妥洛特罗贴剂经皮给药治疗小儿支气管哮喘的疗效

目的监测小儿支气管哮喘患者在综合治疗过程中经皮给予妥洛特罗贴剂后病情的缓解及症状的改善。方法将104例轻中度小儿支气管哮喘患者分为2组:对照组50例,给予综合治疗,抗感染、抗病毒、止咳、化痰等常规治疗;治疗组54例,除综合治疗外,根据年龄的不同,给予妥洛特罗贴剂0.5mg或1mg,观察两组咳嗽时限及痰液排出时间。结果治疗组咳嗽及排痰时限均短于对照组,差异有统计学意义(P<0.05)。结论妥洛特罗经皮给药治疗小儿支气管哮喘,能缩短咳嗽、排痰时限,达到缩短病程的效果。     

小儿肾病综合征合并支气管哮喘临床分析

目的分析小儿肾病综合征（NS）与支气管哮喘之间的关系。方法医院2009年1月-2013年3月收治NS患儿228例,其中合并支气管哮喘症状12例,分析其诊断情况及NS与支气管哮喘的关系。结果228例NS患儿合并支气管哮喘12例（5．3％）,其中导致NS复发6例,2例NS患儿在NS未缓解期间,出现尿蛋白增多,服用激素治疗4周后,患儿尿蛋白尚未转阴。12例NS合并支气管哮喘患儿采用支气管扩张剂沙丁胺醇和表面激素布地奈德吸入治疗2-5d后,患儿哮喘症状得到缓解。12例患儿出院后,继续使用氟替卡松治疗,未再出现喘息,且对NS控制非常有效。结论对于NS合并支气管哮喘患儿,要有效控制患儿的哮喘症状,对患儿进行合理用药,能减少NS复发。     

Why are Polynesian children admitted to hospital for asthma more frequently than European children?

Polynesian children have higher hospital admission rates than European children. This study compared 156 Polynesian children with 199 European children admitted to hospital for asthma. After controlling for socioeconomic status Polynesian children were similar to European children for many variables, but there were a number of important differences. The number of previous hospital admissions for asthma was higher in Polynesians than Europeans (mean (SD), 3.9 (4.6) v 2.8 (3.8) respectively p = 0.028). Despite this, 33% of Polynesian children were not receiving any asthma drugs in the 24 hours prior to admission to hospital compared with 14% of Europeans (relative risk (RR) = 1.94, 95% confidence interval (CI) = 1.25-3.00) and fewer were taking sympathomimetics and cromoglycate. A similar trend in asthma drug usage was seen six months later. Polynesian children were less likely to be referred to hospital by a general practitioner than European children (42% v 64% respectively, RR = 0.72 95% CI = 0.58-0.89). The differences in hospital admission rates are not explained by genetic or socioeconomic factors but seem to be related more to patterns of medical management.     

安脱达尘螨疫苗治疗儿童过敏性哮喘的疗效及安全性评价

目的:评价安脱达尘螨变应原疫苗治疗过敏性哮喘的疗效及安全性。方法:采用自身对照方法,对125例尘螨过敏性哮喘患儿皮下注射特异性免疫疫苗(安脱达),记录治疗前后哮喘症状、合并用药评分,同时计算与免疫相关不良反应发生率,评价其安全性。结果:脱敏治疗1年后125例患儿哮喘症状明显改善,合并用药计分明显减少。80.0%(100/125)的哮喘患儿伴发过敏性鼻炎,脱敏治疗1年后鼻炎症状明显改善。23.2%的患儿因哮喘症状明显好转,在治疗第26周末自行停用合并药物,第52周末随访病情,哮喘复发率为10.3%(3/29)。125例患儿总计接受免疫治疗注射2676次,43例患儿出现100例次局部不良反应,局部不良反应的发生率为3.7%(100/2676),14例患儿出现23例次全身不良反应,全身不良反应发生率0.9%(23/2676),未出现致死性全身不良反应。结论:标准化变应原进行脱敏治疗在规范化操作下是一种安全有效的治疗方法。     

Bacterial contamination of inhalation chambers: results of a pilot study.

Spacers are used in the treatment of children with asthma. It is advised to clean the spacers regularly. However, cleaning can influence drug delivery. One obvious reason to clean a spacer is prevention of bacterial contamination. Whether spacers are contaminated or not is unknown. We cultured spacers, brought in by children with asthma or recurrent wheeze who visited our outpatient clinic during a 4-month period. The spacers of 64 children were studied, and 24 (38%) were contaminated; most often (13 cases), Bacillus species were found. Only one spacer grew a potential pathogenic bacterium (Pseudomonas aeruginosa). No correlation with type of inhaler, duration of usage, drug, or visual aspect was found. Spacers, cleaned according to national guidelines, were not less contaminated. Bacterial contamination of spacers is frequent, but the bacteria cultured are not pathogenic. Intensive cleaning of spacers does not influence the level of contamination with environmental bacteria.     

Literacy and perceived barriers to medication taking among homeless mothers and their children.

PURPOSE: The relation of medical literacy to women-reported barriers to taking medication themselves or giving medication to their children was studied. METHODS: Women in 18 homeless shelters in four counties in central North Carolina were recruited. Head-of-household homeless mothers with psychiatric or substance-abuse disorders and dependent children were eligible to participate. Trained interviewers administered a site-specific questionnaire on medication use. RESULTS: One hundred sixty-four homeless women participated. Forty-two percent of the women were currently taking a medication. Forty-six percent of the women stated that there was a barrier to taking their medications as prescribed. Medical literacy was not significantly related to whether women felt there were barriers to taking a medication. Seventy-five percent of the women reported having one or more children living with them. Thirty-seven percent reported having a child with asthma live with them, and 12% reported having a child with attention-deficit disorder. Forty percent reported a barrier to giving their child a needed medication. Taste was the most commonly reported barrier. Women with lower medical literacy and younger women were significantly more likely to report a barrier to giving their children a needed medication. Over 80% of women listed pharmacists as their first or second choice for receiving drug information orally. CONCLUSION: Race and perceived barriers to medication use affected the medication-taking behavior of homeless women, while their age and literacy level affected the reporting rates of the barriers to medication use for their children. Homeless women preferred receiving both written and oral drug information from a physician or a pharmacist.     

社区获得性肺炎患儿门诊抗菌药物处方分析

目的：探讨临床药师在儿童哮喘规范化管理中的作用,为临床合理用药提供参考。方法：开设儿童哮喘医药综合门诊,并结合临床药师参与2例哮喘患儿的个体化诊疗过程,通过药物基因检测明确患儿对药物的敏感性,向患儿家长解读基因报告,并提出个体化用药建议,指导患儿正确使用雾化吸入制剂。结果：医师采纳临床药师的建议,结合患儿基因检测结果,制定个体化药物治疗方案。结论：临床药师运用自身所掌握的药学专业知识,在哮喘儿童个体化治疗中开展药学服务,可充分发挥专业协助作用,确保治疗过程的安全、有效、经济。     

哮喘患儿的药学监护

目的:确保支气管哮喘患儿长期坚持药物治疗,预防哮喘发作,并安全、有效、正确地使用控制哮喘药。方法:通过采取临床药师协助医师制订治疗方案,对支气管哮喘患儿及家长进行用药教育、药物咨询及为患儿建立药历等方式实施药学监护。结果与结论:实施药学监护,可明显提高哮喘患儿的用药依从性、安全性和有效性,改善其生活质量。     

银杏露配合治疗儿童哮喘临床观察

目的观察银杏露对儿童哮喘(寒型)的作用及作用机制.方法对儿童哮喘66例随机分为两组,对照组采用西药常规治疗,治疗组在应用西药的基础上加用银杏露干预治疗观察其临床疗效及肺功能变化结果治疗组临床症状体征改善(控制显效率)明显优于对照组(P＜0.01),而两组肺功能治疗后无明显差异.结论银杏露配合西药治疗儿童寒型哮喘疗效优于单用西药对照组,提示银杏露具有治疗儿童寒型哮喘的作用.     

哮喘儿童呼吸道支原体检出率及其对临床预后的影响

目的：评价哮喘儿童呼吸道支原体检出率对临床预后和生存质量（QOL）的影响。方法：选择2014年1月至2016年12月在我院就诊的支气管哮喘患儿35例,随访12个月,每2个月一次随访进行哮喘控制问卷（ACQ）、小儿哮喘照护者生命质量问卷（PACQLQ）、药物指数和哮喘严重指数（ACQ与药物指数之和）评价,同时取咽部分泌物进行肺炎支原体（MP）培养,比较MP阳性率与ACQ、PACQLQ、药物指数和哮喘严重指数的相关性。结果：平均每人随访5.32（4.00~7.50）次,其中21例完成6次随访,11例完成3~6次随访,1例完成2次随访;共有20例患儿MP培养阳性,其中阳性率最高的月份为5月和7月;入组后患儿哮喘严重指数和PACQLQ均无明显变化,但Pearson相关分析表明不同时点两指标均存在负相关（P<0.05）;MP阳性访视和阴性访视之间药物指数、ACQ、PACQLQ、哮喘严重指数比较差异均无统计学意义（P>0.05）。结论：支气管哮喘患儿MP阳性率与临床症状、QOL无相关性。     

Gastroesophageal reflux disease in children with asthma: treatment implications

An association between asthma and gastroesophageal reflux disease (GERD) has long been recognized both mechanistically and epidemiologically. The clinical relevance of this interplay continues to be explored, with special interest given to the role of GERD in the worsening of asthma. The effect of GERD is most frequently contemplated in patients with asthma that is difficult to control. Medical and surgical anti-reflux trials attempting to alter asthma symptoms have reported mixed but generally underwhelming results, although asthma symptom scores are generally improved following effective treatment of GERD. Many of the pharmaceutical studies can be criticised for having too short a duration or for likely incomplete acid suppression. Few trials have specifically studied pediatric populations. Because GERD is a common condition, particularly in young children, the role reflux plays in the worsening of asthma symptoms and the potential benefit on asthma of anti-reflux therapy warrants further exploration. Whether or not treating symptomatic GERD reduces the symptoms and severity of asthma in children, GERD coexisting with asthma should be aggressively treated. GERD symptoms in most patients with or without asthma can be controlled medically with continuous use of proton pump inhibitors such as omeprazole and lansoprazole and to a lesser extent by histamine H(2) receptor antagonists such as famotidine and cimetidine.     

参苓白术散辅助治疗儿童哮喘缓解期的疗效评价

目的:探讨参苓白术散辅助治疗儿童哮喘缓解期的临床疗效。方法:选取2011年1月至2014年12月我院收治的34例哮喘缓解期患儿作为观察组,给予参苓白术散加减煎汤剂口服联合沙美特罗替卡松吸入治疗,并选取同期的52例哮喘缓解期患儿作为对照组,单纯给予沙美特罗替卡松吸入治疗,比较两组患儿临床疗效、治疗前和治疗6个月后的哮喘发作次数、哮喘发作持续时间、呼吸道感染发生率、中医症状积分及药物不良反应。结果:观察组治疗总有效率为94.1%,显著高于对照组的84.6%,两组比较差异有统计学意义(P<0.05);观察组患儿治疗6个月后的哮喘发作次数、哮喘发作持续时间、呼吸道感染发生率及中医症状积分均显著低于对照组(P<0.05);两组在治疗过程中均未出现严重不良反应。结论:参苓白术散煎汤剂联合沙美特罗替卡松用于患儿哮喘缓解期,能够控制哮喘发作次数及哮喘发作持续时间,减少呼吸道感染的发生率,改善患儿的临床症状,安全性较好,可作为治疗此类疾病的有效治疗手段,值得临床推广应用。     

温肾健脾益气汤联合布地奈德治疗儿童哮喘缓解期疗效观察

目的:观察自拟温肾健脾益气汤联合布地奈德治疗儿童哮喘缓解期的效果。方法:选取我院2015年1月至2017年1月诊治的哮喘缓解期患儿132例,按随机数表法分为观察组和对照组各66例,均采用抗感染、化痰、止咳、维持酸碱平衡和纠正水电解质紊乱等常规基础治疗,对照组同时给予布地奈德吸入治疗,观察组在对照组基础上加用自拟温肾健脾益气汤,均持续治疗3个月,比较两组患儿治疗前后血清白介素(IL)-4和IL-5水平及免疫功能指标变化情况、主要症状积分、临床疗效及不良反应。结果:治疗后两组患儿哮喘发作次数、呼吸系统感染次数、哮喘发作程度、哮喘发作持续时间症状积分和血清IL-4、IL-5水平均较治疗前降低,且观察组均低于对照组(P均<0.05)。两组患儿CD3+、CD4+水平和CD4+/CD8+均较治疗前升高,且观察组均高于对照组(P均<0.05);两组患儿CD8+水平较治疗前均降低,且观察组低于对照组(P均<0.05)。观察组总有效率96.97%,高于对照组的83.33%(P<0.05),两组治疗期间均未发生明显不良反应。结论:儿童哮喘缓解期给予自拟温肾健脾益气汤联合布地奈德治疗效果显著,能明显降低血清IL-4、IL-5水平。     

Leukotriene receptor antagonists for the treatment of asthma

Leukotriene receptor antagonists (LTRAs) are novel medications that provide symptom control in patients with persistent asthma. Current guidelines recommend the use of LTRAs as a treatment option for patients with mild-persistent asthma of at least 12 years of age. As illustrated by the results of controlled, multicenter clinical trials with zafirlukast and montelukast, as well as studies with pranlukast in Japan, LTRAs reduce daytime and night time asthma symptoms, improve pulmonary function, lower beta-adrenergic agonist use, and reduce asthma morbidity in patients with mild-intermittent to moderate-persistent asthma. Moreover, several recent clinical studies demonstrate that these agents are effective in preventing exercise-induced bronchoconstriction in children, and in improving disease control in symptomatic patients taking inhaled steroids. Based on clinical results to date, LTRAs appear to be safe and well tolerated in patients with mildto- moderate asthma. These agents represent an important addition to the drug armamentarium against asthma.     

福建省福州地区哮喘儿童知信行问卷调查结果分析

目的了解患儿家长对哮喘知识的掌握情况及哮喘患儿日常生活管理和用药情况。方法 2010年7~12月,采用首都儿科研究所提供的哮喘患儿家长知信行问卷,对就诊于福建省福州儿童医院哮喘专科门诊确诊支气管哮喘的患儿的家长进行调查。结果共调查100份问卷,有效问卷86份。问卷中,84.88%家长在孩子的哮喘不发作时,会带孩子复诊;55.81%家长平均1~3个月带孩子去医院复诊一次。63.95%家长认为哮喘的本质是气道慢性炎症性疾病;89.53%家长认为哮喘是能够控制的,但需要规律用药;33.72%家长认为遵从医嘱规律地使用吸入型激素,对孩子的生长发育无影响。27.91%家长认为在孩子哮喘急性发作时,自我紧急处理的首选措施是吸入速效β2受体激动剂;80.23%家长在孩子哮喘没有症状时,会让他/她坚持用药;65.12%家长不愿意给孩子长期用哮喘控制药物的原因是,认为会对孩子的生长发育产生严重的影响。结论福建省福州地区多数哮喘患儿家长对哮喘疾病有较好的认识,但仍需进一步完善哮喘健康知识,提高治疗依从性,改善患儿生活质量。     

Impact of different assumptions on estimates of childhood diseases obtained from health care data: A retrospective cohort study

Purpose

Accurate estimates of disease incidence in children are required to support pediatric drug development. Analysis of electronic health care records (EHR) may yield such estimates but pediatric‐specific methods are lacking. We aimed to understand the impact of assumptions regarding duration of disease episode and length of run‐in period on incidence estimates from EHRs.

Methods

Children aged 0 to 17 years (5–17 years for asthma) registered in the Integrated Primary Care Information database between 2002 and 2014 were studied. We tested the impact of the following: maximum duration of disease episode (0, 14, 30, 60, and 90 days) on recurrent diseases (acute otitis media [common] and acute pyelonephritis [rare]); and database run‐in period on chronic diseases—asthma (common) and type 1 diabetes (DM) (rare). We calculated incidence rate ratios with 95% confidence intervals and stratified using 1‐year age categories.

Results

Altogether, 503 495 children were registered. The incidence of acute otitis media was highest in <2‐year‐old children; using 30 days disease duration as reference, the rate increased with 8% if the duration was 14 days and decreased with 8% when extended to 60 days. Disease duration did not impact acute pyelonephritis (rare). No run‐in (to exclude prevalent cases) versus 24‐month run‐in period overestimated the incidence rate for asthma and DM by a factor of 2.

Conclusions

Analysis of EHR allows for estimation of disease incidence in children, but assumptions regarding episode length and run‐in period impact the incidence estimates. Such assumptions may be routinely explored.     

儿童支气管哮喘的药学服务及临床效果分析

目的：探讨药学服务对儿童哮喘知识知晓程度、用药依从性、肺功能和哮喘控制程度的影响,为改善哮喘患儿的药学服务提供依据。方法：将126例哮喘患儿随机分为观察组和对照组, 每组63例, 进行知识知晓、用药依从性、合理用药、肺功能和哮喘控制的调查和测评;对照组进行常规治疗和健康教育等干预;观察组在对照组健康教育干预措施的基础上,接受为期6个月药学服务干预,干预结束后,实施电话或上门随访跟踪调查。结果：两组患儿在哮喘知识知晓程度、用药依从性、合理用药途径、肺功能（FEV1％和PEF％）和儿童哮喘控制测试（C-ACT）等方面比较差异有统计学意义（P<0.05）。观察组儿童哮喘控制率明显提高（P<0.05）,但仍然存在气雾剂使用不正确（23.81%）、控制药使用不当（20.63%）、哮喘日记欠完整（19.05%）、过分担忧药物不良反应等（14.29%）。结论：药学服务能显著有效改善儿童哮喘知识知晓度、用药依从性、合理用药、肺功能和哮喘控制水平,药师应该更多提供和完善药学服务计划。     

心理行为干预对哮喘患儿治疗效果的影响

目的探讨心理行为干预对哮喘患儿的治疗效果影响。方法将笔者所在医院2010年1～12月收治的88例哮喘患儿随机分为两组,每组44例。对照组患儿给予常规临床治疗,实验组患儿在对照组治疗的基础上,给予心理行为干预。比较两组患儿的治疗效果和复发率,并将结果进行统计学分析。结果对照组总有效率为75.00%,实验组总有效率为95.45%,实验组患儿的治疗效果明显高于对照组(P<0.05);实验组患儿复发10例,对照组患儿复发37例,实验组明显低于对照组(P<0.05)。结论在哮喘患儿常规药物治疗的基础上给予心理行为治疗,能够有效提高患儿的治疗效果,减少复发,值得在临床应用。     

肺炎支原体感染与小儿哮喘的临床特征分析

目的探讨肺炎支原体感染与小儿哮喘的临床特征。方法对照组20例小儿哮喘患儿为非肺炎支原体感染诱发,观察组20例小儿哮喘患儿为肺炎支原体感染诱发。观察两组患儿临床特征、喘息特点以及药物治疗反应。结果观察组20例小儿哮喘患儿发热情况、热程、药物治疗反应、住院时间、C反应蛋白与对照组20例小儿哮喘患儿均有显著差异,对照组小儿哮喘患儿多因上呼吸道感染诱发,观察组均由于肺炎支原体感染诱发;在药物治疗方面,观察组20例小儿哮喘患儿采用平喘类药物联合大环内酯类抗生素治疗疗效极为显著。两组小儿哮喘患儿临床治疗效果具有显著差异性,具备统计学意义(P<0.05)。结论肺炎支原体感染诱发的小儿哮喘与非肺炎支原体感染诱发的小儿哮喘临床特征差异较大,采用平喘类药物联合大环内酯类抗生素治疗疗效极为显著,值得临床推广应用。     

儿童哮喘缓解期吸入性糖皮质激素用药依从性现况调查

目的：探讨儿童哮喘缓解期吸入性糖皮质激素（Inhaled Corticosteroids，ICS）用药依从性及影响因素。方法：对90名哮喘患儿家长进行问卷调查，分析患儿近3个月哮喘缓解期内ICS的使用情况、用药依从性、吸入装置掌握情况及相关影响因素。结果：患儿近3个月内使用最多的ICS为BUD （48.89%），其次是FP （35.56%）、BDP （6.67%）及其他（8.89%）。使用吸入装置最多的是雾化器（24.44%）和干粉吸入剂（都保）（24.44%），其次是压力定量气雾剂（加储物罐）（23.33%）、干粉吸入剂（准纳器）（14.44%）及压力定量气雾剂（无储物罐）（13.33%）。Morisky用药依从性量表调查结果显示，调查对象对于ICS的用药依从性平均得分为5.39，总体判定为依从性差（<6分）。影响依从性的主要影响因素是担心长期用药不良反应、病情好转后停药、各种原因引起的漏用、孩子治疗不配合、吸入装置复杂、用药后无效、用药方案复杂、家庭经济原因以及医师指导不到位等。结论：儿科临床医师和药师应进一步加强诊疗管理，强化吸入技术的使用培训，通过多种途径不断深化哮喘控制宣传、教育和培训工作，提高哮喘患儿长期用药依从性。