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Resumen Introducción. En los países de medianos y bajos ingresos, los datos sobre la mortalidad y los factores de riesgo en pacientes con enfermedad pulmonar obstructiva crónica son limitados. Objetivo. Identificar la incidencia de muerte y sus variables relacionadas en una población colombiana durante 12 meses de seguimiento. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de sujetos con diagnóstico de enfermedad pulmonar obstructiva crónica en una clínica de tercer nivel en Colombia. Los cocientes de probabilidades se calcularon mediante un análisis de regresión logística multivariable con la variable de resultado "mortalidad a los 12 meses". Resultados. Ingresaron 524 pacientes, de los cuales el 18,1 % (95 / 524) murió. La edad promedio fue de 69,7 (DE = 8,92) y el 59,2 % (310 / 524) eran mujeres. Las variables asociadas con la mortalidad fueron la edad (OR = 6,54; IC95%: 3,65-11,36; p < 0,001), años de exposición al humo de leña (OR = 4,59; IC95%: 1,64-12,82; p = 0,002), insuficiencia cardiaca crónica (OR = 1,81; IC95%: 1,13-2,91; p = 0,014), enfermedad cerebrovascular (OR = 3,35; IC95%: 1,04-10,75; p = 0,032) y enfermedad renal crónica (OR=6,96; IC 95%:1,15- 41,67; p = 0,015). Al ajustar las variables en el análisis multivariado únicamente se mostró asociación entre el sexo (OR = 1,55; IC95%: 0,95-2,54; p = 0,008) y la edad (OR = 5,94; IC95%: 3,3-10,69; p < 0,001). Conclusión. La edad, los años de exposición al humo de leña, la insuficiencia cardiaca crónica, la enfermedad cerebrovascular y la renal crónica fueron variables clínicas asociadas a un desenlace fatal. Sin embargo, la edad y el sexo fueron las únicas relacionadas con la mortalidad al ajustarlas por factores de confusión.
Abstract Introduction. Data in low- and middle-income countries on mortality and its related risk factors in patients with chronic obstructive pulmonary disease are limited. Objective. To identify the incidence of death and its relationship with variables in a Colombian population during 12 months of follow-up. Materials and methods. We carried out a retrospective study in subjects diagnosed with chronic obstructive pulmonary disease in a third-level hospital in Colombia. Odds ratios were calculated using multivariable logistic regression analysis with the outcome variable "mortality at 12 months". Results. We included 524 patients, 18.1% (95 / 524) died. The average age was 69.7 (SD = 8.92), and 59.2% (310 / 524) were women. The variables associated with mortality were age (OR = 6.54; 95% CI = 3.65-11.36; p < 0.001), years of exposure to wood smoke (OR = 4.59; 95% CI = 1.64-2.82; p = 0.002), chronic heart failure (OR = 1.81; 95% CI = 1.132.91; p = 0.014), cerebrovascular disease (OR = 3.35; 95% CI = 1.04-10.75; p = 0.032), and chronic kidney disease (OR = 6.96; 95% CI = 1.15-41.67; p=0.015). When adjusting the variables in the multivariate analysis, only an association was found for sex (OR = 1.55; 95% CI = 0.95-2.54; p = 0.008) and age (OR = 5.94; 95% CI = 3.3-10.69; p < 0.001). Conclusion. Age, years of exposure to wood smoke, chronic heart failure, and cerebrovascular and chronic kidney disease were the clinical variables associated with a fatal outcome. However, age and sex were the only variables related to mortality when adjusted for confounding factors.
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Abstract Introduction. Choric obstructive pulmonary disease (COPD) is the third mortality cause in the world, and the development of useful diagnostic tools is necessary to improve timely diagnostic rates in primary care settings. Objective. To develop a web application displaying spirometric and clinical information - including respiratory symptoms and risk factors- to facilitate a COPD diagnosis. Materials and methods. In this cross-sectional study, an expert consensus was carried out with three specialists using the Delphi method to choose the relevant variables for COPD diagnosis. We developed a Python-based web application to diagnose COPD, displaying the clinical variables deemed relevant by the experts along the spirometric curve. Results. Twenty-six clinical variables were included in the web application for the diagnosis of COPD. A fourth expert used the web application to classify a cohort of 695 patients who had undergone spirometry in a third-level centre and had answered at least one of five questionnaires for COPD screening. Out of the 695 subjects, 34% had COPD, according to the expert that diagnosed them using the web application. Only 42% of the patients in the COPD group had received a previous COPD diagnosis and 19% of the patients in the no COPD group had been misdiagnosed with the disease. Conclusion. We developed a web application that displays demographic and clinical information, as well as spirometric data, to facilitate the process of diagnosing COPD in primary care settings.
Resumen Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es la tercera causa de mortalidad en el mundo y es necesario el desarrollo de herramientas diagnósticas útiles para mejorar las tasas de diagnóstico oportuno en los entornos de atención primaria. Objetivo. Desarrollar una aplicación web que muestre la información clínica y de la espirometría -incluyendo síntomas respiratorios y factores de riesgo- para facilitar el diagnóstico de la EPOC. Materiales y métodos. En este estudio transversal se realizó un consenso de expertos con tres especialistas usando el método Delphi para elegir las variables relevantes para el diagnóstico de EPOC. Se desarrolló una aplicación web basada en Python que muestra la información clínica relevante según los expertos, junto con la curva y los datos de la espirometría para el diagnóstico de la EPOC. Resultados. Se incluyeron 26 variables clínicas para el diagnóstico de la EPOC. Un cuarto experto utilizó la aplicación web para clasificar una cohorte de 695 pacientes a los que se les había realizado una espirometría en un centro de tercer nivel y que habían contestado al menos uno de los cinco cuestionarios para la detección de la EPOC. De los 695 sujetos, el 34 % tenían EPOC según el experto que les diagnosticó usando la aplicación web. Sólo el 42 % de los pacientes del grupo con EPOC había recibido un diagnóstico previo de la enfermedad y el 19 % de los pacientes del grupo sin EPOC había sido diagnosticado erróneamente con la enfermedad. Conclusión. Se desarrolló una aplicación web que muestra información demográfica y clínica, así como datos espirométricos, para facilitar el proceso de diagnóstico de la EPOC en entornos de atención primaria.
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Objective:To compare the dynamic changes of transcutaneous partial pressure of carbon dioxide (PtCO 2) and treatment effect of non-invasive intermittent nebulization and non-invasive simultaneous nebulization in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods:This was a randomized parallel controlled trial study. A total of 70 patients with acute exacerbation of COPD in Changzhou First People′s Hospital from October 2021 to September 2022 were selected by convenience sampling method, and divided into control group and experimental group by randomized digits table method with 35 cases in each group. The control group was given non-invasive intermittent oxygen-driven nebulization, and the experimental group was given non-invasive simultaneous oxygen-driven nebulization. The PtCO 2 values at 0, 5, 10, 15 min (the end point of atomization) of the 2 groups were observed, the daily arterial blood gas analysis indexes (mainly including PaCO 2, PaO 2 and pH) were recorded, and the clinical pulmonary infection score and the self-assessment score of COPD patients were recorded before treatment, on the 4th and 7th day of treatment. Results:Finally, 33 patients were included in both the control group and the experimental group. There were 25 males and 8 females in the control group, aged (75.33 ± 8.24) years old. There were 25 males and 8 females in the experimental group, aged (72.39 ± 8.56) years old. The PtCO 2 values at 0, 5, 10, 15 min in the control group were (63.83 ± 12.47), (64.40 ± 12.57), (65.42 ± 13.77), (66.62 ± 14.59) mmHg (1 mmHg=0.133 kPa). There were statistically significant differences in PtCO 2 at all time points ( F=8.05, P<0.01). Further pairwise comparison by Sidak method showed that there were statistically significant differences in PtCO 2 at 15 min compared with 0, 5, 10 min (all P<0.05). The PtCO 2 values at 0, 5, 10, 15 min in the experimental group were (67.62 ± 11.89), (67.15 ± 12.12), (67.82 ± 12.22), (68.15 ± 12.09) mmHg. There was no statistically significant difference in PtCO 2 at all time points ( F=2.00, P>0.05). The PaCO 2 and pH value of the two groups were improved with the treatment time, the control group had a statistically significant difference on the 4th day of treatment compared with before treatment ( P<0.05), while the experimental group on the second day of treatment compared with before treatment ( P<0.05). Conclusions:Both kinds of nebulization have achieved good therapeutic effects, but non-invasive simultaneous nebulization can better maintain the stability of PtCO 2 in the process of nebulization with higher safety, and can improve the arterial blood gas index PaCO 2 and pH value of patients earlier, which is a more suitable nebulization method for the combination of non-invasive ventilation and nebulization, especially for patients with hypercapnia.
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Objective:To explore the effects of early enteral nutrition (EEN) management based on severe feeding process on nutritional status and gastrointestinal tolerance in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after mechanical ventilation.Methods:In the quasi trial study, 30 patients with AECOPD undergoing mechanical ventilation between January 2020 and June 2021 and other 30 patients undergoing mechanical ventilation between July 2021 and December 2022 in Liu′an Hospital of Traditional Chinese Medicine were enrolled as control group and observation group, respectively. The control group was given routine EEN intervention, while the observation group was given EEN management based on severe feeding process. The intakes of calorie and proteins within 7 d after intervention were compared between the two groups. The gastrointestinal tolerance and prognosis were recorded. The levels of hemoglobin, albumin and prealbumin were compared between the two groups before intervention and at 7 d after intervention.Results:In the control group, there were 17 males and 13 females, with age of (66.37±6.09) years old. In the observation group, there were 16 males and 14 females, with age of (65.49 ± 6.35) years old. After intervention, intakes of calorie and proteins within 7 d in the observation group were (3 513.62 ± 94.56) kJ/d and (51.06 ± 5.03) g/d, more than those in the control group (2 859.41 ± 87.23) kJ/d, (36.78 ± 3.14) g/d, the differences were statistically significant ( t=27.85, 13.19, both P<0.05). There were no significant difference in the levels of hemoglobin, albumin and prealbumin before intervention between the two groups (all P>0.05). After intervention, levels of albumin, hemoglobin and prealbumin were (37.16 ± 3.42), (135.43 ± 12.64) g/L and (218.54 ± 15.38) mg/L in the observation group, higher than those in the control group (34.25 ± 4.01), (127.51 ± 11.12) g/L and (201.33 ± 15.04) mg/L, the differences were statistically significant ( t=3.02, 2.58, 4.38, all P<0.05). The incidence rates of reflux aspiration and enteral nutrition interruption in the observation group were 6.67% (2/30), 6.67% (2/30), lower than those in the control group 26.67% (8/30), 30.00% (9/30), the differences were statistically significant ( χ2=4.32, 5.46, both P<0.05). The mechanical ventilation time and stay time in ICU in the observation group were (7.62 ± 1.35), (11.17 ± 2.04) d, shorter than those in the control group (8.57 ± 1.01), (12.83 ± 2.19) d, the differences were statistically significant ( t=3.09, 3.04, both P<0.05). Conclusions:EEN management based on severe feeding process can improve nutritional status, gastrointestinal tolerance and prognosis of AECOPD patients after mechanical ventilation.
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Patients with chronic obstructive pulmonary disease have the disease phenomenon of fear of exercise because of dyspnea, which can accelerate the body degradation rate, weaken muscle strength, reverse increase dyspnea, and delay the recovery of the disease. As a result, this article examines the theoretical underpinnings and specific measures of dyspnea belief intervention programs for chronic obstructive pulmonary disease patients at home and abroad, summarizes the limitations of previous studies, and makes pertinent recommendations in an effort to serve as a guide for early patient prevention and the development of scientific and feasible intervention programs.
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Objective:To search and summarize the best evidence for preoperative prehabilitation in patients with lung cancer complicated by chronic obstructive pulmonary disease and to inform the management of preoperative prehabilitation in patients with lung cancer combined with COPD by clinical providers.Methods:Systematically guideline websites, professional society websites, evidence-based databases, and comprehensive databases were searched for types of literature including clinical decision making, guidelines, expert consensus, evidence summaries, systematic evaluations, Meta-analyses, and randomized controlled trials. The time for the retrieval was from the inception of databases until October 31th, 2023. And the quality of the included literature was evaluated and evidence was extracted, evaluated the quality of the included literature, and extracted evidence.Results:Finally, 18 articles were included, including 8 guidelines, 8 expert consensus, and 2 systematic reviews. Summarized the 30 best evidence in 4 areas of prerehabilitation: need, timing, location, content (including smoking cessation management, respiratory exercise, exercise, nutritional support, and medication management).Conclusions:This study summarizes the best evidence for preoperative prehabilitation in patients with lung cancer combined with chronic obstructive pulmonary disease, and healthcare professionals should be mindful of the need to develop preoperative prehabilitation protocols judiciously, taking into account the specific clinical context during the subsequent translation of the evidence to the clinic.
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Objective To observe changes of CT quantitative indexes in patients with untreated chronic obstructive pulmonary disease(COPD)and relationships with pulmonary function indicators.Methods Totally 99 patients with untreated COPD were retrospectively enrolled.According to the degrees of airflow obstruction,the patients were divided into group A(GOLD grade 1 with mild obstruction,n=36),group B(GOLD 2 with moderate obstruction,n=37)and group C(GOLD 3 or 4 with obvious obstruction,n=26).The results of chest CT and pulmonary function tests conducted at the first diagnosis and the follow-up,as well as their correlations were analyzed.CT quantitative indicators included the whole lung volume,low-attenuation areas less than-950 percentage(LAA％),total number of vessels per 1 cm2 of lung surface area(Ntotal/LSA),total number of vessels with area less than 5 mm2 per 1 cm2 of lung surface area(N＜5mm2/LSA),the square root of the wall area of a hypothetical airway with a 10 mm internal perimeter(Pi10),the entire volume,wall thickness and wall area percentage(WA％)of airway wall,etc.,while results of pulmonary function tests included the forced expiratory volume in one second(FEV1)after administration of a bronchodilator,forced vital capacity(FVC),the ratio FEV1/FVC and FEV1 expressed as percent predicted(FEV1％).Results Compared with those at the first diagnosis,the follow-up results of FVC,FEV1,FEV1/FVC,Ntotal/LSA and N＜5mm2/LSA were lower,whereas LAA％,Pi10 and entire volume of airway were all higher in each group(all P＜0.05).Compared with those in group A,group B and C had decreased LAA％and increased Pi10,and the magnitude increased with the severity of airflow obstruction(all P＜0.05).LAA％,Pi1o and entire volume of airway wall were negatively correlated with pulmonary function indicators(all P＜0.05),while Ntotal/LSA and N＜5 mm2/LSA were positively correlated with pulmonary function indicators(all P＜0.05).Conclusion CT quantitative parameters,including LAA％,Ntotal/LSA,N＜5mm2/LSA,Pi10 and entire volume of airway wall were related to pulmonary function,which might reflect the longitudinal changes of airways and blood vessels in COPD patients.
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Objective:To study the clinical characteristics and management strategies of patients with chronic obstructive pulmonary disease (COPD) in high-altitude areas.Methods:An observational cross-sectional study was conducted in 79 stable COPD patients who visited the outpatient of Respiratory Medicine at Tibet Autonomous Region People′s Hospital and Peking University Third Hospital from August 3 rd 2020 to November 30 th 2020. Patients were divided into Lhasa group ( n=44) and Beijing group ( n=35). The differences of clinical characteristics including demographic characteristics, risk factors, respiratory symptoms, comorbidities, medications and spirometry were analyzed. Further comparative analysis was conducted on the clinical characteristics of smokers ( n=15) and non-smokers ( n=29) in Lhasa group. Results:The proportion of female patients and biofuel exposure in Lhasa group was significantly higher than Beijing group (56.8% vs 0, 86.4% vs 0, both P<0.001). The proportion of smokers in Lhasa group was significantly lower than Beijing group (34.1% vs 100%, P<0.001). The mean score of COPD assessment test (CAT) in Lhasa group was significantly higher than Beijing group (21.27 vs 9.17, P<0.001). The proportion of acute exacerbations ≥2 in the past year in Lhasa group was significantly higher than Beijing group (31.8% vs 11.4%, P=0.032). The median percentage of forced vital capacity in the first second of predicted value (FEV 1%pred) of patients in Lhasa group was significantly higher than Beijing group (63% vs 38%, P<0.001). The proportion of patients treated by inhaled corticosteroid/long-acting β 2-agonist (ICS/LABA) and inhaled long-acting muscarinic antagonists (LAMA) in Lhasa group was significantly lower than Beijing group (4.5% vs 60.0%, 0 vs 65.7%, both P<0.001). There were no significant differences in CAT score, number of acute exacerbations in the past year and lung function between smokers and non-smokers in Lhasa group. Conclusions:Compared with those patients in Beijing, the majority of patients with COPD living in Lhasa are female, with a low proportion of smokers and a high proportion of biofuel exposure. Although their lung function is better, their respiratory symptoms are more severe with more acute exacerbations in the past year, and most patients do not receive standardized medication.
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Objective:To explore the efficacy of online pulmonary rehabilitation (PR) management among community-dwelling patients with stable chronic obstructive pulmonary disease (COPD).Methods:This study was a single-center randomized controlled trail with an unblinded design. A total of 130 patients with stable COPD who visited Zhuanqiao Community Health Service Center in Shanghai Minhang District from October 2020 to March 2022 were randomly divided into study group and control group with 65 cases in each group. Both groups received conventional treatment, while patients in study group attended online rehabilitation management, including face-to-face rehabilitation instruction and multiple online guidance. Pulmonary ventilation function including forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1) and percentage of forced expiratory volume in the first second to forced expiratoty volume (FEV 1%pred), modified British Medical Research Council Dyspnea Scale (mMRC), chronic obstructive pulmonary disease assessment test (CAT), score of 6 minutes walking distance (6MWD) and DOSE (dyspnea, degree of airflow obstruction, smoking status, the number of exacerbation) index were measured at baseline and after 8 weeks of rehabilitation, and compared between two groups. Results:The baseline data of the two groups were comparable. After 8 weeks of management, FVC, FEV 1, FEV 1%pred, mMRC, CAT, 6MWD and DOSE index of both groups were improved compared with the baseline level(control group: t=-7.799, -7.581, -9.010, 3.565, 9.887, -16.677, 3.795; study group: t=-12.623, -13.914, -17.644, 7.404, 22.457, -26.826, 7.968; all P<0.05). The FEV 1%pred, CAT and 6MWD in the study group were better than those in the control group ( t=-2.939, 2.277,-2.130, all P<0.05); while there were no significant differences in FVC, FEV 1, mMRC and DOSE index between the two groups( t=-0.162, -1.280, 0.925, 1.939,all P>0.05). Conclusions:The online pulmonary rehabilitation management can better improve lung function, dyspnea symptoms and exercise tolerance of patients with stable COPD, which can be used for rehabilitation training and management of community-dwelling patients.
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Objective:To investigate the clinical efficacy and safety of non-invasive bilevel positive airway pressure (BiPAP) ventilator combined with oxygen atomization in the treatment of chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods:A total of 80 patients with COPD complicated with type Ⅱ respiratory failure admitted to Haiyan County People′s Hospital from June 2019 to July 2021 were selected, and they were divided into the observation group and the control group by the random number table method, with 40 cases in each group. Patients in both groups received conventional treatment, while patients in the control group were connected with BiPAP non-invasive ventilator and received non-invasive mechanical ventilation in S/T mode; the observation group was given aerosol inhalation drugs during ventilation, and both groups were treated for 7 d. Blood gas indicators and vital signs were collected before treatment and 7 d after treatment. Clinical symptoms were investigated by COPD patient Caring Assessment Tool (CAT) and Dyspnea Scale (DECAF). Serum levels of interleukin (IL)-10, tumor necrosis factor (TNF-α) and CD 4+/CD 8+ were determined, and treatment outcomes and adverse reactions were compared between the two groups. Results:After treatment, the partial pressure of oxygen (PaO 2) and the oxygen saturation (SaO 2) in the observation group were higher than those in the control group: (73.41 ± 5.26) mmHg(1 mmHg = 0.133 kPa) vs. (65.11 ± 4.33) mmHg, 0.921 ± 0.052 vs. 0.884 ± 0.039; the arterial partial pressure of carbon dioxide (PaCO 2), heart rate (HR), respiratory rate (RR) were lower than those in the control group: (45.20 ± 5.33) mmHg vs. (50.52 ± 5.96) mmHg, (90.12 ± 8.56) times/min vs. (98.52 ± 9.63) times/min, (17.41 ± 2.26) times/min vs. (22.10 ± 3.05) times/min, there were statistical differences ( P<0.05). After treatment, CAT scores and DECAF scores in the observation group were lower than those in the control group: (8.45 ± 1.63) scores vs. (12.77 ± 2.36) scores, (0.89 ± 0.15) scores vs. (1.15 ± 0.19) scores, there were statistical differences ( P<0.05). After treatment, the levels of IL-10 and CD 4+/CD 8+ in the observation group were higher than those in the control group: (15.28 ± 3.12) ng/L vs. (13.41 ± 2.96) ng/L, 1.71 ± 0.38 vs. 1.54 ± 0.30; while the level of TNF-α was lower than that in the control group: (215.27 ± 33.96) ng/L vs. (251.11 ± 50.95) ng/L, there were statistical differences ( P<0.05). The hospitalization time in the observation group was shorter than that in the control group: (13.52 ± 3.96) d vs. (15.22 ± 2.74) d, there was statistical difference ( P<0.05). The rates of tracheal intubation and the incidence of adverse reactions between the two groups had no significant differences ( P>0.05). Conclusions:Non-invasive BiPAP ventilator combined with oxygen atomization can improve blood gas index, vital signs and clinical symptoms of COPD patients complicated with type Ⅱ respiratory failure and reduce inflammatory response.
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Objective:To investigate the effects of budegforo combined with doxofylline on inflammatory indexes, monocyte chemotactic protein 1 (MCP-1) and serum amyloid A protein (SAA) levels in patients with moderate and severe chronic obstructive pulmonary disease (COPD) during exacerbation period.Methods:The method of prospective study was adopted, 80 patients with moderate and severe COPD during exacerbation period who were treated in Gongan County People′s Hospital from January 2020 to December 2021 were selected as the research objects, and they were divided into the combined group and the budegforo group by random number table method, with 40 cases in each group. The budegforo group was treated with budegforo inhalation and the conventional maintenance therapy, the combined group was treated with doxofylline on the basis treatment of the budegforo group. The patients of the two groups were treated for 12 weeks. The clinical total effective rate and pulmonary function, inflammatory indexes and MCP-1, SAA levels before and after treatment and adverse reactions of the two groups were compared.Results:The clinical total effective rate in the combined group was higher than that in the budegforo group: 95.00%(38/40) vs. 75.00%(30/40), there was statistical difference ( χ2 = 4.80, P<0.05). After 12 weeks of treatment, the forced expiratory volume in one second (FEV 1), FEV 1 and forced vital capacity (FVC) ratio (FEV 1/FVC), percentage of FEV 1 in predicted value (FEV 1% pred), maximum voluntary ventilation (MVV), percentage of predicted value of diffusing capacity of the lung for carbon monoxide (DLCO% pred) in the combined group were higher than those in the budegforo group: (2.80 ± 0.56) L vs. (2.41 ± 0.27) L, (66.35 ± 8.20)% vs. (61.84 ± 9.77)%, (72.73 ± 7.57)% vs. (65.39 ± 5.41)%, (73.56 ± 7.06) L/min vs. (68.53 ± 6.25) L/min, (71.03 ± 5.85)% vs. (66.37 ± 7.08)%; residual volume (RV) to total lung capacity (TLC) ratio (RV/TLC) level was lower than that in the budegforo group: (45.32 ± 6.64)% vs. (51.73 ± 8.45)%, there were statistical differences ( P<0.05). After 12 weeks of treatment, the levels of interleukin(IL)-17, IL-22, MCP-1, SAA in the combined group were lower than those in the budegforo group: (21.46 ± 5.86) ng/L vs. (30.55 ± 8.74) ng/L, (155.62 ± 14.39) ng/L vs. (170.81 ± 16.70) ng/L, (89.57 ± 7.41) ng/L vs. (105.25 ± 8.70) ng/L, (45.21 ± 8.86) ng/L vs. (57.67 ± 7.16) ng/L, there were statistical differences ( P<0.05). There was no statistical difference in adverse reactions between the two groups ( P>0.05). Conclusions:The application of budegforo combined with doxofylline can improve the pulmonary function and clinical efficacy of patients with moderate and severe COPD during exacerbation period, and also play a positive role in reducing MCP-1 and SAA levels.
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Objective:To analyze the independent risk factors for pneumothorax in older adult patients with chronic obstructive pulmonary disease (COPD), construct and validate a prediction model of pneumothorax risk in patients with COPD.Methods:A total of 500 patients with COPD who received treatment at the Department of Emergency, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2021 were selected using the convenience sampling method and included in this study. Chest CT scan or chest X-ray film findings were used as diagnostic criteria. These patients were divided into a pneumothorax group and a control group according to whether they developed pneumothorax. Taking whether patients develop pneumothorax as a dependent variable and predictive risk factors as independent variables, univariate and multivariate logistic regression analyses of the included risk factors were performed to identify the independent influential factors for developing pneumothorax in patients with COPD. Subsequently, a prediction model for predicting the risk of pneumothorax was constructed and evaluated. A decision curve analysis was conducted to evaluate its clinical practicality.Results:Among 500 patients with COPD, 104 developed pneumothorax, with an incidence of 20.80%. Binary logistic regression analysis showed that long duration of COPD, C-reactive protein, and mechanical ventilation were independent risk factors for the development of pneumothorax in these patients. The percentage of forced expiratory volume in one second (FEV 1%), the FEV 1/forced vital capacity ratio (FEV 1/FVC), and serum albumin are protective factors for the development of pneumothorax in patients with COPD. A prediction model for the risk of developing pneumothorax was constructed. Finally, we obtained the formula: Logit( P) = 12.427 + 2.241 × COPD duration + 0.899 × smoking + 7.715 × CRP + 0.208 × mechanical ventilation history -0.514 × albumin -0.243 × FEV 1%-0.286 FEV 1/FVC. Receiver operating characteristic curve analysis results showed that the area under the curve was 0.815 and the C-Index was 0.781 (95% CI: 0.856-0.891), indicating that the constructed prediction model can better distinguish between patients with and without pneumothorax among those with COPD. Conclusion:C-reactive protein, albumin, FEV 1%, FEV 1/FVC, smoking history, and mechanical ventilation history are all risk factors for the development of pneumothorax. A prediction model has been successfully constructed based on these risk factors, which can effectively predict the risk of pneumothorax. This constructed risk prediction model provides good guidance in taking preventive treatment and nursing measures by medical staff.
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Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by persistent airflow obstruction caused by long-term airway inflammation or alveolar abnormalities, often manifested as chronic respiratory symptoms and decreased lung function. In recent years, experimental research has shown that mesenchymal stem cells (MSC) have anti-inflammatory, immunomodulatory, and repairing properties of lung epithelial cells, which can be used to treat various diseases including COPD. This article is mainly based on the main findings of in vitro and in vivo animal model experiments and clinical studies of MSC treatment for COPD. It summarizes and discusses the possible mechanisms of action of MSC as a new therapy, and provides new ideas for clinical treatment of COPD.
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Objective:To investigate the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and corona virus disease 2019 (COVID-19) infection.Methods:Clinical data of AECOPD patients over 65 years old who were diagnosed in the Respiratory and Emergency Departments of the Dongzhimen Hospital, Beijing University of Chinese Medicine from September 2022 to September 2023 were collected. AECOPD patients were divided into a COVID-19 group ( n=29) and a non COVID-19 group ( n=31). The platelet count, white blood cell count, lymphocyte count, neutrophil count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein (CRP), procalcitonin (PCT), partial pressure of oxygen (PO 2), partial pressure of carbon dioxide (PCO 2), D-dimer (D-D), and interleukin-6 (IL-6) were compared between two groups of patients upon admission Confusion, Uremia, Respiratory, BP, Age 65 Years (CURB-65) was used to compare length of hospital stay, AECOPD grading, and mortality endpoint days. Results:There was no statistically significant difference in platelet count, white blood cell count, lymphocyte count, neutrophil count, NLR, and PLR between the COVID-19 group and the non COVID-19 group (all P>0.05). The proportion of males, CRP, PCO 2, D-D, IL-6, and CURB-65 scores in the COVID-19 group were higher than those in the non COVID-19 group, while PCT and PO 2 were lower than those in the non COVID-19 group, with statistically significant difference (all P<0.05). The proportion of AECOPD grade Ⅲ in the COVID-19 group was significantly higher than that in the non COVID-19 group, and the progression rate of the disease was higher in the COVID-19 group (37.9% vs 22.6%, P<0.05). COVID-19 was an independent influencing factor for the progression of AECOPD. Conclusions:Patients over 65 years old with AECOPD infected with COVID-19 have a more pronounced inflammatory response, and CRP, IL-6, and CURB-65 scores can be used as indicators to evaluate the degree of inflammation. AECOPD infected with COVID-19 are more prone to coagulation disorders, hypoxemia, more severe illness, and easier progression, suggesting that COVID-19 infection is an independent influencing factor for the progression of AECOPD.
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ABSTRACT Objective: To assess differences in the sputum microbiota of community-acquired pneumonia (CAP) patients with either COPD or asthma, specifically focusing on a patient population in Turkey. Methods: This retrospective study included hospitalized patients > 18 years of age with a diagnosis of pneumonia between January of 2021 and January of 2023. Participants were recruited from two hospitals, and three patient groups were considered: CAP patients with asthma, CAP patients with COPD, and CAP patients without COPD or asthma. Results: A total of 246 patients with CAP were included in the study, 184 (74.8%) and 62 (25.2%) being males and females, with a mean age of 66 ± 14 years. Among the participants, 52.9% had COPD, 14.2% had asthma, and 32.9% had CAP but no COPD or asthma. Upon analysis of sputum cultures, positive sputum culture growth was observed in 52.9% of patients. The most commonly isolated microorganisms were Pseudomonas aeruginosa (n = 40), Acinetobacter baumannii (n = 20), Klebsiella pneumoniae (n = 16), and Moraxella catarrhalis (n = 8). CAP patients with COPD were more likely to have a positive sputum culture (p = 0.038), a history of antibiotic use within the past three months (p = 0.03), utilization of long-term home oxygen therapy (p < 0.001), and use of noninvasive ventilation (p = 0.001) when compared with the other patient groups. Additionally, CAP patients with COPD had a higher CURB-65 score when compared with CAP patients with asthma (p = 0.004). Conclusions: This study demonstrates that CAP patients with COPD tend to have more severe presentations, while CAP patients with asthma show varied microbial profiles, underscoring the need for patient-specific management strategies in CAP.
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Introducción: investigaciones recientes con la práctica del taichí mostraron beneficios en la funcionalidad, capacidad de ejercicio y calidad de vida de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). La falta de estudios en nuestro medio y la necesidad de nuevas modalidades de tratamiento impulsó la realización de este trabajo. El objetivo fue valorar el impacto del taichí en un programa de rehabilitación respiratoria de la EPOC. Material y método: estudio piloto, aleatorizado, prospectivo y abierto. Se trabajó con 17 pacientes portadores de EPOC, 7 en el grupo control (CNTL) y 10 en el grupo tratamiento (TCm). Recibieron un programa de rehabilitación respiratoria durante 12 semanas. El grupo TCm con taichí como intervención terapéutica. Se comparó la similitud de las variables sociodemográficas y clínicas. Resultados: los grupos analizados fueron similares en la mayoría de las variables (edad, sexo, sociodemográficas, Gold, Charson, índice tabáquico IPA). En cuanto a las variables resultado, todas las categorías analizadas en los cuestionarios del índice PROMIS previo al inicio, al mes y a los tres meses, evidenciaron una mejoría entre los valores iniciales y finales en ambos grupos, siendo mayor en TCm, aunque no estadísticamente significativo, con valores p ≤ 0,05. En el cuestionario SGRQ, el análisis de los resultados no mostró diferencias significativas entre CNTL vs TCm al mes (44±5 vs 46±5 p 0,742) y a los tres meses (44±5 vs 40±6 p 0,916), con mejoras a favor en los valores del grupo TCm. El índice BODE registró valores menores, evidencia de una mejoría en grupo TCm a los tres meses (2±0,6 vs 3±0,4 p 0,889), sin ser estadísticamente significativa (p ≤ 0,05). Conclusiones: el beneficio del taichí dentro de un programa de rehabilitación tradicional mostró mejoras no significativas en funcionalidad y calidad de vida relacionada con la salud, su inclusión aparece como promisoria, requiriendo una mayor investigación futura.
Recent studies involving Tai Chi have shown benefits in the functionality, exercise capacity, and quality of life of patients with COPD. The lack of studies in our region and the need for new treatment modalities prompted this study. The objective was to assess the impact of Tai Chi in a Pulmonary Rehabilitation Program for COPD. Method: Pilot, randomized, prospective, and open-label study; with two similar groups of patients with COPD, who were included in a Pulmonary Rehabilitation program for 12 weeks; one of them with Tai Chi as a therapeutic intervention. The similarity of sociodemographic and clinical variables was compared. Results: The analyzed groups were similar in most variables (age, sex, sociodemographic, GOLD, Charlson, smoking index IPA). Within the outcome variables in the self-administered PROMIS index prior to the start, at one month, and at three months, all categories analyzed showed an improvement between the initial and final values in both groups, with a greater improvement in the TCm group, although not statistically significant with p-values ≤ 0.05. In the SGRQ questionnaire, the analysis of the results showed no significant differences between the CNTL and TCm groups at one month (44±5 vs. 46±5, p 0.742) and three months (44±5 vs. 40±6, p 0.916); with better values in the TCm group. The BODE Index recorded lower values, indicating an improvement in the TCm group at three months (2±0.6 vs. 3±0.4, p 0.889), although not statistically significant (p ≤ 0.05). Conclusions: The benefit of Tai Chi within a traditional rehabilitation program showed non-significant improvements in functionality and health-related quality of life. Its inclusion appears promising, requiring further future research.
Estudos recentes com Tai-chi mostraram benefícios na funcionalidade, capacidade de exercício e qualidade de vida em pacientes com DPOC. A falta de estudos em nosso meio e a necessidade de novas modalidades de tratamento motivaram o estudo. O objetivo foi avaliar o impacto do Tai-chi em um Programa de Reabilitação Respiratória para DPOC. Método: Estudo piloto, randomizado, prospectivo e aberto, com dois grupos semelhantes de pacientes com DPOC, que receberam um programa de reabilitação respiratória por 12 semanas; um deles com o Tai-chi como intervenção terapêutica. A similaridade das variáveis sociodemográficas e clínicas foi comparada. Resultados: Os grupos analisados foram semelhantes na maioria das variáveis (idade, sexo, dados sociodemográficos, GOLD, Charson, índice de tabagismo IPA). Dentro das variáveis de resultado no índice PROMIS autoadministrado na linha de base, em um mês e em 3 meses, todas as categorias analisadas mostraram uma melhora entre os valores iniciais e finais em ambos os grupos, sendo maior no grupo TCm, embora não estatisticamente significativa com valores de p ≤ 0,05. No questionário SGRQ, a análise dos resultados não mostrou diferenças significativas entre os grupos control e TCm em 1 mês (44±5 vs 46±5, p 0,742) e 3 meses (44±5 vs 40±6, p 0,916), com melhores valores no grupo TCm. O índice BODE registrou valores mais baixos, evidência de uma melhora no grupo TCm aos 3 meses (2±0,6 vs 3±0,4, p 0,889), sem ser estatisticamente significativo (p ≤ 0,05). Conclusões: O benefício do Tai-chi dentro de um programa de reabilitação tradicional mostrou melhorias não significativas na funcionalidade e na qualidade de vida relacionada à saúde; sua inclusão parece promissora e requer mais pesquisas.
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Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Taichi Chuan , Estudios ProspectivosRESUMEN
La aspergilosis es una infección fúngica causada por el microorganismo Aspergillus spp. Las manifestaciones clínicas dependen del estado inmunológico del paciente y de las alteraciones estructurales del parénquima pulmonar. Pese a su baja incidencia, siempre se debe considerar como diagnóstico diferencial en el contexto de pacientes con enfermedades pulmonares de base. Se presenta un caso de hombre de 66 años, agricultor, con antecedente de tuberculosis pulmonar y enfermedad pulmonar obstructiva crónica, quien consultó por cuadro de 5 meses de disnea progresiva, fiebre, tos, hemoptisis y pérdida de peso. Los hallazgos imagenológicos fueron sugestivos de tuberculosis pulmonar asociado a aspergiloma, lo que fue confirmado por tinción de hidróxido de potasio (KOH) y cultivo de hongos positivo para Aspergillus fumigatus. El Gene Xpert fue positivo para Mycobacterium tuberculosis demostrando coinfección activa.
Aspergillosis is a fungal infection caused by the microorganism Aspergillus spp. Clinical manifestations depend on the patient's immune status and structural alterations of the lung parenchyma. Despite its low incidence, it should always be considered as a differential diagnosis in the context of patients with underlying lung diseases. We present the case of a 66-year-old male farmer, with a history of pulmonary tuberculosis and chronic obstructive pulmonary disease, who presented with progressive dyspnea months, fever, cough, hemoptysis and weight loss for 5 months. Imaging findings were suggestive of aspergiloma- associated pulmonary tuberculosis, which was confirmed by potassium hydroxide (KOH) staining and positive fungal culture for Aspergillus fumigatus. Gene Xpert was positive for Mycobacterium tuberculosis showing active co-infection.
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Humanos , Masculino , Anciano , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/diagnóstico , Aspergillus fumigatus/aislamiento & purificación , Tuberculosis Pulmonar/microbiología , Enfermedad Crónica , Enfermedad Pulmonar Obstructiva Crónica , Diagnóstico Diferencial , Aspergilosis Pulmonar/microbiología , Coinfección , Mycobacterium tuberculosis/aislamiento & purificaciónRESUMEN
Objetivo: Comparar as respostas neuromusculares e bioquímicas do dano e fadiga muscular do quadríceps femoral entre indivíduos com doença pulmonar obstrutiva crônica (DPOC) e saudáveis. Métodos: Estudo observacional, transversal e comparativo. A amostra foi composta por 18 indivíduos alocados em dois grupos distintos: Grupo DPOC (GD) e grupo saudáveis (GS), os quais foram avaliados por meio da espirometria, do desempenho neuromuscular do quadríceps, dos marcadores bioquímicos do dano e fadiga muscular, da fatigabilidade e da dor muscular. Resultados: Observou-se diferença estatisticamente significante na potência média entre o GD e GS (99,9 ± 21,0 vs 145,1 ± 51,5, respectivamente; p= 0,02) e uma tendência das médias de pico de torque (85,7 ± 24,4 vs 104,4 ± 31,0; p= 0,45) e trabalho total (1.305,5 ± 329,9 vs 1.671,5 ± 444,5; p= 0,06) serem menores no GD que no GS, respectivamente. A concentração da LDH imediatamente após o teste isocinético foi significantemente maior no GD que no GS (402,3 ± 33,6 vs 289,4 ± 33,6, respectivamente; p= 0,03). Conclusões: O presente estudo mostrou que pacientes com DPOC tem redução da capacidade de gerar força em um determinado período de tempo quando comparado a indivíduos saudáveis. A dosagem plasmática dos marcadores bioquímicos não permitiu confirmar que os pacientes com DPOC tem maior nível de dano muscular quando realizam exercício que os controles saudáveis.
Objective: To compare neuromuscular and biochemical responses of femoral quadriceps muscle damage and fatigue between chronic obstructive pulmonary disease (COPD) and healthy subjects. Methods: Observational, transversal and comparative study. The sample consisted of 18 subjects assigned to two distinct groups: COPD group (CG) and healthy group (HG), who were assessed by spirometry, quadriceps neuromuscular performance, biochemical markers of muscle damage and fatigue, fatigability and muscle pain. Results: Statistically significant difference was observed in mean power between CG and HG (99.9 ± 21.0 vs. 145.1 ± 51.5, respectively; p= 0.02) and a tendency of mean peak torque (85.7 ± 24.4 vs 104.4 ± 31.0, p= 0.45) and total work (1,305.5 ± 329.9 vs 1.671.5 ± 444.5; p= 0.06) were smaller in the CG than HG, respectively. The LDH concentration immediately after the isokinetic test was significantly higher in the CG than HG (402.3 ± 33.6 vs 289.4 ± 33.6, respectively; p= 0.03). Conclusions: The present study showed that patients with COPD have a reduced ability to generate force over a given period of time when compared to healthy subjects. The plasma levels of biochemical markers did not confirm that patients with COPD have a higher level of muscle damage when exercising than healthy controls.
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Objetivos: Evaluar la evolución de las comorbilidades en una cohorte de pacientes EPOC durante 5 años de seguimiento. Evaluar la mortalidad. Valorar y correlacionar la gravedad de la EPOC, el índice de COTE y la mortalidad. Material y Métodos: Estudio prospectivo observacional en una cohorte de pacientes EPOC durante 2015-2020, en el Servicio de Neumonología Hospital Privado Universitario de Córdoba. Información de Historias Clínicas electrónicas. Para predecir riesgo de mortalidad se utilizó el índice de COTE. Análisis estadístico: prueba exacta de Fisher, Prueba t de Student e InfoStat. Resultados: Sesenta y ocho pacientes, masculinos 37 (54,41%), edad 75 ± 6,69. Sin seguimiento: 2 pacientes. En el momento del ingreso, el tiempo del diagnóstico de EPOC fue de 13,23 ± 5,88 años. Más del 50% tenían EPOC moderado. Sin diferencias en VEF1/post-BD (0,57 en 2015 vs. 0,58 en 2020), ni en frecuencia de exacerbaciones en último año (1,06 ± 1,26 vs. 0,85 ± 1,44). En 2015, el 29,41% (n 20) eran TBQ activos y se redujo al 18,18% (n 12). En 2015, recibían CI el 73,53% (n 50) y en 2020 el 56,92% (n 37) (p 0,047). En 2015, un 4,41% (n 3) recibían esteroides sistémicos y se incrementó al 20% (n 13) en 2020 (p 0,007). Sin diferencias significativas en frecuencia de internaciones (0,13 ± 0,38 vs. 0,97 ± 2,34). índice de COTE ≥ 4, no se modificó significativamente a los 5 años: el 23,53% (n 16) vs. el 29,41% (n 20). Se detectó en 2020, un incremento de HTA (el 66%, n 45 vs. el 77%, p 0,181), depresión (el 19,12%, n 13 vs. el 30,30%, n 20, p 0,161) y ansiedad (el 22,06%, n 15 vs. el 32%, n 21, p 0,243). En 2020, diagnóstico de aneurisma de aorta abdominal en el 3,03% (n 2). Reducción de obesidad en el 25% (n 17) al 19,70% (n 13). En el seguimiento, fallecieron 9 pacientes (13,24%) y tenían menos comorbilidades (p < 0,009). Mayor mortalidad en pacientes con índice de COTE ≥ 4 (p 0,429). Los fallecidos tenían mayor gravedad de la EPOC, con menor VEF1/post-BD a 5 años (p 0,102). Aquellos con enfermedad cardiovascular o metabólica, a los 5 años, tenían menor proporción de fallecimiento (p < 0,05). Si bien los pacientes con índice de COTE en 2015 ≥ 4 presentaban menor promedio de VEF1/ post-BD al comienzo y en seguimiento a 5 años, la diferencia no fue significativa. Se observó que el índice de COTE aumentaba en pacientes EPOC con VEF1/post-BD de grado moderado y grave (p < 0,05). Discusión: Las comorbilidades de la EPOC constituyen un factor pronóstico con efecto acumulativo en morbimortalidad; por ello, la importancia de este estudio. Una limitación es la reducida población, que podría explicar que no se observó correlación entre mortalidad y aumento de comorbilidades. Destacamos el sobreuso de CI y esteroides sistémicos en esta población, a pesar de no tener incremento de exacerbaciones ni internaciones. Conclusiones: En 5 años de seguimiento de esta población EPOC con comorbilidades, se detectó un incremento de la HTA, depresión y ansiedad estadísticamente significativos. En un 3,03%, se diagnosticó aneurisma de aorta abdominal. La mortalidad a los 5 años fue del 13,24%. Hubo una correlación significativa entre la gravedad de la EPOC y el índice de COTE ≥ 4, pero ninguna de estas variables se correlacionó con la mortalidad. Nuestra principal limitación fue la reducida cohorte incluida(AU)
Objectives: To evaluate the evolution of comorbidities in a cohort of patients with COPD after 5 years of follow-up. To evaluate mortality. To assess and correlate COPD severity, COPD-specific comorbidity test (COTE) Index, and mortality. Materials and Methods: Prospective observational study in a cohort of patients with COPD during 2015-2020 at the Pulmonology Service of the Hospital Privado Universitario de Córdoba. Information of electronic medical records. In order to predict the mortality risks, we used the COTE Index. Statistical analysis: Fisher's exact test, Student's t test and InfoStat. Results: 68 patients, 37 male (54.41%), age 75 ± 6.69. 2 patients lost to follow-up. The time since COPD diagnosis was 13.23 ± 5.88 years at the study entry. More than 50% of patients had moderate COPD. There were no differences in post-bronchodilator FEV1(forced expiratory volume in one second) (0.57 in 2015 vs. 0.58 in 2020), nor in the frequency of exacerbations in the last year (1.06 ± 1.26 vs. 0.85 ± 1.44). In 2015, 29.41% of patients (n20) were active smokers, and the number was reduced to 18.18% (n12). In 2015, 73.53% of patients (n50) were receiving ICS (inhaled corticosteroids), and in 2020 the number decreased to 56.92% (n37) (p0.047). In 2015, 4.41% of patients (n3) were receiving systemic steroids, and the number increased to 20% (n13) in 2020 (p 0.007). There weren't any significant differences in the frequency of hospitalizations (0.13 ± 0.38 vs. 0.97 ± 2.34). COTE Index ≥ 4; no significant changes after 5 years: 23.53% (n16) vs. 29.41% (n20). In 2020, an increase in arterial hypertension (AHT) (66% n45 vs. 77%, p0.181), depression (19.12% n13 vs. 30.30% n20, p0.161) and anxiety (22.06% n15 vs. 32% n21, p0.243) was detected. In 2020, 3.03% of patients (n2) were diagnosed with abdominal aortic aneurism. Decrease in obesity from 25% (n17) to 19.70% of patients (n13). During follow-up, 9 patients died (13.24%), and they had fewer comorbidities (p < 0.009). Higher mortality in patients with COTE Index ≥ 4 (p0.429). Deceased patients had more severe COPD, with lower post-BD FEV1 after 5 years (p0.102). Patients with cardiovascular or metabolic disease had a lower mortality rate at 5 years (p < 0.05). Although patients with a COTE Index ≥ 4 in 2015 had a lower mean post-BD FEV1 at baseline and after the 5-year follow-up, the difference wasn't significant. It was observed that the COTE Index increased in patients with COPD with post-BD FEV1 of moderate to severe degree (p < 0.05). Discussion: The comorbidities of COPD constitute a prognostic factor with a cumulative effect on morbidity and mortality. Hence, the importance of this study. One limitation is the small population size, which could explain the lack of correlation between mortality and increased comorbidities. We highlight the overuse of ICS and systemic steroids in this population, despite not experiencing increased exacerbations or hospitalizations. Conclusions: After a 5-year follow-up of this COPD population with comorbidities, a statistically significant increase in AHT, depression, and anxiety was detected. 3.03% of patients were diagnosed with abdominal aortic aneurism. There was 13.24% mortality after 5 years. There was a significant correlation between the severity of COPD and a COTE Index ≥ 4, but neither of these variables correlated with mortality. Our main limitation was the small cohort included in this study(AU)
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Objective: To analyze the case characteristics of Chronic obstructive pulmonary disease caused by occupational irritant chemicals (OI-COPD). To provide basis for revising its diagnostic criteria. Methods: From June to December 2021, we investigated the information of OI-COPD patients confirmed by Shandong Institute of Occupational Health and Prevention of Occupational Diseases, Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Qingdao Central Hospital affiliated to Qingdao University and other diagnostic institutions in the past five years, a total of 41 cases. The basic information of OI-COPD cases, occupational risk factors exposure information, medical history, smoking history and clinical symptoms were analyzed retrospectively. The measurement data were tested for normal distribution, which was described by x±s, and compared between groups by t test; Those who do not conform to the normal distribution are described by the median [M (Q(1), Q(3)) ] and analyzed by nonparametric test; The counting data were expressed in frequency and rate (% ), and the comparison between groups was tested. Results: Of the 41 cases, 33 were male and 8 were female. The age of the patient diagnosed with OI-COPD was (49.5±10.3) years old, and the minimum age was 30 years old; Among them, 8 patients had a definite long-term smoking history (more than 5 years) ; The exposure duration of occupational risk factors was (18.6±10.3) years, of which 3 patients had exposure duration of less than 5 years; The occupational risk factors leading to OI-COPD include acids and acid-forming compounds, bases, aldehydes, nitrogen oxides, chlorine and its compounds, etc. The exposure level of occupational risk factors is related to the degree of COPD airflow restriction (χ(2)=6.17, P <0.05). 18 patients with diagnosis age <50 years old were diagnosed as early-onset COPD. The incidence of respiratory symptoms in the early diagnosis COPD group was lower than that in the non-early diagnosis COPD group, and the FEV1% pred was significantly higher than that in the non-early diagnosis COPD group. The difference was statistically significant (P<0.01 ) . Conclusion: The exposure level of occupational risk factors may be the risk factor affecting the degree of COPD airflow restriction. With the increase of the exposure level of COPD patients, the proportion of respiratory symptoms will also increase accordingly.