Efficiency of neural respiratory drive for the assessment of bronchodilator responsiveness in patients with chronic obstructive pulmonary disease: an exploratory study.

BACKGROUND: Conventional lung function parameters, such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and inspiratory capacity (IC) are often used to assess the therapeutic outcomes of bronchodilators, but they lack sensitivity. A novel indicator, namely efficiency of neural respiratory drive (NRD), may objectively evaluate the physiological changes in patients with chronic obstructive pulmonary disease (COPD). We investigated whether this indicator could be used to more accurately assess the responsiveness to inhaled bronchodilators. METHODS: Thirty-six subjects with moderate-to-severe COPD were randomized into group A (n=18) and group B (n=18). Participants in group A inhaled 400 µg placebo, 400 µg salbutamol and 80 µg ipratropium in sequence whereas those in group B had the salbutamol and ipratropium reversed. At different time points after administration of placebo or bronchodilators, evaluated indices included FEV1, FVC, IC, root mean square (RMS) of diaphragm electromyogram (EMGdi), and efficiency of NRD [herein defined as the ratio of minute ventilation (VE) to RMS, or VE/RMS]. RESULTS: FEV1, FVC, IC, RMS, and VE/RMS significantly improved after inhaled bronchodilators and VE/RMS had the largest improvement among five indices. The detection efficiency of VE/RMS was greater than FEV1, FVC, IC (all P<0.05), but not different from RMS. The accuracy and sensitivity of VE/RMS were significantly higher than FEV1, FVC, IC, and RMS (all P<0.05). CONCLUSIONS: Efficiency of NRD may be a sensitive tool to evaluate the efficacy of inhaled bronchodilators in COPD.

Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation, and has many components including mucus hypersecretion, oxidative stress, and airway inflammation. We aimed to assess whether carbocisteine, a mucolytic agent with anti-inflammatory and antioxidation activities, could reduce the yearly exacerbation rate in patients with COPD. METHODS: We did a randomised, double-blind, placebo-controlled study of 709 patients from 22 centres in China. Participants were eligible if they were diagnosed as having COPD with a postbronchodilator forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) ratio (FEV(1)/FVC) of less than 0.7 and an FEV(1) between 25% and 79% of the predicted value, were aged between 40 and 80 years, had a history of at least two COPD exacerbations within the previous 2 years, and had remained clinically stable for over 4 weeks before the study. Patients were randomly assigned to receive 1500 mg carbocisteine or placebo per day for a year. The primary endpoint was exacerbation rate over 1 year, and analysis was by intention to treat. This trial is registered with the Japan Clinical Trials Registry (http://umin.ac.jp/ctr/index/htm) number UMIN-CRT C000000233. FINDINGS: 354 patients were assigned to the carbocisteine group and 355 to the placebo group. Numbers of exacerbations per patient per year declined significantly in the carbocisteine group compared with the placebo group (1.01 [SE 0.06] vs 1.35 [SE 0.06]), risk ratio 0.75 (95% CI 0.62-0.92, p=0.004). Non-significant interactions were found between the preventive effects and COPD severity, smoking, as well as concomitant use of inhaled corticosteroids. Carbocisteine was well tolerated. INTERPRETATION: Mucolytics, such as carbocisteine, should be recognised as a worthwhile treatment for prevention of exacerbations in Chinese patients with COPD.

Epidemiological characteristics and prevention strategies of viral hepatitis in Chongwen District of Beijing during 1997-2006 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the epidemiological features of viral hepatitis, and provide scientific evidence for developing strategies for prevention and control.</p><p><b>METHODS</b>Through descriptive epidemiological methodology, the epidemiological characteristics of 1121 viral hepatitis cases in Chongwen District (1997-2006) were studied. chi2-test was used in ratio comparison.</p><p><b>RESULTS</b>There were 1121 viral hepatitis cases occurring in the past decade, and the incidence rate was declining by year with the average of 27.10/ 100,000. Of which, the incidence rate of viral hepatitis B was the highest (13.90/ 100,000), viral hepatitis C (1.38/100,000) was the lowest. The proportion of viral hepatitis B was the highest (575, 51.29%) and viral hepatitis C (57, 5.08%) was the lowest. The incidence of viral hepatitis A, B and no-typing was declining year by year, while viral hepatitis C and E was climbing. Most viral hepatitis A and E cases occurred in Spring and Winter, and the difference of incidence rate between male and female was observed (chi2 = 188.39, P < 0.001). The findings also showed that viral hepatitis might occur in all kind of occupation, but most were workers (306, 27.3%) and officers (209, 18.64%). For the age distribution, 20 -49 years old group took the majority (749, 66.82%); and for the transmission route, blood transfusion (7.64/ 100,000) was significantly higher than fecal-oral route (3.02/ 100,000) (chi2 = 5.09, P < 0.01).</p><p><b>CONCLUSION</b>It is necessary to raise and increase the public awareness for viral hepatitis prevention and control, and enhance immunization. Moreover, effective measures should be taken to the safety of blood and blood products, and to prevent nosocomial infection.</p>