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.
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 evaluate the effects of cardioselective beta-blockers on respiratory function in patients with chronic obstructive pulmonary disease ( COPD) . Methods We used computer to search the Cochrane Controlled Trials Register database, Medline, Netherlands EMBASE/Excerpta Medica,EBSCO database, China Academic Journal and the Chinese Biomedical Literature Database, as well as respiratory magazines and conference abstracts, without language restrictions. The information was retrieved until December 2011. We collected all the randomized, blinded, controlled clinical trails ( RCTs ) of cardioselective beta-blockers on respiratory function in patients with COPD. Then two evaluators evaluated the quality of RCTs according to the Cochrane Review Manual 4. 2 independently. Meta-analysis was performed using statistical software Stata 11. 0. X2 test was used to analyze their heterogeneity. Standardizedmean difference ( SMD) was used to describe continuous variables. Relative risk degree ( RR) was used to describe categorical variables, and 95% CI was used to describe treatment effect. Results 22 trails met the selection criteria. Meta-analysis showed no change of FEV1 in COPD patients after taking single dose of cardioselective beta-blockers [ SMD - 0. 367, 95% CI( - 0. 786, 0. 052) ] and no respiratory symptoms aggravation [ RR1. 000, 95% CI( 0. 848, 1. 179) ] . Meta-analysis also showed no change of FEV1 in COPD patients who received long-term cardioselective beta-blockers treatment [ SMD - 0. 236, 95% CI( - 0. 523,0.051) ] , and no respiratory symptoms aggravation [ RR 1. 000, 95% CI ( 0. 830, 1. 205) ] . Inhaled beta-2 agonists showed no effect on FEV1 in COPD patients after either long-term administration [ SMD - 0. 200,95% CI( - 0. 586, 0. 187) ] or single dose administration of cardioselective beta-blockers [ SMD - 0. 078,95% CI( - 0. 654, 0. 497) ] . Conclusion Cardioselective beta-blockers, given to patients with COPD in conditions such as heart failure, coronary artery disease and hypertension in the identified studies did not produce adverse respiratory effects.
ObjectiveTo investigate the relationship of diaphragmatic mobility (ΔM) evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease (COPD) , and analyze the factors those affect the diaphragmatic mobility.MethodsA total of 48 male patients with stable COPD were recruited in the study. The body height, body weight, diaphragmatic mobility, airflow obstruction (FEV1%pred), and exercise capacity (6MWD) were measured. The quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ).ResultsThe minimum value of ΔM was 1.89 cm and the maximal value was 8.11 cm in the COPD patients. There were significant correlationship between ΔM and the SGRQ score of the total score, symptom score, impact points, activity points and 6MWD, with correlation coefficients of –0.474, –0.416, –0.432, –0.502 and 0.536, respectively. Multivariate stepwise regression analysis showed that the factors influencing ΔM were height (β=0.407, P=0.021) and FEV1%pred (β=–0.391, P=0.035).ConclusionsDiaphragmatic mobility and quality of life are closely related in COPD patients. The height and FEV1%pred have the greatest effect on diaphragmatic activity. The smaller diaphragm mobility is relevant to the worse quality of life and the smaller activity capacity.
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 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 determine the efficacy of forced expiratory volume in six seconds( FEV6 ) as an alternative for forced vital capacity( FVC) in the diagnosis for mild-moderate chronic obstructive pulmonary disease( COPD) .Methods A total of 402 mild-moderate COPD and 217 non-COPD patients’ spirometric examinations were retrospectively analyzed. The correlation between FEV6 and FVC, FEV1 /FVC and FEV1 /FEV6 was evaluated by the Spearman test. Considering FEV1 /FVC lt;70% as being the ‘golden standard’ for airway obstruction, a ROC curve was used to determine the best cut-off point for the FEV1 /FEV6 ratio in the diagnosis for COPD. Results The Spearman correlation test revealed the FEV1 and FEV6 , FEV1 /FEV6 and FEV1 /FVC ratios were highly correlated ( r = 0. 992, 0. 980, respectively, P = 0. 000) . Using FEV1 /FEV6 lt; 70% as the diagnosis standard, 12. 69% of the 402 patients could not be diagnosed as COPD. The FEV1 /FVC ratio of these patients was very close to 70% . The best cut-off point for the FEV1 /FEV6 ratio in the diagnosis of mild-moderate COPD was 72% while the sensitivity and specificity were 94. 7% and 92. 2% , respectively. Conclusions There is a b correlation between FEV1 /FVC and FEV1 /FEV6 . The FEV6 can be a valid alternative for FVC in the diagnosis for mild-moderate COPD, although it may result in false negative. The best cut-off point for the FEV1 /FEV6 ratio is 72% .
Objective To investigate the cognition degree and clinical use of new COPD classification system of 2011 GOLD in respiratory specialists, and further analyze the reasons of failing to clinical use. Methods Respiratory specialists from 42 hospitals in Chongqing were investigated through questionnaire survey. The questionnaire contains two parts. The first part contains nine questions about the knowledge of 2011 GOLD new COPD classification system and its clinical use. The second part contains six questions about the reasons of failing to clinical use of the COPD classification system. Results A total of 204 valid questionnaires were recovered. More than 90% respiratory specialists had understood the new COPD classification system with different degree, and believed it is suitable for clinical use. More than twothirds respiratory specialists knew well the ways about CAT and mMRC, but only 24% specialists were using these ways. The main reasons of failing to clinical use were as follows: 60% specialists believed the pulmonary function test can evaluate the COPD classification, and 66. 7% specialists were limited by short visit time. The cognition degree and clinical use of the new COPD classification systemin the specialists from third grade A class hospitals was better than those from the other hospitals. But the difference was not significant among specialists with different professional title.Conclusion Respiratory specialists in Chongqing knew well about the new COPD classification systemin 2011 GOLD, but did not use it widely in clinical works due to the complicated operation of the new COPD classification system.
Objective To assess the effects of physiotherapy on pulmonary function in COPD patients with lung cancer after lobectomy or pneumonectomy. Methods Fifty-five COPD patients with lung cancer undergoing lobectomy or pneumonectomy from January 2005 to May 2014 were recruited in the study. They were divided into group A received comprehensive physiotherapy before surgery and group B without comprehensive physiotherapy before surgery. The changes of lung function and tolerance were compared before physiotherapy (T1 time point) and after physiotherapy (T2 time point) in the group A, and between two groups before lung resection (T2 time point) and after lung resection (T3 time point). Results In group A, the forced expiratory volume in one second (FEV1), vital capacity (VC), peak expiratory flow at 50% of vital capacity (FEF50) and FEF25 increased significantly respectively by 16.96%, 14.75%, 20.69% and 13.79% compared with those before physiotherapy. Meanwhile, six-minutes walking distance (6MWD) achieved a significant improvement. After resection of lung, FEV1 and VC appeared to reduce, and pulmonary small airway function, tolerance, and clinical features deteriorated significantly. The differences between T2 and T1 in FEV1, FEF50 and FEF25 in the patients with FEV1%pred ≥80% and 50%-80% were similar with those in the patients with FEV1%pred<50%. The differences between T2 and T3 in FEF50 and FEF25 in the patients with FEV1%pred≥80% and 50%-80% were higher than those with FEV1%pred<50%. For the patients with lobectomy, FEV1 and VC in the group B were lower than those in the group A (FEV1: 10.24% vs. 22.44%; VC: 10.13% vs. 20.87%). For the patients with pulmonary resection, FEV1 and VC had little differences (FEV1: 36.33% vs. 36.78%; VC: 37.23% vs. 38.98%). Conclusion Physiotherapy is very important for the preoperative treatment and postoperative nursing of COPD patients with primary lung cancer.
Objectives To evaluate pulmonary physicians’knowledge level about prevention and treatment of chronic obstructive pulmonary disease( COPD) in some urban areas in China. Methods A total of 258 pulmonary physicians were interviewed face-to-face in 24 hospitals from July to October in 2006. The questionnaire included the knowledge of COPD, prescriptions at initial visit and follow-up, pulmonary function test monitoring, assessment and intervention in stable COPD, knowledge and evaluation of the commonly used medicines, the effects of smoking cessation and adopted measures, as well as the knowledge of treatment prospects and patients’ education. Results Eighty-eight percent of pulmonary physicians considered themselves knowledgeable on COPD, and 95% were familiar with the severity classification. Most of them knew about GOLD and Chinese Guideline of Prevention and Treatment to COPD, and paid attention to chest X-ray and pulmonary function test during diagnosis. The standards in evaluation of stable COPD patients were not well understood, and 92% of physicians claimed for pulmonary function test in stable stage. Seventy-nine percent of physicians actively suggested the patients quit smoking. The prescription for COPD patients at iniative and maintenance therapy met the guideline on the whole, but the mucolytic agents were appreciated too much and used too frequently. Thirty-three percent of physicians took it necessary to treat stable COPD,and 69% believed that pharmacotherapy for stable COPD could rersult in satisfactory quality of life.Conclusions In some big cities in China, the pulmonary physicians have good knowledge about COPD. But long-term prevention and intervention, especially in pharmacotherapy, are still unsatisfactory.