Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri

Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileriKronik obstrüktif akciğer hastalığı (KOAH), akciğer etkilenimi ve çeşitli komorbidetelerden kaynaklanan yıkıcı sonuçları olan kompleks bir hastalıktır. Komorbiditeler, semptomları, yaşam kalitesini, komplikasyonları, hastalığın yönetimini, ekonomik yükünü ve mortalitesini etkilemektedir. Komorbiditelerin önemi, KOAH'ın sonuçları üzerine olan etkilerinden kaynaklanmaktadır. KOAH'ta görülen en sık komorbiditeler, kardiyovasküler, endokrinolojik, müsküloskeletal ve psikolojik olanlar ve akciğer kanseridir. KOAH olgularının en az %50'sinde üç veya daha fazla komorbidite bulunmaktadır. Yeni GOLD kılavuzu komorbiditelerin proaktif olarak araştırılmasını ve tedavisini önermektedir. Ancak bu komorbiditelerin aktif tedavisinin, KOAH'ın sonuçlarını etkilediğine dair kesin bir kanıt yoktur. Öte yandan kardiyovasküler hastalıklar ve akciğer kanseri gibi komorbiditeler, KOAH mortalitesi üzerinde önemli etkiye sahiptir. Çeşitli çalışmalar, Charlson komorbidite indeksinin veya KAOH spesifik komorbidite indeksinin (COTE) KOAH mortalitesi ile ilişkili olduğunu göstermiştir. Bu kısa derleme, KOAH üzerindeki etkileri ile beraber en sık görülen komorbiditeleri özetlemeyi amaçlamıştır.

Anahtar Kelime:

Konular: Solunum Sistemi Kulak, Burun, Boğaz

Comorbidities and their impact on chronic obstructive pulmonary disease

Öz:

Comorbidities and their impact on chronic obstructive pulmonary diseaseChronic obstructive pulmonary disease (COPD) is a complex disease that is associated with devastating outcomes resulting from lung involvement and several comorbidities. Comorbidities could impact on symptomology, quality of life, the complications, the management, economic burden and the mortality of the disease. The importance of comorbidities originates from their impact on the outcome of COPD. The most frequent comorbidities in COPD are cardiovascular, endocrinological, musculoskeletal, phycological disorders and lung cancer. Almost 50% of the COPD patients have 3 or more comorbidities. The recent Global Initiative of Obstructive Lung Disease (GOLD) Guideline suggested proactive search and the treatment of the comorbidities. However, there is no certain evidence demonstrating that active treatment of comorbidities improve the outcomes of COPD. However, it is well known that several comorbidities such as cardiovascular disease and lung cancer have greater impact on mortality caused by COPD. Several studies have shown that Charlson Comorbidity index or more recenty COPD Specific Comorbidity Index (COTE) has been found to be related with mortality of COPD. This concise review intended to summarize the most frequent comorbidities in association with their impact on COPD.

Anahtar Kelime:

Konular: Solunum Sistemi Kulak, Burun, Boğaz

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Pocket quide to COPD diagnosis, management and prevention. Updated 2015. Available: http://www. goldcopd.org/
2. Decramer M, Wim Janssens, Marc Miravitlles. Chronic obstructive pulmonary disease. Lancet 2012;379:1341-51.
3. Hillas G, Perlikos F, Tsiligianni I, Tzanaki N. Managing comorbidities in COPD. International Journal of COPD 2015;10:95-109.
4. Divo MJ, Casanova C, Marin JM, Pinto-Plata VM, de-Torres JP, Zulueta JJ. Chronic obstructive pulmonary disease comorbidities network. Eur Respir J 2015;46:640-50.
5. Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007;29:1224-38.
6. Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014;9:871-88.
7. Ozyilmaz E, Kokturk N, Teksut G, Tatlicioglu T. Unsuspected risk factors of frequent exacerbations requiring hospital admission in chronic obstructive pulmonary disease. Int J Clin Pract 2013;67:691-7.
8. Divo M, Cote C, de Torres JP, Casanova C, Marin JM, PintoPlata V. Comorbidities and risk of mortality in patients with COPD. Am J Respir Crit Care Med 2012;186:155-61.
9. McGarvey LP, John M, Anderson JA, Zvarich M, Wise RA. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee. Thorax 2007;62:411-5.
10. McGarvey LP, Magder S, Burkhart D, Kesten S, Liu D, Manuel RC, et al. Cause-specific mortality adjudication in the UPLIFT® COPD trial: Findings and recommendations. Respir Med 2012;106:515-21.
11. Gibson PG, McDonald WM. Asthma-COPD overlap 2015: now we are six. Thorax 2015;70:683-91.
12. Mannino DM, Aguayo SM, Petty TL, Redd SC. Low Lung Function and Incident Lung Cancer in the United States Data From the First National Health and Nutrition Examination Survey Follow-up. Arch Intern Med 2003;163:1475-80.
13. de Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, Seijo LM, et al. Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. CHEST 2007;132:1932-8.
14. Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, et al. Association of radiographic emphysema and airflow obstruction with lung cancer. Am J Respir Crit Care Med 2008;178:738-44.
15. Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J 2009; 34:380-6.
16. Miller J, Edwards LD, Agusti A, Bakke P, Calverley PM, Celli B, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med 2013;107:1376-84.
17. Gao YH, Guan WJ, Liu Q, Wang HQ, Zhu YN, Chen RC, et al. Impact of COPD and emphysema on survival of patients with lung cancer: A meta-analysis of observational studies. Respirology 2016;21:269-79.
18. Sanchez-Salcedo P, Wilson DO, JP de-Torres JP, Weissfeld VL, Berto J, Campo A, Alcaide AB, et al. Improving selection criteria for lung cancer screening. The potential role of emphysema. Am J Respir Crit Care Med 2015;191:924-31.
19. Cottin V, Nunes H, Brillet PY, Delaval P, Devouassou G, Tillie-Leblond I, et al. Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity. Eur Respir J 2005;26:586-93.
20. Katzenstein AA, Mukhopadhyay S, Zanardi C, Dexter E. Clinically occult interstitial fibrosis in smokers: classification and significance of a surprisingly common finding in lobectomy specimens. Human Pathology 2010;41:316-25.
21. Lin H, Jiang S. Combined pulmonary fibrosis and emphysema (CPFE): an entity different from emphysema or pulmonary fibrosis alone. J Thorac Dis 2015;7:767-9.
22. Laghi F, Adiguzel N, Tobin MJ. Endocrinological derangements in COPD. Eur Respir J 2009;34:975-96.
23. Corona G, Rastrelli G, Maggi M. Diagnosis and treatment of late-onset hypogonadism: Systematic review and metaanalysis of TRT outcomes. Best Practice & Research Clinical Endocrinology&Metabolism 2013;27:557-9.
24. Huhtaniemi I. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment. Asian J Androl 2014;16:192-202.
25. Corona G, Vignozzi L, Sforza A, Maggi M. Risks and benefits of late onset hypogonadism treatment; an expert opinion. World J Mens Health 2013;31:103-25.
26. Mekov E, Slavova Y, Tsakova A, Genova M, Kostadinov D, Minchev D, et al. Metabolic syndrome in hospitalized patients with chronic obstructive pulmonary disease. Peer J 2015;3:e1068.
27. Doehnera W, Haeuslera KG, Endresa M, Ankerb SD, MacNeee W, Lainscak M. Neurological and endocrinological disorders: orphans in chronic obstructive pulmonary disease. Respir Med 2011;105:12-9.
28. Laghi F, Adiguzel N, Tobin MJ. Endocrinological derangements in COPD. Eur Respir J 2009;34:975-96.
29. Mirrakhimov AE. Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony. Cardiovasc Diabetol 2012;11:132.
30. Guvener N, Tutuncu NB, Akcay S, Eyuboglu F, Gokcel A. Alveolar gas exchange in patients with type 2 diabetes mellitus. Endocr J 2003;50:663-7.
31. Burt MG, Roberts GW, Aguilar-Loza NR, Quinn SJ, Frith PA, Stranks SN. Relationship between glycaemia and length of hospital stay during an acute exacerbation of chronic obstructive pulmonary disease. Intern Med J 2013;43:721-4.
32. Pandya D, Puttanna A, Balagopal V. Systemic effects of inhaled corticosteroids: An overview. Open Respir Med J 2014;8:59-65.
33. Henneicke H, Gasparini SJ, Brennan-Speranza TC, Zhou H, Seibel MJ. Glucocorticoids and bone: local effects and systemic implications. Trends Endocrinol Metab 2014;25: 197-211.
34. Suissa S, Kezouh A, Ernst P. Inhaled corticosteroids and the risks of diabetes onset and progression. Am J Med 2010;123:1001-6.
35. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrin Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30.
36. Janssens W, Lehouck A, Carremans C, Bouillon R, Mathieu C, Decramer M. Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med 2009;179:630-6.
37. Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81.
38. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An Official American Thoracic Society/ European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. Am J Respir Crit Care Med 2013;188:13-64.
39. Rabinovich RA, Vilaro J. Structural and functional changes of peripheral muscles in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med 2010;16:123-33.
40. Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigare R, et al; ATS/ERS Ad Hoc Committee on Limb Muscle Dysfunction in COPD. An official American Thoracic Society/European Respiratory Society Statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014;189:15-62.
41. Cielen N, Maes K, Gayan-Ramirez G. Musculoskeletal disorders in COPD. Bio Med Int 2014;2014:965764. Doi: 10.1155/2014/965764
42. Man WD, Kemp P, Moxham J, Polkey MI. Skeletal muscle dysfunction in COPD: clinical and laboratory observations. Clin Sci 2009;117:251-64.
43. Choudhury G, Rabinovich R, MacNee W. Comorbidities and systemic effects of COPD. Clin Chest Med 2014;35:101-30.
44. Pryor JA, Prasad SA. Physiotherapy for respiratory and cardiac problems: adults and paediatrics. 4th ed. Churchill Livingstone: London; 2008.
45. Cielen N, Maes K, Gayan-Ramirez G. Musculoskeletal disorders in COPD. Bio Med Int 2014;2014:965764.
46. Seymour JM, Spruit MA, Hopkinson NS, et al. The prevalence of quadriceps weakness in COPD and the relationship with disease severity. Eur Respir J 2010;36:81-8.
47. Donaldson AV, Maddocks M, Martollini D, Polkey MI, Man WD. Muscle function in COPD: a complex interplay. Int J Chron Obstruct Pulmon Dis 2012;7:523-35.
48. WHO Scientific Group, "Prevention and management of osteoporosis: report of aWHO scientific group," internet communication, 2013.
49. Bolton CE, Ionescu AA, Shiels KM, Pettit RJ, Edwards PH, Stone MD, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170:1286-93.
50. DeVries F, van Staa TP, Bracke SGM, Cooper C, Leufkens HGM, Lammers JWJ. Severity of obstructive airways disease and risk of osteoporotic fracture. Eur Respir J 2005;25:879- 84.
51. Kjensli A, Mowinckel P, Ryg MS, Falch JA. Low bone mineral density is related to severity of chronic obstructive pulmonary disease. Bone 2007;40:493-7.
52. Graat-Verboom L, Wouters EF, Smeenk FW, van den Borne BE, Lunde R, Spruit MA. Current status of research on osteoporosis in COPD: a systematic review. Eur Respir J 2009;341:209-18.
53. Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007;356:775-89.
54. Langhammer A, Forsmo S, Syversen U. Long-term therapy in COPD: any evidence of adverse effect on bone? Int J Chron Obstruct Pulmon Dis 2009;4:365-80.
55. Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014:9;871-88.
56. Patel AR, Hurst JR. Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art. Expert Rev Respir Med 2011:5;647-62.
57. Schols AM, Ferreira IM, Franssen FM, Gosker HR, Janssens W, Muscaritoli M, et al. Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J 2014;44:1504-20.
58. Annemie MWJ. Schols. Nutrition as a metabolic modulator in COPD. Chest 2013;144:1340-5.
59. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33:1165-85.
60. de Miguel Díez J, Chancafe Morgan J, Jiménez García R. The association between COPD and heartfailure risk: a review. Int J Chron Obstruct Pulmon Dis 2013;8:305-12.
61. Ni H, Nauman D, Hershberger RE. Managed care and outcomes of hospitalization among elderly patients with congestive heart failure. Arch Intern Med 1998;158:1231-6.
62. Flu WJ, van Gestel YR, van Kuijk JP, Hoeks SE, Kuiper R, Verhagen HJ, et al. Co-existence of COPD and left ventricular dysfunction in vascular surgery patients. Respir Med 2010;104:690-6.
63. Hillas G, Perlikos F, Tsiligianni I, Tzanakis N. Managing comorbidities in COPD. Int J Chron Obstruct Pulmon Dis 2015:10;95-109.
64. Brekke PH, Omland T, Smith P, Søyseth V. Underdiagnosis of myocardial infarction in COPD-Cardiac Infarction Injury Score (CIIS) in patients hospitalised for COPD exacerbation. Respir Med 2008;102:1243-7.
65. Buch P, Friberg J, Scharling H, Lange P, Prescott E. Reduced lung function and the risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J 2003;21:1012-6.
66. Roversi S, Roversi P, Spadafora G, Rossi R, Fabbri LM. Coronary artery disease concomitant with chronic obstructive pulmonary disease. Eur J Clin Invest 2014;44:93-102.
67. Etminan M, Jafari S, Carleton B, FitzGerald JM. Beta-blocker use and COPD mortality: a systematic review and metaanalysis. BMC Pulm Med 2012;12:48.
68. Mortensen EM, Copeland LA, Pugh MJV, Restrepo MI, de Molina RM, Nakasihima B, et al. Impact of statins and ACE inhibitors on mortality after COPD exacerbations. Respiratory Research 2009:10;45.
69. Collop N. Sleep and sleep disorders in chronic obstructive pulmonary disease. Respiration 2010;80:78-86.
70. Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11:259-70.
71. Sidney S, Sorel M, Quesenberry CP Jr, DeLuise C, Lanes S, Eisner MD. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest 2005;128:2068-75.
72. McNicholas WT, Verbraecken J, Marin JM. Sleep disorders in COPD: the forgotten dimension. Eur Respir Rev 2013;22:365-75.
73. Meecham Jones DJ, Paul EA, Jones PW, Wedzicha JA. Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD. Am J Respir Crit Care Med 1995;152:538-44.
74. Atlantis E, Fahey P, Cochrane B, Smith S. Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest 2013;144:766-77.
75. Stage KB, Middelboe T, Stage TB. Depression in COPDmanagement and quality of life considerations. Int J Chron Obstruct Pulmon Dis 2006;1:315-20.
76. Paz-Diaz H, Montes de Oca M, Lopez JM, Celli BR. Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD. Am J Phys Med Rehabil 2007;86:30-6.
77. Ferrari M, Manea L, Anton K, Bruzzone P, Meneghello M, Zamboni F. Anemia and hemoglobin serum levels are associated with exercise capacity and quality of life in chronic obstructive pulmonary disease. BMC Pulm Med 2015;15:58.

APA	DURSUNOGLU N, Kokturk N, demir baha a, BİLGE A, BÖREKÇİİ Ş, ÇİFTCİ F, Gezmen Karadağ M, ÇALIK KÜTÜKCÜ E, NOYAN A, POLATLI M, ÖNEN Z, SARINÇ S, UMUT S, Uzaslan E, KUBAT ÜZÜM A, AKKOCA YILDIZ Ö (2016). Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. , 289 - 298.
Chicago	DURSUNOGLU NESE,Kokturk Nurdan,demir baha ayse,BİLGE Ahmet Kaya,BÖREKÇİİ Şerminİ,ÇİFTCİ Fatma,Gezmen Karadağ Makbule,ÇALIK KÜTÜKCÜ EBRU,NOYAN Ayşın,POLATLI MEHMET,ÖNEN Zeynep Pınar,SARINÇ Sevinç,UMUT Sema,Uzaslan Esra,KUBAT ÜZÜM Ayşe,AKKOCA YILDIZ Öznur Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. (2016): 289 - 298.
MLA	DURSUNOGLU NESE,Kokturk Nurdan,demir baha ayse,BİLGE Ahmet Kaya,BÖREKÇİİ Şerminİ,ÇİFTCİ Fatma,Gezmen Karadağ Makbule,ÇALIK KÜTÜKCÜ EBRU,NOYAN Ayşın,POLATLI MEHMET,ÖNEN Zeynep Pınar,SARINÇ Sevinç,UMUT Sema,Uzaslan Esra,KUBAT ÜZÜM Ayşe,AKKOCA YILDIZ Öznur Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. , 2016, ss.289 - 298.
AMA	DURSUNOGLU N,Kokturk N,demir baha a,BİLGE A,BÖREKÇİİ Ş,ÇİFTCİ F,Gezmen Karadağ M,ÇALIK KÜTÜKCÜ E,NOYAN A,POLATLI M,ÖNEN Z,SARINÇ S,UMUT S,Uzaslan E,KUBAT ÜZÜM A,AKKOCA YILDIZ Ö Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. . 2016; 289 - 298.
Vancouver	DURSUNOGLU N,Kokturk N,demir baha a,BİLGE A,BÖREKÇİİ Ş,ÇİFTCİ F,Gezmen Karadağ M,ÇALIK KÜTÜKCÜ E,NOYAN A,POLATLI M,ÖNEN Z,SARINÇ S,UMUT S,Uzaslan E,KUBAT ÜZÜM A,AKKOCA YILDIZ Ö Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. . 2016; 289 - 298.
IEEE	DURSUNOGLU N,Kokturk N,demir baha a,BİLGE A,BÖREKÇİİ Ş,ÇİFTCİ F,Gezmen Karadağ M,ÇALIK KÜTÜKCÜ E,NOYAN A,POLATLI M,ÖNEN Z,SARINÇ S,UMUT S,Uzaslan E,KUBAT ÜZÜM A,AKKOCA YILDIZ Ö "Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri." , ss.289 - 298, 2016.
ISNAD	DURSUNOGLU, NESE vd. "Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri". (2016), 289-298.

APA	DURSUNOGLU N, Kokturk N, demir baha a, BİLGE A, BÖREKÇİİ Ş, ÇİFTCİ F, Gezmen Karadağ M, ÇALIK KÜTÜKCÜ E, NOYAN A, POLATLI M, ÖNEN Z, SARINÇ S, UMUT S, Uzaslan E, KUBAT ÜZÜM A, AKKOCA YILDIZ Ö (2016). Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. Tüberküloz ve Toraks, 64(4), 289 - 298.
Chicago	DURSUNOGLU NESE,Kokturk Nurdan,demir baha ayse,BİLGE Ahmet Kaya,BÖREKÇİİ Şerminİ,ÇİFTCİ Fatma,Gezmen Karadağ Makbule,ÇALIK KÜTÜKCÜ EBRU,NOYAN Ayşın,POLATLI MEHMET,ÖNEN Zeynep Pınar,SARINÇ Sevinç,UMUT Sema,Uzaslan Esra,KUBAT ÜZÜM Ayşe,AKKOCA YILDIZ Öznur Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. Tüberküloz ve Toraks 64, no.4 (2016): 289 - 298.
MLA	DURSUNOGLU NESE,Kokturk Nurdan,demir baha ayse,BİLGE Ahmet Kaya,BÖREKÇİİ Şerminİ,ÇİFTCİ Fatma,Gezmen Karadağ Makbule,ÇALIK KÜTÜKCÜ EBRU,NOYAN Ayşın,POLATLI MEHMET,ÖNEN Zeynep Pınar,SARINÇ Sevinç,UMUT Sema,Uzaslan Esra,KUBAT ÜZÜM Ayşe,AKKOCA YILDIZ Öznur Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. Tüberküloz ve Toraks, vol.64, no.4, 2016, ss.289 - 298.
AMA	DURSUNOGLU N,Kokturk N,demir baha a,BİLGE A,BÖREKÇİİ Ş,ÇİFTCİ F,Gezmen Karadağ M,ÇALIK KÜTÜKCÜ E,NOYAN A,POLATLI M,ÖNEN Z,SARINÇ S,UMUT S,Uzaslan E,KUBAT ÜZÜM A,AKKOCA YILDIZ Ö Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. Tüberküloz ve Toraks. 2016; 64(4): 289 - 298.
Vancouver	DURSUNOGLU N,Kokturk N,demir baha a,BİLGE A,BÖREKÇİİ Ş,ÇİFTCİ F,Gezmen Karadağ M,ÇALIK KÜTÜKCÜ E,NOYAN A,POLATLI M,ÖNEN Z,SARINÇ S,UMUT S,Uzaslan E,KUBAT ÜZÜM A,AKKOCA YILDIZ Ö Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri. Tüberküloz ve Toraks. 2016; 64(4): 289 - 298.
IEEE	DURSUNOGLU N,Kokturk N,demir baha a,BİLGE A,BÖREKÇİİ Ş,ÇİFTCİ F,Gezmen Karadağ M,ÇALIK KÜTÜKCÜ E,NOYAN A,POLATLI M,ÖNEN Z,SARINÇ S,UMUT S,Uzaslan E,KUBAT ÜZÜM A,AKKOCA YILDIZ Ö "Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri." Tüberküloz ve Toraks, 64, ss.289 - 298, 2016.
ISNAD	DURSUNOGLU, NESE vd. "Kronik obstrüktif akciğer hastalığında komorbiditelerin hastalık üzerine etkileri". Tüberküloz ve Toraks 64/4 (2016), 289-298.