Dose-response study of oxitropium bromide inhaled as a nebulised solution

Twelve patients suffering from partially reversible chronic obstructive pulmonary disease (COPD) took past in a single blind, randomised, 4-way cross-over trial to determine the optimal dose and duration of action of the anticholinergic agent oxitropium bromide (OTB) inhaled as a nebulised solution.Single doses of 500, 1000, 1500 and 2000 g nebulised OTB were compared during a 6 hour-observation period. Lung function test results indicated that 500 and 100 g OTB only induced slight bronchodilatation, whereas 1500 and 2000 g OTB produced a significantly greater increase in mean FEV1 compared to 500 g. There was a trend for 2000 g to be superior to 1000 g, but 2000 g and 1500 g were not significantly different. Significant bronchodilatation (>15% rise in FEV1 from baseline) persisted for 6 h after 1500 g. A significant decrease in airway resistance (Raw) was observed following inhalation of 2000 g. The mean decrease in Raw was 33% after 30 min, 20% after 4 h and 12% after 6 h.In this trial, 2000 g OTB administered by an ultrasonic nebuliser was the optimal dose, but a satisfactory result was also obtained with 1500 g.     

Forced oscillations, interrupter technique and body plethysmography in the preschool child

The interrupter technique, forced oscillation and plethysmography have been increasingly used to monitor early childhood respiratory diseases over the past 30 years. The techniques are based on different principles but generally yield concordant information. Data from all three techniques indicate significant airway response to bronchodilators in healthy and asthmatic preschool children. The interrupter technique is useful but yields little more than a single value of respiratory resistance. Forced oscillation and plethysmography may provide additional information relevant to the mechanisms of airway obstruction, provided the methodological artefacts are accounted for and corrected.     

Peripheral and proximal lung ventilation in asthma: Short-term variation and response to bronchodilator inhalation

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选择性肺功能检查在老年支气管哮喘诊断中的价值

目的：探讨肺功能试验在老年支气管哮喘（老年哮喘）诊断中的价值。方法：对临床诊断为哮喘的６３ 例老年病人进行基础肺功能、支气管扩张试验（支扩试验）、支气管激发试验（激发试验）等项检查,并与１３７ 例 ３０ 岁以下的青年哮喘患者进行比较。结果：老年组基础肺功能各值大部分较青年组低（ Ｐ＜ ０．０５）。老年组中支气管扩张试验阳性率为８１．７％ ,与青年组（９５．８％ ）比较差异有显著性（ Ｐ＜ ０．０５）。激发试验阳性率为 ８４．１％ ,与青年组（７０．１％ ）比较有显著差异（ Ｐ＜ ０．００１）。结论：老年哮喘患者由于基础病变的干扰,使其症状、体征不典型,临床诊断有一定难度。对可疑老年哮喘的病人,应常规行支气管扩张试验,有条件者可作支气管激发试验,以提高老年哮喘的诊断率,以便及时治疗。     

Efficacy of enprofylline in acute airway obstruction

The efficacy and safety of different regimens of intravenously administered enprofylline, an anti-asthma xanthine, were evaluated in a randomized open study, including 155 patients with acute exacerbation of obstructive lung disease. The regimen 2.5 mg/kg i.v. over 10 min was canceled after seven patients had been included, due to two cases of hypotensive/vasovagal reactions. The regimens 2.0 mg/kg/20 min and 2.5 mg/kg/20 min were significantly more effective with regard to bronchodilation than 2.0 mg/kg/10 min (PEF increase +35%, +30% and +17% respectively). Nausea and headache were the most common side effects (16-33% and 23-33% of the patients respectively on different regimens) with the lowest frequency on 2.0 mg/kg/20 min. Four additional hypotensive reactions occurred; one on each 2.0 mg/kg regimen and two on 2.5 mg/kg/20 min. The regimen 2.0 mg/kg20 min was found to be the most favourable with regard to efficacy and side effects. Enprofylline i.v. was found to be an effective bronchodilating treatment of acute airway obstruction but the frequency of side effects has to be considered.     

支气管扩张剂治疗有效和无效咳嗽变异性哮喘的比较研究

目的探讨支气管扩张剂治疗有效的咳嗽变异性哮喘（cough variant asthma,CVA）和支气管扩张剂治疗无效但糖皮质激素治疗有效CVA在临床表现、气道炎症和炎性介质水平的差异。方法选择CVA患者72例,根据口服支气管扩张剂治疗反应的差异分为支气管扩张剂有效者55例（A组）和支气管扩张剂无效者17例（B组）,支气管哮喘组（C组）和正常对照组（D组）均为26例。比较相应各组间一般临床资料、辣椒素咳嗽敏感性、肺通气功能指标、气道反应性、诱导痰炎症细胞数和分类计数,以及诱导痰上清液中组胺、前列腺素D2（PGD2）、白细胞介素-5（IL-5）及嗜酸粒细胞阳离子蛋白（ECP）含量的差异。结果 A组占所有CVA的76%,B组为24%。A组的咳嗽阈值logC5低于B组（P〈0.05）,肺通气功能指标如FEV1、FVC、FEV1/FVC和MMEF及PD20FEV1与B组相比有下降趋势,但差别无统计学意义。A组诱导痰中嗜酸性粒细胞比例明显高于B组（P〈0.05）,上清液中PGD2和ECP水平也较高（P〈0.01）。A组治疗1周后咳嗽症状积分改善分值与诱导痰嗜酸性粒细胞比例、PGD2、组胺、ECP水平间存在正相关（嗜酸性粒细胞比例：r=0.254,P=0.036;PGD2：r=0.422,P=0.007;组胺：r=0.365,P=0.020;ECP：r=0.371,P=0.020）,与logC5间存在负相关（r=-2.064,P=0.025）。结论 CVA可能存在支气管扩张剂治疗有效和无效两种亚型。两者咳嗽的发生机制可能有所不同,不同气道炎症介质水平导致的支气管收缩程度可能是决定支气管扩张剂疗效的重要因素。