Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
COPD 和肺癌均为最常见的吸烟相关呼吸道疾病。吸入性糖皮质激素( ICS) 近年来被推荐用于重度COPD 的治疗, 同时也被发现在肺癌的化学预防中起重要作用。本文通过综述ICS、COPD 和肺癌之间的关系, 特别是吸入糖皮质激素在肺癌中的化学预防作用, 以期进一步明确ICS 在COPD和肺癌中的作用。
Objective To systematically review the association between -589C/T polymorphism in IL-4 gene and the risk of chronic obstructive pulmonary disease (COPD). Method PubMed, EMbase, CNKI and WanFang Data databases were electronically searched to identify case-control studies which investigated the association between IL-4 -589C/T polymorphism and the risk of COPD. The search date was up to February 23th, 2016. Two reviewers independently screened the studies, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by using RevMan 5.3 software. Results A total of 8 case-control studies involving 1 400 COPD cases and 1 073 controls were included in meta-analysis. The results showed that: the -589C/T polymorphism in IL-4 gene was not associated with the risk of COPD (TT+TC vs. CC: OR=0.84, 95%CI 0.61 to 1.15, P=0.27; TT vs. CC+TC: OR=0.95, 95%CI 0.72 to 1.25, P=0.69; TT vs. CC: OR=1.14, 95%CI 0.74 to 1.76, P=0.55; TC vs. CC: OR=0.83, 95%CI 0.66 to 1.05, P=0.12; T vs. C: OR=0.91, 95%CI 0.72 to 1.14, P=0.40). Conclusion The IL-4 -589C/T polymorphism is not associated with the risk of COPD.
ObjectiveTo systematically evaluate the efficacy and safety of budesonide/formoterol combined with tiotropium versus budesonide/formoterol alone for Chinese patients with COPD. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about budesonide/formoterol combined with tiotropium vs. budesonide/formoterol alone for Chinese COPD patients from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. ResultsA total of 15 studies involving 1123 Chinese patients were included. The results of meta-analysis showed that, compared with the budesonide/formoterol alone group, the budesonide/formoterol plus tiotropium group could significantly improve the levels of FEV1 (MD=0.19, 95%CI 0.12 to 0.25, P<0.00001), FVC (MD=0.35, 95%CI 0.14 to 0.57, P=0.001), FEV1% (MD=5.96, 95%CI 4.48 to 7.43, P<0.00001), FEV1% pred (MD=6.82, 95%CI 2.21 to 11.43, P=0.004), FEV1/FVC (MD=7.72, 95%CI 5.69 to 9.75, P<0.00001), mMRC (MD=-0.43, 95%CI -0.52 to -0.33, P<0.00001), CAT (MD=-1.45, 95%CI -2.26 to -0.64, P=0.0005), SGRQ (MD=-7.05, 95%CI -9.16 to -4.94, P<0.00001) and 6MWT (MD=32.52, 95%CI 16.68 to 48.37, P<0.00001). While there was no significant difference in adverse reaction rates between the two groups (OR=1.77, 95%CI 0.79 to 3.98, P=0.16). ConclusionCurrent evidence shows that budesonide/formoterol plus tiotropium can improve lung function and clinical symptom in Chinese patients with COPD. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
Recently, many researchers paid more attentions to the association between air pollution and chronic obstructive pulmonary disease (COPD). Haze, a severe form of outdoor air pollution, affected most parts of northern and eastern China in the past winter. In China, studies have been performed to evaluate the impact of outdoor air pollution and biomass smoke exposure on COPD; and most studies have focused on the role of air pollution in acutely triggering symptoms and exacerbations. Few studies have examined the role of air pollution in inducing pathophysiological changes that characterise COPD. Evidence showed that outdoor air pollution affects lung function in both children and adults and triggers exacerbations of COPD symptoms. Hence outdoor air pollution may be considered a risk factor for COPD mortality. However, evidence to date has been suggestive (not conclusive) that chronic exposure to outdoor air pollution increases the prevalence and incidence of COPD. Cross-sectional studies showed biomass smoke exposure is a risk factor for COPD. A long-term retrospective study and a long-term prospective cohort study showed that biomass smoke exposure reductions were associated with a reduced decline in forced expiratory volume in 1 second (FEV1) and with a decreased risk of COPD. To fully understand the effect of air pollution on COPD, we recommend future studies with longer follow-up periods, more standardized definitions of COPD and more refined and source-specific exposure assessments.
Objective To assess the quality of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) relevant to COPD besides chronic bronchitis and chronic pulmonary cor disease in strengthening immune published in Chinese medical journals to provide scientific basis of systematic review (SR) of regulating the immune function of COPD in Chinese herbs. Methods 54 articles with clinical controlled trials were obtained by electronic searching and handsearching, and the method for randomized allocation, blindness, multi-centres, sample sizes, diagnosis criteria, exclusion criteria, source of cases, immune markers (cellular immunity, humoral immunity, erythrocyte immunity, nonspecific immunity), the clinical outcome assessment, statistical management, course of treatment and the side effects or adverse drag reaction, follow-up were investigated and then methodologically evaluated. According to the investigation, literatures with the method for randomized allocation, correct controls, appropriate sample sizes (≥60), the nation-wide diagnosis criteria, the objective clinical outcome assessment distinct statistical method were stipulated as the high-quality ones relatively. Results Among the 54 trials, 70.4% had explicit diagnosis criteria, 18.5% with exclusion criteria, 20.4% with comparability of baseline, 37.0% with distinct statistical method. In the therapy, 63.0% were with Chinese herbs. Conclusion The selected 7 articles belong to the high quality and possibly are to be explored in Meta-analysis.
Objective To evaluate and select essential medicine for chronic obstructive pulmonary diseases (COPD) using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Nine guidelines were included (eight foreign guidelines, one domestic guideline; seven based on evidence, two based on expert consensus). (2) A result of one domestic RCT (n=72, high quality) indicated that tiotropium could significantly improve pulmonary function of severe COPD patient complicated with respiratory failure and increase their quality of life (SGRQ score: MD=–10.8%, 95%CI –12.2% to –9.4%). A result of one RCT (n=156, moderate quality) with 3-month follow-up indicated that tiotropium could significantly improve the proportion of measured value to expected value of FEV1 in patients with mild and moderate COPD in stationary phase (MD=10.3%, 95%CI 8.1% to 12.5%). A result of two RCTs (n=160, low quality) indicated that compound ipratropium bromide had efficiencies of 84.2% to 87.5% for moderate and severe COPD. A result of one RCT (n=60, moderate quality) indicated that salmeterol/fluticasone (inhalation) was superior to placebo for improving mild and moderate COPD in stationary phase. A result of one RCT (n=725, moderate quality) indicated that tiotropium combined with salmeterol/fluticasone for COPD in stationary phase was superior to tiotropium alone. A result of one RCT (n=110, low quality) indicated that nebulized budesonide inhalation had an efficiency of 86.8% for acute exacerbation of COPD (AECOPD) and an incidence of 7.9% as to adverse reaction that mainly included laryngo-pharyngeal irritation. (3) Imipenem, meropenem, cefoperazone/ sulbactam and ceftazidime were effective for COPD with low drug resistance rates in treating COPD caused by non-ICU pathogens (less than 8%). Conclusion (1) We offer a b recommendation for tiotropium, ipratropium, salbutamol, formoterol, salmeterol and theophylline used in the treatment of COPD in stationary and exacerbation phases, a b recommendation for streptococcus pneumoniae and influenza vaccines in preventing the deterioration of COPD, a b recommendation for inhaled corticosteroids (ICS) used in the treatment of COPD in stationary phase and a b recommendation for corticosteroids (for oral use) for AECOPD. (2) We offer a b recommendation for cefoperazone/sulbactam, imipenem and meropenem used in the treatment of moderate and severe AECOPD. (3) We offer a weak recommendation for ceftazidime, ciprofloxacin, lavofloxacin, moxifloxacin, amoxicillin amp; clavulanate potassium, amoxicillin, azithromycin, clarithromycin and doxycycline as first-line and second-line antibiotics for mild and moderate AECOPD, and a weak recommendation for compound sulfamethoxazole, cefatriaxone, cefotaxime and cefuroxime used in the treatment of severe and extremely severe COPD, mucolytic agents used in the treatment of stable COPD with difficult expectoration. (4) We make a recommendation against antibiotics, expectorants and corticosteroids (for oral use) as routine use in stationary phase of COPD.
目的:探讨慢性阻塞性肺疾病(COPD)合并糖尿病患者的肺功能及血气分析特点并分析其临床意义。方法:选取2008年1月~2009年1月在我院门诊就诊的稳定期患者53例作为研究对象,并根据是否合并糖尿病分为COPD合并糖尿病组26例,单纯COPD组27例,并通过肺功能检测及血气分析,检测肺活量 (VC)、用力肺活量 (FVC)、第1秒钟用力呼气容积 (FEV1)、 FEV1/用力肺活量 (FVC)、用力呼气中期流速PEF(25%～75%) 、肺一氧化碳弥散(DLCO)及肺一氧化碳弥散量实测值占预计值的百分比(DLCO /PRED)等肺功能指标及PaO2、PaCO2等血气指标,并进行组间分析。结果:COPD合并糖尿病组肺通气功能指标VC、FVC、FEV1、PEF(25%～75%)和弥散功能指标DLCO、DLCO/PRED及PaO2显著低于单纯 COPD组。结论:COPD合并糖尿病时肺通气功能和弥散功能都可受损。
目的:研究呼吸操改善慢性阻塞性肺疾病(COPD)患者肺功能的机制。方法:对本院46例COPD 患者随机分成对照组和治疗组,按常规内科治疗并对其有计划地进行健康知识教育。治疗组在常规内科治疗加康复指导基础上,增加呼吸操训练。测定治疗前后6分钟步行距离、血清白三烯、呼出气中一氧化氮浓度(fractional exhaled nitric oxide, FENO)。结果:治疗组较对照组6分钟步行能力改善,血清白三烯水平下降(Plt;0.05)、呼气NO含量下降(Plt;0.05)。结论:加强COPD患者的健康指导及呼吸操训练可改善患者肺功能状况,明显提高生活质量
Objective To evaluate the clinical efficacy and safety of TanReqing Injection in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD), and to observe its effects on the plasma levels of cytokine IL-17, IL- 8 and Leukotriene B4 in such cases. Methods A randomized, single blind controlled trial (RCT) was designed. Sixty hospitalized COPD patients with an acute exacerbation were randomly allocated to the treatment group (20 ml of TanReqing Injection iv gtt q 24 h) or the control group (20 ml of placebo Injection iv gtt q 24 h) based on the Guideline for Dignosis and Management of COPD issued by Chinese Society for Respiratory Disease and the Criteria of Dignosis and Efficacy Measures of Traditional Chinese Medicine Syndrome and Illness enacted by The State Administration of Traditional Chinese Medicine. All patients were received standard therapy. Each group contained 30 patients. The therapeutic course of both groups was 12 days. The criterias of TCM syndrome of retention of phlegm-heat in the lung were: cough with rough breath, accumulation of sticky or yellow thick sputum, cough with difficulty in expectoration, or accompanied by fever, thirst with desire of drink, red tougue with yellow fur, slippery and rapid pulse. Results According to the analysis on the basis of intention -to -treat and per-protocol population, it showed that the markedly effective rates were 70.00% and 72.41% respectively, and effective rates were 96.67% and 96.55% in the treatment group respectively. While in the control group the markedly effectiverates were 46.67% and 48.28% respectively, and effective rates were 86.67% and 89.65% respectively. Significantly lower plasma concentration of IL-17 and IL-8 in the treatment group was noted when compared with control group. There was a statistically significant difference between two groups (Plt;0.05). Conclusions TanReqing Injection shows a definite clinical effectiveness without obvious toxic-adverse effects in the treatment of patients with acute exacerbations of COPD and its mechnical function may related to the level of the excess expression of plasma cytokine IL-17, IL-8 in such cases.