Clinical efficacy of N-acetylcysteine in adjuvant therapy for acute exacerbation of asthma-chronic obstructive pulmonary disease overlap / 中国医师进修杂志

Objective To investigate clinical efficacy of N-acetylcysteine (NAC) in the adjuvant treatment of patients with acute exacerbation of asthma-chronic obstructive pulmonary disease overlap (ACO). Methods One hundred and forty-six patients with acute exacerbation of ACO admitted to department of respiratory and critical care medicine of Henan provincial people′s hospital from March 2016 to August 2018 were divided into control group and observation group according to random number table, with 73 patients in each group. The control group was given clinical treatment such as bronchodilator, inhaled glucocorticoid and low- flow oxygen inhalation during hospitalization, and inhalation of budesonide/formoterol fumarate powder combined with tiotropium was continued after discharge. The treatment lasted for 4 weeks. The observation group was added with NAC 600 mg, twice daily, totally for 4 weeks on the basis of the control group. Baseline data and duration of hospital stay were collected. Before and after treatment, blood routine, c-reactive protein (CRP), forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and FEV1% pred were recorded. Clinical efficacy and adverse drug reaction were compared between the two groups. Results The white blood cell count, eosinophil count, neutrophil count, CRP, FEV1/FVC and FEV1% pred of two groups were significantly ameliorative after treatment compared with those before treatment, and the difference was statistically significant (P < 0.05). The white blood cell count, eosinophil count, neutrophil count and CRP after treatment in observation group were significantly lower than those in control group: (7.40 ± 1.12)×109/L vs. (8.34 ± 1.56) ×109/L, (0.30 ± 0.15) ×109/L vs. (0.42 ± 0.18) ×109/L, (3.76 ± 1.49) ×109/L vs. (4.58 ± 1.72) × 109/L, (5.33 ± 1.65) mg/L vs. (5.95 ± 1.74) mg/L, and the differences were statistically significant (P<0.05). There were no statistical differences in FEV1/FVC and FEV1%pred after treatment between observation group and control group (P > 0.05). The total effective rate after treatment in observation group was significantly higher than that in control group: 94.52% (69/73) vs. 82.19% (60/73), and the difference was statistically significant (P<0.05). During the treatment, duration of hospital stay in observation group was shorter than that in control group: (5.82 ± 2.29) d vs. (7.25 ± 3.05) d, and the difference was statistically significant (P<0.05). The incidence of adverse reactions in observation group was compared with control group: 10.96% (8/73) vs.5.48% (4/73), and the difference was not statistically significant (P > 0.05). Conclusions NAC has a significant effect in adjuvant treatment of acute exacerbation of ACO, which can significantly inhibit the level of inflammation and shorten the length of hospital stay.

Effectiveness of Statins in Treatment of Chronic Obstructive Pulmonary Disease Combining with Pulmonary Hypertension: A Meta-analysis / 医药导报

Objective To systematically review the effectiveness and safety of statins for chronic obstructive pulmonary diseases (COPD) combining with pulmonary hypertension (PH).Methods The electronic searches in databases of PubMed,EMbase,the Cochrane Library,Web of Science,CBM,CNKI,VIP and Wanfang Data were conducted from the date of their establishment to January 2016 and the references of the include studies were also retrieved for collecting randomized controlled trials (RCTs) or quasi-RCTs on statins treating COPD combining with PH.Two researchers independenlty screened the literature according to the inclusion and exclusion criteria,extracted the data,assessed the quality of the included studies by adopting the Cochrane collaboration' s tool for assessing risk of bias,and performed Meta-analysis by using RevMan 5.3 software.Results A total of 24 studies involving 1 587 cases were included.The results of Meta-analysis showed that:compared with the control group,simvastatin significantly improved FEV1 [MD =0.23,95％ CI:0.16-0.31,P ＜ 0.000 01],FEV1 ％ [MD =6.73,95％ CI:1.34-12.12,P =0.01],FVC [MD =0.39,95％ CI:0.34-0.45,P ＜ 0.000 01],6 minutes walk distance (6MWD)· [MD=59.09,95％CI:54.24-63.93,P ＜0.000 01] and decreased mPAP [MD=6.73,95％ CI:1.34-12.12,P =0.01],SPAP [MD =-4.53,95 ％ CI =-8.87--0.19,P =0.04].Atorvastatin significantly improved FEV1 [MD =6.22,95 ％ CI:2.51-9.93,P =0.001] and 6 MWD [MD =24.10,95 ％ CI:12.98-35.23,P ＜ 0.000 1] and decreased sPAP [MD =-6.44,95％CI:-7.95--4.93,P＜0.00001] andmPAP [MD=-3.51,95％CI:-5.81--1.22,P=0.003].But no significant difference was found in the improvement of FEV1,FVC or FEV1/FVC.Fluvastatin significantly decreased sPAP [MD=-5.89,95％ CI:-6.99--4.79,P ＜0.000 01].There was a significant decrease in the Borg dyspnoea score in statins group [MD =-3.37,95％ CI:-4.61--2.14,P ＜ 0.000 01] as compared with the controls.In addition,the incidence of adverse drug reactions (ADRs) was similar between statins and the control group.Conclusion Current evidence suggests that statins may decrease pulmonary hypertension in patients with COPD combining with PH.However,high-quality clinical trials with large sample size are needed to verify whether the improvement of pulmonary function,6MWD and Borg dyspnoea score are the class effect or the incidence of ADRs is disparate among different statins.

Effects of Shenqi Bufei Tang Decoction on the Expression of HDAC2 and NF-κB p65 in Airway Smooth Muscle Tissues of COPD Rats with Lung-Qi Deficiency Syndrome / 医药导报

Objective To examine the effects of Shenqi Bufei Tang decoction on the expression of histone deacetylase-2 ( HDAC2) and nuclear factor-κB p65 ( NF-κB p65) in the airway smooth muscle tissues of COPD rats with lung-qi deficiency syndrome. Methods A total of 40 male rats were randomly divided into normal control group,model control group,Shenqi Bufei Tang decoction group,and aminophylline group.The COPD rat model with lung-qi deficiency syndrome was established by intra-tracheal instillation of lipopolysaccharide (LPS) and passive smoking for 28 days.Pathological changes of lung tissues were ob-served under the light microscope and the thickness of the small airway wall and airway smooth muscle ( ASM) layer analyzed by the image analysis.Immunohistochemistry,real-time PCR and Western blotting were used to detect the expressions of NF-κB p65 and HDAC2 in ASM. Results The thickness of the airway wall and ASM,and the expression levels of NF-κB p65 mRNA and protein were significantly increased in the model control group when compared with those in the normal control group ( P0.05). Conclu-sion Shenqi Bufei Tang decoction can inhibit the proliferation of ASM in COPD rats with lung-qi deficiency syndrome,which may be associated with the increased expression of HDAC2 and decreased expression of NF-κB p65.

Clinical Study of Nutritional Intervention in 575 Cases Patients with Chronic Obstructive Pulmonary Disease and Malnutrition Risks / 医药导报

Objective To exPlore the efficacy of nutritional interVention in Patients with chronic obstructiVe Pulmonary disease (COPD) and malnutrition risks. Methods From Jan. ,2008 to Dec. ,2012,829 COPD Patients with NRS2002 score≥3 in Qinzhou Second PeoPle's HosPital were enrolled in this study. Patients were randomized into control grouP (254 cases) and treatment grouP (575 cases) by random numerical table of SPSS 13. 0 statistic software. Patients without contraindication to enteral nutrition were giVen enteral nutrition suPPort,while those with contraindication to enteral nutrition were giVen Parenteral nutrition suPPort. Patients in the treatment grouP receiVed intensiVe suPPort with fortified nutrition,whereas Patients in the control grouP receiVed routine nutrition treatment. All other treatment methods were the same between the two grouPs. TelePhone follow_uP lasted for 3 years in both grouPs after discharge. Patients in the treatment grouP with NRS2002 score≥3 were giVen guidance on nutrition food intake. No nutrition guide was giVen to the control grouP. Times of acute attack,times and duration of mechanical Ventilation,mortality rate,and NRS2002 score three years after the treatment were comPared between the two grouPs. Data were analyzed by multi_factor Logistic regression analysis to understand the nutritional factors of COPD Patients affecting their mortality rate. Results After 3 years of follow_uP,times of acute attack,times and duration of mechanical Ventilation were lower in the treatment grouP than in the control grouP. Mortality rate was significantly lower in the treatment grouP (0. 696%) than the control grouP (4. 724%). After treatment,NRS2002 score was PositiVely correlated with mortality rate of COPD Patients with malnutrition risks. Conclusion For the COPD Patients with malnutrition risks, actiVe nutritional interVention can imProVe their nutrition status ( lower NRS2002 score) ,increase the number of resPiratory muscles to alleViate anoxia,enhance cellular immune function, and thus imProVe their Prognosis.

Effectivity of continuous positive airway pressure in treatment of chronic obstructive pulmonary disease complicated with left heart failure / 中华老年医学杂志

Objective To evaluate the clinical effectivity of continuous positive airway pressure in treatment of chronic obstructive pulmonary disease complicated with left heart failure.Methods Totally 103 patients (aged 63-78 years) with chronic obstructive pulmonary disease complicated with left heart failure were randomly divided into two groups:treatment group (received noninvasive ventilation combined with routine medication) and control group (received conventional drug therapy).The patients of two groups were observed in the treatment of 1 hour to one week that blood pressure (SBP),heart rate (HR),arterial blood gas analysis,respiratory rate (RR),brain natriuretic peptide (BNP) and other indicators to improve the situation.Results After treatment,the PaO2 level of patients in treatment group was significantly increased from (56.1 ± 7.8) mm Hg to (91.1 ±11.3)mm Hg,(t=449.94,P＜0.05),PaCO2 decreased from (60.1± 10.9) mm Hg to (42.3± 9.3)mm Hg,(t=4.66,P＜0.05),pH value was improved from (7.26±0.12) to (7.36±0.17) (t=5.88,P＜0.05) and BNP was decreased from (350±181) ng/L to (961±376) ng/L (t=8.07,P＜0.05).In control group,the PaO2 was significantly increased from (55.0±8.1) mm Hg to (89.1±12.0) mm Hg (t=43.17,P＜0.05) after treatment,PaCO2 by decreased from (48.9±10.8) mm Hg,(58.9±10.8) mm Hg to (t=5.13,P＜0.05),pH value by up to (7.27 ±0.08),BNP by decreased from (439 ± 246) ng/L to (947 ±407) ng/L t=9.81,P＜0.05.Compared with the control group,the difference of PaO2 and BNP had no significantly significant.PaCO2 in treatment group was increased more sharply than it in the control group,and pH decreased more (P＜0.05 or P＜0.01).Conclusions The use of continuous positive airway pressure to treatment chronic obstructive pulmonary disease complicated with left heart failure can alleviate fatigue and prevent the respiratory failure.It is remarkable treatment effect and worthy of clinical application.

Influência da técnica de pressão expiratória positiva oscilante e da técnica de expiração forçada na contagem de células e quantidade do escarro induzido em portadores de asma ou doença pulmonar obstrutiva crônica / Influence of oscillating positive expiratory pressure and the forced expiratory technique on sputum cell counts and quantity of induced sputum in patients with asthma or chronic obstructive pulmonary disease

OBJETIVO: Avaliar se técnicas fisioterápicas interferem no número de células e na quantidade do escarro obtido por coleta induzida, em pacientes com asma e doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Ensaio clínico prospectivo e randomizado, no qual os pacientes com asma ou DPOC sob intervenção (n = 16 e 10, respectivamente) foram comparados com grupos controle (n = 16 e 10). Pacientes dos grupos asma/intervenção (A/I) e DPOC/intervenção (D/I) foram submetidos a manobras de pressão expiratória positiva oscilante por 5 min, seguidas de 10 repetições da técnica de expiração forçada. Além disso, esses pacientes foram submetidos a um protocolo de indução de escarro com a inalação de solução salina hipertônica (3 por cento, 4 por cento e 5 por cento), no caso dos A/I, e de solução salina isotônica, no caso dos D/I. Os grupos asma/controle(A/C) e DPOC/controle (D/C) foram somente submetidos ao protocolo padrão de indução de escarro. RESULTADOS: Houve aumento significante do peso média final de escarro no grupo A/I vs. grupo A/C (2.767,25 ± 998,08 mg e 1.689,17 ± 1.189,96 mg, respectivamente; p = 0,03). O número absoluto de células (×10(6)/mL) foi maior nos grupos A/I e D/I do que nos grupos A/C e D/C (média/mediana, 4,06/0,95 e 0,63/0,39, respectivamente; p = 0,05; e 5,08/1,77 e 0,64/0,40; p = 0,02). A viabilidade celular não apresentou diferença estatisticamente significante entre os grupos. CONCLUSÕES: O uso de técnicas respiratórias pode aumentar o peso do escarro em pacientes com asma, assim como aumentar o número absoluto de células em pacientes com asma ou DOPC.

OBJECTIVE: To evaluate whether respiratory therapy techniques influence the number of cells within and quantity of induced sputum in patients with asthma or chronic obstructive pulmonary disease (COPD). METHODS: Randomized clinical trial, in which patients with asthma or COPD under intervention (n = 16 and 10, respectively) were compared with control groups (n = 16 and 10). Patients in the asthma/intervention (A/I) and COPD/intervention (C/I) groups were submitted to oscillating positive expiratory pressure maneuvers for 5 min, followed by 10 forced expiratory technique sequences. These patients were also submitted to an induced sputum protocol with inhaled hypertonic saline (3 percent, 4 percent or 5 percent; A/I group) or inhaled isotonic saline (C/I group). The asthma/control (A/C) and COPD/control (C/C) groups were submitted only to the standard induced sputum protocol. RESULTS: The final mean weight of the sputum samples was significantly greater in the A/I group than in the A/C group (2,767.25 ± 998.08 mg vs. 1,689.17 ± 1,189.96 mg; p = 0.03). The mean/median total cell counts (×10(6)/mL) were higher in the A/I and C/I groups than in the A/C and C/C groups (4.06/0.95 and 0.63/0.39, p = 0.05, vs. 5.08/1.77 and 0.64/0.40, p = 0.02). There were no statistically significant differences among the groups in terms of cell viability. CONCLUSIONS: The use of respiratory therapy techniques can increase sputum sample weight in asthma patients, as well as increasing total cell counts in patients with asthma or COPD.

Role of mycoplasma pneumoniae infection in exacerbated stage of COPD and on celluler immune system of community acquired pneumonia patients / 中华老年医学杂志

Objective To explore the relationship of pulmonary mycoplasma pneumoniae(MP) infection with acute exacerbated stages of chronic obstructive pulmonary disease(COPD) and community acquired pneumonia(CAP)in the elderly,comparing different serum concentrations of IFN -? ,IL-6,TNF-? in these patients. Methods Serologic analysis through ELISA method was used to detect MP-IgM and MP-IgG to determine the presence of MP and the serum concentrations of IFN-?、IL-6、TNF-? in 30 elderly healthy subjects,39 elderly patients with acute exacerbated stage of COPD and 40 elderly patients with CAP. PCR method was also used to determine the presence of MP from the patients ,sputum. Results (1)The positive rates of MP were much higher in the COPD patients than in the CAP and healthy ones according to PCR or MP-IgM method( P

The second grade national prize for science and technology progress study on pathogenesis and treatment of respiratory failure / 中国实用内科杂志

To improve the status of management in respiratory failure in China,the project of Study on Pathogenesis and Treatment of Respiratory Failure was designed and conducted by three medical centers(Beijing Institute of Respiratory Medicine-Beijing Chaoyang Hospital,Affiliated to Capital Medical University,Zhongshang Hospital-Fudan University,Guangzhou Institute of Respiratory Medicine-First Guangzhou Medical College)for more than ten years.This project was focused on pathogenesis and treatment strategies of respiratory failure and achieved the following important innovations:(1)Pulmonary Infection Control Window(PIC Window)was firstly proposed and used to determine the time switching point of sequential invasive-noninvasive ventilation;(2)The largest sample size of early use of noninvasive positive pressure ventilation(NPPV)for acute exacerbated COPD(AECOPD)on general ward provided the evidence-based data for expanding the indication of NPPV from treating respiratory failure to alleviating respiratory muscle fatigue;(3)Three new types of masks with intellectual property for NPPV were developed;(4)Designing of intrinsic expiratory end positive pressure(PEEPi)lung model with property of expiratory flow limitation confirmed that PEEPi was the most important factor that increased inspiratory difficulty;(5)The systematic measurement was established for diaphragm strength and endurance;(6)Aquaporin 1(AQP1)was firstly proved the key channel of fluid transportation in the lung;(7)A multicenter prospective cohort study provided objective data that depression had causal effect on COPD exacerbation and hospitalization;(8)Two guidelines for NPPV and mechanical ventilation of AECOPD were initiated by this group.This project has been widely used in clinical practice and promoted the research and treatment of respiratory failure in China.

Effect of Spleen-invigorating and Lung-nourishing Therapy on Quality of Life in Patients with Chronic Obstructive Pulmonary Disease at Stationary Phase / 广州中医药大学学报

[Objective] To observe the therapeutic effect of spleen-invigorating and lung-nourishing therapy and its influence on nutritive index and quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD) at stationary phase. [ Methods ] Ninety cases of COPD were randomized into three groups. Group A was given routine symptomatic treatment; groups B and C were given oral use of Jianpi yifei Granules and routine symptomatic treatment and group C was additionally treated with garlic-partition moxibustion and acupoint injection of Shenmai Injection on bilateral Zusanli (ST 36) point alternatively. The treatment lasted 2 months. [Results] The effective rate was 93.33% in group C, 86.67% in group B and 56.67% in group A (P 0.05) compared with those before treatment. Scores of activity of daily life (ADL) , depression and anxiety and the total score of QOL were obviously decreased in groups B and C (P

Clinical and Experimental Studies on Chronic Obstructive Pulmonary Diseases Treated by Fufang Xiebai Capsule, Report of 36 cases / 中医杂志

Thirty - six cases were treated with Fufang Xiebai (FX) capsule and compared with control group. There was significant difference (P