Objective
To investigate the application status of titrated oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by means of literature retrieving.
Methods
Database retrieving is taken on eight major domestic medical journals about the treatment for AECOPD patients during the period of January 2013 to December 2015.
Results
There were 70 articles involving the treatment of AECOPD in the eight major journals during 2013 to 2015. Oxygen therapy was not mentioned in 14 articles, oxygen therapy data were incomplete in 13 papers and relatively complete in 43 papers. None of the articals provided full description of oxygen therapy. The arterial blood gas of the patients was analyzed, and showed excessive or not enough on effect of oxygen treatment.
Conclusion
The clinicians did not pay enough attention to oxygen treatment for AECOPD patients, so treatment guideline and clinical pathway should be construed to standardize titrated oxygen therapy.
Objective To systematically evaluate the efficacy of home noninvasive positive pressure ventilation (HNPPV) on patients with severe stable chronic obstructive pulmonary disease in China. Methods Systematic literature search was performed in Chinese BioMedical Literature Database, WanFang Data, VIP Database, Chinese National knowledge Infrastructure databases from inception to January 2018. All randomized controlled trials (RCTs) that reported comparison of the efficacy of HNPPV on patients with severe stable chronic obstructive pulmonary disease were included. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results A total of 767 patients from 14 studies were included in this meta-analysis. The combined results showed that, compared with the control group, HNPPV could significantly reduce the mortality (relative risk 0.51, 95%CI 0.33 – 0.78, P=0.002) and PaCO2 ［weighted mean difference (MD) –10.78, 95%CI –13.17 – –8.39, P<0.000 01］ of patients, improve the levels of PaO2 (MD 7.84, 95%CI 5.81 – 9.87, P<0.000 01), FEV1 (MD 0.13, 95%CI 0.08 – 0.18, P<0.000 01), and the quality of life (MD –6.27, 95% CI –9.04 – –3.51, P<0.000 01). Conclusion HNPPV can reduce the mortality of patients, improve the gas exchange, pulmonary function and the quality of life, but more large sample, high-quality, and multicenter RCT studies are needed.
ObjectiveTo explore the feasibility and clinical application value of low attenuation areas (LAA) scoring system in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsA total of 380 patients with AECOPD were included. Clinical data including general information, laboratory examinations and treatments during hospitalization were collected. According to the high-resolution computed CT (HRCT) imaging performance, the patients were divided into bronchitis phenotype and emphysema phenotype. The clinical data between these two groups were compared to analyze the differences between different phenotypes and the feasibility of LAA scoring system.ResultsIn patients of bronchitis phenotype, the levels of body mass index, C-reactive protein, interleukin-6, procalcitonin, neutrophil-to-lymphocyte ratio, and eosinophil counts on admission were higher than those of emphysema phenotype (P<0.05). Patients with emphysema phenotype had a higher proportion of male, a higher smoking index, higher cystatin C levels and lower bilirubin levels on admission (P<0.05), the rates of using mechanical ventilation and systemic glucocorticoids were higher as also (P<0.05). LAA scores had a positive correlation with the use of mechanical ventilation and systemic glucocorticoids and cystatin C levels, and a negative correlation with interleukin-6 levels (P<0.05).ConclusionsFor patients with AECOPD, using LAA scoring system to classify different phenotype through HRCT has relevant accuracy and clinical practicability. The LAA scoring system might help to evaluate the patient's condition and prognosis to a certain extent.
ObjectiveTo explore the difference in clinical characteristics and airway inflammation in COPD patients with different bronchodilator test results.
MethodsA total of 237 COPD patients visited between January 2013 and December 2014 were recruited in the study. The ability to complete daily living questionnaire (ADL),modified Medicine Research Council (mMRC) score,6-minute walk distance,pulmonary function,and cell count in induced sputum were measured in the patients. They were divided into a positive group and a negative group according to the response to bronchodilator test and compared.
ResultsThere were 58 cases (24.47%) in the positive group,and 179 cases (75.53%) in the negative group. There were no differences in the cumulative amount of smoking[(44.36±17.51) pack-years vs. (50.15±30.51) pack-years],duration of recurrent cough[(14.1±11.1) years vs. (15.5±11.4) years],history of allergic diseases (22.40% vs. 30.80%),or family history of allergic disease (5.17% vs. 2.23%) between two groups. In the positive group,FEV1%pred[(51.04±13.26)% vs. (44.10±14.66)%] and FVC%pred[(73.81±13.60)% vs. (64.33±15.17)%] were better than those of the negative group (both P<0.05). DLCO%pred[(44.66±13.92)% vs. (40.60±17.31)%] and RV/TLC[(51.80±10.57)% vs. (53.16±11.15)%] had no significant differences between two groups. 43.10% of the patients in the positive group and 61.46% in the negative group felt shortness of breath after walking (P<0.05). The positive group scored 22.6±3.8 points in activities of daily living assessment,1.5±0.9 points in mMRC,436.22±102.83 meters in 6-minute walking test,and 2.7±2.1 points in Borg scale score,which were all better than those in the negative group (all P<0.05). There was no significant difference in cell counting in induced sputum between two groups.
ConclusionsA part of COPD patients have positive response to bronchodilator,with better lung function,better ADL score,better mMRC score,and farther 6-minute walking distance. It suggests that a positive bronchodilator response might be a clinical phenotype of COPD.
ObjectiveTo investigate the physiologic effects of different pressure assist (PA) on ventilatory status,oxygenation and work of breathing (WOB) when a new generation of proportional assist ventilation (PAV) is applied in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
MethodsA prospective,crossover randomized physiologic study was performed.80%PA,60%PA and 40%PA was sequentially randomized to be applied with the duration of 30 minutes,and pressure support ventilation (PSV) with the duration of 30 minutes was applied before each PA.Ventilatory status, oxygenation,dyspnea indexes in PSV and different PA were compared,and WOB of patients and ventilator were compared in different PA.
ResultsTwenty-eight patients were recruited into the study.With the decrease of PA,peak inspiratory pressure (PIP),mean airway pressure (Pm),and tidal volume (VT) decreased gradually (P>0.05),respiratory rate (RR) increased gradually (P<0.05),while minute volume (MV),heart rate (HR),systolic blood pressure (SBP),mean arterial pressure (MAP),pH,arterial carbon dioxide tension (PaCO2),and arterial oxygen tension/inspired oxygen fraction (PaO2/FiO2) did not change significantly (P>0.05).Compared with PSV mode,PIP increased significantly in 80%PA (P<0.05),decreased significantly in 60%PA and 40%PA (P<0.05).Pm did not change significantly in 80%PA (P>0.05),decreased significantly in 60%PA and 40%PA (P<0.05).VT increased significantly in 80%PA (P<0.05),decreased significantly in 60%PA and 40%PA (P<0.05).RR did not change significantly in 80%PA (P>0.05),increased significantly in 60%PA and 40%PA (P<0.05).MV did not change significantly in 80%PA (P>0.05),decreased significantly in 60%PA and 40%PA (P<0.05).With the decrease of PA,Borg score and scale for accessory muscle use increased gradually (P<0.05).Compared with PSV mode,Borg score and scale for accessory muscle use did not change significantly in 80%PA (P>0.05),increased significantly in 60%PA and 40%PA (P<0.05).WOB of patients in 40%PA was significantly higher than that in 60%PA (P=0.000) and that in 80%PA (P=0.000),while which in 60%PA was significantly higher than that in 80%PA (P=0.000).On the contrary,WOB of ventilator in 40%PA was significantly lower than that in 60%PA (P=0.004) and that in 80%PA (P=0.000),while which in 60%PA was significantly lower than that in 80%PA (P=0.000).
ConclusionThe new generation of PAV can safely and effectively provide respiratory support to patients with AECOPD.Respiratory pattern,levels of dyspnea and accessory muscle use in 80%PA are similar with those in PSV.With the decrease of PA,levels of spontaneous breathing and WOB increase and dyspnea worsens.PAV can promote spontaneous breathing and prevent respiratory muscle disuse atrophy even more, but easily lead to respiratory muscle fatigue with inappropriate use.
Objective To investigate the rate of pulmonary function test, medication treatment, and relevant factors among patients with chronic obstructive pulmonary disease (COPD) aged 40 years or older in community of Guangdong Province, and to provide evidences for targeted intervention of COPD. Methods A multistage stratified cluster sampling was conducted in the community residents, who participated in the COPD surveillance project of in Guangdong Province during 2019 to 2020. A total of 3384 adults completed questionnaire and pulmonary function test. The Rao-Scott χ2 test based on complex sampling design, and non-conditional Logistic regression were used to explore possible influencing factors of pulmonary function test and medication treatment in COPD patients. Results Out of the 3384 adults, 288 patients with COPD were confirmed, including 253 males (87.8%) and 35 females (12.2%), and 184 patients (60.4%) were over 60 years old or more. The pulmonary function test rate was 10.7% [95% confidence interval (CI) 6.8% - 14.6%], and medication treatment rate was 10.6% (95%CI 7.0% - 14.1%). The results showed that wheezing, awareness of COPD related knowledge and pulmonary function test were related to whether COPD patients had pulmonary function test (P<0.05). Wheezing and personal history of respiratory diseases were related to medication treatment rate (P<0.05). Conclusions The rates of pulmonary function test and medication treatment among COPD patients aged 40 years or older are low. Health education about COPD should be actively carried out, and the screening of individuals with a history of respiratory diseases and respiratory symptoms should be strengthened so as to reduce the burden of COPD diseases.
