An index of open-access Chronic Obstructive Pulmonary Disease content relevant to primary care
Economic Burden of Chronic Obstructive Pulmonary Disease Induced by Tobacco Smoke Exposure in Yunnan Naxi People
LIU Yingnan，WANG Xuming，SHEN Jingrong，CUI Wenlong，HE Lianju，ZUO Chunmei，CAI Le
Chinese General Practice 2021, 24 (32): 4099-4103. DOI: 10.12114/j.issn.1007-9572.2021.01.019
Abstract
Background Chronic obstructive pulmonary disease （COPD） has become a major public health problem due to its high prevalence，cost of treatment，and economic burden of conditions associated with COPD. Objective To analyze the economic burden of COPD attributed to active and passive smoking exposure among the Naxi People in Yunnan province. Methods From July to August 2018，a questionnaire survey and lung function tests were conducted with the Naxi People（≥35 years old） selected from Yunnan's Yulong County by use of multi-stage stratified random sampling. Per capita direct and indirect economic burden of COPD，total economic burden of COPD，and the economic burden attributable to active/passive smoking were estimated. Results Altogether，2 600 cases participated in the survey，and 2 531 of them（97.35%） who completed the survey effectively were finally included. The prevalence of COPD，smoking，and passive smoking among the participants was 17.66%，40.58%，and 38.29%，respectively. Men had obviously higher prevalence of active smoking and notable lower prevalence of passive smoking than women （P<0.001）. Active smokers〔OR=1.903，95%CI（1.507，2.404）〕had a higher likelihood of developing COPD than non-smokers. Passive smokers〔OR=2.195，95%CI（1.718，2.805） 〕 had a higher likelihood of developing COPD than non-passive smokers. The per capita direct，indirect and economic burden of COPD for the COPD participants was 2 827.82 yuan，105.00 yuan and 2 932.82 yuan，respectively，and the total economic burden of COPD was 64.07 million yuan. The economic burden of COPD attributable to active and passive smoking was 17.18 million yuan and 20.11 million yuan，respectively. Passive smoking contributed less to economic burden of COPD than active smoking in men，while for women the opposite was true. Conclusion Active and passive smoking may produce substantial economic burden of COPD in the Naxi people，which might be reduced by reducing the smoking prevalence via increasing tobacco control efforts.
Interpretation of Guideline for the Diagnosis and Treatment of COPD（2021 revision） for General Practitioners
WANG Fengyan，ZHANG Dongying，LIANG Zhenyu，SU Guansheng，ZHENG Jinping，CHEN Rongchang
Chinese General Practice 2021, 24 (29): 3660-3663. DOI: 10.12114/j.issn.1007-9572.2021.01.304
Abstract
According to the Guideline for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease （2021 revision），different levels of medical institutions undertake different tasks in the stratified diagnosis and treatment of chronic obstructive pulmonary disease （hereinafter referred to as COPD）. General practitioners are main force responsible for prevention of COPD. General practitioners use questionnaire surveys and popularize the application of simple lung function to implement early screening of COPD；implement drug treatment for stable maintenance treatment through patient education，supervision and regular follow-up；participate in the overall management of COPD by guiding and verifying the correct use of inhaled drugs，improving compliance，implementing respiratory rehabilitation treatment，etc. With reference to the revised guideline，general practitioners are expectedto participate in the overall management of COPD to improve the medical level of COPD in primary care institutions.
Reference | Related Articles | Metrics
Effect of Mobile Terminal-based Management in Patients with Stable Chronic Obstructive Pulmonary Disease
ZHAO Xinying，WU Hao，GAO Wenjuan，GE Caiying，LI Zhili，KONG Min，CHEN Ying，ZHU Xiayuan
Chinese General Practice 2021, 24 (28): 3609-3614. DOI: 10.12114/j.issn.1007-9572.2021.00.279
Abstract
Background Chronic obstructive pulmonary disease（COPD） requires long-term and effective health management. Mobile APP has many merits in facilitating chronic disease management as an emerging method，but its effect in comprehensive management of stable COPD patients has been insufficiently studied. Objective To examine the effect of mobile terminal-based comprehensive management in stable COPD patients. Methods Eighty stable COPD patients treated in Fangzhuang Community Health Service Center of Fengtai District，Beijing from January to December 2019 were randomly divided into control group and observation group. The control group received routine outpatient treatment and health education，and the observational group received routine outpatient treatment and health education with mobile terminal-based management. Comparisons were made between two groups in terms of the grasp of COPD knowledge and breathing skills，mental state，treatment adherence，lung function indices，clinical assessment of symptoms，and status of acute exacerbation at baseline and 12 months after intervention. Results After the intervention，the proportion of patients with increased knowledge of the etiology，main symptoms and preventive measures of COPD in the observation group was higher than those in the control group（P<0.05）. The patients in the observation group had better mastery of lip contraction breathing and abdominal breathing than those in the control group after the intervention（P<0.05）. After the intervention，the scores of depression and anxiety，the treatment compliance scores of correct medication，diet control and respiratory function exercise and the scores of CAT and mMRC in the observation group were lower than those before the intervention and lower than those in the control group after the intervention（P<0.05）. There was no significant difference in FEV1% and FEV1/FVC between the control group after intervention and before intervention（P>0.05）. After the intervention，FEV1% and FEV1/FVC in the observation group were higher than those before the intervention，and higher than those in the control group after the intervention（P<0.05）. There was no significant difference in the number of emergency and hospitalization in the control group after intervention（P>0.05）. After the intervention, the times of emergency and hospitalization in the observation group were less than those before the intervention，and the times of emergency were less than those in the control group after the intervention（P<0.05）. Conclusion Mobile terminal-based management may contribute to the grasp of COPD knowledge and breathing skills，alleviation of negative mood，improvement of treatment adherence，lung function indicators，and clinical symptoms，as well as the reduction of possibility of acute exacerbation in stable COPD patients.
Impact of Aerobic Exercise on Serum Inflammatory Factors and Cardiopulmonary Function in Patients with Stable Chronic Obstructive Pulmonary Disease
HUANG Xin，QIAN Jun，CHEN Fayu，HAO Jian，YAO Yanmei，ZHU Shifei，WANG Jinghua
Chinese General Practice 2021, 24 (28): 3615-3619. DOI: 10.12114/j.issn.1007-9572.2021.00.217
Abstract
Background Chronic obstructive pulmonary disease（COPD） is a common chronic airway disease that can occur repeatedly throughout the year，seriously endangering the quality of life and health of patients. It is quite necessary to explore the effect of aerobic exercise on enhancing cardiopulmonary reserve and quality of life. Objective To comparatively analyze the levels of serum IL-10，IL-17，matrix metalloproteinase-9（MMP-9） and cardiopulmonary function in stable COPD patients before and after aerobic exercise，to explore the mechanism of aerobic exercise in improving body function and promoting rehabilitation. Methods Sixty admitted inpatients with stable COPD were randomly and equally divided into control group and experimental group. Both groups received oxygen therapy，bronchodilator therapy and other usual care for 12 weeks，the experimental group（except one dropout due to acute exacerbation） also received a 12-week regular cycling with the intensity of the individual anaerobic threshold. Pre- and post-treatment expression levels of IL-10，IL-17 and MMP-9 in peripheral serum and cardiopulmonary functions were compared between the groups. Results Compared to baseline，the mean levels of IL-17，MMP-9，and ratio of ventilation to carbon dioxide production at anaerobic threshold（VE/VCO2 at AT） deceased，while mean levels of IL-10，6-minute walk distance，peak oxygen uptake（Peak VO2） and maximal exercise ventilation（VEmax） as well as mean score of St. George's Respiratory Questionnaire（SGRQ） increased in the experimental group after treatment（P<0.05）. The experimental group showed lower mean post-treatment levels of IL-17 and MMP-9，and VE/VCO2 at AT，and higher mean post-treatment levels of IL-10，6-minute walk distance，peak VO2 and VEmax as well as higher mean post-treatment mean score of SGRQ than the control group（P<0.05）. Conclusion Early initiating aerobic exercise and maintaining aerobic exercise adherence could significantly improve the health status，reduce inflammatory reaction，enhance cardiopulmonary reserve，quality of life and the prognosis of stable COPD patients.
The Effects of Smoking Cessation Intervention on Local Airway Immunity and Life Quality in Patients with Chronic Obstructive Pulmonary Disease in Early Stable Stage
LIU Xianbing，LI Fang，XU Ning，ZHU Lifen，ZHENG Xiaoyan
Chinese General Practice 2021, 24 (23): 2927-2939. DOI: 10.12114/j.issn.1007-9572.2021.00.576
Abstract
Background Smoking is harmful to the local airway immune function and life quality of COPD patients. The harm of tobacco is huge，quitting smoking is imminent. Smoking cessation can benefit quitters. There are currently many literatures on smoking cessation interventions，but fewer studies on moking cessation and local airway immunity，and also fewer studies on smoking cessation intervention for early COPD. Objective To investigate the effect and clinical significance of smoking cessation intervention on airway local immunity and life quality in patients with early stable COPD. Methods A total of 170 patients with stable COPD who met the following inclusion and exclusion criteria enrolled by People's Hospital of Quzhou in Zhejiang Province from June 2016 to June 2019 were selected and divided into smoking cessation group（106 cases）and non-smoking group（64 cases）. The smoking cessation group was divided into a successful cessation group（48 cases）and a smoking cessation group（58 cases）according to the success or failure of smoking cessation. The gender，age，smoking index，etc of the patients were collected.All patients in the three groups were followed up for 12 months after enrollment（ie：0 month，0.5 month，1 month，3 months，6 months，9 months and 12 months）. Induced sputum immune indicators including T lymphocyte subsets（CD3+，CD4+，CD4+/CD8+，CD8+），immunoglobulins（IgG，IgA，lgM）and complement C3，C4；lung function test result〔first second end of expiration volume（FEV1）〕；life quality indicators including cough（cough score），sputum expectoration（sputum expectoration score），dyspnea〔Dyspnea Scale（mMRC）score〕，COPD condition〔chronic obstructive pulmonary disease assessment test（CAT）Score〕，tobacco dependence（tobacco dependence score），smoking severity index，exhaled CO value，combined anxiety/depression〔depression and anxiety scale（HAD）score〕were recorded.The incidence of respiratory tract infection and the acute exacerbation of COPD within 1 year before the follow-up and during the follow-up were also recorded. The chages in related indicators during follow-up were compared. Results There is an interaction between the group and time in terms of cough score，expectoration score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，number of respiratory infections and acute exacerbations during follow-up（P<0.05）. The group has the significant main effect on cough score，sputum score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，number of respiratory infections during follow-up，and number of acute exacerbations during follow-up Significant（P<0.05），time in the cough score，sputum score，FEV1，mMRC score，CAT score，HAD score，tobacco dependence score，smoking severity index score，exhaled CO value，respiratory tract infections during follow-up（P<0.05）. With the extension of follow-up time，the non-smoking group cough score，expectoration score，CAT score，mMRC score，HAD score，tobacco dependence score，smoking severity index，exhaled CO value，number of respiratory infections and acute exacerbation of COPD during follow-up gradually increased，and FEV1 gradually decreased（P<0.05）. There is an interaction between group and time in CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05）；the main effect of the group was significant on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05），and the main effect of the time was significant on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4（P<0.05）. The levels of CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，complement C3，and complement C4 in the successful smoking cessation group were compared at the rest of the follow-up time with that at the 6-month follow-up，and the differences were statistically significant（P<0.05）. The IgM level of the successful smoking cessation group was compared at the rest of the follow-up time with that at the 12-month follow-up，and the difference was statistically significant（P<0.05）. The levels of CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，IgM，complement C3，and complement C4 in the smoking cessation failure group were compared at the rest of each follow-up time with that at 1 month，and the difference was statistically significant（P<0.05）. At the beginning of the follow-up，the CD3+，CD4+，CD4+/CD8+，IgA，IgG，IgM，complement C3，complement C4 and FEV1 in three groups were positively correlated（P<0.05），and were negatively correlated with HAD score，tobacco dependence score，smoking severity index score and exhaled CO detection（P<0.05）. CD8+ was negatively correlated with FEV1（P<0.05），and positively correlated with HAD score，tobacco dependence score，smoking severity index score and expiratory CO value（P<0.05）. At the end of the follow-up，CD3+，CD4+，CD4+/CD8+，IgA，IgG，IgM，complement C3，and complement C4 were positively correlated with FEV1 in the successful and non-quit smoking group（P<0.05），and were negatively correlated with cough score，sputum score，HAD score，tobacco dependence score，smoking severity index score and exhaled CO value（P<0.05）. CD8+ was negatively correlated with FEV1（P<0.05），and positively correlated with HAD score，tobacco dependence score，smoking severity index score，and exhaled CO value（P<0.05）. Conclusion Tobacco is harmful to the local airway immune function and life quality of patients with early COPD. Smoking cessation intervention is conducive to airway immune function and life quality. Those who succeed in smoking cessation benefit more，even if smoking cessation fails，patients who quit smoking in the short term can also benefit.However，the harm of tobacco to the human body is continuous，and the indicators can be significantly improved at least 6 months after quitting smoking. Local airway immune function is related to the quality of life. The improvement of airway immune function can improve the life quality and prognosis of patients，among them，T cell subgroups and IgA and IgG can better reflect the airway immune status.
Velocity Time Integral Guides Fluid Therapy for COPD Patients with Septic Shock：a Clinical Study
YU Jiangquan，ZHENG Ruiqiang，ZHU Jin，ZHAO Yuan，YANG Penglei
Chinese General Practice 2021, 24 (23): 2945-2949. DOI: 10.12114/j.issn.1007-9572.2021.01.003
Abstract
Background Central venous pressure（CVP） provides little value for guiding fluid therapy for septic shock in chronic obstructive pulmonary disease（COPD） patients as they often have right heart insufficiency. The widespread application of ultrasound in the ICU has made bed-side measurement of left ventricular outflow tract velocity-time integral （LVOT VTI） become possible，which is superior to CVP in reflecting volume responsiveness as it is similar to the stroke volume. Objective To examine the clinical value of LVOT VTI in guiding fluid therapy for COPD patients with septic shock. Methods COPD patients with septic shock were selected from the Intensive Care Unit，Northern Jiangsu People's Hospital of Jiangsu Province from March 2017 to June 2018，and randomized into CVP group（treated with fluid therapy guided by CVP，till CVP reaching 15 mm Hg），global end-diastolic volume index（GEDVI） group（treated with fluid therapy guided by GEDVI，till GEDVI reaching 800 ml/m2），and VTI group （treated with fluid therapy guided by LVOT VTI，till the increase of LVOT VTI <15%）. Baseline data（age，gender，APACHEⅡ score，SOFA score，mean arterial pressure，CVP，blood lactate，oxygenation index，and pulmonary hypertension prevalence at ICU admission），fluid treatment-related data （the volume of fluid administered and norepinephrine dosage during the first six and 24 hours of resuscitation，blood lactate level and blood lactate clearance during the first 24 hours of resuscitation，APACHEⅡ score and SOFA score during the first 72 hours of resuscitation），renal replacement therapy rate，mechanical ventilation time，ICU hospital stay，and in-hospital mortality were compared between the groups. Results Three groups showed statistically significant differences in the volume of fluid administered and norepinephrine dosage during the first 24 hours of resuscitation（P<0.05），but showed no significant differences in the volume of fluid administered and norepinephrine dosage during the first six hours of resuscitation，blood lactate level and blood lactate clearance during the first 24 hours of resuscitation，APACHE Ⅱ score and SOFA score during the first 72 hours of resuscitation，renal replacement therapy rate，mechanical ventilation time，ICU hospital stay，and in-hospital mortality（P>0.05）. CVP group received less volume of fluid during the first 24 hours of resuscitation than other groups（P<0.05）. VTI group used less norepinephrine dosage during the first 24 hours of resuscitation than other groups（P<0.05）. Conclusion LVOT VTI used in fluid therapy may help to evaluate the required fluid volume more accurately and reduce the dosage of norepinephrine more significantly，so it may have a good clinical application prospect.
Research Progress of Sputum Biomarkers in the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease
MA Qingsong，LIU Ling，ZHAO Zhihuan
Chinese General Practice 2021, 24 (20): 2624-2628. DOI: 10.12114/j.issn.1007-9572.2021.00.497
Abstract
Sputum is mainly derived from the central airway，which contains inflammatory cells and inflammatory mediators in these parts.The assessment of airway inflammation through sputum cytology classification and detection of related inflammatory mediators has been clinically confirmed.In recent years，sputum biomarkers have made some progress in the study of chronic obstructive pulmonary disease （COPD）.This article reviews the progress of various biomarkers in the diagnosis and treatment of COPD.It is found that the detection of inflammatory cells and inflammatory factors in sputum and the application of cluster analysis to propose more specific subgroup classification methods can better distinguish COPD and asthma，which is conducive to the study of the mechanism of the overlap between the two.Analyze the correlation among sputum biomarkers，various clinical indicators and scoring scales further to propose new disease evaluation indicators.Exploring the biomarkers that mediate the frequent acute attacks of COPD and the increased susceptibility of bacteria and viruses is expected to identify patients with frequent acute exacerbation phenotypes and provide a theoretical basis for the new diagnostic markers and therapeutic targets.
Efficacy and Safety of Revefenacin in Chronic Obstructive Pulmonary Disease：a Meta-analysis
LI Ling，YANG Ming，LI Xuefeng，LIU Fu
Chinese General Practice 2021, 24 (11): 1400-1405. DOI: 10.12114/j.issn.1007-9572.2021.00.414
Abstract
Background Revefenacin is the first anti-muscarinic drug that needs to be administered only once a day for maintenance therapy in patients with chronic obstructive pulmonary disease（COPD）.There is no systematic review of its treatment of COPD in China.Objective To perform a systematic review of the efficacy and safety of revefenacin in COPD，to provide a basis for the selection of drug treatments for COPD.Methods The databases of CNKI，Wanfang Data Knowledge Service Platform，CQVIP，CBM，PubMed，EMBase，The Cochrane Library and ClinicalTrials.gov were searched for clinical studies of revefenacin in treating COPD from inception to May 2019.Literature enrollment was performed using strict inclusion criteria and exclusion criteria.The first author，publication time，NCT number，country（region），intervention，sample size，sex，age，race，course of treatment，indices of efficacy〔trough forced expiratory volume in one second（trough FEV1），peak FEV1，response rate to St.George's Respiratory Questionnaire（SGRQ）〕 and indices of safety（common and serious adverse reactions）regarding the eligible studies were recorded.The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate the methodological quality.RevMan 5.3 was used for meta-analysis.Results A total of 6 randomized controlled trials were included，with a total sample size of 2 175 participants，and high methodological quality.According to the result of meta-analysis：the improvement of trough FEV1 in remifenaxine group was better than that in placebo group 〔MD=146.78，95%CI（133.52，160.05），P<0.000 01〕.Peak FEV1 〔MD=129.50，95%CI（115.69，143.31），P<0.000 01〕，and the SGRQ response rate in remifenaxine group were lower than those of placebo group 〔OR=1.60，95%CI（1.29，1.98），P<0.000 1〕.Both groups showed no significant differences in the incidence of severe adverse reactions〔OR=0.93，95%CI（0.44，1.94），P=0.84〕，upper respiratory tract infection 〔OR=1.42，95%CI（0.72，2.82），P=0.31〕，headache 〔OR=0.88，95%CI（0.49，1.58），P=0.66〕，and cough 〔OR=1.06，95%CI（0.62，1.82），P=0.82〕.The incidence of dyspnea in remifenaxine group was higher than that in placebo group 〔OR=0.54，95%CI（0.33，0.87），P=0.01〕.Conclusion Revefenacin is effective and safe in the treatment of COPD.
Physicians and Nurses' Perspective of Barriers and Solutions to the Delivery of Home-based Pulmonary Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease：a Qualitative Study
FANG Hui，SHI Yan，LIU Xianliang，GUAN Jiabei
Chinese General Practice 2021, 24 (10): 1284-11288. DOI: 10.12114/j.issn.1007-9572.2021.00.034
Abstract
Background The latest epidemiological survey shows that there are about 100 million patients with chronic obstructive pulmonary disease（COPD） in China，about 1 million people die of respiratory diseases each year，and more than 5 million people become disabled due to respiratory diseases. The effectiveness of home-based pulmonary rehabilitation is as good as hospital and community pulmonary rehabilitation in improving the quality of life and lung function of COPD patients. However，there are few studies showing the barriers to the delivery of home-based pulmonary rehabilitation from the perspective of physicians and nurses. Objective To investigate the barriers to the delivery of home-based pulmonary rehabilitation based on a survey of physicians and nurses blocking the quality of life and lung function of COPD. Methods From July to November 2019，in-depth semi-structural interviews regarding the barriers to the delivery of home-based pulmonary rehabilitation based on a self-developed framework were carried out in a purposive sample of 14 medical workers from respiratory and rehabilitation departments of a grade A tertiary hospital in Shanghai. Content analysis was performed to sort out and analyze the recorded interview results. Results Three themes with nine sub-themes（each including three sub-themes） were extracted：patients' negative health，cognitive，and psychological conditions（prevalence of multiple comorbidities and low motivation of receiving home-based pulmonary rehabilitation；insufficient knowledge of home-based pulmonary rehabilitation；distrust of the efficacy of home-based pulmonary rehabilitation and low exercise compliance）. Physicians and nurses' insufficient knowledge and trainings and attentions regarding home-based pulmonary rehabilitation（insufficient related knowledge and feeling incompetent to carry out home-based pulmonary rehabilitation；insufficient related standard trainings；insufficient attentions paid to home-based pulmonary rehabilitation by hospitals and related departments ）. Limited capacities at the organizational level for the delivery of home-based pulmonary rehabilitation（inadequate communication and cooperation among the hospital，community and family and imperfect follow-up monitoring system；insufficient medical professionals for delivering such services；lack of systematic rehabilitation training mode and simple and practical evaluation indicators）. Conclusion There are many barriers to the delivery of home-based pulmonary rehabilitation. To address these barriers to make sure COPD patients can really benefit from home-based pulmonary rehabilitation，strengthened professional trainings for physicians and nurses to improve their knowledge，more attentions paid to the guidance on home-based pulmonary rehabilitation are needed，with the joint help of social supports as well.
Development of a Comprehensive Assessment System for Chronic Obstructive Pulmonary Disease Based on ICF
WANG Lan，ZHENG Jinping，SHEN Yuehao，YU Xi
Chinese General Practice 2021, 24 (10): 1289-1293. DOI: 10.12114/j.issn.1007-9572.2021.00.093
Abstract
Background The health management of chronic obstructive pulmonary disease（COPD） requires comprehensive and individualized treatment based on the whole person assessment，so as to improve the patients' physiological and psychological status and long-term compliance to healthy behaviors. Objective To establish a comprehensive assessment system for COPD based on the International Classification of Functioning，Disability and Health （ICF），to offer a reference for the development of integrated intervention options involving physiology，psychology，functioning and social participation for such patients. Methods From April to August，2019，we constructed a questionnaire based on the comprehensive ICF core set for COPD，and used it to carry out a two-round email-based survey with experts（in fields of clinical diagnosis and treatment，clinical nursing，nursing management，nursing education，pulmonary rehabilitation and psychological therapy related to COPD） using the Delphi technique，then in accordance with the survey results，we improved it and developed the final version. Results The response rate and Cr were 100.0%（21/21） and 0.836，respectively，for the first round of survey，and were 95.2%（20/21） and 0.845，respectively，for the second round of survey. The Kendall's coefficient of concordance were 0.209 and 0.271 for indices and subindices. The average importance value of indices ranged from 3.55-4.90. The variation coefficients of indices ranged from 0.061-0.297，and full mark rate was 15%-90%. The Comprehensive ICF-COPD Assessment System consists of 4 indices，including physical and mental functions，body structure，activities and participation，and environmental factors，and 53 subindices. Conclusion The development of Comprehensive ICF-COPD Assessment System is scientific and rational，which could ensure the comprehensiveness of the assessment content before the formulation of rehabilitation intervention plan.
Exercise Capacity and Prognosis Evaluation Methods for Patients with Chronic Obstructive Pulmonary Disease in the Community
LI Haiyan，YANG Ting，YAO Fanxiu，LIU Hong
Chinese General Practice 2021, 24 (10): 1294-1297. DOI: 10.12114/j.issn.1007-9572.2021.00.031
Abstract
Background Elderly patients are more easily to be found with chronic obstructive pulmonary disease （COPD），as well as its associated sarcopenia and decreased exercise capacity. Exercise capacity has an association with the prognosis，but there is little research on the evaluation methods of the two. Objective To explore simple and accurate methods that can assess the exercise capacity and prognosis of patients with COPD in the community. Methods A total of 100 patients with stable COPD were recruited from China-Japan Friendship Hospital from January 2018 to December 2019. The relationships of six-minute walking distance（6MWD） with Short Physical Performance Battery（SPPB） score and modified British Medical Research Council（mMRC） classification were analyzed. Results The result of 6MWD increased with the decrease of mMRC score for classifying COPD （rs=-0.431，P=0.002）. The AUC of mMRC classification for predicting 6MWD was 0.749 （P<0.001），and the maximum Youden index was 0.426 when 6MWD was 483.5 meters，which was determined as the cut-off threshold. The SPPB was positively correlated with the intragroup data（P<0.001），and its correlation with 5-repetition sit-to-stand（5STS）was the strongest（rs=0.751）. Therefore，6MWD was correlated with 5STS（rs=0.291，P=0.038）. Conclusion Both mMRC classification and 5STS test could be used as simple methods with relatively high accuracy for the assessment of exercise capacity and prognosis of patients with COPD in primary care，and they are partially correlated. When the 6MWD is less than 483.5 meters，dyspnea restricts movement greatly，and pulmonary rehabilitation can be carried out timely.
Improving the Role of General Practitioners in the Early Diagnosis and Management of Chronic Diseases: a Case Analysis of Chronic Obstructive Pulmonary Disease
LI Fan，SHENG Chunfeng，WANG Huanying
Chinese General Practice 2021, 24 (9): 1044-1050. DOI: 10.12114/j.issn.1007-9572.2020.00.607
Abstract
Chronic obstructive pulmonary disease（COPD）is a common and frequently-occurring disease in clinical practice.In China，the number of COPD patients is nearly 100 million，and COPD constitutes another chronic disease with heavy disease burden besides hypertension and diabetes.However，unlike hypertension and diabetes，COPD has not received enough attention from patients，doctors and the government，and its early diagnosis and standardized diagnosis and treatment levels are still relatively low.General practitioners play important roles in the prevention，control and management of COPD，especially in early screening，management of patients in stable phase，as well as pulmonary rehabilitation.And it is imminent to establish a hospital-community-family COPD prevention and control model，conduct the general-specialty care，and develop standardized prevention and control of COPD in primary care.This paper discusses the role of general practitioners in the early diagnosis and management of COPD.
Interpretation of the 2020 GOLD's Global Strategy for Prevention，Diagnosis and Management of COPD（Ⅰ）：Pharmacological Treatment of Stable COPD
LI Zhenghuan，ZHANG Xiaoyun，CHEN Yang，SONG Xueli，QIN Zhongming，LI Hong
Chinese General Practice 2021, 24 (8): 923-929. DOI: 10.12114/j.issn.1007-9572.2021.00.155
Abstract
Chronic obstructive pulmonary disease（COPD）is now the third leading cause of death in the world，after ischemic heart disease and stroke.However，clinical practices in China still have many challenges to address COPD as an important public health issue，such as insufficient patient education，missing follow-up data，non-standardized management of stable COPD and/or acute exacerbations，which may be important causes of frequent aggravation and deterioration of conditions，leading to increased difficulties in treating and higher possibility of poor outcome after late treatment as well as increased social and economic burden of COPD.Therefore，it is of great practical significance to accelerate the standardization of prevention，diagnosis and management of COPD to improve the accuracy and effectiveness of diagnosis and treatment of COPD.To provide a reference for emergency and respiratory clinicians to better treat COPD patients clinically，in view of domestic diagnosis，treatment and studies regarding COPD，we comprehensively interpreted the 2020 GOLD's Global Strategy for Prevention，Diagnosis and Management of COPD in three parts from a clinical perspective： pharmacological and non-pharmacological treatment of stable COPD and management of exacerbations.This paper is the first part of interpretation，mainly including diagnostic evaluation，initial management and follow-up management.
Analysis of the Status Quo and Influencing Factors of Beijing Community General Practitioners on Chronic Obstructive Pulmonary Disease
LIU Qing，CHEN Yahong，WANG Zhong，YU Jing，WU Yonghao
Chinese General Practice 2021, 24 (8): 982-988. DOI: 10.12114/j.issn.1007-9572.2021.00.401
Abstract
Background At present，chronic obstructive pulmonary disease （COPD for short），as a preventable and controllable chronic disease，has become one of the most prominent public health and medical problems in our country，and the prevention and treatment of COPD in grassroots community is particularly important.Understanding the cognitive ability and current status of community general practitioners on COPD can provide a better scientific basis for the prevention and treatment of respiratory diseases in grassroots level.Objective To investigate the status quo of cognition of COPD among general practitioners in community health service institutions in Beijing， and analyze the influencing factors to provide scientific basis for the prevention and treatment of respiratory diseases at the grassroots level.Methods From September 28 to October 4 in 2020，a survey was conducted on the frontline general practitioners in 34 community health service centers and 159 community health service stations in Beijing. Self-designed questionnaire，after joint demonstration，the final draft of the questionnaire formed through star technology platform was published on the WeChat work group.The content of the questionnaire includes the basic information and the approaches to update and learn professional knowledge and general practitioners，the ways to carry out patient education of general practitioners，the knowledge test of COPD prevention and treatment ability（60 points or more is a pass，60 points or less is not enough）. The different demographic characteristics，approaches to obtaining professional knowledge，and the way to conduct patient education of the community health service organization and the situation about the passing of COPD prevention and control ability test of general practitioners were analyzed.And the binary Logistic regression was used to analyze the influencing factors of the prevention and control ability test of general practitioners.Results A total of 1 226 questionnaires were distributed，and 1 226 valid questionnaires were returned.The recovery rate was 100.0%.（1）The total average score of the general practitioner's COPD knowledge test was （45.5±18.5） points，with 987 failing doctors and 239 passing doctors（pass rate 19.5%）.Among them，the passing rate of female doctors was higher than that of males（P<0.05）.The difference in the passing rate of doctors with different academic qualifications is statistically significant（P<0.05）；among them，the passing rate of doctors with master degree and above is higher than the doctors with bachelor degree，college degree，technical secondary school education and below，and the passing rate of doctors with bachelor degree is higher than doctors with college degree，technical secondary school education and below.The difference in the passing rate of doctors with different professional titles was statistically significant（P<0.05）；among them，the passing rate of doctors with senior and intermediate titles was higher than the passing rate of doctors with junior titles（P<0.05）.（2）The passing rate of general practitioners who had passed the COPD prevention and control ability knowledge test at the community health service center/community health service station by listening to the lectures by outside experts and the experts organized by the medical association was higher than the general practitioners without listening to the lectures by experts outside the hospital and the experts organized by the medical society on the spot（P<0.05）.（3）General practitioners who carried out patient education and education had a higher pass rate than those who did not carry out patient education（P<0.05）；general practitioners who disseminate health education manuals，health education lectures and health consultations to teach patients had a higher pass rate than general practitioners without distributing health education manuals，health education lectures and health consultations to teach patients.（4）The results of binary Logistic regression analysis showed that gender，educational background，and professional title were the influencing factors of general practitioners' passing knowledge test of COPD prevention and treatment （P<0.05）.Conclusion The general practitioners in Beijing community health service institutions have insufficient knowledge of COPD，and further training and assessment in this area need to be further strengthened；emphasis should be placed on strengthening community male，low-educated and low-professional title grade practitioners in COPD knowledge training；among the approaches to obtain professional knowledge of COPD，it is more effective to listen to the lectures by experts outside the hospital at the community health service center/community health service station and the experts organized by the medical society on the spot；the general practitioner's cognitive level of COPD can be also improved through the distributing COPD health education manuals，conducting health education lectures and health consultations for patient education.
Recent Advances in Pathogenesis and Nutrition Interventions of Frailty in Chronic Obstructive Pulmonary Disease
TAO Yang，GUO Honghua，ZHANG Caihong
Chinese General Practice 2021, 24 (6): 684-689. DOI: 10.12114/j.issn.1007-9572.2020.00.614
Abstract
With the aging of the global population，frailty，as a geriatric syndrome，has attracted extensive attention from researchers in the field of geriatrics in recent years.Since chronic obstructive pulmonary disease （COPD） is one of the high risk factors of frailty，frailty in COPD has been a research focus.However，previous studies are mainly cross-sectional investigations on the incidence of frailty in COPD and their correlations，while comprehensive studies，especially reviews on the pathogenesis and nutrition interventions of frailty in COPD are relatively lacking.Considering the importance of pathogenesis and effective nutrition interventions of frailty in improving the long-term life quality of COPD patients，we reviewed relevant advances that have been recently achieved，aiming to provide a reference for the development of nutrition intervention programs targeting population with COPD with frailty.
Diaphragmatic Mobility Function and Its Correlation with Pulmonary Function in Patients with COPD
FU Xuming，WANG Jihong，PAN Dianzhu
Chinese General Practice 2021, 24 (5): 561-565. DOI: 10.12114/j.issn.1007-9572.2020.00.329
Abstract
Background Systemic skeletal muscular（including diaphragm）dystrophy and atrophy，are common in chronic obstructive pulmonary disease（COPD）patients.Diaphragmatic fatigue is one of the important pathophysiological bases for disease progression in these patients.But the application of ultrasound combined with pulmonary function in the evaluation of diaphragm function is rarely reported.Objective To perform a disease severity-based analysis of diaphragm mobility and its correlation with pulmonary function in COPD patients.Methods From Ansteel Group Hospital during March 2018 to January 2019，81 COPD patients（consisting of mild，moderate and severe patients evaluated by the GOLD criteria），and 30 healthy controls undergoing examination in Pulmonary Function Examination Room were selected.Pulmonary function test was used to examine lung function related parameters.Ultrasound was carried out to measure the diaphragm mobility during quiet breathing at functional residual capacity（FRC）and during forced breathing at total lung capacity（TLC），respectively.The mMRC Dyspnoea Scale was used to assess the status of dyspnea.The height，weight，body mass index (BMI)，mMRC dyspnoea score，FEV1%pred，FVC%pred，FEV1/FVC，FRC，TLC，TLC-FRC，and inspiratory breath were recorded IC%pred，MVV%pred，RV/TLC%pred were compared.Pearson correlation analysis was used to explore the correlation between diaphragmatic mobility and research variables. Multiple linear regression analysis was used to explore the influencing factors of diaphragm mobility.Results COPD patients had greater average height，weight，and mMRC dyspnoea score，but lower average FEV1%pred，FVC%pred and FEV1/FVC compared with the controls（P<0.05）.The diaphragm mobility in quiet breathing phase，forced breathing phase，and the difference of diaphragm mobility from FRC to TLC were significantly different among mild，moderate and severe COPD patients and controls（P<0.05）.Severe patients had greater average diaphragm mobility at FRC and lower average diaphragm mobility at TLC and difference of diaphragm mobility from FRC to TLC than mild and moderate patients and controls（P<0.05）.Moderate patients showed greater average diaphragm mobility at FRC and lower average diaphragm mobility at TLC and difference of diaphragm mobility from FRC to TLC compared with mild patients and controls（P<0.05）.Mild patients demonstrated lower average difference of diaphragm mobility from FRC to TLC compared with controls（P<0.05）.In COPD group，diaphragm mobility was positively correlated with BMI（r=0.501，P<0.001），FEV1%pred（r=0.697，P<0.001），FVC%pred（r=0.639，P<0.001），FEV1/FVC（r=0.564，P<0.001），IC%pred（r=0.438，P<0.001），MVV%pred（r=0.578，P<0.001），and negatively correlated with mMRC（r=-0.615，P<0.001）and RV/TLC%pred（r=-0.350，P<0.001）.Multiple linear regression analysis showed that FEV1% pred〔β=0.728，95% CI（0.027，0.042），P=0.001〕was the influencing factor of diaphragm mobility.Conclusion Diaphragm mobility in COPD patients can be assessed by ultrasound.The degree of diaphragm mobility is related to the level of pulmonary function.