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To evaluate the utility of neutrophil–lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis. Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34–4.31) vs. 2.29 (1.67–3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62–0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002). Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19. MATERIALS AND METHODS: In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes. RESULTS: There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients (P

BACKGROUND-AIM Noninvasive mechanical ventilation (NIV) failure rate is reported to be 5%-60% of intensive care unit (ICU) patients. Despite all precautions and well-known reasons, the risk factors of NIV failure are unclear for chronic obstructive pulmonary disease (COPD) with acute respiratory failure (ARF). The aim of this study was to examine risk factors for NIV failure in COPD patients with ARF, other than well defined. METHODS The retrospective cohort study was done in ICU of a chest disease hospital. All consecutive COPD patients with hypercapnic ARF were enrolled in study. Demographics, comorbidities, arterial blood gases, reasons of ARF and length of ICU stay were recorded. NIV success was defined as discharge from ICU and NIV failure was defined as need for intubation or died during NIV. Patients were grouped into; NIV failure and success. The groups were compared and NIV failure risk factors were analyzed. RESULTS About 265 NIV success and 142 NIV failure patients were enrolled into the study. Logistic regression test showed the risk factors for NIV failure; higher APACHE-II (≥ 29) (OR:11.71, CI95%4.39-31.18, P

Tracheostomy is life-saving procedure in critical care patients which require long-term mechanical ventilation (MV) and an alternative to endotracheal intubation.(1,2) The factors affecting the survival of tracheostomized patients are not clearly known. The aim of this study was to investigate the factors affecting intensive care unit (ICU) and long-term mortality in the tracheostomized patients due to respiratory failure. A retrospective observational cohort study was planned between January 2016-2019 in tertiary ICU. Each patient underwent percutaneous and surgical tracheostomy was included. Demographic characteristics, diagnoses, causes of tracheostomy, comorbidities, Charlson and APACHE 2 scores, culture antibiogram results, ICU day and mortality (1-3 and 12 months) were recorded. In the analysis of the data, appropriate statistical tests and analyzes were used. 115 of 3620 patients admitted to tertiary ICU and underwent percutaneous and surgical tracheostomy due to respiratory failure between January 2016-2019 were included. 75 (65%) of the patients were male and median age was 68±14 years. Hospital mortality was higher in the group with Acinetobacter baumannii growth (p=0.04). According to Kaplan-Meier survival analysis, long-term follow-up of Acinetobacter baumanii growth did not affect survival (p=0.938). Patients with cerebro-vascular accident (CVA) had lower survival in long-term follow-up (p [Med-Science 2020; 9(1.000): 1-5]

OBJECTIVE: This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. MATERIAL AND METHODS: A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal charac-teristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. RESULTS: Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P

SUMMARY OBJECTIVE: This study aimed to evaluate the prognostic value of inflammatory markers determined during admission among patients with sarcoidosis with chronic and remission groups. METHODS: This study was designed as retrospective single-center study. Patients with sarcoidosis without treatment and who had at least two years of follow-up were included in this study. Patients were divided into two groups as chronic and remission. The primary outcome is to evaluate hematological parameters in remission and chronic sarcoidosis groups. RESULTS: Out of 348 patients with sarcoidosis, 142 patients without treatment and followed up for at least two years were included in this study. Groups had similar demographic features with the predominance of females (80.4 and 77.9%, respectively) and stage I disease (78.6 and 68.6%, respectively). Lymphocyte count [median (IQR) 1.7 (1.3–2.3) 109/L versus 2.1 (1.6–2.4) 109/L, p=0.034] was significantly lower, whereas neutrophil to lymphocyte ratio (NLR) was significantly higher [median (IQR) 2.6 (2.0–3.1) versus 2.0 (1.6–2.8), p=0.006] at admission in the chronic group. No significant difference was determined in inflammatory parameters at admission between groups. CONCLUSION: Lower lymphocyte count and higher neutrophil to lymphocyte ratio were determined in patients with chronic sarcoidosis compared with the remission group, based on monitoring of radiological staging up to five-year after the initial diagnosis. Accordingly, the identification of neutrophil to lymphocyte ratio at diagnosis seems to be a potential prognostic marker in patients with sarcoidosis beside its low cost and easy determination in routine clinical practice.

BACKGROUND Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). AIM/OBJECTIVE The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). METHODS Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. RESULTS 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P

This study was designed to evaluate the influence of gender on the inhaler technique of subjects on inhaler therapy and to determine the factors predicting the correct inhaler technique and a change of inhaler device. METHODS: A total of 568 adult subjects (276 male, 292 female) on inhaler therapy were included in this cross-sectional, observational study. Data on sociodemographic characteristics, inhaler therapy, subject-reported difficulties, and technician-reported errors in inhaler technique were recorded. RESULTS: A change of inhaler device was noted in 71.0\% of male subjects and 77.4\% of female subjects, and this was based on the physicians' decision in most cases (41.7\% and 51.7\%, respectively). A higher percentage of female subjects reported difficulties with using inhalers (63.7\% vs 40.6\%, P < .001). Overall, having received training on the inhaler technique was associated with a higher likelihood of correct inhaler technique (odds ratio 12.56, 95\% CI 4.44-35.50, P < .001) and a lower risk of device change (odds ratio 0.46, 95\% CI 0.27-0.77, P = .004). CONCLUSIONS: Errors in the inhaler technique, including inhalation maneuvers and device handling, were common in subjects on inhaler therapy. Subject-reported difficulties with using inhalers were more prevalent among female subjects, whereas errors in the inhaler technique identified by direct observation were similarly high in both genders. Overall, a lack of training on the inhaler technique predicted a higher likelihood of errors in the inhaler technique and a change of inhaler device.

Introduction: COPD exacerbations have a heterogeneous structure and eosinophilic (E)and noneosinophilic(NE) endotypes cause different phenotypes and severity of exacerbation. It is known that different results on the correlation of CRP and neutrophil lymphocyte ratio(NLR) in the endotype of E and NE-COPD. In this study,we aimed to determine whether 1,3,5,7 days of NLR and CRP values were similar in the E and NE endotype in AECOPD treatment follow-up, which was required to stay in the intensive care unit(ICU). Methods: A retrospective observational cohort study designed with AECOPD patients who were hospitalized in ICU.Patients were divided as eosinophilic(peripheral blood eosinophilia(PBE)>2%) and noneosinophilic(PBE≤2%) according to acute exacerbation endotype. Patients: demographics, comorbidities,1,3,5,7day total blood count,CRP values were recorded.NLR, platelet lymphocyte ratio(PLR) and PLT/MPV were calculated. Correlation of daily CRP and NLR values of endotype groups were compared. Results: A total of 68 patients,E (16%) and NE(84%) were included. The mean age,smoking,BMI and APACHE II score were similar in to groups.In the eosinophilic group, both the hospital and the ICU stay were shorter (p=0.007 vs p=0.040).CRP9s follow-up value and change were similar in both endotypes. The follow-up values and change of NLR were significantly higher in noneosinophilic COPD(p=0.014). Conclusion:In the study, NE-AECOPD treatment follow-up,which requires ICU stay, NLR would be more effective than CRP.

Introduction: There is no evidence about the best strategy to wean patients with acute hypercapnic respirtaory failure (AHRF) from a successful noninvasive ventilation (NIV) treatment. Aim: A multicenter RCT to compare the effectiveness of 3 different strategies in terms of successful rate of weaning and duration of NIV; as well as mortality, length of stay (LOS) in hospital, respiratory ICU (RICU) and ICU. Methods: 197 adult patients successfully treated with NIV for AHRF were prospectively randomized to gradual decrease in duration of NIV (A, n=66), gradual decrease in duration and level of ventilator support (B, n=64), or abrupt discontinuation of NIV (C, n=67). Results: Baseline characteristics were similar in terms of age, gender, body mass index, smoking status, Charlson comorbidity and APACHE II scores, vitals and arterial blood gas findings at enrollment (p>0.05); except for higher incidence of pneumonia and cardiovascular comordities, lower pCO2 level and incidence use of home long-term oxygen-therapy in Group C (p There was no difference between groups for NIV weaning success rates (p>0.05). The median duration of total NIV use after randomization and LOS in RICU was shorter in Group C (p However there was no significant differences in other secondary outcomes. Conclusion: Even though abrupt interruption may reduce NIV and RICU stay duration, all tested strategies are similarly effective in terms of NIV weaning success.

Amaç: Literatürde “büyük taklitçi” olarak anılan inflamatuar bir hastalık olan sarkoidoz olgularında semptomlar ve tutulan organlar açısından cinsiyete göre farklılıklar bildirilmiştir. Bu çalışmada sarkoidoz olgularındaki semptom ve bulguların cinsiyete ve hastalığın evrelerine göre farklılıkları araştırıldı.Gereç ve Yöntemler: Bu retrospektif gözlemsel kohort çalışmamızda sarkoidoz tanılı olgular başvuru semptomlarına göre; asemptomatik, pulmoner semptomlar, ekstrapulmoner semptomlar, pulmoner ve ekstrapulmoner semptom birlikteliği olarak gruplandırıldı. Her iki cinsiyet bulguların sıklığı açısından karşılaştırıldı.Bulgular: Çalışmaya alınan 338 hastanın %71’i kadın olup yaş ortalaması 42,5±11,6 idi. Olguların %86’sı başvuru anında semptomatik olup, semptomların %31’i yalnız pulmoner, %23’ü yalnız ekstrapulmoner, %32’sinde ise hem pulmoner hem de ekstrapulmoner semptomlar birlikte idi. Kadın ve erkeklerde öksürük (sırasıyla %45; %42; p=0,620), balgam çıkarma (sırasıyla %9; %11; p=0,535), hemoptizi (sırasıyla %2; %1; p=0,678), ateş (sırasıyla %4; %4; p=0,999) bulguları açısından cinsiyete göre anlamlı farklılık bulunamadı. Dispne kadınlarda erkek olgulara göre anlamlı olarak daha sık izlendi (sırasıyla %33; %22; p=0,048). Kadın hastalarda erkeklere kıyasla göğüs ağrısı anlamlı olarak daha az görüldü (sırasıyla %7; %20; p=0,001). Aşırı terleme erkeklerde kadınlara göre anlamlı olarak daha fazla görülürken (p=0,004), eritema nodosum kadınlarda erkeklere göre fazla bulundu (p=0,003). Terleme dışındaki konstitüsyonel yakınmalarda cinsiyet farkı izlenmedi.Sonuç: Sarkoidozlu kadınlar daha yaşlıdır ve nefes darlığı ile eritema nodosum, kadınlarda erkeklere göre anlamlı oranda sık bulunmuştur. Erkeklerde ise terleme ve göğüs ağrısı belirgin yüksek tespit edilmiştir., Aim: Sarcoidosis is known as the ‘great imitator’ for its versatile manifestations which differ among genders. The objective of this study is to investigate the signs and symptoms and differences in respect to gender and phases of disease.Material and Methods: This cohort study includes patients with sarcoidosis classified as asymptomatic, with pulmonary symptoms only, extrapulmonary symptoms only and those with both together. The frequency, prevalence, and severity of the signs and symptoms were compared between gender identities.Results: This study enrolled 338 patients, of which 71% were female, and mean age was 42.5±11.6. Most patients (86%) were symptomatic on presentation, and pulmonary symptoms were noted in 31%, extrapulmonary symptoms in 23% and both in 32%. There were no significant differences between genders regarding cough (45% in women, 42% in men, p=0.620), sputum (9%, 11%, respectively, p=0.535), hemoptysis (2%, 1%, respectively, p=0.678), fever (4%, 4%, respectively, p=0.999). Dyspnea was reported significantly more common in women (33% and 22%, respectively, p=0.048) whilst chest pain was more common in men (7%, and %20 respectively, p=0.001). Excessive perspiration was significantly more common in men, and erythema nodosum in women (p=0.004 and p=0.003, respectively). Frequencies of constitutional symptoms other than perspiration did not differ between sexes.Conclusion: Women with sarcoidosis were older than men and dyspnea and erythema nodosum were seen more commonly in women. Frequencies of other symptoms were similar between sexes.

Emine Aksoy, Zuhal Karakurt, Sinem Gungor, Birsen Ocakli, Ä°pek Ozmen, Elif Yildirim, Eylem Tuncay, Meltem Coban Agca, Nezihe Ciftaslan Goksenoglu, Nalan Adigüzel Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey Background: Complete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes. Method: This retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate

Background and Aim: Smoking in pregnancy is a preventable risk factor affecting morbidity and mortality.A multicentre cross-sectional study was planned by “Turkish Thoracic Society Women and Lung Health As a task force group ”. The aim of the study is to determine the attitudes of pregnant women and their surroundings to electronic cigarettes, which have become increasingly prevalent in recent years. Methods: The study was conducted in 11 provinces and 15 centers in Turkey, between September 2017 and December 2017. A Questionnaires were conducted with face-to-face interviews to gynecology outpatients who agreed to participate in the study. There were a total of 60 questions regarding education, socioeconomic status and parents9 habits of smoking cigarettes and electronic cigarettes. Results: A total of 1123 pregnant women with a mean age of 27 ± 5.6 were enrolled. 48% of them were were primary school graduates, 7% were not illiterate, and 56% were housewives. 10% of the pregnant women were active smokers. The most important factor in smoking cessation was the thought it could be harmful to the baby. Nevertheless, 30% of them thought electronic cigarette was not harmful to the baby. The rate of smoking electronic cigarettes among pregnant women was 3%.25% of pregnant women thought that cigarette smoking was more harmful, and the 45% were not aware of the harms and addictive effects of electronic cigarettes. Conclusions: regnant women seem to need more information about electronic cigarettes lately, as if they were harmless. Educational sessions, planned together with the obstetricians and chest physcians would make a significant contribution to maternal and child health.

Sinem Gungor, Feyza Kargin, Ilim Irmak, Fulya Ciyiltepe, Eylem Acartürk Tunçay, Pinar Atagun Guney, Emine Aksoy, Birsen Ocakli, Nalan Adiguzel, Zuhal Karakurt Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey Background: Patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF) due to COPD have high mortality and morbidity. Acidosis has several harmful effects on hemodynamics and metabolism, and the current knowledge regarding the relationship between respiratory acidosis severity on the short- and long-term survival of COPD patients is limited. We hypothesized that COPD patients with severe acidosis would have a poorer short- and long-term prognosis compared with COPD patients with mild-to-moderate acidosis. Patients and methods: This retrospective observational cohort study was conducted in a level III respiratory ICU of a tertiary teaching hospital for chest diseases between December 1, 2013, and December 30, 2014. Subject characteristics, comorbidities, ICU parameters, duration of mechanical ventilation, length of ICU stay, ICU mortality, use of domiciliary noninvasive mechanical ventilation (NIMV) and long-term oxygen therapy (LTOT), and short- and long-term mortality were recorded. Patients were grouped according to their arterial blood gas (ABG) values during ICU admission: severe acidotic (pH≤7.20) and mild-to-moderate acidotic (pH 7.21–7.35). These groups were compared with the recorded data. The mortality predictors were analyzed by logistic regression test in the ICU and the Cox regression test for long-term mortality predictors. Results: During the study period, a total of 312 COPD patients admitted to the ICU with ARF, 69 (72.5% male) in the severe acidosis group and 243 (79% male) in the mild-to-moderate acidosis group, were enrolled. Group demographics, comorbidities, duration of mechanical ventilation, and length of ICU stay were similar in the two groups. The severe acidosis group had a significantly higher rate of NIMV failure (60.7% vs 40%) in the ICU. Mild-to-moderate acidotic COPD patients using LTOT had longer survival after ICU discharge than those without LTOT. On the other hand, severely acidotic COPD patients without LTOT showed shorter survival than those with LTOT. Kaplan–Meier cumulative survival analysis showed that the 28-day and 1-, 2-, and 3-year mortality rates were 12.2%, 36.2%, 52.6%, 63.3%, respectively (p=0.09). The Cox regression analyses showed that older age, PaO2/FiO2

Aim: Early identification and treatment of infections in patients using domiciliary non-invasive mechanical ventilation (NIMV) due to chronic respiratory failure (CRF) can reduce hospital admissions. We assessed C-reactive protein (CRP), procalcitonin, and neutrophil lymphocyte ratio (NLR) as indicators of infection/inflammation. Methods: The study was designed as a retrospective, observational, cross-sectional study, and was performed in 2016 in an intensive care unit outpatient clinic in patients using NIMV. Patients who came to the outpatient clinic with dyspnea, increased sputum, increased prothrombin, and who had hemogram, procalcitonin, and serum CRP, NLR, and PLT/MPV levels assessed, were enrolled into the study. Demographic characteristics, co-morbid diseases, respiratory symptoms, hemogram, biochemistry, CRP, and procalcitonin values in stable and acute attack patients were recorded from patient files. The descriptive statistics and CRP, NLR, and procalcitonin values were assessed. Results: During the study period, 49 patients (24 female) with chronic obstructive pulmonary disease (COPD, n = 24), obesity hypoventilation syndrome (OHS, n = 15), or interstitial lung disease, n = 10), and having had three inflammatory markers assessed, were included in the study. Their mean age was 67 (SD ± 12). Stable patients vs. those who had an acute attack was 41 vs. eight, and within 7 days of outpatient admission four patients were hospitalized. CRP, NLR, and PLT/MPV values were similar in patients' who had sputum purulence, and an increase in dyspnea and sputum, but procalcitonin was significantly higher in patients who had an acute attack. Procalcitonin was not correlated with CRP, NLR, and PLT/MPV. Conclusions: Patients with CRF had similar levels of CRP and NLR during a stable and acute attack state. Procalcitonin may be a better marker for therapeutic decisions in advanced chronic inflammatory diseases.

WOS: 000447618800009, PubMed: 30322437, OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

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

Birsen Ocakli,1 Ipek Ozmen,1 Eylem Acartürk Tunçay,1 Sinem Gungor,1 Hilal Altinoz,1 Nalan Adiguzel,1 Zafer Ali Sak,2 Gokay Gungor,1 Zuhal Karakurt,1 Peri Arbak3 1University of Health Sciences, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; 2Department of Chest Diseases, Harran University, Faculty of Medicine, Sanliurfa, Turkey; 3Department of Chest Diseases, Duzce University, Faculty of Medicine, Duzce, Turkey Purpose: This study was designed to evaluate errors in inhaler technique in COPD vs asthma patients and to investigate the association of poor inhaler technique with patient demographics and clinical variables. Patients and methods: A total of 509 adult patients with COPD (n=328) or asthma (n=181) who were currently using an inhaler device were included in this study. Data on patient demographics, duration of disease, type and duration of inhaler therapy, and assessment of inhaler technique were recorded. Results: Metered dose inhaler (MDI) was the most common type of inhaler used by a similarly high percentage of patients in both COPD (83.2%) and asthma (77.3%) groups. Failure to exhale before inhaling through device (75.8% and 68.5% for MDIs; 73.2% and 71.8% for Aerolizer®/Handihaler®; 53.1% and 66.7% for Turbuhaler®) was the most common error in inhaler technique, in both COPD and asthma groups. Device-specific errors in inhaler techniques were more common in asthma patients as compared with COPD patients, particularly for MDIs (P-values ranged from 0.046 to 0.0005), as associated with female gender (failure to press the buttons on both sides of Aerolizer®/Handihaler®, P=0.006), shorter duration of disease (failure to hold MDI or head in a vertical position, P

Eylem Acartürk Tunçay, Zuhal Karakurt, Emine Aksoy, Cuneyt Saltürk, Sinem Gungor, Nezihe Ciftaslan, Ä°lim Irmak, Dilek Yavuz, Birsen Ocakli, Nalan Adıgüzel Respiratory Intensive Care Unit, Sureyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Turkey Aim: Increased dyspnea, sputum volume, and purulence are subjective symptoms in COPD patients. To diagnose COPD exacerbations with chronic respiratory failure (CRF) and to assess the requirement for antibiotic treatment, physicians require more objective criteria. We aimed to investigate whether neutrophil-to-lymphocyte ratio (NLR) can be used as an infectious exacerbation marker in COPD patients with CRF.Patients and methods: This retrospective cross-sectional study was performed in the intensive care outpatient clinic of a tertiary training hospital between 2014 and 2015. Patients admitted with CRF due to COPD and who had complete blood count (CBC) results were enrolled. CBC results and C-reactive protein (CRP) levels were obtained from the hospital online database. The “modified exacerbation model (MEM)” was defined as follows: exacerbationA, leukocytes ≥12,000/mm3, CRP >10mg/dL; exacerbation B, leukocytes ≥10,000/mm3, CRP >10mg/dL; exacerbation C, leukocytes ≥10,000/mm3, CRP >8mg/dL; exacerbationD, leukocytes≥10,000/mm3, CRP >5mg/dL. The cutoff value of NLR was defined for each model. Patients were split into two groups based on the NLR cutoff value according to the “NLR exacerbation model” and further subgrouped according to peripheral eosinophil percentage (eosinophils ≥2% and

Introduction: One day point prevalence study to evaluate patient profile in ICUs was planned by Turkish Thoracic Society Respiratory Failure and Intensive Care Group. Methods: The study was cross-sectional and data were obtained by a questionnaire in participating ICUs on October 26th 2016 for 24 hours. A questionnaire evaluating characteristics of patients in ICU was prepared. A total of 78 units declared to participate in the survey. Results: Ten centers were excluded from the study because they couldn’t participate on study day. A total of 922 patients were enrolled from 68 units. The mean age was 64.8 ± 17.9 (17-99), 58.6% were male. The mean APACHE II, QSOFA and GCS scores on the study day were 18.5 ± 8.8, 1.4 ±1.4 and 10.2 ± 4.3, respectively, and mean length of stay (LOS) was 20 ± 70 days. The patients were admited from emergency room(44%[n=407]), clinics(39%[n=359]) and other ICUs(17%[n=156]).38.5% of patients had Type 1 respiratory failure(RF),35.6% had Type 2 RF. Comorbidity was seen in 80.6% and malignancy rate was 18.8%. On the study day it was found that 52.1% of the patients underwent invasive mechanical ventilation(IMV),12.3% of the patients had non-invasive ventilation(NIV) 29.1% of them had oxygen therapy. Tracheostomy was performed in 19.7% of patients. 70% of the patients had enteral, 20.7% had parenteral nutrition. The discharge rate was 7% while mortality was 1.1% on that day. Discussion: Most of the patients in ICUs are respiratory failure cases admited from emergency department and clinics. Advanced age, presence of comorbidities and cancer are thought to prolong LOS in ICU. For effective use of ICU beds further regulations for patient admission criteria is necessary.

Background: Elevated RDW levels were associated with mortality in patients with stable COPD. There are limited data about RDW levels in COPD exacerbation. Aim: We evaluated if there is any difference about the RDW levels in patients with COPD exacerbation in out patients clinic, ward and ICU. Methods: The study was designed as cross sectional observational retrospective, in a teaching chest disease hospital in 2014.Previously COPD diagnosed patients who admitted to hospital outpatients clinic, ward and ICU due to COPD exacerbation were included the study.Cancer, pneumonia, anemia, asthma, liver-renal diseases and rheumatologic-neurologic diseases patients were excluded.Demographics, hemogram values included RDW, CRP were recorded from hospital based electronic system. RDW were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11-0.15% (normal).Recorded values were compared according to place where COPD exacerbation was treated. Results: 2771 COPD patients (33% female) and 1429 outpatients clinic, 1156 ward and 186 ICU were enrolled in the study. The median RWD values in outpatientsn clinic, ward and ICU were; 0.16, 0.07 and 0.01 respectively (p Conclusion: Patients with COPD exacerbation, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response.

Obesity hypoventilation Syndrome (OHS) is diagnosed only after eliminating chronic obstructive pulmonary disease (COPD)and any other diagnostic ethiologies. The similar versus nonsimilar clinical and inflammatory laboratory parameters of OHS patients with chronic respiratory insuffiency compared to COPD patients with obesity are quite restrictive. In our study the answer to the question whether there is any other common point except obesity between OHS with respiratory insufficency and COPD with obesity is tried to be found. Method: OHS withpatients with chronic respiratory insufficency and COPD patients with obesity referred and followed by our ICU out patient clinic between 2014-2015 were included in retrospective cohort study.Demographic characteristics, BMI arterial blood gas analysis, spirometry, blood panel, biochemical parameters, CRP, values are all recorded.The two group of patients were compared according to their recorded data. Findings: 365 OHS and 378 COPD patinets were included totally in our study data.Inflammatory markers were insignificantly higher.Laboratory results that significantly higher had no clinical importance.COPD patients with obesity had significantly higher PCO2 values and insignificantly higher HCO3 levels.Spirometry results of OHS patients were in restrictive pattern. Results: Clinical presentation of COPD patients with obesity versus OHS patients looks like more or less the same where as the spirometric pattern is obstructive in COPD but restrictive in OHS.Coexistence of hypercapnia in OHS patient means that there is another underlying ethio pathology other than an airway pathology.

Aim: Sarcoidosis is a multisystemic disease with typical or atypical pulmonary and extra-pulmonary symptoms or frequently without symptoms. Presence of typical clinical findings and symptoms contribute to rapid diagnosis, whereas asymptomatic progression leads to delays in the diagnosis. The aim of this study was to investigate the delay in diagnosis in between patients with pulmonary and/or extra-pulmonary involvement and related symptoms and those without symptoms. Material and Methods: Patients in the sarcoidosis clinics between 2010-2015, were retrospectively evaluated. The cases were grouped according to the presence or absence of symptoms (pulmonary and/or extra-pulmonary). The groups were compared with regard to the delay in diagnosis. Results: Among the 300 patients, 209 (69%) were female. The mean age was 43±11.68. The disease was stage I in 67.3%, stage II in 23.7%, stage III in 5.7% and stage 0 in 3.3% of the patients. No significant difference was observed between symptomatic and asymptomatic patients with regard to total duration until diagnosis (p=0.78). A statistically significant difference was observed between patients groups with regard to physician-related delayed diagnosis(p=0.026). The mean delay in physician-related diagnosis was observed to be longer in asymptomatic cases (21.44 days) compared to patients with pulmonary symptoms (13.66 days)(p=0.036). In asymptomatic cases, the mean duration of physician-related delayed diagnosis (21.44 days) was observed to be longer in comparison with patients with extra-pulmonary symptoms (12.79 days)(p=0.016). In patient-related delayed diagnosis, no difference was observed between groups with regard to the duration until diagnosis(p=0.78). Conclusion: Comparison of delayed diagnosis between patients with or without pulmonary and/or extra-pulmonary symptoms revealed a longer duration of delay in asymptomatic cases compared to symptomatic cases. The timing of diagnosis is very important in sarcoidosis in order to reduce morbidity and mortality; a suspicious approach to asymptomatic patients will increase the possibility of diagnosis and prevent delayed diagnosis.Keywords: Sarcoidosis; diagnosis; delay; extrapulmonary symptoms.

Cüneyt Saltürk, Zuhal Karakurt, Nalan Adiguzel, Feyza Kargin, Rabia Sari, M Emin Celik, Huriye Berk Takir, Eylem Tuncay, Ozlem Sogukpinar, Nezihe Ciftaslan, Ozlem Mocin, Gokay Gungor, Selahattin OztasRespiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching Hospital, Istanbul, TurkeyBackground: COPD exacerbations requiring intensive care unit (ICU) admission have a major impact on morbidity and mortality. Only 10%–25% of COPD exacerbations are eosinophilic.Aim: To assess whether eosinophilic COPD exacerbations have better outcomes than non-eosinophilic COPD exacerbations in the ICU.Methods: This retrospective observational cohort study was conducted in a thoracic, surgery-level III respiratory ICU of a tertiary teaching hospital for chest diseases from 2013 to 2014. Subjects previously diagnosed with COPD and who were admitted to the ICU with acute respiratory failure were included. Data were collected electronically from the hospital database. Subjects’ characteristics, complete blood count parameters, neutrophil to lymphocyte ratio (NLR), delta NLR (admission minus discharge), C-reactive protein (CRP) on admission to and discharge from ICU, length of ICU stay, and mortality were recorded. COPD subjects were grouped according to eosinophil levels (>2% or ≤2%) (group 1, eosinophilic; group 2, non-eosinophilic). These groups were compared with the recorded data.Results: Over the study period, 647 eligible COPD subjects were enrolled (62 [40.3% female] in group 1 and 585 [33.5% female] in group 2). Group 2 had significantly higher C-reactive protein, neutrophils, NLR, delta NLR, and hemoglobin, but a lower lymphocyte, monocyte, and platelet count than group 1, on admission to and discharge from the ICU. Median (interquartile range) length of ICU stay and mortality in the ICU in groups 1 and 2 were 4 days (2–7 days) vs 6 days (3–9 days) (P2%. NLR and peripheral eosinophilia may be helpful indicators for steroid and antibiotic management.Keywords: chronic obstructive pulmonary disease, exacerbation, respiratory failure, intensive care unit, peripheral eosinophilia