OBJECTIVETo investigate the imaging and hemodynamical features of pulmonary artery branches in chronic obstructive pulmonary disease (COPD) with pulmonary artery hypertension (PAH).

METHODSCT pulmonary angiography (CTPA) with ECG-gating was performed in 13 patients with clinical diagnosed COPD and 25 normal subjects. The thin-slice multiple plane reconstruction in systole and diastole phase was conducted, which in turn was used to generate the InSpace reconstructed images with reference frame of the main pulmonary artery and the first two grades branches, the contour of the branches was depicted. On the base of coordinates, the GAMBIT was used to generate nodes and furthermore meshes, then the software Fluent was used for numerical calculation and flow simulation. The velocity and pressure changes in the main pulmonary artery and the first two grades branches during different periods of cardiac cycle were observed in both groups.

RESULTCTPA showed that the diameter of the main pulmonary before bifurcate and proximal of the first two branches was larger in systole period than that in diastole period. The diameter of the second segmental artery of right upper lobe was larger during diastole period. The length of the main pulmonary and the first two branches showed no significant difference in both diastole and systole periods. There was no significant difference in length of pulmonary arteries between COPD and normal groups. The main pulmonary to distal right pulmonary artery appeared larger in diastole period. Compared with normal, in COPD group several arteries increased in diameter including proximal and distal of the proximal right pulmonary artery and the proximal right pulmonary artery during systole and diastole periods. In systole period only the diameter of the main pulmonary before bifurcate got larger and the back basic segmental artery of both lower lobe show smaller than normal. The flow condition analysis in COPD and normal groups suggested higher pressure in pulmonary arteries during systole period than that in diastole period, both groups showed high pressure area below the branching point. In COPD patients the right lower lobe artery endured the most significant pressure fall during the two periods and high pressure distributed larger area than normal. Flow velocity in main branch was faster than lower grade branches and that in systole period was faster than that in diastole period. The trend of diffusion of high pressure area was more prominent in diastole period than normal and the influence more prominent.

CONCLUSIONThe distal part of right pulmonary artery to lower lobe artery may be affected earlier when the pulmonary pressure increased. It is feasible to study the changes of flow condition in pulmonary artery branches though the combination of CTPA image and relevant software.

Adult ; Angiography ; methods ; Case-Control Studies ; Humans ; Hypertension, Pulmonary ; etiology ; physiopathology ; Middle Aged ; Pulmonary Artery ; diagnostic imaging ; physiopathology ; Pulmonary Disease, Chronic Obstructive ; complications ; physiopathology ; Tomography, Spiral Computed

BACKGROUNDImmunostimulating agents made from bacterial extracts represent a class of medications that contains antigens derived from several bacterial strains and their potential ability to prevent bacterial infections results from the stimulation of the nonspecific component of the immune system. The present study investigated the effect of the oral immunostimulant Broncho-Vaxom, which includes material from eight different species of bacteria that are frequently present in the lower respiratory tract, on the frequency and severity of acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease (COPD).

METHODSNinety patients with chronic bronchitis complicated with COPD were randomly divided into groups A and B. Forty-nine subjects in group A received oral capsules containing 7 mg Broncho-Vaxom, while 41 patients in group B received similar placebo capsules. Both groups took one capsule daily for the first 10 days of each month for 3 consecutive months. The frequency of acute exacerbation, symptom scores, and lung function were recorded for the following one year period.

RESULTSThere was a significant decrease in the incidence, duration, and severity of acute exacerbation, as well as a reduction in the course of antibiotics administered and in the dosage of bronchodilator and mucolytic agent in group A, as compared to group B (P < 0.05, respectively). Symptom scores for cough, sputum, dyspnea, as well as symptoms observed upon auscultation of the chest also improved significantly in group A as compared to group B (P < 0.05, respectively). The bacterial clearance rate in sputum cultures from patients who received no antibiotics for the first 3 months was also significantly higher in group A compared to group B (P < 0.01).

CONCLUSIONSOrally administered Broncho-Vaxom is associated with a decrease in the incidence of acute exacerbation and a decrease in the need for antibiotics and symptomatic relief medications in patients with chronic bronchitis accompanied by COPD. Broncho-Vaxom is also associated with a decrease in symptom scores. Without causing any apparent adverse effects, this drug may also help to eradicate pathogenic bacteria in the airways.

Adjuvants, Immunologic ; therapeutic use ; Aged ; Aged, 80 and over ; Bacteria ; Bronchitis ; complications ; Cell Extracts ; therapeutic use ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; therapy

A reduction in diaphragm mobility has been identified in patients with chronic obstructive pulmonary disease (COPD) and has been associated with a decline in pulmonary function parameters. However, little information exists regarding the potential role of diaphragm mobility on hypercapnia in COPD. A new method of assessing the mobility of the diaphragm, using ultrasound, has recently been validated. The purpose of the present study was to investigate the relationship between diaphragm mobility and pulmonary function parameters, as well as that between arterial blood gas values and diaphragm mobility, in COPD patients. Thirty seven COPD patients were recruited for pulmonary function test, arterial blood gas analysis and diaphragm mobility using ultrasound to measure the craniocaudal displacement of the left branch of the portal vein. There were significant negative correlations between diaphragmatic mobility and PaCO2 (r = -0.373, P = 0.030). Diaphragmatic mobility correlated with airway obstruction (FEV1, r = 0.415, P = 0.011) and with ventilatory capacity (FVC, r = 0.302, P = 0.029; MVV, r = 0.481, P = 0.003). Diaphragmatic mobility also correlated significantly with pulmonary hyperinflation. No relationship was observed between diaphragm mobility and PaO2 (r = -0.028, P = 0.873). These findings support a possibility that the reduction in diaphragm mobility relates to hypercapnia in COPD patients.
Aged ; Airway Resistance/physiology ; Carbon Dioxide/blood/physiology ; Diaphragm/physiopathology/*ultrasonography ; Female ; Humans ; Hypercapnia/complications/*physiopathology ; Male ; Middle Aged ; Portal Vein ; Pulmonary Disease, Chronic Obstructive/complications/*physiopathology/ultrasonography ; Pulmonary Gas Exchange ; Respiratory Muscles/physiopathology

OBJECTIVETo investigate the accuracy and potential error range of noninvasive estimation of CO2 pressure (PCO2), arterial O2 pressure (PaO2), and oxygenation index (OI) by measuring the end-tidal CO2 pressure (PETCO2) and pulse oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure, and assess the feasibility of this method for dynamic monitoring of arterial CO2 pressure (PaCO2) and PaO2 in the primary care facilities where arterial blood gases analysis is not available.

METHODSAll the 30 patients with COPD and respiratory failure received routine clinical treatment including bronchodilators, mucolytics, glucocorticosteroid, antibiotics and oxygen therapy (titrated to keep SpO2 above 90%) for 5-7 days. A subgroup of the patients also received NIPPV treatment. All the patients were tested with both the eupnea method and prolonged expiratory method before and after the treatment to obtain the data of PCO2 and SpO2 were respectively performed before and after treatment.

RESULTSThe PETCO2 with eupnea (PETCO2(Q)) was 50.72-/+8.93 mmHg, significantly lower than PaCO2 (71.25-/+9.08 mmHg, Plt;0.01), but the PETCO2(P) (70.35-/+8.91 mmHg) was comparable with PaCO2 (P>0.05). Similar results were obtained after the treatment. The PETCO2(P) before treatment and after treatment was positively correlated to PaCO2 (r=0.96 and 0.97, respectively, P<0.01). The PaO2(Y) before the treatment derived from the oxygen dissociation curve based on SpO2 measurement was close to SpO2 (59.96-/+1.42 mmHg vs 59.07-/+2.22 mmHg, P>0.05). The OI derived from PaO2 and OI(Y) from PaO2 (Y) was also similar (215.70-/+22.77 vs 219.15-/+24.63, P>0.05). Linear regression analysis showed positive correlations between PaO2(Y) to PaO2 (r=0.81, P<0.01) and between OI(Y) and OI (r=0.95, P<0.01).

CONCLUSIONSIn patients with COPD (especially those with also type II respiratory failure), the modified monitoring method of PCO2 and maintenance of SpO2 above 90% can precisely estimate PaCO2 and PaO2. This method is feasible for clinical noninvasive and dynamic evaluation of respiratory failure in COPD patients, especially in primary care facilities where arterial blood gases analysis is not available.

Aged ; Aged, 80 and over ; Blood Gas Monitoring, Transcutaneous ; Capnography ; Humans ; Male ; Middle Aged ; Oximetry ; Pulmonary Disease, Chronic Obstructive ; blood ; complications ; physiopathology ; Respiratory Insufficiency ; blood ; etiology ; physiopathology ; Tidal Volume

BACKGROUND: Lung cancer and chronic obstructive pulmonary disease (COPD) are both common diseases in respiratory system and the leading causes of deaths worldwide. The purpose of this study was to determine whether the severity of COPD affects long-term survival in non-small cell lung cancer (NSCLC) patients after surgical resection. METHODS: A retrospective research was performed on 421 consecutive patients who had undergone lobectomy for NSCLC. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed. RESULTS: A total of 172 patients were diagnosed with COPD, 124 as mild (GOLD-1), 46 as moderate(GOLD-2), and 2 as severe (GOLD-3). The frequencies of recurrence were significantly higher in higher COPD grades group (P<0.001). Recurrence-free survival at five years were 78.1%, 70.4%, and 46.4% in Non-COPD, GOLD-1 COPD, and GOLD-2/3 COPD groups, respectively (P<0.001). In univariate analysis, age, gender, smoking history, COPD severity, tumor size, histology and pathological stage were associated with recurrence-free survival. Multivariate analyses showed that older age, male, GOLD-2/3 COPD, and advanced stage were independent risk factors associated with recurrence-free survival. CONCLUSIONS NSCLC patients with COPD are at higher risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor. The severity of COPD based on pulmonary function test can be a useful indicator to identify patients at high risk for recurrence. Therefore, it can contribute to adequate selection of the appropriate individualized treatment.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; complications ; mortality ; physiopathology ; surgery ; Female ; Humans ; Lung Neoplasms ; complications ; mortality ; physiopathology ; surgery ; Male ; Middle Aged ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; complications ; mortality ; physiopathology ; Respiratory Function Tests ; Retrospective Studies

PURPOSE: The purpose of this study was to identify the factors influencing fatigue in patients with chronic obstructive pulmonary disease. METHODS: A descriptive correlational study design was used. A convenience sample of 125 subjects was recruited from the outpatient respiratory clinic at a large university hospital. Data was collected from June to October, 2005 using structured questionnaires, an oxygen saturation test, a 6-minute walking test, and a pulmonary function test. RESULTS: Subjects had a slightly low degree of fatigue. The fatigue showed a significant correlation with emotion(r= .589, p= .000), dyspnea(r= .304, p= .001), self-efficacy (r= -.278, p= .002), and symptom experience(r= .238, p= .008). Emotion(34.7%) and dyspnea(5.8%) were significant predictors to explain fatigue. CONCLUSION: This study provides comprehensive understanding of the influencing factors on fatigue in patients with chronic obstructive pulmonary disease. Nursing interventions to decrease negative emotion and dyspnea for management of fatigue is suggested.
Aged ; Dyspnea/etiology ; Emotions/physiology ; Fatigue/*etiology/psychology ; Female ; Humans ; Male ; Middle Aged ; Oximetry ; Pulmonary Disease, Chronic Obstructive/*complications/physiopathology/psychology ; Questionnaires ; Regression Analysis

OBJECTIVETo explore the correlation between bone mineral density and Syndrome type of TCM in patients with chronic obstructive pulmonary disease (COPD) for providing the base of clinical integrative traditional Chinese and western medical therapy for the disease through the Syndrome typing and determination of changes in bone metabolism and bone density.

METHODSBone mineral density (BMD) of lumbar vertebrae 2-4, femoral neck, Ward's triangle and trochanter in 27 COPD male patients, 25 male control subjects and 25 healthy persons were determined using dual energy X-ray absorptiometry, patient's Syndrome type, their blood levels of total protein, albumin, alkaline phosphatase, bone glaprotein, hydroxyproline, calcium, phosphate, urine levels of calcium/creatine and phosphorous/creatine as well as arterial blood gas were also determined.

RESULTSThe BMD in COPD patients accompanied with respiratory failure or with course > 10 years was higher than that in COPD patients without respiratory failure or with course < or = 10 years, BMD in COPD patients of Fei-Pi-Shen type was lower than that in those of Fei-Pi, but the urine hydroxyprdine in the former was higher than that in the latter (all P < 0.05).

CONCLUSION(1) COPD is a risk factor for osteoporosis; (2) Shen Deficiency is the key and nucleus of secondary osteoporosis to COPD; (3) It is inferred that early regulation of Shen may be facilitated to prevent osteoporosis in COPD patients.

Aged ; Bone Density ; Diagnosis, Differential ; Humans ; Kidney ; physiopathology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Osteoporosis ; diagnosis ; etiology ; Pulmonary Disease, Chronic Obstructive ; complications ; diagnosis ; Yang Deficiency ; diagnosis

OBJECTIVETo examine the correlation of the changes in the serum markers (C-reactive protein, endothelin-1, interleukin-6, and brain natriuretic peptide) with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension secondary to COPD.

METHODSA total of 174 COPD patients with acute exacerbation, admitted between February 2011 and February, 2013, were enrolled in this study, with 43 volunteers with normal pulmonary functions as controls. Pulmonary arterial pressure was determined by Doppler echocardiograph, and the severities (mild, moderate and severe) of PH secondary to COPD was evaluated. The levels of serum markers were determined using ELISA kits.

RESULTSThe levels of serum markers in patients with COPD was significantly elevated compared with those of the control subjects (P<0.05), and further increased in patients with pulmonary hypertension secondary to COPD (P<0.05). A positive correlation was found between these serum markers and pulmonary artery pressure in COPD patients with mild and moderate pulmonary hypertension. In patients with severe pulmonary hypertension, only the serum level of brain natriuretic peptide continued to increase with pulmonary artery pressure (P<0.05), and the other markers did not further increase.

CONCLUSIONSEarly and combined examination of these serum markers in patients with COPD can help to identify pulmonary hypertension in early stage and estimate the severity of pulmonary hypertension. Hemodynamic monitoring of the changes of these serum markers can be of important clinical value in the treatment of pulmonary hypertension secondary to COPD and in evaluation of the prognosis of COPD.

Aged ; Biomarkers ; blood ; Blood Pressure ; C-Reactive Protein ; metabolism ; Endothelin-1 ; blood ; Female ; Humans ; Hypertension, Pulmonary ; blood ; complications ; physiopathology ; Interleukin-6 ; blood ; Male ; Natriuretic Peptide, Brain ; blood ; Pulmonary Disease, Chronic Obstructive ; blood ; complications ; physiopathology

OBJECTIVETo investigate the impact of proportional assist ventilation (PAV) on tolerance and breathlessness in ventilated chronic obstructive pulmonary disease (COPD), and to describe the patient-ventilator interaction, hemodynamic state, breathing pattern and work of breath during PAV and pressure support ventilation (PSV).

METHODSTen intubated COPD patients on weaning from mechanical ventilation were studied. Elastance and resistance were measured by both the inspiratory-hold technique during a brief period of volume control ventilation and runaway technique during PAV. Each assistance level of PAV (80%, 60% and 40%) and PSV was selected randomly. Patients' response, hemodynamics, blood gas and lung mechanics were monitored.

RESULTSTidal volume and respiratory rate didn't change in a consistent manner as the level of assist was decreased (P > 0.05). With the level of assist increasing, peak inspiratory pressure was increasing significantly (P < 0.05), while patients' work of breath had the tendency to decrease (P < 0.05). A significant difference in the Borg Category Scale was observed between PAV and PSV (0.50 [1.50] vs. 0.75 [2.00], P < 0.05) at the same degree of respiratory muscle unloading. PaCO(2) was significantly higher on PAV (54 [23] mm Hg) than on PSV (48 [23] mm Hg) (P < 0.05). Peak inspiratory pressure on PAV was significantly lower than on PSV (16 +/- 4 cm H(2)O vs. 21 +/- 3 cm H(2)O, respectively, P < 0.05). Hemodynamics and oxygenation remained unchanged.

CONCLUSIONSPAV is a feasible method for supporting ventilator-dependent patients and was well tolerated. It can improve the breathing pattern and reduce inspiratory effort. At the same degree of respiratory muscle unloading, PAV can be implemented at much lower peak inspiratory pressure than PSV. It can also apply proportional pressure support according to the patients' ventilatory demand.

Aged ; Blood Gas Analysis ; Female ; Hemodynamics ; Humans ; Male ; Positive-Pressure Respiration ; Pulmonary Disease, Chronic Obstructive ; complications ; Pulmonary Gas Exchange ; Pulmonary Ventilation ; Respiration, Artificial ; methods ; Respiratory Insufficiency ; etiology ; physiopathology ; therapy

OBJECTIVE: To determine effects of the RhoA/Rho kinase signaling pathway on patients with pulmonary arterial hypertension related to chronic obstructive pulmonary diseases by testing levels of Rho-associated coiled-coil containing protein kinase 1(ROCK1) in peripheral blood monocytes in healthy subjects, patients with chronic obstructive pulmonary diseases (COPD), and patients with pulmonary arterial hypertension related to COPD. METHODS: Ten healthy subjects (Group A), 10 patients with COPD (Group B), and 10 patients with pulmonary arterial hypertension related to COPD (Group C) were enrolled, all of whom were hospitalized in the Third Hospital of Changsha between Dec. 2010 and Apr. 2011. Twenty milliliters of blood was collected from each subject. The peripheral blood mononuclear cells (PBMC) were separated by Percoll and, monocytes were incubated. Levels of ROCK1 in the three groups were measured by ELISA. The pulmonary function was measured by spirometric tests, and the pulmonary arterial systolic pressure (PASP) was detected by color Doppler echocardiogram. RESULTS: 1)The PASP in Group C was significantly higher than that of Groups A and B(P<0.01). 2) The levels of ROCK1 in monocytes of Group C were higher than those of Groups A and B(P<0.05). The levels of ROCK1 in monocytes of Group B were higher than those of Group A (P<0.05). 3) The levels of ROCK1 in monocytes of the three groups showed a positive correlation with PASP(r=0.661, P<0.05). 4) The levels of ROCK1 in monocytes of the three groups showed a negative correlation with forced expiratory volume at the first second/ forced vital capacity (FEV1%)(r=0.131, P>0.05). CONCLUSION Rho kinase plays a key role in the pathogenesis of pulmonary arterial hypertension. The ROCK1 may be a marker of the severity of pulmonary arterial hypertension related to COPD.
Aged ; Female ; Humans ; Hypertension, Pulmonary ; etiology ; metabolism ; physiopathology ; Leukocytes, Mononuclear ; metabolism ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; complications ; Signal Transduction ; physiology ; rho-Associated Kinases ; blood ; metabolism ; rhoA GTP-Binding Protein ; metabolism