| Section 1 The normal value measurement of fractional concentration of exhaled nitric oxide in Chinese adults in Beijing areaObjective:The measurement of FENO is more convenient?accurate and repeatable than other noninvasive techniques. It is a effective noninvasive method in management of respiratory disease and can also be applied to the treatment of chronic asthma. It is a safe and rapid diagnostic test for asthma. To date, however, there have only been a few studies on reference values and determinants of FENO in healthy adults. Therefore, we investigated reference values and determinants of FENO in a Chinese non-smoking, healthy adult population who received a general health check-up in Beijing area.Methods:We recruited non-smoking, Chinese healthy adult volunteers around peking Union Medical College Hospital. All subjects finished a detailed questionnaire about personal medical history, smoking history, atopic history, recent upper airway infection, wheezing, and chronic cough. FENO measurements were performed on all volunteers before they received a routine health check-up. FENO was measured online by a chemiluminescence analyzer (NIOX) according to the most recent American Thoracic Society/European Respiratory Society (ATS/ERS) recommendations. Demographic data such as sex, age, height and weight were all collected and the spirometry was done after FENO measurement. All subjects fulfilled our definition of healthy adults:no history of smoking or physician-diagnosed asthma;no recent upper airway infection; no chronic respiratory symptoms; and no allergic rhinitis and urticaria.Results:A total of 145 non-smoking and non-asthmatic healthy Chinese adults were enrolled prospectively in Beijing area. Among them,70 male and 75 female. The mean FENO was (22.4±10.7) parts per bill ion (ppb) in all subjects, (24.7±10.9) ppb in the male group, (20.5±10.2) ppb in the female group. The value of FENO is a little higher in male group than female group.145 non-smoking healthy Chinese adults were graded according to gender, age, height, weight, BMI. In the univariate analyses, FENO was significantly higher in the male than the female group. FENO differed significantly between groups with different age and different weight,but didn't differ between group with different height and different BMI. After all variables were included for multivariate regression analysis with the natural logarithm of FENO, age was associated positively with FENO values, but sex, height, weight, BMI and pulmonary function (FEV1 and FVC) were not associated with FENO values.Conclusion:The value of FENO in non-smoking and non-asthmatic healthy Chinese adults in Beijing area was higher than westerners. The mean FENO was higher in male group than in female group. Race and environment were the important factors affecting the value of FENO. Age was associated positively with FENO values, but sex, height, weight, BMI and pulmonary function (FEV1 and FVC) were not associated with FENO values. Age was a independent factor associated with FENO value. Section 2 Reliability and validity of CAT Chinese version in Chinese patients with chronic obstructive pulmonary diseaseObjective:The CAT is a valid, reliable, short and simple patient-completed questionnaire for COPD with very good measurement properties. It provide clinicians and patients with a simple and reliable measure of overall COPD-related health status for the assessment. It has been widely confirmed in foreign countries,but the data for Chinese COPD patients hasn't been reprted untill now. The purpose of this study is to determine the reliability and validity of CAT in patients with COPD, and to study its value in evaluating quality of life in Chinese patients.Methods:Patients with COPD in stable condition from Peking Union Medical College Hospital were assessed by interviewed with CAT respectively, and underwent pulmonary function test on the same day. The reliability of CAT score were documented by performing Cronbach's alpha. Correlation analysis and factorial analysis was calculated to evaluate the validity of CAT. In detail, the construct validity was evaluated by factorial analysis, and criterion validity was evaluated by Pearson's correlation coefficients. The stages of COPD determined by CAT score and lung function were compared to observe the value of CAT in determining disease severity.Results:Cronbach's alpha of CAT score was 0.805. CAT score increased with the severity of the disease, and was negatively correlated to forced FEV1 % of predicted significantly (r=-0.567, P<0.01). CAT score varied significantly in patients (I:9.6±4.8,?:16.3±5.7,?:20.9±6.8 and IV:23.4±5.7), with different severity of COPD(X2=48.437, P<0.01). There was a high degree of consistency between the stages of COPD determined by CAT score and lung function.Conclusion:The Chinese version of the CAT had good internal consistency reliability and validity, and can be used to assess the quality of life for Chinese COPD patients. It provided a simple, valid and standardized measurement of COPD health status. Section 3 Application of CAT in evaluating the life quality of Chinese patients with chronic obstructive pulmonary diseaseObjective:The CAT is a valid, simple and reliable measurement to assess overall health-related quality of life for COPD patients. The Objective of this study is to determine the sensitivity and validity of CAT in patients with COPD, and to study its value in evaluating quality of life in Chinese patients.Methods:Patients with COPD in stable condition were recruited for the study from November 2009 to May 2010 in Peking Union Medical College Hospital, and they were assessed by interviewed with CAT and SGRQ respectively and underwent pulmonary function test on the same day. The questionnaires were all done by patients independently. Pulmonary function test include conventional ventilation (FEV1?FVC and PEF) and bronchial dilatation test. Pearson's correlation coefficients were calculated between CAT and SGRQ, and then between CAT and pulmonary function. The patients were followed up after six month to complete CAT, SGRQ and exacerbation of COPD. Patients in stage?and?of the spirometric classification of severity of COPD were reassessed after six months'treatment with inhalation of salmeterol/flutieasone propionate to evaluate the sensitivity of CAT score. Results:192 Chinese patients with a diagnosis of COPD completed the CAT questionnaire. Male gender VS female gender was 146 VS 46. The age was from 45 to 84, mean (64.4±9.8) years. Their smoking index (SI) was from 10 to 90, mean(35.7±17.2) pack years; Pulmonary function test which contains FEV1, FEV1% predicted and FEV1/FVC were (1.4±0.6)L, (43.3±18.7)%, (52.9±11.9)%, respecitively. The total CAT score of the whole 192 Patients was (18.2±6.4). Among them,74 patients completed SGRQ.The symptoms section score, the activity section score, the impacts section score and the total score were (58.0±20.9), (58.4±16.1), (39.2±18.2) and (48.2±15.5). The mean CAT scores by GOLD stage were:I:10.9±4.1,?:15.8±4.2,?:18.9±5.8 and IV:21.6±6.7 (p<0.01) supporting its discriminative validity. The CAT was positively correlated with SGRQ total score, and negatively correlated with pulmonary function.In the study population,192 patients had completed six months follow-up, and 153(79.7%) patients had once or more times acute exacerbations. We used univariate logistic-regression analysis and assessed factors associated with at least one exacerbation during the six months of follow-up, which included gender, age, BMI, smoking status, FEV1, FEV1%, GOLD stage, FEV,/FVC, FVC%, SGRQ and CAT. The results showed that female, old age, pulmonary function decrese, high GOLD stage, high SGRQ score and high CAT score were risk factors of COPD exacerbation and significantly associated with exacerbations. The SGRQ and CAT score were higher in patients with exacerbation than without exacerbation, and the higher the score was, the more frequency exacerbation the patients experience. After six months' treatment with salmeterol/flutieasone propionate, CAT score of stage?and IV patients decreased significantly.Conclusion:The Chinese version of the CAT was a good tool to assessment severity of disease, quality of life and health status in Chinese COPD patients. The CAT signaficately correlated with severity of disease and pulmonary function and was one of risk factors associated with exacerbations.It had a high degree of consistency with SGRQ, and provides a valid, reliable and standardized measurement of COPD health status in Chinese patients similar to those reported in European and US patients. |
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