Recently, many researchers paid more attentions to the association between air pollution and chronic obstructive pulmonary disease (COPD). Haze, a severe form of outdoor air pollution, affected most parts of northern and eastern China in the past winter. In China, studies have been performed to evaluate the impact of outdoor air pollution and biomass smoke exposure on COPD; and most studies have focused on the role of air pollution in acutely triggering symptoms and exacerbations. Few studies have examined the role of air pollution in inducing pathophysiological changes that characterise COPD. Evidence showed that outdoor air pollution affects lung function in both children and adults and triggers exacerbations of COPD symptoms. Hence outdoor air pollution may be considered a risk factor for COPD mortality. However, evidence to date has been suggestive (not conclusive) that chronic exposure to outdoor air pollution increases the prevalence and incidence of COPD. Cross-sectional studies showed biomass smoke exposure is a risk factor for COPD. A long-term retrospective study and a long-term prospective cohort study showed that biomass smoke exposure reductions were associated with a reduced decline in forced expiratory volume in 1 second (FEV1) and with a decreased risk of COPD. To fully understand the effect of air pollution on COPD, we recommend future studies with longer follow-up periods, more standardized definitions of COPD and more refined and source-specific exposure assessments.
摘要:目的:應用區域阻抗法測定慢性阻塞性肺疾病（COPD）患者的肺血流灌注及肺通氣分布的變化,與放射性核素肺顯像方法比較,探討肺區域阻抗方法的臨床應用價值。 方法: 測定對象為18例中重度COPD患者,均為男性,平均年齡63.8歲,應用肺區域阻抗法及放射性核素法,分別測定肺血流灌注及肺通氣的分布。〖HTH〗結果〖HTSS〗: 本研究發現肺區域阻抗法在測定肺血流灌注分布方面,僅在左下肺區域高于核素法測得的數值(Plt;0.05),余肺區測定結果相近,無顯著差異。在肺通氣的測定方面,阻抗法所得數值與核素法測得的數值有一定的不同,在左上、右上區域高于核素法測得的數值,在左中肺區測得的數值低于核素法測得的數值(Plt;0.05),余肺區測定結果相近,無顯著差異。結論: 雖然目前區域阻抗方法暫不能取代放射性核素的測定,但作為一種輔助手段,可簡便、快速了解肺內的通氣、血流等生理病理改變。Abstract: Objective: To evaluate the clinical capability of regional electric impedance pneumograph and scintigraphy in measurement of pulmonary perfusion and ventilation in patients with COPD. Methods: Thirtytwo patients with different respiratory diseases underwent regional electric impedance pneumograph and scintigraphy, the pulmonary perfusion and ventilation were obtained and recorded. Results:The pulmonary perfusion results got by regional electric impedance pneumograph in the left lower region was lower than the results measured by scintigraphy, there were significant difference (Plt;0.05), and no difference in other pulmonary region. The pulmonary ventilation results got by regional electric impedance pneumograph in the both upper region were higher and in the left middle region were lower than the results measured by scintigraphy, there were significant difference(Plt;0.05), and no difference in other pulmonary region. Conclusion:The result got by regional electric impedance pneumograph could not replace the result got by scintigraphy at present, but this is a quick, simple,and convenient measurement to get parameter of the pulmonary perfusion and ventilation.
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.
Objective To evaluate the efficacy and safety of perioperative comprehensive management in non- small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD). Methods Clinical studies about effect of different perioperative comprehensive management on patients with early NSCLC combined with COPD were searched from PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang databases from inception to November 1st, 2017. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and Stata 14.0 softwares. Results A total of 20 articles were identified including 1 079 patients. The results of meta-analysis showed that perioperative comprehensive management improved the forced vital capacity (FVC), maximum minute ventilation (MVV), predictive value of postoperative one-second rate (ppoFEV1%), carbon monoxide diffusing capacity (DLCO) and percent forced expiratory volume in one second (FEV1%) (MD=–0.47, 95%CI –0.62 to –0.32, P<0.000 01; MD=–0.17, 95%CI –0.22 to –0.11, P<0.000 01; MD=–4.24, 95%CI –5.37 to –3.11, P<0.000 01; MD=–7.54, 95%CI –8.33 to –6.76, P<0.000 01; MD=–1.33, 95%CI –2.16 to –0.50, P=0.002; MD=–6.93, 95%CI –9.45 to –4.41, P<0.000 1, respectively). However, there was no significant difference in the rate of DLCO (DLCO%) and ventilation at maximal workload (VEmax) between pre- and post-management (MD=–2.91, 95%CI –11.31 to 5.50, P=0.5; MD= 0.18, 95%CI –2.23 to 2.58, P=0.89, respectively). With regard to cardiac function, perioperative comprehensive management improved the maximal oxygen consumption (VO2max), 6-minute walk distance (6MWD) and anaerobic threshold (AT) (MD=–2.28, 95%CI –3.41 to –1.15, P<0.000 1; MD=–57.77, 95%CI –77.90 to –37.64, P<0.000 1; MD=–2.71, 95%CI –3.30 to –2.12, P<0.000 1, respectively). As to complications, compared with conventional treatment group, perioperative comprehensive management group had fewer postoperative short-term complications (OR=0.39, 95%CI 0.26 to 0.58, P<0.000 01). Besides, perioperative comprehensive management also shortened hospital stay (MD=–2.38, 95%CI –3.86 to –0.89, P=0.002). Conclusion Perioperative comprehensive management can significantly improve lung function in patients with NSCLC combined with COPD, reduce short-term postoperative pulmonary complications and shorten the hospital stay with good efficacy and safety.
Objective To explore the effect of respiratory training based on mechanical vibration-assisted sputum expulsion on arterial blood gases in patients with chronic obstructive pulmonary type 2 respiratory failure and clinical efficacy observation. Methods 105 patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure who were hospitalized in our hospital from November 2019 to February 2023 were selected as study subjects. They were randomly numbered and divided into experimental and control groups according to the order of admission, and 3 patients withdrew from the study cohort due to their own reasons, and 51 cases each of the experimental and control groups were finally included. Patients in the control group were given conventional treatment and lung function exercise, while the experimental group was given respiratory training with mechanical vibration-assisted sputum expulsion. Lung function and blood gas analysis indexes were measured before and 2 weeks after treatment to evaluate the clinical efficacy and incidence of adverse events in the two groups. Results After the treatment, pulmonary function indexes such as PEF, FVC, FEV1 and FEV1/FVC, and blood gas analysis indexes such as PaO2, PaCO2 of the experimental group and daily sputum excretion improved significantly compared with those of the pre-treatment and control groups (P<0.05). The total clinical efficacy rate of the patients in the experimental group was significantly higher than that of the control group (P<0.05), and the incidence of adverse events was lower than that of the control group, but the difference was not statistically significant (P>0.05). Conclusion Respiratory training based on mechanical vibration-assisted sputum expectoration can help improve the lung function and blood gas level of patients with chronic obstructive pulmonary disease combined with type 2 respiratory failure, and it has a certain clinical value in promoting the rehabilitation and prognosis of patients.
ObjectiveTo analyze the causes of death of patients with asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). MethodsA total of 493 patients admitted between January 2006 and Octomber 2015 were respectively analyzed, including 348 asthma patients and 145 ACOS patients. The patients was divided into a survival group and a death group based on the outcome. The ACOS patients were divided into three subgroups based on FEV1% pred level (≥80%, 50%-80%, and < 50%, respectively). The basic characteristics and causes of death were analyzed using χ2-test, t-test and Fish-test based on data type. ResultsThe age (t=3.457, P < 0.001), male proportion (χ2=15.394, P < 0.001) and smoking history (χ2=12.418, P=0.002) had significant differences between the survival group and the death group. The proportion of ACOS patients was higher in the death group (42% vs. 27%, χ2=7.033, P=0.008), and the mortality was also higher in the ACOS patients (21% vs. 12%). The proportion of male patients was higher in the ACOS patients than that in the asthma patients (86% vs. 38%, P < 0.001). The leading three causes of death in the ACOS patients were malignant diseases (45%), pneumonia (26%), and cardiovascular diseases (16%). Malignant diseases were the main cause of death in the ACOS patients with FEV1% pred≥50%, while pneumonia was the main cause of death in those with FEV1% pred≥50%. There was no significant difference in cause of death distribution between three subgroups with different FEV1% pred (P=0.318). ConclusionThe main cause of death of ACOS patients is malignant diseases, the followed are pneumonia and cardiovascular diseases.
COPD是以不完全可逆性氣流受限為特征的進展性肺疾病， 與肺部對香煙煙霧等有害氣體或有害顆粒的異常炎癥反應有關。病理改變存在于外周氣道、中央氣道、肺實質和肺血管系統等， 也可引起肺外的不良效應， 但外周氣道病變和功能異常是導致不完全可逆氣流受限的主要原因。國內外采用吸入支氣管舒張劑后一秒率( FEV1／FVC) 小于70％來進行定性診斷。
ObjectiveTo analyze the association between the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (syndrome of phlegm-heat obstructing lung) and clinical indicators related to COPD. MethodAECOPD in-patients and out-patients were enrolled from the Third People's Hospital of Chengdu from January 2013 to January 2014. The patients were grouped to Tanre Syndrome and non-Tanre Syndrome according to their clinical symptoms, signs and tongue, pulse. All patients underwent the following tests including routine blood test, erythrocyte sedimentation rate, lung function, blood gas analysis, C-reaction protein (CRP), procalcitonin (PCT) and other clinically relevant indicators. The association between AECOPD and clinically relevant indicators were analyzed by using SPSS 19.0 software. ResultsA total of 194 AECOPD patients were included, of which 88 patients were syndrome of phlegm-heat obstructing lung and 106 were non syndrome of phlegm-heat obstructing lung according to the traditional Chinese medicine (TCM) classifications. The results of single factor analysis showed that age (Z=-4.848, P=0.000) and course of disease (Z=-2.455, P=0.014) were associated with syndrome of phlegm-heat obstructing lung. While further logistic regression analysis showed that age (r=0.090, P=0.000) and the level of CRP (r=-0.008, P=0.000) were associated with syndrome of phlegm-heat obstructing lung. ConclusionSyndrome of phlegm-heat obstructing lung is the major clinical TCM syndrome of AECOPD. Syndrome of phlegm-heat obstructing lung is associated with age and level of CRP.
Lung injury could be classified as acute and chronic injuries, such as acute respiratory distress syndrome and chronic obstructive pulmonary disease. Lung function recovery mainly depends on inflammation adjusting, lung and airway remodeling, endogenous stem cell proliferation and differentiation, and tissue repair. The principles of clinical therapy include inhibition of inflammation, balancing coagulation and fibrinolysis, and protective lung ventilation for acute lung injury; while reduction of hyper-secretion, bronchodilation, adjusting airway mucosal inflammation and immunity, as well as improving airway remodeling for chronic obstructive pulmonary disease. The functional recovery of lung and airway depends on endogenous stem cell proliferation and repair. The purpose of clinical treatment is to provide assistance for lung and airway repair besides pathophysiological improvement.
Objective To explore the role of high endothelial venule (HEV) in chronic obstructive pulmonary disease (COPD) at the single cell level. Methods A total of 219257 cells from the lung tissues of 18 COPD patients and 28 healthy controls in the GEO public database (GSE136831) were used to analyze the relationship between HEV with T lymphocytes, B lymphocytes, and dendritic cells. Results Endothelial cells were extracted using single cell analysis technique, and sorting out venous endothelium, CCL14, IGFBP7, POSTN were used as marker genes for HEV endothelial cells. The ratio of HEV endothelial cells was also identified as up-regulated expression in COPD. The function of the differential genes of HEV endothelial cells was analyzed, suggesting the presence of immune regulation. By trajectory analysis, it was suggested that the differential genes of HEV endothelial cells were enriched for extracellular matrix deposition in late development. Finally, by receptor-ligand pairing, it was suggested that HEV endothelial cells was recruited through a series of ligands with T lymphocytes, B lymphocytes, and dendritic cells. Conclusions HEV endothelial cells are elevated in COPD and have an immunomodulatory role by secreting a series of ligands after recruiting T lymphocytes, B lymphocytes as well as dendritic cells for immune action. HEV may be a potential target for the study of COPD therapy.