Effect of chlormadinone acetate on sleep arterial oxygen desaturation in patients with chronic obstructive pulmonary disease

Twelve patients with chronic obstructive pulmonary disease (COPD) were studied in order to evaluate the effect of chlormadinone acetate (CMA), a potent synthetic progesterone, on the degree of hypoxemia during sleep. In patients designated as "correctors," in whom an increase in minute ventilation (VI) during wakefulness was brought about mainly by an increase in tidal volume (VT) and PaCO2 was effectively decreased by the administration of CMA, this agent also proved to be effective during sleep, with hypoxemia improved during both NREM and REM sleep. On the other hand, in patients called "noncorrectors" in whom a decrease in PaCO2 was not seen during wakefulness with CMA, there was also no effect during sleep. These results indicate that CMA is effective in certain selected patients with COPD.     

Effect of ultrasonic nebulization on arterial oxygen saturation in chronic obstructive pulmonary disease.

Twenty patients with mild to severe chronic obstructive pulmonary disease received ultrasonic nebulization to assess the danger of short-term changes in blood gas levels during this therapy. The status of arterial oxygenation was monitored during 20 minutes of therapy and for 20 minutes following therapy. In nine patients with periodic studies of arterial blood, the mean change in arterial oxygen pressure from base line was a decrease of 0.8 mm Hg at ten minutes into therapy, 2.8 mm Hg at the conclusion of therapy, and 2.9 mm Hg 20 minutes after therapy. In all 20 patients, ear oximetric studies showed only a small mean change at ten minutes into therapy, at the end of therapy, and at 20 minutes after therapy. Changes in the status of arterial oxygenation during and after therapy with ultrasonic nebulization in a group of patients with chronic obstructive pulmonary disease are generally small and of no statistical and limited clinical significance; however, alarming falls in arterial oxygenation can occur and cannot be predicted by base-line testing of pulmonary function or studies of arterial blood. It would be prudent to monitor patients with chronic obstructive pulmonary disease during therapy with ultrasonic nebulization or to withhold therapy altogether.     

Effect of nasogastric feedings on arterial oxygen tension in patients with symptomatic chronic obstructive pulmonary disease

Meal-induced hypoxemia may occur in asymptomatic patients with chronic obstructive pulmonary disease (COPD). The need to address the nutritional requirements in symptomatic COPD patients has recently been reported. Accordingly, we studied the effect of nasogastric feedings on arterial oxygen tension in patients receiving nasogastric feedings. Eleven patients studied had heterogeneous symptomatic COPD with various requirements for either bronchodilators, oxygen, or ventilator support. Samples for arterial blood gas (ABG) determinations were drawn (first ABG value) at the time of interrupting continuous feedings (75 ml/hr) or just before a small bolus feeding (75 ml). A repeat ABG sample (second ABG value) was drawn 30 minutes later. There was a small but statistically significant difference between the first and second arterial oxygen tension values. This difference, however, was not clinically significant. Our preliminary results suggest that symptomatic COPD patients experience hypoxemia with nasogastric feedings.     

慢性阻塞性肺疾病昼夜血氧变化及其临床意义

已有研究表明慢性阻塞性肺疾病(COPD)患者血氧的波动在氧化应激、炎症反应中均起重要作用[1]。由于COPD患者白天可能已有低氧血症,因此单纯夜间血氧饱和度水平不能真正反映昼夜血氧变化情况,而目前关于血氧的昼夜变化幅度对病情影响的研究较少。因此,本研究将从COPD患者昼夜血氧变化幅度的角度探讨其临床意义。     

Transcutaneous oxygen saturation and carbon dioxide tension during meals in patients with chronic obstructive pulmonary disease

The effect on transcutaneous SaO2 and transcutaneous carbon dioxide tension (PtCO2) of eating was assessed in 44 patients with severe COPD (FEV1 less than 50 percent). The SaO2, PtCO2, and heart rate (HR) were measured every minute before, during, and until 30 minutes after a standardized meal (445 kcal) was consumed. All patients were measured twice on the same day, while eating a meal with high (80 percent) and low (28 percent) carbohydrate content, respectively. The mean meal desaturation (delta SaO2) was less than 1 percent in normoxemic patients but was -3.2 +/- 0.7 percent (p less than 0.001) in hypoxemic (PaO2 less than 7.3 kPa) patients. Significant differences between hypoxemic patients with a delta SaO2 greater than 4 percent and less than or equal to 4 percent, respectively, were found in FEV1 (16 +/- 3 percent and 29 +/- 8 percent; p less than 0.001), respiratory muscle strength (3.9 +/- 1.2 kPa and 5.9 +/- 1.2 kPa; p less than 0.01), HR (112 +/- 12 beats per minute and 90 +/- 18 beats per minute; p less than 0.001), body weight (54.9 +/- 7.5 kg and 74.7 +/- 10.4 kg; p less than 0.001), and fat-free mass (42.0 +/- 6.6 kg and 52.6 +/- 5.8 kg; p less than 0.005) but not in baseline SaO2 and PtCO2. The decrease in SaO2 and the increase in HR were less during the carbohydrate-rich meal. No significant fluctuations in PtCO2 were found after either meal. Meal-related oxygen desaturation cannot explain weight loss in normoxemic patients with COPD but may contribute to a limited dietary intake in a subgroup of hypoxemic patients exhibiting marked oxygen desaturation during meals. A single carbohydrate-rich meal does not have an immediate impact on PtCO2 in stable COPD.     

Effect of posture on arterial oxygenation in patients with chronic obstructive pulmonary disease.

We studied 117 patients with chronic obstructive pulmonary disease (COPD) to evaluate (1) the frequency and magnitude of postural changes in resting arterial oxygenation and (2) the relationship of these changes to other measures of pulmonary function and exercise arterial blood gases. Compared to the supine measurement, room air PaO2 measured while standing increased more than 3 mm Hg in 28 patients (group 1), did not change (+/- 3 mm Hg) in 57 patients (group 2), and decreased more than 3 mm Hg in 32 patients (group 3) (range = 31 mm Hg increase to 20 mm Hg decrease). Patients in group 1 had significantly less severe disease than patients in the other two groups. There were no significant pulmonary function differences between groups 2 and 3. Supine PaO2 was similar for all groups, suggesting that standing PaO2 accounted for the postural change in PaO2. Because of unpredictable postural changes in PaO2 in patients with COPD, we believe that body position should be noted for arterial blood gas measurements and should be kept constant for valid comparison of serial measurements. These findings may also be important for other diffuse lung diseases.     

Effect of theophylline on sleep and sleep-disordered breathing in patients with chronic obstructive pulmonary disease

To investigate the effect of theophylline on sleep and sleep-disordered breathing in patients with chronic obstructive pulmonary disease (COPD), we studied 12 male nonhypercapnic subjects with a mean +/- SEM age of 62.8 +/- 2.5 yr and a FEV1 of 1.36 +/- 0.11 L using a randomized double-blind crossover protocol. Sustained-action theophylline (250 mg three times or four times a day) or placebo was administered for 2 days, and the alternate drug was administered on the following 2 days. Sleep studies were performed on Nights 2 and 4 with spirometry at 9:00P.M. and 7:00A.M. Two puffs of metaproterenol or albuterol were administered at 10:00P.M. on both study nights. A theophylline level, drawn at bedtime (10:00 to 11:00P.M.), was 14.2 +/- 0.78 micrograms/ml on the theophylline nights and less than 2 on placebo nights. The morning FEV1 was significantly better during theophylline administration (1.27 +/- 0.12 versus 1.00 +/- 0.11 L, p less than 0.001). The mean arterial oxygen saturation (SaO2) and transcutaneous carbon dioxide pressure (PCO2) were also better during NREM sleep on theophylline nights. Neither the mean SaO2 and transcutaneous PCO2 during REM sleep nor the apnea plus hypopnea index (events per hour of sleep) differed between placebo and theophylline nights. Theophylline administration did not impair the amount or architecture of sleep as neither total sleep time nor the fraction of time spent in Stages 1, 2, and 3/4 and REM differed between the two regimens. The number of arousals per hour of sleep was slightly less on theophylline nights (19.9 +/- 1.7 versus 24.9 +/- 2.7, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

阿托伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者慢性炎症反应的影响

目的 探讨阿托伐他汀对慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者慢性炎症反应的影响及其安全性.方法 选择COPD合并PH患者78例,随机分为阿托伐他汀组和常规组,两组各39例.常规组采用常规治疗措施治疗,阿托伐他汀组在常规组基础上加用阿托伐他汀.比较两组患者治疗前、治疗后3个月时炎性因子、一氧化氮(NO)、内皮素-1(ET-1)、肺动脉平均压(PAPm)、肺动脉收缩压(PAPs)及肺功能指标变化情况.结果 两组患者治疗后白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)、ET-1、肺动脉平均压(PAPm)、肺动脉收缩压(PAPs)水平均较治疗前明显降低(P＜0.05),但阿托伐他汀组降低程度更明显(P ＜0.05);NO、FEV1％、FVC较治疗前明显升高(P＜0.05),而阿托伐他汀组升高程度更明显(P＜0.05).阿托伐他汀组服药期间无明显不良反应发生.结论 阿托伐他汀可降低COPD合并PH患者的各种细胞炎性因子,减轻炎症反应,调节NO与ET-1的平衡,降低PH,同时减少肺损伤,改善肺功能,疗效安全可靠,可作为治疗COPD合并PH的有效药物.     

Baseline oxygen saturation predicts exercise desaturation below prescription threshold in patients with chronic obstructive pulmonary disease

BACKGROUND: Recent studies of exercise-induced hypoxemia in patients with chronic obstructive pulmonary disease (COPD) have shown that oxygen supplementation during exertion increases exercise tolerance and alleviates dyspnea. Although measurements of forced expiratory volume in 1 second and diffusion capacity for carbon monoxide (DLCO) are known to predict exercise-induced desaturation in patients with COPD, baseline oxygen saturation has never been studied as a predictor of exercise-induced desaturation. METHODS: A retrospective analysis was performed of 100 consecutive patients with forced expiratory volume in 1 second-forced vital capacity ratio of 70% or less who underwent exercise testing for desaturation. Any desaturation to 88% or less with exercise was considered significant. Nineteen patients with total lung capacity of 80% or less were excluded to avoid evaluating those with combined obstructive and restrictive defects; 81 patients remained available for study. RESULTS: Nineteen (51%) of 37 patients with resting saturation of 95% or less desaturated with exercise as opposed to 7 (16%) of 44 with resting saturation of 96% or greater (P =.001). The sensitivity and the negative predictive value of baseline saturation of 95% or less as a screening test for exercise desaturation were 73% and 84%, respectively. If all patients with DLCO of 36% or less were excluded, 40 patients were left for study. Eight (40%) of 20 patients with baseline saturation of 95% or less compared with 0 of 20 with resting saturation of 96% or greater desaturated with exercise (P =.006). In this subset, the sensitivity and the negative predictive value of baseline saturation of 95% or less as a screening test for exercise desaturation both improved to 100%. CONCLUSIONS: In patients with COPD, baseline saturation of 95% or less is a good screening test for exercise desaturation, especially in patients with DLCO greater than 36%. This readily available office screening procedure merits further study in larger prospective patient cohorts.     

Supplemental oxygen increases arterial stiffness in chronic obstructive pulmonary disease

STUDY OBJECTIVES: Recently, we demonstrated significantly improved baroreflex sensitivity (BRS) and autonomic balance after 31% supplemental oxygen (SuppO2) in resting patients with chronic obstructive pulmonary disease (COPD). In order to investigate whether peripheral arterial stiffness changes may play a role, we evaluated changes in peripheral arterial stiffness and BRS after SuppO2. DESIGN: Single blinded crossover design. SETTING: Pulmonary exercise testing laboratory. PARTICIPANTS: Seventy subjects with moderate to severe COPD. INTERVENTIONS: We measured arterial vascular stiffness using the augmentation index via contour analysis of the radial pulse obtained from applanation tonometry. BRS was derived using the sequence method before and after treatments with compressed air (CA) and 30% SuppO2 in 70 individuals with COPD via a counterbalanced crossover design. RESULTS: Paired t-tests indicated significant differences in oxygen saturation (SaO2) following SuppO2 when compared to CA (mean 96.0+/-2.0% SuppO2 versus mean 92.6+/-3.6% CA, P<0.001). BRS was significantly greater following SuppO2 compared to CA (mean 3.5+/-2.3 ms/mmHg SuppO2 versus mean 3.1+/-2.1 CA ms/mmHg, P<0.03). Vascular stiffness was significantly increased with SuppO2 when compared with CA (mean 13.3+/-6.1% SuppO2 versus mean 10.8+/-4.9% CA, P<0.001). CONCLUSIONS: Our findings indicate that oxygen supplementation ameliorates BRS by changes in vasomotor activity. The amelioration of the BRS into a more normal range is a move towards the restoration of more normal physiology.     

Effect of oxygen therapy on increasing arterial oxygen tension in hypoxemic patients with stable chronic obstructive pulmonary disease while breathing ambient air

Recertification for long-term oxygen therapy (LTOT) has been recommended for patients who are clinically unstable when home oxygen therapy is begun. Periods of observation for clinical stability have ranged from three weeks to three months in large multicenter clinical trials. There is concern, however, that an increase in arterial oxygen tension occurring after three months may be related to the beneficial effects of oxygen rather than to continued changes in clinical stability. In a review of 20 patients receiving transtracheal oxygen (TTO2) therapy, it was found that four (20 percent) did not qualify for oxygen therapy at the end of six months because the PaO2 breathing ambient air had increased to levels above 55 mm Hg. All patients were clinically stable at the time of insertion of the transtracheal catheter and all had been receiving nasal oxygen for at least seven months (mean, 25.8 months) before entering the study. A retrospective analysis of data published by Weitzenblum et al disclosed that four (25 percent) of 16 patients had a similar increase in PaO2 when reexamined after one year of oxygen therapy. All of the patients had been studied at least one year before oxygen therapy was initiated and each had three consecutive arterial blood gas measurements done monthly to ensure clinical stability. The increase in PaO2 to levels above 55 mm Hg observed in patients receiving TTO2 therapy was associated with a reduction in alveolar-arterial oxygen gradient; however, arterial oxygen desaturation with walking persisted. The specific mechanisms for improvement in PaO2 during oxygen therapy require further study. Any recommendation for recertification of LTOT must recognize that an increase in PaO2 after three months may be due to the beneficial effects of the oxygen therapy and does not provide prima facie justification for termination of therapy.     

Transtracheal oxygen delivery and patients with chronic obstructive pulmonary disease

A total of 43 severely ill COPD patients already on 24 h, or near 24 h, per day supplemental O2 were randomly assigned to transtracheal oxygen delivery (n = 22) or usual delivery of O2 by nasal cannula or face mask (n = 21). A few important changes were found in pulmonary function over time such as decreases of PEFR, FEF and MVV for both experimental and control groups, and FEV1% and FEV3% in experimental patients. At the same time, there was a significant decrease in both hematocrit and hemoglobin, and per cent shunting for the experimental group and a significant increase in per cent shunting in the control group. Physical, social and psychologic assessments showed significant improvement over time for experimental patients and declines for the control group. Lastly, medical costs were positively affected, as fewer days were spent in hospital post-study enrollment by experimental than control groups, and post-enrollment relative to pre-enrollment by experimental patients.     

Overlap syndrome: obstructive sleep apnea in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) and sleep apnea-hypopnea syndrome (SAHS) are both common diseases affecting respectively 10 and 5% of the adult population over 40 years of age, and their coexistence, which is denominated overlap syndrome, can be expected to occur in about 0.5% of this population. A recent epidemiologic study has shown that the prevalence of SAHS is not higher in COPD than in the general population, and that the coexistence of the two conditions is due to chance and not through a pathophysiologic linkage between these two diseases. Patients with overlap have a more important sleep-related O(2) desaturation than do patients with COPD with the same degree of bronchial obstruction. They have an increased risk of developing hypercapnic respiratory insufficiency and pulmonary hypertension when compared with patients with SAHS alone and with patients with "usual" COPD. In patients with overlap, hypoxemia, hypercapnia, and pulmonary hypertension can be observed in the presence of mild to moderate bronchial obstruction, which is different from "usual" COPD. Therapy of the overlap syndrome consists of nasal continuous positive airway pressure or nocturnal noninvasive ventilation (NIV), with or without associated nocturnal O(2). Patients who are markedly hypoxemic during daytime (Pa(O(2)) < 55-60 mm Hg) should be given conventional long-term O(2) therapy in addition to nocturnal ventilation.     

慢性阻塞性肺病患者进餐时持续脉氧饱和度监测及其临床意义

目的持续监测慢性阻塞性肺病(COPD)患者进餐时脉氧饱和度(SpO2),并探讨其临床意义。方法2004-11~2005-03对上海新华医院19例COPD患者连续观察其进餐前后脉氧饱和度和胸腹呼吸幅度大小的变化,并测定体重指数(BMI)和肺功能。结果COPD患者餐后SpO2显著低于餐前(P<0.01),胸部呼吸运动在进餐过程中幅度变化差异有显著性(P<0.01)。患者BMI与餐后SpO2呈负相关(P<0.05)。SpO2与肺功能FEV1%及FEV1/FVC存在相关性,而与胸部呼吸波幅变化差异无显著性(P>0.05)。结论COPD患者的营养状况可能与进餐后发生的缺氧,进而导致其摄食减少有关,在营养支持中应考虑采取适当措施干预进餐引起的低氧血症发生。     

长期氧疗对慢性阻塞性肺疾病患者的影响

本文首先介绍了慢性阻塞性肺疾病患者施行长期氧疗主要生理性改变,分析比较了国外关于长期氧疗对慢性阻塞性肺疾病患者病死率、肺功能、睡眠和运动等方面的影响,介绍了目前主要的氧疗指征,并进一步探讨了慢性阻塞性肺疾病患者施行长期氧疗可能的获益及如何预测长期氧疗的效果,从而提高对长期氧疗的全面认识.

Abstract：

This artical describes the major physiological changes of long-term oxygen therapy in chronic obstructive pulmonary disease (COPD) patients. Analysis long-term oxygen therapy on mortality in COPD patients, pulmonary function, sleep, exercise and other aspect in foreign countries, introduce the current main indications for oxygen therapy, and discussed futher in benefit of long-term oxygen therapy in patients with COPD, and how to predict the effects of long-term oxygen therapy, thereby improving the overall knowledge of the long-term oxygen therapy.     

Acute effect of oxygen on pulmonary arterial pressure does not predict survival on long-term oxygen therapy in patients with chronic obstructive pulmonary disease.

The growing number of patients treated with long-term oxygen therapy (LTOT) poses the question which physiologic variables could predict the patients who may benefit the most from this cumbersome and expensive treatment. We wanted to verify if the acute effect of oxygen on pulmonary arterial pressure (PAP) is related to survival on LTOT as was suggested recently in the literature. We studied 46 chronic obstructive pulmonary disease (COPD) patients qualified for LTOT. The acute effects of O2 on pulmonary hemodynamics were assessed by pressure and flow measurements before and after 30 min of O2 breathing via 28% Ventimask. Thirty-nine patients reacted with a fall of the mean PAP of less than 0.7 kPa 5 (mm Hg). These were termed nonresponders (NR). In seven patients, mean PAP fell greater than or equal to 0.7 kPa 5 (mm Hg). They were called responders (R). After the initial investigations, patients were followed up on LTOT for 2 yr or until death. During the first year, four patients died; three from the NR and one from the R group. After 2 yr of LTOT, 15 patients died (12 from NR and 3 from R groups). The 2-yr survival rate was 69% in NR and 57% in R groups, respectively. We conclude that survival on LTOT is not related to the acute effect of oxygen on the PAP in COPD patients investigated in the steady-state period of the disease.     

南京地区慢性阻塞性肺疾病患者的阻塞性睡眠呼吸暂停低通气综合征流行状况

目的探讨南京地区慢性阻塞性肺疾病(COPD)患者阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的发状况及其相关特征。方法对受试人群进行病情评估,内容包括:BMI、6 min步行试验测试、慢性阻塞性肺病评估测试(CAT)、Epworth嗜睡量表(ESS)测试、肺功能检测、多导睡眠监测(PSG)。结果共计纳入患者40例,其中患有重叠综合征(OS)的患者为21例(52.5%),仅患COPD而不存在OSAHS的为19例(47.5%)。两组间BMI、颈围有显著性差异。肺功能和6 min步行试验两组间均无显著性差异。多导睡眠监测结果提示两组间存在显著性差异,OS组呼吸暂停低通气指数(AHI)明显较高,为22.2±19.3次/h,而COPD非OSAHS组基本正常。CAT评分和ESS测试显示两组间有显著性差异。结论 C级至D级COPD患者具有较高的OSAHS发病率,OS患者较单纯COPD患者生活质量和睡眠质量更差。