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.
COPD是以不完全可逆性气流受限为特征的进展性肺疾病， 与肺部对香烟烟雾等有害气体或有害颗粒的异常炎症反应有关。病理改变存在于外周气道、中央气道、肺实质和肺血管系统等， 也可引起肺外的不良效应， 但外周气道病变和功能异常是导致不完全可逆气流受限的主要原因。国内外采用吸入支气管舒张剂后一秒率( FEV1／FVC) 小于70％来进行定性诊断。
Objective To investigate the influence of pulmonary infection on noninvasive ventilation ( NIV) therapy in hypercapnic acute respiratory failure ( ARF) due to acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) , and evaluate the predictive value of simplified version of clinical pulmonary infection score ( CPIS) for the efficacy of NIV therapy in ARF patients with AECOPD. Methods Eighty-four patients with ARF due to AECOPD were treated by NIV, and were divided into a successful group and an unsuccessful group by the therapeutic effect of NIV. The CPIS and simplified version of CPIS between two groups was compared. The predictive value of simplified version of CPIS for the efficacy of NIV wasevaluated using ROC curve analysis. Results The CPIS and the simplified version of CPIS of the successful treatment group ( 4. 0 ±2. 8, 3. 2 ±2. 4) were lower than those of the unsuccessful group ( 8. 0 ±2. 1, 7. 2 ±1. 8) significantly ( P =0. 006, 0. 007) . The area under ROC curve ( AUC) of CPIS and simplified version of CPIS were 0. 884 and 0. 914 respectively, the cut oint of CPIS and simplified version of CPIS were 6 ( sensitivity of 78. 0% , specificity of 91. 2% ) and 5 ( sensitivity of 80. 0% , specificity of 91. 2% ) respectively. Conclusions The level of pulmonary infection is an important influencing factor on the therapeutic effect of NIV in patients with ARF due to AECOPD. Simplified version of CPIS is a helpful predictor for the effect of NIV on ARF of AECOPD.
Objective To assess the effectiveness and safety of moxifloxacin versus levofloxacin for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Such databases as PubMed, EMbase, The Cochrane Library, CBM, CNKI and VIP were electronically searched, and the relevant conference proceedings were also hand-searched. The search time was up to July, 2011. Randomized controlled trials (RCTs) on moxifloxacin versus levofloxacin for AECOPD were included. Literature was screened according to inclusive and exclusive criteria, data were extracted, quality was assessed, and then meta-analysis was performed using RevMan 5.0. Results A total of 6 RCTs involving 482 patients with AECOPD were included. The results of meta-analysis showed that moxifloxacin group was significantly superior to levofloxacin group in the effective rate (OR=3.15, 95%CI 1.80 to 5.49, Plt;0.000 1). The bacterial clearance rate in moxifloxacin group was also higher than that in the levofloxacin group (OR=2.79, 95%CI 1.30 to 5.97, P=0.008). In addition, adverse effects of moxifloxacin group were less than levofloxacin (OR=0.48, 95%CI 0.24 to 0.98, P=0.04). Conclusion Based on current studies, moxifloxacin is superior to levofloxacin in improving effective rate and bacterial clearance rate, and in lowering side effects when treating AECOPD. Hence it is considerable to use moxifloxacin instead of levofloxacin in the treatment of AECOPD if necessary. Due to the limitation of both quantity and quality of included studies, this conclusion should be further confirmed with more high quality and large sample studies.
摘要:目的: 探讨重度、极重度COPD急性加重期合并多MODS临床特征和预后有关的危险因素。 方法 :回顾分析1999～2009年因重度、极重度COPD急性期合并多器官功能障碍而住院的患者临床资料。 结果 :本研究共纳入226例患者,平均年龄为693±52岁。呼吸系统功能障碍发生率最高,有200例。其次是心血管功能障碍和中枢神经功能障碍,各102例。患者的病死率随着器官功能障碍的数目增加而增加。 结论 :治疗重度、极重度COPD急性加重时,在常规治疗基础的同时防治MODS是降低患者病死率的关键。Abstract: Objective: To analyze the clinical characters and risk factors that relevant to prognosis of severe or very severe chronic obstructive pulmonary disease(COPD)exacerbation combining with multiple organ dysfunction syndrome(MODS). Methods :The clinical data of patients who was admitted to hospital for exacerbation of severe or very severe COPD combing with MODS ｉｎ 1999 to 2009 were retrospective analyzed. Results : 226 cases were analyzed in this study, the mean age of patients was 693±52 The incidence of respiratory system dysfunction was highest, which was 200 cases, and followed by the incidence of cardiovascular dysfunction and central nervous system dysfunction, which was 102 respectively. The mortality of these patients increased with the increasing number of organ dysfunction. Conclusion : Pｒｅｖｅｎｔ ａｎｄ te at MODS on the basis of conventional treatment of severe or very severe COPD exacerbation is the key factor that could reduce mortality of these patients.
摘要:目的:应用区域阻抗法测定慢性阻塞性肺疾病（COPD）患者的肺血流灌注及肺通气分布的变化,与放射性核素肺显像方法比较,探讨肺区域阻抗方法的临床应用价值。 方法: 测定对象为18例中重度COPD患者,均为男性,平均年龄63.8岁,应用肺区域阻抗法及放射性核素法,分别测定肺血流灌注及肺通气的分布。〖HTH〗结果〖HTSS〗: 本研究发现肺区域阻抗法在测定肺血流灌注分布方面,仅在左下肺区域高于核素法测得的数值(Plt;0.05),余肺区测定结果相近,无显著差异。在肺通气的测定方面,阻抗法所得数值与核素法测得的数值有一定的不同,在左上、右上区域高于核素法测得的数值,在左中肺区测得的数值低于核素法测得的数值(Plt;0.05),余肺区测定结果相近,无显著差异。结论: 虽然目前区域阻抗方法暂不能取代放射性核素的测定,但作为一种辅助手段,可简便、快速了解肺内的通气、血流等生理病理改变。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.
Objective To investigate the feasibility of dexmedetomidine hydrochloride in sedation practices during NPPV for patients with acute exacerbation of COPD ( AECOPD) and respiratory failure. Methods 50 patients with AECOPD and respiratory failure, admitted in ICU between January 2011 and April 2012, were divide into an observation group and a control group. All patients received conventional treatment and noninvasive positive pressure ventilation ( NPPV) . Meanwhile in the observation group, dexmedetomidine hydrochloride ( 1 μg/kg) was intravenously injected within 10 minutes, then maintained using a micropump by 0.1 ～0. 6 μg·kg- 1 ·h- 1 to maintaining Ramsay Sedation Scale ( RSS) score ranged from 2 to 4. The patients’compliance to NPPV treatment ( conversion rate to invasive ventilation) and ICU stay were compared between two groups. Heart rate,mean arterial pressure, respiratory rate, and arterial blood gas ( pH, PaO2 , PaCO2 ) before and 24 hours after treatment were also compared. Results After 24 hours treatment, heart rate, mean arterial pressure, respiratory rate, and arterial blood gas were all improved in two groups, while the improvements were more remarkable in the observation group. The conversion rate to invasive ventilation ( 4% vs. 16% ) and ICUstay [ ( 5.47 ±3.19) d vs. ( 8.78 ±3.45) d] were lower in the observation group than those in the control group. ( P lt;0.05) . Conclusion Dexmedetomidine hydrochloride may serve as a safe and effective sedative drug during NPPV in patients with AECOPD and respiratory failure.
Objective To observe the genotype distribution of Haemophilus parainfluenzae from patients with acute exacerbations of chronic obstructive pulmonary disease ( AECOPD) and their effects on A549 cells. Methods 80 hospitalized patients with AECOPD in our hospital were enrolled. Haemophilus parainfluezae were collected by sputum culture and genotyped, then inoculated with cell line A549. IL-6 and IL-8 concentrations in the supernatant were detected and cell morphology was observed at different time points. Results The patients were divided into three groups according to their symptoms. 15 Haemophilus parainfuenzae strains were collected and the positive culture rate between type 1 and type 3 COPD patients were statistically different. The concentrations of IL-6 and IL-8 were both significantly higher than control and increased as time passed. 4 genotypes were got by random amplification of polymorphic DNA ( RAPD) . In RAPD Ⅲ group, the IL-8 concentration was higher at 12h and 24h than others. No morphologic change was found in the cells inoculated with Haemophilus parainfuenzae by microscope after fixing. Conclusions Positive culture rate of Haemophilus parainfuenzae was different in different COPD groups according to symptoms. Haemophilus parainfuenzae can stimulate a cytokine response in A549 cells, maybe one of the pathogens of AECOPD, especially the RAPDⅢ type. Haemophilus parainfuenzae is not an intracellular bacteria.
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.
ObjectiveTo evaluate the safety and efficacy of non-invasive positive pressure ventilation (NIPPV) combined with fiberoptic bronchoscopy(FB) on acute exacerbation of chronic obstructive puhmonary disease (AECOPD) patients with acute respiratory failure. MethodsA prospective study was conducted on the AECOPD patients with respiratory failure in respiratory intensive care unit of Tangdu Hospital of Fourth Military Medicine University from February 2010 to February 2011.They were randomly divided into a case group and a control group.The case group was administrated FB and lavage after one hour of NIPPV treatment.The control group was administrated NIPPV without FB and lavage.Other treatment regimen was the same in two groups. ResultsThere were 51 subjects recruited in the study, 25 subjects in the case group and 26 subjects in the control group.All variables at baseline were matched (P > 0.05).All variables improved after one hour of NIPPV before FB, without significant difference between two groups (P > 0.05).During the period of FB, heart rate in the case group was faster than that in the control group (P < 0.05), and other variables were not significantly different between two groups (P > 0.05).Both groups received NIPPV for one hour after FB, the variables including heart rate, respiratory rate, pH, PaO2, PaCO2 were statistically significant between two groups(P < 0.05).At the time of 24 hours after FB, the variables including mean arterial pressure, heart rate, respiratory rate, pH, PaO2 and PaCO2 in the case group were nearly recovered, and differences between two groups were significant (P < 0.05).The positive rate of sputum culture was significantly higher in the case group than that in the control group[88.0%(22/25) vs.58.6%(14/26)].Success rate in the case group were obviously superior to that in control group.The cases of failure, death and refusing in the case group were lower than those in the control group.Complications in two groups had no significant difference (P > 0.05).There was not serious complication such as hear arrest, hemoptysis and apnea during the process of NIPPV combined with early FB. Conclusion It deserves to be used in clinic because of the safety, efficacy and feasible for most of AECOPD patients through NIPPV combined with early FB.