The immediate effects of cortisol on pulmonary function in normals and asthmatics

We investigated short-term effects of corticosteroids on airway caliber, measured by spirometry and body plethysmography, over a period of 6 hr after an intravenous bolus of cortisol (8 mg/kg) or saline placebo was administered in a double-blind crossover format comparing 10 normal and nine asymptomatic unmedicated asthmatics. After 6 hrs isoproterenol (240 μg) was administered to compare the effects of cortisol with a β-agonist bronchodilator. Serum cortisol levels remained >100 μg/dl after cortisol and normal after placebo. Cortisol had no effect on pulmonary function except for a trend of improved flows and decreasing ratios of residual volume to total lung capacity in asthmatics that was not significant at 6 hr. Isoproterenol resulted in immediate improvement in specific conductance and flows in both groups; no interaction with cortisol was seen. We conclude that cortisol had no short-term effect on airway caliber in normals, at best a slowly evolving effect in asymptomatic unmedicated asthmatics, and no interaction with the bronchodilator effects of a maximal dose of isoproterenol in these groups.     

Efficacy and safety of cefditoren pivoxil for exacerbations of chronic obstructive pulmonary disease: A prospective multicenter interventional study

Oral antibiotic therapy for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) usually involves an aminopenicillin with clavulanic acid, a macrolide, or a quinolone. To date, however, the clinical efficacy and safety of the oral cephalosporin cefditoren pivoxil has not been evaluated in Japanese patients with acute exacerbations of COPD. We conducted a prospective, multicenter, single arm, interventional study from January 2013 to March 2017 to determine the efficacy and safety of oral administration of 200 mg cefditoren pivoxil three times daily for 7 days in a cohort of 29 eligible patients from 15 hospitals. The mean age (SD) of participants was 73.1 (8.1) years and 28 had a smoking history (the mean [SD] of smoking index, 1426.7 [931.7]). The primary efficacy endpoint was clinical response (cure rate) at test of cure, which was set at 5–10 days after treatment ceased. Of the 23 patients finally analyzed, cure was achieved in 15 (65.2%), while 8 (34.8%) remained uncured. Previous experience of acute exacerbations significantly affected the cure rate: none of the three patients who had at least two prior exacerbations were cured, while 15 of the 20 patients with one or fewer prior exacerbations were cured (p = 0.032). The microbiological eradication rate was 88.9% at test of cure. During treatment, mild pneumonia was reported as an adverse event in one patient (3.4%) but resolved within 10 days of onset. We conclude that cefditoren pivoxil represents a viable alternative for antibiotic therapy in patients with few prior exacerbations.     

Long term follow-up of infliximab efficacy in pulmonary and extra-pulmonary sarcoidosis refractory to conventional therapy

Introduction

Infliximab, a humanized, chimeric, monoclonal antibody against tumor necrosis alpha (TNF-α), has been shown to reduce the pulmonary and extra-pulmonary manifestations of sarcoidosis, however, there is little information regarding sustained efficacy with long-term use of infliximab. We retrospectively investigate whether a reduction in disease response is maintained, over a prolonged course of therapy (up to 85 months) with infliximab, and report on adverse events associated with its use.

Methods

Subjects with multi-organ sarcoidosis were prescribed infliximab, between January 2000 to June 2010 due to failure of conventional therapy and were identified from the Drexel University College of Medicine sarcoidosis clinic. Retrospective patient reported symptom and objective clinical data analyses of pulmonary and extra-pulmonary findings were evaluated pre-infliximab and post or concurrent infliximab therapy. Any adverse events or reasons for discontinuation during infliximab therapy were reported.

Results

Twenty-six patients with biopsy proven sarcoidosis received anti-TNF therapy and met the criteria for study inclusion. Clinical evidence of sustained resolution or improvement was demonstrated in 58.5% of all organs assessed (p =<0.001). No clinical change in disease activity was seen in 35.8% of all organs evaluated. Despite infliximab treatment, 5.7% had progressive disease activity. Adverse events were seen in 57.7% of patients treated with infliximab over a 46.2 month average duration of therapy. Three (12%) patients had an adverse event that required permanent discontinuation.

Conclusions

Infliximab is efficacious in the treatment of extra-pulmonary sarcoidosis and the efficacy is maintained with prolonged treatment. In patients with pulmonary sarcoid, sustained improvement in pulmonary imaging was seen after initiation of infliximab, however, post-treatment pulmonary function testing was not conclusive. Long-term infliximab therapy was well tolerated for our study group.     

清宣止咳颗粒联合多西环素治疗儿童支原体肺炎的临床研究

目的 探讨清宣止咳颗粒联合盐酸多西环素片治疗儿童支原体肺炎的临床疗效。方法 选取2020年8月—2023年3月张家口市妇幼保健院收治的116例肺炎支原体肺炎患儿,根据随机数字表法将116例患儿分为对照组和治疗组,每组各58例。对照组口服盐酸多西环素片,2.2 mg/kg,1次/d。治疗组在对照组基础上温水冲服清宣止咳颗粒,3次/d,2～3岁：0.5袋/次,4～6岁：0.75袋/次,7岁及以上：1袋/次。两组患儿连续治疗7 d。观察两组的临床疗效,比较两组的患儿症状体征的消失时间、用力肺活量（FVC）、呼气峰值流速（PEF）、最大呼气中期流量（MMEF）、C反应蛋白（CRP）、血沉（ESR）、乳酸脱氢酶（LDH）、降钙素（CT）。结果 治疗后,治疗组的总有效率为94.83%,明显高于对照组的总有效率82.76%,组间差异显著（P＜0.05）。治疗后,治疗组患儿的咳嗽消失时间、肺部啰音消失时间、肺部炎症完全吸收时间均明显短于对照组（P＜0.05）。治疗后,治疗组的FVC、PEF、MMEF高于治疗前（P＜0.05）,且治疗组的FVC、PEF、MMEF高于对照组（P＜0.05）。治疗后,两组的血清CRP、ESR、LDH、CT水平显著降低（P＜0.05）,且治疗组的血清CRP、ESR、LDH、CT水平明显低于对照组（P＜0.05）。结论 宣止咳颗粒联合盐酸多西环素片治疗儿童支原体肺炎的疗效良好,可改善临床症状和肺通气功能,显著减轻炎症反应。     

Comparison of Δ FVC (% Decrease in FVC at the PC20) Between Cough-Variant Asthma and Classic Asthma

The percentage decrease in forced vital capacity (FVC) at the methacholine PC₂₀ (Δ FVC) has been proposed as a surrogate marker of maximal airway response. The aim of this study was to compare the Δ FVC between patients with cough-variant asthma (CVA) and those with classic asthma (CA). We performed a retrospective analysis of methacholine challenge test data from 47 children who were diagnosed as having CVA and from 75 children who had CA of mild severity. The mean (± SD) Δ FVC was significantly (p = 0.001) lower in the CVA group (14.7 ± 3.4%) compared with the CA group (17.1 ± 4.4%), whereas PC₂₀ was not different between the two groups. Our results suggest that CVA is associated with a lower level of maximal airway response than CA.     

复方鲜竹沥液联合异丙托溴铵治疗慢性阻塞性肺疾病急性加重期的临床研究

目的探究复方鲜竹沥液联合异丙托溴铵治疗慢性阻塞性肺疾病急性加重期的疗效。方法选取2015年1月—2016年6月天津市滨海新区大港医院呼吸科收治的慢性阻塞性肺疾病急性加重期患者321例,随机分为对照组(160例)和治疗组(161例)。对照组患者给予异丙托溴铵气雾剂,2揿/次,2次/d。治疗组在对照组的治疗基础上口服复方鲜竹沥液,20 mL/次,2次/d。两组患者均连续治疗7 d。观察两组的临床疗效,同时比较两组治疗前后肺功能指标、血气分析指标、炎症因子水平的变化情况。结果治疗后,对照组和治疗组的总有效率分别为86.88%、96.89%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者一秒用力呼气容积(FEV_1)、一秒用力呼气容积/用力肺活量(FEV_1/FVC)及最大呼气中期流量(MMEF)、氧分压(pO_2)均比治疗前显著升高,二氧化碳分压(pCO_2)显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组FEV_1、FEV_1/FVC、MMEF、pO_2均显著高于对照组,pCO_2低于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者肿瘤坏死因子-α(TNF-α)、人白细胞介素6(IL-6)、C反应蛋白(CRP)均明显降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组TNF-α、IL-6、CRP水平显著低于对照组,两组比较差异有统计学意义(P0.05)。结论复方鲜竹沥液联合异丙托溴铵治疗慢性阻塞性肺疾病急性加重期具有显著的临床疗效,可显著改善肺功能和血气分析指标,降低炎症因子水平,具有一定的临床推广应用价值。