支气管哮喘与慢性肾脏病关系流行病调查研究

目的了解支气管哮喘患者人群中慢性肾脏病流行病学现状,探讨支气管哮喘与慢性肾脏病关系。方法选择2006年1月至2010年1月在郑州大学第二附属医院呼吸科门诊或住院部确诊且≥14岁的支气管哮喘患者为研究对象,对其进行问卷调查、体格检查和肾脏损伤及相关危险因素检测。根据相关疾病诊断标准对资料进行分析。结果郑州市14岁以上支气管哮喘患者人群蛋白尿、血尿和eGFR下降患病率为别为9.41%、10.37%和3.03%,均高于普通人群;CKD患病率高达17.38%,在哮喘分期中急性发作期CKD患病率为24.42%,显著高于慢性持续期和临床缓解期(χ2=12.445,P=0.002)。进一步分析显示支气管哮喘病史>10年、发作频率>1次/d和ACT评分<20分的患者白蛋白尿和慢性肾脏病的患病率显著高于其他组患者(P<0.001)。结论支气管哮喘人群具有较高的肾脏损伤发生率,患者病程、发作频率及控制水平与慢性肾脏病的发生相关。     

School nurse asthma program reduces healthcare utilization in children with persistent asthma

Objective: We examined the impact of a novel, school nurse-supervised asthma therapy program on healthcare utilization. Methods: We retrospectively reviewed charts of 84 children enrolled in this program in central Massachusetts between 2012 and 2015. Physicians identified children with persistent asthma and poor medication adherence. These children were enrolled in the program to receive daily-inhaled corticosteroid at school, supervised by their school nurse, with ongoing communication between physician's office and school nurse through the school year. This program relied on established family, provider and school resources rather than research staff. The primary outcome was change in the number of emergency department (ED) visits in the year before and after enrollment. Secondary outcomes were hospital admissions, school absences, and rescue medication use. Results: The study population was on average 10.5 years old, 63% male, 67% Hispanic, 19% black, 14% white with 95% using Medicaid insurance. Asthma-related ED visits over a 1-year period decreased 37.5%, from a pre-intervention mean of 0.8 visits to a post-intervention mean of 0.3 visits (p < 0.001). Asthma-related hospital admissions decreased from a pre-intervention mean of 0.3 admissions to post-intervention mean of 0 admissions (p < 0.001). Asthma rescue medication refills decreased by 46.3% from the pre- to post-intervention period (p = <.001). There were also non-significant declines in school absences and oral steroid use for children enrolled. Conclusions: We demonstrate a significant reduction in healthcare utilization for children enrolled in this unique school nurse-supervised asthma program, which utilizes a clinical-school partnership to deliver preventative asthma medication to school-aged children under sustainable conditions.     

Differences in prevalence of asthma, rhinitis, and eczema between parental and self-completed questionnaires in adolescents

This study was undertaken to compare, for the first time in a developing country, the prevalence of asthma, rhinitis, and eczema in children aged 13-14 years when questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were independently completed by children and parents. A random sample of 3,178 children completed the ISAAC questionnaire at school, while in another sample of 3,387 children, the questionnaire was completed by their parents at home. The prevalence of asthma, rhinitis, and eczema symptoms was significantly higher when questionnaires were completed by adolescents themselves rather than by the parents, particularly for those symptoms that could be better perceived by children or that were more severe, e.g., wheezing with exercise, severe episodes of wheezing, nocturnal cough, and awaking with wheezing in the last 12 months. The diagnosis of hay fever and eczema was also reported more frequently by adolescents compared to their parents. The prevalence of asthma ever and wheezing in the last 12 months was not significantly different between the two samples. In a randomly selected subset of 550 pairs where adolescents and parents came from the same family, asthma ever had the highest agreement (kappa = 0.72, 95% CI: 0.64-0.80), but agreement was poor for rhinitis and eczema ever. In conclusion, the prevalence of asthma, rhinitis, and eczema symptoms varied according to whether the information was reported by independent samples of adolescent or parents. However, the prevalence of wheezing in the last 12 months and asthma ever was quite similar between adolescents and parents, suggesting that these questions are crucial for assessing asthma in epidemiological studies.     

两种药物联合治疗儿童哮喘并发支原体感染的研究

目的探讨丙卡特罗联合阿奇霉素治疗儿童哮喘并发肺炎支原体感染临床效果情况。方法选取105例儿童哮喘并发肺炎支原体感染患者为研究对象,分成两组,对照组51例,运用阿奇霉素治疗,观察组54例,在对照组基础上加用丙卡特罗联合治疗,比较两组治疗后的临床效果情况。结果对照组显效率21.57%,总临床有效率为72.55%;肺功能好转率81.39%,显著好转率16.28%。观察组的显效率61.11%,总有效率为92.59%;肺功能好转率97.73%,显著好转率52.27%,两组比较有显著差异性(P0.05)。另外两组在外周白细胞、C反应蛋白和症状缓解时间、胸片病灶消失时间、住院时间上比较也有显著差异性(P0.05)。结论丙卡特罗联合阿奇霉素治疗儿童哮喘并发肺炎支原体感染临床效果显著,安全性高。     

Airway hyperresponsiveness: the usefulness of airway hyperresponsiveness testing in epidemiology,in diagnosing asthma and in the assessment of asthma severity

The present PhD thesis was conducted at the Respiratory Research Unit at the Pulmonary Department L in Bispebjerg Hospital, Copenhagen, Denmark and describes airway hyperresponsiveness in asthma patients in four studies. The first study concerned risk factors for the development of asthma in young adults in a 12‐year prospective follow‐up study of a random population sample of 291 children and adolescents from Copenhagen, who were followed up from the age of 7–17 years (1986) until the age of 19–29 years (1998). During follow‐up, 16.1% developed asthma, and in these subjects, the most important predictor of asthma development was airway hyperresponsiveness to histamine at baseline. Airway hyperresponsiveness is associated with more severe asthma and a poorer prognosis in terms of more exacerbations and less chance of remission of the disease. The second study described the relation between airway hyper‐responsiveness to methacholine and the quality of life in 691 asthma patients: In asthma patients with airway hyperresponsiveness to methacholine, the quality of life measured with a validated questionnaire (Junipers Asthma Quality of Life Questionnaire) was significantly reduced compared to asthma patients who did not respond to bronchial provocation with methacholine. Airway hyperresponsiveness is not uncommonly observed in non‐asthmatics, and the response to bronchial provocation with methacholine is therefore relatively non‐specific. The mannitol test is a relatively new bronchial provocation test that acts indirectly on the smooth airway muscle cells through the release of mediators from inflammatory cells in the airways; the mannitol could consequently be a more specific test compared with methacholine. The third study showed that out of 16 non‐asthmatics with airway hyperresponsiveness to methacholine, 15 did not respond to bronchial provocation with mannitol Because of the mechanism of action of mannitol, it seems plausible that the response to mannitol is more closely correlated to airway inflammation in asthma compared with the response to methacholine. The fourth study showed that in 53 adult asthma patients, who did not receive treatment with inhaled steroids, there was a positive correlation between the degree of airway inflammation and the degree of airway responsiveness to mannitol as well as to methacholine. The mannitol does, however, have the advantage of being a faster and simpler test to perform, requiring no additional equipment apart from a spirometer. Conclusions: Airway hyperresponsiveness in children and in adolescents without asthma predicts asthma development in adulthood. Asthma patients with airway hyperresponsiveness to methacholine have a poorer quality of life as well as more severe disease and a poorer prognosis compared with asthma patients without airway hyperresponsiveness. Bronchial provocation with mannitol as well as with methacholine were useful for evaluating the severity of asthma and the degree of airway inflammation, and accordingly for determining the need for steroid statement. The mannitol test does, however, have practical advantages over the methacholine test that make it preferable for clinical use.     

两药联合治疗小儿支气管哮喘的临床效果观察

目的研究观察妥洛特罗贴剂与普米克令舒雾化吸入联合治疗小儿支气管哮喘的疗效。方法小儿支气管哮喘患者86例为临床研究对象。对照组使用普米克令舒雾化吸入治疗,实验组患者在对照组治疗基础上使用妥洛特罗贴剂治疗,对比观察两组治疗效果和安全性。结果实验组咳嗽、气喘、哮鸣音及湿啰音消失时间快,总有效率更高,与对照组患者比较差异明显(P0.05)。实验组患儿治疗后免疫指标及血常规均优于对照组患者(P0.05)。结论联合使用妥洛特罗贴剂与普米克令舒雾化吸入联合治疗小儿支气管哮喘疗效好。     

Complementary and alternative medicine use and asthma: relation to asthma severity and comorbid chronic disease

Objective: To determine (a) the prevalence of complementary and alternative medicine (CAM) use among people with asthma, and (b) if comorbid chronic disease and asthma severity are associated with CAM use. Methods: This cross-sectional study utilized data from n?=?15?276 adults who participated in the 2009 Behavioral Risk Factor Surveillance System (BRFSS) and the 2009 Asthma Callback Survey (ACBS). Binary Logistic regression was used to determine if comorbid disease and asthma severity were associated with CAM use (yes/no). Model covariates were age, sex, income, and education. Results: About 26% of respondents report using at least one form of CAM. The most frequently reported form of CAM use is breathing exercises (19.8%). The results indicate that neither comorbid cardiovascular disease, diabetes, nor stroke are related to CAM use, but individuals with more severe asthma symptoms were more likely to use CAM (OR?=?1.05, 95% CI 1.04, 1.05). Conclusions: CAM remedies most often reported by people with asthma (breathing techniques, vitamins) are unlikely to pose safety risks. Comorbid chronic disease does not motivate people with asthma to seek unconventional remedies. The increase in CAM use with asthma severity prompts questions about factors that might drive this behavior, such as untreated/inadequately treated disease, or medication side effects.     

Upper airway and skin symptoms in allergic and non-allergic asthma: Results from the Swedish GA2LEN study

Background: Allergic and non-allergic asthma are viewed as separate entities, despite sharing similarities. The aims of this study were to determine differences in symptoms from the upper airways and the skin in allergic and non-allergic asthma. The secondary aims were to identify childhood risk factors and to compare quality of life in the two asthma groups. Methods: This cohort (age 17–76 years) consisted of 575 subjects with allergic or non-allergic asthma and 219 controls. The participants participated in an interview, spirometry, FeNO, skin prick test, and responded to the Mini Asthma Quality of Life Questionnaire. Results: Self-reported allergic rhinitis was significantly more common in both allergic and non-allergic asthma (82.3 and 40.7%) groups compared with the controls. The prevalence of chronic rhinosinusitis (CRS) was similar in both asthma groups. Eczema was significantly more common in both asthmatic groups (72.3 and 59.8%) than controls (47.0%) (p < 0.001 and p = 0.012). Severe respiratory infection in childhood and parental allergy were risk factors for both allergic and non-allergic asthma groups. Quality of life was significantly lower in non-allergic than allergic asthma groups (p = 0.01). Conclusion: Concomitant symptoms from the upper airways and the skin were significantly more common in both allergic and non-allergic asthma. This indicates that non-allergic asthma has a systemic component with similarities to what is found in allergic asthma. There were similarities in the childhood risk factor pattern between the two types of asthma but asthma-related quality of life was lower in the non-allergic asthma group.