支气管哮喘病人吸入疗法研究进展

介绍了支气管哮喘吸入治疗的常用药物、吸入装置、吸入技术,为提高吸入治疗效果,改善哮喘控制质量、维持病情长期稳定提供借鉴.     

Prognostic criteria of efficacy of inhalation glucocorticosteroids in non-severe bronchial asthma

The aim of the study was to evaluate efficacy of inhalation glucocorticosteroid (GCS) drugs in patients with persisting bronchial asthma (BA) previously steroid untreated and identify factors influencing the results of GCS therapy. 67 patients with non-severe BA given long-term theophilline with inadequate effect received inhalation GCS drug budesonid which produced a complete clinical effect (group 1), a delayed effect (group 2) or no effect (group 3). The above groups were compared by clinico-anamnestic data, functional respiration parameters, chemiluminescence of mononuclear cells of the peripheral blood measured before therapy with budesonide. The discriminant analysis estimated the minimal set of the initial parameters by which the groups differ. The regression model was used to calculate an individual prognostic index of probable treatment efficacy for each patient. The results of the study agree with the view on BA as a multistage disease in which chronic persisting inflammation provokes progressive remodeling of the respiratory tracts and formation of pathophysiological disorders resistant to glucocorticoids. It is necessary to use inhalation GCS drugs early in persistent BA. They are strictly indicated if BA patients need regular daily intake of short-term beta 2-agonists.     

The clinico-pathogenetic validation and efficacy of using low-energy laser irradiation and glucocorticoids in treating bronchial asthma patients]

Intrapulmonary administration of glucocorticoids and low-energy laser radiation were used in the treatment of infection-dependent bronchial asthma in the phase of exacerbation. To estimate the efficacy of the combined method suggested, the parameters of external respiration, cellular, humoral and local immunity were determined, the provocation inhalation tests with acetylcholine and histamine and exercise tests were performed. The results of the treatment and subsequent follow-up data have shown that the combined use of local (endolymphatic) administration of steroids makes it possible to reduce immunological disorders, to decrease bronchial reactivity, to prolong the disease remission.     

回授法对支气管哮喘患者吸入技术的影响

目的 探讨回授法对支气管哮喘患者吸入技术的影响,为回授法的推广及支气管哮喘患者吸入技术的改善提供参考依据.方法 选取我院呼吸科2013年1月至2014年12月收治的支气管哮喘患者60例,按照随机数字表法分为观察组和对照组各30例,均接受吸入技术讲解,观察组患者加用回授法.比较两组患者吸入技术的掌握程度.结果 两组患者干预4周后健康知识、健康信念、健康行为、健康技能及健康素养总分均显著提高,观察组变化更为明显,差异有统计学意义(P<0.05).两组患者吸入装置打开错误、上药错误发生率比较,差异均无统计学意义(P>0.05);观察组患者呼气错误、吸药错误、屏气错误、漱口错误发生率均显著低于对照组,差异有统计学意义(P<0.05).结论 回授法能够显著提高支气管哮喘患者吸入技术及健康素养、降低吸入操作的错误率,有望提高患者临床症状控制效果,值得推广应用.     

支气管哮喘高流量氧气雾化吸入方法的探讨

支气管哮喘是严重危害人们身心健康的慢性反复发作性疾病,在临床治疗当中往往需要雾化吸入以缓解呼吸困难,但在雾化吸入治疗时患者往往出现胸闷、气短、咳嗽等加重呼吸困难。为解决这一问题,我科收集了需进行雾化吸入治疗的重度哮喘患者120例,将其随机分成2组,分别采用高流量氧气驱动雾化吸入、超声雾化吸入同时鼻塞吸氧2种方法进行比较,观察SpO2变化,结果发现,高流量氧气驱动雾化吸入明显优于超声雾化吸入,能减轻患者雾化吸入治疗中引起的不适,现介绍如下。资料与方法1.一般资料。2004年1-12月收集呼吸内科需雾化吸入的重度哮喘患者120例…     

Tailor-made medicine for bronchial asthma]

Asthma is a complex genetic disorder with variable phenotype, largely attributed to the interactions on environment and multiple genes. Numerous asthma and atopy loci have been reported in studies demonstrating associations and/or linkage levels, and bronchial hyperresponsiveness to alleles of microsatellite markers and single nucleotide polymorphisms with in specific genes. Progress in the field of pharmacogenetics has revealed that the phenotypically different responses of patient to drugs are genetically determined by the polymorphisms in the genes encoding the drug target, such as 5-lipoxigenase and beta 2-adrenergic receptor. The information about polymorphisms, is accumulated, tailor-made medicine will be applicable to medical care of individual asthmatics.     

Effect of calcitrin inhalation on the course of cortico-dependent bronchial asthma

Thirty-five patients with cortico-dependent bronchial asthma were treated with calcitrin inhalations during disease exacerbation. Calcitrin was administered daily for 10-12 days in the doses increased from 1 to 3-4 Units followed by reduction to the initial dose in the presence of routine therapy. According to the clinico-laboratory, spirographic and tachographic studies, the symptoms of asthma exacerbation rapidly degressed, while asphyxia attacks ceased or were relieved. The treatment with calcitrin made it possible to reduce the dose of steroid hormones by 25-50 percent on the average in 24 patients. In 11 patients, administration of the hormones could be discontinued. At the same time the majority of the patients demonstrated amelioration or elimination of the side effects induced by steroids (ossalgia, edema, gastralgia).     

Electrostimulation in the therapy of bronchial asthma]

Programmed electrostimulators of the sinocarotid nerves were implanted to 78 patients with bacterial asthma (BA) with a severe hormone-dependent course (age 18-67 years). Radiofrequency electrostimulation was performed daily for 6 years (impulse current, 30-150 Hz, 0.1-0.4 ms, 0.1-0.5 W. The regime was selected individually by the bronchodilating effect measured at pneumotachometry. The electrostimulation effectively arrested and prevented the majority of asphyxia attacks, reduced their frequency (2.7-fold) and need in medicines (2.7-3.4-fold). Serious complications were absent. Electrostimulation of the sinocarotid nerves can be applied in patients with bronchial asthma resistant to drug therapy, in side effects of glucocorticosteroids and adrenomimetic drugs.     

The clinico-cytological parallels in exacerbated bronchial asthma]

The authors provide the data on estimation of the character and intensity of inflammation in the proximal and distal bronchi as well as in the respiratory compartment of the lungs, obtained as a result of an all-round examination including a cytological assay of the bronchoalveolar washing off of 31 bronchial asthma patients in the period of disease exacerbation. A correlation analysis is given between the interrelationship between the intensity of bronchial obstruction and the level of eosinophilia in peripheral blood, sputum and in bronchoalveolar washing off. It has been revealed that the relative content of eosinophils in bronchoalveolar washing off is in the best agreement with the intensity of bronchial obstruction.     

雾化吸入布地奈德与沙丁胺醇治疗支气管哮喘的效果

目的探讨雾化吸入布地奈德与沙丁胺醇治疗支气管哮喘的效果。方法选择我院58例支气管哮喘患者,随机将其分为对照组和观察组,每组29例。对照组实施沙丁胺醇雾化吸入治疗,观察组实施布地奈德与沙丁胺醇雾化吸入治疗。比较两组治疗效果。结果观察组治疗总有效率高于对照组(P<0.05)。治疗后,两组用力肺活量、高迁移率蛋白1表达量、晨间呼气峰流量和晚间呼气峰流量均有所改善,且观察组改善程度优于对照组(P<0.05)。观察组咳嗽缓解时间、气急症状消失时间、胸闷消失时间和喘息消失时间均短于对照组(P<0.05)。两组不良反应总发生率无显著差异(P>0.05)。结论布地奈德与沙丁胺醇雾化吸入治疗支气管哮喘效果确切,可缩短症状改善时间,改善患者肺功能,且无明显雾化吸入不良反应,安全性高。     

普米克都保联合可必特吸入治疗支气管哮喘的临床观察

2002—2009年,我院采用可必特和普米克都保吸入治疗哮喘患者35例,效果比较满意,现报告如下。1临床资料1.1一般资料本组病例均符合哮喘急性发作期诊断标准和分级标准。     

氦氧混合气联合雾化吸入药物治疗重症哮喘的协同作用

目的：本文就以氦氧混合气（79％氦－21％氧）为驱动气源雾化吸入β2－受体激动剂对支气管哮喘的治疗作用进行探讨。方法：选择门诊24例轻中度支气管哮喘患者，随机分为治疗组（13例，以氦氧混合气为驱动气源）和对照组（11例，以压缩空气为驱动气源）雾化吸入备劳特，观察治疗前后肺功能的变化；选择病房8例重症支气管哮喘患者采用自身对照方式，观察以氦氧混合气为驱动气源和以压缩空气为驱动气源雾化吸入备劳特前后肺功能和血气分析的变化。结果：门诊哮喘患者治疗组与对照组比较除PEF有显著性差异外，主要肺功能指标无统计学意义；病房重症哮喘患者以氦氧混合气为驱动气源与以压缩空气为驱动气源疗效比较，FVC、FEV1．0、FEF50差异具有显著性意义，血气分析结果示PaO2差异具有显著性差异，PaCO2有下降趋势。结论：氦氧混合气与雾化吸入β2－受体激动剂在治疗重症支气管哮喘方面与传统方法比较有明显优势，提示二者有良好的治疗协同作用。     

健康教育在小儿支气管哮喘雾化治疗中的应用

目的探讨健康教育在小儿支气管哮喘雾化治疗中的应用效果。方法将2014年在本院门诊雾化吸入治疗中心做雾化吸入治疗的100例哮喘患儿随机分成观察组及对照组各50例,对照组给予常规雾化吸入治疗,观察组在雾化吸入治疗前先对家长进行健康教育干预。比较2组患儿的治疗依从性及治疗效果。结果观察组治疗依从性良好率92.0%与总有效率94.0%,均显著高于对照组的66.0%与68.0%(P0.05);观察组的总满意度为96.0%,显著高于对照组的68.0%(P0.05);观察组患儿不良反应总发生率为4.0%,显著低于对照组的30.0%(P0.05)。结论实施健康教育干预能提高雾化吸入患儿的依从性及临床疗效。