ObjectiveTo analyze the sensitivity of peak flow meter screening in different subgroups of chronic obstructive pulmonary disease (COPD).
MethodsA total of 156 outpatients with COPD from Peking Union Medical Hospital from May 2013 to December 2014 were recruited in the study. Each patient's symptoms,history of exposure to risk factors,and the times of exacerbation in last year was recorded. All patients completed CAT,mMRC,the St George's Respiratory Questionnaire (SGRQ),6 minutes walking test,spirometry,and peak expiratory flow (PEF) by peak flow meter.
ResultsUsing the cut-off of PEF%pred=80%,the PEF detected 120 COPD patients in 156 subjects. The predictive factors of abnormal PEF%pred in COPD was FEV1%pred and the total score of SGRQ (P<0.05). PEF screening could identify 76.9% of COPD patients,30.0%-60.0% of patients of less symptoms (mMRC<2 or CAT<10 or SGRQ<25),83.3%-90.9% of COPD patients with more symptoms (mMRC ≥ 2 or CAT ≥ 10 or SGRQ ≥ 25),27.7% of COPD patients with mild airflow limitation,68.5% of COPD patients with moderate airflow limitation,83.3% of COPD patients with moderate to very severe airflow limitation. When grouped by GOLD combined assessment method,PEF screening could identify 35.2% of patients of group A,75.0% of patients of group B,and 95.9% of patients of group C and D. The cut-off value of PEF% pred=80% showed low sensitivity to early stage of COPD,but when using the cut-off value of PEF% pred=95%,that sensitivity increased signifcantly.
ConclusionsPeak flow meter may be used as a tool to screen COPD. It can identify part of COPD patients especially for those patients with more symptoms,requiring regular treatment,with deteriorated pulmonary function and high risk of exacerbation.
ObjectivesTo explore the clinical characteristics and risk factors for 30-day mortality of community-acquired pneumonia (CAP) patients with chronic obstructive pulmonary disease (COPD).MethodsThis was a multicentre, retrospective study. Data of patients hospitalized with CAP from four tertiary hospitals in Beijing, Shandong and Yunnan from January 1, 2013 to December 31, 2015 were reviewed. Patients with (COPD-CAP) and without (non COPD-CAP) COPD were compared, including demographic and clinical features, treatment and outcomes. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for 30-day mortality in COPD-CAP patients.ResultsThree thousand three hundred and sixty-six CAP patients were entered into final analysis, COPD-CAP accounted for 12.9% (435/3 366). Compared to non COPD-CAP patients, COPD-CAP patients were more male and more frequent with CURB-65 score 2 and pneumonia severity index (PSI) risk class Ⅲ to Ⅴ. Pseudomonas aeruginosa was the most common etiology and more common in COPD-CAP patients than non COPD-CAP patients. Though the proportion of respiratory failure and heart failure were higher in COPD-CAP patients, there was no significant difference in the 30-day mortality. The 30-day mortality of COPD-CAP patients was 5.7% (25/435). Logistic regression analysis confirmed aspiration (OR 9.505, 95%CI 1.483 - 60.983, P=0.018), blood procalcitonin ≥2.0 ng/mL (OR 5.934, 95%CI 1.162 - 30.304, P=0.032) and PSI risk class (OR 2.533, 95%CI 1.156 - 5.547, P=0.020) were independent risk factors for 30-day mortality in COPD-CAP patients.ConclusionsCOPD-CAP patients present specific characteristics. Besides PSI risk class, clinicians should pay high attention to the aspiration and blood procalcitonin, which could increase the 30-day mortality in COPD-CAP patients.
Objective To explore the clinical value of shear wave elastography in the evaluation of quadriceps femoris lesions in patients with chronic obstructive pulmonary disease (COPD). Methods Fifty-eight COPD patients who were admitted to Chengdu First People’s Hospital and 55 healthy controls were included in the study between August 2021 and February 2022. The thickness, circumference, cross-sectional area and Young's modulus of quadriceps femoris in all subjects were measured using shear wave elastography combined with conventional two-dimensional ultrasound. The differences in ultrasound parameters between the two groups were compared, and the correlation between each ultrasound parameter and clinical evaluation indicators (modified British Medical Research Council Scale, COPD Assessment Test, six-minute walk test, and five-time sit-to-stand test) was analyzed. Results Young’s modulus values of the quadriceps femoris muscle were smaller in the COPD group than those in the healthy control group [COPD Group: rectus femoris 6.72 (6.22, 7.36) kPa, vastus medialis 6.25 (5.82, 6.79) kPa, vastus lateralis 6.94 (6.17, 7.48) kPa; healthy control group: rectus femoris 11.40 (10.23, 12.11) kPa, vastus medialis 10.77 (9.62, 11.42) kPa, vastus lateralis 11.14 (10.42, 12.52) kPa]. The differences were statistically significant (all P<0.05). The Young's modulus value of the rectus femoris muscle correlates with the aforementioned clinical evaluation indicators, with positive correlation with six-minute walk distance and negative correlation with COPD Assessment Test, modified British Medical Research Council Scale, five-time sit-to-stand time (P<0.05). Quadriceps thickness, circumference, and cross-sectional area measured by conventional two-dimensional ultrasound were not significantly different between the two groups, nor were there significant correlations between each parameter and clinical parameters (P>0.05). In addition, shear wave elastography has good reproducibility in the measurement of Young's modulus in quadriceps. Conclusions Shear wave elastography can identify quadriceps lesions earlier than conventional two-dimensional ultrasound in COPD patients, and there is a significant correlation between its measurements and the clinical condition of COPD patients. Shear wave elastography may provide a simple and noninvasive method for clinical evaluation of quadriceps femoris lesions in COPD patients.
ObjectiveTo detect the expression and function of Kv1.3 channel in peripheral blood T lymphocytes of chronic obstructive pulmonary disease (COPD) patients, and to explore the possibility of Kv1.3 channel blockers in treating chronic airway inflammation in patients with COPD.MethodsT lymphocytes were isolated from peripheral blood of COPD patients and healthy controls. Then the mRNA and protein levels of Kv1.3 were detected in T cells. The effects of Kv1.3 channel inhibitors ShK on T cell proliferation and the production of interleukin 2 were detected.ResultsThe Kv1.3 level of peripheral blood T lymphocytes in patients with COPD was significantly higher than that of healthy controls. ShK significantly inhibited the proliferation and interleukin 2 production ability of T lymphocytes.ConclusionsKv1.3 may play important roles in inflammation in COPD. Selective blocking of Kv1.3 channels may be one of the future treatment for COPD.
Objective Sedation and/or analgesia is often applied during noninvasive positive pressure ventilation (NIPPV) to make patients comfortable, and thus improve the synchronization between patients and ventilator. Nevertheless, the effect of sedation and/or analgesia on the clinical outcome of the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation remains controversial. Methods A retrospective study was conducted on patients with AECOPD who received NIPPV after extubation in seven intensive care units in West China Hospital, Sichuan University between December 2013 and December 2017 . A logistic regression model was used to analyze the association between the use of sedation and/or analgesia and clinical outcomes including rate of NIPPV failure (defined as the need for reintubation and mechanical ventilation), hospital mortality, and length of intensive care unit stay after extubation. Results A total of 193 patients were included in the analysis, and 62 cases of these patients received sedation and/or analgesia during NIPPV. The usage of sedation and/or analgesia could result in failure of NIPPV (adjusted odd ratio [OR] 0.10, 95% confidence interval [CI] 0.02 - 0.52, P=0.006) and death (adjusted OR=0.13, 95%CI 0.04 - 0.42, P=0.001). Additionally, intensive care unit stay after extubation was longer in the patients who did not receive sedation and/or analgesia than those who did (11.02 d vs. 6.10 d, P< 0.01). Conclusion The usage of sedation and/or analgesia during NIPPV can decrease both the rate of NIPPV failure and hospital mortality in AECOPD patients after extubation.
ObjectiveTo explore the characteristics of induced sputum microbiome in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsInduced sputum samples from 55 patients with AECOPD and 45 patients with stable COPD were analyzed by sequencing of 16S rRNA gene. Microbiota was measured by alpha diversity, beta diversity and LDA effect size analysis (LefSe).ResultsThe microbiome diversity of induced sputum in the AECOPD group was lower than that in the stable COPD group. The microbiome richness in the AECOPD group was higher than that in the stable COPD group. The microbiome structure changed in the AECOPD group compared with the stable COPD group. The proportion of some common pathogens got enriched. The levels of hypersensitive C reactive protein (hs-CRP), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α) and Global Initative for Chronic Obstructive Lung Disease (GOLD) grade were negatively related to the diversity of microbiome in the AECOPD group.ConclusionsThe microbiome diversity of induced sputum in AECOPD patients is decreased, and is negatively correlated with the levels of hs-CRP, IL-8, TNF-α and GOLD grade. There are differences in the microbiome structure between AECOPD and stable COPD patients. Some enrichment of common pathogens are found in the induced sputum of patients with AECOPD. These results suggest that there is a significant bacterial dysbiosis in patients with AECOPD.
