摘要
Objective To summarize the medication law of TCM in the treatment of chronic bronchitis;To provide reference for clinical medication.Methods Medical records of patients with chronic bronchitis who were hospitalized in the Respiratory Department of the First Affiliated Hospital of Henan University of Chinese Medicine from January 1,2016 to December 31,2021 were extracted based on HIS electronic medical record data.After screening,the TCM prescriptions used by patients with chronic bronchitis were input into Excel 2019 to establish a database.Based on the software Lantern 5.0,the latent structure model was learned,hidden variables and explicit variables were obtained,and the model was interpreted.SPSS Modeler 18.0 was used to establish model points with Apriori algorithm for Chinese materia medica with a frequency greater than 6%,to obtain the association rules between drugs,and to analyze the medication law of TCM in treating chronic bronchitis.Results A total of 3 410 cases were included,involving 423 kinds of Chinese materia medica,with a cumulative frequency of 82 766 times.Among them,109 kinds of Chinese materia medica with a frequency of>6 % had a cumulative frequency of 69 845 times.The top five commonly used medicines were Fritillariae Cirrhosae Bulbus,Poria,Atractyodis Macrocephalae Rhizoma,Asteris Radix et Rhizoma,Citri Reticulatae Pericarpium,mainly with medicines of reducing cough and phlegm,antiasthmatic medicine,tonifying deficiency,clearing heat,relieving superficies,promoting blood circulation and removing blood stasis.The medicinal properties were warming,cold and mild,and the main tastes were bitter,sweet and pungent,and the meridians were mainly lung,spleen,liver and stomach meridians.Through analysis of latent structure,49 hidden variables and 149 hidden classes were obtained.Combined with professional knowledge,10 comprehensive clustering models and 21 core formulas were deduced,such as Sangbaipi Decoction,Xuefu Zhuyu Decoction,Xiaoqinglong Decoction,Erchen Decoction,Shashen Maidong Decoction,Liuwei Dihuang Pills,Yinqiao Powder,Zhisou Powder,Yupingfeng Powder,Xuefu Zhuyu Decoction combined with Daotan Decoction,etc.It was concluded that the chronic bronchitis syndrome included phlegm-heat stagnation lung syndrome,qi stagnation blood stasis syndrome,cold fluid attacking lung syndrome,phlegm-dampness accumulation lung syndrome,lung qi and yin deficiency syndrome,kidney yin deficiency syndrome,wind heat attacking lung syndrome,wind cold attacking lung syndrome,lung qi and spleen deficiency syndrome,phlegm stasis interjunction syndrome.A total of 41 strong association rules were screened in the analysis of association rules,including 5 strong association rules for two and 36 strong association rules for three.The high confidence rules were Saposheikovize Radix + Angelicae Sinensis Radix →Atractyodis Macrocephalae Rhizoma,Saposheikovize Radix + Codonopsis Radix → Atractyodis Macrocephalae Rhizoma,Codonopsis Radix + Citri Reticulatae Pericarpium → Atractyodis Macrocephalae Rhizoma;the higher degree of improvement were Bupleuri Radix + Mori Cortex → Scutellariae Radix,Perillae Fructus + Belamcandae Rhizoma → Fritillariae Cirrhosae Bulbus,Armeniacae Semen Amarum + Pinelliae Rhizoma → Citri Reticulatae Pericarpium,etc.Conclusion In the treatment of chronic bronchitis,TCM is mainly used to reduce phlegm,relieve cough and asthma,and the method of promoting blood circulation and removing blood stasis is commonly used to help eliminate phlegm.In addition,TCM pays attention to the application of methods such as tonifying lung and securing the exterior,invigorating spleen and benefiting qi.
摘要
ObjectiveTo study the effect and mechanism of Linggui Zhugantang in treating chronic bronchitis （CB） induced by exposure to cigarette smoke combined with tracheal instillation of lipopolysaccharide （LPS）. MethodSixty SPF-grade SD rats were randomly divided into normal， model， dexamethasone （1 mg·kg-1）， and high-， medium-， and low-dose （30.06， 15.03， 7.515 g·kg-1， respectively） Linggui Zhugantang groups by the body weight stratification method， with 10 rats in each group. Each group was administrated with 200 μL LPS （1 g·L-1） by tracheal instillation on days 1 and 14， respectively， while the normal group was administrated with an equal volume of normal saline. Except the normal group， the other groups were exposed to cigarette smoke on days 2-13 and 15-30 （10 cigarettes/time/30 min， twice/day） for the modeling of CB. The rats were administrated with corresponding drugs by gavage for 30 consecutive days from day 2 of modeling， and the mental status， behavior， and body weights of the rats were observed and measured. The wet/dry mass ratio （W/D） of the left lung was measured 30 days after modeling. Hematoxylin-eosin staining was employed to observe the pathological changes in the lung and bronchial tissues. The bronchial mucus secretion and goblet cell proliferation were observed by Alcian blue-periodic acid Schiff （AB-PAS） staining. The levels of mucin 5AC （MUC5AC）， interleukin （IL）-13， IL-6， and tumor necrosis factor （TNF）-α in the serum were determined by enzyme-linked immunosorbent assay. The expression of phospholipase A2 （PLA2）， transient receptor potential vanilloid receptor 1 （TRPV1）， and transient receptor potential ankyrin 1 （TRPA1） in the lung tissue was quantitatively analyzed by immunohistochemistry and Western blot. ResultCompared with the normal group， the model group showcased abnormal mental status and behaviors， bloody secretion in the nose and mouth， the mortality rate of 40%， decreased body weight， severe lung bronchial structure damage， a large number of inflammatory mediators and inflammatory cell infiltration in the tube wall， hyperemia， edema， and fibroplasia， massive proliferation of goblet cells， excessive secretion and accumulation of mucus， stenosis and deformation of the lumen， and aggravation of pulmonary edema （P<0.01）. In addition， the model group had higher levels of MUC5AC， IL-13， IL-6， and TNF-α in the serum and higher expression of PLA2 in the lung tissue than the normal group （P<0.01）. Compared with the model group， the medication groups showed normal mental status and behaviors， reduced mortality rate， stable weight gain， reduced lung and bronchial injuries， decreased goblet cell proliferation and mucus secretion， and alleviated pulmonary edema （P<0.01）. Furthermore， Linggui Zhugantang lowered the levels of MUC5AC， IL-13， IL-6， and TNF-α in the serum and down-regulated the protein levels of PLA2， TRPV1， and TRPA1 in the lung tissue （P<0.01）. ConclusionLinggui Zhugantang can reduce the pulmonary inflammation and airway mucus hypersecretion in the rat model of chronic bronchitis. It may exert the effects of reducing inflammation and resolving phlegm by regulating the PLA2-TRPV1/TRPA1 pathway.
摘要
Chronic bronchitis （CB） is a common respiratory system disease that is classified as a lung disease in traditional Chinese medicine （TCM） and is closely related to lung dysfunction. Lung Yang is the Yang Qi of the lungs，which drives the physiological activities within the lungs. It has physiological functions such as warming the lung system，regulating lung fluid，and dispersing the protective Yang. It can be distributed on the surface of the airway's Yin skin through sweat pores in the form of airflow and fluid，playing a protective and nourishing role. If the protective Yang fails to guard the Yin skin or if the lung fluid cannot nourish the Yin skin，the structural integrity of the airway's Yin skin may be compromised. This may weaken lung Yang's functions， such as clearing phlegm turbidity，dispersing lung fluid，and resisting external pathogens. Consequently， the retention of phlegm turbidity，insufficient nourishment of the Yin skin，and invasion by external pathogens all damage the lung Yang，burn the lung fluid，and exacerbate the pathological state of Yin skin unprotected，forming a vicious cycle that ultimately results in lung Yang asthenia and then the onset of CB. Based on the intrinsic connection between "Yin skin unprotected" and "lung Yang asthenia"，this paper interprets the etiology and pathogenesis of CB. It proposes that "Yin skin unprotected" in the airway is the basic cause of CB and "lung Yang asthenia" caused by "Yin skin unprotected" is the core pathogenesis of CB. By integrating micro differentiation indicators with macro differentiation syndromes， the study explores its modern biological basis. Guided by the theory of "warming the lung Yang and protecting the Yin skin" and based on modern pharmacology research，this study further explores the scientific connotation of single TCM and compound formulations for treating TCM by warming the lung Yang and protecting the Yin skin. Furthermore， it proposes methods for dispelling pathogenic factors and protecting the Yin skin during the acute exacerbation phase，as well as nourishing and warming lung Yang during the remission phase，in order to provide new ideas for the early prevention and treatment of TCM.
摘要
Aim To explore the effect of Tanxiang Qingyan Tablets on rat model with chronic bronchitisand the effect of MyD88/NF-κB/ICAM-1 signaling pathway expression in bronchopulmonary tissues of rats.Methods A rat model of chronic bronchitis was established by smoking method combined with lipopolysaccharide(LPS,2g·L-1)tracheal injection.The rats were randomly divided into normal group,sham operation group,model group,and positive drug(Guilong Ruikening tablets)1 g·kg-1)group,Tanxiang Qingyan Tablet high,medium and low dose(1.44,0.72,0.36 g·kg-1)group,with intragastric interventionin continuous 15 days.The pathological changes of bronchopulmonary tissues were observed by HE staining,and the infiltration of bronchial inflammatory cells was counted; ELISA method was used to detect the contents of tumor necrosis factor(TNF-α)and interleukin 10(IL-10)in peripheral serum; Western blot and immunohistochemical methodswere employed to detectmyeloid cell differentiation protein 88(MyD88),nuclear transcription factor-κB(NF-κB)and anti-intercellular adhesion molecule 1(ICAM-1)protein expression in bronchopulmonary tissues.Results Compared with normal group and sham operation group,the bronchial mucosal epithelial cells of model group were severely damaged,the alveolar septum was widened,the bronchial inflammatory infiltrationsignificantly increased,the serum TNF-α levels significantly increased,IL-10 levels decreased, and MyD88,NF-κB and ICAM-1 protein expression levels increased significantly(P<0.05,0.01)in bronchopulmonary tissues; compared with model group,the pathological damage and inflammatory changes of the bronchopulmonary tissues of rats in Tanxiang Qingyan Tablet group were reduced,and the serum TNF-α content was significantly reduced,IL-10 content did not change significantly,and MyD88,NF-κB and ICAM-1 protein expression levels in bronchopulmonary tissues were significantly down-regulated(P<0.05,0.01).Conclusions Tanxiang Qingyan Tablets can effectively improve bronchopulmonary tissue inflammatory infiltration,which may be related to reducing the release of inflammatory mediators such as TNF-α and regulating the expression of MyD88/NF-κB/ICAM-1 signaling pathway.
摘要
Objective:To explore the potential mechanism of Qingke Pingchuan granule in treating acute and chronic bronchitis complicated with chronic obstructive pulmonary disease （COPD） by network pharmacology. Method:The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP） was retrieved to collect the active components of Qingke Pingchuan granule and predict the action targets， followed by the construction of component-target network using Cytoscape 3.8. GeneCards， Online Mendelian Inheritance in Man（OMIM）， and DrugBank were used to harvest disease targets， whose names were put into UniProt for standardization. The treatment targets of Qingke Pingchuan Granule against the two diseases were obtained based on Venn diagram， which were then imported into the STRING platform for constructing the protein-protein interaction （PPI） network. Following the gene ontology（GO） and Kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis based on MetaScape， the active component-common target-signaling pathway network of Qingke Pingchuan granule against acute and chronic bronchitis complicated with COPD was finally constructed. The accuracy of the target was confirmed by literature. Result:A total of 165 active components， 374 related targets， 512 disease-related targets， and 130 common targets were obtained. Among them， the 14 core therapeutic targets were further subjected to GO enrichment analysis， which yielded 390 biological processes， nine cell components， and 23 molecular functions. The KEGG pathway analysis revealed 22 signaling pathways. Conclusion:Qingke Pingchuan granule alleviates the diseases possibly by regulating such targets as vascular endothelial growth factor receptor 2（KDR）， transforming growth factor beta-1 （TGF-<italic>β</italic><sub>1</sub>）， caveolin 1（CAV1）， hypoxia-inducible factor-1alpha（HIF-1<italic>α</italic>）， and interleukin-2（IL-2）， affecting the synthesis and transport of regulatory factors in cytoplasm， and controlling the cell proliferation and apoptosis.
摘要
Objective:To systematically evaluate the clinical efficacy of Tanreqing injection in the treatment of elderly chronic bronchitis. Method:CBM，CNKI，WanFang Data，VIP，PubMed，The Cochrane Library，Embase and other databases were retrieved by computer to screen out randomized controlled trials of Tanreqing injection in the treatment of elderly chronic bronchitis. The retrieval time was from the establishment to December 2019. After two researchers independently screened out the literatures according to the inclusion and exclusion criteria，extracted data and evaluated the literature quality，made meta-analysis using RevMan 5.3 software，and performed Egger test by Stata 14.0 software to evaluate publication bias. In case of any publication bias，clipping and supplementation method was further used to evaluate the effect of bias on the results. Result:A total of 48 studies were included，including 4 356 patients with diabetic nephropathy. The results of Meta-analysis showed that compared with conventional antibiotic therapy，the group of combination with Tanreqing injection was better than the control group in effective rate and lowering serum c-reactive protein （CRP） level，with statistically significant differences. The results of the publication bias test showed that a developmental bias in the effective rate. Further analysis based on the non-parametric clipping and supplementation method showed stable results of meta-analysis and no impact from potential publication bias. The adverse reactions had no statistically significance. Conclusion:This study shows that Tanreqing injection has a significant effect in treating chronic bronchitis in the elderly，and can reduce the serum CRP level of the patients. Compared with the conventional therapy group，the incidence of adverse reactions is not significantly increased，and the results need further clinical tests.
摘要
This study aims to explore the mechanism of fresh Phragmitis Rhizoma against chronic bronchitis airway inflammation. The SD rats of SPF grade were divided into control group, model group, Guilongkechuanning group(GLKCN, 1.125 g·kg~(-1)), high-dose fresh Phragmitis Rhizoma group(LG-HD, 15 g·kg~(-1)), and low-dose fresh Phragmitis Rhizoma group(LG-LD, 7.5 g·kg~(-1)). The chronic bronchitis models of rats in other groups except the control group were induced by the modified smoking method. From the 15 th day of modeling, the rats were given corresponding agents by gavage for 20 consecutive days. After the last administration, the rats were sacrificed for sample collection. Enzyme-linked immunosorbent assay(ELISA) was employed to detect serum transforming growth factor-β(TGF-β) and interleukin-6(IL-6) levels. The protein expression of TGF-β, IL-1β and IL-6 in lung tissue was detected by immunohistochemical method. Masson staining was performed to detect collagen fibers and muscle fibers in lung tissue, and HE staining to detect the pathological changes of lung tissue. Human bronchial epithelial(16 HBE) cells were cultured in vitro, and CCK-8(cell counting kit-8) method was used to detect the cytotoxicity of cigarette smoke extract(CSE) and fresh Phragmitis Rhizoma. After the exposure of 16 HBE cells to 3.5% CSE and appropriate concentration(800, 400 μg·mL~(-1)) of fresh Phragmitis Rhizoma for 24 h, quantitative real-time PCR was conducted to determine the mRNA levels of TGF-β and IL-1β, and Western blot was employed to determine the protein levels of TGF-β and IL-6 in the cells. The rat model of chronic bronchitis induced by smoking was successfully established. Fresh Phragmitis Rhizoma reduced serum TGF-β and IL-6 levels, down-regulated the protein levels of TGF-β, IL-1β, and IL-6 in lung tissue, and alleviated pathological changes and fibrotic lesions in lung tissue. Moreover, it down-regulated the CSE-induced protein expression of TGF-β and IL-6 as well as the mRNA level of TGF-β in 16 HBE cells. These results indicated that fresh Phragmitis Rhizoma could prevent airway inflammation from chronic bronchitis and promote cell repair by inhibiting the TGF-β signaling pathway.
Subject(s)
Animals , Rats , Bronchitis, Chronic/genetics , Drugs, Chinese Herbal/pharmacology , Inflammation , Lung , Poaceae/chemistry , Rats, Sprague-Dawley , Rhizome , Signal Transduction , Transforming Growth Factor beta/genetics摘要
The aim of this paper was to investigate the preventive and therapeutic effects of Xiaoer Feike Granules(XEFK) on chronic bronchitis in rats and its mechanism. Except for 10 rats in the blank group, the remaining 50 of the 60 SD rats were used to establish a model of chronic bronchitis induced by LPS. On the 22 nd day, the model rats were randomly divided into 5 groups according to their body weight, and administrated with purified water, Keteling Capsules 0.11 g·kg~(-1), XEFK 3.2, 1.6 and 0.8 g·kg~(-1)(the dosing concentrations were 0.32, 0.16, 0.08 g·mL~(-1), respectively). These rats took the corresponding drug orally once a day, for consecutive 21 days. The rats were anesthetized 1 hour after the last administration, and the lavage bronchus and alveoli were collected. Then, after the fixation of the smear, neutrophils were counted microscopically, and the contents of glutathione peroxidase(GSH-Px), superoxide dismutase(SOD) and malondialdehyde(MDA) in the bronchoalveolar lavage fluid(BALF) were detected by colorimetric method. Flow cytometry was used to detect the content changes of T cell subsets CD4~+, CD8~+, CD4~+/CD8~(+ )in serum. Hemorheology related indexes were detected by automatic hemorheology. Enzyme-linked immunosorbent assay(ELISA) was used to detect the contents of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), IL-2, IL-6 and IL-10 in serum. The expression of TNF-α and IL-10 mRNA in lung was detected by Real-time quantitative PCR(RT-qPCR). HE staining was used to observe the pathological changes in the bronchitis tissues. Compared with the model group, XEFK high and medium dose groups could significantly reduce the contents of neutrophils and MDA in bronchial lavage fluid, and increase the activities of GSH-Px and SOD in BALF, and repair the chronic inflammatory cell infiltration and lymphoid tissue hyperplasia in the bronchial mucosal layer and submucosal layer. The high-dose group could reduce the plasma viscosity of rats, but there was no statistical difference in other hemorheological indexes. CD4~+, CD8~+, CD4~+/CD8~+, IL-2 and IL-10 contents in each dose group were significantly increased, and TNF-α, IL-1β and IL-6 contents were significantly decreased in serum. Each dose group could significantly down-regulate the expression level of TNF-α mRNA in the lung and increase the expression of IL-10 mRNA. XEFK could reduce lipid peroxidation, increase the content of peripheral blood T cell subsets, regulate the release and secretion of inflammatory factors, and repair the morphological and pathological changes of bronchial tissue. Its mechanism might be related to the improvement of inflammatory response and the enhancement of immune function.
Subject(s)
Animals , Rats , Bronchitis, Chronic/drug therapy , Drugs, Chinese Herbal/pharmacology , Glutathione Peroxidase , Lipopolysaccharides , Lung , Rats, Sprague-Dawley , Tumor Necrosis Factor-alpha摘要
Background: Fired clay bricks, an important construction material, are manufactured in non-mechanized, labour intensive brick kilns which mostly employ unskilled men and women. The workers, as an occupational hazard, are exposed to dust and air pollution leading to respiratory diseases.Methods: This cross sectional study was conducted among brick kiln workers in RS Pura block of Jammu district. The workers were assessed regarding respiratory symptoms and illnesses using translated version of American Thoracic Society Division of Lung Disease questionnaire (ATS-DLD-78A).Results: 692 brick kiln workers were interviewed during the course of survey and 58.8%of them were males. 45% of the respondents were working since last less than three years. Among the respiratory symptoms chronic cough, was present in 23.55% and phlegm in 22.83% of the respondents. Chronic bronchitis was present in 20.52% of the respondents. Association of respiratory symptoms in relation to sex of the respondents was found to be statistically significant (p<0.05).Conclusions: Respiratory symptoms and illness were found to be quite prevalent in the brick kiln workers. More research needs to be conducted to assess other health risks besides respiratory morbidity. Health planners need to plan for their basic sanitation facilities and periodic check ups.
摘要
OBJECTIVE: To isolate and identify the total alkaloids from Aconitum excelsum and to study the therapeutic mechanism of the total alkaloids from Aconitum excelsum on chronic bronchitis in rats. METHODS: The total alkaloids from Aconitum excelsum was isolated by TLC and the structures of compounds were elucidated by a variety of spectral techniques. The rat model of chronic bronchitis (CB) was established with combined utilization of bacillus calmette-guerin and lipopolysaccharide, dexamethasone tablets and total alkaloids from Aconitum excelsum (high and low dose) were ig administrated. The pathological changes of lung tissue in rats were observed by HE and the level changes of interleukin-1 (IL-1), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in serum were determined by ELISA method. RESULTS: Seven alkaloids were identified from the total alkaloids of Aconitum excelsum. The administration of total alkaloids from Aconitum excelsum could decrease the degree of infiltration, epithelial cell shedding, bronchial secretion, inhibit the proliferation of bronchial epithelial cells of the rat bronchial inflammatory cells, and make the bronchial diameter increases and ventilation. The total alkaloids could significantly inhibit the increase of IL-1, IL-8 and TNF-α in the serum of rats with CB, compared with the model group with the statistical significance (P<0.05). CONCLUSION: The total alkaloids from Aconitum excelsum have the better treatment effect on CB, which may be related to its main chemical components, namely lappaconitine (1), ranaconitine (2), septentriod-ine (3), 6-demethyldelsodine (4), 6-methylumbrofine (5), 8-methyl-10-hydroxylycoctonine (6) and 8-methyllycoctonine (7).
摘要
To systematically review the effectiveness and safety of Tanreqing Injection in treating acute exacerbation of chronic bronchitis( AECB). CNKI,Wan Fang,VIP,CBM,Medline,Cochrane Library,EMbase and Web of Science were retrieved,and randomized controlled trials for the effect of Tanreqing Injection in the treatment of acute exacerbation of chronic bronchitis were screened. The quality of the included studies was evaluated according to the Cochrane Handbook's evaluation criteria. The data was analyzed by RevMan 5.3. Totally 23 RCTs involving 1 901 patients were included,including 952 in the experimental group and 949 in the control group. The Meta-analysis demonstrated that in terms of the disappearance time of fever,the group of Tanreqing Injection combined with the conventional therapy was superior to conventional therapy group( RR =-1. 03,95%CI[-1. 45,-0. 62],P<0. 000 01); compared with the conventional therapy group,the group of Tanreqing Injection combined with conventional therapy had a higher cure rate for AECB( RR = 1. 17,95% CI[1. 13,1. 23],P < 0. 000 01). The group of Tanreqing Injection combined with levofloxacin had a higher cure rate for AECB than the levofloxacin group( RR = 1. 23,95% CI[1. 08,1. 41],P = 0. 002). The group of Tanreqing Injection combined with cefuroxime had a higher cure rate for AECB than the cefuroxime group( RR = 1. 22,95%CI[1. 05,1. 42],P = 0. 01).The group of Tanreqing Injection combined with cefoperazone sodium and sulbactam sodium had a higher cure rate for AECB than the group of cefoperazone sodium and sulbactam sodium( RR = 1. 22,95% CI[1. 04,1. 44],P = 0. 02). The outcomes of disappearance time of cough and expectoration had a huge heterogeneity,so were used for descriptive analysis. The adverse reactions mainly included skin rash,dizziness,gastrointestinal reactions. Based on the available data and the results of the analysis,the group of Tanreqing Injection combined with Western medicine has a higher cure rate for acute exacerbation of chronic bronchitis,and the effect in reducing symptoms disappearance time. In view of the limited number of included studies,small sample size and low methodological quality,the results of this study need to be confirmed with high-level clinical trials.
Subject(s)
Humans , Bronchitis, Chronic/drug therapy , Disease Progression , Drugs, Chinese Herbal/therapeutic use , Injections , Randomized Controlled Trials as Topic摘要
Introducción. La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una patología no transmisible, caracterizada por una limitación de flujo de aire en las vías respiratorias debido a una respuesta inmunológica anormal frente a partículas. Objetivo. Conocer la eficacia que tiene la budesonida/formoterol comparado con la fluticasona/salmeterol en la mejoría de la capacidad pulmonar en personas mayores de 40 años con Enfermedad Pulmonar Obstructiva Crónica. Materiales y métodos. Se realizó una revisión sistemática de documentos producidos entre el año 2000 y 2018 en distintas bases de datos, donde se incluyeron ensayos clínicos. Se identificaron cuatro artículos para el análisis final. Resultados. Durante la evaluación comparativa de budesonida con formoterol, los artículos muestran un total de 709 personas evaluadas, con un promedio de edad de 53,5 años. El 65,4 % eran varones, el 21 % manifestaba no haber consumido tabaco, todos con diagnóstico de Enfermedad Pulmonar Obstructiva Crónica moderada-severa, según la escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Los estudios determinaron que al administrar budesonida/formoterol de 400/12 mcg y 320/9 mcg, los pacientes tuvieron una leve mejoría en el Volumen Espiratorio Forzado del primer segundo (VEF1). Solo dos pacientes presentaron efectos adversos. No obstante, para los resultados mencionados anteriormente no se encontró diferencias significativas. Conclusiones. El uso de budesonida/formoterol es eficaz al mejorar la capacidad ventilatoria pulmonar, disminuye el número de exacerbaciones anuales y genera un adecuado control de los síntomas, sin embargo, es igual de efectivo a la fluticasona/salmeterol.
Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a not transmissible disease, characterized by a limitation of airflow in the respiratory tract, due to an abnormal immune response to particles. Objective. This article aims to show that the application of budesonide / formoterol improves lung capacity in people over 40 years with Chronic Obstructive Pulmonary Disease. Materials and methods. A systematic review was conducted in the period between 2000 and 2018 in different databases where clinical trials were included. Four articles were identified for the final analysis. Results. During the comparative evaluation of budesonide with formoterol, a total of 709 people were evaluated, with an average age of 53.5 years, 65.4% were male, 21% reported not having used tobacco, all with a diagnosis of moderate-severe Chronic Obstructive Pulmonary Disease according to the GOLD scale (Global Initiative For Chronic Obstrutive Lung Disease). The studies determined that when budesonide / formoterol of 400/12 mcg and 320/9 mcg was administered, the patients had a slight improvement in the Forced Expiratory Volume of the first second (FEV1). Only two patients presented adverse effects. However, for the results mentioned above no significant differences were found. Conclusions. The use of budesonide / formoterol is effective in improving pulmonary ventilatory capacity, decreases the number of annual exacerbations and generates adequate control of symptoms, however, it is equally effective in fluticasone / salmeterol.
Introdução. A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia não transmissível, caraterizada por uma limitação do fluxo de ar nas vias aéreas devido a uma resposta imune anormal contra partículas. Objetivo. Conhecer a eficiência que apresenta a budesonida/formoterol comparado com fluticasona/salmeterol na melhora da capacidade pulmonar em pessoas com mais de 40 anos com Doença Pulmonar Obstrutiva Crônica. Materiais e métodos. Foi realizada uma revisão sistemática dos documentos produzidos entre 2000 e 2018 em diferentes bancos de dados, onde foram incluídos ensaios clínicos. Quatro artigos foram identificados para a análise final. Resultados. Durante a avaliação comparativa de budesonida com formoterol, os artículos mostram um total de 709 pessoas avaliadas, com uma idade média de 53,5 anos. O 65,4 % eram do sexo masculino, o 21 % disseram que não usavam tabaco, todos diagnosticados com Doença Pulmonar Obstrutiva Crônica moderada a grave, de acordo com a escala GOLD (Global Initiative For Chronic Obstrutive Lung Disease). Os estudos determinaram que administrar budesonida/formoterol de 400/12 mcg e 320/9 mcg, os pacientes apresentaram uma leve melhora no Volume Expiratório Forçado no primeiro segundo (VEF1). Apenas dois pacientes tiveram efeitos adversos. No entanto, não foram encontradas diferenças significativas para os resultados mencionados acima. Conclusões. O uso de budesonida/formoterol é eficaz na melhora da capacidade ventilatória pulmonar, diminui o numero de exacerbações anuais e gera controle adequado dos sintomas, no entanto, é igualmente eficaz para a fluticasona/salmeterol.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Pulmonary Emphysema , Efficacy , Budesonide , Bronchitis, Chronic , Salmeterol Xinafoate , Formoterol Fumarate , Fluticasone摘要
There are increasingly more data on the prevalence and distribution of Chronic Obstructive Pulmonary Disease (COPD) from around the world. COPD is predicted to be the third most frequent cause of death in the world by 2020. COPD is mainly caused by chronic tobacco smoking, which induces important changes in both the airways and lung parenchyma. COPD is a progressive, disabling condition that ultimately ends in respiratory failure and death. Is a multicomponent disease, there is evidence that systemic inflammation and extrapulmonary effects are also common in COPD, although the association between systemic inflammation and systemic manifestations of COPD is still not entirely clear. COPD has been associated with a nihilistic attitude. On the basis of current evidence, this nihilistic attitude is totally unjustified. The disease must be viewed through the lens of a new paradigm: COPD is not only preventable but also treatable. The past decade has witnessed great progress in COPD research. New drugs have been developed and tested and a growing base of scientific evidence now documents the efficacy of various therapies for symptoms and exacerbations. It is clear that many patients with COPD can benefit from aggressive management, with a decrease in the frequency of hospitalizations and improvements in symptoms and quality of life. In addition, basic and clinical scientists have now identified cells, mechanisms, and molecules that appear to play key roles in disease pathogenesis. Additional novel treatments are on the horizon and the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health. The good news about COPD is to increase awareness of the disease. COPD is now viewed under a new paradigm as preventable and treatable.
Subject(s)
Humans , History, 21st Century , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/mortality , Respiratory Function Tests , Tobacco Use Disorder , Bronchitis, Chronic , Pulmonary Disease, Chronic Obstructive/history , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/rehabilitation , Pulmonary Disease, Chronic Obstructive/therapy , Emphysema , Lymph Nodes摘要
Objective To compare the clinical characteristics of chronic bronchitis ( CB),emphysema (EM ), asthma - chronic obstructive pulmonary disease overlapping syndrome ( ACOS ) with frequent exacerbations ( FE ) or infrequent exacerbations ( iFE ) and induced sputum inflammatory cells and the heterogeneity of the transmitter. Methods Ninety-one cases of chronic obstructive pulmonary disease( COPD) with acute exacerbation were divided into CB,EM or ACOS phenotype,among which 44 were frequent,and 47 were non frequent. The clinical data,induced sputum inflammatory cells,interferon-γ(IFN-γ),tumor necrosis factor-α ( TNF-α ), interleukin ( IL )-4, IL-13 were analyzed. Results The FEV1% was ( 47 ± 13. 1 )%, significantly lower than that of non frequent episodes (( 56. 2 ± 10. 2)%),and the difference was statistically significant(P＝0.049).The FEV1/FVC% was (54.3±9.3)%,significantly lower than that of non frequent episodes (60. 1±7. 3)%,and there was a significant difference between them ( P＝0. 001) . The proportion of patients with GOLD III and IV,the percentage of neutrophils in induced sputum,tumor necrosis factor -α(TNF-α) and interferon-γin the patients with frequent episodes were significantly higher than those with non frequent episodes (P＜0. 05). Among them,FEV1/FVC% and TNF-αwere independent risk factors for COPD patients (P＝0. 032, 0. 021) . The FEV1% of patients with CB phenotypic frequent episodes were ( 47. 9 ± 14. 9 )%, significantly lower than that of non frequent episodes ((57. 2±10. 9)%)(P＝0. 000),and FEV1/FVC% was (53. 4± 9. 5)% in patients with CB frequent episodes,significantly lower than that of non frequent episodes ((60. 3±6. 9)%),and the difference was statistically significant (P＝0. 022),while the level of N%,TNF-α in induced sputum were significantly higher in CB phenotype subjects with FE than those in subjects with iFE(P＜0. 01). Patients with frequent episodes of emphysema had longer duration of disease (P＜0. 05),lower FEV1%and FEV1/FVC%(P＜0. 05),the proportion of GOLD III patients and the induced sputum TNF-αwere higher, but there was no significant difference in the number and proportion of phlegm inflammatory cells,interferon-γ, interleukin 4 and interleukin 3. The level of GOLD III and the IL-13 level of induced sputum in patients with frequent ACOS phenotype were significantly higher than those in patients with non frequent episodes (P＜0. 05) . Conclusion The lung function,the severity of the disease,the course of the disease,and the percentage of sputum neutrophils,tumor necrosis factor-α,or interleukin 13 are helpful in diagnosing patients with high risk of frequent episodes.
摘要
<p><b>OBJECTIVES</b>To investigate the mechanism of the Chinese medicine theory that Fei (Lung) and Dachang (Large Intestine) are exteriorly and interiorly related via synchronous observation on the dynamic changes of the respiratory and intestinal microflora.</p><p><b>METHODS</b>Forty specific pathogen free Sprague-Dawley rats were selected and randomly divided into blank (10 rats) and chronic bronchitis model groups (30 rats). The blank group rats were put into the smoke-free environment and the model group rats were put into the smoke environment in order to establish pulmonary disease (chronic bronchitis) model. Then the corresponding changes of the respiratory and intestinal microflflora of the model on 20th, 50th and 70th days were synchronously observed.</p><p><b>RESULTS</b>The respiratory tract microflflora showed an increase in the total aerobic and Staphylococcus aureus and reduced anaerobic amount signifificantly on 20th day in the respiratory tract microflflora (P<0.05 or 0.01). On 50th day, total aerobic, total anaerobic amount and bififidobacterium signifificantly increased (P<0.05). On 70th day, Staphylococcus aureus reduced and lactobacillus increased signifificantly (P<0.01). The intestinal microflflora showed an increase in the total aerobic, Clostridium perfringens, enterobacter and enterococcus significantly increased on 20th day (P<0.05 or 0.01). Staphylococcus aureus on 50th day increased significantly (P<0.05). Total aerobic and enterococcus increased, total anaerobic and Clostridium perfringens reduced signifificantly on 70th day (P<0.05 or 0.01).</p><p><b>CONCLUSION</b>The microecosystem of respiratory tract and intestine of rat model during the pathological process showed a dynamic disorder, indicating an interaction between the lung and large intestine which may be one of the connotations as they exteriorly and interiorly related.</p>
Subject(s)
Animals , Male , Bronchitis, Chronic , Microbiology , Pathology , Disease Models, Animal , Gastrointestinal Microbiome , Intestines , Microbiology , Lung , Microbiology , Rats, Sprague-Dawley , Time Factors摘要
To explore the medication rules of famous veteran traditional Chinese medicine (TCM) doctors in treatment of chronic bronchitis, a structured medical record database for famous veteran TCM doctors in modern clinical books was established. First, Lantern 3.1.2(Kongmin light) implicit structure analysis software was used to build an implicit structure model and make an implicit interpretation. Then, SAS 9.1 was adopted to mine herb-herb, herb-symptom and herb-syndrome association rules. Through the mining, 1 274 commonly used herbs for chronic bronchitis were found, including liquorice, bitter almond, pinellia, dried tangerine or orange peel, poria cocos. The medicine types included antiasthmatic medicine, qi-tonifying medicine, and heat-phlegm removing medicine. The medicine tastes included sweet, pungent and bitter. The meridian distributions included lung, spleen and stomach channels. The famous commonly used prescriptions included Xiaoqinglong decoction, Maxing Shigan decoction and Erchen decoction. The 147-herb implicit structure model for the first diagnosis was built to get 44 hidden variables, 88 hidden classes, 7 comprehensive clustering models, 9 dual herb associations, 50 triple herb associations and 89 quadruple associations. Totally 297 medical records for the second diagnosis were compared to obtain 24 herb-symptom associations, which reduced ephedra, bitter almond, pinellia and added poria cocos, atractylodes, dangshen, 20 dual herb associations and 8 triple herb associations. A model for the top 83 symptoms and top 96 herbs in the first diagnosis was built to get 50 hidden variables and 101 hidden classes. The commonly used herbs of famous veteran TCM doctors included bitter almond, pinellia, dried tangerine or orange peel, poria cocos, which feature mild property and sweet favor and enter lung, spleen, kidney meridians; the commonly herbal pairs included atractylodes and poria cocos, asarum, fructus schisandrae and pinellia, as well as poria cocos, dangshen, pinellia and dried tangerine or orange peel. The herb-syndrome associations involved ephedra, bitter almond, cassia twig and scanty sputum, pinellia and external cold and internal fluid syndrome, turbid phlegm obstructing lung syndrome and spleen deficiency syndrome, bitter almond and turbid phlegm obstructing lung syndrome, phlegm-heat accumulated in the lung and wind-cold invading the lung. The implicit structure model can be used to quantify tacit knowledge of TCM, extend to the herb and syndrome level for the first time, and quantify the major, minor and compatible statues of different variables in the same data. This study concluded that the medication rules of famous veteran TCM doctors in treatment of chronic bronchitis have certain reference value for the clinical diagnosis and treatment. The data sources, analysis methods and mining results were relatively reliable and objective, and can provide a reference for rules of other disease treatment based on syndrome differentiation.
摘要
Objective To observe the clinical therapeutic efficacy of N-acetylcysteine (NAC) on chronic bronchitis. Methods The data were retrieved by computer from data bases, including the data bases in Cochrane library, American National Library Pubmed, Holland Medical Digest EMBase, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Wanfang and the Chinese Journal of Science and Technology (VIP), starting from the dates of various database establishments to April 2017 for collecting the randomized controlled trials (RCTs) of using NAC combined with conventional drugs like ambroxol hydrochloride, montelukast or placebo (treatment group) and simply using the conventional drug alone as above conventional drugs (control group) for treatment of chronic bronchitis, and the therapeutic effects were compared between the two groups. The main indicators were total effective rate, lung function indexes [forced vital capacity (FVC), percentage of forced expiratory volume in one second (FEV1) / the predictive value (FEV1%)]; the secondary indicator was St. George Hospital Respiratory Questionnaire evaluation score (the SGRQ evaluation score). Document quality evaluation and data acquisition were carried out independently by two researchers. Meta-analysis was performed by using RevMan 5.3 software. A funnel graph was drawn to evaluate the article publication bias. Results There were 7 Chinese and 3 English RCTs, including 1521 patients in the study. The results of Meta analyses showed: NAC could elevate the overall therapeutic efficiency of patients with chronic bronchitis [relative risk (RR) = 1.17, 95% confidence interval (95%CI) was 1.10-1.25, P < 0.00001], FVC [mean difference (MD) = 0.22, 95%CI was 0.02-0.42, P = 0.03), FEV1% (MD = 4.10, 95%CI was 1.02-7.18, P = 0.005) and lower the SGRQ score (MD = -6.32, 95%CI was -10.48 to -2.17, P = 0.003), showing that the therapeutic effects on these aspects in using NAC treatment group were more prominent than those in the control group. The subgroup analyses showed that NAC combined with ambroxol hydrochloride could elevate overall therapeutic efficiency (RR = 1.20, 95%CI was 1.11-1.29, P <0.00001), FVC (RR = 1.18, 95%CI was 0.99-1.41, P = 0.04) and FEV1% (MD = 4.10, 95%CI was 1.02-7.18, P = 0.005), showing that the therapeutic effects on these aspects in using NAC combined with ambroxol hydrochloride group were more prominent than those in the control group; the total rate of therapeutic effect of NAC combined with montelukast was superior to that of the control group (RR = 1.12, 95%CI =1.03-1.22, P = 0.006); NAC combined with placebo in elevating FVC aspect was better than the control group (MD =-0.01, 95%CI = -0.02 to -0.01, P < 0.00001); funnel plots showed that no publication bias was found in the literatures in the study. Conclusion It is shown that NAC for treatment of chronic bronchitis can improve the overall therapeutic efficiency, lower the SGRQ evaluation score and elevate the lung function in FVC and FEV1% aspects, but no effect on FEV1/FVC.
摘要
Objective To analyze the effects of different nebulization methods in the treatment of chronic bronchitis. Methods During the period of May 2015 to February 2017 of chronic bronchitis 100 patients as studied objects, were randomly divided into control group and treatment group, the former for compressed atomization treatment, the latter for oxygen driven aerosol treatment. Statistical analysis of the overall curative effect of two groups were compared. Results The total effective rate in the treatment group, blood oxygen saturation, improve sputum volume and quality of life index and reference were similar to that of control group, but no statistical significance; clinical symptoms and signs disappeared time shorter than the reference group, have statistical significance (P<0.05). Conclusion Oxygen atomization inhaler and compression atomizing inhalation atomization inhalation machine for chronic bronchitis is the exact effect in the treatment, two treatment effect significantly, but the oxygen driven aerosol treatment in relieving clinical symptoms and signs of patients with the advantages of better than compression atomizing treatment.
摘要
Objective:To investigate the mechanism of chronic bronchitis with recurrent long duration infections in the production of MPO anti-neutrophil cytoplasmic antibodies(ANCA). Methods:Rats were gave intratracheal injection of LPS and smoked to established chronic bronchitis ( CB ) model. Rat neutrophils were incubated with phorbol-12-myristate-13-acetate ( PMA ) to induce Neutrophil extracellular traps(NETs). NETs were then used to immune chronic bronchitis rats. Serum concentrations of myeloperoxidase anti-neutrophil cytoplasmic antibodies(MPO-ANCA),Citrullinated Histone H3(CitH3),Interferon-α(IFN-α)were evaluated. Results:(1)The serum levels of MPO-ANCA in chronic bronchitis rats immuned with NETs(CB/NETs)were significantly higher than those in chronic bronchitis rats(CB)and healthy control rats,(62. 4975±19. 63764)ng/ml vs (17. 3806±4. 88649)ng/ml,(20. 8884± 4. 39607)ng/ml(both P<0. 01). (2)The serum levels of CitH3 in CB/NETs rat were significantly higher than those in CB rat and healthy control rats,(32. 5974±20. 2915)ng/ml vs (8. 8568±2. 36692)ng/ml,(5. 6225±0. 83738)ng/ml(P<0. 05,P<0. 01). (3)The serum levels of IFN-α were found increased sharply in two CB/NETs rats(3735.7,3428.4 pg/ml). (4)Renal function among three groups showed no significant difference yet. ( 5 ) Serum CitH3 level showed a positive correlation with serum MPO-ANCA level(r=0. 61,P<0. 05). Conclusion:Chronic bronchitis with recurrent infections could induce the production of ANCA probably by the stimulation of NETs,but whether it might develop to AAV remains need a duration.
摘要
Objective To observe the clinical therapeutic efficacy of N-acetylcysteine (NAC) on chronic bronchitis. Methods The data were retrieved by computer from data bases, including the data bases in Cochrane library, American National Library Pubmed, Holland Medical Digest EMBase, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), Wanfang and the Chinese Journal of Science and Technology (VIP), starting from the dates of various database establishments to April 2017 for collecting the randomized controlled trials (RCTs) of using NAC combined with conventional drugs like ambroxol hydrochloride, montelukast or placebo (treatment group) and simply using the conventional drug alone as above conventional drugs (control group) for treatment of chronic bronchitis, and the therapeutic effects were compared between the two groups. The main indicators were total effective rate, lung function indexes [forced vital capacity (FVC), percentage of forced expiratory volume in one second (FEV1) / the predictive value (FEV1%)]; the secondary indicator was St. George Hospital Respiratory Questionnaire evaluation score (the SGRQ evaluation score). Document quality evaluation and data acquisition were carried out independently by two researchers. Meta-analysis was performed by using RevMan 5.3 software. A funnel graph was drawn to evaluate the article publication bias. Results There were 7 Chinese and 3 English RCTs, including 1521 patients in the study. The results of Meta analyses showed: NAC could elevate the overall therapeutic efficiency of patients with chronic bronchitis [relative risk (RR) = 1.17, 95% confidence interval (95%CI) was 1.10-1.25, P < 0.00001], FVC [mean difference (MD) = 0.22, 95%CI was 0.02-0.42, P = 0.03), FEV1% (MD = 4.10, 95%CI was 1.02-7.18, P = 0.005) and lower the SGRQ score (MD = -6.32, 95%CI was -10.48 to -2.17, P = 0.003), showing that the therapeutic effects on these aspects in using NAC treatment group were more prominent than those in the control group. The subgroup analyses showed that NAC combined with ambroxol hydrochloride could elevate overall therapeutic efficiency (RR = 1.20, 95%CI was 1.11-1.29, P <0.00001), FVC (RR = 1.18, 95%CI was 0.99-1.41, P = 0.04) and FEV1% (MD = 4.10, 95%CI was 1.02-7.18, P = 0.005), showing that the therapeutic effects on these aspects in using NAC combined with ambroxol hydrochloride group were more prominent than those in the control group; the total rate of therapeutic effect of NAC combined with montelukast was superior to that of the control group (RR = 1.12, 95%CI =1.03-1.22, P = 0.006); NAC combined with placebo in elevating FVC aspect was better than the control group (MD =-0.01, 95%CI = -0.02 to -0.01, P < 0.00001); funnel plots showed that no publication bias was found in the literatures in the study. Conclusion It is shown that NAC for treatment of chronic bronchitis can improve the overall therapeutic efficiency, lower the SGRQ evaluation score and elevate the lung function in FVC and FEV1% aspects, but no effect on FEV1/FVC.