沙丁胺醇与异丙托溴铵雾化吸入治疗喘息型慢性支气管炎30例

目的：观察沙丁胺醇、异丙托溴铵联合雾化吸入对喘息型慢性支气管炎的疗效。方法：将75例喘息型慢性支气管炎急性发作期患者随机分为单用沙丁胺醇组，异丙托溴铵组及联用沙丁胺醇，异丙托溴铵组，测量雾化前，后30minPEF值，计算PEF改善率，比较疗程前后FEV1％改善程度并作统计分析。结果：三组PEF改善率的优良率分别为28.6%,50.0%,70.0%。三组FEV1％改善率的优良率分别为47.6%,62.5%,80.0%。结论：联合用药组PEF改善率，FEV1％改善程度明显高于单用药组，且临床症状改善明显，不良反应少。     

辅舒酮吸入治疗儿童哮喘的疗效观察

目的 探讨辅舒酮吸入治疗儿童哮喘的临床疗效。方法将40例患儿(年龄4～14岁)随机分两组，每组各20例，常规组长期口服酮替芬片(1mg2次／d)，治疗组长期口服酮替芬片的基础上加用辅舒酮喷雾剂(125μg／喷)吸入治疗，为期3个月，治疗期间定期随访记录临床评分、肺功能(峰流速仪测定PEF值)。结果临床评分说明辅舒酮吸入有效，临床症状得到控制或减轻，治疗组PEF值有提高，常规组PEF值无提高。结论辅舒酮长期吸入治疗后能减轻哮喘的严重程度，使哮喘得到控制，可改善肺功能。     

Fade of pulmonary function during residual neuromuscular blockade

OBJECTIVES: A decrement in evoked muscle force with repetitive nerve stimulation (fade) suggests impaired neuromuscular transmission. We tested the hypothesis that fade of pulmonary function, ie, a decrease in values of FVC with the second spirometric maneuver compared to the first maneuver, occurs during impaired neuromuscular transmission. DESIGN: Prospective study. PARTICIPANTS: Six healthy male volunteers. INTERVENTIONS: A series of three consecutive spirometric maneuvers was performed every 5 min in six awake healthy volunteers before, during, and after partial paralysis evoked by rocuronium (0.01 mg/kg IV plus 2 to 8 microg/kg/min). MEASUREMENTS AND RESULTS: We measured FVC, FEV(1), forced inspiratory volume in 1 s (FIV(1)), peak expiratory flow (PEF), and peak inspiratory flow (PIF) by spirometry, and force of adductor pollicis muscle by mechanomyography (train-of-four [TOF] stimulation). A statistically significant fade (reduction of the second maneuver from the first maneuver) of FVC, FEV(1), FIV(1), PEF, and PIF was observed during neuromuscular blockade. With peak relaxation (TOF ratio, 0.5) fade amounted to medians of 10% (interquartile range [IQR], 9 to 23%), 7% (IQR, 2 to 16%), 31 (IQR, 19 to 47%), 9% (IQR, 3 to 24%), and 30% (IQR, 5 to 43%), respectively. A fade of >or= 10% was always associated with a clinically relevant (>or= 10%) FVC reduction from baseline (ie, FVC before rocuronium administration). However, FVC reduction from baseline was still present in 23% of measurements without a relevant FVC fade. CONCLUSIONS: A clinically relevant fall (fade) in FVC from the first to the second value during or after neuromuscular blockade suggests impaired pulmonary function and may be due to muscle paralysis. For this reason, the first (best) FVC value may overestimate pulmonary function and expose the patient to an unidentified risk.     

Peak expiratory flow values in children relative to the degree of atmospheric air pollution

The purpose of the study was to determine peak expiratory flow (PEF) values in children from three regions with different degrees of atmospheric pollution. The study included 1415 healthy children aged 7–9 years. In each child five measurements of PEF (1/min) were performed with a Vitalograph. The highest result was considered. The greatest degree of airway resistance, as reflected in low PEF values, was noted among children living in the Upper Silesian Industrial Region and in the Olkusz region where the degree of atmospheric pollution is high compared with Zarki.     

Efficacy of nebulized fluticasone propionate compared with oral prednisolone in children with an acute exacerbation of asthma

The aim of the present study was to investigate the efficacy and safety of nebulized fluticasone propionate (FP Nebules) compared with oral soluble prednisolone in children with an acute exacerbation of asthma. The study used an international, multi-centre, randomized, double-blind, parallel group design. Three hundred and twenty-one patients, aged 4-16 years old, who presented with an acute exacerbation of asthma, were randomly allocated to either nebulized FP (1 mg b.d.) or oral prednisolone (2 mg kg(-1) day(-1) for 4 days then 1 mg kg(-1) day(-1) for 3 days) for 7 days. Patients in the FP group showed a significantly greater increase in diary card morning peak expiratory flow (PEF) over 7 days compared with patients in the prednisolone group (difference = 9.51 min(-1), CI = 2.1, 16.8, P = 0.034). Similar increases for both treatments were shown for evening PEF. Clinic PEF improved with both treatments, but was significantly greater in patients taking FP after 7 days (difference = 11.41 min(-1), CI = 2.8, 20.0, P = 0.029). Both treatments reduced symptom scores to a similar extent. The two treatments were well tolerated, and there was no difference in the incidence of adverse events. The present study demonstrated that nebulized FP is at least as effective as oral prednisolone in the treatment of children presenting with an acute exacerbation of asthma.     

Comparison of inhaled salbutamol powder and aerosol in asthmatic patients with low peak expiratory flow level

Summary The short-term bronchodilator effects of dry salbutamol powder and a pressurized salbutamol aerosol were compared in 22 patients with severe asthma, on 3 consecutive mornings, in a double-dummy cross-over study. Only patients with peak expiratory flow (PEF) rate lower than 250 l/min, were recruited. PEF measurement was employed to assess changes in ventilatory function induced by inhalation of the drugs. No significant difference was found between the PEF changes induced by the dry salbutamol powder (400 µg) and the pressurized aerosol (200 µg). Both forms of the drug produced a significant rise in mean PEF values. The study shows that even in asthmatic patients with poor ventilation, a dry powder inhaler and pressurized aerosol are effective means of drug delivery to the lungs.     

Prolonged asthmatic responses to inhaled methacholine

The pattern of asthmatic response after inhalation of atropine and methacholine was studied in six adult asthmatics. After pretreatment with atropine, the provocation concentration of methacholine to cause a fall in FEV₁ of 20% was increased from 0.66 ± 2.09 to 94.90 ± 1.78 mg/ml. In the subsequent 7 hr, four subjects developed prolonged asthmatic responses. These occurred after concentrations of methacholine higher than those used clinically but did not directly relate to the dose of methacholine or to the increase in dose after atropine. In one subject the prolonged response was not accompanied by increased methacholine responsiveness and was not prevented by pretreatment with cromolyn sodium (40 mg). These results show that high doses of methacholine inhaled after pretreatment with atropine can induce prolonged asthmatic responses but the mechanism is unclear.