ObjectiveTo explore the characteristics of induced sputum microbiome in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsInduced sputum samples from 55 patients with AECOPD and 45 patients with stable COPD were analyzed by sequencing of 16S rRNA gene. Microbiota was measured by alpha diversity, beta diversity and LDA effect size analysis (LefSe).ResultsThe microbiome diversity of induced sputum in the AECOPD group was lower than that in the stable COPD group. The microbiome richness in the AECOPD group was higher than that in the stable COPD group. The microbiome structure changed in the AECOPD group compared with the stable COPD group. The proportion of some common pathogens got enriched. The levels of hypersensitive C reactive protein (hs-CRP), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α) and Global Initative for Chronic Obstructive Lung Disease (GOLD) grade were negatively related to the diversity of microbiome in the AECOPD group.ConclusionsThe microbiome diversity of induced sputum in AECOPD patients is decreased, and is negatively correlated with the levels of hs-CRP, IL-8, TNF-α and GOLD grade. There are differences in the microbiome structure between AECOPD and stable COPD patients. Some enrichment of common pathogens are found in the induced sputum of patients with AECOPD. These results suggest that there is a significant bacterial dysbiosis in patients with AECOPD.
Objective To improve the awareness of acute exacerbation of idiopathic pulmonary fibrosis ( AEIPF) and discuss its clinical characteristics, diagnosis, treatment and outcome. Methods The clinical data of patients with AEIPF from June 2006 to June 2011 in 11 hospitals in Jiangsu were collected and analyzed. Resluts There were 18 males and 3 females in the AEIPF patients with mean age of ( 67.4 ± 8.1) years. The duration from IPF diagnosis was ( 7.4 ±8.2) months. The duration of acute symptom before admission was ( 7.0 ±5.3) days. The distribution pattern of new groud-glass opacity was peripheral in 3 patients,multifocal in 5 patients, and diffuse in13 patients. All patients were treated with corticosteroid pulse therapy. Nine patients survived and 12 patients died. The mortality rate was 57.1% . Conclusions AEIPF progresses quickly and the mortality rate is very high. Corticosteroid pulse therapy is the mainstay of therapy in AEIPF patients.
ObjectiveTo systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in Post-extubation acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. MethodsThe Domestic and foreign databases were searched for all published available randomized controlled trials (RCTs) about HFNC therapy in post-extubation AECOPD patients. The experimental group was treated with HFNC, while the control group was treated with non-invasive positive pressure ventilation (NIPPV). The main outcome measurements included reintubation rate. The secondary outcomes measurements included oxygenation index after extubation, length of intensive care unit (ICU) stay, mortality, comfort score and adverse reaction rate. Meta-analysis was performed by Revman 5.3 software. ResultA total of 20 articles were enrolled. There were 1516 patients enrolled, with 754 patients in HFNC group, and 762 patients in control group. The results of Meta-analysis showed that there were no significant difference in reintubation rate [RR=1.41, 95%CI 0.97 - 2.07, P=0.08] and mortality [RR=0.91, 95%CI 0.58 - 1.44, P=0.69]. Compared with NIPPV, HFNC have advantages in 24 h oxygenation index after extubation [MD=4.66, 95%CI 0.26 - 9.05, P=0.04], length of ICU stay [High risk group: SMD –0.52, 95%CI –0.74 - –0.30; Medium and low risk group: MD –1.12, 95%CI –1.56- –0.67; P<0.00001], comfort score [MD=1.90, 95%CI 1.61 - 2.19, P<0.00001] and adverse reaction rate [RR=0.22, 95%CI 0.16 - 0.31, P<0.00001]. ConclusionsCompared with NIPPV, HFNC could improve oxygenation index after extubation, shorten the length of ICU stay, effectively improve Patient comfort, reduce the occurrence of adverse reactions and it did not increase the risk of reintubation and mortality. It is suggested that HFNC can be cautiously tried for sequential treatment of AECOPD patients after extubation, especially those who cannot tolerate NIPPV.
ObjectiveTo explore the changes of the B lymphocyte-derived microparticles (BLMPs) in the bronchoalveolar lavage fluid in patients with chronic obstructive pulmonary disease (COPD),and analyze the correlation between BLMPs changes and the stages of the disease. Methods33 COPD patients in acute exacerbation and 12 COPD patients in stable phase in Southwest Hospital,Xinqiao Hospital,and First Affiliated Hospital of Chongqing Medical University between March 2012 and March 2013 were enrolled in the study. 31 subjects who underwent physical examination and bronchoscopy were recruited as control. The lavage fluid specimens were collected through fiberoptic bronchoscopy,then marked with the corresponding antibodies after centrifugation. The numbers of microparticles were analyzed by flow cytometry. ResultsThe number of the BLMPs was significant different among three groups (P<0.05). Compared with the control group and the stable COPD group,the number of BLMPs in the AECOPD group was significantly reduced (P<0.05). Compared with the control group,the number of the BLMPs in the stable COPD group was reduced but with no significant difference (P>0.05). The numbers of BLMPs had no correlation with the smoking history,gender,age and body surface area. ConclusionThe number of BLMPs is reduced in COPD,especially in the acute exacerbation stage,so the reductions of the BLMPs may be associated with the stages of the disease. Smoking,gender,age,body surface area have no effect on the number of BLMPs.
Objective To analyze the distribution of pathogens, drug susceptibility and multi-drug resistant bacteria (MDRB) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. Methods The clinical data of patients whose discharge diagnosis included AECOPD with pneumonia or pulmonary infection from January 2012 to December 2015 were retrospectively analyzed. Strain identification and drug sensitivity analysis were performed in the pathogenic bacterias isolated from sputum culture. Results A total of 1 978 patients were enrolled in this study, and pathogenic bacterias were isolated from the sputum of 708 patients, including 485 cases of community-acquired pneumonia (CAP) and 223 cases of hospital-acquired pneumonia (HAP); and 786 strains of pathogens were isolated (501 strains from CAP cases, 285 strains from HAP cases), including 448 strains of Gram-negative (G–) bacilli (57.0%), 117 strains of Gram-positive (G+) cocci (14.9%), and 221 strains of fungi (28.1%). Susceptibility testing results showed that G– bacilli were highly resistant to penicillins, third generation cephalosporins, ciprofloxacin, gentamicin, etc., and G+ cocci were highly resistant to penicillin, clindamycin and erythromycin. There were 238 strains of MDRB, mainly including 69 strains of Acinetobacter baumanii [multiple drug resistance rate (MDRR)=67.6%], 27 strains of Escherichia coli (MDRR=52.9%), 25 strains of Klebsiella pneumoniae (MDRR=34.2%), 33 strains of Pseudomonas aeruginosa (MDRR=33.0%) and 24 strains of Stenotrophomonas maltophilia (MDRR=100.0%). MDRR of Enterococcus genus and methicillin-resistant Staphylococcus aureus was 50.0% and 48.0%, respectively. Conclusions The pathogenic bacterias in elderly AECOPD patients complicated with pneumonia are mainly G– bacterias, and the proportion of fungal infection tends to increase. Bacterial drug resistance is serious and the MDRB tends to increase, especially in patients with HAP. Physicians should early find out the characteristics of local pathogenic bacteria and drug sensitivity, rationally select antibiotics, reduce the occurrence of drug-resistant strains and superinfection when treating the elderly patients with AECOPD complicated with pneumonia.
ObjectivesTo explore the safety and efficacy of beta-blockers (BBs) in patients with chronic obstructive pulmonary disease (COPD) and its effect on prognosis. MethodsThe data of 366 patients with acute exacerbation of COPD in this department were analyzed retrospectively. The use rate and related events of BBs were evaluated, including comorbidity, indications, contraindications and related clinical indicators. ResultsOf the 366 patients, 156 (42.6%) had at least one indication of the use of BBs, but only 53 (34.0%) of these patients used BBs, and 61 patients (39.1%) had no contraindications but did not use BBs. At admission, 72 patients (19.7%) were treated with BBs, 177 (45.6%) with antiplatelet drugs, 145 (39.6%) with statins, and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker was used in 168 (45.9%) patients. Twenty-five patients (6.8%) had ischemic heart disease during hospitalization. Fifty-seven patients (15.6%) had cardiovascular and cerebrovascular events during admission. The patients with cardiovascular and cerebrovascular events had longer hospitalization (P<0.01) and higher in-hospital mortality (P=0.02). ConclusionsPatients with COPD have a clear indication of BBs use, but the clinical use rate is still very low. Further research is needed to explore the prescription disorders of BBs in patients with COPD.
ObjectiveTo investigate the effect of diammonium glycyrrhizinate (DG) plus bone marrow mesenchymal stem cells (MSCs) transplantation in the treatment of acute exacerbation of pulmonary fibrosis induced by bleomycin (BLM) in rats.MethodsMSCs were isolated from male Wistar rats and cultured in vitro. Twenty-four female Wistar rats were randomly divided into 4 groups. The NC group was intratracheally injected with normal saline; the BLM group, the MSC group and the DGMSC group were intratracheally injected with BLM for 7 days; then the MSC group was injected with 0.5 mL of MSCs solution (2.5×106 cells) into the tail vein; the DGMSC group was intraperitoneally injected with DG for 21 days in a dose of 150 mg·kg–1·d–1 on the base of the MSCs injection. The rats were sacrificed on the 28th day and the lung tissue was extracted. Pathological examination was performed to determine the degree of alveolitis and pulmonary fibrosis. Immunofluorescence was used to detect the number and distribution of alveolar type Ⅱ epithelial cells. Alkali hydrolysis method was used to determine the content of hydroxyproline (HYP) in lung tissue; thiobarbituric acid method was used to measure the content of malondialdehyde (MDA) in lung tissue; colorimetric method was used to determine the superoxide dismutase activity (SOD) and total antioxidant capacity (T-AOC); enzyme linked immunosorbent assay was used to detect the expression levels of tumor necrosis factor-α (TNF-α ) and transforming growth factor-β1 (TGF-β1) in lung tissue homogenates.ResultsThe DG combined with MSCs injection can reduce the degree of alveolitis and pulmonary fibrosis in BLM model rats. The content of HYP and TGF-β1 in lung tissue homogenate of the DGMSC group were significantly lower than those in the MSC group (P<0.05). Meanwhile, DG combined with MSCs injection significantly increased the antioxidant capacity of the BLM model rats. MDA content decreased, SOD activity and T-AOC ability improved significantly in the DGMSC group compared with the MSC group (P<0.05). The alveolar type Ⅱ epithelial cells were significantly increased and the cell morphology was maintained in the DGMSC group compared with the MSC group.ConclusionsDG has a synergistic effect with MSCs in treatment of acute exacerbation of pulmonary fibrosis. The mechanism may be related to reducing inflammatory factors during pulmonary fibrosis, attenuating oxidative stress and promoting MSCs migration into lung tissue and transformation to alveolar type Ⅱ epithelial cells.
Objective To analyze the difference of sputum flora between acute exacerbation and stable chronic obstructive pulmonary disease (COPD) patients basing on metagenomic next generation sequencing (mNGS), and its relationship with clinical indicators. The role of sputum flora of COPD patients in unexplained deterioration was explored, so as to find a targeted treatment plan. Methods From December 2021 to June 2022, 54 COPD patients who had a history of smoking were recruited, including 25 patients in stable COPD (SCOPD group) and 29 patients in acute exacerbation (AECOPD group). The sputum was collected and sequenced by mNGS, and the difference of sputum flora between the two groups was compared. Results Compared with SCOPD group, the evenness of sputum flora (Shannon index) in AECOPD group decreased significantly (P=0.019, Mann-Whitney U test). At the phylum level, the relative abundance of Fusobacteria in AECOPD group was significantly lower than that in SCOPD group (Z=–2.669, P=0.008). At genus level, compared with SCOPD group, the relative abundance of Fusobacterium and Haemophilus in AECOPD group decreased significantly (Z=–3.062, P=0.002; Z=–2.143, P=0.032), and the relative abundance of Granulicatella increased significantly (Z=–2.186, P=0.029). At species level, the relative abundance of sputum Haemophilus parainfluenzae, Moraxella catarrhalis and Haemophilus influenzae in AECOPD group was significantly lower than that in SCOPD group (Z=–2.230, P=0.026; Z=–2.125, P=0.034; Z=–2.099, P=0.036). At the time of acute exacerbation of COPD, the relative abundance of Gemella in sputum was positively correlated with forced expiratory volume in first second/forced vital capacity (FEV1/FVC) and body mass index (r=0.476, P=0.009; r=0.427, P=0.021), which was negatively correlated with nutrition risk screening 2002 (r=–0.570, P=0.001). The relative abundance of Neisseria and Neisseria subflava was negatively correlated with GOLD grade (r=–0.428, P=0.020; r=–0.455, P=0.013). The relative abundance of Rothia aeria was posotively correlated with C-reactive peotein (r=0.388, P=0.038). Conclusions There are significant differences of sputum flora in phylum, genus and species level between stable and acute exacerbation COPD patients. The evenness of sputum flora in COPD patients in acute exacerbation is significantly lower than that in patients in stable stage. Fusobacteria, Fusobacterium, Gemella and Nesseria (Neisseria subflava) may play a beneficial role in COPD, while Rothia aeria may be associated with COPD exacerbation.
ObjectiveTo study the characteristics of patients hospitalized for asthma exacerbation during 2013-2014 in China-Japan friendship hospital.MethodsThis was a retrospective study involving patients hospitalized for asthma exacerbation in China-Japan friendship hospital during 2013–2014. Information about the demographic features, conditions before the admission, the treatment, the complications and the outcome were collected using the pre-designed case report form.ResultsThe patients hospitalized for asthma exacerbation accounted for 7.5% (250/3 326) of the total patients admitted to the respiratory department. September was the peak month when the most asthmatic patients were admitted to the hospital. A total of 99 asthma patients were included for further analysis and consisted of 12 mild-onset, 22 moderate-onset, 62 severe-onset and 3 life threatening-onset. There were 49.5% (49/99) patients who had a history of previous hospitalization or emergency department visits during the last year. There were up to 54.5% (54/99) of patients who didn't use inhaled corticosteroids before the admission. Only one patient died during the hospitalization. The mortality was 1.0%.ConclusionsThe number of asthmatic patients admitted to the hospital fluctuates with seasons, and September is the peak month. Only a small part of patients use asthma controllers regularly before the admissions.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors. It has been proven beneficial in reducing dyspnea and improving functional capacity and quality of life for patients with stable chronic respiratory disease. However, recent randomized clinical trials reported conflicting results on the timing of intervention, protocol and effectiveness of acute exacerbation or intensive care unit pulmonary rehabilitation to improve patient outcomes. We should find a balance between " dynamic” and " static” to maximize the benefit of patients from early pulmonary rehabilitation.