三拗片联合特布他林治疗咳嗽变异性哮喘的临床研究

目的探讨三拗片联合特布他林治疗咳嗽变异性哮喘的临床研究。方法选取2019年8月—2020年4月在青岛西海岸新区中医医院门诊急诊治疗的咳嗽变异性哮喘患者90例,随机分为对照组(n=45)和治疗组(n=45)。对照组经雾化器吸入硫酸特布他林雾化液,2.5mg/次,3次/d;治疗组在对照组治疗的基础上口服三拗片,2片/次,3次/d。两组均连续治疗14 d。观察两组的临床疗效,比较两组咳嗽症状的缓解和消失时间。比较两组嗜酸性粒细胞和肺功能的变化情况。结果治疗后,治疗组的总有效率95.56%,显著高于对照组的73.33%(P0.05)。治疗后,治疗组咳嗽缓解时间和咳嗽消失时间明显短于对照组(P0.05)。治疗后,两组患者血清中嗜酸性粒细胞水平明显低于治疗前水平(P0.05);治疗组治疗后血清中嗜酸性粒细胞水平显著低于对照组(P0.05)。治疗后,两组患者肺活量(FVC)、第1秒用力呼气量(FEV1)和最大呼气流量(PEF)明显高于治疗前(P0.05);治疗组治疗后FVC、FEV1和PEF显著高于对照组(P0.05)。结论三拗片联合特布他林治疗咳嗽变异性哮喘具有较好的临床疗效,能降低嗜酸性粒细胞水平,有效改善临床症状和肺功能指标,具有一定的临床推广应用价值。     

桂龙咳喘宁胶囊联合福多司坦治疗慢性阻塞性肺疾病急性加重期的临床研究

目的探讨慢性阻塞性肺疾病急性加重期应用桂龙咳喘宁胶囊联合福多司坦治疗的效果。方法 2015年2月-2018年4月天津市宝坻区人民医院呼吸科收治的114例慢性阻塞性肺疾病急性加重期患者,随机分成对照组(n=57)和治疗组(n=57)。对照组口服福多司坦片,0.4 g/次,3次/d,餐后服用。治疗组患者在对照组基础上口服桂龙咳喘宁胶囊,3粒/次,3次/d。两组均连续治疗14 d。比较两组临床疗效和呼吸系统症状体征的缓解时间,治疗前后肺功能参数[第1秒用力呼气容积(FEV1)占预计值百分比(FEV1占预计值%)、FEV1与用力肺活量(FVC)比值(FEV1/FVC)、呼气峰值流量(PEF)]值、慢性阻塞性肺疾病患者自我评估测试问卷(CAT)评分、外周血嗜酸性粒细胞绝对值(EOS#)及中性粒细胞(NEUT)与淋巴细胞(LYM)比值(NLR)和血清学相关指标[嗜酸性粒细胞阳离子蛋白(ECP)、白介素(IL)-13、8-羟基脱氧鸟苷(8-OHdG)、总抗氧化能力(TAC)]水平变化,不良反应发生情况。结果对照组和治疗组的总有效率分别是86.0%、96.5%,两组比较差异有统计学意义(P<0.05)。与对照组相比,治疗组咳嗽、咳痰等急性加重的呼吸系统症状体征的缓解时间均显著更短(P<0.05)。与治疗前对比,两组治疗后FEV1占预计值%、FEV1/FVC及PEF值均显著增高(P<0.05),CAT评分则均显著降低(P<0.05);但治疗后,治疗组上述肺功能参数值较对照组同期均显著更高(P<0.05),而CAT评分显著更低(P<0.05)。两组治疗后外周血EOS#、NLR值及血清ECP、IL-13、8-OHdG水平均显著低于治疗前(P<0.05),血清TAC水平则均显著升高(P<0.05);且治疗后,治疗组以上指标(EOS#、NLR、ECP、IL-13、8-OHdG、TAC)的改善效果均更显著(P<0.05)。两组均无严重不良反应发生。结论桂龙咳喘宁胶囊联合福多司坦治疗慢性阻塞性肺疾病急性加重期的整体疗效显著,能有效缩短稳定患者病情的时间,改善肺通气功能,缓解气道炎症及全身炎症状态,纠正氧化/抗氧化失衡,具有一定的临床推广应用价值。     

Acute Effects of Individual Exposure to Fine Particulate Matter on Pulmonary Function in Schoolchildren

Objective This panel study aimed to determine the acute effects of exposure to fine particulate matter(PM_(2.5)) on schoolchildren's pulmonary function.Methods We selected 51 schoolchildren aged 9–12 years attending a full-time boarding school in Beijing, China, measured the indoor and outdoor PM_(2.5) concentrations for five consecutive days,calculated the PM_(2.5) time-weighted individual exposure levels based on the school micro-environmental concentrations and the time activity pattern recorded by schoolchildren, measured schoolchildren's pulmonary function on the fifth day. The survey was performed three times from December 2018 to April 2019. We used a linear mixed-effects model to evaluate the associations between PM_(2.5) and pulmonary function.Results During the three surveys, the median PM_(2.5) time-weighted individual exposure concentrations were 15.30 μg/m3, 48.92 μg/m3, and 42.89 μg/m3, respectively. There was a significant difference between the three surveys in vital capacity(VC), forced vital capacity(FVC), forced expiratory volume in one second(FEV_1) and forced expiratory volume in one second/forced vital capacity(FEV1/FVC)(P 0.05). The relevance analysis found that PM_(2.5) had lag effect on schoolchildren's pulmonary function,each 10 μg/m~3 increase in PM_(2.5) could cause largest decreases in FEF25%–75%, FEV_1/FVC, FEF75%, and FEV1 on lag 0–1 d(80.44 m L/s, 35.85%, 78.58 m L/s, and 61.34 m L, respectively), and largest decreases in FEF25% on lag 1 d(83.68 m L/s), in VC on lag 4 d(32.34 m L), and in FVC on lag 0–4 d(37.76 m L). Gender subgroup analysis revealed that the increase in PM_(2.5) caused a decrease in FEV_1/FVC and VC on the day of physical examination only in boys, and on lag days it caused changes in different pulmonary function indicators, both for boys and girls, but most of the pulmonary function indicators decreased more in boys than in girls.Conclusion Our findings show that acute PM_(2.5) exposure has significant effects on pulmonary function within 0–4 d, on both small airway indicators and large airway indicators. Boys' pulmonary function is more sensitive to PM_(2.5) than girls.     

Efficacy and safety of mepolizumab in Japanese patients with severe eosinophilic asthma

Background

The MENSA trial assessed the efficacy and safety of mepolizumab in patients with severe eosinophilic asthma. This report describes the efficacy and safety of mepolizumab in Japanese patients from MENSA.

孟鲁司特联合布地奈德治疗重度哮喘的临床研究

目的了解孟鲁司特联合吸入布地奈德治疗重度哮喘的疗效。方法孟鲁司特联合吸入布地奈德治疗30例重度哮喘患者,根据纳入和排除标准筛选病例,据疗效判断标准进行临床疗效的判断。结果孟鲁司特联合吸入布地奈德治疗30例重度哮喘6周后,治疗前早、晚间PEF,治疗前早、晚间喘乐宁气雾剂喷数,治疗前日、夜间哮喘症状评分和治疗后相比具有显著性差异(P<0.01)。结论孟鲁司特联合吸入布地奈德治疗重度哮喘有效。     

空气污染与儿童最大呼气流速变化的关系

本文通过对北京市大气污染较严重地区６０名健康儿童最大呼气流速（ＰＥＦ）的测定以及同步测定大气中ＳＯ２和ＮＯ２浓度及儿童个体接触ＳＯ２和ＮＯ２的剂量，观察空气污染与ＰＥＦ动态变化关系。发现空气中ＮＯ２浓度与家庭用煤取暖和儿童ＰＥＦ的变化显著相关，儿童ＳＯ２个体接触剂量与ＰＥＦ亦有显著相关性。     

Effects of ambient particulate matter on peak expiratory flow rates and respiratory symptoms of asthmatics during Asian dust periods in Korea

OBJECTIVE: Dust generating events frequently produce ambient dust particles that are less than 10 microm in diameter, and these have been linked to adverse effects in the general population. However, the evidence linking these particles to adverse effects on the airways of asthmatic individuals is limited. The objective of this study was to investigate the possible adverse effects of Asian dust events on the respiratory functions and symptoms of subjects with bronchial asthma. METHODOLOGY: From March to June 2002, individuals were enrolled who had been diagnosed as having asthma by bronchial challenge or by their bronchodilator response. The patients were divided into three groups according to asthma severity: mild, moderate and severe. Patients with other major disease states were excluded. Patients completed twice-daily diaries monitoring PEF, respiratory symptoms, and daily activities. The daily and hourly mean levels of particulate matter <10 microm in diameter (PM(10)), as well as nitrogen dioxide (NO(2)), sulphur dioxide (SO(2)), ozone (O(3)) and carbon monoxide (CO) were measured at 10 monitoring sites in Incheon, Korea. RESULTS: Dust events occurred 14 times during the study period. On dusty days there were increased levels of PM(10), decreased levels of NO(2) and SO(2), and no change in the CO levels, compared to the levels on control days. An increase in PM(10) concentration was associated with increases in PEF variability of >20% (P<0.05), more night-time symptoms (P<0.05), and a decrease in the mean PEF (P<0.05), calculated by longitudinal data analysis. In contrast, there was no association between the PM(10) levels and bronchodilator inhaler use or daytime respiratory symptoms. Using a general additive Poisson regression model, a borderline association was noted between PM(10) and respiratory symptoms, with a relative risk of 1.05 (95% confidence interval (CI), 0.99--1.17). There was no association between the PM(10) concentrations and PEF measurements, with PEF variability of >20% between the morning and evening values and a relative risk of 1.05 (95% CI, 0.89--1.24) in all subjects. CONCLUSIONS: This study provides evidence that Asian dust events are impacting on the respiratory symptoms of subjects with bronchial asthma, and ambient air pollution, particularly elevated PM(10), might be one of the aggravating factors.     

噻托溴铵吸入对改善COPD患者急性加重和气流受限的作用

目的探讨噻托溴铵吸入对改善COPD患者急性加重和气流受限的作用。方法选择2009年1月～2011年4月在我院进行治疗的慢性阻塞性肺疾病(COPD)患者40例为研究对象,采取随机双盲的原则随机分为研究组和对照组。研究组吸入噻托溴铵治疗,对照组吸入安慰剂。随访1年,比较两组患者急性加重情况及肺功能改善情况。结果研究组急性加重的比例及每人每年平均加重次数少于对照组(P<0.05或P<0.01),研究组治疗前后各肺功能指标均有显著改善(P<0.05或P<0.01),均优于对照组(P<0.05)。结论噻托溴铵吸入用于COPD稳定期治疗可以减少急性加重的发生,改善气流受限。     

Persistent airway obstruction after virus infection is not associated with airway inflammation

BACKGROUND: This study examined the contribution of airway inflammation to the delayed lung function recovery that occurs in some people following virus-induced asthma exacerbations. METHODS: Subjects (n = 40) were recruited at hospital admission for acute asthma exacerbation. Respiratory virus infection was diagnosed by viral nucleic acid detection and/or cell culture, using induced sputum, nasal, or throat swabs. Data collected included lung function, answers to common cold and asthma control questionnaires, and induced sputum cellular profiles. Subjects were reexamined 4 to 6 weeks postexacerbation and were compared with stable asthmatic subjects (n = 26) who had been recruited from ambulatory care clinics. RESULTS: Persistent airway obstruction, defined as lung function improvement at follow-up (ie, change in FEV1 percent predicted [Delta%FEV1]) of <15%, was observed in 10 subjects (25%). Airway recovery (Delta%FEV1, > or = 15%) was observed in the remaining subjects (30 subjects; 75%). During the acute episode, the airway-recovery group had increased total cell count (p = 0.019), increased number of neutrophils (p = 0.005), and increased percentage of neutrophils (p = 0.0043) compared to the group of stable subjects with asthma. Postexacerbation, the airway-recovery group had reduced numbers of neutrophils and an increased percentage of eosinophils. In contrast, during exacerbation, subjects with persistent airway obstruction showed no differences in inflammatory cell counts compared to stable subjects with asthma, nor did cell counts change postexacerbation. Symptoms improved in both groups postexacerbation. However, in the persistent-airway-obstruction group, asthma remained uncontrolled. CONCLUSION: Persistent airway obstruction and uncontrolled asthma are observed in some people after viral asthma exacerbations. These abnormalities are not associated with inflammatory cell influx into the airway lining fluid during the exacerbation and may reflect the involvement of noncellular elements. Further work should explore other mechanisms leading to incomplete airway recovery.