How Frequent Are Asthma Exacerbations in a Pediatric Primary Care Setting and Do Written Asthma Action Plans Help in Their Management?

Purpose. In the National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma, the expert panel recommends that a written asthma action plan be provided for all patients with asthma. Studies evaluating the usefulness of the asthma action plan in children are limited. We aim to determine exacerbation frequency and usefulness of the asthma action plan in managing exacerbations that occur in a pediatric primary care setting. Methods. Caretakers of asthmatic children attending the general pediatric clinic in an inner-city hospital completed a one-page questionnaire covering topics such as asthma severity, frequency of exacerbations, and possession/usefulness of an asthma action plan. Although controversy exists over the definition of yellow and red zone exacerbations, we defined the yellow zone as symptoms that require albuterol more than three times a day or more than two nights in succession. The red zone was defined as symptoms requiring systemic corticosteroids and/or an urgent physician visit. Results. Seventy of 75 subjects completed the survey. Almost 80% of respondents carried the diagnosis of persistent asthma, whereas the remainder had intermittent asthma. Exacerbation frequency over a 3-month period was determined. Approximately 80% of children experienced at least one yellow zone episode: 42% had one or two yellow zone episodes, and 39.6% had between three and five episodes. Sixty-three percent of patients did not experience a single red zone exacerbation. Almost 75% (44 of 59) of subjects possessed an asthma action plan. Ninety percent (37 of 41) of respondents with action plans found the plan to be useful in managing exacerbations. Conclusion. Approximately four of every five asthmatic children seen in this primary care setting experienced a yellow zone exacerbation at least once during a 3-month period. One third experienced at least one red zone episode. Nine of every 10 caretakers with an action plan reported the asthma action plan to be of value in managing exacerbations.     

Characteristics of Acute Asthma Patients Attended Frequently Compared with Those Attended Only Occasionally in an Emergency Department

Asthma patients that depend on emergency department (ED) services are generally considered to have extremely poor disease control and prognosis. It is important to identify characteristics related to poor disease control and frequent visits to the ED to apply appropriate clinical management. This study comprised a cross-sectional survey of consecutive patients with asthma exacerbation (age ≥12 years) presenting at the adult ED of a large, tertiary care, university-affiliated hospital over a 2-month period. The frequent visitors (FV) were defined by ≥3 visits to the ED in the preceding year, and the occasional visitors (OV) by ≤2 visits. Eighty-six patients (61 females and 25 males) were included in the study (mean age 38 ± 18 years). Of these patients, 51.2% were FV and 48.8% were OV. Sixty-nine percent had annual income lower than A$3000 and 66.3% had ≤8 years of the formal education. Only 18.6% had used inhaled corticosteroids, 79.1% identified the asthma attack severity, 70.9% increased or initiated inhaled β-agonist, 20.9% increased or initiated steroid therapy, and 55.8% had an asthma action plan for attack. The number of hospital admissions in past year (OR 4.3, P = .02), use of home nebulizer (OR 3.6, P = .05) and the lack of a written asthma action plan (OR 3.3, P = .03) were independently associated with frequent visits to the ED. We conclude that a substantial proportion of the patients that visit the ED are FV. These patients are more likely to have hospital admission in the past year, to use a home nebulizer, and to lack a written asthma action plan. They should be considered the most important target for asthma education.     

Psychological aspects of Crohn's disease

This is a critical review of 16 studies reporting a relationship between Crohn's disease and psychological variables. The studies reviewed indicate a relationship between the psychological variables of stressful life events, personality characteristics, and psychopathology and the onset and/or exacerbation of Crohn's symptoms. Personality characteristics such as depression, anxiety, and dependency are frequently reported as are the occurrence of stressful life events and the presence of psychopathology. The nature of the relationship is not explained by the research to date; however, the findings summarized in this report indicate that additional investigation into this association is warranted. A plan for such research is suggested.     

The Effect of Intravenous Magnesium Sulphate as an Adjuvant in the Treatment of Acute Exacerbations of COPD in the Emergency Department: A Double-Blind Randomized Clinical Trial

BackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) are serious complications that often require immediate intervention in an emergency department (ED). The aim of this study was to investigate the effect of intravenous magnesium sulphate as an adjuvant in the treatment of AECOPD in the ED.MethodsIn a double-blind, randomized clinical trial, a total of 60 patients with AECOPD presenting to the ED of Imam Khomeini Hospital in Sari, Iran, were included. The study was conducted between September 2016 and February 2018. Eligible patients were randomly allocated into two groups of intervention and control. Patients in the intervention and control groups received intravenous infusion of magnesium sulfate (2 gr) or normal saline over 30 minutes, respectively. For all patients, Borgdyspnea score, forced expiratory volume in one second (FEV1) result and clinical variables of interest were evaluated before the beginning of the intervention, and also 45 minutes and 6 hours after the commencement of intervention.ResultsRegardless of time of evaluation, pulse rate (PR), respiratory rate (RR) and Borg score in intervention group was lower than control group. Also, FEV1 and SPO2 were greater in intervention group compared to control group. However, these differences were not statistically significant (between-subject differences or group effect) (p<0.001). The trends of FEV1, SPO2, PR, RR and Borg score were similar between two groups of study (no interaction effect; P>0.05).ConclusionAccording to the results of this study, it seems that using intravenous magnesium sulfate has no significant effect on SPO2, FEV1, RR, and PR of patients with AECOPD who presented to ED.     

慢性阻塞性肺疾病急性加重期使用激素治疗与低血钾的关系分析

目的 探讨慢性阻塞性肺疾病(COPD)患者在病情加重时使用激素治疗与低血钾的关系.方法 回顾性分析73例COPD急性加重期使用激素治疗患者,按体重指数(BMI)进行分类比较,了解其与低血钾的关系.结果 超重患者低血钾发生率为31%, 不超重患者为6%,经χ2检验P＜0.05.结论 超重患者出现低血钾的机会较大,应多监测,及时补充和纠正,避免严重心律失常事件的发生.     

血必净注射液对老年慢性阻塞性肺疾病急性加重期合并SIRS患者血CRP及肺功能的影响

目的:观察血必净注射液对老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并全身炎症反应综合症(systemic inflammatory response syndrome,SIRS)患者血C-反应蛋白(c-reactive protein,CRP)及肺功能的影响。方法:选取2011年3月—2014年3月本院收治的老年AECOPD合并SIRS患者49例,随机分为治疗组24例和对照组25例。两组患者均根据痰培养选用敏感抗生素、低流量吸氧、舒张支气管平滑肌及化痰治疗。治疗组在上述治疗基础上加用血必净注射液50 m L(天津红日药业股份有限公司)加生理盐水100 m L静脉滴注。观察两组血CRP、SIRS改善率及肺功能的差异。结果:两组患者治疗后血CRP水平均下降,肺功能指标均明显改善(P0.05);治疗组治疗后血CRP水平、肺功能指标均优于对照组(P0.05);治疗组SIRS症状改善率明显优于对照组(P0.05)。结论:血必净注射液能明显减轻老年AECOPD合并SIRS患者机体的炎症反应,控制SIRS症状,改善肺功能。     

慢性阻塞性肺气肿急性加重相关因素和中医辨证护理临床研究

目的:探讨慢性阻塞性肺气肿急性加重不同证属的相关因素及中医辨证护理。方法:本资料共收集189例以COPD急性发作期入院患者,来自2009年6月—2012年12月上海中医药大学附属曙光医院ICU,按照慢性阻塞性肺疾病的诊断标准、中医辨证分型标准分析相关因素及中医辨证护理。结果:COPD急性发作中医证型与其病情程度存在一定的关系,从痰湿、痰瘀到痰热,病情逐渐加重,肺功能减退,通过中医辨证分型可以粗略了解COPD急性发作期患者肺功能状态,反复感受外邪、气道炎症增加是COPD急性发作肺功能减退的重要因素从而相对应的实施中医辨证护理。结论:根据患者疾病的证型实施辨证施护可以有的放矢,加快患者的康复。     

痰热清注射液治疗慢性阻塞性肺疾病急性加重期的Meta分析

目的系统评价痰热清注射液治疗慢性阻塞性肺疾病急性加重期的临床疗效。方法计算机检索自建库以来至2014年5月中国学术期刊全文数据库（CNKI）、万方数据库、读秀数据库图书馆,手工检索相关杂志,搜索西药常规加痰热清注射液与单纯西药常规比较治疗慢性阻塞性肺疾病急性加重期的临床随机对照试验,经质量评价最终对纳入标准的文献采用Review Manger5．0软件进行Meta分析。结果共纳入23个研究对象,全部为中文。Meta分析结果显示,痰热清注射液组与西药常规治疗组比较：痰热清注射液可提高临床疗效[OR=3．15,95％CI（2．41,4．12）,P〈0．00001];降低c反应蛋白（CRP）[WMD=-4．52,95％CI（-5．77,-3．26）,P〈0．00001];增加一秒用力呼气容积（FEVl）[WMD=0．29,95％CI（0．22,0．37）,P=0．29]。结论痰热清注射液较西药常规治疗慢性阻塞性肺疾病急性加重期可进一步提高临床疗效,降低ClIP,增加FEVl。但纳入文章质量有限,其治疗慢性阻塞性肺疾病急性加重期的疗效需要更多高质量大规模的RCT（随机对照试验）进一步验证。     

吸入用布地奈德混悬液联合复方异丙托溴铵气雾剂雾化吸入治疗慢性阻塞性肺疾病急性加重疗效的Meta分析

目的 系统评价吸入用布地奈德混悬液联合复方异丙托溴铵气雾剂雾化吸入治疗慢性阻塞性肺疾病急性加重（AECOPD）的疗效.方法 计算机检索PubMed、西文生物医学期刊文献数据库、中国期刊全文数据库（CNKI）、中国科技期刊数据库（VIP）、中国医院知识总库（CHKD）及万方数据等数据库,纳入所有吸入用布地奈德混悬液联合复方异丙托溴铵气雾剂雾化吸入治疗AECOPD疗效的随机对照试验.按纳入与排除标准筛选文献、评价质量和提取有效数据后,采用RevMan5.2软件进行Meta分析.结果 最终纳入8个随机对照试验,共638例患者.Meta分析结果显示：与对照组比较,吸入用布地奈德混悬液联合复方异丙托溴铵气雾剂雾化吸入明显改善AECOPD患者动脉血氧分压[均数差（MD）=5.50,95％置信区间（CI）：1.06～9.95,Z=2.43,P=0.02]和第1秒钟用力呼气容积占预计值的百分比（FEV1％）[MD=6.02,95％ CI：2.29 ～9.04,Z=3.90,P＜0.01],差异有统计学意义;其治疗AECOPD的总有效率高于对照组,差异有统计学意义[相对危险度（RR）=4.90,95％ CI：2.45～9.78）,Z=4.50,P＜0.01].结论 吸入用布地奈德混悬液联合复方异丙托溴铵气雾剂雾化吸入能有效改善AECOPD患者肺通气功能,纠正低氧,改善临床症状.     

宣肺通腑法治疗慢性阻塞性肺疾病急性加重期对照观察

[目的]观察宣肺通腑法治疗慢性阻塞性肺疾病急性加重期的临床疗效。[方法]将62例慢性阻塞性肺疾病急性加重期患者随机分为两组,治疗组32例,在西医常规治疗的基础上采用宣肺通腑法治疗;对照组30例,采用西医常规治疗。两组均以10d为1疗程,治疗1个疗程后,进行疗效判定。[结果]治疗组总有效率93.75%,对照组总有效率63.33%,治疗组优于对照组。[结论]宣肺通腑法治疗慢性阻塞性肺疾病急性加重期疗效显著。