Objective The purpose of this study was to explore the correlation between peripheral blood eosinophil (EOS) count and smoking history, some inflammatory indicators, lung function, efficacy of ICS, risk of respiratory failure and chronic pulmonary heart disease, risk of acute exacerbation within 1 year, readmission rate and mortality in patients with acute exacerbation of COPD. Methods Retrospective analysis of the baseline clinical data of 816 patients with acute exacerbation of chronic obstructive pulmonary disease in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Shihezi University from January 1,2019 to December 31,2021. The patients were divided into EOS ≥ 200 cells / μL (High Eosinophi, HE) group and EOS<200 cells / μL (low Eosinophi, LE) group according to whether the peripheral blood EOS was greater than 200 cells / μL at admission. Peripheral venous blood data (including blood eosinophil count, white blood cell count, lymphocyte percentage, neutrophil percentage), blood gas analysis value, lung function index and medication regimen of all patients were collected, and the efficacy of ICS was recorded. The patients were followed up for 1 year to observe the acute exacerbation and readmission rate, and the mortality rate was followed up for 1 year and 2 years. Results Neutrophil count, lymphocyte count and peak expiratory flow (PEF) in HE group were positively correlated with EOS value (P<0.05), and smoking was more likely to increase EOS value. HE group was more sensitive to ICS. The risk of acute exacerbation in HEA group was higher than that in LE group. ICS could reduce the rate of acute exacerbation in HE group. EOS value in LE group was inversely proportional to FEV1 / FVC and MMEF values (P<0.05). The risk of chronic pulmonary heart disease in LE group was higher than that in HE group. The 2-year mortality rate in HE group was higher than that in LE group. Conclusions Peripheral blood EOS count is correlated with some inflammatory indicators, acute exacerbation risk, and lung function. ICS can improve the clinical symptoms and prognosis of patients with higher EOS count.
ObjectiveTo analyze the effect of different nebulization methods in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring non-invasive ventilators (NIV). MethodsOne hundred and two patients with AECOPD were selected according to the standard, and randomly divided into a control group, a trial group I, and a trial group II according to the random number table. The patients in the control group received NIV intermittent oxygen-driven nebulization; the patients in the trial group I received NIV simultaneous oxygen-driven nebulization; and the patients in the trial group II received NIV simultaneous air-driven nebulization. The dynamic fluctuations of transcutaneous partial pressure of carbon dioxide (PtCO2), arterial blood gas indexes (PaCO2, PaO2, pH), vital signs and pulse oxygen saturation (SpO2) fluctuations were compared. ResultsPtCO2 at 15min of nebulization in the trial group II were lower than the other groups (P<0.05). PtCO2 at 15min of nebulization was higher than the other time points in the control group (P<0.05); there was no statistical difference of PtCO2 at different time points in the trial group I (P>0.05); PtCO2 gradually decreased with time in the trial group II (P<0.05). The difference before and after nebulization of PtCO2 (dPtCO2) was larger in trial group II than the other groups (P<0.05). PtCO2 at 0min and 5min after the end of nebulization in trial group II were lower than the other groups (P<0.05); there were no statistical differences of PtCO2 at 10min and 15min after the end of nebulization among three groups (P>0.05). There were statistical differences of the PtCO2 at each time point in the control group except for the PtCO2 at 10 min and 15min after the end of nebulization, all of which decreased with time; PtCO2 at each time points of nebulization decreased with time in the trial group I (P<0.05). PtCO2 only at 5min after the end of nebulization was lower than that at 0min after the end of nebulization in trial group II (P< 0.05), there were no statistical differences in other times (P>0.05). PaCO2, pH at the 4th day of treatment was lower than the pre-treatment in the control group (P<0.01); there were statistical differences of PaCO2 between the pre-treatment and the rest time points in the trial group I and group II (P<0.05). The number of abnormal fluctuations in vital signs and SpO2 during nebulization in three groups was not statistically different (P>0.05). ConclusionsThree groups can achieve good therapeutic effects. NIV intermittent oxygen-driven nebulization can make PtCO2 rise during nebulization; NIV simultaneous oxygen-driven nebulization can make PtCO2 remain stable during nebulization; NIV simultaneous air-driven nebulization can make PtCO2 fall during nebulization.
ObjectiveTo explorer the risk factors for acute exacerbation in patients with bronchiectasis within one year.MethodsFour hundred and twenty-two patients with non-cystic fibrosis bronchiectasis hospitalized were enrolled in The East Region of the People’s hospital of Sichuan between October 2014 and October 2016. The patients’ clinical data were collected, and follow-up began at the time of discharged. The study endpoint was the first acute exacerbation, all patients were followed-up for one year after discharged. The patients were classified into two groups by the occurrence of acute exacerbation or no occurrence. Logistic regression analysis was used to explore the risk factors for acute exacerbation with bronchiectasis.ResultsThe age, sick time, body mass index (BMI) less than 18.5 kg/m2, smoking index, expectoration, hemoptysis, dyspnea, moist sounds, wheezing sounds, types of imaging, CT scores, lung lesion site, sputum culture, whether infected Pseudomonas aeruginosa, level of serum C-reactive protein (CRP), level of serum PCT, serum albumin, arterial carbon dioxide partial pressure, types of respiratory failure, combined with chronic cor pulmonale differed significantly between the two groups (P<0.05), while gender, history of Infection, smoking, cough, chest pain, fever, clubbed-finger, white blood cell counts, neutrophil counts, erythrocyte sedimentation rate, serum globulins, arterial oxygen partial pressure did not significantly differ (P>0.05). Multivariate Logistic regression analysis found that infection with Pseudomonas aeruginosa, BMI<18.5 kg/m2, high level of serum CRP, high level of arterial carbon dioxide partial pressure (PaCO2), high CT score with bronchiectasis, combination with chronic cor pulmonale were risk factors for acute exacerbation in patients with bronchiectasis (P<0.05).ConclusionsInfection with pseudomonas aeruginosa, BMI < 18.5 kg/m2, high serum CRP level, high arterial blood PaCO2 level, high CT score with bronchiectasis and combination of chronic cor pulmonale are risk factors for acute aggravation within 1 year for patients with bronchiectasis. Doctors can identify these risk factors and intervene early, so as to reduce the acute exacerbation of bronchiectasis.
ObjectiveTo investigate the physiologic effects of different pressure assist (PA) on ventilatory status,oxygenation and work of breathing (WOB) when a new generation of proportional assist ventilation (PAV) is applied in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsA prospective,crossover randomized physiologic study was performed.80%PA,60%PA and 40%PA was sequentially randomized to be applied with the duration of 30 minutes,and pressure support ventilation (PSV) with the duration of 30 minutes was applied before each PA.Ventilatory status, oxygenation,dyspnea indexes in PSV and different PA were compared,and WOB of patients and ventilator were compared in different PA. ResultsTwenty-eight patients were recruited into the study.With the decrease of PA,peak inspiratory pressure (PIP),mean airway pressure (Pm),and tidal volume (VT) decreased gradually (P>0.05),respiratory rate (RR) increased gradually (P<0.05),while minute volume (MV),heart rate (HR),systolic blood pressure (SBP),mean arterial pressure (MAP),pH,arterial carbon dioxide tension (PaCO2),and arterial oxygen tension/inspired oxygen fraction (PaO2/FiO2) did not change significantly (P>0.05).Compared with PSV mode,PIP increased significantly in 80%PA (P<0.05),decreased significantly in 60%PA and 40%PA (P<0.05).Pm did not change significantly in 80%PA (P>0.05),decreased significantly in 60%PA and 40%PA (P<0.05).VT increased significantly in 80%PA (P<0.05),decreased significantly in 60%PA and 40%PA (P<0.05).RR did not change significantly in 80%PA (P>0.05),increased significantly in 60%PA and 40%PA (P<0.05).MV did not change significantly in 80%PA (P>0.05),decreased significantly in 60%PA and 40%PA (P<0.05).With the decrease of PA,Borg score and scale for accessory muscle use increased gradually (P<0.05).Compared with PSV mode,Borg score and scale for accessory muscle use did not change significantly in 80%PA (P>0.05),increased significantly in 60%PA and 40%PA (P<0.05).WOB of patients in 40%PA was significantly higher than that in 60%PA (P=0.000) and that in 80%PA (P=0.000),while which in 60%PA was significantly higher than that in 80%PA (P=0.000).On the contrary,WOB of ventilator in 40%PA was significantly lower than that in 60%PA (P=0.004) and that in 80%PA (P=0.000),while which in 60%PA was significantly lower than that in 80%PA (P=0.000). ConclusionThe new generation of PAV can safely and effectively provide respiratory support to patients with AECOPD.Respiratory pattern,levels of dyspnea and accessory muscle use in 80%PA are similar with those in PSV.With the decrease of PA,levels of spontaneous breathing and WOB increase and dyspnea worsens.PAV can promote spontaneous breathing and prevent respiratory muscle disuse atrophy even more, but easily lead to respiratory muscle fatigue with inappropriate use.
Objective To study the effect of glucocorticoid-containing triple therapy on the acute exacerbation frequency of patients with moderate to severe chronic obstructive pulmonary disease (COPD) with different blood eosinophil percentage (EOS%). Methods One hundred and twenty-four patients who were admitted to the hospital with moderate to severe COPD from January 2020 to March 2020 in the Department of Respiratory and Critical Care Medicine in this hospital were selected as the research subjects, and the patients were divided into group A according to EOS% (EOS%<2%) and B group (EOS%≥2%). Then the A and B groups were randomly divided into four subgroups A1, A2 and B1, B2, and the patients in groups A1 and B1 were treated with dual long-acting bronchodilation. The medication for the patients in groups A2 and B2 was a triple preparation containing glucocorticoids. Namely A1 group (EOS%<2%, dual therapy), A2 group (EOS%<2%, triple therapy), B1 group (EOS%≥2%, dual therapy), B2 group (EOS%≥2%, triple therapy). The patients were instructed to take medication regularly as in hospital after discharge. After discharge, patients were followed up by telephone every two weeks for a period of one year. The number of acute exacerbations, the change of forced expiratory volume in the first second as a percentage of the expected value (FEV1%pred) and the incidence of pneumonia were compared between group A and group B during the follow-up period of one year. Results In the patients with EOS%≥2%, triple therapy reduced the number of acute attacks by 40% during treatment compared with dual therapy patients (average 0.875 vs. 1.471 times per patient per year, P=0.0278). While in the patients with EOS%<2%, it was reduced by 4% (1.080 vs. 1.125 times, P=0.3527). In the same use of glucocorticoid-containing triple preparations, the number of acute exacerbations in the patients with EOS%≥2% during medication was 19% less than that of the patients with EOS%<2% (an average of 0.875 to 1.080 times per patient per year, P=0.0462). Regardless of EOS%≥2% or <2%, there was no significant difference in the changes of FEV1%pred between triple therapy and double therapy patients before and after treatment (P>0.05). Regardless of EOS%≥2% or <2%, there was no statistically significant difference in the incidence of pneumonia between patients with triple therapy and double therapy during medication (P>0.05). Conclusion Inhaled glucocorticoid triple therapy is suitable for moderate to severe COPD patients with high percentages of blood eosinophils.
ObjectiveTo systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) in Post-extubation acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. MethodsThe Domestic and foreign databases were searched for all published available randomized controlled trials (RCTs) about HFNC therapy in post-extubation AECOPD patients. The experimental group was treated with HFNC, while the control group was treated with non-invasive positive pressure ventilation (NIPPV). The main outcome measurements included reintubation rate. The secondary outcomes measurements included oxygenation index after extubation, length of intensive care unit (ICU) stay, mortality, comfort score and adverse reaction rate. Meta-analysis was performed by Revman 5.3 software. ResultA total of 20 articles were enrolled. There were 1516 patients enrolled, with 754 patients in HFNC group, and 762 patients in control group. The results of Meta-analysis showed that there were no significant difference in reintubation rate [RR=1.41, 95%CI 0.97 - 2.07, P=0.08] and mortality [RR=0.91, 95%CI 0.58 - 1.44, P=0.69]. Compared with NIPPV, HFNC have advantages in 24 h oxygenation index after extubation [MD=4.66, 95%CI 0.26 - 9.05, P=0.04], length of ICU stay [High risk group: SMD –0.52, 95%CI –0.74 - –0.30; Medium and low risk group: MD –1.12, 95%CI –1.56- –0.67; P<0.00001], comfort score [MD=1.90, 95%CI 1.61 - 2.19, P<0.00001] and adverse reaction rate [RR=0.22, 95%CI 0.16 - 0.31, P<0.00001]. ConclusionsCompared with NIPPV, HFNC could improve oxygenation index after extubation, shorten the length of ICU stay, effectively improve Patient comfort, reduce the occurrence of adverse reactions and it did not increase the risk of reintubation and mortality. It is suggested that HFNC can be cautiously tried for sequential treatment of AECOPD patients after extubation, especially those who cannot tolerate NIPPV.
ObjectiveTo explore the clinical phenotype of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) by cluster analysis and provide a basis for individualized treatment.MethodsA total of 515 patients with acute exacerbation of COPD admitted to this department from January 2014 to December 2016 were enrolled. The age, duration, smoking index, number of hospitalizations in the past 1 year, hospitalization days, treatment costs and other information were collected for cluster analysis.ResultsThe patients were divided into three categories of phenotype: " mild-glucocorticoid resistance-antibiotic dependent”," mild-glucocorticoid sensitive”, and " serious complication”. The patients with the first two phenotypes had a milder condition and lower hospitalization costs. There were differences in the time and cumulative dose of glucocorticoids in different pathways, antibiotic use time and usage rate. The third phenotype was the most serious, with the highest cost of hospitalization, and may merge or co-exist with other diseases such as cardiovascular disease and digestive tract disease.ConclusionCluster analysis may identify different phenotypes of acute exacerbation of COPD to provide a reference for clinical individualized treatment.
Objective To analyze the clinical presentations and radiological characteristics of acute exacerbation of idiopathic pulmonary fibrosis ( IPF) . Methods Clinical and radiological data of 2 patients with acute exacerbation of IPF from April 2006 to July 2008 were retrospectively analyzed and literatures were reviewed. Results Both patients were senior male patients over 60 years old. Dyspnea, cough and inspiratory crackles were the major symptoms and signs. Two patients were experiencing an exacerbation of dyspnea for one week and half of month, respectively. PaO2 /FiO2 of both patients was less than225 mm Hg. In both patients, high-resolution computed tomography ( HRCT) scans at the exacerbation showed typical signs of IPF including peripheral predominant, basal predominant reticular abnormality, with honeycombing and traction bronchiectasis and bronchiolectasis, and newly developing alveolar opacity. HRCT scan showed peripheral area of ground-glass attenuation adjacent to subpleural honeycombing in one patient, and diffusely distributed ground-glass opacity in another patient. Two patients had received corticosteroid treatment. For one patient, the symptoms improved, and ground-glass attenuation adjacent to subpleural honeycombing had almostly resolved. The other patient died of respiratory failure. Conclusions Some acute exacerbation in idiopatic pulmonary fibrosis can be idiopathic. The clinical presentations mainly include the worsening of dyspnea within short time. HRCT generally demonstrates new bilateral ground-glass abnormality with or without areas of consolidation, superimposed on typical changes of IPF.
Objective To evaluate the value of serumprocalcitonin( PCT) guided antibiotic strategy in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) .Methods From August 2011 to June 2012, a total of 96 patients hospitalized for AECOPD were randomly assigned into a PCT-guided group( n = 48) and an empirical therapy group( n = 48) . The PCT levels of PCT-guided group were measured by immunochemiluminometric assays before and 5,7, 10 days after treatment. The PCT-guided group was treated with antibiotics according to serum PCT levels, ie. antibiotic treatment was applied when PCT level ≥ 0. 25 μg/L and was discouraged when PCT level lt; 0. 25 μg/L. The empirical therapy group received antibiotics according to physician’s decision. The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, clinical efficacy, hospital mortality, rate of invasive mechanical ventilation and costs of hospitalization were recorded. Results The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, and costs of hospitalization in the PCT-guided group were all lower than those of the empirical therapy group( P lt;0.05) while clinical efficacy, hospital mortality and rate of invasive mechanical ventilation were similar in two groups(Pgt;0.05) . Conclusion PCT guided antibiotic strategy can be used in the treatment of AECOPD, which may reduce the dose of antibiotic drugs to avoid bacterial resistance and lower costs of hospitalization.
Objective To analyze the distribution of pathogens, drug susceptibility and multi-drug resistant bacteria (MDRB) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. Methods The clinical data of patients whose discharge diagnosis included AECOPD with pneumonia or pulmonary infection from January 2012 to December 2015 were retrospectively analyzed. Strain identification and drug sensitivity analysis were performed in the pathogenic bacterias isolated from sputum culture. Results A total of 1 978 patients were enrolled in this study, and pathogenic bacterias were isolated from the sputum of 708 patients, including 485 cases of community-acquired pneumonia (CAP) and 223 cases of hospital-acquired pneumonia (HAP); and 786 strains of pathogens were isolated (501 strains from CAP cases, 285 strains from HAP cases), including 448 strains of Gram-negative (G–) bacilli (57.0%), 117 strains of Gram-positive (G+) cocci (14.9%), and 221 strains of fungi (28.1%). Susceptibility testing results showed that G– bacilli were highly resistant to penicillins, third generation cephalosporins, ciprofloxacin, gentamicin, etc., and G+ cocci were highly resistant to penicillin, clindamycin and erythromycin. There were 238 strains of MDRB, mainly including 69 strains of Acinetobacter baumanii [multiple drug resistance rate (MDRR)=67.6%], 27 strains of Escherichia coli (MDRR=52.9%), 25 strains of Klebsiella pneumoniae (MDRR=34.2%), 33 strains of Pseudomonas aeruginosa (MDRR=33.0%) and 24 strains of Stenotrophomonas maltophilia (MDRR=100.0%). MDRR of Enterococcus genus and methicillin-resistant Staphylococcus aureus was 50.0% and 48.0%, respectively. Conclusions The pathogenic bacterias in elderly AECOPD patients complicated with pneumonia are mainly G– bacterias, and the proportion of fungal infection tends to increase. Bacterial drug resistance is serious and the MDRB tends to increase, especially in patients with HAP. Physicians should early find out the characteristics of local pathogenic bacteria and drug sensitivity, rationally select antibiotics, reduce the occurrence of drug-resistant strains and superinfection when treating the elderly patients with AECOPD complicated with pneumonia.