[Smoking cessation among rural populations in Beijing].

OBJECTIVE: To survey the smoking cessation among rural populations in Beijing. METHODS: One natural village in Beijing suburb was sampled and all the 1901 villagers were surveyed by face-to-face interview to collect information on smoking status and smoking cessation. The potential factors related with smoking prevalence and smoking cessation were analzyed. RESULTS: The response rate was 91.2%. The ever-smoking rate was 35.8%. Among the 621 ever-smokers, 35.5% had tried or were trying to quit smoking. The vast majority (93.9%) of smoking cessation methods was self-service method. The overall rate of abstinence was 12.4%, and the success rate was higher in those groups of elder age, lower educational level, lower income level, having respiratory symptoms, and/or without nicotine dependence. There were 291 responders (46.9%) had the willingness to quit. Responders at older age, having respiratory symptoms, or with nicotine dependence had higher willingness to quit. CONCLUSIONS: The tobacco control efforts in rural areas should be strengthened. In part of motivated intervention, the advice should be given from the family, friends, doctors to young, asymptomatic smokers.

[Clinical characteristic analysis of 96 cases of hypersensitivity pneumonitis].

OBJECTIVE: To improve understanding of the clinical characteristics and diagnosis of hypersensitivity pneumonitis (HP). METHODS: We retrospectively analyzed the clinical data, including clinical symptoms, laboratory tests, exposure, pulmonary function tests, chest CT imaging and cytological classification of bronchoalveolar lavage (BAL) of 96 patients with HP from Jan 2001 to Jun 2011 in Peking Union Medical College Hospital. We divided the patients into 2 groups: a pathologically-confirmed group and a clinically-suspected group. RESULTS: There were 58 females and 41 males. The median age at the diagnosis was 53 years. The most common exposures were low-molecular-weight chemicals (42.7%) and animal proteins (37.5%). Common clinical symptoms included dyspnea on exertion (90.6%) and cough (76.0%). Pulmonary function test showed diffusion abnormality (73.5%) and restrictive ventilatory impairment (59.7%). Chest CT scan revealed patchy or diffuse bilateral ground-glass opacities (64.6%), centrilobular nodules (21.9%), and air trapping (15.6%). Reticulation (45.8%), traction bronchiectasis (21.9%) and honeycombing(9.4%) were present in chronic HP. BAL lymphocyte counts > 0.2 and CD4/CD8 < 0.9 were more commonly seen in patients with a disease course of less than 1 year. The pathologically-confirmed group and the clinically-suspected group shared many similar characteristics including age at diagnosis, gender, clinical manifestation, pulmonary function impairments and imaging findings, but significant differences existed in certain parameters. In the pathologically- confirmed group, the duration of disease was longer (24 months vs 6 months, Z = -2.492, P = 0.013) and clubbed fingers were more common (23.4% vs 8.2%, χ(2) = 4.227, P = 0.040). Diffusion abnormality was present in more patients of this group (90.7% vs 44.0%, χ(2) = 35.219, P < 0.01). By CT scan, reticulation, traction bronchiectasis and honeycombing (57.5% vs 26.5%, χ(2) = 9.434, P < 0.01) were more evident as compared to the clinically-suspected group. The value of transbronchial lung biopsy for diagnosing HP was limited, with a positive result of only 8.2%. Surgical lung biopsy was needed in uncertain cases. CONCLUSION: The diagnosis of HP was difficult. In some cases a clinical diagnosis can be made by combination of history of exposure, CT manifestations and cell classification of BAL. For atypical cases a multi-disciplinary approach including pathologists, radiologists and pulmonologists is needed.

[Clinical features of thymic neuroendocrine carcinoma: analysis of 21 cases].

OBJECTIVE: To improve the understanding of thymic neuroendocrine carcinoma (TNC) by retrospective analysis of the clinical data of 21 cases. METHODS: The clinical data of 21 patients with TNC treated in the Peking Union Medical College Hospital from 1998 to 2010 were retrospectively analyzed. RESULTS: There were 12 males and 9 females, with onset age ranging from 13 to 67 years and the mean age of 43 years. The clinical manifestation was diverse, in which the malaise of chest and back accounted for 57.1% (12/21), Cushing's syndrome 33.3% (7/21), multiple endocrine neoplasia type 1 accounted for 4.8% (1/21), pharyngeal malaise 4.8%, superior vena cava syndrome 4.8% (1/21) and asymptomatic patients accounted for 4.8% (1/21). Eighteen of them demonstrated metastasis, in which 13 had metastasis to lymph nodes and local vascular invasion, 9 to lung or pleura, 5 to bone, 1 to liver and 1 was recurred in situ. Twenty of them were treated by surgical resection. Eleven of them received radiotherapy and 9 chemotherapy after surgery. One patient was too severe to endure surgery, and was a treated by chemotherapy only. CONCLUSION: TNC is rare, and its clinical features are complex, with a high level of malignancy. The first choice of treatment is resection. Adjuvant radiotherapy and/or chemotherapy may be applied in patients with metastasis.

[The in-vitro effects of arbidol hydrochloride against 2009 new influenza virus A (H1N1)].

OBJECTIVE: To detect the in-vitro effects of arbidol hydrochloride against 2009 new influenza virus A (H1N1). METHODS: The activity of arbidol hydrochloride against 2009 new influenza virus A (H1N1) was determined in MDCK cell cultures. Hemagglutination assay, observation of cytopathic effects, RT-PCR and quantitative RT-PCR tests were performed for determination of virus titers. Inhibition concentration 50% and cytotoxic concentration 50% were calculated with Chou's Menu of Dose-Effect Program. RESULTS: Arbidol hydrochloride showed low cytotoxicity (cytotoxic concentration 50%>100 µmol/L)and significant anti-2009 new influenza virus A (H1N1) activity in cell cultures. Inhibition concentration 50% were (5.5 ± 0.9), (3.4 ± 0.8), and (1.5 ± 0.2) µmol/L in hemagglutination assay, cytopathic effect test, and quantitative RT-PCR assay, respectively. CONCLUSION: Arbidol has low cytotoxicity and high anti-virus activity and can effectively trigger the activities of interferon and immune response, and therefore can be a valuable anti-influenza virus drug.

[Clinical analysis of 25 cases of allergic granulomatous vasculitis].

OBJECTIVE: To improve the understanding of allergic granulomatous vasculitis, also called Churg-Strauss syndrome (CSS). METHODS: The clinical data, including clinical manifestations, laboratory findings, and pathology, of 25 patients with CSS were retrospectively investigated. RESULTS: There were 15 males and 10 females, aging 18 to 72 years (mean 45 ± 16). The clinical manifestations of CSS featured involvement of multiple systems or organs including respiratory system, nervous system, skin, digestive system, heart, and kidney. Eighty percent (20/25) of CSS patients had asthma as their first symptom, whereas 96.0% (24/25) had asthma in the whole course of CSS. The involvement of nasosinusitis of CSS was multi-group and the maxillary sinuses were the most frequently involved, which accounted for 61.1% (11/18). The peripheral nerves were involved in 72.7% (16/22) of patients and the most common manifestation was cerebrovascular event. Skin disease occurred in 60.0% (15/25), whereas heart involvement in 48.0% (12/25), renal involvement in 48.0% (12/25) and digestive system involvement in 32.0% (8/25) of the patients. The positive rate of IgE was 90.0% (18/20), and that of ANCA was 32.0% (8/25), with P-ANCA as the predominant. The main presentation of chest CT scan was patchy infiltration, mostly bilateral, which amounted for 71.4% (15/21). The change in electromyography was mononeuritis multiplex, of which the peroneal nerves and popliteal nerves were the most frequently involved. Electrocardiography of the CSS patients was always normal whereas the echocardiograms showed abnormal finds in 70.0% (14/20) of the patients. The pathological manifestations were necrotizing vasculitis, eosinophilic tissue infiltration, and extravascular granulomas. CONCLUSION: The clinical manifestations of CSS are diverse and complex, with a lack of pathognomonic symptoms. Clinical manifestations, auxiliary examinations and pathology are often required to make a diagnosis. Early diagnosis and treatment will be helpful for a better prognosis.

[The diagnostic value of CT-guided percutaneous needle lung biopsy in diffuse parenchymal lung diseases].

OBJECTIVE: This study was to evaluate the efficacy and limitation of CT-guided percutaneous cutting needle lung biopsy in the diagnosis of diffuse parenchymal lung diseases (DPLD). METHODS: A total of 481 patients admitted in Peking Union Medical College Hospital from January 2000 to December 2008 underwent CT-guided percutaneous cutting needle lung biopsy. The patients were evaluated by clinical history, physical examination and lung HRCT. Those with localized opacity or lesions in a single lung in the CT scan were excluded. Finally, 248 patients with DPLD in HRCT were enrolled for this study. RESULTS: The study patients included 114 males and 134 females, and the mean (± SD) age at diagnosis was 50 ± 16 (range from 13 - 78) years. Confirmed diagnosis by percutaneous needle lung biopsy was obtained in 130 patients (52.4%), including pulmonary infection (35.4%, 46/130), pulmonary malignant diseases (25.4%, 33/130), bronchiolitis obliterans organizing pneumonia/organizing pneumonia (22.3%, 29/130), pulmonary vasculitis (6.2%, 8/130), granulomatous lesions (4.6%, 6/130), pulmonary sarcoidosis (2.3%, 3/130), acute interstitial pneumonia (1.5%, 2/130), pulmonary amyloidosis (1.5%, 2/130), and pulmonary alveolar proteinosis (0.8%, 1/130). Open lung biopsy/video-assisted thoracoscopic surgery was performed in 37 out of 118 cases for which the diagnosis was undetermined by percutaneous lung biopsy. Confirmed diagnosis was obtained in 36 patients, including non-specific interstitial pneumonia (NSIP, 33.3%, 12/36), usual interstitial pneumonia (UIP, 8.3%, 3/36), pulmonary infection (16.7%, 6/36), neoplasm (8.3%, 3/36), lymphoid interstitial pneumonia, pulmonary vasculitis (5.6% 2/36), hypersensitivity pneumonitis (5.6%, 2/36), and pulmonary sarcoidosis, allergic bronchopulmonary aspergillosis, pulmonary hyalinizing granuloma, pneumoconiosis, Castleman's disease, and lymphoproliferative disorder (1 case respectively). CONCLUSION: CT-guided percutaneous cutting needle lung biopsy can provide confirmed diagnosis in half of patients with DPLD, and has a high diagnostic yield in patients with infectious or neoplastic diseases, but it is not a good method for diagnosis of interstitial lung diseases such as NSIP and UIP.

[Evaluation of clinical significance of chronic obstructive pulmonary disease assessment test].

OBJECTIVE: To determine the reliability and validity of the COPD assessment test (CAT) Chinese version in patients with chronic obstructive pulmonary disease (COPD), and to study its value in evaluating quality of life in Chinese patients. METHODS: One hundred and thirty-five patients with COPD in stable condition from Peking Union Medical College Hospital were assessed by interview with CAT Chinese version, and underwent pulmonary function test on the same day. The validity was documented by performing correlation analysis, and Pearson's correlation coefficients were calculated. The stages of COPD determined by CAT score and lung function were compared to observe the value of CAT in determining disease severity. RESULTS: Cronbach's alpha of CAT Chinese version was 0.805. CAT score increased with the severity of the disease, and was negatively correlated to FEV(1)% of predicted (r = -0.567, P < 0.01). CAT score varied significantly in patients (10 ± 5, 16 ± 6, 21 ± 7 and 23 ± 6), with different severity of COPD (χ(2) = 48.437, P < 0.01). There was a high degree of consistency between the stages of COPD determined by CAT score and lung function. CONCLUSIONS: The Chinese version of the CAT had good internal consistency reliability and validity, and can be used to assess the quality of life for Chinese COPD patients. It provided a simple, valid and standardized measurement of COPD health status.

The St. George's Respiratory Questionnaire in lymphangioleiomyomatosis.

OBJECTIVE: To examine the correlation between the health-related quality of life measured by the St. George's Respiratory Questionnaire (SGRQ) and the commonly used physiological measures in lymphangioleiomyomatosis (LAM). METHODS: This study retrospectively analyzed the SGRQ scores and other measures (the Borg scale of breathlessness at rest, 6-minute walking distance, blood oxygen levels, and pulmonary function) of patients diagnosed and confirmed with LAM. Altogether 38 patients between June 2007 and November 2009 were included. RESULTS: The mean values of the SGRQ three components (symptoms, activity, and impacts) and total scores in the LAM patients were 46.95 +/- 28.90, 58.47 +/- 25.41, 47.89 +/- 29.66, and 51.11 +/- 26.35, respectively. The SGRQ total or component scores were correlated well with the Borg scale of breathlessness, 6-minute walking distance, partial pressure of oxygen in arterial blood, spirometry and diffusion capacity of lung. There were poor correlations between SGRQ score and residual volume or total lung capacity. In our preliminary observation, sirolimus improved the SGRQ total and three component scores and the Borg scale of breathlessness significantly after 101-200 days of treatment (n = 6). CONCLUSIONS: The SGRQ score in LAM is correlated well with physiological measures (Borg scale of breathlessness, 6-minute walking distance, blood oxygen levels, and pulmonary function tests). The SGRQ could therefore be recommended in baseline and follow-up evaluation of patients with LAM. Treatment with sirolimus, an inhibitor of mammalian target of rapamycin, may improve the quality of life and patient's perception of breathlessness in LAM.

[A new health-related quality of life questionnaires-chronic obstructive pulmonary disease assessment test].

Chronic obstructive pulmonary disease (COPD) is a major public health problem with high prevalence and mortality. A simple and effective tool for COPD assessment is urgently needed in clinical practice. The COPD Assessment Test is a newly developed questionnaire for assessing and monitoring COPD. This simple, highly sensitive, and highly reliable in assessing the patients quality of life and providing information concerning the severity of disease, and therefore can be widely applied.

[Role of glucocorticoid receptor and nuclear factor-kappaB in patients with stable chronic obstructive pulmonary disease].

OBJECTIVE: To explore the expressions of glucocorticoid receptor (GCR) and nuclear factor-kappaB (NF-kappaB) in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: Bronchial biopsies and blood specimens were obtained from 8 smokers with stable COPD (COPD group) and 8 nonsmokers with normal lung function (control group). The expressions of NF-kappaB and GCR in nucleus protein of bronchial biopsies and peripheral blood lymphocyte from these two groups were examined by Western blot. RESULTS: The expressions of GCR in nuclear protein of peripheral blood lymphocyte and the bronchial biopsies, especially in bronchi, were significantly lower in COPD group than in control group (P<0.05, P <0.01). Also, the expressions of NF-kappaB in nuclear proteins of the bronchial biopsies and peripheral blood lymphocyte were significantly higher in COPD group than in control group (P<0.05). The expressions of NF-kappaB and GCR were significantly higher in bronchial biopsies than in peripheral blood lymphocyte in both groups (P<0.05, P<0.01). CONCLUSION: Chronic inflammation, especially airway inflammation, still exists in patients with stable COPD, as suggested by the different expressions of GCR and NF-kappaB between COPD patients and normal controls.

[Combined pulmonary fibrosis and emphysema syndrome].

OBJECTIVE: To retrospectively analyze clinical presentations, pulmonary function parameters and radiological appearance in patients with combined pulmonary fibrosis and emphysema (CPFE) syndrome. METHODS: We reviewed the clinical features, imaging, and lung function indices from 8 patients diagnosed with CPFE according to the findings by high resolution computerized tomography (HRCT) since 2006 to 2009 at Peking Union Medical College Hospital. RESULTS: All patients were male, aged 65 (59 - 75) years, and 7 of them were smokers. Dyspnea on exertion was presented in 7 patients. Basal crackles were heard in 6 patients and finger clubbing was observed in 4 patients. Pulmonary function demonstrated that forced expiratory volume in one second/forced vital capacity (FEV1/FVC) was slightly lower with a median of 76% (range 60% to 86%), forced vital capacity (FVC) was 73% (51% - 92%), and total lung capacity (TLC) was 80% (59% - 114%). However, carbon monoxide diffusion capacity (D(L)CO) was significantly impaired (44%, 16% - 65%). HRCT findings included emphysema predominantly at the upper zone, while reticular opacities, honeycombing and traction bronchiectasis were in the lower lobes. Pulmonary hypertension was seen in 6 patients. CONCLUSIONS: The co-existence of lower lung fibrosis and upper lung emphysema was found in some smokers. Patients with CPFE syndrome can present with a normal or nearly normal lung volume but a remarkable impairment in gas exchange. A high prevalence of pulmonary hypertension is seen in CPFE syndrome. Further studies to elucidate the pathogenesis and to explore the treatment and prognosis are warranted.

[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.

[The results of transbronchial needle aspiration in 164 cases with enlarged mediastinal and/or hilar lymph nodes].

OBJECTIVE: To evaluate the role of transbronchial needle aspiration (TBNA) in the diagnosis of patients with enlarged mediastinal and/or hilar lymph node. METHODS: Patients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported. All specimens were directly and instantly smeared for pathological examination. RESULTS: From June 1 2004 to December 31 2007, 164 patients were examined: including 80 lung cancers, 69 lung benign diseases, 2 other malignancy tumor, and 13 without definite diagnosis. Total 260 lymph nodes were punctured. TBNA procedures were successfully carried out in 445/463 (96.1%). Sensitivity of TBNA was 82.5% (66/80) in patients who had been proven to suffer from bronchogenic carcinoma. There were 25 patients that diagnosis of lung cancer was pathologically determined by TBNA only. A total of 122 lymph nodes in the 80 lung cancer patients were aspirated by TBNA with a positive rate of 65.6% (80/122). Severe complications were rare except small amount of bleeding at the TBNA site (100/164, 61.0%). From June 1 2006 to December 31 2007, lymph node tissues able to make histology diagnosis were yield in 73.5% (64/87) patients. Through histology pathology, the sensitivities of TBNA were 53.3% (8/15) for sarcoidosis and 78.6% (33/42) for lung cancer. CONCLUSION: TBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, and in diagnosis of benign lung diseases.

[Characteristics of vibration response imaging in chronic obstructive pulmonary disease].

OBJECTIVE: To explore the characteristics of vibration response imaging (VRI) in chronic obstructive pulmonary disease (COPD). METHODS: Sixty-three COPD patients received lung function test (LFT) and VRI examination before and after inhalation of bronchodilator. As the control group, 66 healthy volunteers received LFT and VRI examinations. We defined VRI results as quantitative lung data (QLD), crack counts, and image grade. RESULTS: The results of control group were: QLD of right lung (45.1 +/- 5.9%), mean crack counts 0.1, and mean image grade 0.9. After inhalation of bronchodilator, the VRI results of COPD group were: QLD of right lung (51.0 +/- 12.1)%, mean crack counts 2.7, and image grade 4.2 +/- 1.9. The results between control group and COPD group were significantly different (P < 0.01). The VRI results were similar before and after inhalation of bronchodilator in COPD group (P > 0.05). After inhalation of bronchodilator, there was a linear relationship between VRI image grade and FEV1% (r = 0.31, P = 0.01). The model of the linear regression was: y = 63.85 -2.95 x (y: 100 x FEV1%, x: VRI image grade). CONCLUSIONS: The VRI results differ between COPD patients and healthy people. The VRI results are stable after inhalation of bronchodilator in COPD patients, which may be helpful in the diagnosis of COPD. The VRI image grade after inhalation of bronchodilator is useful to assess the degree of obstruction.

[Exploration of vibration response imaging in evaluating airway resistance of asthmatics].

OBJECTIVE: To explore the value of vibration response imaging (VRI) system in evaluating airway resistance of asthmatics. METHODS: The asthmatic group had 64 patients with a FEV1 of (56 +/- 18)% predicted before bronchodilator, and a FEV1 of (69 +/- 18)% predicted after bronchodilator. The control group had 20 patients with COPD with a FEV1 of (64 +/- 17)% predicted before bronchodilator, and a FEV1 of (66 +/- 19)% predicted after bronchodilator. All patients underwent VRI examination in close proximity of each spirometric recording before and after bronchodilator. VRI outcomes were evaluated to determine whether the VRI technology could detect changes in airway resistance in asthmatics. The statistical analysis in comparison between VRI outcomes before and after bronchodilator was performed using a matched pairs signed rank test. Linear regression was used to describe the relation between the improvements of VRI parameters and the increase in FEV1. ROC curve was used to evaluate the accuracy of this examination. RESULTS: After bronchodilator, VRI outcomes including flow graph characteristics, dynamic appearance, shape of the maximal energy frame and rale counts had significant improvements after bronchodilator (M = 7.5, 14.5, 12.5, 7.5, respectively, all P<0.05). Outcomes in the control group showed no significant improvements (M = 0.5, 2.0, 0.5, 1.0, respectively, all P>0.05). y = 0.12784 + 0.06767x1 + 0.04723x2 + 0.04919x3 + 0.00391x4 was the model of the linear regression between improvements of VRI parameters (x1, x2, x3, x4) and the observed changes in FEV1 (y), F = 10.16, P<0.01. According to the bronchodilation test, the sensitivity was 81.3%, and the specificity was 55.0%. The area under the ROC curve was 0.704. CONCLUSION: VRI outcomes including graph characteristics, dynamic appearance, shape of the MEF and rale counts may be a promising method to evaluate changes of airway resistance in asthmatics.

[Costs of the last hospitalization for patients with acute exacerbation of chronic obstructive pulmonary disease and patients with lung cancer].

OBJECTIVE: To examine the cost for patients who died in hospital with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) compared with those died with lung cancer, and to examine their variations. METHODS: A retrospective cohort study was performed. The patients who died in hospital between January in 2003 and December in 2007 were enrolled. Statistical analysis was performed using the SPSS 13.0. RESULTS: Totally 416 patients were enrolled, with 86 COPD patients and 330 lung cancer patients. Patients with COPD were older than those with lung cancer. The incidences of co-morbidities such as coronary artery disease, hypertension, cerebrovascular disease, respiratory failure and lung infection in AECOPD patients were higher than those in lung cancer patients. Second malignant neoplasm of important organs was found in 211 patients (63.94%) with lung cancer. In the last hospitalization, the total amount of direct medical costs was higher for patients with AECOPD than for patients with lung cancer [74 143 (102 608) RMB vs 37 810 (51 374) RMB], z = 2.48, P < 0.05, especially for the treatment cost [(19 324 (61 843) vs 5876 (9764), z = 4.55, P < 0.01] and the laboratory cost [7976 (18 397) vs 3397 (4096), z = 5.97, P < 0.01]. There was no significant difference in the constituents of the cost between COPD and lung cancer patients (chi(2) = 8.23, P > 0.05). The percentage of the drug cost to the total cost was the highest, followed by the treatment cost and the auxiliary examination cost. The ratio of the drug cost to the total cost was lower in COPD patients (37.2 +/- 12.6)% vs (53.8 +/- 17.6)%, t = 7.34, P < 0.01, while the constituent ratio of treatment cost was higher in COPD than in lung cancer patients CONCLUSIONS: There was significant variability in healthcare resource utilization between COPD and lung cancer patients in their last hospitalization of life, the main reason of which was the increased costs of maintenance of life.

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).

[The diagnostic value of transbronchial lung biopsy in diffuse parenchymal lung diseases].

OBJECTIVE: This study was to evaluate the efficacy and limitations of transbronchial lung biopsy (TBLB) in the diagnosis of diffuse parenchymal lung diseases (DPLD). METHODS: TBLB was performed in 416 patients with diffuse lung diseases from January 2001 to October 2006 in Peking Union Medical College Hospital. The results of clinical data and pathologic diagnosis were retrospectively analyzed. RESULTS: Confirmed diagnosis by TBLB was obtained in 124 patients, the total positive diagnostic rate was 29.8%. The diseases included pulmonary sarcoidosis (52/124, 41.9%), bronchiolitis obliterans organizing pneumonia/organizing pneumonia (BOOP/OP) (28/124, 22.6%), pulmonary alveolar proteinosis (19/124, 15.3%), lung cancer (12/124, 9.7%), pulmonary vasculitis (5/124, 4.0%), pulmonary tuberculosis (3/124, 2.4%), and pneumocystis carinii pneumonia, lung fungal infection, lymphangiomyomatosis, and pulmonary amyloidosis (each 1/124, 0.8%). Open lung or thoracoscopic biopsy was performed in 104 cases in whom the diagnosis was undetermined by TBLB. Confirmed diagnosis was obtained in 109 patients, including nonspecific interstitial pneumonia (37/104, 37.7%), usual interstitial pneumonia (18/104, 18.4%), pulmonary sarcoidosis (11/104, 11.2%), BOOP/OP (6/104, 6.1%), and lung cancer (5/104, 5.1%). CONCLUSIONS: Pathologic diagnosis can be obtained by TBLB in about 30% of the cases with DPLD, and therefore it should be considered to be a routine diagnostic procedure before open lung or thoracoscopic biopsy.

[A clinical analysis of 23 cases of allergic bronchopulmonary aspergillosis].

OBJECTIVE: To describe the clinical characteristics of allergic bronchopulmonary aspergillosis (ABPA). METHODS: The clinical presentations, serologic results, lung function data, chest radiology and the results of treatment of 23 patients with ABPA in Peking Union Medical College Hospital were retrospectively analyzed. RESULTS: There were 11 males and 12 females, with a mean age of (34.0 +/- 13.2) yrs. Tuberculosis, pneumonia, lung cancer and Wegener's granulomatosis were initially diagnosed in 12, 3, 2 and 1 cases respectively. Cough was present in all patients and sputum production in 22 cases, wheeze in 18, sputum plugs in 16, fever in 15 (high degree of fever in 4), hemoptysis in 12, chest pain/backache in 8 and weight loss in 7 cases. Forced expired volume in one second (FEV(1)) was (54.7 +/- 24.1)% predicted, and FEV(1)/forced vital capacity (FVC) was (62.5 +/- 11.9)%. The FEV(1) reversibility was found in 56% (9/16) of the patients. Chest CT were performed in 22 cases. Patchy infiltrations were present in 21, central bronchiectasis in 17, nodular opacities in 9, mucoid impaction (glover-finger/band linear opacities) in 6, consolidation in 5, and mediastinal adenopathy in 11 cases, while 17 cases presented fleeting infiltrations. Twenty-two patients were treated with prednisone plus itraconazole and 17 patients were followed. The median follow up time was 26.2 months (13 days -19 years). Pulmonary infiltrations relapsed in 9 patients and not appeared for more than 6 years in only one patient. CONCLUSIONS: ABPA was mostly misdiagnosed as tuberculosis. Wheeze is present in almost all patients with ABPA, which can be useful in differentiation from tuberculosis. Obstructive ventilatory defect, peripheral blood eosinophilia, fleeting pulmonary infiltration and central bronchiectasis were features of ABPA. Measurement of total IgE, A.fumigatus-specific IgE levels and immediate cutaneous reaction to A.fumigatus are helpful for confirmation of the diagnosis.