Comparison of two chamber devices in patients using a metered-dose inhaler with satisfactory technique.

A randomized clinical crossover trial was carried out to compare the use in the home, during 1-week periods, of two commercially available chamber devices (the Aerochamber and the Spacer) and a standard metered-dose inhaler (MDI) in 24 patients with reversible bronchospasm and satisfactory inhaler technique. Measurements of peak flow, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), ratio of FEV1 to FVC and forced midexpiratory flow rate were made immediately before and 15 minutes after inhalation of terbutaline sulfate. No difference was noted in results of spirometry, peak flow readings or side effects between the devices. The results of spirometry were better during the trial than immediately before it (p less than 0.01). The mean score for inhaler technique was significantly lower at follow-up than during the trial (p less than 0.001). The results suggest that in this population there is no advantage to using either a chamber device rather than an MDI or one chamber device rather than the other.     

The bronchodilator effects of aerosolized terbutaline. A controlled, double-blind study.

The bronchodilator effects of aerosols of a high-dose of terbutaline sulfate (1.5 mg), a low-dose of terbutaline sulfate (0.75 mg), isoproterenol (0.3 mg), and placebo were compared using forced expiratory spirometry, flow-volume curves, and body plethysmography in a double-blind, six-hour, controlled study in 25 patients with reversible airflow obstruction. After isoproterenol therapy, the values peaked at 15 minutes, and none were significantly different (P less than .05) from placebo after the 30-minute observation point. The values for high-dose terbutaline peaked at one hour at a level that exceeded responses to isoproterenol. All values except the forced vital capacity at five and six hours and functional residual capacity at six hours were significantly greater than placebo (P less than .05) at all observation points. The low-dose terbutaline values peaked earlier and at a lower value than the high-dose terbutaline values, and several indexes were significantly greater (P less than .05) than after isoproterenol therapy beyond the two-hour point.     

Spirometric indices of early airflow obstruction.

Thirty cigarette smokers and 25 non-smoking controls, all men were evaluated by history, physical examination and simple spirometry. The history and physical examination were not of much use in predicting airflow obstruction. Forced mid-expiratory flow (FEF 25-75%) was abnormally low in 23 of the 30 subjects, while forced expiratory volume in 1 second (FEV1) and FEV1/FVC (forced vital capacity) were less sensitive. Thus simple spirometry is a useful screening tool to detect early airflow obstruction even when it is clinically undetectable.     

Bronchodilator effects of salbutamol powder administered via Rotahaler and of terbutaline aerosol administered via Misthaler. A comparison study in children with asthma

A study to compare the bronchodilator effect of salbutamol powder (Ventolin, 200 micrograms) administered via a Rotahaler (SR), with that of terbutaline sulphate (Bricanyl, 500 micrograms) administered via a Misthaler (TM) was carried out in 25 children with stable moderate to severe asthma. The bronchodilator effects of salbutamol powder and terbutaline sulphate were measured by means of spirometry and clinical assessment in a double-blind, randomized fashion. The children were monitored for three hours after administration of the medication on three consecutive days. The administration of salbutamol via a Rotahaler and of terbutaline sulphate via a Misthaler resulted in significant bronchodilatation as measured by peak expiratory flow rate and spirometry. There was a significant trend for SR to give greater bronchodilatation than TM at several time intervals. Over 70% (18 of 25) of the children in this study preferred the Ventolin Rotahaler to the Bricanyl Misthaler. Both SR and TM give effective bronchodilatation and, consequently, these devices should be particularly useful in younger children who have difficulty with managing standard, metered aerosols.     

Effect of terbutaline sulphate in chronic "allergic" cough

The effects of terbutaline sulphate were studied in 30 patients who presented with chronic cough at an allergy clinic. After a three week baseline period terbutaline and its placebo were given for two periods of three weeks each in a randomised, double blind, crossover manner. Patients kept a daily record of day and night cough scores and peak expiratory flow readings. Twenty one patients responded to terbutaline; placebo produced no significant effect. Both day and night cough scores (p less than 0.001) and peak expiratory flow rates were significantly improved (p less than 0.05) by the end of the first week of treatment with terbutaline. This improvement was achieved with only a fairly small change in airway calibre.     

Betamethasone valerate compared with sodium cromoglycate in asthmatic children.

A double-blind, cross-over study was undertaken to compare inhalation of betamethasone valerate (BV, 800 microgram daily) with sodium cromoglycate (SCG, 80 mg daily) in twenty children requiring bronchodilators for perennial asthma. Each treatment period lasted 4 weeks but statistical comparisons were made only in respect of the last 14 days of each therapy. When the children were using BV they required not only less of the bronchodilator drugs but had fewer symptoms and higher daily peak expiratory flow rates when taking SCG. Statistically, all these differences were highly significant. For 2 weeks before the main trial each child was given a placebo aerosol (single-blind) to assess severity of asthma. In comparison with this period, SCG was associated with a significantly increased peak expiratory flow rate a lower symptom score by day but not by night, but their usage of bronchodilators followed a similar pattern. When the BV period was compared with the placebo period, patients had an even more significant rise in peak expiratory flow rate, less day and night symptoms, and took hardly any bronchodilators. The response to the two drugs did seem to depend upon which was given first. No monilial infections were found, nor any measurable defect in adrenal response from either treatment. Betamethasone valerate is considered to be superior to sodium cromoglycate as a treatment for childhood asthma insufficiently controlled on bronchodilators.     

Omeprazole in the treatment of asthmatics with nocturnal symptoms and gastro-oesophageal reflux: a placebo-controlled cross-over study.

Eleven adult patients with nocturnal asthma, and gastro-oesophageal reflux documented by endoscopy or ambulatory oesophageal pH monitoring completed a double-blind cross-over study (4 week treatment, one week run-in and cross-over periods) comparing the effects of omeprazole 20 mg daily and placebo on asthma control assessed by symptoms, peak expiratory flow rate and bronchodilator usage. Omeprazole treatment did not improve asthma symptoms during the day or night, or peak expiratory flow rate readings. There was no difference in bronchodilator inhaler usage during omeprazole therapy. Treatment of gastro-oesophageal reflux with omeprazole in patients with nocturnal asthma and gastro-oesophageal reflux does not improve asthma symptoms or peak expiratory flow rate. This suggests that gastro-oesophageal reflux does not exacerbate bronchoconstriction in nocturnal asthma.     

Pulmonary function and airway responsiveness during long-term therapy with captopril

Angiotensin-converting enzyme inhibitors sometimes cause cough; the mechanism is unknown. We therefore studied the effects of ambulatory treatment with captopril on pulmonary function and on nonspecific bronchial responsiveness to methacholine in 15 hypertensive subjects. Lung volumes, expiratory flows and nonspecific bronchial responsiveness to methacholine using doses up to 64 g/L were measured before and four and eight weeks after captopril treatment was started. Throughout the study the subjects recorded respiratory symptoms and peak expiratory flow rates. In four subjects a persistent cough developed related to the use of captopril, but this was not associated with the development of airflow obstruction or bronchial hyperresponsiveness. The mean provocative concentration of methacholine that resulted in a 20% fall in the forced expiratory volume in 1 s was 43.6 +/- 1.8 g/L after eight weeks of captopril treatment compared with 61.6 +/- 1.2 g/L at the baseline evaluation. We concluded that there was no significant change in lung function during treatment with captopril. The development of a cough related to this medication is not associated with the development of airflow obstruction or airway hyperresponsiveness.     

吸入型激素不同给药方法对控制整体气道病的疗效分析

目的探讨吸入型激素不同给药方法时控制整体气道病的临床疗效。方法将整体气道病的90例患儿随机分为观察组和对照组,观察组经面罩储雾罐吸入布地奈德（BUD）气雾剂400μg／d．对照组经口吸入BUD干粉剂400μg／d联合使用丙酸氟替卡松鼻喷雾荆（辅舒良）200μg／d。对哮喘和过敏性鼻炎的症状评分应用峰流速仪测定每日呼气峰流速值（PEF）。结果经过6个月的临床观察,观察组和对照组的哮喘症状评分降低（P〉0．05）,两组的鼻炎症状评分下降（P〉0．05）,两组的PEP明显升高。结论采用面罩储雾罐经鼻吸入糖皮质激素即可有效控制小儿整体气道病。     

婴幼儿肺炎治疗前、后肺功能检测及临床分析

目的:观察并评价婴幼儿肺炎治疗前、后患儿的潮气呼吸流速-容量曲线测定结果,为临床诊断及判定转归情况提供依据。方法:选择婴幼儿肺炎患儿92例,应用婴幼儿肺功能测试仪对患儿治疗前、后行潮气呼吸流速容量环测定,同时选择健康对照组婴幼儿80例进行潮气呼吸测定,对肺功能各项指标进行比较分析。结果:肺炎组患儿肺功能指标V_T/kg、ME/MI、PTEF、t_PTEF/t_E、VPTEF/V_TE、TEF25/PTEF呈现明显减少,与对照组婴幼儿有显著差异(P<0.01或P<0.05),提示肺炎患儿大小气道均有阻塞,但以小气道阻塞为主。治疗后大气道阻塞改善明显,ME/MI指标差异不明显(P>0.05)。但反映小气道阻塞的肺功能指标仍低于健康儿童,PTEF、t_PTEF/t_E、VPTEF/V_TE、TEF25/PTEF差异显著(P<0.01),需要跟踪观察。结论:潮气呼吸肺功能检测能够准确反映出婴幼儿气道阻塞、气管痉挛的病情轻重程度,对婴幼儿肺炎治疗效果及随访具有重要评价作用,可成为呼吸系统疾病临床诊断,评估疗效,判断预后的重要补充,应广泛推广于儿科临床。     

动态肺量测定在支气管哮喘中的应用

目的探讨动态肺量测定技术在支气管哮喘中的应用.方法建立动态肺量测定技术,对20例支气管哮喘患者每天清晨、下午和入睡前连续14 d动态监测气道功能、症状和情绪.结果白天标准肺功能检查结果正常的支气管哮喘患者,第一秒用力呼气量(FEV1)和最大呼气峰流量(PEF)在夜间和凌晨可出现明显下降.肺功能指标与支气管哮喘症状的相关分析发现,只有7例患者(35%)支气管哮喘症状与FEV1和PEF存在相关关系.4例患者(20%)肺功能基本正常,但有很多症状,症状与FEV1和PEF无相关关系,但与负面情绪相关.另外2例患者(10%)肺功能损害严重,但几乎没有症状.结论动态肺量测定技术能客观反映支气管哮喘患者气道功能的昼夜自然变化,因此可以更准确地反映支气管哮喘的严重程度.动态肺量测定技术结合症状和情绪的同步监测,可以帮助识别出特殊症状感觉类型的支气管哮喘患者.     

Establishment and pathological study of models of chronic obstructive pulmonary disease by SO_2 inhalation method

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西替利嗪联合舒利迭治疗成人慢性中度哮喘的疗效

目的比较西替利嗪联合舒利迭与单用舒利迭治疗成人慢性中度哮喘的有效性。方法将68例成人慢性中度哮喘患者随机分成两组,分别给予西替利嗪联合舒利迭（沙美特罗／氟替卡松）及单用舒利迭治疗12周,在治疗前和治疗后观察临床症状和肺功能的改变及用药后的不良反应。结果两组治疗前后西替利嗪与舒利迭联合治疗的临床症状评分明显优于单用舒利迭组（P〈0．01）,第1秒用力呼气量（FEVl）占预计值的百分数、FEVl改善率及呼气峰流速（PEF）占预计值百分比均有显著提高（P〈0．01）。在治疗后第8周和第12周,联合组FEVl占预计值的百分数、FEVl改善率较舒利迭组明显（P〈0．05）。结论应用舒利迭同西替利嗪联合治疗哮喘能更迅速改善临床症状和肺功能,提示二者有一定的疗效相加作用。     

布地奈德联合特布特林雾化吸入治疗儿童支气管哮喘急性发作的临床观察

目的:探讨布地奈德联合特布他林雾化吸入治疗支气管哮喘急性发作的临床疗效。方法:选取我院收治的80例支气管哮喘急性发作患儿的临床资料,随机分为治疗组与对照组,两组患儿在常规治疗的基础上均采用雾化治疗,对照组患儿采用单药布地奈德雾化吸入,治疗组采用布地奈德联合特布他林联合吸入,比较两组患儿临床主要症状改善情况及相关药物不良反应。结果:治疗组患儿主要症状改善时间短,与对照组患者比较,差异有统计学意义(P<0.05);两组患儿均未见严重药物不良反应。结论:布地奈德联合特布他林雾化治疗支气管哮喘急性发作,能在短时间内改善患儿主要症状,缩短疗程,不增加药物不良反应。     

Establishment and pathological study of models of chronic ob structive pulmonary disease by SO2 inhalation method

Objective To establish rat models of chronic obstructive pulmonary disease (COPD) and study the pathological characteristics of airflow obstruction.
Method SO₂ inhalation method was used to establish rat models. After exposure to SO₂ for 7 weeks, peak expiratory flow (PEF), peak inspiratory flow (PIF), intratracheal pressure (IP) and IP slope in rat were measured by Maclab data recording and analysis system. Experimental rats with PEF less than 80% of the mean of the normal rats were classified as airflow obstructed, while those with PEF greater than 80% of mean of normal rats were non-obstructed. Pathological changes in airway and lung tissue were compared between these two groups.
Result In experimental animals, PEF was significantly decreased (P<0.005) and IP slope increased (P<0.001) as compared with normal rats. Epithelial damage, goblet cell hyperplasia and inflammatory cell infiltration in cartilaginous bronchi were more remarkable in experimental rats with airflow obstruction than those without airflow obstruction (P<0.001, <0 .01, <0.001, respectively). Furthermore, pathological changes in airway lumen, epithelium and airway wall in membranous and respiratory bronchioles were more marked in experimental rats with airflow obstruction than those without airflow obstruction (P<0.001 or P<0.05). There was a negative correlation between PEF values and epithelial hyperplasia, goblet cell hyperplasia, inflammatory cell infiltration, smooth muscle hyperplasia and mucous plug in membranous and respiratory bronchioles (P<0.001 or P<0. 05).
Conclusion SO₂ inhalation may cause chronic bronchitis with airflow obstruction, i.e. COPD in rats. COPD was induced in 64% (16 of 25) of the experimental group rats.     

Assessment and management of acute asthma in the elderly: a comparison with younger asthmatics

Assessment on admission and responses to treatment were studied in 20 patients aged 65 years or over admitted with severe acute exacerbations of asthma and were compared with patients aged 40 years or less who were managed similarly. The elderly asthmatic had less marked tachycardia and pulsus paradoxus compared to the younger group for similar degrees of airways obstruction and arterial blood gas abnormalities. Assessment confined to physical examination would, therefore, have underestimated the severity of their asthma. The rates of improvement in airflow obstruction were similar in both young and old but those elderly patients who had required maintenance oral corticosteroids were less likely to reach their predicted peak expiratory flow rate (PEFR) than their peers or younger patients.     

视觉近似评价标尺在儿童哮喘中的应用

目的介绍和评价视觉近似评价标尺（VAS）评分在儿童支气管哮喘中的应用方法和价值。方法对67例6～14岁的支气管哮喘患儿进行规范化吸入治疗前、后的自身对照,观察哮喘症状评分、VAS评分、最大呼气峰流速（PEF）及早、晚PEF测定。结果治疗后6周与12周哮喘患儿的哮喘症状评分中位数比较,差异有显著性（P〈0．05）;治疗后4周与12周哮喘患儿VAS评分中位数比较,差异有显著性（P〈0．05）;治疗后6周与12周PEF均数值比较,差异有显著性（P〈0．05）;治疗后3周PEF变异率明显下降（P〈0．05）。VAS评分与哮喘症状评分、PEF值有显著相关性。结论VAS评分法简单易行、实用方便、相对较客观且敏感,与临床症状评分有一致性,可作为哮喘患儿症状评价的一种方法和指标。     

硫酸沙丁胺醇缓释胶囊治疗儿童咳嗽变异性哮喘

目的：观察硫酸沙丁胺醇缓释胶囊（爱纳灵）治疗儿童咳嗽变异性哮喘临床症状控制的有效性、安全性.方法：采用随机开放性自身对照研究,选择2009年5月-2010年4月期间在广州医学院第一附属医院儿科门诊诊断为咳嗽变异性哮喘患儿46例,年龄范围5岁-13岁,其中男性25例,女性21例.入选者口服爱纳灵每次0.1～0.15 mg/kg,每日早、晚各1次,连续2周.观察期间,记录患儿的咳嗽日间症状评分、夜间症状评分及峰流速（PEF）监测,分别在治疗前、治疗第7天、第14天检查肺功能,记录1秒钟用力呼气量占正常预计值的百分比（FEV1％）及最高PEF占正常预计值的百分比（PEF％）,评估临床疗效评分及有效率,并记录不良反应.结果：在治疗后第7天、第14天观察点的咳嗽日间症状评分、夜间症状评分、FEV1％、PEF％、疗效分均较治疗前有明显改善,差异有统计学意义（P值均＜0.01）.临床总有效数为39例,总有效率为84.78％.在整个观察期,未发现用药不良反应.结论：爱纳灵为高选择性β2受体激动剂,在治疗咳嗽变异性哮喘中能较好地改善患儿的临床症状及肺功能,安全性较好,适用于儿童咳嗽变异性哮喘的治疗.     

Effect of the combination of two bronchodilators on breathlessness in patients with chronic obstructive pulmonary disease. A crossover clinical trial

BACKGROUND: Dyspnea is the major limiting symptom for patients with chronic obstructive pulmonary disease (COPD). This study was designed to investigate the impact of the combination of two bronchodilators on perception of dyspnea in these patients. METHODS: Twenty patients with moderate to severe COPD (age was [mean +/- standard deviation (SD)] 64 +/- 7 years, FEV1/FVC ratio was 45 +/- 11%) were randomized in a crossover, double-blind, placebo-controlled clinical trial to receive two puffs of either ipratropium bromide plus salbutamol (IB+S), IB+placebo (P), S+P, or P+P through metered dose inhalers (MDIs) daily over a 2-week period for each combination. At the end of each period, spirometry was obtained at baseline and 15, 30, 60, and 120 min after bronchodilator. Dyspnea was evaluated using a Borg scale during a 12-min walking test (12-MWT) performed at baseline and 120 min after MDIs use. In addition, the dyspnea component of the Chronic Respiratory Disease Questionnaire (CRDQ) and a diary of symptoms were used to evaluate this symptom. RESULTS: After 15 days of treatment, FEV1 improved significantly with all three combinations of MDIs containing bronchodilator agents. In comparison with placebo, significant improvement in dyspnea during 12-MWT was observed only when the combination of IB+S was used. No significant changes in CRDQ or patients' symptom diaries were observed with any combinations used. CONCLUSIONS: Combination of the two bronchodilators used in this study appears to alleviate perception of dyspnea more than use of either agent alone.     

Aerosol delivery in lung disease

Metered-dose inhalers are the preferred method of aerosol delivery under normal circumstances because of their convenient size, ease of use and better patient compliance. Where poor coordination exists a spacer device, breath-activated inhaler or powder inhalation should be used and if muscular weakness presents a problem a Haleraid should be tried. A clinical air pump with jet nebuliser is appropriate if these methods prove unsatisfactory; where wet aerosol has been shown to result in clearly superior effects; for very small children; and for the "brittle" asthmatic prone to sudden life-threatening attacks, especially patients living in isolated conditions. Regular checks on aerosol techniques and efficacy of therapy are important aspects of follow up and education of all patients with airflow obstruction.