ObjectiveTo investigate the effect of pulmonary rehabilitation on pulmonary function,perception of dyspnea and quality of life in stable COPD patients of different severity. Methods300 patients with COPD in stable stage were divided into a moderate COPD group (n=120),a severe COPD group (n=100) and a very severe COPD group (n=80). Each group was randomly subdivided into a control group and a treatment group. The treatment groups received pulmonary rehabilitation for 6 months in addition to usual care,and the control groups received usual care without pulmonary rehabilitation. Pulmonary function(FEV1),6 minute walking distance (6MWD),modified medical research council (mMRC) scale,and acute exacerbation frequency of COPD were compared before and after intervention and among groups. ResultsAfter pulmonary rehabilitation for 6 months,the quality of life score and 6MWD were significantly improved in the treatment groups with moderate,severe,very severe COPD,and the increscent of 6MWD was greatest in the severe COPD patients. The mMRC of the patients with very severe COPD improved significantly after pulmonary rehabilitation(P<0.05). Lung function before and after the intervention in three groups all showed no significant difference (P>0.05). The acute exacerbation frequency of the severe COPD patients was significantly reduced by pulmonary rehabilitation (P<0.05), while there was no significant change in the moderate and very severe groups (P>0.05). ConclusionPulmonary rehabilitation can improve exercise tolerance and quality of life of COPD patients with different severity,reduce acute exacerbation frequency in severe COPD,reduce the dyspnea degree in very severe COPD. Pulmonary rehabilitation is a cost-effective treatment for stable COPD.
ObjectiveTo explore the changes of the B lymphocyte-derived microparticles (BLMPs) in the bronchoalveolar lavage fluid in patients with chronic obstructive pulmonary disease (COPD),and analyze the correlation between BLMPs changes and the stages of the disease. Methods33 COPD patients in acute exacerbation and 12 COPD patients in stable phase in Southwest Hospital,Xinqiao Hospital,and First Affiliated Hospital of Chongqing Medical University between March 2012 and March 2013 were enrolled in the study. 31 subjects who underwent physical examination and bronchoscopy were recruited as control. The lavage fluid specimens were collected through fiberoptic bronchoscopy,then marked with the corresponding antibodies after centrifugation. The numbers of microparticles were analyzed by flow cytometry. ResultsThe number of the BLMPs was significant different among three groups (P<0.05). Compared with the control group and the stable COPD group,the number of BLMPs in the AECOPD group was significantly reduced (P<0.05). Compared with the control group,the number of the BLMPs in the stable COPD group was reduced but with no significant difference (P>0.05). The numbers of BLMPs had no correlation with the smoking history,gender,age and body surface area. ConclusionThe number of BLMPs is reduced in COPD,especially in the acute exacerbation stage,so the reductions of the BLMPs may be associated with the stages of the disease. Smoking,gender,age,body surface area have no effect on the number of BLMPs.
Objective To evaluate the effects of indoor temperature and relative humidity on acute exacerbations of chronic obstructive pulmonary disease（AECOPD）.Methods A total of 70 moderate to very severe COPD patients were recruited.The data including indoor temperature and relative humidity twice daily，increase over their stable symptoms in "major" symptoms（dyspnea，sputum purulence，sputum amount） and "minor" symptoms（nasal discharge/congestion，sore throat，cough），and adjustment of medication were recorded on diary cards.All data were collected from Jan 2005 to Dec 2005 by telephone inquiring or home visiting.Furthermore，the corresponding median outdoor temperature，relative humidity and air pressure from atmosphere bureau were compared with indoors parameters to examine the different effects on AECOPD.Results Fifty-five cases completed the whole investigation.Indoor temperature and relative humidity were both risk factors when logistic regression was used to evaluate the effect.Our research showed that AECOPD was significantly related to indoor and ourdoor environment factors.The correlation coefficient of all factors were r=－0.686（indoor temperature），r=－0.671（outer temperature），r=0.105（indoor humidity），r=－0.115（outer humidity），r=0.545（atmospheric pressure） respectively.Conclusions The indoor temperature and relative humidity，especially low temperature and high relative humidity，had important effects on AECOPD of moderate to very severe patients.It may be helpful to prevent AECOPD by adjusting the indoor temperature and relative humidity.
Objective To analyze the clinical presentations and radiological characteristics of acute exacerbation of idiopathic pulmonary fibrosis ( IPF) . Methods Clinical and radiological data of 2 patients with acute exacerbation of IPF from April 2006 to July 2008 were retrospectively analyzed and literatures were reviewed. Results Both patients were senior male patients over 60 years old. Dyspnea, cough and inspiratory crackles were the major symptoms and signs. Two patients were experiencing an exacerbation of dyspnea for one week and half of month, respectively. PaO2 /FiO2 of both patients was less than225 mm Hg. In both patients, high-resolution computed tomography ( HRCT) scans at the exacerbation showed typical signs of IPF including peripheral predominant, basal predominant reticular abnormality, with honeycombing and traction bronchiectasis and bronchiolectasis, and newly developing alveolar opacity. HRCT scan showed peripheral area of ground-glass attenuation adjacent to subpleural honeycombing in one patient, and diffusely distributed ground-glass opacity in another patient. Two patients had received corticosteroid treatment. For one patient, the symptoms improved, and ground-glass attenuation adjacent to subpleural honeycombing had almostly resolved. The other patient died of respiratory failure. Conclusions Some acute exacerbation in idiopatic pulmonary fibrosis can be idiopathic. The clinical presentations mainly include the worsening of dyspnea within short time. HRCT generally demonstrates new bilateral ground-glass abnormality with or without areas of consolidation, superimposed on typical changes of IPF.
Objective To explore the imaging features of acute exacerbation of idiopathic pulmonary fibrosis ( IPF) under high-resolution computed tomography ( HRCT) . Methods The HRCT imaging features of six patients who met the criteria for acute exacerbation of IPF were analyzed retrospectively. Results The manifestations of IPF on HRCT scan were various in forms and distribution, as multifocal, ground-glass opacity, reticular shadow, honeycombing densities, capillary bronchiectasis,subpleural lines, traction bronchiolectasis and emphysema. The characteristic lesions were newly diffuse bilateral ground-glass opacity at the time of acute exacerbation, superimposed on subpleural reticular and honeycombing densities. Conclusions Chest HRCT findings in acute exacerbation of IPF are characteristic.HRCT is accurate and superior in diagnosis of IPF and in determining acute exacerbation of IPF.
Objective To investigate the effects of simvastatin on pulmonary function and vascular endothelial growth factor ( VEGF) levels in induced sputumof patients with COPD exacerbation( AECOPD) .Methods Thirty-eight patients with AECOPD were divided into two groups randomly, ie. a routine medical treatment( RT) group( n =30) and a routine + statin medical treatment( RST) group( n =28) . The VEGF levels in serumand induced sputum were detected by ELISA on the first day and after a week treatment in hospital, respectively. Meanwhile, the pulmonary function measurements were performed. Results There were no significant differences in the pulmonary function ( FEV1% pred and FEV1 /FVC) and VEGF levels in induced sputumbetween the two groups before treatment( P gt;0. 05) . The RT group showed no significantchanges in any parameters before and after a week treatment( P gt; 0. 05) . FEV1% pread, FEV1 /FVC and VEGF levels in induced sputum in the RST group after a week treatment significantly increased compared with those before treatment and the RT group( P lt;0. 01, P lt;0. 01, P lt;0. 05) . But There were no significant differences in serumVEGF levels between the two groups before and after a week treatment. The VEGF levels in induced sputum were positively correlated to FEV1% pread and FEV1 /FVC after a week treatment( r =0. 430, P lt;0. 05; r = 0. 388, P lt; 0. 05) . Conclusions Simvastatin may reduce the decline in pulmonary function and decrease the levels of VEGF in induced sputum of patients with AECOPD. Improvement in pulmonary function may be related to down-expression of lung VEGF
Objective To investigate the prevalence and risk factors of venous thromboembolism ( VTE) in patients with acute exacerbation of COPD ( AECOPD) . Methods The patients with AECOPD admitted fromJune 2006 to February 2010 in Beijing Tongren Hospital were included for analysis. VTE was investigated in all patients ( whether or not clinically suspected) by a standardized algorithm based on D-dimer testing, 4-limb venous ultrasonography, and the patients with clinically suspected pulmonarythromboembolism ( PTE) received ventilation/perfusion scan and ( or) computed tomography pulmonary angiography ( CTPA) . Results The total number of patients with AECOPD was 282, and the prevalence of VTE was 6% ( 17 /282) . Among the hypoxemia group( n = 84) , there were 16 patients with DVT with a prevalence of VTE of 19. 1% ( 16/84) in which 3 cases developed with PTE. In the non-hypoxemia group ( n =198) , the prevalence of VTE was 0. 5% ( 1/198) , and there was no case with PTE. The incidence of VTE in the hypoxemia group was significantly higher than that in the non-hypoxemia group( P lt; 0. 01) .Logistic analysis showed that lower PaO2 was the risk factor for VTE ( P lt; 0. 01 ) . Conclusions The incidence of VTE in AECOPD was 6% , mainly in the form of lower limb DVT. Hypoxemia was the risk factor for VTE in patients with AECOPD.
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 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 systematically evaluate the efficacy and safety of montelukast in the treatment of acute asthma in adults.Methods Randomized controlled trials ( RCTs) of montelukast in the treatment of acute asthma compared with placebo were searched in Pubmed, Embase, OVID, and Cochrane Library. The quality of included RCTs was evaluated and the data were extracted. Meta-analyses were performed with RevMan 5. 1 software, and the GRADE system was applied to rate the level of evidence and strength of recommendation. Results Five RCTs ( n = 947) were included. Meta-analyses showed that montelukast could statistically improve peak expiratory flow ( PEF) ( MD = 10. 65 [ 2. 81, 18. 49] , P = 0. 008) , reduce the number of patients with oral corticosteroids ( RR=0. 75[ 0. 62, 0. 92] , NNT= 7[ 4, 46] , P =0. 005) , but there were no statistical differences in decreasing the number of patients with hospitalizations ( RR= 0. 78[ 0. 57, 1. 06] , NNT = 19[ 9, + ∞] , P = 0. 110) and treatment failure ( RR = 0. 85[ 0. 67, 1. 09] , NNT=17[ 9, +∞] , P =0. 314) compared with the placebo. Based on GRADE, the level of evidence was low or moderate, and the strength of recommendation was weak. Conclusion Our study suggests montelukast can improve the lung function and reduce the use of systematic corticosteroids in acute asthma, but the potency to reduce the number of patients with hospitalization and treatment failure need to be explored in future.