慢性阻塞性肺病并发自发性气胸56例分析

目的 分析慢性阻塞性肺病并发自发性气胸的临床特点，提高临床诊治水平。方法对2001年～2008年确诊为慢性阻塞性肺病合并自发性气胸56例患者的临床资料进行回顾性分析。结果误诊率达32．1％。结论慢性阻塞性肺病并发自发性气胸临床表现不典型，误诊率较高，病情发展快，常威胁病人生命，能及时诊断和治疗，可降低死亡率。     

慢性阻塞性肺病合并骨质疏松患者的临床特点

目的 探讨合并骨质疏松的老年慢性阻塞性肺病患者的相关影响因素.方法 选取老年男性慢性阻塞性肺病合并骨质疏松患者28例为研究组,另外选取28例老年骨质疏松但肺功能正常的患者作为对照组,采取X线吸收测定仪对患者股骨骨密度以及L1～L4节段腰骨密度椎进行测量,同时,还采取肺功能仪对患者的肺功能进行测定,并且采取血气分析仪对患者的动脉血气进行测定分析.结果 合并骨质疏松的老年慢性阻塞性肺病患者股骨以及腰椎密度均比对照组患者低(P＜0.05);另外,合并骨质疏松的老年慢性阻塞性肺病患者股骨骨密度以及腰椎骨密度,与第一秒用力呼气容积占预计值、用力肺活量等的百分比(FEV1％、FEV1/FVC)以及氧分压(PaO2)有着密切的关系.结论 老年慢性阻塞性合并骨质疏松患者的股骨骨密度较单纯骨质疏松患者低,肺功能较低;另外,其股骨骨密度与患者体内的肺功能指标、糖皮质使用情况、吸烟以及缺氧等各项指标存在着密切关系.给予慢性阻塞性肺病合并骨质疏松患者骨密度检查,能够及时发现骨质疏松情况.     

电视胸腔镜手术治疗老年重症慢性阻塞性肺病患者117例

目的 总结电视胸腔镜手术治疗重症老年慢性阻塞性肺病患者的治疗体会.方法 分析我科自2005年5月～2011年5月共117例老年慢性阻塞性肺病患者的术前处理、外科治疗方式、术中以及术后处理情况.结果 本组117例均在电视胸腔镜下完成,无死亡病例,术后患者呼吸状况均有明显改善.术后留置胸管时间3～13d,平均4.4d;术后漏气时间较长(＞7 d)者7例,均在保证胸管引流通畅下7～13 d停止漏气,呼吸衰竭1例经呼吸机辅助呼吸22 h后抢救成功.结论 老年慢性阻塞性肺病症状重,常并发自发性气胸,采用电视胸腔镜肺减容术治疗效果确切.     

老年人慢性阻塞性肺病并发张力性气胸18例误诊分析

分析１８例老年慢性阻塞性肺病并发张力性气胸误诊的原因。由于老年患者症状不典型，往往被原发病所掩盖；并且常发生多房性、包裹性气胸而易误诊。但若能提高对本病的警惕性，对突发呼吸困难或呼吸困难突然加重的老年慢性阻塞性肺病患者，作详细的病史询问和体格检查；或抗感染、平喘疗效不佳时，及时行Ｘ线检查，并注意多角度地检查，则能防止误诊。治疗主要在于使肺尽快复张，防止复发。     

多索茶碱引起精神错乱3例

慢性阻塞性肺病（COPD）是老年常见疾病，以往用氨茶碱扩张气道治疗，其心脏反应及胃肠道不适等副作用出现较多，限制了其在临床上广泛应用。近年来，我院使用多索茶碱代替氨茶碱治疗慢性阻塞性肺病急性加重期（AECOPD）患者，取得了较好疗效。但是，在治疗中出现了三例精神错乱，现报告如下。     

老年慢性阻塞性肺病加重期应用噻托溴铵普米克令舒及万托林的效果及安全性

目的探讨噻托溴铵、普米克令舒及万托林在老年慢性阻塞性肺病加重期临床治疗效果及安全性。方法选取2014-12~2015-12该院诊治的80例老年慢性阻塞性肺部加重期患者,根据随机数字表法将患者分为对照组和治疗组两组,每组40例。对照组采用普米克令舒及万托林治疗,治疗组在对照组基础上联合噻托溴铵治疗,治疗10 d,比较两组临床疗效。结果治疗组治疗后喘憋、退热、咳嗽、干湿啰音消失时间以及住院时间显著短于对照组(P0.05);治疗组药物不良反应发生率为7.5%,显著低于对照组的17.5%(P0.05)。结论老年慢性阻塞性肺部加重期患者用普米克令舒及万托林治疗基础上联合噻托溴铵治疗效果较好,值得推广应用。     

老年慢性阻塞性肺病患者挠骨和尺骨矿物质含量测定

老年慢性阻塞性肺病患者挠骨和尺骨矿物质含量测定胡绍，姚青芬，刘道荣已知慢性阻塞性肺病（ＣＯＰＤ）患者中骨矿含量丢失的发病率较高，其发生骨质疏松的可能性较非缺氧患者高出许多倍。我院近年来应用单光子骨密度测定仪，对２５例ＣＯＰＤ患者进行了挠、尺骨的测量，...     

BiPAP呼吸机治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭35例临床观察

目的评价BiPAP呼吸机治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭的疗效。方法应用BiPAP呼吸机对35例慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者进行通气治疗，观察治疗前后2h、1天、2天的血气变化。结果治疗后血气指标PaO2、SaO2明显上升，PaCO2明显下降。结论BiPAP呼吸机治疗Ⅱ型呼吸衰竭患者疗效显著。     

缬沙坦治疗慢性阻塞性肺病并肺动脉高压的疗效观察

目的观察缬沙坦治疗慢性阻塞性肺病并肺动脉高压的疗效。方法慢性阻塞性肺病并肺动脉高压患者100例随机分为两组,各50例。对照组给予常规对症治疗,观察组用缬沙坦治疗,对比两组患者的肺动脉压、肺功能各项指标情况。结果观察组患者平均肺动脉压(舒张压、收缩压)优于对照组(P0.05);用力肺活量(FVC)、1 s用力呼气容积(FEV1)均优于对照组(P0.05)。结论缬沙坦治疗慢性阻塞性肺病并肺动脉高压效果明显。     

地尔硫卓治疗慢性阻塞性肺病合并心房颤动的疗效观察

目的观察地尔硫卓治疗慢性阻塞性肺病急性发作合并心房颤动患者中的疗效。方法将128例慢性阻塞性肺病急性发作合并心房颤动患者随机分为两组。对照组64例,按照慢性阻塞性肺病常规治疗,使用胺碘酮治疗。干预组64例,在慢性阻塞性肺病常规治疗的基础上,使用地尔硫卓治疗。结果干预组心室率控制的例数明显多于对照组(χ2=26.33,P<0.05);对照组转复为窦性心律的患者明显少于干预组(χ2=10.63,P<0.05)。结论地尔硫卓治疗慢性阻塞性肺病急性发作合并心房颤动患者中的效果优于胺碘酮。     

慢性阻塞性肺疾病患者治疗状况与自我认知的多中心调查研究

目的 研究COPD患者的治疗状况及自我认知情况.方法 2007年9月至2008年12月在全国11家医院进行多中心问卷调查,内容包括患者对治疗目标的认知、既往治疗方法和对治疗药物的期望.采用描述性统计方法进行统计学分析.结果 共回收调查问卷2072份,有效问卷1698份.以听说过COPD的653例为基准分析,其中59.1%(384/650)的患者认为COPD的治疗目标是减轻症状;近3个月应用异丙托溴铵、噻托溴铵和茶碱缓释片治疗的患者分别占39.8%(260/653)、27.1%(177/653)和53.7%(351/653);72.0%(465/646)的患者遵医嘱服药;80%以上的患者不知道抗胆碱能药物、β2-受体激动剂、吸入糖皮质激素、吸入糖皮质激素/长效β2-受体激动剂、茶碱有无不良反应;37.4%(240/641)的患者担心吸入糖皮质激素有不良反应;42.2%(274/650)的患者经常服用抗生素,60.1%(391/651)的患者家中没有供氧设备,70.5%(457/648)的患者未接受过呼吸康复训练;77.4%(500/646)的患者认为COPD需要长期规律治疗;79.6%(481/604)的患者认为药效(效果好、起效快和作用时间长)在理想药物中居首位;16.9%(78/461)的患者认为,在既往使用过的治疗COPD的药物中,氟替卡松/沙美特罗或嚷托溴锼是最理想的药物.结论 COPD患者对疾病相关知识的知晓程度较低,应加强对患者的认知教育工作.     

COPD患者合并医院感染50例临床分析

目的探讨COPD患者合并医院感染的临床特点及防治措施。方法对50例COPD患者医院感染情况进行回顾性分析。结果医院感染率为20．3％，病死率为26％，明显高于COPD患者非医院感染的病死率（P〈0．01）。感染部位以下呼吸道为主（78％），其次为上呼吸道、泌尿道、胃肠道等。感染发生率与住院时间成正比。感染与长期连用多种抗生素有关。结论COPD患者医院感染发生率及病死率较高，在积极治疗基础疾病的同时，应合理使用抗生素，缩短住院时间，减少医院感染的发生。     

COPD合并肺动脉高压诊治分析

目的 探讨COPD合并肺动脉高压临床诊断,常规COPD治疗与强调戒烟和氧疗疗效对比.方法本研究随机选取我院就诊确诊为COPD合并肺动脉高压的患者90例为研究对象,随机分为对照组和实验组A、B,对照组仅针对COPD进行规范化治疗,实验组A采取常规的COPD系统化治疗外还特别强调戒烟,实验组B在实验组A治疗的基础上加上无创正压通气治疗.处理6周后,观察肺动脉压的动态变化情况和动脉血气分析情况.结果 实验组A及实验组B对改善肺动脉高压及患者动脉血气上明显高于对照组,P〈0.05.实验组B与实验组A相比,患者肺动脉压降低明显,P〈0.05.结论 规范治疗COPD对COPD合并肺动脉高压患者有很好的疗效,正压通气治疗及戒烟能明显增加患者疗效,改善患者预后.     

Can a standardized acupuncture technique palliate disabling breathlessness: a single-blind, placebo-controlled crossover study

STUDY OBJECTIVES: The management of disabling breathlessness is poor, and a standardized form of acupuncture has been reported as offering benefit. This study was designed to evaluate the efficacy of standardized acupuncture treatment. DESIGN: A single-blind, randomized, crossover study. SETTING: This study was carried out on a domiciliary basis in Southampton (UK). INTERVENTIONS: This study evaluated a standardized acupuncture technique vs an appropriately validated placebo/control (mock transcutaneous electrical nerve stimulation [TENS]) for disabling, nonmalignant breathlessness (largely COPD). The acupuncture was provided by an appropriately trained nurse acupuncturist. Each patient received six treatments in each phase of the study, with an intervening 2-week washout period. MEASUREMENTS AND RESULTS: The primary outcome was worst breathlessness (visual analog scale, 0 to 100 mm), with the sample size based on an 80% power to detect a 10-mm difference between treatment means. Secondary outcomes included the St George's respiratory questionnaire score and treatment credibility. RESULTS: Thirty-six patients were entered into the study (33 with COPD), and 24 patients completed both treatment phases. The primary outcome improved significantly during the course of the study, but there were no significant treatment differences between acupuncture and the placebo/control of mock TENS for either primary or secondary outcomes. The placebo was shown to be a credible control. There was no evidence of a carryover effect from the first to second phase of the study. CONCLUSION: This standardized acupuncture technique does not show specific efficacy in disabling nonmalignant breathlessness, but those entered into the study did experience clinically significant benefit from both treatments.     

Economic benefits of self-management education in COPD

CONTEXT: There is emerging evidence that disease management with self-management education provided by a case manager might benefit COPD patients. OBJECTIVE: To determine whether disease management with self-management education is more cost-effective than usual care among previously hospitalized COPD patients. DESIGN: Economic analysis in conjunction with a multicenter randomized clinical trial comparing patients conducting self-management with those receiving usual care over a 1-year follow-up period. SETTING: Respiratory referral centers. PATIENTS: One hundred ninety-one COPD patients who required hospitalization in the year preceding enrollment were recruited from seven respiratory outpatient clinics. INTERVENTION: In addition to usual care, patients in the intervention group received standardized education on COPD self-management program called "Living Well with COPD" with ongoing supervision by a case manager. MAIN OUTCOME MEASURES: From the perspective of the health-care payer, we compared costs between the two groups and estimated the program cost per hospitalization prevented (incremental cost-effectiveness ratio of the program). We repeated these estimates for several alternate scenarios of patient caseload. RESULTS: The additional cost of the self-management program as compared to usual care, $3,778 (2004 Canadian dollars) per patient, exceeded the savings of $3,338 per patient based on the study design with a caseload of 14 patients per case manager. However, through a highly plausible sensitivity analysis, it was showed that if case managers followed up 50 patients per year, the self-management intervention would be cost saving relative to usual care (cost saving of $2,149 per patient; 95% confidence interval, $38 to $4,258). With more realistic potential caseloads of 50 to 70 patients per case manager, estimated program costs would be $1,326 and $1,016 per prevented hospitalization, respectively. CONCLUSION: The program of self-management in COPD holds promise for positive economic benefits with increased patient caseload and rising costs of hospitalization.     

五家渠地区慢性阻塞性肺疾病稳定期患者吸入药物治疗现状及影响因素分析

目的 了解本地区慢性阻塞性肺疾病(简称慢阻肺)患者中C、D级患者在稳定期吸入长效抗胆碱能受体药物(LAMA)、长效支气管舒张剂/吸入激素联合制剂(LABA/ICS)治疗的现状,对影响治疗的各种因素进行分析,并从此入手提出解决方案,提高遵循GOLD(慢性阻塞性肺疾病全球倡议)指南规范化治疗慢阻肺的执行力.方法 选择就诊我...     

Physician-Patient Concordance in Pharmacological Management of Patients with COPD

A retrospective analysis of a cross-sectional, multicenter survey was conducted in United States (US) medical practices to evaluate the concordance between patients with COPD and their physicians on disease-specific characteristics. Associations between patient and disease-related characteristics with monotherapy, dual therapy, or triple therapy prescribed as COPD maintenance regimens were also examined. Eligible physicians completed patient record forms (PRFs) for up to 6 consecutive patients with COPD. Patients for whom a PRF was completed were invited to complete a patient self-completion (PSC) survey consisting of questions similar to those on the PRF, as well as several validated measures to assess the impact of COPD on patients’ lives. A total of 469 patients completed a PSC that was matched with the PRF completed by their physician, forming the sample for the concordance analysis. Moderate agreement (kappa (κ) = 0.41–0.60) was observed for 79% of measures, with the lowest concordance rating corresponding to hemoptysis (κ = 0.22). There were few differences in demographic or clinical characteristics between patients prescribed monotherapy and dual therapy. Triple therapy rather than monotherapy or dual therapy was more often prescribed for patients with greater frequency of symptoms, negative impact of COPD on daily life and interpersonal relationships, and respiratory impairment based on the most recent FEV1. Diverse factors influence US physicians’ perceptions of disease and treatment choices, including patient symptoms, quality of life, and disease impact. Our results highlight that concordance between physicians and patients regarding symptoms and physical function may contribute to optimal management of COPD.     

The effect of COPD health forecasting on hospitalisation and health care utilisation in patients with mild-to-moderate COPD

Exacerbations are a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD) as well as having a large impact on health care utilisation (HCU). They are more frequent during periods of cold weather with a corresponding increase in hospital admissions. It has been hypothesised that COPD exacerbations and admissions can be reduced by predicting periods of cold weather coupled with patients' alerts and education. Healthy Outlook(?) service provided by the Meteorological Office, UK, was used in patients with mild-to-moderate COPD who consented to participate from three primary care practices. Outcome measures included data relating to hospital admissions for acute exacerbations as well as HCU for these patients during the intervention period (1 Nov 2008-31 Mar 2009) and compared for the same patients and same period 12 months earlier (1 Nov 2007-31 Mar 2008). A cost analysis comparing treatment cost per patient for the two periods was also conducted. A total of 157 (34% of target COPD population) patients took part in the project, with five weather alerts generated (first alert reached 150 patients; second reached 146; third reached 138 patients; fourth reached 137 patients; and the fifth reached 125 patients) during the intervention period. There was a non-statistically-significant increase in hospital admissions per patient (0.07-0.076; p = 0.83). The number of general practice visits per patient dropped from 4.9 to 3.8 (p = 0.001), with drop in average number of visits to patients by out-of-hours services from 0.52-0.14 (p = 0.013). The average number of home consultations provided by general practice increased from 0.05 to 0.92 (p = 0.001). Cost per patient increased by an average of ￡142 (95% CI -￡128 to ￡412). This anticipatory care model was not associated with reduction in admissions from COPD exacerbations. Further research is required to fully understand its role in the management of patients with COPD.     

Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008

Background and objective: Because the mortality and social burden associated with COPD is increasing, repeated surveys of the prevalence of COPD have been used to assess risk factors, detect potential patients, and establish early diagnoses and management protocols. We report the prevalence of spirometrically detected COPD in Korea in 2008, using data from the fourth Korean National Health and Nutrition Survey. Methods: Using nationwide stratified random sampling, based on the Korean Statistical Office census, 6840 subjects aged ≥19 years underwent spirometry, which was performed by four trained technicians, during 2008. The place of residence, levels of education and income and smoking status, as well as other results from a COPD survey questionnaire were also assessed. Results: Airflow obstruction (FEV₁/FVC < 0.7) was detected in 8.8% of subjects aged ≥19 years (11.6% of men and 5.9% of women) and COPD was detected in 13.4% of subjects aged ≥40 years (19.4% of men and 7.9% of women). Of the 6840 subjects, 27.3% were current smokers and 17.2% were former smokers, and the prevalence of COPD was higher in current and former smokers than in never smokers. Approximately 94% of patients with COPD had mild‐to‐moderate disease, without apparent symptoms; only 2.4% had been diagnosed by a physician and only 2.1% of patients had been treated. The independent risk factors for COPD were smoking, advanced age and male gender. Conclusions: Although the prevalence of COPD in Korea is high, the disease is underdiagnosed and most COPD patients are under‐treated.     

Disease Burden of Patients with Asthma/COPD Overlap in a US Claims Database: Impact of ICD-9 Coding-based Definitions

The inclusion of an asthma/chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) population in the 2015 Global Initiative for Chronic Obstructive Lung Disease strategic documents has raised questions about the profile of these patients in clinical practice, as they are mostly excluded from asthma and COPD clinical trials. We estimated the disease burden, co-morbidities, and respiratory treatments of patients with asthma/COPD overlap, utilizing the Truven MarketScan commercial and Medicare databases. Patients with ≥1 COPD or chronic obstructive asthma diagnostic code were identified between January 1, 2008, and December 31, 2011. The asthma/COPD overlap group was defined and stratified based upon type and frequency of asthma diagnostic code (chronic obstructive asthma only, COPD and chronic obstructive asthma, and COPD and ≥1 asthma code). 1,488,613 patients were identified; of these, 1,171,626 were diagnosed with COPD alone and 316,987 with asthma/COPD overlap. Patients with asthma and COPD had higher disease burden indicators and inhaled corticosteroid/long-acting beta-agonist use compared with COPD alone. This trend was consistent for all definitions of asthma/COPD overlap. Patients with obstructive asthma and COPD tended to be older, with greater disease burden compared with other definitions; this population may represent a more severe form of asthma/COPD overlap. Disease burden and treatment also varied based on the codes defining asthma/COPD overlap, indicating possible phenotypic differences. More clinical insight and detailed phenotyping is needed to determine the reasons for coding variation in asthma/COPD overlap, with implications for further research to address unmet needs.