支气管哮喘的现代治疗药物

支气管哮喘是一种慢性气道变应性炎症,目前的治疗主要包括吸入型糖皮质激素（ICS）、β2受体激动剂、茶碱类、抗白三烤类药物和免疫治疗等。其中糖皮质激素是一线治疗用药,ICS和吸入型长效β2受体激动剂（LABA）由于不良反应较小,近年来在临床上应用越来越广泛。联合使用ICS和LABA,可以减少支气管哮喘急性发作次数,减少ICS和短效β2受体激动剂用量,提高患者的生活质量。     

吸入糖皮质激素联用β_2-受体激动剂治疗中度持续性哮喘的临床观察

吸入性糖皮质激素（ICS）是治疗缓解期中度持续性哮喘最常用和最重要药物,临床已证实,ICS可有效防止各种类型哮喘发作,是目前防治慢性哮喘最有效药物。但目前对中度持续性哮喘治疗方案,特别是ICS和长效β2-受体激动剂（LABA）是否应联用有较多争议,本研究基于此点,探讨吸入型糖皮质激素（ICS）和长效β2-受体激动剂（LABA）联用治疗中度持续性哮喘的临床疗效,结果如下。     

哮喘的药物治疗

目的：介绍合理应用治疗哮喘药物的一些基本原则。方法：讨论治疗哮嚅药物,包括抗炎药（糖皮质激素、色甘酸钠、白三烯拮抗药）,支气管扩张药（β2受体激动药、茶碱、抗胆碱药）,抗过敏药（酮替芬）,特异性免疫治疗,免疫调节药和中药的临床应用。结果：吸入治疗是最好的方法,糖皮质激素类抗炎药是治疗和预防哮喘的首选药物。结论：合理使用抗哮喘药物应考虑包括哮喘发作期和缓解期在内的许多因素。     

糖皮质激素治疗支气管哮喘

支气管哮喘为慢性炎症性疾病,糖皮质激素(GCS)仍然为临床哮喘包括慢性哮喘和哮喘急性发作最有效的治疗药物.吸入型糖皮质激素(ICS)可考虑用作慢性持续性哮喘的一线治疗.ICS联合长效β2受体激动剂(LABA)控制哮喘的效果优于单纯增加ICS剂量.本文阐述ICS和ICS/LABA在轻、中度持续性哮喘治疗中的临床地位,以及哮喘急性发作时全身用GCS的效果.     

吸入单一激素3个月治疗轻中度支气管哮喘的临床研究

<正>哮喘是世界范围内严重威胁公共健康的一种主要慢性疾病,其中多数为轻中度持续性哮喘[1]。在治疗药物中,糖皮质激素是目前控制支气管哮喘气道炎症最有效的药物,而吸入治疗是首选的用药方法[2]。虽然近年来长效β2受体激动剂(LABA)联合吸入糖皮质激素(ICS)得到了逐步广泛的应用,但单一吸入激素并按需使用短效β2受体激动剂对轻中度慢性持续期哮喘患者也是常用的治疗方法。布地奈德是一种常用单一吸入激素,现以布     

支气管哮喘的常用药物分析

目的探讨支气管哮喘的临床常用药物。方法药物是治疗哮喘的主要手段。目前临床常用治疗哮喘的药物有糖皮质激素、支气管舒张药物、抗白三烯和抗过敏等药物。结果控制气道炎症和哮喘发作首选糖皮质激素,其次为白三烯受体拮抗药,两者合用有协同作用。结论缓解哮喘发作症状可选用支气管舒张药,预防哮喘发作可选用白三烯受体拮抗约、色甘酸钠、酮替芬等。通过抗炎作用使哮喘维持临床控制。     

妊娠合并支气管哮喘急性发作的发病特点及治疗原则探析

目的妊娠合并支气管哮喘急性发作的特点及治疗原则的探讨。方法回顾性分析44例妊娠合并支气管哮喘急性发作患者的临床资料。结果 40例应用了β受体激动剂和糖皮质激素、补液、纠正水电解质、平衡等去治疗妊娠合并支气管轻、中度哮喘急性发作患者吸氧疾病,严重的并发症没出现,母婴预后良好。4例重度及危重哮喘急性发作患者,经综合治疗,包括半卧位、吸氧、补液、纠正酸碱电解质平衡、应用β受体激动剂和糖皮质激素、广谱抗生素、氨茶碱等药物等等,仍发生了1例呼吸性酸中毒,呼吸性酸中毒并代谢性碱中毒出现2例,发生了2例胎儿生长受限。结论部分哮喘患者出现急性发作并病情加重会受到妊娠的影响,对重度及危重哮喘急性发作患者,主要处理原则是综合治疗,包括以半卧位、吸氧、补液、纠正酸碱电解质平衡、应用β受体激动剂和糖皮质激素、广谱抗生素、氨茶碱等.     

2006年全球哮喘防治创议(GINA)解读

哮喘是由多种细胞包括气道的炎性细胞和结构细胞(如嗜酸粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、平滑肌细胞、气道上皮细胞等)和细胞组分(cellular elements)参与的气道慢性炎症性疾病。治疗哮喘的药物可以分为控制药物和缓解药物。(1)控制药物:指需要长期每天使用的药物。这些药物主要通过抗炎作用使哮喘维持临床控制,包括吸入糖皮质激素(ICS)全身用激素、白三烯调节剂、长效肾上腺素β_2受体(β_2受体)激动剂(LABA,须与ICS联合应用)、缓释茶碱、色苷酸钠、抗IgE抗体及其他有助于减少全身激素剂量的药物等;(2)缓解药物:指按需使用的药物。这些药物通过迅速解除支气管痉挛从而缓解哮喘症状,包括速效吸入β_2受体激动剂(SABA)、全身用激素、吸入性抗胆碱能药物、短效茶碱及短效口服SABA等。激素是最有效的控制气道炎症药物,吸入为首选途径,局部抗炎作用强,药物直接作用于呼吸道,所需剂量较小。ICS是长期治疗哮喘的首选药物,常用ICS见表1。     

老慢支哮喘吸入药物有讲究

慢性阻塞性肺病（俗称老慢支）治疗以长效抗胆碱药为主。可联合应用吸入糖皮质激素和长效β2受体激动剂。哮喘治疗以吸入糖皮质激素和长效β2受体激动剂为主。抗胆碱药为辅。     

门诊哮喘患者吸入药物使用情况分析

目的了解门诊哮喘患者吸入药物使用情况。方法对2010年1月~2010年10月的门诊哮喘患者进行吸入药物使用情况分析,了解吸入糖皮质激素及β2受体激动剂的比例。结果单用糖皮质激素的比例为15.6%,吸入糖皮质激素加长效β2激动剂的比例为11.3%,吸入糖皮质激素加短效β2激动剂的比例为35.0%,未接受吸入治疗患者的比例占33.1%。结论吸入治疗的接受度已经有较大改善,但距离哮喘控制的要求还有较大差距。哮喘规范化诊治的推广任重而道远。     

Asthma, asthma medications and their effects on maternal/fetal outcomes during pregnancy

Maternal asthma may increase the risk of adverse fetal and maternal outcomes such as low birth weight, perinatal mortality, preterm birth, preeclampsia, hypertensive disorders, maternal mortality, uterine hemorrhage, and gestational diabetes. Controlling asthma during pregnancy with appropriate medications leads to improved intrauterine growth of the fetus and fewer adverse perinatal outcomes. Prospective population or birth cohort studies have shown that the medications used to treat asthma, such as bronchodilators (short-acting β2-agonists) and controller medications (inhaled corticosteroids, cromones, theophylline, leukotriene inhibitors), have no or minimal effects on fetal growth, and perinatal complications are reduced when maternal asthma is adequately controlled. However, taking oral corticosteroids during pregnancy may confer increased risk of lower birth weight and congenital malformations. Therefore, managing pregnant asthmatics requires a careful benefit–risk analysis, and when indicated, the benefits of a medication that may have increased risks can dictate its use in severe uncontrolled asthma.     

Recent advances in corticosteroids for the treatment of asthma

The currently available therapy for asthma is highly effective and is able to control the disease in the majority of patients. There are two types of treatments for asthma: rapid relief of symptoms, used as needed and long-term control, used on a regular basis. Rapid relief is provided by short-acting beta2-agonists and anticholinergics. The control of asthma is achieved by treatment with inhaled corticosteroids (ICS), theophylline, long acting beta2-agonists and antileukotrienes. Beta2-agonists and corticosteroids dominate asthma therapy, with over 65% of the market share. Corticosteroids are the most effective drugs available to clinicians for the control of inflammation in patients with asthma. ICS have revolutionized the treatment of asthma and are now the first-line treatment for chronic asthma in all ages.     

低分子肝素钠在心脏病换瓣术后妊娠早期的应用探讨

目的探讨低分子肝素钠在心脏病换瓣术后妊娠早期的应用。方法本文选取55例心脏病换瓣术后孕妇,在妊娠早期使用低分子肝素钠进行抗凝治疗（简称治疗组）,并随机选取55例心脏病换瓣术后孕妇,在妊娠早期使用华法林作为对照（简称对照组）。结果治疗组55例,发现胎儿畸形2例,发生率3．63％;自然流产4例,发生率7．27％抗凝效果良好45例,占81．81％,1例出现心脏瓣膜功能障碍而重新换瓣并终止妊娠,发生率1．81％,。对照组55例,发现胎儿畸形8例,发生率14．55％;自然流产12例,发生率21．81％;抗凝效果良好53例,占96．36％;未发现心脏瓣膜功能障碍病例。两组在胎儿畸形和自然流产比较,差异有显著性（P〈0．05）。结论心脏病换瓣术后妊娠早期抗凝剂选用低分子肝素钠胎儿致畸率及自然流产相对较低,但抗凝效果及导致孕妇心脏瓣膜功能障碍华法令稍优于低分子肝素钠。故心脏病换瓣术后患者在妊娠早期抗凝剂选择用低分子肝素可以降低胎儿畸形率及自然流产率,对母婴无明显副作用,是一种安全、有效的药物。     

Asthma therapy during pregnancy

Numerous pregnant women suffer from asthma and the use of asthma medications during pregnancy may be a necessity. Although some information is known about the effects of asthma medications during pregnancy, there is still a significant amount of information to learn and particular attention is required when prescribing drugs to these patients. In addition, physiological changes associated with pregnancy may affect airway responsiveness in some individuals. Guidelines on the management of asthma are published regularly, the most popular being the Global Initiative for Asthma (GINA), and medication can be prescribed during pregnancy when the apparent benefit of the drug is greater than the apparent risk. Usually, there is at least one 'safe' drug from each major class used to control symptoms. We will review the current literature on this subject.     

新疆地区支气管哮喘控制现状及对疾病认知程度的调查

目的 了解新疆地区支气管哮喘（简称哮喘）控制现状以及各级医院医生及患者对哮喘的认知程度,为新疆持续的哮喘规范化诊治推广工作提供理论依据.方法 对新疆地区56家不同级别医院共485名呼吸内科或内科医师及参加当日哮喘病友会与义诊活动的622例哮喘患者进行哮喘相关知识问卷调查.56家医院中三级医院5家,内科医师37名;二级医院14家,内科医师185名;一级医院19家,内科医师263名.问题涉及哮喘本质、一线控制药物、急性发作首选药物、吸入装置使用方法、哮喘的监测方法及长期管理与教育等.结果 达到控制水平的哮喘患者比例为2.9％ （18/622）,未控制的哮喘患者中合并过敏性鼻炎者占70.3％ （303/431）;认识到哮喘的本质为气道慢性炎症的医师占79.6％（386/485）,患者占32.8％ （204/622）;认识持续期哮喘每日规律使用的一线治疗药物为吸入激素的医师占54.7％（266/485）,患者占26.5％（165/622）;哮喘急性发作首选短效β2受体激动剂急救的医师占47.2％（229/485）,患者占27.7％（172/622）;了解并会使用几种常用吸入装置的医师占42.5％（206/485）,患者占17.8％（111/622）;了解监测方法的医师占37.9％（184/485）,患者占6.3％（39/622）;有16.7％（104/622）的哮喘患者在过去1年中进行过肺功能测定;了解峰流速仪的医师占27.4％（133/485）,拥有峰流速仪的患者占3.5％（22/622）,每日规律使用峰流速仪患者占0.3％（2/622）;为患者制定长期治疗计划的医师占54.6％（265/485）;参加过哮喘教育或培训的医师占52.0％（252/485）,患者仅占19.3％（120/622）.上述问题在一、二级及三级医院间差异均有统计学意义（均P＜0.05）.结论 新疆哮喘控制水平仍较低,应加强基层医师与患者教育的广度与深度,持续大力推广新疆哮喘规范化诊治工作.     

Teriflunomide: a novel oral treatment for relapsing multiple sclerosis

Numerous pregnant women suffer from asthma and the use of asthma medications during pregnancy may be a necessity. Although some information is known about the effects of asthma medications during pregnancy, there is still a significant amount of information to learn and particular attention is required when prescribing drugs to these patients. In addition, physiological changes associated with pregnancy may affect airway responsiveness in some individuals. Guidelines on the management of asthma are published regularly, the most popular being the Global Initiative for Asthma (GINA), and medication can be prescribed during pregnancy when the apparent benefit of the drug is greater than the apparent risk. Usually, there is at least one ‘safe’ drug from each major class used to control symptoms. We will review the current literature on this subject.     

肺部吸入给药制剂及临床应用

目的:分析和综述肺吸入制剂的分类、现状及其临床用药。方法:收集国内外发表出版的相关论文及专著,对肺部吸入给药的特点及临床药物制剂进行了分析总结。结果与结论:肺部吸入给药是防治哮喘、慢性阻塞性肺病等呼吸道疾病的首选给药方式。常见的吸入给药制剂包括定量吸入气雾剂、干粉吸入剂和雾化吸入剂,所用药物主要为β2受体激动剂、抗胆碱药物、吸入性糖皮质激素及复方药物等。     

吸入糖皮质激素联合小剂量茶碱与联合白三烯调节剂治疗5岁以下儿童哮喘的效果比较

目的比较吸入糖皮质激素（ics）联合小剂量茶碱与联合白三烯调节剂治疗5岁以下儿童哮喘的临床效果。方法将90例中度持续性哮喘患者按照随机原则分为ICS＋茶碱组和ICS＋孟鲁司特钠组,每组各45例。两组均常规吸人丙酸氟替卡松,ICS＋茶碱组加用口服缓释茶碱片6mg／（kg·d）,分两次服;ICS＋孟鲁司特组加用口服孟鲁司特钠,1次／d,4mg／次,两组疗程均为6个月。结果治疗3个月及6个月后,两组的H间症状评分、夜间症状评分、ACT评分与治疗前比较,差异有统计学意义（P〈0．05）,两组的上述指标比较,差异无统计学意义（P〉0．05）。结论吸人丙酸氟替卡松联合小剂量茶碱与联合白三烯调节剂治疗5岁以下儿童哮喘的效果相当。     

Pharmacotherapies to enhance smoking cessation during pregnancy

Smoking during pregnancy is a significant public health concern. Maternal smoking increases the risk of spontaneous abortion, low birth weight, premature delivery, sudden infant death syndrome and learning and behavioral problems in the offspring. Unfortunately, the majority of pregnant women do not quit smoking during pregnancy. Although pharmacotherapy may improve smoking cessation rates in pregnancy, very few studies exist that have studied the safety and efficacy of medications to treat pregnant smokers. This article reviews the available safety and efficacy data for the use in pregnancy of the five first-line therapies and two second-line therapies that are recommended for smoking cessation in non-pregnant smokers. Other promising nicotine replacement therapies are also reviewed. Ultimately, the choice whether to use pharmacotherapy for smoking cessation should be made jointly by the pregnant smoker and her health care provider. This article reviews factors that may be considered when prescribing pharmacotherapy to pregnant smokers (i.e. the role of behavioral counseling, identification of appropriate patients, potential advantages and disadvantages of each of the pharmacotherapies, proposed monitoring strategies, dose and duration and goals of treatment). More research regarding the safety and efficacy of pharmacotherapy during pregnancy is needed to define the risk/benefit profile of each medication for use in smoking cessation in pregnant women. [Oncken CA, Kranzler HR. Pharmacotherapies to enhance smoking cessation during pregnancy. Drug Alcohol Rev 2003;22:191 - 202]     

Use,attitudes and knowledge of medications among pregnant women: A Saudi study

Objective

Medication use during pregnancy is a major concern for most women. The aim of the present study was to assess medication use, knowledge and beliefs about medications among pregnant women in Saudi Arabia.

Methods

More than 760 pregnant women, attending the obstetric clinic, filled a semi-structured questionnaire. Data were collected about their sociodemographic background, medication use during pregnancy, medication/pregnancy risk awareness, sources of drug information and beliefs about medications.

Results

Most women had a positive attitude toward medications in general but they believed pregnant women should be more cautious regarding drug-use during pregnancy. A significant association was found between participants’ education and occupation, and beliefs about medications. In this context, well educated women and those working in a health-related career demonstrated more correct beliefs about medications. Women with health-related occupations were more knowledgeable about the life saving effect of drugs on unborn children. Women indicated inadequate provision of drug-related information from physician and pharmacist; they rely on medication pamphlet to get such information. The most frequently used drugs were paracetamol and vitamins (13.2%). Most pregnant women (59.2%) were able to identify drugs to-be avoided in pregnancy that agreed roughly with FDA categories with 23 hits out of 32. They indicated that newborn anomalies (6.5%) were not attributed to drug-use during pregnancy.

Conclusion

During pregnancy, women were more conservative and skeptic toward medication, health-care professionals should be aware of such attitudes when advising pregnant women to take medication.