Purpose:To develop a reliable screening questionnaire for chronic obstructive pulmonary disease (COPD) for primary health care institutions in high-altitude areas. Patients and Methods:This was a large cross-sectional study. The study included individuals who resided at an altitude of more than 2100 meters, were aged 35 years or older. The data were randomly divided into a development set and a validation set at a ratio of 7:3. Single-factor and multifactor logistic regression equations were employed to identify pertinent variables and construct a scoring system. The receiver operating characteristic (ROC) curve, area under the curve (AUC), positive predictive value (PPV) and negative predictive value (NPV) were used to evaluate the discriminative ability of the questionnaire. Results:A total of 2909 individuals were included in this study, including 1304 males (44.83%), with a median age of 47.00 (41.00-55.00) years. A multivariate analysis of the development set revealed that five variables (age, history of pulmonary tuberculosis, smoking status, household air pollution exposure and CPOD Assessment Test (CAT) score) were significantly correlated with COPD. A scoring system was constructed on the basis of these findings. The AUC for the model in the development set was 0.714, whereas that for the validation set was 0.726. ROC analysis indicated that the optimal diagnostic cutoff value for the score was 22 points, with a sensitivity of 85.0% and a specificity of 48.4%. The results indicated that the sensitivity of the model was the highest (87.3%) at altitudes between 2100 and 3000 meters, whereas the specificity was the highest (80.9%) at altitudes >4000 meters. The conclusions were essentially consistent when the lower limit of normal (LLN) was used to verify the values in different altitude areas. Conclusion:The COPD screening questionnaire effectively screens COPD in high-altitude primary healthcare settings.

To investigate the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) severity and fat, bone, and muscle indices. This study included 102 patients with OSAHS and retrospectively reviewed their physical examination data. All patients underwent polysomnography, body composition analysis, dual-energy X-ray absorptiometry, computed tomography (CT) and blood test. Correlation and multiple linear regression analyses were performed using SPSS 22.0. Among the fat indices, fat mass (FM) (r = 0.27–0.43), body fat percentage (BFP) (r = 0. 25–0.35), visceral fat area (VFA) (r = 0.28–0.40) and trunk fat mass (TFM) (r = 0.26–0.34) were positively correlated with hypopnea index (HI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and percent of time spent with oxygen saturation below 90

Introduction:Chronic obstructive pulmonary disease (COPD) has shown a rising trend in morbidity and mortality over the years, leading to a growing economic burden globally. The aim of this study was to establish a predictive score for assessing the risk of death in patients with severe acute exacerbations of COPD (AECOPD) to help clinicians evaluate the condition and prognosis of patients. Material and methods:Patients hospitalized for severe AECOPD were consecutively included. All patients were randomly assigned to the developmental and validation cohorts in a 7 : 3 ratio. We identified independent prognostic factors for in-hospital mortality in the development cohort by univariate analysis and multivariate logistic regression analysis. In the validation cohort, the predictive power of the new score was verified and compared to the other four scores. Results:A total of 488 patients with severe AECOPD who were hospitalized between January 2011 and October 2022 were included. The mean age was 78.0 ±8.2 years and 361 (74.0%) of the patients were male. The development cohort included 342 patients, 40 of whom died during hospitalization. The five independent risk factors associated with in-hospital mortality according to multi-factorial regression analysis were white blood cell count (WBC) > 10 × 109/l, lymphocyte count < 0.8 × 109/l, age > 80 years, confusion, and chronic heart failure. In the validation cohort, the new prediction score had good predictive power (AUC = 0.826, 95% CI: 0.724-0.928) and performed more strongly than other clinical prediction scores. Conclusions:The new predictive score is a simple and effective way to predict mortality in hospitalized patients with severe AECOPD.

Rationale: Spirometry reference equations that are derived from a large, nationally representative general population are warranted in China, and the impact of using prebronchodilator (pre-BD) and post-BD spirometry reference values has yet to be assessed in Chinese populations. Objectives: To present the pre-BD and post-BD spirometry reference values for Chinese adults using the China Pulmonary Health (CPH) Study. Methods: A reference population of 17,969 healthy, nonsmoking participants in the CPH Study was used to calculate the pre- and post-BD reference values for FEV1, FVC, and FEV1/FVC ratio. Pre- and post-BD reference values were applied to the entire CPH population (N = 50,991) to illustrate the divergence between the use of different references in determining disease prevalence and severity grading. Measurements and Main Results: The prevalences of airflow limitation were 5.36% using the pre-BD reference and 8.02% using the post-BD reference. Individuals who had a post-BD FEV1/FVC ratio lower than the post-BD reference value but higher than the pre-BD reference value were found to have significantly higher rates of self-reported respiratory symptoms and significantly lower values on spirometry indicators than those whose post-BD FEV1/FVC ratio was greater than the post-BD reference value. An additional 3.51% of participants were identified as having grade II-IV chronic obstructive pulmonary disease using the post-BD FEV1 predicted values. Conclusions: This study generated and applied pre- and post-BD spirometry reference values in a nationally representative Chinese adult population. Post-BD reference values may serve as an additional criterion in identifying individuals at risk for obstructive pulmonary diseases, and their diagnostic and prognostic values should be further investigated.

Introduction Chronic Obstructive Pulmonary Disease (COPD) has shown a rising trend in morbidity and mortality over the years, leading to a growing economic burden globally. The aim of this study was to establish a predictive score for assessing the risk of death in patients with severe acute exacerbations of COPD (AECOPD) to help clinicians evaluate the condition and prognosis of patients. Material and methods Patients hospitalized for severe AECOPD were consecutively included. All patients were randomly assigned to the developmental and validation cohorts in a 7:3 ratio. We identified independent prognostic factors for in-hospital mortality in development cohort by univariate analysis and multivariate logistic regression analysis. In validation cohort, the predictive power of the new score was verified and compared to the other four scores. Results A total of 488 patients with severe AECOPD who were hospitalized from January 2011 to October 2022 were included. The mean age was (78.0 ± 8.2) years and 361 (74.0%) of the patients were male. The development cohort included 342 patients, 40 of whom died during hospitalization. The five independent risk factors associated with in-hospital mortality according to multi-factorial regression analysis were WBC > 10 × 109/L, lymphocyte count < 0.8 × 109/L, age > 80 years, confusion, and chronic heart failure. In validation cohort, the new prediction scores had good predictive power (AUC=0.826, 95% CI: 0.724-0.928) and performed more strongly than other clinical prediction scores. Conclusions The new predictive score is a simple and effective way to predict mortality in hospitalized patients with severe AECOPD.

Abstract Background There is no general agreement on the preferential use of a fixed ratio (FR) of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7 vs. the lower limit of normal (LLN) of FEV1/FVC to define airflow obstruction. Determining the impact of these different cut-off levels in people living at high altitudes has not been studied. We assessed the prevalence of airflow obstruction and its clinical characteristics in residents living at high altitude using a fixed ratio and the LLN of FEV1/FVC according to Global Lung Initiative 2012 (GLI) reference values. Methods Using a multistage stratified sampling method, 3702 participants (aged ≥ 15 years) living at an altitude of 3000–4700 m in Tibet were included. Results 11.4% and 7.7% of participants had airflow obstruction according to GLI-LLN and a fixed FEV1/FVC cut-off value, respectively. The participants in the FR−/LLN+ group were younger, predominantly female, more frequently exposed to household air pollution, and had a higher proportion of chronic obstructive pulmonary disease assessment test scores ≥ 10 than those in the FR−/LLN− group. They also had a significantly lower FEV1 and a higher frequency of small airway dysfunction. Compared with the participants of the FR+/LLN+ group, those in the FR−/LLN+ group showed no significant difference in the risk factors for airflow obstruction and respiratory symptoms, but had a lower prevalence of small airway dysfunction. Conclusions Defining airflow obstruction according to LLN, instead of using an FR, identified younger individuals with more frequent clinical symptoms of airflow obstruction and small airway dysfunction.

Objective: To explore the correlation between pulmonary quantitative CT measurement indicators and respiratory symptoms in patients with stable chronic obstructive pulmonary disease (COPD). Methods: A total of 186 patients with COPD in stable stage who visited in the outpatient department of Beijing Hospital from March 2021 to February 2022 were prospectively included. Demographic data, respiratory symptoms and lung function were collected. The original DICOM data of high-resolution CT (HRCT) were processed using the FACT medical imaging information system and the pulmonary emphysema index pixel index-950 (PI-950) and the airway wall thickness (4-6 T) and the percentage of airway area (4-6 WA%) of the 4-6 generation bronchi which represent the segmental and subsegmental bronchi were measured automatically. According to the modified British medical research council dyspnea scale (mMRC, 0-1 point for low score group, 2-4 points for high score group), chronic obstructive pulmonary disease assessment test (CAT, score<10 points for low score group,≥10 points for high score group), cough, expectoration and wheezing (asymptomatic group and symptomatic group), they were divided into two groups as dependent variables. The relationship between imaging parameters and the above symptoms was evaluated using a logistic regression model. Results: The study ultimately included 186 patients who met the inclusion criteria, including 162 males and 24 females, aged (68.9±9.3) years old. There were 83 patients in the high mMRC group, 120 patients in the high CAT group, 146 patients in the cough group, 154 patients in the expectoration group, and 65 patients in the wheezing group. The age and emphysema parameter PI-950 in the high score group of mMRC were higher than those in the low score group, while the percentage of the forced expiratory volume in 1 second (FEV1) predicted value (FEV1 pred) after medication, the percentage of carbon monoxide diffusion volume (DLCO) predicted value (DLCO pred), and the percentage of the maximum midexpiratory flow (MMEF) predicted value (MMEF pred) after medication were lower than those in the low score group (all P<0.05). The age of the high CAT group was higher than that of the low score group, while FEV1 pred and MMEF pred after medication were lower than those of the low score group (all P<0.05). The proportion of males, patients with smoking history, and smoking index in the cough group were higher than those in the non cough group, while the 4 WA% was lower than that in the non cough group (all P<0.05). The proportion of males, patients with smoking history, smoking index, and PI-950 in the expectoration group were higher than those in the non expectoration group, while FEV1 pred after medication and 4 WA% were lower than those in the non expectoration group (all P<0.05). The 5 WA% and 6 WA% of the wheezing group were higher than those of the non wheezing group, while MMEF pred after medication was lower than that of the non wheezing group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for demographic characteristics, smoking, combined diseases, lung function and other confounding factors, for every 10% increase in PI-950, the likelihood of developing more severe dyspnea for the patients (high score group according to mMRC) increased by 67.3% (OR=1.673, 95%CI: 1.052-2.658); Every 10% increase in 6WA% increased the likelihood of wheezing by 3.189 times (OR=4.189, 95%CI: 1.070-16.395). No correlation was found between various imaging indicators and cough, expectoration, and CAT scores (P>0.05). Conclusion: Quantitative CT measurement indicators in stable COPD patients can explain the presence and severity of respiratory symptoms, the pulmonary emphysema indicator is associated with dyspnea, and the percentage of proximal airway wall area is associated with wheezing.

Background: Exposure to particulate matter (PM) has been a major public health threat, but the potentially differential effects on asthma of PM remain largely unknown in high altitude settings. We evaluated the effects of ambient PM on asthma in high altitude settings. Methods: The study recruited a representative sample from high altitude settings using a multistage stratified sampling procedure. Asthma was defined by a self-reported history of diagnosis by a physician or by wheezing symptoms in the preceding 12 months. The annual mean PM2.5 and PM10 concentrations were calculated for each grid cell at 1-km spatial resolution based on the geographical coordinates. Results: We analyzed data for participants (mean age 39.1 years, 51.4% female) and 183 (3.7%, 95% confidence interval (CI): 3.2-4.2) of the participants had asthma. Prevalence was higher in women (4.3%, 95% CI 3.5-5.1) than in men (3.1%, 2.4-3.8) and increasing with higher concentration of PM exposures. For an interquartile range (IQR) difference (8.77 mg/m3) in PM2.5 exposure, the adjusted odds ratio (OR) was 1.64 (95% CI 1.46-1.83, P < 0.001) for risk of asthma. For PM10, there was evidence for an association with risk of asthma (OR 2.34, 95% CI: 1.75-3.15, P < 0.001 per IQR of 43.26 mg/m3). Further analyses showed that household mold or damp exposure may aggravate PM exposure associated risks of asthma. Conclusions: This study identified that PM exposure could be a dominate environmental risk factor for asthma but largely unconsidered in the high-altitude areas. The association between PM exposure and asthma should be of interest for planners of national policies and encourage programs for prevention of asthma in residents living at high altitudes.

Background Patients with severe acute exacerbations of chronic obstructive pulmonary disease often have a poor prognosis. Biomarkers can help clinicians personalize the assessment of different patients and mitigate mortality. The present study sought to determine if the lymphocyte count could act as a risk factor for mortality in individuals with severe AECOPD. Methods A retrospective study was carried out with 458 cases who had severe AECOPD. For analysis, patients were divided into two groups on the basis of lymphocyte count: < 0.8 × 10 9 /L and ≥ 0.8 × 10 9 /L. Results Patients who fulfilled the criteria for inclusion were enrolled, namely 458 with a mean age of 78.2 ± 8.2 years. Of these patients, 175 had a low lymphocyte count. Compared to patients with normal lymphocyte counts, those with low counts were older (79.2 ± 7.4 vs. 77.5 ± 8.6 years, p = 0.036), had lower activities of daily living scores on admission (35.9 ± 27.6 vs. 47.5 ± 17.1, p < 0.001), and had a greater need for home oxygen therapy (84.6 vs. 72.1%, p = 0.002). Patients with low lymphocytes had higher mortality rates during hospitalization (17.1 vs. 7.1%, p = 0.001), longer hospital stay (median [IQR] 16 days [12–26] vs. 14 days [10–20], p = 0.002) and longer time on mechanical ventilation (median [IQR] 11.6 days [5.8–18.7] vs. 10.9 days [3.8–11.6], p < 0.001). The logistic regression analysis showed lymphocyte count < 0.8 × 10 9 /L was an independent risk factor associated with in-hospital mortality (OR 2.74, 95%CI 1.33–5.66, p = 0.006). Conclusion Lymphocyte count could act as a predictor of mortality in patients with severe AECOPD.

To the Editor: Chronic airflow obstruction (CAO) is a characteristic feature of chronic obstructive pulmonary disease (COPD) and occurs due to airway and/or alveolar abnormalities typically associated with exposure to noxious particles or gases. The major risk factor for CAO is cigarette smoking, but exposure to solid fuel likely influences CAO development. Studies have found that solid fuel exposure is associated with a high prevalence of CAO, particularly among women. Comparing COPD caused by either solid fuel or tobacco smoke exposure is very significant because about 3 billion people are exposed to solid fuel smoke, and 1.01 billion people smoke tobacco, globally. This study aimed to investigate and compare the clinical and functional characteristics of CAO patients exposed to solid fuel and tobacco smoke using propensity score matching (PSM) in western China.

Chronic obstructive pulmonary disease (COPD) is a common chronic disease that poses a serious risk to human health, and acute exacerbation is the leading cause of death in patients with COPD during hospitalization, imposing an increasing disease burden on patients and society.This article is to describe the research progress of risk factors associated with in-hospital death in patients admitted with acute exacerbations of COPD, so as to contribute to early clinical identification and treatment and to improve patient prognosis.

Interleukin-1 (IL-1) plays an essential role in the immune pro-inflammatory process, which is regarded as one of many factors in the development of type 2 diabetes mellitus (T2DM).Several case-control studies have illustrated the association of the IL-1B (-511) (rs16944, Chr 2:112,837,290, C/T Intragenic, Transition Substitution) and IL-1RN (VNTR) (gene for IL-1 receptor antagonist, IL-1RA, 86 bp tandem repeats in intron 2) polymorphisms with T2DM risk.However, the results were inconsistent and inconclusive.We performed a metaanalysis (registry number: CRD42021268494) to assess the association of the IL-1B (-511) and IL-1RN (VNTR) polymorphisms with T2DM risk.Random-effects models were applied to calculate the pooled ORs (odds ratios) and 95% CIs (confidence intervals) to test the strength of the association in the overall group and subgroups stratified by ethnicity, respectively.Between-study heterogeneity and publication bias were evaluated by the Qtest, I 2 statistic, Harbord test, and Peters test accordingly.Sensitivity analyses were also performed.A total of 12 publications evaluating the association of IL-1B (-511) and IL-1RN (VNTR) polymorphisms with the risk of T2DM development were included.The metaanalysis showed that IL-1RN (VNTR) was related to the increasing development of T2DM risk in the recessive model (OR=1.62,95% CI: 1.09-2.42,P het =0.377, P z =0.018) and in the homozygous model (OR=2.02,95% CI: 1.07-3.83,P het =0.085, P z =0.031), and the IL-1RN 2* allele was found a significant association with evaluated T2DM risk in all ethnicities (OR=2.08,95% CI: 1.43-3.02,P het ＜0.001, P z ＜0.001) and in EA (OR=2.01,95% CI: 1.53-2.66,P het =0.541, P z ＜0.001).Moreover, stratification by ethnicity revealed that IL-1B (-511) was associated with a decreased risk of T2DM in the dominant model (OR=0.76,95% CI:

Interleukin-1 (IL-1) plays an essential role in the immune pro-inflammatory process, which is regarded as one of many factors in the development of type 2 diabetes mellitus (T2DM). Several case-control studies have illustrated the association of the IL-1B (-511) (rs16944, Chr 2:112,837,290, C/T Intragenic, Transition Substitution) and IL-1RN (VNTR) (gene for IL-1 receptor antagonist, IL-1RA, 86 bp tandem repeats in intron 2) polymorphisms with T2DM risk. However, the results were inconsistent and inconclusive. We performed a meta-analysis (registry number: CRD42021268494) to assess the association of the IL-1B (-511) and IL-1RN (VNTR) polymorphisms with T2DM risk. Random-effects models were applied to calculate the pooled ORs (odds ratios) and 95% CIs (confidence intervals) to test the strength of the association in the overall group and subgroups stratified by ethnicity, respectively. Between-study heterogeneity and publication bias were evaluated by the Q-test, I2 statistic, Harbord test, and Peters test accordingly. Sensitivity analyses were also performed. A total of 12 publications evaluating the association of IL-1B (-511) and IL-1RN (VNTR) polymorphisms with the risk of T2DM development were included. The meta-analysis showed that IL-1RN (VNTR) was related to the increasing development of T2DM risk in the recessive model (OR = 1.62, 95% CI [1.09–2.42], Phet = 0.377, Pz = 0.018) and in the homozygous model (OR = 2.02, 95% CI [1.07–3.83], Phet = 0.085, Pz = 0.031), and the IL-1RN 2* allele was found a significant association with evaluated T2DM risk in all ethnicities (OR = 2.08, 95% CI [1.43–3.02], Phet < 0.001, Pz < 0.001) and in EA (OR = 2.01, 95% CI [1.53–2.66], Phet = 0.541, Pz < 0.001). Moreover, stratification by ethnicity revealed that IL-1B (-511) was associated with a decreased risk of T2DM in the dominant model (OR=0.76, 95% CI [0.59–0.97], Phet = 0.218, Pz = 0.027) and codominant model (OR = 0.73, 95% CI [0.54–0.99], Phet = 0.141, Pz = 0.040) in the East Asian (EA) subgroup. Our results suggest that the IL-1RN 2* allele and 2*2* homozygous polymorphism are strongly associated with increasing T2DM risk and that the IL-1B (-511) T allele polymorphism is associated with decreasing T2DM risk in the EA subgroup.

目的 了解西藏与新疆地区常住居民常见代谢危险因素的不同组合,并探讨其与左心室舒张功能障碍(LVDD)的相关性.方法 采用分层多阶段随机抽样的方法于2015-2016年共抽取西藏与新疆地区≥35岁常住居民7529名进行慢性心肺疾病调查,最终5816名纳入分析,其中西藏地区1958名,新疆地区3858名.计算常见代谢危险因素不同组合的构成比和LVDD患病率,并用Logistic回归模型分析主要组合的LVDD患病风险.结果 单一代谢危险因素中,西藏地区高血压占比最高,新疆地区是中心型肥胖;聚集数为2和3的组合中,中心型肥胖+高血压、中心型肥胖+高血压+高甘油三酯均为两地占比最高的组合.在西藏地区,中心型肥胖+高血压在所有组合中占比最高(34.0％),其次为高血压(21.1％),LVDD患病率分别为45.8％和40.2％;新疆地区中心型肥胖+高血压占构成比最高(20.1％),其次为中心型肥胖(18.6％),LVDD患病率分别为44.0％和27.8％.以无代谢危险因素的人群为参照,调整多种因素后的多元Logistic回归分析结果显示,西藏地区LVDD患病风险最高的组合是中心型肥胖+高血压+高甘油三酯(OR=6.342,95％CI 3.359～11.973),新疆地区为中心型肥胖+高血压(OR=2.872,95％CI 2.213～3.728).结论 西藏与新疆地区中心型肥胖合并高血压人群LVDD的患病风险较高,应重点进行干预.

Background: Exacerbations are important events when managing chronic obstructive pulmonary disease (COPD) because they negatively impact disease progression. Inhaled corticosteroid (ICS) usage in patients with COPD is controversial. Therefore, we reviewed the benefits and risks of regular ICS treatment in patients with COPD regarding hospitalized acute exacerbation. Methods: This retrospective multicenter study—conducted in 18 medical centers across China—included 1,862 participants from 34 hospitals in northern China. Baseline characteristics, comorbidities, and administered medicines in the last year were matched using 1:1 propensity score-matching. We reviewed electronic patient medical records to ascertain symptoms, tests, in-hospital treatment, and prognosis. Subsequently, we reviewed computed tomography imaging results and pathogen identification tests. Results: Patients who used ICS in the past year presented more severe respiratory symptoms during acute exacerbations of COPD but less frequent right heart failure or consciousness disturbance. More antibiotics were used during hospitalization, resulting in higher costs; however, their prognosis was not different from patients who did not use ICS. Additionally, although ICS usage could increase gram-negative bacilli in sputum smears, it did not increase the probability of pulmonary infection. Conclusions: ICS use could protect patients from right heart failure, without detrimentally affecting prognosis during hospitalized exacerbations. Therefore, the risk of cardiovascular disease should be taken into consideration when making decisions regarding the potential administration of ICS in patients with COPD.

慢性阻塞性肺疾病（慢阻肺）是一种可以预防和治疗的呼吸系统疾病。近年来研究结果显示，采用一秒率<正常值低限与一秒率<固定气流受限两种慢阻肺诊断标准，在疾病危险因素、患病率、人口学特征、与临床症状相关性、预后等方面均存在一定差异。本文就此两种诊断标准对慢阻肺诊断及预后进行综述。