ABSTRACT
<p><b>BACKGROUND</b>The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD) guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD (AECOPD). This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice.</p><p><b>METHODS</b>A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test (CAT), Modified British Medical Research Council (mMRC) scale, and results of the lung function tests were recorded.</p><p><b>RESULTS</b>Of the 194 patients assessed, 21 had a CAT score ≥10 and an mMRC grade ≤1, 13 had a CAT score <10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second (FEV1%) of <50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of ≥50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% <50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant (P = 0.004). The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant.</p><p><b>CONCLUSIONS</b>The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease (GOLD) 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.</p>
Subject(s)
Female , Humans , Male , Dyspnea , Diagnosis , Pulmonary Disease, Chronic Obstructive , Diagnosis , Respiratory Function Tests , Risk AssessmentABSTRACT
Objective To investigate underdiagnosis problem of chronic obstructive pulmonary disease (COPD) in China.Methods Articles published during January 1 st,2000 and December 30th,2011were searched in Wanfang Database and Medline,search words including COPD and epidemiology survey.The papers were then reviewed,and those original contirbutions with sample size ≥ 1000 and strict quality control entered into the final analysis.Results Only 32.90％ (1095/3328) COPD patients had ever been diagnosed to have emphysema,bronchitis or COPD,and only 9.13％ (237/2597) had undergone lung function test.About 65.40％ (2306/3526) COPD patients were presented with at least one of the following symptoms:cough,phlegm and breathlessness.Stage Ⅰ or Ⅱ COPD was found in 74.52％ (1802/2418)patients.Conclusion Underdiagnosis of COPD was quite common in China,and patients with stage Ⅰ or Ⅱ COPD should have deserved early diagosis.
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Objective To review the etiology of 10 201 adult patients with fever of unknown origin (FUO) in China from 1979 to 2012,and to compare the reasons between the South and the North of China,and to illustrate the change in different periods.Methods Literatures containing key wordfever of unknown origin were selected in China National Knowledge Infrastructure (CNKI) database from 1979 to 2012.Articles were excluded if patient population were less than 100.Diagnostic criteria of FUO were confirmed by the standard of Petersdorf and Beeson in 1961.Totally 43 literatures including 10 201 patients were enrolled in this study.The period of the literatures were divided into the early,middle and later period,and the regions were partitioned into the South and the North.Results A total of 42 articles (including 9787 patients) provided the gender information with 5063 men and 4724 women.The etiologies of 10 201 FUO patients included infectious diseases (53.5％),rheumatic diseases (20.1％) and tumor (12.0％).The positive diagnostic rate was 91.8％.Tuberculosis (23.8％) was the most common reason in infectious diseases.Adult Still's disease (7.0％) was the most common cause of FUO among rheumatic diseases.Lymphoma (3.4％) was the most common tumor in FUO patients.Besides,drug-induced fever (1.7％) should also be considered.In the recent 30 years,the proportion of FUO caused by infectious diseases had decreased,rheumatic diseases and other reason had increased (P ＜ 0.05).The proportion of tumor in middle period was significantly higher than that in the early and later period (P ＜ 0.05).The negative diagnostic rate had increased (all P ＜ 0.05).The proportion of infectious diseases in North China was significantly lower than that in the South (P ＜ 0.05).The proportion of other reason was significantly higher in the North (P ＜ 0.05).Conclusion In the recent 30 years,the most common cause of FUO was still infectious diseases,especially tuberculosis.
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Objective To discover the main factors influencing the hospitalization expenses incurred by cases of community acquired pneumonia(CAP). Methods The hospitalization expenses incurred by 362 cases of CAP treated by the Department of Respiratory Medicine of the authors hospital from 1999 to 2000 as well as the composition of the expenses, the expenses for testing pathogens and the use of antibiotics were analyzed retrospectively. And the influencing factors of the hospitalization expenses were studied by means of stepwise regression. Results The average CAP hospitalization expenses were 9 253 yuan, with the expenses for medicine accounting for 51.4%. Among the antibiotics used, ? lactam was most frequently used. Next came quinolone and macrolides. The expenses for testing CAP pathogens were high while the positive rate was low. The major factors influencing CAP hospitalization expenses were respectively length of stay, time of intravenous drip of antibiotics during hospitalization, incidence or no incidence of heavy pneumonia, and the number of basal disease entities(P