二丙酸倍氯米松干粉剂治疗晚发老年哮喘的临床观察

目的 观察吸入类固醇二丙酸倍氯米松（ＤＢＰ）干粉剂对晚发老年哮喘（ＬＯＡ）的疗效。方法 将２２例ＬＯＡ患者与２３例非老年２哮喘患者进行对比研究,观察吸入β２受体激动剂沙丁胺醇干粉剂后１秒钟用力呼气容积（ＦＥＶ１）的变化以及吸入ＤＢＰ干粉剂后ＦＥＶ１及其占预计值百分比（ＦＥＶ１％）、早晚最大呼气流速（ＰＥＦＲ）及其日内变异率等变化。结果 两组患者在吸入沙丁胺醇干粉剂后ＦＥＶ１均明显增高（Ｐ〈０．０１     

糖皮质激素对哮喘患者白细胞介素—5mRNA表达与嗜酸性粒细胞激活作…

为了观察糖皮质激素对哮喘患者白细胞介素（ＩＬ）－５ｍＲＮＡ表达与嗜酸性粒细胞激活作用的影响，本研究用逆转录（ＲＴ）－聚合酶链反应（ＰＣＲ）法半定量分析了哮喘患者用糖皮质激素治疗前后外周血单个核细胞（ＰＢＭＣ）中ＩＬ－５ｍＲＮＡ表达水平的变化，检测了血清嗜酸细胞阳离子蛋白（ＥＣＰ）浓度、一秒钟用力呼气容积（ＥＦＶ１）下降２０％时的乙酰甲胆碱（ＭＣＨ）激发浓度（ＭＣＨ－ＰＣ２０值）和基础ＦＥＶ１占用力     

浅议慢性阻塞性肺疾病肺功能诊断标准与分级

慢性阻塞性肺疾病（ＣＯＰＤ）是具有气流阻塞特征的慢性支气管炎和（或）肺气肿。而判断有无气流阻塞以及气流阻塞的严重程度主要依靠肺功能检查。我们现就有关ＣＯＰＤ肺功能诊断与分级的两个问题进行讨论,谨供同道参考和指正。一、ＣＯＰＤ气流阻塞的评价指标以一秒钟用力呼气容量（ＦＥＶ１）为好ＦＥＶ１、最大通气量（ＭＶＶ）、用力呼气峰流量（ＰＥＦ）和用力呼气流速容量（ＭＥＦＶ）曲线衍生指标都能在一定程度上反映气流阻塞情况。其中ＭＥＦＶ测定需流量容积测定仪,价格昂贵,难以普及;ＦＥＶ１、ＭＶＶ和ＰＥＦ测定只要肺…     

哮喘患者外周血单个核细胞中白细胞介素—6mRNA表达与气道炎症的 …

目的 探讨外周血单个核细胞（ＰＢＭＣ）中白细胞介素（ＩＬ）－６ｍＲＮＡ表达与血嗜酸细胞阳离子蛋白（ＥＣＰ）和１秒用力呼气容积占用力肺活量比值（ＦＥＶ１％）的关系。方法 对１２例过敏性哮喘发作期患者、８例缓解期患者及９例健康人，采用ＲＴ－ＰＣＲ法和图像分析半定量法检测ＰＢＭＣ中ＩＬ－６ｍＲＮＡ的表达水平及ＥＣＰ和ＦＥＶ１％。结果 发作期患者ＩＬ－６ｍＲＮＡ的表达明显高于缓解期患者和健康人（Ｐ〈０．０     

吸入一氧化氮与沙丁胺醇对哮喘患者肺功能的影响

为探讨吸入一氧化氮（ＮＯ）与吸入沙丁胺醇（Ｖｅｎｔｏｌｉｎ）对支气管哮喘患者肺功能的影响。９例哮喘患者（其中组织胺激发试验阳性者５例）先后吸入２００～４００μｇ的Ｖｅｎｔｏｌｉｎ及１０ｐｐｍＮＯ观察吸入后通气功能的变化，结果显示，吸入Ｖｅｎｔｏｌｉｎ可使患者ＦＶＣ，ＦＥＶ１，ＦＥＶ１／ＦＶＣ，ＰＥＦ，ＭＭＥＦ，Ｖ５０得到明显改善；吸入ＮＯ后患者ＦＶＣ，ＦＥＶ１，ＰＥＦ明显增量ＦＥＶ１的增加幅度不及     

呋塞米吸入治疗对老年慢性哮喘患者肺功能和外周血T淋巴细胞亚群的影响

目的评价呋塞米（速尿）吸入对老年人慢性哮喘的治疗效果。方法７２例老年慢性哮喘患者分别给予速尿（Ａ组）、速尿＋溴化异丙托品（Ｂ组）和溴化异丙托品（Ｃ组）治疗，每组各２４例，并与６０例非老年慢性哮喘患者的结果进行比较。吸入前后测肺功能〔最大肺活量（ＦＶＣ）、一秒钟最大呼气量（ＦＥＶ１）、最大呼气流速（ＰＥＦＲ）〕和外周血Ｔ细胞亚群。结果老年组总有效率（有效＋显效），Ａ、Ｂ、Ｃ组分别为７５％、９２％、６７％。肺功能和Ｔ细胞亚群改变：Ａ组ＦＥＶ１和ＣＤ４吸入前后变化差异有显著性（Ｐ＜００５）；Ｂ组肺功能指标和ＣＤ４、ＣＤ８、ＣＤ４／ＣＤ８差异有非常显著性（Ｐ＜００１或０００１）；Ｃ组除ＰＥＦＲ有显著变化（Ｐ＜００５）外，余项也有改善，但无统计学意义。非老年组的疗效与老年组疗效基本相同。结论速尿吸入对老年人慢性哮喘有防治作用，特别是速尿＋溴化异丙托品联合吸入效果更好     

外源性一氧化氮及氦—氧混合气对支气管哮喘患者通气功能的影响

目的 探讨同时吸入氦－氧混合气和不同浓度的一氧化氮（ＮＯ）对支气管哮喘患者通气功能的影响。方法 选取１８例哮喘患者随机分为两组,一组吸入氦－氧混合气的同时加入１００ｐｐｍ的ＮＯ,另一组则加入４０ｐｐｍ的ＮＯ。在不同时间检测患者的通气功能,并与吸入β２受体激动剂进行比较。结果 哮喘患者吸入氦－氧混合气后与呼吸空气比较其用力肺活量（ＦＶＣ）、１秒钟用于呼气容积（ＦＥＶ１）、呼气流速峰值（ＰＥＦＲ）和最     

糖皮质激素对哮喘患者白细胞介素-5mRNA表达与嗜酸性粒细胞激活作用的影响

为了观察糖皮质激素对哮喘患者白细胞介素（ＩＬ）－５ｍＲＮＡ表达与嗜酸性粒细胞激活作用的影响，本研究用逆转录（ＲＴ）－聚合酶链反应（ＰＣＲ）法半定量分析了哮喘患者用糖皮质激素治疗前后外周血单个核细胞（ＰＢＭＣ）中ＩＬ－５ｍＲＮＡ表达水平的变化，检测了血清嗜酸细胞阳离子蛋白（ＥＣＰ）浓度、一秒钟用力呼气容积（ＦＥＶ１）下降２０％时的乙酰甲胆碱（ＭＣＨ）激发浓度（ＭＣＨ－ＰＣ２０值）和基础ＦＥＶ１占用力肺活量比值（ＦＥＶ１％）等指标。结果发现，糖皮质激素不仅能改善哮喘患者的气道高反应性和通气功能，而且还可抑制ＰＢＭＣ中ＩＬ－５ｍＲＮＡ的表达和降低血清ＥＣＰ浓度（Ｐ＜０．０５）；血清ＥＣＰ浓度下降幅度或ＭＣＨ－ＰＣ２０值改善幅度与ＩＬ－５ｍＲＮＡ表达水平下降幅度之间均呈显著正相关（ｒ分别为０．５４２６和０．４８５７，Ｐ值＜０．０５）。提示糖皮质激素可能是通过抑制ＩＬ－５基因的转录，从而抑制后者对嗜酸性粒细胞的活化，而发挥其抗气道炎症反应和降低气道高反应性的作用。     

一氧化氮吸入对支气管哮喘疗效的初步观察

为了进一步了解一氧化氮（ＮＯ）吸入对支气管哮喘患者的治疗作用，兹选择中度支气管哮喘急性发作期的患者１０例，使用４０ｐｐｍ浓度的ＮＯ吸入２０分钟，在停止吸入后即刻进行临床和肺功能评价。结果发现，所有病人临床症状和肺部哮喘音均有不同程度好转。１秒钟用力呼气容积（ＦＥＶ＿１）、最大呼气流速（ＰＥＦ）改善均有显著性（Ｐ＜０．０５）。为了观察ＮＯ持续作用时间，１０例中各有５例分别在停止吸入ＮＯ２０分钟和２４小时后，重复测定上述肺功能参数，ＦＥＶ＿１及ＰＥＦ值均有增加。但因例数过少，尚难得出结论。本观察结果提示：低浓度ＮＯ吸入似可作为治疗支气管哮喘的一种方法。     

吸入呋塞米对急性发作期支气管哮喘患者肺通气功能的影响

目的 探讨吸入呋塞米对急性发作期支气管哮喘（哮喘）患者肺通气功能的影响。方法 将６例经、中度发作期哮喘患者随机分为Ａ、Ｂ、Ｃ三组,每组各２０例。Ａ组吸入生理盐水５ｍｌ,Ｂ组吸入呋塞米５０ｍｇ（５ｍｌ,１０ｍｇ／ｍｌ）,Ｃ组吸入０．１％沙丁胺醇溶液５ｍｌ。观察三组患者吸药后１５ｍｉｎ肺通气功能的变化。结果 吸药后１５ｍｉｎＢ、Ｃ组用力肺活量（ＦＶＣ）、第１ｓ用力呼气容积（ＦＥＶ１）、最在呼气流量（Ｐ     

Effects of inhaled corticosteroid in elderly patients with chronic obstructive pulmonary disease]

We examined the efficacy of inhaled corticosteroid (beclomethazone dipropionate: BDP) in elderly patients with chronic obstructive pulmonary disease (COPD). Eighty-six patients with COPD were divided into 3 groups: COPD treated without BDP (group 1, n = 26), COPD treated with BDP (group 2, n = 25), and BDP-treated COPD with asthmatic symptoms (group 3, n = 35). Pulmonary function test findings, symptoms, and prognosis for the 3 groups were retrospectively compared. No significant differences in yearly decline of FEV1.0 were observed. Of the patients treated with inhaled corticosteroid (groups 2 and 3), 30% exhibited improved FEV1.0. Of these patients, monthly decline of FEV1.0 correlated negatively with bronchial reversibility in FEV1.0 before and after inhalation of salbutamol (delta FEV1.0) (r = -0.28, p = 0.03). Cough and sputum scores were significantly improved in groups 2 and 3 (p < 0.01). Fewer admissions and episodes of acute exacerbation were noted in groups 2 and 3 than in group 1. From these results, we concluded that inhaled corticosteroid was effective in elderly COPD patients with bronchial reversibility and airway symptoms.     

Additive effects of prednisolone and beclomethasone dipropionate in patients with stable chronic obstructive pulmonary disease

It remains unclear whether inhaled corticosteroids can produce the maximum benefits of corticosteroids in patients with chronic obstructive pulmonary disease (COPD). To assess the additive effects of 30 mg/day prednisolone to high-dose, inhaled beclomethasone dipropionate (BDP), we conducted a randomised double-blind, placebo-controlled cross-over trial. The study population consisted of 21 men with stable COPD. The mean age of the patients was 69.1 +/- 6.8 years, and FEV(1)was 0.86 +/- 0.28 l. Seventeen out of the 21 patients (81%) were considered susceptible to steroids in a previous trial (FEV(1)increased at least 15% from baseline after receiving 14 days of 30 mg/day prednisolone). All of the patients had been on 1600 microg/day BDP for more than 3 months. Spirometry was performed before the entry, and at the end of 3-week placebo and prednisolone periods. The peak expiratory flow (PEF), symptoms, and Guyatt's Chronic Respiratory Disease Questionnaire (CRQ) as a disease specific health-related quality of life over the last seven days of each period were also evaluated. Although a marginal increase in PEF was found during the prednisolone period, no significant differences in FEV(1), FVC, symptoms or CRQ scores were observed between the two treatment periods. We conclude that the therapeutic effects of steroid therapy may be achieved by the long-term use of high-dose, inhaled corticosteroid in some patients with stable COPD.     

Inhaled beclomethasone improves the course of asthma and COPD.

The effects of inhaled beclomethasone dipropionate (BDP), 800 micrograms daily, on the long-term course of asthma and chronic obstructive pulmonary disease (COPD) were investigated in a prospective, controlled study, over three years. During the first two years, patients were treated with a bronchodilator only (salbutamol or ipratropium bromide). Fifty six patients (28 asthma, 28 COPD), with an unfavourable course of disease during bronchodilator therapy alone (an annual decline in forced expiratory volume in one second (FEV1) of > or = 80 ml.yr-1 in combination with at least one exacerbation.yr-1), were selected for additional treatment with inhaled beclomethasone dipropionate (BDP), 800 micrograms daily, during the third year. The FEV1 and provoking concentration of histamine producing a 20% fall in FEV1 (PC20-histamine) were assessed at six-monthly intervals. In asthma, the annual decline in prebronchodilator FEV1 of -158 ml.yr-1 during bronchodilator therapy alone was followed by a significant increase of 562 ml.yr-1 during months 1-6 of BDP treatment (p < 0.0005). During months 7-12 of BDP, the FEV1 declined slightly with -31 ml.yr-1, which was not statistically different from the annual decline before steroid therapy (p = 0.17). In COPD, the increase of 323 ml.yr-1 during months 1-6 of treatment with BDP was different from the annual decline of -156 ml.yr-1 before BDP (p < 0.05). The PC20-histamine improved by 308 doubling doses during 1-12 months of BDP in asthma (p < 0.05) but not in COPD.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of withdrawal of inhaled steroids in men with severe irreversible airflow obstruction

Inhaled corticosteroid therapy has proven efficacy for asthmatics, but the benefit for patients with chronic obstructive pulmonary disease (COPD) is less well supported. We hypothesized that withdrawal of inhaled steroids in elderly patients with severe irreversible airway obstruction would not lead to a deterioration in respiratory function. We designed a prospective, double-blind, randomized, placebo-controlled, crossover study to follow spirometry, quality of life questionnaire, six-minute (6-min) walk test, and sputum markers of inflammation during a 6-wk placebo treatment period and a 6-wk treatment period with beclomethasone dipropionate (BDP), 336 microg/d. There were 24 men receiving BDP who entered the study; 15 completed the study. Their mean age was 66.9 +/- 1.9 yr, and mean FEV(1) was 1.61 +/- 0.1 L (47% of predicted). There was a significant decrease in the mean FEV(1 )while using the placebo inhaler (1.70 L versus 1.60 L, baseline versus placebo: 95% CI, 0.002 to 0.195; p < 0.05). There was a decrease in the mean percentage change in FEV(1) for the study subjects during the placebo treatment period as compared with the BDP treatment period (-6.28 versus 5.03%, placebo versus BDP: 95% CI, -23.38 to 0.76; p = 0.06). Six-minute walk test results and sputum analysis for cell count and differential were not significantly different during placebo and BDP treatment periods. Borg scale assessment of dyspnea after exercise was increased while using the placebo inhaler as compared with baseline, and decreased during the BDP treatment period. Chronic Respiratory Disease Questionnaire (CRQ) scores revealed no significant difference between placebo and BDP. This study has demonstrated that in elderly patients with severe irreversible airway obstruction, withdrawal of inhaled corticosteroid therapy leads to a deterioration in ventilatory function and increased exercise-induced dyspnea.     

吸入舒利迭治疗稳定期COPD的临床研究

目的观察吸入丙酸氟替卡松/沙美特罗（舒利迭）（Fluticasone prpionate,FP）对稳定期COPD的临床疗效。方法 60例稳定期Ⅱ级COPD患者随机分成4组,分别给予不同剂量的丙酸氟地卡松和安慰剂（对照组）吸入治疗12周,于治疗前及治疗2周后、6周后、12周后测定FEV1、血浆皮质醇、骨密度,并记录临床症状记分和生活质量记分。结果临床症状评分各治疗组吸入丙酸氟地卡松迭2周后较治疗前明显下降（P〈0.05）,但治疗后不同时间段间比较无显著性差异（P〉0.05）;各组FEV1治疗前与治疗12周后比较无显著性差异（P〉0.05）。生活质量评分各组治疗前较治疗12周后无显著性差异（P〉0.05）。血浆皮质醇水平高剂量组治疗2周后即较前降低（P〈0.05）,治疗12周后更降低（P〈0.01）;中剂量组治疗12周后较治疗前降低（P〈0.05）;低剂量组和对照组治疗前较治疗12周后无显著性差异（P〉0.05）。股骨颈的股密度各组治疗前后无显著性差异（P〉0.05）。结论吸入一定剂量的丙酸氟地卡松,可减轻稳定期COPD患者的临床症状,而不引起骨密度降低,但不能改善其FEV1,不能改善生活质量,但有可能引起血浆皮质醇水平下降。     

Does addition of inhaled steroid to combined bronchodilator therapy affect health status in patients with COPD?

OBJECTIVE: Withdrawal of corticosteroid is associated with a deterioration of health status in COPD. In this study the aim was to determine whether high dose inhaled corticosteroid improves quality of life in patients with COPD. METHODOLOGY: In total, 38 male patients with moderate COPD were included in the study. Baseline quality of life scores were determined using a Turkish version of the St George's Respiratory Questionnaire (SGRQ). Patients were randomly divided into two groups. Group 1 consisted of 20 patients who received existing bronchodilator therapy plus inhaled corticosteroid (800 micro g budesonide) for 12 weeks, while 18 patients in group 2 received bronchodilator and placebo. The SGRQ was repeated after the treatment period. RESULTS: All patients were male and mean age was 67 +/- 8.2 years. Symptom, activity, impact, and total scores were assessed and a difference of four units with treatment was considered to be clinically significant. Total score and activity score were decreased by six units and eight units, respectively, in the placebo group while symptom and impact scores did not change significantly. Total scores and the three component scores improved significantly in the corticosteroid group compared to the placebo group (Deltatotal score: -22 in corticosteroid group, -6 in placebo group, P < 0.01). CONCLUSION: Inhaled corticosteroid improved quality of life scores in patients with COPD, without significant improvement in airflow obstruction parameters. Since improvement of health status is one of the important aims in COPD treatment, use of inhaled corticosteroids should be considered from this perspective.     

Efficacy of inhaled steroids in undiagnosed subjects at high risk for COPD: results of the detection, intervention, and monitoring of COPD and asthma program

BACKGROUND AND AIM: COPD leads to a progressive decline of pulmonary function. Family physicians treat a substantial number of patients with COPD and are encouraged to start treatment at as early a stage as is possible. This study analyzed the effectiveness of early inhaled corticosteroid treatment on the decline of pulmonary function in COPD patients. PATIENTS AND SETTING: Subjects with a rapid decline in lung function (ie, FEV(1) decline, > 80 mL/yr) who had never before received a diagnosis of asthma or COPD. METHODS: Two-year, randomized, controlled, double-blind clinical trial of fluticasone propionate (250 microg bid; 24 patients) or placebo (25 patients), followed by a 7-month open-label study in which all subjects received fluticasone propionate. The primary outcome was the post-bronchodilator therapy FEV(1,) and secondary outcomes were respiratory symptoms, exacerbations, health state, quality of life, and health-care utilization. RESULTS: After 31 months, there were no statistical differences in post-bronchodilator therapy FEV(1) between the intervention group and the control group. No statistical differences were observed for symptoms, exacerbations, or quality of life, although tendencies were consistently in favor of treatment. There was no significant impact on the direct or indirect costs. CONCLUSIONS: There are no indications that early treatment with inhaled corticosteroids modifies a rapid decline in lung function or respiratory symptoms and quality of life.     

Effective management of COPD in primary care - the role of long-acting beta agonist/inhaled corticosteroid combination therapy.

Chronic obstructive pulmonary disease (COPD) is the internationally preferred term for chronic, progressive lung disorders which are characterised by airflow limitation that is not fully reversible. The symptoms of COPD - including breathlessness, cough, excessive sputum production and reduced muscle tone and muscle wasting - reflect the complex pathophysiology of the disease. In order to address these symptoms, treatment regimens should take into account the multiple components that contribute to COPD. Clinical evidence has emerged indicating that, especially in patients with severe COPD, long-acting beta(2)-agonists (LABAs) and inhaled corticosteroids (ICS) result in improvements in symptoms, reduce the frequency and severity of exacerbations, and improve health-related quality of life. This review evaluates the clinical evidence for the potential of LABA/ICS treatment to address the symptoms of COPD and whether combination therapy of this nature adds significant benefit to patients.     

Comparison of inhaled corticosteroid combined with theophylline and double-dose inhaled corticosteroid in moderate to severe asthma

OBJECTIVE: Recent studies have found that theophylline exerts anti-inflammatory and immunomodulatory effects. This study was performed to compare the efficacy of inhaled corticosteroids (ICS) combined with slow-release theophylline (SRT) with that of double-dose ICS in asthma control, anti-inflammatory activity and safety. METHODOLOGY: In a randomized, open, parallel, control trial, 41 patients with asthma were randomly treated with either beclomethasone dipropionate 500 microg b.i.d. (BDP group) or a combination of BDP 250 microg b.i.d and SRT 0.2 g b.i.d. (SRT/BDP group) for 6 weeks. At the start and at the end of treatment, lung function testing and sputum induction were performed, and plasma cortisol levels were measured. Sputum was analyzed for cell differential counts and the interleukin (IL)-5 level. Patients kept a record of peak expiratory flow (PEF), symptom score, and beta2-agonist use. RESULTS: Significant increases in the morning and the evening PEF and FEV1 were observed (P < 0.05), together with an obvious reduction in symptom score and beta2-agonist use (P < 0.01). Significant decreases in the percentage eosinophils and IL-5 level in induced sputum also occurred (P < 0.05). However, there was no difference between the two groups for all these parameters. There was no significant change in the plasma cortisol level for either group. CONCLUSIONS: Both ICS combined with SRT and double-dose ICS had the same effect on asthma control, improving symptoms and ameliorating lung function. Both therapies had similar anti-airway inflammatory effects and therapeutic safety. Combining SRT with ICS may allow a reduction in ICS dose when treating asthma.     

Pulmonale Erkrankungen im Alter

In asthma, inhaled corticosteroids (ICS) can be regarded as disease-modifying drugs. They represent the mainstay of pharmacotherapy of asthma. In elderly, ICS are currently underused. In chronic obstructive pulmonary disease (COPD), there is recent evidence to suggest that ICS may reduce the rate and severity of COPD exacerbations and may improve health-related quality of life. Particularly patients with moderate-to-severe COPD appear to benefit from ICS therapy. In both asthma and COPD, fixed combinations of ICS and long-acting beta 2-agonists may provide clinically meaningful benefits to patients and may represent a further therapeutic advantage.