[The characteristics and clinical manifestation of subjects with non-specific pattern of pulmonary function tests].

OBJECTIVE: To analyze the characteristics of pulmonary function and the clinical significance of non-specific pattern (NSP). METHODS: A total of 1933 pulmonary function tests of adult patients were analyzed, and those with NSP were selected. The pulmonary function test results, clinical diagnosis and radiological manifestations were analyzed. Normal distribution data were compared by t test, while non-normal distribution data were compared by Mann-Whitney U test, and χ(2) test was used to compare ratios. RESULTS: There were 61 patients in the NSP group and 1017 in the control group. The BMI of the 2 groups was (24.5 ± 4.6) and (24.5 ± 3.8) kg/m(2), respectively, being not significantly different (t = 0.008, P > 0.05). The age was 64 (49-74) years and 56 (42-70) years, and the smoking index was 0.4 (0-20) and 0 (0-10), respectively, showing no significant differences (Z values were -2.209 and -2.571, respectively, all P < 0.05). In the NSP group, FEV1 was 69% (66%-73%) predicted, FVC 75% (70%-77%) predicted, FEV1/FVC 75% (73%-78%), RV 118% (105%-145%) predicted, and TLC 86% (82%- 93%) predicted, which were significantly different as compared to those of the control group [95% (87%-104%), 98% (90%-106%), 79% (76%-84%), 101% (88%-114%) and 94% (88%-102%), respectively],(Z values are -13.059--5.185, all P < 0.05). RV/TLC was (52 ± 11)% in the NSP group and (39 ± 9)% in the control group, the difference being significant (t = -10.351, P < 0.05). The decreased TLC indicated restricted ventilation, while the increased RV and RV/TLC indicated air trapping. The clinical diagnosis of NSP included obstructive and restrictive diseases, some of which showed severe radiological abnormalities, but there were 31 patients without pulmonary lesions. CONCLUSIONS: Age and smoking, but not obesity, may play a role in NSP.NSP has characteristics of obstructive and restrictive ventilation defects, but does not associate with particular diseases, thus having limited clinical significance.

[Interventional effects of different management programs on the outcomes of stable chronic obstructive pulmonary disease patients].

OBJECTIVE: To evaluate the interventional effects of different management programs on the outcomes of stable chronic obstructive pulmonary disease (COPD) patients. METHODS: Systemic education, follow-up and control groups were divided according to the frequency of follow-ups and the profile of participating in education. A total of 157 patients were enrolled into the COPD database from May 2002 to May 2010. They were interviewed face-to-face at our department. The investigation contained general conditions, the frequency of acute exacerbations (AE) the previous year, COPD Assessment Test (CAT), Modified British Medical Research Council Dyspnea Scale (mMRC) and spirometric classification. A combined assessment was conducted. RESULTS: The frequency of AE and rate of AE < once the previous year in systemic education group was 0.9 ± 1.1 and 71.2%, 1.0 ± 0.8 and 68.6% in follow-up group and 1.4 ± 1.1 and 44.4% in control group. And the frequency of AE in systemic education and follow-up groups was significantly less than that in control group (P < 0.05). Rate of AE < once in systemic education and follow-up groups was significantly higher than that in control group (P < 0.01). CAT and rate of CAT ≤ 20 in systemic education, follow-up and control groups were 10.0 ± 5.0 and 96.2%, 11.1 ± 6.0 and 88.2%, 15.3 ± 6.8 and 64.8% respectively. CAT in systemic education and follow-up groups was significantly lower than that in control group (P < 0.01). Rate of CAT ≤ 20 in systemic education and follow-up groups was significantly higher than that in control group (P < 0.01). mMRC in systemic education, follow-up and control groups was 1.5 ± 0.8, 1.6 ± 0.9 and 2.1 ± 1.0 respectively. mMRC in systemic education and follow-up groups was significantly lower than that in control group (P < 0.05). Combined assessment showed that no significant difference existed in Types A and B among three groups (P > 0.05). Type C in the systemic education group was significantly higher than that of the control (P < 0.05). Type D in the systemic education and follow-up groups was significantly lower than that of the control (P < 0.01). CONCLUSION: Long-term systemic education and follow-up management program can reduce the frequency of AE of COPD effectively and improve the health status of COPD patients.

Comparison of symptom and risk assessment methods among patients with chronic obstructive pulmonary disease.

BACKGROUND: The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD) guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD (AECOPD). This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice. METHODS: A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test (CAT), Modified British Medical Research Council (mMRC) scale, and results of the lung function tests were recorded. RESULTS: Of the 194 patients assessed, 21 had a CAT score ≥10 and an mMRC grade ≤1, 13 had a CAT score <10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second (FEV1%) of <50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of ≥50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% <50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant (P = 0.004). The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant. CONCLUSIONS: The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease (GOLD) 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.