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PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
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Female , Humans , Adrenal Cortex Hormones , Asthma , China , Comorbidity , Disease Progression , Education , Food Hypersensitivity , Hospitalization , Hypertension , Inpatients , Medication Adherence , Mortality , Multivariate Analysis , Pulmonary Disease, Chronic Obstructive , Retrospective Studies , Risk Factors , Seasons , Self Care , Smoke , SmokingABSTRACT
Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective To study the inducing factors and clinical characteristics of patients hospitalized for asthma exacerbation in China. Methods Patients hospitalized for asthma exacerbation at 29 hospitals in China were retrospectively recruited during 2013-2014. Results Clinical data of 3 240 asthmatic patients were collected and analyzed including 1 369(42.3%) males and 1 871(57.7%)females. The patients hospitalized for asthma exacerbation counted for 2.95% (6 375/215 955) of all patients hospitalized during the same period. The leading six inducing factors, in sequence, were acute upper respiratory tract infection[42.3%(1 370/3 240)],changes of weather[22.8%(738/3 240)],noxious gas[(4.3% (140/3 240), allergy challenges [3.5%(115/3 240)], strenuous exercise [1.8%(57/3 240)], and air pollution [1.5%(49/3 240)].In older patients,more exacerbations were induced by weather changes,yet less sensitive to allergy challenges. As to middle-aged patients, they were less sensitive to upper respiratory tract infections,however the difference was not statistically significant(P>0.05).In winter more asthma patients were induced by upper respiratory tract infections,while in autumn more patients were induced by weather changes,strenuous exercise and air pollution.In spring and summer more patients were induced by allergy challenges, but the differences failed to achieve statistical significance (P>0.05). In northern cities more patients were induced by upper respiratory infections, whereas in southern cities more by noxious gases. Allergy challenges and air pollution tended to affect more patients in northern cities,but the difference was of no significance (P>0.05). The differences of inducing factors among patients of different gender, with or without a smoking history, and with different exacerbation severity didn't show any statistical significance. The patients with severe and life-threatening exacerbations counted for 20.1%(652/3 240).The percentage of patients older than 60 years was higher in patients with severe or life-threatening exacerbations than in whose with mild or moderate exacerbations,so did the percentage of male patients,of patients with disease duration longer than 10 years, with smoking history, and with a history of hospitalization or emergency department visits due to asthma exacerbation during the last year.Conclusion The acute upper respiratory tract infection ranks top among all the inducing factors. Senility, male gender, long duration of disease, smoking history, and a history of frequent hospital visits might be the risk factors for severe or life-threatening asthma exacerbations.
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Objective To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China.Methods This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast,north,central,east,south,northwest and southwest).The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded.The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared.Results During the study period,6 480 patients were admitted for asthma exacerbation,accounting for 3.14％ of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals.The ratio of asthmatic patients to total inpatients in the northeast area (5.61％) was highest,and the ratio in east area was lowest (1.97％).Statistical analysis showed that the difference among different areas was significant (P＜0.000 1).In most areas,both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October).In the northeast area,east area and south area,the peaks in spring were more obvious,while in the north area and southwest area,the peaks in autumn were more obvious.In the northwest area the peaks occurred in winter (December-January) and summer (June-August),respectively.The differences in hospitalization due to asthma among different months were significant in the northeast,north,and southwest areas (P＜0.005).Conclusion The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China.In most areas,more asthmatic patients were admitted to hospitals in spring and autumn.
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Objective: To explore the effects of 17 β-estradiol (E2) and 2-methoxyestradiol (2ME) on endothelium-1/nitric oxide (ET-1/NO) cascade in experimental rats with hypoxic pulmonary hypertension. Methods: A total of 48 female SD rats were randomly divided into 6 groups:①Sham operation group,②Ovariectomy (OVX) group,③Hypoxia group,④OVX+hypoxia group,⑤OVX+hypoxia+E2 group, the rats received subcutaneous E2 at 20μg/(kg?d) and⑥OVX+hypoxia+2ME group, the rats received subcutaneous 2ME at 240μg/(kg?d).n=8 in each group. Blood levels of ET-1, NO, eNOS activity and the expressions of pulmonary tissue endothelium A receptor (ETAR), ETBR and eNOS were compared among different groups. Results: Compared with Sham operation group, Hypoxia and OVX+hypoxia groups showed small pulmonary artery thickening with lumen narrowing, increased mean pulmonary arterial pressure (mPAP), allP<0.01; the above morphological and mPAP changes were reduced by E2 and 2ME intervention. Compared with Sham operation group, OVX and Hypoxia groups had increased blood ET-1 and pulmonary mRNA, protein expressions of ETAR, decreased pulmonary ETBR, all P<0.01; the above changes were more obvious in OVX+hypoxia group; E2 and 2ME intervention reduced blood ET-1 and pulmonary ETAR expression, but they were still higher than Sham operation group, meanwhile, ETBR expression was elevated, but it was still lower than Sham operation group, allP<0.01; blood ET-1 was lower in OVX+hypoxia+2ME group than OVX+hypoxia+E2 group,P<0.05. Compared with Sham operation group, OVX group had decreased pulmonary eNOS protein expression,P<0.01; Hypoxia group had decreased blood NO and pulmonary eNOS protein expression,P<0.05 orP<0.01; OVX+hypoxia group had decreased blood NO, eNOS activity and decreased pulmonary mRNA and protein expressions of eNOS, allP<0.01; E2 and 2ME intervention elevated the above indexes,P<0.05 orP<0.01, but they were still lower than Sham operation group, allP<0.05. Conclusion: E2 and 2ME could decrease blood ET-1 and pulmonary ETAR expression, increase pulmonary ETBR expression; elevate blood NO, eNOS activity and pulmonary eNOS expression. E2 and 2ME may partially reverse pulmonary hypertension via improving ET-1/NO cascade in experimental rats.
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Objective: To explore the effects of 17 β-estrogen (E2) and 2-methoxyestradiol (2ME) on hypoxic induced factor-1α (HIF-1α) and alkane hydroxylase (AlkB) in experimental rats with ovariectomy and hypoxic pulmonary hypertension. Methods: A total of 60 healthy female SD rats with castrated surgery were randomly divided into 6 groups:①Routine oxygen group,②Routine oxygen + E2 group, the rats received subcutaneous injection of E2 (20 μg/kg?d),③Routine oxygen + 2ME group, the rats received 2ME (240 μg/kg?d) and④Hypoxia group,⑤Hypoxia + E2 group,⑥Hypoxia + 2ME group.n=10 in each group and all animals were treated for 8 weeks to establish the hypoxic pulmonary hypertension model. The mean pulmonary artery pressure (mPAP) was measured after bloodletting, right ventricle hypertrophy index (RVHI) was calculated and small pulmonary artery remodeling was observed by HE staining. The expression level of HIF-1α and AlkB were examined by RT-PCR and Western blot analysis. Results: Compared with Routine oxygen group, the rats in Hypoxia group had obviously thickened small pulmonary artery wall with narrowed lumen, increased mPAP and RVHI; the above changes in Hypoxia + E2 and Hypoxia + 2ME groups were relatively smaller, their mPAP and RVHI were higher than Routine oxygen group, while mPAP and RVHI were similar between Hypoxia + E2 and Hypoxia + 2ME groups. There were no real morphological changes in small pulmonary vessels in Routine oxygen + E2 and Routine oxygen + 2ME groups. The HIF-1α expression was obviously elevated in Hypoxia group than Routine oxygen group, while the elevation was less in Hypoxia + E2 and Hypoxia + 2ME groups. HIF-1α expression had no real changes in Routine oxygen+E2 and Routine oxygen + 2ME groups. The AlkB expression was obviously reduced in Hypoxia group than Routine oxygen group, while the reduction was less in Hypoxia + E2 and Hypoxia + 2ME groups. AlkB expression had no real changes in Routine oxygen + E2 and Routine oxygen + 2ME groups. Conclusion: Estradiol E2 and 2ME could remit pulmonary hypertension which might be via up-regulating AlkB expression and down-regulating HIF-1α expression in experimental rats with hypoxic pulmonary hypertension.
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<p><b>BACKGROUND</b>Little is known about asthma control and perception of asthma among asthmatic patients in China. This study marked the first survey conducted on a national scale that aimed at obtaining baseline information on asthma control and patients' perception of asthma and providing a point of reference for future studies.</p><p><b>METHODS</b>This face-to-face, questionnaire-based survey was conducted from April 2007 to March 2008 with 3 069 asthmatic patients from the respiratory outpatient clinics of 36 general hospitals located in 10 geographically dispersed cities.</p><p><b>RESULTS</b>Consistent with the Global Initiative for Asthma (GINA) guidelines, 28.7% and 45.0% of our patients achieved control and partial control, respectively. Of the patients in the study, only 21.8% had used a peak flow meter (PFM), and 6.6% of these patients used it daily. Inhaled corticosteroids (ICS) plus a long-acting β2 agonist (LABA) and ICS were the two most common medication regimens and were used in 45.6% and 30.4% of patients, respectively. Asthma had a significant effect on the patients' life and work. A considerable number of hospitalizations, emergency department visits, and sick days were observed.</p><p><b>CONCLUSION</b>Despite improvements in asthma control and ICS and PFM compliance compared with past literature, the current level of asthma control countrywide continues to fall short of the goals set in the GINA.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Adrenal Cortex Hormones , Therapeutic Uses , Adrenergic beta-Agonists , Therapeutic Uses , Anti-Asthmatic Agents , Therapeutic Uses , Asthma , Drug Therapy , Epidemiology , China , Epidemiology , Data Collection , Surveys and QuestionnairesABSTRACT
BACKGROUND: At present, common therapies of obstructive sleep apnea syndrome (OSAS) are uvulo-palato-pharyngoplasty and nasal continuous positive airway pressure (N-CPAP). The effective rate of surgical treatment was 50% and the prostecdtive efficacy is decreased gradually. As to treatment with breathing machine, some of the patients can not adapt to it.OBJECTIVE: To investigate the effects of auricular acupoint pressing therapy on clinical indexes of patients with OSAS and its clinical effect,and analyze the possible mechanism.DESIGN: Randomized control observation.SETTING: Department of Acupuncture and Department of Respiration,Second Hospital of Hebei Medical University.PARTICIPANTS: Forty-five outpatients with OSAS between April 2001 and April 2004, who were diagnosed as OSAS in the room of sleep-monitoring of Department of Respiration, were selected from the Clinic of Respiration, Second Hospital of Hebei Medical University, including 44 males and one female. All subjects were randomly divided into treatment group (n=30) and control group (n=15).METHODS: ①Patients in the treatment group were treated by auricular acupoint pressing therapy, acupoint-locating: shenmen, sympathesis, subcortex, heart, lung, spleen, kidney, anterior ear lobe. Each acupoint was pressed about 10-20 times with 3-5 times every day and 10 days as onecourse. Patients in the control group were treated with placebo and orally took 100 mg of Vitamin C three times a day. Patients in both groups were detected by 7hour nocturnal polysomnography before treatment and 10 days after the treatment, and the curative effects were evaluated.②Criteria of the curative effects on clinical symptoms: Effective: clinical symptoms such as dizzy,somnolence, oppressed chest and obstructing etc. were significantly ameliorated with nocturnal times decreased from 4-5 times to once or none and awake times decreased from 4-5 to once or none. Valid: clinical symptoms were improved. Invalid: no amelioration was found in clinicalsymptoms.MAIN OUTCOME MEASURES: Changes of clinical symptoms before and after the treatment and hypopnea index (HI), apnea index (AI), apnea hypopnea index (AHI), minimum blood oxygen saturation as well as the longest apnea time detected by polysomnography were observed.RESULTS: A total of 45 patients with OSAS were involved in the analysis of results, and no one withdrew from the study.①The clinical symptoms in auricular acupoint treatment group were significantly ameliorated than control group. In the treatment group, 17 patients were effective (56.7%), 12 patients were valid and one patient was invalid. The clinical symptoms in the control group were not improved before and after the treatment, and there were significant differences between the treatment group and control group (P ＜ 0.05). ②Comparison in each inspecting indexes by polysomnogram: those in the auricular pressing therapy group were remarkably different from those in the control group after treatment (P ＜ 0.001). There was no significant difference in all indexes of the control group between and after the treatment (P ＞ 0.05).③The differences in AI, HI, AHI, minimum blood oxygen saturation as well as the longest apnea time of the auricular pressing treatment group after the treatment were markedly different from those before treatment [(65.25±7.44), (53.69±10.80) times/hour; (72.40±7.92), (59.22±10.55) times/hour; (9.46±2.6), (6.5±2.9) times/hour; (73.3±4.8)%,(77.67±3.78)%; (90.16±33), (45.33±24.69) s,P ＜ 0.001]. Among them, the maximum decrease of AI was 19.3 times/hour, the maximum decrease of AHI was 17.8 times/hour, the maximum decrease of HI was 12.9 times/hour and the maximum increase of blood oxygen saturation was 7% CONCLUSION: Auricular acupoint pressing therapy, in the treatment of OSAS, can significantly ameliorate the AI, HI; AHI, minimum blood oxygen saturation as well as the longest apnea time with better curative effects.
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Objective To evaluate the changes of alveolar cells apoptosis and the expression of related genes in pulmonary injury induced by ischemia/reperfusion (I/R) in acute experimental pulmonary embolism of rabbits. Methods The left lung artery of rabbits were obstructed by inflating gas of 5F Berman sacculus catheter, then the gas of sacculus was put out to result in blood reperfusion. Thirty-six New Zealand rabbits of either gender and weighing 2.5 to 3.0 kg were studied, and randomly divided into six groups: control group (control), sham operation group (sham), ischemia 1h group (I 1h), ischemia 2h group (I 2h), ischemia2h and reperfusion 1h group (IR 1h), ischemia 2h and reperfusion 2 h group (IR 2h). Alveolar cells apoptosis and Bax, Bcl-2, Fas/FasL protein expression were studied By using flow-cytometry and immunocytochemistry techniques. Results The lung apoptosis cell number was increased in ischemia groups compared with control and sham group. The reperfusion after ischemia further increased the apoptosis cell numbers compared with simple ischemia, and the longer time reperfusion,the larger number of cell apoptosis. Bax, Bcl-2, Fas and FasL protein expression were significantly higher in ischemia, ischemia/reperfusion group than that in those of control groups (P
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Objective:To observe the changes of alveolar cells apoptosis and the expression of Fas/FasL protein in pulmonary injury induced by ischemia/reperfusion in rabbbits,and to explore the related mechanism of pulmonary injury.Methods: The left pulmonary arteries of 30 healthy New Zealand rabbits(either sex) were obstructed and reperfused by inflating and discharging gas of 5F Berman sacculus catheter.The rabbits were then randomly divided into 5 groups: sham operation group,ischemia 1 h group,ischemia 2 h group,ischemia 2 h and reperfusion 1 h group,and ischemia 2 h and reperfusion 2 h group.Another 6 healthy rabbits were taken as control.The pulmonary tissues were harvested after experiment and the lung wet/dry ratio was determined.Alveolar cells apoptosis and Fas/FasL protein expression were determined using flow cytometry and immunocytochemistry techniques,respectively.Results: The lung cell apoptosis was obviously increased in ischemia groups compared with that in the control and sham group.The reperfusion after ischemia further increased the cell apoptosis compared with simple ischemia groups,and the apoptosis was positively related with the reperfusion time(P