Background The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease （COPD） guidelines classify patients into four groups according to the number of symptoms and the l...Background The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease （COPD） guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD （AECOPD）. This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice. Methods A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test （CAT）, Modified British Medical Research Council （mMRC） scale, and results of the lung function tests were recorded. Results Of the 194 patients assessed, 21 had a CAT score 〉10 and an mMRC grade ≤1, 13 had a CAT score 〈10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second （FEV1%） of 〈50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of 〉50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% 〈50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant （P=0.004）. The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant. Conclusions The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease （GOLD） 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.展开更多
Objective To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan＇s syndrome,and discuss some proposed potential mechanisms for this relationship.Data sources The data i...Objective To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan＇s syndrome,and discuss some proposed potential mechanisms for this relationship.Data sources The data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013.The search term was ＂Marfan＇s syndrome and sleep apnea＂.Study selection Clinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan＇s syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan＇s syndrome,and coexisting obstructive sleep apnea.Results A high prevalence of obstructive sleep apnea exists in patients with Marfan＇s syndrome.The potential reasons are craniofacial abnormalities and lax upper airway muscles,which lead to high nasal airway resistance and upper airway collapse.Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms.The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan＇s syndrome.Conclusions Obstructive sleep apnea is strongly associated with Marfan＇s syndrome.Craniofacial abnormalities and lax upper airway are the main mechanisms.Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture.Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan＇s syndrome.展开更多
文摘Background The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease （COPD） guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD （AECOPD）. This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice. Methods A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test （CAT）, Modified British Medical Research Council （mMRC） scale, and results of the lung function tests were recorded. Results Of the 194 patients assessed, 21 had a CAT score 〉10 and an mMRC grade ≤1, 13 had a CAT score 〈10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second （FEV1%） of 〈50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of 〉50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% 〈50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant （P=0.004）. The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant. Conclusions The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease （GOLD） 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81270926 to He Jinhan）, and Outstanding Scholar Foundation of Sichuan University （No. 2013SCU04A17 to He Jinhan）, and Cadres Health Care Committee Foundation of Health Department, Sichuan Province （No. GB2013101 to Mo Li）.
文摘Objective To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan＇s syndrome,and discuss some proposed potential mechanisms for this relationship.Data sources The data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013.The search term was ＂Marfan＇s syndrome and sleep apnea＂.Study selection Clinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan＇s syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan＇s syndrome,and coexisting obstructive sleep apnea.Results A high prevalence of obstructive sleep apnea exists in patients with Marfan＇s syndrome.The potential reasons are craniofacial abnormalities and lax upper airway muscles,which lead to high nasal airway resistance and upper airway collapse.Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms.The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan＇s syndrome.Conclusions Obstructive sleep apnea is strongly associated with Marfan＇s syndrome.Craniofacial abnormalities and lax upper airway are the main mechanisms.Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture.Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan＇s syndrome.
