Long-term follow-up of chronic obstructive pulmonary disease patients on long-term oxygen treatment

Aims: Few studies exist on influence of long‐term oxygen treatment (LTOT) on survival of chronic obstructive pulmonary disease (COPD) patients. This study was designed to determine whether LTOT improves survival or not in severely hypoxaemic COPD patients. Materials: COPD patients prescribed oxygen concentrator were consecutively included. Patients’ baseline characteristics were noted. During follow‐up, patients were divided into three groups according to LTOT utilisation: (i) non‐utilisers, (ii) intermittent utilisers (< 15 h/day) and (iii) true utilisers (≥ 15 h/day). Patients’ status (live or death) and, if died, the date of death were checked throughout the study. The factors which might influence mortality during 5‐year period were analysed. Results: Two‐hundred and twenty‐eight patients completed the study. Of these patients, 55 were in Group 1, 112 were in Group 2 and 61 were in Group 3. Regarding the initial characteristics, there was not any significant difference between groups. Mean follow‐up for whole group was 27.8 ± 18.5 months. Median survivals were similar between groups (19.5 ± 5.6, 32.5 ± 4.1 and 30.0 ± 5.7 months respectively) (p > 0.05). Compared with Group 1, survival was improved in Group 2 (p < 0.05) and there was a positive trend for Group 3 during first 2‐year period. However, this improvement disappeared during further follow‐up. Analysis of multiple factors which might influence mortality during 5‐year period did not yield statistically significant parameter. Discussion and conclusion: We found that, regarding survival, any kind of LTOT proved to be beneficial over no LTOT only in the first 2 years of follow‐up, and that there was not any difference between intermittent and true LTOT utilisation.     

慢性阻塞性肺疾病病人长期家庭氧疗现状调查与护理

目的了解慢性阻塞性肺疾病病人长期家庭氧疗的现状。方法对2014年5月~2014年6月本科出院后愿意接受调查的97例慢性阻塞性肺疾病病人由专科护士进行电话随访调查。结果 97例病人中对氧疗相关知识不了解39例(40.2%);部分了解28例(28.9%);了解30例(30.9%)。未进行家庭氧疗的74例(76.3%),进行家庭氧疗的23例(23.7%),其中14例(14.4%)病人达到要求。结论 COPD患者对长期家庭氧疗的重要性认识不足,呼吸专科医护人员应加强对慢性阻塞性肺疾病病人氧疗相关知识的教育和指导,为病人提供支持和帮助。     

负离子氧疗法治疗慢性阻塞性肺病的疗效观察

目的结合空气负离子与氧疗法医学理疗原理,调研负离子氧疗法对慢性阻塞性疾病的辅助治疗效果。方法临床调查60例患者案例,收集并阅读资料。结果空气负离子与氧气疗法都有治疗慢性阻塞性肺病的功效,两者结合更能相辅相成,提高患者SaO2,提高生活质量,减少失眠、厌食、感冒等现象。结论空气负离子疗法与氧疗法都是新兴的疗养法,在医学上的应用范围很广,而将两者完美结合,更是一种全新的理疗模式。我们应积极探讨并合理利用两者的优势资源,将空气负离子疗法与氧疗法相互交融在一起,不断提高疗养质量。     

Corticosteroid therapy and chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterized in part by a chronic inflammatory state in the airways (largely from chronic noxious stimuli such as tobacco smoke), punctuated with acute inflammatory exacerbations, which are often infectious. Although pathologically and biochemically different from the inflammation of asthma, the chronic inflammation of chronic obstructive pulmonary disease, especially in subgroups with asthma-like features and especially during exacerbations, might be expected to respond to corticosteroid therapy, as does asthma. Complications from long-term corticosteroid use are important, but they appear less when the corticosteroid is given via the inhaled route. Clinical evidence is particularly strong supporting the use of inhaled corticosteroids to prevent exacerbations and oral corticosteroids to reduce the duration and impact of exacerbations.     

推拿治疗慢性阻塞性肺疾病的疗效

目的:观察推拿治疗慢性阻塞性肺疾病、改善肺功能的效应。方法:选择2003-07/2005-08来自上海交通大学附属第一人民医院呼吸科和推拿科收治的缓解期的慢性阻塞性肺疾病患者30例,男28例,女2例,随机分为两组,推拿组和对照组各15例,所有患者均给予常规按需治疗。推拿组患者给予每周5次推拿,每次20min,共8周。头面部及项部操作:①从头顶部到枕部用五指拿法,从枕部到项部用三指拿法。②推桥弓穴。③面部分法。④扫散法。躯干部操作:①横擦前胸部。②横擦肩背、腰部。③斜擦两肋。上肢操作:①直擦上肢。②拿上肢。③运肩关节,理手指,最后搓抖上肢。④重复头面部操作,加震百会、大椎、命门穴。按揉心俞、肺俞、脾俞、肾俞、命门,擦肾俞、命门。治疗前后给予测定肺功能(第1秒用力呼出量、用力肺活量、一秒率);呼吸困难分级评分;6min步行距离实验。结果:30例均进入结果分析,无脱落者。①两组患者康复治疗前后呼吸功能变化:推拿组呼吸困难减轻的有效率明显高于对照组(67%,40%)。②两组患者康复治疗前后肺功能变化:推拿组治疗后第1秒用力呼气量,用力肺活量比治疗前升高犤(1.419±0.953),(1.248±0.743)L;(2.628±0.921),(2.311±0.875)L,P<0.01犦,对照组的升高差异没有显著性。推拿组治疗后肺功能改善情况明显高于对照组(P<0.05)。③两组患者康复治疗前后6min步行距离实验的变化:两组患者6min步行距离实验均有增加,对照组的增加差异不显著(由328m增加到346m),推拿治疗前后差异显著(由330m增加到389m,P<0.01),而且治疗后推拿组较对照组差异有显著性(P<0.05)。结论:推拿治疗缓解期的慢性阻塞性肺疾病,可改善肺功能、减轻呼吸困难,增强运动耐力,值得推广。     

推拿治疗慢性阻塞性肺疾病的疗效

目的：观察推拿治疗慢性阻塞性肺疾病、改善肺功能的效应。方法：选择2003—07／2005—08来自上海交通大学附属第一人民医院呼吸科和推聿科收治的缓解期的慢性阻塞性肺疾病患者30例，男28例，女2例，随机分为两组，推拿组和对照组各15例，所有患者均给予常规按需治疗。推拿组患者给于每周5次推拿，每次20min，共8周。头面部及项部操作：①从头顶部到枕部用五指拿法，从枕部到项部用三指拿法。②推桥弓穴。③面部分法。④扫散法。躯干部操作：①横擦前胸部。②横擦肩背、腰部。③斜擦两肋。上肢操作：①直擦上肢。②拿上肢。③运肩关节，理手指，最后搓抖上肢。④重复头面部操作，加震百会、大椎、命门穴。按揉心俞、肺俞、脾俞、肾俞、命门，擦肾俞、命门。治疗前后给予测定肺功能（第1秒用力呼出量、用力肺活量、一秒率）；呼吸困难分级评分；6min步行距离实验。结果：30例均进入结果分析，无脱落者。①两组患者康复治疗前后呼吸功能变化：推拿组呼吸凼难减轻的有效率明显高于对照组（67％，40％）。②两组患者康复治疗前后肺功能变化：推拿组治疗屙第1秒用力呼气最，用力肺活量比治疗的升高[（1．419&;#177;0.953），（1．248&;#177;0．743）L；（2．628&;#177;0．921），（2.311&;#177;0．875）L，P＜0．01]，对照组的升高差异没有显著性。推拿组治疗后肺功能改善情况明屁高于对照组（P〈0．05）。③两组患者康复治疗前后6min步行距离实验的变化：两组患者6min步行距离实验均有增加，对照组的增加差异不显著（由328111增加到346111），推拿治疗前后差异显著（由330m增加到389m，P＜0．01），而且治疗后推拿组较对照组差异有显著性（P＜0．05）。结论：推拿治疗缓解期的慢性阻塞性肺疾病，可改善肺功能、减轻呼吸困难，增强运动耐力，值得推广。     

慢性阻塞性肺病病人家庭氧疗依从性调查分析

[目的]调查有长期家庭氧疗(LTOT)指证的慢性阻塞性肺病(COPD)病人,实施LTOT的依从性,为护理干预提供依据。[方法]采用自行设计的问卷调查表,对有LTOT指证的住院病人进行调查。[结果]COPD病人对LTOT的依从性与年龄、文化程度、住院次数有关,并普遍存在依从性差的情况。[结论]COPD病人住院期间应加强LTOT相关知识的宣教,并重视对家属的宣教工作。     

New drug therapy of chronic obstructive pulmonary disease

The progression of chronic obstructive pulmonary disease(COPD) can be inhibited by smoking cessation. As adjunct drugs, nicotine replacement therapy and an antidepressant bupropion are found to improve the abstinence rate from smoking. The mainstay of drug therapy of COPD consists of bronchodilators. Inhaled long-acting anticholinergic agents are in development. Inhaled long-acting beta 2-agonists are newly available. Theophylline has weak antiinflammatory effects. The significance of corticosteroids and mucolytic drugs in stable COPD is yet to be elucidated. In severely hypoxemic patients with COPD long-term domicillary oxygen therapy improves the survival rate. There is no drug therapy which can prevent the long-term deterioration of pulmonary function in patients with COPD. New class of drugs are now in development.     

Reevaluation of continuous oxygen therapy after initial prescription in patients with chronic obstructive pulmonary disease

BACKGROUND: Long-term oxygen therapy improves survival and quality of life in hypoxemic patients with chronic obstructive pulmonary disease (COPD). The need for long-term oxygen therapy should be determined when patients are medically stable. The Third Oxygen Consensus Conference recommended reevaluating patients 1-3 months after continuous oxygen therapy (COT) is initiated, if initiated when the patient is medically unstable. METHODS: A cross-sectional study was performed to examine how often orders for COT are reevaluated pursuant to the guidelines promulgated by the Third Oxygen Therapy Consensus Conference, and to assess the impact that following these guidelines would have on the cost of COT. RESULTS: Of 226 patients prescribed home oxygen therapy, 92 had COPD as a primary diagnosis and 57 were prescribed COT. Only 19 (35%) of 55 patients who returned to the clinics were appropriately reevaluated. The rate of appropriate reevaluation was significantly higher among pulmonary physicians than among primary care physicians (65% vs 17%; odds ratio: 9.0; 95% confidence interval: 2.5-32). Of 19 patients who were appropriately reevaluated, 11 (58%) were discontinued from COT. The patients who were discontinued from COT had a significantly higher percent of predicted forced expiratory volume in the first second than those who were not (34 +/- 8.6% vs 25 +/- 8.8%; p = 0.04). CONCLUSIONS: In our study, most patients were clinically unstable when COT was prescribed, and a significant number of patients remained on COT without reevaluation. Up to 60% of those patients could potentially be discontinued from COT if appropriately reevaluated. Referring a patient initiated on COT to a pulmonary specialist for the proper use of oxygen is strongly recommended. Reevaluating such patients in a timely fashion and discontinuing unnecessary oxygen concentrators could possibly save $106-153 million per year in the United States.     

高原地区慢性阻塞性肺病患者加温氧疗的观察及护理

目的 为了解长期湿化加温氧疗对高原地区慢性阻塞性肺病(COPD)患者其生活质量和生存时间的影响.方法 将COPD患者分为长期湿化加温氧疗组和非氧疗组,定期进行血常规、血气分析和肺功能检测,比较2组患者3年中的住院率、病死率.结果 长期湿化加温氧疗组PaO2水平显著高于非氧疗组;长期湿化加温氧疗组其血红蛋白、红细胞压积显著低于非氧疗组,且长期湿化加温氧疗组血红蛋白、红细胞压积与氧疗前相比得到了一定程度的逆转;肺功能下降程度2组无明显差异;长期湿化加温氧疗组在3年中的住院率和病死率均显著低于非氧疗组.结论 高原地区长期湿化加温氧疗可显著降低COPD患者的住院次数和远期病死率,提高生活质量,是COPD患者缓解期康复治疗的一种良好手段.     

高原地区慢性阻塞性肺病患者加温氧疗的观察及护理

目的为了解长期湿化加温氧疗对高原地区慢性阻塞性肺病(COPD)患者其生活质量和生存时间的影响。方法将COPD患者分为长期湿化加温氧疗组和非氧疗组,定期进行血常规、血气分析和肺功能检测,比较2组患者3年中的住院率、病死率。结果长期湿化加温氧疗组PaO2水平显著高于非氧疗组;长期湿化加温氧疗组其血红蛋白、红细胞压积显著低于非氧疗组,且长期湿化加温氧疗组血红蛋白、红细胞压积与氧疗前相比得到了一定程度的逆转;肺功能下降程度2组无明显差异;长期湿化加温氧疗组在3年中的住院率和病死率均显著低于非氧疗组。结论高原地区长期湿化加温氧疗可显著降低COPD患者的住院次数和远期病死率,提高生活质量,是COPD患者缓解期康复治疗的一种良好手段。     

护理干预对老年慢性阻塞性肺疾病患者用氧效果影响

目的探讨护理干预对老年慢性阻塞性肺疾病患者用氧治疗效果。方法选取本院呼吸科收治慢性阻塞性肺疾病(COPD)老年患者125例,根据护理方法不同分为观察组和对照组,给予相应护理后比较2组患者满意度,同时分析影响护理干预的相关影响因素。结果观察组患者护理满意程度高于对照组;病程、合并症、不良情绪、机械损伤4项为影响护理干预老年慢性阻塞性肺病患者用氧效果的相关风险因素。结论老年慢性阻塞性肺疾病采取护理干预后能提高用氧治疗效果,改善患者治疗期间生存质量,同时应根据患者情况对认知和依从性进行纠正。     

Efficacy and indications of home oxygen therapy for patients with chronic obstructive pulmonary disease]

Efficacy of home oxygen therapy (HOT) is well established for patients with chronic obstructive pulmonary disease who fall into chronic respiratory failure. We should consider now how the quality of life improves with HOT in those patients. According to the guideline of the Japanese Respiratory Society, indications of HOT are as follows: 1) A PaO2 of less than 55 Torr at rest while breathing room air, 2) A PaO2 between 55 Torr and 60 Torr in the presence of clear evidence of cor pulmonale, pulmonary hypertension, or a long history of severe hypoxemia during sleep or during exercise. Further studies are definitely required to pick up the patients who do not necessarily meet these indications but who may benefit from HOT.     

Cytokines and statin therapy in chronic obstructive pulmonary disease patients

Abstract

Cytokines are biological response modifiers involved in the pathophysiology of chronic obstructive pulmonary disease (COPD). This study investigated the potential use of cytokines as disease severity biomarkers in COPD patients and the possible effect of statin therapy on cytokine expression. Possible associations between cytokines, body mass index (BMI) and smoking have also been studied. Cytokines IFN-γ, IL-2, IL-12 p70, TNF-α, TNF-β, IL-4, IL-5, IL-6, IL-10, IL-1β and IL-8 were measured in the plasma of 100 clinically stable COPD patients using a fluorescent bead immunoassay on a flow cytometer. When patients were grouped according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (A-D), no significant differences in cytokine concentrations were found (p?>?.05). Significantly decreased concentrations of IL-1β, IL-2, IL-4, IL-8, IL-10, IL-12p70 and TNF-α were found in COPD patients receiving statin therapy in comparison with COPD patients not receiving statin therapy (p?25) had decreased IL-2 (p=.038), IL-8 (p?=?.039) and IL-10 (p?=?.005) concentrations compared to normal BMI (20–25) patients. Current COPD smokers had increased concentrations of IL-5 (p?=?.037) compared to former COPD smokers. Hierarchical cluster analysis showed several patterns of measured cytokines in serum of patients with stable COPD. Statin therapy is associated with decreased expression of selected Th1 and Th2 cytokines in COPD, and this effect could be of relevance in COPD patients with increased cardiovascular risk. Concentrations of Th1 and Th2 cytokines in plasma cannot be used as biomarkers of disease severity or progression of COPD.     

慢性阻塞性肺疾病药物治疗进展

慢性阻塞性肺疾病（COPD）的发病率和死亡率逐年升高，已成为世界性医学问题。本文介绍COPD的药物治疗进展。     

慢性阻塞性肺疾病病人规范化治疗

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是危害公众健康的常见慢性疾病之一，目前是世界上第4位主要死亡原因。COPD现已引起世界各国的重视，在我国COPD占据死因第3位，而在农村则占死因首位。COPD是以呼气气流受限为特征的病变，临床上表现为咳嗽、咳痰及呼吸困难。COPD发病多年后出现的呼吸困难症状是病人求医的主要原因，也是最终导致病人日常活动受限的主要因素之一。由于其迁延不愈，反复发作，病程长，病情复杂，易反复感染且呈进行性加重，严重影响病人的劳动能力和生活质量，给病人身心造成极大痛苦，给社会及个人经济带来严重损失。为普及㈣的防治知识及推广慢性阻塞性肺疾病全球创议（C-OLD），达到控制发作、预防复发、气道重建以及降低致残致死率及节约医疗资源开支的目的，我院于2003年在全市率先成立了COPD俱乐部（以下简称俱乐部）及郊区农村COPD防治网络。