The effect of nebulized budesonide treatment in children with mild to moderate exacerbations of asthma

Background: The role of inhaled corticosteroids in the treatment of acute asthma remains a controversial subject. Objective and methods: A randomized, double-blind, placebo-controlled parallel-group clinical trial on the effect of a 5-d course of nebulized budesonide treatment in children with mild to moderate exacerbation of asthma was performed. The need for systemic corticosteroid intervention was evaluated as the primary outcome measure. Results: Sixty-seven children aged 6 to 15 y were enrolled. During the emergency department phase, they received three nebulizations of either budesonide(1 mg/dose) or placebo, and then in the home phase of the study, they continued their study medications twice a day for another 4 d. Though the level of improvement in the emergency department phase was similar between the groups given either budesonide or placebo treatments (6.8±1.9% vs 4.0±1.5%, p=0.30, respectively), nebulized budesonide caused a trend towards a benefit in terms of the need for systemic corticosteroid intervention (2/33 vs 7/34, p=0.07), but not in secondary outcome measures.

Conclusion: Though we show a tendency towards a benefit with nebulized budesonide in children with mild to moderate exacerbations in terms of prevention of progression of the illness, the documented benefit is small and includes, at least, consideration for clinical significance, cost-effectiveness, impracticality and safety.     

Asthma exacerbations . 1: epidemiology

Asthma exacerbations may be triggered by a number of atmospheric and domiciliary environmental factors as well as by those encountered in schools and workplaces. The majority of exacerbations, particularly in children, coincide with respiratory viral infections, most commonly rhinovirus. As most respiratory viruses and many aeroallergens appear in seasonal patterns, asthma exacerbations, particularly those requiring emergency treatment, show analogous seasonal cycles which differ in form in children and adults. While similar in form between the sexes, they differ in amplitude, with boys having higher risks of exacerbation in childhood and women in adult life. Simultaneous exposure of asthmatics with respiratory viral infections to allergens or air pollutants may significantly increase the risks of exacerbation. Access to and compliance with inhaled corticosteroid treatment is an important predictor of the likelihood of asthma exacerbations occurring, including those that occur during respiratory viral infections. Epidemiologically, the degree of asthma control achieved by asthmatics is an important predictor of the likelihood of disease exacerbation including respiratory failure, death, and health service consumption.     

Asthma exacerbations . 3: Pathogenesis

Asthma exacerbations are an exaggerated lower airway response to an environmental exposure. Respiratory virus infection is the most common environmental exposure to cause a severe asthma exacerbation. Airway inflammation is a key part of the lower airway response in asthma exacerbation, and occurs together with airflow obstruction and increased airway responsiveness. The patterns of airway inflammation differ according to the trigger factor responsible for the exacerbation. The reasons for the exaggerated response of asthmatic airways are not completely understood, but recent studies have identified a deficient epithelial type 1 interferon response as an important susceptibility mechanism for viral infection.     

Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD

OBJECTIVE: The purpose of this study was to understand the outcomes for patients admitted to hospital for an acute exacerbation of COPD, and to determine the factors influencing quality of life and health service utilization of patients with COPD. METHODOLOGY: Hospital outcomes of 282 patients with moderate and severe COPD, for an acute exacerbation, were retrospectively evaluated. After 24 months of follow up, health-related quality of life (QoL) and health service utilization (emergency room (ER) visit and readmission) in 54 patients admitted previously, were surveyed by questionnaires. RESULTS: Of 282 COPD patients admitted for an acute exacerbation, 28 patients (9.9%) died during hospitalization, 241 patients (85.5%) were discharged home, and only 13 patients (4.6%) needed long-term care facilities. Although over 50% of the patients had survived over 2 years after discharge, their QoL was poor. Patients who frequently went to the ER or were admitted, were those with poor QoL, severe dyspnoea and frequent exacerbation. COPD exacerbation and dyspnoea were the main factors influencing QoL of the patients. Age, comorbidity, QoL, FEV1, frequency of COPD exacerbation, long-term oxygen therapy, and family doctor were the factors determining the likelihood of patients visiting the ER. Frequency of COPD exacerbation, family doctor and living alone were the factors determining which patients were likely to be admitted to hospital. CONCLUSION: The outcomes and QoL of patients admitted for an acute exacerbation of COPD were poor. The major factors influencing QoL were frequency of COPD exacerbation and severity of dyspnoea. Improvement of social and medical networks (e.g. reducing the number of patients living alone and providing family doctors for patients) may reduce health care service utilization.     

IL-33 drives influenza-induced asthma exacerbations by halting innate and adaptive antiviral immunity

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Attenuated Listeria monocytogenes as a live vector for induction of CD8+ T cells in vivo: a study with the nucleoprotein of the lymphocytic choriomeningitis virus

Listeria monocytogenes spends most of its intracellular lifecycle in the cytosol of the infected eucaryotic cells. Withinthis cellular compartment originates the endogenous pathwayof antigen processing and presentation. We thus assumed thatrecombinant L. monocytogenes expressing an heterologous protein,the nucleoprotein of the lymphocytic choriomeningltis virus(LCMV), should be able to induce antigen-specific CD8⁺ T cellsin vivo. The LCMV nucleoprotein gene was inserted in phase withthe sequence coding for the putative signal sequence of thehemolysin of L. monocytogenes in order to target its secretioninto the cytosol of the infected cell. The ability of this recombinantbacterium to induce LCMV-reactive CD8⁺ T cells was then monitoredin BALB/c mice. The immune status of the immunized BALB/c micewas studied on the seventh day after a single i.v.injectionof a sublethal dose of the recombinant bacteria: (i) cytotoxicCD8⁺ T cells were detected in liver; (ii) using in vitro re-stimulationwith PMA and ionomycin, secondary cytotoxic CD8⁺ T cells weredetected in spleen; (iii) an early inflammatory reaction dependenton the presence of CD8⁺ T cells occurred in the footpad afterintraplantar inoculation of live LCMV; and (iv) mice were protectedagainst an otherwise lethal intracerebral LCMV challenge; theprotection was accompanied by elimination of the virus. Whenthe immune status of the immunized hosts was monitored for alonger period post-immunization, the balance between immuneprotectiosn and immunopathology described for the anti-LCMVimmune responses was observed; two phases of protection weredetected, flanking a transitory phase of exacerbation of thelymphocytic choriomeningitis disease (weeks 2–5). Takentogether, these results indicate the feasibility of using attenuatedL. monocytogenes as a model of a live vector to induce in vivoCD8-ependent immune responses against intracellular pathogens.     

Pathogenesis and treatment of idiopathic and rheumatoid arthritis-related interstitial pneumonia. The possible lesson from COVID-19 pneumonia

ABSTRACT

Introduction

Main clinical manifestations of SARS-CoV-2 infection are characterized by fever, dyspnea, and interstitial pneumonia, frequently evolving in acute respiratory distress syndrome (ARDS).     

羧甲司坦治疗慢性支气管炎急性发作期的临床疗效

目的:研究羧甲司坦治疗慢性支气管炎急性发作期患者的临床疗效。方法:选择漳州古雷港经济开发区第一医院2022年1月至2022年12月诊治的56例慢性支气管炎急性发作期患者,给予羧甲司坦口服溶液治疗7 d,检测并比较治疗前及治疗后(治疗7 d)血气分析指标、肺功能、炎症因子及T淋巴细胞差异。结果:本研究56例慢性支气管炎急性发作期患者治疗后临床控制36例,减轻14例,无效6例,治疗总有效率为89.3%;患者治疗后氢离子浓度指数(pH)、动脉血氧分压(PaO₂)、经皮动脉血氧饱和度(SpO₂)高于治疗前,动脉血二氧化碳分压(PaCO₂)及碳酸氢根(HCO₃^-)低于治疗前,差异具有统计学意义(P <0.05);患者治疗后用力肺活量(FVC)、第1秒用力呼气量(FEV1)、第1秒用力呼气量占用力肺活量比值(FEV1/FVC)均高于治疗前,差异具有统计学意义(P <0.05);患者治疗后血清肿瘤坏死因子–α(TNF–α)、白细胞介素–6(IL–6)及白细胞介素–8(IL–8)水...     

老年慢性阻塞性肺疾病急性加重期患者凝血功能的监测

目的研究老年慢性阻塞性肺疾病急性加重期(AECOPD)与AECOPD伴呼吸衰竭患者凝血检测的临床意义。方法抽选2013年5月至2014年5月我院收治的老年AECOPD患者96例,按照是否伴呼吸衰竭分为呼衰组(n=44)和AECOPD组(n=52),并选择同期在我院行健康体检并确认健康者50例作为对照组。采用Sysmex XE-5000全自动血细胞分析仪和Sysmex CS-5100全自动凝血分析仪检测三组患者凝血指标:血小板(PLT)、D二聚体(D-D)、血浆纤维蛋白原(Fbg)、血浆凝血酶原时间(PT)、活化部分凝血酶原时间(a PTT);检测炎症指标:C反应蛋白(CRP)、白细胞计数(WBC);采用肺功能检测仪检测用力呼气肺活量(FVC)、第一秒用力呼气容积(FEV1)及血气指标Pa O_2、Pa CO_2。结果呼衰组D-D水平显著高于AECOPD组和对照组,且AECOPD组高于对照组,(P0.05);AECOPD组、呼衰组Fbg水平均高于对照组(P0.05),但两组组间比较无统计学差异(P0.05)。呼衰组、AECOPD组CRP、TNF-α、IL-8水平均高于对照组,且呼衰组显著高于AECOPD组,差异均有统计学意义(P0.05)。呼衰组FEV1、FEV1/FVC、Pa O_2水平均低于AECOPD组低于对照组;Pa CO_2高于AECOPD组高于对照组,组间比较差异均有统计学意义(P0.05)。结论AECOPD伴呼吸衰竭患者存在高凝状态。