COPD和哮喘患者支气管舒张实验用力肺活量和呼气容积的变化

目的 探讨COPD和哮喘患者支气管舒张实验用力肺活量和呼气容积变化.方法 随机选取COPD急性加重期78例和哮喘急性发作期64例,采用支气管舒张实验比较COPD和哮喘患者实验前后用力肺活量(FVC)、一秒用力呼气容积(FEV1)的增加量和增加率.结果 支气管舒张实验后,COPD患者的用力肺活量(FVC)的增加量191 ml,较舒张前增加12.93%,而一秒用力呼气容积(FEV1)的增加量63 ml,较舒张前增加10.01%;哮喘患者的用力肺活量(FVC)的增加量363 ml,较舒张前增加15.34%,而一秒用力呼气容积(FEV1)的增加量289 ml,较舒张前增加23.57%.结论 COPD患者支气管舒张试验后用力肺活量的增加幅度大于呼气容积的增加幅度,而哮喘患者正好相反,因此用力肺活量可鉴别COPD和哮喘患者病情的客观指标.     

小气道功能指标在哮喘诊断及评估中的应用价值

目的通过测定缓解期哮喘患者的肺功能和支气管舒张试验中呼气中期流速等肺功指标,探讨其在哮喘诊断及评估中的应用价值。方法对38例缓解期哮喘患者行基础肺功能检查和支气管舒张试验,比较第1秒用力呼气容积（FEV1）、用力呼气中期平均流速（FEF25%-75%）、50%及75%肺活量位的用力呼气流速（V50、V25）等指标的阳性率。结果与FEV1相比,FEF25%-75%、V50、V25阳性率变化明显。结论在支气管哮喘患者诊断、治疗效果判断中,FEF25%-75%、V50、V25等反映小气道功能的指标可能较FEV1等指标更敏感,更具有早期诊断价值。     

气道高反应性在COPD和哮喘的比较

目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)和支气管哮喘(简称哮喘)患者在组胺支气管激发试验中气道高反应性(airway hyperresponsiveness,AHR)的不同.方法 将我院2008～2010年间诊断为COPD和哮喘的并经随访一年处于稳定期的患者共80例,其中COPD组39例,哮喘组41例,均行支气管组胺激发试验,观察FEF25％～75％/FVC(肺活量为25％～75％时最大呼气流量与用力肺活量的比值)在两组患者的变化.结果 COPD组FEF25％～75％和FEF25％～75 ％/FVC均明显低于哮喘组(P值均＜0.01);以激发试验阳性的两组患者为对象分别进行简单相关分析,在COPD组和哮喘组中FEF25％～75％/FVC与Log10DRS呈负相关(r分别为-0.510和-0.466,P＜0.05),与PD20FEV1呈正相关(r分别为0.518和0.487,P＜0.05),说明相对于肺容积而言,气道容积越小,气道收缩性越强,反应性越高.随后在以气道收缩性指标Log10DRS为因变量,以年龄、体表面积、FEV1％及FEF25％～75 ％/FVC为自变量进行线性回归分析,在COPD组FEV1％对Log10DRS较FEF25％～75％/FVC影响大(P＜0.05),而哮喘组不存在这情况.结论 在COPD中AHR患者并不少见,其发生机制与哮喘是不同的.     

气道高反应性在COPD和哮喘的比较

目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)和支气管哮喘(简称哮喘)患者在组胺支气管激发试验中气道高反应性(airwayhyperresponsiveness,AHR)的不同。方法将我院2008～2010年间诊断为COPD和哮喘的并经随访一年处于稳定期的患者共80例,其中COPD组39例,哮喘组41例,均行支气管组胺激发试验,观察FEF25%～75%/FVC(肺活量为25%～75%时最大呼气流量与用力肺活量的比值)在两组患者的变化。结果 COPD组FEF25%～75%和FEF25%～75%/FVC均明显低于哮喘组(P值均<0.01);以激发试验阳性的两组患者为对象分别进行简单相关分析,在COPD组和哮喘组中FEF25%～75%/FVC与Log10DRS呈负相关(r分别为-0.510和-0.466,P<0.05),与PD20FEV1呈正相关(r分别为0.518和0.487,P<0.05),说明相对于肺容积而言,气道容积越小,气道收缩性越强,反应性越高。随后在以气道收缩性指标Log10DRS为因变量,以年龄、体表面积、FEV1%及FEF25%～75%/FVC为自变量进行线性回归分析,在COPD组FEV1%对Log10DRS较FEF25%～75%/FVC影响大(P<0.05),而哮喘组不存在这情况。结论在COPD中AHR患者并不少见,其发生机制与哮喘是不同的。     

布地奈德福莫特罗联合茶碱缓释片和孟鲁司特钠治疗中重度缓解期支气管哮喘临床观察

目的探讨布地奈德福莫特罗联合茶碱缓释片和孟鲁司特钠治疗中重度支气管哮喘缓解期的临床疗效。方法选择该院2015-02~2016-07收治的缓解期支气管哮喘患者112例作为研究对象,随机分为对照组和观察组各56例。对照组予以孟鲁司特钠联合茶碱缓释片治疗,观察组予以布地奈德福莫特罗联合茶碱缓释片和孟鲁司特钠治疗,两组均治疗2周。对比两组治疗前后的炎症因子水平及肺功能。结果治疗前,两组炎症因子水平及肺功能差异无统计学意义(P0.05)。治疗后观察组的白细胞介素-4(IL-4)、白细胞介素-5(IL-5)及肿瘤坏死因子-α(TNF-α)水平均低于对照组,第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及1秒钟用力呼气容积占用力肺活量的百分比(FEV1/FVC)均高于对照组,差异具有统计学意义(P0.01)。结论对缓解期支气管哮喘患者予以布地奈德福莫特罗联合茶碱缓释片和孟鲁司特钠治疗效果确切,对减轻患者的炎症反应、增强肺功能具有积极的意义。     

支气管哮喘患者呼出气一氧化氮、肺功能、ACQ7评分之间的相关性研究

目的探讨呼出气一氧化氮(FeNO)、肺通气功能及支气管哮喘(简称哮喘)控制水平的相关关系,寻找适用于哮喘患者的气道炎症监测及管理的方法。方法按GINA2008标准入选我院门诊2010年3月至2011年6月就诊65例确诊为哮喘的患者,进行FeNO测定,同时测定肺功能,记录第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、用力肺活量(FVC)、FEV1/FVC、呼气峰流速(PEF)、FEF25/75、FEF25/75%等指标,行诱导痰检测,记数嗜酸粒细胞的比率(EOS%)。进行哮喘控制问卷(ACQ7)及哮喘控制测试(ACT)调查表的填写。结果经多元逐步回归分析,FeNO的值主要受到年龄、FEF25/75、FEF25/75%、日间症状的影响,与体质量指数、过敏等因素无显著相关关系,与FEV1、FEV1%pred、ACQ7评分、ACT评分等亦无显著相关(P0.05),FeNO与诱导痰EOS%呈显著正相关(r=0.327,P=0.022)。ACQ7与FEV1、FEV1%pred呈显著负相关(分别是r=-0.491,P=0.000,r=-0.469,P=0.012)。结论 FeNO能够客观反映气道EOS炎症水平,年龄越小、日间症状越明显、小气道阻力越高,FeNO水平越高。结合肺功能指标和FeNO更能全面反映哮喘疾病现况及控制水平。     

支气管舒张试验对AECOPD小气道功能影响

目的 探讨支气管舒张试验对慢性阻塞性肺疾病急性加重期(AECOPD)小气道功能影响.方法 分析我院2008年1月至2011年4月38例AECOPD患者,行支气管舒张试验,FEV1、FEF 50％、FEF 75％、MMEF 75/25％行配对t检验.结果 支气管舒张试验在AECOPD及支气管舒张试验阳性组小气道功能均存在显著差异;在支气管舒张试验阴性组,FEV1、FEF 50％存在显著差异,但FEF 75％、MMEF 75/25％无差异.结论 支气管舒张试验可改善AECOPD患者小气道功能,但在支气管舒张试验阴性组小气道功能指标FEF 75％、MMEF 75/25％无改善.     

不同程度的慢性阻塞性肺疾病对支气管舒张试验的反应性差异

目的 探讨不同严重程度的慢性阻塞性肺疾病( COPD)患者对支气管舒张试验的反应性差异.方法 入选Ⅰ～Ⅳ级COPD稳定期患者共411例,采用支气管舒张试验比较支气管舒张前后第1秒用力呼气容积(FEV1)、用力肺活量(FVC)和深吸气量(IC)的改变值和改变率.结果 支气管舒张试验后,COPD患者的FEV1、FVC和IC均有增加,比试验前差异有统计学意义(P＜0.01).随着COPD严重程度的增加,FEV1的改变值逐渐减少,而FVC和IC改变值却逐渐增加.结论 随着COPD的严重程度加重,吸入支气管舒张剂后,FVC和IC改变值越大,FVC和IC是重度COPD患者对支气管舒张剂反应性的指标.     

慢性阻塞性肺疾病支气管舒张试验47例临床分析

目的探讨支气管舒张试验不同结果的慢性阻塞性肺疾病(COPD)患者的临床特点。方法对2007年4月至2008年1月上海交通大学医学院附属新华医院呼吸内科住院的47例COPD患者进行肺功能及支气管舒张试验的检查,并收集患者相关临床资料,对于不同的支气管舒张试验结果进行比较分析。结果舒张试验阳性组的COPD患者吸烟史明显少于阴性组(P<0.05),而血清IgE则明显高于阴性组(P<0.05)。阳性组用力肺活量(FVC)改善率、第一秒钟用力呼气容积(FEV1)改善率、功能残气量(FRC)、75%肺活量时的最大呼气流量(MEF75%)改善率、50%肺活量时的最大呼气流量(MEF50%)改善率均高于阴性组(P<0.05),其中尤以FEV1改善率、MEF75%改善率、MEF50%改善率明显(P<0.01)。不同分级的COPD患者舒张试验的结果差异有统计学意义(P<0.05)。结论吸烟是影响COPD患者支气管舒张试验结果的一个因素。支气管舒张试验阳性的COPD患者具有更高的血清IgE水平,可能存在气道高反应性。舒张试验阳性的COPD患者气流受限的小气道的改善不明显,可能是以大中气道的改善为主。轻-中度的COPD患者更具有的气流受限的可逆性。     

50例咳嗽变异型哮喘肺功能临床分析

对比分析典型哮喘患者40例与正常组健康人40例和咳嗽变异型哮喘患者50例的第一秒用力呼气量(FEV1)、用力肺活量(FVC)、第一秒用力呼气量FEV1占FVC比值(FEV1/FVC)、最高呼气流速(PEF)、残气量(RV)及残气量/肺总量(RV/TLC)指标。结果 FEV1、FVC、FEV1/FVC及PEF等肺通气功能指标:正常组最高,咳嗽变异型哮喘次之,而典型哮喘最低,(P0.05),在激发试验前后咳嗽变异型哮喘患者肺功能存在明显可逆性改变。结论咳嗽变异型哮喘存在可逆性气流受限,确诊需要完善肺功能及支气管激发试验(BPT)或支气管舒张试验(BDT)试验。(当患者FEV1≥70%预计值时,可进一步作支气管激发试验;FEV170%预计值提示有气道阻塞时,宜作支气管舒张试验)~([1])     

哮喘儿童肺通气功能检测的临床分析

目的：通过监测哮喘儿童急性发作期与缓解期肺通气功能各指标变化情况,了解其在儿童哮喘病情评估及指导治疗中的作用。方法应用德国Jaeger Master Screen肺功能仪对43例5～12岁哮喘急性发作期和经治疗后进入缓解期的哮喘儿童进行肺通气功能检测,包括大气道指标（ FVC、FEVl、FEV1/FVC、PEF）及小气道指标（ FEF25、FEF50、FEF75、MMEF75/25）,同时收集哮喘患儿病史资料和治疗情况。结果哮喘急性发作期患儿肺功能指标FVC、FEV1、FEV1/FVC、PEF与缓解期及健康对照组儿童比较,差异有统计学意义（ P＜0.01）;哮喘缓解期患儿的FVC、FEV1、PEF与健康对照组比较,差异无统计学意义（ P＞0.05）。小气道功能指标FEF25、FEF50、FEF75、MMEF75/25在哮喘急性发作期患儿中均明显降低,与缓解期组及健康对照组儿童相比差异有统计学意义（ P＜0.01）;哮喘治疗缓解期组中FEF25、FEF50、FEF75、MMEF75/25仍低于健康对照组,差异有统计学意义（ P＜0.05）。哮喘急性发作期不同严重程度患儿的肺通气功能指标（ FVC％pred、FEV1％pred、PEF％pred、FEF25％pred、FEF50％pred、FEF75％pred、MMEF75/25％pred ）随哮喘严重程度增加各指标越低,差异有统计学意义（ P＜0.05）。结论哮喘急性发作期肺通气功能受损,治疗缓解后小气道肺功能指标仍低于正常。肺通气功能的小气道功能指标在儿童哮喘的病情评估及治疗监测指导中意义更大。     

小气道功能与气道高反应性的相关性分析

目的：分析小气道功能与气道高反应的相关性。方法选取2012年10月至2013年5月于北京友谊医院及北京房山区良乡医院呼吸科门诊就诊的符合纳入及排除标准的临床怀疑哮喘的患者110例,用肺通气功能进行支气管激发试验(BPT),比较 BPT 阳性组与阴性组肺通气肺功能参数及小气道异常率,使用受试者工作特征曲线(ROC 曲线)评估 FEF25/FVC、FEF50/FVC、FEF75/FVC、MMEF/FVC 在 BPT 前后的变化量(△FEF25/FVC、△FEF50/FVC、△FEF75/FVC、△MMEF/FVC)对气道高反应的诊断准确性、敏感度及特异度,对阳性组 PD20-FEV1累积量与△FEF25/FVC、△FEF50/FVC、△FEF75/FVC、△MMEF/FVC进行相关性分析。结果 BPT 前后阳性组 FEV1、FEV1/FVC、FEF25、FEF50、FEF75、MMEF、FEF25/FVC、FEF50/FVC、FEF75/FVC、MMEF/FVC与阴性组比较,差异均有统计学意义(P <0.05)。BPT 前后阳性组小气道异常率与阴性组相比,差异均有统计学意义(χ2=22.482,P =0.000;χ2=25.852,P =0.000)。△FEF25/FVC的曲线下面积(AUC)为0.792[95%CI (0.703~0.881)](P =0.000),△FEF50/FVC的 AUC 为0.767[95%CI (0.677~0.858)](P =0.000),△MMEF/FVC 的 AUC 为0.667[95%CI (0.563~0.771)](P =0.004)。△FEF50/FVC、△MMEF/FVC 与 PD20-FEV1呈正相关(r=0.360,P=0.007;r=0.271,P=0.035)。结论存在气道高反应的患者大小气道功能均明显低于气道反应性正常的患者,存在小气道功能异常的患者BPT可能更易出现阳性结果,小气道功能在激发试验前后的变化可以反映气道高反应性的严重程度。     

慢性阻塞性肺疾病稳定期门诊治疗的临床研究

目的研究COPD稳定期的不同治疗方案。方法将90例COPD患者随机分为3组：舒利迭组（吸入沙美特罗氟替卡松50／250μg每天2次）、联合用药组（口服茶碱缓释片0．1g每天2次＋吸入丙酸氟替昔松125μg每天2次）及对照组（按需使用硫酸沙丁胺醇气雾剂）,随访1年,观察1年后的肺功能（FEV1、FVC、FEV1％pred、FEV1/FVC和FEF25—75％）,6分钟步行距离（6 minuteswalkingdistance,6MWD）和1年中急性加重的次数。结果治疗后舒利迭组和联合用药组的FEV1、FVC、FEV1％pred、FEV1／FVC、FEF25—75％和6MWD分别与对照组及治疗前比较均有改善（P值均〈0．05）;治疗后舒利迭组比联合用药组FVC和FEF2575％改善更明显（分别为2．41±0．61和2．11±0．47,44．9±10．1和35．4±8．8。P值均〈0．05）。结论舒利迭（50／250μg）、联合用药（口服茶碱缓释片＋丙酸氟替卡松气雾剂）对稳定期COPD患者疗效肯定,前者对FVC和FEF25—75％的改善较后者强。     

用力吸气流量在COPD和支气管哮喘中的应用

目的 评价用力吸气流量指标在慢性阻塞性肺疾病(COPD)和支气管哮喘中价值。方法 观察COPD80例和支气管哮喘20例在吸入支气管扩张剂后用力吸气流量指标的前后变化。结果 轻度COPD患者和支气管哮喘患者FEV1,FIV1，PEF，PIF，FEF50％，FIF50%指标，在吸入支气管扩张剂前后均有明显的差异。但用力吸气流量指标与用力呼气流量指标在统计学无差别。而中、重度COPD患者FIV1％较FEV1％有显著差异性。结论 在COPD中，在评价支气管的可逆性方面，用力吸气流量具有用力呼气流量同样的效果。甚至在重度COPD患者中．FIV1%比用力呼气流量可能更加敏感。     

Role of forced expiratory flow at 25-75% as an early marker of small airways impairment in subjects with allergic rhinitis.

A close link exists between allergic rhinitis and asthma. Small airway disease (SAD), defined by a reduction in forced expiratory flow at 25-75% of the pulmonary volume (FEF25-75) and normal spirometry (normal forced expiratory volume at 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC ratio), may be a marker for early allergic or inflammatory involvement of the small airways in subjects with allergic diseases and no asthma. The aim of this study was to determine if there is a relationship between SAD, the outcome variable, and several allergic predictors in patients without asthma but with allergic rhinitis. A cross-sectional study was performed. Two hundred eleven midshipmen attending the third and fifth course of the Navy Academy of Livorno were screened. Fifty-eight midshipmen showed slight spirometric anomalies. Thus, they were referred to the Navy Hospital of La Spezia for standardized tests: skin-prick test, nasal cytology, spirometry, and methacholine bronchial challenge. A reduced FEF(25-75) was arbitrarily defined as < 80% of predicted. All 58 subjects had a normal FEV1, FVC, and FEV1/FVC ratio. Twenty subjects had a reduced FEF(25-75), consistent with the definition of SAD. A mean value of FEF(25-75) of 70.3 (SD, 8.5) was measured in patients with a reduced FEF, and it was 108.0 (SD, 14.3) in patients with preserved FEF(25-75). All the candidate allergic predictors appeared to be strongly associated with a reduced FEF(25-75). The proportion of subjects with reduced FEF(25-75) appeared to increase with increasing severity of the allergic predictors, and, correspondingly, the mean value of FEF(25-75) appeared to decrease. This study provides evidence that there is a relationship between SAD and allergic parameters such as nasal symptoms and eosinophils.     

Effects of weight loss on peak flow variability, airways obstruction, and lung volumes in obese patients with asthma

STUDY OBJECTIVES: To clarify the pathophysiologic features of the relation between asthma and obesity, we measured the effects of weight reduction on peak expiratory flow (PEF) variability and airways obstruction, compared to simultaneous changes in lung volumes and ventilatory mechanics in obese patients with stable asthma. METHODS: Fourteen obese asthma patients (11 women and 3 men; aged 25 to 62 years) were studied before and after a very-low-calorie-diet period of 8 weeks. PEF variability was determined as diurnal and day-to-day variations. FEV(1) and maximal expiratory flow values were measured with a flow-volume spirometer. Lung volumes, airways resistance (Raw), and specific airways conductance were measured using a constant-volume body plethysmograph. Minute ventilation was monitored in patients in supine and standing positions. RESULTS: As patients decreased their body mass index (SD) from 37.2 (3.7) to 32.1(4.2) kg/m(2) (p < 0. 001), diurnal PEF variation declined from 5.5% (2.4) to 4.5% (1.5) (p = 0.01), and day-to-day variation declined from 5.3% (2.6) to 3. 1% (1.3) (p < 0.005). The mean morning PEF, FEV(1), and FVC increased after weight loss (p = 0.001, p < 0.005, and p < 0.05, respectively). Flow rate at the middle part of FVC (FEF(25-75)) increased even when related to lung volumes (FEF(25-75)/FVC; p < 0. 05). Functional residual capacity and expiratory reserve volume were significantly higher after weight loss (p < 0.05 and p < 0.005, respectively). A significant reduction in Raw was found (p < 0.01). Resting minute ventilation decreased after weight loss (p = 0.01). CONCLUSION: Weight loss reduces airways obstruction as well as PEF variability in obese patients with asthma. The results suggest that obese patients benefit from weight loss by improved pulmonary mechanics and a better control of airways obstruction.     

气道高反应性患者肺功能特点分析

目的探讨气道高反应患者肺功能特点。方法 220例慢性咳嗽或胸闷患者按支气管激发试验（BPT）结果分阳性组118例,阴性组102例,比较肺功能指标在吸入生理盐水前后的差异。结果阳性组FEV1、FEV1/FVC、FEF 25%、FEF50%、FEF 75%、MMEF较阴性组明显降低（P〈0.01）,吸入生理盐水后阳性组FVC、FEV1、FEF50%及MMEF较阴性组有明显下降（P〈0.05）。Logistic回归显示小气道病变及吸入生理盐水后的△FEV1是BPT阳性结果的危险因素。结论气道高反应患者具有大小气道功能异常特点。小气道病变及吸入生理盐水后FEV1下降率高的患者更易有BPT阳性结果。     

Comparison of maximal midexpiratory flow rate and forced expiratory flow at 50% of vital capacity in children

BACKGROUND: The mid-portion of the maximal expiratory flow-volume (MEFV) curve is often described by values of the mean forced expired flow as lung volume decreases from 75% to 25% of vital capacity (ie, forced expiratory flow, midexpiratory phase [FEF(25-75)]). It is common practice to report also forced expired flow at 50% of vital capacity (FEF(50)). STUDY OBJECTIVE: To investigate whether FEF(50) and FEF(25-75) are highly correlated or whether the difference between them reflects a degree of airways obstruction. Also, we wanted to investigate the correlation between the two in cases of irregularly shaped MEFV curves (ie, "saw-toothing"). DESIGN: Analysis of the correlation between FEF(50) and FEF(25-75) in a single determination. We assessed the relationship between the FEF(50)/FEF(25-75) ratio and the degree of airways obstruction, as reflected by other traditional parameters such as FEV(1), FEV(1)/FVC ratio, and specific airway conductance (SGaw). PATIENTS: There were 1,350 forced expiratory maneuvers performed by children with a broad range of pulmonary abnormalities. RESULTS: FEF(50) correlated with FEF(25-75) as follows: FEF(50) (L/s) = 0.041 + 1.136*FEF(25-75)(L/s); r(2) = 0.956; standard error of the estimate = 0.013; p < 0.0001. The FEF(50)/FEF(25-75) ratio remained stable and did not correlate with FEV(1) (r = 0.12), FEV(1)/FVC ratio (r = 0.11), or SGaw (r = 0.02; difference not significant). The correlation between FEF(25-75) and FEF(50) was similar for both the smooth curve (r = 0.97) and the irregular curve (r = 0.96). CONCLUSIONS: Although not identical, FEF(25-75) and FEF(50) are highly correlated, and the ratio of the two is fairly constant. Therefore, the practice of reporting both of them is unnecessary. We suggest that it is reasonable to prefer FEF(50).     

Response to bronchodilators

Bronchodilator response is usually tested to establish reversibility of airflow obstruction, to aid in diagnosis, and to help plan long-term bronchodilator therapy. Among the various tests to establish bronchodilator response, FEV1, FEF25-75% or FEF50%, and FVC are the most widely used. However, it may be difficult to interpret changes in pulmonary function in COPD patients because of day-to-day variability. A 15 per cent increase in FEV1 or FVC and a 30 per cent increase in isovolume FEF25-75% or FEF50% above baseline are acceptable criteria for bronchodilator response. beta-Adrenergic agonists, theophylline, and anticholinergic agents are available for testing bronchodilator response. Inhalation of two puffs of a beta-adrenergic agonist aerosol from an MDI is the most convenient and practical approach for testing in the laboratory. Bronchodilator response is presumed to be beneficial in the treatment of asthma. However, in the treatment of COPD a positive response may not be a reliable guide for establishing long-term benefit.