孟鲁司特钠联合布地奈德气雾剂治疗儿童哮喘的临床观察

目的研究孟鲁司特钠以及布地奈德气雾剂治疗儿童哮喘的疗效。方法选择本院门诊和住院部儿童哮喘80例,随机分成治疗组和对照组,每组40例。治疗组在吸入布地奈德气雾剂400μg/d基础上加孟鲁司特钠咀嚼片,5mg/d,每晚顿服,共3月,并随访3个月。观察期间如有哮喘急性发作,加用β2受体激动剂。对照组除不用孟鲁司特钠咀嚼片外,其余与治疗组相同。结果治疗组每月日间、夜间发作次数、用β2受体激动剂的次数较对照组明显减轻,差异有统计学意义(P<0.01)。治疗组FEV1占预计值的百分比较对照组改善明显,差异有统计学意义(P<0.01)。观察期间暂无不良反应发生。结论孟鲁司特钠联合布地奈德气雾剂治疗儿童哮喘疗效优于单纯使用布地奈德气雾剂,可适用于经正规治疗而疗效不佳患儿。     

布地奈德雾化吸入联合孟鲁司特口服治疗儿童哮喘急性发作的疗效

目的探讨布地奈德雾化吸入联合孟鲁司特口服治疗治疗儿童哮喘急性发作的疗效。方法选择80例急性发作期的哮喘患儿,随机分为观察组和对照组。两组患儿均采用抗感染、解痉、平喘等常规对症治疗。对照组在此基础上予以布地奈德雾化吸入,观察组在此基础上予以布地奈德雾化吸入联合孟鲁司特片口服。用法:布地奈德混悬液2mL雾化吸入,1日1次,每次10min;孟鲁司特片4mg,1日1次,睡前口服。观察两组患儿治疗后的临床疗效及不良反应,并随访观察半年内患儿哮喘急性发作的次数与发作天数。结果治疗5d后,观察组临床总有效率明显高于对照组(χ2=4.94,P<0.05),观察组治疗有效者随访观察半年内哮喘的发作次数及发作天数均明显少于对照组(P<0.05),两组患儿治疗期间均未见明显的药物不良反应。结论布地奈德雾化吸入联合孟鲁司特口服治疗儿童哮喘的疗效肯定,能明显改善患者临床症状和体征,减少哮喘发作的时间和次数,安全性高。     

孟鲁司特钠联合布地奈德治疗儿童哮喘疗效观察

目的评价孟鲁司特钠联合布地奈德治疗儿童哮喘的临床疗效。方法支气管哮喘患儿77例,随机分成对照组和实验组,进行3个月的治疗,对照组37例给予布地奈德吸入剂200~400μg/d。实验组40例,给予布地奈德吸入剂200~400μg/d,同时口服孟鲁司特钠5 mg/d。两组均按需吸入万托林气雾剂。比较两组临床疗效。结果实验组在日、夜间症状评分及咳嗽评分,平均每周吸入万托林喷数及肺功能改善均好于对照组,差异均有显著性统计学意义(P<0.01),两组患者治疗期间均未见明显不良反应。结论孟鲁司特钠联合布地奈德吸入治疗儿童哮喘较单纯吸入布地奈德具有更好的疗效,并且安全性高。     

布地奈德联合孟鲁司特钠治疗儿童哮喘的临床疗效观察

目的:观察孟鲁司特钠联合布地奈德治疗儿童哮喘的临床疗效。方法:选取自愿入组的轻、中度哮喘患儿80例,其中男47例,女33例,并随机分为治疗组与对照组,治疗组40例,对照组40例,治疗组与对照组分别给予布地奈德气雾剂与布地奈德气雾剂联合孟鲁司特片治疗12周,并观察两组的症状评分、肺功能测定、症状反复发作次数、额外平喘药物使用情况。结果:盂鲁司特联合糖皮质激素吸入组与单纯糖皮质激素吸入组相比,在控制白天症状、夜间症状、哮喘急性发作次数、无哮喘症状的天数、β受体激动剂的应用等均有显著差异,且治疗组肺功能改善较对照组明显,两组之间比较差异有统计学意义(P<0.05),提示孟鲁司特联合糖皮质激素吸入治疗哮喘效果显著。结论:布地奈德气雾剂联合孟鲁司特联用可发挥二者的协同作用,从不同途径改善气道炎症,控制哮喘。     

孟鲁司特联合布地奈德治疗儿童中度哮喘疗效观察

目的观察孟鲁司特联合布地奈德治疗儿童中度哮喘的疗效。方法77例中度哮喘患儿随机分成两组,对照组37例给予布地奈德吸入剂200~400μg·d-1,治疗组40例,给予布地奈德吸入200~400μg·d-1,加孟鲁司特5mg。qd两组均按需吸入喘康速。结果两组在日、夜间、咳嗽症状,使用喘康速及自我评价几方面在2周、6周均有显著性差异,无1例发生不良反应。结论孟鲁司特联合布地奈德吸入治疗儿童中度哮喘中具有良好的有效性、安全性。     

孟鲁司特联合氨溴索雾化防治儿童支气管哮喘

目的评价孟鲁司特钠与吸入氨溴索治疗儿童哮喘的疗效与不良反应。方法选择医院儿科收治的支气管哮喘患儿70例,随机分成治疗组和对照组各35例。治疗组:口服孟鲁司特片5 mg,每晚1次;氨溴索注射液30 mg雾化吸入,1日2次;疗程6个月。对照组:口服孟鲁司特片5 mg,每晚1次,疗程6个月。记录急性发作时喘息时间,每月急性发作次数及使用天数。结果治疗组近期控制、显效、有效及总有效率均明显优于对照组,有显著性差异(P<0.05)。治疗组随用药时间延长临床症状及各项指标有明显改善(P<0.05)。结论孟鲁司特钠与吸入氨溴索联合治疗儿童哮喘具有叠加抗炎作用,其疗效优于单用孟鲁司特,可作为儿童哮喘治疗及预防复发的一种理想的治疗方案。     

布地奈德联合孟鲁司特钠治疗儿童哮喘的临床研究

目的：布地奈德气雾剂联合孟鲁司特钠咀嚼片在支气管哮喘患儿中的应用效果评价。方法将2013年5月~2014年5月深圳市龙岗区第三人民医院儿科门诊接治的70例轻-中度慢性持续期支气管哮喘患儿按照随机数字表法均分2组,在相同常规治疗及护理基础上：研究组35例患儿给予布地奈德气雾剂及口服孟鲁司特钠咀嚼片联合治疗,对照组35例患儿给予布地奈德气雾剂治疗,对两组患儿治疗1个疗程后的哮喘症状评分及随访期间哮喘控制情况进行综合比较。结果治疗1个疗程后,两组患儿日、夜间哮喘症状评分均有明显下降(P<0.05);研究组较对照组下降幅度更为显著(P<0.05);随访期间,研究组哮喘急性发作次数明显少于对照组(P<0.05);研究组无症状天数比例(87.50%)明显高于对照组(71.43%)(P<0.05);两组患儿均无严重药物不良反应情况发生。结论在常规治疗基础上给予慢性持续期支气管哮喘患儿布地奈德气雾剂联合孟鲁司特钠咀嚼片治疗可明显减轻患儿哮喘症状,有利于哮喘症状的长期控制,值得临床推广应用。     

不同用药方案治疗儿童哮喘的临床观察

目的探讨不同用药方案治疗儿童哮喘的临床疗效。方法选择98例儿童哮喘患儿为研究对象,随机分为孟鲁司特钠组、布地奈德组、对照组,分别给予孟鲁司特钠每晚5mg顿服、布地奈德气雾剂200μg/次,1次/d及还尔金5g/次,2次/d口服,12周后观察三组哮喘控制情况及肺功能改善情况,并进行比较。结果孟鲁司特钠组及布地奈德组治疗后FEV1、PEF明显增加,差异有统计学意义（P〈0.05）。孟鲁司特钠组及布地奈德组控制率与对照组比较均明显升高,差异有统计学意义（P〈0.01）,但孟鲁司特钠组与布地奈德组之间比较差异均无统计学意义（P〉0.05）。结论口服孟鲁司特钠及低剂量吸入布地奈德对控制儿童哮喘及肺功能改善疗效确切。     

孟鲁司特钠联合布地奈德治疗小儿咳嗽变异性哮喘的安全性评价

目的评价孟鲁司特钠联合布地奈德治疗小儿咳嗽变异性哮喘的安全性。方法从本院2017年1月至2018年8月儿科接受的小儿变异性哮喘患儿中,抽取82例,随机将其分为对照组与观察组,均41例,对照组给予孟鲁司特咀嚼片进行治疗,观察组增加使用布地奈德雾化混悬液进行治疗,观察两组患儿治疗效果和不良反应发生情况。结果观察组治疗效果显著优于对照组;且不良反应显著低于对照组(P<0.05)。结论孟鲁司特钠联合布地奈德治疗小儿咳嗽变异性哮喘能够改善患儿肺功能,减少哮喘发作次数,提高临床治疗效果且不良反应发生率低,是安全有效的治疗方案,值得推广。     

孟鲁司特联合布地奈德治疗儿童哮喘临床观察

目的研究孟鲁司特联合布地奈德治疗儿童哮喘的疗效及安全性。方法选择支气管哮喘患儿97例,按就诊顺序随机分为观察组47例,对照组50例。对照组患儿常规吸入布地奈德气雾剂200鹇,1次／d,共治疗28周。观察组患儿常规吸入布地奈德气雾剂治疗的同时,加用孟鲁司特钠片,每次4mg,每晚睡前口服1次,共治疗28周。治疗结束后评价两组患儿肺功能、嗜酸细胞计数、血清IgE,并监测安全性指标,进行疗效判定。结果临床总有效率观察组优于对照组（P〈0．01）;两组治疗前后肺功能、IsE水平、嗜酸细胞计数均有显著改善（均P〈0．05）,且观察组优于对照组（均P〈0．05）。安全性指标均无异常变化。结论孟鲁司特钠联合布地奈德对于儿童哮喘疗效肯定,依从性好,无明显不良反应,安全可靠。     

肺炎支原体感染与小儿哮喘的临床特征分析

目的探讨肺炎支原体感染与小儿哮喘的临床特征。方法对照组20例小儿哮喘患儿为非肺炎支原体感染诱发,观察组20例小儿哮喘患儿为肺炎支原体感染诱发。观察两组患儿临床特征、喘息特点以及药物治疗反应。结果观察组20例小儿哮喘患儿发热情况、热程、药物治疗反应、住院时间、C反应蛋白与对照组20例小儿哮喘患儿均有显著差异,对照组小儿哮喘患儿多因上呼吸道感染诱发,观察组均由于肺炎支原体感染诱发;在药物治疗方面,观察组20例小儿哮喘患儿采用平喘类药物联合大环内酯类抗生素治疗疗效极为显著。两组小儿哮喘患儿临床治疗效果具有显著差异性,具备统计学意义(P<0.05)。结论肺炎支原体感染诱发的小儿哮喘与非肺炎支原体感染诱发的小儿哮喘临床特征差异较大,采用平喘类药物联合大环内酯类抗生素治疗疗效极为显著,值得临床推广应用。     

维吾尔族支气管哮喘患儿白三烯C4合成酶基因多态性分析

目的:分析白三烯C4合成酶(LTC4S)基因A-444C位点基因型和等位基因在新疆维吾尔族支气管哮喘患儿中的分布频率,并比较其与不同种族支气管哮喘患儿间的分布差异,为制定维吾尔族支气管哮喘患儿哮喘个体化用药方案提供依据。方法:采用荧光染色原位杂交方法检测190例维吾尔族支气管哮喘患儿的LTC4S A-444C基因多态性,并与国内外不同种族支气管哮喘患儿的该位点基因多态性进行比较,分析基因型频率和等位基因频率间是否存在差异性。结果:190例新疆维吾尔族支气管哮喘患儿中,LTC4S A-444C三种基因型CC、AC和AA的分布频率分别为6.8%、49.0%和44.2%;A、C等位基因频率分别为68.7%、31.3%。维吾尔族支气管哮喘患儿LTC4S A-444C的基因型、等位基因频率与韩国、澳大利亚及中国东北地区汉族支气管哮喘患儿均差异均有统计学意义(P<0.05)。结论:新疆维吾尔族支气管哮喘患儿LTC4S A-444C的基因型与等位基因的分布频率与国内外不同种族支气管哮喘患儿存在较大差异性。通过此研究,可以指导维吾尔族支气管哮喘患儿临床个体化用药,使哮喘临床用药更具有针对性、高效性和安全性。     

Role of chemokines in severe asthma

The severe asthma phenotype is exhibited by a subset of asthma patients whose asthma symptom is poorly controlled by current therapies. Severe asthma represents a high unmet medical need and warrants research into the mechanisms driving the underlying pathophysiology. It is hypothesized that the underlying pathology associated with severe asthma is driving the symptoms experienced by these patients, which may share common features with mild to moderate asthma or may represent a unique pathological phenotype. For the purpose of this review, the pathophysiology associated with asthma in general are described and extended to incorporate severe asthma. Chemokines may contribute towards multiple features of asthma pathophysiology and this current review focuses on the biology of chemokines pertaining to asthma pathophysiology. Chemokines are important recruiters and activators of inflammatory cells and these infiltrating cells interact with resident cells, such as fibroblasts and it is through these pathways that chemokines appear to exert multiple biological actions. Clinical trials are underway with therapeutics targeting chemokine pathways for other inflammatory diseases. It is hoped that the information generated from these studies will contribute towards furthering our understanding of chemokine biology and be applied towards targeting severe asthma.     

Impact of Student Pharmacist-Delivered Asthma Education on Child and Caregiver Knowledge

Objective. To evaluate the effectiveness of asthma education delivered by student pharmacists and to assess the impact of child and caregiver baseline asthma knowledge on asthma control in children.Design. Student pharmacists developed and implemented asthma self-management education interventions for children and their caregivers and performed asthma screenings for children at a series of asthma camps.Assessment. Eighty-seven children, ages 5-17 years, and their caregivers were enrolled in this study. A previously validated asthma questionnaire was modified to assess asthma knowledge among children and adults. Asthma knowledge increased significantly in children following participation in the education intervention (p<0.001). The education intervention, however, did not increase caregiver knowledge of asthma. A significant association was observed between caregiver baseline asthma knowledge and better asthma control in their children (p=0.019).Conclusion. The results of this study demonstrate that student pharmacist-delivered asthma education can positively impact asthma knowledge in children, and that caregivers’ knowledge of asthma is strongly correlated with better asthma control in their children.     

Pharmaceutical treatment of asthma in children

The present review article gives an overview of the present treatment modalities of asthma during childhood and discusses the existing controversies in asthma treatment. Present guidelines of asthma treatment concentrate on treatment for adults and only marginally concern treatment of childhood asthma. The few exceptions are the British Scottish guidelines and the Nordic guidelines, which have separate paragraphs on paediatric asthma management. The main controversy in paediatric asthma treatment is that how early (in age) and how soon (after diagnosis of asthma has been established) should inhaled steroids be instituted. Does treatment with early inhaled steroids influence lung development? Also possible side effects of inhaled steroids as possible impact upon growth and effect upon the hypothalamic adrenal axis are discussed. What is the place of leukotriene antagonists in childhood asthma treatment? Other issues discussed are prevention of asthma (primary, secondary and tertiary) in relationship to treatment of asthma. Primary prevention regards preventive measures to be taken to prevent initial allergic diseases; secondary prevention aims at preventing development of further allergic disease after the initial allergic disorder, as preventing debut of asthma after atopic eczema. Tertiary prevention aims at reducing already existing allergic illness and preventing further progression. For asthma, tertiary prevention regards treatment. During later years, there has been a focus on the respiratory tract as a continuum, and how allergic rhinitis and asthma should be treated when they are coexistent. Treating exercise induced asthma optimally is regarded as an important aim in the general treatment of asthma in childhood. Particularly in childhood asthma, compliance (concordance) with treatment is an important issue. Also some controversial aspects of acute asthma treatment in young children are discussed.     

可溶性细胞间黏附分子-1与支气管哮喘病情程度的关系

目的探讨可溶性细胞间黏附分子－1（sICAM－1）与支气管哮喘发作及其病情严重程度的相关性。方法采用ELISA方法测定134例不同时期支气管哮喘患者及健康志愿者血清sICAM-1水平,同时对支气管哮喘急性发作期患者进行肺功能测定。结果63例急性发作期支气管哮喘患者血清sICAM-1[（298．05±52．33）ng／L]水平较缓解期患者[（213．36±16．88）．g／L]及健康志愿者[（117．83±13．23）ng／L]明显升高,并且随哮喘病情加重其值有明显升高;急性发作期患者肺功能第一秒用力呼吸量（FEV．％）值与血清slCAM-1呈明显负相关。结论slCAM-1是支气管哮喘发病中重要的黏附分子,可作为判断病情严重程度的指标之一。     

Asthma and wheeze in New Zealand adolescents.

Two epidemiological surveys of New Zealand adolescents are reported. The prevalence of asthma was 7.5 percent in Rotorua and 7.9 percent in Wairoa. Additional questions asked in Wairoa identified 18.2 percent of subjects who had experienced wheeze but had not been labelled "asthma". The association of active asthma with nasal obstruction was confirmed. Wheeze which had not been labelled asthma was associated with the combination of subject's own and maternal cigarette smoking. The use of asthma medication was associated with easier geographic and socio-economic access to medical care, as well as with asthma activity.     

Ibuprofen and increased morbidity in children with asthma: fact or fiction?

NSAIDs are commonly avoided by patients with aspirin-induced asthma based on the premise that there is a significant cross-reactivity between aspirin and other NSAIDs. However, ibuprofen, a NSAID sold over the counter in most countries, is commonly given to children for relief of fever and mild-to-moderate pain. Consequently, increased risk of acute bronchospasm induced by ibuprofen in children with asthma remains a persistent concern. More recently, the assumption that children with asthma are at a greater risk for exacerbations of their disease if they take ibuprofen has been questioned. There is little evidence to measurably increases morbidity in the great majority of children with asthma. In addition, recent evidence suggest that ibuprofen measurably increases morbidity in the great majority of [corrected] children with asthma. Given the infrequent occurrence of aspirin/NSAID sensitivity in children with asthma, it seems reasonable to allow the use of ibuprofen in this population unless there is a personal or family history of aspirin-induced asthma. In addition, the inflammatory pathogenesis of asthma, anti-inflammatory effect of ibuprofen, and evidence suggesting ibuprofen may reduce morbidity in children with asthma raises the intriguing possibility that ibuprofen might actually have therapeutic benefit for at least some children with asthma.     

87例支气管哮喘发作与耳鼻咽喉科疾病的相关性临床分析

目的分析87例儿童哮喘发作与其合并耳鼻咽喉疾病的关系。方法回顾性分析我院儿科自2004年6月至2006年6月哮喘儿童中,87例合并有耳鼻咽喉科疾病的儿童,已经过哮喘的规范吸入治疗仍发作者,观察在继续哮喘吸入治疗的基础上进行耳鼻咽喉合并症的治疗前后的临床疗效,分析哮喘发作与其合并耳鼻咽喉疾病的相关性。结果经过哮喘规范吸入治疗儿童哮喘,仍有发作者与其合并过敏性鼻炎、鼻窦炎、扁桃体炎等疾病明显相关。结论合并有耳鼻咽喉疾病的哮喘患儿,要达到理想的哮喘控制目标必须同时治疗其耳鼻咽喉合并症。     

支气管哮喘治疗新药的开发及临床应用

支气管哮喘是临床常见的慢性气道炎症性疾病,尽管大部分哮喘患者可从支气管哮喘规范化治疗方案中获益,但仍有部分哮喘患者症状难以控制并持续加重。近年来随着哮喘发病机制的深入研究,哮喘临床冶疗取得了较大进展和突破,很多新药的出现为哮喘的治疗提供了更多的选择。本文综述支气管哮喘治疗新药的开发和临床应用评价。