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.
ObjectiveTo systematically review the association between inhaled corticosteroids (ICS) and the risk of lung cancer in patients with chronic obstructive pulmonary disease (COPD). MethodsPubMed, EMbase, Web of Science, Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies on the risk of lung cancer in COPD patients using ICS from inception to August 15, 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 8 cohort studies involving 1 184 238 patients were included. The results of meta-analysis showed that ICS use decreased risk of lung cancer in COPD patients (HR=0.68, 95%CI 0.62 to 0.75, P<0.01). The dose of ICS was an influencing factor for the risk of lung cancer in COPD patients and a large dose of ICS could significantly reduce the risk. ConclusionCurrent evidence shows that the use of ICS can reduce the risk of lung cancer in patients with COPD, especially in high-dose patients. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To analyse the content and structure of the health management policy text for chronic obstructive pulmonary disease (COPD) in China, and to provide a reference for the optimization and improvement of subsequent relevant policies. Methods We searched for relevant policy documents on COPD health management at the national level from January 2017 to December 2023, constructed a two-dimensional analysis framework for policy tools and chronic disease health management processes, coded and classified policy texts, and used content analysis method to analyze policy texts. Results Twenty-four policy texts were included. There were 183 codes for policy tool dimension, with supply based, environmental based, and demand based tools accounting for 43.72%, 47.54%, and 8.74%, respectively. There were 124 codes for the dimension of health management processes, with health information collection and management accounting for 12.10%, risk prediction accounting for 14.52%, intervention and treatment accounting for 66.13%, and follow-up and effectiveness evaluation accounting for 7.26%. Conclusions At present, the proportion of policy tools related to the management of COPD in China needs to be dynamically adjusted. Environmental tools should be appropriately reduced, the internal structure of supply tools should be optimized, the driving effect of demand tools should be comprehensively enhanced, the coupling of COPD health management processes should be strengthened, and the relevant policy system and overall quality should be continuously improved.
Objective To compare outcomes after single versus bilateral lung transplantation in patients with end-stage chronic obstructive pulmonary disease (COPD) with retrospective cohort study, and to provide a reference for surgical selection. Methods One hundred and two patients with end-stage COPD who received lung transplantation in Wuxi People's Hospital affiliated to Nanjing Medical University from January 2010 to May 2019 were evaluated, including 97 males and 5 females, aged from 42 to 82 years, with an average age of (59.8±8.0) years. Recipients were divided into single lung transplantation (SLT) group (31 cases) and bilateral lung transplantation (BLT) group (71 cases). Preoperative characteristics, postoperative outcomes, postoperative complications, functional improvement and survival between the two groups were analyzed retrospectively. Results The SLT group were significantly older than the BLT group [(62.6±8.8) years vs. (58.6±7.4) years, P<0.05], which was consistent with the practice mode of single lung transplantation in the elderly patients in this center. The FEV1% predicted and the six‐minute walk distance (6-MWD) in the BLT group were better than those in the SLT group (P<0.05). The cumulative survival rate in 1, 3 and 5 years after operation in the BLT group was higher than that in the SLT group (70.4%, 63.2%, 61.5%, respectively vs. 67.7%, 58.1%, 54.6%, respectively), but there was no statistical difference (P=0.388). The two groups were comparable in other preoperative clinical data (P>0.05). The cold ischemia time and total operation time were shorter in the SLT group than in the BLT group, and the intraoperative blood loss was less than that in the BLT group, but more patients required intraoperative extracorporeal membrane oxygenation support than the BLT group (P<0.05). There were no significant differences in postoperative ventilator support, reoperation, length of intensive care unit stay, postoperative hospital stay, and perioperative mortality (P>0.05). In terms of postoperative complications, the incidence of primary graft dysfunction grades 3 was higher in the SLT group than in the BLT group (35% vs. 8%, P=0.001). There were no significant differences between the two groups in chest complications, airway complications, acute rejection, infection, and bronchial occlusion syndrome (P>0.05). Nine patients (29%) developed acute native lung hyperinflation in the SLT group. ConclusionsBilateral lung transplantation is superior to single lung transplantation in the treatment of end-stage COPD. The advantage is mainly reflected in the simple perioperative management, better functional improvement after operation. Single lung transplantation as a beneficial supplement to double lung transplantation should still be considered in selected patients.
Objective To determine the efficacy of forced expiratory volume in six seconds( FEV6 ) as an alternative for forced vital capacity( FVC) in the diagnosis for mild-moderate chronic obstructive pulmonary disease( COPD) .Methods A total of 402 mild-moderate COPD and 217 non-COPD patients’ spirometric examinations were retrospectively analyzed. The correlation between FEV6 and FVC, FEV1 /FVC and FEV1 /FEV6 was evaluated by the Spearman test. Considering FEV1 /FVC lt;70% as being the ‘golden standard’ for airway obstruction, a ROC curve was used to determine the best cut-off point for the FEV1 /FEV6 ratio in the diagnosis for COPD. Results The Spearman correlation test revealed the FEV1 and FEV6 , FEV1 /FEV6 and FEV1 /FVC ratios were highly correlated ( r = 0. 992, 0. 980, respectively, P = 0. 000) . Using FEV1 /FEV6 lt; 70% as the diagnosis standard, 12. 69% of the 402 patients could not be diagnosed as COPD. The FEV1 /FVC ratio of these patients was very close to 70% . The best cut-off point for the FEV1 /FEV6 ratio in the diagnosis of mild-moderate COPD was 72% while the sensitivity and specificity were 94. 7% and 92. 2% , respectively. Conclusions There is a b correlation between FEV1 /FVC and FEV1 /FEV6 . The FEV6 can be a valid alternative for FVC in the diagnosis for mild-moderate COPD, although it may result in false negative. The best cut-off point for the FEV1 /FEV6 ratio is 72% .
Objective To explore the research trends of traditional Chinese exercise in the rehabilitation of chronic obstructive pulmonary disease (COPD). Methods The Web of Science core collection database was searched to collect literature on traditional Chinese exercise for COPD rehabilitation published from 2004 to 2023. VOSviewer was used for bibliometric analysis of publication year, author, publication institution and country, citation and co-citation information. Results A total of 125 publications were included. No relevant publication was published from 2004 to 2008. Since 2009, the overall number of publications had shown a fluctuating upward trend, with no publications in 2012. From 2019 to 2023, the number of publications on related topics remained at a high level. Reached maximum publication volume in 2020. The annual citation frequency also showed a fluctuating increase, reaching its peak in 2022. Based on comprehensive analysis, Peter M. Wayne and Wu Weibing were the authors with high productivity, high citation, and frequent collaborations. The country with the highest number of publications was China, and the highest institution was Shanghai University of Sport. Initially, the keywords focused on rehabilitation, exercise testing, aerobic exercise, resistance exercise, and respiratory muscle strength. As the times progressed, the focus shifted to lung function, exercise tolerance, and mental health. The current trends included self-management and telemedicine. Conclusions Traditional Chinese exercises have been widely applied in the clinical practice of COPD rehabilitation, showing an upward trend. Facilitating patient self-management and establishing the role and significance of traditional Chinese exercises in remote healthcare for COPD patients may be the focus of future research.
ObjectiveTo investigate the association between serum thyroid hormone levels and prognosis for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) without thyroid disease, and explore the prognostic value of serum thyroid hormone levels for patients with AECOPD.MethodsThe clinical data of 239 hospitalized cases of AECOPD [149 males, 90 females, aged 42-92 (77.7±8.9) years] from January 2013 to November 2017 were retrospectively analyzed. Serum thyroid hormone levels including total tetraiodothyronin (TT4), total triiodothyronin (TT3), thyroid stimulating hormone (TSH), free tetraiodothyronin (FT4) and free triiodothyronin (FT3) were measured by chemiluminescence immunoassay. All patients were divided into a survival group and a death group according to the prognosis. Serum thyroid hormone levels were compared between two groups. Correlations of serum thyroid hormone levels with the occurrence of death in AECOPD patients were analyzed. The prognostic value of serum thyroid hormone levels for AECOPD patients was explored by receiveroperating characteristic (ROC) curve analysis. And the best cut-off value of serum thyroid hormone level in predicting the risk of death was calculated.ResultsSerum TT4, TT3, FT4 and FT3 levels in the survival group were significantly higher than those in the death group [TT4: (89.35±21.45) nmol/L vs. (76.84±21.33) nmol/L; TT3: (1.05±0.34) nmol/L vs. (0.72±0.19) nmol/L; FT4: (16.17±2.91) pmol/L vs. (14.45±2.85) pmol/L; FT3: (3.06±0.81) pmol/L vs. (2.24±0.72) pmol/L; all P<0.05]. The differences of serum TSH level between two groups were not statistically significant [0.98 (0.54-1.83)vs. 0.57 (0.31-1.84), P>0.05]. Spearman correlation analysis showed that serum TT4, TT3, FT4 and FT3 levels were significant correlated with the occurrence of death (r values were 0.226, 0.417, 0.220, 0.387, respectively, P<0.05). And there was no significant correlation between serum TSH level and the occurrence of death (P>0.05). ROC curve analysis was done between serum thyroid hormone levels (TT4, TT3, TSH, FT4 and FT3) and the occurrence of death in the AECOPD patients. The areas under ROC curve were 0.659, 0.793, 0.588, 0.655 and 0.772, respectively. Serum TT3 was the best indicator for predicting the occurrence of death. When serum TT3 level was 0.85nmol/L, the Youden index was the highest (0.486), with a sensitivity of 70.2%, and a specificity of 78.3%. It was the best cut-offl value of serum TT3 to predict the risk of death in AECOPD patients.ConculsionsSerum thyroid hormone levels are significant associated with the prognostic for AECOPD patients. There is certain value of serum thyroid hormone levels in prognostic evaluation of AECOPD patients.
Objectve To measure the serum levels of human IL-32 and explore the clincal implication in patients with chronic obstructive pulmonary disease( COPD) at acute exacerbation or stable stage. Methods 120 patients with COPD were recruited, including 60 patients with acute exacerbation COPD and 60 patients with stable COPD from October 2010 to May 2011. Thirty healthy nonsmoking volunteers were included as controls. The concentrations of interleukin-8 ( IL-8) , tumor necrosis factor alpha ( TNF-α) , and IL-32 in serum were measured by enzyme-linked immunosorbent assay ( ELISA) . The correlations among IL-32, IL-8, TNF-αand lung functions were investigated. The datas were analyzed using a statistical software package ( SPSS13. 0) . Variables were compared with one-way ANOVA . The correlations between variables were analyzed using Pearson’s correlation coefficient or Spearman correlation coefficient. Results SerumIL-32 level was significantly higher in AECOPD patients [ ( 174. 56 ±88. 15) ng/L] than that in healthy subjects [ ( 59. 41 ±20. 98) ng/L] and in stable COPD patients [ ( 89. 40 ±33. 84) ng/L]( P lt;0. 05) while serum IL-32 level was also significantly higher in stable COPD patients than in healthy subjects( P lt;0. 05) . The serumIL-32 1evel in patients with acute exacerbation COPD and stable COPD was positively correlated with the serumIL-8 level, TNF-αlevel ( respectively P lt;0. 01) . The serumIL-32 level was negatively correlated with FEV1 /predicted value, FEV1 /FVC and PaO2 ( respectively, P lt;0. 01) . There was no statistical significance of the serum IL-32, IL-8 or TNF-α levels in COPD patients with different severity ( all P gt;0. 05) . Conclusion The serumlevel of IL-32, a newpro-inflammatory cytokine is elevated in COPD patients, which may be involved in the pathogenesis of inflammation in COPD.
Objective To investigate the influence of airflow limitation upon lung deposition of inhaled corticosteroids in patients with chronic obstructive pulmonary disease ( COPD) . Methods The radionuclide 99mTc was used to lable budesonide which was inhaled through compressor nebulizer. Lung deposition was evaluated by nuclear medicine pulmonary ventilation scintigraphy. Peripheral to central ratio of lung deposition ( P/C% ) was calculated by region of interest ( ROI) metod. Results Forty-threepatients with stable COPD were enrolled in the study, of whom 41 patients completed the trial. The median age was 68 years ( range, 48 to 79 years) and the median FEV1 was 44. 9% predicted. The P/C% was ( 47. 96 ±6. 08) % . The patients with P/C% more than 50% had a higher FEV1% pred and FEV1 /FVC than those with P/C% less than 50% [ FEV1% pred: ( 51. 85 ±18. 20) % vs. ( 40. 52 ±12. 99) % .FEV1 /FVC: ( 59. 95 ±11. 87) % vs. ( 51. 73 ±9. 28) % ] . There was a positive correlation between P/C% and FEV1% pred ( r = 0. 391, P = 0. 024) and FEV1 /FVC ratio ( r = 0. 517, P = 0. 002) . Conclusion Lung peripheral airway deposition of inhaled corticosteroids was limited by airflow obstruction.
ObjectiveTo provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.MethodsThe clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.ResultsThe incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1% vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate.ConclusionCOPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.