哮喘的社区诊治回顾分析与思考

目的 了解社区医务人员对哮喘规范化治疗的认识和执行情况,并提出改进建议.方法 对资料完整的200例哮喘患者(敷贴组65例,敷贴+中药组65例和对照组70例)进行回顾性调查和资料分析.结果 (1)调查显示80%社区医务工作者对哮喘患者的长期治疗认识不足.(2)缓解期患者吸入糖皮质激素(ICS)作长期治疗者仅39例(19.5%);患者初次发病年龄以婴幼儿和儿童为最多见,分别为53.0%和23.5%,因哮喘急性发作患者中诱发因素以气候变化、呼吸道感染为最多见,哮喘急性发作采用速效β2激动剂口服或吸入治疗(61.0%、53.0%)及茶碱类药物口服或静脉给药治疗(51.0%、26.5%).(3)缓解期患者敷贴组和敷贴加中药组有效率(81.5%和83.1%)均高于对照组的28.6%(P＜0.01).结论 (1)应加强社区医务人员继续教育,提高对哮喘病的认识和治疗水平;(2)应利用社区慢性病防治网络,对哮喘患者进行组织管理和哮喘病知识教育;(3)中药辅治控制哮喘效果良好.     

中药穴位敷贴治疗支气管哮喘的临床研究进展

支气管哮喘是一种以多种细胞特别是肥大细胞、嗜酸性粒细胞和T淋巴细胞等炎性细胞参与的气道慢性炎症和以气道高反应性(BHR)为特征的疾病病[1].20世纪60年代以来其发病率不断上升,目前全球患者已接近1.5亿,近20年来该病的防治方法一直是医药界探索的课题.糖皮质激素具有抗炎、抗过敏的强大作用,为西医治疗哮喘的首选药,但长期应用副作用明显,特别是对儿童[2].本病属中医哮证,清代医家张璐另辟蹊径,首创三伏天穴位敷贴药物防治哮喘,将穴位作用与药物作用有机结合,疗效独特.现代诸多医家对该疗法进行了临床观察与研究,兹将近20年来穴位敷贴防治支气管哮喘的进展综述如下.     

浓缩秦氏敷贴方中姜酒和敷贴药渣对哮喘豚鼠的作用研究

目的探讨浓缩秦氏敷贴方中的姜酒和其药渣对哮喘豚鼠的影响。方法选用健康♂豚鼠,随机分为5组：传统秦氏敷贴（A）组、哮喘模型（B）组、空白对照（C）组、姜酒敷贴（D）组、药渣敷贴（E）组。采用雾化吸入鸡卵蛋白（OVA）进行攻击,建立哮喘模型。A组敷贴秦氏敷贴剂,B组敷贴生理盐水,C组正常饲养,D组敷贴含药姜酒,E组敷贴药渣。第2周起OVA攻击后敷贴,1周2次。于第1、2、4和8次OVA攻击后进行哮喘症状评分。于第7次敷贴后处死动物,观察肺脏组织经HE染色后肺组织病理学改变及粒细胞计数。结果第4次OVA攻击后,D组哮喘症状减轻,第8次OVA攻击后,A组、E组哮喘症状减轻。各组哮喘豚鼠肺组织中的粒细胞计数均减少。结论姜酒浓缩敷贴提高了传统秦氏敷贴疗效,在敷贴2次后即显示出疗效。药渣敷贴与传统秦氏敷贴疗效相似。     

中药穴位敷贴治疗支气管哮喘44例

目的观察中药穴位敷贴治疗支气管哮喘的临床疗效。方法将选取的88例支气管哮喘患者随机分为对照组和试验组,各44例。对照组患者接受常规西药治疗,试验组患者在此基础上给予中药穴位敷贴,治疗3个月后比较疗效。结果对照组患者总有效率为61.36%,显效率29.54%,有效率31.82%,无效率38.64%;试验组患者的总有效率为86.36%,显效率45.45%,有效率40.91%,无效率13.64%,疗效明显优于对照组(P<0.05)。两组患者的肺功能指标1秒用力呼气容积(FEV1)实测值均显著高于治疗前(P<0.05),但组间无显著性差异(P>0.05)。结论中药穴位敷贴治疗支气管哮喘具有疗效显著、易于操作、不良反应小等优点,明显优于常规西药治疗。     

穴位敷贴治疗哮喘的体会

应用中医理论选取有效穴位,根据"痰"为该病本质的认识,结合传统的贴敷方法,选用芥末泥在膻中、肺腧、大椎、天突、定喘等穴处敷贴,取得了明显效果。     

通过社区医疗措施防治青少年哮喘

美国加利福尼亚州帕萨登拉(Pasadcna)城哈延顿纪念医院有关人员在H＆HN杂志撰文，对通过社区医疗防治青少年哮喘作了介绍。     

社区医疗在哮喘防治中的作用

哮喘是世界范围内最常见的呼吸系统疾病之一 ,虽然目前还不能根治 ,但在医生的指导下 ,科学地用药 ,寻找和避免引起哮喘急性发作的因素 ,哮喘完全可以被很好控制 ,因此 ,加强对哮喘缓解期患者的教育和管理 ,提高患者对疾病的认识 ,是社区医生的重要职责 ,对哮喘的防治起着重要的作用。资料与方法　 1 观察对象　非急性发作期的属间隙或轻、中度分级的支气管哮喘患者共 60例 ,男性 2 4例、女性 36例 ,平均年龄 4 6岁 ,病程 5～36年。哮喘诊断和病情评价标准见文献〔1〕。实验对象均未合并其他严重心肺、内分泌代谢性疾病及慢性消耗性疾病 ,除…     

社区督导治疗方案对缓解期支气管哮喘患者的效果分析

<正>近几年来,由于我国城市环境污染的加剧,使得支气管哮喘的发病率呈现逐年递增的趋势,且该类疾病容易反复发作,使得患者需承受极大的心理压力。该类疾病主要是由于呼吸道病毒感染、大气污染、遗传、抽烟、药物、食品添加剂、室内变应原、职业性变应原等多种因素引发的一类临床疾病[1]。发作时间集中在凌晨2~5点,以胸闷、发作性咳嗽、干咳、呼吸哮鸣音、呼吸困难[2]等作为主要的临床症状,严重时还会引发肺水肿、细菌感染[3]等多种并发     

哮喘外敷方的豚鼠血清药理学实验

目的：采用血清药理学方法考察哮喘外敷方的抗乙酰胆碱作用。方法：40只豚鼠随机分为正常对照组、模型对照组、中药贴敷1d、7d和14d组，以Hulson法诱导哮喘模型。模型对照组贴敷生理盐水，中药贴敷组贴敷中药膏（1d、7d和14d）。测定各组豚鼠血清对离体气管条收缩力的影响。结果：中药贴敷1d组和空白对照组与模型对照组无显著性差异，中药贴敷7d组和14d组显示出抗乙酰胆碱作用。结论：贴敷哮喘外敷方7d后，豚鼠血清显示出抗乙酰胆碱作用。     

变异性哮喘30例诊治分析

咳嗽变异性哮喘(CVA)是指以慢性咳嗽为唯一或主要的临床表现的一种特殊类型哮喘。因临床表现不典型,肺部一般没有哮鸣音,极易误诊,以至病情得不到及时缓解。2001-09/2008-09我院共收治CVA30例,其中误诊12例,误诊率高达40%,现报告如下。1临床资料1.1一般资料本组男12例,女18例;年龄55～65岁26例,≥66岁4例。有哮喘家族史8例,有过敏性鼻炎、荨麻疹、药物过敏等疾病史10例,病因不详的12例。发病季节:冬春季22例,秋季6例,夏季2例。发病诱因:因吸入油烟等异味18例,气候变化诱发7例,感冒诱发4例,剧烈运动后诱发1例。1.2临床表现本组均有发作性咳嗽持续3周以上,甚至2个月,1例达2a。以咳嗽为主,多数无痰或咳少许白色泡沫痰。部分患者可有胸闷或呼吸困难,体检无典型哮鸣音。28例以深夜或凌晨为重,1例出现发热。12例轻度喘息,16例有喉紧或瘙痒感,8例吸入冷空气后咳嗽加重,6例轻度胸闷。1.3诊断标准(1)不明原因咳嗽持续3周以上,上呼吸道感染,吸入冷空气,剧烈运动后可诱发,深夜或凌晨加重;(2)体检、胸部X线检查正常;(3)肺功能检查多数正常,少数可有轻度阻塞性通气功能障碍的表现,F...     

Contribution of community pharmacists in educating the asthma patients

Background: In asthma, the preventive measures taken by patients play an important role in improving life span and quality of life. This can be done more efficiently by community pharmacist by providing patient counseling and improving knowledge of patient about disease, risk factors, medication management and preventive measures to control asthma. Objectives: The objective of the study was to evaluate the contribution of community pharmacists in improvement of life span and quality of life of asthma patients. Method: The study was performed from Mid September to Mid-November 2014 in Dawadmi, Riyadh province, KSA. Data were collected by using a structured face to face questionnaire with randomly selected different community pharmacies. The questionnaire composed of different closed questions about the action plan of pharmacists in asthma management and factors that affect the counseling of asthma patients by the pharmacists. Results: It is noteworthy to observe that, in general, pharmacists are sufficiently knowledgeable and competent to counsel their asthma patients effectively.     

The management of asthma in adult patients in the community pharmacy setting: Literature review

BackgroundAsthma poses a public health concern, with an estimated 235 million people currently living with the condition globally. The provision of evidence-based, patient-centred services for adult asthma patients in community pharmacy which involves collaboration across the multidisciplinary team could improve their asthma control.ObjectivesA literature review was conducted to examine the evidence of asthma management in community pharmacy setting.MethodsFive databases were searched to identify relevant articles published before February 2021. Screening of the potential studies was performed to remove articles that did not comply with the inclusion criteria. Relevant data from all included studies was collected using a data extraction form to ensure consistency throughout the review.ResultsTwenty studies were included in the review; all were conducted in community pharmacy settings in the period of 2001–2020, in different countries. The studies included randomised controlled trials, controlled trials and observational studies. Several successful community pharmacy-based services that were provided to asthma patients to improve their asthma management were highlighted in this review. These interventions consisted of one or more components and included: patient education, inhaler technique improvement, patient counselling, self-management plans, development and provision of asthma action plans and referral to other health care practitioners. None of the studies involved medication or dosage changes by community pharmacy.ConclusionsThe evidence discussed in this review showed that community pharmacists are well-placed to deliver services to asthma patients and many studies were conducted in the community pharmacy to improve asthma control in adult patients. However, further research could be conducted to explore further opportunities for community pharmacy to enhance asthma patients management of their condition.     

中药穴位贴敷治疗高血压的效果分析

目的 研究中药穴位贴敷治疗高血压的临床效果.方法 抽取86例高血压患者,随机分为对照组与治疗组,每组各43例.对照组采用常规降压药物治疗,治疗组采用常规降压药与中药穴位贴敷联合治疗.结果 治疗组的有效率明显高于对照组;症状表现消失时间、血压水平复常时间、治疗方案实施的总时间明显短于对照组;治疗前后血压水平的改善幅度明显大于对照组;用药期间出现药物不良反应的发生率、停药后高血压的病情复发率明显低于对照组（P＜0.05）.结论 中药穴位贴敷治疗高血压的临床效果非常明显.     

Potential normalization of an asthma mHealth intervention in community pharmacies: Applying a theory-based framework

BackgroundEffective mobile health (mHealth) interventions have been developed to support patients with their medication use, however to date few are widely used in pharmacy practice. Normalization of an intervention is essential to have a population impact, which is defined as ‘the process of getting a new intervention into routine practice’.ObjectiveThe aim of this study was to assess the normalization potential of a complex mHealth intervention for adolescents with asthma (ADolescent Adherence Patient Tool; ADAPT) in community pharmacy practice.MethodsThe Normalization Process Theory (NPT), a sociological action theory, was retrospectively applied to study the normalization potential of ADAPT. NPT explains factors that promote or hinder implementation, embedding, and integration of new interventions in clinical practice. Evaluation data (structured interviews and questionnaires) of 23 pharmacists who used the ADAPT intervention were used for this study.ResultsPharmacists understood the purpose of the ADAPT intervention and were prepared to undertake the necessary work of implementation. However changes at different levels are needed to support full normalization, such as changes in the intervention itself and changes in the pharmacist's work flow. The potential for normalization could also be enhanced by the use of product champions and appropriate reimbursement guidelines, to ensure uptake of the intervention by other pharmacists. Support from professional bodies for the use of mHealth could also promote normalization.ConclusionsNormalization of mHealth is a complex continuous process. The ADAPT intervention has the potential to be normalized in community pharmacy practice, but full normalization would require changes in both daily pharmacy practice and reimbursement models.     

成人支气管哮喘42例诊治分析

目的调查基层医院成人支气管哮喘治疗现状。方法通过对42例支气管哮喘患者治疗情况调查，了解我国支气管哮喘防治指南在本地的执行情况。结果42例患者中平均确诊时间3.5个月，肺功能检查使用率低占11.9％（5／42），使用峰速仪占14.3％（6／42），按要求分级治疗为9.52％（4／42），急性发作抗生素使用率为88.1％（37／42），其中不合理使用抗生素占78.6％（33／42）。控制症状药物使用有待改善，患者依从性较差。结论按支气管哮喘防治指南治疗部分患者明显受益，大部分患者的诊治有待进一步改善。     

晚发老年哮喘28例诊治分析

目的 分析晚发老年哮喘的临床特点,以提高对晚发老年哮喘的认识. 方法 回顾性分析81例晚发老年哮喘患者的临床资料,将全部患者按起病时间（首次发病年龄）分为早发老年哮喘（早发组）和晚发老年哮喘（晚发组）,对比分析各项相关指标. 结果 晚发组28例（34.6%）,与早发组相比,吸烟史、过敏史及家族史、发病病因或诱因、临床表现、基础疾病及并发症、危重症比例、疾病转归、病死率等差异均无统计学意义（均P＞0.05）;晚发组误诊误治时间明显较早发组短（P＜0.05）;晚发组的季节性比早发组明显（P＜0.05）. 结论 晚发老年哮喘患者多有基础疾病、易误诊、易并发呼吸衰竭、病死率高等特点.     

红霉素、氨茶碱联合治疗小儿哮喘临床分析

目的:观察红霉素、氨茶碱治疗小儿哮喘的临床疗效,探讨其有效机制。方法:将232例哮喘合并感染患儿随机分为治疗组112例与对照组120例,均按哮喘合并感染常规治疗,治疗组择用红霉素、氨茶碱,对照组选用其他抗生素和支气管舒张剂。结果:治疗组患儿哮喘发作缓解时间较对照组明显缩短,疗效优于对照组,差异显著(P<0.01)。结论:红霉素和氨茶碱联合是治疗小儿哮喘既有效又经济的药物。     

112例老年哮喘病发病诱因和并发症临床治疗分析

目的分析老年哮喘病的发病诱因和并发症。方法对285例哮喘病患者进行分类,其中老年哮喘病组112例,非老年哮喘病组173例,分别对两组的发病诱因和并发症进行比较分析。随机将112例老年哮喘病患者分为3组,其中A组38例,B组38例,12组36例,A组交替使用p2受体激动剂、糖皮质激素和抗胆碱药物等三种药物,B组选用其中两种药物,也交替用药,C组只用其中一种药物。各组均进行雾化吸入治疗,3次／d,每次治疗20min,7d为1个疗程,交替用药各组每次只使用其中一种药物。结果老年组有家族史者8例（7．14％）,非老年组20例（11．56％）,P〉0．05。老年组有过敏性鼻炎史者13例（11．61％）,非老年组28例（16．18％）,P〉0．05;老年组重度哮喘65例（58．03％）。中度46例（41．07％）;非老年组重度68例（39．31％）,中度105例（60．69％）,P〈0．05。老年组动脉血气PaO2（88．56±5．38）mmHg,PAC02（34．55±6．15）mmHg,非老年组PaO2（86．75±6．23）mmHg,PaCO2（39．24±6．98）mmHg,P均〉0．05。结论哮喘病是一种对公众健康有巨大威胁的复杂疾病。对老年哮喘病患者应给予高度重视,有效的做好老年哮喘病的临床治疗,以提高老年人身体健康。     

丙酸氟替卡松治疗儿童哮喘临床分析

目的：明确丙酸氟替卡松对儿童哮喘的临床治疗效果。方法：选取2009年6月～2010年3月入本院治疗的36例患儿为研究对象,随机将其分为观察组和对照组,每组18例,其中对照组患儿口服酮替芬片（1mg,2次/d）治疗哮喘,观察组患儿在对照组基础上加服丙酸氟替卡松吸入（125μg,2~4次/d）,治疗3个月,记录患儿的肺功能指标并定期随访做记录。结果：观察组患儿的临床症状得到了有效缓解,治疗前后最大呼气峰流速值（PEF）和临床症状评分对比,差异有统计学意义（P〈0.05）,对照组患儿PEF值无变化（P〉0.05）。结论：长期吸入丙酸氟替卡松有助于缓解患儿哮喘的临床症状,改善患儿肺功能,可以在临床中进一步应用。