脉冲磁疗及吸入疗法对支气管哮喘患者肺功能和气道反应性的影响

目的研究脉冲磁疗及超声雾化吸入维生素K3对支气管哮喘患者肺通气功能和气道反应性的影响。方法随机选取支气管哮喘患者68例,分为脉冲磁疗加吸入治疗组(n=36)和吸入对照组(n=32),分别给予脉冲磁疗加超声雾化吸入维生素K3治疗、单纯超声雾化吸入维生素K3治疗。所有患者分别检测治疗前、后肺功能指标FVC、FEV1.0和V50及气道反应性指标Dmin,Cmin和Sd。结果两组患者治疗后FVCFEV1.0、V50提高;Cmin,Dmin升高,Sd降低,脉冲磁疗联合吸入治疗组患者上述指标改善更为明显(P<0.05)。结论脉冲磁疗联合超声雾化吸入维生素K3可提高支气管哮喘患者肺通气功能、降低气道高反应性。     

支气管高反应性者就是支气管哮喘吗

支气管高反应性者就是支气管哮喘吗何权瀛早在１９１０年人们就发现了支气管高反应性（ＢＨＲ）或称气道高反应性这一现象，并且在４０年代就开始认为它具有诊断价值。然而很长一段时间内对于ＢＨＲ的原因、本质、特征、发生机制并不十分清楚。直到最近１０年才陆续明确了...     

咳嗽变异型哮喘患者的肺功能及气道反应性特征

为探讨肺功能及气道反应性测定在诊断咳嗽变异型哮喘（ＣＶＡ）中的作用，用２２００型肺功能仪、６２００型体容积描计仪和ＡｓｔｏｇｒａｐｈＴＣＫ６１００气道反应测定仪检测了２２例典型哮喘患者、３５例ＣＶＡ患者和５１例正常健康者的肺功能及气道反应性。ＣＶＡ组的ＦＥＶ１／ＦＶＣ（％）（１秒钟用力呼气量占用力肺活量加百分比）高于哮喘组（Ｐ＜００１），但与正常组无差异（Ｐ＞００５）；Ｒａｗ（气道阻力）明显低于哮喘组（Ｐ＜００１），但高于正常组（Ｐ＜００１）；Ｒｒｓ（呼吸阻力）明显高于正常组（Ｐ＜００１），但明显低于哮喘组（Ｐ＜００５）。ＣＡＶ组和哮喘组间Ｄｍｉｎ（气道反应阈值）和ＳＧｒｓ（单位时间内诱导控制值之差）均无显著差异（Ｐ＞００５）。气道反应性测定及肺功能检查ＣＶＡ有较高临床价值     

支气管哮喘与气道炎症和支气管高反应性

现已普遍认为支气管哮喘是一种气道炎症（ＡＩ）疾病，支气管高反应性（ＢＨＲ）是其重要特征。本探讨了哮喘与ＡＩ和ＢＨＲ的关系，进而阐述哮喘的可能发病机制。     

支气管哮喘缓解期患者气道反应性测定

支气管哮喘是一种嗜酸性粒细胞、肥大细胞和其他多种细胞参与反应而引起的慢性、持久性的炎症疾病 ,可逆性气道阻塞、气道炎症和气道高反应性是哮喘的三大特征。我们对 2 0例缓解期支气管哮喘患者进行气道反应性测定 ,并与对照组进行比较 ,为缓解期支气管哮喘的诊治提供依据。对象与方法1.对象 :( 1)缓解期组 :缓解期支气管哮喘患者 2 0例 ,年龄19～ 3 5岁 ,吸入激素抗炎治疗 1～ 10个月 ,经过治疗症状、体征消失 ,肺功能恢复到急性发作前水平 ,并维持 4周以上。 ( 2 )对照组 :2 0例 ,为无过敏性疾病 ,皮肤过敏原检查阴性的健康者。2 .方法 …     

变应性鼻炎患者肺功能、气道高反应性的改变及临床意义

目的探讨变应性鼻炎(AR)患者肺功能、气道高反应性(AHR)改变及其临床意义。方法对100例成人AR患者(AR组)及30例正常体检者(对照组)进行肺功能的检查,比较两组肺功能指标,AR组筛选FEV1≥70%预计值的患者行组胺支气管激发试验(BPT)测定,并将AR患者按病程、症状持续时间及病情严重程度分组,比较不同组间AR患者BPT结果。结果 AR组肺功能指标明显低于对照组(P0.05),60.4%AR患者BPT阳性,长病程组较短病程组、持续性AR组较间歇性AR组、轻度AR组较中-重度AR组BPT阳性率高(P0.05)。结论 AR患者大部分已存在肺功能尤其小气道功能的改变及AHR,病程长、持续性、中-重度AR患者较病程短、间歇性、轻度患者呈现出更高水平的AHR。     

类固醇吸入治疗对哮喘患者肺功能与气道高反应性的影响

本研究应用双盲随机方法对支气管哮喘患者应用二丙酸倍氯松气雾剂（Ｂｅｃｏｔｉｄｅ）进行吸入治疗，每次２００μｇ，每日二次，吸入治疗前与治疗后２周，４周分别对肺功能与气道反应性进行了观察，结果表明，治疗组经治疗后肺功能指标有不同程度改善，个别指标无变化，其中肺活量（ＶＣ），用力肺活量（ＦＶＣ）与第一秒用力呼气容积（ＦＥＶ１）改善程度经统计学处理有显著意义。对照组治疗后功能也获一定改善，但除呼气流量峰值     

咳嗽变异性哮喘患者的肺功能和支气管扩张药物治疗评价

目的 进一步探讨“咳嗽变异性哮喘”与变态反应之间的关系,了解肺功能和气道反应性特点,以及吸入支气管扩张药物治疗的反应。方法:1.测定吸入支气管扩张药物Salbutamol前和吸入后的FEV1改善情况;2.测定吸入Methacholine时的气道反应性;3.观察和随访吸入Procaterol和应用氨茶碱等药物治疗的效果。结果:1.吸入支气管扩张剂Salbutamol后FEV1增加0.21±0.04L,增加率为9.0±2.5％;2.气道反应性测定显示吸入Methacholine后气道反应性增加,PC20—FEV1为2.63mg/m1;3.所有患者经吸入Procaterol治疗后,咳嗽均得到不同程度的缓解。结论:1.咳嗽变异性哮喘的发病与变态反应有关,其FEV1变异率和Methacholine激发试验测定结果与哮喘相似;2.此类患者应用支气管扩张剂和氨茶碱等药物治疗有效。     

哮喘和COPD肺功能及气道反应性的比较研究

支气管哮喘和ＣＯＰＤ是常见的和有气流阻塞的两种不同疾病，前者常常是间歇发作，而后者则回复不完全，二者肺功能表现有许多重叠，但ＶＣ、ＦＶＣ、Ｖ２５／Ｈ，ＢＨＲ仍存在显著性差异，短期内重复检测将有利于鉴别哮喘和ＣＯＰＤ。     

Mechanisms of airway hyperresponsiveness in asthma

Abstract:   Airway hyperresponsiveness (AHR) is a fundamental abnormality in asthma. There are many potential factors contributing to the excessive airway response demonstrable on airway challenge. These range from abnormalities of airway smooth muscle, airway remodelling and airway inflammation to abnormalities in the neural control of airway calibre. None of these by themselves fully explains the abnormalities seen on the dose response curves of the asthmatic. In this review, the main mechanisms are described, together with recent evidence providing a pathway by which a number of these mechanisms may interact to cause AHR through abnormality in ventilation distribution and airway closure. There is now evidence for a close relationship between ventilation heterogeneity and AHR which could be exploited clinically.     

Airway hyperresponsiveness: the usefulness of airway hyperresponsiveness testing in epidemiology,in diagnosing asthma and in the assessment of asthma severity

The present PhD thesis was conducted at the Respiratory Research Unit at the Pulmonary Department L in Bispebjerg Hospital, Copenhagen, Denmark and describes airway hyperresponsiveness in asthma patients in four studies. The first study concerned risk factors for the development of asthma in young adults in a 12‐year prospective follow‐up study of a random population sample of 291 children and adolescents from Copenhagen, who were followed up from the age of 7–17 years (1986) until the age of 19–29 years (1998). During follow‐up, 16.1% developed asthma, and in these subjects, the most important predictor of asthma development was airway hyperresponsiveness to histamine at baseline. Airway hyperresponsiveness is associated with more severe asthma and a poorer prognosis in terms of more exacerbations and less chance of remission of the disease. The second study described the relation between airway hyper‐responsiveness to methacholine and the quality of life in 691 asthma patients: In asthma patients with airway hyperresponsiveness to methacholine, the quality of life measured with a validated questionnaire (Junipers Asthma Quality of Life Questionnaire) was significantly reduced compared to asthma patients who did not respond to bronchial provocation with methacholine. Airway hyperresponsiveness is not uncommonly observed in non‐asthmatics, and the response to bronchial provocation with methacholine is therefore relatively non‐specific. The mannitol test is a relatively new bronchial provocation test that acts indirectly on the smooth airway muscle cells through the release of mediators from inflammatory cells in the airways; the mannitol could consequently be a more specific test compared with methacholine. The third study showed that out of 16 non‐asthmatics with airway hyperresponsiveness to methacholine, 15 did not respond to bronchial provocation with mannitol Because of the mechanism of action of mannitol, it seems plausible that the response to mannitol is more closely correlated to airway inflammation in asthma compared with the response to methacholine. The fourth study showed that in 53 adult asthma patients, who did not receive treatment with inhaled steroids, there was a positive correlation between the degree of airway inflammation and the degree of airway responsiveness to mannitol as well as to methacholine. The mannitol does, however, have the advantage of being a faster and simpler test to perform, requiring no additional equipment apart from a spirometer. Conclusions: Airway hyperresponsiveness in children and in adolescents without asthma predicts asthma development in adulthood. Asthma patients with airway hyperresponsiveness to methacholine have a poorer quality of life as well as more severe disease and a poorer prognosis compared with asthma patients without airway hyperresponsiveness. Bronchial provocation with mannitol as well as with methacholine were useful for evaluating the severity of asthma and the degree of airway inflammation, and accordingly for determining the need for steroid statement. The mannitol test does, however, have practical advantages over the methacholine test that make it preferable for clinical use.     

Chemotherapy for malignancy induces a remission in asthma symptoms and airway inflammation but not airway hyperresponsiveness

Inflammation with infiltrations of eosinophils and mast cells into the walls of airways is considered to increase airway hyperresponsiveness (AHR), which in turn characterizes asthma. We present a child with AHR in whom the clinical course of asthma was related to eosinophilic bronchitis. Our patient was admitted at age 6 months with bronchiolitis and at age 4 years with asthma. Inhaled corticosteroids were begun at age 7 years. At age 8 he developed a meningeal sarcoma. While on chemotherapy, his asthma symptoms resolved and he no longer required prophylactic asthma treatment. After 14 months off all chemotherapy, he again had mild episodic asthma. While receiving chemotherapy for malignancy, he had an admission with a coagulase negative staphylococcal bacteremia. During sputum induction with 4.5% saline, he developed cough, wheeze, and a 20% reduction in peak expiratory flow (220 to 180 L/min) that reversed after treatment with salbutamol. The sputum cell count was 1.7 × 10⁶/ml with 1.1 × 10⁶ being neutrophils. Two weeks later and prior to the induction of the second sputum, a 21% increase in FEV₁ was recorded after bronchodilator inhalation (82% to 99% of predicted). The second sputum contained 2.7 × 10⁶/ml cells with 1.6 × 10⁶/ml neutrophils. Neither eosinophils nor mast cells were identified in the sputum. A third sputum obtained 14 months after the cessation of chemotherapy showed a sputum cell count of 16 × 10⁶/ml, with 11.6 × 10⁶ neutrophils and 0.4 × 10⁶ eosinophils; no mast cells were detected. A reversible 15% reduction in FEV₁ was detected on hypertonic saline challenge testing. This boy had persistent airway hyperreactivity and reversible airways obstruction on three occasions during and following chemotherapy. When he developed asthma symptoms, his sputum contained neutrophils and eosinophils; while on chemotherapy his sputum did not contain eosinophils and he was symptom-free and off all asthma therapy. One can speculate that chemotherapy for malignancy can induce a remission in asthma symptoms but not AHR, and remission in symptoms is associated with a lack of eosinophilic or mast cell infiltrates in the sputum. Pediatr Pulmonol. 1998; 25:74–77. © 1998 Wiley-Liss, Inc.     

支气管哮喘急性发作缓解前后的小气道功能测定

目的肺功能检测在支气管哮喘治疗前后小气道功能的评价作用研究。方法选择31例急性期支气管哮喘患者和30名健康志愿者作为对照,测定其急性期和缓解期肺功能,并加以比较。结果 31例支气管哮喘患者,在哮喘急性发作期测舒张实验全部阳性,哮喘组患者急性发作期和缓解期FEV1占预计值%及FEV1/FVC比较差异有统计学意义(P<0.01);哮喘组患者缓解期和健康对照组受试对象FEV1占预计值%和FEV1/FVC比较差异无统计学意义(P>0.05)。结论急性期哮喘患者均存在大、小气道功能异常,缓解期哮喘患者大气道功能恢复,小气道功能虽有一定恢复,但与正常健康对照组比较仍存在异常。     

Lower airway inflammation and hyperresponsiveness in non-asthmatic patients with non-allergic rhinitis

Background

Potential associations between non-allergic rhinitis (NAR) and asthma have been verified epidemiologically, but these associations remain not very clear. It is necessary to further explore the possible implication of lower airway abnormities in NAR patients but without asthma. This study aims to determine lower airway hyperresponsiveness (AHR), inflammation and lung function in non-asthmatic patients with NAR.

Methods

We recruited 262 non-asthmatic patients with NAR, 377 with AR and 264 healthy subjects. All subjects were non-smokers who underwent meticulous history taking, nasal examination, allergen skin prick test (SPT), blood routine test, measurement of fractional exhaled nitric oxide (FeNO), methacholine bronchial challenge test and induced sputum eosinophil count, in this order.

Results

Compared with healthy subjects, non-asthmatic patients with NAR yielded markedly lower FEV₁/FVC, maximal mid-expiratory flow (MMEF), mid-expiratory flow when 50% of FVC has been expired (MEF_50%) and mid-expiratory flow when 75% of FVC has been expired (MEF_25%) (P<0.05). Differences in spirometry between group AR and NAR were unremarkable (P>0.05). Patients with NAR yielded higher rate of AHR and higher FeNO levels than healthy subjects but lower than those with AR. The proportion of lower airways disorders (sputum eosinophilia, high FeNO levels or AHR) was highest in group AR (70.8%), followed by NAR (53.4%) and healthy subjects (24.2%) (P<0.01). However, sputum eosinophils in NAR patients were not higher compared with healthy subjects (P>0.05). Sputum eosinophils and FeNO had significant correlation with positive AHR and MMEF in group AR but not in NAR.

Conclusions

Non-asthmatic patients with NAR harbor lower AHR, small airways dysfunction and inflammation, despite being less significant than those with AR. This offers clues to unravel the link between NAR and asthma.     

临床控制的哮喘患者小气道功能和呼出气 NO 水平测定的临床意义简

目的 检测临床控制的哮喘患者小气道功能和呼出气一氧化氮（NO）的水平,探讨其临床意义.方法 对38例临床控制的哮喘患者做肺功能及呼出气NO浓度测定.选择22例初诊哮喘患者和20例健康者作为对照组.结果 38例临床控制哮喘患者中,小气道功能异常22例（57.9%）,正常16例（42.1%）,呼出气NO浓度为（30.42±25.35） ppb,显著低于初诊哮喘组[（80.28±45.62） ppb,P〈0.01],但显著高于健康对照组[（16.15±11.23） ppb,P〈0.01].小气道功能异常哮喘患者呼出气NO浓度为（42.29±23.12） ppb,显著高于小气道功能正常患者呼出气NO浓度[（20.54±10.12） ppb,P〈0.01].结论临床控制的哮喘患者小气道功能异常可能与气道炎症持续存在有关,测定患者小气道功能和呼出气NO浓度有助于指导哮喘治疗.     

Airway hyperresponsiveness and airway inflammation in elite swimmers

Introduction: The prevalence of respiratory symptoms and airway hyperresponsiveness (AHR) is high in elite athletes; swimmers have one of the highest prevalences. No consensus exists on what airway challenge to use when identifying AHR in elite athletes. Further, knowledge is sparse about when during their active sport career AHR develops and if there is an acute effect on the airway inflammation of a swimming training session. Objectives: We aimed to (i) evaluate the airway response to a methacholine challenge, a eucapnic voluntary hyperpnoea (EVH) test, a field‐based exercise test (FBT) and a laboratory‐based exercise test (LBT) in adult elite swimmers; (ii) investigate airway responsiveness and airway inflammation in adolescent elite swimmers; and (iii) evaluate the acute effect of a training session in an indoor swimming pool on airway inflammation in adolescent elite swimmers. Materials and Methods: Two groups were studied. (i) In adult elite swimmers (n = 16), we examined airway response in four airway provocation tests: methacholine challenge, EVH test, FBT and LBT. (ii) In adolescent elite swimmers (n = 33), we examined airway responsiveness to EVH and methacholine, and airway inflammation and compared the findings with those in asthmatic adolescents (n = 32) and unselected adolescents (n = 35). Further, we examined the acute effect of swimming on airway inflammation in a subpopulation of the adolescent swimmers (n = 21). Airway inflammation was evaluated using sputum induction, measurements of exhaled nitric oxide (FeNO) and exhaled breath condensate (EBC). Results: Of 16 adult swimmers, eight (50%) had AHR; five of the eight (63%) were identified with the EVH test, four (50%) with the FBT, four (50%) with the LBT and none with the methacholine challenge [provocative dose of methacholine causing a 20% fall in FEV1 (PD₂₀) ≤ 2 µmol]. There were no differences in the prevalence of AHR to either EVH or methacholine (PD₂₀ ≤ 8 µmol) among the adolescent swimmers, the asthmatic adolescents and the unselected adolescents. When looking at airway responsiveness as a continuous variable, the swimmers were more responsive to EVH than were the unselected subjects, and less responsive to methacholine than were the asthmatic adolescents. There were no differences in FeNO, EBC pH or in the cellular composition of the sputum among the three groups. Lung function, FeNO, EBC pH, EBC lactate and differential cell counts in sputum were not acutely affected by the swimming session. Conclusion: We found that the EVH test is the most sensitive test for identifying AHR in elite athletes when using the diagnostic criteria set forward by the International Olympic Committe. Whereas a high prevalence of AHR in adult swimmers was found, the prevalence of AHR in the adolescent swimmers did not differ from that in unselected adolescents nor did the adolescent swimmers have signs of airway inflammation. There was no acute effect of a swimming training session in an indoor chlorinated pool on lung function or airway composition in adolescent swimmers. We believe that elite swimming results in airway changes with AHR and airway inflammation.     

The value of concentration of alveolar nitric oxide in diagnosing small airway dysfunction in patients with stable asthma

Background

Exhaled nitric oxide (FeNO) is a simple, noninvasive, and reproducible test, and FeNO (50 ml/s) is often used to reflect airway inflammation. The peripheral small airway/alveolar nitric oxide (NO) concentration is derived from the output of NO at multiple flow rates. Concentration of alveolar NO (CANO), which has been reported to reflect peripheral small airway inflammation, may be related to parameters that reflect abnormal small airway function.

Aim

This study aims to investigate the relationship among CANO levels, clinical features, and small airway function-related indicators in patients with stable asthma and to provide a simple method for monitoring small airway function in asthma.

Design and Methods

We recruited 144 patients with well-controlled, stable asthma, including 69 patients with normal small airway function (normal group) and 75 patients with small airway dysfunction (abnormal group). CANO and pulmonary function were measured.

Results

CANO was significantly higher in the abnormal group ([7.28 ± 3.25] ppb) than the normal group CANO ([2.87 ± 1.50] ppb). FEF25–75%pred ([55.0 ± 16.5]%), FEF50%pred ([46.4 ± 13.2]%), and FEF75%pred ([41.9 ± 13.1]%) in abnormal group were significantly lower compared with normal group ([89.9 ± 7.5]%), ([80.9 ± 6.8]%), and ([73.8 ± 5.0]%). CANO was negatively correlated and FEF25–75%pred, FEF50%pred, and FEF75%pred (r = −0.87, P < 0.001; r = −0.82, P < 0.001; r = −0.78, P < 0.001). CANO was positively correlated with age (r = 0.27, P = 0.001). The area under the ROC curve was 0.875 for CANO. The optimal cutoff point of 5.3 ppb had sensitivity and specificity values of 72% and 92% in diagnosing small airway dysfunction.

Conclusion

CANO has diagnostic value for small airway dysfunction, and the optimal cutoff value is 5.3 ppb. However, the diagnostic evidence is still insufficient, so it still needs further exploration for its value in detecting small airway dysfunction.     

Exhaled nitric oxide continues to reflect airway hyperresponsiveness and disease activity in inhaled corticosteroid-treated adult asthmatic patients

OBJECTIVE: Exhaled nitric oxide (eNO) has been used as a surrogate of airway inflammation in mild asthma. However, whether eNO levels reflect disease activity in symptomatic asthmatics receiving moderate doses of inhaled corticosteroid (ICS) is more uncertain. METHODOLOGY: To examine the relationship between eNO levels, sputum and blood eosinophils (SpE and PbE), PD(20) methacholine as a marker of airway hyperresponsiveness (AHR) and clinical status in 28 ICS-treated asthmatic subjects with persistent asthma compared to that in 25 symptomatic asthmatics managed with beta2-agonists alone. RESULTS: As expected, eNO levels were normalized in ICS-treated subjects and significantly elevated in the beta2-agonist only group (P < 0.001). SpE, PbE and PD20M did not differ between asthmatic groups but FEV1 was significantly worse in ICS-treated subjects (P < 0.01). Exhaled NO levels correlated with PbE within both asthmatic groups (P < 0.005), but with SpE only in ICS-untreated subjects (r(s) = 0.6, P < 0.05). In contrast, PD20M was negatively correlated with eNO and PbE in ICS-treated subjects only (r(s) = - 0.4, r(s) = - 0.4, respectively, P < 0.05). SpE and PbE were strongly correlated in both asthmatic groups (r(s) = 0.8, r(s) = 0.7, respectively, P < 0.005). Exhaled NO levels, SpE and PbE were all positively associated with increased nocturnal awakenings ( P < 0.05) in ICS-treated subjects, but not in ICS-untreated subjects. CONCLUSIONS: In ICS-treated asthma, eNO reflects clinical activity, PbE and AHR but not eosinophilic airway inflammation. Exhaled NO levels are quantitatively and relationally different in asthmatic subjects treated with ICS and continue to have potential for use as a surrogate of asthma pathophysiology in this group.