哮喘持续状态伴发呼吸衰竭的临床治疗分析

目的 探讨哮喘持续状态伴发呼吸衰竭的临床治疗.方法 对本院2005~2010年诊治的45例哮喘持续状态伴发呼吸衰竭的患者临床治疗进行总结分析.结果 45例哮喘持续状态伴发呼吸衰竭的患者入院后,经过综合治疗,病情完全缓解35例,占77.8%,明显好转8例,占17.8%,治疗无效1例,占2.2%,死亡1例,占2.2%.结论 对哮喘持续状态伴发呼吸衰竭进行综合治疗,能够提高治愈率,降低死亡率.     

中西医结合治疗老年慢性持续期哮喘60例临床观察

有关调查资料显示60岁以上的老年哮喘总患病率为0.68%,而发达国家65岁以上老年哮喘则在0.77%～1.54%,表明老年哮喘患病率呈上升趋势[1].为探索对老年哮喘更为有效的治疗方法,采用中西医结合和单用西药治疗方法对老年哮喘患者进行对比治疗,报道如下.     

支气管哮喘分级治疗与管理

尽管支气管哮喘不能完全治愈,但经有效的药物治疗和管理,通常可实现哮喘的控制.Goal研究表明[1],经过一年治疗管理,哮喘完全控制率达50%,良好控制率78%.     

围月经期哮喘诊治进展

一些支气管哮喘(简称哮喘)妇女在月经前或月经期哮喘症状可以加重,称之为月经前期哮喘或月经期哮喘,统称为围月经期哮喘.围月经期哮喘相当常见,大约占哮喘妇女的30%～40%.雌二醇、孕酮、阿司匹林、白三烯可能与其发病有关.根据月经前或月经期哮喘症状加重和呼气峰流速降低可以做出诊断.雌二醇、孕酮、白三烯调节剂可以用于围月经期哮喘的治疗.     

难治性哮喘诊治新认识

尽管难治性哮喘仅占哮喘患者的5%～10%,是导致哮喘治疗费用增高的重要原因之一.本文就难治性哮喘的定义、临床特征、危险因素和处理结合临床体会进行简要概述.     

重庆地区支气管哮喘加重住院的多中心回顾性分析

目的 通过分析重庆地区支气管哮喘(简称哮喘)加重住院治疗的原因,为今后加强哮喘管理,减少哮喘加重住院提供依据.方法 采用多中心、回顾性研究的方法,分析在2007年1～12月期间重庆市14家医院哮喘患者加重住院的情况.结果 在此期间共有符合入选标准的住院哮喘患者570例,其中女性61.9%,明显多于男性,年龄4～87岁,平均50.19岁,平均住院8.16 d,平均住院费用5 711.8元.82.46%(470/570)的患者存在不同的诱因,其中以受凉感冒最多见,占55.26%.78.77%(449/570)的患者在非急性加重期没有规律用药治疗.仅选择氨茶碱或单纯用β受体激动剂进行治疗的占87.17%.虽有16.3%(93/570)的患者曾用吸入性糖皮质激素(ICS)联合长效β2受体激动剂(LABA)治疗,但仅12.81%(73/570)坚持规律用药.全部患者中仅7.89%(45/570)患者是难治性哮喘.绝大部分患者预后良好,97.19%好转出院,2.11%(12/570)自动出院,仅0.70%(4/570)死亡.结论 重庆地区大多数哮喘急性加重患者在稳定期没有进行规范的哮喘治疗,这可能是急性加重的重要原因.因此,加强哮喘患者疾病知识宣教、治疗的管理和指导对减少急性加重具有重要意义.     

杭州市社区医生支气管哮喘知识及管理情况问卷调查结果分析

目的 了解杭州市社区内科医生对支气管哮喘(简称哮喘)基本知识的掌握、规范化治疗及接受再教育情况,以及社区卫生服务中心对哮喘患者教育和管理的情况.方法 采用问卷调查方式,共调查杭州市区45家社区卫生服务中心,每个中心随机抽取2～4名西医内科医生,共114名医牛接受调查.结果 87%(99/114)的受调查者回答哮喘的本质是气道炎症性疾病.69%(79/114)的受调查者选择吸入糖皮质激素(简称激素)为持续期哮喘每日规律使用的一线治疗药物.55%(63/114)的受调查者曾阅读哮喘指南.仅有24%(27/114)的受调查者知道中国哮喘联盟组织,曾访问中国哮喘联盟网站的受调查者仪有6%(7/114),受调查的医生均未参加过中国哮喘联盟在全国进行的普及哮喘规范化防治的讲座.调查前1年中,有55%(63/114)的受调查者未参加任何哮喘相关的会议或讲座.97%(111/114)的受调查者表示希望有上级医院的医生进社区医院进行哮喘相关的讲座.45家社区卫生服务中心中,仅有2家有部分哮喘患者的登记资料,其中仅有1家在调查前1年中对哮喘患者进行了健康教育讲座.结论 社区医生需要更多的继续教育机会以掌握规范的哮喘治疗方案,社区医生的教育工作有待加强.     

难治性哮喘诊治的研究进展

支气管哮喘的发病率逐年增加.临床上,5%～10%的患者经过多种常规平喘药物的治疗仍难以控制,被归为＂难治性哮喘＂.本文综述了其近几年在诊断和治疗方面的进展.     

糖皮质激素联合长效β2-受体激动剂治疗糖皮质激素抵抗型哮喘

目的观察糖皮质激素(GC)联合长效β2-受体激动剂(LABA)对糖皮质激素抵抗型(SR)哮喘患者哮喘症状和肺功能的影响,探讨GC联合LABA对SR哮喘有无治疗作用.方法SR哮喘患者20例,随机分为A、B,每组各10例.A组吸入沙美特罗50 ug,2次/天和氟替卡松500 ug,2次/天.B组每天吸入氟替卡松500 ug,2次/天,急性发作时吸入沙丁胺醇,疗程4周,疗程开始及结束时评价哮喘临床积分和肺功能检查.结果治疗后A组患者哮喘临床积分显著降低(与A组治疗前比较P＜0.01;与B组治疗后比较P＜0.05),肺功能指标用力肺活量(FVC%).第1秒用力呼吸容积(FEV1%)最大呼气流量(PEF%),50%肺活量时最大呼气流量(V50%),25%肺活量时最大呼气流量(V25%),均显著增高.B组治疗后与治疗前比较,上述各项指标均无显著改变(P＞0.05).结论CS联合LABA是治疗SR哮喘的有效方法.     

酮替芬联合沙丁胺醇治疗支气管哮喘的疗效观察

目的 观察酮替芬联合沙丁胺醇治疗支气管哮喘的疗效.方法 纳入150例支气管哮喘患者,并将其随机分成酮替芬联合沙丁胺醇试验组和单用沙丁胺醇对照组,比较两组患者的治疗效果.结果 试验组总有效率为96.0%,对照组总有效率为70.7%,两组疗效比较,差异有统计学意义(P＜0.05);两组患者在用药后均未出现严重不良事件和哮喘相关死亡.结论 酮替芬联合沙丁胺醇治疗支气管哮喘较单独使用沙丁胺醇治疗能显著提高疗效,值得在临床推广.     

支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点及意义

目的探讨支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点,以便为临床诊断提供依据。方法采用日本产ＡＳＴＯＧＡＰＨＴＣＫ６０００ＣＶ气道反应测定仪,以乙酰甲胆碱为气道激发剂,观察６０例支气管哮喘、５８例咳嗽变异性哮喘及３７例急性支气管炎患者气道反应性变化。结果支气管哮喘和咳嗽变异性哮喘病人气道激发试验均为阳性,哮喘病人的气道反应阈值（Ｄｍｉｎ）低于咳嗽变异性哮喘病人（Ｐ＜００５）。急性支气管炎病人中,气道激发试验３３例阴性,占８９％,４例阳性,占１１％。４例阳性急性支气管炎患者的气道反应性曲线与哮喘组及咳嗽变异性哮喘组明显不同,其Ｄｍｉｎ也显著高于哮喘组（Ｐ＜００１）及咳嗽变异性哮喘组（Ｐ＜００５）。结论气道反应性测定对于不同类型哮喘及急性支气管炎的鉴别和指导治疗具有很好的临床应用价值。     

动脉硬化程度与哮喘相关性分析

目的探讨动脉硬化程度与哮喘的联系。方法检测255例参与者的baPWV及CRP水平,其中哮喘急性发作期患者85人,稳定期患者85人,对照组85人,最后进行统计学处理。结果哮喘急性发作期患者的baPWV与CRP水平较稳定期患者及对照组有明显升高。在哮喘急性发作期患者中,baPWV与CRP呈正相关(r=0.229,P=0.039)。哮喘急性发作期,稳定期及对照组中baPWV水平差异明显。结论动脉硬化程度与哮喘具有明显的相关性,baPWV水平的升高可能是哮喘急性加重的一个致病因素。     

Age at asthma onset and asthma self-management education among adults in the United States

Objective: Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. Methods: Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. Results: Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5–14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65–93 years of age (95% CI: ?18.0, ?2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. Conclusions: Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.     

A nationwide survey in Germany on fatal asthma and near-fatal asthma in children: different entities?

In adults fatal and near-fatal asthma have similar clinical characteristics. Therefore, near-fatal asthma in adults can be used as a model for fatal asthma. A nationwide study on fatal and near-fatal asthma in children <16 yrs was performed in order to assess whether, as in adults, near-fatal asthma can be used as a model for fatal asthma. From 1996 to 1998, all paediatric hospitals and paediatric pulmonologists in Germany were asked to report cases of fatal asthma and near-fatal asthma to a central survey unit (Erhebungseinheit für seltene p?diatrische Erkrankungen in Deutschland (ESPED)) on a monthly basis. All reports were followed by detailed questionnaires. Sixteen fatal and 45 near-fatal asthma cases were analysed. Fatal asthma patients were older than near-fatal asthma patients. Respiratory tract infections were frequently reported only in near-fatal asthma (47 versus 0%). The proportion of cases with rapid-type onset (duration of symptoms < or =1 h) was higher in fatal asthma (53 versus 14%). Long-term regular treatment with short acting beta2-agonists was common in both groups, but the use of concomitant inhaled corticosteroids was significantly lower in fatal asthma cases. A high proportion of poor compliance was observed in both groups. As fatal and near-fatal asthma differ significantly in important clinical aspects, analysis of near-fatal asthma might be of limited value in elucidating the causes of fatal asthma in children.     

糖皮质激素抗支气管哮喘治疗的药物基因组学研究进展

支气管哮喘(简称哮喘)是全世界范围儿童最常见的慢性呼吸道疾病.糖皮质激素是哮喘治疗中最有效最常见的药物.临床发现哮喘患者对糖皮质激素的治疗反应存在个体差异和不良反应.药物基因组学研究发现,糖皮质激素通路及相关通路基因、药物代谢酶基因、哮喘易感基因的单核苷酸多态性与糖皮质激素在哮喘治疗中的反应有关.文中主要综述了近年糖皮质激素抗哮喘治疗的药物基因组学研究进展.     

Asthma management in New York City schools: A classroom teacher perspective

Objective: Classroom teachers play an important role in facilitating asthma management in school but little is known about their perspectives around asthma management. We examined the perspectives of classroom teachers around barriers to school asthma management. Methods: We conducted key informant interviews with 21 inner-city classroom teachers from 3rd to 5th grades in 10 Bronx, New York elementary schools. Sampling continued until thematic saturation was reached. Interviews were recorded, transcribed, and independently coded for common themes. We used thematic and content review to analyze interview data. Results: Seven themes representing teachers’ perspectives on in-school asthma management emerged: (1) the problematic process of identifying students with asthma; (2) poor familiarity with the city health department's asthma initiative and poor general knowledge of school policies on asthma management; (3) lack of competency in managing an acute asthma attack in the classroom and poor recognition of symptoms of an asthma attack; (4) lack of confidence in dealing with a hypothetical asthma attack in the classroom; (5) lack of quick access to asthma medication in school; (6) limited communication between school staff; and (7) enthusiasm about learning more about asthma management. Conclusions: Our results revealed several barriers contributing to suboptimal in-school asthma management: ineffective ways of identifying students with asthma, lack of teacher knowledge of guidelines on asthma management, lack of comfort in managing students’ asthma, inadequate access to asthma medication in school, and limited communication between school staff. These issues should be considered in the design of interventions to improve in-school asthma management.     

Patient and physician asthma deterioration terminology: results from the 2009 Asthma Insight and Management survey

Long-term achievement of asthma control is dependent in part on the use of mutually understandable asthma terminology in all verbal and written patient-physician communications. Using data from the Asthma Insight and Management (AIM) survey, the objective of this analysis is to provide a contemporary depiction of asthma deterioration terminology as used by current asthma patients and physicians in the United States. As part of the 2009 AIM survey, current asthma patients (≥12 years of age; weighted n = 2499) and physicians (n = 309) were queried about their recognition, understanding, and/or use of the terms "asthma attack," "asthma flare-up," and "asthma exacerbation" in telephone interviews. Nearly all patients had heard the term "asthma attack" (97%), but relatively few had heard the term "asthma exacerbation" (24%); 71% had heard "asthma flare-up." In contrast, physicians reported using the term "asthma attack" least (65%) and the term "asthma exacerbation" most (77%) when discussing asthma with their patients; 70% reported using "asthma flare-up." Among patients familiar with "asthma flare-up" and "asthma exacerbation" (n = 502), only 38% said that the terms mean the same thing; nearly all physicians (94%) said that the terms mean the same thing. Collectively, data from the AIM survey suggest that patients and physicians use different asthma deterioration terminology and, more importantly, that they do not necessarily understand each other's terms. Standardizing asthma deterioration terminology may help optimize asthma patient-physician communication to improve patient understanding of written asthma action plans and therefore, enhance patient outcomes.     

Survey of asthma control in Thailand

OBJECTIVE: The aim of the study was to determine whether asthma management in Thailand is succeeding in achieving the levels of control, specified in national and international asthma guidelines. METHODOLOGY: Adults with asthma in Bangkok, Chiang Mai, Songkhla, and Khon Kaen were interviewed, and we have reported on their asthma severity, morbidity, control, perception of asthma, and healthcare use. RESULTS: A total of 466 asthma sufferers were interviewed. The burden of asthma was high, with 14.8% of respondents being hospitalized for their asthma in the past year. One-quarter of those surveyed had lost workdays as a result of their asthma, and most patients felt that their lifestyle was limited. The majority of respondents had intermittent asthma (62.9%), 10.5% had mild persistent asthma, 17.6% had moderate persistent asthma, and 9.0% had severe persistent asthma; increasing severity was significantly associated with increased emergency healthcare use (P < 0.00001). Asthma sufferers greatly underestimated the severity of their condition. Only 36.0% used reliever medication, and use of inhaled corticosteroids was low at 6.7%. Understanding of the inflammatory basis of asthma was poor. Few patients underwent lung function tests or took peak flow meter readings. CONCLUSIONS: The burden of asthma is high in Thailand, and guidelines are not being followed. Encouraging greater use of inhaled corticosteroids will be an important step towards improving asthma control.     

生物治疗在重症哮喘中的应用现状和前景

支气管哮喘(哮喘)是目前全世界最普遍的慢性病之一,80%的哮喘患者经过长期规范化治疗可达到临床控制,但仍有20%的哮喘患者表现为重症哮喘,其在第4级或第5级哮喘药物治疗下才能或甚至仍不能维持临床疗效,这给其自身和医疗系统带来巨大的负担。由于生物治疗直接针对哮喘发病的免疫机制,靶向哮喘发作的关键分子,生物治疗日益成为治疗...