Recently, many researchers paid more attentions to the association between air pollution and chronic obstructive pulmonary disease (COPD). Haze, a severe form of outdoor air pollution, affected most parts of northern and eastern China in the past winter. In China, studies have been performed to evaluate the impact of outdoor air pollution and biomass smoke exposure on COPD; and most studies have focused on the role of air pollution in acutely triggering symptoms and exacerbations. Few studies have examined the role of air pollution in inducing pathophysiological changes that characterise COPD. Evidence showed that outdoor air pollution affects lung function in both children and adults and triggers exacerbations of COPD symptoms. Hence outdoor air pollution may be considered a risk factor for COPD mortality. However, evidence to date has been suggestive (not conclusive) that chronic exposure to outdoor air pollution increases the prevalence and incidence of COPD. Cross-sectional studies showed biomass smoke exposure is a risk factor for COPD. A long-term retrospective study and a long-term prospective cohort study showed that biomass smoke exposure reductions were associated with a reduced decline in forced expiratory volume in 1 second (FEV1) and with a decreased risk of COPD. To fully understand the effect of air pollution on COPD, we recommend future studies with longer follow-up periods, more standardized definitions of COPD and more refined and source-specific exposure assessments.
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 investigate the clinical characteristics of acute myocardial infarction ( AMI) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) .Methods Clinical data of 16 elderly patients with AECOPD and AMI from may 2007 to December 2009 were reviewed. Meanwhile, 128 elderly AECOPD patients without AMI were analyzed as control. Results Neither the AMI group nor the control group had typical precordial pain, conscious disturbance, andhypotension. Compared with the control group, the main symptoms of the AMI group were worsening of chest tightness and dyspnea( 16 /16 vs. 4/128, P lt;0. 01) ,most of which accompanying fever( 11/16 vs. 6/128, P lt;0. 05) and anorexia ( 10/16 vs. 23 /128, P lt; 0. 05) . The incidence of patches-like shadow on chest X-rayincreased ( 16 /16 vs. 62/128, P lt;0. 05) , PaO2 ( mm Hg) decreased ( 43. 72 ±3. 64 vs. 82. 26 ±11. 41, P lt;0. 001) , the red blood cell count ( ×1012 /L) increased ( 6. 43 ±0. 42 vs. 4. 11 ±1. 24, P lt; 0. 05) , the concentration of total cholesterol ( mmol /L) increased ( 6. 51 ±0. 84 vs. 3. 93 ±1. 14, P lt; 0. 05) , the needfor invasive mechanical ventilation increased ( 13/16 vs. 11 /128, P lt; 0. 05) , the days in hospital were prolonged ( 35 ±13 vs. 11 ±3, P lt; 0. 01) , the cost ( 1000 RMB) increased( 32 ±11 vs. 7. 6 ±2. 8, P lt;0. 01) , and the mortality also increased ( 2/16 vs. 3 /128, P lt;0. 01) . Conclusion AMI should be alerted in the case of sudden exacerbation of chest tightness and dyspnea in elderly patients with AECOPD.
Objective To explore the role of nuclear factor kappa B(NF-KB)in the pathogenesis of chronic obstructive pulmonary disease(COPD)and the therapeutic efects of glucocorticoid．Methods Twenty-four Wistar rats were randomly divided into three groups，ie．normal control，COPD model and prednisone preventive treatment group．Rat COPD model Was established by exposing the rats to cigarette smoke daily．Prednisone Was given through stomachal injection on altemate days．After COPD model Was set up，bronchoalveolar lavage(BAL)Was performed．Total cell counts and neutrophil counts in BALF were examined．Pathological changes of lung tissue Was observe0 by hematoxylin-eosin staining．The morphological indices of pulmonary emphysema(MLI，MAN and PAA)Was measured by a computerizedimage analyzer and compared in three groups．NF-KB expression in lung tissues were detected by immunohistochemistry assay．Rults Emphysema Was confirmed by three morphological indices in COPD model group compared to those of normal control group[MLI：(97.97±11.10)×10-6m vs (47．23±2．80)×10-6 m，MAN：(95.98±l4.89)×106 ／m vs (164.21±9．30)×106 ／m ，PAA：(64 ±5.7)％vs (44±2.7)％，Plt;0.01]．Total cell counts and neutrophil counts in BALF of COPD model group were significantly higher than those of control group[（5.76±0.29）×108/L vs （1.64±0.12）×108/L，（1.26±0.25）×108/L vs （0.099±0.065）×108/L，Plt;0.01]．After the preventive treatment with prednisone，MLI，MAN and PAA were significantly changed[（57.66±4.62）×10－6mvs （97.97±11.10）×10－6m，（111.40±16.92）×106個/m2 vs （95.98±14.89）×106個/m2，Plt;0.01；（58±6.1）% vs （64±5.7）%，Plt;0.05]，which indicated that airway inflammation and emphysematous injury in preventive treatm ent group were milder than those of COPD mode1．Total ceil counts and neutrophil countsin BALF were found in preventive treatment group as compared to those of COPD model[[（3.18±0.29）×108/L vs （5.76±0.29）×108/L，（0.57±0.12）×108/L vs （1.26±0.25）×108/L，Plt;0.01].The percentage of positive cells of NF-KB nuclear staining in bronchiolar epithelial ceils was significantly increased in the COPD group than that in the control group[（29.02±1.25）% vs （12.17±1.13）%，Plt;0.01]，but was significantly decreased in the preventive treatment group[(19.23±1.18)％vs (29.02±1.25)％，Plt;0．01]．Conclusions NF-KB may be responsible for the persistence and amplification of inflammation in COPD through neutrophil recruitment and activation．Prednisone may suppress airwayinflammation in COPD by inhibiting NF-KB．
Objective To observe the effects of salmeterol / fluticasone combined with tiotropium in the treatment of sever to very sever COPD. Methods Eighty patients with severe to very severe stable COPD were recruited from outpatient of Central Hospital of Cangzhou between May 2008 and October 2009. The subjects were randomly divided into a salmeterol /fluticasone group and a combination group. The salmeterol / fluticasone group received salmeterol / fluticasone propionate, and the combination group received the combination therapy of tiotropium and salmeterol / fluticasone propionate. All patients had received the treatment for 12 months. At baseline and at the end of 1-month, 3-month, 6-month, 12-month, lung function ( FEV1 , IC and FVC) , six-minute walk distance and the St. George’s Respiratory Questionnaire ( SGRQ) score were assessed. The number of exacerbations and the time to the first exacerbation were also recorded. Results At every visit, lung function ( FEV1 , IC and FVC) , six-minute walk distance and the SGRQ score were improved in both groups compared with baseline ( Plt;0. 05) , especially in the combination group ( Plt;0.05) . Compared with the salmeterol /fluticason, the combination therapy with tiotropium significantly decreased the incidence of exacerbations and prolonged the time to the first exacerbation ( Plt;0.05) . And there was no significant difference between two groups in adverse effects ( Pgt;0.05) . Conclusions The combination therapy with salmeterol / fluticasone propionate and tiotropium was superior to salmeterol / fluticasone propionate in treatment of sever to very severe stable COPD patients in improving lung function, exercise tolerance, and quality of life, without additional adverse effects.
ObjectiveTo systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in Post-extubation acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. MethodsThe Domestic and foreign databases were searched for all published available randomized controlled trials (RCTs) about HFNC therapy in post-extubation AECOPD patients. The experimental group was treated with HFNC, while the control group was treated with non-invasive positive pressure ventilation (NIPPV). The main outcome measurements included reintubation rate. The secondary outcomes measurements included oxygenation index after extubation, length of intensive care unit (ICU) stay, mortality, comfort score and adverse reaction rate. Meta-analysis was performed by Revman 5.3 software. ResultA total of 20 articles were enrolled. There were 1516 patients enrolled, with 754 patients in HFNC group, and 762 patients in control group. The results of Meta-analysis showed that there were no significant difference in reintubation rate [RR=1.41, 95%CI 0.97 - 2.07, P=0.08] and mortality [RR=0.91, 95%CI 0.58 - 1.44, P=0.69]. Compared with NIPPV, HFNC have advantages in 24 h oxygenation index after extubation [MD=4.66, 95%CI 0.26 - 9.05, P=0.04], length of ICU stay [High risk group: SMD –0.52, 95%CI –0.74 - –0.30; Medium and low risk group: MD –1.12, 95%CI –1.56- –0.67; P<0.00001], comfort score [MD=1.90, 95%CI 1.61 - 2.19, P<0.00001] and adverse reaction rate [RR=0.22, 95%CI 0.16 - 0.31, P<0.00001]. ConclusionsCompared with NIPPV, HFNC could improve oxygenation index after extubation, shorten the length of ICU stay, effectively improve Patient comfort, reduce the occurrence of adverse reactions and it did not increase the risk of reintubation and mortality. It is suggested that HFNC can be cautiously tried for sequential treatment of AECOPD patients after extubation, especially those who cannot tolerate NIPPV.
ObjectiveTo quantify the global burden of chronic obstructive pulmonary disease (COPD) attributable to high temperature, low temperature, and non-optimal temperature from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 data. MethodsBased on the GBD 2021 data, we analyzed global, regional, and national COPD mortality and disability-adjusted life years (DALYs) from COPD attributable to high, low, and non-optimal temperatures. Joinpoint regression, age-period-cohort modeling, and Bayesian prediction models were employed. ResultsGlobally, age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR) for COPD attributable to low temperature and non-optimal temperature declined. However, the burden from high temperature increased. Low temperature consistently exerted a greater burden than high temperature across all metrics. Significant geographical disparities emerged: high-temperature mortality was highest in South Asia; low-temperature burden was most severe in East Asia; and high-income North America exhibited accelerated high-temperature mortality growth. The highest low-temperature burden occurred in middle-SDI region, while high-temperature impacts predominated in low-middle-SDI region. Age patterns showed rising high-temperature burden in the 15-39 age group and increasing low-temperature burden among adults ≥80 years old. Bayesian projections revealed divergent gender trajectories: a continuing decline in low-temperature burden for males versus a decelerated decline for females (2020-2030). ConclusionLow temperature exposure remains the primary risk factor for COPD within non-optimal temperatures globally, although high-temperature impacts are increasing. Significant regional variations necessitate targeted interventions for three key populations: older adults vulnerable to cold, working-age adults with occupational heat exposure, and older women requiring rehabilitative support.
Objective To investigate the prognostic factors of severe chronic obstructive pulmonary disease ( COPD) in elderly patients, and to guide the clinical assessment and appropriate interventions. Methods A prospective cohort study was carried out from May 1993 to December 2010. A total of 178 elderly patients with severe COPD were recruited for baseline survey, and followed up for the living conditions, whether used non-invasive ventilation, and causes of death. A survival analysis was performed on all patients stratified by lung function. The significant factors on survival rate were analyzed. Results In this cohort the survival rates were 49% and 12% in five and ten years, respectively. The important factors for prognosis were age [ relative risk( RR) = 1. 043, 95% confidence intervals( 95% CI = 1. 010-1. 050] , forced expired volume in one second ( FEV1 , RR = 0. 019, 95% CI = 0. 007-0. 052) , FEV1% pred ( RR = 1. 045, 95% CI = 1. 012-1. 079) , lung function grade ( RR = 2. 542, 95% CI = 1. 310-4. 931) , body mass index ( BMI, RR= 0. 945, 95% CI = 0. 895-0. 952) , and pulmonary heart disease ( RR = 1. 872, 95% CI = 1. 188- 2. 959) . In severe COPD, non-invasive ventilation ( NIV, RR = 1. 167, 95% CI = 0. 041-1. 674) , pulmonary heart disease ( RR = 3. 805, 95% CI = 1. 336-10. 836) , FEV1 ( RR = 0. 081, 95% CI = 1. 001-1. 168) , and arterial partial of oxygen ( PaO2 , RR=0. 956, 95% CI =0. 920-0. 993) were the independent predictors.The patients using NIV had longer survival than those without NIV. The 5 and 10 years survival rate in the patients with NIV were 78% and 50% , much higher than those without ventilation which were 30% and 25% , respectively. In extremely severe COPD, FEV1 ( RR=1. 059, 95% CI =1. 015-1. 105) , arterial partial of carbon dioxide ( PaCO2 , RR=1. 037, 95% CI = 1. 001-1. 074) , age ( RR= 1. 054, 95% CI = 1. 013-1. 096) and pulmonary heart disease ( RR = 1. 892, 95% CI = 1. 125-3. 181) were the independent predictors. Conclusions Age, BMI, FEV1 , PaO2 , PaCO2 , pulmonary heart disease, and NIV were prognostic factors in elderly patients with severe COPD. The prognostic factors between severe and extremely severe COPD were not identical. Patients with severe COPD should be given early intervention, including progressive nutritional support, and long-term home oxygen therapy combining with NIV.
ObjectiveTo investigate the establishment of rat models with chronic obstructive pulmonary disease (COPD) combined with type 2 diabetes mellitus (DM).
MethodsEighty Sprague-Dawley (SD) male rats were randomly divided into four groups:COPD group (n=20), DM group (n=20), COPD combined with DM group (n=20) and normal group (n=20). COPD rats were established by cigarette smoke. Type 2 diabetes rats were modeled by streptozotocin injection. COPD combined with DM rats were modeled by cigarette smoking and streptozotocin injection at the same time. Pathological examination and blood glucose were tested after three months.
ResultsBronchial epithelium was seriously shedding in COPD+DM group, with alveolar structure damaged and some alveolar fused into bullae. The blood glucose level in COPD+DM group was (27.1±1.1) mmol/L, which was statistically different from other groups (P<0.05).
ConclusionRat model of COPD combined with type 2 DM could be established by cigarette smoking and streptozotocin injection, which can provide an animal model for further medical research.
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.
