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.

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.

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.

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.

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

Significant 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 established. 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 pulmonary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

基于NHANES数据库低氧重叠综合征与心血管病的关联性研究

目的探讨阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea,OSA)、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)及重叠综合征(overlap syndrome,OS)与心血管疾病的相关性。方法选取2005年~2008年美国国家健康和营养调查(National health and nutrition examination survey,NHANES)数据,共7716名参与者纳入本研究。按照是否存在OSA、COPD分为4组:无OSA及COPD组(n=3072)、单纯OSA组(n=4062)、单纯COPD组(n=180)、OS组(n=402)。本研究采用多因素logistic回归以探究OSA、COPD及OS与多种心血管疾病的关联。同时探究OSA、COPD和OS与年龄、性别、肥胖等心血管危险因素在心血管疾病中的关联性。结果相较于无OSA及COPD组,OS组心肌梗死(OR=2.85,95%CI=1.94~4.21)、充血性心力衰竭(OR=4.32,95%CI=2.73~6.84)、心绞痛(OR=3.07,95%CI=1.92~4.91)、卒中(OR=2.52,95%CI=1.61~3.97)、冠心病(OR=3.1,95%CI=2.22~4.31)及总体心血管疾病(OR=3.43,95%CI=2.54~4.63)的风险增加显著相关。单纯OSA症状人群中卒中发生率为无OSA及COPD组的1.46倍(OR=1.46,95%CI=1.07~1.99),充血性心力衰竭(OR=3.27,95%CI=1.77~6.07)、冠心病(OR=1.68,95%CI=1.03~2.73)和总体心血管疾病(OR=1.93,95%CI=1.25~3.00)的风险也显著升高。未观察到单纯OSA症状与心血管疾病的风险增加的相关性。OSA、COPD及重叠综合征与总体心血管疾病、冠心病和心肌梗死的关联在各亚组人群中稳定。结论OSA-COPD综合征与心肌梗死、充血性心力衰竭、心绞痛、卒中、冠心病及总体心血管疾病的发生风险增高存在显著相关性。监测及控制OSA-COPD重叠综合征对心血管疾病的预防有着重要意义。

黏蛋白1与呼吸系统疾病关系的研究进展

慢性黏液高分泌导致的气道炎症可能会逐渐进展并影响患者的肺功能。黏液蛋白是黏液层的关键成分,其中黏蛋白1是一种重要的膜结合型黏蛋白,目前的研究聚焦于评估黏蛋白1在肺纤维化、肺癌和间质性肺疾病等肺部疾病中的临床应用,尤其是作为诊断、预测进展和评估治疗效果的生物标志物。因此,深入了解黏蛋白1在肺部疾病中的生物学机制和作用方式,特别是与疾病发展和进展的关联,探索黏蛋白1在肺部疾病早期诊断和预后评估中的预测价值,将为肺部疾病的诊断和治疗提供新的理论依据。

慢性阻塞性肺疾病急性加重期中医证型结构方程分析

目的为慢性阻塞性肺疾病急性加重期(Acute Exacerbation of Chronic Obstructive Pulmonary Disease,AECOPD)临床辨证诊断和证型的量化标准提供参考依据。方法通过临床调研,应用先进的数理统计方法结构方程对AECOPD中医证候进行系统的研究。收集病例资料100例,数据分析软件选择R语言,首先经过探索性分析,利用最大方差旋转方法,提取出五个共因子,归纳为F1至F5,依据中医理论进行证型辨证命名。结果通过结构方程初步揭示了AECOPD的疾病的五个常见的证型:风寒证、肾虚证、脾虚证、阴虚证、痰湿证,同时分析出了五大常见证型的辨证要点。AECOPD结构方程中各因子与临床证型间存在着较好的对应关系。结论AECOPD的基础证型是风寒、肾虚、脾虚、阴虚、痰湿证等。

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.

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.

从气血同治探讨慢性气道疾病的异病同治

支气管哮喘和慢性阻塞性肺疾病(简称慢阻肺)同属慢性气道炎症疾病,在病机和治法上有一定的相似性,其都可通过调节气血以恢复肺气宣肃,行使正常生理功能。针对肺的生理功能和气血的关系,探讨支气管哮喘和慢阻肺的共同病机:支气管哮喘的基本病机是痰伏于肺,外邪引动,痰气互结,肺失宣降,并可兼有瘀血阻络之象;慢阻肺的病机以久病肺虚为本,加之痰浊、水饮、瘀血等病理产物,使得肺失宣降,本虚标实的病机随病程持续进展;进而从气血同治角度探讨支气管哮喘和慢阻肺2种慢性气道疾病的异病同治,得出“气血同治,畅通气道”的治疗理念。结合成药的应用,分析以此病机为指导的丹龙口服液组方特点和功效主治,为丹龙口服液异病同治2种气道疾病提供理论依据。

哮喘-慢阻肺重叠综合征患者血清SIRT1、α-SMA水平及临床意义研究

目的检测哮喘-慢阻肺重叠综合征(ACOS)患者血清沉默信息调节因子1(SIRT1)、α-平滑肌肌动蛋白(α-SMA)水平,并分析其临床意义。方法对52例ACOS患者(A组)、50例单纯哮喘患者(B组)、51例单纯慢阻肺患者(C组)、50例健康体检者(健康组)的资料进行回顾性分析。4组均检测血清SIRT1、α-SMA水平,肺功能[第1s用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC],血清炎症因子水平[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-1β(IL-1β)],气道可逆性和气道重塑指标[血清碱性成纤维生长因子(b-FGF)、基质金属蛋白酶9(MMP-9)、神经生长因子(NGF)、基质金属蛋白酶组织抑制因子1(TIMP-1)],对比4组上述指标差异;分析A组患者血清SIRT1、α-SMA水平与上述指标的相关性。结果A组血清SIRT1、α-SMA,血清TNF-α、IL-6、IL-1β水平,血清b-FGF、MMP-9、NGF、TIMP-1水平均高于其余3组,B组和C组均高于健康组,差异均有统计学意义(P均<0.05);A组FEV1%、FVC、FEV1/FVC均低于其余3组,B组和C组均低于健康组,差异均有统计学意义(P<0.05);A组与B组支气管舒张试验阳性率均高于其余2组,C组高于健康组,差异均有统计学意义(P<0.05);A组患者中血清SIRT1、α-SMA水平与FEV1%、FVC、FEV1/FVC均呈负相关性,与血清TNF-α、IL-6、IL-1β水平,血清b-FGF、MMP-9、NGF、TIMP-1水平均呈正相关性。结论在ACOS患者中血清SIRT1、α-SMA水平偏高,且均明显高于单纯哮喘和单纯慢阻肺患者,且与肺功能、血清炎症因子水平及气道重塑指标均相关。

肺苏颗粒治疗慢性阻塞性肺疾病急性加重期痰热瘀肺证临床研究

目的观察肺苏颗粒治疗慢性阻塞性肺疾病急性加重期(AECOPD)痰热瘀肺证的临床疗效及对患者生活质量、凝血功能和免疫功能的影响。方法采用随机数字表法将120例患者分为观察组和对照组各60例。对照组予常规西医治疗,观察组在对照组基础上予肺苏颗粒口服,每次1袋,每日3次,连续7 d。观察2组临床疗效,比较2组治疗前后中医症状评分、圣乔治呼吸问卷(SGRQ)评分、凝血功能指标(纤维蛋白原、D-二聚体)、免疫功能指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)),并观察不良反应。结果观察组总有效率为93.10%(54/58),对照组为79.66%(47/59),2组比较差异有统计学意义(P<0.05)。与本组治疗前比较,2组治疗后中医症状积分及咳嗽、喘息、脉络瘀血评分,SGRQ评分均下降(P<0.05);2组治疗后比较,观察组上述评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后血浆纤维蛋白原和D-二聚体含量均下降(P<0.05);2组治疗后比较,观察组血浆纤维蛋白原和D-二聚体含量均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后外周血CD4^(+)和CD4^(+)/CD8^(+)均显著升高,CD8^(+)显著降低(P<0.05);2组治疗后比较,观察组外周血CD4^(+)和CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组(P<0.05)。2组均未出现药物相关的不良反应。结论在常规西医治疗基础上联合肺苏颗粒治疗AECOPD痰热瘀肺证可显著提高临床疗效,改善患者生活质量,利于凝血功能恢复,并增强细胞免疫功能。

ClinicalObservationofQiDeficiencySyndromein72PatientswithChronicObstructivePulmonaryDiseaseTreatedwithYiqiMianyiGranule（益气免疫冲

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 ).

氢气在呼吸系统疾病中的作用及研究进展

氢气是一种无色无味、具有生物活性的还原性小分子气体,具有抗炎、抗氧化、抗凋亡等生物学功能,可用于多种疾病的辅助治疗。人们使用氢的方式已不局限于氢气吸入,还出现了氢水饮用、含氢溶液注射、含氢透析液透析等新方法,氢的生物学作用得到广泛关注。本文围绕氢气在慢性阻塞性肺疾病、哮喘、肺癌、新型冠状病毒感染、急性肺损伤、肺纤维化等呼吸系统疾病中的作用及研究进展进行讨论。

基于态靶辨治理论诊疗慢性阻塞性肺疾病

慢性阻塞性肺疾病是常见的呼吸系统气道慢性病,严重影响患者的生活质量。传统的中医辨证论治体系存在对疾病的发生发展规律认识不足,对检查化验指标改善欠佳的问题。仝小林院士经过多年的临床实践,提出“态靶辨治”的现代中医诊疗体系,并将其用于慢性疾病临床诊疗过程中。基于此,以“态靶辨治”理论为指导,结合临床经验与现代药理学研究成果,将慢性阻塞性肺疾病发病过程分为“痰、阻、瘀、衰”四态(四期),每态下进行分证,并结合治疗靶点,确定各阶段相应的靶方靶药,构建慢性阻塞性肺疾病的态靶辨治体系,为提高该病的中医治疗效果提供新的路径。

促进慢性阻塞性肺疾病哮喘患者自我监控空气质量的护理干预措施: 整合性综述

目的哮喘-慢性阻塞性肺疾病肺重叠症(Asthma-chronie obst ructive pulmonary disease overlap,A-CO)患者的生活质量较低,肺功能较差,病情经常加重。由于暴露于污染环境会加重其症状,增加发病率和病死率,环境管理对其至关重要。旨在通过系统性综述,寻找证据,以指导制订护理干预措施,促进ACO患者对空气质量的自我管理。方法2023年3月 ,系统检索CINAHL、Medline、Academie Search Complete .Scopus、WebofScience、Cochrane图书馆、乔安娜布里格斯研究所(JoannaBriggsInstitute,JBI)循证实践数据库,以及GoogleScholar。对纳人研究进行数据提取和综合,并对护理干预措施进行分类。采用JBI研究质量评估工具进行方法学质量评估。结果 共纳入5篇来自不同国家的研究。促进ACO患者自我监控空气质量的干预措施包括:警觉性干预措施(医务人员定期巡诊、进行症状评估),监测干预措施(监测室内外诱发因素) ,教育干预措施(空气质量警报、避免接触过敏原),以及相关政策的影响,如无烟政策和改善空气质量的综合战略。尽管这些研究报告了不同的干预措施,方法质量也存在差异,但这些干预措施显示了预防患者病情恶化、尽量减少急诊就诊和住院治疗的潜力。这些关键点可作为护理干预措施的关键组成部分。结论有必要采取全面措施,让护士参与促进患者自我监控空气质量的多学科团队.提高认识、制订和实施护理干预,从而使ACO患者受益。同时,需要进--步开展研究,以扩大证据基础并完善这些干预措施。