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 investigate the association between serum thyroid hormone levels and prognosis for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) without thyroid disease, and explore the prognostic value of serum thyroid hormone levels for patients with AECOPD.MethodsThe clinical data of 239 hospitalized cases of AECOPD [149 males, 90 females, aged 42-92 (77.7±8.9) years] from January 2013 to November 2017 were retrospectively analyzed. Serum thyroid hormone levels including total tetraiodothyronin (TT4), total triiodothyronin (TT3), thyroid stimulating hormone (TSH), free tetraiodothyronin (FT4) and free triiodothyronin (FT3) were measured by chemiluminescence immunoassay. All patients were divided into a survival group and a death group according to the prognosis. Serum thyroid hormone levels were compared between two groups. Correlations of serum thyroid hormone levels with the occurrence of death in AECOPD patients were analyzed. The prognostic value of serum thyroid hormone levels for AECOPD patients was explored by receiveroperating characteristic (ROC) curve analysis. And the best cut-off value of serum thyroid hormone level in predicting the risk of death was calculated.ResultsSerum TT4, TT3, FT4 and FT3 levels in the survival group were significantly higher than those in the death group [TT4: (89.35±21.45) nmol/L vs. (76.84±21.33) nmol/L; TT3: (1.05±0.34) nmol/L vs. (0.72±0.19) nmol/L; FT4: (16.17±2.91) pmol/L vs. (14.45±2.85) pmol/L; FT3: (3.06±0.81) pmol/L vs. (2.24±0.72) pmol/L; all P<0.05]. The differences of serum TSH level between two groups were not statistically significant [0.98 (0.54-1.83)vs. 0.57 (0.31-1.84), P>0.05]. Spearman correlation analysis showed that serum TT4, TT3, FT4 and FT3 levels were significant correlated with the occurrence of death (r values were 0.226, 0.417, 0.220, 0.387, respectively, P<0.05). And there was no significant correlation between serum TSH level and the occurrence of death (P>0.05). ROC curve analysis was done between serum thyroid hormone levels (TT4, TT3, TSH, FT4 and FT3) and the occurrence of death in the AECOPD patients. The areas under ROC curve were 0.659, 0.793, 0.588, 0.655 and 0.772, respectively. Serum TT3 was the best indicator for predicting the occurrence of death. When serum TT3 level was 0.85nmol/L, the Youden index was the highest (0.486), with a sensitivity of 70.2%, and a specificity of 78.3%. It was the best cut-offl value of serum TT3 to predict the risk of death in AECOPD patients.ConculsionsSerum thyroid hormone levels are significant associated with the prognostic for AECOPD patients. There is certain value of serum thyroid hormone levels in prognostic evaluation of AECOPD patients.
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 summarize the association between CYP1A1 rs4646903 polymorphisms and COPD risk. Methods Systematic literature search was conducted (up to January 2016) in five online databases, ie. PubMed, Embase, China National Knowledge Infrastructure (CNKI), VIP database, and WanFang databases. The strength of association was calculated by odds ratio (OR) and corresponding 95% confidence interval (CI). Results Six case-control studies with 1 050 cases and 1 202 controls were included. This study suggested a significant association between the CYP1A1 rs4646903 polymorphism and COPD risk (CC vs. TT: OR=1.63, 95%CI 1.17-2.27, P=0.004; CC vs. TC+TT: OR=1.62, 95%CI 1.19-2.20, P=0.002). However, there was no significant difference between allele model (C vs. T, OR=1.20, 95%CI 0.95-1.51, P=0.118) and dominant model (CC+TC vs. TT, OR=1.19, 95%CI 0.82-1.72, P=0.366). Conclusions The CYP1A1 rs4646903 polymorphisms might alter the susceptibility of COPD. More well-designed studies with larger sample size are warranted.
ObjectiveTo investigate the role and mechanism of S100A8/A9 in rat model of chronic obstructive pulmonary disease (COPD). Methods Twelve Wistar rats were randomly divided into a normal control group and a COPD group. The COPD model was established by exposing the rats to cigarette smoke and injected lipopolysaccharide (LPS) in bronchus for 1 month. The pathological changes of the lung tissue were observed under light microscope, and the emphysema indexes of pulmonary mean linear intercept (MLI), mean alveolar numbers (MAN) and pulmonary alveolar area (PAA) were analyzed by image analysis system. The concentrations of S100A8/A9 in serum and bronchoalveolar lavage fluid (BALF) were measured by enzyme linked immunosorbent assay. The mRNA expression levels of S100A8, S100A9, Toll-like receptor-4 (TLR4) and myeloid differentiation factor 88 (MyD88) of lung tissues were measured by real time polymerase chain reaction. The protein expressions of S100A8/A9, TLR4 and MyD88 of lung tissues were detected by immunohistochemistry. Results After cigarette smoking and LPS injection for 1 month, the rat lung tissue appeared in accordance with the typical pathological changes of COPD. The MLI, MAN and PAA had obvious difference compared with the normal control group (P<0.05). The concentrations of S100A8/A9 protein in BALF and serum of the COPD group were obviously higher than those of the normal control group (P<0.05). The levels of S100A8, S100A9, TLR4 and MyD88 mRNA of lung tissues in the COPD group were obviously higher than those in the normal control group (P<0.05), and the expression levels of S100A8 and S100A9 mRNA were positively correlated with the expression levels of TLR4 and MyD88 mRNA respectively (P<0.05). The levels of S100A8/A9, TLR4 and MyD88 protein of lung tissues in COPD group were obviously higher than those in normal control group (P<0.05), and the levels of S100A8/A9 protein were positively correlated with the levels of MyD88 and TLR4 protein (P<0.05). Conclusions As a new inflammatory mediator, S100A8/A9 may be involved in the occurrence and development of COPD. By up-regulating the expression of TLR4 and MyD88, the classical TLR4-MyD88 inflammatory pathway is activated, thus promotes the occurrence and development of COPD.
Objective To explore the effect of smoking on pulmonary function parameters of male patients with chronic obstructive pulmonary disease (COPD) and to analyze the correlation between smoking and pulmonary function parameters. Methods From January 2014 to October 2015, the pulmonary function parameters of 223 male outpatients or hospitalized patients with COPD in the Department of Respiratory Medicine were retrospectively analyzed by using SPSS 17.0 software. The patients were randomly divided into smoking group (n=98), smoking cessation group (n=82) and non-smoking group (n=43). Results Various degrees of damage or abnormality of lung capacity, ventilatory function, gas exchange function and airway resistance (Raw) existed in the patients with COPD. Compared with smoking cessation group and non-smoking group, residual volume/ total lung capacity (RV/TLC) and Raw were significantly higher (P< 0.05), maximum ventilatory volume, ventilation reserve percent, forced vital capacity, the percent of first second forced expiratory volume compared its predicted value (FEV1%pred), maximum mid-expiratory flow (MMEF), forced expiratory flow 50%, forced expiratory flow 75% and diffusing capacity of carbon monoxide were significantly lower (P<0.05) in the smoking group. There was a negative relationship between MMEF, FEV1%pred and smoking index (r=–0.352, –0.381, P<0.05), and a positive relationship between Raw, RV/TLC and smoking index (r=0.403, 0.378, P<0.05). Conclusions Most of the male COPD patients smoke or used to smoke. Smoking leads to ventilation and gas exchange function decrease, small airway limitation aggravation, airway resistance and emphysema degree increase in COPD patients. Smoking index has a negative relationship with MMEF, FEV1%pred and a positive relationship with Raw and RV/TLC.
Objective To systematically evaluate risk prediction models for acute exacerbation of chronic obstructive pulmonary disease (COPD), and provide a reference for early clinical identification. Methods The literature on the risk prediction models of acute exacerbation of COPD published by CNKI, VIP, Cochrane, Embase and Web of Science database was searched in Chinese and English from inception to April 2022, and relevant studies were collected on the development of risk prediction models for acute exacerbations of COPD. After independent screening of the literature and extraction of information by two independent researchers, the quality of the included literature was evaluated using the PROBASTA tool. Results Five prospective studies, one retrospective case-control study and seven retrospective cohort studies were included, totally 13 papers containing 24 models. Twelve studies (92.3%) reported the area under the receiver operator characteristic curve ranging 0.66 to 0.969. Only five studies reported calibrated statistics, and three studies were internally and externally validated. The overall applicability of 13 studies was good, but there was a high risk of bias, mainly in the area of analysis. Conclusions The existing predictive risk models for acute exacerbations of COPD are unsatisfactory, with wide variation in model performance, inappropriate and incomplete inclusion of predictors, and a need for better ways to develop and validate high-quality predictive models. Future research should refine the study design and study report, and continue to update and validate existing models. Secondly medical staff should develop and implement risk stratification strategies for acute exacerbations of COPD based on predicted risk classification results in order to reduce the frequency of acute exacerbations and to facilitate the rational allocation of medical resources.
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.
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.
Objective?To investigate the relationship between syndromes of traditional Chinese medicine (TCM) and lung function in patients with chronic obstructive pulmonary disease (COPD) at stable phase. MethodsBased on diagnostic criterion of TCM, five groups of symptoms of TCM about stable COPD were established including lung Qi deficiency, lung and spleen Qi deficiency, lung and kidney Qi deficiency, lung Spleen Kidney Qi deficiency, and deficiency of both Qi and Yin. A total of 300 cases which were up to the standard were differentiated into 5 groups by the symptoms. Some basic details and lung function of the patients were recorded, and then statistical analysis was performed to analyze the differences of lung function among groups. ResultsForced expiratory volume in the first second in descending order was lung Qi deficiency group, lung and spleen Qi deficiency group, lung and kidney Qi deficiency group, and lung spleen kidney Qi deficiency group (P<0.05). ConclusionThese findings suggest that with the progressing of COPD, the symptom type of TCM for COPD patients at stable phase may vary from lung Qi deficiency to lung and spleen Qi deficiency, or to lung and kidney Qi deficiency, and even lung, spleen and kidney Qi deficiency. Lung function tests help reveal substance and pathogenesis of TCM syndromes of patients with stable COPD, and provide evidence for the clinical syndrome.