[Establishment and application effect appraisement of community chronic obstructive pulmonary disease integrated management system].

Objective: To establish the COPD community integrated management system suitable for our national situation and assess its effects in the prevention and treatment for COPD. Methods: The COPD community integrated management system based on the electronic management system was established, including the functional modules of preliminary screening for COPD, electronic health record, grading management and dual referral system, ect. Two townships were randomly selected from the rural areas in north Guangdong as Observational Community and Control Community, respectively. Resident families were randomly selected from the two communities. One resident aged 40 or higher who was selected randomly from each family was enrolled in the trial and followed up for 2 years.Of a total of 460 participants from the Observational Community, 340 participants accomplished the two-years the follow-up, among whom there were 45 COPD patients, 117 high risk population, 178 common population. Of a total of 380 participants from the Control Community, 212 participants accomplished the follow-up, among whom there were 39 COPD patients, 68 high risk population, 105 common population.According to the COPD community integrated management system, the health cares including preliminary screening for COPD, grading management and dual referral, ect. were implemented in the Observational Community. Essential diagnosis and treatment services were performed in the Control Community. The effects of the system were appraised by comparisons of the pulmonary function change, acute exacerbation, quality of life and change of risk factors, ect. between the two communities. Results: After the intervention, the follow-up rate, smoking-quitting rate, the proportions of decline in current smoking, passive smoking and switching to clean energy for cooking in the Observational Community were significantly greater than those in the Control Community(73.9% vs. 55.8%, 70.8% vs. 9.1%, 24.2% vs. 7.1%, 32.6% vs. 3.5%, 67.8% vs. 3.2%, respectively, P<0.05). COPD knowledge rates of residents in the Observational Community, including "knowing about COPD" , "knowing about the symptoms of COPD" , "Whether COPD can be prevented and treated" and "lung function test" were significantly greater than before (84.7% vs.30.0%, 76.4% vs.7.6%, 71.5% vs.6.8%, 72.1% vs.27.4%, respectively, P<0.05) and greater than those in the Control Community(84.7% vs.73.6%, 76.4% vs.9.4%, 71.5% vs.7.1%, 72.1% vs.32.5%, P<0.05). In the Observational Community, FEV(1) and FEV(1) %Pred were significantly greater than before (1.88±0.71 vs. 1.74±0.64, 75.6±25.0 vs. 69.4±20.5, respectively, P<0.05). The values of the difference before and after the experiment in the patients of GOLD 1 grade COPD in the Observational Community were greater than those in the Control Community(P<0.05). In the Control Community, FEV(1)、FEV(1) %Pred had no significant difference before and after experiment(P>0.05). In the Observational Community, 6MWD, standard treatment rate and exercises>3 days per week were significantly greater than before(550.5±76.0 vs. 474.7±75.9, 64.4% vs. 8.9%, 100% vs. 22.2%, respectively, P<0.05) and greater than those in the Control Community(550.5±76.0 vs. 404.5±56.7, 64.4% vs. 10.3%, 100% vs. 30.8%, respectively, P<0.05), acute exacerbation was significantly less than before (4.4% vs. 17.8%, P<0.05). In the Control Unit, 6MWD was significantly less than before (404.5±56.7 vs. 469.8±58.5, P<0.05). Conclusions: The COPD community integrated management system can play a great role in community integrated prevention for COPD.

[PM2.5 from traffic-related ambient air and wood smoke induces epithelial-mesenchymal transition in human bronchial epithelial cells].

Objective: To observe if arterial traffic ambient PM2.5 (TAPM2.5) and wood smoke PM2.5(WSPM2.5) exposure can induce epithelial-mesenchymal transition (EMT) in human bronchial cells (HBEC). Methods: PM2.5 was collected from an arterial traffic road and a typical southern kitchen, and then the collections were extracted by DMSO. The viability of HBEC was measured by Cell Counting Kit (CCK-8) after culture with PM2.5-DMSO extracts for 24 hours. The expressions of EMT markers, including E-cadherin, cytokeratin, α-smooth muscle actin (α-SMA), vimentin and collagen typeⅠ (COL-Ⅰ) in HBEC were assayed by cell immunofluorescence and Western blot analysis after exposed to two different sources of PM2.5-DMSO extracts for 14 days. Results: The cell viability of HBEC increased at low concentrations (1, 2, 10 µg/ml and 1, 5, 10 µg/ml, corresponding to [(118.4±13.7)%, (118.2±8.0)%, (123.0±19.6)% and (112.4±4.1)%, (120±5.4)%, (117.8±7.0)%, respectively, all P<0.05], and then declined at high levels [20, 100, 200 µg/ml and 15, 20, 30, 40 µg/ml, corresponding to (100.7±12.1)%, (53.4±15.3)%, (9.4±1.7)% and (106.8±10.0)%, (93.8±7.9)%, (60.9±9.5)%, (46.2±3.6)%, respectively, P values were 0.923, 0.000, 0.000 and 0.231, 0.278, 0.000, 0.000, respectively] in both TAPM2.5-DMSO and WSPM2.5-DMSO incubation. After exposure for 14 days, the cells lost their typical cobblestone-like shape which implied that EMT might occur. The same treatment caused decreased positive signals of E-cadherin and cytokeratin in a small proportion of the cells. The decreased expressions of cytokeratin were verified by Western blot (TAPM2.5 and WSPM2.5 were 0.063±0.109 and 0.039±0.313, P values were 0.033 and 0.030, respectively), while α-SMA was only significantly upregulated in the WSPM2.5-DMSO group (7.853±4.784, P=0.049). The expressions of E-cadherin decreased in both groups but not statistically significant in Western blot (0.862±0.096 and 0.817±0.212, P values were 0.228 and 0.117, respectively). Another marker of EMT, COL-I, markedly increased in both PM2.5 treatment groups (2.549±1.037 and 3.658±1.207, P values were 0.034 and 0.001). Conclusions: Both PM2.5 from arterial traffic ambient air and wood smoke could induce EMT in human bronchial epithelial cells, while WSPM2.5 appeared to have a more significant influence on EMT in HBEC.