ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
Objective To analyse the content and structure of the health management policy text for chronic obstructive pulmonary disease (COPD) in China, and to provide a reference for the optimization and improvement of subsequent relevant policies. Methods We searched for relevant policy documents on COPD health management at the national level from January 2017 to December 2023, constructed a two-dimensional analysis framework for policy tools and chronic disease health management processes, coded and classified policy texts, and used content analysis method to analyze policy texts. Results Twenty-four policy texts were included. There were 183 codes for policy tool dimension, with supply based, environmental based, and demand based tools accounting for 43.72%, 47.54%, and 8.74%, respectively. There were 124 codes for the dimension of health management processes, with health information collection and management accounting for 12.10%, risk prediction accounting for 14.52%, intervention and treatment accounting for 66.13%, and follow-up and effectiveness evaluation accounting for 7.26%. Conclusions At present, the proportion of policy tools related to the management of COPD in China needs to be dynamically adjusted. Environmental tools should be appropriately reduced, the internal structure of supply tools should be optimized, the driving effect of demand tools should be comprehensively enhanced, the coupling of COPD health management processes should be strengthened, and the relevant policy system and overall quality should be continuously improved.
ObjectiveTo observe the effects of perindopril on expression level of phosphatidylinositol 3-kinase (PI3K) and lung function in rats with obstructive pulmonary disease (COPD),and investigate the therapeutic effects of perindopril on COPD.
MethodsSixty male SD rats were randomly divided into a control group,a COPD group,and a perindopril group,with 20 rats in each group. The rat model of COPD was established by intratracheal instillation of lipopolysachride and exprosure to cigarette smoke in the COPD group and the perindopril group. The rats in the perindopril group were intragastricly infused with perindopril additionally. All rats were sacrificed after 28 days. The lung function was observed and PI3K protein expression was detected using Western blot method. The pathologic changes of the lung tissue and airway were observed by HE staining.
ResultsHE staining revealed that the rat COPD model was successfully established. The COPD group appeared obvious emphysema which was allievated significantly in the perindopril group. Pulmonary function indices in the COPD group and the perindopril group were significantly decreased compared with the control group with VE value decreased by 40% and 22%,PEP value decreased by 33% and 15%,and FEV0.3 value decreased by 18% and 7%,respectively. The expression of PI3K was significantly increased in the COPD group and the perindopril group than the control group,but more significantly in the COPD group (P<0.05).
ConclusionPerindopril can significantly improve lung function in rats with COPD possibly through down-regulation of PI3K expression in the lung.
Objective To investigate the risk factors of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea (OSA) and its relationship with apnea-hypopnea index (AHI). Methods Clinical data of 216 COPD patients with OSA were retrospectively chosen in the period from January 2016 to December 2019 in our hospital. All patients were divided into different groups according to with or without OSA and the clinical features of patients with and without OSA were compared. Multivariate analysis was used to analyze the influencing factors of COPD with OSA and the correlation between AHI and COPD with OSA was also evaluated. Results ① The age, body mass index (BMI), neck circumference, smoking index, forced expiratory volume in 1 second (FEV1), FEV1% predicted (FEV1pred), the ratio of FEV1 to the forced vital capacity of the lungs (FEV1/FVC), COPD assessment test (CAT) score, Epworth sleepiness scale (ESS) score, Charlson comorbidity index (CCI) score, sleep apnea clinical score (SACS) score and proportion of patients with essential hypertension in OSA group were significantly higher than non-OSA group (P<0.05). The course of disease and the proportion of severe COPD and GOLD grade 4 in OSA group were significantly less than non-OSA group (P<0.05). ② AHI was positively correlated with age, BMI, neck circumference, smoking index, FEV1%pred, FEV1%pred<50%, CAT score, ESS score, CCI score and SACS score (P<0.05); and negatively correlated with FEV1%pred<50% (P<0.05). ③ Multivariate analysis showed that BMI, FEV1%pred<50%, CAT score and ESS score were the independent factors of COPD patients with OSA (P<0.05). ④ The proportion of AHI<5 times/h in GOLD grade 4 was significantly higher than GOLD grade 1-3 (P<0.05). The proportion of AHI> 30 times/h in GOLD grade 4 was significantly lower than GOLD grade 1-3 (P<0.05). Conclusion The incidence of COPD with OSA was independently correlated with BMI, FEV1%pred, CAT score and ESS score; patients with severe COPD possess lower OSA risk.
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 investigate the impact of chronic obstructive pulmonary disease (COPD) and surgical approach on postoperative fast track recovery and hospitalization cost of patients undergoing lung cancer resection, and explore clinical pathways and clinical value of fast track recovery.
MethodClinical data of 129 consecutive patients undergoing lung cancer resection by one surgical group in West China Hospital from January 2010 to March 2011 were retrospectively analyzed. According to whether the patients had concomitant COPD, all the patients were divided into COPD group including 53 patients (39 males and 14 females) with their average age of 56.31±10.51 years, and non-COPD group including 76 patients (37 males and 39 females) with their average age of 65.92±7.85 years. According to different surgical approaches, all the patients were divided into complete video-assisted thoracoscopic surgery (VATS) group including 83 patients (44 males and 39 females) with their average age of 61.62±10.80 years, and routine thoracotomy group including 46 patients (32 males and 14 females) with their average age of 62.95±9.97 years. Postoperative morbidity, average hospital stay and hospitalization cost were compared between respective groups.
ResultsThere was no statistical difference in postoperative morbidity (53% vs. 40%, P=0.134)or average hospital stay[(7.66±2.95) days vs. (7.36±2.74)days, P=0.539] between COPD group and non-COPD group. Postoperative morbidity (34% vs. 65%, P < 0.001)and average hospital stay[(6.67±2.52)days vs. (8.61±3.01) days, P < 0.001] of VATS group were significantly lower or shorter than those of routine thoracotomy group. Total hospitalization cost (￥44 542.26±11 447.50 yuan vs. ￥23 634.13±6 014.35 yuan, P < 0.001) and material cost (￥37 352.53±11 807.81 yuan vs. ￥12 763.08±7 124.76 yuan, P < 0.001) of VATS group were significantly higher than those of routine thoracotomy group. Average medication cost of VATS group was significantly lower than that of routine thoracotomy group (￥7 473.54±4 523.70 vs. ￥10 176.71±6 371.12, P < 0.001). There was no statistical difference in other cost between VATS group and routine thoracotomy group.
ConclusionVATS lobectomy can promote postoperative fast track recovery of lung cancer patients, but also increase material cost of the surgery. COPD history does not influence postoperative fast track recovery or hospitalization cost.
