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Pleuroparenchymal fibroelastosis (PPFE) is an uncommon disease of which diagnosis should be established multidisciplinary fashion and has no effective medical therapy. Pulmonary rehabilitation (PR) can be applied, but lung transplantation is the only therapeutic option. There have been few reported cases or studies showing the efficacy of PR in patients with PPFE in the literature. We present our multidisciplinary PR programme including confirmation of the diagnosis and a structured follow-up programme in two PPFE patients. In both cases, after multidisciplinary PR the diagnoses were confirmed and body composition, quality of life, exercise capacity and psychological status improved and some improvements preserved for 6–12 months. They underwent lung transplantation about 2 years after PR. Patients with PPFE should be directed and encouraged to participate in comprehensive multidisciplinary PR programmes. Long-term structured follow-up programmes could preserve the improvements, increase adherence and save time while waiting on the transplant list.

BACKGROUND 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. METHOD 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 1s (FEV1), the forced vital capacity (FVC), the forced mid-expiratory 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

Aims and objectives This study aimed to investigate the effects of socioeconomic-, patient-, treatment-, condition- and health system-related factors on medication adherence in patients with chronic obstructive pulmonary disease (COPD). Background Medication adherence is essential for the management of chronic diseases. The World Health Organization created a Multidimensional Adherence Model (MAM) and showed that medication adherence is affected by a combination of numerous factors. Design A descriptive correlational study was conducted. Methods A total of 114 patients with COPD were included. Data were collected on five dimensions based on the MAM framework. Medication adherence, self-efficacy and symptoms were evaluated using the Adherence to Refills and Medications Scale-7 (ARMS-7), COPD Self-Efficacy Scale (CSES) and COPD Assessment Test (CAT), respectively. The data were analysed using descriptive statistics, correlational statistics and structural equation modelling. The STROBE checklist was used. Results The ARMS-7 scores were associated with the body mass index of patients (F = 4.245, p = .017), smoke pack-years (r = .277, p = .004) and the CSES total score (β = -0.249, p = .002) in patient-related factors. The ARMS-7 score was not associated with socio-economic and health system-related factors. The ARMS-7 score showed a significant correlation between COPD diagnosis duration (r = -.276, p = .003) and the total number of drugs (r = -.215, p = .022) in treatment-related factors. The ARMS-7 scores were associated with the number of comorbid illnesses of patients with COPD in condition-related factors (F = 3.533, p = .033). Conclusion This study showed that medication adherence in COPD was mostly affected by patient-, treatment- and condition-related factors. Relevance to clinical practice Healthcare professionals should establish training and counselling programs to increase the medication adherence level of patients, particularly for patients who are newly diagnosed, require multiple drugs and have comorbid diseases or low self-efficacy.

OBJECTIVES Hospital-at-home (HAH), a pioneering health care model, is an accepted alternative to hospital treatment for patients with a chronic obstructive pulmonary disease (COPD) exacerbations. The aim of the present study was to analyze the effectiveness of HAH for patients with COPD exacerbations. METHODS Two hundred six patients with COPD exacerbations who were admitted to our emergency room (ER) received the HAH model between January 2008 and March 2010. The number of patient's hospitalization, admission to emergency room, unscheduled outpatient attendance, and the length of stay in hospital (day) were recorded before and after a one-year period of HAH. RESULTS After a one-year follow-up period of the HAH program, the number of patient who had hospitalization, admission to ER, unscheduled outpatient attendance rates was decreased 41.3%, 54.4%, 49.5% respectively. The decreases for all parameters were found to be statistically significant (P < 0.001). Additionally the total number of length of stay in hospital (day) after a one-year period after HAH was decreased (46.5%). CONCLUSION Integrated care services, including home care units where HAH models are performed, are necessary to improve the health of patients with COPD, as well as to better manage their condition in terms of disease burden. Physicians should consider this form of management, especially because there is increasing pressure on inpatient bed requirement in Turkey.

Introduction: Pulmonary rehabilitation (PR) is an effective approach for patients with chronic pulmonary disease, and it is also recommended for patients with bronchiectasis. The aims of the current study were to evaluate the efficacy of a multidisciplinary PR program and identify factors associated with improvement in patients with bronchiectasis. Material and ethods: We obtained data from patients with bronchiectasis who completed our PR program which consisted of education and training regarding bronchial hygiene. Pulmonary function test results, body composition, exercise capacity, quality of life, and psychological status were assessed before and after the PR program. Results: We enrolled 130 patients in this retrospective study. Most patients had a history of pneumonia. The Medical Research Council (MRC) dyspnea scale, incremental shuttle walking test (ISWT), endurance shuttle walking test (ESWT), St. George’s Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression (HAD) scores statistically improved after the PR program (all p < 0.001). Improvements were similar regardless of sex, etiology, smoking sta-tus, or number of hospitalizations. Age was negatively correlated with ΔSGRQ (p = 0.024, r = −0.203). Baseline forced expiratory volume in 1s (FEV1) was positively correlated with ΔCRQ (p = 0.015, r = 0.213) and negatively correlated with Δanxiety (p = 0.014, r = −0.215). Baseline MRC was negatively correlated with ΔMRC (p < 0.001, r = −0.563) and ΔSGRQ (p < 0.001, r = −0.308). Baseline ISWT was negatively correlated with ΔISWT (p = 0.043, r = −0.176) and Δanxiety (p = 0.007, r = −0.237). Baseline SGRQ was negatively correlated with ΔMRC (p = 0.003, r = −0.267) and ΔSGRQ (p < 0.001, r = −0.648). Conclusions: Our PR program is efficacious for patients with bronchiectasis regardless of sex, etiologic cause of bronchiectasis, concomitant chronic obstructive pulmonary disease, smoking status, and/or number of hospitalizations. Improvement varied among patients which highlights the need for more studies to determine which patients will benefit most from the program.

Background: Pulmonary rehabilitation (PR) is an effective treatment in patients with chronic obstructive pulmonary disease (COPD) but still underutilized. The aim of this study was to compa...

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.

Background and objective The role of non-invasive ventilation (NIV) during exercise training (ET) in patients with chronic respiratory failure (CRF) is still unclear. The aim of this study was to test whether NIV during ET had an additional effect in increasing the 6-min walking distance (6MWD) and cycle endurance time compared with ET alone. Methods All patients underwent 20 sessions of cycle training over 3 weeks and were randomly assigned to ET with NIV or ET alone. Outcome measures were 6MWD (primary outcome), incremental and endurance cycle ergometer exercise time, respiratory muscle function, quality of life by the Maugeri Respiratory Failure questionnaire (MRF-28), dyspnoea (Medical Research Council scale) and leg fatigue at rest. Results Forty-two patients completed the study. Following training, no significant difference in 6MWD changes were found between groups. Improvement in endurance time was significantly greater in the NIV group compared with the non-NIV training group (754 ± 973 vs 51 ± 406 s, P = 0.0271); dyspnoea improved in both groups, while respiratory muscle function and leg fatigue improved only in the NIV ET group. MRF-28 improved only in the group training without NIV. Conclusion In CRF patients on long-term NIV and long-term oxygen therapy (LTOT), the addition of NIV to ET sessions resulted in an improvement in endurance time, but not in 6MWD.

Even 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. The 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. Of 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

INTRODUCTION: 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. METHODS: 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. DISCUSSION AND 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.

Introduction Pulmonary rehabilitation (PR) is well-proven approach on improving dyspnea, exercise intolerance which are two components of BODE index. But, PR is known to have minimal effect on pulmonary function which is another component of BODE index. There are few studies evaluating PR efficacy by using i-BODE index. Our aim was to evaluate efficacy of PR in patients with chronic obstructive pulmonary disease (COPD) with i-BODE index and to investigate changes in i-BODE index according to GOLD 2011 combined assessment. Materials and Methods A total of 228 stable COPD patients who completed a comprehensive 8 week duration PR program were enrolled into this retrospective study. Result The patients were with mean age of 63.3 ± 8.6 years and mean FEV1% was 38.6 ± 16.2%. According to combined assessment of COPD, 23 patients were group A, 30 patients were B, 31 patients were C and 144 patients were D. Baseline i-BODE scores correlated with body compositions, pulmonary function, dyspnea, exercise capacity, psychological status, quality of life, and age. i-BODE index score decreased from 4.7 ± 2.2 to 3.5 ± 1.8 after PR (p

PURPOSE Pulmonary rehabilitation (PR) is advocated in the pre- and post-lung transplantation (LTx) periods. However, there is limited literature on the benefit of PR post-LTx. The aim of this study was to investigate the efficacy of an outpatient, multidisciplinary, comprehensive PR program in bilateral LTx recipients in the early period after LTx. METHOD Twenty-three LTx recipients were referred to the PR center. Change in incremental and endurance shuttle walk tests, hand and quadriceps strength, respiratory muscle strength (maximum inspiratory/expiratory pressure), dyspnea (Medical Research Council score), quality of life (St George's Respiratory Questionnaire, Chronic Respiratory Questionnaire), and psychological status (Hospital Anxiety Depression Scale) were compared pre- and post-PR. RESULTS Seventeen of 23 (74%) recipients completed PR, comprising 15 male and 2 female patients whose median age was 51 yr. The initiation of the program was 75 ± 15 d after LTx. The incremental shuttle walk test distance was predicted as 23% before PR and it increased to 36% after PR (P < .001); the endurance shuttle walk test distance also increased (P < .01). Significant improvement was seen in upper and lower extremity strength, and St George's Respiratory Questionnaire and Chronic Respiratory Questionnaire scores and Hospital Anxiety Depression Scale scores reflected less anxiety and depressive symptoms. Furthermore, body mass and fat-free mass indices, maximum inspiratory pressure, and maximum expiratory pressure improved significantly. There was no significant change in forced expiratory volume in the first second of expiration, forced vital capacity, or Medical Research Council scores. CONCLUSION This study demonstrated that patients who attended PR within 3 mo of bilateral LTx showed improvements in exercise capacity, respiratory muscle strength, quality of life, body composition, and psychological status.

The effective intervention for selected patients with end-stage pulmonary disease is lung transplantation (LTx). Pulmonary rehabilitaion (PR), as a comprehensive, multidisplinary approach, is required not only pre-LTx but also post-LTx period. The aim of this study was to investigate the efficacy of outpatient, multidisplinary, comprehensive PR program in LTx recipients after discharge from hospital. The number of 23 LTx recipients were refered to PR center between 2013-2017. The previous diagnosis, age, history of smoking, the values of ISWT, ESWT, FEV1, FVC, MIP, MEP, MRC, SGRQ, CRQ, BMI, FFMI, HAD before and after PR were recorded. PR program was supervised multidisplinary, comprehensive outpatients and 8 week duration. Seventeen of tweenty-three recipients (74%) were completed PR. The initiation of program was on 75 ± 15 days after LTx. 15 male, 2 female patients were mean age of 47±10 years. 5 (29%) patients with COPD, 6 (35%) with IPF, 2 (11%) with histiozis-X, 2 (%11) with silicosis, 2 (11%) with bronchiectasis had been underwent bilateral LTx. While ISWT distance was predicted of 23% before PR, it was increased by %36 after PR (p

Introduction: It was shown that exercise capacity improved after repeated PR program in selected patients. In this study, it was aimed to evaluate whether repeated PR efficacy is more effective in exercise capacity, quality of life, body composition in patients with chronic respiratory diseases. Method: The total of twenty-one patients with 16 COPD, 2 asthma, 2 kyphoscoliosis and 1 interstitial lung disease underwent re-rehabilitaion between 2007-2017. The patients’ datas abouth pulmonary function tests, mMRC dyspnea scales, ISWT distances, BMI, FFM, FFMI, SGRQ scores both before and after PR program about were analyzed retrospectively. The results after the first and the second PR program were compared. Results: While, dyspnea sensation, exercise capacity, quality of life were improved after the first and the second PR program, gainings were found statistically similiar. ( p>0,01) Median of the duration between programmes was 27 months (9-91m). There were no significant differences between first initial FEV1 , FVC measurements and the second PRP.( p>0,01) In order to evaluate the effect of disease severity and the the duration between the programmes ∆ FEV1 and ∆FVC predicted % and the duration between PRPs were compared with the improvements of second PRP. No significant differences were found. (p>0,01) Conclusion: In this study after the directly observed comprehensive outpatient pulmonary re-rehabilitation program improvements were seen in dyspnea sensetion, exercise capacity, quality of life and body composition. (p

Introduction Oral nutritional supplement (ONS), an important part of multidisciplinary pulmonary rehabilitation (PR) program, is indicated according to body composition abnormalities in the patients with chronic obtructive pulmonary disease (COPD). We evaluated efficacy of oral nutritional supplement (ONS) during 5-8 months in patients with COPD who completed PR program. Materials and methods The data of 41 patients with stable COPD were recorded after the approval had been taken. Patients were grouped according to ONS duration. Group 1 consisted of patients who took ONS during 2 months, group 2: 5 months, group 3: 8 months. In all patients, pulmonary function tests, quality of life, exercise capacity and body composition datas were recorded before and after PR program, at 3rd, 6th month and in 20 patients 1 year follow-up visit. Result In all groups, improvements after PR in exercise capacity, dyspnea, and body composition sustained at 3 and 6 month. Quality of life was protected in group 1 during six month, in other groups it was over values before PR despite loss at 6. month. All improvements after PR were similiar between groups. In 20 patients with one year follow up, while the improvements in dyspnea and body composition were preserved, both exercise capacity and quality of life decreased, exercise capacity was lower than values before PR. Conclusions In patients with COPD, after multidisplinary PR program, the improvements in dyspnea, exercise capacity, quality of life were maintained during six months regardless of body composition and ONS duration. Furthermore, while the improvements in body composition, dyspnea, quality of life were protected, exercise capacity was found to be lower than baseline.

Objective: Pulmonary rehabilitation (PR) programs can be carried out in hospital or home basis with a different organizational aspect and program content. This study aimed to evaluate the efficacy of a multidisciplinary supervised home-based PR program in patients with chronic respiratory disorders. Methods: Forty patients with chronic respiratory disorders who admitted to our center between September 2007 and May 2012 were enrolled. In all patients before and after PR, dyspnea was assessed with Medical Research Council (MRC) dyspnea scale, exercise capacity with Incremental Shuttle Walk Test (ISWT) and Endurance Shuttle Walk Test (ESWT), health related quality of life with St. Geoerge Respiratory Questionnaire (SGRQ), psychosocial evaluation with hospital anxiety and depression scale (HAD), the body composition with bioelectrical impedance method. Ten patients did not complete home-based PR for various reasons. Results: In patients with Chronic Obstructive Pulmonary Disease (COPD), dyspnea sensation (p=0.026), exercise capacity (p=0.001), quality of life (p=0.001), body composition (p=0.012), anxiety and depression score (p=0.001) improvements were statistically significant. In all patients with COPD and non-COPD perception of dyspnea, exercise capacity, quality of life, anxiety and depression score improvements were above minimal clinically important differences. Conclusion: In this study supervised home-based pulmonary rehabilitation has been shown as an effective and safe modality when applied by an experiencied and multidisciplinary team in selected severe COPD or non-COPD patients.

WOS: 000366030500001, PubMed ID: 26622176, Objective: To determine distribution of COPD assessment categories and physicians' adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods: A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results: Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in > 70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient = 0.993, P < 0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient = 0.237, P < 0.0001) were noted. Conclusion: Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected., Novartis Pharmaceuticals Turkey, The study is funded by Novartis Pharmaceuticals Turkey. We thank Cagla Ayhan, MD and Prof Sule Oktay, MD, PhD from KAPPA Consultancy Training Research Ltd, Istanbul who provided editorial support and Mehmet Berktas, MD, MICR from KAPPA Consultancy Training Research Ltd, Istanbul who performed statistical analysis funded by Novartis Pharmaceuticals Turkey.

INTRODUCTION COPD is among the most common causes for secondary pulmonary hypertension (PH). Pulmonary rehabilitation (PR) is recommended in the standard treatment of COPD. In this study, efficiency of multidisciplinary PR in COPD patients with PH was examined. PATIENTS AND METHODS 88 patients stable COPD patients who applied to our center between 2008-2013 were enrolled. Un-likely PH patients were grouped as Group 1 while possible and likely PH cases were accepted as Group 2. There were no other cause for PH. All the patients received patient-specific, multidisciplinary 8-week PR. Dyspnea perception was assessed via MRC dyspnea scale, health-related quality of life with S. George life quality questionnaire, exercise capacity via incremental shuttle walking test and endurance shuttle walking test and body composition via bioelectrical impedance test before and after PR program. RESULTS In all the patients there were significant improvements in body composition (BMI p= 0.013), quality of life (SGRQ semp., activity, total p< 0.001), dyspnea perception (MRC p< 0.001) and exercise capacity (ISWTT, ESWT, VO2 peak p< 0.001) after PR program. Improvements in Group 2 were observed to be significantly greater. CONCLUSION PR is an effective and safe option in COPD patients with PH. These patients should be directed to PH programs for supervised exercise training and chronic disease management and patient-specific PR programs should be established.

In severely disabled patients who are not capable of following formal pulmonary rehabilitation (PR) and/or tolerating higher training intensities, neuromuscular electrical stimulation (NMES) has been successfully utilized as a localized training method.In this non-randomized controlled observational study 50 patients with severe chronic obstructive pulmonary disease (COPD), who were allocated into two groups. Endurance training group (ET) (n= 27) and NMES group (n= 23). To compare the effects of NMES and ET on health-related quality of life (HRQOL), exercise capacity, muscle strength, dyspnea, psychological status, and body composition in patients with severe COPD. Before and after PR program, the study parameters were assessed using the Medical Research Council (MRC) scale, incremental and endurance shuttle walking tests (ISWT, ESWT), manual muscle testing (MMT), the St. George's Respiratory Questionnaire (SGRQ), bioelectrical impedance analysis, and the Hospital Anxiety and Depression Scale (HADS).After the PR program, walking distance and endurance time significantly increased in both groups (p0.001 for each), whereas the MRC scores of both groups significantly decreased (p0.001 for each). In the ET group, significant decreases were noted in all domains of SGRQ and HADS. In the NMES group, significant improvements were observed in the HADS scores and in all SGRQ domain except symptom domain. No significant differences were observed between the NMES and ET groups regarding the changes from baseline to after PR program in walking distance (p= 0.140), endurance time (p= 0.376), the MRC (p= 0.540), HRQOL (p0.05) and HADS (p0.05) scores, body-mass index (BMI) (p= 0.49), fat-free mass (FFM) (p= 0.50) and fat-free mass index (FFMI) (p= 0.94).NMES can be used as an effective treatment strategy in PR programs for peripheral muscle training in patients with severe COPD.

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: Readmission to the hospital is one of the most important problems in chronic obstructive pulmonary disease (COPD) patients receiving long-term oxygen therapy (LTOT) and noninvasive ventilation (NIV). The aim of this trial is to find out whether a structured discharge and follow-up protocol reduce the rate of unplanned, COPD-related hospital readmissions over 90 days in patients receiving LTOT and/or NIV. Herein the results of the interim analysis are presented. Method: The study was planned as Turkish Thoracic Society and GARD-Turkey project and carried out 10 centers throughout Turkey. COPD patients who were prescribed LTOT and/or NIV were included and randomized to either intervention or control arm. The intervention mainly consisted of detailed training before discharge and close follow-up strategy. Control patients received usual care, which consisted of basic education of the patient about the therapies. Results: A total of 112 patients were included in the study within the first year and data analysis was performed in 65 patients (control group 26, intervention group 39) who finished the study period. It was observed that there was no difference between the study groups for subjective outcomes and the median duration of LTOT/NIV use. The hospital readmission and hospitalization rates were 30.7% and 11.5% in control group and 15.4% and 5.1% in the intervention group, respectively. Conclusion: The preliminary results showed that structured discharge and follow up protocol might be a helpful approach for prevention of recurrent admissions in COPD patients with chronic respiratory failure

Background: There are limited number of studies that investigate clinical variables instead of chronic obstructive lung disease (COPD) management according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 classification. The aim of the study was to investigate whether there was a difference between GOLD 2017 classification and spirometric stage in clinical variables in patients with COPD. The data of 427 male patients with stable COPD were investigated retrospectively. Methods: Patients were allocated into combined assessment of GOLD 2017 and spirometric stage. Age, amount of smoking, pulmonary function, modified Medical Research Council (mMRC), incremental shuttle walk test (ISWT), Hospital Anxiety-Depression Scale (HADS), St. George’s Respiratory Questionnaire (SGRQ), body mass index (BMI), and fat free mass index (FFMI) were recorded. Results: Seventy-three (17%) patients were in group A, 103 (24%) constituted group B, 38 (9%) were included in group C, and 213 (50%) comprised group D according to the combined assessment of GOLD 2017. Twenty-three patients (5%) were in stage 1, 95 (22%) were in stage 2, 149 (35%) were in stage 3, and 160 (38%) were in stage 4 according to spirometric stage. According to GOLD 2017, age, amount of smoking, mMRC, BMI, FFMI, SGRQ, HADS, forced vital capacity, forced expiratory volume in 1 second (FEV1), and ISWT were significantly different between groups. Ages, amount of smoking, FFMI, BMI, HADS of group A were different from B and D. Smiliar values of FEV1 were found in A- C and B-D. A and C had smiliar ISWT. According to spirometric stage, BMI, FFMI of stage 4 were statistically different. mMRC, ISWT, and SGRQ of stages 3 and 4 were different from other stages, amongst themselves. FEV1 was correlated with mMRC, SGRQ, anxiety scores, BMI, FFMI, and ISWT. Conclusion: This study showed that the GOLD ABCD classification might not represent the severity of COPD sufficiently well in terms of lung function or exercise capacity. The combination of both spirometric stage and combined assessment of GOLD 2017 is important, especially for estimating clinical variables.

Role of non-invasive ventilation (NIV) during exercise training in patients with chronic respiratory failure (CRF) is unclear. The aim of this study in CRF patients on long-term home nocturnal NIV was to test whether use of NIV during exercise training can lead to a greater increase in exercise tolerance than that from exercise training alone. Patients (n=50) were randomly assigned to two groups and all underwent 3 weeks (20 sessions) of exercise (cycle and muscle) training either with (group 1) or without (group 2, controls) NIV. Outcome measures were the 6-min walking test (6MWT) (primary outcome), incremental and endurance cycle ergometer exercise tests, respiratory muscle function, quality of life assessed by the Maugeri Respiratory Failure questionnaire (MRF-28), and perceived dyspnoea and leg fatigue at rest (modified Borg scale). After training, no significant difference between groups was found in 6MWT changes (fig 1), but endurance time was significantly longer in group 1 (754±973 vs. 51±406 s, p=0.0271). 68% patients of group 1 vs 31% of controls increasing endurance time more than the reported MID of 200 seconds (p = 0.063). Dyspnoea improved in both groups whereas respiratory muscle function and leg fatigue improved only in group 1. MRF-28 improved only in controls. In CRF patients on long-term NIV, use of NIV as an adjunct to exercise training significantly improved endurance time, but not 6MWT, with respect to exercise training alone.

Introduction Interstitial lung diseases are characterised by dyspnea on exertion, low quality of life, cough and exercise intolerance. The aim of this study was to evaluate the effects of comprehensive pulmonary rehabilitation in patients with interstitial lung disease. Materials and methods Data from patients who were referred to pulmonary rehabilitation with the diagnosis of interstitial lung diseases were included to this study. Ten patients with interstitial lung disease participated to our outpatient, 8 weeks, comprehensive pulmonary rehabilitation programme. Dyspnea was assessed with the Medical Research Council (MRC) scale; health related quality of life was assessed with the St.George's Respiratory Questionnaire (SGRQ). Exercise capacity was measured using the incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT); anxiety and depression were assessed with the hospital anxiety depression scale (HADS). All parameters were recorded before and after pulmonary rehabilitation programme. Results Dyspnea sensation, anxiety and depression scores decreased after pulmonary rehabilitation (p: 0.023, p: 0.026, p: 0.039 respectively). Also impact domains of SGRQ significantly reduced (Z= 1.988; p= 0.047).The difference between median values of ISWT results before and after pulmonary rehabilitation was 60 meters. Although it was not statistically significant (Z= 1.863; p= 0.063), the level of increment was higher than the minimaly important clinical differance for ISWT. Conclusion Our results showed that comprehensive pulmonary rehabilitation programmes were benefical for patients with interstitial lung diseases and it should be regarded as a standard care in this population from the early stages.

Background and objective Chronic obstructive pulmonary disease (COPD) is considered a worldwide major public health problem. Weight loss, muscle and fat mass depletion are common nutritional problems in COPD patients and are determinant factors in pulmonary function, health status, disability and mortality. We aimed to assess the relationships between nutritional status and perception of dyspnoea, pulmonary function tests (PFT), exercise capacity and health-related quality of life (HRQoL) using the subjective global assessment (SGA) in COPD patients who were referred for pulmonary rehabilitation programme. Methods A total of 163 patients with stable COPD who are candidates for outpatient pulmonary rehabilitation programme were included in this study. Nutritional status for all patients was assessed by SGA. Association of SGA scores (A, B and C) and anthropometric measurements, PFT, dyspnoea scales (Medical Research Council and resting BORG scale), HRQoL (St. George Respiratory Questionnaire and Chronic Respiratory Diseases Questionnaire) and exercise testing (shuttle walking test) were studied for statistical significance. Results Based on SGA, 9.2% of patients were severely malnourished (SGA-C). There were significant decreases in forced expiratory volume in the first second (FEV1) (P = 0.009), Medical Research Council scales (P

Introduction: Chronic obstructive pulmonary diseases are common causes of disease in the community and account for considerable percent of the caseload in primary health care facilities. For this reason, it is important to question and improve the knowledge of primary health care physicians. This study is designed to assess the level of knowledge for bronchial asthma and COPD of the primary healthcare physicians, both before and immediately after an educational course structured in the context of GARD Chronic Airway Diseases National Control Program. Materials and Methods: The participating physicians attended an intensive educational course on asthma and COPD. Twenty five item questionnaires for asthma and COPD were administered to the participants both before and immediately after the end of the course. Contribution of education to the level of knowledge was investigated by comparing the percentages of the correct answers in the pre-and post-test. Results: From 11 different cities, 1, NA

Introduction In chronic obstructive pulmonary disease (COPD), skeletal muscle weakness is characterized by reduced muscle strength, reduced muscle endurance and the presence of muscle fatigue especially in lower limbs. There has been little research into the upper limb skeletal muscles. Objectives In this study, we aimed to investigate the relation of upper limb muscle strength with pulmonary function, exercise capacity, quality of life (QoL) and dyspnea sensation. Methods Eigthy-eight patients (89.8% male; age: 64.2 ± 8.7 years) with COPD (FEV1 = 34.2% ± 15.2%) were evaluated. Tests included hand grip strength and actual 1-repetition maximum (1RM) test for upper limb strength. Dyspnea sensation was assessed with medical research council (MRC) scale. St. George Respiratory Questionary (SGRQ) was used to evaluate patients health related QoL. Exercise capacity was evaluated with incremental shuttle walk test and endurance shuttle walk test. Results Upper limb muscle strength correlated with exercise capacity but no correlations were found with pulmonary functions.There were negative correlations with all the domains of SGRQ both actual 1RM and handgrip strength. MRC scores revealed a negative correlation with upper limb muscle strength. Conclusion In our study, we showed that upper limb muscle strength correlated with exercise capacity, QoL, dyspnea sensation. Identifying patients who have greater reductions in strength will allow early interventions with a multidisciplinary manner.

Low exercise tolerance is associated with poor thoracic surgical outcomes. Preoperative pulmonary rehabilitation (PPR) can optimize individuals9 exercise tolerance and overall medical stability before lung cancer resection surgery. Our aim was to evaluate the efficacy of pulmonary rehabilitation before lung cancer surgery. METHODS: A total of 15 male patients (66.6±5.87 years) with the diagnosis of non small cell lung cancer were enrolled a comprehensive, multidisciplinary, supervised inpatient PR program, consisted of bronchial hygiene, breathing control, energy conservation techniques, exercise training (endurance and strength), psychological support, nutritional support. Exercise capacity and VO2 peak were evaluated by using incremental shuttle walk test (ISWT). Dyspnea sensation was assessed with MRC scale, psychological status with Hospital Anxiety and Depression scale, on admission and after PPR. The values before and after PPR was given in RESULTS: After minimum 2 week daily multidisplinary PPR program a significant reduction of MRC and HADS scores were recorded while ISWT and VO2 peak increased CONCLUSIONS: Thus, pulmonary rehabilitation before lung cancer surgery is potentially an attractive technique for optimizing preoperative exercise capacity, dyspnea sensation and psychological status and conceivably, in turn, reducing postoperative respiratory complications.

COPD is among the most common causes for secondary pulmonary hypertension (PH). Pulmonary rehabilitation (PR) is recommended in the standard treatment of COPD. In this study, efficiency of multidisciplinary PR in COPD patients with PH was examined.88 patients stable COPD patients who applied to our center between 2008-2013 were enrolled. Un-likely PH patients were grouped as Group 1 while possible and likely PH cases were accepted as Group 2. There were no other cause for PH. All the patients received patient-specific, multidisciplinary 8-week PR. Dyspnea perception was assessed via MRC dyspnea scale, health-related quality of life with S. George life quality questionnaire, exercise capacity via incremental shuttle walking test and endurance shuttle walking test and body composition via bioelectrical impedance test before and after PR program.In all the patients there were significant improvements in body composition (BMİ p= 0.013), quality of life (SGRQ semp., activity, total p0.001), dyspnea perception (MRC p0.001) and exercise capacity (ISWTT, ESWT, VO2 peak p0.001) after PR program. Improvements in Group 2 were observed to be significantly greater.PR is an effective and safe option in COPD patients with PH. These patients should be directed to PH programs for supervised exercise training and chronic disease management and patient-specific PR programs should be established.

Background: Pulmonary rehabilitation PR is an effective, evidenced-based treatment. Despite its proven effect, it is still underused. The aim of this study was to present the number of patients with chronic obstructive pulmonary disease COPD who underwent PR, general mortality percentages, the rate of patients prescribed PR by pulmonologists, and the distribution of institutions where PR was performed between 2008 and 2016 in Turkey. Materials and methods: The documents were obtained from Turkish Institution of Social Insurance. Ages, sexes, and numbers of patients with COPD who underwent PR between 2008 and 2016 were recorded. The number of patients with COPD who had been prescribed PR by physicians and the type of hospitals in which these patients underwent PR were identified. The general annual and the general total mortality rates between 2008 and 2016 among patients with COPD who underwent PR in 2008 were also determined.Results: The mean age ranges of patients with COPD who underwent PR were 67.4 ± 12.3 to 72.0 ± 13.2 years, and 62.2% n = 60,852 of patients were male. The number of patients increased progressively from 3,214 to 18,664. The rate of patients prescribed PR programs between 2008 and 2016 was between 0.32% and 0.59% among all registered patients with COPD. Between 52.0% and 94.8% 5,488/10,549 and 16,792/17,707 patients, respectively of the programs were prescribed by a pulmonologist, and 62.9% n = 62,613 of patients received PR in secondary public hospitals. The general annual mortality rates were between 6.2% and 11.1% 115/1,855 and 358/3,214 patients in patients who underwent PR in 2008, and the general total mortality rate was 52.8% 1,696/3,214 patients over the 9-year period in the same patient group.Conclusion: PR was still an underutilized approach in Turkey between 2008 and 2016. The awareness of PR should be increased in our country. In order to achieve this, we think that PR should be within the scope of health policies.

INTRODUCTION The objective of this study was to assess the role of shuttle walk test in predicting post-operative complications in lung cancer resection surgery. PATIENTS AND METHODS A consecutive series of patients who were candidate for lung resection surgery with the diagnosis of early stage lung cancer were included to this study. All patients in this study evaluated for exercise capacity testing with shuttle walk test. RESULTS Twenty for patients were included in this study. Mean age was 61.5 ± 8.6 years. Pneumonectomy, lobectomy, bilobectomy and wedge resection were performed in 11 (46%), 10 (42%), 2 (8%), and 1 (4%) patients, respectively. Complications occurred only in six patients. There was no statistically significant relationship between risk for development of post-operative complication and age, incremental shuttle walk test, endurance shuttle walk test and exercise capacity evaluated with peak VO₂ (mL/kg/minute) (p> 0.05). CONCLUSION Shuttle walk tests (incremental and enduronce) had a limited role in predicting post-operative complications in lung cancer resections.

This is a case report of Lemierre's syndrome in a 17-year-old male patient. Lemierre's disease consists of suppurative thrombophelebitis of the internal jugular vein (SIJVT) in the presence of oropharyngeal infection and can be complicated by septic pulmonary embolism. Other causes of SIJVT include deep neck infections and central venous catheterization. The disease usually results from Gram-negative anaerobic organisms such as Fusobacterium necrophorum.