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Stabil KOAH'lı Hastalarda Hastanede Yatış Anamnezi ile Spirometrik Değerler ve Amfizem Paterni Arasındaki ilişki

The Relationship between Hospitalization with Spirometric Findings and Emphysema Pattern in Patients with Stable COPD

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Abstract (2. Language): 
Objective: COPD is a progressive disease that develops with acute exacerbations. The hospitalizations related to exacerbation increase together with progression of disease. Are waited that significantly increases the frequency of hospitalizations in COPD patients with emphysema who have worse respiratory functions. Materials and Methods: Were included 100 stable COPD cases to study. Numbers of acute exacerbations, hospitalization and hospitalization days, spirometric, anthropometric and demographic characteristics of cases were recorded and were evaluated prospectively. Results: : Mean numbers were 1.4±0.1 for yearly exacerbation, 1.2±0.1 for hospitalization and 11.2±1.7 days for hospitalization day. Were observed that total hospitalization numbers correlated with %FEV1(r=-0.367 p<0.001), FEV1/FVC(r=-0.239 p=0.017) values, chest expansasion capacities (r=-0.204 p=0.041) and distances of intersinusal line to dome of diaphragm (r=-0.317 p=0.001) negatively and with retrosternal distances(r=0.282 p=0.004) positively. There was positive correlation between total hospitalization days and SGRQ scores(r=0.423 p<0.001). Were found that total hospitalization days correlated with %FEV1(r=-0.308 p=0.002) and FEV1/FVC values (r=-0.273 p=0.020) negatively. Fiftyone cases were hospitalized at least one time because of acute exacerbation in COPD. In these cases %FEV1(p=0.001) and FEV1/FVC(p=0.012) values were significantly lower than cases that didn't hospitalize. Chest expansasion capacities(p=0.001), distances of intersinusal line to dome of diaphragm(p=0.001) were statistically lower and Saint George Respiratory Questionnaire (SGRQ) scores were higher (p=0.007) in cases who were hospitalized. Conclusion: When COPD progresses, hospitalizations related to acute exacerbation increase too. Lower spirometric values, deterioration of life quality and emphysematous changes correlate with number and frequency of hospitalization.
Abstract (Original Language): 
Amaç: KOAH alevlenmelerle seyreden bir hastalıktır. Hastalığın progresyonuyla alevlenmeye bağlı hastanede yatışlarda artmaya başlar. İleri evre amfızematöz KOAH hastalarında bu yatışlar anlamlı derecede artış gösterir. Çalışmamızda stabil KOAH hastalarında hastanede yatış öyküsüyle hastalığın ağırlığı ve amfizematöz yapısı arasındaki ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya (81 E, 19 K) 100 stabil KOAH'lı hasta dahil edildi. Olguların alevlenme, hastanede toplam yatış ve toplam yatış günü sayıları, spirometrik, antropometrik ve demografik verileri kaydedilerek değerlendirildi. Bulgular: Olguların ortalama yıllık atak sayısı 1.4±0.1, toplam yatış sayısı 1.2±0.1 ve toplam yatış günü 11.2±1.7 idi. Hastanede toplam yatış sayısı ile %FEV1, FEV1/FVC, göğüs ekspansasyon kapasitesi, kardiyofrenik ve kostofrenik sinüs uçlarını birleştiren çizginin diyafragma en uç noktasına uzaklığı arasında negatif; retrosternal mesafe arasında pozitif korelasyon saptandı. Hastanede toplam yatış günü sayısıyla Saint George Respiratory Questionnaire skoru arasında pozitif, %FEV1, FEV1/FVC değerleri arasında negatif korelasyon saptandı. Daha önce KOAH alevlenmesi nedeniyle hastanede en az bir kez yatmış olan olguların (n=51), hiç yatmamış olgulara oranla %FEV1 ve FEV1/FVC değerlerinin anlamlı derecede düşük olduğu belirlendi. Hastanede yatan olguların göğüs ekspansasyon kapasitesinin, kardiyofrenik ve kostofrenik sinüs uçlarını birleştiren çizginin diyafragma en uç noktasına uzaklığının daha düşük, SGRQ skorunun daha yüksek olduğu gözlendi. Sonuç: KOAH'ta hastalığın süresi ve şiddeti arttıkça alevlenmeye bağlı hastanede yatışlar da artar. Hastalığın ağırlığını gösteren düşük spirometrik değerler, yaşam kalitesindeki bozulma ve amfizem göstergeleri, bu yatışların sayısı ve sıklığıyla koreledir.
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REFERENCES

References: 

1. Postma DS, Siafakas NM. Management of choronic obstructive pulmonary disease. 1st ed. Sheffield, European Respiratory Monograph 1998; 3: 264- 277.
2. Senior RM, Shapiro SD. Chronic obstructive pulmonary disease. Epidemiology, pathophysiology and pathogenesis. Fishman AP(ed). Pulmonary disease and Disorders. New York, McGraw-Hill, Third ed, 1998:645-682.
3. Ruchlin HS, Dasbach EJ. An economic overview of chronic obstructive pulmonary disease. Pharmacoeconomics 2001; 19:
623- 642.
4.
Kay
a A, Kaya S, Gülbay BE, Saryal SB. KOAH Atağında Tedavi. Bartu Saryal S, Acıcan T(eds). Güncel Bilgiler Işığın¬da Kronik Obstrüktif Akciğer Hastalığı, Ankara,Bilimsel Tıp Yayınevi, 2003:191-216.
5.
Erdin
ç E. KOAH Atağı. In: Ekim N, Türktaş H. Göğüs Hasta¬lıkları Acilleri. 1st ed. Ankara, Bilimsel Tıp Yayınevi 2000; 231-239.
6. Fan VS, Curtis R, Tu SP, McDonell MB, Fihn SD. Using quality of life to predict hospitalization and mortality in patients with obstructive lung diseases. Chest 2002;122:429-436.
7. Osman IM, Godden DJ, Friend JA, et al. Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax 1997; 52:67-71.
8. Traver GA. Measures of symptoms and life quality to predict emergent use of institutional health care resources in chronic obstructive airways disease. Heart Lung 1988; 17:689-697.
9. Grossman R, Mukherjee J, Vaughan D, et al. A 1-year community based health economic study of ciprofloxacin vs usual antibiotic treatment in acute exacerbations of chronic bronchitis. Chest 1998; 113: 131-141.
10. Wedzicha JA. Exacerbations. Chest 2002; 121:136-141.
11. Yentürk E, Alkan N, Bahar Y, Toraman YA, Tuncay E. Akut atak nedeniyle hospitalize edilen KOAH olgularının özellikleri ve yatış süresini etkileyen faktörler. Akciğer 2007;13:16-21.
258
Fırat Tıp Dergisi 2009;14(4): 254-259
12. ATS Statement. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J
Respir Crit Care Med 1995;152:77-120.
13. Wijnhoven HA, Kriegsman DM, Hesselink AE, et al. Determinants of different dimensions of disease severity in asthma and COPD: pulmonary function and health-related
quality of life. Chest 2001; 119:1034-1042.
14. Esteban C, Quintana JM, Aburto M, Moraza J, et al. Predictors of mortality in patients with stable COPD. J Gen Intern Med.
2008;11:1829-1834.
15. Groenewegen KH: Mortality and mortality related factors after hospitalization for acute exacerbation of COPD. Chest 2003;
124:459-467.
16. Piquette CA, Rennard S, Snider G. Chronic Bronchitis and Emphysema. Respiratory Medicine. In: Murray J, Nadel J (eds), 3th ed, Philedelphia: WB Saunders Company
2000:1199-1201.
17. Wong AW, Gan WQ, Burns J, Sin DD, van Eeden SF. Acute
exacerbation of chronic obstructive pulmonary disease: influence of social factors in determining length of hospital stay and readmission rates. Can Respir J. 2008;15:361-364.
18. Patil SP: In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med
2003; 163:1180-1186.
19. Fujimoto K, Kitaguchi Y, Kubo K, Honda T. Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography.
Respirology. 2006;11:731-740.
20.
Ataso
y Ç. KOAH'ta Radyolojik Bulgular. Bartu Saryal S, Acıcan T (eds). Güncel Bilgiler Işığında Kronik Obstrüktif Akciğer Hastalığı. Ankara, Bilimsel Tıp Yayınevi, 2003:83¬105.
Göçmen ve Ark.
21. Sanders C. The radiographic diagnosis of emphysema. Radiol
Clin North Am 1991;29:1019-1030.
22. Pauwels RA, Buist AS , Calverley PM. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop
summary. Am J Respir Crit Care Med. 163: 2001; 1256-1276.
23. Tu SP, McDonell MBI,Spertus JA, Steele BG, Fihn SD. A
new self-administered questionnaire ton monitor health related
quality of life in patients with COPD. Chest 1997; 112: 614¬622.
24. Lau ACW, Yam LYC, Poon E. Hospital re-admission in patients with acute exacerbation of chronıc obstructive pulmonary disease. Respir. Med. 2001; 95: 876-884.
25. Dahlen I, Janson C. Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive
pulmonary disease. Chest. 2002; 122:1633-1637.
26. McSweeny AJ, Grant I, Heaton RK, Adams KM, Timms RM. Life quality of patients with chronic obstructive pulmonary
disease. Arch Intern Med. 1982; 142:473-478.
27. Fan VS, Ramsey SD, Make BJ, Martinez FJ. Physiologic variables and functional status independently predict COPD hospitalizations and emergency department visits in patients
with severe COPD. COPD 2007; 4:29-39.
28. Pin TN, Niti M, Tan WC, Cao Z, et al. Depressive symptoms and chronic obstructive pulmonary disease. Arch Intern Med.
2007; 167:60-67.

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