哮喘儿童雾化吸入糖皮质激素的疗效分析探讨

目的:探讨哮喘儿童雾化吸入糖皮质激素的疗效.方法:40例哮喘儿童平分为两组,对基础治疗的基础上,对照组加用顺尔宁雾化治疗,治疗组采用布地奈德雾化治疗.结果:哮喘症状评分无论是日间得分还是夜间得分,治疗前治疗组和对照组相比,差异均无统计学意义(P均＞0.05);而治疗4周后两组相比差异有统计学意义(P均＜0.01),治疗组的评分明显好于对照组.经过治疗后,平均每周哮喘急性发作次数治疗组均较对照组少,两组比较差异有统计学意义(P＜0.01).结论:布地奈德雾化吸入治疗可以显著提高儿童哮喘的临床疗效,减少反复发作次数,值得临床推广.     

孟鲁司特联合普米克气雾剂治疗小儿哮喘106例的疗效分析

目的 观察联合应用孟鲁司特与普米克气雾剂治疗小儿哮喘的疗效.方法 笔者所在医院收治的106例哮喘患儿均采用孟鲁司特联合普米克气雾剂吸入,治疗8周.记录患儿的哮喘症状评分、按需吸入速效受体激动剂次数和急性发作次数.结果 治疗后肺功能显著改善,哮喘日间评分、夜间评分、急性发作次数和按需吸入受体激动剂次数分别为（0.1±0.0）分、（0.2±0.1）分、（0.2±0.1）次、（0.6±0.2）次/d,均显著优于治疗前 （P〈0.05）.结论 口服孟鲁司特联合普米克气雾剂吸入治疗小儿哮喘疗效显著.     

雾化吸入糖皮质激素对哮喘儿童骨代谢与身高的影响

【目的】探讨雾化吸入糖皮质激素(inhaled corticosteroids,ICS)对哮喘儿童骨代谢与身高的影响。【方法】1)选择既往未使用过ICS治疗的哮喘儿童30例,在雾化吸入布地奈德(budesonide,BUD)前、后6周测定血清骨钙素,设30例正常健康儿童为对照组;2)选择已规律雾化吸入BUD 1~2年哮喘儿童60例,根据近3个月雾化吸入BUD剂量分为BUD-250组(吸入BUD 250μg),和BUD-500组(吸入BUD 500μg),检测其血清骨钙素并测量身高,设30例正常健康儿童为对照组。【结果】1)哮喘儿童组治疗前、治疗6周与健康对照组的血清骨钙素分别为(4.64±0.34)ng/mL、(4.89±0.30)ng/mL和(4.63±0.46)ng/mL,治疗前后的血清骨钙素及与健康对照组差异无统计学意义(P均0.05);2)BUD-250组、BUD-500组和健康对照组血清骨钙素分别为(4.98±0.50)ng/mL(、4.14±0.36)ng/mL和(4.62±0.46)ng/mL,组间比较差异无统计学意义(F=0.92,P=0.40)。BUD-250组、BUD-500组和健康对照组身高SDS值分别为0.29±0.17、0.23±0.15和0.30±0.11,组间比较差异无统计学意义(F=0.05,P=0.95)。【结论】哮喘儿童长期规律雾化吸入250~1 000μg/d BUD对骨代谢和身高无明显影响。     

经鼻吸入丙酸氟替卡松同步治疗儿童变应性鼻炎合并哮喘的临床观察

[目的]探讨采用面罩储雾罐方式给药,经鼻吸入丙酸氟替卡松气雾剂,同步治疗儿童变应性鼻炎合并哮喘的临床疗效及安全性。[方法]将80例中、重度变应性鼻炎合并轻、中度持续性哮喘的患儿随机分为实验组和对照组。实验组以面罩储雾罐经鼻吸入丙酸氟替卡松气雾剂(200μg/d);对照组经口吸入丙酸氟替卡松气雾剂(200μg/d)联合使用丙酸氟替卡松鼻喷雾剂(200μg/d)。之后进行鼻炎症状、儿童哮喘控制测试(C-ACT)评分,比较晨起呼气峰流速值(PEF,L/min)。[结果]经16周临床观察,实验组和对照组的鼻炎症状评分、哮喘症状评分均明显下降(F=71.22～277.41,P均<0.00),实验组和对照组的PEF均逐渐升高,治疗前后实验组差别有统计学意义(F=4.79,P<0.009),而对照组差别无统计学意义(F=1.49,P=0.19);不良反应比较,实验组鼻腔出血的发生数低于对照组(χ2=4.80,P<0.05),但激素使用量实验组仅为对照组的1/2。[结论]面罩式储雾罐经鼻吸入丙酸氟替卡松气雾剂可同时有效控制儿童变应性鼻炎和哮喘,并有依从性高、不良反应少的特点,激素使用剂量明显少于对照组,应用于轻、中度持续性哮喘合并变应性鼻炎患儿效果良好。     

不同联合药物雾化吸入方案对儿童支气管哮喘急性发作治疗效果及安全性的影响

目的探讨β受体激动剂基础上分别加用布地奈德与丙酸倍氯米松雾化吸入对儿童支气管哮喘急性发作临床治疗效果及安全性差异,为临床治疗方案的选择提供循证依据。方法选取2014年7月-2016年7月宝鸡市人民医院收治的儿童支气管哮喘急性发作患儿130例随机分为A组和B组各65例,两组患儿在β受体激动剂基础上分别加用布地奈德与丙酸倍氯米松雾化吸入,比较两组患儿临床治疗总有效率、临床症状和肺部体征消失时间、住院时间、病情控制率、治疗前后病情严重程度评分、PEF%及不良反应发生率。结果两组患儿临床治疗总有效率差异无统计学意义(P0. 05);两组患儿治疗后临床症状和肺部体征消失时间、住院时间、病情严重程度评分、PEF%水平、病情控制率、患儿不良反应发生率比较差异均无统计学意义(P0. 05)。结论β受体激动剂基础上分别加用布地奈德与丙酸倍氯米松雾化吸入治疗儿童支气管哮喘急性发作具有相近临床效果和安全性,均可用于该病患儿治疗实践。     

喘乐宁、爱全乐及普米克·令舒联合氧气驱动雾化吸入治疗儿童支气管哮喘急性发作临床观察

目的为比较β2受体激动剂,M受体阻滞剂及吸入糖皮质激素,联合氧气驱动雾化吸入与单用β2受体激动剂雾化吸治疗儿童哮喘急性发作的疗效。方法随机选择治疗组39例,对照组35例,观察2组哮喘临床症状消失时间。结果治疗组患儿咳嗽、哮鸣音、气促及三凹征等临床症状消失时间显著短于对照组。结论表明3药联合雾化吸入可明显提高疗效,缩短治疗时间。     

常规日均吸入小剂量辅舒酮和间断雾化给药治疗儿童哮喘的疗效对比

目的探讨常规日均吸入小剂量辅舒酮和间断雾化给药治疗儿童哮喘的临床效果。方法选取2014年1月-2016年12月中国人民解放军第101医院诊治的100例中度持续性哮喘患儿作为研究对象,随机分为A组和B组,每组各50例,两组患儿均采用β2受体激动剂、茶碱等支气管扩张剂进行治疗。A组患儿常规日均吸入小剂量辅舒酮治疗,B组患儿采取间断性雾化吸入给药治疗。对比两组患儿治疗前、治疗3个月后的临床效果。结果治疗前,两组患儿的第1秒用力呼气容积(FEV1)占预计值的百分比、呼气峰值流速(PEF)占预计值百分比比较,差异无统计学意义(P>0.05);治疗后,A组患儿的FEV1占预计值的百分比、PEF占预计值百分比均显著高于B组,差异具有统计学意义(P<0.05)。治疗前,两组患儿的血清免疫球蛋白E(Ig E)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、IL-17、白三烯B4(LTB4)水平、日间哮喘评分、夜间哮喘评分比较差异无统计学意义(P>0.05);治疗后,A组患儿的血清Ig E、TNF-α、IL-8、IL-17、LTB4水平、日间哮喘评分、夜间哮喘评分均显著低于B组,差异有统计学意义(P<0.05)。结论常规日均吸入小剂量辅舒酮治疗中度持续性哮喘患儿的效果优于间断性雾化吸入辅舒酮治疗的效果。     

哮喘儿童呼吸系统症状持续存在的危险因素

大约 2 6 %～ 78%哮喘儿童在成年后呼吸系统症状依然存在。研究者对导致接受统一治疗的哮喘儿童呼吸症状持续存在的危险因素进行了研究。方法　哮喘的诊断和严重性评估标准依据关于哮喘诊断和处理的国际联合公告。间歇哮喘采用按需气雾吸入 β2 激动剂治疗 ;持续性哮喘吸入布地奈德 80 0 μg/d ,1个月症状改善后减量为 4 0 0 μg/d ,随访阶段调整至能控制症状的最小剂量 ,并按需吸入 β2 激动剂。要求患者记录有关症状和治疗内容的日记。哮喘严重性评估根据昼夜症状的发作次数按 4级打分 :1级≤ 3～ 4次 /年 ,2级 1～ 2次 /月 ,3级 1～ 2…     

两种雾化吸入方式治疗中度持续哮喘的临床疗效分析

目的对比分析糖皮质激素和长效β2受体激动剂联合雾化吸入(ICS+LABA)与糖皮质激素和白三烯受体拮抗剂联合雾化吸入(ICS+LTRA)治疗儿童中度持续哮喘的临床疗效,为中度持续哮喘的治疗提供理论依据。方法选取2015-2017年广州市南沙区第一人民医院收治的中度持续哮喘患儿为研究对象,根据外周血嗜酸性粒细胞(EOS)是否增高,将患儿分为EOS升高组和EOS正常组,采用单纯随机的方法,将两组患儿分别分为2个亚组,即ICS+LABA治疗组和ICS+LTRA治疗组。各亚组基础治疗均为急性吸氧,合并感染者使用抗生素或抗病毒剂。各组观察期均为12周。结果 12周后,两亚组患儿咳嗽、气急、喘息、肺内哮鸣音和肺功能均较治疗前明显改善,差异有统计学意义(P0. 05)。EOS升高组中,ICS+LTRA组肺功能改善效果及临床控制情况均显著优于ICS+LABA组,差异有统计学意义(P0. 05);但EOS正常组,两亚组肺功能改善效果及临床控制情况比较,差异无统计学意义(P0. 05)。结论治疗中度持续哮喘患儿,对于EOS增高者,ICS+LTRA疗效较好,对于EOS正常者,ICS+LTRA与ICS+LABA疗效相当。     

空气压缩泵雾化吸入辅助治疗婴幼儿哮喘的临床观察

目的:临床观察空气压缩泵雾化吸入辅助治疗婴幼儿哮喘的疗效。方法:选择长春市儿童医院哮喘门诊治疗800例婴幼儿哮喘患儿随机分为治疗组和对照组各400例,在综合治疗基础上治疗组雾化吸入糖皮质激素及β2受体激动剂,疗程3～5天,观察疗效;对照组给予肺部电超导物理治疗。结果:治疗组显效率和总有效率分别为90%和100%,对照组分别为46%和62%,两组显效率和总有效率比较差异有统计学意义(P<0.01)。结论:用空气压缩泵雾化吸入药物辅助治疗婴幼儿哮喘疗效确切。     

糖皮质激素和长效β2受体激动剂联合吸入治疗稳定期慢性阻塞性肺疾病的临床研究

目的评价吸入型糖皮质激素（ICS）和长效β2受体激动剂（LABA）联合吸入对慢性阻塞性肺疾病（COPD）稳定期患者的疗效。方法60例稳定期的中至重度COPD患者随机分为试验组和对照组。试验组给予ICS/LABA混合吸入剂（舒利迭）吸入,对照组给予LABA干粉吸入剂（施立稳）吸入,1吸/次,2次/d,疗程均为3个月。对比两组治疗前后临床症状积分和肺功能变化。结果53例患者完成本试验（试验组26例,对照组27例）。治疗后两组临床症状积分分别较治疗前明显降低,其差异有统计学意义（分别P〈0.05）,两组FEV1/FVC和FEV1%预计值分别较治疗前明显升高,差异有统计学意义（分别P〈0.05）;治疗后试验组FEV1/FVC和FEV1%预计值也分别高于对照组,差异有统计学意义（分别P〈0.05）。结论对于稳定期COPD患者来说,联合吸入ICS和LABA能明显改善肺功能,减轻症状,提高生活质量。     

纳米穴位贴在小儿哮喘中的应用效果观察

目的 探讨纳米穴位贴在小儿哮喘中的应用效果.方法 选取本院2012年6月至2013年6月收治的支气管哮喘患儿85例为研究对象,将患儿分为观察组43例及对照组42例,对照组患儿雾化吸入布地奈德悬液,观察组患儿在对照组的基础上应用纳米穴位贴治疗,对比分析两组患儿临床治疗效果及症状改善情况.结果 观察组患儿呼吸困难、咳嗽、肺部啰音等临床症状改善时间显著优于对照组,差异有统计学意义（P＜0.05）.观察组哮喘日间症状评分、夜间症状评分显著低于对照组日间症状评分及夜间症状评分,差异有统计学意义（P＜0.05）.结论 对小儿支气管哮喘患儿在雾化吸入糖皮质激素的同时给予纳米穴位贴治疗能有效改善患儿临床症状,提高患者临床治疗效果,值得临床应用.     

右美托咪定滴鼻对小儿术前镇静及吸入麻醉诱导的影响

目的观察术前右旋美托咪定滴鼻对患儿术前镇静及吸入麻醉诱导配合程度的影响。方法选择1⁸岁白内障患儿45例,随机分为3组:Ⅰ组(生理盐水对照组)、Ⅱ组(1μg/kg组)及Ⅲ组(2μg/kg组),每组15例。在麻醉前,Ⅱ组及Ⅲ组分别经鼻滴入1或2μg/kg右美托咪定,Ⅰ组给予等容积的生理盐水。监测给药前(t0)、入睡后(t1)及入手术室后(t2)患儿心率、血氧饱和度的变化,并记录患儿入睡时间、镇静评分、行为评分;评估并记录患儿和父母分离评分、面罩诱导质量评分。结果Ⅲ组患儿入睡时间明显短于Ⅱ组(p<0.05);Ⅱ组、Ⅲ组镇静评分、行为评分、分离评分及面罩诱导评分明显低于Ⅰ组(p<0.05);且Ⅱ组及Ⅲ组使用其他静脉诱导药物的比例明显低于Ⅰ组(p<0.05);Ⅱ组、Ⅲ组间比较无明显差异(p>0.05)。3组患儿在t0、t1、t2时刻血氧饱和度无明显变化(p>0.05);Ⅰ组患儿心率在t2时刻明显高于Ⅱ组、Ⅲ组(p<0.05)。结论 1μg/kg或2μg/kg右美托咪定滴鼻均可安全应用于小儿术前镇静,可明显改善麻醉诱导质量并不增加呼吸抑制等并发症,2μg/kg镇静效果更佳。     

Management of Asthma

Asthma is a chronic inflammatory disorder of the airways. The worldwide prevalence of asthma has increased in recent decades. There is an approximately 20-fold variation (range 1.6% to 36.8%) in the prevalence of childhood asthma throughout the world. The highest prevalence rates are in the UK, Australia, New Zealand, the Republic of Ireland and Canada. The indirect costs of asthma, which include absence from school, lost productivity and premature death, are substantial.The goals of asthma therapy include controlling the disease and maintaining the well-being of the patient. Identification and avoidance of factors that precipitate asthma attacks are important in achieving satisfactory control of asthma. A stepped-care approach to drug therapy, in which anti-inflammatory therapy is the cornerstone, is recommended.Zafirlukast is a cysteinyl leukotriene type 1 receptor antagonist that causes bronchodilation and has anti-inflammatory properties. Oral zafirlukast 20mg twice daily was more effective than placebo in relieving symptoms, improving lung function, reducing requirements for as-needed β₂-agonists and preventing exacerbations in patients ≥12 years of age with mild to moderate asthma. Zafirlukast 20mg twice daily produced improvements in symptoms and reductions in as-needed β₂-agonist rescue medication similar to inhaled sodium cromoglycate in patients with asthma. As an alternative to inhaled corticosteroids, zafirlukast 20mg twice daily produced improvements in night-time wakenings, mornings with asthma and reductions in the use of β₂-agonist rescue medication in patients with mild to moderate asthma. However, beclomethasone dipropionate 200 to 250µg twice daily produced greater improvement than zafirlukast in all efficacy parameters and significantly greater improvements in morning peak expiratory flow rate, forced expiratory volume in 1 second and daytime symptoms than zafirlukast. In patients with asthma uncontrolled on low dosages of inhaled corticosteroids, the addition of oral zafirlukast 40 or 80mg twice daily was as effective as doubling the dose of the inhaled corticosteroid.The most common adverse events associated with zafirlukast in trials ≤20 weeks long were pharyngitis, headache and aggravation reactions, the incidence of which was similar to that in placebo recipients. Drug-drug interactions involving zafirlukast and aspirin, erythromycin, terfenadine, theophylline and warfarin have been described.Zafirlukast is indicated for the prophylactic treatment of chronic asthma. The drug is currently recognised in the US guidelines as an alternative to inhaled corticosteroids in patients aged ≥12 years with mild persistent asthma. As an adjunct to corticosteroids, the role of zafirlukast is still evolving, but it seems likely that patients with asthma of all severities may benefit from the drug.     

Treatment of asthma in children: more than merely 'puffing'

Five children, four boys aged 6, 9, 12 and 13 years and one girl aged 6 years, had persistent asthmatic symptoms despite maintenance treatment with inhaled corticosteroids and short-acting bronchodilators on demand. One of them required the addition of a long-acting beta 2-agonist to become symptom-free. The other four patients did not need to step up their asthma medication after correction of poor inhaler technique, treatment of dysfunctional breathing, treatment of allergic rhinitis, and elimination of passive cigarette-smoke exposure, respectively. All current guidelines on the treatment of asthma in children advise, in case of persistent asthmatic symptoms despite inhaled corticosteroids and short-acting bronchodilators, the addition of long-acting beta 2-agonists. However, various factors may play a role in the persistence of asthma despite adequate therapy and these factors should be evaluated before stepping up the medication.     

Effect of the leukotriene receptor antagonist montelukast therapy on asthma in childhood

The authors have summed up the survey results for children with asthma below 14 years of age participating in the Hunair II. surveillance program. This program proves the efficiency of montelucast 5mg treatment in cases of childhood asthma bronchiale. The 255 patients participating in the survey have received 5 mg montelucast therapy for 8 weeks. During the surveillance period they have used questionnaires to record the change of day and night symptoms, decrease of different restrictions and the quantity change of long- and short-acting beta agonists and inhaled steroids. The use of short-acting agonists decreased from 5 inhalations to 1 in 4 weeks. During the leukotriene antagonist montelucast treatment according to symptom scores 61% of the patients have experienced improvements after the 4th week, 80% after the 8th week. To sum up all the survey results--after the 8th week of treatment the daytime restrictions in the everyday lives of children with asthma have decreased by 88.1%, nighttime restrictions by 80.1%. After the 2nd month of the HUNAIR II. surveillance program it could be deduced that montelucast 5 mg therapy used in child populations less then 14 years of age with asthma has proven useful.     

Combination Therapy for Asthma

As treatment for moderate to severe persistent asthma, inhaled corticosteroid drugs combined with long-acting β-adrenoceptor agonists are being marketed in a single inhaler device. These combination products have important benefits (e.g. convenience, improved adherence, and improved day-to-day asthma symptom control); however, there are also problems (e.g. risk of severe asthma flares associated with long-acting β-adrenoceptor agonist therapy, high price of combination inhalers, and limited ability to titrate the dose of each component independently). Combination therapy is most likely to benefit patients with moderate to severe persistent asthma whose disease is not controlled on inhaled corticosteroids alone. Some patients may prefer this combination product to inhaled corticosteroids plus a leukotriene modifier or theophylline. For other patients with moderate to severe persistent asthma, inhaled corticosteroid adherence may be improved by use of the combination product. Combination long-acting β-adrenoceptor agonist/inhaled corticosteroid therapy is not appropriate for patients with predominantly exercise-induced asthma, patients unable to use the inhaler device, patients with either mild intermittent or mild persistent asthma, and patients whose asthma can be controlled on a low to moderate dose of inhaled corticosteroid medication alone.As currently priced, combination long-acting β-adrenoceptor agonist/inhaled corticosteroid therapy leads to increased costs compared with inhaled corticosteroids alone; however, in appropriately selected patients, this cost is offset by improvements in asthma symptoms and lung function. Some patients may value increases in symptom-free days, convenience, and a less offensive taste (especially with a dry-powder inhaler delivery system). Others may prefer drug minimization and/or may prefer metered-dose inhaler or nebulizer delivery systems. Providers need to be able to match the medication to the medical needs and preferences of the patient/family as best as possible. Providers need to be able to educate the patient and/or parents on the role of the medication, expected results, and inhalation techniques. Inappropriate use of combination therapy, such as for individuals with only mild asthma whose asthma can be controlled on simpler therapy, should be avoided. Health plans are accountable for both quality and costs of care. They are interested in restricting inappropriate use of combination therapy.     

噻托溴铵对轻中度慢性阻塞性肺疾病患者肺功能的影响

目的评估噻托溴铵对轻中度慢性阻塞性肺疾病（COPD）患者肺功能的影响。方法将80例轻中度COPD患者按随机数字表法分为噻托溴铵组（40例）和对照组（40例）,治疗周期为12周,两组患者均经过1周的清洗期,清洗期患者吸入0．9％氯化钠。第2～12周为治疗期,噻托溴铵组患者吸入噻托溴铵干粉胶囊（18μg／粒）,上午给药,每日1次;对照组患者则继续吸入0．9％氯化钠。分别于治疗前及治疗后第6,12周测定患者的肺功能。结果经过连续12周的治疗后,噻托溴铵组肺功能指标深吸气量、第1秒用力呼气容积和用力肺活量均得到明显改善,较治疗前分别增加了（0．43±0．15）,（0．17±0．11）和（0．41±0．14）L,而对照组上升幅度无明显改善,仅分别增加了（0．10±0．12）,（0．01±0．05）和（0．05±0．12）L,两组比较差异有统计学意义（P〈0．05）。两组不良反应发生率和COPD急性发作率比较差异无统计学意义（P〉0．05）。结论轻中度COPD患者每日1次吸入噻托溴铵（18μg）可以显著改善患者的肺功能。     

哮喘患者对疾病认知程度的调查分析

目的了解哮喘患者对疾病的认知程度，为制定哮喘教育和管理工作计划提供参考依据。方法对门诊101例哮喘患者进行问卷调查，采用面对面的调查方法。结果被调查的101例哮喘患者中，依据病情严重程度分级，哮喘间歇状态占23％，轻度持续占29％，中度持续占30％，重度持续占18％。其中，认识哮喘的炎性本质的占70．3％，认识到吸入糖皮质激素在哮喘治疗中的重要性并坚持作为一线用药的占67．3％，认识到短效β2受体激动剂合理使用指征的占88．1％，对哮喘的治疗目标有正确理解的占71．3％。上述结果均高于亚太地区哮喘现状研究报道的平均水平和1997年北京市哮喘防治学组报道的市内区级医院住院医师和主治医师的认知水平。结论通过对哮喘患者进行长期的系统教育和管理，可以明显提高哮喘患者对疾病的认知水平。