Background: Whether individuals with non-obstructive spirometry-defined small airway dysfunction (SAD) have impaired exercise capacity is unclear, particularly in never-smokers. This study clarifies the degree of impaired exercise capacity and its potential cause in individuals with non-obstructive SAD. Methods: This community-based, multiyear cross-sectional study analyzed data collected in Guangdong, China from 2012-2019 by the National Science and Technology Support Plan Program. Measurements of exercise capacity [peak work rate and peak oxygen uptake ((V)over dotO(2peak))] in participants with non-obstructive spirometry-defined SAD (n=157) were compared with those in controls (n=85) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) I patients (n=239). Subgroup analyses were performed by smoking status. Results: The risk of impaired exercise capacity was significantly higher in participants with non-obstructive SAD [(V)over dotO(2peak) <84%predicted, adjusted odds ratio (aOR) =2.53; 95% confidence interval (CI): 1.42-4.52] than in controls but was not significantly different from that in GOLD I patients. Results were consistent within subgroups of smoking status (ever-smokers: non-obstructive SAD vs. controls, aOR =2.44; 95% CI: 1.08-5.51; never-smokers: non-obstructive SAD vs. controls, aOR =2.38, 95% CI: 1.02-5.58). Participants with non-obstructive SAD had a significantly lower peak work rate (beta=-10.5; 95% CI: -16.3 to -4.7) and (V)over dotO(2peak) (%predicted, beta=-4.0; 95% CI: -7.7 to -0.2) and tended to have higher ventilatory equivalents for carbon dioxide at the ventilatory threshold ((V)over dot(E)/(V)over dotCO(2AT), beta=1.1; 95% CI: -0.1 to 2.3) when compared with controls. Both peak work rate and (V)over dot O-2peak were negatively correlated with (V)over dot(E)/(V)over dotCO(2AT). Conclusions: Although not meeting the current criteria for chronic obstructive pulmonary disease, individuals with non-obstructive SAD have impaired exercise capacity that may be associated with ventilatory inefficiency regardless of smoking status.

Purpose:The use of simple and affordable screening tools for chronic obstructive pulmonary disease (COPD) is limited. We aimed to assess the validity of a handheld expiratory flowmeter (Vitalograph Ltd., COPD-6®, Ireland) for COPD screening in Chinese primary care settings.Methods:In our cross-sectional study, subjects were randomly selected in eight primary care settings. Tests with the handheld expiratory flowmeter and the conventional spirometry were sequentially performed on all participants. The correlation between the handheld expiratory flowmeter and the conventional spirometry was determined. Validity was determined by the area under the receiver operator characteristic curve (AUC) of the forced expiratory volume in one second (FEV1)/forced expiratory volume in six seconds (FEV6) that used to detect airway obstruction. The sensitivity, specificity, predictive values, and likelihood ratio were calculated according to different FEV1/FEV6 cut-off points.Results:A total of 229 subjects (15.4%) were diagnosed with airflow limitation by conventional spirometry. FEV1, FEV6, and FEV1/FEV6 measured by the handheld expiratory flowmeter were correlated with FEV1, FVC, and FEV1/FVC measured by the conventional spirometry (r=0.889, 0.835 and 0.647, p<0.001), respectively. AUC of the FEV1/FEV6 to determine airflow obstruction was 0.857 (95% CI: 0.826 to 0.888). No significant difference of AUC was observed between the symptomatic group and the asymptomatic group (AUC=0.869 vs 0.843, P=0.425). A similar phenomenon was found in the AUC of smokers and never-smokers (AUC=0.862 vs 0.840; P=0.515). The cut-off point for FEV1/FEV6 was 0.77 and the corresponding sensitivity and specificity were 71.2% and 89.8%, respectively.Conclusion:The handheld expiratory flowmeter might be used as a screening device for COPD in Chinese primary care settings.

1State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, National Clinical Research Center for Respiratory Disease Guangzhou, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People’s Republic of China; 3The People’s Hospital of Hubei Province, Wuhan, Hubei Province, People’s Republic of China; 4The First People’s Hospital of Guangzhou City, Guangzhou, Guangdong Province, People’s Republic of China

BACKGROUND:Coronavirus disease 2019 (COVID-19) has been a global pandemic disease, with more than 4 million cases and nearly 300,000 deaths. Little is known about COVID-19 in patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the influence of preexisting COPD on the progress and outcomes of COVID-19.METHODS:This was a multicenter, retrospective, observational study. We enrolled 1,048 patients aged 40 years and above, including 50 patients with COPD and 998 patients without COPD, and with COVID-19 confirmed via high-throughput sequencing or real-time reverse transcription-polymerase chain reaction, between December 11, 2019 and February 20, 2020. We collected data of demographics, pathologic test results, radiologic imaging, and treatments. The primary outcomes were composite endpoints determined by admission to an intensive care unit, the use of mechanical ventilation, or death.RESULTS:Compared with patients who had COVID-19 but not COPD, those with COPD had higher rates of fatigue (56.0% vs. 40.2%), dyspnea (66.0% vs. 26.3%), diarrhea (16.0% vs. 3.6%), and unconsciousness (8.0% vs. 1.7%) and a significantly higher proportion of increased activated partial thromboplastin time (23.5% vs. 5.2%) and D-dimer (65.9% vs. 29.3%), as well as ground-glass opacities (77.6% vs. 60.3%), local patchy shadowing (61.2% vs. 41.4%), and interstitial abnormalities (51.0% vs. 19.8%) on chest computed tomography. Patients with COPD were more likely to develop bacterial or fungal coinfection (20.0% vs. 5.9%), acute respiratory distress syndrome (ARDS) (20.0% vs. 7.3%), septic shock (14.0% vs. 2.3%), or acute renal failure (12.0% vs. 1.3%). Patients with COPD and COVID-19 had a higher risk of reaching the composite endpoints [hazard ratio (HR): 2.17, 95% confidence interval (CI): 1.40-3.38; P=0.001] or death (HR: 2.28, 95% CI: 1.15-4.51; P=0.019), after adjustment.CONCLUSIONS:In this study, patients with COPD who developed COVID-19 showed a higher risk of admission to the intensive care unit, mechanical ventilation, or death.

慢性阻塞性肺疾病(COPD)和心血管疾病均是高发生率的常见疾病,两者密切相关,治疗上相互影响.为了优化COPD患者的治疗,“心肺联合管理”的概念被提出.COPD合并心血管疾病的治疗是个复杂的课题.文章系统性回顾了近年来的国内外相关文献,总结分析了COPD合并心血管疾病药物治疗的科学证据,以期对临床工作有一定的指导意义,对优化COPD合并心血管疾病患者的管理有所贡献.

Background: The use of simple and affordable screening tools for chronic obstructive pulmonary disease (COPD) is limited. We aimed to assess the validity of a handheld expiratory flow meter (COPD-6 ® , Vitalograph Ltd., Ireland) for COPD screening in Chinese primary care settings. Methods: In our cross-sectional study, subjects were randomly selected in eight primary care settings. Testing with the Vitalograph-COPD-6 ® and conventional spirometry were sequentially performed on subjects. The correlation between COPD-6 ® and conventional spirometry was determined. Validity was analyzed by the area under the receiver operator characteristic curve (AUC) of the forced expiratory volume in one second (FEV 1 ) / forced expiratory volume in six seconds (FEV 6 ) that used to detect airway obstruction. The sensitivity, specificity, predictive values, and likelihood ratio were calculated according to different FEV 1 /FEV 6 cut-off points. Results: 229 subjects (15.4%) were diagnosed with airflow limitation by standard spirometry. FEV 1 , FEV 6 , and FEV 1 /FEV 6 measured by COPD-6 ® were correlated with FEV 1 , FVC, and FEV 1 /FVC measured by spirometry (r=0.889, 0.835and 0.647, p<0.001), respectively. AUC of the FEV 1 /FEV 6 to determine airflow obstruction was 0.857 (95%CI: 0.826 to 0.888). No significant difference of AUC was observed between the symptomatic group and the asymptomatic population (AUC=0.869 vs. 0.843, P=0.425). A similar phenomenon was found in the AUC of smokers and never-smokers (AUC=0.862 vs.0.840; P=0.515). The value of AUC was largest (i.e., 0.80) when the cut-off point for FEV 1 /FEV 6 was 0.77. Conclusions: The handheld COPD-6 ® could be used as a pre-screening device on early diagnosis of COPD in Chinese primary care settings.

Background: Criteria of obstruction that establish a diagnosis of COPD have been debated in recent years. We carried out a follow-up study to assess the impact of the new LLN reference equation for Chinese on detecting COPD compared with the traditional 0.7fixed criteria. Methods: We examined the prevalence and characteristics of airflow limitation for a non-child population using post-bronchodilator airflow with both age-dependent predicted lower limit of the normal value and fixed-ratio spirometric criterion. Questionnaires and spirometry were completed for all eligible subjects during the baseline examination. Participants with inconsistent diagnosis according to the two criteria, normal participants (controls) and COPD patients in stages I or II, were invited to take a cardiopulmonary exercise testing (CPET) examination and follow up for 2-4 years. Results: A total of 5448 (mean age 50.51 +/- 13.2 yr) study subjects with acceptable spirometry and complete questionnaire data were included in our final analyses. COPD detection based on LLN was consistent with the GOLD 0.7 fixed-ratio in general, as 51 subjects (0.9%) were underdiagnosed, and 61 subjects (1.1%) were overdiagnosed when using LLN as the reference diagnostic criterion. The underdiagnosed subjects were younger, had more symptoms, more exposure to biofuels and worse FEV1 than the normal group; they also demonstrated a damaged cardiopulmonary reserve capacity and significant FEV1 decline. Except for being older, the overdiagnosed subjects differed little from the normal group. Conclusions: Individual-dependent LLN appears to better reveal impacts on detecting airflow limitation. Participants underdiagnosed by GOLD criterion should be paid more attention.

Objective To observe the effect of smoking status on lung function in Chinese people >40 years of age by a 2-year longitudinal follow-up.Methods This study prospectively investigated 2 682 cases of pulmonary ventilation function,smoking status,regularity of residents drug combination and gender,age,height,weight and other information,observation time for two years,2 290 people (85.4%) complete the follow-up study.Results Of the 2 290 people,1 197 people (52.3%) are never-smokers,467 people (20.4%) are ex-smokers,626 people (27.3%) are current smokers.There were statistically significant differences in the number of age,sex,BMI,lung function COPD and combination therapy among the three groups.After 2 years of follow-up,results show that the lung function FEV1,FEV1 % pred,FVC,FEV1 / FVC showed decreased year by year.After adjusted the difference variables,It showed that,to compared with never smokers,ex-smokers significantly reduced lung function FEV1,FEV1 %pred and FEV1 / FVC,P values were 0.030,0.011 and <0.001,current smokers significantly reduced lung function FEV1/FVC.Conclusions Never-smokers have the slowest decline in lung function,We advocate non smoking or smoking as early as possible.

BACKGROUNDPatients with mild or moderate chronic obstructive pulmonary disease (COPD) rarely receive medications, because they have few symptoms. We hypothesized that long-term use of tiotropium would improve lung function and ameliorate the decline in lung function in patients with mild or moderate COPD.METHODSIn a multicenter, randomized, double-blind, placebo-controlled trial that was conducted in China, we randomly assigned 841 patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate) severity to receive a once-daily inhaled dose (18 mu g) of tiotropium (419 patients) or matching placebo (422) for 2 years. The primary end point was the between-group difference in the change from baseline to 24 months in the forced expiratory volume in 1 second (FEV 1) before bronchodilator use. Secondary end points included the between-group difference in the change from baseline to 24 months in the FEV 1 after bronchodilator use and the between-group difference in the annual decline in the FEV 1 before and after bronchodilator use from day 30 to month 24.RESULTSOf 841 patients who underwent randomization, 388 patients in the tiotropium group and 383 in the placebo group were included in the full analysis set. The FEV 1 in patients who received tiotropium was higher than in those who received placebo throughout the trial (ranges of mean differences, 127 to 169 ml before bronchodilator use and 71 to 133 ml after bronchodilator use; P<0.001 for all comparisons). There was no significant amelioration of the mean (+/- SE) annual decline in the FEV 1 before bronchodilator use: the decline was 38 +/- 6 ml per year in the tiotropium group and 53 +/- 6 ml per year in the placebo group (difference, 15 ml per year; 95% confidence interval [CI], -1 to 31; P = 0.06). In contrast, the annual decline in the FEV 1 after bronchodilator use was significantly less in the tiotropium group than in the placebo group (29 +/- 5 ml per year vs. 51 +/- 6 ml per year; difference, 22 ml per year [95% CI, 6 to 37]; P = 0.006). The incidence of adverse events was generally similar in the two groups.CONCLUSIONSTiotropium resulted in a higher FEV 1 than placebo at 24 months and ameliorated the annual decline in the FEV 1 after bronchodilator use in patients with COPD of GOLD stage 1 or 2. (Funded by Boehringer Ingelheim and others; Tie-COPD ClinicalTrials.gov number, NCT01455129.)

Objective The association between exposure to ambient particles with a median aerodynamic diameter less than 10/2.5 mu m (particulate matter, PM10/(2.5)) and COPD remains unclear. Our study objective was to examine the association between ambient PM10/(2.5) concentrations and lung functions in adults.Methods A cross-sectional study was conducted in southern China. Seven clusters were randomly selected from four cities across Guangdong province. Residents aged >= 20 years in the participating clusters were randomly recruited; all eligible participants were examined with a standardised questionnaire and spirometry. COPD was defined as a post-bronchodilator FEV1/FVC less than 70%. Atmosphere PM sampling was conducted across the clusters along with our survey.Results Of the subjects initially recruited, 84.4% (n=5993) were included for analysis. COPD prevalence and atmosphere PM concentration varied significantly among the seven clusters. COPD prevalence was significantly associated with elevated PM concentration levels: adjusted OR 2.416 (95% CI 1.417 to 4.118) for >35 and <= 75 mu g/m(3) and 2.530 (1.280 to 5.001) for >75 mu g/m(3) compared with the level of <= 35 mu g/m(3) for PM2.5; adjusted OR 2.442 (95% CI 1.449 to 4.117) for >50 and <= 150 mu g/m(3) compared with the level of <= 50 mu g/m(3) for PM1. A 10 mu g/m(3) increase in PM2.5 concentrations was associated with a 26 mL (95% CI -43 to -9) decrease in FEV1, a 28 mL (-49 to -8) decrease in FVC and a 0.09% decrease (-0.170 to -0.010) in FEV1/FVC ratio. The associations of COPD with PM10 were consistent with PM2.5 but slightly weaker.Conclusions Exposure to higher PM concentrations was strongly associated with increased COPD prevalence and declined respiratory function.

SESSION TITLE: COPD Phenotypes SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: To investigate the clinical phenotype in patients with COPD caused by biomass smoke. METHODS: The subjects were grouped according to the risk factors exposured: ① COPD group caused by biomass smoke (BSCOPD), ② COPD group caused by cigarette smoke (CSCOPD), ③ Normal control group exposed by biomass smoke (BSNormal), ④ Normal control group exposed by cigarette smoke (CSNormal). All subjects completed a questionnaire regarding demographic data, symptoms, and environmental exposure and underwent spirometry, HRCT of the chest, bronchial mucosal biopsies and bronchoalveolar lavage fluid (BALF). The clinical variables of four groups were compared. RESULTS: There were 29 subjects in BSCOPD,31 in CSCOPD,12 in BSNormal and 10 in CSNormal. Phenotype of pulmonary function:Vcmax% pred and FVC% pred in BSCOPD were greater than that in CSCOPD (P=0.013). PEF25, PEF50, PEF75, MMEF in BSCOPD were less than those in CSCOPD (P<0.05). PEF25, PEF50, PEF75, MMEF, MMEF% pred in BSCOPD and CSCOPD were less than those in control groups (p<0.01). FEV1% pred and FEV1/FVC in BSCOPD and CSCOPD were less than those in control groups (p<0.05) but there was no significant difference between BSCOPD and CSCOPD. Phenotype of HRCT: EI and GVin% in BSCOPD were significantly less than those in CSCOPD (P<0.01). EI and GV in% in BSCOPD and CSCOPD were significantly greater than those in control groups (p<0.05). RVC-860to-950HU in BSCOPD was significantly less than that in CSCOPD (P<0.01). Pathological features:basement membrane thickness of BSCOPD was significantly thicker than CSCOPD and control groups (P<0.01). The basement membrane thickness of CSCOPD had no significant difference with control groups (P>0.05). Endobronchial pigmentation in BSCOPD was significantly more than that in CSCOPD (P<0.05). The proportions of macrophages and lymphocytes of BALF in BSCOPD were significantly greater than those in CSCOPD. The proportion of neutrophils of BALF in BSCOPD was significantly less than that in CSCOPD (P<0.05). CONCLUSIONS: COPD caused by biomass smoke is a distinct phenotype of COPD, with different clinical, radiological, pathological and physiological characteristics compared with COPD caused by cigarette smoke. CLINICAL IMPLICATIONS: COPD caused by biomass smoke maybe have different prognosis or treatment characteristics compared with COPD caused by cigarette smoke. DISCLOSURE: The following authors have nothing to disclose: Dongxing Zhao, Yumin Zhou, Changbin Jiang, Xiaochen Li, Zhuxiang Zhao, Fang He, Sha Liu, Jinding Pu, Pixin Ran No Product/Research Disclosure Information

It is feasible to establish a continuing medical education model with professional content,information technology,diversified forms,union of medical care,teaching and research in the process of demonstration site construction for disease prevention and management.This continuing medical education model is expectable to solve some problems of continuing medical education in the primary health care settings,i.e.professional limitations,inadequate funding,etc.and to improve the overall quality of health team and health services.

INTRODUCTION:Owing to the high and increasing morbidity and mortality, chronic obstructive pulmonary disease (COPD) has become a major public health problem worldwide. Although the majority of patients with COPD are in the early stages, little attention has been paid to them, in particular regarding to early intervention. Tiotropium bromide can significantly relieve symptoms and reduce the incidence of acute exacerbations of COPD. Therefore, we hypothesise that therapy with tiotropium bromide will benefit patients with COPD with early-stage disease.METHOD/ANALYSIS:A randomised, double-blinded, placebo-controlled, parallel-group, multicentre clinical trial (Tiotropium In Early COPD study, Tie-COPD study) is being conducted to evaluate the efficacy and safety of long-term intervention with tiotropium in patients with COPD with early-stage disease. A total of 839 patients with COPD who satisfied the eligibility criteria were randomly assigned (1:1) to receive a once daily inhaled capsule of either tiotropium bromide (18 μg) or matching placebo for 2 years. Measurements will include forced expiratory volume in 1 s, health-related quality of life, grade degree of breathlessness related to activities, COPD exacerbations and pharmacoeconomic analysis.ETHICS/DISSEMINATION:This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University. Recruitment started in November 2011 and ended in October 2013, with 839 patients randomised. The treatment follow-up of participants with Tie-COPD is currently ongoing and is due to finish in November 2015. The authors will disseminate the findings in peer-reviewed publications, conferences and seminar presentations.TRIAL REGISTRATION:ClinicalTrials.gov (NCT01455129).

Objective To assess the severity distribution proportion and quality of life (QOL) of chronic obstructive pulmonary disease(COPD)among population in Southern China.Methods Data were from the cross-sectional survey of COPD which was conducted in an urban and a rural of Guangdong for residents aged over 40 years old.The recruited populations were interviewed with questionnaire and were tested with spirometry.Those with less than 70％ of post-bronchodialator FEV1/FVC were identified as the COPD.The quality of life was assessed with 12-item Short-Form health survey questionnaire (SF-12).Groups (A,B,C and D) were classified according to GOLD using combination of mMRC,FEV1 ％pred and acute exacerbation of COPD in last year.Results Three hundred and three patients with COPD indentified by spirometry testing among population,there were 109 (36.0 ％),77 (25.4 ％),38 (12.5 ％)and 79 (26.1 ％) patients in Group A,B,C and D,respectively.There was statistically difference between each two groups in physical component scores of SF-12 (F =39.593,P ＜0.001) except for difference between Group B and C,with 49.28±4.25,43.21±7.94,44.67±7.90 and 37.45±9.68 for Group A,B,C and D,respectively.A statistically difference was found between four groups in mental component scores of SF-12 (F =2.978,P =0.032),with 57.62±3.31,57.89±4.25,57.22±4.83,55.63±7.95 for Group A,B,C and D,respectively.Group D had a lower mental component scores of SF-12 compare to Group A and C (both P ＜0.05).Conclusions Group A is the highest proportion in population with a minimum of impaired quality of life,and Group D has the most serious damage of quality of life.

BACKGROUND:Biomass smoke is associated with the risk of chronic obstructive pulmonary disease (COPD), but few studies have elaborated approaches to reduce the risk of COPD from biomass burning. The purpose of this study was to determine whether improved cooking fuels and ventilation have effects on pulmonary function and the incidence of COPD.METHODS AND FINDINGS:A 9-y prospective cohort study was conducted among 996 eligible participants aged at least 40 y from November 1, 2002, through November 30, 2011, in 12 villages in southern China. Interventions were implemented starting in 2002 to improve kitchen ventilation (by providing support and instruction for improving biomass stoves or installing exhaust fans) and to promote the use of clean fuels (i.e., biogas) instead of biomass for cooking (by providing support and instruction for installing household biogas digesters); questionnaire interviews and spirometry tests were performed in 2005, 2008, and 2011. That the interventions improved air quality was confirmed via measurements of indoor air pollutants (i.e., SO₂, CO, CO₂, NO₂, and particulate matter with an aerodynamic diameter of 10 µm or less) in a randomly selected subset of the participants' homes. Annual declines in lung function and COPD incidence were compared between those who took up one, both, or neither of the interventions. Use of clean fuels and improved ventilation were associated with a reduced decline in forced expiratory volume in 1 s (FEV₁): decline in FEV₁ was reduced by 12 ml/y (95% CI, 4 to 20 ml/y) and 13 ml/y (95% CI, 4 to 23 ml/y) in those who used clean fuels and improved ventilation, respectively, compared to those who took up neither intervention, after adjustment for confounders. The combined improvements of use of clean fuels and improved ventilation had the greatest favorable effects on the decline in FEV₁, with a slowing of 16 ml/y (95% CI, 9 to 23 ml/y). The longer the duration of improved fuel use and ventilation, the greater the benefits in slowing the decline of FEV₁ (p<0.05). The reduction in the risk of COPD was unequivocal after the fuel and ventilation improvements, with an odds ratio of 0.28 (95% CI, 0.11 to 0.73) for both improvements.CONCLUSIONS:Replacing biomass with biogas for cooking and improving kitchen ventilation are associated with a reduced decline in FEV₁ and risk of COPD.TRIAL REGISTRATION:Chinese Clinical Trial Register ChiCTR-OCH-12002398.