吸入普米克令舒佐治婴幼儿喘息疗效观察

目的　观察普米克令舒雾化吸入佐治婴幼儿喘息的疗效。方法　将 5 0例有喘息症状的婴幼儿随机分两组 ,两组均在综合治疗基础上 ,观察组加入普米克令舒雾化吸入 ,对照组加入地塞米松雾化吸入 ,对治疗前后症状、体征持续时间、显效率参数进行比较。结果　观察组在治愈率、缩短干性口罗音及咳嗽持续时间方面均明显优于对照组 (P<0 .0 1)。结论　普米克令舒雾化吸入治疗婴幼儿喘息性疾病 ,可缩短病程 ,疗效确切 ,且方便、安全 ,可作为常规治疗     

孟鲁司特联合布地奈德治疗儿童哮喘临床疗效及对炎症因子的影响

目的 探讨孟鲁司特联合布地奈德治疗儿童哮喘临床疗效及对炎症因子的影响.方法 将116例哮喘患儿随机分入对照组与观察组,两组患儿均接受常规治疗,对照组给予布地奈德吸入,观察组患者接受孟鲁司特口服联合布地奈德吸入.比较两组临床疗效、肺功能及血清炎症因子的改变.结果 观察组显效率显著高于对照组,差别具有统计学意义（93.3% vs 78.6%,P〈0.05）;治疗后观察组FEV1预计值及PEF预计值显著优于对照组（P〈0.05）;与对照组相比,观察组患者治疗后血清超敏-C反应蛋白、肿瘤坏死因子-α及白细胞介素-6（IL-6）下降更为显著（P〈0.05）.结论 孟鲁司特联合布地奈德治疗儿童哮喘可显著提高临床疗效,降低血清炎症因子水平.     

普米克令舒雾化吸入治疗小儿喘憋性肺炎疗效观察

目的观察普米克令舒雾化吸入治疗小儿喘憋性肺炎的疗效。方法将50例喘憋性肺炎的小儿随机分为两组,两组均在综合治疗基础上,观察组加入普米克令舒雾化吸入,对照组加入地塞米松雾化吸入,对治疗前后症状、体征持续时间、显效率等参数进行比较。结果观察组治愈率、缩短喘鸣音及咳嗽持续时间等方面均明显优于对照组(P<0.01)。结论普米克令舒雾化吸入治疗小儿喘憋性肺炎,可缩短病程,疗效确切,且方便、安全,临床可推广为常规治疗。     

Six-week trial of nebulized flunisolide nasal spray: Efficacy in young children with moderately severe asthma

This study evaluated the clinical efficacy of nebulized flunisolide nasal solution (Nasalide®) in young children with moderately severe asthma. Twenty-two asthmatic children, ages 12–72 months, completed this double-blind placebo-controlled study. After a 6-week observation period, 18 patients were paired according to asthma severity. One child from each pair was randomized to flunisolide, the other to placebo; 4 patients were independently randomized. Placebo or drug was then administered for 6 weeks. Throughout the study, symptoms, drug usage, and analog scales reflecting asthma severity and family disruption were recorded in a diary. Multiple regression analysis was used to compare the flunisolide and placebo groups in regard to the amount of improvement demonstrated from the observation to the active periods of the study. Analog scores of asthma severity and family disruption, albuterol aerosol use, and systemic corticosteroid use fell roughly 40% from baseline in the flunisolide group. This improvement was significant compared to the placebo group. We conclude that 1 ml (250 μg) of nebulized flunisolide nasal spray solution, administered three times daily, reduced the severity of asthma symptoms, and the need for both albuterol aerosol and systemic corticosteroid therapy in young children with moderately severe asthma during a 6-week trial. Longer term studies are warranted. Pediatr. Pulmonol. 1997; 24:397–405. © 1997 Wiley-Liss, Inc.     

Role of budesonide as maintenance therapy for children with asthma

Asthma is a chronic inflammatory disease of the airways. Inhaled corticosteroids are recognized as the preferred long-term control medication for persistent asthma based on their anti-inflammatory properties and significant evidence of efficacy. Inhaled budesonide is the most carefully characterized inhaled corticosteroid for childhood asthma. It is available for administration in children down to six months of age and to date has an excellent safety profile.     

Placebo-controlled study of montelukast and budesonide on short-term growth in prepubertal asthmatic children

BACKGROUND: Inhaled corticosteroids and anti-leukotriene agents are widely used in the treatment of pediatric asthma. Although data on the effect of corticosteroids on growth are available, there are few such data on anti-leukotriene agents. The aim of this study was to assess the influence of montelukast on short-term lower leg growth rate (LLGR) in prepubertal children with asthma. METHODS: Forty-two boys (6- to 12-year old) and 29 girls (6- to 11-year old) with mild asthma were randomized to 1 of 2 crossover arms, with two treatment sequences per arm: montelukast 5 mg once daily/placebo or inhaled dry powder budesonide 200 microg twice daily/placebo. Budesonide was used as a positive control to ensure that the method was sensitive enough to detect a suppression of LLGR. The 3-week double-blind treatment period was followed by a 3-week washout. Primary outcome was LLGR over the 3-week treatment, measured by knemometry. RESULTS: Ninety-four percent of patients completed the study. Mean LLGR was similar between patients receiving montelukast and placebo treatments: mean difference, -0.02 mm/week [95% confidence interval -0.14, 0.11]. Mean LLGR in patients receiving budesonide was significantly less than for those receiving placebo (difference of -0.16 mm/week [-0.25, -0.06], P = 0.002). Mean LLGR was similar for patients taking placebo in the two arms (0.43 and 0.44 mm/week). CONCLUSION: Montelukast 5 mg did not significantly affect short-term LLGR in prepubertal children.     

吸入布地奈德混悬液辅治小儿支原体肺炎的疗效观察

目的研究阿奇霉素静脉滴注联合布地奈德混悬液雾吸治疗肺炎支原体肺炎（MPP）的疗效观察。方法 2007年1月至2008年3月在吴江市第一人民医院儿科病房住院并确诊为MPP的患儿150例为研究对象,随机分为治疗组、对照组。对照组按传统治疗方案予静脉滴注阿奇霉素抗感染;治疗组在上述综合治疗基础上,加用布地奈德混悬液吸入治疗,观察所有入组患儿临床症状、体征消失及住院时间。结果在缓解发热、咳嗽及住院时间方面,两组差异具有统计学意义（P〈0.01）;在肺部湿啰音吸收方面治疗组好于对照组,但两组相比差异无统计学意义;肺部X线影像恢复时间两组相比差异无统计学意义（P〉0.05）。结论阿奇霉素静滴抗感染联合布地奈德混悬液雾吸,较单用阿奇霉素静滴治疗在缓解临床症状方面具有较显著疗效,且方法简便,患儿依从性好,可在基层医院推广。     

布地奈德吸入治疗儿童咳嗽变异性哮喘的疗效研究

目的探讨布地奈德吸入治疗儿童咳嗽变异性哮喘的临床疗效和安全性。方法将60例咳嗽变异性哮喘患儿随机分为观察组30例和对照组30例,观察组采用布地奈德气雾剂,一日200～600μg,分2～4次使用;对照组采用丙酸氟替卡松气雾剂,一日100～500μg,分2次使用。两组疗程均为6d,然后比较两组患儿的治疗效果及安全性。结果观察组和对照的有效率分别为97.67%和76.67%,两组间差异存在显著性（P〈0.05）。两组患者治疗期间均未发生明显不良反应。结论布地奈德吸入治疗儿童咳嗽变异性哮喘安全有效,值得临床推广应用。     

布地奈德联合沙丁胺醇雾化吸入对支气管哮喘急性发作的疗效观察

目的观察布地奈德联合沙丁胺醇雾化吸入对支气管哮喘急性发作的效果。方法80例患者随机分为两组,试验组40例予布地奈德联合沙丁胺醇雾化吸入,对照组40例仅予沙丁胺醇雾化吸入,观察用药前及治疗后15min、第3天和第7天症状改善。结果试验组治疗15min后心率、呼吸频率、治疗第3天、第7天症状评分均较治疗前明显改善（P〈0．05）。结论布地奈德联合沙丁胺醇雾化吸入对支气管哮喘急性发作治疗有效。     

布地奈德混悬液吸人治疗慢性阻塞性肺疾病急性加重期的临床观察

目的 探讨雾化吸入布地奈德混悬液治疗慢性阻塞性肺疾病（COPD）急性加重期患者的疗效。方法 40例COPD急性加重期患者随机分成治疗组和对照组各20例，分别给予布地奈德混悬液及全身性应用糖皮质激素。观察2组治疗前后呼吸困难、肺功能、动脉血气变化及副作用的情况。结果 治疗组和对照组治疗前后的呼吸困难、肺功能、动脉血气变化均差异无显著性，雾化吸入布地奈德混悬液治疗组的副作用明显少于全身应用糖皮质激素的对照组。结论 雾化吸入布地奈德混悬液是治疗COPD急性加重期患者安全有效的方法，值得推广。     

Effects of budesonide/formoterol combination therapy versus budesonide alone on airway dimensions in asthma

Background and objective: Combination therapy with inhaled corticosteroids and long‐acting β₂‐agonists results in improved asthma symptom control compared with the use of inhaled corticosteroids alone. However, the effects of combination therapy on structural changes and inflammation of the airways are still unknown. The aim of this study was to compare the effects of budesonide/formoterol with those of budesonide alone on airway dimensions and inflammation in individuals with asthma. Methods: Fifty asthmatic patients were randomized to treatment with budesonide/formoterol (200/6 µg, two inhalations bd) or budesonide (200 µg, two inhalations bd) for 24 weeks. Airway dimensions were assessed using a validated computed tomography technique, and airway wall area (WA) corrected for body surface area (BSA), percentage WA (WA%), wall thickness/Ösquare root BSA, and luminal area (Ai)/BSA at the right apical segmental bronchus, were measured. The percentage of eosinophils in induced sputum, pulmonary function, and Asthma Quality of Life Questionnaires (AQLQ) were also evaluated. Results: There were significantly greater decreases in WA/BSA (P < 0.05), WA% (P < 0.001) and wall thickness/square root BSA (P < 0.05), and increases in Ai/BSA (P < 0.05), in subjects treated with budesonide/formoterol compared with those treated with budesonide. The reduction in sputum eosinophils and increase in per cent of predicted forced expiratory volume in 1 s (FEV₁%) were greater for subjects treated with budesonide/formoterol compared with those treated with budesonide alone. In the budesonide/formoterol group, the changes in WA% were significantly correlated with changes in sputum eosinophils and FEV_1% (r = 0.84 and r = 0.64, respectively). There were improvements in the AQLQ scores after treatment with budesonide/formoterol. Conclusions: Budesonide/formoterol combination therapy is more effective than budesonide alone for reducing airway wall thickness and inflammation in individuals with asthma.     

Replacement of conventional glucocorticoids by oral pH-modified release budesonide in active and inactive Crohn's disease: results of an open,prospective, multicenter trial

Glucocorticosteroids (GCS) are established in the treatment of active Crohn's ileitis and ileocolitis. Recently, the topical steroid budesonide was found to be effective in untreated patients with Crohn's disease (CD) causing less side effects than conventional GCS. No clinical data have been reported about the effects of switching from conventional GCS to budesonide in terms of side effects and disease activity. The primary aim of this study was to evaluate the development of side effects after switching from conventional GCS treatment to Eudragit L-coated budesonide (pH-modified release formulation) in patients taking 5–30 mg prednisolone equivalent per day for at least two weeks. In all, 178 patients with active CD (N = 88) or CD in remission during GCS treatment (N = 90) were included. Conventional GCS treatment was tapered down during a maximum of three weeks, with simultaneous intake of 3 × 3 mg budesonide. Thereafter, patients received 3 × 3 mg budesonide alone for six weeks. GCS-related side effects, disease activity and adverse events were documented at study entry and after 0, 2, 4, and 6 weeks of budesonide treatment. The percentage of patients with GCS-related side effects decreased from 65.2% (intention-to-treat-population) at entry to 43.3% (P < 0.0001) at the end of the trial. The total number of GCS-related side effects decreased significantly from 269 to 90. Of the patients who entered the study with active disease under conventional GCS therapy, 38.6% were in remission at the end of the study. Of the patients who entered the study with CD in remission, 78% stayed in remission after switching from conventinal GCS to budesonide. In conclusion, switching from conventional GCS treatment to budesonide leads to a significant reduction of GCS related side effects in patients with CD without causing rapid deterioration of the disease.     

Budesonide suspension nebulization treatment in Chinese pediatric patients with cough variant asthma: a multi-center observational study

Objective: To describe the impact of nebulized budesonide inhalation suspension (BIS) on guardian-reported symptoms in Chinese pediatric patients with cough variant asthma (CVA).

Methods: This was a secondary analysis of a prospective, non-interventional study conducted at 39 Chinese sites. Patients with CVA aged?≤5 years were classified according to the severity of baseline symptoms: mild (symptom score?≤3) or severe (symptom score?>3). Daytime and night-time symptom scores, disease control, use of bronchodilators, and improvements in symptoms control were compared after 1, 3, 5 and 7 weeks of treatment between groups. Results: Among 914 patients, 821 (89.8%) completed the 7-week treatment. Among all patients, 368 (40.3%) were classified as mild CVA and 529 (57.9%), as severe CVA. Symptom scores in the severe group were higher than those in the mild group at weeks 1, 3, and 5 (p?< 0.05), but not at week 7 (p?> 0.05). Further, more patients in the mild group achieved disease control at any time point (98.6% at 3 weeks and 99.7% at 7 weeks), compared with the patients in the severe group (p?< 0.001). The proportion of patients requiring bronchodilators differed between the groups until week 5 (p?< 0.001). No severe or drug-related adverse events were reported. Conclusions: Individualized BIS treatment should be formulated according to the severity of baseline symptoms in CVA patients. Patients with mild CVA showed improvement after a shorter treatment time, while patients with severe CVA might require a longer time to respond to the treatment.     

布地奈德混悬液对慢性阻塞性肺疾病急性加重期的疗效观察

目的观察布地奈德混悬液（普米克令舒）雾化吸入治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床疗效与安全性。方法 70例AECOPD的患者随机分为两组,普米克令舒雾化吸入治疗组及全身激素组,对两组的临床症状及肺功能检查进行评价。结果两组都明显改善患者的临床症状及肺功能指标,观察组对血糖的影响更小。结论普米克令舒雾化吸入治疗AECOPD的疗效明显,不良反应少。     

Acute effect of nebulized budesonide in asthmatic children.

The acute anti-inflammatory effects of inhaled steroids at high doses and their use at home and as emergency treatment of acute asthma attacks in children have been evaluated in many clinical studies. However very little is known about their additional bronchodilator response to systemic steroids plus nebulized salbutamol in the early management in children. Asthmatic patients aged between 5-15 years were investigated in a double-blind, placebo-controlled fashion. Both the study group (Group I) and the control group (Group II) received three consecutive doses of nebulized salbutamol (0.15 mg/kg/dose) and one dose of parenteral methylprednisolone (1 mg/kg/dose, intramuscularly). After this treatment, nebulized budesonide (1 mg/dose) was administered to patients in the study group and placebo (nebulized saline) was administered to patients in the control group. Pulmonary index scoring and peak flow meter was performed to both groups before and after the treatment. There were twelve patients in Group I (mean age: 7.90 +/- 2.34 years) and fourteen patients in Group II (mean age: 9.36 +/- 2.55 years). There was no difference between the two groups with respect to age (p = 0.1421), gender (p = 1.000) and inhaled steroid prophylaxis rate (p = 0.2177). No statistically significant difference was detected between the two groups with respect to the pulmonary index score (p = 0.3528). Yet, there was a statistically significant difference between the two groups with respect to the increase in PEFR (p = 0.0155). The positive acute effect of nebulized budesonide in addition to systemic steroids and nebulized salbutamol in improving the spirometric indices in asthmatic children is an encouraging finding for further investigations of its routine use in the pediatric emergency department.     

Addition of montelukast versus double dose of inhaled budesonide in moderate persistent asthma

BACKGROUND: Although current guidelines suggest the use of inhaled corticosteroids as the first line therapy in persistent asthma, the concerns about high-dose corticosteroids may limit their usage. We aimed to investigate the efficacy of inhaled budesonide plus oral montelukast versus a double dose of inhaled budesonide. METHODOLOGY: Thirty patients with moderate asthma took part in the study. Following a 2-week run in period, the patients were randomized into two groups to receive 400 microg/day of inhaled budesonide plus 10 mg/day of montelukast (BUD + M group) or 800 microg/day of inhaled budesonide (high BUD group). The patients were evaluated at 2-week intervals (during a total treatment period of 6 weeks) for symptom scores, asthma exacerbations, lung function, use of short-acting beta2 agonist, blood eosinophil counts and adverse events. RESULTS: At the end of the study, morning and daytime symptom scores were significantly reduced within the groups. Although there was a significant decrease in the frequency of short-acting beta2 agonist use in the BUD + M group, the decrease in the high BUD group was not significant. During the study period, no patient in either group experienced an asthma exacerbation. Blood eosinophil levels significantly declined in both the BUD + M (0.87 +/- 0.31%) and high BUD groups (0.67 +/- 0.29%) as compared with baseline levels (BUD + M = 2.60 +/- 0.65%, high BUD group = 2.60 +/- 0.47%; P < 0.05). CONCLUSION: Our results suggest that the addition of montelukast to low-dose inhaled budesonide is as effective as a double dose of inhaled budesonide in asthma control.     

盂鲁司特联合布地奈德治疗咳嗽变异型哮喘的临床观察

目的探讨苏盂鲁司特钠联合布地奈德气雾剂对咳嗽变异型哮喘(CVA)的临床治疗作用。方法 81例符合咳嗽变异性哮喘诊断标准的患者随机分为观察组42例,给予布地奈德气雾剂吸入和盂鲁司特钠口服。对照组39例,给予布地奈德气雾剂吸入。观察治疗前、治疗4周后血清总Ig E、外周血嗜酸性粒细胞计数(EOS)、肺活量(FVC)、最大呼气峰流速(PEF)的变化。结果治疗前两组患者IgE、EOS、FVC、PEF比较,差异无统计学意义(P0.05)。治疗4周后,观察组IgE、EOS比对照组明显下降(P0.05);FVC、PEF明显提高(P0.05)。结论盂鲁司特钠联合布地奈德气雾剂吸入治疗咳嗽变异型哮喘疗效显著、不良反应较少,明显改善哮喘、咳嗽等临床症状。     

Hypoglycemia due to adrenal suppression secondary to high-dose nebulized corticosteroid

High-dose inhaled corticosteroids, greater than 400 mcg per day of beclomethasone dipropionate or equivalent, can cause adrenal insufficiency, but a hypoglycemic crisis has not been reported with the use of nebulized corticosteroids. We describe a 21-month-old asthmatic boy who had a hypoglycemic seizure during a proven acute adrenal crisis secondary to high-dose nebulized budesonide treatment.