支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点及意义

目的探讨支气管哮喘、咳嗽变异性哮喘及急性支气管炎气道反应性特点,以便为临床诊断提供依据。方法采用日本产ＡＳＴＯＧＡＰＨＴＣＫ６０００ＣＶ气道反应测定仪,以乙酰甲胆碱为气道激发剂,观察６０例支气管哮喘、５８例咳嗽变异性哮喘及３７例急性支气管炎患者气道反应性变化。结果支气管哮喘和咳嗽变异性哮喘病人气道激发试验均为阳性,哮喘病人的气道反应阈值（Ｄｍｉｎ）低于咳嗽变异性哮喘病人（Ｐ＜００５）。急性支气管炎病人中,气道激发试验３３例阴性,占８９％,４例阳性,占１１％。４例阳性急性支气管炎患者的气道反应性曲线与哮喘组及咳嗽变异性哮喘组明显不同,其Ｄｍｉｎ也显著高于哮喘组（Ｐ＜００１）及咳嗽变异性哮喘组（Ｐ＜００５）。结论气道反应性测定对于不同类型哮喘及急性支气管炎的鉴别和指导治疗具有很好的临床应用价值。     

完全控制的支气管哮喘患者肺功能和气道高反应性测定

目的检测完全控制的支气管哮喘患者肺功能和气道反应,探讨其临床意义。方法选择71例完全控制的支气管哮喘患者,测定肺功能和气道反应性。选择30名急性发作期支气管哮喘患者和15名健康老年人作为对照。结果71例完全控制的支气管哮喘患者中,49例(84.5%)支气管激发试验阳性,9例(15.5%)支气管激发试验阴性。完全控制哮喘组和哮喘组患者FEV1占预计值%和FEV1/FVC分比较差异有统计学意义(P0.01);完全控制哮喘组和健康对照组受试对象FEV1占预计值%和FEV1/FVC比较差异无统计学意义(P0.05)。结论完全控制的支气管哮喘患者多数存在气道高反应性,测定患者气道反应性有助于指导哮喘治疗。     

Astograph法支气管激发试验在儿童典型支气管哮喘与咳嗽变异性哮喘鉴别中的应用

目的 探讨Astograph法支气管激发试验在儿童典型支气管哮喘与咳嗽变异性哮喘鉴别中的应用价值。方法 收集典型支气管哮喘患儿59例（A组）、咳嗽变异性哮喘患儿60例（B组）,以吸入用氯醋甲胆碱为支气管激发剂,使用Astograph气道过敏反应测定仪进行支气管激发试验检测。比较两组支气管激发试验指标[基础呼吸阻力（Rrs cont）、基础呼吸传导率（Grs cont）、最小诱发累积剂量或反应阈值（Dmin）、Rrs升高到基础水平115%所需氯醋甲胆碱的累积剂量（PD15）、传导率下降斜率（SGrs）],采用Spearman相关检验分析Dmin与PD15的相关性,采用受试者工作特征（ROC）曲线评估Dmin、PD15对典型支气管哮喘及咳嗽变异性哮喘的判断效能。结果 B组支气管激发试验指标Dmin、PD15高于A组,SGrs低于A组（P均<0.05）,两组Rrs cont、Grs cont比较差异均无统计学意义（P均>0.05）。Spearman相关性分析结果显示,Dmin与PD15呈正相关（r=0.683,P<0.05）。ROC曲线分析结果显示,Dmin区分典型支气管哮...     

肺功能检测在小儿哮喘和咳嗽变异性哮喘中的临床应用

目的分析肺功能检测在小儿哮喘和咳嗽变异性哮喘中的临床应用效果。方法选择在本院接受治疗的小儿哮喘和咳嗽变异性哮喘患儿作为观察组,选择正常小儿作为对照组,比较两组小儿的肺功能指标、检测前后确诊率及误诊率等差异。结果观察组临床缓解期肺功能指标与正常对照组小儿无明显差异(P0.05);急性发作期及慢性持续期FEV1、FEV1/FVC%、PEF、FVC明显低于对照组,RV、RV/TLC%明显高于对照组P0.05);观察组肺功能检测哮喘确诊率(98.72%)、咳嗽变异性哮喘确诊率(93.75%)明显高于常规诊断(P0.05)。结论肺功能检测可以有效观察小儿哮喘和咳嗽变异性哮喘的肺功能变化情况,提高临床确诊率。     

完全控制的支气管哮喘患者186例临床分析

目的探讨获得完全控制的支气管哮喘患者临床特征。方法收集2012年1月至2014年6月深圳市龙岗区人民医院呼吸内科经过规范治疗获得完全控制的支气管哮喘患者186例临床资料与健康对照组进行统计分析。结果完全控制的支气管哮喘患者肺功能指标FEV1%、FEV1/FVC%低于正常对照组,有统计学意义(P0.01),血清总Ig E及外周血EOS显著高于正常对照组(P0.01),获得完全控制的支气管哮喘患者不同剂量药物组之间肺功能检查指标FEV1%、FEV1/FVC%无统计学差别(P0.05)。结论完全控制的支气管哮喘患者肺功能并未恢复正常,仍然存在气道炎症,需要继续抗炎治疗。     

咳嗽变异性哮喘患者的肺功能和支气管扩张药物治疗评价

目的 进一步探讨“咳嗽变异性哮喘”与变态反应之间的关系,了解肺功能和气道反应性特点,以及吸入支气管扩张药物治疗的反应。方法:1.测定吸入支气管扩张药物Salbutamol前和吸入后的FEV1改善情况;2.测定吸入Methacholine时的气道反应性;3.观察和随访吸入Procaterol和应用氨茶碱等药物治疗的效果。结果:1.吸入支气管扩张剂Salbutamol后FEV1增加0.21±0.04L,增加率为9.0±2.5％;2.气道反应性测定显示吸入Methacholine后气道反应性增加,PC20—FEV1为2.63mg/m1;3.所有患者经吸入Procaterol治疗后,咳嗽均得到不同程度的缓解。结论:1.咳嗽变异性哮喘的发病与变态反应有关,其FEV1变异率和Methacholine激发试验测定结果与哮喘相似;2.此类患者应用支气管扩张剂和氨茶碱等药物治疗有效。     

儿童胸闷变异性哮喘肺功能改变的特征

目的探讨胸闷变异性哮喘患儿肺功能改变的特点,为临床诊断和管理提供依据。方法选取2018年8月至2019年5月确诊为胸闷变异性哮喘的44例患儿为研究对象,选取同期初诊的非急性发作期的典型哮喘患儿62例及健康体检儿童46例为对照组。所有入组儿童在初诊或体检时进行呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)和肺通气功能的检测,胸闷变异性哮喘组和典型哮喘组行支气管激发试验。分析对比不同组患儿的FeNO水平、肺通气功能改变及气道高反应性严重程度。结果胸闷变异性哮喘组FeNO中位数值为14.0(8.0,24.0)ppb,其水平明显低于典型哮喘组[31.0(12.0,51.0)ppb,P<0.05],高于健康儿童组[9.0(7.0,18.5)ppb,P<0.05];胸闷变异型哮喘儿童肺通气功能参数中FEV1/FVC[0.998(0.967~1.079)]、PEF[(94.41±12.91)]、FEF50[79.15(64.78~93.75)]、FEF75[66.50(53.10~95.90)]均显著低于健康儿童组[1.080(1.039~1.103),P<0.01]、[(106.38±14.14),P<0.01]、[86.17(79.05~97.67),P<0.05]、[72.29(66.14~81.90),P<0.05],但与典型哮喘组无明显差异(P>0.05);胸闷变异性哮喘组第1秒用力呼气容积(FEV1)下降20%时吸入的乙酰甲胆碱累积剂量(PD20-FEV1)均值为(0.855±0.691)mg,显著高于典型哮喘组[(0.321±0.213)mg,P<0.01]。结论胸闷变异性哮喘患儿FeNO水平高于健康儿童,通气功能FEV1/FVC、PEF及小气道功能指标均低于健康儿童;胸闷变异性哮喘患儿肺通气功能与非急性发作期的典型哮喘患儿接近,但其FeNO水平及气道高反应性的程度均显著低于后者。     

儿童哮喘及咳嗽变异性哮喘肺功能检查临床应用价值研究

目的研究肺功能检查在儿童哮喘及咳嗽变异性哮喘的诊断及病情评估临床应用价值。方法以48例典型哮喘(CA组)及39例咳嗽变异性哮喘儿童(CVA组)为研究对象,68例健康儿童为对照组,比较哮喘及咳嗽变异性哮喘儿童急性期肺功能检查情况;比较不同阶段哮喘及咳嗽变异性哮喘儿童肺功能检查的变化情况。结果正常对照组、CVA组及CA组FVC、FEV_1、PEF、FEV_1/FVC依次降低,RV、RV/TLC%依次升高,任意组间均有统计学差异(P 0. 05); CA组、CVA组患儿慢性持续期、临床缓解期及正常对照组肺功能检FVC、FEV_1、FEV_1/FVC、PEF、RV、RV/TLC%结果均无统计学差异(P 0. 05)。结论肺功能检查在支气管哮喘及咳嗽变异性哮喘诊断及病情评估上具有较高的临床应用价值。     

青中年咳嗽变异性哮喘患者肺功能及变应原检测分析

目的分析青中年咳嗽变异性哮喘患者肺功能及变应原检测结果。方法前瞻性对比观察咳嗽变异性哮喘患者和正常人群FVC%、FEV1%、PEF%、MMEF%、FEF 25%、FEF 50%、FEF 75%、R Occ%指标,体外酶联免疫法检测患者血清变应原抗体。结果两组人群动态肺容积指标中,除FVC%、R Occ%无显著性差异(P0.05)外,其余FEV1%、PEF%、MMEF%、MEF75%、MEF50%、MEF25%指标中,观察组均低于对照组,两组存在显著性差异(P0.01);患者血清中发现变应原抗体的31例,占总数的44.93%。结论未经治疗的CVA患者大小气道气流均出现受阻现象,螨虫是诱导本地区青中年人群发生CVA最主要的变应原因素。     

丙酸倍氯米松联合孟鲁司特钠对小儿咳嗽变异性哮喘患儿气道炎症水平的影响

目的探讨丙酸倍氯米松联合孟鲁司特钠对小儿咳嗽变异性哮喘患儿气道炎症水平的影响。方法选择2015-02~2016-04该院收治的咳嗽变异性哮喘患儿90例,按随机数字表法分为对照组和观察组,各45例。对照组给予丙酸倍氯米松气雾剂治疗,观察组在对照组的基础上给予孟鲁司特钠治疗,均连续治疗12周。比较两组患儿治疗前后气道炎症水平及肺功能变化情况。结果治疗前两组患儿气道炎症水平比较差异无统计学意义(P0.05);治疗后观察组患儿白细胞介素-10(IL-10)、白细胞介素-8(IL-8)、白细胞介素-5(IL-5)、嗜酸性粒细胞(EOS)水平与对照组相比均明显降低,差异有统计学意义(P0.01)。治疗前两组患儿最大呼气中段流量(MMEF)、第1秒用力呼气容积(FEV1)水平比较差异无统计学意义(P0.05);治疗后观察组患儿MMEF、FEV1水平与对照组相比均明显提高,差异有统计学意义(P0.01)。结论丙酸倍氯米松联合孟鲁司特钠治疗小儿咳嗽变异性哮喘能有效改善患儿气道炎症水平,降低炎症反应发生率,在临床应用中具有较高的推广价值。     

改良哮喘日志在儿童哮喘临床控制中的应用

目的探讨改良哮喘日志在儿童支气管哮喘(简称哮喘)临床控制中的应用。方法选取在我院儿科哮喘门诊就诊的哮喘患儿96例,采用改良哮喘日志动态监测病情变化,随访1年后对患儿哮喘控制情况以及患儿病情变化进行分析。结果使用改良哮喘日志规范化治疗后,96例患儿临床控制水平有着明显的改善(P0.05),呼气峰流量(PEF)占预计值百分比随规范化治疗时间改变有着明显改善(P0.05)。结论改良哮喘日志为儿童哮喘临床控制提供动态、实用、易于实施、有效的检测方法。     

Assessing asthma severity among children and adults with current asthma

Background: Asthma severity is a key indicator to assess asthma care and management. Severity status may vary over time. Assessing asthma severity periodically is important for monitoring the health and well-being of people with asthma. Objective: To assess population-based asthma severity and to identify related-risk factors among children and adults with asthma. Methods: We used the 2006–2010 BRFSS child and adult Asthma Call-back Survey. Asthma severity was classified as intermittent or persistent. We performed multivariate logistic regression to identify related-risk factors. Results: Overall, 63.8% of persons with asthma had persistent asthma. Persistent asthma was more prevalent among children aged 0–4 years (71.8%; prevalence rate ratio [PR]?=?1.3). Among adults with current asthma, persistent asthma was more prevalent among those who were 45 years or older (aged 45–54: 69.4%; PR?=?1.1, aged 55–64: 72.6%; PR?=?1.2, and aged 65+: 77.8%; PR?=?1.3); annual household incomes of <$15?000 (74.1%; PR?=?1.1); and first diagnosed at age 55 years or older (first diagnosed at age 55–64: 80.4%; PR?=?1.1, at age 65?+?: 81.5%; PR?=?1.1). The prevalence of persistent asthma was also higher among current smokers who were also exposed to secondhand smoke (SHS) (74.7%; PR?=?1.1); and among those with Chronic Obstructive Pulmonary Disease (COPD) (77.1%; PR?=?1.2). Conclusions: Nearly two-thirds of children and adults with asthma had persistent asthma. Identifying related-risk factors could help improve targeted interventions or strategies to reduce modifiable predictors (low income, smoking, and SHS) of increased asthma severity. Such strategies could improve asthma care and quality of life.     

Work-related asthma: A case-based guide

Work-related asthma is common yet underdiagnosed. It is a significant cause of morbidity and socioeconomic loss. Diagnosis is often difficult, and requires a strong index of suspicion and careful investigation. The Canadian Thoracic Society has endorsed the recent American College of Chest Physicians consensus statement on work-related asthma. The present document illustrates the advised approach to diagnosis and management of work-related asthma using case-based examples of occupational asthma and work-exacerbated asthma. The main statements of advice from the American College of Chest Physicians consensus statement are reproduced with permission.     

雷暴哮喘

在过去的30余年,全球范围内关于雷暴相关严重哮喘发作事件的报道逐年增加,主要集中于澳大利亚、英国。这种因天气因素导致的哮喘发作或加重多发生于花粉季节,认为与花粉或霉菌过敏有关。雷暴哮喘发生机制可能是花粉颗粒在雷暴天气时溶胀、崩解释放大量具有变应原性的碎片,使空气中变应原浓度短时间内明显升高,气道高反应个体暴露后出现哮喘症状。花粉或霉菌导致的过敏性鼻炎、哮喘患者是雷暴哮喘的高危人群。了解雷暴哮喘有助于对其预防,并降低其对患者生命健康及公共卫生服务的危害。     

Difficult-to-control asthma in adults

Difficult-to-control asthma in adults is under-diagnosed and under-treated in the United States, particularly in those 40 years of age or older. Increasing attention has been focused on the subset of adult patients with poorly controlled asthma because they consume up to 85% of all health care dollars spent on asthma, while representing 20% of all asthma patients. In this article, we define difficult-to-control asthma and discuss the problem of misdiagnosis. We present an algorithm for confirming the diagnosis in these patients and highlight the importance of patient self-assessment.     

Japanese guidelines for adult asthma 2017

Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.     

Japanese guidelines for adult asthma 2020

Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.     

Development of a web-based,work-related asthma educational tool for patients with asthma

BACKGROUND:

Asthma is a common chronic condition. Work-related asthma (WRA) has a large socioeconomic impact and is increasing in prevalence but remains under-recognized. Although international guidelines recommend patient education, no widely available educational tool exists.

OBJECTIVE:

To develop a WRA educational website for adults with asthma.

METHODS:

An evidence-based database for website content was developed, which applied evidence-based website design principles to create a website prototype. This was subsequently tested and serially revised according to patient feedback in three moderated phases (one focus group and two interview phases), followed by face validation by asthma educators.

RESULTS:

Patients (n=10) were 20 to 28 years of age; seven (70%) were female, three (30%) were in university, two (20%) were in college and five (50%) were currently employed. Key format preferences included: well-spaced, bulleted text; movies (as opposed to animations); photos (as opposed to cartoons); an explicit listing of website aims on the home page; and an exploding tab structure. Participants disliked integrated games and knowledge quizzes. Desired informational content included a list of triggers, prevention/control methods, currently available tools and resources, a self-test for WRA, real-life scenario presentations, compensation information, information for colleagues on how to react during an asthma attack and a WRA discussion forum.

CONCLUSIONS:

The website met the perceived needs of young asthmatic patients. This resource could be disseminated widely and should be tested for its effects on patient behaviour, including job choice, workplace irritant/allergen avoidance and/or protective equipment, asthma medication use and physician prompting for management of WRA symptoms.