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ObjectiveTo observe the effect of Qingfei Huatan Zhuyu decoction on the lung and intestinal function of rats with chronic obstructive pulmonary diseases （COPD） and explore the deep-seated mechanism of its embodiment of lung and intestinal co-treatment. MethodA total of 60 Wistar rats were randomly divided into six groups， with 10 rats in each group， and the groups were control group， model group， acute syrup group （10 g·kg-1·d-1）， and low， medium， and high-dose groups （10， 15， 20 g·kg-1·d-1） of Qingfei Huatan Zhuyu decoction. The COPD rat model was established by lipopolysaccharide tracheal drip combined with the smoke inhalation method， and the acute syrup group and the Qingfei Huatan Zhuyu decoction group were administered by gavage with corresponding dose concentrations respectively， while the rest groups were controlled by saline gavage， and the lung function and blood gas indexes of rats were monitored after the last administration. The histopathological changes in the lung and intestine were observed microscopically. The expression of serum interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and secretory immunoglobulin A （IgA） in colon tissue were measured by enzyme-linked immunosorbent assay （ELISA）. The biochemical indexes such as serum diamine oxidase （DAO）， D-lactic acid， and malondialdehyde （MDA） were measured. Immunohistochemistry was used to detect the expression of tight junction protein （Occludin） in rat colon tissue. The expression of F4/80 positive alveolar macrophages in rat lung tissue， and the expression of α-actin （α-SMA） and colonic atresia small band protein-1 （ZO-1） were determined by immunofluorescence. The protein expression of p-NF-κB p65， NF-κB p65， p-p38 MAPK， and p-p38 MAPK and the expression of Occludin and ZO-1 in colon tissue were detected in rat lung tissue by Western blot. ResultCompared with the normal group， the model group had pulmonary dysfunction， reduced forced vital capacity （FVC）， arterial partial oxygen pressure （PaO2）， arterial oxygen saturation （SaO2）， and dynamic lung compliance （Cdyn） （P<0.01）， and the pathological changes in the lung and intestine were obvious. The expressions of IL-6， TNF-α， DAO， D-lactic acid， and MDA in serum were increased （P<0.05，P<0.01）， and the protein expression ratio of p-NF-κB p65/NF-κB p65 and p-p38 MAPK/p38 MAPK in lung tissue was increased. The expression of F4/80 positive macrophages in lung tissue was enhanced. The expression of IgA， Occludin， and ZO-1 in colon tissue decreased （P<0.05，P<0.01）. Compared with the model group， the pulmonary function of the rats in the acute syrup group and groups of Qingfei Huatan Zhuyu decoction was significantly improved， and the FVC， PaO2， SaO2， and Cdyn were increased （P<0.05， P<0.01）. The pathological changes in the lung and intestine were significant. The expressions of IL-6， TNF-α， DAO， D-lactic acid， and MDA in serum were decreased （P<0.05，P<0.01）， and the expressions of F4/80 positive macrophages in lung tissue were decreased （P<0.01）. The protein expression ratio of p-NF-κB p65/NF-κB p65 and p-p38 MAPK/p38 MAPK in lung tissue decreased （P<0.01）， and the expression of IgA， Occludin， and ZO-1 in colon tissue increased （P<0.01）. ConclusionQingfei Huatan Zhuyu decoction can effectively reduce the symptoms of COPD rats， and its mechanism of action is related to inhibiting the inflammatory response of lung tissue and improving the barrier function of the intestinal mucosa.
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Background: These Diseases are chronic and often have complex pathologies which lead to polypharmacy and causes unwanted adverse drug reaction (ADRs). We conducted this study at Respiratory Medicine Department of Gandhi Medical College and associated Hamidia Hospitals, Bhopal. Aim and Objective: The objectives of the study were (i) to monitor and assess ADRs in patients of chronic obstructive pulmonary disease (COPD), Asthma, Bronchiectasis; and (ii) to assess causality of the ADR using WHO-UMC causality assessment system and Naranjo’s ADR probability scale. Materials and Methods: The present study indicates the pattern and spectrum of ADRs due to drugs used in the treatment of COPD, Asthma, Bronchiectasis. 159 patients from Respiratory Medicine, Gandhi Medical College receiving chemotherapy were enrolled in study after written informed consent of patients. Approval was obtained from institutional ethics committee. It was cross-sectional, observational study. Prescriptions were analyzed for number of drugs prescribed using a predesigned format. Any ADR observed by patient or treating physician was noted and causality was assessed by Naranjo’s algorithm and WHO-UMC scale. Results: In our study, most important causative drug was Budesonide (12.3%). Causality assessment of ADR by Naranjo’s algorithm showed 22% probable and 78% possible reactions. According to WHO-UMC scale, 81% reactions are possible, 17% are probable, and 2% are unlikely. Conclusion: To minimize this high incidence of ADRs dose individualization and therapeutic monitoring of medicine is important. In clinical practice, special precautions while prescribing these drugs with well-known potential for causing ADRs, early detection and appropriate intervention are required. This may greatly contribute to reduce the incidence, frequency, severity, morbidity, and possible mortality.
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ABSTRACT Introduction: Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by incomplete reversibility of airflow obstruction and persistent respiratory symptoms. Objective: To explore the therapeutic effect of physical exercise on patients with chronic obstructive pulmonary disease in pulmonary rehabilitation. Methods: Forty-eight experimental subjects were divided into control group, experimental group 1, and experimental group 2 for research. The control group received normal medical-related treatment without any other means of intervention. In addition to normal medical-related treatment, experimental group 1 received breathing training and educational interventions and experimental group 2 received exercise, breathing training and educational interventions. Results: The vital capacity of female subjects before and during the experiment ranged from 2.23±0.01 to 2.26±0.04, the FVC ranged from 2.00±0.02 to 2.01±0.03, the FEV1 ranged from 1.03±0.01 to 1.03±0.01,the FEV1% ranged from 55.50±1.29 to 55.25±1.71,the FEV1/FVC ranged from 51.44±0.24 to 50.84±1.00, andthe heart rate ranges from 65.00±0.82 to 65.50±1.29. Conclusions: Exercise training can increase the exercise tolerance of patients with COPD, relieve dyspnea, and improve the quality of life. Level of evidence II; Therapeutic studies - investigation of treatment results.
RESUMO Introdução: A doença pulmonar obstrutiva crônica (DPOC) é uma patologia respiratória caracterizada pela reversibilidade incompleta da obstrução ao fluxo aéreo e sintomas respiratórios persistentes. Objetivo: Explorar o efeito terapêutico do exercício físico em pacientes com doença pulmonar obstrutiva crônica sobre a reabilitação pulmonar. Métodos: Quarenta e oito participantes foram divididos em grupo controle, grupo experimental 1 e grupo experimental 2 para a realização do estudo. O grupo controle recebeu tratamento clínico normal, sem qualquer outra intervenção. Além do tratamento clínico normal, o grupo experimental 1 recebeu treinamento respiratório e intervenções educacionais e o grupo experimental 2 recebeu exercícios, treinamento respiratório e intervenções educacionais. Resultados: A capacidade vital de mulheres antes e durante o experimento variou de 2,23 ± 0,01 a 2,26 ± 0,04, a CVF variou de 2,00 ± 0,02 a 2,01 ± 0,03, o VEF1 variou de 1,03 ± 0,01 a 1,03 ± 0,01, o VEF1% variou de 55,50 ± 1,29 a 55,25 ± 1,71, a VEF1/CVF variou de 51,44 ± 0,24 a 50,84 ± 1,00, e a frequência cardíaca variou de 65,00 ± 0,82 a 65,50 ± 1,29. Conclusões: O treinamento físico pode aumentar a tolerância ao exercício de pacientes com DPOC, atenuar a dispneia e melhorar a qualidade de vida. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.
RESUMEN Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es una patología respiratoria caracterizada por la reversibilidad incompleta de la obstrucción del flujo aéreo y la persistencia de síntomas respiratorios. Objetivo: Explorar el efecto terapéutico del ejercicio físico en la rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: Cuarenta y ocho participantes fueron divididos en grupo de control, grupo experimental 1 y grupo experimental 2 para el estudio. El grupo de control recibió tratamiento clínico normal sin ninguna otra intervención. Además del tratamiento clínico normal, el grupo experimental 1 recibió entrenamiento respiratorio e intervenciones educativas y el grupo experimental 2 recibió ejercicios, entrenamiento respiratorio e intervenciones educativas. Resultados: La capacidad vital de las mujeres antes y durante el experimento osciló entre 2,23 ± 0,01 y 2,26 ± 0,04, la FVC entre 2,00 ± 0,02 y 2,01 ± 0,03, el FEV1 entre 1,03 ± 0,01 y 1, 03 ± 0,01, el FEV1% varió de 55,50 ± 1,29 a 55,25 ± 1,71, la FEV1/FVC varió de 51,44 ± 0,24 a 50,84 ± 1,00, y la frecuencia cardíaca varió de 65,00 ± 0,82 a 65,50 ± 1,29. Conclusiones: El entrenamiento físico puede aumentar la tolerancia al ejercicio en pacientes con EPOC, atenuar la disnea y mejorar la calidad de vida. Nivel de evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.
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Pulmonary administration route has been extensively exploited for the treatment of local lung diseases such as asthma, chronic obstructive pulmonary diseases and respiratory infections, and systemic diseases such as diabetes. Most inhaled medicines could be cleared rapidly from the lungs and their therapeutic effects are transit. The inhaled medicines with extended pulmonary exposure may not only improve the patient compliance by reducing the frequency of drug administration, but also enhance the clinical benefits to the patients with improved therapeutic outcomes. This article systematically reviews the physical and chemical strategies to extend the pulmonary exposure of the inhaled medicines. It starts with an introduction of various physiological and pathophysiological barriers for designing inhaled medicines with extended lung exposure, which is followed by recent advances in various strategies to overcome these barriers. Finally, the applications of the inhaled medicines with extended lung exposure for the treatment of various diseases and the safety concerns associated to various strategies to extend the pulmonary exposure of the inhaled medicines are summarized.
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Objective To explore the characteristics of chronic obstructive pulmonary diseases (COPD) in Chengdu from 2019 to 2020 and analyze its influencing factors. Methods A total of 362 patients with COPD from January 2019 to January 2020 in Chengdu Fifth People's Hospital were collected, and the patients’ medical records were analyzed. The patients’ gender, age, number of hospitalizations, days of hospitalization, disease classification and other information were extracted and analyzed. Results A total of 362 COPD patients were included in this study, including 293 males, accounting for 80.94% of the total. The number of COPD patients over 60 years old was significantly higher than that of patients under 59 years old, with the largest age group being 60 to 79 years old and a median age of 72 years old. The average hospitalization times and days were (8.22±8.75) times and (11.03±5.47) days, respectively. Most patients had COPD of grade II or grade III, accounting for 62.83% of the total. In this study, there were 490 cases of complications occurring in 362 patients, with 1.35 complications per capita. There were 394 cases of respiratory diseases, 74 cases of cardiovascular diseases, and 22 cases of other diseases. The incidence of pulmonary infection was the highest (204 cases, 56.35%), followed by bullae and asthma (83 cases and 64 cases, 22.93% and 17.68%, respectively). The proportion of antiasthmatic drug use was the highest and the use time was the longest, which was 220 times (60.77%) and (10.50±6.23) days, respectively. There were 119 cases (32.87%) treated with antibiotics for (7.85±5.21) days. The anticoagulants were used for 105 times (29.01%) and (7.54±3.18) days. Logistic regression analysis showed that smoking history, passive smoking history, age over 50 years old, family history of respiratory disease and respiratory disease history were independent risk factors for COPD. Conclusion The majority of COPD patients in Chengdu from 2019 to 2020 were male, with the highest incidence in the age group of 60-79 years. Pulmonary infection and other respiratory diseases were the most common complications. Antibiotic use met the guidelines.
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Clara cell 10-kD protein (CC10) is one of the most abundant proteins in the respiratory secretions, and plays an important role in immune response, anti-infection and lung injury repair. Chronic obstructive pulmonary disease and bronchial asthma are common chronic lower respiratory tract inflammatory diseases, the pathogenesis of which are intimately related to the abnormal expression of CC10. Therefore, an in-depth research of the biological characteristics of CC10 are helpful for exploring for the important targets for the treatment of chronic respiratory inflammatory diseases in the future. This review summarizes the current research progress in this field.
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Objective To explore the main influential factors of bronchodilation test positive results in mechanically ventila-ted patients with chronic obstructive pulmonary disease(COPD).Methods A total of 55 inpatients with acute exacerbation of COPD(AECOPD)receiving the invasive ventilation from June 2015 to March 2016 were collected.The accurate respiratory mechan-ics monitoring was performed before and after using the bronchodilator.The airway resistance reduction over 12% after inhaling bronchodilator served as the judgment criteria,the patients were divided into the bronchodilation test positive or negative groups, then the influential factors were compared and statistical analysis was performed.Results Twenty-nine cases(52.7%)showed the positive reaction and 26 cases(47.2%)were negative.After univariate analysis,results of heart rate,SaO2,fungal infection,horm-onotherapy,CKMB,lactic acid and BNP were brought into the multivariable Logistic regression analysis(P< 0.1).The analysis found that fungal infection was an independent factor affecting the results of the bronchodilation test(P<0.05).Conclusion Fun-gal infection is an independent influential factor of the bronchodilation test positive in COPD patients receiving invasive ventilation.
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Objective: To investigate the risk factors of chronic obstructive pulmonary disease (COPD) in Li and Han ethnic group in Hainan, China. Methods: All subjects were randomly selected from various regions in Hainan. General characteristics were compared between COPD cases and healthy control cases in both Li and Han ethnic groups. The odds ratio (OR), the corresponding 95% confidence interval (CI) of COPD were calculated by logistic regression. Results: A total of 277 Li COPD cases, 307 Li healthy control subjects, 290 Han COPD cases and 301 Han healthy control were included in this study. In both the Li and Han groups, the average age exceeded 65 years, and the cigarette number smoked per day and the smoking duration were correlated with risk of COPD. In the Li COPD subjects, low weight, smoking, and recurrent infection of respiratory tract were mainly risk factors; while the mainly risk factor of Han COPD subjects was family history of respiratory disease. Conclusions: The risk factors are different in COPD subjects of Han and Li nationalities in Hainan of China. The age and smoking are strongly correlated with COPD risk.
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To evaluate therapeutic efficacy and safety of Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection in the treatment of chronic obstructive pulmonary diseases (COPD). All clinical trial databases were retrieved from PubMed, EMBase, ClinicalTrials, Cochrane Library, CNKI, CBM, VIP, and Wanfang. Data were searched from inception to February 2018, randomized controlled trials (RCTs) by Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with chemotherapy (experimental group) compared with conventional therapy (control group) in the treatment of COPD were included. All included studies were critically appraised by two independent reviewers according to the cochrane systematic review method and using Revman 5.3 Software and State 12.0 for Meta-analysis. There were 16 RCTs were included in the evaluation and screening of selected articles with a total of 1 259 patients. The Meta-analysis showed that the total clinical efficacy of the patients in the experimental group after treatment was significantly better than that in the control group [OR = 4.67, 95% CI (3.03, 7.19), P < 0.000 01]; The improvement of forced expiratory volume in one second (FEV1) was significantly better than control group [SMD = 1.43, 95% CI (1.14, 1.72), P < 0.000 01]; Forced vital capacity (FVC) was significantly better than control group [SMD = 1.53, 95% CI (1.17, 1.90), P < 0.000 01]; FEV1/FVC was significantly better than control group [SMD = 1.12, 95% CI (0.90, 1.34), P < 0.000 01]; FEV1 in the percentage of the predicted value forced vital capacity (FVC) was significantly better than control group [SMD = 0.62, 95% CI (0.31, 0.93), P < 0.000 1] and the blood gas index of PaO2 was significantly higher than control group [MD= 9.7, 95% CI (7.92, 11.65), P < 0.000 01]; PaCO2 was significantly lower than control group [SMD =-1.51, 95% CI (-1.90, -1.12), P < 0.000 01]; SaO2 was significantly higher than control group [SMD = 0.94, 95% CI (0.48, 1.40), P < 0.000 1]. For the treatment of chronic obstructive pulmonary disease, Salviae Miltiorrhizae and Ligustrazine Hydrochloride Injection combined with chemotherapy can significantly improve the lung function of patients, but the conclusions of the study still need to be confirmed by more high-quality clinical trials.
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Objective:To investigate the risk factors of chronic obstructive pulmonary disease (COPD) in Li and Han ethnic group in Hainan, China.Methods:All subjects were randomly selected from various regions in Hainan. General characteristics were compared between COPD cases and healthy control cases in both Li and Han ethnic groups. The odds ratio (OR), the corresponding 95% confidence interval (CI) of COPD were calculated by logistic regression.Results:A total of 277 Li COPD cases, 307 Li healthy control subjects, 290 Han COPD cases and 301 Han healthy control were included in this study. In both the Li and Han groups, the average age exceeded 65 years, and the cigarette number smoked per day and the smoking duration were correlated with risk of COPD. In the Li COPD subjects, low weight, smoking, and recurrent infection of respiratory tract were mainly risk factors; while the mainly risk factor of Han COPD subjects was family history of respiratory disease.Conclusions:The risk factors are different in COPD subjects of Han and Li nationalities in Hainan of China. The age and smoking are strongly correlated with COPD risk.
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Objective To compare the efficacy of high flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with acute-moderate type Ⅱ respiratory failure,and to explore the feasibility of HFNC in the treatment of COPD with respiratory failure.Methods Patients diagnosed with COPD with acute moderate type Ⅱ respiratory failure (Arterial blood gas pH 7.25-7.35,PaCO2＞ 50 mmHg) admitted to the ICUs from April 2017 to December 2017 were retrospectively analyzed.All patients who were treated with HFNC within the first 4 hours after the admission to the ICUs,and continued for more than 2 hours and for at least 4 hours within the first 24 hours were included in the HFNC group.Those treated with NIV in the same conditions were included in the NIV group.The end point was the failure rates of treatment (changing to respiratory support method in another group or invasive ventilation) and 28-day mortality.Results Eighty-two patients (39 in the HFNC group and 43 in the NIV group) were enrolled.The HFNC group had a treatment failure rate of 28.2％,which was lower than that of the NIV group (39.5％).However,Kaplan-Meier curve analysis showed no significant difference between the two groups (Log Rank test 1.228,P=0.268).The 28-day mortality rate in HFNC group was 15.4％,which was no different from 14％ in NIV group (Log Rank test 0.049,P=0.824).The number of airway care interventions within the first 24 hours was significantly lower in the HFNC group than in the NIV group [5 (3～8) vs.11 (7～15)],whereas the duration of respiratory support within the first 24 hours was significantly longer in the HFNC group than in the NIV group [16 (9～22) hours vs.8 (4～11) hours] (all P＜0.05).The incidence of nasal facial lesions in the NIV group was 20.9％,significantly higher than that of HFNC group (5.1％,P ＜0.05).Conclusion For COPD with acute moderate type Ⅱ respiratory failure,HFNC has similar therapeutic effects as NIV.HFNC has better therapeutic tolerance and is a new potential respiratory support method for clinical treatment of COPD with respiratory failure.
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Introducción. La escala de Tal modificada es utilizada en Chile para determinar la gravedad de la obstrucción bronquial. Existen informes de su validez; sin embargo, carece de antecedentes del análisis de su estructura como escala para cuantificar de forma significativa la gravedad de la obstrucción bronquial. Objetivo. Identificar el patrón de relación entre los ítems de la escala y la dimensión gravedad de la obstrucción bronquial en una muestra de menores de tres años que consultan en dos centros de salud de la provincia de Concepción, Chile. Método. Análisis factorial exploratorio. Selección no aleatoria y voluntaria de participantes, menores de 36 meses, agosto-noviembre de 2015. Evaluados de manera independiente por médico y kinesiólogo, en tiempo seguido. Se aplican medidas de tendencia central, análisis factorial exploratorio, por subgrupo de menores y mayores de 6 meses, y consistencia interna. Resultados. 204 mediciones a 102 menores. Con una varianza explicada de 39%, los ítems se dirigen a dos conceptos diferentes, un factor que agrupa frecuencia respiratoria, sibilancia y retracción, y otro que solo lo determina cianosis, con alfa de Cronbach de 0, 5. Al extraer cianosis del análisis, muestra matriz monofactorial con 38% de varianza total explicada y consistencia interna de 0, 62. Conclusiones. Por medio de sus ítems, la estructura de la escala no se ajusta adecuadamente para esta muestra. Cianosis se muestra como un ítem disociado en la estructura. Al ajustar el modelo a solo tres ítems, la estabilidad del alfa como medida de consistencia interna aumenta, pero a un valor cuestionable, lo que, sin duda, variará al ser aplicada en otra muestra.
Introduction. The modified Tal's score has been used in Chile to determine the severity of bronchial obstruction. Its validity has been reported already; however, its structure as a scale to significantly quantify the severity of bronchial obstruction has not been analyzed. Objective. To identify the relationship pattern among the score's items and the severity of bronchial obstruction in a sample of children younger than 3 years seen in two health care centers in the province of Concepción, Chile. Method. Exploratory factor analysis. Nonrandom, voluntary selection of participants youngerthan36months, August-November 2015. Participants were assessed independently and subsequently by a physician and a physical therapist. The following measurements were applied: central tendency, exploratory factor analysis, subgroups of participants younger and older than 6 months, and internal consistency. Results. A total of 204 measurements were done in 102 children. With a 39% explained variance, items incline towards to two different concepts: one factor groups respiratory rate, wheezing, and retractions, and the other determines only cyanosis, with a Cronbach's alpha of 0.5. Once cyanosis is removed from the analysis, the original one-factor matrix sample shows a 38% total explained variance and a 0.62 internal consistency. Conclusions. Based on its items, the score's structure does not fit adequately to this sample. Cyanosis appears as a dissociated item within the structure. Once the model is adjusted to only 3 items, the stability of Chronbach's alpha as a measure of internal consistency increases but at an objectionable value, which will undoubtedly vary once it is applied to a different sample.
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Humans , Infant, Newborn , Infant , Child, Preschool , Bronchial Diseases/diagnosis , Airway Obstruction/diagnosis , Severity of Illness Index , Chile , Respiratory Sounds/diagnosis , Family Characteristics , Factor Analysis, Statistical , Sensitivity and Specificity , Cyanosis/diagnosis , Respiratory RateABSTRACT
Abstract Objective: The aim of this study was to investigate the incidence of carious lesions, the amount of salivary flow rate and pH value in patients with asthma and chronic obstructive pulmonary diseases (COPD), using inhalation therapy. The obtained results were compared with the results of adult healthy subjects, forming a control group. Material and Methods: The study included 80 participants aging between 18 and 65 years. The experimental group (EG) was comprised of 40 participants, previously diagnosed with asthma or COPD undergoing inhalation therapy for more than five years. The control group (CG), comprised of 40 participants, mirrored the same age and gender status of the EG. Dental status was determined by decayed, missing, and filled teeth (DMFT index). Quantity and pH value of saliva were determined in the laboratory. Results: In the EG, the mean value of the salivary flow rate and pH value were statistically significantly lower than in the CG (p<0.001). Patients in the EG had a higher value of DMFT index when compared with the CG, although the difference was not statistically significant (p=0.199). Mean number of decayed teeth, as well as missing teeth, in the EG was statistically significantly higher than in the CG (p<0.001). Mean number of filled teeth in the EG was statistically significantly lower than in the CG (p<0.001). Conclusion: It was found that patients undergoing inhalation therapy face increasing risk of dental caries due to the lower salivary flow rate and pH value along with the inhalation therapy. They should receive intensive preventive care, including oral hygiene instruction and dietary advice.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Respiratory Therapy/adverse effects , Asthma/therapy , Saliva/chemistry , Pulmonary Disease, Chronic Obstructive/therapy , Dental Caries/etiology , Oral Hygiene , Reference Values , Saliva , Salivation , Secretory Rate , Case-Control Studies , DMF Index , Cross-Sectional Studies , Risk Factors , Statistics, Nonparametric , Hydrogen-Ion ConcentrationABSTRACT
Introducción. En pediatría, es determinante establecer precozmente la gravedad de la obstrucción bronquial (GOB). Objetivo. Evaluar las propiedades psicométricas de escalas de medición de GOB en pacientes pediátricos. Población y método. Revisión sistemática de estudios sobre validez y confiabilidad de escalas de GOB realizados en niños menores de 3 años. Se buscó en Medline, WoS, EMBASE, SciELO, Google Scholar. Los coeficientes de correlación de cada artículo fueron metaanalizados mediante el modelo de efectos aleatorios para determinar la validez de criterio y la confiabilidad a través de promedios ponderados de los coeficientes según el tamaño de la muestra. Resultados. Se incluyeron 9 artículos con un total de 2699 niños; 3 artículos presentaron calidad metodológica buena o excelente. Cuatro artículos determinaron la validez de criterio concurrente considerando la saturación de oxígeno; coeficiente de correlación ponderado -0,627 (IC 95%: de -0,767 a -0,431; p < 0,001); 2 artículos determinaron la validez de criterio convergente; coeficiente de correlación ponderado 0,809 (IC 95%: de 0,721 a 0,871; p < 0,001); 6 artículos determinaron la confiabilidad interobservador; coeficiente de correlación ponderado de 0,500 para kappa y 0,891 para coeficiente de correlación intraclase. Conclusión. La evaluación de las propiedades psicométricas para apoyar la utilidad de escalas para la estimación del constructo GOB mostró una validez de criterio de moderada a adecuada. El porcentaje de acuerdo entre observadores respecto de la medida observada (GOB) se muestra adecuado; sin embargo, hay que considerar las debilidades presentadas en el diseño de los artículos, lo cual podría afectar a la validez interna de los resultados.
Introduction. In pediatrics, identifying the severity of bronchial obstruction in an early manner is a decisive factor. Objective. To assess the psychometric properties of the scales for grading the severity of bronchial obstruction in pediatric patients. Population and Method. This was a systematic review of studies on the validity and reliability of scales for grading the severity of bronchial obstruction conducted in infants and children younger than 3 years old. The search was conducted in Medline, WoS, EMBASE, SciELO, and Google Scholar. The correlation coefficient corresponding to each article was included in a random effects model to establish the criterion validity and reliability using the weighted averages of coefficients as per the sample size. Results. A total of 9 articles were included, which accounted for 2699 children; 3 articles had an adequate or excellent methodological quality. Four articles established the concurrent criterion validity considering oxygen saturation, with a weighted correlation coefficient of -0.627 (95% confidence interval --#91;CI--#93;: -0.767 to -0.431, p 0.001); 2 articles established the convergent criterion validity, with a weighted correlation coefficient of 0.809 (95% CI: 0.721 to 0.871, p < 0.001); 6 articles established the inter-observer reliability, with a weighted correlation coefficient of0.500for kappa and 0.891 for the intraclass correlation coefficient. Conclusion. The assessment of psychometric properties to support the use of scales for grading the construct "severity of bronchial obstruction" showed a moderate to adequate criterion validity. The percentage of agreement among observers in terms of the studied measure (severity of bronchial obstruction) was adequate; however, weaknesses such as the article design should be taken into account since it may affect the internal validity of results.
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Humans , Infant , Child, Preschool , Child , Bronchiolitis/diagnosis , Psychometrics , Severity of Illness Index , Lung Diseases, Obstructive/diagnosisABSTRACT
Objective To test the clinical effects of the expiration control device with mask in the treat-ment of chronic obstructive pulmonary disease. This device developed by the author. Methods A total of 102 pa-tients were treated by the device. Among them ,50 patients received positive end-expiratory pressure and 52 with expiratory flow retard and blocked function. Differences in carbon dioxide partial pressure(PaCO2),oxygen partial pressure(PaO2)and pH of the arterial blood gas analysis were compared ,as well as differences in forced vital ca-pacity(FVC),forced expiratory volume for1 sec(FEV1),tidal volume(VT)of pulmonary function before and af-ter treatment. Results (1) In the positive end-expiratory pressure group ,there were significant differences of FVC,FEV1 and VT before and after treatment(2.95 ± 0.32)L vs(3.22 ± 0.35)L,(1.88 ± 0.17)L vs(2.00 ± 0.15)L,(335.28 ± 43.59)mL vs(364.64 ± 44.28)mL,(P<0.01)differences of PaCO2,PaO2 and pH before and after treatment had statistical significance(50.42 ± 4.77)mmHg vs(48.42 ± 3.76)mmHg,(65.42 ± 4.60)mmHg vs (68.50 ± 4.69)mmHg,(7.35 ± 0.030)vs(7.37 ± 0.037)(P<0.05).(2)In the expiratory flow retard and blocked group,differences of FVC,FEV1andVT before and after treatment had statistical significance(2.93 ± 0.22)L vs (3.10 ± 0.27)L,(1.83 ± 0.14)L vs(1.91 ± 0.16)L,(335.48 ± 44.16)mL vs(362.46 ± 38.66)mL(P<0.05), differences of PaCO2,PaO2 and pH before and after treatment had statistical significance(52.39 ± 3.37)mmHg vs (50.06 ± 3.92)mmHg,(68.05 ± 3.80)mmHg vs(68.99 ± 4.57)mmHg,(7.34 ± 0.035)vs(7.37 ± 0.036)(P<0.05). Conclusion This device can improve the ventilation function in patients with COPD. It is easy to use ,safe and effective,with high clinical application value.
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Objective To investigate the clinical efficacy and safety of six-hole moxibustion box therapy for stable chronic obstructive pulmonary diseases(COPD).Methods Sixty patients with thoracic facet joint disorder were randomly allocated to treatment and control groups, 30 cases each. The control group inhaled tiotropium bromide inhalation powder spray and the treatment group received six-hole moxibustion box therapy in addition. The COPD Assessment Test (CAT) score and the dyspnea score were recorded and peripheral blood oxygen saturation was measured in the two groups before and after treatment. The adverse reactions were monitored in the two groups. Results There were statistically significant pre-/post-treatment differences in the CAT score and the dyspnea score in the two groups (P<0.05). There were statistically significant post-treatment differences in the CAT score and the dyspnea score between the treatment and control groups (P<0.05). There were statistically significant differences in pre-/post- treatment CAT score difference value and dyspnea score difference value between the two groups (P<0.05). There was a statistically significant pre-/post-treatment difference in peripheral blood oxygen saturation in the treatment group (P<0.05). There was a statistically significant post-treatment difference in peripheral blood oxygen saturation between the two groups (P<0.05).Conclusion Six-hole moxibustion box therapy plus tiotropium bromide inhalation powder spray is safe and effective in treating stable COPD.
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Objective To observe the effects of nourishing lung and kidney formulas on inflammatory response of alveolar epithelial cells stimulated by monocytes conditioned medium and study the anti-inflammatory mechanism of the formulas for the treatment of chronic obstructive pulmonary diseases (COPD).Methods The reproduction of inflammation models of A549 cells were stimulated by monocyte THP-1 cell strain conditioned medium.A549 cells were randomly divided into blank control group (20％ blank rabbits serum),model group (20％ blank rabbits serum+25.0％ THP-1 cell conditioned medium),nuclear transcription factor activator protein-1 (AP-1) pathway inhibitor T-5224group (20％ blank rabbits serum+25.0％ THP-1 cells conditioned medium+100 μmol/L T-5224),nourishing lung and kidney group (20％ rabbits serum with nourishing lung and kidney formulas+25.0％ THP-1 cells conditioned medium).The contents of interleukins (IL-6,IL-8),tumor necrosis factor-α (TNF-αα),matrix metalloprotein-9 (MMP-9) in cell culture supernatant were detected with enzyme linked immunosorbent assay (ELISA),the supernatant content of malondialdehyde (MDA) was detected with thibabituric acid (TBA) method,the total activity of superoxide dismutase (T-SOD) was detected with hydroxylamine method,and the activity of AP-1 pathway was detected with electrophoretic mobility shift assay (EMSA) method.Results Compared with the blank control group,the A549 cell proliferation were significantly increased at 24 hours,48 hours stimulation by 25.0％ cell conditioned medium (A value:24 hours was 0.41 ± 0.02 vs.0.37 ± 0.04,48 hours was 1.30 ± 0.09 vs.1.15 ± 0.19).Compared with the blank control group,the contents of IL-6,IL-8,TNF-αα,MMP-9,MDA,AP-1 expression were significantly increased in model group [IL-6 (ng/L):35.00±3.63 vs.23.15±1.72,IL-8 (ng/L):273.09± 164.36 vs.231.45±33.90,TNF-α(ng/L):51.61 ± 9.51 vs.28.87 ± 3.34,MMP-9 (ng/L):442.85 ± 78.86 vs.235.60 ± 14.62,MDA (μmol/L):6.90 ± 0.11 vs.6.01 ± 0.12,AP-1 expression (A value):2.260 ± 0.062 vs.1.000 ± 0.000],MDA/T-SOD ratio was increased (4.43 ± 0.05vs.3.96 ± 0.06).Compared with model group,the levels of IL-8 (ng/L:100.29 ± 17.03),TNF-α (ng/L:25.13 ± 0.46),AP-1 expression (A value:1.38 ± 0.02),and the MDA/T-SOD ratio (4.23 ± 0.23) in T-5224 group,and MMP-9 (ng/L:195.44±9.80),MDA (μmol/L:5.86±0.30),MDA/T-SOD ratio (3.56±0.41),AP-1 expression (A value:0.76 ± 0.01) in nourishing lung and kidney group were all reduced significantly (all P ＜ 0.05).Conclusion Nourishing lung and kidney formulas can suppress the inflammatory response through regulating the alveolar epithelial cells AP-1 signaling pathways.
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Objective To evaluate the clinical efficacy of atorvastatin combined with salvianolate in treatment of chronic obstructive pulmonary disease (COPD) complicated with pulmonary arterial hypertension (PH) , and its influence on hypoxia inducible factor-1 alpha (HIF-1α), endothelin-1 (ET-1), adrenomedullin (ADM) in serum.Methods 30 cases of COPD patients with PH were randomly divided into 2 groups, each of 15 cases.The two groups were given conventional treatment, including rest, continuous low flow oxygen, anti infection, relieving cough and phlegm, relaxing tracheal, correcting water and electrolyte balance.Control group was received Atorvastatin Calcium Tablets 20 mg orally, once daily.Observation group was received Atorvastatin Calcium Tablets 20 mg once daily, once daily;salvianolic 200 mg+0.9% sodium chloride solution 250 mL, intravenous drip, once daily.The course of treatment was 10 d.Before and after treatment, 6 min walking distance(6 MWD) and hemodynamic parameters were detected, including pulmonary artery systolic blood pressure (PASP), cardiac output (CO), right ventricular end diastolic pressure (RVEDP) , and HIF-1, ET-1 and ADM level in serum.Results After treatment, 6MWD, PASP, CO, RVEDP of the two groups were significantly improved compared with the same group before treatment.But compared with control group, observation group was improved significantly, the difference was statistically significant (P<0.05).After treatment, HIF-1 alpha, ET-1 of the two groups were significantly lower than the same group before treatment, but ADM were significantly increaser( P <0.05 ) .Compared with control group, HIF-1 alpha, ET-1 of observation group were significantly decreased, while the ADM was significantly increased, the difference was statistically significant (P<0.05).Conclusion Atorvastatin combined with salvia miltiorrhiza polyphenols can significantly reduce the pulmonary artery pressure in patients with COPD and PH, increase exercise tolerance, and its mechanism maybe related to the regulation of the expressions of HIF-1, ET-1 and ADM.
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Objective To study the influence of bFGF gene transfected bone marrow-derived mesenchymal stem cells (BMSCs) on the inflammatory cytokines of COPD rat. Methods The BMSCs were separated from SD rat and cultured and then bFGF gene was imported to BMSCs by liposome transfection method. The samples were prepared into six groups: normal control group, COPD group (A), BMSCs group (B), pcDNA3.1-BMSCs group (C), bFGF-pcDNA3.1-BMSCs group (D), and bFGF group (E). The expressions of TNF-α and IL-1β by QRT-PCR were detected. Results Compared with COPD group, TNF-α and IL-1β genes from groups B to D dropped significantly (P 0.05). Conclusion BFGF transfected BMSCs, sample BMSCs and pcDNA3.1 transfected BMSCs can inhibit the expression of inflammatory cytokines of TNF-α and IL-1β, but there is no obvious advantage in comparison to bFGF transfected BMSCs and sample BMSCs in respect of inhibiting the expression of inflammatory cytokines of TNF-α and IL-1β.
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Objective To investigate Yiqi Huatan Decoction(YHD), a compound recipe with the actions of tonifying Qi and resolving phlegm, on aquaporin 5(AQP5), tumor necrosis factor-alpha(TNF-α)and mucin 5AC(MUC5AC)in bronchoalveolar lavage fluid(BALF)of chronic obstructive pulmonary diseases(COPD)rats. Methods SD rats were randomized into blank control group, model group, and low-, middle- and high-dose YHD groups(in the dosage of 7.398, 36.99, 73.98 g·kg-1·d-1 respectively). The rat model of COPD was induced by cigarette smoking combined with intratracheal dripping of lipopolysaccharide(LPS). After COPD rats were treated with YHD for 30 days, the histological features of lung tissues were observed after hematoxylin-eosin (HE) staining, the expression of AQP5, TNF -α and MUC5AC in the lung tissue was detected by immunohistochemistry, the concentrations of AQP5, TNF-α and MUC5AC in BALF of rats were measured by enzyme-linked immunosorbent assay(ELISA). Results Compared with the blank control group, the concentration of AQP5 in BALF of the model group was decreased significantly(P<0.01), while the concentrations of TNF-αand MUC5AC were significantly increased(P<0.01). Compared with the model group, the pathological features of the lung tissue were relieved, and the concentration of AQP5 was increased significantly in low-, middle-, high-dose YHD groups (P<0.01), but the concentrations of TNF-α and MUC5AC were significantly decreased (P<0.01), and the effect of high-dose group was superior to low-and middle-dose groups(P<0.01). Conclusion The therapeutic mechanism of YHD for COPD is probably related with the regulation of fluid transport in aquaporin water channels of rats.