[Show abstract][Hide abstract] ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a common disease that severely threatens human health. Acute exacerbation of COPD (AECOPD) is a major cause of disease progression and death, and causes huge medical expenditures. This consensus statement represents a description of clinical features of AECOPD in the People's Republic of China and a set of recommendations. It is intended to provide clinical guidelines for community physicians, pulmonologists and other health care providers for the prevention, diagnosis, and treatment of AECOPD.
Full-text · Article · Apr 2014 · International Journal of COPD
[Show abstract][Hide abstract] ABSTRACT: To determine the clinical variables that best predict long- term continuous positive airway pressure (CPAP) adherence among patients with cardiovascular disease who have obstructive sleep apnea (OSA).
12-mo prospective within-trial observational study.
Centers in China, Australia, and New Zealand participating in the Sleep Apnea cardioVascular Endpoints (SAVE) study.
There were 275 patients age 45-70 y with cardiovascular disease (i.e., previously documented transient ischemic attack, stroke, or coronary artery disease) and OSA (4% oxygen desaturation index (ODI) > 12) who were randomized into the CPAP arm of the SAVE trial prior to July 1, 2010.
Age, sex, country of residence, type of cardiovascular disease, baseline ODI, severity of sleepiness, and Hospital Anxiety and Depression Scale (HADS) scores plus CPAP side effects and adherence at 1 mo were entered in univariate analyses in an attempt to identify factors predictive of CPAP adherence at 12 mo. Variables with P < 0.2 were then included in a multivariate analysis using a linear mixed model with sites as a random effect and 12-mo CPAP use as the dependent outcome variable.
CPAP adherence at 1, 6, and 12 mo was (mean ± standard deviation) 4.4 ± 2.0, 3.8 ± 2.3, and 3.3 ± 2.4 h/night, respectively. CPAP use at 1 mo (effect estimate ± standard error, 0.65 ± 0.07 per h increase, P < 0.001) and side effects at 1 mo (-0.24 ± 0.092 per additional side effect, P = 0.009) were the only independent predictors of 12- mo CPAP adherence.
Continuous positive airway pressure use in patients with coexisting cardiovascular disease and moderate to severe obstructive sleep apnea decreases significantly over 12 months. This decline can be predicted by early patient experiences with continuous positive airway pressure (i.e., adherence and side effects at 1 month), raising the possibility that intensive early interventions could improve long-term continuous positive airway pressure compliance in this patient population.
Clinical Trials, http://www.clinicaltrials.gov, NCT00738179.
Chai-Coetzer CL; Luo YM; Antic NA; Zhang XL; Chen BY; He QY; Heeley E; Huang SG; Anderson C; Zhong NS; McEvoy RD. Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. SLEEP 2013;36(12):1929-1937.
[Show abstract][Hide abstract] ABSTRACT: To investigate the prevalence and risk factors of bronchiectasis in urban city of China.
A cross-sectional survey was conducted in 17 urban areas in Beijing, Shanghai, Tianjin, Chongqing cities, and Guangdong, Liaoning, Shaanxi provinces. In this study, urban population-based cluster samples were randomly selected from each city/province. In the selected city communities, all residents at least 40 years old were recruited, interviewed with questionnaires and tested with spirometry. Each participant was asked whether he/she was ever diagnosed as bronchiectasis by physician, whether had symptoms of respiratory diseases and possible risk factors, etc.
Data of 10 811 participants was enrolled for analysis, with a response rate of 75.4% (10 811/14 337). The overall prevalence of physician-diagnosed bronchiectasis was 1.2% (135/10 811), with 1.5% (65/4382) in male and 1.1% (70/6429) in female, without statistical difference in gender (χ(2) = 3.289, P = 0.070). Prevalence of bronchiectasis increased with age (χ(2) = 31.029, P < 0.001). There were no statistical significances in crude prevalences of bronchiectasis among cities (χ(2) = 10.572, P = 0.103), while there was a significant difference among cities after adjustment with confounders (Wald value = 22.116, P = 0.001), by using logistic regression analysis. Logistic regression analysis showed, bronchiectasis was significantly associated with elder ( ≥ 70 years vs 40-49 years; OR = 4.11, 95% CI 2.29-7.36), the family history of respiratory diseases (having two subjects with respiratory diseases in family vs no suffered relatives; OR = 2.04, 95% CI 1.06-3.94), respiratory infection during childhood (suffering two kinds of respiratory diseases vs never; OR = 4.89, 95% CI 2.03-11.81), exposure to coal (OR = 2.30, 95% CI 1.17-4.52), chronic pharyngitis (OR = 3.96, 95% CI 1.38-11.40) and pulmonary tuberculosis (OR = 3.07, 95% CI 1.89-4.98), heart diseases (OR = 1.64, 95% CI 1.11-2.42) and lung cancer(OR = 18.61, 95% CI 7.67-45.18).
The prevalence of bronchiectasis in population aged 40 years old and above in urban area in China is high and associated with multiple factors such as age, family history of respiratory diseases, respiratory infection during childhood, exposure to coal, chronic pharyngitis, pulmonary tuberculosis, heart diseases, lung cancer and so on.
No preview · Article · May 2013 · Zhonghua nei ke za zhi [Chinese journal of internal medicine]
[Show abstract][Hide abstract] ABSTRACT: The chronic obstructive pulmonary disease assessment test (CAT) is an easy to use health-related quality of life questionnaire, the modified Medical Research Council (mMRC) dyspnea scale is a classic dyspnea scale which is widely used, while the correlation between them is still not clear. This study investigated the use of the Chinese translation of CAT in chronic obstructive pulmonary disease patients and its correlation with the mMRC dyspnea scale.
The multicenter cross-sectional study was conducted in 329 hospitals throughout China from March 1 to April 30, 2010. Chronic obstructive pulmonary disease patients completed both the assessment test and the dyspnea scale during a single study visit.
Six thousand, four hundred and thirty-seven patients were evaluated; 74.9% were male and the mean age was (64.9 ± 10.0) years. Median test scores in dyspnea grades 0 to 4 were 14, 16, 22, 26 and 32, respectively; these differences were statistically significant. The CAT score was moderately correlated with mMRC dyspnea grade (r = 0.579, P < 0.001). There was no significant difference in mean CAT score between males and females, and patients of high and low socioeconomic status. Primary analysis suggested that CAT scores were higher in older patients (>65 years) than in younger patients (≤ 65 years) and increased with duration of formal education, but these findings were repudiated by further analysis of subgroups according to mMRC dyspnea grade.
There was no obvious confounding factor influencing use of the CAT in Chinese patients. CAT scores were moderately correlated with the mMRC dyspnea scale.
No preview · Article · Jan 2013 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: The nocturnal nondipping and elevated morning blood pressure (BP) in patients with obstructive sleep apnea syndrome (OSAS) have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS.
Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points (daytime, evening, nighttime and morning) and polysomnography (PSG) was performed and subjects were classified into four groups by their apnea-hypopnea index (AHI): control, n = 213 with AHI < 5; mild, n = 420 with AHI ≥ 5 and < 15; moderate, n = 460 with AHI ≥ 15 and < 30; and severe, n = 1204 with AHI ≥ 30. SPSS 11.5 software package was used for statistical analysis and figure drawing.
All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a "reversed BP dipping" pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild.
OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.
No preview · Article · May 2012 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: OSA is a common condition associated with cardiovascular (CV) morbidity. It remains underdiagnosed globally in part due to the limited availability and technical requirements of polysomnography (PSG). The aim of this study was to test the accuracy of two simple methods for diagnosing OSA.
Consecutive subjects identified from a community register with high CV risk were invited to complete the Berlin Sleep Questionnaire and undergo simultaneous, home, overnight PSG and ApneaLink device oximetry and nasal pressure recordings. The relative accuracies of the Berlin Questionnaire, oximetry and nasal pressure results in diagnosing PSG-defined moderate-severe OSA were assessed.
Of 257 eligible high CV risk subjects enrolled, 190 completed sleep studies and 143 subjects' studies were of sufficient quality to include in final analyses. Moderate-severe OSA was confirmed in 43% of subjects. The Berlin Questionnaire had low overall diagnostic accuracy in this population. However, ApneaLink recordings of oximetry and nasal pressure areas had high diagnostic utility with areas under the receiver operating characteristic curves of 0.933 and 0.933, respectively. At optimal diagnostic thresholds, oximetry and nasal pressure measurements had similar sensitivity (84% vs 86%) and specificity (84% vs 85%). Technical failure was lower for oximetry than nasal pressure (5.8% vs 18.9% of tests).
In patients with high CV risk overnight single-channel oximetry and nasal pressure measurements may provide high diagnostic accuracy and offer an accessible alternative to full PSG.
[Show abstract][Hide abstract] ABSTRACT: Chronic obstructive pulmonary disease (COPD) has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.
A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents (over 40 years old) were interviewed with a standardized questionnaire and spirometry. Post-bronchodilator forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic, personal and exposure variables were collected and analyzed.
Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 (35.3%) were asymptomatic. The age, sex, body mass index (BMI), rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group. Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV(1) (73.1% vs. 61.0%), FVC (91.9% vs. 82.0%), and a higher ratio of FEV(1)/FVC (62.9% vs. 58.7%) (all P < 0.001) than symptomatic group. More asymptomatic patients were underdiagnosed (91.9% vs. 54.3%, P < 0.001) than symptomatic patients.
This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.
Full-text · Article · Jun 2010 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: Epidemiologic studies have shown an independent and definite association between obstructive sleep apnea (OSA) and hypertension. This study aimed to define the association between daytime blood pressure and severity of OSA in Chinese population in mainland of China.
Twenty university hospital sleep centers in mainland of China were invited by the Chinese Medical Association (CMA) to participate in this epidemiologic study and 2297 consecutive patients (aged 18 - 85 years; 1981 males and 316 females) referred to these twenty sleep centers for evaluation of OSA between January 2004 and April 2006 were prospectively enrolled. Nocturnal polysomnography was performed in each patient, and disease severity was assessed based on the apneahypopnea index (AHI). These patients were classfied into four groups: nonapneic control (control, n = 257) with AHI < or = 5 episodes/hour; mild sleep apnea (mild, n = 402) with AHI > 5 and < or = 15 episodes/hour; moderate sleep apnea (moderate, n = 460) with AHI > 15 and < or = 30 episodes/hour and severe sleep apnea (severe, n = 1178) with AHI > 30 episodes/hour. Daytime blood pressure measurements were performed under standardized conditions in each patient at 10 a.m. in office on the day of referring to sleep centers for getting average value. All the patients were requested to quit medications related to blood pressure for three days before the day of assessing.
Both daytime systolic blood pressure and diastolic blood pressure values were significantly related to AHI positively (r = 0.201 and 0.276, respectively; both P values < 0.001) and to nadir nocturnal oxygen saturation negatively (r = -0.215 and -0.277, respectively; both P values < 0.001), which were the parameters of OSA severity. In two special designed mean plots, means of daytime systolic and diastolic blood pressure increased gradually with increasing AHI. Beyond AHI of 61 - 65, this increasing trend reached a plateau.
The results showed that OSA severity was associated with daytime blood pressure until AHI of 61 - 65, providing evidence for early OSA management, especially in OSA patients with concomitant hypertension.
Full-text · Article · Jan 2010 · Chinese medical journal
[Show abstract][Hide abstract] ABSTRACT: To investigate the current status of prevalence, prevention and management of chronic obstructive pulmonary disease (COPD) in rural area in China.
A cross-sectional survey of COPD was conducted in Beijing city, Shanghai city, Guangdong province, Liaoning province, Tianjin city, Chongqing province and Shanxi province. A population-based cluster sample was randomly selected from each rural area. In the selected community, all residents at least 40 years old were recruited, and interviewed with a modified standardized questionnaire from the international burden of obstructive lung diseases (BOLD) study. All participants were tested with spirometry. Those with airflow limitation were performed on post-bronchodilator spirometry. The post-bronchodilator a ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) less than 70% was defined as the diagnostic criteria of COPD.
(1) Data of 9434 participants was valid for analysis, with a valid response rate of 83.6%; the prevalence of COPD in rural was 8.8% (830/9434), 12.8% in male and 5.4% in female. (2) The percentage of smoking and the exposure to biomass smoke in rural was 43.0% (4059/9434) and 83.1% (7835/9434) respectively; cigarettes cessation rate was 17.5%; only 12.4% (502/4059) of smokers had received advice to quit smoking. (3) Among COPD patients, only 30.0% (249/830) had ever been diagnosed as COPD, bronchitis, emphysema, or asthma, 2.4% (20/830) had ever received spirometric tests, and 74.5% were current smokers; only 7.9% (50/634) COPD patients in stage two or over had received regular drug treatment.
There was high prevalence and poor prevention and management for COPD in rural areas. Therefore, an enforced prevention and management for COPD are urgent.
No preview · Article · Jun 2009 · Zhonghua nei ke za zhi [Chinese journal of internal medicine]
[Show abstract][Hide abstract] ABSTRACT: To evaluate the quality of life (QOL) of patients with chronic obstructive pulmonary disease (COPD) and correlated factors.
Data of 20 245 patients with COPD were collected from the cross-sectional survey of COPD, which was conducted between 2002 and 2004 in urban and rural areas of Beijing, Shanghai, Guangdong, Liaoning, Tianjin, Chongqing and Shanxi for residents aged over 40 years old. The recruited populations were interviewed with questionnaire and tested for spirometry. The quality of life was assessed with 12-item short-form health survey questionnaire (SF-12). Those with less than 70% of post-bronchodilator FEV(1)/FVC were identified as having COPD. The differences between groups in SF-12 scores converted by rank were compared using general linear model. Stepwise multiple linear regressions were conducted to study the main determinants of QOL.
Compared to subjects without COPD, those with COPD had impaired QOL (56 +/- 7 vs. 57 +/- 6 in mental component scores, F = 4.442, P < 0.05; 46 +/- 9 vs. 50 +/- 6 in physical component scores, F = 453.960, P < 0.05). Among COPD patients, the mental component score was associated with scores of dyspnea, BMI, comorbidities, sex and living areas, while the physical component score was associated with scores of dyspnea, severity of COPD, comorbidities, exposure to dusts/gases/fumes, sex, age, educational level and previous diagnosis of respiratory diseases (all P < 0.05).
The QOL in patients with COPD was impaired and associated with scores of dyspnea, severity of COPD, comorbidities and BMI. Improvement of dyspnea, nutritional support, prevention of comorbidities and keeping away from risk factors may improve the QOL in COPD patients.
No preview · Article · May 2009 · Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases
[Show abstract][Hide abstract] ABSTRACT: Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation, and has many components including mucus hypersecretion, oxidative stress, and airway inflammation. We aimed to assess whether carbocisteine, a mucolytic agent with anti-inflammatory and antioxidation activities, could reduce the yearly exacerbation rate in patients with COPD.
We did a randomised, double-blind, placebo-controlled study of 709 patients from 22 centres in China. Participants were eligible if they were diagnosed as having COPD with a postbronchodilator forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) ratio (FEV(1)/FVC) of less than 0.7 and an FEV(1) between 25% and 79% of the predicted value, were aged between 40 and 80 years, had a history of at least two COPD exacerbations within the previous 2 years, and had remained clinically stable for over 4 weeks before the study. Patients were randomly assigned to receive 1500 mg carbocisteine or placebo per day for a year. The primary endpoint was exacerbation rate over 1 year, and analysis was by intention to treat. This trial is registered with the Japan Clinical Trials Registry (http://umin.ac.jp/ctr/index/htm) number UMIN-CRT C000000233.
354 patients were assigned to the carbocisteine group and 355 to the placebo group. Numbers of exacerbations per patient per year declined significantly in the carbocisteine group compared with the placebo group (1.01 [SE 0.06] vs 1.35 [SE 0.06]), risk ratio 0.75 (95% CI 0.62-0.92, p=0.004). Non-significant interactions were found between the preventive effects and COPD severity, smoking, as well as concomitant use of inhaled corticosteroids. Carbocisteine was well tolerated.
Mucolytics, such as carbocisteine, should be recognised as a worthwhile treatment for prevention of exacerbations in Chinese patients with COPD.
[Show abstract][Hide abstract] ABSTRACT: Few studies of the efficacy and safety of therapy with combinations of salmeterol/fluticasone propionate (SFCs) have been conducted in Chinese patients with COPD, and the benefits of combination therapy in nonsmoking patients with COPD are, to our knowledge, not known.
The aims were to establish the efficacy and tolerability of the therapy with SFC (salmeterol, 50 microg/fluticasone, 500 microg, twice daily) in the management of Chinese COPD patients and to investigate the effectiveness of SFC in nonsmokers with COPD.
This was a randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Changes in prebronchodilator and postbronchodilator FEV(1), quality of life determined by the St. George Respiratory Questionnaire (SGRQ) scores, relief bronchodilator use, nighttime awakenings, and frequency of exacerbations of COPD were measured in patients randomized to receive SFC (n = 297) or placebo (n = 148). Never-smokers, former smokers, and current smokers accounted for 11.7%, 66.7%, and 21.6%, respectively, of the study population.
After 24 weeks, the mean changes in prebronchodilator and postbronchodilator FEV(1) were 180 mL (95% confidence interval [CI], approximately 91 to 268; p < 0.001) and 65 mL (95% CI, approximately 14 to 115; p = 0.012), respectively, greater for the SFC group than that for the placebo group. The differences in response to treatment were significant (all p < 0.0001) in former or current smokers but not in never-smokers (p > 0.05). The mean improvement in the total SGRQ score for the SFC group was 5.74 (p < 0.01) greater than that for the placebo group. SFC significantly reduced the frequency of nighttime awakenings and the use of relief bronchodilator. The adjusted ratio of exacerbations of COPD for the SFC group relative to the placebo group was 0.61 (95% CI, approximately 0.45 to 0.84; p < 0.01). There were no significant differences between the SFC and placebo groups in safety measures.
SFC therapy achieved sustained improvement in lung function, quality of life, and control of symptoms, and was well tolerated in Chinese patients. Greater improvements in lung function were found only for COPD patients with a history of smoking. Trial registration: http://ctr.gsk.co.uk/Summary/fluticasone_salmeterol/studylist.asp Identifier: No. SCO100540.
[Show abstract][Hide abstract] ABSTRACT: To investigate the correlation between body mass index (BMI) and chronic obstructive pulmonary disease (COPD), based on a cross-sectional COPD survey conducted in Beijing, Shanghai, Guangdong, Liaoning, Tianjin, Chongqing and Shaanxi of China between 2002-2004.
A multi-stage stratification cluster sampling strategy was used in this cross-sectional survey, and 20,245 subjects (8705 males and 11,540 females) aged 40 years or older were recruited, interviewed with a questionnaire, measured for height and weight, and tested with spirometry. 1668 subjects with post-bronchodilator FEV1/FVC less than 70% were identified as having COPD after other known causes of airflow limitation were excluded. Analysis on relationship between COPD and BMI was performed in 1668 COPD and 18 577 non-COPD subjects.
Compared with non-COPD subjects, BMI was significantly lower in COPD patients [(22.7+/-3.5) vs (24.1+/-3.4) kg/m2, F=158.31, P<0.01]; BMI was also significantly lower in smokers than in non-smokers [(23.6+/-3.4) vs (24.2+/-3.5) kg/m2, F=49.10, P<0.01]. And an addictive interaction to BMI between COPD and smoking was observed (F=6.03, P<0.05). BMI decreased with the increase of the stage of COPD (F=45.6, P<0.01), with a negative relationship (r=-0.08, P<0.01). Lower BMI was significantly associated with increased risk of COPD (chi2=102.68, P<0.01). Compared with subjects with normal BMI (BMI=24.0-27.9 kg/m2), those with lower BMI (BMI<18.5 kg/m2) were more likely to have COPD [adjusted OR=2.12 (95% CI 1.73-2.59)], while those with higher BMI (BMI=24.0-27.9 kg/m2) and obesity (BMI>or=28.0 kg/m2) were less likely to have COPD [adjusted OR=0.67 (95% CI 0.59-0.76); and 0.60 [(95% CI 0.49-0.73), respectively]. Moreover, there was an interaction to COPD between smoking and BMI (chi2=4.73, P<0.05). Compared with COPD patients with normal BMI, the quality of life in those with lower BMI was impaired (55+/-8 vs 57+/-6 in mental scores of SF-12, F=2.96, P<0.05; 42+/-10 vs 46+/-9 in physical scores of SF-12, F=4.21, P<0.01), and their dyspnea scores were higher (1.4+/-1.5 vs 1.1+/-1.3, chi2=14.32, P<0.01).
Lower BMI was strongly associated with COPD, possibly as a risk factor for COPD independent of smoking, and a potential predictor for COPD severity.
No preview · Article · Jan 2007 · Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases
[Show abstract][Hide abstract] ABSTRACT: To explore the risk factors for chronic obstructive pulmonary disease (COPD) in females in Chinese rural areas.
Based on a national multi-center, population-based and cross-sectional survey on prevalence of COPD in seven provinces/cities of China, an analysis on the risk factors for the rural females was conducted in six areas, e.g. Beijing, Shanghai, Guangdong, Liaoning, Tianjin and Shanxi. In the national survey, for each area, one rural and one urban cluster samples were randomly selected using a multi-stage strategy. Residents who were 40 years old or older were interviewed with questionnaires and tested with spirometry. The post-bronchodilators forced expired volume in one second to forced vital capacity ratio (FEV(1)/FVC) x 100% < 70% was used as diagnostic criteria of COPD.
The average prevalence of COPD in females in the six Chinese rural areas was 5.4%. The prevalence varied with risk factor exposure among different areas, and the prevalence in Guangdong province was the highest among all areas. Logistic regression model was conducted, and statistical association of COPD was found with a family history of respiratory diseases (OR = 2.46, 95% CI = 1.86 - 3.26), frequent coughing during childhood (frequent coughing vs never coughing: OR = 3.93, 95% CI = 2.02 - 7.63), lower body mass index (lower body mass index vs normal body mass index: OR = 2.20, 95% CI = 1.47 - 3.29), age (70 years or older vs 40 - 49 years: OR = 8.98, 95% CI = 5.90 - 13.67), smoking (OR = 1.68, 95% CI = 1.20 - 2.35), exposure to occupational dusts (OR = 1.45, 95% CI = 1.07 - 1.96), worse ventilation in kitchen room (OR = 1.47, 95% CI = 1.06 - 2.03) and lower educational level (OR = 2.19, 95% CI = 1.38 - 3.46).
The prevalence of COPD in females in rural areas was associated with multiple factors and prevention of COPD for Chinese women in rural areas is warranted.
No preview · Article · Dec 2006 · Zhonghua nei ke za zhi [Chinese journal of internal medicine]
[Show abstract][Hide abstract] ABSTRACT: To explore the optimal doses of inhaled corticosteroids (ICS) for the management of Chinese asthmatics in order to enhance cost-effectiveness.
A randomized, paralleled and controlled multi-center study was carried out in 11 provincial hospitals. After one week run-in period when only inhaled salbutamol as needed was given, the asthmatic patients (n = 86) were divided into two groups: patients in group G (n = 42) received inhaled ICS with the doses recommended by Global Initiative for Asthma (GINA), ie, fluticasone propionate (FP) 250 microg bid for moderate asthma and 375 microg bid for severe asthma. Patients in group H (n = 44) received half of the above doses of FP (125 microg bid for moderate asthma and 125 microg in the morning, 250 microg in the evening for severe asthma).
There were no significant differences between group G and group H in the 32 measurements after management, including day symptom score (severe asthma in group G 0.7 +/- 0.8, group H 0.4 +/- 0.6 and moderate asthma in group G 0.4 +/- 0.5, group H 0.3 +/- 0.5), FEV(1) [severe asthma in group G (1.5 +/- 0.5) L, group H (1.8 +/- 0.6) L/min and moderate asthma in group G (2.3 +/- 0.6) L, group H (2.3 +/- 0.8) L/min, FEV(1)% of predicted [severe asthma in group G (54 +/- 17)%, group H (59 +/- 19)%, and moderate asthma in group G (79 +/- 14)%, group H (79 +/- 15)%], the increased morning PEF value (45, 67 L/min in moderate and severe asthma in group G and 56, 65 L/min in moderate and severe asthma in group H respectively), frequency of nights awakened (81, 69 in severe asthma in groups G and H respectively), numbers of well controlled cases (88 and 98 d in severe asthma in groups G and H respectively) and the use of extra bronchodilators (salbutamol, puff/day, 5.0 and 3.4 d in severe asthma in groups G and H respectively, P > 0.05). On the other hand, in the subgroups of moderate asthma, night symptom score (0.30 +/- 0.22 in group G, 0.13 +/- 0.33, t = -2.06, P < 0.05), number of exacerbations (3/22 in group G, 11/24 in group H, chi(2) = 4.74, P < 0.05), number of total controlled cases (18/22 cases in group G, 12/24 cases in group H, chi(2) = 4.97, P < 0.05) were significantly different between group G and group H. In the subgroups of severe asthma, the total days of exacerbations were different between group G and group H (11 days in group G, 6 days in group H, U = 31, P < 0.05).
As a whole, similar therapeutic effect was achieved using half of the GINA recommended dose of ICS with/without salbutamol inhalation as needed compared with those receiving the GINA recommended full dose of ICS in most Chinese asthmatics.
No preview · Article · Aug 2005 · Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases