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.

Symptom scores of patients with chronic obstructive pulmonary disease and their response to different inhalation drug treatments / 中国医师杂志

Objective:To analyze the response of patients with chronic obstructive pulmonary disease (COPD) with multiple and few symptoms to different inhalation drugs, including acute exacerbation and symptom changes.Methods:This study was a multi center, retrospective Cohort study. The subjects of this study were patients with chronic obstructive pulmonary disease in stable stage in 12 hospitals in Hunan and Guangxi from December 2016 to February 2022. Demographics data, lung function, Chronic Obstructive Pulmonary Disease Assessment test questionnaire (CAT) score, modified British Medical Research Council dyspnea questionnaire (mMRC) score and inhalation drug scheme of patients were collected. According to the CAT and mMRC scores, patients were divided into a multi symptom group (CAT≥10 points or mMRC≥2 points) or a few symptom group (CAT<10 points and mMRC<1 point); Subsequently, they were divided into four subgroups based on the inhalation drug regimen: long-acting anticholinergic drugs (LAMA) group, long-acting β2-receptor agonists (LABA)+ inhaled corticosteroids (ICS) group, LABA+ LAMA group, and LABA+ LAMA+ ICS group. All patients were followed up for 1 year, with minimum clinical improvement (MCID) defined as a decrease of ≥2 points in the patient′s CAT score at 6 months, and clinical symptom deterioration (CSD) defined as an increase of ≥2 points in the patient′s CAT score at 6 months.Results:A total of 929 patients with chronic obstructive pulmonary disease were included, including 719(77.4%) with multiple symptoms and 210(22.6%) with few symptoms. There was no statistically significant difference in MCID, CSD, acute exacerbation, hospitalization frequency, and mortality rate among subgroups of asymptomatic COPD patients treated with different inhalation drug regimens (all P>0.05). Among patients with multiple symptoms of chronic obstructive pulmonary disease, compared to those who use LAMA or LABA+ ICS, those who used LABA+ LAMA or LABA+ LAMA+ ICS were more likely to obtain MCID and had a more significant improvement in CAT scores, and the risk of acute exacerbation is lower (all P<0.05). Conclusions:Lesser symptomatic COPD patients should receive single drug LAMA as the initial inhalation treatment drug, while multi symptomatic COPD patients should receive LABA+ LAMA as the initial inhalation treatment drug.

Clinical characteristics and guideline compliance analysis of chronic obstructive pulmonary disease patients with initial triple therapy in real-life world / 中国医师杂志

Objective:To observe the clinical characteristics and guideline compliance of chronic obstructive pulmonary disease (COPD) patients with initial triple therapy in real-life world.Methods:This study is a cross-sectional study. The subjects of the study were COPD patients admitted to 13 hospitals in Hunan Province and Guangxi Zhuang Autonomous Region from December 2016 to December 2021. The initial treatment was triple inhaled drugs. The data collected included gender, age, diagnosis, body mass index (BMI), history of acute exacerbation (AE) in the past year, pulmonary function, COPD Assessment Test (CAT) score, modified British Medical Research Council Dyspnea Questionnaire (mMRC), inhaled drugs and other indicators. The characteristics and differences of COPD patients before and after 2020 were analyzed.Results:7 184 patients with COPD were enrolled in this study, including 2 409 COPD patients treated with initial triple therapy, accounting for 33.5%(2 409/7 184). Taking January 1st, 2020 as the cut-off point, 1 825 COPD patients (75.8%) received initial treatment with triple inhaled drugs before 2020 and 584 patients (24.2%) after 2020 were included in this study. Compared with COPD patients before 2020, the COPD patients after 2020 had higher FEV 1% [(40.9±15.5 )% vs (39.3±15.5)%, P=0.040], lower CAT [(15.8±6.5)point vs (17.5±6.2)point, P<0.001], less AE in the past year [1(0, 2)times vs 1(0, 2)times, P=0.001] and higher rate of non-AE [255(43.7%) vs 581(37.1%), P=0.006]. In addition, before 2020, patients with COPD were mainly treated with open triple drugs (1 825/1 825, 100%); after 2020, 306 patients (52.4%) received open triple inhaled drugs, and 278 patients (47.6%) received closed triple inhaled drugs. Conclusions:In real-life world, most of patients with COPD treated with triple therapy have severe lung function, obvious symptoms and high risk of acute exacerbation. The real-world prescribing of triple therapy in patients with COPD does not always reflect recommendations in guidelines and strategies, and overtreatment is common. After 2020, prescribing triple therapy for COPD patients is more positive and worse consistency with guideline.

The level of fractional exhaled nitric oxide and its influencing factors in chronic obstructive pulmonary disease / 中国医师杂志

Objective:To analyze the level of fractional exhaled nitric oxide (FeNO) and its influencing factors in patients with chronic obstructive pulmonary disease (COPD).Methods:678 patients with stable COPD(COPD group), 281 patients with asthma-COPD overlap(COPD with asthma group) and 120 healthy nonsmoker controls (healthy control group) were recruited from the outpatient clinics of Xiangya Second Hospital of Central South University and the 1st People′s Hospital of Huaihua from November 2016 to December 2021. The gender, smoking status, age, height, weight, body mass index (BMI), FEV 1% predicted value (FEV 1% pred), forced expiratory volume in 1 second/forced vital capacity (FEV 1/FVC%), and FeNO value among the three groups were compared. Multiple linear regression analysis was performed to analyze the influencing factors of FeNO levels in COPD patients. Results:There was no significant difference in gender, smoking status, age, height, weight and BMI among the three groups (all P>0.05). The FEV 1% and FEV 1/FVC% in COPD group were lower than those in healthy group and COPD combined with asthma group (all P<0.05). The FeNO in COPD group was lower than that in COPD and asthma group, but higher than that in healthy group (all P<0.05). Univariate analysis showed that FeNO levels in COPD patients were associated with height, BMI, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) classification, and Chronic Obstructive Pulmonary Disease Assessment Test (CAT) score (all P<0.05). Multiple linear regression analysis showed that FeNO level was positively correlated with height ( β=0.094, P=0.014), CAT score ( β=0.129, P=0.001), and negatively correlated with BMI ( β=-0.093, P=0.016). There was no significant correlation between GOLD grading and FeNO level ( P>0.05). Conclusions:The level of FeNO in patients with COPD is higher than that in healthy subjects, which is related to height, BMI and CAT.

Clinical features of chronic obstructive pulmonary disease in women / 中国医师杂志

Objective:To investigate the risk factors, severity of symptoms, acute exacerbations, and pulmonary function in women with chronic obstructive pulmonary disease (COPD).Methods:A total of 4 204 COPD patients, including 533 female COPD patients and 3 671 male COPD patients, were investigated from January 2017 to December 2019 in Second Xiangya Hospital of Central South University, Hunan Prevention and Treatment Institute for Occupational Disease, affiliated Hospital of Guilin Medical College and Guilin Second People's hospital. The risk factors, severity of symptoms, risk of acute exacerbation and clinical characteristics of pulmonary function in patients with COPD were comprehensively analyzed.Results:There was no statistical difference in age between male and female COPD patients ( P>0.05). There were statistically significant differences in smoking history, occupational exposure history and biofuel exposure history ( P<0.001), among which smoking history and occupational exposure history were significantly higher in males than in females ( P<0.001), and exposure history of biofuels was significantly higher in females than in males ( P<0.001). The COPD assessment test (CAT) score of male and female patients was statistically different ( P<0.05), and the mean CAT score of female patients was higher than that of male patients. The modified medical research council dyspnea scale (mMRC) grading results of male and female patients were statistically different ( P<0.05), and the mMRC grading of female patients was higher than that of male patients. There was no statistical difference in the risk of acute exacerbation between male and female patients ( P>0.05). There were statistically significant differences between male and female patients in first second exertional volume as a percentage of predicted value (FEV 1%) and forced expiratory volume in one second/forced vital capacity (FEV 1/FVC) mean value ( P<0.001), and FEV 1% predicted value and FEV 1/FVC of female patients were better than that of male patients. Conclusions:The risk factors, symptom severity and pulmonary function of female patients with COPD are different from those of male patients, providing reference for the individualized treatment of female patients with COPD.

Differences of clinical features between smokers and non-smokers with chronic obstructive pulmonary disease / 中国医师杂志

Objective:To evaluate the clinical differences between smokers and non-smokers with chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 5 183 COPD patients, including 3 688 smoking COPD patients and 1 495 non-smoking patients, were collected from the respiratory and critical medicine clinics of 12 Grade-A hospitals in Hunan Province and Guangxi Zhuang Autonomous Prefecture from December 2016 to December 2019. The general condition, clinical symptoms, acute exacerbation history and pulmonary function of the two groups were compared.Results:⑴ Non-smokers were more likely to be female, to be younger and had a lower educational level ( P<0.05). There was no difference of body mass index (BMI) and marriage statue between two groups ( P>0.05). ⑵ Clinical features: the incidence of chest distress in non-smoking COPD patients was higher than that in smoking COPD patients (86.8% and 81.4%, respectively), and the incidence of asthma was also higher than that of smoking COPD patients (86.0% and 83.1%, respectively), with statistically significant difference ( P<0.05). There was no significant difference in the incidence of cough and expectoration between the two groups ( P>0.05). The COPD assessment test (CAT) score of non-smoking COPD patients was significantly higher than that of smoking group (16.2±6.4) and (15.7± 6.5) ( P<0.05). There was no significant difference in the score of dyspnea modified medical research council dyspnea scale (mMRC) and the risk of acute exacerbation between the two groups ( P>0.05). The first second exertional volume as a percentage of predicted value (FEV 1%) and forced vital capacity (FVC) of non-smoking COPD patients were higher than those of smoking COPD patients ( P<0.05). Conclusions:Compared to smokers with COPD, non-smokers more are more likely to be female and have more severe clinical symptoms.

The situation of nonsmoker COPD / 中国医师杂志

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. In addition to smoking COPD caused by cigarette smoke, the phenotype of non-smoking COPD accounts for at least 1/4. Non-smoking COPD accounts for a large proportion, especially in developing countries. Non-smoking COPD and smoking COPD should be paid equal attention. More in-depth study on the prognosis of non-smoking COPD is needed.

Correlation between inspiratory muscle strength and pulmonary ventilation function in patients with chronic obstructive pulmonary disease / 中国医师杂志

Objective To analyze the correlation between inspiratory muscle strength and pulmonary ventilation function in chronic obstructive pulmonary disease (COPD) patients.Methods A total of 41 COPD patients admitted in the Second Xiangya Hospital from January to September 2018 were screened.The inspiratory muscle strength (MIP) and peak inspiratory flow (PIF) of patients were measured by using POWER breathe K-5 tester.The MIP was also calculated as a percentage of the predicted value.A pulmonary function detector was used to measure the forced vital capacity (FVC),forced expiratory volume in 1 second (FEV1 ％),FEV1 as a percentage of FVC (FEV1/FVC％),peak expiratory flow (PEF),forced expiratory flow as a percentage of the predicted value (FEF 50％) at 50％ of vital capacity and forced expiratory flow rate as a percentage of the predicted value (FEF 75％) at 75％ of vital capacity.According to the Gobal Inistiative for chronic Obstructive Lung Disease (GOLD) classification method of COPD patients,the corresponding MIP value and PIF value of the patients were divided into 4 groups and conducted the comparison between groups.Pearson correlation was used to analyze the correlation between the above-mentioned inspiratory muscle strength test values and lung ventilation function test values,and a scatter diagram was drawn for the ones that had a correlation.Results Among the 41 patients,39 (95.1％) had a decrease in inspiratory muscle strength.According to the GOLD classification,the mean MIP value has a difference among the 4 groups.The mean MIP of grade Ⅲ was [(47.09 ± 29.42) cmH2O],which was higher than that of grade Ⅳ of [(24.72 ± 7.66) cmH2 O] (P ＜ 0.05).There was no difference between PIF.The MIP was positively correlated with FVC (P ＜0.05).There was no correlation between MIP and FEV1 ％,FEV1/FVC％,PEF,FEF50％ and FEF75％ (P ＞0.05).The MIP as a percentage of the predicted value had a weak positive correlation with FVC and FEV1％ (P ＜0.05).There was no significant correlation between MIP as a percentage of the predicted value and FEV1/FVC％,PEF,FEF50％ and FEF75％ (P ＞0.05).PIF had a weak positive correlation with FVC,PEF,FEF50％ and FEF75％,with statistically significant difference (P ＜ 0.05).There was no significant correlation between PIF and FEV1 ％ and FEV1/FVC％ (P ＞0.05).Conclusions Inspiratory muscle dysfunction was common in patients with COPD.There was a difference in MIP among different GOLD lung function classification in COPD patients.Some values of the inspiratory muscle strength and lung ventilation function had a weak-moderate correlation,while some values had no correlation.Therefore,inspiratory muscle strength test cannot replace the lung ventilation function test in COPD patients.

Pay attention to the pulmonary rehabilitation of chronic obstructive pulmonary disease / 中国医师杂志

Post-exercising tachypnea is the main manifestation of chronic obstructive pulmonary disease (COPD).Pulmonary rehabilitation,which is one of non-pharmacotherapy of COPD,can relieve dyspnea,improve exercise tolerance and health-related quality of life.At present,although the pulmonary rehabilitation is developing in China,there is a lack of more emphasis,recognition and unbalance development.Most grass-roots hospitals have not carried out the treatment.Now,there is no unified definition about the prescription of pulmonary rehabilitation for COPD patients.More studies are warranted to standardize the formulation and implementation of the pulmonary rehabilitation program.Therefore,we mainly demonstrate the pulmonary rehabilitation of COPD including assessments and trainings,in order to pay more attention to it.

Pay attention to the assessment and pulmonary rehabilitation of chronic obstructive pulmonary disease / 中国医师杂志

The assessment runs through the diagnosis,treatment and prognosis of chronic obstructive pulmonary disease (COPD).Though there are various methods of assessments,many physicians diagnose patients and prescribe medicine homogeneously according to the lung function or clinical manifestations.Therefore,it is necessary to summarize the measurements of COPD,making it be better known to clinic physicians.On the basis of these measurements,physicians can choose the suitable therapeutic schemes to treat COPD patients.In recent years,pulmonary rehabilitation is growing up gradually,which is one of treatment methods for COPD.To popularize knowledge and form complete treatments of pulmonary rehabilitation is still a long way to go,because of unbalanced development,unpopular and monotherapy in China.In order to benefit patients and improve the patients'life quality,we need to promote actively,intensify constantly and practice the pulmonary rehabilitation one by one.

An experimental study on the relationship between interleukin-18 and the pathogenesis of type 2 diabetes mellitus / 中国医师杂志

Objective To investigate the relationship between interleukin-18(IL-18)and the pathogenesis of type 2 diabetes melli-tus.Methods 72 healthy Sprague-Dawlay male rats were randomly divided into four groups, NC group,NCS group,HF group and HFS group.At the end of the 8th week,NCS group and HFS group were injected with STZ(25mg/kg)into abdominal cavity.At the end of the 10th week,diabetic rats were screened by oral glucose tolerance test(OGTT).The blood sample was collected when the rats were killed at the end of the 14th and 20th week.The levels of serum IL-18,IL-6 and tumor necrosis factor-α(TNF-α)were assayed with ELISA.Results Most rats in HFS group were achieved the diagnostic standard of diabetic rat, and their insulin sensitivity index(ISI)were decreased.At the end of the 14th week and 20th week,the levels of serum IL-18,IL-6 and TNF-α in HFS group were significantly higher than those in NC group(P＜0.01).In HFS group,the levels of serum IL-18,IL-6 and TNF-α at the end of the 20th week were higher than those at the end of the 14th week,but it had no statistic significance(P＞0.05).Pearson linear correlation analysis showed that the level of serum IL-18 in HFS group was positive correlated with FBG,IL-6,and TNF-α(r=0.90,P＜0.01 or r≥0.73,P＜0.05),and negative correlated with ISI(r=-0.86,P＜0.01).Condusions Our results show that IL-18 is related with the pathogenesis of type 2 diabetes mellitus and chronic inflammation plays an important role in the development of type 2 diabetos mellitus.