Taipei consensus on integrative traditional Chinese and Western Medicine.

BACKGROUND: Traditional Chinese medicine and western medicine have coexisted since 1958 in Taiwan. Integrative traditional Chinese and western medicine (TC&WM) remains to be studied and promoted. In response to the documentary report of WHO Traditional Medicine Strategy 2002-2005, the present study was planned and carried out. METHODS: During 2004-2008, 19 integrative TC&WM dialogue forums were held, in which 219 TC&WM scholars and professionals participated by invitation. The proceedings of the forums in Chinese were published. A study team was organized in 2009 to collect the consensus opinions, utilizing a Delphi method. The opinions collected were discussed in an international TC&WM forum held on November 1, 2014. RESULTS: The opinions of TC&WM experts and professionals on the integrative issues and values were quite divergent. Of the 39 integrative issues, 34 (87.8%) reached consensus, agreeing that WM is excellent in the diagnosis and treatment of diseases/disorders, yet is still evolving, and not perfect without defects. TCM is patient-centered, wellness-oriented, inadequate for acute, critical and life-threatening diseases, but has a complementary and alternative role to WM. Of the 44 diseases/disorders, 36 (81.8%) reached consensus, worthy for integrative clinical use or trials. CONCLUSIONS: Integrative TC&WM, combining the best features of two systems, could be a most useful and advanced healthcare medicine in the future, requiring development of regulations and guidelines for the use of TCM and more rigorous efforts have to be made in clinical trials.

Ventilatory function of progressive massive fibrosis among bituminous coal miners in Taiwan.

Geographic and ethnic differences exist for the effects of respirable coal-mine dust on the lung function of miners. In this study, the authors compared 177 coal workers who had radiological evidence of progressive massive fibrosis (PMF) with 87 healthy male control subjects. The authors performed maximal expiratory flow volume measurements, single-breath carbon monoxide diffusing capacity (DLco) measurements, and arterial blood gas analysis on each subject. The data revealed that miners with early PMF (category A) had significantly reduced, but well-preserved, vital capacity (VC) and forced expiratory volume in 1 sec (FEV1.0), whereas FEV1.0/VC and DLco were decreased in both nonsmokers and smokers. Abnormally low (i.e., < 80% of predicted values) VC and FEV1.0, and further decreases in DLco, were observed in miners with late PMF (categories B and C). The predominant impairment patterns for workers in categories A, B, and C were obstructive, obstructive and mixed, and mixed and restrictive, respectively. Smoking increased the magnitude of airway obstruction. The authors concluded that diversity in functional impairment was present among bituminous coal miners, even among those with PMF.

Effects of inspiratory flow waveforms on lung mechanics, gas exchange, and respiratory metabolism in COPD patients during mechanical ventilation.

STUDY OBJECTIVE: The clinical usefulness of varying inspiratory flow waveforms during mechanical ventilation has not been adequately studied. The aim of this study was to compare the effects of three different respiratory waveforms on the pulmonary mechanics, gas exchange, and respiratory metabolism of ventilated patients with COPD. DESIGN: A randomized and comparative trial of consecutive patients. SETTING: Medical ICUs of a 2,000-bed university hospital. PATIENTS: Fifty-four patients with COPD were enrolled. INTERVENTIONS: Constant, decelerating, and sine waveforms were applied to each patient in a random order. MEASUREMENTS AND RESULTS: With tidal volume, inspiratory time, and inspiratory frequency being kept constant, the decelerating waveform produced statistically significant reductions of peak inspiratory pressure, mean airway resistance, physiologic dead space ventilation (VD/VT), PaCO(2), and symptom score. There was also a significant increase in alveolar-arterial oxygen pressure difference with the decelerating flow waveform, but there were no significant changes in mean airway pressure, arterial oxygenation, heart rate, mean BP, and other hemodynamic measurements. In addition, assessment on the work of breathing (WOB) revealed that ventilator WOB values were reduced with the decelerating waveform. Oxygen consumption and carbon dioxide output were virtually not affected by changing inspiratory flow waveforms. Except for VD/VT, the effects of constant square and sine waveforms were similar to each other and could not be separated statistically. CONCLUSIONS: The most favorable flow pattern for ventilated patients with COPD appeared to be the decelerating waveform. There are possibilities for the improvement of ventilation in these patients by selecting an appropriate inspiratory flow.

Bronchial responsiveness and lung function related to cigarette smoking and smoking cessation.

BACKGROUND: The relationships between bronchial responsiveness and both cigarette smoking and smoking cessation are still controversial. METHODS: To investigate the effects of cigarette smoking and smoking cessation on bronchial reactivity and the level of pulmonary function, bronchial responsiveness to methacholine using the forced oscillation method, the transfer factor, and spirometry were measured in 180 nonsmokers, 109 current smokers, and 82 ex-smokers. The following indices of bronchial responsiveness were used: (1) baseline respiratory resistance (Rrs); (2) the cumulative dose of methacholine (DA) causing an increase in Rrs by twice the baseline values (bronchial sensitivity); and (3) the slope of linearly decreased respiratory conductance (SGrs) representing bronchial reactivity. RESULTS: Current smokers had significantly higher baseline Rrs (p<0.001) and bronchial responsiveness than did nonsmokers and ex-smokers. In 24.7% of smokers, Rrs increased by twice or more upon challenge with methacholine (responders), compared with 0% of nonsmokers (p<0.0001) and 19.5% of ex-smokers (p=0.28). SGrs for responders among ex-smokers was found not to differ from that for responders among smokers. However, smokers had a significantly lower DA of inhaled methacholine than did ex-smokers. Cigarette smoking was also associated with an appreciable reduction in FEV1/FVC (forced expiratory volume in 1s/forced vital capacity), DLCO (carbon monoxide diffusing capacity), and DLCO/VA (alveolar volume). CONCLUSION: There seems to be a partially reversible phenomenon that leads to improvement in airway responsiveness and DLCO upon smoking cessation.