Double-blind, dose-response study of metaproterenol inhalant solution in children with acute asthma

One hundred children, aged 6 to 12 years, with acute asthma received nebulized therapy with saline, 5, 10, or 15 mg of metaproterenol aerosol solution according to a prerandomized, double-blind protocol. Pulmonary function and cardiac function were assessed for 60 minutes. All patients then received 5 mg of metaproterenol aerosol solution, and observation continued for another 30 minutes. The best response to therapy in terms of rise in FEV1, forced expiratory flow rate between 25% and 75% of FVC, and area under the curve (change in lung function with time) occurred with 5 and 10 mg of metaproterenol. The highest dose, 15 mg, produced significantly less bronchodilation. Although there were no electrocardiographic abnormalities, pulse rate was significantly higher with 10 and 15 mg of metaproterenol than with 5 mg. Five milligrams of metaproterenol aerosol solution is the optimal bronchodilating dose for treating acute asthma in children. Repeating this dose provides some additional bronchodilation and is well tolerated.     

Response to corticosteroids in chronic bronchitis

Corticosteroid drugs are often employed in the treatment of patients with chronic bronchitis. Although some patients respond favorably to such therapy, the characteristics of such patients are not known. Twenty-four patients with chronic bronchitis were treated with prednisone 30 mg daily or placebo for one week each in a double-blind crossover study. The following were monitored before and after each treatment period: physical examination, symptoms, peripheral blood eosinophil count, sputum cell exmination, forced vital capacity (FVC), before and after isoproterenol aerosol. Seven of 24 patients had an FEV1 increase greater than 30% of the control value on prednisone but not on placebo. Blood eosinophil count was elevated (greater than or equal to 350/mm(3)) in 7 patients; 2 of these 7 improved on steroid. Sputum cell examination revealed preponderance of eosinophils in 1, and occasional clumps of eosinophils in 8. Seven of these 9 responded to steroid. Sputum but not blood eosinophilia is a good predictor of a favorable response to steroid therapy.     

A double-blind evaluation of the use of nebulized metaproterenol and isoproterenol in hospitalized asthmatic children and adolescents.

This study compared two beta-adrenergic agents in the treatment of severe asthma of children and adolescents. Thirty patients admitted to Children's Orthopedic Hospital and Medical Center with acute asthma were treated with either isoproterenol 0.05% (iso) or metaproterenol 0.5% (meta) nebulized in physiologic saline and delivered with O2 in addition to intravenous hydration, aminophylline, and corticosteroids. Vital signs, blood gases, and pulmonary function were monitored frequently. No adverse reactions to the study drugs were encountered. Pulse rates increased similarly after treatments with both drugs. Patients treated with meta had somewhat higher rates than those treated with iso. Diastolic blood pressure decreased significantly from admission in the meta group compared to the iso group. For FVC and FEV1, the meta group had greater percentage increases from admission than the iso group at all times, with the difference being significant (p less than 0.05) at 1 and 12 hr. The same trend occurred for FEF 25%-75%. Though iso seemed to cause greater increases in flow immediately after administrations, these changes were transient compared to improvement caused by meta. Thus, meta seemed to be more effective than iso in reversing bronchospasm as measured by certain pulmonary function parameters.     

The effect of metaproterenol in chronic asthmatic children receiving therapeutic doses of theophylline.

The effect of metaproterenol added to therapeutic doses of theophylline was compared with a combination of placebo and theophylline by measurement of the forced expiratory volume in 1 sec (FEV₁), forced vital capacity (FVC), and maximum midexpiratory flow rate (MMEFR) in 17 asthmatic children in a double-blind crossover study. Plasma theophylline levels were measured at 1.5 hr (peak) and 6 hr (trough) after drug administration on all test days. Children weighing less than 60 pounds received 10 mg of metaproterenol (1 tsp), while those weighing more than 60 pounds received 20 mg every 6 hr. The mean peak theophylline level for both metaproterenol and placebo treatment days was approximately 10 μg/ml, while the trough was 6 μg/ml. Metaproterenol caused a significantly greater increase in FEVI (p < 0.05) of 17% at 1.5 hr when given with theophylline than the placebo- theophylline combination. The metaproterenol effect on MMEFR was even greater with increases over placebo of more than 80% at 1.5 hr and 2 hr (p < 0.0025) and 30% at 3 hr and 4 hr (p < 0.05). No increase in adverse effects with the metaproterenol-theophylline combination compared with placebo-theophylline was observed. This study suggests that metaproterenol can improve pulmonary function of both large and small airways when added to moderate theophylline doses without risking increased side effects in asthmatic children.     

Inhaled albuterol powder for the treatment of asthma--a dose-response study

Many patients are unable to obtain optimal benefit from inhaled bronchodilators as delivered by metered-dose aerosol spray because of difficulty in synchronizing release of medication with the start of inspiration. The Rotahaler is a flow-activated device that avoids this problem since the act of inspiration itself delivers medication to the lungs. In this randomized, double-blind, crossover study, each of 20 male patients with moderate to severe asthma, ages 12 to 23 yr, received a single treatment with 100, 200, or 400 mcg of albuterol powder or placebo by Rotahaler on 4 study days separated by 2 to 10 days. All patients stopped theophylline and inhaled beta-agonists as needed 24 and 12 hr, respectively, before study days. All patients emptied the Rotahaler with a single inhalation. Pulmonary functions were followed for 8 hr after medication. Statistical analyses of FEV1, FEF25-75, and FVC revealed that all doses of albuterol powder were superior to placebo within 5 min with a log dose-response trend for both degree and duration of bronchodilation.     

Metabolic and cardiovascular effects of carbuterol and metaproterenol.

Metabolic and cardiovascular responses to selective beta-adrenergic bronchodilators, carbuterol and metaproterenol, were studied during an asymptomatic period in 8 male subjects with bronchial asthma diagnosed as mile to moderate. On separate days each individual received either placebo, carbuterol 2 mg, carbuterol 4 mg, or metaproterenol 20 mg orally in a double-blind fashion. Subsequently, metabolic and cardiovascular responses were measured periodically for 5 hr. Carbuterol 2 mg was indistinguishable from placebo except for small elevations of glucose at 3 and 4 hr. Carbuterol 4 mg produced significant increases in glucose, insulin, lactate, and free fatty acids as well as in pulse rate and arterial pulse pressure. Metaproterenol produced increases only in plasma glucose and insulin. The majority of patients reported drug-related side effects which were all mild, after taking either carbuterol 4 mg or metaproterenol 20 mg. Fewer subjective side effects were noted with carbuterol 2 mg. These findings indicate that a 2-mg dose of carbuterol can be administered to typical asthmatic subjects without significant subjective or objective side effects. The larger dose (4 mg) may be accompanied by a greater frequency of side effects.     

Epinephrine improves expiratory flow rates in patients with asthma who do not respond to inhaled metaproterenol sulfate

One hundred patients with acute asthma and peak expiratory flow rates (PEFR) less than 150 L/min were randomized and treated in a double-blind treatment protocol with either metaproterenol sulfate aerosol (MPA) inhalation and placebo injection or epinephrine injection (EPI) and inhaled placebo at entry and at 30 and 60 minutes, and then were treated with the crossover comparison regimen at 120, 150, and 180 minutes. The two groups had similar entry PEFRs and FEV1 (MPA, 112 L/min; 0.94 L, respectively; EPI, 111 L/min; 0.85 L, respectively) and similar plasma theophylline levels (MPA, 12.2 micrograms/ml; EPI, 13.8 micrograms/ml). PEFR and FEV1 were measured every 30 minutes for 4 hours. Mean expiratory flow rates among both groups were similar at entry and at 120 and 240 minutes. At 120 minutes, flow rates had improved in 28/46 MPA-treated patients (61%) and 48/54 EPI-treated patients (89%). Among these improved patients, flow rates were significantly higher in the MPA-treated group. At 120 minutes, 18/46 MPA-treated patients (39%) and 6/54 EPI-treated patients (11%) had PEFRs less than 120 L/min and PEFR and FEV1 less than 120% of baseline values (p less than 0.01). In 13 of these 18 MPA-treated patients who did not improve compared to 1/6 EPI-treated patients who did not improve, PEFRs were greater than 120 L/min, and PEFR and FEV1 had increased 20% or more above baseline values after treatment with the crossover comparison regimen (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)     

氨茶碱联合胸腺肽对老年COPD患者IL-6、SAA及hs-CRP的影响

目的 氨茶碱联合胸腺肽对老年COPD患者IL-6、TNF-α、SAA、hs-CRP以及肺功能的影响.方法 选取2015年4月至2016年11月在我院接受治疗的老年COPD患者160例,采用随机数表法将患者分为观察组和对照组,每组各80例患者,对照组患者给予氨茶碱治疗,观察组采用氨茶碱联合胸腺肽治疗,观察两组患者治疗前后血清IL-6、TNF-α、hs-CRP、SAA以及肺功能指标FEV1、FVC以及FEV 1/FVC变化情况,同时比较两组患者治疗后的临床效果.结果 治疗后,两组患者的血清指标IL-6、hs-CRP以及TNF-α水平表达均下降,且观察组(12.30±3.02ng/L、1.98 ±0.53 mg/L、2.12±0.39ng/L)均低于对照组患者(16.45±3.56ng/L、2.60±0.34 mg/L、2.98±0.45ng/L),二者比较差异具有统计学意义(P＜0.05);治疗后,两组患者的SAA水平表达均有所下降,观察组明显低于对照组,两组比较差异具有统计学意义(P＜0.05);治疗后,两组患者的肺功能指标FEV1、FVC以及FEV1/FVC均有所上升,观察组显著高于对照组,差异具有统计学意义(P＜0.05);观察组患者治疗后的总有效率为95.00％高于对照组77.50％,两组比较差异有统计学意义(P＜0.05).结论 采用氨茶碱联合胸腺肽治疗老年COPD患者,能够有效降低患者的血清炎性因子表达,改善患者的肺功能,提高治疗效果,值得临床推广使用.     

吸入用沙丁胺醇联合布地奈德对COPD急性加重期的作用

目的 观察吸入用沙丁胺醇联合布地奈德对COPD急性加重期的作用。方法 选取2015年1月~2017年1月我院治疗的86例COPD急性加重期患者,随机分为观察组和对照组,每组43例。对照组在常规治疗的基础上雾化吸入布地奈德,观察组在对照组的基础上吸入用沙丁胺醇。比较两组治疗前后用力肺活量（FVC）、第1秒用力呼气容积（FEV1）,临床治疗效果。结果 治疗后,两组FVC、FEV1均高于治疗前,观察组FVC、FEV1分别为（2.08±0.57）L、（1.97±0.43）L,高于对照组的（1.69±0.49）L、（1.47±0.36）L,差异有统计学意义（P＜0.05）;观察组治疗有效率为97.67%,高于对照组的76.74%,差异有统计学意义（P＜0.05）。结论 吸入用沙丁胺醇联合布地奈德有助于改善COPD急性期患者FVC、FEV1,具有较高的疗效。     

COPD 患者Th17 细胞和Treg 细胞介导的免疫应答变化及免疫失衡与肺功能的关系研究

目的:探讨慢性阻塞性肺疾病(COPD)患者外周血Th17 细胞和调节性T 细胞(Treg)及其介导的免疫应答变化与患者肺功能的关系。方法:选取本院呼吸内科收治的90 例COPD 患者(COPD 组)和同期年龄、性别基本匹配的45 例健康体检对象作为对照组,并根据COPD 病情进行亚组分析,分别测定各组研究对象肺功能指标、Th17 细胞、Treg 细胞及血清炎症因子水平。结果:在COPD 患者间,随着病情加重,FEV1%、FVC%、FEV1/ FVC 比值中度COPD 组<重度COPD 组<极重度组(P<0.05);在COPD 患者间,随着病情加重,外周血中Th17 细胞、Th17/ Treg 比值中度COPD 组<重度COPD 组<极重度组(P<0.05),外周血Treg 细胞比值中度COPD 组>重度COPD 组>极重度组(P<0.05),且外周血Th17 细胞、Treg 细胞相关细胞因子变化具有一致性;COPD 患者的肺功能指标FEV1%、FVC%、FEV1/ FVC 与外周血中Th17 细胞、Th17/ Treg 比值呈显著的负相关关系(P<0.05),肺功能指标FEV1%、FVC%、FEV1/ FVC 与外周血Treg 比值呈显著的正相关关系(P<0.05)。结论:COPD外周血Th17/ Treg 比值与患者肺功能下降具有显著的相关性。     

Predictors of pulmonary function response to treatment with salmeterol/fluticasone in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and responses to therapies are highly variable. The aim of this study was to identify the predictors of pulmonary function response to 3 months of treatment with salmeterol/fluticasone in patients with COPD. A total of 127 patients with stable COPD from the Korean Obstructive Lung Disease (KOLD) Cohort, which were prospectively recruited from June 2005 to September 2009, were analyzed retrospectively. The prediction models for the FEV(1), FVC and IC/TLC changes after 3 months of treatment with salmeterol/fluticasone were constructed by using multiple, stepwise, linear regression analysis. The prediction model for the FEV(1) change after 3 months of treatment included wheezing history, pre-bronchodilator FEV(1), post-bronchodilator FEV(1) change and emphysema extent on CT (R = 0.578). The prediction models for the FVC change after 3 months of treatment included pre-bronchodilator FVC, post-bronchodilator FVC change (R = 0.533), and those of IC/ TLC change after 3 months of treatment did pre-bronchodilator IC/TLC and post-bronchodilator FEV(1) change (R = 0.401). Wheezing history, pre-bronchodilator pulmonary function, bronchodilator responsiveness, and emphysema extent may be used for predicting the pulmonary function response to 3 months of treatment with salmeterol/fluticasone in patients with COPD.     

The use of humidity in asthmatic children.

Controversy exists as to the advisability of mist therapy in pulmonary disease. We studied the effects of several forms of humidity on asthmatic airways. Thirty-four children were tested over a period of 8 months as follows: (1) mist with a mean particle size of 3 mu was delivered for 30 min by an ultrasonic nebulizer to 11 children individually in a plastic tent; (2) to another 11 subjects in a tent, mist with a mean particle size of 10 mu was delivered by a jet nebulizer for 30 min;3) 15 patients in a croup room recieved for 30 min water droplets ranging from a microscopic fog to large rain particles (mean 16 mu) generated by a Melco natural fog generator; (4) 10 children were challenged with 3 solutions used commonly for the production of mist: distilled water, half-normal saline, and normal saline. Pulmonary functions were studied on each patient pre- and post-mist exposure. Approximately two thirds of the patients had a significant response, either improvement or deterioration, when challenged with the various forms of mist. No particular group trends were produced either by increasing the mean particle size of humidity, or by using solutions of increasing salinity.     

Comparison of four weeks'' treatment with fenoterol and terbutaline aerosols in adult asthmatics : A double-blind crossover study

Fenoterol and terbutaline, two long-acting beta 2-adrenoceptor agonists in aerosol form, were compared in an 8-wk randomized double-blind crossover study in 22 mild to moderately severe asthmatics. Patients completed diary cards, recorded peak expiratory flow rate (PEFR) twice daily, and attended a clinic for measurement of PEFR, 1-sec forced expiratory volume (FEV1), and forced vital capacity (FVC) twice during each treatment period. Fifteen patients completed the study; 5 dropped out while using fenoterol, and 2 while using terbutaline. At clinic attendances, the patients had a significantly higher mean PEFR after 4 wk on terbutaline (385 L/min) than after fenoterol (316 L/min) (p less than 0.001). Similar results were found on analysis of the morning and evening PEFR recordings. On comparing each individual's PEFR recordings during the 2 treatments, it was found that there was no significant difference among the treatments in 3 patients, while 9 patients had a better response to terbutaline, and 3 patients had a better response to fenoterol. While similar number expressed a subjective preference for each treatment, the lung function data suggested that the effectiveness of fenoterol appeared to decline during the trial period.     

The effects of hormone replacement therapy type on pulmonary functions in postmenopausal women

OBJECTIVE: To study whether hormone replacement therapy (HRT) or Tibolone has an effect on pulmonary function in postmenopausal women. METHODS: Seventy-five postmenopausal women without any risk factor for pulmonary disease were included in this randomized, prospective study. Fifty women had undergone natural menopause and 25 had had a hysterectomy/ooforectomy. Twenty-five natural menopause women were randomly allocated to two groups: 25 patients (Group I) were treated with Tibolone 2.5 mg/day, 25 patients (group II) with Estradiol Hemihidrate 2 mg+Norethindron Asetate 1 mg/day. Twenty-five induced menopause women were treated with 17 beta-estradiol 2 mg/day. Lung function tests including forced vital capacity (FVC), forced expiratory volume (FEV(1)), FEV(1)/FVC, forced expiratory flow rate over the 25-75% of the forced vital capacity volume (FEF(25-75%)), and peak expiratory flow rate (PEF) were evaluated at the beginning and 3 months after the treatment to assess the effects of HRT and Tibolone on respiratory function. RESULTS: Regardless of HRT types a significant difference was observed in FVC and FEV(1) after 3 months of the therapy (P=0.001, 0.0001, respectively). No significant difference was found between pre and post therapy values in the other parameters (P>0.05). CONCLUSIONS: We determined a significant increase in FVC and FEV(1) parameters of pulmonary functions after 3 months of the therapy regardless of HRT types. Therefore, we think that HRT regimens have modifying effects on pulmonary function in postmenopausal women.     

Changes in blood gas levels after nebuhaler and nebulizer administration of terbutaline in severe chronic airway obstruction

It has been suggested that patients with severe chronic airway obstruction might suffer dangerous hypoxia after administration of a beta-agonist through an air driven nebulizer. Twenty patients with severe chronic airway obstruction (12 male, mean age 71.1 (SEM 1.5) yr) were monitored with a Biox oximeter and Hewlett-Packard capnometer before and after 4 mg terbutaline was delivered through an air driven nebulizer or Nebuhaler. The eight patients with chronic hypoxia (mean PaO2 6.76 kPa, PaCO2 7.47 kPa. FEV1 0.53 l) experienced a 4.7% increase in oxygen saturation (SaO2) and 2.9% fall in transcutaneous carbon dioxide tension (PtcCO2) (p less than 0.05) during all treatments, followed by a return to initial levels. These changes were attributable to increased ventilation whilst breathing through a mouthpiece. A similar trend was seen in the SaO2 of the twelve normoxic patients (mean PaO2 9.32 kPa, PaCO2 5.34 kPa, FEV1 0.8 l), but there was a sustained fall in PtcCO2 of 3.7% (p less than 0.001) after administration of terbutaline. Inhaled terbutaline in the dosage given did not cause hypoxia in patients with severe chronic airflow obstruction, but nebulizer and Nebuhaler use was associated with a rise in SaO2 related to increased ventilation whilst breathing through a mouthpiece.     

Domiciliary metaproterenol nebulization: a bacteriologic survey

We wanted to determine whether domiciliary jet nebulization (DJN) leads to contamination of the equipment with fungi or aerobic bacteria and, eventually, to respiratory colonization or pneumonia in daily users of the equipment. We surveyed from this standpoint 23 veterans 65 +/- 10.1 years of age, present or former smokers, treated with steroids more than 7 months in the year preceding the survey, and with FEV1/FVC of 42 +/- 11%; they all were daily users of the equipment, diluting the metaproterenol solution with nonbacteriostatic saline dispensed in multiple-dose bottles of 500 to 1000 ml (protocol 1 [P1]). After this protocol was completed, the large saline bottles were replaced by 20 cc vials; 11/23 completed 1 year of this treatment (protocol 2 [P2]). Equipment contamination was checked in all initial 23 patients after one-time nebulization in the laboratory with fresh material (protocol 3 [P3]). We found that DJN leads to equipment contamination in 20/23 subjects of P1 and 3/11 subjects of p2; saline bottles and the nebulizer were the most frequently contaminated items (32/41 equipment items in P1 and 10/55 in P2). The contamination was predominantly bacterial with oropharyngeal saprophytes (19 in p1, O in P2) or gram-negative bacilli (47 in P1, 8 in P2). Bacterial growth was heavier in P1 than in P2. During P3, three equipment items became contaminated in 3/23 subjects; the flora was oropharyngeal. No patient developed respiratory colonization or developed pneumonia during 9000 patient days of DJN.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical and pharmacokinetic evaluation of a sustained-release liquid theophylline preparation

Theolan Suspension is the first long-acting liquid theophylline dosage form. A crossover study comparing the pharmacokinetic and clinical response to Theolan Suspension (administered every 12 hours) with aminophylline solution (administered every 8 hours) in children younger than 12 years of age is reported. Twenty-seven patients completed the study: 17 children were aged 6 years or younger and five patients were 3 years or younger. All patients were withdrawn from bronchodilator therapy and then were titrated to clinically effective doses of study medication. There was an equivalent and significant reduction from baseline levels in the mean symptom score during administration of theophylline suspension (42%; p less than or equal to 0.001) and aminophylline solution (57%; p less than or equal to 0.001). Mean values for FEV1 (1.2 versus 1.3 L), FEV1/FVC (77% versus 79%), and reduction in acute metaproterenol use (24% versus 43%) in children receiving theophylline suspension and aminophylline solution revealed no differences between products. Adverse effects were reported more frequently for the aminophylline solution, possibly caused in part to its taste. Of children stating a taste preference, eight of 10 children chose the Theolan Suspension. The suspension demonstrated a lower peak theophylline blood level at a later time (11.6 micrograms/ml at 3 1/2 hours), compared to the solution (14.6 micrograms/ml at 1 1/2 hours; p less than or equal to 0.01). Indexes of theophylline fluctuation during the dosing interval indicated equivalent or reduced variability for the suspension. Relative bioavailability of theophylline suspension was 89% of that for the solution.(ABSTRACT TRUNCATED AT 250 WORDS)     

慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比

目的 探究慢性阻塞性肺疾病急性加重期与慢性阻塞性肺疾病并发社区获得性肺炎患者的临床对比,旨在为临床的诊断和治疗提供科学依据。方法 选取2017年3月~2018年3月于我院接受治疗的82例COPD患者为研究对象,按照随机数表法分为两组,其中观察组42例为AECOPD患者,对照组40例为COPD合并CAP患者,比较两组患者的临床症状、肺功能以及PCT、CRP水平。结果 观察组患者呼吸困难、咳脓痰、精神差、发热等临床症状的发生率均低于对照组,差异具有统计学意义（P＜0.05）。观察组患者FEV1、FVC、FEV1/FVC分别为（64.15±7.26）ml、（62.85±7.29）ml、（62.03±5.54）%,均高于对照组的（52.51±5.75）ml、（50.85±6.74）ml、（52.34±5.61）%,差异具有统计学意义（P＜0.05）。观察组患者PCT和CRP分别为（0.52±0.07）ng/L和（21.51±1.35）mg/L,均低于对照组的（0.97±0.08）ng/L和（40.05±1.57）mg/L,差异具有统计学意义（P＜0.05）。结论 AECOPD患者与COPD合并CAP患者相比,临床症状发生情况较少,肺功能较好,对患者进行相关检测,能够提高治疗效果。     

Genome-wide linkage analysis of bronchodilator responsiveness and post-bronchodilator spirometric phenotypes in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common, complex disease associated with significant and increasing morbidity and mortality. The cardinal feature of COPD is persistent airflow obstruction, measured by reductions in quantitative spirometric indices including forced expiratory volume at one second (FEV(1)) and the ratio of FEV(1) to forced vital capacity (FEV(1)/FVC). However, many patients have substantial improvement in spirometric measures with inhaled bronchodilator medications, and bronchodilator responsiveness (BDR) has been associated with disease severity and progression. To identify susceptibility loci for BDR phenotypes, we performed a 9 cM genome scan in 72 pedigrees (n=560 members) ascertained through probands with severe, early-onset COPD. Multipoint variance component linkage analysis was performed for quantitative phenotypes including BDR measures and post-bronchodilator FEV(1) and FEV(1)/FVC. Post-bronchodilator FEV(1) was linked to multiple regions, most significantly to markers on chromosome 8p (LOD=3.30) and 1q (LOD=2.24). Post-bronchodilator FEV(1)/FVC was also linked to multiple regions, most significantly to markers on chromosome 2q (LOD=4.42) and 1q (LOD=2.52). When compared with pre-bronchodilator spirometric indices, the post-bronchodilator values demonstrated increased evidence of linkage in multiple genomic regions. In particular, the LOD score for the 8p linkage to FEV(1) roughly doubled from 1.58 to 3.30. Candidate regions on chromosomes 4p (LOD=1.28), 4q (LOD=1.56), and 3q (LOD=1.50) gave the strongest evidence for linkage to BDR measures. Our results provide evidence for significant linkage to airflow obstruction susceptibility loci on chromosomes 2q and 8p, and further suggest that post-bronchodilator spirometric measures are optimal phenotypes for COPD genetic studies. This study has also identified several genomic regions that could contain loci regulating BDR in early-onset COPD families.     

补肺活血汤联合常规西医治疗可降低气道炎症并改善肺功能从而提高COPD 的疗效

目的:分析补肺活血汤联合西医治疗慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)稳定期的疗效及降低气道炎症并改善肺功能的作用。方法:选取我科2013 年2 月至2015 年3 月COPD 稳定期患者共100 例,随机分为联合组和对照组。对照组予以常规吸氧、沙美特罗替卡松粉吸入剂(1 吸/ 次,2 次/ d)及祛痰治疗。联合组在对照组基础上,加用补肺活血汤,疗程均为12 周。对比两组患者的临床疗效及 1 AT 和IL-8 水平变化。结果:联合组治疗后的咳嗽、咳痰、呼吸困难、喘息、哮鸣症状积分显著低于对照组(P<0.05)。联合组治疗后的用力肺活量(Forced vital capacity,FVC)、一秒用力呼气容积(Forced expiratory volume in one second,FEV1)和FEV1/ FVC 显著低于对照组(P<0.05)。联合组治疗后的 1-AT 和NO 显著高于对照组,IL鄄8 和TNF 显著低于对照组(P<0.05)。联合组治疗后的BODE 各项评分显著低于对照组(P<0.05)。结论:补肺活血汤联合西医治疗COPD 可通过抑制炎症反应,改善临床症状、肺功能和生活质量。