Background The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOP...Background The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOPD and the associated factors. Methods A multi-center, retrospective study was conducted in the four hospitals in Beijing including two level III hospitals and two level II hospitals. Patients with AECOPD admitted to the hospitals between January and December in 2006 were enrolled. The hospitalization cost and its relationship with disease severity and treatment were analyzed. Results Totally 439 patients were enrolled with 294 men （67.0%） and a mean age 73.4 years. The mean hospital stay was 20.7 days. A total of 204 patients （46.5%） had respiratory failure, 153 （34.9%） with cor pulmonale, 123 （28.0%） with coronary artery disease, 231 （52.6%） with hypertension, 70 （15.9%） with cerebrovascular disease and 32 （7.3%） with renal failure. The percentage of drug cost to total cost was the highest （71.2%）, followed by laboratory cost （16.7%）, therapy cost （9.7%）, oxygen cost （7.3%）, radiology cost （4.5%）, examination cost （4.5%）, bed cost （4.1%）. Correlation analysis showed that cost was positively correlated with age, hospitalization days, co-morbidities such as respiratory failure and cor pulmonale, hypertension. Three hundred and twenty-one patients were further analyzed. The hospitalization cost increased in patients with non-invasive ventilation （P〈0.01）, invasive mechanical ventilation （P〈0.01）, ICU stay （P〈0.01）, antibiotics （P〈0.05）, systemic steroids （P〈0.01）, and poor prognosis （P〈0.05）. Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second （FEV1%） （r=-0.149, P〈0.05）, pH （r=-0.258, P〈0.01）, and PaO2 （r=-0.131, P〈0.05）, positively correlated with PaCO2 （r=0.319, P〈0.01）, non-invasive positive pressure ventilation （r=0.375, P〈0.01） and duration （r=0.463, P〈0.01）, invasive mechanical ventilation （r=0.416, P〈0.01） and duration （r=0.511, P〈0.01）, ICU stay （r=0.390, P〈0.01） and duration （r=0.650, P〈0.01）, antibiotics （r=0.140, P〈0.05） and systemic steroids （r=0.202, P〈0.01）. Conclusions AECOPD had a great impact on healthcare resources utilization. Disease severity, use of non-invasive or invasive ventilation, ICU stay and usage of antibiotics and systemic steroids were the major determinants of hospitalization cost. Long-term regular treatment aimed at reducing the frequency of acute exacerbation will lower the social and economic burden of chronic obstructive pulmonary disease （COPD）.展开更多
Background Chronic obstructive pulmonary disease （COPD） has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic ...Background Chronic obstructive pulmonary disease （COPD） has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.Methods A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents （over 40 years old） were interviewed with a standardized questionnaire and spirometry.Post-bronchodilator forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic,personal and exposure variables were collected and analyzed.Results Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 （35.3%）were asymptomatic. The age, sex, body mass index （BMI）,rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group.Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV1 （73.1% vs. 61.0%）, FVC （91.9% vs. 82.0%）, and a higher ratio of FEV1/FVC （62.9% vs.58.7%） （all P 〈0.001） than symptomatic group. More asymptomatic patients were underdiagnosed （91.9% vs.54.3%, P〈0.001） than symptomatic patients.Conclusions This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.展开更多
Background Many studies have shown the superior efficacy of budesonide （BUD）/formoterol （FORM） maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative lar...Background Many studies have shown the superior efficacy of budesonide （BUD）/formoterol （FORM） maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative large patient-group. We finished this research to compare BUD/FORM maintenance and reliever therapy and high-dose salmeterol （SALM）/fluticasone （FP） maintenance plus an as-needed short-acting IB2-agonist in Chinese patients with persistent uncontrolled asthma. This was a post hoc analysis based on a 6-month, multicenter, randomized, double-blind study （NCT00242775）. Methods A total of 222 eligible asthma patients from nine centers in China were randomized to either BUD/FORM＋as- needed BUD/FORM （160/4.5 pg/inhalation） （640/18 pg/d; n=111 ）, or SALM/FP＋as-needed terbutaline （0.4 mg/inhalation） （100/1000 pg/d; n=111）. The primary endpoint was time to first severe exacerbation while secondary endpoints included various measures of pulmonary function, symptom control and quality-of-life. Results Time to first severe exacerbation over six months was lower with the BUD/FORM than with the SALM/FP treatment （risk ratio=0.52, 95% CI 0.22-1.22）, but the difference did not achieve statistical significance （P=-0.13）. The cumulative number of severe exacerbations in the BUD/FORM group was lower than in the SALM/FP group （7.2% vs. 13.5%; risk ratio=0.45, P=0.028）. BUD/FORM produced significantly better improvements in reliever use, cumulative mild exacerbations, symptom-free days （%）, and morning/evening peak expiratory flow （PEF） than SALM/FP （P 〈0.05 in all cases）. The two groups achieved similar improvements in their time to first mild exacerbation, forced expiratory volume in one second （FEV1）, asthma control questionnaire and asthma symptom scores, and percentage of nights with awakening（s）. Both treatments were well tolerated. Conclusions In Chinese patients with persistent asthma, BUD/FORM decreased severe and mild exacerbations, decreased reliever use, increased symptom-free days, and improved morning/evening PEF compared with SALM/FP. There were no significant differences in time to first severe exacerbation or other assessments regarding daily asthma control between BUD/FORM and SALM/FP. BUD/FORM was more effective in this Chinese sub-group than in the total cohort involved in the oriclinal study. （Clinical Trial Registry Number： NCT00242775）展开更多
Background Alpha 2A adrenergic receptor （AR） is a subtype of （]2 AR belonging to G protein-coupled receptors, and exerts a variety of biological effects. Recent studies have demonstrated that the a2A AR activation ...Background Alpha 2A adrenergic receptor （AR） is a subtype of （]2 AR belonging to G protein-coupled receptors, and exerts a variety of biological effects. Recent studies have demonstrated that the a2A AR activation was closely related with inflammatory reaction. The present study aimed to investigate the influence of a2A AR antagonist, yohimbine, on the severity of endotoxin-induced acute lung injury in rats.展开更多
Background Pulmonary embolism （PE） is rare and seldom considered in adolescent patients; however it occurs with a greater frequency than is generally recognized, and it is a potentially fatal condition. The aim of t...Background Pulmonary embolism （PE） is rare and seldom considered in adolescent patients; however it occurs with a greater frequency than is generally recognized, and it is a potentially fatal condition. The aim of the current study was to understand its epidemiology, clinical features and the cause of delay of its diagnosis in adolescents. Methods A retrospective analysis of nine adolescents with acute PE admitted to the Peking University Third Hospital over the past 16-year period was performed. The epidemiology, clinical features and risk factors of the adolescents were described and compared with those of adults and elderly patients. The time to diagnosis and misdiagnosed diseases were analyzed. Pretest probability of PE was assessed retrospectively by the Wells score and revised Geneva score. Results The incidence of PE was 43.6 per 100 000 hospitalized adolescents in our hospital. The incidence of PE in adolescents was much lower than that in adults and PE is diagnosed in about 1/50 of elderly people. The clinical features in adolescents were similar to those in adults. But fever and chest pain were more common in adolescents （P〈0.05）. The major risk factors included surgery, systemic lupus erythematosus （SLE）, thrombocytopenia, long-term oral glucocorticoids and trauma. The mean diagnostic time was （7.8±8.4） days. Six cases had a delayed diagnosis. The mean delay time from symptom onset to diagnosis was （11.0±8.8） days. The time of presentation to diagnosis in patients initially admitted to the emergency department was less than one day, and was much shorter than the time in outpatients, （9.4±7.5） days. Most of the patients were initially misdiagnosed with a respiratory tract infection. Most patients＇ values of Wells score or revised Geneva score were in the moderate or high clinical probability categories; 88% by Well score vs. 100% by revised Geneva score. Conclusions PE was seldom considered in the adolescent patients by physicians, especially outpatient physicians, so the diagnosis was often delayed. If adolescent patients complain of dyspnea or chest pain or syncope with/without fever, and they had risk factors such as surgery, thrombocytopenia and trauma, PE should be considered and included in the differential diagnosis.展开更多
文摘Background The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOPD and the associated factors. Methods A multi-center, retrospective study was conducted in the four hospitals in Beijing including two level III hospitals and two level II hospitals. Patients with AECOPD admitted to the hospitals between January and December in 2006 were enrolled. The hospitalization cost and its relationship with disease severity and treatment were analyzed. Results Totally 439 patients were enrolled with 294 men （67.0%） and a mean age 73.4 years. The mean hospital stay was 20.7 days. A total of 204 patients （46.5%） had respiratory failure, 153 （34.9%） with cor pulmonale, 123 （28.0%） with coronary artery disease, 231 （52.6%） with hypertension, 70 （15.9%） with cerebrovascular disease and 32 （7.3%） with renal failure. The percentage of drug cost to total cost was the highest （71.2%）, followed by laboratory cost （16.7%）, therapy cost （9.7%）, oxygen cost （7.3%）, radiology cost （4.5%）, examination cost （4.5%）, bed cost （4.1%）. Correlation analysis showed that cost was positively correlated with age, hospitalization days, co-morbidities such as respiratory failure and cor pulmonale, hypertension. Three hundred and twenty-one patients were further analyzed. The hospitalization cost increased in patients with non-invasive ventilation （P〈0.01）, invasive mechanical ventilation （P〈0.01）, ICU stay （P〈0.01）, antibiotics （P〈0.05）, systemic steroids （P〈0.01）, and poor prognosis （P〈0.05）. Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second （FEV1%） （r=-0.149, P〈0.05）, pH （r=-0.258, P〈0.01）, and PaO2 （r=-0.131, P〈0.05）, positively correlated with PaCO2 （r=0.319, P〈0.01）, non-invasive positive pressure ventilation （r=0.375, P〈0.01） and duration （r=0.463, P〈0.01）, invasive mechanical ventilation （r=0.416, P〈0.01） and duration （r=0.511, P〈0.01）, ICU stay （r=0.390, P〈0.01） and duration （r=0.650, P〈0.01）, antibiotics （r=0.140, P〈0.05） and systemic steroids （r=0.202, P〈0.01）. Conclusions AECOPD had a great impact on healthcare resources utilization. Disease severity, use of non-invasive or invasive ventilation, ICU stay and usage of antibiotics and systemic steroids were the major determinants of hospitalization cost. Long-term regular treatment aimed at reducing the frequency of acute exacerbation will lower the social and economic burden of chronic obstructive pulmonary disease （COPD）.
文摘Background Chronic obstructive pulmonary disease （COPD） has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.Methods A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents （over 40 years old） were interviewed with a standardized questionnaire and spirometry.Post-bronchodilator forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic,personal and exposure variables were collected and analyzed.Results Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 （35.3%）were asymptomatic. The age, sex, body mass index （BMI）,rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group.Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV1 （73.1% vs. 61.0%）, FVC （91.9% vs. 82.0%）, and a higher ratio of FEV1/FVC （62.9% vs.58.7%） （all P 〈0.001） than symptomatic group. More asymptomatic patients were underdiagnosed （91.9% vs.54.3%, P〈0.001） than symptomatic patients.Conclusions This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.
文摘Background Many studies have shown the superior efficacy of budesonide （BUD）/formoterol （FORM） maintenance and reliever therapy, but still lack evidence of its efficacy in Chinese asthma patients in a relative large patient-group. We finished this research to compare BUD/FORM maintenance and reliever therapy and high-dose salmeterol （SALM）/fluticasone （FP） maintenance plus an as-needed short-acting IB2-agonist in Chinese patients with persistent uncontrolled asthma. This was a post hoc analysis based on a 6-month, multicenter, randomized, double-blind study （NCT00242775）. Methods A total of 222 eligible asthma patients from nine centers in China were randomized to either BUD/FORM＋as- needed BUD/FORM （160/4.5 pg/inhalation） （640/18 pg/d; n=111 ）, or SALM/FP＋as-needed terbutaline （0.4 mg/inhalation） （100/1000 pg/d; n=111）. The primary endpoint was time to first severe exacerbation while secondary endpoints included various measures of pulmonary function, symptom control and quality-of-life. Results Time to first severe exacerbation over six months was lower with the BUD/FORM than with the SALM/FP treatment （risk ratio=0.52, 95% CI 0.22-1.22）, but the difference did not achieve statistical significance （P=-0.13）. The cumulative number of severe exacerbations in the BUD/FORM group was lower than in the SALM/FP group （7.2% vs. 13.5%; risk ratio=0.45, P=0.028）. BUD/FORM produced significantly better improvements in reliever use, cumulative mild exacerbations, symptom-free days （%）, and morning/evening peak expiratory flow （PEF） than SALM/FP （P 〈0.05 in all cases）. The two groups achieved similar improvements in their time to first mild exacerbation, forced expiratory volume in one second （FEV1）, asthma control questionnaire and asthma symptom scores, and percentage of nights with awakening（s）. Both treatments were well tolerated. Conclusions In Chinese patients with persistent asthma, BUD/FORM decreased severe and mild exacerbations, decreased reliever use, increased symptom-free days, and improved morning/evening PEF compared with SALM/FP. There were no significant differences in time to first severe exacerbation or other assessments regarding daily asthma control between BUD/FORM and SALM/FP. BUD/FORM was more effective in this Chinese sub-group than in the total cohort involved in the oriclinal study. （Clinical Trial Registry Number： NCT00242775）
文摘Background Alpha 2A adrenergic receptor （AR） is a subtype of （]2 AR belonging to G protein-coupled receptors, and exerts a variety of biological effects. Recent studies have demonstrated that the a2A AR activation was closely related with inflammatory reaction. The present study aimed to investigate the influence of a2A AR antagonist, yohimbine, on the severity of endotoxin-induced acute lung injury in rats.
文摘Background Pulmonary embolism （PE） is rare and seldom considered in adolescent patients; however it occurs with a greater frequency than is generally recognized, and it is a potentially fatal condition. The aim of the current study was to understand its epidemiology, clinical features and the cause of delay of its diagnosis in adolescents. Methods A retrospective analysis of nine adolescents with acute PE admitted to the Peking University Third Hospital over the past 16-year period was performed. The epidemiology, clinical features and risk factors of the adolescents were described and compared with those of adults and elderly patients. The time to diagnosis and misdiagnosed diseases were analyzed. Pretest probability of PE was assessed retrospectively by the Wells score and revised Geneva score. Results The incidence of PE was 43.6 per 100 000 hospitalized adolescents in our hospital. The incidence of PE in adolescents was much lower than that in adults and PE is diagnosed in about 1/50 of elderly people. The clinical features in adolescents were similar to those in adults. But fever and chest pain were more common in adolescents （P〈0.05）. The major risk factors included surgery, systemic lupus erythematosus （SLE）, thrombocytopenia, long-term oral glucocorticoids and trauma. The mean diagnostic time was （7.8±8.4） days. Six cases had a delayed diagnosis. The mean delay time from symptom onset to diagnosis was （11.0±8.8） days. The time of presentation to diagnosis in patients initially admitted to the emergency department was less than one day, and was much shorter than the time in outpatients, （9.4±7.5） days. Most of the patients were initially misdiagnosed with a respiratory tract infection. Most patients＇ values of Wells score or revised Geneva score were in the moderate or high clinical probability categories; 88% by Well score vs. 100% by revised Geneva score. Conclusions PE was seldom considered in the adolescent patients by physicians, especially outpatient physicians, so the diagnosis was often delayed. If adolescent patients complain of dyspnea or chest pain or syncope with/without fever, and they had risk factors such as surgery, thrombocytopenia and trauma, PE should be considered and included in the differential diagnosis.
