支气管舒张剂治疗无效的咳嗽变异性哮喘患者炎性介质水平和炎性细胞百分比的检测及其意义

目的: 检测咳嗽变异性哮喘(CVA)患者炎性介质水平和炎性细胞百分比,阐明白细胞介素8(IL-8)和中性粒细胞在支气管舒张剂治疗无效的CVA发病中的作用。方法: 随机选择60例CVA患者,分为支气管舒张剂治疗无效组(n=30)和支气管舒张剂治疗有效组(n=30),同时选取健康人群作为正常对照组(n=30)。检测3组研究对象诱导痰上清液中IL-8水平和嗜酸性粒细胞阳离子蛋白(ECP)水平,观察诱导痰中细胞学分类,记录咳嗽症状评分。结果: 支气管舒张剂治疗无效组患者诱导痰中IL-8水平明显高于支气管舒张剂治疗有效组和正常对照组(P<0.05);诱导痰中ECP水平明显低于支气管舒张剂治疗有效组(P<0.05),但与正常组水平接近(P>0.05);支气管舒张剂治疗无效组患者诱导痰中中性粒细胞百分比明显高于支气管舒张剂治疗有效组和正常对照组(P<0.05);支气管舒张剂治疗无效组患者咳嗽症状评分与诱导痰中IL-8水平呈正相关关系(r=0.764,P<0.01),并与其中性粒细胞百分比呈正相关关系(r=0.889,P<0.01)。结论: IL-8和中性粒细胞参与支气管舒张剂治疗无效的CVA的发病,可加重气道炎症和气道高反应性,使咳嗽症状加重;在临床上IL-8和中性粒细胞检测可作为CVA诊断、严重程度及疗效判定的辅助手段。     

Additive benefits of tiotropium in COPD patients treated with long-acting beta agonists and corticosteroids

OBJECTIVE AND BACKGROUND: The addition of an alternative class of long-acting bronchodilator is recommended for COPD patients who do not respond satisfactorily to monotherapy. The aim of this study was to investigate the additive benefit of tiotropium in severe COPD and to establish whether the improvement in lung function in these patients can be predicted from their acute bronchodilator response to ipratropium or salbutamol. METHODOLOGY: Forty-six patients with severe COPD treated with inhaled long-acting beta(2) agonists and corticosteroids (LABA/CS) were enrolled. Their prebronchodilator FEV(1) was less than 50% of the predicted value. Tiotropium (18 microg, once daily) was added via a dry-powder inhaler device. After a month of treatment, tiotropium was stopped but their previous medication was continued. Patients were reassessed a month later. Acute bronchodilator response to ipratropium and salbutamol was assessed prior to tiotropium treatment. Pulmonary function and health status were evaluated. RESULTS: Adding tiotropium significantly improved FVC, FEV(1) and inspiratory capacity (IC). The increase in FVC was significantly associated with an increase in IC (r = 0.36, P = 0.019) and a decrease in residual volume (r =-0.56, P < 0.001). Total scores of St. George Respiratory Questionnaire scores were significantly improved after adding tiotropium treatment (P < 0.001). After tiotropium withdrawal, FVC, FEV(1) and IC decreased markedly. Bronchodilator response to ipratropium did not predict the tiotropium-mediated improvement in FEV(1) or FVC. CONCLUSIONS: Adding tiotropium to inhaled LABA/CS can yield clinical benefits in lung function and improved quality of life in COPD patients, as both drugs act through separate yet complementary pathways to maintain airway calibre.     

Bronchodilation and bronchoconstriction: predictors of future lung function in childhood asthma

BACKGROUND: Persistently low levels of lung function are associated with subsequent symptoms in patients with asthma as children. OBJECTIVES: We hypothesized that objective measures of baseline pulmonary function would be independently associated with future lung function in the Childhood Asthma Management Program and that these associations might vary with treatment. METHODS: We evaluated the association of FEV1, airway responsiveness, and bronchodilator response at randomization as predictors of longitudinal growth in FEV1 at the 48-month follow-up visit in the 1041 Childhood Asthma Management Program participants. RESULTS: Baseline levels of airway responsiveness and bronchodilator response were significantly associated with baseline level of lung function. In multivariate models, higher bronchodilator response (beta = 0.22; P < .0001), log PC20 (beta = 1.82; P < .0001), and FEV1 (beta = 0.58; P < .0001) at randomization were each associated with higher levels of prebronchodilator FEV1, as a percent of predicted, after 4 years. Similar associations were noted for prebronchodilator forced vital capacity and FEV1/forced vital capacity ratio. Baseline bronchodilator response was a particularly powerful predictor of lung function improvements while on inhaled corticosteroids, whereas airway responsiveness was a better predictor in subjects not randomized to any controller medications. CONCLUSION: We conclude that baseline bronchodilator response, airway responsiveness, and level of FEV1 are independent predictors of subsequent level of FEV1 in childhood asthma and may have treatment-specific prognostic significance for persistence of symptoms into early adulthood. CLINICAL IMPLICATIONS: In asthma, bronchodilator and bronchoconstrictor responses are independent predictors of future lung function and should not be used interchangeably; bronchodilator response may indicate good response to inhaled corticosteroids.     

吸入支气管舒张剂对COPD肺通气功能的影响

目的探讨单药与联合吸入支气管舒张剂对COPD的疗效。方法50例患者随机分成A组(16例),B组(17例),C组(17例),分别测定基础肺功能。A组吸入溴化异丙托品,B组吸入沙美特罗/氟替卡松(舒利迭),C组吸入溴化异丙托品加舒利迭。于第1,8,15天测吸药后1h的功能参数FEV1、FVC。结果用药后各组FEV1、FVC较基础值有明显差异(P<0.01),C组△FEV1,△FVC明显高于A、B组,(P<0.01)。结论联合应用吸入支气管舒张剂对COPD患者有明显的气道扩张作用。     

Antispasmodic and bronchodilator activities of Artemisia vulgaris are mediated through dual blockade of muscarinic receptors and calcium influx

Aim of the study

The present study describes antispasmodic, antidiarrheal, bronchodilatory and tracheo-relaxant activities of Artemisia vulgaris to rationalize some of its traditional uses.

Materials and methods

Crude extract of Artemisia vulgaris (Av.Cr) was studied in the isolated tissue preparations of rabbit jejunum and guinea-pig trachea, as well as in the in vivo castor oil-induced diarrhea and bronchodilatory techniques.

Results

Av.Cr which tested positive for alkaloids, coumarins, flavonoids, saponins, sterols, tannins and terpenes caused concentration-dependent (0.03–10 mg/mL) relaxation of jejunum spontaneous contractions. Av.Cr inhibited the carbachol (CCh, 1 μM) and K⁺ (80 mM)-induced contractions in a pattern, similar to that of dicyclomine. Av.Cr shifted the Ca²⁺ concentration–response curves to right, like that caused by verapamil and dicyclomine. Av.Cr produced rightward parallel shift in CCh-curves, followed by non-parallel shift at higher concentration with the suppression of the maximum response, similar to that caused by dicyclomine. It exhibited protective effect against castor oil-induced diarrhea and CCh-mediated bronchoconstriction in rodents. In trachea, Av.Cr relaxed the CCh (1 μM) and K⁺ (80 mM)-induced contractions and shifted the CCh-curves to right.

Conclusion

These results indicate that Artemisia vulgaris exhibits combination of anticholinergic and Ca²⁺ antagonist mechanisms, which provides pharmacological basis for its folkloric use in the hyperactive gut and airways disorders, such as abdominal colic, diarrhea and asthma.     

Parauterine leiomyomas in women: A clinicopathologic study of 22 cases

During a systematic pathologic study of surgically excised parauterine connective tissues 22 parauterine leiomyomas were found, of which 10 were paracornual, 6 parametrial and 6 perisalpingeal. Their prevalence was 2.4% (22/928) among patients requiring hysterectomy for common gynecologic conditions. There tumors were often concurrent with intrauterine leiomyomas. Their etiology and clinical relevance are discussed.     

Effect of salbutamol on specific airway resistance in infants with a history of wheezing.

The purpose of this study was to assess the effectiveness of nebulized salbutamol in infants with a history of wheezing. Eighty-eight children aged 3-24 months with a history of wheezing were studied, in seven groups: I (n = 15) and I/A (n = 17) with elevated specific airway resistance (SRaw); II (n = 17) with normal SRaw; III (n = 23), III/A (n = 17), and IV (n = 18) with normal SRaw exposed to carbachol bronchial challenge (CBC); and V (n = 13) serving as control. Infants for groups I/A and III/A were selected to match by age and by baseline and post-carbachol SRaw values, respectively. Baseline airway resistance and thoracic gas volume (TGV) were measured plethysmographically. Specific airway resistance was selected as an index of bronchial function. Thereafter every child in groups I, I/A and II inhaled 200 micrograms of salbutamol by tidal breathing, and the children in groups III, III/A, and IV were exposed to CBC. Following positive reaction to carbachol, children of groups III and III/A inhaled salbutamol (200 micrograms, tidal breathing), and those of group IV received no drug. Controls from group V with normal SRaw received placebo (phosphate-buffered saline). Plethysmography was repeated in all children at 5 minute intervals. Following salbutamol SRaw was reduced in children with elevated and normal SRaw. In contrast, children not receiving salbutamol had unchanged SRaw value. The response to salbutamol measured by SRaw, Raw, and TGV was not significantly different in the spontaneously obstructed infants compared to those who received carbachol. In conclusion, infants with a history of wheezing do respond to inhaled salbutamol.