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Objective@#In most countries, nearly 6% of the adults are suffering from chronic obstructive pulmonary disease (COPD), which puts a huge economic burden on the society. Moreover, COPD has been considered as an independent risk factor for pulmonary embolism (PE). In this review, we summarized the existing evidence that demonstrates the associations between COPD exacerbation and PE from various aspects, including epidemiology, pathophysiological changes, risk factors, clinical features, management, and prognosis.@*Data Sources@#We searched the terms "chronic obstructive pulmonary disease," "pulmonary embolism," "exacerbations," and "thromboembolic" in PubMed database and collected the results up to April 2018. The language was limited to English.@*Study Selection@#We thoroughly examined the titles and abstracts of all studies that met our search strategy. The data from prospective studies, meta-analyses, retrospective studies, and recent reviews were selected for preparing this review.@*Results@#The prevalence of PE in patients with COPD exacerbation varied a lot among different studies, mainly due to the variations in race, sample size, study design, research setting, and enrollment criteria. Overall, whites and African Americans showed significantly higher prevalence of PE than Asian people, and the hospitalized patients showed higher prevalence of PE compared to those who were evaluated in emergency department. PE is easily overlooked in patients with COPD exacerbation due to the similar clinical symptoms. However, several factors have been identified to contribute to the increased risk of PE during COPD exacerbation. Obesity and lower limb asymmetry were described as independent predictors for PE. Moreover, due to the high risk of PE, thromboprophylaxis has been used as an important treatment for hospitalized patients with COPD exacerbation.@*Conclusions@#According to the previous studies, COPD patients with PE experienced an increased risk of death and prolonged length of hospital stay. Therefore, the thromboembolic risk in patients with acute exacerbation of COPD, especially in the hospitalized patients, should carefully be evaluated.
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Adulto , Humanos , Doença Aguda , Progressão da Doença , Prevalência , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica , Embolia Pulmonar , Estudos RetrospectivosRESUMO
OBJECTIVE:To investigate the role of clinical pharmacists on drug therapy for acute exacerbations of chronic ob-structive pulmonary disease(AECOPD)patients with benign prostatic hyperplasia(BPH). METHODS:Clinical pharmacists partici-pated in drug therapy for a AECOPD patient with BPH. According to clinical guideline and relevant literatures,based on the history of disease,the characteristics of bronchodilators and the symptoms of acute urinary retention,it was suggested to stop taking Ip-ratropium bromide solution for inhalation but receive Finasteride capsules 5 mg,po,qd,to reduce prostate volume and improve ob-struction+Terazosin hydrochloride tablets 2 mg,po,qd,to relax urethral smooth muscle;the occurrence of ADR was monitored closely. Salmeterol xinafoate and fluticasone propionate powder for inhalation was suggested and medication guidance for patients af-ter discharge was given by clinical pharmacists. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The pa-tient was stable and had no dysuria. The patient was allowed to leave the hospital with drugs. CONCLUSIONS:Rational use of bronchodilators is directly related to the remission of clinical symptoms and prognosis in AECOPD patients. In view of patient's dis-ease history,drug characteristics and clinical symptoms,clinical pharmacists point to possible risks of anticholinergics use,and as-sist physicians to formulate and adjust therapy plan so as to guarantee the safety and effectiveness of drug use.
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Objective To evaluate the safety of modified sputum induction in moderate to very severe COPD during exacerbation. Methods Ninety patients with moderate, severe or very severe COPD during exacerbation (27 with type Ⅰ and Ⅱ respiratory failure,18 with coronary heart disease, 38 with tachycardia) were chosen as research subjects. All the patients underwent induced sputum. During induction , all patients were given electrocardiographic monitoring and pulmonary function check every 5 minutes and FEV1, HR, SpO2 in the process of testing were recorded. Results Ninety patients underwent 224 sputum inductions progress, 222 were safety. Qualified sputum samples were collected for 216 times, sputum induction was successful in 96.43% of occasions. Heart rate rising and SpO2 reducing during sputum induction mainly occurred in the beginning 5 minutes, FEV1 did not change in the whole process. Conclusion Modified sputum induction can be safe through closely monitoring in patients with moderate-to-very severe COPD with exacerbation, even with type Ⅰ or typeⅡ respiratory failure. But the risk of sputum induction will increase if patients with coronary heart disease and tachyarrhythmia, especially within beginning 5 minutes of sputum induction.
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Objective To observe the clinical effect of Sangpa Zhike decoction in the treatment of acute exacerbations of chronic bronchitis. Methods 180 patients with acute exacerbation of chronic bronchitis admitted to Autonomous Prefecture Hospital of traditional Chinese medicine(TCM)in Changji,Xinjiang,from August 2012 to August 2013 were enrolled. They were divided into Sangpa Zhike decoction treatment group and western medicine treatment control group by random number table,90 cases in each group. General treatments were given to the two groups. In the Sangpa Zhike decoction treatment group,additionally only oral Sangpa Zhike decoction was given(composition:Morus alba 10 g,loquat leaf 10 g,Houttuynia 10 g,honey aster 15 g,honey coltsfoot flower 6 g,Zhejiang Fritillaria 12 g,perilla 10 g,white mustard seed 6 g,Platycodon grandiflorum 10 g,Rhizoma Cynanchi Stauntonii 12 g,tangerine peel 6 g,Stemona 6 g). The ingredients were mixed in water and boiled to form a decoction,one dose daily,divided into two parts to be taken twice a day. In the western medicine treatment group,the infection was controlled by western medicine and the drugs to eliminate cough and phlegm,etc were used. The therapeutic course in both groups was 7 days. The therapeutic effect for treatment of TCM syndromes and the cough quantized integration score in the two groups were observed after treatment. Results The cure rate of Sangpa Zhike decoction treatment group was significantly higher than that of western medicine treatment control group〔70.00%(63/90)vs. 33.33%(30/90),P<0.01〕. Before treatment,the cough symptom quantization integral scores in the two groups had no statistically significance, but after treatment,the scores in the two groups were significantly lower than those before treatment. And the score in Sangpa Zhike decoction treatment group was decreased more significantly (1.66±1.12 vs. 4.36±2.32, P<0.01). Conclusion Sangpa Zhike Decoction has obvious curative effect in the treatment of acute attack of chronic bronchitis.
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[Objective] To observe the effect of acupoint sticking at“Zusanli”(ST36) with magnolia powder on patients with acute exacerbations of chronic obstructive pulmonary disease and gastrointestinal dysfunction. [Method] A total of 78 patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) and gastrointestinal dysfunction were randomly divided into two groups: treatment group(n=40) and control group(n=38). Al patients received conventional therapy for AECOPD and tablet mosapride 5mg tid for 3 days. Patients in treatment group also received acupoint sticking at“Zu-sanli”(ST36) with magnolia powder q8h for 3 days. [Result]The total effective rate was 75.0%for treatment group,and 44.7%for control group. The total effective rate of treatment group was higher than that of control group, and no marked side effects were found. [Conclusion] Acupoint sticking at“Zusan-li”(ST36) with magnolia powder combined with mosapride can relieve gastrointestinal dysfunction of patients with AECOPD.
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Objective To analyze the thyroid hormone levels before and after treatment in the patients with chronic obstructive pulmonary disease in acute exacerbation stage (AECOPD) with respiratory failure.Methods In 40 cases of elderly AECOPD patients with respiratory failure,the thyroid hormone levels before and after the treatment were measured.At the same time,the thyroid hormone levels in another 40 agematched healthy volunteers were determined.Results In elderly AECOPD patients,serum T3,FT3,T4 and FT4were significantly lower than that of the control group:T3 ( [ 1.23 ± 0.25 ] nmol/L vs.[ 1.70 ± 0.29 ] nmol/L,t =3.97,P＜0.01),FT3( [3.27 ±0.59] pmol/L vs.[4.48 ±0.95] pmol/L,t =6.09,P ＜0.01),T4 ([ 109.3 ±17.73 ] nmol/L vs.[ 116.01 ± 18.72 ] nmol/L,t =6.94,P ＜0.01 ),FT4( [ 15.11 ±2.37] pmol/L vs.[ 17.62 ±0.35 ] pmol/L,t =7.23,P ＜ 0.01 ) ; While in the elderly AECOPD patients with respiratory failure,the T3,FT3,T4 and FT4 were lower than those patients without respiratory failure:T3 ( [ 1.08 ± 0.10 ] nmol/L vs.[ 1.35 ±0.26 ] nmol/L,t =4.02,P ＜ 0.01 ),FT3 ( [ 2.89 ± 0.41 ] pmol/L vs.[ 3.59 ± 0.53 ] pmol/L,t =4.58,P ＜0.01 ),T4 ([96.54 ± 14.34] nmol/L vs.[ 115.20 ± 26.10] nmol/L,t =2.71,P ＜ 0.01 ),FT4 ( [ 14.05 ±2.05 ] pmol/L vs.[ 17.11 ± 1.55 ] pmol/L,t =5.37,P ＜ 0.01 ).In elderly AECOPD patients,the post-treatment T3,FT3 and T4 levels were elevated compared with that before treatment.The difference was statistically significant:T3 ( [ 1.43 ± 0.29 ] nmol/L vs.[ 1.25 ± 0.25 ] nmol/L,t =2.93,P ＜ 0.01 ),FT3 ( [ 3.61 ± 0.49 ]pmol/L vs.[3.26 ± 0.60] pmol/L,t =2.73,P ＜ 0.01 ),T4 ( [ 114.31 ± 10.99] nmol/L vs.[ 110.28 ± 16.91 ]nmol/L,t =4.58.P ＜0.01).Conclusion In elderly AECOPD patients,the T3,FT3,T4 and FT4 levels are reduced and those in AECOPD patients with respiratory failure were decreased even more.Supportive treatment is able to enhance the thyroid hormone levels and improve the patients' condition.Therefore,the level of thyroid hormone in elderly AECOPD patients is useful to predict the patient's condition and prognosis.
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BACKGROUND: Early withdrawal of invasive mechanical ventilation (IMV) followed by noninvasive MV (NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with acute respiratory failure (ARF). Using pulmonary infection control window (PIC window) as the switch point for transferring from invasive to noninvasive MV, the time for early extubation can be more accurately judged, and therapy efficacy can be improved. This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy (FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV. METHODS: Since July 2006 to January 2011, 106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization. Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used (group A, n=54) or not (group B, n=52) during sequential weaning from invasive to noninvasive MV. In group A, for sputum suction and bronchoalveolar lavage (BAL), a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube, which was accompanied with uninterrupted use of a ventilator. After achieving PIC window, patients of both groups changed to NIMV mode, and weaned from ventilation. The fol owing listed indices were used to compare between the groups after treatment: 1) the occurrence time of PIC, the duration of MV, the length of ICU stay, the success rate of weaning from MV for the first time, the rate of reventilation and the occurrence rate of ventilator-associated pneumonia (VAP); 2) the convenience and safety of FOB manipulation. The results were compared using Student's t test and the Chi-square test. RESULTS: The occurrence time of PIC was (5.01±1.49) d, (5.87±1.87) d in groups A and B, respectively (P<0.05); the duration of MV was (6.98±1.84) d, (8.69±2.41) d in groups A and B, respectively (P<0.01); the length of ICU stay was (9.25±1.84) d, (11.10±2.63) d in groups A and B, respectively (P<0.01); the success rate of weaning for the first time was 96.30％, 76.92％ in groups A and B, respectively (P<0.01); the rate of reventilation was 5.56％, 19.23％ in groups A and B, respectively (P<0.05); and the occurrence rate of VAP was 3.70％, 23.07％ in groups A and B, respectively (P<0.01). Moreover, it was easy and safe to manipulate FOB, and no side effect was observed. CONCLUSIONS: The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU. It can decrease the duration of MV and the length of ICU stay, increase the success rate from weaning MV for the first time, reduce the rate of reventilation and the occurrence rate of VAP. In addition, such a method is convenient and safe in patients of this kind.
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ObjectiveTo investigate the effects of budesonide inhaled on the levels of interleukin-8 (IL-8), C-reactive protein (CRP) and procalcitonin (PCT) in bronchoalveolar lavage fluid (BALF) of patients with AECOPD treated by using inhalation of budesonide in different doses or by using injection of dexamethasone. MethodsNinety AECOPD patients with mechanical ventilation in ICU ward were enrolled from Jan. 2008 through Sep. 2010. All patients were selected in this study as per the criteria of AECOPD set by the Chinese Medical Association. Ninety AECOPD patients treated with routine therapy were randomly (random number) divided into 3 groups. The patients of group A were given budesonide 2 mg inhaled 1 time/d. The patients of group B was given budesonide 4 mg inhaled 1 time/d. The patients of group C had dexamethasone 2. 5 mg injected 1 time/12h. The changes of IL-8, PCT and CRP in both BALF and serum were respectively detected in three groups at the beginning of treatment, and 3 days and 7days after treatment. The detected data of variables were analyzed by SPSS 13.0 package. ResultsThe level of IL-8 in BALF declined in 3days and 7days after treatment, and the magnitude of decrease in the following order:Group B ( budesonide 4mg/d) ＞ Group A ( budesonide 2 mg/d) ＞ Group C ( intravenous dexamethasone)with significant differences among them ( P ＜ 0. 05 ). The decrease in IL-8 in serum showed the similar trend, but there were no statistical differences among them. The CRP and PCT in both BALF and serum had no significant changes. There was a correlation between the concentration of IL-8 in BALF and the duration of mechanical ventilation.Conclusions The treatment with the inhalation of budesonide could more significantly reduced the IL-8 level in BALF compared with intravenous dexamethasone, whereas the CRP and PCT were not changed. The dynamic changes of IL-8 in BALF might be used as an indicator of prognosis in AECOPD patients with mechanical ventilation.
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Acute exacerbations of COPD (AECOPD) are associated with decline of FEV1 and health related quality of life. Our aim was to evaluate the short-term effects of AECOPD on several functional and clinical indices in a cohort of 60 ex-smokers patients with COPD. During a 6-month follow up, 40 patients experienced one exacerbation (Group 1), mainly moderate, evaluated 30 days after by measuring BMI, dyspnea, FVC, FEV1, inspiratory capacity (IC), Sp02, six-min walking distance (6MWD), BODE index and quality of life (SGRQ). Values were compared with those measured at recruitment in stable conditions and with those obtained in the 20 patients without AECOPD during a similar period (Group 2). Baseline values were similar in both groups. Group 1 showed a significant worsening in FVC, FEV1, Sp02, BMI, 6MWD, and BODE index. Improvement in SGRQ and BODE was found in group 2. Significant differences in changes between groups were found for all variables, except IC and Sp02. The most noteworthy differences were found for BODE index (p = 0.001) and SGRQ (p = 0.004). Results demonstrate that moderate AECOPD produces significant short term functional and clinical impairment in ex-smokers COPD.
Las exacerbaciones de la EPOC deterioran el FEV1y la calidad de vida. Nuestro objetivo fue evaluar el efecto a corto plazo de las exacerbaciones sobre otros índices funcionales y clínicos. Sesenta pacientes ex fumadores con EPOC fueron seguidos durante 6 meses. Cuarenta presentaron una exacerbación (Grupo 1), generalmente moderada, estudiada 30 días después. los 20 pacientes no exacerbados constituyeron el grupo control (Grupo 2). Se midió IMC, disnea, CVF, FEV1h capacidad inspiratoria (CI), SpO2, caminata en 6 min (C6M), índice BODE y calidad de vida (SGRQ). En condiciones basales no hubo diferencias entre grupos. El grupo 1 empeoró CVF, VEF1, SpO2, IMC, C6M e índice BODE, sin cambios de CI ni SGRQ. El grupo 2 no presentó deterioro, mejorando SGRQ y BODE. Al comparar ambos grupos, hubo diferencias significativas en los cambios de todas las variables, excepto Cly SpO2, siendo estas diferencias más notorias en el índice BODE (p = 0,001) y SGRQ (p = 0,004). En suma, las exacerbaciones de la EPOC producen deterioro clínico y funcional significativo en el corto plazo.
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Humanos , Masculino , Feminino , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Índice de Gravidade de Doença , Progressão da Doença , Índice de Massa Corporal , Caminhada/fisiologia , Capacidade Vital/fisiologia , Dispneia/fisiopatologia , Seguimentos , Volume Expiratório Forçado , Qualidade de Vida , Abandono do Hábito de Fumar , Espirometria , Tolerância ao Exercício/fisiologiaRESUMO
OBJECTIVE To study the effects of levofloxacin on QT correction dispersion(QTcd) interval in elderly patients hospitalized with acute exacerbations of COPD(AECOPD).METHODS Totally 124 patients received IV levofloxacin(500 mg qd) for 10-14 days.Evaluations included of 12-lead ECGs at baseline and blood examination before treatment,day 5 and after treatment.RESULTS QT correction(QTc) interval was no significant changes,but the QTcd interval was with significant prolongation.CONCLUSIONS IV levofloxacin could not cause QTc interval prolongation,but could make QTcd interval prolongation,which is a potential risk of arrhythmia in elderly patients with AECOPD.
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Chronic obstructive pulmonary disease is a common stubborn respiratory disease(COPD);it belongs to "lung-distension" in Chinese medicine.The author believes that its pathogenesis should be considered from clinical characteristics,in all COPD stages,according to the specific characteristics of the symptoms,listed several therapies:warming lung for dispelling cold,dispersing lung qi and clearing heat,benefiting qi for warming yang,eliminating phlegm and removing blood stasis,so as to improve the symptoms of patients with COPD.The author used Xiaoqinglong decoction,Buzhongyiqi decoction,Buyuan decoction,Gleditsia pills,Juanxiao decoction,Mahuang Xingren Shigao decoction combined with Mengshi Guntan pills,Mahuangfuzixixin decoction combined with Linguizhugan decoction to treat COPD in all phases.For example,the six cases about acute exacerbations and stable period had improved apparently.Treatment is basically to determine root vacuity and tip repletion,intermingled deficiency and excess.
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BACKGROUND: LB20304(gemifloxacin) is a new fluoroquinolone antibacterial agent with excellent activity against both Gram-negative and Gram-positive organisms. In vitro studies using clinical isolates have shown gemifloxacin to be highly active against penicillin-resistant strains of S. pneumoniae and in contrast to other reference quinolones, gemifloxacin retained good activity against clinical isolates of S. pneumoniae that were resistant to other members of the quinolone class. Therefore, gemifloxacin is thought to be effective in treating acute bacterial exacerbation of chronic bronchitis(AECB). The objective of this study was to evaluate the efficacy and safety of oral gemifloxacin at doses of 160mg or 320mg once daily for 7 days for the treatment of AECB in Korean adult population. METHODS: This was a randomized, multicenter, double-blind, parallel group Phase II study to assess the clinical and antibacterial efficacy and safety of oral gemifloxacin for the treatment of AECB. Treatment Group A (67 patients) took oral gemifloxacin 160mg once daily for seven days and treatment Group B (70 patients) took oral gemifloxacin 320mg once daily for seven days. RESULTS: The demographic profiles of the two treatment groups were similar. The clinical response at follow-up was 84.2% in the gemifloxacin 160-mg group, and 88.7% in the gemifloxacin-320 mg group, showing no statistically significant difference between two treatment groups(p=0.49). The clinical response at the end of therapy was 96.5% in the 160-mg group, and 96.4% in the 320-mg group. The bacteriological response at the end of therapy and follow-up were 81.8% and 78.9%, respectively, in the 160-mg group, and 86.4% and 84.2%, respectively, in the 320-mg group, showing no statistically significant difference between two treatment groups(p=0.68 and 0.68, respectively). S. pneumoniae(12 isolates) and H. influenzae(10 isolates) were the most prevalent pathogens. The MICs were lower for gemifloxacin than other quinolones against these key pathogens, and for S. pneumoniae, the MICs for gemifloxacin were considerably lower(< or = 0.03 ug/mL) than those for other quinolones, beta-lactams and acrolides. In the period on-therapy plus 30 days post-therapy, a total of 18 patients(26.9%) in the gemifloxacin 160mg group and 22 patients(31.4%) in the 320mg group reported at least one adverse event(AE). The most frequently reported AE was abdominal pain(3/67 patients, 4.5%) in the gemifloxacin 160mg group and increased level of hepatic enzyme(5/70 patients, 7.1%) in the 320mg group. The overall AE profiles for the two treatment groups were similar. Two out of 67 patients(3.0%) in the gemifloxacin 160mg group and 1/70 patients(1.4%) in the 320mg group reported at least one serious AE, however, none of which was considered by the investigator to be of suspected or probable relationship to study medication. CONCLUSION: The results of this study showed that gemifloxacin at doses of 160mg or 320mg once daily for 7 days in the treatment of acute exacerbations of chronic bronchitis(AECB) in adult Koreans was a very effective and safe treatment both clinically and bacteriologically.
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Adulto , Humanos , beta-Lactamas , Bronquite Crônica , Método Duplo-Cego , Seguimentos , Mesilatos , Pneumonia , Quinolonas , PesquisadoresRESUMO
BACKGROUND: Moxifloxacin is a newly developed drug which is more potent and safe compared to previous fluoroquinolones. This drug effectively eradicates organisms such as beta-lactamase-producing or other resistant bacteria. Moxifloxacin is known to be effective in treating respiratory infections such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia pneumoniae, Legionella spp. and Mycoplasma pneumoniae. METHODS: In a multicenter, randomized, open, comparative study, the efficacy and safety of oral moxifloxacin taken 400 mg once a day and clarithromycin taken 500 mg twice daily for 7 days were compared for the treatment of Korean patients with acute exacerbations of chronic bronchitis. RESULTS: A total of 170 patients were enrolled, and they were divided into two groups:87 in the moxifloxacin group and 83 in the clarithromycin group. Of those enrolled, 76 (35 for bacteriologic efficacy) in the moxifloxacin group and 77 (31 for bacteriologic efficacy) in the clarithromycin group were included in the efficacy analysis. All were included in the safety analysis. Clinical success was noted in 70 (92.1%) of 76 moxifloxacin-treated patients and 71 (92.2%) of 77 clarithromycin-treated patients. Bacteriologic success rate seemed to be higher in moxifloxacin group (73.5%) than in clarithromycin group (54.8%), but statistically insignificant (p=0.098). Drug susceptibility among organisms initially isolated was higher in moxifloxacin group on Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae(p<0.001). Adverse events were reported by 12.8% of 86 patients receiving moxifloxacin and 21.7% of 83 patients receiveing clarithromycin. Headache (4.7% vs 4.8%, moxiflosacin group vs clarithromycin group, respectively) and indigestion (2.3% vs 6.0%, moxifloxacin group vs clarithromycin group, respectively) were the most frequent side effects in the two groups. CONCLUSION: This study demonstrated that for the treatment of acute exacerbations of chronic bronchitis a 7-days course of moxifloxacin 400 mg od was clinically equivalent and microbiologically superior to clarithromycin 500 mg bid.