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1.
Fisioter. Pesqui. (Online) ; 28(2): 145-150, abr.-jun. 2021. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1339912

ABSTRACT

RESUMO A doença pulmonar obstrutiva crônica (DPOC) é altamente limitante, tanto nos aspectos físicos, quanto socioemocionais, causando dificuldades significativas no cotidiano dos pacientes. Além de afetar os pacientes, a DPOC também influência na vida dos familiares e amigos próximos, pois deles vem a rede de apoio de que os pacientes necessitam. O objetivo deste artigo é avaliar a funcionalidade da família no cotidiano de pacientes acometidos por DPOC. É um estudo transversal que avaliou a funcionalidade de família de pacientes com DPOC em diferentes estágios da doença e que realizam Programa Reabilitação Cardiorrespiratória (PRC). Utilizou-se o instrumento APGAR de Família, sendo este, um acrônimo caracterizado por A = (Adaptation/Adaptação), P = (Partnership/Companheirismo), G = (Grow/Desenvolvimento), A = (Affection/Afetividade), R = (Resolve/Capacidade resolutiva), composto por 5 questões avaliadas em "sempre", "algumas vezes" e "nunca", o que somados resultam em "elevada disfunção familiar", moderada disfunção familiar" e "boa funcionalidade familiar". Foram avaliados 21 pacientes DPOC [sexo masculino (n=11; 52,3%); idade média 66,3±10 anos], com estadiamento entre moderado a muito severo. Através do APGAR da Família identificamos 2 pacientes com elevada disfunção familiar; 2 pacientes com moderada disfunção familiar; 17 pacientes com boa funcionalidade familiar. Dos que relataram elevada e moderada disfunção familiar, os acrômios mais comprometidos foram "companheirismo", "afetividade" e "desenvolvimentos". O grau de obstrução das vias áreas associou-se moderada e positivamente com a funcionalidade da família (r = 0,697; p = 0,004). Pacientes com DPOC participantes do PRC apresentaram boa funcionalidade familiar no seu cotidiano e a gravidade da doença esteve associada a esta funcionalidade. Pacientes que apresentaram maior disfunção familiar relataram falta de "companheirismo", "afetividade" e "desenvolvimentos".


RESUMEN La enfermedad pulmonar obstructiva crónica (EPOC) es muy limitante, tanto en aspectos físicos como socioemocionales, causando dificultades significativas en la vida diaria de los pacientes. Además de afectar a los pacientes, la EPOC también influye en la vida de los familiares y amigos cercanos, ya que de ellos proviene la red de apoyo que los pacientes necesitan. El objetivo de este artículo es evaluar la funcionalidad de la familia en la vida cotidiana de los pacientes afectados por EPOC. Se trata de un estudio transversal que evaluó la funcionalidad familiar de pacientes con EPOC en diferentes etapas de la enfermedad y que realizan un Programa de Rehabilitación Cardiaca (PRC). Se utilizó el instrumento APGAR familiar, que es un acrónimo caracterizado por A = (Adaptation/Adaptación), P = (Partnership/Compañerismo), G = (Grow/Desarrollo), A = (Affection/Afectividad), R = (Resolve/Capacidad de resolución), compuesto por 5 preguntas evaluadas en "siempre", "a veces" y "nunca", que combinadas resultan en "disfunción familiar severa", "disfunción familiar moderada" y "buena funcionalidad familiar". Se evaluaron 21 pacientes con EPOC [sexo masculino (n=11; 52,3%); edad media 66,3±10 años], con una estadificación que varía de moderada a muy grave. A través del APGAR familiar identificamos 2 pacientes con severa disfunción familiar; 2 pacientes con disfunción familiar moderada; 17 pacientes con buena funcionalidad familiar. De los que relataron disfunción familiar severa y moderada, los acrónimos más comprometidos fueron "compañerismo", "afectividad" y "desarrollo". El grado de obstrucción de las vías se asoció moderada y positivamente con la funcionalidad de la familia (r=0,697; p=0,004). Los pacientes con EPOC que participaron en el PCR presentaron una buena funcionalidad familiar en su vida diaria y la gravedad de la enfermedad se asoció a esta funcionalidad. Los pacientes que presentaron mayor disfunción familiar relataron falta de "compañerismo", "afectividad" y "desarrollo".


ABSTRACT Background: Chronic Obstructive Pulmonary Disease (COPD) is highly limiting, both physically and socio-emotionally, causing significant difficulties in the daily lives of patients. In addition, COPD also influences the lives of family and friends, because theirs who come to the support network that patient need. Objective: To evaluate the family functionality in the daily life of COPD patients. Methods: This cross-sectional study evaluated the family functionality in COPD patients with different stages of disease and underwent Cardiorespiratory Rehabilitation Program (CRP). The Family APGAR instrument was used and it is an acronym characterized by A = (Adaptation / Adaptation), P = (Partnership / Companionship), G = (Grow / Development), A = (Affection / Affectivity), R = (Resolve / Resolving capacity), composed of 5 questions assessed in "always", "sometimes" and "never", which together result in "high family dysfunction", moderate family dysfunction "and" good family functionality". We evaluated 21 COPD patients [male gender (n = 11; 52.3%); mean age 66.3 ± 10 years], status disease between moderate to very severe. Through of the Family APGAR we identified 2 patients with high family dysfunction; 2 patients with moderate family dysfunction; 17 patients with good family functionality. Among those who reported high and moderate family dysfunction, the most compromised acromia's were "companionship", "affection" and "developments". The degree of airway obstruction was moderately and positively associated with family functionality (r = 0.697; p = 0.004). Patients with COPD who participated in CRP had good family functionality in their daily lives and the severity of the disease was associated with this functionality. Patients with high family dysfunction reported lack of "companionship", "affection" and "developments".

3.
Arq. bras. cardiol ; 116(2): 295-302, fev. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1152994

ABSTRACT

Resumo Fundamento O padrão pressórico não-dipper é definido por uma redução inferior a 10% na pressão arterial noturna e está associado a doenças cardiovasculares. Acredita-se que a inflamação desempenhe um papel na patogênese da doença pulmonar obstrutiva crônica (DPOC) e no padrão pressórico não-dipper e ambas as doenças estão associadas a uma qualidade de vida mais baixa. Objetivo O objetivo deste estudo foi o de investigar os efeitos do padrão pressórico não-dipper em pacientes com DPOC. Métodos Foi realizado um estudo transversal incluindo 142 pacientes com DPOC. O Questionário Respiratório de Saint George e a Escala de Qualidade de Vida Euro foram utilizados para a coleta de dados. Para entender a rigidez arterial, o índice de aumento e a velocidade da onda de pulso foram medidos; subsequentemente, foi realizada a monitorização ambulatorial da pressão arterial de 24 horas. Foi aplicado um modelo de regressão logística multivariável para entender a relação entre as diferentes variáveis independentes e o padrão pressórico. Foram considerados estatisticamente significativos valores de p inferiores a 0,05. Resultados Como resultado, 76,1% (n = 108) dos pacientes apresentaram o padrão pressórico não-dipper. Os pacientes com padrão não-dipper apresentaram valores mais altos de proteína C reativa (OR: 1,123; IC 95%: 1,016;1,242), índice de aumento (OR: 1,057; IC 95%: 1,011;1,105) e pontuação total no Questionário Respiratório de Saint George (OR: 1,021; IC 95%: 1,001;1,042), em comparação com os pacientes com padrão dipper. Adicionalmente, com o aumento do número de pessoas que habitavam o domicílio, verificou-se que o padrão pressórico não-dipper era mais frequente (OR: 1,339; IC 95%:1,009;1,777). Conclusão O padrão pressórico não-dipper pode aumentar o risco cardiovascular ao desencadear a inflamação e pode afetar adversamente o prognóstico da DPOC diminuindo a qualidade de vida relacionada à doença. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Non-dipper blood pressure is defined by less than a 10% reduction in nighttime blood pressure, and it is associated with cardiovascular disease. Inflammation is thought to play a role in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and non-dipper blood pressure pattern, and both diseases are associated with lower quality of life. Objective The aim of this study was to investigate the effects of non-dipper blood pressure pattern in patients with COPD. Methods A cross-sectional study was carried out with 142 patients with COPD. The Saint George Respiratory Questionnaire and the Euro Quality of Life Scale were used to collect data. To understand arterial stiffness, the augmentation index and pulse wave velocity were measured, and 24-hour ambulatory blood pressure monitoring was subsequently performed. A multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. P values lower than 0.05 were considered statistically significant. Results As a result, 76.1% (n = 108) of the patients had non-dipper blood pressure pattern. Non-dipper patients had higher C-reactive protein (OR:1.123; 95% CI:1.016;1.242), augmentation index (OR: 1.057; 95% CI: 1.011;1.105) and Saint George Respiratory Questionnaire total score (OR: 1.021; 95% CI: 1.001;1.042) than dipper patients. Also, as the number of people living at home increased, non-dipper blood pressure pattern was found to be more frequent (OR: 1.339; 95% CI: 1.009;1.777). Conclusion Non-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive , Hypertension , Quality of Life , Blood Pressure , Cross-Sectional Studies , Circadian Rhythm , Blood Pressure Monitoring, Ambulatory , Pulse Wave Analysis
4.
Arq. bras. cardiol ; 116(2): 259-265, fev. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1152999

ABSTRACT

Resumo Fundamento A dispneia por esforço é uma queixa comum de pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) e doença pulmonar obstrutiva crônica (DPOC). A ICFEP é comum na DPOC e é um fator de risco independente para a progressão e exacerbação da doença. A detecção precoce, portanto, tem grande relevância clínica. Objetivos O objetivo deste estudo foi detectar a frequência de ICFEP mascarada em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular manifesta, e analisar a correlação entre ICFEP mascarada e os parâmetros do teste cardiopulmonar de exercício (TCPE). Métodos Aplicamos o TCPE em 104 pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. A ecocardiografia foi realizada antes e no pico do TCPE. Os valores de corte para disfunção diastólica ventricular esquerda e direita induzida por estresse (DDVE/DDVD) foram E/e' >15; E/e' >6, respectivamente. A análise de correlação foi feita entre os parâmetros do TCPE e o estresse E/d'. Valor de p<0,05 foi considerado significativo. Resultados 64% dos pacientes tinham DDVE induzida por estresse; 78% tinham DDVD induzida por estresse. Ambos os grupos com estresse DDVE e DDVD obtiveram carga menor, V'O2 e pulso de O2 mais baixos, além de apresentarem redução na eficiência ventilatória (maiores inclinações de VE/VCO2). Nenhum dos parâmetros do TCPE foram correlacionados com E/e' DDVE/DDVD induzida por estresse. Conclusão Há uma alta prevalência de disfunção diastólica induzida por estresse em pacientes com DPOC não grave com dispneia aos esforços, sem doença cardiovascular evidente. Nenhum dos parâmetros do TCPE se correlaciona com E/e' induzida por estresse. Isso demanda a realização de Ecocardiografia sob estresse por exercício (EES) e TCPE para detecção precoce e manejo adequado da ICFEP mascarada nesta população. (Arq Bras Cardiol. 2021; 116(2):259-265)


Abstract Background Exertional dyspnea is a common complaint of patients with heart failure with preserved ejection fraction (HFpEF) and chronic obstructive pulmonary disease (COPD). HFpEF is common in COPD and is an independent risk factor for disease progression and exacerbation. Early detection, therefore, has great clinical relevance. Objectives The aim of the study is to detect the frequency of masked HFpEF in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease, and to analyze the correlation between masked HFpEF and the cardiopulmonary exercise testing (CPET) parameters. Methods We applied the CPET in 104 non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. Echocardiography was performed before and at peak CPET. Cut-off values for stress-induced left and right ventricular diastolic dysfunction (LVDD/ RVDD) were E/e'>15; E/e'>6, respectively. Correlation analysis was done between CPET parameters and stress E/e'. A p-value <0.05 was considered significant. Results 64% of the patients had stress-induced LVDD; 78% had stress-induced RVDD. Both groups with stress LVDD and RVDD achieved lower load, lower V'O2 and O2-pulse, besides showing reduced ventilatory efficiency (higher VE/VCO2 slopes). None of the CPET parameters were correlated to stress-induced left or right E/e'. Conclusion There is a high prevalence of stress-induced diastolic dysfunction in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. None of the CPET parameters correlates to stress-induced E/e'. This demands the performance of Exercise stress echocardiography (ESE) and CPET for the early detection and proper management of masked HFpEF in this population. (Arq Bras Cardiol. 2021; 116(2):259-265)


Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Heart Failure/diagnostic imaging , Stroke Volume , Exercise Tolerance , Echocardiography, Stress
5.
J. bras. pneumol ; 47(3): e20200371, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250212

ABSTRACT

ABSTRACT Objective: To test the reliability, validity, and interpretability of the Brazilian version of the Clinical COPD Questionnaire (CCQ) in patients with COPD. Methods: Fifty patients with COPD completed the CCQ by interview on two occasions. At the first visit, the CCQ was administered twice, by two different raters, approximately 10 min apart; the patients also underwent spirometry and were administered the COPD Assessment Test, the modified Medical Research Council scale, and Saint George's Respiratory Questionnaire (SGRQ). At the second visit (1-2 weeks later), the CCQ was readministered. We tested the hypothesis that the CCQ total score would correlate positively with the total and domain SGRQ scores (r ≥ 0.5). Results: Of the 50 patients, 30 (60%) were male. The mean age was 66 ± 8 years, and the mean FEV1 was 44.7 ± 17.9% of the predicted value. For all CCQ items, Cronbach's alpha coefficient (95% CI) was 0.93 (0.91-0.96). To analyze the interrater reliability and test-retest reliability of the CCQ, we calculated the two-way mixed effects model/single measure type intraclass correlation coefficient (0.97 [95% CI: 0.95-0.98] and 0.92 [95% CI: 0.86-0.95], respectively); the agreement standard error of measurement (0.65 for both); the smallest detectable change at the individual level (1.81 and 1.80, respectively) and group level (0.26 and 0.25, respectively); and the limits of agreement (−0.58 to 0.82 and −1.14 to 1.33, respectively). The CCQ total score correlated positively with all SGRQ scores (r ≥ 0.70 for all). Conclusions: The Brazilian version of the CCQ showed an indeterminate measurement error, as well as satisfactory interrater/test-retest reliability and construct validity.


RESUMO Objetivo: Testar a confiabilidade, validade e interpretabilidade da versão brasileira do Clinical COPD Questionnaire (CCQ) em pacientes com DPOC. Métodos: Cinquenta pacientes com DPOC preencheram o CCQ por meio de entrevista em duas ocasiões. Na primeira visita, o CCQ foi aplicado duas vezes, por dois avaliadores, com intervalo de aproximadamente 10 min; os pacientes também foram submetidos a espirometria e aplicação do COPD Assessment Test, da escala modificada do Medical Research Council e do Saint George's Respiratory Questionnaire (SGRQ). Na segunda visita (1-2 semanas depois), o CCQ foi reaplicado. Testamos a hipótese de que a pontuação total no CCQ se correlacionaria positivamente com a pontuação total e a pontuação nos domínios do SGRQ (r ≥ 0,5). Resultados: Dos 50 pacientes, 30 (60%) eram do sexo masculino. A média de idade foi de 66 ± 8 anos, e a média do VEF1 foi de 44,7 ± 17,9% do valor previsto. Para todos os itens do CCQ, o coeficiente alfa de Cronbach (IC95%) foi de 0,93 (0,91-0,96). Para analisar a confiabilidade interavaliadores e teste-reteste do CCQ, calculamos o coeficiente de correlação intraclasse de duas vias modelo de efeitos mistos para medidas únicas (0,97 [IC95%: 0,95-0,98] e 0,92 [IC95%: 0,86-0,95], respectivamente); erro-padrão de medida do tipo concordância (0,65 para ambas); a mínima mudança detectável individual (1,81 e 1,80, respectivamente) e no grupo (0,26 e 0,25, respectivamente); e os limites de concordância (−0,58 a 0,82 e −1,14 a 1,33, respectivamente). A pontuação total no CCQ correlacionou-se positivamente com todas as pontuações no SGRQ (r ≥ 0,70 para todas). Conclusões: A versão brasileira do CCQ apresentou erro de medida indeterminado, assim como confiabilidade interavaliadores/teste-reteste e validade de construto satisfatórias.


Subject(s)
Humans , Male , Middle Aged , Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Quality of Life , Spirometry , Brazil , Surveys and Questionnaires , Reproducibility of Results
6.
J. bras. pneumol ; 47(3): e20200612, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286950

ABSTRACT

ABSTRACT Objective: Impaired respiratory mechanics and gas exchange may contribute to sleep disturbance in patients with COPD. We aimed to assess putative associations of different domains of lung function (airflow limitation, lung volumes, and gas exchange efficiency) with polysomnography (PSG)-derived parameters of sleep quality and architecture in COPD. Methods: We retrospectively assessed data from COPD 181 patients ≥ 40 years of age who underwent spirometry, plethysmography, and overnight PSG. Univariate and multivariate linear regression models predicted sleep efficiency (total sleep time/total recording time) and other PSG-derived parameters that reflect sleep quality. Results: The severity of COPD was widely distributed in the sample (post-bronchodilator FEV1 ranging from 25% to 128% of predicted): mild COPD (40.3%), moderate COPD (43.1%), and severe-very severe COPD (16.6%). PSG unveiled a high proportion of obstructive sleep apnea (64.1%) and significant nocturnal desaturation (mean pulse oximetry nadir = 82.2% ± 6.9%). After controlling for age, sex, BMI, apnea-hypopnea index, nocturnal desaturation, comorbidities, and psychotropic drug prescription, FEV1/FVC was associated with sleep efficiency (β = 25.366; R2 = 14%; p < 0.001), whereas DLCO predicted sleep onset latency (β = −0.314; R2 = 13%; p < 0.001) and rapid eye movement sleep time/total sleep time in % (β = 0.085; R2 = 15%; p = 0.001). Conclusions: Pulmonary function variables reflecting severity of airflow and gas exchange impairment, adjusted for some potential confounders, were weakly related to PSG outcomes in COPD patients. The direct contribution of the pathophysiological hallmarks of COPD to objectively measured parameters of sleep quality seems to be less important than it was previously assumed.


RESUMO Objetivo: O comprometimento da mecânica respiratória e das trocas gasosas pode contribuir para distúrbios do sono em pacientes com DPOC. Objetivamos avaliar associações putativas de diferentes domínios da função pulmonar (limitação do fluxo aéreo, volumes pulmonares e eficiência das trocas gasosas) com parâmetros da qualidade e arquitetura do sono na DPOC derivados da polissonografia (PSG). Métodos: Avaliamos retrospectivamente dados de 181 pacientes com DPOC e idade ≥ 40 anos que foram submetidos a espirometria, pletismografia e PSG de noite inteira. Modelos de regressão linear univariada e multivariada foram utilizados para avaliar a associação de variáveis de função pulmonar com a eficiência do sono (tempo total de sono/tempo total de registro) e outros parâmetros derivados da PSG que refletem a qualidade do sono. Resultados: A gravidade da DPOC foi bem distribuída na amostra (VEF1 pós-broncodilatador variando de 25% a 128% do previsto): DPOC leve (40,3%), DPOC moderada (43,1%) e DPOC grave-muito grave (16,6%). A PSG revelou uma alta frequência de apneia obstrutiva do sono (64,1%) e dessaturação noturna significativa (nadir médio da oximetria de pulso = 82,2% ± 6,9%). Após controle para idade, sexo, IMC, índice de apneia-hipopneia, dessaturação noturna, comorbidades e prescrição de psicotrópicos, a relação VEF1/CVF apresentou associação com a eficiência do sono (β = 25,366; R2 = 14%; p < 0,001), enquanto a DLCO previu a latência para o início do sono (β = −0,314; R2 = 13%; p < 0,001) e o tempo de sono rapid eye movement/tempo total de sono em % (β = 0,085; R2 = 15%; p = 0,001). Conclusões: As variáveis de função pulmonar que refletem a gravidade do comprometimento do fluxo aéreo e das trocas gasosas, ajustadas para alguns potenciais fatores de confusão, apresentaram fraca relação com os resultados da PSG nos pacientes com DPOC. A contribuição direta das características fisiopatológicas da DPOC para os parâmetros da qualidade do sono medidos objetivamente parece ser menos importante do que se supunha anteriormente.


Subject(s)
Humans , Pulmonary Disease, Chronic Obstructive , Sleep , Retrospective Studies , Polysomnography , Lung
7.
J. bras. pneumol ; 47(1): e20200267, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154684

ABSTRACT

ABSTRACT Environmental air pollution is a major risk factor for morbidity and mortality worldwide. Environmental air pollution has a direct impact on human health, being responsible for an increase in the incidence of and number of deaths due to cardiopulmonary, neoplastic, and metabolic diseases; it also contributes to global warming and the consequent climate change associated with extreme events and environmental imbalances. In this review, we present articles that show the impact that exposure to different sources and types of air pollutants has on the respiratory system; we present the acute effects—such as increases in symptoms and in the number of emergency room visits, hospitalizations, and deaths—and the chronic effects—such as increases in the incidence of asthma, COPD, and lung cancer, as well as a rapid decline in lung function. The effects of air pollution in more susceptible populations and the effects associated with physical exercise in polluted environments are also presented and discussed. Finally, we present the major studies on the subject conducted in Brazil. Health care and disease prevention services should be aware of this important risk factor in order to counsel more susceptible individuals about protective measures that can facilitate their treatment, as well as promoting the adoption of environmental measures that contribute to the reduction of such emissions.


RESUMO A poluição do ar ambiental é um dos principais fatores de risco de morbidade e mortalidade global. Ela tem impacto direto na saúde humana, sendo responsável pelo aumento de incidência e de óbitos por doenças cardiorrespiratórias, neoplásicas e metabólicas; também contribui para o aquecimento global e para as consequentes alterações do clima associadas a eventos extremos e aos desequilíbrios ambientais. Nesta revisão, apresentamos artigos que evidenciam o impacto da exposição a diferentes fontes e tipos de poluentes do ar no sistema respiratório; apresentamos os efeitos agudos — como aumento de sintomas e no número de atendimentos em serviços de emergência, internações e óbitos — e crônicos — como o aumento da incidência de asma, DPOC e câncer de pulmão, assim como o declínio acelerado da função pulmonar. Também são apresentados e discutidos os efeitos da poluição atmosférica em populações mais suscetíveis e dos efeitos associados à realização de exercícios físicos em ambientes poluídos. Por fim, apresentamos os principais estudos brasileiros sobre o assunto. Os serviços de atenção à saúde e de prevenção de doenças devem ficar atentos a esse importante fator de risco para orientar indivíduos mais suscetíveis sobre medidas de proteção que possam facilitar seu tratamento, além de estimular a adoção de medidas ambientais que contribuam para a redução dessas emissões.


Subject(s)
Humans , Asthma , Air Pollutants/adverse effects , Air Pollution/adverse effects , Respiratory System , Brazil
8.
J. bras. pneumol ; 47(1): e20200033, 2021. tab
Article in English | LILACS | ID: biblio-1134930

ABSTRACT

ABSTRACT Objective: To evaluate the frequency of asthma-COPD overlap (ACO) in patients with COPD and to compare, from a clinical, laboratory, and functional point of view, patients with and without ACO, according to different diagnostic criteria. Methods: The participants underwent evaluation by a pulmonologist, together with spirometry and blood tests. All of the patients were instructed to record their PEF twice a day. The diagnosis of ACO was based on the Proyecto Latinoamericano de Investigación en Obstrucción Pulmonar (PLATINO, Latin American Project for the Investigation of Obstructive Lung Disease) criteria, the American Thoracic Society (ATS) Roundtable criteria, and the Spanish criteria. We investigated patient histories of exacerbations and hospitalizations, after which we applied the COPD Assessment Test and the modified Medical Research Council scale, to classify risk and symptoms in accordance with the GOLD criteria. Results: Of the 51 COPD patients, 14 (27.5%), 8 (12.2%), and 18 (40.0) were diagnosed with ACO on the basis of the PLATINO, ATS Roundtable, and Spanish criteria, respectively. The values for pre-bronchodilator FVC, post-bronchodilator FVC, and pre-bronchodilator FEV1 were significantly lower among the patients with ACO than among those with COPD only (1.9 ± 0.4 L vs. 2.4 ± 0.7 L, 2.1 ± 0.5 L vs. 2.5 ± 0.8 L, and 1.0 ± 0.3 L vs. 1.3 ± 0.5 L, respectively). When the Spanish criteria were applied, IgE levels were significantly higher among the patients with ACO than among those with COPD only (363.7 ± 525.9 kU/L vs. 58.2 ± 81.6 kU/L). A history of asthma was more common among the patients with ACO (p < 0.001 for all criteria). Conclusions: In our sample, patients with ACO were more likely to report previous episodes of asthma and had worse lung function than did those with COPD only. The ATS Roundtable criteria appear to be the most judicious, although concordance was greatest between the PLATINO and the Spanish criteria.


RESUMO Objetivo: Avaliar a frequência de asthma-COPD overlap (ACO, sobreposição asma-DPOC) em pacientes com DPOC e comparar, do ponto de vista clínico, laboratorial e funcional, os pacientes com e sem essa sobreposição conforme diferentes critérios diagnósticos. Métodos: Os participantes foram submetidos à avaliação com pneumologista, espirometria e exame sanguíneo, sendo orientados a manter o registro do PFE duas vezes ao dia. O diagnóstico de ACO deu-se através dos critérios Projeto Latino-Americano de Investigação em Obstrução Pulmonar (PLATINO), American Thoracic Society (ATS) Roundtable e Espanhol. Foram investigados os históricos de exacerbações e hospitalizações e aplicados os instrumentos COPD Assessment Test e escala Medical Research Council modificada, utilizados para a classificação de risco e sintomas da GOLD. Resultados: Entre os 51 pacientes com DPOC, 14 (27,5%), 8 (12,2%) e 18 (40,0) foram diagnosticados com ACO segundo os critérios PLATINO, ATS Roundtable e Espanhol, respectivamente. Pacientes com sobreposição significativamente apresentaram pior CVF pré-broncodilatador (1,9 ± 0,4 L vs. 2,4 ± 0,7 L), CVF pós-broncodilatador (2,1 ± 0,5 L vs. 2,5 ± 0,8 L) e VEF1 pré-broncodilatador (1,0 ± 0,3 L vs. 1,3 ± 0,5 L) quando comparados a pacientes com DPOC. Os níveis de IgE foram significativamente mais elevados em pacientes com sobreposição diagnosticados pelo critério Espanhol (363,7 ± 525,9 kU/L vs. 58,2 ± 81,6 kU/L). O histórico de asma foi mais frequente em pacientes com a sobreposição (p < 0,001 para todos os critérios). Conclusões: Nesta amostra, pacientes com ACO relataram asma prévia com maior frequência e possuíam pior função pulmonar quando comparados a pacientes com DPOC. O critério ATS Roundtable aparenta ser o mais criterioso em sua definição, enquanto os critérios PLATINO e Espanhol apresentaram maior concordância entre si.


Subject(s)
Humans , Asthma/complications , Asthma/diagnosis , Asthma/epidemiology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Spirometry , Forced Expiratory Volume , Hospitalization , Laboratories
9.
J. bras. pneumol ; 47(6): e20210124, 2021. tab, graf
Article in English | LILACS | ID: biblio-1356421

ABSTRACT

ABSTRACT Objective: The identification of persistent airway obstruction is key to making a diagnosis of COPD. The GOLD guidelines suggest a fixed criterion-a post-bronchodilator FEV1/FVC ratio < 70%-to define obstruction, although other guidelines suggest that a post-bronchodilator FEV1/FVC ratio < the lower limit of normal (LLN) is the most accurate criterion. Methods: This was an observational study of individuals ≥ 40 years of age with risk factors for COPD who were referred to our pulmonary function laboratory for spirometry. Respiratory symptoms were also recorded. We calculated the prevalence of airway obstruction and of no airway obstruction, according to the GOLD criterion (GOLD+ and GOLD−, respectively) and according to the LLN criterion (LLN+ and LLN−, respectively). We also evaluated the level of agreement between the two criteria. Results: A total of 241 individuals were included. Airway obstruction was identified according to the GOLD criterion in 42 individuals (17.4%) and according to the LLN criterion in 23 (9.5%). The overall level of agreement between the two criteria was good (k = 0.67; 95% CI: 0.52-0.81), although it was lower among the individuals ≥ 70 years of age (k = 0.42; 95% CI: 0.12-0.72). The proportion of obese individuals was lower in the GOLD+/LLN+ category than in the GOLD+/LLN− category (p = 0.03), as was the median DLCO (p = 0.04). Conclusions: The use of the GOLD criterion appears to be associated with a higher prevalence of COPD. The agreement between the GOLD and LLN criteria also appears to be good, albeit weaker in older individuals. The use of different criteria to define airway obstruction seems to identify individuals with different characteristics. It is essential to understand the clinical meaning of discordance between such criteria. Until more data are available, we recommend a holistic, individualized approach to, as well as close follow-up of, patients with discordant results for airway obstruction.


RESUMO Objetivo: A identificação de obstrução persistente das vias aéreas é fundamental para o diagnóstico de DPOC. As diretrizes da GOLD sugerem um critério fixo - relação VEF1/CVF pós-broncodilatador < 70% - para definir obstrução, embora outras diretrizes sugiram que a relação VEF1/CVF pós-broncodilatador < o limite inferior da normalidade (LIN) é o critério mais preciso. Métodos: Estudo observacional com indivíduos ≥ 40 anos de idade com fatores de risco para DPOC encaminhados ao nosso laboratório de função pulmonar para espirometria. Também foram registrados sintomas respiratórios. Calculamos a prevalência de obstrução e de ausência de obstrução das vias aéreas segundo o critério GOLD (GOLD+ e GOLD−, respectivamente) e segundo o critério LIN (LIN+ e LIN−, respectivamente). Avaliamos também o grau de concordância entre os dois critérios. Resultados: Foram incluídos 241 indivíduos. Obstrução das vias aéreas foi identificada segundo o critério GOLD em 42 indivíduos (17,4%) e segundo o critério LIN em 23 (9,5%). A concordância global entre os dois critérios foi boa (k = 0,67; IC95%: 0,52-0,81), embora tenha sido menor entre os indivíduos ≥ 70 anos de idade (k = 0,42; IC95%: 0,12-0,72). A proporção de obesos foi menor na categoria GOLD+/LIN+ do que na categoria GOLD+/LIN− (p = 0,03), assim como a mediana de DLCO (p = 0,04). Conclusões: A utilização do critério GOLD parece estar associada a uma maior prevalência de DPOC. A concordância entre os critérios GOLD e LIN também parece ser boa, embora seja mais fraca em indivíduos mais velhos. A utilização de diferentes critérios para definir obstrução das vias aéreas parece identificar indivíduos com diferentes características. É essencial compreender o significado clínico da discordância entre esses critérios. Até que mais dados estejam disponíveis, recomendamos uma abordagem holística e individualizada e também um acompanhamento cuidadoso dos pacientes com resultados discordantes para obstrução das vias aéreas.


Subject(s)
Humans , Aged , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/epidemiology , Spirometry , Vital Capacity , Forced Expiratory Volume , Risk Factors
10.
Article in Chinese | WPRIM | ID: wpr-911749

ABSTRACT

Objective:To explore the independent risk factors that predict 10-year mortality in patients with stable chronic obstructive pulmonary disease(COPD).Methods:The baseline data from a prospective cohort study were analyzed and long-term follow-up were performed. Patients with confirmed diagnosis of stable COPD were consecutively enrolled in the outpatient clinic from January 2010 to December 2010, and were followed up until December 31, 2020. Cox regression analysis was used to determine the independent risk factors for all-cause mortality and mortality from respiratory causes in stable COPD patients.Results:A total of 182 stable COPD patients were enrolled and followed up for a median of 89 months. The 10-year mortality was 51.1%(93/182), and 9 patients died within one year. The leading cause of death was respiratory disorder, followed by cardiovascular and cerebrovascular diseases. The risk factors independently associated with all-cause mortality included old age( HR=1.936,95% CI: 1.610~2.328, P<0.01), increased baseline COPD Assessment Test(CAT)( HR=1.331,95% CI: 1.049-1.689, P=0.02) and the increased CAT in one year( HR=1.314,95% CI: 1.197-1.420, P<0.01). The risk factors independently associated with respiratory cause mortality included increased baseline CAT( HR=1.719,95% CI: 1.026-2.880, P=0.04), emphysema index(LAA%)( HR=1.062,95% CI: 1.007-1.120, P=0.03), and one year inecreased CAT( HR=1.342,95% CI: 1.198-1.505, P<0.01)was a protective factor. Conclusions:Old age, baseline CAT, one year increased in CAT and LAA% were independent influencing factors for 10-year mortality of stable COPD patients.

11.
Article in Chinese | WPRIM | ID: wpr-911728

ABSTRACT

Objective:To survey the knowledge, attitudes, and practice about chronic obstructive pulmonary disease (COPD) among general practitioners in Sichuan province.Methods:From October to November 2020, a questionnaire survey on knowledge, attitudes and practice (KAP) among 104 general practitioners who participated in the training of the comprehensive prevention and control of COPD organized by Sichuan Provincial Health Commission. The content of the questionnaire included the basic information and the KAP status of COPD. The descriptive analysis, Mann-Whitney U test, and Kruskal-Wallis H were used for statistical analysis. Results:A total of 104 questionnaires were distributed and 102 were returned with a response rate of 98.1%. General practitioners with different ages, professional titles, visits of COPD patients each month, and whether or not to refer COPD patients to higher-level hospitals were not significantly different in the scores of knowledge( U=1 276.00, H=0.78, U=1 074.00, U=589.00), attitude( U=1 141.50, H=1.75, U=1 090.00, U=585.00), and practice( U=1 221.00, H=0.31, U=1 163.00, U=499.50) (all P>0.05). In knowledge part the highest correctness rate was "quitting smoking is the most powerful interventions affecting the natural disease course of COPD" (100.0%, 102/102); the lowest was that"the main objective examination for judging the airflow limitation of COPD patients is the lung function test"(5.9%, 6/102). In the part of the attitude, the highest positive rate was "educating patients to quit smoking and avoid exposure to second-hand smoke" (65.7%,67/102); the lowest positive rate was "provide exercise guidance to patients "(43.1%, 44/102) and " be responsible for long-term treatment follow-up" (43.1%, 44/102). In the part of practice, the highest behavioral rate was "when receiving patients with COPD, actively pay attention to the treatment of comorbid diseases" (95.1%, 97/102); the lowest behavioral rate was "when patients with COPD were seen at the clinic, and the patients were advised of the best time to use the inhaler" (65.7%, 67/102). Conclusions:The study indicates that the relevant departments need to increase the intensity of knowledge training for general practitioners in Sichuan province. General practitioners should continuously improve their education, prevention, and treatment ability and implement the primary responsibilities for COPD management.

12.
Article in Chinese | WPRIM | ID: wpr-911716

ABSTRACT

Objective:To evaluate the clinical effectiveness and safety of a respiratory training device (patent No.201320672057.6), which was developed and produced in China.Methods:Sixty patients with chronic respiratory diseases admitted in China-Japan Friendship Hospital from May 2019 to July 2019 were enrolled in the study. Patients were randomly divided into trial group ( n=30) and control group ( n=30), in the trial group, respiratory training device was used on the basis of conventional treatment, while in the control group, patients received conventional treatment only. Baseline data were collected at the time of enrollment, patients were followed up every 4 weeks, and the final data were collected at the 16th week. The primary outcomes were mMRC score, LCQ score and expectoration. The secondary outcomes were pulmonary function, respiratory muscle strength, SpO 2, FeNO, SGRQ score, times of acute exacerbation and adverse events. Results:There was no significant difference in proportion of decreased mMRC score between trial group and control group [36.0% (9/25) vs. 23.1% (6/26), Z=-1.044, P=0.301). On expectoration, the decrease rate of no-sputum patients in the trial group was significantly higher than that in the control group [28.0%(7/25) vs. 7.7%(2/26), Z=2.050, P=0.041]. In addition, 56%(14/25) patients in the trial group had a decrease in sputum volume compared to 19.2%(5/26)in the control group ( Z=-2.574, P=0.010). There was no statistical difference between the two groups before and after the follow-up in LCQ score( F=0.668, P=0.418). The PEF of pulmonary function in the trial group was significantly improved compared to the baseline( F=4.532, P=0.039); and R 35 was also significantly improved in the trial group( F=4.125, P=0.048). In terms of quality of life, the study found no statistical differences in SGRQ scores between baseline and follow-up. However, the SGRQ symptom score decreased significantly in trial group( F=7.481, P=0.009). There was no statistical difference in acute exacerbation between the two groups ( Z=0.297, P=0.766). No adverse events occurred during the follow-up period. Conclusions:This study evaluated the clinical effectiveness and safety of a respiratory training device developed in China. In terms of the clinical effectiveness, the device can reduce sputum, increase PEF, reduce R 35, indicating that there is a certain therapeutic effect. It is not clear that the device can reduce the severity of dyspnea and pulmonary function, improve quality of life, reduce the times of acute exacerbation. In terms of safety, the device did not show adverse effects during follow-up in this study.

13.
Article in Chinese | WPRIM | ID: wpr-911700

ABSTRACT

Objective:To investigate the status quo of the management of chronic obstructive pulmonary disease (COPD) in primary care health institutions in Miyun District of Beijing.Methods:The Measures to Improve Medical Services in Primary Medical and Health Institutions was issued by Beijing Municipal Health Commission in June 2019. In August 2020, a survey on COPD management status after the measures was conducted with self-designed questionnaire among 19 community health service centers and 61 general practitioners (GPs) from 4 centers in Miyun District of Beijing. Two questionnaires were used for the survey: one was on the status of medical institutions (institution questionnaire, filled by the person in charge of the center) and other was on COPD knowledge of general practitioners (doctor questionnaire, filled by selected GPs). Results:For health institution, 19 valid questionnaires were collected. Among them, 12 centers were equipped with lung function examination equipment after reform; 17 centers were equipped with inhaled corticosteroids/long acting β 2 receptor agonists (ICS/LABA); 12 centers carried out the contract management of family doctors for COPD; 267 patients signed the contract, 7 centers followed up the signed patients at least twice a year; 13 centers referred patients to Miyun District Hospital with 2 024 referrals per year. For GPs, 61 valid questionnaire were collected with a recovery rate of 100% (61/61). Among them 12 GPs (20%) had contracted management for COPD patients; 12 GPs (20%) had referred COPD patients to the secondary or tertiary hospitals; and 9/12 of GPs referred the patients for lung function examination due to the needs of diagnosis or follow-up.The mean COPD-related knowledge score was (58.9±20.0), compared with the score of 65 GPs from the 4 same community centers tested in 2018 (63.2±18.9), there was no significant difference ( t=0.456, P>0.05). Conclusions:The implementation of the primary care institution measures in Beijing promoted the management of COPD and improved capacity building in primary health institutions, also promoted the work docking between primary health institutions and secondary, tertiary hospitals. However, it is still necessary to strengthen the ability training of general practitioners in relevant knowledge and skills to improve their management ability of COPD.

14.
Chinese Journal of Geriatrics ; (12): 1040-1044, 2021.
Article in Chinese | WPRIM | ID: wpr-910963

ABSTRACT

Objective:To investigate the effect of empirical antifungal treatment on the diagnostic sensitivity of galactomannan(GM)in bronchoalveolar lavage(BALF)in chronic obstructive pulmonary disease(COPD)patients combined with invasive pulmonary aspergillosis(IPA).Methods:COPD patients with IPA were enrolled between January 2015 and January 2019 as research objects.Patients who were treated with antifungal drugs prior to bronchoscopy were considered as the empirical group, and other patients were considered as the diagnosis-driven group.The results of BALF GM were compared between the two groups.Results:A total of 66 COPD patients with IPA were enrolled in this study, with 5 cases confirmed and 61 cases clinically diagnosed.Of them, 17 cases were in the empirical group and 49 in the diagnosis-driven group.There was no significant difference in the sensitivity of blood GM and microbiological examination between the two groups( χ2=0.248 and 0.379, P=0.619 and 0.538). With BALF GM 0.5 as a cutoff value, the sensitivity of BALF GM was slightly lower in the empirical group than in the diagnosis-driven group but with no significant difference(88.2%, 95% CI: 62.3%-97.9% vs.93.9%, 95% CI: 82.1%-98.4%, χ2=0.051, P=0.821). However, with BALF GM 1.0 as a cutoff value, the sensitivity decreased greatly in the empirical group compared with the diagnosis-driven group(52.9%, 95% CI: 28.5%-76.1% vs.80.6%, 95% CI: 67.4%-90.8%, χ2=4.036, P=0.045). Logistic regression analysis showed that after adjusting for mechanical ventilation( OR=0.807, 95% CI: 0.215-3.026, P=0.750)and use of semisynthetic penicillins( OR=0.498, 95% CI: 0.140-1.776, P=0.283), the false negative rate of BALF GM was associated with empirical antifungal therapy( OR=0.243, 95% CI: 0.068-0.949, P=0.030). Conclusions:Empirical antifungal therapy prior to bronchoscopy can decrease the diagnostic sensitivity of BALF GM in COPD patients with IPA.

15.
Chinese Journal of Geriatrics ; (12): 853-858, 2021.
Article in Chinese | WPRIM | ID: wpr-910928

ABSTRACT

Objective:To investigate the correlations of stable chronic obstructive pulmonary disease(COPD)with inositol 1, 4, 5-trisphosphate 3-kinase C(ITPKC)and phospholipase C-like 1 protein(PLCL1)single nucleotide polymorphisms(SNPs)in the Han elderly population in Ningxia.Methods:A case-control study was conducted.A total of 250 elderly patients with stable COPD were enrolled and divided into the COPD-related pulmonary hypertension(PH)group(n=103)and the COPD non-PH group(n=147). During the same period, 127 healthy elderly Han subjects were included as the control group.The ITPKC gene SNPs and the PLCL1 gene SNP were detected, and differences in alleles and genotype frequencies were compared between the groups.Results:The allele and genotype frequency distributions of rs2288450 and rs9789480 showed statistical differences between the COPD group and the control group(χ 2=6.09, 5.18, 30.14 and 32.89, P=0.048, 0.020, <0.001, <0.001). There was no difference in the allele and genotype frequency distributions of the ITPKC gene SNPs rs2290692 and rs17713068 between the control group and the COPD group(all P>0.05). The allele and genotype frequency distributions of rs9789480 showed differences between the COPD non-PH group and the COPD-PH group(χ 2=94.50 and 72.76, both P<0.001). There was no significant difference in the allele and genotype frequency distributions of rs2290692, rs17713068, rs2288450 between the COPD-PH group and the COPD non-PH group(all P>0.05). Conclusions:The ITPKC gene SNP rs2288450 CA and AA genotypes and A allele can reduce the incidence of COPD and may be a protective factor for COPD in the elderly.The PLCL1 gene SNP rs9789480 CA and AA genotypes and A allele can reduce the incidence of COPD and COPD-PH and may be a protective factor for COPD and COPD-PH in the elderly.

16.
Article in Chinese | WPRIM | ID: wpr-909219

ABSTRACT

Objective:To investigate the clinical effect of compound Xianzhuliye combined with compound ipratropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease. Methods:160 patients with acute exacerbation of chronic obstructive pulmonary disease who received treatment in Zhejiang Putuo Hospital from December 2019 to December 2020 were included in this study. They were randomly assigned to receive either routine treatment combined with compound ipratropium bromide (control group, n = 80) or routine treatment, compound ipratropium bromide and compound Xianzhuliye in combination (observation group, n = 80) for 14 successive days. Curative effects, blood gas analysis indexes (arterial partial pressure of oxygen, oxygenation index and arterial partial pressure of carbon dioxide), respiratory mechanics indexes (peak airway pressure, airway resistance and mean airway pressure), changes in lung function [percentage of predicted forced expiratory volume in 1 second forced expiratory volume in one second (FEV 1%), FEV 1/forced vital capacity], inflammatory factors (C-reactive protein, interleukin-6 and procalcitonin) before and after treatment were compared between the control and observation groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [90.00% vs. 76.25%, χ2 = 5.391, P < 0.05]. After treatment, arterial partial pressure of oxygen and oxygenation index in the observation group were (62.17 ± 6.19) mmHg and (258.83 ± 25.45) mmHg, respectively, which were significantly higher than those in the control group [(53.86 ± 5.46) mmHg, (210.93 ± 23.12) mmHg, t = 9.005, 12.460, both P < 0.05]. After treatment, arterial partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group [(46.89 ± 5.25) mmHg vs. (57.12 ± 4.12) mmHg, t = 13.711, P < 0.05]. After treatment, peak airway pressure in the observation group was significantly higher than that in the control group [(37.87 ± 3.25) cmH 2O vs. (30.82 ± 4.26) cmH 2O, t = 11.768, P < 0.05]. After treatment, airway resistance and mean airway pressure in the observation group were (6.75 ± 1.82) cm H 2O/L/s and (7.34 ± 1.30) cm H 2O, respectively, which were significantly lower than those in the control group [(9.82 ± 2.10) cm H 2O/L/s and (9.12 ± 1.23) cm H 2O, t = 9.881, 8.896, both P < 0.05). After treatment, FEV 1%, FEV 1/ forced vital capacity in the observation group were (67.31 ± 4.56)% and (61.23 ± 3.67)%, respectively, which were significantly higher than those in the control group [(58.98 ± 3.67)%, (52.18 ± 4.68)%, t = 12.729, 13.610, both P < 0.05). After treatment, C-reactive protein, interleukin-6 and procalcitonin in the observation group were (8.86 ± 1.53) mg/L, (65.87 ± 12.90) ng/L and (0.15 ± 0.04) μg/L, respectively, which were significantly lower than those in the control group [(19.90 ± 3.56) mg/L, (109.32 ± 19.76) ng/L and (0.34 ± 0.07) μg/L, t = 25.484, 16.469, 21.079, all P < 0.05). Conclusion:Compound Xianzhuliye combined with compound ipratropium bromide in the treatment of acute exacerbation of chronic obstructive pulmonary disease can acquire good clinical curative effects through improving blood gas analysis indexes, respiratory mechanics indexes and lung function, and reduce inflammatory reactions.

17.
Article in Chinese | WPRIM | ID: wpr-909188

ABSTRACT

Objective:To investigate the effects of noninvasive positive pressure ventilation combined with positive expiratory pressure device on pulmonary function, inflammatory factors and short-term prognosis in older adult patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), which provide objective evidence for clinical treatment and prognosis evaluation of this disease.Methods:Eighty-three older adult patients with AECOPD who received treatment in Taizhou Central Hospital, China between January 2016 and December 2018 were included in this study. They were randomly assigned to undergo either noninvasive positive pressure ventilation (control group, n = 38) or noninvasive positive pressure ventilation combined with positive expiratory pressure device (study group, n = 45) for 7 days. Pulmonary function, blood gas indexes, inflammatory factor levels and curative effect were compared between the two groups. Results:After treatment, partial pressure of oxygen (PaO 2) and oxygenation index (PaO 2/FiO 2) in each group were significantly increased, and partial pressure of carbon dioxide (PaCO 2) was significantly decreased, compared with before treatment (all P < 0.05). The degree of improvement in PaO 2, PaCO 2 and PaO 2/FiO 2 in the study group was greater than that in the control group ( t = 2.261, 6.854, 2.040, all P < 0.05). The ratio of forced expiratory volume in the first second (FEV 1) to forced vital capacity (FEV 1/FVC), the ratio of FEV1 to predicted value (FEV 1/Pre), and the maximum voluntary ventilation (MVV) per minute in each group were significantly increased compared with before treatment. After treatment, the degree of increase in FEV 1/FVC, FEV 1/Pre, and MVV in the study group was greater than that in the control group ( t = 2.442, 2.120, 2.944, all P < 0.05). After treatment, serum levels of inerleukin-8, tumor necrosis factor-α, and high-sensitivity C-reactive protein in each group were significantly decreased compared with before treatment (all P < 0.05). After treatment, the degree of decrease in serum levels of inerleukin-8, tumor necrosis factor-α, and high-sensitivity C-reactive protein in the study group was significantly greater than that in the control group ( t =7.978, 10.857, 8.543, all P < 0.05). Length of hospital stay, duration of antibiotic use, chronic obstructive pulmonary disease assessment test score and St. George's Respiratory Questionnaire score in the study group were (7.52 ± 1.38) days, (7.14 ± 1.38) days, (18.95 ± 4.76) points, (1.73 ± 4.21) points, respectively, which were significantly shorter/lower than those in the control group [(8.55 ± 1.47) days, (8.25 ± 1.45) days, (8.07 ± 5.81) points, (55.97 ± 5.28) points, t = -2.510, -2.722, -7.943, -10.351, all P < 0.05]. Conclusion:Noninvasive positive pressure ventilation combined with positive expiratory pressure device can effectively improve the pulmonary function of older adult patients with AECOPD, decrease the level of inflammatory factors, and improve short-term prognosis. This study is highly innovative and scientific and is of significance for clinical promotion.

18.
Article in Chinese | WPRIM | ID: wpr-908736

ABSTRACT

Objective:to investigate the therapeutic effect of low molecular weight heparin combined with average volumeassuredpressuresupport (AVAPS) on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with type Ⅱ respiratory failure.Methods:A total of 82 patients with AECOPD combined with type Ⅱ respiratory failure in the Second People′s Hospital of Xindu District of Chengdu from February 2018 to April 2020 were selected as the research objects, and they were randomly divided into two groups with 41 cases in each group. The control group was given AVAPS mode, and the observation group was given low molecular weight heparin combined with AVAPS mode. The arterial partial pressure of oxygen (PaO 2), arterial carbon dioxide (PaCO 2), and forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), maximum peak expiratory flow rate (PEF), interleukin (IL)-6, IL-8, tumor necrosis factor-(TNF-α), 16 kDa Clara cell protein (CC16), surfactant protein D(SP-D), adiponectin (APN), superoxide dismutase (SOD), D-dimer, fibrinogen before and after treatment were compared between the two groups and the incidence of adverse reactions were observed. Results:After treatment, the levels of FEV 1, FVC, PEF, PaO 2 in the observation group were higher than those in the control group: (1.78 ± 0.29) L vs. (1.47 ± 0.25) L, (2.47 ± 0.29) L vs.(2.20 ± 0.25) L, (5.14 ± 0.37) ml/s vs. (4.69 ± 0.35) ml/s, (88.37 ± 10.52) mmHg (1 mmHg = 0.133 kPa) vs. (80.16 ± 9.87) mmHg; and the level of PaCO 2 was lower than that in the control group: (65.07 ± 6.71) mmHg vs. (70.84 ± 6.50) mmHg; and the differences were statistically significant ( P<0.05). After treatment, the levels of IL-6, IL-8 and TNF-α in the observation group were lower than those in the control group: (0.47 ± 0.09) ng/L vs. (0.58 ± 0.10) ng/L, (64.37 ± 7.25) ng/L vs. (88.24 ± 8.34) ng/L, (45.37 ± 4.63) ng/L vs. (66.31 ± 4.92) ng/L; and the levels of SOD and APN were higher than those in the control group: (92.37 ± 10.85) U/mg vs. (76.13 ± 9.84) U/mg, (13.94 ± 0.76) mg/L vs. (11.58 ± 1.21) mg/L; and the differences were statistically significant ( P<0.05). After treatment, the level of CC16 in the observation group was higher than that in the control group: (114.78 ± 12.15) μg/L vs. (107.41 ± 11.06) μg/L; while the levels of SP-D, D-dimer and FIB were lower than those in the control group: (93.24 ± 9.85) μg/L vs. (103.25 ± 10.78) μg/L, (0.58 ± 0.07) mg/L vs. (0.79 ± 0.11) mg/L, (1.98 ± 0.29) g/L vs. (2.56 ± 0.34) g/L; and the differences were statistically significant ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Low-molecular-weight heparin combined with AVAPS mode in the treatment of AECOPD complicated with type Ⅱ respiratory failure can significantly improve the lung inflammation and coagulation function in patients, adjust blood gas analysis and CC16, SP-D levels, and promote the recovery of patients′ lung function.

19.
Article in Chinese | WPRIM | ID: wpr-908154

ABSTRACT

Objective:To understand the views of respiratory nurses on the status quo of nursing quality evaluation in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to preliminarily screen the key indexes, so as to provide reference for scientifically constructing the evaluation index system of nursing quality during AECOPD.Methods:Eighteen clinical nurses and nursing managers with rich experience and working in respiratory department from three general tertiary hospitals in Shanghai were selected by means of purpose sampling to conduct focus group interviews, and analyze the collected materials by means of Colaizzi content analysis.Results:Three themes were extracted, namely, lack of specificity and sensitivity of disease care in current nursing quality index, opinions and suggestions on the setting of AECOPD nursing quality index and the setting of key index of AECOPD nursing quality. Besides, twenty-five key indexes were obtained, inclusive of four structural indexes, sixteen process indexes and five result indexes.Conclusions:It is necessary and important to establish AECOPD nursing quality evaluation index system in a scientific manner and it is advised that the qualities of structure, process and result should all be taken into consideration in the course of establishment. The twenty-five key indexes picked out at this stage can serve as reference for further establishment of a scientific AECOPD nursing quality evaluation index system.

20.
Article in Chinese | WPRIM | ID: wpr-907702

ABSTRACT

Objective:By using the network pharmacology method to predict the active constituents and action targets of Suzi-Jiangqi Decoction in the treatment of COPD, and to explore its potential molecular mechanism with multi-component, multi-target and multi-pathway characteristics. Methods:The active constituents and targets of Suzi-Jiangqi Decoction were collected, screened and predicted according to the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) and UniProt software. Search for the gene targets related to COPD in GeneCards, online human Mendelian genetic database (OMIM) and TTD database. The intersection targets of component targets and disease targets were obtained by Veen map online software. The network model with the sequence of active constituents-target-disease was constructed and analyzed by Cytoscape software, and the protein-protein interaction network (PPI) was constructed by STRING database. The gene ontology function annotation (GO) and Tokyo genome encyclopedia (KEGG) pathway enrichment analysis of common targets with metascape online tool. Results:A total of 163 active constituents of Suzi-Jiangqi Decoction were screened, 283 targets were predicted, and 159 targets involved in the treatment of COPD. Quercetin, kaempferol, naringin and luteolin were the key active ingredients. IL6, TNF, MAPK3, JUN, CASP3, CXCL8, CXCL10, MMP9 and MAPK1 were important gene targets. GO analysis showed that the biological processes involved in the enrichment of key gene targets included the response to bacteria, the cytokine mediated signaling pathway, the cell's response to inorganic substances, the response to oxidative stress, the response to LPS, and so on. The enrichment analysis of KEGG pathway showed that the signaling pathway of Suzi-Jiangqi Decoction in the treatment of COPD included TNF signaling pathway, IL-17 signaling pathway, cell cycle, Influenza A, HTLV-I infection, AGE-RAGE signaling pathway, Tuberculosis, Epstein-Barr virus infection and so on. Conclusion:Suzi-Jiangqi Decoction can treat COPD through multi-target and multi-pathway mechanisms of anti-inflammatory, anti infection and immune regulation, which lays a foundation for further study of its molecular mechanism.

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