Knowledge of chronic obstructive pulmonary disease (COPD) as a common, preventable and treatable condition has advanced in the last two decades, as evidenced by the increase in scientific literature. Tobacco smoking still remains a predominant risk factor for COPD. Thus smoking cessation management should be obligatory in every case. Although spirometry is integral to the diagnosis of COPD, one should also be aware of its limitations. COPD is a chronic disease associated with comorbidities that define its extrapulmonary manifestations. Systemic inflammation provides the biological link, while exacerbations play a prominent role in the current approach to disease evaluation. This paper reviews the latest Global Initiative for Chronic Obstructive Pulmonary Disease revision, focusing on the paradigm shift in assessment that would directly influence therapeutic decisions. Also discussed are the newer drugs and combinations of existing inhaler therapies that now present clinicians with more options, as well as bronchoscopic interventions that may perhaps offer a lower-morbidity alternative than surgical lung volume reduction. Finally, this review highlights how integrated care models can bridge the gap between components and complete a comprehensive sphere of COPD care.
Comorbidity ; Humans ; Inflammation ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; physiopathology ; therapy ; Pulmonary Medicine ; methods ; standards ; trends ; Risk Factors ; Smoking ; adverse effects ; Spirometry ; Treatment Outcome

The purpose of this study was to compare the Korean COPD guideline to GOLD consensus report in terms of acute exacerbation. A total of 361 patients were enrolled in this study, and 16.9% of them experienced acute exacerbation during the follow-up. A total of 6.3% of patients in GOLD A, 9.5% in GOLD B, 7.7% in GOLD C and 17.0% of GOLD D experienced exacerbation during the first year of follow-up, respectively (P=0.09). There was no one who experienced exacerbation during the first year of follow-up in the Korean group 'ga'. The 12-month exacerbation rates of Korean group 'na' and 'da' were 4.5% and 16.0%, respectively (P<0.001). We explore the experience of exacerbation in patients with change of their risk group after applying Korean COPD guideline. A total of 16.0% of the patients who were reclassified from GOLD A to Korean group 'da' experienced acute exacerbation,and 15.3% from GOLD B to Korean group 'da' experienced acute exacerbation. In summary, the Korean COPD guideline is useful to differentiate the high risk from low risk for exacerbation in terms of spirometry. This indicates that application of Korean COPD guideline is appropriate to treat Korean COPD patients.
Acute Disease ; Aged ; Disease Progression ; Female ; Humans ; Male ; *Practice Guidelines as Topic ; Pulmonary Disease, Chronic Obstructive/*classification/*diagnosis ; Pulmonary Medicine/*standards ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; *Severity of Illness Index ; Spirometry/*standards

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Chronic Obstructive Pulmonary Disease (COPD) to provide doctors and patients in Singapore with evidence-based treatment for COPD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on COPD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: https://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Adult ; Aged ; Evidence-Based Medicine ; Humans ; Middle Aged ; Palliative Care ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; therapy ; Pulmonary Medicine ; standards ; Quality Improvement ; Radiography, Thoracic ; Risk Factors ; Singapore ; Steroids ; therapeutic use

In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.
Administration, Inhalation ; Adrenal Cortex Hormones/*administration & dosage ; Allergy and Immunology/standards ; Anti-Inflammatory Agents/administration & dosage ; Asthma/*drug therapy/*epidemiology ; Drug Prescriptions/*statistics & numerical data ; Guideline Adherence/*utilization ; Humans ; *Practice Guidelines as Topic ; Prevalence ; Pulmonary Medicine/standards ; Republic of Korea/epidemiology ; Treatment Outcome

OBJECTIVETo investigate the clinical effect of decoction of invigorating Qi and clearing lung combined standardized myrtol on acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODNinety and eight patients with AECOPD patients were randomly divided into the treatment group and the control group, with 50 cases and 48 cases respectively. All the patients were given the conventional treatment. The control group was treated by standardized myrtol with 3 times a day, 300 mg each time taken orally. The treatment group was given decoction of invigorating Qi and clearing lung with 2 times a day, one dose per day taken orally, combined standardized myrtol (usage as above). After Two weeks, the scores of clinical symptom, blood gas analysis and pulmonary function were observed.

RESULTBoth FEV1 and FEV1% were raised in the two groups after treating. And the treatment group was significantly higher than control group (P < 0.01). PaO2 and PaO2/FiO2 rose, with PaCO2 decreased in the two groups (P < 0.01). PaO2 and PaO2/FiO2 were significantly improved, and PaCO2 was significantly decreased in the treatment group compared to the control group (P < 0.01). In the clinical curative effect comparison aspects, clinical control rates were 42.0% in treatment group and 20.83% in control group respectively, with significant difference between the two groups (P < 0.05). Significant efficiency is 86.0% in treatment group and 52.08% in control group respectively, with significant difference between the two groups (P < 0.01).

CONCLUSIONDecoction of invigorating Qi and clearing lung combined with standardized myrtol can obviously improve clinical symptom, blood gas an analysis and pulmonary function in patients with AECOPD.

Aged ; Blood Gas Analysis ; Drug Combinations ; Drug Therapy, Combination ; Female ; Humans ; Lung ; physiopathology ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Monoterpenes ; standards ; therapeutic use ; Pulmonary Disease, Chronic Obstructive ; blood ; physiopathology ; therapy ; Reference Standards ; Respiratory Function Tests ; Treatment Outcome

OBJECTIVESince 1987, professor Wasserman displayed cardiopulmonary exercise test starting (CPET) data as 3 rows and 3 columns 9 panels plots. Although many changes and additions, there still are some important functional parameters were not shown in 9 panels. We want to display more.

METHODSThe 100 Hz sampling data of symptom-limited maximal limit CPET was used to calculate breath-by-breath data after per second cutting technique, and then to calculate the average value of 10 s data for graphic display.

RESULTSIn new 9 plots, panels (1) - (7) use time for the "X" axis, oxygen uptake, carbon dioxide elimination, loaded power, heart rate, systolic blood pressure, diastolic blood pressure, heart rate pressure product, minute ventilation, respiratory exchange ratio, CO2 elimination ventilatory efficiency, oxygen uptake ventilatory efficiency, oxygen pulse, ST segment level and ST segment slope at V5 lead, tidal volume, respiratory rate, end tidal oxygen partial pressure, end tidal carbon dioxide partial pressure and oxygen saturation of 18 noninvasive parameters, and arterial oxygen partial pressure, arterial oxygen saturation, arterial partial pressure of carbon dioxide 3 blood gas parameters for the "Y" axis respectively. There are 3 vertical dashed lines represent dividing lines of the resting, warm-up, incremental power loading exercise and recovery period respectively. In addition, panels (1) and (4) have the horizontal dashed line represents the maximal oxygen uptake (red), oxygen uptake efficiency plateau (red) and the lowest value of carbon dioxide elimation ventilatory efficiency (blue) expected value respectively. Panel ( used heart rate and carbon dioxide elimination (as Y) against to oxygen uptake (as X); the "+" indicates intersection of the predicted maximum values of oxygen uptake and heart rate. Panel (9) used tidal volume (as Y) against over minute ventilation (as X), vertical dashed line is the measured maximum ventilatory volume, the horizontal dashed lines were the inspiratory capacity and vital capacity respectively.

CONCLUSIONNew CPET 9 plots emphasizes on the integration of all circulatory, respiratory and metabolic etc functional parameters in human, and is conductive to optimization of clinical medical service and health management.

Arteries ; Blood Gas Analysis ; Blood Pressure ; Carbon Dioxide ; Exercise ; Exercise Test ; standards ; Heart ; Heart Rate ; Holistic Health ; Humans ; Integrative Medicine ; Oximetry ; Oxygen ; Oxygen Consumption ; Partial Pressure ; Pulmonary Gas Exchange ; Tidal Volume