Low-Attenuation Areas of the Lungs on High-Resolution Computed Tomography in Asthma

To investigate the low-attenuation areas of the lungs (LAA) in asthma, we compared the mean lung density (MLD) and the LAA in 22 asthmatics (12 ex-smokers and 10 nonsmokers) and 13 patients with chronic obstructive pulmonary disease (COPD) by high-resolution computed tomography. The MLD and the relative area of the lung with attenuation values lower than ?950 Hounsfield Units at full inspiration (inspiratory RA₉₅₀) were significantly different in nonsmoking asthmatics compared to patients with COPD and asthmatics with a smoking history. The MLD and the RA₉₅₀ correlated significantly with the FEV₁ in all groups and with the DL_CO in patients with COPD and asthmatics with a smoking history but not in nonsmoking asthmatics. We concluded that the LAA in asthmatics with a smoking history indicates the presence of emphysema, but in nonsmoking asthmatics it reflects hyperinflation and nonemphysematous expiratory airflow limitation rather than emphysematous lesions.     

Decreased computed tomographic lung density during exacerbation of asthma.

Recently, it was shown that both mean lung density (MLD) and the relative lung area with an attenuation of <-950 HU (RA950) are related to severity of asthma in nonsmoking asthmatics. The aim of the present study was to examine whether reduced computed tomography (CT) lung density during exacerbation could change after treatment. A cross-sectional study was performed to compare CT lung density in 30 stable asthmatics, 30 unstable asthmatics and 25 control subjects. In order to investigate longitudinally the effect of treatment on decreased CT lung density, 17 asthmatics with an exacerbation were followed at the initiation of treatment and 2 months after relief. The MLD was significantly lower and the RA950 significantly higher in unstable asthmatics than in controls and stable asthmatics. Both MLD and RA950 changed significantly with administration of systemic glucocorticoid therapy. The changes in forced expiratory volume in one second correlated significantly with those in both MLD and RA950. The changes in residual volume also correlated significantly with those in both MLD and RA950. It was concluded that decreased computed tomographic lung density during an asthma exacerbation is at least partially reversible, and changes in mean lung density and the relative lung area with a radiation attenuation of <-950 HU are related to the change in forced expiratory volume in one second and residual volume.     

Association between CRHR1 polymorphism and improved lung function in response to inhaled corticosteroid in patients with COPD

Background and objective:   Inhaled corticosteroids are used to treat COPD and asthma. An association between sequence variants in the corticotrophin-releasing hormone receptor 1 ( CRHR1 ) gene and improved lung function in asthmatics treated with inhaled corticosteroids was reported recently. This study investigated the association between the change in lung function in response to inhaled corticosteroids and single-nucleotide CRHR1 polymorphisms in patients with COPD.
Methods:   COPD patients ( n  = 87) with a positive smoking history were recruited from the pulmonary clinics of 11 hospitals in Korea. Patients were treated with fluticasone propionate and salmeterol for 12 weeks and lung function was measured at baseline and after the 12-week treatment. Eighty-four of the 87 subjects were successfully genotyped.
Results:   Seventy-one patients with the wild-type GG genotype and 13 patients with the heterozygous GT genotype in rs242 941 were evaluated. After 12-week treatment, the change in FEV₁ was significantly higher in patients with wild-type GG genotype (6.0 ± 0.8% of predicted FEV₁) than in GT heterozygotes (−0.8 ± 1.8, P  = 0.003).
Conclusions:   Improved FEV₁ following inhaled corticosteroid and a long-acting β2-agonist was associated with CRHR1 genetic polymorphism in patients with COPD.     

Chronic obstructive pulmonary disease and interstitial lung disease in patients with lung cancer

Background and objective:   Although lung cancer is frequently accompanied by COPD and interstitial lung disease (ILD), the precise coincidence of these diseases with lung cancer is not well understood. The objectives of this study were to determine the prevalence of abnormal CT and spirometric findings suggestive of COPD or ILD in a population of patients with untreated lung cancer, and to estimate the lung cancer risk in this population.
Methods:   The study population consisted of 256 patients with untreated lung cancer and 947 subjects participating in a CT screening programme for lung cancer. Semi-quantitative analysis of low attenuation area (LAA), fibrosis and ground glass attenuation (GGA) on CT was performed by scoring. Gender- and age-matched subpopulations, with stratification by smoking status, were compared using the Mantel–Haenszel projection method.
Results:   Inter-observer consistency was excellent for LAA, but not as good for fibrosis or GGA scores. Pooled odds ratios for lung cancer risk using LAA, fibrosis, GGA scores and reduced FEV₁/FVC and %VC were 3.63, 5.10, 2.71, 7.17 and 4.73, respectively ( P  < 0.0001 for all parameters). Multivariate regression analyses confirmed these results.
Conclusion:   Abnormal CT and spirometric parameters suggestive of COPD and ILD were strong risk factors for lung cancer, even after adjusting for gender, age and smoking status.     

Smoking and airway inflammation in patients with mild asthma.

STUDY OBJECTIVES: Cigarette smoking is common in asthmatic patients, and we investigated the impact of cigarette smoking on airway inflammation in asthma. DESIGN: Single-center observational study of airway inflammation in asthmatic and healthy smokers and nonsmokers. SETTING: Asthma research unit in a university hospital. PATIENTS OR PARTICIPANTS: Sixty-seven asthmatic and 30 nonasthmatic subjects classified as smokers or nonsmokers. Asthmatics had chronic, stable asthma and were not receiving inhaled or oral steroids at the time of the study. INTERVENTIONS: We examined induced-sputum cell counts and levels of interleukin (IL)-8 and eosinophilic cationic protein (ECP). Bronchial hyperreactivity was assessed using methacholine challenge. MEASUREMENTS AND RESULTS: Asthmatic smokers had higher total sputum cell counts than nonsmoking asthmatics and both smoking and nonsmoking healthy subjects. Smoking was associated with sputum neutrophilia in both asthmatics and nonasthmatics (median, 47% and 41%, respectively) compared with nonsmokers (median, 23% and 22%, respectively), and sputum IL-8 was increased in smokers compared with nonsmokers, both in subjects with asthma (median, 945 pg/mL vs 660 pg/mL, respectively) and in healthy subjects (median, 1,310 pg/mL vs 561 pg/mL, respectively). Sputum eosinophils and ECP levels were higher in both nonsmoking and smoking asthmatics than in healthy nonsmokers. In smoking asthmatics, lung function (FEV(1) percent predicted) was negatively related to both sputum IL-8 (r = - 0.52) and sputum neutrophil proportion (r = - 0.38), and sputum IL-8 correlated positively with smoking pack-years (r = 0.57) and percent neutrophil count (r = 0.51). CONCLUSIONS: In addition to the eosinophilic airway inflammation observed in patients with asthma, smoking induces neutrophilic airway inflammation; a relationship is apparent between smoking history, airway inflammation, and lung function in smoking asthmatics.     

Reduced bronchial CD4+ T-cell density in smokers with occupational asthma.

Cigarette smoking may alter bronchial inflammation in asthma. Multicolour immunohistofluorescent examination on bronchial cryosections was used to examine bronchial inflammatory cell infiltrate in patients with occupational asthma. Monoclonal antibodies to CD3, CD4, CD8, T-cell receptor-delta1, CD68 and human leukocyte antigen-DR were combined to identify T-cell subsets and macrophages in bronchial biopsies from 20 workers with occupational asthma (12 smokers and eight nonsmokers), 15 healthy workers (seven smokers and eight nonsmokers) and 10 nonsmoking, nonexposed controls. The increased subepithelial CD4+ T-cell density in nonsmoking asthmatics was not present in smoking asthmatics, who had the lowest CD4+ T-cell density of all groups. The decreased subepithelial CD4+ and CD8+ T-cell density correlated with a reduction in lung function, as measured by percentage predicted forced expiratory volume in one second, in smoking asthmatics only. Although smoking asthmatics had a significantly increased number of intraepithelial CD8+ T-cells and macrophages compared with nonsmoking asthmatics, the proportion of gammadelta-T-cells was significantly decreased in both asthmatic groups. Smoking asthmatics had a distinctly different distribution of T-cell subsets compared with nonsmoking asthmatics. The accumulation of subepithelial CD4+ T-cells, which was observed in nonsmoking asthmatics, appeared to be inhibited in smoking asthmatics, suggesting a smoking-induced bronchial immune modulation, at least in occupational asthma in the aluminium industry.     

外周血LTA4H基因多态性rs7971150位点检测在老年慢性阻塞性肺疾病患者中的临床意义

目的 探讨外周血LTA4H基因多态性rs7971150位点检测在老年慢性阻塞性肺疾病(COPD)患者中的临床意义以及与吸烟的关系.方法 选择2017年9月-2020年1月在上海市浦东新区浦南医院和上海杨思医院呼吸科病房住院的150例COPD急性加重患者为观察组,150例支气管扩张急性加重和社区获得性肺炎患者为对照组,2...     

Inhaling gas with different CT densities allows detection of abnormalities in the lung periphery of patients with smoking-induced COPD.

STUDY OBJECTIVES: To establish a novel method allowing detection of regional abnormalities in gas distribution at the acinar level by high-resolution CT (HRCT). PARTICIPANTS: Nonsmoking control subjects (n = 28) and patients with smoking-induced COPD (n = 47). MEASUREMENTS AND RESULTS: Changes in lung CT densities were examined by HRCT while the subjects inhaled a gas mixture consisting of 21% O(2) in SF(6) or 21% O(2) in He. HRCT images of the right upper and lower lung fields were obtained at the end of inspiration and expiration of the second and 60th breaths after the start of each gas. Introducing mean lung density (MLD) and relative area with low CT attenuation (%LAA), we analyzed the differences in acinar SF(6) and He distribution in the early phase (second breath) and in the equilibrium state (60th breath). We found that the differences in inspiratory MLD between the SF(6) and He images at the 60th breath were qualitatively consistent with the differences predicted from the physical properties of these gases. However, the differences in inspiratory MLD between the SF(6) and He images taken at the second breath were smaller than those at the 60th breath, especially in the smoking group with COPD. These differences in second-breath inspiratory MLD in the smoking group were smaller in the upper lung field than in the lower lung field. The differences in MLD between the two gases were not detected at end-expiration at the time of either the second or 60th breaths. The %LAA values did not differ between the SF(6) and He images in either the nonsmoking group or the smoking group. CONCLUSIONS: SF(6)/He-associated HRCT images obtained at end-inspiration, but not at end-expiration, in the early breathing phase are useful for predicting acinar gas distribution abnormalities in patients with COPD.     

Differences between asthma and COPD in the elderly.

Asthma and chronic obstructive pulmonary disease (COPD) are both characterized by the presence of airflow obstruction. Both diseases are not rare in the elderly population. Distinguishing between these diseases is difficult and may be impossible in some older patients. The aim of the study was to investigate clinical and functional characteristics and the presence of atopic status in elderly subjects compared to COPD patients. Fifty-one patients over 60 years of age were selected for the study (27 patients with late-onset asthma, 24 patients with COPD). Atopy was defined by skin prick test and serum total IgE concentrations which were measured in all patients. Pulmonary function tests including airflow rates, lung volumes, airway resistance, diffusing capacity, and arterial blood gases analysis were performed in all patients. The rate of skin prick test positivity in asthmatics was significantly higher than that of the COPD patients. FEV1 was lower in COPD patients than in asthmatic patients. Bronchial reversibility in asthmatics became significantly higher than in COPD patients. While FRC and RV were increased in both groups showing same degree of pulmonary hyperinflation, patients with COPD demonstrated significantly decreased DLCO when compared to asthmatic patients. The level of both PO2 and PCO2 in patients with COPD significantly differed from asthmatics. In conclusion, a history of heavy smoking, decreased diffusing capacity for carbon monoxide, the presence of more prominent lung hyperinflation and chronic hypoxemia favour the diagnosis of COPD, whereas atopy and significant bronchodilator responsiveness favour the diagnosis of asthma.     

COPD与肺癌发病的相关性

目的：研究COPD与肺癌发病的相关性。方法收集2010年11月至2013年11月我院收治的门诊或住院患者210例肺癌患者作为实验组,同时选取在玉林市红十字会医院体检中心体检的非癌健康人226例作为对照组,观察2组研究对象个人呼吸系统疾病史、家族呼吸系统疾病史与肺癌之间的关系,同时观察2组中吸烟患者和不吸烟患者的 COPD 发生率。结果呼吸系统疾病中肺炎、哮喘与肺癌的发生无显著关系(P 值均>0.05)；伴有 COPD、支气管炎、肺气肿、肺结核的患者,发生肺癌的风险显著增高(P 值均<0.05),其中 COPD 与肺癌发生的关联性最强(OR =2.73)。具有COPD及肺癌家族史的人群,发生肺癌的风险显著增加(P<0.05)。吸烟患者中实验组COPD的发生率显著高于对照组(χ2=5.482,P<0.05)；实验组未吸烟患者中实验组 COPD的发生率显著高于对照组(χ2=5.901,P<0.05)。结论患有COPD病史及有 COPD家族史的患者,发生肺癌的风险增加,且COPD患者无论是否吸烟,COPD仍然会导致肺癌发生的风险性增加。     

Smoking and asthma: clinical and radiologic features, lung function, and airway inflammation

Smoking may influence the type of airway inflammation observed in asthma and its response to therapy. More studies are needed on how smoking-induced changes in lung function/structure and airway inflammation may result in a change in clinical expression. We compared clinical, physiologic, radiologic, and airway inflammatory features of 22 smoking asthma patients (cigarette smoking history, 14.0 +/- 7.6 pack-years [mean +/- SD]) and 27 nonsmoking asthma patients. Mean age/duration of asthma of smoking and nonsmoking asthma patients were 31 years/14 years and 29 years/17 years, respectively. Quality of life, FEV(1), bronchodilator response, perception of bronchoconstriction, and methacholine responsiveness were similar in the two groups. Compared to nonsmoking asthma patients, smokers had more respiratory symptoms, a lower mean forced expiratory flow at 25 to 75% of FVC, FEV(1)/FVC ratio, and lung diffusion capacity, and a higher functional residual capacity. Induced-sputum neutrophil and bronchial cell counts were higher and exhaled breath condensate pH was more acidic in smoking asthma patients. On high-resolution CT, airway and parenchymal abnormalities were more common in smoking asthma patients than in nonsmokers. In conclusion, compared with nonsmoking asthma patients, smoking asthma patients have features similar to what could be found in early stages of COPD.     

Expression of Transforming Growth Factor β1 in Bronchial Biopsies in Asthma and COPD

The role of transforming growth factor β₁ (TGF β₁) in airway remodeling in asthma and chronic obstructive pulmonary disease (COPD) has not been fully described. To evaluate the possible pathogenetic role of TGF β₁ in asthma and COPD, immunohistochemical expression of TGF β₁ was described in bronchial biopsies from patients with asthma and COPD compared with healthy individuals. Twelve subjects with asthma, 13 subjects with COPD, and 10 healthy individuals enrolled in the study. Bronchial biopsies were stained with hematoxylin and eosin and anti-TGF β₁ antibody. As a result, immunoreactive TGF β₁ was mainly localized in association with connective tissue in all groups. The staining intensity was not statistically different among the groups in bronchial epithelium, whereas it was significantly higher in the group of asthma in the submucosa. Because there is evidence showing a significant increase of staining intensity in the submucosa from asthmatics but not from subjects with COPD, we may conclude that TGF β₁ may play a significant role in pathogenesis of asthma but not in COPD.     

上海市崇明岛不同程度生物燃料的使用与慢性阻塞性肺疾病及肺功能的相关性分析

目的通过研究上海市崇明岛居民生物燃料的使用程度与慢阻肺患病情况及肺功能的变化,探讨不同程度的生物燃料使用与慢阻肺患病情况及对肺功能影响的差异,进一步推进崇明岛慢阻肺的防治工作,以及为世界级生态岛的建设提供一定的依据。方法将崇明岛3842例调查人群中的1673例有生物燃料使用史的人群,剔除其中主动吸烟与被动吸烟者,再次筛选出1492例有生物燃料使用史的人群,并根据每日使用频次及使用年限的差异,分析相应人群的慢阻肺的患病率的差异及肺功能的变化。结果将崇明岛3842例调查人群筛选出有生物燃料使用史,但没有主动吸烟和被动吸烟史的人群,共计1492例,其中慢阻肺患者169例,患病率11.3%,高于总体慢阻肺患病率,但统计学差异不明显(P>0.05)。同时与主动吸烟人群及被动吸烟人群的慢阻肺患病率分析发现,也无明显统计学差异(P>0.05)。但研究发现生物燃料每日使用频率越高,慢阻肺患病率越高;使用年限越长,慢阻肺患病率越高,均存在明显的统计学差异(P<0.01);研究也发现随着生物燃料每日使用频次与使用年限的增高,FEV₁、FVC也呈现下降趋势(P<0.01)。结论不同程度的生物燃料使用与慢阻肺患病情况,存在相关性,每日使用频率越高,慢阻肺患病率越高;使用年限越高,慢阻肺的患病率也越高;同时随着生物燃料每日使用频次与使用年限的增高,FEV₁、FVC也呈现下降趋势。     

慢性阻塞性肺疾病合并肺癌临床特征分析

目的 分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺癌患者的临床特征,以及COPD患者发生肺癌的危险因素,为COPD中的肺癌高危人群筛查提供思路,以提高肺癌的早期诊断率.方法 回顾性分析西安交通大学第二附属医院2017年3月至2019年12月收治的19...     

Lung attenuation measurements in healthy young adults

BACKGROUND: High-resolution computed tomography (HRCT) attenuation measurements may be more sensitive in finding early emphysematous changes in relatively young subjects than lung function measurements. OBJECTIVES: To define lung attenuation parameters in smokers and never-smokers. METHODS: A prospective comparative study in a university hospital setting was designed with 20 healthy smoking and 20 nonsmoking volunteers. Attenuation measurements on spirometrically controlled HRCT at three levels in the upper half of the lungs at 10% and 90% of vital capacity (VC10% and VD90%) were done, and lung function measurements were performed. RESULTS: Mean lung attenuation (MLD) and pixel index (PI) were correlated with lung function and smoking history. Small attenuation differences in the left and right lung were found but no sex-related differences. At main carina (MC) level, the PI was higher at VC90% (p < 0.0001) but lower at VC10% (p < 0.01) compared to the apex. Age correlated with attenuation parameters at VC10%, whereas for pack-years no correlation was found. There were attenuation correlations with VC (PI: R = 0.31, p < 0.05 at VC10%/90%), residual volume (MLD: R = -0.31, p < 0.05 at VC10%), and total lung capacity (PI: R = 0.31, p < 0.05 at VC10%/VC90%). CONCLUSIONS: Lung attenuation during inspiration was lower at the MC level than at the top, but higher on expiratory scans. No sex-related differences were found. Lung attenuation decreases with age on expiratory scans. This seemed to be of more importance than the amount of pack-years of smoking. A relationship with lung function parameters is not uniformly proven.     

The effect of cigarette smoking on exhaled nitric oxide in mild steroid-naive asthmatics.

STUDY OBJECTIVES: It has been demonstrated previously that exhaled nitric oxide (eNO) is increased in steroid-naive asthmatics and that inhaled steroids reduce eNO in these patients. Cigarette smoking has also been reported to reduce the eNO in healthy volunteers. Recently a correlation has been demonstrated between eNO and airway hyperresponsiveness in steroid-naive, mild asthmatics. We hypothesized that cigarette smoking would reduce the eNO level in steroid-naive asthmatics and might, therefore, affect the correlation between eNO and airway hyperresponsiveness. DESIGN: Comparison of eNO in healthy smoking and nonsmoking volunteers with the level of eNO in steroid-naive and steroid-treated asthmatics. Correlate the eNO level with the provocative concentration of histamine causing a 20% fall in FEV1 (PC20hist) in the asthmatic smoking and nonsmoking patients. SETTING: University outpatient asthma clinic. PATIENTS AND METHODS: eNO levels and PC20hist were measured in three different asthmatic patient groups (group A = 29 steroid-naive, nonsmoking asthmatics; group B = 19 steroid-treated, nonsmoking asthmatics; and group C = 13 smoking, steroid-naive asthmatics) and in two healthy volunteer groups (group D = 18 nonsmoking; and group E = 16 smoking). RESULTS: eNO in group A was significantly increased compared with the values in groups B and D (21.8+/-12.7, 12.8+/-4.9, and 10.6+/-2.2 parts per billion [ppb], respectively). Cigarette smoking decreased eNO in healthy volunteers (7.4+/-1.8 ppb, group E) as well as in steroid-naive asthmatics (12.7+/-5.1 ppb, group C). There was a significant correlation between eNO and PC20hist in group A (r = -0.45, p < 0.05); this correlation was, however, lost in both groups B and C. CONCLUSION: Cigarette smoking and inhaled steroids reduce the eNO in patients with mild asthma to a comparable extent. Because the correlation between eNO and airway hyperresponsiveness was lost in steroid-treated and smoking, steroid-naive asthmatics, we question the value of eNO as a marker of airway inflammation, at least in mild asthmatics who are already being treated with inhaled steroids or who are currently smoking.     

Complexity of terminal airspace geometry assessed by computed tomography in asthma

Low attenuation areas in computed tomography images from patients with chronic obstructive pulmonary disease have been reported to represent macroscopic and/or microscopic emphysema. The cumulative size distribution of the clusters has been shown to follow a power law characterized by the exponent D, a measure of the complexity of the terminal airspace geometry. We have previously found increased low attenuation areas in nonsmoking subjects with asthma. We examined the size distribution of the clusters in nonsmoking subjects with asthma compared with both nonsmoking control subjects and subjects with asthma with a smoking history. The percentage of lung field occupied by low attenuation areas (LAA%) and D in subjects with asthma with a smoking history differed significantly from nonsmoking subjects with asthma and control subjects. In nonsmoking subjects with asthma, both parameters differed significantly between severe asthma and mild or moderate asthma. The LAA% differed significantly between moderate and mild asthma, but D did not. In mild and moderate asthma, a highly significant correlation between LAA% and D was observed in patients with a smoking history, but not in nonsmoking subjects with asthma. Our results suggest that decreased D is mostly related to emphysematous change, and both measurements of LAA% and D may provide useful information to characterize low attenuation areas in subjects with asthma.     

Increased expression of the chemokine receptor CXCR3 and its ligand CXCL10 in peripheral airways of smokers with chronic obstructive pulmonary disease

CXCR3 is a chemokine receptor preferentially expressed on lymphocytes, particularly on type-1 T-lymphocytes. Smokers who develop chronic obstructive pulmonary disease (COPD) have a chronic bronchopulmonary inflammation that is characterized by an increased infiltration of T-lymphocytes, particularly CD8(+), in the airways and lung parenchyma. To investigate the expression of CXCR3 and its ligand interferon-induced protein 10/CXCL10 in COPD, we counted the number of CXCR3(+) cells and analyzed the expression of CXCL10 in the peripheral airways of 19 patients undergoing lung resection for localized pulmonary lesions. We examined lung specimens from seven smokers with fixed airflow limitation (COPD), five smokers with normal lung function, and seven nonsmoking subjects with normal lung function. The number of CXCR3(+) cells was immunohistochemically quantified in the epithelium, in the submucosa, and in the adventitia of peripheral airways. The number of CXCR3(+) cells in the epithelium and submucosa was increased in smokers with COPD as compared with nonsmoking subjects, but not as compared with smokers with normal lung function. Immunoreactivity for the CXCR3-ligand CXCL10 was present in the bronchiolar epithelium of smokers with COPD but not in the bronchiolar epithelium of smoking and nonsmoking control subjects. Most CXCR3(+) cells coexpressed CD8 and produced interferon gamma. These findings suggest that the CXCR3/CXCL10 axis may be involved in the T cell recruitment that occurs in peripheral airways of smokers with COPD and that these T cells may have a type-1 profile.     

慢性阻塞性肺疾病患者影像学表型的临床治疗及疗效探究

目的探讨慢性阻塞性肺疾病(COPD)患者影像学表型个体化治疗的临床效果。方法按照2012年慢性阻塞性肺疾病全球倡议[1],选取符合C、D组稳定期COPD患者75例,收集入组者胸部高分辨率CT资料,将患者分为A型、E型、M型三型,分别予布地奈德福莫特罗粉吸入剂,布地奈德/福莫特罗粉吸入剂(160μg/4.5μg,2次/d)治疗。分别于用药前,用药3个月后测定:肺功能指标(FEV1、RV/TCL、FEV1%Pre);检测C反应蛋白(CRP),并做COPD评估测试问卷(CAT评分)评价。结论 A型、E型、M型经ICS+LABA治疗后,A型对ICS+LABA反应优于M和E型,M型的患者对ICS+LABA的反应优于E型。A型、M型对激素的反应优于E型。提示E型患者的病情较重、生活质量差、肺通气明显减退,单一支气管扩张剂改善患者疗效不佳,对于E型患者需要更大剂量或多种作用途径药物联合治疗。     

Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD

Background and objective:   Lung cancer patients with COPD are at high risk during surgery. Tiotropium, a long-acting bronchodilator, is a preferred maintenance therapy for COPD, but its efficacy in the perioperative period has not been clarified.
Methods:   A retrospective review was performed of the medical records of 102 patients with primary lung cancer and COPD, who underwent scheduled surgery. Twenty-one lung cancer patients with untreated mild-to-severe COPD received tiotropium preoperatively. Spirometry was performed prior to and after 2 weeks of treatment with tiotropium, and at 3 months after surgery.
Results:   Two-week preoperative treatment with tiotropium significantly improved respiratory symptoms and pulmonary function as reflected by FVC (median 3.43 L pretreatment vs 3.52 L post-treatment), FEV₁ (median 2.06 L vs 2.32 L) and FEV₁% (73.2% vs 81.0%) (all P  < 0.001). Postoperative FEV₁% was significantly increased from a median of 56.0% (interquartile range 51.6–60.3) to 63.4% (60.8–66.0) ( P  < 0.001). The increase in FEV₁ was inversely associated with severity of COPD ( r  = −0.59, P  < 0.005). Lung resections were successfully accomplished without complications. The postoperative FEV₁ predicted prior to tiotropium treatment was underestimated (median predicted postoperative FEV₁ 1.65 L vs median measured postoperative FEV₁ 1.96 L, P  < 0.001).
Conclusions:   Preoperative treatment with tiotropium may facilitate surgical treatment for lung cancer patients with COPD. This is encouraging for COPD patients who may require curative lung resections.