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Objective The purpose of this study was to compare the upper extremity exercise capacity and activities of daily living (ADLs) in individuals with bronchiectasis and controls. Methods Twenty-four individuals with bronchiectasis and 24 healthy controls were assessed for upper extremity exercise capacity (6-minute pegboard and ring test [6PBRT]) and ADLs (Glittre ADL test). Energy expenditure was measured using a wearable metabolic monitor during the Glittre ADL test. Results The mean 6PBRT score of individuals with bronchiectasis was significantly lower than the mean score of controls (196.50 [SD = 51.75] versus 243.00 [SD = 29.76] number of rings). The Glittre ADL test duration was significantly higher in individuals with bronchiectasis compared with controls (3.54 [SD = 1.53] versus 2.36 [SD = 0.18] min), despite similar energy expenditure during the Glittre ADL test between the groups (17.67 [SD = 5.28] kcal in individuals with bronchiectasis versus 18.13 [SD = 5.71] kcal in controls). The 6PBRT score and the Glittre ADL test duration were negatively correlated in individuals with bronchiectasis (r = −0.694). Conclusions The individuals with bronchiectasis had reduced upper extremity exercise capacity compared with healthy controls. Energy expenditure during ADLs was similar between individuals with bronchiectasis and healthy controls, despite lower ADL performance in individuals with bronchiectasis. The upper extremity exercise capacity and ADLs are related in individuals with bronchiectasis. Given the relationship between upper extremity exercise capacity and ADLs in bronchiectasis, inclusion of upper extremity exercise training to pulmonary rehabilitation programs should be considered. Impact Considering the impairment of upper extremity exercise capacity and ADLs in individuals with bronchiectasis highlights the necessity to tailor preventive strategies and preclude further unfavorable effects. Lay Summary Bronchiectasis may cause deterioration in upper extremity exercise capacity and ADLs. The assessment of upper exercise capacity and ADLs by physical therapists in individuals with bronchiectasis may be useful for designing comprehensive rehabilitation programs and thus the management of bronchiectasis.

OBJECTIVE: In this study, we aimed to evaluate the accuracy of the original and simplified pulmonary embolism (PE) severity index (PESI) to predict all-cause mortality after 30 days of acute PE diagnosis up to five years within consecutive sub-periods. METHODS: Adult patients diagnosed with acute PE between January 1, 2003, and June 30, 2013, were retrospectively included. Data on baseline characteristics and mortality during a five-year follow-up were collected. RESULTS: The study included 414 patients (Male/Female=192/222). The median age at diagnosis was 61.5 (minimum–maximum, 18–93) years. Mortality rates were 13.3% at 30 days, 21.8% at 90 days, 32.6% at one year, and 51.0% at five years. Both stratification into risk classes according to the original PESI and low vs. high-risk classification of original and simplified PESI were significantly correlated with the 30-day, 31–90-day, 91-day-one-year, and one-five-year mortality. Significant PESI predictors for mortality were history of cancer [hazard ratio (HR): 3.31, 95% confidence interval (CI): 1.64–6.68; p=0.001] and heart failure (HR: 2.35, 95% CI: 1.04–5.32, p=0.041) at 31–90-day, history of cancer (HR: 5.45, 95% CI: 2.86–10.40, p

Introduction Oxygen desaturation is a significant event during bronchoscopy. In this study, it was aimed to identify factors related to oxygen desaturation during flexible bronchoscopy (FB) and Endobronchial ultrasound (EBUS). Materials and Methods From 16 April 2019 to 14 February 2020, 196 consecutive patients (146 FB and 50 EBUS) undergoing bronchoscopy were evaluated retrospectively. The patients' oxygen saturations were monitored on admission and during the procedure by finger pulse oximetry. Desaturation was defined as saturation below 90%. Demographic characteristics, comorbidities, types of interventions, vitals before and during the procedure, amount of saturation decline, and sedative agents used were recorded. The data obtained were compared between the desaturated and non-desaturated groups in both FB and EBUS. We evaluated the risk factors for desaturation during bronchoscopic procedures. Result The mean age of those who underwent FB was higher (62 [52-68] years vs. 55 [44-65] years, p= 0.05), and males were more frequent (54%, vs 19.2%, p

Objective: The aim of the study is to describe the clinical characteristics of Antineutrophil cytoplasmic antibodies-associated vasculitis and to analyze the parameters affecting the outcome. Materials and Methods: The study is a retrospective cohort study. Totally 130 patients with Antineutrophil cytoplasmic antibodies-associated vasculitis (18 years and over) who were followed up between October 2014 and October 2019 were analyzed. Demographic data, laboratory values, clinical course, thorax computed tomography findings and treatment approaches were noted from the charts of patients. Patients were divided into two groups as those with pulmonary involvement and non-pulmonary involvement. Results: We retrospectively reviewed the medical records of 130 patients with Antineutrophil cytoplasmic antibodies-associated vasculitis; 111 with granulomatosis with polyangiitis, 15 with microscopic polyangiitis, 1 with eosinophilic granulomatosis with polyangiitis, and 3 with other types of vasculitis. The ratio of having the abnormality in thoracic computed tomography was 72.2%. There were 84 cases with pulmonary involvement and 46 cases with non-pulmonary involvement. The frequency of microscopic polyangiitis was significantly higher (p=0.034) in non-pulmonary involvement cases. There were 67 cases with proteinase 3 Antineutrophil cytoplasmic antibodies and 39 cases with myeloperoxidase Antineutrophil cytoplasmic antibodies positivity. Most of the cases with proteinase 3 Antineutrophil cytoplasmic antibodies positivity were classified as granulomatosis with polyangiitis, this was statistically significant. Recovery was referenced for the outcome. Any of the variables were found statistically significant effective on outcome. Conclusions: Cases with pulmonary involvement were more than the cases without pulmonary involvement in our study. microscopic polyangiitis was significantly higher in non- pulmonary involvement cases. We studied on a large group, and these significant findings may have important implications for the investigation, pathogenesis, and treatment of Antineutrophil cytoplasmic antibodies-associated vasculitis.

INTRODUCTION A prolonged mismatch between the demand for respiratory muscle work and the capacity to meet that demand in chronic obstructive pulmonary disease (COPD) can result in symptoms of dyspnea and the development of muscle fatigue. OBJECTIVES The purpose of this study was to compare two different respiratory muscle endurance assessment methods of sustainable inspiratory pressure (SIP) and incremental threshold loading (ITL) in COPD. METHODS Thirty-four patients diagnosed with COPD were included in the study. Physical and demographic characteristics of the subjects were recorded. Pulmonary function testing (PFT), modified Medical Research Council (MMRC) dyspnea scale, COPD assessment test, inspiratory and expiratory muscle strength (MIP and MEP, respectively) measurement and six-minute walk test (6MWT) were used to assess subjects. Two different respiratory muscle endurance tests (SIP and ITL) were performed within 48 hours apart, and each test was repeated two times on the same day. RESULTS There was no correlation between the SIP and ITL tests (r = 0.069, P = .699). According to the test-retest reliability analysis, both tests were reproducible (ICC = 0.843; P < .001 for SIP, ICC = 0.905; P < .001 for ITL). Finding no differences between repeated tests showed that tests are not affected by learning effect. CONCLUSION The SIP and ITL tests are used for the same purpose but have different characteristics. Regarding the relationship between the other parameters and tests, the ITL is well tolerated and reflects the differences in respiratory muscle endurance better.

Background The 6 min pegboard and ring test (6PBRT) is a valid and reproducible test of unsupported arm exercise endurance. The aim of this study was to determine the associations between the 6PBRT, activities of daily living (ADL) and hemoglobin levels in chronic obstructive pulmonary disease (COPD). Methods This study included 40 stable patients with COPD. All participants underwent the 6PBRT, peripheral venous blood sampling, arm ergometer test and the Glittre-ADL and ADL simulation tests for the ADLs performance. Results An average 172.51 +/- 25.94 rings were moved in 6 min. The number of rings in 6PBRT was significantly positively correlated with the number of cycles in ADL simulation test (r = 0.553, p < 0.001), peak oxygen consumption in arm ergometer (r = 0.381, p = 0.024) and serum hemoglobin level (r = 0.411, p = 0.011). Conclusion The number of rings moved in the 6PBRT is associated with ADL simulation test performance that reflects upper extremity ADLs. Therefore, the 6PBRT can be used for estimating limitation in upper extremity ADLs as a simple and quick evaluation in patients with GOLD stage II-III COPD.

A few studies have implied that patients with bronchiectasis have a more inactive lifestyle than healthy counterparts do. The main objective of this study was to compare physical activity (PA) levels subjectively and objectively between patients with bronchiectasis and healthy individuals using an accelerometer and a questionnaire.The study included 41 patients with bronchiectasis aged 18-65 years and 35 healthy age- and sex-matched control subjects. The PA level was assessed objectively using a multisensorial PA monitor, the SenseWear Armband (SWA), and subjectively with the International Physical Activity Questionnaire (IPAQ). All participants performed the incremental shuttle walk test (ISWT) for the assessment of exercise capacity. Pulmonary function, dyspnea, severity of bronchiectasis, respiratory and peripheral muscle strength, and quality of life were assessed.The pulmonary function test parameters, respiratory and peripheral muscle strength, exercise capacity, step count, moderate- and vigorous-intensity PA duration were significantly lower in patients with bronchiectasis than in the healthy control group (p 0.05). Sedentary, moderate, vigorous, and total PA duration measured using the SWA were higher than those obtained using the IPAQ (p 0.05).Patients with bronchiectasis have a reduced PA level compared with healthy counterparts. The IPAQ (based on the subjective estimation of PA) outcomes differed from the SWA outcomes, reinforcing the necessity for a disease-specific PA questionnaire. IPAQ underestimates the physical activity level compared with objective measurements.

The decline in ambulatory activities and negative alterations in gait characteristics may impair balance and increase fall risk in obstructive lung diseases. Few studies have evaluated balance and gait parameters in individuals with bronchiectasis.This study aimed to compare the gait parameters and functional balance in individuals with non-cystic fibrosis (CF) bronchiectasis and healthy subjects.This cross-sectional and retrospective study analyzed data from 22 individuals with non-CF bronchiectasis and 32 healthy controls recorded between July 2019 and July 2020. Functional balance was assessed using the Timed Up and Go (TUG) test. Gait parameters were evaluated using the Biodex Gait Trainer. Step cycle (s), gait speed (m/s), the number of steps per minute, and ambulation index were measured for 6 min.Results The TUG time (s) was significantly longer (p = .019, effect size = 0.66), and gait speed (m/s) (p ˂ 0.001, effect size = 2.47), step cycle (s) (p ˂ 0.001, effect size = 2.23), and ambulation index (p ˂ 0.001, effect size = 2.56) were significantly reduced in individuals with non-CF bronchiectasis compared with healthy controls.Non-CF bronchiectasis is related to unfavorable changes in gait characteristics, such as slower gait speed and the decreased average step cycle. In addition, impairment in functional balance and mobility exists in a small percentage of adults with non-CF bronchiectasis. In comprehensive pulmonary rehabilitation, balance and gait evaluations should be included to prevent falls in adults with non-CF bronchiectasis.

Recent reports have identified pain as a comorbidity in obstructive lung diseases, but data regarding pain in certain obstructive lung diseases such as COPD and bronchiectasis vs. healthy controls and differences in pain between these chronic lung diseases are limited.The primary aim of this study was to compare pain sensitivity, postural abnormalities, and functional balance in patients with COPD/bronchiectasis vs. healthy controls. The secondary aim was to evaluate differences in these parameters between two different lung diseases (COPD and bronchiectasis).Twenty-nine patients with moderate to severe COPD/bronchiectasis and 31 healthy age/gender-matched individuals participated in the study. Pain sensitivity was assessed with an algometer. Postural abnormalities were analyzed from the lateral and posterior view. Functional balance was evaluated using the Timed Up and Go test (TUG).Significantly more patients reported pain compared to the healthy controls (89.7% vs. 19.4%, respectively) (p 0.05). The pressure pain thresholds of the trapezius and deltoid muscles and pain tolerance of the pectoralis major muscle were significantly lower in patients compared to healthy subjects (p 0.05). Total and posterior posture scores and TUG time were significantly higher in patients compared to the control group (p 0.05).This study showed that pain perception, severity, and sensitivity are increased in patients with COPD or bronchiectasis compared to the healthy population. These patients also have more severe postural abnormalities and functional balance impairment than the healthy population.

Background We investigated plasma YKL-40 levels and chitotriosidase (CHIT1) activity in patients with cystic fibrosis (CF) lung disease and evaluated clinically relevant factors that may affect their levels. Methods Plasma samples were obtained from pediatric (n = 19) and adult patients (n = 15) during exacerbation, discharge and stable period of the disease. YKL-40 levels and chitotriosidase activity were measured by enzyme-linked immunosorbent assay and fluorometric assay, respectively. Data were compared with healthy children and adults of similar age. Results YKL-40 levels of pediatric and adult CF patients at all periods were significantly higher than controls (p

Information on the interaction between frailty and chronic obstructive pulmonary disease (COPD) is limited.This study aimed to compare activities of daily living (ADL), exercise capacity, balance, and cognition in COPD patients with and without frailty.Twenty frail and 28 non-frail COPD patients aged 55 years and over were included. Frailty was determined according to Fried et al. Dyspnea was evaluated using the modified Medical Research Council (mMRC) dyspnea scale. Respiratory and peripheral muscle strength were measured. Functional capacity was assessed using a 6-min walk test (6MWT); ADL performance was evaluated using the Glittre ADL test. The balance was evaluated using the functional reach test (FRT). Cognitive function was assessed using the Montreal Cognitive Evaluation (MoCA) Test. Quality of life was measured using the COPD Assessment Test (CAT).The mMRC and CAT scores were higher in the frail patients as compared with the non-frail patients (p0.05). The maximal inspiratory pressure, handgrip strength, 6MWT distance, and FRT score were lower in the frail patients as compared with the non-frail patients (p0.05). The duration for the Glittre ADL test was longer in the frail patients than the non-frail patients (p0.05). There was no significant difference between MoCA scores between groups (p0.05).Frail COPD patients have increased dyspnea perception, impaired muscle strength, and functional capacity, ADL performance, balance, and quality of life. Whether pulmonary rehabilitation programs for patients with frail COPD need to be adapted with new rehabilitation strategies, including components of frailty, needs further investigation.

This registry-based case-control study aimed to assess the association between asbestos deposits in the birthplace and/or residence and nonmalignant pleural findings, namely pleural plaques (PPs) and pleural thickening (PT), on chest CT scans. In total, 39,472 CT scans obtained over five years in a tertiary referral hospital in Ankara, Turkey, were evaluated. Cases involving patients with PP (n = 537), PT (n = 263), PP&PT (n = 69), and controls (n = 543) from the same study base without those conditions were included. Each case group was compared to controls using unconditional logistic regression. The presence of asbestos deposits in the district of birthplace (adjusted OR = 2.13, 95% CI: 1.35-3.37) and both birthplace and residence (aOR = 4.32, 95% CI: 2.26-8.27) was significantly related to the PPs. As the importance of environmental asbestos exposure in Turkey continues, future prospective studies could contribute to developing screening strategies.

Aim: Our aim is to determine the risk factors for patients whose clinical stability can not be reached or whose can not be discharged with the optimal care. Material-Method: It is a multicenter, prospective observational study. 434 patients who were hospitalized (non-ICU) with severe exacerbation were included in the study. The primary endpoint for "difficult-to-manage COPD exacerbation" is prolonged hospitalization (PH). Hospitalizations of >8 days accepted as PH. To identify risk factors and to develop a scoring system that predicts PH. Results: 361 (83.2%) of the patients are male and the mean age is 69.2±9.3 year. 285 (67.2%) of the patients are in the GOLD-D group. There was prolonged hospitalization in 237 patients (54.6%). The factors related with PH are smoking,pathological X-ray,GOLDgroup C/D,high CRP, HAP,requiriment of NIV/parenteral nutrition,delaying examination. A combined scoring system that can predict the odds of PH is shown in Table1. The risk of PH increases 4 times in patients who score ≥3 (OR:3.9, 95%GA 2.5-61,P>0.001). Conclusion: Factors that can be related with PH for the COPD exacerbations should be evaluated in terms of patient, disease and hospital dynamics. We think that the scoring system developed in this study can be used to predict PH and therefore diffucult to manage COPD.

Introduction and Background: BODEx index which is a multidimensional disease severity index and simplified version of BODE in chronic obstructive pulmonary disease (COPD) patients. There is limited use of BODEx index in Europe but it can be practical for daily living activities (ADL) status in COPD. Aim and Objectives: The aim was to evaluate the association between BODEx index and ADL, occupational performance, psychosocial status and health related quality of life (HRQoL) in patients with COPD. Methods: Twenty-seven patients with COPD (mean age: 58.6 ± 9.6 years, mean %FEV1=50.6±13.7) were included in the study. BODEx index was calculated according to Body mass index, airflow Obstruction, Dyspnea with MMRC scale and Exacerbations. ADL was evaluated with London Chest ADL Scale (LCADL). Occupational performance was assessed by Canadian Occupational Performance Measurement (COPM). Psychosocial status was determined with Hospital Anxiety amd Depression Scale (HADS) and HRQoL was assessed with COPD Assesment Test (CAT). Results: Mean BODEx score of patients was 3.6±1.6. The BODEx score was significantly correlated with COPM-satisfaction score (r=-0.474, p=0.014), LCADL-leisure time score (r=0.473, p=0.013), HADS-anxiety score (r=0.420, p=0.029) and CAT score (r=0.430, p=0.028). Conclusions: As the multidimensional disease severity increase, daily living activities, satisfaction from occupational performance, health related quality of life and psychosocial status deteriorate in COPD. BODEx index can be a practical metod for understanding functional impairment of patients in pulmonary rehabilitation.

Objective:The purpose of this study was to compare the respiratory functions, exercise performance, and quality of sleep in patients with Obstructive Sleep Apnea syndrome (OSAS) and Chronic Obstructive Pulmonary disease (COPD) compared to healthy individuals.Materials and Methods:Seventeen patients with OSAS (12 M, 5 F), 24 patients with COPD (20 M, 4 F) and 20 healthy subjects (15 M, 5 F) participated in this cross-sectional study. Respiratory function and muscle strength tests were performed. Knee extensors, shoulder abductors, and hand grip strength were measured in patients with OSAS and COPD using a digital hand-held dynamometer. Exercise performance was evaluated using a 6-minute walk test (6MWT), and sleep quality was assessed by the Pittsburgh Sleep Quality index (PSQI).Results:The 6MWT distance, 6MWT% distance, actual and percentage values of shoulder abductors muscle strength of patients with COPD were significantly lower than those of the OSAS group (p

Objective Computed tomography pulmonary angiography (CTPA) is used for the main diagnosis in acute pulmonary embolism (APE). Determining the thrombus location in the pulmonary vascular tree is also important for predicting disease severity. This study aimed to analyze the correlation of the thrombus location and the clot burden with the disease severity and the risk stratification in patients with APE. Methods The study included patients with APE diagnosed by CTPA who were admitted to the hospital between January 28, 2016, and July 1, 2019. Data collected were markers of severity in APE, including patient demographics, comorbidities, length of hospital stay, pulmonary embolism severity index (PESI) score, modified PESI score, Wells score, risk stratification according to the American Heart Association, systolic blood pressure (SBP), right ventricle diameter to left ventricle diameter ratio, pulmonary arterial pressure, brain natriuretic peptide, troponin, D-dimer, and plasma lactate levels, and vessel location of the thrombus, clot burden score, ratio of the pulmonary artery trunk diameter/aortic diameter, superior vena cava diameter (SVC) by CTPA, and survival. All parameters were analyzed in correlation with clot load and vessel location. Results Thrombus vascular location was found to be correlated with risk stratification and negatively correlated with SBP. Simplified Mastora score was correlated with risk stratification, SVC diameter, and D-dimer and negatively correlated with SBP. Occlusion of both the pulmonary artery trunk and any pulmonary artery with thrombus was associated with massive APE. Conclusion The level of the occluded vessel on CTPA may provide the ability to risk-stratify, and the clot burden score may be used for assessing both risk stratification and cardiac strain.

[No Abstract Available]

Purpose: Dyspnea, sedentary lifestyle, and comorbid diseases may reduce the desire to engage in physical movement in chronic obstructive pulmonary disease (COPD). The aims of this study were to ass...

Exercise capacity is impaired in patients with bronchiectasis. Incremental shuttle walk test (ISWT) stresses cardiorespiratory system physiologically to symptom-limited maximal exercise capacity. The purpose of this study was to investigate the clinical determinants of ISWT in adults with non-cystic fibrosis (CF) bronchiectasis. Forty-one clinically stable bronchiectasis patients aged 18–72 years (27 females, 14 males) participated in the study. Subjects’ demographics and physical characteristics were recorded. Bronchiectasis Severity Index was used to identify disease severity. Pulmonary function test was performed. Dyspnea perception was assessed using the modified Medical Research Council Dyspnea Scale. Maximum inspiratory and expiratory pressures were measured. Peripheral muscle strength using a hand held dynamometer was measured. ISWT was performed to determine exercise capacity. Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Leicester Cough Questionnaire were used to determine fatigue, psychosocial status, and quality of life. Patients’ mean ISWT distance was 469.5 m. The ISWT distance was significantly related with age (r = − 0.472), height (r = 0.469), gender (r = 0.520), FEV1 (r = 0.651), and FVC (r = 0.545, p

The 6 min pegboard and ring test (6PBRT) is a valid and reproducible test of unsupported arm exercise endurance. The aim of this study was to determine the associations between the 6PBRT, activities of daily living (ADL) and hemoglobin levels in chronic obstructive pulmonary disease (COPD).This study included 40 stable patients with COPD. All participants underwent the 6PBRT, peripheral venous blood sampling, arm ergometer test and the Glittre-ADL and ADL simulation tests for the ADLs performance.An average 172.51 ± 25.94 rings were moved in 6 min. The number of rings in 6PBRT was significantly positively correlated with the number of cycles in ADL simulation test (r = 0.553, p 0.001), peak oxygen consumption in arm ergometer (r = 0.381, p = 0.024) and serum hemoglobin level (r = 0.411, p = 0.011).The number of rings moved in the 6PBRT is associated with ADL simulation test performance that reflects upper extremity ADLs. Therefore, the 6PBRT can be used for estimating limitation in upper extremity ADLs as a simple and quick evaluation in patients with GOLD stage II-III COPD.

Purpose: Frailty defines a clinical syndrome characterized by multiple system effects leading to decreased functional reserve and increased sensitivity to mortality or mortality following minor stress events. Inflammation, lack of physical activity, reduced exercise efficiency and maximum oxygen uptake may contribute to the development of fragility in patients with chronic obstructive pulmonary disease (COPD). We aimed to compare exercise capacity, physical activity level, and balance in patients with and without frail COPD. Methods: Thirty-one clinically stable COPD patients (11 frail [3F,8M, mean age=65.55±5.92 years]; 20 non-frail [1F,19M, mean age=66.10±5.66 years]) were included in study. Frailty was identified by presence of three or more of the following criteria unintentional weight loss, weakness (grip strength), self-reported exhaustion, slow walking speed (4-m walk test) and low physical activity (International Physical Activity Questionnaire-Short Form). Exercise capacity was assessed using the 6-min walk test (6MWT). Physical activity level was assessed using a triaxial armband monitor. The functional reach test was used to evaluate. Results: The 6MWT distance of frail COPD patients was significantly lower than non-frail patients (p Conclusion: The presence of fragility in COPD patients contribute to exercise intolerance, physical inactivity as well as impaired balance and vice versa. The development of specific treatment strategies seems to be necessary according to presence of frailty.

Background: Upper extremity exercise has been identified as a part of pulmonary rehabilitation. Determination of arm exercise capacity may be predictive for maintaining and improving upper extremity and activities of daily living (ADL) in patients with chronic lung disease. Aim: We aimed to determine arm exercise capacity and ADL performance in patients with bronchiectasis and compare with healthy controls. Methods: We included 12 bronchiectasis patients (8F, 4M, 35.2±17.2 years, FEV1 73.12±12.1% pred) and ten controls (8F, 2M, 39.0±7.9 years, FEV1 93.3±14.2% pred.). The arm exercise capacity and ADL performance were assessed using 6-minute pegboard and ring test (6PBRT) and Glittre ADL test, respectively. Energy expenditure during Glittre ADL test was measured using a multi-sensor armband. Results: The 6PBRT score was significantly lower in patients with bronchiectasis as compared to controls (p=0.018). Energy expenditure during Glittre ADL test was significantly higher in patients with bronchiectasis (p=0.021) even though there was no significant difference in ADL test duration between the groups (p>0.05). Conclusions: Patients with bronchiectasis have reduced arm exercise capacity compared with controls. Since oxygen cost of breathing constitutes an important part of energy expenditure during exercise, increased cost of oxygen may be explanatory for increased energy expenditure during activities in patients despite similar test duration to healthy controls. This may be led by an increased oxygen use of respiratory muscles in a particular workload and the loss of lean body mass in patients with bronchiectasis.

Introduction The knowledge of the relationship between exercise capacity and activities of daily living (ADLs) is important to minimize the negative outcomes in ADLs resulting from reduced exercise capacity in patients with chronic obstructive pulmonary disease (COPD). There is a limited study about the association between exercise capacity and ADLs in patients with COPD. This study aimed to investigate the relationship between maximal exercise capacity and ADLs in patients with GOLD stage II–III COPD. Methods Twenty-seven clinically stable GOLD stage II–III COPD patients were included (mean age = 58.59 ± 9.63 years and mean FEV1 = 50.6 ± 13.7%) in this cross-sectional study. Maximal and submaximal exercise capacity were evaluated using an incremental shuttle walk test (ISWT) and 6-min walk test (6MWT), respectively. Activities of daily living were assessed using Glittre-ADL test. Results The ISWT distance was significantly correlated with Glittre-ADL test time (r = −0.517, p = 0.006). There was also a negative correlation between 6MWT distance and Glittre-ADL test time (r = −0.506, p = 0.007). Conclusion A moderate relationship was found between maximal exercise capacity and general activities of daily living performance. The reduction in exercise capacity increases the negative influences in ADLs and strengthens our beliefs that exercise interventions in pulmonary rehabilitation could influence activities of daily living positively.

Pertussis is a vaccine-preventable disease that is transmitted from infected to susceptible individuals by respiratory route. Bordetella pertussis infection may occur at any age as neither vaccine nor natural infection induced immunity lasts life-long. This study was planned to demonstrate the serological evidence of infection among adults, to raise awareness among clinicians and to provide data for the development of strategies to protect vulnerable infants. A total of 538 patients (345 female, 193 male) ages between 18-87 years who had a complain of prolonged cough for more than two weeks were included in the study. Antipertussis toxin (PT) IgG and anti-filamentous hemagglutinin (FH) IgG levels from single serum samples were measured by an in-house ELISA test which was standardized and shown to be efficient previously. Anti-PT IgG antibody levels of >= 100 EU/ml were considered as acute/recent infection with B. pertussis. In our study, 9.7% (52/538) of the patients had high levels of anti-PT IgG (>= 100 EU/ml) and among those patients 43 (43/52; 82.7%) also had high (>= 100 EU/ml) anti-FHA IgG levels. There were no statistically significant differences in terms of age, gender, education level, DPT (diphtheria-pertussis-tetanus) vaccination history, smoking history or average daily cigarette consumption (p> 0.05) between the cases with high antibody levels (n=52). When the symptoms and the presence of cases with high antibody levels were evaluated, it was detected that no one parameter was significantly different from others, except that 24.1% of the cases with inspiratory whooping had high anti-PT levels. There was also no statistically significant difference between high anti-PT levels >= 100 EU/ml and the patients with risk factors [smoking (21/200; 10.5%), presence of disease that cause chronic cough and/or drug usage (19/171; % 11.1), and whole factors which cause chronic cough (32/306; % 10.5)] and without risk factors (p=0.581; p=0.357; p=0.249, respectively). The distribution of anti-PT IgG geometric mean titer (GMT) according to the age groups, was as follows; 32.41 in 18-30 years; 36.28 in 31-50 years; 36.82 in 51-70 years and 31.15 in >= 71 years. Our results indicated that B. pertussis infections are also present among adult population with a frequency not to be underestimated (9.7%) and the results also emphasized that since typical whooping cough symptoms may not be seen in adults, pertussis infection should be considered as a differential diagnosis in adults with prolonged cough, even if there are some other underlying factors of cough. The data obtained from this study was also considered to be helpful in the development of adult vaccination policies for the protection of infants who have not completed the vaccination schedule yet.

Objectives Chronic obstructive pulmonary disease (COPD) remains a globally significant cause of mortality, although COPD mortality varies from country to country, and across different regions within each country. The primary objective of this study was to determine the mortality rates of COPD patients who present with acute respiratory failure (ARF) to a tertiary care referral center in different stages of their follow-up (ICU, in-hospital and after discharge). The secondary objective was to determine factors associated with mortality in this group of patients. Results Medical records of consecutive COPD patients over a 10-year period were reviewed.The study included 147 patients. Of these, 72 were treated initially with noninvasive positive pressure ventilation (NIPPV), and 12 of these required intubation after NIPPV failed. Therefore, 86 patients were intubated for invasive mechanical ventilation (IMV), while NIPPV was succesful in 60 patients. Survival time was independently associated with advanced age, high APACHE II score, co-morbidity and the need for IMV. The cumulative mortality was 27% in the medical ICU and 31% in hospital following ICU discharge. The mortality rate at 1, 2 and 5 years was 54%, 66% and 84%, respectively. Conclusion COPD patients admitted to the ICU for ARF have an approximately 70% chance of leaving hospital alive, but half of these may die in the first 6 months after discharge. The risk factors related to mortality were advanced age, high APACHE II score, co-morbidity and IMV requirement.

OBJECTIVES: The London Chest Activity of Daily Living Scale (LCADL) is a simple, useful, and comprehensive measure of dyspnea perception in activities of daily living. This study was conducted to determine the validity and reliability of the Turkish version of the LCADL. MATERIALS AND METHODS: A total of 64 patients with obstructive lung disease (24 chronic obstructive pulmonary disease, 20 asthma, and 20 bronchiectasis patients) were included. The Turkish LCADL was evaluated for interobserver reliability, test–retest reliability, and criterion validity. Two different observers applied the scale with an interval of 10 minutes to assess interobserver reliability. The second observer applied the scale twice at an interval of 10–15 days to assess test–retest reliability. Criterion validity was assessed using the 6-minute walk test (6MWT), Nottingham Health Profile (NHP), and Saint George Respiratory Questionnaire (SGRQ). RESULTS: The interobserver reliability of the scale was very high (r(s)=0.985, p

Purpose: Dyspnea, cough and sputum are the main symptoms in obstructive pulmonary diseases. Along with these symptoms, fatigue is a very common but often ignored symptom. The aim of the present study was to determine and compare fatigue between patients with obstructive pulmonary disease and determine factors potentially associated with experience of fatigue in patients with obstructive pulmonary disease. Method: Twenty-four COPD, twenty asthma and twenty bronchectasis; total sixty-four patients diagnosed with obstructive pulmonary disease participated in this study. 6 minute walk test (6MWT) used to determine exercise capacity. All groups were assessed by all questionnaires following: Fatigue Impact Scale (FIS), International Physical Activity Questionnaire (IPAQ), Beck Depression Inventory, Nottingham Health Profile (NHP) and London Chest Activities of Daily Living Scale (LCADL). Results: Patients characteristics are presented in Table 1. According to Fatigue Impact Scale, all patients perceive fatigue and there was no statistically significant difference between groups (p>0.05). FIS has high correlation with SGRQ, NHP and Beck. There was moderate correlation between FIS and LCADL. Also, FIS has low correlation with IPAQ and 6MWT distance. (Table 2). Conclusion: This study demonstrates that obstructive pulmonary disease patients perceive fatigue. Fatigue perceptions of all three groups was statisticially similar but asthma and copd patients fatigue perceptions were more than bronchectasis patients. Experiences of fatigue has been associated with dyspnea perception in daily life activities, depression, physical activity level, functional capacity and therefore quality of life.

Background and objective Inspiratory muscle training (IMT) enhances velocity of inspiratory muscle contraction and modifies inspiratory and expiratory time. This study aimed to examine the impact of high-intensity IMT (H-IMT) on exercise capacity in bronchiectasis. Methods Forty-five patients were included. Lung function, respiratory muscle strength and endurance, exercise capacity, dyspnoea, fatigue and quality of life (QOL) were evaluated. Patients were randomized into two groups: H-IMT and control groups. Twenty-three patients underwent H-IMT for 8 weeks, using threshold loading with a target workload of maximal inspiratory pressure (MIP) of at least 70%, with 3-min cycles (as 2-min training: 1-min rest intervals) for 21 min. There was a total period of 14 min of loaded breathing and 7 min of recovery. The control group (n = 22) underwent low-intensity IMT at 10% of the initial MIP and was maintained at the same intensity until the end of the training. Results After training, both MIP and maximal expiratory pressure (MEP) and the incremental shuttle walk distance were increased in the H-IMT group compared with the control group (P < 0.05). There was a significant difference in constant threshold load, time and pressure-time units in the H-IMT group (P < 0.05) but not in the control group (P > 0.05). A significant decrease was found in fatigue in both groups (P < 0.05). The Leicester Cough Questionnaire social score for the H-IMT group decreased significantly after the treatment (P < 0.05). Conclusion The H-IMT increased exercise capacity in patients with non-cystic fibrosis bronchiectasis. It has also positive effects on respiratory muscle strength and endurance, and social aspects of QOL.

Introduction and background: Although there are studies about the relationship between daily physical activities and exercise capacity in the literature, there is limited study about the association between exercise capacity and activities of daily living (ADL) in patients with chronic obstructive pulmonary disease (COPD). Aim and objectives: The aim of this trial was to investigate relationship between maximal exercise capacity and ADL in patients with GOLD stage II-III COPD. Methods: Twenty-seven clinically stable GOLD stage II-III COPD patients were included (mean age=58.6±9.6 and mean FEV1 (%)=50.6±13.7) in the study. Maximal exercise capacity was evaluated with Incremental Shuttle Walk Test (ISWT). Activities of daily living was assessed with two performance based Glittre-ADL test and ADL Simulation Test. Results: ISWT distance was significantly correlated with Glittre-ADL test time (r=-0.517, p=0.006) and number of circuits in ADL Simulation test (r=0.394, p=0.042). Conclusions: A moderate to weak relationship was found between maximal exercise capacity and upper extremity specific and general activities of daily living. These results show that reduction in exercise capacity increases the negative influences in ADL and strengthen our beliefs that exercise interventions in pulmonary rehabilitation could influence activities of daily living positively.

Objectives Arm strength training may improve functional performance for patients with chronic obstructive pulmonary disease (COPD). This trial investigated the effects of arm strength training on arm exercise capacity, activities of daily living (ADL) and occupational performance in patients with COPD. Methods These was a randomized controlled trial in an outpatient clinic. Forty-two stable patients with COPD were randomly assigned into treatment and control groups. The treatment group underwent an 8-week (23 sessions) arm strength training programme. Both groups completed daily breathing exercises at home. Tests included hand grip strength, arm ergometer test, the Glittre-ADL and ADL Simulation tests and measures included the Milliken ADL Scale (MAS) and the Canadian Occupational Performance Measure (COPM). Results Statistically significant increases were detected in hand grip strength and %hand grip strength values, peak arm ergometer workload and the number of ADL simulation test cycles for the treatment group (P

Objective: Pulmonary arterial hypertension (PAH) is a devastating complication of inflammatory rheumatic diseases. The aim of this study was to determine the role of screening for the early diagnosis of pulmonary hypertension (PH) in inflammatory rheumatic diseases. Material and Methods: Data of patients with inflammatory rheumatic diseases and PH who had no obvious cause of PH and who were evaluated by Working Group for Pulmonary Hypertension in Hacettepe University were investigated retrospectively. All patients with inflammatory disease were evaluated by right heart catheterization (RHC) to check if they had systolic pulmonary arterial pressure (sPAP) ≥40 mmHg and/or symptoms related to PH unless explained by other causes. Results: RHC was performed in 47 patients with inflammatory rheumatic diseases and PH out of 50 patients who were to be evaluated by RHC based on clinical and Doppler echocardiographic findings. There was a positive correlation between sPAP estimated by Doppler echocardiography and sPAP determined by RHC in patients with inflammatory rheumatic diseases (r=0.66; p

Aim: Patients with asthma and bronchiectasis are confronted with reduced physical activity and reduced health related quality of life caused by breathlessness. The aim of this study was to compare the differences for dyspnea at activities of daily living (ADL), depression and physical activity level between the patients with asthma and bronchiectasis. Methods: 19 asthma and 17 bronchiectasis patients participated in this study. Pulmonary function testing was performed. International Physical Activity Questionnaire (IPAQ) for physical activity level, Beck Depression Inventory for depression level, Nottingham Health Profile (NHP) for quality of life and London Chest Activities of Daily Living Scale (LCADL) for dyspnea perception in ADL were assessed. Results: Demographic characteristics were similar in both groups (p>0.05). There was no statistically significant difference in pulmonary function test results and NHP scores between the groups (p>0.05). There was significant difference in total scores of IPAQ, LCADL and Beck Depression (p Conclusion: Asthmatic patients are more likely to perceive dyspnea and further restrict their physical activity levels. Pulmonary rehabilitation programs, for asthmatic patients should be planned taking into account these disadvantages.

Aim: In recent years, methods based on technology have gained importance to enhance attendance to pulmonary rehabilitation. We aimed to investigate short-term effects of virtual reality (VR) and music on participants’ affective responses and satisfaction level during exercise training (ET). Method: Seven patients with chronic respiratory disease (53±17 years, 5F, 2M) were included. Exercise capacity was assessed using cycle ergometer test. Patients participated in three 20-min ET sessions on stationary bicycle: ET-only, ET with VR (ET+VR) and ET with music (ET+music). For ET+VR session, a VR eyewear was used. For ET+music session, a song with 120 bpm was used. Before and after the ET sessions, heart rate (HR), oxygen saturation (SpO2), dyspnea perception and affective responses (the Feeling Scale and the Profile of Mood States) were recorded. At the end of each session, satisfaction level was assessed using a 10-cm Visual Analog Scale. Results: The satisfaction level of ET+music session was higher and dsypnea perception was lower than those of ET-only session (p Conclusion: Higher satisfaction level and lower dyspnea were found in ET+music session. Music may enhance attendance and persistence to an exercise program. Since dissatisfaction with VR seems to be the characteristics of VR devices, effects of different methods of VR should be investigated. Further studies with larger number of participants are needed.

Aim: In obstructive pulmonary disease, gait is affected by impaired functional capacity and balance and peripheral muscle dysfunction. The aim of the study was to investigate the effect of pulmonary rehabilitation program on gait parameters and functional balance in obstructive pulmonary disease. Methods: Thirteen patients with obstructive pulmonary disease (10 males, 3 females, FEV1: 53.5±14.7%) with a mean age of 59.7±5.4 years were included in the study. Exercise training program was applied for 30 minutes for 3 days per week at 60-75% of maximal heart rate for eight weeks. Measurements of six-minute walk distance (6MWD) and gait parameters were performed before and after exercise training. Functional balance was assessed using Timed Up and Go (TUG) test. Gait parameters were assessed using the Biodex Gait Trainer (Biodex-Gait Trainer-RTM600-US). Step cycle (sec), walking speed (m/sec), number of steps per minute, ambulance index were measured for six minutes. Results: Statistically significant differences were found in 6MWD (507.8±60.7 m vs 539.4± 66.7 m), walking speed (0.71±0.8 m/s vs 1.1±0.2 m/s), step cycle (0.75±0.12 sec vs 0.99±0.27 sec), ambulance index (65.1±7.2 vs. 76.1±6.7), and TUG test time (12.4±1.6 sec vs 10.2±1.2 sec) after eight weeks of exercise training (p Conclusion: Gait parameters and functional balance improve after exercise training in obstructive pulmonary disease. Further study is needed to clarify whether objective evaluation of gait analysis could be included in the outcome measures of pulmonary rehabilitation.

Introduction:Combination therapy with four drugs (isoniazid, rifampicin, pyrazinamid and ethambutol) is the treatment of choice in tuberculosis but hepatotoxicity due to these drugs is an important medical concern. Therefore identification of patient groups with increased risk for antituberculosis therapy induced hepatotoxicity is crucial.Material and Methods:This retrospective cohort study included hospitalized patients with the diagnosis of tuberculosis during a ten year period. Only patients with microbiological (culture positive) or histopathological (presence of granulomatous reaction with caseification necrosis in the tissue) evidence of tuberculosis infection were included. Incidence of hepatotoxicity and the association of hepatotoxicity with known and unknown risk factors were investigated.Results:Sixty four patients (33 female-31 male; median age 48.0 years) were included into the study. Most of the patients had extrapulmonary tuberculosis (n=49). Antituberculosis therapy was started with four drugs in all patients and 7 patients developed hepatotoxicity. Age, gender, previous tuberculosis history, extent of tuberculosis, positive hepatitis B virus serology, diabetes mellitus and chronic renal insufficiency were not related with the development of hepatotoxicity. The presence of rheumatologic disease and chronic corticosteroid use was associated with increased risk of hepatotoxicity (p

WOS: 000399794400008, PubMed ID: 29404162, Since the Global Initiative for Obstructive Lung Disease (GOLD) published its first guidelines on chronic obstructive pulmonary disease (COPD) in 2001, much has changed till 2017. Previous versions of GOLD guidelines mentioned the forced expiratory volume in one second (FEV1)-based approach for staging and treatment modalities. Since 2011, a composite multi-dimensional approach has been introduced to cover various aspects of the disease. Unfortunately, this approach was not found to be correlated with mortality as well as the FEV1 -based approach, despite the fact that it was better for estimating exacerbation rates. Although this assessment tool has been considered as a big step in personalized medicine, the system was rather complex to use in daily practice. In 2017, GOLD introduced a major revision in many aspects of the disease. This mainly includes a revised assessment tool and treatment algorithm. This new ABCD algorithm has excluded spirometry for guiding pharmacological therapy. Treatment recommendations are mainly based on symptoms and exacerbation rates. Escalation and de-escalation strategies have been proposed for the first time. The spirometric measurement has only been retained to confirm the diagnosis and lead to nonpharmacological therapies. In this report, the Turkish Thoracic Society COPD assembly aimed to summarize and give an insight to the Turkish interpretation of GOLD 2017.