Ultrasonic nebulization of hypertonic solution: a new method for obtaining specimens from nasal mucosa for morphologic and biochemical analysis in allergic rhinitis

Various techniques are used to collect specimens from the nasal mucosa for morphologic and biochemical analysis. The purpose of this study was to devise a method that overcomes some of the disadvantages (e.g., invasive procedure, samples not suitable for cytologic and biochemical analysis, lack of standardization, and poor reproducibility) of these techniques. The new method requires subjects, with neck extended, to inhale an ultrasonic nebulization of a hypertonic (3% NaCl) solution (UNHS) for 5 min. They then blow their nose into a Petri dish, one nostril at a time with the other one blocked. The secretions are dispersed with 0.1% dithiothreitol in phosphate buffer solution for 20 min. Total cell count (TCC) is evaluated, and the cellular suspension is divided into two aliquots: one is centrifuged and the supernatants are collected for eosinophil cationic protein (ECP) measurements; the other is cytocentrifuged and the slides, stained with Diff-Quik, are used for differential cell count. The results obtained with the UNHS and nasal lavage (NL) methods were compared. Eleven nonatopic healthy subjects and 19 allergic rhinitic patients were studied. Total cell count (×10⁵) was significantly higher with UNHS than with NL (13.0±12.3 vs 1.911.6; P<0.0]) The differential cell count was similar with the two procedures. ECP levels (μg/l) were higher with UNHS than with NL (39.1+38.2 V.S 16.7±41.2; P<0.01). For evaluation of reproducibility, four healthy and six rhinitic subjects underwent UNHS on two occasions within 5 days, and the results of two samples (sample 1 vs sample 2) were analyzed. Reproducibility was good as to TCC, differential cell count, and ECP     

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??Inhaled corticosteroids??ICS?? are the most effective medicine for chronic airway inflammation nowdays. Atomization inhalation has been widely applied in clinics because of its efficacy??fewer side-effects and convenience. Here??we focused on some points which should be paid attention to??including how to choose appropriate patients??how to ensure the effectiveness of inhaled steroids and how to reduce possible side-effects.     

Salbutamol in acute organophosphorus insecticide poisoning – a pilotdose-response phase II study

Background: Treatment of acute organophosphorus (OP) insecticide poisoning is difficult, with many patients dying despite best care. Pre-clinical studies have shown benefit from salbutamol, possibly due speeding alveolar fluid clearance or reducing bronchoconstriction. In this small pilot dose-response study, we aimed to explore whether addition of nebulized salbutamol to standard care might improve resuscitation.

Methods: We performed a single-blind phase II study comparing the effect of two different doses of nebulized salbutamol versus saline placebo, in addition to standard treatment. Primary outcome was oxygen saturations over the first 60?min of resuscitation; secondary outcomes included heart rate, incidence of dysrhythmias, time to ‘atropinization’, atropine dose required, and mortality.

Result: Seventy-five patients were randomized to receive 5?mg (Salb5, n?=?25) or 2.5mg (Salb2.5, n?=?25) of salbutamol, or saline placebo (NoSalb, n?=?25), by nebulizer. Oxygen saturations did not differ between groups over the first 60?min of resuscitation (median AUC NoSalb: 1376 [95% CI 1282 to 1470], Salb2.5: 1395 [1305 to 1486], Salb5: 1233 [1100 to 1367]; p?=?.9898). Heart rate was also similar across the three arms. Median time to full atropinization, and atropine dose required, were the same for all three arms (NoSalb 15.0 [10–16] min and 12.6 [8.0–13.4] mg, Salb2.5 15.0 [10–16] min and 12.6 [9.3–16.8] mg, and Salb5 15.0 [10–20] min and 12.6 [10.7–20.6] mg; p?=?.4805 and p?=?.1871, respectively). Three (12%) patients died in the Salb2.5 and Salb5 groups and two (8%) in the NoSalb group.

Conclusion: This pilot study, within the limitations of its small size and variation between patients, found no apparent evidence that administration of nebulized salbutamol improved resuscitation of patients with acute OP insecticide self-poisoning. The data obtained provides a basis to design further studies to ultimately test the role of salbutamol in OP insecticide poisoning.     

Formoterol fumarate inhalation solution (Perforomist™) for COPD

Formoterol fumarate is an effective treatment for chronic obstructive pulmonary disease (COPD) patients with moderate or greater severity of airflow obstruction. Published studies indicate that formoterol has a rapid onset of bronchodilation, which may enhance compliance, and sustained bronchodilation over 12 h, which produces a cumulative effect when inhaled twice daily. With long-term use, formoterol fumarate increases trough forced expiratory volume in 1 s and improves measures of hyperinflation, which correlate with relief of symptoms and a decreased need for additional short-acting bronchodilators as rescue treatment. The combination of formoterol with anticholinergic bronchodilators, especially the long-acting anticholinergic tiotropium, appears to further improve bronchodilation, decrease hyperinflation, improve symptoms and decrease the need for rescue therapy, compared with either agent alone. The availability of formoterol fumarate inhalation solution (Perforomist?) for treatment of COPD now extends these benefits to patients who prefer nebulizer therapy and/or cannot use metered-dose or dry-powder inhalers effectively.     

特布他林联合复方甲氧那明胶囊治疗咳嗽变异性哮喘的临床研究

目的探讨特布他林联合复方甲氧那明胶囊治疗咳嗽变异性哮喘的临床疗效。方法选取2016年1月—2017年1月在首都医科大学宣武医院治疗的咳嗽变异性哮喘患者86例,根据治疗方案的差别分为对照组(43例)和治疗组(43例)。对照组患者口服复方甲氧那明胶囊,2粒/次,3次/d。治疗组在对照组基础上雾化吸入硫酸特布他林雾化液,5 mg/次加入生理盐水2 m L,3次/d。两组患者均治疗4周。评价两组患者临床疗效,同时比较治疗前后两组患者临床症状评分、肺功能和血清学指标。结果治疗后,对照组患者总有效率为79.07%,显著低于治疗组的95.35%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者慢性咳嗽、咳痰、咽痒和喘息急促等临床症状积分均显著降低(P0.05);且治疗组临床症状评分比对照组更低(P0.05)。治疗后,两组患者第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气流量(PEF)均显著增高(P0.05);且治疗组患者肺功能明显好于对照组(P0.05)。治疗后,两组患者血清白细胞介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)和降钙素原(PET)水平显著降低,白细胞介素-10(IL-10)和干扰素-γ(IFN-γ)水平显著升高,同组比较差异具有统计学意义(P0.05);且治疗组上述指标变化明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论特布他林联合复方甲氧那明胶囊治疗咳嗽变异性哮喘不仅能够有效改善临床症状和肺功能,还可改善血清相关炎性因子水平,具有一定的临床推广应用价值。     

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??Nebulized bronchodilator can relieve the airway to improve the ventilation.In order to standardize the use of nebulized bronchodilators in children. In this paper we focus on drugs currently used asnebulization bronchodilators in children??evaluate the requirement for nebulized bronchodilator in children and the effect of nebulized bronchodilator therapy on the patients with different respiratory disease.     

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??Family nebulization therapy is getting more and more attention with the increasing number of patients who need long-term nebulization of inhaled corticosteroids. Scientific management of family nebulization ICS, which is one of the most important treatment for children with chronic respiratory diseases, will enhance the compliance of long-term treatment and improve prognosis. More attention needs to be paid to the details of family nebulization, and improve the overall efficacy of treatment.     

三种雾化吸入辅助治疗COPD患者的对比性研究

目的 比较3种雾化吸入方法对慢性阻塞性肺疾病(COPD)患者动脉血气分析及临床症状的影响.方法 将60例COPD病人随机分为3组,每组20例,用相同剂量的安溴索和特布他林雾化混悬液,分别采用超声雾化(A组)、空气压缩雾化(B组)、氧驱雾化(C组),雾化吸入前后分别采集动脉血做血气分析,同时观察病人临床症状的变化.结果 3组雾化吸入前后比较,pH及PaCO2差异无显著性意义(P>0.05),PaO2及SaO2A组降低(P<0.05),而C组升高(P<0.05).临床症状加重的病人数A组多于B组(P<0.05)、C组(P<0.01).结论 氧驱雾化和空气压缩雾化均优于超声雾化.而氧驱雾化又优于空气压缩雾化,可作为COPD病人优选的雾化吸入方法.