Chronic obstructive pulmonary disease (COPD) is a lung disease characterized with limitation of airflow that is not completely reversible, progressive deterioration of airways and systemic ...inflammation. This study has been planned to determine daily symptom variability of patients, expectations of patient and physicians from treatment and patient profiles. A total of 514 patients with COPD from 25 centers were included in this national, multicenter, cross-sectional observational study. Data regarding demographic features, concomitant diseases, history and treatment of COPD and expectations of patients and physicians were all obtained in a single visit. Mean standard deviation (SD) age of the patients was 64.1 (9.5) years; age range was 41-92 years, 50% of the patients were younger than 65 years and 91% were males. Educational level of the patients was at least primary school in 80.2%; and 54.3% (30.4%) of the patients had at least one concomitant disease, particularly a cardiovascular disease. Mean (SD) duration of having COPD was 5.4 (4.6) years. The majority of patients were at moderate (43.2%) and severe (35.0%) COPD stages and one or more exacerbations per year was determined in 71%. Inhaled beta-2 agonists (84.2%), inhaled steroids (76.3%) and inhaled long-acting anti-cholinergics (70.0%) were the most commonly used medications. Dyspnea (99.0%), sputum production (92.8%) and wheezing (90.5%) were the most common symptoms, and symptom variability for dyspnea (41.1%), sputum production (61.0%) and cough (53.5%) were seen the most in the morning hours (p< 0.001). Most commonly affected morning activity was climbing up/down the stairs (point of effect: 6.7), followed by wearing socks/shoes (point of effect: 4.3) and showering/bathing (point of effect: 4.2) by COPD. Major treatment expectations of patients were greater symptomatic relief (82.3%) and greater mobility (70.0%), faster symptomatic relief (61.1%) and improvement in morning activities (59.3%); while major treatment expectations of physicians included increased quality of life (100.0%) and decreased morbidity (96.0%). Quitting smoking was the most commonly recommended (88.3%) and implemented (67.9%) non-drug protective approach aimed at decreasing the frequency of exacerbations. Consequently, our results demonstrate that COPD is not a disease of only the elderly, is an important healthcare issue that often disrupt daily living of the patients due to inadequate disease awareness leading to overlooking of the symptoms by patient and physicians, and that a patient-centered approach based on the living standards, life expectancies and preferences of patients was crucial in patient management.
Prenatal dönemde sigaraya maruz kalan bebeklerin kord kanı kotinin düzeylerinin
belirlenmesi ve pasif maruziyetin etkilerinin gösterilmesi amacıyla;
doğum yapmak üzere doğumhaneye alınan 107 gebe ...çalışmaya
alınmıştır. Tüm gebelere sigara alışkanlıklarını ve demografik özelliklerini
sorgulayan anket uygulanmıştır. Daha sonra annelerden 5cc venöz kan,
doğum eylemi gerçekleştikten hemen sonra da 5cc kord kanı alınarak
bu örneklerde kotinin düzeyleri çalışılmıştır. Ayrıca bebeklerin ağırlıkları,
boyları ve gestasyonel yaşları kaydedilmiştir. Gebeler, ankete verdikleri
yanıtlara göre üç gruba ayrılmıştır; aktif içici (n=35), pasif içici (n=36),
kontrol grubu (n=36). Aktif içiciler ve pasif içicilerin anne ve bebek kord
kanı kotinin seviyeleri, kontrol grubuna göre istatistiksel olarak anlamlı
derecede yüksek bulunmuştur (p<0.05). Aktif içicilerin anne ve bebek
kord kanlarındaki kotinin miktarının pasif içicilerinkinden anlamlı derecede
yüksek olduğu (p<0.05) ve anne kanı kotinin düzeyleri ile kord kanı
kotinin düzeyleri arasında kuvvetli bir korelasyon olduğu saptanmıştır.
Ayrıca içilen veya maruz kalınan sigara sayısı ile doğru orantılı olarak
anne ve kord kanı kotinin seviyelerinin de arttığı görülmüştür (p<0.05).
Bebeklerin boy, ağırlık ve gestasyonel yaşları bakımından üç grup karşılaştırıldığında
anlamlı bir fark saptanmamıştır (p>0.05). Bu sonuçlar
gebenin sigara dumanına maruz kalması durumunda fetusun da bu dumana
maruz kaldığını göstermiştir. Ancak fetustaki bu maruziyetin ne gibi
zararlı etkiler yaptığını göstermek için daha ayrıntılı ve uzun süreli araştırmalar
yapılması gereklidir.
The aim of this study was to determine the cotinine levels in the cord
blood of infants who were exposed to cigarette smoke in the prenatal
period and to emphasize the effects of passive exposure. Just before
delivery, 107 pregnant women were included in the study. They were included
in a questionnaire about their smoking habits and demographical
status. After the blood was drawn from mother and the cord just after
the baby delivered, serum cotinine levels were measured. Besides the
height, weight and gestational age of the infants were recorded. According
to the self reports, cases divided into three groups as follows; active
smokers (n=35), passive smokers (n=36), group of no exposure (control
group) (n=36). When compared with the control group the cotinine
levels were significantly higher either in the mother or the cord blood of
active and passive smokers (p<0.05). The cotinine levels in the mother
and cord blood in active smokers were also found to be significantly
higher than the passive smokers (p<0.05), and a strong correlation
has been determined between the mother's and the cord blood cotinine
levels. Besides there were an increased linear correlation between the
cotinine levels of mother and cord blood levels related to the number of
exposed or smoked cigarette (p<0.05). No significant difference has
been determined with respect to the height, weight and gestational ages
of the infants between three groups (p>0.05). These results suggested
that when the pregnant exposed to active or passive cigarette smoke,
fetus also exposed to smoke at intrauterine period. But in order to find
out the harmful effects of exposure more detailed and long-term studies
are needed.
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