determining the short-term prognosis in hospitalized COPD patients. Prospective studies involving more patients are needed.

The aim of this study is to identify the factors affecting mortality in patients with chronic obstructive pulmonary disease (COPD) hospitalized with exacerbation.A COPD cohort study was designed.Demographic data, the reason of mortality, Charlson co-morbidity index (CCI), COPD comorbidity index (COTE), age, dyspnea, airway obstruction (ADO) index, modified ADO index and dyspnea, airway obstruction, smoking, exacerbation (DOSE) index, and their relationship with mortality were investigated.One hundred and forty COPD patients hospitalized with exacerbation were included in the study.Eighty-seven (62.15%) of the patients were alive and 53 (37.85%) of them were deceased.The number of patients with CCI ≥ 7 was none in living patients and 11 (20.8%) in the deceased group (p<0.001).The percentage of treatment compliant patients during stable conditions was lower in the deceased group (p<0.001).ADO and COTE indices were significantly higher in the deceased group.There was no difference in modified ADO and DOSE scores between the groups.Multivariate analysis showed that lung cancer, CCI 7, hypoxemia (PaO2 <60 mmHg), and longer admission to the intensive care unit were independently associated with 3.4, 4.4, 2.1, and 3.0-fold mortality, respectively (p <0.05).Additionally, COTE ≥ 4 and noncompliance to regular COPD treatment were found to be associated with shorter survival in Kaplan Meier analysis (p<0.05).In conclusion, comorbidities and most notably lung cancer was associated with mortality in COPD.Also, high CCI and COTE index were risk factors for increased mortality.

Chronic obstructive pulmonary disease (COPD) is an important public health problem that manifests with exacerbations and causes serious mortality and morbidity in both developed and developing countries. COPD exacerbations usually present to emergency departments, where these patients are diagnosed and treated. Therefore, the Emergency Medicine Association of Turkey and the Turkish Thoracic Society jointly wanted to implement a guideline that evaluates the management of COPD exacerbations according to the current literature and provides evidence-based recommendations. In the management of COPD exacerbations, we aim to support the decision-making process of clinicians dealing with these patients in the emergency setting.

OBJECTIVE:We aimed to investigate the effect of inhaled corticosteroids (ICS) in the outcomes of community-acquired pneumonia (CAP), as well as to determine if ICS usage is exist among the risk factors for mortality in those patients.MATERIALS AND METHODS:In this retrospective cross-sectional multicentre study, 1069 hospitalised CAP patients were investigated using CAP Database of Turkish Thoracic Society (TURKCAP Database). The patients were divided into two groups, depending on their ICS use. The data were analysed by appropriate statistical methods.RESULTS:172 (75.8%) of the 227 patients who were on ICS had COPD and 37 (16.3%) had asthma. There were fewer patients with fever among ICS-users compared to non-ICS users (P = 0.013), and less muscle pain (P = 0.015) and fewer GIS symptoms (P = 0.022). No statistically significant difference was found between ICS use/ type of ICS and the duration of hospitalisation (P = 0.286). The multivariate regression analysis showed that patients using ICS had lower body temperature and, less crackles/bronchial sound. In the multivariate logistic regression model lung cancer (OR: 6.75), glucose (OR: 1.01) and CURB-65 (OR: 1.72) were significantly associated with mortality in the CAP patients. ICS usage were not found to be associated with mortality.CONCLUSION:The use of ICS by the patients with CAP admitted to the hospital is not independently related with any radiological pattern, hospitalisation duration and mortality. ICS usage may diminish fever response and may suppress the findings of crackles and/or bronchial sounds. This needs further confirmation.

Aim: Our aim is to determine risk factors for 30 and 90days of readmission after severe COPD exacerbation. Material-Method: It is a prospective, observational recording study.415 patients who were hospitalized with severe COPD exacerbation (non-ICU) were included. On the 30 and 90 days after the patients discharge, readmission were questioned by phone. Data were analyzed by appropriate statistical method and risk factors about readmission were determined by logistic regression analysis. Results: The mean age is 69±9.1 / year, 346 (83%) are male. The 30day readmission rate is 42.4% (n:176), the 90day is 46% (n:191).Risk factors about 30 and 90 day readmission determined by logistic regression analysis are shown in Table 1. Conclusion: 30 and 90 day readmission rates are very high in COPD patients who hospitalized with severe exacerbation. The type of exacerbation is related on readmission. However,comorbid conditions (especially anxiety/depression),HAP and hospitalization from the emergency department are also related to readmission.Further studies are needed on the subject.