鑒于慢性阻塞性肺疾病(COPD)的氣流受限特點是進行性發展，而且不能完全可逆，同時COPD帶來沉重的社會經濟負擔，成為勞動力喪失和死亡的重要原因之一。因而近年來國外一些學者主張早期干預COPD，并且提出許多理由，諸如早期干預COPD可以減少癥狀，減少動態過度充氣，改善肺功能，提高生命質量等。然而，必須看到COPD的早期干預是一項很艱難的系統工程，有許多問題需要大家認真思考和討論，尤其是在我國這個問題尤為重要和復雜。故愿就我國COPD的早期干預問題談一些不成熟的看法，以就正于同道。
Objectives To evaluate pulmonary physicians’knowledge level about prevention and treatment of chronic obstructive pulmonary disease( COPD) in some urban areas in China. Methods A total of 258 pulmonary physicians were interviewed face-to-face in 24 hospitals from July to October in 2006. The questionnaire included the knowledge of COPD, prescriptions at initial visit and follow-up, pulmonary function test monitoring, assessment and intervention in stable COPD, knowledge and evaluation of the commonly used medicines, the effects of smoking cessation and adopted measures, as well as the knowledge of treatment prospects and patients’ education. Results Eighty-eight percent of pulmonary physicians considered themselves knowledgeable on COPD, and 95% were familiar with the severity classification. Most of them knew about GOLD and Chinese Guideline of Prevention and Treatment to COPD, and paid attention to chest X-ray and pulmonary function test during diagnosis. The standards in evaluation of stable COPD patients were not well understood, and 92% of physicians claimed for pulmonary function test in stable stage. Seventy-nine percent of physicians actively suggested the patients quit smoking. The prescription for COPD patients at iniative and maintenance therapy met the guideline on the whole, but the mucolytic agents were appreciated too much and used too frequently. Thirty-three percent of physicians took it necessary to treat stable COPD,and 69% believed that pharmacotherapy for stable COPD could rersult in satisfactory quality of life.Conclusions In some big cities in China, the pulmonary physicians have good knowledge about COPD. But long-term prevention and intervention, especially in pharmacotherapy, are still unsatisfactory.
長期以來人們一直將吸煙, 包括吸煙成癮看作是一種習慣, 并沒有將其視為一種疾病。這樣使得戒煙變得很困難和復雜。吸煙之所以長期廣泛流行并造成十分嚴重的社會經濟危害, 原因包括一系列生物、心理、社會因素, 其中最重要的原因是由于香煙煙霧中的尼古丁是一種可以使人成癮的物質, 使得吸煙人產生煙草依賴。1998 年世界衛生組織正式提出煙草依賴是一種慢性病, 列入國際疾病分類( ICD-10,F17. 2) 。這在吸煙與控煙歷史上具有劃時代的意義, 將會使控煙工作從此進入一個與以往不同的時代。
2007年1月6日、13日，國內部分呼吸病學專家分別在廣州和上海舉行(2006年全球支氣管哮喘防治創議(GINA)》研討會。新年伊始的兩次最重要的學術活動均圍繞著GINA展開，充分說明我國呼吸學界對此次新版GINA的極大興趣和高度重視。
Objective To investigate the reasons, status, treatment and precautions of misdiagnosis of pulmonary inflammatory pseudotumor. Methods Between January 2005 and December 2015, one hundred eighteen articles about pulmonary inflammatory pseudotumor published in Wanfang and CNKI databases were retrospectively analyzed, among them forty-four articles referring to misdiagnosis rate. The misdiagnosis rate, distribute of misdiagnosed diseases, reasons and main means of definite diagnosis were analyzed. Results There were 1 286 cases of pulmonary inflammatory pseudotumor in the 44 articles, of them 1 012 cases were misdiagnosed. The misdiagnosis rate was 78.84%. Pulmonary inflammatory pseudotumor was often misdiagnosed as lung cancer (65.81%), tuberculosis (15.42%, which included 72 cases of tuberculoma and accounted for 7.11%) and benign pulmonary neoplasms (9.59%). Most misdiagnosed patients did not suffer from adverse consequences, except a few patients undergo unnecessary extended operations. Lack of specificity in clinical manifestations, lack of awareness about the disease, dependent on auxiliary examination and lack of awareness about the fine feature of the disease were the main reasons of misdiagnosis. The majority of misdiagnosed cases were terminal pathological diagnosed through the operation or after percutaneous biopsy. Conclusions Pulmonary inflammatory pseudotumor is lack of specificity in clinical manifestations and easy to be misdiagnosed. It is very important to analyze and identify the fine feature of imaging changes. To reduce and avoid misdiagnosis, clinicians should improve the awareness of this disease.
Objective To investigate the application status of titrated oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by means of literature retrieving. Methods Database retrieving is taken on eight major domestic medical journals about the treatment for AECOPD patients during the period of January 2013 to December 2015. Results There were 70 articles involving the treatment of AECOPD in the eight major journals during 2013 to 2015. Oxygen therapy was not mentioned in 14 articles, oxygen therapy data were incomplete in 13 papers and relatively complete in 43 papers. None of the articals provided full description of oxygen therapy. The arterial blood gas of the patients was analyzed, and showed excessive or not enough on effect of oxygen treatment. Conclusion The clinicians did not pay enough attention to oxygen treatment for AECOPD patients, so treatment guideline and clinical pathway should be construed to standardize titrated oxygen therapy.
阻塞性睡眠呼吸暫停綜合征（OSAS）是在睡眠過程中上氣道完全或部分狹窄導致患者反復呼吸暫停或低通氣，出現鼾聲、低氧血癥及睡眠中反復微覺醒引起日間疲乏、嗜睡等癥狀的一組癥候群。高血壓是以體循環動脈壓升高為主要特點的臨床綜合征，是最常見的心血管疾病，也是現代社會最主要的流行病之一。近十幾年來，越來越多的研究證實OSAS與高血壓的形成與發展獨立相關，是非常重要的致高血壓發生的危險因素[1-4]。 動脈壓持續升高可導致心、腦、腎和血管等損害，并可引起全身代謝異常，嚴重危害人類的健康。但同時高血壓又是可以防治的疾病，有效控制血壓可明顯地降低心腦血管疾病的死亡率。然而臨床上難治性高血壓的發生比例逐漸增加，原因之一在于部分由OSAS引起的繼發性高血壓被誤診為原發性高血壓，從而使這些患者未得到根本性的病因治療[5，6]。因此，如何預防和減少OSAS引起的高血壓成為現代醫學關注的焦點。本文將從流行病學、發病機制、臨床意義及治療幾個方面論述OSAS與高血壓之間的相關性。
Objective To examine the levels of nitrite /nitrate( NO2 /NO3 ) , IL-4 and IFN-γin exhaled breath condensates( EBCs) in patients with asthma, and to investigate the effect of corticosteroid treatment. Methods Forty patients diagnosed as mild to moderate asthma were recruited. Among them, twenty were newly diagnosed and steroid naive( non-treatment group) . The other 20 patients had been treated with corticosteroid treatment( treatment group) . Twenty healthy volunteers were enrolled as normal control.EBC samples were taken for measurement of NO2 /NO3, IL-4 and IFN-γlevels. Serum IL-4 and IFN-γ concentrations were also measured. Results NO2 /NO3 level in EBC of the non-treatment group was significantly higher than that of the normal controls and the treatment group[ ( 48. 55 ±27. 37) μmol / L vs( 24. 51 ±18. 22) μmol /L, ( 36. 06 ±25. 13) μmol /L, respectively, both P lt; 0. 05] , and no significant difference was found between the treatment group and the normal controls( P gt;0. 05) . The IL-4 and IFN-γ levels in both EBC and serum had no significant difference between the three groups ( all P gt; 0. 05) . Conclusion NO2 /NO3 in EBCs increases in asthmatic patients, and decreases after corticosteroid treatment. Whether IL-4 and IFN-γlevels can be used for reflecting airway inflammation need further study.
Objective To investigate the control level in asthmatic patients who were members of asthma association in the People’s Hospital of Peking university.Methods 76 asthmatic patients attended the Third Meeting of asthma association and asthma test was conducted.The patients self-evaluated the state of illness，filled the questionnaire of asthma control test（ACT） while peak expiratory flow（PEF） was measured.The steroids usage was also investigated.Results The average age of the patient investigated was（60.6±11.5）year old.The percentage of well control by self-evaluation was 89.5%（62/76）；75%（48/64） by ACT questionairs.50.8%（31/61）of the patients fell in green region and 36.1%（22/61）fell in yellow region of PEF.The coincidence rate of self-evaluation with ACT was 40.6%.ACT scores comparable to green region，yellow region and red region were 21.33±3.44，21.12±3.24 and 17.43±4.47 respectively.There were no significant difference of ACT score between green region group and yellow region group，or yellow region group and red region group.Conclusions Most of asthma association members could achieved well control which could be ascribed to asthma education and management program on the basis of partner relationship between doctors and patients.