血清中ECP、IgE的表达水平及FEV1的检测对支气管哮喘患儿的诊断意义

目的探讨血清嗜酸粒细胞阳离子蛋白(ECP)和免疫球蛋白(IgE)表达水平以及第1秒用力呼气流量(FEV1)的值与支气管哮喘之间的关系。方法采用变态反应法和双抗体夹心(ELISA)法分别检测80例急性发作期和缓解期哮喘患儿和30例健康儿血清中ECP、IgE的表达水平和FEV1的值。结果 哮喘发作期血清ECP、IgE表达水平显著高于稳定期、缓解期及健康对照组,但缓解期与稳定期差异无显著性,仍明显高于正常对照组。哮喘发作期FEV1水平显著低于稳定期、缓解期及健康对照组,但缓解期与稳定期差异无显著性,仍明显低于正常对照组。结论ECP、IgE在哮喘的急性发病中起着重要作用,其可能是构成气道慢性炎症的各类因素之一,同时气道阻塞越重,病情也越明显。联合测定血清ECP、IgE水平和FEV1水平有助于哮喘的诊断及判断病情。     

Biological markers in diagnosing, monitoring, and treating asthma: a focus on noninvasive measurements

Asthma is a major concern for society, healthcare professionals, and individuals and families directly affected by asthma due to rising morbidity rates and costs associated with the disease. The pathological hallmark of asthma is airway inflammation that is considered to be a major cause of exacerbations and persistent structural alterations of the airways. Assessing airway inflammation is important for investigating the underlying mechanisms of the disease and possibly for following the progression and resolution of the disease. The presence and type of airway inflammation can be difficult to detect clinically, and may result in delays in initiating appropriate therapy. The purpose of this article is to review noninvasive methods for assessing biological markers of airway inflammation and their potential role in the future for diagnosing, monitoring, and treating asthma. The article reviews the noninvasive measurements of induced sputum and exhaled nitric oxide as indicators of airway inflammation.     

Biologic markers of airway inflammation in asthma

Asthma is a serious chronic disease of the airways that affects approximately 14% of the population in the United States. The fundamental pathophysiologic component of asthma is airway narrowing, which causes airflow obstruction. Both inflammation and bronchoconstriction contribute to airway narrowing. The pathogenesis of airway inflammation in asthma and the natural history of the disease are the subject of intense research and study in many countries of the world. The mechanisms of airway inflammation are only partially understood but are the basis for the devastating symptoms that affect the quality of life of millions of people. Treatment of asthma is directed at decreasing airway inflammation to gain long-term control of the disease.     

Childhood asthma: treatment update

The prevalence of childhood asthma has risen significantly over the past four decades. A family history of atopic disease is associated with an increased likelihood of developing asthma, and environmental triggers such as tobacco smoke significantly increase the severity of daily asthma symptoms and the frequency of acute exacerbations. The goal of asthma therapy is to control symptoms, optimize lung function, and minimize days lost from school. Acute care of an asthma exacerbation involves the use of inhaled beta2 agonists delivered by a metered-dose inhaler with a spacer, or a nebulizer, supplemented by anticholinergics in more severe exacerbations. The use of systemic and inhaled corticosteroids early in an asthma attack may decrease the rate of hospitalization. Chronic care focuses on controlling asthma by treating the underlying airway inflammation. Inhaled corticosteroids are the agent of choice in preventive care, but leukotriene inhibitors and nedocromil also can be used as prophylactic therapy. Long-acting beta2 agonists may be added to one of the anti-inflammatory medications to improve control of asthma symptoms. Education programs for caregivers and self-management training for children with asthma improve outcomes. Although the control of allergens has not been demonstrated to work as monotherapy, immunotherapy as an adjunct to standard medical therapy can improve asthma control. Sublingual immunotherapy is a newer, more convenient option than injectable immunotherapy, but it requires further study. Omalizumab, a newer medication for prevention and control of moderate to severe asthma, is an expensive option.     

哮喘患者血浆肾上腺髓质素浓度测定及临床意义

目的探讨肾上腺髓质素（ａｄｒｅｎｏｍｅｄｕｌｉｎ,ＡＭ）在哮喘急性发作期的病理生理作用。方法用放射免疫测定的方法对哮喘急性发作期患者及健康对照组血浆ＡＭ和ＥＴ－１含量进行测定,并做相关分析。结果哮喘急性发作期血浆ＡＭ及ＥＴ－１浓度均较健康对照组显著升高（Ｐ＜００１,Ｐ＜００５）,ＡＭ与ＥＴ－１浓度呈显著正相关（ｒ＝０４５,Ｐ＜００５）。结论哮喘急性发作期血浆ＡＭ浓度显著升高,这对于扩张支气管和抑制气道炎症可能起重要作用。     

哮喘儿童嗜酸性粒细胞趋化蛋白的含量变化及意义

目的探讨支气管哮喘患儿嗜酸性粒细胞趋化蛋白（Eotaxin）水平的变化及临床意义。方法随机选择哮喘专科收治的哮喘患儿急性发作期35例、缓解期25例、正常对照组25例,采用酶联免疫吸附试验（ELISA）测定3组血清Eotaxin水平。结果急性发作组较缓解组、正常对照组明显升高（P〈0．01）,缓解组与对照组无显著差异。急性发作组中重度发作组明显高于轻中度组（P〈0．01）。结论Eotaxin水平与哮喘病情变化一致,可以用来监测哮喘的气道炎症状况,判断治疗效果及预后。     

Eosinophilic bronchitis: an imortant cause of prolonged cough

The recent development of noninvasive techniques to measure airway inflammation has led to the recognition of eosinophilic bronchitis, a condition characterized by a sputum eosinophilia identical to that seen in asthma, but without any of the functional abnormalities associated with asthma. The condition is interesting for a number of reasons. Firstly, eosinophilic bronchitis is a common cause of chronic cough, which is important to recognize as it responds well to corticosteroids. However, recognition is not straightforward because it requires assessment of airway inflammation. Secondly, the natural history of eosinophilic bronchitis is uncertain. Some patients with chronic obstructive pulmonary disease without a history of previous asthma have sputum eosinophilia, thus one possibility is that eosinophilic bronchitis may develop into fixed airflow obstruction. Finally, the difference in the association of eosinophilic airway inflammation to airway dysfunction between eosinophilic bronchitis and asthma is of interest as it is possible that it reflects important differences in the nature or site of the airway inflammation. Further study of this interesting condition may shed light on the relationship between airway inflammation and airway responsiveness, leading to a greater understanding of both eosinophilic bronchitis and asthma.     

Eosinophilic bronchitis: an important cause of prolonged cough

The recent development of noninvasive techniques to measure airway inflammation has led to the recognition of eosinophilic bronchitis, a condition characterized by a sputum eosinophilia identical to that seen in asthma, but without any of the functional abnormalities associated with asthma. The condition is interesting for a number of reasons. Firstly, eosinophilic bronchitis is a common cause of chronic cough, which is important to recognize as it responds well to corticosteroids. However, recognition is not straightforward because it requires assessment of airway inflammation. Secondly, the natural history of eosinophilic bronchitis is uncertain. Some patients with chronic obstructive pulmonary disease without a history of previous asthma have sputum eosinophilia, thus one possibility is that eosinophilic bronchitis may develop into fixed airflow obstruction. Finally, the difference in the association of eosinophilic airway inflammation to airway dysfunction between eosinophilic bronchitis and asthma is of interest as it is possible that it reflects important differences in the nature or site of the airway inflammation. Further study of this interesting condition may shed light on the relationship between airway inflammation and airway responsiveness, leading to a greater understanding of both eosinophilic bronchitis and asthma.     

Advances in the immunobiology of eosinophils and their role in disease

Eosinophils play a protective role in host immunity to infections by parasitic worms and, detrimentally, are involved in the pathophysiology of asthma and other allergic diseases. Airway inflammation is central to the pathology of asthma and is characterized by infiltration of the bronchial mucosa by large numbers of proinflammatory cells, amongst which the eosinophil is prominent despite being a minority constituent of circulating leukocytes. Crucial steps in eosinophilic inflammation include augmented production of eosinophils in the bone marrow, their increased release into the circulation, and their selective accumulation in the conducting airways. The eosinophil has a potent armory of proinflammatory mediators, including cytotoxic granule proteins, cytokines and lipid mediators with considerable potential to initiate and sustain an inflammatory response. Thus there is much interest in the elucidation of the mechanisms responsible for eosinophil accumulation, persistence, activation and ultimate fate. This article reviews our current understanding of the role of the eosinophil in human disease and the immunobiology of this important proinflammatory cell.     

哮喘患儿血清细胞因子与IgE水平的临床研究

目的探讨白细胞介素4（IL-4）、白细胞介素13（IL-13）和γ-干扰素（IFN-γ）与免疫球蛋白E（IgE）在哮喘患儿急性发作期血清中的变化及临床价值。方法对65例哮喘急性发作期患儿进行血清IL-4、IL-13、IFN-γ和IgE的检测,并与45例健康儿童作比较。结果65例患儿血清IL-4、IL-13、IgE水平均明显高于正常对照组（P〈0．01）;IFN-γ水平则明显低于对照组（P〈0．01）;哮喘患儿血清中IL-4、IL-13水平与IgE水平呈显著正相关,而IFN-γ水平与IgE呈显著负相关。结论多种细胞因子分泌紊乱、形成的免疫调控异常可能是导致哮喘患儿急性发作的重要因素,而细胞因子IL-4、IL-13、IFN-1等在其发生发展中起着重要的调控作用。     

Management of persistent symptoms in patients with asthma

The main goals of asthma therapy are to control symptoms, prevent acute attacks, and maintain lung function as close to normal as possible. Customizing the regimen to relieve the patient's symptoms and control airway inflammation is important. If asthma is not well controlled, an initial inhaled corticosteroid boost will treat the underlying heightened airway inflammation, and the addition of a long-acting beta2-adrenergic agonist or leukotriene receptor antagonist will rapidly control symptoms. Most patients do not require prolonged treatment with expensive combination or additive agents. Exercise-induced bronchoconstriction is a common source of symptoms. Treatments for scheduled and unscheduled exercises differ. Inhaled corticosteroids prevent frequent and severe asthma exacerbations. When patients have persistent symptoms despite a pharmacological regimen, environmental factors and nonpharmacological interventions must be considered before medication is increased. When an inhaled corticosteroid is being considered, issues of compliance, drug delivery device, and proper inhaler techniques are as important as issues of potency, clinical efficacy, and adverse effects. The new hydrofluoroalkane preparations offer more lung deposition and may be important in treating inflammation of the small airways in patients with asthma.     

Symbicort Turbuhaler: a new concept in asthma management

Symbicort is a novel asthma product containing both budesonide and formoterol in a single inhaler, Turbuhaler. Budesonide is a corticosteroid that treats underlying airway inflammation in asthma; formoterol is a rapid- and long-acting beta2-agonist that prevents and reverses airway obstruction. Budesonide and formoterol therefore have complementary effects, treating two different components of asthma. Clinical studies have shown that Symbicort is more effective in the treatment of asthma than double-dose corticosteroid, and clinical experience to date indicates that Symbicort is at least as effective and well tolerated as budesonide and formoterol given in separate inhalers. Symbicort has a fast onset of effect, which may help patients feel more in control of their condition and improve adherence to their medication, and a long duration of effect that allows twice-daily or even once-daily dosing during periods of good control. More convenient treatment represents another important benefit for patients with asthma, as ease of use can also result in improved adherence, leading to better disease control.     

支气管哮喘患儿不同治疗方法内皮素和降钙素基因相关肽结果比较

Background: Bronchial asthma is an allergic pulmonary disease. The attack is mostly induced by the inhalation of or contact with allergens, such as pollens, dusts, insects (such as mite), germs, etc. During the attack, patients have severe dyspnea which is due to spasm of bronchial smooth muscles, swelling of the bronchial mucosa, and hypersecretion of the mucus, leading to bronchial obstruction. To observe the endothelin(ET) and calcitonin gene related peptide(CGRP) changes in treating children with bronchial asthma by dopamine( DP), dobutamine( DOB),and regitine.     

An overview of drug therapy for chronic adult asthma.

Asthma involves bronchoconstrictor mechanisms, possible abnormalities of airway smooth muscles and an inflammatory response. Past emphasis on bronchodilator therapy ignored the underlying inflammatory response. Since chronic asthma can eventually lead to irreversible airflow obstruction from uncontrolled inflammation, current drug therapy stresses both inflammation reduction and bronchodilatation. This article discusses the rationale of current pharmacologic management for the adult client with chronic asthma and presents a step-care approach for management of the disease. Inhaled beta-agonists--effective bronchodilators--are the primary drug of choice. Steroids administered via inhalation are the most effective anti-inflammatory agents available. Cromolyn sodium is useful for prophylactic management of asthma. Theophylline, previously the cornerstone of asthma treatment, is now introduced later in the therapeutic plan as an additional bronchodilator. Inhaled anticholinergics may be tried as adjunctive asthma treatment. With careful assessment, intervention and management, health care providers can successfully care for most adult clients with chronic asthma.     

New directions in asthma management.

Asthma affects people of all ages, and the mortality rate associated with the disease is increasing. The proper understanding of the pathogenic mechanisms, including airway inflammation and bronchoconstriction, can lead to a more logical treatment approach. Recognition of the important role of allergic triggers in influencing the sensitivity of the airways can help direct therapy toward prevention. Avoidance of irritants will help patients maintain normal airway function with fewer medications. Appropriate monitoring by the patient or the parent can help the medical team recognize worsening asthma before emergency treatment or hospitalization is required. The proper management of asthma necessitates understanding of the disease, medications, and goals by both the physician and the patient.     

Vagus Nerve and Vagus Nerve Stimulation,a Comprehensive Review: Part III

Vagus nerve stimulation (VNS) is currently undergoing multiple trials to explore its potential for various clinical disorders. To date, VNS has been approved for the treatment of refractory epilepsy and depression. It exerts antiepileptic or antiepileptogenic effect possibly through neuromodulation of certain monoamine pathways. Beyond epilepsy, VNS is also under investigation for the treatment of inflammation, asthma, and pain. VNS influences the production of inflammatory cytokines to dampen the inflammatory response. It triggers the systemic release of catecholamines that alleviates the asthma attack. VNS induces antinociception by modulating multiple pain‐associated structures in the brain and spinal cord affecting peripheral/central nociception, opioid response, inflammation process, autonomic activity, and pain‐related behavior. Progression in VNS clinical efficacy over time suggests an underlying disease‐modifying neuromodulation, which is an emerging field in neurology. With multiple potential clinical applications, further development of VNS is encouraging.     

中医扶正固本法防治儿童哮喘的研究

目的　用扶正固本法防治儿童哮喘病。方法　用安喘舒片治疗儿童哮喘 2 0 0例 ,并进行对照观察。结果　说明治疗组优于对照组 ,经药效试验表明安喘舒片各组用药后引喘潜伏期明显延长 (P <0 .0 1)。结论　本研究对防治哮喘有积极作用     

呼出气一氧化氮测定在支气管哮喘诊断和管理中的价值

慢性气道炎症是支气管哮喘的本质。临床上急需能客观准确地反映气道炎症的炎性标志物来指导哮喘的诊断和管理,呼出气一氧化氮(FeNO)测定是一种符合临床需要的快速检测方法,现就FeNO在哮喘诊断、气道炎症监测、哮喘严重程度评级及预测哮喘发作等方面的研究进展做一综述。     

Corticosteroid therapy and chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterized in part by a chronic inflammatory state in the airways (largely from chronic noxious stimuli such as tobacco smoke), punctuated with acute inflammatory exacerbations, which are often infectious. Although pathologically and biochemically different from the inflammation of asthma, the chronic inflammation of chronic obstructive pulmonary disease, especially in subgroups with asthma-like features and especially during exacerbations, might be expected to respond to corticosteroid therapy, as does asthma. Complications from long-term corticosteroid use are important, but they appear less when the corticosteroid is given via the inhaled route. Clinical evidence is particularly strong supporting the use of inhaled corticosteroids to prevent exacerbations and oral corticosteroids to reduce the duration and impact of exacerbations.     

老年支气管哮喘急性发作30例舒适护理

目的:探讨老年支气管哮喘急性发作患者的舒适护理方法及临床效果.方法:将60例老年支气管哮喘急性发作患者随机分为观察组和对照组各30例.对照组采用呼吸内科常规护理,观察组在此基础上实施舒适护理,比较两组患者护理后肺功能改善情况、住院时间、治疗依从性、哮喘积分、患者满意度及复发率.结果:观察组患者护理后肺功能改善情况、住院时间、治疗依从性、哮喘积分、患者满意度、复发率均优于对照组(P<0.05).结论:舒适护理可改善支气管哮喘急性发作患者的肺功能情况,缩短住院时间,提高治疗效果及患者满意度,减少复发,有利于患者康复.