Chronic airway diseases constitute the majority of mortality of respiratory diseases in China. The 2017 Global Initiative for Chronic Obstructive Lung Disease has proposed a novel scheme for classification of disease severity. The mainstream for chronic obstructive pulmonary disease (COPD) management has shifted to the combination of long acting β2 agonists (LABA) and long acting muscarinic cholinergic antagonists instead of inhaled corticosteroid and LABA. Tiotropium was effective in early COPD with little or even without symptoms. The manangement strategy on COPD may be moving to the upper stream (early intervention). Greater interest has been focusing on clinical phenotyping and inflammatory pathways in asthma. The greater understanding of the pathogenesis of asthma has been associated with the clinical trial progress which suggests that multiple medications targeting at Th2 pathways may provide benefits for implementing personalized therapy. Medications targeting at neutrophilic airway inflammation and blockade of KIT pathways are expected to provide novel rationales for managing asthma with different phenotypes. There has been a considerable progress in bronchiectasis research in China, particularly in terms of etiology, bacteriology and clinical phenotying investigations. The establishment of bronchiectasis research centers in China may help better understanding of the pathogenesis of bronchiectasis, thus identifying potential targets for intervention, which may provide crucial rationale for future intervention to improve the long-term prognosis.
Objective To summarize the clinical features of motor neuron disease ( MND) with main presentation of pulmonary hypertension, so as to improve the diagnosis.Methods A patientwithMND whose main presentation was pulmonary hypertension was analyzed retrospectively. Meanwhile related literatures were reviewed. Clinical data including symptoms, early signs, misdiagnosis causes, and necessary functional examination of respiratory muscle were collected. Results The symptoms of MND was slow-onset and insidious with gradual progression over time. History inquiring found that the symptoms of muscle wasting and physical debilitation emerged long time before the respiratory symptoms. Physical examination also revealed obvious sign of muscle atrophy. Conclusions MND with main presentation of pulmonary hypertension has been recognized insufficiently and often misdiagnosed as other pulmonary diseases. Detailed history taking, systematic physical examination, and convenient functional examination of respiratory muscle,can not only reduce misdiagnosis, but also avoid some expensive and traumatic process.
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 Chronic cough is often present as increasing cough reaction to various physical and chemical stimulating factors. This study is aimed to investigate the difference of cough sensitivity and its mechanisms which are not clear among different causes of chronic cough. Methods Patients with chronic cough were recruited from cough clinic of Guangzhou Institute of Respiratory Diseases between 2005 to 2010. Using a modified diagnostic algorithm of chronic cough, common causes were identified. Capsaicin cough provocation test was also performed in these patients to assess the cough threshold. The relations between cough reflex sensitivity and duration of cough, cough severity, pulmonary function, induced sputum cell counts were then investigated. Results Through the diagnostic algorithm of chronic cough, the current study evaluated 133 adult patients, including 24 cases with upper airway cough syndrome (UACS) , 26 patients with cough variant asthma (CVA) , 31 cases with eosinophilic bronchitis (EB) , 30 patients with atopic cough (AC) , 22 cases with gastroesophageal reflux induced cough (GERC) . There were 30 healthy volunteers recruited as normal control. The cough threshold of LgC5 in AC, CVA, EB, GERC and UACS was 1.70 ±0.70, 2.12 ±0.67, 2.13 ±0.69, 1.69 ±0.73, 2.16 ±0.66, respectively. The LgC5 of the normal group ( 2.63 ±0.39) was higher than those in chronic cough groups( All P lt; 0.05) . The LgC5 of AC and GERC were lower than CVA, EB and UACS ( all Plt;0.05) . Duration and daytime score of cough showed positive correlations with LgC5( r =-0. 280, -0. 168, all P lt;0.05) . Pulmonary function and differential cell count of induced sputumwere not associated with LgC5 ( all Pgt;0.05) . Conclusions Different cause of chronic cough exhbit high cough reflex sensitivity to different extent. The difference of cough sensitivity may reflect the different pathogenesis among different causes, and may be related to the type of nerve fiber dominating the cough reflex.
Objective To investigate the etiological diagnosis of chronic cough with pharyngitis-like manifestations. Methods Patients with chronic cough and pharyngitis-like manifestations were recruited from Outpatient Department of Guangzhou Institute of Respiratory Diseases between December 2002 to March 2010. The causes of chronic cough were investigated using a well-established diagnostic protocol, including history taking and physical examination, pulmonary function tests, induced sputum cytology, 24-h esophageal pH monitoring, etc. The final diagnosis depended on clinical manifestations, examination findings, and a successful response to therapy. Results 326 patients with chronic cough and pharyngitislike manifestations were included in the study with amedian duration of 24 ( 2 ～480) months, amean age of 41 ±13 years. The causes of chronic cough were identified as follows: post nasal drip syndrome or upper airway cough syndrome in 73 cases ( 23. 31% ) , cough variant asthma in 61 cases( 18. 71% ) , eosinophilic bronchitis in 70 cases( 22. 47% ) , gastroesophageal reflux-induced cough in 54 cases ( 16. 56% ) , atopiccough in 48 cases ( 14. 72% ) , and others in 40 cases ( 12. 27% ) . There is no significant difference in percentage of common causes of chronic cough ( P gt; 0. 05) . Conclusion The proportions of upper airway syndrome and other common causes are similar in chronic cough with pharyngitis-like manifestatioins, whichsuggest pharyngitis-like manifestations are not specific for diagnosis of upper airway cough syndrome.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
【Abstract】Objective To investigate the contribution of occupational exposure to dusts / gases / fumes to chronic obstructive pulmonary disease( COPD) and respiratory symptoms in China. Methods Based on the crosssectional survey of COPD which was conducted in urban and rural areas of Beijing, Shanghai, Guangdong,Liaoning, Tianjin, Chongqing and Shanxi for residents aged 40 years or older, the association between the occupational exposure to dusts/ gases/ fumes and COPD and respiratory symptoms was analyzed. The recruited populations were interviewed with questionnaire and were tested with spirometry. The post-bronchodilators FEV1 /FVC lt; 70% was used as diagnostic criteria of COPD. Having any cough, sputum, wheezing and dyspnea was defined as having respiratory symptoms. Results The prevalence of occupational exposure to dusts/ gases /fumes was 20. 5% . As shown by multiple-variables Logistic regression analyses, occupational exposure to dusts / fumes /gases [ OR = 1. 20 ( 1. 04, 1. 39) ] and dusts of grain [ 1. 48 ( 1. 18, 1. 86) ] were associated with COPD;occupational exposure to dusts / fumes / gases [ OR = 1. 37( 1. 25, 1. 49) ] , hard-rock mining [ OR = 2. 31( 1. 67,3. 20) ] , coal mining [ OR = 1. 71( 1. 09, 2. 70) ] , dusts of cement [ OR = 1. 92( 1. 47, 2. 52) ] , chemical or plastics manufacturing [ OR =1. 58( 1. 37, 1. 83) ] , spray painting [ OR= 1. 46( 1. 16, 1. 84) ] , and other dusts or fumes [ OR = 1. 46 ( 1. 29, 1. 64 ) ] were associated with the respiratory symptoms. Smoking and occupational exposure to dusts / gases / fumes had synergic effects on the increasing risk of respiratory symptoms. The populationattributable risk ( PAR) of exposure to dusts / gases / fumes was 3. 94% and 7. 05% for COPD and respiratory symptoms respectively. Conclusions Occupational exposure to dusts /gases /fumes is associated with COPD and respiratory symptoms. Smoking and occupational exposure to dusts/ gases /fumes may have synergic effects on respiratory symptoms.