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.

<i>Lily bulb</i>Nectar Produces Expectorant and Anti-Tussive Activities, and Suppresses Cigarette Smoke-Induced Inflammatory Response in the Respiratory Tract in Mice

Air pollutants pose a major environmental threat to the respiratory system. Pathogen invasion and the exposure to particulate matters in atmospheric air, particularly, cigarette smoke (CS), have been found to be associated with acute and chronic respiratory diseases, including asthma. Therefore, the search for agents that can protect the respiratory system against potentially harmful substances is of interest in preventive health. Lily bulb Nectar (LBN), which contains Lily bulb, Pyrus pyrifolia N., Siraitia grosvenorii and Apricot kernel as its ingredients, is a health supplement intended to improve the wellness of the respiratory system in humans. Lily bulb, Pyrus pyrifolia N., Siraitia grosvenorii and Apricot kernel are commonly prescribed for the treatment of respiratory tract disorders such as bronchitis, pneumonia and cough in the practice of traditional Chinese medicine. Pharmacological studies have shown that these herbs can produce beneficial effects on the respiratory tract or even the lungs. In the present study, we investigated the effects of LBN on mouse respiratory tract function under normal and challenged conditions. LBN was first examined for its expectorant and anti-tussive activities in mice. The effect of LBN on long-term exposure to CS was also investigated. Our findings showed that long-term LBN treatment enhanced the expectorant activity and suppressed the SO2-induced coughing in mice. LBN treatment also suppressed the CS-induced inflammation in the respiratory tract, as assessed by differential cell count and cytokine production. In conclusion, long-term LBN consumption may produce beneficial effects on the respiratory tract function in humans, particularly in the face of challenge by irritants in the inhaling air.

Experimental Study on Pharmacodynamic of Qingyan Granules

Objective: To investigate the pharmacodynamics of Qingyan granules. Methods: To investigate the efficancy of qingyan granules, the animal experience of maximum tolerated dose of mice was made. And the auricular swelling model of mice, the foot swelling model of rat, the phenol red secretion method, and the hot-plate and glacial acetic acid stimulation writhing method was established and used to test the anti-inflammatory effect, the expectorant effect, and the analgesia effect. Results: Pharmacodynamics experiment proved that the maximum dosage for mice was 42g/kg, the equivalent of 56 times for human. Qingyan granules has obvious inhibitory effect on mouse auricle swelling caused by xylene, and has obvious inhibitory effect on carrageenan-induced rat paw edem. Also, the mice pain caused by thermal and chemical stimulation has obviously inhibited by Qingyan granules. Qingyan granules can prolong the pain reaction time on mice caused by acetic acid. Conclusions: Qingyan granules have evident effects of anti-inflammatory effect, analgesic effect and expectorant effect.

Evaluation of Acute and Repeated Dose Toxicity of the Polyherbal Formulation Linkus Syrup in Experimental Animals

The objective of the present study was to evaluate the pre-clinical efficacy and toxicity of polyherbal cough syrup Linkus. Method: Animals (healthy Wistar albino rats;(150 - 250 g) of either sex) were housed under standard environmental conditions;i.e. 25°C ± 1°C and 12 h dark/light cycle. Food and water were available at libitum. The rats were treated orally with the recommended doses of the test drug (Linkus). After 15 minutes, they were individually placed in a closed Plexiglas chamber (20 × 10 × 10 cm) and exposed to citric acid (0.1 g/ml) inhalation for 7 minutes. The cough reflexes were produced and counted for the last 5 minutes and compared with those of the control animals. The following studies were conducted to evaluate the toxicity of the test drug in healthy Wistar albino rats: lethal dose50 (LD50);rats of either sex (n = 10/sex) were treated orally with doses (1 or 5 g/kg) of the test drug. Mortality and behavioral changes were observed for 1 week. Repeated dose toxicity on the healthy Wistar albino rats of both sexes (n = 5/dose/sex) was treated orally with doses of 20 mg/kg (adult human dose = ~1400 mg), 500 mg/kg (adult human dose = ~35,000 mg) and 1000 mg/kg (adult human dose = ~70,000 mg) of test drug (Linkus) for 14 days. Additionally, the control animals were treated orally with water for 14 days. Results: In female rats, the test drug (Linkus) at the dose of 300 mg/kg caused significant (p < 0.01) reduction in the cough reflexes as compared to the control. However, in male rats, a significant reduction was observed at the tested dose of 200 mg/kg (p < 0.05) and 300 mg/kg (p < 0.01). The test product did not cause mortality in rats at the given doses of 1 or 5 g/kg. Other signs of toxicity like hair loss and weight reduction were not observed. In female and male rats, the test drug (Linkus) at different doses did not show any abnormal effects on complete blood count profile of rats. Serum enzyme markers, i.e. alanine aminotransferase (ALT), alakaline phosphatase, gamma glutamyle transferase (GGT), direct bilirubin, creatinine, and proteins were also observed and found that the test drug at a higher dose did not cause any of the abnormality and had shown significant p value as compared to the control. Conclusion: The test drug (Linkus) could be an effective and safe cough syrup because it did not show any of the side effects or toxicity on experimental animals.

Pharmacology and Toxicology of Extract from Arcangelisia gusanlung

Objective To study the pharmacology and toxicology of the extracts from Arcangelisia gusanlung(EAG). Methods The anti-inflammatory activities were investigated using various inflammatory models including ear edema induced by xylene in mice, paw edema induced by carrageenan, and cotton pellet granuloma in rats. The analgesic effect was observed in hot-plate test and writhing test in mice and the antipyretic effect was observed in rat fever model induced by yeast. The antitussive action was tested in mice by sequential method and expectorant action was evaluated by tracheal excretion of phenol red. The antidiarrhea function was observed on normal intestinal propulsion of mouse model of diarrhea induced by decoction of Sennae Folium. The toxicity was measured by toxicological experiment.Results Each dose of EAG could significantly inhibit the paw edema, cotton pellet granuloma, and intestinal propulsion. EAG significantly reduced writhing times and amount of wet manure. Obvious antipyretic action to fevered rat was observed. EAG obviously increased the tracheal excretion of phenol red and prolonged the latency of cough. No toxic reaction was shown in the observed period, and the maximum tolerance dose of mice was equivalent to 1360 times of common-used dose in human. Conclusion The clinical dosage of EAG is safe, and its anti-inflammatory, analgesia, antipyresis, antitussive, expectorant, and antidiarrhea effects are significant.

Clinical and Experimental Studies on Treatment of Asthma with Juanxiao Tablet(蠲哮片)

Objective: To evaluate the therapeutic effect of Juanxiao Tablet (JXT) in treating asthma. Methods: Clinical observation on 447 cases of asthma was done in double- or single-blinded control method, and the therapeutic effect and safety of JXT were analysed. The effect of JXT in anti-asthma, expectorant, antisepsis, hypoxia tolerance was studied, and its acute and chronic toxicity was also examined. Results: The clinical control rate in patients treated with JXT was 38.2%, the markedly effective rate 31.2% and the total effective rate 93.4%, whereas in patients treated with Oleum Vitex Negundo, the respective rates were 13.3%, 20.0% and 68.5%. Results of pulmonary function and IgE measurement were consistent with clinical effect. Experimental study showed that JXT has the actions of anti-asthma, expectorant, antisepsis and hypoxia tolerance enhancement, with its LD50 (40.48±5.17) g/kg. Conclusion: JXT is a new Chinese herbal preparation of good effect, with less toxic-side effect for asthma treatment.

Clinical and Experimental Study on Treatment of Childhood Cough with Zhenkeling Oral Liquid(镇咳灵口服液)

Objective: To observe the effect of Zhenkeling (ZKL) oral liquid in treating cough in children.Methods: One hundred and seventy patients with cough were assigned into two groups at random. The 120 cases in the ZKL group were treated with ZKL, and pectoral syrup was given to the other 50 cases in the control group, Results: The total effective rates of ZKL group and the control group were 96. 7% and 56. 0 % respectively, and the markedly effective rates were 80. 8 % and 18. 0 % respectively (P ＜0. 01 ). Animal experiments indicated that ZKL had the effect of relieving cough, reducing sputum and ameliorating wheeze. Also it had antibiotic and anti-inflammatory effect. Acute and chronic intoxicating test showed that ZKL has neither side-ef-effect nor toxicity. Conclusion: ZKL is an effective Chinese herbal preparation in treating cough of children and is safe in use.