2017年 · 第40卷第12期

At the end of the year, the flying snow welcomes the new year, and another year flies by in the blink of an eye. Thank you to the readers, authors and editors who have worked together with us to make common progress in the coming 2017.

Chronic obstructive pulmonary disease (COPD) is a common chronic airway disease. Its incidence is increasing year by year in China, and it has become the third to fourth disease burden and cause of death. According to the prevalence and population data, the number of COPD patients in China exceeds 60 million. However, the research and clinical standardized management level of COPD in China is far lower than that in developed countries. In recent years, under the strong appeal and promotion of experts in respiratory diseases, the research of COPD has received great attention from the Ministry of Science and Technology of China and the Natural Science Foundation of China, and the investment in research funds has increased, which has injected impetus into the future research and diagnosis and treatment of COPD. The research on COPD is about to enter an era of all-round and individualized research and exploration. These combined clinical research results will provide scientific basis for the writing of future guidelines for the diagnosis and treatment of COPD and the optimization of treatment plans, so as to improve the level of clinical diagnosis and treatment.

According to the 2016 Global Burden of Disease Report, there are currently 328 million patients with chronic obstructive pulmonary disease (COPD) worldwide, and it is estimated that COPD will become the third leading cause of death in the world by 2020^[1]。 With the morbidity and mortality increasing year by year, COPD has become one of the most concerned diseases in the world. At present, the global prevalence of COPD in people over 40 years old is as high as 10%, and if mild patients (GOLD grade 1) are included, this rate can reach 20% to 30%^[2]。 The results of a large-scale cross-sectional survey based on lung function measurement conducted in 2002 showed that the prevalence rate of people over 40 years old in China reached 8.2%^[3]The epidemiological survey of COPD in China conducted from 1990 to 2014 showed that the prevalence of COPD in people over 40 years old has risen to 9.9%^[4]It suggests that the situation of prevention and treatment of COPD in China is very severe.

Chronic obstructive pulmonary disease (COPD) is a disease characterized by airflow restriction, which is incompletely reversible and progressively developed. The prevalence of COPD among people aged 40 and above in China is 9.9%^[1]。 It is expected that by 2020, slow obstructive pulmonary disease will be the third leading cause of death in the world. Acute exacerbation of COPD is the most important cause of hospitalization and death in patients with COPD, and its treatment aims to quickly relieve symptoms and reduce mortality. In addition to conventional drugs and oxygen therapy, respiratory support is also an important treatment method. noninvasive positive pressure ventilation (NIPPV) has positive efficacy, and some critically ill patients need invasive mechanical ventilation (IPPV). In recent years, high-flow nasal cannula (HFNC), extra-corporeal carbon dioxide removal (ECCO₂R) and helium/oxygen ventilation and other respiratory support methods are gradually applied in clinic. The choice of respiratory support strategies and modes for patients with acute exacerbation of COPD is introduced as follows.

Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammatory disease characterized by persistent and progressive airflow restriction^[1]。 Because of China's large population base, smoking and biofuel exposure, COPD has a high incidence, disability rate and mortality rate, which seriously affects the quality of life of patients and brings a large economic and social burden. It is a major chronic non-communicable disease that seriously affects the health of Chinese people^[2]。 Early diagnosis and standardized diagnosis and treatment have important clinical significance for the management and prognosis improvement of COPD patients. According to the guidelines developed by the Respiratory Branch of the Chinese Medical Association and the Global Initiative of COPD, pulmonary function tests are the "gold standard" for the diagnosis of COPD^[1,3]After years of training and publicity, pulmonary function tests have received more and more attention and play an important role in the diagnosis and treatment of COPD. However, we have noticed that the practice of pulmonary function testing in Chinese patients with COPD is still not optimistic. The current situation, some problems and countermeasures of pulmonary function testing in the diagnosis and treatment of Chinese patients with COPD are briefly summarized as follows.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease. The 2017 edition of the Global Initiative on Chronic Obstructive Pulmonary Disease (GOLD Guidelines) defines COPD as "a preventable and treatable common respiratory disease characterized by persistent respiratory symptoms and restricted airflow, usually caused by exposure to harmful particles or gases and/or caused by alveolar abnormalities."^[1]。 COPD is a progressive disease without a definite pathological and clinical starting point, and the appearance of clinical symptoms indicates that serious, irreversible damage has been caused.

A 63-year-old female was admitted to Tianjin Chest Hospital on March 15, 2016 due to "cough, expectoration, hoarseness for 2 weeks, aggravation with dyspnea for 2 days". Two weeks before admission, after sorting out moldy items at home, I developed cough, yellow-white sticky sputum, hoarseness, fear of cold, fever and other symptoms, and went to the local hospital. Routine blood test of white blood cells was 9.05×10⁹/L, neutrophils accounted for 0.87; Chest CT showed no obvious abnormalities. Considered as "upper respiratory tract infection", "levofloxacin 0.2 g, twice/d, intravenous drip for more than 1 week" was given, but the effect was not good. Two days before admission, the patient's cough was aggravated, the phlegm was not easy to get out, accompanied by dyspnea, inability to lie down, fever, and the maximum body temperature was 38.2℃. For clear diagnosis and treatment, the patient was admitted to our department by the emergency department. The patient had a history of diabetes for more than 10 years and had poor blood sugar control. He denied the history of tuberculosis and bronchial asthma, and had no history of infectious diseases and genetic diseases in his family. Physical examination at admission: body temperature 37.8 ℃, pulse 102 beats/min, breathing 26 beats/min, blood pressure 130/80 mmHg (1 mmHg =0.133 kPa), wheezing, hoarseness, coarse breathing sounds in both lungs, and audible wheezing sounds.

The patient was a 38-year-old male. He was admitted to hospital on March 13, 2017 due to "fever for 8 days, cough and asthma for 5 days". The patient suddenly developed fever without obvious trigger 8 days ago, with a body temperature of about 38.5 ℃. At the same time, herpes appeared on the left thumb, and pus gradually appeared in the herpes. The body temperature gradually increased, chills and chills were obvious, up to 41.0℃, so I went to the local hospital for treatment. The patient was treated with ceftriaxone and ribavirin, and the high fever persisted. Five days ago, the patient developed a cough with a little pus and blood sputum, accompanied by chest tightness and asthma, herpes similar to the left hand appeared in the corner of the right eye and lip, and the conjunctiva of the right eye was congested with purulent discharge. X-ray chest radiograph showed no abnormalities in both lungs (Figure 1)。 Due to high fever and asthma, he was transferred to our hospital on March 12, 2017. Chest CT examination in the emergency department showed extensive patches and nodular shadows on both lungs (Figure 2,Figure 3,Figure 4)； Blood routine showed a white blood cell count of 15.16×10⁹/L, 0.906 for neutrophils, 0.046 for lymphocytes and 0.15×10 for eosinophil count⁹/L, 171 g/L for hemoglobin and 226×10 for platelets⁹/L, CRP was 227 mg/L; Blood gas analysis: pH 7.44, PaCO₂was 34.6 mmHg (1 mmHg =0.133 kPa), PaO₂56 mmHg. Being in good health. Physical examination on admission: body temperature 38.4 ℃, respiratory rate 30 times/min, blood pressure 135/100 mmHg, clear consciousness, asthmatic appearance, frequent and severe cough, conjunctiva congestion of right eye, purulent secretion, no abnormality in conjunctiva of left eye, herpes on right lip, local scab, about 7 mm pustule on the back of left thumb, with scab on the surface (Figure 5), the breathing sounds of both lungs were coarse, a small amount of wet rales could be heard, the heart rate was 96 beats/min, the rhythm was uniform, there was no murmur, and there was no abnormality in the abdomen. Admission diagnosis: severe pneumonia, type I respiratory failure, right eye conjunctivitis, oral herpes, and cutaneous herpes.

It has been eight years since I first encountered sleep medicine as a graduate student in 2009. Here, taking my doctoral research topic "Sleep Apnea and Valvular Heart Disease" as an example, I communicate with young colleagues how to build my own database and publish a series of papers. It will be introduced from the following aspects: (1) Why do sleep apnea and heart valve disease related research; (2) how the series of studies are done step by step; (3) Analyze the sustainability and scalability of research; (4) Preparation related to clinical research-ethics and clinical research registration.

Immunomodulatory drugs such as glucocorticoids, thymosin and gamma globulin are commonly used in clinical treatment of severe infections, but it is still difficult to determine their efficacy. Academic circles are debating endlessly about this. The reason is that the most fundamental problem of infection is not clear.

COPD is a common chronic airway disease that seriously endangers human health. It is expected to become the fifth disease with the largest economic burden and the third largest mortality rate in the world by 2020^[1]。 The global initiative for chronic obstructive lung disease (GOLD) proposes that stable treatment of COPD includes both pharmacological and non-pharmacological treatments, with respiratory rehabilitation being the first-line non-pharmacological treatment for COPD^[1]。

Mechanical ventilation is an effective treatment for critically ill patients, but a series of organ dysfunctions such as ICU acquired dysfunction (ICUAW) will occur in patients with long-term mechanical ventilation immobilization^[1,2]And will further prolong the time of mechanical ventilation and increase the mortality rate^[3]。 Early pulmonary rehabilitation is an effective means to alleviate the treatment of ICUAW, which can reduce the mortality rate and reduce medical expense^[4,5]。 This paper expounds the latest research progress of early pulmonary rehabilitation in patients with mechanical ventilation from the aspects of interventional opportunity, means and evaluation.

Compared with other administration methods, airway inhalation of drugs has the advantages of high local drug concentration in respiratory tract, rapid onset of action, exact curative effect and less systemic adverse reactions. In recent years, more and more kinds of drugs can be used for airway inhalation. Besides the commonly used bronchodilators, mucolytics and glucocorticoids, antibiotics, vaccines and antihypertensive drugs are also included^[1]。 Therefore, the continuous innovation and optimization of airway drug inhalation technology plays an important role in ensuring higher drug delivery and inhalation efficiency, thereby improving patient efficacy. Inhalation devices are mainly divided into three categories: small volume nebulizer, pressure meter dose inhaler (pMDI) and dry power inhaler (DPI)^[2]。 Recently, the new airway drug inhalation technology mainly innovates and optimizes from the aspects of aerosol generation mechanism, delivery mode, equipment material, booster, on-demand atomization and auxiliary devices, etc. The research progress of airway drug inhalation technology in recent years is reviewed as follows.

China is one of the three countries with MDR-TB and high disease burden in the world^[1]。 At present, the new diagnostic technology of tuberculosis still has some defects in the detection of MTB in special samples and the detection of rare drug-resistant mutant genes^[2,3]。 Digital PCR detection technology can quickly detect pathogenic microorganisms and mutant genes, which has been paid more and more attention in the diagnosis of tuberculosis. The characteristics, advantages and applications of digital PCR in MTB detection are summarized as follows.

A 40-year-old male was admitted to the hospital on April 6, 2017 mainly because of "pulmonary shadows found for 1 week". During the physical examination in the unit 1 week ago, the chest X-ray of the patient found the shadow of the left upper lung, and there was no fever, cough, wheezing, hemoptysis, chest pain, night sweats, etc. Chest CT examination in the outpatient department of our hospital showed central bronchiectasis in the upper lobe of the left lung, and columnar high-density shadow was seen in the tongue segment (Figure 1,Figure 2,Figure 3,Figure 4)。 Previous history of asthma for 10 years, wheezing attacks every autumn and after a cold, irregular medication. Physical examination: There was no rash on the skin and mucous membranes, and the superficial lymph nodes were not palpable and swollen. No abnormalities were observed in the heart, lung and abdomen. Preliminary diagnosis: the cause of lung shadow is to be investigated; Bronchial asthma.

The patient is a 34-year-old female, a photo studio staff member. He was admitted to hospital on November 14, 2016 due to "chest tightness, shortness of breath for 2 months, cough and sputum for 15 days". In September 2016, the patient experienced chest tightness and shortness of breath without obvious triggers, slight shortness of breath at rest, slightly worsened after activity, no cough, expectoration, fever, hemoptysis, chest pain, palpitations, night sweats, fatigue, anorexia and weight loss, and was not diagnosed and treated. At the end of October 2016, there was a paroxysmal cough without inducement, occasionally cough a little white sticky sputum, and the symptoms of shortness of breath were the same as before. So he came to our hospital on November 13, 2016. X-ray chest radiographs showed extensive miliary lesions in both lungs (Figure 1), chest CT showed diffuse lesions in both lungs (Figure 2,Figure 3,Figure 4,Figure 5,Figure 6), lymphangioleiomyomatosis is suspected. Since the onset of the disease, the patient has good spirit, appetite and sleep, normal urine and defecation, and no obvious change in weight. In the past, I was married and had no children. In February 2014, I underwent "laparoscopic left fallopian tube fenestration and embryo removal + right fallopian tube stoma + pelvic adhesion decomposition" due to "ectopic pregnancy". At that time, I found "adenomyosis" and normal menstruation; A significant increase in CA-199 was found in February 2015 (495 U/ml, normal reference<35 U/ml), no abnormalities were found on gastroscopic enteroscopy, CA-199 was 498 U/ml on March 2, 2015 and CA-199 was 415 U/ml on March 11, 2015; Complained that in March 2015, he had chest CT examination in the local hospital due to "cough and expectoration for 1 week" and showed multiple nodules in the lungs (Figure 7,Figure 8,Figure 9,Figure 10), considering "pneumonia", symptoms were relieved after anti-infective treatment (medication unknown), and chest CT was not re-examined; Denial of tobacco and alcohol addiction.