Publication: Kronik obstrüktif akciğer hastalığı olan hastalarda ilaç profilinin belirlenmesi ve hastaların yaşam kalitesinin değerlendirilmesi
Abstract
1. ÖZET Çalışmamızda kronik obstüktif akciğer hastalığı (KOAH) olan hastalarda SF-36 (Short-Form 36) ve SGRQ (Saint George’s Respiratory Questionnaire) yaşam kalitesi anketleriyle yaşam kalitesini ölçmeyi, %FEV1 ve dispnenin yaşam kalitesi üzerine etkisini, stabil dönemde reçetelenen ilaç sayısını ve tipini etkileyen faktörleri belirlemeyi amaçladık. Ayrıca akut alevlenme döneminde hastaların balgam kültürü sonucu ile %FEV1 değeri arasındaki ilişkinin saptanmasını ve intravenöz teofilin kullanan hastalarda serum teofilin konsantrasyonlarının ölçülmesini planladık. Çalışmamıza katılan 59 hastada SF-36’nın ağrı dışında yedi skalasında (genel sağlık, fiziksel fonksiyon, fiziksel rol, emosyonel rol, sosyal fonksiyon, enerji, mental sağlık) SGRQ’nun tüm komponentlerinde, yaşam kalitesindeki belirgin bozulma gösterilmiştir. Hastalık evresi ve dispnenin ağırlaşmasıyla yaşam kalitesindeki bozulmanın arttığı görülmüştür. %FEV1 ile SF-36’nın genel sağlık, fiziksel fonksiyon, fiziksel rol skalaları ve SGRQ’nun tüm komponentleri arasında, dispne ile ise SF-36’nın genel sağlık, fiziksel fonksiyon ve sosyal fonksiyon skalaları, SGRQ’nun aktivite ve toplam komponentleri arasında orta dereceli korelasyon bulunmuştur (r=0,50-0,75). %FEV1 değerinin azalması, dispnenin artması, yaşam kalitesinin bozulmasıyla kullanılan ilaç sayısındaki artış görülmüştür. Antikolinerjik ve kısa etkili b2 agonist reçetelenmesinde %FEV1 ile birlikte dispne, sağlıkla ilişkili yaşam kalitesi, vücut kitle indeksi, son 1 sene içinde KOAH alevlenmesi nedeniyle hastaneye yatış sayısı gibi faktörlerin de etkili olduğu belirlenmiştir. Pseudomonas aeruginosa üremesi saptanan hastalarda üreme olmayan hastalara oranla istatistiksel olarak anlamlı derecede düşük %FEV1 değerleri saptanmıştır (p<0.05). Akut alevlenme tedavisi olarak hastanede teofilin uygulanan hastaların %40’ında subterapötik düzey belirlenmiştir. Sonuç olarak klinik eczacıların KOAH’ın şiddetinin değerlendirilmesinde ve tedavinin belirlenmesinde birçok faktörün (dispne, yaşam kalitesi, vücut kitle indeksi) göz önünde bulundurarak, teofilin dozunun bireyselleştirerek etkin rol oynayacağını düşünmekteyiz. 2.
THE ASSESSMENT OF QUALITY OF LIFE AND DETERMINATION OF DRUG PROFILE IN PATIENTS’ WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE The aim of the study was to assess the quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients by Short-Form-36 (SF-36) and Saint George’s Respiratory Questionnaire (SGRQ); and to investigate the effects of %FEV1 and dyspnea degree on QoL and the factors that affect the number and type of prescribed medications in stable periods. The other objectives of this study were the assessment of the relation between the %FEV1 value and the result of sputum culture and determination of serum theophylline concentrations of patients during the acute exacerbation periods. The patients were found to have significantly bad QoL scores on the SF-36 scales except the pain scale and components of SGRQ. It was observed that the QoL scores got worse as the disease and dyspnea stage advanced. The decrease in the %FEV1, the increase in the dyspnea degree and low the health-related QoL score resulted in an increase in the number of medications used. The anticholinergic and short-acting beta-2 agonist prescribing were affected %FEV1, dyspnea, health-related QoL, body mass index, the number of hospitalizations due to chronic obstructive pulmonary disease during the past year. Pseudomonas aeruginosa-positive patients significantly had lower %FEV1 levels when compared with the P.aeruginosa-negative patients (p<0.05). 40% of the patients who received intravenous theophylline for acute exacerbations in the hospital were found to have a subtherapeutic level. The results of this study suggest the necessity of considering a number of various factors including the health-related QoL for the assessment of COPD severity and therapy. Also, therapeutic serum concentration of theophylline should be individualized.
THE ASSESSMENT OF QUALITY OF LIFE AND DETERMINATION OF DRUG PROFILE IN PATIENTS’ WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE The aim of the study was to assess the quality of life (QoL) of chronic obstructive pulmonary disease (COPD) patients by Short-Form-36 (SF-36) and Saint George’s Respiratory Questionnaire (SGRQ); and to investigate the effects of %FEV1 and dyspnea degree on QoL and the factors that affect the number and type of prescribed medications in stable periods. The other objectives of this study were the assessment of the relation between the %FEV1 value and the result of sputum culture and determination of serum theophylline concentrations of patients during the acute exacerbation periods. The patients were found to have significantly bad QoL scores on the SF-36 scales except the pain scale and components of SGRQ. It was observed that the QoL scores got worse as the disease and dyspnea stage advanced. The decrease in the %FEV1, the increase in the dyspnea degree and low the health-related QoL score resulted in an increase in the number of medications used. The anticholinergic and short-acting beta-2 agonist prescribing were affected %FEV1, dyspnea, health-related QoL, body mass index, the number of hospitalizations due to chronic obstructive pulmonary disease during the past year. Pseudomonas aeruginosa-positive patients significantly had lower %FEV1 levels when compared with the P.aeruginosa-negative patients (p<0.05). 40% of the patients who received intravenous theophylline for acute exacerbations in the hospital were found to have a subtherapeutic level. The results of this study suggest the necessity of considering a number of various factors including the health-related QoL for the assessment of COPD severity and therapy. Also, therapeutic serum concentration of theophylline should be individualized.