Absence of a late-phase response or increase in histamine responsiveness after bronchial provocation with adenosine 5'-monophosphate in atopic and non-atopic asthma

1. Adenosine 5'-monophosphate (AMP) causes bronchoconstriction in atopic and non-atopic asthma by a mechanism believed to involve histamine release from airway mast cells. To determine whether preformed mast cell mediators, principally histamine, can initiate a late-phase bronchoconstriction we have investigated the effect on the airways over a 24 h period of a single bronchial challenge with AMP. 2. Six atopic asthmatic subjects (all late responders to inhaled allergen) and six non-atopic asthmatic subjects were studied on two occasions for a 24 h period after inhalation of the provocation concentration of AMP required to produce a 20% fall in forced expiratory volume in 1 s (FEV1) from baseline (PC20) and 0.9% (w/v) sodium chloride placebo, respectively. The atopic asthmatic subjects were studied on a further occasion after challenge with the PC20 allergen. 3. Inhalation of the PC20 AMP resulted in an immediate fall in FEV1 to a mean maximum 25.5% below baseline without resulting in any late decrease in airway calibre. No significant increase in non-specific bronchial responsiveness as determined by measuring the PC20 histamine before, and at 3, 9 and 24 h after, AMP challenge, occurred. Inhalation of the PC20 allergen caused a reproducible late-phase bronchoconstriction and increase in non-specific bronchial responsiveness in all the atopic asthmatic subjects studied. 4. These results suggest that preformed mast cell mediators, principally histamine, play no role in the initiation of the late-phase reaction in allergen-provoked asthma, although they may contribute to the inflammatory changes involved.     

炎性因子在支气管哮喘急性发作患者血清中的表达及意义

目的 探讨支气管哮喘急性发作患者血清中炎性因子的变化。方法 将支气管哮喘急性发作患者92例,根据病情严重程度分为2组,选择体检健康人作为对照,检测肺功能及血清白细胞介素（IL） 6、IL 17、肿瘤坏死因子（TNF） α、γ 干扰素(IFN γ)、转化生长因子β2（TGF β2）水平。结果 与对照组相比,哮喘组IL 6、IL 17、TNF α均明显增高,而IFN γ明显降低（P＜0.01）,3组TGF β2差异无统计学意义（P＞0.05）。哮喘严重程度与IL 6、TNF α、IL 17呈正相关（r=0.970、0.868、0.723,P＜0.05）。与FEV1/FVC及IFN γ呈负相关(r=-0.957、-0.934,P＜0.05);与TGF B2无相关性(r=0.321,P>0.05)。结论 血清炎性因子变化与哮喘的发病密切相关,对哮喘严重程度的评估具有一定的参考价值。     

支气管哮喘急性发作并发低钾血症临床分析

目的 了解支气管哮喘急性发作时并发低钾血症的发生率和临床特点。方法 回顾性分析1998～2001年收住入院的哮喘急性发作患者并发低钾血症的病例。结果 哮喘急性发作患者97例 ,并发低钾血症45例 ,发生率高达46.4%。在哮喘急性发作及其治疗过程中 ,存在多种原因可导致低钾血症 ,但其临床表现缺乏特异性而易漏诊。 结论 哮喘急性发作时并发低钾血症的发生率高 ,具有潜在危险性 ,需要提高警惕 ,及时防治。     

Treatment of nocturnal asthma in children with a single dose of sustained-release theophylline taken after supper

In a placebo-controlled, double-blind cross-over study of 2 X 3 weeks' duration, twenty-four children with stable asthma who were wheezing during the night, were treated with a single dose of sustained-release theophylline (SRT) taken after supper. The mean serum theophylline levels 4 and 12 hr after dosing were 7.7 and 11.2 mg/l, respectively. Few side-effects were seen. The mean morning peak expiratory flow (PEF) was significantly higher during SRT treatment (244 +/- 11 1/min) than during placebo treatment (207 +/- 121/min) (P less than 0.001). The mean difference between morning and evening PEF was reduced from 20.7 to 8.6% by treatment with SRT (P less than 0.001). Theophylline significantly reduced the severity of attacks of bronchoconstriction during the night as judged by PEF measurement and use of extra bronchodilator treatment per attack. The response to inhaled terbutaline was increased during SRT treatment compared with that in the placebo period, however pre-treatment PEF did differ significantly between the two periods. The number of acute asthma attacks during the night, the number of symptom-free nights and the use of extra bronchodilators during the night were all significantly improved by SRT treatment (P less than 0.001). Seventeen children correctly identified the SRT period whilst six children showed no preference for either period. A single dose of SRT taken after supper is an effective treatment for nocturnal asthma in children.     

无创正压机械通气治疗支气管哮喘急性发作合并呼吸衰竭的疗效观察

目的探讨采用无创正压机械通气治疗支气管哮喘急性发作合并呼吸衰竭的疗效。方法选取2013年1月至2014年12月首都医科大学良乡教学医院就诊的85例支气管哮喘急性发作合并Ⅱ型呼吸衰竭患者为研究对象,按数字表法随机分为观察组42例与对照组43例,两组患者采用相同的基础治疗方案,对照组患者根据病情给予面罩或鼻导管吸氧;观察组加用无创正压机械通气治疗;比较两组临床疗效,观察并记录两组患者治疗前、治疗后30 min、4 h、24 h、48 h心率(HR)、呼吸频率(RR)和动脉血气分析指标(Pa O2、Pa CO2、p H值)。采用SPSS 19.0软件进行统计分析,率的比较采用χ2检验及校正χ2检验,均数比较采用单因素方差分析及t检验。结果治疗后观察组临床疗效总有效率为90.5%,明显高于对照组的72.1%,差异具有统计学意义(χ2=4.699,P=0.030);观察组在治疗后4 h、24 h、48 h HR、RR、Pa O2、Pa CO2和p H值均显著改善(P<0.05),治疗后24 h、48 h观察组HR和RR与对照组比较均显著改善(P<0.05),治疗48 h后观察组Pa O2、Pa CO2、p H值与对照组比较均显著改善(P<0.05);观察组插管率为4.8%,与对照组(20.9%)比较差异具有统计学意义(P<0.05);观察组病死率为2.4%,与对照组(7.7%)比较差异无统计学意义(P>0.05);观察组住院时间与对照组比较显著缩短(P<0.05)。结论无创正压机械通气治疗支气管哮喘急性发作合并呼吸衰竭可显著改善患者缺氧状态及临床症状,稳定病情,效果较好。     

Changes in the lipid composition of cell membranes in patients with bronchial asthma after glucocorticosteroid therapy

Levels of phospholipids (PL) and cholesterol (CS) were measured in erythrocytic membranes (EM) of 17 bronchial asthma (BA) patients. A relationship was established between BA aggravations and elevated CS but reduced PL concentrations in EM. These parameters responded positively on day 10 of glucocorticosteroids administration. There was a good clinical effect. The changes observed may be attributed to decreasing EM viscosity improving the function of adenylate cyclase and to the action of glucocorticosteroids on phospholipase A2 by rising PL values. Some patients, in the presence of abnormal PL and CS levels, showed qualitative shifts in PL: lower proportion of sphingomyelin-containing PL. Further study of specific membrane impairment in BA promises introduction of new approaches to BA treatment.     

沙丁胺醇联合布地奈德雾化吸入疗法治疗支气管哮喘急性发作临床观察

目的探讨沙丁胺醇联合布地奈德雾化吸入疗法治疗支气管哮喘急性发作的临床应用价值及安全性。方法回顾性研究分析本院急诊内科治疗的80例支气管哮喘急性发作患者,随机均分成2组,观察组采用沙丁胺醇和布地奈德雾化吸入疗法联合治疗,对照组采用地塞米松磷酸钠注射液治疗。观察2组治疗前后的总体疗效和肺功能改善指标等。结果观察组在治疗后肺功能恢复情况和外周血的各项指标的改善情况显著优于对照组,且观察组的胸闷气短、肺哮鸣音、咳嗽等主要临床症状的持续时间显著下降。结论沙丁胺醇联合布地奈德雾化吸入疗法治疗支气管哮喘急性发作疗效确切,可快速改善哮喘急性发作症状,增强肺功能,且不良反应少,安全可靠,值得临床推广应用。     

支气管哮喘合并过敏性鼻炎的中西医结合治疗

目的研究中西医结合治疗支气管哮喘合并过敏性鼻炎的临床效果。方法随机抽取2010年1月至2011年6月间收治支气管哮喘合并过敏性鼻炎的患者100例,并随机将其分为治疗组和对照组,每组50例。对照组采用生黄芪15 g,党参12 g,白术、当归、熟地黄、茯苓各10 g,法半夏、陈皮、紫苏子各6 g,柴胡、防风、荆芥、羌活、射干、杏仁、紫菀、款冬花各5 g,麻黄4 g,白芥子、甘草各3 g,将此剂熬制后服用。治疗组是对照组的基础上采用硫酸沙丁胺醇雾化溶液雾化吸入治疗方式进行治疗。并将两组患者的过敏性鼻炎体征评分及肺功能的变化进行统计分析。结果治疗组患者通过治疗后,患者过敏性鼻炎体征评分无显著性差异(P>0.05)。治疗组患者的肺功能改善情况显著优于对照组的改善(P<0.05)。结论中西医结合联合治疗支气管哮喘合并过敏性鼻炎能够充分地改善患者的鼻炎症状,改善肺功能,促进患者的康复。     

哮喘急性发作患者的中西医结合护理

目的：护士主动积极地配合医师进行治疗、药物浓度检测和护理,减少患者哮喘急性发作并发症发生。方法：运用中西医结合的护理措施。结果：全部病例均得到及时缓解,无护理并发症及意外发生。结论：对于哮喘急性发作患者,精心治疗及护理对其病情缓解意义重大。     

Acupuncture in children and adolescents with bronchial asthma: a randomised controlled study

Objective

This randomised controlled trial evaluates the immediate effects of acupuncture as an add-on therapy in in-patient rehabilitation of children and adolescents with bronchial asthma.

Patients and methods

In a pre–post design, the severity of symptoms, lung function, illness-specific quality of life (Paediatric Asthma Quality of Life Questionnaire – PAQLQ) and general and asthma-specific level of anxiety (State-Trait Anxiety Inventory for Children – STAIC) were investigated in 46 acupuncture and 47 control patients. In addition to asthma sports, climate therapy and behavioural training, the intervention group received acupuncture treatment with a standardised needle pattern (12× 30 min.).

Results

With acupuncture, the peak expiratory flow variability differs significantly (p < 0.01) from that of the control patients’ group. Moreover, the acupuncture group differs significantly in their rehabilitation response at the time of discharge concerning perceived anxiety (STAIC-S). The lung function tests do not present differences between groups.

Conclusion

After additional acupuncture, amelioration of peak expiratory flow variability and anxiety can be shown, without any difference in objective lung function tests and quality of life between study groups. Further studies might evaluate the effects of acupuncture on childhood asthma in an outpatient setting.     

Acupuncture and bronchial asthma: a long-term randomized study of the effects of real versus sham acupuncture compared to controls in patients with bronchial asthma

BACKGROUND: Acupuncture has traditionally been used in China in the treatment of bronchial asthma and is being increasingly applied in Western countries. Although there are many published studies on acupuncture and asthma, few meet the scientific criteria necessary to prove the effectiveness of acupuncture. OBJECTIVE: To examine the short- and long-term effects of real versus sham or no acupuncture in patients with bronchial asthma. DESIGN: Randomized partially blinded study with three parallel groups. SUBJECTS: Sixty-six (66) patients of both genders (mean age, 39 years) with mild-to-moderate persistent bronchial asthma. INTERVENTIONS: After 2 weeks of run-in, the patients with asthma were randomized to receive either real (23 patients) or sham acupuncture (23 patients) or no acupuncture (20 patients). Two acupuncture periods (each 4 weeks) within the first 4 months were followed by a 6-month observation. MEASUREMENTS: Primary outcome was the change of peak expiratory flow (PEF) variability at the end of the two treatment periods. Secondary outcomes were changes in forced expiratory volume in 1 second (FEV1), airway responsiveness, symptoms of asthma, the use of asthma drugs, and patients' well-being. Moreover, the effect of the intervention on eosinophils and eosinophil cationic protein (ECP) in blood and sputum was assessed. RESULTS: PEF variability decreased in all groups. In a subgroup of patients whose asthma medication remained fairly unchanged, PEF variability decreased significantly after needling of real as well as sham points at month 4 and 5 compared to controls (p < or = 0.005). However, there was no difference in the decrease of PEF variability between patients who had the blinded treatment with real or sham acupuncture. Most of the other functional and clinical variables did not differ from those obtained in controls. Eosinophils and ECP in blood and sputum decreased in all groups, but the only significant differences were found in blood eosinophil count at 4 months between sham acupuncture and the control group (p < 0.05) and at 10 months between real and sham acupuncture (p < 0.05) suggesting a possible effect on eosinophilic inflammation. CONCLUSIONS: In view of the fact that the effects after real and sham acupuncture compared to controls who had no needling at all were small, in all likelihood clinically irrelevant, our data do not seem to support the use of acupuncture in the management of pharmacologically well-treated patients with mild-to-moderate persistent asthma.     

布地奈德福莫特罗粉吸入剂联合脾氨肽治疗支气管哮喘急性发作的效果研究

目的 观察布地奈德福莫特罗粉吸入剂联合脾氨肽治疗支气管哮喘急性发作的效果.方法 将98例支气管哮喘急性发作患者随机分为对照组和研究组,每组49例.对照组给予布地奈德福莫特罗治疗,研究组给予布地奈德福莫特罗联合脾氨肽治疗.比较2组症状改善情况、肺功能指标[第1秒用力呼气量(FEV1)、第1秒用力呼气量与肺活量的比值(FEV1/FVC)、晨间测定最大呼气峰值流速(PEFam)、晚间测定最大呼气峰值流速(PEFpm)]、辅助性T细胞1/辅助性T细胞2(Th1/Th2)漂移状况及微小RNA-146a(miR-146a)表达水平.结果 研究组憋喘、咳嗽、哮鸣音、湿啰音症状改善时间均短于对照组,差异有统计学意义(P＜0.05).治疗后,2组FEV1、FEV1/FVC、PEFam、PEFpm均高于治疗前,且研究组FEV1、FEV1/FVC、PEFam、PEFpm均高于对照组,差异有统计学意义(P＜0.05).治疗后,2组白细胞介素-2(IL-2)、γ-干扰素(IFN-γ)、Th1、Th1/Th2均高于治疗前,白细胞介素-5(IL-5)、白细胞介素-13(IL-13)、Th2均低于治疗前,且研究组IL-2、IFN-γ、Th1、Th1/Th2均高于对照组,IL-5、IL-13、Th2均低于对照组,差异有统计学意义(P＜0.05).治疗后,2组miR-146a表达水平均低于治疗前,且研究组miR-146a表达水平低于对照组,差异有统计学意义(P＜0.05).结论 布地奈德福莫特罗联合脾氨肽治疗支气管哮喘急性发作效果显著,能加快症状缓解,改善肺功能,其机制可能与逆转Th1/Th2漂移方向、下调miR-146a表达水平有关.     

Comparison of nebulised magnesium sulphate and salbutamol combined with salbutamol alone in the treatment of acute bronchial asthma: a randomised study

Objective

To test the hypothesis that combined administration of multiple doses of nebulised salbutamol and magnesium sulphate provides additional benefit compared with salbutamol alone in adult patients with acute asthma.

Design

Randomised, double blind, prospective study.

Methods

A total of 100 patients presenting to an emergency department with an acute attack of bronchial asthma were randomised to two groups: nebulisation with a combination of salbutamol and magnesium sulphate (group A) and nebulisation with salbutamol only (group B). Both groups received nebulisation thrice at intervals of 20 minutes. Salbutamol and magnesium sulphate were administered in doses of 0.5 mg and 500 mg, respectively, and the solutions were made isotonic to plasma osmolality. Pulse rate, blood pressure, and peak expiratory flow rate (PEFR) were measured at baseline and at 15, 60, 75, and 120 minutes. Serum magnesium levels and blood gases were measured at 0 and 120 minutes in both groups.

Results

All patients had either acute severe or life threatening asthma. The baseline characteristics were comparable in the two groups. Both groups showed significant rise in PEFR at all time intervals, however, there was no significant difference between the groups in rise in PEFR at any time point. Serum magnesium levels remained within normal limits, and there was no difference in requirement of additional medication during the study or hospital admission rates in both groups. No significant side effects were noted.

Conclusion

This study suggests that there is no therapeutic benefit of adding magnesium sulphate to salbutamol nebulisation in the treatment of patients with acute severe or life threatening asthma.     

沙丁胺醇联合布地奈德雾化吸入治疗支气管哮喘急性发作的临床效果

目的探讨沙丁胺醇联合布地奈德雾化吸入治疗支气管哮喘急性发作的临床效果。方法将我院2017年1月至2018年12月收治的80例支气管哮喘急性发作患者按随机数字表法分为对照组(n=40)和观察组(n=40)。对照组给予沙丁胺醇雾化吸入治疗,观察组给予沙丁胺醇联合布地奈德雾化吸入治疗。比较两组的治疗效果。结果观察组咳嗽、哮鸣音、气促缓解时间均短于对照组(P<0.05)。治疗后,两组患者的FVC、FEV1、PEF均升高,且观察组高于对照组(P<0.05)。治疗后,两组患者IL-5水平均降低、IL-10水平均升高,且观察组优于对照组(P<0.05)。治疗后,两组患者HMGB1、IgE水平及嗜酸性粒细胞计数较治疗前显著降低,且观察组低于对照组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论沙丁胺醇联合布地奈德雾化吸入治疗支气管哮喘急性发作的效果理想,其可改善患者的肺功能,减轻气道高炎症反应,不良反应轻,值得临床推广应用。     

The prophylactic treatment of bronchial asthma in children with ketotifen: a double-blind comparison with placebo

Report on a double-blind parallel group comparison of ketotifen and placebo in two groups of twenty-five children with extrinsic bronchial asthma. Duration of treatment: 12 weeks, dosage adapted to body-weight, 0.5-1 mg b.i.d. Main parameters: Overall assessment of efficacy by the treating physician, total duration and frequency of asthmatic episodes per observation period. In all parameters ketotifen was far superior to placebo in spite of decreased concomitant bronchodilator therapy. The tolerance and acceptability of the compound was good.     

An increase in the serum amylase level in patients after peroral double-balloon enteroscopy: an association with the development of pancreatitis

BACKGROUND AND STUDY AIMS: Double-balloon enteroscopy (DBE) is a novel technique that allows the enteroscope to be inserted deep into the small intestine. The procedure has been thought to be safe, but cases of acute pancreatitis after peroral DBE have recently been observed. The aim of this study was to confirm the occurrence of hyperamylasemia after peroral DBE. PATIENTS AND METHODS: Peroral DBE was carried out in 13 patients from July 2005 to February 2006. Blood samples were taken before and 3 h after the procedure, and serum pancreatic amylase levels were measured. The patients were also evaluated for pancreatic-type abdominal pain after the procedure. Hyperamylasemia after peroral DBE was defined as an elevation of the serum pancreatic amylase level to more than the upper normal limit and twice the level before the procedure. Pancreatitis was diagnosed on the basis of both pancreatic-type abdominal pain and hyperamylasemia. RESULTS: Hyperamylasemia after peroral DBE occurred in six patients (46.2 %). One of the six patients with hyperamylasemia had pancreatic-type abdominal pain after the procedure and developed acute pancreatitis. The average procedure time was 105 min (range 65 - 155 min) in the patients with hyperamylasemia, and did not significantly differ from that in the group without hyperamylasemia (99 min). CONCLUSIONS: Hyperamylasemia after peroral DBE occurs frequently and may be associated with development of pancreatitis.