老年慢性阻塞性肺病患者肺功能10年随访研究

目的：探讨老年慢性阻塞性肺病（COPD）患者肺功能10年变化规律，方法：严格挑选入选研究对象共89例，I组为20例不吸烟健康老年人，II组为9例不吸烟老年COPD患者，III组为20例已戒烟轻度肺气肿患者，IV组为20例已戒中度肺气肿气肿患者，V组为20例已戒烟重度肺气肿患者，III，IV，V组肺气肿患者在入选时均已戒烟10年以上，肺功能按常规方法检查，结果：10年后肺功能实测值与衩始肺功能值相比均有改变，以戒轻后轻，中，重度肺气肿患者最为明显，其中第1秒用力呼气容积（FEV1），呼气峰流速（PEF），最大呼气中期流量（MMEF），最大通气量（MVV）改变差异有显著性（P＜0．05或P＜0．01），已戒烟的轻，中度肺气肿患者用力肺活量（FVC）差异亦有显著性（P＜0．05）， 老年不吸COPD患者肮功能年改变值与不吸烟健康老年人的肺功能名项指标比较，肺活量（P＜0．01），已戒烟不同程度的COPD患者肺功能年改变值差异无显著性（P＞0．55），结论：肺功能随增龄而减退，不吸烟老年COPD患者肺功能改变要重于不吸烟健康老年人肺功能改变，COPD患者，尽管戒烟10年以上，但10年前，后肺功能多数指标减退明显，不同程度的COPD患者之间肺功能年改变值差异不明显。     

脉冲震荡法测定吸烟者肺功能分析

目的 探讨脉冲震荡（IOS）法测定吸烟者肺功能的变化。方法 应用IOS及常规通气功能测定我院2003年10月至2005年12月878例患者肺功能,吸烟者706例,非吸烟者172例。结果 吸烟可损害肺通气功能,IOS肺功能测定,能更早发现吸烟的肺损害,其中Fers这一指标最为敏感。结论 吸烟对肺功能的损害是肯定的,长期较大量吸烟者肺功能的损害尤为明显。     

老年肺功能改变及其与胸腹手术后并发症的相关性分析

目的观察老年人肺功能的变化,分析老年人吸烟/慢支病史时行胸、腹部手术的并发症发生情况。方法健康成年人35例与健康老年人20例的肺通气、弥散功能指标对比,分析52例患胆石症、前列腺增生、肺癌病人经不同术式,并发症出现的关系。结果发现健康老年组的MVV、V.25、FEV1、V.75、DLco减少,RV增加(P<0.05),FVC、V.50、TLC变化不明显。并发症发生率胸部手术31.8%,腹部手术6.25%。胸部手术的吸烟组/慢支病史组肺功能受损100%,并发症发生60%,而不吸烟组/无慢支病史组肺功能受损66.7%,并发症8.3%。前列腺增生组肺功能受损28.6%,并发症为零,胆石症组肺功能减退56.3%,并发症12.5%。结论老年人随年龄增加可出现肺通气功能和弥散功能功能减退。在胸、腹部手术比较中,吸烟组/慢支病史组并发症大于不吸烟组/无慢支病史组,胸部手术大于腹部,上腹部手术大于下腹部手术。     

214例老年人肺弥散功能测定分析

目的探讨健康老年人和老年ＣＯＰＤ患者肺弥散功能差异和临床应用价值。方法用美国６２００ＡｕｔｏｂｏｘＤＬ型体积描记仪分别测定９７例健康老年人和１１７例ＣＯＰＤ患者的肺弥散功能。结果慢支组与健康组比较肺一氧化碳弥散量（ＤＬＣＯ）差异非常显著（Ｐ＜０．０１）。轻、中、重度肺气肿组与健康组比较ＤＬＣＯ、弥散量／肺泡容积比值（ＤＬＣＯ／ＶＡ）、转送系数（Ｋｃｏ）、弥散时间常数（ＣＯＴ．Ｃ．）相差非常显著（Ｐ＜０．０１）。结论老年人患有慢性呼吸道病变时，肺弥散功能测定是一项较为敏感的指标，常在其他肺功能检查出现异常之前就已有变化。     

运动、吸烟和饮食咸淡对老年人健康的影响

目的　探讨如何为指导老年人提高生活质量和保健提供科学依据。方法　对长春市三级中心男女老年人进行分类分组 ,分运动与非运动组、吸烟与非吸烟组 ,饮食清淡组与喜咸组 ,进行肺功能及血清 HDL- C测定。结果　运动有助于提高老年人肺功能和血清 HDL- C含量 ,喜淡饮食有助于提高血清 HDL- C含量。结论　吸烟有害 ,可降低肺功能 ,运动和喜淡饮食有益于老年人健康。     

呼吸系统疾病

20003059吸烟及运动对老年人肺功能的影响/王萍…//中华老年医学杂志一2。()0,19(2)一144一145 15。名肺功能值1997年较此年前均有下降,吸烟组(32例)通气功能、小气道功能、弥散功能随年龄增长下降的速度比预计值快。与不吸烟组(60名)比较,各指标1984年差异无显著性,1997年差异有极显著J性。吸烟组FEVI年平均下降80 nll,而不吸烟组下降46 ml。戒烟组(58例)与不吸烟组无显著差异。示戒烟可延缓肺功能的下降,长期戒烟,小气道功能有所恢复。长期适量运动,通过调动心肺功能的潜力,有利于保持和改善肺功能。表2参2(梁一伍)20003060 80例革兰氏…     

老年男性健康人和慢性阻塞性肺疾病患者的骨密度改变

通过测定健康青年人、健康老年人及老年肺气肿、肺心病患者骨密度的变化，了解骨密度与年龄，老年人慢性阻塞性肺疾病的关系。应用ＤＰＸ－Ｌ型双能Ｘ线骨密度测定仪分别对３０例青年、３６例老年男性健康人及３０例肺气肿，肺心病患者进行股骨，腰椎骨密度测定，对２０例健康老年人和ＣＯＰＤ患者动脉血气进行测定。老年ＣＯＰＤ组的股骨颈、股骨三角、股骨粗隆和腰椎骨密度分别为０．７８±０．１３、０．６０±０．１３、０．７１     

辽宁省六城市4168例老年吸烟者流行病学调查及肺功能检测情况

目的 了解老年人吸烟的流行病学状况及吸烟后对肺功能的影响.方法 对辽宁省六城市部分社区的60岁以上老年人采用统一问卷调查及体检,总结相关的流行病学特征,并经筛选和剔除后,对4168例吸烟者及3598例非吸烟者进行肺功能测定.结果 60岁以上老年人吸烟者占到同年龄人群的30.89％.吸烟者的肺功能指标低于非吸烟者:肺容积指标残气量(RV)/肺总量(TCL)比较,有显著性差异(P＜0.05)；肺通气功能指标一秒钟用力呼气容积( FEV1)、FEV1用力肺活量(FVC)％比较,有显著性差异(P＜0.05)；反映小气道功能的指标MMEF比较有显著性差异(P＜0.001),而且其降低程度与年龄呈正相关.结论 吸烟对老年人肺功能的损伤不容忽视,应尽早戒烟,保护老年人的肺功能.     

慢性阻塞性肺疾病患者血清IL-21、IL-17、TLR4的表达及临床意义

目的探讨慢性阻塞性肺疾病(简称慢阻肺)稳定期患者血清白细胞介素-21(Interleukin-21,IL-21)、白细胞介素-17(Interleukin-17,IL-17)、Toll样受体4(Toll-like receptor 4,TLR4)的表达水平及三者与肺功能指标第一秒钟用力呼气容积占预计值百分比(FEV_1%pred)及健康损害程度的相关性。方法 70例吸烟慢阻肺稳定期患者为慢阻肺组,70例健康吸烟者为健康吸烟对照组,70例健康非吸烟者为健康非吸烟对照组,采用酶联免疫吸附(ELISA)法测定各组血清IL-21、IL-17、TLR4的表达水平;应用德国耶格肺功能仪检查各组肺功能指标FEV_1%pred;用慢阻肺评估测试量表(CAT)评分,评定慢阻肺患者的健康损害程度;分析血清IL-21、IL-17、TLR4表达水平与FEV_1%pred、CAT评分的相关性。结果慢阻肺稳定期组血清IL-21、IL-17、TLR4的表达水平均高于健康吸烟对照组及健康非吸烟对照组,(P均0.05);慢阻肺稳定期患者血清中IL-21、IL-17、TLR4表达水平与FEV_1%pred均呈负相关(r=-0.586、-0.703、-0.638,P均0.05);慢阻肺稳定期患者血清IL-21、IL-17、TLR4表达水平与CAT评分均呈正相关(r=0.718、0.677、0.596,P均0.05)。结论慢阻肺稳定期患者血清IL-21、IL-17、TLR4表达水平增高,且三者均与患者肺功能指标FEV_1%pred、健康损害程度具有相关性。     

体外膈肌起搏改善老年人肺通气功能30例报告

体外膈肌起搏改善老年人肺通气功能３０例报告江苏省苏州市第二人民医院（２１５００２）赵建华蔡薇盛传勤慢性呼吸系统疾病是老年人常见病、多发病，且病程较长，常使患者肺功能有不同程度损害，使老年人生活质量下降。近年来我科采用体外膈肌起搏治疗肺通气功能受损患者...     

Possible effects of vascular endothelial growth factor in the pathogenesis of chronic obstructive pulmonary disease

PURPOSE: Expression of vascular endothelial growth factor (VEGF) is reduced in the lungs of patients with emphysema. We examined whether VEGF levels in sputum differed in patients with emphysema, bronchitis, or asthma, as compared with controls. METHODS: Fifty-nine patients with chronic obstructive pulmonary disease (COPD) (25 with emphysema, 19 with chronic bronchitis, and 15 with a mixed type), 20 patients with bronchial asthma, and 11 normal controls were included in the study. The concentration of VEGF in induced sputum and the correlations between VEGF levels and pulmonary function were examined. RESULTS: The mean (+/- SD) concentration of VEGF in induced sputum was significantly higher in patients with asthma (6440 +/- 1820 pg/mL, P <0.0001) or bronchitis (4120 +/- 1100 pg/mL, P <0.0001) than in normal controls (1860 +/- 1220 pg/mL), but significantly lower in patients with emphysema (500 +/- 300 pg/mL, P =0.03). The concentration of VEGF in sputum from patients with bronchitis correlated inversely with forced expiratory volume in 1 second (r = -0.87; P =0.0002); in contrast, there was a positive correlation between these two measurements in patients with emphysema (r = 0.82; P <0.0001). In addition, sputum VEGF concentrations correlated with the diffusing capacity of carbon monoxide in patients with emphysema (r = 0.87; P <0.0001), but not in those with bronchitis (r = -0.22; P =0.36). CONCLUSION: In patients with bronchitis, increased levels of VEGF in induced sputum were associated with airflow limitation. In contrast, decreased levels of VEGF were associated with airflow limitation and alveolar destruction in patients with emphysema. Thus, our findings suggest that VEGF may affect the pathogenesis of these two common types of COPD.     

Smoking pattern of smokers with and without tobacco-smoke-related lung diseases

The number of cigarettes smoked, the duration of the smoking habit, and the tar content of the smoke influence the occurrence of tobacco-smoke-related lung diseases, as may also patterns of smoke inhalation. We therefore determined the smoking pattern, especially the time relation between cigarette puff and inhalation, in smokers with and without tobacco-smoke-related lung diseases. On the basis of clinical and radiologic findings as well as pulmonary function tests, 91 smokers were classified as smokers without lung disease, with small airway disease, with simple chronic bronchitis, with obstructive bronchitis, with pulmonary emphysema, and with lung cancer. Smoking and breathing patterns were recorded, using a smoke-flow machine and a strain-gauge belt while the subject smoked a cigarette. Blood levels of COHb were determined before and after smoking. Of the smoking characteristics assessed, puff-inhalation time, puff peak pressure, and the venous difference in COHb level before and after smoking varied significantly among the smoker groups. Puff-inhalation time, reflecting the duration of smoke retention in the mouth, was only 0.08 s (i.e., practically zero) in smokers with pulmonary emphysema and differed significantly from the time in the other groups. This puffing characteristic may be the consequence or the cause of emphysema. If the latter is true, smokers with emphysema may perhaps lack the acute airway response to smoke inhalation that normally protects most smokers from immediately inhaling tobacco smoke.     

Severe Chronic Bronchitis in Advanced Emphysema Increases Mortality and Hospitalizations

Abstract

Background: Chronic bronchitis in COPD has been associated with an increased exacerbation rate, more hospitalizations, and an accelerated decline in lung function. The clinical characteristics of patients with advanced emphysema and chronic bronchitis have not been well described. Methods: Patients randomized to medical therapy in the National Emphysema Treatment Trial were grouped based on their reports of cough and phlegm on the St. George's Respiratory Questionnaire(SGRQ) at baseline: chronic bronchitis(CB+) and no chronic bronchitis(CB–). The patients were similarly categorized into severe chronic bronchitis(SCB+) or no severe chronic bronchitis (SCB–) based on the above definition plus report of chest trouble. Kaplan-Meier survival analysis was used to determine the relationships between chronic bronchitis and severe chronic bronchitis and survival and time to hospitalization. Lung function and SGRQ scores over time were compared between groups. Results: The CB+(N = 234; 38%) and CB- groups(N = 376; 62%) had similar survival (median 60.8 versus 65.7 months, p = 0.19) and time to hospitalization (median 26.9 versus 24.9 months, p = 0.84). The SCB+ group(N = 74; 12%) had worse survival (median 47.7 versus 65.7 months, p = 0.02) and shorter time to hospitalization (median 18.5 versus 26.7 months, p = 0.02) than the SCB- group (N = 536; 88%). Mortality and hospitalization rates were not increased when chest trouble was analyzed by itself. The CB+ and CB–groups had similar lung function and SGRQ scores over time. The SCB+ and SCB–groups had similar lung function over time, but the SCB+ group had significantly worse SGRQ scores. Conclusions: Severe chronic bronchitis is associated with worse survival, shorter time to hospitalization, and worse health-related quality of life.     

Airway responsiveness to inhaled histamine in chronic obstructive airways disease. Chronic bronchitis vs emphysema

Airway responsiveness to inhaled histamine was examined in two groups of carefully selected patients with nonasthmatic chronic obstructive airways disease (COAD). Twelve patients with chronic bronchitis and airflow obstruction but little emphysema and 13 with predominantly emphysema and airflow obstruction but little bronchitis were selected based on history, chest roentgenogram, and diffusing capacity for carbon monoxide (Dsb). Emphysema patients had less cough, less sputum, less chronic bronchitis, lower Dsb, and more radiographic evidence of vascular deficiency. There was no difference in anthropometric features, smoking history, atopic skin sensitivity, hemoglobin, blood eosinophilia, PaO2, PaCO2, ECG, lung volumes, or expiratory flow rates. The two groups had similar airway responsiveness to inhaled histamine; the geometric mean provocation concentrations producing a 20 percent FEV1 fall (PC20) was 0.56 mg/ml for the bronchitis patients and 0.28 mg/ml for the emphysema patients (p greater than 0.20). Regression of log histamine PC20 vs percent predicted FEV1 showed a high correlation in both groups (r = 0.73, p less than 0.01 in bronchitis and r = 0.79, p less than 0.001 in emphysema). The regression lines were almost identical. These data suggest that in COAD bronchial responsiveness to inhaled histamine is mainly due to the altered airway geometry, and that there is no difference in histamine responsiveness between patients with emphysematous COAD and nonemphysematous COAD with chronic bronchitis.     

Mucociliary clearance in patients with chronic bronchitis and bronchial carcinoma

We measured the mucociliary clearance rates and lung function data of 40 normal subjects, of 30 smokers with chronic bronchitis and of 64 patients with bronchial carcinoma. The mucociliary clearance rate of cancer patients was significantly lower than that of normal subjects and of patients with chronic bronchitis who smoked the same amount of cigarettes. The fast clearing phase of the central bronchial tree is more delayed than the peripheral mucociliary clearance rate in smokers with and without carcinoma. With our mucociliary clearance measurement we assessed the self-cleaning filter function of about the first 10 generations of the branching bronchial tree where also most bronchial carcinomas develop. The correlation between lung function data (MMEF) and smoking habits is much better (r = 0.73) than with the measured mucociliary clearance rates (r = 0.3), suggesting that inborn errors of mucociliary transport are nearly as important as external lung damage due to smoking and infection in the development of chronic bronchitis and bronchial carcinoma.     

Prevalence of obstructive lung diseases and respiratory symptoms in southern Sweden

The prevalence of obstructive lung diseases is increasing in Scandinavia and worldwide. The reasons for this are not known. The prevalence varies between countries but also between different areas within the same country. In northern Europe a north-south gradient and also an east-west gradient have been proposed. To our knowledge this is the first comprehensive epidemiological study concerning obstructive lung diseases and respiratory symptoms in the southern part of Sweden. The prevalence of bronchial asthma, chronic bronchitis/emphysema, respiratory symptoms, smoking habits and medication in a random sample of 12,071 adults aged 20-59 years was assessed in a postal survey with a slightly modified questionnaire previously used in central and northern Sweden (the OLIN Studies). The questionnaire was based on the British Medical Research Council (BMRC) questionnaire. We also compared the prevalence figures of asthma found in the postal survey with those reported in the medical records in a part of the study area. After two reminders, the response rate was 70.1% (n = 8469); 33.8% of the responders were smokers. Among younger (20-39 year age group) individuals, smoking was most common in women, whereas in those aged 40-59 years, smoking was more common in men. In all, 469 subjects (5.5%) stated that they had asthma, 41.6% of whom reported a family history of asthma compared to 15.9% of the study sample not reporting asthma. Of all subjects reporting asthma, 60.1% (n = 282) answered that they used asthma drugs. Inhaled steroids were used by 20.7%. Chronic bronchitis and/or emphysema was reported by 4.6% (n = 392), 28.6% of whom reported a family history of chronic bronchitis or emphysema compared to 6.8% of the study sample not reporting chronic bronchitis. The most common respiratory symptom in the study population was 'phlegm when coughing' reported by 15.1% (n = 1279). Our data show a prevalence of self-reported asthma of 5.5% compared with 7% reported by Lunb?ck et al. in northern Sweden, which indicates a north-south gradient.     

上海市嘉定区社区慢性阻塞性肺疾病防治状况调查

目的探讨上海市嘉定区2个社区卫生服务中心慢性阻塞性肺疾病(CODP)高危人群的患病情况并分析其危险因素。方法于2011年5~12月对上海市嘉定区真新及华亭2个社区卫生服务中心服务区域内常住居民中的高危人群进行肺功能检测,同时进行问卷调查。以肺功能检测结果作为COPD的诊断依据,分析COPD患者肺功能、男女比例、吸烟及治疗情况等。结果共有2008例有效对象纳入本调查,平均年龄(66.2±2.5)岁,高危人群COPD患病率达8.2%(165/2008),男性患病率为10.5%(100/956),女性为6.2%(65/1052)。其中无症状COPD患者65例,既往被诊断为慢性支气管炎、肺气肿80例,诊断为COPD者5例,80例患者未被诊断出慢性支气管炎、肺气肿或COPD,COPD患者的漏诊率为48.5%(80/165)。1年中COPD患者服用过茶碱类药物80例(48.5%),口服长效用β2受体激动剂23例(13.9%),吸入支气管扩张剂19例(11.5%),吸入糖皮质激素的仅3例(1.8%)。男有40例COPD(占24.2%)患者服用过含糖皮质激素的外地邮购药物。在73例Ⅲ、Ⅳ级COPD患者中,家庭氧疗的仅为2例。多因素分析显示,吸烟及厨房无通风设备是COPD的危险因素。结论作为诊断标准的肺功能检测在社区医院开展的不够,社区COPD患者诊断治疗严重不足,对于年龄40岁,有吸烟史,厨房无通风设备等高危因素的人群早期行肺功能检查是很有必要的。     

老年人肺间质纤维化合并肺气肿综合征的临床特征及相关因素分析

目的:探讨老年肺间质纤维化合并肺气肿综合征(CPFE)的临床特点及发病的相关因素。方法:选取北京医院于2015年1月至2020年1月入院的42例CPFE和83例特发性肺纤维化(IPF)老年患者进行回顾性研究,比较两组临床资料、实验室检查、影像学、肺功能及治疗转归的差异,分析一氧化碳弥散量(DLCO)与肺容量、肺通气指标...     

Adult bronchiolitis. Evaluation by bronchoalveolar lavage and response to prednisone therapy

Four adult patients with biopsy-proven bronchiolitis were identified and prospectively evaluated. Each patient presented with the rapid onset (weeks to months) of severe respiratory disease that was clinically distinct from asthma, chronic bronchitis, bronchiectasis, cystic fibrosis, and emphysema. Bronchiolitis patients were evaluated by pulmonary function testing and bronchoalveolar lavage (BAL) before and after two months of treatment with 1 mg/kg/day of prednisone. Initial BAL results of bronchiolitis patients were compared to those of cigarette smokers with chronic bronchitis (n = 4), asymptomatic cigarette smokers (n = 5), and normal nonsmoking volunteers (n = 5). Neutrophils comprised 53 +/- 13 percent of the cells recovered by BAL in bronchiolitis patients but only 3 +/- 2 percent of the cells in chronic bronchitis patients, 1.5 +/- 0.6 percent of the cells in asymptomatic smokers, and 0.3 +/- 0.3 percent of the cells in normal volunteers (p less than 0.01, all comparisons). Moreover, prednisone produced a striking decrease in lower respiratory tract neutrophils (53 +/- 13 percent to 8 +/- 3 percent, p less than 0.05) in all bronchiolitis patients while lung function either improved (two patients) or remained unchanged (two patients). These findings suggest a central role for the neutrophil in bronchiolitis and argue that BAL may be clinically useful in the diagnosis and management of these patients.     

Prevalence of respiratory symptoms related to chronic obstructive pulmonary disease and asthma among middle aged and older adults

OBJECTIVE: The aim of this study was to assess the prevalence of chronic obstructive pulmonary disease in middle aged and older adults. METHODOLOGY: A random sample of 7,005 adults aged between 45 and 69 years was drawn from electoral rolls for Melbourne, Victoria, Australia. A postal survey was conducted using the European Community Respiratory Health Survey respiratory screening questionnaire with additional questions on chronic bronchitis and emphysema. Participants were asked to return the survey by reply mail. Non-responders were sent a reminder postcard after 2 weeks, a replacement questionnaire after 4 weeks and then contacted by telephone. RESULTS: Completed questionnaires were returned by 4,906 (70.0%) participants. The commonest symptoms were exertional dyspnoea (27.2%) and wheezing (20.5%). Chronic bronchitis was reported by 12.0% and emphysema by 1.2%. Males were significantly more likely to report cough and sputum, while females were more likely to report asthma. The prevalence of exertional dyspnoea, cough and sputum, emphysema and heart disease increased with age. Chronic bronchitis, emphysema and most respiratory symptoms were associated with smoking. CONCLUSIONS: Self-reported chronic bronchitis or emphysema affect one in eight middle aged and older adults. Differences between men and women are partly explained by differences in smoking. These findings require confirmation with lung function tests.