Treatment Of Obstructive Pulmonary Disease Research Articles

Clinical research of bilevel non-invasive mechanical ventilation in the treatment of chronic obstructive pulmonary disease with respiratory failure

Objective To explore the application of bilevel non-invasive mechanical ventilation in the treatment of chronic obstructive pulmonary disease(COPD) with respiratory failure. Methods 126 COPD patients with type Ⅱ respiratory failure were selected and divided into control group and research group, 63 cases in each group.The control group received regular treatment, and the research group received bilevel non-invasive mechanical ventilation on the basis of regular treatment., The results of blood gas analysis, respiratory frequency(RR), heart rate(HR) and expiratory flow(PEF) were observed and compared between the two groups. Results The indicators of pH, PaCO2, PaO2 in the research group after treatment were (7.41±0.08), (51.26±12.13)mmHg, (77.28±15.34)mmHg, which in the control group were (7.26±0.07), (67.21±13.05)mmHg, (69.26±14.31)mmHg, compared with before treatment, pH and PaO2 of the two groups were increased, PaCO2 was decreased after treatment, and the three indicators of the research group were changed significantly better than those of the control group, the differences were statistically significant(t=11.2, 7.11, 3.03, all P<0.01). After treatment, HR and PR of the two groups were decreased, PEF was increased.The three indicators of the research group were also changed significantly better than those of the control group, the differences were statistically significant(t=3.13, 8.58, 5.45, all P<0.01). Conclusion Bilevel non-invasive mechanical ventilation in the treatment of COPD with respiratory failure has remarkable clinical effects, can significantly improve the patients' blood gas analysis index, HR, RR and PEF, and it is worthy of clinical application. Key words: Ventilators, mechanical; Positive-pressure respiration; Pulmonary disease, chronic obstructive; Respiratory insufficiency

Observation of the effect of cefuroxime combined with methylprednisolone in the treatment of chronic obstructive pulmonary disease with emphysema

Objective To observe and analyze the clinical effect of cefuroxime combined with methylprednisolone in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary emphysema. Methods 92 COPD patients complicated with pulmonary emphysema were selected as study objects, and they were randomly divided into observation group and control group. 46 cases in the control group were treated with antibiotic treatment, and 46 cases in the observation group were treated with cefuroxime combined with methylprednisolone. The clinical curative effect, pulmonary function, blood gas index and incidence of adverse reactions were compared between the two groups. Results The total effective rate of the observation group was 91.30%, which was significantly higher than 76.09% of the control group (χ2=8.476, P 0.05). Conclusion In elderly COPD patients with emphysema, using cefuroxime combined with methylprednisolone therapy can effectively alleviate the clinical symptoms, improve lung function and blood gas index, and has less adverse reactions, higher safety and high clinical application value. Key words: Chronic obstructive pulmonary disease; Pulmonary emphysema; Antibiotics; Glucocorticoid; Aged

Molecular mechanisms of corticosteroid resistance in patients with chronic obstructive pulmonary disease

Glucocorticoids are widely used for the treatment of chronic obstructive pulmonary disease (COPD) because of their antiinflammatory properties. However, their therapeutic effectiveness is significantly limited in COPD. Molecular mechanisms of steroid resistance include defective glucocorticoid receptor (GR) binding and translocation into the nucleus, increased expression of GRβ isoform, elevated expression of macrophage migration inhibitory factor (MIF), decreased expression of mitogenactivated protein kinase phosphatase 1 (MKP1) and histone deacetylase 2 (HDAC2). HDAC2 is involved in suppression of inflammatory genes by glucocorticoids, and its reduced activity and expression are the result of oxidative and nitrative stress induced by cigarette smoke. Oxidative stress causes activation of phosphoinositide3kinase δ (PI3Kδ) which leads to phosphorylation (activation) of Akt kinase, phosphorylation (inhibition) of glycogen synthase kinase 3β and phosphorylation (inactivation) of HDAC2. Understanding of the mechanisms leading to steroid resistance allowed identification drugs targeting this condition. Antidepressant nortriptyline and macrolide solithromycin reverse corticosteroid resistance through inhibition of Akt phosphorylation. Combination of glucocorticoid and longacting β2agonist increases GR nuclear translocation and inhibits Akt phosphorylation. The phosphodiesterase 4 inhibitor roflumilast in combination with dexamethasone improves steroid responsiveness through modulation of PI3Kδ, HDAC2, MKP1, MIF and GRβ expression. Investigation of the molecular mechanisms of steroid resistance can increase antiinflammatory properties of steroids and lead to more effective COPD treatment.

An International Study of Adherence to Guidelines for Patients Hospitalised with a COPD Exacerbation

ABSTRACTGuideline adherence rates for the treatment of chronic obstructive pulmonary disease (COPD) exacerbation are low. The aim of this study is to perform an importance-performance analysis as an approach for prioritisation of interventions by linking guidelines adherence rates to expert consensus rates for the in-hospital management of COPD exacerbation. We illustrate the relevance of such approach by describing variation in guideline adherence across indicators and hospitals. A secondary data analysis of patients with an acute COPD exacerbation admitted to Belgian, Italian and Portuguese hospitals was performed. Twenty-one process indicators were used to describe adherence to guidelines from patient record reviews. Expert consensus on the importance for follow-up of these 21 indicators was derived from a previous Delphi study. Three of the twenty-one indicators had high level of expert consensus and a high level of adherence. Eleven of the twenty-one indicators had high level of expert consensus but a low level of adherence. For none of the 378 patients included in this study were all process indicators adhered to, patients received 41.0% of the recommended care on average, and only 34.1% of the patients received 50% or more of the care they should receive. There was also a large variation within and between hospitals regarding the care received. This study confirms the findings of previous studies, indicating that COPD exacerbations are largely undertreated. Importance-performance analysis provides a decision-making tool for prioritising indicators. All hospitals in this study would benefit from having in place a quality framework for systematic follow-up of these indicators.

Application effect of critical care professional nursing team in the treatment of chronic obstructive pulmonary disease with respiratory failure

Objective To observe the application effect of critical care professional nursing team applied to sequential mechanical ventilation in the treatment of chronic obstructive pulmonary disease (COPD) with respiratory failure. Methods Totally 80 patients of COPD with respiratory failure from May 2014 to April 2015 were divided into study group and control group by random number table method, 40 patients in each group. Study group was applied to critical care professional nursing team. Control group was given routine nursing. The two groups were treated for 4 weeks. The clinical indicators of positive end expiratory pressure (PEEP), pressure support ventilation (PSV), carbon dioxide partial pressure (PaCO2), oxygen partial pressure (PaO2), forced expiratory volume in one second (FEV1), heart rate, arterial systolic blood pressure, respiratory rate in two groups were compared. The clinical indicators such as the duration of the stay, the duration of the total ventilation, and the time of invasive ventilation, etc, in two groups were compared; and nursing satisfaction was also compared. Results Before nursing, there were no statistical differences between the study group and the control group in PaCO2, PaO2, FEV1, heart rate, systolic arterial blood pressure, respiration rate and PEEP, PSV indicators (t=0.04-0.63, P > 0.05). And after the intervention, the above indicators of the study group were (36.4±2.0) mmHg (1 mmHg=0.133 kPa), (94.7±4.8) mmHg, (45.2±16.0)%, (84.2±4.3) beats/min, (94.2±5.3) mmHg, (15.2±3.0) times/min, (3.6±1.2) mmHg, (10.2±2.0) ml and (48.5±5.3) mmHg, (88.3±4.1) mmHg, (36.9±14.1)%, (92.4±6.2) beats/min, (110.4±6.2) mmHg, (20.9±4.1) times/min, (4.2±1.6) mmHg, (13.9±2.4) ml in the control group. The differences were statistically significant (t=4.37-13.51, P < 0.01). After nursing care, the study group of patients with clinical indicators such as admission time, total duration of ventilation, the time of invasive ventilation were (12.5±1.5) d, (10.2±2.6) h, (5.2±2.1) h, while (18.2±2.6) d, (15.9±1.1) h, (7.9±2.9) h in the control group, the differences were statistically significant (t=12.01, 12.77, 4.77, P < 0.01).The nursing satisfaction rate was 80.0% (32/40) in the study group while 62.5% (25/40) in the control group, the difference was statistically significant (χ2=6.30, P < 0.01). Conclusions Sequential mechanical ventilation therapy and nursing care in patients with COPD can significantly improve the clinical symptoms, improve nursing satisfaction, it is worthy of clinical promotion. Key words: Pulmonary disease, chronic obstructive; Respiratory insufficiency; Critical care professional nursing team; Sequential mechanical ventilation

Novel inhalation devices for treatment of chronic obstructive pulmonary disease

The aim of this review was to introduce readers to technical characteristics and advantages of recently available inhalers used for treatment of chronic obstructive pulmonary disease. Such inhalation devices as Breezehaler, Ellipta, Genuair, NEXThaler, and Respimat were described in details in this article.

Comparison of treatment of chronic obstructive pulmonary disease (COPD) by family physician and consultants

The goal of the study is to determine whether care for COPD patients is more consistent with guidelines when a Consultant rather than a Family Physician treat the patients. We use the Global Initiative for Obstructive Lung Disease Guidelines as a standard 1. We studied seven parameters, offering Pulmonary Function Test, Smoking cassation guidance, vaccination, use of oral steroid, inhaled steroids, inhaled Impratropium bromide, and symptom documentation. We concluded that both Family Physicians and Consultants are not fully following the guidelines. In compression Consultants are better than Family Physicians.

Efficacy of Continuous Positive Airway Pressure in the Treatment of Chronic Obstructive Pulmonary Disease Combined With Respiratory Failure

Our aim is to investigate the efficacy of continuous positive airway pressure (CPAP) in chronic obstructive pulmonary disease (COPD) combined with respiratory failure. Electronic and manual searches were applied to retrieve published studies relevant to CPAP, COPD, and respiratory failure. The retrieved studies were screened based on stringent inclusion and exclusion criteria to identify high-quality clinical studies for meta-analysis. Comprehensive meta-analysis 2.0 was conducted to statistical analysis. Initially, we retrieved 958 studies based on stringent inclusion and exclusion criteria, 10 studies, containing a total of 372 patients with COPD combined with respiratory failure, were selected for meta-analysis. The result of our meta-analysis revealed that partial pressure of carbon dioxide (PaCO2) in patients with COPD combined with respiratory failure was significantly lower 24 hours after CPAP treatment, and partial pressure of oxygen (PaO2) and pH were markedly higher 24 hours after CPAP treatment in the same patient group, indicating statistically significant differences as a result of CPAP treatment. Subgroup analysis based on ethnicity demonstrated that PaCO2 in patients with COPD combined with respiratory failure is evidently lower 24 hours after CPAP treatment among whites, but no such statistical correlation was observed among Asians. The results of this meta-analysis indicate that CPAP can effectively improve the respiratory function of patients with COPD combined with respiratory failure, and CPAP can be an effective way of treating COPD.

Economic evaluations of fluticasone-propionate/salmeterol combination therapy for chronic obstructive pulmonary disease: a review of published studies

ABSTRACTThis review identifies and evaluates the comprehensive reporting of peer-reviewed economic evaluations of the effectiveness of fluticasone-propionate/salmeterol combination (FSC) therapy for maintenance treatment of chronic obstructive pulmonary disease (COPD). Economic evaluations were included if published in English since 2003. Evaluation categories included in the review were cost-effectiveness, cost-utility, and cost-consequence analyses. FSC is cost-effective in comparison to short-acting bronchodilators (SABDs). Cost and outcome differences between FSC and other long-acting therapies were modest. Studies exhibited large variations in populations, designs and environment, limiting the ability to draw conclusions. Many new maintenance treatments for COPD have been approved since 2010. Most have yet to be compared to older treatments like FSC. Evaluations are needed that consider costs and outcomes from a societal perspective (e.g., patients’ ability to keep working) and evaluations that include subgroup analyses to investigate differential impacts according to clusters of patient characteristics.

Long-term (52 weeks) safety and tolerability of umeclidinium in Japanese patients with chronic obstructive pulmonary disease

Objective Umeclidinium bromide (UMEC) 62.5 μg is a long-acting muscarinic antagonist (LAMA) that is administered once daily via inhalation for chronic obstructive pulmonary disease (COPD) treatment. The objective of this study was to evaluate the safety and tolerability of long-term treatment with UMEC 125 μg in Japanese patients with COPD.Methods This was a 52 week, multicenter, open-label study to evaluate the safety and tolerability of UMEC 125 μg once daily delivered via a novel dry powder inhaler (nDPI) in Japanese patients with COPD. The primary endpoint was the incidence and severity of all adverse events (AEs) throughout the 52 week treatment period.Clinical trial registration number ClinicalTrials.gov identifier is NCT01702363.Results A total of 153 patients were enrolled in the study. Of these, 131 patients started treatment with UMEC 125 μg, and 111 patients (85%) completed the study. AEs did not differ greatly in incidence over the various time periods (Weeks 0 to 12, 13 to 24, 25 to 36, and 37 to 52 of treatment) and did not increase with continued treatment. The incidence of drug-related AEs associated with the pharmacological effects of LAMAs (including constipation, blurred vision, and thirst) was low. Serious adverse events (SAEs) during the treatment period were reported in 17 patients (13%). SAEs reported in more than one patient were COPD exacerbation and pneumonia (3 patients each, 2%). One SAE of angina pectoris was considered to be drug related. No fatalities were reported during this study.Conclusions No new AEs were identified beyond those attributable to the pharmacological effects of LAMAs. UMEC 125 μg was well tolerated over 52 weeks of treatment in Japanese patients with COPD.

COMPARATIVE ANALYSIS OF MEDICATION ASSORTMENT FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE TREATMENT PRESENTED AT UKRAINIAN AND POLISH PHARMACEUTICAL MARKETS

&lt;p&gt;&lt;strong&gt;COMPARATIVE ANALYSIS OF MEDICATION ASSORTMENT FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE TREATMENT PRESENTED AT UKRAINIAN AND POLISH PHARMACEUTICAL MARKETS&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;О.І. &lt;/strong&gt;&lt;strong&gt;On&lt;/strong&gt;&lt;strong&gt;у&lt;/strong&gt;&lt;strong&gt;shkiv&lt;/strong&gt;&lt;strong&gt;, &lt;/strong&gt;&lt;strong&gt;I&lt;/strong&gt;&lt;strong&gt;.Р. &lt;/strong&gt;&lt;strong&gt;Lech&lt;/strong&gt;&lt;strong&gt;, &lt;/strong&gt;&lt;strong&gt;T&lt;/strong&gt;&lt;strong&gt;. &lt;/strong&gt;&lt;strong&gt;A&lt;/strong&gt;&lt;strong&gt;. &lt;/strong&gt;&lt;strong&gt;Hroshovyi&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;I.Ya.HorbachevskyTernopilStateMedicalUniversity&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary&lt;/strong&gt;: It was made a comparative study of Ukrainian and Polish pharmaceutical markets of medications used for treatment of chronic obstructive pulmonary disease. Also it was analyzed the structure of the assortment of the researched group due to the manufacturing countries, dosage forms and composition of active pharmaceutical ingredients and their origin. The results of market research can determine the main ways of domestic assortment improvement of medications studied at the pharmaceutical and therapeutic group.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords&lt;/strong&gt;: medications for treatment of chronic obstructive pulmonary disease, the pharmaceutical market of Ukraine and Poland.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction&lt;/strong&gt;. Nowadays, chronic obstructive pulmonary disease (COPD) is one of the biggest health problem. It is a major cause of morbidity and mortality in the world due to the medical, social and economic terms. Thus, according to the latest data of the World Health Organization, currently about 210 million people are suffering from COPD and more than 2.75 million people die of COPD each year. Late diagnosis and inappropriate treatment lead to incapacitation and early disability. After 10 years, every fourth ill patient with COPD becomes disabled.&lt;/p&gt;&lt;p&gt;In accordance with the mentioned above information, comparative marketing analysis of medication assortment for the treatment of COPD are currently important at the domestic pharmaceutical market and at the market of Poland as one of the most developed markets of the European Union to determine the feasibility of developing new medications and the possibility to take the particular market field.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results and discussion. &lt;/strong&gt;During the study it was used general rules for secondary collecting market information, methods of mathematical statistics. The information technologies are used for processing the results of the research. The analysis of the range of medication was done according to the classification of Anatomical Therapeutic Chemical (ATC) system using secondary information of electronic database of the State Registry of Medicines, Compendium, Pharmindex and data of information and analytical system «Baza leków DrWidget».&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;The objects of the study were medications of R03 group «Medications used for the obstructive respiratory diseases» (according to the ATC classification): adrenergic medications for inhalation use (group R03A), inhaled asthma agents (group R03B), adrenergic medications for regular use (group R03C), other medications for regular use of the obstructive respiratory diseases (group R03D). Market research of medications for the treatment of COPD was performed on various parameters, including the manufacturing countries, dosage form and content of active pharmaceutical ingredients and their origin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;1. It was studied the medication assortment for COPD treatment listed on the pharmaceutical markets inUkraineandPoland. As a result of studies, it was found that the products in both countries are generally represented by foreign manufacturers, particularly inUkraine, their market share is 78.57 %, while inPoland– 80 %.&lt;/p&gt;&lt;p&gt;2. The market analysis data indicates that among foreign manufacturers of medication for COPD treatment at Ukrainian pharmaceutical market leading positions are occupied by 4 countries: the Great Britain, Spain, Poland and India; at the Polish market, the following countries are the leaders of medication delivery: the Great Britain, Germany, Switzerland and Israel.&lt;/p&gt;&lt;p&gt;3. The comparison of assortment represented at the pharmaceutical market ofUkraineandPolandon the dosage form indicates that the largest share has aerosols (23.81 %) at Ukrainian market and chewable tablets (29.57 %) at Polish.&lt;/p&gt;&lt;p&gt;4. The medication assortment for COPD treatment is represented only with synthetic drugs at both pharmaceutical markets, while the main group inUkraineis a group of medications based on montelukast, theophylline, budesonide, fluticasone and inPoland– montelukast, salbutamol, budesonide.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;References&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;1. Feshchenko Yu.I., Yashyna L.O., Potoczniak O.V. Chronic obstructive pulmonary disease and concomitant depression – an important medical and social problem // Ukrainian pulmonological journal. – 2013. – No.3. – P.56 – 58. – Access mode: http://www.ifp.kiev.ua/doc/journals/upj/13_dop/56.pdf&lt;br /&gt; 2. Tytova O.N. Clinical and pharmacoeconomic approaches for effective medical rehabilitation of patients disabled by chronic obstructive pulmonary disease: abstract of the thesis of the Candidate of Medical Sciences / O.N. Tytova – St. Pitersberg, 2008. – 25 p.&lt;/p&gt;&lt;p&gt;3. State Registry of Medicines of Ukraine. – [electronic version].– Access mode: http://www.drlz.kiev.ua/&lt;br /&gt; 4. Pharmindex [ electronic version]. – Access mode: &lt;a href="http://pharmindex.pl/"&gt;http://pharmindex.pl&lt;/a&gt;&lt;/p&gt;&lt;p&gt;5. Baza leków DrWidget [electronic version]. – Access mode: &lt;a href="http://drwidget.pl/"&gt;http://drwidget.pl/&lt;/a&gt;&lt;/p&gt;&lt;p&gt;6. Compendium. – [electronic version].– Access mode: http://compendium.com.ua/&lt;/p&gt;

B2-Агонисты ультрадлительного действия и их роль в терапии хронической обструктивной болезни легких и бронхиальной астмы

b2-Агонисты ультрадлительного действия и их роль в терапии хронической обструктивной болезни легких и бронхиальной астмы

CHRONIC OBSTRUCTIVE PULMONARY DISEASE: DEFINITION, EPIDEMIOLOGY, PATHOPHYSIOLOGY, CLINICAL PICTURE AND TREATMENT (GOLD 2013)

Chronic obstructive pulmonary disease: definition, epidemiology, pathophysiology, clinical picture (GOLD 2013). Vatutin M.T., Smyrnova G.S., Taradin G.G. The represented translation of the new international guidelines (GOLD 2013) reflected the epidemiology, pathophysiology, clinical picture and treatment of chronic obstructive pulmonary disease.

Clinical observation and nursing of noninvasive ventilation in the treatment of chronic obstructive pulmonary disease combined with respiratory failure

Objective To explore the clinical observation and nursing of noninvasive ventilation in the treatment for chronic obstructive pulmonary disease combined with respiratory failure. Methods A total of 152 cases of patients diagnosed with chronic obstructive pulmonary disease combined with respiratory failure in our hospital from January 2014 to March 2015 were randomly divided into treatment group and control group, with 74 cases in each group.Patients of control group were given conventional treatment, and those of observation group were given noninvasive ventilation.And blood gas analysis before and after the treatment, clinical treatment and respiratory frequency and heart rate of patients were compared between two groups. Results There was no obvious difference between two groups in index of blood gas analysis, respiratory frequency and heart rate before treatment.The differences between the two groups were statistically significant after treatment (P<0.05). The control group had no significant change in pH before and after treatment.While compared with pre-treatment, PaO2 and PaCO2 of the control group changed a lot.There was significantly difference between before and after the treatment in patients of observation group in index of blood gas analysis.Statistical significance was shown on the incidence of complications, duration of treatment, efficiency between two groups. Conclusion The introduction of noninvasive ventilation in treating chronic obstructive pulmonary disease combined with respiratory failure can effectively relieve clinical symptoms, and improve the index of blood gas analysis and quality of life in patients.The treatment method is safe, ideal and reliable, so that it has a broad prospect. Key words: Noninvasive ventilation; Chronic obstructive pulmonary disease; Respiratory failure

Once-daily glycopyrronium bromide (Seebri Breezhaler®) for the treatment of chronic obstructive pulmonary disease (COPD)

Introduction: Long-acting bronchodilators are the mainstay of pharmacological therapy for patients with chronic obstructive pulmonary disease (COPD). The choice of optimal bronchodilator therapy for COPD is increasingly difficult for clinicians as new treatments are marketed.Areas covered: Inhaled glycopyrronium bromide (Seebri Breezhaler®) is a well-tolerated long-acting anti-muscarinic agent (LAMA) with a fast onset of action. In patients with moderate to severe COPD, glycopyrronium bromide has clinically important effects on level of FEV1, use of relief medication, day-time dyspnea scores, and probably also on health status. Furthermore, glycopyrronium bromide also has beneficial effects on dynamic hyperinflation and, probably by that, exercise tolerance. Glycopyrronium bromide has been shown to reduce the rate of exacerbations in patients with moderate to severe COPD, although as a secondary outcome only. Expert opinion: Once-daily inhaled glycopyrronium bromide has positive impact on important COPD outcomes, comparable to the effects of other marketed LAMAs. Once-daily administration may improve adherence, and glycopyrronium bromide has the potential for a role in the future management of COPD similar to that of other long-acting anti-muscarinic agents, including tiotropium. Studies of glycopyrronium bromide with exacerbation rate as the primary outcome of interest is needed.

An integrative approach in the treatment of chronic obstructive pulmonary disease: The role of the ozone therapy

An integrative approach in the treatment of chronic obstructive pulmonary disease: The role of the ozone therapy

Trends in In-Hospital Outcomes Among Adults Hospitalized With Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Although substantial advances have been made in the treatment of chronic obstructive pulmonary disease (COPD), little is known regarding the impact of these advancements on inpatient outcomes over time. We sought to examine temporal trends in in-hospital outcomes among adults hospitalized with COPD exacerbation.Methods: The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample was utilized to identify a cohort of adults hospitalized with COPD exacerbation, identified through International Classification of Diseases-9 codes. Baseline demographics, medical history, and clinical outcomes were assessed in 3,060,565 hospitalizations in patients with COPD exacerbation from 2006–2009.Results: In-hospital all-cause mortality significantly decreased over the 4-year study period (5.1%, 4.7%, 4.5%, and 4.2% from 2006-2009; p < 0.001). The decline in mechanical ventilation (5.8% 5.7%, 5.3%, and 5.4% from 2006–2009; p < 0.001) was accompanied by a nearly 50% rise in noninvasive positive pressure ventilation utilization (NIPPV) (2.3%, 2.9%, 3.3%, and 3.5% from 2006–2009; p < 0.001). Average hospital length of stay (LOS) decreased over the study period (6.3, 6.1, 5.8, and 5.7 days from 2006-2009; p < 0.001). These relationships remained significant in fully-adjusted multivariate analyses (referent year 2006: p < 0.001 for years 2007–2009 for mortality, mechanical ventilation, and hospital LOS; p < 0.001 for years 2008–2009). Multivariate analysis of predictors of mortality remained similar for Years 2006–2009 with mechanical ventilation, age greater than 75 years, and NIPPV use serving as the strongest predictors of mortality.Conclusion: During 2006–2009, a significant decline in mortality was accompanied by less frequent mechanical ventilation, more frequent NIPPV use, and shorter LOS in adults hospitalized with COPD exacerbation.

Advances in Prevention and Treatment of Chronic Obstructive Pulmonary Disease.

Advances in Prevention and Treatment of Chronic Obstructive Pulmonary Disease.

The clinical effect observation of the non invasive positive pressure mechanical ventilation for the treatment of chronic obstructive pulmonary disease with II respiratory failure

Objective To explore the noninvasive positive pressure ventilation combined with pulmonary function and blood gas analysis of chronic obstructive pulmonary disease(COPD)with typeⅡrespiratory failure. Methods 120 COPD patients with type II respiratory failure were selected,they were randomly divided into the control group and observation group by using the random number table method,with 60 cases each group.The control group was given conventional low flow oxygen therapy,the observation group was application of noninvasive positive pressure ventilation treatment.The change of blood gas levels,the forced expiratory volume in one second(FEV1),forced expiratory volume in one second to forced vital capacity ratio(FEV1/FVC)before treatment and after one week treatment,and the intubation rate,the average hospitalization time were observed .Results After treatment,FEV1,FEV1/ FVC(%),PaO2,p H of the two groups were higher than those before treatment,while PaCO2 was lower than that before treatment,the differences were statistically significant(t= 8.33,12.56,14.71,10.82,7.88,10.14,13.20,15.63, 11.48,8.37,all P<0.05).FEV1 and FEV1/FVC(%)of the observation group after treatment were(2.84±0.42)L and(69.93±0.72),which were higher than those of the control group after the treatment(2.69±0.39)L and(67.11 ±0.78),the difference was statistically significant(t= 8.95,10.76,all P< 0.05).PaO2 and p H of the observation group after treatment were(77.90±1.12)mm Hg and(7.41±0.10),which were higher than those of the control group after treatment(70.88±1.14)mm Hg and(7.29±0.08),the difference was statistically significant(t= 11.58, 7.94,all P<0.05).PaCO2 of the observation group was(50.14±1.23)mm Hg,which was lower than that of before treatment(54.26±1.12)mm Hg,the difference was statistically significant(t= 9.81,P< 0.05).The intubation rate of the observation group was 1.67%(1/60),which was lower than that of the control group 13.33%(8/60),the difference was statistically significant(χ2= 7.90,P< 0.05).The average hospital stay time of the observation group was(11.69±1.32)d,which was lower than that of the control group(15.10±1.28)d,the difference was statistically significant(t= 9.84,P< 0.05). Conclusion Noninvasive positive pressure ventilation could significantly improve lung function of COPD patients with type II respiratory failure,increase PaO2,improve the respiratory status of the patients,reduce intubation rate and shorten the hospitalization time. Key words: Positive pressure ventilation; Pulmonary disease,chronic obstructive; Respiratory failure,type II

Application effect of Thymalfasin for injection in the treatment of chronic obstructive pulmonary disease

Objective To explore the application effect of Thymalfasin for injection in the treatment of chronic obstructive pulmonary disease. Methods Clinical data of 80 patients with chronic obstructive pulmonary disease were retrospectively analyzed. According to different treatment methods, they were divided into the treatment group and control group,40 cases in each group. The control group was given routine treatment,the observation group were given Thymalfasin for injection with thymus method on the basis of conventional treatment. The treatment effect, improve pulmonary function, blood gas and TLC immune function of the two groups were observed. Results The total effective rate of the observation group was 95.0%,which was significantly higher than 82.5%of the control group(χ2=5.274 5,P<0.05);After treatment in patients with pulmonary function, blood gas to improve the situation and TLC were better than those of the control group(all P<0.05);The rate of adverse reactions of the observation group was 5.0%,which was significantly lower than 20.0%of the control group(χ2=4.114 3,P<0.05). Conclusion Thymalfasin for injection with thymus method in chronic obstructive pulmonary disease treatment has good effect, high cure rate, less adverse reaction. Key words: Pulmonary Disease, Chronic Obstructive; Thymalfasin; Treatment Outcome