维生素D3治疗小儿变异性哮喘的效果

目的讨论思考丙酸氟替卡松、硫酸沙丁胺醇吸入联合维生素D3治疗小儿变异性哮喘的临床效果。方法抽选于2018年12月-2019年12月期间本院儿科门诊共收治的小儿变异性哮喘患儿72例入组,根据计算机随机分组法均分为两组。对照组(n=36)给予丙酸氟替卡松联合硫酸沙丁胺醇吸入治疗,研究组(n=36)给予丙酸氟替卡松、硫酸沙丁胺醇吸入联合维生素D3治疗。评价及对比两组的疗效、T淋巴细胞含量、血清生化指标。结果研究组的疗效高于对照组(P<0.05);研究组的血清生化指标均优于对照组(P<0.05);研究组的CD4^+、CD4^+/CD8^+含量低于对照组,且CD8^+含量高于对照组(P<0.05)。结论丙酸氟替卡松、硫酸沙丁胺醇吸入联合维生素D3治疗小儿变异性哮喘,疗效确切,可协同增效、相互补充,缓解症状,维持T淋巴细胞亚群平衡,减轻炎症反应,值得临床借鉴应用。     

丙酸氟替卡松预防婴幼儿毛细支气管炎后喘息的临床观察

目的观察丙酸氟替卡松气雾剂吸入预防婴幼儿病毒诱发性喘息发作的临床效果。方法将145例符合毛细支气管炎诊断的婴幼儿随机分为预防组75例、对照组70例,两组在常规治疗出院后,预防组采用丙酸氟替卡松吸入3个月,而对照组不做相应处理。出院后随访1年,比较1年内两组婴幼儿喘息的发病构成比、喘息发作次数及发作持续时间。结果在随访一年内,预防组中有21例患儿未发生喘息,37例发生1次喘息,17例发生2次以上喘息;对照组有5例患儿未发生喘息,19例发生1次喘息,46例发生2次以上喘息。预防组发生喘息患儿平均喘息持续时间也较对照组明显缩短。结论吸入糖皮质激素早期干预可以缓解毛细支气管炎患儿后期病毒诱发性喘息反复发作。     

Evaluating fluticasone furoate + vilanterol for the treatment of chronic obstructive pulmonary disease (COPD)

Introduction: Inhaled corticosteroid/long-acting β-2 agonists (ICS/LABA) combination inhalers have been a lifeline for a generation of chronic obstructive pulmonary disease (COPD) and asthma patients. Fluticasone furoate and Vilanterol (FF/VI) as a once-daily ICS/LABA combination have an extensive clinical trial and real-world data to support its use in COPD patients.

Areas covered: The authors provide pharmacological profiles of fluticasone furoate, vilanterol and the FF/VI fixed dose combination. Salient clinical trials evaluating efficacy and safety of the FF/VI combination, and studies demonstrating the impact on COPD exacerbation risk and mortality are also discussed.

Expert opinion: ICS/LABA combinations provide bronchodilation and decrease the frequency of COPD exacerbations. Individualizing treatment of each COPD patient based on unique phenotypes will maximize chances of therapeutic responsiveness. Asthma-COPD overlap (ACO), patients with sputum and/or blood eosinophilia, patients with a brisk bronchodilator response, and patients with frequent exacerbations are more likely to show a therapeutic response to ICS than populations who have none of these features. FF/VI will likely remain a popular ICS/LBA combination to treat COPD, as a once-daily inhaled therapy delivered via the Ellipta device popular with COPD patients, with extensive clinical trial and real-world data to support its use.     

噻托溴铵粉雾剂联合沙美特罗替卡松粉吸入剂治疗慢性阻塞性肺疾病急性加重期伴呼吸衰竭的临床研究

目的观察噻托溴铵粉雾剂联合沙美特罗替卡松粉吸入剂治疗慢性阻塞性肺疾病(COPD)急性加重期伴呼吸衰竭的临床疗效及安全性。方法将76例COPD急性加重期伴呼吸衰竭患者随机分为对照组38例和试验组38例。对照组予以常规治疗配合呼吸机辅助通气治疗;试验组在对照组治疗的基础上,予以沙美特罗替卡松粉吸入剂每次1吸,bid,吸入治疗+噻托溴铵粉雾剂每次18μg,qd,吸入治疗。2组患者均治疗2周。比较2组患者的临床疗效、动脉血气指标、降钙素原和免疫功能,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为92.11%(35例/38例)和73.68%(28例/38例),差异有统计学意义(P<0.05)。治疗后,试验组和对照组的动脉血氧分压分别为(86.35±7.04)和(77.49±6.85)mm Hg,氧合指数分别为(310.89±29.87)和(281.34±27.53)mm Hg,降钙素原分别为(1.42±0.54)和(1.93±0.61)ng·m L^-1,肿瘤坏死因子-α分别为(275.49±48.62)和(310.05±54.73)ng·L^-1,白细胞介素-8分别为(312.62±75.64)和(389.75±78.76)pg·m L^-1,超敏C-反应蛋白分别为(4.73±2.45)和(8.34±2.53)mg·L^-1,差异均有统计学意义(均P<0.05)。2组患者治疗期间均未发生药物不良反应。结论噻托溴铵粉雾剂联合沙美特罗替卡松粉吸入剂治疗COPD急性加重期伴呼吸衰竭的临床疗效确切,其能显著降低患者的降钙素原水平,改善患者的血气指标和免疫功能,且安全性较好。     

沙美特罗替卡松粉吸入剂治疗儿童哮喘疗效观察

目的探讨沙美特罗替卡松粉吸入剂(商品名舒利迭Seretide,葛兰素史克公司生产)治疗儿童哮喘的疗效及副作用.方法62例儿童哮喘按就诊顺序随机分成两组,治疗组患儿按病情严重程度分别予舒利迭50/100、100/200、150/300μg·d-1吸入,对照组按病情严重分别予丙酸氟替卡松吸入剂(商品名辅舒酮,葛兰素史克公司生产)125、250、375μg-1吸入,分别于治疗后4、8、12周评价其日、夜间哮喘症状计分及PEFR值变化.结果治疗后4、8、12周,治疗组与对照组相比,患儿日夜间哮喘症状计分明显减少(P＜0.01);治疗组PEFR值占预计值的百分比与对照组相比明显改善(P＜0.05),差异非常显著.且两组患儿在治疗期间均未发现明显副作用.结论联合应用糖皮质激素和长效β2-肾上腺素受体激动剂具有协同抗炎和平喘作用,且联合使用时可以减少糖皮质激素的用量,减少较大剂量的糖皮质激素的不良反应.舒利迭就是含有沙美特罗和丙酸氟替卡松的混合干粉吸入剂,用舒利迭治疗不同程度的儿童哮喘疗效明显优于辅舒酮.     

孟鲁司特钠联合糠酸莫米松对变应性鼻炎患者的疗效

目的探究变应性鼻炎(AR)患者予以孟鲁司特钠与糠酸莫米松联合应用的临床效果。方法本文为前瞻性随机对照试验。选取2019年7月至2022年7月威海市中心医院收治的AR患者98例为研究对象, 采用随机数字表法将其分为两组, 各49例。对照组男27例、女22例, 年龄(35.47±7.09)岁, 予以糠酸莫米松治疗;联合组男23例、女26例, 年龄(36.85±7.37)岁, 予以糠酸莫米松与孟鲁司特钠联合治疗。对比两组临床疗效、炎症水平及用药不良反应。采用χ2检验、t检验。结果联合组总有效率为97.96%(48/49), 明显高于对照组83.67%(41/49), 差异有统计学意义(χ2=4.404, P=0.036)。治疗前, 两组患者白细胞介素-4(IL-4)、细胞间黏附分子-1(ICAM-1)、C反应蛋白(CRP)水平比较, 差异均无统计学意义(均P>0.05);治疗后, 联合组IL-4[(115.43±12.83)ng/L]、ICAM-1[(5.74±1.15)μg/L]、CRP水平[(7.36±1.46)mg/L]均明显低于对照组[(127.45±14.16)ng/L、(6...     

孟鲁司特联合沙美特罗替卡松治疗儿童支气管哮喘疗效分析

目的：分析孟鲁司特联合沙美特罗替卡松治疗儿童支气管哮喘的疗效。方法：以我院2012年4月～2015年4月收治的60例支气管哮喘患儿为研究对象,以随机双盲法将其分为两组,各30例,对照组采取单纯沙美特罗替卡松治疗,观察组在对照组基础上联合孟鲁司特治疗,比较两组临床疗效、临床症状缓解时间及治疗前后肺功能达标情况。结果：观察组总有效率、治疗3个月肺功能达标率分别为96.7%、73.3%,较对照组的80.0%、43.3%差异有统计学意义（P＜0.05）。两组喘息消失时间[（4.6±1.5）VS（5.8±1.3）]d、气促消失时间[（5.3±2.2）VS（6.5±2.3）]d、肺部啰音消失时间[（5.5±2.4）VS（7.8±2.3）]d比较差异有统计学意义（P＜0.05）。结论：孟鲁司特联合沙美特罗替卡松治疗儿童支气管哮喘疗效明确,能明显改善临床症状,促进肺功能恢复,值得临床推广。     

Advances in pharmacotherapy for the treatment of allergic rhinitis; MP29-02 (a novel formulation of azelastine hydrochloride and fluticasone propionate in an advanced delivery system) fills the gaps

Introduction: Effective pharmacologic treatment exists for most patients suffering from allergic rhinitis (AR). However, both in clinical trials and in real-life studies, many patients are dissatisfied with treatment. Physicians often use multiple therapies, in an attempt to improve symptom control, often with limited evidence of success. Novel treatment options are needed and must consider unmet medical needs.

Areas covered: This article reviews the clinical data for a new AR treatment. MP29-02 (Dymista®, Meda, Solna, Sweden) contains azelastine hydrochloride (AZE) and fluticasone propionate (FP), in a novel formulation and delivered in an improved device as a single nasal spray. It has shown superior efficacy in AR patients than either commercially available AZE or FP monotherapy for both nasal and ocular symptom relief, regardless of disease severity. MP29-02 also provided more effective and rapid symptom relief than either AZE or FP monotherapy delivered in the MP29-02 formulation and device. However, the effect was less than that observed versus commercial comparators, suggesting the impact of formulation and device on clinical efficacy.

Expert opinion: MP29-02 simplifies AR management, surpassing the efficacy of gold standard treatment, intranasal corticosteroids (INS), for the first time. It is indicated for the treatment of moderate-to-severe seasonal allergic rhinitis and perennial allergic rhinitis when monotherapy with either intranasal antihistamine or INS is NOT considered sufficient. Most patients present with moderate/severe disease, with evidence of current or previous treatment insufficiency. MP29-02 should be the treatment of choice for these patients.