支气管哮喘与睡眠呼吸紊乱的关系

目的探讨支气管哮喘与睡眠呼吸紊乱的关系,提出可行性治疗策略。方法对136例支气管哮喘患者进行睡眠问卷调查及夜间血氧饱和度监测,睡眠问卷包括是否打鼾及白天嗜睡情况（爱波沃斯评分,ESS）,夜间动态血氧监测指标包括氧减饱和指数（ODI4）、最低血氧饱和度（LSaO2）、平均血氧饱和度（MSaO2）、血氧饱和度低于90％的时间占睡眠总时间的百分比（SIT90％）。结果45．6％（62／136）的哮喘患者ODI4≥5次／小时,19．1％（26／136）的哮喘患者ODI4≥10次／小时,8．8％（12／136）的哮喘患者ODI4≥15次／lh时,SIT90％≥5％者占49．3％（67／136）,SIT90％≥10％者占37．5％（51／136）,SIT90％≥15％者占27．9％（38／136）。维族与汉族哮喘患者间体质量指数（BMI）,SIT90％及FEV1％比较差异有统计学意义（P〈0．05）。结论汉族与维族哮喘患者中睡眠呼吸紊乱的患病率均较高,且普遍存在夜间低氧现象,维族低于汉族,夜间持续正压通气治疗可能是控制夜间哮喘的重要治疗方法。     

Evaluation of severity of bronchial asthma through an exercise bronchial challenge

Optimum treatment of bronchial asthma requires accurate diagnosis and severity classification. We studied the use of an exercise bronchial challenge in the asthmatic patient as a diagnostic tool. An exercise bronchial challenge test was carried out in 431 asthmatic children and 114 children without a history of asthma in a moderate-altitude environment (2,230 m above sea level/7,314 feet above sea level). Values of peak expiratory flow (baseline and maximum fall) were analyzed through time in each asthma severity group (intermittent, mild persistent, moderate persistent, severe persistent, and nonasthmatic controls). There was a significant difference among responses of asthma severity groups for almost all variables. No difference was found between nonasthmatic and intermittent groups who had similar behavior, except in bronchodilator response. An exercise bronchial challenge helps classify a patient according to asthma severity; it is easy to reproduce and does not require expensive equipment. It allows diagnosing and classifying asthma severity easily and supplementing the clinical evaluation. Based on our results, we propose a fall of PEF >or= 11% as new cutoff point for making a diagnosis of persistent bronchial asthma. A fall of 11-25% indicates mild persistent asthma; from 25-50%, moderate persistent asthma; and a bigger fall, severe persistent asthma.     

Preliminary research on possibility of bronchial asthma treatment with hyperbaric oxygenation

The total of the persons examined was divided into 3 groups. There were 11 men and 5 women with various diseases diagnosed in Group I, 5 healthy men in Group II and 9 man and 2 women with allergy in Group III, the control group. The subjects were treated with hyperbaric oxygenation exposures from 1.8 to 2.5 ata O2 within a 60-90 minute period. The number of exposures ranged from 1-4 for Group II till 10-15 for Group I and Group III. In all the cases the following examinations were carried out: hematological tests (Hb, Ht, erythrocytes, leucocytes, and blood platelets counts, blood picture), immunological tests (IgG, IgM, IgA, IgD, IgE, C3 fraction of complement and hematolytical activity of complement--CH50) and all required additional clinical tests. These examinations were made before the series of hyperbaric exposures, after 4 exposures, after their completion and a month later. Full documentation in Group I was obtained in 6 cases and in the 10 remaining only before the exposures and after their completion. In Group II full documentation was available only in 1 person, but before the exposures and after their completion in the rest, and finally, in Group III full documentation was obtained in 7 persons, but before the exposures and after their completion in 4 others. Generally, it was in allergic states that a positive therapeutic effect of hyperbaric oxygenation was found. It had already been corroborated by the respective shifts of immunological coefficients, noted by other authors too. The above observations need to be confirmed in a wider material, in different periods of the disease and with other additional examinations employed.     

Are tidal breathing indices useful in infant bronchial challenge tests?

Tidal breathing indices have been used to assess histamine-induced airway obstruction in adults and children. The aim of this study was to see whether they could be used to assess histamine challenge in infants. Tidal flow during quiet breathing was measured using a face mask and pneumotachograph and maximum flow at functional residual capacity (V_maxFRC) was measured from partial forced expirations in 18 sleeping, sedated infants who responded to histamine challenge and in 18 nonresponders. The tidal indices calculated were inspiratory and expiratory time (t₁, and t_e), tidal peak expiratory flow (PEF), mean tidal expiratory flow rate (V_T/t_e) and the expiratory time constant of the respiratory system (t_rs). The time to maximal expiration divided by expiratory time (t_me/t_e) and 2 revised forms of this index (t_me(a)t_e and t_me(b)( t_me(b) /t_e) were also calculated. Recordings of t_me(a) and t_me(b) were taken at 95% of peak tidal expiratory flow, before and after the peak, respectively. In nonresponders, there was an insignificant mean rise in V_maxFRC of 11.8% but no change in any tidal index. In responders, the mean percentage fall in V_maxFRC was 43.3% (range, ?31 to ?81%); t_rs fell from 0.61 s to 0.51 s (P < 0.05) and breathing frequency and mean tidal expiratory flow rate increased from 34.0 to 37.5 min^?1 (P < 0.01) and from 66.6 to 72.6 mL.s^?1 (P < 0.05), respectively, suggesting that infants had adopted a strategy of active expiration in response to bronchial challenge. There was no change either in t_me/t_e, or in the revised indices after challenge., It is therefore concluded that t_me/t_e is an insensitive index of airflow obstruction compared to V_maxFRC and cannot be used to assess the response to bronchial challenge. Changes in other indices were small and related to a presumed pattern of active expiration after challenge. Pediatr Pulmonol. 1994; 17:225–230. © 1994 Wiley-Liss, Inc.     

Effect of verapamil inhalation on bronchial asthma

The effect of inhaled verapamil 20 mg on pulmonary functions and arterial blood gases in 15 patients with extrinsic bronchial asthma was studied in single-blind fashion. A significant decrease (p less than 0.05) in airway resistance and a significant increase (p less than 0.01) in specific conductance was observed after verapamil inhalation. A small increase (p less than 0.1) was observed in forced vital capacity and peak expiratory flow rate after verapamil inhalation; however, this was not statistically significant. None of the parameters of pulmonary function tests showed a significant change after normal saline inhalation. A significant fall in PaO2 (p less than 0.05) and PaCO2 (p less than 0.05) was noted after normal saline inhalation. PaCO2 showed a significant fall (p less than 0.01) after verapamil inhalation. Alveolar arterial oxygen gradient P(A-a)O2 widened significantly (p less than 0.001) after normal saline inhalation. A larger dose (20 mg) of verapamil inhalation produces a significant bronchodilator effect on large airways, but does not produce a significant change in arterial oxygen tension from the baseline value in patients with bronchial asthma.     

儿童支气管哮喘缓解期气道反应性测定

目的：了解支气管哮喘缓解患儿的气道反应性。方法：测定26例哮喘缓解期患儿的气道反应性。结果：均显示气道反应性增高。结论：气道反应性测定对本病的诊断、病情及药物疗效以及指导治疗是非常必要的。     

Ventilation-perfusion mismatch after methacholine challenge in patients with mild bronchial asthma

To investigate the effects of methacholine (MTH) challenge on spirometry, lung mechanics, respiratory gases, and ventilation-perfusion (VA/Q) distributions, 16 subjects 16 to 58 yr of age with stable mild asthma (FEV1, 92 +/- 5% [SEM] predicted; FEF25-75, 71 +/- 7% predicted; respiratory system resistance (Rrs) at 4 Hz, 4.6 +/- 0.4 cm H2O/L-1 s; PaO2, 88 +/- 3 mm Hg; AaPO2, 23 +/- 3 mm Hg) were recruited. Baseline VA/Q distributions were unimodal and relatively narrow in 12 patients and modestly bimodal in the other four. The dispersion of pulmonary blood flow (log SD Q) was slightly enlarged (0.71 +/- 0.09) and that of ventilation (log SD V) was normal (0.57 +/- 0.04) (normal range, 0.3 to 0.6); an index of overall VA/Q heterogeneity (DISP R-E*) was also mildly abnormal (5.3 +/- 0.8) (normal values less than 3.0). After MTH challenge, FEV1, FEF25-75, and PaO2 fell (to 62 +/- 3 and 35 +/- 3% predicted, and to 71 +/- 1 mm Hg, respectively), whereas Rrs (p less than 0.001 each), minute ventilation (p less than 0.02), heart rate (p less than 0.01), and AaPO2 increased (p less than 0.001). VA/Q relationships mildly to moderately worsened (log SD Q increased to 0.98 +/- 0.04 [p less than 0.01], log SD V to 0.79 +/- 0.04, and DISP R-E* to 9.8 +/- 0.6 [p less than 0.001 each]). Qualitatively, the pattern of blood flow distribution was broadly unimodal in 13 patients and modestly bimodal in three, of whom only one had a bimodal baseline distribution.(ABSTRACT TRUNCATED AT 250 WORDS)     

大环内酯类抗生素对支气管哮喘的免疫调节作用

支气管哮喘是全球最常见的慢性疾病之一。研究发现大环内酯类抗生素对支气管哮喘有免疫调节作用,归纳其方式可能有⑴调控变态反应,⑵抗气道炎症作用,⑶“节约类固醇”作用,本文进行扼要综述。     

Effect of antiallergic agents and bronchial hypersensitivity in short-term bronchial asthma.

The effect of antiallergic agents with no antihistamine activity on bronchial hypersensitivity to histamine inhalation was studied in 37 asthmatic patients. Improvement in bronchial hypersensitivity to histamine was observed in 11 out of the 24 (46 percent) antiallergic agents-treated patients, but in none of the 13 (0 percent) untreated patients. The 11 patients whose bronchial hypersensitivity improved with antiallergic agents consisted of eight short-term cases of less than one year's duration and three long-term cases of more than one year's duration. Thus, improvement in bronchial hypersensitivity was observed in 8 of 11 (73 percent) short-term cases, and 3 of 13 (23 percent) long-term cases. A significant improvement in %FEV1 was observed only in the short-term cases treated with antiallergic agents, but the improvement of baseline FEV1 did not seem to explain entirely the improvement in bronchial hypersensitivity seen. The decrease in bronchial hypersensitivity was in parallel with that of other asthmatic symptoms. These results suggest that antiallergic agents might be most effective in the treatment of asthmatic patients with a short-term disease duration.