Research Status of TCM Rehabilitation in Chronic Obstructive Pulmonary Disease (COPD)

This paper mainly analyzes the application status of TCM rehabilitation in chronic obstructive pulmonary disease(COPD),hoping to provide support and help for clinical staff through this study,and promote the further development of COPD rehabilitation program.

A systematic review of the effectiveness of clinical nurse specialist interventions in patients with chronic obstructive pulmonary disease(COPD)

Objective： This review aimed to examine the effectiveness of clinical nurse specialist （CNS） interventions in patients with chronic obstructive pulmonary disease （COPD）. COPD significantly affects people＇s health worldwide. With the development in nursing, CNSs are playing increasingly important roles in different departments. However, the studies on the effectiveness of CNSs in COPD are not as well organized as the studies on the effectiveness of CNSs in bronchiectasis and asthma. Therefore, this review aims to find some updated evidence on the CNS interventions for patients with COPD and on whether these interventions are effective.Methods： A narrative analysis of the data was performed for the eligible studies. Four databases were chosen： CINAHL, MEDLINE, British Nursing Index, and Cochrane Library. Other websites such as the National Institute for Health and Clinical Excellence, National Health Service Evidence, Association of Respiratory Nurse Specialists, and National Association of Clinical Nurse Specialist were searched as well. Two reviewers performed study identification independently, and all the retrieved articles were stored using the EndNote X7 software. The risk of bias in the included studies was assessed using the Cochrane Collaboration＇s risk of bias tool. Results： A total of nine studies were included in this review. There were five current interventions by CNSs for patients with COPD. These interventions were home nursing support, CNS]s supported discharge, multidisciplinary cooperation programs, nurse-led care programs, and self-care management education. The effectiveness of these five interventions was evaluated individually. There is low- to moderate-quality evidence indicating that home nursing support interventions may have a positive effect on mortality and quality of life. No significant difference in quality of life has been found between the CNS-supported discharge intervention and the usual service. The multidisciplinary cooperation program probably had a positive effect on quality ot life in patients with COPD. Both nurse-led care and self-care management education intervention had a positive effect on mortality of patients with COPD.Conclusions： The findings of this review provide updated evidence on the effectiveness of CNS interventions for patients with COPD. Although nine trials were included and five types of interventions were identified, there is still lack of high-quality evidence.

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.

Systematic review and meta-analysis of additional Yupingfeng powder combined with western medicine treatment at stable period of chronic obstructive pulmonary disease

Objective:To systematically evaluate the effect and safety of additional Yupingfeng powder combined with western medicine for the stable period of chronic obstructive pulmonary disease(COPD).Method:Databases including Pubmed、Web of Science、Cochrane Library、CNKI、VIP、CBM and Wanfang Data base,were searched for relevant randomized controlled trials.for Chinese and English literature about randomized controlled trials of additional Yupingfeng in the treatment of COPD on stable stage which were published from the establishment of the database to December 2019.Two researchers independently screened for,selected studies according to the inclusion and exclusion criteria and extracted data.Methodological quality was evaluated using the Cochrane Risk of Bias tool.Meta-analysis was performed using Revman 5.3 software.Results:Ninetine randomized controlled trials including 1511 patients with COPD were meta-analyzed.The total sample size was 1511.The results showed that the treatment grop with additional Yupingfeng powder could improve the clinical efficacy[OR=0.26,95%CI(0.18,0.37)],FEV1 percentage of the estimated value[MD=4.61,95%CI(2.43,6.79)],6MWD[MD=43.90,95%CI(29.48,58.32)]and patient's immunity IgA[MD=0.25,95%CI(0.17,0.34)]and can mitigate cough effectively[MD=-0.34,95%CI(-0.46,-0.23)].Conclusion:Additional Yupingfeng powder combined with routine treatment for COPD has more advantages than conventional treatment alone in improving the clinical efficacy,lung function,immune function and have less adverse events.As most of the included studies in this systematic evaluation had poor quality,the evidence to support conclusion was weak,so it was necessary to conduct more multi-center clinical trials with high quality methods and rigorous design.

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.

Comparative Study on the Efficacy of Tiotropium Bromide Inhalation and Oral Doxofylline Treatment of Moderate to Severe Stable Chronic Obstructive Pulmonary Disease

This study compared the efficacy and safety of tiotropium bromide inhalation powder （spiriva） and doxofylline oral tablet （doxofylline） in the treatment of chronic obstructive pulmonary disease （COPD）. A multi-center, randomized, double-blind, double-dummy, parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder （18 μg/day） or oral doxofylline tablets （0.2 g/time, 2 times a day） for 12 and 24 weeks. Before and after treatment for 12 weeks and 24 weeks, respectively, pulmonary function, 6-min walking distance and dyspnea index were recorded. The results showed that in both tiotropium group and doxofylline groups, after 12-week treatment, FEV1, FEV1/FVC% and 6-min walk distance were sig-nificantly higher than those before the medication, while dyspnea index decreased as compared with that before treatment. After 24-week treatment, a slight improvement in the measures was observed as compared with that of 12-weeks treatment, but the difference was not statistically significant. With both 12-week and 24-week treatment, the effect of tiotropium was slightly better than that of doxofylline tablets, with the difference being statistically insignificant. The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases （9.9%） and 12 cases （12.9%）, respectively, and no statistically significant difference was found between them. We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day （two times a day） are effective and safe for the treatment of COPD.

Health Effect of Forest Bathing Trip on Elderly Patients with Chronic Obstructive Pulmonary Disease

Forest bathing trip is a short, leisurely visit to forest. In this study we determined the health effects of forest bathing trip on elderly patients with chronic obstructive pulmonary disease （COPD）. The patients were randomly divided into two groups. One group was sent to forest, and the other was sent to an urban area as control. Flow cytometry, ELISA, and profile of mood states （POMS） evaluation were performed. In the forest group,

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.

The risk factors for chronic obstructive pulmonary disease in Li and Han ethnic groups in Hainan, China

Objective: To investigate the risk factors of chronic obstructive pulmonary disease(COPD) in Li and Han ethnic group in Hainan, China. Methods: All subjects were randomly selected from various regions in Hainan. General characteristics were compared between COPD cases and healthy control cases in both Li and Han ethnic groups. The odds ratio(OR), the corresponding 95% confidence interval(CI) of COPD were calculated by logistic regression.Results: A total of 277 Li COPD cases, 307 Li healthy control subjects, 290 Han COPD cases and 301 Han healthy control were included in this study. In both the Li and Han groups, the average age exceeded 65 years, and the cigarette number smoked per day and the smoking duration were correlated with risk of COPD. In the Li COPD subjects, low weight, smoking, and recurrent infection of respiratory tract were mainly risk factors; while the mainly risk factor of Han COPD subjects was family history of respiratory disease. Conclusions: The risk factors are different in COPD subjects of Han and Li nationalities in Hainan of China. The age and smoking are strongly correlated with COPD risk.

Regulatory Effect of Shenge Yifei Capsule on TGF-β1/Smad Signaling Pathway in Rats with Chronic Obstructive Pulmonary Disease

[Objectives]This study aimed to study the effects of Shenge Yifei capsule on the TGF-β1/Smad signaling pathway in rats with chronic obstructive pulmonary disease(COPD).[Methods]Ten rats were randomly selected as the control group,and the other 40 rats were selected for modeling by fumigation combined with Klebsiella pneumoniae infection.A total of 38 rats were successfully modeled.They were randomly divided into model group(8 rats),low-dose Shenge Yifei capsule group(10 rats),high-dose Shenge Yifei capsule group(10 rats)and theophylline group(10 rats)in accordance with the principle of half male and half female.The rats in the model and control groups were given with distilled water by gavage,and the rats in the drug administration groups were given with corresponding drugs.The TGF-β1 level in the serum,and the expression levels of TGF-β1,Smad2,Smad3 and Smad7 and TGF-β1,Smad3 and Smad7 in airway tissues were detected.[Results]After 12 weeks,the serum TGF-β1 levels of the theophylline group and high-dose Shenge Yifei capsule group were lower than that of the low-dose Shenge Yifei capsule group(P<0.05).The expression levels of TGF-β1 and Smad3 in the theophylline group and high-dose Shenge Yifei capsule group were lower than that in the low-dose Shenge Yifei capsule group(P<0.05).The expression levels of TGF-β1 and Smad3 in the high-dose Shenge Yifei capsule group were lower than those in the low-dose Shenge Yifei capsule group and theophylline group(P<0.05).The expression levels of Smad7 and the proteins in the model group were lower than those in the other groups(P<0.05).The expression levels of Smad7 in the theophylline group and high-dose Shenge Yifei capsule group were higher than that in the low-dose Shenge Yifei capsule group(P<0.05).After 18 weeks,no significant difference was found in serum TGF-β1 level among the theophylline group and low and high-dose Shenge Yifei capsule groups(P>0.05).The expression levels of Smad7 and the proteins in the model group were lower than those in the other groups.The expression level of Smad7 in the high-dose Shenge Yifei capsule group was lower than that in the theophylline group(P<0.05).[Conclusions]Shenge Yifei capsule can regulate the TGF-β1/Smads signaling pathway.They can down-regulate the expression of TGF-β1,Smad2 and Smad3 and up-regulate the expression of Smad7,reducing the degree of airway modeling,delaying the development of COPD disease.Conventional high-dose Shenge Yifei capsule is more effective in inhibiting the expression of Smad2.

Current status and progress of prevention andtreatment of chronic obstructive pulmonarydisease in China

Chronic obstructive pulmonary disease (COPD) is the most prevalent chronic respiratory disease, leading toa great number of death and a huge disease burden to China. Recently, as the promulgation of a series of national healthpolicies, the diagnosis and treatment of COPD has gradually gained attention. The prevention and treatment capacity ofCOPD in China has been greatly improved, but there are still problems of insufficient diagnosis and irregular treatment. Theproblem is mainly related to the lack of universal pulmonary function test, insufficient number and level of doctors, and thenonstandard use of drugs. The prevention and treatment of COPD in primary medical institutions is particularly lacking. Inorder to promote the prevention and treatment of COPD, China has innovatively adopted a number of measures, including"Happy Breathing" project, standardized diagnosis and treatment system and capacity building for respiratory diseases inprimary medical institutions, el at. Effective progress has been made through these methods, and great improvement of theprevention, diagnosis and treatment of COPD has been achieved.

Chronic Obstructive Pulmonary Disease and Semantic Language Abilities

Objective: The main aim of the present study is to evaluate the semantic language abilities of patients with Chronic Obstructive Pulmonary Disease (COPD) compared to normal group. Secondly to examine the role of hypoxemia, hypercapnia and pulmonary parameters on language scores. Method: We assessed 100 COPD patients with the use of a comprehensive battery of neurocognitive tests standardized for the Greek population, examining semantic language abilities, namely the Boston Naming Test (BNT), the Picture Peabody Vocabulary Test (PPVT) and the Controlled Oral Word Fluency Test (COWAT). Results: The results revealed that although the overall performance of our group of patients was within normal range, it was statistically significant lower compared to normal distribution on all semantic language tests. Moreover, we found that the percentile of COPD patients that performed in the deficient range was significantly higher compared to normal distribution. Further analysis of pulmonary parameters showed that Forced Expiratory Volume in 1 sec (FEV1, FEV1%), Forced Vital Capacity (FVC, FVC%) and FEV1/FVC were not correlated with patients’ performance on the language tests. Low Partial Pressure of Oxygen in blood oxygen levels (PaO2) was found to be able to predict the performance of patients on BNT, PPVT and semantic verbal fluency test. Abnormally elevated Partial Pressure of Carbon Dioxide (PCaO2) in blood were not found to be related to language dysfunctions. Conclusions: Our findings indicate that our group of COPD patients is more prone to present semantic language impairments compared to normal group while low blood oxygen levels were associated with reduced performance on BNT, PPVT and semantic verbal fluency tests.

Study on the Correlation between Temperature and Chronic Obstructive Pulmonary Disease in Shijiazhuang, China—Retrospective Cohort

Using the chronic obstructive pulmonary disease (COPD) medical records from January 1st to December 31st of 2013 and the Meteorological observation data, the air pollution data in the same time periods, generalized additive models were used to quantitatively analyze the relationship between COPD hospitalizations and temperature with controlling the confounding effects of time trend, meteorological factors and air pollution index (AQI). Results showed: variable temperature in 24 h (BT), 3d lagged minimum temperature (Tm3) and 5d lagged diurnal maximum temperature and minimum temperature range (Tc5) have different effects on COPD hospitalizations. When BT is between -4.4°C and -0.7°C, the relative risk (RR) increases to 1.0207 (95% CI: 1.0074 - 1.0342)with every 1°C increase in BT;when Tm3 is between -3.6°C and 3.2°C, the relative risk (RR) increases to 1.0118 (95% CI: 1.0015 - 1.0222)with every 1°C increase in Tm3, and when Tm3 is greater than 20.5°C, the relative risk (RR) increases to 1.0069 (95% CI: 1.0005 - 1.0133) with every 1°C increase in Tm3;when Tc5 is between 0.9°C and 8.6°C, if the Tc5 increases 1°C, the relative risk (RR) increases to 1.0125 (95% CI: 1.0066 - 1.0185. There are different effects for weather in different seasons on COPD hospitalizations: in autumn and winter, it is mainly of little BT and heavy air pollution weather;in spring, the large Tc5 weather is a main feature, and in summer, it’s mainly of high temperature and low pressure weather. The results help to provide some guidance on COPD forecasting services.

Efficacy Evaluation of Self-created"Lung Health Breathing Exercise"in Adjuvant Therapy for Patients with Stable Chronic Obstructive Pulmonary Disease

[Objectives]To evaluate the intervention effect and safety of self-created Lung Health Breathing Exercise on TCM syndromes,6-min walk test(6MWT)and quality of life in patients with stable chronic obstructive pulmonary disease(COPD).[Methods]76 cases of outpatient or inpatient patients who were diagnosed with stable COPD in Nanchong Traditional Chinese Medicine Hospital from January 2020 to March 2021 were selected,randomly divided into experimental group and control group,38 cases in each group.Both groups were given conventional western medicine treatment and nursing measures.The experimental group was added with the self-created Lung Health Breathing Exercise.After 12 weeks of treatment,the TCM syndrome score,6MWT distance,quality of life score and the incidence of adverse events were observed in the both groups.[Results]After treatment,the 6MWT distance and quality of life scores in both groups were significantly improved(P<0.01),and the TCM syndrome scores were significantly lower than those before treatment(P<0.01).[Conclusions]Lung Health Breathing Exercise can benefit patients in terms of symptom improvement,quality of life and exercise ability,and is a safe and effective rehabilitation measure for patients with stable COPD.

Ambulatory Oxygen in Chronic Obstructive Pulmonary Disease

Ambulatory oxygen has been shown to improve pulmonary hemodynamics and reduce dynamic hyperinflation in patients with Chronic Obstructive Pulmonary Disease. Therefore, it is hypothesized to be of benefit in patients with either exertional desaturation or dyspnoea. There is evidence of short-term improvements in exercise distance, exercise time, breathlessness, oxygen saturation and minute ventilation. However, longer term studies only identified improvements in oxygenation and minute ventilation. The benefits were even more limited in patients with no resting hypoxemia. The role in improving exercise training in pulmonary rehabilitation by increasing exercise time and reducing dyspnoea was marginal and no improvements were detected in walking distance or quality of life. Practical considerations make compliance with ambulatory oxygen therapy a major issue with the weight of oxygen and social unacceptability the most often quoted problems. The evidence for any benefit of ambulatory oxygen is therefore limited despite the theoretical benefits.

腹部肥胖对COPD急性加重的影响

目的探讨腹部肥胖相关指标对慢性阻塞性肺疾病(COPD)患者急性加重的影响。方法对“新疆多民族自然人群队列建设及健康随访研究”招募的和田墨玉县常住居民经肺功能检测诊断为COPD的患者,进行问卷及常规检查测量腰围,体成分检测内脏脂肪等级,计算腰高比、体重调整腰围指数(WWI),随访患者至少1年急性加重住院情况。以急性加重住院为结局分析腹部肥胖相关指标对COPD急性加重的影响,并比较不同腹部肥胖指标对COPD急性加重的预测价值。结果631名COPD患者经过随访,报告了186例COPD急性加重住院病例。整个随访期间,COPD急性加重和无急性加重患者在年龄、肺结核疾病史、吸烟、二手烟、烹饪和取暖燃料、慢阻肺患者评价评分(CAT评分)等方面的比较差异有统计学意义(均P<0.05)。单因素及模型1和2显示,腰围、腰高比、WWI、内脏脂肪等级均对COPD急性加重有影响,指标每增加一个单位急性加重均有增加;腰高比及内脏脂肪等级对COPD急性加重影响的结果较稳定,多重调整后腰高比OR=1.304(1.010~1.683),内脏脂肪等级OR=1.912(1.122~3.257)。腹部肥胖相关指标对COPD急性加重均有预测价值,其中WWI的曲线下面积最大,为0.614。结论腹部肥胖指标腰高比、WWI、内脏脂肪等级是COPD急性加重的危险因素,COPD的防控应考虑减少腹部肥胖的干预策略。

COPD急性加重期患者外周血单个核细胞SOCS-1、TLR4 mRNA及血清cTnT、尿酸水平变化分析

目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者外周血单个核细胞中细胞因子信号抑制蛋白-1(SOCS-1)、Toll样受体4(TLR4)mRNA水平及血清心肌肌钙蛋白T(cTnT)、尿酸水平变化。方法收集COPD急性加重期(组)患者70例,COPD稳定期(组)患者40例,对照组健康志愿者40名。检测外周血单个核细胞SOCS-1、TLR4 mRNA水平及血清cTnT、尿酸浓度;行肺功能检查并记录相关指标(FEV1、FEV1%、FEV1/FVC%)。对COPD急性加重期患者进行1 a随访,分为预后不良组和预后良好组。对外周血单个核细胞SOCS-1、TLR4 mRNA水平、血清cTnT、尿酸浓度行Pearson相关性分析,并对COPD急性加重期患者预后评估价值进行ROC曲线分析。结果COPD急性加重期组SOCS-1 mRNA表达水平明显低于COPD稳定期组、对照组,TLR4 mRNA水平及血清cTnT、尿酸浓度明显高于COPD稳定期组和对照组(均P<0.01)。COPD急性加重期组FEV1、FEV1%、FEV1/FVC%明显低于COPD稳定期组和对照组(P<0.05)。COPD急性加重期患者FEV1/FVC%与外周血单个核细胞SOCS-1 mRNA表达水平呈正相关关系(P<0.01),与外周血单个核细胞TLR4 mRNA水平及血清cTnT、尿酸浓度呈负相关关系(P<0.01)。预后不良组SOCS-1 mRNA水平明显低于预后良好组,TLR4 mRNA水平及血清cTnT、尿酸浓度明显高于预后良好组(P<0.05)。外周血单个核细胞SOCS-1、TLR4 mRNA水平及血清cTnT、尿酸联合检测对COPD急性加重期患者预后具有较高的评估价值。结论COPD急性加重期患者SOCS-1低表达,TLR4、cTnT、尿酸高表达,且与肺功能水平密切相关,联合检测对患者预后具有较高的评估价值。

连续性、多元化院外健康管理在氟替美维吸入粉雾剂治疗COPD稳定期患者中的应用价值

目的 探讨连续性、多元化院外健康管理在氟替美维吸入粉雾剂治疗慢性阻塞性肺疾病(COPD)稳定期患者中的应用价值。方法 选取南阳市第一人民医院2022年6月~2023年6月收治的112例COPD稳定期患者,依据随机数字表法分成多元化管理组(56例)、常规管理组(56例)。常规管理组接受常规健康管理,多元化管理组接受连续性、多元化院外健康管理,干预3个月,对比两组知识掌握情况、依从性、肺功能改善情况[用力肺活量(VC)、第1秒用力呼气量(FEV1)、第1秒用力呼气量占用力肺活量比率(FEV1/FVC)]、自我效能感[一般自我效能感量表(GSES)]、心理状况[正性与负性情绪量表(PANAS)]及生活质量[慢性阻塞性肺疾病评估测试问卷(CAT)]。结果 干预3个月后,多元化管理组功能锻炼、用药、疾病知识评分高于常规管理组(P<0.05);多元化管理组依从率(96.43%)高于常规管理组(83.93%)(P<0.05);干预3个月后,多元化管理组VC、FEV1、FEV1/FVC均高于常规管理组(P<0.05);干预3个月后,多元化管理组GSES、PANAS-正性评分明高于常规管理组,CAT、PANAS-负性评分低于规管理组(P<0.05)。结论 对于氟替美维吸入粉雾剂治疗的COPD稳定期患者,连续性、多元化院外健康管理可提升患者对疾病的认知、依从性和自我效能,调节负性心理状态,进而改善肺功能,提高生活质量。

Digital health in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease(COPD)can be prevented and treated through effective care,reducing exacerbations and hospitalizations.Early identification of individuals at high risk of COPD exacerbation is an opportunity for preventive measures.However,many patients struggle to follow their treatment plans because of a lack of knowledge about the disease,limited access to resources,and insufficient clinical support.The growth of digital health-which encompasses advancements in health information technology,artificial intelligence,telehealth,the Internet of Things,mobile health,wearable technology,and digital therapeutics-offers opportunities for improving the early diagnosis and management of COPD.This study reviewed the field of digital health in terms of COPD.The findings showed that despite significant advances in digital health,there are still obstacles impeding its effectiveness.Finally,we highlighted some of the major challenges and possibilities for developing and integrating digital health in COPD management.

Twenty years of changes in the definition of early chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease(COPD)is a chronic inflammatory airway disease that affects the quality of life of nearly one-tenth of the global population.Due to irreversible airflow obstruction and progressive lung function decline,COPD is characterized by high mortality and disability rates,which imposes a huge economic burden on society.In recent years,the importance of intervention in the early stage of COPD has been recognized and the concept of early COPD has been proposed.Identifying and intervening in individuals with early COPD,some of whom have few or no symptoms,might halt or reverse the progressive decline in lung function,improve the quality of life,and better their prognosis.However,understanding of early COPD is not yet well established,and there are no unified and feasible diagnostic criteria,which complicates clinical research.In this article,we review evolution of the definition of early COPD over the past 20 years,describe the changes in awareness of this concept,and propose future research directions.