Introduction: Pulmonary hypertension (PH) is a significant complication and is poor prognostic fa... more Introduction: Pulmonary hypertension (PH) is a significant complication and is poor prognostic factor for sarcoidosis. We evaluated various tests of diagnosis and treatment as well as the associations between PH and value of six-minute walk test (6 MWT) in sarcoidosis patients. Methods: This study was conducted with fifty patients with sarcoidosis. We grouped patients according to echocardiography. Results: PH prevalence in sarcoidosis was found to be 10%. In cases with likely PH, FEV1%, FVC%, MMF% was found to be lower. Although DLCO was less than 80% in the group of likely PH and over 80% in the other, there were no statistical differences between two groups. Mean value of FVC/DLCO ratio was 1.1 ± 0.38 in group of likely PH. There was no significant difference between groups. Mean distance of 6 MWT was 464 ± 105 m in all cases. There were no statistical differences between two groups in 6 MWT. Significant desaturation with exercise was observed in cases with PH (p = 0.007). Conclusion: In all stages, patients who have longer disease duration and abnormal pulmonary function tests, should be examined about PH. Patients should undergo 6 MWT and presence of desaturation after 6 MWT, even without hypoxemia, should be looked after and dealt with accordingly.
Tele-pulmonary rehabilitation (PR) is a good option for patients who underwent lung transplantati... more Tele-pulmonary rehabilitation (PR) is a good option for patients who underwent lung transplantation or on the waiting list during the COVID-19 pandemic; in addition, optimum content, duration, and optimum remote assessment tests have not been defined for tele-PR. We reported our tele-PR model and two cases of exercise capacity, which were assessed remotely. Tele-PR can be effective in improving the exercise capacity in patients who underwent lung transplantation and in those who have advanced lung disorders and are on the waiting list for transplantation. Furthermore, shuttle tests can be practical and convenient to use for remote assessment.
Aspiration of a foreign body is a life-threatening emergency which is seen exclusively in childho... more Aspiration of a foreign body is a life-threatening emergency which is seen exclusively in childhood. Some cases are detected in adulthood with very variable symptoms according to localization of the material. The history is very important in diagnosis as the foreign bodies in the tracheobronchial tree may mimick many pathologic conditions. Wrong diagnosis may lead to inappropriate interventions or irrational treatment. This report presents a patient with aspirated foreign body in main bronchus who had been followed and treated for difficult asthma.
To the Editor, Pulmonary rehabilitation (PR) is an effective approach which results in improving ... more To the Editor, Pulmonary rehabilitation (PR) is an effective approach which results in improving symptoms, exercise capacity, decreasing hospital care services, reducing the cost of care, improving adherence to healthy-life behavours in patients with chronic respiratory disorders (1). PR programs can be applied in different modalities due to the center/unit structure, patients' characteristics. In early stages of pandemic times center-based, face-to-face programs were recommended to suspend and telehealth solutions were advised to provide care remotely (2,3). Telehealth is defined as delivery of health care services, where patients and providers are separated by distance through the use of information and communications technology (4). Several different applications of telehealth technology have been used to provide health services to people with chronic respiratory diseases; such applications include telemonitoring, teleconsultation, tele-education, and tele-PR. Tele-PR is defined as the delivery of PR content through various communication modalities (e.g. videoconferencing, telephone), which connects patients to healthcare professional. Telemonitoring may be used in conjunction with tele-PR (5). Tele-PR has been found as effective as conventional PR in terms of improvements in exercise capacity and respiratory symptoms and also, more efficient in program completion (6-8). Symptomatic patients after covid infection, patients with chronic lung disease who has increased need for PR due to pandemic period or patients with transfer problems
Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare form of pulmonary aspergillosis. The... more Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare form of pulmonary aspergillosis. The radiological findings in CNPA are very diverse. We present a mildly imunosuppresive, elderly 71-year-old woman with the diagnosis of chronic necrotizing pulmonary aspergillosis presenting as transient migratory thoracic mass.
Background/aim: Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstruct... more Background/aim: Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstructive pulmonary disease (COPD), but the benefits decrease over time. We evaluated the effects of a structured follow-up program after PR on patient pulmonary function, dyspnea, body composition, exercise capacity, quality of life, psychological status, i-BODE index, hospitalization status, 5-year survival rate. We explored whether this follow-up program could serve as a maintenance program. Materials and methods: COPD patients who completed PR attended follow-up visits over 5 years. We administered incremental (ISWT), endurance shuttle walk tests (ESWT), measured body (BMI), fat-free mass indices (FFMI), recorded modified Medical Research Council (mMRC), St. George's respiratory questionnaire (SGRQ), anxiety-depression scores. We also noted the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the forced midexpiratory flow (FEF25-75), hospitalization, survival rates before, after PR, and in years 1, 2, 3, 5. This was a retrospective observational study. Results: Thirty-three COPD patients with a mean age of 58 ± 8 years were enrolled. Twenty-seven (82%) were male. The mean FEV1 was 47 ± 16% of the predicted. After PR, the mMRC scale, SGRQ, anxiety, depression scores; i-BODE index; ISWT, ESWT results improved (all p < 0.001), with the improvements persisting through the first year. Patient body composition, pulmonary function did not differ from the baseline over the 5 years (except for a decrease in the FEF25-75 value in year 5; p = 0.003). The hospitalization rate, i-BODE index did not change significantly over the 5 years, the improvements in the ISWT, ESWT outcomes were preserved for 3 years (p = 0.013/0.005, respectively). The quality-of-life, anxiety scores deteriorated in year 1 (both p < 0.001) and year 3 (p = 0.005/0.010, respectively). The dyspnea, depression scores increased progressively over the 5 years. Conclusion: Structured follow-up programs with visits at 6-month intervals may effectively maintain improvements in COPD. Longterm randomized controlled studies are needed to verify these results.
Journal of Cardiopulmonary Rehabilitation and Prevention, Jul 1, 2019
L ung transplantation (LTx) is a therapeutic, effective, and life-saving intervention for selecte... more L ung transplantation (LTx) is a therapeutic, effective, and life-saving intervention for selected patients with end-stage pulmonary disease who are unresponsive to medical or surgical treatment. All chronic lung diseases commonly occur in association with several comorbidities. One of the most common and important extrapulmonary manifestations is skeletal muscle dysfunction, 1 , 2 which results in deteriorated physical activity, exercise capacity, and quality of life. 3 Although exercise capacity and quality of life have been found to be improve after LTx, especially after the fi rst year, exercise capacity is lower than in healthy controls. 4 , 5 The most important reason for exercise intolerance is skeletal muscle dysfunction. The main underlying mechanisms of skeletal muscle dysfunction are not fully understood, but there are several possible causes such as time spent in the intensive care unit, hospital stay duration, and sedentary lifestyle after discharge. Furthermore, muscle weakness may be infl uenced by infections, acute rejection, and the use of immunosuppressive medication in LTx recipients. 6 It has also been shown that changes in skeletal muscle are associated with decreased oxidative capacity, lactate threshold, and ratio of type I muscle fi bers. 7 Therefore, pulmonary rehabilitation (PR), as a comprehensive, multidisciplinary approach, is advocated pre-LTx and in the post-LTx period. The aim of this study was to investigate the effect of a multidisciplinary, comprehensive outpatient PR program on exercise capacity; hand, quadriceps, and respiratory muscle strength; dyspnea and quality of life; psychological status; pulmonary function; and body composition in LTx recipients in the early period after hospital discharge. METHODS SAMPLE CHARACTERISTICS Twenty-three bilateral LTx recipients were referred to the PR center between 2013 and 2017. This study was conducted in accordance with the amended Declaration of Helsinki. The patients' parameters were recorded after obtaining intuitional review board approval and receiving written informed consent. The diagnoses of the 23 patients were chronic obstructive pulmonary disease (30%), idiopathic pulmonary fi brosis (30%), histiocytosis-X (13%), silicosis (9%), bronchiectasis (9%), α-1 antitrypsin defi ciency (4%), and pulmonary alveolar proteinosis (4%). Six patients did not complete the PR program. The reasons of dropout were 1 case each of bronchial stenosis, venous thrombosis, and pneumonia, and 3 with transportation problems. The initiation of the program was 75 ± 15 d after LTx. The demographic characteristics of patients are presented in Table 1. All patients were under immunosuppressive treatment including tacrolimus, mycophenolate mofetil, systemic steroids, and prophylactic antifungal, antibacterial, and antiviral treatment as with the standard recommended medical treatment for LTx recipients. 8 None of the recipients had symptoms or diagnoses of infectious and noninfectious complications such as anastomotic problems, allograft rejection,
Objective: Our chronic respiratory failure service where we manage the patients with acute /chron... more Objective: Our chronic respiratory failure service where we manage the patients with acute /chronic respiratory failure, is a hospital unit with multidisciplinary team with structured integrated pulmonary rehabilitation (PR) and home care unit. The aim of the study was to present our weaning experiences of inpatient hospital service in patients with prolonged mechanical ventilation (MV) and whether multidisciplinary structured inpatient service model could be an alternative method for weaning. Method: Twenty-three patients with home invasive mechanical ventilation (IMV) who underwent multidisciplinary inpatient PR program and weaning trials were analyzed. Dyspnea scores, body composition, respiratory muscle strength, physicological status, echocardiagraphic measurements before PR and weaning process, duration of IMV (since the opening of the tracheostomy), ABG levels before and 24 hours after weaning were recorded. Results: One patient was with pneumonia, 13 with COPD, 5 with bronchiectasis, 2 with kyphoscoliosis, and 2 with congestive heart failure. The median value of duration of IMV was 126 days. The weaning trial was performed on 15 of 21 patients. Six patients were not found to be appropriate for weaning. 12 of 15 patients were decannulated with 80% weaning success. Four patients were discharged with long term oxygen therapy (LTOT), nocturnal non-IMV, 7 with LTOT, and 1 without device. The patients with weaning failure had higher anxiety depression scores, systolic pulmonary arterial pressures, lower maximum inspiratory, expiratory pressures, and shorter duration of IMV. Conclusion: This study showed that chronic respiratory failure inpatients services consisting of multidisciplinary team and integrating PR into patients' managements could serve as weaning centers in case of absence of specialized centers in prolonged MV.
The aim of study was to evaluate the efficiency of pr in COPD patients with and without PH.Accord... more The aim of study was to evaluate the efficiency of pr in COPD patients with and without PH.According to Echocardiographic diagnosis 2009 ERS/ESC guideline, patients were divided into grup1(PH unlikely) and group2(PH possible,likely). 88 stable COPD Patients underwent an 8week hospital based outpatient PR. Dyspnea was assessed with MRC scale,health related quality of life with St.GeoergeRespiratoryQuestionnaire(SGRQ).Exercise capacity was measured using Incremental Shuttle Walk Test (ISWT) and Endurance Shuttle Walk Test (ESWT); the body composition with bioelectrical impedance method.In all patients body composition (BMI p:0,01),quality of life (SGRQ symptom,activity,total p:0,00),dyspnea sensation,exercise capasity (ISWT,ESWT,VO2 peak p:0,00) were improved. When the improvements were compared between groups, there was no statistically significant difference except change in ESWT.In grup2 increase in ESWT was more than grup1(p:0,002). Pulmonary rehabilitation is safe and effective in COPD patients with PH. COPD patients with PH should be refered for comprehensive, multidisplinary, individually, tailored PR programs.
Expert Review of Respiratory Medicine, Jul 4, 2015
We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment tes... more We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment test (CAT) and improvements after pulmonary rehabilitation (PR) and PR efficiency in COPD patients. Forty COPD patients completed PR. After PR, mean change in CAT score was found to be 13 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), Medical Research Council (MRC), St George&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Respiratory Questionnaire (SRGQ) and London Chest Activity Daily Living (LCADL) scores decreased, while Endurance Shuttle Walking Test (ESWT) time and Incremental Shuttle Walking Test (ISWT) distance increased significantly. Baseline CAT scores correlated with MRC, SRGQtotal, %FVC, ISWT, ESWT, LCADL. Change in CAT was significantly correlated with changes in MRC, SGRQtotal, LCADL-leisure scores, and ESWT. CAT score shows moderate degree correlation with some measures of outcome of PR and response to PR efficacy.
SummaryBackgroundEven though many studies have investigated the effectiveness of weight loss inte... more SummaryBackgroundEven though many studies have investigated the effectiveness of weight loss interventions, the efficacy of pulmonary rehabilitation (PR) has not yet been proven in obese patients with asthma. The aims of this study were to investigate the efficacy of PR on asthma exacerbations in the first year after PR and to evaluate the efficacy of PR in exercise capacity, quality of life, psychosocial symptoms and control of asthma in overweight patients.MethodsThe exercise capacity, health-related quality of life scores, psychosocial symptoms, asthma control test (ACT) data, number of emergency admissions and hospitalizations of 35 overweight patients with asthma who completed a 1-year multidisciplinary PR program were recorded and analyzed.ResultsOf the participants 30 were female, the mean age was 45 ± 9 years, 13 (37%) patients were overweight and 22 (63%) were obese. The average number of emergency admissions (from 1.2 ± 1.1 to 0.3 ± 0.8) and hospitalizations (from 0.6 ± 0.9 to 0.0 ± 0.1) decreased significantly 1 year after PR (both p<0.001). After PR, statistically significant improvements in exercise capacity as measured by the incremental shuttle walking test (ISWT) from 281 ± 104 m to 339 ± 95 m (p < 0.001), the endurance shuttle walking test (ESWT) from 13.3 ± 7.4 min to 17.5 ± 4.5 min (p = 0.005), quality of life measured by the St. George’s respiratory questionnaire (SGRQ total from 64 ± 14 to 28 ± 10, p < 0.001), dyspnea sensation with the Medical Research Council (MRC) scale (from 2.6 ± 0.6 to 2.1 ± 0.4, p <0.001) and hospital anxiety depression scores (HADS, anxiety score from 9.9 ± 1.6 to 7.1 ± 2.1, depression score from 9.4 ± 1.9 to 7.2 ± 2.3, both p < 0.001) were found. A reduction in body mass index (BMI) was found in obese patients only, but the fat-free mass index (FFMI) improved in both overweight and obese patients (from 19.00 ± 1.90 to 19.45 ± 2.04, p = 0.01). The mean ACT score increased significantly (from 18 to 21 points, p < 0.001). The number of patients with poorly controlled asthma decreased from 21 (60%) to 10 (28%).ConclusionThis study showed that comprehensive multidisciplinary PR was associated with a decreased number of emergency admissions and hospitalizations for asthma exacerbations in 1 year, and improvements of dyspnea sensation, quality of life, exercise capacity, and psychosocial status in overweight and obese patients.
Expert Review of Respiratory Medicine, Oct 9, 2019
Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obst... more Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but it is still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients. Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables. Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity(p=0.003), quality of life(p=0.045), FEV1(p=0.001), lower pack-year smoking (p<0.001) than outpatient PR.After home PR, exercise capacity (p<0.05), quality of life(p<0.001), dyspnea(p<0.05), anxiety(p<0.001), depression(p<0.001) were improved except endurance shutte test. Improvements in exercise capacity(p<0.05), quality of life(p<0.001), dyspnea(p=0.023), anxiety(p<0.001), depression (p=0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Nonfinishers of home PR had more pack-year smoking than finishers of home PR (p=0.039); other baseline parameters were similar. Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.
Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of... more Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of this study was to determine the rates and associated factors of influenza and pneumonia vaccinations in patients who were hospitalized because of acute respiratory failure. Patients hospitalized because of acute hypoxemic or hypercapnic respiratory failure were recruited for this retrospective study. A survey was conducted with 97 patients. Primary diagnoses, ages, reasons of hospitalizations, education status, vaccination rates, information resources, and thoughts about vaccinations were recorded. Results: In total 45 (46%) of the patients were female, and 52 (54%) were male. The mean age was 67 ± 12 years. The primary diagnoses were lung disorders (n = 77, 79%), cardiac disorders (n = 16, 17%), and neuromuscular disorders (n = 5, 4%). In total 72 (74%) patients had chronic obstructive pulmonary disease (COPD) with primary lung disorders. All patients were hospitalized due to acute respiratory failure. The main reason for acute respiratory failure was infection in 40 patients (42%). The overall influenza and pneumococcal vaccination rates were 26% and 15%, respectively; for patients with COPD it was 30% and 17%, respectively. The main providers of information were doctors (42%). Vaccination status was not associated with infections or other reasons of hospitalization, age, sex, educational status, and number of hospital admissions in the previous year. A total of 51 patients (52%) had no belief in the benefits of vaccinations. Conclusion: Vaccination rates were found to be low in patients who were frequently hospitalized. Vaccination status was not related with hospitalization due to infections and history of hospitalization; awareness of vaccinations should be improved both in doctors and patients.
Idiopathic pulmonary fibrosis (IPF) is characterized by progressively worsening lung function, ve... more Idiopathic pulmonary fibrosis (IPF) is characterized by progressively worsening lung function, ventilation capacity, dyspnea, and finally reduced exercise intolerance. All of these have a significant negative impact on functional capacity and quality of life. In this study, we aim to evaluate the effects of pulmonary rehabilitation (PR) in IPF and assess the predictors of success. Methods: Data from 17 IPF patients who completed the program from the total of 27 patients who applied to PR were used in our study. We evaluated their pulmonary function tests, exercise capacity, peripheral-respiratory muscle strength, body composition, quality of life, and psychological states before and after PR. Results: Following the PR program, improvements over the minimal clinically important differences were observed in almost all parameters compared to the baseline; however, statistically significant improvements were only observed in the medical research council (P=0.020), the St. George respiratory questionnaire (P=0.002), the maximal inspiratory pressure (P=0.024), the anxiety score (P=0.001), the depression score (P=0.002), and the right quadriceps muscle strength (P=0.046). There was only a statistically significant negative correlation between the initial forced vital capacity and the forced expiratory volume in one-second value with the increase in patients' maximal inspiratory pressure values after PR. Discussion: After a multidisciplinary, comprehensive PR program, dyspnea sensation, exercise capacity, endurance time, quality of life, respiratory and peripheral muscle strengths, and psychological status were improved regardless of age, gender, antifibrotic treatment, and comorbidities. Therefore, patients should be referred to PR units before the deterioration in the quality of life in the early stages of the disease.
Background After COVID-19 infection, persistent exercise intolerance, changes in lung function ha... more Background After COVID-19 infection, persistent exercise intolerance, changes in lung function have been shown. Our aim is to investigate the correlation between impulse oscillometry (IOS) parameters and exercise capacity by using incremental and endurance shuttle walk tests (ISWT, ESWT) and investigate the factors and parameters which might have an effect on both IOS parameters and exercise capacity tests. Method The patients who had a history of COVID-19 were enrolled into cross-sectional study according to inclusion criteria. The IOS parameters, ISWT, ESWT, smoking status, time since COVID-19 diagnosis, length of hospital stay, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), body mass index (BMI), fat-free mass index (FFMI), dyspnea, hospital anxiety-depression and fatigue severity scores were recorded. Results The study comprised 72 patients, 71% of whom were male, with a mean age of 54 ± 10 years. After COVID-19 diagnosis, the median duration was 3 (min: 1, max: 5) months and 51 (71%) of the patients were hospitalized. The FEV1 and FVC values were in normal range. The area of reactance (AX), resonance frequency (Fres), reactance at 20 Hz (X20) and the difference between resonance at 20 and 5 Hz
Introduction: Pulmonary hypertension (PH) is a significant complication and is poor prognostic fa... more Introduction: Pulmonary hypertension (PH) is a significant complication and is poor prognostic factor for sarcoidosis. We evaluated various tests of diagnosis and treatment as well as the associations between PH and value of six-minute walk test (6 MWT) in sarcoidosis patients. Methods: This study was conducted with fifty patients with sarcoidosis. We grouped patients according to echocardiography. Results: PH prevalence in sarcoidosis was found to be 10%. In cases with likely PH, FEV1%, FVC%, MMF% was found to be lower. Although DLCO was less than 80% in the group of likely PH and over 80% in the other, there were no statistical differences between two groups. Mean value of FVC/DLCO ratio was 1.1 ± 0.38 in group of likely PH. There was no significant difference between groups. Mean distance of 6 MWT was 464 ± 105 m in all cases. There were no statistical differences between two groups in 6 MWT. Significant desaturation with exercise was observed in cases with PH (p = 0.007). Conclusion: In all stages, patients who have longer disease duration and abnormal pulmonary function tests, should be examined about PH. Patients should undergo 6 MWT and presence of desaturation after 6 MWT, even without hypoxemia, should be looked after and dealt with accordingly.
Tele-pulmonary rehabilitation (PR) is a good option for patients who underwent lung transplantati... more Tele-pulmonary rehabilitation (PR) is a good option for patients who underwent lung transplantation or on the waiting list during the COVID-19 pandemic; in addition, optimum content, duration, and optimum remote assessment tests have not been defined for tele-PR. We reported our tele-PR model and two cases of exercise capacity, which were assessed remotely. Tele-PR can be effective in improving the exercise capacity in patients who underwent lung transplantation and in those who have advanced lung disorders and are on the waiting list for transplantation. Furthermore, shuttle tests can be practical and convenient to use for remote assessment.
Aspiration of a foreign body is a life-threatening emergency which is seen exclusively in childho... more Aspiration of a foreign body is a life-threatening emergency which is seen exclusively in childhood. Some cases are detected in adulthood with very variable symptoms according to localization of the material. The history is very important in diagnosis as the foreign bodies in the tracheobronchial tree may mimick many pathologic conditions. Wrong diagnosis may lead to inappropriate interventions or irrational treatment. This report presents a patient with aspirated foreign body in main bronchus who had been followed and treated for difficult asthma.
To the Editor, Pulmonary rehabilitation (PR) is an effective approach which results in improving ... more To the Editor, Pulmonary rehabilitation (PR) is an effective approach which results in improving symptoms, exercise capacity, decreasing hospital care services, reducing the cost of care, improving adherence to healthy-life behavours in patients with chronic respiratory disorders (1). PR programs can be applied in different modalities due to the center/unit structure, patients' characteristics. In early stages of pandemic times center-based, face-to-face programs were recommended to suspend and telehealth solutions were advised to provide care remotely (2,3). Telehealth is defined as delivery of health care services, where patients and providers are separated by distance through the use of information and communications technology (4). Several different applications of telehealth technology have been used to provide health services to people with chronic respiratory diseases; such applications include telemonitoring, teleconsultation, tele-education, and tele-PR. Tele-PR is defined as the delivery of PR content through various communication modalities (e.g. videoconferencing, telephone), which connects patients to healthcare professional. Telemonitoring may be used in conjunction with tele-PR (5). Tele-PR has been found as effective as conventional PR in terms of improvements in exercise capacity and respiratory symptoms and also, more efficient in program completion (6-8). Symptomatic patients after covid infection, patients with chronic lung disease who has increased need for PR due to pandemic period or patients with transfer problems
Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare form of pulmonary aspergillosis. The... more Chronic necrotizing pulmonary aspergillosis (CNPA) is a rare form of pulmonary aspergillosis. The radiological findings in CNPA are very diverse. We present a mildly imunosuppresive, elderly 71-year-old woman with the diagnosis of chronic necrotizing pulmonary aspergillosis presenting as transient migratory thoracic mass.
Background/aim: Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstruct... more Background/aim: Pulmonary rehabilitation (PR) has proven useful in patients with chronic obstructive pulmonary disease (COPD), but the benefits decrease over time. We evaluated the effects of a structured follow-up program after PR on patient pulmonary function, dyspnea, body composition, exercise capacity, quality of life, psychological status, i-BODE index, hospitalization status, 5-year survival rate. We explored whether this follow-up program could serve as a maintenance program. Materials and methods: COPD patients who completed PR attended follow-up visits over 5 years. We administered incremental (ISWT), endurance shuttle walk tests (ESWT), measured body (BMI), fat-free mass indices (FFMI), recorded modified Medical Research Council (mMRC), St. George's respiratory questionnaire (SGRQ), anxiety-depression scores. We also noted the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC), the forced midexpiratory flow (FEF25-75), hospitalization, survival rates before, after PR, and in years 1, 2, 3, 5. This was a retrospective observational study. Results: Thirty-three COPD patients with a mean age of 58 ± 8 years were enrolled. Twenty-seven (82%) were male. The mean FEV1 was 47 ± 16% of the predicted. After PR, the mMRC scale, SGRQ, anxiety, depression scores; i-BODE index; ISWT, ESWT results improved (all p < 0.001), with the improvements persisting through the first year. Patient body composition, pulmonary function did not differ from the baseline over the 5 years (except for a decrease in the FEF25-75 value in year 5; p = 0.003). The hospitalization rate, i-BODE index did not change significantly over the 5 years, the improvements in the ISWT, ESWT outcomes were preserved for 3 years (p = 0.013/0.005, respectively). The quality-of-life, anxiety scores deteriorated in year 1 (both p < 0.001) and year 3 (p = 0.005/0.010, respectively). The dyspnea, depression scores increased progressively over the 5 years. Conclusion: Structured follow-up programs with visits at 6-month intervals may effectively maintain improvements in COPD. Longterm randomized controlled studies are needed to verify these results.
Journal of Cardiopulmonary Rehabilitation and Prevention, Jul 1, 2019
L ung transplantation (LTx) is a therapeutic, effective, and life-saving intervention for selecte... more L ung transplantation (LTx) is a therapeutic, effective, and life-saving intervention for selected patients with end-stage pulmonary disease who are unresponsive to medical or surgical treatment. All chronic lung diseases commonly occur in association with several comorbidities. One of the most common and important extrapulmonary manifestations is skeletal muscle dysfunction, 1 , 2 which results in deteriorated physical activity, exercise capacity, and quality of life. 3 Although exercise capacity and quality of life have been found to be improve after LTx, especially after the fi rst year, exercise capacity is lower than in healthy controls. 4 , 5 The most important reason for exercise intolerance is skeletal muscle dysfunction. The main underlying mechanisms of skeletal muscle dysfunction are not fully understood, but there are several possible causes such as time spent in the intensive care unit, hospital stay duration, and sedentary lifestyle after discharge. Furthermore, muscle weakness may be infl uenced by infections, acute rejection, and the use of immunosuppressive medication in LTx recipients. 6 It has also been shown that changes in skeletal muscle are associated with decreased oxidative capacity, lactate threshold, and ratio of type I muscle fi bers. 7 Therefore, pulmonary rehabilitation (PR), as a comprehensive, multidisciplinary approach, is advocated pre-LTx and in the post-LTx period. The aim of this study was to investigate the effect of a multidisciplinary, comprehensive outpatient PR program on exercise capacity; hand, quadriceps, and respiratory muscle strength; dyspnea and quality of life; psychological status; pulmonary function; and body composition in LTx recipients in the early period after hospital discharge. METHODS SAMPLE CHARACTERISTICS Twenty-three bilateral LTx recipients were referred to the PR center between 2013 and 2017. This study was conducted in accordance with the amended Declaration of Helsinki. The patients' parameters were recorded after obtaining intuitional review board approval and receiving written informed consent. The diagnoses of the 23 patients were chronic obstructive pulmonary disease (30%), idiopathic pulmonary fi brosis (30%), histiocytosis-X (13%), silicosis (9%), bronchiectasis (9%), α-1 antitrypsin defi ciency (4%), and pulmonary alveolar proteinosis (4%). Six patients did not complete the PR program. The reasons of dropout were 1 case each of bronchial stenosis, venous thrombosis, and pneumonia, and 3 with transportation problems. The initiation of the program was 75 ± 15 d after LTx. The demographic characteristics of patients are presented in Table 1. All patients were under immunosuppressive treatment including tacrolimus, mycophenolate mofetil, systemic steroids, and prophylactic antifungal, antibacterial, and antiviral treatment as with the standard recommended medical treatment for LTx recipients. 8 None of the recipients had symptoms or diagnoses of infectious and noninfectious complications such as anastomotic problems, allograft rejection,
Objective: Our chronic respiratory failure service where we manage the patients with acute /chron... more Objective: Our chronic respiratory failure service where we manage the patients with acute /chronic respiratory failure, is a hospital unit with multidisciplinary team with structured integrated pulmonary rehabilitation (PR) and home care unit. The aim of the study was to present our weaning experiences of inpatient hospital service in patients with prolonged mechanical ventilation (MV) and whether multidisciplinary structured inpatient service model could be an alternative method for weaning. Method: Twenty-three patients with home invasive mechanical ventilation (IMV) who underwent multidisciplinary inpatient PR program and weaning trials were analyzed. Dyspnea scores, body composition, respiratory muscle strength, physicological status, echocardiagraphic measurements before PR and weaning process, duration of IMV (since the opening of the tracheostomy), ABG levels before and 24 hours after weaning were recorded. Results: One patient was with pneumonia, 13 with COPD, 5 with bronchiectasis, 2 with kyphoscoliosis, and 2 with congestive heart failure. The median value of duration of IMV was 126 days. The weaning trial was performed on 15 of 21 patients. Six patients were not found to be appropriate for weaning. 12 of 15 patients were decannulated with 80% weaning success. Four patients were discharged with long term oxygen therapy (LTOT), nocturnal non-IMV, 7 with LTOT, and 1 without device. The patients with weaning failure had higher anxiety depression scores, systolic pulmonary arterial pressures, lower maximum inspiratory, expiratory pressures, and shorter duration of IMV. Conclusion: This study showed that chronic respiratory failure inpatients services consisting of multidisciplinary team and integrating PR into patients' managements could serve as weaning centers in case of absence of specialized centers in prolonged MV.
The aim of study was to evaluate the efficiency of pr in COPD patients with and without PH.Accord... more The aim of study was to evaluate the efficiency of pr in COPD patients with and without PH.According to Echocardiographic diagnosis 2009 ERS/ESC guideline, patients were divided into grup1(PH unlikely) and group2(PH possible,likely). 88 stable COPD Patients underwent an 8week hospital based outpatient PR. Dyspnea was assessed with MRC scale,health related quality of life with St.GeoergeRespiratoryQuestionnaire(SGRQ).Exercise capacity was measured using Incremental Shuttle Walk Test (ISWT) and Endurance Shuttle Walk Test (ESWT); the body composition with bioelectrical impedance method.In all patients body composition (BMI p:0,01),quality of life (SGRQ symptom,activity,total p:0,00),dyspnea sensation,exercise capasity (ISWT,ESWT,VO2 peak p:0,00) were improved. When the improvements were compared between groups, there was no statistically significant difference except change in ESWT.In grup2 increase in ESWT was more than grup1(p:0,002). Pulmonary rehabilitation is safe and effective in COPD patients with PH. COPD patients with PH should be refered for comprehensive, multidisplinary, individually, tailored PR programs.
Expert Review of Respiratory Medicine, Jul 4, 2015
We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment tes... more We evaluated the relationship between chronic obstructive pulmonary disease (COPD) assessment test (CAT) and improvements after pulmonary rehabilitation (PR) and PR efficiency in COPD patients. Forty COPD patients completed PR. After PR, mean change in CAT score was found to be 13 (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), Medical Research Council (MRC), St George&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Respiratory Questionnaire (SRGQ) and London Chest Activity Daily Living (LCADL) scores decreased, while Endurance Shuttle Walking Test (ESWT) time and Incremental Shuttle Walking Test (ISWT) distance increased significantly. Baseline CAT scores correlated with MRC, SRGQtotal, %FVC, ISWT, ESWT, LCADL. Change in CAT was significantly correlated with changes in MRC, SGRQtotal, LCADL-leisure scores, and ESWT. CAT score shows moderate degree correlation with some measures of outcome of PR and response to PR efficacy.
SummaryBackgroundEven though many studies have investigated the effectiveness of weight loss inte... more SummaryBackgroundEven though many studies have investigated the effectiveness of weight loss interventions, the efficacy of pulmonary rehabilitation (PR) has not yet been proven in obese patients with asthma. The aims of this study were to investigate the efficacy of PR on asthma exacerbations in the first year after PR and to evaluate the efficacy of PR in exercise capacity, quality of life, psychosocial symptoms and control of asthma in overweight patients.MethodsThe exercise capacity, health-related quality of life scores, psychosocial symptoms, asthma control test (ACT) data, number of emergency admissions and hospitalizations of 35 overweight patients with asthma who completed a 1-year multidisciplinary PR program were recorded and analyzed.ResultsOf the participants 30 were female, the mean age was 45 ± 9 years, 13 (37%) patients were overweight and 22 (63%) were obese. The average number of emergency admissions (from 1.2 ± 1.1 to 0.3 ± 0.8) and hospitalizations (from 0.6 ± 0.9 to 0.0 ± 0.1) decreased significantly 1 year after PR (both p<0.001). After PR, statistically significant improvements in exercise capacity as measured by the incremental shuttle walking test (ISWT) from 281 ± 104 m to 339 ± 95 m (p < 0.001), the endurance shuttle walking test (ESWT) from 13.3 ± 7.4 min to 17.5 ± 4.5 min (p = 0.005), quality of life measured by the St. George’s respiratory questionnaire (SGRQ total from 64 ± 14 to 28 ± 10, p < 0.001), dyspnea sensation with the Medical Research Council (MRC) scale (from 2.6 ± 0.6 to 2.1 ± 0.4, p <0.001) and hospital anxiety depression scores (HADS, anxiety score from 9.9 ± 1.6 to 7.1 ± 2.1, depression score from 9.4 ± 1.9 to 7.2 ± 2.3, both p < 0.001) were found. A reduction in body mass index (BMI) was found in obese patients only, but the fat-free mass index (FFMI) improved in both overweight and obese patients (from 19.00 ± 1.90 to 19.45 ± 2.04, p = 0.01). The mean ACT score increased significantly (from 18 to 21 points, p < 0.001). The number of patients with poorly controlled asthma decreased from 21 (60%) to 10 (28%).ConclusionThis study showed that comprehensive multidisciplinary PR was associated with a decreased number of emergency admissions and hospitalizations for asthma exacerbations in 1 year, and improvements of dyspnea sensation, quality of life, exercise capacity, and psychosocial status in overweight and obese patients.
Expert Review of Respiratory Medicine, Oct 9, 2019
Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obst... more Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but it is still underutilized. The aim of this study was to compare unsupervised home PR with supervised outpatient PR in terms of various clinical variables in COPD patients. Methods: We conducted retrospective study consisting of 247 patients with COPD who were categorized into three group. 127 patients underwent unsupervised home PR, of whom 60 (47%) completed program (finishers), 67(53%) were lost to follow-up (non-finishers), 120 completed supervised outpatient PR. We compared baseline, post-treatment changes in demographic, clinical variables. Results: Sex, age were statistically similar between groups. Finishers of home PR had higher exercise capacity(p=0.003), quality of life(p=0.045), FEV1(p=0.001), lower pack-year smoking (p<0.001) than outpatient PR.After home PR, exercise capacity (p<0.05), quality of life(p<0.001), dyspnea(p<0.05), anxiety(p<0.001), depression(p<0.001) were improved except endurance shutte test. Improvements in exercise capacity(p<0.05), quality of life(p<0.001), dyspnea(p=0.023), anxiety(p<0.001), depression (p=0.001) scores were different between completed PR programs, in favor of supervised outpatient PR. Nonfinishers of home PR had more pack-year smoking than finishers of home PR (p=0.039); other baseline parameters were similar. Conclusion: Unsupervised home PR was effective in terms of improving exercise capacity, quality of life, dyspnea, psychological status, but less than supervised outpatient programs.
Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of... more Background and method: Despite their proven effect, the rates of vaccinations are low. The aim of this study was to determine the rates and associated factors of influenza and pneumonia vaccinations in patients who were hospitalized because of acute respiratory failure. Patients hospitalized because of acute hypoxemic or hypercapnic respiratory failure were recruited for this retrospective study. A survey was conducted with 97 patients. Primary diagnoses, ages, reasons of hospitalizations, education status, vaccination rates, information resources, and thoughts about vaccinations were recorded. Results: In total 45 (46%) of the patients were female, and 52 (54%) were male. The mean age was 67 ± 12 years. The primary diagnoses were lung disorders (n = 77, 79%), cardiac disorders (n = 16, 17%), and neuromuscular disorders (n = 5, 4%). In total 72 (74%) patients had chronic obstructive pulmonary disease (COPD) with primary lung disorders. All patients were hospitalized due to acute respiratory failure. The main reason for acute respiratory failure was infection in 40 patients (42%). The overall influenza and pneumococcal vaccination rates were 26% and 15%, respectively; for patients with COPD it was 30% and 17%, respectively. The main providers of information were doctors (42%). Vaccination status was not associated with infections or other reasons of hospitalization, age, sex, educational status, and number of hospital admissions in the previous year. A total of 51 patients (52%) had no belief in the benefits of vaccinations. Conclusion: Vaccination rates were found to be low in patients who were frequently hospitalized. Vaccination status was not related with hospitalization due to infections and history of hospitalization; awareness of vaccinations should be improved both in doctors and patients.
Idiopathic pulmonary fibrosis (IPF) is characterized by progressively worsening lung function, ve... more Idiopathic pulmonary fibrosis (IPF) is characterized by progressively worsening lung function, ventilation capacity, dyspnea, and finally reduced exercise intolerance. All of these have a significant negative impact on functional capacity and quality of life. In this study, we aim to evaluate the effects of pulmonary rehabilitation (PR) in IPF and assess the predictors of success. Methods: Data from 17 IPF patients who completed the program from the total of 27 patients who applied to PR were used in our study. We evaluated their pulmonary function tests, exercise capacity, peripheral-respiratory muscle strength, body composition, quality of life, and psychological states before and after PR. Results: Following the PR program, improvements over the minimal clinically important differences were observed in almost all parameters compared to the baseline; however, statistically significant improvements were only observed in the medical research council (P=0.020), the St. George respiratory questionnaire (P=0.002), the maximal inspiratory pressure (P=0.024), the anxiety score (P=0.001), the depression score (P=0.002), and the right quadriceps muscle strength (P=0.046). There was only a statistically significant negative correlation between the initial forced vital capacity and the forced expiratory volume in one-second value with the increase in patients' maximal inspiratory pressure values after PR. Discussion: After a multidisciplinary, comprehensive PR program, dyspnea sensation, exercise capacity, endurance time, quality of life, respiratory and peripheral muscle strengths, and psychological status were improved regardless of age, gender, antifibrotic treatment, and comorbidities. Therefore, patients should be referred to PR units before the deterioration in the quality of life in the early stages of the disease.
Background After COVID-19 infection, persistent exercise intolerance, changes in lung function ha... more Background After COVID-19 infection, persistent exercise intolerance, changes in lung function have been shown. Our aim is to investigate the correlation between impulse oscillometry (IOS) parameters and exercise capacity by using incremental and endurance shuttle walk tests (ISWT, ESWT) and investigate the factors and parameters which might have an effect on both IOS parameters and exercise capacity tests. Method The patients who had a history of COVID-19 were enrolled into cross-sectional study according to inclusion criteria. The IOS parameters, ISWT, ESWT, smoking status, time since COVID-19 diagnosis, length of hospital stay, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), body mass index (BMI), fat-free mass index (FFMI), dyspnea, hospital anxiety-depression and fatigue severity scores were recorded. Results The study comprised 72 patients, 71% of whom were male, with a mean age of 54 ± 10 years. After COVID-19 diagnosis, the median duration was 3 (min: 1, max: 5) months and 51 (71%) of the patients were hospitalized. The FEV1 and FVC values were in normal range. The area of reactance (AX), resonance frequency (Fres), reactance at 20 Hz (X20) and the difference between resonance at 20 and 5 Hz
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