吸入丙酸氟替卡松加孟鲁司特预防毛细支气管炎后反复喘息疗效分析

目的对痊愈出院的毛细支气管炎患儿进行吸入丙酸氟替卡松加孟鲁司特治疗,观察该方法预防病后喘息再发作的疗效。方法前瞻性研究,将100例痊愈出院的毛细支气管炎患儿随机分成两组,治疗组和对照组,跟踪随访1年,观察并统计两组在观察期内喘息再发作的病例、发作次数及持续的时间。结果治疗组出现再发喘息病例数明显少于对照组,差异有统计学意义（P〈0.05）,且用药期间未见不良反应。结论吸入丙酸氟替卡松加孟鲁司特预防毛细支管炎后反复喘息疗效确切、不良反应小,可作为预防毛细支管炎后反复喘息的干预措施,值得临床推广。     

丙酸氟替卡松预防婴幼儿毛细支气管炎后喘息的临床观察

目的观察丙酸氟替卡松气雾剂吸入预防婴幼儿病毒诱发性喘息发作的临床效果。方法将145例符合毛细支气管炎诊断的婴幼儿随机分为预防组75例、对照组70例,两组在常规治疗出院后,预防组采用丙酸氟替卡松吸入3个月,而对照组不做相应处理。出院后随访1年,比较1年内两组婴幼儿喘息的发病构成比、喘息发作次数及发作持续时间。结果在随访一年内,预防组中有21例患儿未发生喘息,37例发生1次喘息,17例发生2次以上喘息;对照组有5例患儿未发生喘息,19例发生1次喘息,46例发生2次以上喘息。预防组发生喘息患儿平均喘息持续时间也较对照组明显缩短。结论吸入糖皮质激素早期干预可以缓解毛细支气管炎患儿后期病毒诱发性喘息反复发作。     

口服孟鲁司特干预毛细支气管炎后喘息的效果观察

目的探讨口服孟鲁司特预防毛细支气管炎后反复喘息的效果。方法将87例临床治愈出院的毛细支气管炎患儿随机分成干预组（46例）和对照组（41例）。干预组给予孟鲁司特口服,1次／d,4mg／次,持续3个月;对照组治愈出院后未予任何治疗。随访观察1年两组喘息再发作的情况。结果干预组再发喘息率明显低于对照组（P〈0．01或〈0．05）。结论口服孟鲁司特可预防毛细支气管炎后反复喘息及预防哮喘的发生。     

丙酸氟替卡松气雾剂和孟鲁司特钠对毛细支气管炎后喘息反复发作干预效果观察

目的比较口服白三烯受体拮抗剂、吸入糖皮质激素对毛细支气管炎(简称:毛支炎)后喘息反复发作的疗效。方法选择初次毛支炎治愈后患儿78例,将患者随机分为三组,A组26例口服孟鲁司特钠,B组28例吸入丙酸氟替卡松气雾剂,疗程均为12周,C组24例未给予治疗,随访观察2年,了解两种干预治疗对患儿反复喘息发作的影响。结果 C、B、A三组患者毛支炎后喘息再发时间依次延长,喘息再发次数及进展成哮喘的例数依次减少,差异有统计学意义(P0.05),三组喘息再发率差异无统计学意义(P0.05),B组与C组2年内进展成哮喘的比例差异无统计学意义(α'=0.017,P0.017)。结论两种干预方法不能减少毛支炎后喘息的再发,但可以延长再发时间、减少发作次数,白三烯受体拮抗剂降低毛支炎后哮喘发生率的效果优于吸入糖皮质激素。     

孟鲁司特钠联合沙美特罗/氟替卡松治疗咳嗽变异性哮喘疗效分析

目的比较孟鲁司特钠联合沙美特罗/氟替卡松、沙美特罗/氟替卡松治疗咳嗽变异性哮喘的疗效。方法选择60名咳嗽变异性哮喘患者,随机分成两组：对照组：吸入沙美特罗/氟替卡松（50 ug/250 ug）早晚各1吸,治疗组：联合孟鲁司特钠10mg每晚口服。每组按需吸入沙丁胺醇气雾剂。观察两组病人的临床疗效、不良反应和复发率。结果治疗组临床疗效明显改善,与对照组相比有显著差异性（P〈0.05）。结论孟鲁司特钠联合沙美特罗/氟替卡松治疗咳嗽变异性哮喘疗效明显,值得推广。     

丙酸氟替卡松治疗哮喘预测指数阳性喘息婴幼儿的疗效观察

目的观察丙酸氟替卡松治疗哮喘预测指数阳性喘息婴幼儿的疗效。方法选择该院儿科门诊及住院诊断为哮喘预测指数阳性的喘息婴幼儿作为研究对象,共100例。按随机号码表法分为研究组50例和对照组50例,两组急性期均接受沙丁胺醇气雾剂吸入治疗。缓解期研究组接受丙酸氟替卡松预防治疗,对照组不接受丙酸氟替卡松治疗干预。对研究组和对照组3个月、6个月、9个月时喘息发生率、急诊/住院率进行比较。在两组患儿5岁时回访,计算两组患儿哮喘诊断率。结果 (1)研究组3个月、6个月、9个月喘息发生率、急诊/住院率分别为22%、12%、4%、6%,对照组分别为30%、20%、18%、24%,两组比较差异有统计学意义。研究组和对照组哮喘诊断率分别为16%和44%,差异有统计学意义。结论丙酸氟替卡松能明显减轻婴幼儿喘息发作程度,减少喘息发作次数。     

沙美特罗替卡松粉吸入剂联合孟鲁司特钠治疗慢性支气管炎的临床研究简

目的探讨沙美特罗替卡松粉吸入剂联合孟鲁司特钠治疗慢性支气管炎的临床效果。方法病例选自2010年6月至2012年6月在我院就治的慢性支气管炎患者70例,将其随机分为两组,各35例。研究组采用沙美特罗替卡松粉吸入剂联合孟鲁司特钠治疗,对照组单独用沙美特罗替卡松粉吸入剂治疗。观察比较两组患者治疗前后的肺功能变化情况,以及治疗后两组的疗效情况。结果两组患者的第1s用力呼气量占预计值的百分比（FEVl％）及呼气流速峰值（PEF）均较治疗前改善,研究组治疗后改善更为明显,与对照组及治疗前比较差异有统计学意义,P〈0．05。治疗后,研究组的总有效率为（94．2％）,高于对照组（71．5％）,两组比较,差异有统计学意义,P〈0．05。结论沙美特罗替卡松粉吸入剂联合孟鲁司特钠治疗慢性支气管炎疗效好,不良反应少,患者肺功能恢复比较理想,值得在临床上推广使用。     

不同孟鲁司特钠方案预防特应质喘息性支气管炎患儿发作的研究

目的观察并探讨不同孟鲁司特钠服药方案预防特异质喘息性支气管炎患儿喘息及哮喘发作的临床疗效。方法入选2012年1月~2014年6月收治的150例喘息性支气管炎患儿为研究对象,患儿治疗稳定后根据随机数字表分为3个月服药组、6个月服药组和对照组,每组各50例,3个月服药组给予口服孟鲁司特钠3个月预防性服药方案,6个月服药组给予口服孟鲁司特钠6个月服药方案,对照组不给于药物干预,随访6个月后采血检测血清IgE、白三烯E4等炎性介质,比较三组随访期间喘息及哮喘发生率。结果随访6个月后三组患儿血清IgE、LTE4、IL-4、IL-8、IL-10浓度差异显著(P0.05),6月组上述指标均低于3月组,3月组均低于对照组,两两比较差异均有统计学意义(P0.05)。随访3个月、6个月时三组患儿喘息发生率与哮喘发生率差异显著(P0.05);对照组喘息与哮喘发生率均高于两个服药组,3个月服药物喘息与哮喘发作率略高于6个月组,两个服药组喘息与哮喘发作率差异无统计学意义(P0.05)。结论对稳定期特应质喘息性支气管炎患儿预防性口服孟鲁司特钠能有效降低喘息与哮喘发生率,6个月服药方案较3个月方案具有比较优势。     

孟鲁司特联合氟替卡松吸入治疗支气管哮喘的效果观察

目的观察孟鲁司特联合氟替卡松吸入对支气管哮喘的治疗效果。方法共有200例支气管哮喘患者参加研究。患者随机分为观察组(100例)和对照组(100例),除基本治疗外,观察组给予孟鲁司特联合氟替卡松吸入,对照组给予异丙托溴铵联合氟替卡松吸入,主要终点为哮喘恶化,次要终点为因症状加重增加皮质激素治疗、症状恶化及FEV1减低。结果观察组治愈率、症状缓解率优于对照组,哮鸣音持续时间明显缩短(P<0.05)。哮喘恶化无显著差异,治疗后FEV1显著改善(P<0.05)。结论孟鲁司特联合氟替卡松吸入治疗支气管哮喘有显著效果,不亚于异丙托溴铵联合氟替卡松吸入效果。     

沙美特罗/氟替卡松联合酮替芬和联合孟鲁司特钠治疗支气管哮喘的疗效观察

目的 观察吸入沙美特罗/氟替卡松联合酮替芬与吸入沙美特罗/氟替卡松联合孟鲁司特对支气管哮喘的临床治疗效果及安全性.方法 将我院住院及门诊就诊确诊为支气管哮喘的患者随机分成两组,对照组:吸入沙美特罗/氟替卡松(50μg/250μg)早晚各1吸联合酮替芬口服治疗;观察组:吸入沙美特罗/氟替卡松(50μg/250μg)早晚各1吸联合孟鲁司特钠口服治疗.两组疗程均为8周,比较治疗前后临床症状及肺功能改善情况、哮喘控制测试(ACT)评分,不良反应等.结果 治疗12周后,两组ACT评分比较,差异有统计学意义(P＜0.05);两组第1S用力呼气末容积(FEV1)和呼气峰流量(PEF)比较,差异均无统计学意义(P＞0.05).治疗组不良反应发生率明显低于对照组,差异有统计学意义(P＜0.05).结论 吸入沙美特罗/氟替卡松联合口服孟鲁司特治疗支气管哮喘优于吸入沙美特罗/氟替卡松联合口服酮替芬,能有效改善患者的临床症状,且安全性好,值得在临床推广.     

沙美特罗/氟替卡松联合孟鲁斯特钠治疗咳嗽变异型哮喘的疗效观察

目的观察沙美特罗/氟替卡松联合孟鲁斯特钠治疗咳嗽变异型哮喘(CVA)的疗效。方法收集我院门诊及住院的CVA患者96例,随机分为A、B、C组。A组给予吸入沙美特罗/氟替卡松粉入剂50μg/250μg早,晚各1次,同时给予孟鲁斯特钠10 mg口服,每天1次;B组给予孟鲁斯特钠10mg口服,每天1次;C组给予沙美特罗/氟替卡松粉入剂50μg/250μg吸入早、晚各一次。三组疗程均为8周。对比三组治疗前后的临床疗效及肺功能改变。结果三组治疗的临床疗效及肺功能均较治疗前有不同程度的改善(P0.05);治疗后三组比较,A组的临床疗效及肺功能改善明显优于B、C两组(P0.05),B组和C组临床疗效及肺功能改善相当,差异无统计学意义。结论沙美特罗/氟替卡松联合孟鲁斯特钠改善CVA的临床症状及肺功能明显,疗效更为显著。     

Salmeterol/Fluticasone Propionate versus Fluticasone Propionate Plus Montelukast

Introduction and objective

Asthma, owing to its chronic nature, is associated with a substantial economic burden. Healthcare providers need to compare the cost effectiveness of alternative asthma treatment options to ensure that they obtain the best value for money from the resources they control. The objective of the current study was to compare the cost effectiveness of salmeterol/fluticasone propionate in combination with fluticasone propionate plus montelukast in patients with symptomatic asthma uncontrolled with inhaled corticosteroid (ICS) monotherapy.

Study design and methods

Direct healthcare resource data were prospectively collected during a double-blind, randomized, 12-week clinical study of inhaled salmeterol/fluticasone propionate 50/100µg twice daily (n = 356) and inhaled fluticasone propionate 100µg twice daily plus oral montelukast 10mg daily (n = 369). Resources were costed in Dutch guilders (NLG) from the perspective of The Netherlands healthcare system using 1999/2000 prices, but have been presented in US dollars and euros. The primary effectiveness measure was the proportion of successfully treated weeks (based on mean morning PEF values). Secondary measures were episode-free days, symptom-free days, and symptom-free nights.

Results

Salmeterol/fluticasone propionate was more effective than fluticasone propionate plus montelukast as measured by the proportion of successfully treated weeks mean 63.3% vs 39.0%; median difference 25%; p < 0.001). Salmeterol/fluticasone propionate was also more effective than fluticasone propionate plus montelukast according to the secondary effectiveness measures. The mean total direct daily healthcare costs per patient were 16% higher with fluticasone propionate plus montelukast than with salmeterol/fluticasone propionate mainly due to higher drug costs in the former group ($US2.25 vs 1.94; € 1.92 vs 1.66, respectively; the NLG was fixed against the euro at a rate of €1 = NLG2.2 on 31 December 1998; $US1 = NLG1.883, June 2003; $US1 = €0.848, June 2003). Incremental cost-effectiveness analyses showed that salmeterol/fluticasone propionate was dominant over fluticasone propionate plus montelukast and sensitivity analyses showed these results to be robust.

Conclusion

Salmeterol/fluticasone propionate is a more cost-effective treatment option than fluticasone propionate plus montelukast for patients with symptomatic asthma uncontrolled by ICS.

     

舒利迭和顺尔宁联合应用对CODP肺功能的影响

目的探讨沙美特罗替卡松（舒利迭）联合孟鲁斯特钠（顺尔宁）对慢性阻塞性肺疾病（COPD）患者肺功能的影响。方法40例患者随机分为舒利迭组（对照组）和舒利迭加顺尔宁组（试验组）各20例。两组入院期间均给于常规抗感染、吸氧、化痰和平喘对症治疗。对照组加用舒利迭,试验组加用舒利迭和顺尔宁,两组平喘治疗包括普通氨茶碱,按需使用喘康速气雾剂（特布他林）。出院后对照组继续使用舒利迭,试验组继续使用舒利迭和顺尔宁,共随访观察12周。两组均于治疗前查肺功能,治疗症状好转出院,12周后再次测定上述指标。结果两组治疗前肺功能无明显差异;治疗后两组肺功能较治疗前均有显著改善。试验组较对照组第一秒用力呼气容积（FEV1）、用力肺活量（FVC）、第一秒用力呼气容积／用力肺活量（FEV1／FVC）和第一秒用力呼气容积占预计值百分比（FEV1 ％ Pred）等明显改善,差异有显著性;试验组较对照组每天按需使用特布他林次数减少,差异有显著性。结论舒利迭和顺尔宁共同作用对COPD患者肺功能更有显著的改善作用。     

Short-term and long-term asthma control in patients with mild persistent asthma receiving montelukast or fluticasone: a randomized controlled trial

PURPOSE: To determine whether montelukast is as effective as fluticasone in controlling mild persistent asthma as determined by rescue-free days. SUBJECTS AND METHODS: Participants aged 15 to 85 years with mild persistent asthma (n = 400) were randomized to oral montelukast (10 mg once nightly) or inhaled fluticasone (88 mug twice daily) in a year-long, parallel-group, multicenter study with a 12-week, double-blind period, followed by a 36-week, open-label period. RESULTS: The mean percentage of rescue-free days was similar between treatments after 12 weeks (fluticasone: 74.9%, montelukast: 73.1%; difference = 1.8%, 95% confidence interval [CI]: -3.2% to 6.8%) but not during the open-label period (fluticasone: 77.3%, montelukast: 71.1%; difference = 6.2%, 95% CI: 0.8% to 11.7%). Although both fluticasone and montelukast significantly improved symptoms, quality of life, and symptom-free days during both treatment periods, greater improvements occurred with fluticasone in lung function during both periods and in asthma control during open-label treatment. Post hoc analyses revealed a difference in rescue-free days favoring fluticasone in participants in the quartiles for lowest lung function and greatest albuterol use at baseline. CONCLUSION: In patients with mild persistent asthma, rescue-free days and most asthma control measures improved similarly with fluticasone or montelukast over the short term, but with prolonged open-label treatment, asthma control improved more with fluticasone. Improved asthma control with fluticasone appeared to occur in those with decreased lung function and greater albuterol use at baseline. In the remaining patients, the two treatments appeared to be comparable. These results suggest that classification criteria for mild persistent asthma may need to be re-evaluated.     

匹多莫德辅助孟鲁司特治疗咳嗽变异性哮喘的临床疗效

目的探讨匹多莫德辅助孟鲁司特对咳嗽变异性哮喘(CVA)患者血清TNF-α、CRP及全血嗜酸性粒细胞计数(EOS)表达水平及肺功能的影响。方法 100例CVA患者按照随机数字表法分为对照组50例,给予止咳平喘常规治疗,并服用孟鲁司特片;研究组50例,在对照组治疗基础上加服匹多莫德口服液。观察治疗前、8周后两组患者血清TNF-α、CRP、外周血EOS水平及肺功能变化,并观察两组日间、夜间咳嗽症状评分的变化情况。结果治疗前两组患者血清TNF-α、CRP、外周血EOS水平、肺功能、日间及夜间咳嗽症状评分比较,差异均无统计学意义(P0.05)。治疗8周后,研究组TNF-α、CRP、EOS水平明显低于对照组(P0.05),肺功能显著改善(P0.05),患者日间、夜间咳嗽症状评分均较对照组患者明显改善(P0.05)。两组总有效率比较,研究组明显高于对照组(P0.05)。结论匹多莫德辅助孟鲁司特治疗咳嗽变异型哮喘能明显改善咳嗽症状,疗效显著。     

Comparison of add-on therapy to inhaled fluticasone propionate in children with asthma: residual volume and exhaled nitric oxide as outcome measures.

The purpose of this study was to evaluate changes in lung function and fractional exhaled nitric oxide (FeNO) in children with mild to moderate persistent asthma treated with low-dose inhaled steroids but still manifesting significantly increased residual volume (RV). This was a crossover study evaluating lung function and FeNO before and after a 2-week crossover therapy period by adding either montelukast or salmeterol to inhaled fluticasone propionate in 12 children with asthma. Salmeterol increased forced expiratory volume at 1 second (FEV(1)) and decreased RV without effects on eNO. Addition of montelukast produced a statistically significant decrease both for RV (from 191.7 +/- 60.8% to 132.4 +/- 36.1%; p = 0.03) and for eNO (from 14.0 +/- 6.3 ppb to 8. 5+/- 5.0 ppb; p < 0.01). No effect was observed for the montelukast treatment period in FEV(1) and forced expiratory flow at 25-75%. Add-on therapy may reduce RV and decrease levels of FeNO, leading to consideration of a possible anti-inflammatory additive effect that could improve the control of the disease.     

Roles of angiopoietin-1 and angiopoietin-2 on airway microvascular permeability in asthmatic patients

BACKGROUND: Vascular endothelial growth factor (VEGF) increases microvascular permeability. Recently, considerable attention has been devoted to the physiologic roles of angiopoietin-1 and angiopoietin-2 as regulatory factors of VEGF. This study was designed to examine the roles of angiopoietin-1 and angiopoietin-2 in controlling airway microvascular permeability in asthma. METHODS: Levels of these angiogenic factors and airway vascular permeability index were examined in 30 asthmatics and 12 control subjects. After 2-week run-in period, all asthmatics were randomly assigned to receive fluticasone propionate (400 mug/d) or montelukast (10 mg) for 12 weeks. RESULTS: VEGF, angiopoietin-1, and angiopoietin-2 levels in induced sputum were significantly higher in asthmatics than in control subjects. We found an inverse correlation between angiopoietin-1 level and vascular permeability index in asthmatics, while there was a positive correlation between angiopoietin-2 level and that index. VEGF and angiopoietin-1 levels were significantly decreased after fluticasone therapy, while VEGF and angiopoietin-2 levels were significantly decreased after montelukast therapy. Although VEGF levels after treatment were different between two groups, vascular permeability index in the montelukast group was the same level as that in the fluticasone group. Moreover, improvement in vascular permeability index after fluticasone therapy was inversely correlated with decrease in angiopoietin-1 level, while that after montelukast therapy was positively correlated with decrease in angiopoietin-2 level. CONCLUSIONS: Angiopoietin-1 and angiopoietin-2 play complementary and coordinated roles in regulating microvascular permeability stimulated by VEGF in asthma. Combination of corticosteroids with leukotriene antagonists might effectively improve plasma leakage and provide a new strategy in treating bronchial asthma.