Metabolic alterations in the sera of Chinese patients with mild persistent asthma: a GC-MS-based metabolomics analysis.

AIM: To character the specific metabolomics profiles in the sera of Chinese patients with mild persistent asthma and to explore potential metabolic biomarkers. METHODS: Seventeen Chinese patients with mild persistent asthma and age- and sex-matched healthy controls were enrolled. Serum samples were collected, and serum metabolites were analyzed using GC-MS coupled with a series of multivariate statistical analyses. RESULTS: Clear intergroup separations existed between the asthmatic patients and control subjects. A list of differential metabolites and several top altered metabolic pathways were identified. The levels of succinate (an intermediate in tricarboxylic acid cycle) and inosine were highly upregulated in the asthmatic patients, suggesting a greater effort to breathe during exacerbation and hypoxic stress due to asthma. Other differential metabolites, such as 3,4-dihydroxybenzoic acid and phenylalanine, were also identified. Furthermore, the differential metabolites possessed higher values of area under the ROC curve (AUC), suggesting an excellent clinical ability for the prediction of asthma. CONCLUSION: Metabolic activity is significantly altered in the sera of Chinese patients with mild persistent asthma. The data might be helpful for identifying novel biomarkers and therapeutic targets for asthma.

High-dose N-acetylcysteine in the prevention of COPD exacerbations: rationale and design of the PANTHEON Study.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation; from a pathophysiological point of view it involves many components, including mucus hypersecretion, oxidative stress and inflammation. N-acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties. Long-term efficacy of NAC 600mg/d in COPD is controversial; a dose-effect relationship has been demonstrated, but at present it is not known whether a higher dose provides clinical benefits. The PANTHEON Study is a prospective, ICS stratified, randomized, double-blind, placebo-controlled, parallel-group, multi-center trial designed to assess the efficacy and safety of high-dose (1200 mg/daily) NAC treatment for one year in moderate-to-severe COPD patients. The primary endpoint is the annual exacerbation rate. Secondary endpoints include recurrent exacerbations hazard ratio, time to first exacerbation, as well as quality of life and pulmonary function. The hypothesis, design and methodology are described and baseline characteristics of recruited patients are presented. 1006 COPD patients (444 treated with maintenance ICS, 562 ICS naive, aged 66.27±8.76 yrs, average post-bronchodilator FEV1 48.95±11.80 of predicted) have been randomized at 34 hospitals in China. Final results of this study will provide objective data on the effects of high-dose (1200 mg/daily) long-term NAC treatment in the prevention of COPD exacerbations and other outcome variables.

[The prevalence and risk factors of bronchiectasis in residents aged 40 years old and above in seven cities in China].

OBJECTIVE: To investigate the prevalence and risk factors of bronchiectasis in urban city of China. METHODS: A cross-sectional survey was conducted in 17 urban areas in Beijing, Shanghai, Tianjin, Chongqing cities, and Guangdong, Liaoning, Shanxi provinces. In this study, urban population-based cluster samples were randomly selected from each city/province. In the selected city communities, all residents at least 40 years old were recruited, interviewed with questionnaires and tested with spirometry. Each participant was asked whether he/she was ever diagnosed as bronchiectasis by physician, whether had symptoms of respiratory diseases and possible risk factors, etc. RESULT: Data of 10 811 participants was enrolled for analysis, with a response rate of 75.4% (10 811/14 337). The overall prevalence of physician-diagnosed bronchiectasis was 1.2% (135/10 811), with 1.5% (65/4382) in male and 1.1% (70/6429) in female, without statistical difference in gender (χ² = 3.289, P = 0.070). Prevalence of bronchiectasis increased with age (χ² = 31.029, P < 0.001). There were no statistical significances in crude prevalences of bronchiectasis among cities (χ² = 10.572, P = 0.103), while there was a significant difference among cities after adjustment with confounders (Wald value = 22.116, P = 0.001), by using logistic regression analysis. Logistic regression analysis showed, bronchiectasis was significantly associated with elder ( ≥ 70 years vs 40-49 years; OR = 4.11, 95% CI 2.29-7.36), the family history of respiratory diseases (having two subjects with respiratory diseases in family vs no suffered relatives; OR = 2.04, 95% CI 1.06-3.94), respiratory infection during childhood (suffering two kinds of respiratory diseases vs never; OR = 4.89, 95% CI 2.03-11.81), exposure to coal (OR = 2.30, 95% CI 1.17-4.52), chronic pharyngitis (OR = 3.96, 95% CI 1.38-11.40) and pulmonary tuberculosis (OR = 3.07, 95% CI 1.89-4.98), heart diseases (OR = 1.64, 95% CI 1.11-2.42) and lung cancer(OR = 18.61, 95% CI 7.67-45.18). CONCLUSION: The prevalence of bronchiectasis in population aged 40 years old and above in urban area in China is high and associated with multiple factors such as age, family history of respiratory diseases, respiratory infection during childhood, exposure to coal, chronic pharyngitis, pulmonary tuberculosis, heart diseases, lung cancer and so on.

[Incidence of comorbidities in hospitalized chronic obstructive pulmonary disease patients and correlated risk factors].

OBJECTIVE: To explore the incidence of comorbidities in hospitalized chronic obstructive pulmonary disease (COPD) patients and influencing factors. METHODS: A retrospective review of medical records was performed for 495 hospitalized COPD patients in Peking University Third Hospital from January 2003 to December 2008. Their comorbidities were identified and ranked in prevalence. The risk factors of comorbidities were analyzed by multivariable Logistic regression. RESULTS: The most frequent comorbidities were: hypertension (60.0%), ischemic heart disease (16.0%), malignant tumor (10.9%), diabetes mellitus (10.5%), chronic heart failure (9.9%) and dyslipidemia (9.9%). The percentage of patients with ischemic heart disease in people with FEV(1)% Pred < 30%, 30% ≤ FEV(1)%Pred < 50%, 50% ≤ FEV(1)%Pred < 80% and FEV(1)%Pred ≥ 80% were 9.2%, 12.7%, 21.3% and 16.5% respectively (P = 0.052). The percentage of patients with dyslipidemia in people with FEV(1)%Pred < 30%, 30% ≤ FEV(1)%Pred < 50%, 50% ≤ FEV(1)%Pred < 80%, FEV(1)%Pred ≥ 80% were 5.3%, 5.7%, 10.9% and 20.3% respectively (P = 0.002). The percentage of patients with ischemic heart disease in people with body mass index (BMI) < 18.5, 18.5 - 23.9, 24.0 - 27.9, ≥ 28.0 kg/m(2) were 13.6%, 14.2%, 14.6% and 28.3% respectively (P = 0.051). The percentage of patients with dyslipidemia in people with BMI < 18.5, 18.5 - 23.9, 24.0 - 27.9, ≥ 28.0 kg/m(2) were 5.5%, 5.7%, 14.6% and 25.0% respectively (P = 0.000). The levels of C-reactive protein (CRP) were higher than the 75(th) percentile (OR = 2.371, P = 0.014), and complications with metabolic syndrome (OR = 2.694, P = 0.003) were independent risk factors of ischemic heart disease in COPD patients. CONCLUSIONS: The incidence of comorbidities varies in different COPD populations. Higher levels of CRP and complications with metabolic syndrome are independent risk factors of ischemic heart disease in COPD patients.

Involvement of endogenous hydrogen sulfide in cigarette smoke-induced changes in airway responsiveness and inflammation of rat lung.

Hydrogen sulfide (H2S), recently considered the third endogenous gaseous transmitter, may have an important role in systemic inflammation. We investigated whether endogenous H2S may be a crucial mediator in airway responsiveness and airway inflammation in a rat model of chronic exposure to cigarette smoke (CS). Rats randomly divided into control and CS-exposed groups were treated with or without sodium hydrosulfide (NaHS, donor of H2S) or propargylglycine (PPG, inhibitor of cystathionine-γ-lyase [CSE], an H2S-synthesizing enzyme) for 4-month exposure. Serum H2S level and CSE protein expression in lung tissue were higher, by 2.04- and 2.33-fold, respectively, in CS-exposed rats than in controls (P<0.05). Exogenous administration of NaHS to CS-exposed rats alleviated airway reactivity induced by acetylcholine (Ach) or potassium chloride (KCl) by 17.4% and 13.8%, respectively, decreased lung pathology score by 32.7%, inhibited IL-8 and TNF- α concentrations in lung tissue by 34.2% and 31.4%, respectively, as compared with CS-exposed rats (all P<0.05). However, blocking endogenous CSE with PPG in CS-exposed rats increased airway reactivity induced by Ach or KCl, by 24.1% and 24.5%, respectively, and aggravated lung pathology score, by 44.8%, as compared with CS-exposed rats (all P<0.01). Incubation in vitro with NaHS, 1-3 mmol/L, relaxed rat tracheal smooth muscle precontracted by Ach or KCl. However, the NaHS-induced relaxation was not blocked by glibenclamide (10⁻4 mol/L), L-NAME (10⁻4 mol/L), or ODQ (1 µmol/L) or denudation of epithelium. Endogenous H2S may have a protective role of anti-inflammation and bronchodilation in chronic CS-induced pulmonary injury.

[Change in airway anaphylatoxin-complement factors C3a of sputum in patients with chronic obstructive pulmonary disease].

OBJECTIVE: To investigate the possible role of anaphylatoxin(C3a) in chronic obstructive pulmonary disease (COPD). METHODS: Sixty-four elderly patients with COPD (including 51 males, 13 females, 31 with acute exacerbation of COPD and 33 with stable COPD) and 25 healthy controls were recruited in the study. The levels of C3a in the serum of centrifugated induced sputum and cell differential count in sendiment were determined. RESULTS: The level of C3a [44.2 (13.2-48.5) µg/L] in induced sputum in acute exacerbation of COPD was significantly higher than those in the stable COPD [5.5 (3.6-20.7) µg/L, Z=-2.974, P=0.003] and the controls [1.7 (0.1-5.9) µg/L, Z=-3.145, P=0.002]. The level of C3a in the stable COPD was higher than that in the healthy subjects, but the statistical difference was not significant. The C3a levels in smokers and non-smokers of the healthy controls were 1.97 (0.12-6.27) µg/L and 1.36 (0.09-5.57) µg/L, respectively, and had no difference (P>0.05). The level of C3a in induced sputum was positively correlated with the number of total leukocytes (r=0.543, P<0.05). CONCLUSION: C3a in induced sputum is significantly increased in COPD, and its high level correlates with the advanced stage of the disease, which suggests a possible role of C3a in the pathogenesis of COPD.

[Clinical analysis of diffusive interstitial lung diseases with positive anti-neutrophil cytoplasmic antibody].

OBJECTIVE: To explore the features of pulmonary interstitial pathological changes in diffuse interstitial lung disease (DILD) patients with positive anti-neutrophil cytoplasmic antibody (ANCA), and the similarities as well as differences between ANCA positive patients with non-primary vasculitis and primary systematic vasculitis. METHODS: Clinical data of 122 patients with DILD having ANCA examined from October 1995 to September 2008, were reviewed. Among the ANCA positive patients with non-primary vasculitis (Group A), those with primary systematic vasculitis (Group B), and the ANCA negative patients (Group C), the results of syndromes, signs, radiological manifestations, pulmonary function tests, bronchoscope examinations, bronchoalveolar lavage fluid (BALF) cytology and other laboratory examinations were compared. RESULTS: In the 122 DILD patients with ANCA results, 36 patients' ANCA (29.51%) were positive. The numbers of patients in Groups A, B, and C were 7, 29, and 86. Total lung capacity (TLC) decreased less and pleural pathological changes were more seen in Groups A and B than in Group C. Oliguria, haematuria, proteinuria, anaemia, and renal inadequacy in Group A, which were similar in Group C, appeared less than in Group B. Results of bronchoscope examination, BALF cytology, anti-nuclear antibody (ANA), and etc. were not significantly different among the three groups. CONCLUSION: In DILD patients, pulmonary interstitial changes of those with positive ANCA accompany with more pleural pathological changes and TLC decreased less than those with negative ANCA. In patients with positive ANCA, non-primary vasculitis had some similar clinical manifestations as primary systematic vasculitis, however, anaemia and renal damages were less seen in the non-primary vasculitis patients.

[Causes of chronic obstructive pulmonary disease-related death and influencing factors of survival time].

OBJECTIVE: To study the causes of chronic obstructive pulmonary disease (COPD)-related death and influencing factors of survival time from first hospitalization due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: All patients with a primary or secondary diagnosis of COPD (International Classification of Diseases (ICD)-10 Codes J40-J47) were continuously enrolled at our hospital from January 2006 to December 2008. A retrospective review was performed on the medical records of COPD patients who died during hospitalization. The causes of death were coded and analyzed according to the International Classification of Diseases (ICD)-10. The underlying causes of death were identified and ranked in order of prevalence. The medical records of first hospitalization due to AECOPD were reviewed. Retrospective analysis was performed for the clinical data. And Cox regression analysis was used to select the independent risk factors of influencing the survival time. RESULTS: Sixty-seven patients died during hospitalization. The median FEV(1) (forced expiratory volume in 1 second percentage) was 34%. The causes of death in the COPD inpatients were as follows: respiratory diseases (n = 39), cardio-cerebrovascular diseases (n = 16), malignant tumors (n = 10), diabetes mellitus (n = 1) and suicide (n = 1). Among them, 54 patients had a history of hospitalization due to AECOPD. Thirteen deceased patients were never hospitalized because of AECOPD. The mean interval between the first admission with AECOPD as the primary diagnosis and death was 38 months (range: 1 - 159). The independent risk factors of influencing the survival time were as follows: complications with coronary artery disease & severe pulmonary hypertension, age, body mass index (BMI) and serum level of C-reactive protein (CRP) (all P < 0.05). CONCLUSION: The major cause of death in moderate-severe COPD patients is respiratory disease. complicated with coronary artery disease & severe pulmonary hypertension, age, BMI and serum level of CRP are the independent risk factors of affecting the survival time from first hospitalization due to AECOPD.

[Correlation of the quality of life with the inspiratory capacity in patients with chronic obstructive pulmonary disease].

OBJECTIVE: To evaluate the correlation of the quality of life in patients with chronic obstructive pulmonary disease (COPD) with the lung function tests, especially the inspiratory capacity (IC). METHODS: Sixty-two stable COPD patients were enrolled between Jan. 2006 and Mar. 2007 (55 males and 7 females), with an age range of 43 - 79 (66 +/- 8) years. Lung volume, spirometry and small airway function measurements were performed in all patients. The St George respiratory questionnaire (SGRQ) score was collected. Pearson's correlation coefficients were calculated. RESULTS: The total score of the 62 COPD patients was 43 +/- 17. The 3 component scores were: symptoms (54 +/- 23), activity (54 +/- 19) and impact (33 +/- 20). The FEV(1) pred% was (43 +/- 13)%, FEV(1)/FVC was (52 +/- 11)%, residual volume (RV) pred% was (194 +/- 50)%, RV/total lung capacity (TLC) was (166 +/- 31)%, and IC pred% was (74 +/- 21)%. The SGRQ scores were significantly correlated with IC pred%, RV pred%, RV/TLC, FEV(1) pred%, FEV(1)/FVC and small airway function measurements (FEF(50%), FEF(25%), MMEF). The correlation coefficients between the parameters of spirometry and the total score of SGRQ were -0.336 to -0.479, while those between the parameter of small airway function and the total score of SGRQ were -0.368 to -0.411. Among all these lung function measurements, IC pred% was best correlated with the SGRQ score, and the correlation coefficients between the IC pred% and the total score and the other 3 component scores of SGRQ were -0.418 to -0.521, respectively, P < 0.05. The symptoms section score had the poorest correlation with the lung function test. CONCLUSIONS: The lung function test results correlate with the quality of life in patients with COPD. IC pred%, together with FEV(1) pred% should be used for clinical evaluation of patients with COPD.

[Attitudes and actions of chronic obstructive pulmonary disease patients on treatment:a national multi-center investigative study].

OBJECTIVE: To investigate the attitudes and actions of patients with chronic obstructive pulmonary disease (COPD) on treatment. METHODS: A nation-wide multi-center, questionnaire study was carried out to investigate the patient understanding and experience of COPD treatment between Sep. 2007 and Dec. 2008. The questionnaire included the patients' understanding of goal of COPD treatment, previous treatment, and expectation on drugs. The data were analyzed by descriptive statistical methods. RESULTS: 2072 patients with COPD in 11 centers were interviewed in the study. The final effective questionnaires were collected from 1698 cases. 653 patients had known of COPD. The attitudes and actions on treatment were analyzed based on these patients. The patients had different understanding of goals for COPD treatment, including 59.1% (384/650) for relieving symptoms. In recent 3 months, the most commonly used drugs were theophylline (53.7%, 351/653), iprotropium (39.8%, 260/653), tiotropium (27.1%, 177/653). 72.0% (465/646) patients used the drugs according to the prescriptions. There were more than 80% patients who did not understand the side effects of anti-cholinergics, ß-adrenergic agonists, inhaled steroids, inhaled steroid/long-acting ß-agonist combination therapy, or theophyllines. 37.4% (240/641) patients were afraid of side effects of inhaled steroids. 42.2% (274/650) patients often took antibiotics. There was no oxygen supply at home in 60.1% (391/651) patients. 70.5% (457/648) did not have pulmonary rehabilitation. Requirement of long-term regular treatment was considered in 77.4% (500/646) patients. The most important thing about patients' attitude on ideal drugs for COPD was drug efficacy (79.6%, 481/604). The most ideal drug used in the past was fluticasone/salmeterol or tiotropium (16.9%, 78/461). CONCLUSIONS: Patients had different attitudes and actions on COPD treatment. Patient education should be strengthened to realize treatment goals for COPD.

Endogenous hydrogen sulfide reduces airway inflammation and remodeling in a rat model of asthma.

Endogenous hydrogen sulfide (H(2)S) is hypothesized to have an important role in systemic inflammation. We investigated if endogenous H(2)S may be a crucial mediator in airway inflammation and airway remodeling in a rat model of asthma and if endogenous H(2)S may exert its anti-inflammatory effect by inhibiting inducible nitric oxide synthase (iNOS)/NO pathway. Cystathionine-gamma-lyase (CSE; a H(2)S-synthesizing enzyme) was mainly expressed in airway and vascular smooth muscle cells in rat lung tissue. Levels of endogenous H(2)S was decreased in pulmonary tissue in ovalbumin (OVA)-treated rats. Exogenous administration of NaHS alleviated airway inflammation and airway remodeling: peak expiratory flow (PEF) increased, goblet cell hyperplasia and collagen deposition score decreased, with decreased total cells recovered from bronchoalveolar fluid (BALF) and influx of eosinophils and neutrophils. The H(2)S levels of serum and lung tissue were positively correlated with PEF and negatively correlated with the level of eosinophils and neutrophils in BALF, score of lung pathology. NaHS treatment significantly attenuated pulmonary iNOS activation in OVA-treated rats. These results suggest that the CSE/H(2)S pathway plays an anti-inflammatory and anti-remodeling part in asthma pathogenesis and could be a novel target in prevention and treatment of asthma.

Serum hydrogen sulfide as a novel marker predicting bacterial involvement in patients with community-acquired lower respiratory tract infections.

BACKGROUND AND OBJECTIVE: Endogenous hydrogen sulfide (H2S) may be involved in the pathogenesis of systemic inflammation. It was investigated whether serum H2S levels differed among patients with community-acquired pneumonia, those with exacerbations of COPD or control subjects, and whether H2S may be used as a surrogate marker of the need for antibiotic treatment. METHODS: Serum H2S levels were measured in 129 patients with pneumonia or COPD exacerbations and in 72 healthy control subjects. RESULTS: The mean serum H2S concentration was 36% lower in patients with pneumonia (22.7 +/- 14.6 micromol/L) than in control subjects (35.4 +/- 5.3 micromol/L) (P < 0.01). Serum H2S concentration did not differ between patients with acute exacerbations of COPD (33.8 +/- 18.6 micromol/L) and control subjects. Within the COPD group, patients with Anthonisen type 1 exacerbations had a lower serum H(2)S concentration (22.5 +/- 11.6 micromol/L) than control subjects, and those with type 3 exacerbations had a higher serum H2S concentration (54.2 +/- 21.3 micromol/L) than control subjects. There was no difference between patients with type 2 exacerbations (41.7 +/- 8.4 micromol/L) and control subjects. In patients requiring antibiotics, serum H2S concentration was 41% lower than in those not requiring antibiotics. The area under the receiver operating characteristic curve for H(2)S as a surrogate marker of the need for antibiotics was 0.862 (95% confidence interval: 0.805-0.919, P < 0.01). Serum H2S levels were inversely correlated with serum CRP levels (r = -0.337, P < 0.01). CONCLUSIONS: Serum H2S levels may be used as a marker in lower respiratory tract infections. Further studies are required to validate the role of serum H2S levels in guiding antibiotic selection.

Clinical evaluation of oral levofloxacin 500 mg once-daily dosage for treatment of lower respiratory tract infections and urinary tract infections: a prospective multicenter study in China.

Levofloxacin (LVFX), a fluoroquinolone agent, has a broad spectrum that covers Gram-positive and -negative bacteria and atypical pathogens. It demonstrates good clinical efficacy in the treatment of various infections, including lower respiratory tract infections (LRTIs) and urinary tract infections (UTIs). To evaluate the efficacy and safety of oral LVFX 500 mg once daily, a large open-label clinical trial was conducted in 1266 patients (899 with LRTIs and 367 with UTIs) at 32 centers in China. In the per-protocol population, the clinical efficacy rate (cure or improvement) at 7 to 14 days after the end of treatment was 96.4% (666/691) for LRTIs and 95.7% (267/279) for UTIs. In 53 patients diagnosed with atypical pneumonia the treatment was effective. The bacteriological efficacy rate was 96.6% (256/265) for LRTIs and 93.3% (126/135) for UTIs. The eradication rate of the causative pathogens was 100% (33/33) for Haemophilus influenzae and 96.0% (24/25) for Streptococcus pneumoniae in LRTIs, and 94.1% (80/85) for Escherichia coli in UTIs. The overall efficacy rates were 89.3% (617/691) for LRTIs and 87.8% (245/279) for UTIs. The incidence of drug-related adverse events (ADRs) was 17.3% (215/1245), and the incidence of drug-related laboratory abnormalities was 15.7% (191/1213). Common ADRs were dizziness, nausea, and insomnia. Common laboratory abnormalities included "WBC decreased", "alanine aminotransferase (ALT) increased", "aspartate aminotransferase (AST) increased", and "lactate dehydrogenase (LDH) increased". All of these events were mentioned in the package inserts of fluoroquinolones including LVFX, and most events were mild and transient. Thirty-four patients (2.7%) were withdrawn from the study because of the ADRs. No new ADRs were found. This study concluded that the dosage regimen of LVFX 500 mg once daily was effective and tolerable for the treatment of LRTIs and UTIs.

[Current status of prevention and management of chronic obstructive pulmonary disease in rural area in China].

OBJECTIVE: To investigate the current status of prevalence, prevention and management of chronic obstructive pulmonary disease (COPD) in rural area in China. METHODS: A cross-sectional survey of COPD was conducted in Beijing city, Shanghai city, Guangdong province, Liaoning province, Tianjin city, Chongqing province and Shanxi province. A population-based cluster sample was randomly selected from each rural area. In the selected community, all residents at least 40 years old were recruited, and interviewed with a modified standardized questionnaire from the international burden of obstructive lung diseases (BOLD) study. All participants were tested with spirometry. Those with airflow limitation were performed on post-bronchodilator spirometry. The post-bronchodilator a ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) less than 70% was defined as the diagnostic criteria of COPD. RESULTS: (1) Data of 9434 participants was valid for analysis, with a valid response rate of 83.6%; the prevalence of COPD in rural was 8.8% (830/9434), 12.8% in male and 5.4% in female. (2) The percentage of smoking and the exposure to biomass smoke in rural was 43.0% (4059/9434) and 83.1% (7835/9434) respectively; cigarettes cessation rate was 17.5%; only 12.4% (502/4059) of smokers had received advice to quit smoking. (3) Among COPD patients, only 30.0% (249/830) had ever been diagnosed as COPD, bronchitis, emphysema, or asthma, 2.4% (20/830) had ever received spirometric tests, and 74.5% were current smokers; only 7.9% (50/634) COPD patients in stage two or over had received regular drug treatment. CONCLUSION: There was high prevalence and poor prevention and management for COPD in rural areas. Therefore, an enforced prevention and management for COPD are urgent.

[The quality of life of patients with chronic obstructive pulmonary disease and correlated factors].

OBJECTIVE: To evaluate the quality of life (QOL) of patients with chronic obstructive pulmonary disease (COPD) and correlated factors. METHODS: Data of 20 245 patients with COPD were collected from the cross-sectional survey of COPD, which was conducted between 2002 and 2004 in urban and rural areas of Beijing, Shanghai, Guangdong, Liaoning, Tianjin, Chongqing and Shanxi for residents aged over 40 years old. The recruited populations were interviewed with questionnaire and tested for spirometry. The quality of life was assessed with 12-item short-form health survey questionnaire (SF-12). Those with less than 70% of post-bronchodilator FEV(1)/FVC were identified as having COPD. The differences between groups in SF-12 scores converted by rank were compared using general linear model. Stepwise multiple linear regressions were conducted to study the main determinants of QOL. RESULTS: Compared to subjects without COPD, those with COPD had impaired QOL (56 +/- 7 vs. 57 +/- 6 in mental component scores, F = 4.442, P < 0.05; 46 +/- 9 vs. 50 +/- 6 in physical component scores, F = 453.960, P < 0.05). Among COPD patients, the mental component score was associated with scores of dyspnea, BMI, comorbidities, sex and living areas, while the physical component score was associated with scores of dyspnea, severity of COPD, comorbidities, exposure to dusts/gases/fumes, sex, age, educational level and previous diagnosis of respiratory diseases (all P < 0.05). CONCLUSIONS: The QOL in patients with COPD was impaired and associated with scores of dyspnea, severity of COPD, comorbidities and BMI. Improvement of dyspnea, nutritional support, prevention of comorbidities and keeping away from risk factors may improve the QOL in COPD patients.

Metabolomic Analysis of Serum Glycerophospholipid Levels in Eosinophilic and Neutrophilic Asthma.

OBJECTIVE: To compare the serum glycerophospholipid levels in the inflammatory subtypes of asthma by using targeted metabolomic analysis. METHODS: Demographic and clinical data were collected from 51 patients with asthma between January 2015 and December 2015. Routine blood and sputum induction tests were performed. Eosinophilic asthma was defined as induced sputum containing ⪖ 3% eosinophils, and neutrophilic asthma, as induced sputum containing ⪖ 71% neutrophils. Serum metabolic glycerophospholipid profile was determined by liquid chromatography-mass spectrometry. Differences in glycerophospholipid levels between eosinophilic and non-eosinophilic asthma and between neutrophilic and non-neutrophilic asthma were analyzed using partial least squares discriminant analysis. RESULTS: The serum lysophosphatidylglycerol level was significantly higher in the group with ⪖ 3% eosinophils in sputum than in the group with < 3% eosinophils in sputum. The area under the receiver-operating characteristic curve was ⪖ 70%. There was no significant difference in the serum metabolic glycerophospholipid profile between the group with sputum neutrophils ⪖ 71% and the group with sputum neutrophils < 71%. CONCLUSION: Serum lysophosphatidylglycerol is produced abundantly in eosinophilic asthma and may be a biomarker of eosinophilic asthma. This information is helpful for identifying and tailoring treatment for the common asthma subtypes.

Economic analysis in admitted patients with acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOPD and the associated factors. METHODS: A multi-center, retrospective study was conducted in the four hospitals in Beijing including two level III hospitals and two level II hospitals. Patients with AECOPD admitted to the hospitals between January and December in 2006 were enrolled. The hospitalization cost and its relationship with disease severity and treatment were analyzed. RESULTS: Totally 439 patients were enrolled with 294 men (67.0%) and a mean age 73.4 years. The mean hospital stay was 20.7 days. A total of 204 patients (46.5%) had respiratory failure, 153 (34.9%) with cor pulmonale, 123 (28.0%) with coronary artery disease, 231 (52.6%) with hypertension, 70 (15.9%) with cerebrovascular disease and 32 (7.3%) with renal failure. The percentage of drug cost to total cost was the highest (71.2%), followed by laboratory cost (16.7%), therapy cost (9.7%), oxygen cost (7.3%), radiology cost (4.5%), examination cost (4.5%), bed cost (4.1%). Correlation analysis showed that cost was positively correlated with age, hospitalization days, co-morbidities such as respiratory failure and cor pulmonale, hypertension. Three hundred and twenty-one patients were further analyzed. The hospitalization cost increased in patients with non-invasive ventilation (P < 0.01), invasive mechanical ventilation (P < 0.01), ICU stay (P < 0.01), antibiotics (P < 0.05), systemic steroids (P < 0.01), and poor prognosis (P < 0.05). Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second (FEV(1)%) (r = -0.149, P < 0.05), pH (r = -0.258, P < 0.01), and PaO(2) (r = -0.131, P < 0.05), positively correlated with PaCO2 (r = 0.319, P < 0.01), non-invasive positive pressure ventilation (r = 0.375, P < 0.01) and duration (r = 0.463, P < 0.01), invasive mechanical ventilation (r = 0.416, P < 0.01) and duration (r = 0.511, P < 0.01), ICU stay (r = 0.390, P < 0.01) and duration (r = 0.650, P < 0.01), antibiotics (r = 0.140, P < 0.05) and systemic steroids (r = 0.202, P < 0.01). CONCLUSIONS: AECOPD had a great impact on healthcare resources utilization. Disease severity, use of non-invasive or invasive ventilation, ICU stay and usage of antibiotics and systemic steroids were the major determinants of hospitalization cost. Long-term regular treatment aimed at reducing the frequency of acute exacerbation will lower the social and economic burden of chronic obstructive pulmonary disease (COPD).

[Plasma level of endogenous hydrogen sulfide in patients with acute asthma].

OBJECTIVE: To investigate the role of endogenous hydrogen sulfide (H2S) in patients with asthma. METHODS: Levels of serum H2S, lung function and cell differential count in induced sputum were studied in 44 patients with acute exacerbation of asthma, 33 patients with stable asthma and 12 health subjects. Of the 33 patients with stable asthma, 3 failed to achieve induced sputum. RESULTS: The serum H2S level was (75.2+/-13.0) micromol/L in controls (12 cases), (55.8+/-13.6) micromol/L in patients with stable asthma (33 cases), (57.8+/-6.3) micromol/L in patients with mild of acute exacerbation asthma (9 cases), (40.8+/-5.1) micromol/L in that with moderate of acute exacerbation asthma (13 cases), and (31.3+/-2.9) micromol/L in that with severe of acute exacerbation asthma (22 cases, F = 44.592, P < 0.01). The level of serum H2S was significantly lower in smokers (45.4+/-19.5) micromol/L as compared with nonsmokers (52.7+/- 16.0) micromol/L (F = 4.804, P < 0.05). Status of the subjects (in good health, stable asthma, and exacerbation of asthma) was positively correlated with H2S in serum (r = 0.712, P < 0.01). H2S in serum was positively correlated with FEV1.0 % (r = 0.877, P < 0.01) and the percentage of sputum macrophages (r = 0.791, P < 0.01); and it was negatively correlated with count of sputum cells (r = -0.348, P < 0.01) and the percentage of sputumneutrophils (r = -0.906, P < 0. 01). CONCLUSION: Endogenous H2S may be involved in the pathogenesis of airway obstruction in asthma and may be a noninvasive marker of disease activity and severity.

[Patient' s perspective of chronic obstructive pulmonary disease in Yanqing county of Beijing].

OBJECTIVE: To evaluate the patients' comprehension, recognition and burden of COPD in the rural area of Beijing. METHODS: Of the 1624 people aged more than 40 in 5 villages in Yanqing county of Beijing, 148 were diagnosed to have COPD. Patients' comprehension of the disease and COPD control, the medication use, the impact of quality of life, and the experience of exacerbations of COPD were evaluated. RESULTS: According to the GOLD standards the disease classification was 23.6% (35/148), 49.3% (73/148), 23.0% (34/148) and 4.1% (6/148) respectively in stage I, stage II, stage III and stage IV COPD. None of the 148 COPD patients had ever heard the term COPD, and none of them had been diagnosed COPD. Lung function tests and health education had never been performed for these patients. Only 4.1% (6/148) of the patients in stable stage took theophylline irregularly. None of the stable COPD patients took inhalers regularly or temporally. No oxygen therapy and pulmonary rehabilitation were done in those patients. During acute exacerbation, only 6.8% (10/148) took theophylline and 6.8% (10/148) had antibiotics. Only 3.4% (5/148) of the patients had been admitted to hospital during the past year. For the general health status, 4.1% (6/148) was excellent, 20.9% (31/148) very good, 26.4% (39/148) good, 27.7% (41/148) ordinary, 20.9% (31/148) poor. 47.3% (70/148) of the patients had limitation of activity. 25.0% (37/148) had feelings of depression sometimes and 25.7% (38/148) had some impacts no their social activity. CONCLUSION: Patients have a poor understanding of COPD in the rural area in Beijing. The management of both stable and exacerbation of COPD was inadequate. COPD appears to have a significant impact on patient activities of daily living and mood. Health education should play an important role in the management of COPD.