| BackgroundChronic obstructive pulmonary disease(COPD)is a common chronic inflammatory airway disease.The incidence of COPD has been increasing in recent years,and it is now one of the top three causes of death worldwide.Its high prevalence and high mortality rate have brought about a huge socioeconomic burden,and it is expected that the burden of COPD will continue to increase in the coming decades.Chronic mucus hypersecretion(CMH)is a major pathophy siological feature of COPD and an independent risk factor affecting the condition and prognosis of COPD.Patients with CMH who have symptoms of airway mucus hypersecretion have poorer lung function,more hospitalizations,and higher mortality rates.In addition,decreased airway mucus clearance leads to increased bacterial colonization,which can also cause lung infections and acute exacerbations in patients with COPD.2023 Global Strategy for the Diagnosis,Management and Prevention of COPD states that mucus hypersecretion poses a multitude of clinical problems and that every patient with COPD should be kept highly suspicious of being in a state of mucus hypersecretion.Several scholars have also suggested that airway mucus hypersecretion should be considered as an important target for the treatment of chronic obstructive pulmonary disease.Therefore,the state of airway mucus hypersecretion should be closely monitored in patients with chronic obstructive pulmonary disease.In Chinese medicine,airway mucus hypersecretion belongs to "phlegm" and "drink",and several doctors have already identified and treated chronic obstructive pulmonary disease based on "phlegm and drink",which has good clinical effects and can significantly improve patients’The clinical efficacy is good,and it can significantly improve the clinical symptoms and physical and chemical indices of patients.However,there are few studies on the correlation between Chinese medical evidence and physicochemical indexes.ObjectiveTo investigate the factors associated with airway mucus hypersecretion in chronic obstructive pulmonary disease,the distribution of TCM evidence types and the clinical characteristics of patients with different TCM evidence types of airway mucus hypersecretion in chronic obstructive pulmonary disease,in order to provide a reference basis for TCM classification and treatment of airway mucus hypersecretion in chronic obstructive pulmonary disease.MethodA cross-sectional survey study was conducted to include patients with chronic obstructive pulmonary disease in the respiratory ward of Xiyuan Hospital,Chinese Academy of Traditional Chinese Medicine from January 2020 to November 2022.Patients with airway mucus hypersecretion were screened,and information on patients’ basic data,TCM evidence type,CASA-Q score,number of acute exacerbations in the past 1 year,CAT score,mMRC classification,clinical symptoms,pulmonary function indexes,chest CT,inflammatory indexes,coagulation function,clinical drug use,etc.were collected,and CASA-Q score was compared with pulmonary function and inflammation for difference and correlation analysis,and the included patients were grouped according to TCM evidence type.The patients were grouped,and the differences were compared among the groups to explore the factors associated with the airway mucus hypersecretion status of patients with airway mucus hypersecretion in chronic obstructive pulmonary disease and the distribution characteristics of TCM evidence.Result1.General situation of patients with airway mucus hypersecretion in slow-onset lung(1)Basic information:A total of 189 patients with airway mucus hypersecretion in slow-onset lung were included in this study,and there were 168 cases after excluding patients with incomplete data.There were 133 males and 35 females,with a mean age of(72.06±9.30)years,a mean disease duration of(9.68±10.64)years,a mean BMI value of(23.96±3.76)kg/m2,and a mean number of acute exacerbations in the last 1 year of(1.65±0.71).There were 114 patients with a history of smoking in the included patients,accounting for 67.86%of the total sample size.(2)CASA-Q score:the mean score of COUS(50.44±16.76),the mean score of COUI score(46.10±12.87),the mean score of SPUS score(39.09±12.72),the mean score of SPUI(49.31±11.86),and the mean score of CASA-among the 168 patients with airway mucus hypersecretion in chronic obstructive pulmonary disease included Q total score was(46.87±9.76).(3)Distribution of TCM evidence types:Among the 168 patients included in this study,the largest number of patients with phlegm-heat congestion of the lung evidence was 70,accounting for 41.67%of the total sample size,and the smallest number of patients with lung-kidney-yin deficiency evidence was 14,accounting for 8.33%of the total sample size.The distribution of cases in each group of TCM evidence was from highest to lowest:phlegm-heat congestion in the lung>phlegm-stasis interconnection>qi deficiency and phlegm obstruction>phlegmdampness inclusion in the lung>lung-kidney-yin deficiency.2.Factors associated with airway mucus hypersecretion status(1)CASA-Q score and general information:there was no statistically significant difference between the gender,smoking history,CT-reported mucus plug,age,disease duration,number of acute exacerbations in the past year,BMI status and CASA-Q of the included patients.(2)CASA-Q score and pulmonary function,quality of life:FEV1/FVC,FEV1%Pred and total CASA-Q score had a positive correlation(r=0.266,P=0.001;r=0.178,P=0.021).GOLD classification had a negative correlation with total CASA-Q score(r=-0.284,P=0.000)The CAT score and mMRC grading did not have a correlation with the total CASA-Q score.(3)CASA-Q score and inflammatory indexes:neutrophil percentage of included patients had a negative correlation with CASA-Q score(r=-0.164,P=0.040);the remaining indexes had no correlation.3.Comparison of clinical characteristics of patients with different TCM evidence types of chronic obstructive pulmonary airway mucus hypersecretion(1)Basic data of patients with different TCM evidence types:there were statistically significant differences in age and BMI classification of patients with airway mucus hypersecretion in slowonset lung with different TCM evidence types(P<0.05).In the BMI classification of patients with phlegm-heat congestion lung evidence,phlegm-stasis interconnection evidence and qi deficiency phlegm obstruction evidence,there were more cases in the BMI normal group and BMI overweight group compared with the BMI lean group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the duration of chronic obstructive pulmonary disease in the different TCM evidence groups(P>0.05).(2)Smoking history and number of acute exacerbations in the past 1 year in patients with different TCM evidence types:there was a statistically significant difference(P<0.05)in the number of patients with smoking history in patients with chronic obstructive pulmonary airway mucus hypersecretion in different TCM evidence types,with a statistically significant difference(P<0.05)in the number of acute exacerbations in patients with lung-kidney yin deficiency evidence than phlegm-damp lung evidence.(3)Assessment of the severity of airway mucus hypersecretion in patients with different TCM evidence types:there were statistically significant differences in the total CASA-Q score,cough impact domain and cough symptom domain in patients with different TCM evidence types(P<0.01).The cough impact domain(COUI)had lower scores for phlegm-heat-congested lung evidence and phlegm-damp-containing lung evidence;the cough and sputum symptom domain(SPUS)had lower scores for phlegm-heat-congested lung evidence.(4)Pulmonary function tests and quality of life assessment of patients with different TCM evidence types:the differences in FEV1%pred,FEV1/FVC,GOLD grading,CAT score and mMRC grading of patients with different TCM evidence types were not statistically significant(P>0.05).(5)Mucus embolism in patients with different TCM evidence types:the highest percentage of patients with phlegm-stasis interconnection evidence reported mucus embolism on imaging,with 28.21%,and lower in phlegm-heat congestion of lung evidence(5.17%)and qi deficiency phlegm obstruction evidence(10.34%),with statistically significant.differences(P<0.05).(6)Inflammation and coagulation indexes in patients with different TCM evidence types:lymphocyte percentage was higher in patients with lung-kidney-yin deficiency evidence and phlegm-heat congestion lung evidence compared with patients with phlegm-dampnesscontaining lung evidence,with statistically significant differences(P<0.05).Fibrinogen concentrations were higher in patients with phlegm-heat and phlegm-damp lung evidence,and the difference was statistically significant(P<0.05);fibrinogen concentrations were higher in patients with phlegm-damp lung evidence compared with those with qi deficiency and phlegm obstruction,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the remaining laboratory test indexes between the different TCM evidence types(P>0.05).Study conclusionsThe results of this study showed that the severity of airway mucus hypersecretion status in the included patients was positively correlated with FEV1%Pred and FEV1/FVC,and negatively correlated with GOLD classification and NEU%.In terms of TCM evidence types,phlegmheat congestion lung evidence was the main evidence type during the acute exacerbation of airway mucus hypersecretion in patients with chronic obstructive pulmonary disease,indicating that phlegm-heat may be the main pathological factor in patients with chronic obstructive pulmonary airway mucus hypersecretion.The clinical characteristics of the patients included in the study were as follows:1.Patients with Phlegm-Heat Congestion Lung Certificate had more severe cough and sputum symptoms than the other certificates,and their daily life may be more affected by airway mucus hypersecretion symptoms,so more attention should be paid to their cough and sputum;2.Patients with PhlegmStasis Interconnection Certificate had lower domain scores of cough and sputum symptoms than the other certificates,and a higher proportion of cough and sputum symptoms and CT examinations reported mucus embolism than the other certificates,suggesting that this type of patient has a higher percentage of small airway obstruction.Patients with phlegm-deficiency and phlegm obstruction were the least affected by cough,had the least cough symptoms,but had the least mucus embolism;4.Patients with phlegm-damp lung evidence had the most severe airway mucus hypersecretion,were older overall,had the smallest proportion of smoking history,and had the least number of acute exacerbations in the past year;5.The lowest percentage of patients with lung and kidney yin deficiency,the smallest median age,but the largest number of patients with smoking history,and more cases with thin BMI. |
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