Correlation between clinical features and disease progression of chronic obstructive pulmonary disease in middle-aged and elderly patients

  Objective  To investigate the correlation between clinical features and disease progression of chronic obstructive pulmonary disease (COPD) in middle-aged and elderly people.

  Methods  A total of 136 COPD patients were selected by double-blind method, and were divided into stable phase of COPD group (n=52) and acute exacerbation phase of COPD (AECOPD) group(n=44), and asthma COPD overlap syndrome (ACOS) group(n=40). Baseline data [age, gender, body mass index(BMI), smoking status, alcohol history, history of hypertension, diabetes mellitus, history of allergies, COPD course, clinical manifestations, signs and symptoms, lung auscultation and CT test results], pulmonary function indexes [forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), FEV₁/FVC, fractional exhaled nitric oxide (FeNO)]were analyzed, and laboratory indexes such as white blood cell count (WBC), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), total immunoglobulin E (IgE), partial arterial oxygen pressure [p_a(O₂)], partial arterial carbon dioxide pressure[p_a(CO₂)], pH value and other laboratory indicators were compared.

  Results  The age of ACOS group was higher than that of the stable phase of COPD group and AECOPD group, and the difference was statistically significant (P < 0.05). The proportions of first symptoms of breath shortness and dry as well as dry and wet rales in lungs in the ACOS group were higher, and the proportions of moist rales in lungs and lung emphysema as well as pulmonary bulla in CT findings were higher than those of the stable phase of COPD group and AECOPD group (P < 0.05). The proportions of lung emphysema as well as pulmonary bulla in CT findings of AECOPD group were significantly higher than those of the stable phase of COPD group (P < 0.05). FEV₁, FVC, FEV₁/FVC and p_a(O₂) of the ACOS group were significantly lower than those of the stable phase of COPD group and AECOPD group (P < 0.05), and FeNO, WBC, IL-6, TNF-α, CRP, total IgE andp_a(CO₂) were significantly higher than those of the stable phase of COPD group and AECOPD group (P < 0.05). FEV₁, FVC, FEV₁/FVC and p_a(O₂) of the AECOPD group were significantly lower than those of the stable phase of COPD group, and WBC, IL-6, TNF-α, CRP, total IgE and p_a(CO₂) of the AECOPD group were significantly higher than those of the stable phase of COPD group(P < 0.05). Age, FEV₁, FVC, FEV₁/FVC and total IgE were independent risk factors of ACOS (P < 0.05).

  Conclusion  COPD the clinical characteristics of AECOPD and ACOS differ from COPD at stable phase. Therefore, age and lung function should be attached great importance in clinic to prevent and treat progression of COPD.