Asthma-chronic obstructive pulmonary disease overlap syndrome: A diagnostic puzzle for the clinicians

Although asthma and chronic obstructive pulmonary disease(COPD) are distinct airway diseases characterized by chronic inflammation, in some cases distinguishing between them is puzzling. For example, chronic smoking leads asthmatic inflammation to a differentiated pattern resembling the COPD inflammation, and in some cases to fixed obstruction as in COPD, and on the other hand, few COPD patients may present with airway reversibility. ACOS is the condition sharing features encountered both in asthma and COPD. Asthma-COPD overlap syndrome(ACOS) represents a diagnostic challenge in the clinical practice, since there is lack of specific indicators to distinguish it from asthma or COPD, and moreover, genetic risk factors, underlying pathology and molecular pathways, clinical characteristics, therapeutic interventions, response to treatment and prognosis are poorly described. The management of ACOS is recommended to be individualized and should target on the maximum effectiveness with the least side effects. Combination therapy with ICS/LABA or LAMA, or newly developed specific anti-eosinophil therapies and treatments specifically targeting neutrophils might be of relevance in the management of ACOS, but studies are needed in order to assess the response and prognosis. Based on the current knowledge about ACOS thus far, it would be recommended that we approached chronic obstructive airway disease rather by describing than by classifying the disease; this would allow us to have a picture that better describes the disease and to implement an individualized therapeutic approach, according to the custom phenotype. Nevertheless, more studies are needed in order to clarify several important issues with regard to ACOS, such as the genetic risk factors for developing ACOS, the links between genotype and phenotype, the molecular pathways and underlying mechanisms of ACOS, the identification of possible specific biomarkers for diagnosis and targeted treatment, the optimal therapeutic interventions, and finally, the prognosis of ACOS.

Exploring the biological mechanism of qi deficiency syndrome with chronic obstructive pulmonary disease(COPD)based on integrated pharmacology

Objective:To explore the potential biological mechanism of chronic obstructive pulmonary disease(COPD)qi deficiency syndrome,we used the integrated pharmacology network computing platform and carried out experimental verification.Methods:Using an integrated pharmacology strategy to analyze the potential biological targets of COPD qi deficiency syndrome.Based on the established qi deficiency syndrome rat model of COPD,the biological targets of lung and skeletal muscle were detected by electron microscopy,adenosine triphosphate(ATP)content assays,and western blotting.Results:According to the integrated pharmacological results,it was found that the locations of cell components related to COPD qi deficiency syndrome were mainly mitochondria.Electron microscopy results using lung tissue showed that mitochondria in the lipopolysaccharide(LPS group)and pulmonary instillation of LPS combined with cigarette smoke(LPStCS group)were swollen,deformed,and fragmented,with disappearing or broken crista.Results also showed that the total content of ATP in the lung and skeletal muscle of both groups was significantly lower than that in the control group at the 12th week(P<.05).At the 12th week,the expression of dynamin-related protein 1(DRP1)and mitofusin 1(MFN1)protein was significantly difference than that of the control group(P<.05).At the 10th and 14th weeks,changes in fission and fusion proteins in mitochondria of the lung and skeletal muscle were further detected.There was also a significant difference in the expression between the two groups compared to that in the control group at the 10th week and 14th week(P<.05).Conclusion:These findings suggest that the changes in mitochondrial morphology and ATP content and the unbalanced expression of DRP1 and MFN1 might be the key mechanisms underlying qi deficiency syndrome in rats with COPD.

Expiratory Flow Limitation and Its Relation to Dyspnea and Lung Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease: Analysis Using the Forced Expiratory Flow-Volume Curve and Critique

Background: Tidal expiratory flow limitation (tEFL) is defined as absence of increase in air flow during forced expiration compared to tidal breathing and is related to dyspnea at rest and minimal exertion in patients with chronic airflow limitation (CAL). Tidal EFL has not been expressed as a continuous variable (0% - 100%) in previous analyses. Objective: To relate the magnitude of tEFL to spirometric values and Modified Medical Research Council (MMRC) score and Asthma Control Test (ACT). Methods: Tidal EFL was computed as percent of the tidal volume (0% - 100%) spanned (intersected) by the forced expiratory-volume curve. Results: Of 353 patients screened, 192 (114 M, 78 F) patients (136 with COPD, 56 with asthma) had CAL. Overall characteristics: (mean ± SD) age 59 ± 11 years, BMI 28 ± 7, FVC (% pred) 85 ± 20, FEV1 (% pred) 66 ± 21, FEV1/FVC 55% ± 10%, RV (% pred) 147 ± 42. Tidal EFL in patients with tEFL was 53% ± 39%. Using univariate analysis, strongest correlations were between tEFL and FVC and between tEFL and RV in patients with BMI < 30 kg/m2. In patients with nonreversible CAL, tEFL was positively associated with increasing MMRC, negatively with spirometric measurements, and positively with RV/TLC. In asthmatics, ACT scores were higher in patients with mean BMI ≥ 28 kg/m2 (p < 0.00014) and RV/TLC values > 40% (p < 0.03). Conclusions: Dyspnea is strongly associated with tEFL and lung function, particularly in patients with nonreversible CAL. Air trapping and BMI contribute to tEFL.

Traditional Chinese medicine nursing protocols for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease(COPD)is a complex respiratory disorder,characterized by chronic airflow limitation and an elevated inflammatory response of the airways.The people with COPD are more likely to develop comorbidities,with significant impacts on patients'quality of life,exacerbation frequency,and survival.Traditional Chinese medicine(TCM)exhibits good therapeutic effects on improving the clinical symptoms,lung function and quality of life in patients with COPD.Herein,this article primarily summarized the key points of common syndromes,TCM nursing methods and healthy guidance of COPD,aiming at maintaining and developing the strengths of TCM,improving its efficacy and standardizing its behavior.

Measurement of Pulmonary Diffusing Capacity for Carbon Monoxide(D_LCO)in Application to Chronic Obstructive Pulmonary Diseases

The pulmonary diffusing capacity for carbon monoxide(D_LCO)was measuredin 50 normal subjects,50 patients with emphysema and 31 with asthma.The results sh-owed that the D_LCO value of the asthma group was markedly higher than that of thehealthy group,while the D_LCO/pr% and KCO values of the asthma group were similarto those of the healthy group.The values of D_LCO,D_LCO/pr% and KCO in the emphy-sema group were very significantly lower than those in the asthma and healthy groups.Our study suggests that the measurement of D_LCO is onc of the useful pulmonary func-tion tests in differentiation of emphysema from asthma.The mechanism ofdiffcrcnt D_LCOvalues between emphysema and asthma is discussed.The D_LCO values in patients withmild to severe emphysema gradually decreased with the severity of emphysema.The KCOvalues between the mild emphysema and healthy groups were dramatically different.Thisis helpful in the early diagnosis of emphysma as combined with other clinical data.

Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review

Signifcant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been esta-blished. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pul-monary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

Research Progress on the Association Between Gut Microbiota and Respiratory System Diseases

This paper aims to review the association between gut microbiota and respiratory system diseases, and explore their potential mechanisms and clinical significance. Gut microbiota, as an important microbial ecosystem in the human body, has profound effects on host health. Recent studies have shown that the imbalance of gut microbiota is closely related to the occurrence and development of respiratory system diseases, including asthma, chronic obstructive pulmonary disease (COPD), and pneumonia. We comprehensively analyzed the current research progress and found that gut microbiota may affect respiratory system diseases through various pathways, including immune regulation, inflammatory responses, and airway mucus secretion. Additionally, environmental factors, lifestyle, and dietary habits are also closely related to gut microbiota and respiratory system health. Understanding the relationship between gut microbiota and respiratory system diseases not only helps to reveal the mechanisms of disease occurrence but also provides a theoretical basis for the development of new treatment strategies. Future research should focus on exploring the types and functions of gut microbiota, conducting clinical trials based on this, investigating the effects of gut microbiota modulation on the treatment and prevention of respiratory system diseases, and providing new directions for personalized medicine.

Effects of TCM Nursing Based on Syndrome Differentiation on Pulmonary Function and Quality of Life in Patients with Acute Exacerbation of COPD

[Objectives] To investigate the effects of TCM nursing based on syndrome differentiation on pulmonary function and quality of life in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). [Methods] A total of 92 patients with AECOPD who came to Nanchong Chinese Medicine Hospital from March 2022 to February 2023 were selected for the study, and the intervention group (TCM nursing based on syndrome differentiation, 46 cases) and the conventional group (basic nursing, 46 cases) were selected for the study, and the pulmonary function and quality of life of the two groups were compared. [Results] Before nursing, there was no significant difference in levels of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and percentage of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) between the intervention group and conventional group ( P >0.05). After 3 months of nursing, the levels of FVC, FEV1 and FEV1/FVC in the intervention group were higher than those in the conventional group ( P <0.05). Before nursing, there was no significant difference in the scores of health, emotion and social functions between the two groups ( P >0.05). At three months of nursing, the scores of health, emotion, and social functions in the intervention group were higher than those in the conventional group ( P <0.05). [Conclusions] The implementation of TCM nursing based on syndrome differentiation in patients with AECOPD can effectively improve the pulmonary function and quality of life of patients, and has significant clinical implementation value.

Endothelial function and T-lymphocyte subsets in patients with overlap syndrome of chronic obstructive pulmonary disease and obstructive sleep apnea

Background:The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is termed overlap syndrome (OS).COPD and OSA both have increased risks of developing cardiovascular diseases.This study aimed to explore if patients with OS exhibited a higher prevalence of cardiovascular complications,and if patients with OS exhibited vascular endothelial dysfunction and abnormalities in the cellular immune function of T lymphocytes.Methods:Totally 25 patients with stable COPD (COPD group),25 patients with OSA (OSA group),25 patients with OS (OS group),and 20 healthy adults (control group) were enrolled between January 2017 and December 2017 from the Respiratory Department of Tianjin Medical University General Hospital.The clinical characteristics of the four groups were collected and the expression levels of soluble vascular cell adhesion molecule-1 (sVCAM-1),tumor necrosis factor-α(TNF-α),and T-lymphocyte subsets were detected.One-way analysis of variance,x^2 test and Pearson correlation were used to manage the data.Results:The prevalence of hypertension and coronary heart disease was significantly higher in the OS group than in the control,OSA,and COPD groups (x^2 =20.69,P < 0.05 and x^2 =11.03,P < 0.05,respectively).The levels of sVCAM-1 and TNF-α were significantly higher in the OS group than in other groups (F =127.40,P < 0.05 and F =846.77,P < 0.05,respectively).The percentage of CD4+ lymphocytes and CD4+/CD8+ were both significantly lower in the OS group than in any other group (F =25.40,P < 0.05 and F =75.08,P < 0.05,respectively).There were significantly negative correlations in the levels of sVCAM-1 and TNF-α with CD4^+/CD8^+ lymphocytes (r =-0.77,P < 0.05 and r =-0.83,P < 0.05,respectively).Conclusions:The prevalence of hypertension and coronary heart disease was higher in patients with OS than in patients with either OSA or COPD alone.Patients with OS exhibited more severe vascular endothelial injury,stronger inflammatory response,and lower cellular immune function.

Efficacy and safety of Qingfei Huatan formula in the treatment of acute exacerbation of chronic obstructive pulmonary disease:A multi-centre,randomised,double-blind,placebo-controlled trial

Background Chronic obstructive pulmonary disease(COPD),a common respiratory disease,can be effectively treated by traditional Chinese medicine(TCM).Qingfei Huatan,a TCM formula,has been reported to effectively alleviate the clinical symptoms of COPD patients.However,there is a lack of multi-centre,randomised,double-blind,controlled clinical trials documenting the clinical efficacy and safety of this formula in the treatment of acute exacerbation of COPD(AECOPD).Objective This study evaluated the efficacy and safety of Qingfei Huatan formula in the treatment of AECOPD,thereby providing high-quality clinical evidence.Design,setting,participants and interventions A total of 276 patients with AECOPD were included in this multi-centre,randomised,double-blind,placebo-controlled trial and were randomised into treatment and control groups at a ratio of 1:1.Patients in the treatment and control groups took Qingfei Huatan granules or simulated Qingfei Huatan granules twice a day,for 14 days,in addition to Western medicine treatment.All patients were followed up for 3 months.Main outcome measures The primary outcome was time taken to symptom stabilisation.The secondary outcomes included duration of antibiotic use,clinical symptom and sign score,TCM syndrome score,dyspnoea score,and quality of life(QOL)score.Meanwhile,the safety of the formula was assessed through routine urine and stool tests,electrocardiograms,liver and kidney function tests,and the observation of adverse events throughout the trial.Results The time taken for effective stabilisation(P<0.05)and obvious stabilisation(P<0.01),and the duration of antibiotic use(P<0.05)were significantly shorter in the treatment group than in the control group.On days 6,9,12 and 14 of treatment,clinical symptom and sign score decreased in both groups,particularly in the treatment group(P<0.01).On days 9,12 and 14 of treatment,the TCM syndrome scores of both groups were reduced(P<0.01),with more significant reductions in the treatment group.At 3 months after the end of treatment,the treatment group continued to have lower clinical symptom and sign score and TCM syndrome score than the control group(P<0.01).On days 6,9,12 and 14 of treatment,dyspnoea and QOL scores were markedly reduced in the two groups(P<0.05 and P<0.01,respectively),especially in the treatment group.At 3 months after the end of treatment,dyspnoea and QOL scores were lower in the treatment group than those in the control group(P<0.01).No serious adverse events were observed in either group.Conclusion The Qingfei Huatan formula can effectively shorten the duration of AECOPD and antibiotic use,significantly relieve clinical symptoms,and increase QOL for AECOPD patients,with a favourable safety profile.These results suggest that this formula can be used as a complementary treatment for AECOPD patients.

Inflammatory bowel disease and airway diseases

Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease(IBD). However,the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association,as airway diseases are highly prevalent conditions with a substantial public health impact.

Role of Neutrophil Extracellular Traps in Asthma and Chronic Obstructive Pulmonary Disease

Objective： Asthma and chronic obstructive pulmonary disease （COPD） are representative chronic inflammatory airway diseases responsible for a considerable burden of disease. In this article, we reviewed the relationship between neutrophil extracellular traps （NETs） and chronic inflammatory airway diseases. Data Sources： Articles published up to January 1, 2017, were selected from the PubMed, Ovid Medline, Embase databases, with the keywords of＂asthma＂ or ＂pulmonary disease, chronic obstructive＂, ＂neutrophils＂ and ＂extracellular traps.＇＂ Study Selection： Articles were obtained and reviewed to analyze the role of NETs in asthma and COPD. Results： NETs are composed of extracellular DNA, histones, and granular proteins, which are released from activated neutrophils. Multiple studies have indicated that there are a large amount of NETs in the airways of asthmatics and COPD patients. NETs can engulf and kill invading pathogens in the host. However, disordered regulation of NET lbrmation has shown to be involved in the development of asthma and COPD. An overabundance of NETs in the airways or lung tissue could cause varying degrees of damage to lung tissues by inducing the death of human epithelial and endothelial cells, and thus resulting in impairing pulmonary function and accelerating the progress of the disease. Conclusions： Excessive NETs accumulate in the airways of asthmatics and COPD patients. Although NETs play an essential role in the innate immune system against infection, excessive components of NETs can cause lung tissue damage and accelerate disease progression in asthmatics and COPD patients. These findings suggest that administration of NETs could be a novel approach to treat asthma and COPD. Mechanism studies, clinical practice, and strategies to regulate neutrophil activation or directly interrupt NET thnction in asthmatics and COPD patients are desperately needed.

Inflammatory airway features and hypothalamic-pituitary- adrenal axis function in asthmatic rats combined with chronic obstructive pulmonary disease

Background Bronchial asthma （BA） and chronic obstructive pulmonary disease （COPD） are both inflammatory airway diseases with different characteristics. However, there are many patients who suffer from both BA and COPD. This study was to evaluate changes of inflammatory airway features and hypothalamic-pituitary-adrenal （HPA） axis function in asthmatic rats combined with COPD. Methods Brown Norway （BN） rats were used to model These three models were compared and evaluated with the inflammatory airway diseases of BA, COPD and COPD＋BA. respect to clinical symptoms, pulmonary histopathology, airway hyperresponsiveness （AHR）, inflammatory cytokines and HPA axis function. Results The inflammatory airway features and HPA axis function in rats in the COPD＋BA model group were greatly influenced. Rats in this model group showed features of the inflammatory diseases BA and COPD. The expression of inflammatory cytokines in this model group might be up or downregulated when both disease processes are present. The levels of corticotrophin releasing hormone mRNA and corticosterone in this model group were both significantly decreased than those in the control group （P 〈0.05）. Conclusions BN rat can be used as an animal model of COPD＋BA. By evaluating this animal model we found that the features of inflammation in rats in this model group seem to be exaggerated. The HPA axis functions in rats in this model group have been disturbed or impaired, which is prominent at the hypothalamic level.

Metabolomic Profiling Differences among Asthma,COPD,and Healthy Subjects:A LC-MS-based Metabolomic Analysis

Objective Asthma and chronic obstructive pulmonary disease(COPD)feature different inflammatory and cellular profiles in the airways,indicating that the cellular metabolic pathways regulating these disorders are distinct.Methods We aimed to compare the serum metabolomic profiles among mild persistent asthmatic patients,individuals with stable COPD,and healthy subjects and to explore the potential metabolic biomarkers and pathways.The serum metabolomic profiles of 17 subjects with mild persistent asthma,17 subjects with stable COPD,and 15 healthy subjects were determined by an untargeted metabolomic an alysis utilizi ng liquid chromatography-mass spectrometry.A series of multivariate statistical an a lyses was subsequently used.Results Multivariate analysis indicated a distinct separation between the asthmatic patients and healthy controls in electrospray positive and negative ions modes,respectively.A total of 19 differential metabolites were identified.Similarly,a distinct separation between asthma and COPD subjects was detected in the two ions modes.A total of 16 differential metabolites were identified.Among the identified metabolites,the serum levels of hypoxanthine were markedly higher in asthmatic subjects compared with those in COPD or healthy subjects.Conclusions Patients with asthma present a unique serum metabolome,which can distinguish them from individuals with COPD and healthy subjects.Purine metabolism alteration may be distinct and involved in the pathogenesis of asthma.

Heart and lung, a dangerous liaison-Tako-tsubo cardiomyopathy and respiratory diseases: A systematic review

AIM: To investigate the possible association between Tako-tsubo cardiomyopathy(TTC)-a reversible clini-cal condition mimicking an acute myocardial infarction characterized by multifactorial pathophysiologic mecha-nisms- and respiratory system diseases. METHODS: We systematically searched PubMed and EMBASE medical information sources, to identify the different triggering causes, limiting our search to ar-ticles in English. The search keywords were: "tako-tsubo cardiomyopathy", "takotsubo", "takotsubo cardiomyopa-thy", "broken heart syndrome", "stress-induced cardio-myopathy", "apical ballooning syndrome", and "ampulla cardiomyopathy in combination with respiratory dis-eases, lung, pulmonary disease. For each kind of dis-ease, we registered: author, year and country of study, patient sex, age, concurring situation, and outcome. RESULTS: Out of a total of 1725 articles found, we se-lected 37 papers reporting a total of 38 patients. As ex-pected, most patients were women(81.6%), mean age was 65 ± 10 years. Outcome was favorable in 100% of cases, and all the patients have been discharged un-eventfully in a few days. CONCLUSION: An association between respiratory diseases and TTC is likely to exist. Patients with severe respiratory diseases, due to the high dosages of β2-agonists used or to the need of invasive procedures, are highly exposed to the risk of developing TTC.

Gastroesophageal reflux disease and the airway-essentials for the surgeon

Gastroesophageal reflux disease(GERD) has many protean manifestations.Some of the most vexing have to do with the airway.GERD affects the tracheobronchial tree directly,leading to aspiration pneumonia and asthma,or exacerbating existing pulmonary disease,such as asthma or chronic obstructive pulmonary disease.In addition to the respiratory manifestation of GERD,there are unique pharyngeal and laryngeal manifestations.These include voice hoarseness,throat-clearing,chronic cough,globus,and "post-nasal drip".Linking these symptoms to GERD is challenging and frequently the diagnosis is that of exclusion.Despite proton pump inhibitor therapy being the mainstay of treatment,with anti-reflux surgery being reserved for intractable cases,there is no definitive evidence of the superiority of either.

The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

Clinical Observation of Qi Deficiency Syndrome in72 Patients with Chronic Obstructive Pulmonary DiseaseTreated with Yiqi Mianyi Granule (益气免疫冲剂)

Seventy-two patients of chronic obstructive pulmonary disease (COPD) of Qi deficiency syn-drome with abnormal immune indices were treated with Yiqi Mianyi Granule (YQMYG) and the efficacy wascompared with that of 30 cases treated with Zhenqi fuzheng Granule (ZQFZG) for control. Results showedthat the markedly effective rate of symptomatic improvement ot Qi deficiency in YQMYG group was 65. 3%,the total effective rate 93. 1 % . 88. 6% of the immune indices lower than normal were corrected and 43. 7%ot them were normalized, while for indices that were higher than normal the rate were 78. 2 % and 52 . 9% re-spectively. These results suggested that YQMYG could improve symptom of Qi Deficiency markedly,strengthen cellutar immunity and regulate immune dysfunction. its therapeutic efficacy was obvfously superiorto ZQFZG ( P < 0 . 05 ).

单纯性支气管扩张症与支气管扩张症-慢性阻塞性肺疾病重叠综合征患者的病原菌对比研究

背景我国慢性阻塞性肺疾病(简称慢阻肺)及支气管扩张症(简称支扩)患者数量庞大,均为高发病率、高病死率的慢性呼吸系统疾病。支气管扩张症-慢性阻塞性肺疾病重叠综合征(BCOS)作为一种特殊临床亚型虽常见但易被忽略。感染常是其急性恶化的诱因,但相关病原学研究相对匮乏。目的分析单纯性支气管扩张症(BE)与BCOS患者病原菌分布、耐药性特点,比较两者差异。为临床合理使用抗菌药物提供参考。方法选取2016年1月—2023年1月在马鞍山市人民医院呼吸与危重医学科住院的支扩患者584例为研究对象,根据是否合并慢阻肺将患者分为两组:BE组(未合并慢阻肺,335例)和BCOS组(合并慢阻肺,249例)。回顾性分析患者病原菌构成、药敏结果及变迁,分析两组病原菌分布及耐药性差异。结果584例支扩患者共分离299株病原菌,BE组分离病原菌146株,其中革兰阴性菌87株(59.59%),革兰阳性菌3株(2.05%),分枝杆菌9株(6.16%),真菌47株(32.19%);BCOS组分离病原菌153株,其中革兰阴性菌80株(52.29%),革兰阳性菌1株(0.65%),分枝杆菌2株(1.31%),真菌70株(45.75%);BCOS组患者白色念珠菌构成比高于BE组(χ^(2)=5.274,P=0.022)。两组铜绿假单胞菌耐药率分别为:亚胺培南10.64%、25.53%,哌拉西林他唑巴坦6.98%、15.91%,环丙沙星12.77%、21.28%,阿米卡星2.13%、2.13%;两组肺炎克雷伯菌耐药率分别为:亚胺培南0、14.29%,哌拉西林他唑巴坦0、14.29%,环丙沙星15.38%、35.71%,阿米卡星0、7.14%;BCOS组铜绿假单胞菌对氨苄西林舒巴坦耐药率低于BE组(P=0.026)。BCOS组患者产超广谱β内酰胺酶肠杆菌科(χ^(2)=4.357,P=0.037)及耐碳青霉烯类铜绿假单胞菌分离率均高于BE组(χ^(2)=5.593,P=0.018)。2016—2022年支扩患者分离铜绿假单胞菌株数均最高,呈先降后升趋势;分离肺炎克雷伯菌株数在2021、2022年明显升高,仅次于铜绿假单胞菌;2020—2022年分离分枝杆菌株数及2021—2022年分离曲霉菌株数均呈上升趋势。结论BCOS作为一种特殊表型,其病原菌分布、耐药性有其自身特点,值得关注。铜绿假单胞菌目前是BE及BCOS患者常见分离致病菌,近年来分离肺炎克雷伯菌株数仅次于铜绿假单胞菌。分离分枝杆菌、曲霉菌株数较前亦明显上升,应引起重视,尤其是BE患者。

肠道菌群、运动干预与呼吸系统疾病

背景:肠道菌群是位于人体胃肠道中的一种多样化和动态的微生物群落总称,对维持人体免疫和健康有着至关重要的作用。近年提出“肠-肺轴”概念,提示肠道菌群与肺密切相关,且运动可通过维持肠道菌群平衡调节呼吸系统疾病。目的:综述了肠道菌群与肺炎、肺癌、哮喘病和慢性肺阻塞疾病等不同呼吸系统疾病的关系、不同运动方式对肠道菌群和呼吸系统疾病的影响,为深入探讨运动调控肠道菌群在呼吸系统疾病中的作用机制提供新的思路。方法:检索1944-2024年间CNKI和PubMed数据库相关文献,中文检索词包括“肠道菌群、肠道细菌、呼吸系统疾病、肺炎、肺癌、哮喘病和慢性肺阻塞疾病、有氧运动、抗阻运动”等;英文检索词包括“Intestinal flora,Gut bacteria,Respiratory illness,Pneumonia,Lung cancer,Asthma,Chronic obstructive pulmonary diseases,Aerobic exercise、Resistance training”等,根据纳入和排除标准选择101篇文献进行归纳总结。结果与结论:①肠道菌群在肺炎、肺癌、哮喘病和慢性肺阻塞疾病等多种呼吸系统疾病中发挥着重要的调节作用。②不同运动方式与肠道菌群密切相关:有氧运动可通过改善胰岛素敏感性、增加菌群多样性和抑制全身慢性炎症在肠道菌群的调控中发挥有益效应;抗阻运动可降低肠黏膜通透性并促进短链脂肪酸的产生;有氧联合抗阻运动也可提升肠道菌群多样性、影响肠道菌群组成。③运动可通过调节炎症反应和减轻氧化应激损伤,提高心肺功能和运动表现进而改善呼吸系统疾病。④运动通过调控肠道菌群抑制炎症反应、调节氧化应激、改善肠屏障通透性和维持肠道菌群稳态,在防治呼吸系统疾病中发挥关键作用。