ObjectiveTo explore the distribution of mite allergens in chronic obstructive pulmonary disease (COPD) patients and the role of allergen in acute exacerbation of COPD (AECOPD) in Hainan Province. MethodsWe selected 65 COPD patients, 58 other patients without allergic disease and 34 healthy subjects as the control group from January to June in 2009. All subjects underwent skin prick test (SPT) to make statistical analysis. We observed the COPD patients for 3 years to analyze the correlation between SPT positive incidence and frequency of acute exacerbation. ResultsThe SPT positive incidence was higher in the COPD group (P<0.05). The most frequent allergen in COPD group was Blomia Tropicalis. But the SPT positive incidence and frequency of acute exacerbation was not obvious correlated (P>0.05). ConclusionThe exogenous allergens may participate in the pathogenesis of COPD. Blomia Tropicalis may be an important allergen of COPD patients in Hainan Province other than Dermatophagoides Pteronyssinus and Dermatophagoides Farinae. But allergy does not play a role in acute exacerbation of COPD.
Objective To evaluate the efficacy and safety of traditional Chinese medicine(TCM) paste in treating chronic obstructive pulmonary disease (COPD) in stable stage. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2016), VIP, WanFang Data, CNKI and CBM to collect randomized controlled trials (RCTs) regarding TCM paste in combination with conventional Western therapy versus Western therapy alone in treating stable COPD from inception to December 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The meta-analysis was conducted by RevMan 5.3 software. Results A total of 9 RCTs involving 605 Chinese patients were included. The results of meta-analysis showed that: when compared with conventional Western medicine alone, TCM paste combined with the conventional Western medicine significantly improved clinical effective rate (RR=1.20, 95% CI 1.10 to 1.31,P<0.000 1), decreased SGRQ score (MD=–4.53, 95% CI –5.41 to –3.65,P<0.000 01) and CAT score (MD=–2.45, 95% CI –3.38 to –1.51,P<0.000 01), increased FEV1% (MD=3.80, 95% CI 0.40 to 7.20,P=0.03), and reduced the frequency of acute exacerbation (P<0.05). No serious adverse reaction occurred in both groups. Conclusion The current evidence shows that combination of TCM paste and conventional Western medicine may improve clinical effective rate, quality of life, increase FEV1%, and reduce the frequency of acute exacerbation in patients with stable COPD. Due to the limited quality and quantity of included studies, the above results are needed to verify by more studies.
Objective To investigate the changes of pulmonary diffusing capacity and pulmonary capillary blood volume in stable COPD patients with mixed ventilation dysfunction, and explore the possible pathophysiological factors. Methods 159 stable COPD patients with mixed ventilation dysfunction were recruited in the study and 36 normal subjects were recruited as control. The Belgium medisoft box5500 was used to determine the pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity. The measured parameters included forced vital capacity ( FVC) , forced expiratory volume in one second ( FEV1 ) ,maximal voluntary ventilation ( MVV) , vital capacity ( VC) , total lung capacity( TLC) , residual volume ( RV) , minute volume of alveolar ventilation ( VA ) , lung diffusing capacity for carbon monoxide ( DLCO) , pulmonary membrane diffusing capacity for carbon monoxide ( DMCO) , and pulmonary capillary blood volume ( Vc) . The above parameters were compared between the COPD patients and the normal subjects. The relationship was analyzed between DLCO% pred, DMCO% pred, Vc% pred and all the ventilation parameters. Results In stable COPD patients with mixed ventilation dysfunction, all parameters of pulmonary ventilation function, lung capacity, and pulmonary diffusing capacity were significantly different from the normal subjects ( Plt;0. 05 or Plt;0.01) . FVC, VC, VA, and DMCO of the COPD patients were about 66% of the calculated value or more. The average TLC%pred was a little higher than the normal. FEV1 , MVV, DLCO and Vc were abnormally lower which were between 36% ～44% . The average RV%pred was 188% of the predicted value. Obvious correlation could be detected between DLCO% pred, DMCO% pred, Vc%pred and FEV1%pred, FEV1/FVC, TLC% pred, RV%pred, RV/TLC and VA% pred etc.Conclusions In COPD patients with mixed ventilation dysfunction, the pulmonary blood capillary is damaged seriously which lead to a significant decrease of the capacity of pulmonary blood capillary, as well as seriously air distribution disturbance and ventilation/bloodstream mismatch. The Vc decline may develope before the impairment of pulmonary diffusing capacity which may contribute to the damaged of DLCO and DMCO.
Objective To investigate the effect of chronic altitude hypoxia exposure on serum lipoprotein levels in healthy subjects and patients with pulmonary hypertension, and whether there is a difference in serum lipoprotein levels between patients with pulmonary hypertension at middle and high altitude. Methods The case data of 245 Han patients with COPD complicated with pulmonary hypertension admitted to the Affiliated Hospital of Qinghai University from January 2018 to September 2022 were retrospectively analyzed. According to the altitude of their long-term residence before onset, the patients were divided into two groups, 119 cases in the middle altitude group (1500 m~2500 m). 126 cases were in the high altitude group of 2500 m~4500 m. In addition, the physical examination data of 50 healthy people in the intermediate and high altitude groups were collected as the control group (the age and gender of the healthy people in the same altitude group were similar to those in the COPD-PH group), a total of 4 groups were collected. The general data, pulmonary artery systolic blood pressure (PASP), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) of the four groups were compared, and the correlation between pulmonary artery systolic blood pressure (PASP) and related variables was analyzed. ResultsThere were no significant differences in age, gender, smoking and drinking between the healthy control group and COPD-PH group (all P>0.05). There were significant differences in body mass index, PASP, TC, TG, HDL-C, LDL-C, TG/HDL-C, HDL-C/LDL-C between the healthy control group and the COPD-PH group (all P<0.05). In the healthy control group, only BMI was significantly different between the high altitude group and the middle altitude group (P<0.05). In the COPD-PH group, PASP, BMI, TC, HDL-C and TG/HDL-C in the high altitude group were significantly different from those in the moderate altitude group (all P<0.05). There were no significant differences in age, gender, smoking, drinking, TG, LDL-C and HDL-C/LDL-C between the two groups (all P>0.05), when gender, age, altitude, body mass index, PASP, smoking and drinking were included in the multi-factor linear regression equation of lipoprotein (TC, TG, HDL-C and LDL-C), it was found that different elevations (middle and higher elevations) only had statistically different effects on HDL-C (b=-0.046, t=-2.209, P=0.028). Correlation analysis showed that PASP was not correlated with age, altitude, body mass index and blood lipids (TC, TG, HDL-C, LDL-C) in the healthy control group (all P>0.05). However, in the COPD-PH group, PASP was negatively correlated with blood lipid indicators (TC, HDL-C and LDL-C). PASP was positively correlated with altitude (a risk factor for hypoxia). ConclusionsHypoxia environment factors characterized by altitude are closely related to the severity of pulmonary artery pressure in patients with COPD-PH, and higher pulmonary artery systolic pressure is closely related to lower levels of TC, HDL-C and LDL-C.
ObjectiveTo investigate the prevalence of chronic obstructive pulmonary disease (COPD) and related risk factors in two districts and five counties in Jiaxing city of Zhejiang province. MethodsWe randomly selected people over the age of 40 in 10 communities of two districts and five counties in Jiaxing city by cluster sampling and random sampling to investigate the prevalence of COPD from January 2013 to December 2013. All included patients received pulmonary function test at the same time. ResultsA total of 1 256 cases of adults over the age of 40 were included, among which, 1 056 cases with complete data and qualified for pulmonary function test. There were 410 males with mean age of 58.74±11.62, and 646 females with mean age of 59.45±11.72. The overall prevalence of COPD was 13.60%. Male and female prevalence rates were 13.90% and 13.41%, respectively. Divided by age, the prevalence of the age of 40 to 50 was 3.38%, the age of 51 to 60 was 9.57%, the age of 61 to 70 was 19.15%, and the age of above 70 was 29.35%. The results of multivariate logistic regression analysis showed that the main risk factors of COPD were smoking, passive smoking, history of dust exposure, chronic respiratory disease history and age. ConclusionThe total prevalence of COPD in Jiaxing area is high, and the female prevalence rate is especially higher than the national average level, which is the epidemiological characteristic of this area. Because the risk factors of COPD are complex, an integrated control strategy should be adopted.
Objective To investigate the influence of different mechanical ventilation modes on inflammatory reaction among COPD patients with severe respiratory failure. Methods A total of 102 COPD patients with severe respiratory failure, admitted in Zhongshan Hospital between January 20007 and June 2012, were enrolled in this study. The subjects were divided into an ASV group receiving adaptive support ventilation, and a SIMV + PSV group received synchronized intermittent mandatory ventilation and pressure support ventilation, with 51 cases in each group. Breathing pattern, respiratory mechanics, hemodynamic parameters and seruminflammatory factors were examined among all patients. Results Tidal volume ( VT ) was significantly higher, and the control respiratory rate and ventilation time were significantly lower in the ASV group than those in the SIMV + PSV group ( P lt; 0.05) . Comparing with the SIMV + PSV group, obviously lower peak airway pressure ( Ppeak) ,mean airway pressure ( Pmean) and airway plateau pressure ( Pplat) were observed in the ASV group ( P lt; 0.05) . The patients in the ASV group had obviously lower levels of C-reactive protein, procalcitonin and α1 acid glycoprotein. Conclusion ASV ventilation mode may reduce the inflammatory reaction, facilitate spontaneously breathing and decrease mechanical ventilation time.
ObjectiveTo observe the frequency and severity of carotid atherosclerotic stenosis in senior chronic obstructive pulmonary disease (COPD) patients and explore the related risk factors in order to provide a theoretical basis for the effective prevention of cardiovascular comorbidity in COPD. MethodsStable COPD out-patients followed up in Sichuan Provincial People's Hospital were prospectively enrolled between August 2012 and August 2015, who had carotid atherosclerosis confirmed by cervical vascular color ultrasonic inspection within 3 months. All the patients were divided into a carotid stenosis group and a non-carotid stenosis group. Demographic and laboratory data were extracted and compared between two groups. Pearson correlation and Logistic regression analysis were performed to analyze the risk factors related to carotid stenosis. ResultsOf 380 consecutive senior patients with COPD and carotid atherosclerosis, 199 (52.37%) had carotid stenosis. Compared with those without carotid stenosis, the patients in the carotid stenosis group had significantly higher levels of hypersensitive C reactive protein (hs-CRP), uric acid (UA), brain natriuretic peptide (BNP) and smoking index (P < 0.05). Lower levels of forced expiratory volume in one second (FEV1%) and body mass index (BMI) were also observed in the carotid stenosis group (P < 0.05). Pearson correlation and logistic regression analysis showed that hs-CRP (OR 1.040, 95%CI 1.011-3.070), UA (OR 1.003, 95%CI 1.000-2.006), FEV1 (OR 0.899, 95%CI 0.200-5.722), smoking index (OR 1.002, 95%CI 1.001-2.904) and BMI (OR 0.955, 95%CI 0.312-4.866) were associated with carotid stenosis. ConclusionsCarotid atherosclerotic stenosis is common in senior COPD patients. Higher levels of hs-CRP, UA and smoking index and lower levels of FEV1 and BMI may be independent risk factors for carotid stenosis in COPD.
Objective To compare the clinical characteristics and treatment of patients with chronic obstructive pulmonary disease (COPD) in the year of 2018, 2019, 2020, and 2021. Methods A cross-sectional multicenter study was conducted on patients with stable COPD from 13 hospitals of China south area in year of 2018, 2019, 2020 and 2021. The demographic data, pulmonary function, COPD assessment test (CAT), exacerbation in the past year and treatment regimens were collected. Results The CAT scores of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (16.5±6.7), (14.5±6.7), (14.1±6.2) and (13.4±6.6), respectively. The CAT scores decreased year by year (P<0.05). The forced expiratory volume in one second percentage predicted value (FEV1%pred) of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (52.8±21.4)%, (51.3±19.2)%, (53.4±21.5)% and (56.6±21.7)%, respectively. Compared with year of 2018, the patients in 2019, 2020 and 2021 had higher FEV1%pred. Compared with year of 2019 and 2020, the patients 2021 had higher FEV1%pred (P<0.05). The median of exacerbation in the past year of the COPD patients in the year of 2018, 2019, 2020 and 2021 were 1, 1, 0 and 0, respectively. Compared with year of 2018 and 2019, the median of exacerbation in the past year in 2020 and 2021 were lower (P<0.05). The proportion of double [long-acting β2-agonist (LABA)+long-acting muscarinic antagonist (LAMA)] and triple inhaled [LAMA+LABA+ inhaled corticosteroid (ICS)] drugs were 0%, 0.7%, 3.5% and 17.0%, as well as 47.9%, 41.2%, 27.8% and 26.0%. Compared with year of 2018 and 2019, the proportion of double inhaled drugs in 2020 and 2021 was higher, while triple inhaled drugs was lower (P<0.05). In addition, the proportion of influenza vaccine/pneumonia vaccine was 0%, 0.1%, 3.5% and 4.3%, respectively. Compared with year of 2018 and 2019, the proportion of influenza vaccine/pneumonia vaccine in year of 2020 and 2021 was higher (P<0.05). Conclusions Symptoms and exacerbation burden of patients with COPD tend to be less in China in recent years and the time of patients visited hospital tends to move forward. Furthermore, the proportion of patients with double inhaled drugs (LABA+LAMA) increased, while triple inhaled (LAMA+LABA+ICS) decreased. In addition, the proportion of patients vaccinated with influenza/pneumonia is increased but the overall proportion is still low.
Objective To investigate the effectiveness of noninvasive positive pressure ventilation( NPPV) in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) complicated with severe type Ⅱ respiratory failure.Methods 37 patients who were admitted fromJanuary 2008 to June 2009 due to AECOPD complicated with severe type Ⅱ respiratory failure and had received NPPV therapy were enrolled as a NPPV group. Another similar 42 cases who had not received NPPV therapy served as control. All subjects received standard medication therapy according to the guideline. Arterial blood gases before and after treatment, the duration of hospitalization and intubation rate were observed. Results The arterial pH, PaO2 ,and PaCO2 improved significantly after treatment as compared with baseline in both groups ( P lt; 0. 05) .Compared with the control group, the average duration of hospitalization was significantly shorter ( 10 ±5 vs.19 ±4 days, P lt;0. 05) and the intubation rate was significantly lower ( 2. 7% vs. 16. 7% , P lt;0. 05) in the NPPV group. Conclusion The use of NPPV in AECOPD patients complicated with severe type Ⅱ respiratory failure is effective in improving arterial blood gases, reducing the duration of hospitalization and intubation rate.
ObjectiveTo investigate the expression of CD4+CD25highCD127lowTreg (Treg) and related cytokines in peripheral blood of COPD patients with pulmonary hypertension and explore its clinical significance. MethodsPeripheral blood lymphocytes and serum were collected from 65 COPD patients with chronic pulmonary hypertension (the CPH group) and 20 COPD patients with normal pulmonary artery pressure (the control group). Flow cytometry was used to detect the Treg/CD4+ T cells and calculate its ratio, enzyme-linked immunosorbent assay was used to detect the serum contents of interleukin (IL)-6,IL-10 and tumor necrosis factor α (TNF-α). ResultsTreg can be detected in the peripheral blood of patients of COPD with or without PH, however, the Treg ratio in the CPH group was significantly lower than that in the control group [(7.41±1.12)% vs. (9.04±2.11)%, P<0.05]. Compared with the control group, the IL-10 level was significantly lower [(4.47±0.88)pg/mL vs. (5.18±0.26)pg/mL], while IL-6and TNF-α contents were significantly higher in the CPH group [(7.49±0.95)pg/mL vs. (6.76±0.35)pg/mL, (28.61±9.16)pg/mL vs. (19.64±4.85)pg/mL, P<0.05]. There was a positive correlation between Treg ratio and serum IL-10 level (r=0.41, P<0.05), and negative correlation between Treg ratio and TNF-α or IL-6 contents (r=0.45 or 0.37,P<0.05). The Treg ratio of the patients with severe pulmonary hypertension was lower than that in the patients with mild pulmonary hypertension [(7.42±1.03)% vs. (10.47±2.55)%,P<0.05). ConclusionsContents of Treg and IL-10 decrease while IL-6 and TNF-α increase in peripheral blood of COPD patients with pulmonary hypertension. It suggests that Treg cells and related cytokines may involve in the pathogenesis and progression of CPH. Treg may becomea potential biological prognosis indicator and treatment target of CPH in the future.