Effect Analysis of Lung Rehabilitation Training in 5A Nursing Mode for Elderly Patients with COPD Based on X-Ray

Xu, Peihong; Zheng, Wei; Zhu, Yanjun

doi:https://doi.org/10.1155/2022/1963426

Computational and Mathematical Methods in Medicine

On this page

Abstract Introduction Materials and Methods Results Discussion Conclusion Data Availability Conflicts of Interest References Copyright Related Articles

Special Issue

Mathematical Modelling of IoT-Based Health Monitoring System

View this Special Issue

Research Article | Open Access

Volume 2022 | Article ID 1963426 | https://doi.org/10.1155/2022/1963426

Effect Analysis of Lung Rehabilitation Training in 5A Nursing Mode for Elderly Patients with COPD Based on X-Ray

Peihong Xu,¹Wei Zheng,¹and Yanjun Zhu¹

Academic Editor: Ahmed Faeq Hussein

Received13 Mar 2022

Revised20 May 2022

Accepted23 May 2022

Published13 Jun 2022

Abstract

This study was aimed at evaluating the application effect of pulmonary rehabilitation training under 5A nursing mode based on X-ray in elderly patients with chronic obstructive pulmonary disease (COPD). Then, 84 elderly patients with chronic obstructive emphysema were selected as the research subjects. COPD knowledge level questionnaire, caregiver self-efficacy scale (CSES), COPD assessment test (CAT), and 6-minute walking experiment (6MWD) were adopted, and the clinical application effect of pulmonary rehabilitation training and conventional nursing under 5A nursing mode was comprehensively compared. The results show that after two and four months of intervention, the average score of COPD knowledge level questionnaire in the test group was 27.43 points and 30.08 points, respectively, higher than that in the control group (). After two and four months of intervention, the number of patients with good compliance in the test group was remarkably improved, and the severity of airflow restriction in the test group was slower than that in the control group. In short, pulmonary rehabilitation training under 5A nursing mode based on X-ray can effectively improve the disease knowledge level, self-efficacy, and pulmonary rehabilitation training compliance of elderly COPD patients, which played an important role in improving the quality of life of patients and alleviating the degree of dyspnea of patients.

1. Introduction

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder. The disease has a high incidence in the elderly population and has a high risk of disability and death, causing serious economic burden to the families of patients, which has become a public health problem of major concern in China [1–3]. Studies pointed out that the global incidence of COPD in recent years is 4%~10%, and the incidence of COPD in China’s population over 40 years old is about 8.2%. The incidence rate of the elderly group over 60 years old is about 27%, and the mortality rate is as high as 17.6% [4, 5]. Therefore, it is of great significance to improve the clinical diagnosis and treatment level of COPD, put forward reasonable prevention programs, and reduce the economic burden of patients’ families [6, 7].

5A nursing model is a new nursing model proposed by the International Cancer Society, including assessment, consensus, assistance, advice, and follow-up [8–11]. 5A nursing mode is often used for management of diabetes and chronic anemia. Puschel et al. (2008) implemented a smoking cessation management program based on 5A nursing mode for female smokers. The results showed that the amount of smoking of the target population decreased with the extension of intervention time [12–15]. Although 5A nursing mode has been widely applied in cancer management and diabetes management in China, it is seldom applied in pulmonary rehabilitation training for elderly COPD patients.

At present, the commonly used imaging examination methods for COPD include chest X-ray plain film, computed tomography (CT), and pulmonary function examination. Pulmonary function examination is the main method to evaluate the severity of COPD, but it has great limitations. On the one hand, this method requires patients to have a high ability to cooperate, while elderly patients have poor ability to cooperate and even cannot tolerate it in severe cases. On the other hand, pulmonary function examination can only evaluate the overall lung condition of patients, and cannot effectively reflect the specific clinical symptoms of patients [16–19].

In summary, COPD has a high incidence and mortality rate in the elderly population. How to improve the clinical diagnosis and treatment level of COPD is of great clinical significance. 5A nursing mode is rarely used in pulmonary rehabilitation training of COPD patients. In this study, a total of 84 patients with chronic obstructive emphysema were randomly divided into an experimental group (pulmonary rehabilitation nursing under 5A mode) and a control group (routine nursing), 42 cases in each group. The effects of 5A-mode-based lung rehabilitation training on elderly patients with COPD were comprehensively evaluated through questionnaire on the knowledge level of chronic obstructive pulmonary disease, caregiver self-efficacy scale (CSES), chronic obstructive pulmonary disease assessment test (CAT), 6-minute walk test (6MWD), and X-ray image scanning.

2. Materials and Methods

2.1. Research Objects and Grouping

A total of 84 patients with chronic obstructive emphysema admitted to hospital from June 2020 to June 2021 were selected as the research objects, and the patients were randomly divided into test group and control group, with 42 patients in each group. Patients in the test group and control group were 60-80 years old. There were no substantial differences in gender, age, and education level between the two groups (). Inclusion criteria: (i) patients aged ≥60 years; (ii) patients conformed to the Guidelines for Diagnosis and Treatment of Chronic Obstructive Pulmonary Diseases [20]; (iii) patient’s pulmonary function was grades II to III; and (iv) patients had good compliance and could cooperate with the study. Exclusion criteria: (i) patients cannot complete pulmonary rehabilitation training due to their own diseases; (ii) patients with malignant tumor or serious blood diseases; and (iii) patients with a history of cognitive impairment or mental illness. This study had been approved by the ethics committee of the hospital.

2.2. Intervention Measures

The control group received routine nursing, including oxygen therapy, medication guidance, health education, smoking cessation guidance, and diet guidance.

Based on the routine treatment of patients in the test group, a pulmonary rehabilitation group was established. The team was composed of respiratory physicians, nurses, and nutritionists.

In the assessment phase, the pulmonary rehabilitation team comprehensively evaluated the patient’s specific condition within two days of admission. General clinical data, COPD severity, disease-related knowledge, family economic status, self-efficacy, compliance, and exercise tolerance were collected. Through the collected information, the rehabilitation team negotiated and formulated training programs according to the patient’s own situation. The main assessment scales used were knowledge level questionnaire, self-efficacy scale (CSES), and COPD assessment questionnaire (CAT) (Table 1).

Recommendation stage: health education was conducted for patients and their families two days before admission, one week after hospitalization, and two days before discharge.

Consensus stage: medical staff set up a rehabilitation goal for patients and encouraged patients and their families to actively carry out pulmonary rehabilitation training by using successful cases in the process of pulmonary rehabilitation training.

Assistance stage: the Richmond Agitation-Sedation Scale (RASS) and MAC muscle strength assessment scale were adopted, combined with recommended guidelines, for pulmonary rehabilitation training, as shown in Table 2.

During the follow-up period, the pulmonary rehabilitation team established a COPD service platform using the Internet to answer questions for patients after discharge. The patient was followed up by telephone within two days after discharge. One follow-up visit was paid per month within two months after discharge. Follow-up visits were performed every two months after discharge. Each follow-up lasted 25-35 minutes.

2.3. Imaging Examination and Image Reconstruction

The patient was placed in the supine position, arms were raised, the positioning film was scanned first, and then, the scanning range (from the lung apex to the lung base) was determined on the positioning film. It should scan while holding your breath after taking a deep breath or holding your breath after calming your breath.

2.4. Pulmonary Function Test

The German Jeager Master Screen Body pulmonary function instrument was employed. The patient was instructed to take a sitting position, and the pulmonary function was measured by the instrument after inhaling bronchodilators. Deep inspiratory volume (IC), residual volume (RV), total lung volume (TLC), forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC) were recorded. The percentage of FEV1 in forced expiratory lung capacity (FEV1/FVC %) and residual air volume/total lung volume (RV/TLC) were calculated, and the maximum value was obtained after three repetitions. was mild; was moderate; was severe; was extremely severe.

2.5. Data Analysis

SPSS 20.0 was used for data entry and statistical processing. Descriptive statistical analysis was used for the general data of the research objects, and () was used for statistical description of the measurement data. The frequency and percentage of counting data were systematically described. test was used to compare the measurement data of normal distribution between groups. Chi-square test was used for comparison between counting data groups, and was considered statistically significant.

3. Results

3.1. X-Ray Images of Elderly Patients with COPD

Figure 1 showed the image data from a male COPD patient with polymyalgia rheumatica, chronic gastritis, and a history of smoking. Physical examination revealed a blood pressure of 130/79 mmHg, a heart rate of 100 beats/min, a SpO2 of 97%, and a normal heart rate. The abdomen was soft, without tenderness, and no clubs or edema were seen in the extremities. X-ray images showed sparse markings in both lungs, widened anteroposterior diameter of the chest, and emphysema with bullae in both lungs.

Figure 2 showed image data showing a male COPD patient with interstitial lung, hepatic insufficiency, and smoking history. Physical examination revealed blood pressure of 126/79 mmHg, heart rate of 120 beats/min, SpO2 of 94%, and no lymphadenopathy on neck examination. X-ray showed emphysema, decreased lung elasticity, increased retrosternal space, barrel chest, and bullae and interstitial lesions in both lungs.

3.2. Comparison of COPD Knowledge between the Two Groups

Before intervention, the average score of COPD knowledge level questionnaire in test group and control group was 20.22 and 21.07 points, respectively, with no statistical significance (). After two and four months of intervention, the average score of COPD knowledge questionnaire in the test group was remarkably improved, which was 27.43 points and 30.08 points, respectively, higher than that in the control group (22.79 points and 24.13 points), and the difference was significant (, Figure 3).

3.3. Comparison of Quality of Life between Two Groups before and after Intervention

Before intervention, the average score of CAT scale in the test group and the control group was 22.31 and 21.45, respectively, with no statistical significance (). After two and four months of intervention, the quality of life of patients in the test group was remarkably improved, and the average scores of CAT scale were 18.14 and 14.87, respectively, lower than those in the control group (21.06 and 19.33), with substantial differences (, Figure 4).

3.4. Comparison of Pulmonary Rehabilitation Training Compliance between Two Groups

Before intervention, there was no substantial difference in compliance between the test group and the control group (). Two months after intervention, the number of patients with good compliance in the test group increased significantly. After 4 months of intervention, the number of people with good compliance in the test group increased to 17, and only 1 person had poor compliance. In the control group, only 4 people had good compliance and 24 people had poor compliance; the differences were statistically significant (, Figure 5).

(a)

(b)

(c)

3.5. Comparison of Self-Efficacy between the Two Groups

Before intervention, the average scores of CSES scale in the test group and the control group were 78.64 and 79.52, respectively, with no statistical significance (). After two and four months of intervention, the self-efficacy of patients in the test group was remarkably improved, and the average scores of CSES scale were 103.21 and 107.36, respectively, higher than those in the control group (85.24 and 82.75), with substantial differences (, Figure 6).

3.6. Comparison of BMI between the Two Groups before and after Intervention

Before intervention, BMI of patients in the test group and control group was 19.23 kg/m² and 19.39 kg/m², respectively, with no statistical significance (). After two and four months of intervention, BMI of patients in the test group was also remarkably improved with the improvement of quality of life (20.32 kg/m² and 21.45 kg/m²), which were considerably superior to those in the control group (19.76 kg/m² and 20.08 kg/m²), and the difference was significant (, Figure 7).

3.7. Comparison of Exercise Tolerance between the Two Groups

Before intervention, the average length of 6MWD scale in test group and control group was 299.87 m and 300.53 m, respectively, with no statistical significance (). After two and four months of intervention, exercise tolerance of patients in the test group was remarkably improved, and the average length of 6MWD scale increased to 328.95 m and 337.62 m, respectively, which were higher than those in the control group (305.24 m and 306.89 m), with substantial differences (, Figure 8).

3.8. Comparison of Pulmonary Function-Related Indicators between the Two Groups

There were no substantial differences in FEV1, FVC, and FEV1/FVC between the test group and the control group before and after intervention (). However, the decrease trend of EV1/FVC in the test group was slower than that in the control group after two and four months of intervention (Figure 9).

(a)

(b)

(c)

4. Discussion

The main pathological changes in elderly COPD patients are chronic inflammation of small airways and destruction of lung parenchyma, among which chronic inflammation of small airways is an important factor leading to airflow limitation of small airway remodeling [21–24]. Pulmonary rehabilitation training is one of many exercise exercises for COPD patients and has been proven in clinical trials. Pulmonary rehabilitation training plays a certain role in improving patients’ quality of life [25]. Therefore, to further explore the application effect of pulmonary rehabilitation training under 5A nursing mode in elderly COPD patients, a total of 84 patients with chronic obstructive emphysema were included as research objects. The clinical effect of pulmonary rehabilitation training and routine nursing under 5A nursing mode was compared with the corresponding scale. The results showed that before intervention, there was no substantial difference in the average score of COPD knowledge questionnaire between the test group and the control group (). After two and four months of intervention, the average score of COPD knowledge questionnaire in the test group was remarkably improved, which was 27.43 points and 30.08 points, respectively, higher than that in the control group (). A clear understanding of the related pathological knowledge of COPD in the elderly plays a good role in improving patients’ compliance and enthusiasm for coordinated treatment. The pathological knowledge level of COPD in the elderly is affected by the patient’s age and education level. Most elderly patients have one-sided knowledge and understanding of diseases, so it is particularly important to strengthen patients’ health education in the treatment of diseases [26, 27]. The CSES scale is a commonly used scale to evaluate patients’ self-efficacy. The results showed that after two and four months of intervention, the self-efficacy of patients in the test group was remarkably improved, and the average scores of CSES scale were 103.21 and 107.36, respectively, which were considerably superior to those in the control group (). Self-efficacy refers to an individual’s perception of ability, and the CSES scale is a commonly used self-efficacy scale in clinical practice. The higher the self-efficacy, the higher the patient’s recognition and effort of lung health training. Cameron-Tucker et al. (2014) [28] explored the application of chronic disease self-management program (CDSMP) in COPD patients and evaluated exercise self-efficacy, quality of life, self-management behavior, exercise tolerance, etc. The results showed that the chronic disease self-management plan remarkably improved exercise self-efficacy and quality of life of patients, which was in line with the results of this study. Better compliance is an important factor affecting the rehabilitation effect. The lung rehabilitation compliance of two groups of patients before and after intervention was compared. The results showed that two months after intervention, the number of patients with good compliance in the test group increased significantly. After 4 months of intervention, the number of patients with good compliance in the test group increased to 17 and only 1 patient with poor compliance. Lenferink et al. (2017) [29] analyzed the application of self-management interventions in improving the rehabilitation effect of COPD patients, which suggested that better compliance is a key factor in improving the rehabilitation effect of patients, which was in line with the results of this study. Finally, FEV1, FVC, and FEV1/FVC % were compared between the two groups before and after intervention. The results showed that there were no substantial differences in FEV1, FVC, and EV1/FVC% between the test group and the control group before and after intervention (). However, EV1/FVC% decreased more in test group than in control group after two and four months of intervention. COPD is a disease with relatively slow progress. The small airway is open during inhalation and closed during exhalation, so there is a difference in the degree of airflow restriction between the inspiratory phase and the expiratory phase, and the small airway forms fixed stenosis with the aggravation of airflow restriction [30]. In this study, although pulmonary function training under 5A nursing mode did not improve airflow limitation significantly, its downward trend was slower than that of conventional nursing.

5. Conclusion

In this study, 84 patients with chronic obstructive emphysema were randomly divided into experimental group (pulmonary rehabilitation nursing in 5A mode) and control group (routine nursing), with 42 patients in each group. Through chronic obstructive pulmonary disease knowledge level questionnaire, self-efficacy scale of nurses (CSES), chronic obstructive pulmonary disease assessment test (CAT), 6-minute walking test (6MWD), X-ray image scanning, etc., the results showed that pulmonary rehabilitation training under 5A nursing mode can effectively improve the disease knowledge level, self-efficacy, and compliance of pulmonary rehabilitation training of elderly COPD patients and play an important role in improving the quality of life of patients and alleviating the degree of dyspnea of patients. However, there are some limitations, such as short follow-up time, lack of large sample study, and overall representativeness, so it is necessary to increase the sample size and follow-up time in future studies. Overall, this study provides valid data support for the clinical treatment of elderly patients with COPD.

Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest

The authors declare no conflicts of interest.

References

S. K. Park, “Trajectories of change in cognitive function in people with chronic obstructive pulmonary disease,” Journal of Clinical Nursing, vol. 27, no. 7-8, pp. 1529–1542, 2018, Epub 2018 Mar 26.
View at: Publisher Site | Google Scholar
H. Issac, C. Moloney, M. Taylor, and J. Lea, “Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol,” BMJ Open, vol. 10, no. 7, article e036060, 2020.
View at: Publisher Site | Google Scholar
B. Callejón-Leblic, A. Pereira-Vega, E. Vázquez-Gandullo, J. L. Sánchez-Ramos, J. L. Gómez-Ariza, and T. García-Barrera, “Study of the metabolomic relationship between lung cancer and chronic obstructive pulmonary disease based on direct infusion mass spectrometry,” Biochimie, vol. 157, pp. 111–122, 2019, Epub 2018 Nov 13.
View at: Publisher Site | Google Scholar
P. Yarra and S. Annangi, “Early integration of palliative care in chronic obstructive pulmonary disease (COPD) is warranted based on symptom burden and quality of life,” Evidence-Based Nursing, vol. 24, no. 4, p. 130, 2021, Epub 2020 Oct 1.
View at: Publisher Site | Google Scholar
Z. A. Usmani, K. V. Carson-Chahhoud, A. J. Esterman, and B. J. Smith, “A randomized placebo-controlled trial of paroxetine for the management of anxiety in chronic obstructive pulmonary disease (PAC Study),” Journal of Multidisciplinary Healthcare, vol. 11, pp. 287–293, 2018.
View at: Publisher Site | Google Scholar
M. I. Saad, L. McLeod, C. Hodges et al., “ADAM17 deficiency protects against pulmonary emphysema,” American Journal of Respiratory Cell and Molecular Biology, vol. 64, no. 2, pp. 183–195, 2021.
View at: Publisher Site | Google Scholar
P. Porter, S. Claxton, J. Brisbane et al., “Diagnosing chronic obstructive airway disease on a smartphone using patient-reported symptoms and cough analysis: diagnostic accuracy study,” JMIR Formative Research, vol. 4, no. 11, article e24587, 2020.
View at: Publisher Site | Google Scholar
Ø. Rasch-Halvorsen, E. Hassel, B. M. Brumpton et al., “Lung function and peak oxygen uptake in chronic obstructive pulmonary disease phenotypes with and without emphysema,” PLoS One, vol. 16, no. 5, article e0252386, 2021.
View at: Publisher Site | Google Scholar
C. Moloney, E. Sneath, T. Phillips, H. Issac, G. Beccaria, and A. Mullens, “Recommendations and practices for holistic chronic obstructive pulmonary disease (COPD) assessment and optimal referral patterns in emergency department presentations: a scoping review protocol,” BMJ Open, vol. 9, no. 8, article e030358, 2019.
View at: Publisher Site | Google Scholar
H. Petersen, R. Vazquez Guillamet, P. Meek, A. Sood, and Y. Tesfaigzi, “Early endotyping: a chance for intervention in chronic obstructive pulmonary disease,” American Journal of Respiratory Cell and Molecular Biology, vol. 59, no. 1, pp. 13–17, 2018.
View at: Publisher Site | Google Scholar
X. Ji, H. Yao, M. Meister, D. S. Gardenhire, and H. Mo, “Tocotrienols: dietary supplements for chronic obstructive pulmonary disease,” Antioxidants, vol. 10, no. 6, p. 883, 2021.
View at: Publisher Site | Google Scholar
N. D. Lane, K. Brewin, T. M. Hartley et al., “Specialist emergency care and COPD outcomes,” BMJ Open Respiratory Research, vol. 5, no. 1, article e000334, 2018.
View at: Publisher Site | Google Scholar
Y. Su, H. Luo, and J. Yang, “Heparin-binding EGF-like growth factor attenuates lung inflammation and injury in a murine model of pulmonary emphysema,” Growth Factors, vol. 36, no. 5-6, pp. 246–262, 2018, Epub 2019 Jan 2.
View at: Publisher Site | Google Scholar
H. Luo, V. W. Q. Lou, Y. Li, and I. Chi, “Development and validation of a prognostic tool for identifying residents at increased risk of death in long-term care facilities,” Journal of Palliative Medicine, vol. 22, no. 3, pp. 258–266, 2019, Epub 2018 Nov 7.
View at: Publisher Site | Google Scholar
K. Puschel, B. Thompson, G. Coronado, Y. Huang, L. Gonzalez, and S. Rivera, “Effectiveness of a brief intervention based on the '5A' model for smoking cessation at the primary care level in Santiago, Chile,” Health Promotion International, vol. 23, no. 3, pp. 240–250, 2008.
View at: Publisher Site | Google Scholar
Y. Chen and L. Pan, “Nursing research on patients with chronic obstructive pulmonary disease and respiratory failure based on big data,” Journal of Healthcare Engineering, vol. 2021, Article ID 2541751, 8 pages, 2021.
View at: Publisher Site | Google Scholar
A. Valipour, F. J. Herth, O. C. Burghuber et al., “Target lobe volume reduction and COPD outcome measures after endobronchial valve therapy,” The European Respiratory Journal, vol. 43, no. 2, pp. 387–396, 2014.
View at: Publisher Site | Google Scholar
R. P. Young and R. J. Hopkins, “Chronic obstructive pulmonary disease (COPD) and lung cancer screening,” Translational Lung Cancer Research, vol. 7, no. 3, pp. 347–360, 2018.
View at: Publisher Site | Google Scholar
L. Y. W. Tang, H. O. Coxson, S. Lam, J. Leipsic, R. C. Tam, and D. D. Sin, “Towards large-scale case-finding: training and validation of residual networks for detection of chronic obstructive pulmonary disease using low-dose CT,” Lancet Digit Health., vol. 2, no. 5, pp. e259–e267, 2020.
View at: Publisher Site | Google Scholar
J. A. Barberà, G. Peces-Barba, A. G. Agustí et al., “Guía clínica para el diagnóstico y el tratamiento de la enfermedad pulmonar obstructiva crónica,” Archivos de Bronconeumología, vol. 37, no. 6, pp. 297–316, 2001.
View at: Publisher Site | Google Scholar
W. Rao, S. Wang, M. Duleba et al., “Regenerative metaplastic clones in COPD lung drive inflammation and fibrosis,” Cell, vol. 181, no. 4, pp. 848–864.e18, 2020.
View at: Publisher Site | Google Scholar
Y. Zhou, N. S. Zhong, X. Li et al., “Tiotropium in early-stage chronic obstructive pulmonary disease,” The New England Journal of Medicine, vol. 377, no. 10, pp. 923–935, 2017.
View at: Publisher Site | Google Scholar
H. G. C. Van Spall, S. F. Lee, F. Xie et al., “Effect of patient-centered transitional care services on clinical outcomes in patients hospitalized for heart failure: the PACT-HF randomized clinical trial,” JAMA, vol. 321, no. 8, pp. 753–761, 2019.
View at: Publisher Site | Google Scholar
H. Aboumatar, M. Naqibuddin, S. Chung et al., “Effect of a hospital-initiated program combining transitional care and long-term self-management support on outcomes of patients hospitalized with chronic obstructive pulmonary disease: a randomized clinical trial,” JAMA, vol. 322, no. 14, pp. 1371–1380, 2019.
View at: Publisher Site | Google Scholar
I. A. Yang, J. L. Brown, J. George et al., “COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update,” The Medical Journal of Australia, vol. 207, no. 10, pp. 436–442, 2017.
View at: Publisher Site | Google Scholar
R. Spies, M. Potter, R. Hollamby et al., “Sputum colour as a marker for bacteria in acute exacerbations of COPD: protocol for a systematic review and meta-analysis,” Systematic Reviews, vol. 10, no. 1, p. 211, 2021.
View at: Publisher Site | Google Scholar
D. Chandra, A. Gupta, P. J. Strollo Jr. et al., “Airflow limitation and endothelial dysfunction. unrelated and independent predictors of atherosclerosis,” American Journal of Respiratory and Critical Care Medicine, vol. 194, no. 1, pp. 38–47, 2016.
View at: Publisher Site | Google Scholar
H. L. Cameron-Tucker, R. Wood-Baker, C. Owen, L. Joseph, and E. H. Walters, “Chronic disease self-management and exercise in COPD as pulmonary rehabilitation: a randomized controlled trial,” International Journal of Chronic Obstructive Pulmonary Disease, vol. 9, pp. 513–523, 2014.
View at: Publisher Site | Google Scholar
A. Lenferink, M. Brusse-Keizer, P. D. van der Valk et al., “Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease,” Cochrane Database of Systematic Reviews, vol. 8, no. 8, article CD011682, 2017.
View at: Publisher Site | Google Scholar
C. Mouronte-Roibás, V. Leiro-Fernández, A. Fernández-Villar, M. Botana-Rial, C. Ramos-Hernández, and A. Ruano-Ravina, “COPD, emphysema and the onset of lung cancer. A systematic review,” Cancer Letters, vol. 382, no. 2, pp. 240–244, 2016.
View at: Publisher Site | Google Scholar

Copyright

Copyright © 2022 Peihong Xu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation

Download other formats

Order printed copies

Views

371

Downloads

481

Citations