SIK ATAK GEÇİREN KOAH HASTALARINDA KÜÇÜK HAVA YOLLARININ ÖNEMİ

Year 2014, Volume: 28 Issue: 1, 15 - 22, 01.05.2014

Yelda Varol Ceyda Anar Levent Usta Günseli Balcı Rıfat Özacar

Abstract

KOAH alevlenmeleri, hastalığın seyrini etkileyen önemli bir etmendir. Klinik çalışmalar bazı hastaların FEV1 düzeyinden bağımsız daha sık alevlenme geçirdiğini göstermiş ve sık alevlenme geçiren bir alt grup tanımlanmıştır. Küçük hava yolu hasarı KOAH hastalık progresyonunda önemli bir rol oynar ancak küçük hava yolu hasarı ile KOAH alevlenmeleri arasındaki ilişki netlik kazanmamıştır. Çalışmamızda sık alevlenme geçiren KOAH fenotipinin küçük hava yolu hasarı açısından ve sık alevlenme geçirmeyen alt gruptan farklılığı araştırılmıştır. Çalışmaya Nisan 2011- Şubat 2012 arasında 96 stabil KOAH hastası alındı. Son 1 yıl içinde 2 ve üzerinde atak geçiren hastalar sık atak geçiren grup, son 1 yıl içinde 1 ve altında atak geçiren hastalar sık atak geçirmeyen grup olarak kabul edildi. Sık atak geçiren 51 hastanın ortalama FEV 1'i 880ml (%34), FVC'si 1500 ml (%45) FEV1/FVC: 60, FEF25- 75 değeri 549 ml (%17) saptandı. Sık atak geçirmeyen 45 hastanın ortalama FEV 1'i 1210ml (%44), FVCsi 1780 ml (%53) FEV1/FVC: 65, FEF25-75 değeri 750 ml (%25) saptanmıştır. Sık atak geçiren ve geçirmeyen hastaların FEF 25-75 değeri (p=0.009), FEF 25-75 % (p= 0.000), FEV1 ml (p=0.016), FEV1 % (p=0.007), FEV1/FVC (p=0.021) değeri arasında istatistiksel anlamlı fark saptanmıştır. Son 1 yıl için de KOAH akut atak nedeniyle hastaneye yatan hastalar ile yatmayan hastalar karşılaştırıldığında yalnızca FEF25-75 ml (p=0.015) ve FEF 25-75 % (p=0.014) değerleri arasında istatistiksel anlamlı fark saptanmıştır. Sık atak geçiren ve hastane yatışı gerektiren atak geçiren KOAH hastalarının FEF25-75 değerleri istatistiksel anlamlı daha düşük bulunmuştur. Küçük hava yolu obstrüksiyonu ve atak sıklığını araştıran klinik çalışmalara gereksinim duyulmaktadır.

Keywords

KOAH, atak, küçük hava yolları, FEF25-75

IMPAIRMENT OF SMALL AIRWAYS IN COPD PATIENTS WITH FREQUENT EXACERBATIONS

Abstract

COPD exacerbations are important and affects the course of the disease. Clinical trials showed that a subgroup of COPD patients had more exacerbations independent from their FEV1 values and thus a frequent exacerbation subgroup was defined. Small-airway damage has a role for the disease progression of COPD, but the exact relationship between small-airway damage and COPD exacerbations is not entirely clarified. In our study, we investigated the COPD patients who had frequent exacerbations in terms of small airway damage and their difference from patients who had not frequent exacerbations. 96 stable COPD patients between April 2011 and February 2012 were included in our study. If the patients had two or more exacerbation in the last year, they were defined as frequent exacerbators, if not they were defined as unfrequent exacerbators. The mean FEV1 value of 51 frequent exacerbator was 880ml(34%). Their mean FVC was 1500 ml(45%), mean FEV1/FVC was 60 and mean FEF25-75 was 549 ml(17%). The mean FEV1, FVC, FEV1/FVC and FEF25- 75 values of 45 unfrequent exacerbators were found as 1210ml(44%), 1780 ml(53%), 65 and 750 ml(25%) respectively. When we compared frequent and unfrequent exacerbators, statistical significance was found in FEF 25-75(p=0.009), FEF 25-75 %(p= 0.000), FEV1 ml(p=0.016), FEV1 %(p=0.007), FEV1/FVC(p=0.021) values. In addition, we found statistical significance only in FEF25-75 ml(p=0.015) and FEF 25-75 %(p=0.014) values between patients who were hospitalized in the last year because of COPD exacerbation or not. The FEF25-75 values were found significantly low in frequent exacerbators and who hospitalized due to COPD exacerbations. However, additional comprehensive randomized trials dealing with small-airway obstruction and exacerbation frequency are essential.

Keywords

COPD, exacerbations, small airways, FEF25–75

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