Table of Content

20 June 2024, Volume 5 Issue 3

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Special Topic

Current status and prospects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Wang Lin, Zhang Zinan

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  191-196.  doi:10.19983/j.issn.2096-8493.2024056

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Chronic obstructive pulmonary disease (COPD) is a common chronic disease in clinical practice, with a heavy social and economic burden. Pulmonary rehabilitation is the main non pharmacological treatment method for COPD. Currently, there is a lack of guidelines and standards for pulmonary rehabilitation, and clinical practice experience will accumulate more data for research related to pulmonary rehabilitation. The authors elaborate on the importance of pulmonary rehabilitation in patients with COPD, the difficulties in research, and future research directions, in order to enhance clinical understanding and importance of pulmonary rehabilitation in patients with COPD.

Original Articles

Correlation analysis of physical activity levels and symptom clusters in lung cancer chemotherapy patients during hospitalization

Chen Xinxin, Liu Guofeng, Yang Yingzi, Hu Yachen, Jin Ying, Li Yumei

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  197-206.  doi:10.19983/j.issn.2096-8493.2024048

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Objective: Investigate the patients’ willingness to engage in exercise and level of physical activity with patients with lung cancer undergoing chemotherapy, and analyze the correlation between their physical activity level and symptom clusters. Methods: A cross-sectional survey was conducted from June to August 2022 among 232 lung cancer chemotherapy patients hospitalized at the Department of Respiratory Medicine, Shanghai Pulmonary Hospital, using a general questionnaire, the International Physical Activity Questionnaire (IPAQ), the revised version of the lung cancer module of the M.D. Anderson Symptom Inventory (MDASI-LC). A total of 229 valid questionnaires were collected, with an effective recovery rate of 98.71%. Exploratory factor analysis was employed to identify the categories of symptom clusters, and Spearman’s rank correlation analysis was used to examine the correlation between their physical activity level and symptom clusters. Results: Six symptom clusters were identified in patients with lung cancer undergoing chemotherapy: respiratory symptom cluster, sleep-related symptom cluster, psychological symptom cluster, gastrointestinal symptom cluster, lung cancer-specific symptom cluster and cachexia symptom cluster. Moderate-intensity physical activity was negatively associated with psychological and cachexia symptoms (r=-0.153, -0.159; both P<0.05), while walking activity was negatively correlated with respiratory, sleep-related, psychological, and lung cancer-specific symptom clusters (r=-0.257, -0.222, -0.284, -0.181; all P<0.05). Total physical activity level was also negatively correlated with the respiratory, sleep-related, psychological, and cachexia symptom clusters (r=-0.252, -0.218, -0.304, -0.132; all P<0.05). Conclusion: The level of physical activity in lung cancer chemotherapy patients was negatively correlated with symptom clusters, with higher activity levels corresponding to lower symptom burden. It is recommended to design personalized exercise prescriptions, health education, and exercise guidance based on patients’ activity levels and symptom load, aiming to increase physical activity and alleviate symptom burden.

The correlation between symptom burden and quality of life in patients with chronic obstructive pulmonary disease

Zheng Xiaoxia, Zhu Xiaoxiao, Wu Yifan, Gu Fen

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  207-211.  doi:10.19983/j.issn.2096-8493.2024034

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Objective: To investigate the correlation between symptom burden and quality of life in chronic obstructive pulmonary disease (COPD) patients. Methods: Totally 116 COPD patients from the First Hospital Affiliated with Ningbo University were selected by convenience sampling method. A general situation questionnaire, Chinese version of memory symptom assessment scale and COPD assessment test (CAT) scale were used to survey them. Results: Among the symptoms of COPD patients, the prevalence (81.03%, 94/116), frequency (51.72%, 60/116), severity (41.38%, 48/116), and bothersome (39.66%, 46/116) of shortness of breath all ranked the first. In the symptom burden score, the median score of psychological symptom distress score was the highest at 0.58 (0.00, 1.28); the total score of quality of life was significantly positively correlated with the total symptom burden score, physical symptom distress score, psychological symptom distress score, and global distress index (r=0.66, r=0.52, r=0.61, r=0.58, all P<0.05). Conclusion: In clinical practice, attention should be paid to the dyspnea symptoms of patients with COPD. The higher the symptom burden, the worse the quality of life. Healthcare professionals should strengthen the assessment of symptom burden in COPD patients, especially psychological symptom burden, take targeted intervention measures to reduce the symptom burden of COPD patients and improve their quality of life.

Effect of early limb active exercise on incidence of pulmonary embolism among patients received lung cancer surgery

Pan Qiong, Tian Yayuan, Tong Fei

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  212-218.  doi:10.19983/j.issn.2096-8493.2024061

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Objective: To analyze the effect of early active limb movement in reducing postoperative pulmonary embolism (PE) in lung cancer patients. Methods: Using retrospective research method, according to enrolment criteria, 187 patients who had received surgical treatment of lung cancer in Shanghai Ninth People’s Hospital affiliated to Shanghai Jiaotong University School of Medicine from January to December 2019 were selected as control group, and 194 patients treated from January to December 2020 were selected as observation group. The control group was given routine nursing, while the observation group took early active limb activity on top of routine nursing. We compared the levels of platelet indicators (PLT, PDW, MPV) and fibrinolytic indicators (PAI-1, tPA, D-dimer) between the two groups of patients on postoperative day 1 and 7, as well as the incidence of PE within 1 and 7 days, the survival of patients in 7-day, 1-month, 6-month, 1-year, and 3-year periods after surgery. Results: The incidence of MPV ((7.29±0.51) fl and (7.22±0.82) fl), PLT ((173.13±21.56)×10⁹/L and (169.11±19.64)×10⁹/L), PAI-1 ((6.61±0.80) AU/ml and (6.53±1.21) AU/ml), tPA ((0.81±0.21) IU/ml and (0.82±0.11) IU/ml) on day 1 and day 7, and D-dimer ((0.31±0.11) mg/L) on day 1, as well as the incidence of PE (2.58% (5/194)) on day 7 were lower in the observation group than in the control group ((8.23±0.69) fl and (8.11±1.13) fl, (184.56±23.71)×10⁹/L and (181.61±21.78)×10⁹/L, (7.41±1.22) AU/ml and (7.32±1.11) AU/ml, (0.92±0.21) IU/ml and (0.91±0.41) IU/ml, (0.41±0.11) mg/L, and 9.63% (18/187)), whereas the survival rates (85.57% (166/194) and 63.40% (123/194)) at 1 and 3 years after surgery were significantly higher than those of the control group (70.05% (131/187) and 51.87% (97/187)), and the differences were statistically significant in all cases (t=18.294, P=0.043; t=15.011, P=0.039; t=20.415, P=0.048; t=19.669, P=0.046; t=18.214, P=0.028; t=19.015, P=0.032; t=17.141, P=0.033; t=18.011, P=0.039; t=15.326, P=0.049; χ²=8.195,P=0.019; χ²=5.148, P=0.031; χ²=7.047, P=0.007). No patient developed PE on postoperative day 1 in either group, and there were no deaths within 7 days or 1 month. Conclusion: Early active limb activity program can reduce the incidence of postoperative PE in patients with lung cancer, improve the prognosis of patients and prolong the survival period, which is worthy of promotion and application.

Research of symptom groups of chronic obstructive pulmonary disease and their correlation with patient’s quality of life

Qiu Qiaojing, Tao Yang, Shen Jiani, Xu Jiapin, Zhu Lihong, Gu Fen

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  219-224.  doi:10.19983/j.issn.2096-8493.2024067

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Objective: To explore the composition of symptom groups at different stages of chronic obstructive pulmonary disease (COPD) patients, the interrelationships between symptom groups, and the correlation between symptom groups and patient’s quality of life. Methods: Convenience sampling was used to select 223 COPD patients who were hospitalized from November 2022 to November 2023 in Department of Respiratory and Critical Care Medicine, Ningbo University Affiliated to People’s Hospital. A patient basic information questionnaire, memorial symptom assessment scale (MSAS), and COPD assessment test (CAT) were used to evaluate symptoms, breathing difficulties, and emotions of the patients on the first day of hospitalization (T₁, disease exacerbation phase), the day before or on the day of discharge (T₂), and one month (T₃) and three months (T₄) after discharge(disease stable phase). Statistical description, factor analysis, and cluster analysis were used to analyze the symptoms and evaluate their impact on the patient’s quality of life. Results: The average numbers of symptoms in COPD patients between T₁ and T₄ were 29 (26, 31), 25 (22, 28), 27 (25, 29), and 29 (27, 31), respectively. There were three different symptom groups at four time points: respiratory perception related symptom group, psychological perception related symptom group, and gastrointestinal perception related symptom group. The average total scores of CAT scales for COPD patients between T₁ and T₄ were 29.13±6.37, 20.31±6.47, 18.68±6.27, and 20.31±6.47, respectively, variance analysis showed that the difference was statistically significant (F=126.284, P<0.001). The correlation analysis between three symptom groups and patient’s quality of life showed that except for gastrointestinal perception related symptom group at T₄ which was not correlated with the total score of CAT (r=0.009,P>0.05), all other symptom groups were positively correlated with the total score of CAT (Ps<0.05). Conclusion: COPD patients experience different symptoms during the acute and stable phases of the disease, with symptoms clustering in three forms and worsening. The more severe the distress on the patient, the greater the impact on their quality of life.

Application effect and safety analysis of a sputum splash prevention device

Zhu Xiaoxiao, Tian Yayuan, Wang Pengfei, Huang Jiali, Gu Fen

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  225-229.  doi:10.19983/j.issn.2096-8493.2024051

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Objective: To analyze the effect and safety of a device for preventing sputum splashing in reducing sputum splash contamination patients undergoing tracheotomy. Methods: Fifty-four patients who were prepared to undergo tracheotomy in the Intensive Care Unit of the General Surgery Department of the Ninth People’s Hospital affiliated to Shanghai Jiaotong University School of Medicine from April to December 2023 were selected as research objects. A convenient sampling method was used to include those with odd-numbered of medical records were included in observation group (wearing the new sputum splash prevention device) and those with even-numbered medical records were included in the control group (wearing the self-made simple plastic bottle sputum splash prevention device), 27 cases in each group. The sputum splash, blood oxygen saturation, partial pressure of carbon dioxide, and incidence of pulmonary infection were compared between the two groups before and after wearing the device. Results: In the observation group, no patient splashed sputum into the surrounding environment after using the new device, and no patient had pulmonary infection after 1 month of using the device, while in the control group, sputum flowed along the wall of the cup, and 4 patients (14.8%) had lung infection after 1 month of using the device. The mean oxygen saturation before and after using the device in the control group were (96.42±4.93) % and (97.01±3.40) %, and the partial pressures of carbon dioxide were (39.88±7.64) mmHg and (38.13±8.09) mmHg, while in the observation group before and after the use of the new device, the mean oxygen saturation were (97.43±3.73) % and (98.33±1.40) %, and the partial pressures of carbon dioxide were (38.14±9.05) mmHg and (42.05±7.89) mmHg. None of the differences were statistically significant (t=-1.329,P=0.197;t=0.476,P=0.638;t=1.965,P=0.060;t=-1.284,P=0.212). Conclusion: The new device for preventing sputum splash is simple to operate, and the avoidance of sputum splash after wearing is better than the self-made simple plastic bottle device, which effectively prevents lung infection and does not affect the patient’s oxygen saturation and carbon dioxide partial pressure. The new device for preventing sputum splash can be used for patients who are taken off the machine after tracheotomy in the intensive care unit, and it can be widely used in clinical practice.

The effectiveness of multidisciplinary graded collaborative management on swallowing screening and intervention in patients with chronic obstructive pulmonary disease

Wu Shaozhu, Yu Xueying, Luo Yuanrong, Liu Yanfei, Ke Caixia

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  230-235.  doi:10.19983/j.issn.2096-8493.20230122

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Objective: To explore the effectiveness of multi-disciplinary graded collaborative management on swallowing screening and intervention in patients with chronic obstructive pulmonary disease (COPD). Methods: Data were collected on COPD participants who received swallowing screening and intervention from May to October 2022 in The Third Affiliated Hospital, Sun Yat-sen University. Intervention was composed of the followings: (1)A multidisciplinary management team was established. (2)A swallowing function screening and intervention process for patients with COPD was developed. (3)A multidisciplinary graded collaborative management process and feeding management routine were formulated, training program and quality control program were developed. (4) Nurses were trained and assessed. Results: A total of 186 patients with COPD were screened, of whom 43 had swallowing disorders, with a positive rate of 23.12% (43/186). After the implementation of multidisciplinary graded collaborative management, the swallowing screening rate of patients was 100.00% (186/186),the intervention rate of positive patients based on the volumetric viscosity swallowing test results was 100.00% (43/43), the consultation rate of nutrition swallowing specialist nurses was 24.19% (45/186), the consultation rate of nutrition doctors was 19.89% (37/186), and the consultation rate of swallowing rehabilitation therapists was 5.91% (11/186). After intervention, the average body weight ((61.21±10.99) kg), hemoglobin ((132.44±11.27) g/L), serum albumin ((37.63±3.51) g/L) and serum prealbumin ((199.77±40.15) mg/L) of the 43 positive patients were all increased than those before intervention (respectively (59.99±10.96) kg, (124.67±10.86) g/L, (35.01±2.82) g/L, (177.12±40.09) mg/L, (t=-9.871, -8.634, -7.708, -11.703, all P<0.001)); After intervention, the average nutritional risk NRS 2002 score (2.47±0.74), the incidence of dominant aspiration (16.28% (7/43)) and aspiration pneumonia (2.33% (1/43)) were lower than before intervention (respectively (3.53±0.91), 89.74% (35/39), 35.90% (14/39), (t=10.488, χ²=44.177, 0.245, all P<0.001)); After intervention, the average clinical nutrition and swallowing theory scores (86.43±3.80) and skill scores (87.29±2.51) of the specialist nursing team were increased than those before intervention ((76.00±6.04) and (76.76±4.95), respectively, t=-10.890, -8.584, P<0.001). Conclusion: Routine screening of swallowing function in patients with COPD and multi-disciplinary graded collaborative management can reduce the nutritional risk of patients, improve the safety of patients’ feeding and promote the refined development of specialized nursing care.

Analysis of influencing factors on treatment failure in initially treated patients with bacterial positive pulmonary tuberculosis

Jiang Ruoxi, Zhong Da, Dou Xiaojie

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  236-243.  doi:10.19983/j.issn.2096-8493.2024031

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Objective: To analyze the influencing factors of treatment failure in initially treated patients with bacterial positive pulmonary tuberculosis, and provide evidence for improving the treatment success rate. Methods: A retrospective study was conducted to collect the clinical data of 392 new patients with positive bacteria results, who were registered from January to December 2020 in Tianjin Tuberculosis Control Center and completed a one-year follow-up. The data was extracted from Hospital Information System of Tianjin Tuberculosis Control Center. The data included sex, age, marriage, occupation, education level, income, living conditions, smoking and alcohol history, body mass index, basic diseases, symptomatic visits, whether regular physical examination, delayed visits, delayed diagnosis, adverse drug reactions, whether regular drug use, drug resistance of Mycobacterium tuberculosis, and imaging examination results. Single- and multi-variable logistic regression models were used to analyze the factors associated with treatment failure. Results: Among 392 patients, the failure rate of pulmonary tuberculosis treatment was 8.16% (32/392). The multivariate logistic regression analysis showed that the presence of adverse drug reactions (OR=3.109, 95%CI: 1.186-8.151), delayed visits (OR=2.028, 95%CI: 1.742-5.541), delayed diagnosis (OR=3.231, 95%CI: 1.213-8.604), Mycobacterium tuberculosis resistance (OR=8.478, 95%CI: 2.111-34.055), and irregular medication use (OR=1.825, 95%CI: 1.185-2.810) were risk factors for treatment failure, while regular health examinations (OR=0.568, 95%CI: 0.357-0.904) was protective factor for treatment failure in new bacterial positive patients. Conclusion: Improving regular health examinations to detection of potential patients as early as possible, promoting of patients with suspected tuberculosis symptoms to seek medical service and receiving timely diagnosis, carrying out self-management awareness of drug resistance testing, active handling of adverse drug reactions during treatment, strengthening medication safety guidance, guiding patients to improve their own lifestyle habits and medication compliance can all improve the success rate of treatment for new bacterial positive pulmonary tuberculosis patients.

Analysis of the results of pulmonary tuberculosis screening among the elderly in Haizhu District, Guangzhou

Cai Xiaoting, Jiang Kunhong, He Liqian, De Hong, Wang Ting, Lai Keng, Wu Xiaoying

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  244-248.  doi:10.19983/j.issn.2096-8493.2024075

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Objective: To analyze the chest X-ray screening results and the knowledge of core information on tuberculosis among the elderly in Haizhu District, Guangzhou. Methods: From May to July 2022, a questionnaire survey, pulmonary tuberculosis symptom screening, chest X-ray screening, and health education were conducted among the elderly ≥65 years old from 9 districts in Haizhu District. Based on the data obtained from this screening, statistical analysis were conducted. Results: In 2022, a total of 4435 people aged ≥65 years old in Haizhu District, Guangzhou, completed chest X-ray screening and questionnaire. The male-to-female ratio was 0.77∶1 (male 1923,female 2512). The ages ranged from 65 to 102 years old, average age was (72.08±5.48) years old. There were 291 cases of suspected symptoms of pulmonary tuberculosis in the last month, and 490 cases of abnormal chest X-ray results. Among the abnormal chest X-ray cases, 58 cases had suspected symptoms of pulmonary tuberculosis, and 6 cases were finally diagnosed with active pulmonary tuberculosis. The detection rate of pulmonary tuberculosis was 135.29/100000. The total awareness rate of tuberculosis core information among 3633 elderly people was 78.29% (14222/18165), of which the awareness rate of “Pulmonary tuberculosis is a serious chronic infections disease” was the lowest, 56.79% (2063/3633). Conclusion: Tuberculosis screening for the elderly ≥65 years old is helpful for the early detection of elderly pulmonary tuberculosis patients; Tuberculosis publicity and education should continue to be strengthened to increase the awareness rate of tuberculosis core information.

Review Articles

Current status and nursing research progress of long-term oxygen therapy for patients with chronic obstructive pulmonary disease

Zhang Yidan, Gu Fen, Li Nannan

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  249-253.  doi:10.19983/j.issn.2096-8493.2024064

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Chronic obstructive pulmonary disease (COPD) is the most common chronic airway disease characterized by airflow limitation and the third leading cause of death worldwide, imposing a significant health and economic burden worldwide. As the disease progresses, patients tend to develop hypoxemia, resulting in impaired cardiopulmonary function. Long-term oxygen therapy is an important measure to delay the progression of disease in patients with COPD, and the standardization of its development has not yet formed a unified standard. Therefore, this paper reviews and discusses the implementation status and nursing management plans of long-term oxygen therapy nursing for patients with COPD, so as to provide a reference for better long-term oxygen therapy nursing for COPD patients in the future.

Research progress on continuous nursing of patients with chronic obstructive pulmonary disease

Qu Chunjin, Peng Jiayi, Liu Xinyi, Xiao Guanchen, Gu Fen, Li Nannan

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  254-259.  doi:10.19983/j.issn.2096-8493.2024063

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Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by persistent respiratory symptoms and restricted airflow. With the increasing aging population and worsening environmental pollution, the incidence and mortality of COPD are on the rise. Continuous nursing, as an effective mode of chronic disease management, realizes the transition from hospital to community and home nursing through regular follow-up, personalized education and self-management support. Therefore, continuous nursing of COPD is of great significance for improving patients’ quality of life and prognosis. The author reviewed the current status, implementation models, intervention studies and other aspects of COPD continuous nursing for patients both domestically and internationally, aiming to offer insights for the development of COPD continuous nursing tailored to the Chinese context.

Research progress on the correlation between pyroptosis and metastasis of non-small cell lung cancer

Chang Yuting, Zhang Xinran, Han Gaohua

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  260-266.  doi:10.19983/j.issn.2096-8493.2024082

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With the increasing incidence and mortality of non-small cell lung cancer (NSCLC), the focus and challenge of researches have been shifted towards delaying disease progression and prolonging patient survival. Metastasis is an inevitable aspect of tumor development which significantly affects patients’ median length of survival. Therefore, predicting metastasis occurrence and conducting preventive treatment are crucial for improving NSCLC prognosis. Some researchers have raised concerns about pyroptosis as a programmed cell death mode that can be expressed in both normal tissue and tumor cells, with distinctive biological effects in different types of tumor. This paper provides a summary of different activation pathways and application values of pyroptosis, focusing on its dual role in NSCLC metastasis. It suggests that pyroptosis may play an important role in targeted metastasis when considering current researches on brain metastasis of non-small cell lung cancer, offering a new approach to study the correlation between cell pyroptosis and NSCLC metastasis.

Research progress of respiratory system injury caused by novel coronavirus

Xu Siyun, Lu Nihong

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  267-272.  doi:10.19983/j.issn.2096-8493.2024041

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When SARS-CoV-2 infects the respiratory system, it induces a cytokine storm leading to acute inflammation, acute respiratory distress syndrome (ARDS), respiratory failure, and other clinical manifestations, potentially exerting a long-term impact on respiratory health. In severe cases, the infection may lead to pulmonary interstitial fibrosis, resulting in permanent lung damage that profoundly affects individuals’ health and quality of life. The SARS-CoV-2 is in a state of continuous mutation, giving rise to various mutant strains with enhanced transmissibility and virulence. This review primarily consolidates the pathological features, mechanisms, principal clinical manifestations, therapeutic interventions, and prognostic outcomes associated with respiratory system damage caused by SARS-CoV-2 infection. The objective of this review is to enhance the understanding of the respiratory impairments linked to SARS-CoV-2.

Current status of diagnosis and clinical treatment on co-existent pulmonary tuberculosis and lung cancer

Yang Hongjie, Qi Fei, Zhang Hongmei, Wu Hongbo, Hu Aimin, Zhang Tongmei

Journal of Tuberculosis and Lung Disease. 2024, 5(3):  273-278.  doi:10.19983/j.issn.2096-8493.2024054

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Lung cancer and pulmonary tuberculosis are two major respiratory diseases that seriously endanger human health. Each disease causes about 1.6 million deaths per year worldwide. Particularly in developing countries, there are high incidences of both diseases. Epidemiological evidence suggests that pulmonary tuberculosis increases the risk of lung cancer. The clinical symptoms of pulmonary tuberculosis and lung cancer are too similar, the co-existence and mutual influence of the two diseases make it difficult to diagnose and treat them, which brings a huge burden to patients. This paper reviews the pathogenesis, diagnosis and treatment of lung cancer complicated with pulmonary tuberculosis.