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% (

AIM Wrong use of an inhaler arising from a lack of knowledge can negatively affect treatment management. Therefore, this study was performed with the aim of determining the effects on treatment management of inhaler training carried out under the leadership of a nurse in individuals with medium and advanced stage chronic obstructive pulmonary disease (COPD). METHODS This was an experimentally designed pre-test post-test study with a control group. Participants were interviewed four times in 1 year. The experimental group performed inhaler training. A Patient Description and Follow-Up Form, an Inhaler Drug Use Skill Chart, the Morisky eight-item Medication Adherence Scale, the COPD Assessment Test, and the St. George Respiration Questionnaire were used to collect data. Data analysis was performed by SPSS, using nonparametric tests. RESULTS Although there was no significant difference between the groups, a reduction in hospital visits and admissions because of attacks was seen in the experimental group (p = .239, p = .492). It was found there was a greater increase in the correct use of the inhaler in the experimental group than in the control group, and that correct use of the handihaler increased significantly (p = .008). Also, the increases in adherence to treatment (p = .006) and quality of life (p = .010) in the experimental group were significantly different from the control group. In the control group, the annual decline in forced expiratory volume in 1 s increased significantly (p = .016). CONCLUSIONS It was seen that long-term inhaler training given by nurses at regular intervals made a significant contribution to treatment management.

İn this study, renal transplant recipients who were complicated with tuberculosis, were analyzed with special reference to prevalence, outcome, therapy and drug toxicity. Among 520 patients, 22 (4.2%) were diagnosed to be complicated with various organ tuberculosis. The time interval between transplantation and diagnosis of tuberculosis was 44.5 ±33.5 (range 3 to 111) months. In 18 (82%) of the patients, tuberculosis was detected after the first year of transplantation. The most common form was pleuro/pulmonary tuberculosis (54%), but various localisations such as liver, jejunum, bone and urogenital tract were also noted. Six (30%) of the patients were presented with fever oj unknown origin, while the others complained from low grade fever, constitutional symptoms and symptoms related with the involved organs. Sixteen of the 22 patients responded favorably to the treatment and improved with excellent allograft function, whereas 6 (27.2%) were lost. Two of the patients returned to hemodialysis within the following 6 months of antituberculosis therapy. Toxic hepatitis was seen intensif 4 (18%) patients, and one was complicated with acute hepatocellular failure. As compared to pretreatment period, cyclosporine dose was increased about 0.5 to fourfold inlO of the patients in order to achieve the aimed serum levels and reached the stable serum drug levels in nearly 4 weeks after instutition of rifampicin. It was concluded that, tuberculosis, is a common infection in renal transplant recipients, especially after the first year of transplantation and may result in significant mortality and morbidity. Close follow-up of the patients especially during the first month of antituberculosis therapy, could effect the patient and graft survival rates favourably.

Objective: Our aim is to measure the level of awareness of patient’s relatives COPD, to determine the caregiver burden of patient9s relatives, and to determine whether there is a work day loss. Material and method: 252 COPD patients and 252 patient’s relatives from 11 centers were included in this questionnaire study. Ethics committee was approval. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the patient’s relatives were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days and Zarit Scale used in chronic diseases were used. Results: 128(50.8%) of the patients according to GOLD were group-D.97(38.5%) of the patient9s relatives were working. 253(94.4%) knew that COPD was a lung disease. 62(24.7%) were not able to go to work for 1-14 days. 125(57.1%) spent outside the home from 1 to 14 nights, because those accompanied to patients. In univariate analysis were detected mMRC(p<0.001), CAT(p<0.001), the number of comorbidities of patients(p=0.027), FEV1cc(p=0.009), FEV1% (p<0.001), the presence of USOT and the number of comorbidities of the patient9s relatives(p=0.06) increased the care load. In multivariate analysis, CAT score (p=0.001) and patient number of comorbidities (p=0.01) increased the caregiving burden. Conclusion: In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psycho-social and legal regulations should be investigated and solutions should be produced for the person who gives care to COPD patients.

OBJECTIVES:To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor-alpha (TNF-α) antagonists and the related factors with tuberculosis.METHODS:Patient's demographics, tuberculin skin test (TST), isoniazid prophylaxis and type of TNF-α antagonist were recorded. TST conversion (≥5 mm increase) was evaluated for patients who had baseline and 1-year TST.RESULTS:Files of 1887 patients who were receiving TNF-α antagonists between August 2005 and June 2015 were evaluated. TST significantly increased at the end of 1 year (n = 748 baseline:7.36 ± 7.2 mm vs. 1 year:9.52 ± 7.5 mm, P < 0.001). One-third of patients (31.2%) who had negative TST at baseline had positive TST at 1 year. Tuberculosis developed in 22 patients (1.16%). The annual incidence of tuberculosis was 423/100 000 patient-year. TNF-α antagonist indications were ankylosing spondylitis (n = 8), inflammatory bovel diseases (n = 7) and rheumatoid arthritis (n = 4). Ten (45.5%) patients received infliximab, six (27.3%) patients received etanercept and six (27.3%) patients received adalimumab. Nineteen (86.4%) patients were under isoniazid prophylaxis. Twelve patients had extrapulmonary tuberculosis (54.5%; four lymph node, three pleura, two periton, one pericarditis, one intestinal, one joint). Atypical mycobacterium was detected in one patient. Adalimumab treatment (9.5× increase), male sex (15.6× increase) and previous tuberculosis disease history (11.5× increase) were risk factors for active tuberculosis. Conversion of TST was not found related with tuberculosis.CONCLUSIONS:Despite the high proportion of isoniazid prophylaxis, the incidence of tuberculosis in our patients receiving TNF-α antagonist was higher than the literature. Adalimumab treatment, male sex and previous tuberculosis disease history were found as risk factors for tuberculosis.

Frequency of Deep Venous Thrombosis and Pulmonary Embolism in COPD Patients with Acute Exacerbations Infections, deep venous thrombosis(DVT) and pulmonary embolism(PE), and cardiac rhythm problems are frequent causes of acute exacerbations in COPD. We investigated DVT and PE incidence prospec tively in 56 COPD patients who had been hospitalized due to acute exacerbations. DVT was evaluated by color doppler ultrasonography and by venography in 2 suspected cases. PE was evaluated by ventila tion/perpfusion scintigraphy in 8 cases with intermediatte-high clinical probability. DVT was diagnosed in 6 cases (%10.7) and pulmonary embolism was diagnosed in 5 cases (%8.9) Our results did not show any predictive value of patient’s age, height, weight, duration of illness, pulmonary function tests, arter ial blood gases and hematocrit values in the diagnosis of PE and DVT.

Introduction: Conflicting results has been achieved in a small number of clinical studies evaluating the efficiency of magnesium sulphate ( MS) in COPD exacerbations. We aimed to investigate the efficiency of nebulised MS in COPD exacerbations.Patients and Methods: Twenty patients who met the study criteria were randomized into two groups. All patients were treated with O-2, antibiotics and oral corticosteroids. Additionally one group received ipratropium bromide ( IB) 500 mu g together with MS 151 mg/dose, while the other group received IB together with placebo. The patients were followed-up with forced expiratory volume in 1 second ( FEV1) and visual analogue scale dyspnea scores for 48 hours. Peak expiratory flow rates ( PEFRs) were measured before and 10, 30, 60 and 120 minutes after each nebule treatment.Results: The baseline characteristics of the patients in both groups were similar. The FEV1 values measured at 24 and 48 hours did not show significant changes compared to baseline in both groups. Dyspnea scores in both groups decreased significantly in the first day, and in only MS group in the second day. The % change in the dyspnea score at the end of first day was significantly more in the MS group [-23.8% ( 13.6)] compared with the placebo group [-9.4% ( 12.9)] ( p= 0.002). The % changes in PEFRs at 10 minutes [ 4.7 ( 7.5) and -3.5 ( 6.0), p= 0.005] and 30 minutes [ 8.2 ( 6.7) and 1.3 ( 5.5), p= 0.03] were significantly greater in the MS group compared with the placebo group on the first day. No side effects developed due to MS.Conclusion: Nebulised MS is a cheap, feasible and safe drug that can be added to the standart bronchodilator treatment since it provides additional relief of dyspnea in patients with COPD exacerbations. This needs to be evaluated in future clinical studies including greater number of patients.

Introduction: Ehlers-Danlos syndrome (EDS) is an uncommon cause of hemoptysis and spontaneous hemopneumothorax. We present a case with recurrent hemoptysis who had bronchial artery pathology and anomalous pulmonary venous return associated with EDS. Case: Twenty-years-old female presented with recurrent hemoptysis for two years. Thoracic tomography was normal. Six months of antituberculosis therapy were given due to M. tuberculosis growth in sputum cultures. Ear-nose-throat examination revealed lesions in bilateral nasal conchae and lesions were cauterized. As the hemoptysis persisted, a diagnostic bronchoscopy was performed and revealed an active source of bleeding at the orifice of superior segment of the right lower lobe. Bronchial artery ligation was performed via right thoracotomy. Echocardiogram revealed mitral and tricuspid valve prolapsed. Ophthalmologic examination was performed due to atypical localization of pupils. Bilateral coloboma, nistagmus and ectopia lentis were found. Patient history was positive for spontaneous ecchymosis, premature loss of teeth, increased joint laxity. Genetic physicians found these findings to be consistent with EDS type 6. Skin and subcutaneous tissue biopsies were performed and the definitive diagnosis was made using electron microscopy, fibroblast culture and mutation analysis. A hereditary transmission could not be demonstrated. Pulmonary angiography revealed a tortuous course in distal branches of bronchial arteries and early venous return consistent with arteriovenous fistula. Bilateral bronchial artery embolization was performed. Patient9s hemoptysis regressed. Conclusion: In this care, EDS was found as an uncommon cause of hemoptysis.

Introduction: Bronchial thermoplasty (BT) is a new technique for uncontrolled asthma. It delivers thermal energy to the large airways and decrease the amount of smooth muscle. BT has been shown to reduce asthma exacerbations, and improve asthma control and quality of life. Metods: Stable adult asthmatics requiring optimal inhaler treatment (beclomethasone ≥200μg, salmeterol ≥100μg), post-bronchodilator FEV1 50-80% predicted; and, non- smoker for 1yr or former smoker Case I: A 45year-old male with uncontrolled asthma for 20 years, underwent BT. He had been receiving optimal medical therapy with p.o prednisolone 8mg/daily. Symptoms did not persist after BT. FEV1 prior to BT was 65% (1830ml), ACQ: 4, ACT:11. During 12 week follow-up, FEV1: 44% (1480ml), ACQ:1 and ACT:23. Case II: A 45year-old female with uncontrolled asthma for 14 years underwent BT. She were receiving optimal medical therapy with p.o prednisolone 16mg/daily and omalizumab. FEV1 prior to BT was 82% (3610ml), ACQ: 5,5, ACT: 5. During 12 weeks follow-up, FEV1 was 89% (3940ml), ACQ: 0,2 and ACT: 25. Case III: A 40-year-old male with uncontrolled asthma for 20 years, underwent BT. He had been receiving optimal medical therapy with p.o prednisolone 16mg/daily. Heamoptysis (10cc) occured a week after third seance. Symptoms improved after BT. FEV1 prior to BT was 66 % (2370ml), ACQ:2.7, ACT:5. During 12 week follow-up, FEV1:65% (2340ml), ACQ:0.8 and ACT:25. Conclusion: Response to BT varies from one patient to another. Further studies with different asthma phenotypes are required to define the better responders from BT.

SESSION TITLE: Tuberculosis Posters

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) who have nocturnal oxygen desaturation (NOD) should be treated with nocturnal oxygen therapy (NOT) for avoiding morbidity and mortality. Nocturnal oximetry is an expensive and time consuming test that used for evaluating NOD individuals. AIM: To evaluate whether desaturation during 6-minute walk test (6MWT) is useful for predicting NOD in COPD. METHODS: Stable moderate or severe COPD patients were enrolled in this study. Spirometry and carbon monoxide diffusion test (DLCO), arterial blood gas analysis, 6MWT and nocturnal oximetry were performed. Patients with obstructive sleep apnea, hypoxemic respiratory failure, and who were receiving noninvasive mechanical ventilation therapy were excluded. RESULTS: Totally 61 patients (55 male, age: 65.8±8.4) were analysed. Thirty of them had moderate and the others (n=31) had severe COPD. Forced expiratory volume 1 second was 1352±348ml (51.2%±11.8%). Patients who were desaturated during 6MWT had significantly lower DLCO, PaO2, SaO2 and higher PaCO2 levels than the patients who did not desaturated (p CONCLUSION: 6MWT can be recommended as a simple, cheap tool for predicting NOD and selecting individuals for NOT particularly in severe COPD.

BACKGROUND: Simpler and radiation free alternatives have been researched to estimate postoperative lung functions. Objective of the study is to investigate the reliability of predicted postoperative (ppo) forced expiratory volume in 1 second (FEV₁) and carbon monoxide diffusion capacity (DLCO) calculated by vibration response imaging (VRI) to guide the selection of patients for lung resection surgery in comparison with quantitative perfusion scintigraphy (Q scan). METHODS: 35 candidates for lung resection were enrolled in the study for preoperative and postoperative evaluation of FEV₁ and DLCO. RESULTS: Totally 25 patients had preoperative tests. VRI measurements showed strong correlation with Q scan measurements of predicted postoperative (ppo) FEV₁% (r= .87, p<.001), ppo FEV₁(L) (r=.90, p<.001) and ppo DLCO% (r=.90, p<.001). There was a correlation between ppo FEV₁ (% and L) calculated by Q scan and postoperative actual FEV₁ (% and L) (r=.47, p<.05; r=.73, p<.001). There was no difference between VRI measurements of ppo FEV₁(% and L) and postoperative actual FEV₁ values. There was a correlation between ppo FEV₁ (% and L) calculated by VRI and postoperative actual FEV₁(% and L) (r= .52, p<.05; r= .79, p<.001). The mean differences between ppo and postoperative actual FEV₁ values was 49ml for VRI versus 230ml for Q scan. Both VRI and Q scan ppo DLCO% did not show agreement with postoperative actual DLCO%. CONCLUSIONS: VRI, which is a non-invasive, radiation free and simple test, may be valuable in the preoperative evaluation of lung resection surgery. It may be a good alternative to Q scan.

Background: Patients with severe chronic obstructive pulmonary disease (COPD) have limited treatment options. Exercise capacity and health related quality of life (HRQL) of these patients are affected by the progress of respiratory failure. Thus, there is a need for new treatments that can palliate. Endo-bronchial volum reduction treatment (EBVRT) which is a minimally invasive method has been come up. Endobronchial valves (EBV) that allow air to escape from a pulmonary lobe but not enter. It can induce a reduction in lobar volume that may thereby improve lung function and exercise tolerance in patients with advanced emphysema. Method: To evaluate the safety and effectiveness of the EBVRT of lower lobe predominant heterogeneous emphysema. Functional capacity was evaluated with spirometry, 6minute walk distance (6MWD). SGRQ were applied to evaluate the HRQL. Result: Five patients with heterogeneous lower lobe predominant emphysema (two left, three right lower lobe) were treated with EBV. Most of the patients were male (80%). The mean age was 65 years. Valves were placed into left lower lobe (n=2) and right lower lobes (n=3). Valves were placed in airways with 100% technical success. There were no procedure-related deaths and complications. At the third month, there was an increase of 4.6% in the forced expiratory volume 1 second (FEV1) and 2.3% increase of 6MWD were observed. Also, there was a decrease of 2.3% in the SGRQ score was observed. Conclusion: EBVRT for heterogeneous lower lobe predominant emphysema patients induced modest improvements in lung function, exercise tolerance, and HRQL. EBVRT is a new safety method for the patients with severe COPD.