吸入一氧化氮与沙丁胺醇对哮喘患者肺功能的影响

为探讨吸入一氧化氮（ＮＯ）与吸入沙丁胺醇（Ｖｅｎｔｏｌｉｎ）对支气管哮喘患者肺功能的影响。９例哮喘患者（其中组织胺激发试验阳性者５例）先后吸入２００～４００μｇ的Ｖｅｎｔｏｌｉｎ及１０ｐｐｍＮＯ观察吸入后通气功能的变化，结果显示，吸入Ｖｅｎｔｏｌｉｎ可使患者ＦＶＣ，ＦＥＶ１，ＦＥＶ１／ＦＶＣ，ＰＥＦ，ＭＭＥＦ，Ｖ５０得到明显改善；吸入ＮＯ后患者ＦＶＣ，ＦＥＶ１，ＰＥＦ明显增量ＦＥＶ１的增加幅度不及     

吸入呋塞米对急性发作期支气管哮喘患者肺通气功能的影响

目的 探讨吸入呋塞米对急性发作期支气管哮喘（哮喘）患者肺通气功能的影响。方法 将６例经、中度发作期哮喘患者随机分为Ａ、Ｂ、Ｃ三组,每组各２０例。Ａ组吸入生理盐水５ｍｌ,Ｂ组吸入呋塞米５０ｍｇ（５ｍｌ,１０ｍｇ／ｍｌ）,Ｃ组吸入０．１％沙丁胺醇溶液５ｍｌ。观察三组患者吸药后１５ｍｉｎ肺通气功能的变化。结果 吸药后１５ｍｉｎＢ、Ｃ组用力肺活量（ＦＶＣ）、第１ｓ用力呼气容积（ＦＥＶ１）、最在呼气流量（Ｐ     

呋塞米吸入治疗对老年慢性哮喘患者肺功能和外周血T淋巴细胞亚群的影响

目的评价呋塞米（速尿）吸入对老年人慢性哮喘的治疗效果。方法７２例老年慢性哮喘患者分别给予速尿（Ａ组）、速尿＋溴化异丙托品（Ｂ组）和溴化异丙托品（Ｃ组）治疗，每组各２４例，并与６０例非老年慢性哮喘患者的结果进行比较。吸入前后测肺功能〔最大肺活量（ＦＶＣ）、一秒钟最大呼气量（ＦＥＶ１）、最大呼气流速（ＰＥＦＲ）〕和外周血Ｔ细胞亚群。结果老年组总有效率（有效＋显效），Ａ、Ｂ、Ｃ组分别为７５％、９２％、６７％。肺功能和Ｔ细胞亚群改变：Ａ组ＦＥＶ１和ＣＤ４吸入前后变化差异有显著性（Ｐ＜００５）；Ｂ组肺功能指标和ＣＤ４、ＣＤ８、ＣＤ４／ＣＤ８差异有非常显著性（Ｐ＜００１或０００１）；Ｃ组除ＰＥＦＲ有显著变化（Ｐ＜００５）外，余项也有改善，但无统计学意义。非老年组的疗效与老年组疗效基本相同。结论速尿吸入对老年人慢性哮喘有防治作用，特别是速尿＋溴化异丙托品联合吸入效果更好     

吸入糖皮质激素治疗非哮喘性慢性阻塞性疾病的研究

目的 研究中等剂量二丙酸氯地米松（ＢＤＰ）短疗程吸入治疗非哮喘慢性阻塞性肺疾病（ＣＯＰＤ）是否有疗效，方法 按照随机，对照，单盲的设计，６１例非哮喘性ＣＯＰＤ患分两组，分别予ＢＤＰ（１０００μｇ．ｄ＾－１）与安慰剂吸入治疗６周，治疗前后测定肺功能一秒钟用力呼气容积（ＦＥＶ１）用力肺活量（ＦＶＣ），最大呼气中段流速（ＭＭＥＦ）值和血浆内纱（ＥＴ－１）的浓度，并记录临床症状记分，生活质量记分，结果     

溴化异丙托品与沙丁胺醇雾化吸入对COPD病人的支气管扩张作用

以随机公开对照试验比起对ＣＯＰＤ病人的支气管扩张作用及副作用．雾化吸入沙丁胺醇（５００μｇ）为Ａ组１６例；雾化吸入溴优异丙托品（５０μｇ）为Ｂ组１５例，雾化吸入沙丁胺醇（５０μｇ）合并异丙托品（５００μｇ）为Ｃ组１５例。结果：Ａ组１５分钟起效；Ｂ组６０分钟起效，其ＦＥＶ１（第一秒用力肺活量）及ＦＶＣ（用力肺活量）的最大改善率（２２．０％、２２．７％）与Ａ给（２１．５％、２３．２％）相比无差异（Ｐ＞０．０５），Ｃ组５、１５分钟ＦＥＶ１的改善率（８．７％、１３．０％）高于Ｂ组（０％、２％）；１８０、３６０分钟ＦＥＶ１的改善率为（２３．９％、１７．３％）高于Ａ组（１３．７％、５．８％）（Ｐ＜０．０５），ＦＶＣ与ＦＥＶ１的改变相近，三组均无严重的副反应。提示：ＣＯＰＤ患者雾化吸入异丙托品具有与沙丁胺醇相近的气道扩张作用．但起效慢．两者合用时，起效快，持续时间长，作用优于单药应用．     

二丙酸倍氯米松吸入治疗慢性喘息型支气管炎52例分析

为了探讨二丙酸倍氯米松（ＢＤＰ）吸入是否可改善慢性喘息型支气管炎（慢喘支）患者的肺通气功能，随机选取５２例慢喘支患者，加用ＢＤＰ２００～６００μｇ每天气道内吸入，连续使用１个月。治疗前和疗程结束时检查肺通气功能和动脉血气分析。结果：治疗后患者临床症状改善，总有效率（临床控制＋显效）４６２％，治疗前ＦＥＶ１（１秒钟用力呼气量）、ＰＥＦ（最大呼气流量）、ＦＶＣ（最大肺活量）分别为（０８７±０．４４）Ｌ、（２．０７±１．１０）Ｌ／ｓ、（１．５０±０．６５）Ｌ，治疗后分别为（１．０７±０．５３）Ｌ、（２．８６±１．１３）Ｌ／ｓ、（１．６８±０．６５）Ｌ，治疗前Ｐａｃｏ２为（６．０８±１．６９）ｋＰａ，治疗后Ｐａｃｏ２为（５．３７±１．１０）ｋＰａ，Ｐ值均＜００１。口腔真菌感染略增加（Ｐ＞００５），未见全身性副作用。说明低剂量ＢＤＰ气道内雾化吸入可改善慢喘支患者的通气功能。     

一氧化氮吸入对支气管哮喘疗效的初步观察

为了进一步了解一氧化氮（ＮＯ）吸入对支气管哮喘患者的治疗作用，兹选择中度支气管哮喘急性发作期的患者１０例，使用４０ｐｐｍ浓度的ＮＯ吸入２０分钟，在停止吸入后即刻进行临床和肺功能评价。结果发现，所有病人临床症状和肺部哮喘音均有不同程度好转。１秒钟用力呼气容积（ＦＥＶ＿１）、最大呼气流速（ＰＥＦ）改善均有显著性（Ｐ＜０．０５）。为了观察ＮＯ持续作用时间，１０例中各有５例分别在停止吸入ＮＯ２０分钟和２４小时后，重复测定上述肺功能参数，ＦＥＶ＿１及ＰＥＦ值均有增加。但因例数过少，尚难得出结论。本观察结果提示：低浓度ＮＯ吸入似可作为治疗支气管哮喘的一种方法。     

双盲对照吸入倍氯米松一年对气道高反应性与哮喘的防治作用

目的探讨长期吸入糖皮质激素对哮喘患者的治疗作用和对无症状的气道高反应性（ＢＨＲ）者发生哮喘的预防作用。方法以随机、双盲对照法比较５９例ＢＨＲ学生，年龄１２～１８岁，吸入倍氯米松干粉剂（ＢＤＰ，６００μｇ／ｄ）或安慰剂１年对气道反应性及哮喘症状的作用。结果试验１年后哮喘ＢＤＰ组气道高反应性（使ＦＥＶ１较基础值下降２０％的累积吸入组胺量的对数ｌｇＰＤ２０－ＦＥＶ１）显著下降（分别为０．３８５±０．４２４、１．１８７±０．６０３μｍｏｌ组胺，Ｐ＜０．０２），只有３０％哮喘者仍有喘息，而对照组则有８６％仍有喘息（Ｐ＝０．０７６）；无症状ＢＨＲ学生的ｌｇＰＤ２０－ＦＥＶ１在ＢＤＰ组及对照组间差异无显著性，但ＢＤＰ组不出现喘息症状，而对照组则有３例出现喘息（１５％）；ＢＨＲ者吸入ＢＤＰ组的累积症状计分显著低于对照组（分别为１．５０±２．５４分、５．５８±６．２２分，Ｐ＜０．０１）。结论ＢＤＰ能降低哮喘患者的ＢＨＲ及减轻其症状，且可能有预防无症状ＢＨＲ者发生哮喘的作用     

呋塞米吸入治疗对老年慢性哮喘患者肺功能和外周血T淋巴？…

目的 评价呋塞米（速尿）吸入对老年人慢性哮喘的治疗效果。方法 ７２例老年慢性哮喘患者分别给予速尿（Ａ组），速尿＋溴化异丙托品（Ｂ组）和溴化民丙托品（Ｃ组）治疗，每组各２４例，并与６０例非老年慢性哮喘患者的结果进行比较，吸入前后测肺功能（最大肺活量（ＦＶＣ），一秒钟最大呼气量（ＦＥＶ１），最大呼气流速（ＰＥＦＲ）和外周血Ｔ细胞亚群，结果 老年组总有效率（有效＋显效），Ａ，Ｂ，Ｃ组分别为７５％，９２％     

缓解期哮喘患者吸入类固醇激素后V_(50)、V_(25)的变化及意义

为了探讨吸入类固醇激素（ＩＣＳ）对缓解期哮喘患者的临床疗效,我们给４８例缓解哮喘患者吸入必可酮气雾剂（ＢＤＰ）３个月,并观察其用药前后最大呼气流量—容积（ＭＥＦＶ）曲线中５０％肺活量最大呼气流量（Ｖ５０）及２５％肺活量最大呼气流量（Ｖ２５）的变化。现...     

Dose-ranging study of a new steroid for asthma: mometasone furoate dry powder inhaler.

A new formulation of mometasone furoate (MF) for administration by dry powder inhaler (DPI) was evaluated for the treatment of asthma. A 12-week, double-blind, placebo-controlled dose-ranging study compared the efficacy and safety of three doses of MF DPI (100, 200 and 400 mcg b.i.d) with beclomethasone dipropionate (BDP) 168 mcg b.i.d. administered by metered dose inhaler in 365 adult or adolescent patients being treated with inhaled glucocorticoids. The mean change from baseline to endpoint (last treatment visit) for forced expiratory volume in 1 sec (FEV1) was the primary efficacy variable. Secondary efficacy variables included other objective measures of pulmonary function [forced vital capacity (FVC), forced expiratory flow 25-75% (FEV25-75%.) and peak expiratory flow rate (PEFR)] as well as subjective measures of therapeutic response (patients' daily evaluation of asthma symptoms and physicians' evaluation). At endpoint, all four active treatments were significantly more effective than placebo (P < 0.01) in improving FEV1 (MF DPI 5 to 7%, BDP 3%, placebo -6.6%) and all other measures of pulmonary function (FVC: MF DPI 4 to 5%, BDP 2%, placebo -4.7%; FEF25-75%: MF DPI 6 to 18%, BDP 7.5%, placebo -9.5%; PEFR (AM): MF DPI 5 to 10%, BDP 5.7%, placebo -7%). A consistent trend was observed for better improvement in patients treated with MF DPI 200 mcg b.i.d. than with MF DPI 100 mcg b.i.d., with no apparent additional benefit of MF DPI 400 mcg b.i.d. Results for the MF DPI 100 mcg b.i.d. and BDP 168 mcg b.i.d. treatment groups were similar. Patients' and physicians' subjective evaluations of symptoms found similar improvement in the MF DPI 200 and 400 mcg b.i.d. treatment groups, which were slightly better than that in the MF DPI 100 mcg b.i.d. group. Symptoms tended to worsen in the placebo group. MF DPI was well tolerated at all dose levels and the most frequently reported treatment-related adverse effects were headache, pharyngitis and oral candidiasis. No evidence of HPA-axis suppression was detected in any treatment group. In summary, all doses of MF DPI were well tolerated and significantly improved lung function and MF DPI 400 mcg (200 mcg b.i.d.) was the optimal dose in this study of patients with moderate persistent asthma.     

Equivalent efficacy and safety of a new HFA-134a formulation of BDP compared with the conventional CFC in adult asthmatics.

The present study demonstrates the equivalent efficacy for BDP 500 microg bid given via MDI with the new HFA-134a propellant (Chiesi Farmaceutici S.p.A., Parma) compared to a conventional CFC propellant (Becotide, Allen & Hanburys, UK). One hundred and sixteen adult patients with stable mild to moderate asthma (FEV1 > or = 60% of predicted normal) entered a 2-week run-in period where they maintained their own inhaled corticosteroids and were then assigned to a 12-week treatment with the test drug in a randomized, multicentre, double-blind, double-dummy, parallel-group design. Ninety-one patients completed the study period. Morning and evening peak expiratory flow rate (PEFR), use of rescue salbutamol, number of daytime and nighttime asthma attacks, number of nighttime awakenings, and clinical symptoms were recorded daily by patients on a diary card. Pulmonary function tests (FEV1, FVC, PEFR, MEF50 and FEF25) were completed at study entry, at the start of treatment and every 2 weeks thereafter. Morning (08.00-10.00 AM) serum cortisol was measured at the start and at the end of treatment. Adverse events were collected for the total study period. Equivalence between groups was demonstrated for the primary end-point morning PEFR, as well as for evening PEFR and FEV1 (the 95% CI of the treatments' difference was within the 5% of the LSM of BDP CFC). The other secondary pulmonary function tests measured at the clinic visit showed a satisfactory asthma control, albeit without statistically significant differences between groups. Decreases in the use of rescue salbutamol and in clinical symptoms were also reported in both groups, with no differences between them. Adverse events were reported in 81.4% of patients in the BDP HFA group and in 82.5% in the CFC group. There were 73 and 59 adverse drug reactions in the two groups, respectively; the difference was mainly due to differences in taste. No drug-related serious adverse events were reported in either group. No difference was seen for morning serum cortisol between baseline and end of treatment, or between groups. In conclusion, the BDP-HFA 134a formulation proved to be statistically equivalent to the standard BDP CFC product over 12 weeks in adult patients with mild to moderate asthma.     

Relationship between changes in diurnal variation of expiratory flows, lung volumes and respiratory symptoms after acute asthma

We looked at the comparative recovery of asthma symptoms and changes in airflow obstruction after an acute exacerbation of asthma in 26 asthmatics, aged 18-69 years (mean = 43). In the 4 weeks following the acute episode, they recorded their respiratory symptoms and twice-daily peak expiratory flow rates (PEFR). In 14 subjects, lung volumes were also measured on days 1, 7 and 30. Mean initial FVC and FEV1 [+/- SEM (% predicted)] were 2.30 +/- 0.16 (61%) and 1.18 +/- 0.08 (39%). The rate of improvement of airflow obstruction initially paralleled that of asthma symptoms in subjects with mild or with a recent onset of asthma. On the first study day, diurnal variation of PEFR was minimal, increased rapidly during the first week of treatment and stabilized thereafter. Mean daily delta PEFR was significantly higher in the first than at the fourth week (P = 0.005). Recovery of asthma symptoms was associated with an overall reduction in FRC and RV but there was no significant correlation between FRC or RV and dyspnea score or PEFR. Perception of airflow obstruction was generally lower, improvement of symptoms slower and of smaller amplitude in those with long-standing asthma. In conclusion, during recovery from acute asthma: (1) diurnal variation of PEFR is initially minimal, increases rapidly after beginning steroids and stabilize in the two following weeks; (2) in patients with more than mild or long-standing asthma, and magnitude and range of perception of asthma symptoms is reduced and correlates less with PEFR; and (3) no significant correlation could be found between FRC or RV and dyspnea score or PEFR.     

福多司坦联合小剂量吸入性激素治疗支气管哮喘的临床研究

目的观察福多司坦联合小剂量吸入性糖皮质激素治疗轻中度哮喘的临床效果。方法将40例哮喘患者随机分为两组,实验组给与福多司坦联合小剂量二丙酸倍氯米松气雾剂,对照组给予大剂量二丙酸倍氯米松气雾剂。治疗前后评价PEFRv、FEVl%及不良反应。同时检测治疗前后诱导痰上清中IL-8含量的变化。结果福多司坦联合小剂量吸入性激素治疗轻、中度哮喘可显著降低PEFRv及提高FEVl%(P<0.05),两组间PEFRv改善百分比和FEVl%改善百分比均无明显统计学差异(P>0.05)。两组均可明显降低哮喘患者的诱导痰上清中IL-8的水平。结论小剂量吸入性激素联合福多司坦和大剂量吸入性激素对治疗轻中度哮喘的疗效相当。     

福莫特罗、孟鲁司特和溴醋茶碱治疗支气管哮喘的疗效比较

目的 比较福莫特罗、孟鲁司特和溴醋茶碱联合应用布地奈德治疗支气管哮喘(简称哮喘)的疗效.方法 利用观察、前瞻、对比研究方法,选取2014年5月至2015年2月于延安市人民医院诊断为哮喘患者78例,随机分成3组,分别接受福莫特罗(6 μg/喷)+布地奈德(100 μg/喷)联合吸入剂(2次/d,每次2喷)、口服孟鲁司特(10 mg,1次/d)+布地奈德(100μg/喷,2次/d,每次2喷)和口服溴醋茶碱(100mg,2次/d)+布地奈德(100 μg/喷,2次/d,每次2喷).患者在治疗后随访4周,记录治疗前后的肺量测定值包括FEV1和最大呼气流速(PEFR).利用哮喘生命质量问卷(AQLQ)方法评估患者治疗前后的生命质量情况.结果 与基线期相比,在接受4周药物治疗后3组患者的FEV1、PEFR和生命质量均表现出显著改善.3组每两组间比较结果显示,区域A、C和D无明显差异.但在区域B,福莫特罗组患者与其他2组相比能够更有效地控制哮喘症状(治疗4周后AQLQ评分为0.45±0.02 vs 0.61±0.03,0.83±0.15;t=2.18,2.25;P＜0.05).溴醋茶碱组中3例患者有胃刺激反应,而其他组患者无明显不良反应.结论 福莫特罗、孟鲁司特和溴醋茶碱联合应用布地奈德在治疗哮喘方面疗效类似.     

Comparison between peak expiratory flow rate and forced expiratory volume in one second in the evaluation of children suspected to have asthma

This study was conducted to evaluate whether forced expiratory volume in 1 second (FEV1) for the diagnosis of bronchial reactivity by means of the free-running exercise test and bronchodilator inhalation, could be appropriately replaced by simple measurements of peak expiratory flow rate (PEFR) in children.We studied 108 referred symptomatic children (due to chronic cough or wheezing) suspected to have asthma aged 5-14y. Forced breathing spirometry and the "Mini-Wright peak flow meter" tests were recorded before and fifteen minutes after the challenge with free- running exercise or bronchodilator (Salbutamol) inhalation, regarding the baseline FEV1 value (FEV1> 80% considered as normal).There was a high correlation between PEFR and FEV1 (in absolute value and percent predicted) measured before and after bronchodilator inhalation test (r = 0.48, P = 0.05) in comparison to the values referred to free- running exercise test (r = 0.26, P = 0.01)."forced breathing spirometry" and "Mini-Wright peak flow" cannot be used interchangeably for diagnosing asthma, and PEFR measurement should remain a procedure for monitoring and following up the patients.     

A Preliminary Study of PEFR Monitoring in Patients with Chronic Cough

It is important to make a differential diagnosis of cough variant asthma in patients with chronic cough. To examine whether or not peak expiratory flow rate (PEFR) is useful for the differential diagnosis of cough variant asthma in such patients, diurnal variation rates of PEFR were calculated in 23 patients who presented with dry cough lasting four or more weeks and who showed no abnormalities on chest radiographs. None of the patients had wheezes, and pulmonary function testing at the time of visit to the hospital revealed no abnormalities. During the control period, the mean diurnal variation rate of PEFR in 23 patients was 16.3 ± 7.9%. Six, nine and eight patients had PEFR diurnal variations rates of <10% (Group 1), 10–19% (Group 2), and 20% (Group 3), respectively. At week 3 of treatment with bronchodilators, only Group 3 showed a significant decrease in PEFR diurnal variation rate from 25.7% to 10.1%. The cough score decreased significantly in Group 3 only. These patients had enhanced bronchial hyperresponsiveness and showed eosinophils in induced sputum, leading to the diagnosis of cough variant asthma (CVA). After making the diagnosis of CVA, an inhaled corticosteroid or a Th2 cytokine production inhibitor suplatast tosilate was administered to patients; consequently, they showed no recurrence of cough. PEFR monitoring allowed the detection of morning dip and was suggested to be potentially useful for the differential diagnosis of cough variant asthma in patients with chronic cough.     

A new HFA-134a propellant in the administration of inhaled BDP via the Jet spacer: controlled clinical trial vs the conventional CFC

This study was carried out with the aim of demonstrating the efficacy and tolerability of beclomethasone dipropionate (BDP) aerosol spray 500 microg b.i.d. via a spacer device (Jet, Chiesi Farmaceutici S.p.A.) using a new HFA-134a formulation or chlorofluorocarbon (CFC) propellant. After having completed a 2-week run-in period, 154 adult patients (77 in each group) with mild-to-moderate persistent asthma were randomised into two groups to receive the study treatment for a duration of 12 weeks in a double-blind, multinational, multicentre, parallel-group design. Morning and evening peak expiratory flow rate (PEFR), use of rescue salbutamol, number of day- and night-time asthma attacks, number of night-time awakenings due to asthma and clinical symptoms were recorded daily by patients on diary cards. Pulmonary function tests (FEV1, FVC, PEFR, FEF25-75%, MEF50 and FEF25) and vital signs were measured at the clinic at study entry, at the start of treatment and every 2 weeks thereafter. Morning serum cortisol (8.00-10.00 a.m.) was measured at the start and at the end of the treatment period. Adverse events were recorded throughout the total study period. Significant improvements over baseline were reported in both groups in terms of lung function, symptoms and use of rescue inhaled salbutamol. Equivalence between groups was demonstrated for the primary end-point morning PEFR, as well as for evening PEFR and FEV1. No statistically significant differences in the comparisons between groups, except for FEF25 (P=0.044), were observed in any of the other efficacy variables. Adverse events were reported in 31% of patients in the BDP-HFA group and in 32% in the CFC group. Adverse drug reactions were 4 and 2 in the two groups, respectively. No drug-related serious adverse events were reported in either of the groups. No signs of relevant adrenal suppression were observed in both groups: 2 patients in each group had final values below the normal range. In conclusion, the BDP-HFA-134a formulation proved to be equivalent in efficacy and comparable in safety to the standard BDP-CFC product over 12 weeks in adult patients with mild-to-moderate persistent asthma.     

沙美特罗替卡松粉剂吸入治疗70岁以上中、重度AECOPD临床疗效观察

目的 观察沙美特罗替卡松粉剂(舒利迭)吸入用于治疗70岁以上中重度慢性阻塞性肺疾病急性加重期(AECOPD)的疗效.方法 将108例70岁以上中、重度AECOPD患者随机分为沙美特罗/替卡松粉剂吸入组、硫酸沙丁胺醇气雾剂吸入组,对两组治疗前后的FEV1、FEV1/FVC、FEV1占预计值百分比及临床症状改善情况进行比较.结果 使用舒利迭组患者在治疗早期肺功能即有明显改善,随着使用时间延长,肺功能改善得到逐渐提高.使用硫酸沙丁胺醇组,治疗初期,临床症状迅速改善,随着治疗时间延长,疗效有所下降,肺功能无明显改善.结论 舒利迭治疗70岁以上中、重度AECOPD,临床改善明显,能持续改善患者的肺功能.