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KOAH Hastalarında İnhaler Kullanımı ile Ağız Kuruluğu Düzeyi Arasındaki İlişki: Analitik Kesitsel Bir Araştırma

The Relationship Between Inhaler Use and Dry Mouth Severity in Patients with Chronic Obstructive Pulmonary Disease: An Analytical Cross-Sectional Study

Alev Yıldız Ilıman(AMASYA ÜNİVERSİTESİ)0000-0001-7957-8873
Caner Kalınbacak(AMASYA ÜNİVERSİTESİ)0009-0008-0714-0424
Sayfa
299–309
Yayın Tarihi
2026-08-13
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⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Bulgular: KOAH hastalarında, kontrol grubuna kıyasla tükürük pH’ı daha düşük ve ağız kuruluğu düzeyi daha yüksektir (p<0.001).

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Amaç & Hipotez:KOAH Hastalarında İnhaler Kullanımı ile Ağız Kuruluğu Arasındaki İlişki: Kesitsel Bir Araştırma ÖZET Amaç: Bu çalışmanın amacı, kronik obstrüktif akciğer (KOAH) hastalarında inhaler kullanımının ağız kuruluğu ve tükürük pH üzerindeki etkisini değerlendirmek ve farklı inhaler türlerinin bu parametreler üzerindeki potansiyel etkilerini karşılaştırmaktır.
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Temel Bulgular & Veri:Yöntem: Tanımlayıcı, kesitsel ve kontrol gruplu olarak planlanan bu araştırmanın örneklemini, Sabuncuoğlu Şerefeddin Eğitim ve Araştırma Hastanesi Yetişkin Acil Servisi’ne Eylül-Kasım 2024 tarihleri arasında başvuran, evde inhaler ilaç tedavisi uygulayan 37 KOAH hastası ve KOAH tanısı bulunmayan kontrol grubundaki 30 hasta oluşturmuştur.
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Sonuç & Katkı:Bulgular: KOAH hastalarında, kontrol grubuna kıyasla tükürük pH’ı daha düşük ve ağız kuruluğu düzeyi daha yüksektir (p<0.001).
🔬Tür:Uygulamalı Anket & Alan Araştırması
📍Kapsam:2024 · 30 hasta
⚙️Değişkenler:KOAH · İNHALER TEDAVİ · AĞIZ KURULUĞU

Özet

KOAH Hastalarında İnhaler Kullanımı ile Ağız Kuruluğu Arasındaki İlişki: Kesitsel Bir Araştırma ÖZET Amaç: Bu çalışmanın amacı, kronik obstrüktif akciğer (KOAH) hastalarında inhaler kullanımının ağız kuruluğu ve tükürük pH üzerindeki etkisini değerlendirmek ve farklı inhaler türlerinin bu parametreler üzerindeki potansiyel etkilerini karşılaştırmaktır. Yöntem: Tanımlayıcı, kesitsel ve kontrol gruplu olarak planlanan bu araştırmanın örneklemini, Sabuncuoğlu Şerefeddin Eğitim ve Araştırma Hastanesi Yetişkin Acil Servisi’ne Eylül-Kasım 2024 tarihleri arasında başvuran, evde inhaler ilaç tedavisi uygulayan 37 KOAH hastası ve KOAH tanısı bulunmayan kontrol grubundaki 30 hasta oluşturmuştur. Veriler, yüz yüze görüşme ile “Kişisel Bilgi Formu”, pH indikatörü ve gözyaşı test stribi kullanılarak toplanmıştır. Verilerin analizinde, parametrik ve non-parametrik testler kullanılmıştır. Bulgular: KOAH hastalarında, kontrol grubuna kıyasla tükürük pH’ı daha düşük ve ağız kuruluğu düzeyi daha yüksektir (p<0.001). İnhaler kullanan bireylerin büyük çoğunluğu inhalasyon sonrası ağız çalkalama ve ağız sağlığına yönelik davranışlarının olmadığı belirlenmiştir. İnhaler kullanan KOAH hastalarında; cinsiyet, yaş, sigara/alkol kullanımı, diş kaybı, protez varlığı, su tüketimi ve ağız sağlığı davranışları ile tükürük pH ve ağız kuruluğu düzeyleri arasında istatistiksel olarak anlamlı bir fark saptanmamıştır. KOAH grubu ile kontrol grubu demografik değişkenler açısından benzer özellikte dağılım göstermiştir. Sonuç: KOAH hastalarında ağız kuruluğu düzeyleri anlamlı şekilde yüksektir. KOAH hastalarında inhaler tedavi, tükürük sekresyonunu azaltarak ağız kuruluğuna ve tükürükte pH düşüşüne neden olmaktadır. Bu durum, ağız mukozasında lokal yan etkiler ve ağız sağlığı problemleri riskini artırmaktadır. Anahtar kelimeler: KOAH;inhaler tedavi;ağız kuruluğu. Destekleyen kurumlar: Çalışma herhangi bir kurum tarafından desteklenmemiştir. Aberg, F., & Helenius-Hietala, J. (2022). Oral health and liver disease: Bidirectional associations—a narrative review. Dent J (Basel), 10(16). Agha-Hosseini, F., Shirzad, N., & Moosavi, M. S. (2015). Evaluation of xerostomia and salivary flow rate in Hashimoto’s thyroiditis. Med Oral Patol Oral Cir Bucal, 21, e1–e6. Agostini, B. A., Cericato, G. O., Silveira, E. R., Nascimento, G. G., Costa, F. S., Thomson, W. M., et al. (2018). How common is dry mouth? Systematic review and meta-regression analysis of prevalence estimates. Braz Dent J, 29, 606–618. Bairappan, S., & Puranik, M. P. (2020). Impact of asthma and its medication on salivary characteristics and oral health in adolescents: A cross-sectional comparative study. Special Care in Dentistry, 40(3), 227–237. Beltrán, V., Muñoz-Sepúlveda, F., Acevedo, C., Navarro, P., Venegas, B., Salgado, C., et al. (2024). A rural teledentistry care experience: A geriatric approach to assessing oral health status and treatment needs in older adults from a Mapuche community in Chile. Front Public Health, 12, 1356622. Bozejac, B. V., Stojšin, I., Ðuric, M., Zvezdin, B., Brkanić, T., Budišin, E., Vukoje, K., & Sečen, N. (2017). Impact of inhalation therapy on the incidence of carious lesions in patients with asthma and COPD. Journal of Applied Oral Science, 25, 506–514. Brigic, A., Kobaslija, S., & Zukanovic, A. (2015). Cariogenic potential of inhaled antiasthmatic drugs. Med Arch, 69, 247. Chumpitaz-Cerrate, V., Bellido-Meza, J. A., Chávez-Rimache, L., & Rodríguez-Vargas, C. (2020). Impact of inhaler use on dental caries in asthma pediatrics patients: A case-control study. Arch Argent Pediatr, 118, 38–46. Ciardo, A., Simon, M. M., Eberhardt, R., Brock, J. M., Ritz, A., & Kim, T. S. (2024). Severe chronic obstructive pulmonary disease is associated with reduced oral health conditions. Oral Dis, 30, 3400–3412. Dewi, P. M. K., & Wesnawa, M. A. D. P. (2024). Effect of inhalation therapy on oral health in patients with chronic airway disease. World J Adv Res Rev, 23, 2502–2508. Donohue, J. F., Maleki-Yazdi, M., Kilbride, S., Mehta, R., Kalberg, C., & Church, A. (2013). Efficacy and safety of once-daily umeclidinium/vilanterol 62.5/25 mcg in COPD. Respir Med, 107, 1538–1546. Donohue, J. F., van Noord, J. A., Bateman, E. D., Langley, S. J., Lee, A., Witek, T. J. Jr., et al. (2002). A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest, 122, 47–55. Elyassi Gorji, N., Nasiri, P., Malekzadeh Shafaroudi, A., & Moosazadeh, M. (2021). Comparison of dental caries (DMFT and DMFS indices) between asthmatic patients and control group in Iran: A meta-analysis. Asthma Res Pract, 7, 1–9. Ersin, N. K., Gülen, F., Eronat, N., Coğulu, D., Demir, E., Tanaç, R., et al. (2006). Oral and dental manifestations of young asthmatics related to medication, severity and duration of condition. Pediatr Int, 48, 549–554. Ferreira, M. K. M., de Oliveira Ferreira, R., Castro, M. M. L., Magno, M. B., Carvalho, A. P. C. P. S., Fagundes, N. C. F., Maia, L. C., & Lima, R. R. (2019). Is there an association between asthma and periodontal disease among adults? Systematic review and meta-analysis. Life Sciences, 223, 74–87. Gani, F., Caminati, M., Bellavia, F., Baroso, A., Faccioni, P., Pancera, P., et al. (2020). Oral health in asthmatic patients: A review: Asthma and its therapy may impact on oral health. Clin Mol Allergy, 18, 1–8. Godara, N., Godara, R., & Khullar, M. (2011). Impact of inhalation therapy on oral health. Lung India, 28, 272–275. Gomes-Filho, I. S., Cruz, S. S., Trindade, S. C., Passos-Soares, J. S., Carvalho-Filho, P. C., Figueiredo, A. C. M. G., et al. (2020). Periodontitis and respiratory diseases: A systematic review with meta-analysis. Oral Dis, 26, 439–446. Görgün, E. A., Çağlayan, F., & Tohumcu, A. (2021). Sağlıklı bireylerde kuru ağız subjektif semptomlarının görülme sıklığının değerlendirilmesi. Curr Res Health Sci, 1, 48–51. Jacob, L. E., Krishnan, M., Mathew, A., Mathew, A. L., Baby, T. K., & Krishnan, A. (2022). Xerostomia – A comprehensive review with a focus on mid-life health. J Midlife Health, 13, 100–106. Johnstone, L. K., Bereznicki, B. J., Jacobson, G., & Thompson, A. J. (2021). Implementation of mouth rinsing after use of inhaled corticosteroids in Australia. Int J Clin Pharm, 43, 549–555. Köktürk, N., & Adına, K. Ç. G. (2017). Türk Toraks Derneği'nin GOLD 2017 Kronik Obstrüktif Akciğer Hastalığı (KOAH) raporuna bakışı. Lipsky, M. S., Singh, T., Zakeri, G., & Hung, M. (2024). Oral health and older adults: A narrative review. Dent J (Basel), 12, 30. Liu, B., Dion, M. R., Jurasic, M. M., Gibson, G., & Jones, J. A. (2012). Xerostomia and salivary hypofunction in vulnerable elders: Prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol, 114, 52–60. Lopez-de-Andres, A., Vazquez-Vazquez, L., Martinez-Huedo, M. A., Hernández-Barrera, V., Jimenez-Trujillo, I., Tapias-Ledesma, M. A., de Miguel-Diez, J., & Jimenez-Garcia, R. (2018). Is COPD associated with periodontal disease? A population-based study in Spain. Int J Chron Obstruct Pulmon Dis, 3435–3445. Okuno, K., Masago, A., Himejima, A., & Takahashi, K. (2024). The efficacy of occlusal appliance with a moisturizing gel pocket on sleep quality in patients with nocturnal xerostomia: A case series. J Prosthodont Res. Advance online publication. Orozco, R. J., Rodriguez, D., Hunter, K., & Roy, S. (2024). The 2021 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and the outpatient management: Examining physician adherence and its effects on patient outcome. J Fam Med Prim Care, 13, 736–742. Przybyłowska, D., Mierzińska‐Nastalska, E., Swoboda‐Kopeć, E., Rubinsztajn, R., & Chazan, R. (2016). Potential respiratory pathogens colonisation of the denture plaque of patients with chronic obstructive pulmonary disease. Gerodontology, 33, 322–327. Raj, R., Manu, M. K., Prakash, P. Y., Singhal, D. K., & Acharya, S. (2018). The effect of 6 months or longer duration of chronic obstructive respiratory disease medication on the oral health parameters of adults. Special Care in Dentistry, 38(3), 133–138. Shi, Q., Zhang, B., Xing, H., Yang, S., Xu, J., & Liu, H. (2018). Patients with chronic obstructive pulmonary disease suffer from worse periodontal health—evidence from a meta-analysis. Front Physiol, 9, 33. Silva Junior, M. F., Sousa, M. d. L. R., & Batista, M. J. (2019). Reducing social inequalities in the oral health of an adult population. Braz Oral Res, 33, e102. Singh, D., Agusti, A., Anzueto, A., Barnes, P. J., Bourbeau, J., Celli, B. R., et al. (2019). Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD science committee report 2019. Eur Respir J, 53(5). Smith, C. H., Boland, B., Daureeawoo, Y., Donaldson, E., Small, K., & Tuomainen, J. (2013). Effect of aging on stimulated salivary flow in adults. J Am Geriatr Soc, 61, 805–808. Sreebny, L. M., & Schwartz, S. S. (1997). A reference guide to drugs and dry mouth (2nd ed.). Gerodontology, 14, 33–47. Świątkowska-Bury, M., Zawadzka-Krajewska, A., Kulus, M., & Olczak-Kowalczyk, D. (2021). The effect of the type of inhaled anti-asthmatic therapy on the properties of saliva in children–a phantom study. J Stomatol, 74, 22–27. Toraman, C. (2022). Kronik obstrüktif akciğer hastalığı olan bireylerde ağız sağlığı yaşam kalitesinin genel yaşam kalitesi üzerine etkisi [Yüksek lisans tezi, İstanbul Sağlık Bilimleri Enstitüsü]. Tuğrul, E. (2022). The relationship between inhaler use and oral problems in patients with COPD and affecting factors: A cross-sectional study. Florence Nightingale J Nurs, 30, 196. Vincken, W., Van Noord, J., Greefhorst, A., Bantje, T. A., Kesten, S., Korducki, L., et al. (2002). Improved health outcomes in patients with COPD during 1 yr’s treatment with tiotropium. Eur Respir J, 19, 209–216. Wang, Z., Zhou, X., Zhang, J., Zhang, L., Song, Y., Hu, F. B., et al. (2009). Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease. J Clin Periodontol, 36, 750–755. Yohannes, A. M., Willgoss, T. G., & Vestbo, J. (2011). Tiotropium for treatment of stable COPD: A meta-analysis of clinically relevant outcomes. Respir Care, 56, 477–487. Yokohama, H., Nakajima, Y., & Yamamura, Y. (2005). Investigation of mouth washing after inhaled corticosteroids in the patients. Yakugaku Zasshi, 125, 455–461.

Abstract

ABSTRACT Aim; The aim of this study is to evaluate the effects of inhaler use on dry mouth and salivary pH in patients with COPD and to compare the potential impacts of different types of inhalers on these parameters. Methods; This descriptive, cross-sectional, and controlled study was conducted with a sample consisting of 37 chronic obstructive pulmonary disease (COPD) patients who were receiving inhaler therapy at home and 30 individuals without a COPD diagnosis, serving as the control group. Participants were recruited from the Adult Emergency Department of Sabuncuoğlu Şerefeddin Training and Research Hospital between September and November 2024. Data were collected through face-to-face interviews using a “Personal Information Form,” pH indicator strips, and Schirmer’s tear test strips. Parametric and non-parametric statistical tests were employed for data analysis. Results; Compared to the control group, COPD patients exhibited significantly lower salivary pH levels and higher degrees of dry mouth (p<0.001). The majority of individuals using inhalers did not perform mouth rinsing or engage in oral hygiene practices after inhalation. Among COPD patients using inhalers, there were no statistically significant differences in salivary pH and dry mouth levels based on gender, age, tobacco/alcohol use, tooth loss, presence of dental prostheses, water consumption, or oral health behaviors. Conclusion; Dry mouth levels were significantly higher in COPD patients. Inhaler therapy in COPD may reduce salivary secretion, leading to increased xerostomia and decreased salivary pH. This condition elevates the risk of local side effects on the oral mucosa and may contribute to oral health complications. Keywords: COPD; inhaler therapy;dry mouth. Funding: This study was not supported by any institution. Aberg, F., & Helenius-Hietala, J. (2022). Oral health and liver disease: Bidirectional associations—a narrative review. Dent J (Basel), 10(16). Agha-Hosseini, F., Shirzad, N., & Moosavi, M. S. (2015). Evaluation of xerostomia and salivary flow rate in Hashimoto’s thyroiditis. Med Oral Patol Oral Cir Bucal, 21, e1–e6. Agostini, B. A., Cericato, G. O., Silveira, E. R., Nascimento, G. G., Costa, F. S., Thomson, W. M., et al. (2018). How common is dry mouth? Systematic review and meta-regression analysis of prevalence estimates. Braz Dent J, 29, 606–618. Bairappan, S., & Puranik, M. P. (2020). Impact of asthma and its medication on salivary characteristics and oral health in adolescents: A cross-sectional comparative study. Special Care in Dentistry, 40(3), 227–237. Beltrán, V., Muñoz-Sepúlveda, F., Acevedo, C., Navarro, P., Venegas, B., Salgado, C., et al. (2024). A rural teledentistry care experience: A geriatric approach to assessing oral health status and treatment needs in older adults from a Mapuche community in Chile. Front Public Health, 12, 1356622. Bozejac, B. V., Stojšin, I., Ðuric, M., Zvezdin, B., Brkanić, T., Budišin, E., Vukoje, K., & Sečen, N. (2017). Impact of inhalation therapy on the incidence of carious lesions in patients with asthma and COPD. Journal of Applied Oral Science, 25, 506–514. Brigic, A., Kobaslija, S., & Zukanovic, A. (2015). Cariogenic potential of inhaled antiasthmatic drugs. Med Arch, 69, 247. Chumpitaz-Cerrate, V., Bellido-Meza, J. A., Chávez-Rimache, L., & Rodríguez-Vargas, C. (2020). Impact of inhaler use on dental caries in asthma pediatrics patients: A case-control study. Arch Argent Pediatr, 118, 38–46. Ciardo, A., Simon, M. M., Eberhardt, R., Brock, J. M., Ritz, A., & Kim, T. S. (2024). Severe chronic obstructive pulmonary disease is associated with reduced oral health conditions. Oral Dis, 30, 3400–3412. Dewi, P. M. K., & Wesnawa, M. A. D. P. (2024). Effect of inhalation therapy on oral health in patients with chronic airway disease. World J Adv Res Rev, 23, 2502–2508. Donohue, J. F., Maleki-Yazdi, M., Kilbride, S., Mehta, R., Kalberg, C., & Church, A. (2013). Efficacy and safety of once-daily umeclidinium/vilanterol 62.5/25 mcg in COPD. Respir Med, 107, 1538–1546. Donohue, J. F., van Noord, J. A., Bateman, E. D., Langley, S. J., Lee, A., Witek, T. J. Jr., et al. (2002). A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest, 122, 47–55. Elyassi Gorji, N., Nasiri, P., Malekzadeh Shafaroudi, A., & Moosazadeh, M. (2021). Comparison of dental caries (DMFT and DMFS indices) between asthmatic patients and control group in Iran: A meta-analysis. Asthma Res Pract, 7, 1–9. Ersin, N. K., Gülen, F., Eronat, N., Coğulu, D., Demir, E., Tanaç, R., et al. (2006). Oral and dental manifestations of young asthmatics related to medication, severity and duration of condition. Pediatr Int, 48, 549–554. Ferreira, M. K. M., de Oliveira Ferreira, R., Castro, M. M. L., Magno, M. B., Carvalho, A. P. C. P. S., Fagundes, N. C. F., Maia, L. C., & Lima, R. R. (2019). Is there an association between asthma and periodontal disease among adults? Systematic review and meta-analysis. Life Sciences, 223, 74–87. Gani, F., Caminati, M., Bellavia, F., Baroso, A., Faccioni, P., Pancera, P., et al. (2020). Oral health in asthmatic patients: A review: Asthma and its therapy may impact on oral health. Clin Mol Allergy, 18, 1–8. Godara, N., Godara, R., & Khullar, M. (2011). Impact of inhalation therapy on oral health. Lung India, 28, 272–275. Gomes-Filho, I. S., Cruz, S. S., Trindade, S. C., Passos-Soares, J. S., Carvalho-Filho, P. C., Figueiredo, A. C. M. G., et al. (2020). Periodontitis and respiratory diseases: A systematic review with meta-analysis. Oral Dis, 26, 439–446. Görgün, E. A., Çağlayan, F., & Tohumcu, A. (2021). Sağlıklı bireylerde kuru ağız subjektif semptomlarının görülme sıklığının değerlendirilmesi. Curr Res Health Sci, 1, 48–51. Jacob, L. E., Krishnan, M., Mathew, A., Mathew, A. L., Baby, T. K., & Krishnan, A. (2022). Xerostomia – A comprehensive review with a focus on mid-life health. J Midlife Health, 13, 100–106. Johnstone, L. K., Bereznicki, B. J., Jacobson, G., & Thompson, A. J. (2021). Implementation of mouth rinsing after use of inhaled corticosteroids in Australia. Int J Clin Pharm, 43, 549–555. Köktürk, N., & Adına, K. Ç. G. (2017). Türk Toraks Derneği'nin GOLD 2017 Kronik Obstrüktif Akciğer Hastalığı (KOAH) raporuna bakışı. Lipsky, M. S., Singh, T., Zakeri, G., & Hung, M. (2024). Oral health and older adults: A narrative review. Dent J (Basel), 12, 30. Liu, B., Dion, M. R., Jurasic, M. M., Gibson, G., & Jones, J. A. (2012). Xerostomia and salivary hypofunction in vulnerable elders: Prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol, 114, 52–60. Lopez-de-Andres, A., Vazquez-Vazquez, L., Martinez-Huedo, M. A., Hernández-Barrera, V., Jimenez-Trujillo, I., Tapias-Ledesma, M. A., de Miguel-Diez, J., & Jimenez-Garcia, R. (2018). Is COPD associated with periodontal disease? A population-based study in Spain. Int J Chron Obstruct Pulmon Dis, 3435–3445. Okuno, K., Masago, A., Himejima, A., & Takahashi, K. (2024). The efficacy of occlusal appliance with a moisturizing gel pocket on sleep quality in patients with nocturnal xerostomia: A case series. J Prosthodont Res. Advance online publication. Orozco, R. J., Rodriguez, D., Hunter, K., & Roy, S. (2024). The 2021 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and the outpatient management: Examining physician adherence and its effects on patient outcome. J Fam Med Prim Care, 13, 736–742. Przybyłowska, D., Mierzińska‐Nastalska, E., Swoboda‐Kopeć, E., Rubinsztajn, R., & Chazan, R. (2016). Potential respiratory pathogens colonisation of the denture plaque of patients with chronic obstructive pulmonary disease. Gerodontology, 33, 322–327. Raj, R., Manu, M. K., Prakash, P. Y., Singhal, D. K., & Acharya, S. (2018). The effect of 6 months or longer duration of chronic obstructive respiratory disease medication on the oral health parameters of adults. Special Care in Dentistry, 38(3), 133–138. Shi, Q., Zhang, B., Xing, H., Yang, S., Xu, J., & Liu, H. (2018). Patients with chronic obstructive pulmonary disease suffer from worse periodontal health—evidence from a meta-analysis. Front Physiol, 9, 33. Silva Junior, M. F., Sousa, M. d. L. R., & Batista, M. J. (2019). Reducing social inequalities in the oral health of an adult population. Braz Oral Res, 33, e102. Singh, D., Agusti, A., Anzueto, A., Barnes, P. J., Bourbeau, J., Celli, B. R., et al. (2019). Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD science committee report 2019. Eur Respir J, 53(5). Smith, C. H., Boland, B., Daureeawoo, Y., Donaldson, E., Small, K., & Tuomainen, J. (2013). Effect of aging on stimulated salivary flow in adults. J Am Geriatr Soc, 61, 805–808. Sreebny, L. M., & Schwartz, S. S. (1997). A reference guide to drugs and dry mouth (2nd ed.). Gerodontology, 14, 33–47. Świątkowska-Bury, M., Zawadzka-Krajewska, A., Kulus, M., & Olczak-Kowalczyk, D. (2021). The effect of the type of inhaled anti-asthmatic therapy on the properties of saliva in children–a phantom study. J Stomatol, 74, 22–27. Toraman, C. (2022). Kronik obstrüktif akciğer hastalığı olan bireylerde ağız sağlığı yaşam kalitesinin genel yaşam kalitesi üzerine etkisi [Yüksek lisans tezi, İstanbul Sağlık Bilimleri Enstitüsü]. Tuğrul, E. (2022). The relationship between inhaler use and oral problems in patients with COPD and affecting factors: A cross-sectional study. Florence Nightingale J Nurs, 30, 196. Vincken, W., Van Noord, J., Greefhorst, A., Bantje, T. A., Kesten, S., Korducki, L., et al. (2002). Improved health outcomes in patients with COPD during 1 yr’s treatment with tiotropium. Eur Respir J, 19, 209–216. Wang, Z., Zhou, X., Zhang, J., Zhang, L., Song, Y., Hu, F. B., et al. (2009). Periodontal health, oral health behaviours, and chronic obstructive pulmonary disease. J Clin Periodontol, 36, 750–755. Yohannes, A. M., Willgoss, T. G., & Vestbo, J. (2011). Tiotropium for treatment of stable COPD: A meta-analysis of clinically relevant outcomes. Respir Care, 56, 477–487. Yokohama, H., Nakajima, Y., & Yamamura, Y. (2005). Investigation of mouth washing after inhaled corticosteroids in the patients. Yakugaku Zasshi, 125, 455–461.

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Bu Makaleye Atıf Yap

Ilıman, A. Y., Kalınbacak, C. (2026). KOAH Hastalarında İnhaler Kullanımı ile Ağız Kuruluğu Düzeyi Arasındaki İlişki: Analitik Kesitsel Bir Araştırma. Ege Üniversitesi Hemşirelik Fakültesi Dergisi, Cilt: 42 Sayı: 2, 299–309. https://doi.org/10.53490/egehemsire.1772642

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Kaynakça (53)

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