急性呼吸道感染后咳嗽的治疗体会一附128例分析

目的探讨急性呼吸道感染后咳嗽的合理治疗。方法128例急性呼吸道感染后反复咳嗽患者，抗生素静脉滴注治疗3天后，未见好转者行支气管激发试验，58例气道反应性增高患者随机分成两组，A组30例采用舒弗美、氨溴索、酮替芬口服治疗，B组28例采用舒弗美、氨溴索、酮替芬口服联合必可酮吸入治疗，疗程7天，观察两组的咳嗽症状得分、气道反应性分级情况。结果常规抗感染治疗未见好转者，94％气道反应性增高；A、B两组治疗后咳嗽症状较治疗前明显减轻，气道反应性降低，均为P〈0．05；但A组与B组同期治疗相比，差异无统计学意义（P〉0．05）。结论对于感染后气道反应性增高病人，抗生素治疗无效，舒弗美、氨溴索、酮替芬可有效缓解咳嗽症状。     

支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点及意义

目的探讨支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点,以便为临床诊断提供依据。方法采用日本产ＡＳＴＯＧＡＰＨＴＣＫ６０００ＣＶ气道反应测定仪,以乙酰甲胆碱为气道激发剂,观察６０例支气管哮喘、５８例咳嗽变异性哮喘及３７例急性支气管炎患者气道反应性变化。结果支气管哮喘和咳嗽变异性哮喘病人气道激发试验均为阳性,哮喘病人的气道反应阈值（Ｄｍｉｎ）低于咳嗽变异性哮喘病人（Ｐ＜００５）。急性支气管炎病人中,气道激发试验３３例阴性,占８９％,４例阳性,占１１％。４例阳性急性支气管炎患者的气道反应性曲线与哮喘组及咳嗽变异性哮喘组明显不同,其Ｄｍｉｎ也显著高于哮喘组（Ｐ＜００１）及咳嗽变异性哮喘组（Ｐ＜００５）。结论气道反应性测定对于不同类型哮喘及急性支气管炎的鉴别和指导治疗具有很好的临床应用价值。     

小剂量罗红霉素对轻度哮喘吸烟患者治疗的影响

目的观察罗红霉素对吸烟的轻度支气管哮喘患者吸入激素疗效及气道炎症的影响。方法对36例吸烟的轻度支气管哮喘患者随机分为治疗组（A组）及对照组（B组）,B组每日吸入必可酮500μg及按需吸入万托林,A组在B组的基础上每天口服罗红霉素分散片0．15g,治疗4周,治疗前后进行肺功能测定、气道反应性试验及诱导痰细胞分数计数。结果B组患者吸入糖皮质激素治疗四周后清晨呼气峰流速（PEF）、第1秒用力呼气容积FEV1（％）、气道反应性及诱导痰中中性粒细胞均无明显改善（P〉0．05）;A组患者的清晨PEF、FEV1（％）及气道反应性改善（P〈0．01）,并同时患者诱导痰中中性粒细胞降低（P〈0．01）,且经相关分析显示诱导痰中的中性粒细胞数量与清晨PEF及FEV1（％）呈负相关（P〈0．01）,而与气道反应性呈正相关（P〈0．01）。结论吸烟哮喘患者气道中的中性粒细胞数量与清晨PEF及FEV1（％）呈负相关,而与气道反应性呈正相关;罗红霉素能减少吸烟哮喘患者气道中的中性粒细胞并促进必可酮及万托林改善吸烟哮喘患者的清晨PEF、FEV1（％）、气道反应性。     

吸烟对轻度支气管哮喘患者吸入激素疗效的影响

目的　观察吸烟对轻度支气管哮喘患者吸入激素疗效的影响。方法　对不吸烟 (1 8例 )及吸烟 (1 7例 )的支气管哮喘患者每日吸入二丙酸倍氯米松 5 0 0μg治疗 4周 ,治疗前后进行肺功能测定及气道反应性试验 ,用药过程中监测呼气峰流速 (peak expiratory flow,PEF)。结果　不吸烟组患者治疗后的清晨 PEF、睡前 PEF、FEV1 %及气道反应性均较治疗前改善 (P<0 .0 5 )。而吸烟组患者在治疗前后上述指标却变化不大 (P>0 .0 5 )。结论　吸烟能明显减弱支气管哮喘患者吸入激素的疗效 ,支气管哮喘患者应积极戒烟以取得较好的疗效     

双盲对照吸入倍氯米松一年对气道高反应性与哮喘的防治作用

目的探讨长期吸入糖皮质激素对哮喘患者的治疗作用和对无症状的气道高反应性（ＢＨＲ）者发生哮喘的预防作用。方法以随机、双盲对照法比较５９例ＢＨＲ学生，年龄１２～１８岁，吸入倍氯米松干粉剂（ＢＤＰ，６００μｇ／ｄ）或安慰剂１年对气道反应性及哮喘症状的作用。结果试验１年后哮喘ＢＤＰ组气道高反应性（使ＦＥＶ１较基础值下降２０％的累积吸入组胺量的对数ｌｇＰＤ２０－ＦＥＶ１）显著下降（分别为０．３８５±０．４２４、１．１８７±０．６０３μｍｏｌ组胺，Ｐ＜０．０２），只有３０％哮喘者仍有喘息，而对照组则有８６％仍有喘息（Ｐ＝０．０７６）；无症状ＢＨＲ学生的ｌｇＰＤ２０－ＦＥＶ１在ＢＤＰ组及对照组间差异无显著性，但ＢＤＰ组不出现喘息症状，而对照组则有３例出现喘息（１５％）；ＢＨＲ者吸入ＢＤＰ组的累积症状计分显著低于对照组（分别为１．５０±２．５４分、５．５８±６．２２分，Ｐ＜０．０１）。结论ＢＤＰ能降低哮喘患者的ＢＨＲ及减轻其症状，且可能有预防无症状ＢＨＲ者发生哮喘的作用     

上呼吸道感染后慢性咳嗽的临床分析

目的探讨上呼吸道感染后慢性咳嗽的临床特征。方法收集符合条件的患者共42例,分气道高反应性（AHR组）和正常反应性（ANR组）;正常对照组（C组）。观察咳嗽的性质和时间,并测定其血常规、肺功能及气道反应性、诱导痰炎性细胞分布。结果咳嗽时间平均为6.5周（3～11周）,37例（88.1%）患者为干咳,38例（90.5%）患者血常规正常。12例（28.6%）患者具有气道高反应性（AHR组）,诱导痰中以巨噬细胞和中性粒细胞为主,其中嗜酸性细胞较高,与气道正常反应性组（ANR组）和正常对照组（C组）比较有显著性差异;ANR组和C组比较亦有显著性差异。结论上呼吸道感染后慢性咳嗽患者在某种程度上具有与嗜酸细胞支气管炎、咳嗽变异型哮喘相类似的临床特征。     

慢性咳嗽患者气道反应性测定的意义

目的探讨测定咳嗽患者气道反应性的方法和意义。方法对仅有咳嗽症状,持续3周以上,无体检及X线检查阳性发现的患者,采用氧气驱动的雾化吸入器,吸入10%氯化钠灭菌溶液,以峰流速仪测定最大呼气流速,观察其下降值和氯化钠消耗量。结果测定患者68人,阳性26人,平均雾化量3.47ml。受试者多可耐受。阳性者用支气管扩张剂可缓解症状。结论雾化吸入氯化钠测定气道反应性对慢性咳嗽的诊断治疗有一定指导意义,方法简捷,适于基层医院推广。     

吸入糖皮质激素对哮喘患者HPA轴影响的观察

为了探讨吸入糖皮质激素对哮喘患者ＨＰＡ轴的影响，采用放射免疫法测定了３０例哮喘患者吸入二丙酸倍氯米松气雾剂每日８００μｇ３个月治疗前后的血皮质醇浓度。结果表明治疗后上午８时血皮质醇浓度均值有轻度下降，其中４例降至正常范围以下，但无统计学意义（Ｐ＞０．０５）。肺功能、症状记分有显著改善（Ｐ＜０．００１）。提示吸入二丙酸倍氯米松每日８００μｇ对多数哮喘病人ＨＰＡ轴无明显影响，但对个别病人ＨＰＡ轴可产生抑制。     

黄芪党参甘草等中药降低气道反应性的研究

目的探讨黄芪、党参、甘草等中药降低气道反应性的作用。方法对２８例哮喘患者治疗前测定用力肺活量（ＦＶＣ），一秒钟用力呼气容积（ＦＥＶ１），高峰呼气流速（ＰＥＦ），并用乙酰甲胆碱（Ｍｃｈ）累积量０．０３３μｍｏｌ和１．９８μｍｏｌ进行激发试验，用黄芪、党参、甘草等中药治疗６周后，再次测定这组患者的三项指标，然后进行治疗前后的对比分析。结果２８例患者经黄芪、党参、甘草等治疗后，ＦＶＣ显著增加（３４±０２～３５±０２Ｌ，Ｐ＜０．０５），且ＦＥＶ１（２３±０１～２６±０１）、ＰＥＦ（４９±０３～５３±０３）的增加均具有高度显著性意义（Ｐ＜０．０１）。结论黄芪、党参、甘草等中药能够降低哮喘患者气道反应性。     

吸入皮质激素改善二尖瓣狭窄患者气道反应性和减轻症状的作用

喘息和咳嗽是充血性心力衰竭和二尖瓣狭窄患者常见的临床症状。作者就吸入倍氯米松(ＢＤＰ)对二尖瓣狭窄患者气道反应性的作用进行了研究。方法　患者12例,男4例,女8例,平均年龄498岁。剔除过敏性疾病,合并其它肺疾病和吸烟的患者。二尖瓣狭窄根据体检、超声心动图和心导管检查确诊,纽约心脏病协会心力衰竭Ⅱ～Ⅲ级。根据二维超声心动图检查二尖瓣口面积为09～19±039ｃｍ,平均肺动脉压474±186ｍｍＨｇ。组胺激发试验按照常规方法进行。患者按随机双盲法吸入ＢＤＰ1200ｍｇ/ｄ或安慰剂治疗,并于治疗6个月复查。结果　用力肺活量(ＦＶＣ)和1…     

双盲对照吸入倍氯以一年对道高反应性与哮喘的防治作用

目的 探讨长期吸入糖皮质激素对哮喘患的治疗作用和无症状的气道高反应性（ＢＨＲ）发生哮喘的预防作用。方法 以随机、双盲对照法比较５９例ＢＨＲ学生，年龄１２－１８岁，吸入倍氯米松粉剂（ＢＤＰ，６００μｇ／ｄ）安慰剂１年对气道反应性及哮喘症关诉作用。结果 试试验１年后哮喘ＢＤＰ组气道高反应性（使ＦＥＶ１较基础值下降２０％的累积吸入组胺量的对数ｌｇＰＤ２０－ＦＥＶ１）显下降（分别为０．３８５±０．４     

Bronchial hyperreactivity in patients with mitral stenosis before and after successful percutaneous mitral balloon valvulotomy

OBJECTIVES: We aimed to identify the bronchial response to inhaled methacholine in patients with mitral stenosis (MS) and to clarify whether or not the bronchial hyperreactivity (BHR) is reversible after percutaneous mitral balloon valvulotomy (PBMV). PATIENTS AND SETTING: Thirty patients with MS and 28 age-matched healthy control subjects were prospectively evaluated with pulmonary function tests and methacholine challenge. The productive concentration of methacholine causing 20% decrease in FEV(1) (PC(20)) was calculated and used as a parameter of bronchial responsiveness. BHR was defined as a PC(20) < 8 mg/mL. Mean pulmonary artery pressure (PAP) and mean pulmonary capillary wedge pressure (PCWP) were recorded in all patients through a Swan-Ganz balloon-tipped catheter. Sixteen patients underwent PMBV, and a methacholine test was repeated after each procedure. RESULTS: Bronchial response to methacholine was significantly increased in patients with MS, so that 53% of them had BHR, whereas all control subjects were nonresponders. The PC(20) was closely correlated with the PAP (r = - 0.777; p < 0.001), PCWP (r = - 0.723; p < 0.001), and mitral valve area (MVA; r = 0.676; p < 0. 001). Balloon valvulotomy was successfully performed in all of the 16 patients, and the cardiac parameters (MVA, PAP, and PCWP) significantly improved after the procedure. In contrast, no significant changes were shown in pulmonary function test variables (total lung capacity, vital capacity [VC], FEV(1), and FEV(1)/VC). Although significant improvement was observed in the mean PC(20) values (from 4.97 +/- 5.24 to 7.47 +/- 6.96 mg/mL; p = 0.0006), BHR was completely eliminated in only one patient. CONCLUSIONS: Our data shows that BHR is fairly common among patients with MS, and severity of bronchial responsiveness is significantly correlated with the severity of MS. Moreover, PMBV leads to significant reduction in pulmonary congestion and a consequent improvement in BHR.     

小剂量皮质类固醇吸入合并小剂量茶碱口服对支气管哮喘 …

目的 研究小剂量茶碱合并小剂量皮质类固醇对哮喘患者的疗产及对下丘脑－垂体－肾上腺轴的影响。方法 ４３例以轻、中度的哮喘患者随机分成两组。茶碱激素组（Ａ）组２１例：给予无水缓释放茶口服,每晚２００ｍｇ,加二丙酸倍氯米松（ＢＤＰ）每天３００μｇ吸入;单纯激素组（Ｂ）组２２例：仅给予ＢＤＰ每天６００μｇ吸入及每晚口服安慰剂,疗程１３周。结果 治疗前、后的症状计分、呼气峰流速值（ＰＥＦ）及其变异率（ＰＥＦ     

Effect of treating allergic rhinitis with corticosteroids in patients with mild-to-moderate persistent asthma

STUDY OBJECTIVES: Rhinitis and asthma are considered to be synchronic or sequential forms of the same allergic syndrome. Treating the inflammation associated with allergic rhinitis influences the control of asthma. However, few studies have investigated the effect of treating perennial rhinitis on persistent asthma and vice versa. We determined the effects of inhaled or topical nasal beclomethasone dipropionate (BDP) administered separately or in combination on the control of asthma and bronchial hyperresponsiveness (BHR) in patients with the rhinitis/asthma association. DESIGN: A double-blind, parallel, three-group study. SETTING: Outpatient clinic of Pulmonary Division/Heart Institute (InCor) and the Division of General Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil. PATIENTS: Seventy-four patients with mild-to-moderate asthma and allergic rhinitis (median age, 25 years). INTERVENTIONS: Patients received nasal or inhaled BDP separately or in combination for 16 weeks after a 2-week placebo run-in period. MEASUREMENTS AND RESULTS: Nasal and pulmonary symptoms, as well as pulmonary function and BHR, were compared among the three groups after 4 weeks and 16 weeks of treatment. Patients in all three groups demonstrated a progressive and significant decrease in nasal and pulmonary symptoms, which started after 4 weeks (p < 0.05) and continued through the end of treatment (p < 0.001). Clinical improvement was similar and parallel in the three groups. Asthma-related morbidity, evaluated by quantifying absence from work, emergency department visits, and nighttime awakenings, also decreased in the three groups (p < 0.05). CONCLUSIONS: Failure to consider treatment of rhinitis as essential to asthma management might impair clinical control of asthma. Furthermore, these data suggest that asthma and rhinitis in some patients can be controlled by the exclusive use of nasal medication.     

H1阻滞剂联用吸入糖皮质激素对支气管哮喘并变应性鼻炎的防治作用

目的　在观察低剂量吸入糖皮质激素的基础上联合应用H1阻滞剂对变应性哮喘的防治作用。方法　采用多中心、随机、双盲、安慰剂对照方法 ,将 67例轻、中度变应性哮喘伴变应性鼻炎患者分为氯雷他定组 (3 4例 )和对照组 (3 3例 ) ,进行 3～ 6个月的治疗 ,观察吸入二丙酸倍氯米松每天40 0 μg ,14天后减至每天 2 0 0 μg ,并联合应用氯雷他定 10mg或安慰剂 (每天 2次 )。记录患者的哮喘症状评分、鼻炎发作天数、感冒次数、按需吸入 β2 激动剂的次数和测定气道反应性与血清中上皮细胞粘附分子 1(ICAM 1)和血管内皮粘附分子 1(VCAM 1)的变化。结果　对照组治疗前、后每周哮喘症状计分为 (4 6± 0 9)分、(3 1± 0 9)分 ,氯雷他定组为 (4 8± 1 2 )分、(2 4± 0 9)分 ,两组比较差异有显著性 (P <0 0 1) ;对照组鼻炎患者每周发作天数治疗前、后分别为 (4 0± 1 0 )天、(3 5± 1 2 )天、(4 0±1 2 )天、(1 9± 0 9)天 ,两组比较差异有显著性 (P <0 0 0 1) ;对照组患者每月感冒样症状的发生次数为 (1 1± 0 4)次 ,氯雷他定组为 (0 8± 0 5 )次、两组比较差异有显著性 (P <0 0 0 1) ;按需吸入 β2 激动剂的平均次数减少 (P <0 0 0 1) ;治疗后气道反应性改善更明显 (P <0 0 5 ) ;而血清中ICAM 1、VCA     

Long-term treatment with sodium cromoglycate, nedocromil sodium and beclomethasone dipropionate reduces bronchial hyperresponsiveness in asthmatic subjects.

165 patients (106 males, 59 females) entered an open group comparative study of a 12-week test treatment on bronchial hyperresponsiveness (BHR) determined by methacholine challenge. Patients were randomly allocated to receive nedocromil sodium (4 mg q.i.d.), sodium cromoglycate (10 micrograms q.i.d.) and beclomethasone dipropionate (500 micrograms t.i.d.). At the end of the study, an 2.25-fold increase of the PD20FEV1 was noted in all the treated patients. No significant difference was noted among the treatments.     

Inhaled corticosteroids reduce the severity of bronchial hyperresponsiveness in asthma but oral theophylline does not

In a double-blind crossover study, we compared the relative effects of inhaled beclomethasone dipropionate (BDP) 800 micrograms per day and oral theophylline on the severity of bronchial hyperresponsiveness (BHR) to histamine. Daily doses of theophylline were sufficient to keep serum levels between 55 and 110 mumol/L. The subjects were 26 patients with severe asthma whose symptoms were inadequately controlled by regular treatment with inhaled salbutamol. The severity of BHR improved within 3 wk in the group treated with BDP, whereas no change occurred in the group treated with theophylline. There were no significant changes in FEV1 in either group during the study. When BDP was changed to theophylline there was a deterioration in BHR. Aerosol steroids, rather than theophylline, are the treatment of choice when reduction in the severity of BHR is the aim of treatment in patients with severe asthma.     

Early bronchial airflow impairment in patients with persistent allergic rhinitis and bronchial hyperreactivity

BACKGROUND: Allergic rhinitis and its impact on asthma (ARIA) document underlines the link between upper and lower airways. Patients suffering from allergic rhinitis frequently (up to 80%) show bronchial hyperreactivity (BHR). OBJECTIVES: This study aimed at evaluating a group of subjects suffering from persistent allergic rhinitis, with BHR but with nasal symptoms only, to investigate the type and intensity of nasal symptoms, nasal and bronchial airflow, and BHR grade during the pollen season. METHODS: One hundred and twenty one polysensitized rhinitics were investigated. Total symptom score (TSS) was assessed in all patients. Rhinomanometry, spirometry and methacholine bronchial challenge were performed in all patients. RESULTS: 65 (53.7%) patients had impaired FEF 25-75 values. TSS correlated with nasal airflow (P<0.001) and BHR grade (P<0.001). Nasal airflow correlated with FEF 25-75 values (P<0.05) and BHR (P<0.001). FEF 25-75 values correlated with FEV(1) levels (P<0.003), BHR grade (P<0.001), and nasal obstruction symptom (P<0.05). Severe BHR correlated with FEV(1) (P<0.05) and FEF 25-75 (P<0.03) values, nasal airflow (P<0.05) and nasal symptoms (P<0.001). CONCLUSIONS: This study evidences that early bronchial impairment is frequently detectable in patients with persistent allergic rhinitis and BHR. Moreover, nasal function is strictly related with bronchial calibre and BHR grade. Therefore, careful evaluation of lower airways should be investigated in all rhinitics as suggested by the ARIA document.     

Effect of inhaled beclomethasone and nedocromil sodium on bronchial hyperresponsiveness to histamine and distilled water.

In a randomized, cross-over study we compared the effects of inhaled nedocromil sodium, 4 mg q.i.d., with inhaled beclomethasone dipropionate, 200 micrograms q.i.d. in 23 atopic asthmatic patients. After a 3 week single-blind placebo period, regarded as the baseline, and after 4 and 8 weeks of active treatment, drug effects were assessed with regard to bronchial hyperresponsiveness to histamine and distilled water, lung function and beta 2-agonist use. After 4 and 8 weeks of treatment, nedocromil sodium reduced the histamine responsiveness (p < 0.005 and p < 0.0005), but not the distilled water responsiveness, and did not improve lung function and peakflow measurements compared to baseline. After 4 and 8 weeks of treatment, beclomethasone caused a significant increase in lung function (p < 0.005) and decrease in bronchial hyperresponsiveness to histamine (p < 0.0005) and distilled water (p < 0.0005) as compared to baseline. beta 2-agonist use was significantly diminished after an 8 week treatment with beclomethasone, whereas nedocromil sodium had no effect. Treatment with beclomethasone was superior to treatment with nedocromil sodium with regard to bronchial hyperresponsiveness to histamine and distilled water (p < 0.0005 and p < 0.005), lung function (p = 0.003), peakflow measurements (p < 0.05) and beta 2-agonist use (p < 0.005).     

P—选择素在速激肽类致气道高反应性中的作用

目的 探讨黏附分子Ｐ－选择素和速激肽类Ｐ－物质、血管活性肠肽（ＶＩＰ）与气道高反应性的关系。方法 测定５７例支气管哮喘病人（激素治疗组２７例,非激素治疗组３０例）和２２例正常人的气道反应性,观察血浆Ｐ－选择素、Ｐ－物质和ＶＩＰ的变化。结果５３例哮喘病人气道激发试验阳性（９２．９８％）,４例阴性（７．０２％）,２２例正常人全部阴性。非激素治疗组患者血浆Ｐ－选择素和Ｐ－物质较正常人及激素治疗组显著升