The value of exhaled nitric oxide in assessing the risk of acute exacerbation and guiding the use of ICS in patients with COPD / 中国医师杂志

Objective:To explore the predictive value of exhaled nitric oxide (FeNO) for the risk of acute exacerbation in stable chronic obstructive pulmonary disease (COPD) patients over the next year and evaluate whether it can guide the use of inhaled corticosteroids (ICS).Methods:This study was a multicenter, retrospective and observational cohort study. The subjects of this study were stable COPD patients who were hospitalized in 12 hospitals in Hunan Province and Guangxi from January 2017 to December 2021. The patient′s basic Demography information, previous acute exacerbation history, pulmonary function, FeNO, chronic obstructive pulmonary disease assessment test questionnaire (CAT) score, modified British Medical Research Council dyspnea questionnaire (mMRC) score, chronic obstructive pulmonary disease control questionnaire (CCQ) score, and detailed treatment plan were collected. Based on FeNO 25 ppb, patients were divided into a high FeNO group and a normal FeNO group. All patients were followed up for 1 year and information on acute exacerbation was recorded.Results:A total of 825 patients were included, aged (63.5±9.1)years, with a median of 25 ppb of FeNO. A number of 825 patients were followed up for 1 year, of which 262(31.8%) experienced acute exacerbation. Multivariate logistic regression found that FeNO, CAT score, smoking cessation, and past history of acute exacerbation were independent factors predicting acute exacerbation in COPD patients in the next year (all P<0.05). High FeNO was a protective factor for acute exacerbation in COPD patients in the next year, with an OR value of 0.10 ( P<0.001). Further analysis found that the proportion of patients in the high FeNO group using ICS was significantly higher than that in the normal FeNO group [58.8%(247/420) vs 48.6%(197/405), P=0.003]. In the high FeNO group, using ICS can reduce the incidence of acute exacerbation of COPD in the next year [8.9%(22/247) vs 15.6%(27/173), P<0.05], while in the normal FeNO group, there was no statistically significant difference in the frequency of acute exacerbation between patients using ICS and those not using ICS ( P>0.05). Conclusions:FeNO is an independent factor predicting the acute exacerbation of COPD in the next year, and patients with high FeNO levels may consider using ICS in combination.

The recent advances of asthma-chronic obstructive pulmonary disease overlap / 中国医师杂志

Asthma and chronic obstructive pulmonary disease overlap (ACO) is a hot topic in recent years. Although the precise definition of ACO is still controversial, scholars have found that the patients with overlapping features of asthma and COPD have a worse prognosis and increased medical cost than those with asthma or COPD alone. Thus, there is a big challenge to have a better understanding and to manage these patients in clinical practice. To strengthen awareness of this type of patients, the Global initiative for Chronic Obstructive Lung Disease (GOLD) and Global initiative for asthma (GINA) in 2014 named them as " Asthma Chronic Obstructive Lung Overlap Syndrome" (ACOS), which was further revised to the Asthma Chronic Obstructive Lung Overlap (ACO) in the follow-up GINA guidelines (2017). In the updated version, it emphasized that ACO was not a separate disease. However, although the research on ACO has increased significantly in recent years, there are still many controversies, which includes the definition, diagnostic criteria and treatment therapies. In this review, we provide the recent advances in the diagnosis and an overview of available treatment for of ACO.

The recent advances of asthma-chronic obstructive pulmonary disease overlap / 中国医师杂志

Asthma and chronic obstructive pulmonary disease overlap (ACO) is a hot topic in recent years.Although the precise definition of ACO is still controversial,scholars have found that the patients with overlapping features of asthma and COPD have a worse prognosis and increased medical cost than those with asthma or COPD alone.Thus,there is a big challenge to have a better understanding and to manage these patients in clinical practice.To strengthen awareness of this type of patients,the Global initiative for Chronic Obstructive Lung Disease (GOLD) and Global initiative for asthma (GINA) in 2014 named them as " Asthma Chronic Obstructive Lung Overlap Syndrome" (ACOS),which was further revised to the Asthma Chronic Obstructive Lung Overlap (ACO) in the follow-up GINA guidelines (2017).In the updated version,it emphasized that ACO was not a separate disease.However,although the research on ACO has increased significantly in recent years,there are still many controversies,which includes the definition,diagnostic criteria and treatment therapies.In this review,we provide the recent advances in the diagnosis and an overview of available treatment for of ACO.

Clinical COPD questionnaire (CCQ) in patients with COPD / 中国医师杂志

The overall impact of chronic obstructive pulmonary disease (COPD) on individuals is multifaceted and it causes impairment not only in lungs but also in other organs,and even in psychological conditions that result in multiple symptomatic effects and poorer quality of life.Therefore,it is critical to e valuate patients'quality of life in the clinical practice.Besides modified Medical British Research Council (mMRC) and COPD assessment test (CAT),the clinical COPD questionnaire (CCQ),a self-administered questionnaire was also recommended by GOLD2013 to assess patients'health status.Compared to the wide spread use of mMRC and CAT,CCQ was paid less attention in our clinical work.This study focused on the development,reliability,validity and responsiveness of the CCQ among subjects with COPD.We found that CCQ was easily understood with good reliability,validity and responsiveness and the use of the CCQ should be promoted as a health status measurement in more countries and regions.

Advances in pulmonary imaging evaluation of chronic obstructive pulmonary disease / 中国医师杂志

Chronic obstructive pulmonary disease (COPD) is a common disease that can be prevented and treated with persistent respiratory symptoms and airflow limitation.Emphysema and small airway disease are important pathological features.Lung imaging technology can assess the patient's airway disease,and evaluate the prognosis.Chest CT examination can provide more information for early diagnosis in patients with COPD,and can objectively evaluate emphysema,small airway,pulmonary function,pulmonary blood vessels,and classify the patients into subgroup and make individual assessment of drug treatment;MRI examination can assess pulmonary microvascular blood flow (PMBF).Making full use of lung imaging examination could provide a reliable theoretical basis of the early diagnosis of COPD,disease assessment,and prognosis evaluation.This article made a review of the latest progress imaging based on the literature.