Exhaled nitric oxide measure using multiple flows in clinically relevant subgroups of COPD

Although there is widespread interest in fractional exhaled nitric oxide (FeNO) as a non-invasive, time and cost effective biomarker for assessing airway inflammation in chronic obstructive pulmonary disease (COPD), its usefulness is still controversial. We examined the FeNO levels in clinically meaningful subgroups of COPD in a group of 91 COPD patients with FEV(1) 17-77% of predicted. Multiple flow rates FeNO at 10, 30, 50, 100 and 200 mL/s were measured and a two-compartment model was used to estimate the diffusion Capacity (D), alveolar NO concentration (Calv) and airway wall NO concentration (Caw). All patients had spirometry, assessment of symptoms with questionnaires and low-dose CT scan as well as assessment of weight and body composition. We examined the following subgroups of COPD: Patients with 1) Severe emphysema, 2) Chronic bronchitis, 3) Frequent exacerbations, 4) Loss of lean body mass and 5) Low fat-free mass index. We used advanced non-linear mixed model adjusted for age and gender. The modelled differences in D, Calv or Caw among COPD subgroups were small and not statistically significant. The analysis showed significant effects of current smoking on Caw and of gender on D and Calv. The results were the same if the advanced non-linear mixed model was substituted by more standard analysis techniques. This study questions the relevance of using FeNO as a biomarker to evaluate local inflammation in COPD and points to a need for developing novel non-invasive biomarkers for research laboratory work and daily clinical practice.     

妥洛特罗贴剂治疗婴幼儿喘憋性肺炎急性发作的临床疗效观察

目的观察妥洛特罗贴剂治疗儿童喘憋性肺炎急性发作的临床疗效。方法选择喘憋性肺炎急性发作患儿80例,在常规治疗基础上加用妥洛特罗贴剂,每次1片(0.5 mg),每日1次,记录给药5 d内患儿一般情况、临床症状及体征变化。结果给药5 d内,患儿一般状况、喘息及肺部啰音等临床症状和体征逐渐得到改善,显效26例,有效7例,无效3例,总有效率为91.7%。治疗期间无1例患者出现不良反应。结论妥洛特罗贴剂治疗儿童喘憋性肺炎急性发作疗效显著安全,不良反应少。     

High frequency of β-lactamase-negative, ampicillin-resistant strains of Haemophilus influenzae in patients with chronic bronchitis in Japan

In Japan, the increasing incidence of β-lactum-resistant Haemophilus influenzae infections is of growing concern. We retrospectively studied whether the prevalence of β-lactamase-negative ampicillin-resistant strains of H. influenzae was influenced by chronic lung diseases. H. influenzae isolates, obtained from patients who were diagnosed with acute or chronic bronchitis, or acute exacerbation of chronic bronchitis in 2005, were studied. In addition to susceptibility testing, polymerase chain reaction (PCR) was performed for the detection of TEM-1 β-lactamase, and Asn526-Lys and Ser385-Thr amino acid substitutions in the ftsI gene encoding penicillin-binding protein-3 (PBP-3). The minimum inhibitory concentration values of β-lactams were found to be increased in isolates from patients with chronic bronchitis who had been repeatedly administered antibiotics. Genetic analysis using PCR suggested that this might be associated with a high frequency of β-lactamase-negative strains with mutations in PBP-3. The presence of β-lactum-resistant strains needs to be considered for patients with chronic bronchitis in whom H. influenzae is isolated as a causative pathogen.     

儿童塑型性支气管炎9例临床特征及病原学分析

目的 探讨儿童塑型性支气管炎的临床特点及病原学分析。方法 回顾分析2011~2012 年9 例确诊为塑型性支气管炎患儿的临床资料,对其临床、影像、纤维支气管镜（纤支镜）特点、病原体及治疗进行总结。结果 9 例患儿均以高热、咳嗽起病,在发病1~3 d 出现呼吸困难,并进行性加重;一侧或双侧肺部呼吸音减低,肝脾肿大;合并呼吸衰竭6 例次、中毒性脑病6 例次、中毒性肝炎7 例次、休克3 例次、心力衰竭3 例次、肾功能衰竭2 例次。胸片或胸部CT 均表现为单个及多个肺叶段实变及不张, 4 例合并胸腔积液。纤支镜镜下均可见灰白色黏液栓堵塞支气管开口,吸出支气管样塑形物。9 例患儿均检出流感病毒（IFVs）,以甲型流感病毒（IFV-A）为主（67%）。IFV-A 合并肺炎支原体及细菌的混合感染率为50%。3 例乙型流感病毒（IFV-B）感染患儿中,1 例合并肺炎支原体感染。9 例患儿均予抗感染、激素、丙种球蛋白及必要的呼吸支持治疗;均经纤支镜行内生异物取出及肺泡灌洗治疗;5 例予奥司他韦抗病毒治疗。痊愈7 例,死亡2 例。结论 儿童塑型性支气管炎临床与重症肺炎类似;流感病毒是其主要病原;治疗上除抗感染、糖皮质激素、丙种球蛋白、呼吸支持等常规治疗外,经纤支镜内生异物取出及早期奥司他韦抗病毒治疗可获得良好疗效。     

帮备佐治慢性支气管炎急性加重期的疗效观察

目的　探讨口服片剂帮备对慢性支气管炎急性加重期的治疗效果。方法　5 0例患者随机分为治疗组和对照组,每组各2 5例,治疗组接受口服片剂帮备治疗。结果　治疗组在改善咳嗽、咳痰、气喘等方面有效率达92 % ,平均住院天数比对照组明显减少(P <0 .0 5 )。结论　帮备是一种疗效好,依从性好的支气管扩张剂,能有效控制病情,缩短病程。     

益气化痰法治疗慢性支气管炎浅析

从慢性支气管炎病理基础为气虚痰阻、基本疗法为益气化痰等论述益气化痰法治疗慢性支气管炎。认为,理中汤合小青龙汤既能补表里之气,又能祛表里之湿起到益气化痰的作用。