常用哮喘控制药物的安全性

哮喘是一种慢性气道炎症性疾病。哮喘控制药物通过抗炎作用控制哮喘的慢性气道炎症、从而预防哮喘发作,是哮喘药物治疗的重要组成。本文就常用的几类哮喘控制药物（包括糖皮质激素、长效β2-受体激动剂、白三烯受体拮抗剂和茶碱缓释制剂）的安全性作一概述,以期医生和药师能更合理、安全地使用这些药物。     

无创通气联合药物治疗对哮喘患者肺功能的影响

目的 探讨无创通气联合药物治疗在哮喘患者中的应用效果.方法 将90例哮喘患者按照治疗方法的不同分为观察组和对照组,对照组采用综合药物治疗,观察组在对照组的基础上采用无创通气治疗,比较两组的治疗效果.结果 观察组的总有效率为93.3％,显著高于对照组的80.0％(x2=3.89,P＜0.05).两组治疗后的二氧化碳分压(PCO2)、氧分压(PO2)、最大呼气流量(PEF)、呼吸频率(RR)均较治疗前有显著性改善(t=10.85、8.73、2.57、4.91、8.58、6.75、2.06、3.68,P＜0.05),但观察组的治疗效果显著优于对照组(t=5.13、6.52、1.98、2.91,P＜0.05).观察组的住院时间显著少于对照组(t=5.89,P＜0.05).结论 无创通气联合药物治疗能够显著改善哮喘患者的肺功能,缓解患者的临床症状,能够促进患者早日康复,值得临床推广.     

抗支气管哮喘药物的进展与评价

目的:介绍抗支气管哮喘药物的进展,评价其临床疗效,以供临床参考。方法:查阅国内、外近年来相关文献,对抗支气管哮喘药物进行分析、评价。结果与结论:合理的药物治疗可控制哮喘,抗哮喘药的研制与开发具有广阔前景。     

抗支气管哮喘药物应用的调查

目的了解本院抗支气管哮喘药物临床用药情况,评价其合理性并进一步指导临床合理用药。方法依据本院2011-01～12支气管哮喘患者103人次的住院患者用药医嘱情况,统计分析所用支气管哮喘药物的种类、金额及支气管哮喘不同分级的用药情况等,计算用药频度（DDDs）和约定日均用药费用（DDDc）。结果2011年支气管哮喘药物销售金额最高的为糖皮质激素类,占42．02％;132受体激动剂使用频度（DDDs）最高,为15030．23日剂量,占30．6％;日均药费最高的为糖皮质类,为12．20元。支气管哮喘用药中应用最多的为二联用药。结论本院抗支气管哮喘药物的目前应用状况基本符合GINA和我国2012版《支气管哮喘防治指南》的要求,建议在临床上用药时可以更多的结合支气管分级和分期的要求合理用药。     

哮喘中气道壁重建：研制抗哮喘药的新靶点

由于认识到血管平滑肌增生和肥厚是高血压和动脉粥样硬化的重要病理学特征，近年来对血管平滑肌增生的调节机制进行了广泛研究，本文讨论了哮喘类似于高血压和动脉粥样硬化呈现的血管的结构改变的病理学研究新进展。     

108例住院精神分裂症患者使用药物情况的调查

现代社会生活节奏越来越快,竞争日趋激烈,随之而来的工作、生活压力日渐加大。据中华医学会行为医学分会的统计,国内各种精神疾病的总患病率已由20世纪50年代的2.7‰升至20世纪末的13.47‰,目前精神障碍在我国各类疾病总负担的排名已居首位,超过了心脑血管、呼吸系统及恶性肿瘤等疾病,故精神疾病的治疗日趋重要。笔者于2001年到贵州省黔南州精神病院工作半年,对该院住院精神分裂症患者用药情况及使用新型抗精神病药物情况进行了调查,现将结果报告如下。     

Safety of omalizumab in asthma

Introduction: Omalizumab is the first mAb to be introduced for the management of asthma. It is also the first agent designed to block the effects of IgE in initiating the allergic cascade resulting in asthma manifestations. Introduced in 2003, it is now widely used as an effective therapeutic tool in moderate-to-severe allergic asthmatics who are uncontrolled on maximal conventional therapy, including high-dose inhaled steroids and long-acting β-agonists. There is still understandable concern regarding the long-term effects of this drug.

Areas covered: The authors provide a review of safety data generated by controlled clinical trials and post-marketing surveillance as well as a brief overview of the clinical indications and efficacy of omalizumab. They also address specific issues of concern, including the risk of anaphylaxis and malignancy. The reader will gain a working knowledge of the role of omalizumab in current guidelines for the management of asthma.

Expert opinion: Omalizumab appears to be safe and well-tolerated. The possible association of malignancy with omalizumab has been of the greatest concern to patients and physicians. Analysis of clinical study data shows that this incidence is rare and the relative risk of cancer with omalizumab is not significantly different from that which is expected in the general population of people with asthma. As part of a relatively new class of agents, continued surveillance is needed as its indications expand and its use in the population continues to grow.     

抗菌药与哮喘用药的合用

哮喘的发作与感染有一定的关系，需针对致病原选择抗微生物药物。茶碱类、肾上腺皮质激素、抗组胺药等哮喘患者用药与多种抗菌药具有相互作用，临床应予注意。     

Emerging drugs for asthma

Background: Current therapies for asthma are aimed at controlling disease symptoms and for the majority of asthmatics inhaled corticosteroid anti-inflammatory therapy is effective. However, this approach requires life-time therapy while a subset of patients remains symptomatic despite optimal treatment creating a clear unmet medical need. Objectives: It is recognised that airway inflammation is key to asthma pathogenesis. Biopharmaceutical approaches may identify new therapies that target key cells and mediators that drive the inflammatory responses in the asthmatic lung. Such an approach may provide disease-modifying treatments. Results: Significant areas of drug development include humanised monoclonal antibodies (mAb) for asthma therapy including those against IgE, IL-4 and IL-5. Asthma-relevant cytokines or chemokines have been targeted in a number of other ways. These include the use of humanised receptor blocking mAb or the removal of cytokines or chemokines via their binding to soluble receptor constructs. Small-molecule receptor antagonists also target receptors or the cellular signal transduction pathways that are activated following cytokine or chemokine receptor ligation. Another approach is to target asthma relevant mediators or the pathways controlling pro-inflammatory leukocyte accumulation within the asthmatic lung. Conclusions: This review will discuss the current status, therapeutic potential and potential problems of these novel drug developments in asthma therapy. Current therapies for asthma are aimed at controlling disease symptoms, and for the majority of asthmatics inhaled corticosteroid anti-inflammatory therapy is effective. However, this approach requires lifetime therapy; and a subset of patients remains symptomatic despite optimal treatment, creating a clear unmet medical need. It is recognised that airway inflammation is key to asthma pathogenesis. Biopharmaceutical approaches may identify new therapies that target key cells and mediators that drive the inflammatory responses in the asthmatic lung. Such an approach may provide disease-modifying treatments. Significant areas of drug development include humanised mAb for asthma therapy, including those against IgE, IL-4 and IL-5. Asthma-relevant cytokines or chemokines have been targeted in a number of other ways. These include the use of humanised receptor blocking mAb or the removal of cytokines or chemokines via their binding to soluble receptor constructs. Small-molecule receptor antagonists also target receptors or the cellular signal transduction pathways that are activated following cytokine or chemokine receptor ligation. Another approach is to target asthma-relevant mediators, or the pathways controlling pro-inflammatory leukocyte accumulation within the asthmatic lung. This review will discuss the current status, therapeutic potential and potential problems of these novel drug developments in asthma therapy.     

Critical review of long-term ozone exposure and asthma development

Asthma, a chronic respiratory disorder with complex etiology and various phenotypes, is a considerable public health concern in the USA and worldwide. While there is evidence suggesting ambient ozone exposure may exacerbate asthma, information regarding the potential role of ozone in asthma development is more limited. Thus, we conducted a critical review of observational epidemiology studies to determine whether long-term ambient ozone exposure is a risk factor for asthma development. We identified 14 relevant studies; 11 evaluated asthma development in children, while three studies, based on a single cohort, assessed this outcome in adults. Studies of childhood asthma and long-term ozone exposure – including exposure in utero, during the first year of life and during early childhood – reported inconsistent findings, which were further weakened by critical methodological limitations in statistical analyses and in exposure and outcome assessments, such as exposure measurement error and a lack of adjustment for key confounders. For adult-onset asthma, long-term ozone exposure was associated with an increased risk in men but not women. In addition to considerable uncertainties due to potential exposure measurement error and a lack of adjustment for key confounders, this study has limited generalizability to the US general population. While experimental evidence indicates that it may be biologically plausible that long-term ozone exposure could contribute to asthma development, it does not provide insight regarding an established mode of action. Future research is needed to address the uncertainties regarding the role of long-term ambient ozone exposure in asthma development.     

Short- and long-term safety of glaucoma drugs

Glaucoma, a leading cause of blindness worldwide, is a chronic neurodegenerative disorder. Patients with glaucoma may require long-term administration of intraocular pressure (IOP)-lowering medications. These medications belong to several classes of molecules including β-adrenergic blockers, cholinergic agents, α-adrenergic agonists, carbonic anhydrase inhibitors and ocular hypotensive lipids. Most adverse effects associated with IOP-lowering medications are mild and ocular in nature; however, several of them are associated with systemic risks as well as serious ocular effects, especially following chronic use. The following review discusses the acute and long-term effects of commonly used IOP-lowering medications.     

社区卫生服务中心住院患者平喘药物的用药分析

目的：分析天平社区卫生服务中心住院患者平喘药物的使用情况,评价其用药合理性,了解社区在哮喘和慢性阻塞性肺病诊治指南执行中存在的问题,并探讨原因。方法：对2015年374例住院（出院及在院）患者中使用平喘药物的52例患者资料进行回顾性调查和分析。结果：52例患者使用的平喘药物排列前4位的分别是二羟丙茶碱注射液占49.15%（87/177）、复方甲氧那明占19.21%（34/177）、地塞米松注射液占11.86%（21/177）、硫酸特布他林占5.09%（9/177）。结论：中心住院患者平喘药物的使用存在不合理情况,需从完善中心药品配置、加强医务人员继续教育、改变患者用药观念等方面进行改善。     

茶碱类药物在哮喘治疗中的应用

近年研究表明,小剂量茶碱有抗炎、免疫调节和扩张支气管等多方面的作用,与吸入糖皮质激素联用有协同抗炎、改善肺功能的作用。     

治疗骨质疏松症的药物概述

骨质疏松是一种以骨密度和骨质量减低为特征的导致骨质松软、骨折危险性增加的疾病。骨质疏松和相关的骨折是导致死亡的重要原因。本文对目前正处在研究阶段的治疗骨质疏松症的药物进行了综述,包括骨吸收抑制剂,促进骨形成的药物及其他类。     

长期使用质子泵抑制剂对老年患者骨代谢和骨密度的影响

目的 探讨长期使用质子泵抑制剂对老年患者骨代谢和骨密度的影响.方法 连续收集因反流性食管炎需要长期服用质子泵抑制剂的老年患者50例作为观察组,同期收集50例健康老年人作为对照组.比较两组的骨密度和骨代谢情况.结果 入组时,两组患者股骨颈骨密度差异无统计学意义(0.80 ±0.10 vs 0.79 ±0.09 g·cm-2,P=0.708).3个月和6个月时,观察组股骨颈骨密度均显著低于对照组[(0.73±0.10 vs 0.82±0.09 g·cm-2,P =0.000)和(0.68±0.11 vs 0.79 ±0.09 g·cm-2,P=0.000)].两组研究对象入组时降钙素、骨钙素、碱性磷酸酶和Ⅰ型胶原羧基末端肽均差异无统计学意义(P＞0.05).6个月时,观察组降钙素、骨钙素和碱性磷酸酶均显著低于对照组[(221.87 ±68.82 vs 251.53 ±58.72 ng·L-1,P=0.023)、(9.82 ±2.56 vs 11.66 ±2.88μg·L-1,P =0.001)、(10.47 ±2.18 vs 12.66 ±1.75μg·L-1,P =0.000)],Ⅰ型胶原羧基末端肽显著高于对照组(253.85 ±51.66 vs 225.39 ±52.88 ng·L-1,P=0.008).结论 长期使用质子泵抑制剂可导致骨破坏增加,进而导致骨质疏松.