BAL联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭临床观察

目的:探讨支气管肺泡灌洗(BAL)联合无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)合并II型呼吸衰竭的临床效果。方法:选取我中心2011年1月至2013年1月间出诊送到同一家医院且收治的COPD合并II型呼吸衰竭的患者86例,随机分为观察组与对照组,观察组在常规治疗的基础上应用BAL联合NIPPV治疗,对照组单独采用NIPPV治疗,对比两组患者血气指标、心率、平均动脉压、APACHE II评分变化及不良反应发生情况。结果:两组患者治疗后Pa CO2均较治疗前显著下降,治疗前后比较差异有统计学意义(P<0.05);观察组患者治疗后Pa CO2下降较对照组更加迅速,组间比较差异有统计学意义(P<0.05);且观察组患者在治疗后24h、48h Pa O2均显著高于对照组,组间比较差异有统计学意义(P<0.05);且观察组患者气管插管率显著低于对照组,组间比较差异有统计学意义(P<0.05);两组患者心率、平均动脉压治疗24h后比较无统计学差异(P>0.05)。结论:BAL联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭能有效的降低患者Pa CO2,提高Pa O2,可迅速缓解患者呼吸衰竭症状,是治疗COPD合并II型呼吸衰竭的有效治疗方案。     

Bronchodilator efficacy of tiotropium–formoterol via single pressurized meter dose inhaler (pMDI) versus tiotropium alone in COPD

BackgroundBronchodilators form the main stay of treatment for COPD. When symptoms are not adequately controlled with one bronchodilator, addition of another bronchodilator is recommended. We have recently developed a combination of tiotropium and formoterol in a single pressurized metered dose inhaler (pMDI) (Cipla Ltd., India). The aim of this study was to compare the bronchodilator effects of a single dose of 18 mcg of tiotropium versus a single dose of a combination of 18 mcg tiotropium plus 12 mcg formoterol administered via a pMDI in subjects with moderate-to-severe COPD.Study design44 COPD subjects were enrolled in this randomized, double-blind, multi-centre, cross-over study. 18 mcg tiotropium and 18 mcg tiotropium plus 12 mcg formoterol were administered via pressurized metered dose inhalers on two separate days. FEV₁, FVC and Inspiratory capacity (IC) were measured before, 15, 30 min, 1, 2, 3, 4, 6, 8, 12 and 24 h after the study drugs were administered.ResultsCompared with tiotropium alone, a combination of tiotropium plus formoterol showed a faster onset of bronchodilator response (p < 0.01 for FEV1 and FVC), a greater mean maximum change in FEV1 (p = 0.01) and FVC (p = 0.008) and greater AUC_0–24h values for FEV₁, FVC and IC. Trough FEV₁ and FVC values were also greater in the combination group.ConclusionA combination of tiotropium plus formoterol administered via a single inhaler produced a superior bronchodilator response than tiotropium alone over a period of 24 h.     

以循证支持为基础的综合护理对慢阻肺合并2型糖尿病患者预后的影响

目的探究以循证支持为基础的综合护理对慢阻肺合并2型糖尿病患者预后的影响。方法选取该院2018年3月—2019年3月收治的慢阻肺合并2型糖尿病患者88例,采用双盲法分为A组和B组,各44例。A组采用以循证支持为基础的综合护理,B组采用常规护理。护理2个月后观察效果,包括并发症发生率、呼吸功能评分及空腹血糖、餐后2 h血糖、糖化血红蛋白等指标。结果A组并发症发生率2.27%,低于B组的22.73%,对比差异有统计学意义(P<0.05)。A组呼吸功能评分(0.32±0.05)分,低于B组(1.05±0.12)分,对比差异有统计学意义(P<0.05)。A组空腹血糖、餐后2 h血糖、糖化血红蛋白等指标均低于B组,对比差异有统计学意义(P<0.05)。结论以循证支持为基础的综合护理在慢阻肺合并2型糖尿病患者中具有显著效果,可改善患者呼吸功能及血糖各指标,降低并发症发生风险,值得临床推广。     

Chronic obstructive pulmonary disease in heart failure: accurate diagnosis and treatment

Coincidence of COPD and heart failure (HF) is challenging as both diseases interact on multiple levels with each other, and thus impact significantly on diagnosis, disease severity classification, and choice of medical therapy. The current overview aims to educate caregivers involved in the daily management of patients with HF and (possibly) concurrent COPD in how to deal with clinically relevant issues such as interpreting spirometry, the potential role of extensive pulmonary function testing, and finally, the potential beneficial, but also detrimental effects of medication used for HF and COPD on either disease.     

Clinical Trial Simulation To Assist In COPD Trial Planning And Design With A Biomarker-Based Diagnostic: When To Pull The Trigger?

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with a wide range of clinical phenotypes that vary from predominantly airway disease (chronic bronchitis) to predominantly parenchymal disease (emphysema). Current advances for the treatment of COPD are increasingly focused on targeted treatments and development of novel biomarker-based diagnostics (Dx)'s to select the patients most likely to benefit. Clinical trial planning and design with biomarkers includes additional considerations beyond those for conventional trials in un-selected populations, e.g., the heterogeneity of COPD phenotypes in the population, the ability of a biomarker to predict clinically meaningful phenotypes that are differentially associated with the response to a targeted treatment, and the data needed to make Go/No Go decisions during clinical development.

We developed the Clinical Trial Object Oriented Research Application (CTOORA), a computer-aided clinical trial simulator of COPD patient outcomes, to inform COPD trial planning with biomarkers. CTOORA provides serial projections of trial success for a range of hypothetical and plausible scenarios of interest. In the absence of data, CTOORA can identify characteristics of a biomarker-based Dx needed to provide a meaningful advantage when used in a clinical trial. We present a case study in which CTOORA is used to identify the scenarios for which a biomarker may be used successfully in clinical development. CTOORA is a tool for robust clinical trial planning with biomarkers, to guide early-to-late stage development that is positioned for success.