Objective To assess the quality of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) relevant to COPD besides chronic bronchitis and chronic pulmonary cor disease in strengthening immune published in Chinese medical journals to provide scientific basis of systematic review (SR) of regulating the immune function of COPD in Chinese herbs. Methods 54 articles with clinical controlled trials were obtained by electronic searching and handsearching, and the method for randomized allocation, blindness, multi-centres, sample sizes, diagnosis criteria, exclusion criteria, source of cases, immune markers (cellular immunity, humoral immunity, erythrocyte immunity, nonspecific immunity), the clinical outcome assessment, statistical management, course of treatment and the side effects or adverse drag reaction, follow-up were investigated and then methodologically evaluated. According to the investigation, literatures with the method for randomized allocation, correct controls, appropriate sample sizes (≥60), the nation-wide diagnosis criteria, the objective clinical outcome assessment distinct statistical method were stipulated as the high-quality ones relatively. Results Among the 54 trials, 70.4% had explicit diagnosis criteria, 18.5% with exclusion criteria, 20.4% with comparability of baseline, 37.0% with distinct statistical method. In the therapy, 63.0% were with Chinese herbs. Conclusion The selected 7 articles belong to the high quality and possibly are to be explored in Meta-analysis.
COPD 和肺癌均为最常见的吸烟相关呼吸道疾病。吸入性糖皮质激素( ICS) 近年来被推荐用于重度COPD 的治疗, 同时也被发现在肺癌的化学预防中起重要作用。本文通过综述ICS、COPD 和肺癌之间的关系, 特别是吸入糖皮质激素在肺癌中的化学预防作用, 以期进一步明确ICS 在COPD和肺癌中的作用。
Objective To evaluate and select essential medicine for chronic obstructive pulmonary diseases (COPD) using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Nine guidelines were included (eight foreign guidelines, one domestic guideline; seven based on evidence, two based on expert consensus). (2) A result of one domestic RCT (n=72, high quality) indicated that tiotropium could significantly improve pulmonary function of severe COPD patient complicated with respiratory failure and increase their quality of life (SGRQ score: MD=–10.8%, 95%CI –12.2% to –9.4%). A result of one RCT (n=156, moderate quality) with 3-month follow-up indicated that tiotropium could significantly improve the proportion of measured value to expected value of FEV1 in patients with mild and moderate COPD in stationary phase (MD=10.3%, 95%CI 8.1% to 12.5%). A result of two RCTs (n=160, low quality) indicated that compound ipratropium bromide had efficiencies of 84.2% to 87.5% for moderate and severe COPD. A result of one RCT (n=60, moderate quality) indicated that salmeterol/fluticasone (inhalation) was superior to placebo for improving mild and moderate COPD in stationary phase. A result of one RCT (n=725, moderate quality) indicated that tiotropium combined with salmeterol/fluticasone for COPD in stationary phase was superior to tiotropium alone. A result of one RCT (n=110, low quality) indicated that nebulized budesonide inhalation had an efficiency of 86.8% for acute exacerbation of COPD (AECOPD) and an incidence of 7.9% as to adverse reaction that mainly included laryngo-pharyngeal irritation. (3) Imipenem, meropenem, cefoperazone/ sulbactam and ceftazidime were effective for COPD with low drug resistance rates in treating COPD caused by non-ICU pathogens (less than 8%). Conclusion (1) We offer a b recommendation for tiotropium, ipratropium, salbutamol, formoterol, salmeterol and theophylline used in the treatment of COPD in stationary and exacerbation phases, a b recommendation for streptococcus pneumoniae and influenza vaccines in preventing the deterioration of COPD, a b recommendation for inhaled corticosteroids (ICS) used in the treatment of COPD in stationary phase and a b recommendation for corticosteroids (for oral use) for AECOPD. (2) We offer a b recommendation for cefoperazone/sulbactam, imipenem and meropenem used in the treatment of moderate and severe AECOPD. (3) We offer a weak recommendation for ceftazidime, ciprofloxacin, lavofloxacin, moxifloxacin, amoxicillin amp; clavulanate potassium, amoxicillin, azithromycin, clarithromycin and doxycycline as first-line and second-line antibiotics for mild and moderate AECOPD, and a weak recommendation for compound sulfamethoxazole, cefatriaxone, cefotaxime and cefuroxime used in the treatment of severe and extremely severe COPD, mucolytic agents used in the treatment of stable COPD with difficult expectoration. (4) We make a recommendation against antibiotics, expectorants and corticosteroids (for oral use) as routine use in stationary phase of COPD.
Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
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 systematically evaluate the efficacy and safety of budesonide/formoterol combined with tiotropium versus budesonide/formoterol alone for Chinese patients with COPD. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about budesonide/formoterol combined with tiotropium vs. budesonide/formoterol alone for Chinese COPD patients from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. ResultsA total of 15 studies involving 1123 Chinese patients were included. The results of meta-analysis showed that, compared with the budesonide/formoterol alone group, the budesonide/formoterol plus tiotropium group could significantly improve the levels of FEV1 (MD=0.19, 95%CI 0.12 to 0.25, P<0.00001), FVC (MD=0.35, 95%CI 0.14 to 0.57, P=0.001), FEV1% (MD=5.96, 95%CI 4.48 to 7.43, P<0.00001), FEV1% pred (MD=6.82, 95%CI 2.21 to 11.43, P=0.004), FEV1/FVC (MD=7.72, 95%CI 5.69 to 9.75, P<0.00001), mMRC (MD=-0.43, 95%CI -0.52 to -0.33, P<0.00001), CAT (MD=-1.45, 95%CI -2.26 to -0.64, P=0.0005), SGRQ (MD=-7.05, 95%CI -9.16 to -4.94, P<0.00001) and 6MWT (MD=32.52, 95%CI 16.68 to 48.37, P<0.00001). While there was no significant difference in adverse reaction rates between the two groups (OR=1.77, 95%CI 0.79 to 3.98, P=0.16). ConclusionCurrent evidence shows that budesonide/formoterol plus tiotropium can improve lung function and clinical symptom in Chinese patients with COPD. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically review the association between -589C/T polymorphism in IL-4 gene and the risk of chronic obstructive pulmonary disease (COPD). Method PubMed, EMbase, CNKI and WanFang Data databases were electronically searched to identify case-control studies which investigated the association between IL-4 -589C/T polymorphism and the risk of COPD. The search date was up to February 23th, 2016. Two reviewers independently screened the studies, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software. Results A total of 8 case-control studies involving 1 400 COPD cases and 1 073 controls were included in meta-analysis. The results showed that: the -589C/T polymorphism in IL-4 gene was not associated with the risk of COPD (TT+TC vs. CC: OR=0.84, 95%CI 0.61 to 1.15, P=0.27; TT vs. CC+TC: OR=0.95, 95%CI 0.72 to 1.25, P=0.69; TT vs. CC: OR=1.14, 95%CI 0.74 to 1.76, P=0.55; TC vs. CC: OR=0.83, 95%CI 0.66 to 1.05, P=0.12; T vs. C: OR=0.91, 95%CI 0.72 to 1.14, P=0.40). Conclusion The IL-4 -589C/T polymorphism is not associated with the risk of COPD.
Objective To systematically review the effectiveness and safety of cordyceps sinensis for chronic obstructive pulmonary diseases (COPD). Methods We electronically searched databases including CBM, CNKI, WanFang Data, VIP, PubMed, Cochrane Central Register of Controlled Trials (Issue 7, 2013) and EMbase for randomized controlled trial (RCT) and quasi-RCTs on the effectiveness and safety of cordyceps sinensis for COPD. According to Cochrane methods, two reviewers independently screened literature, extracted data, assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results Fourteen quasi-RCTs involving 1 162 patients were included. The results of meta-analysis showed that: a) compared with routine treatment alone, cultured cordyceps sinensis in combination of routine treatment improved total effective rates (stationary stage: RR=1.33, 95%CI 1.14 to 1.54, P=0.000 3; advanced period: RR=1.36, 95%CI 1.14 to 1.62, P=0.000 8). Also cultured cordyceps sinensis in combination of routine treatment improved lung function (FEV1/FVC: MD=5.48, 95%CI 3.22 to 7.74, Plt;0.000 01; FEV1%: MD=3.75, 95%CI 0.91 to 6.59, P=0.010), and prolonged exercise duration (MD=43.51, 95%CI 27.66 to 59.36, Plt;0.000 01) for COPD patients in stationary stage. However, no evidence was found in blood gas analysis, immune function, and quality of life; and b) the results of one study showed that, cultured cordyceps sinensis in combination of routine treatment was comparable with immune regulator (BCG-PSY) in combination of routine treatment with regards to total effective rates, but it could better improve lung function of patients. Conclusion Current evidence suggests that cultured cordyceps sinensis is effective in treating COPD, especially in treating lung function and exercise duration of COPD patients in stationary stage and increasing total effective rates. However, the strength of evidence is affected by poor methodological quality of the included studies. High-quality trials with large sample size are needed to verify its clinical effects.
ObjectiveTo investigate the association between polymorphism of V4,F+1 in ADAM33 (adisintegrin and metalloproteinase 33) gene and COPD in a northwestern Uighur population. MethodsA total of 100 Uighur COPD patients and 140 healthy volunteers were recruited in the study. Genotypes were determined by restriction fragment lengthpolymorphism(PCR-RFLP). All subjects had a epidemiological investigation including modified british medical research council(mMRC),COPD assessment test(CAT),and pulmonary function test. The 100 Uighur COPD patients were assessed by revised GOLD2011. ResultsAssessed by revised GOLD2011,the patients of A,B and C grade accounted for 22%,35% and 30%,respectively. There was no statistical significance in the distributions of the V4,F+1 alleles between the patients and the controls(P>0.05). There was no statistical significance between SNPs in ADAM33(V4 and F+1) with the decreased lung function and the grade of COPD(P>0.05). ConclusionThere was no association between polymorphism of V4,F+1 in ADAM33 gene and COPD in a northwestern Uighur population.
目的:探讨慢性阻塞性肺疾病(COPD)合并糖尿病患者的肺功能及血气分析特点并分析其临床意义。方法:选取2008年1月~2009年1月在我院门诊就诊的稳定期患者53例作为研究对象,并根据是否合并糖尿病分为COPD合并糖尿病组26例,单纯COPD组27例,并通过肺功能检测及血气分析,检测肺活量 (VC)、用力肺活量 (FVC)、第1秒钟用力呼气容积 (FEV1)、 FEV1/用力肺活量 (FVC)、用力呼气中期流速PEF(25%～75%) 、肺一氧化碳弥散(DLCO)及肺一氧化碳弥散量实测值占预计值的百分比(DLCO /PRED)等肺功能指标及PaO2、PaCO2等血气指标,并进行组间分析。结果:COPD合并糖尿病组肺通气功能指标VC、FVC、FEV1、PEF(25%～75%)和弥散功能指标DLCO、DLCO/PRED及PaO2显著低于单纯 COPD组。结论:COPD合并糖尿病时肺通气功能和弥散功能都可受损。