Emine Aksoy

Introduction: Long-term home non-invasive mechanical ventilation (NIV) is widely used in patients with hypercapnic chronic obstructive pulmonary disease (COPD). However, its efficacy is heavily dependent on patient adherence. Body mass index (BMI) can influence tolerance and ventilatory load, but its impact on adherence remains unclear. Additionally, NIV for later use at home is frequently initiated during hospitalization to facilitate early discharge, and its ongoing necessity varies. Methods: This retrospective cohort study included patients with stable hypercapnic COPD prescribed home NIV between 2017 and 2025 at a tertiary respiratory intensive care unit outpatient clinic. Demographics, arterial blood gases, spirometry, ventilator settings, and first-month NIV usage data were extracted from the patients’ medical records. We used correlation analyses and Poisson regression modeling to evaluate factors associated with daily hours of NIV use. Results: A total of 413 patients were included. The mean partial pressure of carbon dioxide was 48 ± 7 mmHg. The mean forced expiratory volume in the first second was 28%, indicating severe airflow limitation. Overall adherence was very poor, with approximately 80% of patients using NIV for < 4 hours a day, regardless of their BMI category. We found no significant linear correlation between BMI and NIV adherence. A large proportion of the low-adherence group had elevated bicarbonate (HCO₃⁻) levels (≥ 27 mmol/L), suggesting chronic compensated hypercapnia. Multivariable analysis found BMI to predict slightly higher adherence (risk ratio [RR] 1.01; p = 0.050), whereas higher HCO₃⁻ was associated with lower adherence (RR 0.96; p = 0.020). Discussion: BMI was not a major determinant of first-month NIV adherence, whereas elevated HCO₃⁻ levels may help identify patients at increased risk of poor early NIV adherence.

This study aimed to evaluate the impact of post-COVID syndrome across a multitude of health domains among COVID-19 survivors via comparative analysis in previously hospitalized vs. non-hospitalized patients. A total of 158 adult COVID survivors who had symptoms that continued during post-COVID recovery were included in this prospective observational study. Data on handgrip strength, the 1-minute sit-to-stand test (1-MSTST), radiological scoring (CXR), Medical Research Council (MRC) dyspnea, Fatigue Assessment Scale (FAS), International Physical Activity Questionnaire, Post-COVID-19 Functional Status, Hospital Anxiety-Depression Scale, and Short Form Health Survey 36 (SF-36) health-related quality of life (SF-36 HRQoL) were recorded. Post-COVID 1st-month data revealed dyspnea (MRC scale ≥2 in 57.0% of patients) and fatigue (FAS scores ≥22 in 55.7%), a decrease in handgrip strength (60.0%) and physical activity (60.0%), poor HRQoL (SF-36 general health score ≤50 in 61.4%), and radiological disease progression (CXR score ≥3 in 56.8%) in at least half of patients, along with depression (34.8%) or anxiety (43.7%). Post-COVID 6th-month values for fat-free mass index (p=0.008, respectively), 1-MSTST recovery time (p=0.012), and 3rd-month CXR scores (p=0.024) were significantly higher, and 3rd-month SF-36 social functioning domain scores (p=0.026) were significantly lower in previously hospitalized vs. non-admitted patients. In conclusion, our findings indicate a diverse range of impairments in several health domains in COVID-19 survivors, while radiological disease progression and functional limitations were more remarkable in those with previous hospitalization. A comprehensive assessment of health status and persisting rehabilitation needs is necessary in COVID-19 survivors, regardless of disease severity.

Background: Kyphoscoliosis is a restrictive thoracic disorder frequently associated with chronic respiratory failure. While home non-invasive ventilation (NIV) improves short-term outcomes, long-term mortality predictors remain underexplored in this context. Methods: This retrospective cohort study evaluated 88 kyphoscoliosis patients with chronic respiratory failure who were initiated on home-based NIV between 2008 and 2018 at a tertiary ICU outpatient clinic. The demographic, clinical, and laboratory data were analyzed. Survival was assessed using Kaplan–Meier analysis, and independent predictors of mortality were identified via Cox regression. Results: Among the 88 patients (52% male), 28 (32%) died during long-term follow-up. Age, BMI, pulmonary function, and arterial blood gas values were similar between survivors and non-survivors. Non-survivors had significantly higher mMRC dyspnea scores, were more likely to be active smokers, and had a higher prevalence of coronary artery disease (CAD) (p = 0.015). The Kaplan–Meier survival analysis revealed significantly lower survival in patients with CAD (p = 0.021) and active smokers (p = 0.034). Cox regression analysis indicated that the presence of CAD (HR: 5.69, 95% CI: 1.34–24.08, p = 0.018) and hospital admission after the initiation of home-based NIV therapy (HR: 1.97, 95% CI: 1.01–3.85, p = 0.040) increased the risk of mortality. Conversely, a higher pH at the last outpatient visit was associated with improved survival (HR: 0.50, 95% CI: 0.00–0.692, p = 0.003). Conclusions: CAD, pH value, and increased ICU admissions after the initiation of home-based NIV are predictors of mortality in kyphoscoliosis patients. The study results highlight reduced survival associated with the presence of coronary artery disease and smoking, emphasizing the importance of routine cardiovascular assessment and close clinical follow-up in this high-risk population.

Background/Objectives: The association between past coronavirus disease-19 (COVID-19) infection and pulmonary thromboembolism (PTE) is a potential research topic. We aimed to research the prevalence of previous COVID-19 infection in patients with PTE and to determine whether there is a difference in embolism severity in these cases. Methods: Study design: Multicenter, observational, cross-sectional. Patients diagnosed with PTE between 11 March 2022 and 11 March 2023 were prospectively included in this study, excluding cases with PTE along with active COVID-19, patients under the age of 18, and pregnant patients. Group 1 consisted of PTE cases with previous COVID-19, and Group 2 consisted of PTE cases without previous COVID-19. Key variables are D-Dimer level, right ventricle/left ventricle (RV/LV) ratio, simplified pulmonary embolism severity score, and treatment type. Results: A total of 1185 patients (Group 1; n = 360, Group 2; n = 825) were included in this study. The proportion of patients with RV/LV ratio > 1 on computed tomography pulmonary angiography (CTPA) was significantly high in Group 2 compared to Group 1 (27.9% vs. 19.7%, p = 0.003). In multivariate logistic regression analysis, the absence of any identifiable risk factor for PTE was found to be a 0.46-fold protective factor in the presence of previous COVID-19 (OR: 0.456 95% CI: 0.274–0.760, Wald = 9.070, df = 1, p = 0.003) and an RV/LV ratio > 1 on CTPA was found to be a 0.60-fold protective factor (OR: 0.603, 95% CI: 0.365–0.998, Wald = 3.874, df = 1, p = 0.049). Conclusions: The prevalence of previous COVID-19 infection in PTE cases was 30.4%, and 26.3% of idiopathic cases had previous COVID-19 infection. Although the parameters related to embolism severity were higher in the non-COVID-19 group, multivariate analyses revealed a 2.2-fold increased risk for idiopathic PTE and a 1.7-fold increased risk for RV/LV ratio > 1 on CTPA in patients without COVID-19 compared to those with prior COVID-19.

Objective To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence. Methods A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease–related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded. Results Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70–270 days and 1.1–37 months, respectively in simple aspergilloma, while they were ranged 150–180 days and 30–43.3 months, respectively in other CPA forms. Conclusions Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.

Aims: The cough affects adversely the comfort of patient and process during fiberoptic bronchoscopy. Various studies have been made to prevent cough during bronchoscopy. However, there is no any medication that usage of it becomes definite. The influence of usage codeine in bronchoscopy premedication in addition to the midazolam on the comfort of patient and physicians is examined. Methods: 96 patients made bronchoscopy for various indications were included to the study. The study was carried out as a prospective, placebo-controlled and double-blind. The patients were divided into two groups. Group 1 (n = 48) 20 mg fenocodeine tablets divided into 4 doses were administered one day before process. Group 2 (n = 48) the placebo tablets divided four dose were administered one day before process. Both of two groups were administered midazolam before procedure. Topical anesthesia was administered as needed during the operation and its doses were recorded. Two questionnaire form that examined the level of comfort of patients and physicians, the amount of secretion and the severity of cough with a visual analogue scale (VAS) were prepared and they were immediately completed after procedure. Results: In both groups, any complication wasn’t occurred that require to terminate the process. In the scala evaluated by patients given fenocodein, the amount of cough was statistically significantly low (p = 0.026). In the scale evaluated by doctors, the amount of secretion was lower (p = 0.02). Comfort level of doctor was found significantly higher in Group 2 (p = 0.02). Conclusion: It was determined that the amount of secretion and cough had decreased and the level of comfort had increased when fenocodeine was given with midazolam prior to bronchoscopy

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.

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 < 0.001), culture positivity (OR:7.59, CI95%3.21‐17.92,P < 0.001), sepsis (OR:6.53 CI95%3.59‐11.85,P < 0.001) and pneumonia (OR:3.71 CI95%0.60‐2.02,P < 0.043) significantly. COPD patients using home‐based NIV had less risk for NIV failure (OR: 0.49 CI95%0.28‐0.87,P < 0.014).Conclusions: APACHE II ≥ 29 score, culture positivity, sepsis and pneumonia are the risk factors for NIV failure in COPD patients with ARF. COPD patients previously on home‐based NIV showed half times less risk for NIV failure.

Turkthoracj, Turkish Thoracic Journal

Turkthoracj, Turkish Thoracic Journal