老年中重度稳定期慢性阻塞性肺疾病患者应用噻托溴铵的疗效与安全性

目的探讨老年中重度稳定期慢性阻塞性肺疾病(COPD)患者应用噻托溴铵(吸入剂量18μg,1次/d)的疗效和安全性。方法在中重度稳定期96例COPD患者,连续3年应用噻托溴铵,每3个月检测肺功能第1秒用力呼吸气量占预计值的百分比(FEV1)和用力肺活量(FVC),圣·乔治呼吸问卷计分(SGRQ)评估生活质量,观察急性加重的发生率及用药的不良反应。结果经连续3年的治疗观察,与对照组比较,噻托溴铵治疗组用药后的FEV1较基线值显著增加,FEV1增加0.26 L(P0.01),并且重度COPD患者肺功能改善明显,治疗组在6个月后肺功能下降趋势明显变缓。噻托溴铵组患者SGRQ评分低于对照组,在重度治疗后的第3个月,噻托溴铵治疗组SGRQ总评分较基线低了6.85,对照组SGRQ总评分较基线低了1.14,SGRQ总评分治疗组较对照组明显改善(P0.01);在中度患者中治疗6个月后SGRQ总评分治疗组较对照组比较有明显改善。COPD急性加重率治疗组与对照组之比为0.75(95%CI 0.58~0.96;P0.05)。在安全指标方面治疗组与对照组没有显著差异。结论噻托溴胺对于改善肺通气功能、健康状态及降低急性发作频率等方面显示出了独特的长处,且耐受性良好,是目前稳定期COPD患者的有效药物。     

稳定期慢性阻塞性肺疾病肺康复治疗的新进展

慢性阻塞性肺疾病是一种高发病率、高致残率、高死亡率的疾病.目前对于稳定期慢性阻塞性肺疾病患者的主要非药物管理办法是推行肺康复治疗,在不同程度上改善患者运动耐力、呼吸功能和生活质量.肺康复治疗主要包括健康教育及运动训练.现就其训练方式方法 和强度时间等作一综述.     

Effect of ivabradine on pulmonary hypertension in chronic obstructive pulmonary disease

In order to assess effect of If-channel blocker ivabradine on severity of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) we studied 60 patients with III-IV stage COPD. We divided these patients into 2 groups with similar clinical characteristics and therapy. Patients of one of these groups received ivabradine (10 mg/day) for 2 weeks, patients of another served as controls. The use of ivabradine was associated with statistically significant lowering of pulmonary hypertension, heart rate, and increase of exercise tolerance without negative effects on myocardial contractility, electrophysiological parameters, or data of spirometry.     

Efficacy and safety of roflumilast in patients with stable chronic obstructive pulmonary disease: A meta-analysis

BackgroundCurrently, several large studies showed that roflumilast has been demonstrated efficacy during treatment chronic obstructive pulmonary disease (COPD) patients, but also caused some side effects.AimTo assess the efficacy and safety of roflumilast in COPD patients.MethodsA computerized search through electronic databases included PubMed, EMBASE, CINAHL, the Cochrane clinical trials database, Physiotherapy Evidence Database and ClinicalTrials.gov was performed to identify randomized controlled trials. The primary outcomes were trough forced expiratory volume in 1 s (FEV₁) (reported pre-bronchodilator values) and exacerbation rate. Secondary outcomes included other spirometric parameters, health-related quality of life, the overall mortality rate and adverse events. Weighted mean differences (WMDs), relative risks (RRs) and 95% confidence intervals (CIs) were calculated and pooled using a random effects model.ResultsEleven trials involving 9675 patients met the inclusion criteria. Roflumilast significantly reduced the mean exacerbation rate (mild, moderate or severe) (WMD = −0.23; 95% CI = −0.33 to −0.13; p < 0.00001) and improved trough FEV₁ (WMD = 53.52 ml; 95% CI = 42.49 to 64.55; p < 0.00001), and other post-bronchodilator spirometric parameters (e.g., forced vital capacity, etc.). Roflumilast did not improve St George's Respiratory Questionnaire total score (WMD = −0.70 units; 95% CI = −2.65 to 1.26; p = 0.49) and decrease the overall mortality rate (RR = 0.90; 95% CI = 0.63 to 1.29; p = 0.56). Roflumilast increased some adverse events including diarrhea, headache, nausea, weight loss, and insomnia.ConclusionsRoflumilast significantly reduces the mean exacerbation rate in COPD patients. Although there are insufficient clinical evidence on other clinical endpoints and high risk of some adverse events, roflumilast therapy may benefit COPD patients. Further studies are needed to pay more attention to the long-term efficacy and safety of roflumilast.     

孟鲁司特在慢性阻塞性肺疾病稳定期患者中的应用

目的观察孟鲁司特(顺尔宁)对稳定期慢性阻塞性肺疾病(简称慢阻肺)患者呼吸困难和肺功能的作用。方法 70例稳定期慢阻肺病人,随机分为治疗组(35例)和对照组(35例)两组,给予相同的基础治疗,治疗组同时加用孟鲁司特10mg,每晚1次,疗程3个月。观察两组治疗前与治疗后1、3、6个月肺功能变化、呼吸困难和急性发作情况。结果治疗组患者治疗1个月后,分钟最大通气量占预计值百分比(MVV/预计值)、用力肺活量(FVC)、一秒量占预计值的百分比(FEV_1/预计值)、一秒率(FEV_1/FVC)明显高于治疗前(均P0.01);而在开始治疗3、6个月后与治疗1个月后的肺功能各项指标对比无显著差异(均P0.05);对照组患者治疗前与治疗后各项肺功能指标亦有明显改善(均P0.05);治疗后治疗组与对照组比较,差异有统计学意义(P0.05);而且在观察期间治疗组的呼吸困难改善好于对照组,急性发作次数低于对照组(P0.05)。结论慢阻肺稳定期患者常规治疗基础上口服孟鲁司特能更好地改善肺功能,更好地缓解呼吸困难症状,同时还能减少患者急性发作的次数。     

Enteral feeding in stable chronic obstructive pulmonary disease patients

OBJECTIVE: The study aimed to compare the effectiveness of a defined formula diet with a blenderized diet on nutritional and respiratory function parameters and to determine the bacteriological load of the two formulations. METHODOLOGY: Seventeen patients, aged 50-75 years, admitted to the University of the Philippines-Philippine General Hospital for chronic bronchitis and/or emphysema, were studied. They were divided into two groups according to dietary regimens. Each group of patients received either the standardized commercial formula or the blenderized formula for 2 weeks. Evaluation of dietary intake, anthropometric measurements, laboratory examinations and lung function were assessed. Subjective evaluation (patient's and physician's assessment) was also sought. Microbiological examinations were performed on the prepared enteral formulas. RESULTS: There was a slight increase in weight and in pulmonary function in both groups but these results did not differ significantly. Possible formula contamination was confirmed. Furthermore, in the overall assessment, the physician and patients rated both formulas as comparable.     

Oxygen consumption and transport in stable patients with chronic obstructive pulmonary disease

We studied the relationship between oxygen consumption and systemic oxygen transport in 30 clinically stable patients with chronic obstructive pulmonary disease (COPD) before and after increasing oxygen transport by passive leg elevation to raise the cardiac output. Results were compared with those observed in 10 patients with silicosis. The effect of leg elevation on oxygen consumption was also studied in 12 normal subjects. Oxygen consumption was measured by a closed circuit system, cardiac output by the direct Fick method, and arterial oxygen content by a cooximeter. Supine oxygen consumption was correlated with oxygen transport in patients with COPD (r = 0.50, p less than 0.01), and with leg elevation transport increased from a mean of 516 +/- 23 (SEM) to 567 +/- 26 ml X min-1 X m-2 and consumption increased from a mean of 136 +/- 3 to 148 +/- 4 ml X min-1 X m-2 (both p less than 0.01). In patients with silicosis, leg elevation raised mean oxygen transport from 620 +/- 40.0 to 745 +/- 54.0 ml X min-1 X m-2 and mean consumption from 161 +/- 6 to 192 +/- 6 ml X min-1 X m-2 (both p less than 0.01). In normal subjects, no change in oxygen consumption was observed with leg elevation (154 +/- 8 to 152 +/- 6 ml X min-1 X m-2).(ABSTRACT TRUNCATED AT 250 WORDS)     

Efficacy of diaphragmatic breathing in patients with chronic obstructive pulmonary disease

This study investigated the effects of diaphragmatic breathing (DB) on ventilation and breathing pattern, seeking to identify predictors of its efficacy in patients with chronic obstructive pulmonary disease (COPD). Twenty-nine patients with moderate and severe COPD were monitored using respiratory inductance plethysmography and metabolic gas analysis. After 4 minutes of natural breathing, subjects completed 2 minutes of DB followed by 4 minutes of natural breathing. Dyspnea was measured using a visual analogue scale. Diaphragmatic mobility was assessed using chest radiography. DB was associated with a significant increase in tidal volume and reduction in breathing frequency, leading to higher ventilation and oxygen saturation, with a reduction in dead space ventilation and ventilatory equivalent for carbon dioxide. A total of 10 subjects with moderate (5) and severe (5) COPD performed DB with asynchronous thoracoabdominal motion, worsening the dyspnea, and decreasing the gain of tidal volume. Diaphragmatic mobility, inspiratory muscular strength, lower scores for dyspnea and hypoxemia as well as coordinated thoracoabdominal motion are associated with effective DB. In patients with COPD, DB can improve breathing pattern and ventilatory efficiency without causing dyspnea in patients whose respiratory muscular system is preserved.     

戒烟对稳定期慢性阻塞性肺疾病的治疗作用

目的探讨戒烟对稳定期COPD的治疗作用。方法纳入2011年7月-2013年7月经福建医科大学附属泉州第一医院肺功能室检查确诊的稳定期COPD患者193例,按是否采用戒烟治疗及最终完成情况分为戒烟成功组、戒烟失败组及非戒烟组：戒烟成功亚组62例,均为男性,平均年龄为（60．82±5．63）岁,平均吸烟指数为（852±100）年·支;戒烟失败亚组36例,均为男性,平均年龄为（60．61±4．91）岁,平均吸烟指数为（812±139）年·支;非戒烟组95例,均为男性,平均年龄为（60．49±8．77）岁,平均吸烟指数为（833土143）年·支。采用FEV。为肺功能评价指标,CAT评分为COPD病情评价指标。进行为期半年的随访。结果各试验组患者在年龄、体质量指数及吸烟指数等方面差异无统计学意义。戒烟成功组患者治疗后体质量增加（2．85±1．27）kg,CAT评分下降（6．05±2．60）分,戒烟前后对比差异有统计学意义（t值分别为17．763、18．351,P值均d0．01）;FEV,增加（O．04±0．18）L,戒烟前后对比差异无统计学意义（t=1．900,P=0．062）。而戒烟失败组及未戒烟组治疗前后体质量、CAT评分及FEV,变化差异均无统计学意义（P值均〉0．05）。结论戒烟半年即对稳定期COPD具有=定的治疗作用,主要表现在体质量增加、临床症状减轻,而肺功能则无明显改善。     

肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用研究

目的 分析探讨肺呼吸康复治疗在慢性阻塞性肺疾病稳定期患者中的应用效果.方法 选择2018年1月至2020年3月间收治的80例慢阻肺稳定期患者,随机分为常规治疗组和肺呼吸康复治疗组.常规治疗组予以常规治疗,肺呼吸康复治疗组在常规治疗基础上,采用呼吸训练器进行吸气和呼气训练.观察比较两组患者出院随访4周后的肺功能、生活质量...     

Efficacy of nebulized flunisolide combined with salbutamol and ipratropium bromide in stable patients with moderate-to-severe chronic obstructive pulmonary disease

BACKGROUND: The efficacy of nebulized corticosteroids in the prevention of exacerbation of chronic obstructive pulmonary disease (COPD) has been poorly studied. OBJECTIVE: To evaluate the efficacy and tolerability of nebulized flunisolide (1 mg) + salbutamol/ipratropium bromide (1,875/375 microg) b.i.d. in comparison with placebo + salbutamol/ipratropium bromide. METHODS: This was a randomized, parallel-group, double-blind study on 114 patients with COPD of moderate-to-severe degree. The main outcome was the frequency of severe exacerbations over a 6-month period. Before and after treatment, respiratory symptoms, forced expiratory volume in 1 s (FEV(1)), shuttle walking test distance and St. George's Respiratory Questionnaire scores were evaluated. RESULTS: The total number of exacerbations was slightly lower in the flunisolide group compared to the placebo group (19 vs. 34, p = 0.054); the number of patients experiencing at least one exacerbation during the study was also decreased (16 vs. 26, p = 0.059). In particular, type 3 Anthonisens's exacerbations were significantly reduced by flunisolide (p = 0.044). In the placebo group, scores were higher than in the flunisolide group but nonsignificant for dyspnea, cough, sputum amount and purulence. FEV(1) was significantly increased compared to baseline in both groups, and the area under the FEV(1)-time curve during the 6-month period was significantly greater in the flunisolide group (5.2 +/- 10.6 vs. 2.1 +/- 5.0, flunisolide vs. placebo, respectively; p = 0.047). For shuttle walking test distance and scores of the St. George's Respiratory Questionnaire, no significant difference between the baseline evaluation and the end of the study was observed in both groups. CONCLUSIONS: Nebulized flunisolide is a good alternative to other inhaled corticosteroids when added to nebulized salbutamol/ipratropium bromide in the long-term treatment of moderate-to-severe COPD patients.     

Corticosteroids in stable chronic obstructive pulmonary disease

Although systemic corticosteroids are widely used in treating stable chronic obstructive pulmonary disease (COPD), the evidence for their efficacy is still disputed. To reappraise this evidence, the authors used a new analytic strategy in which the 14 available randomized clinical trials were evaluated according to a methodologic "review of systems" and an examination of the statistical precision of the outcome results. Although none of the trials satisfied all of the methodologic criteria for both validity and clinical pertinence, the trials finding steroids efficacious were generally better designed and more statistically precise than trials failing to show efficacy. The authors propose a set of five main methodologic guidelines that require a stable baseline state, a crossover design with suitable washout, adequate doses of corticosteroids, pragmatic designs, and comprehensive choices of outcome events. Attention to these guidelines can help improve both design and evaluation for future trials of systemic steroids for stable COPD.     

Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease

The documentation of a 20.5% prevalence of heart failure (withischaemic heart disease as the underlying cause in 20.2%) instable chronic COPD¹ is consistent with the observation madeby Keistinen et al.² that coronary heart disease was     

Lipid profile and atherogenic indices in patients with stable chronic obstructive pulmonary disease

Background and aimsLimited number of studies investigated lipid profile in chronic obstructive pulmonary disease (COPD) with inconsistent results. This study aimed to investigate lipid parameters in sera of patients with stable COPD and their associations with disease severity, smoking, comorbidities and therapy.Methods and resultsThe study included 137 COPD patients and 95 controls. Triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were assessed. Non-HDL-C (NHC), atherogenic coefficient (AC), TG/HDL-C, atherogenic index of plasma (AIP), Castelli's risk index I and II (CRI-I, CRI-II), and monocyte to HDL ratio (MHR) were calculated.HDL-C and MHR were increased, while other lipid parameters and indices were decreased in COPD patients compared to healthy individuals. Smoking did not influence lipid parameters. However, lipid profile was altered only in more severe disease stages. AC, CRI-I and CRI-II showed positive association with lung function parameters in COPD patients, and negative with COPD multicomponent indices (ADO, BODCAT, BODEx, CODEx and DOSE). Combined model that included CRI-II, C-reactive protein, fibrinogen and white blood cells showed great diagnostic performances, and correctly classified 72% of study participants with an AUC of 0.800 (0.742–0.849), P < 0.001. Bronchodilator monotherapy and statins have opposite impact on TC, LDL-C and NHC, while TG, TG/HDL-C and AIP were increased in COPD patients with cardiovascular diseases.ConclusionLipid disbalance is present in COPD, and it seems to occur later as the disease progresses. Further studies are needed to illuminate the underlying mechanism of dyslipidaemia.     

A study on pulmonary hemodynamic in patients with stable chronic obstructive pulmonary disease]

Pulmonary hemodynamic changes in 63 chronic obstructive pulmonary disease (COPD) were studied with right heart catheter and impedance pulmonary rheogram (IPR) both at rest and during exercise. The two regression equations for estimating exercise PAPM with rest and exercise IPR parameters were established as follows: PAPM (kPa) = -1.40-0.88lnHs + 8.30B-F + 5.78Q-B/B-Y. PAPM (kPa) = 6.46-5.04Hs/square root of R-R + 4.35Q-B/B-Y-19.34Q-C.6 patients with normal rest PAPM were found to have PAPM increased during exercise and 4 patients with Cor Pulmonale had normal PAPM both at rest and at exercise. PCWP in all patients with and without Cor Pulmonale was normal. We also found that SV, SVI reduced significantly at exercise when compared with these at rest. With the patient's condition aggravating. SV, SVI decreased while RVSWI and dp/dt max of right ventricular systolic pressure increased.     

Treatment of stable chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a readily diagnosable disorder that responds to treatment. Smoking cessation can reduce symptoms and prevent progression of disease. Bronchodilator therapy is key in improvement of lung function. Three classes of bronchodilators-beta agonists, anticholinergics, and theophylline-are available and can be used individually or in combination. Inhaled glucocorticoids can also improve airflow and can be combined with bronchodilators. Inhaled glucocorticoids, in addition, might reduce exacerbation frequency and severity as might some bronchodilators. Effective use of pharmacotherapy in COPD needs integration with a rehabilitation programme and successful treatment of co-morbidities, including depression and anxiety. Treatment for stable COPD can improve the function and quality of life of many patients, could reduce admissions to hospital, and has been suggested to improve survival.     

肺康复治疗对稳定期慢性阻塞性肺疾病病人的疗效分析

目的观察肺康复治疗对稳定期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者的效果。方法测定以下肢训练为主的社区康复治疗前后患者的FEV1(第一秒用力呼气量占预计值百分比)、6 min步行距离、呼吸困难评分(Borg评分)、年人均急性发作次数、年人均住院次数。结果肺康复治疗前后的FEV1、6 min步行距离、Borg评分明显好于治疗前(P0.05),年COPD急性发作次数及住院次数治疗前后有统计学意义。结论肺康复治疗可改善COPD患者的呼吸功能,减少年均急性发作次数及住院次数。