Background: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. Objective: To find the causes and the treatment results for acute exacerbation of COPD at Department of Respiratory of Bach Mai Hospital. Subjects and method: A study conducted in 87 patients treated by an acute exacerbation of COPD at Department of Respiratory of Bach Mai Hospital from March to August 2005. Results and conclusions: 88.5% of patients were men. Severe patients were most common in age over 55 years. The risk factor was smoking (over 66.7%). 47.8% of patients were in III stage and 37.7% were in IV stage. The cause of acute exacerbation of COPD was bronchial surinfection (83.9%); and 37.9% of them refused an antibiotic or bronchodilatators at home when they had severe symptoms of exacerbation. Most of them did not have enough condition in their homes for treatment (oxygen, aerosol machine). After 20 days (16.69 \xb1 8.7 days) treated by antibiotics, bronchodilatators, corticoid and oxygen, 90.8% of our patients were at good health. 2 of them were died by severe disease.
Pulmonary Disease ; Chronic Obstructive/ therapy

Background: Exacerbation of chronic obstructive pulmonary disease (COPD) is the common complication of COPD and sometimes is lethal cause of patients. Objective: To study clinical manifestations of exacerbation of 150 patients with COPD by Anthonisen's classification at the Department of Respiratory of Bach Mai hospital. Subjects and method: A retrospective, prospective, descriptive study included 150 patients in Department of Respiratory of Bach Mai hospital, from February 2005 to March 2006. Retrospective study included 100 patients and prospective study included 50 patients. Results and conclusions: The male - to - female ratio is 6:1. The average age of patients was 68.85 \xb1 9.45 years. The most of age group was 61 - 70 years. 73.33% patients hospitalized were belonged to type I - this was serious type and similarity of III-IV stage according to GOLD 2003' classification of COPD. 100% of cases hospitalized with dyspnea, 90.6% cough with purulent sputum, 58.7% fever.
Pulmonary Disease ; Chronic Obstructive/ diagnosis ; therapy

Humans ; Pulmonary Disease, Chronic Obstructive/therapy* ; Asthma/therapy*

We propose a clinical pathway of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) based on state machine. Clinical event-driven response was utilized to control workflow execution of the AECOPD clinical pathway. By comparison with the traditional clinical pathway management, clinical numerical results showed that the proposed method was better in hospitalization days, average hospitalization expense and aberration rate, and better handled the variability in the AECOPD clinical pathway execution.
Critical Pathways ; Humans ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; nursing ; therapy

BACKGROUNDThe evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life (HRQL), survival and mortality in severe stable COPD patients.

METHODSRandomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated.

RESULTSFive RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included. NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26, -1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23, 5.44) mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV(1)) was 0.00 (0.29, 0.29). And the benefits for exercise tolerance, mood, survival and mortality remained unclear.

CONCLUSIONSPatients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.

Chronic obstructive pulmonary disease (COPD) remains a severe public health problem. Acute exacerbation of COPD (AECOPD) is a major factor that influences the process of COPD. Strengthening the treatment of AECOPD is very essential. AECOPD risk window (AECOPD-RW) refers to the period from AECOPD remission to the time before the stable phase. The condition is very unstable. Symptoms are relieved but continually exist. The lung function has not restored to the levels of the stable phase. The inflammatory reactions continually exist. In this period patients are most liable to suffer from AECOPD, resulting in higher hospital admission rate and higher mortality. Dispelling pathogens should be taken as the main principle for AECOPD treatment. However, when it transforms from AECOPD to AECOPD-RW, strengthening the body resistance should be taken as the main principle. The proposal of AECOPD-RW has provided new thoughts and strategies for COPD. In this period deficiency syndrome dominates, most being lingering pathogens due to deficient vital qi. Qi deficiency and qi-yin deficiency are the most common syndromes, involving Fei, Pi, and Shen. Deficiency of both Fei and Shen dominates, complicated with phlegm and stasis. Therefore, the treatment principle of AECOPD-RW should focus on tonifying the deficiency and strengthening the body resistance, assisted with dissipating phlegm and activating blood circulation.
Humans ; Medicine, Chinese Traditional ; methods ; Pulmonary Disease, Chronic Obstructive ; therapy

Global Health ; Humans ; Pulmonary Disease, Chronic Obstructive ; prevention & control ; therapy

OBJECTIVE: To systematically evaluate the efficacy and safety of conventional therapy combined with moxibustion in the treatment of chronic obstructive pulmonary disease (COPD) in stable phase based on Meta-analysis medicine. METHODS: The randomized controlled trials (RCTs) of moxibustion as adjuvant therapy for COPD were retrieved from the databases of CNKI, Wanfang, SinoMed, PubMed, Web of Science, Cochrane Library and Ebsco. RevMan5.3 software was used for Meta analysis, and the quality of evidence was evaluated according to GRADE standards. RESULTS: A total of 16 RCTs were included, involving 1425 patients. The results of Meta-analysis showed that: compared with the conventional treatment, ①the adjuvant therapy with moxibustion had advantages in reducing the number of acute exacerbations [ CONCLUSION The efficacy of moxibustion as adjuvant therapy for COPD in stable phase is better than that of simple conventional therapy. Due to insufficient clinical evidence and the limitations of this study, clinical safety is unclear and further evidence is needed to support the results.
Humans ; Lung ; Moxibustion ; Pulmonary Disease, Chronic Obstructive/therapy* ; Treatment Outcome

The plateau environment is characterized by low oxygen, low air pressure, low temperature, and strong ultraviolet rays, etc. Chronic obstructive pulmonary disease (COPD) is a preventable and treatable chronic lung disease. High altitude environment increases COPD prevalence, clinical manifestation and mortality. The therapeutic window of theophylline drugs for COPD is narrow, and the high altitude environment has an influence on the pharmacokinetics of the drugs. This review summarizes the differences in the prevalence, mortality, clinical manifestation and clinical symptoms of COPD in the plateau and plain, providing a basis for identifying the risk factors of COPD in the plateau areas. The effects of plateau hypoxic environment on the pharmacokinetics of COPD drugs were also discussed. It can provide a rationale for more effective prevention and treatment of COPD at high altitude.
Humans ; Altitude ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Oxygen ; Hypoxia

Chronic obstructive pulmonary disease (COPD) has a high global morbidity and mortality and a severe disease burden, yet progress in treatment and prevention has been slow in recent decades. Early COPD has few symptoms and is severely underdiagnosed and undertreated; it is crucial to search for effective clues of early COPD and provide management interventions. By reviewing the definition, risk factors, diagnosis and management interventions, this study explores the disease evolution of early-stage COPD, which can help clinical practice to develop more effective preventive and therapeutic strategies for stopping or slowing down the natural progression of the disease, improving the long-term prognosis, and reducing the disease burden.
Humans ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Prognosis ; Risk Factors