Ayşenur YILMAZ, Mukaddes KILINÇ, Orçin TELLİ ATALAY, Melis METİN, Erhan UĞURLU, Hande ŞENOL, Göksel ALTINIŞIK ERGUR

Bronşektazide öksürme kuvvetinin değerlendirilmesi

Amaç: Bu çalışmada bronşektazi hastalarında öksürme kuvvetinin değerlendirilmesi amaçlandı. Ayrıca öksürme kuvveti ile egzersiz kapasitesi ve yaşam kalitesi arasındaki ilişkiyi incelemeyi planladık. Gereç ve yöntem: Çalışmaya 24 bronşektazi hastası (bronşektazi grubu) ve 25 sağlıklı birey (sağlıklı grup) dahil edildi. Egzersiz kapasitesi 6 dakika yürüme testi (6DYT) ile değerlendirildi. Öksürme kuvveti (Tepe öksürük akımı (TÖA)), Mini-WrightTM Pef cough metre (PCM) kullanılarak değerlendirildi. Yaşam kalitesi, Leicester Öksürük anketi (LÖA) ile değerlendirildi. Bulgular: Gruplar karşılaştırıldığında TÖA, 6DYT, LÖA total puan ve alt boyutları arasında sağlıklı grup lehine anlamlı fark görüldü (p<0,05). TÖA ile 6DYT ve LÖA total puan arasında pozitif yönde yüksek düzeyde anlamlı ilişki saptandı (sırasıyla r=0,780, p<0,000 ve r=0,885, p<0,000). Sonuç: Bronşektazi hastalarının öksürme kuvvetinin sağlıklı bireylere göre daha kötü olduğu görüldü. Ayrıca, öksürme kuvveti egzersiz kapasitesini ve yaşam kalitesini olumsuz etkilediği için değerlendirme parametrelerine öksürük kuvveti eklenmelidir.

Anahtar Kelimeler:

Bronşektazi, öksürme kuvveti, tepe öksürük akımı, egzersiz kapasitesi, yaşam kalitesi

Evaluation of cough strength in bronchiectasis

Purpose: This study aimed to evaluate the cough strength in bronchiectasis patients. We also planned to examine the relationship between cough strength, exercise capacity and quality of life. Materials and methods: The study included 24 bronchiectasis patients (bronchiectasis group) and 25 healthy individuals (healthy group). Exercise capacity was evaluated with the six minute walk test (6MWT). Cough strength (Peak cough flow (PCF)) was assessed using Mini-WrightTM peak flow meter (PFM) with a mouthpiece. The quality of life was evaluated with Leicester Cough Questionnaire (LCQ). Results: A significant difference was found between the groups in terms of PCF, 6MWT, LCQ total score and subdimension scores showed significant differences in favor of the healthy group (p<0.05). A positive high correlation was observed between PCF and the following variables: 6MWT and LCQ total score (r=0.780, p<0.000 and r=0.885, p<0.000, respectively). Conclusion: This study found that cough strength was worse in bronchiectasis patients compared with healthy individuals. In addition, cough strength could negatively affect exercise capacity and quality of life. Therefore, cough strength should be added to the evaluation parameters.

Keywords:

Bronchiectasis, cough strength, peak cough flow, exercise capacity, quality of life,

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1. Boyton RJ. Bronchiectasis. J Med 2008;36:315-320.
2. Albert RK, Spiro SG, Jett JR. Comprehensive respiratory medicine. Mosby International Ltd; 1999.
3. Onen ZP, Gulbay BE, Sen E, et al. Analysis of the factors related to mortality in patients with bronchiectasis. Respir Med 2007;101:1390-1397. https://doi.org/10.1016/j.rmed.2007.02.002
4. Koulouris NG, Retsou S, Kosmas E, et al. Tidal expiratory flow limitation, dyspnoea and exercise capacity in patients with bilateral bronchiectasis. Eur Respir J 2003;21:743-748. https://doi.org/10.1183/09031936.03.00301103
5. Stewart DG, Drake DF, Robertson C, Marwitz JH, Kreutzer JS, Cifu DX. Benefits of an inpatient pulmonary rehabilitation program : a prospective analysis. Arch Phys Med Rehabil 2001;82:347-352. https://doi.org/10.1053/apmr.2001.20838
6. Cho PSP, Birring SS, Fletcher HV, Turner RD. Methods of cough assessment. JACI 2019;7:1715-1723. https://doi.org/10.1016/j.jaip.2019.01.049
7. Key AL, Holt K, Hamilton A, Smith JA, Earis JE. Objective cough frequency in idiopathic pulmonary fibrosis. Cough 2010;6:1-7. https://doi.org/10.1186/1745-9974-6-4
8. Spinou A, Lee KK, Sinha A, et al. The objective assessment of cough frequency in bronchiectasis. Lung 2017;195:575-585. https://doi.org/10.1007/s00408-017-0038-x
9. Winck JC, LeBlanc C, Soto JL, Plano F. The value of cough peak flow measurements in the assessment of extubation or decannulation readiness. Rev Port Pneumol 2015;21:94-98. https://doi.org/10.1016/j.rppnen.2014.12.002
10. Lalmolda C, Prados H, Mateu G, Noray M, Pomares X, Luján M. Titration of mechanical ınsufflation – exsufflation optimal pressure combinations in neuromuscular diseases by flow / pressure waveform analysis. Arch Bronconeumol 2019;55:246-251. https://doi.org/10.1016/j.arbr.2018.10.012
11. Vanderschueren D, Decramer M, Van Den Daele P, Dequeker J. Pulmonary function and maksimal transrespiratory pressures in ankylosing spondylitis. Ann Rheum Dis 1989;48:632-635. https://doi.org/10.1136/ard.48.8.632
12. Gregg I, Nunn AJ. Peak expiratory flow in normal subjects. Br Med J 1973;3:282-284. https://doi.org/10.1136/bmj.3.5874.282
13. Sancho J, Servera E, Díaz J, Marin J. Comparison of peak cough flows measured by pneumotachograph and a portable peak flow meter. Am J Phys Med Rehabil 2004;83:608-612. https://doi.org/10.1097/01.PHM.0000133431.70907.A2
14. Jay SJ. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 2000;161:1396. https://doi.org/10.1164/ajrccm.161.4.16147a
15. Birring SS, Prudon B, Carr AJ, Singh SJ, Morgan MDL, Pavord ID. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax 2003;58:339-343. https://doi.org/10.1136/thorax.58.4.339
16. Swaminathan S, Kuppurao KV, Somu N, Vijayan VK. Reduced exercise capacity in non-cystic fibrosis bronchiectasis. Indian J Pediatr 2003;70:553-556. https://doi.org/10.1007/BF02723157
17. Crisafulli E, Clini EM. Measures of dyspnea in pulmonary rehabilitation. Multidiscip Respir Med 2010;5:202-210. https://doi.org/10.4081/mrm.2010.529
18. Guan WJ, Chen RC, Zhong NS. The bronchiectasis severity index and FACED score for bronchiectasis. Eur Respir J 2016;47:382-384. https://doi.org/1183/13993003.01717-2015
19. Jiang C, Esquinas A, Mina B. Evaluation of cough peak expiratory flow as a predictor of successful mechanical ventilation discontinuation: a narrative review of the literature. J Int Care 2017;5:33. https://doi.org/10.1186/s40560-017-0229-9
20. Ellis HC, Cowman S, Fernandes M, Wilson R, Loebinger MR. Predicting mortality in bronchiectasis using bronchiectasis severity index and FACED scores: a 19-year cohort study. Eur Respir J 2016;47:482-489. https://doi.org/10.1183/139993003.01312-2015
21. Kosmas EN, Milic Emili J, Retsou S, et al. Exercise testing and exercise-limiting factors in patients with bilateral bronchiectasis. Pneumon 2009;22:306-314.
22. Troosters T, Gosselink R, Decramer M. Respiratory muscle assessment. Eur Respir Mon 2005;31:57-71. https://doi.org/10.1183/1025448x.00031004
23. Gibson GJ. Measurement of respiratory muscle strength. Respir Med 1995;89:529-535. https://doi.org/10.1016/0954-6111(95)90153-1
24. Lee AL, Cecins N, Hill CJ, et al. The effects of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: protocol for a randomised controlled trial. BMC Pulm Med 2010;10:5. https://doi.org/10.1186/1471-2466-10-5
25. Arifin SWA, Indra R, Widjanantie SC, Nusdwinuringtyas N. Improvement of the functional parameter in patient with chronic obstructive pulmonary disease after pulmonary rehabilitation. IndoJPMR 2017;6:44-50. https://doi.org/10.36803/ijpmr.v6i02.161