Chronic obstructive pulmonary disease (COPD) is one of the common chronic airway disorders, which accounts for the third to fourth cause of death worldwide. Recently, the focuses of researches are on the multi-factorial risks for development of COPD, mechanisms related to COPD development, early detection and early intervention of COPD, individualized use of long-term maintenance medications as well as phenotypes of acute exacerbation of COPD and their corresponding management. There are huge amount of COPD patients with variety of risk factors or different phenotypes in China, which makes it possible to establish a network for cohort study or real life registration study of COPD. The results will provide new information on the characteristics of COPD in China. Individualized treatment could be recommended according to the phenotypes or endotypes information. All these new findings or progresses could provide impetus for improvement of the ability of research and clinical management of COPD to the worldwide top level.
Objective To investigate the effects of different inspiratory rise time during noninvasive positive pressure ventilation ( NPPV) on work of breathing in patients with acute exacerbation of chronic obstructive pulmonary disease ( COPD) . Methods Eleven patients with acute exacerbation of COPD received different inspiratory rise time ( 0. 1sec, 0. 3sec, 0. 5sec) during NPPV. The changes of inspiratory muscle effort and breathing pattern of the patients were observed. Results The average respiratory rate,minute ventilation, and tidal volume were higher during NPPV compared with spontaneous breathing. But the changes of average minute ventilation and tidal volume were not significant ( P gt; 0. 05) . The pressure time product ( PTP) , transdiaphragmatic pressure ( Pdi) , and work of breathing of inspiratory muscle reduced significantly during different inspiratory rise time as compared with spontaneous breathing ( P lt;0. 01) . PTP,Pdi, and work of breathing reduced 59. 2% , 62. 7% , and 49% respectively when inspiratory rise time was 0. 1sec. They reduced more significantly during inspiratory rise time of 0. 1sec. Conclusions The present study confirms NPPV can unload inspiratory muscles in patients with acute exacerbation of COPD. It is more effective to reduce inspiratory load when inspiratory rise time is set at 0. 1sec while the patients feel most comfortable.
ObjectiveTo explore the cytologic profile of induced sputum and its relationship with the treatment response in patients with chronic obstructive pulmonary disease (COPD). MethodsSixty-five treatment-naive patients with COPD and 26 normal subjects were recruited for the study. Sputums induced by the inhalation of hypertonic saline were collected, and the associations of differential cell counting were analyzed with pulmonary function, modified Medical Research Council dyspnea scale, St. George's Respiratory Questionnaire score (SGRQ) before and after the treatment with inhaled corticosteroid and long-acting β2-agonist. ResultsThe cell percentages of neutrophil (Neu), macrophage, eosinophil (Eos) and lymphocyte in induced sputum of the COPD patients were (86.24±15.04)%, (5.75±6.96)%, (4.71±4.79)%, and (1.30±1.09)%, respectively. The eosinophil percentage (Eos%) was≥3% in 31 patients (60.78%). The neutrophil percentage (Neu%) was inversely correlated with forced expiratory volume in 1 second (FEV1), percent of predicted value of FEV1 (FEV1% pred), forced vital capacity (FVC), and percent of predicted value of FVC (FVC% pred) (P < 0.01, respectively), and positively correlated with the SGRQ symptom score (r=0.304, P=0.034). The Eos% was inversely correlated with FEV1/FVC ratio (r=-0.399, P=0.004). The patients with Eos%≥3% improved significantly in FEV1 and symptom score (P < 0.05, respectively) than the patients with Eos% < 3%. ConclusionsAn eosinophilic airway inflammation is present in a subgroup of COPD. The Eos% is inversely correlated with pulmonary function and may be a predictive indicator of response to treatment with inhaled corticosteroids and long-acting β2-agonists.
Objective To investigate the effects of positive end-expiratory pressure (PEEP) level on end-expiratory lung volume (EELV) during assisted ventilation in chronic obstructive pulmonary disease （COPD） patients，to provide physiological evidence to guide optimal setting of PEEP level in clinical practice.Methods Eight intubated patients with acute exacerbation of COPD were recruited for the study when the patients were in relatively stable condition after treatment.The static intrinsic PEEP (PEEPistat) and dynamic intrinsic PEEP (PEEPidyn) were measured by using airway occlusion method and esophageal balloon-tipped catheter technique,respectively.Changes in EELV (ΔEELV) were measured with inspiratory capacity (IC) method.Relations between PEEP level and ΔEELV were analyzed by curve estimation method.Results ΔEELV as a function of level of PEEP was shown as a sigmoid model.The low inflection points of the curves when PEEP levels were expressed as PEEP/PEEPistat ratio，PEEP/PEEPidyn ratio or actual PEEP setting (PEEP-a) were 0.74，0.76 or 3.6 cm H2O,respectively.The corresponding ΔEELV expressed as ΔEELV/IC（%） were 9.6%，9.1% and 7.4%,respectively.Conclusions In AECOPD patients demanding mechanical ventilation，the changes of lung volume (ΔEELV) in response to progressive increase of PEEP level were shown to be a sigmoid model.Setting PEEP level at 0.74 of PEEPistat，or 0.76 of PEEPidyn can avoid the steep increase of lung volume.
Objective To evaluate the effects of inhaled bronchodilators on respiratory mechanics in moderate and severe chronic obstructive pulmonary disease（COPD） patients during eupnea.Methods Twenty moderate to severe COPD subjects were divided into three groups.Lung function，Borg score，breathing pattern and respiratory mechanics indexes were measured at baseline and 30 min after inhaled placebo，salbutamol 400 μg (or ipratropium 80 μg)，and ipratropium 80 μg (or salbutamol 400 μg) in sequence at interval as specified in different groups.Results In all groups，inhaled bronchodilators improved lung function (FEV1，FVC，IC) (Plt;0.05)，decreased Pdi，Peso，PTPdi，PTPeso and Raw (Plt;0.05，respectively)，in comparison with placebo.The reduction of PTPeso was positively correlated with the reduction of Peso (r=0.713，Plt;0.01）and Raw (r=0.602，Plt;0.01).Borg score decreased after inhaled bronchodilators (Plt;0.05).The reduction of dyspnea was positively correlated with the reduction of inspiratory work of breathing (ΔPTPeso%) (r=0.339，Plt;0.05) and Raw (ΔRaw) (r=0.358，Plt;0.05)，while was not associated with the changes of FEV1，FVC and IC.Conclusions In COPD patients，inhaled bronchodilators can reduce inspiratory work of breathing and airway resistance，the reduction of inspiratory work of breathing contributed to the reduction of airway resistance.Alleviation of dyspnea by inhaled bronchodilators is suggested to be ascribed to reduction of airway resistance and inspiratory work of breathing.
Objective To assess the effect of continuous positive airway pressure ( CPAP) on expiratory flow limitation in severe chronic obstructive pulmonary disease ( COPD) patients during noninvasive ventilation by oscillatory reactance ( Xrs ) . Methods Eight patients with stable COPD and chronic hypercapnic respiratory failure( type II) received noninvasive ventilation with a traditional CPAP ventilator through a nasal mask were enrolled. The CPAP were successively set as 4, 8 and 12 cm H2O respectively. The forecd oscillation( 5 Hz, 2 cm H2O) was imposed into the mask and the flow and nasal pressure were measured at the airway opening. The difference between inspiratory and expiratory Xrs( ΔXrs)were calculated for each breathing cycle and average ΔXrs was calculated at different pressure levels according to the established algorithm. Meanwhile, the oesophageal pressure was also measured by a balloontipped catheter and transpulmonary pressure was calculated. The breathing cycles above were analyzed subsequently and classified as expiratory flow-limited( EFL) and non-EFL breath. In addition, flow and nasal pressure when breathing naturally( CPAP = 0 cmH2O) was also collected for each patient and the EFL breath cycles was identified as baseline. Then, the percentage of EFL breathing cycles and ΔXrs were calculated for each CPAP level and their relationship was analyzed. The threshold value of ΔXrs with maximum sensitivity and specificity to detect EFL and the optimal CPAP to suppress the development of EFL were computed. Results ①CPAP increased from4 to 8 and 12 cm H2O resulted in fall of mean values of ΔXrs from2. 67 to 1. 62 and 1. 31 cm H2O· s- 1 · L- 1 , respectively( ΔXrs at CPAP 0 cm H2O was not detected) , and the decrease of ΔXrs when CPAP up to 8 cm H2O from 4 cm H2 O was significant ( Z = - 2. 68, P = 0. 01) . ②CPAP significantly suppressed the development of EFL, when CPAP increased from0 cm H2O to 4,8 and12 cmH2O resulted in decrease in the percentage of breathing cycle from 29. 8% to 9. 9% , 8. 1% and 4. 4%, respectively( 2 = 15. 6, P = 0. 01) . ③ ΔXrs was related to the degree of EFL and the mean value of ΔXrs in EFL breathing cycles was significantly higher than that in non-EFL’s. When ΔXrs decreased to 1. 83 cm H2O· s- 1 · L- 1, the majority of breath showed non-EFL, with a sensitivity of 94% and specificity of 97% for detecting EFL, respectively. Conclusions ΔXrs is an indicator of the occurrence of EFL. Appropriate CPAP to render the value of ΔXrs equal to or slightly less than 1. 83 cm H2O·s - 1 ·L- 1 may effectively suppress the development of EFL in severe COPD patients during noninvasive ventilation.
Objective To investigate the correlation between dynamic intrinsic positive endexpiratory pressure ( PEEPidyn) and volume dependence of elastance and resistance of respiratory system ( Evd/Rvd) derived from nonlinear analysis of respiratory mechanics in COPD patients during pressure support ventilation ( PSV) . Methods Twenty-five COPD patients mechanically ventilated using mode of PSV were ventilated at a PSV level of no less than 20 cm H2O in a period of 15 minutes to attain so-callednear-relaxation state. The pressure( P) , flow( V′) and volume( V) data were analyzed by nonlinear mode of respiratory motion. PEEPidyn was determined by esophageal balloon-tipped catheter technique. The correlations between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were analyzed. Results The correlation coefficients between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were 0. 85,0. 80, and 0. 90, respectively. Conclusions Nonlinear mode of respiratory motion is suitable to analyze respiratory mechanics of COPD patients mechanically ventilated using mode of PSV. There are good correlations between PEEPidyn and Evd,Rvd as well as Evd ×Rvd which may be used to noninvasively monitor PEEPidyn in mechanically ventilated COPD patients using mode of PSV.
ObjectiveTo improve the knowledge of clinical features,image and pathology of Behcet's disease with the pulmonary artery aneurysm. MethodsOne typical female patient aged 40 years with recurrent pulmonary artery aneurysm caused by Behcet's disease was analyzed including clinical data,image and pathological features.The Pubmed (1967.1 to 2013.10) and Wanfang database (1982.1 to 2013.10) were searched with "Behcet's disease","pulmonary artery aneurysm" as search terms. ResultsRecurrent hemoptysis was major clinical manifestation of pulmonary artery aneurysm caused by Behcet's disease.Features of image including hilar enlargement,pulmonary artery aneurysm and primary thrombus.During the first hospitalization,the patient was diagnosed as pulmonary artery aneurysm.Then pulmonary lobectomy was performed and pathology examination revealed artery aneurysm and primary thrombus.During the second hospitalization,she was diagnosed as pulmonary thromboembolism and it was considered as failure of treatment of anticoagulant therapy.During the third hospitalization,she was diagnosed as pulmonary artery aneurysm of Behcet's disease,and recurrent hemoptysis was fully ameliorated by the combination treatment of glucocorticoid and immunodepressant. ConclusionPulmonary artery aneurysm is the typical feature of pulmonary vascular lesions of Behcet's disease,and recurrent hemoptysis is major clinical manifestation.CT angiography can identify location of pulmonary artery aneurysm.The key drugs of therapy are imunosuppressive drugs in combination with steroids.
ObjectiveTo evaluate the effectiveness of different biopsy methods in the diagnosis of idiopathic interstitial pneumonia (IIP). MethodsA retrospective analysis was performed in patients hospitalized and diagnosed as IIP between January 2010 to December 2013 in the Department of Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University. The patients were divided based on initial diagnoses. The performance of invasive examinations including both transbronchoscopic lung biopsy (TBLB) and surgical lung biopsy (SLB) and final diagnoses were recorded. ResultsThree hundred and ninety-one patients were included in the study with mean age of 62.5±11.9 years. There were 299 patients receiving TBLB, 43 patients receiving SLB, and 49 patients receiving non-invasive examinations. Among 299 patients who underwent TBLB, parenchymal tissue was not obtained in 132 (44.1%) but successfully obtained in 167 (55.9%) patients, with 79 (47.3% out of 167) clinically helpful. TBLB-based specific diagnoses were as follows:30 cases of non-specific interstitial pneumonia (NSIP), 22 cases of cryptogenic organizing pneumonia (COP), 18 cases of idiopathic pulmonary fibrosis (IPF), 4 cases of acute interstitial pneumonia (AIP), 2 cases of respiratory bronchiolitis-interstitial lung disease (RB-ILD) and lymphocytic interstitial pneumonia (LIP) for each, 1 case of desquamative interstitial pneumonia (DIP), respectively. Among 43 patients who underwent SLB, parenchymal tissue was obtained in all cases with 40(93.0% out of 43) pathologically diagnostic, including 20 cases of NSIP, 12 cases of IPF, 3 cases of COP and LIP for each, and 2 cases of RB-ILD and DIP for each. Finally, among 181 patients who failed to obtain parenchymal tissue or did not undergo invasive examination, specific diagnoses could be established in 40 patients with all finally diagnosed as IPF. ConclusionsThe pathological diagnosis, either based on TBLB or SLB, is very important in the diagnostic procedure of IIP. The biopsy technique of hospital and patient conditions should be considered when making the decision of biopsy method.