哮喘268例治疗计划坚持情况分析

目的　初步了解哮喘患儿的治疗计划坚持情况 ,分析存在的问题 ,并探讨相应防治措施。方法　对2 68例哮喘患儿治疗计划坚持情况进行问卷调查 ,重点统计并对比分析中断治疗的相关因素。结果　 76.1%患儿中断治疗 ,停药原因依次为担心药物副作用、经济原因、症状缓解、治疗效果不好和小儿不配合或遗忘等 ,家长知识水平、医患关系和疗程也有相应影响。结论　本地区哮喘患儿治疗计划的坚持率仍较低 ,对哮喘知识的认知不足仍是治疗计划坚持性的主要障碍     

伴特应质的哮喘患儿190例临床分析

目的 了解特应质与儿童哮喘之间的关系。方法 对190例哮喘患儿进行分析。比较有无特应质的哮喘患儿在哮喘发作频率、无症状天数、最大呼气峰流速、家族史方面的差异。结果 55．3％的哮喘患儿伴特应质，51．6％有阳性家族史，而且伴特应质的哮喘患儿69．5％有阳性家族史，特应质与非特应质的哮喘患儿间在吸入治疗前后的哮喘发作频率、无症状天数方面，差异均有非常显著性（P〈0．01）。结论 儿童哮喘的发生与特应质相关，伴特应质的哮喘患儿吸入激素治疗有效。     

小儿哮喘的综合治疗、教育管理与效果分析

目的探讨小儿哮喘吸入疗法的疗效及综合管理教育的临床效果。方法对1998—2003年在我科哮喘专科门诊登记建档治疗的患儿418例，观察患儿用药前后病情、PEF、急诊次数、住院次数以及经过长期管理教育后各方面变化并进行分析。结果(1)患儿病情得到有效控制，总有效率99．3％，临床控制率72．2％。(2)PEF测定可客观评价和监测哮喘的严重程度、疗效。(3)患儿家长与医生建立良好的伙伴合作关系，通过哮喘的管理计划，可对患儿建立一个个体化哮喘长期管理治疗计划，为定期随访保健打下基础。结论吸人治疗是目前哮喘治疗最重要而有效的方法；个体化长期综合管理是吸人治疗顺利实施有力保障，临床应大力推行。     

卡介菌多糖核酸注射液和特异性免疫治疗对哮喘的疗效

目的研究卡介菌多糖核酸（BCG-PNA）和特异性免疫治疗（SIT）对哮喘患儿肺功能、血清IgE和分泌细胞因子的影响。方法用BCG-PNA和SIT治疗哮喘患儿45例，治疗前后检测肺功能，酶联免疫吸附试验检测血清IgE和外周血单个核细胞分泌细胞因子IL-4、IFN-γ、IL-13、IL-12水平。结果BCG-PNA和SIT明显改善哮喘患儿的用力肺活量、第1秒用力呼气容量、25％最大呼气流量等指标，降低血清IgE，抑制IL-4、IL-13分泌，促进IFN-γ、IL-12产生，两者联合治疗对于降低IL-13、增加IFN-γ产生有协同作用。结论BCG-PNA和SIT能改善哮喘患儿肺功能，增强Th1反应，降低Th2应答，调节Th1／Th2平衡。两者联合治疗对改善哮喘患儿失衡的细胞因子网络有一定协同作用。     

重症哮喘患儿20例治疗体会

目的探讨研究重症哮喘患儿治疗体会。方法回顾性研究20例重症哮喘患儿治疗过程。结果经多方面治疗后19例患儿症状于24h内得以改善，死亡1例（于入院时呼吸、心跳已停止）。结论重症哮喘治疗的主要药物为支气管扩张剂和肾上腺皮质激素。     

黄精多糖对哮喘患儿红细胞免疫功能影响的体外实验研究

目的:观察黄精多糖(PSP)对哮喘患儿红细胞免疫功能的影响及其意义。方法：采用花环试验法对哮喘患儿(包括PSP组和生理盐水组)及健康儿童进行红细胞C3b受体花环率及免疫复合物(IC)花环率检测。结果：①哮喘组红细胞C3b受体花环率明显低于正常对照组(t=6.32,P<0.01),IC花环率明显高于正常对照组(t=5.89,P<0.01);②体外试验PSP组哮喘患儿红细胞C3b受体花环率较生理盐水组明显升高(t=6.33,P<0.01),而IC花环率两组差异无显著性(t=1.38,P>0.05);③PSP在一定浓度范围内均可显著增加哮喘患儿红细胞C3b受体花环率且呈剂量依赖关系。结论：哮喘患儿红细胞免疫功能明显低下,PSP可增强哮喘患儿的红细胞免疫功能,这是其预防哮喘复发的机制之一。     

儿童哮喘临床治疗效果观察

目的 探讨对哮喘儿童规范治疗的疗效。方法 随机分管理组和对照组，两组均观察1年以来。管理组在医师指导下正确使用喘乐宁、必可酮气雾剂MDI方法，进行中哮喘管理教育，对照组不规则使用喘乐宁、必可酮气雾剂MDI方法，无哮喘管理教育。结果 两组疗效有显著性差异，管理组疗效成于对照组（P＜0．0001），管理组临床控制率70．2％。肺功能管理组的1s用力呼气治疗后的平均升高值大于对照且（P＜0．0001）。年急诊率和年住院率管理组少于对照组。管理组用药1年无药物副作用。结论 对哮喘儿童进行规范治疗可使患儿临床症状缓解，生活质量提高。     

哮喘患儿呼出气一氧化氮的变化

目的观察哮喘患儿呼出气一氧化氮（ＮＯ）的变化。方法采用化学发光法对１２８名７～１２岁正常儿童和７６例６～１４岁哮喘患儿进行呼出气ＮＯ浓度测定，同时测定哮喘儿童一秒钟用力呼气容积（ＦＥＶ１）及其占预计值百分比（ＦＥＶ１％）。对其中２１例哮喘患儿进行治疗后８个月内随访，监测其呼出气ＮＯ浓度，采用组胺激发试验测定其治疗前和治疗６个月后气道反应性。结果哮喘患儿呼出气ＮＯ浓度为３９±２１ｐｐｂ，正常儿童呼出气ＮＯ浓度为２３±１３ｐｐｂ，两组差异有显著意义（Ｐ＜０．００１）；发作期哮喘患儿呼出气ＮＯ浓度略高于缓解期患儿，但差异无显著意义（４２±２４ｐｐｂ，３５±２１ｐｐｂ，Ｐ＞０．０５）；哮喘患儿呼出气ＮＯ浓度与ＦＥＶ１％无明显相关性（ｒ＝０．０９２，Ｐ＞０．０５）。１１例吸入糖皮质激素治疗的哮喘患儿治疗２周后缓解期呼出气ＮＯ浓度较治疗前降低（２７±９ｐｐｂ，４４±１８ｐｐｂ，Ｐ＜０．０５），治疗６个月后气道高反应性（ＡＨＲ）程度表现下降趋势，另１０例未用糖皮质激素治疗的患儿缓解期呼出气ＮＯ浓度和ＡＨＲ程度均无明显改变。结论哮喘患儿呼出气ＮＯ浓度高于正常，吸入糖皮质激素治疗可降低呼出气ＮＯ浓度和ＡＨＲ。     

319例哮喘患儿喘乐宁雾化吸入前后肺功能变化

３１９例哮喘患儿喘乐宁雾化吸入前后肺功能变化李元陈育智李硕赵京韩秀兰丁燕通过对哮喘患儿进行喘乐宁雾化吸入前后肺功能的监测、分析，为临床提供判断病情的客观指标，以利于指导临床的治疗工作。方法：３１９例观察对象全部来自我所哮喘专业门诊的患儿，诊断按１９９...     

儿童哮喘规范化管理治疗效果评价

目的评价儿童哮喘规范化管理治疗的效果。方法对150例哮喘患儿建立哮喘医疗管理档案,按是否接受规范化管理治疗分为管理组和对照组,对管理组78例患儿及家长进行哮喘基本知识教育、健康教育并定期随访等综合教育管理,同时进行哮喘的规范化治疗;对照组72例未进行哮喘教育管理,仅接受一般临床治疗。观察1年,比较两组儿童哮喘临床疗效、家长知信行变化及患儿用药依从性情况。结果管理组患儿哮喘控制率明显高于对照组(χ2=54.68,P0.01);在随访1年内,管理组患儿哮喘发作次数、急诊次数、住院次数均明显减少,与对照组比较差异有统计学意义(P均0.01);两组比较,管理组患儿家长对哮喘知识的了解和对患儿治疗及管理执行情况等知信行水平显著提高(P0.01);同期管理组患儿用药依从性也显著高于对照组(χ2=66.27,P0.01)。结论推广儿童哮喘规范化管理治疗,可提高哮喘患儿家长的知信行水平,改善患儿治疗依从性,从而有效控制哮喘。     

Improving the psychological status of children with asthma: a randomized controlled trial.

Children with asthma are at special risk for problems in psychological functioning, as are children with other chronic illnesses. We conducted a controlled trial of a combined education and stress management program among children ages 6 to 14 years with asthma. Eighty-one children were randomly assigned to an intervention or a control group; 56 children completed data collection, 29 intervention and 27 control. Psychological status was assessed by the Child Behavior Checklist (CBCL) before and after the intervention, as were children's knowledge of asthma, stress (as measured by children's life events), and functional status (as indicated by such activities as school attendance, time playing with friends, and daily chore performance). Children in the intervention group had a significant improvement in the total Behavior Problems score (p less than .04) and Internalizing scale (p less than .01) on the CBCL and a significant increase in daily chores (p less than .04) compared with the control group. Before intervention, the two groups had statistically significant positive relationships between negative life events and behavior problems scores. After intervention, children in the control group still demonstrated a significant relationship between negative life events and total and Internalizing Behavior Problem scores, although participation in the intervention group negated that relationship. Children in the intervention group whose knowledge of asthma increased were more likely to report an increase in daily chores (p less than .02). We conclude that the intervention had a beneficial effect on psychological status and on children's daily activities. The effect may have occurred in part by decreasing the likelihood that perceived stress from negative life events led to poorer adjustment.     

The relationship of fall school opening and emergency department asthma visits in a large metropolitan area

BACKGROUND: Asthma morbidity is seasonal, with the fewest exacerbations occurring in summer and the most exacerbations in early fall. OBJECTIVE: To determine if the fall increase in pediatric asthma emergency department (ED) visits is related to the school year start. DESIGN: Time-series study of daily asthma ED visits taken from an administrative claims database for the years 1991 to 2002. SETTING: Eleven municipal hospitals in New York City, NY.Patients Emergency department visits with asthma as the primary diagnosis among children aged 2 to 4, 5 to 11, and 12 to 17 years and adults with asthma aged 22 to 45 years as comparative group.Main Outcome Measure Rate of asthma ED visits after the September school opening compared with before the opening, during a 60-day window of each year. The delayed effect of school opening was examined by the lagged school-opening indicator for lag 0 through 9 days. The model adjusted for factors that may influence morbidity. There were 86 731 ED visits within the study period. RESULTS: Asthma ED visits for children aged 5 to 11 years were significantly associated with school opening day, with the highest lagged rate ratio being 1.46 (95% confidence interval [CI], 1.29-1.65). For children aged 2 to 4 years, the highest rate ratio was 1.19 (95% CI, 1.06-1.35), and for children aged 12 to 17 years, the highest lagged rate ratio was 1.13 (95% CI, 0.98-1.31). The rise in adult ED visits following school opening was less substantial, with the highest lagged rate ratio being 1.07 (95% CI, 1.00-1.14). CONCLUSION: The start of the September school year was associated with increases in pediatric asthma ED visits, particularly among grade school children.     

School readiness among urban children with asthma.

BACKGROUND: Children with chronic illnesses, including asthma, are at risk for school problems. Developmental problems, however, may begin before school entry, and the developmental status of preschool children with asthma has not been evaluated. OBJECTIVE: To test the hypothesis that urban preschool children with asthma have lower parent-reported developmental scores compared with children without asthma. METHODS: A comprehensive survey of children beginning kindergarten in 1998 in the urban school system in Rochester, NY, collected parent reports of demographic, medical, and developmental data. We compared children with asthma with and without limitation of activity to children without asthma for motor, language, socioemotional, and school readiness skills and the need for extra help with learning. Linear and logistic regression were used to determine associations between asthma and developmental outcomes. RESULTS: Among the 1058 children in this sample, 9% had asthma, including 5% with asthma with limitation of activity. After adjustment for multiple potential confounding variables, the children with asthma with limitation had lower scores on school readiness skills compared with children without asthma (2.0 vs 2.5, P <.001). Further, the parents of children with asthma with limitation were substantially more likely (P <.05) to describe them as needing extra help with learning (74% vs 56%; odds ratio, 3.2; 95% confidence interval, 1.5--7.8). CONCLUSIONS: Urban preschool children with significant asthma had poorer parent-reported school readiness skills and a greater need for extra help with learning compared with children without asthma. This finding suggests that developmental problems for children with asthma may begin before school entry.     

Asthma among children attending kindergarten in Alsace in 1998: prevalence and medical management]

Asthma is one of the most frequent disease in childhood. The objectives of this survey were to study asthma and asthma related symptoms epidemiology in preschool children and to analyse their medical management. METHODS: A cross-sectional survey was conducted in 1998 in Alsace-France by school doctors, on a randomized sample of 2,765 pupils attending third year kindergarten. The first questionnaire accessed diagnosed asthma and asthma related symptoms history, and school absenteeism. The cumulative prevalence was estimated for diagnosed asthma on the period since birth and for asthma related symptoms unassociated with diagnosed asthma for the past 12 months. Parents who reported diagnosed asthma or asthma related symptoms unassociated with diagnosed asthma of their children were interviewed with a supplemental questionnaire examining clinical patterns, health care and asthma-related hospitalization. RESULTS: Prevalence of asthma was 6.5%. Prevalence of asthma related symptoms unassociated with a diagnosis of asthma was 7.2%. The "chesty" pupils school absenteeism was important. Most of the patients (91.3%) had a mild disease form. One third of them were not getting specific treatment. The drugs mostly prescribed were inhaled bronchodilators for acute episodes of asthma and antihistamines in prophylactic treatment. The rate of asthma-related hospitalization was 11.9%. Severe clinical pattern was statistically related to treatment and asthma-related hospitalization. CONCLUSION: Asthma prevalence is high in children attending nursery school in Alsace. This disease is still nowadays undiagnosed, underinvestigated and undertreated.     

34例小儿自身免疫性胶质纤维酸性蛋白星形胶质细胞病的临床特征分析

目的 探讨儿童哮喘管理与哮喘控制水平的影响因素。 方法 选取202例哮喘患儿,通过哮喘控制水平与家长管理调查问卷,收集儿童哮喘控制水平影响因素与家庭生活管理项目,分析家长对儿童哮喘的认识与管理意识,以及对儿童哮喘控制水平的影响,并分析两者的相关性。 结果 完全控制组哮喘病程、治疗时间均比未完全控制组长（P<0.05）;完全控制组1年内哮喘发作次数≥3次者、因哮喘发作需要雾化治疗>3次者的比例均低于未完全控制组（P<0.05）;完全控制组呼吸道感染频繁者、呼吸道感染时发生喘息者及有家族过敏性疾病史的比例均低于未完全控制组（P<0.05）;完全控制组的家长呼吸道感染短期升级哮喘用药意识与维持用药的管理明显增强（P<0.05）;未完全控制组初始肺功能异常者比例高于完全控制组（P<0.05）。哮喘控制水平与呼吸道感染时短期升级哮喘用药及初始肺功能相关（P<0.05）。 结论 儿童哮喘控制水平与哮喘严重程度、儿童哮喘综合管理密切相关,早期治疗和家庭管理特别是呼吸道感染早期短期升级治疗对哮喘控制有重要意义。 ［中国当代儿科杂志,2023,25（1）：73-79］     

Controlled trial of a home and ambulatory program for asthmatic children

Care of asthmatic children is often episodic and more therapeutic than preventive. A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures. Interventions for the study group during the first year included 3-month clinic visits, education, and home visits by a specially trained research nurse. Control subjects continued to receive regular care from a family physician or pediatrician. Eight-nine subjects (93%) completed the study. Study subjects had less school absenteeism than control subjects (10.7 vs. 16.0 days, P = .04) and showed significantly better small airway function after 1 year. Asthma severity improved in 13 study subjects and worsened in 5. The reverse was true for control subjects. Study subjects exhibited better metered aerosol technique than control subjects (P = .0005). Fewer days were spent in hospital by the study subjects admitted compared with control subjects (3.67 vs 11.2 days, P = .02). After 1 year, more study than control families (72.1% vs 33.1%, P = .006) reported that their asthmatic child took responsibility for the asthma management. The intervention failed to reduce exposure to secondhand smoke or to household pets. There were no significant differences in medical visits, theophylline levels, or records of asthma symptoms. One year after discontinuing the intervention, a marked "washout" effect was observed. Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.     

A comparison of absentee rates of elementary schoolchildren with asthma and nonasthmatic schoolmates

Daily school attendance has been suggested as a health status measure for children. The present study compares school absence in children known to have asthma (N = 95) with a random sample of nonasthmatic elementary schoolchildren (N = 711). The differences in average percentage of days absent over one year were analyzed by comparing both groups' conditioning on ethnicity, sex, socioeconomic status, and grade. Children with asthma have a significantly higher absentee rate (absent 8.4% of days) than do nonasthmatic children (absent 5.9% of days) (P less than 9001). This significant difference holds true regardless of ethnicity of sex and for most socioeconomic groups. A comparison by grade level shows a similar trend for children with asthma and nonasthmatic children: absentee rates decrease as children get older; however, except for one grade level, children with asthma have a greater percentage of school days absent. Mean absentee rates for children with asthma were different when compared according to their mother's perception of severity of asthma--mild (6.9%), moderate (7.9%), and severe (13.9%).     

Time trend for the prevalence of asthma among school children in a Swedish district in 1985-2005.

AIM: To assess the temporal trend for asthma and asthma-like symptoms over a period of 20 years. METHOD: Repeated cross-sectional surveys with identical study design were carried out among all school children (7-16 years) in a well-defined area in Sweden in 1985, 1995 and 2005. RESULTS: In 2005, the parents of 1110 out of 7825 children (14.2%) answered yes to a screening question on asthmatic symptoms. Of these, 783 out of 1110 (70.5%) replied to a postal questionnaire with detailed questions concerning symptoms and asthma management. The rate of affirmative response to the screening question was unchanged between 1995 and 2005. However, the percentage of children with wheezing or three or more asthma-like symptoms decreased, whereas the percentage of children with physician-diagnosed asthma increased steadily since 1985. The number of reported symptoms was closely associated with the number of days with physical restriction. The annual sale of inhaled steroids from local pharmacies was stable between 1995 and 2005. CONCLUSION: The increase in asthmatic symptoms in school children has peaked. Reduced severity of symptoms and divergent trends for wheezing and physician-diagnosed asthma suggest an increased awareness of asthma with improved management of the symptoms. However, differences in trends between allergic and nonallergic asthma could not be excluded.     

Extended-stay hospitalization for childhood asthma in Japan

Background:  While recent advances in asthma management have enabled adequate control to be frequently achieved in outpatient settings, children whose asthma remains poorly controlled despite outpatient treatment are often referred to extended-stay hospitals. The aim of the present study was to examine trends concerning extended-stay hospitalization and to evaluate the present status of this approach.
Methods:  A retrospective study was conducted to assess changes in the number of admissions among 408 children with extended stays at Kamiamakusa General Hospital between 1989 and 2005. Medical and laboratory data of 236 patients admitted since 1994 were obtained from clinical records.
Results:  The number of children with extended-stay hospitalizations since 2000 declined dramatically compared with the early 1990s, while the percentage of patients with complications of childhood asthma, such as severe atopic dermatitis, school absenteeism, and obesity, have increased significantly in the recent past. Practical benefits of extended-stay hospitalization were demonstrated by significant improvement of exercise performance and measurement of pulmonary function parameters and serum IgE concentrations by time of discharge. In addition to improvement in asthmatic symptoms, maintenance drug requirements and frequency of school absenteeism were reduced.
Conclusions:  The medical mission of extended-stay hospitalizations is currently limited due to the availability of improved pharmacotherapy. Some patients, however, with exceptionally severe asthma or psychological problems that interact with their medical condition still fare poorly under outpatient care and could benefit from group care. Further study is needed to identify the components of long-term programs essential to produce change.     

Time trend for the prevalence of asthma among school children in a Swedish district in 1985–2005

Aim: To assess the temporal trend for asthma and asthma-like symptoms over a period of 20 years.
Method: Repeated cross-sectional surveys with identical study design were carried out among all school children (7–16 years) in a well-defined area in Sweden in 1985, 1995 and 2005.
Results: In 2005, the parents of 1110 out of 7825 children (14.2%) answered yes to a screening question on asthmatic symptoms. Of these, 783 out of 1110 (70.5%) replied to a postal questionnaire with detailed questions concerning symptoms and asthma management. The rate of affirmative response to the screening question was unchanged between 1995 and 2005. However, the percentage of children with wheezing or three or more asthma-like symptoms decreased, whereas the percentage of children with physician-diagnosed asthma increased steadily since 1985. The number of reported symptoms was closely associated with the number of days with physical restriction. The annual sale of inhaled steroids from local pharmacies was stable between 1995 and 2005.
Conclusion: The increase in asthmatic symptoms in school children has peaked. Reduced severity of symptoms and divergent trends for wheezing and physician-diagnosed asthma suggest an increased awareness of asthma with improved management of the symptoms. However, differences in trends between allergic and nonallergic asthma could not be excluded.