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.
Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV1 / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.
Objective To study the effect of glucocorticoid-containing triple therapy on the acute exacerbation frequency of patients with moderate to severe chronic obstructive pulmonary disease (COPD) with different blood eosinophil percentage (EOS%). Methods One hundred and twenty-four patients who were admitted to the hospital with moderate to severe COPD from January 2020 to March 2020 in the Department of Respiratory and Critical Care Medicine in this hospital were selected as the research subjects, and the patients were divided into group A according to EOS% (EOS%<2%) and B group (EOS%≥2%). Then the A and B groups were randomly divided into four subgroups A1, A2 and B1, B2, and the patients in groups A1 and B1 were treated with dual long-acting bronchodilation. The medication for the patients in groups A2 and B2 was a triple preparation containing glucocorticoids. Namely A1 group (EOS%<2%, dual therapy), A2 group (EOS%<2%, triple therapy), B1 group (EOS%≥2%, dual therapy), B2 group (EOS%≥2%, triple therapy). The patients were instructed to take medication regularly as in hospital after discharge. After discharge, patients were followed up by telephone every two weeks for a period of one year. The number of acute exacerbations, the change of forced expiratory volume in the first second as a percentage of the expected value (FEV1%pred) and the incidence of pneumonia were compared between group A and group B during the follow-up period of one year. Results In the patients with EOS%≥2%, triple therapy reduced the number of acute attacks by 40% during treatment compared with dual therapy patients (average 0.875 vs. 1.471 times per patient per year, P=0.0278). While in the patients with EOS%<2%, it was reduced by 4% (1.080 vs. 1.125 times, P=0.3527). In the same use of glucocorticoid-containing triple preparations, the number of acute exacerbations in the patients with EOS%≥2% during medication was 19% less than that of the patients with EOS%<2% (an average of 0.875 to 1.080 times per patient per year, P=0.0462). Regardless of EOS%≥2% or <2%, there was no significant difference in the changes of FEV1%pred between triple therapy and double therapy patients before and after treatment (P>0.05). Regardless of EOS%≥2% or <2%, there was no statistically significant difference in the incidence of pneumonia between patients with triple therapy and double therapy during medication (P>0.05). Conclusion Inhaled glucocorticoid triple therapy is suitable for moderate to severe COPD patients with high percentages of blood eosinophils.
Objective To explore the correlations between nutritional markers and pressure injury (PI) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods Retrospective analysis was conducted on elderly patients with COPD and PI who were admitted to the geriatric department of West China Hospital of Sichuan University or Dujiangyan People’s Hospital between January 2020 and December 2021. The blood biochemical indicators mainly including nutritional markers were collected, and their correlations with PI risk factor index Braden score and PI severity index PI stage were analyzed. Results A total of 293 patients with COPD and PI were included. Among the five Braden score groups, the differences in the levels of albumin and prealbumin were statistically significant (P<0.05), and the Braden score was positively correlated with albumin (rs=0.241, P<0.001), prealbumin (rs=0.179, P=0.002), and hemoglobin (rs=0.199, P=0.001). Among the six PI stage groups, the differences in the levels of albumin, globulin, red blood cell count, serum sodium, blood chloride and C-reactive protein were statistically significant (P<0.05), and the PI stage was negatively correlated with albumin (rs=−0.192, P=0.001), and positively correlated with serum sodium (rs=0.139, P<0.001), blood chloride (rs=0.184, P<0.001), and C-reactive protein (rs=0.177, P=0.020). Conclusion When PI risk assessment and severity assessment are performed on elderly COPD patients, it is necessary to pay more attention to nutritional markers and assess whether the patients are at risk of protein malnutrition, which will help to improve the accuracy of PI risk assessment and severity prediction, and effectively improve the efficacy of PI prevention and treatment.
Objective To investigate the current status of disease uncertainty and alexithymia in elderly hospitalized patients with chronic obstructive pulmonary disease (COPD). Methods By using the convenience sampling method, a total of 165 elderly patients with COPD were investigated by using general information questionnaire, Mishel's uncertainty in illness Scale (MUIS) and Toronto alexithymia scale (TAS-20). Results The disease course of the elderly hospitalized patients with COPD was mostly 3 - 6 years (40.0%), and most of them had 1 - 2 chronic diseases (59.4%). More than half of the elderly had a history of smoking and drinking. The severity of COPD in the elderly was moderate (57.0%), and the number of hospitalization in the year was more than 2 times (58.8%). The score of disease uncertainty in the elderly hospitalized patients with COPD was 89.49±9.45, and the score of uncertainty was the highest (36.59±4.08), followed by the lack of information (18.51±1.86). The score of alexithymia in the elderly hospitalized patients with COPD was 55.32±6.37, and the score of all dimensions was the highest (21.87±2.93), followed by affective recognition disorder (18.27±2.55). The results of correlation analysis showed that the total score and scores of each dimension were positively correlated (P<0.01). The results of multi-factor analysis showed that age and course of disease and severity of COPD were the main influencing factors of disease uncertainty in elderly hospitalized patients with COPD (P<0.05). Conclusions The elderly hospitalized patients with COPD have a moderate level of disease uncertainty and a high degree of alexithymia. Besides, the greater the disease uncertainty is, the more serious the alexithymia. Therefore, clinical doctors and nurses should pay more attention to give emotional and psychological support and education guidance to the elderly patients with COPD, in order to improve their clinical efficacy and quality of life.
Objective To investigate the clinical significance of lateral position ventilation in the treatment of invasive ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods From October 2014 to December 2016, 60 eligible patients with AECOPD who meeting the inclusion criteria were randomly assigned to an intervention group (n=30) or a control group (n=30). Expectorant, antiasthmatic, anti-infective, invasive ventilation, bronchoscopy, analgesic sedation, invasive-noninvasive sequential ventilation, nutritional support, intensive care and other treatment were conducted in two groups, but lateral position ventilation was subsequently performed in the intervention group and the control group used half lateral position. Outcome measurements included pH, PaO2/FiO2, arterial partial pressure of carbon dioxide (PaCO2), heart rate (HR), respiratory rate (R) and air way resistance (Raw) before and one day after invasive ventilation, and duration of control of pulmonary infection (PIC), invasive mechanic ventilation (IMV), mechanic ventilation (MV) and intensive care unit (ICU) stay. Results Compared with before ventilation, the levels of PaO2/FiO2, PaCO2, HR, R and Raw were significantly changed in two groups after ventilation (P<0.05). One day later after ventilation, pH [interventionvs. control: (7.43±0.07) vs. (7.37±0.11)], PaO2/FiO2[(253.52±65.33) mm Hg (1 mm Hg=0.133 kPa) vs. (215.46±58.72) mm Hg] and PaCO2 [(52.45±7.15) mm Hg vs. (59.39±8.44) mm Hg] were statistically significant (P<0.05), but no significant difference was found in HR, R or Raw between two groups (P>0.05). Compared with the control group, PIC [(3.7±1.4) daysvs. (5.3±2.2) days], IMV [(4.0±1.5) days vs. (6.1±3.0) days], MV [(4.7±2.0) days vs. (7.3±3.7) days] and ICU stay [(6.2±2.1) days vs. (8.5±4.2) days] were significantly decreased (P<0.05) in the intervention group. Conclusions In AECOPD patients, invasive ventilation using lateral position ventilation can significantly improve arterial blood gas index, decrease Raw, shorten the time of PIC, IMV, MV and ICU stay.
摘要:目的: 探讨重度、极重度COPD急性加重期合并多MODS临床特征和预后有关的危险因素。 方法 :回顾分析1999～2009年因重度、极重度COPD急性期合并多器官功能障碍而住院的患者临床资料。 结果 :本研究共纳入226例患者,平均年龄为693±52岁。呼吸系统功能障碍发生率最高,有200例。其次是心血管功能障碍和中枢神经功能障碍,各102例。患者的病死率随着器官功能障碍的数目增加而增加。 结论 :治疗重度、极重度COPD急性加重时,在常规治疗基础的同时防治MODS是降低患者病死率的关键。Abstract: Objective: To analyze the clinical characters and risk factors that relevant to prognosis of severe or very severe chronic obstructive pulmonary disease(COPD)exacerbation combining with multiple organ dysfunction syndrome(MODS). Methods :The clinical data of patients who was admitted to hospital for exacerbation of severe or very severe COPD combing with MODS ｉｎ 1999 to 2009 were retrospective analyzed. Results : 226 cases were analyzed in this study, the mean age of patients was 693±52 The incidence of respiratory system dysfunction was highest, which was 200 cases, and followed by the incidence of cardiovascular dysfunction and central nervous system dysfunction, which was 102 respectively. The mortality of these patients increased with the increasing number of organ dysfunction. Conclusion : Pｒｅｖｅｎｔ ａｎｄ te at MODS on the basis of conventional treatment of severe or very severe COPD exacerbation is the key factor that could reduce mortality of these patients.
Objective To investigate the potential causal relationship between chronic rhinosinusitis (CRS) and chronic obstructive pulmonary disease (COPD) using a two-sample two-way Mendelian randomization (MR) approach. Methods In the forward study, single nucleotide polymorphisms (SNPs) closely associated with CRS were selected as instrumental variables from publicly available genome-wide association studies datasets, with COPD as the outcome variable; conversely, in the reverse study, SNPs closely associated with COPD were selected as instrumental variables, with CRS as the outcome variable. MR analysis was conducted using three regression models: inverse variance weighted (IVW), MR-Egger regression analysis, and weighted median (WME) to assess the causal relationship between CRS and COPD. Cochran’s Q statistic, MR-Egger intercept, MR-PRESSO, and “leave-one-out” methods were employed to test for heterogeneity and horizontal pleiotropy, thereby evaluating the stability and reliability of the MR results. Results A total of 14 SNPs closely associated with CRS were included in the forward study; the IVW-fixed effects analysis indicated that CRS may increase the risk of developing COPD [odds ratio=1.003, 95% confidence interval (1.002, 1.004), P<0.001], which was confirmed by the WME method, while the MR-Egger regression method did not show a causal link between CRS and COPD. Heterogeneity test (IVW result: Cochran’s Q=7.910, P=0.849; MR-Egger regression result: Cochran’s Q=7.450, P=0.827), MR-Egger intercept method (P=0.510), MR-PRESSO test (P=0.917), and “leave-one-out” method showed that the MR analysis results were reliable. In the reverse study, a total of 12 SNPs related to COPD were included as instrumental variables; MR analysis did not support the notion that COPD would increase the risk of CRS (P>0.05). Heterogeneity test (IVW result: Cochran’s Q=5.947, P=0.877; MR-Egger regression result: Cochran’s Q=5.937, P=0.821), MR-Egger intercept method (P=0.921), MR-PRESSO test (P=0.875), and “leave-one-out” analysis method showed that the MR analysis results were reliable. Conclusions There is a potential causal association between CRS and COPD, and CRS may increase the risk of developing COPD. But there is no evidence to suggest that COPD increases the risk of CRS.
Objective To explore the expression levels and clinical significance of serum long noncoding RNA myocardial infarction associated transcript (lncRNA MIAT) and microRNA-515-5p (miR-515-5p) in elderly patients with chronic obstructive pulmonary disease (COPD) at different periods. Methods From April 2021 to June 2023, 90 elderly patients with acute exacerbation of COPD treated in Huaibei People’s Hospital were selected as a COPD acute exacerbation group, 88 elderly patients with stable COPD as a COPD stable group, and 90 healthy elderly individuals undergoing physical examination as a control group. The white blood cell count (WBC) and serum lncRNA MIAT and miR-515-5p expression levels were detected in all subjects, blood gas analysis and pulmonary function indexes [oxygenation index (PaO2/FiO2), arterial blood carbon dioxide partial pressure (PaCO2), ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), and FEV1 as a percentage of predicted value (FEV1%pred)] were detected in the patients with COPD. The correlation between serum lncRNA MIAT, miR-515-5p and smoking, WBC, blood gas analysis and pulmonary function indexes were analyzed in the elderly patients with acute exacerbation of COPD. The influencing factors of acute exacerbation of COPD, and the value of serum lncRNA MIAT, miR-515-5p in predicting the occurrence of acute exacerbation of COPD were also analyzed. Results The smoking proportion, WBC, serum lncRNA MIAT expression levels of the control group, the COPD stable group and the COPD acute exacerbation group were increased in turn, serum miR-515-5p expression levels were decreased in turn (P<0.05). Compared with the COPD stable group, PaCO2 was significantly increased in the COPD acute exacerbation group, while PaO2/FiO2, FEV1/FVC and FEV1%pred were significantly decreased (P<0.05); serum lncRNA MIAT in the elderly patients with acute exacerbation of COPD was positively correlated with smoking, WBC, PaCO2 (P<0.05), and negatively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p (P<0.05); serum miR-515-5p was negatively correlated with smoking, WBC, PaCO2 (P<0.05), and positively correlated with PaO2/FiO2, FEV1/FVC, FEV1%pred (P<0.05). Smoking, WBC, PaCO2, and lncRNA MIAT were risk factors affecting the acute exacerbation of COPD patients, PaO2/FiO2, FEV1/FVC, FEV1%pred, miR-515-5p were protective factors affecting the acute exacerbation of elderly COPD patients (P<0.05). The area under the ROC curve (AUC) of serum lncRNA MIAT, miR-515-5p and their combination in predicting acute exacerbation in elderly COPD patients were 0.823, 0.862 and 0.919, respectively, higher than the AUC predicted by serum lncRNA MIAT and miR-515-5p separately (P<0.05). Conclusions Serum lncRNA MIAT expression was high in elderly patients with COPD, and serum miR-515-5p expression was low, and the changes of both were more obvious in patients with acute exacerbation. Both were correlated with blood gas analysis and pulmonary function indexes in patients with acute exacerbation, and have high value in predicting the occurrence of acute exacerbation in elderly patients with COPD.
Objective To explore the differences in lung function, neutrophil polarization, and serum total immunoglobulin E (IgE) levels among bronchial asthma patients, chronic obstructive pulmonary disease (COPD) patients, and asthma-COPD overlap syndrome (ACO) patients. Methods The retrospective analysis enrolled 127 patients with respiratory system diseases diagnosed and treated in Wuwei People’s Hospital between March 2016 and March 2019. Among them, 45 patients with moderate and severe bronchial asthma were in included the asthma group, 42 patients with acute exacerbations of COPD were included in the COPD group, and 40 patients with moderately persistent and severely persistent ACO were included in the ACO group. Forty-eight healthy examinees in the same period were selected as the control group. The pulmonary function [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1 to FVC (FEV1/FVC) ratio, and percentage of FEV1 to predicted value (FEV1%pred)], neutrophil polarization, and serum total IgE levels of the four groups were compared. Results In the control group, the ACO group, the asthma group, and the COPD group, the FEV1 values were (3.65±0.79), (2.04±0.58), (1.81±0.46), and (1.59±0.43) L, respectively, the FVC values were (4.13±0.92), (3.18±0.76), (2.69±0.63), and (2.43±0.58) L, respectively, the serum total IgE levels were (92.36±12.20), (334.81±55.96), (455.61±65.59), and (142.65±28.36) U/mL, respectively, and the between-group differences were all statistically significant (P<0.05). In addition, the FEV1/FVC ratios in the asthma group, the COPD group, and the ACO group were (67.93±11.51)%, (63.81±9.22)%, and (61.28±9.23)%, respectively, the FEV1%pred levels were (74.55±11.70)%, (63.29±8.60)%, and (61.34±7.91)%, respectively, which were lower than those in the control group [(83.60±7.18)% and (94.23±8.21)%] (P<0.05). The spontaneous polarization rates in the ACO group, the asthma group, the COPD group, and the control group were (29.43±5.58)%, (25.11±4.09)%, (16.28±4.51)%, and (7.18±2.12)%, respectively, the arbitrary polarization rates in the ACO group, the asthma group, the control group, and the COPD group were (30.01±5.29)%, (25.76±5.53)%, (21.42±4.36)%, and (19.85±5.00)%, respectively, the directional polarization rates in the asthma group, the ACO group, the control group, and the COPD group were (14.67±2.30)%, (8.21±1.81)%, (5.12±1.10)%, and (2.52±0.63)%, respectively, and the between-group differences were all statistically significant (P<0.05). Conclusion There are certain differences in lung function, neutrophil polarization, and serum immunoglobulin E level among patients with bronchial asthma, COPD, and asthma-COPD overlap syndrome.