Assessment of the Severity of Asthma in a Family Practice

The objective of this study was to evaluate clinical history and self-perception of severity as predictors of asthma severity. A short-term longitudinal study was conducted in a family practice in Melbourne, Australia, utilizing peak flow monitoring, medication diary, and self-administered asthma severity questionnaire. Seventy-two asthmatic subjects with a positive bronchodilator or exercise test, aged between 6 and 79 years, were studied. Symptom and treatment items were correlated with peak flow variability and minimal peak expiratory flow rate (PEFR). An asthma severity scale was generated using the partial credit version of Item Response Theory and the participants' severity scores were validated against lung function tests and medication usage. Quantitative modeling procedures were used to investigate the interrelationships of factors associated with peak flow variability. Severity scores demonstrated significant relationships with peak flow variability (partial r = 0.34) and treatment items. Self-perceived severity of asthma in the preceding 2 weeks showed significant association with peak flow variability (partial rho = 0.46) and minimal PEFR (rho = -0.41). The severity module of the Monash Respiratory Questionnaire is a valid and reliable instrument. The most important symptoms appear to be the frequency of use of bronchodilator and frequency of nocturnal attacks. A carefully structured clinical history in conjunction with the peak flow criteria of variability and minimal peak flow rate would be appropriate in the evaluation of asthma severity. Patients' self-perception of the severity of their asthma needs further evaluation.     

皮质类固醇对哮喘患者T淋巴细胞亚群的影响

应用Ｔ淋巴细胞亚群单克隆抗体对类固醇治疗前后哮喘患者外周血Ｔ淋巴细胞亚群的变化进行检测，结果提示：类固醇治疗后ＯＫＴ８较治疗前增高，ＯＫＴ４／ＯＫＴ８比值较治疗前降低并且接近正常，说明Ｔ淋巴细胞是类固醇作用的靶细胞，类固醇可直接影响Ｔ细胞亚群分布，发挥其非特异性抗炎作用。     

A Comparison of Two Simple Measures to Evaluate the Health Status of Asthmatics: The Asthma Bother Profile and the Airways Questionnaire 20

Simple and concise measures for health status are desirable in clinical practice. The Asthma Bother Profile (ABP), which consists of 23 items, has been developed to assess how much asthma bothers patients. The Airways Questionnaire 20 (AQ20) is a simple instrument which consists of 20 items. The purpose of this study was to investigate how the ABP and AQ20 evaluate the health status of patients with asthma. A total of 166 patients with chronic asthma (age: 48 ± 16 yr, 77 males) completed pulmonary function testing, measurement of airway hyperresponsiveness, dyspnea rating, assessments of their anxiety and depression (HADS; Hospital Anxiety and Depression Scale), and assessments of their health status. The health status was assessed using the ABP, AQ20, the short-form 36 health survey questionnaire (SF-36), the Living With Asthma Questionnaire (LWAQ) and the Asthma Quality of Life Questionnaire (AQLQ). The Japanese version of the ABP included only 15 'bother' items out of the original 23 items due to cultural differences. The scores on the ABP were widely distributed, whereas the scores on the AQ20 were skewed towards the milder end of the scale. The ABP had a strong correlation with the Avoidance and Distress constructs on the LWAQ, and Anxiety and Depression on the HADS (Rs = 0.56 ∼ 0.79), and its strongest correlation with the General Health (Rs = - 0.64) scale among the 8 subscales on the SF-36. The AQ20 had a less significant correlation with the LWAQ, AQLQ, and SF-36 than the ABP. The ABP and AQ20 were short and simple to complete, and both measures could easily be used in clinical practice. The ABP can evaluate patients more specifically with respect to distress and bother than the AQ20.     

利多卡因和异丙酚预先给药对哮喘大鼠肺组织NO和内皮素水平的影响

目的通过观察预先给予利多卡因和异丙酚对哮喘大鼠内皮素（ET）和一氧化氮（NO）的影响,探讨其对哮喘作用的机制。方法Wistar大鼠32只,随机分为4组（n=8）：对照组（Ⅰ组）、哮喘组（Ⅱ组）、异丙酚组（Ⅲ组）和利多卡因组（Ⅳ组）。Ⅱ组、Ⅲ组、Ⅳ组大鼠用卵清蛋白辅以氢氧化铝注射致敏及雾化吸入诱发哮喘。Ⅲ组、Ⅳ组在诱发前30 min分别从股静脉输注异丙酚50 mg·kg^-1·h^-1或利多卡因12 mg·kg^-1·h^-1。哮喘发作后10 min,采集动脉血行动脉循环内皮细胞（CEC）计数,处死大鼠后,测定支气管肺泡灌洗液（BALF）中ET、NO浓度,计算NO/ET比值;取肺组织,计算肺湿干重比（W/D）、观察肺组织病理学结果。结果与Ⅰ组相比,Ⅱ组、Ⅲ组、Ⅳ组CEC计数及W/D增加,Ⅱ组BALF中ET、NO浓度增高,NO/ET比值下降（P＜0．05）;与Ⅱ组相比,Ⅲ组、Ⅳ组CEC计数及W/D降低, BALF中ET、NO浓度下降,NO/ET比值升高（P＜0．05）。Ⅱ组肺组织呈支气管壁增厚、炎性细胞浸润表现,Ⅲ组、Ⅳ组病理损伤程度减轻。结论利多卡因和异丙酚预先给药可通过降低肺组织ET、NO的水平、调节NO/ET的平衡,减轻了大鼠哮喘的发作程度。     

海洛因依赖者支气管哮喘的临床特点及防治

目的：探讨海洛因依赖者支气管哮喘临床特点，为防治和治疗提供科学根据。方法：2004年1月至2005年1月1752例海洛因依赖者中伴发哮喘40例与随机抽取同期戒毒的100例患者进行回顾性分析与对照。结果：研究组病例的日滥用量、吸毒方式、吸毒年限与对照组病例相比均呈显著差异（P〈0．01）。研究组中：轻度发作24例（60％）；中度发作12例（30％）；重度发作3例（7．5％）；危重度1例（2．5％），哮喘多出现在脱毒中期；在有效脱毒的基础上，抗炎平喘，结合心理治疗与干预，轻度发作者多在4小时内缓解，中度发作者多在48小时内缓解，重度及危重度发作者多在3～5天内缓解。结论：长期大剂量烫吸海洛因是支气管哮喘发作的危险因素。应完善相关检查、及时发现，积极有效抗炎平喘，制定合理治疗方案，注意心理因素的影响。更重要的是，对海洛因依赖者进行教育，使他们了解哮喘知识、戒除毒品，才能从根本上预防和治疗此类并发症。     

耳穴压豆法治疗儿童哮喘50例

采用耳穴压豆法治疗儿童哮喘５０例，并随访１年。结果：痊愈１１例；好转３７例；无效２例，总有效率为９６％。认为此法不仅能预防哮喘的发作，还能避免药物引起的副作用。     

生活环境因素暴露对支气管哮喘非急性发作期患者呼出气一氧化氮水平的影响

背景 呼出气一氧化氮(FeNO)的测量具有安全、无创、简便、重复性好等特点已经被广泛应用于哮喘患者气道炎症的评估,但FeNO的测定结果受到多种因素的影响,生活环境因素暴露可能与FeNO水平有较为密切的关系,而目前关于生活环境因素暴露对FeNO水平影响的研究较少。目的 分析生活环境因素暴露对支气管哮喘非急性发作期患者FeNO水平的影响,以提高临床医生利用FeNO管理哮喘的效能。方法 纳入2018年7月至2020年6月就诊于广州医科大学附属第二医院呼吸内科门诊的109例支气管哮喘非急性发作期患者作为研究对象,通过问卷调查的方法收集资料,问卷信息主要包括一般资料(性别、年龄、身高、体质量)、生活环境因素(包括吸烟史,家人在家是否吸烟,过敏史,居住地位置,居住地离车流量大的主干道位置,居住地周围有无工厂,居住房屋楼层,房屋居住年限,床单、被/枕套清洗晾晒的频率,家中窗帘材料,家中有无盆栽花草,家中垃圾桶有无定期清洗,家中有无饲养宠物,家中有无蟑螂,厨房垃圾有无当天处置,家中是否有毛绒玩具),并收集FeNO的检查资料。根据FeNO水平将支气管哮喘患者分成3组:FeNO低水平组(FeNO<2...     

Asthma and the diver

Self-contained underwater breathing apparatus (scuba) diving has grown in popularity, with nearly 9 million sport divers in the United States alone. Approximately 7% of the population has been diagnosed with asthma, which is similar to the percentage of divers admitting they have asthma. Numerous concerns exist regarding subjects with asthma who choose to participate in recreational diving. Among these concerns are pulmonary barotrauma, pneumomediastinum, pneumothorax, arterial gas embolism, ear barotrauma, sinus barotrauma, and dental barotrauma. Despite these concerns, a paucity of information exists linking asthma to increased risk of diving complications. However, it has long been the norm to discourage individuals with asthma from participating in recreational scuba diving. This article examines the currently available literature to allow for a more informed decision regarding the possible risks associated with diving and asthma. It examines the underlying physiological principles associated with diving, including Henry’s law and Boyle’s law, to provide a more intimate understanding on physiological changes occurring in the respiratory system under compressive stress. Finally, this article offers a framework for guiding the patient with asthma who is interested in scuba diving. Under the right circumstances, the patient with asthma can safely participate in recreational diving without apparent increased risk of an asthma-related event.     

支气管哮喘患者血清IL-10、IL-5和ECP的变化及其意义

目的 通过对支气管哮喘患者和正常对照组的血清IL-10, IL-5和 ECP水平的测定以及相互关系的研究,探讨它们在支气管发病中的作用.方法 应用Pharmacia UniCAP系统和ELISA方法分别测定支气管哮喘患者和正常对照组的血清E CP和IL-10、IL-5水平.结果 正常对照组和发作期的支气管哮喘患者的 ECP水平分别为(3.97±2.13) μg/L和(21.76±12.08) μg/L.正常对照组,支气管哮喘ECP 升高组和支气管哮喘ECP正常组的血清IL-5水平分别为(10.90±4.41) pg/mL,(20.62± 15.7 4) pg/mL和(9.24±7.16) pg/mL.正常对照组和支气管哮喘ECP升高组之间IL-5水平有显著差异(P＜0.01),正常对照组和支气管哮喘ECP正常组之间IL-5水平无差异(P＞0.05) ,支气管哮喘ECP正常组和ECP升高组之间IL-5水平有显著差异(P＜0.01),ECP与IL-5 明显相关 ,两者之间的相关系数r=0.465(P＜0.01).正常对照组,支气管哮喘ECP升高组和支气管哮喘ECP正常组的血清IL-10水平分别为(38.28±15.17) pg/mL,(22.76±15.25) pg/mL 和(42.32±14.61) pg/mL,支气管哮喘ECP正常组和ECP升高组之间IL-10水平有显著差异( P＜0. 01).结论 支气管哮喘的发生与嗜酸粒细胞有密切的关系,ECP和IL-5可反映嗜酸粒细胞的活化程度,在支气管哮喘发作时嗜酸粒细胞处于激活状态,易于释放蛋白颗粒;IL-5对嗜酸粒细胞有调控作用.支气管哮喘组的血清IL-10水平较正常对照组低,提示支气管哮喘患者IL-10分泌减少,不能有效抑制炎症或促炎症细胞因子的合成及释放,亦即不能有效抑制炎症反应,可能是导致或加重气道炎症的原因之一.     

小儿重症哮喘多因素回归分析

应用电脑对111例儿童哮喘50项指标进行多因素逐步回归分析,把发作时喘憋严重,平时也有不同程度的喘息症状患儿列入小儿重症哮喘,与非重症哮喘比较,结果显示夜间喘、急性发作持续天数、非特异性刺激诱发、间歇期症状、发绀、呼吸困难、入院后激素治疗、中性粒细胞、IgA、pH、哮喘持续状态等11个因素入选重症哮喘回归方程,表明这些因素与小儿重症哮喘相关,提出儿童哮喘危险信号的临床指标。