Purpose: Effective management of chronic obstructive pulmonary disease (COPD) depends on sustained adherence to inhaled therapies, yet real-world factors associated with inhaler adherence and disease awareness are not fully characterized. This study aimed to evaluate inhaler medication adherence among patients with COPD and to explore its associations with sociodemographic, clinical, and contextual factors, including self-reported disease awareness. Patients and Methods: This single-center, cross-sectional descriptive study was conducted between July and October 2025 in the Chest Diseases Outpatient Clinic of a tertiary hospital. Patients aged ≥ 18 years with a confirmed diagnosis of COPD based on GOLD 2025 criteria were included. Sociodemographic and clinical data were collected using structured, interviewer-administered questionnaires. Inhaler adherence was assessed using a structured questionnaire adapted from the Test of Adherence to Inhalers (TAI). Symptom burden and dyspnea were evaluated using the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) dyspnea scale, respectively. Statistical analyses were performed using IBM SPSS Statistics version 23.0, with a two-sided p value < 0.05 considered statistically significant. Results: A total of 170 patients were included in the analysis (GOLD group A: 31.2%, group B: 44.1%, and group E: 24.7%). Marital status (p = 0.003), family history of COPD (p< 0.001), and home use of nebulizers or oxygen concentrators (p< 0.001) were significantly associated with higher inhaler adherence, whereas age, educational level, income status, and smoking status were not. TAI adherence scores did not differ significantly across GOLD groups (p> 0.05), whereas exacerbation frequency and hospitalization rates increased significantly with disease severity (p< 0.001). Conclusion: In this single-center cross-sectional study, inhaler adherence in patients with COPD was found to be associated with contextual and social factors, such as marital status, family history of COPD, and home use of respiratory support devices, rather than with demographic characteristics or disease severity. These findings highlight the importance of routinely assessing inhaler use and adherence in clinical practice and suggest that contextual factors may play a role in adherence behaviors, in line with current GOLD recommendations.

Background: Various studies have shown that viral pneumonia pathogens display distinct inflammatory profiles, and hematological indices, such as the Neutrophil/Lymphocyte Ratio (NLR), Lymphocyte/Monocyte Ratio (LMR), and Platelet/Lymphocyte Ratio (PLR), can serve as accessible markers of disease severity. Moreover, the seasonal distribution of respiratory viruses appears to have shifted during the COVID-19 pandemic. Methods: This retrospective case–control study was conducted on patients diagnosed with PCR-confirmed viral pneumonia in the emergency department of a tertiary care center between 1 January and 31 December 2024. The control group comprised age- and sex-matched individuals without viral pneumonia. Subjects with comorbidities or ongoing treatments potentially affecting hematological indices were excluded. Seasonal distribution of viral pathogens was recorded. Hematological and inflammatory parameters at admission—including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR)—were evaluated. The associations between these biomarkers, Pneumonia Severity Index (PSI) scores, and hospitalization status were statistically analyzed. Results: In this study, it was determined that Influenza A/B was more common in winter (67.3%) and SARS-CoV-2 in summer (70.7%). The relationship between the Pneumonia Severity Index and hemogram parameters was examined in determining the severity of pneumonia. In SARS-CoV-2, leukocyte and neutrophil counts were positively correlated (R: 0.392, p: 0.003; R: 0.466, p: <0.001), while in Influenza A/B, lymphocyte, platelet, and monocyte counts showed a negative correlation (R: −0.402, p: 0.005; R: −0.331, p: 0.021; R: −0.327, p: 0.023). Correlations were found between inflammation parameters and the Pneumonia Severity Index, except for the Lymphocyte/Monocyte Ratio, between SARS-CoV-2 and Influenza A/B (p < 0.05). Conclusions: The seasonal distribution of viral pneumonia pathogens has been revealed following the COVID-19 pandemic. Due to differences in inflammation patterns in viral infections, different leukocyte subgroups have been suggested as biomarkers.

Premature Deaths and Socio-economic Status: The Role of Fine Particulate Matter in Türkiye (2019) - Thoracic Research and Practice

Arterial stiffness is associated with increased cardiovascular risk in chronic obstructive pulmonary disease (COPD). However, whether this increase reflects disease-specific vascular effects or is primarily driven by age and hemodynamic factors remains unclear, particularly in early disease states such as pre-COPD and preserved ratio impaired spirometry (PRISm). This study aimed to evaluate arterial stiffness across the COPD spectrum and to determine the independent predictors of pulse wave velocity (PWV). This cross-sectional study included healthy controls (n=60), a combined pre-COPD/PRISm group (n=121), and COPD patients (n=120) classified according to spirometric criteria. Arterial stiffness was assessed noninvasively using brachial oscillometric PWV. Clinical characteristics, smoking exposure, spirometric parameters, symptom scores, and hemodynamic measurements were recorded. Correlation analyses and hierarchical multivariate linear regression were performed to identify independent determinants of PWV. PWV values were significantly higher in the pre-COPD/PRISm and COPD groups than in healthy controls, with the highest levels observed in COPD patients at GOLD stage E (p<0.001). Although PWV showed significant correlations with spirometric parameters and symptom scores in unadjusted analyses, these associations lost significance after adjustment for age and smoking exposure. In contrast, mean arterial pressure and central pulse pressure remained strongly associated with PWV (p<0.001). In multivariate analysis, age was the strongest independent predictor of PWV, followed by mean arterial pressure and body surface area, while FEV1% was not a significant contributor. Arterial stiffness is increased not only in COPD but also in individuals with pre-COPD/PRISm. However, this increase appears to be primarily driven by age-related and hemodynamic factors rather than disease-specific airflow limitation. These findings highlight the importance of early cardiovascular risk assessment focusing on hemodynamic parameters.

The Bronchiectasis Health Questionnaire (BHQ), a 10-question instrument designed to assess quality of life and disease-specific issues, was developed in 11 languages, including English. The present study aims to translate the original version of the BHQ into Turkish using a standardised methodology and to evaluate the validity and reliability of the Turkish version of the BHQ. This cross-sectional study was conducted at Giresun Training and Research Hospital between August 2024 and January 2025, with ethical approval (decision number 03.07.2024/03) and informed consent from all participants. A total of 132 clinically stable participants with bronchiectasis were enrolled. The study was performed in two stages: (1) cross-cultural adaptation of the original Bronchiectasis Health Questionnaire (BHQ) into Turkish (T-BHQ) according to established guidelines, and (2) psychometric validation of the T-BHQ. Alongside the T-BHQ, data on socio-demographics, clinical characteristics, mMRC dyspnea score, pulmonary function tests, Bronchiectasis Severity Index (BSI), SF-12 quality of life questionnaire, and exacerbation history were collected. Reliability was assessed using Cronbach’s alpha and test–retest analysis, while construct validity was evaluated through exploratory and confirmatory factor analyses, convergent validity with clinical measures, and Bland–Altman analysis. The validity and reliability of the T-BHQ were evaluated in present study involving a total of 134 participants with bronchiectasis, and a Cronbach’s alpha of 0.729 was obtained. In the exploratory factorial analysis, factorial loadings of > 0.40 were determined for all items and were evaluated as appropriate. Utilising the Bland-Altman analysis to assess the test’s repeatability, (mean difference: 0,059, β = 0.03, p:0.840). The convergent validity of the T-BHQ with mMRC was strong (r = − 0.648, p:< 0.001), with BSI were moderate (r: -0,437, p:<0,001), while concurrent validity with SF-12 subtypes mainly were at a moderate level (Physical role functioning: r = − 0.661 p:<0.001, other subtypes at a moderate level). The T-BHQ has been demonstrated to possess both reliability and validity in evaluating the disease-related quality of life and health status of participants with bronchiectasis in Turkey.