Evolutionary and Prognostic Particularities in Patients with COPD, Chronic Cor Pulmonale and COVID-19

Chronic obstructive pulmonary disease (COPD) is a chronic disease of the respiratory airways due to the partially reversible obstruction of the airflow caused by an abnormal inflammatory response to toxic substances, most often to cigarette smoke.(1) COVID-19 is a mild to severe respiratory disease caused by a coronavirus from the genus Betacoronavirus.(2) Patients with COPD have a major risk of COVID-19 infection. Treating patients with COPD, chronic cor pulmonale and COVID-19 is a current challenge.

Evolutionary and Prognostic Particularities in Pacients with COPD, Chronic Cor Pulmonale and COVID-19

COPD is a chronic disease of the respiratory airways due to the partially reversible obstruction of the airflow caused by an abnormal inflammatory response to toxic substances, most often to cigarette smoke(1). COVID-19 is a mild to severe respiratory disease caused by a coronavirus from the Betacoronavirusgenus(2). Patients with COPD have a major risk of COVID-19 infection. Treating patients with COPD, chronic cor pulmonale and COVID-19 is a current challenge.

Hypertension and chronic cor pulmonale were the independent risk factors for a prolonged length of hospital stay in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients: a multicenter cross-sectional study

Background: AECOPD is a severe status of COPD. The prolonged length of hospital stay (LHS) was associated with poor prognosis and higher medical costs in AECOPD patients. Identification of the risk factors for prolonged LHS will help physicians provide targeted and personalized interventions, reduce LHS, and avoid unnecessary health services in COPD patients. This study aimed to explore the risk factors for prolonged LHS in hospitalized AECOPD patients. Methods: In this multicenter cross-sectional study, 598 AECOPD patients were screened. In the end, the LHS of 111 were <7 days (Normal LHS, N-LHS), 218 were 7-10 days (Mild Prolonged LHS, MP-LHS), and 100 were≥11 days (Severe Prolonged LHS, SP-LHS). Demographic data, underlying diseases, symptoms, and laboratory findings were collected. Multiple logistics regression was performed to investigate the independent risk factors for prolonged LHS in AECOPD patients. Results: The significant differences in 11 variables were found by univariate analysis. Since significant collinearities among white blood cells (WBC), neutrophils (NS), and NS% were observed, WBC and NS% were excluded. Therefore, 9 factors were included in multiple logistics regression. Subsequently, our results identified that the rates of hypertension and chronic cor pulmonale (CCP) were independently associated with prolonged LHS in AECOPD patients. Conclusions: Collectively, our results suggested that complications of hypertension and CCP were at a higher risk of prolonged LHS in AECOPD patients. It also indicated that AECOPD combined with hypertension and/or CCP probably more severe. Then, more extensive management should be initially administrated.

Effect of external diaphragmatic pacing therapy on patients with chronic cor pulmonale: a randomized, controlled trial

Objectives This study aimed to evaluate the effects of external diaphragmatic pacing (EDP) on patients with chronic cor pulmonale (CCP). Methods Fifty patients with CCP were enrolled in Kashgar Prefecture Second People’s Hospital in Xinjiang Uygur Autonomous Region of China from 2016 to 2017. The patients were randomized into a group that received anti-CCP therapy (negative control group) or a group that received additional EDP treatment (EDP group). We recorded and compared maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and the 6-minute walking test between the two groups on the first and tenth days of treatment. Results Ten days after treatment began, MIP, FVC, and the 6-minute walking test were significantly improved in both groups. Importantly, MIP and FVC were significantly higher in the EDP group compared with the control group on the tenth day. Conclusion In addition to treatment for CCP, these patients can obtain extra benefit by using EDP treatment.

Ginkgo leaf extract and dipyridamole injection for chronic cor pulmonale: a PRISMA-compliant meta-analysis of randomized controlled trials

Ginkgo leaf extract and dipyridamole injection (GLED), a kind of Chinese herbal medicine preparation, has been considered as a promising supplementary treatment for chronic cor pulmonale (CCP). Although an analysis of the published literature has been performed, the exact effects and safety of GLED have yet to be systematically investigated. Therefore, a wide-ranging systematic search of electronic databases from which to draw conclusions was conducted. All randomized controlled trials concerning the GLED plus conventional treatments for CCP were selected in the present study. Main outcomes were treatment efficacy, blood gas and hemorrheology indexes, and adverse events. Data from 28 trials with 2457 CCP patients were analyzed. The results indicated that, compared with conventional treatments alone, the combination of conventional treatments with GLED obviously improved the markedly effective rate (RR = 1.44, 95% CI = 1.31–1.58, P &lt; 0.00001) and total effective rate (RR = 1.28, 95% CI = 1.18–1.38, P &lt; 0.00001). Moreover, the hemorrheology (PaO2, P &lt; 0.00001; PaCO2, P &lt; 0.00001; SaO2, P &lt; 0.00001; pH value, P = 0.05) and blood gas indexes (PV, WBHSV, WBMSV, WBLSV, hematocrit and FBG, P &lt; 0.01) of CCP patients were also significantly ameliorated after the combined therapy. The frequency of adverse events did not differ significantly between the two groups (P &gt; 0.05). In summary, evidence from the meta-analysis suggested that the combination of conventional treatments and GLED appeared to be effective and relatively safe for CCP. Therefore, GLED mediated therapy could be recommended as an adjuvant treatment for CCP.

Specific course of tuberculosis in elderly and senile patients

The objective: to identify specific features of the clinical course of tuberculosis in elderly and senile patients under the current epidemic situation.The specific clinical course of tuberculosis was analyzed in 54 patients at the age of 61 years and older and compared with the course of 234 patients at the age from 18 to 39 years selected by the continuous sampling of all 472 patients discharged from hospital in 2018. The following features were found to be typical of patients of 61 years and older: more frequent chronic forms of the disease (37.0%) and complications (35.2%), the major complication was chronic cor pulmonale (33.3%); more frequent concurrent chronic nonspecific lung diseases (13.0%) and coronary heart disease/arterial hypertension (14.8%); more frequent deaths (31.5%), mainly due to pulmonary heart disease; less frequent generalization of tuberculosis (5.5%) and concurrent HIV infection (7.4%).