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

Bronchial asthma and chronic obstructive pulmonary disease (COPD), as chronic airway inflammatory diseases, seriously threaten the health of human beings. Chinese medicine has obvious advantages in prevention and treatment of them. "Preventive treatment theory" is a sort summarization of preventive medicine in Chinese medicine. The theory is not only reflected at the disease prevention levels, also embodied in the active treatment and the rehabilitation process. It was especially deep and colorfully embodied in the prevention and treatment of chronic airway inflammatory diseases such as asthma and COPD. In this paper,clarified were the prevention and treatment targets, ways of thinking and methods in different stages of asthma and COPD from various viewpoints including prevention before disease occurrence, treating disease at disease onset, preventing the aggravation once disease occurs, and consolidation after disease occurs. We hope to improve ways of thinking and prevention and treatment levels of bronchial asthma and COPD by Chinese medicine.
Asthma ; prevention & control ; Chronic Disease ; Humans ; Medicine, Chinese Traditional ; methods ; Pulmonary Disease, Chronic Obstructive ; prevention & control

Humans ; Laryngeal Diseases ; prevention & control ; Larynx ; Pharyngeal Diseases ; prevention & control ; Pharynx ; Pulmonary Disease, Chronic Obstructive ; prevention & control

A comprehensive review of the research of the effectiveness of influenza vaccine and 23 valent pneumococcal polysaccharide vaccine (PPV23) in patients with chronic obstructive pulmonary disease (COPD) both at home and abroad in recent years showed that influenza vaccine and PPV23 immunization can significantly reduce the risk for influenza and pneumonia in COPD patients, and reduce the acute exacerbation of disease and related hospitalization. In particular, the influenza vaccination can also reduce the risk for ischemic heart disease, acute coronary syndrome, ventricular arrhythmia, lung cancer, dementia and death in the patients, and the immunization of both vaccines has a more significant protective effect. It is recommended by authoritative guidelines both at home and abroad that COPD patients can receive influenza vaccine and PPV23. At present, the coverage of domestic influenza and pneumococcal vaccines are low, and there are less studies in the applications of both vaccines in patients with COPD. Effective measures should be taken to strengthen the health education and increase the vaccination coverage. Additionally, the clinical research of influenza vaccine and PPV23 for COPD patients, especially the analysis on clinical benefit of immunization of both vaccines, should be further strengthened to effectively improve the survival and prognosis of COPD patients.
Humans ; Influenza Vaccines/therapeutic use* ; Influenza, Human/prevention & control* ; Pneumococcal Vaccines ; Pulmonary Disease, Chronic Obstructive ; Vaccination

Acute Disease ; Humans ; Pneumonia ; prevention & control ; Pulmonary Disease, Chronic Obstructive ; complications ; Respiration, Artificial ; Respiratory Insufficiency ; therapy ; Ventilators, Mechanical ; adverse effects

OBJECTIVETo investigate the protective and therapeutic effects of pulmonary surfactant in the pathogenesis of chronic obstructive pulmonary disease (COPD) in hamsters.

METHODSCOPD animal model was established by smoke inhalations and intratracheal instillations of pancreatic elastase in hamsters. Ninty hamsters were divided into 9 groups as follows: normal group (N), two groups received smoke inhalations for 1 and 3 months (S1 and S3), one group received intratracheal instillation of surfactant (10 mg/100 g BW) for once after 1 month smoking (SP1), one group was treated with surfactant after 1.5, 2 and 2.5 months of smoking (SP3), and two groups received intratracheal administration of elastase (40 U/100 g BW) and were killed after 1 month and 3 months, respectively (E1 and E3). The surfactant was injected intratracheally after 1 week, 0.5, 1.0, 1.5, 2.0, and 2.5 months, followed by administration with elastase (EP1 and EP3). EP1 group were killed at the first month, and EP3 at the third month. Light microscopy and electromicroscopy observations were performed in each group. Pulmonary mean linear intercept (MLI), mean alveolar numbers (MAN), and pulmonary alveolar area (PAA) was measured by image analysis. The expression of surfactant protein A (SP-A) were observed by immunohistochemistry.

RESULTSSmoking for 3 months and instillations of elastase resulted in chronic bronchitis and emphysema. MLI and PAA increased and MAN decreased in all the experimental groups compared with in the normal group (P < 0.05 or P < 0.01). Administration of surfactant for 3 months resulted in statistically significant inhibition of pulmonary injury. MLI and PAA decreased and MAN increased in SP3 compared with in S3. Only MLI decreased in EP3 compared with E3. The expressions of SP-A in the type II alveolar epithelia decreased in S3 and E3 (compared with the normal group P < 0.01). After pulmonary surfactant intervention, the expression of SP-A increased significantly.

CONCLUSIONPulmonary surfactant may have a long-term protective effect on chronic smoking and elastase-induced COPD.

Animals ; Cricetinae ; Male ; Mesocricetus ; Pancreatic Elastase ; Pulmonary Alveoli ; ultrastructure ; Pulmonary Disease, Chronic Obstructive ; metabolism ; prevention & control ; Pulmonary Surfactant-Associated Protein A ; metabolism ; Pulmonary Surfactants ; therapeutic use ; Smoking

Objective: To forecast the burden of chronic obstructive pulmonary disease (COPD) in China by 2030 and evaluate the effectiveness of controlling risk factors based on the predictive model. Methods: Based on the relationship between the death of COPD and exposure to risk factors and the theory of comparative risk assessment, we used the estimates of the Global Burden of Disease Study 2015 (GBD2015) for China, targets for controlling risk factors, and proportion change model to project the number of deaths, standardized mortality rate, and probability of premature mortality from chronic respiratory diseases by 2030 in different scenarios and to evaluate the impact of controlling the included risk factors to the disease burden of COPD in 2030. Results: If the trends in exposure to risk factors from 1990 to 2015 continued, the number of deaths and the mortality for COPD would be 1.06 million and 73.85 per 100 000 population in China by 2030, respectively, with an increase of 15.81% and 10.69% compared to those in 2015. Compared to 2015, the age-standardized mortality rate would decrease by 38.88%, and the premature mortality would reduce by 52.73% by 2030. If the smoking rate and fine particulate matter (PM_2.5) concentration separately achieve their control targets by 2030, there would be 0.34 and 0.27 million deaths that could be avoided compared to the predicted numbers based on the natural trends in exposure to risk factors and the probability of premature death would reduce to 0.59% and 0.52%, respectively. If the control targets of all included risk factors were achieved by 2030, a total of 0.53 million deaths would be averted, and the probability of premature death would decrease to 0.44%. Conclusions: If the exposures to risk factors continued as showed from 1990 to 2015, the number of deaths and mortality for COPD would increase by 2030 compared to 2015, and the standardized mortality and the probability of premature death would decrease significantly, which would achieve the targets of preventing and controlling COPD. If the exposure to the included risk factors all achieved the targets by 2030, the burden of COPD would be reduced, suggesting that the control of tobacco use and air pollution should be enhanced to prevent and control COPD.
Air Pollutants/analysis* ; Air Pollution/prevention & control* ; China/epidemiology* ; Cost of Illness ; Environmental Exposure ; Humans ; Particulate Matter/analysis* ; Pulmonary Disease, Chronic Obstructive/prevention & control* ; Risk Factors

BACKGROUND: One method for achieving medical practice to be more evident, especially in the field of primary care, is to encourage the use of clinical guidelines. If development of guidelines is difficult because of time and cost, an evidence based foreign guidelines can be selected and translated into Korean for application. METHODS: A team was formed, consisting of 11 family physician experts on evidence based medicine and clinical practice guidelines. We selected six respiratory diseases requiring clinical guidelines because of variability in practice. We searched several clinical practice guideline databases and selected one guideline according to currency, scope of guideline, whether it was evidence based, and its feasibility in the field of primay care. We translated selected guideline's full-texts or summaries which were done by authorized organization into Korean. RESULTS: The selected respiratory diseases were chronic obstructive pulmonary disease, asthma, pneumonia, sinusitis, rhinitis, and influenza. According to criterion, we selected GOLD (Global Initiative for Chronic Obstructive Lung Disease) for chronic obstructive lung disease, GINA (Global initiative for asthma) for asthma, CDC (Center for disease control) guideline for influenza, IDSA (Infectious Diseases Society of America) guideline for pneumonia, AAP (American Academy of Pediatrics) guideline for sinusitis, and JCAAI (Joint Council of Allergy, Asthma and Immunology) for rhinitis. CONCLUSION: We selected six common respiratory diseases and the most appropriate evidence based guidelines for those particular diseases.
Asthma ; Centers for Disease Control and Prevention (U.S.) ; Evidence-Based Medicine ; Humans ; Hypersensitivity ; Influenza, Human ; Lung ; Physicians, Family ; Physicians, Primary Care* ; Pneumonia ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive ; Rhinitis ; Sinusitis

OBJECTIVETo investigate the expression and role of adrenomedullin (ADM) and adrenomedullin receptor (ADMR) in patients with chronic obstructive pulmonary disease (COPD).

METHODSSmall pulmonary artery remodeling was observed using morphometric analysis. The expression of ADM and ADMR mRNA in lung tissue was calculated by in situ hybridization in 9 COPD cases. Cardiac catheterization was performed in 22 COPD cases to monitor changes of hemodynamic parameters and patients were divided into two groups based on mean pulmonary artery pressure (mPAP). The cases without pulmonary hypertension (PH) were placed in Group A (n = 12) and those with PH were placed in Group B (n = 10). The levels of pulmonary arterial plasma ADM were measured by radioimmunoassay. Blood gas analysis was also conducted.

RESULTSThe ratio of vascular wall thickness to external diameter (MT%) and the ratio of vascular wall area to total area (MA%) were higher in patients with COPD (P < 0.01). In situ hybridization showed that ADM mRNA and ADMR mRNA were expressed in the pulmonary artery walls of control subjects. The expression levels were significantly higher in those of COPD sufferers (P < 0.01). Statistically positive relationships were visible between ADM and ADMR, and the plasma ADM level of Group B was significantly higher than that of Group A (P < 0.05). The plasma ADM level had a significantly positive correlation to mPAP and pulmonary vascular resistance (PVR), while being negatively correlated to levels of PaO(2).

CONCLUSIONADM may play an extremely protective role as a local autocrine/paracrine factor in COPD.

Adrenomedullin ; Adult ; Aged ; Aged, 80 and over ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Oxygen ; blood ; Peptides ; blood ; genetics ; physiology ; Pulmonary Disease, Chronic Obstructive ; prevention & control ; RNA, Messenger ; analysis ; Receptors, Adrenomedullin ; Receptors, Peptide ; genetics ; physiology

OBJECTIVETo study the diagnostic criteria of severity of chronic obstructive pulmonary diseases (COPD), early intervention, and the effect of health education on the relationship between smoking and health.

METHODSData from 713 remissive COPD patients who had results of pulmonary function test in the past 10 years were reviewed. All patients were classified by correlative diagnostic criteria, and the results were compared with the diagnostic criteria of WHO Global Initiative for chronic obstructive lung disease (GOLD). Other indexes such as history of smoking, quantity of smoking and the rate of giving up smoking were also analyzed.

RESULTSAccording to the diagnostic criteria set by the Chinese Respiratory College in 1997 and traditional pulmonary function criteria, 339 patients were identified as having severe COPD, taking up 56.0% of all COPD patients; 200 patients were moderate (28.0%); 114 patients were mild (16.0%). FEV(1)/FVC in mild COPD patients was 70.5% +/- 1.1%, higher than the criteria of 70% in GOLD. Three hundred and thirty-five patients were smokers, taking up 46.9% of total patients. In these patients, 312 patients were men (93%) and 23 patients were women (7%). The average smoking history was 32.9 years, and the average quantity of daily smoking was 22. Two hundred sixteen patients had given up smoking which took up 64.5% of all the smokers.

CONCLUSIONSIt was debatable that FEV(1)/FVC was decisive criteria for COPD diagnoses by GOLD and the revised diagnostic criteria of Chinese Respiratory College in 2002. It might miss diagnosing a number of COPD patients who having combined ventilatory disturbance or were in earlier stages. Only 15.9% of mild COPD patients had seen a doctor, that indicated a very low rate of early intervention which was disadvantageous for the prevention and cure of COPD. In contrast to the rate of 28.0% when giving up smoking in ordinary people who had received general intervention, the rate of giving up smoking in COPD patients remained 64.5% much higher and was dissatisfactory. Health education should be improved to include measures to give up smoking.

Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; Female ; Health Education ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; epidemiology ; prevention & control ; Respiratory Function Tests ; Retrospective Studies ; Smoking ; adverse effects