罗红霉素加小剂量茶碱治疗咳嗽变异型哮喘疗效观察

观察罗红霉加小剂量茶碱治疗咳嗽变异型哮喘（dough variant asthma，CVA）的疗效。     

吸入皮质类固醇治疗支气管哮喘的不良反应综述

吸入糖皮质激素的口腔沉积率约为 80～ 90 %,是引发局部和全身副作用的主要原因。不良反应多为下丘脑 -垂体-肾上腺轴(HPAA)抑制作用、骨质疏松、局部刺激、真菌感染等。根据病情适量用药,并于用药后及时漱口是防止糖皮质激素各种副作用的有效措施。     

吸入激素联合茶碱和双倍剂量吸入激素治疗哮喘的临床对照研究

目的:对照研究双倍剂量激素吸入与常规剂量激素联合茶碱治疗哮喘的疗效差异.方法:35例中重度持续哮喘患者(观察组)接受常规剂量激素+小剂量茶碱的治疗方案,另外35例中重度持续哮喘患者(对照组)行双倍剂量的激素治疗,比较两组治疗前后FEV1、FVC等肺功能.结果:两组治疗后肺功能指标、血气指标及痰IL-5等对比无显著差异(P>0.05),观察组不良反应发生率11.4%,低于对照组的17.1%(P<0.05).结论:相比双倍剂量激素吸入,常规剂量+小剂量茶碱通过减少激素剂量,一定程度上减少了大剂量激素潜在的风险,更具推广价值.     

小剂量茶碱与西替利嗪口服联合小剂量激素吸入对哮喘的治疗作用

目的研究小剂量茶碱、西替利嗪口服联合小剂量激素吸入对哮喘的治疗效果。方法将48例轻、中度哮喘患者用抽签法随机分成2组,各2,4例,联合组每晚给予无水缓释茶碱200nag、西替利嗪15样口服,二丙酸倍氯米松（BDP）250μg吸入;对照组仅给予BDP500μg／d吸入,每晚给予安慰剂2片,疗程12周。测定2组患者血浆茶碱浓度、呼气峰流速值及其变异率、沙丁胺醇使用次数。结果治疗前后的呼气峰流速值及变异率：联合组分别为（301．12±80．46）L／min和（500．35±90．72）L／min以及（24．12±5．29）％和（5．08±1．30）％。对照组分别为（320．52±81．59）L／min和（452．33±93．09）L／min以及（25．48±6．12）％和（5．70±1．08）％,2组治疗前后比较差异有统计学意义（P〈0．01）,2组间比较有统计学意义（P〈0．05）。治疗期间夜间使用B：受体激动剂的次数联合组（1．67±0．52）次与对照组（2．99±0．82）次比较,差异有统计学意义（P〈0．05）。结论小剂量茶碱、西替利嗪口服联合小剂量激素吸入对哮喘疗效优于同单纯大剂量激素吸入对哮喘的疗效,并减少了夜间使用β2受体激动剂的次数,且避免了因大量使用激素产生的药物不良反应。     

警惕茶碱与大环内酯类抗生素的相互作用

<正>茶碱是临床常用的平喘药,红霉素、罗红霉素、克拉霉素及阿奇霉素是临床常用的大环内酯类抗生素。呼吸科疾病如慢性阻塞性肺部疾病(COPD)的治疗经常会将平喘药与抗感染药物伍用,又如当哮喘病人合并感染时也会将平喘药与抗感染药物伍用。     

罗红霉素与布地奈德干粉吸入剂联用治疗哮喘的临床研究

目的：通过与单纯吸入布地奈德干粉吸入剂（普米克都保）组比较，观察口服罗红霉素联用布地奈德干粉吸入剂治疗哮喘的疗效及对血清可溶性IL-2受体（sIL-2R）、IL-8和血嗜酸性粒细胞（EOS）计数水平的影响。方法：选择门诊轻、中度急性发作哮喘患者45例，随机分组。治疗组口服罗红霉素联合吸入布地奈德干粉吸入剂，对照组吸入布地奈德干粉吸入剂，疗程4周。治疗前、治疗4周后检测肺功能、血sIL-2R、IL-8和EOS计数水平，并按临床症状记分。结果：40例完成了试验。治疗4周后临床症状记分、肺功能一秒钟用力呼气量（FEV1）、FEV1占预计值百分比（FEV1／pred％）、最大呼气流量（PEF）和PEF占预计值百分比（PEF／pred％）改善，血sIL-2R、IL-8和EOS计数水平较治疗前降低，且治疗组较对照组改善更为明显，两组副作用相似。结论：罗红霉素具有抗炎和免疫调节作用，罗红霉素与布地奈德干粉吸入剂联用可以提高疗效。     

长期低剂量大环内酯类抗生素的抗哮喘作用

以红霉素为代表的大环内酯类抗生素在感染性疾病中应用相当广泛,疗效确切。经过长期的药理研究和临床实践,人们发现此类抗生素除具有抗感染作用外,对支气管哮喘亦有一定作用。近年来国内外对其研究逐渐增多,笔者就大环内酯类抗生素在哮喘治疗中的机理及疗效作一综述。     

茶碱缓释胶囊治疗支气管哮喘临床研究

目的观察茶碱缓释胶囊治疗支气管哮喘的疗效。方法 40例支气管哮喘患者通过服用茶碱缓释胶囊治疗,观察病情变化并测定血清中茶碱浓度。结果 40例患者,临床控制5例,显效8例,好转17例,无效10例,总有效率为75.0%。结论茶碱缓释胶囊治疗该病疗效确切,可减少药剂不良反应,适合临床推广应用。     

阿司咪唑治疗支气管哮喘

目的：观察阿司咪唑治疗哮喘的疗效。方法：４４例轻、中度支气管哮喘病人（男性２４例,女性２０例,年龄２７ａ±ｓ７ａ）口服阿司咪唑２０ｍｇ,ｑｄ,疗程４ｗｋ。结果：服药后症状评分显著减少。ＰＥＦＲ,ＦＥＶ１和ＦＥＶ１％显著提高（Ｐ＜０．０１）,未见明显不良反应。结论：阿司咪唑是一种治疗轻、中度哮喘的安全有效的药物。     

小剂量氨茶碱配合激素吸入治疗变异性哮喘

目的 观察小剂量氨茶碱与吸入皮质激素治疗小儿咳嗽变异性哮喘的协同抗炎作用及治疗对预后的影响。方法 选择我院专科门诊诊断为咳嗽变异性哮喘的40例患儿．随机分为治疗组23例．对照组17例。治疗组采用氨茶碱3mg／kg／次,每日3次,疗程为症状缓解后1个月并吸入普米克气雾剂16个月：对照组吸入普米克气雾剂。结果 治疗6个月后观察统计治疗组缓解时间短．复发率较对照组低。结论 小剂量茶碱配合吸入皮质激素治疗小儿咳嗽变异性哮喘症状缓解时间短,无茶碱不良反应．复发或转为典型哮喘率低且不必强调茶碱的血药浓度监测。值得在基层医院推广应用。     

吸入糖皮质激素联合小剂量茶碱与联合白三烯调节剂治疗5岁以下儿童哮喘的效果比较

目的比较吸入糖皮质激素（ics）联合小剂量茶碱与联合白三烯调节剂治疗5岁以下儿童哮喘的临床效果。方法将90例中度持续性哮喘患者按照随机原则分为ICS＋茶碱组和ICS＋孟鲁司特钠组,每组各45例。两组均常规吸人丙酸氟替卡松,ICS＋茶碱组加用口服缓释茶碱片6mg／（kg·d）,分两次服;ICS＋孟鲁司特组加用口服孟鲁司特钠,1次／d,4mg／次,两组疗程均为6个月。结果治疗3个月及6个月后,两组的H间症状评分、夜间症状评分、ACT评分与治疗前比较,差异有统计学意义（P〈0．05）,两组的上述指标比较,差异无统计学意义（P〉0．05）。结论吸人丙酸氟替卡松联合小剂量茶碱与联合白三烯调节剂治疗5岁以下儿童哮喘的效果相当。     

吸入性糖皮质激素对婴幼儿重症肺炎患儿潮气呼吸肺功能的影响

目的观察及探讨吸入性糖皮质激素治疗对婴幼儿重症肺炎患儿潮气呼吸肺功能的影响及意义。方法选择该院儿科重症监护病房（PICU）2012年6月至2013年6月收治的婴幼儿重症肺炎患儿80例,年龄1-35个月,分为A、B组各40例。两组患儿均给予常规吸氧、抗感染对症支持等综合治疗,A组在综合治疗基础上于住院时以及出院后加用布地奈德混悬液（500μg,每天2次）吸入治疗,疗程3个月。另选择38例无呼吸系统疾病健康婴幼儿作为健康对照组（C组）,其中男20例,女18例,平均月龄（18.1±0.7）个月。分别测定入院时、临床治愈时及出院后3个月三组患儿的潮气呼吸肺功能主要测定参数：潮气量（VT）、呼吸频率（RR）、吸气时间（TI）、呼气时间（TE）、吸呼比（TI/TE）、达峰时间比（TPTEF/TE）及达峰容积比（VPTEF/VE）。观察各组患儿肺功能指标变化及改善率的差异。结果入院时A、B组分别与C组比较,RR增快、TI缩短、TE缩短、TI/TE、TPTEF/TE、VPTEF/VE及VT明显降低,差异均有统计学意义（P〈0.05）;临床治愈时A、B组VT增加,RR下降,与入院时比较,差异有统计学意义（P〈0.05）,两组TPEF/TE、VPEF/VE指标较治疗前增高,且A组改善明显优于B组,差异均有统计学意义（P〈0.05）,但两组仍明显低于C组,差异均有统计学意义（P〈0.05）,A组TPEF/TE、VPEF/VE较B组明显增高,差异有统计学意义（P〈0.05）;出院后3个月A、B组RR、VT、TI、TE、TI/TE均与C组相当,A组TPTEF/TE、TPTEF/VE指标进一步改善,其水平与C组相当,且显著优于B组,差异有统计学意义（P〈0.05）;B组TPEF/TE、VPEF/VE仍显著低于C组,差异均有统计学意义（P〈0.05）。结论婴幼儿重症肺炎患儿潮气呼吸肺功能明显受损,临床症状缓解后其肺功能损害仍持续存在,吸入性糖皮质激素治疗可改善其肺功能损害。     

吸入性糖皮质激素对哮喘气道重塑模型平滑肌的影响

目的探讨吸入性糖皮质激素对哮喘气道重塑模型平滑肌的影响。方法雄性豚鼠108只,随机分为哮喘发作组(A组)、治疗组(B组)和对照组(C组)。每组动物分别予以卵蛋白(OVA)、布地奈德或生理盐水处理,在每个时点末次激发后24 h处死,留取肺组织,测量气道平滑肌的厚度。结果在12周时各组气道平滑肌层厚度,A组(26.56±3.39)μm,B组(18.29±4.11)μm,C组(9.85±3.59)μm,两两比较均有显著性差异(P<0.05)。在首次激发后24 h各组气道平滑肌层厚度分别为(7.66±1.86)μm、(7.81±1.61)μm和(7.79±1.55)μm,两两比较均无显著性差异(P>0.05),直到激发8周后各组平滑肌层厚度才出现显著性差异(P<0.05)。结论吸入性糖皮质激素能抑制气道平滑肌层增厚,但这种作用是不完全的。     

Clinical effectiveness of inhaled corticosteroids versus montelukast in children with asthma: prescription patterns and patient adherence as key factors

Abstract

Objectives:

To examine the real-life effectiveness of inhaled corticosteroids (ICS) versus leukotriene receptor antagonists (LTRA) monotherapy in children with mild or moderate asthma.     

Resource utilization in asthma:combined fluticasone propionate/salmeterol compared with inhaled corticosteroids

ABSTRACT

Background: Asthma management guidelines recommend low-dose inhaled corticosteroids (ICS) for initial treatment of mild persistent asthma. Instead, data from primary care practice show that many patients start on combination therapy with fluticasone propionate/salmeterol (FPS) for mild asthma. The consequences of this variance from guideline recommendations are not well described.

Objective: Compare healthcare utilization and asthma-related outcomes for patients with mild asthma who began treatment with FPS or ICS alone.

Design and data source: A retrospective analysis of asthma-related insurance claims. Patients initially treated with FPS or ICS were identified from an administrative health insurance claims database and followed for 1 year. Analyses of resource utilization 6 months before therapy initiation identified patients with mild asthma. Propensity score matching managed between-group differences in clinical characteristics and controlled for selection bias.

Outcome measures: Resource use was determined for asthma-related outpatient visits, emergency room services, hospitalizations, and medications.

Results: Demographic characteristics and comorbidities were similar for each group (FPS, n = 1888; ICS, n = 1888). During the 12?month follow-up period, total asthma-related costs were significantly higher for FPS versus ICS ($1206 vs. $804; p < 0.0001), owing primarily to significantly higher drug costs for FPS versus ICS ($677 vs. $357; p < 0.0001). The percentage of patients experiencing an exacerbation (14.0% FPS, 13.5% ICS) and the average number of exacerbations in each group (0.175 FPS, 0.164 ICS) were similar.

Conclusions: Healthcare costs were found to be lower in patients receiving ICS than in those receiving FPS, with similar health outcomes in both groups. Study limitations included the use of claims data and a proxy definition of asthma severity, and potential confounding by unobserved factors.     

Actual use of inhaled corticosteroids and risk of hospitalisation: a case-control study

Background: The relationship between therapy and adverse outcome in asthma is debated especially for naturally occurring situations. This is due in part to insufficient information regarding actual use of medications. Objective: This study was conducted to clarify the relationship between actual intake of anti-asthma drugs and asthma hospitalisation, considered as an outcome. Methods: A case-control study was performed. Patients hospitalised for an asthma exacerbation were matched to community controls identified in surrounding general practices. Patients were questioned to identify prior use of anti-asthma medications, level of use of inhaled corticosteroids and attitude towards therapy. Results: Twenty-three cases and 31 matched controls were interviewed. Cases tended to have more severe asthma than controls, as judged by more frequent use of oral corticosteroids. Cases tended to make more frequent use of oral xanthines and inhaled anticholinergics, but the proportion of patients using inhaled β₂-adrenoceptor agonists and inhaled corticosteroids was similar in both groups. Use of lower doses of inhaled corticosteroids was associated with an increased risk of hospitalisation, while higher dosage was associated with␣decreased risk. Cases and controls differed as to their answers to a questionnaire concerning attitudes: cases expressed less interest in optimal usage of inhaled␣corticosteroids than controls; they also expressed more confidence in inhaled β₂-agonists. When both risks were combined, overconfidence in β₂-agonists and suboptimal use of inhaled steroids, the relationship with hospitalisation was significant (OR 5.5, 95% CI 1.1; 26.1). Conclusion: The results suggest that patients' attitudes to inhaled corticosteroids and actual consumption of these medications are directly related to adverse outcome in asthma. Received: 12 April 1996 / Accepted in revised form: 7 October 1996     

Smoking influences response to inhaled corticosteroids in patients with asthma: a meta-analysis

Abstract

Objective:

To determine the effects of smoking on efficacy of inhaled corticosteroids in asthmatics.     

顺尔宁联合糖皮质激素吸入和单纯糖皮质激素吸入治疗儿童哮喘的效果对比

目的探讨顺尔宁联合糖皮质激素吸入和单纯糖皮质激素吸入治疗儿童哮喘的临床效果。方法将2014年2月~2016年12月在我院接受治疗的60例儿童哮喘患者作为本次研究对象,将其按照随机数字法平均分为两组,30例采用单纯糖皮质激素吸入治疗(对照组),30例给予顺尔宁联合糖皮质激素吸入治疗(研究组)。将两组患者临床疗效、湿啰音消失时间、哮鸣音消失时间、咳嗽消失时间、住院时间、FEV1、PEF、Eos指标及不良反应发生情况进行比较。结果研究组临床总有效率为86.66%,对照组临床总有效率为63.33%,研究组患者临床总有效率显著高于对照组(P<0.05)。研究组患者湿啰音消失时间、哮鸣音消失时间、咳嗽消失时间及住院时间均显著短于对照组(P<0.05)。干预前两组患者FEV1、PEF、Eos指标比较差异无统计学意义(P>0.05),干预后两组患者FEV1、PEF指标均显著升高,Eos指标均显著降低(P<0.05),且研究组较对照组改善显著(P<0.05)。研究组不良反应发生率为6.66%,对照组不良反应发生率为10.00%。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论在儿童哮喘患者治疗中选择顺尔宁联合糖皮质激素吸入治疗可显著缩短患者临床症状消失时间及住院时间,提高治疗效果,降低患者经济负担,改善患者肺功能,且不良反应低安全有效,值得在临床上推广使用。