过敏性鼻炎-哮喘综合征的临床经济学研究

目的明确过敏性鼻炎-哮喘综合征（combinedallergicrhinitisandasthmasyndrome，CARAS）这一新的医学诊断术语。从临床经济学角度出发，对经鼻吸入糖皮质激素对CARAS联合治疗与传统的采用鼻喷雾剂和口喷雾剂分别治疗的成本／效果比（C／E）进行研究比较。方法哮喘门诊中随机选择CARAS患者74例，随机分为两组。其中一组为联合治疗组，采用经鼻吸入糖皮质激素喷雾剂进行治疗；另一组为传统治疗组，采用鼻喷雾剂和口喷雾剂分别进行治疗，疗程3个月。分别计算两组治疗的总费用（C），治疗后鼻部症状改善总评分（E1）、胸部症状改善总评分（E2）和PEFR增加值（E3），分别计算联合治疗组和传统治疗组的C／E1，C／E2和C／E3。结果C／E1，联合组为8．194，传统组为17．499；C／E2，联合组为9．001，传统组为15．432；C／E3，联合组为8。489，传统组为15．867。结论联合治疗组和传统治疗组在临床疗效基本相同的情况下，联合治疗组3个指标的C／E都远远低于传统治疗组的C／E，联合治疗这一新的治疗方式更具有临床经济学意义。     

过敏性鼻炎-哮喘综合征的临床经济学研究

目的明确过敏性鼻炎一哮喘综合征（combinedallergicrhinitisandasthmasyndrome,CARAs）这一新的医学诊断术语。从临床经济学角度出发,对经鼻吸入糖皮质激素对CARAS联合治疗与传统的采用鼻喷雾剂和口喷雾剂分别治疗的成本／效果比（C／E）进行研究比较。方法哮喘门诊中随机选择CARAS患者74例,随机分为两组。其中一组为联合治疗组,采用经鼻吸入糖皮质激素喷雾剂进行治疗;另一组为传统治疗组,采用鼻喷雾剂和口喷雾剂分别进行治疗,疗程3个月。分别计算两组治疗的总费用（C）,治疗后鼻部症状改善总评分（E1）、胸部症状改善总评分（E2）和PEFR增加值（E3）,分别计算联合治疗组和传统治疗组的C／E1,C／E2和C／E3。结果C／E1,联合组为8．194,传统组为17．499;C／E2,联合组为9．001,传统组为15．432;C／E3,联合组为8．489,传统组为15．867。结论联合治疗组和传统治疗组在临床疗效基本相同的情况下,联合治疗组3个指标的C／E都远远低于传统治疗组的C／E,联合治疗这一颓的治疗方式更具有临床经济学意义。     

经鼻吸入布地奈德治疗过敏性鼻炎-哮喘综合征

目的 最近世界变态反应组织(WAO)提出了过敏性鼻炎-哮喘综合征(combined allergic rhinitis and asthma syndrome,CARAS)这一新的诊断术语.同时指出上、下呼吸道疾病需要进行联合诊断和联合治疗.采用了鼻-口两用雾化器(spacer),分别经口或经鼻吸入糖皮质激素治疗CARAS患者,以评价经鼻吸入糖皮质激素在防治CARAS的价值.方法 采用鼻-口两用雾化器(商品名:吸保)吸入布地奈德气雾剂治疗86例CARAS患者,随机将患者分为经口吸入组和经鼻吸入组,同时观察了两组治疗前后的鼻部症状记分、胸部症状记分、肺功能和气道反应性.结果 鼻吸组与口吸组均可显著改善胸部症状、肺通气功能,降低气道高反应性.治疗前后差异有统计学意义(P＜0.01),两组间比较差异无统计学意义(P＞0.05),但在改善鼻部症状记分方面鼻吸组明显优于口吸组(P＜0.01).结论 与口腔吸入比较,经鼻吸入给予布地奈德气雾剂是一种既可控制过敏性鼻炎,又可防治哮喘的治疗方法,应在伴有过敏性鼻炎的哮喘和CARAS患者的防治中推荐使用.     

经鼻吸入布地奈德治疗过敏性鼻炎-哮喘综合征

目的最近世界变态反应组织提出了过敏性鼻炎-哮喘综合征（combined allergic rhinitis and asthma syndrome,CARAS）这一新的诊断术语。同时指出上、下呼吸道疾病需要进行联合诊断和联合治疗。采用了鼻-口两用雾化器（spacer）,分别经口或经鼻吸入糖皮质激素治疗CARAS患者,以评价经鼻吸入糖皮质激素在防治CARAS的价值。方法采用鼻-口两用雾化器（商品名：吸保）吸入布地奈德气雾剂治疗86例CARAS患者,随机将患者分为经口吸入组和经鼻吸入组,同时观察了两组治疗前后的鼻部症状记分、胸部症状记分、肺功能和气道反应性。结果鼻吸组与口吸组均可显著改善胸部症状、肺通气功能,降低气道高反应性。治疗前后差异有统计学意义（P〈0．01）,两组间比较差异无统计学意义,但在改善鼻部症状记分方面鼻吸组明显优于口吸组（P〈0．01）。结论与口腔吸入比较,经鼻吸入给予布地奈德气雾剂是一种既可控制过敏性鼻炎,又可防治哮喘的治疗方法,应在伴有过敏性鼻炎的哮喘和CARAS患者的防治中推荐使用。     

激素不同吸入方法对过敏性鼻炎-哮喘综合症患者临床症状及生存质量的影响

目的 探讨激素不同吸入方法对CARAS患者临床症状及生存质量的影响.方法 90例CARAS患者被随机分为鼻吸组、口吸组及联合组,分别于治疗前后统计患者鼻炎症状积分,ACT、QOL评分及肺功能指标.结果 鼻吸组和联合组治疗后鼻炎症状评分明显减少(P＜0.05),口吸组也有减少,但无统计学意义(P＞0.05).口吸组、联合组比鼻吸组治疗后ACT、QOL评分及肺功能指标明显提高,且联合组在ACT、QOL评分优于口吸组(P＜0.05).结论 口鼻联合吸入激素是控制CARAS患者鼻炎症状、提高哮喘控制水平、改善生存质量的最好方法.     

经鼻吸入布地奈德及特布他林治疗支气管哮喘急性发作并变应性鼻炎患者的临床疗效观察

目的观察经鼻吸入布地奈德及特布他林治疗支气管哮喘急性发作并变应性鼻炎患者的临床疗效。方法选取2013年9月—2015年5月淮安市淮阴医院收治的支气管哮喘急性发作并变应性鼻炎患者96例,采用随机数字表法分为对照组和观察组,每组48例。两组患者入院后均给予支气管哮喘常规干预,对照组患者在此基础上经口吸入布地奈德和特布他林,观察组患者在此基础上经鼻吸入布地奈德和特布他林。比较两组患者治疗前、治疗后3 d、出院前视觉模拟量表(VAS)评分、哮喘控制问卷(ACT)评分,住院时间及住院期间糖皮质激素静脉给药量。结果治疗前两组患者VAS、ACT评分比较,差异无统计学意义(P0.05);治疗3 d后、出院前观察组患者VAS评分低于对照组,ACT评分高于对照组(P0.05)。观察组患者住院时间短于对照组,住院期间糖皮质激素静脉给药量少于对照组(P0.05)。结论经鼻吸入布地奈德及特布他林治疗支气管哮喘急性发作并变应性鼻炎患者的临床疗效确切,可有效控制鼻炎及哮喘症状,缩短住院时间并减少糖皮质激素用量。     

吸入激素联合噻托溴铵治疗哮喘-慢阻肺重叠综合症的临床疗效评价

目的观察不使用长效β2-激动剂情况下,应用噻托溴铵联合吸入糖皮质激素对哮喘-慢阻肺重叠综合征(ACOS)患者的治疗作用,并与单用噻托溴铵及单纯吸入糖皮质激素的治疗手段进行对比。方法根据"ACOS"诊断标准选择60例患者,分为噻托溴铵联合布地奈德粉吸入剂组、单用布地奈德粉吸入剂组、单用噻托溴铵组,三组分别进行肺功能、ACT、CAT及急性加重次数的比较。结果治疗后3组患者中噻托溴铵联合布地奈德(C)组肺功能改善率明显高于噻托溴铵(A)组、布地奈德粉吸入剂(B)组(P0.05)。治疗后三组患者用于哮喘症状评估的ACT评分噻托溴铵联合布地奈德(C)组较单用噻托溴铵、单用布地奈德治疗的两组症状改善更明显(P0.05),而治疗后三组患者CAT评分噻托溴铵联合布地奈德(C)组较单用噻托溴铵、单用布地奈德治疗的两组症状改善更明显。结论噻托溴铵联合糖皮质激素吸人治疗可以明显改善ACOS患者的肺功能和临床症状,减少急性发作次数,其疗效优于单用糖皮质激素吸入和单用噻托溴铵吸入治疗,可改善其短期预后。     

吸入糖皮质激素(布地奈德)/长效β2受体激动剂(福莫特罗)复合制剂治疗中、重度持续支气管哮喘的疗效研究

目的 观测联合吸入糖皮质激素(布地奈德)/长效β2受体激动剂(福莫特罗)干粉吸入剂治疗期间支气管哮喘(简称哮喘)患者诱导痰嗜酸粒细胞(EOS)计数、肺功能与哮喘临床症状的关系.方法 本院健康呼吸中心就诊的中、重度持续哮喘患者33例(哮喘组)联合吸入糖皮质激素/长效β2受体激动剂复合制剂治疗6个月,测定肺功能(FEV1、FEV1/FVC、PEF),诱导痰中EOS计数,记录哮喘控制得分(ACT)及患者哮喘生命质量评分.哮喘组在治疗开始后1个月,2个月,3个月和6个月时进行重复测定.且以10名健康者做为对照组,同期测定上述观察指标.同时记录吸入用药后的不良反应.结果 研究共纳入38例患者,共有33例完成6个月或更长的随访观察.吸入糖皮质激素/长效β2受体激动剂复合制剂治疗后1个月,FEV1值明显改善[分别为(2.53±0.46)L,(2.89±0.62)L,P<0.01];3个月后上述变化更为显著达(3.19±0.47)L,与治疗1个月后相比发生显著变化(P<0.05);哮喘组诱导痰中EOS显著升高达(0.156±0.047)×10<'6>(P<0.05),激素吸入治疗过程中可见显著性变化,3个月降至(0.072±0.015)×10<'6>,6个月后痰中EOS计数明显减少,与治疗前相比较差异有统计学意义(q=6.58,P<0.05).吸入治疗后ACT评分明显改善,从治疗前(8±5)分增加至治疗后2个月(15±6)分,治疗后3个月到(20±4)分,与治疗前相比较差异有统计学意义(F=5.72,P<0.05).治疗6个月后,患者哮喘生命质量评分明显提高(P<0.05).哮喘组中共有12例患者(36.36%)获得完全控制.结论 联合吸入糖皮质激素/长效β2受体激动剂复合制剂治疗哮喘明显改善患者肺功能,减少痰EOS计数,有较好的临床疗效,且应至少连用6个月或以上.     

依据呼出气一氧化氮浓度联合哮喘控制测试评分调整吸入糖皮质激素剂量控制支气管哮喘的应用研究

目的分析依据呼出气一氧化氮浓度(FeNO)联合哮喘控制测试(ACT)评分调整吸入糖皮质激素剂量控制支气管哮喘的应用效果。方法选取2016年1月—2017年9月廊坊市人民医院收治的支气管哮喘患者250例,采用随机数字表法分为对照组和观察组,每组125例。在常规干预基础上,对照组患者依据ACT评分调整吸入糖皮质激素剂量,观察组患者则依据Fe NO联合ACT评分调整吸入糖皮质激素剂量。记录两组患者随访6个月期间支气管哮喘急性发作次数、入住急诊次数、住院次数、吸入糖皮质激素剂量,并比较两组患者治疗前及随访6个月肺功能指标、支气管哮喘生命质量问卷(AQLQ)评分。结果随访6个月期间观察组患者支气管哮喘急性发作次数、入住急诊次数及住院次数少于对照组,吸入糖皮质激素剂量低于对照组(P0.05)。治疗前两组患者第1秒用力呼气容积(FEV1)、呼气峰流速(PEF)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)及AQLQ评分比较,差异无统计意义(P0.05);随访6个月两组患者FEV1、PEF、FEV1/FVC比较,差异无统计学意义(P0.05),而观察组患者AQLQ评分高于对照组(P0.05)。结论与单纯依据ACT评分相比,依据FeNO联合ACT评分调整吸入糖皮质激素剂量对支气管哮喘的控制效果较好,有利于减少糖皮质激素用量,改善支气管哮喘患者生命质量,20 ppb和35 ppb可作为FeNO指导支气管哮喘患者调整吸入糖皮质激素剂量的切点。     

糖皮质激素联合长效β2-受体激动剂治疗糖皮质激素抵抗型哮喘

目的观察糖皮质激素(GC)联合长效β2-受体激动剂(LABA)对糖皮质激素抵抗型(SR)哮喘患者哮喘症状和肺功能的影响,探讨GC联合LABA对SR哮喘有无治疗作用.方法SR哮喘患者20例,随机分为A、B,每组各10例.A组吸入沙美特罗50 ug,2次/天和氟替卡松500 ug,2次/天.B组每天吸入氟替卡松500 ug,2次/天,急性发作时吸入沙丁胺醇,疗程4周,疗程开始及结束时评价哮喘临床积分和肺功能检查.结果治疗后A组患者哮喘临床积分显著降低(与A组治疗前比较P＜0.01;与B组治疗后比较P＜0.05),肺功能指标用力肺活量(FVC%).第1秒用力呼吸容积(FEV1%)最大呼气流量(PEF%),50%肺活量时最大呼气流量(V50%),25%肺活量时最大呼气流量(V25%),均显著增高.B组治疗后与治疗前比较,上述各项指标均无显著改变(P＞0.05).结论CS联合LABA是治疗SR哮喘的有效方法.     

支气管哮喘合并过敏性鼻炎的临床治疗观察

目的了解布地奈德鼻喷剂联合舒利迭吸入剂对过敏性鼻炎-哮喘综合症患者的治疗效果。方法60例过敏性鼻炎-哮喘综合症患者,随机分为两组,对照组30例,给予吸入舒利迭50/100μg或50/250μg,1吸/次,2次/日。试验组30例,在吸入舒利迭治疗基础上,同时给予布地奈德鼻喷剂治疗,每个鼻孔各1喷,64μg/喷,2次/日。治疗时间为8周。结果试验组比对照组能显著提高患者的生存质量,对照组不能有效改善患者的鼻炎症状。结论联合治疗过敏性鼻炎和支气管哮喘比单纯治疗支气管哮喘更能有效地提高患者的生存质量。     

Leukotriene modifier vs inhaled corticosteroid in mild-to-moderate asthma: clinical and anti-inflammatory effects

STUDY OBJECTIVE: Evidence for the anti-inflammatory activity of leukotriene receptor antagonists in humans is somewhat limited. There are also no data comparing the anti-inflammatory effects of leukotriene receptor antagonists with those of inhaled corticosteroids. This study was designed to assess the clinical efficacy and anti-inflammatory effects of leukotriene receptor antagonist plus low-dose inhaled corticosteroids compared to those of a high-dose inhaled corticosteroid in patients with mild-to-moderate asthma. METHODS: Forty-nine patients with newly diagnosed asthma were recruited. They were randomly assigned to groups that received, for a 6-week period, either (1) budesonide, 600 microg bid (1,200 microg/d) or (2) budesonide, 200 microg (400 microg/d), and zafirlukast, 20 mg bid. The variables of asthma control were recorded daily. Sputum induction and methacholine provocation tests were performed. RESULTS: The results indicated that the administration of a low-dose inhaled corticosteroid plus zafirlukast was as effective as that of a high-dose inhaled corticosteroid regarding clinical improvement and anti-inflammatory effects (ie, eosinophil percentage, and eosinophilic cationic protein [ECP] and cysteinyl leukotriene C4 levels in induced sputum). Nineteen (group 1, 8 patients; group 2, 11 patients) of 49 patients (38.8%) had returned to normal airway responsiveness after treatment. Among these patients, 16 patients (84.2%) had normal ECP levels and 10 patients (52.6%) had normal percentages of eosinophils. ECP level, but not the eosinophil percentage, was significantly associated with symptom scores. The peak expiratory flow rate (PEFR) showed a significant correlation with the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) instead of with symptom scores. CONCLUSIONS: The addition of a leukotriene modifier to treatment with low-dose inhaled corticosteroids is equivalent to treatment with high-dose inhaled corticosteroids in patients with newly diagnosed mild-to-moderate asthma. In addition to symptoms and PEFR, the monitoring of ECP and PC20 may be of great value in achieving optimal control of asthma.     

A randomized controlled trial of inhaled flunisolide in the management of acute asthma in children

BACKGROUND: Inhaled corticosteroids (ICS) may provide benefit in the therapy of acute asthma. The purpose of this study was to test the hypothesis that ICS are as effective as oral corticosteroids (OCS) in the management of acute childhood asthma. METHODS: A randomized, masked, placebo-controlled study was conducted in children aged 6 to 16 years seeking emergent care for an acute exacerbation of asthma. Patients were randomized into one of two groups: group 1 (OCS), oral prednisone, 2 mg/kg (maximum of 60 mg/d) for 7 days, and placebo pressurized metered-dose inhaler with valved holding chamber, four inhalations bid; and group 2 (ICS), flunisolide, four inhalations (1 mg) bid for 7 days, and daily placebo tablets. Spirometry (FEV(1)) was performed at baseline, day 3, and day 7 of the study. A symptom diary and twice-daily peak expiratory flow were recorded. RESULTS: A total of 58 subjects receiving ICS (n = 27) or OCS (n = 28) were enrolled. Baseline asthma severity, race, gender, and age were balanced between the two groups. chi(2) showed no significant difference in symptom severity between the two groups at any time during the study. FEV(1) percentage of predicted was lower in the ICS group on day 3 (65% vs 78%, p = 0.03) and on day 7 (77% vs 95%, p = 0.002). CONCLUSION: ICS were found to be useful in the management of acute asthma in children; however, spirometry data suggested a more rapid resolution of asthma with OCS.     

The position of pranlukast, a cysteinyl leukotriene receptor antagonist, in the long-term treatment of asthma. 5-year follow-up study

BACKGROUND: Adverse effects, tachyphylaxis, and the position of pranlukast, a cysteinyl leukotriene receptor antagonist, in asthma treatment have not been fully established. OBJECTIVES AND METHODS: To address these questions, adverse effects and long-term efficacy of pranlukast were evaluated in 82 patients [28 patients with moderate asthma (group I), 27 with severe persistent asthma not on oral corticosteroid (OCS; group II) and 27 with severe persistent asthma on OCS (group III)] at 4 and 16 weeks. In the following, pranlukast was either withdrawn 1 year after the start of therapy, or if that was not possible due to reappearance of symptoms, the dose of OCS or inhaled corticosteroid (ICS) was reduced. The efficacy of pranlukast was evaluated during 5 years by peak expiratory flow rate (PEFR), and symptom and treatment scores. RESULTS: Adverse reactions appeared in 4 patients (4.9%; diarrhea, dizziness and leg edema). The mean improvement in PEFR on week 16 was 18.5 +/- 2.3, 18.8 +/- 3.2, and 15.2 +/- 3.8% in groups I-III, respectively (p < 0.01, for all groups). However, increases in PEFR in 29 of 72 patients (40.3%) were less than 15%. Pranlukast could not be withdrawn in 28 of 42 responders (66.7%), but their dose of ICS was reduced by 363 +/- 97 microg/day (group II) and that of OCS by 3.4 +/- 0.7 mg/day (group III). Tachyphylaxis was not recognized during the 5-year period. CONCLUSION: Pranlukast is safe when taken for up to 5 years, and is effective irrespective of asthma severity. In the majority of patients with persistent asthma, pranlukast may help to control the disease in the long term.     

Asthma exacerbations: pharmacological prevention

Asthma exacerbations are responsible for many emergency medical interventions and account for a significant proportion of the health costs of the disease. Increased airway inflammation is a key feature of exacerbations in asthma and therefore inhaled corticosteroids (ICS) are considered as first-line therapy for long-term asthma control. ICS have been demonstrated to reduce the risk of asthma exacerbations, as well as improving lung function. Oral leukotriene receptor antagonists also reduce the incidence of asthma exacerbations but are less effective than ICS. In patients with inadequately controlled persistent asthma despite low-dose ICS, the addition of a long-acting inhaled beta-agonist (LABA) should be considered. LABA should not be given alone and should always be associated with ICS in asthma. The anti-immunoglobulin E antibody, omalizumab, reduces severe exacerbations and emergency visits in patients with severe allergic asthma. In clinical trials measurement of the inflammatory response in induced sputum could provide information concerning appropriate drug therapy. Asthma-associated comorbidities should be investigated and treated, particularly in severe asthma. Despite a high prevalence of both gastro-oesophageal reflux and allergic rhinitis among patients with asthma, treatment with proton-pump inhibitors or nasal corticosteroids does not reduce the rate of asthma exacerbations.