Respiratory symptoms and chronic obstructive pulmonary disease among cement factory workers

OBJECTIVES: This study assessed chronic respiratory symptoms and chronic obstructive pulmonary disease (COPD) among workers exposed to cement dust at a Tanzanian cement factory. METHODS: A total of 120 exposed workers and 107 controls participated in this cross-sectional investigation. Information on demographics, occupational history, chronic respiratory symptoms, smoking habits, and use of respiratory protection equipment was collected by questionnaire. Ventilatory function testing and measurement of personal total dust exposure were also carried out. COPD was diagnosed for workers with chronic bronchitis who also had spirometric airflow obstruction. Chronic respiratory symptoms and COPD were correlated with cumulative total dust exposure and adjusted for age, pack-years, and education. RESULTS: The exposed workers had more chronic cough [odds ratio (OR) 4.5, 95% confidence interval (95% CI) 1.9-10.4], chronic sputum production (OR 10.8, 95% CI 4.4-26.4.), dyspnea (OR 5.3, 95% CI 1.9-15.2), work-related shortness of breath (OR 4.8, 95% CI 1.6-14.2), and chronic bronchitis (OR 5.5, 95% CI 2.0-15.3) than the controls. Chronic cough, chronic sputum production, dyspnea, work-related shortness of breath, and chronic bronchitis were significantly related to cumulative dust exposure of 20.0-99.9 and > or = 100.0 versus <20.0 mg/m3-years. The prevalence of COPD was higher for the exposed group (18.8%) than for the controls (4.8%). The odds ratio for COPD was significantly increased for cumulative dust exposure, > or = 100.0 versus <20.0 mg/m3-years (OR 11.2, 95% CI 2.2-56.0). CONCLUSIONS: Cement workers seem to be at high risk of developing chronic respiratory symptoms and COPD, probably caused by cumulative total dust exposure independent of smoking habits.     

Reactive oxygen metabolites as an index of chronic obstructive pulmonary disease severity

AIM: The purpose of this study was to determine whether reactive oxygen metabolite species (ROMs) correlated with lung function in patients with chronic obstructive pulmonary disease (COPD) and to investigate whether ROMs could be used as an index of COPD severity. METHODS: ROMs were evaluated in plasma by a colorimetric method (d-ROM-test) in 94 patients with COPD and in 31 healthy nonsmokers subjects. Spirometry, exhaled carbon monoxide and pulse oxymetry was performed in all patients. RESULTS: Mean plasma ROMs were significantly increased (330.38 Carratelli units) in patients with COPD. There was a negative correlation of ROMs with forced expiratory volume in the first second (r= -0.275, P<0.007), with forced vital capacity (r= -0.278, P<0.007), with forced expiratory flow (r= -0.226, P<0.029) and with oxygen saturation (r= -0.315, P<0.010). In addition a positive correlation was found between the age of the patients and the oxidative stress (r= 0.366, P<0.000). CONCLUSIONS: These data indicate the presence of systemic oxidative stress in patients with COPD. The increased oxidative stress in COPD patients was concomitant with the impairment of lung function.     

慢性阻塞性肺疾病长期家庭氧疗的临床观察

目的 观察长期家庭氧疗(LTDOT)对慢性阻塞性肺疾病(COPD)患者的治疗效果.方法 将COPD患者随机分为LTDOT组和对照组,每组各26例,常规治疗相同,LTDOT组进行LTDOT,对照组在家无氧疗.两组于缓解期治疗前及治疗后2年测定肺功能、血气分析、进行生活质量评估等.结果 治疗后2年LTDOT组第1秒用力呼气容积(FEV1)为(1.42±0.42)L,动脉血氧分压(PaO2)为(80.0±2.6)mm Hg(1 mm Hg=0.133 kPa),与对照组的(0.72±0.38)L、(55.0±2.2)mmHg比较差异有统计学意义(P<0.01);最大肺活量、动脉血二氧化碳分压两组比较差异无统计学意义(P>0.05);生活质量评分LTDOT组优于对照组;LTDOT组急诊次数为(2.3±1.2)次,住院时间为(16.0±2.4)d,与对照组的(5.2±1.3)次、(36.0±2.2)d比较差异有统计学意义(P<0.01).结论 COPD缓解期患者行LTDOT能增加FEV1、PaO2,提高生活质量,减少急诊次数和住院时间.     

Nutritional and pulmonary function assessment in patients with chronic obstructive lung disease

This investigation was undertaken to determine the prevalence and degree of malnutrition among patients with chronic obstructive pulmonary disease and to determine if a relationship exists between nutritional assessment parameters and pulmonary function. Thirty-seven patients admitted for the treatment of chronic obstructive pulmonary disease to a respiratory care unit of a Veterans Administration facility were studied. Nutritional status was evaluated using anthropometric measurements, laboratory data and immunologic assay. Deficits in anthropometric measurements were frequent and severe in this group of patients. Furthermore, our data demonstrated that patients with a forced vital capacity <30% of predicted value had significantly reduced lean body mass as measured by the mid-arm muscle circumference (p<0.05). Investigation of the nutritional status of patients with chronic obstructive pulmonary disease using controlled nutrition intervention trials may elucidate the relationship of nutritional state to pulmonary function in this group of patients.     

Circulating visfatin in chronic obstructive pulmonary disease

ObjectiveMalnutrition and continuous systemic inflammation occur frequently in patients with chronic obstructive pulmonary disease (COPD). Visfatin is a new adipokine, which increases in some inflammatory diseases. Its plasma level and relation with nutritional status and inflammation in COPD remain unknown. This study compared visfatin levels, nutritional status, and inflammation markers in patients with COPD and healthy controls.MethodsPlasma visfatin, tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were measured in 35 patients with COPD and 28 healthy controls. Body composition was assessed with bioelectrical impedance analysis.ResultsSignificantly lower body mass index and percentage of body fat were observed in patients with COPD compared with control subjects. The levels of plasma visfatin were higher in the COPD group compared with healthy controls (2.07 ± 0.18 versus 1.88 ± 0.15 ng/mL, P < 0.001). Levels of TNF-α and CRP were also significantly higher in patients with COPD compared with controls. Plasma CRP and TNF-α were positively correlated with visfatin in the COPD group. No significant correlations were found between visfatin and body mass index or percentage of body fat in both groups.ConclusionPlasma visfatin levels increased in patients with COPD. This increased adipocytokine was significantly correlated with TNF-α and CRP. Visfatin may be a new proinflammatory adipocytokine in this disease.     

Exacerbations of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterised by a progressive decline in lung function, reduced exercise performance, and worsening of health status. Exacerbations are important clinical events in chronic obstructive pulmonary disease and are defined as sudden worsening of respiratory symptoms and function requiring medical intervention. The most common causes of chronic obstructive pulmonary disease exacerbations are bacterial or viral infections, but comorbidity may be important. A major issue is the decision regarding home management or hospital management of exacerbations. Because of exacerbations, a frequent assessment of severity of chronic obstructive pulmonary disease is required for targeting pharmacological therapy.     

Epidemiology of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality, all over the world. COPD, which was the sixth leading cause of death worldwide in 1990, will become the third one in 2020. COPD is a complex disease, influenced by genetic, behavioral, and environmental factors. The most important factor for developing COPD is tobacco smoke. Also environmental conditions represents risk for developing COPD. Furthermore, diet and a low socioeconomic status are correlated to the disease. Genetic factors, familial history, and childhood lower respiratory tract infections play an important role in the etiology of COPD. Burden of COPD is very high for community. Furthermore, the disease often is under-diagnosed and treated only at advanced stages, whilst it is a substantial health problem even among young adults. This needs to be taken into account by health personnel and decision-makers.     

Pathology of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disorder of the lung characterized by poorly reversible airflow limitation. It is not a unique disease entity but rather a complex of conditions which include emphysema, chronic bronchitis and, sometimes, asthma. Moreover, COPD is a progressive disease often associated with exacerbations. Cigarette smoking, which is the most important risk factor for the development of COPD, induces pathological changes involving lung parenchyma, peripheral airways and central airways. Since lung parenchyma and peripheral airways are the sites responsible for airflow limitation and central airways are the main site of mucus hypersecretion, pathological changes in these compartments may be relevant in the development of COPD.     

Pathophysiology of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a disease state characterised by airflow obstruction that is not fully reversible and progressive. Symptoms, as cough, sputum production and dyspnoea, functional impairment and complications of COPD can all be explained on the basis of the underlying lung inflammation and the resulting pathology. The chronic airflow obstruction is caused by a mixture of small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema). On one hand, chronic inflammation causes remodelling and narrowing of the small airways. On the other hand, destruction of the lung parenchyma, also by an inflammatory process, leads to the loss of alveolar attachments to the small airways and decreases lung elastic recoil. In turn, these changes reduce the ability of the airways to remain open during expiration.     

肺功能康复治疗老年慢性阻塞性肺疾病临床观察

目的 近年来,国外已开展防治慢性阻塞性肺疾病(COPD)患者肺功能康复计划,然而国内关于肺功能康复干预仍处于摸索阶段.本研究探讨老年COPD患者肺功能康复的临床疗效.方法 选取2018-07-01-2019-07-01河南大学第一附属医院收治的老年COPD患者60例为研究对象,采用性别、年龄、病程和体质量等一般资料组间...     

Pulmonary function and the risk of functional limitation in chronic obstructive pulmonary disease

The authors' objective was to analyze the impact of respiratory impairment on the risk of physical functional limitations among adults with chronic obstructive pulmonary disease (COPD). They hypothesized that greater pulmonary function decrement would result in a broad array of physical functional limitations involving organ systems remote from the lung, a key step in the pathway leading to overall disability. The authors used baseline data from the Function, Living, Outcomes, and Work (FLOW) study, a prospective cohort study of adults with COPD recruited from northern California in 2005-2007. They studied the impact of pulmonary function impairment on the risk of functional limitations using validated measures: lower extremity function (Short Physical Performance Battery), submaximal exercise performance (6-Minute Walk Test), standing balance (Functional Reach Test), skeletal muscle strength (manual muscle testing with dynamometry), and self-reported functional limitation (standardized item battery). Multiple variable analysis was used to control for confounding by age, sex, race, height, educational attainment, and cigarette smoking. Greater pulmonary function impairment, as evidenced by lower forced expiratory volume in 1 second (FEV(1)), was associated with poorer Short Physical Performance Battery scores and less distance walked during the 6-Minute Walk Test. Lower forced expiratory volume in 1 second was also associated with weaker muscle strength and with a greater risk of self-reported functional limitation (p < 0.05). In conclusion, pulmonary function impairment is associated with multiple manifestations of physical functional limitation among COPD patients. Longitudinal follow-up can delineate the impact of these functional limitations on the prospective risk of disability, guiding preventive strategies that could attenuate the disablement process.     

噻托溴铵对轻中度慢性阻塞性肺疾病患者肺功能的影响

目的评估噻托溴铵对轻中度慢性阻塞性肺疾病（COPD）患者肺功能的影响。方法将80例轻中度COPD患者按随机数字表法分为噻托溴铵组（40例）和对照组（40例）,治疗周期为12周,两组患者均经过1周的清洗期,清洗期患者吸入0．9％氯化钠。第2～12周为治疗期,噻托溴铵组患者吸入噻托溴铵干粉胶囊（18μg／粒）,上午给药,每日1次;对照组患者则继续吸入0．9％氯化钠。分别于治疗前及治疗后第6,12周测定患者的肺功能。结果经过连续12周的治疗后,噻托溴铵组肺功能指标深吸气量、第1秒用力呼气容积和用力肺活量均得到明显改善,较治疗前分别增加了（0．43±0．15）,（0．17±0．11）和（0．41±0．14）L,而对照组上升幅度无明显改善,仅分别增加了（0．10±0．12）,（0．01±0．05）和（0．05±0．12）L,两组比较差异有统计学意义（P〈0．05）。两组不良反应发生率和COPD急性发作率比较差异无统计学意义（P〉0．05）。结论轻中度COPD患者每日1次吸入噻托溴铵（18μg）可以显著改善患者的肺功能。     

2003—2016年上海市杨浦区阻塞性肺疾病死亡趋势分析

了解上海市宝山区户籍居民10年间慢性阻塞性肺疾病（COPD）的死亡率和潜在寿命损失年数（PYLL）的变化情况,为今后开展COPD防治工作提供策略和依据。

基于2010—2019年上海市宝山区居民死因监测系统,采用Excel 2010软件、SPSS 22.0软件和Joinpoint回归模型整理历年数据并综合分析,计算粗死亡率、标准化死亡率、年龄别死亡率、PYLL、年度变化百分比（APC）等指标。

2010—2019年间,上海市宝山区COPD年均粗死亡率为48.08/10万,标化后死亡率为39.95/10万,占同期总死亡人数的5.82%,位列宝山区死因顺位第3位。10年间,COPD男性粗死亡率、标化死亡率始终高于女性（P<0.01）。COPD粗死亡率和标化死亡率随年份增加均呈下降趋势（P<0.001）。COPD死亡率随年龄的增长呈现上升的趋势,其中≥75岁组的死亡占比最高,占全年龄段的85.71%。因COPD死亡所导致的PYLL总计为2 352.5年,其中男性为1 977.5年,女性为375.0年,COPD导致的每万人中的男性减寿年数（4.18年）远高于女性（0.82年）。

2010—2019年间上海市宝山区户籍居民COPD标化后死亡率呈明显下降趋势,但由于COPD患病带来的疾病负担重,尤其对老年、男性居民的健康危害影响深远,建议将COPD作为公共卫生服务中慢性病防制的重点疾病,并采取有效的干预防制措施。

     

Preserved muscle metaboreflex in chronic obstructive pulmonary disease

The objective of this study was to measure the magnitude of the muscle metaboreflex in people with chronic obstructive pulmonary disease (COPD) compared with healthy controls and to assess the relationships between disease severity, exercise capacity, and the magnitude of the muscle metaboreflex. Nine people with mild-to-severe COPD and 11 age- and gender-matched healthy controls performed isometric handgrip exercise (IHG), followed by postexercise circulatory occlusion (PECO) while hemodynamic changes were measured. Continuous measures of heart rate, arterial pressure, leg blood flow, leg vascular resistance, and total peripheral resistance were obtained. Participants then performed a cycle test to exhaustion. Heart rate, blood pressure, and blood flow responses during IHG and PECO were similar between the COPD group and healthy controls (p > 0.05). There was no association between disease severity or exercise capacity and the magnitude of the muscle metaboreflex. We observed a preserved muscle metaboreflex in mild-to-severe COPD, suggesting the metaboreflex is not a contributing factor to the development of exercise intolerance in this population.