Antibiotics for acute exacerbations of chronic obstructive pulmonary disease (COPD)

OBJECTIVE: This study had for aim to evaluate the rationale and indications for antibiotic treatment in acute exacerbations of COPD and to identify potential differences among various antibiotics available for the treatment of exacerbations in France. METHODS: A search was performed in Medline and for references quoted in identified articles from 1995 to 2005. Open or blind randomized studies involving antibiotics available in France were reviewed. RESULTS: About 50% of all exacerbations are related to bacterial infection. Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae are the main pathogens responsible for bacterial exacerbations. Pseudomonas aeruginosa and enterobacter spp are frequently found in patients with severe functional impairment. Increased purulence of sputum is associated with bacterial infection. Patients with severe functional impairment benefit the most from antibiotic treatment. Although new molecules have larger antibiotic spectrum and better pharmacological properties, the evidence supporting their use compared to standard therapy remains scarce. CONCLUSIONS: Additional studies are needed to better identify the subset of patients benefiting from antibiotics and to determine whether new molecules produce significant improvement on relevant outcomes such as exacerbation free interval compared to standard therapy.     

老年慢性阻塞性肺疾病合并呼吸衰竭危险因素分析

目的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并呼吸衰竭是老年人常见病和多发病,严重影响老年人生活质量及生命健康。本研究分析老年COPD合并呼吸衰竭的相关危险因素,为临床预防及治疗提供依据。方法选择2016-03-15-2018-04-30广饶县大码头中心卫生院接收的84例COPD合并呼吸衰竭老年患者作为病例组,同时选取84例单纯COPD老年患者作为对照组。分析两组患者一般资料、肺功能指标、动脉血气指标以及降钙素原水平差异,采用多因素Logistic回归分析,明确COPD合并呼吸衰竭的影响因素。结果两组患者年龄(t=1.793,P=0.075)、体质量指数(t=0.240,P=0.811)和吸烟(χ~2=2.885,P=0.089)比较,差异无统计学意义;病例组病程≥10年61例(72.62%),高于对照组的48例(57.14)%,差异有统计学意义,χ~2=4.415,P=0.036。病例组动脉血氧分压(arterial oxygen partial pressure,PaO2)水平为(53.77±4.98)mm Hg,低于对照组的(64.10±4.58)mm Hg,t=13.981,P<0.001;病例组第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)水平为(2.16±0.12)L,低于对照组的(2.67±0.18)L,t=21.073,P<0.001;病例组二氧化碳分压(partial pressure of carbon dioxide,PaCO_2)水平为(55.48±5.37)mm Hg,高于对照组的(46.94±3.04)mm Hg,t=12.671,P<0.001;病例组降钙素原(procalcitionin,PCT)水平为(0.76±0.13)ng/mL,高于对照组的(0.57±0.09)ng/mL,t=11.208,P<0.001;病例组第1秒钟用力呼气容积占预计值百分比(forced expiratory volume%of predicted value in the first second,FEV1/FVC)为(58.24±2.62)%,与对照组的(58.56±2.11)%差异无统计学意义,t=0.616,P=0.539;病例组pH值为7.36±0.14,与对照组的7.35±0.12比较差异无统计学意义,t=0.351,P=0.726。Logistic多元回归分析结果显示,病程长(OR=1.989,95%CI为1.043～3.793,P=0.037)、PaCO_2水平高(OR=0.643,95%CI为0.561～0.737,P<0.001)和PCT水平高(OR=0.980,95%CI为0.974～0.986,P<0.001)是影响老年COPD患者合并呼吸衰竭的独立危险因素。结论病程较长、PaCO_2及PCT水平升高等因素是导致老年COPD患者合并呼吸衰竭发生的主要因素,应针对以上因素,加强老年COPD合并呼吸衰竭患者动脉血气指标监测,提高早期诊断率。     

吸烟对慢性阻塞性肺疾病及呼吸道症状的影响

  目的   探讨吸烟对慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)及呼吸道症状的影响。   方法   利用多阶段分层整群随机抽样的方法在安徽5个COPD监测点抽取≥40岁调查对象, 并对其进行问卷调查、身体测量和肺功能检测。利用复杂抽样Logistic回归分析模型分析吸烟对COPD及呼吸道症状的影响。   结果   ≥30包年的吸烟者在总人群中占13.9%(95% CI:10.3%~17.5%, P < 0.001), ≥40年的吸烟者在总人群中占8.5%(95% CI:6.7%~10.3%, P < 0.001)。吸烟者平均吸烟年数为32.4 (95% CI:31.2~33.5)年, 吸烟者日均吸烟量为21.1 (95% CI:19.6~22.7)支/天。调整混杂因素后, COPD和呼吸道症状的患病风险均随吸烟包年和吸烟年数的增加而呈上升趋势(均有P_trend < 0.001)。   结论   吸烟增加COPD及呼吸道症状的患病风险, 吸烟包年和吸烟年数越多, 慢阻肺和呼吸道症状的患病风险越大。     

慢性阻塞性肺病呼吸衰竭时低磷血症

磷具有许多重要的生物学功能,低磷血症或磷缺乏可引起许多病变.在胸部疾病、呼吸道感染或呼吸衰竭中,低磷血症的发生率为17%～28%.本文综述有关磷的代谢,慢性阻塞性肺病呼吸衰竭时低磷血症的病因,临床表现和处理.     

New treatments for chronic obstructive pulmonary disease

No currently available treatments reduce the progression of chronic obstructive pulmonary disease (COPD) or suppress the inflammation in small airways and lung parenchyma. However, several new treatments now in development for COPD are targeted at the inflammation process. Antagonists of mediators, such as leukotriene B4, interleukin-8, and tumour necrosis factor-alpha and inhibitors of oxidative and nitrative stress are in clinical development. Phosphodiesterase-4 inhibitors are in clinical trials and drugs that inhibit p38 MAP kinase, nuclear factor-kappaB and phosphoinositide-3 kinase-gamma are now in early development. There is also a search for elastase inhibitors to prevent the development of emphysema and drugs that may even reverse the lung destruction.     

Validation of self-reported chronic obstructive pulmonary disease in a cohort study of nurses

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death, and its prevalence is increasing; however, few strategies are available for disease prevention or modification besides smoking interventions. To facilitate examination of modifiable risk factors for COPD in the Nurses' Health Study, the authors validated a questionnaire-based definition of COPD in a subset of this US cohort. Participants were surveyed biennially about lifestyle factors, including smoking, since 1976 and physician diagnosis of COPD since 1988. Self-reported cases were defined as reporting COPD on both the original (1988-1996) and supplemental (1998) questionnaires. The authors requested medical records for a 10% random sample of 2,790 cases and reviewed these records in a systematic, blinded fashion. Validated cases required obstructive spirometry, emphysema on chest radiograph or computed tomography, or physician diagnosis. COPD was confirmed for 78% of 273 cases. Spirometry or radiographic results were available for 84%; when available, mean forced expiratory volume in 1 second was 51% predicted (standard deviation, 19). Applying these results to a hypothetical cohort, the authors estimated the degree to which disease misclassification biases relative risks toward the null value, confirming that questionnaire-based COPD research should focus on minimizing false positives rather than false negatives. In conclusion, COPD can be studied in large, questionnaire-based cohorts of health professionals.     

Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease

Background  

Exposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies.     

慢性阻塞性肺疾病患者呼吸指导及护理

对252例慢性阻塞性肺疾病急性加重期患者进行呼吸指导和护理,认为在对慢性阻塞性肺疾病的治疗期间,提高护理质量及呼吸指导尤为重要.     

Guidelines for the management of chronic obstructive pulmonary disease

As public smoking and tobacco advertising are increasingly banned in North America and Europe, tobacco companies are likely to attempt to boost their sales in other parts of the world: Africa, Asia, the Caribbean, and the former Communist states in Eastern Europe. The current epidemic of chronic obstructive pulmonary disease (COPD) will be transferred to these countries as well. COPD can be definitively diagnosed only by spirometry. The median survival time is 5-10 years. In the long run, the most effective treatment will be smoking cessation programs. Pharmaceutical interventions include bronchodilators and, for a minority of patients, inhaled steroids. Domiciliary oxygen should be provided only when there is demonstrable hypoxia. The British Thoracic Society guidelines on COPD are relevant to developing countries as well as the UK.     

Controlled exposure of volunteers with chronic obstructive pulmonary disease to nitrogen dioxide

Twenty-two volunteers with chronic obstructive pulmonary disease were exposed to nitrogen dioxide at 0.0, 0.5, 1.0, and 2.0 ppm in a controlled environment chamber. Exposure lasted 1 hr and included two 15-min exercise periods, during which the mean ventilation rate was roughly 16 L/min. Pulmonary mechanical function was evaluated pre-exposure, after initial exercise, and at the end of exposure. Blood oxygenation was measured by ear oximetry pre-exposure and during the second exposure period. Symptoms were recorded during exposures and for 1-wk periods afterward. No statistically significant changes in symptom reporting could be attributed to nitrogen dioxide exposure at any concentration, compared to the 0.0 ppm control condition. Measures of pulmonary mechanics showed either no significant changes, or small and equivocal changes. Arterial oxygen saturation showed marginal improvement with exercise, regardless of nitrogen dioxide concentration.     

基于倾向性评分匹配的慢性阻塞性肺疾病影响因素研究

目的  经倾向性评分匹配(propensity score matching, PSM)均衡组间人口学特征后,研究慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)与生活行为习惯、个体疾病等因素的关系。方法  使用2014―2015年山西省居民COPD监测数据,其中病例组277人,对照组1 795人。采用PSM按1:1选取在人口学特征上与病例相近的对照个体;采用条件Logistic回归分析模型分析COPD的影响因素。结果  成功匹配275对,条件Logistic回归分析模型结果显示,知晓COPD者患病风险降低了92.8%;既往经常咳嗽、有呼吸道疾病史、接触有害气体、吸烟者患COPD的风险分别提高了1.489倍、1.371倍、1.013倍、0.834倍。结论  加强COPD的健康教育、禁烟、不接触有害气体、及时治疗呼吸系统疾病是预防和减少COPD发生的重要措施。     

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.