Gaye ULUBAY, İrem ŞERİFOĞLU

KOAH erken tanısında spirometri dışındaki yöntemler

Kronik obstrüktif akciğer hastalığı (KOAH) tüm dünyada mortalite ve morbidite nedenidir. KOAH tanısı, klinik semptomların varlığında 1. saniye içinde bronkodilatör sonrası zorlu ekspirasyon hacminin 1. saniye içinde zorlu ekspiratuvar vital kapasiteye (FEV1/FVC) oranının 0.7’den küçük olması ile konulur. KOAH’ın karakteristik bir özelliği olan hava akımının kalıcı olarak kısıtlanması tekrarlanabilir ve en sık kullanılan akciğer fonksiyon testidir, spirometri ile ölçülür. Küçük hava yolu hastalığı ve parankimal yıkım, KOAH patogenezinde farklı oranlarda rol oynar ve zamanla kronik hava akımı kısıtlanmasıyla sonuçlanır. Bu patolojiler her zaman aynı anda birlikte olmayabilir ve KOAH patogenezine katkısı kişiden kişiye farklılık gösterir. Küçük hava yolu hastalığının KOAH patogenezindeki yeri kanıtlanmıştır. Küçük hava yolu hastalığı; mukus, düz kas hipertrofisi, inflamatuvar infiltrasyon veya hava duvarı kalınlaşmasına bağlı olarak geliştiğinde, sonuç artan direnç ve havalanma bozukluğu olmaktadır. Parankimal yıkım görüntüleme metodları ile tahmin edilebilir. KOAH hastasının ilk değerlendirmesinde, eşlik eden akciğer hastalıkları ve/veya ayırıcı tanıda görüntüleme metodlarından faydalanılır. KOAH tanısı henüz spirometri ile kanıtlanmayan ancak tanısı alternatif yöntem ve yaklaşımlara dayanan semptomatik bireylere ilgi artmaktadır. Günümüzde spirometriye alternatif yöntem ve yaklaşımlar genellikle klinik araştırmalar için kullanılmasına rağmen, KOAH hastalarını erken aşamada saptayabilmek için klinisyene fırsat sunmaktadır. Bu amaçla, KOAH henüz kanıtlanmamışken erken tanıda spirometri dışındaki mevcut yöntemleri tartışacağız.

The methods other than spirometry in the early diagnosis of COPD

Chronic obstructive pulmonary disease (COPD) is a major cause of mortalityand morbidity around the world. The diagnosis od COPD is based on thepresence of clinical symptoms and the fact that the ratio of post-bronhodilatorforced expiratory volume in 1 second to forced expiratory vital capacity(FEV1/FVC) is less than 0.70. Persistent limitation of airflow which is a characteristicsof COPD is reproducible and most common lung function test that is why itis usually measured by spirometry. The small airway diseases and the parenchymal destruction play a role in the pathogenesis of COPD at different ratesover time resulting in chronic airflow limitation. These pathologies are notalways together at the same time and the contribution of those to the development of COPD differ from one individual to another. The pathophysiological involvement of small airways in COPD has been confirmed. When theobstruction of the small airways occur either by mucus, smooth muscle hypertrophy, inflammatory infiltration or air wall thickening; then the consequenceis the increased resistance and ventilation impairment. The parenchymaldestruction can be estimated via scanning and at the initial assessment of aCOPD patient, it gives information about the concomitant pulmonary diseasesand/or differential diagnosis. There is an increasing interest on symptomaticindividuals whose whose COPD diagnosis has not been confirmed yet withspirometry but diagnosis is based on alternative methods and approaches.Although these methods nowadays are commonly used for the clinicalresearch, they will offer an opportunity to the clinician to find out the COPDpatients at an early stage. Herein we will discuss the available methods otherthan spirometry in the early diagnosis of COPD before the overt disease isconfirmed.

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