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Öğe Adherence to Current COPD Guidelines in Turkey(Taylor & Francis Ltd, 2016) Turan, Onur; Emre, Julide Celdir; Deniz, Sami; Baysak, Aysegul; Turan, Pakize Ayse; Mirici, ArzuIntroduction-objective: Despite the availability of national and international guidelines, chronic obstructive pulmonary diseases (COPD) treatment is not always prescribed according to these recommendations. We aimed to see if COPD patients in Turkey have been treated appropriately according to COPD guidelines. Methods: This is a cross-sectional study carried out in six different chest diseases clinics. The COPD outpatients were categorized by spirometry classification (SC) and the combined classification (CC) of COPD. The treatment protocols were evaluated to check whether they were suitable for both classifications. Results: Overall, 307 patients were included in the study. Of the treatment protocols, 40.4% were suitable for both classifications: 30.9% for CC and 20.8% for SC. A total of 51.8% of the patients were reported to be using an unsuitable therapy for SC and 38.4% for CC. Ninety-eight per cent of the unsuitable treatment was overtreatment. Fifty-eight per cent of the patients were using LABA+LAMA+ICS. Improper ICS usage was identified in 97.1% in CC, 93.1% in SC. The cost savings of all patients in one year would be 17,099$ with an appropriate treatment protocol following COPD guidelines. Conclusion: The most common type of inappropriate COPD treatments is overtreatment, generally with ICS. As treatment protocols following COPD guidelines change over time, there is still a low rate of adherence by clinicians in their clinical practice to guideline recommendations. Awareness of these guidelines by pulmonary specialists should be improved.Öğe Anxiety and depression levels of healthcare workers during Covid-19 pandemic(Makerere Univ, Coll Health Sciences,Sch Med, 2022) Turan, Onur; Demirci, Nilgun Yilmaz; Ak, Guntulu; Akcay, Sule; Akturk, Ulku Aka; Bilaceroglu, Semra; Coskun, FundaBackground: Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since march 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact Methods: this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). Results: A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having Conclusion: Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychoÖğe Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study(Wiley, 2019) Gulbas, Gazi; Turan, Onur; Sarioglu, Nurhan; Diken, Ozlem Ercen; Ogan, Nalan; Kadioglu, Esra Ekbic; Kurtipek, ErcanIntroduction Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. Objective It was aimed to determine relationship and survival between COPD and CIMT. Methods CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. Results There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT >= 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). Conclusion This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.Öğe Characteristics of hospitalised COVID-19 patients and parameters associated with severe pneumonia(John Wiley & Sons Ltd, 2021) Turan, Onur; Mirici, Arzu; Duru Akçalı, Serap; Turan, Pakize Ayşe; Batum, Özgür; Şengül, AysunBackground: After the first case of coronavirus disease 2019 (COVID-19) was reported in China in December 2019, it caused a global pandemic, including Turkey. Objectives: The aim of this study was to analyse the characteristics of hospitalised COVID-19 patients and assess the parameters related to severe pneumonia. Methods: Included in the study were hospitalised COVID-19 patients with positive naso-oropharyngeal swabs. Patients’ demographics, admission symptoms, laboratory and radiological findings were recorded retrospectively. Results: Of 1013 patients, 583 were males (57.6%) and 430 were females (42.4%), with a mean age of 53.7 ± 17.9. More than half of the patients had at least one comorbidities, the most common of which were hypertension and diabetes mellitus. Cough (59.8%), fatigue (49.5%) and fever (41.2%) were the most common presenting symptoms. Of the hospitalised COVID-19 patients, 84.9% had pneumonia and 83.5% had typical radiological COVID-19 appearances (94.5%: ground-glass areas). The most common laboratory findings were high C-reactive protein (CRP) (73.6%) and lactate dehydrogenase (LDH) (46.2%) levels, as well as lymphopenia (30.1%). Severe pneumonia was present in 28.1% of COVID-19 patients. Multivariate logistic regression analysis indicated that advanced age, hypotension, anaemia and elevated CRP and LDH serum levels were independent risk factors for the severity of COVID-19 pneumonia (P =.011,.006,.017,.003 and.001, respectively). Conclusion: This study, as one of the first multicentre studies about characteristics of COVID-19 in Turkey, may guide about disease-related parameters and severity of pneumonia. Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID-19 pneumonia.Öğe Chronic obstructive pulmonary disease and COVID-19(Kare Publ, 2020) Turan, Onur; Mirici, ArzuThe coronavirus disease 2019 (COVID-19) pandemic tends to have a more severe clinical picture in the elderly and in patients with chronic diseases, one of which is chronic obstructive pulmonary disease (COPD). Around 2%-3% of patients infected with coronavirus have had the diagnosis of COPD; the critical care, intubation requirement, and mortality rate have been higher among this group of patients with the development of hypoxemia. Exacerbation and COVID-19 pneumonia are two differential diagnoses in patients with COPD; the fever among the symptoms, lymphopenia among the laboratory findings, and typical radiological findings in thoracic tomography of patients may be helpful in the diagnosis of COVID-19. The stabilization of the disease is important in the follow-up of patients with COPD during this pandemic; the continuation of maintenance treatment of patients has been accepted as the main strategy. Droplet and contact transmissions should be decreased, and basic hygiene and nutritional rules should be followed in the COPD patient group in which the risk of infection development is high. There are various opinions on the administration of treatment through nebulizers during the pandemic; the use of inhaler devices is the safer and recommended method. Since noninvasive mechanical ventilators may increase the risk of contamination, they are not included among the routine treatment recommendations for patients with COPD.Öğe Clinical characteristics and outcomes of hospitalized COVID-19 patients with COPD(Taylor and Francis Ltd., 2021) Turan, Onur; Arpınar Yigitbaş, Burcu; Turan, Pakize Ayşe; Mirici, ArzuBackground: Although COPD is not one of the most common comorbidities in COVID-19 patients, it can be more fatal in this group. This study aimed to investigate the characteristics and prognosis of COPD patients among the population with COVID-19. Research design and methods: Patients diagnosed with positive PCR test were included in our multicentered, retrospective study. Patients with airway obstruction (previous spirometry) were included in ‘COPD group’. Results: The prevalence of COPD in COVID-19 patients was 4.96%(53/1069). There was a significant difference between COPD and non-COPD COVID-19 patients in terms of gender, mean age, presence of dyspnea, tachypnea, tachycardia, hypoxemia and presence of pneumonia. The mortality rate was 13.2% in COPD, 7% in non-COPD patients(p = 0.092). The significant predictors of mortality were higher age, lymphopenia (p < 0.001), hypoxemia (p = 0.028), high D-dimer level (p = 0.011), and presence of pneumonia (p = 0.043) in COVID-19 patients. Conclusions: Our research is one of the first studies investigating characteristics of COPD patients with COVID-19 in Turkey. Although COPD patients had some poor prognostic features, there was no statistical difference between overall survival rates of two groups. Age, status of oxygenization, serum D-dimer level, lymphocyte count and pneumonia were significantly associated parameters with mortality in COVID-19.Öğe Parameters affecting inhalation therapy adherence in elderly patients with chronic obstructive lung disease and asthma(Wiley, 2017) Turan, Onur; Turan, Pakize Ayse; Mirici, ArzuAimOne of the most significant problems in the treatment of elderly patients is incorrect use of inhaler devices. The purpose of the present study was to assess the parameters affecting treatment adherence among elderly patients. MethodsSpirometry, the Mini-Mental State Examination for cognitive impairment and the Morisky Medication Adherence Scale-4 were carried out in 121 (88 chronic obstructive lung disease patients according to the Global Initiative for Chronic Obstructive Lung Disease, 33 asthma patients according to The Global Initiative for Asthma (GINA) criteria) participants aged over 65years. ResultsThe patients with cognitive impairment, low socioeconomic status, a high number of admissions to an emergency service in past year and the presence of dyspnea or sputum had significantly lower inhalation device use scores (P=0.017, 0.03, 0.025, 0.03 and 0.02). The patients with high Mini-Mental State Examination scores and forced expiratory volume in 1s (as liter and percentage) were found to be more successful in using inhaler devices (P=0.005, 0.007 and 0.022). There was a negative correlation between number of hospitalizations and inhalation device score (P=0.021).The participants without education/training by a doctor about the inhaler device had a significantly poorer treatment adherence (P<0.001). ConclusionsOlder chronic obstructive lung disease and asthmatic patients have more difficulty with the correct use of inhaler devices. Cognitive impairment might be an important parameter that can affect inhalation device technique. Socioeconomic status, smoking, pulmonary symptoms and admissions to hospital were also thought to have effects on the adherence to inhalation therapy. The type of chronic respiratory disease (chronic obstructive lung disease/asthma) is not a major factor influencing therapy adherence. Assessment of cognitive functions, choosing suitable inhalation devices and educational programs for inhaler use could improve the success of inhaler technique in elderly patients. Geriatr Gerontol Int 2017; 17: 999-1005.Öğe The CO-MIND Study: Chronic Obstructive Pulmonary Disease Management in Daily Practice and Its Implications for Improved Outcomes According to GOLD 2019 Perspective(Dove Medical Press Ltd, 2022) Gunen, Hakan; Kokturk, Nurdan; Nayci, Sibel; Ozkaya, Sevket; Yildiz, Birsen Pinar; Turan, Onur; Gumus, AzizPurpose: GOLD 2019 proposed a novel treatment decision tool for follow-up based on the predominant trait (exacerbation or dyspnea) of patients, alongside treatment escalation and de-escalation strategies. This study was designed to provide an up-to-date snapshot of patient and disease characteristics, treatment pathways, and healthcare resource use (HRU) in COPD in real life, and comprehensively examine patients considering GOLD 2019 recommendations.Patients and Methods: This mixed design, observational, multicenter (14 pulmonology clinics) study included all patients with a documented COPD diagnosis (excluding asthma-COPD overlap [ACO]) for >12 months, aged >40 years at diagnosis who had a COPD-related hospital visit, spirometry test and blood eosinophil count (BEC) measurement under stable conditions within the 12 months before enrollment between February and December 2020. Data were collected cross-sectionally from patients and retro-spectively from hospital medical records. Results: This study included 522 patients (GOLD group A: 17.2%, B: 46.4%, C: 3.3%, D: 33.1%), of whom 79.5% were highly symptomatic and 36.2% had high risk of exacerbation. Exacerbations (n = 832; 46.6% moderate, 25.5% severe) were experienced by 57.5% of patients in the previous 12 months. Inter-rater agreement between investigators and patients regarding the reason for visit was low (Kappa coefficient: 0.338, p = 0.001). Inhaled treatment was modified in 88 patients at index, mainly due to symptomatic state (31.8%) and exacerbations (27.3%); treatment was escalated (57.9%, mainly switched to LABA+LAMA+ICS), inhaler device and/or active ingredient was changed (36.4%) or treatment was de-escalated (5.7%). 27% had >1 hospital overnight stay over 12 months. Emergency department visits and days with limitation of daily activities were higher in group D (p < 0.001). Conclusion: Despite being on-treatment, many patients with COPD experience persistent symptoms and exacerbations requiring hospital-related HRU. A treatable trait approach and holistic disease management may improve outcomes by deciding the right treatment for the right patient at the right time.Öğe THE EFFECTS OF INDOOR AND OUTDOOR AIR QUALITY ON RESPIRATORY PARAMETERS IN CANAKKALE(Wiley-Blackwell, 2015) Mirici, Arzu; Mentese, Sibel; Bakar, Coskun; Otkun, Muserref; Cevizci, Sibel; Turan, Onur[Anstract Not Available]Öğe The evaluation of psychological status in newly diagnosed chronic obstructive pulmonary disease patients(Wolters Kluwer Medknow Publications, 2019) Turan, Onur; Turan, Pakize Ayse; Mirici, ArzuBACKGROUND: As chronic obstructive pulmonary disease (COPD) and its symptoms may change psychological attributes, psychiatric disorders may be seen in COPD. AIMS: We aimed to assess the effect of taking diagnosis of COPD and using bronchodilator therapy on the psychological status of COPD patients. MATERIALS AND METHODS: It is a cross-sectional study including newly diagnosed COPD outpatients. Spirometry, Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), and St. George's Respiratory Questionnaire (SGRQ) were performed at the first visit (date of new diagnosis) and 6 months later as the second visit. RESULTS: Ninety new diagnosed COPD patients (71 men and 19 women) with a mean age of 61.7 +/- 9.8 were included. There were high scores of anxiety in 23.5% and depression in 38.2% (HADS)-52.9% (BDI) patients at the first visit. The symptoms about anxiety reduced to 19%, depression to 33.3% (HADS)/47.6% (BDI) six months later. All the participants who were active smokers had lower spirometric levels (42.9%) at the second visit compared with the first visit levels. There was an improvement in psychological status and quality of life (QOL) (P < 0.001). There was a negative correlation between SGRQ score and forced expiratory volume in 1 s levels (P = 0.045) and positive correlation of SGRQ score with HAD and BDI scores (P = 0.041 and 0.011). Participants who quitted smoking in 6-month period had statistically lower anxiety and depression scores (P = 0.003 and 0.026). CONCLUSION: Depression and anxiety states are frequent among COPD patients. Pulmonary symptoms may regress with the bronchodilator therapy at newly diagnosed COPD patients, which can cause an improvement in pulmonary functions, psychological status, and QOL. Psychological aspects need to be carefully assessed in patients with new diagnosis of COPD.Öğe The Importance of Partner Support and Psychological Status in Smoking Cessation(Aves, 2017) Turan, Onur; Turan, Pakize Ayse; Mirici, ArzuObjective: The habit of smoking is more common in members of a family living in the same house. People with psychiatric symptoms smoke more cigarettes. We conducted a study to examine whether the psychological status of couples and partner support affects smoking cessation success. Methods: The outpatients who started taking a therapy for smoking cessation between July 2014 and January 2015 in our clinic were included in this prospective, single-center study. Each couple was assessed on the basis of the Marital Adjustment Scale (MAS) and Hospital Anxiety-Depression Scale (HADS). The smoking status of the participants was assessed after 6 months, and they filled out the Partner Interaction Questionnaire (PIQ). Results: Of 141 volunteers, 55% joined the smoking cessation program as couples. A total of 55.3% of the participants managed to quit smoking. Further, 42.3% of couples quitted smoking. Nearly 96.2% of couples had the same result regarding smoking cessation. The smoking cessation rate was significantly lower in couples with high anxiety depression scores (participant: p=0.028 and 0.037; partner: p=0.003 and 0.007), smoker partners (p<0.01), and participants with low marital adjustments (p<0.01). Logistic regression analysis showed that the independent parameters affecting smoking cessation success were support and the smoking status of partners (p<0.001 and 0.021, respectively). Conclusion: Partner support and psychological status were important parameters associated with smoking cessation. The presence of non-smoker partners made quitting smoking easier. Reducing anxiety and depressive symptoms and support of partners may help in smoking cessation.Öğe The parameters that may affect inhalation therapy success in elderly COPD and asthma patients(European Respiratory Soc Journals Ltd, 2015) Turan, Onur; Kasan, Turgay; Turan, Pakize Ayse; Mirici, Arzu[Anstract Not Available]
