慢性阻塞性肺疾病评估测试评分对预后的评估意义

目的探讨慢性阻塞性肺疾病评估测试(CAT)评分与慢性阻塞性肺疾病(COPD)患者预后因素之间的相关性,明确CAT评分对COPD患者预后评估的应用价值。方法选取2013年1月至2015年1月我院呼吸内科住院及门诊就诊的106例COPD患者为研究对象。对106例患者治疗前后进行CAT评分、6 min步行实验(6MWD)、改良英国MRC呼吸困难指数(m MRC)、BODE(B为体质量指数,O为气道阻塞程度,D为呼吸困难分数,E为运动耐力)指数、圣乔治呼吸问卷(SGRQ)评分及肺功能的测定。采用单因素线性相关分析CAT评分与患者各临床特征之间的相关性。结果随着CAT评分的升高,患者6MWD、用力呼气容积(FVC)实测值、FVC实测/预测值、一秒用力呼气容积(FEV1)实测值、FEV1实测/预测值、FEV1/FVC、呼气峰流速(PEF)实测值、PEF实测/预测值均明显降低(P0.05),而m MRC评分、BODE指数及SGRQ总评分明显升高(P0.05);患者经短期治疗后,CAT评分、BODE指数及SGRQ总评分均显著低于治疗前(P0.05),而6MWD、FEV1实测值、FEV1实测/预测值、FEV1/FVC则均显著高于治疗前(P0.05);单因素相关分析发现,治疗前CAT评分与m MRC评分(r=0.254,P=0.018)、BODE指数(r=0.426,P=0.009)及SGRQ总评分(r=0.563,P=0.007)呈显著正相关,与6MWD(r=-0.387,P=0.008)、FVC实测值(r=-0.181,P=0.023)、FVC实测/预测值(r=-0.192,P=0.021)、FEV1实测值(r=-0.201,P=0.016)、FEV1实测/预测值(r=-0.214,P=0.013)及FEV1/FVC(r=-0.223,P=0.012)呈显著负相关;治疗后CAT评分与m MRC评分(r=0.304,P=0.011)、BODE指数(r=0.382,P=0.010)及SGRQ总评分(r=0.621,P=0.004)呈显著正相关,与6MWD(r=-0.407,P=0.007)、FEV1实测值(r=-0.211,P=0.014)、FEV1实测/预测值(r=-0.228,P=0.012)及FEV1/FVC(r=-0.231,P=0.011)呈显著负相关。结论 CAT评分与COPD患者m MRC评分、BODE指数、SGRQ总评分、6MWD及肺功能指标均有较好的相关性,具有较好的预测COPD患者预后的应用价值。     

Subjective measurement of activity in chronic obstructive pulmonary disease

Activity is an essential part of life. Daily activities include caring for one's self and one's environment, moving about the home and community, and fulfilling various social roles. Personal fulfillment activities, such as interaction with others, hobbies, and attending social or entertainment events, play an important role in life satisfaction and well-being. Physical activity in the form of movement and exercise is essential for optimal fitness and health. Given these varied perspectives, what constitutes "activity" and how is it measured, both generally and in chronic obstructive pulmonary disease specifically? How should "activity" be measured as an outcome of treatment - pharmacologic, surgical, or rehabilitation? This paper discusses patient-reported measurement of activity, with specific reference to patients with chronic obstructive pulmonary disease. It begins with an overview of key measurement issues to consider when selecting or developing instruments, followed by clarification of two perspectives or classes of patient-reported activity assessment: functional and physical activity. Examples of measures designed to capture these concepts are provided. The paper concludes with recommendations for evaluating activity-related outcomes in patients with chronic obstructive pulmonary disease.     

Maximal respiratory pressure: normal values and changes in chronic obstructive pulmonary disease (COPD)

The measurement of maximal inspiratory and expiratory pressures generated at the mouth (PImax and PEmax)respectively is an accepted noninvasive clinical method for evaluating the strength of respiratory muscles, however at present the normal values have been not unified. We measured PImax and PEmax in 50 healthy subjects and 50 patients with stable chronic obstructive pulmonary disease (COPD). The results showed that our normal values of PImax and PEmax approximated to the lower end of the ranges of normal values in healthy subjects and the PImax and PEmax of patients with moderate reported in foreign countries COPD were lower than healthy subjects.     

Pathogenesis of the chronic obstructive pulmonary disease (COPD)

An inflammation in the bronchial wall is usually present already in an early stage of the disease. An inflammatory infiltration cause predominantly mononuclear cells in the mucous membrane and neutrophiles in the phlegm produced by airways. Also eosinophiles can participate in the inflammation. Lymphocytes distribution is different from asthma because there is mainly submucosa infiltrated in COPD. Metaplasia of goblet cells appears. Chronic bronchial obstruction characterizing COPD is induced by conjunction of small airways disease (obstructive bronchiolitis) and a destruction of pulmonary parenchyma (emphysema) which both contribute to an impairment and differ form person to person. Chronic inflammation is a cause of remodeling and narrowing of small airways. Destruction of pulmonary parenchyma and the inflammation cause loss of alveolar connection with small airways and elastic pulmonary stress decreases. Two theories try to explain COPD--a theory of imbalance between proteinases and antiproteinases and a theory of oxidation stress.     

外周血白介素-17检测在气道慢性炎症性疾病诊断中的临床价值

目的探讨外周血CD4+T细胞亚群Th17代表性细胞因子IL-17在哮喘、慢性阻塞性肺疾病(COPD)以及哮喘COPD重叠综合征(ACOS)等气道慢性炎症性疾病鉴别诊断中的临床价值。方法收集哮喘患者26例、COPD患者33例及ACOS患者14例的血清、临床资料及实验室检查资料,检测哮喘、COPD、ACOS患者外周血IL-17等细胞因子、炎症介质、外周血白细胞分类计数、血清免疫球蛋白亚型以及肺通气功能,并进行组间比较。健康体检者69例作为对照。结果 Th17细胞因子IL-17在哮喘及ACOS组升高较COPD组更为明显(P0.01)。调节性T细胞的主要细胞因子IL-10在哮喘患者中的水平明显低于COPD患者(P0.05)。外周血炎症细胞比例、免疫球蛋白亚型在哮喘、COPD、ACOS鉴别诊断中具有一定参考价值。但肺通气功能指标对于以上三者的鉴别价值有限。哮喘及ACOS组患IL-17与肺通气功能指标呈负相关关系。结论 IL-17作为新型Th17细胞分泌的代表性细胞因子,在鉴别上述疾病中具有重要的参考价值。Th17/Treg细胞失衡可能是难治性哮喘的潜在发病机制。     

Epidemiology of chronic obstructive pulmonary disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality in the industrialized and the developing countries. During 1997, COPD has been estimated to be the number four cause of death after cardiovascular diseases, tumors and cerebrovascular diseases in the United States. In 2020 COPD will probably become the third leading cause of death all over the world, following the trend of increasing prevalence of lung cancer. The impact of this respiratory disease worldwide is expected to increase with a heavy economic burden on individuals and society. In the United States direct and indirect costs of COPD were estimated at about USD24 billion in 1993. Unfortunately, there are few data on health-care utilization despite the great interest in COPD among researchers. As all chronic diseases, the prevalence of COPD is strongly associated with age. Data collected in a general population sample (living in Italy) showed a progressive increase of the prevalence of chronic bronchitis and emphysema with age, both in males and in females. COPD is determined by the action of a number of various risk factors either singly or interacting among themselves in a synergistic way. Among these, the most important is cigarette smoking, ranking at the first level for developing chronic bronchitis and emphysema. Also air pollution and some occupational exposures represent risks for developing COPD. Many epidemiological studies have indicated an association between the prevalence of chronic bronchitis and a low socioeconomic status. Furthermore, in the etiology of COPD we must consider endogenous risk factors such as gender, genetic features, presence of respiratory troubles in childhood, and family history. To date, epidemiologic studies have been of great importance for the characterization of the disease at a population level, indicating possible causes and assessing its impact on the individual and on society as a whole. Unfortunately, international standards for the diagnosis of COPD are lacking, which complicates the organization of appropriate epidemiological surveys.     

Mental disorders in chronic obstructive pulmonary disease (COPD)

Recent research using questionnaire measures has demonstrated high prevalence rates of mental disorders in chronic obstructive pulmonary disease (COPD). However, clinical interviews and clinical rather than healthy control groups have rarely been employed. The aim of the present study was to assess mental disorders in patients with COPD with advanced methodology, to identify moderating factors explaining mental co-morbidities and to compare results with a clinical control group without COPD. A standardized clinical interview (F-DIPS) and a range of questionnaires were used to assess mental disorders, perceived physical symptoms and cognitions in 20 hospitalized patients with mild-to-moderate COPD (mean FEV(1)/VC (%)=61.3). Results were compared with a hospitalized clinical control group without pulmonary dysfunction (CCG; N=20). Results showed that 55% of patients with COPD received a diagnosis of a mental disorder compared to 30% of CCG patients. All principal mental diagnoses in the COPD group were anxiety disorders (especially Panic Disorder with Agoraphobia), while CCG patients received a wider range of diagnoses (anxiety, pain, alcohol abuse). There was no systematic association between anxiety levels and respiratory function in the whole COPD group, but a positive correlation between anxiety levels and perceived physical symptoms (p<0.001) as well as negative cognitions (p<0.001 and p<0.05, respectively) for COPD patients with anxiety disorder (N=11). The present results confirm the high prevalence rate of anxiety in patients with COPD and suggest further that anxiety in COPD patients may be mediated by cognitive processes. These findings are discussed in terms of their implications for treatment.     

Variability of breathlessness measurement in patients with chronic obstructive pulmonary disease

The purpose of our study was to evaluate the reproducibility of a Borg rating of dyspnea in patients with COPD. We examined nine patients with COPD who performed a SST on four separate days within a ten-day period. The patients walked on a treadmill for 6 min. At the end of each minute, patients matched a Borg rating to the intensity of their breathlessness. We measured the HR, VE, VO2, VT and f at the end of each minute. While the mean VO2, VE, HR, VT and f stabilized after one or two attempts, the Borg ratings decreased with successive tests. We conclude that the Borg scale for measuring breathlessness shows progressive decreases with repetition whereas VO2, VE, HR, VT and f stabilize after one or two practice attempts. This suggests that desensitization to dyspnea may play a role in the improvement of patients after exercise.     

Identification of patients with chronic obstructive pulmonary disease (COPD) by measurement of plasma biomarkers

Introduction: Inflammation is an important constituent of the pathology of chronic obstructive pulmonary disease (COPD), leading to alveolar destruction and airway remodelling. Objective: The aim of this study was to assess the difference in plasma biomarkers of inflammation between asymptomatic smokers and patients with COPD. Methods: We used commercially available enzyme‐linked immunosorbent assay kits to measure the plasma levels of tumour necrosis factor‐α (TNF‐α), interleukin‐8 (IL‐8), matrix metalloproteinase‐9 (MMP‐9), monocyte chemotactic protein‐1 (MCP‐1), tissue inhibitor of metalloproteinase‐1 (TIMP‐1) and tissue inhibitor of metalloproteinase‐2 (TIMP‐2) on two occasions with a 2‐week interval in patients with COPD (n = 20), asymptomatic smokers (n = 10) and healthy lifelong non‐smokers (n = 10). The participants were characterised clinically, physiologically and by quantitative computed tomography by measuring the relative area of emphysema below ?910 Hounsfield units (RA‐910). Results: The results of the biomarker measurements on the two occasions were highly reproducible. Patients with COPD had significantly higher plasma levels of IL‐8 (P = 0.004) and significantly lower levels of TIMP‐1 (P = 0.02) than smokers and non‐smokers. There was no statistically significant difference between the three groups in the level of TNF‐α, MMP‐9, MCP‐1 and TIMP‐2. The IL‐8/TIMP‐1 ratio correlated significantly with the degree of airway obstruction measured as forced expiratory volume in 1 second (FEV₁) % predicted (r = ?0.47, P < 0.01); with the diffusion capacity (r = ?0.41, P < 0.01); and with the grade of emphysema measured as RA‐910 (r = 0.39, P = 0.01). Conclusion: These findings suggest that the measurement of plasma biomarkers, such as IL‐8/TIMP‐1, may aid to discriminate patients with COPD from smokers at lower risk of developing COPD. Please cite this paper as: Shaker SB, von Wachenfeldt KA, Larsson S, Mile I, Persdotter S, Dahlbäck M, Broberg P, Stoel B, Bach KS, Hestad M, Fehniger TE and Dirksen A. Identification of patients with chronic obstructive pulmonary disease (COPD) by measurement of plasma biomarkers. The Clinical Respiratory Journal 2008; 2: 17–25.     

The role of indacaterol for chronic obstructive pulmonary disease (COPD)

Indacaterol is the first long-acting β2-agonist (LABAs) approved for the treatment of chronic obstructive pulmonary disease (COPD) that allows for once-daily (OD) administration. It is rapidly acting, with an onset of action in 5 minutes, like salbutamol and formoterol but with a sustained bronchodilator effect, that last for 24 hours, like tiotropium. In long-term clinical studies (12 weeks to 1 year) in patients with moderate to severe COPD, OD indacaterol 150 or 300 μg improved lung function (primary endpoint) significantly more than placebo, and improvements were significantly greater than twice-daily formoterol 12 μg or salmeterol 50 μg, and noninferior to OD tiotropium bromide 18 μg. Indacaterol was well tolerated at all doses and with a good overall safety profile. Cost-utility analyses show that indacaterol 150 μg has lower total costs and better outcomes than tiotropium and salmeterol. These findings suggest that indacaterol can be considered a first choice drug in the treatment of the patient with mild/moderate stable COPD. However, in people with COPD who remain symptomatic on treatment with indacaterol, adding a long-acting muscarinic antagonist (LAMA) is the preferable option. In any case, it is advisable to combine indacaterol with a OD inhaled corticosteroid (ICS), such as mometasone furoate or ciclesonide, in patients with low FEV1, and, in those patients who have many symptoms and a high risk of exacerbations, to combine it with a LAMA and a OD ICS.KEY WORDS : Long-acting β2-agonists (LABAs), indacaterol, chronic obstructive pulmonary disease (COPD), combination therapy     

慢性阻塞性肺疾病治疗进展

慢性阻塞性肺疾病（COPD）是一种重要的慢性呼吸系统疾病，本文综述了近年来在COPD治疗上的最新进展，包括COPD药物应用，手术治疗及氧疗等。     

Reasons for hospitalization in patients with chronic obstructive pulmonary disease(COPD)

Reasons for cohort of patients with COPD hospitalisation in a 90-bed internal diseases ward within the 1st January and 31st December 2001 are discussed. Four hundred ten medical histories of COPD patients were analysed. The number of hospitalizations and the number of patients were distinguished. The majority of findings have been related to the number of hospitalizations. Percentage of COPD patients, spirometries and history of smoking have been related to the number of patients. In 12 months, the total number of hospitalizations has been 3,352, including 452 hospitalizations of COPD patients--13.8%. 2,731 patients, including 333 COPD (12.2%) patients, have been hospitalised once or more times. Analysed group included 1,975 female (58.9%) and 1,377 male patients (41.1%), and 225 female (49.8%) and 227 male patients (50.2%) in the COPD group. Average age was 64.8 +/- 16.3 years (men--61.7 +/- 16.4 and women--67.0 +/- 15.8), while average age of COPD patients was 68.8 +/- 10.4 years (men--68.6 +/- 10.2 and women--69.0 +/- 10.7). Average hospitalisation duration was 9.0 +/- 5.7 days, while for COPD patients--10.5 +/- 6.0 days. In this cohort COPD has been the main diagnosis in the 195 hospitalizations. Severity of the disease has been graded according to GOLD and the Polish Phtisiopneumonological Society recommendations. A structure of deaths in COPD group, treatment and history of smoking were analysed.