Effects of acetylcysteine on micro-inflammation and pulmonary ventilation in chronic obstructive pulmonary disease exacerbation

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is a serious complication of chronic obstructive pulmonary disease,often characterized by increased morbidity and mortality.In traditional Chinese medicine,AECOPD is linked to phlegm-heat and blood-stasis,presenting symptoms like thick sputum,fever,and chest pain.It has been shown that acetylcysteine inhalation in conjunction with conventional therapy significantly reduced inflammatory markers and improved lung function parameters in patients with AECOPD,suggesting that acetylcysteine may be an important adjunctive therapy for patients with phlegm-heat-blood stasis type AECOPD.AIM To investigate the effect of acetylcysteine on microinflammation and lung ventilation in patients with phlegm-heat and blood-stasis-type AECOPD.METHODS One hundred patients with phlegm-heat and blood-stasis-type AECOPD were randomly assigned to two groups.The treatment group received acetylcysteine inhalation(10%solution,5 mL,twice daily)along with conventional therapy,whereas the control group received only conventional therapy.The treatment duration was 14 d.Inflammatory markers(C-reactive protein,interleukin-6,and tumor necrosis factor-alpha)in the serum and sputum as well as lung function parameters(forced expiratory volume in one second,forced vital capacity,and peak expiratory flow)were assessed pre-and post-treatment.Acetylcysteine inhalation led to significant reductions in inflammatory markers and improvements in lung function parameters compared to those in the control group(P<0.05).This suggests that acetylcysteine could serve as an effective adjunct therapy for patients with phlegm-heat and blood-stasis-type AECOPD.RESULTS Acetylcysteine inhalation significantly reduced inflammatory markers in the serum and sputum and improved lung ventilation function parameters in patients with phlegm-heat and blood-stasis type AECOPD compared with the control group.These differences were statistically significant(P<0.05).The study concluded that acetylcysteine inhalation had a positive effect on microinflammation and lung ventilation function in patients with this type of AECOPD,suggesting its potential as an adjuvant therapy for such cases.CONCLUSION Acetylcysteine inhalation demonstrated significant improvements in reducing inflammatory markers in the serum and sputum,as well as enhancing lung ventilation function parameters in patients with phlegm-heat and bloodstasis type AECOPD.These findings suggest that acetylcysteine could serve as a valuable adjuvant therapy for individuals with this specific type of AECOPD,offering benefits for managing microinflammation and optimizing lung function.

The effect of traditional Chinese medicine rehabilitation exercise(pulmonary Daoyin)in patients with chronic obstructive pulmonary disease:A systematic review and meta-analysis

Objective:Previous research has demonstrated that pulmonary Daoyin could be an efficacious way to ameliorate the physical and psychological state of sufferers with chronic obstructive pulmonary disease(COPD)and bolster the quality of life.However,the results are not consistent.Thus,the objective of this research is to assess the impacts of pulmonary Daoyin in individuals with COPD.Methods:Relevant articles were searched in Web of Science,Cochrane Library,PubMed,EMBASE,SinoMed,CNKI,Wanfang,and VIP from database inception to January 2024.Results:There were a total of 15 randomized controlled trials(RCTs)included in this meta-analysis involving 1732 patients,of which 864 participated in the intervention group and 868 in the control group.When comparing with the control group,the COPD patients practicing pulmonary Daoyin demonstrated a significant improvement in 6 min walking distance(mean difference[MD]=24.53,95%confidence interval[CI][18.55,30.52],P<0.00001),forced expiratory volume in the 1 s(FEV_(1))(MD=0.39,95%CI[0.18,0.59],P=0.0002),percentage of FEV_(1)to the predicted value(FEV_(1)%)(MD=5.35,95%CI[3.22,7.48],P<0.0001),the forced vital capacity(FVC)(MD=0.39,95%CI[0.06,0.73],P=0.02),percentage of FVC to the predicted value(FVC%)(MD=7.52,95%CI[4.91,10.13],P<0.00001),the ratio of FEV_(1)/FVC(MD=4.95,95%CI[0.91,8.99],P=0.02),peak expiratory flow rate(standardized MD=0.98,95%CI[0.74,1.22],P<0.00001),modified Medical Research Council(mMRC)scale(MD=-0.47,95%CI[-0.89,-0.04],P=0.03),and Borg scale(MD=-0.65,95%CI[-0.75,-0.55],P<0.00001).Conclusions:Our findings may illuminate the influence of pulmonary Daoyin on exercise ability,breathlessness,and pulmonary function in COPD patients.More rigorous RCTs with larger samples and longer-term interventions will be required moving forward.

Observation on the Effect of Non-Invasive Ventilator Combined with Conventional Therapy in the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Objective:To explore the clinical effect of a non-invasive ventilator combined with conventional therapy in the treatment of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:68 patients with COPD combined with respiratory failure treated in our hospital from September 2021 to October 2023 were selected as the research subjects.Using the random number table method,they were divided into a control group and an experimental group of 34 cases each.The control group received conventional symptomatic treatment,and the experimental group received non-invasive ventilator treatment based on the control group.The clinical effects,blood gas indicators(partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),arterial oxygen saturation(SaO_(2))),lung function(forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),6 min walking distance),complications,and inflammatory factor levels(c-reactive protein(CRP),interleukin-6(IL-6),neutrophil-to-lymphocyte ratio(NLR))of the two groups of patients were observed.Results:(1)The clinical efficacy of the patients in the experimental group(33/97.06%)was more significant as compared with the control group(25/73.53%)(P<0.05);(2)After treatment,the clinical efficacy of the two groups of patients in terms of FEV1,FEV1/FVC,6-minute walking distance,PaO_(2)and SaO_(2)all increased in the experimental group as compared to that of the control group(P<0.05);(3)After treatment,the PaCO_(2),CRP,IL-6,and NLR of the two groups of patients decreased,and the decrease in the experimental group was higher than that of the control group(P<0.05);(4)The patients’complication rate in the experimental group(2/5.88%)was lower as compared to that of the control group(9/26.46%)(P<0.05).Conclusion:Non-invasive ventilators combined with conventional therapy achieved good clinical results in treating patients with COPD and respiratory failure.

The Effect of O2O Education Combined with Peer Education Management Model in Patients with Chronic Obstructive Pulmonary Disease

Objective:To explore the effect of online-to-offline(O2O)education combined with the peer education management model in patients with chronic obstructive pulmonary disease(COPD).Methods:Using convenience sampling,72 patients with COPD who were hospitalized in the respiratory medicine department of a tertiary-level hospital from March to December 2021 were selected as study subjects.Randomized grouping was carried out using the random number table method,the control group was given routine COPD health education in the department,and the intervention group applied O2O trinity health management combined with peer education on the basis of routine care.After 6 months of follow-up after discharge,the two groups were observed and compared for changes in pulmonary function,depression status,self-care ability,and quality of life.Results:At 3 and 6 months after the intervention,the lung function indexes and depression status of the two groups of patients improved significantly,and the improvement effect was more significant in the intervention group(P<0.05);after the intervention,the self-care ability scores of the patients in the intervention group were significantly higher than those of the control group(P<0.05);the quality-of-life scores of the two groups of patients decreased at 3 months after discharge,in which the quality-of-life scores in the intervention group was significantly lower than that of the control group(P<0.05).Conclusion:O2O education combined with the peer education management model can effectively improve the lung function of patients with COPD,depression,self-care ability,and quality of life.

Eff ects of early standardized enteral nutrition on preventing acute muscle loss in the acute exacerbation of chronic obstructive pulmonary disease patients with mechanical ventilation

BACKGROUND:To investigate the eff ects of early standardized enteral nutrition(EN)on the crosssectional area of erector spine muscle(ESMcsa),plasma growth diff erentiation factor-15(GDF-15),and 28-day mortality of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with invasive mechanical ventilation(MV).METHODS:A total of 97 AECOPD patients with invasive MV were screened in the ICUs of the First People's Hospital of Lianyungang.The conventional EN group(stage Ⅰ)and early standardized EN group(stage Ⅱ)included 46 and 51 patients,respectively.ESMcsa loss and GDF-15 levels on days 1 and 7 of ICU admission and 28-day survival rates were analyzed.RESULTS:On day 7,the ESMcsa of the early standardized EN group was significantly higher than that of the conventional EN group,while the plasma GDF-15 levels were significantly lower than those in the conventional EN group(ESMcsa:28.426±6.130 cm^(2) vs.25.205±6.127 cm^(2);GDF-15:1661.608±558.820 pg/mL vs.2541.000±634.845 pg/mL;all P<0.001).The 28-day survival rates of the patients in the early standardized EN group and conventional EN group were 80.40%and 73.90%,respectively(P=0.406).CONCLUSION:ESMcsa loss in AECOPD patients with MV was correlated with GDF-15 levels,both of which indicated acute muscular atrophy and skeletal muscle dysfunction.Early standardized EN may prevent acute muscle loss and intensive care unit-acquired weakness(ICU-AW)in AECOPD patients.

Clinical study of NFNC in the treatment of acute exacerbation chronic obstructive pulmonary disease patients with respiratory failure

BACKGROUND Most patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)have respiratory failure that necessitates active correction and the improvement of oxygenation is particularly important during treatment.High flow nasal cannula(HFNC)oxygen therapy is a non-invasive respiratory aid that is widely used in the clinic that improves oxygenation state,reduces dead space ventilation and breathing effort,protects the loss of cilia in the airways,and improves patient comfort.AIM To compare HFNC and non-invasive positive pressure ventilation in the treatment of patients with AECOPD.METHODS Eighty AECOPD patients were included in the study.The patients were in the intensive care department of our hospital from October 2019 to October 2021.The patients were divided into the control and treatment groups according to the different treatment methods with 40 patients in each group.Differences in patient comfort,blood gas analysis and infection indices were analyzed between the two groups.RESULTS After treatment,symptoms including nasal,throat and chest discomfort were significantly lower in the treatment group compared to the control group on the 3rd and 5th days(P<0.05).Before treatment,the PaO_(2),PaO_(2)/FiO_(2),PaCO_(2),and SaO_(2)in the two groups of patients were not significantly different(P>0.05).After treatment,the same indicators were significantly improved in both patient groups but had improved more in the treatment group compared to the control group(P<0.05).After treatment,the white blood cell count,and the levels of C-reactive protein and calcitonin in patients in the treatment group were significantly higher compared to patients in the control group(P<0.05).CONCLUSION HFNC treatment can improve the ventilation of AECOPD patients whilst also improving patient comfort,and reducing complications.HFNC is a clinically valuable technique for the treatment of AECOPD.

Clinical evaluation of ventilation mode on acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

BACKGROUND At present,understanding of the most effective ventilation methods for treating chronic obstructive pulmonary disease(COPD)patients experiencing acute worsening symptoms and respiratory failure remains relatively limited.This report analyzed the efficiency and side effects of various ventilation techniques used for individuals experiencing an acute COPD exacerbation.AIM To determine whether pressure-controlled ventilation(PCV)can lower peak airway pressures(PAPs)and reduce the incidence of barotrauma compared to volume-controlled ventilation(VCV),without compromising clinical outcomes and oxygenation parameters.METHODS We have evaluated 600 patients who were hospitalized due to a severe COPD exacerbation,with 400 receiving mechanical ventilation for the respiratory failure.The participants were divided into two different groups,who were administered either VCV or PCV,along with appropriate management.We thereafter observed patients'attributes,clinical factors,and laboratory,radiographic,and arterial blood gas evaluations at the start and during their stay in the intensive care unit(ICU).We have also employed appropriate statistical methods for the data analysis.RESULTS Both the VCV and PCV groups experienced significant enhancements in the respiratory rate,tidal volume,and arterial blood gas values during their time in the ICU.However,no significant distinctions were detected between the groups in terms of oxygenation indices(partial pressures of oxygen/raction of inspired oxygen ratio)and partial pressures of carbon dioxide improvements.There was no considerable disparity observed between the VCV and PCV groups in the hospital mortality(32%vs 28%,P=0.53),the number of days of ICU stay[median interquartile range(IQR):9(6-14)d vs 8(5-13)d,P=0.41],or the duration of the mechanical ventilation[median(IQR):6(4-10)d vs 5(3-9)d,P=0.47].The PCV group displayed lower PAPs compared to the VCV group(P<0.05)from the beginning of mechanical ventilation until extubation or ICU departure.The occurrence of barotrauma was considerably lower in the PCV group in comparison to the VCV group(6%vs 16%,P=0.03).CONCLUSION Both VCV and PCV were found to be effective in treating patients with acute COPD exacerbation.However,PCV was associated with lower PAPs and a significant decrease in barotrauma,thus indicating that it might be a safer ventilation method for this group of patients.However,further large-scale study is necessary to confirm these findings and to identify the best ventilation approach for patients experiencing an acute COPD exacerbation.

Anxiety, Depression and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common and frequently occurring disease, which not only has a higher fatality rate, but also leads to loss of labor force and an obvious decrease in the quality of life in the course of long-term disease, patients with chronic obstructive pulmonary disease complicated with anxiety and depression are a major public health problem. Objective: To investigate the status of anxiety, depression and quality of life and related factors in patients with COPD. Methods: One hundred patients admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Dali University with chronic obstructive pulmonary disease evaluated by anxiety self-assessment scale, depression self-assessment scale and quality of life rating scale for patients with chronic obstructive pulmonary disease. Results: The incidence of anxiety in COPD patients was 82.5%, and the incidence of depression was 87.3%. The probability of both anxiety and depression was high, and the prevalence of women was significantly higher than that of men. Correlation analysis and logistic regression results showed that education level was negatively correlated with the occurrence of anxiety, and age was positively correlated with the occurrence of anxiety. Elderly patients were prone to anxiety and had lower quality of life. Conclusion: The older and less educated the COPD patients are, the higher the incidence of anxiety and depression, and the higher the incidence in female patients.

Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain.

Meta-analysis of the acupoint application therapy for stable chronic obstructive pulmonary disease

Objective:To systematically evaluate the clinical efficacy and safety of acupoint application in the treatment of stable chronic obstructive pulmonary disease.Methods:A comprehensive search of domestic and international databases,the search time is limited to nearly ten years,collecting traditional Chinese medicine acupoint application in the treatment of chronic obstructive pulmonary disease in stable phase of randomized controlled trials.Literature screening,information extraction and literature quality evaluation were carried out independently by two researchers,and Meta analysis was carried out by Revman software.Results:A total of 42 RCTs with a total of 4192 patients were included.The results of Meta analysis showed that:Compared with the routine treatment of western medicine,the addition of acupoint application therapy can significantly increase the effective rate[RR=1.23,95%CI(1.19,1.27),P<0.00001]and FEV1/FVC[MD=4.46,95%CI(3.17,5.76),P<0.00001].Significantly improved BODE index[MD=-0.63,95%CI(-0.87,-0.40),P<0.00001],SGRQ score[MD=-6.77,95%CI(-9.81,-3.72),P<0.00001],CAT score[MD=-3.33,95%CI(-3.87,-2.79),P<0.00001]and TCM syndrome integral[MD=-3.51,95%CI(-3.96,-3.06),P<0.00001].The differences is statistically significant and the safety profile is good.Conclusion:On the basis of routine treatment of COPD western medicine,acupoint application therapy can significantly improve the clinical symptoms of patients with less adverse reactions.However,due to the limitations of the research,high-quality research is still needed to provide further evidence.

Prospects of DNA microarray application in management of chronic obstructive pulmonary disease:A systematic review

Chronic obstructive pulmonary disease(COPD)is incurable chronic disease which kills 3.3 million each year worldwide.Number of global cases of COPD is steadily rising alongside with life expectancy,disproportionally hitting middle-income countries like Russia and China,in such conditions,new approaches to the COPD management are desperately needed.DNA microarray technology is a powerful genomic tool that has the potential to uncover underlying COPD biological alteration and brings up revolutionized treatment option to clinicians.We executed systematic review studies of studies published in last 10 years regarding DNA microarray application in COPD management,with complacence to PRISMA criteria and using PubMed and Medline data bases as data source.Out of 920 identified papers,39 were included in the final analysis.We concluded that Genome-wide expression profiling using DNA microarray technology has great potential in enhancing COPD management.Current studied proofed this method is reliable and possesses many potential applications such as individual at risk of COPD development recognition,early diagnosis of disease,COPD phenotype identification,exacerbation prediction,personalized treatment optioning and prospect of oncogenesis evaluation in patients with COPD.Despite all the proofed benefits of this technology,researchers are still in the early stage of exploring it’s potential.Therefore,large clinical trials are still needed to set up standard for DNA microarray techniques usage implementation in COPD management guidelines,subsequently giving opportunity to clinicians for controlling or even eliminating COPD entirely.

Effects of Combined Inhalation of Budesonide,Formoterol,and Tiotropium Bromide on Arterial Blood Gas and Pulmonary Function Indexes in Patients with Chronic Obstructive Pulmonary Disease

Objective:To analyze the effect of combined inhalation of budesonide formoterol and tiotropium bromide on arterial blood gas and pulmonary function indexes in patients with chronic obstructive pulmonary disease(COPD).Methods:100 patients with COPD treated from January to December 2022 were selected as observation objects,and were divided into a control group(n=50,in which budesonide and formoterol were administered)and an experimental group(n=50,the treatment drug was budesonide formoterol combined with tiotropium bromide)according to the computer grouping method,and compared the treatment results.Results:(i)Before treatment,there was no difference in the partial pressure of carbon dioxide and partial pressure of oxygen between the control group and the experimental group(P>0.05);after treatment,the partial pressure of carbon dioxide and partial pressure of oxygen in the experimental group were higher than those in the control group,with significant differences(P<0.05).(ii)Before treatment,there was no difference in forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC between the control group and the experimental group(P>0.05);after treatment,the FVC,FEV1,and FEV1/FVC in the experimental group were significantly higher than those in the control group(P<0.05).(iii)There was no difference in the levels of CRP,IL-6,and TNF-αbetween the control group and the experimental group(P>0.05);after treatment,the levels of CRP,IL-6,and TNF-αin the experimental group were lower than those in the control group,with significant differences(P<0.05).(iv)Compared to the total incidence of adverse reactions in the control group(28.00%),the incidence of total adverse reactions in the experimental group was lower at 10.00%,and the difference was significant(P<0.05).Conclusion:The combined inhalation of budesonide and formoterol with tiotropium bromide has demonstrated a clear therapeutic efficacy and safety in treating chronic obstructive pulmonary disease.This treatment approach effectively enhances arterial blood gas levels and lung function,showing promising potential for widespread application.

The Effect of Psychosocial Nursing on Elderly Patients with Chronic Obstructive Pulmonary Disease

Objective:To explore the clinical effect of psychosocial nursing in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:The sample of this study included 100 elderly patients with COPD who were admitted to our hospital from January 2021 to June 2023.They were divided into a research group(n=50)and a control group(n=50).The patients in the two groups received essential nursing intervention,and those in the study group received psychological nursing intervention along with it.The Hamilton Anxiety Rating Scale(HAM-A),Hamilton Depression Rating Scale(HAM-D),quality of life score,and nursing satisfaction of the two groups were compared.Results:After the nursing intervention,the HAM-A score and HAM-D score of the research group were lower than those of the control group(P<0.05),and the quality-of-life score and the nursing satisfaction of the research group were higher than that of the control group(P<0.05).Conclusion:Psychosocial nursing for elderly patients with chronic obstructive pulmonary disease can enhance their emotional well-being,quality of life,and satisfaction with nursing care,demonstrating its potential for broader application and adoption.

Study on the Application Effects of the Teach-Back Method Combined with WeChat Tutorials on Chronic Disease Self-Management in Patients with Chronic Obstructive Pulmonary Disease(COPD)

Objective:To study the application effects of teach-back method combined with WeChat education in patients with chronic obstructive pulmonary disease(COPD).Methods:Convenience sampling was used to select 103 patients with COPD hospitalized in the department of respiratory medicine of a tertiary-level hospital from March to June 2021 as study subjects.Randomized grouping was carried out using the random number table method.The routine care was given in the control group,and the teach-back method combined with WeChat tutorials on the basis of routine care was applied in the intervention group.In the follow-up three months after discharge,the changes in pulmonary function,self-care ability,and quality of life of patients in the two groups were observed and compared.Results:After the intervention,the pulmonary function indexes of both groups improved significantly,and the improvement effect was more significant in the intervention group(P<0.05);after the intervention,the self-care ability scores of the patients in the intervention group were significantly higher than those of the control group(P<0.05);the quality-of-life scores of the patients in the two groups decreased at 3 months after discharge,and the scores of the patients in the intervention group were significantly lower than those of the patients in the control group(P<0.05).Conclusion:The teach-back method combined with WeChat education can effectively improve the pulmonary function,self-care ability,and quality of life of patients with COPD.

Evaluation of the Effect of Comfort Nursing on Patients with Chronic Obstructive Pulmonary Disease Complicated with Respiratory Failure

Objective:To explore and analyze the effect of comfort nursing in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods:60 patients with COPD and respiratory failure who were admitted to the Department of Respiratory Medicine of our hospital from May 2020 to May 2023 were selected as subjects of this study,and they were divided into comfort group and reference group by odd and even number draw method,with 30 cases in each group.The comfort group received comfort nursing,and the reference group received general nursing.The lung function performance and living conditions were compared between the groups.Results:Before the intervention,there was no statistically significant difference(P>0.05)in terms of lung functions such as forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),and the ratio FEV1/FVC between the groups;after the intervention,the lung functions of the comfort group were significantly better than those in the reference group(P<0.05).Before the intervention,there was no statistically significant difference(P>0.05)between the groups in terms of mental state,physical function,social situation,and spiritual aspects;after the intervention,the mental state,physical function,social situation,and spiritual aspects of the comfort group were significantly better than those of the reference group(P<0.05).Conclusion:Comfort nursing care for COPD patients with respiratory failure can improve their lung function and quality of life,and achieve ideal nursing effects.

Predictive role of interleukin-6 and CAT score in mechanical ventilation in patients with chronic obstructive pulmonary disease at the acute exacerbation stage in the emergency department

BACKGROUND:The study aimed to evaluate the predictive role of interleukin-6(IL-6)and chronic obstructive pulmonary disease(COPD)assessment test(CAT)score in mechanical ventilation(MV)in COPD patients at the acute exacerbation stage in the emergency department(ED).METHODS:For a one-year period,among adult patients in the ED who met the criteria of acute exacerbation of COPD,158 who received MV within 48 hours after admission were compared to 294 who didn't require MV within the same period after admission.IL-6 level and CAT score were compared between the two groups.The predicted value of IL-6 and CAT score was assessed by logistic regression analysis and a receiver operating characteristic(ROC)curve.RESULTS:The IL-6 and CAT scores in the 158 MV patients were much higher than those without.IL-6 and CAT scores were independent predictors of MV within 48 hours using logistic regression analysis(IL-6:odds ratio[OR]1.053,95%confidence interval[CI]1.039–1.067,P<0.001;CAT score:OR 1.122,95%CI 1.086–1.159,P<0.001).The combination of IL-6 and CAT scores(area under ROC curve[AUC]0.826,95%CI 0.786–0.866,P<0.001)improved the accuracy of predicting MV within 48 hours when compared with IL-6(AUC 0.752,95%CI 0.703–0.800,P<0.001)and CAT scores alone(AUC 0.739,95%CI 0.692–0.786,P<0.001).The sensitivity and specificity were 69.6%,74.1%,75.32%and 63.6%,respectively.CONCLUSION:The combined of IL-6 and CAT scores is useful for evaluating the risk of COPD patients at acute exacerbation in ED,and can provide a predictive value for MV or not within 48 hours.

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.

Effect of low-dose glucocorticoid on corticosteroid insufficient patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insuffi ciency(CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit(ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group(n=32) and a control group(n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone(150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers ofinfl ammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically signifi cant.RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4%. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI(23.8% vs. 8.7%, P<0.01). KaplanMeier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group(P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group(18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers ofinfection and inflammation(P<0.01), such as C-reactive protein(13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α(26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin(3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group(P<0.01).CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers ofinfection and infl ammation.

Value of refined care in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Under physiological conditions,sputum produced during acute exacerbation of chronic obstructive pulmonary disease(AECOPD)can move passively with the cilia in the airway;the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway.However,when the sputum is thick,the cough is weak,or the tracheal cilia are abnormal,sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung.Furthermore,the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients,which is the main factor leading to AECOPD.Therefore,promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention.AIM To explore the effect of refined nursing strategies in patients with AECOPD and dysphagia.METHODS We selected 126 patients with AECOPD and difficulty of expectoration at our hospital,and divided them into a refined care group and a routine care group,with 63 cases each,using a random number table.The two groups of patients were treated with expectorant,anti-infection,oxygen inhalation,and other basic treatment measures;patients in the refined care group were given refined nursing intervention during hospitalization,and the routine care group received conventional nursing intervention.The differences in sputum expectoration,negative pressure suction rate,blood gas parameters,dyspnea score measured through the tool developed by the Medical Research Council(MRC),and quality of life were compared between the two groups.RESULTS After 7 d of intervention,the sputum expectoration effect of the refined care group was 62.30%,the effective rate was 31.15%,and the inefficiency rate was 6.56%.The sputum expectoration effect of the routine care group was 44.07%,the effective rate was 42.37%,and the inefficiency rate was 13.56%.The refined care group had better sputum expectoration than the routine care group(P<0.05).The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment(22.95%vs 44.07%,P<0.05).Before the intervention,the arterial oxygen saturation(PaO2)and arterial carbon dioxide saturation(PaCO2)values were not significantly different between the two groups(P>0.05);the PaO2 and PaCO2 values in the refined care group were comparable to those in the routine care group after 7 d of intervention(P>0.05).Before the intervention,there was no significant difference in the MRC score between the two groups(P>0.05);the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention,but the difference was not statistically significant(P>0.05).Before intervention,there was no significant difference in the symptoms,activities,disease impact,or St.George’s Respiratory questionnaire(SGRQ)total scores between the two groups(P>0.05).After 7 days of intervention,the symptoms,activities,and total score of SGRQ of the refined care group were higher than those of the routine care group,but the difference was not statistically significant(P>0.05).CONCLUSION AECOPD with thick sputum,weak coughing reflex,and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung.Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration,alleviate clinical symptoms,and improve the quality of life.

Diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia and acute exacerbation of chronic obstructive pulmonary disease in Gansu Province:A case report

BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29,2020,a total of 91 confirmed cases had been reported in Gansu Province.This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.CASE SUMMARY The patient,a 94-year-old female,lived in Maiji District of Tianshui,Gansu Province,China.On January 30,2020,she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia.She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3,2020 for treatment.Upon initial examination,her body temperature was 36.7°C,pulse was 80,breathing was 20,and blood pressure was 130/80 mmHg.She was conscious with normal development and normal nutrition.The pharynx was not red,and bilateral tonsils were not red and swollen.The lungs sounded slightly coarse with no dry or wet rales.The first symptoms were cough and fatigue on 2 February.The patient was hospitalized for 12 d.After active treatment,she was discharged on February 14 with a good prognosis.CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection,and population clustering is a high risk factor for transmission.Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms.Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome.Nucleic acid testing is extremely important and needs to be repeated several times.Laboratory and auxiliary examination indicators during the first week of admission are extremely important.It is feasible to carry out dynamic and continuous index monitoring,which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.