Associative conditioning of the exercise ventilatory response in humans

Repeated hypercapnic exercise augmented the ventilatory response to subsequent trials of exercise alone in running goats and in humans performing arm exercise, suggesting a form of associative conditioning or 'long-term modulation' had taken place. These studies did not include 'control' single stimulus conditioning paradigms. This study demonstrated that ten repeated trials of familiar leg bicycling exercise with dead-space induced hypercapnia also elicited similar significant increases in inspired ventilation (+ 22%; P < 0.009) and tidal volume (VT; + 255 +/- 73 ml(BTPS); mean +/- S.E.M.; P = 0.004) within the first 20 sec of subsequent exercise only trials. Long-term modulation of the early ventilatory response to cycling was not fully replicated by ten trials of 'control' paradigms involving either repeated exercise alone or resting dead space alone. This study thus demonstrated that long term modulation of the early ventilatory response exercise was due to an explicit effect of associative conditioning and not simply sensitisation to repeated trials of a single stimulus.     

Evaluation of Quality of Life with the Chronic Obstructive Pulmonary Disease Assessment Test in Chronic Obstructive Pulmonary Disease and the Effect of Dyspnea on Disease-Specific Quality of Life in These Patients

Purpose

The chronic obstructive pulmonary disease (COPD) assessment test (CAT) was recently introduced for use in assessing disease-specific quality of life and follow-up of patients with COPD. The purpose of this study was to evaluate the effect of the dyspnea on disease-specific quality of life detected by CAT score in patients with COPD.

Materials and Methods

In this study, 90 stable patients with COPD as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. The level of dyspnea was assessed with the Medical Research Council (MRC) dyspnea scale, and disease-specific quality of life was assessed with CAT score.

Results

The mean±SD age was 68.5±10.9 (range 41-97) years. A significant relationship was established between CAT score, MRC dyspnea scale score and GOLD stage in patients with COPD. There was also a positive correlation between dyspnea scale scores and GOLD stage in the patients (p<0.001), as well as positive correlation between CAT score and dyspnea scale score (p<0.001). CAT score showed a significant correlation with hospitalization and exacerbations (p<0.05).

Conclusion

Dyspnea is an important symptom that may impact quality of life in patients with COPD. CAT was shown to be a simple, fast and intelligible measurement of disease-specific quality of life, and was correlated with levels of dyspnea in patients with COPD.     

Ratings of perceived exertion in chronic obstructive pulmonary disease — a possible indicator for exercise training in patients with this disease

Summary The purpose of this study was to evaluate the usefulness of ratings of perceived exertion (RPE) as an indicator of exercise intensity in patients with chronic obstructive pulmonary disease (COPD). The subjects were ten male patients with COPD, whose mean forced expiratory volume in 1 s was 1.091, SD 0.41, and ten healthy middle-aged men. Ramp incremental exercise on a cycle-ergometer was performed and RPE was determined by the Borg 15-point scale. The absolute oxygen uptake at each RPE was significantly greater in the healthy subjects than in the patients with COPD. However, oxygen uptake calculated as a percentage of maximal at any RPE did not differ significantly between the two groups. Arterial blood lactate concentration at points 15 to 19 on the RPE scale was increased in healthy subjects (P<0.05–P<0.001), while the dyspnoea index at points 11 to 19 on the RPE scale was higher in patients with COPD (P<0.05–P<0.001). The main complaints on stopping exercise were dyspnoea in the patients with COPD and fatigue in the healthy subjects. Although the nature of RPE may have been different in the two groups, RPE could be a possible indicator of exercise intensity when physicians prescribe exercise to patients with COPD.Presented in part at the 28th annual meeting of the Japanese Society of Chest Diseases, Sendai, on April 27, 1988     

Effects of the dopamine antagonists haloperidol and domperidone on the normoxic ventilatory response to CO2 in cats

We investigated the effects of the dopamine antagonists haloperidol and domperidone on the ventilatory response following square-wave changes in end-tidal CO₂ during normoxia in chloralose-urethane anaesthetized cats. In 7 cats these responses were measured before (control, 28 runs) and after the administration of 1 mg/kg haloperidol i.v. (26 runs) and in 8 other cats before (39 runs) and after 0.5 mg/kg domperidone i.v. (34 runs). Each response was separated into a slow central and a fast peripheral part by fitting two exponential functions to the measured ventilation. These functions have as parameters a CO₂ sensitivity, a time constant, a time delay and an apnoeic threshold B (extrapolated PETCO₂ of the steady-state response curve at zero ventilation). Haloperidol significantly diminished the peripheral (Sp) and the central (Sc) ventilatory sensitivity to CO₂ and the B-value (P<0.001). The ratio Sp/Sc, the time constants and the time delays were not significantly changed. Domperidone only diminished the B-value significantly (P<0.001). Since domperidone does not readily cross the blood-brain barrier, its effect was a CO₂ independent increase of the ventilation mediated by the peripheral chemoreceptors. Haloperidol exhibited, besides the peripheral stimulatory effect a depressant central effect due to an action on the central integrative structure, resulting in a proportional decrease of Sp and Sc.     

艾司西酞普兰对慢性阻塞性肺疾病合并抑郁焦虑患者的疗效及生存质量的影响

目的研究艾司西酞普兰对慢性阻塞性肺疾病(COPD)患者抑郁焦虑症状疗效及安全性,并评价患者用药前后的生活质量。方法采用汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)(17项)测量心理状况,将总分值分别大于10和12分判定存在轻中度焦虑、抑郁症状的COPD患者共53例分为艾司西酞普兰组(29例)及对照组(24例),治疗4周后再检测患者COPD的各项指标并用圣乔治呼吸问卷(SGRQ)评价生活质量,应用副反应量表(TESS)记录药物副反应。结果①在53例COPD患者中有抑郁症状20例(37.74%),焦虑症状22例(41.51%),抑郁及焦虑症状并存11例(20.75%);②30例男性COPD患者中表现抑郁症状为40.0%(12/30),焦虑症状为43.3%(13/30);23例女性COPD患者中有抑郁症状34.8%(8/23),焦虑症状为39.1%(9/23),两性间差异无统计学意义(P>0.05);③COPD患者治疗前后HAMA及HAMD评分比较:服用艾司西酞普兰治疗前后各阶段的HAMA、HAMD总分下降与治疗前有显著性差异(P<0.05)。FEV1占预计值及FEV1/FVC(%)均有明显改善(P<0.05),生活质量各评分与对照组比较,差异有显著性意义(P<0.05)。结论艾司西酞普兰能改善COPD患者的焦虑及抑郁症状,治疗期间不良反应较少,能明显提高患者的生活质量。     

慢性阻塞性肺疾病T淋巴细胞亚群与生化参数变化及其相关性分析

利用基于免疫荧光标记技术为原理的流式细胞分析技术研究慢性阻塞性肺疾病(COPD)患者免疫功能与生化参数的变化及其相关性分析.对31例COPD患者与30名健康者T淋巴细胞亚群与生化参数等13项指标进行检测,并进行统计学相关分析.结果表明,COPD组和对照组免疫指标比较,CD3 CD4 T淋巴细胞计数无显著性差异(P>0.05),而COPD组中CD3 CD8 T淋巴细胞计数低于对照组(P<0.05),并且CD4/CD8比值升高(P<0.05);COPD组UN、UA、GLU、HDL-C均高于对照组(P<0.05),Cr则明显高于对照组(P<0.01),其余生化参数均无显著性差异(P>0.05);COPD组UA与CD3 CD8 T淋巴细胞呈负相关(r=-0.463,P<0.01),TG与CD3 T淋巴细胞呈负相关(r=-0.493,P<0.01),TG与CD3 CD4 T淋巴细胞呈负相关(r=-0.413,P<0.05).COPD患者的免疫功能与尿酸和血脂水平相关.     

慢性阻塞性肺疾病合并2型糖尿病的老年患者肺功能、免疫失衡研究

目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并2型糖尿病(type 2 diabetes mellitus,T2DM)老年患者的肺功能、免疫水平变化及其临床意义.方法 选取北京市垂杨柳医院2015年1月至2016年1月收治的120例COPD患者进行研究,其中合并T2DM患者48例(T2DM组)、单纯COPD患者62例(单纯COPD组),比较两组患者肺功能、免疫指标的差异.结果 T2DM组的CD3+、CD4+、CD4+/CD8+测定值均低于单纯COPD组患者(t=4.209、t=4.598、t=5.617,P<0.05),T2DM组CD8+测定值高于单纯COPD组(t=4.157,P<0.05);T2DM组的血清IFN-γ、IL-10的水平均显著的低于单纯COPD组患者(t=4.839、t=8.529,P<0.05),T2DM组的血清IL-4、IL-8的水平高于单纯COPD组(t=4.209、t=4.517,P<0.05);T2DM组的用力肺活量(forced vital capatiry,FVC)、用力呼气容积(forced expiratory volume in 1 second,FEV lung for carbon monoxide,DLCO)水平均显著的低于单纯COPD组患者(t=3.006、t=5.966,t=6.210,P<0.05).结论 老年COPD合并T2DM患者的肺功能损害更加严重,可能与炎症反应水平增强及免疫失衡有关.     

联合FEV1/FEV3与血清IL-6、TNF-α对轻中度慢性阻塞性肺疾病诊断和预后评估的研究

目的评估第1秒用力呼气容积(FEV1)/第3秒用力呼气容积(FEV3)联合血清白介素6(IL- 6)、肿瘤坏死因子α(TNF-α)对轻中度慢性阻塞性肺疾病(COPD)的诊断及预后评估价值。方法收集我院2011年1月至2013年10月140 例轻中度COPD患者为病例组,与同期在我院行体检的健康人群150 例为对照组,对两组研究对象进行肺功能检查与血清IL- 6、TNF-α检测。采用受试者工作特征曲线(ROC)分析FEV1/FEV3、IL- 6、TNF-α对COPD的诊断价值。依据患者纳入研究的时间依次进行40个月的随访,统计随访期间COPD急性加重(AECOPD)的发生次数与死亡人数,采用Kaplan- Meier法和对数秩检验(log- rank test)进行生存分析。结果 COPD患者的FEV1/FEV3显著低于健康人群,而血清IL- 6、TNF-α水平则显著高于对照组,差异具有统计学意义( P <0.05)。ROC分析结果表明,FEV1/FEV3、IL- 6、TNF-α诊断COPD的曲线下面积(AUC)分别为:0.786(95% CI :0.702~0.871, P <0.001)、0.518(95% CI :0.421~0.616, P =0.708)和0.684(95% CI :0.592~0.776, P <0.001);灵敏度/特异性分别为:86.1%/67.4%、58.1%/57.7%和58.4%/78.4%;联合三项指标的AUC为0.901(95% CI :0.840~0.963, P <0.001),在“并联”时,“PRE- 1值”约登指数为最大值时的灵敏度和特异性分别为90.6%和64.2%,对应的FEV1/FEV3、IL- 6和TNF-α的判断值分别为73.95%、10.13 ng/L和2.26μg/L;在“串联”时,“PRE- 1值”约登指数为最大值时的灵敏度为78.2%,特异性为98.1%,对应的FEV1/FEV3、IL- 6和TNF-α的判断值分别为72.32%、9.73 ng/L和2.21μg /L。随访及生存分析结果表明,低FEV1/FEV3组及高IL- 6、高TNF-α组的COPD患者AECOPD的平均发生次数及发生率均增高,而低FEV1/FEV3组及高TNF-α组生存时间均降低,差异具有统计学意义( P <0.05)。结论 FEV1/FEV3联合血清IL- 6、TNF-α检测对轻中度COPD具有较高的诊断和预后评估价值,可考虑在临床推广使用。     

家庭护理干预对提高稳定期慢性阻塞性肺疾病患者 生活质量的研究

目的 研究家庭护理干预对提高稳定期慢性阻塞性肺疾病患者生活质量的影响。方法 选取2017年1月~2018年12月在我院诊治的180例稳定期慢性阻塞性肺疾病患者为研究对象,将其随机分为对照组和观察组,各90例。对照组采用常规护理干预,观察组在对照组基础上实施家庭护理干预,两组均随访3个月。比较两组患者出院1个月时生活质量评分及治疗依从性,出院3个月时两组复发率。结果 干预后观察组心理状态、社会功能、躯体功能、工作情况评分均高于出院前,差异有统计学意义（P＜0.05）,对照组生活质量评分低于出院前,且观察组高于对照组,差异有统计学意义（P＜0.05）;观察组合理饮食、坚持氧疗、用药依从、情绪稳定评分均高于对照组,差异有统计学意义（P＜0.05）;出院3个月观察组复发率为8.88%,低于对照组的32.22%,差异有统计学意义（P＜0.05）。结论 家庭护理干预可提高稳定期慢性阻塞性肺疾病患者生活质量,有效降低复发率,改善患者预后效果,具有一定的临床应用价值。     

中西医结合治疗慢性阻塞性肺疾病并高黏血症的临床疗效分析

目的:观察银杏达莫注射液联合内服外敷中药治疗慢性阻塞性肺疾病(简称慢阻肺,COPD)合并高黏血症的临床疗效。方法:88例COPD合并高黏血症患者分为治疗组(n=44)与对照组(n=44),对照组给予西医常规治疗,治疗组在对照组治疗的基础上,给予静脉滴注银杏达莫注射液,并予以中药内服和穴位贴敷。14天后观察两组临床疗效及血液流变学指标变化。结果:连续治疗14天后,治疗组临床痊愈率明显高于对照组(45.45%vs25.00%,P0.05),无效率显著低于对照组(6.82%vs22.73%,P0.05)。治疗组高切表观黏度、低切表观黏度、红细胞压积、血浆黏度、血浆纤维蛋白原含量和红细胞聚集指数等指标均较治疗前明显改善(P0.01);治疗组与对照组治疗后比较,除红细胞聚集指数外,其它指标均显著降低,差异有统计学意义(P0.05)。结论:银杏达莫注射液联合内服外敷中药治疗COPD合并高黏血症,可明显提高临床痊愈率并显著改善血液流变状态。     

Forced oscillation technique in the detection of smoking-induced respiratory alterations: diagnostic accuracy and comparison with spirometry

INTRODUCTION:

Detection of smoking effects is of utmost importance in the prevention of cigarette‐induced chronic airway obstruction. The forced oscillation technique offers a simple and detailed approach to investigate the mechanical properties of the respiratory system. However, there have been no data concerning the use of the forced oscillation technique to evaluate respiratory mechanics in groups with different degrees of tobacco consumption.

OBJECTIVES:

(1) to evaluate the ability of the forced oscillation technique to detect smoking‐induced respiratory alterations, with special emphasis on early alterations; and (2) to compare the diagnostic accuracy of the forced oscillation technique and spirometric parameters.

METHODS:

One hundred and seventy subjects were divided into five groups according to the number of pack–years smoked: four groups of smokers classified as <20, 20–39, 40–59, and >60 pack–years and a control group. The four groups of smokers were compared with the control group using receiver operating characteristic (ROC) curves.

RESULTS:

The early adverse effects of smoking in the group with <20 pack–years were adequately detected by forced oscillation technique parameters. In this group, the comparisons of the ROC curves showed significantly better diagnostic accuracy (p<0.01) for forced oscillation technique parameters. On the other hand, in groups of 20–39, 40–59, and >60 pack–years, the diagnostic performance of the forced oscillation technique was similar to that observed with spirometry.

CONCLUSIONS:

This study revealed that forced oscillation technique parameters were able to detect early smoking‐induced respiratory involvement when pathologic changes are still potentially reversible. These findings support the use of the forced oscillation technique as a versatile clinical diagnostic tool in helping with chronic obstructive lung disease prevention, diagnosis, and treatment.     

穴位注射联合沙美特罗替卡松粉吸入剂治疗 慢性阻塞性肺疾病稳定期的临床疗效观察

目的 观察穴位注射黄芪注射液联合沙美特罗替卡松粉吸入剂（舒利迭）治疗慢性阻塞性肺疾病（COPD）稳定期的临床疗效。方法 选取2016年8月~2018年2月上海市宝山区中西医结合医院呼吸内科门诊慢性阻塞性肺病临床缓解期的患者66例,随机分为试验组和对照组,各33例。对照组予以舒利迭治疗,试验组予以穴位注射黄芪注射液联合舒利迭治疗,疗程均2个月。观察两组治疗前后中医证候积分主证分、CAT评分、血清IL-8变化。结果 治疗后,两组中医证候主证分均改变,试验组与治疗前比较差异有统计学意义（P＜0.05）,对照组与治疗前比较差异无统计学意义（P＞0.05）,且试验组与对照组主证分改变比较,差异有统计学意义（P＜0.05）;治疗后,试验组CAT评分下降优于对照组,差异有统计学意义（P＜0.05）;治疗后,试验组IL-8水平下降优于对照组,差异有统计学意义（P＜0.05）。结论 穴位注射能改善慢性阻塞性肺疾病患者的中医证候主证分,降低患者的炎症介质,提高患者的生活质量。     

右美托咪定及咪达唑仑分别应用于AECOPD伴呼吸衰竭治疗的效果观察

目的 观察右美托咪定及咪达唑仑在慢性阻塞性肺疾病急性加重期（AECOPD）伴呼吸衰竭患者机械通气治疗过程中镇静效果。方法 选择在我院进行治疗的92例AECOPD伴呼吸衰竭患者作为研究对象,按照随机数字表法分为实验组和对照组,每组46例。实验组给予盐酸右美托咪定注射液治疗,对照组给予咪达唑仑注射液治疗。观察两组患者的镇静效果和镇静情况（停药后清醒时间、机械通气时间、ICU住院时间）。结果 实验组患者停药后清醒时间、机械通气时间和ICU住院时间均短于对照组,镇静有效率高于对照组,差异均有统计学意义（P＜0.05）。结论 右美托咪定在AECOPD伴呼吸衰竭患者机械通气治疗过程中镇静效果好,有利于促进患者病情转归、改善预后。     

Improving the uptake of pulmonary rehabilitation in patients with COPD:: qualitative study of experiences and attitudes

Background

Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status.

Aim

To identify a strategy for improving the uptake of pulmonary rehabilitation.

Design of study

Qualitative interviews with patients.

Setting

Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK.

Method

In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory.

Results

Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating.

Conclusion

A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients'' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake.     

舒适护理在布地奈德联合氨溴索雾化吸入治疗 慢阻肺急性发作患者的效果分析

目的 研究分析舒适护理在布地奈德联合氨溴索雾化吸入治疗慢阻肺急性发作患者中的作用。方法 随机选取2014年1月~2017年1月我院收治的慢阻肺急性发作患者78例,所有患者都接受布地奈德联合氨溴索雾化吸入治疗;按照平行的原则将患者分为对照组和观察组,每组39例。对照组患者接受常规护理,观察组患者接受舒适护理,观察对比两组患者临床症状、FEV1 占预计值与FEV1/FVC改善情况、并发症效果比较。结果 观察组39例患者的喘憋缓解天数、啰音消失天数以及咳嗽缓解天数均优于对照组;观察组患者与对照组患者护理后FEV1占预计值与FEV1/FVC改善情况优于对照组;观察组39例患者中有1例患者切口感染,1例患者临近器官损伤,并发症发生率为5.13%;对照组39例患者中有3例患者切口感染,2例患者临近器官损伤,1例大出血并发症发生率为15.38%;观察组低于对照组,差异有统计学意义（P＜0.05）。结论 慢阻肺急性发作患者在接受布地奈德联合氨溴索雾化吸入治疗时应用舒适护理效果显著,舒适护理能够缓解患者临床症状,降低并发症发生率。     

Assessment of the long-term safety of mepolizumab and durability of clinical response in patients with severe eosinophilic asthma

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Airway microbiota signals anabolic and catabolic remodeling in the transplanted lung

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