Objective To investigate the effect of inhaled anticholinergics on heart rate recovery (HRR) in patients with stable chronic obstructive pulmonary disease (COPD). Methods Sixty clinically stable patients with stage Ⅱ-Ⅳ COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines were recruited. HRR was analyzed in this study between 28 patients who had received tiotropium≥1 year and 32 patients who never used anticholinergics as control, so as to reflect parasympathetic reactivity of the heart. Results HRR was significantly lower in the subjects with tiotropium than that in the controls [(16±6) beats/min vs. (22±8) beats/min, P<0.05]. Multivariate regression analysis revealed that anticholinergics medication could be used as an independent predictor of HRR in the COPD patients. Conclusion Anticholinergics can affect cardiac autonomic function of stable COPD patients.
Objective To determine if the levels of high-sensitivity C-reactive protein ( hs-CRP)and fibrinogen ( Fbg) can predict the risk of acute exacerbation of chronic obstructive pulmonary disease ( COPD) . Methods hs-CRP was measured by latex-enhanced immunoturbidimetric assay and Fbg was assessed by Von Clauss method. The number of exacerbations was recorded during a 6-month follow-up period. Results Fifty patients with stable COPD were enrolled in the study, of whom48 patients completed the trial and two patients dropped out. During the follow-up, 16 patients had once or more acute exacerbations while other 32 patients had no acute exacerbation. The patients were stratified into two groups ( A-exacerbation, B-no exacerbation) . At the baseline, the patients of the group A had lower FEV1 than thegroup B [ ( 1. 1 ±0. 4) L vs. ( 1. 4 ±0. 5) L, P lt;0. 05] . And the group A had higher hs-CRP and Fbg than the group B [ hs-CRP: ( 4. 6 ±3. 3) mg/L vs. 4. 3 mg/L( IQR 5. 5 mg/L) , P lt;0. 05] ; Fbg: ( 3. 8 ±0. 7) g/L vs. ( 3. 1 ±0. 5) g/L, P lt;0. 05] . Nine of 16 patients with a higher level of hs-CRP( hs-CRP gt;3 mg/L) had acute exacerbations. Seven of other 32 patients with normal hs-CRP level had acute exacerbations. The difference in the acute exacerbations rate between the two groups was significant ( 56. 25% vs. 21. 88% , P lt;0. 05) . All four patients with a higher level of Fbg( Fbg gt;4 g/L) had acute exacerbations. Twelve of 44 patients with normal Fbg level ( Fbg≤4 g/L) had acute exacerbations. The patients with Fbg more than 4 g/L had a higher rate of acute exacerbations( 100% vs. 27. 27%, P lt;0. 05) . After adjusting by age, bodymass index ( BMI) , FEV1 , tobacco consumption and other chronic diseases, the risk of acute exacerbation in individuals with baseline hs-CRP gt;3 mg/L was 9. 33 times higher than those with baseline hs-CRP≤3 mg/L ( 95% CI 1. 870-46. 573) . Conclusion Higher level of hs-CRP is associated with the high risk of exacerbation in patients with COPD.
Objective To investigate the influence of airflow limitation upon lung deposition of inhaled corticosteroids in patients with chronic obstructive pulmonary disease ( COPD) . Methods The radionuclide 99mTc was used to lable budesonide which was inhaled through compressor nebulizer. Lung deposition was evaluated by nuclear medicine pulmonary ventilation scintigraphy. Peripheral to central ratio of lung deposition ( P/C% ) was calculated by region of interest ( ROI) metod. Results Forty-threepatients with stable COPD were enrolled in the study, of whom 41 patients completed the trial. The median age was 68 years ( range, 48 to 79 years) and the median FEV1 was 44. 9% predicted. The P/C% was ( 47. 96 ±6. 08) % . The patients with P/C% more than 50% had a higher FEV1% pred and FEV1 /FVC than those with P/C% less than 50% [ FEV1% pred: ( 51. 85 ±18. 20) % vs. ( 40. 52 ±12. 99) % .FEV1 /FVC: ( 59. 95 ±11. 87) % vs. ( 51. 73 ±9. 28) % ] . There was a positive correlation between P/C% and FEV1% pred ( r = 0. 391, P = 0. 024) and FEV1 /FVC ratio ( r = 0. 517, P = 0. 002) . Conclusion Lung peripheral airway deposition of inhaled corticosteroids was limited by airflow obstruction.